Mysterious blood clots are COVID-19's latest lethal surprise

News Network
April 28, 2020

Washington, Apr 28: After nearly three weeks in an intensive care unit in Los Angeles, doctors treating 41-year-old Broadway actor Nick Cordero for COVID-19 were forced to amputate his right leg.

The flow of blood had been impeded by a blood clot: yet another dangerous complication of the disease that has been bubbling up in frontline reports from China, Europe and the United States.

To be sure, so-called "thrombotic events" occur for a variety of reasons among intensive care patients, but the rates among COVID-19 patients are far higher than would be otherwise expected.

"I have had 40-year-olds in my ICU who have clots in their fingers that look like they'll lose the finger, but there's no other reason to lose the finger than the virus," Shari Brosnahan, a critical care doctor at NYU Langone said.

One of these patients is suffering from a lack of blood flow to both feet and both hands, and she predicts an amputation may be necessary, or the blood vessels may get so damaged that an extremity could drop off by itself.

Blood clots aren't just dangerous for our limbs, but can make their way to the lungs, heart or brain, where they may cause lethal pulmonary embolisms, heart attacks, and strokes.

A recent paper from the Netherlands in the journal Thrombosis Research found that 31 percent of 184 patients suffered thrombotic complications, a figure that the researchers called "remarkably high" -- even if extreme consequences like amputation are rare.

Behnood Bikdeli, a doctor at New York-Presbyterian Hospital, assembled an international consortium of experts to study the issue. Their findings were published in the Journal of The American College of Cardiology.

The experts found the risks were so great that COVID-19 patients "may need to receive blood thinners, preventively, prophylactically," even before imaging tests are ordered, said Bikdeli.

What exactly is causing it? The reasons aren't fully understood, but he offered several possible explanations.

People with severe forms of COVID-19 often have underlying medical conditions like heart or lung disease -- which are themselves linked to higher rates of clotting.

Next, being in intensive care makes a person likelier to develop a clot because they are staying still for so long. That's why for example people are encouraged to stretch and move around on long haul flights.

It's also now clear the COVID-19 illness is associated with an abnormal immune reaction called "cytokine storm" -- and some research has indicated this too is linked to higher rates of clotting.

There could also be something about the virus itself that is causing coagulation, which has some precedent in other viral illnesses.

A paper in the journal The Lancet last week showed that the virus can infect the inner cell layer of organs and of blood vessels, called the endothelium. This, in theory, could interfere with the clotting process.

According to Brosnahan, while thinners like Heparin are effective in some patients, they don't work for all patients because the clots are at times too small.

"There are too many microclots," she said. "We're not sure exactly where they are."

Autopsies have in fact shown some people's lungs filled with hundreds of microclots.

The arrival of a new mystery however helps solve a slightly older one.

Cecilia Mirant-Borde, an intensive care doctor at a military veterans hospital in Manhattan, told AFP that lungs filled with microclots helped explain why ventilators work poorly for patients with low blood oxygen.

Earlier in the pandemic doctors were treating these patients according to protocols developed for acute respiratory distress syndrome, sometimes known as "wet lung."

But in some cases, "it's not because the lungs are occupied with water" -- rather, it's that the microclotting is blocking circulation and blood is leaving the lungs with less oxygen than it should.

It has just been a little under five months since the virus emerged in Wuhan, China, and researchers are learning more about its impact every day.

"While we react surprised, we shouldn't be as surprised as we were. Viruses tend to do weird things," said Brosnahan.

While the dizzying array of complications may seem daunting, "it's possible there'll be one or a couple of unifying mechanisms that describe how this damage happens," she said.

"It's possible it's all the same thing, and that there'll be the same solution."

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News Network
January 22,2020

Davos, Jan 22: President Donald Trump has said that the US is watching the developments between India and Pakistan over Kashmir "very closely" and repeated his offer to "help" resolve the longstanding dispute between the two neighbours as he met Prime Minister Imran Khan on the sidelines of the World Economic Forum here in the Swiss ski resort.

Addressing the media with the Pakistan Prime Minister prior to their private meeting on Tuesday, President Trump asserted that trade and borders were both critical points for discussion, while Khan said that for him, Afghanistan was the top priority.

Trump told Khan, whom he referred to as "my friend", that he would speak to Prime Minister Narendra Modi about the ongoing Kashmir issue. The US president is expected to visit India in the coming weeks, marking his first visit after taking up his post in the White House.

"What's going on between Pakistan and India … if we can help, we certainly will be willing to. We have been watching it very closely and it's an honour to be here with my friend," he said.

"The Pakistan-India conflict is a very big issue for us in Pakistan and we expect the US to always play its part in deescalating the tensions, because no other country can," Khan said.

President Trump has repeatedly offered to mediate following India's August 5 decision to revoke the special status to Jammu and Kashmir and bifurcate the state into two Union Territories, evoking strong reaction from Pakistan which has been trying to internationalise the Kashmir issue.

New Delhi has defended the move, saying Jammu and Kashmir is an integral part of India and the issue was strictly internal to the country, and the special status provisions only gave rise to terrorism in Jammu and Kashmir.

"The country took the decision of abrogation of Article 370, which had only given separatism and terrorism to that state," Prime Minister Narendra Modi said at a function in October last year.

This is the third meeting between Trump and Khan since Pakistan premier assumed office in 2018 and it came against the backdrop of Pakistan Foreign Minister Shah Mehmood Qureshi's recent trip to the US, amid reports that the US and Afghan Taliban were close to striking a peace deal.

"There are issues we want to talk about. The main issue is Afghanistan because it concerns the US and Pakistan. Fortunately, we are on the same page. Both of us are interested in peace there and an orderly transition in Afghanistan with talks with Taliban and the government," Khan said.

When a reporter asked Trump if he would visit Pakistan considering he was already set to visit India, the US president said he was meeting the Pakistan premier in Davos.

"Well, we're visiting right now. So we don't really have to. I wanted to say that from a relationship standpoint, we got a great relationship. From the standpoint our two countries, we're getting along very well. I would say we've never been closer with Pakistan the way we're right now. And this is a big statement," Trump said.

Khan left for Switzerland to attend the World Economic Forum and meet the world leaders, including President Trump, on the sidelines of the annual event which kicked off at the ski resort town of Davos on Tuesday.

The four-day summit marks the 50th anniversary of the forum.

A total of 53 heads of State are on the guest list. Nearly 3,000 participants from 118 countries are expected to attend the event during which political leaders, business executives, heads of international organisations and civil society representatives are set to deliberate on contemporary economic, geopolitical, social and environmental issues.

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News Network
June 18,2020

Washington, Jun 18: US Defence officials are concerned over China's use of COVID-19 situation to gain stakes in strategically important companies of United States as the impact of novel coronavirus has left several companies in dire need of capital.

Amid the pandemic, it getting hard for the defence department to keep an eye on national security and help protect smaller companies down the chain, CNN reported.

"We are paying close attention to any indicators that China is leveraging Covid-19 to take advantage of a situation where defence companies need capital more than ever," a defence official told CNN.

In April, Ellen Lord, undersecretary of defence for acquisition and sustainment said it is paying close attention to 'adversaries' against the 'economic warfare' with the United States.

"We have to be very, very careful about the focused efforts some of our adversaries have to really undergo sort of economic warfare with us, which has been going on for some time," Ellen Lord, undersecretary of defence for acquisition and sustainment was quoted as saying by CNN.

US Committee on Foreign Investment protects its interest against hostile countries gaining ownership in strategically important companies. But the pandemic is changing the definition of national security concerns to include drugs, protective gear and medical supplies.

"These are now national security needs and we probably should have been thinking about it a long time ago in terms of biowarfare that we should have a trusted industrial base or a set of trusted allies -- the UK, or NATO allies or Japan or Korea -- who are trusted in that regard," Bill Greenwalt, a former Pentagon official.

Give the threat posed by foreign acquisition, Pentagon has been offering tools to help small US businesses defend themselves against adversarial investment and conducting background checks with other government agencies to ensure transparency.

US President Donald Trump's trade adviser Peter Navarro recently told CNN if Trump wins reelection, Washington DC will likely take offshore supply chains as national security priorities.

"If we fail to do that in the face of this crisis, we will have failed this country and all future generations of Americans," Navarro said.

The US State Department has also warned US allies to "avoid economic overreliance on China" and "guard their critical infrastructure" from China's influence.

Chad P Bown, a senior fellow at the Peterson Institute for International Economics, pointed to recent China's economic coercion of Australia on the political matter saying, "this is how China operates and everybody knows it."

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Agencies
June 16,2020

India continues to remain ranked 43rd on an annual World Competitiveness Index compiled by Institute for Management Development (IMD) with some traditional weaknesses like poor infrastructure and insufficient education investment keeping its ranking low, the international business school said on Tuesday.

Singapore has retained its top position on the 63-nation list.

Denmark has moved up to the second position (from 8th last year), Switzerland has gained one place to rank 3rd, the Netherlands has retained its 4th place and Hong Kong has slipped to the fifth place (from 2nd in 2019).

The US has moved down to 10th place (from 3rd last year), while China has also slipped from 14th to 20th place. Among the BRICS nations, India is ranked second after China, followed by Russia (50th), Brazil (56th) and South Africa (59th).

India was ranked 41st on the IMD World Competitiveness Ranking, being produced by the business school based in Switzerland and Singapore every year since 1989, but had slipped to 45th in 2017 before improving to 44th in 2018 and then to 43rd in 2019.

While its overall position has remained unchanged in the 2020 list, it has recorded improvements in areas like long-term employment growth, current account balance, high-tech exports, foreign currency reserves, public expenditure on education, political stability and overall productivity, the IMD said.

However, it has moved down in areas like exchange rate stability, real GDP growth, competition legislation and taxes.

Arturo Bris, Head of Competitiveness Center at IMD Business School, said India continues to struggle on the list and the recent country rating downgrade by Moody’s reflects the uncertainties regarding the economy’s future.

"In our ranking this year, we again emphasize the traditional weaknesses of India -- poor infrastructure, an important deficit in education investment, and a health system that does not reach everybody. For India to follow the path of China, it must stress its intangible infrastructure," Bris said.

"In a less global world, with China, USA, and Europe looking inwards, currencies like the rupee (and the Brazilian real for instance) are going to suffer and display high volatilities.

"Moody’s has threatened the country with a downgrade to junk and that would put India in a terrible position to attract foreign capital. So the urgency for the government should be to fix the short-term problems—and this requires to improve the credibility of the government itself," Bris added.

With the exception of Singapore, the Philippines, Taiwan and the Korean Republic, most Asian economies dropped in rankings this year, the IMD said.

The reason for the Asian economies’ less stellar performance as a region, this year is partly the result of the trade frictions between China and the US, particularly because these economies are highly dependent on trade with China.

About Singapore, which moved to the top rank last year, the IMD said its position is largely driven by the relative ease of setting up business, availability of skilled labour and its cutting-edge technological infrastructure.

The IMD said the impact of COVID-19 on the competitiveness ranking has partially been captured by executives’ opinions about the effectiveness of the different health systems.

In the ASEAN countries included in the survey, only Singapore and Thailand have a positive performance in the effectiveness of the health infrastructure.

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