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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Agencies
June 12,2020

Kabul, Jun 12: A blast in a mosque during Friday prayers in the western part of capital Kabul has killed at least four people and wounded many more, Afghanistan's interior ministry said.

"Explosives placed inside the Sher Shah Suri Mosque exploded during Friday prayers," said a statement issued by the ministry, which added that the mosque's prayer leader Mofleh Frotan was among those killed.

Interior ministry spokesman Tariq Arian said police have cordoned off the area and helped move the wounded to ambulances and nearby hospitals.

No group immediately claimed responsibility for the attack but a mosque attack earlier this month was claimed by an ISIL (or ISIS) group affiliate, headquartered in eastern Afghanistan's Nangarhar province.

"Interestingly, every time you have the peace process gaining some momentum and pace, you have these kinds of attacks in the country," Habib Wardak, a national security analyst based in Kabul, told Al Jazeera.

"The Islamic State group claimed responsibility for the attack that happened last week on a mosque in Kabul, so despite the fact that you have these news and press conference from the government that they have eliminated ISIL, how can they conduct such sophisticated operations?"

Friday's blast had parallels to one earlier this month, when an explosion tore apart a famous Kabul mosque and led to the death of renowned Afghan cleric Maulvi Ayaz Niazi.

"In this attack, the imam seems to be the target, not the rest of the crowd. These are the imams who have supported the peace process with the Taliban movement," Wardak said.

"The other political aspect for these kinds of attacks is that there are peace spoilers trying to convey a message that peace with the Taliban will not eradicate violence in the country because you have ISIL."

Violence has spiked in recent weeks in Afghanistan with most of the attacks claimed by the ISIL affiliate.

The United States blamed the armed group for a horrific attack last month on a maternity hospital in the capital that killed 24 people, including two infants and several new mothers.

The ISIL affiliate also took responsibility for an attack on a bus carrying journalists in Kabul on May 30, killing two.

It also claimed credit for an attack on the funeral of a strongman loyal to the government last month that killed 35 people.

Meanwhile, the US is attempting to broker peace talks between the Afghan government and the Taliban to end 18 years of war.

Washington's peace envoy Zalmay Khalilzad was in the region earlier this week trying to resuscitate a US peace deal with the Taliban.

The peace deal signed in February calls for the withdrawal of the US and NATO troops from Afghanistan in return for a commitment by the Taliban to not launch attacks on the US or its allies.

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Agencies
January 12,2020

Washington, Jan 12: The US State Department has described the recent visit of envoys of 15 countries to Jammu and Kashmir as an "important step" but expressed concern over the continued detention of political leaders and restrictions on internet in the region.

Alice Wells, the Acting Assistant Secretary of State for South Asia, tweeted on Saturday that she was "closely following" the visit of the envoys to Kashmir, describing it an "important step".

Wells, who will be visiting India this week, added: "We remain concerned by detention of political leaders and residents and Internet restrictions. We look forward to a return to normalcy."

The group of diplomats made a two-day visit to the Union Territory on Thursday and Friday to see the conditions thereafter Jammu and Kashmir's special constitutional status was removed last August.

While some US politicians and media have criticised the action by Prime Minister Narendra Modi's government, the US has officially appeared to support the abrogation of the Constitution's Article 370 on the special status.

Last October, Wells told the House of Representatives Subcommittee on Asia and the Pacific that the State Department supported the objectives behind it, while not directly mentioning the abrogation.

"The Indian government has argued that its decision on Article 370 was driven by a desire to increase economic development, reduce corruption, and uniformly apply all national laws in Jammu and Kashmir, particularly in regard to women and minorities.

"While we support these objectives, the Department remains concerned about the situation in the Kashmir Valley, where daily life for the nearly eight million residents has been severely impacted since August 5," she had said.

Washington has banked on India's democratic institutions - the judiciary and public debates - being able to steer the country.

Bearing this out, the Supreme Court last week ordered the government to review its decision to shut down the internet in Kashmir, which it declared was a fundamental right, thus taking a step to address Wells's concern.

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News Network
March 18,2020

Washington, Mar 18: Hundreds of distressed Indian students, stuck in the Philippines, are seeking help through video messages as they are unable to fly back home due to the travel restrictions imposed by India to contain the spread of the deadly novel coronavirus, according to friends and relatives of some of these students in the US.

The Indian government on Tuesday banned the entry of passengers from Afghanistan, Philippines and Malaysia to India with immediate effect amid stepped up efforts against the spread of COVID-19.

In a video message by one of these students Akhil Bala Nair, around 200 Indian students had booked their flight tickets for India in the next few days. But all of them have been cancelled due to the new policy.

Most of the students, she said, had booked their flights for March 17 and rest were schedule to travel to India on March 19 and 20. But the flights were cancelled and scores of Indian students are now stuck at the airport in Manila, Nair said in the video message sent to Prem Bhandari, head of the Jaipur Foot USA.

“It is need of the hour that the Indian government send a plane to bring these Indian students back home,” Bhandari, who in the past has worked for the cause of the Indian diaspora, and who was approached by these students told PTI.

According to these students, some 100 of them have been at the airport since Tuesday.

They all have confirmed tickets but the airport authorities are not allowing them to check in because of the new travel regulations.

While the airport authorities have asked them to go back to their respective place of residence, the students said they were unable to travel because of the absence of local taxi or shared ride services.

The students said that they are running out of time as the Philippines government has given them 72 hours time to exit the country, which started from March 16, after which the country will go into lockdown.

“This means we would not be able to travel anywhere outside Philippines after March 20,” Nair said in her message.

The students said that there are many of them who have applied for renewal of their visas and are unable to travel to India.

There are nearly 1,000 Indian students presently in Manila who are willing to travel back home, they said.

Meanwhile, the Indian Embassy in Manila, in a tweet, said that they, along with the Ministry of External Affairs, are trying to work out a solution.

“It is requested to all to kindly have patience,” the embassy said.

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