Pak court indicts Musharraf; rejects plea to travel abroad

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."

The coronavirus pandemic has sickened more than 2,425,000 people, according to official counts. So far at least 164,000 people have died, and the virus has been detected in at least 177 countries, as the following table shows.

Washington, Feb 28: US intelligence agencies are monitoring the global spread of coronavirus and the ability of governments to respond, sources familiar with the matter said on Thursday, warning that there were concerns about how India would cope with a widespread outbreak.

While there are only a few known cases in India, one source said the country's available countermeasures and the potential for the virus to spread given India's dense population was a focus of serious concern.

US intelligence agencies are also focusing on Iran, where the country's deputy health minister has fallen ill during a worsening outbreak.

US Secretary of State Mike Pompeo said on Tuesday the United States was "deeply concerned" Tehran may have covered up details about the spread of coronavirus. A US government source said Iran's response was considered ineffective because the government only has minimal capabilities to respond to the outbreak.

Another source said US agencies were also concerned about the weak ability of governments in some developing countries to respond to an outbreak.

The US House of Representatives Intelligence Committee has received a briefing on the virus from the spy agencies. "The Committee has received a briefing from the IC (intelligence community) on coronavirus, and continues to receive updates on the outbreak on a daily basis," an official of the House Intelligence Committee told Reuters.

"Addressing the threat has both national security and economic dimensions, requiring a concerted government-wide effort and the IC is playing an important role in monitoring the spread of the outbreak, and the worldwide response," the official added.

A source familiar with the activities of the Senate Intelligence Committee, led by Republican Senator Richard Burr and Democratic Senator Mark Warner, said the panel was receiving daily updates. The role of US intelligence agencies in responding to the coronavirus epidemic at this point principally involves monitoring the spread of the illness around the world and assessing the responses of governments.

They are working closely with health agencies, such as the US Center for Disease Control, in sharing information they collect and targeting further intelligence gathering.

One source said US agencies would use a wide range of intelligence tools, ranging from undercover informants to electronic eavesdropping tools, to track the virus' impact.