Philippines storm toll tops 200, tens of thousands displaced

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."

Washington, Jan 25: US President Donald Trump's legal team was preparing his defence on Saturday after the Democratic prosecutors ended their marathon 24-hour argument to oust him from office during the Senate trial.

In the arguments spread over three days ending on Friday, the Democrat prosecutors from the House of Representatives that had impeached Trump last month, mostly rehashed the testimonies from the hearings before their committees during the investigation and statements in their chamber.

Like the Democrats' arguments, the Trump defence's counter-arguments, also with 24 hours allotted for it, will be mind-numbing monologues for the most part and the real drama will be on a tussle between the two parties on calling witnesses.

The Democrats failed in their repeated attempts on the first day of the trial on January 28 to include calling testimonies from witnesses in the rules of procedure, but they will get another chance to press their case when the defence rests.

There is a tense wait speckled with speculations to see if the Democrats can get four Republicans to defect and vote to call witnesses after failing to sway a mass defection to get the two-thirds majority to convict Trump.

Trump is charged with abuse of power and obstruction of Congress in the trial presided over by Supreme Court Chief Justice John Roberts with the Senators acting as jurors.

As the time allotted for the prosecution wound down on Friday, the leading prosecutor, Adam Schiff, demanded that the Republican-controlled Senate convict and remove Trump from office, because he was an "imminent threat" to the US and the nation could not wait for the election to throw him out.

Schiff, who heads the House Intelligence Committee that investigated Trump, gave them a personal warning: "No matter how close you are to this president, do you think for a moment that if he felt it was in his interest, he wouldn't ask you to be investigated?

Jerry Nadler, the head of the Judicial Committee that framed the charges in the impeachment, called Trump a "dictator".

Instead of a full sitting of eight hours, the defence will present its case for only two to three hours on Saturday in what Trump's lawyer Jay Sekulow called a "trailer (for) coming attractions" in the defence counterarguments.

They will get to use their remaining time next week.

The shorter session starting with fuller presentations next week is partly a concession to media savvy Trump who tweeted that daytime Saturday when his defence was slated is a "death valley" on TV as few viewers would watch a political event at that time.

With Trump certain to be acquitted because the Democrats do not have the two-thirds vote, the impeachment process and the Senate trial are only meant to be an extended media show in their campaign for the November election.

The Democrats want to spiff up the TV spectacle by calling former National Security Adviser John Bolton and Trump's acting Chief of Staff Mick Mulvaney as witnesses.

Trump could exercise his executive privilege to stop them from testifying, in which case they could go to court to compel their appearance at the Senate trial extending its duration by months if not weeks.

The House charged him with obstruction of Congress because he refused to allow some of this staff to testify and release documents requested by the House investigators.

The Republicans, who want a quick end to the trial, can also counter the Democrats' request for witnesses by calling former Vice President Joe Biden and his son, Hunter, to testify in order to embarrass them and their party.

The Bidens are at the root of the abuse of power charges against Trump.

Trump had asked newly-elected Ukrainian President Volodymyr Zelentsky in a July phone call to investigate the Bidens' dealings in his country as a "favour".

Democrats say that this was inviting foreign intervention in US elections because Joe Biden is the leading Democratic party candidate for the nomination to oppose him.

Moreover, they say that he froze about $400 million in Congressionally-approved military aid for pressure Zelentsky to order the probe and this endangered US national security as Ukraine is at war with Russia.

chiff and the other prosecutors said delaying the aid was an attempt at a quid pro quo.

Zelentsky has said that he did not feel pressured by Trump.

Hunter Biden, who was removed from the Navy allegedly due to drug use and had no energy business experience landed a directorship in a Ukrainian gas company with monthly payments reportedly between $50,000 and $83,000 while his father was overseeing Washington's dealings with Kiev.

The former Vice President has publicly admitted that he got the Ukrainian leaders to fire the prosecutor investigating his son's company.

The Republicans have said that the son's appointment was unethical and the father had the prosecutor removed to protect his son's company.

In their arguments, the Democratic prosecutors said there was nothing wrong in Hunter Biden getting the job and his father had the prosecutor dismissed because he was corrupt.

The defence team is expected to assert that Trump withheld the aid because he wanted to be sure that the new government was not corrupt and the aid was released without a probe.

Anticipating the argument, Schiff said that Trump had allowed the aid to go forward only because it became known and his intent still made him guilty.

In another development impinging on the Trump case, a secret recording said to be of the president ordering the firing of Marie Yovanovitch as US ambassador to Ukraine in 2018 has surfaced.

She was one of the witnesses at the House investigations of the charges against Trump.

Washington, Apr 12: The US has overtaken Italy as the country with the highest number of deaths due to COVID-19 pandemic with the fatalities crossing 20,000, according to Johns Hopkins University data, as the novel coronavirus continues to wreak havoc across the globe.

The deadly coronavirus, that originated in China in December last year, has so far killed more than one lakh people across the globe. The United States on Saturday became the country with the highest number of deaths at 20,597, surpassing Italy's 19,468 fatalities.

More than 5.3 lakh Americans have tested positive for coronavirus, which is about the same for the next four countries put together: Spain (163,027), Italy (152,271), Germany (125,452) and France (93,790). In terms of fatalities, the US and Italy are followed by Spain (16,606), France (13832) and United Kingdom (9,875), the varsity data showed.

New York City, the financial capital of the world, has emerged as the epicenter of coronavirus in the world. A city of 8.3 million, which is one of the most densely populated cities in the US, by Saturday night had as many as 8,627 deaths and more than 180,000 people had tested positive for COVID-19.

President Donald Trump has declared a national emergency and all the 50 States have been notified with major disaster declaration. More than 95 per cent of the country's 330 million population are under stay-at-home order. Trump has deployed more than 50,000 personnel from the armed forces in fight against COVID-19.

After an initial two-week social mitigation measures, that includes social distancing, the measures have been extended till April 30. Initially, members of the White House Task Force on Coronavirus had projected between one and two lakhs deaths. Now, they have dropped the projection to 60,000 deaths, mainly due to the successful implementation of these measures.

"The people of our country have gone through a lot. But we did it the right way. And we look like we'll be coming in on the very, very low side, really below the lowest, the lowest side of the curve of death," Trump told Fox News on Saturday night.

Trump asserted that situation was improving in places like New York, where there is a drop in new patients. Responding to a question, he said he wanted the country to open up as soon as possible.

However, he has not taken a decision so far, even as some media reports said that he the President was looking for early May.

"I think it's going to be the toughest decision that I've ever made. I really, hopefully that I ever will have to make. But it's certainly the toughest decision that I've ever made. I hope that I'm going to make the right decision," Trump said, adding that he will be making a decision reasonably soon.

"We're setting up a council now of some of the most distinguished leaders in virtually every field including politics and business and medical. We'll be making that decision fairly soon," Trump said.

Meanwhile, The New York Times reported that its investigations have revealed that the president was warned about a potential pandemic but that internal divisions, lack of planning and his faith in his own instincts led to a halting response.

According to The Washington Post, coronavirus is killing about one in 10 hospitalised middle-aged patients and four in 10 older than 85 in the United States. It is particularly lethal to men even when taking into account common chronic diseases that exacerbate risk.

Globally, the novel coronavirus has killed 108,862 people and infected over 1.7 million people globally. The US has the highest number of infections at 529,887, according to Johns Hopkins University data.