Russia preparing to supply S-400 missile systems to India

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."

May 15: Global deaths linked to the novel coronavirus passed 300,000 on Thursday, while reported cases of the virus are approaching 4.5 million, according to a news agency tally.

About half of the fatalities have been reported by the United States, the United Kingdom and Italy.

The first death linked to the disease was reported on January 10 in Wuhan, China. It took 91 days for the death toll to pass 100,000 and a further 16 days to reach 200,000, according to the Reuters tally of official reports from governments. It took 19 days to go from 200,000 to 300,000 deaths.

By comparison, an estimated 400,000 people die annually from malaria, one of the world’s most deadly infectious diseases.

The United States had reported more than 85,000 deaths from the new coronavirus, while the United Kingdom and Italy have reported over 30,000 fatalities each.

While the current trajectory of COVID-19 falls far short of the 1918 Spanish flu, which infected an estimated 500 million people, killing at least 10% of patients, public health experts worry the available data is underplaying the true impact of the pandemic.

Apr 26: The remarkable story of an airman who overcame prejudice to become one of only a handful of Indian fighter pilots in the First World War has emerged in newly-released archive files by the UK's Commonwealth War Graves Commission (CWGC).

Lieutenant Shri Krishna Chanda Welinkar is one of the thousands of moving stories from the war preserved in family correspondence and being brought alive as part of a digitisation project.

The never-before-published files contain thousands of letters, pictures and other papers sent between the Commission and the next of the kin of First World War dead.

Among them is the story of Welinkar, who hailed from Bombay in colonial India. After much hardship and discrimination, he eventually became a pilot and went missing while on patrol over the skies above the Western Front in June 1918.

His family had to wait nearly three years before they finally knew for certain that he had died, and his grave was located.

“For everyone who died in the First World War, there was inevitably a partner, parent or child back home who had questions. The heartbreaking letters in CWGC's archive give us an insight into what it was like for those families trying to come to terms with their loss,” said Andrew Fetherston, chief archivist for CWGC.

“They are stories that show desperate searches for closure, former enemies uniting and, on many occasions, the sad realisation that a missing loved one would always remain so. We are pleased to be able to make this invaluable piece of World War history accessible to a new generation and help deepen our understanding of how the First World War impacted those who were left behind,” he said.

Welinkar was one of the 1.3 million Indians who answered the call to fight for the British Empire. Nearly 74,000 never saw their homeland again and are remembered today in cemeteries and memorials throughout the world, including France, Belgium, the Middle East and Africa.

Welinkar was a well-educated man studying at Cambridge University. He trained to become an aviator in Middlesex and wished to join the Royal Flying Corps, later known as the Royal Air Force.

Upon attempting to enlist, Welinkar encountered the same prejudices as his other fellow Indian airmen and was encouraged to become an air mechanic instead.

He was eventually given a commission in the Royal Flying Corps as an Officer. In 1918, he was posted to France and patrolled the skies above the Western Front.

In June 1918, Lieutenant Welinkar embarked on what would be his final patrol; he did not return and was reported missing. His fate remained unknown for many months afterwards.

The newly-released e-files chronicle the remarkable discovery of Welinkar and his final resting place long after the war had ended. Colonel Barton, who knew Welinkar, acted on behalf of his mother and helped find her missing son. They spoke to former enemies and honed their search to the grave of an unidentified man, buried by the Germans as “Oberleutnant S.C. Wumkar” in a grave in Rouvroy, Belgium.

The body was later moved and reinterred in Hangard Communal Cemetery Extension but it wasn't until the vital clue, found in the original German burial records in February 1921, that it was confirmed beyond doubt this grave was of Welinkar's.

In May 1921, Colonel Barton, on behalf of Welinkar's mother, requested that a Commission headstone be placed on the grave with the following personal inscription: “To the Honoured Memory of One of the Empire's Bravest Sons”.

This records – known as Enquiry Files – are part of a collection of nearly 3,000 files which have never been made available to the public before. Nearly half have been digitised so far, alongside a previously unreleased collection of more than 16,000 photographs held in negatives in the Commission's archive.

The files, internally referred to simply as E-Files, contain correspondence between the CWGC and the next of kin of the war dead. They often contain letters, typed memos between Commission staff and on occasion photos, maps and diagrams.

CWGC only holds an enquiry file for a small proportion of the 1.7 million people it commemorates from the Commonwealth. Today it is only possible to release those surviving records from the First World War because correspondence with families of Second World War casualties often involves people still alive today and cannot be made public for many years, due to the UK's data protection rules.

To date, more than 1,300 of the surviving 3,000 First World War enquiry files have been digitised.

The CWGC commemorates the 1.7 million Commonwealth servicemen and women who died during the two World Wars. It also holds and updates an extensive and accessible records archive, while operating over 23,000 locations in more than 150 countries and territories.