US firms going abroad can't say 'bye-bye and fire everybody'

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."

Hundreds of thousands of people across the world are joining the anti-racism demonstrations days after the killing of George Floyd in United Sates. 

The protests are being held in cities including London, Manchester, Cardiff, Leicester and Sheffield.

Demonstrators attached ropes to the statue of Edward Colston before pulling it down to cheers and roars of approval from the crowd. Images on social media show the statue was eventually rolled into the city's harbour. 

It was not the only statue targeted on Sunday. In Brussels, protesters clambered onto the statue of former King Leopold II and chanted "reparations".

The word "shame" was also graffitied on the monument, reference perhaps to the fact that Leopold is said to have reigned over the mass death of 10 million Congolese.

In London, thousands of people congregated around the US embassy for the second day running.

While protests were mainly peaceful, there were some scuffles near the office of Prime Minister Boris Johnson and outside the Parliament gates.

In Hong Kong, about 20 people staged a rally in solidarity with the Black Lives Matter movement on Sunday outside the US consulate in the semi-autonomous Chinese city.

"It's a global issue," Quinland Anderson, a 28-year-old British citizen living in Hong Kong, told The Associated Press news agency.

"We have to remind ourselves despite all we see going on in the US and in the other parts of the world, Black lives do indeed matter."

Several dozen demonstrators took part in a Black Lives Matter protest held in Tel Aviv's central Rabin Square.

A rally in Rome's sprawling People's Square was noisy but peaceful, with the majority of protesters wearing masks to protect against coronavirus. Participants listened to speeches and held up handmade placards saying "Black Lives Matter" and "It's a White Problem".

In Spain, several thousand people gathered on the streets of Barcelona and at the US embassy in Madrid.

Many in Madrid carried homemade signs reading "Black Lives Matter", "Human rights for all" and "Silence is pro-racist".

"We are not only doing this for our brother George Floyd," said Thimbo Samb, a spokesman for the group that organised the events in Spain mainly through social media. "Here in Europe, in Spain, where we live, we work, we sleep and pay taxes, we also suffer racism."

Beijing, Feb 9: After making sure everyone's face mask is on and sanitizer is to hand, the Qiao family heads out to Jingshan Park, a former royal sanctuary beside the Forbidden City in China's capital Beijing.

Snow has fallen for a second day, a rare event in the city of 21.5 million that would normally bring hundreds of thousands of people out to take photos and play. But the streets are empty and the parks are so quiet the only sound is of birds chirping.

It's not just Beijing. Shanghai, China's financial hub, and other cities in the world's most populous nation have turned into ghost towns after the government extended a holiday and asked residents not to go out because of the coronavirus.

"We know the situation of the coronavirus is severe. But the epicentre is far away, so we think it should be fine here ... It's a God-given chance to enjoy this family moment with snow and without work," said Mr Qiao, who has an 11-year-old daughter.

The epidemic has killed 722 people and infected nearly 32,000 in China as of February 8. More than three-quarters of the cases are in the central Hubei province where the virus originated - more than 1,000 km (620 miles) from Beijing.

Only a few people are brave enough to come out. A security guard at Jingshan Park said there were less than a third of the number of tourists than usual, even with the rare snowfall.

Even at one of the best spots for snapping photos of snowy Beijing just outside the Forbidden City, there's barely a crowd, while the usual tour buses and groups of people speaking different dialects are nowhere to be seen.

"Last year when it snowed, I took a few hours off work to come down here to take a picture and the crowd was several layers deep," said a man in his 30s who gave his surname as Yang. "But this year, I am not at all worried about finding a space to take a photo. The virus is keeping people indoors."

Security guards along Wangfujing street, a popular pedestrianised shopping area in downtown Beijing, said it was normally so crowded during the holiday period that it was hard to move around.

"Look at it now, there are more security guards and street cleaners than tourists!" said one of the guards.

Businesses, including shops, bars and restaurants, have been severely hit by the epidemic as the government has banned mass gatherings and even group meals in an effort to curb the spread of the coronavirus.

"You would have to wait outside for a table on a normal day," said a waitress at a restaurant with more than 50 tables. Just five were taken at the peak lunch hour.

Only a handful of the more than 100 restaurants along Beijing's famous food street, Guijie, were open, and the remaining outlets were wondering how long they can hold out.