India, Pak ink visa pact; but concern on terror remains

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."

Jul 2: Democratic presidential candidate and former US vice-president Joe Biden has said that if he wins the November elections, strengthening the relationship with India which is America’s "natural partner", will be a high priority for his administration.

"India needs to be a partner in the region for our safety's sake and quite frankly for theirs," he said in response to a question on India-US relationship during a virtual fundraiser event on Wednesday.

At the fundraiser hosted by Chairman and CEO of Beacon Capital Partners Alan Leventhal, the former vice president said that India and the United States were natural partners.

"That partnership, a strategic partnership, is necessary and important in our security," Biden said when asked by an attendee whether India is critical to the US' national security.

Referring to his eight years as the vice president, he said, "In our administration, I was proud to play a role more than a decade ago in securing Congressional approval for the US-India Civil Nuclear Agreement, which is a big deal".

"Helping open the door to great progress in our relationship and strengthening our strategic partnership with India was a high priority in the Obama-Biden administration and will be a high priority if I'm elected president,” Biden said.

Both as the vice president and a senator from Delaware, he was a big supporter of India-US relationship.

About the November polls, Biden said that the character of the country is on the ballot. The upcoming election is the most important poll of a lifetime and that the country is currently engaged in a battle for its soul, he claimed.

Biden also slammed President Donald Trump and his administration over the handling of the coronavirus pandemic.

"Trump ignored warnings from the very beginning, refused to prepare and failed to protect the country. Not just now but throughout his presidency, undermining the very core pillars of ours, what I would argue, moral and economic strength.

"I really do believe that our country is crying out for leadership and maybe even more important, some healing. Today, we have an enormous opportunity not only to rebuild but to build back better than before. To build a better future. That's what America does," he added.

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.