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Ventilators Could Be Doing More Harm Than Good As US Changes COVID-19 Strategy

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A concern has started to bother doctors across the globe on treating coronavirus impacted patents. The question which is disturbing the doctors is — when should patients who need help breathing be placed on ventilators — and could intubation do some people more harm than good?

Coronavirus ventilator: How it works, why COVID-19 patients need it

It’s one of the biggest medical problems, globally, besides gauging the impact of hydroxychloroquine (HCQ) drug for treating Covid-19 patients, a US doctor told AFP. The data is insufficient and there isn’t any confirmed research on the subject since the virus itself is so new and we don’t have the advantage of hindsight.

It’s also difficult to understand for sure whether the patients placed on ventilators would have died anyway because of their deteriorating condition. However, a large number of doctors have stated that coronavirus impacted patients appear to fade quickly when they are put on ventilators and tubes are placed down their windpipes.

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In recent weeks, US hospitals have started delaying the use of ventilators. The first warning signs came from Italy, where the vast majority of patients placed on artificial breathing collapsed.

The statistics are also bad in the UK and in the city of New York, where 80% of intubated patients died, according to the state’s governor, often after spending a week or two in intensive care in which they are placed in an artificial coma and their muscles atrophy.

At the beginning of the coronavirus outbreak,  patients who were completely out of breath were administered for severe lung condition — Acute Respiratory Distress Syndrome (ARDS). This condition, which limits the lungs from getting in enough oxygen to pass on to other organs, can be triggered by infection or by physical injury.

It’s very threatening, with studies placing the overall fatality rate at around 40%. The standard procedure for these patients is to intubate relatively early, and this is how coronavirus infected patients have generally been treated.

Until, that is, medics began to understand lung complications among patients weren’t quite the same as “typical” ARDS patients, at least not in all cases. The lungs aren’t degraded in the same way — they are less “stiff.”

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Doctor Luciano Gattinoni and his colleagues in Milan described at the end of February how they had to adjust their procedures. “All we can do (by) ventilating these patients is ‘buying time’ with minimum additional damage,” he wrote in a research letter to the journal of the American Thoracic Society where he argued for lower air pressure settings.

Kevin Wilson, guideline director for the American Thoracic Society guideline, affirmed the need for caution. “Most of the health care community has gone a little nervous by these bad reports about people not doing well on the ventilator, and actually is moving towards trying to delay intubation,” he told AFP. “We delay as long as we can, but not to a point where it becomes emergent,” he added.

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Medics acknowledged that some Covid-19 impacted patients having very low blood oxygen levels and would normally be intubated could infact go without it. Instead of directly using ventilators, doctors are opting to use less invasive methods — like nasal cannulas that feed oxygen up the nose, conventional or more sophisticated breathing masks, or even placing the patients on their stomachs, which helps the lungs. “We’re learning as we go,” said Wilson.

Medical societies, including international experts from the Surviving Sepsis Campaign, are in the process of writing best practice guidelines. None yet have a definitive answer.

Via: AFP

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Anti-China ‘QUAD Alliance’ Between US, India, Australia & Japan Could Soon Be A Reality

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The QUAD alliance could soon be a reality as India is prepared to allow Australia to join the annual trilateral Malabar naval exercise involving India-Japan-USA. With Australia joining in, this could cement the QUAD alliance which Beijing considers as an anti-China grouping.

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The latest decision to allow Australia to be a part of exercise comes at the heels of Chinese aggression in Ladakh, South China Sea (SCS) and the Strait of Taiwan. According to experts, the arrival of Australia could re-activate the Quadrilateral Alliance (QUAD) between Australia-India-Japan-USA.

Defence officials speaking to The Hindu said that while a decision to on whether to extend the invitation is expected “soon”, it was unlikely to be announced during today’s “virtual summit” between Prime Minister Narendra Modi and his Australian counterpart Scott Morrison.

The summit will focus on cooperation in the Indo-Pacific region and strengthening of defence ties between New Delhi and Canberra. The long-pending Mutual Logistics Support Agreement (MLSA) is also likely to be concluded as part of the measures to elevate the strategic partnership.

The signing of MLSA would allow reciprocal use of each other’s military bases in exchange for fuel and provisions to simplify logistical support and improve operational turnaround. New Delhi and Canberra have been working on finalising the MLSA since last year but the deal could not go through due to unavoidable circumstances such as COVID-19.

In a bid to solidify their Indo-Pacific friendship, both countries are also working on a maritime cooperation agreement with an emphasis on Maritime Domain Awareness (MDA). Such an agreement makes sense as they share common military platforms.

The QUAD

If India does formally invite Australia, it could reshape the Indo-Pacific region. As reported by EurAsian Times earlier, QUAD was an informal security dialogue established to counter growing Chinese influence in the Indian and Pacific Ocean. Although never formalised, the group could not work since China issued all four partners a demarche after it was announced.

Experts at EurAsian Times believe that India’s decision to allow Australia to participate at Malabar 2020 could lead to a re-activation of the QUAD. Since member countries were earlier hesitant to get on the wrong side of Beijing, QUAD did not really take-off. The last time Australia participated in the naval drill was in 2007 along with Singapore.

Australia did requests to India to join the Malabar drill in the past but New Delhi rejected it in a bid to not strain its ties with China. However, the recent India-China tensions at the Line of Actual Control in Ladakh may have brought more flexibility to the decision-making process.

Japan and the US are unlikely to oppose Canberra’s inclusion in the exercise since Chinese aggression in the India and Pacific Ocean have only increased. Since the outbreak of COVID-19, China has made provocative moves to test the response of neighbouring countries and allies in the SCS, India Ocean region and the Strait of Taiwan.

Malabar 2020 will be held in Japan in either July or August. The exercise started in 1992 between New Delhi and Washington and was expanded to include Tokyo in 2015. The arrival of Canberra will be a welcome break and would suggest the growing seriousness and synergy among four key Indo-Pacific powers and re-activation of QUAD.

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Indian-Chinese Border Dispute Direct Result Of US’ ‘Financial Actions’ Against Beijing: Experts

The dispute between the Indian-Chinese border troops started when China objected to the construction of a road in the Galwan valley by the Indian BRO. Experts link the US angle to India-China border dispute.

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With flaring tensions on the Indian-Chinese border, Indian military expert suspect that there’s a link between China’s mishandling of the virus with the border incursions with India. 

“Globally, China is losing its leverage as it is believed to have caused the pandemic. Industries are looking to move out of China. This is causing China to divert attention from the COVID-19 situation,” said Lt. Gen. Vinod Bhatia, India’s former director-general of military operations (DGMO).

As earlier reported by EurAsian Times, India dispatched troops along the border after it was reported that China is pitching tents near river Galwan, which was the 1962 flashpoint between China and India. This came after the recent instance when the two sides got into an ‘armless’ scuffle at the Naku La pass in North Sikkim, injuring soldiers from both sides. The Chinese military helicopters were later seen flying close to the undefined Line of Actual Control (LAC) on several occasions.

The conflict between the Indian-Chinese border troops started when China objected to the construction of a road in the Galwan valley. The road is being built at the junction of Shyok and Galwan rivers, about 200 km north of the Pangong Tso lake.

India and China have turbulent relations since the brief war that was fought in 1962 due to similar border issues at Aksai Chin. “This issue is a long haul. Military-to-military talks have not been successful, diplomats are now discussing the issue. We cannot rule out that the politicians may have to get involved,” said retired Gen. Ved Prakash Malik, the former army chief who led Indian forces during the 1999 Kargil War.

“Isolated incidents have occurred in the past because of an undefined grey area at the LAC. This time, however, it is different as the Chinese soldiers have dug-in and sat down at various disputed areas,” he added. 

Indian Defence Minister, Rajnath Singh, has clarified that both the nations are in the process of resolving the current border issues through established diplomatic channels and don’t need the US to mediate between them.

This was in reference to US President Donald Trump’s offer to mediate between the two nuclear-armed nations. The Chinese side has also rejected the offer when the Chinese Foreign Ministry spokesman Zhao Lijian said that the two countries did not want the “intervention” from a third party to resolve their differences.

“China respects strength, India will do well to follow the concept of no blinking, no brinkmanship, standing firm on the ground and exploiting the established mechanisms of flag meetings,” said former DGMO.

Meanwhile, Chinese media has reported that Chinese President, Xi Jinping, has ordered the military to think about worst-case scenarios and scale up training and battle preparedness.

According to Brigadier S K Chatterji (Retired) who served in the Regiment of Artillery of the Indian Army, the foremost reasons driving Chinese responses are the coronavirus-related backlashes that China is facing. Much of the world believes that China lied. At best, it kept quiet early in the outbreak and now faces a global trust deficit.

Several countries including India have asked for a probe into the origins of COVID-19 which is suspected to come from China. This has resulted in building up pressure on China as many governments have aggressively pitched for a transparent inquiry into the pandemic and also threatened to cut ties with Beijing.

New Delhi has also brought in new regulations to deter Chinese firms, which recovered from the crisis earlier than other countries, to acquire vulnerable Indian companies. “Some major global companies are thinking about moving their manufacturing facilities to India or other Asian countries. The Chinese want the world to believe that India has unstable times ahead. It plans to get these companies to rethink their strategy,” wrote Chatterji.

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Trump’s Mediation Offer ‘Naive’; US Actually Wants India To Challenge Chinese Dominance: Russian Experts

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As Trump’s offer to mediate the India-China border conflict has publically failed, experts argue that “Washington’s policy-makers, who seek to pit the Indians against the Chinese, maybe as naïve as Trump”.

The fierce military standoff between China and India that has been in the headlines for over a month now started in early May when clashes erupted between the troops of both the nuclear nations, that left scores of soldiers injured from both the sides driving a steady build-up of troops in the border region.

The US President, Donald Trump had recently offered to “mediate and arbitrate” the conflict, however, the offered was duly refused by both the involved countries.

Artyom Lukin, an associate professor of international relations at Far Eastern Federal University in Russia opines that Trump’s mediation offer “was perhaps inspired by his recent success in bringing about an OPEC+ deal that ended a brutal oil price war between Saudi Arabia and Russia.”

In April this year, with Trump’s apparent mediation, the oil giants Saudi Arabia led by Crown Prince Mohammed bin Salman and Russia led by President Vladimir Putin with 21 other countries as a part of the OPEC+ agreement collectively agreed to reduce oil output by 9.7 million barrels per day between May and June, in an attempt to combat the drop in international demand caused by the coronavirus pandemic.

The Pentagon on Trump’s offer

It is reported that Pentagon and experts in Washington do not share the same perspective as Trump’s on the issue of mediation. Lukin believes that “they understand that a rising and ambitious India is the only realistic counter-balance against China.

There are just no other candidates for this role. Russia is in cahoots with China. Japan is a declining and militarily weak power.”

It is widely understood that to maintain control over the whole Eurasian region, “the US needs to keep this super-continent divided against itself, which means never allowing a true rapprochement between Asia’s two biggest powers, India and China.”

Trump’s failure to mediate the Sino-Indian conflict

Lukin puts forward two primary reasons for Trump’s failure to intervene in the Sino-Indian conflict. “Firstly, it is difficult to be an effective mediator or arbiter in international politics if you don’t have leverage over the parties in question.”

He believes that in the case of India and China, “it is not clear what rewards or penalties the US has in reserve for China and India. Most likely there are none.”

Secondly, the scholar in international relations claims that “the best mediator is one that is perceived as unbiased and impartial. On this count, the White House has an obvious handicap, since the US views India as a crucial associate and friend, while China is considered a competitor and rival.”

The Blame on China

US’s rivalry with China has been taken into account by many international critics. Apart from the trade war and technology rivalry, Washington blamed Beijing for the ongoing coronavirus pandemic and has also pointed at China for playing aggressively in the disputed Himalayan region.

It is reported that Alice Wells, principal deputy assistant secretary of state for South and Central Asia, called China’s behaviour “aggression, the constant attempt to shift the norms, to shift what is the status quo, that has to be resisted whether it’s in the South China Sea… or whether it’s in India’s own backyard, both on land as well as in the Indian Ocean.”

On the flip side, Indian defence experts like Lt Gen H S Panag believes that China’s is ultimately protecting its own “status quo,” that is continuously been threatened by India’s strategic growth in the contested territories along the border.

Since New Delhi seeks to maximize its benefits from the partnerships that it shares with the US, it strategically refrains from being involved in American-led efforts to contain China. “In this sense, Washington’s policy-makers, who seek to pit the Indians against the Chinese, maybe as naive as Trump with his peace-making initiatives” concludes Lukin.

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