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Thromboembolic involvement and its possible pathogenesis in COVID-19 mortality: lesson from post-mortem reports

Abstract. – The emergence of Coronavirus Disease 19 (COVID-19) as a pandemic has claimed hundreds of thousands of lives worldwide since its initial breakout. With increasing reports from clinical observations and autopsy findings, it became clear that the disease causes acute respiratory distress syndrome (ARDS), as well as a broad spectrum of systemic and multiorgan pathologies, including angiopathy, endothelialitis, and thrombosis. Coagulopathy is associated with the activity of megakaryocytes, which play crucial roles in modulating the platelet homeostasis. Only a few autopsy reports include findings on thrombosis formation and the presence of megakaryocytes. Here we review and summarize the possible involvement and the pathophysiology of the thromboembolic events in COVID-19 patients based on post-mortem reports. We reviewed post-mortem reports from March 2020 to September 2020.

Vaccine-induced and Natural Immunity

Which is more effective, immunity that is induced by vaccination or immunity acquired after being infected with Covid-19? This question is important to raise after Covid-19 has exceeded the positive rate of a million, triggering the government to take the pandemic more seriously. Vaccination is being intensified. The first phase for healthcare workers is under way and will soon be followed by the next group of priority recipients. The government also imposes public activity restrictions (PPKM), with several provinces applying micro-scale PPKM, which are watched over by the Public Order Agency (Satpol PP), the National Police and even the Indonesian Military. This indicates the government’s greater awareness of mobility restrictions as an important pillar to prevent the spread of infection besides increasing testing and tracing. We certainly should not ignore the criticism of some epidemiologists about the presence of data on millions of affected people that are claimed to be hidden.

Vaccination and Threat of Virus Mutation

The new chapter opened with the Covid-19 vaccine, which has buoyed public optimism, needs to be accompanied with honesty (and fairness) in government policies. The new chapter opened with the Covid-19 vaccine, which has buoyed public optimism, needs to be accompanied with honesty (and fairness) in government policies. The Food and Drug Monitoring Agency has issued emergency use authorization after the Indonesian Ulema Council stated that the Sinovac vaccine is halal. President Joko Widodo became the first person to receive a Sinovac shot on 14 January 2021 to set an example for Covid-19 immunization. A week earlier, Coordinating Economic Minister Airlangga Hartarto as the chairman of the Committee for Covid-19 Handling and National Economic Recovery announced the enforcement of new large-scale social restrictions (PSBB) for Java and Bali from 11-25 January. This is a good step, as well as a corrective one.

The Fading Voice of Doctors in Pandemic Policy

The widely circulating reports about preparing vaccinations against Covid-19 have given rise to optimism and anxiety at the same time amid the protracted pandemic. The widely circulating reports about preparing vaccinations against Covid-19 have given rise to optimism and anxiety at the same time amid the protracted pandemic. Some people are so optimistic that they are convinced that a vaccine will mean the end of the pandemic. As someone who works every day at a hospital and still has time to read various medical journals and media reports, this writer still finds it hard to understand the present circumstances. Nine months since President Joko Widodo announced the first patients to test positive for Covid-19 in Depok, the number of confirmed Covid-19 cases has kept increasing until today. Worse still, public fear over the pandemic is waning.

Age Perception, Millennial Generation in the Presidential Election

  Age is an attractive factor in the 2019 presidential election compared to our previous elections. Two pairs of presidential and vice-presidential candidates have an age range that has been widely discussed in political conversation. Joko “Jokowi” Widodo, 57 years old (born on June 21, 1961), pairs up with Ma’ruf Amin, and Prabowo Subianto, 66 years old (born on October 17, 1951), pairs with Sandiaga Uno. Meanwhile, at present it is known that there is a thick layer of the millennial generation that is believed to be able to determine the direction of the presidential election with more than 40 percent of voters. The millennial generation is a bone of contention for the two camps even though in their calculations they use the opposite strategies. Jokowi chooses 75-year-old Ma’ruf (born March 11, 1943) and Prabowo appointed Sandiaga, who has a much younger age, 49 years old (born June 28, 1969).