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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."

Tokyo, Feb 26: Two more Indians onboard quarantined cruise ship -- Diamond Princess -- were tested positive for novel coronavirus, the Indian embassy here said on Tuesday, adding that those Indians not infected by the virus will be repatriated to the homeland on February 26.

A total of 16 Indian nationals onboard the luxury ship -- quarantined off the coast of Japan since February 5 -- have been tested positive for coronavirus so far, the embassy informed.

"A chartered flight is being arranged to repatriate Indian nationals onboard #DiamondPrincess, provided they have (a) consented; (b) not tested positive for #COVID19; (c) cleared by the medical team. An email advisory to this effect, with details, has been sent to them," the embassy tweeted.

The repatriation of the Indian nationals will be facilitated by the Indian government.

"PCR test results for ALL Indian nationals declared-02 more Indians tested positive to #COVID19, taking the total to 16. Those fulfilling conditions and consenting to repatriation to India on 26 Feb being facilitated by the Indian Government. Details shared with them," the following tweet read.

A total of 138 Indians, including 132 crew and 6 passengers, were among the 3,711 people on board the luxury cruise ship which was quarantine off Japan on February 5 after it emerged that a former passenger had tested positive for the virus.

Paris, Apr 10: French pharma major Sanofi said on Friday it has decided to donate 100 million doses of hydroxychloroquine, the anti-malaria drug which could be a potential weapon against novel coronavirus, across 50 countries.

The company has already doubled its incremental production capacity on top of the usual production for current indications across its eight hydroxychloroquine manufacturing sites worldwide and is on track to quadruple it by the summer.

"In this global health emergency, Sanofi stands ready to assist as many countries as possible, starting with countries where its medicine is registered for current approved indications as well as countries where there are no hydroxychloroquine suppliers or countries with underserved populations," it said in a statement.

Sanofi called for coordination among the entire hydroxychloroquine chain worldwide to ensure the continued supply of the medicine if proven to be a well-tolerated and effective treatment in COVID-19 patients.

"The COVID-19 pandemic is an unprecedented health and economic crisis which is shaking some of the very fundamentals of international solidarity and cooperation among countries," said Chief Executive Officer Paul Hudson. "This virus does not care about the concept of borders, so we should not either," he added.

"It is critical that international authorities, local governments, manufacturers and all other players involved in the hydroxychloroquine chain work together in a coordinated manner to ensure all patients who may benefit from this potential treatment can access it. If the trials prove positive, we hope our donation will play a critical role for patients," said Hudson.

While hydroxychloroquine is generating a lot of hope for patients around the world, said Sanofi, it should be remembered that there are no results from ongoing studies and the results may be positive or negative.

To date, there is insufficient clinical evidence to draw any conclusion over the safety and efficacy of hydroxychloroquine in the management of COVID-19 patients.

It is one of several medicines being investigated by the World Health Organisation (WHO) in its international clinical trial seeking a treatment solution for COVID-19. "Sanofi is supporting ongoing trials by providing the medicine to some participating investigator sites and other independent research centres," it said.