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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."

Global coronavirus infections passed 14 million on Friday, according to a Reuters tally, marking the first time there has been a surge of 1 million cases in under 100 hours.

The first case was reported in China in early January and it took three months to reach 1 million cases. It has taken just four days to climb to 14 million cases from 13 millionrecorded on July 13.

The United States, with more than 3.6 million confirmed cases, is still seeing huge daily jumps in its first wave of Covid-19 infections. The United States reported a daily global record of more than 77,000 new infections on Thursday, while Sweden has reported 77,281 total cases since the pandemic began.

Despite the surging cases, a cultural divide is growing in the country over wearing masks to slow the spread of the virus, a precaution routinely taken in many other nations.

U.S. President Donald Trump and his followers have resisted a full-throated endorsement of masks and have been calling for a return to normal economic activity and reopening schools despite the surging cases.

COVID-19 Pandemic Tracker: 15 countries with the highest number of coronavirus cases, deaths

Other hard-hit countries have “flattened the curve” and are easing lockdowns put in place to slow the spread of the novel virus while others, such as the cities of Barcelona and Melbourne, are implementing a second round of local shutdowns.

The number of cases globally is around triple that of severe influenza illnesses recorded annually, according to the World Health Organization.

The pandemic has now killed more than 590,000 people in almost seven months, edging towards the upper range of yearly influenza deaths reported worldwide. The first death was reported on Jan. 10 in Wuhan, China before infections and fatalities then surged in Europe and later in the United States.

The Reuters tally, which is based on government reports, shows the disease is accelerating the fastest in the Americas, which account for more than half the world’s infections and half its deaths.
In Brazil, more than 2 million people have tested positive including President Jair Bolsonaro, and more than 76,000 people have died.

India, the only other country with more than 1 millioncases, has been grappling with an average of almost 30,000 new infections each day for the last week.

Those countries were the main drivers behind the World Health Organization on Friday reporting a record one-day increase in global coronavirus cases of 237,743.

In countries with limited testing capacity, case numbers reflect only a proportion of total infections. Experts say official data likely under-represents both infections and deaths.

Washington, Feb 6: The US has expressed concern over the current situation of religious freedom in India and raised the issue with Indian officials, a senior State Department official has said.

The remarks came in the wake of widespread protests held across India against the Citizenship Amendment Act (CAA).

The senior State Department official, on condition of anonymity, said that he has met with officials in India about what is taking place in the nation and expressed concern.

"We are concerned about what's taking place in India. I have met with the Indian foreign minister. I've met with the Indian ambassador (to express my concern)," the official, who was recently in India, told reporters on Wednesday.

The US has also "expressed desire first to try to help and work through some of these issues", the official said as Secretary of State Mike Pompeo launched a 27-nation International Religious Freedom Alliance.

"To me, the initial step we try to do in most places is say what can we do to be of help you work through an issue to where there's not religious persecution. That's the first step, is just saying can we work with you on this," the official said.

India maintains that the Indian Constitution guarantees fundamental rights to all its citizens, including its minority communities.

It is widely acknowledged that India is a vibrant democracy where the Constitution provides protection of religious freedom, and where democratic governance and rule of law further promote and protect fundamental rights, a senior official of the Ministry of External Affairs has said.

According to the CAA, members of Hindu, Sikh, Buddhist, Jain, Parsi and Christian communities who have come from Pakistan, Bangladesh and Afghanistan till December 31, 2014 following religious persecution there will get Indian citizenship.

The Indian government has been emphasising that the new law will not deny any citizenship rights, but has been brought to protect the oppressed minorities of neighbouring countries and give them citizenship.

Defending the CAA, Prime Minister Narendra Modi last month said that the law is not about taking away citizenship, it is about giving citizenship.

"We must all know that any person of any religion from any country of the world who believes in India and its Constitution can apply for Indian citizenship through due process. There's no problem in that," he said.