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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."

India's COVID-19 tally raced past the seven lakh-mark with 22,252 fresh infections on Tuesday, five days after crossing the six lakh post, while the death toll climbed to 20,160 as 467 more people succumbed to the disease, according to the Union health ministry.

With this, the country has recorded over 20,000 cases of the infection for the fifth consecutive day.

India's coronavirus infection caseload stands at 7,19,665, the ministry's data updated at 8 am showed.

With a steady rise, the number of recoveries stands at 4,39,947, while there are 2,59,557 active cases of coronavirus infection in the country.

"Thus, around 61.13 % of patients have recovered so far," an official said.

The total number of confirmed cases also includes foreigners.

Of the 467 deaths reported in the last 24 hours, 204 are from Maharashtra, 61 from Tamil Nadu, 48 from Delhi, 29 from Karnataka, 24 from Uttar Pradesh, 22 from West Bengal, 17 from Gujarat.

Telangana and Haryana reported 11 deaths each; Madhya Pradesh nine; Andhra Pradesh seven; Jammu and Kashmir six; Rajasthan and Punjab five each; Bihar, Kerala and Odisha two each; and Arunachal Pradesh and Jharkhand one each.

Kashmir, Jan 9: US Ambassador to India Kenneth I Juster along with envoys from 15 other countries arrived in Srinagar on a two-day visit to Jammu and Kashmir on Thursday, the first visit by diplomats since the abrogation of the erstwhile state's special status in August last year.

The Delhi-based envoys arrived in Srinagar by a special chartered flight at Srinagar's technical airport where top officials from the newly carved out union territory received them, officials said.

Later in the day, they would be going to Jammu, the winter capital of the newly created Union Territory, for an overnight stay. They will meet Lt Governor G C Murmu as well as civil society members, they said.

Besides the US, the delegation will include diplomats from Bangladesh, Vietnam, Norway, Maldives, South Korea, Morocco, and Nigeria, among others.

Brazil's envoy Andre Aranha Correa do Lago was also scheduled to visit Jammu and Kashmir. However, he backed out because of his preoccupation here, the officials said on Wednesday.

Envoys from the European Union (EU) countries are understood to have conveyed that they will visit the union territory on a different date and are also believed to have stressed on meeting the three former chief ministers -- Farooq Abdullah, Omar Abdullah and Mehbooba Mufti -- who are under detention.

Officials said envoys of several countries had requested the government for a visit to Kashmir to get a first-hand account of the situation in the Valley following the August 5 decision to abrogate provisions of Article 370 and bifurcate it into two union territories, Jammu and Kashmir, and Ladakh.

This is the second visit of a foreign delegation to Jammu and Kashmir since August 5. Earlier, Delhi-based think tank International Institute for Non-Aligned Studies, a Delhi-based think tank took 23 EU MPs on a two-day visit to assess the situation in the union territory.

The government had distanced itself from the visit with Minister of State for Home G Kishan Reddy informing Parliament that the European parliamentarians were on a "private visit".