Pakistan reports 3,938 new COVID-19 cases, death toll reaches 1,621

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."

Beijing, Jun 16: The coronavirus situation in China's capital is "extremely severe", a city official warned Tuesday, as 27 new infections were reported from Beijing where a new cluster has sparked a huge trace-and-test programme.

The COVID-19 resurgence -- believed to have started at the sprawling Xinfadi wholesale food market in the capital -- has sparked alarm as China had largely brought its outbreak under control through mass testing and lockdowns imposed earlier in the year.

The new cases took the number of confirmed infections in Beijing over the past five days to 106, as authorities locked down almost 30 communities in the city and tested tens of thousands of people.

"The epidemic situation in the capital is extremely severe," Beijing city spokesman Xu Hejian warned at a press conference.

The World Health Organization had already expressed concern about the cluster, pointing to Beijing's size and connectivity.

Officials in the capital have said they will test stall owners and managers at all of the city's food markets, restaurants and government canteens.

Beijing's coronavirus testing capacity has been expanded to 90,000 a day, according to China's official news agency Xinhua.

On Tuesday, the capital's transport commission banned taxi- and ride-hailing services from driving out of the city, Xinhua reported, in another move to try and contain the new outbreak.

All indoor sports and entertainment venues in Beijing were ordered to shut on Monday, and some other cities across China warned they would quarantine those arriving from the capital.

The National Health Commission also reported four new domestic infections in Hebei province, which surrounds Beijing, and a case reported in southwestern Sichuan province was linked to the Beijing cluster.

Authorities were also racing to track people from Beijing who had travelled to other parts of China, and those who visited the capital have been encouraged to get tested.

Beijing spokesman Xu said: "High-risk people who have left Beijing must inform local authorities immediately."

Market inspections

Authorities shut down another market on Tuesday -- Tiantaohonglian in the central Xicheng district -- after one employee there was diagnosed with COVID-19, state broadcaster CCTV reported.

Seven residential estates surrounding that market were also locked down.

In total, Beijing officials said Tuesday they have disinfected 276 agricultural markets, closed 11 markets, and disinfected more than 33,000 food and beverage businesses in a bid to stamp out the new cluster.

Officials had warned Sunday that since May 30, 200,000 people had visited the Xinfadi market -- the original site of the new outbreak.

More than 8,000 workers from Xinfadi have been tested and sent to centralised quarantine facilities.

Until this recent outbreak, most of China's cases in recent months were nationals returning home as the pandemic spread to other countries.

China's Center for Disease Control and Prevention said Monday that the virus strain found in the Beijing outbreak was a "major epidemic strain in the European countries".

While the virus was detected on chopping boards used to handle imported salmon at Xinfadi, "it does not clearly or definitely indicate it's from imported seafood", Wu Zunyou, the body's chief epidemiologist, said in an interview with state broadcaster CCTV.

"Ever since new cases suddenly emerged in Beijing, we have tried to figure out the reasons for the outbreak since there were no COVID-19 cases found over the past two months," Wu Zunyou said.

"We came up with several possibilities, and the most likely one is that the carrier of the novel coronavirus comes from outside China or other parts of China and brought it here."

On Tuesday, another eight imported cases were reported.

Washington, Mar 27: The United States has seen a record 18,000 new confirmed coronavirus cases and 345 deaths over the past 24 hours, according to a Johns Hopkins University tracker.

There are now 97,028 declared virus cases in the country and there have been 1,475 deaths, Johns Hopkins said.