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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."

New Delhi, Jan 3: US aviation regulator Federal Aviation Administration on Thursday warned America's airlines and their pilots that there is risk involved in operating flights in Pakistan airspace due to "extremist or militant activity", according to an official document.

"Exercise caution during flight operations. There is a risk to US civil aviation operating in the territory and airspace of Pakistan due to extremist/militant activity," said the US Federal Aviation Administration (FAA) in a notice to airmen (NOTAM) dated December 30, 2019.

The NOTAM is applicable to all US-based airlines and US-based pilots.

The US regulator said in its NOTAM that there continues to be a risk to US civil aviation sector from attacks against airports and aircraft in Pakistan, particularly for aircraft on the ground and aircraft operating at low altitudes, including during the arrival and departure phases of flights.

"The ongoing presence of extremist/militant elements operating in Pakistan poses a continued risk to US civil aviation from small-arms fire, complex attacks against airports, indirect weapons fire, and anti-aircraft fire, any of which could occur with little or no warning," it said.

The FAA said that while, to date, there have been no reports of man-portable air defense systems or Manpads being used against the civil aviation sector in Pakistan, some extremist or terrorist groups operating there are suspected of having access to these Manpads.

"As a result, there is potential risk for extremists/militants to target civil aviation in Pakistan with Manpads," it said.

The regulator added that pilots or airlines must report safety or security incidents - which may happen in Pakistan - to the FAA.

Pakistan on July 16 last year opened its airspace for India after about five months of restrictions imposed in the wake of a standoff with New Delhi.

Following the Balakot airstrikes by the Indian Air Force, Pakistan had closed its airspace on February 26 last year.

Pakistan in October last year had denied India's request to allow Prime Minister Narendra Modi's VVIP flight to use its airspace for his visit to Saudi Arabia over the Jammu and Kashmir issue.

Beijing, May 24: The Chinese virology institute in the city where COVID-19 first emerged has three live strains of bat coronavirus on-site, but none match the new contagion wreaking chaos across the world, its director has said.

Scientists think COVID-19 -- which first emerged in Wuhan and has killed some 340,000 people worldwide -- originated in bats and could have been transmitted to people via another mammal.

But the director of the Wuhan Institute of Virology told state broadcaster CGTN that claims made by US President Donald Trump and others that the virus could have leaked from the facility were "pure fabrication".

"Now we have three strains of live viruses... But their highest similarity to SARS-CoV-2 only reaches 79.8 percent," she said, referring to the coronavirus strain that causes COVID-19.

US demands immediate start to WHO review

The United States called on the World Health Organisation on Friday to begin working immediately on investigating the source of the novel coronavirus, as well as its handling of the response to the pandemic.

One of their research teams, led by Professor Shi Zhengli, has been researching bat coronaviruses since 2004 and focused on the "source tracing of SARS", the strain behind another virus outbreak nearly two decades ago.

"We know that the whole genome of SARS-CoV-2 is only 80 percent similar to that of SARS. It's an obvious difference," she said.

"So, in Professor Shi's past research, they didn't pay attention to such viruses which are less similar to the SARS virus."

Conspiracy rumours that the biosafety lab was involved in the outbreak swirled online for months before Trump and US Secretary of State Mike Pompeo brought the theory into the mainstream by claiming that there is evidence the pathogen came from the institute.

The lab has said it received samples of the then-unknown virus on December 30, determined the viral genome sequence on January 2 and submitted information on the pathogen to the WHO on January 11.

Wang said in the interview that before it received samples in December, their team had never "encountered, researched or kept the virus."

"In fact, like everyone else, we didn't even know the virus existed," she said. "How could it have leaked from our lab when we never had it?"

The World Health Organization said Washington had offered no evidence to support the "speculative" claims.

In an interview with Scientific American, Shi said the SARS-CoV-2 genome sequence did not match any of the bat coronaviruses her laboratory had previously collected and studied.