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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."

Jun 2: Pakistan's COVID-19 cases reached 76,398 on Tuesday after 3,938 new infections were reported across the country, while the death toll due to the coronavirus has gone up to 1,621, according to the health ministry.

The Ministry of National Health Services said that 78 COVID-19 deaths were recorded in the last 24 hours, taking the total number of fatalities in Pakistan to 1,621.

A total of 27, 110 people have recovered, it said.

Sindh has 29,647 patients, Punjab 27,850, Khyber-Pakhtunkhwa 10,485, Balochistan 4,514, Islamabad 2,893, Gilgit-Baltistan 738 and Pakistan-occupied Kashmir 271, it added.

The authorities have conducted 577,974 tests, including 16,548 in the last 24 hours.

The jump in the number of cases comes a day after Prime Minister Imran Khan said that people should learn to live with COVID-19 until a vaccine is developed.

Khan addressed the media after chairing the meeting of National Coordination Committee, the highest body to tackle the pandemic.

"Coronavirus will not go away until the vaccine is discovered. We need to learn to live with it and we can live with it if we follow precautions," he said.

He said the one million volunteers of the government's coronavirus force will raise awareness of the need to follow guidelines.

The government also said that all sectors will be opened slowly after deciding the negative list of businesses which will not be allowed.

Sao Paulo, June 20: Brazil’s government confirmed on Friday that the country has risen above 1 million confirmed coronavirus cases, second only to the United States.

The country’s health ministry said that the total now stood at 10,32,913, up more than 50,000 from Thursday. The ministry said the sharp increase was due to corrections of previous days’ underreported numbers.

Brazilian President Jair Bolsonaro still downplays the risks of the virus after nearly 50,000 deaths from COVID-19 in three months, saying the impact of social isolation measures on the economy could be worse than the disease itself.

Specialists believe the actual number of cases in Brazil could be up to seven times higher than the official statistic. Johns Hopkins University says Brazil is performing an average of 14 tests per 1,00,000 people each day, and health experts say that number is up to 20 times less than needed to track the virus.

Official data show a downward trend of the virus in Brazil’s north, including the hard-hit region of the Amazon, a plateau in cases and deaths in the countries’ biggest cities near the Atlantic coast, but a rising curve in the south.

In the Brazilian countryside, which is much less prepared to handle a crisis, the pandemic is clearly growing. Many smaller cities have weaker health care systems and basic sanitation that’s insufficient to prevent contagion.

“There is a lot of regional inequality in our public health system and a shortage of professionals in the interior,” said Miguel Lago, executive director of Brazil’s Institute for Health Policy Studies, which advises public health officials.

That creates many health care deserts, with people going long distances to get attention. When they leave the hospital, the virus can go with them.

The cattle-producing state of Mato Grosso was barely touched by the virus when it hit the nation’s biggest cities in March. Sitting far from the coast, between the Bolivian border and Brazil’s capital of Brasilia, its 33 lakh residents led a mostly normal life until May. But now its people live under lockdown and meat producers have dozens of infected workers.

In Tangará da Serra, a city of 1,03,000 people in Mato Grosso, the mayor decided Friday to forbid the sale of alcoholic drinks for two weeks as an incentive for people to stay home.

Fᢩo Junqueira said the measure was needed after a spike in COVID-19 cases that filled 80% of the city’s 54 intensive care beds. The city has had nearly 300 cases of the disease, plus three fatalities.

In Rondonópolis, only 300 miles away from Tangará da Serra and home to a thriving economy, health authorities closed the local meatpacking industry after 92 cases were confirmed there. The city of 1,44,000 inhabitants counted 21 deaths from the virus and more than 600 cases. The mayor has also decided to limit sales of alcoholic beverages.

Even regions once considered examples of successful efforts against the virus are now struggling.

Porto Alegre, home to about 14 lakh people, had success in slowing the virus’ spread over the last three months. But now its mayor is considering increasing social isolation measures after ICU occupancy in the city jumped to 80% this month.

We were already making projections for schools to come back, Mayor Nelson Marchezan Jr. told The Associated Press. Now the trend is to impose more restrictions. Outside Sao Paulo city, five regions of the state’s countryside will have to close shops starting Monday due to a rise in coronavirus cases. Governor João Doria announced the decision Friday.

Dr. Mike Ryan, the World Health Organization’s executive director, said at a news conference that Brazil needs to increase its efforts to stop the spread of infections.

“The epidemic is still quite severe in Brazil. I believe health workers are working extremely hard and under pressure to be able to deal with the number of cases that they see on a daily basis,” Dr. Ryan said.

“Certainly the rise is not as exponential as it was previously, so there are some signs that the situation is stabilising. But we’ve seen this before in other epidemics in other countries.”

Margareth Dalcolmo, a clinical researcher and professor of respiratory medicine at the state-funded Oswaldo Cruz Foundation in Rio de Janeiro, believes the reopening in major cities and the virus traveling by road into Brazil’s heartland will keep the pressure on the country’s health system.

“The risk in the interior now is very big,” she said. “Our health system just can’t solve the most serious cases of COVID in many places of the countryside.”