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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."

Seoul/South Korea, Apr 27: North Korean leader Kim Jong Un is "alive and well", a top security adviser to the South's President Moon Jae-in said, downplaying rumours over Kim's health following his absence from a key anniversary.
"Our government position is firm," said Moon's special adviser on national security Moon Chung-in, in an interview with CNN on Sunday. "Kim Jong Un is alive and well."

The adviser said that Kim had been staying in Wonsan -- a resort town in the country's east -- since April 13, adding: "No suspicious movements have so far been detected."

Conjecture about Kim's health has grown since his conspicuous absence from the April 15 celebrations for the birthday of his grandfather Kim Il Sung, the North's founder -- the most important day in the country's political calendar.

Kim has not made a public appearance since presiding over a Workers' Party politburo meeting on April 11, and the following day state media reported him inspecting fighter jets at an air defence unit.

North Korean leader Kim Jong Un was not gravely ill, two South Korean government sources said on Tuesday, following reports he had undergone a cardiovascular procedure and was now in "grave danger."

His absence unleashed a series of unconfirmed media reports over his condition, which officials in Seoul previously poured cold water on.

"We have nothing to confirm and no special movement has been detected inside North Korea as of now," the South's presidential office said in a statement last week.

South Korea's unification minister Kim Yeon-chul reiterated Monday that remained the case, adding the "confident" conclusion was drawn from "a complex process of intelligence gathering and assessment".

'Grave danger'

Daily NK, an online media outlet run mostly by North Korean defectors, has reported Kim was undergoing treatment after a cardiovascular procedure earlier this month.

Citing an unidentified source inside the country, it said Kim, who is in his mid-30s, had needed urgent treatment due to heavy smoking, obesity and fatigue.

Soon afterwards, CNN reported that Washington was "monitoring intelligence" that Kim was in "grave danger" after undergoing surgery, quoting what it said was an anonymous US official.

US President Donald Trump on Thursday rejected reports that Kim was ailing but declined to state when he was last in touch with him.

On Monday, the official Rodong Sinmun newspaper reported that Kim had sent a message of thanks to workers on the giant Wonsan Kalma coastal tourism project.

It was the latest in a series of reports in recent days of statements issued or actions taken in Kim's name, although none has carried any pictures of him.

Satellite images reviewed by 38North, a US-based think tank, showed a train probably belonging to Kim at a station in Wonsan last week.

It cautioned that the train's presence did not "indicate anything about his health" but did "lend weight" to reports he was staying on the country's eastern coast.

Reporting from inside the isolated North is notoriously difficult, especially regarding anything to do with its leadership, which is among its most closely guarded secrets.

Previous absences from the public eye on Kim's part have prompted speculation about his health.

In 2014 he dropped out of sight for nearly six weeks before reappearing with a cane. Days later, the South's spy agency said he had undergone surgery to remove a cyst from his ankle.

Beijing, Feb 18: A hospital director at the epicentre of China's virus epidemic died on Tuesday, state media said, the latest medical worker to fall victim to the new coronavirus spreading across the country.

The COVID-19 virus, which is believed to have originated in Wuhan late last year, has infected more than 72,000 people and killed nearly 1,900.

Liu Zhiming, the director of Wuchang Hospital in Wuhan, died Tuesday morning after "all-out rescue efforts failed," state broadcaster CCTV reported.

China said last week that six medical workers had died from the virus, while 1,716 have been infected.

Liu's death was initially reported by Chinese media and bloggers shortly after midnight on Tuesday -- but the stories were later deleted and replaced with reports that doctors were still trying to save him.

After initial reports of his death were denied, the hospital told AFP on Tuesday morning that doctors were giving him life-saving treatment.

Liu's death has echoes of that of Wuhan ophthalmologist Li Wenliang, who had been punished by authorities for sounding the alarm about the virus in late December.

Li's death prompted a national outpouring of grief as well as anger against the authorities, who were accused of mishandling the crisis.

People took to social media to mourn Liu on Tuesday, with many users on the Twitter-like Weibo platform drawing critical comparisons between Liu's death and Li's.

In both cases their deaths were initially reported in state media posts -- later deleted -- and their deaths denied, before being finally confirmed again.

"Has everyone forgotten what happened to Li Wenliang? They forcefully attempted resuscitation after he died," one Weibo commenter wrote.

Another commenter said, Liu "already died last night, (but) some people are addicted to torturing corpses".

A hashtag about Liu's death had 29 million views by Tuesday afternoon.

Doctors in Wuhan face shortages of masks and protective bodysuits, with some even wearing makeshift hazmat suits and continuing to work despite showing respiratory symptoms, health workers have told AFP.

Hubei province and its capital Wuhan have been the hardest hit by the virus, accounting for nearly 1,800 of the deaths from the virus so far.