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Tokyo, April 6: Japan Prime Minister Shinzo Abe is planning to declare a state of emergency in view of the surging cases of coronavirus in the country, especially in Tokyo and other large cities, government sources said on Monday.

Pressure had been mounting on Abe to make the declaration amid a spurt in COVID-19 cases recently, with calls for the move from Tokyo Governor Yuriko Koike and the Japan Medical Association intensifying, Xinhua news agency reported.

The Tokyo metropolitan government, along with healthcare specialists, said that the number of hospital beds available for coronavirus patients will soon reach capacity, with the health ministry rapidly trying to secure more beds.

Adding to pressure on the government to demonstrably bolster its preventive and countermeasures to the spread of the virus, a panel of government experts warned recently that the country's healthcare system could collapse if coronavirus cases continue to spike.

The healthcare system in Tokyo and four other prefectures are under increased strain and "drastic countermeasures need to be taken as quickly as possible," the experts said.

As of Sunday, 143 new cases of COVID-19 were recorded in Tokyo, a record daily high for the capital, bringing the total to 1,034, with Japan's health ministry and local governments adding that nationwide cases rose to 3,531 as of Sunday afternoon.

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, Feb 24: The lockdown of Guo Jing's neighbourhood in Wuhan -- the city at the heart of China's new coronavirus epidemic -- came suddenly and without warning.

Unable to go out, the 29-year-old is now sealed inside her compound where she has to depend on online group-buying services to get food.

"Living for at least another month isn't an issue," Guo told news agency, explaining that she had her own stash of pickled vegetables and salted eggs.

But what scares her most is the lack of control -- first, the entire city was sealed off, and then residents were limited to exiting their compound once every three days.

Now even that has been taken away.

Guo is among some 11 million residents in Wuhan, a city in central Hubei province that has been under effective quarantine since January 23 as Chinese authorities race to contain the epidemic.

Since then, its people have faced a number of tightening controls over daily life as the death toll from the virus swelled to over 2,500 in China alone.

But the new rules this month barring residents from leaving their neighbourhoods are the most restrictive yet -- and for some, threaten their livelihoods.

"I still don't know where to buy things once we've finished eating what we have at home," said Pan Hongsheng, who lives with his wife and two children.

Some neighbourhoods have organised group-buying services, where supermarkets deliver orders in bulk.

But in Pan's community, "no one cares".

"The three-year-old doesn't even have any milk powder left," Pan told news agency, adding that he has been unable to send medicine to his in-laws -- both in their eighties -- as they live in a different area.

"I feel like a refugee."

The "closed management of neighbourhoods is bound to bring some inconvenience to the lives of the people", Qian Yuankun, vice secretary of Hubei's Communist Party committee, said at a press briefing last week.

Authorities on Monday allowed healthy non-residents of the city to leave if they never had contact with patients, but restrictions remained on those who live in Wuhan.

Demand for group-buying food delivery services has rocketed with the new restrictions, with supermarkets and neighbourhood committees scrambling to fill orders.

Most group-buying services operate through Chinese messaging app WeChat, which has ad-hoc chat groups for meat, vegetables, milk -- even "hot dry noodles", a famous Wuhan dish.

More sophisticated shops and compounds have their own mini-app inside WeChat, where residents can choose packages priced by weight before orders are sent in bulk to grocery stores.

In Guo's neighbourhood, for instance, a 6.5-kilogramme (14.3-pound) set of five vegetables, including potatoes and baby cabbage, costs 50 yuan ($7.11).

"You have no way to choose what you like to eat," Guo said. "You cannot have personal preferences anymore."

The group-buying model is also more difficult for smaller communities to adopt, as supermarkets have minimum order requirements for delivery.

"To be honest, there's nothing we can do," said Yang Nan, manager of Lao Cun Zhang supermarket, which requires a minimum of 30 orders.

"We only have four cars," she said, explaining that the store did not have the staff to handle smaller orders.

Another supermarket told AFP it capped its daily delivery load to 1,000 orders per day.

"Hiring staff is difficult," said Wang Xiuwen, who works at the store's logistics division, adding that they are wary about hiring too many outsiders for fear of infection.

Closing off communities has split the city into silos, with different neighbourhoods rolling out controls of varying intensity.

In some compounds, residents have easier access to food -- albeit a smaller selection than normal -- and one woman said her family pays delivery drivers to run grocery errands.

Her compound has not been sealed off either, the 24-year-old told AFP under condition of anonymity, though they are limited to one person leaving at a time.

Some districts have implemented their own rules, such as prohibiting supermarkets from selling to individuals, forcing neighbourhoods to buy in bulk or not at all.

"In the neighbourhood where I live, the reality is really terrible," said David Dai, who is based on the outskirts of Wuhan.

Though his apartment complex has organised group-buying, Dai said residents were unhappy with price and quality.

"A lot of tomatoes, a lot of onions -- they were already rotten," he told , estimating over a third of the food had to be thrown away.

His family must "totally depend" on themselves, added the 49-year-old, who has resorted to saving and drying turnip skins to add nutrients to future meals.

The uncertainty of not knowing when the controls will be lifted is also frustrating, said Ma Chen, a man in his 30s who lives alone.

"I have no way of knowing how much (food) I should buy."