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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."

London, Mar 26: British Prime Minister Boris Johnson has said that the country's NHS risks becoming "overwhelmed" by the coronavirus outbreak and that the situation in Britain is just two or three weeks behind Italy.
"The numbers are very stark, and they are accelerating. We are only a matter of weeks -- two or three -- behind Italy," Johnson said, as reported by CNN.
"The Italians have a superb health care system. And yet their doctors and nurses have been completely overwhelmed by the demand. The Italian death toll is already in the thousands and climbing.
He added, "Unless we act together unless we make the heroic and collective national effort to slow the spread -- then it is all too likely that our own NHS will be similarly overwhelmed,"
"That is why this country has taken the steps that it has, in imposing restrictions never seen before either in peace or war." He said.
The problem reached a crunch point in the UK, which has dramatically increased its response to the virus outbreak this week.
Food banks that provide a lifeline for some of the estimated 14 million in poverty are running low on volunteers, many of whom have been forced to self-isolate, as well as the food itself, which is in short supply following panic-buying.
The UK has confirmed more 9,600 cases of the deadly virus with 460 deaths.
The global tally of cases has crossed 487,000 as on Thursday with 22,030 deaths globally as per the data presented by the Johns Hopkins University.

Jul 3: China under President Xi Jinping has stepped up its "aggressive" foreign policy toward India and "resisted" efforts to clarify the Line of Actual Control that prevented a lasting peace from being realised, according to a report released by a US Congress appointed commission.

The armies of India and China have been locked in a bitter standoff at multiple locations in eastern Ladakh for the last seven weeks, and the tension escalated after 20 Indian soldiers were killed in a violent clash in the Galwan Valley on June 15.

“Under General Secretary of the Chinese Communist Party (CCP) Xi Jinping, Beijing has stepped up its aggressive foreign policy toward New Delhi. Since 2013, China has engaged in five major altercations with India along the Line of Actual Control (LAC),” said a brief issued by US-China Economic and Security Review Commission.

"Beijing and New Delhi have signed a series of agreements and committed to confidence-building measures to stabilise their border, but China has resisted efforts to clarify the LAC, preventing a lasting peace from being realised,” said the report and was prepared at the request of the Commission to support its deliberations.

Authored by Will Green, a Policy Analyst on the Security and Foreign Affairs Team at the Commission, the report says that the Chinese government is particularly fearful of India’s growing relationship with the United States and its allies and partners.

“The latest border clash is part of a broader pattern in which Beijing seeks to warn New Delhi against aligning with Washington,” it said.

After Xi assumed power in 2012, there was a significant increase in clashes, despite the fact that he met Prime Minister Narendra Modi several times and Beijing and New Delhi have agreed to a series of confidence-building mechanisms designed to mitigate tensions.

Prior to 2013, the last major border clash was in 1987. The 1950s and 1960s were a particularly tense period, culminating in 1962 with a war that left thousands of soldiers dead on both sides, according to the records of China's People's Liberation Army, the report said.

“The 2020 skirmish is in line with Beijing’s increasingly assertive foreign policy. The clash came as Beijing was aggressively pressing its other expansive sovereignty claims in the Indo-Pacific region, such as over Taiwan and in the South and East China seas,” it said.

China is engaged in hotly contested territorial disputes in both the South China Sea and the East China Sea. Beijing has built up and militarised many of the islands and reefs it controls in the region. Both areas are stated to be rich in minerals, oil and other natural resources and are vital to global trade.

China claims almost all of the South China Sea. Vietnam, the Philippines, Malaysia, Brunei and Taiwan have counter claims over the area.

Several weeks before the clash in the Galwan Valley, Chinese Defence Minister Wei Fenghe called on Beijing to “use fighting to promote stability” as the country’s external security environment worsened, a potential indication of China’s intent to proactively initiate military tensions with its neighbours to project an image of strength, the report said.