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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."

The US Commission on International Religious Freedom (USCIRF) has reprimanded the Imran Khan government for denying food aid to Hindus and Christians in Pakistan amid the coronavirus pandemic and warned that it will trigger an additional crisis due to religious discrimination.

The USCIRF is an independent federal government entity set up by the US Congress to monitor and report on religious freedom in the world.

Pakistan continues to be in the tier one of the USCIRF list of the countries whose record on religious freedom remains abysmal.

In a statement issue on Monday, the USCIRF said it was troubled by the reports of food aid being denied to Hindus and Christians in Pakistan amid pandemic.

Citing one of the examples of religious discrimination, the USCIRF said that in Karachi, the Saylani Welfare International Trust, a non-government organization set up to help the homeless and seasonal workers, has been refusing food aid to Hindus and Christians and providing it only Muslims.

Describing such actions "reprehensible", the USCIRF commissioner Anurima Bhargava said: "As COVID-19 continues to spread, vulnerable communities within Pakistan are fighting hunger and to keep their families safe and healthy. Food aid must not be denied because of one's faith."
One of the USCIRF commissioners, Johnnie Moore warned that if the Khan government continued with such policies, Pakistan would add an additional crisis.

"In a recent address by Prime Minister Khan to the international community, he highlighted that the challenge facing governments in the developing world is to save people from dying of hunger while also trying to halt the spread of COVID-19. This is a monumental task laying before many countries.

"Prime Minister Khan's government has the opportunity to lead the way but they must not leave religious minorities behind. Otherwise, they may add on top of it all one more crisis, created by religious discrimination and inter-communal strife."

The organization which makes foreign policy recommendations to the US President, the Secretary of State, and Congress, urged the Pakistani government to ensure that food aid from distributing organizations is shared equally with Hindus, Christians, and other religions minorities.

Last year, in its annual report, the USCIRF had noted that Hindus and Christians in Pakistan "face continued threats to their security and are subjected to various forms of harassment and social exclusion".

New Delhi, Feb 21: Global terror financing watchdog FATF on Friday decided continuation of Pakistan in the "Grey List" and warned the country that stern action will be taken if it fails to check flow of money to terror groups like the LeT and the JeM, sources said.

The decision has been taken at the Financial Action Task Force's plenary in Paris.

The FATF decided to continue Pakistani in the "Grey List". The FATF also warned Pakistan that if it doesn't complete a full action plan by June, it could lead to consequences on its businesses, a source said.