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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."

Beijing, May 18: China has reported 25 new COVID-19 patients, the health authorities said on Monday, as 14 asymptomatic cases were detected in Wuhan, the first epicentre of the coronavirus where officials are doing mass testing of the city's entire 11 million population, taking the number of such cases in the city to 337, the highest in the country.

The death toll in China remained at 4,634 on Sunday with no new fatalities reported.

China's National Health Commission (NHC) reported seven new confirmed cases of COVID-19 and 18 asymptomatic cases on Sunday.

Jilin province where the government has implemented strict control measures in the last few days following reports of clusters of cases in Jilin city reported two cases on Sunday, while Shanghai city has reported one.

As of Sunday, the overall confirmed cases in China had reached 82,954, including 82 patients who are still being treated, and 78,238 people who have been discharged after recovery.

Also on Sunday, 18 new asymptomatic cases including two from abroad were reported in China, taking the total number under medical observation to 448, the NHC said.

Asymptomatic cases pose a problem as the patients are tested COVID-19 positive but develop no symptoms such as fever, cough or sore throat. However, they pose a risk of spreading the disease to others.

Wuhan which is undergoing mass testing of the city's entire over 11 million population to determine the prevalence of the virus has reported no new confirmed cases, but 14 new asymptomatic infections, taking the number of such cases in the city to 337, the highest in the country, according to the figures released by the local health commission on Sunday.

The death toll in Hubei province stood at 4,512, including 3,869 in Wuhan.

The province so far has reported 68,134 confirmed COVID-19 cases in total, including 50,339 in Wuhan, according to the officials figures.

As the cases dropped, China on Sunday exempted people in Beijing from wearing masks, signalling that the virus is under control in the national capital.

As the virus is abating in the country, China is opening up all its business including entertainment centres like Shanghai Disneyl and to show that it has managed to control the dreaded virus while the world is struggling with it with lockdowns and massive casualties.

The novel coronavirus which originated in Wuhan in December last year has claimed 315,185 lives and infected over 4.7 million people globally, according to Johns Hopkins University data.

The total number of global COVID-19 cases was nearing 9 million, while the deaths have increased to over 467,000, according to the Johns Hopkins University.

By Monday morning, the total number of cases stood at 8,927,195, while the fatalities increased to 467,636, the University's Center for Systems Science and Engineering (CSSE) revealed in its latest update.

With 2,279,306 cases and 119,967 deaths, the US continues with the world's highest number of COVID-19 infections and fatalities, according to the CSSE.

Brazil comes in the second place with 1,083,341 infections and 50,591 deaths.

In terms of cases, Russia ranks third (583,879), and was followed by India (410,461), the UK (305,803), Peru (251,338), Spain (246,272), Chile (242,355), Italy (238,499), Iran (204,952), France (197,008), Germany (191,272), Turkey (187,685), Mexico (180,545), Pakistan (176,617), Saudi Arabia (157,612), Bangladesh (112,306) and Canada (103,078), the CSSE figures showed.

The other countries with over 10,000 deaths are the UK (42,717), Italy (34,634), France (29,643), Spain (28,323), Mexico (21,825) and India (13,254).