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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, Jan 25: The death toll due to the novel coronavirus (2019-nCoV) outbreak in China has soared to 41, while the number of infected persons were 1,287, the National Health Commission said on Saturday.

The Commission said that 444 fresh cases were reported since Friday, with 237 patients in serious conditions, while 38 had been cured and discharged from hospitals, reports Efe news.

Health authorities have carried out check-ups on 15,197 people who have come into close contact with the infected persons. Nearly 14,000 of them continue to be monitored for symptoms.

The others cases outside of China were reported in France (two), Australia (one), Thailand (four including two cured), Japan (two including one cured), South Korea (two), the US (two), Vietnam (two), Singapore (three), Nepal (one), Hong Kong (five), Macao (two) and Taiwan (three).

The symptoms of the new coronavirus, provisionally designated by the World Health Organization as 2019-nCoV, are similar to those of cold but may be accompanied by fever and fatigue, dry cough and dyspnea (shortness of breath).

The WHO has so far to declared the outbreak as an international health emergency.

Strict measures were being carried out in China, which include complete suspension of transport in around a dozen cities in Hubei province and also cancelling Chinese New Year celebrations.

Traditional events at Lama Temple and Ditan Park in Beijing were cancelled due to the risk of spreading the virus, authorities reported Friday, while the famous Forbidden City has also been closed indefinitely.

Wuhan, the capital of Hubei, where the virus was first reported, has been on lockdown since Thursday to prevent further spread of the virus and the city's authorities have begun to build a "special hospital" with 1,000 beds for infected patients.

"Construction of the special hospital with a capacity of 1,000 beds for patients with #nCoV2019 has begun in Wuhan," official China Daily said on Twitter.

The hospital in Wuhan will be based on the model of a similar facility that was built in just seven days in Beijing to deal with SARS in 2003.

Washington, May 29: Reiterating his offer to mediate on the border dispute between India and China, US President Donald Trump has said that he spoke with Narendra Modi about the "big conflict" and asserted that the Indian Prime Minister is not in a "good mood" over the latest flare-ups between the two countries.

Speaking with the reporters in the Oval Office of the White House on Thursday, Trump said a "big conflict" was going on between India and China.

"I like your prime minister a lot. He is a great gentleman," the president said.

"Have a big conflict …India and China. Two countries with 1.4 billion people (each). Two countries with very powerful militaries. India is not happy and probably China is not happy," he said when asked if he was worried about the border situation between India and China.

"I can tell you; I did speak to Prime Minister Modi. He is not in a good mood about what is going on with China," Trump said.

A day earlier, the president offered to mediate between India and China.

Trump on Wednesday said in a tweet that he was "ready, willing and able to mediate" between the two countries.

Responding to a question on his tweet, Trump reiterated his offer, saying if called for help, "I would do that (mediate). If they thought it would help" about "mediate or arbitrate, I would do that," he said.

India on Wednesday said it was engaged with China to peacefully resolve the border row, in a carefully crafted reaction to Trump's offer to arbitrate between the two Asian giants to settle their decades-old dispute.

"We are engaged with the Chinese side to peacefully resolve it," External Affairs Ministry Spokesperson Anurag Srivastava said, replying to a volley of questions at an online media briefing.

While the Chinese Foreign Ministry is yet to react to Trump's tweet which appears to have caught Beijing by surprise, an op-ed in the state-run Global Times said both countries did not need such a help from the US President.

"The latest dispute can be solved bilaterally by China and India. The two countries should keep alert on the US, which exploits every chance to create waves that jeopardise regional peace and order," it said.

In Beijing, Chinese Foreign Ministry spokesman Zhao Lijian said on Wednesday that both China and India have proper mechanisms and communication channels to resolve the issues through dialogue and consultations.

Trump previously offered to mediate between India and Pakistan on the Kashmir issue, a proposal which was rejected by New Delhi.

The situation in eastern Ladakh deteriorated after around 250 Chinese and Indian soldiers were engaged in a violent face-off on the evening of May 5 which spilled over to the next day before the two sides agreed to "disengage" following a meeting at the level of local commanders.

Over 100 Indian and Chinese soldiers were injured in the violence.

The incident in Pangong Tso was followed by a similar incident in north Sikkim on May 9.