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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."

Jun 24: The coronavirus tally in Pakistan reached 188,926 with the detection of 3,892 new cases in the last 24 hours, the health ministry said on Wednesday.

Sixty more people died due to the viral infection, taking the death toll to 3,755.

As many as 3,337 patients are in critical condition across the country, the ministry said.

With the detection of 3,892 new cases in the last 24 hours, the coronavirus tally in the country now stands at 188,926, it said.

Sindh reported the maximum number of 72,656 cases, followed by 69,536 in Punjab, 23,388 in Khyber-Pakhtunkhwa, 11,483 in Islamabad, 9,634 in Balochistan, 1,337 in Gilgit-Baltistan and 892 in Pakistan-occupied Kashmir (Pok).

Health authorities have so far conducted 1,150,141 coronavirus tests, including 23,380 in the last 24 hours.

A total of 77,754 patients have recovered so far from the disease.

Beijing, May 9: Mounting a strong defence of the ruling Communist Party of China, President Xi Jinping has said the COVID-19 fight has once again shown that the CPC leadership and the country's socialist political system can overcome any challenge.

Xi's comments came as China faced global criticism for its initial inaction to act against the novel coronavirus, which according to Chinese officials emerged in the central Chinese city of Wuhan in December last year.

Pressure is also mounting on Beijing to agree for an international probe on the origins of the vicious virus, including from the Wuhan Institute of Virology (WIV), as claimed by the US leadership.

China curbed the spread of the coronavirus in over a month and brought COVID-19 under control at its first epicentre in Wuhan in about three months, Xi, also the General Secretary of the CPC, said at a symposium held on Friday to get suggestions from non-ruling Communist Party of China (CPC) parties on COVID-19 prevention and control.

He termed the curbing of the COVID-19 pandemic as "hard-won achievements" for the world's most populous country and the second-biggest economy.

The COVID-19 fight has once again shown that the CPC leadership, China's socialist system and its governance system can overcome any challenge and make big contributions to the progress of human civilisation, he said.

Xi said China had basically curbed the spread of the virus in over one month, managed to bring the daily number of new domestically-transmitted cases down to single digits in about two months, and secured decisive achievements in protecting epicentres Wuhan and Hubei province in about three months.

"For a huge country with 1.4 billion people, these are hard-won achievements," he said

Besides the top CPC officials, the symposium was attended by members of the central committees of non-CPC parties in China, the All-China Federation of Industry and Commerce, and persons without party affiliation.

The speakers at the symposium praised the Chinese leadership in handling the crisis, saying it fully demonstrated the political advantage of China's socialist system and showed that China was a major responsible country.

Xi, who is also the head of the People's Liberation Army, praised China's one-party political system governed by the CPC.

His comments on the country's political system came as Beijing is also defending the role of the CPC as US President Donald Trump and Secretary of State Mike Pompeo have blamed the ruling party for not being transparent in the fight against the pandemic.

Both Trump and Pompeo have been pressing Beijing to allow American experts for a probe on whether the virus emerged from the WIV, China's premier research lab where viruses of different types are reportedly researched.

At the symposium attended by the top CPC officials, Xi's leadership came for praise for successfully handling the situation, the state-run Xinhua news agency reported.

"Attendees noted the major strategic achievements in the COVID-19 fight under the strong leadership of the CPC Central Committee with Comrade Xi Jinping at the core," the report said.

The meeting was held amid reports of murmurs of internal criticism within the CPC about Xi's handling of the coronavirus crisis.

While China's move of handling the coronavirus from January 23 by locking down Hubei province and its capital Wuhan to prevent the spread of the virus and curbing it by deploying 42000 medical personnel has been praised, Beijing is criticised for its slow reaction after it emerged in December last year.

China used less than a week to identify the full genome sequence of the novel coronavirus and isolate the virus strain, produced various testing kits and swiftly selected a number of effective drugs and treatments. Different types of vaccines have also entered clinical trials.

President Xi said during the COVID-19 fight, China upheld the centralised and unified leadership of the CPC and concentrated the nation's best doctors, the most advanced equipment and the most needed resources to treat patients, with all treatment expenses covered by the state.

It managed to maximise the testing and cure rates while minimising the infection and fatality rates.

As of Friday, the COVID-19 death toll in China remained at 4,633 with no new fatalities reported for several days while the total number of cases stood at 82,887. In contrast, Chinese officials point out the death toll in the US which has crossed 75,000 with over 1.2 million cases, besides the mounting global toll.

Almost all countries in the world have been under lockdown for weeks to control the spread of the virus.

Xi called for mobilising the whole society, leveraging the institutional strength of concentrating resources to get things done and tapping the composite national strength as well as closely relying on science and technology.

On international cooperation, Xi said China had helped countries and international organisations to the best of its ability, demonstrating the nation's sense of responsibility as a major and responsible country.

Xi also stressed fixing the shortcomings in the country's major epidemic prevention and control mechanism and for the national public health system to raise the ability to deal with major public health emergencies.

He emphasised on targeted and effective measures to guard against the importation of cases and prevent a resurgence of the epidemic.