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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."

Apr 29: US President Donald Trump doubled down on China for failing to tame the coronavirus at its very origin, saying it has led to 184 countries "going through hell", as several American lawmakers demanded steps to reduce dependence on Beijing for manufacturing and minerals.

Trump has been publicly blaming China for the global spread of the "invisible enemy" and launched an investigation against it. He has also indicated that the US may be looking at "a lot more money" in damages from China than the USD 140 billion being sought by Germany from Beijing for the pandemic.

Leaders of the US, the UK and Germany believe that the deaths and the destruction of the global economy could have been avoided, had China shared the information about the virus in its early phases.

"It's in 184 countries, as you hear me say often. It's hard to believe. It's inconceivable," Trump told reporters at White House Tuesday. "It should have been stopped at the source, which was China. It should have been stopped very much at the source, but it wasn't. And now we have 184 countries going through hell.”

The virus, which originated in China's Wuhan city in mid-November, has killed more than two lakh people and infected over three million globally. The largest number of them are in the US: nearly 59,000 deaths and over one million infections.

The massive outbreak in the US has put Trump under increasing pressure from American lawmakers to decrease US dependence on Beijing and they have also sought compensation from China.

Senator Ted Cruz and his colleagues have urged Defence Secretary Mark Esper and Interior Secretary David Bernhardt to support the development of a fully domestic supply chain of rare earths and other minerals that are critical for manufacturing defence technologies and supporting national security.

“It is clear that our dependence on China for vital rare earths threatens our US manufacturing and defence-industrial base. As the October 2018 Defence Industrial Base Report states: ‘China represents a significant and growing risk to the supply of materials deemed strategic and critical to US national security.' [...] Ensuring a US supply of domestically sourced rare earths will reduce our vulnerability to supply disruptions that poses a grave risk to our military readiness," the Senators wrote.

The US is 100 percent import-dependent for rare earths as well as 13 other metals and minerals on the US Government Critical Minerals List and more than 75 percent import reliant for an additional 10 minerals.

Congressman Brian Mast on Tuesday introduced a legislation to hold China accountable for its "coronavirus deception". The resolution would empower the US to withhold payments on debts owed to China equal to the costs incurred by the US in response to COVID-19.

“China's total lack of transparency and mishandling of the coronavirus outbreak has cost tens of thousands of lives, millions of jobs and left untold economic destruction. Congress must hold China accountable for their cover-up and force them to pay back the taxpayer dollars that have been spent as a result,” Mast said.

Cruz, member of the Senate Foreign Relations Committee, announced his intention to introduce a legislation to cut off Hollywood studios from assistance they receive from the Department of Defence if those studios censor their films for screening in China.

This legislation is part of Sen. Cruz's comprehensive push to combat China's growing influence over what Americans see and hear, which includes legislation targeting information warfare from the Chinese Communist Party across higher education, sports, films, radio broadcasts, and more.

Indian-American Congressman Ami Bera and Congressman Ted S. Yoho, both members of the House Foreign Affairs Committee, will lead a bipartisan virtual Special Order to highlight the importance of US global leadership during the COVID-19 pandemic.

“If we abdicate our place as a leader in global health, there is another country eager to take the reins. China has not been subtle in asserting itself on global health issues, and often not for the benefit of other nations. China's recent coronavirus debacle should be evidence enough that their communist regime cannot be trusted to lead with accountability, transparency, or pragmatism, traits that are essential when fighting widespread disease,” Yoho said.

“As for how China would fare as a global health leader, look no further than the disastrous initial response by the WHO to coronavirus, one that was clearly influenced by Beijing. Information was slow-walked, warnings from nations like Taiwan were ignored at crucial turning points, and cooperation with outside health experts was spurned until it was too late. And it has resulted in the largest public health disaster the world has seen in over a century,” he said.

In an interview to Fox News, Senator Marco Rubio alleged that if China had acted when those warnings were being made, instead of silencing the people that were talking about it, they could have limited the spread.

“So there was no doubt that that was a deliberate decision made on their part. The one way to hold them accountable is to do what we should be doing anyway. That is moving the means of production to become less and less dependent upon them. What you're going to see after this pandemic is that more and more countries are going to prioritize their healthcare manufacturing capabilities and other industries,” he said.