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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."

Islamabad, Apr 26: Pakistan Prime Minister Imran Khan has been trumped by the country's powerful military yet again, this time over his government's inadequate steps and its poor response in curbing the coronavirus outbreak in the country, even as cases soared over 12,500.

In his address to the nation on March 22, Khan explained the reasons for not imposing a countrywide lockdown, asserting that millions would lose their jobs and affect families, who are below the poverty line, struggling to find enough food to eat. However, less than 24 hours later, Pakistan Army spokesperson Major General Babar Iftikhar announced the implementation of lockdown in the country having a population of over 200 million, contradicting the statements made by Imran Khan.

As lockdown was imposed, the military has deployed troops across Pakistan and is orchestrating the COVID-19 response through the National Core Committee, a body set up to coordinate policy between the national and provincial governments.

"The government left a big gap in its handling of the coronavirus. The army has tried to fill that gap, there was no choice," an unnamed retired general was quoted by Financial Times as saying.

The virus crisis in Pakistan has once again made things crystal clear about who is calling the shots -- the military, widely believed to bring Imran Khan to power in 2018.

The armymen have taken over the COVID-19 crisis as an opportunity to prove their competency in contrast to Imran Khan, who was mocked after urging youth to come forward and join Corona Relief Tigers Force, a volunteer body to wage "jihad" against the virus.

According to analysts, the military's seizure of the coronavirus response marks yet another policy failure for Imran Khan in the eyes of the generals, as per the Financial Times report.

The 67-year-old cricketer-turned-politician has repeatedly failed to gain international traction over the Kashmir issue and has struggled to convince the Financial Action Task Force (FATF) in getting his country removed from 'grey list' for terror funding.

In times of emergency, one has to take clear decisions and take them through. You can't dither. The whole world is advising strong lockdown. If the prime minister does not show that he is decisive, somebody else will," said Nafisa Shah, a Member of Parliament from the opposition Pakistan Peoples Party (PPP).

Even after the lockdown was imposed, Imran Khan continued to question the need for its implementation, raising eyebrows over the country's response in tackling the virus, as cases continue to rise. This comes even as such drastic measures are in place in many countries across the world, including neighbouring India.

According to The Dawn, the country has 12,657 confirmed cases of COVID-19, which includes 2,755 recoveries and 265 deaths. Punjab has the highest number of cases -- 5,326 --, followed by 4,232 in Sindh.

However, experts suggest that the actual numbers could be more given the low testing rates and inadequate supply of testing kits.

Doctors and nurses across the country have staged protests over the lack of personal protective equipment, as increasing numbers of health workers contract COVID-19.

"Because of the lack of resources, there is chaos among the doctors and healthcare workers. They know people are dying, they know the severity of the illness and they have to work without PPE," Shoaib Hasan Tarar, a doctor working in Rawalpindi, was quoted as saying.

As the coronavirus crisis continues to ravage Pakistan, the country's overwhelming health infrastructure has put a toll on its already floundering economy. The IMF said that the GDP will shrink 1.5 per cent in 2020. The cash-strapped nation is set to be the first major emerging economy to apply to a G-20 initiative to request debt repayment relief, according to Financial Times.

In early March, Pakistan saw a surge in coronavirus cases, when infected pilgrims and workers crossed the border from Qom, a religious city in Iran, which is a hotspot.

Pakistan's limited resources were exposed when quarantined pilgrims agitated against unhealthy conditions at Taftan camp on Pakistan-Iran border, where five people were living in a tent with no access to toilets.

While the lockdown is in place, authorities have been confronted by hardline clerics who have defied social distancing terms and downplayed the threat of the virus. During Friday prayers every week, worshippers violate the restrictions by gathering at various mosques.

Last week, Islamabad inked an agreement allowing mosques to stay open for Ramzan. It stipulated that people should follow 20 rules, including maintaining a six feet distance from each other.

"There is little consistency in terms of how the lockdown is being approached. Coronavirus has shown the disconnect between the national government, regional governments and the military. Imran Khan has been left behind as the cheerleader for keeping Pakistan's morale high. I think people are starting to ask, 'How long is he going to last?'", said Sajjan Gohel, South Asia expert and guest teacher at the London School of Economics.