Nine dead, four missing as avalanche hits Mount Manaslu climbers in Nepal

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 12: Pope Francis called on Sunday for an "immediate" ceasefire in global conflict and urged European nations to show "solidarity" in the face of a coronavirus pandemic that has claimed more than 109,000 lives worldwide.

"May Christ our peace enlighten all who have responsibility in conflicts, that they may have the courage to support the appeal for an immediate global ceasefire in all corners of the world," the pope said in a livestreamed Easter message.

Francis added that it was time for Europe, which he described as his "beloved continent", to "rise again, thanks to a concrete spirit of solidarity" similar to that shown after World War II.

Christians around the world are marking a solitary Easter, forced to celebrate the most joyful day in the Christian calendar largely alone amid the sorrowful reminders of the devastation wrought by the coronavirus pandemic

As Peru begins to ease its strict coronavirus lockdown, the country's biggest LGBTQ nightclub opened its doors on Tuesday, but there will be no nighttime revellers; its dance floor will instead be filled with shelves stocked with groceries.

Instead of slinging cocktails at the bar or dancing on stage, ValeTodo Downtown's famed staff of drag queens will sell customers daily household products as the space reopens as a market while nightclubs are ordered to remain closed.

The Peruvian government will lift the lockdown in most regions of the country at the beginning of July but will keep borders closed, as well as nightclubs and bars.

The lockdown has been a struggle for the club's 120 employees like drag queen Belaluh McQueen. Her life completely changed when the government announced the quarantine. Her nights were spent at home, rather than performing as a dancer at the club in vivid-coloured costumes.

"I was very depressed because I have been doing this art for years, but you have to adapt to new challenges for the future," said McQueen, who is identified by her stage name.

Now McQueen is back to work as a grocery store employee, wearing a sequined suit, high heels and a mask. A DJ will play club music as patrons shop. "We have a new job opportunity," McQueen added.

Renamed as Downtown Market, the club, which has been a mainstay hallmark of the local LGBTQ community, ushered in its reopening with an inauguration ceremony.

"Before, I used to come here to dance and have a good time, but now we come to buy," said Alexandra Herrera, a regular attendee of the club. "The thing is to reinvent yourself."

The club's general manager, Claudia Achuy, said that the pandemic impacted the heart of Lima nightlife, but she chose to reopen as a market rather than risk cutting staff. "If we had just stayed as a nightclub we did not have a close horizon or a way of working," Achuy said.

Peru's confirmed coronavirus cases rose to 282,364 with 9,504 associated deaths on Monday, according to government data. It has the second-highest outbreak in Latin America after Brazil, according to a Reuters tally.