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Washington, May 23: President Donald Trump has labeled churches and other houses of worship as “essential" and called on governors nationwide to let them reopen this weekend even though some areas remain under coronavirus lockdown.

The president threatened Friday to “override” governors who defy him, but it was unclear what authority he has to do so.

“Governors need to do the right thing and allow these very important essential places of faith to open right now — for this weekend," Trump said at a hastily arranged press conference at the White House. Asked what authority Trump might have to supersede governors, White House press secretary Kayleigh McEnany said she wouldn't answer a theoretical question.

Trump has been pushing for the country to reopen as he tries to reverse an economic free fall playing out months before he faces reelection. White evangelical Christians have been among the president's most loyal supporters, and the White House has been careful to attend to their concerns throughout the crisis.

Following Trump's announcement, the Centers for Disease Control and Prevention released new guidelines for communities of faith on how to safely reopen, including recommendations to limit the size of gatherings and consider holding services outdoors or in large, well-ventilated areas.

Public health agencies have generally advised people to avoid gatherings of more than 10 people and encouraged Americans to remain 6 feet (1.8 meters) away from others when possible. Some parts of the country remain under some version of remain-at-home orders.

In-person religious services have been vectors for transmission of the virus. A person who attended a Mother's Day service at a church in Northern California that defied the governor's closure orders later tested positive, exposing more than 180 churchgoers. And a choir practice at a church in Washington state was labeled by the CDC as an early “superspreading" event.

But Trump on Friday stressed the importance of churches in many communities and said he was “identifying houses of worship — churches, synagogues and mosques — as essential places that provide essential services.”

“Some governors have deemed liquor stores and abortion clinics as essential” but not churches, he said. “It's not right. So I'm correcting this injustice and calling houses of worship essential." “These are places that hold our society together and keep our people united,” he added.

Dr. Deborah Birx, coordinator of the White House coronavirus task force, said faith leaders should be in touch with local health departments and can take steps to mitigate risks, including making sure those who are at high risk of severe complications remain protected.

“There's a way for us to work together to have social distancing and safety for people so we decrease the amount of exposure that anyone would have to an asymptomatic," she said.

A person familiar with the White House's thinking who spoke on condition of anonymity to discuss internal deliberations said Trump had called the news conference, which had not been on his public schedule, because he wanted to be the face of church reopenings, knowing how well it would play with his political base.

Churches around the country have filed legal challenges opposing virus closures.

In Minnesota, after Democratic Gov. Tim Walz this week declined to lift restrictions on churches, Roman Catholic and some Lutheran leaders said they would defy his ban and resume worship services. They called the restrictions unconstitutional and unfair since restaurants, malls and bars were allowed limited reopening.

Some hailed the president's move, including Kelly Shackelford, president of the conservative First Liberty Institute.

“The discrimination that has been occurring against churches and houses of worship has been shocking," he said in a statement. "Americans are going to malls and restaurants. They need to be able to go to their houses of worship.” But Rabbi Jack Moline, president of Interfaith Alliance, said it was “completely irresponsible” for Trump to call for a mass reopening of houses of worship.

“Faith is essential and community is necessary; however, neither requires endangering the people who seek to participate in them,” he said.

“The virus does not discriminate between types of gatherings, and neither should the president." Rhode Island Gov. Gina Raimondo, a Democrat, made clear that churches and other houses of worship will not resume in-person services in her state until at least next weekend and said she was skeptical Trump had the authority to impose such a requirement.

“It's reckless to force them to reopen this weekend. They're not ready,” she said. “We've got a good plan. I'm going to stick with it.” New Hampshire Gov. Chris Sununu, a Republican, said he would review the federal guidance, while maintaining a decision rests with him.

"Obviously we'd love to get to the point where we can get those open, but we'll look at the guidance documents and try to make some decisions rather quickly, depending on what it might say,” he said. “It's the governor's decision, of course.”

The CDC more than a month ago sent the Trump administration documents the agency had drafted outlining specific steps various kinds of organizations, including houses of worship, could follow as they worked to reopen safely.

But the White House dragged its feet, concerned that the recommendations were too specific and could give the impression the administration was interfering in church operations.

The guidance posted Friday contains most of the same advice as the draft guidance. It calls for the use of face coverings and recommends keeping worshippers 6 feet from one another and cutting down on singing, which can spread aerosolized drops that carry the virus.

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."

May 20: The novel coronavirus is behaving differently in patients in northeast China who have contracted it recently compared with early cases, indicating it is changing as it spreads, a prominent doctor said.

China, which has largely brought the virus under control, has found new clusters of infections in the northeastern border provinces of Jilin and Heilongjiang in recent weeks, raising concern about a second wave.

Qiu Haibo, an expert in critical care medicine who is part of a National Health Commission expert group, said the incubation period of the virus in patients in the northeast was longer than that of patients in Wuhan, the central city, where the virus emerged late last year.

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"This causes a problem, as they don't have any symptoms. So when they gather with their families they don't care about this issue and we see family cluster infections," Qiu told state broadcaster CCTV in a programme broadcast late on Tuesday.

Patients in the northeastern clusters were also carrying the virus for longer than earlier cases in Wuhan, and they were taking longer to recover, as defined by a negative nucleic acid test, he said.

Patients in the northeast also rarely exhibited fever and tended to suffer damage to the lungs rather than across multiple organs, he said.

He said the virus found in the northeastern clusters was probably imported from abroad, which could account for the differences.

He did not say where he though they might have come from but both Jilin and Heilongjiang border Russia.

China reported five new coronavirus cases on Wednesday, down from six a day earlier.

Four of the new cases were local transmissions and one was imported by a traveller coming from abroad, the commission said in a statement, compared with three imported cases reported the previous day.

China's total number of coronavirus infections stands at 82,965, while the death toll 4,634.