World War II bomb removed from airport in Japan

Washington, Mar 27: The United States has seen a record 18,000 new confirmed coronavirus cases and 345 deaths over the past 24 hours, according to a Johns Hopkins University tracker.

There are now 97,028 declared virus cases in the country and there have been 1,475 deaths, Johns Hopkins said.

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."

Beijing, Apr 17: China denied Friday it had covered up the extent of its coronavirus outbreak, as it responded to growing questions from Western powers led by the United States.

A foreign ministry spokesman acknowledged that the virus's rapid spread had contributed to undercounting that resulted in China raising its death toll earlier Friday, but he added "there has never been any concealment, and we'll never allow any concealment."

The allegations China is too close to the World Health Organization (WHO), were an attempt at "smearing" Beijing, Zhao said.

US President Donald Trump has questioned China's handling of the pandemic and whether it had been completely transparent since the virus emerged in the central city of Wuhan late last year.

On Thursday, British Foreign Secretary Dominic Raab and French President Emmanuel Macron also expressed doubts about China's virus response.

These doubts were spotlighted again on Friday when authorities in Wuhan, which has borne the brunt of Chinese deaths, abruptly raised its death toll by 50 percent -- or 1,290 deaths -- to a new total of 3,869.

That also pushed the nationwide death toll up sharply to 4,632, based on official national data released earlier in the day.

Wuhan authorities cited several reasons for the missed cases, including that the city's medical staff were overwhelmed in the early days as infections climbed, leading to "late reporting, omissions or mis-reporting".

Zhao said such miscounting was to be expected in the initial stages of a major disease outbreak.

US President Donald Trump -- under fire himself for initially denying the seriousness of the pandemic -- has accused the WHO of doing the same and being too trusting of China's assurances over the outbreak.

On Tuesday he announced a suspension of US funding to the world body.

Asked about the US allegations, Zhao defended the WHO and China.

"I think they are all smearing China and cooking up stories about China," he said, without specifying which countries he was referring to.

China has largely brought the contagion under control domestically via tough measures including the unprecedented lockdown of Wuhan and tens of millions of people in surrounding areas, but not before it spread worldwide.