Judges hammer attorneys on both sides of travel ban case

Beijing/Zurich, Mar 4: China has approved the use of Swiss drugmaker Roche's anti-inflammation drug Actemra for patients who develop severe complications from the coronavirus as it urgently hunts for new ways to combat the deadly infection that is spreading worldwide.

China is hoping that some older drugs could stop severe cytokine release syndrome (CRS), or cytokine storms, an overreaction of the immune system which is considered a major factor behind catastrophic organ failure and death in some coronavirus patients.

Actemra, a biologic drug approved in 2010 in the United States for rheumatoid arthritis (RA), inhibits high Interleukin 6 (IL-6) protein levels that drive some inflammatory diseases.

China's National Health Commission said in treatment guidelines published online on Wednesday that Actemra can now be used to treat coronavirus patients with serious lung damage and high IL-6 levels.

Separately, researchers in the country are testing Actemra, known generically as tocilizumab, in a clinical trial expected to include 188 coronavirus patients and running until May 10.

Roche, which donated 14 million yuan ($2.02 million) worth of Actemra during February, said the trial was initiated independently by a third party with the aim of exploring the efficacy and safety of the drug in coronavirus patients with CRS.

It added that there was currently no published clinical trial data on the drug's safety or efficacy against the virus.

More than 3,000 people have died and 93,000 have been infected by the novel coronavirus thought to have originated in Wuhan, China, before spreading to around 90 countries including the United States, Italy, Switzerland, France and Germany.

The Swiss company, for which China is its No. 2 market behind the United States, also makes diagnostic gear to detect the coronavirus.

Since Actemra's approval a decade ago, it has become a go-to drug against other inflammatory conditions, including cytokine storms in cancer patients receiving cell therapies from Novartis and Gilead Sciences.

In 2012 it helped save the life of a young U.S. girl, the first child to be treated for leukaemia with Novatis' Kymriah, from a post-treatment rush of IL-6.

Priced at between $20-30,000 annually for RA according to SSR Health, Roche's medicine is also used for rare juvenile arthritis and giant cell arteritis, or inflammation of the blood vessels.

Washington, May 27: Most viruses and other germs do not spread easily on flights, the US Center for Disease Control and Prevention has said in its COVID-19 guidelines which do not recommend following social distancing between two passengers inside a plane or keeping the middle seat unoccupied.

As a result of coronavirus pandemic, air traffic inside the US has come to a near halt. Air traffic is said to be down to about 90 per cent. For all travellers coming from overseas, the Center for Disease Control and Prevention (CDC) has recommended 14 days quarantine.

"Most viruses and other germs do not spread easily on flights because of how air circulates and is filtered on aeroplanes," the CDC has said in its set of COVID-19 guidelines for air travellers.

However, it noted that the air travellers were not risk-free especially in the time of the coronavirus pandemic and recommended Americans to avoid travel as far as possible.

"Air travel requires spending time in security lines and airport terminals, which can bring you in close contact with other people and frequently touched surfaces," it said.

"Social distancing is difficult on crowded flights, and you may have to sit near others (within six feet), sometimes for hours. This may increase your risk for exposure to the virus that causes COVID-19," the CDC said.

But instead of recommended social distancing inside commercial planes, the CDC has advised a series of preventive and hygienic measures to be taken by the airlines pilot and crew to prevent the spread of coronavirus.

The US Department of Transportation and Federal Aviation Administration in its latest safety alerts for operators on May 11 said that air carriers and crews conducting flight operations having a nexus to the US, including both domestic and foreign air carriers, should follow CDC's occupational health and safety guidance.

The CDC issued its guidelines in first guidelines for the airlines and airline crew on March and again in May.

The CDC, which has issued an exhaustive social guideline measures in various sections, is silent on keeping the middle seat of a plane unoccupied so as to maintain the six feet distance between two passengers.

It calls for the plane crew to report to the CDC a traveller with specific COVID-19 symptoms like fever, persistent cough, difficulty in breathing and appearing unwell.

Asking the airlines and cabin crew to review infection control guidelines for cabin crew, the CDC recommends several measures for cabin crew to protect themselves and others, manage a sick traveller, clean contaminated areas, and take actions after a flight.

Prominent among them include washing hands often with soap and water for at least 20 seconds, particularly after assisting sick travellers or touching potentially contaminated body fluids or surfaces and use of alcohol-based hand sanitizer (containing at least 60 per cent alcohol) if soap and water are not available.

Airlines should consider providing alcohol-based hand sanitizer to cabin and flight crews for their personal use, it said.

The CDC guidelines do not recommend following social distancing inside a plane between two passengers or keeping the middle seat unoccupied. But it asks to minimise contact between passengers and cabin crew and the sick person.

"If possible, separate the sick person from others (by a distance of 2 meters or 6 feet, ideally) and designate one crew member to serve the sick person. Offer a facemask, if available and if the sick person can tolerate it. If a facemask is not available or cannot be tolerated, ask the sick person to cover their mouth and nose with tissues when coughing or sneezing," said the CDC guidelines.

If no symptomatic passengers were identified during or immediately after the flight, the CDC recommends airlines to follow routine operating procedures for cleaning aircraft, managing solid waste, and wearing PPE.

"If symptomatic passengers are identified during or immediately after the flight, routine cleaning procedures should be followed, and enhanced cleaning procedures should also be used," it said.

Clean porous (soft) surfaces (e.g, cloth seats, cloth seat belts) at the seat of the symptomatic passengers and within 6 feet of the symptomatic passengers in all directions, it added.

Jun 9: The World Health Organization says it still believes the spread of the coronavirus from people without symptoms is “rare,” despite warnings from numerous experts worldwide that such transmission is more frequent and likely explains why the pandemic has been so hard to contain.

Maria Van Kerkhove, WHO''s technical lead on COVID-19 said at a press briefing on Monday that many countries are reporting cases of spread from people who are asymptomatic, or those with no clinical symptoms.

But when questioned in more detail about these cases, Van Kerkhove said many of them turn out to have mild disease, or unusual symptoms.

Although health officials in countries including Britain, the U.S. and elsewhere have warned that COVID-19 is spreading from people without symptoms, WHO has maintained that this type of spread is not a driver of the pandemic and is probably accounts for about 6 per cent of spread, at most.

Numerous studies have suggested that the virus is spreading from people without symptoms, but many of those are either anecdotal reports or based on modeling.

Van Kerkhove said that based on data from countries, when people with no symptoms of COVID-19 are tracked over a long period to see if they spread the disease, there are very few cases of spread.

“We are constantly looking at this data and we''re trying to get more information from countries to truly answer this question,” she said. “It still appears to be rare that asymptomatic individuals actually transmit onward.”