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New Delhi, May 26: With India now in the bracket of top 10 nations worst hit by the novel coronavirus, experts have attributed the surge in cases to easing of travel restrictions and movement of migrants besides enhanced testing capacity.

According to AIIMS Director, Randeep Guleria, the present rise in cases has been reported predominantly from hotspot areas but there is a possibility of further rise in the number of COVID-19 cases in the coming few days due to increased travel.

"Those who are asymptomatic or are in presymptomatic stage will pass through screening mechanisms and may reach areas where there have been minimal or less cases," Guleria said.

He said there was a need for more intense surveillance and monitoring in areas where migrants have returned to contain the spread of the disease.

If proper social distancing and hand hygiene is not maintained at a time when people are out on roads, the coronavirus infection will transmit much faster, he said.

Guleria also noted that testing capacity has been significantly ramped up which is reflecting in the increasing number of cases being detected.

Commenting on the partial resumption of rail and road transport services and migrants returning to their native places, Dr Chandrakant S Pandav, former president of the Indian Public Health Association and Indian Association of Preventive and social medicine, said the floodgates have been opened.

"This is a classic case of creating an enabling environment for coronavirus to spread like wildfire. In the coming few days, the number will rise dramatically. While it is true that lockdown cannot go on forever, the opening up should have been in a measured, calibrated and informed manner," he said.

"Travelling leads to spread of the infection. Now, the government will have to ensure even stronger surveillance to curb the infection but if that will be done is something to be observed," he said.

The death toll due to COVID-19 rose to 4,167 and the number of cases climbed to 1, 45,380 in the country, registering an increase of 146 deaths and 6,535 cases since Monday 8 am, according to the Union Health Ministry.

Dr K K Aggarwal, President of the Confederation of Medical Association of Asia and Oceania (CMAAO), and former IMA President, said there will be a further surge in cases in the coming days if migration continues without any proper social distancing.

"Within the next ten days, the cases will cross two lakh. The very fact that number of cases was rising before the end of the third lockdown and continuing during the fourth lockdown means that people are not following physical distancing as required," he said.

"Even in the last week of May when the temperature is very high, the rising number of cases would mean that human-to-human transmission is more important than surface-to-human transmission. Normally in heat the surface-to-human transmission should have reduced the new cases by half which has not happened," Aggarwal said.

However, Professor K Srinath Reddy, president of the Public Health Foundation of India, said an increase in the number of cases reflects both an increase in testing rates and an increase in spread.

"What we need to see is the number of new tests performed per day and the number of new cases that were identified from them. That gives a better idea of the rate of spread than the total number of new cases alone.

"We also have to see if the testing criteria has remained the same between the two periods of comparison.We may open up gradually but will have to continue case detection, contact tracing and follow personal protection measures as vigorously as possible," he added.

A total of 31,26,119 samples have been tested as on May 26, 9 am and 92,528 samples have been tested in the last 24 hours, ICMR officials said.

India is the tenth most affected nation by the pandemic after the US, Russia, UK, Spain, Italy, Brazil, Germany, Turkey and France, as per the John Hopkins University data.

The country has recorded 6,088, 6,654, 6,767 and 6977 cases on May 22, 23, 24 and 25 respectively. Also, the number of RT-PCR tests for detection of COVID-19 in the country crossed the 30-lakh mark on Monday.

The first two phases of the lockdown led to 14-29 lakh COVID-19 cases being averted, while the number of lives saved in that period was between 37,000 and 78,000, the government said last Friday, citing various studies, and asserted that the unprecedented shutdown has paid "rich dividends" in the fight against the pandemic.

Seoul, Jun 24: North Korea on Wednesday said leader Kim Jong Un suspended a planned military retaliation against South Korea, possibly slowing the pressure campaign it has waged against its rival amid stalled nuclear negotiations with the Trump administration.

Last week, the North had declared relations with the South as fully ruptured, destroyed an inter-Korean liaison office in its territory and threatened unspecified military action to censure Seoul for a lack of progress in bilateral cooperation and for activists floating anti-Pyongyang leaflets across the border.

Analysts say North Korea, after weeks deliberately raising tensions, may be pulling away just enough to make room for South Korean concessions.

Pyongyang's official Korean Central News Agency said Kim presided by video conference over a meeting Tuesday of the ruling Workers' Party's Central Military Commission, which decided to postpone plans for military action against the South brought up by the North's military leaders.

KCNA didn't specify why the decision was made. It said other discussions included bolstering the country's "war deterrent".

Yoh Sang-key, spokesman of South Korea's Unification Ministry, said Seoul was "closely reviewing" the North's report but didn't further elaborate.

Yoh also said it was the first report in state media of Kim holding a video conferencing meeting, but he didn't provide a specific answer when asked whether that would have something to do with the coronavirus.

The North says there hasn't been a single COVID-19 case on its territory, but the claim is questioned by outside experts.

Kim Dong-yub, an analyst from Seoul's Institute for Far Eastern Studies, said it's likely that the North is waiting for further action from the South to salvage ties from what it sees as a position of strength, rather than softening its stance on its rival.

"What's clear is that the North said (the military action) was postponed, not cancelled," said Kim, a former South Korean military official who participated in inter-Korean military negotiations.

Other experts say the North would be seeking something major from the South, possibly a commitment to resume operations at a shuttered joint factory park in Kaesong, which was where the liaison office was located, or restart South Korean tours to the North's Diamond Mountain resort.

Those steps are prohibited by the international sanctions against the North over its nuclear weapons programme.

The public face of the North's recent bashing of the South has been Kim Yo Jong, the powerful sister of leader Kim Jong Un, who has been confirmed as his top official on inter-Korean affairs.

Issuing harsh statements through state media, she had said the North's demolishing of the liaison office would be just the first in a series of retaliatory action against the enemy South and that she would leave it to the North's military to come up with the next steps.

The General Staff of the North's military has said it would send troops to the mothballed inter-Korean cooperation sites in Kaesong and Diamond Mountain and restart military drills in frontline areas.

Such steps would nullify a set of deals the Koreas reached during a flurry of diplomacy in 2018 that prohibited them from taking hostile action against each other.

Also condemning the South over North Korean refugees floating anti-Pyongyang leaflets across the border, the North said Monday it printed 12 million of its own propaganda leaflets to be dropped over the South in what would be its largest ever anti-Seoul leafleting campaign.

It wasn't immediately clear whether Kim's decision to hold back military action would affect the country's plans for leafleting. The North's military had said it would open border areas on land and sea and provide protection for civilians involved in the leafleting campaigns.

The North has a history of dialling up pressure against the South when it fails to get what it wants from the United States. The North's recent steps came after months of frustration over Seoul's unwillingness to defy US-led sanctions and restart the inter-Korean economic projects that would breathe life into its broken economy.

Nuclear negotiations between Pyongyang and Washington largely stalled after Kim's second summit with President Donald Trump last year in Vietnam, where the Americans rejected North Korea's demands for major sanctions relief in exchange for a partial surrender of its nuclear capabilities.

Washington, Jun 9: When epidemiologists talked about "flattening the curve," they probably didn't mean it this way: the US hit its peak coronavirus caseload in April, but since that time the graph has been on a seemingly unending plateau.

That's unlike several other hard-hit countries which have successfully pushed down their numbers of new cases, including Spain and Italy, which now have bell-shaped curves.

Experts say the prolonged nature of the US epidemic is the result of the cumulative impact of regional outbreaks, as the virus that started out primarily on the coasts and in major cities moves inward.

Layered on top of that are the effects of lifting lockdowns in parts of the country that are experiencing rising cases, as well as a lapse in compliance with social distancing guidelines because of economic hardship, and in some cases a belief that the threat is overstated.

"The US is a large country both in geography and population, and the virus is at very different stages in different parts of the country," Tom Frieden, a former director of the Centers for Disease Control and Prevention told AFP.

The US saw more than 35,000 new cases for several days in April. While that figure has declined, it has still been exceeding 20,000 regularly in recent days.

By contrast, Italy was regularly hitting more than 5,000 cases per day in March but is currently experiencing figures in the low hundreds.

"We did not act quickly and robustly enough to stop the virus spreading initially, and data indicate that it travelled from initial hotspots along major transport routes into other urban and rural areas," added Frieden, now CEO of the non-profit Resolve to Save Lives.

To wit: the East Coast states of New York, New Jersey and Massachusetts accounted for about 50 percent of all cases until about a month or so ago -- but now the geographic footprint of the US epidemic has shifted to the Midwest and southeast, including Florida.

Another key problem, said Jennifer Nuzzo, an epidemiologist at Johns Hopkins, is that the United States is still not doing enough testing, contact tracing and isolation.

After coming late to the testing party -- for reasons ranging from technical issues to regulatory hurdles -- the US has now conducted more COVID-19 tests than any other country.

It even has one of the highest per capita rates per country of 62 per 1,000 people, according to the website ourworldindata.org -- better than Germany (52 per 1,000) and South Korea (20 per 1,000).

But according to Nuzzo, these numbers are misleading, because "the amount of testing that a country should do should be scaled to the size of its epidemic.

"The United States has the largest epidemic in the world so obviously we need to do a lot more testing than any other country."

For Johns Hopkins, the more important metric is the positivity rate -- that is, out of all tests conducted, how many came back positive for COVID-19.

As of June 7, the United States had an average daily positivity rate of 14 percent, well above the World Health Organization guideline of 5 percent over two weeks before social distancing guidelines should be relaxed.

By contrast, Germany, which has tested far fewer people in relation to its population, has a positivity rate of 5 percent.

Even if testing were scaled up, carrying out tests in of itself does very little good without the next steps -- finding out who was exposed and then asking them to isolate.

Here also, too many US states are lagging woefully behind.

Texas, which is experiencing a surge in cases after relaxing its lockdown, is a case in point. The state targeted hiring a modest 4,000 tracers by June, but according to local reports is still more than a thousand shy of even that goal.

Opt-in app based efforts have also been slow to get off the ground.

Then there is the fact that some people are growing tired of lockdowns, while others don't have the economic luxury of being able to stay home for prolonged periods.

The government sent some 160 million Americans a single stimulus check of up to $1,200 back in April but it's not clear whether more will be forthcoming.

Still others, particularly in so-called red states under Republican leadership, have chafed under restrictions and mask-wearing guidelines that they see as an affront to their personal freedom.

"The US is kind of on the extreme of the individual liberty side," Sten Vermund, dean of the Yale School of Public Health, told AFP.

Part of this has to do with mixed messaging from Republican leaders, including President Donald Trump, said Nuzzo.

"We have had at the highest political level an assertion that this is a situation that's been overblown, and that maybe certain protective behaviors are not necessary," she said.

More recently, tens of thousands of people across the country have taken to the streets to protest the killing on an unarmed black man by police, risking coronavirus infection to demonstrate against the public health threat of racialized state violence.