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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.

New Delhi, Jun 25: The Supreme Court on Thursday asked the Centre and the CBSE to issue fresh notification in connection with Class 12 exams, clarifying the option between internal assessment and exams later.

The observation from the top court after it was informed that the CBSE has decided to cancel the remaining board exams for Class 10 and Class 12.

A bench comprising Justices AM Khanwilkar, Dinesh Maheshwari and Sanjiv Khanna asked the Centre to clarify the issue of taking the option between internal assessment and exams later.

"Clarify the date of results," said the bench, noting that the CBSE will have to submit a fresh draft notification cancelling class 12 Board exams and affidavit on Friday morning, before the top court continues to hear the matter again at 10.30 a.m.

The apex court also sought clarity on the beginning of the new academic year.

It told Solicitor General Tushar Mehta, representing the Centre, that the CBSE is willing to conduct exams when the situation is conducive, but this may vary from state to state. "Will the decision be taken by a central authority or will the state government take the decision? How are you going to deal with that situation?"

Mehta replied that the decision must be taken according to the situation. To this, the bench said should not the solution be pan-India?

"You have not said when you will decide on this issue, and when you will take stock of these things. Some time frame will have to be given," noted the bench.

Continuing its queries, the bench said: "What about state regional board exams... the CBSE does not hold all the exams. The state Board is also there."

Mehta replied that the instructions from the controller of examinations are that exams are controlled centrally. "State boards assist the CBSE," he replied.

The bench observed that the government should modify the draft notification and include the state board issue. "Clear the stand that decision will be taken at the central level and not at the state level... other courses will have to be delayed till CBSE exam results come out," it said.

Mehta replied the assessment results will be published now, and if a student wants to opt to give the exam, then that will be conducted later. The top court asked Mehta to bring this on record and redraft the notification.

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.