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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.

The Ministry of Health and Family Welfare has prepared a draft for guidelines for home quarantine, as well as for the use of masks by public, in view of coronavirus.

What to do in Home Quarantine?

The government says, for those taking refuge to home quarantine should stay in a well-ventilated single-room preferably with an attached or separate toilet. It adds that if another family member needs to stay in the same room, it's advisable to maintain a distance of at least 1 metre between the two.

The government advised, coronavirus patients to stay away from elderly people, pregnant women, children and persons with co-morbidities within the household as their immune system may be low. The health minister also suggested to restrict the patient's movement within the house. "Under no circumstances attend any social/religious gathering e.g. wedding, condolences, etc, said the guideline.

It also instructed the corona virus infected person to avoid sharing household items like dishes, drinking glasses, cups, eating utensils, towels, bedding, or other items with others at home. The guideline also demanded that even though home quarantine, the patient should wear a surgical mask at all times. "The mask should be changed every 6-8 hours and disposed off. Disposable masks are never to be reused, it added.

"Masks used by patients/ caregivers/ close contacts during home care should be disinfected using ordinary bleach solution (5 per cent) or sodium hypochlorite solution (1%) and then disposed of either by burning or deep burial," instructs the government.

Even for family members of a patient, the health ministry clearly instructs to use disposable gloves when cleaning the surfaces or handling soiled linen. No visitors, under any circumstances will be allowed, said the guideline.

"In case the person being quarantined becomes symptomatic, all his close contacts will be home quarantined (for 14 days) and followed up for an additional 14 days or till the report of such case turns out negative on lab testing," states the draft.

How to wear & dump masks?

There is a specific and elaborate do's and don'ts also released by the ministry. For those unsure in which mask to choose, it says, "Medical masks of different sizes and shapes are available in the market. The common ones are flat pleated masks of woven fabric which covers the nose and mouth and affixed behind the head with straps/ elastic fasteners. There are also conical or duck bill shaped masks with valves (or without valves) that fit in the contour of face over the nose and mouth, but are costlier."

However, the ministry warns, medical masks should not be used by healthy persons who are not having any symptoms "because it creates a false sense of security". Instead, it suggests to refrain from touching face, mouth, nose and eyes as well as washing hands regularly with soap for 20 seconds each time.

However, when a person develops a cough or fever, the suspected patient needs to switch to medical masks. "Use of medical three layer masks when ill, will prevent your infection from spreading to others. However you also need to wash your hands frequently to avoid spreading infection to others," read the guideline.

Even if one is not tested positive but showing symptoms, they are advised to wear masks while visiting a healthcare facility. "Close family contacts of such suspect/confirmed cases undergoing home care should also use Triple layer medical mask," it warns.

The ministry has also given point by point guideline on how to use a mask like to make sure that they are facing down while unfolding or for that matter to ensure there are no gaps on either side of the mask.

It even warns, "Fit flexible nose piece (a metallic strip that can easily be located) over nose-bridge" to ensure no one else are infected. The government also warns against simple dumping of the masks once used. Instead one should disinfect "using ordinary bleach solution (5 per cent) or sodium hypochlorite solution (1 per cent) and then disposed of either by burning or deep burial," says the Health Ministry.

COVID-19 emerged in early December 2019 in China's Wuhan province and has now spread to over 100 countries. As on March 9, 2020, India has reported 42 cases mostly among those who had travelled from affected countries.

However the government says, "It causes a minor illness in majority of patients with symptoms of fever and or cough. A small proportion of such persons may progress to severe disease with difficulty in breathing."

Washington, Feb 21: Days ahead of his India visit, US President Donald Trump on Thursday said the two countries could make a "tremendous" trade deal.

"We're going to India, and we may make a tremendous deal there," Trump said in his commencement address at the Hope for Prisoners Graduation Ceremony in Las Vegas.

Trump, accompanied by First Lady Melania Trump, is scheduled to travel to Ahmedabad, Agra and New Delhi on February 24 and 25.

Ahead of the visit, there have been talks about India and the United States agreeing on a trade package as a precursor to a major trade deal.

During his commencement address, Trump indicated that the talks on this might slowdown if he did not get a good deal.

"Maybe we'll slow down. We'll do it after the election. I think that could happen too. So, we'll see what happens," he said.

"But we're only making deals if they're good deals because we're putting America first. Whether people like it or not, we're putting America first," Trump said.

Bilateral India-US trade in goods and services is about three per cent of the US' world trade.

In a recent report, the Congressional Research Service (CRS) said the trading relationship is more consequential for India -- in 2018 the United States was its second largest goods export market (16.0 per cent share) after the European Union (EU, 17.8 per cent), and third largest goods import supplier (6.3 per cent) after China (14.6 per cent) and the EU 28 (10.2 per cent).

"The Trump Administration takes issue with the US trade deficit with India, and has criticised India for a range of 'unfair' trading practices," the CRS said.

"Indian Prime Minister Modi's first term fell short of many observers' expectations, as India did not move forward with anticipated market opening reforms, and instead increased tariffs and trade restrictions," it said.

"Modi's strong electoral mandate may embolden the Indian government to press ahead with its reform agenda with greater vigour. Slowing economic growth in India raises concerns about its business environment," CRS said.

As per a fact sheet issued by the Council on Foreign Relations (CFR), trade in goods and services between the two countries from 1999 to 2018 surged from $16 billion to $142 billion.

India is now the United States' eighth-largest trading partner in goods and services and is among the world's largest economies.

India's trade with the United States now resembles, in terms of volume, the US' trade with South Korea ($167 billion in 2018) or France ($129 billion), said Alyssa Ayres from CFR.

"The United States for two years now has set out in stone pretty clearly the things that they wanted to see to try to get an agreement, and it's basically then on India's doorstep on whether they want to take those steps," Rick Rossow, Wadhwani Chair in US-India Policy Studies at the Center for Strategic and International Studies think-tank told reporters during a conference call.

"The list of US asks has been pretty static all throughout. Not to say that any of these things are easy for India to do, but the United States to my knowledge didn't change the goalposts just because we now consider India to be a middle-income country. The things that we wanted to see happen to get this trade agreement have been pretty static all throughout, no matter how difficult they are," he said in response to a question.