Why the US is experiencing a coronavirus plateau

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.

Tehran, Jun 29: Iran has issued an arrest warrant and asked Interpol for help in detaining President Donald Trump and dozens of others it believes carried out the drone strike that killed a top Iranian general in Baghdad, a local prosecutor reportedly said Monday.

While Trump faces no danger of arrest, the charges underscore the heightened tensions between Iran and the United States since Trump unilaterally withdrew America from Tehran’s nuclear deal with world powers.

Tehran prosecutor Ali Alqasimehr said Trump and more than 30 others whom Iran accuses of involvement in the Jan. 3 strike that killed Gen. Qassem Soleimani in Baghdad face “murder and terrorism charges,” the semiofficial ISNA news agency reported.

Alqasimehr did not identify anyone else sought other than Trump, but stressed that Iran would continue to pursue his prosecution even after his presidency ends.

Interpol, based in Lyon, France, did not immediately respond to a request for comment.

Alqasimehr also was quoted as saying that Iran requested a “red notice” be put out for Trump and the others, which represents the highest level arrest request issued by Interpol. Local authorities end up making the arrests on behalf of the country that request it. The notices cannot force countries to arrest or extradite suspects, but can put government leaders on the spot and limit suspects’ travel.

After receiving a request, Interpol meets by committee and discusses whether or not to share the information with its member states. Interpol has no requirement for making any of the notices public, though some do get published on its website.

It is unlikely Interpol would grant Iran’s request as its guideline for notices forbids it from “undertaking any intervention or activities of a political” nature.

The U.S. killed Soleimani, who oversaw the Revolutionary Guard’s expeditionary Quds Force, and others in the January strike near Baghdad International Airport. It came after months of incidents raising tensions between the two countries and ultimately saw Iran retaliate with a ballistic missile strike targeting American troops in Iraq.

Wuhan, Feb 9: President Xi Jinping strode onstage before an adoring audience in the Great Hall of the People in Beijing less than three weeks ago, trumpeting his successes in steering China through a tumultuous year and promising "landmark" progress in 2020.

"Every single Chinese person, every member of the Chinese nation, should feel proud to live in this great era," he declared to applause on the day before the Lunar New Year holiday. "Our progress will not be halted by any storms and tempests."

Xi made no mention of a dangerous new coronavirus that had already taken tenacious hold in the country. As he spoke, the government was locking down Wuhan, a city of 11 million people, in a frantic attempt to stop the virus spreading from its epicenter.

The coronavirus epidemic, which has killed more than 800 people in China as of Sunday and sickened tens of thousands, comes as Xi has struggled with a host of other challenges: a slowing economy, huge protests in Hong Kong, an election in Taiwan that rebuffed Beijing and a protracted trade war with the United States.

Now Xi faces an accelerating health crisis that is also a political one: a profound test of the authoritarian system he has built around himself over the past seven years. As the Chinese government struggles to contain the virus amid rising public discontent with its performance, the changes that Xi has ushered in could make it difficult for him to escape blame.

"It’s a big shock to the legitimacy of the ruling party. I think it could be only second to the June 4 incident of 1989. It’s that big," said Rong Jian, a writer about politics in Beijing, referring to the armed crackdown on Tiananmen Square protesters that year.

"There’s no doubt about his control over power," he added, "but the manner of control and its consequences have hurt his legitimacy and reputation."

Xi himself has recognized what is at stake, calling the outbreak "a major test of China’s system and capacity for governance."

Yet as China’s battle with the coronavirus intensified, Xi put the country’s No. 2 leader, Li Keqiang, in charge of a leadership group handling the emergency, effectively turning him into the public face of the government’s response. It was Li Keqiang who traveled to Wuhan to visit doctors.

Xi, by contrast, receded from public view for several days. That was not without precedent, though it stood out in this crisis, after previous Chinese leaders had used times of disaster to try to show a more common touch. State television and newspapers almost always lead with fawning coverage of Xi’s every move.

That retreat from the spotlight, some analysts said, signaled an effort by Xi to insulate himself from a campaign that may falter and draw public ire. Yet Xi has consolidated power, sidelining or eliminating rivals, so there are few people left to blame when something goes wrong.

"Politically, I think he is discovering that having total dictatorial power has a downside, which is that when things go wrong or have a high risk of going wrong, then you also have to bear all the responsibility," said Victor Shih, an associate professor at the University of California San Diego who studies Chinese politics.

Much of the country’s population has been told to stay at home, factories remain closed, and airlines have cut service. Experts warn that the coronavirus could slam the economy if not swiftly contained.

The government is also having trouble controlling the narrative. Xi now faces unusually sharp public discontent that even China’s rigorous censorship apparatus has been unable to stifle entirely.

The death of an ophthalmologist in Wuhan, Dr. Li Wenliang, who was censured for warning his medical school classmates of the spread of a dangerous new disease in December, has unleashed a torrent of pent-up public grief and rage over the government’s handling of the crisis. Chinese academics have launched at least two petitions in the wake of Li’s death, each calling for freedom of speech.

State media still portray Xi as ultimately in control, and there’s no sign that he faces a serious challenge from within the party leadership. The crisis, though, has already tainted China’s image as an emerging superpower — efficient, stable and strong — that could eventually rival the United States.

How much the crisis might erode Xi’s political standing remains to be seen, but it could weaken his position in the long run as he prepares to take a likely third term as Communist Party general secretary in 2022.

In 2018, Xi won approval to remove the constitutional limits on his term as the country’s president, making his plan for another five-year term seem all but certain.

If Xi comes out of this crisis politically insecure, the consequences are unpredictable. He may become more open to compromise within the party elite. Or he may double down on the imperious ways that have made him China’s most powerful leader in generations.

"Xi’s grip on power is not light," said Jude Blanchette, the Freeman Chair in China Studies at the Center for Strategic and International Studies.

"While the ham-fisted response to this crisis undoubtedly adds a further blemish to Xi’s tenure in office," Blanchette added, "the logistics of organizing a leadership challenge against him remain formidable."

In recent days, despite a dearth of public appearances, state media have portrayed Xi as a tireless commander-in-chief. This week they began calling the government’s fight against the virus the "people’s war," a phrase used in the official readout of Xi’s telephone call with President Donald Trump on Friday.

There are increasing signs that the propaganda this time is proving less than persuasive.

The Lunar New Year reception in Beijing where Xi spoke became a source of popular anger, a symbol of a government slow to respond to the suffering in Wuhan. Xi and other leaders appear to have been caught off guard by the ferocity of the epidemic.

Senior officials would almost certainly have been informed of the emerging crisis by the time national health authorities told the World Health Organization on Dec. 31, but neither Xi nor other officials in Beijing informed the public.

Xi’s first acknowledgment of the epidemic came Jan. 20, when brief instructions were issued under his name. His first public appearance after the lockdown of Wuhan on Jan. 23 came two days later, when he presided over a meeting of the Communist Party’s top body, the Politburo Standing Committee, which was shown at length on Chinese television. "We’re sure to be able to win in this battle," he proclaimed.

Back then, the death toll was 106. As it rose, Xi allowed other officials to take on more visible roles. Xi’s only appearances have been meeting foreign visitors in the Great Hall of the People or presiding over Communist Party meetings.

On Jan. 28, Xi met with the executive director of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus, and told Tedros that he "personally directed" the government’s response. Later reports in state media omitted the phrase, saying instead that Xi’s government was "collectively directing" the response.

Since nothing about how Xi is portrayed in state media happens by accident, the tweak suggested a deliberate effort to emphasize shared responsibility.

Xi did not appear on official broadcasts again for a week — until a highly scripted meeting Wednesday with the authoritarian leader of Cambodia, Hun Sen.

There is little evidence that Xi has given up power behind the scenes. Li Keqiang, the premier in formal charge of the leadership group for the crisis, and other officials have said that they take their orders from Xi. The group is filled with officials who work closely under Xi, and its directives emphasize his authority.

"The way the epidemic is being handled now from the top just doesn’t fit with the argument that there’s been a clear shift toward more collective, consultative leadership," said Holly Snape, a British Academy Fellow at the University of Glasgow who studies Chinese politics.

The scale of discontent and the potential challenges for Xi could be measured by repeated references online to the nuclear accident at Chernobyl. Many of them came under the guise of viewer reviews of the popular television miniseries of the same name, which is still available for streaming inside China.

"In any era, any country, it’s the same. Cover everything up," one reviewer wrote.

The Soviet Union of 1986, however, was a different country than China in 2020.

The Soviet state was foundering when Chernobyl happened, said Sergey Radchenko, a professor of international relations at Cardiff University in Wales who has written extensively on Soviet and Chinese politics.

"The Chinese authorities, by contrast, are demonstrating an ability to cope, a willingness to take unprecedented measures — logistical feats that may actually increase the regime’s legitimacy," he added.

Radchenko compared Xi’s actions to those of previous leaders in moments of crisis: Mao Zedong after the Cultural Revolution or Deng Xiaoping after the Tiananmen Square crackdown.

"He’s doing what Mao and Deng would have done in similar circumstances: stepping back into the shadows while remaining firmly in charge."