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Italy's president Conte tells Italians to follow the rules for quarantine, and not to follow old habits of "furbizia" that were used mostly to overcome the bureaucracy by working around rules. The Lombardy region including Milan is now under quarantine for the coronavirus. Programs on television urge people not to mingle, and to stay at home. 

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Angela Merkel said that contact tracing was "above all else" in importance in tracking down infection chains. Apps would not work in Germany because tracking movements and recording information is a sensitive subject in Germany with its history of communism and fascism. Germany still did it but very early on adopted a low tech way that so far is working. Staff from provincial administrations have shifted to do contact tracing work as other work is slow or suspended. Volunteers also have taken up the work. Germany's goal is 5 contact tracers for every 25,000 people- or about 16,000 for a population of 83 million. All the contact tracers have is the phone and a central database of information on the desktop computer as shown here in this report in the Washington Post. There is no advanced technology or software.  Most important say experts is social skills - to talk to people in a way that makes them feel comfortable to share information about how they are and their contacts in a very informal friendly setting, that even includes some humor. Here a contact tracer in Reinikendorf describes the work she is doing and a typical day. There are about 75 contact tracers for 260,0000 people in her area. When she calls someone she notes down what contacts they have had and puts them in Category 1,  2 , or 3 depending on the need for quarantine. The calling is mainly about asking the contact about his or her movements. A contact for more than 15 minutes is Category 1, less than 15 minutes Category 2. The whole conversation is for 10 minutes. Then someone from the health department will call the person contacted everyday. Reickendorf began building up contact tracing in March after an outbreak in a kindergarten was too much for the usual number of health officials to handle. The German trace and quarantine approach, home grown, low tech,  and based on what resources are available, the most important thing being start immediately, has its flaws. Yet it has worked to limit infections and deaths.  In about 65% of cases health authorites have no idea how a person was infected. Asymptomatic carriers are not detected. In some area the resources are limited.  This effort has helped control the virus first cluster in Bavaria at a car part manufacturer. Sixteen people had tested positive and hundreds were quarantined. The German approach is that testing is fine but if you are in quarantine testing is not going to make a difference in spreading. Testing with a negative result is also not helping as it could be that its too early for the infection to register because of the incubation period. ...

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The problems Shanghai residents are facing during the covid lockdown in 2022. The experience of a 34 year old technology worker in Shanghai who is sent to a quarantine center in a 16 hour bus ride shows the difficulties people are facing in Shanghai, China. The zero covid policy is affecting the economy and the daily lives of people in China. In the US Democrats shifted away from strict covid protocols in 2021 after realizing that there were economic costs and costs for daily living of ordinary people, with lockdowns becoming less frequent in states such as Michigan, New York and California.

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The Centres for Disease Control agency in the U.S. was unprepared for this pandemic in the early period from January to March. This report in the NYT shows how the agency failed to respond effectively in the early days leading to the loss of lives now past 100,000. When travelers arrived at U.S. airports in February from China carrying the virus with them these flights were diverted to selected airports with CDC conducted screening but the screening proved to be defective. Health officils desperate to set up isolation and quarantine could not act because the information provided was not accurate and missed many details resulting in the inability to quarantine early and isolate clusters as other countries Germany and South Korea have done.

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The experience of Pintung county in Taiwan with a coronvirus outbreak is shown in The Guardian. Home quarantining of a couple from Peru leads to an outbreak. Community cooperation, a speedy response from local health authorities, testing and quarantining help to limit and control the outbreak. When it started this county on the coast, one of the poorest in the country, had limited health resources and no one was vaccinated. Most of the control response was through testing and quarantine, with vaccination assistance from the Taiwan government. Local people say strict quarantine is essential as the source of infections was from a couple who visited Peru and were allowed to home isolate. Taiwan government is now enforcing quarantine at hotels for all persons returning from overseas. WHO Emergencies program head, Dr Michael Ryan, says it is important to act quickly. He says "Be fast, have no regrets. You must be the first mover. The virus will always get you if you don't move quickly."  This happened in this Taiwan county as the local health authorites setup a soft lockdown of the two affected villages within 3 days of detecting the first case of Delta variant. This was announced over loudspeaker and food plus daily necessities were delivered to each household. A command centre was setup to take and coordinate the action daily. Taiwan authorites have enforced repeat testing and extended testing. ...

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China reports no new coronavirus infections for the first time on March 19. The outbreak in Italy now surpasses that in China.  The U.S. government is now shifting to social distancing as the most effective way to control the spread and away from focus on widespread testing as a containment tool. The experience in China shows social distancing works, quarantine works. Countries and regions that have neglected to do this early are the ones worst hit, including most of Europe.  The reintroduction of the infection after its containment is addressed by quarantine and social distancing and use of masks, government disinfecting hard surfaces in all public areas, a program implemented strictly in Asian countries such as Singapore, China, Taiwan, and other Asian countries. Use of masks was common in Asian countries in earlier episodes of SARS and other epidemics, making it widely used long before this crisis. This is making a significant impact in addition to social distancing and other quarantine measures taken in China.   ...

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This BBC report looks at how doctors, nurses, police, railway employees, and sanitation workers in India are tackling the job of preventing the spread of coronavirus as India goes into a complete lockdown. The lockdown and quarantine are intended to slow the epidemic for enough time to enable bringing it under control.

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The economic damage is larger in some states with a larger manufacturing base and one tending to be cyclical. 20% of Michigan's GDP is in auto manufacturing. The large jump in cases to 40,000 and 3600 deaths have led to stricter quarantine. The unemployment rate in Michigan is forecast at 23% much higher than the national average of 16% that peaks in May. It is also likely to last longer till early 2020. As a result of the strict quarantine  larger parts of retail, service and construction sectors are affected. This has led to protests in areas where the coronavirus threat is not as large as it is in Detroit.

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For the second time Sweden takes a laid back approach to the coronavirus during the second wave in November. Swedish prime minister Stefan Lofven is in quarantine after he went into self isolation, following someone in his circle having contact with someone having coronavirus. The government only issues recommendations but there are no required restrictions, no strict rules to follow.

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On the Matterhorn mountain at night the messages "Stay at Home,"  "Hope," and the Swiss flag are beamed on snowy slopes, as Switzerland enters the 11th day of quarantine. It is about working hard at following simple rules and staying at home, an appeal to Swiss people who believe in working hard and being sensible.

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Why the lessons of Wuhan have not been understood correctly says this WSJ report. Merely putting lockdowns is not enough, systematic testing and quarantining of the affected persons is needed for controlling the outbreak. The outbreak in Wuhan was controlled by sending affected persons to makeshift hospitals and temporary quarantine centers. Two hospitals were quickly setup in Wuhan in 2-3 days to isolate affected people from the rest.

It is slow but this is being done as New York sets up a makeshift mobile hospital with 1000 beds at the Jacob Javits Convention Centre. And London sets up 4000 beds at a conference centre in the city.

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This report in DW.com looks at the response of Germany to the coronavirus epidemic and says Germany may have let a window of opportunity to act quickly slip from its grasp. It says Germany's leader Merkel has not shown the leadership required by the health crisis. Germany DW.com points out recorded its first case on January 27, yet Merkel's first press conference on the subject of coronavirus came on March 11, when Italy was on lockdown quarantine for 2 days.  Germany lacks a quarantine and effective government action to mandate and require social distancing across the country to limit the spread. The steps this report points out pale in comparison with the actions taken in other neighboring countries. Spain earlier and Belgium on March 17th joined a lockdown in Italy. Merkel called on Germans to stay home, yet enforcement is lacking.  In this situation the calm and reacting with reason may be obsolete, a proactive approach being the right one. And a braver one because it would anticipate what happens a week two weeks from now based on experience of China and Italy, and act quickly with a lockdown and quarantine to prevent spread. Waiting in this manner risks too much says DW.com.  ...

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By lifting all covid restrictions China makes a dramatic U turn in December 2022 from its zero covid policies. This Guardian editorial looks at the implications of the new policy. Testing booths are being dismantled. Quarantine rules and travel restrictions are significantly relaxed. The primary covid tracking app is scrapped.  The turnaround is truly astonishing in its speed says The Guardian. Because older people are less vaccinated than in other countries and the smaller effectiveness of domestic vaccines this still has risks when it is being done so suddenly that the health system has little time to prepare.

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A big surge in travel to mainland China from Asian countries and business travel from the US and Europe. Chinese travel outside of China to Hong Kong and Europe is also surging. Travel from China to Japan will face quarantines as Japan says there is no clarity on covid situation in China. A surge in cases and overcrowded hospitals is also causing much anxiety along with relief from the fatigue of lockdowns.

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Lessons from an Italian family about staying fit and getting exercize during the lockdown within the home. The father is part of a running team in Rome. He has spent 18 days with his wife and teenage son at home already, as Italy remains in quarantine. He can't run the Rome marathon so he and his friends divide the 42 kilometres so that each person runs 1 kilometre at home. Other advice- plan your day carefully, stay in different rooms so its easier to spend a whole day, and the next day and the next together. do some hobbies, exercize to stay fit. 

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The commissioner of the Food and Drug Administration 2017-2019 and the deputy medical director of its medical device center, give their thoughts on how to setup a sentinel surveillance system that would help tackle coronavirus and future epidemics. The idea is to track an outbreak in real time, with results sent to central labs so that outbreaks can be contained early and the surveillance operates to isolate affected areas for treatment and quarantine. High quality data from specific locations in real time and testing to isolate small pockets of infection, with rapid and reliable diagnostic tools are critical parts of this system.

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The new approach to tackle the coronavirus is to quarantine areas where it starts. The approach is being adopted in China, Italy, the U.S., Japan and other countries. Another part of this is closing of schools as in Japan and Hong Kong. Experts support this approach even though it was used in the 14th century.

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The testing shortages in the states and the lack of enough cartridges provided by the U.S. government for Abbott Labs testing machines is causing much frustration, as shown here in the WSJ. Illinois one hotspot is an example. Illinois governor Pritzker says he spoke to Abbott Labs a week ago and thought he had an agreement to conduct 3000 tests a day. He then learned that the U.S. government was taking over the purchasing and distribution of the tests.  He  received 15 Abbott machines and 120 cartridges for all of Illinois which would enable 120 tests from the U.S. government. Abbott currently is making 50,000 test cartridges a day for the rapid test. Detroit which had better experience with the Abbott machines says it has conducted 1000 Abbott rapid tests, shortly after Abbott got approval on March 27. With the 1000 tests Detroit was able to test first responders and bus drivers in quarantine. Detroit recently purchased another 4000 additional tests from Abbott which it wants to use in nursing homes and homeless shelters, vulnerable populations in the city. The Abbott test provides result in 15 minutes making it very effective in implementing fast quarantine action when the virus is spreading quickly in a specific population.  Other governors say they are banging their head against a wall trying to get more tests. ...

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Delivering the mail by boat across Penobscot Bay, Maine in the northeast U.S. The mail has been delivered to six small and rugged islands here in Maine's coastal area by the same family since 1905. This could be the last year as Maine has a 14 day quarantine for visitors from outside. Maine has the largest median age in the country at 45. Known for its coastline it gets millions of visitors in the spring and summer months adding $6.5 billion to its economy. Depending on this tourism are thousands of small businesses. Coronavirus is changing the rhythm of life even here in a place which has known quieter rhythms.

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The U.S. bans travel from most of  Europe and India imposes quarantine on visitors and overseas citizens entering the country for 14 days. Countries around the world reacted quickly to the situation in Italy, France and Germany. The strict measures taken by China are gradually being adopted by other countries. Quarantine done early has worked limiting the spread of the coronavirus. Countries with strong public health systems are better positioned to weather the health crisis. Where strong action is taken early and in anticipation, with a strong public health response, there is better control over the spread. This comes with some economic cost as it has hit the Chinese economy, yet the rebound is likely to be that much quicker and done with more confidence. For instance air travel in China declined by 85% in February from a year earlier to 8.3 million journeys according to Chinese aviation officials. Moves to keep social interactions to a minimum have yielded results. Only food stores and pharmacies remain open in China till March 25.  ...

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Spain and Italy, the New York region, delayed their response, just as Japan and Sweden are doing today, resulting in the severity of the pandemic in these countries and regions. This pandemic is showing the earlier you act to lockdown, quarantine, use contact tracing and isolation of clusters method, the better it is with fewer people infected and fewer deaths. This is the single most important lesson of this crisis, which health experts worldwide, including Dr Birx, head of the White House Response, and Dr. Fauci, never get tired of repeating.

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It took a week longer for each country to impose a lockdown. In China first Wuhan then the whole country went into lockdown and quarantine. The same process is repeated in Europe and in America as authorites see numbers of infections increasing rapidly without strict controls. First the Lombardy region in Italy around Milan, then the provinces in Northern Italy, followed by a complete lockdown in the country on March 10 as infection spread faster without lockdown and enforcement of lockdowns. Germany and Britain follow Spain and Italy on March 20. France followed Spain in the days after Italy's complete lockdown. Macron ordered the lockdown on March 16 with stringent enforcement. Infectious Disease specialists at Imperial College warned of "unintended consequences for the entire nation" if a lockdown of Britain did not take place. The goal is to limit the spread of infections from rapid to slow as public health systems and economic measures are ramped up in preparation for the crisis. Most countries were lacking the preparatory steps having lost time waiting to see what happens next or analyzing data in the vain hope the virus does not spread.  Bad economic results of lockdowns were initially a concern, but this concern became less important as the coronavirus spread rapidly in Europe. Decision makers in Europe decided that not acting forcefully would lead to equally or worse economic outcomes. Public health systems overwhelmed would diminish public confidence rapidly and lead to equally bad or much worse economic outcomes. The European Union executive body has supported state aid, stimulus action and border controls in this crisis. In America and in Europe the hope is that shoring up the safety net with massive aid to businesses and households would buy time to tackle and overcome the coronavirus through a combination of lockdowns, quarantines, contact tracing, large scale testing and medical technology measures. The examples of China, South Korea, Taiwan showed this pathway exists for phased control and reducing fatalities to zero. ...

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States in Germany that have imposed quarantine and lockdown are Bavaria, Saarland, Rhineland-Palatinate., Hamburg, Lower Saxony, and Hesse. People are asked to stay inside unless going to the doctor or supermarket.  Bavaria where Munich is located reported few violations. Chancellor Merkel is meeting with state premiers on March 21 to decide on a nationwide lockdown as in Spain and Italy. 

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The mistakes  and the right action done in Italy that the world can learn from as Italy tackles the coronavirus. The coronavirus is a dangerous pandemic yet there is one part of it that can be used to take the right action. The timeline of countries affected early in January and February and early March with information from these countries on what worked very effectively and what did not work with bad results is available. The mistakes were made in Bergamo, a town in Lombardy region of northern Italy with the highest number of infections and deaths in Italy. Bergamo had limited testing, no rigorous attitude for quarantining those who had come in contact with people testing positive, and lack of contact tracing. In Vo another town in northern Italy the situation is a complete contrast with resort to mass testing and isolation of clusters which has reduced infections to zero and made it a safe place. Vo is a small rural town 85 miles east of Bergamo in the Veneto region. This was the method used in South Korea, China, Taiwan and other Asian countries that have overcome the virus. Bergamo is an example of what failed in Italy with the worst number of fatalities. The health crisis worldwide has shown this  method of first general quarantine to buy time to build capabilities for testing  and preventing things spiralling out of control,  then mass testing, contact tracing and isolating the people who test positive, and repeating this process again and again till infections are way down,  is the only way to control this crisis. In the early days massive quarantine or stay at home strictly enforced is the best solution till production of tests accelerates to permit mass testing and isolating the clusters of infections. This mass quarantine buys time for accelerated production of tests and building up the capabilities of labs to process these tests, including use of a central national lab centre with national data on computers for microbiologists to monitor the entire country. This was done in South Korea reports in WSJ show. This is vital for everyone involved in the effort to control the virus to understand based on the experience of  countries that have successfully overcome coronavirus. It is the experience in South Korea and Italy that the U.S. White House response coordinator Dr. Brx is looking at and learning from as she and the White House team in the U.S., governors of all 51 states, health officials including CDC, are looking at as they execute their action plan in phases.  ...