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Italy is paying a heavy price for the delay in implementing a complete lockdown and other measures. The first delay was on Day 6 and Day 12 after the first coronavirus infection on Feb. 20, when the regional authorites in Milan region kept bars and cafes open and reopened Milan Cathedral to tourists as reported here in the NYT. This was happening even as the pandemic was surging in a case of ample denial. Then again on the 18th day after the detection of the first case on March 8, the lockdown announced was leaked leading to people leaving Milan and other towns for the south and other parts of Italy. This lockdown of March 8 was not specific enough and lacked details so that it was not properly implemented immediately. The final lockdown of the entire country came as the situation worsened on March 10. As a result the virus continued to spread leaving hospitals and health personnel overburdened and the country in severe crisis. The Veneto region fared better than the Lombardy region because of strict quarantines, higher rate of testing and contact tracing to enforce isolation of clusters. In towns such as Vo in Veneto the virus is under control as reported in the WSJ. ...

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Quidel Corp. gets the first FDA approval of an antigen test which tests for the disease itself. Quidel is a company specializing in tests for the flu and infectious diseases. It uses an older technology to detect the disease. Quidel CEO Douglas Bryant, says he will ramp up the manufacturing of the test to go from 200,000 tests a week in the week of May 11, to more than a million a week in several weeks. The current testing technology has several shortcomings. The most common test so far is the PCR test which magnifies virus particles to ease their detection. It is cumbersome technology because it takes time to run the test and analyze the results. The new antigen tests have several advantages. They have a simpler design, are easier to process, and can be produced at lower prices because of the simpler design. They are designed to identify the virus in people in real time, to process results quickly in minutes in Quidel's Sofia analyzers. Because of the simple design and proven technology it can be scaled up quickly to do millions of tests.  The U.S. currently has the problem that it is not able to do enough testing- about twice the current rate is needed to do what health experts recommend. A minimum of 4 million tests weekly is needed and followed up with contact tracing to make it safe for people to go back to work, says Ashish Jha of the Harvard Global Health Institute.   The U.S.   ...

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What is the difference between South Korea and the U.S., Europe in the handling of coronavirus? It is tracking and testing.  President Trump and health adviser Dr. Fauci, see South Korea as the successful model to be followed in controlling the coronavirus. What has happened till now it is accepted with shortage of basic medical supplies and equipment, stress on hospital systems, are merely mitigation actions. South Korea was prepared for the coronavirus crisis because of the MERS and other epidemics, and failures resulting in corrective actions. Labs were centralized and better equipped for testing and tracking the infected. One of the key tools is testing. President Trump says the goal is for the U.S. to exceed and far surpass tests per capita in South Korea. Five million tests are planned by the end of April in the U.S. Where the U.S. falls short is in use of multipronged digital tracking using data from people's use of mobile phones, credit card usage, and use of apps designed to separate infected people from others. South Korea is a democracy with a population of 52 million people, about the size of France. People who were student activists in the democratization era in South Korea say the use of digital technology is a need today. We have to adapt in emergency situation they say. Ki Mo-ran, epidemiologist, and adviser to South Korean government says this is a key part lacking in the European and U.S. efforts to control coronavirus. She says in South Korea we know the patient's contacts, where he goes and stays, so we don't have to lock down everybody. Without digital tracking one cannot know which place is contaminated, which place is clean, so that there can be a lockdown of just that area and not the whole country, says Ki Mo-ran. She asks the question- is one person's privacy more important than the lives of a family or other people who are affected. Is it OK to lockdown every child in the country in a home as in Spain for over a month so that particular people's privacy is respected? These are serious questions for western society, are they exceptions or is democracy not just a western idea but equally cherished in Asian societies, people talk about Confucianism in China and the Asian culture forgetting that the biggest democracies are quite large and functioning well in India in addition to South Korea, Taiwan Indonesia, Malaysia, Bangladesh and Japan, far larger in area and population than China. The French government has chosen the app TraceTogether as the least intrusive one adaptable to France for use there. The U.S. is having Google and Apple develop one of its own. India will be developing one of its own. The NYT raises the question will it be watered down so much in France or in the U.S. and UK to be less effective than the  dire need for an alternative to lockdowns? ...

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The British public is very conservative when it comes to reopening. 73% support prioritizing the health of citizens only 17% say prioritize the economy. This is the highest of industrialized nations, Japan being the next highest with 60% supporting prioritizing health only 16% in Japan saying the economy.  For Boris Johnson as he makes the speech on Sunday May 10 on reopening the political margin for error in decision is nonexistent. Britain's tabloid press and other media simply took the idea that to heck with it lets reopen reflecting a lack of caution in the headlines after Mr. Johnson expressed his intention to reopen. After seeing this Johnson and his closest advisers met without his hawkish ministers to reflect on what was happening in the country. The British government's scientific advisers say whether there are 100,000 deaths by the end of the year depends on many factors including testing, contact tracing, the way the lockdown is eased, the situation at nursing homes, and other government action  to prevent a resurgence in infections. At the meeting with Gove, Sunak Raab and Hancock, Mr Johnson stepped back and reversed any plans except for mild reopening- giving people more time outside for exercize, opening limited locations such as garden centres and advising strongly to wear masks on public transport. Both Johnson and Dominic Cummings his adviser had coronavirus, and Johnson spent some time in ICU. They know the impact of the coronavirus from their own personal experience.  For Johnson there is only one chance, Tory senior advisers say the public will forgive mistakes going into coronavirus, but will never forgive mistakes getting out of cotronavirus. He told Keir Starmer of Labour in parliament that he bitterly regrets what has happened in nursing homes. The scientists have warned him that the staff at nursing homes could seed communities once again. And that the coronavurus R ratio (1 being the level it starts growing again) could go up back to 1. This is the situation on May 10 as Johnson prepares to speak to the nation on Sunday at 7 pm, as he shifts to "maximum caution." ...

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In a Senate hearing Dr. Fauci, head National Institute of Infectious Diseases, Dr. Redfield, head of CDC, and Dr. Hahn, head of the FDA, answered questions from U.S. Senators including committee chairman Lamar Alexander and Senator Murray. Dr. Fauci told senators that with some states reopening without meeting federal guidelines that include seeing an extended period of falling numbers of cases and deaths, "there is a real risk you could trigger an outbreak ... that could set you back rather than going forward."  Dr Fauci is concerned about the situation in the fall when schools and colleges reopen with possible spread. In other comments Robert Redfield the CDC head told the committee- "timely testing is vital to reopen America, increased contact tracing is critical." Redfield says CDC has created a state by state assessment of contact tracing and was working with states on these surveillance systems. This contact tracing effort is one of the less developed areas in which the focus is being shifted to along with testing capabilities. Admiral Giror who heads testing capability buildup says 40 to 50 million tests should be available by September 2020, so that hotspots could be addressed quickly. ...

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Kerala state of 35 million people who speak the language Malayalam, is one of the rare places today that has only 4 deaths from coronavirus, 524 cases confirmed and no community transmission. Here the Guardian looks at the reasons why. The Health minister KK Shailaja started very early on January 23, with a meeting of her rapid response team when the virus was still in China.  She setup a control room and instructed Kerala's 14 districts to do this on Jan. 24. When the first case arrived on Jan. 27 on a plane from Wuhan, Kerala had already adopted the WHO  protocol of test, trace, isolate and support. These passengers were checked for temperature, tested and quarantined. With some at a nearby hospital and others in home isolation. This is all the more amazing considering that Kerala is a state in southern India on the west coast that has a large number of people living and working overseas. Many are in the Gulf countries and the arrival of these refugees could have triggered a second outbreak. This was prevented by careful testing, and contact tracing of clusters.  When one group was evasive and concealed information from an airport surveillance team -arriving from Venice, Italy,  in late Feb- a case was detected back to them.  Contact tracers tracked down all of the hundreds whom they had been in contact with and quarantined them.  By 23 March all flights to 4 Kerala airports from overseas were stopped, including Cochin and Trivandrum. On March 25 India went into lockdown.  Some of the achievements in Kerala include quarantining 170,000 people early. with strict surveillance, which is now down to 21,000. Accomodating and feeding 150,000 migrant workers from other states, before returning them on charter trains to their home areas. A big reason for the success is the high literacy rate in the state. A big emphasis on education and healthcare is a part of the Kerala model. Shailaja is a secondary school teacher, and Health minister. From the days since independence of India in 1947 the state has a strong socialist tradition of taking care of the basics- health, education and public services. It also generates a part of its GDP with income from workers who are overseas.  Another reason for the success in dealing with coronavirus is experience. The state had a virus epidemic called Nipah in 2018 which has become the story for a movie called Virus in Malayalam. There is decentralized public health system in the state and people value their health care facilities, understand and trust the health care authorites. There are hospitals at every level of administration and 10 medical colleges. But trust and education, experience tackling the virus before, are key. Kerala is showing that poor countries can deal effectively with the virus, and create a better life by adopting the right model of creating good societies that value education, healthcare services, better economic structures and distribution of wealth, and  a degree of trust and responsibility found in a state that values public spiritedness. ...

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In a corner of Wales known for its coastline and scenic beauty, a biology teacher Mr. Barry Rees sets up a homemade contact tracing system that worked. He is the director of Ceredigion county council. It is the safest county in mainland Britain with only 45 recorded cases in the last week for 75,000 residents. Early on in the coronavirus epidemic Mr. Rees decided to take up contact tracing with whatever resources were on hand and start quickly. This was was happening in German states which were also following low tech, get started quickly approach, but Rees was not aware of what was already happening in Germany. He knew about South Korea and Singapore efforts in contact tracing which put a lot of emphasis on human skills in calling and tracing and getting started immediately. Rees started with the people calling in sick of the 4000 people who worked for the county administration, as he had no testing resources. He started tracing these people and their contacts, and even though some were defensive the majority supported intervention to isolate. At the time there were fears of 200 deaths in the county so that there was no time to lose.  By April the area was facing an influx of people from Aberystwyth University and tourists visiting its sandy beaches, another reason for taking on the task with a homemade system. Today it has one tenth the cases in the rest of Wales.  The hidden fear in the country is that word can get out and lead to more visitors from outside the county. ...

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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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Some of the concern about the economy comes from the economic damage done by the coronavirus. The longer the shutdowns continue the more the damage. About 17 million have filed claims for unemployment benefits. The WSJ consensus of 57 economists is that 14.4 million jobs will be lost in coming months, and the unemployment rate will rise to a record 13% in June, from a 50 year low of 3.5% in February. The earliest the economy could go back to the level in February 2020 is 27 months says the WSJ economist survey. The brighter side of this comes in two aspects of this pandemic recovery curve. By flattening the curve and strict testing, contact tracing and isolation till the vaccine is developed about half the jobs lost can be recovered by the end of summer, says Moody's Analytics. The vaccine a year from now or in 9 months by November 2020 would allow the economy to recover faster. A more optimistic view comes from Daiwa Capital Markets which predicts many of people laid off will be recalled quickly allowing the labor market to recover in 6 months by September or October 2020. Only finance and real estate might take longer but most of the industries where the vast majority of jobs are could be back on their feet. The credible evidence supporting this perspective of a rebound comes from Colorado and Washington which require large employers to specify whether layoffs are temporary or permanent, 70% this year are temporary. Compare this to the prior 2009 recession where this figure was less than 1%- as reported by WSJ. The big push in this direction will be the $2 trillion that the Trump administration and U.S. Congress have committed to this task. Even more so is the determination of president Trump to protect American workers at all costs, that every job counts, and that businesses without exception to get the money have to show that workers are retained. The very success of the aid is being judged by how quickly people are back to work. Now for a look at where the situation is today- Oxford Economics, a UK based forecasting and consulting firm, projects 27.9 million jobs lost with industries other than those ordered to close making up 8 to 10 million of that number. It projects April's report will will capture late March layoffs. It will show cuts to 3.4 million business services workers, including lawyers, software groups, architects and consultants, advertising professionals, in addition to 1.5 million non-essential healthcare workers, 100,000 information workers. One conclusion of this report is that the virus does not discriminate across business groups and business service workers are also affected. Many companies that were hiring will cancel that move and many will cut hours worked. Many of these business services are not a priority. Hospitals are affected too, as they cut elective surgical procedures and routine care that are major revenue sources. Some are now charging for telemedicine visits to maintain some revenue stream. State and local governments employ 20 million workers. As tax receipts decline these local governments will face choices of cutting payrolls and services without enough federal government relief. In a way laying off workers and having them take unemployment benefits shifts that burden to the federal government so that services for overtime to police and paramedics, retention and deployment of nurses in schools.    ...