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The situation in Europe as Germany, Austria enforce travel restrictions with Italy. France has not placed restrictions yet on travel to and from Italy. Many Italians are wondering whether the quarantine and other steps taken now should have been taken earlier, says this report in WSJ. The Italian government is conducting a campaign where people say "lo resto a casa," or "I'm staying home."

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India has done well with low cost, scalable, low tech solutions in the past. This is also being done now to tackle the coronavirus. This is being used to support what may be the largest lockdown in history. Everyone is expected to remain at home. Only shops selling essential items such as food and pharmaceuticals are allowed to remain open. All but essential offices are closed, with workers told to stay home. Indelible ink that takes two weeks to wash away was widely available following the election. It is being widely used with high numbers of infections having the back of their hand stamped "Home Quarantined." After India announced a nationwide lockdown all wireless carriers were asked by the government to  insert a taped coronavirus health advisory that comes on after callers dial and before the call connects.Th recorded message talks about how to protect against the coronavirus. Prime time news shows are interrupted three times a day for back to back news conferences from the prime minister, and local officials.   ...

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This report shows the level of coronavirus testing as of March 27, 2020 in different states in the U.S. The U.S. testing program and supplies of tests are being ramped up quickly. About 65,000 tests are being done on Americans each day. The need is for 150,000 tests a day say public health officials. Testing is slow in California compared to aggressive testing in New York which has 60% of all coronavirus cases. California with twice the population of New York has done 77,000 tests compared to 122,000 in New York. Texas has done only 21,000 states by comparison. Every week new testing technology is being developed in different labs, medical companies, and universities. Including tests that can be conducted quickly and not requiring health workers or health workers with protective gear. Speed of processing test, least point of testing contact, and the protocol for quarantine, are all part of the testing and isolating of clusters mechanism to tackle the virus. This is critical in the coronavirus action plan being developed by Dr Brx of the U.S. White House team. ...

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Chinese president Xi Jinping is learning from the country's Covid experience in the way Biden and Democrats learned from their initial push for tighter restrictions in 2020-2021. Most covid restrictions, quarantines, testing is being lifted in China and efforts are being made to stabilize the economy hurt by frequent lockdowns, and a new path is being taken that responds to the Covid lockdown fatigue of the people.  This will lower Chinese growth below the central bank forecast of 3.3% for 2023, yet it also offers a learning curve for the Chinese leadership and new government that was put in place after the CCP party congress in 2022. This may be experimental in the short run but offer benefits for China and the world in the long term. For the first time it means China's trade tensions with the US are turning the corner in a way no number of tariffs and rhetoric could do between the two countries. The evidence- China's exports to the US have declined by 25% already in the last few months. Exports to the EU have declined as well by 11%. China's trade surplus in November 2022 showed a drop to $70 billion from $85 billion in October. ...

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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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The critical variable in knowing whether lockdowns of cities and countries are working is called the coronavirus RO, or reproduction ratio. This ratio measures the average number of people infected by a carrier A. It could be that he infects 1 person at work and transport call it B people , or in large gatherings call it C people he infects 2 persons, or in other surroundings such as restaurants he infects 1 person call it D people. The people A has infected B+C+D are the ones now not infected by A with the lockdowns such as in New York, Italy, Germany, UK and France. It is determined by global health experts that the number of B+C+D is about an average of 4 persons infected by 1 person A with coronavirus, though it may be much higher in practice in some areas. The natural rate of RO or reproduction ratio is considered by the European Centre for Disease Prevention and Control to be 3.86 or about 4, if no lockdown or social distancing or other prevention is practiced. This in a situation where people behaved as before unaware that the virus was around them. Governments such as New York and France, UK, Germany are including this key variable in their determination of how long a lockdown lasts, and for determining if the reopening is not going the right way or failing. In such situations the lockdown would be reinstated, or if it is a phased reopening such as in the U.S. and other countries go back to the previous phase. In Italy and Germany the RO reproduction ratio for coronavirus is estimated by official experts at 0.8. Germany's RO estimated by the Robert Koch Institute and Italy's by Franco Locatelli, scientific advisor to the government. In New York the margin is thin- with RO of 0.9, estimate from the state's governor. In France which has one of the tightest lockdowns of all with a document required to go outside it is at 0.6, the figure coming from the prime minister Mr. Philippe. In the UK it is below 1.0 but no accurate figure is reported. As Dr. Birx- leading the coordinated response in the U.S. - emphasizes over and over again this is a very contagious virus, about which not much is known. Social distancing, wearing masks, basic prevention measures such as frequent handwashing, and not gathering in large numbers of people, is essential for defeating this virus. This has to be followed up with extensive testing and contact tracing to win this fight.   ...

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In an astonishing contrast to other European countries, including neighbors Norway, FInaland and Denmark, the Swedish government decided to not impose a lockdown, keeping bars, restaurants, hairdressers, gyms, primary and middle schools open. Secondary schools, museums were closed, sports gatherings, gatherings of more than 50 people were not allowed. Social distancing was not enforced, and entirely voluntary. Sweden now has 29000 cases according to Statista and its death rate of 358 per million population is higher than in the U.S. which is 267, and Denmark 93, Finland 53.  Critics such as Lena EInhorn, a virologist, say the Swedish government did not set up a broad testing program, and let a problem develop for elder care in nursing homes. She says a 14 day quarantine of household members of a person infected with the virus would have made a difference. Most action we take for granted was not taken in Sweden. Restaurants that were not required to close spread airborne transmission. Einhorn also says that the government officials have denied it but under their breaths they have acknowledged working on a herd immunity strategy. Denmark has opened schools with social distancing and other measures and reopened its economy. Sweden is in reverse with calls for stricter action and an ongoing debate. No reopening as there was no lockdown, yet considerable and nagging uncertainty. The speed of transmission of coronavirus is the biggest danger, as it can let the numbers grow very quickly if the wrong decisions are taken or something is left out. ...

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With cases from foreigners exceeding cases locally, outside of Hubei province for the last 6 days, China is now restricting entry of foreigners. All foreigners entering the country from South Korea, Italy, Iran or Japan are subject to a 14 day quarantine. A voluntary quarantine for 14 days is required for other visitors. 

Germany has relied on state and local governments to take action, with the federal government not intervening. 

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This BBC report shows how contact tracing works in Singapore to control the spread of coronavirus. On 4 February 20 Chinese tourists visited a traditional Chinese medicine shop in Singapore. Only 18 coronavirus cases had been recorded in Singapore on that date. That visit to the medicine shop created a new cluster for the disease to spread. Singapore's contact tracing units traced such locations through its well developed and extensive contact tracing programme, which follows the chain of the virus, identifying and isolating people before they can spread the virus further. For about 40% of the 243 cases so far on March 19 the first indication they had was a call from the Singapore Health Ministry.      About 6000 people have been contact traced so far, using a combination of CCTV footage, labor intensive detective work with phone calling. This includes an incident of a taxi ride of 6 minutes in which the person a yoga teacher was identified and contacted by the Health Ministry. Enforcement is done as the person was contacted at her home by three people who showed her a quarantine order, which said you could not go out or its fine time and jail time. With about 8000 people per square kilometre, Singapore is small and densely crowded. It could easily be overwhelmed with hospitals not able to cope and the health system collapsing if this was not done. Wuhan could have happened here, says infectious diseases specialist Dr. Leong at Mont Elizabeth Novena hospital, who advises the government.  Because the crime rate is low the police were given this task of tracing as a priority in addition to hospital units working on tracing. It also included the armed forces personnel helping with tracing so that it could be done quickly without delay. This provides a lesson on how countries that have faced the health crisis have used innovative methods to tackle it with good results. ...

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One of the key findings of a joint panel of the WHO and South Korea on the MERS outbreak is the lack of transparency in the South Korean government's handling of MERS. Lee Jong-Koo, leader of the South Korean side in the panel said at a news conference: "One of the things South Korea failed to do was a transparent and rapid distribution of information, which is the most important thing to do." What caused serious concern for health officials is the speed of the outbreak- between May 20 when the first patient was identified and June 10 at least 145 people were infected. The chief WHO official on the panel, Keiji Fukuda, says South Korea needs to enforce a robust quarantine and monitoring system, and invest more in public health with more epidemiologists and laboratories' capacity.

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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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This interview with Indian Health Minister, Harsh Vardhan, by Amitabh Bachchan and Anant Goenka of the Indian Express covers a range of questions including India's low fatality rate for coronavirus of 1: 46, its vaccination programs for polio, malaria and other diseases long before the pandemic for a population of 1.3 billion people, respect for healthcare workers, and the distribution of the new vaccines under development in India. Vardhan says there are of the 100 vaccines being developed 30 are in India,and of the ones nearing approval 5 are in India.  India makes 60% of the world's vaccines and its distribution capacity for such a large population has been proven many times. During this coronavirus months of preparation are going into reaching the whole population including remote parts in the mountainous areas. Vardhan says the plan is to vaccinate about 30 crores or 300 million people by June-July 2021 out of a total population of 135 crores or 1.35 billion. The vaccination will start with health care workers, moving on to essential service personnel in the military, police and other occupations, and to vulnerable parts of the population based on age and health conditions. Vardhan who is also the chair of the executive board of the WHO as India's representative, says the prime minister is personally holding two 3 hour long meetings to monitor the preparations for the vaccine and its distribution. Vardhan lists the achievements of the Modi administration and the quality of leadership provided by the prime minister- 2100 testing labs, 97% of the country having a testing facility within 3 kms, testing 1-1.5 million people each day, 1 million testing kits produced daily, 2 million beds in India with oxygen support or in ICU, 13,000 quarantine centers. By personally visiting the vaccine development facilities in Ahmedabad, Pune and Hyderabad, the prime minister also directly supported and encouraged scientists and their efforts. ...

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The dire situation for basic education in the U.S. states during the pandemic in 2020 and what this means for children growing up is the subject of this WSJ report. Early retirements and quarantines have forced some school administrators to have parents, even bus drivers to conduct classrooms with children. Asymptomatic teachers are allowed in classrooms. Public school employment in U.S. in November was down 9% from February lowest since 2000, according to the Bureau of Labor statistics. The shortage is compounded by layoffs of support staff such as teachers' aides and clerical workers, leaving the burden to be taken up by teachers.  More than 40 states in the U.S. report shortfalls in math, science and special education. The worse off states include Arizona, where school districts were not able to hire certified teachers for 78% of 6,145 open positions in August, and one third of the positions are still vacant. This report looks at the situation and the damage as teachers handle larger classes of over 50 children, do online and in person classes simultaneously, deep clean their classrooms, and take turns as crossing guards. The result burnout for teachers, more teachers quit, parents are frustrated and students do not make progress. Much of the capital investment allocation in the U.S. has gone badly wrong with capital chasing a tech industry with the industry reaching saturation and diminishing returns in, in speculative ventures, at the neglect of infrastructure, manufacturing, health and education. A recent WSJ article points to dilapidated or outdated infrastructure as one of the reasons American manufacturing has suffered. ...

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The southern and southwestern U.S. which were expected to peak late are now seeing a surge in the coronavirus cases. This includes Alabama, Florida, Texas and Arizona. New York imposes a quarantine of 14 days on residents of these states travelling to N.Y.

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The WHO, World Health Organization, comes under criticism for failing to warn about the pandemic. President Trump says the U.S. finances the WHO with $450 million but the WHO has opposed some of the basic common sense approaches to the virus such as early quarantines and suspension of flights from virus hotspots. Including opposing the U.S. action taken by president Trump on January 27, 2020 to close all passenger flights between U.S. and China. A 14 day quarantine was put into effect for Hubei province. About 8.5 million passengers visited the U.S. from China in 2018 according to the U.S.Transportation Department. Reports show Chinese cities deserted on NYT January 30, but infections only 1300 a week earlier going up to 12,000 and only 259 deaths. President Trump says the world was misled by the WHO on the extent of the crisis developing in China, as he sets up a review of the WHO's role in the crisis and on funding by the U.S. President Trump says the crisis in the U.S. would be much larger if some of the 8.5 million passengers from China arrived in U.S. cities. He also says the decision was his own intuition about what was happening with health experts not realizing the extent of the crisis as there was very little data on the crisis. Most of the experts Mr. Fauci and Dr Birx were also not aware at the time of the gravity of the crisis, and some leading epidemiologists at American universities even called it an emotional reaction. ...

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President Trump's failure to followup on his decision to shut down all flights to China on January 29 with speedy action on preparing for the coronavirus as suggested by some of his advisors is the subject of this article in the NYT.  There were two distractions one was the trade deal with China that was being negotiated, and then the impeachment trial in the U.S. Congress that was set in motion by Democrats. Another problem was the lack of good information about the extent of the virus spread in China and infected case numbers. As it turns out no one really knows the real scale of infections in China. If is was known that there were as many cases in China as there are in the U.S. today this would have resulted in shaking up any complacency in the Trump administration and in the states. Considering the experience of Europe and the U.S. it could be that China had the same number of infected cases as the U.S. does today for a population three times the size. China had a strict quarantine but it also did not realize what it was up against in the first weeks of the crisis in January. It appears now that China, Europe and the U.S. all lost some time from 2-4 weeks before realizing the severe consequences facing each region. This report says one of the vital pieces of information that was learned about infected people in China, was learned as late as the end of February by leaders of a government team looking at the coronavirus threat. It was that seemingly normal healthy people without symptoms but infected by the virus could spread the virus. This meant that this was very, very contagious. The lack of good information played a significant part, adding to the level of complacency in states such as New York and in the Trump administration. Politics such as the impeachment trial and political infighting added an unnecessary distraction. ...

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Two divergent approaches to the coronavirus are shown in this report in the WSJ. One in Italy which relies on quarantine and lockdown and mandatory social distancing, and the other on keeping borders open and aggressively tracking down the infected using data and testing. In South Korea infections have stabilized at 8000, and in Italy the are rising at 15,000. The divergent approaches and the results vary with the people's history, culture and recent experience. The cultural difference in Asian societies with people willing to cooperate and work together with health authorites for the social stability and good of the country is different from the more individualistic nature of western societies. In addition Italy has a long period of foreign rule of Hapsburgs nd French that has created an attitude of working around authority, the tendency to being furbo which prime minister Conte referred to in a nationwide address.  South Korea and Taiwan also have experience with the SARS and MERS virus during which public health regulations were instituted and comprehensive databases setup that are now being used to combat the new health crisis by tracking down people with health needs. The precedents have taught people in South Korea and Taiwan of how serious this kind of crisis can become, which was absent in Italy in the early stages. Both South Korea and Italy are democracies. The difference being that one has experience with public health crises from experience with SARS, MERS, H1N1, and has developed policy tools, broadened public support and increased state powers in anticipation of such crises. In South Korea there were fines of $8300 for those not willing to be treated and the government aggressively tracked down people. Public support and awareness also helped in controlling the situation. Taiwan has done better than South Korea as covered in a separate article in the WSJ, and shown here, controlling the situation from the beginning including shutting down flights from China early because of its close proximity to China.  ...

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India has learned lessons from past health epidemics- the plague Gujarat 1994, avian flu H5N1 in 2005-2006 Maharashtra, Madhya Pradesh, swine flu H1N1 Pune, and more recently MERS. The Indian Express looks at past epidemics, how they were tackled and what India learned from them. Major improvements in sanitation and hygiene since then and advances in medicine, public health.  Experience was gained. The municipal commissioner of Thane near Mumbai was district collector of Jalgaon during the avian flu epidemic. He used quarantine to restrict transmission of infected material. He shifted bus stands, closed weekly markets, and had health workers check symptoms in a 3 kilometre radius area. His message for today- have a contingency plan, track, test and treat people, stay focused, not panic, and know exactly what has to be done. Moving migrant crisis today was also seen in Surat, 1994, with the plague epidemic when migrant workers left the city. The government had to use paramilitary units in 1994 to quarantine the entire area. During these earlier epidemics the Indian Council of Medical Research and other medical organizations played a significant role. One of the lessons learned from the H1N1 epidemic that originated in Mexico was the need for effective surveillance and real time reporting so that the pathogen can be recognized in real time and tests done at labs to determine what it is, followed by effective response through isolation of region and patients. Dr. Pradeep Awate, Maharashtra's surveillance officer, says robust surveillance systems are important to understand the magnitude of the problem and strategically place resources. The strategies put in place for the Nipah virus in Kerala state by its Health Department in 2019 are the same ones now being used for cornonavirus - contact tracing and management of persons under quarantine. ...

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As the pandemic continues to spread and numbers grow with reopening of the economy the question remains -what can we learn from other countries positive experience in controlling spread? Here the Times provides the example of German contact tracing- chancellor Merkel has emphasized that a lot depends on "total" contact tracing, and contact tracing "above all else." Germany's experience is that even if you don't get everything right, you make an honest effort with everything you've got and do it early it makes a real difference. Some of the offices across Germany are stretched and short of staff but they have been working since the beginning of March, sometimes in the early days 7 days a week. Only 33% or one third of the offices throughout Germany for contact tracing have the required 5 person team for every 20,000 people, and 35% are overstretched or at their limit, according to one survey. No apps, just a low tech effort with people from the state administrations who were not working during lockdown trying doing something else, or volunteers. Mainly using the phone, talking to people and tracing the contact chain of people testing positive. Putting this information on the computer with a central database.  The Berlin office has 115 workers and has tracked down every one of 666 virus cases it was given. Because of privacy concerns at the Munich office sometimes even the patient's name is not given and office staff have to locate the name and the person. It requires dedication, flexibility and above all resilience, says Harold Rau, the deputy Mayor of the Cologne office, cited in this Times report. The doctor alerts the local office with a test result. The office calls the person and finds out who he has been in contact with for the last 14 days. Then the people who were in contact with are grouped based on the directness of contact, face to face, so on. These people are asked to quarantine for 14 days, sometimes with the rest of their household. They get daily call to find out how their doing for symptoms. The effort goes back to Robert Koch in the 1892 cholera epidemic in Hamburg. Robert Koch, microbe hunter in Germany, was called in after the epidemic spread from Moscow. It devastated Moscow and Tokyo, but Hamburg suffered far less about 8605 deaths as a result of the contact tracing and strict closing off quarantining of affected chains after isolating them, closing off affected parts of the city. Bit by bit the cholera epidemics sparks were put out before turning into flames, says Koch. In the current pandemic Germany has suffered 8241 deaths and 178,000 confirmed cases. So far this is in line with the cholera epidemic in Hamburg 1892, and this for all of Germany. And it is not just affluent nations that can do this. where there is a will there is a way. In Kerala state in southwestern India, similar efforts have worked to limit spread  with even better results than Germany. ...

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In a couple of weeks one can expect a digital Covid certificate that allows freedom of travel within the European Union countries. The European parliament and member states have agreed on setting this up. The travel pass will be a QR code on a smartphone or printed on paper. By accepting the travel pass EU states will drop travel restrictions such as further testing and quarantines unless necessary. With only 10% of EU citizens fully vaccinated there was concern about fairness but as vaccination speeds up in Germany, France and other EU states, this is giving way to the need to make travel easier during the summer.

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A look at two crises in 1918 and 1957 of virus pandemics shows early and decisive action to prevent public from gathering and intermingling, are critical. In today's densely populated urban environments this translates into lockdowns and quarantines that are strictly enforced. The 1918 pandemic took 50 million lives worldwide, the 1957 pandemic took 1 million lives worldwide, says this report based on some estimates. MIstakes were made then and science was not as developed for vaccines and new drugs. Which is why health authorites are taking this very seriously. Greg Ip of the WSJ looks at coronavirus health crisis in relation to earlier disasters- SARS 2003 originating in China, 1957 flu epidemic, 1918 Spanish flu epidemic, to draw insights on what measures have worked best. Previous epidemics and crises provide clues on what makes things worse or better and the long term consequences of actions. The more health and safety are prioritized there is some impact on the economy. But crises have proven that the economic impact is temporary and short lived with the economy and jobs bouncing right back once the crisis has passed. The second insight is that early on in the crisis there is a great deal of uncertainty, leading to fumbled or delayed, or timid response. Sort of like lets wait for more information coming out of China, or now Italy, which happened first in February, and then again in March. Tim Adams who worked in the U.S. Treasury Department during 9/11 and Hurricane Katrina, and is now the president of the Institute of International Finance, says if you look to plan a perfect response you lose valuable time. Time is of the essence. Learning to make speed the priority, to think in tranches, be visible, and worrying about how to pay for it later, is what he says he has learned from these crises response efforts. In the case of the coronavirus, some valuable time was lost becausee of the uncertainty and lack of early information, making speed and rapid comprehensive action very critical. The Spanish flu epidemic of 1918 infected over 500 million people worldwide and killed 50 million or more, including 675,000 in the U.S., according to the Centers for Disease Control and Prevention. During this epidemic the Chicago public health commissioner flatly opposed closing businesses, saying worry kills people more than the epidemic. A 2007 study shows cities that took that attitude saw higher death tolls in the Spanish flu epidemic of 1918. Philadelphia waited 16 days before restricting social gatherings, St Louis took just 2 days. The result: the daily death rate from the epidemic peaked at level five or more times higher in Philadelphia than in St. Louis. Social distancing was not much of an issue then as people worked in jobs that required less contact, such as farming, fishing and forestry, as well as other jobs that did not require that contact in large offices.   ...