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The European automobile market staged a recovery in 2014 with sales up 5.7% to 12.6 million, according to the European Automobile Manufacturers Association. The big gains were made by the lower cost brands such as Renault's Dacia made in Romania, and VW's Skoda made in the Czech Republic. Dacia sales increased in 2014 by 24% to 359,141 and Skoda's sales increased by 14% to 554,479. A Dacia Sandero without air conditioning, power locks or radio is priced at 7,990 euros in France compared to a better equiped Skoda Fabia at 12,640 euros and a VW Golf at 17,388, a big price difference for budget car buyers. The major brands continue to dominate with the Golf model continuing as the best selling model in Europe. GM and Ford with the Opel Corsa and Ford Fiesta also increased market share. VW's market share is 12.7%, Skoda's 4.4%.

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The message of the Five Star Party of Beppe Grillo against cronyism, the older politics in Italy, corruption in government, unrestricted immigration, clearly resonated in the south of Italy with the party winning in southern Italy. FIve Star brings younger faces to the Italian parliament just as Macron's movement did in France. The Democratic Left Party under Renzi was a clear loser as it won about 20% of the vote compared to 32% of the vote and over 216 seats in parliament for Five Star. Renzi and the left parties clearly failed to gauge the voter's mood and frustration with economic conditions- 11% unemployment and 18 million Italians at risk of poverty reports BBC News. About 600,000 immigrants entered Italy from North Africa and other regions creating anti-immigration sentiment that shifted support to Five Star and the right wing Northern League under Salvini, which had broadened its appeal from its local base in Milan to all of Northern Italy under Salvini, 44 years old. The Northern League won in most of Northern Italy and with the Forze italia of Berlusconi won 37% of the vote. A coalition of Five Star and the Nrothern League would bring together 2 Euroskeptic parties. ...

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Renault signs an agreement with labor unions which provide for longer working hours and a one year wage freeze to reduce labor costs. Renault will in turn not close French factories and invest 1.1 billion euros to increase production in France. A similiar agreement was signed by Renault in Spain in 2012 and increased the urgency for reaching an agreement in France. Renault says increasing working hours 6.5% provided in the agreement will save the company 300 euros per car. Analysts estimate lower breakeven point for Renault after the deal. Renault said it will increase production to 710,000 cars in France by 2016 as part of the deal, taking output up to 85% of factory capacity. Production in 2012 declined to 532,000 in 2012, from 646,000 in 2011 and 1.2 million in 2007. Unions went into the negotiations sensing the danger in lack of competitiveness vs. Spain and Germany, and CFDT published a book titled "Renault in Danger!." Based on the experience in the U.S. as the economy recovered and sales recovered for Ford and GM, Renault may be seeing the effects of a gradual recovery in Europe by 2016. The 710,000 figure is a one third increase from the low 2012 figure, leaving room for expansion if this strategy succeeds. Renault's market share declined in Europe by one percentage point in 2012 to 8.4%, and its sales in Europe declined by 19%, according to the European Automobile Manufacturers Association. The increased production planned by Renault also includes 80,000 cars made for its partner Nissan....

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Buddhism gives people the opportunity follow a path to spiritual life and peace of mind without getting involved in politics. Here NYT provides a look at Buddhism in China as it is practiced to get people to set better moral standards to rejuvenate China. The founder was a small child traveling across China with his mother searching for their father after the Japanese invasion of China. He joined a monastery they passed by. After the Communist takeover of the mainland in 1949 and during the years of the Cultural Revolution he was active in a missionary movement for Buddhism and Buddhist culture in Taiwan.  Chinese president Xi Jinping has met with him 4 times and supports the movement in China as part of an effort to rejuvenate China and improve moral standards lost during the rush to modernization and industrialization. At one point even telling him "I have read all the books you have sent me Master."  For this movement to revive Buddhist culture and ethics the politics is secondary, what matters is the quality of people's lives and their finding fulfillment by living lives that honor the values of a good society that is caring for fellow beings, and practicing good moral standards.  Imagine a 100 acre facility that holds 2 million books in Yangzhou, including 100,000 volume collection of Buddhist scriptures. Built in two valleys of bamboo forest the temple in Yixing  is special, the atmosphere quiet and reflective, and with reading rooms, rooms for calligraphy, for tea. It was started in 2006 and is active with many people visiting the temple. In Buddhist countries such as Burma, Sri Lanka, Thailand, wherever Buddhism has got entangled with politics the purity and purpose of Buddhism has suffered. Putting Buddhist culture, learning, and quality of living first is essentially the way the Buddha had meant it to be. In a rare and profound way both Mr. Xi and the founder of this Buddhist group have made a unique and lasting connection to rejuvenate China after 100 years of tumult, war, and strife that started with the wars at Chinese ports in the 1850's, and 50 years of rush to industrialize that made weary and weakened the soul of a nation. During the period post coronavirus pandemic China and the Chinese people may find in Buddhist culture much that can enhance the quality of life just as the European nations France, Britain and Germany look back to their own culture and tradition for rejuvenation and renewal. In this sense even as China faces a West determined to protect its industry and technology, and returns to its roots, China can find a way to its own roots, confident that the period of European domination can no longer torment its soul. ...

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Efforts to limit the increasing use of industrial or frozen food in restaurants by requiring the label on menus for fresh ingredients or "fait mason" (homemade).

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Not much will change in Italy's place in the European Union, says Maria Ferraresi, editor of Italy's Domani newspaper. Italy expects 200 billion euros of solidarity aid from the European Union that is dependent on following EU rules. And coalition partner Berlusconi says he will drop his support if Meloni adopts any anti EU rules positions. Meloni's Brothers of Italy party with 26% of the vote has roots going back to the Social Movement in Italy in the 1930's. To attract support she has remained in opposition even when Matteo Salvini of the League and Silvio Berlusconi of Forza Italia parties joined Mario Draghi's unity government during the pandemic. She has turned to a pro EU stand from a EU skeptical stand. Meloni is also forming one of seventy Italian governments since 1945 such is the pace of government change in Italy making every government dependent on fickle political sentiments that shift quickly. The Italian economy has fallen into a stagnant situation with growth less than 1% in 2022, and the main concern of voters and the elected governments is the economy and standards of living, so that EU aid acts as a critical part of rejuvenating the economy. The Eu solidarity aid of $200 billion in coming years is critical for Italy's economic revival. It also shows the European Union in action after the years following World War II when it was realized that some sort of sound European economic framework was needed for the common good. Ferraresi also points out that Italy has also gone through an EU led effort to make the judiciary fully independent and able to function similar to the judiciary in France and other EU nations. Italy also has a very de.centralized government with state and local governments playing a major role in administration. This reduces the impact of changes in the capital Rome.  ...

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How is the push by Toyota to hybrids making up 50% of its cars- including shift of RAV4 and Camry entirely to hybrid cars- affecting revival of US manufacturing and advanced technologies for electrification of cars? Toyota will invest $14 billion in a battery plant site in North Carolina, at a site located between Greensboro and Raleigh.The plant will make batteries for EV's and hybrids so that Toyota can respond to market demand and regulatory changes. This North Carolina plant will supply factories assembling cars, hybrids, plug ins that travel short distances before switching to gas. Hybrids including plug in hybrids make about 15% of US sales, a sector Toyota dominates. How does it affect tariffs risk? Currently Toyota plays a 15% tariff to import plug-in hybrids. The North Carolina plant will build capacity for batteries to put in 74,000 plug in cars, 45,000 EV's, 600,000 hybrid cars. How will it fight climate change? Toyota has always believed that hybrids with twice the mileage of gas cars are a good way to fight climate change, even when EV's were the rage in the days of the Biden administration. Hybrid Camry at $25,000 and RAV4 at $29,000 give 51 and 41 mpg. This strategy is now turning out to be the right one because of cost of living concerns balancing climate change concerns as priorities. It was alone in this view and took a lot of criticism for this. Now that rare earth metals that are hard to access from China are needed for EV's it is proving doubly right- giving Toyota the opportunity to double down on hybrids and also move into EV's with short range distances using gas after that. Future design of cities that are self sustaining in smaller distances, eliminating long commutes, could make this an interesting option, a style of living being tried out in Nordic countries and in Germany, France. With India and China burning coal and investing in renewables at the same time this was overlooked by the climate change planners in US and EU- the solution being natural gas and renewables including hybrids for the US and EU/ Japan advanced nations.   ...

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This NYT article looks at another side of Biden in the meeting with Putin, Biden's optimism. Biden says of his style- "the important thing is to put an optimistic front, an optimistic face." By doing this he achieved more with Putin than was thought possible after years of deteriorating relations. In a way it could be said that Biden brought the optimism that Russia, Germany, France, India, and other nations, the rest of the world also need, especially now during the pandemic. He prepared carefully for his meeting, more than most presidents, much more than Reagan, Trump or Obama. He met with German and French  leaders, prepared with Blinken and Sullivan, coordinated with G-7 allies at Cornwall in the UK, in a way that was rarely done before.  After the meeting Biden could tell reporters "The country has put a different face on where we've been and where we're going- and I feel good about it." It is also a measure of Biden's leadership style that he took a constructive approach in the face of difficult issues.  Biden based it on a sound footing. The way Biden says "is to know what your adversary's interests are." In Russia's case Biden and his team see this as "legitimacy, standing in the world stage." And for Russia "desperately wanting to be relevant." For the most part Putin and Russia responded positively to this effort by Biden to change the tone, texture of voice, and manner in the conversation. ...

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The full text of the letter is given here. In this letter the U.S. sets out some important facts about events that happened during the coronavirus crisis during the crucial 4 month period from December 2019 to March 2020. Every week lost in this time due to reasons of a lack of transparency, openness meant hundreds of thousands of people more infected and tens of thousands of deaths worldwide. There are questions of transparency, of openness and this raises questions about the manner in which the World Health Assembly operates with hundreds of small countries in Africa and Asia having votes equal to that of the U.S., India, Brazil, Mexico with votes taken of over 200 countries. The entire election process can now be seen as questionable, when over a billion people in one country alone such as India or hundreds of millions in Brazil and Mexico would have to bear the consequences of poor decisions made by small countries that can be swayed in one direction or another based on political bias and other considerations that have nothing to do with global health.  At the conclusion of the letter by the U.S. to the current WHO shaped by a controversial election in 2017 the following is stated about the standards set by Gro Harlem Brundtland and which helped the world prevent the SARS crisis which originated in China in 2003 from spreading to the large countries of the world India, Brazil, Mexico, and other such countries in Asia and Africa, Latin America, and the U.S. European Union. "In 2003, in response to the outbreak of the Severe Acute Respiratory Syndrome (SARS) in China, Director-General Harlem Brundtland boldly declared the World Health Organization’s first emergency travel advisory in 55 years, recommending against travel to and from the disease epicenter in southern China. She also did not hesitate to criticize China for endangering global health by attempting to cover up the outbreak through its usual playbook of arresting whistleblowers and censoring media. Many lives could have been saved had you followed Dr. Brundtland’s example." Even this does not come to grips with the flawed way in which the election of WHO head is done. It can no longer be relied on when there is the danger that lack of transparency can emerge in the WHO leadership itself because of a flawed process. It risks endangering the lives and livelihoods of hundreds of millions in countries such as India, Brazil, Mexico, as well as in the relatively small countries of Africa and Latin America where even basic water supplies are at risk but which could tilt elections at the World Health Assembly. Consider that a cyclone just hit the Indian state of West Bengal and Bangladesh on May 20 just as the coronavirus pandemic is spreading. That this region of 1.5 billion people had just 2 votes out of over 200 cast at the World Health Assembly in 2017 shocking. And even these votes cast based on old geopolitical considerations not how good the candidate is, and how good the country he is coming from is in terms of its record  on public health. The irony here is that private foundations in the advanced countries in the U.S. and Europe some of whom are major donors to WHO did not think that more experienced candidates in their own countries with a better record of public health such as in France or Germany are better qualified, in a flawed NGO support mentality left from the Clinton years. Basically the people in these large countries such as India, Brazil, Mexico were disenfranchised, when the austerity policies were consuming the European Union, and the U.S. had just elected a new administration itself groping for ways to reverse years of neglect of public services and infrastructure priorities. They would trust good leaders no matter where they come from, who have a record of transparency, leadership, and all the values we cherish together no matter where we come from. ...

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Brad Stulberg reflects in this article on the idea of groundedness and how it creates internal strength and a sense of fulfillment in life. The pandemic has worsened mental health and created the need to reflect on living a better healthier life. Here he points out that one needs to accept the present, the mess of vulnerabilities he says we find ourselves in, as a natural part of life. To build on a good process that gets us there. This means clarity, simplicity, and concentration so that one does not end up wasting one's energies in different directions. Focus on one or two tasks, what he calls deep focus work, play and connection. Experts say it is not true that there are sudden leaps in performance. Most work is diligently done each step preparing ne for the next step which eventually with patience and persevering on tasks brings results. They only appear to be sudden achievements, but always build on work done before patiently and step by step. This can be seen in the work of recent Nobel prize winners in science who have worked on a new discovery for decades with failures that were overcome, and obstacles that were surmounted with patient work day after day. Stolberg quotes St. Augustine and the Buddha on the importance of close knit groups, companionship and being part of a deep community. When Buddha's disciple Ananda says this is half of the spiritual life, Buddha says in response -  not so, this deep community is the whole spiritual life. Stolberg's new book is "The Practice of Groundedness." Much of this is also seen as important in the Bhagavad Gita and in Christianity- the ideas of simplicity and concentration in life on just one or two tasks, the clarity of mind that comes from this free of tensions.  The Cistercian monasteries all over Europe in the Middle Ages attest to this. One such abbey the restored Abbey of Fontenay in France, embodies this idea. Written about the restored abbey are the words- "The sun brings life to the austere bareness of Cistercian architecture, the way God's light spreads grace through the simplicity loving souls of the monks." ...

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France showed zero GDP growth in the second quarter of 2012 compared to the first quarter, according to the national statistics office Insee. French president Hollande will have to raise 33 billion euros in spending cuts or higher taxes to reach the target for the budget deficit of 3% of GDPin 2013, according to a July report of Cour des Comptes, a body that audits public institutions. This will be harder now that the slowdown globally is leading to expectations of slower growth than the 1% growth forecast used in the audit. French president Hollande has so far received good marks from analysts and financial markets. French borrowing costs have reached new lows especially in short term maturity bonds where bondholders are lending money at zero interest rates, partly because of the flight to safety from Italian and Spanish bonds.

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Foreign investment in the electricity generation industry has be encouraged by Russia. Ane Eni the Italian electricity generating company is a big investor acquiring one of the 5 OGK companies when its investments are complete of about $6 billion. And other European companies are following suit. E.ON a German utility has bought 47% of another wholesaler OGK-4 one of the five companies of the former UES parent of these 5 generation companoies and will acquire 70%. And a Finnish utility has invested in a regional generator. Gaz France and Korea Electric Power Corporation are looking at making investments. Russia's electricity generating business is growing at 6% and Russia is the world's fourth biggest power market. Though profits are small at present it is hoped that with deregulation profit margins will be good. The market to businessusers is already being deregulated.

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Sometimes a story gives clues to what might be happening in a way political reports and warime reports cannot. This is the account of a girl who as a teenager grew up in Tshkinvali, the Ossetian capital, at a time when Georgians and Ossetians intermarried, who has relatives in Georgia and Ossetia and in Russia. She sees the first signs of Georgian nationalism in the years following the collapse of the Soviet Union and in the years following 1991, things getting worse as Ossetians felt themselves treated differently from Georgians and felt isolated. Around 1991 the anti Ossetian pro Georgian mood was promoted by an antiSoviet dissident named Gamasakhurdia. Ms. Androva leaves Ossetia for study in Toulouse, France, in 2001, she returns in 2008 to see Tshkinvali and what has changed. She also recalls her own experiences.

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Carlos Tavares runs Stellantis the company that combined the operations of France's Peugeot, Italy's Fiat and America's Chrysler right out of his living room in his Lisbon, Portugal home one week every month. He is a believer in the advantages of hybrid work model and says most of the 75,000 workers at the company can work remotely most of the time.The quality time that is generated in this new work model that allows life balance and getting fresh air walks outside is needed when you consider that auto companies such as his are embracing world of electric cars- Stellantis will have 75 models of electric cars by 2030 In this interview with the WSJ shown here he says the fact that one is giving back high quality time that otherwise goes to commuting means you get more time during the day. Carlos Tavares says remote work is an opportunity to recreate a better life balance. He doesn't see any risk in it at all. He sees how hard people are working, harder than they did before, and says giving back one half hour or two hours of quality time actually helps the process of getting good work. Look he says after a long day of remote work people need that time to go out and have a walk for an hour just to refresh one's mind, because the work was so intense. Tavares asks why shouldn't we trust each other? He believes it is the only way to go. Asked about his own work routine for remote work.He says it is the Portuguese routine of  7 am to 4 pm or 5 pm and then an hour out for a walk. He has a small desk in his living room, and he is sitting there with his iPad, grandkids are going by but nobody sees them. Does he miss the face to face contact? He does says Tavares. He still sees other employees as he does go to the office. What about mentoring for junior  employees? This does not have to be five days a week, you may want coaching one day a week, what you don't want is someone on your back five days a week. For Tavares it is all about the quality of time that is used. On company culture the much abused word Tavares makes some good points. If you say this is the culture and hand it to somebody then how do you get that creative mind to exercize his own judgement, how do you get diversity of thinking. Tavares is forthright and honest here- he says if I give you a culture and put you in that box I will get it wrong, and by killing the valuable diversity of thinking I will make it counterproductive. Actually with French, Italian and American operations under one roof and employees of 170 nationalities there is a value in appreciating the value each employee can bring. Practices at Stellantis- Tavares says if you want your people to be in game shape or in great shape mentally don't call them or email them on weekends, so that they can use the weekend to recharge themselves. He even apologizes for calling on a weekend. Or if you email your people tell them to not respond till Monday. ...

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Christina Passariello's exceptional report from Richard Toll in Senegal on Danone's 10 cent Dolima drinkable yogurt, which is a popular snack for Senegalese. This is part of an effort to reach customers in emerging markets such as Indonesia, Mexico and other countries who live on food budgets of 1-2 dollars a day. Sales of Dolima are growing by 10% each month. The first emerging market yogurt product was a 10 cent plastic 70 gram bottle introduced in Indonesia, which took off quickly with 10 million bottles sold in the first 3 months at the end of 2004. It is popular with low income Indonesians and especially with children. In 2006 Danone introduced a 7 cent yogurt product called Shakti Doi "gives strength" in Bangladesh, with sales initially planned for rural villages but later placed in urban stores. In 2008 the concept was taken to Sengal. To do this Danone's CEO, Franck Riboud, sent a senior product manager Isabelle Sultan who had worked on the Bangladesh project to Senegal. She came up with several new ideas to improve an existing product by improving the flavor and making it creamier, using the Senegalese flag colors of red, yellow and green on the package to help illiterate customers recognize the packaging, and priced it at the 50 CFA coin or 10 cents, a common coin used in Senegal. The name "dolima" means "give me more" in the local Wolof language. In 2009 42% of Danone's sales were from emerging markets, increasing from 6% 10 years earlier. Danone now reaches 700 million people and is aiming at reaching one billion customers by 2013. Other products include water at 15 cents in Mexico- where the alternative for many rural Mexicans is soft drinks that increase obesity. P&G is promoting hygiene for women in Mexico with its low price shampoos and feminine hygiene products and helping improve the quality of life for ordinary Mexicans. ...

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This view from Udo Bauer of DW.com about the Berlin elections says the result with the CDU and the SPD each losing about 6-7% of the votes cast is more about the unpopularity of the CDU candidate Henkel and the SPD candidate Muller. He says Muller had about the charisma and appeal of a paper clip compared to the previous Berlin Mayor Klaus Wowereit who showed vision and assertive action. Other local issues were important in the election including crumbling infrastructure and dissatisfaction with services. The AfD won about 14% of the votes with its appeal to voters opposed to the refugee policy of chancellor Merkel. Yet Bauer thinks, like the Republican party in the past this could be a passing phenomenon, after voters have expressed their grievances about chancellor Merkel's "we can manage it" on the refugees. Something Merkel now says people read too much into. The SPD too has a lot to reflect on for handling local issues, says Bauer.

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This report in The Guardian provides and interactive way of understanding easily what is happening in Ukraine that is affecting the world's grain supplies. The severe impact is in Africa and Arab countries such as Egypt that depend heavily on Ukraine and Russia for wheat imports. Prices are now twice or three times for food supplies that put severe constraint with lack of funds in heavily indebted countries. World Food Programme lacks funds for supplies to Yemen and other countries affected by war or drought conditions. The heat wave has also reduced agricultural production by 5-10% in countries that normally export from Europe such as France.

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Moritz Kramer, a managing director at S&P, says Spain, Italy, France and Portugal cannot depend on austerity measures and cuts in spending alone to resolve the eurozone crisis. This is only one aspect of the problem facing the countries in southern Europe. The major reason for the problem is the lack of competitiveness in their economies. Nobel winner Stiglitz also points this out and adds that its important to note that the human and natural resources of Europe are the same and the potential just as good today as before the eurozone financial crisis. He says southern Europe has failed to utilize its human and capital resources and improve its technologies in ways that would make it more competitive with Asian countries. Experts point to the decade it took Germany to address problems created by inflexible labor markets, wage competitiveness, and investments in technology and human resources to get to where it is today.

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Krugman questions whether the assumptions behind the austerity policies are true- that they would inspire confidence in economic recovery, or that in the absence of austerity policies borrowing costs would go through the roof. The recent events in Holland with the collapse of the government in the Netherlands- when a party leader supporting the government said he did not want to hurt pensioners in the Netherlands just to satisfy German opinion- and the mood in France with economic anxiety vote going to Marie Le Pen and Francois Hollande in the first round of presidential elections, shows that very little confidence has been created. High unemployment and economic anxiety are leading to a reappraisal of austerity cuts that depress the economy and reduce tax revenues, but Krugman says no changes are taking place to correct these policies. This is true for Spain with its high unemployment, and Britain which now has two quarters of negative growth.

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India lags behind in the number of tourists visiting the country. Part of the reason was the lack of good infrastructure in the country. Indian Railways and new highways, modern river transport has opened up remote parts of the country from the jungles of Assam to deserts of Rajasthan, the mountainous regions of Kashmir, Sikkim, Bhutan and Ladakh, Arunachal, and the river regions of the Brahmaputra river and Ganges to tourism. Compared to France with 100 million tourists a year India has about a tenth of that.  Tourism is now seen as an engine for job growth as small handicraft industries can tap into the tourist market, hotels and restaurants can add to employment. The new budget for 2025-26 recognizes this by almost tripling the 95 million euros budget for 2024 to 283 million euros in 2025. Delhi with images of pollution is a distraction yet the tourist from Europe or America can find much to see in smaller towns and metros in the country from Buddhist and Vedic civilizations thousands of years old and recent history after invasions from Western Asia and Europe since 1600, and interesting cuisine, culture, language and regional influences. ...

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WSJ looks at the changes in the way medicine should be practiced in the light of what we have learned from the pandemic.  Medicine practiced before the pandemic and still today relies mainly on a visit to the doctor or specialist who is short of time. There is a shortage of doctors. Patients have many illnesses as a result of decades of neglect of proper nutrition, and exercize habits. Obesity is at about 40% in the U.S. about 30% in the UK and 17% in France, and high also in other parts of the world. These high rates were unknown throughout history and result in many illnesses and increase by four times the vulnerability to the coronavirus. One authority in medicine calls obesity pouring gasoline on a fire for effects of the virus.  A doctor's appointment with doctors short of time with no coordination around a whole range of factors related to obesity, illnesses, health checkups, mental health, is now seen as a heavily handicapped way to practice medicine or for patient healthcare and wellbeing. The alternative is discussed here as the way forward. A  team will be responsible for a patient's care not just an individual doctor. The team would care for general health after a patient's checkup, cover individual illnesses, weight issues, mental health, exercize nutritional needs and other good healthcare habits. Instead of relying on doctors at a time of shortages of doctors the team would be led by nurse practitioners.  A nurse practitioner is someone with a bachelors degree and a masters degree or doctoral degree in nursing with 1000 hours of clinical training. Studies have shown that they are effective and even more effective than individual doctors. Today particularly with the problem of doctors with limited time compounded by the built up problems of decades of bad habits in nutrition and exercize and poor "cultural" habits getting entrenched, there has never been a greater need for a better way to practice real healthcare for a person's wellbeing. Particularly in rural areas with an even larger shortage of doctors the health practitioner led team will play a big role. Patients will under this setting receive more care virtually and get more followup care by phone and video messaging. The numbers tell the story- there are shortages of doctors in USA, Europe, Africa, Latin America and Asia. In the U.S. shortage of doctors is 55,000 projected to 2033 by Association of American Medical Colleges. There are 290,000 nurse practitioners licensed in the U.S. and 131,0000 physician assistants. The goal will be to get an adequate number of nurse practitioners licensed in this decade to take care of these teams. The pandemic has made virtual visits to doctors and nurse practitioners popular. Medicine reimbursement should and would be practiced on the basis of how well a patient is doing not on a fee for each micro service that is delivered. For this to happen the teams led by the nurse practitioner have to commit to patient education of the benefits from good practices and good habits for nutrition, exercize, caring for oneself. A doctor short of time is hardly the person to carry on this patient education which is where the major opportunities for a new system arise. The virtual care also provides a new medium for patient education and awareness of the risks of getting illnesses, preventive actions to be taken in advance. One approach being tested in California and Texas is for a monthly fee for patients more payments by health plans to doctors or healthcare teams if the patient is healthier. Additional health professionals are added to the team including health coaches, dietitians and medical assistants to increase its effectiveness in counseling and education and monitoring.  The nurse practitioner team approach is already being practiced in parts of the U.S. including the example of New Hampshire shown here, and is predicted to be the approach for primary care in the next decade. ...

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One foreign policy expert says president Trump tried to reverse everything in Obama's foreign policy almost to the point of an obsession. He visits Saudi Arabia before visiting Mexico and Canada, close neighbors, as other presidents have done. The relationships with Mexico and Canada deteriorated. Yet Mr. Trump has a good personal connection with Trudeau of Canada and Macron of France.  Taking the advice of advisers including Commerce Secretary Wilbur Ross, president Trump despite tough talk on the North American Free Trade Agreement, takes a moderate approach on NAFTA renegotiation. Trump also softens some of the rhetoric on China as he seeks Chinese help to restrain North Korea. An international coalition of states supported by the U.S. reverses gains by Islamic State, with Iraq and Iran gaining over Islamic State. President Obama's policy of not taking decisive action, reversed towards the end of the second term, had led to the rise of Islamic State and the refugee crisis in Europe as refugees left Syria and Iraq. NATO or the South Korean defense was not significantly weakened as feared at the beginning of the first year. Missile defense proceeded in South Korea with U.S. missile systems. The appointment of a senior senator from Texas, Kay Hutchinson, signaled that the NATO policy had not changed significantly. As a result it could be said that the year 2018 began with a bang about the risks internationally with president Trump's unconventional approach, and ended without some of the worst fears being realized. Relations between North and South Korea improved as Koreans decided to work together for peace in the peninsula- with North Korea agreeing to participate in the Winter Olympics in South Korea.   ...

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There are differences between the governors of 10 worst hit states and the president of the U.S. on when to reopen the economy. The seven on the East Coast including New York, New Jersey, Connecticut, Massachusetts, and three on the West Coast including California and Washington, all but one have Democrat governors and want to wait beyond May 1, till it is believed to be safe to reopen.190,000 of the 592,000 infected cases and over 10,000 of 25,000 cases of deaths are from New York alone. This is as though a third of the problem is in one state. The feeling in New York is that it should be the last to reopen, other states can go first in the middle of the country. The position in the U.S. Constitution is for states to maintain public order and safety. This was the basis of the president's position to work with the governors and continues to be the case, though there is pressure from economic advisers to the president to reopen earlier balanced by the opinion of health experts around the president.  Some states are taking action to reopen because the virus has not severely affected these states. President Trump says it is for governors to decide what is best for each state in consultation with the federal government. The U.S. government would step in if a state is taking risky action with the coronavirus. On the issue of whether the president could have acted quickly in February following his decision to stop flights from China and set up quarantines in January, the BBC has this to say. Dr. Fauci, the president's respected health expert was one of many public officials who did not see the magnitude of the crisis evolving with lack of good information from China. BBC North America Editor Jon Sopel cites Dr. Fauci's comments on February 13- that the coronavirus danger is "just miniscule" compared with the "real and present danger" of flu. As it happened the president acted alone in his sense of the danger from the outbreak in China through incoming flights and not relying on others. Here is what the situation of each country on reopening is- India -  has extended the lockdown to May 3. France - has extended the lockdown till May 11. U.S. - has extended the lockdown to May 1. States are taking the responsibility. UK - continues lockdown restrictions till May. The French president Macron had a simple answer to the question " when will we be able to get back to a normal, prior life?" Macron said "Quite frankly, humbly, I have no definitive answer to that." Some nurseries and schools will reopen May 11. Not restaurants, hotels, museums and theaters. By May 11 France will be able to test and quarantine anyone with symptoms and general public masks will be available to all. This is what Dr. Fauci in the U.S. also wants to see before being able to reopen, that testing and tracing, isolating, procedures be efficient and reliable. ...

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The close alliance between the CDU and the CSU in Bavaria appears to be unraveling. The immigrants at German borders have dwindled down a trickle, about 11,000 immigrants today compared to the wave of immigrants entering Germany in 2015. The CSU's prime minister in Bavaria Mr. Soder and the Federal Interior minister from the CSU Mr. Seehofer, blame the conflict between the two parties on the 2015 decision by Merkel on immigration. The German ARD broadcaster shows 62% of Germans favor stronger action on immigration. The pressure on the CSU comes from the gains by the anti-immigration party AfD in recent national elections. The CSU hopes that by shifting its own position on immigration to a standoff with the CDU and Merkel's position it can hold off the Afd in the elections in Bavaria in October 2018. The pressure on Merkel comes from members in the CDU and from the SPD leadership, which have accomodated some of the criticism of open immigration to reduce the immigrants at German borders, yet now see the need to meet any challenges to Merkel's authority. This is why the head of the SPD, Ms. Nahles called Mr. Soder's push for a confrontation on the immigration issue as acting "like a bonzai Trump." The CDU party leaders in Bavaria call for a "axis of the willing" joining leaders of the governments in Austria and Hungary. and the newly elected government in Italy to impose immediate controls on immigration at the borders. Merkel says she is open to different points of view within the CDU-CSU alliance, but action should be based on keeping the European Union together, and be taken after EU meetings in Brussels. Will this result in a fall of the government? Angela Merkel has adapted to the changing situation on immigration leading to the small trickle in new immigrants at German borders today. Even if the AfD anti immigration party joins the CSU the percentage of the vote for the AfD is mainly in the eastern part of Germany, and CSU in Bavaria, with 12.6% voting AfD in 2017 elections, and about 7% voting CSU mainly in Bavaria. This compares with the Left at 8.9%, Greens at 9.2%, and SPD at 20.5% for a combined 38.6% of the vote that favor Merkel's new coalition policies. This combined with the 25% of the vote gained by Merkel's CSU party gives it about 64% of the vote and about 489 seats in the 709 seat German parliament. A test of Merkel's authority is not likely to be sustained. By making this a pro-European position Merkel has shifted the issue from one of immigration which is now minimal and one on which Merkel has adapted her policies to a stand on Germany as leader with France of the European Union. At this particularly sensitive time when Germany and France are negotiating with the U.S. on trade and Britain on Brexit, German public opinion is likely to consider the impact of new elections and more uncertainty as not good for Germany. With the SPD, Left, Greens and CSU having 64% of the vote, and the anti immigrant parties CSU, AFD about 20% concentrated in the less economically developed eastern part and in Bavaria, the chances that Merkel's position would be weakened or her authority challenged is very unlikely.   ...

LyrArc Article Gist
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. ...