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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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 South Korea has run about 300,000 coronavirus tests, double that in Italy and ten times that in the U.S., says this report in the WSJ. This report shows how the South Korean testing works and the workday of Lee Hyuk-min, a clinical microbiologist at a testing lab of Yonsei University Health System Severance Hospital in Seoul, who is working from 4.45 am to 11 pm. South Korea's effectiveness in controlling the spread is based on a strategy of efficient testing that enables isolating quickly people and areas. South Korea's testing network is a legacy of the MERS coronavirus outbreak in 2015, and the government failure at that time to control it.  It brings together doctors, medical staff, labs, and political leaders in roles following the protocols established since then. Dr Lee and others are the final checkpoint in the system which coordinates a diagnostic operation that combines together 633 test sites and 100 labs. The protocol includes a uniform setup- same testing equipment, same training, same decision making process. At 8 am each day all labs upload results to a shared database, which allows public and private hospitals to monitor patient results and report them to Korea Centers for Disease Prevention and Control. Hospitals upload testing details to an online directory. This surveillance allows South Korea to predict where to concentrate its efforts for controlling spread, says Dr Lee who advises the South Korean government on lab testing issues. Action plan took 2 years for the new rules to be implemented following MERS in 2015. The plan included accelerated bio testing company approval for tests. The first company got approval on Feb 4, followed by 4 other firms. Dr Lee says testing is only part of the equation as labs are needed to process and confirm results. Another key is innovation. South Korea setup testing in drive thru locations, that limit contact and speed up testing, which the U.S. is adopting. Dr Lee says early identification is key, and identifying the first coronavirus patient which was done in South Korea on January 20. Other countries including the U.S. took too long to identify the first patient, says Dr. Lee. ...

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

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On March 20, reports show that the testing facilities in states in the U.S. have had to set priorities on who gets tested first. High risk areas identified by authorites come first. For this reason Corlado health authorites moved a test centrer in Denver to Telluride a ski community that has been hard hit. In Minnesota health department commissioner identified priorities and limited testing to health care workers, inpatients at hospitals and people in group living facilities. A backlog means tests can take 5 days in Colorado, and Colorado has capacity for 250 tests a day (March 20). Testing was centred first by the U.S. government at the Centre for Disease Control. On reconsideration the state and local authorites, private companies, were allowed to conduct the tests, to speed things up. But local areas in many cases lack supplies or enough test kits and protective gear that is needed. This WSJ report says that the Trump administration is also shifting their strategy to social distancing to contain the outbreak. The federal government says it is aware of shortages in chemicals used in the tests. New York City officials say they have testing capacity for 5000 people per day, and New York State Governor Cuomo says the state can test 6000 people per day. (March 20). ...

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

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Seattle is now the first U.S. city experiencing what it is like in a lockdown with streets empty. Seattle metro area is a city of 4 million with growing economy - at 6.9% growth, and 50% increase in jobs since 2010. New rules in Washington state are to wash your hands leaving the house and re-entering, no one going to anyone else's house. 

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As the coronavirus hits the economy and money markets, not even gold and safe bonds are places people are turning to. The shortest term bonds and cash have become important. Short term money markets are strained and companies are drawing down on their credit facilities while they can be accessed. From the view of small business or big business it is liquidity and cash that matters now. People and businesses need cash to cover rent, fixed costs, other bills. Small businesses have less room for error and need to plan carefully. The dollar is surging against all other currencies. This is the situation on March 18, 2020.

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The Trump administration is preparing direct aid to Americans and American industries hurt by the coronavirus epidemic. Each check will be based on family size and income, according to a Treasury Department memo seen by WSJ. The direct payments in two rounds will be on April 6 and May 18. This is part of a $1 trillion stimulus program. $50 billion lending facility is being setup for the airlines. Another $150 billion goes to distressed sectors in the economy. $300 billion will go to a small business interruption loan program, which will go to temporarily cover payroll costs for employees. The idea is to put a safety net and support workers who will need help while they are not working. The measures include two weeks of paid emergency leave for a large number of people. Money also goes to additional Medicaid funding, more money for food stamps, and for unemployment insurance program. Congress has passed the bill and president Trump is expected to sign it into law. Other bills will follow in Congress. A third economic package will cover additional needs of agencies of government, with $11.5 billion for Department of Health and Human Services, and Departments of Defense, Veterans Affairs, Homeland Security. All this is being done in Congress and by the Trump administration at top speed. ...

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The divergent approach to coronavirus taken in Asian societies and Europe.

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Some young people in Germany, France, Spain, Italy and the U.S. who are ignoring the rules about social distancing and restricted social gatherings are seen as endangering the fight against coronavirus. Health authorites are highly concerned about carefree youths and young people not following the new rules.

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The word "elderly" is going out of common use, the CDC in the U.S. has crossed it out and uses the words 'over 60." Parents bristle as the term elderly takes on a new meaning in the days of coronavirus in March 2020. One of the baby boomers at age 64, who has completed 40 triathlons in last 7 years asks if she can really be called elderly. Parents bristle with texts and calls from children in the thirties to change travel plans, with most deciding to stay put at home. Yet as other reports show most younger people in their thirties and forties are also working from home with their kids around them.

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The mandatory social distancing required to overcome the coronavirus epidemic is leading to more parents working from home. With about half the schools in the U.S. closed and entirely closed in other countries, kids are also at home. Traditional options of child care provided by grandparents, family friends are now not acceptable with the required social distancing. This report looks at how parents are coping by setting time aside when kids are asleep for work. Advice to parents offered here is to accept that the day will be broken by interruptions, to take a break at these times and relax rather than try to follow the organized routine of a workday when things were normal.

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Every day lost in the struggle with coronavirus is a big thing, which is why Itay's most affluent northern region has gone from being well equipped with resources of healthcare to seeing the health system overburdened to the point of disaster. This WSJ report shows why this has a lesson and an early warning for how the U.S. and other countries should design their response. It is also why the White House team that includes President Trump in the U.S. emphasized the plan for just the first 15 Days in the news conference at the Brady Room in the White House on March 16. It is saying the first 15 days are critical, not a day to lose.  It does not matter if you are an advanced economy with state of the art hospitals. Social behaviours must change, old rules rewritten and implemented throughout nations, quickly in days. Here WSJ shows lessons learned by Dr. Cereda at the Hospital of the University of Pennsylvania who trained in Milan and was in constant contact with colleagues in Milan and elsewhere. Many of the lessons relate to not overburdening hospitals and health systems and protecting health systems. This means mild to moderate cases are managed from home and not in the hospital, through massive deployment of outreach services and telemedicine. It means therapies can be delivered at home or through mobile clinics. The second major lesson from Italy is to protect healthcare workers and doctors. The entire White House team with Dr Faucci of CDC and Dr Brx, head of Infectious Diseases in the U.S. news conference of president Trump March 16, focused on the goal of protecting healthcare workers, doctors and hospitals, so they remained strong to take on the crisis. The second goal of the White House team is to protect the elderly with medical conditions. To do this only the most serious patients are treated in hospitals the rest for mild to moderate at home.  Studying the conditions in Bergamo and other parts of Lombardy and northern Italy, is helping U.S. medical leaders to prepare for the current nationwide effort, the 15 days plan announced by the White House. The lessons from the Papa Giovanni Hospital in Bergamo are important say U.S. medical leaders, including Dr. Brendan Carr, head of emergency medicine at Mount Sinai Health System in New York.  He says build capacity in hospital beds before we need it. Clear out hospital space and add new hospital beds.  ...