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How is it that Britain's regulatory agency approved the Pfizer vaccine before the U.S. FDA agency? This report in the NYT says FDA looks at the raw data. Britain's Medicine and Healthcare Products Regulatory Agency looks at the information provided by the company. It still does the testing batch by batch and has access to the data and looks at thousands of pages of data. What about the European Union? The European Union Medicines Agency meets on December 29. It takes days after it meets to get input of 27 countries so that vaccination cannot start till January. The U.S. president summoned the FDA to the White House to find out how soon the FDA could act. Both Britain and the U.S. are feeling the impact of the second wave of coronavirus.

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South Korea has tested about 300,000 people for coronavirus. About 20,000 can be tested daily for coronavirus through 40 drive thru locations. South Korea invented this method of testing. Another feature of the South Korean method is the tracking down of people who have come into contact with those testing positive for coronavirus. The South Korean government is able to do this because it can access the credit card and cell phone information of people in the country. This is possible through laws that were passed after the failures during a previous epidemic of MERs. The government then tracks down and isolates the people who came into contact with infected persons. This includes people who show no symptoms, an important aspect of the South Korean program which needs to be adopted in other countries once the production of test kits and testing is ramped up. The reason is that about 30% of people who tested positive in South Korea were not showing any symptoms but acted as silent carriers. This is similar to the figures for people in the Wuhan region of China. This testing capability is one of South Korea's key strengths, though Germany's Robert Koch Institute says it has a similar capability to test 160,000 people a week. The U.S. has tested about 30,000 people by comparison. The U.S. government is procuring 60,000 test kits under the Defense Production Act. South Korea also enforces social distancing though a $2500 fine and a 1 year prison sentence. Germany now has a 2500 euros fine in some states for curfew violations.  By comparison the fine in Britain is insignificant.  Another difference between China and South Korea with Germany and the rest of Europe, the U.S., is that in China and South Korea self-isolation is monitored, tightening the control over coronavirus spread at every turn.   ...

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

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This analysis from The Times of London provides critical information on the strategy for successfully tackling the coronavirus following the example of South Korea and progress in Britain.

The random community testing is key to getting an idea of the scale of infections in the community at large. The critical ratio called reproduction ratio tell one if the virus is under control and how lockdowns can be lifted. For Britain this 0.7 estimated by Imperial College. It has a 2 week lag. 1.0 or close to 1.0 is not good. Germany after being at about 0.7 has moved up to 1.0 with 2 week lag in information says the Robert Koch Institute. This means a lot of work ahead, it won't be easy.

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British prime minister Boris Johnson announces tough new measures that make it illegal to socialize in gatherings of more than six. This is an effort to fight a second wave of coronavirus in Britain. The government now believes that normal life will not return till spring and that "moonshot" mass testing will be needed to contain the virus. The new "rule of six" goes into effect in Britain on September 14, and anyone "breaking the rule risks being dispersed, fined and possibly arrested." Covid marshals will patrol city centres to split up large groups.

Schools workplaces and restaurants will be able to hold more than six people in total but they will have to be groups kept separate. The prime minister said it was needed to stop Britain from the exponential growth happening in France. He said "a stitch in time saves nine."

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Jeremy Hunt, head of the Health Select Committee and Health Secretary 2012-2018, says Britain needs to take up mass contact tracing as its next national mission. Britain he says has passed 20,000 tests a day for coronavirus. America has passed 150,000 tests a day. Both more than South Korea. What is missing when compared to South Korea and Taiwan is mass contact tracing.  The app TraceTogether is not enough, as it was used by only 20% of Singapore's population. Only South Korea and Taiwan are able to open up the economy, have workplaces and life function close to normal through extensive testing and mass contact tracing, with feet on the ground. This is the only path that has worked with South Korea successfully out of the lockdown. This means "feet on the street." Making these calls requires skills, getting information, getting cooperation, offering guidance, and ensuring people isolate themselves after contact with an infected person. Sometimes it is by phone and sometimes in person wearing full PPE. They need to be sensitive enough in talking to someone feeling ill and to see how home isolation can be achieved, who else the coronavirus infected person or someone in the chain of contacts has been in contact with. Mr. Hunt says no effort should be spared in doing this as the millions of jobs in Britain, of people without work, the economy, and the need for light at the end of the tunnel of lockdowns, requires a way out. A huge task but a lot of impossible tasks are being tackled in the health services. The resources of Britain, every spare civil servant, every administrator not working, every one who can do this, needs to be enlisted to do this. The same task needs to be tackled in America, and in other countries as a national mission. ...

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The asymptomatic coronavirus infected people are a large fraction of the people with coronavirus. This is a huge problem as these people unaware of the danger are unwittingly spreading the virus. This is one of the most unusual aspects of this virus compared to other virus epidemics, and why it has become so dangerous. It is also why social distancing alone is not enough. Strict enforcement of stay at home orders by public health authorites, state and federal governments is essential as the unwitting spread by asymptomatic people who are not following the required guidelines is a huge problem.  Even as the public now calls for stricter action the lax behaviours in March in U.S. Britain, France, Germany, and in Italy in February, have created a population of infected people that acts as a backlog for testing, creating a surge in April. One of the novel features of this public health crisis is that lax behaviours stemming from a lack of understanding of the severe contagiousness of the coronavirus is making it a larger crisis on a scale not encountered before.  The contamination potential of this virus is only now being tackled with experts in fluid dynamics at labs such as the MIT Lab in the U.S. looking into how it can contaminate environments, as shown on BBC News.  With pieces of the contamination puzzle only now being put together. Heeding public health expert warnings and guidelines is all the more essential for this reason. ...

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Britain recorded the most deaths in Europe. Brazil and Russia have over 10,000 cases of coronavirus each, and the U.S. records cases close to that in the peak in April. Cases were up worldwide for May 6 to 92,000 with a quarter of these cases or about 24,000 in the U.S. The jump in cases takes the total to 3.77 million with a third of them in the U.S., according to John Hopkins database. Russia and Brazil had a slow start but are now registering large numbers of cases showing that India and other countries with limited testing could face the same situation. Russia has ramped up testing, and so have the U.S. and the UK. Moscow's mayor Sergei Sobyanin says for example that about 300,000 of the 12 million people in Moscow have the virus based on sampling surveys, more than 3 times the confirmed cases. Restrictions remain in place in Moscow beyond May 11.  Countries that were hit earlier by the virus such as Spain and France are reopening gradually after May 11. France will use red and green zones to handle restrictions so that the restrictions are customized to each place in the country. ...

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This report in the Times says there are divisions in 10 Downing Street, between Mark Sedwill, the top civil servant, and the prime minister, Boris Johnson on implementation of a coronavirus plan, Mr. Sunak the finance minister and Mr. Johnson on reopening of the economy and the spending plans. There are also frustrations among Tory MP's, women, and ministers, who are left out of the centralized decision making where only a few people around Mr. Johnson- Gove, Hancock, Sedwill, Sunak, Cummings - know what is going on.  Mr. Johnson has not rested well says the Times and Mr. Sedwill also had the virus it is reported. Mr. Hancock is not trusted by Tory MP's to execute the plan correctly for testing, tracing and isolation of clusters, crucial to controlling the pandemic and restoring confidence in the economy. Mr. Johnson also face the prospect of an inquiry into nursing homes- he responded to Keir Starmer of the Labor party in parliament that he"bitterly regrets" what happened there. More money is being poured to control this. There is a sentiment of acceptance that Brexit talks are going nowhere and Britain simply walks out with no deal.   ...

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

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Germany has shown that low tech contact tracing efforts work- no apps needed, a phone, a desktop computer with a centralized database, and most important the human relations skills of the person doing the calls. The  sensitivity to the situation facing each person being called, being able to talk to the person in the language they speak in a multilingual environment such as California, is shown here. A 40 person team operates in San Francisco consisting of public health officials, clinicians, medical students and librarians. They call the contacts of people with coronavirus, arrange tests, and as needed send packages of food and medicines to hotel rooms or homes. Every call is expected to last 15 minutes but all sorts of questions are handled.  English and Spanish are used. Here one of the persons doing the contact tracing says she does not use apps, just an open source software used in the fight against Ebola. Definitely low tech, no waiting, get going is the message to every city in the world. She says apps software such as what Google and Apple are putting out can tell you whether the person went to some place, but cannot tell you more about that person, cannot tell you about problems the person is having being tested, and how they are having difficulty providing for families. One of the big lessons from Germany and efforts such as this one in San Francisco, and in other places such as Paris, Singapore, Taiwan, is that there is a complex nature to contact tracing that cannot be solved by tech. In fact the best thing to do is to get started immediately, with a phone and a database on a computer, as long as you have a person who has the motivation and skills, empathy with people, a lot can be done. Waiting for apps is a dangerous waste of time is shown by the low tech German experience, and the experience in other places. Most important is starting immediately. The example shown here of working with migrant workers in contact tracing shows in the most vulnerable places it is these human relations skills that count, that no tech app can do. It requires detective skills to find out and get people to share their history of movements and contacts for 14 days . In Singapore crowded dormitories house 300,000 of 1.4 million migrant workers. Singapore using an app also but its use is secondary. Apps don't work in many situations but fail in the most critical situations such as these dormitories and other eccentric or atypical situations such as faced by South Korea with religious groups and gay communities, elderly people in Europe, that generate the worst dangers of spread and need to be cluster isolated quickly. Human contact tracing has a history of being an effective method and was used in China and South Korea during the 2003 SARS epidemic. More countries need to adopt the method used in Asia and in Germany, particularly Britain, the U.S., France and India. It is OK that Britain's NHS and India's national government with Aarogya Setu app have put out their own apps which balance privacy concerns with the need to act immediately and cover the entire country, but the hard slog of human contact tracing teams in each district is indispensable. This is why the former Health minister in Britain calls it Britain's national mission to do this. Speed is key- putting together teams across the country in every district from skilled volunteers or government workers, and pulling together the phone and a centralized database on a computer as basic equipment. The fact that this is easily doable and people with human skills needed can always be recruited as they have been in Germany- from public officials in local government who are less busy in lockdowns, medical students, clinicians, volunteers, people from different professions- makes it inexcusable not to learn from others experience and get going. Just Do It. You want to reopen business, professions, offices and public services- Just Do It, it makes this possible. You want to prevent spread of the virus- Just Do It, it makes this possible. You want to limit damage to the economy and get the recovery going- Just Do It, it makes this possible. People of all shades of opinion can agree on this- its the only thing that works, even when there is a lack of enough proper accurate testing. ...

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The React-1 study from the Imperial College of London acts as an early warning system for the UK on coronavirus. The latest study has raised alarm about spread of the virus that is not related to testing and is across all age groups leading to the new rule of six by prime minister Johnson. This bans gatherings of more than six as Christmas approaches. During the  period in July to August the virus was taking 17 days to double now this is at 7 days.  The React-1 study for Aug 22 to Sept 2 shows 13 per ten thousand being infected and compares to 4 per ten thousand July 24 to Aug 11. It is a robust study with swabs sent in for tests from 300,000 volunteers in Britiain. Prof. Eliott the director of the study at Imperial College, London, says that "there is an epidemic in the community and there is no room for complacency." The R rate is measured at 1.7 in this study which is taken seriously by the government as an early warning of what could happen. ...

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

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The coronavirus pandemic and the disaster in nursing homes, the chaotic conditions in the first wave, the lack of staff and poor attention to residents during the pandemic, has exposed the major weakness of nursing home care in western countries. Much of this sector is in the hands of private operators seeking a profit.  The staff is paid low wages and lacks the experience and empathy needed for care of older people. During a virus all these factors turn deadly. With some staff sick the other staff is overburdened. If the sick turn up for work they are likely to risk the safety of other staff and the residents. With the incubation period lack of testing there is no way to know. When deaths occur and the nursing homes are sealed from the outside world the deaths happen with no goodbyes as happened in U.S., Britain and Sweden. This has exposed the scandalous and shocking way in which the elderly are treated in today's environment where ridiculous amounts of money are being spent on other things and the the most basic "one's parents" are neglected and allowed to die in horrific manner in a pandemic. The new trend for home care for the elderly is a welcome trend and long overdue as one of the worst aspects of the system in the west is the treatment of elderly parents in nursing homes run for profit. The new technology tools available for monitoring a elderly person at home, and the help of stores such as Best Buy which are serving elderly at home, is making this more and more a choice for the elderly. Even older patients and ones needing significant care can recover and spend time at home in a better environment, a less costly one, as hospital managers and families have learned in 2020. Some hospitals in the U.S. say they never want to go back. That the drive to get every patient home who can be home is the right one for patients and families and for the government paying for the care so that dollars are well spent in quality of care. Home health care companies are working on providing new services for sicker patients recovering at home. Technology helps do better monitoring. Medicare now pays for digital doctor visits and intense hospital type care at home after coronavirus showed this as vitally needed.  Both the Biden and Trump administrations are firmly focused on this issue. Seema Verma as head of Medicare is clear about the need for a national conversation on how we take care of the elderly, of our parents. And Mr. Biden wants to spend $450 billon to make certain that people who need long term care can get the support they need in the home and the community. This report looks at the home health care companies and how they are improving their services. This and telemedicine are two of the major constructive changes coming out of the pandemic, clearing out some of the worst aspects of the old system of living the older years in the western world.  Nothing speaks more about humanity and a human world than the story here of Savanna Hollar, 90 years old and almost blind. She broke her shoulder in August, Her sons decided not to send her to a the rehab facility she went to after a broken hip 3 years earlier. The sons brought her home to recover in the farmhouse near Yadkinville, N.C., where she has lived since 1951. One of her sons himself 63 years says that at a nursing home she would be lonely, scared and afraid to move. The sons hired two people to help her during the day and a rotating system was used for having people help her. At home Mrs. Hollar could enjoy her gray cat, Buddy, her favorite recliner and tomato sandwiches made with produce from her garden. Really, if we can't do this much what good is the U.S.A.? or Britain? or Sweden? or India? ...