LyrArc Article Gist
About 40% of Americans are obese with BMI, body mass index of over 30. About 71% of Americans are overweight or obese with BMI over 25. This is a finding in a new report by the Centers for Disease Control and Prevention. This report does not mention a separate finding covered in the Guardian online newspaper showing less than 15% of Americans get the daily recommended intake of fruits and vegetables, crucial in preventing major diseases such as heart disease, cancer, diabetes. The cost to America for obesity related or weight related medical bills is estimated at $190 billion a year, in three years this would help renovate the aging U.S. infrastructure if people changed their habits and education was designed to help change the way Americans live. Even harder to understand is that only 2% of America's farmland grows fruits and vegetables, according to the Guardian report which says this would need to be 4% to meet the needs of the people in the U.S.. These are alarming facts and need more public awareness by this being getting widespread attention on the internet. ...

LyrArc Article Gist
The knowledge that the virus  caused human to human transmission and that it spreads to wide parts of the population very quickly were critical pieces of information that remained with Chinese epidemiologists, doctors and medical researchers, and were suppressed by local authorites in Wuhan.  Yet China's version of the U.S. CDC, China's Centre of Disease Control and Prevention, modeled on the U.S. control efforts worked effectively to identify the problem. Virologist Gao Fu, heads China's CDC. This report in Germany's Der Spiegel says Mr. Fu made it a habit to scan China's internet before bedtime for any signs of possible disease outbreaks. On the night of December 30 he came across rumors of an internal memo from the Wuhan Health Commission of an outbreak of a vaguely worded lung disease. When he called the Wuhan health authority he found their answers to be evasive which alarmed him. The next morning December 31 Mr. Fu sent the first of three teams to Wuhan which is how China was able to identify the problem, in the sense that Chinese authorites in Beijing were to rely on Dr Gao Fu to overcome the problem of Wuhan provincial authorites. He informed the World Health Organization Beijing office on that day. The Der Spiegel report says "shortly afterward," the Seattle Times in its report says this was about New Years Day 2020- Mr Fu made a call to Dr. Redfield, head of the U.S. Centre for Disease Control, who was on vacation. Redfield is deeply disturbed on hearing this from Fu and they have conversations over the next few days to the point that Dr. Gao Fu is in tears about what has happened. On January 1 Taiwanese public health authorites shared the information with WHO that the cornonavirus was a human to human transmission, would the Taiwanese authorites not have shared it with the U.S. the same week during calls from the U.S. CDC or other public health authorites alarmed about the situation. (The WHO was proving useless by Jan 14 when it contradicted Taiwan's more reliable assessment  on Jan 14 going by the letter from president Trump to WHO). On January 6 a few days later Dr Redfield and Dr. Azar head of Health and Human Services ask China for permission to send a team of CDC U.S. experts to China. This is cited in the U.S. letter to the World Health organization- the lack of human to human transmission information being given to the U.S. officially early by China. A risk that could have been a topic of conversation between the U.S. and China heads of CDC. That letter from president Trump also points out that the team of experts the U.S. planned to send was not accepted by China till Feb 16, one and half months after that series of conversations between Dr. Gao Fu of China CDC and Dr. Redfield of U.S. CDC in an alert message.  In effect removing one of the key defences for the U.S. and Europe in making their own defensive actions and plans, laying the basis of the worldwide coronavirus pandemic affecting millions of people. Dr Redfield is a AIDS researcher at the University of Maryland who spent most of his life trying to control spread of HIV and was appointed by president Trump to head CDC agency in 2018. He set a goal of eliminating AIDS by 2030 and is more comfortable with aids patients and research than the bureaucratic nature of agencies- CDC has about 11,000 employees. Once it was clear that a team of U.S. experts was not given permission to make its own assessment in Wuhan in the few days after January 6 offer to sent the team to China by Redfield of U.S. CDC and Dr. Azar, would it have alerted the U.S. that something was seriously heading the wrong way for a epidemic risk. That letter of president Trump cites how the head of WHO during the first SARS crisis in 2003, Dr. Harlem Brundtland acted when she faced China's lack of cooperation during that crisis by saying openly that this was a danger to world public health and millions. Could CDC in the U.S. and the other connected health authorites have taken the responsibility and filled Dr Brundtland's role in this crisis, that the WHO failed to perform?    ...

LyrArc Article Gist
NYT looks at the new Director for Centers for Disease Control or CDC in the US, Dr. Walensky. The CDC is seen as a wobbly bureaucracy during the pandemic.

LyrArc Article Gist
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). ...

LyrArc Article Gist
Rochelle Walensky talks about her plans to restructure the CDC which she says has failed the American public, in this interview in the WSJ. She calls the mistakes by the Centers for Disease Control during the pandemic "pretty dramatic, and pretty public." WSJ's Ryan Knutson conducts the interview about the Agency's many errors.

LyrArc Article Gist
Estimates show one in five new mothers or about 800,000 mothers in America are experiencing anxiety disorders during the pregnancy or a year after giving birth. Mental health disorders are now the leading cause of maternal death, says the Centers for Disease Control and Prevention. The US is the only high income nation in the world without paid maternity leave and this increases risks of mental health. About one in four women return to work within 4 weeks of giving birth. This report shows the work done by the University of North Carolina Chapel Hills's Center for Women Mood Disorders, one of only 3 inpatient facilities for mental health in the US. 

LyrArc Article Gist
Asymptomatic people infected by coronavirus are acting as spreaders of the coronaavirus making it more essential than ever that everyone wear masks. This is a widely accepted practice in Asia- wearing masks to prevent others from getting a virus. This now needs badly to become the practice in the U.S. and Europe. The longer it is delayed the worse the crisis can get and the longer it takes to eradicate it. Even low grade cotton masks are useful as is the practice in Asian countries. It is now part of the new guidelines of the Centers for Disease Control in the U.S. This needs to be adopted as safe practice everywhere.

LyrArc Article Gist
The Centres for Disease Control agency in the U.S. was unprepared for this pandemic in the early period from January to March. This report in the NYT shows how the agency failed to respond effectively in the early days leading to the loss of lives now past 100,000. When travelers arrived at U.S. airports in February from China carrying the virus with them these flights were diverted to selected airports with CDC conducted screening but the screening proved to be defective. Health officils desperate to set up isolation and quarantine could not act because the information provided was not accurate and missed many details resulting in the inability to quarantine early and isolate clusters as other countries Germany and South Korea have done.

LyrArc Article Gist
The failure to set clear and consistent guidelines by the U.S. Centres for Disease Control that the public can easily grasp and follow without retractions or errors has affected how the public responded in the pandemic. Here the CDC is shown to have first put forward a draft version on the role of aerosol and respiratory droplets in the air for spreading coronavirus infections and then pulled it back followed by putting it back on last week.

Much of it is about being definitive and 100% certain instead of focussing on the steps that are clearly going to reduce the spread of the pandemic and appealing to the good common sense of the public about following reasonable precautions of social distancing, masks, ventilation, staying away from gatherings.

LyrArc Article Gist
Omicron cases are up in an almost vertical line on a graph with cases doubling every 2-3 days in the UK, similar to the pattern in South Africa during the beginning of the spread in South Africa. Since then early data in South Africa show the trend in the province of Gauteng, center of the omicron outbreak in South Africa in the Johannesburg area, has reached its peak. On Dec. 16 it recorded 27% of national infections compared to 70% the week before. Head of the National Institute of Communicable Diseases in South Africa, Michael Groome, says "we had areally dramatic increase in Gauteng, which has now leveled off."  Hospital admissions in South Africa show a different pattern than earlier hospital admission rates in previous waves, with only 1.7% of cases being hospitalized in this Omicron wave compared to 19% for the Delta variant wave at a similar point in the wave, says Health Minister Joe Phaahla. In UK as of Dec. 14, this WSJ report cites health authorites saying 73% of cases in London are omicron variant, doubling every 1-2 days, with omicron making up 41% of all cases in England. In the US the Centers for Disease Control show Omicron variant making up 2.9% of all cases in US as of Dec. 11, with highest concentration in New York, New Jersey of 13.1%. Proportion of positive tests went up from 3.3% to 5% in New York City. A convention in New York City, Anime convention at Javits Center, November 23, 2021, shown in a recent NYT report, could potentially have acted as a super spreader event in New York according to NYT though not confirmed, similar to football stadiums events in Italy in March 2020. Dense atmosphere and large crowds increase the risk of a super spreader event happening, say experts. ...

LyrArc Article Gist
During this swine flu epidemic in Mexico a number of experts and organizations in Mexico and the U.S. worked well together and acted quickly. Dr Sada, a respected epidemiologist at Mexico's health ministry, Dr Lezana a top government epidemiologist, the director of the National Insititute of Respiratory Diseases in Mexico City, Dr Ruiz, chief of Epidemiology at a Oaxaca hospital, Dr Gerardo Lescas in Oaxaca, Mexico, who treated some of the patients, Frank Plummer a Canadian scientist who analyzed samples at a Canadian lab, and the Centers for Disease Control of the USA, moved rapidly to take action. This helped contain the swine flu epidemic in Mexico, and created a model for other countries faced with a similiar situation. This is a detailed account of how Mexico responded.

LyrArc Article Gist
The head of the European Centres for Disease Control ECDC, Dr. Andrea Ammon, says the Delta variant of the coronavirus will make up 70% of all cases in Europe by early August, and 90% of all cases by the end of August. ECD modeling shows that there is a risk of another wave like the one after last summer in Europe. The Delta variant is much more infectious than the UK Alpha variant and the UK variant much more infectious than the original variant. A 50% reduction in non-pharmaceutical interventions such as allowing the staging of events would lead to an increase in infection in all age groups. Latest ECDC data show 34% of people in Europe fully vaccinated and 57% with one dose. One dose offers much less protection. Younger individuals have a lower vaccination rate and are vulnerable. Also vulnerable are the older people not vaccinated yet. About 40% of people over 60 are not yet vaccinated, and 30% of people over 80 years are not yet vaccinated in the European Union. As in the US vaccination varies by region within the EU. All these vulnerable groups can be affected in another wave of the coronavirus similar to after last summer when restrictions were removed. Dr. Ammon is a former advisor to the German government. She says it is important for young people who are not vaccinated to continue to follow the strict social distancing precautions.  This is not happening today as governments are relaxing mask mandates in Britain, France and Spain. Soccer games are coming back to fan filled stadiums increasing the risk. Tourist spots in Portugal and Greece are now looking similar to the vacation spots in Croatia that increased infections in Europe after summer 2020. ...

LyrArc Article Gist
Larry Rohter says Mexico handled the swine flu epidemic much beter than China handled the SARS epidemic in 2002. Before it was brought under control SARS cost 700 lives, by contrast Mexico's response was much quicker and the government and health authorites in Mexico worked with labs in North America and the Centers for Disease Control ad Prevention in the USA, to prevent its spread. The cost in lives was much smaller, with 42 lives lost. Mexico is not the failed state that it is presented as in the media suggests Lohter. This is the impression created by adetailed account of the crisis in the WSJ, see the link, on the swine flu epidemic.

LyrArc Article Gist
Though the smoking rate has dropped in the U.S. to 15% of adults smoking, the figures conceal a socioeconomic fact. Many of the smokers are now concentrated in rural areas and among less educated people. The rate for people with only a high school diploma is about 40%, according to the Centers for Disease Control and Prevention. The result is that people in rural areas are diagnosed of lung cancer at rates 18-20 % higher than city residents. These are two worlds says one rural resident who has grandchildren in D.C. suburbs. She is fighting the battle against smoking yet sees this is less of an issue for city residents. Her experience is that the family, health, work and other problems drive people to smoke more in rural areas of Virginia, including her small town of Martinsville, Virgina. An added problem is the marketing by tobacco companies to these areas.

LyrArc Article Gist
 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. ...

LyrArc Article Gist
Jessica Todd, a USDA economist, says in a report that about 20% of the improvement in the diets of people surveyed comes from Americans eating out less at fast food places or restaurants. And this particular improvement she says is from an increased awareness on nutrition in picking out food, more choices available, and more nutritional information available to buyers. About one third of U.S. adults or 36% were obese in 2009-2010, according to the Centers for Disease Control and Prevention. This is a large increase from 15% in 1980. Studies show this is now declining gradually with increased public awareness of the risks of poor eating habits, including risks of diabetes.

LyrArc Article Gist
Only 12% of Americans take the minimum daily recommended fruit for healthy living, and only 9% of Americans take the minimum daily recommended vegetables, according to the Centers of Disease Control and Prevention (CDC). The minimum for fruit is daily taking one and half cups fruit. For vegetables it is daily taking two to three cups of vegetables. Women consume a bit more at 15% for fruit. An interesting finding in this study that explains the widespread obesity in the U.S. regardless of incomes is that of affluent and wealthy Americans only about 12% consume enough vegetables. This is very close to the percentage of poor people eating the recommended 2-3 cups of vegetables a day, which is at 7%. This is an alarming fact in that all sections of society are doing very badly, creating acatastrophic effect for healthcare. A diet without fruits and vegetable brings higher rates of obesity, cancer, heart disease, diabetes. If rich and poor upper middle class and lower middle class are all sharing the same lack of awareness it points to the lack of education in eating right as the big culprit. This is one area where government, universities, and the informed private sector, can change things if they wanted to. A challenge as big as that in literacy and education for the U.S. Alarmingly even though it is in the top ten read articles in the Guardian newspaper online edition on November 16, 2017, we checked the other sites. We could not find it under Health in CNN, where other topics such as sexual harrassment, and sugar cravings, were covered. NBC covered a different CDC report showing 71% of Americans are overweight or obese with BMI over 25, but made no mention of this report by CDC. Equally alarming is the statistic cited in the Guardian from the Union of Concerned Scientists that shows only 2% of American farmland is used to cultivate fruits and vegetables. That this would have to go up at least to 4% if all Americans are to get their daily required fruits and vegetables. Meanwhile little change is to be seen, and no alarm bells are ringing in the U.S.. These facts are hardly mentioned in any healthcare discussion in media, as if they can be ignored or shoved under the carpet. This is the kind of thing that will never go viral, as a discussion on sexual harrassment or some other topic would, yet deserves just as much attention and education. ...

LyrArc Article Gist
Epidemiologist Marc Lipsitch of the Harvard School of Public Health says in Jan 2018 issue of Harvard Chan Institute of Public Health journal that an "accidental pandemic" could result from the lifting of the ban on a risky kind of research favored by some virologist professionals.  In "Three Questions, Three Answers" Lipsitch tells why. Most members of the broader scientific and medical community had serious questions and were fiercely against such research which had questionable value and great risk. At the beginning the interviewer Karen Feldscher writes:  "January 8, 2018- Last month the US government lifted a three year moratorium on funding risky research to genetically alter deadly viruses in ways that could make them even more lethal. Epidemiologist Marc Lipsitch of Harvard Chan School thinks the move could create an accidental pandemic." Lipsitch says rejecting the virologists who supported this dangerous research: "Others, like myself, worry that the human error could lead to the accidental release of a virus that has been enhanced in the lab so that it is more deadly and contagious than it already is." He cites an accident in 2014 at US Centers for Disease Control and Prevention Lab where workers were exposed to anthrax that was improperly handled. "Another accident like that- if it involved a virus that was both newly created and highly contagious- has the potential to jeopardize millions of people."  Lipsitch points out that this kind of research has given us modest scientific knowledge, was not essential to tackling the virus epidemics, was only one type of many types of research, and a type of research whose aims could be achieved in other ways that were not deadly to humans. Lipsitch pointed this out in The Journal of Medical Ethics stating the ethical considerations at stake. The lifting of the ban led to research at labs that is seen as a possible scenario of what happened to cause an accidental pandemic. The people of the world, and not just in America but the people of the whole world, and the poorest countries with little resources- Asia, Africa, Latin America bearing the consequences of this decision that violated medical ethical considerations of setting up a potential accidental pandemic.   ...

LyrArc Article Gist
The U.S. birthrate edged up slightly for the first time since the recession of 2008 led American families of childbearing age to defer having children. There were 62.9 births for every 1000 women of childbearing age in 2014, increasing from 62.5 in 2013, according to the Centers for Disease Control and Prevention. The total fertility rate also increased slightly to 1.862 children in 2014 from 1.858 in 2013. This is below the rate of 2.1 children a woman would have over her lifetime to keep population at the same level, without immigration. Kenneth Johnson, a demographer at the University of New Hampshire, estimates about 2.3 million more births if the 2008 recession had not led women to defer having babies. In 2014 U.S. births increased 1.4% to 3.99 million children from 3.93 million in 2013. Women over 30 and better educated are showing a larger increase in births.

LyrArc Article Gist
Three very important point about a soda tax. First, obesity was rated as the No 1 problem of concern for business leaders at a WSJ conference for business leaders at the beginning of the Obama administration in January 2009. If obesity related costs are taken out of health care, and even though they are not collected as statistics they must be significant, it would reduce the costs of providing universal health insurance. Especially considering that most diseases are exacerbated by obesity, and in some obesity figures as one of the leading causes. Second, Centers for Disease Control Data shows that a typical person now consumes 190 calories a day from sugary drinks, up from 70 a day in the late 1970's. That 120 calorie increase, an almost threefold jump in consumption of sugary sodas, represents one-half of the total daily caloric increase during that span per person, according to C.D.C. data. This is a crucial finding. Just one product alone can cause so much disruption in people's lives. Just as thrifty ways of living are becoming popular in America, better education in schools and communities on good nutrition and eating habits can become popular to reverse the bad habits acquired in the last 20 years, habits that are careless and reckless. Third, research shows that soda drinkers are price sensitive, so that in the past when soda prices went up by 10%, consumption dropped about 8%. So a tax on sugary sodas would make sense. The huge soda sizes at fast food places are one of the signs of the excess of this age with no regard for the consequences to health. living habits....

LyrArc Article Gist
The Federal Trade Commission says food companies in the U.S. spent $2.3 billion in 2006 for advertising to children. With the epidemic in childhood obesity in the U.S., this raises serious questions about how product packaging, images and themes affect the eating behaviour of children. New guidelines have now been written at the request of Congress. They were written by the F.T.C., the Food and Drug Administration, the Agriculture Department, and the Centers for Disease Control. The regulatory agencies say they will take comments and consider changes before submitting a report to Congress. The guidelines call for foods advertised to children to include healthy ingredients such as whole grains, fresh fruits and vegetables, or low fat milk. The foods cannot contain unhealthy amounts of sugar, saturated fat, trans fat and salt. The sugar requirement would have cereals contain no more than 8 grams of added sugar per serving. Fruit Loops for example contains 12 grams of sugar per serving. The guidelines apply to both children and teenagers. However these guidelines are voluntary. At this time an industry led effort has not produced results. The Children's Food and Beverage Advertising Initiative, which is operated by the industry, lets each company set its own nutritional criteria. The regulatory agencies see the need for the food industry to follow a uniform set of standards. Without serious action on this issue the U.S. healthcare system will continue to be burdened with high rates of obesity related illnesses in the general population, and out of control costs. And the U.S. will continue to face the urgent problem of a lack of healthy eating habits of children teenagers, and adults....

LyrArc Article Gist
A 35 year old Engineering professor from Texas who studies how transportation systems propagate infectious diseases and her 2 graduate students from China started and since January maintain the database of coronavirus confirmed cases and deaths. This is one of the widely used databases, also used by public health officials in the U.S. The database was started with a hunch from one of Lauren Gardner's students from China Ensheng Dong who comes from Shanxi province, north of Wuhan. A geography and mapping specialist he had studied in the U.S. since 2012, and spent many hours inputting data by hand following his classes. This WSJ report says the website was built in 1 day and was launched on January 22, when the coronavirus cases were practically nonexistent in the rest of the world and were concentrated in the Wuhan area. This report says behind the data reported in the media everyday is a complicated supply chain filled with challenges that come with data, what is reported, underreported and with what assumptions it is reported. Dr. Gardner says she is dealing with so much data on her dashboard, 4000 points of data, that its hard enough to pull all the data scraped together from different sources, its impossible for her to check the assumptions behind the data for consistency and trying to figure out facts underlying the data.  One of the ways the virus developed in the rest of the world is the surprise with which it caught western countries and then the rest of the world. As a result something that the government authorites would do such as the Centres of Disease Control is being done in a totally ad hoc manner. The U.S. government uses the University of Washington Health Metrics database, and in turn the University of Washington Health Metrics database takes some of the data from the John Hopkins database. Because a complacent population in the western countries were relying on numbers counted as cases to know how serious this epidemic was or whether there was an epidemic, the significance of data count from China assumed a signifcance far out of proportion to what it might normally be. This was because the western countries in Europe and America never encountered an epidemic of this kind in living memory, the last one forgotten from 1917 hundred years ago. Researchers in Gottingen University study in Germany conducted analysis of data in studies of cases published in Lancet Journal and found that only 6% of cases were being shown- that a much larger part of the population was infected. A researcher at Princeton University Ramanan Laxminarayan says countries tend to delay reporting until a problem becomes certain, because telling others comes with economic costs such as a rapid drop in trade and travel. Yet he says early warning systems are key to prevention. Early warning from the different publicly available data bases was not possible for many reasons. Relying on such ad hoc data was hazardous considering that as the NYT reported recently when there was the first confirmed detected case reported in New York there were already 10,000 persons estimated to be undetected. James Glanz and Benedict Carey, say in the NYT.com on May 7, that hidden outbreaks spread through U.S. cities far earlier than Americans knew, estimates show, which makes the publicly available databases giving a false sense of security, and not acting as an early warning because of the inadequacy of the resources for this task for individual researchers to handle. Not depending on  hurriedly put together databases with inadequate resources and having an independent sense of what the danger was as German chancellor Merkel described it in her first coronavirus address in March, was a better early warning signal than the databases in retrospect. And this too had come late. The reason is that the response had to be fast, very fast, and public perceptions had to be shaped quickly about the magnitude and speed of enormous proportions of the coronavirus, so that actions could be shaped quickly and executed quickly to stop it in its tracks.    ...

LyrArc Article Gist
Nationally the new Omicron offshoot variant, the XBB.1.5 represents 40.5% of the cases in the US by Dec. 31, according to the Centers for Disease Prevention and Control or CDC. In New England and New York it is about 75% of cases and is a rapidly rising variant in Europe also. Only 38% of persons over 65 years in the US have got the updated covid booster bivalent vaccine shot.

LyrArc Article Gist
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.   ...