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China has used the experience gained from an earlier SARS outbreak to tackle the virus outbreak in 2019 which started at a food market in Wuhan. Early detection, strict quarantines, and other measures, were taken. A viral pneumonia outbreak happened in Wuhan, a city of 19 million. 59 people were quarantined and the largest food and seafood market in Wuhan was shut down quickly. Between the first case on December 12 to the detection of the new strain of coronavirus in 1 month, China acted with speed, showing China's strength in public health resources and research labs.

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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?    ...

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Kerala state of 35 million people who speak the language Malayalam, is one of the rare places today that has only 4 deaths from coronavirus, 524 cases confirmed and no community transmission. Here the Guardian looks at the reasons why. The Health minister KK Shailaja started very early on January 23, with a meeting of her rapid response team when the virus was still in China.  She setup a control room and instructed Kerala's 14 districts to do this on Jan. 24. When the first case arrived on Jan. 27 on a plane from Wuhan, Kerala had already adopted the WHO  protocol of test, trace, isolate and support. These passengers were checked for temperature, tested and quarantined. With some at a nearby hospital and others in home isolation. This is all the more amazing considering that Kerala is a state in southern India on the west coast that has a large number of people living and working overseas. Many are in the Gulf countries and the arrival of these refugees could have triggered a second outbreak. This was prevented by careful testing, and contact tracing of clusters.  When one group was evasive and concealed information from an airport surveillance team -arriving from Venice, Italy,  in late Feb- a case was detected back to them.  Contact tracers tracked down all of the hundreds whom they had been in contact with and quarantined them.  By 23 March all flights to 4 Kerala airports from overseas were stopped, including Cochin and Trivandrum. On March 25 India went into lockdown.  Some of the achievements in Kerala include quarantining 170,000 people early. with strict surveillance, which is now down to 21,000. Accomodating and feeding 150,000 migrant workers from other states, before returning them on charter trains to their home areas. A big reason for the success is the high literacy rate in the state. A big emphasis on education and healthcare is a part of the Kerala model. Shailaja is a secondary school teacher, and Health minister. From the days since independence of India in 1947 the state has a strong socialist tradition of taking care of the basics- health, education and public services. It also generates a part of its GDP with income from workers who are overseas.  Another reason for the success in dealing with coronavirus is experience. The state had a virus epidemic called Nipah in 2018 which has become the story for a movie called Virus in Malayalam. There is decentralized public health system in the state and people value their health care facilities, understand and trust the health care authorites. There are hospitals at every level of administration and 10 medical colleges. But trust and education, experience tackling the virus before, are key. Kerala is showing that poor countries can deal effectively with the virus, and create a better life by adopting the right model of creating good societies that value education, healthcare services, better economic structures and distribution of wealth, and  a degree of trust and responsibility found in a state that values public spiritedness. ...

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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.    ...