LyrArc Article Gist
Except in Britain where there is concern about the government's handing of the crisis in nursing homes most European leaders have improved their standing with voters with their coronavirus response. Public confidence has increased for Germany's Merkel, Italy's Conte, France's Macron, and Spain's Sanchez. France's Macron enjoys a personal popularity rating of 44% and satisfaction with his government's response has increased to 42%, after a decline in mid-April when there was a jump in cases. In Italy satisfaction with the government response is at 66%, and Conte remains popular. Mr. Sanchez's response to the coronavirus crisis in Spain is approved by 46% of voters. Most European leaders have shown unity and composure in the crisis, strengthening the community spirit in the European Union.

LyrArc Article Gist
The mistakes  and the right action done in Italy that the world can learn from as Italy tackles the coronavirus. The coronavirus is a dangerous pandemic yet there is one part of it that can be used to take the right action. The timeline of countries affected early in January and February and early March with information from these countries on what worked very effectively and what did not work with bad results is available. The mistakes were made in Bergamo, a town in Lombardy region of northern Italy with the highest number of infections and deaths in Italy. Bergamo had limited testing, no rigorous attitude for quarantining those who had come in contact with people testing positive, and lack of contact tracing. In Vo another town in northern Italy the situation is a complete contrast with resort to mass testing and isolation of clusters which has reduced infections to zero and made it a safe place. Vo is a small rural town 85 miles east of Bergamo in the Veneto region. This was the method used in South Korea, China, Taiwan and other Asian countries that have overcome the virus. Bergamo is an example of what failed in Italy with the worst number of fatalities. The health crisis worldwide has shown this  method of first general quarantine to buy time to build capabilities for testing  and preventing things spiralling out of control,  then mass testing, contact tracing and isolating the people who test positive, and repeating this process again and again till infections are way down,  is the only way to control this crisis. In the early days massive quarantine or stay at home strictly enforced is the best solution till production of tests accelerates to permit mass testing and isolating the clusters of infections. This mass quarantine buys time for accelerated production of tests and building up the capabilities of labs to process these tests, including use of a central national lab centre with national data on computers for microbiologists to monitor the entire country. This was done in South Korea reports in WSJ show. This is vital for everyone involved in the effort to control the virus to understand based on the experience of  countries that have successfully overcome coronavirus. It is the experience in South Korea and Italy that the U.S. White House response coordinator Dr. Brx is looking at and learning from as she and the White House team in the U.S., governors of all 51 states, health officials including CDC, are looking at as they execute their action plan in phases.  ...

LyrArc Article Gist
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.  ...

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.   ...

LyrArc Article Gist
With U.S. crossing the 300,000 mark in infections on April 5 the country enters a new and critical phase in the fight against the global pandemic. Globally cases of infections jumped by 100,000 for the first time to 1.2 million. Health experts say the next 2 weeks are critical for winning the war against the global pandemic. White House coronavirus response coordinator Deborah Birx urges people to isolate themselves, avoiding even the trips to the grocery store or the pharmacy. Models show the infections peaking in New York, Detroit, and New Orleans in the next 6-7 days Birx says. In Europe the pandemic may be reaching a peak in Paris area and eastern France. High speed trains transferred patients from eastern France to western France as the fight continues. In Italy and Spain strict containment measures are now bringing in results with rate of infections increasing by less than 5% from the previous day. Daily deaths are less and pressure on hospitals is beginning to ease, with number of patients in intensive care decreasing. Queen Elizabeth II will address the British nation in a prerecorded address, the fourth one in seven decades of her reign, to thank health care workers. ...

LyrArc Article Gist
The U.S. bans travel from most of  Europe and India imposes quarantine on visitors and overseas citizens entering the country for 14 days. Countries around the world reacted quickly to the situation in Italy, France and Germany. The strict measures taken by China are gradually being adopted by other countries. Quarantine done early has worked limiting the spread of the coronavirus. Countries with strong public health systems are better positioned to weather the health crisis. Where strong action is taken early and in anticipation, with a strong public health response, there is better control over the spread. This comes with some economic cost as it has hit the Chinese economy, yet the rebound is likely to be that much quicker and done with more confidence. For instance air travel in China declined by 85% in February from a year earlier to 8.3 million journeys according to Chinese aviation officials. Moves to keep social interactions to a minimum have yielded results. Only food stores and pharmacies remain open in China till March 25.  ...

LyrArc Article Gist
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.  ...

LyrArc Article Gist
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. ...

LyrArc Article Gist
The US vaccination drive appears to be stalling when it comes to getting younger people vaccinated. On a recent day 1.13 million persons were vaccinated. About 150 million Americans are fully vaccinated or about 47% of the population. About 53% of the population have one dose. This still leaves the rest of the population close to one half unvaccinated as the US is opening up fully and removing the social distancing and mask mandates that existed before. The problem is that the coronavirus delta variant is about twice as transmissible than the original coronavirus of March 2020. Vaccination is uneven across the US. Large parts of the southern states and the western states lag behind. In these areas as well as areas with large urban concentrations of population, the densely populated cities where social distancing and mask mandates are being lifted as if the coronavirus crisis is over, are at risk of seeing a more powerful virus spread quickly before gene sequencing catches up with new variants- making the response lag behind in terms of weeks. That lag in response could lead to another wave in the US. Consider also that tourism is opening up in Europe with removal of mask mandates, that gene sequencing to track variants is tiny in even countries such as Italy and France. A WSJ report on June 22 shows gene sequencing to track variants at 1% of positive tests in Italy, and virologists in Italy saying they feel as if they are flying blind. This report in the Washington Post says surveys show as many as one third of Americans have no immediate plans to get vaccinated. This is showing up in the low numbers for the vaccination drive, of around 1 million a day at this time in June 2021. In April this was 3 million vaccine doses adminstered on a single day on average. India where the new delta variant has had the most serious impact has stepped up its response with the federal government taking complete responsibility for vaccine supplies and vaccination drives. It is now vaccinating aggressively in the range of 6 million to 8 million doses a day during the last 7 days with a plan to ensure enough vaccine supplies for 1.2 billion people to get vaccinated by December 31.  The European Union and the US have  vaccinated just over 50% of their population for a variant that is more than twice as transmissible than the original virus. This leaves the unvaccinated at real risk because all the social distancing and mask mandates that existed earlier are being removed- in the US, in France, in Italy, and other countries. Soccer stadiums are filling up in Europe, the kind of sports events that later hit Bergamo, Italy, in March 2020. Summer tourism is back in Portugal and Greece. The best intentions will not be enough. Are mask and social distancing protocols being lifted too quickly especially in tourist locations reminiscent of last summer in Europe and elsewhere. Germany and Britain are holding on to them a bit longer. Will this be enough to tackle a new variant. ...

LyrArc Article Gist
A look at two crises in 1918 and 1957 of virus pandemics shows early and decisive action to prevent public from gathering and intermingling, are critical. In today's densely populated urban environments this translates into lockdowns and quarantines that are strictly enforced. The 1918 pandemic took 50 million lives worldwide, the 1957 pandemic took 1 million lives worldwide, says this report based on some estimates. MIstakes were made then and science was not as developed for vaccines and new drugs. Which is why health authorites are taking this very seriously. Greg Ip of the WSJ looks at coronavirus health crisis in relation to earlier disasters- SARS 2003 originating in China, 1957 flu epidemic, 1918 Spanish flu epidemic, to draw insights on what measures have worked best. Previous epidemics and crises provide clues on what makes things worse or better and the long term consequences of actions. The more health and safety are prioritized there is some impact on the economy. But crises have proven that the economic impact is temporary and short lived with the economy and jobs bouncing right back once the crisis has passed. The second insight is that early on in the crisis there is a great deal of uncertainty, leading to fumbled or delayed, or timid response. Sort of like lets wait for more information coming out of China, or now Italy, which happened first in February, and then again in March. Tim Adams who worked in the U.S. Treasury Department during 9/11 and Hurricane Katrina, and is now the president of the Institute of International Finance, says if you look to plan a perfect response you lose valuable time. Time is of the essence. Learning to make speed the priority, to think in tranches, be visible, and worrying about how to pay for it later, is what he says he has learned from these crises response efforts. In the case of the coronavirus, some valuable time was lost becausee of the uncertainty and lack of early information, making speed and rapid comprehensive action very critical. The Spanish flu epidemic of 1918 infected over 500 million people worldwide and killed 50 million or more, including 675,000 in the U.S., according to the Centers for Disease Control and Prevention. During this epidemic the Chicago public health commissioner flatly opposed closing businesses, saying worry kills people more than the epidemic. A 2007 study shows cities that took that attitude saw higher death tolls in the Spanish flu epidemic of 1918. Philadelphia waited 16 days before restricting social gatherings, St Louis took just 2 days. The result: the daily death rate from the epidemic peaked at level five or more times higher in Philadelphia than in St. Louis. Social distancing was not much of an issue then as people worked in jobs that required less contact, such as farming, fishing and forestry, as well as other jobs that did not require that contact in large offices.   ...