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After averaging over 433 deaths daily over the past week California now leads the U.S. in deaths from coronavirus surpassing New York. The U.S. vaccination drive is reaching 1.5 million vaccinations daily.

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With vaccine hesitancy in the US the goal of vaccinating a large part of the US population is still elusive. Less than half of the US population is fully vaccinated as of July 30. The vaccination rates in the US are now much slower than India even taking into account the population difference. The vaccination in India is at the rate of 4 to 5 million a day for the past week in India. In the US this report in The Guardian shows 4.7 million vaccinated in the past 2 weeks. On July 30 856,000 people were vaccinated in the US compared to over 5 million in India.  Newspaper reporting that encourages vaccine hesitancy people to delay getting vaccinated because of poorly reported headlines is adding to vaccine hesitancy in the US. This has led to much frustration at the White House. The threat of the Delta variant is making more people to take vaccination. Southern states are seeing a jump in vaccinations. Many prominent Republicans are now endorsing vaccination.  One of the problems in tackling the Delta variant is the confusing nature of the CDC guidance on masks. On May 13 CDC issued guidance saying masks were not necessary indoors and outdoors. Now 3 months later in July the CDC says the threat of Delta variant means mask wearing is essential particularly indoors because of the higher transmissibility of the delta variant.  ...

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Eleanor Morgan describes her work giving vaccination jabs at a mass vaccination centre in North London. She had experience as an assistant psychologist and signed up for training to join the historic vaccination drive of the NHS in Britain.

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Israel remains a laboratory for the rest of the world in tackling coronavirus. During the beginning of 2021 Israel was the first country to push ahead with Pfizer vaccines for the over 18 population in a country of 10 million people. As winter approaches Israel has given a third booster shot to 50% of the population and is able to conduct normal life with a green pass system and the use of masks indoors. Each time a major surge has been prevented. The green pass in Israel is now for people who have had a third shot or booster shot. By thinking one step ahead, making decisions rapidly, and coordinating action early between the government and other organizations to vaccinate everyone, Israel provides lessons for the rest of the world. Not that there are no unvaccinated -about 700,000 people do not believe in vaccination and are unvaccinated. They are a vocal group but only about 8% of the population, and the vast majority of Israelis are in favor of vaccination and the green pass system. ...

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France sees a surge in bookings for vaccination after president Macron announces that vaccination pass will be required to go out to eat or drink, go to a shopping center, or to take a long distance train. Macron said "The health pass is not obligatory right away, but we are going to extend the health pass to the maximum to encourage as many of you as possible to get yourselves vaccinated."

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A look at countries in Europe shows different strategies for tackling coronavirus Delta variant as schools reopen in September 2021. Italy requires all teachers to carry a covid digital certificate that shows vaccination or PCR test results. France, Germany and Spain do not require vaccination for teachers to go to schools, and rely mostly on social distancing and mask requirements in schools. Britain not only does not require vaccination digital certificate, but also has not made masks and social distancing mandatory. Health experts say there are serious risks in this approach with mass return to schools and offices after August 2021, and the fall weather with more time indoors. This could lead to a surge in coronavirus as in the US where the reopening of schools and Delta variant has led to surge particularly in states such as Texas, Florida, California. In UK 65% of total population is now fully vaccinated, in Italy 62%. Teachers in Italy fully support the new rules. In Lombardy region with Milan as the capital, only 300 out of 300,000 workers returned to schools without the green pass, according to regional officials. Britain remains an outlier says this report in the WSJ, taking more risks than is proper at this time, and simply hoping for the best. Not the best strategy in this situation.   ...

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France has made the health pass for coronavirus mandatory for leisure and cultural venues starting July 21. The health pass will be mandatory for having a coffee, eating at a restaurant, or shopping in a mall from the beginning of August. The health pass is already in use in some form in many European Union countries. Denmark and Austria are using it for 2 months. Germany and Portugal are using it regionally depending on where the epidemic is severe. Greece which has a surge of tourism in summer from other EU countries is making it mandatory starting July 16 for entry into shops and restaurants. It was the absence of  any form of constraints on behavior in places such as Croatia with high tourism in summer that increased the surge in Germany and Austria last summer. Italy and Ireland are planning to make vaccination mandatory following France as the number of cases from the variants increase. Establishments that are violators of the mandatory rule in France will be fined 45,000 euros and persons responsible having to spend 1 year in prison. The mandatory rule has significantly increased the number of people seeking vaccination in France.      ...

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Six European Union states pass Britain, France and Germany in fully vaccinated percentages on August 5, 2021- Belgium, Denmark, Ireland, Spain, Portugal and Malta. Fully vaccinated are very close to 60% in these states. The fully vaccinated person in the EU gets a EU Digital Covid Certificate as shown here. The vaccination drives in Britain, France and Germany have now stalled due to the vaccine hesitant groups. To get some idea of this the second dose was given to 265,000 in France and 165,000 in UK on August 4. In the US southern states vaccination drive never got off to a good start adding to the problem of unvaccinated who are most of the people in new daily cases, leading to a new surge by August 4. France will soon overtake the UK in fully vaccinated percentage, showing that an early start as in UK is not enough. One in three in the UK in the 18-30 years age group has not taken the first shot, which is alarming. The US has a similar problem in the southern states in an aggravated form and also across the US in some form where young people have not taken up vaccination. ...

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The rule requiring health pass showing one is fully vaccinated goes into effect in France starting July 28 at restaurants, coffee shops, trains, and other public places. For the first week restaurants will not be fined. After this they can be fined 1500 euros for a single violation. The passe sanitaire in France is now required  for all public places where more than 50 people gather, such as events and museums including the Louvre in Paris. It will be extended to restaurants, cafes and shopping centres in August.

French premier Castex says 97% of the 18000  daily average new cases in France, up by 150% since the prior week, are from the unvaccinated. This has made health authorites and the government concerned about the delta variant high transmission rates and the high proportion of people still not vaccinated. For France this poses risk of a new kind of fourth wave, causing the government to take strong action to accelerate vaccinations.

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Some local governments in China are making vaccination mandatory. China is setting a goal of getting 64%  of the population fully vaccinated by the end of 2021. In European Union countries mandatory vaccination by country or region is now being put in place to fight new coronavirus variants that spread faster in the population. The reopening of economy, business and tourism is increasing the risk from variants in summer 2021. The mandatory vaccination is a way to increase the percentage of the population that is vaccinated. Getting younger people who lag behind to get vaccinated is important to protect the percentage of the elderly population that is still not vaccinated. There are risks also to the younger population as seen in previous waves of the pandemic. The initial hesitation to make health pass showing a person is vaccinated mandatory was because only a small fraction of the population was vaccinated in Europe. Now that over 50% are vaccinated in most EU countries and UK, that hesitation thinking that it is discriminatory to those people who did not have access to vaccines no longer exists. Ample vaccine supplies and the misinformation spread about vaccines are making action on health pass necessary to protect the overall population. National governments in France, Denmark, Austria, Greece, and local governments in Germany, Portugal and other EU countries such as Ireland, Italy, see the danger from coronavirus variants that spread quickly as too big to take any risks a second time. ...

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About 85% of people in Portugal a country of 10 million people are fully vaccinated in October 2021, highest in Europe. Strict precautions for prevention such as social distancing and mask remained in place after the surge in January 2021 which led to deaths at a rate that was three times the peak rate in the US.

On October 1, 2021 the restrictions such as 30% limit on filling soccer stadiums were lifted. For the Benefica vs Bayern Munich soccer game restrictions were lifted leading to filled stadiums with vaccination pass mandatory. As people return to indoors in winter this could still result in increase in cases. Because Portugal depends on tourism and stadiums are filled to capacity there is the risk of a smaller surge. Cruise ships are back in Portuguese ports and tourists,are back in large numbers. Soccer fans, fill subways, leading to new concern about a limited spread of the coronavirus.

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Passage through Congress of the $1.9 trillion relief bill is expected with a close vote as some Democrats in the House of Representatives oppose the concessions made on the minimum wage and reducing jobless benefits to $300 instead of $400 a week. Senator Manchin, Democrat of West Virginia asked for these concessions in the Senate, saying he would join the Republicans if these concessions were not made. This shows how close the vote is in the Senate which voted 50 to 49  to pass the Biden bill. Overall the bill does much to bring relief to Americans suffering from the effects on income from the coronavirus, and supports local governments. It funds more vaccination sites and more vaccination teams. Unemployment benefits are extended from March 14 to September 6 at $300 a week. About 85% of the population qualifies for a one time cheque of $ 1400. It also increases rent support for struggling tenants and includes $510 million for the homeless. State and local governments can now rehire1.3 million employees using $350 billion in federal aid. ...

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Vaccine mandates are becoming a favored action as companies and governments see the dangers of rapid spread of highly transmissible delta variant. Following the action by the French government to make vaccinations mandatory for all healthcare workers, and require health pass passe sanitaire showing one is fully vaccinated at restaurants, cafes, and trains, more governments are taking up this action. This is supported by French premier Castex showing that 97% of the 18000 average daily cases in France this week, up 150% from prior week, are from unvaccinated people. Similar situation prevails in the US making it critical that governments take action early, and not miss the right time for such action.

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This Times leading article on UK government's coronavirus policy says it is inconsistent, and a muddled effort just as the third wave is accelerating. It asks the public to be cautious when going outside and still opens nightclubs with covid passports not required till the end of September. By August cases could reach 100,000 say experts so that the nightclub and bars reopening can only fuel the rise in cases. The British government must be aware that the Netherlands opened nightclubs and bars in June and this led to a sudden jump in cases with 40% of new cases coming from nightclubs.  The policy is undermining public confidence. It is doing this at the same time as it is asking people to self isolate for 10 days. The policy also does not require covid vaccination pass for all events and for shops and restaurants as is being done in France and in other countries on a regional basis as in Germany. 

 

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The new tiered system of tighter restrictions passed in the British parliament 291 to 78 with 51 Tory rebels voting against and 10 Tories abstaining. Labour abstained from the vote getting it to pass. Tory rebels are voting with their constituents in Tory seats in parliament that have lower rate from coronavirus and see the restrictions hurting the lives of people in their areas. The prime minister had to make a special plea to them to get it passed including promising to review in granular detail these areas which needed lifting restrictions because of low infection rates.

Other steps the government is taking are to seek emergency approval of vaccines with the first approval done for Pfizer vaccine. This means Britain will be the first country to start vaccinations in 24-48 hours- December 3 or December 4.

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European Union countries reopen for travel this summer. A new travel pass or digital Covid certificate is approved to promote freedom of travel as more people get vaccinated. About a third of people are vaccinated for first shot in France and about 40% in Germany, which means in coming weeks they will have the second shot and enough antibodies to make a return to normal life possible. The EU has negotiated this time with Pfizer for 1.8 billion doses and is building enough vaccine supplies. For the first time governments are stepping up with plans and resources allocated - in India the government now has plans to create supplies of 2 billion doses by the end of the year. This means there is new hope if the vaccination is accompanied by efforts to build booster shot supplies this time planning ahead. Managing the risk of those who are vaccine skeptical remains a problem to be tackled. Masks and other essential precautions also need to be followed in crowded spaces as this was neglected where there was a second or third wave. Public education for this is essential to better manage the pandemic. ...

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Years of poor funding of public health departments in the US, Europe, and other countries have left public health departments lacking basics, lacking staff and resources. Here the WSJ shows how this has affected Alabama in the southern US. Alabama has the slowest vaccination program in the US with 10,000 doses given per 100,000 population. Positivity rate is very high at 29.1% for coronavirus, one of the highest for positive coronavirus tests in US in the past month of  Jan. 2021.

A large portion of the population of Alabama lives in rural areas. These rural areas are some of the worst hit in healthcare in the US. Since 2009 7 hospitals have closed in Alabama resulting from poverty of patient populations and population loss. This is part of the general erosion of rural healthcare infrastructure across the US in the last 20 years. A problem that now faces the Biden and future administrations. to tackle the problems of rural US communities.

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 Biden's kickoff speech for president in 2024- "We've got a lot more work to do." Biden was able to get the US on track for huge investments in infrastructure, chips, climate change, renewable energy, cost of living help, of trillions of dollars. He told a union audience- "Under my predecessor (Mr. Trump), infrastructure week became a punchline. On my watch infrastructure has become a decade headline- a decade headline." (Not much was actually done for infrastructure by Trump.) What Baker in NYT says Biden was not able to do is where Republicans blocked his efforts- to cut student loan debt, for pre-school education assistance, for tuition free community college, for parental leave, and help to workers and families struggling with the cost of living. Biden also helped tackle the period of mass vaccination and exit from the pandemic, and bringing unemployment to below 4%.  Baker has covered 5 presidents for the Washington Post and the NYT. His book on Trump is- The Divider: Trump in the White House 2017-2021.  ...

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The Oxford vaccine developed by British scientists could be ready by September. Astra Zeneca has joined with Oxford so that it can produce 100 million vaccine doses by the end of the year. This is because in a sense the vaccine is not new. It uses an existing tech platform where there is a lot of experience. The use of ring vaccination method shortens the process of testing on humans the vaccine to a few months. The core of the virus ChAdox1 already exists in chimpanzees and has a mild effect on humans. This is an adenovirus. It is combined with another virus to produce the covid vaccine for coronavirus. Researchers at Oxford have used ChAdox1 in the past to test vaccines for Ebola and MERS as well as other virus.  Already tests have been conducted on rhesus macaques. The rhesus macaques given the vaccine at a Montana lab did not get coronavirus.The surface protein of coronavirus is simply added to the ChAdox1 so that it is able to attach to host cells and infect them in the human body, and let antibodies develop from this. The purpose is to let the human body develop defense mechanism against this attaching to a human cell.   ...

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Lessons can be learned about careful reopening in fighting the coronavirus from other countries. Here the Netherlands experienced a rise of cases by 500% within two weeks of reopening after some poor decisions. The Mark Rutte government decided to open all bars and nightclubs resulting in a twelve fold surge in these locations in one week. Most of the new coronavirus cases were in people 18-29. Data from Dutch public health institute shows 4 out of 10 new cases linked to bars and nightclubs with 262% surge in cases for young people 18-24 years. This goes to show that with the vaccination drive what we see is the cases shifting to younger people, the unvaccinated, and to activities like nightlife. People going to work, or doing hybrid remote work with trips to the office, workers in factories, people doing essential shopping, are not causing the rise in cases. Much can be learned from these examples in working out reopening that does not lead to new crises with surging cases in new waves of coronavirus. Earlier in 2020 summer tourists who ignored mask and social distancing restrictions in Croatia brought on a post summer coronavirus wave to Germany and Austria. This time Greece and Portugal are introducing restrictions. Greece plans to make vaccine health pass required effective July 21 to go into restaurants. Another lesson from Netherlands this week is that a 20,000 person music event of 2 days in Utrecht where QR codes were required showing vaccination or PCR tests failed. About 1000 cases were attributed to the Utrecht event alone. Reasons given are that people faked the QR codes, or that the covid testing system produced too many false results as much as 20%. The same QR code system was followed at nightclubs resulting in big problems. One can never be sure that things work as expected and the risks are great as this adds up. Even vaccines offer limited protection and only if fully vaccinated depending on the type of vaccine. One dose of the vaccine is simply inadequate, and obesity, other morbidities can lead to problems. Withdrawing the mandatory use of face masks in most situations is also a risky decision of the Dutch government. Face masks offer the added protection at a time of variants that spread quckly, and when large parts of the population have only one dose of the vaccine, some elderly are still not vaccinated, and young people have not been vaccinated in large numbers. ...

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 Edward Jenner invented the small pox vaccine in 1796. Before this a method called variolation was used. Pieces of fabric or threads moistened with a sick person's small pox postules were pulled through incisions in a person's arm. This was effective until Edward Jenner invented the vaccine itself for mass vaccination efforts. Tom Parfitt of The Times writes about how Catherine Empress of Russia invited Dr Dimsdale from Britain to give her the inoculation against smallpox. She became the first person to be inoculated in Russia and had the courage to do so after this method had been tried and successfully tested in Britain. Catherine writes in this letter to Count Rumyantsev that she had only mild discomfort. She then championed smallpox inoculation for the Russian people and says "it does not call for huge expenditure." Today the Russian government is making its best efforts to vaccinate the Russian people, yet only 38% are fully vaccinated. The example of a medical revolution 200 years ago and how it was handled in Europe is new inspiration for renewed efforts. ...

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Donald Trump is acquitted in the second impeachment trial with a vote in the Senate of 53 in favor to 47 against. A two thirds majority is required to impeach a president. Senators Burr of North Carolina and Cassidy of Louisiana were Republicans who joined the expected ones to vote for impeachment- the Republicans Mitt Romney of Utah, Pat Toomey of Pennsylvania, Ben Sasse of Nebraska, Susan Collins of Maine, Lisa Murkowski of Alaska. The Republican defense lawyer insisted that Trump's speech to his supporters was not an intention to incite them on the day of the Capitol riot on Jan. 6, 2021 but an expression of his rights to free speech guaranteed under the U.S. Constitution First Amendment. He made the point that the prosecution lawyers had selectively focused attention on the words "fight like hell" and taken them out of the entire context in which they were made, ignoring key parts of Mr. Trump's speech. The defense argued that the president had already left office and this made an impeachment unconstitutional. Seventy five million voters voted for Mr. Trump and he cited this as the most number of votes won by a sitting president. President Biden is shifting his attention to the president's agenda and needs Republican support to pass key legislation including financial help to households, unemployed, and business to recover from the pandemic. The U.S. health effort behind the vaccination drive and seeing the struggle in Europe to access key medical supplies of vaccine is also leading to new efforts to move beyond the rhetoric to the hard work ahead with support of all parties. As part of this the trial once it reached the Senate was quickly resolved in about 5 days. The defense used only a small fraction of the time allotted with bipartisan effort to not let the trial drag on, bipartisan effort to putting some statements simply on the record and not calling witnesses.   ...

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The Indian prime minister talks in his radio program Mann Ki Baat (Talking our Mind) about Indian athletes at the Tokyo Olympics and overcoming any hesitancy for vaccines. He remembers athletes from the Olympics past- Milkha Singh India's fastest runner, who worked hard and emerged from the partition bloodshed as a survivor in 1947 to compete in the Rome Olympics in 1960. Milkha Singh was the first Indian male athlete to reach the finals of the Olympics when he barely missed the bronze medal by 0.1 seconds in the 400 metres race. He remembered for this years Tokyo Olympics hockey player Neha Goel, race walker Priyanka Goswami, javelin thrower Shivpal Singh, archers Deepika Kumari, Pravin Jadhav, badminton player Chirag Shetty. Pravin Jadhav is a laborer's son from Satara district in Maharashtra who is competing in archery. The prime minister talked about two people from Betul district, Madhya Pradesh, with vaccine fears from spread of disinformation. He pointed out that over 300 million people have been vaccinated and this includes his own 100 year old mother. He urged India to trust science and scientists. Sometimes, he said, people get a mild fever, that lasts only a few days. "Avoiding the vaccine can be very dangerous, you are not only putting yourself at risk but also  your family and the entire village." In the new phase of the vaccination drive vaccines are made available for free in all states and union territories. ...

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In a couple of weeks one can expect a digital Covid certificate that allows freedom of travel within the European Union countries. The European parliament and member states have agreed on setting this up. The travel pass will be a QR code on a smartphone or printed on paper. By accepting the travel pass EU states will drop travel restrictions such as further testing and quarantines unless necessary. With only 10% of EU citizens fully vaccinated there was concern about fairness but as vaccination speeds up in Germany, France and other EU states, this is giving way to the need to make travel easier during the summer.

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Prime minister Modi's visit to the US comes at a time when US president Biden is eager to show the US is fully engaged in the Indo-Pacific region with its allies in the Quad 4 countries- Australia, Japan and India. The recently announced Aukus defense agreement brought together 2 members of the Quad 4 the US and Australia, plus the UK. Aukus is designed to strengthen US presence as a naval power in the Indo-Pacific region in the Indian and Pacific oceans around India, Southeast Asia, China, and across the Pacific. After a futile engagement in Afghanistan the US is reorganizing its presence where it is strongest- in the oceans. In a way that Britain once did in the eighteenth and nineteenth century, the US is dominant in the high seas. US naval power far exceeds that of all navies in the world combined. This is meant to reassure India, Bangladesh, Sri Lanka, Thailand, Malaysia, Indonesia, Philippines, Vietnam, Australia and Japan, which together have close to twice the population of China, that the US has not diminished its presence in any way from that it had in the 1950's following the Second World War. With this new framework India enters discussions that will focus on health to deal with the pandemic and its after effects, with security and rule of law in the Indo-Pacific region, with trade, technology, new supply chain manufacturing structure in which India plays a key role. With this new focus and clearing past engagements made by other US  presidents, including some mistaken policies, the US emerges as a new force in the Indian ocean, China seas and Pacific ocean region.  On September 23 Modi meets Tim Cook for what could be new supply chain arrangements that Apple could be preparing as it and other US corporations build new supply chain structures to rebuild US manufacturing technologies capabilities that were lost to China over the period 2000-2020. During that period manufacturing technology knowhow was shifted out of the US in a mistaken policy that assumed design and invention were sufficient for the US to keep. The first step in this direction was a change of CEO's at Intel Corp with US president Biden pushing for new US technology reclaiming policy. Following that the new CEO at Intel Corp, Patrick Gelsinger, completely reassessed Intel's mistaken policies of ceding its entire semiconductor manufacturing technologies capabilities to Taiwan and China. Intel made a U turn and is now investing all or most of $50 billion in the US instead of in China or Taiwan.  On September 24 Modi meets Mr Biden to discuss trade, investment, defense, and security. On the same day the leaders of Japan, Australia, Mr. Suga and Mr. Morrison join Modi and Biden for the Quad 4 talks. Indian infrastructure capabilities and Indian economic growth would be key goals to strengthen India along its land borders along Tibet occupied region and Himalayas as part of the overall effort to build a new US and allied presence in Asia.  On September 21 Modi attends a Covid Summit that will look at the way forward in the aftermath of the pandemic and ways to vaccinate the remaining unvaccinated population in the world, as well as vaccination passports.  ...