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New information from the recordings of the World Health Organization as reported by Associated Press, show that during the week of January 6 WHO's lead experts were having difficulty getting information about the coronavirus outbreak in Wuhan, China. Maria Van Kerkhove, an epidemiologist and the WHO technical lead for coronavirus says she was going on very minimal information. The WHO's top official in China, Gauden Galea, says in one of the recordings that they were in the situation where information was given to WHo officials in China only 15 minutes prior to it going on China's state television CCTV. In early January Michael Ryan, the WHO's chief of emergencies, says he feared a repeat of the SARS epidemic in 2002, which was initially covered up by Chinese officials, according to the AP report shown in the Guardian. Ryan says he found himself in the same situation as in 2002 SARS, endlessly trying to get updates from China about what was going on, and adds that WHO barely got out of the SARS with its reputation intact given the transparency issues, in the AP report shown in the Guardian. By June 1 about 6.3 million confirmed cases are reported of coronavirus in the world and 375,000 deaths, and huge losses to economies and people. China's authorites did not lockdown Wuhan till January 23, by which time this report in the Guardian says at least 5 million residents had left. China denied entry requested by the U.S.on January 6 for a team of experts into Wuhan, The team was not allowed into Wuhan for a crucial period of 6 weeks during which the virus had time to spread in the western world. This is taken up in Mr. Trump's letter to the WHO, and the work of Gro Harlem Brundtland is clearly stated in the conclusion of that letter. Brundtland was head of the WHO at the time of the SARS epidemic in 2003, and acted decisively with early warnings to prevent its spread.  Because of the extremely contagious nature of the coronavirus the failure of early warning systems resulted in enormous damage to lives and economic losses worldwide.  ...

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The crowded sports stadiums for soccer games during early February in the Lombardy region accelerated the spread of coronavirus in Italy by the end of February. The sports stadiums soccer games spread the virus like wildfire in northern Italy. This is why along with nursing homes, sports stadiums pose the greatest threat from coronavirus. The tens of thousands of people from a single game can contaminate as many as 40,000 or 50,000 people as these 10,000 people go on subways, restaurants and other places. This spreads to millions very quickly creating a wildfire effect. Airports and sports stadiums or music venues, theatres have this wildfire spreading effect that is then compounded by the use of public transport and restaurants other close proximity places, spreading it far and wide. These are also not essential activities as work and office, employees working at companies or in manufacturing, which are essential to the economy.  This is why in terms of priority sports and leisure travel can be deferred till a vaccine is developed. Business travel is increasingly being substituted by using videoconferencing and other ways of staying in touch remotely. ...

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A scientist from the Robert Koch Institute in Germany will head a WHO team going to China to conduct research on the origins of the coronavirus.

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The word "elderly" is going out of common use, the CDC in the U.S. has crossed it out and uses the words 'over 60." Parents bristle as the term elderly takes on a new meaning in the days of coronavirus in March 2020. One of the baby boomers at age 64, who has completed 40 triathlons in last 7 years asks if she can really be called elderly. Parents bristle with texts and calls from children in the thirties to change travel plans, with most deciding to stay put at home. Yet as other reports show most younger people in their thirties and forties are also working from home with their kids around them.

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India is joining Australia, New Zealand, Japan, South Korea, Britain, France, Russia, and many other countries in calling for an investigation by the World Health Organization into how the coronavirus crisis escalated into a pandemic with millions of cases and hundreds of thousands of deaths and how adequate the response of the WHO has been. 

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Guidance from the World Health Organization for people to stay mentally healthy during the difficult period of the coronavirus impact. The need to be empathetic and kind.

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This WSJ report on critical analysis of coronavirus data has a very useful chart of Estimated Range of Symptomatic Cases Reported by Country. Complete coronavirus data for all symptomatic persons who have the coronavirus infection is lacking in most countries. Many people in large populations have symptoms and are positive but are not reflected in the official data collection. This is a big problem as the total number of cases are understated by a magnitude of twice to five times the numbers reported in official tally.   South Korea has done a good job of getting more of the symptomatic people with the infection in its data, as about 53% to 90% of such persons are reflected in official data. Next comes Germany at a range of 38% to 55%.  China comes third and has about 28% to about 38% of such persons reflected in its data, the U.S. currently on April 4 at about 14% to 19%, according to this chart in the WSJ. The source for this is Mathematical Modeling Center at the London School of Hygiene and Tropical Medicine. What this means is that the US. number of cases at 278,000  reported infected people with symptoms (April 4) is only 14% to 19% of the true number. Another way to say this is that the actual infected persons with symptoms is about 5 times what is reported, or over 1 million not the 278,000 reported.  As happens for China data collection agencies may never get the true number. To be comparable to the Chinese numbers, as the U.S. is a large country, the figure closer to the true numbers would be twice the 278,000 reported or over half a million symptomatic infections of coronavirus in the U.S. Why is this data important. With widespread testing as in South Korea one gets data that tells one how many people are infected (the size of the problem) and therefore the resources needed and the point of greatest impact. Also it tells one the typical transmission rate per person, and it helps hospitals in each area know what to expect and what resources are needed to prepare- not find people suddenly turn up in the E.R. in unpredictable numbers. The lack of widespread testing and better reporting in the data to get a grip on the pandemic is shown in this chart for countries hardest hit, less than 5-6% for Italy and Spain. The UK and France at 5-8%.   ...

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Angela Merkel's handling of the coronavirus crisis wins praise from world leaders and leaders in Germany. Public opinion from Argentina and New Zealand to Britain and the U.S. gives her a lot of credit for the way she has tackled the situation. She now has the highest approval ratings in Germany since 2017, after a period of 2 years during which her popularity waned with the migrant crisis.  Much of her period in office was consumed by crises- the eurozone financial crisis, the migrant crisis, and now the coronavirus crisis. She brings her style of a scientist rationally looking at the situation, her experience, and her willingness to take bold positions under much criticism. Today even one of the premiers in Thuringia from the socialist Left party praises Merkel for being "pleasantly calm and goal oriented, particularly evident in the well structured video and telephone conferences." He says he prefers a leader "a quiet scientist" rather than "pompous men who as populists, dangerously ignore the facts of the danger." Merkel now assumes the 6 month presidency of the Council of the European Union on July 1.  Germany faces the future in rebuilding its economy, in rebuilding its infrastructure and public services, for now Merkel provides the leadership needed for this time. As Andreas Nick, vice president of the Parliamentary Assembly of the Council of Europe puts it she is "always analytically scrutinizing and carefully weighing up, soberly Protestant and refreshingly unpretentious, a trained scientist with life experience in the downfall of an all too self-confident ideological system."   ...

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

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After the outbreaks in July Florida, the Carolinas, Arizona, and other states in the southern U.S. imposed some form of mask mandates either locally or at the state level. This combined with the restrictions on gatherings and reversal of opening of restaurants and bars, other places of gatherings, have helped slow the spread and reduce cases. Even though the cases are still high there is a levelling off in late August, says this report in the NYT, with graphs in color showing trends.

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The economic damage is larger in some states with a larger manufacturing base and one tending to be cyclical. 20% of Michigan's GDP is in auto manufacturing. The large jump in cases to 40,000 and 3600 deaths have led to stricter quarantine. The unemployment rate in Michigan is forecast at 23% much higher than the national average of 16% that peaks in May. It is also likely to last longer till early 2020. As a result of the strict quarantine  larger parts of retail, service and construction sectors are affected. This has led to protests in areas where the coronavirus threat is not as large as it is in Detroit.

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This report shows improvements in the situation for coronavirus in Pakistan. It is still to early to tell how the reopening of the economy is likely to affect the cases for coronavirus. Not enough testing is taking place. The Eid holiday taking place this weekend also could have repercussions later in August with more crowds and gatherings for the religious event. Pakistan has 278,000 cases of infection and 6000 reported deaths. At one point the situation seemed to be following the situation in Brazil but has stabilized recently.

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This article gives some simple answers to questions about how the NHS test and Trace system setup by Baroness Harding could go so wrong. It was setup as a separate agency and ignored some of the vital information of how contact tracing should be done close to local area coming out of Germany. This information was available early and was also on the Lyrarc site, as Germany had effective contact tracing as early as March-April. First Britain wasted time waiting for some brilliant App to do the work. The when this was going nowhere the NHS Test and Trace was setup but ignored the need for this to be done locally and followed up with personal visits to the homes of those needing to be visited to isolate. Most important- the local knowledge and the persons doing the calling having human skills to get people to cooperate and feel reassured. Less important or not at all- sophisticated equipment, a simple desktop, national database to which data is connected and sourced and a desk, a skilled motivated local person the key. Germany resorted to using the underutilized state or local employees who were diverted to these tasks but extraordinarily effective.  ...

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This story in the WSJ is about pregnant Emergency Room doctors still working. These three doctors are in the University of Maryland Medical System. They have leave but are working because if all three were to take leave it would pose significant strain on their group and their colleagues.

They have to reuse their respirator masks for a week till they are soiled and visibly damaged says this report in WSJ, which should be unacceptable in America. The risks they take are also unacceptable in the face of so much happening at hospitals. How long will this go on in hospitals across America with shortages of basic protection equipment for healthcare workers putting their lives at risk is what everyone is asking.

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Cases in Germany rise exponentially in a third wave of coronavirus. The Times shows the old square in Prague with thousands of crosses painted on it to commemorate the first anniversary of the first death from coronavirus. A woman and a girl arrive with flowers to the Old Town Square in Prague. France Germany and other parts of the EU all face a surge in cases.

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Richard Levitan, a physician expert on patient oxygen levels treated patients at a New York Hospital, and found this very important fact about coronavirus and its attack on patient lungs. Early detection and treatment, use of pulse oximeter monitoring, are shown to be critical for coronavirus.  Covid or cornavirus pneumonia is different from normal pneumonia in that it attacks the lungs but patients can be low on oxygen without realizing it through shortness of breath. As it turns out and confirmed by this physician expert who has invented intubation techniques and served at a New York hospital to understand why coronavirus was killing patients, the patient simply breathes faster and deeper without knowing it and is not short of breath even though his oxygen saturation is going down. This delays treatment- use of pulse oximeter is therefore recommended, an easy test placed on a finger that shows the oxygen reading. This kind of fast breathing then suddenly leads to the complete collapse of the patient's lungs, which is why so many end up in hospitals late and end up later on ventilators. British prime minister Boris Johnson received this kind of monitoring and early treatment to be able to return to work.  ...

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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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Typical of so much of what is written about the World Health Organization and its role in the pandemic, this podcast in the WSJ fails to quickly convey the critical function of the WHO as an early warning system the world has depended on, including China. The H1N1 epidemic originated in Mexico. Asian countries including China and India depended on very quick response from the country where the epidemic originated  in allowing entry into the affected area for experts from advanced countries such as the U.S. The global response was then coordinated across countries quickly with complete transparency. The head of China's CDC himself faced a problem with transparency with the provincial authorites in Wuhan. 1.    Fundamentally this quick entry was denied the U.S. Request by U.S. to China was made on Jan. 6 for U.S. team to go to Wuhan, quick permission was denied and given only about 6 weeks later on Feb 16. This delay is the crux of the problem for the U.S.. Taiwan confirmed human to human transmission on Jan. 1, the WHO was saying this was not clear as late as Jan. 14. These costly delays are what the U.S.  letter is about.  The head of the CDC China Gao Fu called Dr. Redfield head of CDC in the U.S. on the next day after he suspected Wuhan provincial authorites were vague about what was happening. Gao Fu was alarmed when scanning the internet on December 30, 2019, about rumors of a vaguely worded lung disease in internal memos of Wuhan. He called Wuhan authorites and was not getting clear answers on that day, then deciding on December 31 to send his own team to Wuhan, as reported in German magazine Der Spiegel- Hackenbroch, Zand, 05/20/2020.  Der Spiegel says in its special report on the early period in Wuhan that Gao Fu was so alarmed about what was happening enough to be in tears in his series of calls with Dr. Redfield in the immediate days that followed. The date was shortly after the GAO Fu sent the team to Wuhan, December 31 and New Years Day 2020, as reported in Der Spiegel. See the link to Lyrarc gist of Der Spiegel's "A Failed Deception: The Early Days of the Coronavirus in Wuhan."  2.  President Trump points out the standards of the WHO- in the concluding point of his letter to WHO- when a three time prime minister of Norway, Gro Brundtland was head of the WHO during the SARS crisis of 2003. She acted quickly and decisively and no time was lost. It is this failure of the early warning system under the new president of the WHO after 2017 Dr. Tedros that alarms the U.S.  with about 100,000 deaths.  3.  This failure it can now be said was partly a result of a election in 2017 for the position of WHO president which was flawed. This was the first time a WHO head, an important position was put up for an election. The Executive Board was responsible for this appointment since the founding of the WHO as part of the UN, based in Geneva, Switzerland, after World War II. This system worked. The election was clearly a bad process for appointing the president of the WHO which should be done entirely on the capabilities of the person holding this position not on a flawed voting process. It is flawed because India and Bangladesh hit by a cyclone during the coronavirus have suffered greatly, as have other countries, but had only 2 votes for 1.5 billion people, when Barbados (385,000 population) and Laos (7 million) which had less than one  hundredth the population had the same number of votes. The U.S. had one vote. The election resulted in lobbying and a process in which many candidates stayed away because they simply would not go through such a process. The position was too important to the world- most of the advanced countries had forgotten about the danger of epidemics to let this happen by 2017, as shown in the way the austerity years led to cancellation of the preparations for pandemic in France and Britain. The austerity years and neglect of public health during these tech boom years in the western world made it possible for this to happen. 3.   Along with the 1 month ultimatum action is already being taken to restore the effectiveness of the importance of the Executive Board. The head of the health ministry in India, Dr. Harsh Vardhan, has been appointed the new chairman of the Executive Board on May 22. This restores the voice of billions of people in Asia in the process, and brings the major countries with the greatest risk in a pandemic into the decision process for tackling the pandemic, this includes the rest of the world.     ...

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 Turkish German scientist Ugur Sahin who invented the mRNA vaccine for coronavirus is interviewed by Der Spiegel. He sees a new world of pharmaceuticals from this invention, with the first treatments of cancer.

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For the regions hardest hit by the coronavirus and its variants- the US, Brazil, India, Europe, Russia, China and Africa, the researchers and the frontline workers in South Africa are doing an incredible job. This report by Stephanie Nolan in the NYT shows the work of researchers at KRISPS advanced medical research center and the frontline workers in South Africa, who are making a difference. Shown are researchers and scientists at KwaZulu Natal Research Innovation and Sequencing Platform in Durban, South Africa on whom the world depends for stepping up the fight against the coronavirus- Dr Tulio de Oliveira, principal investigator of the national genetic monitoring network, and Saleem Abdul Karim, epidemiologist. On the frontline workers who visit patients homes to make sure immune compromised patients have access to their medications is Sizakele Mathe, community health worker. Stephanie Nolan has provided a much needed account of what work is being done on the frontlines to keep us all safe. ...