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Jeremy Hunt, head of the Health Select Committee and Health Secretary 2012-2018, says Britain needs to take up mass contact tracing as its next national mission. Britain he says has passed 20,000 tests a day for coronavirus. America has passed 150,000 tests a day. Both more than South Korea. What is missing when compared to South Korea and Taiwan is mass contact tracing.  The app TraceTogether is not enough, as it was used by only 20% of Singapore's population. Only South Korea and Taiwan are able to open up the economy, have workplaces and life function close to normal through extensive testing and mass contact tracing, with feet on the ground. This is the only path that has worked with South Korea successfully out of the lockdown. This means "feet on the street." Making these calls requires skills, getting information, getting cooperation, offering guidance, and ensuring people isolate themselves after contact with an infected person. Sometimes it is by phone and sometimes in person wearing full PPE. They need to be sensitive enough in talking to someone feeling ill and to see how home isolation can be achieved, who else the coronavirus infected person or someone in the chain of contacts has been in contact with. Mr. Hunt says no effort should be spared in doing this as the millions of jobs in Britain, of people without work, the economy, and the need for light at the end of the tunnel of lockdowns, requires a way out. A huge task but a lot of impossible tasks are being tackled in the health services. The resources of Britain, every spare civil servant, every administrator not working, every one who can do this, needs to be enlisted to do this. The same task needs to be tackled in America, and in other countries as a national mission. ...

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Germany has shown that low tech contact tracing efforts work- no apps needed, a phone, a desktop computer with a centralized database, and most important the human relations skills of the person doing the calls. The  sensitivity to the situation facing each person being called, being able to talk to the person in the language they speak in a multilingual environment such as California, is shown here. A 40 person team operates in San Francisco consisting of public health officials, clinicians, medical students and librarians. They call the contacts of people with coronavirus, arrange tests, and as needed send packages of food and medicines to hotel rooms or homes. Every call is expected to last 15 minutes but all sorts of questions are handled.  English and Spanish are used. Here one of the persons doing the contact tracing says she does not use apps, just an open source software used in the fight against Ebola. Definitely low tech, no waiting, get going is the message to every city in the world. She says apps software such as what Google and Apple are putting out can tell you whether the person went to some place, but cannot tell you more about that person, cannot tell you about problems the person is having being tested, and how they are having difficulty providing for families. One of the big lessons from Germany and efforts such as this one in San Francisco, and in other places such as Paris, Singapore, Taiwan, is that there is a complex nature to contact tracing that cannot be solved by tech. In fact the best thing to do is to get started immediately, with a phone and a database on a computer, as long as you have a person who has the motivation and skills, empathy with people, a lot can be done. Waiting for apps is a dangerous waste of time is shown by the low tech German experience, and the experience in other places. Most important is starting immediately. The example shown here of working with migrant workers in contact tracing shows in the most vulnerable places it is these human relations skills that count, that no tech app can do. It requires detective skills to find out and get people to share their history of movements and contacts for 14 days . In Singapore crowded dormitories house 300,000 of 1.4 million migrant workers. Singapore using an app also but its use is secondary. Apps don't work in many situations but fail in the most critical situations such as these dormitories and other eccentric or atypical situations such as faced by South Korea with religious groups and gay communities, elderly people in Europe, that generate the worst dangers of spread and need to be cluster isolated quickly. Human contact tracing has a history of being an effective method and was used in China and South Korea during the 2003 SARS epidemic. More countries need to adopt the method used in Asia and in Germany, particularly Britain, the U.S., France and India. It is OK that Britain's NHS and India's national government with Aarogya Setu app have put out their own apps which balance privacy concerns with the need to act immediately and cover the entire country, but the hard slog of human contact tracing teams in each district is indispensable. This is why the former Health minister in Britain calls it Britain's national mission to do this. Speed is key- putting together teams across the country in every district from skilled volunteers or government workers, and pulling together the phone and a centralized database on a computer as basic equipment. The fact that this is easily doable and people with human skills needed can always be recruited as they have been in Germany- from public officials in local government who are less busy in lockdowns, medical students, clinicians, volunteers, people from different professions- makes it inexcusable not to learn from others experience and get going. Just Do It. You want to reopen business, professions, offices and public services- Just Do It, it makes this possible. You want to prevent spread of the virus- Just Do It, it makes this possible. You want to limit damage to the economy and get the recovery going- Just Do It, it makes this possible. People of all shades of opinion can agree on this- its the only thing that works, even when there is a lack of enough proper accurate testing. ...

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Prof. John Ashton, regional director of public health for the northwest of England offers this advice on pitfalls to avoid in the testing and contact tracing systems of the UK and other countries. He says there is a problem in sending testing kits through the mail or postal service. He points out that the swabs needed for testing correctly are quite invasive, the risk of an inadequate sample taken in high, resulting in a false negative report. 

On contact tracing he says the current recruiting system has pitfalls of contact tracing people not having local knowledge. Needed are people who know the local population and are able to fully engage with these people.

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With staff shortages and the spread of omicron variant some German states are no longer doing contact tracing. Contact tracing is not happening in Berlin or Hamburg says this report in DW.com. The chair of the Federal Association of Doctors, Dr. Teichert, in an interview with RND says "comprehensive followup is almost no longer taking place at the moment." He also said there is a "massive fluctuation" in staffing levels for nearly two years. Experts even say that because of staff leaves and office closures infection rates will not be really known till later, a "sink into ignorance" says a medical statistician.

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The failure to respond quickly with testing and contact tracing has been a major weakness of the response to the coronavirus in Europe and the U.S. Repeated fumbling in contact tracing has been common throughout Europe and in states in the U.S.

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Angela Merkel said that contact tracing was "above all else" in importance in tracking down infection chains. Apps would not work in Germany because tracking movements and recording information is a sensitive subject in Germany with its history of communism and fascism. Germany still did it but very early on adopted a low tech way that so far is working. Staff from provincial administrations have shifted to do contact tracing work as other work is slow or suspended. Volunteers also have taken up the work. Germany's goal is 5 contact tracers for every 25,000 people- or about 16,000 for a population of 83 million. All the contact tracers have is the phone and a central database of information on the desktop computer as shown here in this report in the Washington Post. There is no advanced technology or software.  Most important say experts is social skills - to talk to people in a way that makes them feel comfortable to share information about how they are and their contacts in a very informal friendly setting, that even includes some humor. Here a contact tracer in Reinikendorf describes the work she is doing and a typical day. There are about 75 contact tracers for 260,0000 people in her area. When she calls someone she notes down what contacts they have had and puts them in Category 1,  2 , or 3 depending on the need for quarantine. The calling is mainly about asking the contact about his or her movements. A contact for more than 15 minutes is Category 1, less than 15 minutes Category 2. The whole conversation is for 10 minutes. Then someone from the health department will call the person contacted everyday. Reickendorf began building up contact tracing in March after an outbreak in a kindergarten was too much for the usual number of health officials to handle. The German trace and quarantine approach, home grown, low tech,  and based on what resources are available, the most important thing being start immediately, has its flaws. Yet it has worked to limit infections and deaths.  In about 65% of cases health authorites have no idea how a person was infected. Asymptomatic carriers are not detected. In some area the resources are limited.  This effort has helped control the virus first cluster in Bavaria at a car part manufacturer. Sixteen people had tested positive and hundreds were quarantined. The German approach is that testing is fine but if you are in quarantine testing is not going to make a difference in spreading. Testing with a negative result is also not helping as it could be that its too early for the infection to register because of the incubation period. ...

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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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Contact tracing being setup using iphones and android phones with bluetooth technology by Apple and Google. The idea is being studied for adoption by the U.S. government. The problem is that this kind of contact tracing is not as effective as the kind used by South Korea, Taiwan and Singapore with information from cellphone carriers. Contact tracing apps would be written by developers for each country and chosen by Apple and Google one for each country. How it works- When a person comes down with symptoms he can upload the information about who he has been close to stored on the phone. This information would then be used to contact the person who was exposed to the person with symptoms but unaware of this. A message would tell that person he was exposed to someone who now has symptoms and to contact public health authorites and take effective steps. When the person with symptoms gets tested if he was positive that would also appear on a exposed person's phone without name or other information.  The normal contact tracing is time intensive requiring many phone calls and using data from cellphone carriers. This is done in Singapore, Taiwan and South Korea. It is considered to be more effective. The approach of these Asian countries is more thorough and allows effective tracing and isolation, quarantining of persons having coronavirus or having exposure in countries with rampant coronavirus. The U.S. needs to move quickly to adopt the methods used in these Asian countries. The loss of hundreds of thousands of lives should be weighed against privacy concerns and clearly there should be a way to allow one time use of personal information for coronavirus, so that this kind of information is used only in public emergency situations. All three Asian countries are democracies. Putting health care workers at great risk including working pregnant doctors, as in the story in WSJ about a hospital in Maryland, should make it clear that everything including privacy concern should be placed in context, and use of personal information be permitted in a public emergency such as a contagious virus- with information protections removal for the period of the crisis. ...

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The UK government's chief scientific adviser, Sir Patrick Vallance, says coronavirus testing has not been scaled quickly enough. Public health experts warn that Downing Street is in the position to face "an unforgiving reckoning." The UK has done 5400 tests per million population, the U.S. 8894 tests per million, and Germany 15,700 per million, according to data from Worldometer website. UK got off to a slow start.  Experts at Imperial College, London, say a major problem is the lack of contact trace, test, isolate. Contact tracing having fallen behind. The government is relying too much they say on an app from Google and Apple to do the tracing because for this kind of work humans are needed, "boots on the ground" are needed. South Korea and Taiwan have successfully used people to do the contact tracing by using access to cellphone carrier data that was made possible from protocols established in earlier MERS crisis. ...

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As the pandemic continues to spread and numbers grow with reopening of the economy the question remains -what can we learn from other countries positive experience in controlling spread? Here the Times provides the example of German contact tracing- chancellor Merkel has emphasized that a lot depends on "total" contact tracing, and contact tracing "above all else." Germany's experience is that even if you don't get everything right, you make an honest effort with everything you've got and do it early it makes a real difference. Some of the offices across Germany are stretched and short of staff but they have been working since the beginning of March, sometimes in the early days 7 days a week. Only 33% or one third of the offices throughout Germany for contact tracing have the required 5 person team for every 20,000 people, and 35% are overstretched or at their limit, according to one survey. No apps, just a low tech effort with people from the state administrations who were not working during lockdown trying doing something else, or volunteers. Mainly using the phone, talking to people and tracing the contact chain of people testing positive. Putting this information on the computer with a central database.  The Berlin office has 115 workers and has tracked down every one of 666 virus cases it was given. Because of privacy concerns at the Munich office sometimes even the patient's name is not given and office staff have to locate the name and the person. It requires dedication, flexibility and above all resilience, says Harold Rau, the deputy Mayor of the Cologne office, cited in this Times report. The doctor alerts the local office with a test result. The office calls the person and finds out who he has been in contact with for the last 14 days. Then the people who were in contact with are grouped based on the directness of contact, face to face, so on. These people are asked to quarantine for 14 days, sometimes with the rest of their household. They get daily call to find out how their doing for symptoms. The effort goes back to Robert Koch in the 1892 cholera epidemic in Hamburg. Robert Koch, microbe hunter in Germany, was called in after the epidemic spread from Moscow. It devastated Moscow and Tokyo, but Hamburg suffered far less about 8605 deaths as a result of the contact tracing and strict closing off quarantining of affected chains after isolating them, closing off affected parts of the city. Bit by bit the cholera epidemics sparks were put out before turning into flames, says Koch. In the current pandemic Germany has suffered 8241 deaths and 178,000 confirmed cases. So far this is in line with the cholera epidemic in Hamburg 1892, and this for all of Germany. And it is not just affluent nations that can do this. where there is a will there is a way. In Kerala state in southwestern India, similar efforts have worked to limit spread  with even better results than Germany. ...

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A sense that the U.S. and Britain have still not got contact tracing right. Contact tracing is key to controlling the pandemic and letting jobs come back to normal. We've got to get contact tracing right say communities and experts across the U.S.  About 30 per every 100,000 people are needed. but the U.S. has got only a fraction of this. By the time it is organized more people can get infected, and this is a very serious problem. Indiana for instance needs 2000 contact tracers for six million people. With this so disorganized communities are taking up the task themselves. The Mt. Carmel Indian fire department is putting its 171 fire fighters on this job as additional work as contact tracers.States need to take up this task and do this quickly following the German example where speed is what counts and low tech is the way to go, requiring only a computer with a central database and a phone, and most important the good human relations skills to make calling work with people facing a strange formidable virus. Too much time is being wasted on high tech apps. See the German example by searching for "Germany contact tracing." ...

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Data from India in a large study shown in Science magazine show useful findings. Only a small number of people cause the wide spread of the coronavirus. This study covers the two southern states of Tamilnadu and Andhra Pradesh with total population of 128 million. Contact tracers in the 2 states reached about 3 million contacts for the 435,000 coronavirus cases. Researchers analyzed data from 85000 of these cases where enough data was available with 600,000 contacts. Some interesting findings are- About 5300 children infected 2500 contacts among other school age children showing children in schools can spread the virus. About 5% of the people account for 80% of the infections detected by contact tracing. 71% of the people did not seem to have transferred the virus to someone else. Median hospital stay is only 5 days much less than in the U.S. The number of deaths in India is much smaller than the U.S. less than 100,000. 5.2 million people out of 6.2 million people have recovered.       ...

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Massachusetts is moving into no. 3 or no. 4 position after New York and New Jersey and possibly Michigan in coronavirus cases with 34,000 reported. More than 3700 were hospitalized  in the state.

Massachusetts is close to hotspot New York. It also has a more aggressive testing strategy and is hiring hundreds of volunteers to do contract tracing, and uses Partners in Health, a nonprofit. Michigan and Massachusetts have followed a more aggressive strategy of testing compared to California which has taken a different approach of not doing aggressive testing and contact tracing leading to lower numbers in California now adjusted for population that could be different later on.

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Contact tracing apps in the U.S. Britain and France have failed. Contact tracing app in Germany was downloaded 12 million times in the first week. Yet much of the contact tracing in Germany and cluster isolation has been achieved using low tech methods- using a computer with database, and teams of people in district offices all over Germany calling people.

The NHS App in Britain failed to get the cooperation of Apple. In the U.S. Google and Apple planned to have a contact tracing app ready but failed to come up with one. Tech has failed to come up with solutions during coronavirus and low tech solutions have worked well as in Germany and in places such as Kerala, India, when implemented quickly with very little delay.

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Tech is not going to fix this, say software experts from tech companies. Google and Apple's efforts in coming up with an app have fizzled out, says this report in thee WSJ. Has the U.S. lost precious time in waiting for an app by tech companies to be developed, instead of doing what India and Britain have done. India introduced its own app Aarogya Setu app from the Indian government. Britain had the National Health Service develop its app. India acted quickly. Is an app needed or essential? Germany decided that contact tracing based on Asian country experience was mainly about human contact tracers with skills to make the phone calls. All they needed was a centralized database on a computer and a phone. Germany set up teams at offices in each district in Germany and quickly plodded ahead even if all the offices were not fully staffed. In fact a third of the offices needed more people and resources. Yet the speed of action is something like 80 to 90% of the contact tracing effort when the team has the skill set to call. This is because clusters of infections do not wait - they spread. There is simply no time to waste. The German effort has produced the best results so far of any country of this size- Germany has 85 million people. The reproduction ratio is at 1.13 and Germany remains vigilant. It is the first country to reopen in Europe, and is methodically doing the right actions, much that the world can and should learn from. Contact tracing teams worked round the clock in the early days, they are still hard at work today, using their human skills to talk to people and find out who they were in contact with, calling the contacts in turn, at each step working to isolate where needed with followup calls from the state health departments. ...

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The lack of effort and results in Britain's contact tracing for coronavirus is the subject of this report.

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As German schools reopen few countries can match Germany's robust effort to do speedy testing and contact tracing to limit the spread of the virus.

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This BBC report shows how contact tracing works in Singapore to control the spread of coronavirus. On 4 February 20 Chinese tourists visited a traditional Chinese medicine shop in Singapore. Only 18 coronavirus cases had been recorded in Singapore on that date. That visit to the medicine shop created a new cluster for the disease to spread. Singapore's contact tracing units traced such locations through its well developed and extensive contact tracing programme, which follows the chain of the virus, identifying and isolating people before they can spread the virus further. For about 40% of the 243 cases so far on March 19 the first indication they had was a call from the Singapore Health Ministry.      About 6000 people have been contact traced so far, using a combination of CCTV footage, labor intensive detective work with phone calling. This includes an incident of a taxi ride of 6 minutes in which the person a yoga teacher was identified and contacted by the Health Ministry. Enforcement is done as the person was contacted at her home by three people who showed her a quarantine order, which said you could not go out or its fine time and jail time. With about 8000 people per square kilometre, Singapore is small and densely crowded. It could easily be overwhelmed with hospitals not able to cope and the health system collapsing if this was not done. Wuhan could have happened here, says infectious diseases specialist Dr. Leong at Mont Elizabeth Novena hospital, who advises the government.  Because the crime rate is low the police were given this task of tracing as a priority in addition to hospital units working on tracing. It also included the armed forces personnel helping with tracing so that it could be done quickly without delay. This provides a lesson on how countries that have faced the health crisis have used innovative methods to tackle it with good results. ...

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900 volunteers are part of a special contact tracing programme launched by French hospitals in the Paris region called "Covisan."

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Any idea that herd immunity is the way out is dispelled by a simple look at these pictures from the NYT showing what the level of infections are today and what they would have to be for "herd immunity." No Asian nation has even mentioned the word. Most Asian nations have the most experience with virus of all sorts. The only government that supported the idea without saying so openly is Sweden as indicated in a report in FR24 on the amplification of coronavirus in Sweden compared to neighboring Denmark, Norway, Finland. Imagine with a threshhold of 60% of people having antibodies provided by experts for herd immunity, the current New York level of about 20% would have to triple, and Sweden's 7% would have to grow seven fold. It is hard to imagine New York going through something of these proportions. Looking at what works now that other countries handling it have set examples of what works provides a better way- low tech contract tracing the German way, and one used in Asian countries, and the cluster isolation through testing and contact tracing adopted in many Asian countries as well as Germany. Strengthening public health systems, and working one's way out of the crisis where there are no easy answers offers real and realistic hope. ...

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About 90 countries are seeking help from the International Monetary Fund, the IMF. And 60 countries are seeking help from the World Bank. The IMF has about $1 trillion to lend. The World Bank has $160 billion to give out. 

The World Bank headed by Mr. Malpass has given India $1 billion for screening, contact tracing and lab diagnostics, to produce personal protective equipment, and set up isolation wards. 

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The work of David Malpass at the World Bank in approving $1 billion for India's coronavirus emergency response and health preparedness project. 

This will help India move quickly to setup the contact tracing, isolation centers, treatment facilities, and healthcare preparedness for coronavirus, so that the transmission of coronavirus is strictly limited.