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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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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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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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Beijing residents say they began to relax in wearing masks or not wearing them, not wearing masks properly, after 8 weeks with no cases. A vegetable and fruits wholesale market in Beijing, in southwestern district of Fengtai,  which supplies 80% of the fruits and vegetables to Beijing's 21 million people is now seen by health authorites in Beijing as the source of a new outbreak. 79 new cases are traced back to this market on June 15.  In Beijing restaurants and shops had reopened. Primary schools and other schools had reopened. Public health experts are looking at the possibility that the source is a cutting board for frozen salmon imported from overseas possibly Europe-. because of the DNA sequencing of the virus experts say. Contaminated seafood or meat is suspected as a source. China's CDC says the virus can survive on frozen meat or seafood for 3 months. Just when this new cluster was detected in Beijing, the city of Wuhan the origin city of the virus is permitting indoor sports and entertainment facilities reopen, and this WSJ report says Wuhan is making masks no longer mandatory outdoors. Beijing authorites have responded with mass testing, and contact tracing through neighborhood committees. About 100,000 people are organized by neighborhood committees to visit the city's 7000 residential compounds for contact tracing to identify people who visited the market and get them to test for coronavirus. This is the typical response in China to get large numbers of low level officials, workers and volunteers mobilized for contact tracing and testing. By June 14 about 76,000 people were tested - of this 13,000 are from the 29,000 who visited the market since May 30, according to Beijing government statistics. ...

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The people in the U.S. are shifting to widespread use of masks. There was some cultural resistance in Europe and the U.S. to use of masks, compared to Japan, South Korea and China where the use of masks in epidemics was common in earlier health crises. Europe changed first and now the U.S. is adopting masks as a way to avoid th spread of coronavirus. Health authorites in the U.S. now recommend use of masks to prevent asymptomatic people with infection from spreading the infection. Health experts say the widespread use of masks in Asia is one reason in addition to quarantines, contact tracing and isolation of clusters, is how China, South Korea, Taiwan and Singapore have controlled coronavirus to the point where it is no longer a serious danger.

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The lessons from Italy, the epicenter now of the coronavirus pandemic, are clear- act early and decisively, impose quarantines and lockdown quickly to prevent intermingling. These steps need to be put early, with absolute clarity, and strictly enforced. This report in the NYT shows how decisive action early is the only way to prevent the crisis from becoming a large one that threatens the health system and millions. German states such as Bavaria and others now have a $25,000 euro and some have jail time. Singapore has jail time and fines for violating the stay home quarantine orders which it imposes after contact tracing. Taiwan has similar measures. Enforcement and strict control are part of the tools that have worked in these places and in China, South Korea.  Britain has still to close flights from Iran, Italy, which The Times reports on March 20 are still landing at Heathrow. This is after the U.S. weeks earlier banned flights from China, Iran, Italy, and last week from Europe after EU nations failed to take action early.  ...

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South Korea has tested about 300,000 people for coronavirus. About 20,000 can be tested daily for coronavirus through 40 drive thru locations. South Korea invented this method of testing. Another feature of the South Korean method is the tracking down of people who have come into contact with those testing positive for coronavirus. The South Korean government is able to do this because it can access the credit card and cell phone information of people in the country. This is possible through laws that were passed after the failures during a previous epidemic of MERs. The government then tracks down and isolates the people who came into contact with infected persons. This includes people who show no symptoms, an important aspect of the South Korean program which needs to be adopted in other countries once the production of test kits and testing is ramped up. The reason is that about 30% of people who tested positive in South Korea were not showing any symptoms but acted as silent carriers. This is similar to the figures for people in the Wuhan region of China. This testing capability is one of South Korea's key strengths, though Germany's Robert Koch Institute says it has a similar capability to test 160,000 people a week. The U.S. has tested about 30,000 people by comparison. The U.S. government is procuring 60,000 test kits under the Defense Production Act. South Korea also enforces social distancing though a $2500 fine and a 1 year prison sentence. Germany now has a 2500 euros fine in some states for curfew violations.  By comparison the fine in Britain is insignificant.  Another difference between China and South Korea with Germany and the rest of Europe, the U.S., is that in China and South Korea self-isolation is monitored, tightening the control over coronavirus spread at every turn.   ...

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France was exceptionally well prepared says France 24, citing a report in Le Monde, for the SARS crisis in 2002 and the H1N1 influenza in 2009. A billion masks were stockpiled by 2009. Following the H1N1 influenza not appearing in any significant way the media, political parties and the public shifted their attention away from public health crises preparation. For H1N1 the government spent 1 billion dollars some of it going to pharmaceutical labs. The eurozone financial crisis that followed the global financial crisis shifted policy to austerity measures. The entire preparation effort for influenza type health crises was abandoned as too costly.  The same pattern repeated in Britain which was also well prepared before 2010. Austerity budgets after 2010 had little room for public health investment.  One could say a similar pattern was seen in the U.S. Today the worst hit countries are U.S., Britain, France and other European countries. France which had 1 billion masks in 2009 to tackle a possible H1N1 epidemic finds itself with 150 million masks in March 2020 and scrambling to find masks. Some masks which were usable were even destroyed as expired, ministers and experts who had built up the prevention effort in 2009 were even demoted and forgotten, as was much of the preparation in these years. It wasn't just medical supplies pubic awareness had practically disappeared. In the U.S., in Europe, the same situation of a lack of public awareness so that experts, government, and the public could work together quickly, was clear to see. In countries such as Taiwan the preparation led to speedy response at all levels, making contact tracing, isolation of clusters effective. In the U.S. and Europe this early, early, period was lost leading to makeup mitigation measures and the growing sense of a loss of control over the virus. ...

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It took a week longer for each country to impose a lockdown. In China first Wuhan then the whole country went into lockdown and quarantine. The same process is repeated in Europe and in America as authorites see numbers of infections increasing rapidly without strict controls. First the Lombardy region in Italy around Milan, then the provinces in Northern Italy, followed by a complete lockdown in the country on March 10 as infection spread faster without lockdown and enforcement of lockdowns. Germany and Britain follow Spain and Italy on March 20. France followed Spain in the days after Italy's complete lockdown. Macron ordered the lockdown on March 16 with stringent enforcement. Infectious Disease specialists at Imperial College warned of "unintended consequences for the entire nation" if a lockdown of Britain did not take place. The goal is to limit the spread of infections from rapid to slow as public health systems and economic measures are ramped up in preparation for the crisis. Most countries were lacking the preparatory steps having lost time waiting to see what happens next or analyzing data in the vain hope the virus does not spread.  Bad economic results of lockdowns were initially a concern, but this concern became less important as the coronavirus spread rapidly in Europe. Decision makers in Europe decided that not acting forcefully would lead to equally or worse economic outcomes. Public health systems overwhelmed would diminish public confidence rapidly and lead to equally bad or much worse economic outcomes. The European Union executive body has supported state aid, stimulus action and border controls in this crisis. In America and in Europe the hope is that shoring up the safety net with massive aid to businesses and households would buy time to tackle and overcome the coronavirus through a combination of lockdowns, quarantines, contact tracing, large scale testing and medical technology measures. The examples of China, South Korea, Taiwan showed this pathway exists for phased control and reducing fatalities to zero. ...

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What is the difference between South Korea and the U.S., Europe in the handling of coronavirus? It is tracking and testing.  President Trump and health adviser Dr. Fauci, see South Korea as the successful model to be followed in controlling the coronavirus. What has happened till now it is accepted with shortage of basic medical supplies and equipment, stress on hospital systems, are merely mitigation actions. South Korea was prepared for the coronavirus crisis because of the MERS and other epidemics, and failures resulting in corrective actions. Labs were centralized and better equipped for testing and tracking the infected. One of the key tools is testing. President Trump says the goal is for the U.S. to exceed and far surpass tests per capita in South Korea. Five million tests are planned by the end of April in the U.S. Where the U.S. falls short is in use of multipronged digital tracking using data from people's use of mobile phones, credit card usage, and use of apps designed to separate infected people from others. South Korea is a democracy with a population of 52 million people, about the size of France. People who were student activists in the democratization era in South Korea say the use of digital technology is a need today. We have to adapt in emergency situation they say. Ki Mo-ran, epidemiologist, and adviser to South Korean government says this is a key part lacking in the European and U.S. efforts to control coronavirus. She says in South Korea we know the patient's contacts, where he goes and stays, so we don't have to lock down everybody. Without digital tracking one cannot know which place is contaminated, which place is clean, so that there can be a lockdown of just that area and not the whole country, says Ki Mo-ran. She asks the question- is one person's privacy more important than the lives of a family or other people who are affected. Is it OK to lockdown every child in the country in a home as in Spain for over a month so that particular people's privacy is respected? These are serious questions for western society, are they exceptions or is democracy not just a western idea but equally cherished in Asian societies, people talk about Confucianism in China and the Asian culture forgetting that the biggest democracies are quite large and functioning well in India in addition to South Korea, Taiwan Indonesia, Malaysia, Bangladesh and Japan, far larger in area and population than China. The French government has chosen the app TraceTogether as the least intrusive one adaptable to France for use there. The U.S. is having Google and Apple develop one of its own. India will be developing one of its own. The NYT raises the question will it be watered down so much in France or in the U.S. and UK to be less effective than the  dire need for an alternative to lockdowns? ...

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European Commissioner Michael Barnier calls for banning credit ratings on countries receiving financial aid. This comes after Moody's strongly downgraded Portugal's rating to Ba2 in July 2011.The downgrade was more severe than expected and comes right after the Greek parlaiment passed austerity measures in Greece. Moody's Ba2 rating suggests a 5 year default probability of 8.1% for Portugal, according to Deutsche Bank.

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Merkel expresses her support for Portugal during a meeting with prime minister Pedro Passos Coelho of Portugal in Lisbon on Nov. 11, 2012. In a news conference which was live on German television Merkel said: " I feel a great sense of determination here in Portugal to overcome this difficult phase." Recognizing the cost of austerity measures and spending cuts, the 16% unemployment rate, Merkel added: " I know that its very hard for some people. Unemployment is high, especially among young people. Consequently, Germany in particular wants to support Portugal through professional training for young people." The German chancellor is travelling with a German business delegation which is meeting with Portuguese executives to determine areas for German cooperation with Portugal to generate growth in the economy.

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The Portuguese government asked the European Union for bailout loans. The aid the EU is providing to Portugal comes with conditions- asking Portugal to make additional austerity cuts even as new elections loom. The aid is essentially more loans at high interest rates, even if the rates are lower than the steep rates in financial markets for a country with a collapsing credit rating. There is serious concern about whether this formula applied by the EU is going to work because at this rate it may take a decade or more for Portugal to pay off all the loans. The major problem is that with severe spending cuts- a country that lacks competitiveness and cannot devalue its currency because of being the euro zone- it is that much harder to generate growth. Simon Tilford, chief economist for the Center for European Reform in London, says the EU leaders have failed to come to grips with the core of the problem for Ireland, Greece and now Portugal- which is how to restore the finances to some sustainability, and how this could ever be achieved by a policy of deeper and deeper spending cuts. Tilford points out that the other more fundamental problem EU leaders are not tackling, is that the problem is deep down the large amount of Portuguese, Irish and Greek debt held by German, French, British, Spanish and Dutch banks. If these countries default the governments of these countries would have to recapitalize their banks at the expense of the taxpayers of Germany, France, Britain, Netherlands. Political leaders of these countries want to avoid confronting angry taxpayers and lose political support. Germany has called for a bondholder haircut, something that banking interests do not support. Tilford says Portugal is not getting a bailout, because for a bailout there would need to be a default by Portugal. What it is getting along with Ireland and Greece, are loans at high interest rates, and an EU plan that simply stifles the ability to pay back accumulated debt, leaving the situation in limbo for some future resolution....