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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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Most people would not guess or recognize that this place where elderly people in society were treated shabbily is a country in northern Europe, and a country where citizens pay high taxes for precisely better healthcare across different age groups. Sweden is where about half of the 6000 people dead from coronavirus were elderly people.  Over the last two decades Sweden has cut hospital capacity and discouraged elderly people from entering hospitals during the early period of the pandemic, says this report in the NYT. The for profit nursing homes in the centre of Stockholm were unable to cope. Having turned the work in these homes to low wage workers, it put these workers and the elderly at risk with lack of staff, lack of adequate PPE oreven  basic masks, says this report in NYT.  One of the lessons of this pandemic is the failure not just in turning over manufacturing of health care equipment and pharmaceuticals to China, but also turning over the basic care of elderly to for profit institutions that were totally unprepared and could not give elderly the dignity and care they deserve. Year of cuts to public services and health services now showed in a glaring way what can happen when this is done. It has lessons for countries from Europe to North America, and to Latin America, India and other Asian countries as they redesign policy and allocate resources to public services in the next 10-20 years. ...

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Social isolation, economic isolation is affecting many parts of Japanese society. Mental health decline is seen in working women, part time employed, unemployed workers, and elderly. Prime minister Suga has appointed 71 year old Testsushi Sakamoto to a newly created post- Minister of Loneliness. The pandemic has worsened the social and economic isolation of people.

Another state of emergency is expected for Tokyo and Osaka as coronavirus cases rise in April 2021. Income adversity is affecting many people from women laid off, workers furloughed during the pandemic, students, and others.

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Serum Institute in India's vaccine developed with Oxford University is a leading one of the 6 candidates in India for coronavirus vaccine. It is expected to be ready by September. ICMR also has a vaccine that could be ready by India's Independence Day of August 15. One of the vaccines is for the elderly. Serum Institute has the advantage of being one of the leading manufacturers of vaccines in the world. India makes 60% of the world's vaccines giving it much experience in manufacturing that is needed today.

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The rotting carcasses of the minks that were culled will be dug up to be incinerated. Environmental inspectors found that some water sources might have been contaminated by bacteria. The 17 million minks in Denmark were the target of culling after fears of coronavirus in minks. The whole issue has shown the problems in some of the Nordic countries that were seen as models for healthcare and public services. Sweden's treatment of the elderly in nursing homes was seen all over Europe as shabby and the king of Sweden called it a "failure.

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Two studies now show that it isn't that coronavirus just takes away the infirm or elderly who would have died anyway this year or the next. It is taking people away who still had over 10 years to live. Professor Biggs at the London School of Health Hygiene and Tropical Medicine says this is is what is happening from the study he is conducting.

A paper by Scotland based researchers published online by the Wellcome Trust a London based foundation found the average number of years of life lost to coronavirus for healthy adults is 14 for men and 12 for women. Using data from Italy and UK on the kind of long term conditions in the general population , the researchers found that for those suffering from common chronic illnesses and cancer including multiple conditions, the researchers found that people of this type lost about 10 years on average.

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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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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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Jenny Medina looks at America's Biden 10 months into his presidency. Biden compared his presidency to that of FDR in his first years in office in 1933 with America in the depths of the Great Depression.  This report says FDR was better able to communicate how the New Deal would help families and workers in the face of distrust. Biden needs this today. During the ten months of the presidency Biden has already taken the tough decisions that are needed. For the vaccination drive, for the vaccine mandate on the coronavirus pandemic. On Afghanistan Biden took a similar tough decision to step away after learning the lessons of that conflict. He has quietly moved forward to build the alliance with Europe. On the infrastructure plan he has made the tough decision to make certain the essential components of spending on healthcare, education, childcare, support for mothers and older Americans are put in place, so that one bill for infrastructure is not passed without the bill for healthcare, childcare, mothers, elderly and education. Only this can provide the needed credibility for Republicans in states such as Tennessee who support community college open to all to come behind the overall Biden families and workers plan, and for working families throughout the whole country to support further spending for renewal of America.  ...

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So far 17 million people in the UK have received the Astra Zeneca vaccine.  35 cases of blood clots, 15 of pulmonary embolism and 22 of deep vein thrombosis have been reported across the UK and EU. In a normal year more than this number of cases of blood clots are seen say experts. These occur naturally in the population, including elderly population. Astra Zeneca's chief medical officer, Ann Taylor, says the number of blood clots in the 17 million people who have received the vaccine across Europe is actually lower than would be expected in the general population. The EU countries of Germany, France, Netherlands and Italy have temporarily stopped using it after 3 healthcare workers in Norway had blood clots. In Germany 7 out of 1.6 million had a rare condition of cerebral sinus thrombosis. Both EU and medical regulators say that there is no evidence that these blood clots are caused by the vaccine. The number of clots are similar to what was seen in the population before the coronavirus. Also this report in The Times says taken together there is no difference between the number of clots in the population that received the Pfizer vaccine or the Astra Zeneca vaccine.  The Daily Telegraph reports that one in 1000 people have blood clots every year, so that for 17 million people in vaccinated population with the Astra Zeneca vaccine there would be 17000 cases of blood clots over 12 months. During the clinical trials Astra Zeneca reported there were fewer people with blood clots who had been vaccinated than in the people who were not vaccinated. ...

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The pandemic and ensuing lockdowns, unemployment in the US separated workers from their jobs just long enough to give them a chance to rethink how bad their jobs, incomes, and working conditions were before 2020, says this expert in the NYT. The aid to unemployed workers through long term unemployment benefits, moratorium of rent payments, direct money to households, gave workers enough financial room to make the choice not to go back to poor paying jobs with huge contact risks from coronavirus in the restaurant, fast food franchise, travel and entertainment industries, related industries.  With the Biden administration investing in child care, maternity leave, care for elderly leave, new opportunities for relocating and looking for work were opening for women, and for men who had stuck to old jobs and put up with lousy conditions because of a lack of alternatives. Biden administration's Families and Workers Plans, the effects of the pandemic, helped to shape a new culture of what was possible for workers- a sense that dignity in the workplace was part of culture in America. Restored by FDR/Truman and now again by Biden after two tech booms in the 1920's and the 1990's. A similar situation of a change in culture respecting the dignity of workers and of work is taking place in European Union as stated by SPD leader Olaf Scholz in his election campaign in Germany. Scholz is now incoming Chancellor replacing Merkel. European Union countries have better laws and rules in place for worker retention, and also better worker protections so that the great resignation that happened in America took place in a milder version. ...

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The southern U.S. which was early to reopen the economy after the lockdown with some states having only partial lockdowns, is emerging from the coronavirus in much better shape than the rest of the U.S. The unemployment rate fell to 6.9% in August, the lowest of any region. The number of people employed was only 6% lower in August than in February, when most of the U.S. went into lockdown, compared with declines of 10.6% in the Northeast, 8.2% in the West, and 7% in the Midwest. Some of this was a result of aggressive reopening in Texas and other southern states. Overall deaths in the south were 60 per 100,000 people compared to 132 in the Northeast including New York and New Jersey, Midwest at 52, and West at 40. The Northeast numbers are high because of the elderly in nursing homes hit hard in New York and New Jersey.  In the southern states by comparison the deaths came later and among young people taking risks. The virus hit the northeast early and parts of the midwest, southern states had the advantage of some of the work already being initiated in March to fight the virus nationwide. Many of these states are also Republican and residents feared the virus much less. Republican Governors followed their instincts and aggressively reopened putting the economy first. The numbers tell the story. In South Carolina 44% of Republicans say they aren't afraid of the virus outbreak in the local area, compared to just 2% of Democrats, according to Civiqs poll. Georgia and Florida have similar numbers, all with Republican Governors. One factor favoring southerners is that cities in the south are much less dense and less populated than in the North and West. Smaller cities than Los Angeles and New York. ...

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Every day lost in the struggle with coronavirus is a big thing, which is why Itay's most affluent northern region has gone from being well equipped with resources of healthcare to seeing the health system overburdened to the point of disaster. This WSJ report shows why this has a lesson and an early warning for how the U.S. and other countries should design their response. It is also why the White House team that includes President Trump in the U.S. emphasized the plan for just the first 15 Days in the news conference at the Brady Room in the White House on March 16. It is saying the first 15 days are critical, not a day to lose.  It does not matter if you are an advanced economy with state of the art hospitals. Social behaviours must change, old rules rewritten and implemented throughout nations, quickly in days. Here WSJ shows lessons learned by Dr. Cereda at the Hospital of the University of Pennsylvania who trained in Milan and was in constant contact with colleagues in Milan and elsewhere. Many of the lessons relate to not overburdening hospitals and health systems and protecting health systems. This means mild to moderate cases are managed from home and not in the hospital, through massive deployment of outreach services and telemedicine. It means therapies can be delivered at home or through mobile clinics. The second major lesson from Italy is to protect healthcare workers and doctors. The entire White House team with Dr Faucci of CDC and Dr Brx, head of Infectious Diseases in the U.S. news conference of president Trump March 16, focused on the goal of protecting healthcare workers, doctors and hospitals, so they remained strong to take on the crisis. The second goal of the White House team is to protect the elderly with medical conditions. To do this only the most serious patients are treated in hospitals the rest for mild to moderate at home.  Studying the conditions in Bergamo and other parts of Lombardy and northern Italy, is helping U.S. medical leaders to prepare for the current nationwide effort, the 15 days plan announced by the White House. The lessons from the Papa Giovanni Hospital in Bergamo are important say U.S. medical leaders, including Dr. Brendan Carr, head of emergency medicine at Mount Sinai Health System in New York.  He says build capacity in hospital beds before we need it. Clear out hospital space and add new hospital beds.  ...

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The coronavirus pandemic and the disaster in nursing homes, the chaotic conditions in the first wave, the lack of staff and poor attention to residents during the pandemic, has exposed the major weakness of nursing home care in western countries. Much of this sector is in the hands of private operators seeking a profit.  The staff is paid low wages and lacks the experience and empathy needed for care of older people. During a virus all these factors turn deadly. With some staff sick the other staff is overburdened. If the sick turn up for work they are likely to risk the safety of other staff and the residents. With the incubation period lack of testing there is no way to know. When deaths occur and the nursing homes are sealed from the outside world the deaths happen with no goodbyes as happened in U.S., Britain and Sweden. This has exposed the scandalous and shocking way in which the elderly are treated in today's environment where ridiculous amounts of money are being spent on other things and the the most basic "one's parents" are neglected and allowed to die in horrific manner in a pandemic. The new trend for home care for the elderly is a welcome trend and long overdue as one of the worst aspects of the system in the west is the treatment of elderly parents in nursing homes run for profit. The new technology tools available for monitoring a elderly person at home, and the help of stores such as Best Buy which are serving elderly at home, is making this more and more a choice for the elderly. Even older patients and ones needing significant care can recover and spend time at home in a better environment, a less costly one, as hospital managers and families have learned in 2020. Some hospitals in the U.S. say they never want to go back. That the drive to get every patient home who can be home is the right one for patients and families and for the government paying for the care so that dollars are well spent in quality of care. Home health care companies are working on providing new services for sicker patients recovering at home. Technology helps do better monitoring. Medicare now pays for digital doctor visits and intense hospital type care at home after coronavirus showed this as vitally needed.  Both the Biden and Trump administrations are firmly focused on this issue. Seema Verma as head of Medicare is clear about the need for a national conversation on how we take care of the elderly, of our parents. And Mr. Biden wants to spend $450 billon to make certain that people who need long term care can get the support they need in the home and the community. This report looks at the home health care companies and how they are improving their services. This and telemedicine are two of the major constructive changes coming out of the pandemic, clearing out some of the worst aspects of the old system of living the older years in the western world.  Nothing speaks more about humanity and a human world than the story here of Savanna Hollar, 90 years old and almost blind. She broke her shoulder in August, Her sons decided not to send her to a the rehab facility she went to after a broken hip 3 years earlier. The sons brought her home to recover in the farmhouse near Yadkinville, N.C., where she has lived since 1951. One of her sons himself 63 years says that at a nursing home she would be lonely, scared and afraid to move. The sons hired two people to help her during the day and a rotating system was used for having people help her. At home Mrs. Hollar could enjoy her gray cat, Buddy, her favorite recliner and tomato sandwiches made with produce from her garden. Really, if we can't do this much what good is the U.S.A.? or Britain? or Sweden? or India? ...

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 This message from Pope Francis is especially relevant today during coronavirus. Francis says of the mistaken priorities of today away from healthcare, education, infrastructure and "coherence" in society and the pain and hardship this is causing in society, there is much that can give people thought to reflect on. Francis  new book, "Let us Dream: The Path To a Better Future" will be out December 1. "If we are to come out of this crisis less selfish than when we went in, we have to let ourselves be touched by others’ pain." He cites a line in Friedrich Hölderlin’s “Hyperion” that speaks to him, about how the danger that threatens in a crisis is never total; there’s always a way out, that where the danger is, also God plants the saving power, a way out. And not simply a way out, God also gives human beings a chance to grasp for and hold onto renewal if only one makes the endeavour. As it says in the Bhagavad Gita God gives man a chance to warm himself near the fire, only those who make the effort to go to the fire can feel the warmth, it is a choice man has to make. And again God says in the Bhagavad Gita that he is not partial to any man. Ever since the global financial crisis hurt working families in the middle and lower classes hard in 2009 because of banks misbehaviour and greed, Pope Francis has called for countries in the western world to heed his warnings about the dangers of greed and corruption to us all. Even George Washington warned of this in his inaugural address, so the warnings are not new. Reminding people once again he says "we cannot return to the false securities of the political and economic systems we had before the pandemic. We need economies that give to all access to the fruits of creation, to the basic needs of life: to land, lodging and labor. We need a politics that can integrate and dialogue with the poor, the excluded and the vulnerable, that gives people a say in the decisions that affect their lives. We need to slow down, take stock and design better ways of living together on this earth." The pandemic has exposed the paradox that while we are more connected, we are also more divided. Francis is never tired of warning that the present political and economic structures and people who staff them have not felt others pain, so he reminds us it is hard to build a culture of encounter in which we meet as people with a shared dignity, within a throwaway culture that regards the well-being of the elderly, the unemployed, the disabled and the unborn as peripheral to our own well-being. Where only self preservation counts. Francis reminds us of the Christian concept that no one is saved alone. This is not just an abstract concept. When Francis was only 18 years and a second year student he was admitted to a Buenos Aires hospital for a severe respiratory disease, so severe that he lost a part of his lungs. He remembers the day August 13, 1957. He understands this pandemic from personal experience. He knows what it is like to be on a ventilator. Surgeons removed the upper right lobe of his lung. Francis struggled to breathe. He was  saved Francis says not even by the doctors, but by a Dominican sister, a senior ward matron, who had been a teacher in Athens before being sent to Buenos Aires. She understood that Francis was dying and after the doctors left asked the nurse to double the prescription dose of penicillin and streptomycin. Sister Cornelia Caraglio, knew better than the doctors from her regular contacts with sick people what they needed, and she had the courage to act on that knowledge.      ...

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Sweden's king Gustaf says the coronavirus policy of voluntary action has failed. Sweden now has 350,000 cases and deaths at 7800. This is more than all other Nordic countries combined and one of the highest rates per 100,000 of the population. Most are elderly who never had time to say goodbye. The makes Sweden a target of worldwide criticism for neglecting older people who never got a chance to say goodbye and died in chaotic conditions. It puts into spotlight the values of Swedish society of self centredness. Sweden, Netherlands and some Northern European countries also opposed the large stimulus planned by Merkel and Macron for the EU. showing lack of sensitivity for the plight of poorer countries in Europe such as Greece Portugal, Spain and Eastern Europe that were already hit by the eurozone financial crisis. The king said 2020 "was a terrible year" for Sweden. Now that the second wave has hit Germany hard, Sweden has acted to close schools, limit gatherings for Christmas and is following the restrictions practiced in the rest of Europe. To get some sense of how hard the second wave is hitting countries Germany recorded  952 deaths a day December 16, close to one third of that in the U.S. on Dec 15. ...

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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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Marie Le Pen and the National Front performed very poorly in French elections. Perceptions of voters are changing. The efforts in tackling the coronavirus, effective vaccination drives, public health protection, and building access to vaccine supplies, have shown the need for good leadership that believes in a science driven direction. Immigration is no longer the issue it once was and in some polls it is seventh on the list after climate change, economy,  education, pensions. The National Front in France and AfD are losing regional elections and popularity is dropping to about 10%. The Greens party in Germany and the Gaullist Republicans in France are being revitalized. Other factors are also present. The search for authenticity and effectiveness. After dismissing a popular prime minister who tackled the health crisis in 2020 France's president Macron fared badly in recent regional elections. His party En Marche was hastily put together in the last year of the administration of Mr. Hollande, the predecessor from the Socialist party. Its initial popularity has not turned into grassroots support. Mr. Hollande, Mr. Macron, are now seen as one term presidents. It is not so much that the centrist parties are gaining as a search for parties that can provide effective alternatives in the face of the challenges placed on the world by the pandemic- renewal of supply chains. climate change, public services, infrastructure, health, education, lives of the elderly. In the US, Europe, and India, countries in Latin America, there is a growing awareness of the need to rebuild with the people in mind, the people who have suffered badly in this health crisis and the financial crisis that preceded it in 2009. ...