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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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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 report in DW.com looks at the response of Germany to the coronavirus epidemic and says Germany may have let a window of opportunity to act quickly slip from its grasp. It says Germany's leader Merkel has not shown the leadership required by the health crisis. Germany DW.com points out recorded its first case on January 27, yet Merkel's first press conference on the subject of coronavirus came on March 11, when Italy was on lockdown quarantine for 2 days.  Germany lacks a quarantine and effective government action to mandate and require social distancing across the country to limit the spread. The steps this report points out pale in comparison with the actions taken in other neighboring countries. Spain earlier and Belgium on March 17th joined a lockdown in Italy. Merkel called on Germans to stay home, yet enforcement is lacking.  In this situation the calm and reacting with reason may be obsolete, a proactive approach being the right one. And a braver one because it would anticipate what happens a week two weeks from now based on experience of China and Italy, and act quickly with a lockdown and quarantine to prevent spread. Waiting in this manner risks too much says DW.com.  ...

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Airports and airlines are trying to promote flying by offering coid testing to avoid quarantines imposed by state and federal governments. Airports are opening test centres offering the PCR test which takes 48 hours for results and rapid tests that take 15 minutes but are not as accurate. Some airlines are looking at designating certain flights as covid tested flights with all passengers either tested and negative or having been removed from the flight. Lufthansa has testing at airports in Frankfurt and Munich with the German government agreeing to it that people tested and negative did not have to quarantine for 14 days. Following this summer traffic jumped. The head of the resting task force at Lufthansa, Mr. Leffers, says testing is now becoming an integral part of the flying experience. Bermuda has some of the toughest testing rules with tests required on Day 1, Day 4, Day 7 and Day 14, resulting in low traffic over the summer. Yet with covid rates rising elsewhere Bermuda has become a safer destination resulting in a large increase in traffic this month. ...

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The Centres for Disease Control agency in the U.S. was unprepared for this pandemic in the early period from January to March. This report in the NYT shows how the agency failed to respond effectively in the early days leading to the loss of lives now past 100,000. When travelers arrived at U.S. airports in February from China carrying the virus with them these flights were diverted to selected airports with CDC conducted screening but the screening proved to be defective. Health officils desperate to set up isolation and quarantine could not act because the information provided was not accurate and missed many details resulting in the inability to quarantine early and isolate clusters as other countries Germany and South Korea have done.

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What is it like crossing borders today in Europe during the coronavirus, and what are European cities like at this time. Two NYT journalists Kingsley and Vancon are finding out by driving 3700 miles by car across many European borders. The hardest they find is entering Germany from the Czech border, where they were stopped and questioned in every way. Germany has strict restrictions- you can only leave for 48 hours if it is longer than this one has to do 14 days in quarantine. Germany also has managed the coronavirus better than its other neighbors France, Switzerland and Eastern European countries.

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States in Germany that have imposed quarantine and lockdown are Bavaria, Saarland, Rhineland-Palatinate., Hamburg, Lower Saxony, and Hesse. People are asked to stay inside unless going to the doctor or supermarket.  Bavaria where Munich is located reported few violations. Chancellor Merkel is meeting with state premiers on March 21 to decide on a nationwide lockdown as in Spain and Italy. 

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The U.S. bans travel from most of  Europe and India imposes quarantine on visitors and overseas citizens entering the country for 14 days. Countries around the world reacted quickly to the situation in Italy, France and Germany. The strict measures taken by China are gradually being adopted by other countries. Quarantine done early has worked limiting the spread of the coronavirus. Countries with strong public health systems are better positioned to weather the health crisis. Where strong action is taken early and in anticipation, with a strong public health response, there is better control over the spread. This comes with some economic cost as it has hit the Chinese economy, yet the rebound is likely to be that much quicker and done with more confidence. For instance air travel in China declined by 85% in February from a year earlier to 8.3 million journeys according to Chinese aviation officials. Moves to keep social interactions to a minimum have yielded results. Only food stores and pharmacies remain open in China till March 25.  ...

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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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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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This analysis from The Times of London provides critical information on the strategy for successfully tackling the coronavirus following the example of South Korea and progress in Britain.

The random community testing is key to getting an idea of the scale of infections in the community at large. The critical ratio called reproduction ratio tell one if the virus is under control and how lockdowns can be lifted. For Britain this 0.7 estimated by Imperial College. It has a 2 week lag. 1.0 or close to 1.0 is not good. Germany after being at about 0.7 has moved up to 1.0 with 2 week lag in information says the Robert Koch Institute. This means a lot of work ahead, it won't be easy.

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The situation in Europe as Germany, Austria enforce travel restrictions with Italy. France has not placed restrictions yet on travel to and from Italy. Many Italians are wondering whether the quarantine and other steps taken now should have been taken earlier, says this report in WSJ. The Italian government is conducting a campaign where people say "lo resto a casa," or "I'm staying home."

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With cases from foreigners exceeding cases locally, outside of Hubei province for the last 6 days, China is now restricting entry of foreigners. All foreigners entering the country from South Korea, Italy, Iran or Japan are subject to a 14 day quarantine. A voluntary quarantine for 14 days is required for other visitors. 

Germany has relied on state and local governments to take action, with the federal government not intervening. 

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