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France and Italy are imposing strict rules for their lockdown and tougher enforcement to control spread of coronavirus. India has imposed a quarantine, a total ban on leaving the home with a televised address by prime minister Modi that set a 21 day lockdown period. Modi said "if the pandemic cannot be managed in 21 days it would set India back by 21 years." 

Fines of $3000 euros are imposed in Italy and cars seized by the police. A special form has to filled out in Italy showing where one is going and checked by police if leaving the home. In France one needs an Affidavit of Movement by Special Dispensation is a filled form required for everyone outside the home. All open air markets are closed in France and drones are used to warn people outside.

All domestic and international flights in India are stopped. All domestic passenger trains and bus services in India are also stopped.

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This BBC report looks at how doctors, nurses, police, railway employees, and sanitation workers in India are tackling the job of preventing the spread of coronavirus as India goes into a complete lockdown. The lockdown and quarantine are intended to slow the epidemic for enough time to enable bringing it under control.

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India imposes a travel ban for 30 days for visitors and overseas citizens of India in an effort to control spread of the coronavirus. The rule goes into effect on March 13, Friday. Visitors to India will face a quarantine of 14 days. The ban was announced on the same day that the U.S. president Trump announced a travel ban for 26 European countries for 30 days.

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The Indian state of Kerala has experience tackling virus situations. Most recently with a Nipah brain damaging virus in 2018. For cases to double Kerala has 72 days, compared to a national average of 8 days. With total 437 cases and 3 deaths Kerala has shown "the importance of early tracking, screening, home quarantine, strict isolation and public participation," says Dr. B Iqbal, chairman of the Kerala state expert committee on coronavirus in an interview with DW. com. The first case was a medical student arriving from Wuhan on Jan. 24, diagnosed 6 days later. During the Nipah virus crisis Kerala limited deaths to 17. Kerala is an example of the importance of a well funded and well established and organized health care system. The Indian state of Chhatisgarh has taken a proactive approach color zoning districts. Of 28 districts 23 are free of coronavirus. Less cases and zero deaths.The key state health minister says was early preparations and then luck playing a part. Most cases today are concentrated in India in the Mumbai area, state of Maharashtra. ...

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This interview with Indian Health Minister, Harsh Vardhan, by Amitabh Bachchan and Anant Goenka of the Indian Express covers a range of questions including India's low fatality rate for coronavirus of 1: 46, its vaccination programs for polio, malaria and other diseases long before the pandemic for a population of 1.3 billion people, respect for healthcare workers, and the distribution of the new vaccines under development in India. Vardhan says there are of the 100 vaccines being developed 30 are in India,and of the ones nearing approval 5 are in India.  India makes 60% of the world's vaccines and its distribution capacity for such a large population has been proven many times. During this coronavirus months of preparation are going into reaching the whole population including remote parts in the mountainous areas. Vardhan says the plan is to vaccinate about 30 crores or 300 million people by June-July 2021 out of a total population of 135 crores or 1.35 billion. The vaccination will start with health care workers, moving on to essential service personnel in the military, police and other occupations, and to vulnerable parts of the population based on age and health conditions. Vardhan who is also the chair of the executive board of the WHO as India's representative, says the prime minister is personally holding two 3 hour long meetings to monitor the preparations for the vaccine and its distribution. Vardhan lists the achievements of the Modi administration and the quality of leadership provided by the prime minister- 2100 testing labs, 97% of the country having a testing facility within 3 kms, testing 1-1.5 million people each day, 1 million testing kits produced daily, 2 million beds in India with oxygen support or in ICU, 13,000 quarantine centers. By personally visiting the vaccine development facilities in Ahmedabad, Pune and Hyderabad, the prime minister also directly supported and encouraged scientists and their efforts. ...

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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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Weak and poorly equipped public health systems, densely crowded conditions, make coronavirus spread extremely serious in South Asian and African countries. India imposed a complete lockdown of the entire country. South Africa imposed a 21 day lockdown enforced by the military. Decisive and strong action is needed early. Pakistan acted early to quarantine pilgrims entering the country from Iran. Pakistan's government has announced a $20 monthly wage subsidy for poorer households. The average in Africa is 20, according to the UN, and South Asian populations are also very young. Generally hotter climates may offer some offsetting factors to makeup for the lack of strong public health systems. India made major strides in direct deposit to bank accounts of 1.3 billion citizens by the government for many social safety net schemes in the last 5 years. It has also computer records of all citizens under a plan underway for a decade. The nationwide rollout of 4G mobile technologies has connected every citizen including remote areas. This should assist in the identification and isolation of affected areas and people. Other factors that mitigate the spread will be access to medicine when medicine and vaccine is developed for the virus. India has a large pharmaceutical industry, scientific labs and other medical resources similar to South Korea, which should help limit the affected areas and people. ...

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India has done well with low cost, scalable, low tech solutions in the past. This is also being done now to tackle the coronavirus. This is being used to support what may be the largest lockdown in history. Everyone is expected to remain at home. Only shops selling essential items such as food and pharmaceuticals are allowed to remain open. All but essential offices are closed, with workers told to stay home. Indelible ink that takes two weeks to wash away was widely available following the election. It is being widely used with high numbers of infections having the back of their hand stamped "Home Quarantined." After India announced a nationwide lockdown all wireless carriers were asked by the government to  insert a taped coronavirus health advisory that comes on after callers dial and before the call connects.Th recorded message talks about how to protect against the coronavirus. Prime time news shows are interrupted three times a day for back to back news conferences from the prime minister, and local officials.   ...

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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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Kerala state of 35 million people who speak the language Malayalam, is one of the rare places today that has only 4 deaths from coronavirus, 524 cases confirmed and no community transmission. Here the Guardian looks at the reasons why. The Health minister KK Shailaja started very early on January 23, with a meeting of her rapid response team when the virus was still in China.  She setup a control room and instructed Kerala's 14 districts to do this on Jan. 24. When the first case arrived on Jan. 27 on a plane from Wuhan, Kerala had already adopted the WHO  protocol of test, trace, isolate and support. These passengers were checked for temperature, tested and quarantined. With some at a nearby hospital and others in home isolation. This is all the more amazing considering that Kerala is a state in southern India on the west coast that has a large number of people living and working overseas. Many are in the Gulf countries and the arrival of these refugees could have triggered a second outbreak. This was prevented by careful testing, and contact tracing of clusters.  When one group was evasive and concealed information from an airport surveillance team -arriving from Venice, Italy,  in late Feb- a case was detected back to them.  Contact tracers tracked down all of the hundreds whom they had been in contact with and quarantined them.  By 23 March all flights to 4 Kerala airports from overseas were stopped, including Cochin and Trivandrum. On March 25 India went into lockdown.  Some of the achievements in Kerala include quarantining 170,000 people early. with strict surveillance, which is now down to 21,000. Accomodating and feeding 150,000 migrant workers from other states, before returning them on charter trains to their home areas. A big reason for the success is the high literacy rate in the state. A big emphasis on education and healthcare is a part of the Kerala model. Shailaja is a secondary school teacher, and Health minister. From the days since independence of India in 1947 the state has a strong socialist tradition of taking care of the basics- health, education and public services. It also generates a part of its GDP with income from workers who are overseas.  Another reason for the success in dealing with coronavirus is experience. The state had a virus epidemic called Nipah in 2018 which has become the story for a movie called Virus in Malayalam. There is decentralized public health system in the state and people value their health care facilities, understand and trust the health care authorites. There are hospitals at every level of administration and 10 medical colleges. But trust and education, experience tackling the virus before, are key. Kerala is showing that poor countries can deal effectively with the virus, and create a better life by adopting the right model of creating good societies that value education, healthcare services, better economic structures and distribution of wealth, and  a degree of trust and responsibility found in a state that values public spiritedness. ...

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There are differences between the governors of 10 worst hit states and the president of the U.S. on when to reopen the economy. The seven on the East Coast including New York, New Jersey, Connecticut, Massachusetts, and three on the West Coast including California and Washington, all but one have Democrat governors and want to wait beyond May 1, till it is believed to be safe to reopen.190,000 of the 592,000 infected cases and over 10,000 of 25,000 cases of deaths are from New York alone. This is as though a third of the problem is in one state. The feeling in New York is that it should be the last to reopen, other states can go first in the middle of the country. The position in the U.S. Constitution is for states to maintain public order and safety. This was the basis of the president's position to work with the governors and continues to be the case, though there is pressure from economic advisers to the president to reopen earlier balanced by the opinion of health experts around the president.  Some states are taking action to reopen because the virus has not severely affected these states. President Trump says it is for governors to decide what is best for each state in consultation with the federal government. The U.S. government would step in if a state is taking risky action with the coronavirus. On the issue of whether the president could have acted quickly in February following his decision to stop flights from China and set up quarantines in January, the BBC has this to say. Dr. Fauci, the president's respected health expert was one of many public officials who did not see the magnitude of the crisis evolving with lack of good information from China. BBC North America Editor Jon Sopel cites Dr. Fauci's comments on February 13- that the coronavirus danger is "just miniscule" compared with the "real and present danger" of flu. As it happened the president acted alone in his sense of the danger from the outbreak in China through incoming flights and not relying on others. Here is what the situation of each country on reopening is- India -  has extended the lockdown to May 3. France - has extended the lockdown till May 11. U.S. - has extended the lockdown to May 1. States are taking the responsibility. UK - continues lockdown restrictions till May. The French president Macron had a simple answer to the question " when will we be able to get back to a normal, prior life?" Macron said "Quite frankly, humbly, I have no definitive answer to that." Some nurseries and schools will reopen May 11. Not restaurants, hotels, museums and theaters. By May 11 France will be able to test and quarantine anyone with symptoms and general public masks will be available to all. This is what Dr. Fauci in the U.S. also wants to see before being able to reopen, that testing and tracing, isolating, procedures be efficient and reliable. ...

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India has learned lessons from past health epidemics- the plague Gujarat 1994, avian flu H5N1 in 2005-2006 Maharashtra, Madhya Pradesh, swine flu H1N1 Pune, and more recently MERS. The Indian Express looks at past epidemics, how they were tackled and what India learned from them. Major improvements in sanitation and hygiene since then and advances in medicine, public health.  Experience was gained. The municipal commissioner of Thane near Mumbai was district collector of Jalgaon during the avian flu epidemic. He used quarantine to restrict transmission of infected material. He shifted bus stands, closed weekly markets, and had health workers check symptoms in a 3 kilometre radius area. His message for today- have a contingency plan, track, test and treat people, stay focused, not panic, and know exactly what has to be done. Moving migrant crisis today was also seen in Surat, 1994, with the plague epidemic when migrant workers left the city. The government had to use paramilitary units in 1994 to quarantine the entire area. During these earlier epidemics the Indian Council of Medical Research and other medical organizations played a significant role. One of the lessons learned from the H1N1 epidemic that originated in Mexico was the need for effective surveillance and real time reporting so that the pathogen can be recognized in real time and tests done at labs to determine what it is, followed by effective response through isolation of region and patients. Dr. Pradeep Awate, Maharashtra's surveillance officer, says robust surveillance systems are important to understand the magnitude of the problem and strategically place resources. The strategies put in place for the Nipah virus in Kerala state by its Health Department in 2019 are the same ones now being used for cornonavirus - contact tracing and management of persons under quarantine. ...

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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. ...