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

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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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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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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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Britain's Cabinet Office minister supports the scientific community in its efforts to ensure contact tracing combined with random testing to track community levels of virus penetration. This supports reopening with reliable data and information on how to proceed. Britain is pursuing this strategy.

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Britain has opted to take the approach of South Korea and Taiwan, where the app developed for contact tracing adopts a centralized approach sending information to a central server.  The Google Apple app is taking a decentralized approach where the information on who has the virus and who they came into contact with is not sent to a central server. Asian countries with success in lifting lockdowns have adopted a centralized approach as this has given proven results in allowing the rest of society to function smoothly without lockdown, by isolating a few people who have or have come into contact with people with virus. In a crisis of this magnitude with the huge risks involved democracies such as South Korea and Taiwan, other Asian countries, and now Britain, see less risk in relying on the centralized approach, because it works more effectively to accomplish the task of limiting spread and letting society function without lockdown.

 

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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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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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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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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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In a corner of Wales known for its coastline and scenic beauty, a biology teacher Mr. Barry Rees sets up a homemade contact tracing system that worked. He is the director of Ceredigion county council. It is the safest county in mainland Britain with only 45 recorded cases in the last week for 75,000 residents. Early on in the coronavirus epidemic Mr. Rees decided to take up contact tracing with whatever resources were on hand and start quickly. This was was happening in German states which were also following low tech, get started quickly approach, but Rees was not aware of what was already happening in Germany. He knew about South Korea and Singapore efforts in contact tracing which put a lot of emphasis on human skills in calling and tracing and getting started immediately. Rees started with the people calling in sick of the 4000 people who worked for the county administration, as he had no testing resources. He started tracing these people and their contacts, and even though some were defensive the majority supported intervention to isolate. At the time there were fears of 200 deaths in the county so that there was no time to lose.  By April the area was facing an influx of people from Aberystwyth University and tourists visiting its sandy beaches, another reason for taking on the task with a homemade system. Today it has one tenth the cases in the rest of Wales.  The hidden fear in the country is that word can get out and lead to more visitors from outside the county. ...

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The British public is very conservative when it comes to reopening. 73% support prioritizing the health of citizens only 17% say prioritize the economy. This is the highest of industrialized nations, Japan being the next highest with 60% supporting prioritizing health only 16% in Japan saying the economy.  For Boris Johnson as he makes the speech on Sunday May 10 on reopening the political margin for error in decision is nonexistent. Britain's tabloid press and other media simply took the idea that to heck with it lets reopen reflecting a lack of caution in the headlines after Mr. Johnson expressed his intention to reopen. After seeing this Johnson and his closest advisers met without his hawkish ministers to reflect on what was happening in the country. The British government's scientific advisers say whether there are 100,000 deaths by the end of the year depends on many factors including testing, contact tracing, the way the lockdown is eased, the situation at nursing homes, and other government action  to prevent a resurgence in infections. At the meeting with Gove, Sunak Raab and Hancock, Mr Johnson stepped back and reversed any plans except for mild reopening- giving people more time outside for exercize, opening limited locations such as garden centres and advising strongly to wear masks on public transport. Both Johnson and Dominic Cummings his adviser had coronavirus, and Johnson spent some time in ICU. They know the impact of the coronavirus from their own personal experience.  For Johnson there is only one chance, Tory senior advisers say the public will forgive mistakes going into coronavirus, but will never forgive mistakes getting out of cotronavirus. He told Keir Starmer of Labour in parliament that he bitterly regrets what has happened in nursing homes. The scientists have warned him that the staff at nursing homes could seed communities once again. And that the coronavurus R ratio (1 being the level it starts growing again) could go up back to 1. This is the situation on May 10 as Johnson prepares to speak to the nation on Sunday at 7 pm, as he shifts to "maximum caution." ...

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Britain will miss the target of 100,000 tests a day set by Matt Hancock, the Health Secretary. It should be achieved in the next few days though. It was right to set an ambitious target say officials as the most important thing is the direction of travel. It was right to set a brave target even though there are shortcomings needing to be corrected. It is a moving target as about 120,000 tests a day will be needed for health care workers alone, say NHS officials.

Matt Hancock is planning to set up a test and contact tracing system similar to South Korea by middle of May. 18,000 tracers will be needed by middle of May. A smartphone app developed by NHS will be used to track and alert people.

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Barry Ritholtz lists the causes of the financial crisis, He says New York Mayor Bloomberg's exoneration of the financial industry is simply false- what he calls "the Big Lie"- even though Congress, regulators and the Greenspan Fed acted irresponsibly and created favorable conditions for the actions of the financial industry.

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Did U.S. Treaury Secretary, Timothy Geithner, ignore a key request by President Obama to present plans for the restructuring of Citigroup after the government bailout of Citigroup? Ron Suskind says this is what happened in his book on the Obama administration and how the White House operated to make key decisions. Ron Suskind, intervewed key members of the Obama White House economic policy team, Lawrence Summers, Christina Romer, Peter Orszag. In all Suskind conducted 700 hours of interviews for his new book in Sept 2011: "Confidence Men: Wall Street, Washington and the Education of a President." According to the book, in early 2009 after Obama authorized a series of stress tests for banks he told Geithner to develop a plan for restructuring Citigroup. A month later at a meeting not attended by Geithner Obama raised a question about the status of the plan. He was told by Romer that no restructuring plan had been developed for Citi. Suskind says Geithner disagreed about a plan to restructure Citi and decided to ignore the request. Geithner and the Treasury Department say Obama asked Geithner to develop a backup plan to overhaul banks if the government was forced to keep a big ownership stake in the companies, and "there was fortunately never a need to put them in place." Geithner told Suskind that he doesn't slow-walk the President on any matter. Other aspects of the operation of the economic policy team that Suskind covers are a series of memos from top aide Pete Rouse raising questions that ongoing communication between some members of the economic team and Summers was giving Summers power to shape policy. Summers, Director of the National Economic Council, is shown as trying to keep out the views of Romer and budget director Orszag from reaching the President without going through him. When Orszag gives a private report to the president on the deficit, Summers objects saying that this was immoral. Obama lacked the fresh ideas needed to tackle the problems created by the mortgage and banking crisis of 2008, when he used the Clinton administration economic policy team of the 1990's- Rubin, Bernanke, Summers and Geithner. Fresh approaches were needed two decades after Clinton's election in 1992, and the Bush administration that followed, as many of the problems developed during this period. The similiar embedded thinking was shared during the Clinton and Bush administrations and the economic advisors about dealings with the banking sector, but the situation for deficits, unemployment, housing, and the economy had completely changed requiring fresh approaches. ...

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Friedman compares the anti-corruption movements in India and the U.S., the world's two largest democracies. The Occupy Wall Street anti-corruption movement in the U.S. focusses on the excessive influence of banks on lawmakers, regulators, and the government, through the use of campaign money, revolving door for government officials and regulators to join banks, and intense lobbying. The anti-corruption movement focusses on corruption in government at higher levels, such as the handling of government licenses, and at the basic levels of needing to bribe officials for something as simple as getting a birth certificate or other government document. Both have pernicious effects, in the U.S. excesssive bank influence leads to taking excessive risk for higher bonuses, putting the entire financial system at risk and creating a crisis in housing that delays the economic recovery. And in India the corruption leads to retarded progress, as funds to invest in infrastructure and development are siphoned off, business and entrepreneurs are required to pay bribes at each step, and ordinary people face the need to pay bribes for the most routine interactions with government officials. In the process this creates more unequal societies by skewing the distribution of benefits from wealth created to groups that are better equipped to game the system. The economic system once distorted in these ways has tendencies to take talent away from productive activity and innovation which create wealth, and direct it towards speculative activities....