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This editorial in the WSJ commends Congress for the $2 trillion U.S. aid package for households, small business and large corporations to keep workers on payroll, and aid to hospitals. It also commends the Federal Reserve for swift action to maintain liquidity in all corners of money markets. It was important to prevent a run on money market funds and municipal bond funds. The U.S. Senate bill adds $454 billion for Treasury that can support further Fed action if needed. This has also resulted in a recovery in the stock markets. The editors of WSJ caution Treasury from intervening too far up the risk curve to help companies that had overleveraged themselves with risk before coronavirus hit. It makes clear that the U.S. central bank the Fed should only offer liquidity against good collateral to companies that were healthy before the shock. As president  Trump never tires of telling listeners to his daily briefings from the Brady room in the White House- Boeing and the airlines were healthy before coronavirus hit. It was not their fault that coronavirus hit so suddenly. These companies deserve government help, says the president. By making the distinction between otherwise healthy companies and companies that overleveraged themselves on their own, the Fed, Treasury, and the U.S. government can get more bang for the buck. The WSJ editorial also says there is a bit of good news in the behaviour of politicians, media and the public in the way they are ignoring the trivial politics and self-centred behaviours, including indiscriminately being critical of the president, and focusing on the important matters that affect all our lives.  ...

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The chief scientific adviser to the government of Britain says "go hard, and go early" to prevent a surge of coronavirus in Britain in the autumn and winter with more activity indoors. Things are flattish at the moment, but if hospitalizations pick up the government needs to quickly shift from Plan A without vaccine mandate and without mandatory mask use to requiring vaccinations and mask use, calling for working from home, as part of Plan B. Unlike France and other countries in Europe Britain has not taken the strong action that is necessary. Prime minister Boris Johnson is pushing for new efforts in getting the remaining people vaccinated.

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The U.S. trade deficit with China was declining till the coronavirus hit in February. Now it is back on the way up, a warning signal for the Trump administration as it seeks to stop sending American wealth out of the country in an utterly disproportionate way of $346 billion in just 2019 after taking action on tariffs and renegotiating trade agreements.  Imports grew 11% in July to $231 billion. While exports increased but not as much by 8.1% to $168 billion in July, still well below February/s $209 billion. That leaves a trade gap of $63 billion. This is the largest trade deficit since July 2008. The U.S. trade deficit is a major issue and is watched carefully as the Trump administration sets a goal of rebalancing world trade so that the U.S. no longer runs such large trade deficits with China, and Germany, and does not shift wealth overseas. The U.S. trade deficit with China in 2019 was $346 billion, with Japan and Germany it is much smaller close to $70 billion for each country. The Trump administration goal is to all out reduce this deficit through trade agreements and other actions that stop the current outflow of U.S. wealth overseas by $1 billion a day to just one country. For this it seek a level playing field which means other countries have to face tariffs if they unfairly subsidize their industries or violate labor rights for unfair competition, or in other ways seek to unfairly gain an advantage over the U.S. including through transfer of technologies from the U.S. ...

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U.S. president Trump announces U.S. withdrawal from the World Health Organization on May 30, 2020. Earlier the president had sent a letter to the WHO as a 30 day ultimatum and that he would reconsider membership if the WHO did "not commit to major substantive improvements within the next 30 days." The U.S. has given $450 million a year to the WHO compared to $50 million by China, yet China president Trump says has "total control over the WHO," showing deep seated dissatisfaction at the way the WHO has under current leadership has handled the coronavirus crisis and failed to take early action for an early warning system as were taken by earlier heads of the WHO such as Gro Harlem Brundtland of Norway during the H1N1 crisis in 2003, who was cited in Mr. Trump's letter.

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Tory MP's rebels in the southern part of England are opposed to prime minister Boris Johnson's second lockdown for the whole of England. This report in The Times of London looks at how Johnson's conservative government might have to get Labor party support to pass the lockdown measures in parliament. Or Labor may decide to abstain from the vote. Mr. Gove says the NHS risks being overwhelmed if the lockdown does not take place. Responding to the statements that southern England does not have high or has falling rates of coronavirus Mr. Johnson says it has been shown that a low rate catches up in one area when it is next to a high rate area for coronavirus so that the result is the spread of the virus to the point where the NHS cannot cope.  The NHS like the French health system and other health systems in the European Union, U.S.  India, and other countries are strained to the limit. Most healt care workers in hospitals have felt severe strain on themselves and their families during the first wave. Most are exhausted and are in a situation of fatigue with the added factor of some healthcare workers on leave from the virus illness. This puts additional burdens on the system. Without the action taken the health system may be overwhelmed in many countries leading to disaster.   ...

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This article in The Lancet published in February 2018 throws much light on how the ban on gain of function research on virus was lifted -research that carries with it the danger of increasing transmission of virus if something unexpected happens in the manipulation of a virus. It was lifted in 2018 in the US by officials in the US Health Ministry, NIH and HHS. The Cambridge group of scientists and experts opposed lifting the ban on such dangerous research that could make the virus more contagious through manipulation. Epidemiologist Marc Lipsitch of Harvard School of Public Health wrote at the time that the lab research to create a more lethal strain of virus could lead to "an accidental pandemic" yet he was ignored. The public in America and in the world is unaware of how this created serious risks for public health in the world through the coronavirus.  Did US health officials lift the ban on such research without consulting other countries such as India, Brazil, France, Germany, Italy, and the EU on its ramifications. Were public health experts and the publics themselves in the US and around the world not drawn into the discussion of public health and the dangers that existed. Not only did officials in HHS and NIH restart the research by lifting the ban but also sent funds overseas for such research- was this a proper or thoughtful action considering the risks involved.  Is enhanced surveillance of virus- a dubious benefit from manipulation of a virus- something a few health officials can decide for the whole world in addition to the US. How are health officials in one or two countries responsible to the people in India, Brazil, Europe and the poorest populations in the world in the world in Africa, Latin America, and Asia, people who have suffered devastating consequences from transmissibility of the virus, including children and older people with health problems. India, Brazil, Italy, Spain, France, UK, and other countries worst hit by the coronavirus must ask serious questions about how they can protect their people if institutions in the US and international institutions are seen as failing to protect world public health. ...

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In an astonishing contrast to other European countries, including neighbors Norway, FInaland and Denmark, the Swedish government decided to not impose a lockdown, keeping bars, restaurants, hairdressers, gyms, primary and middle schools open. Secondary schools, museums were closed, sports gatherings, gatherings of more than 50 people were not allowed. Social distancing was not enforced, and entirely voluntary. Sweden now has 29000 cases according to Statista and its death rate of 358 per million population is higher than in the U.S. which is 267, and Denmark 93, Finland 53.  Critics such as Lena EInhorn, a virologist, say the Swedish government did not set up a broad testing program, and let a problem develop for elder care in nursing homes. She says a 14 day quarantine of household members of a person infected with the virus would have made a difference. Most action we take for granted was not taken in Sweden. Restaurants that were not required to close spread airborne transmission. Einhorn also says that the government officials have denied it but under their breaths they have acknowledged working on a herd immunity strategy. Denmark has opened schools with social distancing and other measures and reopened its economy. Sweden is in reverse with calls for stricter action and an ongoing debate. No reopening as there was no lockdown, yet considerable and nagging uncertainty. The speed of transmission of coronavirus is the biggest danger, as it can let the numbers grow very quickly if the wrong decisions are taken or something is left out. ...

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President Trump's failure to followup on his decision to shut down all flights to China on January 29 with speedy action on preparing for the coronavirus as suggested by some of his advisors is the subject of this article in the NYT.  There were two distractions one was the trade deal with China that was being negotiated, and then the impeachment trial in the U.S. Congress that was set in motion by Democrats. Another problem was the lack of good information about the extent of the virus spread in China and infected case numbers. As it turns out no one really knows the real scale of infections in China. If is was known that there were as many cases in China as there are in the U.S. today this would have resulted in shaking up any complacency in the Trump administration and in the states. Considering the experience of Europe and the U.S. it could be that China had the same number of infected cases as the U.S. does today for a population three times the size. China had a strict quarantine but it also did not realize what it was up against in the first weeks of the crisis in January. It appears now that China, Europe and the U.S. all lost some time from 2-4 weeks before realizing the severe consequences facing each region. This report says one of the vital pieces of information that was learned about infected people in China, was learned as late as the end of February by leaders of a government team looking at the coronavirus threat. It was that seemingly normal healthy people without symptoms but infected by the virus could spread the virus. This meant that this was very, very contagious. The lack of good information played a significant part, adding to the level of complacency in states such as New York and in the Trump administration. Politics such as the impeachment trial and political infighting added an unnecessary distraction. ...

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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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Argentina's government of president Alberto Fernandes is making a state takeover of Vicentin, a soyabean exporter which filed for bankruptcy in 2019 and is in ongoing court proceedings. Mr. Fernandes says he is doing this to rescue the century old agricultural firm to protect Vicentin workers, and 2600 farmers who sell crops to the company. Vicentin is Argentina's top exporter of soy meal and soy cooking oil. Mr. Fernandez says the company is a very important asset for the entire Argentine economy. Argentina's farm exports are its main source of earnings in dollars.  A drought in Argentina's farm sector in April 2018 led to a drop in export revenues and worsened Argentina's financial position leading to the 2020 default on Argentine debt. In 2018 the farm sector lost a third of its crop value and 1.5% of GDP. Growth in 2017 was 3% but declined to 1% in 2018. A number of other factors including overborrowing using dollar denominated debt led to the economic crisis in 2020 right in the middle of the pandemic in May 2020. Fernandez is a moderate compared to the previous Kirchner administrations and was elected in 2019 to get Argentina out of the debt crisis after confidence in president Mauricio Macri declined. Fernandez has tackled the coronavirus crisis with an early lockdown compared to neighboring Brazil which has not taken decisive action making Brazil the second largest after the U.S. in cases. This gives Argentina some room to tackle the debt crisis and negotiations with the IMF, lenders. ...

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The experience of Pintung county in Taiwan with a coronvirus outbreak is shown in The Guardian. Home quarantining of a couple from Peru leads to an outbreak. Community cooperation, a speedy response from local health authorities, testing and quarantining help to limit and control the outbreak. When it started this county on the coast, one of the poorest in the country, had limited health resources and no one was vaccinated. Most of the control response was through testing and quarantine, with vaccination assistance from the Taiwan government. Local people say strict quarantine is essential as the source of infections was from a couple who visited Peru and were allowed to home isolate. Taiwan government is now enforcing quarantine at hotels for all persons returning from overseas. WHO Emergencies program head, Dr Michael Ryan, says it is important to act quickly. He says "Be fast, have no regrets. You must be the first mover. The virus will always get you if you don't move quickly."  This happened in this Taiwan county as the local health authorites setup a soft lockdown of the two affected villages within 3 days of detecting the first case of Delta variant. This was announced over loudspeaker and food plus daily necessities were delivered to each household. A command centre was setup to take and coordinate the action daily. Taiwan authorites have enforced repeat testing and extended testing. ...

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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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This important WSJ report shows how the CDC labs failed to come with the test after contamination of a component and failure of the third part of the three part test components. In the absence of a working test from CDC where delays cost three weeks of February the private labs all over the country and state labs could have developed their own test, yet HHS and FDA required approval for these labs to develop their own test and use it. From Feb. 8 when state and city public health labs detected problems with the CDC test to Feb 29 when solutions were developed including simply excluding the third part of the three component test, and letting labs around the country do their own test, were 3 crucial weeks that let the virus spread out of control. The CDC, HHHS, and the FDA and their managers and heads of departments bear responsibility for these errors. Week after week the delays continued, instead the two component test which detects if the genetic material in the sample is coronavirus material, could simply have been approved at the outset instead of the approval for this given weeks later. The third component of the test checks if the virus mutated, according to this report. There is no explanation why the labs all over the U.S. were not allowed to go ahead on February 9 itself or within a few days after that to develop their own tests once it was clear the CDC test did not work on that day. CDC officials failed to recognize that there was a possibility that they may not be able to fix the faulty third component of the test and the risks if they gave false reassurances. There is also no explanation of why a German designed test was not used once the CDC test failed on Feb. 9, which would be a proper way for action considering that this pandemic had already shutdown parts of China by this time. Alarming also is the mention in this report that on Feb. 22 a FDA official in charge of lab diagnostics  flies to Atlanta where the CDC Respiratory Diagnostic lab which developed the test is located. His boss FDA medical device center director is cited from later information as describing the lab as "filthy" meaning the lab had the potential to contaminate, and going so far as saying that if it had been any other lab it would have been shut down. Considering that investment in public health has deteriorated over the last two decades and that there has been a massive misallocation of capital in the country away from public infrastructure this is appalling. The thought of critical labs for emergency health needs as not being up to high quality standards in the U.S. as a result of two decades of misspending, that this shows, is very disturbing.  This WSJ report is based on interviews with people who know about the testing crisis, and undisclosed emails, correspondence on the issues involved. Community transmission began in January 2020 in the U.S. These delays were costly in February and could have been prevented either by going with the German design on Feb 10 or asking labs across the U.S. to develop their own test, and letting other labs immediately use the modified 2 component test of CDC that worked instead of doing this action weeks later. Mardi Gras on Feb 25 and other places where large crowds gathered in sports stadiums could have been stopped had testing gone forward and shown the true extent of the community transmission in these critical weeks.  First China delayed a U.S. team of experts coming into the country for weeks, and then the CDC, FDA, HHS, failed to get testing started, creating  a false sense of complacency. Two crucial errors outside and inside the country that caused so much damage to America and the world.   ...

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This report in WSJ shows how European countries are maintaining salaries of employees who would otherwise be laid off. Governments have setup programs in France, Britain, Germany and other countries to provide employers with the money for 80-84% of salaries up to 2500 pounds ($3165) in Britain and 5330 euros a month in France. As a result 1 worker out of three in the private sector in France for subsidy applications for 6.9 million workers are already received. For the German program 2.4 million workers will get this benefit. About 1 million companies in Europe retain employees with this program of governments simply sending out the salaries with funds directly to households. This helps to keep out the stress for families, particularly families with children. It is as if the employees are not really laid off but asked to stay at home for manufacturing facilities and work from home in shorter hours where work can be done remotely.  Money is quickly deposited into the bank account of employees in these countries, though it is slower in Italy and Spain. It is as if the European approach is put the whole economy on pause for 2 months and restart it almost like before with only a small dent in employment once the coronavirus is pushed out with lockdowns and strict control actions. This will cap German unemployment at 5.9% compared with 5% last year, only a modest increase. The cost is not that much considering what it accomplishes. 10 billion euros is the cost in Germany where the state fund for this has 26 billion euros. 10 billion pounds in Britain. And 20 billion euros in France.  The U.S. adopts a similar approach also through its $349 billion program which provides loans to companies with less than 500 employees to meet payroll for 8 weeks and pay some overhead. Loans are forgiven based on job retention and employees on the payroll and only if the employees are retained. Another program is for companies larger than this. And a third program targets entire industries such as airlines, aerospace, and companies in other industries so that they do not have to layoff employees. U.S. unemployment insurance is modified to work along similar lines maintaining incomes of employees laid off because of the pandemic. Another program sends checks directly of $1200 to households with lower incomes to help them and to help people at poverty level or without jobs. The thrust of both the European and American efforts is the same, lose as few jobs as possible, keep people's incomes steady, and do this in a way that the economy can pick up quickly to the former level in as short a time as possible. Compared to Europe U.S. unemployment will be higher predicted at 9.8% with the expected rebound lowering the unemployment in 2021. ...

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Underreporting of coronavirus cases in China poses risks for other nations in not giving them a sense of the magnitude and severity of coronavirus. This leads to a false sense of security- in Japan, Sweden and other countries, much delayed action and a sense of exceptionalism that we can ride this thing through like an ordinary virus, In the U.S. and Italy, Spain, UK and Germany, loss of crucial weeks before taking action. Looking to the future this poses new risks as it still leaves people without a sense of how long to continue lockdowns.  The pandemic poses huge risks for Asia and Latin America because of poverty, crowded conditions and sanitation levels. The early action by prime minister Modi was a huge step in the right direction before coronavirus spread could damage the economy and people- as Mr. Modi said if not done right such as with a 21 day lockdown this could set India back by 21 years. It had value in that it alerted other countries such as Philippines, Indonesia, Malaysia, Bangladesh, Pakistan to take strong action early. As the WSJ says here in this essay by what is important for China and all other countries reporting on coronavirus is that this reporting is vital only because it can save many other countries from making costly mistakes. Which is why the direct doctor to doctor contact between Chinese doctors and American doctors is an encouraging right step, says WSJ.  ...

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This WSJ report looks at how China is run today with attention to details by president Xi Jinping. Mr. Jinping takes interest in all matters that relate to wellbeing, reducing gaps in wealth and privilege, coronavirus pandemic, corrupt businessmen or officials, climate change, and the economy. Some decisions have to be reversed after they appear not to be working. In some situations goals conflict such as climate change action on coal requiring shutting down intensive coal dependent factories, and economy jobs goals requiring use of coal intensive factories. Leading to a complete reversal of the original decision to cut back on use of coal as happened in 2021 when factory shutdowns affected the economy.  Jinping does not see it as micromanagement. Previous leaders such as Hu Jintao had little interest and did not put in the effort to seek out areas where policies were not working for families and workers, delegating this to lower level officials. Jinping's style is hands-on and energetic to act on issues that affect how China should be run so that the quality of life of ordinary Chinese is improved. Jinping says that if he did not take action there just is'nt the level of initiative on the part of local officials. Many officials are not competent to tackle complicated issues. Jinping says that "some officials only act when the central party leadership has instructed them to do so." And that he acts as a last resort- "I issue instructions as a last line of defense." His willingness to reverse decisions or let them be implemented with local officials using their discretion if he thinks that would be wise also shows a level of flexibility and humility. Basic to his decisions is a general idea that the original vision of China of the founding leaders in 1948 was forgotten in the headlong rush to modernization of the last 20 years. This means a balance was needed to restore some measure of equality and empowering of the disadvantaged. Xi Jinping's father was one of these founding leaders under Mao and under premier Deng during the market economy founding in the 1990's. Xi Zhongxun, Jinping's father was an energetic leader who also took a keen interest on a whole range of issues for China's modernization drive, a trait now found in Mr. Jinping. The first market economy experiment was done under Xi Zhongxun with premier Deng's encouragement. Xi Zhongxun set up the Guangdong and Shenzen special economic zone in 1979, as governor of the province in an effort to liberalize the economy and slow the exodus to Hong Kong. At the time wages in Shenzen were 1/100 of wages in Hong Kong. Some of this style can be seen in India with Mr. Narendra Modi delving into details of policy and taking intitatives that local officials had neglected to do on a whole range of issues related to modernization, development and technological progress. One of the decisions made by Jinping was to tackle Covid aggressively with a zero Covid policy, which means frequent lockdowns and restrictions even with a few cases. Mr. Modi has also acted vigorously on Covid after warning in March 2020 that this could set India 20 years back, with a policy to get over a billion people fully vaccinated. In both situations the only two countries with over 1 billion population needed this kind of strong leadership with an interest in a whole range of issues that relate to lives of ordinary people during the pandemic to inspire some essential level of public confidence and build public wellbeing.     ...

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The U.S. Fed, America's central bank, barrs bank buyback of shares and limits dividend payouts to quarterly profit. The Fed does this as it warns banks they could sustain heavy losses of $700 billion for soured loans if the economy is slow to recover over several quarters, and unemployment remains high. The Fed's latest stress test for banks included the impact of the coronavirus epidemic. At this time the Fed says banks are healthy and this is protective action to keep the banks in safety.

Another sign of the changes taking place in finance and banking- swift action by the U.S. central bank leadership to stop early any potential improper behaviour of banks to do debt buybacks or dividend payout not meeting rules related to profit. 

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WSJ looks at the changes in the way medicine should be practiced in the light of what we have learned from the pandemic.  Medicine practiced before the pandemic and still today relies mainly on a visit to the doctor or specialist who is short of time. There is a shortage of doctors. Patients have many illnesses as a result of decades of neglect of proper nutrition, and exercize habits. Obesity is at about 40% in the U.S. about 30% in the UK and 17% in France, and high also in other parts of the world. These high rates were unknown throughout history and result in many illnesses and increase by four times the vulnerability to the coronavirus. One authority in medicine calls obesity pouring gasoline on a fire for effects of the virus.  A doctor's appointment with doctors short of time with no coordination around a whole range of factors related to obesity, illnesses, health checkups, mental health, is now seen as a heavily handicapped way to practice medicine or for patient healthcare and wellbeing. The alternative is discussed here as the way forward. A  team will be responsible for a patient's care not just an individual doctor. The team would care for general health after a patient's checkup, cover individual illnesses, weight issues, mental health, exercize nutritional needs and other good healthcare habits. Instead of relying on doctors at a time of shortages of doctors the team would be led by nurse practitioners.  A nurse practitioner is someone with a bachelors degree and a masters degree or doctoral degree in nursing with 1000 hours of clinical training. Studies have shown that they are effective and even more effective than individual doctors. Today particularly with the problem of doctors with limited time compounded by the built up problems of decades of bad habits in nutrition and exercize and poor "cultural" habits getting entrenched, there has never been a greater need for a better way to practice real healthcare for a person's wellbeing. Particularly in rural areas with an even larger shortage of doctors the health practitioner led team will play a big role. Patients will under this setting receive more care virtually and get more followup care by phone and video messaging. The numbers tell the story- there are shortages of doctors in USA, Europe, Africa, Latin America and Asia. In the U.S. shortage of doctors is 55,000 projected to 2033 by Association of American Medical Colleges. There are 290,000 nurse practitioners licensed in the U.S. and 131,0000 physician assistants. The goal will be to get an adequate number of nurse practitioners licensed in this decade to take care of these teams. The pandemic has made virtual visits to doctors and nurse practitioners popular. Medicine reimbursement should and would be practiced on the basis of how well a patient is doing not on a fee for each micro service that is delivered. For this to happen the teams led by the nurse practitioner have to commit to patient education of the benefits from good practices and good habits for nutrition, exercize, caring for oneself. A doctor short of time is hardly the person to carry on this patient education which is where the major opportunities for a new system arise. The virtual care also provides a new medium for patient education and awareness of the risks of getting illnesses, preventive actions to be taken in advance. One approach being tested in California and Texas is for a monthly fee for patients more payments by health plans to doctors or healthcare teams if the patient is healthier. Additional health professionals are added to the team including health coaches, dietitians and medical assistants to increase its effectiveness in counseling and education and monitoring.  The nurse practitioner team approach is already being practiced in parts of the U.S. including the example of New Hampshire shown here, and is predicted to be the approach for primary care in the next decade. ...

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A look at two crises in 1918 and 1957 of virus pandemics shows early and decisive action to prevent public from gathering and intermingling, are critical. In today's densely populated urban environments this translates into lockdowns and quarantines that are strictly enforced. The 1918 pandemic took 50 million lives worldwide, the 1957 pandemic took 1 million lives worldwide, says this report based on some estimates. MIstakes were made then and science was not as developed for vaccines and new drugs. Which is why health authorites are taking this very seriously. Greg Ip of the WSJ looks at coronavirus health crisis in relation to earlier disasters- SARS 2003 originating in China, 1957 flu epidemic, 1918 Spanish flu epidemic, to draw insights on what measures have worked best. Previous epidemics and crises provide clues on what makes things worse or better and the long term consequences of actions. The more health and safety are prioritized there is some impact on the economy. But crises have proven that the economic impact is temporary and short lived with the economy and jobs bouncing right back once the crisis has passed. The second insight is that early on in the crisis there is a great deal of uncertainty, leading to fumbled or delayed, or timid response. Sort of like lets wait for more information coming out of China, or now Italy, which happened first in February, and then again in March. Tim Adams who worked in the U.S. Treasury Department during 9/11 and Hurricane Katrina, and is now the president of the Institute of International Finance, says if you look to plan a perfect response you lose valuable time. Time is of the essence. Learning to make speed the priority, to think in tranches, be visible, and worrying about how to pay for it later, is what he says he has learned from these crises response efforts. In the case of the coronavirus, some valuable time was lost becausee of the uncertainty and lack of early information, making speed and rapid comprehensive action very critical. The Spanish flu epidemic of 1918 infected over 500 million people worldwide and killed 50 million or more, including 675,000 in the U.S., according to the Centers for Disease Control and Prevention. During this epidemic the Chicago public health commissioner flatly opposed closing businesses, saying worry kills people more than the epidemic. A 2007 study shows cities that took that attitude saw higher death tolls in the Spanish flu epidemic of 1918. Philadelphia waited 16 days before restricting social gatherings, St Louis took just 2 days. The result: the daily death rate from the epidemic peaked at level five or more times higher in Philadelphia than in St. Louis. Social distancing was not much of an issue then as people worked in jobs that required less contact, such as farming, fishing and forestry, as well as other jobs that did not require that contact in large offices.   ...