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The testing shortages in the states and the lack of enough cartridges provided by the U.S. government for Abbott Labs testing machines is causing much frustration, as shown here in the WSJ. Illinois one hotspot is an example. Illinois governor Pritzker says he spoke to Abbott Labs a week ago and thought he had an agreement to conduct 3000 tests a day. He then learned that the U.S. government was taking over the purchasing and distribution of the tests.  He  received 15 Abbott machines and 120 cartridges for all of Illinois which would enable 120 tests from the U.S. government. Abbott currently is making 50,000 test cartridges a day for the rapid test. Detroit which had better experience with the Abbott machines says it has conducted 1000 Abbott rapid tests, shortly after Abbott got approval on March 27. With the 1000 tests Detroit was able to test first responders and bus drivers in quarantine. Detroit recently purchased another 4000 additional tests from Abbott which it wants to use in nursing homes and homeless shelters, vulnerable populations in the city. The Abbott test provides result in 15 minutes making it very effective in implementing fast quarantine action when the virus is spreading quickly in a specific population.  Other governors say they are banging their head against a wall trying to get more tests. ...

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When the coronavirus spread in China it was expected that Taiwan would be affected badly. Yet Taiwan has managed the situation in a number of ways that has limited cases to 50. Health experts attribute this to quick preparation and early intervention. After the 2002 and 2003 SARS epidemic Taiwan setup the National Health Command Center (NHCC) to combine resources for managing a health crisis. This was to prepare for the next crisis. Taiwan acted early imposing a ban on travel to China, Macau and Hong Kong, and a ban on the exporting of surgical masks to keep a stockpile in Taiwan.  Taiwanese government integrated data from national health insurance with immigration and customs data. A program was developed  that allowed people to report travel histories and symptoms by scanning a QR code when they arrive in Taiwan. Travelers receive a text message with their health status that allows customs officers to focus on the ones requiring attention. The public's willingness to follow government regulation is now much higher after the difficulties caused by the SARS crisis. This makes them willing to follow more readily action taken by the government, as SARS memory is still fresh in their minds. Investments in public health systems and in biomedical research is much further advanced than in other countries. A research team at Academia Sinica has developed antibodies that can identify the protein that causes coronavirus, The aim is to shorten the test time for diagnosis to 20 minutes. The lead researcher Yang says the next step is to validate it before turning out a rapid test kit. ...

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The World Vaccine Summit raises about $7 billion to immunize about 300 million children for polio, diphtheria and measles, over 5 years. Prime minister Boris Johnson who opened the summit called it "the greatest shared endeavour of our times." Bill Gates donated $1.6 billion and Britain pledged 1.65 billion pounds over 5 years, making Britain the largest donor. Mr. Trump also addressed the summit in virtual manner- "we will work hard, we will work strong... good luck, let's get the answer." Mr. Johnson called for renewing "the collective resolve."  Specifically he stated: " Just as we have great military alliances like NATO.... where countries collaborate on building their collective military defence, so we now need that sam spirit of collaboration and collective defense agains the common enemy of disease." Referring to failure of early warning systems for coronavirus with crucial weeks between Jan 6 to Feb 16 lost for the West with lack of international cooperation- "It will require a new international effort to cooperate on the surveillance and sharing of information- data is king- that can underpin a global alert system, so we can rapidly identify any future outbreak. And that will mean a rapid scale-up of our global capacity to respond."  ...

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A 35 year old Engineering professor from Texas who studies how transportation systems propagate infectious diseases and her 2 graduate students from China started and since January maintain the database of coronavirus confirmed cases and deaths. This is one of the widely used databases, also used by public health officials in the U.S. The database was started with a hunch from one of Lauren Gardner's students from China Ensheng Dong who comes from Shanxi province, north of Wuhan. A geography and mapping specialist he had studied in the U.S. since 2012, and spent many hours inputting data by hand following his classes. This WSJ report says the website was built in 1 day and was launched on January 22, when the coronavirus cases were practically nonexistent in the rest of the world and were concentrated in the Wuhan area. This report says behind the data reported in the media everyday is a complicated supply chain filled with challenges that come with data, what is reported, underreported and with what assumptions it is reported. Dr. Gardner says she is dealing with so much data on her dashboard, 4000 points of data, that its hard enough to pull all the data scraped together from different sources, its impossible for her to check the assumptions behind the data for consistency and trying to figure out facts underlying the data.  One of the ways the virus developed in the rest of the world is the surprise with which it caught western countries and then the rest of the world. As a result something that the government authorites would do such as the Centres of Disease Control is being done in a totally ad hoc manner. The U.S. government uses the University of Washington Health Metrics database, and in turn the University of Washington Health Metrics database takes some of the data from the John Hopkins database. Because a complacent population in the western countries were relying on numbers counted as cases to know how serious this epidemic was or whether there was an epidemic, the significance of data count from China assumed a signifcance far out of proportion to what it might normally be. This was because the western countries in Europe and America never encountered an epidemic of this kind in living memory, the last one forgotten from 1917 hundred years ago. Researchers in Gottingen University study in Germany conducted analysis of data in studies of cases published in Lancet Journal and found that only 6% of cases were being shown- that a much larger part of the population was infected. A researcher at Princeton University Ramanan Laxminarayan says countries tend to delay reporting until a problem becomes certain, because telling others comes with economic costs such as a rapid drop in trade and travel. Yet he says early warning systems are key to prevention. Early warning from the different publicly available data bases was not possible for many reasons. Relying on such ad hoc data was hazardous considering that as the NYT reported recently when there was the first confirmed detected case reported in New York there were already 10,000 persons estimated to be undetected. James Glanz and Benedict Carey, say in the NYT.com on May 7, that hidden outbreaks spread through U.S. cities far earlier than Americans knew, estimates show, which makes the publicly available databases giving a false sense of security, and not acting as an early warning because of the inadequacy of the resources for this task for individual researchers to handle. Not depending on  hurriedly put together databases with inadequate resources and having an independent sense of what the danger was as German chancellor Merkel described it in her first coronavirus address in March, was a better early warning signal than the databases in retrospect. And this too had come late. The reason is that the response had to be fast, very fast, and public perceptions had to be shaped quickly about the magnitude and speed of enormous proportions of the coronavirus, so that actions could be shaped quickly and executed quickly to stop it in its tracks.    ...

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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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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.   ...