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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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These simulations show the  importance of flattening the curve for coronavirus especially the steep jump in the curve when it grows exponentially as people mingle in crowded environments, on trains and subways, and in public gatherings of more than 10 people. This is shown here in four different simulations in the Washington Post. Social distancing and quarantine worked in China, Taiwan, Singapore and South Korea. Though the attempted quarantine simulation here does not cover the situations in China, Taiwan and Singapore where quarantine has worked and was the only way to tackle the coronavirus in time to do least damage. Additional simulations would show the way it was limited in Singapore through contact tracing and mandated staying at home for all who have come in contact with affected persons. And in South Korea a simulation could show how this worked through containment by testing and limiting spread, or China by an effective quarantine or lockdown of a city or province.  The basic idea is to limit contact and separate so that intermingling is restricted to as few places as possible for a limited period during which health authorites can achieve a controlled situation through systemwide organized efforts.  ...

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

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Daegu in South Korea was hit early and hard by coronavirus. Now 3 months later the social distancing rules are practiced diligently and people have become used to it. Large gatherings are still banned. Daegu is South Korea's Wuhan the center of the epidemic in China,  with a city of 2.4 million having 40% of South Korea's cases. People in Daegu remain comfortable with social distancing guidelines. What they worry about is not having to practice these guidelines- these are an accepted way and it makes everyone feel safer. It also gives people in Daegu a sense that this way another upsurge is less likely to happen and drive away consumers from shops, shops then having to close. In fact preparation and disciplined approach, with backup scenario planning and continued testing for cluster isolation and quarantine following contact tracing, is giving people here an extra sense of confidence. In some areas markets and shops have gained back 80% of customers, and most shop owners want to keep it that way.  ...

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President Trump extends the U.S. lockdown for social distancing till April 30, on the advice of health experts. China meanwhile resumes industrial production and schools reopen. Factories, offices and retail outlets were shutdown for 2 months nearly nationwide in China. The U.S. has a social distancing lockdown not a complete quarantine of hotspots such as New York, New Jersey. Mr. Trump planned to quarantine New York but faced opposition from the governors of New York and New Jersey, including possible legal challenges. U.S. governors have acted imposing travel restrictions to their states from hotspots in other places in the country, forcing people traveling to self-isolate, stopping vehicles with out of state license plates and asking them to stay away. The U.S. cases have jumped from 100 in early March to 143,000 as of March 28, 2020, and 2514 deaths, according to John Hopkins. New estimates from president Trump and his team of experts are for the peak to be reached by April 15, and recovery gradually taking place by June 1, 2020. Based on the timeline in China shown below the time from the first set of 27 cases by December 15 to March 28 when China's factories were back to work and schools reopened across the country, is a period of 75 days. Based on this president Trump's timeline of June 1 for recovery has some foundation. China quarantined strictly compared to the U.S. yet in the early days it had no warning which the U.S. had in particular from Italy. The Trump administration by extending social distancing and lockdown restrictions till April 30 without a strict quarantine of the East coast areas yet with states outside imposing their own restrictions for outsiders, is doing what other countries such as China, South Korea, have to control this epidemic. The first coronavirus case was reported on November 17, 2019 according to the South China Morning Post, By December 15, the number of cases had reached 15. On December 27 on a single day 180 cases were recorded and the Head of the Respiratory Department at Hubei Provincial Hospital reported this to health authorites in China, according to the South China Morning Post, based on data collected in China.   ...

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The people in the U.S. are shifting to widespread use of masks. There was some cultural resistance in Europe and the U.S. to use of masks, compared to Japan, South Korea and China where the use of masks in epidemics was common in earlier health crises. Europe changed first and now the U.S. is adopting masks as a way to avoid th spread of coronavirus. Health authorites in the U.S. now recommend use of masks to prevent asymptomatic people with infection from spreading the infection. Health experts say the widespread use of masks in Asia is one reason in addition to quarantines, contact tracing and isolation of clusters, is how China, South Korea, Taiwan and Singapore have controlled coronavirus to the point where it is no longer a serious danger.

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The mistakes  and the right action done in Italy that the world can learn from as Italy tackles the coronavirus. The coronavirus is a dangerous pandemic yet there is one part of it that can be used to take the right action. The timeline of countries affected early in January and February and early March with information from these countries on what worked very effectively and what did not work with bad results is available. The mistakes were made in Bergamo, a town in Lombardy region of northern Italy with the highest number of infections and deaths in Italy. Bergamo had limited testing, no rigorous attitude for quarantining those who had come in contact with people testing positive, and lack of contact tracing. In Vo another town in northern Italy the situation is a complete contrast with resort to mass testing and isolation of clusters which has reduced infections to zero and made it a safe place. Vo is a small rural town 85 miles east of Bergamo in the Veneto region. This was the method used in South Korea, China, Taiwan and other Asian countries that have overcome the virus. Bergamo is an example of what failed in Italy with the worst number of fatalities. The health crisis worldwide has shown this  method of first general quarantine to buy time to build capabilities for testing  and preventing things spiralling out of control,  then mass testing, contact tracing and isolating the people who test positive, and repeating this process again and again till infections are way down,  is the only way to control this crisis. In the early days massive quarantine or stay at home strictly enforced is the best solution till production of tests accelerates to permit mass testing and isolating the clusters of infections. This mass quarantine buys time for accelerated production of tests and building up the capabilities of labs to process these tests, including use of a central national lab centre with national data on computers for microbiologists to monitor the entire country. This was done in South Korea reports in WSJ show. This is vital for everyone involved in the effort to control the virus to understand based on the experience of  countries that have successfully overcome coronavirus. It is the experience in South Korea and Italy that the U.S. White House response coordinator Dr. Brx is looking at and learning from as she and the White House team in the U.S., governors of all 51 states, health officials including CDC, are looking at as they execute their action plan in phases.  ...

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One of the key findings of a joint panel of the WHO and South Korea on the MERS outbreak is the lack of transparency in the South Korean government's handling of MERS. Lee Jong-Koo, leader of the South Korean side in the panel said at a news conference: "One of the things South Korea failed to do was a transparent and rapid distribution of information, which is the most important thing to do." What caused serious concern for health officials is the speed of the outbreak- between May 20 when the first patient was identified and June 10 at least 145 people were infected. The chief WHO official on the panel, Keiji Fukuda, says South Korea needs to enforce a robust quarantine and monitoring system, and invest more in public health with more epidemiologists and laboratories' capacity.

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More games are being played in stadiums behind closed doors as in Japanese baseball or canceled altogether as in Italy. The coronavirus is leading to restrictions on mass gatherings, both in live entertainment and in sports.  Japan has changed its sports calendar postponing most events. Switzerland banned gatherings of over 1000 people, and France suspended events with gatherings of over 5000 people.  There is an acceptance of the fact that social distancing reduces the speed and extent of the spread of the virus, with countries that acted with quarantines and restrictions having a slower spread. This is now the case in China. In South Korea the lack of effective quarantine has led to spread of the virus. The extra time gained from slowing down the spread is important to let hospitals and medical systems cope. Things can be less intense for the medical community which is important for all countries.  Players and performers also are reluctant to be exposed to the virus in the current situation, particularly in locker rooms and other locations in stadiums. ...

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Two divergent approaches to the coronavirus are shown in this report in the WSJ. One in Italy which relies on quarantine and lockdown and mandatory social distancing, and the other on keeping borders open and aggressively tracking down the infected using data and testing. In South Korea infections have stabilized at 8000, and in Italy the are rising at 15,000. The divergent approaches and the results vary with the people's history, culture and recent experience. The cultural difference in Asian societies with people willing to cooperate and work together with health authorites for the social stability and good of the country is different from the more individualistic nature of western societies. In addition Italy has a long period of foreign rule of Hapsburgs nd French that has created an attitude of working around authority, the tendency to being furbo which prime minister Conte referred to in a nationwide address.  South Korea and Taiwan also have experience with the SARS and MERS virus during which public health regulations were instituted and comprehensive databases setup that are now being used to combat the new health crisis by tracking down people with health needs. The precedents have taught people in South Korea and Taiwan of how serious this kind of crisis can become, which was absent in Italy in the early stages. Both South Korea and Italy are democracies. The difference being that one has experience with public health crises from experience with SARS, MERS, H1N1, and has developed policy tools, broadened public support and increased state powers in anticipation of such crises. In South Korea there were fines of $8300 for those not willing to be treated and the government aggressively tracked down people. Public support and awareness also helped in controlling the situation. Taiwan has done better than South Korea as covered in a separate article in the WSJ, and shown here, controlling the situation from the beginning including shutting down flights from China early because of its close proximity to China.  ...

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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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Vietnam has an excellent record in the coronavirus epidemic with zero deaths and 324 cases. No locally originated cases are seen. The country has an astounding 792 tests per confirmed case compared to 144 for Taiwan and 57 for South Korea. Vietnam acted quickly to close its borders, quarantine foreign travelers in camps, close schools, and imposed an early lockdown.  This gives Vietnam an opportunity to restart its economy and maintain its growth. With the reallocation of supply chains away from China underway, Vietnam sets an ambitious growth rate of 5% for 2020, down only slightly from 7% for 2019.  The coronavirus also had some positive effects including the digital transformation that is taking place-  the rate of online transactions in public services increased from 12% to 24% during the 2 month lockdown. The discipline showed in Vietnam for tackling the crisis contrasts with other countries in Europe and America. This report says some small businesses and export industries in clothing and shoes are affected, yet even a 3% growth rate in 2020 makes Vietnam a winner, as the future in 2021 looks good. ...

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

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