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The U.S. faces a critical gap in its coronavirus effort - the lack of one centralized source of reliable quality data. What we have today says this report in WSJ, are many disparate sources of information, without any uniform set of rules, different chronologies, and lacking consistency, all feeding into national or global databases run by individuals or private organizations that lack the resources needed. Not  the centralized government source for quality data that is being used in other countries. This is the second of articles in the WSJ on this problem. The first was on the John Hopkins database run by students and a professor lacking the funding or the resources for such a critical task, dependent on disparate and multiple sources of information without any set of rules. Other sources at the University of Washington or run by private institutions face similar problems. The data coming out of these databases is only as good as the data going in, say experts. As a substitute for quality data from a centralized U.S. government source these sources cannot give the decision makers in states the confidence they need, and the federal public health decision makers the confidence they need in their decisions for reopening in stages, says this report in the WSJ. ...

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New hotspots for coronavirus in the U.S. include California, Illinois, Florida, Texas and Arizona. Cases are close to 200,000 in California.

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As U.S. coronavirus cases reached 2 million, a new virus hotspot emerges in Arizona. With the economy reopening attention has shifted to how the economic damage can be reduced and businesses remaining open. Many retail businesses relied on online orders,or in the case of restaurants on takeout orders, now these stores and businesses are gradually reopening with social distancing and other rules.

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Merkel say to Gemany in a weekly video message that "the danger posed by coronavirus remains serious. "Take it seriously because the situation is serious." It requires everyone to act responsibly. "By following the rules for social distancing, hand hygiene, facial coverings, every one of us contributes to our shared destiny, " she said. It is a message that should resonate in the U.S. India, Brazil and other countries hit hard by the virus. Germany's cases are approaching 200,000 with fresh outbreaks in some areas. Reopening everywhere creates new risks, vigilance is essential.

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The University of Washington Institute of Health Metrics and Evaluation has doubled its forecast of coronavirus deaths in the U.S. to 135,000, about twice what it is today at 69,000, by early August 2020. This is based on the assumption that with reopening the economy and return to actively operating in offices and shops, in construction and factories, the social distancing will be relaxed. Factors such as rising temperatures are not seen as offsetting the increased mobility in reopening. Dr. Fauci, top U.S. infectious disease official said on My 4, that the relaxing of social distancing could get a rebound started considering the coronavirus "phenomenal capabilities of spreading like wildfire." There is concern that the cases may be much higher in Brazil where there is not much testing, even higher than in the U.S. according to one university study. Argentina is a contrast having imposed a lockdown much earlier and has only 246 coronavirus deaths. ...

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This analysis from The Times of London provides critical information on the strategy for successfully tackling the coronavirus following the example of South Korea and progress in Britain.

The random community testing is key to getting an idea of the scale of infections in the community at large. The critical ratio called reproduction ratio tell one if the virus is under control and how lockdowns can be lifted. For Britain this 0.7 estimated by Imperial College. It has a 2 week lag. 1.0 or close to 1.0 is not good. Germany after being at about 0.7 has moved up to 1.0 with 2 week lag in information says the Robert Koch Institute. This means a lot of work ahead, it won't be easy.

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The U.S. and India see a surge in coronavirus cases. Per day cases surged to 40,000 on June 25 in U.S. and 17,000 in India. Alabama, Idaho, Nevada, Arizona, California, Florida are seeing a surge in new cases. Texas, California and Florida all recorded more than 5000 cases each. In California cases for hospitalization surged 32% with more than 4200 in hospitals.

India now has 490,000 cases with death toll of 15,301. Indian Railways cancelled all bookings. In the U.S. Texas is paused reopening plans.

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As the growth of coronavirus cases slows in the U.S. and Europe, cases in India surged by 9000 in a biggest single day increase with total cases passing 200,000. Deaths in New York dropped below 50 on June 2. Outdoor dining opens in upstate New York as this part of New York enters second phase of reopening- tables 6 feet apart and staff wearing masks at all times. Customers required to wear masks when not seated. New York City enters Phase 1 of reopening on June 8. New York City will distribute 1 million face masks and it will be mandatory to wear masks on mass transit. Hand sanitizer will be provided at stations. Every other seat will be blocked off on buses. 

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China is gradually getting back to normal. With few new infections from coronavirus, factories are starting production again, and stores are reopening, people gradually coming outdoors.

For factories there is one problem- as Europe and the U.S. battle the coronavirus and impose their own lockdowns demand has evaporated. Factories are seeing canceled orders and having to operate with smaller number of workers.

All the graphs shown in this report for Beijing traffic congestion, Guangzhou subway rides and property transactions show the curves for 2020 way, way below the curves for 2019.

This also gives some idea of what the road ahead will look like in the U.S. and Europe. That the recovery will take time and patience after a difficult period ahead tackling the coronavirus state by state. Lost jobs, diminished confidence and fallen income will take time to recover.

 

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The coronavirus surge in southern states in the U.S. is different from the surge earlier in the northeast including New York and New Jersey. More young people are getting the virus. About half of those testing positive are now 18-35 years of age in Texas and Florida. Social distancing and masks is not mandatory with young people not practicing these safety guidelines. Many took the reopening to mean they could go back to the usual summer routines. Not taking it seriously is leading to more infections of young people. Cultural issues with practicing the guidelines and a tendency to not take it seriously has been a problem in the U.S. and parts of Europe since the beginning of the crisis leading to larger number of cases.

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US economic growth surged at a rate of 6.5% for the April to June period in 2021. This pushes the economy beyond its pre-pandemic size. Growth was lower than the 8.4% forecast of economists, yet strong enough to increase its size to exceed the pre pandemic level. It was powered by the business reopenings, vaccination drive, and the government infusion of pandemic aid to households and business. New restrictions after this summer for coronavirus following last year's pattern with extensive summer tourism and spread of coronavirus, could again slow the economy. Government infusions of aid aided consumer spending, and this could slow in the months ahead, and lockdown restrictions could limit growth.

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Already vaccination experts at the Baylor College of Medicine cited here say they foresee another wave of the coronavirus in the Southern US because of vaccine skepticism barriers to vaccination, and much of the population not being vaccinated. The percentage of the population in the Carolinas, Georgia, Georgia and Louisiana, that has both doses of vaccine is low. About 50% have had just one dose. In southern states Mississippi and Alabama the vaccination rates are much lower leaving large parts of the population unvaccinated. The widespread presence of the Delta variant in the UK and the R rate being between 1.00 and 1.2 in UK shows that the UK even with higher vaccination rates than the US is still facing a danger of another wave as it reopens.  The ominous aspect of this is that from just over 400,000 the vaccinations per day dropped to 316,000i n the US. This means there will be a period when vaccination drive is stalled while the reopening is fully underway with a new contagious variant twice as contagious as the original coronavirus. This leaves the US at risk of another wave, with the south and western US, younger people who are out more and unvaccinated, more at risk.  ...

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In a piece of good news in the reopening U.S. job losses declined in May sharply to match levels seen before the coronavirus. In May 1.8 million workers were laid off from jobs, according to the Labor Department. This is down significantly from 7.7 million in April and 11.5 million in March. May job losses were in line with January and February job losses before the pandemic.

There were 5.4 million job openings in May also a good recovery sign. There are still 21 million Americans shown as unemployed in May. Overall U.S. job gains were 7.5 million jobs added in May and June, after 22.2 million jobs lost in March and April.

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The NYT provides a good look at the situation in India in September where cases are over 4.5 million, the world's second largest after U.S. During the lockdown in April and May India had successfully stemmed the coronavirus. After reopening in June a lot has changed as can be seen in this look at the steep curve in June, July, August and September. Cases are now at the rate of 95,000 daily and deaths at 1172 daily as of September 9. The deaths are up 16% and cases up 29% over 2 weeks. Maps show the situation in the states with Maharashtra, Andhra, Tamilnadu, Karnataka, and Uttar Pradesh showing the highest cases. Maharashtra has about 1 million cases and the two states in the south east Andhra and Tamilnadu have about 1 million combined with Uttar Pradesh at about 250,000 cases. Delhi has about 200,000 cases. So that about half of the 4.5 million cases are in three states in the southeast and the western state where Mumbai (Bombay) is located. The increase was seen after increased testing from 200,000 a day to 1 million a day by the end of August, a steep jump being seen in late August and September. At the end of July the coronavirus recovery rate of 70% in India and 90% in Delhi were the favorable signs, until things changed in August with increased testing and the spread to rural areas. India is doing over 1 million tests daily. On September 3, 1.1 million people were tested, taking the total to 45 million tested throughout India.  As in Europe and America the reopening which is essential for the economy and jobs has resulted in a big jump in cases. The laws for lockdown were carefully obeyed without many of the problems seen in America and Europe, the early complete lockdown was implemented with success, and Indian pharmaceutical companies are some of the largest in the world giving the public wide access to essential medicines and drugs. The postal service has functioned remarkably well during the lockdown for delivery of essentials throughout the country, and earlier action to establish bank accounts for each and every individual in the country, has enabled rural Indians to get through this most difficult period. This has given the government some breathing room as it faces the cases from reopening in a vast country of 1380 million people.   ...

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About half of people in Britain in a recent poll taken during the second wave of coronavirus say they see a negative impact on mental health. Depression is affecting a fifth of the population in Britain. It has never been more important to be kind to each other and ourselves as the second wave hits a weary and fatigue stricken society.  People found many activities and hobbies to do during the 6 week lockdown period and there was an expectation that spring would bring better conditions. During the second wave of coronavirus there is a sense of a dreary period that goes on through Christmas. The uncertainty from the U.S. elections, Brexit in Britain, the reopening in countries such as India, the loss of jobs and income in countries that range from severe in Brazil, Mexico and Argentina to moderate in China, adds to the anxiety of daily life with surging cases. Creating what amounts to a low grade depressive effect during the second wave that needs to be addressed by the authorites, by health agencies, and in other ways, says this report in The Times. ...

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Britain recorded the most deaths in Europe. Brazil and Russia have over 10,000 cases of coronavirus each, and the U.S. records cases close to that in the peak in April. Cases were up worldwide for May 6 to 92,000 with a quarter of these cases or about 24,000 in the U.S. The jump in cases takes the total to 3.77 million with a third of them in the U.S., according to John Hopkins database. Russia and Brazil had a slow start but are now registering large numbers of cases showing that India and other countries with limited testing could face the same situation. Russia has ramped up testing, and so have the U.S. and the UK. Moscow's mayor Sergei Sobyanin says for example that about 300,000 of the 12 million people in Moscow have the virus based on sampling surveys, more than 3 times the confirmed cases. Restrictions remain in place in Moscow beyond May 11.  Countries that were hit earlier by the virus such as Spain and France are reopening gradually after May 11. France will use red and green zones to handle restrictions so that the restrictions are customized to each place in the country. ...

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A look at countries in Europe shows different strategies for tackling coronavirus Delta variant as schools reopen in September 2021. Italy requires all teachers to carry a covid digital certificate that shows vaccination or PCR test results. France, Germany and Spain do not require vaccination for teachers to go to schools, and rely mostly on social distancing and mask requirements in schools. Britain not only does not require vaccination digital certificate, but also has not made masks and social distancing mandatory. Health experts say there are serious risks in this approach with mass return to schools and offices after August 2021, and the fall weather with more time indoors. This could lead to a surge in coronavirus as in the US where the reopening of schools and Delta variant has led to surge particularly in states such as Texas, Florida, California. In UK 65% of total population is now fully vaccinated, in Italy 62%. Teachers in Italy fully support the new rules. In Lombardy region with Milan as the capital, only 300 out of 300,000 workers returned to schools without the green pass, according to regional officials. Britain remains an outlier says this report in the WSJ, taking more risks than is proper at this time, and simply hoping for the best. Not the best strategy in this situation.   ...

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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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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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The critical variable in knowing whether lockdowns of cities and countries are working is called the coronavirus RO, or reproduction ratio. This ratio measures the average number of people infected by a carrier A. It could be that he infects 1 person at work and transport call it B people , or in large gatherings call it C people he infects 2 persons, or in other surroundings such as restaurants he infects 1 person call it D people. The people A has infected B+C+D are the ones now not infected by A with the lockdowns such as in New York, Italy, Germany, UK and France. It is determined by global health experts that the number of B+C+D is about an average of 4 persons infected by 1 person A with coronavirus, though it may be much higher in practice in some areas. The natural rate of RO or reproduction ratio is considered by the European Centre for Disease Prevention and Control to be 3.86 or about 4, if no lockdown or social distancing or other prevention is practiced. This in a situation where people behaved as before unaware that the virus was around them. Governments such as New York and France, UK, Germany are including this key variable in their determination of how long a lockdown lasts, and for determining if the reopening is not going the right way or failing. In such situations the lockdown would be reinstated, or if it is a phased reopening such as in the U.S. and other countries go back to the previous phase. In Italy and Germany the RO reproduction ratio for coronavirus is estimated by official experts at 0.8. Germany's RO estimated by the Robert Koch Institute and Italy's by Franco Locatelli, scientific advisor to the government. In New York the margin is thin- with RO of 0.9, estimate from the state's governor. In France which has one of the tightest lockdowns of all with a document required to go outside it is at 0.6, the figure coming from the prime minister Mr. Philippe. In the UK it is below 1.0 but no accurate figure is reported. As Dr. Birx- leading the coordinated response in the U.S. - emphasizes over and over again this is a very contagious virus, about which not much is known. Social distancing, wearing masks, basic prevention measures such as frequent handwashing, and not gathering in large numbers of people, is essential for defeating this virus. This has to be followed up with extensive testing and contact tracing to win this fight.   ...

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Short time work programs, paid leave, aid to small business for employee retention with the government paying a big percentage of wages, and unemployment benefits till companies rehire employees with government paying for this, are all different ways in which the U.S. and Europe are coping with the coronavirus crisis.  In the U.S. 22 million have applied for unemployment benefits with the U.S. government picking up a substantial part of the wages till companies rehire these employees. In the UK the government has launched a program that gives 2500 pounds or $3100 to each worker each month upto 80% of the worker's pay. The money is sent to businesses for retaining employees. This could cover estimated 8.3 million workers in the UK at a cost of $52 billion. The U.S. has a similar program with the first phase $377 billion already distributed to small businesses which requires retention of employees for government forgiveness of these loans. The basic idea is retain employees who could stay at home or be in short work programs or work from home. The French government is paying the wages of 9.6 million workers, almost half of workers in the private sector by sending the money to 785,000 small businesses. In Germany the Kurzarbeit program covers 725,000 companies which supports the wages of employees in a downturn and is financed from a special fund. The cost for Germany, France and Spain is about $147 billion or 135 billion euros for such programs. The European Union will step in with a 100 billion euros loan package. ...

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Italy faces tighter restrictions and a national lockdown at Easter for the coronavirus, Italians who were the first to go into lockdown on March 10, 2020, now think they will be the last to exit lockdowns. The mood in Europe is of frustration with the slow vaccination drive and the failure to procure enough vaccine supplies and to approve vaccines in time. The US and Britain have vaccination drives that are moving rapidly leading to a reduction in cases and deaths. In Europe new cases are rising since mid February 2021, and there is the spread of the new variant first detected in the UK.  The variants make up 70% of new cases in France says Health Minister Olivier Veran. ICU's in France are 80% full. Elections in France in 2022 and in Germany in September 2021 are leading to government reluctance to impose tighter restrictions. The government strategy is now being questioned. Only 30% of Germans now have confidence in chancellor Merkel's ability to make competent decisions. The CDU's partner in the government, the SDU socialists have even less trust with SDU getting less than 10%. There are signs of a third wave of coronavirus in Germany resulting from variants of the virus, slow vaccinations, and reopenings. ...

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It seems like good common sense -surely studies come later that masks can cut coronavirus cases by 40%- as Texas is learning the hard way. As coronavirus cases jump in Texas the governor makes wearing face coverings or masks mandatory in the state. Texas recorded over 8000 cases in a single day on July 3, 2020. "wearing a face covering will help us to keep Texas open for business." As a grim warning to Texans he said "we are now at a point where the virus is spreading so fast there is little margin for error." As the virus cases surged Mr. Abbott, the governor of Texas, ordered all bars shut and cut restaurant capacity by 75% last week and reversed step taken to open the economy. Another lesson learned the hard way when it seems like common sense- consider that on June 20 as reported in the WSJ a staggering 500,000 people went to bars in Los Angeles county the day after bars reopened. It is this type of activity that makes Dr. Fauci, say cases could reach 100,000 a day in the U.S. Infection rates are now increasing in 40 of 50 states with the southern states, western states doing badly.  A lot of it was plain common sense. A German study shows a 40% reduction of coronavirus cases when masks or face coverings are worn. For those arguing for the reopening so that economic hurt is mitigated there is even more reason to wear masks as it makes it possible to get back to work by following strict social distancing and mask guidelines. Everything in life is about adapting and making small changes for the larger good. Younger people have badly failed to show fellow feeling with lack of following social distancing guidelines on beaches and gatherings leading to the numbers now showing that people 18-34 are now equally at risk. ...

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Mr. Trump says he will wear a mask on a visit to soldiers at Army's Walter Reed Hospital. Trump says its "a very appropriate thing. I have no problem with a mask." As cases hit 3 million in the U.S., close to 1 million in India and Russia, Mr. Trump joins the movement for masks worldwide. Early on Mr. Trump  took up the issue of transmission from Wuhan by banning flights from China, failed to get WHO and China to respond quickly to the pandemic requests from U.S. by providing information and allowing a team to visit Wuhan quickly in January. A stumbling block appeared within the health ministry in the U.S. with poor leadership which Trump had to overcome by relying on Vice President Pence to lead the stop coronavirus team at the White House.   Trump's reopening decision came under criticism and he says he had to balance the damage to jobs and economic well being that also affected health. Some of the states and young people responded in ways that led to public gatherings that have led to surges in the south and the western states such as Calfornia. The WSJ reported that in Los Angeles County on June 20 half a million people went to bars after they reopened, showing that culturally even counties in states like California lacked what is accepted good sense. For instance Tokyo bars were paid by the Japanese government not to reopen, according to one report. By wearing a mask Trump is simply acknowledging facts about transmission - a German study shows 40% reduction in cases with face coverings. ...