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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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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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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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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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European Union countries, Britain and the US face the risk of a resurgence of coronavirus through the Delta variant and other variants. The Delta variant detected in India is 40% to 80% more transmissible than the Alpha variant detected in the UK, with the Alpha variant 50% more transmissible than the original coronavirus that originated in Wuhan.    Virologists in Italy feel they are flying blind at this time because of the lack of genetic sequencing in Italy, Spain, France and across most European Union countries. The UK has done genetic sequencing on 27% of recent covid positive tests. The figure drops to 1% for Italy and is tiny for most of the EU countries including Spain and France. Without genetic sequencing it is hard to predict and take steps. Another problem in the EU is that the southern economies Spain, Portugal, Greece, Italy, Croatia are dependent on summer tourism for the economy. The UK economy can handle a delay to a full opening for 6 weeks without serious impact to the economy, says WSJ. Southern European economies can afford only short delays to full reopening. Croatia acted as a door to spread of coronavirus into central Europe when Germans and Austrians went to vacation spots in Croatia in summer 2020. This situation could be happening again in 2020 with British and other tourists visiting vacation areas in Portugal, and Germans visiting Greece and other summer tourism spots. Portugal's national health institute says the Delta variant represents 60% of new cases in the area around Lisbon based on early data. The government of Portugal is facing criticism for letting a Champions League soccer final to take place in Porto, Portugal between two English teams. Thousands of English fans watched the game at the stadium. Other problems are in relaxing of mask rules in France and Italy, last week in France and in the coming week in Italy. French nightclubs open July 9 without mask requirement. Germany is maintaining some social distancing measures and this includes mandating medical masks in closed public spaces and on public transport. Half of French, Italians, Germans are vaccinated and quarter fully vaccinated. Yet the gaps of unvaccinated people is large enough to cause serious concern of another wave. The relaxation of mask rules- the entire stadium in Budapest was packed for a recent game between Hungary and Italy for a soccer Euro 2021 game with no masks to be seen. Stadiums played a key role for the spread of the original coronavirus in Italy with a game in Bergamo, Italy, in the area near Milan. All this makes health officials concerned about the risks of still another wave of the coronavirus.   ...

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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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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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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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Public health experts warn that it is essential that countries reopening their economy have a reproduction ratio of much less than 1.0 so that the rate of increase is under control. Germany's Robert Koch Institute which advises the German government says the reproduction ratio which was 0.70 in mid April is now up to 0.96 after creeping back up. This is based on a mathematical model and extrapolated from infection numbers several weeks back.  It doesn't reflect the change by recent easing of lockdown measures starting with reopening smaller stores. This validates the careful approach adopted by France which was put forward by prime minister Edouard Philippe in his address to the National Assembly. The Assembly approved the plan 368 to 100. More legislation will back up the French government's authority to ban non essential travel between French departments and the creation of a large brigade to perform contract tracing. That involves finding testing and isolating everyone potentially infected, using dedicated locations. Detailed restrictions on travel, work and gatherings will take effect when France reopens partially on May 11.  France is also putting resources behind its testing program to test every person having coronavirus symptoms, and all they are in contact with. That means about 700,000 tests a week. Officials will generate a color coded map from this with red areas facing more restrictions than green areas. Student size is capped at 115 per class. Cafes, restaurants, movie theatres and large museums will remain closed. Gatherings of more than 10 banned. Those who can work from home asked to do so. Public transit users will be required to use masks, and marks on platforms will indicate the social distance required. Only essential travel is allowed more than 62 miles from home. These rules remain till June 2, when new ones will be set. Large music festivals and sporting events are canceled till the fall. Mr. Philippe says "these efforts will not be in vain and should allow us to arrange for a better summer season." ...

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The southern U.S. which was early to reopen the economy after the lockdown with some states having only partial lockdowns, is emerging from the coronavirus in much better shape than the rest of the U.S. The unemployment rate fell to 6.9% in August, the lowest of any region. The number of people employed was only 6% lower in August than in February, when most of the U.S. went into lockdown, compared with declines of 10.6% in the Northeast, 8.2% in the West, and 7% in the Midwest. Some of this was a result of aggressive reopening in Texas and other southern states. Overall deaths in the south were 60 per 100,000 people compared to 132 in the Northeast including New York and New Jersey, Midwest at 52, and West at 40. The Northeast numbers are high because of the elderly in nursing homes hit hard in New York and New Jersey.  In the southern states by comparison the deaths came later and among young people taking risks. The virus hit the northeast early and parts of the midwest, southern states had the advantage of some of the work already being initiated in March to fight the virus nationwide. Many of these states are also Republican and residents feared the virus much less. Republican Governors followed their instincts and aggressively reopened putting the economy first. The numbers tell the story. In South Carolina 44% of Republicans say they aren't afraid of the virus outbreak in the local area, compared to just 2% of Democrats, according to Civiqs poll. Georgia and Florida have similar numbers, all with Republican Governors. One factor favoring southerners is that cities in the south are much less dense and less populated than in the North and West. Smaller cities than Los Angeles and New York. ...

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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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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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State run programs that help businesses to retain employees and avoid layoffs are a great way to operate during the lockdowns and gradual reopening. In these workshare programs workers work reduced hours and collect prorated unemployment benefits to offset lost wages. This avoids full layoffs. As the coronavirus is a temporary setback companies need their employees in a healthy economy. How to retain employees. Shift some of the cost of retaining employees to the U.S. or state governments funded by the federal government which comes in the form of unemployment benefits. Workers can then do shorter hours and get through this period.

Such programs are now set up by states in more than half of American states covering about 70% of payrolls. The problem is getting companies and employees to use this program. As of March 28 only 1% of 8.2 million employees have used the program, but it is growing.