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Prof. John Ashton, regional director of public health for the northwest of England offers this advice on pitfalls to avoid in the testing and contact tracing systems of the UK and other countries. He says there is a problem in sending testing kits through the mail or postal service. He points out that the swabs needed for testing correctly are quite invasive, the risk of an inadequate sample taken in high, resulting in a false negative report. 

On contact tracing he says the current recruiting system has pitfalls of contact tracing people not having local knowledge. Needed are people who know the local population and are able to fully engage with these people.

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Jeremy Hunt, head of the Health Select Committee and Health Secretary 2012-2018, says Britain needs to take up mass contact tracing as its next national mission. Britain he says has passed 20,000 tests a day for coronavirus. America has passed 150,000 tests a day. Both more than South Korea. What is missing when compared to South Korea and Taiwan is mass contact tracing.  The app TraceTogether is not enough, as it was used by only 20% of Singapore's population. Only South Korea and Taiwan are able to open up the economy, have workplaces and life function close to normal through extensive testing and mass contact tracing, with feet on the ground. This is the only path that has worked with South Korea successfully out of the lockdown. This means "feet on the street." Making these calls requires skills, getting information, getting cooperation, offering guidance, and ensuring people isolate themselves after contact with an infected person. Sometimes it is by phone and sometimes in person wearing full PPE. They need to be sensitive enough in talking to someone feeling ill and to see how home isolation can be achieved, who else the coronavirus infected person or someone in the chain of contacts has been in contact with. Mr. Hunt says no effort should be spared in doing this as the millions of jobs in Britain, of people without work, the economy, and the need for light at the end of the tunnel of lockdowns, requires a way out. A huge task but a lot of impossible tasks are being tackled in the health services. The resources of Britain, every spare civil servant, every administrator not working, every one who can do this, needs to be enlisted to do this. The same task needs to be tackled in America, and in other countries as a national mission. ...

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The UK government's chief scientific adviser, Sir Patrick Vallance, says coronavirus testing has not been scaled quickly enough. Public health experts warn that Downing Street is in the position to face "an unforgiving reckoning." The UK has done 5400 tests per million population, the U.S. 8894 tests per million, and Germany 15,700 per million, according to data from Worldometer website. UK got off to a slow start.  Experts at Imperial College, London, say a major problem is the lack of contact trace, test, isolate. Contact tracing having fallen behind. The government is relying too much they say on an app from Google and Apple to do the tracing because for this kind of work humans are needed, "boots on the ground" are needed. South Korea and Taiwan have successfully used people to do the contact tracing by using access to cellphone carrier data that was made possible from protocols established in earlier MERS crisis. ...

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Angela Merkel said that contact tracing was "above all else" in importance in tracking down infection chains. Apps would not work in Germany because tracking movements and recording information is a sensitive subject in Germany with its history of communism and fascism. Germany still did it but very early on adopted a low tech way that so far is working. Staff from provincial administrations have shifted to do contact tracing work as other work is slow or suspended. Volunteers also have taken up the work. Germany's goal is 5 contact tracers for every 25,000 people- or about 16,000 for a population of 83 million. All the contact tracers have is the phone and a central database of information on the desktop computer as shown here in this report in the Washington Post. There is no advanced technology or software.  Most important say experts is social skills - to talk to people in a way that makes them feel comfortable to share information about how they are and their contacts in a very informal friendly setting, that even includes some humor. Here a contact tracer in Reinikendorf describes the work she is doing and a typical day. There are about 75 contact tracers for 260,0000 people in her area. When she calls someone she notes down what contacts they have had and puts them in Category 1,  2 , or 3 depending on the need for quarantine. The calling is mainly about asking the contact about his or her movements. A contact for more than 15 minutes is Category 1, less than 15 minutes Category 2. The whole conversation is for 10 minutes. Then someone from the health department will call the person contacted everyday. Reickendorf began building up contact tracing in March after an outbreak in a kindergarten was too much for the usual number of health officials to handle. The German trace and quarantine approach, home grown, low tech,  and based on what resources are available, the most important thing being start immediately, has its flaws. Yet it has worked to limit infections and deaths.  In about 65% of cases health authorites have no idea how a person was infected. Asymptomatic carriers are not detected. In some area the resources are limited.  This effort has helped control the virus first cluster in Bavaria at a car part manufacturer. Sixteen people had tested positive and hundreds were quarantined. The German approach is that testing is fine but if you are in quarantine testing is not going to make a difference in spreading. Testing with a negative result is also not helping as it could be that its too early for the infection to register because of the incubation period. ...

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A sense that the U.S. and Britain have still not got contact tracing right. Contact tracing is key to controlling the pandemic and letting jobs come back to normal. We've got to get contact tracing right say communities and experts across the U.S.  About 30 per every 100,000 people are needed. but the U.S. has got only a fraction of this. By the time it is organized more people can get infected, and this is a very serious problem. Indiana for instance needs 2000 contact tracers for six million people. With this so disorganized communities are taking up the task themselves. The Mt. Carmel Indian fire department is putting its 171 fire fighters on this job as additional work as contact tracers.States need to take up this task and do this quickly following the German example where speed is what counts and low tech is the way to go, requiring only a computer with a central database and a phone, and most important the good human relations skills to make calling work with people facing a strange formidable virus. Too much time is being wasted on high tech apps. See the German example by searching for "Germany contact tracing." ...

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Contact tracing apps in the U.S. Britain and France have failed. Contact tracing app in Germany was downloaded 12 million times in the first week. Yet much of the contact tracing in Germany and cluster isolation has been achieved using low tech methods- using a computer with database, and teams of people in district offices all over Germany calling people.

The NHS App in Britain failed to get the cooperation of Apple. In the U.S. Google and Apple planned to have a contact tracing app ready but failed to come up with one. Tech has failed to come up with solutions during coronavirus and low tech solutions have worked well as in Germany and in places such as Kerala, India, when implemented quickly with very little delay.

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Tech is not going to fix this, say software experts from tech companies. Google and Apple's efforts in coming up with an app have fizzled out, says this report in thee WSJ. Has the U.S. lost precious time in waiting for an app by tech companies to be developed, instead of doing what India and Britain have done. India introduced its own app Aarogya Setu app from the Indian government. Britain had the National Health Service develop its app. India acted quickly. Is an app needed or essential? Germany decided that contact tracing based on Asian country experience was mainly about human contact tracers with skills to make the phone calls. All they needed was a centralized database on a computer and a phone. Germany set up teams at offices in each district in Germany and quickly plodded ahead even if all the offices were not fully staffed. In fact a third of the offices needed more people and resources. Yet the speed of action is something like 80 to 90% of the contact tracing effort when the team has the skill set to call. This is because clusters of infections do not wait - they spread. There is simply no time to waste. The German effort has produced the best results so far of any country of this size- Germany has 85 million people. The reproduction ratio is at 1.13 and Germany remains vigilant. It is the first country to reopen in Europe, and is methodically doing the right actions, much that the world can and should learn from. Contact tracing teams worked round the clock in the early days, they are still hard at work today, using their human skills to talk to people and find out who they were in contact with, calling the contacts in turn, at each step working to isolate where needed with followup calls from the state health departments. ...

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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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About 90 countries are seeking help from the International Monetary Fund, the IMF. And 60 countries are seeking help from the World Bank. The IMF has about $1 trillion to lend. The World Bank has $160 billion to give out. 

The World Bank headed by Mr. Malpass has given India $1 billion for screening, contact tracing and lab diagnostics, to produce personal protective equipment, and set up isolation wards. 

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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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What went wrong to get 100,000 deaths in the UK? A lot says this analysis in The Times. Don't need a big test and contact tracing effort was the early response, no quick decisions to build the infrastructure for this like South Korea or Taiwan. The Cheltenham Festival? Superspreader events a bad idea. Open Borders- another bad idea. After a break in the coronavirus weather by summer- relaxing vigilance and preventive steps, another bad idea. So on till a coronavirus variant stepped in through the open borders. You make your own luck, says this analysis in The Times of London.

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The use of apps and tech based solutions have been largely ineffective in doing effective contact tracing and testing to isolate people with coronavirus. Epidemiologists question its effectiveness when it does not lead to people isolating themselves to prevent spread.  A major problem is lack of confidence in the tech based solutions. 27 states in the U.S. have no apps or are not developing one.  Apps do not use the entire set of tech resources available because of dilution from concerns about privacy. Another major problem is that there is no national approach. California, Washington and Oregon have a pilot program on the Google-Apple system, Delaware and Pennsylvania launched an app in September from Irish developer NearForm. New York and New Jersey started with a NearForm app in October. States using apps are doing this without much conviction that this is a tool that will work to do effective contact tracing and testing to isolate infected persons. For this reason one sees pilots and launches this late in the coronavirus pandemic. Early efforts stumbled.  The UK and French apps also proved ineffective. Germany opted for low tech solution that proved surprisingly effective in the first wave of the coronavirus. Germany relied on teams from state employees which used a national database, personal computers and phones to call individuals who needed to be isolated and tracked. Asian countries have less concern for privacy leading to apps being more effective. Even here low tech solutions with national database and teams of people with personal computers and phones calling and making personal contact including visiting homes has worked better than apps. Human relations skills to reassure people affected by coronavirus, legwork to contact personally at homes and check up, and persuasion to have people isolate have been more effective than app based impersonal tech solutions. ...

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This article gives some simple answers to questions about how the NHS test and Trace system setup by Baroness Harding could go so wrong. It was setup as a separate agency and ignored some of the vital information of how contact tracing should be done close to local area coming out of Germany. This information was available early and was also on the Lyrarc site, as Germany had effective contact tracing as early as March-April. First Britain wasted time waiting for some brilliant App to do the work. The when this was going nowhere the NHS Test and Trace was setup but ignored the need for this to be done locally and followed up with personal visits to the homes of those needing to be visited to isolate. Most important- the local knowledge and the persons doing the calling having human skills to get people to cooperate and feel reassured. Less important or not at all- sophisticated equipment, a simple desktop, national database to which data is connected and sourced and a desk, a skilled motivated local person the key. Germany resorted to using the underutilized state or local employees who were diverted to these tasks but extraordinarily effective.  ...

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Requests, consensus, and social pressure played a bigger role than just strict rules and penalties in controlling the virus in Japan. By contrast in Germany states imposed strict rules and fines, some consensus, a better equipped hospital system, added contact tracing, to limit the spread. More than 100 industries in Japan have drawn up new guidelines for reopening to minimize risks. Prime minister Abe said recently " Now we are going to venture into a new arena. Therefore we need to create a new lifestyle from now on. We need to change our way of thinking." The new social consensus on the best way to behave outdoors and at work is the way Japan is tackling reopening.  The effort is focused on avoiding high risk situations the 3 C's crowded, closed spaces, and close contact, close conversations. Japan started with a fumbled response but gradually the right spirit and social distancing caught on. The universal health care system helped Japan detect cases early, even in the remote rural areas. ...

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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 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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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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WHy did NHS Test and Trace fail to contact no more than 50% of the persons who tested positive. Why was it not able to followup with the people who needed to be visited in their homes to ensure isolation. Why was NHS associated in the name when the NHS had not been consulted and involved in the design of this service. In fact it ignored lessons from Germany where the contact tracing was entirely from local, started very quickly with the key being local or state employees who were diverted to this task and were skilled and motivated to do it. Why was this critical task simply handed out to outsource it to private companies.  Germany's example was there very early in March-April and it was working. Why reinvent the wheel. Setup quickly and entirely local it required only a desk, a desktop PC, and a national database to which PC was connected, the skilled caller being the key to getting people to talk to and cooperate. About 80% of those testing positive needed to be contacted. NHS Test and Trace was reaching about 50% and many that needed to be visited at home could not be followed up quickly. The shift is only now being made to go local. It worked in Leicester and other places but the learning came the hard way, as with many things during this pandemic. ...

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South Korea has tested about 300,000 people for coronavirus. About 20,000 can be tested daily for coronavirus through 40 drive thru locations. South Korea invented this method of testing. Another feature of the South Korean method is the tracking down of people who have come into contact with those testing positive for coronavirus. The South Korean government is able to do this because it can access the credit card and cell phone information of people in the country. This is possible through laws that were passed after the failures during a previous epidemic of MERs. The government then tracks down and isolates the people who came into contact with infected persons. This includes people who show no symptoms, an important aspect of the South Korean program which needs to be adopted in other countries once the production of test kits and testing is ramped up. The reason is that about 30% of people who tested positive in South Korea were not showing any symptoms but acted as silent carriers. This is similar to the figures for people in the Wuhan region of China. This testing capability is one of South Korea's key strengths, though Germany's Robert Koch Institute says it has a similar capability to test 160,000 people a week. The U.S. has tested about 30,000 people by comparison. The U.S. government is procuring 60,000 test kits under the Defense Production Act. South Korea also enforces social distancing though a $2500 fine and a 1 year prison sentence. Germany now has a 2500 euros fine in some states for curfew violations.  By comparison the fine in Britain is insignificant.  Another difference between China and South Korea with Germany and the rest of Europe, the U.S., is that in China and South Korea self-isolation is monitored, tightening the control over coronavirus spread at every turn.   ...

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In a corner of Wales known for its coastline and scenic beauty, a biology teacher Mr. Barry Rees sets up a homemade contact tracing system that worked. He is the director of Ceredigion county council. It is the safest county in mainland Britain with only 45 recorded cases in the last week for 75,000 residents. Early on in the coronavirus epidemic Mr. Rees decided to take up contact tracing with whatever resources were on hand and start quickly. This was was happening in German states which were also following low tech, get started quickly approach, but Rees was not aware of what was already happening in Germany. He knew about South Korea and Singapore efforts in contact tracing which put a lot of emphasis on human skills in calling and tracing and getting started immediately. Rees started with the people calling in sick of the 4000 people who worked for the county administration, as he had no testing resources. He started tracing these people and their contacts, and even though some were defensive the majority supported intervention to isolate. At the time there were fears of 200 deaths in the county so that there was no time to lose.  By April the area was facing an influx of people from Aberystwyth University and tourists visiting its sandy beaches, another reason for taking on the task with a homemade system. Today it has one tenth the cases in the rest of Wales.  The hidden fear in the country is that word can get out and lead to more visitors from outside the county. ...

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Quidel Corp. gets the first FDA approval of an antigen test which tests for the disease itself. Quidel is a company specializing in tests for the flu and infectious diseases. It uses an older technology to detect the disease. Quidel CEO Douglas Bryant, says he will ramp up the manufacturing of the test to go from 200,000 tests a week in the week of May 11, to more than a million a week in several weeks. The current testing technology has several shortcomings. The most common test so far is the PCR test which magnifies virus particles to ease their detection. It is cumbersome technology because it takes time to run the test and analyze the results. The new antigen tests have several advantages. They have a simpler design, are easier to process, and can be produced at lower prices because of the simpler design. They are designed to identify the virus in people in real time, to process results quickly in minutes in Quidel's Sofia analyzers. Because of the simple design and proven technology it can be scaled up quickly to do millions of tests.  The U.S. currently has the problem that it is not able to do enough testing- about twice the current rate is needed to do what health experts recommend. A minimum of 4 million tests weekly is needed and followed up with contact tracing to make it safe for people to go back to work, says Ashish Jha of the Harvard Global Health Institute.   The U.S.   ...

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What is the difference between South Korea and the U.S., Europe in the handling of coronavirus? It is tracking and testing.  President Trump and health adviser Dr. Fauci, see South Korea as the successful model to be followed in controlling the coronavirus. What has happened till now it is accepted with shortage of basic medical supplies and equipment, stress on hospital systems, are merely mitigation actions. South Korea was prepared for the coronavirus crisis because of the MERS and other epidemics, and failures resulting in corrective actions. Labs were centralized and better equipped for testing and tracking the infected. One of the key tools is testing. President Trump says the goal is for the U.S. to exceed and far surpass tests per capita in South Korea. Five million tests are planned by the end of April in the U.S. Where the U.S. falls short is in use of multipronged digital tracking using data from people's use of mobile phones, credit card usage, and use of apps designed to separate infected people from others. South Korea is a democracy with a population of 52 million people, about the size of France. People who were student activists in the democratization era in South Korea say the use of digital technology is a need today. We have to adapt in emergency situation they say. Ki Mo-ran, epidemiologist, and adviser to South Korean government says this is a key part lacking in the European and U.S. efforts to control coronavirus. She says in South Korea we know the patient's contacts, where he goes and stays, so we don't have to lock down everybody. Without digital tracking one cannot know which place is contaminated, which place is clean, so that there can be a lockdown of just that area and not the whole country, says Ki Mo-ran. She asks the question- is one person's privacy more important than the lives of a family or other people who are affected. Is it OK to lockdown every child in the country in a home as in Spain for over a month so that particular people's privacy is respected? These are serious questions for western society, are they exceptions or is democracy not just a western idea but equally cherished in Asian societies, people talk about Confucianism in China and the Asian culture forgetting that the biggest democracies are quite large and functioning well in India in addition to South Korea, Taiwan Indonesia, Malaysia, Bangladesh and Japan, far larger in area and population than China. The French government has chosen the app TraceTogether as the least intrusive one adaptable to France for use there. The U.S. is having Google and Apple develop one of its own. India will be developing one of its own. The NYT raises the question will it be watered down so much in France or in the U.S. and UK to be less effective than the  dire need for an alternative to lockdowns? ...

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France was exceptionally well prepared says France 24, citing a report in Le Monde, for the SARS crisis in 2002 and the H1N1 influenza in 2009. A billion masks were stockpiled by 2009. Following the H1N1 influenza not appearing in any significant way the media, political parties and the public shifted their attention away from public health crises preparation. For H1N1 the government spent 1 billion dollars some of it going to pharmaceutical labs. The eurozone financial crisis that followed the global financial crisis shifted policy to austerity measures. The entire preparation effort for influenza type health crises was abandoned as too costly.  The same pattern repeated in Britain which was also well prepared before 2010. Austerity budgets after 2010 had little room for public health investment.  One could say a similar pattern was seen in the U.S. Today the worst hit countries are U.S., Britain, France and other European countries. France which had 1 billion masks in 2009 to tackle a possible H1N1 epidemic finds itself with 150 million masks in March 2020 and scrambling to find masks. Some masks which were usable were even destroyed as expired, ministers and experts who had built up the prevention effort in 2009 were even demoted and forgotten, as was much of the preparation in these years. It wasn't just medical supplies pubic awareness had practically disappeared. In the U.S., in Europe, the same situation of a lack of public awareness so that experts, government, and the public could work together quickly, was clear to see. In countries such as Taiwan the preparation led to speedy response at all levels, making contact tracing, isolation of clusters effective. In the U.S. and Europe this early, early, period was lost leading to makeup mitigation measures and the growing sense of a loss of control over the virus. ...

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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. ...