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China has used the experience gained from an earlier SARS outbreak to tackle the virus outbreak in 2019 which started at a food market in Wuhan. Early detection, strict quarantines, and other measures, were taken. A viral pneumonia outbreak happened in Wuhan, a city of 19 million. 59 people were quarantined and the largest food and seafood market in Wuhan was shut down quickly. Between the first case on December 12 to the detection of the new strain of coronavirus in 1 month, China acted with speed, showing China's strength in public health resources and research labs.

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Why the lessons of Wuhan have not been understood correctly says this WSJ report. Merely putting lockdowns is not enough, systematic testing and quarantining of the affected persons is needed for controlling the outbreak. The outbreak in Wuhan was controlled by sending affected persons to makeshift hospitals and temporary quarantine centers. Two hospitals were quickly setup in Wuhan in 2-3 days to isolate affected people from the rest.

It is slow but this is being done as New York sets up a makeshift mobile hospital with 1000 beds at the Jacob Javits Convention Centre. And London sets up 4000 beds at a conference centre in the city.

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A draft decree in the prime minister's office shows a plan to place quarantine covering the Lombardy region of Italy and nearby provinces, including the cities of Milan, Venice and Modena. The population in this region of 10 million people will face restrictions on mobility. The draft decree says transit in and out of the quarantine zones will be granted only in the event of "grave situations." It urges people to stay inside their homes and not travel. A similar quarantine in China around the Wuhan region helped limit the spread of coronavirus and bring it under control. Today the worst hit and not yet under control are Iran and Italy.

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China has used the quarantine and strict measures to contain the coronavirus. After being taken by surprise in the way the coronavirus developed in Wuhan region China shifted to large scale containment and quarantine. To do this China used technology, mobile carrier information, volunteers going from door to door and enforced quarantine action. Other countries in Europe, including Italy, are adopting measures such as quarantine and appeals to the public for cooperative behaviours.

The entire approach is new yet shows how government and citizens can work together to contain epidemics of this kind in the modern world of urbanized areas and close contact in subways, streets, and stadiums. The approach in democratic countries may vary from China yet essentially strong bold action has proved to be the way to go, not vacillating and acting one step at a time till things are out of control. 

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Global update on the pandemic April 7, 2020. The U.S. has 368,000 confirmed infections, and over 10,000 deaths, as of April 6, based on John Hopkins University data.

Japanese prime minister Shinzo Abe issued an order for a month long state of emergency covering Tokyo, Osaka and five other prefectures.

Philippine president Duterte extended the quarantine for Luzon island to April 30.

The lockdown was placed on Wuhan, China, epicenter of the pandemic on January 23. On March 25 about 2 months later some travel restrictions were lifted. On April 6 trains were allowed to leave for several cities in China. 

Countries in Europe that stepped in early with restrictions such as Denmark and Czech Republic moved to ease them a bit. Czech Republic and Austria will require people to wear masks outside.

 

 

 

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The Indian state of Kerala has experience tackling virus situations. Most recently with a Nipah brain damaging virus in 2018. For cases to double Kerala has 72 days, compared to a national average of 8 days. With total 437 cases and 3 deaths Kerala has shown "the importance of early tracking, screening, home quarantine, strict isolation and public participation," says Dr. B Iqbal, chairman of the Kerala state expert committee on coronavirus in an interview with DW. com. The first case was a medical student arriving from Wuhan on Jan. 24, diagnosed 6 days later. During the Nipah virus crisis Kerala limited deaths to 17. Kerala is an example of the importance of a well funded and well established and organized health care system. The Indian state of Chhatisgarh has taken a proactive approach color zoning districts. Of 28 districts 23 are free of coronavirus. Less cases and zero deaths.The key state health minister says was early preparations and then luck playing a part. Most cases today are concentrated in India in the Mumbai area, state of Maharashtra. ...

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

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It took a week longer for each country to impose a lockdown. In China first Wuhan then the whole country went into lockdown and quarantine. The same process is repeated in Europe and in America as authorites see numbers of infections increasing rapidly without strict controls. First the Lombardy region in Italy around Milan, then the provinces in Northern Italy, followed by a complete lockdown in the country on March 10 as infection spread faster without lockdown and enforcement of lockdowns. Germany and Britain follow Spain and Italy on March 20. France followed Spain in the days after Italy's complete lockdown. Macron ordered the lockdown on March 16 with stringent enforcement. Infectious Disease specialists at Imperial College warned of "unintended consequences for the entire nation" if a lockdown of Britain did not take place. The goal is to limit the spread of infections from rapid to slow as public health systems and economic measures are ramped up in preparation for the crisis. Most countries were lacking the preparatory steps having lost time waiting to see what happens next or analyzing data in the vain hope the virus does not spread.  Bad economic results of lockdowns were initially a concern, but this concern became less important as the coronavirus spread rapidly in Europe. Decision makers in Europe decided that not acting forcefully would lead to equally or worse economic outcomes. Public health systems overwhelmed would diminish public confidence rapidly and lead to equally bad or much worse economic outcomes. The European Union executive body has supported state aid, stimulus action and border controls in this crisis. In America and in Europe the hope is that shoring up the safety net with massive aid to businesses and households would buy time to tackle and overcome the coronavirus through a combination of lockdowns, quarantines, contact tracing, large scale testing and medical technology measures. The examples of China, South Korea, Taiwan showed this pathway exists for phased control and reducing fatalities to zero. ...

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This BBC report shows how contact tracing works in Singapore to control the spread of coronavirus. On 4 February 20 Chinese tourists visited a traditional Chinese medicine shop in Singapore. Only 18 coronavirus cases had been recorded in Singapore on that date. That visit to the medicine shop created a new cluster for the disease to spread. Singapore's contact tracing units traced such locations through its well developed and extensive contact tracing programme, which follows the chain of the virus, identifying and isolating people before they can spread the virus further. For about 40% of the 243 cases so far on March 19 the first indication they had was a call from the Singapore Health Ministry.      About 6000 people have been contact traced so far, using a combination of CCTV footage, labor intensive detective work with phone calling. This includes an incident of a taxi ride of 6 minutes in which the person a yoga teacher was identified and contacted by the Health Ministry. Enforcement is done as the person was contacted at her home by three people who showed her a quarantine order, which said you could not go out or its fine time and jail time. With about 8000 people per square kilometre, Singapore is small and densely crowded. It could easily be overwhelmed with hospitals not able to cope and the health system collapsing if this was not done. Wuhan could have happened here, says infectious diseases specialist Dr. Leong at Mont Elizabeth Novena hospital, who advises the government.  Because the crime rate is low the police were given this task of tracing as a priority in addition to hospital units working on tracing. It also included the armed forces personnel helping with tracing so that it could be done quickly without delay. This provides a lesson on how countries that have faced the health crisis have used innovative methods to tackle it with good results. ...

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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. ...