LyrArc Article Gist
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.

LyrArc Article Gist
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. ...

LyrArc Article Gist
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.  ...

LyrArc Article Gist
Contact tracing being setup using iphones and android phones with bluetooth technology by Apple and Google. The idea is being studied for adoption by the U.S. government. The problem is that this kind of contact tracing is not as effective as the kind used by South Korea, Taiwan and Singapore with information from cellphone carriers. Contact tracing apps would be written by developers for each country and chosen by Apple and Google one for each country. How it works- When a person comes down with symptoms he can upload the information about who he has been close to stored on the phone. This information would then be used to contact the person who was exposed to the person with symptoms but unaware of this. A message would tell that person he was exposed to someone who now has symptoms and to contact public health authorites and take effective steps. When the person with symptoms gets tested if he was positive that would also appear on a exposed person's phone without name or other information.  The normal contact tracing is time intensive requiring many phone calls and using data from cellphone carriers. This is done in Singapore, Taiwan and South Korea. It is considered to be more effective. The approach of these Asian countries is more thorough and allows effective tracing and isolation, quarantining of persons having coronavirus or having exposure in countries with rampant coronavirus. The U.S. needs to move quickly to adopt the methods used in these Asian countries. The loss of hundreds of thousands of lives should be weighed against privacy concerns and clearly there should be a way to allow one time use of personal information for coronavirus, so that this kind of information is used only in public emergency situations. All three Asian countries are democracies. Putting health care workers at great risk including working pregnant doctors, as in the story in WSJ about a hospital in Maryland, should make it clear that everything including privacy concern should be placed in context, and use of personal information be permitted in a public emergency such as a contagious virus- with information protections removal for the period of the crisis. ...

LyrArc Article Gist
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. ...

LyrArc Article Gist
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. ...

LyrArc Article Gist
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. ...

LyrArc Article Gist
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.   ...

LyrArc Article Gist
The failure to respond quickly with testing and contact tracing has been a major weakness of the response to the coronavirus in Europe and the U.S. Repeated fumbling in contact tracing has been common throughout Europe and in states in the U.S.

LyrArc Article Gist
The lack of effort and results in Britain's contact tracing for coronavirus is the subject of this report.

LyrArc Article Gist
Data from India in a large study shown in Science magazine show useful findings. Only a small number of people cause the wide spread of the coronavirus. This study covers the two southern states of Tamilnadu and Andhra Pradesh with total population of 128 million. Contact tracers in the 2 states reached about 3 million contacts for the 435,000 coronavirus cases. Researchers analyzed data from 85000 of these cases where enough data was available with 600,000 contacts. Some interesting findings are- About 5300 children infected 2500 contacts among other school age children showing children in schools can spread the virus. About 5% of the people account for 80% of the infections detected by contact tracing. 71% of the people did not seem to have transferred the virus to someone else. Median hospital stay is only 5 days much less than in the U.S. The number of deaths in India is much smaller than the U.S. less than 100,000. 5.2 million people out of 6.2 million people have recovered.       ...

LyrArc Article Gist
The work of David Malpass at the World Bank in approving $1 billion for India's coronavirus emergency response and health preparedness project. 

This will help India move quickly to setup the contact tracing, isolation centers, treatment facilities, and healthcare preparedness for coronavirus, so that the transmission of coronavirus is strictly limited.

LyrArc Article Gist
Massachusetts is moving into no. 3 or no. 4 position after New York and New Jersey and possibly Michigan in coronavirus cases with 34,000 reported. More than 3700 were hospitalized  in the state.

Massachusetts is close to hotspot New York. It also has a more aggressive testing strategy and is hiring hundreds of volunteers to do contract tracing, and uses Partners in Health, a nonprofit. Michigan and Massachusetts have followed a more aggressive strategy of testing compared to California which has taken a different approach of not doing aggressive testing and contact tracing leading to lower numbers in California now adjusted for population that could be different later on.

LyrArc Article Gist
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.

LyrArc Article Gist
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. ...

LyrArc Article Gist
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.

LyrArc Article Gist
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.

LyrArc Article Gist
With coronavirus spread out over wide parts of each country and with so many people infected it is very difficult to do the contact tracing and isolation that was tried during the first wave. In Germany during the first wave efforts for contact tracing and isolation worked reasonably well. During the second wave in November things have changed. In Germany authorites do not know in November where 75% of the people testing positive for coronavirus got it. In Spain this figure is 93% for the last week of October. In France and Italy it is at 80%. In New York it is over 50%. Other problems are the increasing number of cases where the coronavirus is spread in an home setting, the lack of restaurant data collected on who visits, and the delay in getting test results. In Germany frequently people say they cannot remember where they were. Researchers from the German version of the FBI, the Pasteur Institute in France and the Koch Institute in Germany are getting involved in November to understand in what settings the virus spreads most. ...

LyrArc Article Gist
Any idea that herd immunity is the way out is dispelled by a simple look at these pictures from the NYT showing what the level of infections are today and what they would have to be for "herd immunity." No Asian nation has even mentioned the word. Most Asian nations have the most experience with virus of all sorts. The only government that supported the idea without saying so openly is Sweden as indicated in a report in FR24 on the amplification of coronavirus in Sweden compared to neighboring Denmark, Norway, Finland. Imagine with a threshhold of 60% of people having antibodies provided by experts for herd immunity, the current New York level of about 20% would have to triple, and Sweden's 7% would have to grow seven fold. It is hard to imagine New York going through something of these proportions. Looking at what works now that other countries handling it have set examples of what works provides a better way- low tech contract tracing the German way, and one used in Asian countries, and the cluster isolation through testing and contact tracing adopted in many Asian countries as well as Germany. Strengthening public health systems, and working one's way out of the crisis where there are no easy answers offers real and realistic hope. ...

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

LyrArc Article Gist
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. ...

LyrArc Article Gist
The British public is very conservative when it comes to reopening. 73% support prioritizing the health of citizens only 17% say prioritize the economy. This is the highest of industrialized nations, Japan being the next highest with 60% supporting prioritizing health only 16% in Japan saying the economy.  For Boris Johnson as he makes the speech on Sunday May 10 on reopening the political margin for error in decision is nonexistent. Britain's tabloid press and other media simply took the idea that to heck with it lets reopen reflecting a lack of caution in the headlines after Mr. Johnson expressed his intention to reopen. After seeing this Johnson and his closest advisers met without his hawkish ministers to reflect on what was happening in the country. The British government's scientific advisers say whether there are 100,000 deaths by the end of the year depends on many factors including testing, contact tracing, the way the lockdown is eased, the situation at nursing homes, and other government action  to prevent a resurgence in infections. At the meeting with Gove, Sunak Raab and Hancock, Mr Johnson stepped back and reversed any plans except for mild reopening- giving people more time outside for exercize, opening limited locations such as garden centres and advising strongly to wear masks on public transport. Both Johnson and Dominic Cummings his adviser had coronavirus, and Johnson spent some time in ICU. They know the impact of the coronavirus from their own personal experience.  For Johnson there is only one chance, Tory senior advisers say the public will forgive mistakes going into coronavirus, but will never forgive mistakes getting out of cotronavirus. He told Keir Starmer of Labour in parliament that he bitterly regrets what has happened in nursing homes. The scientists have warned him that the staff at nursing homes could seed communities once again. And that the coronavurus R ratio (1 being the level it starts growing again) could go up back to 1. This is the situation on May 10 as Johnson prepares to speak to the nation on Sunday at 7 pm, as he shifts to "maximum caution." ...

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