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Richard Levitan, a physician expert on patient oxygen levels treated patients at a New York Hospital, and found this very important fact about coronavirus and its attack on patient lungs. Early detection and treatment, use of pulse oximeter monitoring, are shown to be critical for coronavirus.  Covid or cornavirus pneumonia is different from normal pneumonia in that it attacks the lungs but patients can be low on oxygen without realizing it through shortness of breath. As it turns out and confirmed by this physician expert who has invented intubation techniques and served at a New York hospital to understand why coronavirus was killing patients, the patient simply breathes faster and deeper without knowing it and is not short of breath even though his oxygen saturation is going down. This delays treatment- use of pulse oximeter is therefore recommended, an easy test placed on a finger that shows the oxygen reading. This kind of fast breathing then suddenly leads to the complete collapse of the patient's lungs, which is why so many end up in hospitals late and end up later on ventilators. British prime minister Boris Johnson received this kind of monitoring and early treatment to be able to return to work.  ...

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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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A coronavirus map of the U.S. in November shows darkened areas in the midwest and the mountain states as the most hard hit regions. The U.S., India, Brazil, Russia and France, populous countries in Asia and Europe, and Americas, lead the way in the number of daily cases in the second wave as they did in the first wave of the coronavirus.

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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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China's healthcare system is overburdened and overwhelmed, says this report in the NYT. The changes in living and investment in infrastructure and housing are not matched by similar investments in the health system. Shortages of hospital beds and doctors is making tackling the coronavirus in the Wuhan region more difficult. A new hospital is being built in 6 days in late January 2020 in Wuhan for the coronavirus patients, showing how severe the situation is. 

The lack of strict regulation and lack of enforcement at the local level is leading to the situation where the virus was detected in twice- in 2003 in wild animal meat and again in 2019. Public anger and call for a ban on wild animal meat is happening today.

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New information from the recordings of the World Health Organization as reported by Associated Press, show that during the week of January 6 WHO's lead experts were having difficulty getting information about the coronavirus outbreak in Wuhan, China. Maria Van Kerkhove, an epidemiologist and the WHO technical lead for coronavirus says she was going on very minimal information. The WHO's top official in China, Gauden Galea, says in one of the recordings that they were in the situation where information was given to WHo officials in China only 15 minutes prior to it going on China's state television CCTV. In early January Michael Ryan, the WHO's chief of emergencies, says he feared a repeat of the SARS epidemic in 2002, which was initially covered up by Chinese officials, according to the AP report shown in the Guardian. Ryan says he found himself in the same situation as in 2002 SARS, endlessly trying to get updates from China about what was going on, and adds that WHO barely got out of the SARS with its reputation intact given the transparency issues, in the AP report shown in the Guardian. By June 1 about 6.3 million confirmed cases are reported of coronavirus in the world and 375,000 deaths, and huge losses to economies and people. China's authorites did not lockdown Wuhan till January 23, by which time this report in the Guardian says at least 5 million residents had left. China denied entry requested by the U.S.on January 6 for a team of experts into Wuhan, The team was not allowed into Wuhan for a crucial period of 6 weeks during which the virus had time to spread in the western world. This is taken up in Mr. Trump's letter to the WHO, and the work of Gro Harlem Brundtland is clearly stated in the conclusion of that letter. Brundtland was head of the WHO at the time of the SARS epidemic in 2003, and acted decisively with early warnings to prevent its spread.  Because of the extremely contagious nature of the coronavirus the failure of early warning systems resulted in enormous damage to lives and economic losses worldwide.  ...

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Biotech firm CureVac is developing a vaccine for coronavirus that should be available by fall 2020. It hopes to develop the vaccine using mRNA (messenger ribonucleic acid) as a source of information. Managing director of Hopp Biotech the holding company for CureVac, says mRNA has several advantages, including one related to a vaccine developed by CureVac for rabies. He says 1 microgram could suffice to vaccinate 1 million people because it is very potent, and because it can be mass produced quickly.

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Researchers at Gottingen University in Germany analyzing data from a study published in the Lancet Infectious Diseases monthly journal say countries around the world have only discovered on average about 6% of all coronavirus infection cases. The true total of infections could be tens of millions worldwide. Why this is important- the recurrence of the virus is a real danger even after it appears that it is under control, making relaxation of essential guidelines for prevention very risky.

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Photos on exercize and walking, gardening, birdwatching, during the time of coronavirus from DW.com- the importance of renewing body and mind during this time. Pictures of how gardening, birdwatching and other activities can push out anxiety and boost our spirits in different ways.

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China is building a new hospital in Wuhan the center of the coronavirus outbreak, to contain the outbreak. The plan is to build it in just 6 days. China has taken a new approach to tackling this health crisis, isolating the area and speeding up action to find solutions to the virus. A shortage of hospital beds and resources in Wuhan led to the decision to build a new hospital rapidly. China's rapid response is the first high speed response and could be a model for future outbreaks. Before this during the SARS crisis in China, and other health crises worldwide, action was taken gradually by hospital and government authorites leading to more deaths and wider spread of disease.

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President Trump has listened intently to Dr. Fauci and Dr. Brx of the White House team led by Vice President Pence, as he shapes policy decisions on tackling the epidemic. The White House team met again March 30 to see the data  about the coronavirus impact without lockdown and strict social distancing measures extended to April 30. Following this Mr. Trump extended the lockdown till April 30, 2020. This WSJ report shows how Mr. Fauci has forged a relationship with the president at a time of public health crisis. Dr. Fauci wins the respect of Democrats and Republicans, and the American people for the work he has done against epidemics, the valuable experience gained and how he is bringing this experience to the current crisis. It is also true that this is a team bringing different strengths and with mutual respect for each other- the calm demeanor and grip on data of Dr Brx, the experience of Dr. Fauci fighting epidemics for 30 years, the patience and hard work of Vice President Pence, and the president's fighting spirit and listening skills. ...

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India's testing for coronavirus is at about 30,000 per million. For the first time India's positive cases exceed 78,000 on August 30, the highest daily cases ever in any country. India continues to reopen its economy. The official count of deaths is at about 2%. 

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India overtakes Brazil to be after the U.S. the largest in coronavirus cases on September 6.

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The National Health Service in Britain already had a backlog of 4.4 million cases in February 2020. It now has another 1.3 million added to this during the coronavirus interruptions of service. Estimates are for this to go up to 7.2 million by September. 3.5 million people will need an outpatient appointment this month as services restart.

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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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Weak and poorly equipped public health systems, densely crowded conditions, make coronavirus spread extremely serious in South Asian and African countries. India imposed a complete lockdown of the entire country. South Africa imposed a 21 day lockdown enforced by the military. Decisive and strong action is needed early. Pakistan acted early to quarantine pilgrims entering the country from Iran. Pakistan's government has announced a $20 monthly wage subsidy for poorer households. The average in Africa is 20, according to the UN, and South Asian populations are also very young. Generally hotter climates may offer some offsetting factors to makeup for the lack of strong public health systems. India made major strides in direct deposit to bank accounts of 1.3 billion citizens by the government for many social safety net schemes in the last 5 years. It has also computer records of all citizens under a plan underway for a decade. The nationwide rollout of 4G mobile technologies has connected every citizen including remote areas. This should assist in the identification and isolation of affected areas and people. Other factors that mitigate the spread will be access to medicine when medicine and vaccine is developed for the virus. India has a large pharmaceutical industry, scientific labs and other medical resources similar to South Korea, which should help limit the affected areas and people. ...

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On October 28 France reported 36,000 daily coronavirus cases. French president Macron announced a new lockdown starting October 30 that last till December 1.  Under this second lockdown people can leave home only to go to work, to go to school, to give assistance to loved ones, for essential shopping and for 1 hour of physical exercize. People will have to show documentation when leaving home. Travel between regions is banned. Bars and restaurants and nonessential businesses will be closed. Universities and higher education will be done online. Schools will remain open, essential businesses will remain open. Most public services will be open. Factories, farms and construction sites can continue to operate. There will be extensive economic support for business and people. Small businesses will have access to 10,000 euros per month of assistance, employees get short term work assistance, and people having trouble with rent receive assistance. About half of intensive care beds are now taken in France. And Macron said transferring patients to other regions will not be possible as the virus is everywhere. ...

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The Times correspondent in Beijing says he sees two Chinas one that is showing technological advancement in 5G, in space technologies, in information technologies, infrastructure building in big cities. The other China is in rural areas away from the big cities, in smaller towns in regions away from Beijing and Shanghai. These areas have suffered neglect and have changed little over decades, with the focus during industrialization on larger cities and the coastal areas. This is evident in the manner health services infrastructure and development of medical personnel and doctors were neglected in the rush towards building manufacturing and infrastructure of road and rail. There is a shortage of doctors and hospitals, health services are costly, and waiting lists for beds at hospitals is huge. Doctors are also not held in high esteem because the focus is on profit in the market economy that has taken over the health sector.  Education of citizenry on respecting the common welfare which is expected and normal in Europe and America has also suffered during the rush to industrialization. Efforts to ban and eliminate use of certain wild animal foods not being respected by fellow citizens can be seen in this context. This caused the SARS virus epidemic and the epidemic today from the coronavirus. Seen from this angle a slowdown in construction, infrastructure building, and a slowdown in the economy, can even be healthy, so that focus can be shifted to better health, better sanitation, and better medical infrastructure including medical human resource capabilities. Investment in public education on health and self enforcement of rules by citizenry for a better society is indispensable for progress. It is in these conditions that the challenge of the national and international emergency of the coronavirus can be seen today. It also provides an opportunity to reflect on progress so far and the needs of the future. These challenges are even tougher than repeating what one has done before such as building more and more infrastructure, as they involve building a better society through public discipline along with investment in health and education services. This provides a lesson for many Asian, Latin American and African countries in the rush to industrialization. Turning over the health sector to a market economy making services costly and distributed unevenly in the population has not worked in the U.S. for the betterment of all citizens and a healthy society. Carrying this over from U.S. to China and not learning from Europe in what Europe has done well in the less costly and broad distribution of health services for the people, is one of the poorer lessons learned. This is also true for India and South Asia, South East Asian countries in their rush towards industrialization.  ...

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Maps of U.S. coronavirus by state as of April 1, 2020, that reached 189,000. How coronavirus is surging worldwide with 75,000 added on March 31 to reach 874,000 coronavirus cases detected worldwide. China's numbers have not included coronavirus cases that are asymptomatic. 

China continues to see coronavirus cases with 166 new cases on March 31, showing that it public health authorites have to be vigilant about a restart of the epidemic once it comes under control.

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This report in the WSJ looks at the failure of the World Health Organization in providing the timely information and proper guidance in tackling the pandemic from the coronavirus.

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

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A NYT video simulation that shows how early action is critical with decisive steps for quarantine and lockdown with enforcement, to control the spread of coronavirus. It shows the spread along a timeline of the coronavirus in the U.S.

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If only there was a way to keep the streets in big cities such as Paris, New York, and Mumbai quieter after the coronavirus. This report looks at ways in which cities changed during the coronavirus with less noise pollution. Bicycle lanes are becoming popular and some cities have converted car lanes into bicycle lanes. In many cities on a walk through parks one could hear bird songs. The audio clips in this NYT report and with SONYC's project provide a glimpse of how life changed on streets during the coronavirus.

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A 35 year old Engineering professor from Texas who studies how transportation systems propagate infectious diseases and her 2 graduate students from China started and since January maintain the database of coronavirus confirmed cases and deaths. This is one of the widely used databases, also used by public health officials in the U.S. The database was started with a hunch from one of Lauren Gardner's students from China Ensheng Dong who comes from Shanxi province, north of Wuhan. A geography and mapping specialist he had studied in the U.S. since 2012, and spent many hours inputting data by hand following his classes. This WSJ report says the website was built in 1 day and was launched on January 22, when the coronavirus cases were practically nonexistent in the rest of the world and were concentrated in the Wuhan area. This report says behind the data reported in the media everyday is a complicated supply chain filled with challenges that come with data, what is reported, underreported and with what assumptions it is reported. Dr. Gardner says she is dealing with so much data on her dashboard, 4000 points of data, that its hard enough to pull all the data scraped together from different sources, its impossible for her to check the assumptions behind the data for consistency and trying to figure out facts underlying the data.  One of the ways the virus developed in the rest of the world is the surprise with which it caught western countries and then the rest of the world. As a result something that the government authorites would do such as the Centres of Disease Control is being done in a totally ad hoc manner. The U.S. government uses the University of Washington Health Metrics database, and in turn the University of Washington Health Metrics database takes some of the data from the John Hopkins database. Because a complacent population in the western countries were relying on numbers counted as cases to know how serious this epidemic was or whether there was an epidemic, the significance of data count from China assumed a signifcance far out of proportion to what it might normally be. This was because the western countries in Europe and America never encountered an epidemic of this kind in living memory, the last one forgotten from 1917 hundred years ago. Researchers in Gottingen University study in Germany conducted analysis of data in studies of cases published in Lancet Journal and found that only 6% of cases were being shown- that a much larger part of the population was infected. A researcher at Princeton University Ramanan Laxminarayan says countries tend to delay reporting until a problem becomes certain, because telling others comes with economic costs such as a rapid drop in trade and travel. Yet he says early warning systems are key to prevention. Early warning from the different publicly available data bases was not possible for many reasons. Relying on such ad hoc data was hazardous considering that as the NYT reported recently when there was the first confirmed detected case reported in New York there were already 10,000 persons estimated to be undetected. James Glanz and Benedict Carey, say in the NYT.com on May 7, that hidden outbreaks spread through U.S. cities far earlier than Americans knew, estimates show, which makes the publicly available databases giving a false sense of security, and not acting as an early warning because of the inadequacy of the resources for this task for individual researchers to handle. Not depending on  hurriedly put together databases with inadequate resources and having an independent sense of what the danger was as German chancellor Merkel described it in her first coronavirus address in March, was a better early warning signal than the databases in retrospect. And this too had come late. The reason is that the response had to be fast, very fast, and public perceptions had to be shaped quickly about the magnitude and speed of enormous proportions of the coronavirus, so that actions could be shaped quickly and executed quickly to stop it in its tracks.    ...

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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. ...