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Coronavirus cases cross 90 million with 2 million deaths around the world by January 2021. In late October the numbers were 45 million cases. Britain plans to give vaccinations to all vulnerable people by mid-Feb. 2021. This means vaccinating 15 million people. Meanwhile British hospitals are treating 55% more coronavirus cases than during the peak in April 2020.

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For the first time deaths in Britain from coronavirus exceed 100,000. Deaths reached 103,602 on January 27, 2021, with all of the UK in lockdown again. Britain now has the highest coronavirus deaths per million population in the world. Analysis in The Times looks at what went wrong.

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The knowledge that the virus  caused human to human transmission and that it spreads to wide parts of the population very quickly were critical pieces of information that remained with Chinese epidemiologists, doctors and medical researchers, and were suppressed by local authorites in Wuhan.  Yet China's version of the U.S. CDC, China's Centre of Disease Control and Prevention, modeled on the U.S. control efforts worked effectively to identify the problem. Virologist Gao Fu, heads China's CDC. This report in Germany's Der Spiegel says Mr. Fu made it a habit to scan China's internet before bedtime for any signs of possible disease outbreaks. On the night of December 30 he came across rumors of an internal memo from the Wuhan Health Commission of an outbreak of a vaguely worded lung disease. When he called the Wuhan health authority he found their answers to be evasive which alarmed him. The next morning December 31 Mr. Fu sent the first of three teams to Wuhan which is how China was able to identify the problem, in the sense that Chinese authorites in Beijing were to rely on Dr Gao Fu to overcome the problem of Wuhan provincial authorites. He informed the World Health Organization Beijing office on that day. The Der Spiegel report says "shortly afterward," the Seattle Times in its report says this was about New Years Day 2020- Mr Fu made a call to Dr. Redfield, head of the U.S. Centre for Disease Control, who was on vacation. Redfield is deeply disturbed on hearing this from Fu and they have conversations over the next few days to the point that Dr. Gao Fu is in tears about what has happened. On January 1 Taiwanese public health authorites shared the information with WHO that the cornonavirus was a human to human transmission, would the Taiwanese authorites not have shared it with the U.S. the same week during calls from the U.S. CDC or other public health authorites alarmed about the situation. (The WHO was proving useless by Jan 14 when it contradicted Taiwan's more reliable assessment  on Jan 14 going by the letter from president Trump to WHO). On January 6 a few days later Dr Redfield and Dr. Azar head of Health and Human Services ask China for permission to send a team of CDC U.S. experts to China. This is cited in the U.S. letter to the World Health organization- the lack of human to human transmission information being given to the U.S. officially early by China. A risk that could have been a topic of conversation between the U.S. and China heads of CDC. That letter from president Trump also points out that the team of experts the U.S. planned to send was not accepted by China till Feb 16, one and half months after that series of conversations between Dr. Gao Fu of China CDC and Dr. Redfield of U.S. CDC in an alert message.  In effect removing one of the key defences for the U.S. and Europe in making their own defensive actions and plans, laying the basis of the worldwide coronavirus pandemic affecting millions of people. Dr Redfield is a AIDS researcher at the University of Maryland who spent most of his life trying to control spread of HIV and was appointed by president Trump to head CDC agency in 2018. He set a goal of eliminating AIDS by 2030 and is more comfortable with aids patients and research than the bureaucratic nature of agencies- CDC has about 11,000 employees. Once it was clear that a team of U.S. experts was not given permission to make its own assessment in Wuhan in the few days after January 6 offer to sent the team to China by Redfield of U.S. CDC and Dr. Azar, would it have alerted the U.S. that something was seriously heading the wrong way for a epidemic risk. That letter of president Trump cites how the head of WHO during the first SARS crisis in 2003, Dr. Harlem Brundtland acted when she faced China's lack of cooperation during that crisis by saying openly that this was a danger to world public health and millions. Could CDC in the U.S. and the other connected health authorites have taken the responsibility and filled Dr Brundtland's role in this crisis, that the WHO failed to perform?    ...

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In January 2020 employees met at a local Maryland bar to find out how they might salvage their careers in a 33 year old company that had failed to develop an approved vaccine, says this story in WSJ. Only months later following the coronavirus pandemic everything changed as in a miracle for Novavax. The company had to sell manufacturing assets at one point, and had enough cash for another 6 months just months before. By Feb. 2021 shares which had dropped to $4 were up to $229 and valuation which had declined to $127 million went up to 15 billion. Coronavirus has turned things upside down where newcomers are using previously unproven technologies and making them work in this pandemic. The persistence, perseverance and confidence of Novavax even in the most difficult situations shows how the right attitude can lead to remarkable results. Novavax vaccine can be kept in refrigerators for 3 months, and do not require very low freezing temperatures like Moderna and Pfizer vaccines. This is considered a potent weapon in the fight against coronavirus. Novavax says it can produce a couple of billion doses over the next 12 months beginning in April. Novavax has released data showing its vaccine is effective for protection against coronavirus. Results of late stage US trials are expected in March. ...

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About 85% of people in Portugal a country of 10 million people are fully vaccinated in October 2021, highest in Europe. Strict precautions for prevention such as social distancing and mask remained in place after the surge in January 2021 which led to deaths at a rate that was three times the peak rate in the US.

On October 1, 2021 the restrictions such as 30% limit on filling soccer stadiums were lifted. For the Benefica vs Bayern Munich soccer game restrictions were lifted leading to filled stadiums with vaccination pass mandatory. As people return to indoors in winter this could still result in increase in cases. Because Portugal depends on tourism and stadiums are filled to capacity there is the risk of a smaller surge. Cruise ships are back in Portuguese ports and tourists,are back in large numbers. Soccer fans, fill subways, leading to new concern about a limited spread of the coronavirus.

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"For months I was asking for equipment," Martin Hirsch, head of the Paris hospital network tells president Macron, "and we had only enough for 3 days to fight against the coronavirus." The French president told one hospital " we undoubtedly made a mistake, we should have done it 10 years ago," as some increase in funding came only in January of 2020. France had a tenth of the intensive care beds in Germany and a far higher fatality rate says this report in France 24.

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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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Hospitals in New York City are coping better in the current wave of coronavirus variant in December 2021 as the symptoms of patients are milder and patients are going home quicker. This report covers NYU Langone, Northwell and Mt Sinai, Presbyterian  health systems. Only about 2% of healthcare workers were lost through dismissals because of the vaccine mandate at Northwell, which is the largest health system in New York City with about two dozen hospitals. About 400 covid patients turned up on Friday Dec. 17, a fraction of the 1350 last January and of the 3500 in early spring 2021. The head of integrated operations,, Dr. John D'Angelo says Northwell has enough staff to meet projected needs. Most covid patients had underlying health problems and a quarter are vaccinated up from 10-15% a month ago. Vaccinations and two years of experience make for a different picture now, though there will be challenges and I think we're going to have to think through a bit carefully, says Dr. D'Angelo. ...

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Friedman in the NYT says China overreached especially since 2012 on trade, technology transfers, and in relations with American allies Australia, India, Japan, and America underperformed for its people by not investing in infrastructure, in workers incomes and in health and public services, education. Underinvestment in the very structure and backbone of American society while billions were wasted in foreign wars and in misallocation of investments by Silicon Valley and other investors. The coronavirus failure to get adequate warning through WHO and China's cooperation for American teams to be admitted immediately after January 10 request by the U.S. for Wuhan was a turning point.  

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An India like surge is feared for Indonesia with the spread of the Delta variant and rising cases. Sudden spikes in Jakarta, central Java, and Bangkalan on the Java coast are straining hospitals. A nation of 270 million Indonesia has only a small vaccination program dependent on Sinovac vaccine from China, and only 5% are vaccinated.

Doctors say whether you are young or old have co-morbidities or not you can catch the coronavirus delta variant. Several members of a household can catch it and the deterioration happens quickly. Doctors in India made similar comments during the surge there in May 2021. Kudus region in central Java is typical. At first cases were declining from a January peak by May. Then cases jumped in June. A third of cases turned up positive for PCR tests.

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The story of the Pfizer BioNTech vaccine is the story of 2 chikdren of Turkish immigrants to Germany. Sahin the son of a engineer working at a Ford factory in Cologne, and Tureci the daughter of a surgeon working at a hospital in Mainz Germany. Sahin was born in 1965 on the Mediterranean coast in Iskerundun, Turkey and he went to Germany when he was 4 years old, his father being recruited in a new effort to rebuild Germany with foreign labour. Both are motivated by scientific research and the drive to come up with some method to tackle cancer for patients with new research and cures.  Both did their doctoral dissertation on experimental therapies at the Johannes-Gutenberg University of Mainz in Germany, and both joined the faculty there. Sahin spent years studying the mRNA , genetic instructions that can be delivered to the body to help it defend itself against viruses and other threats. Much of this mRNA research was already at an advanced stage in January 2020 when Sahin heard about the coronavirus in China. At that point he saw the potential of retargeting the mRNA research to tackling the coronavirus. By this time he already had his own company with over 200 million euros invested in it  by investors including Helmut Jeggle, now supervisory board chairman of BioNTech. This report says he sat down one Saturday, January 25, 2020 and working on his computer designed the template for 10 possible coronavirus vaccines, one of which would become BNT162b2, the vaccine now approved in Britain. On the same day he told a surprised Jettle that he would refocus the company on the new virus that had not yet hit Europe. Shain he says cited the Hong Kong flu that claimed 4 million lives. Why Pfizer. Pfizer had already been working with BioNTech on a new flu vaccine based on mRNA technology. A cooperation deal was signed with Pfizer in March for organizing clinical trials, manufacture globally, and distribute the vaccine. BioNTech then acquired a U.S. company and a German pharmaceutical factory in Germany. ...

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President Biden's scorecard for the first year- 3.9% unemployment down from 6.4% in January 2021. Created 6.1 million jobs the most since 1939. $ 1 trillion infrastructure building plan approved in Congress with support from Republicans, the money going quickly and directly to specific much needed rebuilding projects all over the USA for the first time.  73% of the population of American adults fully vaccinated with two shots. And $1.9 trillion relief to Americans to restore their finances. Suspended student loan payments during the pandemic. Action on climate change, children's education, help to women, held up in Congress by two Democratic senators joining the Republicans opposed to Biden. It could be said that more was accomplished in 1 year than at any time since the presidency of Franklin Delano Roosevelt in the thirties and forties. And this comes in the middle of the pandemic of coronavirus with 853,000 Americans dead from the virus. Biden puts is faith not in the polls but in getting things done.   ...

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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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Britain staged a rehearsal for a pandemic called Cygnus in 2016. Till that time the preparations for a pandemic that started years earlier during the SARS crisis were conducted vigorously. Yet the by this time Britain was becoming immersed in the Brexit struggles in the ruling Conservative Party. Prime minister Cameron resigned on July 13, 2016  and was replaced by Theresa May. From that time on the struggles with pro Brexit factions led by Boris Johnson consumed the COnservative Party and sucked the life out of the pandemic planning that Britain had conducted for years before. The recommendations to correct deficiencies from the pandemic rehearsal exercize were ignored. The second failure happened as the crisis approached. Again the Brexit date of January 31 intervened and the months long struggle to get Brexit had taken so much energy and tired out most of the British public including new prime minister and leader of the Conservative Party Boris Johnson. Johnson did not attend the first Cobra meeting of the highest level ministers and military, convened on January 25, 2020, as reported in the Times. Such meeting are convened only for a national threat. Only 5 weeks later on March 2 did the prime minister attend a Cobra meeting. During this time the situation was grave in Italy with rising cases and infections. The entire process was conducted during this time by the Health minister Mr. Hancock who had assured the public that the situation was under control. Britain now has the highest number of infections in Europe exceeding that in Italy- at 240,000 on May 15, 2020. The prime minister and his adviser Mr. Cummings, were also infected by the virus, and Mr. Johnson spent time in ICU before recovering. Queen Elizabeth addressed the nation on Easter day, the first such address since 1940, to boost Briain's spirits. Never had Britain been less prepared as in 2020 when earlier preparations were ditched for austerity plans and events such as Brexit fatigue conspired to strip the nation of the crucial 5-6 weeks of preparation since the first January 25 Cobra meeting of the highest people in government.  Never had such preparation even for 6 weeks been more crucial than in February and March as the infectivity ratio was determined by infectious disease specialists at the best British universities and scientific institutions to be between 2.6 and 3.4 compared to the Spanish flu pandemic of 1918 which was somewhere between 2.0 and 3.0. This means every one person infects another 3 persons, compared to about 1 person in a regular flu season. This reproduction ratio and the nature of coronavirus remain a threat today as Britain, Europe, the U.S. and the world reopens.  As reported in the Times the infectivity ratio was also the reason for the mindset that refused to believe that the virus was real because at 3.0 infectivity the only way to tackle it was a "lockdown," and this was itself an "apocalypse" scenario for many in the pro-Brexit Conservative party that won the election, which badly wanted to get back to economic activity after Brexit. ...

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How a small Kansas town of Grinnell in America finds a way to deal with the rural-urban divide and covid anxiety generated in the tumultuous years of 2020-2021, is the subject with pictures of this report in the WSJ. Grinnell is heartland America and its residents find a way to set Kansas and America in the right direction. One one side some resident worried they would end up like Minneapolis or Portland with protesters. An incident of drivers along Highway 70 emptying shelves of toilet paper in neighborhood stores is seen negatively by some  Grinnell residents and leads to forming an Emergency Preparedness Group to prevent outside agitators from creating problems. Others like the Enlightened Ladies Group try to calm things down. Gene Tilton, 84, and his son 63 years, whose family arrived in Kansas in 1880's did'nt see the need for forming some sort of vigilante group. He raises cattle and crops on a 10,000 acre farm. Michael Machen who practiced medicine in Gove County for 35 years also felt the same way and believed law enforcement could tackle the problem if there was one. Sheriff Mesch attended the Gove County emergency Preparedness Group public meeting by invitation in January 2021. This about the time when the Capitol in Washington DC was stormed by protesters and the country was divided after the election. At that time after 19 months of coronavirus deaths, racial unrest and political violence America was on edge, communities all over America were struggling with the idea that the immediate threat they faced was from other Americans not foreign adversaries. The sheriff told everyone at the Emergency Preparedness Group's public meeting where he stood- law enforcement could handle any threat and he didn't anticpate anything his deputies could not handle. He told the Emergency Preparedness Group that he appreciated their sentiment though, if he needed help he would ask, yet concluded that is the only way. From that rebuff by the sheriff the Group paused its activity and shifted its message to offering to help anyone deal with the deep cold spell in February, to cope with snow, tornadoes, fires, rattlesnake bites and similar hazards. They sponsored first aid classes, and a "Homesteader Gardening Class." Soon their idea was "we're here to help people, the last thing we want is for people to be uncomfortable." "Gove County" says Don Tilton, "has moved on." So must America today. ...

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Typical of so much of what is written about the World Health Organization and its role in the pandemic, this podcast in the WSJ fails to quickly convey the critical function of the WHO as an early warning system the world has depended on, including China. The H1N1 epidemic originated in Mexico. Asian countries including China and India depended on very quick response from the country where the epidemic originated  in allowing entry into the affected area for experts from advanced countries such as the U.S. The global response was then coordinated across countries quickly with complete transparency. The head of China's CDC himself faced a problem with transparency with the provincial authorites in Wuhan. 1.    Fundamentally this quick entry was denied the U.S. Request by U.S. to China was made on Jan. 6 for U.S. team to go to Wuhan, quick permission was denied and given only about 6 weeks later on Feb 16. This delay is the crux of the problem for the U.S.. Taiwan confirmed human to human transmission on Jan. 1, the WHO was saying this was not clear as late as Jan. 14. These costly delays are what the U.S.  letter is about.  The head of the CDC China Gao Fu called Dr. Redfield head of CDC in the U.S. on the next day after he suspected Wuhan provincial authorites were vague about what was happening. Gao Fu was alarmed when scanning the internet on December 30, 2019, about rumors of a vaguely worded lung disease in internal memos of Wuhan. He called Wuhan authorites and was not getting clear answers on that day, then deciding on December 31 to send his own team to Wuhan, as reported in German magazine Der Spiegel- Hackenbroch, Zand, 05/20/2020.  Der Spiegel says in its special report on the early period in Wuhan that Gao Fu was so alarmed about what was happening enough to be in tears in his series of calls with Dr. Redfield in the immediate days that followed. The date was shortly after the GAO Fu sent the team to Wuhan, December 31 and New Years Day 2020, as reported in Der Spiegel. See the link to Lyrarc gist of Der Spiegel's "A Failed Deception: The Early Days of the Coronavirus in Wuhan."  2.  President Trump points out the standards of the WHO- in the concluding point of his letter to WHO- when a three time prime minister of Norway, Gro Brundtland was head of the WHO during the SARS crisis of 2003. She acted quickly and decisively and no time was lost. It is this failure of the early warning system under the new president of the WHO after 2017 Dr. Tedros that alarms the U.S.  with about 100,000 deaths.  3.  This failure it can now be said was partly a result of a election in 2017 for the position of WHO president which was flawed. This was the first time a WHO head, an important position was put up for an election. The Executive Board was responsible for this appointment since the founding of the WHO as part of the UN, based in Geneva, Switzerland, after World War II. This system worked. The election was clearly a bad process for appointing the president of the WHO which should be done entirely on the capabilities of the person holding this position not on a flawed voting process. It is flawed because India and Bangladesh hit by a cyclone during the coronavirus have suffered greatly, as have other countries, but had only 2 votes for 1.5 billion people, when Barbados (385,000 population) and Laos (7 million) which had less than one  hundredth the population had the same number of votes. The U.S. had one vote. The election resulted in lobbying and a process in which many candidates stayed away because they simply would not go through such a process. The position was too important to the world- most of the advanced countries had forgotten about the danger of epidemics to let this happen by 2017, as shown in the way the austerity years led to cancellation of the preparations for pandemic in France and Britain. The austerity years and neglect of public health during these tech boom years in the western world made it possible for this to happen. 3.   Along with the 1 month ultimatum action is already being taken to restore the effectiveness of the importance of the Executive Board. The head of the health ministry in India, Dr. Harsh Vardhan, has been appointed the new chairman of the Executive Board on May 22. This restores the voice of billions of people in Asia in the process, and brings the major countries with the greatest risk in a pandemic into the decision process for tackling the pandemic, this includes the rest of the world.     ...

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During the first days of vaccination drive in India the uptake is lower than expected, below 48% in many states of India. Healthcare workers are coming forward in smaller numbers. The glitches in the app that was used to transmit information is one reason, the other being that not enough information was disclosed about the two vaccines.  On the first day Jan. 16 India vaccinated 200,000 healthcare workers. The target was 300,000. The uptake is lowest in states such as Tamilnadu and Punjab.  One of the reasons for the low uptake is also that India has a lower number of cases, and cases are in decline in India for coronavirus. The first wave peaked on September 13 at over 90,000 and has declined ever since to 13,000 on January 19, 2021. The Indian diet includes vegetables and a large part of the country is vegetarian. Indian diet also includes herbs such as turmeric, ginger and cinnamon, and many others that help build immunity. The lack of cars for large numbers of the population means a lot more exercize walking long distances is essential in daily living. Another factor is that the mandate for masks is strictly followed everywhere. Also helpful is that after independence in 1947 the pharmaceutical industry was built up to serve the large population with prices regulated carefully by the government, enabling steady supply of medicine during the pandemic. ...

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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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Contrast the slow US vaccine export response with that of India, Russia, EU and China. Only in May 2021 after India's daily Covid cases were close to 400,000 a day did the US make a serious offer of vaccines to other countries in need of assistance. U.S. president Biden says that 80 million vaccine doses would be exported by the end of June 2021. The WSJ says citing Airfinity, a London research firm, as of May 10 more than 333 million doses of vaccine were produced by the US and only 3 million vaccine doses were exported. Contrast that with the European Union which has shipped 111 million doses overseas one third of its total production, Russia which has exported 27 million doses.  India has exported 66 million doses according to the Ministry of External Affairs website as of May 17, 2021. This includes 4 million doses to Brazil, 4 million to Nigeria. Within its own region Bangladesh received 10 million and Sri Lanka 1.2 million doses, Afghanistan 1 million. Mexico received about 1 million doses. In Africa the Democratic Republic of the Congo which has suffered from many epidemics including Ebola virus received 1.7 million doses, Nigeria 4 million doses, Kenya 1 million, Uganda 1 million. Of the 66 million about half of it is a direct grant assistance and Brazil, Mexico, Morocco received all vaccine as grant assistance, 70% of Bangladesh's is grant assistance. The list on the Ministry of External Affairs site of the Government of India shows 95 countries including many of the most struggling nations of Latin America and Africa, bringing hope to countries which are struggling to hold onto hope for a better life beyond the pandemic. Sending help overseas through vaccine supplies is suspended for the moment but will resume in July after India has pulled in all of its pharmaceutical manufacturing industry under a government guided effort to go all out. Never has so much help bringing much needed hope gone to so many countries of the world in the twentieth or twenty first century from a nation that is struggling to meet its own needs. The US in pursuing a US first policy of vaccinating all its citizens has not taken into account the need to bring this evolving vaccine technology into the hands of as many qualified pharmaceutical manufacturers as possible. This in a rapid response to expand manufacturing capabilities to meet world wide demand. The risks of not doing so were not taken on early- the very same way the virus spread in January to March of 2020 can be repeated as people travel around the world particularly for tourism, business family reasons. This risk takes on anew dimension of contagious mutations of the virus which are 50% more- the Indian variant being 50% more contagious by some estimates than the UK variant, which itself was estimated to be 50% more contagious than the original one.  The result a pandemic that stretches out indefinitely unless billions of doses are made in a short timetable to beat the timetable of Nature through the coronavirus. India is doing this for the first time with plans to produce billions of doses by engaging the whole of the Indian pharmaceutical manufacturing industry in the effort in a rapid response so that July to December would see 1.2 billion people vaccinated. The US effort, the European effort is left to the individual effort of pharmaceutical makers in the US and Europe, not a government guided effort to engage the entire pharmaceutical industry of the US and Europe in a rapid response timetable of 2-6 months.  ...

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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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Having an adequate supply of N95 masks is critical for each hospital tackling the coronavirus pandemic. The lack of enough masks leaves health care personnel without the basic protection and is a grave emergency. Hospitals are resorting to reuse of the masks in this crisis and this is not a good practice as it increases the chances of infection. President Trump has invoked the Defense Production Act on April 2 against 3M. This gives the federal government more control over 3M's operations to ensure that it goes all out to make the healthcare N95 masks that the hospitals need in this grave emergency. This report in the WSJ covers the situation as of April 3 on the supply of M95 masks for health workers and others. N95 masks block 95% of very small particles. Supply in the U.S. is for 50 million N95 masks. Demand in the U.S. is for 300 million N95 masks as estimated by the Department of Health and Human Services. in March- this is how many are needed by health care workers to fight this pandemic in the U.S. The principal manufacturer is 3M. 3M company has doubled its production since January 2020. The trend before this pandemic was to send production over to China and other countries. This is changing now with the pandemic and the U.S. policy shifting to be self sufficient in medical supplies in the event of an emergency. A policy Peter Navarro, who heads the agency in charge of getting medical supplies, says President Trump is insisting be implemented. Hospital buyers supported the earlier trend to keep costs down, but this appears to be a costly mistake, putting health care workers in hospitals across the U.S. without the basic protection they need. Minnesota based 3M invented the first modern disposable masks in the 1960's. Interestingly 3M continued to make millions of masks in the U.S. even though competitors moved manufacturing overseas. The 50 million disposable masks 3M made globally went to workers in industries where it provided extra safety from metal shavings or other substances, and medical workers. Now 90% of masks go to medical workers. 3M ramped up production globally since January 11 when the pandemic first hit to 100 million masks a month globally, and 35 million a month in the U.S. at plants in South Dakota and Nebraska. 3M says that it will import 10 million masks from its factory in China, which earlier this year was restricted from shipping it outside China as China needed masks for the pandemic. About 10 million more masks are made by two other manufacturers Alpha Pro and Louis Gerson Co.  U.S. Department of Health and Human Services ordered 600 million N95 masks from 5 companies to distribute to hospitals and build up the national medical supply stockpile. 190 million each of this is from 3M and Honeywell and 130 million Owens & Minor Inc.  3M says it will make 50 million a month in the U.S. by June. Honeywell which had moved production overseas, plans to bring back production to the U.S. by making 10 million masks by May at its Rhode Island and Phoenix plants. There is a company in Singapore that makes one million masks a day in China and other Asian countries, Pasture Pharma Pte, but most of it is committed to government agencies in China.   ...

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This important WSJ report shows how the CDC labs failed to come with the test after contamination of a component and failure of the third part of the three part test components. In the absence of a working test from CDC where delays cost three weeks of February the private labs all over the country and state labs could have developed their own test, yet HHS and FDA required approval for these labs to develop their own test and use it. From Feb. 8 when state and city public health labs detected problems with the CDC test to Feb 29 when solutions were developed including simply excluding the third part of the three component test, and letting labs around the country do their own test, were 3 crucial weeks that let the virus spread out of control. The CDC, HHHS, and the FDA and their managers and heads of departments bear responsibility for these errors. Week after week the delays continued, instead the two component test which detects if the genetic material in the sample is coronavirus material, could simply have been approved at the outset instead of the approval for this given weeks later. The third component of the test checks if the virus mutated, according to this report. There is no explanation why the labs all over the U.S. were not allowed to go ahead on February 9 itself or within a few days after that to develop their own tests once it was clear the CDC test did not work on that day. CDC officials failed to recognize that there was a possibility that they may not be able to fix the faulty third component of the test and the risks if they gave false reassurances. There is also no explanation of why a German designed test was not used once the CDC test failed on Feb. 9, which would be a proper way for action considering that this pandemic had already shutdown parts of China by this time. Alarming also is the mention in this report that on Feb. 22 a FDA official in charge of lab diagnostics  flies to Atlanta where the CDC Respiratory Diagnostic lab which developed the test is located. His boss FDA medical device center director is cited from later information as describing the lab as "filthy" meaning the lab had the potential to contaminate, and going so far as saying that if it had been any other lab it would have been shut down. Considering that investment in public health has deteriorated over the last two decades and that there has been a massive misallocation of capital in the country away from public infrastructure this is appalling. The thought of critical labs for emergency health needs as not being up to high quality standards in the U.S. as a result of two decades of misspending, that this shows, is very disturbing.  This WSJ report is based on interviews with people who know about the testing crisis, and undisclosed emails, correspondence on the issues involved. Community transmission began in January 2020 in the U.S. These delays were costly in February and could have been prevented either by going with the German design on Feb 10 or asking labs across the U.S. to develop their own test, and letting other labs immediately use the modified 2 component test of CDC that worked instead of doing this action weeks later. Mardi Gras on Feb 25 and other places where large crowds gathered in sports stadiums could have been stopped had testing gone forward and shown the true extent of the community transmission in these critical weeks.  First China delayed a U.S. team of experts coming into the country for weeks, and then the CDC, FDA, HHS, failed to get testing started, creating  a false sense of complacency. Two crucial errors outside and inside the country that caused so much damage to America and the world.   ...

LyrArc Article Gist
As Dr Harsh Vardhan, India's representative and Health Minister, takes on responsibilities as the Chairman of the Executive Board of the World Health Organization this can be said about this critical juncture.The WHO is going through soul searching and a reevaluation of how it has implemented the vision of its founders during the closing years of a world torn apart  by war in 1945, and actual founding in 1946.  At the UN conference in San Francisco in 1945, Dr. Szeming Sze of China, Dr. Geraldo da Paula Souza of Brazil and Karl Ewang of Norway, were keen to set up an international organization for cooperation on health. The Indian representative was Arcot Ramaswamy Mudaliar, a member of Winston Churchill's War Cabinet, who chaired the committee on economic and social problems. He was the president of the Economic and Social Council which called for an international health conference in Feb. 1946. It was at that conference on 19 June 1946 that the World Health Conference came into being. A native of Madras he then returned to Mysore as chief minister. The vision at the time for international cooperation on problems such as smallpox which killed 2 million people each year were quite different from the fast moving epidemics with international travel in 2020. Today 4.4 billion passengers traveled by air in 2018, according to International Travel Association, 100 times compared to less than 40 million in 1950, and about 10 times the 400 million when Nixon's visit opened up China in 1972. The world we live in is different and the World Health Organization needs to be redesigned for the 21st century. The entire process of how the WHO operates has to be rethought. Immediate steps include- 1. The appointment by Executive Board should be reinstated as this is more representative of the world population and the major centres of advanced public health, including the major countries. Throughout its life the WHO made appointments through the Executive Board not by election. The election in 2019 by 200 countries was actually not representative of the world population as it gave India, Brazil and other early founders at the 1945-46 conferences only 1 vote each with population of 1.2 billion and 210 million, the same as tiny countries Barbados population 385,000 and Laos 7 million. 2. Reassessment of the entire process in which nations are requested to give permission of teams from major countries in Europe, North America and Asia, major population centres, so that the 6-7 week delay between the U.S. request to China for a special team to go to Wuhan on January 6, 2020 and the permission granted Feb 16, a costly delay of 7 weeks which added millions of cases and hundreds of thousands of deaths. In a super fast moving pandemic with international sports stadiums and 4 billion air passengers spreading it like wild fire around the world, there is little room for error, every day counts. Never should this happen again, as Dr. Sze Szeming China's representative said once in 1945 we must learn from mistakes, as mistakes were made in the years before World War II that were costly for China, India, North and South America, Other Asia, Africa, large population centres. 3. As was the effort then in 1946 and the early years, the effort to keep the staffing positions of leadership in the World Health Organization should be kept far from politics. Very experienced and capable people are needed from major countries with long records of public health experience and committed to the huge task, as was the vision of the founders.     ...