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This WSJ report on critical analysis of coronavirus data has a very useful chart of Estimated Range of Symptomatic Cases Reported by Country. Complete coronavirus data for all symptomatic persons who have the coronavirus infection is lacking in most countries. Many people in large populations have symptoms and are positive but are not reflected in the official data collection. This is a big problem as the total number of cases are understated by a magnitude of twice to five times the numbers reported in official tally.   South Korea has done a good job of getting more of the symptomatic people with the infection in its data, as about 53% to 90% of such persons are reflected in official data. Next comes Germany at a range of 38% to 55%.  China comes third and has about 28% to about 38% of such persons reflected in its data, the U.S. currently on April 4 at about 14% to 19%, according to this chart in the WSJ. The source for this is Mathematical Modeling Center at the London School of Hygiene and Tropical Medicine. What this means is that the US. number of cases at 278,000  reported infected people with symptoms (April 4) is only 14% to 19% of the true number. Another way to say this is that the actual infected persons with symptoms is about 5 times what is reported, or over 1 million not the 278,000 reported.  As happens for China data collection agencies may never get the true number. To be comparable to the Chinese numbers, as the U.S. is a large country, the figure closer to the true numbers would be twice the 278,000 reported or over half a million symptomatic infections of coronavirus in the U.S. Why is this data important. With widespread testing as in South Korea one gets data that tells one how many people are infected (the size of the problem) and therefore the resources needed and the point of greatest impact. Also it tells one the typical transmission rate per person, and it helps hospitals in each area know what to expect and what resources are needed to prepare- not find people suddenly turn up in the E.R. in unpredictable numbers. The lack of widespread testing and better reporting in the data to get a grip on the pandemic is shown in this chart for countries hardest hit, less than 5-6% for Italy and Spain. The UK and France at 5-8%.   ...

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WSJ was first to point out the dangers of holiday hotspots in Spain, Greece and Croatia in spreading the coronavirus in Europe. One story in the WSJ showed how 21 million tourists visiting Croatia in the summer were not following the basic social distancing and mask guidelines. These tourists returning to Germany, Austria and other countries were spreading the virus after becoming infected in bars and restaurants, shops in Croatia which had not followed the basic guidelines that had been followed earlier in Croatia in April. Over the summer after months of lockdown people simply used fatigue with restrictions as a reason for going the other way and ignoring them.

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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.       ...

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

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

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The first spread event for Omicron outside of South Africa is now known to be in Norwegian capital of Oslo. Some workers of renewable energy company Scatec SA returning from South Africa where the company has a solar panel project attended an annual holiday party. The party was at Louise an upscale Oslo restaurant, with 120 people all vaccinated, and tested the day before. More than half have tested positive for covid 19, with at least 13 having the new variant Omicron. Oslo municipal health department says it expects more Omicron cases among the 64 coronavirus cases as remaining workers get tested. The results so far are anecdotal and thin to be sure, yet they show none of the infected employees were seriously ill, says this report in WSJ, citing a company spokesman. The spokesman says people had different sysmptoms but none were severe. Tine Ravlo, assistant superintendent of the Oslo municipal government says- all of them are under isolation at home. And  for now they have what they describe as mild symptoms such as headache, cough, sore throat, and flulike symptoms.  Norway has 80% of population of 5.4 million people fully vaccinated. Mask mandates are in place again in Norway, private indoor gatherings limited to fewer than 100 people. ...

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Indian finance minister Sitharaman announces a new stimulus package "Atman Nirbhar Bharat." This includes an effort to incentivize creation of employment opportunities for people making less than Rs. 15,000 a month ($215 a month), called "Atman Nirbhar Rozghar Yojana, for a period of 2 years. Sitharaman cited stock market rebound and foreign reserves reaching $560 billion to show that along with the government efforts and planned infrastructure the economy would make a robust recovery. Because of India's large informal economy help to street vendors and other small retail is critical in the Indian economy. The finance minister cited the "One Nation, One Ration Card" which allows street vendors and other retail merchants to access foodgrains from FPS of choice in 28 states and union territories in India. This is part of the effort to build demand and upward mobility in the economy. The names given for these efforts or yojanas are unique- PM SVANidhi stands for PM's Street Vendors Atmannirbhar Nidhi. Atmannirbhar is the overall plan for self reliance in the economy and the prime minister Modi has pushed for buying Made in India, to promote jobs and technology + capital accumulation in Indian manufacturing. India took a blow from the coronavirus with close to 9 million infected by the virus and lockdown in March. By September 20 the daily cases reached 100,000, and by November 10 the daily cases have dropped to 44,000. Social distancing and mask wearing are widely accepted in India. India has other advantages in the large pharmaceutical industry and access to drugs at government regulated and low prices as part of the planned effort after independence in 1947. Other aspects of Indian life are cultural preference for vegetables and fruits in the diet, and spices, herbs in cooking, yoga practice, which are anti-inflammatory and promote healthy living.  With the largest population in the world the region in the Indian ocean comprising the countries of India, Bangladesh, Pakistan, Burma and Indonesia, former parts of the British and Dutch empires, is a region where the coronavirus posed a great threat to human life. An early carefully orchestrated lockdown by prime minister Modi  helped with the message in March that India faced a singular choice - between going back 21 years in development or controlling the coronavirus in 21 crucial days. The setting up of the direct transfer of money to bank accounts  of farmers, urban street vendors and lower income people in rural areas by giving everyone a bank account under a government plan early in the first term of the current administration enabled it to send aid directly when coronavirus hit the country. Other schemes included cooking gas for women in rural areas who depended on firewood for cooking. These schemes and sanitation infrastructure setup under the Clean India campaign, helped India build an element of resilience when coronavirus hit.  The government plan to remove interstate barriers to commerce and integrate tax system collection at the federal level, bringing parts of the informal economy into the formal economy, have increased revenues that now finance an infrastructure plan that hopes to match the one in China over the next decade.   ...

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In an astonishing contrast to other European countries, including neighbors Norway, FInaland and Denmark, the Swedish government decided to not impose a lockdown, keeping bars, restaurants, hairdressers, gyms, primary and middle schools open. Secondary schools, museums were closed, sports gatherings, gatherings of more than 50 people were not allowed. Social distancing was not enforced, and entirely voluntary. Sweden now has 29000 cases according to Statista and its death rate of 358 per million population is higher than in the U.S. which is 267, and Denmark 93, Finland 53.  Critics such as Lena EInhorn, a virologist, say the Swedish government did not set up a broad testing program, and let a problem develop for elder care in nursing homes. She says a 14 day quarantine of household members of a person infected with the virus would have made a difference. Most action we take for granted was not taken in Sweden. Restaurants that were not required to close spread airborne transmission. Einhorn also says that the government officials have denied it but under their breaths they have acknowledged working on a herd immunity strategy. Denmark has opened schools with social distancing and other measures and reopened its economy. Sweden is in reverse with calls for stricter action and an ongoing debate. No reopening as there was no lockdown, yet considerable and nagging uncertainty. The speed of transmission of coronavirus is the biggest danger, as it can let the numbers grow very quickly if the wrong decisions are taken or something is left out. ...

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The full text of the letter is given here. In this letter the U.S. sets out some important facts about events that happened during the coronavirus crisis during the crucial 4 month period from December 2019 to March 2020. Every week lost in this time due to reasons of a lack of transparency, openness meant hundreds of thousands of people more infected and tens of thousands of deaths worldwide. There are questions of transparency, of openness and this raises questions about the manner in which the World Health Assembly operates with hundreds of small countries in Africa and Asia having votes equal to that of the U.S., India, Brazil, Mexico with votes taken of over 200 countries. The entire election process can now be seen as questionable, when over a billion people in one country alone such as India or hundreds of millions in Brazil and Mexico would have to bear the consequences of poor decisions made by small countries that can be swayed in one direction or another based on political bias and other considerations that have nothing to do with global health.  At the conclusion of the letter by the U.S. to the current WHO shaped by a controversial election in 2017 the following is stated about the standards set by Gro Harlem Brundtland and which helped the world prevent the SARS crisis which originated in China in 2003 from spreading to the large countries of the world India, Brazil, Mexico, and other such countries in Asia and Africa, Latin America, and the U.S. European Union. "In 2003, in response to the outbreak of the Severe Acute Respiratory Syndrome (SARS) in China, Director-General Harlem Brundtland boldly declared the World Health Organization’s first emergency travel advisory in 55 years, recommending against travel to and from the disease epicenter in southern China. She also did not hesitate to criticize China for endangering global health by attempting to cover up the outbreak through its usual playbook of arresting whistleblowers and censoring media. Many lives could have been saved had you followed Dr. Brundtland’s example." Even this does not come to grips with the flawed way in which the election of WHO head is done. It can no longer be relied on when there is the danger that lack of transparency can emerge in the WHO leadership itself because of a flawed process. It risks endangering the lives and livelihoods of hundreds of millions in countries such as India, Brazil, Mexico, as well as in the relatively small countries of Africa and Latin America where even basic water supplies are at risk but which could tilt elections at the World Health Assembly. Consider that a cyclone just hit the Indian state of West Bengal and Bangladesh on May 20 just as the coronavirus pandemic is spreading. That this region of 1.5 billion people had just 2 votes out of over 200 cast at the World Health Assembly in 2017 shocking. And even these votes cast based on old geopolitical considerations not how good the candidate is, and how good the country he is coming from is in terms of its record  on public health. The irony here is that private foundations in the advanced countries in the U.S. and Europe some of whom are major donors to WHO did not think that more experienced candidates in their own countries with a better record of public health such as in France or Germany are better qualified, in a flawed NGO support mentality left from the Clinton years. Basically the people in these large countries such as India, Brazil, Mexico were disenfranchised, when the austerity policies were consuming the European Union, and the U.S. had just elected a new administration itself groping for ways to reverse years of neglect of public services and infrastructure priorities. They would trust good leaders no matter where they come from, who have a record of transparency, leadership, and all the values we cherish together no matter where we come from. ...

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Prof. David Spiegelhalter of Cambridge University is critical of the British government for not finding out how many people may be infected by coronavirus. He says he is not telling how anybody should feel or what they should be worried about, but at least the people's anxiety should be proportional to the risks they actually face. His estimate is that based on the death rate of 1% its possible that there could be 3.5 million people in Britain who are infected with coronavirus or higher. Sir Spiegelhalter is professor at Cambridge University for the public understanding of science. He says this "basic information" is essential in making the decision such as how far and when to go out of lockdown, and that the British government has failed to do this in a timely manner required for tackling coronavirus without risking more lives.

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A look at two crises in 1918 and 1957 of virus pandemics shows early and decisive action to prevent public from gathering and intermingling, are critical. In today's densely populated urban environments this translates into lockdowns and quarantines that are strictly enforced. The 1918 pandemic took 50 million lives worldwide, the 1957 pandemic took 1 million lives worldwide, says this report based on some estimates. MIstakes were made then and science was not as developed for vaccines and new drugs. Which is why health authorites are taking this very seriously. Greg Ip of the WSJ looks at coronavirus health crisis in relation to earlier disasters- SARS 2003 originating in China, 1957 flu epidemic, 1918 Spanish flu epidemic, to draw insights on what measures have worked best. Previous epidemics and crises provide clues on what makes things worse or better and the long term consequences of actions. The more health and safety are prioritized there is some impact on the economy. But crises have proven that the economic impact is temporary and short lived with the economy and jobs bouncing right back once the crisis has passed. The second insight is that early on in the crisis there is a great deal of uncertainty, leading to fumbled or delayed, or timid response. Sort of like lets wait for more information coming out of China, or now Italy, which happened first in February, and then again in March. Tim Adams who worked in the U.S. Treasury Department during 9/11 and Hurricane Katrina, and is now the president of the Institute of International Finance, says if you look to plan a perfect response you lose valuable time. Time is of the essence. Learning to make speed the priority, to think in tranches, be visible, and worrying about how to pay for it later, is what he says he has learned from these crises response efforts. In the case of the coronavirus, some valuable time was lost becausee of the uncertainty and lack of early information, making speed and rapid comprehensive action very critical. The Spanish flu epidemic of 1918 infected over 500 million people worldwide and killed 50 million or more, including 675,000 in the U.S., according to the Centers for Disease Control and Prevention. During this epidemic the Chicago public health commissioner flatly opposed closing businesses, saying worry kills people more than the epidemic. A 2007 study shows cities that took that attitude saw higher death tolls in the Spanish flu epidemic of 1918. Philadelphia waited 16 days before restricting social gatherings, St Louis took just 2 days. The result: the daily death rate from the epidemic peaked at level five or more times higher in Philadelphia than in St. Louis. Social distancing was not much of an issue then as people worked in jobs that required less contact, such as farming, fishing and forestry, as well as other jobs that did not require that contact in large offices.   ...