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 South Korea has run about 300,000 coronavirus tests, double that in Italy and ten times that in the U.S., says this report in the WSJ. This report shows how the South Korean testing works and the workday of Lee Hyuk-min, a clinical microbiologist at a testing lab of Yonsei University Health System Severance Hospital in Seoul, who is working from 4.45 am to 11 pm. South Korea's effectiveness in controlling the spread is based on a strategy of efficient testing that enables isolating quickly people and areas. South Korea's testing network is a legacy of the MERS coronavirus outbreak in 2015, and the government failure at that time to control it.  It brings together doctors, medical staff, labs, and political leaders in roles following the protocols established since then. Dr Lee and others are the final checkpoint in the system which coordinates a diagnostic operation that combines together 633 test sites and 100 labs. The protocol includes a uniform setup- same testing equipment, same training, same decision making process. At 8 am each day all labs upload results to a shared database, which allows public and private hospitals to monitor patient results and report them to Korea Centers for Disease Prevention and Control. Hospitals upload testing details to an online directory. This surveillance allows South Korea to predict where to concentrate its efforts for controlling spread, says Dr Lee who advises the South Korean government on lab testing issues. Action plan took 2 years for the new rules to be implemented following MERS in 2015. The plan included accelerated bio testing company approval for tests. The first company got approval on Feb 4, followed by 4 other firms. Dr Lee says testing is only part of the equation as labs are needed to process and confirm results. Another key is innovation. South Korea setup testing in drive thru locations, that limit contact and speed up testing, which the U.S. is adopting. Dr Lee says early identification is key, and identifying the first coronavirus patient which was done in South Korea on January 20. Other countries including the U.S. took too long to identify the first patient, says Dr. Lee. ...

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The head of South Korea's Disease Control committee says that patients with coronavirus can't relapse. About 277 patients tested positive after recovery. Looking at this the scientists found that there were harmless traces that were incorrectly detected by the RNA test which are not live so that patients are still in good health with no relapse. This is a very important bit of information for reopening different countries to modified normal life.

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

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South Korea has tested about 300,000 people for coronavirus. About 20,000 can be tested daily for coronavirus through 40 drive thru locations. South Korea invented this method of testing. Another feature of the South Korean method is the tracking down of people who have come into contact with those testing positive for coronavirus. The South Korean government is able to do this because it can access the credit card and cell phone information of people in the country. This is possible through laws that were passed after the failures during a previous epidemic of MERs. The government then tracks down and isolates the people who came into contact with infected persons. This includes people who show no symptoms, an important aspect of the South Korean program which needs to be adopted in other countries once the production of test kits and testing is ramped up. The reason is that about 30% of people who tested positive in South Korea were not showing any symptoms but acted as silent carriers. This is similar to the figures for people in the Wuhan region of China. This testing capability is one of South Korea's key strengths, though Germany's Robert Koch Institute says it has a similar capability to test 160,000 people a week. The U.S. has tested about 30,000 people by comparison. The U.S. government is procuring 60,000 test kits under the Defense Production Act. South Korea also enforces social distancing though a $2500 fine and a 1 year prison sentence. Germany now has a 2500 euros fine in some states for curfew violations.  By comparison the fine in Britain is insignificant.  Another difference between China and South Korea with Germany and the rest of Europe, the U.S., is that in China and South Korea self-isolation is monitored, tightening the control over coronavirus spread at every turn.   ...

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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 opening of bars and restaurants risks restarting the coronavirus epidemic in South Korea again after a 29 year old man visited 5 clubs and later tested positive. Contact tracing identified the man but similar cases in the Itaewon neighborhood have led to the conclusion that about one third of 5000 people believed to be involved in bars have not been traced. Over 50 cases have been traced to this one person alone. 

It is now believed that the entire South Korean efort could unravel with the mistakes of a few people. Now president Moon says "its not over till its over," and that it will be a long time before the coronavirus is ended completely. He warned a new wave of infections could happen anytime anywhere.

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A women's rights advocate, and mayor of Seoul, South Korea, and one who as a lawyer was active in defending women's rights against harassment, is found dead. This happened 2 days after a former secretary who joined his office in 2017 filed a complaint at a police precinct about sexual harassment. Park Won-Soon was mayor of Seoul since 2011 and led the fight against the coronavirus. He had also fought for civil rights with the ruling party leaders in the struggle against the dictatorship in the 1980's.  The city of Seoul was in shock after it became apparent that Park had killed himself. South Korean president Roh Moo-hyun took his life in 2009 after the state prosecutors began investigating corruption allegations against his family. Culture in South Korea and Japan is changing from a long history and tradition of male dominant society as women assert rights to equality under the law and fair treatment at work. This is an unusual twist to the story as Park was actually one of the people initiating and supporting constructive change, and is the reason it has led to mourning in South Korea for the loss of Park Won-Soon.  ...

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

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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 went wrong to get 100,000 deaths in the UK? A lot says this analysis in The Times. Don't need a big test and contact tracing effort was the early response, no quick decisions to build the infrastructure for this like South Korea or Taiwan. The Cheltenham Festival? Superspreader events a bad idea. Open Borders- another bad idea. After a break in the coronavirus weather by summer- relaxing vigilance and preventive steps, another bad idea. So on till a coronavirus variant stepped in through the open borders. You make your own luck, says this analysis in The Times of London.

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

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Merkel of Germany's approval rating for her handling of the coronavirus pandemic is up to 67%, in South Korea Moon won a landslide victory. In the U.S. Mr. Trump has 49% approval rating 6 points above his average. Boris Johnson in UK gets personal sympathy but his government's response is being questioned.

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India is joining Australia, New Zealand, Japan, South Korea, Britain, France, Russia, and many other countries in calling for an investigation by the World Health Organization into how the coronavirus crisis escalated into a pandemic with millions of cases and hundreds of thousands of deaths and how adequate the response of the WHO has been. 

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With better control over the coronavirus than U.S. and Europe, South Korea is not rushing to buy the vaccines developed by Pfizer or Moderna. It is waiting to see how the vaccine rollouts work in other countries before buying the vaccine. South Korea is also looking at getting better price from manufacturers after the rollouts in the U.S. and Europe. South Korea is moving cautiously and has said it wants to get 10 million doses through the Covax initiative the main global effort to provide broad access to vaccines. Another 20 million doses would be secured from private companies. This is in contrast to the approach in Japan where the government has signed deals for purchase of 290 million doses for 145 million people for its population of 126 million. The money allocated is $6.5 billion and the goal is to vaccinate everyone by first half of 2021.  If it works this would prepare Japan for the Tokyo Summer Olympics to open in July, after 1 year delay. South Korea has the freedom to do this and wait to see what vaccine works best with least long term effects because their are relatively fewer cases there. A total of 313 new daily cases on November 18, lower than daily cases in a single county in the state of Michigan in the U.S. Moderna and Pfizer vaccines use anew kind of gene based technology that has never been approved to prevent infectious diseases. Other competition is the vaccine from Oxford and Astra Zeneca which uses an existing technology that is used in existing vaccines modified for use in coronavirus. The Oxford vaccine and a vaccine from Johnson and Johnson are expected to have a lower price. Because life is functioning very close to normal South Korea is in the unusual position of saying that its people have no reason to be anxious for vaccine procurement, as indicated by its deputy director of Korea Disease Control and Prevention Agency. Only three fifths of the population is the target for vaccination by fall of 2021. ...

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The price of Brent crude oil drops 20% to $36.07 and global stock markets decline sharply. A price war between Saudi Arabia and Russia leads to the sharp drop in oil prices. The swing in oil prices and the increase in coronavirus cases in Italy, France, South Korea, and other countries leads to sharp decline in stock prices.

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Researchers at Beihang University and Tsinghua University in Beijing studied how temperatures and relative humidity affected the natural transmission of coronavirus in 100 cities across China, The looked at data on January 21, 22 and 23, before Chinese authorites stopped its spread. They calculated that the infection was more contagious in northern China, with temperatures and relative humidity low, than among the cities along China's warmer and more humid south east coast. Their conclusion- high temperature and high relative humidity significantly reduce the transmission of coronavirus. The researchers are funded by the National Natural Science Foundation of China. Researchers at the Institute of Virology, University of Maryland, have found that the consistently similar weather across the Northern Hemisphere between 30 degrees latitude and 50 degrees latitude north, running through China to South Korea, Japan, Iran, Italy, France, provides temperatures of between 5 and 11 degrees Celsius (41 to 51 degree Fahrenheit, with relative humidity between 44% to 84% and low specific and absolute humidity. The conditions in which the coronavirus thrives.  ...

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Two divergent approaches to the coronavirus are shown in this report in the WSJ. One in Italy which relies on quarantine and lockdown and mandatory social distancing, and the other on keeping borders open and aggressively tracking down the infected using data and testing. In South Korea infections have stabilized at 8000, and in Italy the are rising at 15,000. The divergent approaches and the results vary with the people's history, culture and recent experience. The cultural difference in Asian societies with people willing to cooperate and work together with health authorites for the social stability and good of the country is different from the more individualistic nature of western societies. In addition Italy has a long period of foreign rule of Hapsburgs nd French that has created an attitude of working around authority, the tendency to being furbo which prime minister Conte referred to in a nationwide address.  South Korea and Taiwan also have experience with the SARS and MERS virus during which public health regulations were instituted and comprehensive databases setup that are now being used to combat the new health crisis by tracking down people with health needs. The precedents have taught people in South Korea and Taiwan of how serious this kind of crisis can become, which was absent in Italy in the early stages. Both South Korea and Italy are democracies. The difference being that one has experience with public health crises from experience with SARS, MERS, H1N1, and has developed policy tools, broadened public support and increased state powers in anticipation of such crises. In South Korea there were fines of $8300 for those not willing to be treated and the government aggressively tracked down people. Public support and awareness also helped in controlling the situation. Taiwan has done better than South Korea as covered in a separate article in the WSJ, and shown here, controlling the situation from the beginning including shutting down flights from China early because of its close proximity to China.  ...

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The consensus in South Korean society about rules for tackling coronavirus surge are breaking down, because some groups are pushing for keeping the economy free of lockdown and some are pushing for stricter rules as the cases increase once again into the hundreds. Berlin had a big rally of right wing protesters last week showing that the consensus is fraying as tempers rise about the effects of the lockdown, as cases increase and the government is forced to restrict activity and gatherings.

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Coronavirus testing is being ramped up in the U.S. as the Food and Drug Administration new regulations allow commercial labs to manufacture and distribute  coronavirus tests. Now many players can now acquire and conduct tests including state and local governments, hospitals, universities, and private companies. so that tracking nationwide distribution is still difficult. Deborah Brx the response coordinator of the White House task force on coronavirus says U.S. has completed 220,000 tests in last 8 days.  In New York the scaled up efforts in a region with over half the coronavirus cases in the U.S., 13,000 were tested on Monday, March 23. Some hospitals in New York such as Mount Sinai expect to do double or triple the tests a day in a scaling up effort by March 30. In Los Angeles a city councilman negotiated with a South Korean company for delivery of 100,000 tests a week, having already secured 20,000 new tests. Additionally swabs and protective equipment are also needed to conduct tests and labs need to process results with speed. ...

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Germany has shown that low tech contact tracing efforts work- no apps needed, a phone, a desktop computer with a centralized database, and most important the human relations skills of the person doing the calls. The  sensitivity to the situation facing each person being called, being able to talk to the person in the language they speak in a multilingual environment such as California, is shown here. A 40 person team operates in San Francisco consisting of public health officials, clinicians, medical students and librarians. They call the contacts of people with coronavirus, arrange tests, and as needed send packages of food and medicines to hotel rooms or homes. Every call is expected to last 15 minutes but all sorts of questions are handled.  English and Spanish are used. Here one of the persons doing the contact tracing says she does not use apps, just an open source software used in the fight against Ebola. Definitely low tech, no waiting, get going is the message to every city in the world. She says apps software such as what Google and Apple are putting out can tell you whether the person went to some place, but cannot tell you more about that person, cannot tell you about problems the person is having being tested, and how they are having difficulty providing for families. One of the big lessons from Germany and efforts such as this one in San Francisco, and in other places such as Paris, Singapore, Taiwan, is that there is a complex nature to contact tracing that cannot be solved by tech. In fact the best thing to do is to get started immediately, with a phone and a database on a computer, as long as you have a person who has the motivation and skills, empathy with people, a lot can be done. Waiting for apps is a dangerous waste of time is shown by the low tech German experience, and the experience in other places. Most important is starting immediately. The example shown here of working with migrant workers in contact tracing shows in the most vulnerable places it is these human relations skills that count, that no tech app can do. It requires detective skills to find out and get people to share their history of movements and contacts for 14 days . In Singapore crowded dormitories house 300,000 of 1.4 million migrant workers. Singapore using an app also but its use is secondary. Apps don't work in many situations but fail in the most critical situations such as these dormitories and other eccentric or atypical situations such as faced by South Korea with religious groups and gay communities, elderly people in Europe, that generate the worst dangers of spread and need to be cluster isolated quickly. Human contact tracing has a history of being an effective method and was used in China and South Korea during the 2003 SARS epidemic. More countries need to adopt the method used in Asia and in Germany, particularly Britain, the U.S., France and India. It is OK that Britain's NHS and India's national government with Aarogya Setu app have put out their own apps which balance privacy concerns with the need to act immediately and cover the entire country, but the hard slog of human contact tracing teams in each district is indispensable. This is why the former Health minister in Britain calls it Britain's national mission to do this. Speed is key- putting together teams across the country in every district from skilled volunteers or government workers, and pulling together the phone and a centralized database on a computer as basic equipment. The fact that this is easily doable and people with human skills needed can always be recruited as they have been in Germany- from public officials in local government who are less busy in lockdowns, medical students, clinicians, volunteers, people from different professions- makes it inexcusable not to learn from others experience and get going. Just Do It. You want to reopen business, professions, offices and public services- Just Do It, it makes this possible. You want to prevent spread of the virus- Just Do It, it makes this possible. You want to limit damage to the economy and get the recovery going- Just Do It, it makes this possible. People of all shades of opinion can agree on this- its the only thing that works, even when there is a lack of enough proper accurate testing. ...