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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. ...

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Contact tracing apps in the U.S. Britain and France have failed. Contact tracing app in Germany was downloaded 12 million times in the first week. Yet much of the contact tracing in Germany and cluster isolation has been achieved using low tech methods- using a computer with database, and teams of people in district offices all over Germany calling people.

The NHS App in Britain failed to get the cooperation of Apple. In the U.S. Google and Apple planned to have a contact tracing app ready but failed to come up with one. Tech has failed to come up with solutions during coronavirus and low tech solutions have worked well as in Germany and in places such as Kerala, India, when implemented quickly with very little delay.

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The use of apps and tech based solutions have been largely ineffective in doing effective contact tracing and testing to isolate people with coronavirus. Epidemiologists question its effectiveness when it does not lead to people isolating themselves to prevent spread.  A major problem is lack of confidence in the tech based solutions. 27 states in the U.S. have no apps or are not developing one.  Apps do not use the entire set of tech resources available because of dilution from concerns about privacy. Another major problem is that there is no national approach. California, Washington and Oregon have a pilot program on the Google-Apple system, Delaware and Pennsylvania launched an app in September from Irish developer NearForm. New York and New Jersey started with a NearForm app in October. States using apps are doing this without much conviction that this is a tool that will work to do effective contact tracing and testing to isolate infected persons. For this reason one sees pilots and launches this late in the coronavirus pandemic. Early efforts stumbled.  The UK and French apps also proved ineffective. Germany opted for low tech solution that proved surprisingly effective in the first wave of the coronavirus. Germany relied on teams from state employees which used a national database, personal computers and phones to call individuals who needed to be isolated and tracked. Asian countries have less concern for privacy leading to apps being more effective. Even here low tech solutions with national database and teams of people with personal computers and phones calling and making personal contact including visiting homes has worked better than apps. Human relations skills to reassure people affected by coronavirus, legwork to contact personally at homes and check up, and persuasion to have people isolate have been more effective than app based impersonal tech solutions. ...

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

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The UK government's chief scientific adviser, Sir Patrick Vallance, says coronavirus testing has not been scaled quickly enough. Public health experts warn that Downing Street is in the position to face "an unforgiving reckoning." The UK has done 5400 tests per million population, the U.S. 8894 tests per million, and Germany 15,700 per million, according to data from Worldometer website. UK got off to a slow start.  Experts at Imperial College, London, say a major problem is the lack of contact trace, test, isolate. Contact tracing having fallen behind. The government is relying too much they say on an app from Google and Apple to do the tracing because for this kind of work humans are needed, "boots on the ground" are needed. South Korea and Taiwan have successfully used people to do the contact tracing by using access to cellphone carrier data that was made possible from protocols established in earlier MERS crisis. ...

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As the pandemic continues to spread and numbers grow with reopening of the economy the question remains -what can we learn from other countries positive experience in controlling spread? Here the Times provides the example of German contact tracing- chancellor Merkel has emphasized that a lot depends on "total" contact tracing, and contact tracing "above all else." Germany's experience is that even if you don't get everything right, you make an honest effort with everything you've got and do it early it makes a real difference. Some of the offices across Germany are stretched and short of staff but they have been working since the beginning of March, sometimes in the early days 7 days a week. Only 33% or one third of the offices throughout Germany for contact tracing have the required 5 person team for every 20,000 people, and 35% are overstretched or at their limit, according to one survey. No apps, just a low tech effort with people from the state administrations who were not working during lockdown trying doing something else, or volunteers. Mainly using the phone, talking to people and tracing the contact chain of people testing positive. Putting this information on the computer with a central database.  The Berlin office has 115 workers and has tracked down every one of 666 virus cases it was given. Because of privacy concerns at the Munich office sometimes even the patient's name is not given and office staff have to locate the name and the person. It requires dedication, flexibility and above all resilience, says Harold Rau, the deputy Mayor of the Cologne office, cited in this Times report. The doctor alerts the local office with a test result. The office calls the person and finds out who he has been in contact with for the last 14 days. Then the people who were in contact with are grouped based on the directness of contact, face to face, so on. These people are asked to quarantine for 14 days, sometimes with the rest of their household. They get daily call to find out how their doing for symptoms. The effort goes back to Robert Koch in the 1892 cholera epidemic in Hamburg. Robert Koch, microbe hunter in Germany, was called in after the epidemic spread from Moscow. It devastated Moscow and Tokyo, but Hamburg suffered far less about 8605 deaths as a result of the contact tracing and strict closing off quarantining of affected chains after isolating them, closing off affected parts of the city. Bit by bit the cholera epidemics sparks were put out before turning into flames, says Koch. In the current pandemic Germany has suffered 8241 deaths and 178,000 confirmed cases. So far this is in line with the cholera epidemic in Hamburg 1892, and this for all of Germany. And it is not just affluent nations that can do this. where there is a will there is a way. In Kerala state in southwestern India, similar efforts have worked to limit spread  with even better results than Germany. ...

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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? ...