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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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A scientist from the Robert Koch Institute in Germany will head a WHO team going to China to conduct research on the origins of the coronavirus.

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

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A 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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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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The impact of coronavirus deaths is higher for men with certain behaviours such as smoking and alcohol consumption. For infections it is not clear that the rate is much higher for men than women. The data from graphs provided by WSJ of global data from different countries shows a higher rate of infection for men in Italy, just about 52% in men in China, but a lower rate for men in South Korea and France. Some of the higher impact of coronavirus death can be explained by habits such as smoking in men- in China smoking for men is ten times that of women. In Italy over twice as many men smoke than women. Researchers say that the prevalence of the receptor that helps the new coronavirus enter human cells is higher in smokers. The other reason researchers say is higher alcohol consumption in men than women. China's data also show more men infected because most of the people in the labor trades such as construction and other work is done by men. This made them more exposed to the pathogen in the local market where the virus originated. ...

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How is it that Britain's regulatory agency approved the Pfizer vaccine before the U.S. FDA agency? This report in the NYT says FDA looks at the raw data. Britain's Medicine and Healthcare Products Regulatory Agency looks at the information provided by the company. It still does the testing batch by batch and has access to the data and looks at thousands of pages of data. What about the European Union? The European Union Medicines Agency meets on December 29. It takes days after it meets to get input of 27 countries so that vaccination cannot start till January. The U.S. president summoned the FDA to the White House to find out how soon the FDA could act. Both Britain and the U.S. are feeling the impact of the second wave of coronavirus.

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Delayed elective procedures and surgeries are a serious problem during the pandemic. To get some idea of the magnitude of the problem- Britain had 6 million on the waiting list for elective procedures at the end of October 2021. This is up 41% over March 2020 when the coronavirus was first detected, according to data collected from Britain's National Health Service. The same data show 300,000 were waiting for over 1 year compared to 3000 in March 2020.

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The most accurate study so far of what age groups get affected by coronavirus comes from the Office of National Statistics in Britain, showing that children are as likely to get infected as adults. Estimates in modeling created jointly by Public Health England and the Cambridge University show 18% of children in the data from 5  to 14 years age are infected by the virus in England, compared to 18% in the adults over 45 years age.  Across all age groups the modeling data found that there is no difference between age categories for infection by the coronavirus.

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

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The coronavirus variant surge has led to burnout for frontline medical workers in the US. It has been calamitous for the mental health of public health workers in the US. These are the data analysts, policy advisors and other workers in public health departments. Many have quit their job as reported here in The Guardian. A CDC survey of 26,000 public health workers in the US shows about half have problems of mental health. Public health workers have to face problems with elected officials as well as public resentment on issues such as vaccination.

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Studies that show coronavirus cases are just as prevalent in the younger age groups 15-34 years as with older Germans. One such study uses data from the Robert Koch Institute and published in Eurosurveillance, a journal on infectious diseases. In this study scientists conclude that relative risk (RR) for coronavirus for residents of Germany 15-34 years, and particularly 20-24 years, was noticeably higher than in all other age groups. This study also determined that similar patterns emerged in South Korea where 20-29 years old age group had the highest number of detected cases.

This DW.com report attributes this higher coronavirus cases in younger age groups to work in high contact jobs in service industries, and to greater use of public transport. Laxity early on in following social distancing guidelines is also mentioned as a cause. Other causes could be greater attendance in sports stadiums and music venues.

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The commissioner of the Food and Drug Administration 2017-2019 and the deputy medical director of its medical device center, give their thoughts on how to setup a sentinel surveillance system that would help tackle coronavirus and future epidemics. The idea is to track an outbreak in real time, with results sent to central labs so that outbreaks can be contained early and the surveillance operates to isolate affected areas for treatment and quarantine. High quality data from specific locations in real time and testing to isolate small pockets of infection, with rapid and reliable diagnostic tools are critical parts of this system.

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The third or booster dose of vaccine is needed to take out the Omicron variant. The UK Health Security Agency analyzed data from 581 Omicron cases and thousands of Delta cases to calculate how effective vaccines such as Pfizer and Astra Zeneca were against the Omicron variant. This early analysis shows a third booster dose prevents around 75% of people from getting any coronavirus symptoms. The double dose of the vaccine however provides good protection against severe coronavirus that needed hospital treatment says the UK Health Security Agency. Of equal concern is the rate of spread of the Omicron variant. Here this BBC report shows graphs of UK National Health Security Agency which show the rate of spread is rapid with cases doubling every 2-3 days. For the UK which on December 10 had about 1265 cases this means says this BBC report that the number of Omicron cases could be well above 100,000 in the UK by the end of December. The BBC graph shows the curve for Omicron cases moving in a close to vertical direction upwards. Reports say the experience in South Africa where the Omicron variant was first detected is similar in pattern causing rapid spread. ...

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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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When the coronavirus spread in China it was expected that Taiwan would be affected badly. Yet Taiwan has managed the situation in a number of ways that has limited cases to 50. Health experts attribute this to quick preparation and early intervention. After the 2002 and 2003 SARS epidemic Taiwan setup the National Health Command Center (NHCC) to combine resources for managing a health crisis. This was to prepare for the next crisis. Taiwan acted early imposing a ban on travel to China, Macau and Hong Kong, and a ban on the exporting of surgical masks to keep a stockpile in Taiwan.  Taiwanese government integrated data from national health insurance with immigration and customs data. A program was developed  that allowed people to report travel histories and symptoms by scanning a QR code when they arrive in Taiwan. Travelers receive a text message with their health status that allows customs officers to focus on the ones requiring attention. The public's willingness to follow government regulation is now much higher after the difficulties caused by the SARS crisis. This makes them willing to follow more readily action taken by the government, as SARS memory is still fresh in their minds. Investments in public health systems and in biomedical research is much further advanced than in other countries. A research team at Academia Sinica has developed antibodies that can identify the protein that causes coronavirus, The aim is to shorten the test time for diagnosis to 20 minutes. The lead researcher Yang says the next step is to validate it before turning out a rapid test kit. ...

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

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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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With coronavirus spread out over wide parts of each country and with so many people infected it is very difficult to do the contact tracing and isolation that was tried during the first wave. In Germany during the first wave efforts for contact tracing and isolation worked reasonably well. During the second wave in November things have changed. In Germany authorites do not know in November where 75% of the people testing positive for coronavirus got it. In Spain this figure is 93% for the last week of October. In France and Italy it is at 80%. In New York it is over 50%. Other problems are the increasing number of cases where the coronavirus is spread in an home setting, the lack of restaurant data collected on who visits, and the delay in getting test results. In Germany frequently people say they cannot remember where they were. Researchers from the German version of the FBI, the Pasteur Institute in France and the Koch Institute in Germany are getting involved in November to understand in what settings the virus spreads most. ...

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Two studies now show that it isn't that coronavirus just takes away the infirm or elderly who would have died anyway this year or the next. It is taking people away who still had over 10 years to live. Professor Biggs at the London School of Health Hygiene and Tropical Medicine says this is is what is happening from the study he is conducting.

A paper by Scotland based researchers published online by the Wellcome Trust a London based foundation found the average number of years of life lost to coronavirus for healthy adults is 14 for men and 12 for women. Using data from Italy and UK on the kind of long term conditions in the general population , the researchers found that for those suffering from common chronic illnesses and cancer including multiple conditions, the researchers found that people of this type lost about 10 years on average.

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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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Take a a look at the moving BBC chart  "How the coronavirus spread" to see the dizzying speed at which the virus spread in America. In the beginning of March there are only about 200 confirmed infection cases in the U.S., by April 7 the number skyrocketed to 379,000. The public health experts were right including Dr. Fauci and Dr Birx. Even these experts may have been astounded at the speed with which it has spread, and going through a very difficult time convincing others including the skeptical public about the great danger to America. China's quarantine of the entire country of about 1 billion people, Italy's experience and data freely available from Italian doctors to American doctors, were warnings of what lay ahead for America. 

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The head of the European Centres for Disease Control ECDC, Dr. Andrea Ammon, says the Delta variant of the coronavirus will make up 70% of all cases in Europe by early August, and 90% of all cases by the end of August. ECD modeling shows that there is a risk of another wave like the one after last summer in Europe. The Delta variant is much more infectious than the UK Alpha variant and the UK variant much more infectious than the original variant. A 50% reduction in non-pharmaceutical interventions such as allowing the staging of events would lead to an increase in infection in all age groups. Latest ECDC data show 34% of people in Europe fully vaccinated and 57% with one dose. One dose offers much less protection. Younger individuals have a lower vaccination rate and are vulnerable. Also vulnerable are the older people not vaccinated yet. About 40% of people over 60 are not yet vaccinated, and 30% of people over 80 years are not yet vaccinated in the European Union. As in the US vaccination varies by region within the EU. All these vulnerable groups can be affected in another wave of the coronavirus similar to after last summer when restrictions were removed. Dr. Ammon is a former advisor to the German government. She says it is important for young people who are not vaccinated to continue to follow the strict social distancing precautions.  This is not happening today as governments are relaxing mask mandates in Britain, France and Spain. Soccer games are coming back to fan filled stadiums increasing the risk. Tourist spots in Portugal and Greece are now looking similar to the vacation spots in Croatia that increased infections in Europe after summer 2020. ...