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France has made the health pass for coronavirus mandatory for leisure and cultural venues starting July 21. The health pass will be mandatory for having a coffee, eating at a restaurant, or shopping in a mall from the beginning of August. The health pass is already in use in some form in many European Union countries. Denmark and Austria are using it for 2 months. Germany and Portugal are using it regionally depending on where the epidemic is severe. Greece which has a surge of tourism in summer from other EU countries is making it mandatory starting July 16 for entry into shops and restaurants. It was the absence of  any form of constraints on behavior in places such as Croatia with high tourism in summer that increased the surge in Germany and Austria last summer. Italy and Ireland are planning to make vaccination mandatory following France as the number of cases from the variants increase. Establishments that are violators of the mandatory rule in France will be fined 45,000 euros and persons responsible having to spend 1 year in prison. The mandatory rule has significantly increased the number of people seeking vaccination in France.      ...

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A look at countries in Europe shows different strategies for tackling coronavirus Delta variant as schools reopen in September 2021. Italy requires all teachers to carry a covid digital certificate that shows vaccination or PCR test results. France, Germany and Spain do not require vaccination for teachers to go to schools, and rely mostly on social distancing and mask requirements in schools. Britain not only does not require vaccination digital certificate, but also has not made masks and social distancing mandatory. Health experts say there are serious risks in this approach with mass return to schools and offices after August 2021, and the fall weather with more time indoors. This could lead to a surge in coronavirus as in the US where the reopening of schools and Delta variant has led to surge particularly in states such as Texas, Florida, California. In UK 65% of total population is now fully vaccinated, in Italy 62%. Teachers in Italy fully support the new rules. In Lombardy region with Milan as the capital, only 300 out of 300,000 workers returned to schools without the green pass, according to regional officials. Britain remains an outlier says this report in the WSJ, taking more risks than is proper at this time, and simply hoping for the best. Not the best strategy in this situation.   ...

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Tory MP's rebels in the southern part of England are opposed to prime minister Boris Johnson's second lockdown for the whole of England. This report in The Times of London looks at how Johnson's conservative government might have to get Labor party support to pass the lockdown measures in parliament. Or Labor may decide to abstain from the vote. Mr. Gove says the NHS risks being overwhelmed if the lockdown does not take place. Responding to the statements that southern England does not have high or has falling rates of coronavirus Mr. Johnson says it has been shown that a low rate catches up in one area when it is next to a high rate area for coronavirus so that the result is the spread of the virus to the point where the NHS cannot cope.  The NHS like the French health system and other health systems in the European Union, U.S.  India, and other countries are strained to the limit. Most healt care workers in hospitals have felt severe strain on themselves and their families during the first wave. Most are exhausted and are in a situation of fatigue with the added factor of some healthcare workers on leave from the virus illness. This puts additional burdens on the system. Without the action taken the health system may be overwhelmed in many countries leading to disaster.   ...

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Efforts by the Physiology Society and Centre for Ageing Better (CAB), Make Movement Your Mission, and other groups in Britain to launch a national public health campaign. This effort is designed to get older people to exercize and form the contact with others that helps physical and mental health during the coronavirus restrictions and lockdown. It is a campaign for public health resilience.

Medical experts warn that lack of activity even for a few days can build up into negative effects on muscle mass. Three "snack sized" breaks of exercize for 20 minutes each day are suggested as well as super bubbles of 4 people, and guidance on nutrition, mental well being.

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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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Some local governments in China are making vaccination mandatory. China is setting a goal of getting 64%  of the population fully vaccinated by the end of 2021. In European Union countries mandatory vaccination by country or region is now being put in place to fight new coronavirus variants that spread faster in the population. The reopening of economy, business and tourism is increasing the risk from variants in summer 2021. The mandatory vaccination is a way to increase the percentage of the population that is vaccinated. Getting younger people who lag behind to get vaccinated is important to protect the percentage of the elderly population that is still not vaccinated. There are risks also to the younger population as seen in previous waves of the pandemic. The initial hesitation to make health pass showing a person is vaccinated mandatory was because only a small fraction of the population was vaccinated in Europe. Now that over 50% are vaccinated in most EU countries and UK, that hesitation thinking that it is discriminatory to those people who did not have access to vaccines no longer exists. Ample vaccine supplies and the misinformation spread about vaccines are making action on health pass necessary to protect the overall population. National governments in France, Denmark, Austria, Greece, and local governments in Germany, Portugal and other EU countries such as Ireland, Italy, see the danger from coronavirus variants that spread quickly as too big to take any risks a second time. ...

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Years of poor funding of public health departments in the US, Europe, and other countries have left public health departments lacking basics, lacking staff and resources. Here the WSJ shows how this has affected Alabama in the southern US. Alabama has the slowest vaccination program in the US with 10,000 doses given per 100,000 population. Positivity rate is very high at 29.1% for coronavirus, one of the highest for positive coronavirus tests in US in the past month of  Jan. 2021.

A large portion of the population of Alabama lives in rural areas. These rural areas are some of the worst hit in healthcare in the US. Since 2009 7 hospitals have closed in Alabama resulting from poverty of patient populations and population loss. This is part of the general erosion of rural healthcare infrastructure across the US in the last 20 years. A problem that now faces the Biden and future administrations. to tackle the problems of rural US communities.

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India has done well with low cost, scalable, low tech solutions in the past. This is also being done now to tackle the coronavirus. This is being used to support what may be the largest lockdown in history. Everyone is expected to remain at home. Only shops selling essential items such as food and pharmaceuticals are allowed to remain open. All but essential offices are closed, with workers told to stay home. Indelible ink that takes two weeks to wash away was widely available following the election. It is being widely used with high numbers of infections having the back of their hand stamped "Home Quarantined." After India announced a nationwide lockdown all wireless carriers were asked by the government to  insert a taped coronavirus health advisory that comes on after callers dial and before the call connects.Th recorded message talks about how to protect against the coronavirus. Prime time news shows are interrupted three times a day for back to back news conferences from the prime minister, and local officials.   ...

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The mistakes  and the right action done in Italy that the world can learn from as Italy tackles the coronavirus. The coronavirus is a dangerous pandemic yet there is one part of it that can be used to take the right action. The timeline of countries affected early in January and February and early March with information from these countries on what worked very effectively and what did not work with bad results is available. The mistakes were made in Bergamo, a town in Lombardy region of northern Italy with the highest number of infections and deaths in Italy. Bergamo had limited testing, no rigorous attitude for quarantining those who had come in contact with people testing positive, and lack of contact tracing. In Vo another town in northern Italy the situation is a complete contrast with resort to mass testing and isolation of clusters which has reduced infections to zero and made it a safe place. Vo is a small rural town 85 miles east of Bergamo in the Veneto region. This was the method used in South Korea, China, Taiwan and other Asian countries that have overcome the virus. Bergamo is an example of what failed in Italy with the worst number of fatalities. The health crisis worldwide has shown this  method of first general quarantine to buy time to build capabilities for testing  and preventing things spiralling out of control,  then mass testing, contact tracing and isolating the people who test positive, and repeating this process again and again till infections are way down,  is the only way to control this crisis. In the early days massive quarantine or stay at home strictly enforced is the best solution till production of tests accelerates to permit mass testing and isolating the clusters of infections. This mass quarantine buys time for accelerated production of tests and building up the capabilities of labs to process these tests, including use of a central national lab centre with national data on computers for microbiologists to monitor the entire country. This was done in South Korea reports in WSJ show. This is vital for everyone involved in the effort to control the virus to understand based on the experience of  countries that have successfully overcome coronavirus. It is the experience in South Korea and Italy that the U.S. White House response coordinator Dr. Brx is looking at and learning from as she and the White House team in the U.S., governors of all 51 states, health officials including CDC, are looking at as they execute their action plan in phases.  ...

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Lessons can be learned about careful reopening in fighting the coronavirus from other countries. Here the Netherlands experienced a rise of cases by 500% within two weeks of reopening after some poor decisions. The Mark Rutte government decided to open all bars and nightclubs resulting in a twelve fold surge in these locations in one week. Most of the new coronavirus cases were in people 18-29. Data from Dutch public health institute shows 4 out of 10 new cases linked to bars and nightclubs with 262% surge in cases for young people 18-24 years. This goes to show that with the vaccination drive what we see is the cases shifting to younger people, the unvaccinated, and to activities like nightlife. People going to work, or doing hybrid remote work with trips to the office, workers in factories, people doing essential shopping, are not causing the rise in cases. Much can be learned from these examples in working out reopening that does not lead to new crises with surging cases in new waves of coronavirus. Earlier in 2020 summer tourists who ignored mask and social distancing restrictions in Croatia brought on a post summer coronavirus wave to Germany and Austria. This time Greece and Portugal are introducing restrictions. Greece plans to make vaccine health pass required effective July 21 to go into restaurants. Another lesson from Netherlands this week is that a 20,000 person music event of 2 days in Utrecht where QR codes were required showing vaccination or PCR tests failed. About 1000 cases were attributed to the Utrecht event alone. Reasons given are that people faked the QR codes, or that the covid testing system produced too many false results as much as 20%. The same QR code system was followed at nightclubs resulting in big problems. One can never be sure that things work as expected and the risks are great as this adds up. Even vaccines offer limited protection and only if fully vaccinated depending on the type of vaccine. One dose of the vaccine is simply inadequate, and obesity, other morbidities can lead to problems. Withdrawing the mandatory use of face masks in most situations is also a risky decision of the Dutch government. Face masks offer the added protection at a time of variants that spread quckly, and when large parts of the population have only one dose of the vaccine, some elderly are still not vaccinated, and young people have not been vaccinated in large numbers. ...

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Viewing people as "pass throughs for units of fiscal stimulus" that is no longer an option, no longer wise, no longer possible. Brian Deese, US president Biden's economic adviser, uses this sentence as he describes the approach of president Biden in putting together a $2 trillion plan to invest in infrastructure and in the people of America. He compares 2009 to 2021 and talks about the differences then and now after the pandemic. The coronavirus pandemic exposed all the weak spots in the American fabric and society and in the way national life was organized. Today the pain is felt in socio economic groups throughout the country.    US president Biden wants to make a decisive impact with large investments in infrastructure, education, health and jobs. In American manufacturing competitiveness and in America's technological advancement. The investments made in 2009 were in simple recovery mode, this time the investments are intended to bring America back to its position in the world after 1945, the hope and the optimism for a better future. ...

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Young people are the major source of transmission of coronavirus in the US with school sports as a major cause. Michigan, New York, Florida, New Jersey, Pennsylvania, makeup 42% of cases on April 11. Adults ages 20 to 39 are affected the most in Michigan. With cases for children under 19 quadrupling from a month ago. 301 reported school outbreaks in Michigan alone. A big problem is that the spread of the variant B.1.1.7  from the UK started in clusters earlier in February. It now has spread to the general population. India has seen a surge in the past 5 days and public health officials are learning from this experience in Europe and the US. The focus  should be on micro containment zones, prime minister Modi told state chief ministers in a virtual meeting on April 10, with screening, testing, tracking, and that health officials should not let higher numbers affect their persistent effort to screen, test and track as with the unceasing effort the results will come. ...

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Addressing the UN General Assembly in a virtual setting Mr. Trump tells delegates that China should be held accountable for certain actions in letting the coronavirus pandemic spread. He included the denial by China of human to human transmission very early before Feb-March, and its allowing Chinese flights to go overseas when it had completely banned flights domestically. He said flights were allowed to leave China after the virus spread from Wuhan even after Mr. Trump banned flights from China to the U.S. This spread the virus from China to Europe and to America.  Mr. Trump says the WHO is controlled by China. And this happened after foundations such as the Bill and Melinda Gates foundation and other foundations partly replaced the strong role played by the U.S. government at the world health agency during the post war period maintaining strong U.S. and European oversight in the earlier period. The lack of cooperation by China to let American experts into Wuhan immediately in January played a role in delaying the U.S. getting a first hand look at the coronavirus at the epicentre. Instead a 2-3 week delay left the U.S. Europe and India unprepared for the speed and havoc caused.  The only way to tackle the coronavirus was with speed and that speedy response was doubly needed because Europe and the U.S. had no recent experience with epidemics. Even India and rest of Asia, Latin America, Africa have no experience with this type of transmission and spread making time absolutely critical.  This speed was affected because China and the WHO acted as stumbling blocks in this view of what happened. The result was that in past pandemics were fought together, this pandemic was fought on a country by country basis, a bad precedent. ...

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People have to take charge of their own lives by eating healthy food and lots of fruits and vegetables, to reduce obesity in this pandemic. Studies show that people with obesity were twice as likely to end up in hospital, and 74% more likely to end up in intensive care. Efforts to rid our diets of sugary drinks and junk or processed foods need to be escalated, and exercize, walking, cycling, other activity need to be made part of our daily activity. This needs to be taken up as a fight for life, a war against decades of neglect and reckless behaviour in eating habits.  Even vaccines will not work well when body mass index BMI is over 30. Obesity has reached unbelievable and scary levels - 66% in the UK, U.S., high in the Middle East, and increasing all over the world. Added risk is high smoking levels in China and India. Coca Cola takes the place of water in parts of Mexico where obesity is high and Mexico has suffered from high coronavirus cases. ...

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Beijing residents say they began to relax in wearing masks or not wearing them, not wearing masks properly, after 8 weeks with no cases. A vegetable and fruits wholesale market in Beijing, in southwestern district of Fengtai,  which supplies 80% of the fruits and vegetables to Beijing's 21 million people is now seen by health authorites in Beijing as the source of a new outbreak. 79 new cases are traced back to this market on June 15.  In Beijing restaurants and shops had reopened. Primary schools and other schools had reopened. Public health experts are looking at the possibility that the source is a cutting board for frozen salmon imported from overseas possibly Europe-. because of the DNA sequencing of the virus experts say. Contaminated seafood or meat is suspected as a source. China's CDC says the virus can survive on frozen meat or seafood for 3 months. Just when this new cluster was detected in Beijing, the city of Wuhan the origin city of the virus is permitting indoor sports and entertainment facilities reopen, and this WSJ report says Wuhan is making masks no longer mandatory outdoors. Beijing authorites have responded with mass testing, and contact tracing through neighborhood committees. About 100,000 people are organized by neighborhood committees to visit the city's 7000 residential compounds for contact tracing to identify people who visited the market and get them to test for coronavirus. This is the typical response in China to get large numbers of low level officials, workers and volunteers mobilized for contact tracing and testing. By June 14 about 76,000 people were tested - of this 13,000 are from the 29,000 who visited the market since May 30, according to Beijing government statistics. ...

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The World Trade Organization is about to choose a new director-general to succeed Mr. Azevedo, a career diplomat from Brazil. The two candidates are a former finance minister from Nigeria,  Ms. Okonjo-Iweala supported by the European Union and the trade minister of South Korea, Ms. Yoo Myung-hee, supported by the U.S. Japan supports the Nigerian candidate because of its trade disputes with South Korea. The role of head of WTO is important today because of trade issues between countries particularly the trade issues between China and the U.S., U.S. and other countries. And the sense that the WTO arrangement is not working for many countries in recent years without a level playing field in many industries from improper subsidies. Before the U.S. withdrawal from the World Health Organization not much attention was given by the U.S. to how it had changed after new elections. As a result non profit foundations like the Gates Foundation from the U.S. played a leading part in representation of American interests and China played a leading role leading to the crisis facing WHO today. During the coronavirus pandemic the WHO lacking adequate influence of U.S. or European Union countries was not able to act in a way that met the needs and concerns of these countries with advanced health systems. In the past pandemics were better addressed worldwide when the U.S. and EU played a major role from the beginning because of long experience and technological resources,  a role that was missing in the current pandemic. Ebola and other virus were tackled in Africa only when the U.S. or European countries played a leading and critical role. This role was sorely missed in the current crisis. This is why changes at the World Trade Organization matter. World trade is important for the world economy and can best operate when the concerns of U.S. and European Union about a level playing field and fair competition are met. This level playing field and fair competition also meet the interests of developing countries such as India which are industrializing rapidly and need to protect their own markets from unfair dumping, as well as Indonesia and other parts of Asia, Latin America and Africa that are part of the supply chain for the world economy. ...

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The treaty of handover by Britain of Hong Kong under one country, two systems was flawed in the way it was negotiated. French commentators looking at the problem say the city is caught between its past in the British Empire and the new monolithic state that China represents. Under the British French visitors looked at the city and wondered how there was freedom but no democracy, people were just selfishly just interested in making money. Chris Patten, Britain's administrator of the territory tried but failed to get democratic process, During the negotiations in 1984 for handover the chief British negotiator, Percy Cradock, a former ambassador to China, tells the Australian Broadcasting Corporation that - In Hong Kong where there is such a disparity in strength between the two sides, you go for the best you can get, I take the simple view that half a loaf is better than no bread." Britain had very little leverage to secure a separate future for Hong Kong because it was small compared to much larger China resulting unequal negotiations. The same is true today as the best Britain could do is to get out a joint declaration with Australia and Canada saying that it did not approve the new security law, that it violated the treaty signed by Britain and China. The French view expressed by the editor of La Croix is that hasty poorly planned British exits- as happened in British India -have led to crises and conflicts for postcolonial generations, a legacy of British colonial rule. India and Pakistan still sorting out Kashmir, and India and China still fighting about the McMahon Line border area. The situation is very different for the U.S. which now has to respond in some way, and this comes as trade tensions and coronavirus tensions about its origins in China and the failure of Beijing to allow quick entry for an American team into Wuhan. This being for 7 weeks between Jan 6 request and February 16 permission. America sees this as losing 7 precious weeks to make up its own determination of the dangers when every week health experts say means saving or losing tens of thousands of lives. With loss of 100,000 lives the Trump administration has a sense of being misled. This French report in FR24 points out that the lack of a strong response from the U.S. would be something similar to letting the Berlin Wall happen without a response. Both sides in a situation where the territory of Hong Kong remained mostly about money and with a disproportionate influence of business interests similar to its founding under the unequal treaties of the 1850's. ...

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India has learned lessons from past health epidemics- the plague Gujarat 1994, avian flu H5N1 in 2005-2006 Maharashtra, Madhya Pradesh, swine flu H1N1 Pune, and more recently MERS. The Indian Express looks at past epidemics, how they were tackled and what India learned from them. Major improvements in sanitation and hygiene since then and advances in medicine, public health.  Experience was gained. The municipal commissioner of Thane near Mumbai was district collector of Jalgaon during the avian flu epidemic. He used quarantine to restrict transmission of infected material. He shifted bus stands, closed weekly markets, and had health workers check symptoms in a 3 kilometre radius area. His message for today- have a contingency plan, track, test and treat people, stay focused, not panic, and know exactly what has to be done. Moving migrant crisis today was also seen in Surat, 1994, with the plague epidemic when migrant workers left the city. The government had to use paramilitary units in 1994 to quarantine the entire area. During these earlier epidemics the Indian Council of Medical Research and other medical organizations played a significant role. One of the lessons learned from the H1N1 epidemic that originated in Mexico was the need for effective surveillance and real time reporting so that the pathogen can be recognized in real time and tests done at labs to determine what it is, followed by effective response through isolation of region and patients. Dr. Pradeep Awate, Maharashtra's surveillance officer, says robust surveillance systems are important to understand the magnitude of the problem and strategically place resources. The strategies put in place for the Nipah virus in Kerala state by its Health Department in 2019 are the same ones now being used for cornonavirus - contact tracing and management of persons under quarantine. ...

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The coronavirus pandemic and the disaster in nursing homes, the chaotic conditions in the first wave, the lack of staff and poor attention to residents during the pandemic, has exposed the major weakness of nursing home care in western countries. Much of this sector is in the hands of private operators seeking a profit.  The staff is paid low wages and lacks the experience and empathy needed for care of older people. During a virus all these factors turn deadly. With some staff sick the other staff is overburdened. If the sick turn up for work they are likely to risk the safety of other staff and the residents. With the incubation period lack of testing there is no way to know. When deaths occur and the nursing homes are sealed from the outside world the deaths happen with no goodbyes as happened in U.S., Britain and Sweden. This has exposed the scandalous and shocking way in which the elderly are treated in today's environment where ridiculous amounts of money are being spent on other things and the the most basic "one's parents" are neglected and allowed to die in horrific manner in a pandemic. The new trend for home care for the elderly is a welcome trend and long overdue as one of the worst aspects of the system in the west is the treatment of elderly parents in nursing homes run for profit. The new technology tools available for monitoring a elderly person at home, and the help of stores such as Best Buy which are serving elderly at home, is making this more and more a choice for the elderly. Even older patients and ones needing significant care can recover and spend time at home in a better environment, a less costly one, as hospital managers and families have learned in 2020. Some hospitals in the U.S. say they never want to go back. That the drive to get every patient home who can be home is the right one for patients and families and for the government paying for the care so that dollars are well spent in quality of care. Home health care companies are working on providing new services for sicker patients recovering at home. Technology helps do better monitoring. Medicare now pays for digital doctor visits and intense hospital type care at home after coronavirus showed this as vitally needed.  Both the Biden and Trump administrations are firmly focused on this issue. Seema Verma as head of Medicare is clear about the need for a national conversation on how we take care of the elderly, of our parents. And Mr. Biden wants to spend $450 billon to make certain that people who need long term care can get the support they need in the home and the community. This report looks at the home health care companies and how they are improving their services. This and telemedicine are two of the major constructive changes coming out of the pandemic, clearing out some of the worst aspects of the old system of living the older years in the western world.  Nothing speaks more about humanity and a human world than the story here of Savanna Hollar, 90 years old and almost blind. She broke her shoulder in August, Her sons decided not to send her to a the rehab facility she went to after a broken hip 3 years earlier. The sons brought her home to recover in the farmhouse near Yadkinville, N.C., where she has lived since 1951. One of her sons himself 63 years says that at a nursing home she would be lonely, scared and afraid to move. The sons hired two people to help her during the day and a rotating system was used for having people help her. At home Mrs. Hollar could enjoy her gray cat, Buddy, her favorite recliner and tomato sandwiches made with produce from her garden. Really, if we can't do this much what good is the U.S.A.? or Britain? or Sweden? or India? ...