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A draft decree in the prime minister's office shows a plan to place quarantine covering the Lombardy region of Italy and nearby provinces, including the cities of Milan, Venice and Modena. The population in this region of 10 million people will face restrictions on mobility. The draft decree says transit in and out of the quarantine zones will be granted only in the event of "grave situations." It urges people to stay inside their homes and not travel. A similar quarantine in China around the Wuhan region helped limit the spread of coronavirus and bring it under control. Today the worst hit and not yet under control are Iran and Italy.

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France and Italy are imposing strict rules for their lockdown and tougher enforcement to control spread of coronavirus. India has imposed a quarantine, a total ban on leaving the home with a televised address by prime minister Modi that set a 21 day lockdown period. Modi said "if the pandemic cannot be managed in 21 days it would set India back by 21 years." 

Fines of $3000 euros are imposed in Italy and cars seized by the police. A special form has to filled out in Italy showing where one is going and checked by police if leaving the home. In France one needs an Affidavit of Movement by Special Dispensation is a filled form required for everyone outside the home. All open air markets are closed in France and drones are used to warn people outside.

All domestic and international flights in India are stopped. All domestic passenger trains and bus services in India are also stopped.

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In an effort to take decisive action early the quarantine is extended from Lombardy to the whole of Italy. Travel is restricted to places where people live. Italy has suspended payment of bills, taxes and mortgages. All open air assembly and sporting events are banned. Italy's quarantine is similar to the quarantine in Hubei province China, where cases have dropped sharply showing that it worked in China. Italy is also setting aside 10 billion euros for the effort to contain the coronavirus crisis and mitigate the economic impact.

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China has used the experience gained from an earlier SARS outbreak to tackle the virus outbreak in 2019 which started at a food market in Wuhan. Early detection, strict quarantines, and other measures, were taken. A viral pneumonia outbreak happened in Wuhan, a city of 19 million. 59 people were quarantined and the largest food and seafood market in Wuhan was shut down quickly. Between the first case on December 12 to the detection of the new strain of coronavirus in 1 month, China acted with speed, showing China's strength in public health resources and research labs.

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The lessons from Italy, the epicenter now of the coronavirus pandemic, are clear- act early and decisively, impose quarantines and lockdown quickly to prevent intermingling. These steps need to be put early, with absolute clarity, and strictly enforced. This report in the NYT shows how decisive action early is the only way to prevent the crisis from becoming a large one that threatens the health system and millions. German states such as Bavaria and others now have a $25,000 euro and some have jail time. Singapore has jail time and fines for violating the stay home quarantine orders which it imposes after contact tracing. Taiwan has similar measures. Enforcement and strict control are part of the tools that have worked in these places and in China, South Korea.  Britain has still to close flights from Iran, Italy, which The Times reports on March 20 are still landing at Heathrow. This is after the U.S. weeks earlier banned flights from China, Iran, Italy, and last week from Europe after EU nations failed to take action early.  ...

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A NYT video simulation that shows how early action is critical with decisive steps for quarantine and lockdown with enforcement, to control the spread of coronavirus. It shows the spread along a timeline of the coronavirus in the U.S.

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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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China has used the quarantine and strict measures to contain the coronavirus. After being taken by surprise in the way the coronavirus developed in Wuhan region China shifted to large scale containment and quarantine. To do this China used technology, mobile carrier information, volunteers going from door to door and enforced quarantine action. Other countries in Europe, including Italy, are adopting measures such as quarantine and appeals to the public for cooperative behaviours.

The entire approach is new yet shows how government and citizens can work together to contain epidemics of this kind in the modern world of urbanized areas and close contact in subways, streets, and stadiums. The approach in democratic countries may vary from China yet essentially strong bold action has proved to be the way to go, not vacillating and acting one step at a time till things are out of control. 

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This analysis from The Times of London provides critical information on the strategy for successfully tackling the coronavirus following the example of South Korea and progress in Britain.

The random community testing is key to getting an idea of the scale of infections in the community at large. The critical ratio called reproduction ratio tell one if the virus is under control and how lockdowns can be lifted. For Britain this 0.7 estimated by Imperial College. It has a 2 week lag. 1.0 or close to 1.0 is not good. Germany after being at about 0.7 has moved up to 1.0 with 2 week lag in information says the Robert Koch Institute. This means a lot of work ahead, it won't be easy.

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Italy is planning to place a quarantine in the north covering the region around Milan and 11 provinces nearby, in a draft decree from the prime minister's office, says this report in the WSJ. When a final decision is made the quarantine would go into effect March 8 and go on till April 3, 2020. This move is similar to the quarantine steps taken in China which helped limit the health crisis in China from coronavirus. The new decree also includes tight restrictions on travel in the affected areas. 

The new action is being taken as earlier measures have not limited the spread of coronavirus. They were requested by the government in Lombardy, which combined with Emilia Romagna and Veneto are the worst hit of the regions in northern Italy with about 85% of cases. It also means the industrial economy with 40% of GDP is affected.

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Actions being taken in the UK to prevent spread from variants of coronavirus in July 2021 as increasing number of British tourists visit France, Greece and Portugal. Quarantine is now required at home for 8 days for vaccinated people from UK coming back from France because of a rise of cases in France

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For the second time Sweden takes a laid back approach to the coronavirus during the second wave in November. Swedish prime minister Stefan Lofven is in quarantine after he went into self isolation, following someone in his circle having contact with someone having coronavirus. The government only issues recommendations but there are no required restrictions, no strict rules to follow.

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Italy's president Conte tells Italians to follow the rules for quarantine, and not to follow old habits of "furbizia" that were used mostly to overcome the bureaucracy by working around rules. The Lombardy region including Milan is now under quarantine for the coronavirus. Programs on television urge people not to mingle, and to stay at home. 

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This BBC report looks at how doctors, nurses, police, railway employees, and sanitation workers in India are tackling the job of preventing the spread of coronavirus as India goes into a complete lockdown. The lockdown and quarantine are intended to slow the epidemic for enough time to enable bringing it under control.

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China is building a new hospital in Wuhan the center of the coronavirus outbreak, to contain the outbreak. The plan is to build it in just 6 days. China has taken a new approach to tackling this health crisis, isolating the area and speeding up action to find solutions to the virus. A shortage of hospital beds and resources in Wuhan led to the decision to build a new hospital rapidly. China's rapid response is the first high speed response and could be a model for future outbreaks. Before this during the SARS crisis in China, and other health crises worldwide, action was taken gradually by hospital and government authorites leading to more deaths and wider spread of disease.

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The critical variable in knowing whether lockdowns of cities and countries are working is called the coronavirus RO, or reproduction ratio. This ratio measures the average number of people infected by a carrier A. It could be that he infects 1 person at work and transport call it B people , or in large gatherings call it C people he infects 2 persons, or in other surroundings such as restaurants he infects 1 person call it D people. The people A has infected B+C+D are the ones now not infected by A with the lockdowns such as in New York, Italy, Germany, UK and France. It is determined by global health experts that the number of B+C+D is about an average of 4 persons infected by 1 person A with coronavirus, though it may be much higher in practice in some areas. The natural rate of RO or reproduction ratio is considered by the European Centre for Disease Prevention and Control to be 3.86 or about 4, if no lockdown or social distancing or other prevention is practiced. This in a situation where people behaved as before unaware that the virus was around them. Governments such as New York and France, UK, Germany are including this key variable in their determination of how long a lockdown lasts, and for determining if the reopening is not going the right way or failing. In such situations the lockdown would be reinstated, or if it is a phased reopening such as in the U.S. and other countries go back to the previous phase. In Italy and Germany the RO reproduction ratio for coronavirus is estimated by official experts at 0.8. Germany's RO estimated by the Robert Koch Institute and Italy's by Franco Locatelli, scientific advisor to the government. In New York the margin is thin- with RO of 0.9, estimate from the state's governor. In France which has one of the tightest lockdowns of all with a document required to go outside it is at 0.6, the figure coming from the prime minister Mr. Philippe. In the UK it is below 1.0 but no accurate figure is reported. As Dr. Birx- leading the coordinated response in the U.S. - emphasizes over and over again this is a very contagious virus, about which not much is known. Social distancing, wearing masks, basic prevention measures such as frequent handwashing, and not gathering in large numbers of people, is essential for defeating this virus. This has to be followed up with extensive testing and contact tracing to win this fight.   ...

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China's healthcare system is overburdened and overwhelmed, says this report in the NYT. The changes in living and investment in infrastructure and housing are not matched by similar investments in the health system. Shortages of hospital beds and doctors is making tackling the coronavirus in the Wuhan region more difficult. A new hospital is being built in 6 days in late January 2020 in Wuhan for the coronavirus patients, showing how severe the situation is. 

The lack of strict regulation and lack of enforcement at the local level is leading to the situation where the virus was detected in twice- in 2003 in wild animal meat and again in 2019. Public anger and call for a ban on wild animal meat is happening today.

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China is in isolation and in a freeze in ways that are unprecedented, that have never happened before. It has depressed world trade, disrupted supply chains of world trade, forced companies to restrict their employees movement, or bring them back home. Apple with 10,000 employees has closed operations and offices in China till Feb. 9. This is happening for many foreign companies in China as they deal with something they have never encountered before.  There is slowing down in demand fro crude oil as the lockdown affects the economy of China and world trade, Oil prices dropped 16% since the virus was detected. When the Sars virus happened in 2003 the Chinese economy was sixth in size in the world, now it is the second largest. At that time 7 million Chinese travelled abroad, today it is about 150 million, affecting international tourism. First quarter growth in China is now forecast by economists surveyed by WSJ at 4.9%, the lowest in decades. ...

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President Trump extends the U.S. lockdown for social distancing till April 30, on the advice of health experts. China meanwhile resumes industrial production and schools reopen. Factories, offices and retail outlets were shutdown for 2 months nearly nationwide in China. The U.S. has a social distancing lockdown not a complete quarantine of hotspots such as New York, New Jersey. Mr. Trump planned to quarantine New York but faced opposition from the governors of New York and New Jersey, including possible legal challenges. U.S. governors have acted imposing travel restrictions to their states from hotspots in other places in the country, forcing people traveling to self-isolate, stopping vehicles with out of state license plates and asking them to stay away. The U.S. cases have jumped from 100 in early March to 143,000 as of March 28, 2020, and 2514 deaths, according to John Hopkins. New estimates from president Trump and his team of experts are for the peak to be reached by April 15, and recovery gradually taking place by June 1, 2020. Based on the timeline in China shown below the time from the first set of 27 cases by December 15 to March 28 when China's factories were back to work and schools reopened across the country, is a period of 75 days. Based on this president Trump's timeline of June 1 for recovery has some foundation. China quarantined strictly compared to the U.S. yet in the early days it had no warning which the U.S. had in particular from Italy. The Trump administration by extending social distancing and lockdown restrictions till April 30 without a strict quarantine of the East coast areas yet with states outside imposing their own restrictions for outsiders, is doing what other countries such as China, South Korea, have to control this epidemic. The first coronavirus case was reported on November 17, 2019 according to the South China Morning Post, By December 15, the number of cases had reached 15. On December 27 on a single day 180 cases were recorded and the Head of the Respiratory Department at Hubei Provincial Hospital reported this to health authorites in China, according to the South China Morning Post, based on data collected in China.   ...

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What is it like crossing borders today in Europe during the coronavirus, and what are European cities like at this time. Two NYT journalists Kingsley and Vancon are finding out by driving 3700 miles by car across many European borders. The hardest they find is entering Germany from the Czech border, where they were stopped and questioned in every way. Germany has strict restrictions- you can only leave for 48 hours if it is longer than this one has to do 14 days in quarantine. Germany also has managed the coronavirus better than its other neighbors France, Switzerland and Eastern European countries.

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More games are being played in stadiums behind closed doors as in Japanese baseball or canceled altogether as in Italy. The coronavirus is leading to restrictions on mass gatherings, both in live entertainment and in sports.  Japan has changed its sports calendar postponing most events. Switzerland banned gatherings of over 1000 people, and France suspended events with gatherings of over 5000 people.  There is an acceptance of the fact that social distancing reduces the speed and extent of the spread of the virus, with countries that acted with quarantines and restrictions having a slower spread. This is now the case in China. In South Korea the lack of effective quarantine has led to spread of the virus. The extra time gained from slowing down the spread is important to let hospitals and medical systems cope. Things can be less intense for the medical community which is important for all countries.  Players and performers also are reluctant to be exposed to the virus in the current situation, particularly in locker rooms and other locations in stadiums. ...