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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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The failure to respond quickly with testing and contact tracing has been a major weakness of the response to the coronavirus in Europe and the U.S. Repeated fumbling in contact tracing has been common throughout Europe and in states in the U.S.

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This report shows the level of coronavirus testing as of March 27, 2020 in different states in the U.S. The U.S. testing program and supplies of tests are being ramped up quickly. About 65,000 tests are being done on Americans each day. The need is for 150,000 tests a day say public health officials. Testing is slow in California compared to aggressive testing in New York which has 60% of all coronavirus cases. California with twice the population of New York has done 77,000 tests compared to 122,000 in New York. Texas has done only 21,000 states by comparison. Every week new testing technology is being developed in different labs, medical companies, and universities. Including tests that can be conducted quickly and not requiring health workers or health workers with protective gear. Speed of processing test, least point of testing contact, and the protocol for quarantine, are all part of the testing and isolating of clusters mechanism to tackle the virus. This is critical in the coronavirus action plan being developed by Dr Brx of the U.S. White House team. ...

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

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

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About 60% of Americans think the testing for coronavirus and getting medical supplies to health care workers is too slow, in a poll by Wall Street Journal/NBC News. About 6 in 10 Americans in a new survey say they are concerned that the U.S. would move too fast to loosen coronavirus restrictions to slow the spread, and only 3 in 10 say they are concerned that it is not moving fast enough. About twice as many Americans thinking the risks were higher that public authorites and governors would reopen states too soon. About 75% of respondents in the survey say they are very or somewhat worried about themselves or a family member getting the virus. Mr. Trump's approval rating  remains unchanged from March with 46% approving. Most people place their faith in the governor of their state- 66%, and Mr. Fauci, Director National Institute of Infectious Diseases- 60%, than anyone else. On the economy president Trump is seen as being better at handling the economy 47% to 36% than Democratic nominee Biden, even though Biden has a nine point lead. This confirms the widespread dissatisfaction at the way medical supplies shortages are felt at hospitals, and the way testing for coronavirus is happening with not enough testing. President Trump perceived by business and the public as better at handling the economy is also confirmed in this survey. The dissatisfaction with the president for supplies shortages and testing lagging behind may also be tempered by a sense that the public has not taken aggressive action in supporting an early lockdown with many governors and people not supporting or following strict distancing rules till late March. By contrast the president acted quickly to stop all flights from China. ...

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The coronavirus surge in southern states in the U.S. is different from the surge earlier in the northeast including New York and New Jersey. More young people are getting the virus. About half of those testing positive are now 18-35 years of age in Texas and Florida. Social distancing and masks is not mandatory with young people not practicing these safety guidelines. Many took the reopening to mean they could go back to the usual summer routines. Not taking it seriously is leading to more infections of young people. Cultural issues with practicing the guidelines and a tendency to not take it seriously has been a problem in the U.S. and parts of Europe since the beginning of the crisis leading to larger number of cases.

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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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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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The NYT provides a good look at the situation in India in September where cases are over 4.5 million, the world's second largest after U.S. During the lockdown in April and May India had successfully stemmed the coronavirus. After reopening in June a lot has changed as can be seen in this look at the steep curve in June, July, August and September. Cases are now at the rate of 95,000 daily and deaths at 1172 daily as of September 9. The deaths are up 16% and cases up 29% over 2 weeks. Maps show the situation in the states with Maharashtra, Andhra, Tamilnadu, Karnataka, and Uttar Pradesh showing the highest cases. Maharashtra has about 1 million cases and the two states in the south east Andhra and Tamilnadu have about 1 million combined with Uttar Pradesh at about 250,000 cases. Delhi has about 200,000 cases. So that about half of the 4.5 million cases are in three states in the southeast and the western state where Mumbai (Bombay) is located. The increase was seen after increased testing from 200,000 a day to 1 million a day by the end of August, a steep jump being seen in late August and September. At the end of July the coronavirus recovery rate of 70% in India and 90% in Delhi were the favorable signs, until things changed in August with increased testing and the spread to rural areas. India is doing over 1 million tests daily. On September 3, 1.1 million people were tested, taking the total to 45 million tested throughout India.  As in Europe and America the reopening which is essential for the economy and jobs has resulted in a big jump in cases. The laws for lockdown were carefully obeyed without many of the problems seen in America and Europe, the early complete lockdown was implemented with success, and Indian pharmaceutical companies are some of the largest in the world giving the public wide access to essential medicines and drugs. The postal service has functioned remarkably well during the lockdown for delivery of essentials throughout the country, and earlier action to establish bank accounts for each and every individual in the country, has enabled rural Indians to get through this most difficult period. This has given the government some breathing room as it faces the cases from reopening in a vast country of 1380 million people.   ...

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The asymptomatic coronavirus infected people are a large fraction of the people with coronavirus. This is a huge problem as these people unaware of the danger are unwittingly spreading the virus. This is one of the most unusual aspects of this virus compared to other virus epidemics, and why it has become so dangerous. It is also why social distancing alone is not enough. Strict enforcement of stay at home orders by public health authorites, state and federal governments is essential as the unwitting spread by asymptomatic people who are not following the required guidelines is a huge problem.  Even as the public now calls for stricter action the lax behaviours in March in U.S. Britain, France, Germany, and in Italy in February, have created a population of infected people that acts as a backlog for testing, creating a surge in April. One of the novel features of this public health crisis is that lax behaviours stemming from a lack of understanding of the severe contagiousness of the coronavirus is making it a larger crisis on a scale not encountered before.  The contamination potential of this virus is only now being tackled with experts in fluid dynamics at labs such as the MIT Lab in the U.S. looking into how it can contaminate environments, as shown on BBC News.  With pieces of the contamination puzzle only now being put together. Heeding public health expert warnings and guidelines is all the more essential for this reason. ...

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There are differences between the governors of 10 worst hit states and the president of the U.S. on when to reopen the economy. The seven on the East Coast including New York, New Jersey, Connecticut, Massachusetts, and three on the West Coast including California and Washington, all but one have Democrat governors and want to wait beyond May 1, till it is believed to be safe to reopen.190,000 of the 592,000 infected cases and over 10,000 of 25,000 cases of deaths are from New York alone. This is as though a third of the problem is in one state. The feeling in New York is that it should be the last to reopen, other states can go first in the middle of the country. The position in the U.S. Constitution is for states to maintain public order and safety. This was the basis of the president's position to work with the governors and continues to be the case, though there is pressure from economic advisers to the president to reopen earlier balanced by the opinion of health experts around the president.  Some states are taking action to reopen because the virus has not severely affected these states. President Trump says it is for governors to decide what is best for each state in consultation with the federal government. The U.S. government would step in if a state is taking risky action with the coronavirus. On the issue of whether the president could have acted quickly in February following his decision to stop flights from China and set up quarantines in January, the BBC has this to say. Dr. Fauci, the president's respected health expert was one of many public officials who did not see the magnitude of the crisis evolving with lack of good information from China. BBC North America Editor Jon Sopel cites Dr. Fauci's comments on February 13- that the coronavirus danger is "just miniscule" compared with the "real and present danger" of flu. As it happened the president acted alone in his sense of the danger from the outbreak in China through incoming flights and not relying on others. Here is what the situation of each country on reopening is- India -  has extended the lockdown to May 3. France - has extended the lockdown till May 11. U.S. - has extended the lockdown to May 1. States are taking the responsibility. UK - continues lockdown restrictions till May. The French president Macron had a simple answer to the question " when will we be able to get back to a normal, prior life?" Macron said "Quite frankly, humbly, I have no definitive answer to that." Some nurseries and schools will reopen May 11. Not restaurants, hotels, museums and theaters. By May 11 France will be able to test and quarantine anyone with symptoms and general public masks will be available to all. This is what Dr. Fauci in the U.S. also wants to see before being able to reopen, that testing and tracing, isolating, procedures be efficient and reliable. ...

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Wuhan has announced  only 3 new confirmed cases since March 18. Restrictions on travel were lifted after a 77 day lockdown on the city, allowing inbound and outbound travel. Some restrictions on housing complexes have been tightened after reports of dozens of asymptomatic cases. The number of asymptomatic cases remains unknown. There is a fear of a second outbreak and authorites are staying vigilant, as it is feared that the first outbreak was worse than previously thought. Epidemiologists, intelligence agencies, and health experts believe the number of cases reported in Wuhan and China are undercounted. This could be they say a result of local officials wanting to present a better picture, of not enough testing in the early stages, not counting people who died at home, and including people who died of pneumonia under pneumonia instead of coronavirus. Dr Birx, head of the U.S. response effort,  says the U.S. lists people who died of pneumonia in New York as coronavirus deaths because of how widespread it is there, hitting seven people in a thousand. In addition there is a problem for all countries in counting people without symptoms. No one even knows how big that is, and Dr Birx in the U.S. says it is important to find out. ...

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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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This important WSJ report shows how the CDC labs failed to come with the test after contamination of a component and failure of the third part of the three part test components. In the absence of a working test from CDC where delays cost three weeks of February the private labs all over the country and state labs could have developed their own test, yet HHS and FDA required approval for these labs to develop their own test and use it. From Feb. 8 when state and city public health labs detected problems with the CDC test to Feb 29 when solutions were developed including simply excluding the third part of the three component test, and letting labs around the country do their own test, were 3 crucial weeks that let the virus spread out of control. The CDC, HHHS, and the FDA and their managers and heads of departments bear responsibility for these errors. Week after week the delays continued, instead the two component test which detects if the genetic material in the sample is coronavirus material, could simply have been approved at the outset instead of the approval for this given weeks later. The third component of the test checks if the virus mutated, according to this report. There is no explanation why the labs all over the U.S. were not allowed to go ahead on February 9 itself or within a few days after that to develop their own tests once it was clear the CDC test did not work on that day. CDC officials failed to recognize that there was a possibility that they may not be able to fix the faulty third component of the test and the risks if they gave false reassurances. There is also no explanation of why a German designed test was not used once the CDC test failed on Feb. 9, which would be a proper way for action considering that this pandemic had already shutdown parts of China by this time. Alarming also is the mention in this report that on Feb. 22 a FDA official in charge of lab diagnostics  flies to Atlanta where the CDC Respiratory Diagnostic lab which developed the test is located. His boss FDA medical device center director is cited from later information as describing the lab as "filthy" meaning the lab had the potential to contaminate, and going so far as saying that if it had been any other lab it would have been shut down. Considering that investment in public health has deteriorated over the last two decades and that there has been a massive misallocation of capital in the country away from public infrastructure this is appalling. The thought of critical labs for emergency health needs as not being up to high quality standards in the U.S. as a result of two decades of misspending, that this shows, is very disturbing.  This WSJ report is based on interviews with people who know about the testing crisis, and undisclosed emails, correspondence on the issues involved. Community transmission began in January 2020 in the U.S. These delays were costly in February and could have been prevented either by going with the German design on Feb 10 or asking labs across the U.S. to develop their own test, and letting other labs immediately use the modified 2 component test of CDC that worked instead of doing this action weeks later. Mardi Gras on Feb 25 and other places where large crowds gathered in sports stadiums could have been stopped had testing gone forward and shown the true extent of the community transmission in these critical weeks.  First China delayed a U.S. team of experts coming into the country for weeks, and then the CDC, FDA, HHS, failed to get testing started, creating  a false sense of complacency. Two crucial errors outside and inside the country that caused so much damage to America and the world.   ...

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On the first day of the new vaccine policy on June 21, 2021, India has vaccinated 6.9 million people. India has now vaccinated 287 million people out of a population of 1.2 billion. This is a race against time as new variants caused the second wave of coronavirus in April and May of 2021 with cases peaking at over 300,000 a day.  The shortcoming of the old vaccine policy are being corrected. The entire vaccine supply process and the vaccination drive is now being handled by the federal government. Earlier during the second wave vaccine supply and the vaccination drives were under an arrangement with no clear overall responsibility. States shared responsibility with the federal government and target vaccination goals were missed, vaccine supplies were inadequate.  A similar arrangement in Germany failed and Germany's vaccination supplies were inadequate and vaccination drive stalled. This caused immense frustration in Germany in April-May 2021. Germany's troubled history before World War II led to a reliance on decentralized actions, and state governments imposed different rules in a relatively small country compared to India. This was corrected with the federal government taking on the entire responsibility for the vaccine supply and vaccination drive leading to good results today in vaccines. With India's huge population and political process of different state governments, some lacking experience in administration for a complex process, and others failing to coordinate well with the federal government, the lack of overall responsibility at the federal government posed serious risks of missing targets for vaccines and letting the coronavirus wreck the economy and public confidence. Complex negotiations with other governments in Europe and the US for vaccine manufacture in India could only be handled at the federal level. The resources and planning at the federal level were already in place in India for infrastructure and other projects, experience and setting targets in that area at the federal level could now be transferred to this task in vaccines. Somewhere in the range of 8 million vaccines a day need to be reached and sustained from August to December 2021 for India to reach the goal of vaccinated all 1.2 billion people ahead of any further attack from a third or fourth wave, say experts. This is not a choice for the federal government, it is simply something India has got to accomplish to be a healthy nation that can grow with neighbors in Europe, the US, Australia and Japan and build confidence in its Asia-Pacific region. The entire Asia-Pacific region has a lot resting on how well India achieve this goal and moves on to the next phase of assisting its neighbors in the region.  ...

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Short time work programs, paid leave, aid to small business for employee retention with the government paying a big percentage of wages, and unemployment benefits till companies rehire employees with government paying for this, are all different ways in which the U.S. and Europe are coping with the coronavirus crisis.  In the U.S. 22 million have applied for unemployment benefits with the U.S. government picking up a substantial part of the wages till companies rehire these employees. In the UK the government has launched a program that gives 2500 pounds or $3100 to each worker each month upto 80% of the worker's pay. The money is sent to businesses for retaining employees. This could cover estimated 8.3 million workers in the UK at a cost of $52 billion. The U.S. has a similar program with the first phase $377 billion already distributed to small businesses which requires retention of employees for government forgiveness of these loans. The basic idea is retain employees who could stay at home or be in short work programs or work from home. The French government is paying the wages of 9.6 million workers, almost half of workers in the private sector by sending the money to 785,000 small businesses. In Germany the Kurzarbeit program covers 725,000 companies which supports the wages of employees in a downturn and is financed from a special fund. The cost for Germany, France and Spain is about $147 billion or 135 billion euros for such programs. The European Union will step in with a 100 billion euros loan package. ...

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Some of the concern about the economy comes from the economic damage done by the coronavirus. The longer the shutdowns continue the more the damage. About 17 million have filed claims for unemployment benefits. The WSJ consensus of 57 economists is that 14.4 million jobs will be lost in coming months, and the unemployment rate will rise to a record 13% in June, from a 50 year low of 3.5% in February. The earliest the economy could go back to the level in February 2020 is 27 months says the WSJ economist survey. The brighter side of this comes in two aspects of this pandemic recovery curve. By flattening the curve and strict testing, contact tracing and isolation till the vaccine is developed about half the jobs lost can be recovered by the end of summer, says Moody's Analytics. The vaccine a year from now or in 9 months by November 2020 would allow the economy to recover faster. A more optimistic view comes from Daiwa Capital Markets which predicts many of people laid off will be recalled quickly allowing the labor market to recover in 6 months by September or October 2020. Only finance and real estate might take longer but most of the industries where the vast majority of jobs are could be back on their feet. The credible evidence supporting this perspective of a rebound comes from Colorado and Washington which require large employers to specify whether layoffs are temporary or permanent, 70% this year are temporary. Compare this to the prior 2009 recession where this figure was less than 1%- as reported by WSJ. The big push in this direction will be the $2 trillion that the Trump administration and U.S. Congress have committed to this task. Even more so is the determination of president Trump to protect American workers at all costs, that every job counts, and that businesses without exception to get the money have to show that workers are retained. The very success of the aid is being judged by how quickly people are back to work. Now for a look at where the situation is today- Oxford Economics, a UK based forecasting and consulting firm, projects 27.9 million jobs lost with industries other than those ordered to close making up 8 to 10 million of that number. It projects April's report will will capture late March layoffs. It will show cuts to 3.4 million business services workers, including lawyers, software groups, architects and consultants, advertising professionals, in addition to 1.5 million non-essential healthcare workers, 100,000 information workers. One conclusion of this report is that the virus does not discriminate across business groups and business service workers are also affected. Many companies that were hiring will cancel that move and many will cut hours worked. Many of these business services are not a priority. Hospitals are affected too, as they cut elective surgical procedures and routine care that are major revenue sources. Some are now charging for telemedicine visits to maintain some revenue stream. State and local governments employ 20 million workers. As tax receipts decline these local governments will face choices of cutting payrolls and services without enough federal government relief. In a way laying off workers and having them take unemployment benefits shifts that burden to the federal government so that services for overtime to police and paramedics, retention and deployment of nurses in schools.    ...