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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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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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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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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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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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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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This report in DW.com looks at the response of Germany to the coronavirus epidemic and says Germany may have let a window of opportunity to act quickly slip from its grasp. It says Germany's leader Merkel has not shown the leadership required by the health crisis. Germany DW.com points out recorded its first case on January 27, yet Merkel's first press conference on the subject of coronavirus came on March 11, when Italy was on lockdown quarantine for 2 days.  Germany lacks a quarantine and effective government action to mandate and require social distancing across the country to limit the spread. The steps this report points out pale in comparison with the actions taken in other neighboring countries. Spain earlier and Belgium on March 17th joined a lockdown in Italy. Merkel called on Germans to stay home, yet enforcement is lacking.  In this situation the calm and reacting with reason may be obsolete, a proactive approach being the right one. And a braver one because it would anticipate what happens a week two weeks from now based on experience of China and Italy, and act quickly with a lockdown and quarantine to prevent spread. Waiting in this manner risks too much says DW.com.  ...

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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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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. ...

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It took a week longer for each country to impose a lockdown. In China first Wuhan then the whole country went into lockdown and quarantine. The same process is repeated in Europe and in America as authorites see numbers of infections increasing rapidly without strict controls. First the Lombardy region in Italy around Milan, then the provinces in Northern Italy, followed by a complete lockdown in the country on March 10 as infection spread faster without lockdown and enforcement of lockdowns. Germany and Britain follow Spain and Italy on March 20. France followed Spain in the days after Italy's complete lockdown. Macron ordered the lockdown on March 16 with stringent enforcement. Infectious Disease specialists at Imperial College warned of "unintended consequences for the entire nation" if a lockdown of Britain did not take place. The goal is to limit the spread of infections from rapid to slow as public health systems and economic measures are ramped up in preparation for the crisis. Most countries were lacking the preparatory steps having lost time waiting to see what happens next or analyzing data in the vain hope the virus does not spread.  Bad economic results of lockdowns were initially a concern, but this concern became less important as the coronavirus spread rapidly in Europe. Decision makers in Europe decided that not acting forcefully would lead to equally or worse economic outcomes. Public health systems overwhelmed would diminish public confidence rapidly and lead to equally bad or much worse economic outcomes. The European Union executive body has supported state aid, stimulus action and border controls in this crisis. In America and in Europe the hope is that shoring up the safety net with massive aid to businesses and households would buy time to tackle and overcome the coronavirus through a combination of lockdowns, quarantines, contact tracing, large scale testing and medical technology measures. The examples of China, South Korea, Taiwan showed this pathway exists for phased control and reducing fatalities to zero. ...

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Lessons from an Italian family about staying fit and getting exercize during the lockdown within the home. The father is part of a running team in Rome. He has spent 18 days with his wife and teenage son at home already, as Italy remains in quarantine. He can't run the Rome marathon so he and his friends divide the 42 kilometres so that each person runs 1 kilometre at home. Other advice- plan your day carefully, stay in different rooms so its easier to spend a whole day, and the next day and the next together. do some hobbies, exercize to stay fit. 

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The new approach to tackle the coronavirus is to quarantine areas where it starts. The approach is being adopted in China, Italy, the U.S., Japan and other countries. Another part of this is closing of schools as in Japan and Hong Kong. Experts support this approach even though it was used in the 14th century.

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Spain and Italy, the New York region, delayed their response, just as Japan and Sweden are doing today, resulting in the severity of the pandemic in these countries and regions. This pandemic is showing the earlier you act to lockdown, quarantine, use contact tracing and isolation of clusters method, the better it is with fewer people infected and fewer deaths. This is the single most important lesson of this crisis, which health experts worldwide, including Dr Birx, head of the White House Response, and Dr. Fauci, never get tired of repeating.

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States in Germany that have imposed quarantine and lockdown are Bavaria, Saarland, Rhineland-Palatinate., Hamburg, Lower Saxony, and Hesse. People are asked to stay inside unless going to the doctor or supermarket.  Bavaria where Munich is located reported few violations. Chancellor Merkel is meeting with state premiers on March 21 to decide on a nationwide lockdown as in Spain and Italy. 

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China reports no new coronavirus infections for the first time on March 19. The outbreak in Italy now surpasses that in China.  The U.S. government is now shifting to social distancing as the most effective way to control the spread and away from focus on widespread testing as a containment tool. The experience in China shows social distancing works, quarantine works. Countries and regions that have neglected to do this early are the ones worst hit, including most of Europe.  The reintroduction of the infection after its containment is addressed by quarantine and social distancing and use of masks, government disinfecting hard surfaces in all public areas, a program implemented strictly in Asian countries such as Singapore, China, Taiwan, and other Asian countries. Use of masks was common in Asian countries in earlier episodes of SARS and other epidemics, making it widely used long before this crisis. This is making a significant impact in addition to social distancing and other quarantine measures taken in China.   ...

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Under new rules the whole of Italy is under restricted travel, with people required not to travel outside the area where they live. This is similar to steps taken in China that have helped control the spread in China and reduced the severity of the crisis. Quarantine and restricted travel is seen by health authorites worldwide as the most practical option and required to be taken early.

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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 U.S. bans travel from most of  Europe and India imposes quarantine on visitors and overseas citizens entering the country for 14 days. Countries around the world reacted quickly to the situation in Italy, France and Germany. The strict measures taken by China are gradually being adopted by other countries. Quarantine done early has worked limiting the spread of the coronavirus. Countries with strong public health systems are better positioned to weather the health crisis. Where strong action is taken early and in anticipation, with a strong public health response, there is better control over the spread. This comes with some economic cost as it has hit the Chinese economy, yet the rebound is likely to be that much quicker and done with more confidence. For instance air travel in China declined by 85% in February from a year earlier to 8.3 million journeys according to Chinese aviation officials. Moves to keep social interactions to a minimum have yielded results. Only food stores and pharmacies remain open in China till March 25.  ...

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Italy is paying a heavy price for the delay in implementing a complete lockdown and other measures. The first delay was on Day 6 and Day 12 after the first coronavirus infection on Feb. 20, when the regional authorites in Milan region kept bars and cafes open and reopened Milan Cathedral to tourists as reported here in the NYT. This was happening even as the pandemic was surging in a case of ample denial. Then again on the 18th day after the detection of the first case on March 8, the lockdown announced was leaked leading to people leaving Milan and other towns for the south and other parts of Italy. This lockdown of March 8 was not specific enough and lacked details so that it was not properly implemented immediately. The final lockdown of the entire country came as the situation worsened on March 10. As a result the virus continued to spread leaving hospitals and health personnel overburdened and the country in severe crisis. The Veneto region fared better than the Lombardy region because of strict quarantines, higher rate of testing and contact tracing to enforce isolation of clusters. In towns such as Vo in Veneto the virus is under control as reported in the WSJ. ...

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The situation in Europe as Germany, Austria enforce travel restrictions with Italy. France has not placed restrictions yet on travel to and from Italy. Many Italians are wondering whether the quarantine and other steps taken now should have been taken earlier, says this report in WSJ. The Italian government is conducting a campaign where people say "lo resto a casa," or "I'm staying home."

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Two divergent approaches to the coronavirus are shown in this report in the WSJ. One in Italy which relies on quarantine and lockdown and mandatory social distancing, and the other on keeping borders open and aggressively tracking down the infected using data and testing. In South Korea infections have stabilized at 8000, and in Italy the are rising at 15,000. The divergent approaches and the results vary with the people's history, culture and recent experience. The cultural difference in Asian societies with people willing to cooperate and work together with health authorites for the social stability and good of the country is different from the more individualistic nature of western societies. In addition Italy has a long period of foreign rule of Hapsburgs nd French that has created an attitude of working around authority, the tendency to being furbo which prime minister Conte referred to in a nationwide address.  South Korea and Taiwan also have experience with the SARS and MERS virus during which public health regulations were instituted and comprehensive databases setup that are now being used to combat the new health crisis by tracking down people with health needs. The precedents have taught people in South Korea and Taiwan of how serious this kind of crisis can become, which was absent in Italy in the early stages. Both South Korea and Italy are democracies. The difference being that one has experience with public health crises from experience with SARS, MERS, H1N1, and has developed policy tools, broadened public support and increased state powers in anticipation of such crises. In South Korea there were fines of $8300 for those not willing to be treated and the government aggressively tracked down people. Public support and awareness also helped in controlling the situation. Taiwan has done better than South Korea as covered in a separate article in the WSJ, and shown here, controlling the situation from the beginning including shutting down flights from China early because of its close proximity to China.  ...

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With cases from foreigners exceeding cases locally, outside of Hubei province for the last 6 days, China is now restricting entry of foreigners. All foreigners entering the country from South Korea, Italy, Iran or Japan are subject to a 14 day quarantine. A voluntary quarantine for 14 days is required for other visitors. 

Germany has relied on state and local governments to take action, with the federal government not intervening. 

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Kerala state of 35 million people who speak the language Malayalam, is one of the rare places today that has only 4 deaths from coronavirus, 524 cases confirmed and no community transmission. Here the Guardian looks at the reasons why. The Health minister KK Shailaja started very early on January 23, with a meeting of her rapid response team when the virus was still in China.  She setup a control room and instructed Kerala's 14 districts to do this on Jan. 24. When the first case arrived on Jan. 27 on a plane from Wuhan, Kerala had already adopted the WHO  protocol of test, trace, isolate and support. These passengers were checked for temperature, tested and quarantined. With some at a nearby hospital and others in home isolation. This is all the more amazing considering that Kerala is a state in southern India on the west coast that has a large number of people living and working overseas. Many are in the Gulf countries and the arrival of these refugees could have triggered a second outbreak. This was prevented by careful testing, and contact tracing of clusters.  When one group was evasive and concealed information from an airport surveillance team -arriving from Venice, Italy,  in late Feb- a case was detected back to them.  Contact tracers tracked down all of the hundreds whom they had been in contact with and quarantined them.  By 23 March all flights to 4 Kerala airports from overseas were stopped, including Cochin and Trivandrum. On March 25 India went into lockdown.  Some of the achievements in Kerala include quarantining 170,000 people early. with strict surveillance, which is now down to 21,000. Accomodating and feeding 150,000 migrant workers from other states, before returning them on charter trains to their home areas. A big reason for the success is the high literacy rate in the state. A big emphasis on education and healthcare is a part of the Kerala model. Shailaja is a secondary school teacher, and Health minister. From the days since independence of India in 1947 the state has a strong socialist tradition of taking care of the basics- health, education and public services. It also generates a part of its GDP with income from workers who are overseas.  Another reason for the success in dealing with coronavirus is experience. The state had a virus epidemic called Nipah in 2018 which has become the story for a movie called Virus in Malayalam. There is decentralized public health system in the state and people value their health care facilities, understand and trust the health care authorites. There are hospitals at every level of administration and 10 medical colleges. But trust and education, experience tackling the virus before, are key. Kerala is showing that poor countries can deal effectively with the virus, and create a better life by adopting the right model of creating good societies that value education, healthcare services, better economic structures and distribution of wealth, and  a degree of trust and responsibility found in a state that values public spiritedness. ...