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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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The UK government's chief scientific adviser, Sir Patrick Vallance, says coronavirus testing has not been scaled quickly enough. Public health experts warn that Downing Street is in the position to face "an unforgiving reckoning." The UK has done 5400 tests per million population, the U.S. 8894 tests per million, and Germany 15,700 per million, according to data from Worldometer website. UK got off to a slow start.  Experts at Imperial College, London, say a major problem is the lack of contact trace, test, isolate. Contact tracing having fallen behind. The government is relying too much they say on an app from Google and Apple to do the tracing because for this kind of work humans are needed, "boots on the ground" are needed. South Korea and Taiwan have successfully used people to do the contact tracing by using access to cellphone carrier data that was made possible from protocols established in earlier MERS crisis. ...

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Prof. John Ashton, regional director of public health for the northwest of England offers this advice on pitfalls to avoid in the testing and contact tracing systems of the UK and other countries. He says there is a problem in sending testing kits through the mail or postal service. He points out that the swabs needed for testing correctly are quite invasive, the risk of an inadequate sample taken in high, resulting in a false negative report. 

On contact tracing he says the current recruiting system has pitfalls of contact tracing people not having local knowledge. Needed are people who know the local population and are able to fully engage with these people.

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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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Massachusetts is moving into no. 3 or no. 4 position after New York and New Jersey and possibly Michigan in coronavirus cases with 34,000 reported. More than 3700 were hospitalized  in the state.

Massachusetts is close to hotspot New York. It also has a more aggressive testing strategy and is hiring hundreds of volunteers to do contract tracing, and uses Partners in Health, a nonprofit. Michigan and Massachusetts have followed a more aggressive strategy of testing compared to California which has taken a different approach of not doing aggressive testing and contact tracing leading to lower numbers in California now adjusted for population that could be different later on.

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Angela Merkel said that contact tracing was "above all else" in importance in tracking down infection chains. Apps would not work in Germany because tracking movements and recording information is a sensitive subject in Germany with its history of communism and fascism. Germany still did it but very early on adopted a low tech way that so far is working. Staff from provincial administrations have shifted to do contact tracing work as other work is slow or suspended. Volunteers also have taken up the work. Germany's goal is 5 contact tracers for every 25,000 people- or about 16,000 for a population of 83 million. All the contact tracers have is the phone and a central database of information on the desktop computer as shown here in this report in the Washington Post. There is no advanced technology or software.  Most important say experts is social skills - to talk to people in a way that makes them feel comfortable to share information about how they are and their contacts in a very informal friendly setting, that even includes some humor. Here a contact tracer in Reinikendorf describes the work she is doing and a typical day. There are about 75 contact tracers for 260,0000 people in her area. When she calls someone she notes down what contacts they have had and puts them in Category 1,  2 , or 3 depending on the need for quarantine. The calling is mainly about asking the contact about his or her movements. A contact for more than 15 minutes is Category 1, less than 15 minutes Category 2. The whole conversation is for 10 minutes. Then someone from the health department will call the person contacted everyday. Reickendorf began building up contact tracing in March after an outbreak in a kindergarten was too much for the usual number of health officials to handle. The German trace and quarantine approach, home grown, low tech,  and based on what resources are available, the most important thing being start immediately, has its flaws. Yet it has worked to limit infections and deaths.  In about 65% of cases health authorites have no idea how a person was infected. Asymptomatic carriers are not detected. In some area the resources are limited.  This effort has helped control the virus first cluster in Bavaria at a car part manufacturer. Sixteen people had tested positive and hundreds were quarantined. The German approach is that testing is fine but if you are in quarantine testing is not going to make a difference in spreading. Testing with a negative result is also not helping as it could be that its too early for the infection to register because of the incubation period. ...

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As German schools reopen few countries can match Germany's robust effort to do speedy testing and contact tracing to limit the spread of the virus.

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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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Britain's Cabinet Office minister supports the scientific community in its efforts to ensure contact tracing combined with random testing to track community levels of virus penetration. This supports reopening with reliable data and information on how to proceed. Britain is pursuing this strategy.

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Any idea that herd immunity is the way out is dispelled by a simple look at these pictures from the NYT showing what the level of infections are today and what they would have to be for "herd immunity." No Asian nation has even mentioned the word. Most Asian nations have the most experience with virus of all sorts. The only government that supported the idea without saying so openly is Sweden as indicated in a report in FR24 on the amplification of coronavirus in Sweden compared to neighboring Denmark, Norway, Finland. Imagine with a threshhold of 60% of people having antibodies provided by experts for herd immunity, the current New York level of about 20% would have to triple, and Sweden's 7% would have to grow seven fold. It is hard to imagine New York going through something of these proportions. Looking at what works now that other countries handling it have set examples of what works provides a better way- low tech contract tracing the German way, and one used in Asian countries, and the cluster isolation through testing and contact tracing adopted in many Asian countries as well as Germany. Strengthening public health systems, and working one's way out of the crisis where there are no easy answers offers real and realistic hope. ...

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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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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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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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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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As the pandemic continues to spread and numbers grow with reopening of the economy the question remains -what can we learn from other countries positive experience in controlling spread? Here the Times provides the example of German contact tracing- chancellor Merkel has emphasized that a lot depends on "total" contact tracing, and contact tracing "above all else." Germany's experience is that even if you don't get everything right, you make an honest effort with everything you've got and do it early it makes a real difference. Some of the offices across Germany are stretched and short of staff but they have been working since the beginning of March, sometimes in the early days 7 days a week. Only 33% or one third of the offices throughout Germany for contact tracing have the required 5 person team for every 20,000 people, and 35% are overstretched or at their limit, according to one survey. No apps, just a low tech effort with people from the state administrations who were not working during lockdown trying doing something else, or volunteers. Mainly using the phone, talking to people and tracing the contact chain of people testing positive. Putting this information on the computer with a central database.  The Berlin office has 115 workers and has tracked down every one of 666 virus cases it was given. Because of privacy concerns at the Munich office sometimes even the patient's name is not given and office staff have to locate the name and the person. It requires dedication, flexibility and above all resilience, says Harold Rau, the deputy Mayor of the Cologne office, cited in this Times report. The doctor alerts the local office with a test result. The office calls the person and finds out who he has been in contact with for the last 14 days. Then the people who were in contact with are grouped based on the directness of contact, face to face, so on. These people are asked to quarantine for 14 days, sometimes with the rest of their household. They get daily call to find out how their doing for symptoms. The effort goes back to Robert Koch in the 1892 cholera epidemic in Hamburg. Robert Koch, microbe hunter in Germany, was called in after the epidemic spread from Moscow. It devastated Moscow and Tokyo, but Hamburg suffered far less about 8605 deaths as a result of the contact tracing and strict closing off quarantining of affected chains after isolating them, closing off affected parts of the city. Bit by bit the cholera epidemics sparks were put out before turning into flames, says Koch. In the current pandemic Germany has suffered 8241 deaths and 178,000 confirmed cases. So far this is in line with the cholera epidemic in Hamburg 1892, and this for all of Germany. And it is not just affluent nations that can do this. where there is a will there is a way. In Kerala state in southwestern India, similar efforts have worked to limit spread  with even better results than Germany. ...

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

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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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Germany has shown that low tech contact tracing efforts work- no apps needed, a phone, a desktop computer with a centralized database, and most important the human relations skills of the person doing the calls. The  sensitivity to the situation facing each person being called, being able to talk to the person in the language they speak in a multilingual environment such as California, is shown here. A 40 person team operates in San Francisco consisting of public health officials, clinicians, medical students and librarians. They call the contacts of people with coronavirus, arrange tests, and as needed send packages of food and medicines to hotel rooms or homes. Every call is expected to last 15 minutes but all sorts of questions are handled.  English and Spanish are used. Here one of the persons doing the contact tracing says she does not use apps, just an open source software used in the fight against Ebola. Definitely low tech, no waiting, get going is the message to every city in the world. She says apps software such as what Google and Apple are putting out can tell you whether the person went to some place, but cannot tell you more about that person, cannot tell you about problems the person is having being tested, and how they are having difficulty providing for families. One of the big lessons from Germany and efforts such as this one in San Francisco, and in other places such as Paris, Singapore, Taiwan, is that there is a complex nature to contact tracing that cannot be solved by tech. In fact the best thing to do is to get started immediately, with a phone and a database on a computer, as long as you have a person who has the motivation and skills, empathy with people, a lot can be done. Waiting for apps is a dangerous waste of time is shown by the low tech German experience, and the experience in other places. Most important is starting immediately. The example shown here of working with migrant workers in contact tracing shows in the most vulnerable places it is these human relations skills that count, that no tech app can do. It requires detective skills to find out and get people to share their history of movements and contacts for 14 days . In Singapore crowded dormitories house 300,000 of 1.4 million migrant workers. Singapore using an app also but its use is secondary. Apps don't work in many situations but fail in the most critical situations such as these dormitories and other eccentric or atypical situations such as faced by South Korea with religious groups and gay communities, elderly people in Europe, that generate the worst dangers of spread and need to be cluster isolated quickly. Human contact tracing has a history of being an effective method and was used in China and South Korea during the 2003 SARS epidemic. More countries need to adopt the method used in Asia and in Germany, particularly Britain, the U.S., France and India. It is OK that Britain's NHS and India's national government with Aarogya Setu app have put out their own apps which balance privacy concerns with the need to act immediately and cover the entire country, but the hard slog of human contact tracing teams in each district is indispensable. This is why the former Health minister in Britain calls it Britain's national mission to do this. Speed is key- putting together teams across the country in every district from skilled volunteers or government workers, and pulling together the phone and a centralized database on a computer as basic equipment. The fact that this is easily doable and people with human skills needed can always be recruited as they have been in Germany- from public officials in local government who are less busy in lockdowns, medical students, clinicians, volunteers, people from different professions- makes it inexcusable not to learn from others experience and get going. Just Do It. You want to reopen business, professions, offices and public services- Just Do It, it makes this possible. You want to prevent spread of the virus- Just Do It, it makes this possible. You want to limit damage to the economy and get the recovery going- Just Do It, it makes this possible. People of all shades of opinion can agree on this- its the only thing that works, even when there is a lack of enough proper accurate testing. ...

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Germany which handled the first wave of the coronavirus better than France or Spain with better testing and contact tracing is now facing the second wave. Following the reopening Germany went back to normal with fewer restrictions. Some Germans ignored restrictions and Germans travelled to other countries. German students in Croatia in summer tourism are reported to be part of the 21 million tourists in the country in summer that failed to follow any restrictions. The result is that Germans now fear the second wave is beginning to hit Germany.

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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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Public health experts warn that it is essential that countries reopening their economy have a reproduction ratio of much less than 1.0 so that the rate of increase is under control. Germany's Robert Koch Institute which advises the German government says the reproduction ratio which was 0.70 in mid April is now up to 0.96 after creeping back up. This is based on a mathematical model and extrapolated from infection numbers several weeks back.  It doesn't reflect the change by recent easing of lockdown measures starting with reopening smaller stores. This validates the careful approach adopted by France which was put forward by prime minister Edouard Philippe in his address to the National Assembly. The Assembly approved the plan 368 to 100. More legislation will back up the French government's authority to ban non essential travel between French departments and the creation of a large brigade to perform contract tracing. That involves finding testing and isolating everyone potentially infected, using dedicated locations. Detailed restrictions on travel, work and gatherings will take effect when France reopens partially on May 11.  France is also putting resources behind its testing program to test every person having coronavirus symptoms, and all they are in contact with. That means about 700,000 tests a week. Officials will generate a color coded map from this with red areas facing more restrictions than green areas. Student size is capped at 115 per class. Cafes, restaurants, movie theatres and large museums will remain closed. Gatherings of more than 10 banned. Those who can work from home asked to do so. Public transit users will be required to use masks, and marks on platforms will indicate the social distance required. Only essential travel is allowed more than 62 miles from home. These rules remain till June 2, when new ones will be set. Large music festivals and sporting events are canceled till the fall. Mr. Philippe says "these efforts will not be in vain and should allow us to arrange for a better summer season." ...

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A growing consensus among experts that it is not so much surface contamination as the air we breathe in that is the problem. The longer you spend time with people talking in face to face interactions, or inhaling air aerosolized in the air from small droplets, the easier it is to get the virus. This means social distancing matters in a big way. Masks are a big way to cut the risk. The worst you can do then is to be in a crowded event, ot have closeup face to face interactions for long periods. Being where there is loud talking or singing is a bad idea. This is why actions such as plexiglass installed as barrier, requiring masks in stores, using good ventilations systems and keeping windows has an enormous impact. This means that people can do a lot of work, exercize and other activities outside if one takes the basic precautions to heart and practices seriously. Contact tracing and testing, and other measures can be targeted to keep the spots that have a surge under control. ...

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Daegu in South Korea was hit early and hard by coronavirus. Now 3 months later the social distancing rules are practiced diligently and people have become used to it. Large gatherings are still banned. Daegu is South Korea's Wuhan the center of the epidemic in China,  with a city of 2.4 million having 40% of South Korea's cases. People in Daegu remain comfortable with social distancing guidelines. What they worry about is not having to practice these guidelines- these are an accepted way and it makes everyone feel safer. It also gives people in Daegu a sense that this way another upsurge is less likely to happen and drive away consumers from shops, shops then having to close. In fact preparation and disciplined approach, with backup scenario planning and continued testing for cluster isolation and quarantine following contact tracing, is giving people here an extra sense of confidence. In some areas markets and shops have gained back 80% of customers, and most shop owners want to keep it that way.  ...

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WHy did NHS Test and Trace fail to contact no more than 50% of the persons who tested positive. Why was it not able to followup with the people who needed to be visited in their homes to ensure isolation. Why was NHS associated in the name when the NHS had not been consulted and involved in the design of this service. In fact it ignored lessons from Germany where the contact tracing was entirely from local, started very quickly with the key being local or state employees who were diverted to this task and were skilled and motivated to do it. Why was this critical task simply handed out to outsource it to private companies.  Germany's example was there very early in March-April and it was working. Why reinvent the wheel. Setup quickly and entirely local it required only a desk, a desktop PC, and a national database to which PC was connected, the skilled caller being the key to getting people to talk to and cooperate. About 80% of those testing positive needed to be contacted. NHS Test and Trace was reaching about 50% and many that needed to be visited at home could not be followed up quickly. The shift is only now being made to go local. It worked in Leicester and other places but the learning came the hard way, as with many things during this pandemic. ...

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Contact tracing being setup using iphones and android phones with bluetooth technology by Apple and Google. The idea is being studied for adoption by the U.S. government. The problem is that this kind of contact tracing is not as effective as the kind used by South Korea, Taiwan and Singapore with information from cellphone carriers. Contact tracing apps would be written by developers for each country and chosen by Apple and Google one for each country. How it works- When a person comes down with symptoms he can upload the information about who he has been close to stored on the phone. This information would then be used to contact the person who was exposed to the person with symptoms but unaware of this. A message would tell that person he was exposed to someone who now has symptoms and to contact public health authorites and take effective steps. When the person with symptoms gets tested if he was positive that would also appear on a exposed person's phone without name or other information.  The normal contact tracing is time intensive requiring many phone calls and using data from cellphone carriers. This is done in Singapore, Taiwan and South Korea. It is considered to be more effective. The approach of these Asian countries is more thorough and allows effective tracing and isolation, quarantining of persons having coronavirus or having exposure in countries with rampant coronavirus. The U.S. needs to move quickly to adopt the methods used in these Asian countries. The loss of hundreds of thousands of lives should be weighed against privacy concerns and clearly there should be a way to allow one time use of personal information for coronavirus, so that this kind of information is used only in public emergency situations. All three Asian countries are democracies. Putting health care workers at great risk including working pregnant doctors, as in the story in WSJ about a hospital in Maryland, should make it clear that everything including privacy concern should be placed in context, and use of personal information be permitted in a public emergency such as a contagious virus- with information protections removal for the period of the crisis. ...