Coronavirus COVID-19 - Global Health Pandemic #49

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I keep hearing that we need testing of all workers before opening up the economy. If the US had around 130 million full time workers before the pandemic, what is the logistics for testing all of those people?

How long will it take to set up? How long will it take to complete? If we include part time workers what effect would that have on the timeline?

This would have to be an ongoing test that workers would have to take on a regular basis right? Otherwise the infection could spread again.

Seems to be a very difficult task. JMO

U.S.: Number of full-time workers 1990-2018 | Statista

I think if that's what's being suggested that it doesn't sound a very great plan. The standard for something that's contagious/communicable in this way is normally ring containment, which would mean much more targeted testing around confirmed cases, rather than testing every single person in the population.

If it was done during a lockdown with rapid testing, then the testing could focus on healthcare workers, key/essential workers, and anyone entering a hospital or other healthcare setting. Any positive tests can have the 'containment ring' placed around them using quarantine/isolation/testing...and if the people in the contact list for the positive cases obey the quarantine/isolation they don't necessarily need testing.

After that, you just need to test anyone with symptoms and combine that with strict contact tracing. An app would be very useful. I think that during the lockdown period (of my 'plan' that I am developing in my mind) then anyone working should be using a contact tracing app at least during work hours and travel to/from work hours...outside those hours the main risk would be to people in the same living quarters and it would be easy enough to find out who they are, so I think it might suffice to make it voluntary outside of the working/travel hours.

After a few weeks of that, then you could mop up smaller outbreaks with more ring containment for each case/outbreak and the rest of the country could go back to work, preferably maintaining some kind of contact records for a while, but if people are bothered by an app, that could probably be people signing in and out of the workplace or areas within the workplace, maintaining social distancing within the workplace as much as possible, and limiting the number of workers who come into close contact with each other, say by having groups of workers who work together each day and trying to maintain that group through the working week.

My thoughts on developing this 'plan' in my head are based more on the UK, and would have to involve testing anyone entering the country, possibly having anyone entering the country stay isolated for x number of days so that they can have a second test after the first in case there isn't enough antigen to trigger a positive in the first test but that builds up in the next few days. With increased testing protocols they could work out optimum times for those two tests before a person gets the all clear.

I don't know how much of this 'plan' is wishful thinking but it's based on established procedures for overcoming outbreaks. Things like Ebola didn't used to have a vaccine, so these kind of practices were the only thing that could stop outbreaks in their tracks. The major difference here is that we'd have to do this on a national level rather than isolating a few villages and towns in a single region of a nation that doesn't have a lot of national travel, let alone international travel. Even so, they achieved it in the Ebola outbreak a few years ago that was centred in several west African countries. Yes, Ebola's a totally different disease, but it's still the same general principles at work to combat an outbreak of a disease that's communicable by being in close proximity to other people.

So it can be done without vaccines, at least to reduce the size and spread of outbreaks until we get vaccines. And when vaccines do come, if they are also rolled out first to priority groups and then using ring vaccination, then you don't need as much initial supplies of vaccine in order to have a massive effect, so we could roll vaccination out over the globe without needing 7 billion+ doses right at the outset or in the first year. I don't think it's as much about reinventing the wheel but applying these principles in modern nations that aren't used to using contact tracing apps, and never before considered they could have a three-week or longer 'lockdown'. We also need human contact tracing (done by humans) on a scale we aren't used to, but that doesn't mean it can't be built up and achieved.
 
Capt Tom to be guest of honour at hospital opening

A 99-year-old war veteran who raised an incredible £25m for the NHS is to be guest of honour at the opening of a Nightingale hospital in Harrogate.

Captain Tom Moore originally aimed to raise £1,000 for NHS Charities Together by completing 100 laps of his garden before his 100th birthday.

The veteran, who was born in Keighley, West Yorkshire, will appear via video link at the opening on Tuesday.

He said it was an honour and a chance to thank NHS workers directly.

Capt Tom, who lives in Marston Moretaine in Bedfordshire, said: "I am still amazed by the amount of kindness and generosity from the UK public who continue to give despite it being an uncertain time for many.

"I think the amount raised demonstrates just how much we all value the dedication and sacrifices made by our NHS workers. I have fought during a war and they are now fighting in a war too."

NHS Charities Together said it was "truly inspired and humbled" by his efforts.

I'm looking forward to the live stream tomorrow (he's now almost at 28 million) in addition to other honors he may have bestowed upon him for his NHS/Nightingale efforts.
 
Shake Shack returning $10 million government loan meant for small businesses

The program offered to forgive the loans if recipients rehired furloughed and laid-off workers by June, and because Shake Shack and its parent company had already furloughed hundreds of employees, they said, they gambled that "the best chance of keeping our teams working, off the unemployment line and hiring back our furloughed and laid off employees, would be to apply now and hope things would be clarified in time."

But they said they had no idea the fund would dry up so quickly, so after they were able to secure separate funding last week, "we've decided to immediately return the entire $10 million" so restaurants that "need it most can get it now."

"We now know that the first phase of the PPP was underfunded, and many who need it most, haven't gotten any assistance," Meyer and Garutti wrote, urging Congress to ensure that "all restaurants no matter their size have equal ability to get back on their feet and hire back their teams."

"Our people would benefit from a $10 million PPP loan, but we're fortunate to now have access to capital that others do not," they wrote. "Until every restaurant that needs it has had the same opportunity to receive assistance, we’re returning ours."
 
Coronavirus updates: Germany eases restrictions on shops - BBC News

  1. Germany starts to reopen smaller shops after deciding the outbreak is coming under control
  2. The Czech Republic allows some markets and other small businesses to restart
  3. US oil prices drop to 21-year low as demand dries up
  4. The UK is to try to use the blood of survivors to treat patients
  5. Three beaches in Sydney re-open as New South Wales records just six new cases
  6. New York's governor says cases there are "slowing, not growing"
  7. The number of deaths in the US now exceeds 41,000
  8. There are more than 2.4m infections worldwide, with more than 165,000 deaths
Live Reporting


Edited by Paulin Kola

  1. Posted at 11:3811:38
    What is the WHO's position on masks?
    There's been a lot of debate on whether healthy people should wear masks, and many places around the world have now either made it compulsory or issued advisories. Germany for instance has become the latest country to urge its residents to wear masks in public. But what is the official advice from the World Health Organization? After a recent meeting to discuss the issue, it still maintains that medical masks should be reserved only for healthcare workers and not for the general public.

    The BBC's health correspondent Laura Foster explains the WHO's position and the scientific argument behind it.

    Video content
    02:13
    Video caption: Should I wear a mask to stop coronavirus?
 
Warning over Irish 'complacency', shops and schools in Germany begin re-opening: Today's Covid-19 main points

HEALTH MINISTER SIMON Harris has expressed concerns that “some complacency” is becoming apparent in the response of Irish people to the Covid-19 crisis.

In a video message on Twitter last night, Harris urged people not to relax their interpretation of the phrase ‘stay at home’ and to abide by the 2km rule when exercising, warning that not doing so could be “disastrous” for the country.

His comments came as health officials confirmed another 39 deaths from the virus last night, bringing the total number of deaths from Covid-19 in Ireland to 610.

Here are today’s main Covid-19 points:

  • Health officials confirmed an additional 39 deaths from Covid-19 in Ireland last night. The total number of confirmed cases now stands at 15,251 and 610 people have died.
  • Minister for Health Simon Harris has warned that ”some complacency” may be setting in among the Irish public regarding attempts to fight the spread of the coronavirus.
  • Campaigners have warned that domestic abuse charities remain seriously underfunded despite a government campaign urging victims to reach out for help.
  • The Banking and Payments Federation Ireland has said that banks will be able to extend the period for which its customers have secured mortgage approval during the current outbreak.
 
I think if that's what's being suggested that it doesn't sound a very great plan. The standard for something that's contagious/communicable in this way is normally ring containment, which would mean much more targeted testing around confirmed cases, rather than testing every single person in the population.

If it was done during a lockdown with rapid testing, then the testing could focus on healthcare workers, key/essential workers, and anyone entering a hospital or other healthcare setting. Any positive tests can have the 'containment ring' placed around them using quarantine/isolation/testing...and if the people in the contact list for the positive cases obey the quarantine/isolation they don't necessarily need testing.

After that, you just need to test anyone with symptoms and combine that with strict contact tracing. An app would be very useful. I think that during the lockdown period (of my 'plan' that I am developing in my mind) then anyone working should be using a contact tracing app at least during work hours and travel to/from work hours...outside those hours the main risk would be to people in the same living quarters and it would be easy enough to find out who they are, so I think it might suffice to make it voluntary outside of the working/travel hours.

After a few weeks of that, then you could mop up smaller outbreaks with more ring containment for each case/outbreak and the rest of the country could go back to work, preferably maintaining some kind of contact records for a while, but if people are bothered by an app, that could probably be people signing in and out of the workplace or areas within the workplace, maintaining social distancing within the workplace as much as possible, and limiting the number of workers who come into close contact with each other, say by having groups of workers who work together each day and trying to maintain that group through the working week.

My thoughts on developing this 'plan' in my head are based more on the UK, and would have to involve testing anyone entering the country, possibly having anyone entering the country stay isolated for x number of days so that they can have a second test after the first in case there isn't enough antigen to trigger a positive in the first test but that builds up in the next few days. With increased testing protocols they could work out optimum times for those two tests before a person gets the all clear.

I don't know how much of this 'plan' is wishful thinking but it's based on established procedures for overcoming outbreaks. Things like Ebola didn't used to have a vaccine, so these kind of practices were the only thing that could stop outbreaks in their tracks. The major difference here is that we'd have to do this on a national level rather than isolating a few villages and towns in a single region of a nation that doesn't have a lot of national travel, let alone international travel. Even so, they achieved it in the Ebola outbreak a few years ago that was centred in several west African countries. Yes, Ebola's a totally different disease, but it's still the same general principles at work to combat an outbreak of a disease that's communicable by being in close proximity to other people.

So it can be done without vaccines, at least to reduce the size and spread of outbreaks until we get vaccines. And when vaccines do come, if they are also rolled out first to priority groups and then using ring vaccination, then you don't need as much initial supplies of vaccine in order to have a massive effect, so we could roll vaccination out over the globe without needing 7 billion+ doses right at the outset or in the first year. I don't think it's as much about reinventing the wheel but applying these principles in modern nations that aren't used to using contact tracing apps, and never before considered they could have a three-week or longer 'lockdown'. We also need human contact tracing (done by humans) on a scale we aren't used to, but that doesn't mean it can't be built up and achieved.

I think this plan below is similar to yours? There’s even “an app for that.” It would require a tremendous and whole-hearted commitment and organization from the White House and lots of money and patience to accomplish. I don’t see any indication of that happening. And maybe I don’t have enough confidence in the American people to cooperate with the contact tracing and possible isolation, but given the desire to open the economy quickly, I’m afraid there would be resistance. The following is a portion of a very complete article or two...

In a report titled "Roadmap to Pandemic Resilience," set to be released on Monday, a blue-ribbon panel of thought leaders across the political spectrum called COVID-19 "a profound threat to our democracy, comparable to the Great Depression and World War II."

"It's a moment for a 'Can Do America' to really show up and put itself to work," Danielle Allen, lead author of the report and a professor at Harvard University's Edmond J.Safra Center on Ethics, told ABC News.

The report says that ending the quarantine safely will require testing, tracing, and supported isolation, a combination known by the acronym TTSI.

"What people need to recognize is that a massively scaled-up testing, tracing and supported isolation system is the alternative to national quarantine," Allen said. "We all had to learn PPE [Personal Protective Equipment] and we all had to learn about flattening the curve ... now we have to learn about TTSI."
<snip>
The report details 4 specific phases to reopening the economy and ending the lockdown:

Phase 1: (May-June) 40% of the population -- including all essential workers (health care workers, firemen, police, sanitation, etc) -- will be tested and their contacts traced.

Phase 2: (June-July) 70% of the population goes back to work -- including workers directly supporting the health sector, such as delivery, service, construction workers, building engineers, maintenance and food workers. The government makes massive infrastructure investments.

Phase 3: (July-Aug) 80% of the population is back to work, including those who must work at locations and in offices.

Phase 4: (Aug-March) All workers return to work and schools reopen. Continue to take precautions until a vaccine is widely available, but the lockdown is over.
BBM

A graphic showing how this would work at this link:
Pandemic Resilience Roadmap

'Road map' to recovery report: 20 million coronavirus tests per day needed to fully open economy

The US economy can't reopen without widespread coronavirus testing. Getting there will take a lot of work and money

Cuomo says:
Cuomo: Millions and millions of tests needed to open economy
 
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Here's one of today's Dr. Campbell's videos for ya.... ask, and ye shall receive it seems with Dr. Seheult and Dr. Campbell. We talk about an item, they cover the next day! I'll do an ETA after watching to see if your question is answered. (I would expect most immunosufficient folks to clear in the same amount of time of the virus... most under 14 days/quarantine but about UP TO 21-28 days or less? MOO/no links - but these two guys HAVE covered such subject previously but I cannot find the link)

Perhaps WHO will speak to such today as this question is now coming up more often... and goes against their original stance that asymptomatic spread was not a driver. They may want to do a 180 on that now and clarify?

Asymptomatic spread and 2 different ships

Thank you @dixiegirl (and my apologies many strings ago calling you DixieQueen). But, I really do love to listen to Dr. Campbell every day. He is spending more and more time on the asymptomatic and presymptomatic, and he is using excellent studies to discuss. This big question does remain however---how long one stays asymtomatic. We have to get closer and closer to understanding that. I could see efforts "to open up more" with an age-stepped approach with constant temperature measuring, and hopefully testing. That would certainly be a first in the US, and would touch some real civil liberties. It could easily be called "age discrimination" instead of "age protection". But if "older" became a protected class for a while, I could see it happening. As long as they did not get discriminated against, when they came back into the workforce... I do shudder to think about this, but am thinking about this none the less.
 
Just be sure to do your research first. Know exactly what this entails before jumping in. I love caring for chickens, but it would be a royal pain if I didn't. You need to be there at sun-up and sundown every day unless you can afford fancy remote control doors or have people who are willing to do it for you on a regular basis .
I was so lucky living on a farm in NH for so long with free range chickens who had two big covered pens on different parts of the property...and they became "self trained" to go back at night. So all we had to do was lock the gates, to protect them from the many predators that did take a lot of them over the years. I tried to research having chickens here in north FL.... but it was just too hard, and now our county forbids in my part of the county. People were so angry about the new laws a few years back...and they are rumbling very loudly again.... And such loud pro and con about opening the beaches as well. What feels so hard to accept right now is this breaking down of "we are all in this together".. Lots of "old arguments" are re-brewing. New stories in many parts of the world are showing this.... I hope we can just try harder to get back to "we are all in this together"
 
We have a wind power factory in our city that produces wind turbine blades. 800 people work there. None them have been wearing PPE. A few days ago, they had a drive through testing of 400 of the employees. Approximately 122 tested positive for the virus. The plant is shut down for cleaning and all the employees have been ordered to stay home and self quarantine for 2 weeks. However, anyone who lives in the household where any of these employees are living, are not required to self quarantine. Does that make any sense?

At the beginning of last week, we had a total of 11 people test positive in our county so far. Now we have 133.

Next week they're going to test the other 400.
That does seem like quite a rapid rise in just one week. Did they give any stats on asymptomatic?
 
No Fontenot peppers but my husband grows Tabasco peppers. He makes chow chow. It’s his favorite pepper. His family had a pepper business for 2 generations. I’ll have to ask him about Fontenot peppers. There are a bunch of Fontenot (people) in my area. Good old Cajun name.
When I went to buy peppers...I just got so confused, so waited until i could research. I know I don't like "hot peppers", I am really a wimp when it comes to peppers. But I really did wonder if the tabasco ones are really that hot, and if they really have a tabascoey flavor. I would appreciate any wisdom on this. I am looking for something flavorful, but very very light on the "hot". Sortof sounds like why bother, eh? But I would appreciate some wisdom here.
The Villages is not in Broward County. Most of The Villages is in Sumter County, extending into Lake and Marion Counties. It is where I live, which some posters have no doubt guessed.

We are doing quite well. I believe we have fewer than 114 cases, with a population of @ 120,000. Our regional hospital leaves a lot to be desired. I would go to Ocala if I had a choice.

The overwhelming majority of peeps are taking this seriously.
I have felt that you are getting good services there in the Villages. And some research projects going on as well. Palm Beach County is what is so striking, with the death rate. I am just not so sure why it is so different than Broward and the counties to the North. I mean, there is such a heavy concentration of higher age, snow birds etc.... but why is PBC so high in overall as well as death rate? Do you hear more about this.
 
They could start with requiring Hepa Filters (high quality) in their ventilation systems. The difference in price between a regular filter and a Hepa Filter is about $2000-5000 a year for most larger buildings. Environmental control companies come in and fit new filters, then the business has to continue to change them out. THey should be inspected and they should be mandated to have them.

But this is not the kind of thing that the federal government usually does, and it is certainly antithetical to everything regulatory that the current administration favors. So it has to be cities, counties and states that enact those requirements.

Which is actually EASIER to do and people should go to their City Councils and demand it (by Zoom if need be) But instead, some people just demand we "reopen" everything with no changes.

If those same people would go to their City Councils, County Boards and State Legislators and focus on each needed change individually, they would be helpful. Instead of hindering the entire recovery from this.

That one change (plus mandated testing for the employees - and temperature checks for employees) would change the situation dramatically. Then...a reduction in beds per facility (that means less profit though - and you know how some people hate that).

If outgoing air goes directly outside, and incoming air comes directly from outside and those vents are not near one another, how does air get from one room to another through the ventilation system? I can understand that viruses can be found in the outgoing ventilation system, but shouldn't there be constant movement toward the outside?
 
Common sense and rigid adherence is my first guess. But there are other reasons, too (rapidity of response is probably the big one).

In China, severity and rigidity of lockdown was key. In Japan, people locked themselves down with haste - they have a different history than the US, the reasons are many. Japan was fast (like the Republic of Georgia - which also remembers its history), Japan had voluntary compliance and knew what to do. Contact testing fully operational in China, Japan and Germany.

It IS skyrocketing in Sweden - where are you hearing otherwise? They just decided to do it that way. They aren't a very big country, but their curve was exponential (skyrocketing) until at least yesterday. For the first 11 days it was steep and is now leveling off:

Coronavirus Disease (COVID-19) – Statistics and Research

Sweden and China are really two extremes, with different outcomes in terms of who is dying and how fast.

Germany is very interesting and closer to our culture in the US, much to be learned there. But apparently social distancing is built into the German culture in some ways (same with all the Northern European nations...)
There was an article about Sweden a few threads back. Made me really want to keep up with Sweden over the long haul to see how their more open approach works.
One of the statistics in that article still has me curious, and am hoping someone can address. The statement said "over 40% of the population lives alone". I can see how this does, in fact, influence lower infection rates. But how does Swedish culture explain this. Minimal multi-generational families? Divorce? Low birth rates? Knowledge welcome.
 
When will a second wave of the coronavirus hit, and what will it look like?
Coronavirus: Herd immunity, vaccines will determine COVID second wave

“Until there’s a vaccine “it’s unfortunately not unlikely that we may see a second wave or even a third wave,” said Peter Marks, director of the U.S. Food and Drug Administration’s Center for Biologics Evaluation and Research, which oversees vaccines.

“I shudder to think of that, but I think we have to be realistic."”
-more at link
 
I think this plan below is similar to yours? There’s even “an app for that.” It would require a tremendous and whole-hearted commitment and organization from the White House and lots of money and patience to accomplish. I don’t see any indication of that happening. And maybe I don’t have enough confidence in the American people to cooperate with the contact tracing and possible isolation, but given the desire to open the economy quickly, I’m afraid there would be resistance. The following is a portion of a very complete article or two...

In a report titled "Roadmap to Pandemic Resilience," set to be released on Monday, a blue-ribbon panel of thought leaders across the political spectrum called COVID-19 "a profound threat to our democracy, comparable to the Great Depression and World War II."

"It's a moment for a 'Can Do America' to really show up and put itself to work," Danielle Allen, lead author of the report and a professor at Harvard University's Edmond J.Safra Center on Ethics, told ABC News.

The report says that ending the quarantine safely will require testing, tracing, and supported isolation, a combination known by the acronym TTSI.

"What people need to recognize is that a massively scaled-up testing, tracing and supported isolation system is the alternative to national quarantine," Allen said. "We all had to learn PPE [Personal Protective Equipment] and we all had to learn about flattening the curve ... now we have to learn about TTSI."
<snip>
The report details 4 specific phases to reopening the economy and ending the lockdown:

Phase 1: (May-June) 40% of the population -- including all essential workers (health care workers, firemen, police, sanitation, etc) -- will be tested and their contacts traced.

Phase 2: (June-July) 70% of the population goes back to work -- including workers directly supporting the health sector, such as delivery, service, construction workers, building engineers, maintenance and food workers. The government makes massive infrastructure investments.

Phase 3: (July-Aug) 80% of the population is back to work, including those who must work at locations and in offices.

Phase 4: (Aug-March) All workers return to work and schools reopen. Continue to take precautions until a vaccine is widely available, but the lockdown is over.
BBM

A graphic showing how this would work at this link:
Pandemic Resilience Roadmap

'Road map' to recovery report: 20 million coronavirus tests per day needed to fully open economy

The US economy can't reopen without widespread coronavirus testing. Getting there will take a lot of work and money

Cuomo says:
Cuomo: Millions and millions of tests needed to open economy

From your link...

"Among the report’s top recommendations is the need to deliver at least 5 million tests per day by early June to help ensure a safe social opening. This number will need to increase to 20 million tests per day by mid-summer to fully re-mobilize the economy."

IMHO, (acknowledging that delivering tests is not the same as having tests completed) to have 20 million tests per day.... 0% of that happening... therefore will be discounted as an option.

And Dr. Campbell has just uploaded his second video for today

 
I bought some of those for the first time this year. I planted potatoes in them. I can't wait to see how well they work. There's this guy on youtube that grows everything in the grow bags and uses baby pools to make them self watering. I'm not doing it with my potatoes but I thought it was fascinating. Search "Kiddie Pool Grow Bag System" and you should find lots of interesting videos on the watering method.

ETA: @CSIDreamer I meant to quote you too. :oops:
And following your input, Gardner, I have bought some too. .. I am doing a number of veggies..not potatoes though. My tomato plants are in them and growing nicely. We will have to compare growing notes down the road into summer... But now I want to research the kiddie pool.. my puppy dog might not be happy...but I do have one.
 
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Thank you @dixiegirl (and my apologies many strings ago calling you DixieQueen). But, I really do love to listen to Dr. Campbell every day. He is spending more and more time on the asymptomatic and presymptomatic, and he is using excellent studies to discuss. This big question does remain however---how long one stays asymtomatic. We have to get closer and closer to understanding that. I could see efforts "to open up more" with an age-stepped approach with constant temperature measuring, and hopefully testing. That would certainly be a first in the US, and would touch some real civil liberties. It could easily be called "age discrimination" instead of "age protection". But if "older" became a protected class for a while, I could see it happening. As long as they did not get discriminated against, when they came back into the workforce... I do shudder to think about this, but am thinking about this none the less.

I'm not @dixiegirl ... another member has my first part of my name/avatar which I didn't even know until you posted this... not to be confused with me as I am @dixiegirl1035 and never even saw the reference to dixiequeen lol.

I too listen to every single Dr. Campbell and Dr. Seheult video. So much of a learning curve I have done...
 
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[rsbm]
What feels so hard to accept right now is this breaking down of "we are all in this together".. Lots of "old arguments" are re-brewing. New stories in many parts of the world are showing this.... I hope we can just try harder to get back to "we are all in this together"

Last night I was gleaning the reports from South Korea to find out how their practices are the same as our and different than ours. What can we learn from their success? What were their challenges?

At the time of writing the article below, S.Korea had the highest incidence of CoV19 outside of China. The writer divides his findings into the Good, the Bad. and the Ugly.

The Good included having a consistent standard operating procedure (SOP). This was carried out in five steps:
-an aggressive and transparent information campaign
-high volume testing
-quarantine of infected individuals
-treatment of those in need
-and disinfection of contaminated environments

The information campaign was constant, over all media, and gave clarity to what the people needed to do. It helped prevent misinformation and unhelpful practices.

The Bad was that S. Korea experienced their own group of people who would not comply. They were mostly seniors who were suspicious of the SOP, with low science literacy, and with strong political and religious leanings that came into conflict with the SOP. It was interesting in that the younger people were called upon to assist the seniors in compliance.

The Ugly consisted of politicization of the outbreak in the media. S. Korea was on the cusp of an election (held April 15th). Negative political coverage made compliance to the SOP more difficult.

One thing S. Korea learned was that it was vital to bring the religious leaders into the discussion well before an outbreak and to garner their cooperation with containment efforts.

Lessons From South Korea’s COVID-19 Outbreak: The Good, Bad, and Ugly
 
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