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The painting shown in Dr. López Prater’s class is in one of the earliest Islamic illustrated histories of the world, “A Compendium of Chronicles,” written during the 14th century by Rashid-al-Din (1247-1318).Shown regularly in art history classes, the painting shows a winged and crowned Angel Gabriel pointing at the Prophet Muhammad and delivering to him the first Quranic revelation. Muslims believe that the Quran comprises the words of Allah dictated to the Prophet Muhammad through the Angel Gabriel.

The image is “a masterpiece of Persian manuscript painting,” said Christiane Gruber, a professor of Islamic art at the University of Michigan. It is housed at the University of Edinburgh; similar paintings have been on display at places like the Metropolitan Museum of Art. And a sculpture of the prophet is at the Supreme Court.Dr. Gruber said that showing Islamic art and depictions of the Prophet Muhammad have become more common in academia, because of a push to “decolonize the canon” — that is, expand curriculum beyond a Western model.

Dr. Gruber, who wrote the essay in New Lines Magazine defending Dr. López Prater, said that studying Islamic art without the Compendium of Chronicles image “would be like not teaching Michaelangelo’s David.”

Yet, most Muslims believe that visual representations of Muhammad should not be viewed, even if the Quran does not explicitly prohibit them. The prohibition stems from the belief that an image of Muhammad could lead to worshiping the prophet rather than the god he served.

There are, however, a range of beliefs. Some Muslims distinguish between respectful depictions and mocking caricatures, while others do not subscribe to the restriction at all.

Omid Safi, a professor of Asian and Middle Eastern Studies at Duke University, said he regularly shows images of the Prophet Muhammad in class and without Dr. López Prater’s opt-out mechanisms. He explains to his students that these images were works of devotion created by pious artists at the behest of devout rulers.“That’s the part I want my students to grapple with,” Dr. Safi said. “How does something that comes from the very middle of the tradition end up being received later on as something marginal or forbidden?”

Dr. López Prater, a self-described art nerd, said she knew about the potential for conflict on Oct. 6, when she began her online lecture with 30 or so students.She said she spent a few minutes explaining why she was showing the image, how different religions have depicted the divine and how standards change over time.“I do not want to present the art of Islam as something that is monolithic,” she said in an interview, adding that she had been shown the image as a graduate student. She also showed a second image, from the 16th century, which depicted Muhammad wearing a veil.

Dr. López Prater said that no one in class raised concerns, and there was no disrespectful commentary.

After the class ended, Ms. Wedatalla, a business major and president of the university’s Muslim Student Association, stuck around to voice her discomfort.Immediately afterward, Dr. López Prater sent an email to her department head, Allison Baker, about the encounter; she thought that Ms. Wedatalla might complain.Ms. Baker, the chair of the digital and studio art department, responded to the email four minutes later.“It sounded like you did everything right,” Ms. Baker said. “I believe in academic freedom so you have my support.”

As Dr. López Prater predicted, Ms. Wedatalla reached out to administrators. Dr. López Prater, with Ms. Baker’s help, wrote an apology, explaining that sometimes “diversity involves bringing contradicting, uncomfortable and coexisting truths into conversation with each other.”

Ms. Wedatalla declined an interview request, and did not explain why she had not raised concerns before the image was shown. But in an email statement, she said images of Prophet Muhammad should never be displayed, and that Dr. López Prater gave a trigger warning precisely because she knew such images were offensive to many Muslims. The lecture was so disturbing, she said, that she could no longer see herself in that course.

Four days after the class, Dr. López Prater was summoned to a video meeting with the dean of the college of liberal arts, Marcela Kostihova.

Dr. Kostihova compared showing the image to using a racial epithet for Black people, according to Dr. López Prater.“It was very clear to me that she had not talked to any art historians,” Dr. López Prater said.

A couple of weeks later, the university rescinded its offer to teach next semester.

Dr. López Prater said she was ready to move on. She had teaching jobs at other schools. But on Nov. 7, David Everett, the vice president for inclusive excellence, sent an email to all university employees, saying that certain actions taken in an online class were “undeniably inconsiderate, disrespectful and Islamophobic.”

Dr. López Prater, who had only begun teaching at Hamline in the fall, said she felt like a bucket of ice water had been dumped over her head, but the shock soon gave way to “blistering anger at being characterized in those terms by somebody who I have never even met or spoken with.” She reached out to Dr. Gruber, who ended up writing the essay and starting the petition.

At the Dec. 8 forum, which was attended by several dozen students, faculty and administrators, Ms. Wedatalla described, often through tears, how she felt seeing the image.“Who do I call at 8 a.m.,” she asked, when “you see someone disrespecting and offending your religion?”Other Muslim students on the panel, all Black women, also spoke tearfully about struggling to fit in at Hamline. Students of color in recent years had protested what they called racist incidents; the university, they said, paid lip service to diversity and did not support students with institutional resources.

“Dr Seuss Enterprises has made a moral decision of choosing not to profit from work with racist caricature in it and they have taken responsibility for the art they are putting into the world and I would support that,” Nel said.

“Dr Seuss Enterprises has made a moral decision of choosing not to profit from work with racist caricature in it and they have taken responsibility for the art they are putting into the world and I would support that,” Nel said.

The titles in question are And to Think That I Saw It on Mulberry Street, If I Ran the Zoo, McElligot’s Pool, On Beyond Zebra!, Scrambled Eggs Super! and The Cat’s Quizzer

Nel said the decision to no longer publish titles including caricatures of people of African, Asian and Arab descent showed just one way to address problematic material.

After this week’s announcement, amid uproar eagerly stoked by conservatives in the media and Congress, Dr Seuss books swiftly dominated sales charts. On Friday, the House minority leader, Kevin McCarthy, went so far as to share a video of himself reading from Green Eggs and Ham, a perennial strong seller.

Geisel’s stepdaughter, Lark Grey Dimond-Cates, told the New York Post there “wasn’t a racist bone in that man’s body”, but also said suspending publication of the six titles was “a wise decision”.

Geisel’s stepdaughter, Lark Grey Dimond-Cates, told the New York Post there “wasn’t a racist bone in that man’s body”, but also said suspending publication of the six titles was “a wise decision”

Nel said the decision to no longer publish titles including caricatures of people of African, Asian and Arab descent showed just one way to address problematic material.

After this week’s announcement, amid uproar eagerly stoked by conservatives in the media and Congress, Dr Seuss books swiftly dominated sales charts. On Friday, the House minority leader, Kevin McCarthy, went so far as to share a video of himself reading from Green Eggs and Ham, a perennial strong seller.

Later in life, he made efforts to tone down racial stereotypes in some of his books. Such revisions “were imperfect but will-intentioned efforts that softened but did not erase the stereotyping”, Nel said, noting that Geisel also made a joke of the changes, “which served only to trivialise the importance of the alterations”.

Geisel died in 1991. Later in life, he made efforts to tone down racial stereotypes in some of his books. Such revisions “were imperfect but will-intentioned efforts that softened but did not erase the stereotyping”, Nel said, noting that Geisel also made a joke of the changes, “which served only to trivialise the importance of the alterations”.

“Children understand more than they can articulate,” he said. “If you inflict racist images on them before they can express what they’re articulating they may endure a harm they cannot process.”In the case of Dr Seuss, Nel said, that “is itself a reason to withdraw the books or to bring in books or art that counter stereotypes with truth.”

“Children understand more than they can articulate,” he said. “If you inflict racist images on them before they can express what they’re articulating they may endure a harm they cannot process.”

In the case of Dr Seuss, Nel said, that “is itself a reason to withdraw the books or to bring in books or art that counter stereotypes with truth.”

only 22% of children’s books published in 2018 featured non-white characters.

only 22% of children’s books published in 2018 featured non-white characters.

Merely putting the question of what a child can or cannot see to parents would not be an adequate solution, Nel said.“Parents may not have training in anti-racist education,” he said, “or may not know how to have these conversations. So in the case of Dr Seuss it’s a way of addressing the gap in what one might hope a responsible adult would know and what we can expect a responsible adult to know.

“Parents may not have training in anti-racist education,” he said, “or may not know how to have these conversations. So in the case of Dr Seuss it’s a way of addressing the gap in what one might hope a responsible adult would know and what we can expect a responsible adult to know

Security concerns, moreover, keep most information about stockpile purchases under wraps. Details about the contracts and inventory are rarely made public, and even the storage locations are secret.

Former Emergent employees, government contractors, members of Congress, biodefense experts and current and former officials from agencies that oversee the stockpile described a deeply dysfunctional system that contributed to the shocking shortages last year.

Purchases are supposed to be based on careful assessments by government officials of how best to save lives, but many have also been influenced by Emergent’s bottom line

The stockpile has long been the company’s biggest and most reliable customer for its anthrax vaccines, which expire and need to be replaced every few years.

In the two decades since the repository was created, Emergent’s aggressive tactics, broad political connections and penchant for undercutting competitors have given it remarkable sway over the government’s purchasing decisions related to the vaccines

While national security officials still consider anthrax a threat, it has not received specific mention since 2012 in the intelligence community’s annual public assessment of dangers facing the country, a report that has repeatedly warned of pandemics.

Emergent bought the license for the country’s only approved anthrax vaccine in 1998 from the State of Michigan. Over time, the price per dose the government agreed to pay Emergent increased nearly sixfold, accounting for inflation, contributing to record revenues last year that topped $1.5 billion

The company, whose board is stocked with former federal officials, has deployed a lobbying budget more typical of some big pharmaceutical companies

Competing efforts to develop a better and cheaper anthrax vaccine, for example, collapsed after Emergent outmaneuvered its rivals, the documents and interviews show.

preparations for an outbreak like Covid-19 almost always took a back seat to Emergent’s anthrax vaccines

the government approved a plan in 2015 to buy tens of millions of N95 respirators — lifesaving equipment for medical workers that has been in short supply because of Covid-19 — but the masks repeatedly lost out in the competition for funding over the years leading up to the pandemic

After Dr. Frieden and others in the Obama administration tried but failed to lessen Emergent’s dominance over stockpile purchases, the company’s fortunes rose under Mr. Trump, who appointed a former Emergent consultant with a background in bioterrorism to run the office that now oversees the stockpile

“If I could spend less on anthrax replenishment, I could buy more N95s,” Dr. Kadlec said in an interview shortly after leaving office. “I could buy more ventilators. I could buy more of other things that quite frankly I didn’t have the money to buy.”

And now, as some members of Congress push for larger reserves of ventilators, masks and other equipment needed in a pandemic, a trade group led in part by a top Emergent lobbyist has warned that the purchases could endanger companies focused on threats like anthrax and smallpox by drawing down limited funds.

Last year, as the pandemic raced across the country, the government paid Emergent $626 million for products that included vaccines to fight an entirely different threat: a terrorist attack using anthrax.

“I think it’s pretty clear that the benefit of the vaccine is marginal,” he said in an interview

“They’re very vicious in their behavior toward anybody they perceive as having a different point of view,” said Dr. Tara O’Toole, a former Homeland Security official who says she ran afoul of Emergent in 2010 after telling Congress that the nation needed a newer and better anthrax vaccine.

That year, the company that would become Emergent — then known as BioPort — paid Michigan $25 million to buy the license for a government-developed anthrax vaccine and an aging manufacturing plant.

The company opened its doors with one product, called BioThrax, and one customer, the Defense Department, which required the vaccine for service members.

Emergent’s anthrax vaccine was not the government’s first choice. It was more than 30 years old and plagued by manufacturing challenges and complaints about side effects. Officials instead backed a company named VaxGen, which was developing a vaccine using newer technology licensed from the military.

Emergent’s successful campaign against VaxGen — deploying a battalion of lobbyists, publicly attacking its rival and warning that it might cease production of its own vaccine if the government didn’t buy it — established its formidable reputation. By 2006, VaxGen had lost its contract and the government had turned to Emergent to supply BioThrax.

“They were totally feared by everybody,” Dr. Philip Russell, a top health official in the administration of President George W. Bush, said in an interview. He said that he clashed with Emergent when he backed VaxGen, and that his reputation came under attack, which was documented by The Times in 2006. (Dr. Russell died this January.)

the group of federal officials who make decisions about the stockpile and other emergency preparations — known as the Phemce, for the Public Health Emergency Medical Countermeasures Enterprise — ordered up a study. It found in 2010 that the government could not afford to devote so much of its budget to a single threat.

Instead, the review concluded, the government should invest more in products with multiple applications, like diagnostic tests, ventilators, reusable respirator masks and “plug and play” platforms that can rapidly develop vaccines for a range of outbreaks.

from 2010 through 2018, the anthrax vaccine consumed more than 40 percent of the stockpile’s budget, which averaged $560 million during those years.

Emergent and the government have withheld details of the stockpile contracts, including how much the company has charged for each dose of BioThrax, but executives have shared some of the missing information with investors.

The company in 1998 agreed to charge the government an average of about $3.35 per dose, documents show. By 2010, the price had risen to about $28, according to financial disclosures and statements by Emergent executives, and now it is about $30

Over the past 15 years, the company recorded a gross profit margin of about 75 percent for the vaccine, in an arrangement that one Emergent vice president called a “monopoly.”

Emergent’s rise is the stuff of lore in biodefense circles — a tale of savvy dealings, fortuitous timing and tough, competitive tactics.

One afternoon in October 2010, Wall Street investors gathered at the Millennium Broadway Hotel in Manhattan for a presentation by Mr. Burrows. He shared with them a secret number: 75 million.That was how many BioThrax doses the government had committed to stockpiling, and it was the backbone of Emergent’s thriving business. In pursuit of that goal, the government had already spent more than $900 million, and it continued to buy virtually every dose Emergent could produce. It had even awarded the company more than $100 million to expand its Michigan factory.

“The best approach toward anthrax is antimicrobial therapy,” Dr. Anthony S. Fauci, the government’s top infectious-disease expert, told Congress as early as 2007.

In an analysis published in 2007, the firm determined that giving antibiotics immediately after a large outdoor anthrax attack was likely to reduce serious illnesses by more than 80 percent. Administering the vaccine would then cut serious illnesses only by an additional 4 percent.

Dr. Ali S. Khan, who ran the C.D.C. office managing the stockpile until 2014, said bluntly: “We overpaid.”

“A bunch of people, including myself, were sitting in a room and asking what kind of attack might happen,” said Dr. Kenneth Bernard, a top biodefense adviser to Mr. Bush, recalling a meeting in the months after the 2001 attacks.

“And somebody said, ‘Well, I can’t imagine anyone attacking more than three cities at once,’” he said. “So we took the population of a major U.S. city and multiplied by three.”

A team of Homeland Security and health officials began doing just that in 2013. The group determined, in a previously undisclosed analysis, that the government could stockpile less BioThrax and still be prepared for a range of plausible attacks, according to two people involved in the assessment. Separately, government researchers concluded that two doses of BioThrax provided virtually the same protection as three.

the National Intelligence Council, which helped draft the assessments during Mr. Obama’s second term, said in an interview that the idea of a three-city attack affecting 25 million people was “straining credulity.”

“If you talk to the head of the House Intelligence Committee,” Don Elsey, Emergent’s chief financial officer, told investors in 2011, “and you say, ‘What are you most worried about?’ he’ll say, ‘Let me see: Number one, anthrax; number two, anthrax; number three, anthrax.’”

Emergent’s sales strategy was to address that fear by promising the federal government peace of mind with its vaccine.

“There’s a political element involved,” Mr. Burrows, the company’s vice president of investor relations, said at an industry conference in 2016. “I don’t have a marketing expense. I have lobbying expense.”

Since 2010, the company has spent an average of $3 million a year on lobbying — far outspending similarly sized biotech firms, and roughly matching the outlays of two pharmaceutical companies with annual revenues at least 17 times greater, AstraZeneca and Bristol Myers Squibb

In 2015, as stockpile managers questioned the large purchases of BioThrax, the spending topped $4 million

“They were pouring it on — how poor they were and how this was going to ruin the company, and they’d have to close down factories, and America was going to be left without anthrax vaccine,”

“Their revolving door is moving at 60 miles per hour,” said former Senator Claire McCaskill, a Democrat from Missouri who had questioned spending on the vaccine while in the Senate. “There is really a lot of incestuousness because it’s such a specialized field.”

Ms. DeLorenzo, the Emergent spokeswoman, said the lobbying was necessary because government investment “in biodefense and other public health threats has not been as strongly prioritized as it should be.”

Over the past 10 years, Emergent’s political action committee has spread almost $1.4 million in campaign contributions among members of both partie

The move followed a yearslong pattern of retaining a bipartisan lobbying corps of former agency officials, staff members and congressmen, including Pete Hoekstra of Michigan, Tom Latham of Iowa and Jim Saxton of New Jersey.

“You have people coming and saying, ‘There’s no market for this — nobody’s going to produce this unless you buy enough of it to keep the production line open,’” he said. “It’s an absolutely appropriate argument to make.”

Emergent’s campaign proved effective. Despite the 2015 recommendation by the stockpile managers, Senate overseers made clear they opposed the reduction, and the government went ahead and bought $300 million worth of BioThrax.

Emergent executives, meanwhile, warned that there could be job losses at the factory in Lansing, Mich. — the capital of a swing state at the center of a contentious presidential campaign between Mr. Trump and Hillary Clinton.

Because Emergent was the sole manufacturer of a product deemed critical to national security, the company has played what one former executive described to The Times as “the we’re-going-to-go-bankrupt card.”

Dr. Hatchett said the idea gave him pause. But, he explained in an interview, “if there’s only one partner that can provide a product and only one customer for that product, the customer needs the partner to survive.”

Just a year later, Emergent spent about $200 million in cash, and made other financial commitments, to acquire Sanofi’s smallpox vaccine and GlaxoSmithKline’s anthrax treatment, two products with established pipelines to the stockpile. The purchases expanded Emergent’s hold over the reserve.

Ms. DeLorenzo said the acquisitions did not suggest the company was better off than it had claimed, but Dr. Bright said he and others involved in the bailout felt used.

a plan five years earlier to create an emergency supply of N95 respirators was simply not funded. A team of experts had proposed buying tens of millions of the masks to fill the gap during an outbreak until domestic manufacturing could ramp up, according to five officials involved in the assessment, which has not been previously disclosed.

By the time the novel coronavirus emerged, the stockpile had only 12 million of the respirators. The stockpile has since set a goal of amassing 300 million.

Dr. Kadlec, the Trump administration official overseeing the stockpile, said he used the previous administration’s mask recommendation to raise alarms as early as 2018.

Dr. Annie De Groot, chief executive of the small vaccine company EpiVax, spoke about the need to break Emergent’s lock on research dollars at a biodefense forum in 2015.

“Politicians want to look like they’ve addressed the problem,” she said. “But we need to actually listen to the scientists.”

Over the last five years, Emergent has received nearly a half-billion dollars in federal research and development funding, the company said in its financial disclosures.

“We know ahead of time when funding opportunities are going to come out,” Barbara Solow, a senior vice president, told investors in 2017. “When we talk to the government, we know how to speak the government’s language around contracting.”

The company used federal money to make improvements to BioThrax, and also found a way to earn government money from a competing anthrax vaccine it had excoriated. After the demise of VaxGen in 2006, Emergent bought the company’s unfinished vaccine and in 2010 persuaded the federal government to continue paying for research on it

By the time the research contract was canceled in 2016, Emergent had collected about $85 million, records show. The company then shelved the vaccine. “If the U.S. government withdraws funding, we re-evaluate whether there is any business case for continuing,” Ms. DeLorenzo said.

For more than 30 years, the government had been encouraging the development of a BioThrax replacement. In 2002, the Institute of Medicine had concluded that an alternative based on more modern technology was “urgently needed.” By 2019, there were three leading candidates, including one made by Emergent, known as AV7909.

Emergent’s candidate was hardly the breakthrough the government was seeking, former health officials said. AV7909 was essentially an enhanced version of BioThrax. The competitors were using more modern technology that could produce doses more rapidly and consistently, and were promising significant cost savings for the stockpile.

To qualify for emergency authorization, a vaccine must be at an advanced stage of development with no approved alternatives. Emergent acknowledged in its financial disclosures that there was “considerable uncertainty” whether the new vaccine met those requirements.

The election of Mr. Trump as president was good news for Emergent.

Dr. Lurie, the senior health official in the Obama administration who had tried to scale back BioThrax purchases, was out. Mr. Trump’s pick to replace her was Dr. Kadlec, a career Air Force physician and top biodefense official in the Bush administration who was fixated on bioterrorism threats, especially anthrax, current and former officials said

Soon after entering the Trump administration in 2017, Dr. Kadlec took a series of actions that he characterized as streamlining a cumbersome bureaucracy but that had the effect of benefiting Emergent.

He assumed greater control of purchasing decisions, diminishing the authority of the Phemce, the oversight group that had proposed buying less BioThrax. And in 2018, he backed a decision to move control of the stockpile to his office in the Department of Health and Human Services and away from the C.D.C., which is based in Atlanta and prides itself on being insulated from the influence of lobbyists.

Dr. Frieden, the former C.D.C. director, was strongly opposed. The move, he said, “had almost as an explicit goal to give the lobbyists more say in what got purchased.”

That July, the government made the announcement Emergent had been banking on, committing to buying millions of doses. Separately, it said it would stop funding Emergent’s competitors.

The decision to side with Emergent did not surprise Dr. Khan, the former C.D.C. official overseeing the stockpile.“Again and again, we seem unable to move past an old technology that’s bankrupting the stockpile,” he said.

Last month, as the death toll from Covid-19 neared a half-million, Mr. Kramer, the company’s chief executive, told analysts there had been no “evidence of a slowdown or a delay or a deprioritization,” and echoed a statement he had made in April when asked whether the pandemic might interrupt Emergent’s sales to the stockpile.“It’s pretty much business as usual,” he said then.

Dr. Shi’s group was fascinated by how coronaviruses jump from species to species. To find viruses, they took samples from bats and other animals, as well as from sick people living near animals carrying these viruses or associated with the wildlife trade. Much of this work was conducted in partnership with the EcoHealth Alliance, a U.S.-based scientific organization that, since 2002, has been awarded over $80 million in federal funding to research the risks of emerging infectious diseases.

Their research showed that the viruses most similar to SARS‑CoV‑2, the virus that caused the pandemic, circulate in bats that live roughly 1,000 miles away from Wuhan. Scientists from Dr. Shi’s team traveled repeatedly to Yunnan province to collect these viruses and had expanded their search to Southeast Asia. Bats in other parts of China have not been found to carry viruses that are as closely related to SARS-CoV-2.

When the Covid-19 outbreak was detected, Dr. Shi initially wondered if the novel coronavirus had come from her laboratory, saying she had never expected such an outbreak to occur in Wuhan.

The SARS‑CoV‑2 virus is exceptionally contagious and can jump from species to species like wildfire. Yet it left no known trace of infection at its source or anywhere along what would have been a thousand-mile journey before emerging in Wuhan.

The year before the outbreak, the Wuhan institute, working with U.S. partners, had proposed creating viruses with SARS‑CoV‑2’s defining feature

The laboratory pursued risky research that resulted in viruses becoming more infectious: Coronaviruses were grown from samples from infected animals and genetically reconstructed and recombined to create new viruses unknown in nature. These new viruses were passed through cells from bats, pigs, primates and humans and were used to infect civets and humanized mice (mice modified with human genes). In essence, this process forced these viruses to adapt to new host species, and the viruses with mutations that allowed them to thrive emerged as victors.

Worse still, as the pandemic raged, their American collaborators failed to publicly reveal the existence of the Defuse proposal. The president of EcoHealth, Peter Daszak, recently admitted to Congress that he doesn’t know about virus samples collected by the Wuhan institute after 2015 and never asked the lab’s scientists if they had started the work described in Defuse.

By 2019, Dr. Shi’s group had published a database describing more than 22,000 collected wildlife samples. But external access was shut off in the fall of 2019, and the database was not shared with American collaborators even after the pandemic started, when such a rich virus collection would have been most useful in tracking the origin of SARS‑CoV‑2. It remains unclear whether the Wuhan institute possessed a precursor of the pandemic virus.

In 2021, The Intercept published a leaked 2018 grant proposal for a research project named Defuse, which had been written as a collaboration between EcoHealth, the Wuhan institute and Ralph Baric at the University of North Carolina, who had been on the cutting edge of coronavirus research for years. The proposal described plans to create viruses strikingly similar to SARS‑CoV‑2.

Coronaviruses bear their name because their surface is studded with protein spikes, like a spiky crown, which they use to enter animal cells. The Defuse project proposed to search for and create SARS-like viruses carrying spikes with a unique feature: a furin cleavage site — the same feature that enhances SARS‑CoV‑2’s infectiousness in humans, making it capable of causing a pandemic. Defuse was never funded by the United States.

owever, in his testimony on Monday, Dr. Fauci explained that the Wuhan institute would not need to rely on U.S. funding to pursue research independently.

While it’s possible that the furin cleavage site could have evolved naturally (as seen in some distantly related coronaviruses), out of the hundreds of SARS-like viruses cataloged by scientists, SARS‑CoV‑2 is the only one known to possess a furin cleavage site in its spike. And the genetic data suggest that the virus had only recently gained the furin cleavage site before it started the pandemic.

Ultimately, a never-before-seen SARS-like virus with a newly introduced furin cleavage site, matching the description in the Wuhan institute’s Defuse proposal, caused an outbreak in Wuhan less than two years after the proposal was drafted.

When the Wuhan scientists published their seminal paper about Covid-19 as the pandemic roared to life in 2020, they did not mention the virus’s furin cleavage site — a feature they should have been on the lookout for, according to their own grant proposal, and a feature quickly recognized by other scientists.

At the Wuhan Institute of Virology, a team of scientists had been hunting for SARS-like viruses for over a decade, led by Shi Zhengl

In May, citing failures in EcoHealth’s monitoring of risky experiments conducted at the Wuhan lab, the Biden administration suspended all federal funding for the organization and Dr. Daszak, and initiated proceedings to bar them from receiving future grants. In his testimony on Monday, Dr. Fauci said that he supported the decision to suspend and bar EcoHealth.

Separately, Dr. Baric described the competitive dynamic between his research group and the institute when he told Congress that the Wuhan scientists would probably not have shared their most interesting newly discovered viruses with him. Documents and email correspondence between the institute and Dr. Baric are still being withheld from the public while their release is fiercely contested in litigation.

In the end, American partners very likely knew of only a fraction of the research done in Wuhan. According to U.S. intelligence sources, some of the institute’s virus research was classified or conducted with or on behalf of the Chinese military.

In the congressional hearing on Monday, Dr. Fauci repeatedly acknowledged the lack of visibility into experiments conducted at the Wuhan institute, saying, “None of us can know everything that’s going on in China, or in Wuhan, or what have you. And that’s the reason why — I say today, and I’ve said at the T.I.,” referring to his transcribed interview with the subcommittee, “I keep an open mind as to what the origin is.”

The Wuhan lab pursued this type of work under low biosafety conditions that could not have contained an airborne virus as infectious as SARS‑CoV‑2.

Labs working with live viruses generally operate at one of four biosafety levels (known in ascending order of stringency as BSL-1, 2, 3 and 4) that describe the work practices that are considered sufficiently safe depending on the characteristics of each pathogen. The Wuhan institute’s scientists worked with SARS-like viruses under inappropriately low biosafety conditions.

​​Biosafety levels are not internationally standardized, and some countries use more permissive protocols than others.

In one experiment, Dr. Shi’s group genetically engineered an unexpectedly deadly SARS-like virus (not closely related to SARS‑CoV‑2) that exhibited a 10,000-fold increase in the quantity of virus in the lungs and brains of humanized mice. Wuhan institute scientists handled these live viruses at low biosafety levels, including BSL-2.

Even the much more stringent containment at BSL-3 cannot fully prevent SARS‑CoV‑2 from escaping. Two years into the pandemic, the virus infected a scientist in a BSL-3 laboratory in Taiwan, which was, at the time, a zero-Covid country. The scientist had been vaccinated and was tested only after losing the sense of smell. By then, more than 100 close contacts had been exposed. Human error is a source of exposure even at the highest biosafety levels, and the risks are much greater for scientists working with infectious pathogens at low biosafety.

An early draft of the Defuse proposal stated that the Wuhan lab would do their virus work at BSL-2 to make it “highly cost-effective.” Dr. Baric added a note to the draft highlighting the importance of using BSL-3 to contain SARS-like viruses that could infect human cells, writing that “U.S. researchers will likely freak out.”

Years later, after SARS‑CoV‑2 had killed millions, Dr. Baric wrote to Dr. Daszak: “I have no doubt that they followed state determined rules and did the work under BSL-2. Yes China has the right to set their own policy. You believe this was appropriate containment if you want but don’t expect me to believe it. Moreover, don’t insult my intelligence by trying to feed me this load of BS.”

SARS‑CoV‑2 is a stealthy virus that transmits effectively through the air, causes a range of symptoms similar to those of other common respiratory diseases and can be spread by infected people before symptoms even appear. If the virus had escaped from a BSL-2 laboratory in 2019, the leak most likely would have gone undetected until too late.

One alarming detail — leaked to The Wall Street Journal and confirmed by current and former U.S. government officials — is that scientists on Dr. Shi’s team fell ill with Covid-like symptoms in the fall of 2019. One of the scientists had been named in the Defuse proposal as the person in charge of virus discovery work. The scientists denied having been sick.

The hypothesis that Covid-19 came from an animal at the Huanan Seafood Market in Wuhan is not supported by strong evidence.

In December 2019, Chinese investigators assumed the outbreak had started at a centrally located market frequented by thousands of visitors daily. This bias in their search for early cases meant that cases unlinked to or located far away from the market would very likely have been missed

To make things worse, the Chinese authorities blocked the reporting of early cases not linked to the market and, claiming biosafety precautions, ordered the destruction of patient samples on January 3, 2020, making it nearly impossible to see the complete picture of the earliest Covid-19 cases. Information about dozens of early cases from November and December 2019 remains inaccessible.

A pair of papers published in Science in 2022 made the best case for SARS‑CoV‑2 having emerged naturally from human-animal contact at the Wuhan market by focusing on a map of the early cases and asserting that the virus had jumped from animals into humans twice at the market in 2019

More recently, the two papers have been countered by other virologists and scientists who convincingly demonstrate that the available market evidence does not distinguish between a human superspreader event and a natural spillover at the market.

Furthermore, the existing genetic and early case data show that all known Covid-19 cases probably stem from a single introduction of SARS‑CoV‑2 into people, and the outbreak at the Wuhan market probably happened after the virus had already been circulating in humans.

Not a single infected animal has ever been confirmed at the market or in its supply chain. Without good evidence that the pandemic started at the Huanan Seafood Market, the fact that the virus emerged in Wuhan points squarely at its unique SARS-like virus laboratory.

With today’s technology, scientists can detect how respiratory viruses — including SARS, MERS and the flu — circulate in animals while making repeated attempts to jump across species. Thankfully, these variants usually fail to transmit well after crossing over to a new species and tend to die off after a small number of infections

investigators have not reported finding any animals infected with SARS‑CoV‑2 that had not been infected by humans. Yet, infected animal sources and other connective pieces of evidence were found for the earlier SARS and MERS outbreaks as quickly as within a few days, despite the less advanced viral forensic technologies of two decades ago.

Even though Wuhan is the home base of virus hunters with world-leading expertise in tracking novel SARS-like viruses, investigators have either failed to collect or report key evidence that would be expected if Covid-19 emerged from the wildlife trade. For example, investigators have not determined that the earliest known cases had exposure to intermediate host animals before falling ill.

No antibody evidence shows that animal traders in Wuhan are regularly exposed to SARS-like viruses, as would be expected in such situations.

In previous outbreaks of coronaviruses, scientists were able to demonstrate natural origin by collecting multiple pieces of evidence linking infected humans to infected animals

In contrast, virologists and other scientists agree that SARS‑CoV‑2 required little to no adaptation to spread rapidly in humans and other animals. The virus appears to have succeeded in causing a pandemic upon its only detected jump into humans.

it was a SARS-like coronavirus with a unique furin cleavage site that emerged in Wuhan, less than two years after scientists, sometimes working under inadequate biosafety conditions, proposed collecting and creating viruses of that same design.

a laboratory accident is the most parsimonious explanation of how the pandemic began.

Given what we now know, investigators should follow their strongest leads and subpoena all exchanges between the Wuhan scientists and their international partners, including unpublished research proposals, manuscripts, data and commercial orders. In particular, exchanges from 2018 and 2019 — the critical two years before the emergence of Covid-19 — are very likely to be illuminating (and require no cooperation from the Chinese government to acquire), yet they remain beyond the public’s view more than four years after the pandemic began.

it is undeniable that U.S. federal funding helped to build an unprecedented collection of SARS-like viruses at the Wuhan institute, as well as contributing to research that enhanced them.

Advocates and funders of the institute’s research, including Dr. Fauci, should cooperate with the investigation to help identify and close the loopholes that allowed such dangerous work to occur. The world must not continue to bear the intolerable risks of research with the potential to cause pandemics.

A successful investigation of the pandemic’s root cause would have the power to break a decades-long scientific impasse on pathogen research safety, determining how governments will spend billions of dollars to prevent future pandemics. A credible investigation would also deter future acts of negligence and deceit by demonstrating that it is indeed possible to be held accountable for causing a viral pandemic

Last but not least, people of all nations need to see their leaders — and especially, their scientists — heading the charge to find out what caused this world-shaking event. Restoring public trust in science and government leadership requires it.

Last year, a Chinese scientist he worked with published a specific forecast: “It is highly likely that future SARS- or MERS-like coronavirus outbreaks will originate from bats, and there is an increased probability that this will occur in China.”

Humans today are exposed to more deadly new pathogens than ever. They typically come from animals, as global travel, trade and economic development, such as meat production and deforestation, push people, livestock and wildlife closer together

Scientists knew infectious disease outbreaks were becoming more common, with 2010 having more than six times the outbreaks of pathogens from animal origins than in 1980, according to data in a study by Brown University researchers.

Yet plenty was left undone, in areas including funding, early-warning systems, the role of the WHO and coordination with China. A big chunk of U.S. funding went toward protecting Americans against a bioterror attack. Government funding for pandemics has come largely in emergency, one-time packages to stop an ongoing outbreak.

She said a better solution would be to fund public health more like national defense, with much more guaranteed money, year in, year out.

“Will there be another human influenza pandemic?” Dr. Webster asked in a paper presented at an NIH meeting in 1995. “The certainty is that there will be.”

Experts including Dr. Webster were particularly concerned about the potential for spillover in southern China, where large, densely populated cities were expanding rapidly into forests and agricultural lands, bringing people into closer contact with animals. Two of the three influenza pandemics of the 20th century are thought to have originated in China.

Dr. Webster and others warned it could re-emerge or mutate into something more contagious. With U.S. funding, he set up an animal influenza surveillance center in Hong Kong. The WHO, which hadn’t planned for pandemics before, started compiling protocols for a large-scale outbreak, including contingency plans for vaccines.

At a dinner back in the U.S., he remembers one guest saying, “Oh, you really needed to have someone in the U.S. to be impacted to really galvanize the government.”

That “drove home the reality in my own mind of globalization,” said Dr. Fukuda. SARS showed that viruses can crisscross the globe by plane in hours, making a local epidemic much more dangerous.

The WHO’s director-general, Gro Harlem Brundtland, publicly criticized China. The government under new leaders reversed course. It implemented draconian quarantines and sanitized cities, including a reported 80 million people enlisted to clean streets in Guangdong.

By May 2003, the number of new SARS cases was dwindling. It infected around 8,000 people world-wide, killing nearly 10%.

After SARS, China expanded epidemiologist training and increased budgets for new laboratories. It started working more closely in public health with the U.S., the world’s leader. The U.S. CDC opened an office in Beijing to share expertise and make sure coverups never happened again. U.S. CDC officials visiting a new China CDC campus planted a friendship tree.

In Washington in 2005, a powerful player started driving U.S. efforts to become more prepared. President George W. Bush had read author John M. Barry’s “The Great Influenza,” a history of the 1918 flu pandemic

Mr. Bush leaned toward the group of 10 or so officials and said, “I want to see a plan,” according to Dr. Venkayya. “He had been asking questions and not getting answers,” recalled Dr. Venkayya, now president of Takeda Pharmaceutical Co. ’s global vaccine business unit. “He wanted people to see this as a national threat.”

Mr. Bush launched the strategy in November, and Congress approved $6.1 billion in one-time funding.

The CDC began exercises enacting pandemic scenarios and expanded research. The government created the Biomedical Advanced Research and Development Authority to fund companies to develop diagnostics, drugs and vaccines.

A team of researchers also dug into archives of the 1918 pandemic to develop guidelines for mitigating the spread when vaccines aren’t available. The tactics included social distancing, canceling large public gatherings and closing schools—steps adopted this year when Covid-19 struck, though at the time they didn’t include wide-scale lockdowns.

A year after the plan was released, a progress report called for more real-time disease surveillance and preparations for a medical surge to care for large numbers of patients, and stressed strong, coordinated federal planning.

A European vaccine makers’ association said its members had spent around $4 billion on pandemic vaccine research and manufacturing adjustments by 2008.

The $6.1 billion Congress appropriated for Mr. Bush’s pandemic plan was spent mostly to make and stockpile medicines and flu vaccines and to train public-health department staff. The money wasn’t renewed. “The reality is that for any leader it’s really hard to maintain a focus on low-probability high-consequence events, particularly in the health arena,” Dr. Venkayya said.

In the U.S., President Barack Obama’s administration put Mr. Bush’s new plan into action for the first time. By mid-June, swine flu, as it was dubbed, had jumped to 74 countries. The WHO officially labeled it a pandemic, despite some evidence suggesting the sickness was pretty mild in most people.

That put in motion a host of measures, including some “sleeping” contracts with pharmaceutical companies to begin vaccine manufacturing—contracts that countries like the United Kingdom had negotiated ahead of time so they wouldn’t have to scramble during an outbreak.

In August, a panel of scientific advisers to Mr. Obama published a scenario in which as many as 120 million Americans, 40% of the population, could be infected that year, and up to 90,000 people could die.

H1N1 turned out to be much milder. Although it eventually infected more than 60 million Americans, it killed less than 13,000. In Europe, fewer than 5,000 deaths were reported.

The WHO came under fire for labeling the outbreak a pandemic too soon. European lawmakers, health professionals and others suggested the organization may have been pressured by the pharmaceutical industry.

France ordered 94 million doses, but had logged only 1,334 serious cases and 312 deaths as of April 2010. It managed to cancel 50 million doses and sell some to other countries, but it was still stuck with a €365 million tab, or about $520 million at the time, and 25 million extra doses.

The WHO had raised scares for SARS, mad-cow disease, bird flu and now swine flu, and it had been wrong each time, said Paul Flynn, a member of the Council of Europe’s Parliamentary Assembly and a British lawmaker, at a 2010 health committee hearing in Strasbourg.

Ultimately, an investigation by the council’s committee accused the WHO and public-health officials of jumping the gun, wasting money, provoking “unjustified fear” among Europeans and creating risks through vaccines and medications that might not have been sufficiently tested.

“I thought you might have uttered a word of regret or an apology,” Mr. Flynn told Dr. Fukuda, who as a representative of the WHO had been called to testify.

Back in Washington, scientist Dennis Carroll, at the U.S. Agency for International Development, was also convinced that flu wasn’t the only major pandemic threat. In early 2008, Dr. Carroll was intrigued by Dr. Daszak’s newly published research that said viruses from wildlife were a growing threat, and would emerge most frequently where development was bringing people closer to animals.

If most of these viruses spilled over to humans in just a few places, including southern China, USAID could more easily fund an early warning system.

“You didn’t have to look everywhere,” he said he realized. “You could target certain places.” He launched a new USAID effort focused on emerging pandemic threats. One program called Predict had funding of about $20 million a year to identify pathogens in wildlife that have the potential to infect people.

Drs. Daszak, Shi and Wang, supported by funds from Predict, the NIH and China, shifted their focus to Yunnan, a relatively wild and mountainous province that borders Myanmar, Laos and Vietnam.

One key discovery: a coronavirus resembling SARS that lab tests showed could infect human cells. It was the first proof that SARS-like coronaviruses circulating in southern China could hop from bats to people. The scientists warned of their findings in a study published in the journal Nature in 2013.

Evidence grew that showed people in the area were being exposed to coronaviruses. One survey turned up hundreds of villagers who said they recently showed symptoms such as trouble breathing and a fever, suggesting a possible viral infection.

Over the next several years, governments in the U.S. and elsewhere found themselves constantly on the defensive from global viral outbreaks. Time and again, preparedness plans proved insufficient. One, which started sickening people in Saudi Arabia and nearby

On a weekend morning in January 2013, more than a dozen senior Obama administration officials met in a basement family room in the suburban home of a senior National Security Council official. They were brainstorming how to help other countries upgrade their epidemic response capabilities, fueled by bagels and coffee. Emerging disease threats were growing, yet more than 80% of the world’s countries hadn’t met a 2012 International Health Regulations deadline to be able to detect and respond to epidemics.

The session led to the Global Health Security Agenda, launched by the U.S., the WHO and about 30 partners in early 2014, to help nations improve their capabilities within five years.

Money was tight. The U.S. was recovering from the 2008-09 financial crisis, and federal funding to help U.S. states and cities prepare and train for health emergencies was declining. Public-health departments had cut thousands of jobs, and outdated data systems weren’t replaced.

“It was a Hail Mary pass,” said Tom Frieden, who was director of the CDC from 2009 to 2017 and a force behind the creation of the GHSA. “We didn’t have any money.”

At the WHO, Dr. Fukuda was in charge of health security. When the Ebola outbreak was found in March 2014, he and his colleagues were already stretched, after budget cuts and amid other crises.

The United Nations created a special Ebola response mission that assumed the role normally played by the WHO. Mr. Obama sent the U.S. military to Liberia, underscoring the inability of international organizations to fully handle the problem.

It took the WHO until August to raise an international alarm about Ebola. By then, the epidemic was raging. It would become the largest Ebola epidemic in history, with at least 28,600 people infected, and more than 11,300 dead in 10 countries. The largest outbreak before that, in Uganda, had involved 425 cases.

Congress passed a $5.4 billion package in supplemental funds over five years, with about $1 billion going to the GHSA. The flood of money, along with aggressive contact tracing and other steps, helped bring the epidemic to a halt, though it took until mid-2016.

Global health experts and authorities called for changes at the WHO to strengthen epidemic response, and it created an emergencies program. The National Security Council warned that globalization and population growth “will lead to more pandemics,” and called for the U.S. to do more.

r. Carroll of USAID, who had visited West Africa during the crisis, and saw some health workers wrap themselves in garbage bags for protection, started conceiving of a Global Virome Project, to detect and sequence all the unknown viral species in mammals and avian populations on the planet.

Billionaire Bill Gates warned in a TED talk that an infectious disease pandemic posed a greater threat to the world than nuclear war, and urged world leaders to invest more in preparing for one. The Bill & Melinda Gates Foundation helped form a new initiative to finance vaccines for emerging infections, the Coalition for Epidemic Preparedness Innovations.

Congress established a permanent Infectious Diseases Rapid Response Fund for the CDC in fiscal 2019, with $50 million for that year and $85 million in fiscal 2020.

In May 2018, John Bolton, then President Trump’s national security adviser, dismantled an NSC unit that had focused on global health security and biodefense, with staff going to other units. The senior director of the unit left.

It pushed emerging disease threats down one level in the NSC hierarchy, making pandemics compete for attention with issues such as North Korea, said Beth Cameron, a previous senior director of the unit. She is now vice president for global biological policy and programs at the Nuclear Threat Initiative.

Deteriorating relations with China reduced Washington’s activities there just as researchers were becoming more certain of the threat from coronaviruses.

Dr. Carroll had earlier been ordered to suspend his emerging pandemic threats program in China.

Dr. Carroll pitched to USAID his Global Virome Project. USAID wasn’t interested, he said. He left USAID last year. A meeting that Dr. Carroll planned for last August with the Chinese CDC and Chinese Academy of Sciences to form a Chinese National Virome Project was postponed due to a bureaucratic hang-up. Plans to meet are now on hold, due to Covid-19.

Epstein gives away his sexism immediately by opening his op-ed with the advice that "no one should call himself 'Dr.' unless he has delivered a child." In other words, part of his problem appears to be that Dr. Biden is not a man.

Epstein also argues that it has become easy to get a doctorate degree these days. He makes this inaccurate and offensive claim despite never having managed to earn one himself.

In 2018, when Dr. Julia Baird earned her Ph.D. and changed her title on Twitter, she ignited a firestorm of complaints -- mostly from men. The discussion that ensued among academics revealed that women are routinely ridiculed for using the titles they earn, while the expertise of men doesn't seem to meet with the same level of skepticism and censure. One man who holds a Ph.D. responded, "I had no idea doctorate-shaming was even a thing!"

A 2017 study found that when men introduced female medical doctors at a professional event, they used their titles 50 percent of the time -- but when men introduced fellow male doctors, they used their titles over 70 percent of the time.

As Cornell philosopher Kate Manne writes in her 2020 book "Entitled: How Male Privilege Hurts Women," when women make claims, their credibility is questioned much more than that of men. In fact, Rebecca Solnit wrote an entire book entitled "Men Explain Things to Me" after suffering through a man explaining one of her other books to her at a party. Scores of female academics have taken to Twitter to describe similar experiences of men explaining their own publications to them.

America needs to stop lecturing and start learning from women who have expertise. By using her "Dr." title in the White House, Dr. Biden would show by example that women shouldn't deny their rightful authority.

In 2017, Dr. Biden spoke at the commencement ceremony at Hofstra University, where I teach. The president of our university told her that one of my colleagues, a university administrator, had just earned her graduate degree but was not planning to walk in the ceremony. Dr. Biden insisted that my colleague put on a robe and go up to the stage with her classmates because it was important to recognize all the work that had gotten her there.

The president, though, was slow to absorb the scale of the risk and to act accordingly, focusing instead on controlling the message, protecting gains in the economy and batting away warnings from senior officials.

Mr. Trump’s response was colored by his suspicion of and disdain for what he viewed as the “Deep State” — the very people in his government whose expertise and long experience might have guided him more quickly toward steps that would slow the virus, and likely save lives.

The slow start of that plan, on top of the well-documented failures to develop the nation’s testing capacity, left administration officials with almost no insight into how rapidly the virus was spreading. “We were flying the plane with no instruments,” one official said.

But dozens of interviews with current and former officials and a review of emails and other records revealed many previously unreported details and a fuller picture of the roots and extent of his halting response as the deadly virus spread:

The National Security Council office responsible for tracking pandemics received intelligence reports in early January predicting the spread of the virus to the United States, and within weeks was raising options like keeping Americans home from work and shutting down cities the size of Chicago. Mr. Trump would avoid such steps until March.

Despite Mr. Trump’s denial weeks later, he was told at the time about a Jan. 29 memo produced by his trade adviser, Peter Navarro, laying out in striking detail the potential risks of a coronavirus pandemic: as many as half a million deaths and trillions of dollars in economic losses.

The health and human services secretary, Alex M. Azar II, directly warned Mr. Trump of the possibility of a pandemic during a call on Jan. 30, the second warning he delivered to the president about the virus in two weeks. The president, who was on Air Force One while traveling for appearances in the Midwest, responded that Mr. Azar was being alarmist

Mr. Azar publicly announced in February that the government was establishing a “surveillance” system

the task force had gathered for a tabletop exercise — a real-time version of a full-scale war gaming of a flu pandemic the administration had run the previous year. That earlier exercise, also conducted by Mr. Kadlec and called “Crimson Contagion,” predicted 110 million infections, 7.7 million hospitalizations and 586,000 deaths following a hypothetical outbreak that started in China.

By the third week in February, the administration’s top public health experts concluded they should recommend to Mr. Trump a new approach that would include warning the American people of the risks and urging steps like social distancing and staying home from work.

But the White House focused instead on messaging and crucial additional weeks went by before their views were reluctantly accepted by the president — time when the virus spread largely unimpeded.

When Mr. Trump finally agreed in mid-March to recommend social distancing across the country, effectively bringing much of the economy to a halt, he seemed shellshocked and deflated to some of his closest associates. One described him as “subdued” and “baffled” by how the crisis had played out. An economy that he had wagered his re-election on was suddenly in shambles.

He only regained his swagger, the associate said, from conducting his daily White House briefings, at which he often seeks to rewrite the history of the past several months. He declared at one point that he “felt it was a pandemic long before it was called a pandemic,” and insisted at another that he had to be a “cheerleader for the country,” as if that explained why he failed to prepare the public for what was coming.

Mr. Trump’s allies and some administration officials say the criticism has been unfair.

The Chinese government misled other governments, they say. And they insist that the president was either not getting proper information, or the people around him weren’t conveying the urgency of the threat. In some cases, they argue, the specific officials he was hearing from had been discredited in his eyes, but once the right information got to him through other channels, he made the right calls.

“While the media and Democrats refused to seriously acknowledge this virus in January and February, President Trump took bold action to protect Americans and unleash the full power of the federal government to curb the spread of the virus, expand testing capacities and expedite vaccine development even when we had no true idea the level of transmission or asymptomatic spread,” said Judd Deere, a White House spokesman.

Decision-making was also complicated by a long-running dispute inside the administration over how to deal with China

The Containment IllusionBy the last week of February, it was clear to the administration’s public health team that schools and businesses in hot spots would have to close. But in the turbulence of the Trump White House, it took three more weeks to persuade the president that failure to act quickly to control the spread of the virus would have dire consequences.

There were key turning points along the way, opportunities for Mr. Trump to get ahead of the virus rather than just chase it. There were internal debates that presented him with stark choices, and moments when he could have chosen to ask deeper questions and learn more. How he handled them may shape his re-election campaign. They will certainly shape his legacy.

Facing the likelihood of a real pandemic, the group needed to decide when to abandon “containment” — the effort to keep the virus outside the U.S. and to isolate anyone who gets infected — and embrace “mitigation” to thwart the spread of the virus inside the country until a vaccine becomes available.

Among the questions on the agenda, which was reviewed by The New York Times, was when the department’s secretary, Mr. Azar, should recommend that Mr. Trump take textbook mitigation measures “such as school dismissals and cancellations of mass gatherings,” which had been identified as the next appropriate step in a Bush-era pandemic plan.

The group — including Dr. Anthony S. Fauci of the National Institutes of Health; Dr. Robert R. Redfield of the Centers for Disease Control and Prevention, and Mr. Azar, who at that stage was leading the White House Task Force — concluded they would soon need to move toward aggressive social distancing

A 20-year-old Chinese woman had infected five relatives with the virus even though she never displayed any symptoms herself. The implication was grave — apparently healthy people could be unknowingly spreading the virus — and supported the need to move quickly to mitigation.

The following day, Dr. Kadlec and the others decided to present Mr. Trump with a plan titled “Four Steps to Mitigation,” telling the president that they needed to begin preparing Americans for a step rarely taken in United States history.

a presidential blowup and internal turf fights would sidetrack such a move. The focus would shift to messaging and confident predictions of success rather than publicly calling for a shift to mitigation.

These final days of February, perhaps more than any other moment during his tenure in the White House, illustrated Mr. Trump’s inability or unwillingness to absorb warnings coming at him.

He instead reverted to his traditional political playbook in the midst of a public health calamity, squandering vital time as the coronavirus spread silently across the country.

A memo dated Feb. 14, prepared in coordination with the National Security Council and titled “U.S. Government Response to the 2019 Novel Coronavirus,” documented what more drastic measures would look like, including: “significantly limiting public gatherings and cancellation of almost all sporting events, performances, and public and private meetings that cannot be convened by phone. Consider school closures. Widespread ‘stay at home’ directives from public and private organizations with nearly 100% telework for some.”

his friend had a blunt message: You need to be ready. The virus, he warned, which originated in the city of Wuhan, was being transmitted by people who were showing no symptoms — an insight that American health officials had not yet accepted.

On the 18-hour plane ride home, Mr. Trump fumed as he watched the stock market crash after Dr. Messonnier’s comments. Furious, he called Mr. Azar when he landed at around 6 a.m. on Feb. 26, raging that Dr. Messonnier had scared people unnecessarily.

The meeting that evening with Mr. Trump to advocate social distancing was canceled, replaced by a news conference in which the president announced that the White House response would be put under the command of Vice President Mike Pence.

The push to convince Mr. Trump of the need for more assertive action stalled. With Mr. Pence and his staff in charge, the focus was clear: no more alarmist messages. Statements and media appearances by health officials like Dr. Fauci and Dr. Redfield would be coordinated through Mr. Pence’s office

It would be more than three weeks before Mr. Trump would announce serious social distancing efforts, a lost period during which the spread of the virus accelerated rapidly.Over nearly three weeks from Feb. 26 to March 16, the number of confirmed coronavirus cases in the United States grew from 15 to 4,226

The China FactorThe earliest warnings about coronavirus got caught in the crosscurrents of the administration’s internal disputes over China. It was the China hawks who pushed earliest for a travel ban. But their animosity toward China also undercut hopes for a more cooperative approach by the world’s two leading powers to a global crisis.

It was early January, and the call with a Hong Kong epidemiologist left Matthew Pottinger rattled.

Mr. Trump was walking up the steps of Air Force One to head home from India on Feb. 25 when Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases, publicly issued the blunt warning they had all agreed was necessary.

It was one of the earliest warnings to the White House, and it echoed the intelligence reports making their way to the National Security Council

some of the more specialized corners of the intelligence world were producing sophisticated and chilling warnings.

In a report to the director of national intelligence, the State Department’s epidemiologist wrote in early January that the virus was likely to spread across the globe, and warned that the coronavirus could develop into a pandemic

Working independently, a small outpost of the Defense Intelligence Agency, the National Center for Medical Intelligence, came to the same conclusion.

By mid-January there was growing evidence of the virus spreading outside China. Mr. Pottinger began convening daily meetings about the coronavirus

The early alarms sounded by Mr. Pottinger and other China hawks were freighted with ideology — including a push to publicly blame China that critics in the administration say was a distraction

And they ran into opposition from Mr. Trump’s economic advisers, who worried a tough approach toward China could scuttle a trade deal that was a pillar of Mr. Trump’s re-election campaign.

Mr. Pottinger continued to believe the coronavirus problem was far worse than the Chinese were acknowledging. Inside the West Wing, the director of the Domestic Policy Council, Joe Grogan, also tried to sound alarms that the threat from China was growing.

The Consequences of ChaosThe chaotic culture of the Trump White House contributed to the crisis. A lack of planning and a failure to execute, combined with the president’s focus on the news cycle and his preference for following his gut rather than the data cost time, and perhaps lives.

the hawks kept pushing in February to take a critical stance toward China amid the growing crisis. Mr. Pottinger and others — including aides to Secretary of State Mike Pompeo — pressed for government statements to use the term “Wuhan Virus.”Mr. Pompeo tried to hammer the anti-China message at every turn, eventually even urging leaders of the Group of 7 industrialized countries to use “Wuhan virus” in a joint statement.

Others, including aides to Mr. Pence, resisted taking a hard public line, believing that angering Beijing might lead the Chinese government to withhold medical supplies, pharmaceuticals and any scientific research that might ultimately lead to a vaccine.

Mr. Trump took a conciliatory approach through the middle of March, praising the job Mr. Xi was doing.

That changed abruptly, when aides informed Mr. Trump that a Chinese Foreign Ministry spokesman had publicly spun a new conspiracy about the origins of Covid-19: that it was brought to China by U.S. Army personnel who visited the country last October.

On March 16, he wrote on Twitter that “the United States will be powerfully supporting those industries, like Airlines and others, that are particularly affected by the Chinese Virus.”

Mr. Trump’s decision to escalate the war of words undercut any remaining possibility of broad cooperation between the governments to address a global threat

Mr. Pottinger, backed by Mr. O’Brien, became one of the driving forces of a campaign in the final weeks of January to convince Mr. Trump to impose limits on travel from China

he circulated a memo on Jan. 29 urging Mr. Trump to impose the travel limits, arguing that failing to confront the outbreak aggressively could be catastrophic, leading to hundreds of thousands of deaths and trillions of dollars in economic losses.

The uninvited message could not have conflicted more with the president’s approach at the time of playing down the severity of the threat. And when aides raised it with Mr. Trump, he responded that he was unhappy that Mr. Navarro had put his warning in writing.

From the time the virus was first identified as a concern, the administration’s response was plagued by the rivalries and factionalism that routinely swirl around Mr. Trump and, along with the president’s impulsiveness, undercut decision making and policy development.

Even after Mr. Azar first briefed him about the potential seriousness of the virus during a phone call on Jan. 18 while the president was at his Mar-a-Lago resort in Florida, Mr. Trump projected confidence that it would be a passing problem.

“We have it totally under control,” he told an interviewer a few days later while attending the World Economic Forum in Switzerland. “It’s going to be just fine.”

The efforts to sort out policy behind closed doors were contentious and sometimes only loosely organized.

That was the case when the National Security Council convened a meeting on short notice on the afternoon of Jan. 27. The Situation Room was standing room only, packed with top White House advisers, low-level staffers, Mr. Trump’s social media guru, and several cabinet secretaries. There was no checklist about the preparations for a possible pandemic,

Instead, after a 20-minute description by Mr. Azar of his department’s capabilities, the meeting was jolted when Stephen E. Biegun, the newly installed deputy secretary of state, announced plans to issue a “level four” travel warning, strongly discouraging Americans from traveling to China. The room erupted into bickering.

A few days later, on the evening of Jan. 30, Mick Mulvaney, the acting White House chief of staff at the time, and Mr. Azar called Air Force One as the president was making the final decision to go ahead with the restrictions on China travel. Mr. Azar was blunt, warning that the virus could develop into a pandemic and arguing that China should be criticized for failing to be transparent.

Stop panicking, Mr. Trump told him.That sentiment was present throughout February, as the president’s top aides reached for a consistent message but took few concrete steps to prepare for the possibility of a major public health crisis.

As February gave way to March, the president continued to be surrounded by divided factions even as it became clearer that avoiding more aggressive steps was not tenable.

the virus was already multiplying across the country — and hospitals were at risk of buckling under the looming wave of severely ill people, lacking masks and other protective equipment, ventilators and sufficient intensive care beds. The question loomed over the president and his aides after weeks of stalling and inaction: What were they going to do?

Even then, and even by Trump White House standards, the debate over whether to shut down much of the country to slow the spread was especially fierce.

In a tense Oval Office meeting, when Mr. Mnuchin again stressed that the economy would be ravaged, Mr. O’Brien, the national security adviser, who had been worried about the virus for weeks, sounded exasperated as he told Mr. Mnuchin that the economy would be destroyed regardless if officials did nothing.

in the end, aides said, it was Dr. Deborah L. Birx, the veteran AIDS researcher who had joined the task force, who helped to persuade Mr. Trump. Soft-spoken and fond of the kind of charts and graphs Mr. Trump prefers, Dr. Birx did not have the rough edges that could irritate the president. He often told people he thought she was elegant.

During the last week in March, Kellyanne Conway, a senior White House adviser involved in task force meetings, gave voice to concerns other aides had. She warned Mr. Trump that his wished-for date of Easter to reopen the country likely couldn’t be accomplished. Among other things, she told him, he would end up being blamed by critics for every subsequent death caused by the virus.

Volcanic ash, more generally known as tephra, sometimes hides in ice. It’s a special find because it can be geochemically tied to a specific volcano. “The tephra comes from the magma itself,

Sulfur is also indicative of a past eruption. Sulfur dioxide, a gas commonly belched by erupting volcanoes, reacts with water in the atmosphere to create sulfate aerosols. These tiny particles can linger in the stratosphere for years, riding wind currents, but they, like tephra, eventually fall back to Earth.

The ice also carries a time stamp. Dr. McConnell and his colleagues look for variations in elements like sodium, which is found in sea spray that’s seasonally blown inland. By simply counting annual variations in these elements, it’s possible to trace the passage of time, Dr. McConnell said. “It’s like a tree-ring record.”

In layers of ice corresponding to the early months of 43 B.C., they spotted large upticks in sulfur and, crucially, bits of material that were probably tephra. The timing caught the scientists’ attention.

Researchers have previously hypothesized that an environmental trigger may have helped set in motion the crop failures, famines and social unrest that plagued the Mediterranean region at that time. But until now, “There hasn’t been the kind of data that these scholars brought forth to really get those theories into the mainstream,”

The match was spot on, Dr. Plunkett said. “There are some events that are tricky. With Okmok, there’s nothing else that looks like it.”

This eruption was one of the largest of the last few millenniums, Dr. McConnell and his collaborators concluded, and the sulfate aerosols it created remained in the stratosphere for several years. These tiny particles are particularly good at reflecting sunlight, which means they can temporarily alter Earth’s climate.

“They’ve created, for a short term, global cooling events,”

Using climate models to simulate the impact of an Okmok eruption, Dr. McConnell and his collaborators estimated that parts of the Mediterranean, roughly 6,000 miles away, would have cooled by as much as 13.3 degrees Fahrenheit.

Rain patterns changed as well — some regions would have been drenched by 400 percent more precipitation than normal, the modeling revealed.

That climate shock came at precisely the wrong time, Dr. Clark said. “This was a period of Mediterranean-wide political, social and economic upheaval.”

Historical records compiled by Roman writers and philosophers note food shortages and famines. In 43 B.C., Mark Antony, the Roman military leader, and his army had to subsist on wild fruit, roots, bark and “animals never tasted before,” the philosopher Plutarch wrote.

For a society already reeling from the assassination of Julius Caesar the year before, such trying conditions might have exacerbated social unrest, the researchers concluded. They might even have kick-started transfers of political power that led to the rise of the Roman Empire.

“It’s an incredible coincidence that it happened exactly in the waning years of the Roman Republic when things were falling apart,”

The links in the study are probable, but not definite. “They’re not being heavy handed and saying this is absolutely it,” Dr. Holmberg said.

Egyptian society, before the installation of the Aswan Low Dam in the early 20th century, was anchored by the annual summer flooding of the Nile River. These summer floods, sustained by monsoon rains in the highlands of Ethiopia, delivered irrigation and silt, both critical to Egypt’s agrarian society. “The whole rhythm of the year was built around responding to the flood,” Dr. Manning of Yale said.

But volcanic eruptions, even those on the other side of the world, could have disrupted that flooding, Dr. Manning and his colleagues recently showed. Using records from Cairo’s Nilometer — an octagonal marble column that was used for recording Nile flood height from 622 to 1902 A.D., the team found that flooding tended to be weaker, or entirely absent, during years when there was a large volcanic eruption somewhere in the world.

he culprit, the team reasoned in a paper published a few years ago, was cooling caused by sulfate aerosols. When Earth cools after a large eruption, its atmospheric circulation patterns change. That can shift the invisible meeting point of Northern and Southern Hemisphere trade winds — the Intertropical Convergence Zone — that affects where monsoon rains tend to fall. When less precipitation falls over Ethiopia, home to a major tributary of the Nile, there’s less water available for flooding that year.

Ptolemaic-era records revealed that this reduced flooding had socioeconomic and political consequences. Revolts increased in the years following “Nile failure,” Dr. Manning and his colleagues found. Priestly decrees — intended to establish the political legitimacy of Greek rulers — also became more commonplace.

“There are still large unsourced mystery eruptions up until the early 19th century.”

Right now, roughly a dozen volcanoes are erupting. In all likelihood, they’re nothing to worry about — it’s doubtful you’ve even heard of them. But every once in a while, there’s bound to be a really big eruption. How its effects ripple around the world awaits to be seen.

Dr. Atlas’s position has been challenged by medical advisers around him who have backgrounds in infectious disease response, revealing a significant rift in the White House over the right approach. Dr. Deborah L. Birx, the White House’s coronavirus response coordinator, has pushed for aggressive, broad testing even among young and healthy people, often clashing with Dr. Atlas in meetings.

“I would always be happy if we had 100 percent of students tested weekly,” Dr. Birx said on Wednesday in an appearance at Penn State University, “because I think testing changes behavior.”

Dr. Atlas at one point influenced the administration’s efforts to install new Centers for Disease Control and Prevention guidance that said it was not necessary to test people without symptoms of Covid-19 even if they had been exposed to the virus, upsetting Dr. Birx and Dr. Robert R. Redfield, the C.D.C. director

The administration’s efforts to fund federal and state testing have long been fraught. In July, as administration officials and top Senate Republicans clashed over the contours of their initial $1 trillion proposal, the White House initially balked at providing billions of dollars to fund coronavirus testing and help federal health agencies.

Since the early days of the pandemic, Mr. Romer has argued for a wide-scale testing program, costing as much as $100 billion. He had hoped to persuade Dr. Atlas that if officials could quickly identify and isolate people carrying the virus, they would slow its spread and allow normal economic activity to resume more quickly.

In his email, sent to Dr. Atlas’s personal account, Mr. Romer proposed additional testing and isolation efforts that could allow far more Americans to return to work and shopping, generating economic activity that would be 10 or 100 times larger than the cost of the testing program itself.

Dr. Atlas replied that the push for such testing was the result of “a fundamental error of the public health people perpetrated on the world.”Mr. Romer said he was taken aback by the answer: “Atlas just responded in a way that just honestly made it seem like he was in over his head,” he said.

An aperiodic tiling displays no such “translational symmetry,” and mathematicians have long sought a single shape that could tile the plane in such a fashion. This is known as the einstein problem.

“I’m always messing about and experimenting with shapes,” said Mr. Smith, 64, who worked as a printing technician, among other jobs, and retired early. Although he enjoyed math in high school, he didn’t excel at it, he said. But he has long been “obsessively intrigued” by the einstein problem.

now a new paper — by Mr. Smith and three co-authors with mathematical and computational expertise — proves Mr. Smith’s discovery true. The researchers called their einstein “the hat,

“The most significant aspect for me is that the tiling does not clearly fall into any of the familiar classes of structures that we understand.”

black and white squares also can make weird nonperiodic patterns, in addition to the familiar, periodic checkerboard pattern. “It’s really pretty trivial to be able to make weird and interesting patterns,” he said. The magic of the two Penrose tiles is that they make only nonperiodic patterns — that’s all they can do.“But then the Holy Grail was, could you do with one — one tile?” Dr. Goodman-Strauss said.

Sir Roger found the proofs “very complicated.” Nonetheless, he was “extremely intrigued” by the einstein, he said: “It’s a really good shape, strikingly simple.”

The simplicity came honestly. Mr. Smith’s investigations were mostly by hand; one of his co-authors described him as an “imaginative tinkerer.”

When in November he found a tile that seemed to fill the plane without a repeating pattern, he emailed Craig Kaplan, a co-author and a computer scientist at the University of Waterloo.

“It was clear that something unusual was happening with this shape,” Dr. Kaplan said. Taking a computational approach that built on previous research, his algorithm generated larger and larger swaths of hat tiles. “There didn’t seem to be any limit to how large a blob of tiles the software could construct,”

The first step, Dr. Kaplan said, was to “define a set of four ‘metatiles,’ simple shapes that stand in for small groupings of one, two, or four hats.” The metatiles assemble into four larger shapes that behave similarly. This assembly, from metatiles to supertiles to supersupertiles, ad infinitum, covered “larger and larger mathematical ‘floors’ with copies of the hat,” Dr. Kaplan said. “We then show that this sort of hierarchical assembly is essentially the only way to tile the plane with hats, which turns out to be enough to show that it can never tile periodically.”

some might wonder whether this is a two-tile, not one-tile, set of aperiodic monotiles.

Dr. Goodman-Strauss had raised this subtlety on a tiling listserv: “Is there one hat or two?” The consensus was that a monotile counts as such even using its reflection. That leaves an open question, Dr. Berger said: Is there an einstein that will do the job without reflection?

“the hat” was not a new geometric invention. It is a polykite — it consists of eight kites. (Take a hexagon and draw three lines, connecting the center of each side to the center of its opposite side; the six shapes that result are kites.)

“It’s likely that others have contemplated this hat shape in the past, just not in a context where they proceeded to investigate its tiling properties,” Dr. Kaplan said. “I like to think that it was hiding in plain sight.”

Incredibly, Mr. Smith later found a second einstein. He called it “the turtle” — a polykite made of not eight kites but 10. It was “uncanny,” Dr. Kaplan said. He recalled feeling panicked; he was already “neck deep in the hat.”

Dr. Myers, who had done similar computations, promptly discovered a profound connection between the hat and the turtle. And he discerned that, in fact, there was an entire family of related einsteins — a continuous, uncountable infinity of shapes that morph one to the next.

this einstein family motivated the second proof, which offers a new tool for proving aperiodicity. The math seemed “too good to be true,” Dr. Myers said in an email. “I wasn’t expecting such a different approach to proving aperiodicity — but everything seemed to hold together as I wrote up the details.”

Mr. Smith was amazed to see the research paper come together. “I was no help, to be honest.” He appreciated the illustrations, he said: “I’m more of a pictures person.”

A high vaccination rate was especially important in Florida, which trails only Maine in the share of residents 65 and older. By the end of July, Florida had vaccinated about 60 percent of adults, just shy of the national average

Had it reached a vaccination rate of 74 percent — the average for five New England states at the time — it could have prevented more than 16,000 deaths and more than 61,000 hospitalizations that summer, according to a study published in the medical journal The Lancet.

in Florida, unlike the nation as a whole — and states like New York and California that Mr. DeSantis likes to single out — most people who died from Covid died after vaccines became available to all adults, not before.

Mr. DeSantis and his aides have said that his opposition was to mandates, not to the vaccinations themselves. They say the governor only questioned the efficacy of the shots once it became evident that they did not necessarily prevent infection — which prompted him to criticize experts and the federal government.

The governor had early success in following his instincts. In 2020, the state supplied its nearly 4,000 long-term care homes with Covid tests and isolated Covid patients, avoiding New York’s mistake of releasing Covid patients from hospitals to nursing homes where they infected others. Florida’s death rate in the pandemic’s first year, adjusted for age, was lower than all but 10 other states’.

Florida was also one of only four states to require schools to hold in-person classes in the fall of 2020, a move that Mr. DeSantis has said defied the nation’s public health experts

In fact, Dr. Anthony S. Fauci, a federal infectious disease expert on former President Donald J. Trump’s task force, said repeatedly that summer and fall that schools could open safely with the right precautions. Nonetheless, facing strong opposition from teachers’ unions, nearly three-fourths of the nation’s 100 largest school districts offered only remote learning that fall.

At the same time, though, the governor was embracing more extreme views, including those of Dr. Scott W. Atla

Both he and Dr. Bhattacharya argued that people who were not at risk of severe consequences should not face Covid restrictions. If they were infected, they would develop natural immunity, which would eventually build up in the population and cause the virus to fade away, they said.

Many public health experts were alarmed by this strategy, which was articulated in a document known as the Great Barrington Declaration. They said it would be impossible to ring-fence the vulnerable, or even to clearly communicate to the public who they were. Besides older Americans, as many as 41 million younger adults were considered to be at high risk of severe disease if infected because of underlying medical conditions like obesity.

Dr. Atlas, however, argued that the virus was not dangerous to an overwhelming majority of Americans. Both he and Dr. Bhattacharya said the Covid death rate for everyone under 70 was very low. Dr. Atlas claimed that children had “virtually zero” risk of death.

As of this summer, more than 345,000 Americans under 70 have died of the virus, and more than 3.5 million have been hospitalized

The disease has killed nearly 2,300 children and adolescents, and nearly 200,000 have been hospitalized.

Mr. DeSantis gave him a platform at a series of public events in Florida at the end of the summer of 2020. He would go on to echo Dr. Atlas’s views, sometimes in modified form, throughout the pandemic.

Mr. DeSantis subsequently promoted the shots in 27 counties. Florida offered the vaccine to everyone 65 and older, an eligibility system simpler than an early one recommended by the Centers for Disease Control and Prevention, and adopted by many states, that prioritized essential workers and those over 75.

But his enthusiasm for shots waned fast, tracking the growing hostility toward them among the party’s conservative activists. In late February, when Mr. DeSantis hosted a gathering of such activists for the Conservative Political Action Conference in Orlando, he boasted that Florida was an “oasis of freedom” in a nation led by misguided health authorities.

By the time all adults became eligible for the vaccines in April of that year, Mr. DeSantis was rarely promoting them.

“Some are choosing not to take it, which is fine,” he said in March, at a 100-minute public event on Covid in which he did not once urge people to get vaccinated. In dozens of appearances on Fox News in the first half of 2021, he was carefully neutral about shots, except for those over 65.

“Younger people are just simply at very little risk for this,”

A few months later, he told Fox News that he had concluded early on that Covid “was something that was risky for elderly people,” but that it posed minimal risks for people “who were in reasonably good health, who were, say, under 50.”

The data-driven governor also turned away from Covid case data.

In May 2021, Florida closed its 27 state-run testing centers. The next month, on orders from the governor’s office, the Health Department halted daily reports on infections and deaths, switching to weekly reports that drew less attention.

Both polls and political events showed that Republicans were not as excited as Democrats about the shots. At an Alabama political rally that August, Mr. Trump recommended the vaccine — and was booed. When a reporter asked Mr. DeSantis later that year if he had gotten a booster shot, he responded that he had gotten “the normal shot.”

After the highly contagious Delta variant began spreading in Florida that summer, Mr. DeSantis insisted that his approach had worked. Younger adults were driving the surge but “they’re not getting really sick from it or anything,” he said, adding: “They will develop immunity as a result of those infections.”

But they were getting sick. And vaccinations, which Mr. DeSantis suddenly began recommending again in late July, took weeks to confer protection

With hospitalizations rising, he began a campaign to offer monoclonal antibody treatments — a triage response to the pandemic’s frightening resurgence.

The drug cost vastly more than shots and required more medical staff to administer. Within about six weeks, the state had administered more than 90,000 treatments and probably kept 5,000 people out of the hospital, Dr. Rivkees said.

Mr. DeSantis accused the media in early August of “lying” about Covid patients’ flooding hospitals. Two weeks later, Mary C. Mayhew, head of the Florida Hospital Association, said: “There can be no question that many Florida hospitals are stretched to their absolute limits.”

“Our patients are younger and sicker,” Mr. Smith wrote. Of 17 patients on ventilators in intensive care on Aug. 13, 2021, more than half were younger than 55. Only one was vaccinated.

“People say that the decision about vaccination is a personal one and it doesn’t affect anyone else,” Mr. Smith wrote. “Tell that to the kids who lost their mom.”

When shots became available last year for children under 5, Florida did not preorder them because, Mr. DeSantis said, he did not consider them “appropriate.” Florida’s vaccination rates are well below the national average for children under 5. The state also trails in booster shots.

After Dr. Ladapo issued misleading claims about the risks of Covid shots for young men, the heads of the C.D.C. and the Food and Drug Administration sent a scathing four-page rebuttal. Such misinformation “puts people at risk of death or serious illness,” they said.

While the pandemic waned, leaving more than 80,000 Floridians and 1.13 million Americans dead, the governor continued to push policies that kept him at the vanguard of the anti-vaccine and anti-mandate conversation. A new state law, signed by Mr. DeSantis in May, bans government agencies, businesses and schools from requiring Covid testing, vaccination or mask wearing.

“Everything involving Covid — I think there needs to be major, major accountability,” he said in Iowa this month. “Because if there’s not, if you don’t have a reckoning, they are going to do it again.”

Dr. Monteiro and his colleagues developed a food classification system called Nova, named after the Portuguese and Latin words for “new.” It has since been adopted by researchers across the world.

Unprocessed or minimally processed foods, like fresh or frozen fruits and vegetables, beans, lentils, meat, poultry, fish, eggs, milk, plain yogurt, rice, pasta, corn meal, flour, coffee, tea and herbs and spices.

Processed culinary ingredients, such as cooking oils, butter, sugar, honey, vinegar and salt.

If you look at the ingredient list and you see things that you wouldn’t use in home cooking, then that’s probably an ultraprocessed food,”

his group includes freshly baked bread, most cheeses and canned vegetables, beans and fish. These foods may contain preservatives that extend shelf life.

Ultraprocessed foods made using industrial methods and ingredients you wouldn’t typically find in grocery stores — like high-fructose corn syrup, hydrogenated oils and concentrated proteins like soy isolate.

They often contain additives like flavorings, colorings or emulsifiers to make them appear more attractive and palatable.

Think sodas and energy drinks, chips, candies, flavored yogurts, margarine, chicken nuggets, hot dogs, sausages, lunch meats, boxed macaroni and cheese, infant formulas and most packaged breads, plant milks, meat substitutes and breakfast cereals.

Processed foods made by combining foods from Category 1 with the ingredients of Category 2 and preserving or modifying them with relatively simple methods like canning, bottling, fermentation and baking

That has led to debate among nutrition experts about whether it’s useful for describing the healthfulness of a food, partly since many UPFs — like whole grain breads, flavored yogurts and infant formulas — can provide valuable nutrients

Most research linking UPFs to poor health is based on observational studies, in which researchers ask people about their diets and then track their health over many years.