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Recent letters by another group of scientists and international affairs experts argued at length for the relative likelihood of a laboratory leak. Previous statements from other scientists and the W.H.O. report both asserted that a natural origin was by far the most plausible.

The list of signers includes researchers with deep knowledge of the SARS family of viruses, such as Ralph Baric at the University of North Carolina, who had collaborated with the Chinese virologist Shi Zhengli in research done at the university on the original SARS virus. Dr. Baric did not respond to attempts to reach him by email and telephone.

Speaking for himself only, Dr. Relman said in an interview that “the piece that Kristian Anderson and four others wrote last March in my view simply fails to provide evidence to support their conclusions.”

Angela Rasmussen, a virologist at University of Saskatchewan’s Vaccine and Infectious Disease Organization, has criticized the politicization of the laboratory leak theory.

She supports further investigation, but said that “there is more evidence (both genomic and historical precedent) that this was the result of zoonotic emergence rather than a laboratory accident.”

Aviation is safe in large part because it learns from its disasters. Investigators from the U.S. National Transportation Safety Board go immediately to accident sites to begin assessing evidence. After months or even years of research, their detailed reports try to lay out the “accident chain” and explain what went wrong

with respect to the coronavirus pandemic, it has suffered by far the largest number of fatalities, about one-quarter of the global total, despite having less than one-20th of the world’s population.

What if the NTSB were brought in to look at the Trump administration’s handling of the pandemic? What would its investigation conclude?

This was a journey straight into a mountainside, with countless missed opportunities to turn away. A system was in place to save lives and contain disaster. The people in charge of the system could not be bothered to avoid the doomed course.

Timelines of aviation disasters typically start long before the passengers or even the flight crew knew anything was wrong, with problems in the design of the airplane, the procedures of the maintenance crew, the route, or the conditions into which the captain decided to fly. In the worst cases, those decisions doomed the flight even before it took off. My focus here is similarly on conditions and decisions that may have doomed the country even before the first COVID-19 death had been recorded on U.S. soil.

What happened once the disease began spreading in this country was a federal disaster in its own right: Katrina on a national scale, Chernobyl minus the radiation. It involved the failure to test; the failure to trace; the shortage of equipment; the dismissal of masks; the silencing or sidelining of professional scientists; the stream of conflicting, misleading, callous, and recklessly ignorant statements by those who did speak on the national government’s behalf

As late as February 26, Donald Trump notoriously said of the infection rate, “You have 15 people, and the 15 within a couple of days is going to be down close to zero.” What happened after that—when those 15 cases became 15,000, and then more than 2 million, en route to a total no one can foretell—will be a central part of the history of our times.

1. The Flight Plan

the most important event was the H5N1 “bird flu” outbreak, in 2005. It originated in Asia and was mainly confined there, as the SARS outbreak had been two years earlier. Bush-administration officials viewed H5N1 as an extremely close call. “

Shortly before Barack Obama left office, his administration’s Pandemic Prediction and Forecasting Science and Technology Working Group—yes, that was a thing—released a report reflecting the progress that had been made in applying remote-sensing and AI tools since the early days of Global Argus. The report is freely available online and notes pointedly that recent technological advances “provide opportunities to mitigate large-scale outbreaks by predicting more accurately when and where outbreaks are likely to occur, and how they will progress.”

“Absolutely nothing that has happened has been a surprise. We saw it coming. Not only did we see it, we ran the models and the gaming exercises. We had every bit of the structure in place. We’ve been talking about a biohazard risk like this for years. Anyone who says we did not see this coming has their head in the sand, or is lying through their teeth.”

The system the government set up was designed to warn not about improbable “black swan” events but rather about what are sometimes called “gray rhinos.” These are the large, obvious dangers that will sooner or later emerge but whose exact timing is unknown.

other U.S. leaders had dealt with foreign cover-ups, including by China in the early stages of the SARS outbreak in 2002. Washington knew enough, soon enough, in this case to act while there still was time.

During the Obama administration, the U.S. had negotiated to have its observers stationed in many cities across China, through a program called Predict. But the Trump administration did not fill those positions, including in Wuhan. This meant that no one was on site to learn about, for instance, the unexplained closure on January 1 of the city’s main downtown Huanan Seafood Wholesale Market, a so-called wet market

“It was in the briefings by the beginning of January,” a person involved in preparing the president’s briefing book told me. “On that there is no dispute.” This person went on: “But knowing it is in the briefing book is different from knowing whether the president saw it.” He didn’t need to spell out his point, which was: Of course this president did not.

To sum up: The weather forecast showed a dangerous storm ahead, and the warning came in plenty of time. At the start of January, the total number of people infected with the virus was probably less than 1,000. All or nearly all of them were in China. Not a single case or fatality had been reported in the United States.

2. The Air Traffic Controllers

In cases of disease outbreak, U.S. leadership and coordination of the international response was as well established and taken for granted as the role of air traffic controllers in directing flights through their sectors

in normal circumstances, its location in China would have been a plus. Whatever the ups and downs of political relations over the past two decades, Chinese and American scientists and public-health officials have worked together frequently, and positively, on health crises ranging from SARS during George W. Bush’s administration to the H1N1 and Ebola outbreaks during Barack Obama’s.

One U.S. official recalled the Predict program: “Getting Chinese agreement to American monitors throughout their territory—that was something.” But then the Trump administration zeroed out that program.

“We had cooperated with China on every public-health threat until now,” Susan Shirk, a former State Department official and longtime scholar of Chinese affairs at UC San Diego, told me. “SARS, AIDS, Ebola in Africa, H1N1—no matter what other disputes were going on in the relationship, we managed to carve out health, and work together quite professionally. So this case is just so anomalous and so tragic.” A significant comparison, she said, is the way the United States and the Soviet Union had worked together to eliminate smallpox around the world, despite their Cold War tensions. But now, she said, “people have definitely died because the U.S. and China have been unable to cooperate.”

What did the breakdown in U.S.-Chinese cooperation mean in practice? That the U.S. knew less than it would have otherwise, and knew it later; that its actions brought out the worst (rather than the merely bad) in China’s own approach to the disease, which was essentially to cover it up internally and stall in allowing international access to emerging data; that the Trump administration lost what leverage it might have had over Chinese President Xi Jinping and his officials; and that the chance to keep the disease within the confines of a single country was forever lost.

In addition to America’s destruction of its own advance-warning system, by removing CDC and Predict observers, the Trump administration’s bellicose tone toward China had an effect. Many U.S. officials stressed that a vicious cycle of blame and recrimination made public health an additional source of friction between the countries, rather than a sustained point of cooperation, as it had been for so many years.

“The state of the relationship meant that every U.S. request was met with distrust on the Chinese side, and every Chinese response was seen on the American side as one more attempt to cover up,”

Several officials who had experience with China suggested that other presidents might have called Xi Jinping with a quiet but tough message that would amount to: We both know you have a problem. Why don’t we work on it together, which will let you be the hero? Otherwise it will break out and become a problem for China and the whole world.

“It would have taken diplomatic pressure on the Chinese government to allow us to insert our people” into Wuhan and other disease centers, Klain said. “The question isn’t what leverage we had. The point is that we gave up leverage with China to get the trade deal done. That meant that we didn’t put leverage on China’s government. We took their explanations at face value.”

3. The Emergency Checklist

The president’s advance notice of the partial European ban almost certainly played an important part in bringing the infection to greater New York City. Because of the two-day “warning” Trump gave in his speech, every seat on every airplane from Europe to the U.S. over the next two days was filled. Airport and customs offices at the arrival airports in the U.S. were unprepared and overwhelmed. News footage showed travelers queued for hours, shoulder to shoulder, waiting to be admitted to the U.S. Some of those travelers already were suffering from the disease; they spread it to others. On March 11, New York had slightly more than 220 diagnosed cases. Two weeks later, it had more than 25,000. Genetic testing showed that most of the infection in New York was from the coronavirus variant that had come through Europe to the United States, rather than directly from China (where most of the early cases in Washington State originated).

Aviation is safe because, even after all the advances in forecasting and technology, its culture still imagines emergencies and rehearses steps for dealing with them.

Especially in the post-9/11 era of intensified concern about threats of all sorts, American public-health officials have also imagined a full range of crises, and have prepared ways to limit their worst effects. The resulting official “playbooks” are the equivalent of cockpit emergency checklists

the White House spokesperson, Kayleigh McEnany, then claimed that whatever “thin packet of paper” Obama had left was inferior to a replacement that the Trump administration had supposedly cooked up, but which has never been made public. The 69-page, single-spaced Obama-administration document is officially called “Playbook for Early Response to High-Consequence Infectious Disease Threats and Biological Incidents” and is freely available online. It describes exactly what the Trump team was determined not to do.

What I found remarkable was how closely the Obama administration’s recommendations tracked with those set out 10 years earlier by the George W. Bush administration, in response to its chastening experience with bird flu. The Bush-era work, called “National Strategy for Pandemic Influenza” and publicly available here, differs from the Obama-era playbook mainly in the simpler forms of technology on which it could draw

consider the one below, and see how, sentence by sentence, these warnings from 2005 match the headlines of 2020. The topic was the need to divide responsibility among global, national, state, and community jurisdictions in dealing with the next pandemic. The fundamental premise—so widely shared that it barely needed to be spelled out—was that the U.S. federal government would act as the indispensable flywheel, as it had during health emergencies of the past. As noted, it would work with international agencies and with governments in all affected areas to coordinate a global response. Within its own borders it would work with state agencies to detect the potential for the disease’s spread and to contain cases that did arise:

Referring to the detailed pandemic playbooks from the Bush and Obama administrations, John R. Allen told me: “The moment you get confirmation of a problem, you would move right to the timeline. Decisions by the president, actions by the secretary of defense and the CDC, right down the list. You’d start executing.”Or, in the case of the current administration, you would not. Reading these documents now is like discovering a cockpit checklist in the smoking wreckage.

4. The Pilot

a virtue of Sully is the reminder that when everything else fails—the forecasts, the checklists, the triply redundant aircraft systems—the skill, focus, and competence of the person at the controls can make the difference between life and death.

So too in the public response to a public-health crisis. The system was primed to act, but the person at the top of the system had to say, “Go.” And that person was Donald Trump.

n a resigned way, the people I spoke with summed up the situation this way: You have a head of government who doesn’t know anything, and doesn’t read anything, and is at the mercy of what he sees on TV. “And all around him, you have this carnival,”

“There would be some ballast in the relationship,” this person said. “Now all you’ve got is the trade friction”—plus the personal business deals that the president’s elder daughter, Ivanka, has made in China,

5. The Control Systems

The deadliest airline crash in U.S. history occurred in 1979. An American Airlines DC-10 took off from O’Hare Airport, in Chicago—and just as it was leaving the ground, an incorrectly mounted engine ripped away from one of the wings. When the engine’s pylon was pulled off, it cut the hydraulic lines that led from the cockpit to the control surfaces on the wings and tail. From that point on, the most skillful flight crew in the world could not have saved the flight.

By the time the pandemic emerged, it may have already been too late. The hydraulic lines may already have been too damaged to transmit the signals. It was Trump himself who cut them.

The more complex the organization, the more its success or failure turns on the skill of people in its middle layers—the ones who translate a leader’s decision to the rest of the team in order to get results. Doctors depend on nurses; architects depend on contractors and craftsmen; generals depend on lieutenants and sergeants

Because Donald Trump himself had no grasp of this point, and because he and those around him preferred political loyalists and family retainers rather than holdovers from the “deep state,” the whole federal government became like a restaurant with no cooks, or a TV station with stars but no one to turn the cameras on.

“There is still resilience and competence in the working-level bureaucracy,” an intelligence-agency official told me. “But the layers above them have been removed.”

Traditionally, the National Security Council staff has comprised a concentration of highly knowledgeable, talented, and often ambitious younger figures, mainly on their way to diplomatic or academic careers.

“There is nobody now who can play the role of ‘senior China person,’” a former intelligence official told me. “In a normal administration, you’d have a lot of people who had spent time in Asia, spent time in China, knew the goods and bads.” Also in a normal administration, he and others pointed out, China and the United States would have numerous connective strands

The United States still possesses the strongest economy in the world, its military is by far the most powerful, its culture is diverse, and, confronted with the vicissitudes of history, the country has proved resilient. But a veteran of the intelligence world emphasized that the coronavirus era revealed a sobering reality. “Our system has a single point-of-failure: an irrational president.” At least in an airplane cockpit, the first officer can grab the controls from a captain who is steering the aircraft toward doom.

Every president is “surprised” by how hard it is to convert his own wishes into government actions

Presidents cope with this discovery in varying ways. The people I spoke with had served in past administrations as early as the first George Bush’s. George H. W. Bush came to office with broad experience in the federal government—as much as any other president. He had been vice president for eight years, a CIA director, twice an ambassador, and a member of Congress. He served only four years in the Oval Office but began with a running start. Before he became president, Bill Clinton had been a governor for 12 years and had spent decades learning and talking about government policies. A CIA official told me that Clinton would not read his President’s Daily Briefs in the morning, when they arrived, but would pore over them late at night and return them with copious notes. George W. Bush’s evolution from dependence on the well-traveled Dick Cheney, in his first term, to more confident control, in his second, has been well chronicled. As for Obama, Paul Triolo told me: “By the end of his eight years, Obama really understood how to get the bureaucracy to do what he wanted done, and how to get the information he needed to make decisions.” The job is far harder than it seems. Donald Trump has been uninterested in learning the first thing about it.

In a situation like this, some of those in the “regular” government decide to struggle on. Others quit—literally, or in the giving-up sense

The ‘process’ is just so chaotic that it’s not a process at all. There’s no one at the desk. There’s no one to read the memos. No one is there.”

“If this could happen to Fauci, it makes people think that if they push too hard in the wrong direction, they’ll get their heads chopped off. There is no reason in the world something called #FireFauci should even exist. The nation’s leaders should maintain high regard for scientific empiricism, insight, and advice, and must not be professionally or personally risk averse when it comes to understanding and communicating messages about public safety and health.”

Over nearly two decades, the U.S. government had assembled the people, the plans, the connections, and the know-how to spare this nation the worst effects of the next viral mutation that would, someday, arise. That someday came, and every bit of the planning was for naught. The deaths, the devastation, the unforeseeable path ahead—they did not have to occur.

The language of an NTSB report is famously dry and clinical—just the facts. In the case of the pandemic, what it would note is the following: “There was a flight plan. There was accurate information about what lay ahead. The controllers were ready. The checklists were complete. The aircraft was sound. But the person at the controls was tweeting. Even if the person at the controls had been able to give effective orders, he had laid off people that would carry them out. This was a preventable catastrophe.”

“Whether the Delta variant is already at that plateau, or whether there’s going to be further increases before it gets to that plateau, I can’t say. But I do think that plateau exists.”

Antibodies, which can prevent the virus from entering our cells, are engineered to latch onto specific molecules on the surface of the virus, snapping into place like puzzle pieces. But genetic mutations in the virus can change the shape of those binding sites.

“If you change that shape, you can make it impossible for an antibody to do its job,”

But as more people acquire antibodies against the virus, mutations that allow the virus to slip past these antibodies will become even more advantageous.

The good news is that there are many different kinds of antibodies, and a variant with a few new mutations is unlikely to escape them all, experts said.

its sleeve to counteract the evolution of the virus,” Dr. Pepper said. “Knowing that there is this complex level of diversity in the immune system allows me to sleep better at night.”

“It’s a lot harder to evade T cell responses than antibody responses,”

And then there are B cells, which generate our army of antibodies. Even after we clear the infection, the body keeps churning out B cells for a while, deliberately introducing small genetic mutations. The result is an enormously diverse collection of B cells producing an array of antibodies, some of which might be a good match for the next variant that comes along.

Whether the virus will become more virulent — that is, whether it will cause more serious disease — is the hardest to predict,

Unlike transmissibility or immune evasion, virulence has no inherent evolutionary advantage.

Some scientists predict that the virus will ultimately be much like the flu, which can still cause serious illness and death, especially during seasonal surges.

“The virus has no interest in killing us,” Dr. Metcalf said. “Virulence only matters for the virus if it works for transmission.”

It is too early to say whether SARS-CoV-2 will change in virulence over the long-term. There could certainly be trade-offs between virulence and transmission; variants that make people too sick too quickly may not spread very far.

Then again, this virus spreads before people become severely ill. As long as that remains true, the virus could become more virulent without sacrificing transmissibility.

Moreover, the same thing that makes the virus more infectious — faster replication or tighter binding to our cells — could also make it more virulent.

Although many possible paths remain open to us, what is certain is that SARS-CoV-2 will not stop evolving — and that the arms race between the virus and us is just beginning.

We lost the first few rounds, by allowing the virus to spread unchecked, but we still have powerful weapons to bring to the fight. The most notable are highly effective vaccines, developed at record speed. “I think there is hope in the fact that the SARS-CoV-2 vaccines at this point are more effective than flu vaccines have probably ever been,”

“I have great faith that we can sort any detrimental evolutionary trajectories out by improving our current or next generation vaccines,”

be you have a re-infection, but it’s relatively mild, which also boosts your immunity,”

rising vaccination rates may already be suppressing new mutations.And the evolution rate could also slow down as the virus becomes better adapted to humans.

“There’s low-hanging fruit,” Dr. Lauring said. “So there are certain ways it can evolve and make big improvements, but after a while there aren’t areas to improve — it’s figured out all the easy ways to improve.”

Eventually, as viral evolution slows down and our immune systems catch up, we will reach an uneasy equilibrium with the virus, scientists predict. We will never extinguish it, but it will smolder rather than rage.

So far, studies suggest that our antibody, T cell and B cell responses are all working as expected when it comes to SARS-CoV-2. “This virus is mostly playing by immunological rules we understand,”

Others are more optimistic. “My guess is that one day this is going to be another cause of the common cold,”

There are four other coronaviruses that have become endemic in human populations. We are exposed to them early and often, and all four mostly cause run-of-the-mill colds.

much of the world remains unvaccinated, and this virus has already proved capable of surprising us. “We should be somewhat cautious and humble about trying to predict what it is capable of doing in the future,”

While we can’t guard against every eventuality, we can tip the odds in our favor by expanding viral surveillance, speeding up global vaccine distribution and tamping down transmission until more people can be vaccinated

The future, he said, “depends much, much more on what humans do than on what the virus does.”

According to Cirium, an aviation-industry consulting firm, more than 200,000 flights in and out of China have been canceled, a 60 percent decline. In 2003, in the midst of SARS, global air travel was down 25 percent.

Fear dissipates eventually, replaced by a more realistic sense of the risks. An epidemic, even one of a disease as seemingly easy to transmit as COVID-19, while burdening public-health systems and potentially deadly for the elderly and those with compromised immune systems, is eminently survivable by the majority of the population

Which brings us to the last stage of epidemic grief: rational response. After denial, panic, and fear, we can finally get down to the business of basic sanitary measures and infection protocols

there are only four things you need to know about a virus: “What is it? What does it do? Where does it come from? And how do you kill it?”

We never did develop a vaccine. With SARS, infections peaked sometime in May 2003, at about 9,000 cases. By then, the daily rate of new infections had dipped below the number declared cured or dead

That is the inflection point of any outbreak, the point at which the worst is over.

Why did the rate of transmission slow? Part of the answer is seasonality: The Northern Hemisphere’s virus season tends to run from winter to mid-spring, perhaps because people aren’t clustered indoors and so are less contagious, or because viruses might weaken in lower relative humidity or direct sunlight. (Nobody actually knows.)

In the antibiotic era, infection control has been largely delegated to IV drips rather than sanitary cordons. With respiratory diseases like SARS, MERS, and COVID-19, 19th-century medical techniques and equipment—masks, gloves, galoshes, sealed wards, quarantines, and ventilation—are what comprise a rational response.

Your antibodies may be not as effective, but they’re still going to be effective. If you have 10 times the amount of antibody that you need and you lose half of that, you’re still going to be well protected. And I think that’s where these variants are. Most people will be well protected from the worst aspects of disease.

There are four or five common-cold coronaviruses. Many of them have their roots in animals, whether they be bats or cows or other animal species, and then jumped into humans. None of those viruses cause severe disease. They’re all relatively transmissible, and you can get infected every two or three years with them.

There is some possibility [SARS-CoV-2] will go along that route. Once we’ve all gotten some level of baseline immunity—we’ve seen a virus like this or very similar to this—the next time you have it, it [may cause] a mild infection but, for the most part, you won’t end up in a hospital or on a respirator. That’s kind of the trajectory that you could expect, but again, we don’t know.

This event could have happened in 2002 with [SARS-CoV-1], but that virus was effectively stopped through quarantining and other procedures. We have an event now where most of the world will have seen this virus, either through a vaccine or through natural immunity, and so its trajectory in a few years is really hard to predict. I’m hopeful that it’s going to be more like a common-cold coronavirus. The best outcome would be that it’s like SARS 1 and it just disappears from the Earth.

deliberate, systematic use of its digital health infrastructure.

Every person in Taiwan has a health card with a unique ID that all doctors and hospitals use to access online medical records. Providers use the card to document care episodes for reimbursement from the Ministry of Health. As a result, the card gives the ministry regular, nearly real-time data on physician and hospital visits and use of specific services.

When Covid-19 hit, the health card and electronic health records system were repurposed to fight the spread of the virus.

“Taiwan enhanced Covid-19 case finding by proactively seeking out patients with severe respiratory symptoms (based on information from the National Health Insurance [NHI] database) who had tested negative for influenza and retested them for Covid-19.” The availability of almost immediate data on patient visits allowed the country to efficiently identify, test, trace, and isolate cases. This has dramatically reduced Covid-19 spread without the need for extensive lockdowns.

we seem reluctant to allow the Department of Health and Human Services to monitor patient encounters, as Taiwan does, to track disease and determine what medical tests and treatments to order.

Insurers already get data based on hospital and physician claims, but only weeks or months after encounters, making the information less useful for tracking infectious outbreaks

years of painstakingly worded treaties, high-level visits and cutting-edge disease surveillance—all meant to encourage good-faith cooperation—have only bitten around the edges of the problem.

“It can’t demand entry into a country because they think something bad is happening.”

Nearly 200 countries were counting on an agency whose budget—roughly $2.4 billion in 2020—is less than a sixth of the Maryland Department of Health’s. Its donors, largely Western governments, earmark most of that money for causes other than pandemic preparedness.

In 2018 and 2019, about 8% of the WHO’s budget went to activities related to pandemic preparedness

the agency’s bureaucratic structure, diplomatic protocol and funding were no match for a pandemic as widespread and fast-moving as Covid-19.

To write its recommendations, the WHO solicits outside experts, which can be a slow process.

It took those experts more than four months to agree that widespread mask-wearing helps, and that people who are talking, shouting or singing can expel the virus through tiny particles that linger in the air. In that time, about half a million people died.

As months rolled on, it became clear that governments were reluctant to allow the U.N. to scold, shame or investigate them.

In particular, The Wall Street Journal found:

* China appears to have violated international law requiring governments to swiftly inform the WHO and keep it in the loop about an alarming infectious-disease cluster

—there are no clear consequences for violations

* The WHO lost a critical week waiting for an advisory panel to recommend a global public-health emergency, because some of its members were overly hopeful that the new disease wasn’t easily transmissible from one person to another.

* The institution overestimated how prepared some wealthy countries were, while focusing on developing countries, where much of its ordinary assistance is directed

Public-health leaders say the WHO plays a critical role in global health, leading responses to epidemics and setting health policies and standards for the world. It coordinates a multinational effort every year to pick the exact strains that go into the seasonal flu vaccine, and has provided public guidance and advice on Covid-19 when many governments were silent.

The world’s public-health agency was born weak, created in 1948 over U.S. and U.K. reluctance. For decades, it was legally barred from responding to diseases that it learned about from the news. Countries were required to report outbreaks of only four diseases to the WHO: yellow fever, plague, cholera and smallpox, which was eradicated in 1980.

Nearly three times that amount was budgeted for eradicating polio, a top priority for the WHO’s two largest contributors: the U.S. and the Bill & Melinda Gates Foundation.

SARS convinced governments to retool the WHO. The next year, delegates arrived in the Geneva palace where the League of Nations once met to resolve a centuries-old paradox: Countries don’t report outbreaks, because they fear—correctly—their neighbors will respond by blocking travel and trade.

“Everybody pushed back. No sovereign country wants to have this.”

China wanted an exemption from immediately reporting SARS outbreaks. The U.S. argued it couldn’t compel its 50 states to cooperate with the treaty. Iran blocked American proposals to make the WHO focus on bioterrorism. Cuba had an hourslong list of objections.

Around 3:15 a.m. on the last day, exhausted delegates ran out of time. The treaty they approved, called the International Health Regulations, imagined that each country would quickly and honestly report, then contain, any alarming outbreaks

In return, the treaty discouraged restrictions on travel and trade. There would be no consequences for reporting an outbreak—yet no way to punish a country for hiding one.

The treaty’s key chokepoint: Before declaring a “public health emergency of international concern,” or PHEIC, the WHO’s director-general would consult a multinational emergency committee and give the country in question a chance to argue against such a declaration.

Delegates agreed this could give some future virus a head start but decided it was more important to discourage the WHO from making any unilateral announcements that could hurt their economies.

On Jan. 22, a committee of 15 scientists haggled for hours over Chinese data and a handful of cases in other countries. Clearly, the virus was spreading between people in China, though there was no evidence of that in other countries. The question now: Was it mainly spreading from very sick people in hospitals and homes—or more widely?

On Jan. 3, representatives of China’s National Health Commission arrived at the WHO office in Beijing. The NHC acknowledged a cluster of pneumonia cases, but didn’t confirm that the new pathogen was a coronavirus, a fact Chinese officials already knew.

That same day, the NHC issued an internal notice ordering laboratories to hand over or destroy testing samples and forbade anyone from publishing unauthorized research on the virus.

China’s failure to notify the WHO of the cluster of illnesses is a violation of the International Health Regulations

China also flouted the IHR by not disclosing all key information it had to the WHO

The WHO said it’s up to member states to decide whether a country has complied with international health law, and that the coming review will address those issues.

While Chinese scientists had sequenced the genome and posted it publicly, the government was less forthcoming about how patients might be catching the virus.

WHO scientists pored over data they did get, and consulted with experts from national health agencies, including the CDC, which has 33 staff detailed to the WHO.

Then a 61-year-old woman was hospitalized in Thailand on Jan. 13.

The next day, Dr. van Kerkhove told reporters: “It’s certainly possible that there is limited human-to-human transmission.” MERS and SARS, both coronaviruses, were transmissible among people in close quarters. Epidemiological investigations were under way, she said.

Over the next few years, emergency committees struggled over how to determine whether an outbreak was a PHEIC. It took months to declare emergencies for two deadly Ebola epidemics

The committee met over two days, but was split. They mostly agreed on one point: The information from China “was a little too imprecise to very clearly state that it was time” to recommend an emergency declaration,

On Jan. 28, Dr. Tedros and the WHO team arrived for their meeting with Mr. Xi

Leaning across three wooden coffee tables, Dr. Tedros pressed for cooperation. In the absence of information, countries might react out of fear and restrict travel to China, he repeated several times throughout the trip. Mr. Xi agreed to allow a WHO-led international team of experts to visit. It took until mid-February to make arrangements and get the team there.

China also agreed to provide more data, and Dr. Tedros departed, leaving Dr. Briand behind with a list of mysteries to solve. How contagious was the virus? How much were children or pregnant women at risk? How were cases linked? This was vital information needed to assess the global risk, Dr. Briand said

Back in Geneva, Dr. Tedros reconvened the emergency committee. By now it was clear there was human-to-human transmission in other countries. When it met on Jan. 30, the committee got the information the WHO had been seeking. This time the committee recommended and Dr. Tedros declared a global public-health emergency.

President Trump and New York Gov. Andrew Cuomo both assured constituents their health systems would perform well. The U.K.’s chief medical officer described the WHO’s advice as largely directed at poor and middle-income countries. As for keeping borders open, by then many governments had already closed them to visitors from China.

The WHO shifted focus to the developing world, where it believed Covid-19 would exact the heaviest toll. To its surprise, cases shot up just across the border, in northern Italy.

Lessons learned

If there were one thing the WHO might have done differently, it would be to offer wealthier countries the type of assistance with public-health interventions that the WHO provides the developing world

the WHO’s warning system of declaring a global public-health emergency needs to change. Some want to see a warning system more like a traffic light—with color-coded alarms for outbreaks, based on how worried the public should be

Emergency committees need clearer criteria for declaring a global public-health emergency and should publicly explain their thinking

The WHO should have more powers to intervene in countries to head off a health crisis

the WHO’s health emergencies unit should report to the director-general and not member states, and its budget should be protected so it doesn’t have to compete with other programs for money.

Implementing many of those ideas would require herding diplomats back for another monthslong slog of treaty revisions. If and when such talks begin, new governments will likely be in place, and political priorities will float elsewher

“Unfortunately, I’m very cynical about this,” he said. “We are living through cycles of panic and neglect. We’ve been through all of this before.”

“Never before have so many opportunities existed for pathogens to pass from wild and domestic animals to people,” she told the Guardian, explaining that 75% of all emerging infectious diseases come from wildlife.“Our continued erosion of wild spaces has brought us uncomfortably close to animals and plants that harbour diseases that can jump to humans.”

“There are too many pressures at the same time on our natural systems and something has to give,” she added. “We are intimately interconnected with nature, whether we like it or not. If we don’t take care of nature, we can’t take care of ourselves. And as we hurtle towards a population of 10 billion people on this planet, we need to go into this future armed with nature as our strongest ally.”

Human infectious disease outbreaks are rising and in recent years there have been Ebola, bird flu, Middle East respiratory syndrome (Mers), Rift Valley fever, sudden acute respiratory syndrome (Sars), West Nile virus and Zika virus all cross from animals to humans.

Cunningham said other diseases from wildlife had much higher fatality rates in people, such as 50% for Ebola and 60%-75% for Nipah virus, transmitted from bats in south Asia. “Although, you might not think it at the moment, we’ve probably got a bit lucky with [Covid-19],” he said. “So I think we should be taking this as a clear warning shot. It’s a throw of the dice.”

“The animals have been transported over large distances and are crammed together into cages. They are stressed and immunosuppressed and excreting whatever pathogens they have in them,” he said. “With people in large numbers in the market and in intimate contact with the body fluids of these animals, you have an ideal mixing bowl for [disease] emergence. If you wanted a scenario to maximise the chances of [transmission], I couldn’t think of a much better way of doing it.”

Aaron Bernstein, at the Harvard School of Public Health in the US, said the destruction of natural places drives wildlife to live close to people and that climate change was also forcing animals to move: “That creates an opportunity for pathogens to get into new hosts.”

The billion-dollar illegal wildlife trade is another part of the problem, said John Scanlon, the former secretary general of the Convention on International Trade of Endangered Species of Wild Fauna and Flora.

The Covid-19 crisis may provide an opportunity for change, but Cunningham is not convinced it will be taken: “I thought things would have changed after Sars, which was a massive wake up call – the biggest economic impact of any emerging disease to that date,” he said.

Researchers believe the incubation period before symptoms is roughly five days on average. In studying the pattern of illness, epidemiologists have made the dismaying discovery that people start shedding the virus — potentially making others sick — in advance of symptoms.

The bulldozer nature of coronavirus means widespread severe illnesses and deaths from covid-19 can happen with terrifying speed.

a large percentage of the world’s population, potentially billions of people, could become infected within the next couple of years. Frantic efforts to develop a safe and effective vaccine are likely to take a year or more.

covid-19 may be many times as lethal for an infected person as seasonal flu.

the virus has a gift for stealth transmission. It seeds itself in communities far and wide,

But on Jan. 23, China imposed extreme travel restrictions and soon put hundreds of millions of people into some form of lockdown as authorities aggressively limited social contact. The R0 plummeted below 1, and the epidemic has been throttled in China, at least for now.

R0, pronounced “R naught.” That is the average number of new infections generated by each infected person.

he R0 is not an intrinsic feature of the virus. It can be lowered through containment, mitigation and ultimately “herd immunity,”

In the early days in China, before the government imposed extreme travel restrictions in Wuhan and nearby areas, and before everyone realized exactly how bad the epidemic might be, the R0 was 2.38, according to a study published in the journal Science. That is a highly contagious disease.

The pandemic appears to be largely driven by direct, human-to-human transmission. That is why public health officials have told people to engage in social distancing

its ability to spread depends also on the vulnerability of the human population, including the density of the community.

Without a vaccine or a drug to stop infections, the best hope is to break the chain of transmission one infection at a time

“Social distancing is building speed bumps so that we can slow the spread of the virus. We have to respect the speed bumps,”

the efficacy of social distancing “is the million-dollar question right now.”

She compared the current public measures to what happened during the 1918 influenza pandemic that killed an estimated 675,000 people in the United States, and in which some cities were more careful than others about enforcing social distancing.

“The USA is currently in a natural experiment of sorts, which each state implementing their own version of social distancing,” she said. “We will be able to compare the efficacy of these various public health policies, but not until more time has passed.”

Not only must people limit their direct contact, they need to limit the amount that their paths overlap, because the virus can linger on surfaces.

The virus degrades outside a host because of exposure to moisture and sunlight, or from drying out

in pristine laboratory conditions, some SARS-CoV-2 particles can remain potentially viable on metal or plastic for up to three days.

Absent hard data, limiting contact with shared surfaces, such as door handles or checkout machines, and frequent hand-washing is highly advisable.

people have some innate, mechanical defenses against viruses just like they do against pollen and dust, Taubenberger noted. Cells in the respiratory tract have tiny hairlike projections, called cilia, that move mucus toward the throat in a manner that helps clear invasive particles. This is not our body’s first viral rodeo.

we see the classic “Confucian values” (or “Asian values”) argument that has historically been deployed to explain everything from the economic success of East Asian nations to the prevalence of authoritarian single-party rule in Asia, and even, most recently, China’s supposed edge in AI research.

So, yeah, kudos to Taiwan for keeping its people safe, but here in America we’re going to do what we always do in a crisis—line up at a gun store and accuse the opposing political party of acting in bad faith. Not for us, those Asian values.

But the truth is that Taiwan, one of Asia’s most vibrant and boisterous democracies, is a terrible example to cite as a cultural other populated by submissive peons

Taiwan’s self-confidence and collective solidarity trace back to its triumphal self-liberation from its own authoritarian past, its ability to thrive in the shadow of a massive, hostile neighbor that refuses to recognize its right to chart its own path, and its track record of learning from existential threats.

There is no doubt that in January it would have been difficult for the US to duplicate Taiwan’s containment strategy, but that’s not because Americans are inherently more ornery than Taiwanese

It’s because the United States has a miserable record when it comes to learning from its own mistakes and suffers from a debilitating lack of faith in the notion that the government can solve problems—something that dates at least as far back as the moment in 1986 when Ronald Reagan said, “The nine most terrifying words in the English language are: ‘I’m from the government and I’m here to help.’”

The Taiwan-US comparison is the opposite of a clash of civilizations; instead, it’s a deathly showdown between competence and incompetence.

To be fair, there are some cultural aspects of East Asian societies that may work in Taiwan’s favor

There is undeniably a long tradition in East Asia of elevating scholars and experts to the highest levels of government,

The country’s president Tsai Ingwen, boasts a PhD from the London School of Economics, and the vice president, Chen Chien-jen, is a highly regarded epidemiologist

“Taiwan actually has a functioning democratic government, run by sensible, well-educated people—the USA? Not so much.”)

First, and most important was Taiwan’s experience battling the SARS outbreak in 2003, followed by the swine flu in 2009

The threat of SARS put Taiwan on high alert for future outbreaks, while the past record of success at meeting such challenges seems to have encouraged the public to accept socially intrusive technological interventions.

Taiwan’s commitment to transparency has also been critical

In the United States, the Trump administration ordered federal health authorities to treat high-level discussions on the coronavirus as classified material.

In Taiwan, the government has gone to great lengths to keep citizens well informed on every aspect of the outbreak, including daily press conferences and an active presence on social media

“Do not forget that Taiwan has been under China’s threat constantly,” wrote Wang Cheng-hua, a professor of art history at Princeton, “which has raised social consciousness about collective action. When the collective will supports government, then all of the strict measures implemented by the government make sense.”

But Taiwan’s own success at building a functional democracy is probably the most potent rebuke to the Asian values thesis.

The democracy activists who risked their lives and careers during the island nation’s martial law era were not renowned for their willingness to accept government orders or preach Confucian social harmony

some of the current willingness to trust what the government is telling the people is the direct “result of having experienced the transition from an authoritarian government that lied all the time, to a democratic government and robust political dialogue that forced people to be able to evaluate information.”

Because of the opposition of the People’s Republic of China, Taiwan is not a member of the United Nations or the World Health Organization

“The reality of being isolated from global organizations,” wrote Tung, “also makes Taiwanese very aware of the publicity of its success in handling a crisis like this. The more coverage from foreign media, the more people feel confident in government policy and social mobilization.”

Given what we know about Taiwan’s hard-won historical experience, could the US have implemented a similar model?

The answer, sadly, seems to be no

it would be impossible for the US to successfully integrate a health care database with customs and travel records because there is no national health care database in the United States. “The US health care system is fragmented, making it difficult to organize, integrate, and assess data coming in from its various government and private-sector parts,”

more tellingly, continued Fidler, “the manner in which the United States has responded to Covid-19 demonstrates that the United States did not learn the lessons from past outbreaks and is struggling to cobble together a semblance of a strategy. ”

There’s where the contrast between the United States and Taiwan becomes most salient. The US is not only bad at the act of government but has actively been getting worse.

Over the past quarter-century, Taiwan’s government has nurtured public trust by its actions and its transparency.

But over that same period, powerful political and economic interests in the US have dedicated themselves to undermining faith in government action, in favor of deregulated markets that have no capacity to react intelligently or proactively to existential threats.

And instead of learning from history, US leaders actively ignore it, a truth for which there could be no better symbolic proof than the Trump administration’s dismantling of the National Security Council pandemic office created by the Obama administration in the wake of the Ebola outbreak

Finally, instead of seeking to keep the public informed to the best of our ability, some of our political leaders and media institutions have gone out of their way to muddy the waters.

In Taiwan, one early government response to the Covid-19 outbreak was to institute a fine of $100,000 for the act of spreading fake news about the epidemic.

In the US the most popular television news network in the country routinely downplayed or misrepresented the threat of the coronavirus, until the severity of the outbreak became too large to ignore.

If there is any silver lining here, it’s that the disaster now upon us is of such immense scope that it could finally expose the folly of the structural forces that have been wreaking sustained havoc on American governmental institutions

So maybe we are finally about to learn that competence matters, that educated leaders are a virtue, and that telling the truth is a responsibility

Americans might have to learn this the hard way, like we did in Hong Kong and Singapore.”

We’re about to find out how hard it’s going to be. But will we learn?

Other studies showed different consequences. Children born during the pandemic grew into shorter, poorer, less educated adults with higher rates of physical disability than one would expect

the microorganisms likely killed more people than the war did. And their effects weren’t confined to European battlefields, but spread across the globe, emptying city streets and filling cemeteries on six continents.

Unlike the war, the flu was incomprehensible—the influenza virus wasn’t even identified until 1931. It inspired fear of immigrants and foreigners, and anger toward the politicians who played down the virus

killed more men than women, skewing sex ratios for years afterward. Can one be sure that the ensuing, abrupt changes in gender roles had nothing to do with the virus?

the accompanying flood of anti-Semitic violence. As it spread through Germany, Switzerland, France, Spain, and the Low Countries, it left behind a trail of beaten cadavers and burned homes.

In northern Italy, landlords tended to raise wages, which fostered the development of a middle class. In southern Italy, the nobility enacted decrees to prevent peasants from leaving to take better offers. Some historians date the separation in fortunes of the two halves of Italy—the rich north, the poor south—to these decisions.

When the Black Death began, the English Plantagenets were in the middle of a long, brutal campaign to conquer France. The population losses meant such a rise in the cost of infantrymen that the whole enterprise foundered. English nobles did not occupy French châteaus. Instead they stayed home and tried to force their farmhands to accept lower wages. The result, the Peasants’ Revolt of 1381, nearly toppled the English crown. King Richard II narrowly won out, but the monarchy’s ability to impose taxes, and thus its will, was permanently weakened.

The coronavirus is hitting societies that regarded deadly epidemics as things of the past, like whalebone corsets and bowler hats.

The American public has not enjoyed its surprise reentry into the world of contagion and quarantine—and this unhappiness seems likely to have consequences.

People sought new sources of authority, finding them through direct personal experience with the world and with God.

With the supply of European workers suddenly reduced and the demand for labor relatively unchanged, medieval landowners found themselves in a pickle: They could leave their grain to rot in the fields, or they could abandon all sense of right and wrong and raise wages enough to attract scarce workers

Within a few decades, Cohn wrote, hysteria gave way to sober observation. Medical tracts stopped referring to conjunctions of Saturn and prescribed more earthly cures: ointments, herbs, methods for lancing boils. Even priestly writings focused on the empirical. “God was not mentioned,” Cohn noted. The massacres of Jews mostly stopped.

the lesson seems more that humans confronting unexpected disaster engage in a contest for explanation—and the outcome can have consequences that ripple for decades or centuries.

Columbus’s journey to the Americas set off the worst demographic catastrophe in history

Somewhere between two-thirds and nine-tenths of the people in the Americas died. Many later European settlers, like my umpteen-great-grandparents, believed they were coming to a vacant wilderness. But the land was not empty; it had been emptied—a world of loss encompassed in a shift of tense.

Absent the diseases, it is difficult to imagine how small groups of poorly equipped Europeans at the end of very long supply chains could have survived and even thrived in the alien ecosystems of the Americas

“I fully support banning travel from Europe to prevent the spread of infectious disease,” the Cherokee journalist Rebecca Nagle remarked after President Trump announced his plan to do this. “I just think it’s 528 years too late.”

a possible legacy of Hong Kong’s success with SARS is that its citizens seem to put more faith in collective action than they used to

The result will be, among other things, a test of how much contemporary U.S. society values the elderly.

The speed with which pundits emerged to propose that the U.S. could more easily tolerate a raft of dead oldsters than an economic contraction indicates that the reservoir of appreciation for today’s elders is not as deep as it once was

the 2003 SARS epidemic in Hong Kong. That epidemic, which killed about 300 people, was stopped only by heroic communal efforts. (As a percentage of the population, the equivalent U.S. death toll would be about 15,000.)

For Native peoples, the U-shaped curve was as devastating as the sheer loss of life. As an indigenous archaeologist once put it to me, the epidemics simultaneously robbed his nation of its future and its past: the former, by killing all the children; the latter, by killing all the elders, who were its storehouses of wisdom and experience.

Past societies mourned the loss of collective memory caused by epidemics. Ours may not, at least at first.

On top of that, Holmes says, the bat species carrying these viruses are common across most of Southeast Asia. "So imagine if you ran our experiment across the whole of Southeast Asia. You'd find an amazing diversity of coronaviruses," Holmes says. "And there's just an enormous number of them."

And depending on how you define a virus species, Holmes says, there are likely thousands of different coronaviruses all around the world. "We're only just starting to scratch the surface," he says. "The virusphere of coronaviruses is just immense."

How often do these viruses jump from animals into people and how often do they make people sick?

In one area, they found that nearly 3% of people had been infected with an unknown coronavirus in the past few years. "

If you expand those findings to all parts of Southeast Asia where people are exposed to these bats, Daszak estimates that more than a million people are infected with unknown coronaviruses each year.

"It's happening every day," Daszak says. "I look at the spillover event a bit like rain or snow. These viruses are getting into and trickling across our populations."

But each one gives the virus the opportunity to adapt and spread more easily from person to person. Every once in a while, a contagious virus infects a person who finds their way to a dense city, such as Wuhan.

"Coronavirus pandemics are not a once in a hundred year event. "The next one could come at any time. It could come in 50 years or in 10 years. Or it could be next year."

"If you want to make a new influenza vaccine using the traditional methods, you have to isolate the virus, learn how to grow it, learn how to inactivate it, and purify it. That takes months. With RNA, you only need the sequence,"

"When the Chinese released the sequence of the SARS-CoV-2 virus, we started the process of making RNA the next day. A couple weeks later, we were injecting animals with the vaccine."

Weissman's lab is now working on a universal coronavirus vaccine that would protect against Covid-19, SARS, MERS, coronavirus that cause the common cold -- and future strains.

"We started working on a pan-coronavirus vaccine last spring," Weissman said. "There have been three coronavirus epidemics in the past 20 years. There are going to be more."

The mRNA approach promises to send instructions for making the healthy version of a protein, and Weissman sees special promise in treating sickle cell disease, in particular.

Different tumor cell types have various, recognizable structures on the outside that the immune system can recognize. "You can imagine being able to inject someone with an mRNA that encodes an antibody that specifically targets that receptor," McLellan said.

"We identify mutations found on a patient's cancer cells," the company says on its website. Computer algorithms predict the 20 most common mutations. "We then create a vaccine that encodes for each of these mutations and load them onto a single mRNA molecule," Moderna says.

BioNtech has been working with academic researchers to use mRNA to treat mice genetically engineered to develop a disease similar to multiple sclerosis -- an autoimmune disease that starts when the immune system mistakenly attacks the myelin, a fatty covering of the nerve cells.In the mice, the treatment appeared to help stop the attack, while keeping the rest of the immune system intact.

The idea behind gene therapy is to replace a defective gene with one that works properly.

Another obvious use for mRNA technology is to fight cancer. The human body fights off cancer every day, and using mRNA could help it do so even better.

"It's gene therapy without the half a million dollar price tag," he added. "It should be just an IV injection and that's it."

"The idea there is if you are immune to tick saliva proteins, when the tick bites you, the body produces inflammation and the tick falls off," Weissman said.

Finally, there is deforestation. What Brazil does with its rainforest and what we do with our urban sprawl and what China does with its rapid urbanization into wilderness areas is everybody’s business. All three countries are removing natural buffers and expanding the interface, the touch points, between wildlife and people where pandemics emerge. That has to stop.

Almost all of these accidental mutations are inconsequential: The virus still looks and functions just as its parent before it did. Over time, though, sets of mutations can layer on top of one another and accumulate, and the virus begins to function differently. Some of these differences confer an advantage of one sort or another—for example, increased transmissibility.

He has been at the forefront of identifying and tracking the variant, but says huge questions remain unanswered. “There’s still considerable uncertainty as to the long-term consequences” of B.1.1.7, Pybus told me. “We don’t even know whether this lineage truly originated in the U.K., with so many countries not doing this surveillance.”

The problem echoes the country’s catastrophic stumbles early in the pandemic, when a lack of testing allowed the virus to spread widely. Currently, only a tiny fraction of all positive coronavirus tests in the United States are forwarded for further sequencing.

t if scientists don’t know what strains are moving through the population, the mutations that matter may pop up undetected.

For months, scientists have been sounding alarms and trying to ramp up genetic sequencing of test samples, but the effort has been plagued by a lack of funding, political will and federal coordination

Centers for Disease Control and Prevention Director Rochelle Walensky said Friday that the government is increasing the level of sequencing nationwide.“We have scaled up surveillance dramatically just in the last 10 days, in fact. But our plans for scaling up surveillance are even more than what we’ve done so far,”

Ultimately, the country needs real-time data — similar to the dashboards now used to track daily cases, hospitalizations and deaths — to track variants and their prevalence across the country

“None of that exists right now. We’re incredibly behind compared to other countries,”

The U.S. effort is so underdeveloped that it’s impossible to say exactly how many virus cases are sequenced daily.

The CDC has warned that the variant found in the United Kingdom — which British scientists said could be up to 70 percent more transmissible — could become dominant in the United States by March.

It also recently contracted with four private companies — Quest, Labcorp, Illumina and Helix — to conduct more sequencing. By mid-February, those contracts should hit full capacity, analyzing 6,000 samples per week, CDC officials said.

Illumina estimates that the country needs to sequence 5 percent of its coronavirus cases to detect a new variant when the variant represents about 0.1 percent to 1.0 percent of the country’s case

However, the United States so far has only sequenced about 0.32 percent of its total cases

the country ranks 38th out of 130 countries reporting whole-genome sequencing data.

The United States has sequenced 84,177 samples out of 25.7 million cases as of Friday, according to a Washington Post analysis. By comparison, the United Kingdom, in ninth place, has sequenced 214,000 genomes — almost 6 percent — of the country’s 3.7 million cases.

Unlike the United States, the U.K. invested in genetic sequencing early on in the pandemic, launching its genomics consortium in March with a $27 million investment and a multimillion-dollar boost late last year.

Even before the emergence of mutations such as the variants first discovered in South Africa and the United Kingdom, U.S. experts had been warning for months about the need for a national standard for genetic surveillance.

In May, the CDC launched a surveillance program for the coronavirus called SPHERES (SARS-CoV-2 Sequencing for Public Health Emergency Response, Epidemiology, and Surveillance). But, in practice, the program relied on a haphazard patchwork of academic labs contributing genetic sequencing on a volunteer basis.

A July report by the National Academies of Science said that “poor funding, coordination, and capacity” had led to a “patchy, typically passive, and reactive” U.S. sequencing effort.

We must not ignore the threat of bad actors gaining access to these dangerous pathogens, which are the ultimate terror weapons, due to their potentially massive impact

In Germany, security services interdicted vast amounts of the toxin ricin, which, authorities said, a couple was planning to use in a biological attack in 2018

Instead of looking to weaponize a highly virulent pathogen like anthrax -- the spore-forming bacterium which was infamously mailed out to media outlets and politicians in a bio attack in 2001, killing five people and injuring 17 more -- bad actors are now likely considering the efficacy of a less virulent but highly transmissible pathogen like SARS-CoV-2, which has brought the world to its knees in the last year. This pathogen has shown that transmissibility -- rather than toxicity -- is a major factor when it comes to mass disruption.

When it comes to policies that are already in place, there is the Biological and Toxic Weapons Convention (BTWC), a multilateral treaty that went into effect in 1975, which prohibits the development, production, acquisition and stockpiling of biological agents and toxins and any related delivery systems that have "no justification for prophylactic, protective or other peaceful purposes."

However, it is poorly funded in comparison to other treaties like the Chemical Weapons Convention, and does not have a corresponding body like the Organization for the Prohibition of Chemical Weapons (OPCW) to police it.

The World Health Organization could also implement an early warning system to predict pandemics, showing its progress around the globe.

MCMs are products such as vaccines, biologics and pharmaceutical drugs that can diagnose, protect or treat the effects of a naturally occurring new disease or biological attack. In the future, it may be more cost effective to pay the pharmaceutical industry ahead of time to produce treatments and vaccines rather than wait for a pandemic to develop.

The pandemic has also underscored the importance of manufacturing and stockpiling medical gear including personal protective equipment to avoid logjams in the supply chain and a reliance on other countries like China for these critical supplies. Providing accurate and accessible information to the public is also key; propaganda and disinformation must not be taken lightly.

Going forward, we should treat biosecurity threats with the same urgency in the 21st century as world leaders approached atomic bombs in the 20th century.

A first step would be for the UN Security Council to fund and enforce the Biological and Toxic Weapons Convention.

he made this association: “Censorship does not make us wiser. It does not make us better informed. If it did, we’d be speaking Russian right now. The Soviet Union would run the world; it would have worked. But, instead, the Soviet Union is extinct. It collapsed under the weight of its own absurdities, absurdities abetted by censorship,” he said, working up to this point: “And that’s the most basic lesson of dictatorships, all of them. Anything built on lies falls apart over time.”

Except that’s not true anymore. Lies are working well these days, thanks to all the soft places they have to lay their eggs. As proof, we have Donald Trump, whose lies during the 2016 presidential campaign secured an electoral college victory. We have QAnon, the vile conspiracy-theory community knocking on the door of Congress. And we have “Tucker Carlson Tonight,” a program so stocked with deception and misdirection that it racked up the biggest ratings numbers in cable-news history earlier this year.

Although Covid-19 and SARS-CoV-2 are often used interchangeably, they are fundamentally different. You can’t have the disease without the virus, but you can have the virus without the disease — as many asymptomatic people already know. It’s possible that vaccinated people are protected against Covid-19 themselves, but still spread SARS-CoV-2 to others who are not vaccinated.

From everything we know so far, it’s highly unlikely that vaccines that are 95 percent effective at preventing symptomatic disease would have no impact whatsoever on infection.

The countries that SARS bypassed also relied on experience, in a way, but that experience had taught them to hope that pandemics were something peculiar to Asia or Africa or other places where Everything Is Different. Running that playbook against this coronavirus turned out to be disastrous.

America’s outbreak thus far hasn’t been unusually bad. With about 250 deaths per million citizens, we’re solidly in the middle of the pack.

The United States is underperforming Germany and Canada but roughly on par with Switzerland, and we’re doing significantly better than France, Italy, Spain, Sweden and Britain.

there are countries that learned from the experience of others, notably Germany. Like us, Germany is large and rich and has a bustling trade with China. Moreover, Germany’s political framework also gives local governments significant autonomy. Yet Germany’s death rate is only about a third of ours, and declining, while the United States seems stuck on a high plateau.

In fact, death rates are declining sharply in most of the countries I mentioned, except for Canada and the United States.

It’s understandable if a country that hasn’t weathered a serious pandemic in a century needed to learn what to do from hard experience. But it’s starting to look like we still haven’t, and won’t, unless that experience gets harder still.