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But for those hoping that 25 percent represents a true ceiling for pandemic spread in a given community, well, it almost certainly does not, considering that recent serological surveys have shown that perhaps 93 percent of the population of Iquitos, Peru, has contracted the disease; as have more than half of those living in Indian slums; and as many as 68 percent in particular neighborhoods of New York City

overshoot of that scale would seem unlikely if the “true” threshold were as low as 20 or 25 percent.

But, of course, that threshold may not be the same in all places, across all populations, and is surely affected, to some degree, by the social behavior taken to protect against the spread of the disease.

we probably err when we conceive of group immunity in simplistically binary terms. While herd immunity is a technical term referring to a particular threshold at which point the disease can no longer spread, some amount of community protection against that spread begins almost as soon as the first people are exposed, with each case reducing the number of unexposed and vulnerable potential cases in the community by one

you would not expect a disease to spread in a purely exponential way until the point of herd immunity, at which time the spread would suddenly stop. Instead, you would expect that growth to slow as more people in the community were exposed to the disease, with most of them emerging relatively quickly with some immune response. Add to that the effects of even modest, commonplace protections — intuitive social distancing, some amount of mask-wearing — and you could expect to get an infection curve that tapers off well shy of 60 percent exposure.

Looking at the data, we see that transmissions in many severely impacted states began to slow down in July, despite limited interventions. This is especially notable in states like Arizona, Florida, and Texas. While we believe that changes in human behavior and changes in policy (such as mask mandates and closing of bars/nightclubs) certainly contributed to the decrease in transmission, it seems unlikely that these were the primary drivers behind the decrease. We believe that many regions obtained a certain degree of temporary herd immunity after reaching 10-35 percent prevalence under the current conditions. We call this 10-35 percent threshold the effective herd immunity threshold.

Indeed, that is more or less what was recently found by Youyang Gu, to date the best modeler of pandemic spread in the U.S

he cautioned again that he did not mean to imply that the natural herd-immunity level was as low as 10 percent, or even 35 percent. Instead, he suggested it was a plateau determined in part by better collective understanding of the disease and what precautions to take

Gu estimates national prevalence as just below 20 percent (i.e., right in the middle of his range of effective herd immunity), it still counts, I think, as encouraging — even if people in hard-hit communities won’t truly breathe a sigh of relief until vaccines arrive.

If you can get real protection starting at 35 percent, it means that even a mediocre vaccine, administered much more haphazardly to a population with some meaningful share of vaccination skeptics, could still achieve community protection pretty quickly. And that is really significant — making both the total lack of national coordination on rollout and the likely “vaccine wars” much less consequential.

At least 20 percent of the public, and perhaps 50 percent, had some preexisting, cross-protective T-cell response to SARS-CoV-2, according to one much-discussed recent paper. An earlier paper had put the figure at between 40 and 60 percent. And a third had found an even higher prevalence: 81 percent.

The T-cell story is similarly encouraging in its big-picture implications without being necessarily paradigm-changing

These numbers suggest their own heterogeneity — that different populations, with different demographics, would likely exhibit different levels of cross-reactive T-cell immune response

The most optimistic interpretation of the data was given to me by Francois Balloux, a somewhat contrarian disease geneticist and the director of the University College of London’s Genetics Institute

According to him, a cross-reactive T-cell response wouldn’t prevent infection, but would probably mean a faster immune response, a shorter period of infection, and a “massively” reduced risk of severe illness — meaning, he guessed, that somewhere between a third and three-quarters of the population carried into the epidemic significant protection against its scariest outcomes

the distribution of this T-cell response could explain at least some, and perhaps quite a lot, of COVID-19’s age skew when it comes to disease severity and mortality, since the young are the most exposed to other coronaviruses, and the protection tapers as you get older and spend less time in environments, like schools, where these viruses spread so promiscuously.

Balloux told me he believed it was also possible that the heterogeneous distribution of T-cell protection also explains some amount of the apparent decline in disease severity over time within countries on different pandemic timelines — a phenomenon that is more conventionally attributed to infection spreading more among the young, better treatment, and more effective protection of the most vulnerable (especially the old).

Going back to Youyang Gu’s analysis, what he calls the “implied infection fatality rate” — essentially an estimated ratio based on his modeling of untested cases — has fallen for the country as a whole from about one percent in March to about 0.8 percent in mid-April, 0.6 percent in May, and down to about 0.25 percent today.

even as we have seemed to reach a second peak of coronavirus deaths, the rate of death from COVID-19 infection has continued to decline — total deaths have gone up, but much less than the number of cases

In other words, at the population level, the lethality of the disease in America has fallen by about three-quarters since its peak. This is, despite everything that is genuinely horrible about the pandemic and the American response to it, rather fantastic.

there may be some possible “mortality displacement,” whereby the most severe cases show up first, in the most susceptible people, leaving behind a relatively protected population whose experience overall would be more mild, and that T-cell response may play a significant role in determining that susceptibility.

That, again, is Balloux’s interpretation — the most expansive assessment of the T-cell data offered to me

The most conservative assessment came from Sarah Fortune, the chair of Harvard’s Department of Immunology

Fortune cautioned not to assume that cross-protection was playing a significant role in determining severity of illness in a given patient. Those with such a T-cell response, she told me, would likely see a faster onset of robust response, yes, but that may or may not yield a shorter period of infection and viral shedding

Most of the scientists, doctors, epidemiologists, and immunologists I spoke to fell between those two poles, suggesting the T-cell cross-immunity findings were significant without necessarily being determinative — that they may help explain some of the shape of pandemic spread through particular populations, but only some of the dynamics of that spread.

he told me he believed, in the absence of that data, that T-cell cross-immunity from exposure to previous coronaviruses “might explain different disease severity in different people,” and “could certainly be part of the explanation for the age skew, especially for why the very young fare so well.”

the headline finding was quite clear and explicitly stated: that preexisting T-cell response came primarily via the variety of T-cells called CD4 T-cells, and that this dynamic was consistent with the hypothesis that the mechanism was inherited from previous exposure to a few different “common cold” coronaviruses

“This potential preexisting cross-reactive T-cell immunity to SARS-CoV-2 has broad implications,” the authors wrote, “as it could explain aspects of differential COVID-19 clinical outcomes, influence epidemiological models of herd immunity, or affect the performance of COVID-19 candidate vaccines.”

“This is at present highly speculative,” they cautioned.

Chinese scientists have even submitted a paper for publication to the Lancet – although it has not yet been peer-reviewed – that claims “Wuhan is not the place where human-to-human Sars-CoV-2 transmission first happened”, suggesting instead that the first case may have been in the “Indian subcontinent”.

Claims that the virus had origins outside China are given little credence by western scientists. Michael Ryan, director of the health emergencies programme at the World Health Organization (WHO), said last week that it would be “highly speculative” to argue that the disease did not emerge in China. “It is clear from a public health perspective that you start your investigations where the human cases first emerged,” he told a news briefing in Geneva.

Reports of Covid circulating in Italy in autumn 2019, based on samples from a cancer unit, seem “weak”, said Prof Jonathan Stoye, a virologist at the Francis Crick Institute in London. “The serological data [from Italy] can most likely be explained by cross-reactive antibodies directed against other coronaviruses.” In other words, antibodies found in the cases in Italy had been triggered in individuals who had been infected by different coronaviruses, not those responsible for Covid-19

And while traces of coronavirus have been found on frozen food packaging, scientists think that represents a very low risk for a disease now believed to be overwhelmingly transmitted through respiratory droplets.

A positive test “doesn’t indicate infectious virus, just that some signal from the virus is present on that surface,” Andrew Pekosz of the Bloomberg School of Public Health at Johns Hopkins University told AP. “I’ve seen no convincing data that Sars-CoV-2 on food packaging poses a significant risk for infection.”

But as the human and economic toll of the pandemic mounts, Beijing is keen to protect its reputation at home and abroad. Covid-19 has now infected over 60 million people and killed nearly 1.5 million.

“China is still struggling to deal with the fact that it is held responsible for the “original sin” of the outbreak, which undercuts virtually every effort to salvage its image,” said Andrew Small, a China scholar and senior fellow with the German Marshall Fund, a US thinktank.

“Recent months have shown what a catastrophic impact the pandemic has had for China in international public opinion.”

He does not think there is any doubt in the minds of senior Chinese leadership about the origin of the virus, and sees the focus on reporting possible alternative origins as a propaganda campaign.

The reports fit an internal narrative of a strong China led by an efficient Communist party. Domestically, Beijing has promoted its enormous success in virtually eradicating the disease and returning life within its borders to something like normal

Internationally, China’s aims probably include introducing some doubt for global audiences who are likely to believe it, turning basic facts into a “contested, politically sensitive matter” in relations with Beijing, Small said.

China’s questioning of the origin of the virus in Wuhan might be more credible if it was supporting an independent investigation into the disease, but instead authorities have repeatedly proved obstructive

WHO investigators who visited Wuhan earlier this year were not able to visit the food market linked to the initial outbreak. A new team is expected to head to China soon to build on initial work by a Chinese team, but they still don’t have a date for travel, with the WHO saying only that they will travel “in due time”.

On Friday, those figures had passed 45 million cases and more than 1.1 million deaths, according to Johns Hopkins University.

Taiwan's landmark achievement comes in a week when France and Germany are enacting new lockdowns and the United States identified a record 88,000-plus cases in a day. The state of Florida, which has a similar population size to Taiwan, with approximately 21 million people, identified 4,188 cases on Wednesday alone.

Taiwan's response focused on speed. Taiwanese authorities began screening passengers on direct flights from Wuhan, where the virus was first identified, on December 31, 2019 -- back when the virus was mostly the subject of rumors and limited reporting.

Taiwan confirmed its first reported case of the novel coronavirus on January 21 and then banned Wuhan residents from traveling to the island. All passengers arriving from mainland China, Hong Kong and Macao were required to undergo screening.

All this happened before Wuhan itself went into lockdown on January 23.

By March, Taiwan banned all foreign nationals from entering the island, apart from diplomats, residents and those with special entry visas.

One is geography -- Taiwan is an island, so it's easier for officials to control entry and exit through its borders.

Taiwan also had experience on its side. After suffering through the deadly outbreak of severe acute respiratory syndrome (SARS) in 2003, Taiwan worked to build up its capacity to deal with a pandemic

Authorities activated the island's Central Epidemic Command Center, which was set up in the wake of SARS, to coordinate between different ministries. The government also ramped up face mask and protective equipment production to make sure there would be a steady supply of PPE.

The government also invested in mass testing and quick and effective contact tracing.

"Very careful contact tracing, and very stringent quarantines of close contacts are the best way to contain Covid-19," he said.

When citizens cannot imagine security, politics becomes the distribution of insecurity, the allocation of fears and anxieties that push us away from an idea of common citizenship and toward authoritarianism. What is lethal for Americans is also lethal for our democracy.

I am an American historian who has seen the pandemic from both sides of the Atlantic, and who has just written a book about health care in the United States. When journalists from other countries ask me why so many Americans have died during the coronavirus pandemic, they phrase the question actively: “What have Americans done to bring about such needless mayhem?” And that is the right way to think about our COVID-19 policy. It is not a blundering, but a bludgeoning.

In other rich nations, it is easier to see a doctor and harder to die than in the United States. As I write these lines, I am sick in Austria. That means that if I call a doctor, I see her the same day, get tests right away, fill out no forms, and pay no fees. Without worries about access to care, I am a freer person. On the scale of a whole society, the gain in liberty is extraordinary. 

Lost to us are the political consequences: If we take for granted radical inequality and repeated emergencies in the realm of health, we are primed for authoritarianism in the realm of life.

Our babies and their mothers die at rates that Europeans find unbelievable. American Millennials will likely pay more for health care yet die younger than their parents and grandparents did. Life expectancy peaked here in 2014, even as it continues to rise elsewhere.

Americans pay twice as much per capita for health care as the citizens of peer countries do, for the privilege of dying years younger.

Many of us, by some calculations nearly half, simply avoid care because it seems unaffordable.

Those of us with insurance think about how good our insurance is, and where it will get us. Those of us who get access believe that we deserve it. It does not occur to us that the less-bad access we have is worse than what everyone has in countries with universal health care.

Too many of us take for granted that health and freedom are somehow in contradiction—and so we exclude our own bodies from our notion of rights. We treat as normal a system of commercial medicine in which decisions about life and death are made on the basis of profit.

ur sense that suffering is normal is also racial

Many white Americans regard their own suffering as virtuous, while maintaining that public health care would only be abused by Black people and immigrants. In other words, suffering is normal so long as others suffer more

In the health-care debate in the United States, proposals to extend coverage to all are decried as government overreach, socialism, even outright tyranny. But the lack of health security is what makes Americans vulnerable to demagogues and authoritarians.

Racial inequality brings unnecessary death. It also brings a sentiment that an authoritarian leader can exploit: Namely, that those who suffer the most are themselves at fault. When racism is a preexisting condition, the disproportionate death rates of Americans of color during a pandemic seem normal.

America’s only hope of stopping the COVID-19 pandemic was to do so at the outset. Such efforts have been mounted before. Under George W. Bush, the number of SARS cases in the U.S. was limited, and no one died. In 2014, the Obama administration took the fight against Ebola to West Africa, a prudent step that was normal then but that seems like science fiction now.

Before the novel coronavirus arrived in the U.S., the Trump administration dismantled the institutions that were responsible for early warning and early action

By telling Americans in February what they wanted to hear about the virus—that it was not serious, that it would disappear, that everyone could get a test—Trump ensured that death would be widespread.

By failing to institute a regime of testing, he made it normal for us to follow our own guesswork and emotions rather than dealing with facts.

The Trump administration announced a kind of new federalism, in which governors would have to show their loyalty to get federal assistance, and in which the Democratic ones would be blamed regardless of what happened

The bluster shrouded the basic decision, which was not to launch a federal response to the pandemic. No nationwide lockdown, no national testing initiative, no national contact-tracing initiative, no nationwide signaling on wearing masks and washing hands. This set the United States apart from every other comparable country.

After first blaming Democrats for not doing enough, Trump switched to blaming them for doing too much.

This is America’s basic problem: Health care is not a promise for all, but rather an expectation of the rich that they will do relatively better than the poor, and of white people that they will do relatively better than Black people

Suffering can seem meaningful if it affirms this basic order, even if that suffering is one’s own

Yet a democracy can become suffused with suffering, to the point where many voters do not even expect that policy might help them or loved ones stay well

An aspiring authoritarian such as Trump knows what to do: provide the emotional jolts of pleasure that distract from the general decline. “Winning” is no longer about gaining something for oneself, such as a healthier or longer life, but about taking pleasure in the suffering of others. This is a sensibility—the strong survive; the weak get what they deserve—that favors authoritarianism over democracy.

In this election, Americans face a choice not between individuals, but between regimes: between tyranny and a republic as forms of government, and between suffering and happiness as its aims. If Trump is defeated, our democracy should be reinforced by universal health care. Health and freedom collapse together, and they can be recovered together. We would be much freer as a people if we accorded ourselves health care as a right.

The military was also given positions of responsibility in the Wuhan institute, according to a US Senate report. A book published in 2015 by the military academy discusses how Sars viruses represent a “new era of genetic weapons” that can be “artificially manipulated into an emerging human disease virus, then weaponised and unleashed”.

The authors are PLA researchers, and one of the book’s editors has collaborated on numerous scientific papers with Wuhan scientists. They discuss how Sars can be weaponised by fusing it with other viruses and “serial passaging” the resulting mutant to make it more dangerous.

The investigators believe the Chinese military had taken an interest in developing a vaccine for the viruses so they could be used as potential bioweapons. If a country could inoculate its population against its own secret virus, it might have a weapon to shift the balance of world power.

The PLA had its own vaccine specialist, Zhou Yusen, a decorated military scientist at the academy, who had collaborated with the Wuhan scientists on a study of the Mers coronavirus and was working with them at the time of the outbreak.

Suspicion fell on him after the pandemic because he produced a patent for a Covid vaccine with remarkable speed in February 2020, little more than a month after the outbreak of the virus had first been admitted to the world by China.

In May 2020, aged just 54, Zhou appears to have died, a fact mentioned only in passing in a Chinese-media report and in a scientific paper that placed the word “deceased” in brackets after his name. Witnesses are said to have told the US investigation that Zhou fell from the roof of the Wuhan institute, although this has not been verified.

However, there was a no-go area: the Moijang mine. Seven of Hughes’s team headed to the mine in June 2020, including Camping Huang, the PhD student who had investigated the miners’ mystery illness soon after they died.

The investigators also saw communications intercepts that allegedly show three Wuhan institute researchers working at its level 3 laboratory on coronavirus gain-of-function work had fallen sick with coronavirus symptoms in the second week of November 2019, when many experts believe the pandemic began. One of the researchers’ family members later died.

An investigator said: “We were rock-solid confident that this was likely Covid-19 because they were working on advanced coronavirus research in the laboratory of Dr Shi. They’re trained biologists in their thirties and forties. Thirty-five-year-old scientists don’t get very sick with influenza.”

On November 19, the safety director of the Chinese Academy of Sciences made a visit, according to the institute’s website. He addressed a meeting of the institute’s leadership with important “oral and written” instructions from China’s president, Xi Jinping, regarding “a complex and grave situation”.

A later study by academics at Wuhan University located the hotspots in Wuhan where people were reporting on social media that they needed treatment for Covid. At the time, the authorities were eager to play down the suggestion that the city’s Huanan seafood market was the source of the outbreak; the study was used to show that the initial hotspots in December and January were several miles away.

When the study was first published, the Wuhan institute was not marked on the map it provided. So a report by the US Senate did just that — and found the institute right next to the biggest hotspot in the month before the province was locked down on January 23. The first case in Britain was recorded a week later.

Even before the West was told a mysterious virus was killing people in Wuhan, the Chinese authorities were beginning an information clampdown.

In the first months of the pandemic, there was a strong desire among Chinese scientists to head off to the bat caves in Yunnan to see whether they could find a place where Covid may have originated.

One of the investigator sources said the secret military-funded experiments on the mine virus, RaTG13, began in 2016. At around that time, the Wuhan institute became even less open about its work and mostly stopped revealing any new coronaviruses it discovered. In the lead-up to the pandemic, the Wuhan institute frequently experimented on coronaviruses alongside the Academy of Military Medical Sciences, a research arm of the People’s Liberation Army (PLA). In published papers, military scientists are listed as working for the Beijing Institute of Microbiology and Epidemiology, which is the military academy’s base.

When they arrived, they were told the Moijang mine was closed, so they sampled bats in another abandoned copper mine nearby. On the first day of their work, police arrived, seized the samples and took them to their station, where they were interrogated and detained for 48 hours.

Officers also went to their hotel and seized the samples they had collected from elsewhere. Even though the team had approval to test in the area, they were ordered to leave. “We did provide documentation to show we were there legally,” said Hughes. “But there was just too much fear and so they didn’t release those samples.”

Most coronavirus experts in China, she said, were too fearful of the consequences to examine Covid’s origins. “They haven’t touched it because of the risks associated with working on it.

“In reality there’s not much empathy,” he said. “It’s not a caring tone they’re using. It’s a warning tone. I don’t feel very comfortable about it.”

China has a major incentive to track down potential carriers of the disease. The coronavirus outbreak has put parts of the country under lockdown, brought the world’s second-largest economy to a virtual standstill and erected walls between China and the rest of the world.

Still, even some government officials called for understanding as concerns about prejudice spread. Experts warned such marginalization of an already vulnerable group could prove counterproductive, further damaging public trust and sending those who should be screened and monitored deeper underground.

While networks of volunteers and Christian groups have been vocal about offering help, many local leaders have focused efforts on finding and isolating people from Hubei. On big screens and billboards, propaganda videos and posters warn people to stay inside, wear masks and wash hands.

In the northern province of Hebei, one county offered bounties of 1,000 yuan, or about $140, for each Wuhan person reported by residents. I

In the eastern province of Jiangsu, quarantine turned to imprisonment after authorities used metal poles to barricade shut the door of a family recently returned from Wuhan. To get food, the family relied on neighbors who lowered provisions with a rope down to their back balcony

“They’re only working to separate Wuhan people from Nanjing people,” Mr. Li said. “They don’t care at all if Wuhan people infect each other.”

Across the country, the response from local authorities often resembles the mass mobilizations of the Mao era rather than the technocratic, data-driven wizardry depicted in propaganda about China’s emerging surveillance state. They have also turned to techniques Beijing used to fight the outbreak of SARS, another deadly disease, in 2002 and 2003, when China was much less technologically sophisticated.

Checkpoints to screen people for fevers have popped up at tollbooths, at the front gates of apartment complexes and in hotels, grocery stores and train stations. Often those wielding the thermometer guns don’t hold them close enough to a person’s forehead, generating unusually low temperature readings. Such checks were worthless, for instance, against one man in the western province of Qinghai, whom police are investigating on suspicion that he covered up his symptoms to travel.

“I feel that the villagers are ignorant and the government isn’t helping; instead it’s leaking the information everywhere without telling them that I don’t have any symptoms,”

The third instance, an order compelling GM to begin manufacturing ventilators, was the most far-reaching as Trump came under criticism from state governors, Democrats and doctors for playing down a nationwide shortage of ventilators.

Covid-19 is a respiratory illness. Most who contract it recover but it can be fatal, particularly among older people and those with underlying health problems. Ventilators enable a person with compromised lungs to keep breathing.

After Trump invoked the act, GM said it had been working around the clock for more than a week with Ventec Life Systems, a medical device company, and parts suppliers to build more ventilators. The company’s commitment to build Ventec’s ventilators “has never wavered”, it said.

Trump also announced that the White House trade adviser Peter Navarro would become the national DPA policy coordinator for the federal government. Navarro has been a leading advocate of Trump’s protectionist trade agenda, championing tariffs against China and the European Union.

The House speaker, Nancy Pelosi, welcomed Trump’s use of the DPA as “an important but seriously belated step”. She added in a statement on Friday: “Much more must be done. The president must use the full powers of this law to address the dire, widespread shortage of materials required to fight this pandemic, including diagnostic test supplies, masks and other personal protective equipment.”

Critics say Trump ignored early warnings about the threat of the pandemic and had he acted sooner, mass production of ventilators would now be well under way.

In another bizarre moment, when Trump was asked for a message to schoolchildren forced to stay at home, he said: “You can call it a germ, a flu, a virus, you can call it many things. I’m not sure people know what it is.” Scientists have identified it as coronavirus disease (Covid-19), an infectious disease caused by a newly discovered coronavirus called Sars-CoV-2.

In another sign that Trump is not living up to his appeal for bipartisanship, Trump did not invite Pelosi or any other Democrats to the signing of a $2.2tn emergency relief bill. Pelosi said in a statement on Friday: “We must do more to address the health emergency, mitigate the economic damage, and provide for a strong recovery.”

if healthy individuals start stockpiling surgical masks and high-grade N95 masks, they can also make it harder for health workers to get the resources they need to help on the front lines.

But studies of influenza pandemics have shown that when high-grade N95 masks are not available, surgical masks do protect people a bit more than not wearing masks at all. And when masks are combined with hand hygiene, they help reduce the transmission of infections.

When researchers conducted systematic review of a variety of interventions used during the SARS outbreak in 2003, they found that washing hands more than 10 times daily was 55 percent effective in stopping virus transmission, while wearing a mask was actually more effective — at about 68 percent

Wearing gloves offered about the same amount of protection as frequent hand-washing, and combining all measures — hand-washing, masks, gloves and a protective gown — increased the intervention effectiveness to 91 percent.

Classified data from the Chinese government that was reported in the South China Morning Post indicated that up to a third of all people who tested positive for the coronavirus could have been silent carriers.

Widespread testing on the Diamond Princess showed that half of the positive cases on board the cruise ship had no symptoms.

While wearing a mask may not necessarily prevent healthy people from getting sick, and it certainly doesn’t replace important measures such as hand-washing or social distancing, it may be better than nothing,

“It’s still hard to tell what percentage of people are truly asymptomatic because many go on to develop symptoms a few days later,

“What we do know is that individuals can shed virus about 48 hours before they develop symptoms and masking can prevent transmission from those individuals.”

Wearing a mask can also reduce the likelihood that people will touch their face

In many Asian countries, everyone is encouraged to wear masks, and the approach is about crowd psychology and protection. If everyone wears a mask, individuals protect each other, reducing overall community transmission

The sick automatically have one on and are also more likely to adhere to keeping their mask on because the stigma of wearing one is removed.

Masks are also an important signal that it’s not business as usual during a pandemic

They may also serve as an act of solidarity, showing that all citizens are on board with the precautionary measures needed to bring infections under control.

“If everyone in the community wears a mask, it could decrease transmission,” Dr. Fishman said. “But unfortunately I think that we don’t have enough masks to make that effective policy in the U.S.”

then things suddenly veered off course. A multibillion-dollar maker of medical devices bought the small California company that had been hired to design the new machines. The project ultimately produced zero ventilators.

That failure delayed the development of an affordable ventilator by at least half a decade, depriving hospitals, states and the federal government of the ability to stock up

The stalled efforts to create a new class of cheap, easy-to-use ventilators highlight the perils of outsourcing projects with critical public-health implications to private companies; their focus on maximizing profits is not always consistent with the government’s goal of preparing for a future crisis

“We definitely saw the problem,” said Dr. Thomas R. Frieden, who ran the Centers for Disease Control and Prevention from 2009 to 2017. “We innovated to try and get a solution.

The project — code-named Aura — came in the wake of a parade of near-miss pandemics: SARS, MERS, bird flu and swine flu.

Federal officials decided to re-evaluate their strategy for the next public health emergency. They considered vaccines, antiviral drugs, protective gear and ventilators, the last line of defense for patients suffering respiratory failure

In 2006, the Department of Health and Human Services established a new division, the Biomedical Advanced Research and Development Authority, with a mandate to prepare medical responses to chemical, biological and nuclear attacks, as well as infectious diseases.

In its first year in operation, the research agency considered how to expand the number of ventilators. It estimated that an additional 70,000 machines would be required in a moderate influenza pandemic.

In 2014, with no ventilators having been delivered to the government, Covidien executives told officials at the biomedical research agency that they wanted to get out of the contract, according to three former federal officials. The executives complained that it was not sufficiently profitable for the company.

The goal was for the machines to be approved by regulators for mass development by 2010 or 2011,

The ventilators were to cost less than $3,000 each. The lower the price, the more machines the government would be able to buy.

Ventilators at the time typically went for about $10,000 each, and getting the price down to $3,000 would be tough. But Newport’s executives bet they would be able to make up for any losses by selling the ventilators around the world.

In 2011, Newport shipped three working prototypes from the company’s California plant to Washington for federal officials to review.

In April 2012, a senior Health and Human Services official testified before Congress that the program was “on schedule to file for market approval in September 2013.” After that, the machines would go into production.

In May 2012, Covidien, a large medical device manufacturer, agreed to buy Newport for just over $100 million.

Newport executives and government officials working on the ventilator contract said they immediately noticed a change when Covidien took over. Developing inexpensive portable ventilators no longer seemed like a top priority.

Government officials and executives at rival ventilator companies said they suspected that Covidien had acquired Newport to prevent it from building a cheaper product that would undermine Covidien’s profits from its existing ventilator business.

Some Newport executives who worked on the project were reassigned to other roles. Others decided to leave the company.

The research agency convened a panel of experts in November 2007 to devise a set of requirements for a new generation of mobile, easy-to-use ventilators.

The stockpile is “still awaiting delivery of the Trilogy Evo,” a Health and Human Services spokeswoman said. “We do not currently have any in inventory, though we are expecting them soon.”

Neither the advice nor the science were followed that week. My colleagues, led by Neil Ferguson, published a report on 16 March estimating that without strong suppression, 250,000 people could die in the UK. The government responded that day with a recommendation for social distancing, avoiding pubs and working from home if possible. But there was still no enforcement, and it was left up to individuals and employers to decide what to do. Many people were willing but unable to comply as we showed in a report on 20 March. It was only on 23 March that a more stringent lockdown and economic support was announced.

etween 12 and 23 March, tens, if not hundreds of thousands, of people will have been infected.

The current best estimate is that around 1% of those infected will die.

So where to now? Once again, public health experience, including modelling, leads to some very clear recommendations. First, find cases in the community as well as hospitals and care homes; isolate them, and trace their contacts using a combination of local public health teams and digital tools.

Second, know your epidemic. Track the epidemic nationally and locally using NHS, public health and digital surveillance to see where cases are continuing to spread

Build community resilience by providing local support for vulnerable people affected by the virus and the negative impact of the control measures.

Third, ensure transmission is suppressed in hospitals, care homes and workplaces through the right protective equipment, testing, distancing and hygiene

Fourth, ensure that the most vulnerable, socially and medically, are fully protected through simple access to a basic income, rights for migrants, and safety for those affected by domestic violence.

I am not looking to blame – but for scrutiny so that lessons can be learned to guide our response. We need to avoid further mistakes, and ensure that the government is hearing, and acting on, the best advice.

That life on Earth is generally stable, not precarious.

That, despite what we know from the historical and geological and biological record, human civilization—thanks to advancements in science and medicine and social and governmental structures—exists inside a bubble, protected from the kind of cataclysmic event we are currently experiencing.

this supposed technological bubble was just that: a thin layer that popped easily.

Even as our stark new reality becomes clear, it remains hard to accept that “normal” was the fiction. It will take some time to let go of the long-held, seldom-questioned assumptions of everyday life: that tomorrow will look like yesterday, next year like the last.

These assumptions are a luxury. For me, they are a cross product of my intersecting privileges: born in the United States, to professional parents, at a point in history where my life has proceeded, for the most part, through a series of economic booms without major socio- or geopolitical upheavals.

What we really mean when we say that this pandemic feels “unimaginable” is that we had not imagined it. Just as imagination can mislead us, though, it will be imagination—scientific, civic, moral—that helps us find new ways of doing things, helps remind us of how far we have to go as a species

A story with a beginning and middle and end. A story that has structure and rules. A story that means something.

But the reality is, zooming out to the largest scale, fighting the pandemic effectively requires us to take actions that go against our instincts, our intuitions, the things we evolved to be good at.

We can find meaning in how we fight it, but relying on our old illusions, assuming that we, as humans, will prevail, is dangerous. Life, for us and the virus, is about genes propagating themselves. No amount of magical thinking or bluster or can-do attitude can change that fact.

it will be important to remember: Things don’t have to be resolved in a way that works out all right for us, or for our economy, for any particular systems or ways of living. Things aren’t necessarily going to be okay in a reasonable timeframe just because we want them to. To think otherwise is to succumb to the fiction, a sheltered, resource-rich mindset

Five hundred years ago, Copernicus re-centered the universe away from us, outward. The COVID-19 outbreak is a reminder: The world isn’t for us; we are part of it. We’re not the protagonists of this movie; there is no movie.

SARS-CoV-2 has been around in some form for thousands of years or more. It is novel only to us, Homo sapiens, the one species that imagines its survival, its success, as the central narrative of the story of this planet.

How little we still understand about our place in this world—terrifying and awful at the moment—but also how much we still get to discover. How fragile and rare our ordered structures are, our fictions, and how precious. How next time, we might rebuild them, stronger.

No one knows exactly how many people died from influenza in 1918; estimates range from 15 million to 100 million globally. Historians estimate that the virus killed about 675,000 people in the United States across three waves of the pandemic

confirmed cases. But in this global crisis, both the numerator and the denominator are fuzzy.

the rising rate may reflect the disease’s gradual progression, combined with discoveries of additional deaths.

The “virulence” of the virus — its ability to cause illness — has been steadily coming into focus.

One scholarly estimate finds that the 1918-1920 pandemic killed 218 out of every 100,000 people living in the world at that time

In Spain, the death toll already stands at 41 out of 100,000 people; in Belgium the number is 45. In New York state, it is 63, and that number rises even higher if you consider the “probable” death toll in New York City.

So is the coronavirus as deadly? “This depends on how long this continues,”

The disease is far more likely to cause severe outcomes in older people, with the oldest cohorts the most vulnerable. That said, in every age group — even 85-plus — most people who contract the disease will recover.

But more than a month later, the WHO number has gone even higher: On April 16, the WHO showed a global fatality rate of 6.6 percent among confirmed cases.

Preliminary research indicates that the virus is not mutating significantly as it spreads, and so there is no evidence that some countries are dealing with a more virulent strain of SARS-CoV-2.

the median age of patients in Italy is 63 or 64 years; the median age of patients in Germany is 47. The mortality is much lower [in Germany] because they avoided having the older population affected.”

The other major factor in mortality is chronic disease. Most people hospitalized with severe cases of covid-19 have chronic health conditions such as diabetes, lung disease and heart disease. Where there is a high percentage of noncommunicable diseases like high blood pressure, the coronavirus will also be more deadly

“We saw it everyday. African Americans have three times the rate of chronic kidney disease that Caucasians have, and 25 percent higher heart disease. They’ve got higher rates of diabetes, hypertension and asthma,” Duggan said. “I fully expect that when people are hit hard and they are on a ventilator to breathe and their body needs to fight the infection, that people who already have compromised hearts or kidneys or lungs are that much more in jeopardy.”

Also critical is the nature, and robustness, of the national health system. For instance, Japan, where the current case fatality rate is 1.6 percent, and Singapore are reporting extremely high rates of hospitalization for coronavirus patients, at 80 percent and higher, figures that are unheard of in the United States. But this probably helps improve treatment and also reduces disease spread by isolating patients. The result is fewer deaths.

Several of the countries with low fatality rates — Germany, South Korea, Norway — have very high rates of coronavirus testing. This gave them a better look at the disease within their borders.

San Francisco General Hospital, noted that the hospital nearly tripled the capacity of its intensive care unit by adding doctors, nurses and technicians while the city adopted social distancing measures shortly ahead of New York.

“We were ready for a surge that never happened,” Balmes said. “They’re every bit as good as we are in intensive care in New York, but the system was overwhelmed. We did physical distancing just a few days earlier than New York, but it was a few days to the good.”

in a news conference that the global case fatality rate was 3.4 percent. That was treated as a revelation about the innate deadliness of the disease, but in fact was simply the WHO’s crude mortality ratio for confirmed covid-19 cases up to that point in time.

“If, in fact, the case fatality rate is higher than the 1918 flu, then this one has the potential to kill even more people,

A new study from researchers at Stanford, not yet peer-reviewed, looked for coronavirus antibodies in a sample population in Santa Clara County, Calif., and concluded that the actual infection rate in the county by early April was 50 to 85 times greater than the rate of confirmed cases.

“The story of this virus is turning out to be more about its contagiousness and less about its case fatality rate,” said David Rubin, director of PolicyLab at Children’s Hospital of Philadelphia and a University of Pennsylvania professor of pediatrics. “It’s less fatal than we thought, but it’s more contagious.”

Where extensive testing has been done, estimates for the case fatality rate are often below 1 percent, The Post has found, suggesting these countries are getting closer to a rate that takes into account all infections

In Iceland, which has tested over 10 percent of the population, vastly more than other countries, the fatality rate is just 0.5 percent.

Harvard epidemiologist Marc Lipsitch has written that he and most experts suspect the fatality rate is about 1 to 2 percent for symptomatic cases. A 1 percent fatality rate is 10 times the average fatality rate for seasonal flu.

“It’s probably about an order of magnitude higher for covid-19,” said Viboud, the NIH epidemiologist. “It’s more severe in terms of mortality than the pandemics we’ve seen since 1918.”

As to the most likely nature of that mysterious virus, most modelling assumed that disease X would be flu-like in behaviour, says Dr Josie Golding, the epidemics lead at the Wellcome Trust. After all, influenza had caused so many deadly global outbreaks in the past. As a result, a lot of investment went into making influenza vaccines in preparation, she says. “But have we been thinking about diseases other than influenza that might become pandemics? I don’t think we have. There has been a real gap in our thinking.”

“The report that really grabbed my attention came out in mid-January,” says epidemiologist Professor Mark Woolhouse at Edinburgh University. “It said 41 cases of this new respiratory illness had now been diagnosed in one small area of China, around Wuhan. And that set the alarm bells ringing for me.”

But helped perhaps by having an epidemiologist as vice-president, the government set up a gold standard regime of testing and contact tracing that means that nearly three months on from its first confirmed infection, it has registered fewer than 400 cases and six deaths.

In February, sporadic cases of Covid-19 were appearing round the country, recalls Tom Wingfield, a clinician and infectious disease expert based at the Liverpool School of Tropical Medicine. “These were cases that had been brought into the country, mainly from China or Italy. Then there was an outbreak in Brighton and I realised that the virus had established itself in a community there. It was a turning point.”

“Perhaps some of us should have got up in front of BBC News and said you lot ought to be petrified because this is going to be a pandemic that will kill hundreds of thousands of people,” adds Ball. “None of us thought this was a particularly constructive thing to do, but maybe with hindsight we should have. If there had been more voices, maybe politicians would have taken this a bit more seriously.”

“He had just received a text message from a colleague about the outbreak and we started to discuss the implications,” Nurse recalls. “It did not take us long for us both to realise this was going to be very significant. It took another two or three weeks to confirm these worst fears – by mid-February.”

Taiwan could have been at high risk of a major Covid-19 epidemic. Tourists and business people travelled regularly back and forth.

Taiwan’s extensive testing and thorough contact tracing are precisely the kind of action that the former health secretary Jeremy Hunt is demanding before the UK lockdown is lifted. Hunt points out that it is one of the essential conditions set by the WHO to avoid a second wave resulting from an easing of restrictions.

Hong Kong, which also suffered from the Sars crisis, also moved early to enforce quarantine and social distancing, as well as widespread mask wearing, and today has registered just over 1,000 cases and only four deaths.

South Korea looked like it was on a trajectory to disaster, with the highest number of confirmed cases outside China, and numbers rising rapidly. But after the country’s first infection, the government met medical companies and urged them to start developing coronavirus test kits on a massive scale. The results were impressive. When the epidemic hit, it was ready to deploy largescale testing. Its measures allowed South Korea to become the second country to flatten its coronavirus curve, without the sweeping shutdowns of society and economic activity that China had pioneered and the west would be forced to adopt.

If the UK has serious questions to answer, the country that so far has seen the worst of the outbreak, the United States, was slowest of all to act. Trump for months ignored, played down or lied about the threat posed by coronavirus, leaving individual states to act unilaterally as it became clear it had already taken hold on US soil.

in the UK the attitude among politicians and also scientists was that it was really just some form of a flu. All the government’s pandemic planning was based on a flu scenario. And then it turned out to be something different and far, far worse and the response was completely inadequate.”

Don’t expect a vaccine to come to the rescue in the short term, says Nabarro. “For the foreseeable future, we are going to have to find ways to go about our lives with this virus as a constant threat to our lives. That means isolating those who show signs of the disease and also their contacts. Older people will have to be protected. That is going to be the new normal for us all.”

They worried that a vaccine would initially elude scientists, that weary citizens would abandon restrictions despite the risks, that the virus would be with us from now on.

Most experts believed that once the crisis was over, the nation and its economy would revive quickly. But there would be no escaping a period of intense pain.

Exactly how the pandemic will end depends in part on medical advances still to come. It will also depend on how individual Americans behave in the interim. If we scrupulously protect ourselves and our loved ones, more of us will live. If we underestimate the virus, it will find us.

More Americans may die than the White House admits.

The epidemiological model often cited by the White House, which was produced by the University of Washington’s Institute for Health Metrics and Evaluation, originally predicted 100,000 to 240,000 deaths by midsummer. Now that figure is 60,000.

The institute’s projection runs through Aug. 4, describing only the first wave of this epidemic. Without a vaccine, the virus is expected to circulate for years, and the death tally will rise over time.

Fatality rates depend heavily on how overwhelmed hospitals get and what percentage of cases are tested. China’s estimated death rate was 17 percent in the first week of January, when Wuhan was in chaos, according to a Center for Evidence-Based Medicine report, but only 0.7 percent by late February.

Various experts consulted by the Centers for Disease Control and Prevention in March predicted that the virus eventually could reach 48 percent to 65 percent of all Americans, with a fatality rate just under 1 percent, and would kill up to 1.7 million of them if nothing were done to stop the spread.

A model by researchers at Imperial College London cited by the president on March 30 predicted 2.2 million deaths in the United States by September under the same circumstances.

China has officially reported about 83,000 cases and 4,632 deaths, which is a fatality rate of over 5 percent. The Trump administration has questioned the figures but has not produced more accurate ones.

The tighter the restrictions, experts say, the fewer the deaths and the longer the periods between lockdowns. Most models assume states will eventually do widespread temperature checks, rapid testing and contact tracing, as is routine in Asia.

In this country, hospitals in several cities, including New York, came to the brink of chaos.

Only when tens of thousands of antibody tests are done will we know how many silent carriers there may be in the United States. The C.D.C. has suggested it might be 25 percent of those who test positive. Researchers in Iceland said it might be double that.

China is also revising its own estimates. In February, a major study concluded that only 1 percent of cases in Wuhan were asymptomatic. New research says perhaps 60 percent were.

The virus may also be mutating to cause fewer symptoms. In the movies, viruses become more deadly. In reality, they usually become less so, because asymptomatic strains reach more hosts. Even the 1918 Spanish flu virus eventually faded into the seasonal H1N1 flu.

The lockdowns will end, but haltingly.

it is likely a safe bet that at least 300 million of us are still vulnerable.

Until a vaccine or another protective measure emerges, there is no scenario, epidemiologists agreed, in which it is safe for that many people to suddenly come out of hiding. If Americans pour back out in force, all will appear quiet for perhaps three weeks.

The gains to date were achieved only by shutting down the country, a situation that cannot continue indefinitely. The White House’s “phased” plan for reopening will surely raise the death toll no matter how carefully it is executed.

Every epidemiological model envisions something like the dance

On the models, the curves of rising and falling deaths resemble a row of shark teeth.

Surges are inevitable, the models predict, even when stadiums, churches, theaters, bars and restaurants remain closed, all travelers from abroad are quarantined for 14 days, and domestic travel is tightly restricted to prevent high-intensity areas from reinfecting low-intensity ones.

In his wildly popular March 19 article in Medium, “Coronavirus: The Hammer and the Dance,” Tomas Pueyo correctly predicted the national lockdown, which he called the hammer, and said it would lead to a new phase, which he called the dance, in which essential parts of the economy could reopen, including some schools and some factories with skeleton crews.

Even the “Opening Up America Again” guidelines Mr. Trump issued on Thursday have three levels of social distancing, and recommend that vulnerable Americans stay hidden. The plan endorses testing, isolation and contact tracing — but does not specify how these measures will be paid for, or how long it will take to put them in place.

On Friday, none of that stopped the president from contradicting his own message by sending out tweets encouraging protesters in Michigan, Minnesota and Virginia to fight their states’ shutdowns.

China did not allow Wuhan, Nanjing or other cities to reopen until intensive surveillance found zero new cases for 14 straight days, the virus’s incubation period.

Compared with China or Italy, the United States is still a playground.Americans can take domestic flights, drive where they want, and roam streets and parks. Despite restrictions, everyone seems to know someone discreetly arranging play dates for children, holding backyard barbecues or meeting people on dating apps.

Even with rigorous measures, Asian countries have had trouble keeping the virus under control

But if too many people get infected at once, new lockdowns will become inevitable. To avoid that, widespread testing will be imperative.

Reopening requires declining cases for 14 days, the tracing of 90 percent of contacts, an end to health care worker infections, recuperation places for mild cases and many other hard-to-reach goals.

Immunity will become a societal advantage.

Imagine an America divided into two classes: those who have recovered from infection with the coronavirus and presumably have some immunity to it; and those who are still vulnerable.

“It will be a frightening schism,” Dr. David Nabarro, a World Health Organization special envoy on Covid-19, predicted. “Those with antibodies will be able to travel and work, and the rest will be discriminated against.”

Soon the government will have to invent a way to certify who is truly immune. A test for IgG antibodies, which are produced once immunity is established, would make sense

Dr. Fauci has said the White House was discussing certificates like those proposed in Germany. China uses cellphone QR codes linked to the owner’s personal details so others cannot borrow them.

As Americans stuck in lockdown see their immune neighbors resuming their lives and perhaps even taking the jobs they lost, it is not hard to imagine the enormous temptation to join them through self-infection

My daughter, who is a Harvard economist, keeps telling me her age group needs to have Covid-19 parties to develop immunity and keep the economy going,”

It would be a gamble for American youth, too. The obese and immunocompromised are clearly at risk, but even slim, healthy young Americans have died of Covid-19.

The virus can be kept in check, but only with expanded resources.

Resolve to Save Lives, a public health advocacy group run by Dr. Thomas R. Frieden, the former director of the C.D.C., has published detailed and strict criteria for when the economy can reopen and when it must be closed.

once a national baseline of hundreds of thousands of daily tests is established across the nation, any viral spread can be spotted when the percentage of positive results rises.

To keep the virus in check, several experts insisted, the country also must start isolating all the ill — including mild cases.

“If I was forced to select only one intervention, it would be the rapid isolation of all cases,”

In China, anyone testing positive, no matter how mild their symptoms, was required to immediately enter an infirmary-style hospital — often set up in a gymnasium or community center outfitted with oxygen tanks and CT scanners.

There, they recuperated under the eyes of nurses. That reduced the risk to families, and being with other victims relieved some patients’ fears.

Still, experts were divided on the idea of such wards

Ultimately, suppressing a virus requires testing all the contacts of every known case. But the United States is far short of that goal.

In China’s Sichuan Province, for example, each known case had an average of 45 contacts.

The C.D.C. has about 600 contact tracers and, until recently, state and local health departments employed about 1,600, mostly for tracing syphilis and tuberculosis cases.

China hired and trained 9,000 in Wuhan alone. Dr. Frieden recently estimated that the United States will need at least 300,000.

There will not be a vaccine soon.

any effort to make a vaccine will take at least a year to 18 months.

the record is four years, for the mumps vaccine.

for unclear reasons, some previous vaccine candidates against coronaviruses like SARS have triggered “antibody-dependent enhancement,” which makes recipients more susceptible to infection, rather than less. In the past, vaccines against H.I.V. and dengue have unexpectedly done the same.

A new vaccine is usually first tested in fewer than 100 young, healthy volunteers. If it appears safe and produces antibodies, thousands more volunteers — in this case, probably front-line workers at the highest risk — will get either it or a placebo in what is called a Phase 3 trial.

It is possible to speed up that process with “challenge trials.” Scientists vaccinate small numbers of volunteers, wait until they develop antibodies, and then “challenge” them with a deliberate infection to see if the vaccine protects them.

Normally, it is ethically unthinkable to challenge subjects with a disease with no cure, such as Covid-19.

“Fewer get harmed if you do a challenge trial in a few people than if you do a Phase 3 trial in thousands,” said Dr. Lipsitch, who recently published a paper advocating challenge trials in the Journal of Infectious Diseases. Almost immediately, he said, he heard from volunteers.

The hidden danger of challenge trials, vaccinologists explained, is that they recruit too few volunteers to show whether a vaccine creates enhancement, since it may be a rare but dangerous problem.

if a vaccine is invented, the United States could need 300 million doses — or 600 million if two shots are required. And just as many syringes.

“People have to start thinking big,” Dr. Douglas said. “With that volume, you’ve got to start cranking it out pretty soon.”

Treatments are likely to arrive first.

The modern alternative is monoclonal antibodies. These treatment regimens, which recently came very close to conquering the Ebola epidemic in eastern Congo, are the most likely short-term game changer, experts said.

as with vaccines, growing and purifying monoclonal antibodies takes time. In theory, with enough production, they could be used not just to save lives but to protect front-line workers.

Having a daily preventive pill would be an even better solution, because pills can be synthesized in factories far faster than vaccines or antibodies can be grown and purified.

Goodbye, ‘America First.’

A public health crisis of this magnitude requires international cooperation on a scale not seen in decades. Yet Mr. Trump is moving to defund the W.H.O., the only organization capable of coordinating such a response.

And he spent most of this year antagonizing China, which now has the world’s most powerful functioning economy and may become the dominant supplier of drugs and vaccines. China has used the pandemic to extend its global influence, and says it has sent medical gear and equipment to nearly 120 countries.

This is not a world in which “America First” is a viable strategy, several experts noted.

“If President Trump cares about stepping up the public health efforts here, he should look for avenues to collaborate with China and stop the insults,”

If we alienate the Chinese with our rhetoric, I think it will come back to bite us,” he said.“What if they come up with the first vaccine? They have a choice about who they sell it to. Are we top of the list? Why would we be?”

Once the pandemic has passed, the national recovery may be swift. The economy rebounded after both world wars, Dr. Mulder noted.

In one of the most provocative analyses in his follow-up article, “Coronavirus: Out of Many, One,” Mr. Pueyo analyzed Medicare and census data on age and obesity in states that recently resisted shutdowns and counties that voted Republican in 2016.

He calculated that those voters could be 30 percent more likely to die of the virus.

In the periods after both wars, Dr. Mulder noted, society and incomes became more equal. Funds created for veterans’ and widows’ pensions led to social safety nets, measures like the G.I. Bill and V.A. home loans were adopted, unions grew stronger, and tax benefits for the wealthy withered.

If a vaccine saves lives, many Americans may become less suspicious of conventional medicine and more accepting of science in general — including climate change

“The window of opportunity is still there, but the window of opportunity is narrowing,” WHO Director General Tedros Adhanom Ghebreyesus said on Friday. “We need to act quickly before it closes completely.”

At the beginning of any disease outbreak, public health experts painstakingly trace the contacts of every person who becomes sick. The experts build a family tree of possible illness, with branches that include anyone who might have shaken hands with, or been sneezed on by an infected person

with confirmed infections approaching 80,000 people, contact tracing on a case-by-case basis could soon be impractical.

“What we find is that this virus is going to be very difficult to contain,” said Jeffrey Shaman, an infectious disease researcher at Columbia University and co-author of the study posted Monday. “Personally, I don’t think we can do it.”

The word ‘pandemic’ invokes fear, but it describes how widespread an outbreak may be, not its deadliness.

“I think we should assume that this virus is very soon going to be spreading in communities here, if it isn’t already, and despite aggressive actions, we should be putting more efforts to mitigate impacts,”

The virus would be easier to contain if people who are contagious were obviously so, as was the case with SARS, which started an outbreak that burned itself out in 2003. But the new virus appears to spread among people who in some cases are not noticeably sick.

among the more than 600 passengers from the Diamond Princess cruise ship who have tested positive, about half had no obvious symptoms.

If the coronavirus becomes a true pandemic, a large proportion of the human population — a third, a half, two-thirds even — could become infected

Harvard epidemiologist Marc Lipsitch estimates that 40 to 70 percent of the human population could potentially be infected by the virus if it becomes pandemic. Not all of those people would get sick

The novel coronavirus may be particularly suited for stealth community transmission since its symptoms can be indistinguishable from those of a cold or flu, and testing capabilities are still being ramped up.

Experts estimate it takes about a week for the number of people infected in a given community to double. Based on that, it would likely take several weeks for a new infection cluster to be picked up by a local health department

By mid-March, he estimated, officials should know if there is community transmission and a true pandemic.

“I want to be clear that we are not seeing community spread here in the United States yet,” she said Friday. “But it’s very possible, even likely, that may eventually happen.”

“If a large number of countries are unsuccessful in preventing sustained multi-generation transmissions, then we could witness the next pandemic.”

A pandemic is a line in the sand, and every expert has a slightly different definition for when an outbreak crosses it. Generally, it means that there are self-sustaining lines of infection in multiple countries and continents — where the family tree of possible illness begins to encompass the entire population.

I think we’re not in as dire straits as we might be, and that’s because everyone is pulling together internationally.”

Public health experts are devising strategies on how to conserve N95 respirators, specialized masks that are in a limited supply amid surging demand.

“Extrapolating from some of the numbers we’ve seen on the impact to the health care system in China, it means we’ll have to surge fast.”

unwarranted certainty, and an under-appreciation of the unknown, might be our collective downfall, because it blinds us to a new dynamic governing humanity: The world is getting more complicated, and therefore less predictable.

Yes, the future is always unknowable. But there’s reason to believe it’s becoming even more so, because when it comes to affairs involving masses of human beings — which is most things, from politics to markets to religion to art and entertainment — a range of forces is altering society in fundamental ways

These forces are easy to describe as Davos-type grand concepts: among others, the internet, smartphones, social networks, the globalization and interdependence of supply chains and manufacturing, the internationalization of culture, unprecedented levels of travel, urbanization and climate change.

their effects are not discrete. They overlap and intertwine in nonlinear ways, leaving chaos in their wake.

In the last couple of decades, the world has become unmoored, crazier, somehow messier. The black swans are circling; chaos monkeys have been unleashed

there is some controversy about the thesis that black-swan events are increasing due to global complexity, and the claim is difficult to prove empirically. But there is theoretical backing to the idea that more-connected, complicated systems lead to more surprising, unexpected outcomes.

the claim makes sense intuitively, too. For instance, increased global connectivity is one of the reasons Covid-19 has been so hard to contain.

the growing unpredictability of human affairs is clear in the number of surprises we seem to be enduring lately. What was the 2008 financial crisis if not an out-of-the-blue event that stymied most prognosticators? Or, for that matter, the election of the first African-American president, America’s hyper-fast flip on gay rights, Brexit, Trump’s election, or the rise of Bernie Sanders?

If the worst-case scenario comes true, are there still things we can do to minimise the pandemic’s impact?Absolutely. We can mobilise more health officials and keep engaging the public, implementing sensible travel controls and ensuring that frontline health workers have ready access to diagnostic tests and are vigilant – that they don’t send anyone who may have been exposed home without testing them, for example

Was an epidemic like that of Covid-19 inevitable?From a biological standpoint an outbreak of a novel pathogen was inevitable, but this one happened in the worst place at the worst time. Wuhan is a big city and a crossroads,

is in people’s minds – even though the risk of another one is real. I’ve written about a hypothetical situation in which a new and dangerous pathogen emerges, a vaccine is developed, and you still get a pandemic, because large numbers of millennials refuse the vaccine. In the US, 20% of millennials believe that vaccines cause autism.

You have said that time and trust are critical to good epidemic management. What do you mean?The delay between the frontline health workers noticing something unusual, in the form of an emerging disease, and that information travelling up the line to central decision-makers is critical. To illustrate that, a 2018 simulation that the Gates Foundation conducted of a flu pandemic estimated that there would be 28,000 after one month, 10 million after three months, and 33 million after six months. The virus used in that simulation was more contagious and deadly than Covid-19 – though they are both respiratory viruses – but the example shows how all epidemics grow exponentially. So if you can catch an epidemic in the first few weeks, it makes all the difference.

The problem is bad information. As my students often remind me, news tends to be behind paywalls, while fake news is free.

y (GHS) Index – that scores countries on six dimensions: prevention, detection, response, health system, risk environment and compliance with international standards. No country scores perfectly on all six. China has detected and responded to this epidemic pretty well, though its health system is now stretched beyond capacity, but it is weak on prevention

How well is the US prepared?The US ranks high on the GHS index, but is still unprepared for a severe pandemic, should one happen. Malfunctioning coronavirus tests have frustrated public health labs and delayed outbreak monitoring. Supplies of masks, suits and other protective material for health workers are running low in the midst of a moderately severe flu season.

Since the creation of a much-needed public health emergency preparedness fund in the aftermath of 9/11, its budget and the public health functions it supports have been steadily reduced. This is the mentality that left the world vulnerable to the devastating 2014 outbreak of Ebola in west Africa – that is, close the fire department and cancel the fire insurance as nobody’s house or factory has burned down lately. It’s time we learned that the bugs never stop mutating and crossing over to humans.

What exactly should we be doing faster?Fewer than one in three countries are close to being prepared to confront an epidemic, which leaves the vast majority of the world’s population vulnerable.

For months, Trump himself referred to the illness as “the coronavirus.” In early March, though, several conservative media figures began using Wuhan virus or Chinese virus instead. On March 16, Trump himself began to refer to it as the “Chinese Virus,” prompting commentators to charge that he was racializing the epidemic

Even before Trump’s adoption of Chinese virus, Asian Americans had been facing a wave of discrimination, harassment, and violence in response to the epidemic. The president’s rhetoric did not start this backlash, but the decision to embrace the term Chinese virus reinforced the association between a worldwide pandemic and people of a particular national origin.

Legitimizing that link with all the authority of the office of the president of the United States is not just morally abhorrent, but dangerous.

The president’s now-constant use of Chinese virus is the latest example of a conservative phenomenon

Trump and his acolytes are never more comfortable than when they are defending expressions of bigotry as plain common sense, and accusing their liberal critics of being oversensitive snowflakes who care more about protecting “those people” than they do about you. They seek to reduce any political dispute to this simple equation whenever possible.

“I want them to talk about racism every day,” the former Trump adviser Steve Bannon told The American Prospect in 2017. “If the left is focused on race and identity, and we go with economic nationalism, we can crush the Democrats.”

n this instance, though, the gambit served two additional purposes: distracting the public from Trump’s catastrophic mishandling of the coronavirus pandemic, and disguising the fact that Trump’s failures stemmed from his selfishness and fondness for authoritarian leaders, which in turn made him an easy mark for the Chinese government’s disinformation

Trump understands that overt expressions of prejudice draw condemnation from liberals, which in turn rallies his own base around him. Calling the coronavirus the “Chinese virus” not only informs Trump’s base that foreigners are the culprits, it also offers his supporters the emotional satisfaction of venting fury at liberals for unfairly accusing conservatives of racism.

The point is to turn a pandemic that threatens both mass death and the collapse of the American economy into a culture-war argument in which the electorate can be polarized along partisan lines.

Since that report, Chinese officials have engaged in a propaganda offensive, expelling American journalists, minimizing their early missteps, and putting forth a conspiracy theory that the virus was engineered by the U.S. military. Compared with all this, the president’s defenders argue, Trump referring to the coronavirus as the “Chinese virus” seems trivial.

Lost in that comparison, however, is the fact that the most effective target of CCP disinformation has been Trump himself.

According to The Washington Post, at the same time that Trump was stating that Beijing had the disease under control, U.S. intelligence agencies were already warning him that “Chinese officials appeared to be minimizing the severity of the outbreak.”

Administration officials directly warned Trump of the danger posed by the virus, but “Trump’s insistence on the contrary seemed to rest in his relationship with China’s President Xi Jingping, whom Trump believed was providing him with reliable information about how the virus was spreading in China,” The Washington Post reported, “despite reports from intelligence agencies that Chinese officials were not being candid about the true scale of the crisis.”

The right’s rhetorical shift then, is not just another racism rope-a-dop

It is also an attempt to cover up the fact that the Chinese government’s propaganda campaign was effective in that it helped persuade the president of the United States not to take adequate precautionary measures to stem a tide of pestilence that U.S. government officials saw coming.

Now faced with the profound consequences of that decision, the right has settled on a strategy that does little to hold Beijing accountable for its mishandling of the coronavirus, but instead plays into Beijing’s attempt to cast any criticism of the Chinese government’s response as racism

The term makes no distinction between China’s authoritarian government and people who happen to be of Chinese origin, and undermines the unified front the Trump administration would want if it were actually concerned with countering Chinese-government propaganda.

Instead, the Trump administration has chosen a political tactic that strengthens the president’s political prospects by polarizing the electorate, and covers up his own role as Xi’s patsy, while making its own pushback against CCP propaganda less effective

This approach reflects the most glaring flaws of Trumpist governance, which have become only more acute during the coronavirus crisis: It exacerbates rather than solves the underlying problem, placing the president’s political objectives above all other concerns, even the ones both the president and his supporters claim to value.