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The federal government never intended to provide treatment, and though penicillin became widely available in 1943, the men were not treated. At least 28 and perhaps up to 100 men died from syphilis or its complications by the time the study was halted in 1972. Hundreds went on to infect their wives, some of whom then transmitted the disease to their children.

Second, the federal government knowingly withheld treatment for 40 years from the same citizens it was supposed to protect.

There have been numerous reports of Black people being turned away at emergency departments, sent home without having been examined or treated and later dying of the virus

In an August essay about Covid-19 treatment written for the California Health Care Foundation, Dr. Vanessa Grubbs, a nephrologist, noted, "No available data suggest such implicit bias is happening on a large scale and resulting in worse outcomes. But the lack of data is less a sign that the problem does not exist than a reflection of what data we choose not to gather."

First, the study had been developed to test the repulsive idea that Black people are biologically different than White people. This idea -- suggesting Black people are somehow less than human -- has powerful echoes in medical training and practice today.

We live in a country organized around structural racism. This means Black Americans are less likely to receive the health care we deserve. We are more likely to live in neighborhoods with poor air quality and fewer outlets to purchase healthy food. We are more likely to work in low-paying "essential" jobs that put us more at risk for contracting Covid-19.

Because the vaccine came to market so quickly, we do not have long-term safety studies, and there are still many unanswered questions.

One of the lasting lessons of Tuskegee is that denying medical care is among the biggest breaches of trust between citizens and their governments. We must ensure that marginalized groups like Black, Indigenous and people of color, immigrants, disabled people and people in prison can receive this vaccine. We must also ensure people are allowed to ask questions to make informed and uncoerced decisions about their health care.

Misinformation has complicated efforts by some states to reach out to Black and Hispanic residents, particularly when health officials have provided special registration codes for vaccine appointments. Instead of a benefit, in some cases the codes have become the basis for new false narratives.

Anti-vaccine activists have drawn on historical examples, including Nazi doctors who ran experiments in concentration camps, and the Baltimore hospital where, 70 years ago, cancer cells were collected from Henrietta Lacks, a Black mother of five, without her consent.

The state figures vary widely. In Texas, where people who identify as Hispanic make up 42 percent of the population, only 20 percent of the vaccinations had gone to that group. In Mississippi, where Black people make up 38 percent of the population, they received 22 percent of the vaccinations

According to an analysis by The New York Times, the vaccination rate for Black Americans is half that of white people, and the gap for Hispanic people is even larger

Research conducted by the nonprofit Kaiser Family Foundation in mid-February showed a striking disparity between racial groups receiving the vaccine in 34 states that reported the data.

An experiment conducted in 1943 on nearly 400 Black men in Tuskegee, Ala., is one of the most researched examples of medical mistreatment of the Black community. Over four decades, scientists observed the men, whom they knew were infected with syphilis, but didn’t offer treatments so that they could study the disease’s progression. When the experiment came to light in the 1970s, it was condemned by the medical community as a major violation of ethical standards.

While Tuskegee averaged several hundred mentions a week on Facebook and Twitter, there were several noticeable spikes that coincided with the introduction of Covid-19 vaccines, according to Zignal Labs, a media insights company.

Last month, a poll by the NORC Center for Public Affairs Research found that 23 percent of Republicans said they would “definitely” not get vaccinated, while 21 percent said they “probably” would not get a coronavirus vaccine.

Native American groups have been battling vaccine fears in their communities, and doctors have reported that some of their Chinese-American patients have been bringing in articles in Chinese-language media outlets questioning vaccines made in the United States.

Many Black and Hispanic people were already struggling to make appointments and reach vaccination sites that are often in whiter, wealthier neighborhoods

Misinformation about who is allowed to receive the vaccine, when it is available and how it was safety tested has added even more difficulty, Ms. Mitchell, said.

Many Flint residents are Black, and they have long memories of racist treatment by doctors who dismissed or neglected their medical needs.

Dr. Joneigh Khaldun, chief medical executive of the state Department of Health and Human Services, said the state's plan to vaccinate 70 percent of residents as quickly as possible includes efforts to enlist people like block club captains, fraternity and sorority presidents and religious leaders to promote the vaccine — an effort Khaldun said is especially important in the Black community, where what she called "vaccine hesitancy" is high.

"When you tell us that the water is safe but it really wasn't, that relationship between leadership and the community is still damaged," said Todd Womack, the pastor of community connections at Central Church of the Nazarene in Flint. "That just layers the historical trauma that has presented itself in our community."

"In this country, we know that African Americans have always been targeted as test dummies," he said, referring to unethical medical experiments including the infamous Tuskegee study, which left hundreds of Black men with untreated syphilis for decades.

"There is still systemic racism that exists. There is still, quite frankly, sometimes explicit bias that exists in the health care system, and so I think we need to name it and not shame these groups of people where they may have some hesitancy."

The process of spreading the information is just beginning, but it's going to need to come from more than one place, said Debra Furr-Holden, an epidemiologist who has been leading community discussions about the virus as director of the Flint Center for Health Equity Solutions

But at the same time, "relationships are built on trust, and trust takes time," she said. "They developed a vaccine at warp speed, and they're trying to skip a bunch of processes in the trust and relationship-building process."

"You don't allow your pulpit to become a platform," he said, adding that he understands "what you are risking when you open these platforms to a community that's already been taken advantage of, misused, abused."

"There's a reason, a quite valid reason, for there to be concerns about how the health care system in general, and often health care systems and the government together, have treated the African American community historically in the United States,"

"There was this push for everybody to use the water from the city," both during the crisis and after the city switched to a cleaner water source and started distributing filters and replacing corroded pipes, Womack said.

These articles are submitted to a group from Translators Without Borders that produces medical articles for Wikipedias in languages spoken in countries that often lack high-quality medical information. Examples include an article in Javanese on dengue fever and one in Hindi on urinary tract infection. Creating these high-quality medical articles fits neatly with efforts by the Wikimedia Foundation to make deals with cellphone carriers to provide Wikipedia content free of data charges, especially in the developing world

“If we want to get high-quality information to all the world’s population, Wikipedia is not just a viable option, but the only viable option,” Dr. Azzam said.

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 Democrats’ message, Schrier said, should be clear and simple: All vaccines are good. And the best thing American can do to protect themselves and their loved ones is to get a shot.

Pelosi spokesman Henry Connelly said the Speaker was simply reflecting concerns in her diverse caucus about whether minority communities were being treated equitably in the aggressive push to vaccinate all Americans.

That disparity has been attributed, in part, to the fact that the earlier Moderna and Pfizer vaccines each require two shots and colder refrigeration, complicating storage and distribution. That’s created additional barriers for getting the vaccine to poorer, historically underserved populations and rural communities.

Black people are nearly three times more likely to be hospitalized with COVID-19 than white people and nearly two times more likely to die from the disease; Hispanics are more than three times more likely to be hospitalized with COVID-19 than whites and 2.3 times more likely to die. 

White people have been vaccinated for COVID-19 at two times the rate of Black people, according to a New York Times analysis. The figures are worse for Hispanics. 

The disagreement among Democrats comes during a pivotal moment in the fight against the coronavirus pandemic as states like Texas and Mississippi end their mask mandates and lift restrictions on businesses, and health experts worry about a surge in cases driven by COVID-19 variants.

Because the new Johnson & Johnson vaccine requires only one shot and regular refrigeration levels, some officials like New Jersey Gov. Phil Murphy (D) have ordered that shipments of that vaccine be prioritized for harder-to-reach Black and brown communities. 

But while Pfizer and Moderna vaccines have an overall efficacy of about 95 percent in preventing moderate to severe disease, that number for the Johnson & Johnson version is just 66 percent — though experts point out the J&J vaccine was being tested after more contagious variants had begun spreading in the U.S., unlike the Pfizer and Moderna versions. 

That's led to some in those minority communities voicing concerns in recent days that they are being given a less-effective vaccine than more affluent, white communities.

Rep. André Carson (D-Ind.), another CBC member, noted that those suspicions have historic roots, pointing to the infamous Tuskegee syphilis study — a deadly federal research project that targeted poor Black people in rural Alabama in 1930s — as evidence of the "painful history" of biomedical mistreatment of African Americans in the United States. 

Despite such reservations, the broad consensus in the caucus appears to favor efforts to maximize vaccinations in the shortest possible time, regardless which shot is available in a given community.

On Wednesday, Kelly is set to join Rep. Joyce BeattyJoyce Birdson BeattyDemocrats spar over COVID-19 vaccine strategy Black Caucus backs Biden's pick to head DOJ Civil Rights Division Sole GOP vote on House police reform bill says he 'accidentally pressed the wrong voting button' MORE (D-Ohio), head of the Black Caucus, in an online forum with medical experts designed to educate minority communities on best vaccine practices. 

Rep. Anthony BrownAnthony Gregory BrownOvernight Defense: Pentagon chief to press for Manchin's support on Colin Kahl | House Dems seek to limit transfer of military-grade gear to police Democrats spar over COVID-19 vaccine strategy 140 lawmakers call for Biden administration to take 'comprehensive' approach to Iran MORE (D-Md.) said officials should monitor the distribution of vaccines to identify “patterns” that might indicate prejudices in the dispensation. But he’s also encouraging all of his constituents to get whatever vaccine is available first, and he highlighted the advantages of the one-dose Johnson & Johnson shot, particularly in hard-to-reach populations like the homeless. 

With its pages and pages of statistical charts, Race Traits helped catapult Hoffman into national and international prominence as the “dean” of American statisticians. In his day, Hoffman “achieved greatness,” assessed his biographer. “His career illustrates the fulfillment of the ‘American dream.’”

e don’t see any American dream,” Malcolm X said in 1964. “We’ve experienced only the American nightmare.”

A nightmare is essentially a horror story of danger, but it is not wholly a horror story. Black people experience joy, love, peace, safety. But as in any horror story, those unforgettable moments of toil, terror, and trauma have made danger essential to the black experience in racist America. What one black American experiences, many black Americans experience. Black Americans are constantly stepping into the toil and terror and trauma of other black Americans

Because they know: They could have been them; they are them. Because they know it is dangerous to be black in America, because racist Americans see blacks as dangerous.

To be black and conscious of anti-black racism is to stare into the mirror of your own extinction.

Ask the souls of the 10,000 black victims of COVID-19 who might still be living if they had been white. Ask the souls of those who were told the pandemic was the “great equalizer.” Ask the souls of those forced to choose between their low-wage jobs and their treasured life. Ask the souls of those blamed for their own death. Ask the souls of those who disproportionately lost their jobs and then their life as others disproportionately raged about losing their freedom to infect us all. Ask the souls of those ignored by the governors reopening their states.

The American nightmare has everything and nothing to do with the pandemic. Ask the souls of Breonna Taylor, Ahmaud Arbery, and George Floyd. Step into their souls.

History ignored you. Hoffman ignored you. Racist America ignored you. The state did not want you to breathe. But your loved ones did not ignore you. They did not ignore your nightmare. They share the same nightmare.

Your loved ones are protesting your murder, and the president calls for their murder, calls them “THUGS,” calls them “OUT OF STATE” agitators. Others call the violence against property senseless—but not the police violence against you that drove them to violence. Others call both senseless, but take no immediate steps to stem police violence against you, only to stem the violence against property and police.

Hoffman compiled racial health disparities to argue that black Americans are, by their very nature and behavior, a diseased and dying people. Hoffman cataloged higher black mortality rates and showed that black Americans were more likely to suffer from syphilis, tuberculosis, and other infectious diseases than white Americans.

perhaps the worst of the nightmare is knowing that racist Americans will never end it. Anti-racism is on you, and only you. Racist Americans deny your nightmare, deny their racism, claim you have a dream like a King, when even his dream in 1967 “turned into a nightmare.”

Black people are supposed to be feared by all, murdered by police officers, lynched by citizens, and killed by COVID-19 and other lethal diseases. It has been proved. No there there. Black life is the “hopeless problem,” as Hoffman wrote.

In the first nationwide compilation of racial crime data, Hoffman used the higher arrest and incarceration rates of black Americans to argue that they are, by their very nature and behavior, a dangerous and violent people—as racist Americans still say today.

Mayors issue curfews. Governors rattle their sabers. The National Guard arrives to protect property and police. Where was the National Guard when you faced violent police officers, violent white terrorists, the violence of racial health disparities, the violence of COVID-19—all the racist power and policy and ideas that kept the black experience in the American nightmare for 400 years?

While black Americans view their experience as the American nightmare, racist Americans view black Americans as the American nightmare.

Racist Americans, especially those racists who are white, view themselves as the embodiment of the American dream. All that makes America great. All that will make America great again. All that will keep America great.

Their American dream—that this is a land of equal opportunity, committed to freedom and equality, where police officers protect and serve—is a lie. Their American dream—that they have more because they are more, that when black people have more, they were given more—is a lie. Their American dream—that they have the civil right to kill black Americans with impunity and that black Americans do not have the human right to live—is a lie.

Take Minneapolis. Black residents are more likely than white residents to be pulled over, arrested, and victimized by its police force. Even as black residents account for 20 percent of the city’s population, they make up 64 percent of the people Minneapolis police restrained by the neck since 2018, and more than 60 percent of the victims of Minneapolis police shootings from late 2009 to May 2019. According to Samuel Sinyangwe of Mapping Police Violence, Minneapolis police are 13 times more likely to kill black residents than to kill white residents, one of the largest racial disparities in the nation. And these police officers rarely get prosecuted.

A typical black family in Minneapolis earns less than half as much as a typical white family—a $47,000 annual difference that is one of the largest racial disparities in the nation. Statewide, black residents are 6 percent of the Minnesota population, but 30 percent of the coronavirus cases as of Saturday, one of the largest black case disparities in the nation, according to the COVID Racial Data Tracker.

In April, many Americans chose the racist explanation: saying black people were not taking the coronavirus as seriously as white people, until challenged by survey data and majority-white demonstrations demanding that states reopen. Then they argued that black Americans were disproportionately dying from COVID-19 because they have more preexisting conditions, due to their uniquely unhealthy behaviors. But according to the Foundation for AIDS Research, structural factors such as employment, access to health insurance and medical care, and the air and water quality in neighborhoods are drivers of black infections and deaths, and not “intrinsic characteristics of black communities or individual-level factors.”

Americans should be asking: Why are so many unarmed black people being killed by police while armed white people are simply arrested? Why are officials addressing violent crime in poorer neighborhoods by adding more police instead of more jobs? Why are black (and Latino) people during this pandemic less likely to be working from home; less likely to be insured; more likely to live in trauma-care deserts, lacking access to advanced emergency care; and more likely to live in polluted neighborhoods? The answer is what the Frederick Hoffmans of today refuse to believe: racism.

Traditionally, a scientist submits her paper to a journal, which sends it to a (surprisingly small) group of peers for (several rounds of usually anonymous) comments; if the paper passes this (typically months-long) peer-review gantlet, it is published (often behind an expensive paywall). Languid and opaque, this system is ill-suited to a fast-moving outbreak. But biomedical scientists can now upload preliminary versions of their papers, or “preprints,” to freely accessible websites, allowing others to immediately dissect and build upon their results. This practice had been slowly gaining popularity before 2020, but proved so vital for sharing information about COVID‑19 that it will likely become a mainstay of modern biomedical research. Preprints accelerate science, and the pandemic accelerated the use of preprints. At the start of the year, one repository, medRxiv (pronounced “med archive”), held about 1,000 preprints. By the end of October, it had more than 12,000.

The U.S. is now catching up. In April, the NIH launched a partnership called ACTIV, in which academic and industry scientists prioritized the most promising drugs and coordinated trial plans across the country. Since August, several such trials have started.

Researchers have begun to uncover how SARS‑CoV‑2 compares with other coronaviruses in wild bats, the likely reservoir; how it infiltrates and co-opts our cells; how the immune system overreacts to it, creating the symptoms of COVID‑19. “We’re learning about this virus faster than we’ve ever learned about any virus in history,” Sabeti said.

Similar triumphs occurred last year—in other countries. In March, taking advantage of the United Kingdom’s nationalized health system, British researchers launched a nationwide study called Recovery, which has since enrolled more than 17,600 COVID‑19 patients across 176 institutions. Recovery offered conclusive answers about dexamethasone and hydroxychloroquine and is set to weigh in on several other treatments. No other study has done more to shape the treatment of COVID‑19.

SARS‑CoV‑2’s genome was decoded and shared by Chinese scientists just 10 days after the first cases were reported. By November, more than 197,000 SARS‑CoV‑2 genomes had been sequenced. About 90 years ago, no one had even seen an individual virus; today, scientists have reconstructed the shape of SARS‑CoV‑2 down to the position of individual atoms

Respiratory viruses, though extremely common, are often neglected. Respiratory syncytial virus, parainfluenza viruses, rhinoviruses, adenoviruses, bocaviruses, a quartet of other human coronaviruses—they mostly cause mild coldlike illnesses, but those can be severe. How often? Why? It’s hard to say, because, influenza aside, such viruses attract little funding or interest.

COVID‑19 has developed a terrifying mystique because it seems to behave in unusual ways. It causes mild symptoms in some but critical illness in others. It is a respiratory virus and yet seems to attack the heart, brain, kidneys, and other organs. It has reinfected a small number of people who had recently recovered. But many other viruses share similar abilities; they just don’t infect millions of people in a matter of months or grab the attention of the entire scientific community

Thanks to COVID‑19, more researchers are looking for these rarer sides of viral infections, and spotting them.

These factors pull researchers toward speed, short-termism, and hype at the expense of rigor—and the pandemic intensified that pull. With an anxious world crying out for information, any new paper could immediately draw international press coverage—and hundreds of citations.

“There’s a perception that they’re just colds and there’s nothing much to learn,” says Emily Martin of the University of Michigan, who has long struggled to get funding to study them. Such reasoning is shortsighted folly. Respiratory viruses are the pathogens most likely to cause pandemics, and those outbreaks could potentially be far worse than COVID‑19’s.

Their movements through the air have been poorly studied, too. “There’s this very entrenched idea,” says Linsey Marr at Virginia Tech, that viruses mostly spread through droplets (short-range globs of snot and spit) rather than aerosols (smaller, dustlike flecks that travel farther). That idea dates back to the 1930s, when scientists were upending outdated notions that disease was caused by “bad air,” or miasma. But the evidence that SARS‑CoV‑2 can spread through aerosols “is now overwhelming,”

Another pandemic is inevitable, but it will find a very different community of scientists than COVID‑19 did. They will immediately work to determine whether the pathogen—most likely another respiratory virus—moves through aerosols, and whether it spreads from infected people before causing symptoms. They might call for masks and better ventilation from the earliest moments, not after months of debate

They will anticipate the possibility of an imminent wave of long-haul symptoms, and hopefully discover ways of preventing them. They might set up research groups to prioritize the most promising drugs and coordinate large clinical trials. They might take vaccine platforms that worked best against COVID‑19, slot in the genetic material of the new pathogen, and have a vaccine ready within months

the single-minded focus on COVID‑19 will also leave a slew of negative legacies. Science is mostly a zero-sum game, and when one topic monopolizes attention and money, others lose out.

Long-term studies that monitored bird migrations or the changing climate will forever have holes in their data because field research had to be canceled.

negligence has left COVID‑19 long-haulers with few answers or options, and they initially endured the same dismissal as the larger ME community. But their sheer numbers have forced a degree of recognition. They started researching, cataloging their own symptoms. They gained audiences with the NIH and the World Health Organization. Patients who are themselves experts in infectious disease or public health published their stories in top journals. “Long COVID” is being taken seriously, and Brea hopes it might drag all post-infection illnesses into the spotlight. ME never experienced a pivot. COVID‑19 might inadvertently create one

Other epistemic trespassers spent their time reinventing the wheel. One new study, published in NEJM, used lasers to show that when people speak, they release aerosols. But as the authors themselves note, the same result—sans lasers—was published in 1946, Marr says. I asked her whether any papers from the 2020 batch had taught her something new. After an uncomfortably long pause, she mentioned just one.

The incentives to trespass are substantial. Academia is a pyramid scheme: Each biomedical professor trains an average of six doctoral students across her career, but only 16 percent of the students get tenure-track positions. Competition is ferocious, and success hinges on getting published

Conservationists who worked to protect monkeys and apes kept their distance for fear of passing COVID‑19 to already endangered species.

Among scientists, as in other fields, women do more child care, domestic work, and teaching than men, and are more often asked for emotional support by their students. These burdens increased as the pandemic took hold, leaving women scientists “less able to commit their time to learning about a new area of study, and less able to start a whole new research project,

published COVID‑19 papers had 19 percent fewer women as first authors compared with papers from the same journals in the previous year. Men led more than 80 percent of national COVID‑19 task forces in 87 countries. Male scientists were quoted four times as frequently as female scientists in American news stories about the pandemic.

American scientists of color also found it harder to pivot than their white peers, because of unique challenges that sapped their time and energy.

Science suffers from the so-called Matthew effect, whereby small successes snowball into ever greater advantages, irrespective of merit. Similarly, early hindrances linger. Young researchers who could not pivot because they were too busy caring or grieving for others might suffer lasting consequences from an unproductive year. COVID‑19 “has really put the clock back in terms of closing the gap for women and underrepresented minorities,”

In 1848, the Prussian government sent a young physician named Rudolf Virchow to investigate a typhus epidemic in Upper Silesia. Virchow didn’t know what caused the devastating disease, but he realized its spread was possible because of malnutrition, hazardous working conditions, crowded housing, poor sanitation, and the inattention of civil servants and aristocrats—problems that require social and political reforms. “Medicine is a social science,” Virchow said, “and politics is nothing but medicine in larger scale.”

entists discovered the microbes responsible for tuberculosis, plague, cholera, dysentery, and syphilis, most fixated on these newly identified nemeses. Societal factors were seen as overly political distractions for researchers who sought to “be as ‘objective’ as possible,” says Elaine Hernandez, a medical sociologist at Indiana University. In the U.S., medicine fractured.

New departments of sociology and cultural anthropology kept their eye on the societal side of health, while the nation’s first schools of public health focused instead on fights between germs and individuals. This rift widened as improvements in hygiene, living standards, nutrition, and sanitation lengthened life spans: The more social conditions improved, the more readily they could be ignored.

The ideological pivot away from social medicine began to reverse in the second half of the 20th century.

Politicians initially described COVID‑19 as a “great equalizer,” but when states began releasing demographic data, it was immediately clear that the disease was disproportionately infecting and killing people of color.

These disparities aren’t biological. They stem from decades of discrimination and segregation that left minority communities in poorer neighborhoods with low-paying jobs, more health problems, and less access to health care—the same kind of problems that Virchow identified more than 170 years ago.

In March, when the U.S. started shutting down, one of the biggest questions on the mind of Whitney Robinson of UNC at Chapel Hill was: Are our kids going to be out of school for two years? While biomedical scientists tend to focus on sickness and recovery, social epidemiologists like her “think about critical periods that can affect the trajectory of your life,” she told me. Disrupting a child’s schooling at the wrong time can affect their entire career, so scientists should have prioritized research to figure out whether and how schools could reopen safely. But most studies on the spread of COVID‑19 in schools were neither large in scope nor well-designed enough to be conclusive. No federal agency funded a large, nationwide study, even though the federal government had months to do so. The NIH received billions for COVID‑19 research, but the National Institute of Child Health and Human Development—one of its 27 constituent institutes and centers—got nothing.

The horrors that Rudolf Virchow saw in Upper Silesia radicalized him, pushing the future “father of modern pathology” to advocate for social reforms. The current pandemic has affected scientists in the same way

COVID‑19 could be the catalyst that fully reunifies the social and biological sides of medicine, bridging disciplines that have been separated for too long.

“To study COVID‑19 is not only to study the disease itself as a biological entity,” says Alondra Nelson, the president of the Social Science Research Council. “What looks like a single problem is actually all things, all at once. So what we’re actually studying is literally everything in society, at every scale, from supply chains to individual relationships.”