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Ventilation systems in schools, nursing homes, residences and businesses may need to minimize recirculating air and add powerful new filters.

in an open letter to the W.H.O., 239 scientists in 32 countries have outlined the evidence showing that smaller particles can infect people, and are calling for the agency to revise its recommendations

Whether carried aloft by large droplets that zoom through the air after a sneeze, or by much smaller exhaled droplets that may glide the length of a room, these experts said, the coronavirus is borne through air and can infect people when inhaled

But the infection prevention and control committee in particular, experts said, is bound by a rigid and overly medicalized view of scientific evidence, is slow and risk-averse in updating its guidance and allows a few conservative voices to shout down dissent.

“If we started revisiting airflow, we would have to be prepared to change a lot of what we do,” she said. “I think it’s a good idea, a very good idea, but it will cause an enormous shudder through the infection control society.”

In early April, a group of 36 experts on air quality and aerosols urged the W.H.O. to consider the growing evidence on airborne transmission of the coronavirus. The agency responded promptly, calling Lidia Morawska, the group’s leader and a longtime W.H.O. consultant, to arrange a meeting.

But the discussion was dominated by a few experts who are staunch supporters of handwashing and felt it must be emphasized over aerosols, according to some participants, and the committee’s advice remained unchanged.

Dr. Morawska and others pointed to several incidents that indicate airborne transmission of the virus, particularly in poorly ventilated and crowded indoor spaces. They said the W.H.O. was making an artificial distinction between tiny aerosols and larger droplets, even though infected people produce both.

We’ve known since 1946 that coughing and talking generate aerosols,

Scientists have not been able to grow the coronavirus from aerosols in the lab.

Most of the samples in those experiments have come from hospital rooms with good air flow that would dilute viral levels.

In most buildings, she said, “the air-exchange rate is usually much lower, allowing virus to accumulate in the air and pose a greater risk.”

The W.H.O. also is relying on a dated definition of airborne transmission, Dr. Marr said. The agency believes an airborne pathogen, like the measles virus, has to be highly infectious and to travel long distances.

Dr. Marr and others said the coronavirus seemed to be most infectious when people were in prolonged contact at close range, especially indoors, and even more so in superspreader events — exactly what scientists would expect from aerosol transmission.

Experts all agree that the coronavirus does not behave that way.

“We have this notion that airborne transmission means droplets hanging in the air capable of infecting you many hours later, drifting down streets, through letter boxes and finding their way into homes everywhere,”

The agency lagged behind most of its member nations in endorsing face coverings for the public. While other organizations, including the C.D.C., have long since acknowledged the importance of transmission by people without symptoms, the W.H.O. still maintains that asymptomatic transmission is rare.

Many experts said the W.H.O. should embrace what some called a “precautionary principle” and others called “needs and values” — the idea that even without definitive evidence, the agency should assume the worst of the virus, apply common sense and recommend the best protection possible.

“There is no incontrovertible proof that SARS-CoV-2 travels or is transmitted significantly by aerosols, but there is absolutely no evidence that it’s not,

So at the moment we have to make a decision in the face of uncertainty, and my goodness, it’s going to be a disastrous decision if we get it wrong,” she said. “So why not just mask up for a few weeks, just in case?”

he agency also must consider the needs of all its member nations, including those with limited resources, and make sure its recommendations are tempered by “availability, feasibility, compliance, resource implications,” she said.

if the W.H.O. were to push for rigorous control measures in the absence of proof, hospitals in low- and middle-income countries may be forced to divert scarce resources from other crucial programs.

That’s the balance that an organization like the W.H.O. has to achieve,” he said. “It’s the easiest thing in the world to say, ‘We’ve got to follow the precautionary principle,’ and ignore the opportunity costs of that.”

In interviews, other scientists criticized this view as paternalistic. “‘We’re not going to say what we really think, because we think you can’t deal with it?’ I don’t think that’s right,”

Even cloth masks, if worn by everyone, can significantly reduce transmission, and the W.H.O. should say so clearly, he added.

The W.H.O. tends to describe “an absence of evidence as evidence of absence,” Dr. Aldis added. In April, for example, the W.H.O. said, “There is currently no evidence that people who have recovered from Covid-19 and have antibodies are protected from a second infection.”

The statement was intended to indicate uncertainty, but the phrasing stoked unease among the public and earned rebukes from several experts and journalists. The W.H.O. later walked back its comments.

In a less public instance, the W.H.O. said there was “no evidence to suggest” that people with H.I.V. were at increased risk from the coronavirus. After Joseph Amon, the director of global health at Drexel University in Philadelphia who has sat on many agency committees, pointed out that the phrasing was misleading, the W.H.O. changed it to say the level of risk was “unknown.”

But W.H.O. staff and some members said the critics did not give its committees enough credit.“Those that may have been frustrated may not be cognizant of how W.H.O. expert committees work, and they work slowly and deliberately,”

In the past two decades, the list of British calamities, policy misjudgments, and forecasting failures has been eye-watering: the disaster of Iraq, the botched Libyan intervention in 2011, the near miss of Scottish independence in 2014, the woeful handling of Britain’s divorce from the European Union from 2016 onward

What emerges is a picture of a country whose systemic weaknesses were exposed with appalling brutality, a country that believed it was stronger than it was, and that paid the price for failures that have built up for years

The most difficult question about all this is also the simplest: Why?

The human immune system actually has two parts. There is, as Cummings correctly identifies, the adaptive part. But there is also an innate part, preprogrammed as the first line of defense against infectious disease. Humans need both. The same is true of a state and its government, said those I spoke with—many of whom were sympathetic to Cummings’s diagnosis. Without a functioning structure, the responsive antibodies of the government and its agencies cannot learn on the job. When the pandemic hit, both parts of Britain’s immune system were found wanting.

Britain’s pandemic story is not all bad. The NHS is almost universally seen as having risen to the challenge; the University of Oxford is leading the race to develop the first coronavirus vaccine for international distribution, backed with timely and significant government cash; new hospitals were built and treatments discovered with extraordinary speed; the welfare system did not collapse, despite the enormous pressure it suddenly faced; and a national economic safety net was rolled out quickly.

One influential U.K. government official told me that although individual mistakes always happen in a fast-moving crisis, and had clearly taken place in Britain’s response to COVID-19, it was impossible to escape the conclusion that Britain was simply not ready. As Ian Boyd, a professor and member of SAGE, put it: “The reality is, there has been a major systemic failure.”

“It’s obvious that the British state was not prepared for” the pandemic, this official told me. “But, even worse, many parts of the state thought they were prepared, which is significantly more dangerous.”

When the crisis came, too much of Britain’s core infrastructure simply failed, according to senior officials and experts involved in the pandemic response

Like much of the Western world, Britain had prepared for an influenza pandemic, whereas places that were hit early—Hong Kong, South Korea, Singapore, Taiwan—had readied themselves for the type of respiratory illness that COVID-19 proved to be.

The consequences may be serious and long term, but the most immediately tragic effect was that creating space in hospitals appears to have been prioritized over shielding Britain’s elderly, many of whom were moved to care homes, part of what Britain calls the social-care sector, where the disease then spread. Some 25,000 patients were discharged into these care homes between March 17 and April 16, many without a requirement that they secure a negative coronavirus test beforehand.

There was a bit too much exceptionalism about how brilliant British science was at the start of this outbreak, which ended up with a blind spot about what was happening in Korea, Taiwan, Singapore, where we just weren’t looking closely enough, and they turned out to be the best in the world at tackling the coronavirus,” a former British cabinet minister told me.

The focus on influenza pandemics and the lack of a tracing system were compounded by a shortfall in testing capacity.

Johnson’s strategy throughout was one that his hero Winston Churchill raged against during the First World War, when he concluded that generals had been given too much power by politicians. In the Second World War, Churchill, by then prime minister and defense secretary, argued that “at the summit, true politics and strategy are one.” Johnson did not take this approach, succumbing—as his detractors would have it—to fatalistic management rather than bold leadership, empowering the generals rather than taking responsibility himself

“It was a mixture of poor advice and fatalism on behalf of the experts,” one former colleague of Johnson’s told me, “and complacency and boosterism on behalf of the PM.”

What it all adds up to, then, is a sobering reality: Institutional weaknesses of state capacity and advice were not corrected by political judgment, and political weaknesses were not corrected by institutional strength. The system was hardwired for a crisis that did not come, and could not adapt quickly enough to the one that did.

Britain’s NHS has come to represent the country itself, its sense of identity and what it stands for. Set up in 1948, it became known as the first universal health-care system of any major country in the world (although in reality New Zealand got there first). Its creation, three years after victory in the Second World War, was a high-water mark in the country’s power and prestige—a time when it was a global leader, an exception.

Every developed country in the world, apart from the United States, has a universal health-care system, many of which produce better results than the NHS.

Yet from its beginnings, the NHS has occupied a unique hold on British life. It is routinely among the most trusted institutions in the country. Its key tenet—that all Britons will have access to health care, free at the point of service—symbolizes an aspirational egalitarianism that, even as inequality has risen since the Margaret Thatcher era, remains at the core of British identity.

In asking the country to rally to the NHS’s defense, Johnson was triggering its sense of self, its sense of pride and national unity—its sense of exceptionalism.

Before the coronavirus, the NHS was already under considerable financial pressure. Waiting times for appointments were rising, and the country had one of the lowest levels of spare intensive-care capacity in Europe. In 2017, Simon Stevens, the NHS’s chief executive, compared the situation to the time of the health sevice’s founding decades prior: an “economy in disarray, the end of empire, a nation negotiating its place in the world.”

When the pandemic hit, then, Britain was not the strong, successful, resilient country it imagined, but a poorly governed and fragile one. The truth is, Britain was sick before it caught the coronavirus.

In effect, Britain was rigorously building capacity to help the NHS cope, but releasing potentially infected elderly, and vulnerable, patients in the process. By late June, more than 19,000 people had died in care homes from COVID-19. Separate excess-death data suggest that the figure may be considerably higher

Britain failed to foresee the dangers of such an extraordinary rush to create hospital capacity, a shift that was necessary only because of years of underfunding and decades of missed opportunities to bridge the divide between the NHS and retirement homes, which other countries, such as Germany, had found the political will to do.

Ultimately, the scandal is a consequence of a political culture that has proved unable to confront and address long-term problems, even when they are well known.

other health systems, such as Germany’s, which is better funded and decentralized, performed better than Britain’s. Those I spoke with who either are in Germany or know about Germany’s success told me there was an element of luck about the disparity with Britain. Germany had a greater industrial base to produce medical testing and personal protective equipment, and those who returned to Germany with the virus from abroad were often younger and healthier, meaning the initial strain on its health system was less.

However, this overlooks core structural issues—resulting from political choices in each country—that meant that Germany proved more resilient when the crisis came, whether because of the funding formula for its health system, which allows individuals more latitude to top up their coverage with private contributions, or its decentralized nature, which meant that separate regions and hospitals were better able to respond to local outbreaks and build their own testing network.

Also unlike Britain, which has ducked the problem of reforming elderly care, Germany created a system in 1995 that everyone pays into, avoids catastrophic costs, and has cross-party support.

A second, related revelation of the crisis—which also exposed the failure of the British state—is that underneath the apparent simplicity of the NHS’s single national model lies an engine of bewildering complexity, whose lines of responsibility, control, and accountability are unintelligible to voters and even to most politicians.

Britain, I was told, has found a way to be simultaneously overcentralized and weak at its center. The pandemic revealed the British state’s inability to manage the nation’s health:

Since at least the 1970s, growing inequality between comparatively rich southeast England (including London) and the rest of the country has spurred all parties to pledge to “rebalance the economy” and make it less reliant on the capital. Yet large parts remain poorer than the European average. According to official EU figures, Britain has five regions with a per capita gross domestic product of less than $25,000. France, Germany, Ireland, Austria, the Netherlands, Denmark, and Sweden have none

If Britain were part of the United States, it would be anywhere from the third- to the eighth-poorest state, depending on the measure.

Britain’s performance in this crisis has been so bad, it is damaging the country’s reputation, both at home and abroad.

Inside Downing Street, officials believe that the lessons of the pandemic apply far beyond the immediate confines of elderly care and coronavirus testing, taking in Britain’s long-term economic failures and general governance, as well as what they regard as its ineffective foreign policy and diplomacy.

the scale of the task itself is enormous. “We need a complete revamp of our government structure because it’s not fit for purpose anymore,” Boyd told me. “I just don’t know if we really understand our weakness.”

In practice, does Johnson have the confidence to match his diagnosis of Britain’s ills, given the timidity of his approach during the pandemic? The nagging worry among even Johnson’s supporters in Parliament is that although he may campaign as a Ronald Reagan, he might govern as a Silvio Berlusconi, failing to solve the structural problems he has identified.

This is not a story of pessimistic fatalism, of inevitable decline. Britain was able to partially reverse a previous slump in the 1980s, and Germany, seen as a European laggard in the ‘90s, is now the West’s obvious success story. One of the strengths of the Westminster parliamentary system is that it occasionally produces governments—like Johnson’s—with real power to effect change, should they try to enact it.

It has been overtaken by many of its rivals, whether in terms of health provision or economic resilience, but does not seem to realize it. And once the pandemic passes, the problems Britain faces will remain: how to sustain institutions so that they bind the country together, not pull it apart; how to remain prosperous in the 21st century’s globalized economy; how to promote its interests and values; how to pay for the ever-increasing costs of an aging population.

“The really important question,” Boyd said, “is whether the state, in its current form, is structurally capable of delivering on the big-picture items that are coming, whether pandemics or climate change or anything else.”

Dr. Conley said Monday it was possible the president would no longer be contagious before the 10-day period ends.

The president has repeatedly played down the threat of the virus, which medical experts say is very real, especially for older people and people with pre-existing health problems. After returning to the White House on Monday from Walter Reed National Military Medical Center, Mr. Trump stood on a White House balcony, removed his mask and flashed two thumbs up.

Biden said that he was glad Mr. Trump “seems to be coming along pretty well” but that he hoped the president would “communicate the right lesson to the American people: Masks matter.”

including Regeneron Pharmaceuticals Inc.’s experimental antibody drug cocktail

Mr. Trump’s physicians declined to answer several questions about the president’s case

“That’s crucial information,” he said. Without it, he said, it isn’t clear how badly the illness has affected him, particularly whether he contracted pneumonia. Mr. Trump’s early treatment with dexamethasone, which is typically given to people with more-severe breathing problems who are further along in the illness, raised questions, Dr. Chin-Hong said.

other experts on the committee said all available evidence indicated the vaccine is safe and effective for nursing home residents and older Americans generally.

As people age, bodily defenses against pathogens weaken, and the response to vaccines also falters.

“We have a clear and present danger of Covid, and we have social isolation,” Dr. Farrell said. “We know that that’s an independent risk factor for mortality, even stronger than individual chronic diseases.”

“For many, the immune response can sometimes be diminished or dampened or delayed,”

“When you’ve come to near-death experiences twice, volunteering for a vaccine trial — it wasn’t a great sense of worry or apprehension for me,”

Some people worry, incorrectly, that the vaccine may somehow give them Covid-19. In fact, the vaccine carries instructions to make only a single protein from the virus.

Every time she gets a flu shot, Ms. Ebrani said, she feels unwell for three days, with headaches and a deep exhaustion. But she gets that vaccine anyway, because she feels healthy the rest of the year and because her doctor has told her she should.

If this does drive the evolution of the virus, we may have to regularly update the vaccines, as we do for flu, to keep up.

The concern was that antibodies from the blood of survivors was less effective at attacking that variant of virus.

And while there’s no reason to suspect that a third dose would be particularly unsafe in healthy people, the FDA hasn’t explicitly declared it safe.

How exactly you get your booster shot matters too. Say you don’t qualify for an extra shot and one falls into your lap anyway. Taking it isn’t necessarily a moral error as long as you’re truthful, Faith Fletcher, an assistant professor at Baylor College of Medicine’s Center for Medical Ethics and Health Policy, told me. But lying about your health or vaccine status is strictly out, she said, because it undermines the rules and guidelines that public-health officials design “to really maximize the greatest good among the greatest amount of people.”

The real moral failure, Fletcher said, is a systemic one: the fact that shots are falling into the laps of the healthy and vaccinated, rather than programs that bring vaccines to essential workers at their jobs, or to Black Americans at barber shops and stylists, or to walk-up and mobile clinics that can reach people who don’t have internet access.

When I reached out to Walgreens, CVS, and Rite Aid, representatives from all three pharmacy chains insisted that their stores are following the rules, but acknowledged that they’re relying on customers to tell the truth.

Asking patients to do anything more in order to get the vaccine would be a mistake, Jason Schwartz, a vaccine-policy expert at the Yale School of Public Health, told me. “It’s far more important to get folks vaccinated and to take down barriers that could keep folks who want to get vaccinated from getting [their shots], even if it means that some folks may be playing fast and loose with their own eligibility,” he said.

​​lying (overtly or by omission) to get a third dose can mess up the data on how well third shots are performing among the immunocompromised and how well a two-dose regimen is protecting those with healthy immune systems.

On an even more basic level, under-the-table boosting could skew data on national vaccination rates, making public-health authorities think more people have gotten their first or second shots than is actually the case. Essentially, getting a third shot before the CDC’s go-ahead can make it harder for health officials to determine when and if everyone else will really need them.

You can understand why the booster bandits have done what they’ve done: Getting another shot offers a sense of safety and control, however fleeting. After 18 months of pandemic life, it’s hard to begrudge anyone that. But the rule-breaking and the lying could help keep us all from really getting the virus under control for that much longer.

A shot of the Pfizer-BioNTech vaccine also raised the antibody levels of Johnson & Johnson recipients more than Johnson & Johnson did, the study found, although not as much as Moderna did

The study’s researchers warned against using the findings to conclude that any one combination of vaccines was better.

Providers also might not have access to a vaccine a patient initially received

“From a public health perspective, there’s a clear need in some situations for individuals to receive a different vaccine,

Regulators have not authorized booster shots for recipients of Moderna and Johnson & Johnson vaccines yet.

The F.D.A. authorized boosters for workers whose jobs put them at high risk of exposure to potentially infectious people.

Yes. The C.D.C. says the Covid vaccine may be administered without regard to the timing of other vaccines, and many pharmacy sites are allowing people to schedule a flu shot at the same time as a booster dose.

ut the only Moderna recipients who are expected to become eligible for boosters are those who are at least 65 or otherwise considered at high risk, following the same eligibility requirements for recipients of Pfizer-BioNTech’s vaccine.

Among Americans who have received a booster, just 1.6 percent chose Johnson & Johnson.

An increased risk for the condition has also been linked to the shot from AstraZeneca, which is not authorized in the United States. It has not been linked to the Moderna or Pfizer vaccines.

“It’s really important, though, that we not completely eliminate this vaccine,”

The people who died ranged in age from 28 to 62. Seven were women, and all were white. Obesity was the most common underlying medical condition. Two of the people who died did not have known medical problems, he said.

It was previously reported that males between 16 and 29 years had a heightened risk of developing myocarditis. Nearly 11 out of every 100,000 of them developed the condition a few days after being fully vaccinated. On balance, it was estimated that for boys 12 to 17, the shots would cause an estimated 70 myocarditis cases but prevent 5,700 infections, 215 hospitalizations and two deaths, the C.D.C. said. But most recovered within a short period of time.

despite the clotting concerns, the Johnson & Johnson vaccine prevented thousands of U.S. Covid hospitalizations compared to three to a dozen cases of the clotting syndrome, depending on the age group. Those over 64 avoided the most hospital stays. Like those immunized with other vaccines, thousands avoided hospitalization

some South African scientists have pointed out that the travel ban may also be hampering the race to learn more about Omicron by blocking supplies of the reagents they need to study it.

Partly because of this South Africa was, until recently, recording less than one-tenth as many daily covid cases as Britain. “It boggles the mind that people in the United Kingdom can pile into a full football stadium and in the United States it appears as though it’s business as usual, but as soon as something happens on African soil, those countries go into a hysterical tailspin,”

The new travel restrictions will wallop the region’s tourism industry, just as hotels, game reserves and wine estates were preparing for their busiest months of the year

Because of the drop in tourism and the imposition of lockdowns the economy shrank by about 6% last year. Thousands of small businesses collapsed

The ripples may spread far beyond southern Africa to countries such as Kenya and Uganda that do not yet face travel restrictions.

South Africa’s health workers are gearing up for another December of mayhem as covid’s fourth wave washes over the country.

The emergence of Omicron, which seems to spread easily, will probably upset those estimates. “It looks like it's spreading quickly but there’s so much that’s unknown, specifically if it will evade the vaccines and its severity,”

The virus that became Omicron may have been contained in an isolated population that recently re-established contact with the outside world. It may have jumped into an animal and back out again.

over the nobody safe/everyone safe maxim

as the disease continues to circulate, everyone on Earth will sooner or later be exposed to covid and not just once, but often. One thing you can be sure of is that, given enough time, covid will reach Omega.

Vaccination may lower the frequency of these events. How much is unclear, but the EU has fully vaccinated 79% of over-12s and cases are nevertheless running at 2.5m a week.

a lot of virus is circulating in the EU—and mutating.

confused arguments can end up seeming manipulative and sanctimonious, weakening the very cause they are designed to support.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And suppose it takes five days between a person’s getting infected and their infecting others. After 30 days, the more transmissible virus is now causing 26, or 64, times as many new cases as the less transmissible one.

Not every case will be mild, though, and even a small hospitalization rate on top of a huge case number will be a big number.

Now, as my colleague Ed Yong reports, Omicron could push a collapsing health-care system further into disaster. Hospitals are already dealing with the flu and other winter viruses. They’re already canceling elective surgeries.

If there are no changes to behavior or policy, this year’s winter wave would peak at about double the hospitalizations of last winter at its worst, and 20 percent more deaths, according to the most pessimistic of projections

The most optimistic projection sees a caseload similar to last winter’s, but hospitalizations and deaths at about half of where they were back then, assuming the vaccines keep up their very high protection against severe illness.

If that holds, it’s a “huge decrease,” Meyers says, and one that matches the assumptions of her team’s grimmer—but not grimmest—projections. When they modeled scenarios where vaccine effectiveness against hospitalization dropped by about that much, they saw a difference of tens of thousands of deaths.

Very preliminary data from South Africa’s largest health insurer suggest that two doses of the Pfizer-BioNTech vaccine were 70 percent effective at preventing hospitalization from Omicron infections, down from 93 percent before.

Vaccine protection against severe illness should be more durable than it is against infection, but may still take a hit

The available evidence on Omicron’s inherent severity is likely to be biased in ways that make it appear more promising. First of all, hospitalizations lag infections.

Second, the first people infected may skew young and are thus more likely to have mild cases regardless of the variant

third, some of the mildness attributed to the virus may result instead from existing immunity. In South Africa, where doctors are reporting relatively low hospitalizations compared with previous waves, many cases are probably reinfections

The South Africa health-insurer data suggest that Omicron might carry a 29 percent lower risk of hospitalization than the original virus, when adjusted for risk factors including age, sex, vaccination status, and documented prior infection—but many prior infections may be undocumented, which would make the reduction in risk seem bigger than it really is. (A recent analysis of early U.K. cases found “at most, limited changes in severity compared with Delta.”)

Either way, in the short run, we will have a massive number of Omicron cases on top of a massive number of Delta cases. Together they will infect huge numbers of people, vaccinated or not

One of the first questions experts asked me was whether my family was vaccinated. Yes, I said: My husband and I are vaccinated and boosted, and our kids are vaccinated but not yet boosted. This is a relevant question because, if you’re exposed to the virus that causes Covid-19, “your immune system kicks into action a lot faster if you’re vaccinated versus not vaccinated,”

First, the swift immune reaction slows the rate of viral reproduction and spread. “This is what the vaccines are there for — to educate your immune system so that it gets a jump on the invaders before they are able to replicate out of control,”

Because the virus doesn’t replicate as quickly in vaccinated people, they may be less likely to test positive for Covid-19 after coronavirus exposure, because their immune system “keeps the viral load below the level of detection,”

It’s possible, then, that my husband and son did catch Covid-19, but their vaccinated immune systems fended off the infection so well that they never had enough viral proteins in their nose or throat to test positive. And their continual negative tests probably meant that they were never that contagious

If my husband and son never tested positive, why did they feel sick? Even if a vaccinated person doesn’t have much virus in their body, they can still have powerful Covid symptoms

That’s because many illness symptoms — fever, malaise, runny nose, fatigue — are actually caused by the immune system’s response to the virus, rather than the virus itself

And as for why I felt fine, Dr. Morrison said that perhaps my immune system fought off the incoming virus so quickly that I didn’t even have a chance to feel sick. “It sounds to me like you were definitely exposed,”

maybe I had high levels of vaccine antibodies or immune cells called T cells that were able to kill the invading virus before it had a chance to alert the parts of my immune system that would incite symptoms.

All this said, nobody really knows what happened to me, my son or my husband. When it comes to understanding how Covid-19 affects the body, “there are so many open questions,”

people can have different experiences for many different reasons. For instance, Dr. Andino said, it’s possible that the virus was replicating in parts of my husband’s or my son’s body that the tests didn’t reach

Research suggests that the coronavirus can replicate in the pancreas, heart, brain, kidneys and other organs, although vaccination may reduce the chance that the virus spreads outside the respiratory system.

Dr. Andino said that he and his colleagues have been conducting studies in which they follow and repeatedly test entire households after one person in the home tests positive for Covid-19. “What we see is exactly what you described — that some people in the household don’t test positive,”

that would be on par with what we experience with flu viruses, which scientists estimate hit us about every two to five years, less often in adulthood. It also matches up well with the documented cadence of the four other coronaviruses that seasonally trouble humans, and cause common colds.

For now, every infection, and every subsequent reinfection, remains a toss of the dice. “Really, it’s a gamble,” says Ziyad Al-Aly, a clinical epidemiologist and long-COVID researcher at Washington University in St. Louis. Vaccination and infection-induced immunity may load the dice against landing on severe disease, but that danger will never go away completely, and scientists don’t yet know what happens to people who contract “mild” COVID over and over again

Or maybe not. This virus seems capable of tangling into just about every tissue in the body, affecting organs such as the heart, brain, liver, kidneys, and gut; it has already claimed the lives of millions, while saddling countless others with symptoms that can linger for months or years.

considering our current baseline, “less dangerous” could still be terrible—and it’s not clear exactly where we’re headed. When it comes to reinfection, we “just don’t know enough,”

Perhaps, as several experts have posited since the pandemic’s early days, SARS-CoV-2 will just become the fifth cold-causing coronavirus.

A third or fourth bout might be more muted still; the burden of individual diseases may be headed toward an asymptote of mildness that holds for many years

Future versions of SARS-CoV-2 could continue to shape-shift out of existing antibodies’ reach, as coronaviruses often do. But the body is flush with other fighters that are much tougher to bamboozle—among them, B cells and T cells that can quash a growing infection before it spirals out of control

Those protections tend to build iteratively, as people see pathogens or vaccines more often. People vaccinated three times over, for instance, seem especially well equipped to duke it out with all sorts of SARS-CoV-2 variants, including Omicron and its offshoots.

promising patterns: Second infections and post-vaccination infections “are significantly less severe,” she told me, sometimes to the point where people don’t notice them at all

Bodies, wised up to the virus’s quirks, can now react more quickly, clobbering it with sharper and speedier strikes.

“There are still very good reasons” to keep exposures few and far between, Landon, of the University of Chicago, told me. Putting off reinfection creates fewer opportunities for harm: The dice are less likely to land on severe disease (or chronic illness) when they’re rolled less often overall. It also buys us time to enhance our understanding of the virus, and improve our tools to fight it.

Immunity, though, is neither binary nor permanent. Even if SARS-CoV-2’s assaults are blunted over time, there are no guarantees about the degree to which that happens, or how long it lasts.

A slew of factors could end up weighting the dice toward severe disease—among them, a person’s genetics, age, underlying medical conditions, health-care access, and frequency or magnitude of exposure to the virus.

for everyone else, no amount of viral dampening can totally eliminate the chance, however small it may be, of getting very sick.

Long COVID, too, might remain a possibility with every discrete bout of illness. Or maybe the effects of a slow-but-steady trickle of minor, fast-resolving infections would sum together, and bring about the condition.

Every time the body’s defenses are engaged, it “takes a lot of energy, and causes tissue damage,” Thomas told me. Should that become a near-constant barrage, “that’s probably not great for you.”

Bodies are resilient, especially when they’re offered time to rest, and she doubts that reinfection with a typically ephemeral virus such as SARS-CoV-2 would cause mounting damage. “The cumulative effect is more likely to be protective than detrimental,” she said, because of the immunity that’s laid down each time.

people who have caught the virus twice or thrice may be more likely to become long-haulers than those who have had it just once.

Some other microbes, when they reinvade us, can fire up the immune system in unhelpful ways, driving bad bouts of inflammation that burn through the body, or duping certain defensive molecules into aiding, rather than blocking, the virus’s siege. Researchers don’t think SARS-CoV-2 will do the same. But this pathogen is “much more formidable than even someone working on coronaviruses would have expected,

Seasonal encounters with pathogens other than SARS-CoV-2 don’t often worry us—but perhaps that’s because we’re still working to understand their toll. “Have we been underestimating long-term consequences from other repeat infections?” Thomas said. “The answer is probably, almost certainly, yes.”

the rhythm of reinfection isn’t just about the durability of immunity or the pace of viral evolution. It’s also about our actions and policies, and whether they allow the pathogen to transmit and evolve. Strategies to avoid infection—to make it as infrequent as possible, for as many people as possible—remain options, in the form of vaccination, masking, ventilation, paid sick leave, and more.

Gordon and Swartz are both hopeful that the slow accumulation of immunity will also slash people’s chances of developing long COVID.

The outlooks of the experts I spoke with spanned the range from optimism to pessimism, though all agreed that uncertainty loomed. Until we know more, none were keen to gamble with the virus—or with their own health. Any reinfection will likely still pose a threat, “even if it’s not the worst-case scenario,” Abdool Karim told me. “I wouldn’t want to put myself in that position.”

“In a properly functioning education system, that’s giving them really robust messaging about what it means to be a man, they would have antibodies to fight off the sick messaging that Tate is giving. All they see is the guy who’s got a Bugatti and joking about telling women to make him a sandwich.

“When teachers try to explain why Tate isn’t someone to look up to, the teenage boys ask them, ‘Well, what colour is your Bugatti?’

“The premise needs to be attacked directly, which is that ‘no, money isn’t the main index of masculinity’. Otherwise, we would all just be looking up to gangsters and criminals.”

Knowland, who teaches English and has forged a career as an online tutor, was sacked in 2020 after refusing to take down a video he made for his students called The Patriarchy Paradox, which repeated claims that women would revert to a primitive life without men.

Knowland believes the issues he was seeking to address in the lecture, which is still on his YouTube channel and has had 255,000 views, have only increased since his sacking.

The Teaching Regulation Agency (TRA) decided to take no action against Knowland after an inquiry. Eton College has previously said that the ruling did not undermine its decision to dismiss him.

The school reported the lecture to the TRA, which considered charges of undermining tolerance and failing to safeguard students but closed the case with no further action. In a statement, the school said: “This does not mean that Mr Knowland did nothing wrong or that Eton was not entitled to dismiss him.”

He added: “I think the most interesting part about the lecture and what resonated with my supporters was my stress on chivalry and the idea that a man’s strength should be put to the service of the weak and his family.

“Chivalry is the thing that we’re missing today and it’s become deformed and turned into machismo, which is masculinity without any sense of humility or meekness. I think this is what we need to return to. Some of the problems that Tate is addressing, things like men should be assertive, men should be competitive, men should be strong, etcetera, chivalry agrees with.

“But chivalry says, ‘Why do they need to be those things? Because it’s to serve the weak, not themselves.”

Knowland, 37, believes that Tate — who rose to infamy last year after videos of his diatribes led to him becoming the world’s most googled person — has tapped into a “malaise” among young men caused by the teaching of boys in schools.

As an example, last month Scotland had to pause movement of transgender prisoners after a row over whether a transgender female rapist should be imprisoned with biological women.

“For some, even saying that there are biological differences between men and women is offensive. That’s what my lecture said, that men are stronger,” Knowland added. “I don’t think that [women] should [compete in sport against transgender women]. I don’t think it’s safe.

The example I gave in the lecture [was] of the transgender fighter who fractured the woman’s skull, and could easily have killed her. I think there are good reasons why sporting bodies are moving towards and in some cases have already decided that there’s not going to be next events like that.”

During the Eton furore Simon Henderson, the head master of Eton, was criticised in some quarters for pursuing a “woke” culture at the school and his critics referred to him as “Trendy Hendy”. They pointed to pupils being asked to wear Black Lives Matter waistcoats and decolonising its curriculum as examples of the institution being captured by ideologues.

The content Knowland produces on his YouTube channel continues to be controversial. A recent video by the devout Catholic is entitled “Eight facts that killed evolution for me”.

“The lecture was addressing some very live issues at the time and it’s only got worse since then,” he said. “Women now feel that they haven’t got safe spaces to get undressed to go to a swimming pool. So those concepts in the lecture were hard hitting and provocative, because these are topics that are big ones that people have strong feelings about.”

While Knowland does not agree with the term transgender — “there are only two categories of sex, using the term transgender concedes too much ground” — he is alive to the issue of transphobic bullying. The issue has been in the spotlight this month after Brianna Ghey, a 16-year-old transgender girl, was stabbed to death in a park.

“People being subjected to transphobia is terrible,” he said. “People shouldn’t mistreat anybody just because they’ve got a mistaken idea that they are a woman. They need to be treated with compassion, not attacked or bullied.”

Knowland’s newfound career as an online tutor, as well as hosting a podcast, has eased some of the pressure he felt after his sacking. He said: “At Eton our family home was a benefit, so that was on my mind when I was leaving. I had to wait a couple of years after leaving to get a home because being self-employed, you have to get all the paperwork to get a mortgage.

“I’ve actually had parents get in touch because they supported me over what happened at Eton and wanted me to tutor their children.

“Losing my job was concerning but it gave me an insight into what it feels for someone to be cancelled. Fear is such a powerful weapon to stop people believing what they’re passionate about.

“People feel they can’t say anything, because consequences are going to be too severe, but now I’ve been through it I’ve actually found it freeing.”