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. Roughly 60% of new pathogens come from animals — including those pressured by diversity loss — and roughly one-third of those can be directly attributed to changes in human land use, meaning deforestation, the introduction of farming, development or resource extraction in otherwise natural settings

Today, climate warming is demolishing those defense systems, driving a catastrophic loss in biodiversity that, when coupled with reckless deforestation and aggressive conversion of wildland for economic development, pushes farms and people closer to the wild and opens the gates for the spread of disease.

ignoring how climate and rapid land development were putting disease-carrying animals in a squeeze was akin to playing Russian roulette.

the virus is believed to have originated with the horseshoe bat, part of a genus that’s been roaming the forests of the planet for 40 million years and thrives in the remote jungles of south China, even that remains uncertain.

China for years and warning that swift climate and environmental change there — in both loss of biodiversity and encroachment by civilization — was going to help new viruses jump to people.

until now, the planet’s natural defense systems were better at fighting them off.

Vector-borne diseases — those carried by insects like mosquitoes and ticks and transferred in the blood of infected people — are also on the rise as warming weather and erratic precipitation vastly expand the geographic regions vulnerable to contagion.

Climate is even bringing old viruses back from the dead, thawing zombie contagions like the anthrax released from a frozen reindeer in 2016, which can come down from the arctic and haunt us from the past.

It is demonstrating in real time the enormous and undeniable power that nature has over civilization and even over its politics.

it also makes clear that climate policy today is indivisible from efforts to prevent new infectious outbreaks, or, as Bernstein put it, the notion that climate and health and environmental policy might not be related is “a ​dangerous delusion.”

The warming of the climate is one of the principal drivers of the greatest — and fastest — loss of species diversity in the history of the planet, as shifting climate patterns force species to change habitats, push them into new regions or threaten their food and water supplies

What’s known as biodiversity is critical because the natural variety of plants and animals lends each species greater resiliency against threat and together offers a delicately balanced safety net for natural systems

As diversity wanes, the balance is upset, and remaining species are both more vulnerable to human influences and, according to a landmark 2010 study in the journal Nature, more likely to pass along powerful pathogens.

even incremental and seemingly manageable injuries to local environments — say, the construction of a livestock farm adjacent to stressed natural forest — can add up to outsized consequences.

Coronaviruses like COVID-19 aren’t likely to be carried by insects — they don’t leave enough infected virus cells in the blood. But one in five other viruses transmitted from animals to people are vector-borne

the number of species on the planet has already dropped by 20% and that more than a million animal and plant species now face extinction.

Americans have been experiencing this phenomenon directly in recent years as migratory birds have become less diverse and the threat posed by West Nile encephalitis has spread. It turns out that the birds that host the disease happen to also be the tough ones that prevail amid a thinned population

as larger mammals suffer declines at the hands of hunters or loggers or shifting climate patterns, smaller species, including bats, rats and other rodents, are thriving, either because they are more resilient to the degraded environment or they are able to live better among people.

It is these small animals, the ones that manage to find food in garbage cans or build nests in the eaves of buildings, that are proving most adaptable to human interference and also happen to spread disease.

Warmer temperatures and higher rainfall associated with climate change — coupled with the loss of predators — are bound to make the rodent problem worse, with calamitous implications.

As much as weather changes can drive changes in species, so does altering the landscape for new farms and new cities. In fact, researchers attribute a full 30% of emerging contagion to what they call “land use change.”

only 15% of the planet’s forests remain intact. The rest have been cut down, degraded or fragmented to the point that they disrupt the natural ecosystems that depend on them.

Already, more than one-third of the planet’s land surface, and three-quarters of all of its fresh water, go toward the cultivation of crops and raising of livestock. These are the places where infectious diseases spread most often.

The U.S. Centers for Disease Control and Prevention says that fully three-quarters of all new viruses have emerged from animals

Almost every major epidemic we know of over the past couple of decades — SARS, COVID-19, Ebola and Nipah virus — jumped to people from wildlife enduring extreme climate and habitat strain, and still, “we’re naive to them,” she said. “That puts us in a dangerous place.”

A 2008 study in the journal Nature found nearly one-third of emerging infectious diseases over the past 10 years were vector-borne, and that the jumps matched unusual changes in the climate

Ticks and mosquitoes now thrive in places they’d never ventured before. As tropical species move northward, they are bringing dangerous pathogens with them.

by 2050, disease-carrying mosquitoes will ultimately reach 500 million more people than they do today, including some 55 million more Americans.

In 2013, dengue fever — an affliction affecting nearly 400 million people a year, but normally associated with the poorest regions of Africa — was transmitted locally in New York for the first time.

“The long-term risk from dengue may be much higher than COVID,

As the global population surges to 10 billion over the next 35 years, and the capacity to farm food is stressed further again by the warming climate, the demand for land will only get more intense.

it’s only a matter of time before other exotic animal-driven pathogens are driven from the forests of the global tropics to the United States or Canada or Europe because of the warming climate.

it will also shape how easily we get sick. According to a 2013 study in the journal PLOS Currents Influenza, warm winters were predictors of the most severe flu seasons in the following year

Even harsh swings from hot to cold, or sudden storms — exactly the kinds of climate-induced patterns we’re already seeing — make people more likely to get sick.

The chance of a flu epidemic in America’s most populated cities will increase by as much as 50% this century, and flu-related deaths in Europe could also jump by 50%.

Slow action on climate has made dramatic warming and large-scale environmental changes inevitable, he said, “and I think that increases in disease are going to come along with it.”

By late 2018, epidemiologists there were bracing for what they call “spillover,” or the failure to keep a virus locally contained as it jumped from the bats and villages of Yunnan into the wider world.

In late 2018, the Trump administration, as part of a sweeping effort to bring U.S. programs in China to a halt, abruptly shut down the research — and its efforts to intercept the spread of a new novel coronavirus along with it. “We got a cease and desist,” said Dennis Carroll, who founded the PREDICT program and has been instrumental in global work to address the risks from emerging viruses. By late 2019, USAID had cut the program’s global funding.

The loss is immense. The researchers believed they were on the cusp of a breakthrough, racing to sequence the genes of the coronaviruses they’d extracted from the horseshoe bat and to begin work on vaccines.

They’d campaigned for years for policymakers to fully consider what they’d learned about how land development and climate changes were driving the spread of disease, and they thought their research could literally provide governments a map to the hot spots most likely to spawn the next pandemic.

They also hoped the genetic material they’d collected could lead to a vaccine not just for one lethal variation of COVID, but perhaps — like a missile defense shield for the biosphere — to address a whole family of viruses at once

Carroll said knowledge of the virus genomes had the potential “to totally transform how we think about future biomedical interventions before there’s an emergence.

PREDICT’s staff and advisers have pushed the U.S. government to consider how welding public health policy with environmental and climate science could help stem the spread of contagions.

Since Donald Trump was elected, the group hasn’t been invited back.

What Daszak really wants — in addition to restored funding to continue his work — is the public and leaders to understand that it’s human behavior driving the rise in disease, just as it drives the climate crisis

“We turn a blind eye to the fact that our behavior is driving this,” he said. “We get cheap goods through Walmart, and then we pay for it forever through the rise in pandemics. It’s upside down.”

In 1982, when some pundits were bemoaning the supposed end of the American Dream, a reporter asked Bailyn about the cultural changes the country was witnessing. No doubt drawing on his experience studying the paranoia of the American revolutionaries, Bailyn responded: “That’s ridiculous. . . . There’s never been a time when people didn’t think the country was falling apart.”

In its spiritual prequel, The Barbarous Years (2012), Bailyn would focus on “the peopling of British North America” in the 17th century, highlighting the internal and external conflict among the British, Dutch, Swedish, Africans, and Native Americans.

The debate continues. Rather “than generate clear resolutions,” Alan Taylor writes in American Revolutions (2016), the American Revolution “created powerful new contradictions.” Echoing Bailyn’s discussion of the “contagion of liberty,” Taylor argues that “the revolution generated clashing contagions, of slavery and liberty, and pitted them against one another” and which one would win out was far from obvious

Similarly, the New York Times’s “1619 Project” centered slavery in the minds and hearts of the patriots, claiming the Revolution was fought in defense of slavery (although the Times eventually published a “clarification” walking back that assertion).

Sean Wilentz, in his latest work, No Property in Man (2018), defends the Founding and examines the anti-slavery attitudes that went into the framing of the Constitution—for which he attracted fierce criticism.

Gordon Wood—critical both of Taylor’s book and the 1619 Project—has zeroed in on a key question: “Can a revolution conceived mainly as sordid, racist and divisive be the inspiration for a nation?”

Besides teenage girls, another new group was referred to us: young people from the inpatient psychiatric unit, or the emergency department, of St. Louis Children’s Hospital. The mental health of these kids was deeply concerning—there were diagnoses like schizophrenia, PTSD, bipolar disorder, and more. Often they were already on a fistful of pharmaceuticals.

Being put on powerful doses of testosterone or estrogen—enough to try to trick your body into mimicking the opposite sex—-affects the rest of the body. I doubt that any parent who's ever consented to give their kid testosterone (a lifelong treatment) knows that they’re also possibly signing their kid up for blood pressure medication, cholesterol medication, and perhaps sleep apnea and diabetes. 

There are rare conditions in which babies are born with atypical genitalia—cases that call for sophisticated care and compassion. But clinics like the one where I worked are creating a whole cohort of kids with atypical genitals—and most of these teens haven’t even had sex yet. They had no idea who they were going to be as adults. Yet all it took for them to permanently transform themselves was one or two short conversations with a therapist.

Other girls were disturbed by the effects of testosterone on their clitoris, which enlarges and grows into what looks like a microphallus, or a tiny penis. I counseled one patient whose enlarged clitoris now extended below her vulva, and it chafed and rubbed painfully in her jeans. I advised her to get the kind of compression undergarments worn by biological men who dress to pass as female. At the end of the call I thought to myself, “Wow, we hurt this kid.”

How little patients understood what they were getting into was illustrated by a call we received at the center in 2020 from a 17-year-old biological female patient who was on testosterone. She said she was bleeding from the vagina. In less than an hour she had soaked through an extra heavy pad, her jeans, and a towel she had wrapped around her waist. The nurse at the center told her to go to the emergency room right away.

We found out later this girl had had intercourse, and because testosterone thins the vaginal tissues, her vaginal canal had ripped open. She had to be sedated and given surgery to repair the damage. She wasn’t the only vaginal laceration case we heard about.

Bicalutamide is a medication used to treat metastatic prostate cancer, and one of its side effects is that it feminizes the bodies of men who take it, including the appearance of breasts. The center prescribed this cancer drug as a puberty blocker and feminizing agent for boys. As with most cancer drugs, bicalutamide has a long list of side effects, and this patient experienced one of them: liver toxicity. He was sent to another unit of the hospital for evaluation and immediately taken off the drug. Afterward, his mother sent an electronic message to the Transgender Center saying that we were lucky her family was not the type to sue.

Here’s an example. On Friday, May 1, 2020, a colleague emailed me about a 15-year-old male patient: “Oh dear. I am concerned that [the patient] does not understand what Bicalutamide does.” I responded: “I don’t think that we start anything honestly right now.”

There are no reliable studies showing this. Indeed, the experiences of many of the center’s patients prove how false these assertions are. 

Many encounters with patients emphasized to me how little these young people understood the profound impacts changing gender would have on their bodies and minds. But the center downplayed the negative consequences, and emphasized the need for transition. As the center’s website said, “Left untreated, gender dysphoria has any number of consequences, from self-harm to suicide. But when you take away the gender dysphoria by allowing a child to be who he or she is, we’re noticing that goes away. The studies we have show these kids often wind up functioning psychosocially as well as or better than their peers.” 

When a female takes testosterone, the profound and permanent effects of the hormone can be seen in a matter of months. Voices drop, beards sprout, body fat is redistributed. Sexual interest explodes, aggression increases, and mood can be unpredictable. Our patients were told about some side effects, including sterility. But after working at the center, I came to believe that teenagers are simply not capable of fully grasping what it means to make the decision to become infertile while still a minor.

To begin transitioning, the girls needed a letter of support from a therapist—usually one we recommended—who they had to see only once or twice for the green light. To make it more efficient for the therapists, we offered them a template for how to write a letter in support of transition. The next stop was a single visit to the endocrinologist for a testosterone prescription. 

The doctors privately recognized these false self-diagnoses as a manifestation of social contagion. They even acknowledged that suicide has an element of social contagion. But when I said the clusters of girls streaming into our service looked as if their gender issues might be a manifestation of social contagion, the doctors said gender identity reflected something innate.

Frequently, our patients declared they had disorders that no one believed they had. We had patients who said they had Tourette syndrome (but they didn’t); that they had tic disorders (but they didn’t); that they had multiple personalities (but they didn’t).

The girls who came to us had many comorbidities: depression, anxiety, ADHD, eating disorders, obesity. Many were diagnosed with autism, or had autism-like symptoms. A report last year on a British pediatric transgender center found that about one-third of the patients referred there were on the autism spectrum.

This concerned me, but didn’t feel I was in the position to sound some kind of alarm back then. There was a team of about eight of us, and only one other person brought up the kinds of questions I had. Anyone who raised doubts ran the risk of being called a transphobe. 

I certainly saw this at the center. One of my jobs was to do intake for new patients and their families. When I started there were probably 10 such calls a month. When I left there were 50, and about 70 percent of the new patients were girls. Sometimes clusters of girls arrived from the same high school. 

Until 2015 or so, a very small number of these boys comprised the population of pediatric gender dysphoria cases. Then, across the Western world, there began to be a dramatic increase in a new population: Teenage girls, many with no previous history of gender distress, suddenly declared they were transgender and demanded immediate treatment with testosterone. 

Soon after my arrival at the Transgender Center, I was struck by the lack of formal protocols for treatment. The center’s physician co-directors were essentially the sole authority.

At first, the patient population was tipped toward what used to be the “traditional” instance of a child with gender dysphoria: a boy, often quite young, who wanted to present as—who wanted to be—a girl. 

During the four years I worked at the clinic as a case manager—I was responsible for patient intake and oversight—around a thousand distressed young people came through our doors. The majority of them received hormone prescriptions that can have life-altering consequences—including sterility. 

I left the clinic in November of last year because I could no longer participate in what was happening there. By the time I departed, I was certain that the way the American medical system is treating these patients is the opposite of the promise we make to “do no harm.” Instead, we are permanently harming the vulnerable patients in our care.

Today I am speaking out. I am doing so knowing how toxic the public conversation is around this highly contentious issue—and the ways that my testimony might be misused. I am doing so knowing that I am putting myself at serious personal and professional risk.

Almost everyone in my life advised me to keep my head down. But I cannot in good conscience do so. Because what is happening to scores of children is far more important than my comfort. And what is happening to them is morally and medically appalling.

For almost four years, I worked at The Washington University School of Medicine Division of Infectious Diseases with teens and young adults who were HIV positive. Many of them were trans or otherwise gender nonconforming, and I could relate: Through childhood and adolescence, I did a lot of gender questioning myself. I’m now married to a transman, and together we are raising my two biological children from a previous marriage and three foster children we hope to adopt. 

The center’s working assumption was that the earlier you treat kids with gender dysphoria, the more anguish you can prevent later on. This premise was shared by the center’s doctors and therapists. Given their expertise, I assumed that abundant evidence backed this consensus. 

All that led me to a job in 2018 as a case manager at The Washington University Transgender Center at St. Louis Children's Hospital, which had been established a year earlier. 

Polarization put cracks in that confidence. And once people no longer believed the other side would observe the norm, the norm collapsed remarkably quickly.

here’s the problem: The breakdown of the norms that have traditionally induced restraint in the judicial-confirmation process will not end with the creation of polarized judicial nominations and confirmations. It will run deeper. A highly polarized Senate in interaction with a winner-take-all presidency picking judges on the basis of raw power alone and creating party factions on every court in the country is a contagion that will spread.

In the world that I argued for, liberal senators would support Kavanaugh. They would do so because he is qualified, because the decision to give President Trump the authority to select judges was made when the electorate chose Trump over Hillary Clinton, and because the cost of opposing Kavanaugh—that Republican senators would oppose similarly qualified judges when the presidency is in Democratic hands—exceeds the possible benefits of opposition. This set of assumptions was driven by norms: not by law, not by the Constitution, not even by Senate rules. It was just the way things worked, because everything worked better if everyone behaved that way. And everyone behaved that way because everyone had confidence that those on the other side would behave that way as well.

Why not break up courts that routinely do things that political majorities don’t like?

Even the Supreme Court is not immune from a much more activist Congress. We tend to think of the Supreme Court’s jurisdiction as vast, but it’s only vast because Congress makes it so.

If Congress doesn’t want the Supreme Court to hear abortion cases, it could strip it of appellate jurisdiction over them—or at least, it could try.

In a world of polarized partisan control over the gateways to courts and thus partisan factions on the courts themselves, I can see no reason why these things won’t eventually happen. And I won’t even be able to make a principled argument that they shouldn’t happen.

the mortality rate here is (at time of writing) 7.17% compared with 0.05% in Sweden and 0.2% in Germany

Nor do we understand why the contagion has spread so fast in Italy: the cases per million of the population is, at 250, far higher than anywhere else in the world: Iran stands at 120, China at 56.

Even as this slow-motion, medical tsunami was moving towards the UK, the prime minister, Boris Johnson, was sneering at the need for “draconian” measures. We watched in disbelief as thousands of people travelled to watch horse racing in Cheltenham and 3,500 gathered in Paris dressed as smurfs just to break a world record.

From our lockdown in Italy, it seemed at that time as if the world’s addiction to sport, partying and frivolity was blinding it to the most serious pandemic in our lifetimes.

Because actually Italians are very well-informed (some might even say obsessive) about personal health. They learn about plague and contagion at school because two of the classics of Italy’s literary canon – Alessandro Manzoni’s The Betrothed and Giovanni Boccaccio’s The Decameron, deal with precisely those themes. Italians, on the whole, know far more about hygiene and medicine than their European counterparts

the coronavirus more often infects clusters of family members, friends and work colleagues,

“You can contain clusters,” Dr. Heymann said. “You need to identify and stop discrete outbreaks, and then do rigorous contact tracing.”

The microphone should not even be at the White House, scientists said, so that briefings of historic importance do not dissolve into angry, politically charged exchanges with the press corps, as happened again on Friday.

Americans must be persuaded to stay home, they said, and a system put in place to isolate the infected and care for them outside the home

Travel restrictions should be extended, they said; productions of masks and ventilators must be accelerated, and testing problems must be resolved.

It was not at all clear that a nation so fundamentally committed to individual liberty and distrustful of government could learn to adapt to many of these measures, especially those that smack of state compulsion.

What follows are the recommendations offered by the experts interviewed by The Times.

they were united in the opinion that politicians must step aside and let scientists both lead the effort to contain the virus and explain to Americans what must be done.

medical experts should be at the microphone now to explain complex ideas like epidemic curves, social distancing and off-label use of drugs.

doing so takes intelligent, rapidly adaptive work by health officials, and near-total cooperation from the populace. Containment becomes realistic only when Americans realize that working together is the only way to protect themselves and their loved ones.

Above all, the experts said, briefings should focus on saving lives and making sure that average wage earners survive the coming hard times — not on the stock market, the tourism industry or the president’s health.

“At this point in the emergency, there’s little merit in spending time on what we should have done or who’s at fault,”

The next priority, experts said, is extreme social distancing.If it were possible to wave a magic wand and make all Americans freeze in place for 14 days while sitting six feet apart, epidemiologists say, the whole epidemic would sputter to a halt.

The virus would die out on every contaminated surface and, because almost everyone shows symptoms within two weeks, it would be evident who was infected. If we had enough tests for every American, even the completely asymptomatic cases could be found and isolated.

The crisis would be over.

Obviously, there is no magic wand, and no 300 million tests. But the goal of lockdowns and social distancing is to approximate such a total freeze.

In contrast to the halting steps taken here, China shut down Wuhan — the epicenter of the nation’s outbreak — and restricted movement in much of the country on Jan. 23, when the country had a mere 500 cases and 17 deaths.Its rapid action had an important effect: With the virus mostly isolated in one province, the rest of China was able to save Wuhan.

Even as many cities fought their own smaller outbreaks, they sent 40,000 medical workers into Wuhan, roughly doubling its medical force.

Stop transmission within cities

the weaker the freeze, the more people die in overburdened hospitals — and the longer it ultimately takes for the economy to restart.

People in lockdown adapt. In Wuhan, apartment complexes submit group orders for food, medicine, diapers and other essentials. Shipments are assembled at grocery warehouses or government pantries and dropped off. In Italy, trapped neighbors serenade one another.

Each day’s delay in stopping human contact, experts said, creates more hot spots, none of which can be identified until about a week later, when the people infected there start falling ill.

South Korea avoided locking down any city, but only by moving early and with extraordinary speed. In January, the country had four companies making tests, and as of March 9 had tested 210,000 citizens — the equivalent of testing 2.3 million Americans.

As of the same date, fewer than 9,000 Americans had been tested.

Fix the testing mess

Testing must be done in a coordinated and safe way, experts said. The seriously ill must go first, and the testers must be protected.In China, those seeking a test must describe their symptoms on a telemedicine website. If a nurse decides a test is warranted, they are directed to one of dozens of “fever clinics” set up far from all other patients.

Isolate the infected

As soon as possible, experts said, the United States must develop an alternative to the practice of isolating infected people at home, as it endangers families. In China, 75 to 80 percent of all transmission occurred in family clusters.

Cellphone videos from China show police officers knocking on doors and taking temperatures. In some, people who resist are dragged away by force. The city of Ningbo offered bounties of $1,400 to anyone who turned in a coronavirus sufferer.

In China, said Dr. Bruce Aylward, leader of the World Health Organization’s observer team there, people originally resisted leaving home or seeing their children go into isolation centers with no visiting rights — just as Americans no doubt would.

In China, they came to accept it.“They realized they were keeping their families safe,” he said. “Also, isolation is really lonely. It’s psychologically difficult. Here, they were all together with other people in the same boat. They supported each other.”

Find the fevers

Make masks ubiquitous

In China, having a fever means a mandatory trip to a fever clinic to check for coronavirus. In the Wuhan area, different cities took different approaches.

In most cities in affected Asian countries, it is commonplace before entering any bus, train or subway station, office building, theater or even a restaurant to get a temperature check. Washing your hands in chlorinated water is often also required.

The city of Qianjiang, by contrast, offered the same amount of money to any resident who came in voluntarily and tested positive

Voluntary approaches, like explaining to patients that they will be keeping family and friends safe, are more likely to work in the West, she added.

Trace the contacts

Finding and testing all the contacts of every positive case is essential, experts said. At the peak of its epidemic, Wuhan had 18,000 people tracking down individuals who had come in contact with the infected.

Dr. Borio suggested that young Americans could use their social networks to “do their own contact tracing.” Social media also is used in Asia, but in different ways

When he lectured at a Singapore university, Dr. Heymann said, dozens of students were in the room. But just before he began class, they were photographed to record where everyone sat.

Instead of a policy that advises the infected to remain at home, as the Centers for Disease and Prevention now does, experts said cities should establish facilities where the mildly and moderately ill can recuperate under the care and observation of nurses.

There is very little data showing that flat surgical masks protect healthy individuals from disease. Nonetheless, Asian countries generally make it mandatory that people wear them.

The Asian approach is less about data than it is about crowd psychology, experts explained.All experts agree that the sick must wear masks to keep in their coughs. But if a mask indicates that the wearer is sick, many people will be reluctant to wear one. If everyone is required to wear masks, the sick automatically have one on and there is no stigma attached.

Also, experts emphasized, Americans should be taught to take seriously admonitions to stop shaking hands and hugging

Preserve vital services

Only the federal government can enforce interstate commerce laws to ensure that food, water, electricity, gas, phone lines and other basic needs keep flowing across state lines to cities and suburbs

“I sense that most people — and certainly those in business — get it. They would prefer to take the bitter medicine at once and contain outbreaks as they start rather than gamble with uncertainty.”

Produce ventilators and oxygen

The manufacturers, including a dozen in the United States, say there is no easy way to ramp up production quickly. But it is possible other manufacturers, including aerospace and automobile companies, could be enlisted to do so.

Canadian nurses are disseminating a 2006 paper describing how one ventilator can be modified to treat four patients simultaneously. Inventors have proposed combining C-PAP machines, which many apnea sufferers own, and oxygen tanks to improvise a ventilator.

One of the lessons of China, he noted, was that many Covid-19 patients who would normally have been intubated and on ventilators managed to survive with oxygen alone.

Retrofit hospitals

In Wuhan, the Chinese government famously built two new hospitals in two weeks. All other hospitals were divided: 48 were designated to handle 10,000 serious or critical coronavirus patients, while others were restricted to handling emergencies like heart attacks and births.

Wherever that was impractical, hospitals were divided into “clean” and “dirty” zones, and the medical teams did not cross over. Walls to isolate whole wards were built

Decide when to close schools

Recruit volunteers

China’s effort succeeded, experts said, in part because of hundreds of thousands of volunteers. The government declared a “people’s war” and rolled out a “Fight On, Wuhan! Fight On, China!” campaign.

Many people idled by the lockdowns stepped up to act as fever checkers, contact tracers, hospital construction workers, food deliverers, even babysitters for the children of first responders, or as crematory workers.

“In my experience, success is dependent on how much the public is informed and participates,” Admiral Ziemer said. “This truly is an ‘all hands on deck’ situation.”

Prioritize the treatments

Clinicians in China, Italy and France have thrown virtually everything they had in hospital pharmacies into the fight, and at least two possibilities have emerged that might save patients: the anti-malaria drugs chloroquine and hydroxychloroquine, and the antiviral remdesivir, which has no licensed use.

An alternative is to harvest protective antibodies from the blood of people who have survived the illness,

The purified blood serum — called immunoglobulin — could possibly be used in small amounts to protect emergency medical workers, too.

“Unfortunately, the first wave won’t benefit from this,” Dr. Hotez said. “We need to wait until we have enough survivors.”Find a vaccine

testing those candidate vaccines for safety and effectiveness takes time.

The roadblock, vaccine experts explained, is not bureaucratic. It is that the human immune system takes weeks to produce antibodies, and some dangerous side effects can take weeks to appear.

After extensive animal testing, vaccines are normally given to about 50 healthy human volunteers to see if they cause any unexpected side effects and to measure what dose produces enough antibodies to be considered protective.

If that goes well, the trial enrolls hundreds or thousands of volunteers in an area where the virus is circulating. Half get the vaccine, the rest do not — and the investigators wait. If the vaccinated half do not get the disease, the green light for production is finally given.

In the past, some experimental vaccines have produced serious side effects, like Guillain-Barre syndrome, which can paralyze and kill. A greater danger, experts said, is that some experimental vaccines, paradoxically, cause “immune enhancement,” meaning they make it more likely, not less, that recipients will get a disease. That would be a disaster.

One candidate coronavirus vaccine Dr. Hotez invented 10 years ago in the wake of SARS, he said, had to be abandoned when it appeared to make mice more likely to die from pneumonia when they were experimentally infected with the virus.

Reach out to other nations

Some people clucked over his decision to keep his annual St. Patrick’s Day date with President Trump in Washington during the early days of the outbreak. While there, he called a dramatic news conference at Blair House, opposite the White House, to announce he was closing Irish schools and banning large gatherings.

he compensated for those stumbles with an address on St. Patrick’s Day that was viewed by commentators as one of the most memorable ever delivered by an Irish leader.

while Ireland lags top performers like Iceland and Norway, it has tested at more than double the rate of Britain.

Last month, Ireland got in early in negotiating a €208 million ($226 million) deal with China for this protective gear and scheduled Aer Lingus flights to bring it back. Some of the gowns had been cut for Chinese medics and were too short for Irish doctors. But today Ireland is not suffering from the shortages that afflict other countries

Nor does it have a shortage of ventilators, thanks to a chain of manufacturers.

At the outset of the contagion, Dr. Kearney said, Ireland aggressively tested and traced the contacts of people with symptoms. That quickly stretched its testing capacity, and it was forced to pull back.

Dr. Varadkar’s decision to go back to work as a physician was motivated by a desire to help ease the burden on health care workers, his spokesman said. He also issued a plea for emigrant Irish doctors and nurses, and others who had left the field, to return to help with the surge of patients. So far, 60,000 have responded.

Ireland also moved swiftly to impose social distancing, working off an influenza pandemic plan developed 13 years ago

It called off a major rugby match between Ireland and Italy in late February, an unpopular decision at the time. But now, experts said, people are adhering to Ireland’s lockdown better than those in Britain.

“We’ve all rolled in behind these measures,” Dr. McConkey said. “Even though we’ve had a legacy of shooting at each other over decades, we’re actually quite a socially cohesive society.”

In the months since inoculations started in December, the alliance grouping extremist organizations with the anti-vaccination movement has grown larger and more vocal, as conspiracy theories about vaccines proliferated while those about the presidential vote count receded

A new report by the Network Contagion Research Institute at Rutgers University noted, however, that although the deplatforming of extremist groups made their campaigns harder to follow, the alliance has the potential to meld disparate factions into a large anti-government movement united around public health issues.“It increases the opportunity for a big tent enemy,” said Joel Finkelstein, a fellow at Rutgers who runs the institute. “If you are feeling dispossessed, like all these right-wing groups are, boy do I have a tent for you.”Ben Decker contributed research.

She emerged from that time as an internist looking for something new.As she finished her residency, she remembered hearing about the Epidemic Intelligence Service, the CDC's disease detective program.

She thought: "Maybe that would be a fun thing to do. Maybe just spending two years learning how to investigate outbreaks would be interesting and a little less intense than what I had just been through before I spend my life in practice."

But instead of returning to a medical practice, she stayed with the CDC. "I just fell in love with what we do, how we do it, the people that we work with and the impact that we can have," Schuchat says.

This virus is really difficult. I think that a severe toll was going to happen, but we have seen such variation in countries and in communities' ability to counter it. And so I wish that we had not had as much loss of life and ongoing loss of life as we've had around the world. But this virus was going to be difficult under the best circumstances of response. And of course, we've had very variable response to this.

We were not ready for that, OK. There are many things that our colleagues in Korea did that allowed them to have a very effective initial response.

If it were to happen again next year, five years from now, which is plausible, would we be ready then?We have a lot of work to do. So I think I am really encouraged by the investments and the seriousness that we're seeing in the administration, in the agencies, in the communities. You know, this has been really bad and I just hope people continue to feel that commitment to do better.

As a disease detective, with the experience that you have, what have you thought about as people have raised more questions about the origins of the virus?I want all the questions to be answered. There's so much we need to learn about this virus and this pandemic so that we do better next time and prevent where we can. ... Sometimes scientists have questions because they're kind of curious, and more is better. But I think there's a lot we really do need to know here. So understanding where this came from and how it spread so easily I think is important.

Physical shocks, however, can only be remedied by understanding and addressing the underlying physical causes. Our recent collective experience, whether in the public or the private sector, has been more often shaped by financial shocks, not physical ones. The current pandemic provides us perhaps with a foretaste of what a full-fledged climate crisis could entail

Pandemics and climate risk also share many of the same attributes. Both are systemic, in that their direct manifestations and their knock-on effects propagate fast across an interconnected world.

They are both nonstationary, in that past probabilities and distributions of occurrences are rapidly shifting and proving to be inadequate or insufficient for future projections.

Both are nonlinear, in that their socioeconomic impact grows disproportionally and even catastrophically once certain thresholds are breached

They are both risk multipliers, in that they highlight and exacerbate hitherto untested vulnerabilities inherent in the financial and healthcare systems and the real economy

Both are regressive, in that they affect disproportionally the most vulnerable populations and subpopulations of the world.

Finally, neither can be considered as a “black swan,” insofar as experts have consistently warned against both over the years

They also require a present action for a future reward that has in the past appeared too uncertain and too small given the implicit “discount rate.” This is what former Bank of England Governor Mark Carney has called the “tragedy of the horizon.”

addressing pandemics and climate risk requires the same fundamental shift, from optimizing largely for the shorter-term performance of systems to ensuring equally their longer-term resiliency

The coronavirus pandemic and the responses that are being implemented (to the tune of several trillion dollars of government stimulus as of this writing) illustrate how expensive the failure to build resiliency can ultimately prove

In climate change as in pandemics, the costs of a global crisis are bound to vastly exceed those of its prevention.

both reflect “tragedy of the commons” problems, in that individual actions can run counter to the collective good and deplete a precious, common resource.

Neither pandemics nor climate hazards can be confronted without true global coordination and cooperation

there are also some notable differences between pandemics and climate hazards.

A global public-health crisis presents imminent, discrete, and directly discernable dangers, which we have been conditioned to respond to for our survival.

The risks from climate change, by contrast, are gradual, cumulative, and often distributed dangers that manifest themselves in degrees and over time.

What lessons can be learned from the current pandemic for climate change? What implications—positive or negative—could our pandemic responses hold for climate action?

the timescales of both the occurrence and the resolution of pandemics and climate hazards are different.

What this means is that a global climate crisis, if and when ushered in, could prove far lengthier and far more disruptive than what we currently see with the coronavirus (if that can be imagined).

Finally, pandemics are a case of contagion risk, while climate hazards present a case of accumulation risk.

Contagion can produce perfectly correlated events on a global scale (even as we now witness), which can tax the entire system at once; accumulation gives rise to an increased likelihood of severe, contemporaneous but not directly correlated events that can reinforce one another.

Climate change—a potent risk multiplier—can actually contribute to pandemics

For example, rising temperatures can create favorable conditions for the spread of certain infectious, mosquito-borne diseases, such as malaria and dengue fever, while disappearing habitats may force various animal species to migrate, increasing the chances of spillover pathogens between them.

Third, investors may delay their capital allocation to new lower-carbon solutions due to decreased wealth.

Factors that could support and accelerate climate action

For starters, certain temporary adjustments, such as teleworking and greater reliance on digital channels, may endure long after the lockdowns have ended, reducing transportation demand and emissions

Second, supply chains may be repatriated, reducing some Scope 3 emissions (those in a company’s value chain but not associated with its direct emissions or the generation of energy it purchases)

Third, markets may better price in risks (and, in particular, climate risk) as the result of a greater appreciation for physical and systemic dislocations.

There may, additionally, be an increased public appreciation for scientific expertise in addressing systemic issues.

there may also be a greater appetite for the preventive and coordinating role of governments in tackling such risks

Moreover, lower interest rates may accelerate the deployment of new sustainable infrastructure

lastly, the need for global cooperation may become more visible and be embraced more universally.

Factors that may hamper and delay climate action

Simultaneously, though, very low prices for high-carbon emitters could increase their use and further delay energy transition

A second crosscurrent is that governments and citizens may struggle to integrate climate priorities with pressing economic needs in a recovery

he environmental impact of some of the measures taken to counter the coronavirus pandemic have been seen by some as a full-scale illustration of what drastic action can produce in a short amount of time.

Finally, national rivalries may be exacerbated if a zero-sum-game mentality prevails in the wake of the crisis.

For governments, we believe four sets of actions will be important

First, build the capability to model climate risk and to assess the economics of climate change.

Second, devote a portion of the vast resources deployed for economic recovery to climate-change resiliency and mitigation

Third, seize the opportunity to reconsider existing subsidy regimes that accelerate climate change

Fourth, reinforce national and international alignment and collaboration on sustainability, for inward-looking, piecemeal responses are by nature incapable of solving systemic and global problems.

For companies, we see two priorities. First, seize the moment to decarbonize, in particular by prioritizing the retirement of economically marginal, carbon-intensive assets

Second, take a systematic and through-the-cycle approach to building resilience.

For all—individuals, companies, governments, and civil society—we see two additional priorities. First, use this moment to raise awareness of the impact of a climate crisis, which could ultimately create disruptions of great magnitude and duration.

That includes awareness of the fact that physical shocks can have massive nonlinear impacts on financial and economic systems and thus prove extremely costly.

Second, build upon the mindset and behavioral shifts that are likely to persist after the crisis (such as working from home) to reduce the demands we place on our environment—or, more precisely, to shift them toward more sustainable sources.

Moving toward a lower-carbon economy presents a daunting challenge, and, if we choose to ignore the issue for a year or two, the math becomes even more daunting.

it is also critical that we begin now to integrate the thinking and planning required to build a much greater economic and environmental resiliency as part of the recovery ahead.

There’s plenty of blame to go around, involving Democrats as well as Republicans, but Trump in particular “recklessly squandered lives,” in the words of an unusual editorial this month in the New England Journal of Medicine. Death certificates may record the coronavirus as the cause of death, but in a larger sense vast numbers of Americans died because their government was incompetent.

As many Americans are dying every 10 days of Covid-19 as U.S. troops died during 19 years of war in Iraq and Afghanistan

The paradox is that a year ago, the United States seemed particularly well positioned to handle this kind of crisis. A 324-page study by Johns Hopkins found last October that the United States was the country best prepared for a pandemic.

Then there’s an immeasurable cost in soft power as the United States is humbled before the world.

“It’s really sad to see the U.S. presidency fall from being the champion of global health to being the laughingstock of the world,”

in terms of destruction of American lives, treasure and well-being, this pandemic may be the greatest failure of governance in the United States since the Vietnam War.

the economists David Cutler and Lawrence Summers estimate that the economic cost of the pandemic in the United States will be $16 trillion, or about $125,000 per American household — far more than the median family’s net worth.

It’s true that the Obama administration did not do enough to refill the national stockpile with N95 masks, but Republicans in Congress wouldn’t provide even the modest sums that Obama requested for replenishment. And the Trump administration itself did nothing in its first three years to rebuild stockpiles.

The Obama administration updated this playbook and in the presidential transition in 2016, Obama aides cautioned the Trump administration that one of the big risks to national security was a contagion. Private experts repeated similar warnings. “Of all the things that could kill 10 million people or more, by far the most likely is an epidemic,” Bill Gates warned in 2015.

Credit for that goes to President George W. Bush, who in the summer of 2005 read an advance copy of “The Great Influenza,” a history of the 1918 flu pandemic. Shaken, Bush pushed aides to develop a strategy to prepare for another great contagion, and the result was an excellent 396-page playbook for managing such a health crisis.

Trump argues that no one could have anticipated the pandemic, but it’s what Bush warned about, what Obama aides tried to tell their successors about, and what Joe Biden referred to in a blunt tweet in October 2019 lamenting Trump’s cuts to health security programs and adding: “We are not prepared for a pandemic.”

When the health commission of Wuhan, China, announced on Dec. 31 that it had identified 27 cases of a puzzling pneumonia, Taiwan acted with lightning speed. Concerned that this might be an outbreak of SARS, Taiwan dispatched health inspectors to board flights arriving from Wuhan and screen passengers before allowing them to disembark. Anyone showing signs of ill health was quarantined.

If either China or the rest of the world had shown the same urgency, the pandemic might never have happened.

In hindsight, two points seem clear: First, China initially covered up the scale of the outbreak. Second, even so, the United States and other countries had enough information to act as Taiwan did. The first two countries to impose travel restrictions on China were North Korea and the Marshall Islands, neither of which had inside information.

That first half of January represents a huge missed opportunity for the world. If the United States, the World Health Organization and the world media had raised enough questions and pressed China, then perhaps the Chinese central government would have intervened in Wuhan earlier. And if Wuhan had been locked down just two weeks earlier, it’s conceivable that this entire global catastrophe could have been averted.

the C.D.C. devised a faulty test, and turf wars in the federal government prevented the use of other tests. South Korea, Germany and other countries quickly developed tests that did work, and these were distributed around the world. Sierra Leone in West Africa had effective tests before the United States did.

It’s true that local politicians, Democrats and Republicans alike, made disastrous decisions, as when Mayor Bill de Blasio of New York City urged people in March to “get out on the town despite coronavirus.” But local officials erred in part because of the failure of testing: Without tests, they didn’t know what they faced.

t’s unfair to blame the testing catastrophe entirely on Trump, for the failures unfolded several pay grades below him. Partly that’s because Trump appointees, like Robert Redfield, director of the C.D.C., simply aren’t the A team.

In any case, presidents set priorities for lower officials. If Trump had pushed aides as hard to get accurate tests as he pushed to repel refugees and migrants, then America almost certainly would have had an effective test by the beginning of February and tens of thousands of lives would have been saved.

Still, testing isn’t essential if a country gets backup steps right. Japan is a densely populated country that did not test much and yet has only 2 percent as many deaths per capita as the United States. One reason is that Japanese have long embraced face masks, which Dr. Redfield has noted can be at least as effective as a vaccine in fighting the pandemic. A country doesn’t have to do everything, if it does some things right.

Trump’s missteps arose in part because he channeled an anti-intellectual current that runs deep in the United States, as he sidelined scientific experts and responded to the virus with a sunny optimism apparently meant to bolster the financial markets.

Yet in retrospect, Trump did almost everything wrong. He discouraged mask wearing. The administration never rolled out contact tracing, missed opportunities to isolate the infected and exposed, didn’t adequately protect nursing homes, issued advice that confused the issues more than clarified them, and handed responsibilities to states and localities that were unprepared to act.

The false reassurances and dithering were deadly. One study found that if the United States had simply imposed the same lockdowns just two weeks earlier, 83 percent of the deaths in the early months could have been prevented.

A basic principle of public health is the primacy of accurate communications based on the best science. Chancellor Angela Merkel of Germany, who holds a doctorate in physics, is the global champion of that approach

Trump was the opposite, sowing confusion and conspiracy theories; a Cornell study found that “the President of the United States was likely the largest driver of the Covid-19 misinformation.”

A conservative commentariat echoed Trump in downplaying the virus and deriding efforts to stay safe.

A University of Chicago study found that watching the Sean Hannity program correlated to less social distancing, so watching Fox News may well have been lethal to some of its fans.

Americans have often pointed to the Soviet Union as a place where ideology trumped science, with disastrous results. Stalin backed Trofim Lysenko, an agricultural pseudoscientist who was an ardent Communist but scorned genetics — and whose zealous incompetence helped cause famines in the Soviet Union. Later, in the 1980s, Soviet leaders were troubled by data showing falling life expectancy — so they banned the publication of mortality statistics

It was in the same spirit that Trump opposed testing for the coronavirus in the hope of holding down the number of reported cases.

Most striking, Trump still has never developed a comprehensive plan to fight Covid-19. His “strategy” was to downplay the virus and resist business closures, in an effort to keep the economy roaring — his best argument for re-election.

This failed. The best way to protect the economy was to control the virus, not to ignore it, and the spread of Covid-19 caused economic dislocations that devastated even homes where no one was infected.

Eight million Americans have slipped into poverty since May, a Columbia University study found, and about one in seven households with children have reported to the census that they didn’t have enough food to eat in the last seven days.

More than 40 percent of adults reported in June that they were struggling with mental health, and 13 percent have begun or increased substance abuse, a C.D.C. study found

More than one-quarter of young adults said they have seriously contemplated suicide

So in what is arguably the richest country in the history of the world, political malpractice has resulted in a pandemic of infectious disease followed by pandemics of poverty, mental illness, addiction and hunger.

The rejection of science has also exacerbated polarization and tribalism

An old school friend shared this conspiracy theory on Facebook:Create a VIRUS to scare people. Place them in quarantine. Count the number of dead every second of every day in every news headline. Close all businesses …. Mask people. Dehumanize them. Close temples and churches …. Empty the prisons because of the virus and fill the streets with criminals. Send in Antifa to vandalize property as if they are freedom fighters. Undermine the law. Loot …. And, in an election year, have Democrats blame all of it on the President. If you love America, our Constitution, and the Rule of Law, get ready to fight for them.

During World War II, American soldiers died at a rate of 9,200 a month, less than one-third the pace of deaths from this pandemic, but the United States responded with a massive mobilization

Yet today we can’t even churn out enough face masks; a poll of nurses in late July and early August found that one-third lacked enough N95 masks

Trump and his allies have even argued against mobilization. “Don’t be afraid of Covid,” Trump tweeted this month. “Don’t let it dominate your life.”

It didn’t have to be this way. If the U.S. had worked harder and held the per capita mortality rate down to the level of, say, Germany, we could have saved more than 170,000 lives

And if the U.S. had responded urgently and deftly enough to achieve Taiwan’s death rate, fewer than 100 Americans would have died from the virus.

“It is a slaughter,” Dr. William Foege, a legendary epidemiologist who once ran the C.D.C., wrote to Dr. Redfield. Dr. Foege predicted that public health textbooks would study America’s response to Covid-19 not as a model of A-plus work but as an example of what not to do.

It was only in July, when case counts began soaring in a trio of populous, Republican-leaning states — Arizona, Florida and Texas — and polls showed a majority of Americans disapproving of Trump’s handling of the pandemic, that the president and his top aides renewed their public activity related to the virus.

Trump and many of his top aides talk about the virus not as a contagion that must be controlled through social behavior but rather as a plague that eventually will dissipate on its own. Aides view the coronavirus task force — which includes Fauci, Birx and relevant agency heads — as a burden that has to be managed, officials said.

. An internal model by Trump’s Council on Economic Advisers predicts a looming disaster, with the number of infections projected to rise later in August and into September and October in the Midwest and elsewhere, according to people briefed on the data.

As the nation confronts a once­in-a-century health crisis that has killed at least 158,000 people, infected nearly 5 million and devastated the economy, the atmosphere in the White House is as chaotic as at any other time in Trump’s presidency — “an unmitigated disaster,” in the words of a second former senior administration official.

“It’s extraordinary that a country that helped eradicate smallpox, promoted HIV/AIDS treatment worldwide and suppressed Ebola — we were the world’s leader in public health and medicine, and now we can’t even protect our own people from the most devastating epidemic in decades.”

Asked who was to blame for the pandemic’s dark summer turn, Pelosi said, “1600 Pennsylvania Avenue.”“The delay, the denial . . . the hoax that it’s going to go away magically, a miracle is going to happen, we’ll be in church together by Easter, caused death,” Pelosi added.

In Trump’s White House, there is little process that guides decision-making on the pandemic. The president has been focused first and foremost on his reelection chances and reacting to the daily or hourly news cycle as opposed to making long-term strategy, with Meadows and other senior aides indulging his impulses rather than striving to impose discipline.

“He sits in the Oval Office and says, ‘Do this,’ or, ‘Do that,’ and there was always a domino blocker. It was John Bolton or H.R. McMaster on national security or John Kelly. Now there are no domino blockers.”

What’s more, with polls showing Trump’s popularity on the decline and widespread disapproval of his management of the viral outbreak, staffers have concocted a positive feedback loop for the boss. They present him with fawning media commentary and craft charts with statistics that back up the president’s claim that the administration has done a great — even historically excellent — job fighting the virus.

“Everyone is busy trying to create a Potemkin village for him every day. You’re not supposed to see this behavior in liberal democracies that are founded on principles of rule of law. Everyone bends over backwards to create this Potemkin village for him and for his inner circle.”

Although Fauci, Birx and other medical professionals sit on the coronavirus task force, many of the more pressing decisions lately have been made by the smaller group that huddles in the morning and mostly prioritizes politics. The cadre includes Meadows, senior adviser Jared Kushner and strategic communications director Alyssa Farah.

The policy process has fallen apart around Meadows, according to four White House officials, with the chief of staff fixated on preventing leaks and therefore unwilling to expand meetings to include experts or to share documents with senior staffers who had been excluded from discussions.

Luciana Borio, a director for medical and biodefense preparedness at the National Security Council during the first two years of the Trump administration, decried “a response in disarray hampered by a lack of clear, consistent public health-oriented guidance to the public.

“It’s very difficult to know who to trust,” Borio said. “To expect the public to sort out the facts in a time of tremendous stress leads to inconsistent and disparate actions, and that really hurts our collective effort to fight the virus.”

What also has frustrated a number of the president’s allies and former aides is that he simply seems uninterested in asserting full leadership over the crisis, instead deferring to state leaders to make the more difficult decisions while using his presidential bully pulpit to critique their performances.

“A suppression-level effort to shrink and not just mitigate the spread of covid requires a national strategy that includes standards and significant federal funding. Such a strategy is lacking right now.”

The Trump administration has resisted devising a national testing program and instead ceded the task to state governments, even as cases of infection average more than 60,000 a day and some people wait 10 days or longer for test results, delays that render the results essentially useless.

While some states have been able to largely meet the needs of their populations, the federal government is the only entity with the power to coordinate testing across state lines, push and enable manufacturers to increase production of test kits and supplies, surge those supplies as needed and ensure fair payment.

Without federal coordination, states, businesses, hospitals — and soon schools and universities — find themselves competing with each other for limited supplies, often overpaying as a result.

Despite repeated calls to invoke the Defense Production Act to help resolve testing-supply shortages, the administration has resisted doing so. Trump and several White House aides have instead continued to think that it is politically advantageous to cede the issue to the states to avoid taking ownership or blame for the issue, even though testing shortages are largely seen as a federal failure.

“Other countries have taken this virus seriously, trusted their public health officials and scientists, and now they’ve flattened the curve,” he said. “Meanwhile, our situation gets worse and worse every day and some Americans think, ‘Oh, that’s just the way it is.’ But that isn’t how it has to be.

He’s just not oriented towards things that even in the short term look like they’re involving something that’s hard or negative or that involves sacrifice or pain,” a former senior administration official explained. “He is always anxious to get to a place of touting achievements and being the messenger for good news.”

It’s also a culture that values physical toughness. It’s a culture that celebrates people who are willing to fight to defend their honor.

It’s also a culture with a lot of collective pride.

Sports has become the binding religion, offering identity, value, and solidarity.

From 1945 to 1995, conservative and liberal elites shared variations of the same vision of the future. Liberals emphasized multilateral institutions and conservatives emphasized free trade. Either way, the future would be global, integrated and multiethnic.

This honor code has been decimated lately. Conservatives argue that it has been decimated by cosmopolitan cultural elite

Much of this pride is nationalistic.

Most of all, it has been undermined by rampant consumerism, by celebrity culture, by reality-TV fantasies that tell people success comes in a quick flash of publicity, not through steady work. The sociologist Daniel Bell once argued that capitalism would undermine itself because it encouraged hedonistic short-term values for consumers while requiring self-disciplined long-term values in its workers. At least in one segment of society, Bell was absolutely correct

There’s now a rift within the working class between mostly older people who are self disciplined, respectable and, often, bigoted, and parts of a younger cohort that are more disordered, less industrious, more celebrity-obsessed, but also more tolerant and open to the world.

But the honor code has also been decimated by the culture of the modern meritocracy, which awards status to the individual who works with his mind, and devalues the class of people who work with their hands.

But the elites pushed too hard, and now history is moving in the opposite direction. The less-educated masses have a different conception of the future, a vision that is more closed, collective, protective and segmented.

When people feel their world is vanishing, they are easy prey for fact-free magical thinking and demagogues who blame immigrants.

We need a better form of nationalism, a vision of patriotism that gives dignity to those who have been disrespected, emphasizes that we are one nation and is confident and open to the world.

Anybody who spends time in the working-class parts of America (and, one presumes, Britain) notices the contagions of drug addiction and suicide, and the feelings of anomie, cynicism, pessimism and resentment.

Many vaccines contain traces of the formaldehyde used to inactivate viruses, and this can be alarming to those of us who associate formaldehyde with dead frogs in glass jars. Large concentrations are indeed toxic, but formaldehyde is a product of our bodies, essential to our metabolism, and the amount of formaldehyde already circulating in our systems is considerably greater than the amount we receive through vaccination.

As for mercury, a child will almost certainly get more mercury exposure from her immediate environment than from vaccination. This is true, too, of the aluminum that is often used as an adjuvant in vaccines to intensify the immune response.

Our breast milk, it turns out, is as polluted as our environment at large. Laboratory analysis of breast milk has detected paint thinners, dry-cleaning fluids, flame retardants, pesticides, and rocket fuel. “Most of these chemicals are found in microscopic amounts,” the journalist Florence Williams notes, “but if human milk were sold at the local Piggly Wiggly, some stock would exceed federal food-safety levels for DDT residues and PCBs.”

fear of toxicity strikes me as an old anxiety with a new name. Where the word filth once suggested, with its moralist air, the evils of the flesh, the word toxic now condemns the chemical evils of our industrial world.

like filth theory, toxicity theory is anchored in legitimate dangers

the way we think about toxicity bears some resemblance to the way we once thought about filth. Both theories allow their subscribers to maintain a sense of control over their own health by pursuing personal purity. For the filth theorist, this means a retreat into the home, where heavy curtains and shutters might seal out the smell of the poor and their problems. Our version of this shuttering is now achieved through the purchase of purified water, air purifiers, and food produced with the promise of purity.

Purity, especially bodily purity, is the seemingly innocent concept behind a number of the most sinister social actions of the past century.

I’d say Huntington was also wrong in the way he defined culture.

In some ways, each of us is like every person on earth; in some ways, each of us is like the members of our culture and group; and, in some ways, each of us is unique. Huntington minimized the power of universal political values and exaggerated the influence of distinct cultural values.

Culture is important, but underneath cultural differences there are these universal aspirations for dignity, for political systems that listen to, respond to and respect the will of the people.

Finally, I’d say Huntington misunderstood the nature of historical change. In his book, he describes transformations that move along linear, projectable trajectories. But that’s not how things work in times of tumult. Instead, one person moves a step. Then the next person moves a step. Pretty soon, millions are caught up in a contagion, activating passions they had but dimly perceived just weeks before. They get swept up in momentums that have no central authority and that, nonetheless, exercise a sweeping influence on those caught up in their tides.

Third, the European banking system would have to be recapitalized and put under European, as distinct from national, supervision.

Fourth, the government bonds of the other deficit countries would have to be protected from contagion.

The German public still thinks that it has a choice about whether to support the euro or to abandon it. That is a mistake. The euro exists and the assets and liabilities of the financial system are so intermingled on the basis of a common currency that a breakdown of the euro would cause a meltdown beyond the capacity of the authorities to contain. The longer it takes for the German public to realize this, the heavier the price they and the rest of the world will have to pay.

The fact that arrangements are made for the possible default or defection of three small countries does not mean that those countries would be abandoned. On the contrary, the possibility of an orderly default—paid for by the other eurozone countries and the IMF—would offer Greece and Portugal policy choices.

he discussions ought to start right away because even under extreme pressure they will take a long time to conclude. Once the principle of setting up a European Treasury is agreed upon, the European Council could authorize the ECB to step into the breach, indemnifying the ECB in advance against risks to its solvency. That is the only way to forestall a possible financial meltdown and another Great Depression.

Even when there is some legal system in place, it’s not designed to impose law and order for the people. It is there to protect the regime from the people. The well-connected want a legal system that can be bought and sold.

people without our inherited institutions live on the other side of the threshold and have a different reality. They live within a contagion of chaos. They live where the primary realities include violence, theft and radical uncertainty. Their world is governed less by long-term economic incentives and more by raw fear. In a world without functioning institutions, predatory behavior and the passions of domination and submission blot out economic logic.

The primary problem of politics is not creating growth. It’s creating order.

Second, you’ve got a large group of people who are bone-deep suspicious of globalization, what it does to their jobs and their communities.

You get the rise of the anti-science folks, who distrust the realm of far-off studies and prefer anecdotes from friends to data about populations.

So you get the rise of the anti-vaccine parents

Third, you’ve got the culture of instant news. It’s a weird phenomenon of the media age that, except in extreme circumstances, it is a lot scarier to follow an event on TV than it is to actually be there covering it.

Fourth, you’ve got our culture’s tendency to distance itself from death.

“In every calm and reasonable person there is a hidden second person scared witless about death.” In cultures where death is more present, or at least dealt with more commonly, people are more familiar with that second person, and people can think a bit more clearly about risks of death in any given moment.

The Ebola crisis has aroused its own flavor of fear.

It’s a sour, existential fear. It’s a fear you feel when the whole environment seems hostile, when the things that are supposed to keep you safe, like national borders and national authorities, seem porous and ineffective, when some menace is hard to understand.

In these circumstances, skepticism about authority turns into corrosive cynicism. People seek to build walls, to pull in the circle of trust. They become afraid. Fear, of course, breeds fear.

The idea that the Wall Street crash caused the depression has also gone out of favour in recent years.

As with the rise of protectionism, it seems that the Wall Street crash was a symptom of problems in the global economy, rather than the underlying cause of them.