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America's daily new cases topped 100,000 on Wednesday, and its death toll exceeds 234,000, a staggering figure even accounting for its greater population than Australia, which has recorded 907 deaths.

Meanwhile, in the United States, 52,049 people are hospitalized and 10,445 are in an ICU

No new cases were reported on the island continent Thursday, and only seven since Saturday, besides travelers in hotel quarantine. Eighteen patients are hospitalized with covid-19, the disease caused by the coronavirus. One is in an intensive care unit. Melbourne, the main hotbed of Australia's outbreak that recently emerged from lockdown, has not reported a case since Oct. 30.

Australia provides a real-time road map for democracies to manage the pandemic. Its experience, along with New Zealand's, also shows that success in containing the virus isn't limited to East Asian states (Singapore, South Korea, Taiwan) or those with authoritarian leaders (China, Vietnam).

Several practical measures contributed to Australia's success

The country chose to quickly and tightly seal its borders, a step some others, notably in Europe, did not take.

Health officials rapidly built up the manpower to track down and isolate outbreaks.

And unlike the U.S. approach, all of Australia's states either shut their domestic borders or severely limited movement for interstate and, in some cases, intra­state travelers.

Perhaps most important, though, leaders from across the ideological spectrum persuaded Australians to take the pandemic seriously early on and prepared them to give up civil liberties they had never lost before, even during two world wars.

"We told the public: 'This is serious; we want your cooperation,' 

A lack of partisan rancor increased the effectiveness of the message

The conservative prime minister, Scott Morrison, formed a national cabinet with state leaders — known as premiers — from all parties to coordinate decisions

Political conflict was largely suspended, at least initially, and many Australians saw their politicians working together to avert a health crisis.

"Regardless of who you vote for, most Australians would agree their leaders have a real care for their constituents and a following of science," McLaws said. "I think that helped dramatically.

Australians' willingness to conform — especially in Melbourne, where residents endured a lengthy state-ordered lockdown — reflects political attitudes that differ from those in parts of the United States

In a nation where compulsory voting produces conventionally center-left or center-right political leaders, governments tend to be regarded as the solution to society's problems rather than the cause.

Australia's national response was led by Health Minister Greg Hunt, a former McKinsey & Co. management consultant and a Yale University graduate. Hunt and Morrison worked with the state premiers, who hold responsibility for on-the-ground health policy, to develop a common approach to the pandemic.

The government closed Australia's borders to travelers from China on Feb. 1, the same day as the Trump administration in the United States. But unlike the Trump administration, which has criticized its primary infectious-disease adviser, Anthony S. Fauci, Hunt relied heavily on health experts from the start.

"In January and February, we were focused on containing the risk of a catastrophic outbreak," Hunt said in an interview. "We had a clear strategic plan, which was the combination of containment and capacity-building."

"We closed the border and concentrated on testing, tracing and social distancing," he added. "We built up our capacity to fight the virus in primary and aged care and hospitals. We invested in ventilators, and vaccine and treatment research."

Hunt's department oversaw the purchase of huge amounts of protective equipment and clothing, including masks, which became mandatory on Aug. 2 in the state of Victori

After a sick doctor in his 70s treated more than 70 people in the city before being diagnosed, Hunt accelerated a 10-year plan to phase in video consultations with physicians. Within 10 days, almost anyone in Australia could see a doctor over the Internet under Australia's highly subsidized health-care system, including psychiatrists.

When private hospitals said they were in danger of going broke because non-urgent surgery had been canceled, the government stepped in with emergency funding, securing beds that could be used for coronavirus patients.

In private, Hunt swapped ­practical stories with his wife, Paula Hunt, a former infectious-diseases nurse who kept a 1995 bestseller by U.S. science journalist Laurie Garrett, "The Coming Plague: Newly Emerging Diseases in a World Out of Balance," on her bedside table, he said.

While opinion polls show strong support for the tough measures, many people have been badly affected. Australia entered its first recession in 29 years, small businesses have closed, and reports of depression are up. On Tuesday, an anti-lockdown protest in Melbourne turned violent. Police arrested 404 people.

for a time, it appeared Australia's early success was imperiled, after lax security at hotels in Melbourne that were housing returned travelers led to a second outbreak in July. By August, more than 700 cases a day were diagnosed. It looked like Australia could lose control of the virus.

Almost all public life in Melbourne ended. After 111 days of lockdown, the number of average daily cases fell below five. On Oct. 28, state officials allowed residents to leave their homes for any reason.

Australia currently bans its citizens and residents from overseas travel, a decision that has been particularly tough on its 7.5 million immigrants.

Most Australians will have access to a vaccine by the middle of next year, Hunt said, a major step toward allowing them to travel.

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.

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.

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.

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.

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.

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.

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.

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.

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

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

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

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.

“I guess an email is notification of exposure,” said Erin Sanders, a nurse practitioner and certified contact tracer in Boston. “But that is not contact tracing,” she said, “and not how a responsible public health agency handles a super-spreading cluster of a deadly virus.”

an internal C.D.C. email on Friday asked the agency’s scientists to be ready to go to Washington for contact tracing, but a request from the White House for assistance never came, according to two senior C.D.C. scientists.

Experts at the C.D.C. could have immediately put in place contact tracing for President Trump and others who have been infected, working with health departments of the states to which Mr. Trump and others have traveled. But regulations require that the C.D.C. be asked to step in.

During the 48-hour window before Mr. Trump’s diagnosis that White House contact tracers are focusing on, the president debated former Vice President Joseph R. Biden Jr. in Cleveland; traveled to a rally of thousands in Minnesota; met with supporters and donors at his golf club in Bedminster, N.J.; and conferred with dozens of aides at the White House, all while not wearing a mask.

The timing of the diagnosis of Mr. Trump’s illness makes it highly likely that he and the others became infected on Saturday, medical experts said. Symptoms typically appear around five days after exposure to the virus; Mr. Trump began showing symptoms on Thursday, “right smack dab in the day” he would be expected to, Dr. Maldonado said.

“Staff should not go to the White House Medical Unit clinic for any Covid-19 testing inquiries,” the memo said. But some officials have continued to go to work.

In a sign that European governments remain concerned about a jump in new infections, masks in the continent are increasingly becoming obligatory. In France and the U.K., masks will be mandatory in public enclosed spaces from next week. In Germany, Italy and much of Spain, they already are. Austria is considering reinstating its indoor-mask order following a recent rise in infections.

“When I look at Europe, there is no single, best way: There are lots of ways,” he adds. “There is no magic formula, but they all begin with taking the virus seriously and not having debates about inane things.”

What will be so cruel about this American version of Russian roulette is how unfair it will be

This is the state of play when you have a president who one minute is responsibly issuing sober guidelines for when and how people should go back to work, and the next minute is telling states that they are responsible for getting the testing, tracking and tracing units that we need in place and then, in the third minute, is inciting people on Twitter to “liberate” their workplaces, cities and beaches — even though none of the conditions are in place to do so safely.

“Liberate”? Think about the use of that word. We were not in jail! We were not doing something wrong! We were doing what our president, governor, mayor, and national epidemic experts told us to do: behave responsibly and shelter in place to break the transmission of this virus.

it is clear that millions of Americans are going to stop sheltering in place — their own President is now urging them to liberate themselves — before we have a proper testing, tracking and tracing system set up.

When the president is calling on governors to “let their people go” before comprehensive testing facilities are in place, he is basically saying that, until there is a vaccine, we are betting on herd immunity. Achieving herd immunity requires that more than two-thirds of a community be immune, a process that could involve many more deaths, if proper preparations are not in place.

That may work out for some places and people. It may not.

First, this is the bet Trump is urging you to make in his “liberate” tweets — when he should be ordering out the National Guard and mobilizing American industry to get testing everywhere.

Second, this bet will fall very unfairly and unevenly in our society, when so little testing and tracing is in place.

third, if this is the future, every business, restaurant, hotel, theater, sporting facility, factory, nonprofit and government office needs to ask itself: What does my business look like when, on the best days, the responsible people coming to my door will be wearing a mask, gloves, distancing six feet apart and volunteering to have their temperature taken before they enter, and the irresponsible ones won’t be? How do I handle that?

Bottom line, my fellow Americans: Your president is telling you that you’re on your own to make these decisions. And if this strategy works, you can be sure that he will take credit. And if it doesn’t, you can be sure that he will tweet that it was all Anthony Fauci’s idea.

The plan was published Sunday by the American Enterprise Institute. Its lead author — Scott Gottlieb, former Food and Drug Administration commissioner in the Trump administration

“The goal is to outline a plan that will allow a gradual return to a more normal way of life without increasing the risk” that the epidemic will resurge.

Most economists and health experts say there is no way to restart the economy without addressing the underlying problem of the coronavirus. As long as the pandemic continues to spread, the markets will be in turmoil and any businesses will struggle to stay open, they say.

instead of giving false reassurances and deadlines, the White House should tell people the hard truth about the current situation and a coherent strategy they can work toward. “The social distancing, being stuck at home, the deaths we’re going to be seeing. People want to know what it’s for. That there’s a plan.”

the road map Gottlieb’s group outlined stresses the need to move away from the current decentralized system and “toward more coordinated execution of response.”

The plan divides coming months into four phases and sets “triggers” for states to move from one phase to the next.

The latest proposal is a 19-page plan with a step-by-step timeline, with clear benchmarks states and regions would need to meet to safely move forward to the next step

With most of the nation now in phase one of the epidemic, the goal should be a sharp increase in hospital critical care beds and an increase of testing to 750,000 people a week to track the epidemic — a number Gottlieb said could be achieved in the next week or two.

For a state to move to phase two, it should see a sustained reduction in new cases for at least 14 days, and its hospitals need to be able to provide care without being overwhelmed.

“The reason we set it at 14 days is that’s the incubation period of the virus,” said Rivers of Johns Hopkins. “That way you know the downward trend is certain and not because of a holiday or blip or some other delay in reported cases.”

States that have moved into phase two would begin gradually lifting social distancing measures and opening schools and businesses, while increasing surveillance.

The key goals thereafter would be accelerating the development of new treatments and deploying tests to determine who has recovered from infection with some immunity and could rejoin the workforce.

Phase 3 occurs when the nation has a vaccine or drugs to treat covid-19 in place and the government launches mass vaccinations

For weeks, World Health Organization officials have stressed such lockdowns are only helpful for slowing down the virus and buying time to deploy more targeted and comprehensive measures, which the U.S. has not yet done.

Trump has repeatedly returned to strategies of bans and movement restriction

Phase 4 involves rebuilding the nation’s capacity to deal with the next pandemic by building up its scientific and public health infrastructure.

Mike Ryan, WHO head of emergency programs, recently urged countries to focus on finding and isolating infected people and their contacts. “It’s not just about physical distancing, it’s not just about locking down,”

Many experts’ recent proposals for a U.S. strategy have similar stressed the importance of large-scale contact tracing — because it was a cornerstone for successful efforts like South Korea and Singapore.

as countries have shown success with it against this coronavirus, that thinking has changed.

such contact tracing is “impractical now in many places but more practical once case numbers have been reduced and testing scaled up” and “could alleviate the need for stringent social distancing to maintain control of the epidemic.”

Rapidly building up that capacity — either with community volunteers or short-term hires — will be crucial in coming months, said Rivers of Johns Hopkins. “If you build capacity up and bring cases down, it starts looking a lot more possible.”

Many proposals tackle the problem of the tanking economy.

Gottlieb-Johns Hopkins plan, for example, calls for widespread use of blood tests to identify people who have had the infection and now are immune — called serology testing

People who are immune could return to work, or take on high-risk roles in the health care system and help people, especially the elderly, who are still quarantined at home.

Such serology tests have not been deployed before like this on such a large scale

during Ebola outbreaks in Africa, survivors were often the ones who provided care, watched over the children of sick patients and buried the dead.

One challenge unaddressed by most proposals and op-eds, however, is how to get such detailed plans adopted by the White House, whose response has weighed down by infighting and unclear leadership ping-ponging in recent weeks among Trump, Pence and health advisers like Anthony S. Fauci and Deborah Birx and others.

Health officials and scientists involved in the federal response, especially from the Centers for Disease Control and Prevention, have fought to be heard while straining to avoid offending Trump, who bristles at being publicly contradicted, undercut or overshadowed by praise for ideas or people beside himself, according to people who spoke on the condition of anonymity about sensitive deliberations.

On Thursday, Trump unveiled a plan of his own, though scarce in detail. He said he planned to help communities ease their restrictions and reopen for business by using on “robust” surveillance and categorizing counties across America into three “risk levels” — low, medium and high. More details are likely in coming days, White House officials said.

In interviews with The Post, several rally attendees said they didn’t deny the threat of the coronavirus but also didn’t believe they needed to stay home indefinitely. Some noted that they take risks each time they get on their bikes. A number said they wore masks or made other minor concessions but were determined to go on with their lives.

“This motorcycle rally was and is such a big thing that people come from miles and miles away and they come from right next door. And it’s not reported anywhere who they are, where they live,” said Benjamin Aaker, president of the South Dakota State Medical Association.

But other countries offer examples of more robust and coordinated contact-tracing efforts, Michaud said. Japan uses what’s called retrospective contact tracing — working backward to determine where a person was infected and who else may have gotten the virus there, he said. It’s particularly effective in dealing with the coronavirus, which is often transmitted by a small number of people infecting many others in clusters.

It was “fairly obvious” that a gathering the size of the motorcycle rally represented a risk, Michaud said — and more rigorous contact tracing could have revealed the actual impact. It might also have prevented some of the secondary and tertiary spread.

And in contrast with participants in the Black Lives Matter protests this summer, many Sturgis attendees spent time clustered indoors at bars, restaurants and tattoo parlors, where experts say the virus is most likely to spread, especially among those without masks.

“Anytime you’re bringing individuals together, you’re going to have times where you’re having covid-19 transmission,” state epidemiologist Joshua Clayton said last month. “That’s a risk whether you’re in South Dakota, or in other states.

Noem, the governor, attributed the rise in cases to increases in testing, echoing President Trump’s explanation of growing U.S. infections. “That’s normal, that’s natural, that’s expected,” she told the Associated Press. She did not explain how extra testing could have accounted for the rise in hospitalizations in the state, which hit record highs in October.

Balcom, whose case was mild, cried in the car, relieved he was coming home. She never said “I told you so,” or got angry with him. She was upset, though, when she found out Cervantes’s case wasn’t included in covid-19 tallies linked to Sturgis.“If we had an accurate representation of what’s going on, then people might say, ‘Maybe it’s not a good idea to go to the concert or go to the gathering,'" she said. “Everyone is just muddling through this because no one knows what the hell is going on.”

Cervantes now looks at things differently. Watching football, he worried how many of the thousands of fans admitted to a recent Kansas City Chiefs game might become infected, even as he noticed they sat apart. He once put on a mask to humor Balcom; now he says he has to resist the urge to yell at strangers to wear them.

After weeks of missed work, his stint in the hospital and a return visit to the ER over a blood clot concern, he’s come to deeply regret his decision.

“I was naive,” he said. “I was dumb, you know? I shouldn’t have went. I did; I can’t change that, so I just got to move forward. But sitting here just the past few days, that’s all I keep thinking about. I’m like, Jesus, look at the hell I’m going through, the hell I put everybody through. It ain’t worth it. It wasn’t. It really wasn’t.”

But as cases skyrocket again in many states, many health officials have conceded that interviewing patients and dutifully calling each contact will not be enough to slow the outbreak. “Contact tracing is not going to save us,” said Dr. Ogechika Alozie, chief medical officer at Del Sol Medical Center in El Paso, where hospitalizations in the county have soared by more than 400 percent and officials issued a new order for residents to stay at home.

Uncovering the path of transmission from person to person, known as contact tracing, is seen as a key tool for containing the spread of the coronavirus.

Infections are rising in 41 states, the country is recording an average of more than 79,000 new cases each day, and more Americans say they feel left to do their own lonely detective work.

The problem, of course, is that failing to fully track the virus makes it much harder to get a sense of where the virus is flourishing, and how to get ahead of new outbreaks.

In some places, overwhelmed health officials have abandoned any pretense of keeping up.

Now, though, any sense of control has vanished. Active cases of Covid-19 have quadrupled since the beginning of October to 912 in Grand Forks County, and about half the people contacted by the health department say they are not sure how they became infected.

In earlier, quieter periods of the pandemic, the virus spread with some degree of certainty. In all but the hardest-hit cities, people could ask a common question — “Where did you get it?” — and often find tangible answers.

A popular college bar in East Lansing, Mich., Harper’s Restaurant and Brewpub, became a hot spot this summer after dozens of people piled into the bar, drinking, dancing and crowding close together. At least 192 people — 146 people at the bar and 46 people with ties to those at the bar — were infected. Afterward, Gov. Gretchen Whitmer shut down indoor dining in bars in parts of the state.

Heidi Stevens is among the newly infected who considers her case a mystery. As a columnist at The Chicago Tribune, Ms. Stevens works from home. Her children attend school online. She wears a mask when she goes for a run, and she has not had a haircut since January.So when she got a precautionary test a few weeks ago, with the hopes of inviting friends over to have cake for her daughter’s 15th birthday, Ms. Stevens was shocked to learn she was positive.

The government hopes to use the findings to unravel a riddle that will allow Germany to move securely into the next phase of the pandemic: Which of the far-reaching social and economic restrictions that have slowed the virus are most effective and which can be safely lifted?

Other countries like Iceland and South Korea have tested broadly for infections, or combined testing with digital tracking to undercut the spread of the virus. But even the best laid plans can go awry; Singapore attempted to reopen only to have the virus re-emerge.

President Trump is in a hurry to restart the economy in an election year, but experts warn that much wider testing is needed to open societies safely.

Both Britain and the United States, where some of the first tests were flawed, virtually forfeited the notion of widespread testing early in their outbreaks and have since had to ration tests in places as they scramble to catch up

Germany, which produces most of its own high-quality test kits, is already testing on a greater scale than most — 120,000 a day and growing in a nation of 83 million.

Merkel, a trained scientist, said this week that the aim was nothing less than tracing “every infection chain.”

Every 10 people infected with the virus now pass it to seven others — a sharp decline in the infection rate for a virus that has spread exponentially.

The generosity and solidarity on such striking display inside of Europe’s largest and richest economy have been missing in Germany’s response to poorer European nations in the south, which were hit hardest by the virus.

the chancellor’s mixture of calm reassurance and clear-eyed realism — as well as her ability to understand the science and explain it to citizens — has been widely praised and encouraged Germans to follow social distancing rules. Her approval ratings are now higher than 80 percent.

That broad confidence in government has given Germany a tremendous advantage. It is much of the reason a knock on the door by a police officer and strangers dressed like aliens asking for blood can engender good will rather than alarm

Nationally, the Robert Koch Institute, the government’s central scientific institution in the field of biomedicine, is testing 5,000 samples from blood banks across the country every two weeks and 2,000 people in four hot spots who are farther along in the cycle of the disease.

Its most ambitious project, aiming to test a nationwide random sample of 15,000 people across the country, is scheduled to begin next month.

“In the free world, Germany is the first country looking into the future,”

“We are leading the thinking of what to do next.”

In Gangelt, a small town of about 12,000 in northwest Germany, tests of a first group of 500 residents found that 14 percent had antibodies to the virus. Another 2 percent tested positive for the coronavirus, raising hopes that about 15 percent of the local population may already have some degree of immunity.

“The process toward reaching herd immunity has begun,”

t may hold valuable insights for places that lag behind as the pandemic runs its course.

The mortality rate in the town, for example, turned out to be 0.37 percent, much lower than the national rate of 2.9 percent which is calculated based only on detected infections.

“We are at a crossroads,” said Mr. Hoelscher, the professor. “Are we going the route of loosening more and increasing immunity in the summer to slow the spread of this in the winter and gain more freedom to live public life? Or are we going to try to minimize transmissions until we have a vaccine?

“This is a question for politicians, not for scientists,” he added. “But politicians need the data to make an informed risk assessment.”

“I thought to myself if we’re going into lockdown, we need to start working on an exit strategy now,”

The next day, he said he wrote a short pitch to the Bavarian government. Six hours later, he had the green light. It took another three weeks until the test kits had arrived, a new lab was opened and teams of medics started fanning out across the city.

Six days after they first rung his doorbell, a doctor and two medical students came back to Mr. Germann’s apartment, household number 420 out of 3,000.They put on disposable protection suits, gloves and goggles and one of them sat down on a plastic stool they had brought along to take a small vial of his blood. Then they removed and bagged their suits, disinfected the stool and any surface they had touched and left. It took all of 10 minutes.

The AEI proposal is the closest thing to a middle path between these plans. It’s more testing, but nothing approaching Romer’s hopes. It’s more contact tracing, but it doesn’t envision an IT-driven panopticon. But precisely for that reason, what it’s really describing is a yo-yo between extreme lockdown and lighter forms of social distancing, continuing until a vaccine is reached.

The CAP and Harvard plans both foresee a digital pandemic surveillance state in which virtually every American downloads an app to their phone that geotracks their movements, so if they come into contact with anyone who later is found to have Covid-19, they can be alerted and a period of social quarantine can begin

o state the obvious: The technological and political obstacles are massive. While similar efforts have borne fruit in Singapore and South Korea, the US is a very different country, with a more mistrustful, individualistic culture. Already, polling shows that 70 percent of Republicans, and 46 percent of Democrats, strongly oppose using cellphone data to enforce quarantine orders.

The alternative to mass surveillance is mass testing. Romer’s proposal is to deploy testing on a scale no one else is contemplating — 22 million tests per day — so that the entire country is being tested every 14 days, and anyone who tests positive can be quickly quarantined

All of them then imagine a phase two, which relaxes — but does not end — social distancing while implementing testing and surveillance on a mass scale. This is where you must begin imagining the almost unimaginable.

This, too, requires some imagination. Will governors who’ve finally, at great effort, reopened parts of their economies really keep throwing them back into lockdown every time ICUs begin to fill? Will Trump have the stomach to push the country back into quarantine after he’s lifted social distancing guidelines?

even if the political hurdles could be cleared, it’s obvious, reading the AEI proposal, that there’ll be no “V-shaped recovery” of the economy. Scott Gottlieb, the former FDA commissioner who helped craft the plan, says he thinks something like 80 percent of the economy will return — that may sound like a lot, but it’s an economic collapse of Great Depression proportions.

As unlikely as these futures may be, I think the do-nothing argument is even less plausible: It imagines that we simply let a highly lethal virus kill perhaps millions of Americans, hospitalize tens of millions more, and crush the health system, while the rest of us go about our daily economic and social business.

That is, in my view, far less likely than the construction of a huge digital surveillance state. I care about my privacy, but not nearly so much as I care about my mother.

My point isn’t to criticize these plans when I have nothing better to offer. Indeed, my point isn’t to criticize them at all. It’s simply to note that these aren’t plans for returning to anything even approaching normal

They either envision life under a surveillance and testing state of dystopian (but perhaps necessary!) proportions, or they envision a long period of economic and public health pain, as we wrestle the disease down only to see it roar back, as seems to be happening in Singapore.

As of now, the White House has neither chosen nor begun executing on a plan of its own. That’s a terrible abdication of leadership, but reading through the various proposals, you can see why it’s happened. Imagine you’re the president of the United States in an election year. Which of these futures, with all its costs and risks and pain, would you want to try and sell to the American people?

In both countries, the public initially resisted and then complied, in part because the information flowing from officials at every level was largely consistent.

Playing their own versions of explainer in chief, Mr. Morrison has veered toward conservative radio, while Ms. Ardern prefers Facebook Live. But they’ve both received praise from scientists for listening and adapting to evidence.

“It’s a case of politicians just not being in the way,” said Ian Mackay, an immunologist at the University of Queensland who has been involved in response planning for the pandemic. “It’s a mix of things, but I think it comes down to taking advice based on expertise.”

Australia and New Zealand have squashed the curve

Australia, a nation of 25 million people that had been on track for 153,000 cases by Easter, has recorded a total of 6,670 infections and 78 deaths. It has a daily growth rate of less than 1 percent, with per capita testing among the highest in the world.

New Zealand’s own daily growth rate, after soaring in March, is also below 1 percent, with 1,456 confirmed cases and 17 deaths. It has just 361 active cases in a country of five million.

These figures put the two countries closer to Taiwan and South Korea, which have controlled the virus’s spread for now, than to the United States and Europe — even places seen as success stories, like Germany.

That collaboration set the tone. Many of the state and local task forces spurred on by Mr. Morrison’s early action have stayed in constant contact, drawing in academics who independently started to model the virus’s spread

The government then opened the budgetary floodgates to support suffering workers and add health care capacity. When infections started climbing, many of the labs and hospitals hired second and third rounds of scientists to help.

It all started with scientists. In Australia, as soon as China released the genetic code for the coronavirus in early January, pathologists in public health laboratories started sharing plans for tests. In every state and territory, they jumped ahead of politicians.

The newly formed national cabinet has delivered a surprising level of consensus for a country with a loose federal system subject to high levels of discord among state premiers, whose roles and powers resemble those of American governors.

Dr. Michael Baker, a physician and professor at the University of Otago in Wellington, became a prominent voice outside the government pushing for elimination of the virus, not just its suppression.

In Australia, officials are mostly discussing elimination in private, as a potential side effect of a strategy they still describe as suppression

elimination would be a “nirvana” scenario — an achievement that would be tough to maintain without indefinite bans on international travel or 14-day quarantines until a vaccine arrives.

Like Dr. Anthony Fauci, the face of the American government’s scientific response, they are known for extensive public health pedigrees, calm demeanors and no-nonsense adherence to facts.

He and others like him at the local level are key factors in a revival of trust in government that has appeared in poll after poll lately, even as the two countries’ economies have cratered and people have been told to severely restrict their lives.

some scientists wonder if eliminating the virus with good management might rebuild some faith not just in democracy, but also in the value of expertise.

“Maybe we’ll see the return of science,” Dr. Mackay added. “I doubt it, but who knows.”

It’s almost impossible to decipher which path the UK government has chosen.

Without these measures in place, the past seven weeks of lockdown will have been completely pointless. As quarantine measures are lifted, the virus will continue to spread, the number of daily cases will rise and a second peak will become inevitable

this debate misses a more fundamental point: containment (the first path) is the best strategy for public health, the economy and society. The decision in early March to shift from containing to mitigating the virus was disastrous on all three of these fronts

The confusion turns on an internal struggle between two opposing camps. The first seems to think the government should attempt to get over the worst of the pandemic by allowing the virus to spread through the population, albeit at a slower pace to ease the strain on the NHS, and by creating more hospital and mortuary capacity to cope with a spike in deaths. The second camp wants to drive down the number of coronavirus cases and reduce the rate of infection – or R – to as close to zero as possible. It recognises the uniquely dangerous nature of this virus, and the emerging evidence that it can cause long-term health complications in survivors and that immunity may only be temporary.

Now, the key challenge facing the government is to replace this lockdown with a package of public health interventions involving mass testing, surveillance and real-time data to identify clusters of the virus and quarantine those who are infected.

Everyone agrees that we need to get out of the lockdown as soon as possible, but doing so will require massive investment in public health infrastructure. Countries such as South Korea, Hong Kong, Taiwan, New Zealand and Australia have already built this capacity

why has the government made such little progress in building the public health infrastructure necessary to control the virus and ease the lockdown? You could be forgiven for thinking that the lockdown was simply a way to reassure the public that the government was “doing something”. We need to be asking: what measures has the government put in place to ensure we’re in a better position to release the lockdown and prevent a second wave?

Everyone wants to know when the lockdown will end and life will go back to “normal”. The better question to ask is how we ease lockdown measures in the coming months and years while preventing a second wave of infections and keeping R well below one

There are a number of endings to this story. First, an accessible and affordable vaccine could become available within the next 18 months; second, the government could embark on a resource-intensive and gruelling campaign to eliminate the virus, particularly if emerging data proves coronavirus is as dangerous as diseases such as smallpox and polio; or third, antiviral therapies could become available to treat Covid-19 that make it a mild illness, so the population would gradually and safely build up natural herd immunity.

on our current path we seem destined for a disastrous ending. Lifting lockdown without the public health infrastructure in place to contain the virus will allow Covid-19 to spread through the population unchecked. The result could be a Darwinian culling of the elderly and vulnerable, and an individual gamble for those exposed to the virus. This should be avoided at all costs.

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

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

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

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

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

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

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

1. The Flight Plan

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

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

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

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

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

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

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

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

2. The Air Traffic Controllers

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

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

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

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

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

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

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

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

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

3. The Emergency Checklist

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

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

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

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

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

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

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

4. The Pilot

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

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

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

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

5. The Control Systems

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

in a pandemic, encouraging the sick to haul themselves into work can be disastrous. The plan backfired. Hundreds of Smithfield employees were infected, forcing the plant to shut down for more than three weeks. If we stay the current course, we risk repeating the same mistake across the whole economy.

The economy consists of people who have hopes and fears. As long as they are afraid of a lethal virus, they will avoid restaurants, travel and workplaces.

The only way to restore the economy is to earn the confidence of both vulnerable industries and vulnerable people through testing, contact tracing and isolation.

To pull off this balancing act, the country should be divided into red, yellow and green zones. The goal is to be a green zone, where fewer than one resident per 36,000 is infected.

Here, large gatherings are allowed, and masks aren’t required for those who don’t interact with the elderly or other vulnerable populations.

Two weeks ago, a modest 1,900 tests a day could have kept 19 million Americans safely in green zones. Today, there are no green zones in the United States.

A disease prevalence greater than 1 percent defines red zones.

even in yellow zones, the economy could safely reopen with aggressive testing and tracing, coupled with safety measures including mandatory masks.

Today, 30 million Americans live in such hot spots — which include Detroit, New Jersey, New Orleans and New York City.

Most Americans — about 298 million — live in yellow zones, where disease prevalence is between .002 percent and 1 percent

In addition to the yellow-zone interventions, these places require stay-at-home orders.

by strictly following guidelines for testing and tracing, red zones could turn yellow within four weeks, moving steadfastly from lockdown to liberty.

Getting to green nationwide is possible by the end of the summer, but it requires ramping up testing radically. The United States now administers more than 300,000 tests a day, but according to our guidelines, 5 million a day are needed (for two to three months)

Researchers estimate that the current system has a latent capacity to produce 2 million tests a day, and a surge in federal funding would spur companies to increase capacity. The key is to do it now, before manageable yellow zones deteriorate to economically ruinous red zones.

States can administer these “test, trace and supported isolation” programs — but Congress would need to fund them. The total cost, we estimate, is $74 billion, to be spent over 12 to 18 months

That amount is a lot, but not compared to the cost of a crippled economy. In Congress’s latest relief package, $75 billion went to struggling hospitals alone, $380 billion to help small businesses and $25 billion toward testing.

Economists talk about “multipliers” — an injection of spending that causes even larger increases in gross domestic product. Spending on testing, tracing and paid isolation would produce an indisputable and massive multiplier effect.

Nations that have invested the most in disease control have suffered the least economic hardship: Taiwan grew 1.5 percent in the first quarter, whereas the United States’ gross domestic product contracted by 4.8 percent

Looking forward, we will see stark economic contrasts across states, depending on their investment in disease control.

When local and state governments become accountable for adopting strategies that work, we can expect more innovation.

How do we know that testing, tracing and supported isolation would work? It already has worked in New Zealand, South Korea and Taiwan

When England started its first phase five days earlier on 13 May, new daily cases had fallen but were still about 75% of its late-April to early-May peak.

There was another stark difference. Ireland started lifting lockdown only after testing and contact-tracing systems were fully scaled up. England took the plunge before its systems were ready.

he UK appeared to lack sufficient testing and contact-tracing capacity for such a surge, said L’Estrange. “Perhaps they can get it up and running quickly. But they’re behind the curve and playing catch-up. You have to have sufficient testing and contact-tracing capacity ready to go before you ease restrictions. They’ve put the cart before the horse. They released the virus without having the apparatus in place to control it, and they’ve released it at a high level.”

Ireland’s lockdown easing started after England’s and is scheduled to go more cautiously and slowly, with the last phase starting on 10 August, and schools opening in September. England’s plan envisages schools starting to open on 1 June and the final phase of lifting starting on 4 July.

the decision about schools was political. “It is not a scientific decision. Scientists can offer some advice.”

An editorial in the British Medical Journal this week excoriated the UK’s record on testing and tracing. “Meaningless political soundbites promising to recruit 18,000 contact tracers, test 200,000 people a day, or invest in unjustified contact tracing apps, divert focus and could lead to more deaths. These headline grabbing schemes should be replaced by locality-led strategies rooted in communicable disease control,” it said.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“At the beginning, when we had relatively few cases, when it came to finding them and isolating them, we did quite well in Germany,”

Initially, at least, the country’s health authorities tracked infection clusters meticulously. When an individual tested positive, they used contact tracing to find other people with whom they had been in touch and then tested and quarantined them, which broke infection chains

Germany’s high diagnostic capacity had “secured us an extreme lead . . . in the detection of the epidemic.”

But he cautioned against complacency, and said the death rate would increase: “We are no exception.”

As community spread became prevalent, infection chains in some cases became impossible to trace. Some doctors said they had no choice but to send people seeking tests back home to call jammed coronavirus hotlines because they lacked protective equipment to conduct them safely.

With cases growing exponentially, health authorities have moved on to ordering social distancing and banning mass events. Federal states have restricted gatherings outside the home to a maximum of two people.

outh Korea, which has been praised as a model for responding to the outbreak, has a death rate of 1.2 percent.

“In South Korea, there’s been a longer duration of infections, so we can’t really compare,” he said. “We have lots of newly positive cases. They didn’t have the chance to die yet.”

Busse said Germany is more comparable to Norway. The Scandinavian country is at a similar point in its outbreak, it’s also worked to test and contain cases, and it also has a death rate of 0.4 percent.

a period of exponential growth might be slowing, but cautioned that it was too early to say, given fluctuations in data. He said the picture should be clearer by Wednesday.

many initial cases had clear links to overseas travel.

the German outbreak started with large numbers of young people — “people who came back from holidays.”

Lauterbach said he expected Germany’s death rate to rise as more vulnerable segments of society are infected.

Because testing is not universal, and many people with the coronavirus might never be diagnosed, a true death rate is impossible to ascertain. But experts say the rate is likely to be significantly higher in countries such as Spain and Italy, where care is collapsing.

With more intensive care beds and ventilators than most other European nations and early measures to prevent the spread of the virus, Lauterbach said, he didn’t see Germany turning into Italy or Spain. Still, he has been advocating for wider restrictions.

“I think with all things considered, Germany will do reasonably well in this first round of a long fight,”

2. Seriously ramp up testing The Biden campaign says the goal is to "ensure that all Americans have access to regular, reliable and free testing." It would work to double the number of drive-through testing sites and invest in "next-generation testing" including home tests and instant tests.

1. Set consistent, evidence-based guidance to stop outbreaks

4. Help people get health insurance Millions of American have lost health insurance during the pandemic. Biden's coronavirus plan proposes to have the federal government cover 100% of the costs of COBRA coverage for the duration of the crisis. "So when people lose their employer-based health insurance, they can stay on that insurance, given the moment we are in and the pandemic," says Stef Feldman, Biden's national policy director.

5. Create a caregiving workforce During the pandemic, Biden says many families are struggling to find affordable care for their children, aging relatives or loved ones with disabilities. "At the same time, professional caregivers have either lost their jobs or continue to work while putting their lives at risk without sufficient pay," his campaign plan notes.

6. Bolster resources for vaccine distribution and PPE production States will need a lot of money to distribute a vaccine and make sure it gets to everyone who wants it. There are complex logistics that will require planning and resources. For instance, states may need freezers to store their vaccines, and given how many people are hesitant to be vaccinated, they will need public education materials and guidance. Currently state governors are asking for more guidance and financial assistance.