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Find everyone they interact with by deploying contact tracing on a scale America has never attempted before.

focus restrictions more narrowly on the infected and their contacts so the rest of society doesn’t have to stay in permanent lockdown.

Instead, the president and his top advisers have fixated almost exclusively on plans to reopen the U.S. economy by the end of the month, though they haven’t detailed how they will do so without triggering another outbreak

Administration officials, speaking on the condition of anonymity to describe internal deliberations, say the White House has made a deliberate political calculation that it will better serve Trump’s interest to put the onus on governors — rather than the federal government — to figure out how to move ahead.

without substantial federal funding, states’ efforts will only go so far

The next failure is already on its way, Frieden said, because “we’re not doing the things we need to be doing in April.”

In recent days, dozens of leading voices have coalesced around the test-trace-quarantine framework, including former FDA commissioners for the Trump and George W. Bush administrations, Microsoft founder Bill Gates and top experts at Johns Hopkins, Columbia and Harvard universities.

On Wednesday, former president Barack Obama weighed in, tweeting, “Social distancing bends the curve and relieves some pressure … But in order to shift off current policies, the key will be a robust system of testing and monitoring — something we have yet to put in place nationwide.”

And Friday, Apple and Google unveiled a joint effort on new tools that would use smartphones to aid in contact tracing.

What remains unclear is whether this emerging plan can succeed without the backing of the federal government.

“It’s mind-boggling, actually, the degree of disorganization,” said Tom Frieden, former Centers for Disease Control and Prevention director. The federal government has already squandered February and March, he noted, committing “epic failures” on testing kits, ventilator supply, protective equipment for health workers and contradictory public health communication.

Experts and leaders in some states say remedying that weakness should be a priority and health departments should be rapidly shored up so that they are ready to act in coming weeks as infections nationwide begin to decrease

In America, testing — while still woefully behind — is ramping up. And households across the country have learned over the past month how to quarantine. But when it comes to the second pillar of the plan — the labor-intensive work of contact tracing — local health departments lack the necessary staff, money and training.

In South Korea, Taiwan, China and Singapore, variations on this basic strategy were implemented by their national governments, allowing them to keep the virus in check even as they reopened parts of their economy and society

In a report released Friday, the Johns Hopkins Center for Health Security and the Association of State and Territorial Health Officials — which represents state health departments — estimate 100,000 additional contact tracers are needed and call for $3.6 billion in emergency funding from Congress.

“We can’t afford to have multiple community outbreaks that can spiral up into sustained community transmission,” he said in the interview.

Unless states can aggressively trace and isolate the virus, experts say, there will be new outbreaks and another round of disruptive stay-at-home orders.

“All people are talking about right now is hospital beds, ventilators, testing, testing, testing. Yes, those are important, but they are all reactive. You are dealing with the symptoms and not the virus itself,”

The nonprofit Partners in Health quickly put together a plan to hire and train 1,000 contact tracers. Working from their homes making 20 to 30 calls a day, they could cover up to 20,000 contacts a day.

Testing on its own is useless, Nyenswah explained, because it only tells you who already has the virus. Similarly, tracing alone is useless if you don’t place those you find into quarantine. But when all three are implemented, the chain of transmission can be shattered.

Until a vaccine or treatment is developed, such nonpharmaceutical interventions are the only tools countries can rely on — besides locking down their cities.

to expand that in a country as large as the United States will require a massive dose of money, leadership and political will.

“You cannot have leaders contradicting each other every day. You cannot have states waiting on the federal government to act, and government telling the states to figure it out on their own,” he said. “You need a plan.”

When Vermont’s first coronavirus case was detected last month, it took two state health workers a day to track down 13 people who came into contact with that single patient. They put them under quarantine and started monitoring for symptoms. No one else became sick.

He did the math: If each of those 30 patients had contact with even three people, that meant 90 people his crew would have to locate and get into quarantine. In other words, impossible.

Since 2008, city and county health agencies have lost almost a quarter of their overall workforce. Decades of budget cuts have left the them unable to mount such a response. State health departments have recently had to lay off thousands more — an unintended consequence of federal officials delaying tax filings until July without warning states.

In Wuhan, a city of 11 million, the Chinese had 9,000 health workers doing contact tracing, said Frieden, the former CDC director. He estimates authorities would need roughly one contact tracer for every four cases in the United States.

“In the second wave, we have to have testing, a resource base, and a contact-tracing base that is so much more scaled up than right now,” he said. “It’s an enormous challenge.”

Gov. Charlie Baker (R) partnered with an international nonprofit group based in Boston

“You will never beat a virus like this one unless you get ahead of it. America must not just flatten the curve but get ahead of the curve.”

The group is paying new hires roughly the same salary as census takers, more than $20 an hour. As of Tuesday — just four days after the initial announcement — the group had received 7,000 applicants and hired 150.

“There’s a huge untapped resource of people in America if we would just ask.”

“There needs to be a crash course in contact tracing because a lot of the health departments where this is going to need to happen are already kind of flat-out just trying to respond to the crisis at hand,”

Experts have proposed transforming the Peace Corps — which suspended global operations last month and recalled 7,000 volunteers to America — into a national response corps that could perform many tasks, including contact tracing.

On Wednesday, the editor in chief of JAMA, a leading medical journal, proposed suspending the first year of training for America’s 20,000 incoming medical students and deploying them as a medical corps to support the “test, trace, track, and quarantine strategy.”

The national organization for local STD programs says $200 million could add roughly 1,850 specialists, more than doubling that current workforce.

Technology could also turn out to be pivotal. But the invasive nature of cellphone tracking and apps raises concerns about civil liberties.

Such technology could take over some of what contact tracers do in interviews: build a contact history for each confirmed patient and find those possibly exposed. Doing that digitally could speed up the process — critical in containing an outbreak — and less laborious.

In China, authorities combined the nation’s vast surveillance apparatus with apps and cellphone data to track people’s movements. If someone they came across is later confirmed as infected, an app alerts them to stay at home.

In the United States, about 20 technology companies are trying to create a contact tracing app using geolocation data or Bluetooth pings on cellphones

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

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

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

More Americans may die than the White House admits.

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

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

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

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

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

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

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

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

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

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

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

The lockdowns will end, but haltingly.

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

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

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

Every epidemiological model envisions something like the dance

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

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

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

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

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

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

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

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

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

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

Immunity will become a societal advantage.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Still, experts were divided on the idea of such wards

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

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

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

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

There will not be a vaccine soon.

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

the record is four years, for the mumps vaccine.

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

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

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

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

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

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

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

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

Treatments are likely to arrive first.

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

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

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

Goodbye, ‘America First.’

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

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

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

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

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

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

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

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

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

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

He praised Republican Gov. Mike DeWine for taking bold steps early, including declaring a state of emergency when there were only three reported cases on March 9, four days before the federal government followed suit. Thirty states had declared a state of emergency by the time Trump declared a national emergency on March 13.

“They didn’t move fast enough,” said Crossley, of the federal government. “And what you’ve seen is more local and state officials sounding the alarm. “We needed a national response to this event.”

With seven reported infections in the United States by the end of the day, Health and Human Services Secretary Alex Azar declared a public health emergency on Jan. 31, and Trump announced strict travel restrictions, barring most foreign visitors coming from China. He also imposed the nation’s first mandatory quarantine in 50 years.

Officials spent three hours war-gaming how they would respond. The drill prompted the state to send 300 employees home early to test their remote work capability. That unmasked a serious problem: A quarter of the team could not perform their jobs at home because they needed access to secure computer systems.

Then he heard the news: The United States had identified its first case of person-to-person transmission involving someone who had not traveled overseas. Also, the World Health Organization classified the coronavirus as a public health emergency of international concern.

Chicago Jan. 31: 9,927 cases worldwide, seven cases in the United States

Tallahassee Jan. 30: 8,234 cases worldwide, five cases in the United States

“We are concerned about our public health system’s capacity to implement these measures, recognizing they may inadvertently distract us from our ongoing tried-and-true efforts to isolate confirmed cases and closely monitor their contacts,” according to a previously unreported Feb. 6 letter. “We also worry about the potential to again overwhelm laboratory capacity, recognizing that national capacity has not been adequate to quickly test our highest-risk individuals.”

“In the first few sets of conversations, we were not hearing answers to those questions,” Lightfoot, a Democrat, said of her talks with federal officials. “It was kind of like, either silence, or ‘Do the best you can,’ which was obviously not acceptable.”

she drafted a letter to Trump on behalf of the mayors from Detroit, Los Angeles, New York, San Francisco and Seattle. They insisted on clear, written directions from the federal government, according to the letter, and worried about diverting health-care resources during flu season, when hospitals were already stretched.

Americans who had visited China’s Hubei province would be forced to quarantine for 14 days, and those who visited other parts of China would be screened for symptoms and asked to isolate themselves for two weeks. Chicago Mayor Lori Lightfoot was caught off guard. The directive came with little guidance. Where were local governments supposed to quarantine the travelers? What would they do if someone refused to quarantine? Who was going to pay for the resources needed to quarantine people?

Mount Kisco, N.Y. Feb. 9: 40,150 cases worldwide, 11 cases in the United States

Weeks earlier, Amler had started fitting employees for personal protective equipment and training them on how to use the gear. In January, she watched what was happening in Wuhan with growing concern: “It seemed impossible that it wouldn’t eventually spill out of China into the rest of the world.”

San Francisco Feb. 24: 79,561 cases worldwide, 51 cases in the United States

Trump continued to reassure the public that there was little to worry about. On Feb. 24, he tweeted, “The Coronavirus is very much under control in the USA.”

But Colfax and his public health staff in San Francisco were seeing something else when they studied the “curves” of the pandemic — graphs showing how many cases were reported in other regions over time.

Wuhan’s curve was climbing exponentially, and other countries, such as Italy, were seeing soaring infection rates as well. Colfax noticed that in every infected region, officials were more and more aggressive about restricting their populations

“It became apparent that no jurisdiction that was where the virus was being introduced, was sort of, in retrospect, thinking, ‘Oh, we overreacted,’ ” Colfax said.

On Feb. 24, Colfax and other health officials assembled their research and met with Mayor London Breed. They made an urgent request: Declare a state of emergency

by the end of the meeting, Breed was convinced. They needed to declare a state of emergency so that they could tap into state and federal funds and supplies, and redeploy city employees. The next day, San Francisco became one of the first major cities in the United States to do so, after Santa Clara and San Diego counties did earlier in the month.

It would take another 17 days, as the virus infected people in nearly every state, before Trump declared a national emergency.

In New Orleans, officials moved ahead with Mardi Gras festivities in late February that packed people into the streets. It was a decision the mayor would later defend as coronavirus cases traced to the celebration piled up.

On Feb. 27, at a White House reception, Trump predicted that the coronavirus would disappear. “Like a miracle,” he said.

“No red flags were given,” by the federal government, New Orleans Mayor LaToya Cantrell, a Democrat, later said in a CNN interview. “If we were given clear direction, we would not have had Mardi Gras, and I would’ve been the leader to cancel it.

San Antonio Feb. 29: 86,011 cases worldwide, 68 cases in the United States

The last day of February marked a major turning point for the coronavirus in the United States: The first American who had been diagnosed with the illness died

In a Saturday news conference, Trump described the patient from the Seattle area as a “medically high-risk” person who had died overnight. A CDC official said that the man, who was in his 50s, had not traveled recently — another sign that the virus was snaking through local communities.

During the announcement, Trump asked the media to avoid inciting panic as there was “no reason to panic at all.”

“We’re doing really well,” he said. “Our country is prepared for any circumstance. We hope it’s not going to be a major circumstance, it’ll be a smaller circumstance. But whatever the circumstance is, we’re prepared.”

That same afternoon in San Antonio, the CDC mistakenly released a woman from quarantine who was infected. The woman was one of dozens of evacuees from Wuhan whom the federal government had brought to a nearby military base and then isolated at the Texas Center for Infectious Disease.

the woman had been dropped off at a Holiday Inn near the San Antonio airport and headed to a mall where she shopped at Dillard’s, Talbots and Swarovski and ate in the food court.

As local officials learned details about the infected woman’s movements and how she had been transported at 2 a.m. back to the Texas Center for Infectious Disease, they waited for the CDC to issue a statement. Hours passed, but they heard nothing. “They were like quiet little mouses,” Wolff said. “They were all scared to talk because I think they felt they were going to get in trouble with the president of the United States because he was saying there was not a problem.”

The next day, San Antonio officials declared a public health emergency and filed a lawsuit to prevent the CDC from releasing the 120 people in quarantine until they were confirmed negative for the virus or completed a 28-day quarantine. A judge denied the motion, but the CDC agreed that evacuees must have two consecutive negative tests that are 24 hours apart and that no one with a pending test can be released.

In Oklahoma City, the coronavirus became a reality for Mayor David Holt, a Republican, when the NBA abruptly canceled a Thunder basketball game after a Utah Jazz player tested positive on March 11. Until then, Holt said, the coronavirus felt “distant on many levels.”

Mount Kisco, N.Y. March 3: 92,840 cases worldwide, 118 cases in the United States

Within days, state authorities set up an emergency operations center in New Rochelle and created a one-mile containment zone. Inside the perimeter, schools and community centers shuttered and large gatherings were prohibited.

Through it all, local officials faced backlash from some community leaders who thought they were overreacting.

San Francisco March 5: 97,886 cases worldwide, 217 cases in the United States

Days after San Francisco’s emergency declaration, Breed stood in front of news cameras to announce the city’s first two cases of the coronavirus.

They were not related, had not traveled to any coronavirus-affected areas and had no contact with known coronavirus patients: It was spreading in the community.

By then, Miami Mayor Francis X. Suarez, a Republican, had announced the cancellation of the Ultra Music festival, a three-day celebration that draws about 50,000 people. Miami was the first city to call off a major music festival, and Suarez faced tremendous backlash

When he tried to order more masks, none were immediately available. By then the entire country was scrambling for protective gear.

Days later, Holt huddled on the phone with other leaders from the United States Conference of Mayors. For about 20 minutes, Seattle Mayor Jenny Durkan, a Democrat, detailed the crisis seizing her city

“She sounded like the main character in a Stephen King novel,” Holt recalled. “She had hundreds of cases, she had dozens of deaths.”

“Any struggles that we’re having, whether it be testing or other issues, or even just convincing our public of the seriousness of the matter, there are some roots back to the time period in January and February, when not all national leadership was expressing how serious this was,” Holt said.

While the mayors held their conference call on March 13, Trump declared a national emergency to combat the coronavirus.

By then, Suarez had tested positive for the coronavirus and was in quarantine. As of Sunday, he remained in isolation, leading the city by phone calls and video chats. He wanted to stop flights into Miami and the governor to order residents to shelter in place as California and other states had already done.

In no other high-income country — and in only a few countries, period — have political leaders departed from expert advice as frequently and significantly as the Trump administration. President Trump has said the virus was not serious; predicted it would disappear; spent weeks questioning the need for masks; encouraged states to reopen even with large and growing caseloads; and promoted medical disinformation.

many agree that the poor results in the United States stem in substantial measure from the performance of the Trump administration.

“As an American, I think there is a lot of good to be said about our libertarian tradition,” Dr. Jared Baeten, an epidemiologist and vice dean at the University of Washington School of Public Health, said. “But this is the consequence — we don’t succeed as well as a collective.”

That tradition is one reason the United States suffers from an unequal health care system that has long produced worse medical outcomes — including higher infant mortality and diabetes rates and lower life expectancy — than in most other rich countries.

First, the United States faced longstanding challenges in confronting a major pandemic. It is a large country at the nexus of the global economy, with a tradition of prioritizing individualism over government restrictions.

The New York Times set out to reconstruct the unique failure of the United States, through numerous interviews with scientists and public health experts around the world. The reporting points to two central themes.

When it comes to the virus, the United States has come to resemble not the wealthy and powerful countries to which it is often compared but instead far poorer countries, like Brazil, Peru and South Africa, or those with large migrant populations, like Bahrain and Oman.

That’s more than five times as many as in all of Europe, Canada, Japan, South Korea and Australia, combined.

Over the past month, about 1.9 million Americans have tested positive for the virus.

one country stands alone, as the only affluent nation to have suffered a severe, sustained outbreak for more than four months: the United States.

Nearly every country has struggled to contain the coronavirus and made mistakes along the way.

it quickly became clear that the United States’ policy was full of holes. It did not apply to immediate family members of American citizens and permanent residents returning from China, for example. In the two months after the policy went into place, almost 40,000 people arrived in the United States on direct flights from China.

On Jan. 31, his administration announced that it was restricting entry to the United States from China: Many foreign nationals — be they citizens of China or other countries — would not be allowed into the United States if they had been to China in the previous two weeks.

A travel policy that fell short

In retrospect, one of Mr. Trump’s first policy responses to the virus appears to have been one of his most promising.

The administration’s policy also did little to create quarantines for people who entered the United States and may have had the virus.

ven more important, the policy failed to take into account that the virus had spread well beyond China by early February. Later data would show that many infected people arriving in the United States came from Europe

South Korea, Hong Kong and Taiwan largely restricted entry to residents returning home. Those residents then had to quarantine for two weeks upon arrival

South Korea and Hong Kong also tested for the virus at the airport and transferred anyone who was positive to a government facility.

“People need a bit more than a suggestion to look after their own health,” said Dr. Mackay, who has been working with Australian officials on their pandemic response. “They need guidelines, they need rules — and they need to be enforced.”

Travel restrictions and quarantines were central to the success in controlling the virus in South Korea, Hong Kong, Taiwan and Australia, as well as New Zealand, many epidemiologists believe. In Australia, the number of new cases per day fell more than 90 percent in April. It remained near zero through May and early June, even as the virus surged across much of the United States.

the tolls in Australia and the United States remain vastly different. Fewer than 300 Australians have died of complications from Covid-19, the illness caused by the virus. If the United States had the same per capita death rate, about 3,300 Americans would have died, rather than 158,000.

there is a good chance that a different version of Mr. Trump’s restrictions — one with fewer holes and stronger quarantines — would have meaningfully slowed the virus’s spread.

travel restrictions had been successful enough in fighting the coronavirus around the world that those views may need to be revisited.“Travel,” he said, “is the hallmark of the spread of this virus around the world.”

Traditionally, public health experts had not seen travel restrictions as central to fighting a pandemic, given their economic costs and the availability of other options, like testing, quarantining and contact tracing

But he added that

By early March, with the testing delays still unresolved, the New York region became a global center of the virus — without people realizing it until weeks later. More widespread testing could have made a major difference, experts said, leading to earlier lockdowns and social distancing and ultimately less sickness and death.

While the C.D.C. was struggling to solve its testing flaws, Germany was rapidly building up its ability to test. Chancellor Angela Merkel, a chemist by training, and other political leaders were watching the virus sweep across northern Italy, not far from southern Germany, and pushed for a big expansion of testing.

By the time the virus became a problem in Germany, labs around the country had thousands of test kits ready to use. From the beginning, the government covered the cost of the tests. American laboratories often charge patients about $100 for a test.

Without free tests, Dr. Hendrik Streeck, director of the Institute of Virology at the University Hospital Bonn, said at the time, “a young person with no health insurance and an itchy throat is unlikely to go to the doctor and therefore risks infecting more people.”

Germany was soon far ahead of other countries in testing. It was able to diagnose asymptomatic cases, trace the contacts of new patients and isolate people before they could spread the virus. The country has still suffered a significant outbreak. But it has had many fewer cases per capita than Italy, Spain, France, Britain or Canada — and about one-fifth the rate of the United States.

One measure of the continuing troubles with testing is the percentage of tests that come back positive. In a country that has the virus under control, fewer than 5 percent of tests come back positive, according to World Health Organization guidelines. Many countries have reached that benchmark. The United States, even with the large recent volume of tests, has not.

In Belgium recently, test results have typically come back in 48 to 72 hours. In Germany and Greece, it is two days. In France, the wait is often 24 hours.

The conflicting advice, echoed by the C.D.C. and others, led to relatively little mask wearing in many countries early in the pandemic. But several Asian countries were exceptions, partly because they had a tradition of mask wearing to avoid sickness or minimize the effects of pollution.

The double mask failure

By January, mask wearing in Japan was widespread, as it often had been during a typical flu season. Masks also quickly became the norm in much of South Korea, Thailand, Vietnam, Taiwan and China.

In the following months, scientists around the world began to report two strands of evidence that both pointed to the importance of masks: Research showed that the virus could be transmitted through droplets that hang in the air, and several studies found that the virus spread less frequently in places where people were wearing masks.

we see the classic “Confucian values” (or “Asian values”) argument that has historically been deployed to explain everything from the economic success of East Asian nations to the prevalence of authoritarian single-party rule in Asia, and even, most recently, China’s supposed edge in AI research.

So, yeah, kudos to Taiwan for keeping its people safe, but here in America we’re going to do what we always do in a crisis—line up at a gun store and accuse the opposing political party of acting in bad faith. Not for us, those Asian values.

But the truth is that Taiwan, one of Asia’s most vibrant and boisterous democracies, is a terrible example to cite as a cultural other populated by submissive peons

Taiwan’s self-confidence and collective solidarity trace back to its triumphal self-liberation from its own authoritarian past, its ability to thrive in the shadow of a massive, hostile neighbor that refuses to recognize its right to chart its own path, and its track record of learning from existential threats.

There is no doubt that in January it would have been difficult for the US to duplicate Taiwan’s containment strategy, but that’s not because Americans are inherently more ornery than Taiwanese

It’s because the United States has a miserable record when it comes to learning from its own mistakes and suffers from a debilitating lack of faith in the notion that the government can solve problems—something that dates at least as far back as the moment in 1986 when Ronald Reagan said, “The nine most terrifying words in the English language are: ‘I’m from the government and I’m here to help.’”

The Taiwan-US comparison is the opposite of a clash of civilizations; instead, it’s a deathly showdown between competence and incompetence.

To be fair, there are some cultural aspects of East Asian societies that may work in Taiwan’s favor

There is undeniably a long tradition in East Asia of elevating scholars and experts to the highest levels of government,

The country’s president Tsai Ingwen, boasts a PhD from the London School of Economics, and the vice president, Chen Chien-jen, is a highly regarded epidemiologist

The threat of SARS put Taiwan on high alert for future outbreaks, while the past record of success at meeting such challenges seems to have encouraged the public to accept socially intrusive technological interventions.

First, and most important was Taiwan’s experience battling the SARS outbreak in 2003, followed by the swine flu in 2009

“Taiwan actually has a functioning democratic government, run by sensible, well-educated people—the USA? Not so much.”)

Taiwan’s commitment to transparency has also been critical

In the United States, the Trump administration ordered federal health authorities to treat high-level discussions on the coronavirus as classified material.

In Taiwan, the government has gone to great lengths to keep citizens well informed on every aspect of the outbreak, including daily press conferences and an active presence on social media

“Do not forget that Taiwan has been under China’s threat constantly,” wrote Wang Cheng-hua, a professor of art history at Princeton, “which has raised social consciousness about collective action. When the collective will supports government, then all of the strict measures implemented by the government make sense.”

Over the past quarter-century, Taiwan’s government has nurtured public trust by its actions and its transparency.

The democracy activists who risked their lives and careers during the island nation’s martial law era were not renowned for their willingness to accept government orders or preach Confucian social harmony

some of the current willingness to trust what the government is telling the people is the direct “result of having experienced the transition from an authoritarian government that lied all the time, to a democratic government and robust political dialogue that forced people to be able to evaluate information.”

Because of the opposition of the People’s Republic of China, Taiwan is not a member of the United Nations or the World Health Organization

“The reality of being isolated from global organizations,” wrote Tung, “also makes Taiwanese very aware of the publicity of its success in handling a crisis like this. The more coverage from foreign media, the more people feel confident in government policy and social mobilization.”

Given what we know about Taiwan’s hard-won historical experience, could the US have implemented a similar model?

The answer, sadly, seems to be no

it would be impossible for the US to successfully integrate a health care database with customs and travel records because there is no national health care database in the United States. “The US health care system is fragmented, making it difficult to organize, integrate, and assess data coming in from its various government and private-sector parts,”

more tellingly, continued Fidler, “the manner in which the United States has responded to Covid-19 demonstrates that the United States did not learn the lessons from past outbreaks and is struggling to cobble together a semblance of a strategy. ”

There’s where the contrast between the United States and Taiwan becomes most salient. The US is not only bad at the act of government but has actively been getting worse.

But Taiwan’s own success at building a functional democracy is probably the most potent rebuke to the Asian values thesis.

But over that same period, powerful political and economic interests in the US have dedicated themselves to undermining faith in government action, in favor of deregulated markets that have no capacity to react intelligently or proactively to existential threats.

And instead of learning from history, US leaders actively ignore it, a truth for which there could be no better symbolic proof than the Trump administration’s dismantling of the National Security Council pandemic office created by the Obama administration in the wake of the Ebola outbreak

Finally, instead of seeking to keep the public informed to the best of our ability, some of our political leaders and media institutions have gone out of their way to muddy the waters.

In Taiwan, one early government response to the Covid-19 outbreak was to institute a fine of $100,000 for the act of spreading fake news about the epidemic.

In the US the most popular television news network in the country routinely downplayed or misrepresented the threat of the coronavirus, until the severity of the outbreak became too large to ignore.

If there is any silver lining here, it’s that the disaster now upon us is of such immense scope that it could finally expose the folly of the structural forces that have been wreaking sustained havoc on American governmental institutions

So maybe we are finally about to learn that competence matters, that educated leaders are a virtue, and that telling the truth is a responsibility

Americans might have to learn this the hard way, like we did in Hong Kong and Singapore.”

We’re about to find out how hard it’s going to be. But will we learn?

Today, in the case of COVID-19, “all states face the same essential threat, and each government’s response is a kind of laboratory experiment,” Tierney said.

“The United States had the advantage of being struck relatively late by the virus, and this gave [us] a priceless chance to copy best practices and avoid the mistakes of others,” he noted.

When China began confining millions of people to their homes in January, the U.S. government should have gotten the message that the Chinese were grappling with a grave threat to the wider world, the Yale sociologist and physician Nicholas Christakis told me in March.

We lost six weeks” in the United States to prepare—“to build ventilators, get protective equipment, organize our ICUs, get tests ready, prepare the public for what was going to happen so that our economy didn’t tank as badly. None of this was done adequately by our leaders.”

By one estimate, from the epidemiologists Britta L. Jewell and Nicholas P. Jewell, if social-distancing policies had been implemented just two weeks earlier in March, 90 percent of the cumulative coronavirus deaths in the United States during the first wave of the pandemic might have been prevented.

Rather than using diagnostic tests that the World Health Organization had distributed to other countries early in the global outbreak, the Centers for Disease Control and Prevention insisted on developing its own, only to botch the rollout of those tests.

Even now, as a number of countries have swum feverishly toward safer ground, the United States has spent the past couple of months of near-nationwide lockdown merely treading water. It has yet to roll out robust testing across the country

It has also failed to develop proper contact-tracing systems, as other nations have, and to meaningfully flatten the curve outside New York.

Amid all this, Trump has exhibited more hubris than humility. The president has repeatedly claimed that the United States is leading the world in testing, which in part is an unflattering reflection of the U.S. outbreak’s huge scale and also is not true on a per-capita basis

As an example of ideas the United States could borrow from other countries, Tierney cited the fact that 750,000 people in Britain, which would be equivalent to nearly 4 million Americans, responded to the British government’s request to enlist in a “volunteer army” to help deliver food to vulnerable populations and provide other assistance.

A number of countries that have had more success against the coronavirus have demonstrated greater open-mindedness about learning from their peers. Taiwanese officials are watching Iceland’s mass-testing efforts, while the German government is explicitly modeling its response after South Korea’s “trace, test, and treat” campaign.

“Things have moved so quickly that there hasn't been much time for considered lesson-drawing,” he noted. Some countries were slow to institute strict lockdowns, despite witnessing the horrifying spread of the virus in Italy, while others “embraced approaches that broke with the broader consensus,” including “Sweden’s proposal

New Zealand’s record of learning

His colleague at the University of Otago, Michael Baker, told me that as a government adviser on the nation’s coronavirus taskforce, he was personally very influenced by a February 2020 WHO-China Joint Mission report, which suggested that the pandemic could be contained, and led him to advocate for New Zealand’s current strategy of eliminating the virus entirely from the country.

Yet Wilson added that New Zealand has lagged behind Asian countries in encouraging mass mask wearing, in rigorously quarantining incoming travelers, and in using digital technologies for contact tracing

In the United States too, even before the virus hit, attitudes toward learning from other countries were beginning to change

“The No. 1 place to live out the American Dream right now is Denmark,” Pete Buttigieg stated during one debate.

as a senator, Romney is urging the U.S. government to follow South Korea’s lead and “learn from those countries that were successful” in dealing with their outbreaks. Conservatives are championing Sweden’s laissez-faire approach as a blueprint for how to mitigate public-health damage while preserving freedom and the economy.

with the exception of the U.S. Paycheck Protection Program, “most of our economic-policy response has ignored useful lessons from abroad, explaining why our unemployment rate is skyrocketing above those in many other affected countries.”

Kelemen noted that the coronavirus crisis has led to a surge in interest among the American public and U.S. policy makers in harvesting lessons from other countries, most evident in the fact that everyone is following “the comparative charts of how countries are doing over time on infection rates or changes in year-on-year death counts.

To contain such a pathogen, nations must develop a test and use it to identify infected people, isolate them, and trace those they’ve had contact with. That is what South Korea, Singapore, and Hong Kong did to tremendous effect. It is what the United States did not.

That a biomedical powerhouse like the U.S. should so thoroughly fail to create a very simple diagnostic test was, quite literally, unimaginable. “I’m not aware of any simulations that I or others have run where we [considered] a failure of testing,”

The testing fiasco was the original sin of America’s pandemic failure, the single flaw that undermined every other countermeasure. If the country could have accurately tracked the spread of the virus, hospitals could have executed their pandemic plans, girding themselves by allocating treatment rooms, ordering extra supplies, tagging in personnel, or assigning specific facilities to deal with COVID-19 cases.

None of that happened. Instead, a health-care system that already runs close to full capacity, and that was already challenged by a severe flu season, was suddenly faced with a virus that had been left to spread, untracked, through communities around the country.

With little room to surge during a crisis, America’s health-care system operates on the assumption that unaffected states can help beleaguered ones in an emergency.

That ethic works for localized disasters such as hurricanes or wildfires, but not for a pandemic that is now in all 50 states. Cooperation has given way to competition

Partly, that’s because the White House is a ghost town of scientific expertise. A pandemic-preparedness office that was part of the National Security Council was dissolved in 2018. On January 28, Luciana Borio, who was part of that team, urged the government to “act now to prevent an American epidemic,” and specifically to work with the private sector to develop fast, easy diagnostic tests. But with the office shuttered, those warnings were published in The Wall Street Journal, rather than spoken into the president’s ear.

Rudderless, blindsided, lethargic, and uncoordinated, America has mishandled the COVID-19 crisis to a substantially worse degree than what every health expert I’ve spoken with had feared. “Much worse,”

“Beyond any expectations we had,” said Lauren Sauer, who works on disaster preparedness at Johns Hopkins Medicine. “As an American, I’m horrified,” said Seth Berkley, who heads Gavi, the Vaccine Alliance. “The U.S. may end up with the worst outbreak in the industrialized world.”

it will be difficult—but not impossible—for the United States to catch up. To an extent, the near-term future is set because COVID-19 is a slow and long illness. People who were infected several days ago will only start showing symptoms now, even if they isolated themselves in the meantime. Some of those people will enter intensive-care units in early April

A “massive logistics and supply-chain operation [is] now needed across the country,” says Thomas Inglesby of Johns Hopkins Bloomberg School of Public Health. That can’t be managed by small and inexperienced teams scattered throughout the White House. The solution, he says, is to tag in the Defense Logistics Agency—a 26,000-person group that prepares the U.S. military for overseas operations and that has assisted in past public-health crises, including the 2014 Ebola outbreak.

The first and most important is to rapidly produce masks, gloves, and other personal protective equipment

it would also come at a terrible cost: SARS-CoV-2 is more transmissible and fatal than the flu, and it would likely leave behind many millions of corpses and a trail of devastated health systems.

This agency can also coordinate the second pressing need: a massive rollout of COVID-19 tests.

These measures will take time, during which the pandemic will either accelerate beyond the capacity of the health system or slow to containable levels. Its course—and the nation’s fate—now depends on the third need, which is social distancing.

There are now only two groups of Americans. Group A includes everyone involved in the medical response, whether that’s treating patients, running tests, or manufacturing supplies. Group B includes everyone else, and their job is to buy Group A more time. Group B must now “flatten the curve” by physically isolating themselves from other people to cut off chains of transmission.

Given the slow fuse of COVID-19, to forestall the future collapse of the health-care system, these seemingly drastic steps must be taken immediately, before they feel proportionate, and they must continue for several weeks.

Persuading a country to voluntarily stay at home is not easy, and without clear guidelines from the White House, mayors, governors, and business owners have been forced to take their own steps.

when the good of all hinges on the sacrifices of many, clear coordination matters—the fourth urgent need

Pundits and business leaders have used similar rhetoric, arguing that high-risk people, such as the elderly, could be protected while lower-risk people are allowed to go back to work. Such thinking is seductive, but flawed. It overestimates our ability to assess a person’s risk, and to somehow wall off the ‘high-risk’ people from the rest of society. It underestimates how badly the virus can hit ‘low-risk’ groups, and how thoroughly hospitals will be overwhelmed if even just younger demographics are falling sick.

A recent analysis from the University of Pennsylvania estimated that even if social-distancing measures can reduce infection rates by 95 percent, 960,000 Americans will still need intensive care.

There are only about 180,000 ventilators in the U.S. and, more pertinently, only enough respiratory therapists and critical-care staff to safely look after 100,000 ventilated patients. Abandoning social distancing would be foolish. Abandoning it now, when tests and protective equipment are still scarce, would be catastrophic.

If Trump stays the course, if Americans adhere to social distancing, if testing can be rolled out, and if enough masks can be produced, there is a chance that the country can still avert the worst predictions about COVID-19, and at least temporarily bring the pandemic under control. No one knows how long that will take, but it won’t be quick. “It could be anywhere from four to six weeks to up to three months,” Fauci said, “but I don’t have great confidence in that range.”

there are three possible endgames: one that’s very unlikely, one that’s very dangerous, and one that’s very long.

The first is that every nation manages to simultaneously bring the virus to heel, as with the original SARS in 2003. Given how widespread the coronavirus pandemic is, and how badly many countries are faring, the odds of worldwide synchronous control seem vanishingly small.

The second is that the virus does what past flu pandemics have done: It burns through the world and leaves behind enough immune survivors that it eventually struggles to find viable hosts. This “herd immunity” scenario would be quick, and thus tempting

The U.S. has fewer hospital beds per capita than Italy. A study released by a team at Imperial College London concluded that if the pandemic is left unchecked, those beds will all be full by late April. By the end of June, for every available critical-care bed, there will be roughly 15 COVID-19 patients in need of one.  By the end of the summer, the pandemic will have directly killed 2.2 million Americans,

The third scenario is that the world plays a protracted game of whack-a-mole with the virus, stamping out outbreaks here and there until a vaccine can be produced. This is the best option, but also the longest and most complicated.

there are no existing vaccines for coronaviruses—until now, these viruses seemed to cause diseases that were mild or rare—so researchers must start from scratch.

The first steps have been impressively quick. Last Monday, a possible vaccine created by Moderna and the National Institutes of Health went into early clinical testing. That marks a 63-day gap between scientists sequencing the virus’s genes for the first time and doctors injecting a vaccine candidate into a person’s arm. “It’s overwhelmingly the world record,” Fauci said.

The initial trial will simply tell researchers if the vaccine seems safe, and if it can actually mobilize the immune system. Researchers will then need to check that it actually prevents infection from SARS-CoV-2. They’ll need to do animal tests and large-scale trials to ensure that the vaccine doesn’t cause severe side effects. They’ll need to work out what dose is required, how many shots people need, if the vaccine works in elderly people, and if it requires other chemicals to boost its effectiveness.

No matter which strategy is faster, Berkley and others estimate that it will take 12 to 18 months to develop a proven vaccine, and then longer still to make it, ship it, and inject it into people’s arms.

as the status quo returns, so too will the virus. This doesn’t mean that society must be on continuous lockdown until 2022. But “we need to be prepared to do multiple periods of social distancing,” says Stephen Kissler of Harvard.

First: seasonality. Coronaviruses tend to be winter infections that wane or disappear in the summer. That may also be true for SARS-CoV-2, but seasonal variations might not sufficiently slow the virus when it has so many immunologically naive hosts to infect.

Second: duration of immunity. When people are infected by the milder human coronaviruses that cause cold-like symptoms, they remain immune for less than a year. By contrast, the few who were infected by the original SARS virus, which was far more severe, stayed immune for much longer.

scientists will need to develop accurate serological tests, which look for the antibodies that confer immunity. They’ll also need to confirm that such antibodies actually stop people from catching or spreading the virus. If so, immune citizens can return to work, care for the vulnerable, and anchor the economy during bouts of social distancing.

Aspects of America’s identity may need rethinking after COVID-19. Many of the country’s values have seemed to work against it during the pandemic. Its individualism, exceptionalism, and tendency to equate doing whatever you want with an act of resistance meant that when it came time to save lives and stay indoors, some people flocked to bars and clubs.

“We can keep schools and businesses open as much as possible, closing them quickly when suppression fails, then opening them back up again once the infected are identified and isolated. Instead of playing defense, we could play more offense.”

The vaccine may need to be updated as the virus changes, and people may need to get revaccinated on a regular basis, as they currently do for the flu. Models suggest that the virus might simmer around the world, triggering epidemics every few years or so. “But my hope and expectation is that the severity would decline, and there would be less societal upheaval,”

After infections begin ebbing, a secondary pandemic of mental-health problems will follow.

But “there is also the potential for a much better world after we get through this trauma,”

Testing kits can be widely distributed to catch the virus’s return as quickly as possible. There’s no reason that the U.S. should let SARS-CoV-2 catch it unawares again, and thus no reason that social-distancing measures need to be deployed as broadly and heavy-handedly as they now must be.

Pandemics can also catalyze social change. People, businesses, and institutions have been remarkably quick to adopt or call for practices that they might once have dragged their heels on, including working from home, conference-calling to accommodate people with disabilities, proper sick leave, and flexible child-care arrangements.

Perhaps the nation will learn that preparedness isn’t just about masks, vaccines, and tests, but also about fair labor policies and a stable and equal health-care system. Perhaps it will appreciate that health-care workers and public-health specialists compose America’s social immune system, and that this system has been suppressed.

Attitudes to health may also change for the better. The rise of HIV and AIDS “completely changed sexual behavior among young people who were coming into sexual maturity at the height of the epidemic,”

Years of isolationist rhetoric had consequences too.

“People believed the rhetoric that containment would work,” says Wendy Parmet, who studies law and public health at Northeastern University. “We keep them out, and we’ll be okay. When you have a body politic that buys into these ideas of isolationism and ethnonationalism, you’re especially vulnerable when a pandemic hits.”

Pandemics are democratizing experiences. People whose privilege and power would normally shield them from a crisis are facing quarantines, testing positive, and losing loved ones. Senators are falling sick. The consequences of defunding public-health agencies, losing expertise, and stretching hospitals are no longer manifesting as angry opinion pieces, but as faltering lungs.

After COVID-19, attention may shift to public health. Expect to see a spike in funding for virology and vaccinology, a surge in students applying to public-health programs, and more domestic production of medical supplies.

The lessons that America draws from this experience are hard to predict, especially at a time when online algorithms and partisan broadcasters only serve news that aligns with their audience’s preconceptions.

“The transitions after World War II or 9/11 were not about a bunch of new ideas,” he says. “The ideas are out there, but the debates will be more acute over the next few months because of the fluidity of the moment and willingness of the American public to accept big, massive changes.”

One could easily conceive of a world in which most of the nation believes that America defeated COVID-19. Despite his many lapses, Trump’s approval rating has surged. Imagine that he succeeds in diverting blame for the crisis to China, casting it as the villain and America as the resilient hero.

One could also envisage a future in which America learns a different lesson. A communal spirit, ironically born through social distancing, causes people to turn outward, to neighbors both foreign and domestic. The election of November 2020 becomes a repudiation of “America first” politics. The nation pivots, as it did after World War II, from isolationism to international cooperation

The U.S. leads a new global partnership focused on solving challenges like pandemics and climate change.

In 2030, SARS-CoV-3 emerges from nowhere, and is brought to heel within a month.

On the Global Health Security Index, a report card that grades every country on its pandemic preparedness, the United States has a score of 83.5—the world’s highest. Rich, strong, developed, America is supposed to be the readiest of nations. That illusion has been shattered. Despite months of advance warning as the virus spread in other countries, when America was finally tested by COVID-19, it failed.

The study reveals, for the first time, the genetic sequence of the virus that may have infected Mr. Trump and dozens of others, researchers said.

In a study released on Thursday, the C.D.C. cited genetic sequencing and intensive contact tracing that documented an super-spreading event at a high school retreat in Wisconsin.

The genomes believed by these researchers to be connected to the White House outbreak do not identify a recent geographic source, in part because they are unusual.

The results show that even weeks after it was identified, the White House outbreak would be better understood by sequencing samples of more people who were infected.

Viruses constantly mutate, picking up tiny, accidental alterations to their genetic material as they reproduce. Few mutations alter how a virus functions. But by comparing patterns of mutations across many genetic sequences, scientists can construct family trees of a virus, illuminating how it spreads.

But the Trump administration is not known to have conducted its own genetic analysis of people infected in the outbreak. The White House declined to respond to questions on genetic sequencing of Mr. Trump and the cluster of aides and officials who tested positive or became ill.

Scientists not involved in the research who reviewed the results agreed with the conclusion that the two samples sharing rare mutations strongly suggested they are part of the same outbreak.

“These genomes are probably going to be identical or nearly identical to the genome that infected the president,” said Michael Worobey, head of the department of ecology and evolutionary biology at the University of Arizona.

For months, the White House minimized the threat of the virus and eschewed basic safety precautions at official events, like wearing a mask or keeping people six feet apart.

At least 11 people who attended a Rose Garden celebration on Sept. 26 for Judge Barrett, which included an indoor event without masks, became infected with the coronavirus, including Mr. Trump.

The work is convincing, and it is the best way to piece together the progression of such an outbreak, said David Engelthaler, head of the infectious disease branch of the Translational Genomics Research Institute in Arizona, where he and colleagues have sequenced thousands of genomes to track the spread of the coronavirus, including devastating outbreaks at Native American reservations in the state.

South Korea’s economy is expected to decline by just 0.8% this year, the best among the Organization for Economic Cooperation and Development’s forecasts for member nations.

When the supply of face masks ran short early on in the crisis, the government seized production.

The nation fast-tracked approval of domestic testing kits as soon as cases began hitting

It tapped into its relative wealth and hyperconnectivity, blasting text alerts to citizens if infections occurred in their area

The key to South Korea’s success came from blending technology and testing like no other country, centralized control and communication—and a constant fear of failure.

“You don’t need or want to eradicate the virus. But you modify your behavior and get on with life.”

Nearly everyone in the country wears masks.

Every confirmed patient, even those with no or mild symptoms, gets isolated at hospitals or converted dormitories run by the government. Treatment is free.

As a result, South Korea never had to mandate a lockdown, so restaurants and business were able to stay open, cushioning the blow to the economy.

“No country has adapted to living with, and containing, the virus like South Korea,”

Some parts of its playbook wouldn’t work in most Western societies—and received backlash in South Korea as well

It detected the country’s first case 10 days later using a test that screened for all known coronavirus strains—the same tactic practiced during the December simulation.

Health officials have unfettered access to individuals’ private mobile data, and early on used government websites to share the whereabouts of confirmed patients, plucked from smartphone GPS history

The government now offers anonymous testing and leaves out identifying information and specific names of places visited in contact-tracing disclosures.

After a major cluster linked to a megachurch in the city of Daegu emerged on Feb. 18, the government made a flurry of moves

Cases peaked in 11 days.

The day after cases reached a five-month high of 441 on Aug. 27, South Korea’s top public-health official gave a grim forecast: “We could see 800 to 2,000 infections next week

South Koreans took the advice and adjusted. Population mobility, as measured by local telecom operators, soon fell by one-quarter. Most schools closed and diners had to leave restaurants by 9 p.m. Aug. 27 turned out to be the peak.

After two weeks of aggressive social distancing, South Koreans could again head back to schools, gyms and sports stadiums.

In total, South Korea, with a population of 52 million, has reported 23,455 cases and 395 deaths.

One reason South Korea was prepared: It learned painful lessons in 2015 from an outbreak of Middle East respiratory syndrome

“The only way to make the government prepared is to actually have an outbreak,”

After MERS, the government started twice-a-year training sessions simulating a rapid spread of viral disease

“Oddly enough, last December’s ‘war game’ was a novel coronavirus,”

At twice-a-day briefings, health officials express worry when they can only trace the origins of three-quarters of confirmed cases.

One firm, Kogene Biotech Co., demonstrated a successful test and got the regulatory green light within four days. A second manufacturer would be added by Feb. 12. The tests all used the same methodology and could be sent to any of the country’s roughly 120 laboratories that promised turnaround times of between six to 24 hours.

Cases, which had been slowly rising, suddenly doubled in a day, to over 100. Experts predicted it would soon surge to levels seen nowhere else but China.

That triggered a Feb. 20 late-night message in a group chat with eight South Korean infectious-disease experts: “We need to quickly devise a way to conduct mass testing,”

an answer: drive-through clinics.

Dr. Kim sent a PowerPoint presentation to the group within hours, at 3:53 a.m., outlining how tests would take just 10 minutes and saved much-needed protective gear since outdoor workers didn’t have to change gowns after each patient

Two days later, cars rumbled through the country’s first drive-through clinic. Testing capacity multiplied 100 times, giving South Korea a critical early edge.

As South Korea’s coronavirus problems mounted, Mr. Moon intentionally kept his profile low. “His stance is that it’s more objective for an expert to hold the briefings, and that is the way to gain the trust of the people,”

Even with the swift response, a lack of hospital beds became a major issue. In just 11 days, South Korea’s case count had gone from 31 to 3,150. Thousands were waiting to be hospitalized. A handful died while waiting.

South Korea’s infectious-disease experts had a proposal. Confirmed patients should be divided into four categories, based on the risk profile and severity of symptoms, with only the most serious cases hospitalized. Those with mild or no symptoms should be isolated at makeshift treatment facilities.

Dr. Peck set up a meeting with senior officials from the Samsung conglomerate, asking that an empty facility near Daegu be lent to the South Korean government. By first having a company volunteer a venue, Dr. Peck recalled thinking, it would pressure South Korea’s health ministry to act.

About 80% of South Korea’s coronavirus patients have been hospitalized in the community treatment centers. Those who are asymptomatic or have mild symptoms are still sent there.

That changed in August. Unlike February’s outbreak, the new wave of infections fanned out across South Korea to all 15 of the country’s major cities and provinces. The country’s national testing capacity had by then expanded to 50,000 a day with test results notified within 24 hours, up from 20,000 in February

The U.S. conducted about 900,000 tests a day over the past week through Thursday, according to data from the Covid Tracking Project. But South Korea performs six times as many tests per confirmed Covid-19 case than the U.S. doe

South Korea’s three-tier system created in June for social distancing went off script. With health experts split on whether to adopt the maximum levels last month, a government advisory committee landed at a “level 2.5” social-distancing for the Seoul area that closed schools and banned church services and gatherings of more than 10 people.

On Tuesday, South Korea reported its lowest one-day infections in over a month, with just 61 cases.

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