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But with 1,295 deaths, Germany’s fatality rate stood at 1.4 percent, compared with 12 percent in Italy, around 10 percent in Spain, France and Britain, 4 percent in China and 2.5 percent in the United States. Even South Korea, a model of flattening the curve, has a higher fatality rate, 1.7 percent.

There are several answers experts say, a mix of statistical distortions and very real differences in how the country has taken on the epidemic.

The average age of those infected is lower in Germany than in many other countries. Many of the early patients caught the virus in Austrian and Italian ski resorts and were relatively young and healthy, Professor Kräusslich said.“It started as an epidemic of skiers,

“The reason why we in Germany have so few deaths at the moment compared to the number of infected can be largely explained by the fact that we are doing an extremely large number of lab diagnoses,”

Another explanation for the low fatality rate is that Germany has been testing far more people than most nations. That means it catches more people with few or no symptoms, increasing the number of known cases, but not the number of fatalities.

But there are also significant medical factors that have kept the number of deaths in Germany relatively low, epidemiologists and virologists say, chief among them early and widespread testing and treatment, plenty of intensive care beds and a trusted government whose social distancing guidelines are widely observed.

TestingIn mid-January, long before most Germans had given the virus much thought, Charité hospital in Berlin had already developed a test and posted the formula online.

By the time Germany recorded its first case of Covid-19 in February, laboratories across the country had built up a stock of test kits.

the average age of contracting the disease remains relatively low, at 49. In France, it is 62.5 and in Italy 62, according to their latest national reports.

At the end of April, health authorities also plan to roll out a large-scale antibody study, testing random samples of 100,000 people across Germany every week to gauge where immunity is building up.

Early and widespread testing has allowed the authorities to slow the spread of the pandemic by isolating known cases while they are infectious. It has also enabled lifesaving treatment to be administered in a more timely way.

Medical staff, at particular risk of contracting and spreading the virus, are regularly tested. To streamline the procedure, some hospitals have started doing block tests, using the swabs of 10 employees, and following up with individual tests only if there is a positive result.

If it slows a little more, to between 12 and 14 days, Professor Herold said, the models suggest that triage could be avoided.

One key to ensuring broad-based testing is that patients pay nothing for it, said Professor Streeck. This, he said, was one notable difference with the United States

By now, Germany is conducting around 350,000 coronavirus tests a week, far more than any other European country

Tracking

In most countries, including the United States, testing is largely limited to the sickest patients, so the man probably would have been refused a test.

Not in Germany. As soon as the test results were in, the school was shut, and all children and staff were ordered to stay at home with their families for two weeks. Some 235 people were tested.“Testing and tracking is the strategy that was successful in South Korea and we have tried to learn from that,” Professor Streeck said.Germany also learned from getting it wrong early on: The strategy of contact tracing should have been used even more aggressively, he said.

All those who had returned to Germany from Ischgl, an Austrian ski resort that had an outbreak, for example, should have been tracked down and tested, Professor Streeck said

A Robust Public Health Care System

Before the coronavirus pandemic swept across Germany, University Hospital in Giessen had 173 intensive care beds equipped with ventilators. In recent weeks, the hospital scrambled to create an additional 40 beds and increased the staff that was on standby to work in intensive care by as much as 50 percent.

“We have so much capacity now we are accepting patients from Italy, Spain and France,”

All across Germany, hospitals have expanded their intensive care capacities. And they started from a high level. In January, Germany had some 28,000 intensive care beds equipped with ventilators, or 34 per 100,000 people

By comparison, that rate is 12 in Italy and 7 in the Netherlands.

By now, there are 40,000 intensive care beds available in Germany.

The time it takes for the number of infections to double has slowed to about eight days

“A young person with no health insurance and an itchy throat is unlikely to go to the doctor and therefore risks infecting more people,” he said.

Trust in Government

many also see Chancellor Angela Merkel’s leadership as one reason the fatality rate has been kept low.

Ms. Merkel has communicated clearly, calmly and regularly throughout the crisis, as she imposed ever-stricter social distancing measures on the country.

The restrictions, which have been crucial to slowing the spread of the pandemic, met with little political opposition and are broadly followed.

“Maybe our biggest strength in Germany,” said Professor Kräusslich, “is the rational decision-making at the highest level of government combined with the trust the government enjoys in the population.”

Last year, a Chinese scientist he worked with published a specific forecast: “It is highly likely that future SARS- or MERS-like coronavirus outbreaks will originate from bats, and there is an increased probability that this will occur in China.”

Humans today are exposed to more deadly new pathogens than ever. They typically come from animals, as global travel, trade and economic development, such as meat production and deforestation, push people, livestock and wildlife closer together

Scientists knew infectious disease outbreaks were becoming more common, with 2010 having more than six times the outbreaks of pathogens from animal origins than in 1980, according to data in a study by Brown University researchers.

Yet plenty was left undone, in areas including funding, early-warning systems, the role of the WHO and coordination with China. A big chunk of U.S. funding went toward protecting Americans against a bioterror attack. Government funding for pandemics has come largely in emergency, one-time packages to stop an ongoing outbreak.

She said a better solution would be to fund public health more like national defense, with much more guaranteed money, year in, year out.

“Will there be another human influenza pandemic?” Dr. Webster asked in a paper presented at an NIH meeting in 1995. “The certainty is that there will be.”

Experts including Dr. Webster were particularly concerned about the potential for spillover in southern China, where large, densely populated cities were expanding rapidly into forests and agricultural lands, bringing people into closer contact with animals. Two of the three influenza pandemics of the 20th century are thought to have originated in China.

Dr. Webster and others warned it could re-emerge or mutate into something more contagious. With U.S. funding, he set up an animal influenza surveillance center in Hong Kong. The WHO, which hadn’t planned for pandemics before, started compiling protocols for a large-scale outbreak, including contingency plans for vaccines.

At a dinner back in the U.S., he remembers one guest saying, “Oh, you really needed to have someone in the U.S. to be impacted to really galvanize the government.”

That “drove home the reality in my own mind of globalization,” said Dr. Fukuda. SARS showed that viruses can crisscross the globe by plane in hours, making a local epidemic much more dangerous.

The WHO’s director-general, Gro Harlem Brundtland, publicly criticized China. The government under new leaders reversed course. It implemented draconian quarantines and sanitized cities, including a reported 80 million people enlisted to clean streets in Guangdong.

By May 2003, the number of new SARS cases was dwindling. It infected around 8,000 people world-wide, killing nearly 10%.

After SARS, China expanded epidemiologist training and increased budgets for new laboratories. It started working more closely in public health with the U.S., the world’s leader. The U.S. CDC opened an office in Beijing to share expertise and make sure coverups never happened again. U.S. CDC officials visiting a new China CDC campus planted a friendship tree.

In Washington in 2005, a powerful player started driving U.S. efforts to become more prepared. President George W. Bush had read author John M. Barry’s “The Great Influenza,” a history of the 1918 flu pandemic

Mr. Bush leaned toward the group of 10 or so officials and said, “I want to see a plan,” according to Dr. Venkayya. “He had been asking questions and not getting answers,” recalled Dr. Venkayya, now president of Takeda Pharmaceutical Co. ’s global vaccine business unit. “He wanted people to see this as a national threat.”

Mr. Bush launched the strategy in November, and Congress approved $6.1 billion in one-time funding.

The CDC began exercises enacting pandemic scenarios and expanded research. The government created the Biomedical Advanced Research and Development Authority to fund companies to develop diagnostics, drugs and vaccines.

A team of researchers also dug into archives of the 1918 pandemic to develop guidelines for mitigating the spread when vaccines aren’t available. The tactics included social distancing, canceling large public gatherings and closing schools—steps adopted this year when Covid-19 struck, though at the time they didn’t include wide-scale lockdowns.

A year after the plan was released, a progress report called for more real-time disease surveillance and preparations for a medical surge to care for large numbers of patients, and stressed strong, coordinated federal planning.

A European vaccine makers’ association said its members had spent around $4 billion on pandemic vaccine research and manufacturing adjustments by 2008.

The $6.1 billion Congress appropriated for Mr. Bush’s pandemic plan was spent mostly to make and stockpile medicines and flu vaccines and to train public-health department staff. The money wasn’t renewed. “The reality is that for any leader it’s really hard to maintain a focus on low-probability high-consequence events, particularly in the health arena,” Dr. Venkayya said.

In the U.S., President Barack Obama’s administration put Mr. Bush’s new plan into action for the first time. By mid-June, swine flu, as it was dubbed, had jumped to 74 countries. The WHO officially labeled it a pandemic, despite some evidence suggesting the sickness was pretty mild in most people.

That put in motion a host of measures, including some “sleeping” contracts with pharmaceutical companies to begin vaccine manufacturing—contracts that countries like the United Kingdom had negotiated ahead of time so they wouldn’t have to scramble during an outbreak.

In August, a panel of scientific advisers to Mr. Obama published a scenario in which as many as 120 million Americans, 40% of the population, could be infected that year, and up to 90,000 people could die.

H1N1 turned out to be much milder. Although it eventually infected more than 60 million Americans, it killed less than 13,000. In Europe, fewer than 5,000 deaths were reported.

The WHO came under fire for labeling the outbreak a pandemic too soon. European lawmakers, health professionals and others suggested the organization may have been pressured by the pharmaceutical industry.

France ordered 94 million doses, but had logged only 1,334 serious cases and 312 deaths as of April 2010. It managed to cancel 50 million doses and sell some to other countries, but it was still stuck with a €365 million tab, or about $520 million at the time, and 25 million extra doses.

The WHO had raised scares for SARS, mad-cow disease, bird flu and now swine flu, and it had been wrong each time, said Paul Flynn, a member of the Council of Europe’s Parliamentary Assembly and a British lawmaker, at a 2010 health committee hearing in Strasbourg.

Ultimately, an investigation by the council’s committee accused the WHO and public-health officials of jumping the gun, wasting money, provoking “unjustified fear” among Europeans and creating risks through vaccines and medications that might not have been sufficiently tested.

“I thought you might have uttered a word of regret or an apology,” Mr. Flynn told Dr. Fukuda, who as a representative of the WHO had been called to testify.

Back in Washington, scientist Dennis Carroll, at the U.S. Agency for International Development, was also convinced that flu wasn’t the only major pandemic threat. In early 2008, Dr. Carroll was intrigued by Dr. Daszak’s newly published research that said viruses from wildlife were a growing threat, and would emerge most frequently where development was bringing people closer to animals.

If most of these viruses spilled over to humans in just a few places, including southern China, USAID could more easily fund an early warning system.

“You didn’t have to look everywhere,” he said he realized. “You could target certain places.” He launched a new USAID effort focused on emerging pandemic threats. One program called Predict had funding of about $20 million a year to identify pathogens in wildlife that have the potential to infect people.

Drs. Daszak, Shi and Wang, supported by funds from Predict, the NIH and China, shifted their focus to Yunnan, a relatively wild and mountainous province that borders Myanmar, Laos and Vietnam.

One key discovery: a coronavirus resembling SARS that lab tests showed could infect human cells. It was the first proof that SARS-like coronaviruses circulating in southern China could hop from bats to people. The scientists warned of their findings in a study published in the journal Nature in 2013.

Evidence grew that showed people in the area were being exposed to coronaviruses. One survey turned up hundreds of villagers who said they recently showed symptoms such as trouble breathing and a fever, suggesting a possible viral infection.

Over the next several years, governments in the U.S. and elsewhere found themselves constantly on the defensive from global viral outbreaks. Time and again, preparedness plans proved insufficient. One, which started sickening people in Saudi Arabia and nearby

On a weekend morning in January 2013, more than a dozen senior Obama administration officials met in a basement family room in the suburban home of a senior National Security Council official. They were brainstorming how to help other countries upgrade their epidemic response capabilities, fueled by bagels and coffee. Emerging disease threats were growing, yet more than 80% of the world’s countries hadn’t met a 2012 International Health Regulations deadline to be able to detect and respond to epidemics.

The session led to the Global Health Security Agenda, launched by the U.S., the WHO and about 30 partners in early 2014, to help nations improve their capabilities within five years.

Money was tight. The U.S. was recovering from the 2008-09 financial crisis, and federal funding to help U.S. states and cities prepare and train for health emergencies was declining. Public-health departments had cut thousands of jobs, and outdated data systems weren’t replaced.

“It was a Hail Mary pass,” said Tom Frieden, who was director of the CDC from 2009 to 2017 and a force behind the creation of the GHSA. “We didn’t have any money.”

At the WHO, Dr. Fukuda was in charge of health security. When the Ebola outbreak was found in March 2014, he and his colleagues were already stretched, after budget cuts and amid other crises.

The United Nations created a special Ebola response mission that assumed the role normally played by the WHO. Mr. Obama sent the U.S. military to Liberia, underscoring the inability of international organizations to fully handle the problem.

It took the WHO until August to raise an international alarm about Ebola. By then, the epidemic was raging. It would become the largest Ebola epidemic in history, with at least 28,600 people infected, and more than 11,300 dead in 10 countries. The largest outbreak before that, in Uganda, had involved 425 cases.

Congress passed a $5.4 billion package in supplemental funds over five years, with about $1 billion going to the GHSA. The flood of money, along with aggressive contact tracing and other steps, helped bring the epidemic to a halt, though it took until mid-2016.

Global health experts and authorities called for changes at the WHO to strengthen epidemic response, and it created an emergencies program. The National Security Council warned that globalization and population growth “will lead to more pandemics,” and called for the U.S. to do more.

r. Carroll of USAID, who had visited West Africa during the crisis, and saw some health workers wrap themselves in garbage bags for protection, started conceiving of a Global Virome Project, to detect and sequence all the unknown viral species in mammals and avian populations on the planet.

Billionaire Bill Gates warned in a TED talk that an infectious disease pandemic posed a greater threat to the world than nuclear war, and urged world leaders to invest more in preparing for one. The Bill & Melinda Gates Foundation helped form a new initiative to finance vaccines for emerging infections, the Coalition for Epidemic Preparedness Innovations.

Congress established a permanent Infectious Diseases Rapid Response Fund for the CDC in fiscal 2019, with $50 million for that year and $85 million in fiscal 2020.

In May 2018, John Bolton, then President Trump’s national security adviser, dismantled an NSC unit that had focused on global health security and biodefense, with staff going to other units. The senior director of the unit left.

It pushed emerging disease threats down one level in the NSC hierarchy, making pandemics compete for attention with issues such as North Korea, said Beth Cameron, a previous senior director of the unit. She is now vice president for global biological policy and programs at the Nuclear Threat Initiative.

Deteriorating relations with China reduced Washington’s activities there just as researchers were becoming more certain of the threat from coronaviruses.

Dr. Carroll had earlier been ordered to suspend his emerging pandemic threats program in China.

Dr. Carroll pitched to USAID his Global Virome Project. USAID wasn’t interested, he said. He left USAID last year. A meeting that Dr. Carroll planned for last August with the Chinese CDC and Chinese Academy of Sciences to form a Chinese National Virome Project was postponed due to a bureaucratic hang-up. Plans to meet are now on hold, due to Covid-19.

Dr. Shi’s group was fascinated by how coronaviruses jump from species to species. To find viruses, they took samples from bats and other animals, as well as from sick people living near animals carrying these viruses or associated with the wildlife trade. Much of this work was conducted in partnership with the EcoHealth Alliance, a U.S.-based scientific organization that, since 2002, has been awarded over $80 million in federal funding to research the risks of emerging infectious diseases.

Their research showed that the viruses most similar to SARS‑CoV‑2, the virus that caused the pandemic, circulate in bats that live roughly 1,000 miles away from Wuhan. Scientists from Dr. Shi’s team traveled repeatedly to Yunnan province to collect these viruses and had expanded their search to Southeast Asia. Bats in other parts of China have not been found to carry viruses that are as closely related to SARS-CoV-2.

When the Covid-19 outbreak was detected, Dr. Shi initially wondered if the novel coronavirus had come from her laboratory, saying she had never expected such an outbreak to occur in Wuhan.

The SARS‑CoV‑2 virus is exceptionally contagious and can jump from species to species like wildfire. Yet it left no known trace of infection at its source or anywhere along what would have been a thousand-mile journey before emerging in Wuhan.

The year before the outbreak, the Wuhan institute, working with U.S. partners, had proposed creating viruses with SARS‑CoV‑2’s defining feature

The laboratory pursued risky research that resulted in viruses becoming more infectious: Coronaviruses were grown from samples from infected animals and genetically reconstructed and recombined to create new viruses unknown in nature. These new viruses were passed through cells from bats, pigs, primates and humans and were used to infect civets and humanized mice (mice modified with human genes). In essence, this process forced these viruses to adapt to new host species, and the viruses with mutations that allowed them to thrive emerged as victors.

Worse still, as the pandemic raged, their American collaborators failed to publicly reveal the existence of the Defuse proposal. The president of EcoHealth, Peter Daszak, recently admitted to Congress that he doesn’t know about virus samples collected by the Wuhan institute after 2015 and never asked the lab’s scientists if they had started the work described in Defuse.

By 2019, Dr. Shi’s group had published a database describing more than 22,000 collected wildlife samples. But external access was shut off in the fall of 2019, and the database was not shared with American collaborators even after the pandemic started, when such a rich virus collection would have been most useful in tracking the origin of SARS‑CoV‑2. It remains unclear whether the Wuhan institute possessed a precursor of the pandemic virus.

In 2021, The Intercept published a leaked 2018 grant proposal for a research project named Defuse, which had been written as a collaboration between EcoHealth, the Wuhan institute and Ralph Baric at the University of North Carolina, who had been on the cutting edge of coronavirus research for years. The proposal described plans to create viruses strikingly similar to SARS‑CoV‑2.

Coronaviruses bear their name because their surface is studded with protein spikes, like a spiky crown, which they use to enter animal cells. The Defuse project proposed to search for and create SARS-like viruses carrying spikes with a unique feature: a furin cleavage site — the same feature that enhances SARS‑CoV‑2’s infectiousness in humans, making it capable of causing a pandemic. Defuse was never funded by the United States.

owever, in his testimony on Monday, Dr. Fauci explained that the Wuhan institute would not need to rely on U.S. funding to pursue research independently.

While it’s possible that the furin cleavage site could have evolved naturally (as seen in some distantly related coronaviruses), out of the hundreds of SARS-like viruses cataloged by scientists, SARS‑CoV‑2 is the only one known to possess a furin cleavage site in its spike. And the genetic data suggest that the virus had only recently gained the furin cleavage site before it started the pandemic.

Ultimately, a never-before-seen SARS-like virus with a newly introduced furin cleavage site, matching the description in the Wuhan institute’s Defuse proposal, caused an outbreak in Wuhan less than two years after the proposal was drafted.

When the Wuhan scientists published their seminal paper about Covid-19 as the pandemic roared to life in 2020, they did not mention the virus’s furin cleavage site — a feature they should have been on the lookout for, according to their own grant proposal, and a feature quickly recognized by other scientists.

At the Wuhan Institute of Virology, a team of scientists had been hunting for SARS-like viruses for over a decade, led by Shi Zhengl

In May, citing failures in EcoHealth’s monitoring of risky experiments conducted at the Wuhan lab, the Biden administration suspended all federal funding for the organization and Dr. Daszak, and initiated proceedings to bar them from receiving future grants. In his testimony on Monday, Dr. Fauci said that he supported the decision to suspend and bar EcoHealth.

Separately, Dr. Baric described the competitive dynamic between his research group and the institute when he told Congress that the Wuhan scientists would probably not have shared their most interesting newly discovered viruses with him. Documents and email correspondence between the institute and Dr. Baric are still being withheld from the public while their release is fiercely contested in litigation.

In the end, American partners very likely knew of only a fraction of the research done in Wuhan. According to U.S. intelligence sources, some of the institute’s virus research was classified or conducted with or on behalf of the Chinese military.

In the congressional hearing on Monday, Dr. Fauci repeatedly acknowledged the lack of visibility into experiments conducted at the Wuhan institute, saying, “None of us can know everything that’s going on in China, or in Wuhan, or what have you. And that’s the reason why — I say today, and I’ve said at the T.I.,” referring to his transcribed interview with the subcommittee, “I keep an open mind as to what the origin is.”

The Wuhan lab pursued this type of work under low biosafety conditions that could not have contained an airborne virus as infectious as SARS‑CoV‑2.

Labs working with live viruses generally operate at one of four biosafety levels (known in ascending order of stringency as BSL-1, 2, 3 and 4) that describe the work practices that are considered sufficiently safe depending on the characteristics of each pathogen. The Wuhan institute’s scientists worked with SARS-like viruses under inappropriately low biosafety conditions.

​​Biosafety levels are not internationally standardized, and some countries use more permissive protocols than others.

In one experiment, Dr. Shi’s group genetically engineered an unexpectedly deadly SARS-like virus (not closely related to SARS‑CoV‑2) that exhibited a 10,000-fold increase in the quantity of virus in the lungs and brains of humanized mice. Wuhan institute scientists handled these live viruses at low biosafety levels, including BSL-2.

Even the much more stringent containment at BSL-3 cannot fully prevent SARS‑CoV‑2 from escaping. Two years into the pandemic, the virus infected a scientist in a BSL-3 laboratory in Taiwan, which was, at the time, a zero-Covid country. The scientist had been vaccinated and was tested only after losing the sense of smell. By then, more than 100 close contacts had been exposed. Human error is a source of exposure even at the highest biosafety levels, and the risks are much greater for scientists working with infectious pathogens at low biosafety.

An early draft of the Defuse proposal stated that the Wuhan lab would do their virus work at BSL-2 to make it “highly cost-effective.” Dr. Baric added a note to the draft highlighting the importance of using BSL-3 to contain SARS-like viruses that could infect human cells, writing that “U.S. researchers will likely freak out.”

Years later, after SARS‑CoV‑2 had killed millions, Dr. Baric wrote to Dr. Daszak: “I have no doubt that they followed state determined rules and did the work under BSL-2. Yes China has the right to set their own policy. You believe this was appropriate containment if you want but don’t expect me to believe it. Moreover, don’t insult my intelligence by trying to feed me this load of BS.”

SARS‑CoV‑2 is a stealthy virus that transmits effectively through the air, causes a range of symptoms similar to those of other common respiratory diseases and can be spread by infected people before symptoms even appear. If the virus had escaped from a BSL-2 laboratory in 2019, the leak most likely would have gone undetected until too late.

One alarming detail — leaked to The Wall Street Journal and confirmed by current and former U.S. government officials — is that scientists on Dr. Shi’s team fell ill with Covid-like symptoms in the fall of 2019. One of the scientists had been named in the Defuse proposal as the person in charge of virus discovery work. The scientists denied having been sick.

The hypothesis that Covid-19 came from an animal at the Huanan Seafood Market in Wuhan is not supported by strong evidence.

In December 2019, Chinese investigators assumed the outbreak had started at a centrally located market frequented by thousands of visitors daily. This bias in their search for early cases meant that cases unlinked to or located far away from the market would very likely have been missed

To make things worse, the Chinese authorities blocked the reporting of early cases not linked to the market and, claiming biosafety precautions, ordered the destruction of patient samples on January 3, 2020, making it nearly impossible to see the complete picture of the earliest Covid-19 cases. Information about dozens of early cases from November and December 2019 remains inaccessible.

A pair of papers published in Science in 2022 made the best case for SARS‑CoV‑2 having emerged naturally from human-animal contact at the Wuhan market by focusing on a map of the early cases and asserting that the virus had jumped from animals into humans twice at the market in 2019

More recently, the two papers have been countered by other virologists and scientists who convincingly demonstrate that the available market evidence does not distinguish between a human superspreader event and a natural spillover at the market.

Furthermore, the existing genetic and early case data show that all known Covid-19 cases probably stem from a single introduction of SARS‑CoV‑2 into people, and the outbreak at the Wuhan market probably happened after the virus had already been circulating in humans.

Not a single infected animal has ever been confirmed at the market or in its supply chain. Without good evidence that the pandemic started at the Huanan Seafood Market, the fact that the virus emerged in Wuhan points squarely at its unique SARS-like virus laboratory.

With today’s technology, scientists can detect how respiratory viruses — including SARS, MERS and the flu — circulate in animals while making repeated attempts to jump across species. Thankfully, these variants usually fail to transmit well after crossing over to a new species and tend to die off after a small number of infections

investigators have not reported finding any animals infected with SARS‑CoV‑2 that had not been infected by humans. Yet, infected animal sources and other connective pieces of evidence were found for the earlier SARS and MERS outbreaks as quickly as within a few days, despite the less advanced viral forensic technologies of two decades ago.

Even though Wuhan is the home base of virus hunters with world-leading expertise in tracking novel SARS-like viruses, investigators have either failed to collect or report key evidence that would be expected if Covid-19 emerged from the wildlife trade. For example, investigators have not determined that the earliest known cases had exposure to intermediate host animals before falling ill.

No antibody evidence shows that animal traders in Wuhan are regularly exposed to SARS-like viruses, as would be expected in such situations.

In previous outbreaks of coronaviruses, scientists were able to demonstrate natural origin by collecting multiple pieces of evidence linking infected humans to infected animals

In contrast, virologists and other scientists agree that SARS‑CoV‑2 required little to no adaptation to spread rapidly in humans and other animals. The virus appears to have succeeded in causing a pandemic upon its only detected jump into humans.

it was a SARS-like coronavirus with a unique furin cleavage site that emerged in Wuhan, less than two years after scientists, sometimes working under inadequate biosafety conditions, proposed collecting and creating viruses of that same design.

a laboratory accident is the most parsimonious explanation of how the pandemic began.

Given what we now know, investigators should follow their strongest leads and subpoena all exchanges between the Wuhan scientists and their international partners, including unpublished research proposals, manuscripts, data and commercial orders. In particular, exchanges from 2018 and 2019 — the critical two years before the emergence of Covid-19 — are very likely to be illuminating (and require no cooperation from the Chinese government to acquire), yet they remain beyond the public’s view more than four years after the pandemic began.

it is undeniable that U.S. federal funding helped to build an unprecedented collection of SARS-like viruses at the Wuhan institute, as well as contributing to research that enhanced them.

Advocates and funders of the institute’s research, including Dr. Fauci, should cooperate with the investigation to help identify and close the loopholes that allowed such dangerous work to occur. The world must not continue to bear the intolerable risks of research with the potential to cause pandemics.

A successful investigation of the pandemic’s root cause would have the power to break a decades-long scientific impasse on pathogen research safety, determining how governments will spend billions of dollars to prevent future pandemics. A credible investigation would also deter future acts of negligence and deceit by demonstrating that it is indeed possible to be held accountable for causing a viral pandemic

Last but not least, people of all nations need to see their leaders — and especially, their scientists — heading the charge to find out what caused this world-shaking event. Restoring public trust in science and government leadership requires it.

The TraceTogether smartphone app and token are used by 78% of the people in Singapore, a country of 5.7 million. Balakrishnan called it "perhaps the most successful contact-tracing program in the world."

He said contact-tracing data have been used once so far, in a murder case, according to The Straits Times.

Eugene Tan, a law professor at Singapore Management University and a former nominated member of Parliament, told The Straits Times that the government's backtracking on privacy assurances undermines trust and credibility. "This damage could undermine its future efforts, given its reiteration that Singapore has only managed to keep COVID-19 under control due to the people's trust in the government's measures," he told the paper.

COVID-19 testing has been an unmitigated failure in this country.

Rather than growing rapidly—as all experts think is absolutely necessary—the daily number of tests administered in some jurisdictions has even decreased. In New York, for instance, 10,241 tests were performed on April 6, but supply limits forced a huge drop a few days later to 25 total tests.

Quest Diagnostics, one of the two biggest firms that run tests, just furloughed 9 percent of its workforce. In addition, news reports suggest that, as of last week, 90 percent of the 15-minute tests developed by Abbott Laboratories are idle due to a lack of necessary reagents and qualified personnel

How many tests do we need in order to safely relax social-distancing measures, reopen nonessential businesses and schools, and allow large gatherings

we should be conducting a minimum of 500,000 tests a day.

Paul Romer, has called for the capacity to run 20 million to 30 million tests a day

Even this has been criticized as insufficient for the task of identifying enough of the asymptomatic spreaders to keep the pandemic in check.

Current guidelines from the Centers for Disease Control and Prevention give priority first to hospitalized patients and symptomatic health-care workers, then to high-risk patients

ptomatic individuals are not tested, even if they had contact with people who tested positive.

This is an enormous mistake. If we want to control the spread of COVID-19, the United States must adopt a new testing policy that prioritizes people who, although asymptomatic, may have the virus and infect many others.

We should target four groups. First, all health-care workers and other first responders who directly interact with many people

Second, workers who maintain our supply chains and crucial infrastructure, including grocery-store workers, police officers, public-transit workers, and sanitation personnel.

The next group would be potential “super-spreaders”—asymptomatic individuals who could come into contact with many people. This third group would include people in large families and those who must interact with many vulnerable people, such as employees of long-term-care facilities

The fourth group would include all those who are planning to return to the workplace. These are precisely the individuals without symptoms whom the CDC recommends against testing.

Not testing suspected COVID-19 patients will not harm those patients

Symptomatic patients should be tested only in the rare case where a positive test would meaningfully change what type of care is delivered.

To shift the focus of testing away from the sickest patients and toward the people most likely to spread the coronavirus, we will have to conduct millions of tests a day.

How can we close this gap between our needs and current capacity? We need a national strategy over the next 10 weeks, one that draws on the many strengths of our research system

We also need to encourage rapid adoption of the saliva test that now has an emergency approval from the FDA and expedite the approval of tests that require fewer reagents and staff.

Another promising pathway is to pool many tests and run them together. If a pooled sample tests negative, everyone in the pool is negative. If it is positive, the members of the pool can be tested individually

A more sophisticated version of this approach uses genetic “bar codes” that make it possible to trace back which of the many samples in a pool was the one that had RNA from the virus, without any retesting.

How can we get this testing capacity up and running? One idea is for Congress to award in the next stimulus bill, say, $150 million in unrestricted research funds to the first five universities that can process 10 million tests in a week or less

Another catalyst could be to subsidize businesses that agree to test all their employees as they return to work

When someone tests positive, officials should identify close contacts, find them, and test them. To do the tracing, we may need to hire 100,000 to 200,000 additional public-health workers.

This type of voluntary contact tracing is labor-intensive and requires some training, but it does not require highly specialized skills

If we adopt and follow a coherent plan, we can have a testing regime that keeps us safe without compromising our freedoms

ay Butler, the CDC's deputy director for infectious diseases, who warned that the U.S. is showing a "distressing trend" with cases surging over 75 percent of the country.

The guidance is based on a study out today showing brief exposures to infected individuals and resulted in virus spread

The Vermont Department of Health said the officer wore a cloth mask, gown and goggles and had 22 interactions totaling about 17 minutes with six unmasked inmates who tested positive for the virus.

The updated guidance could change how public health departments across the country conduct their contact tracing, by increasing the pool of potentially infected individuals.

President Donald Trump continues to call for a return to pre-pandemic conditions. The CDC in May released guidelines for reopening schools that Trump later disavowed, saying they were too burdensome.

The U.S. is reporting an average 60,000 cases per day with the Midwest seeing the largest increases in cases.

Now, based on the U.S. response since February, Lipsitch believes that we’re still likely to see the virus spread to the point of becoming endemic.

That would mean it is with us indefinitely, and the current pandemic would end when we reach levels of “herd immunity,” traditionally defined as the threshold at which enough people in a group have immune protection so the virus can no longer cause huge spikes in disease.

Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, said that, because of a “general anti-science, anti-authority, anti-vaccine feeling,” the U.S. is “unlikely” to achieve herd immunity even after a vaccine is available.

The case-fatality rate for COVID-19 is now very roughly 1 percent overall. In the absolute simplest, linear model, if 70 percent of the world were to get infected, that would mean more than 54 million deaths.

Without a better plan, this threshold—the percentage of people who have been infected that would constitute herd immunity—seems to have become central to our fates.

Some mathematicians believe that it’s much lower than initially imagined. At least, it could be, if we choose the right future.

Gomes explains, “There doesn’t need to be a lot of variation in a population for epidemics to slow down quite drastically.”

in dynamic systems, the outcomes are more like those in chess: The next play is influenced by the previous one. Differences in outcome can grow exponentially, reinforcing one another until the situation becomes, through a series of individually predictable moves, radically different from other possible scenarios. You have some chance of being able to predict the first move in a game of chess, but good luck predicting the last.

“selective depletion” of people who are more susceptible—can quickly decelerate a virus’s spread. When Gomes uses this sort of pattern to model the coronavirus’s spread, the compounding effects of heterogeneity seem to show that the onslaught of cases and deaths seen in initial spikes around the world are unlikely to happen a second time.

Based on data from several countries in Europe, she said, her results show a herd-immunity threshold much lower than that of other models.“We just keep running the models, and it keeps coming back at less than 20 percent,” Gomes said. “It’s very striking.”

If that proves correct, it would be life-altering news. It wouldn’t mean that the virus is gone. But by Gomes’s estimates, if roughly one out of every five people in a given population is immune to the virus, that seems to be enough to slow its spread to a level where each infectious person is infecting an average of less than one other person

That’s the classic definition of herd immunity. It would mean, for instance, that at 25 percent antibody prevalence, New York City could continue its careful reopening without fear of another major surge in cases.

Lipsitch also believes that heterogeneity is important to factor into any model. It was one reason he updated his prediction, not long after we spoke in February, of what the herd-immunity threshold would be. Instead of 40 to 70 percent, he lowered it to 20 to 60 percent. When we spoke last week, he said he still stands by that, but he is skeptical that the number lands close to the 20 percent end of the range. “I think it’s unlikely,” he said, but added, “This virus is proving there can be orders-of-magnitude differences in attack rates, depending on political and societal decisions, which I don’t know how to forecast.”

he believes that the best we can do is continually update models based on what is happening in the real world. She can’t say why the threshold in her models is consistently at or below 20 percent, but it is. “If heterogeneity isn’t the cause,” she said, “then I’d like for someone to explain what is.”

Biological variations in susceptibility could come down to factors as simple as who has more nose hair, or who talks the loudest and most explosively, and Langwig shares the belief that these factors can create heterogeneity in susceptibility and transmission. Those effects can compound to dramatically change the math behind predictions for the future.

What’s important to her, rather, is that people are not misled by the idea of herd immunity. In the context of vaccination, herd-immunity thresholds are relatively fixed and predictable. In the context of an ongoing pandemic, thinking of this threshold as some static concept can be dangerously misleading.

She worries that many people conflate academic projections about reaching herd immunity with a “let it run wild” fatalism. “My view is that trying to take that route would lead to mass death and devastation,” she says.

Left totally unchecked, Bansal says, the percentage of infected people could go even higher than 70 percent.

“Within certain populations that lack heterogeneity, like within a nursing home or school, you may even see the herd-immunity threshold be above 70 percent,” Bansal says. If a population average led people in those settings to get complacent, there could be needless death.

Bansal believes that heterogeneity of behavior is the key determinant of our futures. “That magic number that we’re describing as a herd-immunity threshold very much depends on how individuals behave,” Bansal says, since R0 clearly changes with behaviors. On average, the R0 of the coronavirus currently seems to be between 2 and 3, according to Lipsitch.

Social distancing and other reactive measures changed the R0 value, and they will continue to do so. The virus has certain immutable properties, but there is nothing immutable about how many infections it causes in the real world.

The threshold can change based on how a virus spreads. The spread keeps on changing based on how we react to it at every stage, and the effects compound. Small preventive measures have big downstream effects

In other words, the herd in question determines its immunity. There is no mystery in how to drop the R0 to below 1 and reach an effective herd immunity: masks, social distancing, hand-washing, and everything everyone is tired of hearing about. It is already being done.

“I think it no longer seems impossible that Switzerland or Germany could remain near where they are in terms of cases, meaning not very much larger outbreaks, until there’s a vaccine,” he said. They seem to have the will and systems in place to keep their economies closed enough to maintain their current equilibrium.

Other wealthy countries could hypothetically create societies that are effectively immune to further surges, where the effective herd-immunity threshold is low.

We have the wealth in this country to care for people, and to set the herd-immunity threshold where we choose. Parts of the world are illuminating a third way forward, something in between total lockdown and simply resuming the old ways of life. It happens through individual choices and collective actions, reimagining new ways of living, and having the state support and leadership to make those ways possible

as much attention as we give to the virus, and to drugs and our immune systems, the variable in the system is us. There will only be as much chaos as we allow.

2 doses = fully vaccinated

< 6 feet + > 15 minutes = close contact

Get within six feet of an infected person for at least 15 minutes over a 24-hour period, and congratulations—you’ve had a “close contact.”

scientists have known for years that SARS-CoV-2 can hitch a ride in bubbles of spittle and snot small enough to drift across rooms and remain aloft for hours, especially in poorly ventilated indoor spaces. Pathogens don’t slam up against a magic wall “at the six-foot mark,

Nor will viruses bide their time for 14 minutes and 59 seconds before launching themselves noseward at 15 minutes on the dot

5 days = end of isolation

Many people now report strings of negative results early in their symptom course, then positives that persist into their sixth, seventh, or eighth day of sickness or later, raising the possibility that they remain quite contagious past when formal isolation may end. “I find it impossible to believe you can end isolation without testing,”

And yet, many workplaces have already embraced the five-day rule with no exit test, using that timeline as the basis for when employees should return.

Infection + 90 days = no retest

reinfections have gotten more common, and far closer together. They were happening even in the era of Delta; now, with so many immunity-evading Omicron offshoots at the helm, and masks and other mitigation matters mostly vanished, they’ve become a quite-frequent fixture.

The number of people who have caught the virus twice within just a matter of weeks “has grown so much that we should forget these windows,”

the 90-day number, Malaty Rivera said, is no longer relevant. “It has to be deleted from people’s minds.”

200 cases + 10 hospital admissions per 100,000 = mask?

t waiting to just suggest masks at those levels of transmission and hospitalization—not even require them—leaves far too much time for widespread disease, disability, even death, experts told me. A bar that high still lets long COVID slip through; it continues to imperil the vulnerable, immunocompromised, and elderly,

Case rates, Malaty Rivera pointed out, are also a terrible yardstick right now because so many people have been testing at home and not reporting the results to public-health agencies.

A better system would flip on protections earlier—taking a preventive approach, rather than scrambling to react.

They blamed Italy’s high number of infections on aggressive testing of people without symptoms in the north, which they argued only created hysteria and tarnished the country’s image abroad.

Even once the Italian government considered a universal lockdown necessary to defeat the virus, it failed to communicate the threat powerfully enough to persuade Italians to abide by the rules, which seemed riddled with loopholes.

Still, he acknowledged that the health minister had struggled to persuade his government colleagues to move more quickly and that the difficulties of navigating Italy’s division of powers between Rome and the regions resulted in a fragmented chain of command and inconsistent messages.

For the coronavirus, 10 days can be a lifetime.

Politicians across the spectrum worried about the economy and feeding the country, and found it difficult to accept their impotence in the face of the virus.

Most importantly, Italy looked at the example of China, Ms. Zampa said, not as a practical warning, but as a “science fiction movie that had nothing to do with us.” And when the virus exploded, Europe, she said, “looked at us the same way we looked at China.”

A day later, on March 9, when the positive cases reached 9,172 and the death toll climbed to 463, Mr. Conte toughened the restrictions and extended them nationally.

But he also had not had any direct contacts with China, and experts suspect he contracted the virus from another European, meaning Italy did not have an identifiable patient zero or a traceable source of contagion that could help it contain the virus.

The virus had already been active in Italy for weeks by that time, experts now say, passed by people without symptoms and often mistaken for a flu

“Who we call ‘Patient One’ was probably ‘Patient 200,’ ” said Fabrizio Pregliasco, an epidemiologist.

Mr. Fontana, who had been pressing the central government for tougher action, agreed. He said that the mixed messages from Rome and the easing of restrictions had led Italians to believe “that everything was a joke, and they kept living as they used to.”

“They were convinced that the situation was less serious and they did not want to hurt our economy too much,”

the nation became divided between those who saw the threat and those who didn’t.

some regional governors independently ordered people coming from the newly locked-down area to self quarantine. Others didn’t.

Mr. Ricciardi said Italy had the bad luck of having a super spreader in a densely populated and dynamic area who went to the hospital not once, but twice, infecting hundreds of people, including doctors and nurses.“He was incredibly active,” Mr. Ricciardi said.

Italy is still paying the price of those early mixed messages by scientists and politicians. The people who have died in staggering numbers recently — more than 2,300 in the last four days — were mostly infected during the confusion of a week or two ago.

Roberto Burioni, a prominent virologist at the San Raffaele University in Milan, said that people had felt safe to go about their usual routines and he attributed the spike in cases last week to “that behavior.”

Leaders in the north are desperate for the government to crack down harder.

On Friday, Mr. Fontana complained that the 114 troops the government deployed were insignificant, and that at least 1,000 should be sent. On Saturday, he closed public offices, work sites and banned jogging. He said in an interview that the government needed to stop messing around and “apply rigid measures.”

“At least this slows down the virus’ speed,’’ Mr. Zaia said, arguing that testing helped identify potentially contagious people without symptoms. ‘‘And slowing down the virus’ speed allows the hospitals to breathe.’’

The half-life is a measurement of the time it takes for a given amount of the virus to become reduced by half.

the half-life of the virus, in the absence of sunlight (indoors), lowers from 18 hours to one hour when the temperature rises from around room temperature (70 to 75 degrees) to 95 degrees and the humidity increases from 20 percent to 80 percent.

The laboratory experiment also tested how the virus decays when exposed to various elements while suspended in the air. When the airborne virus at temperatures between 70 and 75 degrees is exposed to sunlight, its half-life decreases from around 60 minutes before exposure to 1.5 minutes after.

“Within the conditions we’ve tested to date, the virus in droplets of saliva survives best in indoors and dry conditions. … The virus dies quickest in the presence of direct sunlight.”

“Increasing the temperature and humidity of potentially contaminated indoor spaces appears to reduce the stability of the virus,” he said. “And extra care may be warranted for dry environments that do not have exposure to solar light.”

A slide presented by Bryan also recommended moving activities outside.

in the real world, the virus on a playground surface exposed to direct sunlight would die quickly, but the virus could survive longer in shaded areas.

If the summer months reduce the transmission rates of the virus, that would help officials’ efforts to squelch its spread without resorting to drastic mitigation measures, such as stay-at-home orders, that have had massive economic repercussions.

“It would be irresponsible for us to say summer will kill the virus,” Bryan said, calling summer conditions “another tool in toolbox” to use against the virus.

The weather is no panacea when it comes to the coronavirus pandemic, considering that warm states, such as Georgia and Florida, already are seeing significant outbreaks, as are warm and humid countries, including Singapore. Even if the virus were to wane during the summer, a dreaded second wave would still be likely in the fall, as has happened with past pandemic flu outbreaks.

That report pointed to shortcomings in the studies published so far that trace the spread of the coronavirus and connect the pattern of spread to temperature and humidity, stating they “should be interpreted with caution.”

The NAS report states: “There is some evidence to suggest that SARS-CoV-2 may transmit less efficiently in environments with higher ambient temperature and humidity; however, given the lack of host immunity globally, this reduction in transmission efficiency may not lead to a significant reduction in disease spread” without mitigation measures, such as social distancing

But Democrats counter that the bill takes a holistic look at the entire American economy and how it was affected by the pandemic.

Senate Democrats agreed to lower the income cutoff at which payments phase out from $100,000 to $80,000 for individuals, and from $200,000 to $160,000 for couples filing jointly, following demands from moderate Democrats.

Progressive Democrats vigorously pursued including a minimum wage hike in this legislation, which would have gradually increased the federal minimum wage to $15 an hour by 2025.

Individuals earning up to $75,000 and couples earning up to $150,000 would receive the full direct payments of $1,400 per person. Individuals will also receive an additional $1,400 payment for each dependent claimed on their tax returns.

"The major pieces of the bill — payments to individuals, extended unemployment, money for states and localities, money for schools — all of those things were in the COVID package that passed last year that all the Republicans voted for. So they were OK then, but they're not OK now, and I frankly can't really figure out that argument."

Under the Senate version, federal unemployment insurance payments will remain at $300 per week — down from $400 per week

The bill includes $7.25 billion in new money for the small-business loan program known as PPP and would allow more nonprofits to apply, including those groups that engage in advocacy and some limited lobbying. It also allows larger nonprofits to be eligible.

There are over $128 billion in grants to state educational agencies, with 90% allocated to local educational agencies, plus $39 billion in grants to higher education institutions.

The bill includes $4.5 billion for the Low Income Home Energy Assistance Program, known as LIHEAP, to help families with home heating and cooling costs.

The bill provides $37 million to the Commodity Supplemental Food Program for low-income seniors.

The Centers for Disease Control and Prevention is set to receive $7.5 billion to track, administer and distribute COVID-19 vaccines. Another $46 billion would go toward diagnosing and tracing coronavirus infections, and $2 billion would go toward buying and distributing various testing supplies and personal protective equipment.

There is $25 billion for emergency rental assistance, including $5 billion for emergency housing vouchers for people experiencing homelessness, survivors of domestic violence and victims of human trafficking.

Florida’s dashboard was created in part by Rebekah D. Jones, a state data scientist who was fired for insubordination in May 2020, a conflict that she said came to a head when she refused to manipulate data to show that rural counties were ready to reopen from coronavirus lockdowns.

Ms. Jones’s firing became a flash point as Mr. DeSantis, a close ally of then-President Donald J. Trump, touted Florida’s early success in battling the virus — a victory lap that turned out to be premature at the time and led to a disastrous summer. State officials insisted that her claims about hiding virus data were false.

In December, state police agents with guns drawn raided Ms. Jones’s home in Tallahassee to execute a search warrant in a criminal investigation, after police said a breach at the Florida Department of Health was traced to her computer. She denied having anything to do with the breach.

Ms. Jones’s dashboard generally shows a higher number of cases than the number reported by the state.

Scientists say that a national surveillance program would be able to determine just how widespread the new variant is and help contain emerging hot spots, extending the crucial window of time in which vulnerable people across the country could get vaccinated.

That would cost several hundred million dollars or more. While that may seem like a steep price tag, it’s a tiny fraction of the $16 trillion in economic losses that the United States is estimated to have sustained because of Covid-19.

With such a system in place, health officials could warn the public in affected areas and institute new measures to contend with the variant — such as using better masks, contact tracing, closing schools or temporary lockdowns — and do so early, rather than waiting until a new surge flooded hospitals with the sick.

Experts point to Britain as a model for what the U.S. could do. British researchers sequence the genome — that is, the complete genetic material in a coronavirus — from up to 10 percent of new positive samples

But the U.S. falls far short of that goal now. Over the past month, American researchers have only sequenced a few hundred genomes a day,

In March, Britain started what many American experts yearn for: a well-run national program to track mutations of the new coronavirus. The country invested 20 million pounds — roughly $27 million — to create a scientific consortium that enlisted hospitals across the country, giving them standard procedures for sending samples to dedicated labs that would sequence their viruses.

Using cloud computing, experts analyzed the mutations and figured out where each lineage of the virus fit on an evolutionary tree.

“What the U.K. has done with sequencing is, to me, the moonshot of the pandemic,”

“They decided they were going to do sequencing and they just stood up an absolutely incredible program from scratch.”

In the U.S., a constellation of labs, mostly at universities, have been analyzing coronavirus genomes since the spring. Many of them spend their own modest funds to do the work

Now, to the East, this behaviour is both jaw-dropping and bewildering. It goes beyond mere irresponsibility, and is considered something more like stupidity, ignorance, malice, deceit, or all four

That is what civilization is, and where it begins: the presence of the very first kind of enlightened mind, which can nourish, protect, and elevate another

What does Mead’s Femur have do with the West’s stunning failure that let Covid spiral out of control? As it turns out, everything.

These days, the tourists are gone, mostly. But — and here’s the point — the bars, restaurants, and clubs are still full. I pass by them on my daily walk to the park and wonder: what are these people doing? How are they sitting there so close to one another, with no social distancing in place, laughing, joking in the middle of a literal pandemic that’s exploding all around them? What the?

The people I pass by in the bars are made of two social groups, largely. Young people, and the working class. That’s the same group, in a sense, since most young people are working class, until they amass enough wealth to rise beyond it

They have made a choice. Their beer and burger or cocktail and steak matters more than stopping the spread of a deadly disease. What the?

This group is putting the most vulnerable in society at profound risk. Those who are already ill, and immunocompromised. Those even lower down the socioeconomic ladder than them — minorities, the underclass, and so forth, among whom death rates are astronomical. The elderly, the frail, the aged.

Certain groups in Western society have made the decision that the vulnerable’s lives matter less than their right to party, to have a beer and a burger, a cocktail and a steak, a laugh at the pub with friends. What the?

The groups who are now apparently completely indifferent to spreading Covid seem to have taken their cues from leaders. Young people and the working class seem to have no conscience or compunction left whatsoever about spreading Covid

To act in such a way as to put your elders, or the ill, especially, at risk, is something that is a grave violation of social norms. Easterners can’t understand why Westerners are behaving like…spoiled children. Are they right?

There is a kind of toxic indifference that seems to have spread through Western societies. Life itself is treated with a kind of shrugging fatalism — especially those of the vulnerable. It is literally valued less than a night out at the pub by much of society.

The attitude of toxic indifference is what the West seems to share in common now, and that is why it has been brought to its knees by Covid.

the West” is not monolithic. Certainly, toxic indifference is not at the same level across all of it

let me discuss the most extreme examples — America and Britain — to highlight where toxic indifference comes from: leadership.

In Britain and America, Covid cases have now exploded well past their first peak. America is approaching 100,000 cases per day — the point at which social breakdown will begin. Britain is hitting more than that, on a per capita basis. And yet neither of these societies has a national lockdown.

uccessful societies — New Zealand, Taiwan, Vietnam, and many more — deliberately crunched the curve. Their strategy was to eradicate Covid, through what’s now a global template of best practices — lock down, test, trace, quarantine, isolate, and so forth.

The approach of Western leaders, in other words, was reactive, hesitant, and cautious, not decisive, swift, and proactive:

Margaret Mead once said that the beginning of human civilisation was found in a healed femur. That that single, simple discovery meant that someone took the time to invest in healing someone else’s broken leg — without which they surely would have died

Western leaders, in other words, modelled toxic indifference for their societies. They gave people a license to be indifferent, by acting largely indifferent themselves.

Young people justify it by saying that “they need to have social lives” — as if they weren’t spending most of their social lives online before Covid, and the working class by saying they need to work. Both of those arguments are partially true. But it’s truer to say that these are groups which have become dangerously indifferent to preserving the value of the lives of the vulnerable.

The young and the working class are punching down, as American leftists would put it.

More formally, more accurately, Covid has made Western societies predatory ones. The young and working class are exploiting and abusing those more powerless than them

Neither group seems to consider the possibility much that society needs to come together to defeat the pandemic, once and for all, and the only way that can be done is to put the vulnerable first.

America treating Covid indifferently is no surprise, after all — it’s a nation where kids are gunned down in schools, diabetics are simply left to die, people beg strangers online for money to pay for crippling healthcare costs

But it’s more surprising to see Europe turning predatory due to Covid, or having Covid expose its vulnerability to becoming predatory

I don’t mean to single the young and working class out. That is missing my point. What I am saying is that toxic indifference is trickling down in the West. From elites, like leaders, to the bourgeois — that’s been the case for the last few decades

Indifference is trickling down from the elite and the bourgeois, to the working class and the young.

we know where a society of indifference ends. It ends in America. In stupidity, ignorance, violence, hate, racism, brutality, and the poverty and despair which underlies it all.

The indifferent cannot act collectively, therefore they cannot invest, transform, change, unite, come together, and therefore they cannot live in a modern, functioning society, with an expansive, sophisticated, supportive, generous social contract

So what about climate change? Mass extinction? Ecological collapse? The massive waves of depression and ruin those will unleash — in the next decade? How can societies that can’t unite, act wisely, behave responsibly to fight Covid come together to do much about even larger catastrophes?

Covid reveals the decivilizing of the West. As I mentioned, Margaret Mead said the fundamental test of civilization is the healed femur: that someone took the time and effort to heal someone else. It is the absence of indifference and the presence of care, in other words

What made the West special, once upon a time, was not its brutality, but its idea of civilization, as the elevation and nourishment of every life, with dignity, purpose, belonging, truth, justice, and, more crucially, the idea that freedom was a society that was able to act in a civilised way.

freedom became free-dumb: the idea that my right to be abusive, exploitative, ignorant, violent, selfish — to carry a gun to Starbucks or deny you healthcare and retirement — came to prevail

If the pattern of the West’s decaying attitudes, the spread of the foolish American idea of free-dumb as “freedom,” is what Covid has revealed — I punch down, on the person below me, I exploit and abuse the person even lower than me in the socioeconomic hierarchy, because that is what I must do to survive, or at least what I have been taught to do to feel good and worthy — then the simple fact is that the West has little future

Their failure teaches us something. Civilization matters. When a society gives up on the idea of being civilized, it collapses harder and faster than its most learned wise men often imagine. That is because no society can withstand a tidal wave of stupidity and violence. Is that where the West is headed?

In a simpler way, maybe the simplest, what I am talking about is a lack of simple human goodness. That is what Mead’s Femur points to — the presence of goodness — and it is what is missing in America and Britain. They are now societies with a massive, gaping, jaw-dropping lack of human goodness, and Covid is just the latest example. But that deficit spells real trouble — it isn’t some kind of abstract moral concern.

Covid is a cold wind, and it shows that the flame is flickering. If anything, it shows us the future of civilization — in Mead’s sense, as the absence of violence, and the presence of decency, dignity, care, nourishment, equality, of human goodness realized — may lie in the East.

we need to see the course of this crisis in three parts.

First is the initial outbreak which we hope we’re getting some handle on. But there won’t be a return to a real normal until there’s a widely available vaccine or very effective treatments for COVID-19

in the best case scenario we face what I’ll call Phase Two of the crisis – a lengthy period after the initial outbreak in which the challenge will be to get back to an Interim New Normal until vaccines or treatments come online

The third phase will be the arrival of an effective vaccine that can finally in some sense end at least the epidemiological crisis.

A great system in one state and a crappy one next door won’t cut it.

Another key concept: Testing isn’t all the same. One form of testing is diagnostic, tests you give to a particular person to guide their treatment.

The other is surveillance testing, testing to measure and manage the prevalence of the diseas

You can’t go back to even a semblance of normal economic and social life until you have an integrated, national system of surveillance testing in place that will give us a good shot at avoiding a rolling series of outbreaks and lockdowns for another year.

So Phase One: Initial Outbreak. Phase Two: Sustaining an Interim New Normal. Phase Three: Vaccines and/or robust Treatments arrive and the crisis ends.

some building blocks are clear. The first is building a robust and vast system of testing across the country, both testing for infection and testing for antibodies

You also need a system of data collection and analysis that allows all those tests to be analyzed to granularly measure the prevalence and possible spread of the disease, both nationally and on the local level

You also need to keep the scale of infection low enough that contact tracing of new infections is at all possible.

Conventional contact tracing alone with armies of disease detectives probably isn’t up to the challenge, at least not on its own. That is why there’s already extensive discussions of using big data and geolocation tracking on cell phones to do some of this work at scale

A lot of that discussion has focused on taking something China did with mobile applications and adapting it to our social mores and laws. Put simply, you download an app. You say you’re healthy. If you get sick and test positive you tell the app. The app has recorded your movements over the last two weeks and a lot of other peoples. Once I test positive, the people who’ve been in close proximity to me get alerted and told they should get tested.

This is a very blunt instrument version of contact tracing. But unlike conventional contact tracing which operates with disease detectives, phone calls and interviews it can potentially be done at scale and almost instantaneously.

Ezra Klein published a look at a number of the proposed plans for this Phase Two/Interim New Normal and he found all of them almost totally unworkable. They all involve levels of technical capacity, privacy intrusion and political will that seem almost fantastical

we’ll either do one of these plans or all stay in our houses for a year or engage in the truly fantastical approach of going about life as usual while hundreds of thousands of Americans are dying and our national health care system collapsing around us.

The reality is that we’ll likely get some mix of all three. But knowing the alternatives helps focus our attention not on the seeming impossibility of these strategies but the fact that we need to get down to the business of planning and implementing them.

Phase Two is much more complicated. It is what everyone involved in any sort of public policy needs to be focusing on right now. Unfortunately the federal government has shown very, very little ability to mount any kind of coherent, national response.

And the President is focused on finding a date and calling an all clear as soon as possible.

They compared the 18 counties where Mr. Trump held rallies with as many as 200 counties with similar demographics and similar trajectories of confirmed Covid-19 cases before the rally date.

Based on their models, the researchers concluded that on average, the 18 events produced increases in confirmed cases of more than 250 per 100,000 residents.

Public health officials in states and counties where Mr. Trump has held rallies said in interviews this week that it was impossible to tie particular infections or outbreaks to the gatherings for several reasons: Caseloads are rising over all, rally attendees often travel from other locations, contact tracing is not always complete, and contact tracers do not always know where infected people have been.

A little more than two weeks after the event, Tulsa recorded 206 new confirmed coronavirus cases in a single day, a record high at the time

Around the country, state and local public health officials have also wrestled with the question of whether Mr. Trump’s rallies have become so-called superspreader events. With thousands of people gathered together in close quarters, many not wearing masks, the gatherings provide a fertile environment for the virus to spread.

In Minnesota, for example, state officials traced 16 coronavirus infections and two hospitalizations to a Trump rally on Sept. 18 in the city of Bemidji, in Beltrami County.

Assessing the risk of campaign rallies is “a noisy process,”

Professor Bernheim said, and focusing on a single event is misleading.

In Taiwan, officials boarded planes arriving from Wuhan and assessed passengers for symptoms before allowing anyone to disembark. Within days, Singapore, South Korea and other Asian states had implemented similar steps.

A year after SARS, Taiwan established a National Health Command Center that brought together all levels and branches of government, preparing for the possibility of another disease outbreak. Its interventions over the past two months have been decisive in keeping Taiwan ahead of the curve

They didn’t hesitate, they didn’t want to die,” Wang said. “The mortality rate was so high [during SARS] and they didn’t know how bad this one was going to be. Nobody thought it was like the flu.”

As early as Jan. 5, Taiwan was tracing people who had been in Wuhan in the previous 14 days. Those with symptoms of respiratory infections were quarantined.

In subsequent weeks, authorities used data and technology to identify and track cases, communicated effectively to reassure the public, offered relief to businesses and allocated medical resources where they were needed most — rationing face masks and dramatically increasing their production.

On Jan. 27, Taiwan combined the databases of its National Health Insurance Administration and National Immigration Agency, allowing it to track everyone who had been in Wuhan in the recent past and alert doctors to patients’ travel histories

Now, Taiwan is hoping to keep its infection numbers down and has asked residents not to travel abroad after its biggest single-day jump of cases — 23 — on Wednesday. It is also barring most noncitizens from entering.

South Korea, meanwhile, has become the poster child for testing. Its success is rooted in a previous failure: The limited availability of test kits was seen as having aggravated the 2015 MERS outbreak, when the country suffered the second-highest caseload after Saudi Arabia.

Whereas the United States and Japan keep testing tightly controlled by a central authority, South Korea opened the process to the private sector, introducing a path to grant “emergency usage approval” to tests for pathogens of pandemic potential.

More than 260,000 people in South Korea have been tested for the virus, the highest per capita anywhere, with testing and treatment fees covered by the government and drive-through centers capturing global attention

Singapore, too, benefited from its own capabilities to test, as did Hong Kong and Japan. All developed their own diagnostic tests when the covid-19 genome sequence was published.

Outside mainland China, the territory had been the biggest casualty of the Communist Party’s coverup of the SARS outbreak, with some 300 deaths and little clarity on what was unfolding until it was too late.

This time, though, and without needing to be told much, Hong Kong residents took matters into their own hands. The city’s financial district was reduced to a ghost town in early February as companies closed offices. Bakeries known for hour-long weekend lines were abandoned.

Parties, weddings and family gatherings were canceled — without any government order. Almost everyone rushed to ­procure masks; a recent study ­estimated that 74 percent to 98 percent of residents wore them when leaving their homes. Voluntary social distancing was hailed as a key reason for the lower rate of infections.

From electronic wristbands to smartphone trackers, Asian jurisdictions have pulled out all the stops to ensure that suspected patients comply with quarantine and isolation orders, monitoring that is backed by laws that were tightened post-SARS.

Singapore used its FBI equivalent, the Criminal Investigation Department, to effectively interrogate every confirmed case with stunning granularity — even using patients’ digital wallets to trace their footsteps. Those caught lying face fines and jail time.