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Within a week of its first confirmed case, South Korea’s disease control agency had summoned 20 private companies to the medical equivalent of a war-planning summit and told them to develop a test for the virus at lightning speed. A week after that, the first diagnostic test was approved and went into battle, identifying infected individuals who could then be quarantined to halt the advance of the disease.

Some 357,896 tests later, the country has more or less won the coronavirus war. On Friday only 91 new cases were reported in a country of more than 50 million.

The US response tells a different story. Two days after the first diagnosis in Washington state, Donald Trump went on air on CNBC and bragged: “We have it totally under control. It’s one person coming from China. It’s going to be just fine.”

Though the decision to allow private and state labs to provide testing has increased the flow of test kits, the US remains starkly behind South Korea, which has conducted more than five times as many tests per capita. That makes predicting where the next hotspot will pop up after New York and New Orleans almost impossible.

Today, 86,012 cases have been confirmed across the US, pushing the nation to the top of the world’s coronavirus league table – above even China.

Most worryingly, the curve of cases continues to rise precipitously, with no sign of the plateau that has spared South Korea.

Jeremy Konyndyk, who led the US government’s response to international disasters at USAid from 2013 to 2017, frames the past six weeks in strikingly similar terms. He told the Guardian: “We are witnessing in the United States one of the greatest failures of basic governance and basic leadership in modern times.”

It was not until 29 February, more than a month after the Journal article and almost six weeks after the first case of coronavirus was confirmed in the country that the Trump administration put that advice into practice. Laboratories and hospitals would finally be allowed to conduct their own Covid-19 tests to speed up the process.

If Trump’s travel ban did nothing else, it staved off to some degree the advent of the virus in the US, buying a little time. Which makes the lack of decisive action all the more curious.

In the absence of sufficient test kits, the US Centers of Disease Control and Prevention (CDC) initially kept a tight rein on testing, creating a bottleneck. “I believe the CDC was caught flat-footed,” was how the governor of New York, Andrew Cuomo, put it on 7 March. “They’re slowing down the state.”The CDC’s botched rollout of testing was the first indication that the Trump administration was faltering as the health emergency gathered pace. Behind the scenes, deep flaws in the way federal agencies had come to operate under Trump were being exposed.

In 2018 the pandemic unit in the national security council – which was tasked to prepare for health emergencies precisely like the current one – was disbanded. “Eliminating the office has contributed to the federal government’s sluggish domestic response,” Beth Cameron, senior director of the office at the time it was broken up, wrote in the Washington Post.

It was hardly a morale-boosting gesture when Trump proposed a 16% cut in CDC funding on 10 February – 11 days after the World Health Organization had declared a public health emergency over Covid-19.

The Food and Drug Administration (FDA), which regulates the diagnostic tests and will control any new treatments for coronavirus, has also shown vulnerabilities. The agency recently indicated that it was looking into the possibility of prescribing the malaria drug chloroquine for coronavirus sufferers, even though there is no evidence it would work and some indication it could have serious side-effects.

As the former senior official put it: “We have the FDA bowing to political pressure and making decisions completely counter to modern science.”

Trump has designated himself a “wartime president”. But if the title bears any validity, his military tactics have been highly unconventional. He has exacerbated the problems encountered by federal agencies by playing musical chairs at the top of the coronavirus force.

The president began by creating on 29 January a special coronavirus taskforce, then gave Vice-President Mike Pence the job, who promptly appointed Deborah Birx “coronavirus response coordinator”, before the federal emergency agency Fema began taking charge of key areas, with Jared Kushner, the president’s son-in-law, creating a shadow team that increasingly appears to be calling the shots.“There’s no point of responsibility,” the former senior official told the Guardian. “It keeps shifting. Nobody owns the problem.”

So it has transpired. In the wake of the testing disaster has come the personal protective equipment (PPE) disaster, the hospital bed disaster, and now the ventilator disaster.Ventilators, literal life preservers, are in dire short supply across the country. When governors begged Trump to unleash the full might of the US government on this critical problem, he gave his answer on 16 March.In a phrase that will stand beside 20 January 2020 as one of the most revelatory moments of the history of coronavirus, he said: “Respirators, ventilators, all of the equipment – try getting it yourselves.”

In the absence of a strong federal response, a patchwork of efforts has sprouted all across the country. State governors are doing their own thing. Cities, even individual hospitals, are coping as best they can.

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.

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

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.

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

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

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

The world may be paying for those missteps right now. Testing is central to the effort to fight the spread of the virus. Countries that test widely can isolate infected people and prevent or slow new infections. Without early and widespread testing, health officials and policymakers will be flying blind, epidemiologists say.

“Y​ou cannot fight a fire blindfolded,” said Tedros Adhanom Ghebreyesus, W.H.O.’s director general. “And we cannot stop this pandemic​ i​f we don’t know who is infected.”

As the virus reached into the United States in late January, President Trump and his administration spent weeks downplaying the potential for an outbreak. The Centers for Disease Control opted to develop its own test rather than rely on private laboratories or the World Health Organization.

The outbreak quickly outpaced Mr. Trump’s predictions, and the C.D.C.’s test kits turned out to be flawed, leaving the United States far behind other parts of the world — both technically and politically.

It was not a question of science. Researchers say a viral test is relatively easy to develop.

“The window of opportunity to contain the epidemic has now shut,” Mr. McCoy said.

France says that it is able to test 2,500 cases daily, though officials won’t say how many people they have tested. The United States has run about 25,000 tests. Neither country has contained the virus or tested aggressively for it. Korea and Singapore have so far been able to do both.

“We were not just looking at having a very good diagnostics test. That’s kind of a given. You can’t do anything without that,” said Dr. Sidney Yee, the chief executive of Singapore’s Diagnostics Development Hub. “We were also looking at getting people prepared and getting accurate messages out.”

national leaders set the tone. “What you’re seeing today is the impact of those earlier comments, and that earlier attitude,”

With no treatment for the disease, many countries are telling sick people to stay home unless they become seriously ill. Hospitals cannot afford to be overwhelmed by nervous people asking for tests.

But patients who self-quarantine likely won’t ever be tested, making it difficult to know the true scope of the disease. And as the disease spreads, the practicality of testing declines, as does its value.

“Testing of contacts, I believe, will be totally out of control very soon,”

due to limited capacity, until now testing in the U.S. has largely been used diagnostically

In addition to diagnostic testing, the new funding will enable schools to use frequent testing as a screening tool, which can "identify asymptomatic disease and prevent clusters before they start,"

The CDC released additional guidance that focuses on testing in specific settings, including correctional and detention facilities, non-health care workplaces, higher education institutions, and homeless shelters and encampments.

the investments and guidance are intended to clear the way toward schools opening.

"The question I think for the administration, and for schools in the country, is not whether they can open, but how,"

We’re paying this lofty price in large part because Myriad owns broad patents on these two BRCA genes, which it acquired in 1997 and 1998, respectively — and refuses to license the test to any other American company.

we need legislative action for rational and appropriate pricing. We don’t make vaccines prohibitively expensive so only the rich can protect themselves. Nor should we let other preventive measures that can save thousands of lives be priced at levels far above what normal “market conditions” would suggest.

In the case of a diagnostic test like that for the BRCA genes, for example, insurance companies could pay for the intellectual property, buy a license on behalf of their insured customers (you and me), and then make sure as many at-risk individuals as possible were tested.

in the past 30 years, software and robots have thrived at replacing a particular kind of occupation: the average-wage, middle-skill, routine-heavy worker, especially in manufacturing and office admin. 

the next wave of computer progress will continue to shred human work where it already has: manufacturing, administrative support, retail, and transportation. Most remaining factory jobs are "likely to diminish over the next decades," they write. Cashiers, counter clerks, and telemarketers are similarly endangered

here's a chart of the ten jobs with a 99-percent likelihood of being replaced by machines and software. They are mostly routine-based jobs (telemarketing, sewing) and work that can be solved by smart algorithms (tax preparation, data entry keyers, and insurance underwriters)

I've also listed the dozen jobs they consider least likely to be automated. Health care workers, people entrusted with our safety, and management positions dominate the list.

If you wanted to use this graph as a guide to the future of automation, your upshot would be: Machines are better at rules and routines; people are better at directing and diagnosing. But it doesn't have to stay that way.

Although the past 30 years have hollowed out the middle, high- and low-skill jobs have actually increased, as if protected from the invading armies of robots by their own moats

Higher-skill workers have been protected by a kind of social-intelligence moat. Computers are historically good at executing routines, but they're bad at finding patterns, communicating with people, and making decisions, which is what managers are paid to do

lower-skill workers have been protected by the Moravec moat. Hans Moravec was a futurist who pointed out that machine technology mimicked a savant infant: Machines could do long math equations instantly and beat anybody in chess, but they can't answer a simple question or walk up a flight of stairs. As a result, menial work done by people without much education (like home health care workers, or fast-food attendants) have been spared, too.

robots are finally crossing these moats by moving and thinking like people. Amazon has bought robots to work its warehouses. Narrative Science can write earnings summaries that are indistinguishable from wire reports. We can say to our phones I'm lost, help and our phones can tell us how to get home. 

In a decade, the idea of computers driving cars went from impossible to boring.

The first wave showed that machines are better at assembling things. The second showed that machines are better at organization things. Now data analytics and self-driving cars suggest they might be better at pattern-recognition and driving. So what are we better at?

One conclusion to draw from this is that humans are, and will always be, superior at working with, and caring for, other humans. In this light, automation doesn't make the world worse. Far from it: It creates new opportunities for human ingenuity.  

But robots are already creeping into diagnostics and surgeries. Schools are already experimenting with software that replaces teaching hours. The fact that some industries have been safe from automation for the last three decades doesn't guarantee that they'll be safe for the next one.

It would be anxious enough if we knew exactly which jobs are next in line for automation. The truth is scarier. We don't really have a clue.

Chan, whose agency was assailed as too slow in reacting to West Africa's Ebola epidemic that killed more than 10,000 people in the past two years, cited "first and foremost the big concern about microcephaly," the birth defect that causes babies to be born with abnormally small heads and improperly developed brains.

This marks the fourth time the WHO has declared a global health emergency since such procedures were put in place in 2007, with the others arising from influenza, Ebola and polio.

Brazil is due to host the Olympics in Rio de Janeiro in August, and President Dilma Rousseff's chief of staff said on Monday there is no risk of cancelling the games due to Zika.

The emergency designation, recommended by a committee of independent experts following criticism of a hesitant response to Zika so far, should help fast-track international action and research priorities. The move lends official urgency to research funding and other steps to stem the spread of the virus.

U.S. Centers for Disease Control and Prevention (CDC) head Thomas Frieden said the WHO emergency declaration "calls the world to action" on Zika. The CDC added four more countries and territories to its list of locales that pose a risk for Zika infection, advising pregnant women to consider avoiding travel to those areas.

The Zika virus has raised questions worldwide about whether pregnant women should avoid infected countries. Chan said delaying travel was something pregnant women "can consider" but added that if they needed to travel they should take protective measures by covering up and using mosquito repellent.

Brazil has reported some 3,700 suspected cases of microcephaly. Brazilian Health Minister Marcelo Castro told Reuters the epidemic was worse than believed because in 80 percent of cases the infected people had no symptoms.

As the virus spreads from Brazil, other countries in the Americas are also likely to see cases of babies with Zika-linked birth defects, experts believe. The clinical symptoms of Zika are usually mild and often similar to dengue, which is transmitted by the same mosquito, leading to fears that Zika will spread into all parts of the world where dengue is commonplace.

More than a third of the world’s population lives in areas at risk of dengue infection, in a band stretching through Africa, India, Southeast Asia and Latin America.Zika's rapid spread in Latin America is attributed to the prevalence of Aedes aegypti and a lack of immunity among the population.

A senior Obama administration official, speaking on condition of anonymity, said, "This is not an Ebola-type situation where you have to stop people at the border."

New York State Governor Andrew Cuomo said the state's health department would offer free tests for individuals with symptoms of infection who have traveled to countries impacted by Zika.

At least 12 groups are working to develop a vaccine.

European Medicines Agency (EMA), Europe's drugs regulator, said it established an expert task force to advise companies working on Zika vaccines and medicines, mirroring similar action during the two-year-long Ebola epidemic that started in December 2013 and the pandemic flu outbreak in 2009.

There are no vaccines or treatment for Zika and none even undergoing clinical studies. Most infected people either have no symptoms or develop mild ones like fever and skin rashes.

"The good news is this is not like Ebola; people don't die of Zika. A lot of people get it and don't even know that they have it," Obama told CBS News

Most of the money sought by Obama, who faces pressure from Republicans and some fellow Democrats to act decisively on Zika, would be spent in the United States on testing, surveillance and response in affected areas, including the creation of rapid-response teams to contain outbreak clusters.

Much remains unknown about Zika, including whether the virus actually causes microcephaly, a condition marked by abnormally small head size that can result in developmental problems.Brazil is investigating the potential link between Zika infections and more than 4,000 suspected cases of microcephaly. Researchers have identified evidence of Zika infection in 17 of these cases, either in the baby or in the mother, but have not confirmed that Zika can cause microcephaly. 

Obama's funding request to Congress includes $335 million for the U.S. Agency for International Development to support mosquito-control, maternal health and other Zika-related public health efforts in affected countries in the Americas.

Fauci said he anticipated beginning a so-called Phase 1 trial this summer for a Zika vaccine that would take about three months to test if it is safe and induces a good immune response before further studies can be conducted.

The CDC said its Zika emergency operations center, with a staff of 300, has been placed on its highest level of activation, reflecting a need for accelerated preparedness for possible local virus transmission by mosquitoes in the continental United States.

Dr. Anne Schuchat, principal deputy director of the U.S. Centers for Disease Control and Prevention, said she was not expecting "large-scale amounts of serious Zika infections" in the continental United States as warmer months bring larger and more active mosquito populations.

Word that Zika can be spread by sexual transmission and blood transfusions and its discovery in saliva and urine of infected people have added to concern over the virus.

The World Health Organization declared the outbreak an international health emergency on Feb. 1, citing a "strongly suspected" relationship between Zika infection in pregnancy to microcephaly.

Brazil is grappling with the virus even as it prepares to host the Olympic Games in Rio de Janeiro in August, with tens of thousands of athletes and tourists anticipated.The U.S. Olympic Committee has told U.S. sports federations that athletes and staff concerned about their health due to Zika should consider not going to the Olympics.

Former Olympian Donald Anthony, president and board chairman of USA Fencing, said, "One of the things that they immediately said was, especially for women that may be pregnant or even thinking of getting pregnant, that whether you are scheduled to go to Rio or no, that you shouldn't go."

“Talents for low intrigue, and the little arts of popularity,” might suffice for someone to be elected to the governorship of a state, but not the presidency. Election would “require other talents, and a different kind of merit,” to gain “the esteem and confidence of the whole Union,” or enough of it to win the presidency. As a result, there would be “a constant probability of seeing the station filled by characters pre-eminent for ability and virtue.” This was the Framers’ goal in designing the system that would make “the choice of the person to whom so important a trust was to be confided.”

In a nutshell, while carrying out his official duties, a president has to put the country, not himself, first; he must faithfully follow and enforce the law; and he must act with the utmost care in doing all that.

can Trump do all that? Does his personality allow him to? Answering those questions doesn’t require mental-health expertise, nor does it really require a diagnosis. You can make the argument for Trump’s unfitness without assessing his mental health: Like James Fallows, for example, you could just ask whether Trump would have been allowed to retain any other job in light of his bizarre conduct

More than a diagnosis, what truly matters, as Lincoln’s case shows, is the president’s behavioral characteristics and personality traits. And understanding how people behave and think is not the sole province of professionals; we all do it every day, with family members, co-workers, and others.

its criteria for personality disorders—they don’t require a person to lie on a couch and confess his or her innermost thoughts. They turn on how a person behaves in the wild, so to speak.

Donald Trump, as president of the United States, is probably the most observable and observed person in the world. I’ve personally met and spoken with him only a few times, but anyone who knows him will tell you that Trump, in a way, has no facade: What you see of him publicly is what you get all the time, although you may get more of it in private

accounts of a person’s behavior from laypeople who observe him might be more accurate than information from a clinical interview, and that this is especially true when considering two personality disorders in particular—what the DSM calls narcissistic personality disorder and antisocial personality disorde

These two disorders just happen to be the ones that have most commonly been ascribed to Trump by mental-health professionals over the past four years. Of these two disorders, the more commonly discussed when it comes to Trump is narcissistic personality disorder, or NPD—pathological narcissism

it touches directly upon whether Trump has the capacity to put anyone’s interests—including the country’s and the Constitution’s—above his own.

A certain amount of narcissism is healthy, and helpful—it brings with it confidence, optimism, and boldness. Someone with more than an average amount of narcissism may be called a narcissist. Many politicians, and many celebrities, could be considered narcissists

“Pathological narcissism begins when people become so addicted to feeling special that, just like with any drug, they’ll do anything to get their ‘high,’ including lie, steal, cheat, betray, and even hurt those closest to them,”

The “fundamental life goal” of an extreme narcissist “is to promote the greatness of the self, for all to see,

To many mental-health professionals, Donald Trump provides a perfect example of such extreme, pathological narcissism: One clinical psychologist told Vanity Fair that he considers Trump such a “classic” pathological narcissist that he is actually “archiving video clips of him to use in workshops because there’s no better example”

The goal of a diagnosis is to help a clinician guide treatment. The question facing the public is very different: Does the president of the United States exhibit a consistent pattern of behavior that suggests he is incapable of properly discharging the duties of his office?

Even Trump’s own allies recognize the degree of his narcissism. When he launched racist attacks on four congresswomen of color, Senator Lindsey Graham explained, “That’s just the way he is. It’s more narcissism than anything else.” So, too, do skeptics of assigning a clinical diagnosis. “No one is denying,” Frances told Rolling Stone, “that he is as narcissistic an individual as one is ever likely to encounter.” The president’s exceptional narcissism is his defining characteristic—and understanding that is crucial to evaluating his fitness for office

The DSM-5 describes its conception of pathological narcissism this way: “The essential feature of narcissistic personality disorder is a pervasive pattern of grandiosity, need for admiration, and lack of empathy that begins by early adulthood and is present in a variety of contexts.”

The diagnostic criteria offer a useful framework for understanding the most remarkable features of Donald Trump’s personality, and of his presidency. (1) Exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements?

(2) Preoccupied with fantasies of unlimited success, power, brilliance

(3) Believes that he or she is “special” and unique and should only associate with other special or high-status people?

Trump claims to be an expert—the world’s greatest—in anything and everything. As one video mash-up shows, Trump has at various times claimed—in all seriousness—that no one knows more than he does about: taxes, income, construction, campaign finance, drones, technology, infrastructure, work visas, the Islamic State, “things” generally, environmental-impact statements, Facebook, renewable energy, polls, courts, steelworkers, golf, banks, trade, nuclear weapons, tax law, lawsuits, currency devaluation, money, “the system,” debt, and politicians.

(4) Requires excessive admiration? Last Thanksgiving, Trump was asked what he was most thankful for. His answer: himself, of course. A number of years ago, he made a video for Forbes in which he interviewed two of his children. The interview topic: how great they thought Donald Trump wa

(5) A sense of entitlement? (9) Arrogant, haughty behaviors? Trump is the man who, on the infamous Access Hollywood tape, said, “When you’re a star, they let you do it. You can do anything you want”—including grabbing women by their genitals. He’s the man who also once said, “I could stand in the middle of Fifth Avenue and shoot somebody and I wouldn’t lose any voters.”

(8) Envious of others? Here’s a man so unable to stand the praise received by a respected war hero and statesman, Senator John McCain, that he has continued to attack McCain months after McCain’s death;

(6) Interpersonally exploitative? Just watch the Access Hollywood tape, or ask any of the hundreds of contractors and employees Trump the businessman allegedly stiffed, or speak with any of the two dozen women who have accused Trump of sexual misconduct, sexual assault, or rape.

Finally, (7) Lacks empathy: is unwilling to recognize or identify with the feelings or needs of others? One of the most striking aspects of Trump’s personality is his utter and complete lack of empathy

The notorious lawyer and fixer Roy Cohn, who once counseled Trump, said that “Donald pisses ice water,” and indeed, examples of Trump’s utter lack of normal human empathy abound.

“It made no sense, Priebus realized, unless you understood … ‘The president has zero psychological ability to recognize empathy or pity in any way.’

What kind of human being, let alone politician, would engage in such unempathetic, self-centered behavior while memorializing such horrible tragedies? Only the most narcissistic person imaginable—or a person whose narcissism would be difficult to imagine if we hadn’t seen it ourselves. The evidence of Trump’s narcissism is overwhelming—indeed, it would be a gargantuan task to try to marshal all of it, especially as it mounts each and every day.

A second disorder also frequently ascribed to Trump by professionals is sociopathy—what the DSM-5 calls antisocial personality disorder

Central to sociopathy is a complete lack of empathy—along with “an absence of guilt.” Sociopaths engage in “intentional manipulation, and controlling or even sadistically harming others for personal power or gratification. People with sociopathic traits have a flaw in the basic nature of human beings … They are lacking an essential part of being human.” For its part, the DSM-5 states that the “essential feature of antisocial personality disorder is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood.”

Trump’s sociopathic characteristics sufficiently intertwine with his narcissistic ones that they deserve mention here. These include, to quote the DSM-5, “deceitfulness, as indicated by repeated lying, use of aliases, or conning others.” Trump’s deceitfulness—his lying—has become the stuff of legend; journalists track his “false and misleading claims” as president by the thousands upon thousands.

Other criteria for antisocial personality disorder include “failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest”; “impulsivity or failure to plan ahead”; and “lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

As for impulsivity, that essentially describes what gets him into trouble most: It was his “impulsiveness—actually, total recklessness”—that came close to destroying him in the 1980s

And lack of remorse? That’s a hallmark of sociopathy, and goes hand in hand with a lack of human conscience. In a narcissistic sociopath, it’s intertwined with a lack of empathy. Trump hardly ever shows remorse, or apologizes, for anything. The one exception: With his presidential candidacy on the line in early October

In a way, Trump’s sociopathic tendencies are simply an extension of his extreme narcissism

articular, “They change reality to suit themselves in their own mind.” Although Trump “lies because of his sociopathic tendencies,” telling falsehoods to fool others, Dodes argues, he also lies to himself, to protect himself from narcissistic injury. And so Donald Trump has lied about his net worth, the size of the crowd at his inauguration, and supposed voter fraud in the 2016 election.

The latter kind of lying, Dodes says, “is in a way more serious,” because it can indicate “a loose grip on reality”—and it may well tell us where Trump is headed in the face of impeachment hearings. Lying to prevent narcissistic injury can metastasize to a more significant loss of touch with reality

Experts haven’t suggested that Trump is psychotic, but many have contended that his narcissism and sociopathy are so inordinate that he fits the bill for “malignant narcissism.” Malignant narcissism isn’t recognized as an official diagnosis; it’s a descriptive term coined by the psychoanalyst Erich Fromm, and expanded upon by another psychoanalyst, Otto Kernberg, to refer to an extreme mix of narcissism and sociopathy, with a degree of paranoia and sadism mixed in

In the view of some in the mental-health community, such as John Gartner, Trump “exhibits all four” components of malignant narcissism: “narcissism, paranoia, antisocial personality and sadism.”

Mental-health professionals have raised a variety of other concerns about Trump’s mental state; the last worth specifically mentioning here is the possibility that, apart from any personality disorder, he may be suffering cognitive decline.

His “mental state,” according to Justin A. Frank, a former clinical professor of psychiatry and physician who wrote a book about Trump’s psychology, “include[s] so many psychic afflictions” that a “working knowledge of psychiatric disorders is essential to understanding Trump.” Indeed, as Gartner puts it: “There are a lot of things wrong with him—and, together, they are a scary witch’s brew.”

when you line up what the Framers expected of a president with all that we know about Donald Trump, his unfitness becomes obvious. The question is whether he can possibly act as a public fiduciary for the nation’s highest public trust. To borrow from the Harvard Law Review article, can he follow the “proscriptions against profit, bad faith, and self-dealing,” manifest “a strong concern about avoiding ultra vires action” (that is, action exceeding the president’s legal authority), and maintain “a duty of diligence and carefulness”? Given that Trump displays the extreme behavioral characteristics of a pathological narcissist, a sociopath, or a malignant narcissist—take your pick—it’s clear that he can’t.

To act as a fiduciary requires you to put someone else’s interests above your own, and Trump’s personality makes it impossible for him to do that. No president before him, at least in recent memory, has ever displayed such obsessive self-regard

Indeed, Trump’s view of his presidential powers can only be described as profoundly narcissistic, and his narcissism has compelled him to disregard the Framers’ vision of his constitutional duties in every respect

Trump’s incapacity affects all manner of subjects addressed by the presidency, but can be seen most acutely in foreign affairs and national security.

All in all, Trump sought to impede and end a significant counterintelligence and criminal investigation—one of crucial importance to the nation—and did so for his own personal reasons. He did precisely the opposite of what his duties require. Indeed, he has shown utter contempt for his duties to the nation

hat constitutional mechanisms exist for dealing with a president who cannot or does not comply with his duties, and how should they take the president’s mental and behavioral characteristics into account?

it turns out that impeachment is a more practical mechanism

In short, now that the House of Representatives has embarked on an impeachment inquiry, one of the most important judgments it must make is whether any identified breaches of duty are likely to be repeated. And if a Senate trial comes to pass, that issue would become central as well to the decision to remove the president from office. That’s when Trump’s behavioral and psychological characteristics should—must—come into pla

One of the most compelling arguments about the meaning of those words is that the Framers, in Article II’s command that a president faithfully execute his office, imposed upon him fiduciary obligations. As the constitutional historian Robert Natelson explained in the Federalist Society Review, the “founding generation [understood] ‘high … Misdemeanors’ to mean ‘breach of fiduciary duty.’

Eighteenth-century lawyers instead used terms such as breach of trust—which describes the same thing. “Parliamentary articles of impeachment explicitly and repetitively described the accused conduct as a breach of trust,” Natelson argues, and 18th-century British legal commentators explained how impeachment for “high Crimes and Misdemeanors” was warranted for all sorts of noncriminal violations that were, in essence, fiduciary breaches.

why the discussion of Morris’s suggestion was so brief—the drafters knew what the words historically meant, because, as a House Judiciary Committee report noted in 1974, “at the time of the Constitutional Convention the phrase ‘high Crimes and Misdemeanors’ had been in use for over 400 years in impeachment proceedings in Parliament

Certainly Alexander Hamilton knew by the time he penned “Federalist No. 65,” in which he explained that impeachment was for “those offenses which proceed from the misconduct of public men, or, in other words, from the abuse or violation of some public trust.

What constitutes such an abuse or violation of trust is up to Congress to decide: First the House decides to bring impeachment charges, and then the Senate decides whether to convict on those charges. The process of impeachment by the House and removal by trial in the Senate is thus, in some ways, akin to indictment by a grand jury and trial by a petit jury

As Laurence Tribe and Joshua Matz explain in their recent book on impeachment, “the Constitution explicitly states that Congress may not end a presidency unless the president has committed an impeachable offense. But nowhere does the Constitution state or otherwise imply that Congress must remove a president whenever that standard is met … In other words, it allows Congress to exercise judgment.”

As Tribe and Matz argue, that judgment presents a “heavy burden,” and demands that Congress be “context-sensitive,” and achieve “an understanding of all relevant facts.” A president might breach his trust to the nation once in some small, inconsequential way and never repeat the misbehavior, and Congress could reasonably decide that the game is not worth the candle.

It’s also an appropriate mechanism, because the constitutional magic words (other than Treason and Bribery) that form the basis of an impeachment charge—high Crimes and Misdemeanors, found in Article II, Section 4 of the Constitution—mean something other than, and more than, offenses in the criminal-statute books. High Crimes and Misdemeanors is a legal term of art, one that historically referred to breaches of duties—fiduciary duties—by public officeholders. In other words, the question of what constitutes an impeachable offense for a president coincides precisely with whether the president can execute his office in the faithful manner that the Constitution requires.

there’s another reason as well. The people have a right to know, and a need to see. Many people have watched all of Trump’s behavior, and they’ve drawn the obvious conclusion. They know something’s wrong, just as football fans knew that the downed quarterback had shattered his leg. Others have changed the channel, or looked away, or chosen to deny what they’ve seen. But if Congress does its job and presents the evidence, those who are in denial won’t be able to ignore the problem any longer.

The rules almost certainly mean that the United States is still greatly understating the number of people nationwide who are sick with COVID-19, experts say. There are more than 1,800 discovered coronavirus cases in the United States, but estimates of the outbreak using statistical and genetic models suggest that thousands of people are already sick.

The CDC guidelines—which do not carry legal force—allow for testing a wider array of patients than is currently allowed under many state-level rules. Under guidelines updated earlier this week, the agency noted that “priorities for testing” may include severely ill hospitalized patients with no other diagnosis; symptomatic adults who are older or who have a complicating factor, such as heart disease or a suppressed immune system; and any patient who had close contact with a “suspect or laboratory-confirmed” COVID-19 patient.

But the guidelines may also keep doctors from understanding the “local epidemiology”—that is, the extent of the coronavirus’s spread—in their own region.

Most state guidelines do not apply to tests conducted by private laboratory firms that do routine medical testing, such as Quest Diagnostics and LabCorp. Those firms say they can test 5,000 people a day, combined, but they take three to four days to deliver results, compared with 24 hours for a state public-health or on-site hospital lab test.

The third instance, an order compelling GM to begin manufacturing ventilators, was the most far-reaching as Trump came under criticism from state governors, Democrats and doctors for playing down a nationwide shortage of ventilators.

Covid-19 is a respiratory illness. Most who contract it recover but it can be fatal, particularly among older people and those with underlying health problems. Ventilators enable a person with compromised lungs to keep breathing.

After Trump invoked the act, GM said it had been working around the clock for more than a week with Ventec Life Systems, a medical device company, and parts suppliers to build more ventilators. The company’s commitment to build Ventec’s ventilators “has never wavered”, it said.

Trump also announced that the White House trade adviser Peter Navarro would become the national DPA policy coordinator for the federal government. Navarro has been a leading advocate of Trump’s protectionist trade agenda, championing tariffs against China and the European Union.

The House speaker, Nancy Pelosi, welcomed Trump’s use of the DPA as “an important but seriously belated step”. She added in a statement on Friday: “Much more must be done. The president must use the full powers of this law to address the dire, widespread shortage of materials required to fight this pandemic, including diagnostic test supplies, masks and other personal protective equipment.”

Critics say Trump ignored early warnings about the threat of the pandemic and had he acted sooner, mass production of ventilators would now be well under way.

In another bizarre moment, when Trump was asked for a message to schoolchildren forced to stay at home, he said: “You can call it a germ, a flu, a virus, you can call it many things. I’m not sure people know what it is.” Scientists have identified it as coronavirus disease (Covid-19), an infectious disease caused by a newly discovered coronavirus called Sars-CoV-2.

In another sign that Trump is not living up to his appeal for bipartisanship, Trump did not invite Pelosi or any other Democrats to the signing of a $2.2tn emergency relief bill. Pelosi said in a statement on Friday: “We must do more to address the health emergency, mitigate the economic damage, and provide for a strong recovery.”

The absence of robust screening until it was “far too late” revealed failures across the government, said Dr. Thomas Frieden, the former C.D.C. director. Jennifer Nuzzo

Across the government, they said, three agencies responsible for detecting and combating threats like the coronavirus failed to prepare quickly enough. Even as scientists looked at China and sounded alarms, none of the agencies’ directors conveyed the urgency required to spur a no-holds-barred defense.

Dr. Robert R. Redfield, 68, a former military doctor and prominent AIDS researcher who directs the C.D.C.,

trusted his veteran scientists to create the world’s most precise test for the coronavirus and share it with state laboratories.

Dr. Stephen Hahn, 60, the commissioner of the Food and Drug Administration, enforced regulations that paradoxically made it tougher for hospitals, private clinics and companies to deploy diagnostic tests in an emergency.

Alex M. Azar II, who led the Department of Health and Human Services, oversaw the two other agencies and coordinated the government’s public health response to the pandemic.

. By the end of the month, Mr. Trump claimed the virus was about to dissipate in the United States, saying: “It’s going to disappear. One day — it’s like a miracle — it will disappear.”

And that absence was illustrated just as vividly by news coverage of planes full of medical supplies from China arriving in Italy, at a time when the US was quietly flying in half a million Italian-made diagnostic swabs for use in its own under-equipped health system

“To me what is so striking is the complete absence of the US from public debates. The US is basically off the map, and China very much is on the map,”

what is happening now is going to linger on, simply because what we’re going through now is such a traumatic experience … It is going to remain very much in our individual and collective memories.”

this week’s $2tn stimulus bill contained scarcely more than $1bn (about 0.06%) for spending outside the US.

additional aid has done little to soften the image of an administration that has employed xenophobic rhetoric and breaking with its closest partners in its efforts to intensify economic pressure on its enemies, Iran and Venezuela, whose populations are at high risk from the coronavirus.

Despite its responsibility for allowing the virus to run rampant in the first place, China has had notable success in reshaping its image as a leader by its later efforts to contain the disease and its outreach to Italy and other vulnerable countries.

“China is filling a public goods vacuum, not a leadership vacuum,” Khanna said. “People here are not idiots. They know exactly where this came from, so you don’t need to worry about China winning any global narrative campaign in the world.”

the coronavirus crisis will inflict more lasting damage on the US’s standing than the 2003 Iraq invasion.

“China wasn’t in the wings in 2003,” she said. “It wasn’t ready to take over that global role. Well, it’s now in a position where it can take over global leadership, and it’s just waiting for the US to misstep or to lose support among its allies

From the debacle over testing to Trump’s months-long denial about the scale of the threat and his constant political point-scoring, the US has showed itself to be anything but a model for the rest of the world to emulate.

worldwide faith in US competence has been one of the pillars of its global standing, and is currently crumbling.

“Far from making ‘America great again,’ this epic policy failure will further tarnish the United States’ reputation as a country that knows how to do things effectively,” Walt wrote in Foreign Policy, in a commentary titled “the death of American competence”.

Khanna pointed out that China’s neighbours in Asia are well aware that Beijing’s censorship during the initial outbreak in Wuhan resulted in a missed opportunity to contain the virus

“US global leadership won’t just end because they bungled their response to the coronavirus, but I think we will come to find that this was a pivotal point,”

the extent to which China succeeds in exploiting the crisis to pursue global primacy would be dependent on whether Beijing can be successfully challenged, for example from a change to a more outward leadership in Washington, or a Europe that can transcend its divisions.

“It basically depends on how everyone else reacts more than how China itself acts,”

The army has been deployed to deep clean hospitals and other facilities as well as some 900 nursing homes, where at least 1,517 deaths have reportedly been recorded.

Meanwhile, the health ministry said some 9,000 rapid diagnostic tests imported from China through a Spanish company had proved defective. It said the kits had European approval and their use had been suspended.

In Italy, the head of the National Health Institute, Silvio Brusafero, said the numbers suggested the rate of new cases was "slowing down", showing that the strict measures implemented across the country were "having their effects".

“Losing two months is close to disastrous, and that’s what we did,” Ashish Jha, director of the Harvard Global Health Institute, told Bloomberg.

if we are being honest with ourselves, we would have to admit that the United States has long been failing. We remain one of the richest countries in the world, but by international standards we look more like a Third World nation.

we lag in almost every measure of societal well-being among the wealthy nations (now 36) of the Organization for Economic Cooperation and Development (OECD).

we had the second-highest poverty rate, the highest level of income inequality and the highest level of obesity.

We were also below average on renewable energy, infrastructure investment and voter turnout.

We spent the most on education but produced less-than-average results

We are the only OECD nation that doesn’t mandate paid family leave.

One area where we do lead is gun violence. Our homicide rate is nearly 50 percent above the OECD average.

We spend more on health care than any other country in the world, but we are the only OECD country without universal medical coverage (27.9 million Americans lacked health insurance in 2018)

Child mortality in the United States is the highest in the OECD, and life expectancy is below average

We have far fewer hospital beds per 1,000 people than other advanced democracies (2.4 compared to 12.2 in South Korea), which makes us particularly vulnerable to a pandemic.

Why has America become so backward? That is a complex topic. I would direct readers to the work of analysts such as Jonathan Rauch, Francis Fukuyama, and Norman Ornstein and Thomas Mann

I would ascribe a lot of what’s wrong to growing partisan polarization that makes it almost impossible to address our most pressing needs. Republicans are getting more conservative and Democrats more liberal — although not to the same degree. The GOP is far more extreme than the Democratic Party.

President Trump has exacerbated the problem, but he didn’t start it. He is himself the product of decades of right-wing revolt against government and increasingly against reason itself.

America is unusual in having a major party — and a major television network — devoted to climate denialism and protecting the “right” of everyone to own an assault rifle. The GOP and the right-wing media have long been a hotbed of nutty conspiracy theories, and their reluctance to face the reality of the new coronavirus set back efforts to save lives.

The Republicans’ decades-long demonization of government has consequences

the federal civilian workforce has fallen as a percentage of total nonfarm employment from 18 percent in 1980 to 15 percent today, and their salaries top out at just under $200,000 — “only slightly more than an entry-level engineer makes at Google.”

There are still plenty of high-quality civil servants, but their ranks are too thin, and they are too much at the mercy of political yahoos.

“When a typical European parliamentary government changes hands from one party to another, the ministers and a handful of staffers turn over,” Fukuyama notes. “In the U.S., a change of administration (even within the same party) opens up some 5,000 ‘Schedule C’ job positions to political appointees.”

We must not only beat this pandemic; we must also address a host of other ills that have been festering for decades. In recent years, America has been “exceptional” mainly in the scale of our governmental failures compared with those of other industrialized democracies.

If the worst-case scenario comes true, are there still things we can do to minimise the pandemic’s impact?Absolutely. We can mobilise more health officials and keep engaging the public, implementing sensible travel controls and ensuring that frontline health workers have ready access to diagnostic tests and are vigilant – that they don’t send anyone who may have been exposed home without testing them, for example

Was an epidemic like that of Covid-19 inevitable?From a biological standpoint an outbreak of a novel pathogen was inevitable, but this one happened in the worst place at the worst time. Wuhan is a big city and a crossroads,

is in people’s minds – even though the risk of another one is real. I’ve written about a hypothetical situation in which a new and dangerous pathogen emerges, a vaccine is developed, and you still get a pandemic, because large numbers of millennials refuse the vaccine. In the US, 20% of millennials believe that vaccines cause autism.

The problem is bad information. As my students often remind me, news tends to be behind paywalls, while fake news is free.

You have said that time and trust are critical to good epidemic management. What do you mean?The delay between the frontline health workers noticing something unusual, in the form of an emerging disease, and that information travelling up the line to central decision-makers is critical. To illustrate that, a 2018 simulation that the Gates Foundation conducted of a flu pandemic estimated that there would be 28,000 after one month, 10 million after three months, and 33 million after six months. The virus used in that simulation was more contagious and deadly than Covid-19 – though they are both respiratory viruses – but the example shows how all epidemics grow exponentially. So if you can catch an epidemic in the first few weeks, it makes all the difference.

y (GHS) Index – that scores countries on six dimensions: prevention, detection, response, health system, risk environment and compliance with international standards. No country scores perfectly on all six. China has detected and responded to this epidemic pretty well, though its health system is now stretched beyond capacity, but it is weak on prevention

How well is the US prepared?The US ranks high on the GHS index, but is still unprepared for a severe pandemic, should one happen. Malfunctioning coronavirus tests have frustrated public health labs and delayed outbreak monitoring. Supplies of masks, suits and other protective material for health workers are running low in the midst of a moderately severe flu season.

Since the creation of a much-needed public health emergency preparedness fund in the aftermath of 9/11, its budget and the public health functions it supports have been steadily reduced. This is the mentality that left the world vulnerable to the devastating 2014 outbreak of Ebola in west Africa – that is, close the fire department and cancel the fire insurance as nobody’s house or factory has burned down lately. It’s time we learned that the bugs never stop mutating and crossing over to humans.

What exactly should we be doing faster?Fewer than one in three countries are close to being prepared to confront an epidemic, which leaves the vast majority of the world’s population vulnerable.

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.

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

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.

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.

In South Korea, information on the movements of infected people before they were tested is collected and relayed over smartphones, creating a real-time ma

Taiwan tracks infected people’s whereabouts via smartphones

In Hong Kong, everyone subject to a compulsory quarantine must activate real-time location-sharing on their phone or wear an electronic wristband.

These measures have been backed by local populations that lived through previous epidemics and have largely shed concerns about privacy and tracking.

Americans should not focus “only on the kind of high-profile displays of state power that have made headlines from China” but also look at countries such as South Korea that are “balancing Democratic openness with rapid, concerted public-health action.”

Experts agree, though, that Western governments must be prepared to limit their citizens’ movements, mandate isolation for positive cases and track contacts regardless of privacy concerns.

All of these are wrong, of course. But we didn’t get here overnight. It took practice.

The Republican Party has gone from admiring William F. Buckley Jr., an Ivy League intellectual, to viewing higher education as a left-wing conspiracy to indoctrinate the young.

somewhere along the way, it became, “all government is bad.” Now we are in a crisis that can be solved only by massive government intervention. That’s awkward.

Next, somehow, the party of idealistic Teddy Roosevelt, pragmatic Bob Dole and heroic John McCain became anti-intellectual, by which I mean, almost reflexively opposed to knowledge and expertise. We began to distrust the experts and put faith in, well, quackery

Long before Trump, the Republican Party adopted as a key article of faith that more government was bad. We worked overtime to squeeze it and shrink it, to drown it in the bathtub, as anti-tax activist Grover Norquist liked to say.

In retribution, we started defunding education.

Conservatives have spent years trying to cut funds for basic science and research, lamenting government seed money for nearly every budding technology and then hoping for the best

Finally, there is the populist GOP distrust and dislike of the other, the foreign.

Yes, it is annoying that the Chinese didn’t come clean and explain everything to us from the start. But it appears that a Swiss company is helping to jump-start us in testing; and it is a German company that American officials reportedly tried to lure to the United States recently to help develop a vaccine for the virus.

What is happening now is the inevitable result of a party that embraced fear, weaponized xenophobia and regarded facts as dangerous, left-wing landmines that must be avoided.

Yes, elections have consequences. Those of us in the Republican Party built this moment. Now the nation must live with those consequences.