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No one knows exactly how many people died from influenza in 1918; estimates range from 15 million to 100 million globally. Historians estimate that the virus killed about 675,000 people in the United States across three waves of the pandemic

confirmed cases. But in this global crisis, both the numerator and the denominator are fuzzy.

the rising rate may reflect the disease’s gradual progression, combined with discoveries of additional deaths.

The disease is far more likely to cause severe outcomes in older people, with the oldest cohorts the most vulnerable. That said, in every age group — even 85-plus — most people who contract the disease will recover.

One scholarly estimate finds that the 1918-1920 pandemic killed 218 out of every 100,000 people living in the world at that time

In Spain, the death toll already stands at 41 out of 100,000 people; in Belgium the number is 45. In New York state, it is 63, and that number rises even higher if you consider the “probable” death toll in New York City.

So is the coronavirus as deadly? “This depends on how long this continues,”

The “virulence” of the virus — its ability to cause illness — has been steadily coming into focus.

But more than a month later, the WHO number has gone even higher: On April 16, the WHO showed a global fatality rate of 6.6 percent among confirmed cases.

Preliminary research indicates that the virus is not mutating significantly as it spreads, and so there is no evidence that some countries are dealing with a more virulent strain of SARS-CoV-2.

the median age of patients in Italy is 63 or 64 years; the median age of patients in Germany is 47. The mortality is much lower [in Germany] because they avoided having the older population affected.”

“If, in fact, the case fatality rate is higher than the 1918 flu, then this one has the potential to kill even more people,

“We saw it everyday. African Americans have three times the rate of chronic kidney disease that Caucasians have, and 25 percent higher heart disease. They’ve got higher rates of diabetes, hypertension and asthma,” Duggan said. “I fully expect that when people are hit hard and they are on a ventilator to breathe and their body needs to fight the infection, that people who already have compromised hearts or kidneys or lungs are that much more in jeopardy.”

Also critical is the nature, and robustness, of the national health system. For instance, Japan, where the current case fatality rate is 1.6 percent, and Singapore are reporting extremely high rates of hospitalization for coronavirus patients, at 80 percent and higher, figures that are unheard of in the United States. But this probably helps improve treatment and also reduces disease spread by isolating patients. The result is fewer deaths.

Several of the countries with low fatality rates — Germany, South Korea, Norway — have very high rates of coronavirus testing. This gave them a better look at the disease within their borders.

San Francisco General Hospital, noted that the hospital nearly tripled the capacity of its intensive care unit by adding doctors, nurses and technicians while the city adopted social distancing measures shortly ahead of New York.

“We were ready for a surge that never happened,” Balmes said. “They’re every bit as good as we are in intensive care in New York, but the system was overwhelmed. We did physical distancing just a few days earlier than New York, but it was a few days to the good.”

in a news conference that the global case fatality rate was 3.4 percent. That was treated as a revelation about the innate deadliness of the disease, but in fact was simply the WHO’s crude mortality ratio for confirmed covid-19 cases up to that point in time.

The other major factor in mortality is chronic disease. Most people hospitalized with severe cases of covid-19 have chronic health conditions such as diabetes, lung disease and heart disease. Where there is a high percentage of noncommunicable diseases like high blood pressure, the coronavirus will also be more deadly

A new study from researchers at Stanford, not yet peer-reviewed, looked for coronavirus antibodies in a sample population in Santa Clara County, Calif., and concluded that the actual infection rate in the county by early April was 50 to 85 times greater than the rate of confirmed cases.

“The story of this virus is turning out to be more about its contagiousness and less about its case fatality rate,” said David Rubin, director of PolicyLab at Children’s Hospital of Philadelphia and a University of Pennsylvania professor of pediatrics. “It’s less fatal than we thought, but it’s more contagious.”

Where extensive testing has been done, estimates for the case fatality rate are often below 1 percent, The Post has found, suggesting these countries are getting closer to a rate that takes into account all infections

In Iceland, which has tested over 10 percent of the population, vastly more than other countries, the fatality rate is just 0.5 percent.

Harvard epidemiologist Marc Lipsitch has written that he and most experts suspect the fatality rate is about 1 to 2 percent for symptomatic cases. A 1 percent fatality rate is 10 times the average fatality rate for seasonal flu.

“It’s probably about an order of magnitude higher for covid-19,” said Viboud, the NIH epidemiologist. “It’s more severe in terms of mortality than the pandemics we’ve seen since 1918.”

Kevin McCullough, a columnist for the conservative website Town Hall, wrote a column that ran last week with the headline “Antibody Testing: Proves We’ve Been Had!”

“Those higher numbers of case fatality rates, they’re still true,” Viboud said. “It’s your probability of dying if you’re clinically sick with it, which is something that people may care about, too.”

Moreover, the fatality rate of a virus, however it is defined, is not an innate feature of the pathogen. It depends on many variables, including the age and health of the population and access to health care.

The most controversial such study came out of Santa Clara County, Calif., the heart of Silicon Valley. It claimed that the true number of infections in the county in early April may have been 50 to 85 times the official coronavirus case counts. Extrapolating from that, it gave an estimated infection fatality rate of between 0.12 and 0.2 percent.

That provided what seemed like reliable ammunition to those who believe the danger of covid-19 has been overstated. They said the numbers show this disease is not much different from seasonal flu.

A commonly cited statistic about seasonal flu is that it has a fatality rate of 0.1 percent, That, however, is a case fatality rate. The infection fatality rate for flu is perhaps only half that, Viboud said. Shaman estimated that it’s about one-quarter the case fatality rate.

Shaman, the epidemiologist, said he hopes the higher estimates for infections and commensurately lower fatality rates are correct. Everyone needs more testing and better data, he said.

we can’t simply replace one simplistic narrative, about the super power of mitigation policy, for another, focused only on the burdens it imposed and not at all on the costs of doing much less — or nothing at all.

Let’s start with the title. What is the big failure, as you see it?

McLean: I think it gets at things that had happened in America even before the pandemic hit. And among those things were, I think, a failure to recognize the limits of capitalism, a failure of government to set the right rules for it, particularly when it comes to our health care system; a focus on profits that may have led to an increase in the bottom line but created fragility in ways people didn’t understand; and then our growing polarization that made us incapable of talking to each other

How big is the failure? When I look at The Economist’s excess mortality data, I see the U.S. had the 53rd-worst outcome in the world — worse than all of Western Europe, but better than all of Eastern Europe.

McLean: I think one way to quantify it is to take all those numbers and then put them in the context of our spending on health care. Given the amount we spend on health care relative to other countries, the scale of the failure becomes more apparent.

o me, the most glaring example is the schools. They were closed without people thinking through the potential consequences of closing down public schools, especially for disadvantaged kids.

to compound it, in my view, public health never made the distinction that needed to be made between the vulnerabilities of somebody 70 years old and the vulnerabilities of somebody 10 years old.

In the beginning of the book you write, in what almost feels like a thesis statement for the book: “A central tenet of this book is that we could not have done better, and pretending differently is a dangerous fiction, one that prevents us from taking a much needed look in the mirror.”

This claim, that the U.S. could not have done any better, runs against your other claim, that what we observed was an American failure. It is also a pretty extreme claim, I think, and I wanted to press you on it in part because it is, in my view, undermined by quite a lot of the work you do in the book itself.

Would the U.S. not have done better if it had recognized earlier that the disease spread through the air rather than in droplets? Would it not have done better if it hadn’t bungled the rollout of a Covid test in the early months?

McLean: Everything that you mentioned — the point of the book is that those were set by the time the pandemic hit.

in retrospect, what we were doing was to try to delay as much spread as we could until people got vaccinated. All the things that we did in 2020 were functionally serving or trying to serve that purpose. Now, given that, how can you say that none of that work saved lives?

McLean: I think that the test failure was baked into the way that the C.D.C. had come to operate

But the big question I really want to ask is this one: According to the C.D.C., we’ve had almost 1.2 million deaths from Covid. Excess mortality is nearly 1.4 million. Is it really your contention that there was nothing we might’ve done that brought that total down to 1.1 million, for instance, or even 900,000?

McLean: It’s very — you’re right. If you went through each and every thing and had a crystal ball and you could say, this could have been done, this could have been moved up by a month, we could have gotten PPE …

When I came to that sentence, I thought of it in terms of human behavior: What will humans put up with? What will humans stand for? How do Americans act? And you’ve written about Sweden being sort of average, and you’ve written about China and the Chinese example. They lock people up for two years and suddenly the society just revolts. They will not take it anymore. They can’t stand it. And as a result, a million and a half people die in a month and a half.

Well, I would tell that story very differently. For me, the problem is that when China opened up, they had fully vaccinated just under two-thirds of their population over 80. So to me, it’s not a failure of lockdowns. It’s a failure of vaccinations. If the Chinese had only achieved the same elderly vaccination rate as we achieved — which by global standards was pretty poor — that death toll when they opened up would have been dramatically lower.

What do you mean by “lockdown,” though? You use the word throughout the book and suggest that China was the playbook for all countries. But you also acknowledge that what China did is not anything like what America did.

Disparities in health care access — is it a dangerous fiction to think we might address that? You guys are big champions of Operation Warp Speed — would it not have been better if those vaccines had been rolled out to the public in nine months, rather than 12

. But this isn’t “lockdown” like there were lockdowns in China or even Peru. It’s how we tried to make it safer to go out and interact during a pandemic that ultimately killed a million Americans.

McLean: I think that you’re absolutely right to focus on the definition of what a lockdown is and how we implemented them here in this country. And I think part of the problem is that we implemented them in a way that allowed people who were well off and could work from home via Zoom to be able to maintain very much of their lives while other people couldn’t

And I think it depends on who you were, whether you would define this as a lockdown or not. If you were a small business who saw your small business closed because of this, you’re going to define it as a lockdown.

n the book you’re pretty definitive. You write, “maybe the social and economic disasters that lockdowns created would have been worth it if they had saved lives, but they hadn’t.” How can you say that so flatly?

I think there are still open questions about what worked and how much. But the way that I think about all of this is that the most important intervention that anybody did anywhere in the world was vaccination. And the thing that determined outcomes most was whether your first exposure came before or after vaccination.

Here, the shelter-in-place guidelines lasted, on average, five to seven weeks. Thirty nine of the 40 states that had issued them lifted them by the end of June, three months in. By the summer, according to Google mobility data, retail and grocery activity was down about 10 percent. By the fall, grocery activity was only down about 5 percent across the country

Nocera: Well, on some level, I feel like you’re trying to have it both ways. On the one hand, you’re saying that lockdowns saved lives. On the other hand, you said they weren’t real lockdowns because everybody was out and about.

I don’t think that’s having it both ways. I’m trying to think about these issues on a spectrum rather than in binaries. I think we did interrupt our lives — everybody knows that. And I think they did have an effect on spread, and that limiting spread had an effect by delaying infections until after vaccination.

Nocera: Most of the studies that say lockdowns didn’t work are really less about Covid deaths than about excess mortality deaths. I wound up being persuaded that the people who could not get to the hospital, because they were all working, because all the doctors were working on Covid and the surgical rooms were shut down, the people who caught some disease that was not Covid and died as a result — I wound up being persuaded about that.

We’re in a pandemic. People are going to die. And then the question becomes, can we protect the most vulnerable? And the answer is, we didn’t protect the most vulnerable. Nursing homes were a complete disaster.

There was a lot of worry early on about delayed health care, and about cancer in particular — missed screenings, missed treatments. But in 2019, we had an estimated 599,600 Americans die of cancer. In 2020, it was 602,000. In 2021, it was 608,000. In 2022, it was 609,000.

Nocera: See, it went up!But by a couple of thousand people, in years in which hundreds of thousands of Americans were dying of Covid.

Nocera: I think you can’t dispute the excess mortality numbers.I’m not. But in nearly every country in the world the excess mortality curves track so precisely with Covid waves that it doesn’t make sense to talk about a massive public health problem beyond Covid. And when you add all of these numbers up, they are nowhere near the size of the footfall of Covid. How can you look back on this and say the costs were too high?

Nocera: I think the costs were too high because you had school costs, you had economic costs, you had social costs, and you had death.

McLean: I think you’re raising a really good point. We’re making an argument for a policy that might not have been doable given the preconditions that had been set. I’m arguing that there were these things that had been put in place in our country for decades leading up to the pandemic that made it really difficult for us to plant in an effective way, from the outsourcing of our PPE to the distrust in our health care system that had been created by people’s lack of access to health care with the disparities in our hospital system.

How would you have liked to see things handled differently?Nocera: Well, the great example of doing it right is San Fran

I find the San Francisco experience impressive, too. But it was also a city that engaged in quite protracted and aggressive pandemic restrictions, well beyond just protecting the elderly and vulnerable.

McLean: But are we going to go for stay-at-home orders plus protecting vulnerable communities like San Francisco did? Or simply letting everybody live their lives, but with a real focus on the communities and places like nursing homes that were going to be affected? My argument is that we probably would’ve been better off really focusing on protecting those communities which were likely to be the most severely affected.

I agree that the public certainly didn’t appreciate the age skew, and our policy didn’t reflect it either. But I also wonder what it would mean to better protect the vulnerable than we did. We had testing shortages at first. Then we had resistance to rapid testing. We had staff shortages in nursing homes.

Nocera: This gets exactly to one of our core points. We had spent 30 years allowing nursing homes to be owned by private equity firms that cut the staff, that sold the land underneath and added all this debt on

I hear you saying both that we could have done a much better job of protecting these people and that the systems we inherited at the outset of the pandemic would’ve made those measures very difficult, if not impossible, to implement.

But actually, I want to stop you there, because I actually think that that data tells the opposite story.

And then I’m trying to say at the same time, but couldn’t we have done something to have protected people despite all of that?

I want to talk about the number of lives at stake. In the book, you write about the work of British epidemiologist Neil Ferguson. In the winter of 2020, he says that in the absence of mitigation measures and vaccination, 80 percent of the country is going to get infected and 2.2 million Americans are going to die. He says that 80 percent of the U.K. would get infected, and 510,000 Brits would die — again, in the abs

In the end, by the time we got to 80 percent of the country infected, we had more than a million Americans die. We had more than 200,000 Brits die. And in each case most of the infections happened after vaccination, which suggests that if those infections had all happened in a world without vaccines, we almost certainly would have surpassed two million deaths in the U.S. and almost certainly would’ve hit 500,000 deaths in the U.K.

In the book, you write about this estimate, and you endorse Jay Bhattacharya’s criticism of Ferguson’s model. You write, “Bhattacharya got his first taste of the blowback reserved for scientists who strayed from the establishment position early. He co-wrote an article for The Wall Street Journal questioning the validity of the scary 2 to 4 percent fatality rate that the early models like Neil Ferguson’s were estimating and that were causing governments to panic. He believed, correctly as it turns out, that the true fatality rate was much lower.”

Nocera: I know where you’re going with this, because I read your story about the nine pandemic narratives we’re getting wrong. In there, you said that Bhattacharya estimated the fatality rate at 0.01 percent. But if you actually read The Wall Street Journal article, what he’s really saying is I think it’s much lower. I’ve looked at two or three different possibilities, and we really need some major testing to figure out what it actually is, because I think 2 percent to 4 percent is really high.

He says, “if our surmise of 6 million cases is accurate, that’s a mortality rate of 0.01%. That is ⅒th the flu mortality rate of 0.1%.” An I.F.R. of 0.01 percent, spread fully through the American population, yields a total American death toll of 33,000 people. We have had 1.2 million deaths. And you are adjudicating this dispute, in 2023, and saying that Neil was wrong and Jay was right.

hird, in the Imperial College report — the one projecting two million American deaths — Ferguson gives an I.F.R. estimate of 0.9 percent.

Bhattacharya’s? Yes, there is some uncertainty around the estimate he offers. But the estimate he does offer — 0.01 percent — is one hundred times lower than the I.F.R. you yourselves cite as the proper benchmark.

Nocera: In The Wall Street Journal he does not say it’s 0.01. He says, we need to test to find out what it is, but it is definitely lower than 2 to 4 percent.

Well, first of all, the 2 percent to 4 percent fatality rate is not from Neil Ferguson. It’s from the W.H.O.

But I think that fundamentally, at the outset of the pandemic, the most important question orienting all of our thinking was, how bad could this get? And it turns out that almost all of the people who were saying back then that we shouldn’t do much to intervene were extremely wrong about how bad it would be

The argument then was, more or less, “We don’t need to do anything too drastic, because it’s not going to be that big a deal.” Now, in 2023, it’s the opposite argument: “We shouldn’t have bothered with restrictions, because they didn’t have an impact; we would have had this same death toll anyway.” But the death toll turned out to be enormous.

Now, if we had supplied all these skeptics with the actual numbers at the outset of the pandemic, what kind of audience would they have had? If instead of making the argument against universal mitigation efforts on the basis of a death toll of 40,000 they had made the argument on the basis of a death toll of more than a million, do you think the country would’ve said, they’re right, we’re doing too much, let’s back off?

McLean: I think that if you had gone to the American people and said, this many people are going to die, that would’ve been one thing. But if you had gone to the American people and said, this many people are going to die and a large percentage of them are going to be over 80, you might’ve gotten a different answer.

I’m not arguing we shouldn’t have been trying to get a clearer sense of the true fatality rate, or that we shouldn’t have been clearer about the age skew. But Bhattacharya was also offering an estimate of fatality rate that turned out to be off by a factor of a hundred from the I.F.R. that you yourselves cite as correct. And then you say that Bhattacharya was right and Ferguson was wrong.

And you, too, Joe, you wrote an article in April expressing sympathy for Covid skeptics and you said ——Nocera: This April?No, 2020.Nocera: Oh, oh. That’s the one where I praised Alex Berenson.You also cited some Amherst modeling which said that we were going to have 67,000 to 120,000 American deaths. We already had, at that point, 60,000. So you were suggesting, in making an argument against pandemic restrictions, that the country as a whole was going to experience between 7,000 and 60,000 additional deaths from that point.

when I think about the combination of the economic effects of mitigation policies and just of the pandemic itself and the big fiscal response, I look back and I think the U.S. managed this storm relatively well. How about each of you?

in this case, Congress did get it together and did come to the rescue. And I agree that made a ton of difference in the short term, but the long-term effects of the fiscal rescue package were to help create inflation. And once again, inflation hits those at the bottom of the socioeconomic distribution much harder than it does those at the top. So I would argue that some of what we did in the pandemic is papering over these long-term issues.

I think as with a lot of the stuff we’ve talked about today, I agree with you about the underlying problems. But if we take for granted for a moment that the pandemic was going to hit us, when it did, under the economic conditions it did, and then think about the more narrow context of whether, given all that, we handled the pandemic well. We returned quickly to prepandemic G.D.P. trends, boosted the wealth of the bottom half of the country, cut child poverty in half, pushed unemployment to historical lows.

What sense do you make of the other countries of the world and their various mitigation policies? Putting aside China, there’s New Zealand, Australia, South Korea — these are all places that were much more aggressive than the U.S. and indeed more than Europe. And had much, much better outcomes.

Nocera: To be perfectly honest, we didn’t really look, we didn’t really spend a lot of time looking at that.

McLean: But one reason that we didn’t is I don’t think it tells us anything. When you look at who Covid killed, then you have to look at what the pre-existing conditions in a country were, what percentage of its people are elderly. How sick are people with pre-existing conditions?

I just don’t think there’s a comparison. There’s just too many factors that influence it to be able to say that, to be able to compare America to any other country, you’d have to adjust for all these factors.

But you do spend a bit of time in the book talking about Sweden. And though it isn’t precisely like-for-like, one way you can control for some of those factors is grouping countries with their neighbors and other countries with similar profiles. And Sweden’s fatality rate in 2020 was 10 times that of Norway, Finland and Iceland. Five times that of Denmark. In the vaccination era, those gaps have narrowed, but by most metrics Sweden has still done worse, overall, than all of those countries.

On the matter of omniscience. Let’s say that we can send you back in time. Let’s put you both in charge of American pandemic response, or at least American communication about the pandemic, in early 2020. What would you want to tell the country? How would you have advised us to respond?

McLean: What I would want is honesty and communication. I think we’re in a world that is awash in information and the previous methods of communication — giving a blanket statement to people that may or may not be true, when you know there’s nuance underneath it — simply doesn’t work anymore

o I would’ve been much more clear — we think masks might help, we don’t know, but it’s not that big of an ask, let’s do it. We think the early data coming out of Italy shows that these are the people who are really, really at risk from Covid, but it’s not entirely clear yet. Maybe there is spread in schools, but we don’t know. Let’s look at this and keep an open mind and look at the data as it comes in.

The following month ended up being the second-most active April on record for tornadoes, behind only 2011 for total number. Every day in April but one -- April 5 -- saw at least a Marginal Risk (level 1 of 5) for severe storms somewhere across the contiguous US,

2020's second significant outbreak -- on April 12 and 13 -- produced more than 140 tornadoes. It was also the deadliest tornado outbreak in six years, with 32 fatalities

"Tornadoes are the same way. Some of the strongest tornadoes every year occur in rural parts of the country, so damage can be limited, but if a tornado, even a weaker one, strikes a major metro area, damage and fatalities can be extensive,"

There were 14 killer tornadoes in April 2020. Then, into May 2020, a shift in the weather pattern began to favor development of strong troughs in the eastern US.

Another potentially deadly weather phenomenon -- lightning strikes -- also saw tallies drop in 2020. There were about 170 million lightning events last year across the continental US, down about 52 million from 2019,

Unsurprisingly, Texas ranks No. 1 in total lightning strikes, due in part to its huge land area, Vaisala reports. By square kilometer, though, Florida tops the list, with Texas sixth. Iowa, Montana, New Mexico, and Wyoming all saw far fewer lightning strikes in 2020.

Sometimes a single event can account for a large number of lightning strikes. An example is the Midwestern derecho event last summer. It spawned 8% of all Iowa lightning strikes in 2020, with over 27,000 cloud-to-ground strikes. Despite this, Iowa -- which based off the average from 2010-2019 places 13th for most strikes -- actually dropped to the No. 22 spot last year.Other states saw big increases in lightning strikes in 2020. Georgia jumped four spots, cracking the Top 10 for only the third time. Ohio, Michigan and North Dakota also notched more lightning strikes last year, with over 2 million cloud-to-ground strikes each.

Preliminary numbers show lightning killed 17 people across the US in 2020, the second-lowest total since 2010, according to the National Weather Service.

Lightning in some Western states can be especially concerning in the summer months due to the potential for sparking wildfires. But not all lightning is created equal.

And lightning frequency isn't the only consideration for fire weather.

Oftentimes as thunderstorms develop out West, the surrounding air is so dry that any rain that falls actually gets evaporated before it reaches the ground, a phenomena called "virga." Lightning can still occur within these storms, which don't have the benefit of moisture to extinguish any fires a strike might set.

Lower gas prices are one possible reason. When gasoline is cheaper, people drive more—and more time on the road translates into more fatal accidents.

For instance, the increase in traffic deaths exceeded 20 percent in the region that includes Alaska, Oregon, Washington, Idaho, and Montana, but only went up by about 3 percent in the region that includes California, Arizona, Hawaii, and other Pacific territories.

But while car-safety technology has improved dramatically in recent decades, handguns have barely changed in a century.

Gun deaths surpassed motor-vehicle deaths in 21 states plus the District of Columbia in 2014, according to analysis by the Violence Policy Center.

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.

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.

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.

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.

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

“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.

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

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

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.”

0.6 percent of the world’s population is 47 million people, and 0.6 percent of the American population is 2 million people. The virus remains a major threat.

China had reported 90,294 cases as of Friday and 4,634 deaths, which is a C.F.R. of 5 percent. The United States was very close to that mark. It has had 2,811,447 cases and 129,403 deaths, about 4.6 percent

So far, in most countries, about 20 percent of all confirmed Covid-19 patients become ill enough to need supplemental oxygen or even more advanced hospital care

it is difficult to measure fatality rates during pandemics, especially at the beginning.

In the chaos that ensues when a new virus hits a city hard, thousands of people may die and be buried without ever being tested, and certainly without them all being autopsied.

Normally, once the chaos has subsided, more testing is done and more mild cases are found — and because the denominator of the fraction rises, fatality rates fall. But the results are not always consistent or predictable.

Ten sizable countries, most of them in Western Europe, have tested bigger percentages of their populations than has the United States, according to Worldometer, which gathers statistics. They are Iceland, Denmark, Spain, Portugal, Belgium, Ireland, Italy, Britain, Israel and New Zealand.

But their case fatality rates vary wildly: Iceland’s is less than 1 percent, New Zealand’s and Israel’s are below 2 percent. Belgium, by comparison, is at 16 percent, and Italy and Britain at 14 percent

Those percentages are far higher rates than the 2.5 percent death rate often ascribed to the 1918 flu pandemic.

Whether those patients survive depends on a host of factors, including age, underlying illnesses and the level of medical care available.

Death rates are expected to be lower in countries with younger populations and less obesity, which are often the poorest countries. Conversely, the figures should be higher in countries that lack oxygen tanks, ventilators and dialysis machines, and where many people live far from hospitals. Those are also often the poorest countries.

new evidence that people with Type A blood are more likely to fall deathly ill could change risk calculations. Type A blood is relatively rare in West Africa and South Asia, and very rare among the Indigenous peoples of South America.

it had relied on a mix of data sent in by member countries and by academic groups, and on a meta-analysis done in May by scientists at the University of Wollongong and James Cook University in Australia.

Those researchers looked at 267 studies in more than a dozen countries, and then chose the 25 they considered the most accurate, weighting them for accuracy and averaged the data. They concluded that the global I.F.R. was 0.64 percent.

The 25 studies that the Australian researchers considered the most accurate relied on very different methodologies. One report, for example, was based on diagnostic PCR tests of all passengers and crew aboard the Diamond Princess, the cruise ship that docked in Japan after it was overcome by the coronavirus. Another study drew data from an antibody survey of 38,000 Spaniards, while another included only 1,104 Swedes.

To arrive at the C.D.C.’s new estimate, researchers tested samples from 11,933 people for antibodies to the coronavirus in six regions in the United States. New York City reported 53,803 cases by April 1, but the actual number of infections was 12 times higher — nearly 642,000, the agency estimated.

The global fatality rates could still change. With one or two exceptions, like Iran and Ecuador, the pandemic first struck wealthier countries in Asia, Western Europe and North America where advanced medical care was available.

Many experts fear that infections and deaths will shoot up in the fall as colder weather forces people indoors, where they are more likely to infect one another. Discipline about wearing masks and avoiding breathing on one another will be even more important then.

In each of the eight influenza pandemics to hit the United States since 1763, a relatively mild first wave — no matter what time of year it arrived — was followed by a larger, much more lethal wave a few months later

More than a third of all the people killed by the Spanish flu, which lasted from March 1918 to late 1920, died in the short stretch between September and December 1918 — about six months after a first, relatively mild version of what may have been the same virus broke out in western Kansas.

Based on this seroprevalence data, the authors estimate that in Santa Clara County the true infection fatality rate is somewhere in the range of 0.12% to 0.2%—far closer to seasonal influenza than to the original, case-based estimates.

In New York City, a study published in the New England Journal of Medicine examined 215 women entering two hospitals to give birth between March 22 and April 4. These patients had a Covid-19 infection rate over 15%. Of expectant mothers who tested positive for active infections, 88% were asymptomatic at the time of admission. That infection rate is about 10 times the rate of known cases in the city

Similar proportions of infections to cases are now being discovered around the world: 30 times in Robbio, Italy; 10 times in Iceland; 14 times in Gangelt, Germany; 27 times in Denmark. Germany and Denmark are now leading Europe in reopening their economies in the coming week

a path forward demands continued monitoring of seroprevalence as well as new case testing, identifying and protecting those most vulnerable to more serious or even fatal infections, and supporting hospital capacity to handle surges of respiratory intensive-care patients.

The science to support better modeling and decision making is rapidly becoming available. One hopes that it will inform better policy decisions.

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

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

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

More Americans may die than the White House admits.

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

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

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

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

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

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

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

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

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

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

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

The lockdowns will end, but haltingly.

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

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

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

Every epidemiological model envisions something like the dance

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

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

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

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

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

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

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

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

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

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

Immunity will become a societal advantage.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Still, experts were divided on the idea of such wards

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

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

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

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

There will not be a vaccine soon.

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

the record is four years, for the mumps vaccine.

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

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

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

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

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

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

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

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

Treatments are likely to arrive first.

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

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

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

Goodbye, ‘America First.’

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

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

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

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

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

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

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

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

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

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

"There was a 2016 research survey by Pew of something like 7,800 law enforcement personnel all over the country," King continued. "They found that 73% of law enforcement officers have never fired their weapon, ever. Forty percent of the Vallejo police department had been in at least one shooting [according to Open Vallejo research], and about a third of those had been in two or more."

That includes now-fired Vallejo officer Ryan McMahon, who was involved in two fatal shootings, CNN affiliate KGO reports

McMahon shot 33-year-old Ronell Foster during a confrontation over a missing headlamp on Foster's bike

Vallejo officers had fatally shot 18 people in less than a decade, according to KTVU. Between 2005 and 2017, the Bay Area community of 122,000 people had the third-highest rate of police killings per capita in the state,

The string of fatal shootings by Vallejo officers, including the killing of 21-year-old Angel Ramos in 2017, led to protests as families of the deceased demanded answers and accountability

Williams, who is the city's first Black police chief, seemed to acknowledge this history at his swearing-in as he pledged to rebuild trust with a skeptical community, according to KGO. "Today," Williams said, "we chart a new direction."

On June 2, amid nationwide protests in response to George Floyd's death at the hands of police, 22-year-old Sean Monterrosa was shot and killed by a Vallejo officer in a Walgreens parking lot. Police, who were investigating reports of looting, said a hammer in Monterrosa's pocket was mistaken for a gun.

In July, the troubling news continued: a report from Open Vallejo alleged that some Vallejo officers were bending the tips of their police badges to mark fatal shootings while on the job.

"It's important to me that we approach these community concerns with empathy and compassion," he continued. "Change takes time. I can't change the past, but I can impact the future -- and that's what we're focused on."

Chloroquine had produced what he called “spectacular improvements” in the Chinese patients. “It’s excellent news — this is probably the easiest respiratory infection to treat of all,” Raoult said. “The only thing I’ll tell you is, be careful: Soon the pharmacies won’t have any chloroquine left!”

Raoult wrote his first research paper, in 1979, on a tick-borne infection sometimes known as Marseille fever. The disease was also called “benign summer fever,” and more than 50 years of science said it was nonlethal. And yet one of the 41 patients in his data set had died.

Before submitting the paper, Raoult, who was then a young resident, gave it to a supervising professor for review. “And he takes it,” Raoult told me, “he doesn’t show it to me again, and he publishes it — and he’d taken out the death. Because he didn’t know how to make sense of the death.”

Raoult was disgusted, and the incident shaped his philosophy of scientific inquiry. “I learned that the people who wanted to follow the familiar path were prepared to cheat in order to do it,” he said.

In Raoult’s view, French science was a duchy of appearances, connections and self-reverence. “It was people saying” — he mimed the drone of an aristocrat — “ ‘Oh, him, yes, he’s very good.’ And this reputation, you don’t know what it’s based on, but it’s not the truth.”

“He was a ‘follower,’” Raoult said of the professor. “And these ‘followers’ are all cheaters. That’s what I thought. And it’s still what I think.”

He is, fundamentally, a contrarian. In Raoult’s view, little of consequence has been accomplished by researchers who endorse the habitual tools and theories of their age.

“I’ve spent my life being ‘against,’” he told me. “I tell young scientists: ‘You know, you don’t need a brain to agree. All you need is a spinal cord.’” He is thrilled by conflict. It is a matter both of philosophy — the influence, no doubt, of the thinker he refers to admiringly as “master Nietzsche” — and of temperament.

His peers shake their heads at this behavior but grant him a grudging respect. “You can’t knock him down,” said Mark Pallen, a professor of microbial genomics at the University of East Anglia. “In terms of his place in the canon, the sainthood of science, he’s pretty secure there.”

In 1985 and 1986, Raoult worked at the Naval Medical Research Institute in Bethesda, Md., where he discovered the Science Citation Index. The index, a tool that can be used to measure a scientist’s influence on the basis of his or her publication history, was relatively unknown in France. Raoult looked up the researchers reputed to be the best in Marseille. “It was really the emperor wears no clothes,” he said. “These people didn’t publish. There was one who hadn’t written a paper in 10 years.”

In subsequent work, he demonstrated that Marseille fever was indeed fatal in almost precisely one in every 41 cases.

Raoult’s name sits atop several thousand; in each of the past eight years, he has produced more than 100. In 2020, he has already published at least 54.

Like many doctors, Molina viewed Raoult’s study with skepticism, but he was also curious to see if his proposed treatment regimen might in fact work. He tested hydroxychloroquine and azithromycin in 11 of his own patients. “We had severe patients, and we wanted to try something,” Molina told me. Within five days, one had died, and two others had been transferred out of his service to intensive care. In another patient, the treatment was suspended after the onset of cardiac issues, a known side effect of the drugs. Eight of the 10 surviving patients still tested positive for SARS-CoV-2 at the conclusion of the study period

Raoult is reputed to be an indefatigable worker, but he also achieves his extreme rate of publication by attaching his name to nearly every paper that comes out of his institute.

In recent years, Raoult has amused himself, it seems, by staking out tendentious scientific claims, sometimes in territories that are well beyond the scope of his expertise.

He is skeptical, for instance, of the utility of mathematical modeling in the realm of epidemiology.

The same logic has led him to conclude that climate modelers are no more than “soothsayers” for our “scientistic era” and that their dire predictions are mostly just an attempt to expiate our intense but irrational feelings of guilt.

Raoult’s most recent book, “Epidemics: Real Dangers and False Alerts,” was published in late March, by which time the W.H.O. had reported more than 330,000 confirmed cases of Covid-19 worldwide and more than 14,500 deaths. “This anguish over epidemics,” he writes, “is completely untethered from the reality of deaths from infectious diseases.”

Testing had been scheduled to run for two weeks per patient, but after only six days, the results were so favorable that Raoult decided to end the trial and publish

Others might have proceeded with more caution or perhaps waited to confirm these results with a larger, more rigorous trial. Raoult likes to think of himself as a doctor first, however, with a moral obligation to treat his patients that supersedes any desire to produce reliable data.

For decades, Raoult has boasted of his prodigious rates of publication and citation, which, as objective statistics, he considers to be the best measure of his worth as a researcher.

This observation has come to be known as the parachute paradigm: We tend to accept the claim that parachutes reduce injury among people who leap from airplanes, but this effect has never been proved in a randomized study that compares an experimental parachute group to an unlucky parachuteless control.

“If you don’t have something that’s visible in 10 patients, or 30, it’s useless. It’s not of any consequence.” An effective treatment for a potentially lethal infectious disease will be visible to the naked eye.

There is much about Raoult that might make him, and by extension his proposed treatment, appealing to a man like Trump. He is an iconoclast with funny hair; he thinks almost everyone else is stupid, especially those who are typically regarded as smart; he is beloved by the angry and conspiracy-minded; his self-congratulation is more or less unceasing.

Raoult classified Trump’s psychology as that of an “entrepreneur,” by way of contrast with that of a “politician.” “Entrepreneurs are people who know how to decide, who know how to take risks,” he said. “And at a certain point, to decide is to take a risk. Every decision is a risk.”

The French waited far too long, in his estimation, to approve the use of hydroxychloroquine in Covid-19 patients. The authorization came only after Raoult announced in the press that he would continue, “in accordance with the Hippocratic oath” and effectively in defiance of the government, to treat patients with his combination therapy. “I’m convinced that in the end, everyone will be using this treatment,” Raoult told Le Parisien. “It’s just a matter of time before people agree to eat their hats.”

Raoult had already begun assembling data for a larger study, but he dismissed the need for anything particularly vast or lengthy. Like other critics of the R.C.T., he likes to point out that a number of self-evidently useful developments in the realm of human health have never been validated by such rigorous tests.

Raoult’s study had measured only viral load. It offered no data on clinical outcomes, and it was not clear if the patients’ actual symptoms had improved or indeed whether the patients lived or died. At the outset, 26 patients were assigned to receive hydroxychloroquine, six more than the 20 who appeared in the final results.

The six additional patients had been “lost in follow-up,” the authors wrote, “because of early cessation of treatment.” The reasons given were concerning. One patient stopped taking the drug after developing nausea. Three patients had to be transferred out of the institute to intensive care. One patient died. (Another patient elected to leave the hospital before the end of the treatment cycle.)

“So four of the 26 treated patients were actually not recovering at all,” noted Elisabeth Bik, a scientific consultant who wrote a widely circulated blog post on Raoult’s study. She paraphrased the sarcasm circulating on Twitter: “My results always look amazing if I leave out the patients who died.”

The report was also riddled with discrepancies and apparent errors.

This apparent sloppiness was unsurprising to many of those who have tracked Raoult’s work in the past. A prominent French microbiologist told me that, in terms of publication, Raoult’s reputation among scientists has been “long gone” for some time.

Beyond its apparent errors and omissions, the study’s design — its small size, its flawed control, the unrandomized assignment of patients to the treatment and control groups — was widely viewed to render its results meaningless. Fauci repeatedly called its results “anecdotal”;

Large, well-controlled randomized trials are by no means the only way to arrive at useful scientific insights. Their utility is that they enhance statistical signals such that, amid the noise of human variability and random chance, even the faint effect of some new treatment can be detected.

The results of his initial trial have yet to be replicated. “I think what he secretly hopes is that no one will ever be able to show anything,”

The prime statistical hurdle that any proposed treatment for Covid-19 will have to overcome — one that is delicate for even Raoult’s critics to make note of, amid the sorrow and fear of this pandemic — is that the signal is likely to be very faint, because the disease is, in the end, rarely fatal. Nearly everyone survives; an effective treatment will save the life of the one or so patients in every hundred who would not have lived without it.

“Alzheimer’s drugs, obesity drugs, cardiovascular drugs, osteoporosis drugs: Over and over, there have been what looked like positive results that evaporated on closer inspection. After you’ve experienced this a few times, you take the lesson to heart that the only way to be sure about these things is to run sufficiently powered controlled trials. No shortcuts, no gut feelings — just data.”

“I’ve invented 10 or so treatments in my life,” Raoult told me. “Half of them are prescribed all over the world. I’ve never done a double-blind study in my life, never. Never! Never done anything randomized, either.”

“When you tell the story, it’s extremely straightforward, no? It’s subject, verb, complement: You detect a disease; there’s a drug that’s cheap, whose safety we know all about because there’s two billion people who take it; we prescribe it, and it changes what it changes. It might not be a miracle product, but it’s better than doing nothing, no?”

Raoult had by then begun to lose his composure. He accused Lacombe of being a shill for the pharmaceutical industry; his fans sent her death threats. On Twitter, he called Bik, the consultant who wrote critically about the first study, a “witch hunter” and called a study that she tweeted — one of several published in April and May that seemed to suggest that Raoult’s treatment regimen was ineffectual or even harmful — “fake news.” The authors of another such study were accused of “scientific fraud.” “My detractors are children!” Raoult told an interviewer.

It is possible that hydroxychloroquine and azithromycin are an effective treatment for Covid-19. But Raoult’s study showed, at best, that 20 people who would almost certainly have survived without any treatment at all also survived for six days while taking the drugs Raoult prescribed.

In recent weeks, Raoult has in fact tempered his claims about the virtues of his treatment regimen. The published, peer-reviewed version of the final study noted that another two patients had died, bringing the total to 10. Where the earlier version called the drugs “safe and efficient,” they were now described merely as “safe.”

He has shown flickers of what appears to be doubt.

“I don’t trust popularity,” he told the interviewer. “When too many people think you’re wonderful, you should start to wonder.” His initial YouTube video, “Coronavirus: Game Over!” has also been renamed. The new language is more measured, and in place of the exclamation point there now stands a question mark.

as if to balance Hamas’s blame for every single death in the conflict, Goldblog feels the need to chide the Israeli prime minister for his “mistake” in having utter contempt for any two-state solution. “Mistake” is an interesting word to use. It implies a relatively minor slip-up, a miscalculation, a foolish divergence from sanity. But it is perfectly clear to anyone not always finding excuses for the Israeli government that Netanyahu wasn’t making a mistake. He was simply reiterating his longstanding view that Israel will never, ever allow a sovereign Palestinian state to co-exist as a neighbor. And unless you understand that, nothing he has done since taking office makes any sense at all. Everything he has said and done presupposes permanent Greater Israel. And he is not some outlier. Israel’s entire political center of gravity is now firmly where Netanyahu is. The rank failure of the peace process simply underlines this fact. As do half a million Jewish settlers and religious fanatics on the West Bank.

Despite protestations otherwise, possession of the West Bank has become a fundamental and existential part of the character of Israeli nationhood. Possession of the West Bank is not temporary, it is not contingent, and it is not an exception to the general rule of the character of Israeli nationhood. Occupation and settlement are as central to the Israeli nation, its politics and culture, as burritos, Hollywood, and Sunbelt conservatism are to American politics, culture, and national identity.

This is what really put Israel’s occupation and settlement of the West Bank in perspective for me: Israel has possessed the West Bank for almost precisely the same proportion of its national existence as the United States has possessed Texas and California. About seven-tenths

the United States would first have to become an existentially different nation before it would even consider peaceably permitting California and Texas to leave the union. Just so with Israel

Since the whole idea of a two-state solution is as dead as the infamous parrot, why on earth are Americans still pursuing it? I think because many want Israel to be other than what it plainly is. They understand that this project of a bi-national state with Jim Crow segregation and disenfranchisement is a horrible fate. Jeffrey is as eloquent on this today as he has ever been: If Netanyahu has convinced himself that a Palestinian state is an impossibility, then he has no choice but to accept the idea that the status quo eventually brings him to binationalism, either in its Jim Crow form—Palestinians absorbed into Israel, except without full voting rights—or its end-of-Israel-as-a-Jewish-state form, in which the two warring populations, Jewish and Arab, are combined into a single political entity, with chaos to predictably ensue. But this is clearly the reality. The Obama administration was the last hope for some kind of agreement, and the Israelis have told the president to go fuck himself on so many occasions the very thought of accommodation is preposterous. With the acceleration of the settlements, and the ever-rising racism and religious fundamentalism in Israel itself, this is what Israel now is.

It also helps distract from the fact that Hamas itself did not kill the three Israeli teens which was the casus belli for the latest Israeli swoop through the West Bank; that Netanyahu had called for generalized revenge in the wake of the killings, while concealing the fact that the teens had been murdered almost as soon as they had been captured; and that Israeli public hysteria, tapping into the Gilad-like trauma of captivity, then began to spawn increasingly ugly, sectarian and racist acts of revenge and brutality.

The video showed deputies repeatedly firing at the man, even after he fell to the ground. The Sheriff's Department said the man had fired shots into the air and pointed the weapon at the deputies before they opened fire. Officials also said they recovered a loaded .45-caliber handgun at the scene.

The incident comes amid increasing public scrutiny over police-involved shootings both in the Los Angeles area and nationwide. Over the last two years, the Los Angeles Police Department has dealt with several controversial shootings by officers, including one involving an unarmed homeless man on skid row that was also captured on video. That case is still under investigation.

The suspect, whose name has not been released by the Sheriff's Department, was pronounced dead at the scene. No deputies were injured. Relatives identified the suspect as Nicholas Robertson, 28.

At the shooting site, more than a dozen people gathered in protest Saturday evening, holding signs and yelling into megaphones, “No more stolen lives!” Helmet-clad deputies formed a line and looked on, and one recorded the scene with a video camera.

The activists they want the U.S. Department of Justice to investigate the shooting and launch a broader probe into the use of force by the Sheriff’s Department.

According to authorities, witnesses said that moments before, Robertson turned and pointed the gun at the deputies.At least a dozen gunshots are then heard, and Robertson falls to the ground. He drags himself on the ground alongside an Arco gas station.

A brief pause in gunfire follows, then shots begin once more.When the camera pans back, two deputies can be seen a few yards way, both with arms up, pointing their weapons in Robertson's direction.

Seth Stoughton, a criminal law professor at the University of South Carolina and a former Tampa, Fla., police officer, said there are circumstances under which an officer can shoot at a suspect walking away from them. “If the deputies reasonably believe the suspect with a firearm presents a danger by walking toward a gas station with vehicles and bystanders, they would be justified in using deadly force.

“It does not strike me as egregious like [the] Walter Scott video here in South Carolina.... If the suspect wasn't armed or they didn't have a solid basis for that belief, that would more problematic,” Stoughton said. More facts, he cautioned, are needed to determine what occurred outside the video.

Once the suspect is on the ground, how close the gun is to him is key in whether shots are justified, he added.

Experts familiar with use-of-force cases said deputies will need to explain why they opened fire and continued to shoot as Robertson was on the ground.

“They are going to have to articulate why they made every one of those shots,” said Ed Obayashi, an Inyo County deputy and an attorney. “They must show they reasonably used deadly force.”

The U.S. Marshals Service said a task force was trying to arrest the man on a state warrant for being a felon in possession of a firearm.

The state Bureau of Criminal Apprehension and the federal Bureau of Alcohol, Tobacco and Firearms both tweeted that they were responding to help investigate. The Marshals said the state BCA is leading the investigation.The Minneapolis Police Department said it was not involved in the shooting.

It was not clear how many law enforcement officers fired their weapons. A spokeswoman with the U.S. Marshals said the U.S. Marshals leads the task force, which is comprised of several agencies.

an aerial view of the top level of the parking ramp where Thursday's shooting reportedly occurred showed a silver sport utility vehicle with a shattered back window. It was surrounded by many other vehicles near a white pop-up tent. Several officers were nearby and in a glass-enclosed stairwell.

The man, who was in a parked car, didn't comply with law enforcement and "produced a handgun resulting in task force members firing upon the subject," the U.S. Marshals said in a statement.

Before Thursday night's unrest, tensions in Minneapolis already had risen after crews early Thursday removed concrete barriers that blocked traffic at a Minneapolis intersection where a memorial to Floyd was assembled after his death.

Deputy Daniel Meads came back on June 1 and Deputy Robert Morgan came back on June 2, Wooten said in a statement.

Pasquotank County deputies fatally shot Brown, a 42-year-old Black man, on April 21, while trying to serve search and arrest warrants for drug-related charges at his home in Elizabeth City, N.C

Seven deputies were initially put on administrative leave following the shooting, but four of them returned to work after the sheriff's office said that a review of body camera footage revealed that those deputies did not fire their weapons.

Brown's death ignited protests in the city, with calls for the public release of body cam footage of the shooting and demands for the firings of the deputies involved in the incident.

Attorneys for Brown's family described footage of the shooting as an "execution." An independent autopsy commissioned by the family found that Brown died from a gunshot to the back of the head.

Cole was the third person to have been shot and killed by Mensah since 2015, according to multiple reports.

"Mensah's two earlier shootings had also been found to be in self-defense, and the officer was not disciplined," as NPR's Brakkton Booker reported.

“Our police officers are being vilified this evening for doing their job and keeping the community safe, after being confronted by a man with a knife,” he said. “We support and defend these officers, as they too are traumatized by being involved in a fatal shooting.”

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.