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Of all the measures South Africa put in place, Dawood said the most important against the flu was school closures. Studies have shown that children exhibit the highest rates of infection and illness due to influenza. “I think that was the one that interrupted flu’s whole chain,”

experts have offered numerous explanations for why it is more infectious than the seasonal flu. Foremost is the extent to which it spreads when those who carry it are asymptomatic. Flu is almost always transmitted through symptoms such as sneezing and coughing.

People also began taking extra health precaution

Many people also carry “background immunities” for influenza, Dawood said. Repeated infections, as well as worldwide annual vaccination campaigns, have given large portions of the global population at least some influenza antibodies, although new strains appear nearly every year.

With coronavirus cases climbing steeply at the beginning of the country’s flu season, many people rushed to clinics to get flu shots, hoping to avoid at least one co-morbidity.

The continued implementation of personal protective measures may be so effective against flu transmission that entire strains of the virus that relied on incubation in the Southern Hemisphere’s winter before being passed back north might be eliminated for good

“If it works out like this, it would be a very beautiful positive side effect of covid, one of the few good things to come of it.”

The main threat to that possibility is reintroduction from the Northern Hemisphere, where many countries, and parts of the United States in particular, have not required mask-wearing and school closures.

‘Odds are, people are going to get sick this year,’”

In typical years, flu hospitalizes an estimated 140,000 to 710,000 people in the United States alone; some years, RSV can add on some 200,000 more. “Our baseline has never been great,” Yvonne Maldonado, a pediatrician at Stanford, told me. “Tens of thousands of people die every year.”

this time of year, on top of RSV, flu, and COVID, we also have to contend with a maelstrom of other airway viruses—among them, rhinoviruses, parainfluenza viruses, human metapneumovirus, and common-cold coronaviruses.

Illnesses not severe enough to land someone in the hospital could still leave them stuck at home for days or weeks on end, recovering or caring for sick kids—or shuffling back to work

“This is a more serious pathogen that is also more infectious,” Ajay Sethi, an epidemiologist at the University of Wisconsin at Madison, told me. In the past year, COVID-19 has killed some 80,000 Americans—a lighter toll than in the three years prior, but one that still dwarfs that of the worst flu seasons in the past decade.

Globally, the only infectious killer that rivals it in annual-death count is tuberculosis

Rivers also pointed to CDC data that track trends in deaths caused by pneumonia, flu, and COVID-19. Even when SARS-CoV-2 has been at its most muted, Rivers said, more people have been dying—especially during the cooler months—than they were at the pre-pandemic baseline.

This year, for the first time, millions of Americans have access to three lifesaving respiratory-virus vaccines, against flu, COVID, and RSV. Uptake for all three remains sleepy and halting; even the flu shot, the most established, is not performing above its pre-pandemic baseline.

COVID could now surge in the summer, shading into RSV’s autumn rise, before adding to flu’s winter burden, potentially dragging the misery out into spring. “Based on what I know right now, I am considering the season to be longer,” Rivers said.

barring further gargantuan leaps in viral evolution, the disease will continue to slowly mellow out in severity as our collective defenses build; the virus may also pose less of a transmission risk as the period during which people are infectious contracts

even if the dangers of COVID-19 are lilting toward an asymptote, experts still can’t say for sure where that asymptote might be relative to other diseases such as the flu—or how long it might take for the population to get there.

it seems extraordinarily unlikely to ever disappear. For the foreseeable future, “pretty much all years going forward are going to be worse than what we’ve been used to before,”

although a core contingent of Americans might still be more cautious than they were before the pandemic’s start—masking in public, testing before gathering, minding indoor air quality, avoiding others whenever they’re feeling sick—much of the country has readily returned to the pre-COVID mindset.

When I asked Hanage what precautions worthy of a respiratory disease with a death count roughly twice that of flu’s would look like, he rattled off a familiar list: better access to and uptake of vaccines and antivirals, with the vulnerable prioritized; improved surveillance systems to offer  people at high risk a better sense of local-transmission trends; improved access to tests and paid sick leave

Without those changes, excess disease and death will continue, and “we’re saying we’re going to absorb that into our daily lives,” he said.

And that is what is happening.

last year, a CDC survey found that more than 3 percent of American adults were suffering from long COVID—millions of people in the United States alone.

“We get used to things we could probably fix.” The years since COVID arrived set a horrific precedent of death and disease; after that, this season of n+1 sickness might feel like a reprieve. But compare it with a pre-COVID world, and it looks objectively worse. We’re heading toward a new baseline, but it will still have quite a bit in common with the old one: We’re likely to accept it, and all of its horrors, as a matter of course.

when the Spanish flu spread across the United States in the fall of 1918, both the government and the media continued the same rosy strategy “to keep morale up.”

President Woodrow Wilson released no public statements. Surgeon General Rupert Blue said, “There is no cause for alarm if proper precautions are observed.” Another top health official, Barry said, dismissed it as “ordinary influenza by another name.”

But it wasn’t. The Spanish flu had a mortality rate of 2 percent — much higher than seasonal influenza strains, and similar to some early estimates about the coronavirus.

For the most part, the media followed the government’s lead and self-censored dire news. That made everything worse, Barry said.

For example, in Philadelphia, local officials were planning the largest parade in the city’s history. Just before the scheduled event, about 300 returning soldiers started spreading the virus in the city.

“And basically every doctor, they were telling reporters the parade shouldn’t happen. The reporters were writing the stories; editors were killing them,” he said. “The Philadelphia papers wouldn’t print anything about it.”

Philadelphia became one of the hardest hit areas of the country. The dead lay in their beds and on the streets for days; eventually, they were buried in mass graves. More than 12,500 residents died

The parade was held and, 48 hours later, Spanish flu slammed the city. Even once schools were closed and public gatherings were banned, city officials claimed it wasn’t a public health measure and there was no cause for alarm,

The Jefferson County Union in Wisconsin warned about the seriousness of the flu on Sept. 27, 1918. Within days, an Army general began prosecution against the paper under a wartime sedition act, claiming it had “depressed morale.

As the pandemic raged through October of that year, Americans could see with their own eyes that the “absurd reassurances” coming from local and national officials weren’t true. This crisis of credibility led to wild rumors about bogus cures and unnecessary precautions

The Spanish flu ultimately killed about 50 million people worldwide, including 675,000 people in the United States, according to the Centers for Disease Control and Prevention. Even President Wilson caught it, in the middle of negotiations to end the Great War.

“I think the No. 1 lesson that came out of the experience is that if you want to prevent panic, you tell the truth,”

Now, with coronavirus, Barry said he’s “a little bit worried” about the plan being followed. He doesn’t think the Trump administration is “outright lying, but they’re definitely giving you interpretations that seem to be the best-case scenarios.”

He’s particularly concerned about President Trump’s decision to have Vice President Pence oversee the response, instead of an expert such as Anthony Fauci, the doctor who heads the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.

Given the credibility crisis that happened with the 1918 pandemic, Barry said that was “the exact wrong thing to do.”

Bloom and others have identified specific mutations that make the nucleoprotein better at resisting the human immune system. The first-wave flu viruses did not have them, but the second-wave ones did, possibly because they had had the time to adapt to infecting humans.

This mutation-by-mutation analysis of the 1918 flu virus would have been impossible to imagine at the time of the pandemic. Doctors then hadn’t even figured out that influenza was caused by a virus. “There’s no way the individual who saved these samples in 1918 had any idea of what could be done to them,” Mehle said. “To my mind, this is a beautiful example of fundamental research.”

Without the pathologist who painstakingly preserved these samples and the museums that kept them for decades before science caught up, our understanding of the 1918 flu would be all the poorer.

When the 1918 pandemic swept through the world, it apparently completely replaced whatever flu existed before. Its modern-day descendants continue to infect us today as seasonal flu.

Leaders in the deeply conservative Utah say they need the law to protect women's sports. As cultural shifts raise LGBTQ visibility, the lawmakers argue that, without their intervention, more transgender athletes with apparent physical advantages could eventually dominate the field and change the nature of women's sports.

he team is also partially owned by NBA all-star Dwyane Wade, who has a transgender daughter.

The looming threat of a lawsuit worries school districts and the Utah High School Athletic Association, which has said it lacks the funds to defend the policy in court. Later Friday, lawmakers are expected to change the bill so state money would cover legal fees.

The group Visit Salt Lake, which hosts conferences, shows and events, said the override could cost the state $50 million in lost revenue. The Utah-based DNA-testing genealogy giant Ancestry.com also urged the Legislature to find another way. The American Principles Project is confident that states with bans won't face boycotts like North Carolina did after limiting public restrooms transgender people could use. It focused on legislation in populous, economic juggernaut states like Texas and Florida that would be harder to boycott, Schilling said.

Friday's deliberations came after more than a year of debate and negotiation between social conservatives and LGBTQ advocates. Republican sponsor Rep. Kera Birkeland worked with Cox and civil rights activists at Equality Utah before introducing legislation that would require transgender student-athletes to go before a government-appointed commission.

The proposal, although framed as a compromise, failed to gain traction on either side. LGBTQ advocates took issue with Republican politicians appointing commission members and evaluation criteria that included body measurements such as hip-to-knee ratio.

But the ban won support from a vocal conservative base that has particular sway in Utah's state primary season. Even with primaries looming, however, some Republicans stood with Cox to reject the ban.

Ready for more bad infectious diseases news? There's an outbreak of bird flu making its way into U.S. poultry flocks. If the virus continues to spread, it could affect poultry prices — already higher amid widespread inflation. The price of chicken breasts this week averaged $3.63 per pound at U.S. supermarkets — up from $3.01 a week earlier and $2.42 at this time last year, the Agriculture Department says.

The latest data from the USDA show 59 confirmed sites of avian flu across commercial and backyard flocks in 17 states since the start of the year. That figure includes chickens, turkey and other poultry. The USDA identified a case of avian flu in a wild bird in mid-January, the first detection of the virus in wild birds in the U.S. since 2016. Wild birds can spread the virus to commercial and backyard flocks. By Feb. 9, the virus had been identified in a commercial flock in Indiana.

The last major avian flu outbreak in the U.S. was from December 2014 to June 2015, when more than 50 million chickens and turkeys either died from highly pathogenic avian influenza (HPAI) or were destroyed to stop its spread.

Whether the 2022 avian flu will affect the price of eggs and poultry depends on how widespread it becomes, says Ron Kean, a poultry science expert at the University of Wisconsin-Madison Department of Animal and Dairy Sciences. "In 2015, we did see quite an increase in egg prices," Kean told Wisconsin Public Radio. "The chicken meat wasn't severely affected at that time. We did see quite a loss in turkeys, so turkey prices went up. So, we'll see. If a lot of farms contract this, then we could see some real increases in price."

For producers who suspect their flock may be affected by avian flu, the USDA has a guide to the warning signs, including a sudden increase in bird deaths, lack of energy and appetite, and a decrease in egg production. If a flock is found to be infected by bird flu, the USDA moves quickly — within 24 hours — to assist producers to destroy the flock and prevent the virus from spreading.

A new Virginia state law prohibiting mask mandates in public schools does not apply to 12 students with disabilities whose parents challenged the law, a federal judge has ruled. Last month, the parents of 12 students across Virginia asked the court to halt enforcement of the law, saying it violated their rights under the federal American with Disabilities Act. The law, signed by newly elected Republican Gov. Glenn Youngkin, went into effect March 1; it gives parents a say over whether their children should wear masks in school.

The group of parents have children whose health conditions range from cystic fibrosis to asthma that put them at heightened risk for COVID-19.

The American Civil Liberties Union, which was one of several legal organizations that filed on behalf of the plaintiffs, said the injunction served as a "blueprint."

In a statement, Virginia Attorney General Jason Miyares said the ruling affirms that "parents have the right to make choices for their children."

When Judge Katanji Brown Jackson entered the Senate chamber this week to face questions on her readiness to join the Supreme Court, she did so as the first Black woman in the nation's history to be nominated to that position. For many Black law students and professionals, including a group of 150 who traveled from across the country to watch the historic hearing, Jackson's rise to likely associate justice gives a message of profound hope for what they too might one day be able to accomplish.

Dudley was one of 100 law students selected nationwide to attend a series of events and watch parties for Jackson's nomination, hosted by the progressive organization, Demand Justice. The group also included 50 public defenders — a nod to Jackson's own background in that field. "I see a lot of myself in her. I see a lot of my friends in her, and I wanted to be there to support," Dudley said, calling Jackson "overly qualified to sit on the Supreme Court."

The cohort of legal professionals cheered on Jackson as she faced questions from Republicans about her past cases, particularly those relating to child sex abuse, and on what school of thought she would bring to determining the constitutionality of high-profile cases. Republicans had vowed to oppose President Joe Biden's nominees to the court, and when news of Justice Stephen Breyer's imminent retirement broke, the GOP quickly mobilized to attack potential nominees who might replace the longtime liberal justice on the bench.

Particularly, some sentencing decisions in child pornography cases drew GOP fire. But Jackson's measured responses throughout the three days of questioning solidified the support of many onlookers, who reveled in what it would mean to have a Black woman sit on the bench for the first time in the court's 233-year history. "The fact of the matter is that I'm the father of three black girls, right? And to be able to tell them that finally, someone who is Black — female nonetheless — is finally on the precipice of a mountain that has never been climbed before by any other Black woman, is huge," said Edrius Stagg, a third-year law student at Southern University Law Center in Baton Rouge.

Sen. Joe Manchin of West Virginia — whose break from Democrats on a number of politically fraught votes had worried some as to whether he would support Biden's nominee — announced on Friday he would vote in favor of Jackson's confirmation, all but assuring her path to join the bench.

For some, the optics of seeing Jackson — a Black woman — defend her credentials to a group of largely white, predominantly male detractors, was a familiar scene. It has played out, students said, in workplaces the world over and across the socioeconomic spectrum.

Booker called the attacks on Jackson's record "dangerous" and "disingenuous," noting the complexities of cases that had been boiled down to their basest points in order to damage Jackson's image.

"I'm not gonna let my joy be stolen," he continued. "Because I know, you and I, we appreciate something that we get that a lot of my colleagues don't." And while Jackson's opponents peppered her with politically polarizing questions, her supporters grew even more convinced that Jackson was qualified for the job. "To see her hold her composure and just answer the questions just to the best of her capabilities was just really great to see," said Jasmine McMillion, a third-year law student at Florida Agricultural and Mechanical University College of Law.

That language was lacking in 1918. In large swathes of the world, people still viewed epidemics as acts of god and considered themselves helpless against them.

the plague’s lethality didn’t only vary across time, it varied across space too. If you lived in certain parts of Asia, you were 30 times more likely to die of the Spanish flu than if you lived in certain parts of Europe. New York City lost 0.5 per cent of its population, Western Samoa 22 per cent.

We now have the vocabulary to explain these troubling disparities. Concepts like immune memory and genetic predisposition have taken over that task from divine retribution. We understand that social and economic factors shape health as much as biological ones—something that was much less well appreciated at the time

we have it in our linguistic toolbox to explain other features of the pandemic too, that were inexplicable then—features such as the subsequent wave of lethargy and “melancholia” (depression) that washed over the world. Today, we call this postviral syndrome.

As these concepts were recognized and labelled, the pandemic began to acquire meaning—or rather, a different meaning: the one we recognize today. But it took time.

wars and pandemics are remembered differently. Collective memories for war seem to be born instantly, fully formed—though subject, of course, to endless embellishment and massage—and to fade over time.

Memories of cataclysmic pestilence therefore build up more slowly, and once they have stabilized at some kind of equilibrium—determined, perhaps, by the scale of death involved—they are, in general, more resistant to erosion.

There is a precedent in the 14thcentury Black Death, after all. Like the Spanish flu, it overlapped with a war—the Hundred Years’ War, in its case. Like the Spanish flu it was far more lethal than the war with which it overlapped. But unlike the Spanish flu it is not treated as a mere footnote to that war.

On average, seasonal flu strains kill about 0.1 percent of the people they infect.

The coronavirus, on the other hand, has killed more than 210,000 people in the United States, and more than one million worldwide, since the start of 2020.

Still, estimates from experts tend to put the coronavirus’s death rate higher than the flu’s.

Researchers still don’t fully understand the long-term consequences of coronavirus infections, which have saddled a growing number of people, called long-haulers, with serious and debilitating symptoms that can linger for weeks or months.

Medical experts have also warned that as the northern hemisphere cools for winter, the flu and Covid-19 could collide, fueling a new spate of deaths.

Julia Lyons saw an opportunity. Figuring nobody would have time to check her lack of credentials, she signed on at a home-nurse registry under various names. In late 1918, the Tribune chronicled the fake flu nurse’s escapades like a dime detective novel.

The police tapped the phone and learned Julia lived nearby. Detectives trailed Julia. One day she set off to marry Charlie the Greek, who ran the Victory Restaurant on West Madison Avenue. Before vows could be exchanged, Julia was in handcuffs.

Instead of transporting Julia to the courthouse in a patrol wagon, the deputy sheriff took her on a street car. In court, some 50 victims testified against her. She was held under $13,000 bond, the equivalent of more than $190,000 today.Deputy Hickey started back to the county jail with Julia in tow. An hour and a half later he called the police and “excitedly” told them she had jumped from a moving street car and hopped into a waiting automobile. Based on the reported location, one official speculated Hickey and his prisoner had been going to cabarets.

Soon Julia was back at her old tricks. In March 1919, the police traced her through the nurse registry to a home on Fullerton Boulevard. When Julia answered the door, the police nabbed her.

Frank M. Snowden, a Yale historian who studies pandemics, wrote in his book “Epidemics and Society” that definitive accounts of this plague have largely vanished.

History Today, a monthly magazine of historical writing published in London, calls this pandemic “the greatest catastrophe ever.” The number of deaths — 200 million — is just astounding. Put it this way: That would be like wiping out roughly 65 percent of the current U.S. population. (Covid-19 disease modeling predicts U.S. deaths to potentially reach 240,000.)

Like the Plague of Justinian, the Black Death was caused by the bubonic plague.

Explorers arrived to the New World bearing more than just turnips and grapes. They also brought smallpox, measles and other viruses for which New World inhabitants had no immunity.

There were no treatments. If you caught it, you had roughly two weeks to live. This caused people to become desperate.

Again, blame the rats with those pesky fleas on their backs: “They were attracted by city streets filled with rubbish and waste, especially in the poorest areas,” according to the National Archives in England. While doctors, lawyers and royalty fled town, the poor were ravaged by the disease

it is estimated that upwards of 80–95 percent of the Native American population was decimated within the first 100–150 years following 1492

The epidemic that swept London in 1854 spawned the sort of epidemiological investigations that take place in disease outbreaks today. That’s thanks to John Snow, an English physician who almost single-handedly took on the bacteria. While some scientists suspected cholera was transmitted through the air, Snow thought otherwise. “Through carefully mapping the outbreak, he finds that everyone affected has a single connection in common: they have all retrieved water from the local Broad Street pump,”

according to a CDC history. He ordered the pump-handle turned off, and people stopped getting sick.

In 1793, yellow fever swept through Philadelphia, then the nation’s capital, killing roughly 10 percent of the population. President George Washington and Secretary of State Thomas Jefferson high-tailed it out of town, ultimately settling on Washington as the nation’s capital.

It wasn’t until 1900 that U.S. Army researchers “pinpointed mosquitoes as the transmission vector for the disease,” according to a vaccine history project at the College of Physicians of Philadelphia.

The covid-19 pandemic has inspired lots of comparisons to the 1918 flu, sometimes called the Spanish flu, which got its name not because it originated in Spain but because it was World War I, and Spain was the only country being honest about the toll the pandemic took on the country.

The flu came in two waves, starting in 1918 and ending in 1920. The number of infected is staggering —as many as 500 million, with estimates of 50 million deaths worldwide, according to the CDC.

One man saw it coming: Maurice Hilleman. The doctor later regarded as the godfather of vaccines was working at the Walter Reed Army Institute of Research in 1957 when he read a New York Times article about a nasty flu outbreak in Hong Kong that mentioned glassy-eyed children at a clinic.

Hilleman requested samples of the virus be shipped to U.S. drugmakers right away so they could get a vaccine ready. Though 70,000 people in the United States ultimately died, “some predicted that the U.S. death toll would have reached 1 million without the vaccine that Hilleman called for,” according to the Philadelphia vaccine history project. “Health officials widely credited that vaccine with saving many lives.”

Before covid-19, this was the world’s most recent pandemic, infecting as much as 21 percent of the world’s population. Swine flu was a hodgepodge of several different flu strains that had never been collectively seen together

The most revealing false claim: The flu mortality rate

VirusesAwareness of Ebola in 2014Comparing the coronavirus outbreak with the Ebola situation of 2014, Trump said, "At that time, nobody had ever even heard of Ebola." -- February 25 press conference in New Delhi, India "Nobody knew anything about it. Nobody had ever heard of anything like this." -- February 26 coronavirus press conference Facts First: Some Americans certainly didn't know a whole lot about Ebola before 2014, but the claims that "nobody" had ever even heard of Ebola and that "nobody" knew anything about it are absurd. Ebola was discovered in 1976. It had been the subject of considerable media coverage in the next three decades, not to mention scientific study.

Gupta, CNN chief medical correspondent, told Trump at a press conference, "Mr. President, you talked about the flu and then in comparison to the coronavirus. The flu has a fatality ratio of about 0.1%." Trump said, "Correct." But Trump later disputed the figure, saying, "And the flu is higher than that. The flu is much higher than that." -- February 26 coronavirus press conferenceFacts First: Even if Trump meant that the flu has a "much higher" fatality rate than 0.1% -- rather than meaning that the flu's mortality rate is "much higher" than that of the novel coronavirus -- he was wrong. The mortality rate for seasonal flu is "about 0.1%, 0.2% at the most," Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health -- who appeared with Trump at this same news conference -- told this to USA Today in mid-February, echoing the comments of other experts and Centers for Disease Control and Prevention data since 2010.

“I will still feel a responsibility to protect others from my illness when I have a cold or bronchitis or something along those lines,” said Gwydion Suilebhan, a writer and arts administrator in Washington who said he also plans to continue wearing masks in situations like flying on airplanes.

So far, Dr. Leung said, there has been no clear evidence from randomized controlled trials — the gold standard in scientific research — that masking reduced transmission of influenza viruses in a community.

For similar reasons, the fact that the flu all but vanished in the United States during the coronavirus pandemic — and that many Americans anecdotally reported that they caught fewer colds than usual in 2020 — is not evidence alone that masks were responsible.

Officials once boastful about their preparedness were frantically trying to secure protective gear and materials for tests, as death rates soared in Britain, France, Spain, Italy and Belgium.

Many European leaders felt so secure after the last pandemic — the 2009 swine flu — that they scaled back stockpiles of equipment and faulted medical experts for overreacting.

But that confidence would prove their undoing. Their pandemic plans were built on a litany of miscalculations and false assumptions

European leaders boasted of the superiority of their world-class health systems but had weakened them with a decade of cutbacks. When Covid-19 arrived, those systems were unable to test widely enough to see the peak coming — or to guarantee the safety of health care workers after it hit.

Accountability mechanisms proved toothless. Thousands of pages of national pandemic planning turned out to be little more than exercises in bureaucratic busy work

Officials in some countries barely consulted their plans; in other countries, leaders ignored warnings about how quickly a virus could spread.

Mathematical models used to predict pandemic spreads — and to shape government policy — fed a false sense of security.

National stockpiles of medical supplies were revealed to exist mostly on paper, consisting in large part of “just in time” contracts with manufacturers in China. European planners overlooked the risk that a pandemic, by its global nature, could disrupt those supply chains

Now South Korea, with a death toll below 300, is a paragon of success against the pandemic. Many epidemiologists there are dumbfounded at the mess made by their mentors.

Europe is grappling with how a continent considered among the most advanced failed so miserably.

Dr. Whitty, 54, initially praised in British newspapers as the reassuring “geek-in-chief,” has declined to speak publicly about his role in those decisions. His friends say the government has set him up to take the blame.

Sir David King, a former British chief science officer, said, “The word ‘arrogance’ comes to mind, I am afraid.” He added: “What hubris.”

when swine flu emerged, British leaders again turned to Professor Ferguson and the large modeling department he had built at Imperial College. He projected that swine flu, in a reasonable worst case, could kill nearly 70,000.

But the modelers’ “reasonable worst case” was wildly off. Swine flu ended up killing fewer than 500 people in Britain, less than in a seasonal flu.

For Mr. Johnson, the swine flu episode reinforced instincts not to impose restrictions in the name of public health.

Some experts now say Europe learned the wrong lesson from the swine flu.

“It created some kind of complacency,” said Prof. Steven Van Gucht, a virologist involved in the Belgian response. “Oh, a pandemic again? We have a good health system. We can cope with this.”

It also coincided with Europe’s worst economic slump in decades. French legislators were furious at the cost of buying millions of doses of vaccines and faulted the government for needlessly stockpiling more than 1.7 billion protective masks.

The idea of a government warehousing medical supplies came to seem outdated,” said Francis Delattre, a French senator who raised alarms about dependence on China. “Our fate was put into the hands of a foreign dictatorship.”

“France has a superiority complex,” Mr. Delattre added, “especially when it comes to the health sector.”

“It’s pretty difficult to build a stockpile for something you’ve not seen before,” said Dr. Ben Killingley, an infectious disease expert who advises the government on what to stockpile. “It depends how much you want to spend on your insurance.”

National governments barred the European Centre for Disease Prevention and Control from setting benchmarks or pointing out deficiencies. So the agency’s public remarks were almost unfailingly positive

“We couldn’t say, ‘You should have this,’” said Arthur Bosman, a former agency trainer. “The advice and the assessment had to be phrased in an observation.”

the European Union in 2016 solicited bids to build a continent-wide repository. But the initiative fizzled because Britain, France and other large countries thought they had the situation covered

European and global health officials had thoroughly reviewed Belgium’s pandemic plan over the years. But when Covid-19 hit, Belgian officials did not even consult it.

“It has never been used,” said Dr. Emmanuel André, who was drafted to help lead the country’s coronavirus response

“I don’t understand why we were not prepared,” said Dr. Matthieu Lafaurie, of the Saint-Louis hospital in Paris. “It was very surprising that every country had to realize itself what was going on, as if they didn’t have the examples of other countries.

He insisted that he had warned privately in early March that Britain’s insufficient testing meant the scientists did not have enough information to track the epidemic.Across Europe, he said, more testing “would have been the single thing which would have made the biggest difference.”

there is another lesson to learn, said Dr. André, who spent years fighting epidemics in Africa before advising Belgium on the coronavirus.“They keep on telling countries what they should do, very clearly. But all these experts, when it happens in your own countries? There’s nothing,” he said.“One lesson to learn is humility.”

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.

In Rochester, N.Y. the Safety Commissioner told police to keep the noise levels down, out of consideration for the high number of people sick with flu or pneumonia who need “rest and quiet” to get better.

In Maryland, concerned that warm weather would bring people out and too close together, the Baltimore Health Commissioner banned “frolics” such as street celebrations, arguing that “while the epidemic’s sweep was becoming milder, it was still dangerous to permit large assemblages of persons.”

“ticklers and brushes are particularly forbidden, and confetti throwing will not be allowed because in contact with the hands clothes and the persons of the people throwing enhances the danger of spreading influenza,” reported the Oct. 30 Pittsburgh Gazette Times.

Indoor Halloween parties were banned as well. “Halloween parties are taboo, as are all other indoor gatherings, as the danger of spreading the influenza is still great,” declared Denver Mayor W.F.R. Mills, according to the Denver Post.

In Indianapolis, the top health official lifted the ban on public gatherings just for Halloween, allowing residents to “go ahead and have all the Halloween parties they wanted to,”

On the other hand, even where cities tried to target large gatherings, local newspaper coverage of scattered incidents of individual mischief-making suggests that the tricks part of trick-or-treating was especially pronounced.

It’s unclear what kind of effect these rowdy Halloweens had on case counts more than a century ago, especially given that it wasn’t the only event drawing people into crowds around that time: Election Day was just a week later, and people flocked to the streets again to celebrate the end of World War I just days after that.

Regardless of Halloween’s role, a long winter was ahead, and the flu did continue to spread at pandemic levels well into 1919, spiking in the following winter and in early 1920 as well. In the end, about 675,000 Americans and 50 million people died, and about 500 million people were infected globally.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

SARS-CoV-2 is not thought to present a risk at distances further than six feet. Instead, the virus’s principal mode of spread appears to be through prolonged social contact, such as occurs in family groupings.

SARS-CoV-2 is principally a risk to the elderly, those sixty and over, and people with underlying medical conditions.

There is also no firm evidence, as yet, that children are a significant vector of infection

On the debit side, there is mounting evidence that people who are symptom-free but infected may be capable of transmitting the virus

the average reproduction rate of SARS-CoV-2—that is, the number of people who will be infected by one infected person—is running at 2.2, which is markedly higher than the rate for Spanish flu, which was 1.8. 

in 1918 almost everyone had been exposed to some type of influenza before, meaning most people could count on a degree of immunity. The result was that the Spanish flu infected only a third of the world’s population. By contrast, no one has any immunity to the new coronavirus—hence the estimates that as much as 80 percent of the world’s population could have been infected by the time the pandemic will have run its course. 

The greatest reason for concern, though, is that so far, SARS-CoV-2 appears to kill about 2 percent of confirmed cases. That is a very similar mortality rate to the Spanish flu.

even that should not be a cause for panic or despair.

One of the chief lessons of the 1918 pandemic is that cities such as St. Louis that acted early and decisively to contain the virus by banning large public gatherings, closing schools, and isolating ill or suspected case, fared notably better than cities such as Philadelphia that failed to take timely measures or did not sustain them.

“They were well aware of the ravages of the 1918 flu, and this virus appeared to be closely related,”

One manufacturer produced 2 million doses with the wrong strain. As tests progressed, more scientific problems emerged — even as there were few, if any, signs that a pandemic was materializing. In June, tests showed the vaccine was not effective in children, prompting a public squabble between Salk and Sabin over who should be vaccinated.

Every American, Ford said, would be vaccinated.The government had never attempted such an endeavor — both in its breadth and speed.Almost immediately, there was chaos.

And then more problems emerged. There were reports of sporadic deaths possibly connected to the vaccine. Cases of Guillain-Barre syndrome also emerged, and are still cited today by the anti-vaccine movement. Panic emerged, with dozens of states pausing vaccinations.

By December, following 94 reports of paralysis, the entire program was shut down.

Almost immediately, in grand Washington fashion, fingers were pointed. Scientists and government officials turned on each other, with allegations that Ford acted recklessly for political gain without knowing for sure whether a pandemic would emerge — an impossible predictive game, his defenders argued.The recriminations were fueled by the fact that the swine flu pandemic hadn’t materialized.

The program “appears clearly to have been based on concern for the public good,” Skidmore wrote, “not to achieve political advantage.”