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these are central to our national well-being. Our lives are threatened less by the Taliban in Afghanistan than by unregulated contaminants at home.

Initially, this concept was highly controversial among obesity experts, but a growing number of peer-reviewed studies have confirmed his finding and identified some 20 substances as obesogens.

The most important time for exposure appears to be in utero and in childhood. It’s not clear whether most obesogens will do much to make an ordinary adult, even a pregnant woman, fatter (although one has been shown to do so), and the greatest impact seems to be on fetuses and on children before puberty.

Dr. Blumberg, the pioneer of the field, says he strongly recommends that people — especially children and women who are pregnant or may become pregnant — try to eat organic foods to reduce exposure to endocrine disruptors, and try to avoid using plastics to store food or water. “My daughter uses a stainless steel water bottle, and so do I,” he said.

Science-based decisions to improve public health — like the removal of lead from gasoline — have been among our government’s most beneficial public policy moves

In this case, a starting point would be to boost research of endocrine disruptors and pass the Safe Chemicals Act. That measure, long stalled in Congress, would require more stringent safety testing of potentially toxic chemicals around us.

Endocrine disruptors are a class of chemicals that mimic hormones and therefore confuse the body. Initially, they provoked concern because of their links to cancers and the malformation of sex organs. Those concerns continue, but the newest area of research is the impact that they have on fat storage.

The role of these chemicals has been acknowledged by the presidential task force on childhood obesity, and the National Institutes of Health has become a major funder of research on links between endocrine disruptors and both obesity and diabetes.

Just this month, a new study in the journal Environmental Health Perspectives found that endocrine disruptors that are sometimes added to PVC plastic cause mice to grow obese and suffer liver problems — and the effect continues with descendants of those mice, generation after generation.

Scientists call these two shapes the prefusion and postfusion forms of the spike. Antibodies against the prefusion shape work powerfully against the coronavirus, but postfusion antibodies don’t stop it.

they discovered a way to keep the protein locked in a tulip-like prefusion shape. All they had to do was change two of more than 1,000 building blocks in the protein into a compound called proline.

All three of the vaccines that have been authorized so far in the United States — from Johnson & Johnson, Moderna and Pfizer-BioNTech — use the 2P spike.

Other vaccine makers are using it as well. Novavax has had strong results with the 2P spike in clinical trials and is expected to apply to the Food and Drug Administration for emergency use authorization in the next few weeks. Sanofi is also testing a 2P spike vaccine and expects to finish clinical trials later this year.

Dr. McLellan’s ability to find lifesaving clues in the structure of proteins has earned him deep admiration in the vaccine world. “This guy is a genius,” said Harry Kleanthous, a senior program officer at the Bill & Melinda Gates Foundation. “He should be proud of this huge thing he’s done for humanity.”

The potency of the vaccine brought an extra benefit: The researchers needed fewer viruses for an effective dose. A single egg may yield five to 10 doses of NDV-HXP-S, compared to one or two doses of influenza vaccines.

once Dr. McLellan and his colleagues handed off the 2P spike to vaccine makers, he turned back to the protein for a closer look. If swapping just two prolines improved a vaccine, surely additional tweaks could improve it even more.

The winner contained the two prolines in the 2P spike, plus four additional prolines found elsewhere in the protein. Dr. McLellan called the new spike HexaPro, in honor of its total of six prolines.

The structure of HexaPro was even more stable than 2P, the team found. It was also resilient, better able to withstand heat and damaging chemicals. Dr. McLellan hoped that its rugged design would make it potent in a vaccine.

the University of Texas set up a licensing arrangement for HexaPro that allows companies and labs in 80 low- and middle-income countries to use the protein in their vaccines without paying royalties.

The first wave of authorized Covid-19 vaccines require specialized, costly ingredients to make. Moderna’s RNA-based vaccine, for instance, needs genetic building blocks called nucleotides, as well as a custom-made fatty acid to build a bubble around them. Those ingredients must be assembled into vaccines in purpose-built factories.

The way influenza vaccines are made is a study in contrast. Many countries have huge factories for making cheap flu shots, with influenza viruses injected into chicken eggs. The eggs produce an abundance of new copies of the viruses. Factory workers then extract the viruses, weaken or kill them and then put them into vaccines.

In March, he joined forces with two fellow University of Texas biologists, Ilya Finkelstein and Jennifer Maynard. Their three labs created 100 new spikes, each with an altered building block. With funding from the Gates Foundation, they tested each one and then combined the promising changes in new spikes. Eventually, they created a single protein that met their aspirations.

PATH then connected the Mount Sinai team with influenza vaccine makers. On March 15, Vietnam’s Institute of Vaccines and Medical Biologicals announced the start of a clinical trial of NDV-HXP-S. A week later, Thailand’s Government Pharmaceutical Organization followed suit. On March 26, Brazil’s Butantan Institute said it would ask for authorization to begin its own clinical trials of NDV-HXP-S.

n vaccine maker Avi-Mex as an intranasal spray. The company will start clinical trials to see if the vaccine is even more potent in that form.

A fierce debate has raged over whether the virus escaped from a lab in Wuhan or originated in the wild. Initially, prominent scientists publicly derided the so-called lab leak theory -- embraced by then-President Donald Trump and his allies -- as a conspiracy theory, and the intelligence community put out a rare public statement in late April 2020 affirming that it "also concurs with the wide scientific consensus that the Covid-19 virus was not manmade or genetically modified."

But as early as March 27, 2020, the Defense Intelligence Agency -- which is home to one of the intelligence community's most robust scientific cells -- in a classified assessment reported by Newsweek found that it was possible that the virus had emerged "accidentally" due to "unsafe laboratory practices."

And the Chinese government's lack of transparency and the restricted sharing of data have also hindered the intelligence community's ability to thoroughly investigate the lab leak theory. The US and Britain called on China last week to participate in a second phase of a World Health Organization investigation into the pandemic's origins, but China responded that its role in the probe "has been completed."

"If you want to make a new influenza vaccine using the traditional methods, you have to isolate the virus, learn how to grow it, learn how to inactivate it, and purify it. That takes months. With RNA, you only need the sequence,"

"When the Chinese released the sequence of the SARS-CoV-2 virus, we started the process of making RNA the next day. A couple weeks later, we were injecting animals with the vaccine."

Weissman's lab is now working on a universal coronavirus vaccine that would protect against Covid-19, SARS, MERS, coronavirus that cause the common cold -- and future strains.

"We started working on a pan-coronavirus vaccine last spring," Weissman said. "There have been three coronavirus epidemics in the past 20 years. There are going to be more."

The mRNA approach promises to send instructions for making the healthy version of a protein, and Weissman sees special promise in treating sickle cell disease, in particular.

Different tumor cell types have various, recognizable structures on the outside that the immune system can recognize. "You can imagine being able to inject someone with an mRNA that encodes an antibody that specifically targets that receptor," McLellan said.

"We identify mutations found on a patient's cancer cells," the company says on its website. Computer algorithms predict the 20 most common mutations. "We then create a vaccine that encodes for each of these mutations and load them onto a single mRNA molecule," Moderna says.

BioNtech has been working with academic researchers to use mRNA to treat mice genetically engineered to develop a disease similar to multiple sclerosis -- an autoimmune disease that starts when the immune system mistakenly attacks the myelin, a fatty covering of the nerve cells.In the mice, the treatment appeared to help stop the attack, while keeping the rest of the immune system intact.

The idea behind gene therapy is to replace a defective gene with one that works properly.

Another obvious use for mRNA technology is to fight cancer. The human body fights off cancer every day, and using mRNA could help it do so even better.

"It's gene therapy without the half a million dollar price tag," he added. "It should be just an IV injection and that's it."

"The idea there is if you are immune to tick saliva proteins, when the tick bites you, the body produces inflammation and the tick falls off," Weissman said.

On July 8, 1972, Hanson borrowed her brother's bicycle to go to a baseball game and never returned home, said Marshall during a news conference. She was reported missing to the Naperville police and her body was discovered later that day in a field with multiple stab wounds.

A suspect in the case was not immediately identified. But after 49 years of continued investigation, authorities were led to an arrest through technological advancements in DNA and genetic genealogy analysis,

At the time of the Hanson's killing, Whelpley was 27 years old and lived within one mile of Hanson's home, police said.

The Will County State's Attorney Office has charged Whelpley with three counts of first-degree murder with a bond set at $10 million.

The Hanson family said in a statement that they are grateful to all who have worked on the case throughout the years, according to police.

A large test of the Novavax COVID-19 vaccine's effectiveness, conducted in tens of thousands of volunteers in the United States and Mexico, is about to wrap up. Dr. Gregory Glenn, president of research and development for Novavax, told an audience at a recent webinar hosted by the International Society for Vaccines that "we anticipate filing for authorization in the U.K., U.S. and Europe in the third quarter."

To make the virus protein, Novavax uses giant vats of cells grown in the lab. But there's another way to make the protein: Get plants in a greenhouse to do it.

"Especially in elderly individuals in that study, it was not as immunogenic as it should be," says Dr. Paul Goepfert at the University of Alabama at Birmingham, who was one of the researchers involved in those early studies. He says the issue turned out to be an incorrect calculation of the dose of vaccine being delivered."So instead of giving 10 micrograms of the dose, they were actually giving one microgram," Goepfert says.

Early studies suggest Medicago's candidate vaccine does just that, and the company is confident enough in those findings that it's already begun a large study in people that could involve as many as 30,000 volunteers in 11 countries.

Another latecomer that's coming is the pharmaceutical giant Sanofi. Its protein subunit vaccine against the coronavirus is also grown in cells in the lab.

Late last year the company was getting ready to mount a large study of the vaccine's effectiveness when the early results in a smaller group of people showed it did not seem to be inducing the immune response that would be protective.

The plants used are related to the tobacco plant, and have been modified to contain the genetic instructions to make the viral protein.The plants do something very valuable — they make a lipid shell that surrounds a bunch of the viral proteins, with the proteins sticking out.

Goepfert says it'll be a good thing if all these vaccines make it to consumers. But that alone isn't going to solve the problem of getting people vaccinated.Why? "Because the vaccines that we have now are just beyond our wildest dreams kind of effective," he says. "And I'm living in a state right now where it just frustrates me how slow our vaccine uptake is."

Their culture is matrilinear, and information about the new dangers may have been passed on in the same way whale matriarchs share knowledge about feeding grounds.

Sperm whales are highly socialised animals, able to communicate over great distances. They associate in clans defined by the dialect pattern of their sonar clicks

It was a frighteningly rapid killing, and it accompanied other threats to the ironically named Pacific. From whaling and sealing stations to missionary bases, western culture was imported to an ocean that had remained largely untouched

Sperm whales also possess the largest brain on the planet. It is not hard to imagine that they understood what was happening to them.

The hunters themselves realised the whales’ efforts to escape. They saw that the animals appeared to communicate the threat within their attacked groups. Abandoning their usual defensive formations, the whales swam upwind to escape the hunters’ ships, themselves wind-powered. ‘This was cultural evolution, much too fast for genetic evolution,’

Now, just as whales are beginning to recover from the industrial destruction by 20th-century whaling fleets – whose steamships and grenade harpoons no whale could evade – they face new threats created by our technology. ‘They’re having to learn not to get hit by ships, cope with the depredations of longline fishing, the changing source of their food due to climate change,’ says Whitehead

Perhaps the greatest modern peril is noise pollution, one they can do nothing to evade.

Whitehead and Randall have written persuasively of whale culture, expressed in localised feeding techniques as whales adapt to shifting sources, or in subtle changes in humpback song whose meaning remains mysterious. The same sort of urgent social learning the animals experienced in the whale wars of two centuries ago is reflected in the way they negotiate today’s uncertain world and what we’ve done to it.

So in recent years, scientists started creating structures that resemble human embryos in the lab by using chemical signals to coax cells into forming themselves into entities that look like very primitive human embryos.

Now, Wu's team and another international team of scientists have gone further than ever before. They created hollow balls of cells that closely resemble embryos at the stage when they usually implant in the womb, which are known as blastocysts. The new laboratory-made embryos have been dubbed "blastoids."

Now with this technique we can make hundreds of these structures. So this will allow us to scale up our understanding of very early human development. We think this will be very important." Some other scientists are hailing the research.

The goal of the experiments is to gain important insights into early human development and find new ways to prevent birth defects and miscarriages and treat fertility problems.But the research, which was published in two separate papers Wednesday in the journal Nature Portfolio, raises sensitive moral and ethical concerns.

The two experiments started with different cells to get similar results. Wu's group created his blastoids from human embryonic stem cells, and from "induced pluripotent stem cells," which are made from adult cells. Polo's group started with adult skin cells.

Hyun agrees the research is very important and could lead to a many other advances. But Hyun says it's important to come up with clear guidelines about how scientists can responsibly be permitted to pursue this kind of research.

Hyun favors revising a guideline known as the 14-day rule, which prohibits experiments on human embryos in the lab beyond two weeks of their existence. Hyun says exceptions should be allowed under certain carefully reviewed conditions.

But others worry about easing the 14-day rule.That could mean "we could just keep growing these sort-of humans in a test tube and not even considering the fact that they're so close to being human, right?"

In fact, another team of scientists at the Weizmann Institute of Science in Israel figured out how to grow mouse embryos outside the womb — a step toward creating an "artificial womb," according to report published Wednesday in the journal Nature.

dislikes the term breakthrough case, which evokes a barrier walling humans off from disease. “It’s very misleading,” she told me. “It’s like the virus ‘punches’ through our defenses.”

Immunity is not a monolith, and the degree of defense roused by an infection or a vaccine will differ from person to person, even between identical twins. Some people might have underlying conditions that hamstring their immune system’s response to vaccination; others might simply, by chance, churn out fewer or less potent antibodies and T cells that can nip a coronavirus infection in the bud.

An ideal response to vaccination might create an arsenal of immune molecules and cells that can instantaneously squelch the virus, leaving no time for symptoms to appear. But sometimes that front line of fighters is relatively sparse

Should the virus make it through, “it becomes a race [against] time,” Ellebedy told me. The pathogen rushes to copy itself, and the immune system recruits more defenders. The longer the tussle drags on, the more likely the disease is to manifest.

The range of vaccine responses “isn’t a variation of two- to threefold; it’s thousands,”

“Being vaccinated doesn’t mean you are immune. It means you have a better chance of protection.”

The number of post-vaccination infections is also contingent on “the ongoing transmission situation,” Omer told me. “It depends on how much people are mixing.”

he circumstances of exposure to any version of the coronavirus will also make a difference. If vaccinated people are spending time with groups of unvaccinated people in places where the virus is running rampant, that still raises their chance of getting sick. Large doses of the virus can overwhelm the sturdiest of immune defenses, if given the chance.

under many circumstances, vaccines are still best paired with safeguards such as masks and distancing—just as rain boots and jackets would help buffer someone in a storm.

Even excellent vaccines aren’t foolproof, and they shouldn’t be criticized when they’re not. “We can’t expect it’s going to be perfect, on day one, always,” Borio said.

The numbers for asymptomatic infections are still crystallizing, but they’re likely to be lower.

“Whenever someone tests positive, the real question is, are they sick, and how sick are they? That’s a big difference.”

Efficacy, a figure specific to clinical trials, also doesn’t always translate perfectly to the messiness of the real world, where there’s immense variability in how, when, where, by whom, and to whom shots are administered

The vaccine’s performance under these conditions is tracked by a separate measure, called effectiveness. Studies rigorously examining vaccine effectiveness are challenging, but early data suggest that the Pfizer-BioNTech and Moderna shots are living up to their initial hype.

Vaccination is actually more like a single variable in a dynamic playing field—a layer of protection, like an umbrella, that might guard better in some situations than others. It could keep a lucky traveler relatively dry in a light drizzle, but in a windy maelstrom that’s whipping heavy droplets every which way, another person might be overwhelmed.

A vaccine with a recorded efficacy of 95 percent, for example, doesn’t give everyone who’s vaccinated a 5 percent chance of getting sick. Not all of those people will even encounter the virus

The key is how vaccination changes the outcome for those who are meaningfully exposed: Among 100 individuals who might have fallen ill without the vaccine, just five symptomatic cases might appear.

Scientists have said that reinfections are likely to be asymptomatic or mild because the immune system will suppress the virus before it can do much damage.

“You can certainly not rely on a past infection as protecting you from being ill again, and possibly quite ill if you are in the elderly segment,” said Steen Ethelberg, an epidemiologist at Statens Serum Institut, Denmark’s public health agency.

Rigorous estimates of second infections have generally been rare because many people worldwide did not initially have access to testing, and laboratories require genetic sequences from both rounds of testing to confirm a reinfection.

The researchers looked at the results from 11,068 people who tested positive for the coronavirus during the first wave in Denmark between March and May 2020. During the second wave, from September to December, 72 of those people, or 0.65 percent, again tested positive, compared with 3.27 percent of people who became infected for the first time.

She and other experts noted that while 80 percent might not seem superb, protection from symptomatic illness was likely to be higher.

The findings indicate that people who have recovered from Covid-19 should get at least one dose of a coronavirus vaccine to boost the level of protection, Dr. Krammer added.

“I wish it had actually been broken down into specific decades over 65,” Dr. Pepper said. “It would be nice to know whether the majority of people who were getting reinfected were over 80.”

“This really does emphasize the need to cover older people with the vaccine, even if they have had Covid first.”

The school’s power structure is strange to me. The school prefects are not appointed by staff, or elected via secret ballot by their own year. Instead they are chosen by the prefects in the year above. The result is that if a boy wishes to be socially prominent at school, there are only twenty people whose approval he truly needs

I watch boys campaign for election as prefects with a vigour that I will later see in the world of politics, and I will realise that this is the kind of place where these politicians learned it, that this is what they mean by networking

Networking is the art of laughing a little longer and louder than necessary at the jokes of the person whose patronage you seek, of standing silently by their shoulders when they are making a nonsensical argument, of hanging around just in case they need an extra pint, of strategically making sure you are in the same place as them on holiday. It is the least dignified behaviour I can imagine, but I will see boys carry it out with such ease that it appears to be genetic.

I think a great deal about the English concept of fair play: the idea that there are some things that are simply not done. The older I get, the more I wonder how much that concept was created to keep people of a certain social class in their place

I look at the most confident people in my year and I realise that the greatest gift that has been bestowed upon them is that of shamelessness.

Shamelessness is the superpower of a certain section of the English upper classes. While so many other people in the country are hamstrung by the deference and social embarrassment they have been taught since birth, the upper classes calmly parade on through the streets and boardrooms to claim the spoils

They don’t learn shamelessness at Eton, but this is where they perfect it.

The disease would ravage Wuhan before it was brought under control in March. The city was locked down on Jan. 23 with little or no warning. The hardships endured and lives lost became a source of both sorrow and pride for residents once the 76-day lockdown was lifted on April 8.

Scientists initially suspected the virus came from wild animals sold in the market.

The Wuhan Institute of Virology maintains an extensive archive of genetic sequences of bat coronaviruses built in the wake of the 2003 SARS pandemic, which spread from China to many countries.

China has firmly rejected calls for an independent outside investigation. The head of the WHO recently expressed impatience with how long China took to make necessary arrangements for the expert team's visit.

China stifled independent reports about the outbreak and has published little information on its search for the origins of the virus. An AP investigation found that the government has strictly controlled all scientific research related to the outbreak and forbids researchers from speaking to the press.

On Saturday, Britain reported eight cases of one of the variants found in Brazil, hours after the British authorities imposed a travel ban from Latin American countries and Portugal, which is linked to Brazil by its colonial history and by current travel and trade ties. Italy also suspended flights from Brazil, its health minister, Roberto Speranza, announced on Facebook.

The Moderna vaccine is a particularly attractive candidate for rapid scaling, since it can be kept at normal freezer and refrigerator temperatures, which makes it easier to store and transport.

After all, viruses know no borders. Protecting Americans from Covid-19 requires protecting all people from the disease. We will not end the pandemic until everyone, across the world, can receive highly effective vaccines. And the U.S. can help the world more quickly this time. Pepfar was launched seven years after effective H.I.V. treatments were available in rich countries.

the reason a neighborhood turns into a “poverty trap” is also related to a common perception of the way people in a community act and think. When people see graffiti and garbage, do they find it acceptable or see serious disorder? Do they respect the legal system or have a high level of “moral cynicism,” believing that “laws were made to be broken”?

Daniel Patrick Moynihan, then an assistant labor secretary in the Johnson administration, introduced the idea of a “culture of poverty” to the public in a startling 1965 report. Although Moynihan didn’t coin the phrase (that distinction belongs to the anthropologist Oscar Lewis), his description of the urban black family as caught in an inescapable “tangle of pathology” of unmarried mothers and welfare dependency was seen as attributing self-perpetuating moral deficiencies to black people, as if blaming them for their own misfortune.

For more than 40 years, social scientists investigating the causes of poverty have tended to treat cultural explanations like Lord Voldemort: That Which Must Not Be Named.

“Culture is back on the poverty research agenda,” the introduction declares, acknowledging that it should never have been removed.

Views of the cultural roots of poverty “play important roles in shaping how lawmakers choose to address poverty issues,”

Younger academics like Professor Small, 35, attributed the upswing in cultural explanations to a “new generation of scholars without the baggage of that debate.”

The authors claimed to have taken family background into account, Professor Wilson said, but “they had not captured the cumulative effects of living in poor, racially segregated neighborhoods.”He added, “I realized we needed a comprehensive measure of the environment, that we must consider structural and cultural forces.”

Scholars like Professor Wilson, 74, who have tilled the field much longer, mentioned the development of more sophisticated data and analytical tools. He said he felt compelled to look more closely at culture after the publication of Charles Murray and Richard Herrnstein’s controversial 1994 book, “The Bell Curve,” which attributed African-Americans’ lower I.Q. scores to genetics.

a study by Professor Sampson, 54, that found that growing up in areas where violence limits socializing outside the family and where parents haven’t attended college stunts verbal ability, lowering I.Q. scores by as much as six points, the equivalent of missing more than a year in school

Conservatives also deserve credit, said Kay S. Hymowitz, a fellow at the conservative Manhattan Institute, for their sustained focus on family values and marriage even when cultural explanations were disparaged.

even now some sociologists avoid words like “values” and “morals” or reject the idea that, as The Annals put it, “a group’s culture is more or less coherent.” Watered-down definitions of culture, Ms. Hymowitz complained, reduce some of the new work to “sociological pablum.”

“What a concept. Values, norms, beliefs play very important roles in the way people meet the challenges of poverty.”

But a host of new research — including close genetic analysis of outbreaks and lab work with hamsters and human lung tissue — has supported the view that the mutated virus did in fact have a distinct advantage

There is no evidence that a coronavirus with the 614G mutation causes more severe symptoms, kills more people or complicates the development of vaccines.

But the subtle change in the virus’ genome appears to have had a big ripple effect

The original variant spotted in Wuhan, China, in late 2019 was already highly contagious

Even so, Dr. Andersen said that the variant’s higher transmissibility could help explain why some countries that were initially successful in containing the virus became susceptible to it later. The virus may have been “harder to contain than the first time around,” he said.

But other researchers said that a lack of proper containment measures, not the mutation, is largely to blame for resurgent outbreaks.

Scientists consider animal experiments a critical step to test whether a mutation that makes viruses more infectious in a lab dish also does so in a living population.

The virus will continue to change. and while most of those changes will be mere typos, some may be more meaningful, Dr. Engelthaler said. “There will be the possibility of additional alterations that change the nature of the pandemic,” he said.

There’s plenty of blame to go around, involving Democrats as well as Republicans, but Trump in particular “recklessly squandered lives,” in the words of an unusual editorial this month in the New England Journal of Medicine. Death certificates may record the coronavirus as the cause of death, but in a larger sense vast numbers of Americans died because their government was incompetent.

As many Americans are dying every 10 days of Covid-19 as U.S. troops died during 19 years of war in Iraq and Afghanistan

The paradox is that a year ago, the United States seemed particularly well positioned to handle this kind of crisis. A 324-page study by Johns Hopkins found last October that the United States was the country best prepared for a pandemic.

Then there’s an immeasurable cost in soft power as the United States is humbled before the world.

“It’s really sad to see the U.S. presidency fall from being the champion of global health to being the laughingstock of the world,”

in terms of destruction of American lives, treasure and well-being, this pandemic may be the greatest failure of governance in the United States since the Vietnam War.

the economists David Cutler and Lawrence Summers estimate that the economic cost of the pandemic in the United States will be $16 trillion, or about $125,000 per American household — far more than the median family’s net worth.

It’s true that the Obama administration did not do enough to refill the national stockpile with N95 masks, but Republicans in Congress wouldn’t provide even the modest sums that Obama requested for replenishment. And the Trump administration itself did nothing in its first three years to rebuild stockpiles.

The Obama administration updated this playbook and in the presidential transition in 2016, Obama aides cautioned the Trump administration that one of the big risks to national security was a contagion. Private experts repeated similar warnings. “Of all the things that could kill 10 million people or more, by far the most likely is an epidemic,” Bill Gates warned in 2015.

Credit for that goes to President George W. Bush, who in the summer of 2005 read an advance copy of “The Great Influenza,” a history of the 1918 flu pandemic. Shaken, Bush pushed aides to develop a strategy to prepare for another great contagion, and the result was an excellent 396-page playbook for managing such a health crisis.

Trump argues that no one could have anticipated the pandemic, but it’s what Bush warned about, what Obama aides tried to tell their successors about, and what Joe Biden referred to in a blunt tweet in October 2019 lamenting Trump’s cuts to health security programs and adding: “We are not prepared for a pandemic.”

When the health commission of Wuhan, China, announced on Dec. 31 that it had identified 27 cases of a puzzling pneumonia, Taiwan acted with lightning speed. Concerned that this might be an outbreak of SARS, Taiwan dispatched health inspectors to board flights arriving from Wuhan and screen passengers before allowing them to disembark. Anyone showing signs of ill health was quarantined.

If either China or the rest of the world had shown the same urgency, the pandemic might never have happened.

In hindsight, two points seem clear: First, China initially covered up the scale of the outbreak. Second, even so, the United States and other countries had enough information to act as Taiwan did. The first two countries to impose travel restrictions on China were North Korea and the Marshall Islands, neither of which had inside information.

That first half of January represents a huge missed opportunity for the world. If the United States, the World Health Organization and the world media had raised enough questions and pressed China, then perhaps the Chinese central government would have intervened in Wuhan earlier. And if Wuhan had been locked down just two weeks earlier, it’s conceivable that this entire global catastrophe could have been averted.

the C.D.C. devised a faulty test, and turf wars in the federal government prevented the use of other tests. South Korea, Germany and other countries quickly developed tests that did work, and these were distributed around the world. Sierra Leone in West Africa had effective tests before the United States did.

It’s true that local politicians, Democrats and Republicans alike, made disastrous decisions, as when Mayor Bill de Blasio of New York City urged people in March to “get out on the town despite coronavirus.” But local officials erred in part because of the failure of testing: Without tests, they didn’t know what they faced.

t’s unfair to blame the testing catastrophe entirely on Trump, for the failures unfolded several pay grades below him. Partly that’s because Trump appointees, like Robert Redfield, director of the C.D.C., simply aren’t the A team.

In any case, presidents set priorities for lower officials. If Trump had pushed aides as hard to get accurate tests as he pushed to repel refugees and migrants, then America almost certainly would have had an effective test by the beginning of February and tens of thousands of lives would have been saved.

Still, testing isn’t essential if a country gets backup steps right. Japan is a densely populated country that did not test much and yet has only 2 percent as many deaths per capita as the United States. One reason is that Japanese have long embraced face masks, which Dr. Redfield has noted can be at least as effective as a vaccine in fighting the pandemic. A country doesn’t have to do everything, if it does some things right.

Trump’s missteps arose in part because he channeled an anti-intellectual current that runs deep in the United States, as he sidelined scientific experts and responded to the virus with a sunny optimism apparently meant to bolster the financial markets.

Yet in retrospect, Trump did almost everything wrong. He discouraged mask wearing. The administration never rolled out contact tracing, missed opportunities to isolate the infected and exposed, didn’t adequately protect nursing homes, issued advice that confused the issues more than clarified them, and handed responsibilities to states and localities that were unprepared to act.

The false reassurances and dithering were deadly. One study found that if the United States had simply imposed the same lockdowns just two weeks earlier, 83 percent of the deaths in the early months could have been prevented.

A basic principle of public health is the primacy of accurate communications based on the best science. Chancellor Angela Merkel of Germany, who holds a doctorate in physics, is the global champion of that approach

Trump was the opposite, sowing confusion and conspiracy theories; a Cornell study found that “the President of the United States was likely the largest driver of the Covid-19 misinformation.”

A conservative commentariat echoed Trump in downplaying the virus and deriding efforts to stay safe.

A University of Chicago study found that watching the Sean Hannity program correlated to less social distancing, so watching Fox News may well have been lethal to some of its fans.

Americans have often pointed to the Soviet Union as a place where ideology trumped science, with disastrous results. Stalin backed Trofim Lysenko, an agricultural pseudoscientist who was an ardent Communist but scorned genetics — and whose zealous incompetence helped cause famines in the Soviet Union. Later, in the 1980s, Soviet leaders were troubled by data showing falling life expectancy — so they banned the publication of mortality statistics

It was in the same spirit that Trump opposed testing for the coronavirus in the hope of holding down the number of reported cases.

Most striking, Trump still has never developed a comprehensive plan to fight Covid-19. His “strategy” was to downplay the virus and resist business closures, in an effort to keep the economy roaring — his best argument for re-election.

This failed. The best way to protect the economy was to control the virus, not to ignore it, and the spread of Covid-19 caused economic dislocations that devastated even homes where no one was infected.

Eight million Americans have slipped into poverty since May, a Columbia University study found, and about one in seven households with children have reported to the census that they didn’t have enough food to eat in the last seven days.

More than 40 percent of adults reported in June that they were struggling with mental health, and 13 percent have begun or increased substance abuse, a C.D.C. study found

More than one-quarter of young adults said they have seriously contemplated suicide

So in what is arguably the richest country in the history of the world, political malpractice has resulted in a pandemic of infectious disease followed by pandemics of poverty, mental illness, addiction and hunger.

The rejection of science has also exacerbated polarization and tribalism

An old school friend shared this conspiracy theory on Facebook:Create a VIRUS to scare people. Place them in quarantine. Count the number of dead every second of every day in every news headline. Close all businesses …. Mask people. Dehumanize them. Close temples and churches …. Empty the prisons because of the virus and fill the streets with criminals. Send in Antifa to vandalize property as if they are freedom fighters. Undermine the law. Loot …. And, in an election year, have Democrats blame all of it on the President. If you love America, our Constitution, and the Rule of Law, get ready to fight for them.

During World War II, American soldiers died at a rate of 9,200 a month, less than one-third the pace of deaths from this pandemic, but the United States responded with a massive mobilization

Yet today we can’t even churn out enough face masks; a poll of nurses in late July and early August found that one-third lacked enough N95 masks

Trump and his allies have even argued against mobilization. “Don’t be afraid of Covid,” Trump tweeted this month. “Don’t let it dominate your life.”

It didn’t have to be this way. If the U.S. had worked harder and held the per capita mortality rate down to the level of, say, Germany, we could have saved more than 170,000 lives

And if the U.S. had responded urgently and deftly enough to achieve Taiwan’s death rate, fewer than 100 Americans would have died from the virus.

“It is a slaughter,” Dr. William Foege, a legendary epidemiologist who once ran the C.D.C., wrote to Dr. Redfield. Dr. Foege predicted that public health textbooks would study America’s response to Covid-19 not as a model of A-plus work but as an example of what not to do.