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The shortfall in testing isn’t just a problem for individual patients and their doctors. It is also holding back large-scale surveys of seemingly healthy populations, in workplaces and elsewhere, and scientific research into fundamental properties of the virus and the disease it causes.

there is an escalating need to test much larger groups repeatedly—to track the spread of the virus as restrictions ease—and to carry out population-based studies that will reveal more about how this virus behaves.

in determining whether an individual is safe to enter a workplace or school on a given morning. Ideally, for the later purposes, tests would be conducted swiftly and at high volume at the places where samples are taken

One such approach, still in development, would exploit the ability of the well-known bacterial gene-editing system known as CRISPR to recognize coronavirus RNA.

While the need for greatly expanded testing in the next phase of this pandemic is widely acknowledged, the United States has no coordinated plan for how to achieve it. The technical building blocks are in hand, but how to put them together is not yet clear. Moreover, major regulatory hurdles limit the use of the results from novel tests in patient care, especially in certain states such as New York. And the logistics of deploying enough personnel to track samples and deliver results are daunting. Because of the complexity and importance of such testing, a centralized program, run by a strong scientific leader and paid for with federal dollars, may be the only solution.

rmed with efficient and accurate tests to detect the virus (indicating active infection) and reliable tests to measure antibodies against it (implying prior exposure and possible immunity), public-health programs could paint an accurate picture of the current pandemic. Small and large businesses, schools, health-care facilities, and other organizations could track the outcomes of their attempts to restore normal activities, and scientists could answer key questions about viral transmission and host immunity.

decisive answers will come only from studying human beings who are exposed to the virus under real-life conditions. Such studies may be feasible only under circumstances in which natural transmission is occurring at significant rates, as it currently is. Therefore, if we are to get answers to the following questions, we must act now.

tudies to answer these questions require identifying enough people who have recovered, then testing them repeatedly for the appearance of a new infection. Such people are relatively easy to find. They include doctors and nurses in hospitals in hard-hit metropolitan areas such as New York City; staff and residents at nursing homes with high rates of infection; and crews of U.S. Navy ships that have experienced outbreaks of COVID-19.

identify asymptomatic infections. Following up on those cases will shed light on how many asymptomatic people ultimately develop symptoms; how long it takes for them to do so; whether asymptomatic people who ultimately develop symptoms have higher viral loads than those who don’t get sick; whether symptomatic and asymptomatic people have different immune responses; whether other, simpler procedures (such as tests for some chemical abnormality in the blood) might be used to screen for infection; and how large a contribution asymptomatic people make to the ongoing transmission of the virus.

Despite repeated warnings after prior epidemics about the likelihood of new ones caused by novel microbes, the United States and many other countries failed to respond efficiently to this one. Scientists might have detected the new coronavirus much earlier with the better tools for microbial surveillance that already exist; prevented the pathogen’s worldwide spread by more aggressive testing and contact tracing; and supported better and safer health care with larger stockpiles and pipelines for procurement of medical equipment. Humanity should never be this unprepared again.

But for those hoping that 25 percent represents a true ceiling for pandemic spread in a given community, well, it almost certainly does not, considering that recent serological surveys have shown that perhaps 93 percent of the population of Iquitos, Peru, has contracted the disease; as have more than half of those living in Indian slums; and as many as 68 percent in particular neighborhoods of New York City

overshoot of that scale would seem unlikely if the “true” threshold were as low as 20 or 25 percent.

But, of course, that threshold may not be the same in all places, across all populations, and is surely affected, to some degree, by the social behavior taken to protect against the spread of the disease.

we probably err when we conceive of group immunity in simplistically binary terms. While herd immunity is a technical term referring to a particular threshold at which point the disease can no longer spread, some amount of community protection against that spread begins almost as soon as the first people are exposed, with each case reducing the number of unexposed and vulnerable potential cases in the community by one

you would not expect a disease to spread in a purely exponential way until the point of herd immunity, at which time the spread would suddenly stop. Instead, you would expect that growth to slow as more people in the community were exposed to the disease, with most of them emerging relatively quickly with some immune response. Add to that the effects of even modest, commonplace protections — intuitive social distancing, some amount of mask-wearing — and you could expect to get an infection curve that tapers off well shy of 60 percent exposure.

Looking at the data, we see that transmissions in many severely impacted states began to slow down in July, despite limited interventions. This is especially notable in states like Arizona, Florida, and Texas. While we believe that changes in human behavior and changes in policy (such as mask mandates and closing of bars/nightclubs) certainly contributed to the decrease in transmission, it seems unlikely that these were the primary drivers behind the decrease. We believe that many regions obtained a certain degree of temporary herd immunity after reaching 10-35 percent prevalence under the current conditions. We call this 10-35 percent threshold the effective herd immunity threshold.

Indeed, that is more or less what was recently found by Youyang Gu, to date the best modeler of pandemic spread in the U.S

he cautioned again that he did not mean to imply that the natural herd-immunity level was as low as 10 percent, or even 35 percent. Instead, he suggested it was a plateau determined in part by better collective understanding of the disease and what precautions to take

Gu estimates national prevalence as just below 20 percent (i.e., right in the middle of his range of effective herd immunity), it still counts, I think, as encouraging — even if people in hard-hit communities won’t truly breathe a sigh of relief until vaccines arrive.

If you can get real protection starting at 35 percent, it means that even a mediocre vaccine, administered much more haphazardly to a population with some meaningful share of vaccination skeptics, could still achieve community protection pretty quickly. And that is really significant — making both the total lack of national coordination on rollout and the likely “vaccine wars” much less consequential.

At least 20 percent of the public, and perhaps 50 percent, had some preexisting, cross-protective T-cell response to SARS-CoV-2, according to one much-discussed recent paper. An earlier paper had put the figure at between 40 and 60 percent. And a third had found an even higher prevalence: 81 percent.

The T-cell story is similarly encouraging in its big-picture implications without being necessarily paradigm-changing

These numbers suggest their own heterogeneity — that different populations, with different demographics, would likely exhibit different levels of cross-reactive T-cell immune response

The most optimistic interpretation of the data was given to me by Francois Balloux, a somewhat contrarian disease geneticist and the director of the University College of London’s Genetics Institute

According to him, a cross-reactive T-cell response wouldn’t prevent infection, but would probably mean a faster immune response, a shorter period of infection, and a “massively” reduced risk of severe illness — meaning, he guessed, that somewhere between a third and three-quarters of the population carried into the epidemic significant protection against its scariest outcomes

the distribution of this T-cell response could explain at least some, and perhaps quite a lot, of COVID-19’s age skew when it comes to disease severity and mortality, since the young are the most exposed to other coronaviruses, and the protection tapers as you get older and spend less time in environments, like schools, where these viruses spread so promiscuously.

Balloux told me he believed it was also possible that the heterogeneous distribution of T-cell protection also explains some amount of the apparent decline in disease severity over time within countries on different pandemic timelines — a phenomenon that is more conventionally attributed to infection spreading more among the young, better treatment, and more effective protection of the most vulnerable (especially the old).

Going back to Youyang Gu’s analysis, what he calls the “implied infection fatality rate” — essentially an estimated ratio based on his modeling of untested cases — has fallen for the country as a whole from about one percent in March to about 0.8 percent in mid-April, 0.6 percent in May, and down to about 0.25 percent today.

even as we have seemed to reach a second peak of coronavirus deaths, the rate of death from COVID-19 infection has continued to decline — total deaths have gone up, but much less than the number of cases

In other words, at the population level, the lethality of the disease in America has fallen by about three-quarters since its peak. This is, despite everything that is genuinely horrible about the pandemic and the American response to it, rather fantastic.

there may be some possible “mortality displacement,” whereby the most severe cases show up first, in the most susceptible people, leaving behind a relatively protected population whose experience overall would be more mild, and that T-cell response may play a significant role in determining that susceptibility.

That, again, is Balloux’s interpretation — the most expansive assessment of the T-cell data offered to me

The most conservative assessment came from Sarah Fortune, the chair of Harvard’s Department of Immunology

Fortune cautioned not to assume that cross-protection was playing a significant role in determining severity of illness in a given patient. Those with such a T-cell response, she told me, would likely see a faster onset of robust response, yes, but that may or may not yield a shorter period of infection and viral shedding

Most of the scientists, doctors, epidemiologists, and immunologists I spoke to fell between those two poles, suggesting the T-cell cross-immunity findings were significant without necessarily being determinative — that they may help explain some of the shape of pandemic spread through particular populations, but only some of the dynamics of that spread.

he told me he believed, in the absence of that data, that T-cell cross-immunity from exposure to previous coronaviruses “might explain different disease severity in different people,” and “could certainly be part of the explanation for the age skew, especially for why the very young fare so well.”

the headline finding was quite clear and explicitly stated: that preexisting T-cell response came primarily via the variety of T-cells called CD4 T-cells, and that this dynamic was consistent with the hypothesis that the mechanism was inherited from previous exposure to a few different “common cold” coronaviruses

“This potential preexisting cross-reactive T-cell immunity to SARS-CoV-2 has broad implications,” the authors wrote, “as it could explain aspects of differential COVID-19 clinical outcomes, influence epidemiological models of herd immunity, or affect the performance of COVID-19 candidate vaccines.”

“This is at present highly speculative,” they cautioned.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Aviation is safe in large part because it learns from its disasters. Investigators from the U.S. National Transportation Safety Board go immediately to accident sites to begin assessing evidence. After months or even years of research, their detailed reports try to lay out the “accident chain” and explain what went wrong

with respect to the coronavirus pandemic, it has suffered by far the largest number of fatalities, about one-quarter of the global total, despite having less than one-20th of the world’s population.

What if the NTSB were brought in to look at the Trump administration’s handling of the pandemic? What would its investigation conclude?

This was a journey straight into a mountainside, with countless missed opportunities to turn away. A system was in place to save lives and contain disaster. The people in charge of the system could not be bothered to avoid the doomed course.

Timelines of aviation disasters typically start long before the passengers or even the flight crew knew anything was wrong, with problems in the design of the airplane, the procedures of the maintenance crew, the route, or the conditions into which the captain decided to fly. In the worst cases, those decisions doomed the flight even before it took off. My focus here is similarly on conditions and decisions that may have doomed the country even before the first COVID-19 death had been recorded on U.S. soil.

What happened once the disease began spreading in this country was a federal disaster in its own right: Katrina on a national scale, Chernobyl minus the radiation. It involved the failure to test; the failure to trace; the shortage of equipment; the dismissal of masks; the silencing or sidelining of professional scientists; the stream of conflicting, misleading, callous, and recklessly ignorant statements by those who did speak on the national government’s behalf

As late as February 26, Donald Trump notoriously said of the infection rate, “You have 15 people, and the 15 within a couple of days is going to be down close to zero.” What happened after that—when those 15 cases became 15,000, and then more than 2 million, en route to a total no one can foretell—will be a central part of the history of our times.

1. The Flight Plan

the most important event was the H5N1 “bird flu” outbreak, in 2005. It originated in Asia and was mainly confined there, as the SARS outbreak had been two years earlier. Bush-administration officials viewed H5N1 as an extremely close call. “

Shortly before Barack Obama left office, his administration’s Pandemic Prediction and Forecasting Science and Technology Working Group—yes, that was a thing—released a report reflecting the progress that had been made in applying remote-sensing and AI tools since the early days of Global Argus. The report is freely available online and notes pointedly that recent technological advances “provide opportunities to mitigate large-scale outbreaks by predicting more accurately when and where outbreaks are likely to occur, and how they will progress.”

“Absolutely nothing that has happened has been a surprise. We saw it coming. Not only did we see it, we ran the models and the gaming exercises. We had every bit of the structure in place. We’ve been talking about a biohazard risk like this for years. Anyone who says we did not see this coming has their head in the sand, or is lying through their teeth.”

The system the government set up was designed to warn not about improbable “black swan” events but rather about what are sometimes called “gray rhinos.” These are the large, obvious dangers that will sooner or later emerge but whose exact timing is unknown.

other U.S. leaders had dealt with foreign cover-ups, including by China in the early stages of the SARS outbreak in 2002. Washington knew enough, soon enough, in this case to act while there still was time.

During the Obama administration, the U.S. had negotiated to have its observers stationed in many cities across China, through a program called Predict. But the Trump administration did not fill those positions, including in Wuhan. This meant that no one was on site to learn about, for instance, the unexplained closure on January 1 of the city’s main downtown Huanan Seafood Wholesale Market, a so-called wet market

“It was in the briefings by the beginning of January,” a person involved in preparing the president’s briefing book told me. “On that there is no dispute.” This person went on: “But knowing it is in the briefing book is different from knowing whether the president saw it.” He didn’t need to spell out his point, which was: Of course this president did not.

To sum up: The weather forecast showed a dangerous storm ahead, and the warning came in plenty of time. At the start of January, the total number of people infected with the virus was probably less than 1,000. All or nearly all of them were in China. Not a single case or fatality had been reported in the United States.

2. The Air Traffic Controllers

In cases of disease outbreak, U.S. leadership and coordination of the international response was as well established and taken for granted as the role of air traffic controllers in directing flights through their sectors

in normal circumstances, its location in China would have been a plus. Whatever the ups and downs of political relations over the past two decades, Chinese and American scientists and public-health officials have worked together frequently, and positively, on health crises ranging from SARS during George W. Bush’s administration to the H1N1 and Ebola outbreaks during Barack Obama’s.

One U.S. official recalled the Predict program: “Getting Chinese agreement to American monitors throughout their territory—that was something.” But then the Trump administration zeroed out that program.

“We had cooperated with China on every public-health threat until now,” Susan Shirk, a former State Department official and longtime scholar of Chinese affairs at UC San Diego, told me. “SARS, AIDS, Ebola in Africa, H1N1—no matter what other disputes were going on in the relationship, we managed to carve out health, and work together quite professionally. So this case is just so anomalous and so tragic.” A significant comparison, she said, is the way the United States and the Soviet Union had worked together to eliminate smallpox around the world, despite their Cold War tensions. But now, she said, “people have definitely died because the U.S. and China have been unable to cooperate.”

What did the breakdown in U.S.-Chinese cooperation mean in practice? That the U.S. knew less than it would have otherwise, and knew it later; that its actions brought out the worst (rather than the merely bad) in China’s own approach to the disease, which was essentially to cover it up internally and stall in allowing international access to emerging data; that the Trump administration lost what leverage it might have had over Chinese President Xi Jinping and his officials; and that the chance to keep the disease within the confines of a single country was forever lost.

In addition to America’s destruction of its own advance-warning system, by removing CDC and Predict observers, the Trump administration’s bellicose tone toward China had an effect. Many U.S. officials stressed that a vicious cycle of blame and recrimination made public health an additional source of friction between the countries, rather than a sustained point of cooperation, as it had been for so many years.

“The state of the relationship meant that every U.S. request was met with distrust on the Chinese side, and every Chinese response was seen on the American side as one more attempt to cover up,”

Several officials who had experience with China suggested that other presidents might have called Xi Jinping with a quiet but tough message that would amount to: We both know you have a problem. Why don’t we work on it together, which will let you be the hero? Otherwise it will break out and become a problem for China and the whole world.

“It would have taken diplomatic pressure on the Chinese government to allow us to insert our people” into Wuhan and other disease centers, Klain said. “The question isn’t what leverage we had. The point is that we gave up leverage with China to get the trade deal done. That meant that we didn’t put leverage on China’s government. We took their explanations at face value.”

3. The Emergency Checklist

The president’s advance notice of the partial European ban almost certainly played an important part in bringing the infection to greater New York City. Because of the two-day “warning” Trump gave in his speech, every seat on every airplane from Europe to the U.S. over the next two days was filled. Airport and customs offices at the arrival airports in the U.S. were unprepared and overwhelmed. News footage showed travelers queued for hours, shoulder to shoulder, waiting to be admitted to the U.S. Some of those travelers already were suffering from the disease; they spread it to others. On March 11, New York had slightly more than 220 diagnosed cases. Two weeks later, it had more than 25,000. Genetic testing showed that most of the infection in New York was from the coronavirus variant that had come through Europe to the United States, rather than directly from China (where most of the early cases in Washington State originated).

Aviation is safe because, even after all the advances in forecasting and technology, its culture still imagines emergencies and rehearses steps for dealing with them.

Especially in the post-9/11 era of intensified concern about threats of all sorts, American public-health officials have also imagined a full range of crises, and have prepared ways to limit their worst effects. The resulting official “playbooks” are the equivalent of cockpit emergency checklists

the White House spokesperson, Kayleigh McEnany, then claimed that whatever “thin packet of paper” Obama had left was inferior to a replacement that the Trump administration had supposedly cooked up, but which has never been made public. The 69-page, single-spaced Obama-administration document is officially called “Playbook for Early Response to High-Consequence Infectious Disease Threats and Biological Incidents” and is freely available online. It describes exactly what the Trump team was determined not to do.

What I found remarkable was how closely the Obama administration’s recommendations tracked with those set out 10 years earlier by the George W. Bush administration, in response to its chastening experience with bird flu. The Bush-era work, called “National Strategy for Pandemic Influenza” and publicly available here, differs from the Obama-era playbook mainly in the simpler forms of technology on which it could draw

consider the one below, and see how, sentence by sentence, these warnings from 2005 match the headlines of 2020. The topic was the need to divide responsibility among global, national, state, and community jurisdictions in dealing with the next pandemic. The fundamental premise—so widely shared that it barely needed to be spelled out—was that the U.S. federal government would act as the indispensable flywheel, as it had during health emergencies of the past. As noted, it would work with international agencies and with governments in all affected areas to coordinate a global response. Within its own borders it would work with state agencies to detect the potential for the disease’s spread and to contain cases that did arise:

Referring to the detailed pandemic playbooks from the Bush and Obama administrations, John R. Allen told me: “The moment you get confirmation of a problem, you would move right to the timeline. Decisions by the president, actions by the secretary of defense and the CDC, right down the list. You’d start executing.”Or, in the case of the current administration, you would not. Reading these documents now is like discovering a cockpit checklist in the smoking wreckage.

4. The Pilot

a virtue of Sully is the reminder that when everything else fails—the forecasts, the checklists, the triply redundant aircraft systems—the skill, focus, and competence of the person at the controls can make the difference between life and death.

So too in the public response to a public-health crisis. The system was primed to act, but the person at the top of the system had to say, “Go.” And that person was Donald Trump.

n a resigned way, the people I spoke with summed up the situation this way: You have a head of government who doesn’t know anything, and doesn’t read anything, and is at the mercy of what he sees on TV. “And all around him, you have this carnival,”

“There would be some ballast in the relationship,” this person said. “Now all you’ve got is the trade friction”—plus the personal business deals that the president’s elder daughter, Ivanka, has made in China,

5. The Control Systems

The deadliest airline crash in U.S. history occurred in 1979. An American Airlines DC-10 took off from O’Hare Airport, in Chicago—and just as it was leaving the ground, an incorrectly mounted engine ripped away from one of the wings. When the engine’s pylon was pulled off, it cut the hydraulic lines that led from the cockpit to the control surfaces on the wings and tail. From that point on, the most skillful flight crew in the world could not have saved the flight.

By the time the pandemic emerged, it may have already been too late. The hydraulic lines may already have been too damaged to transmit the signals. It was Trump himself who cut them.

The more complex the organization, the more its success or failure turns on the skill of people in its middle layers—the ones who translate a leader’s decision to the rest of the team in order to get results. Doctors depend on nurses; architects depend on contractors and craftsmen; generals depend on lieutenants and sergeants

Because Donald Trump himself had no grasp of this point, and because he and those around him preferred political loyalists and family retainers rather than holdovers from the “deep state,” the whole federal government became like a restaurant with no cooks, or a TV station with stars but no one to turn the cameras on.

“There is still resilience and competence in the working-level bureaucracy,” an intelligence-agency official told me. “But the layers above them have been removed.”

Traditionally, the National Security Council staff has comprised a concentration of highly knowledgeable, talented, and often ambitious younger figures, mainly on their way to diplomatic or academic careers.

“There is nobody now who can play the role of ‘senior China person,’” a former intelligence official told me. “In a normal administration, you’d have a lot of people who had spent time in Asia, spent time in China, knew the goods and bads.” Also in a normal administration, he and others pointed out, China and the United States would have numerous connective strands

The United States still possesses the strongest economy in the world, its military is by far the most powerful, its culture is diverse, and, confronted with the vicissitudes of history, the country has proved resilient. But a veteran of the intelligence world emphasized that the coronavirus era revealed a sobering reality. “Our system has a single point-of-failure: an irrational president.” At least in an airplane cockpit, the first officer can grab the controls from a captain who is steering the aircraft toward doom.

Every president is “surprised” by how hard it is to convert his own wishes into government actions

Presidents cope with this discovery in varying ways. The people I spoke with had served in past administrations as early as the first George Bush’s. George H. W. Bush came to office with broad experience in the federal government—as much as any other president. He had been vice president for eight years, a CIA director, twice an ambassador, and a member of Congress. He served only four years in the Oval Office but began with a running start. Before he became president, Bill Clinton had been a governor for 12 years and had spent decades learning and talking about government policies. A CIA official told me that Clinton would not read his President’s Daily Briefs in the morning, when they arrived, but would pore over them late at night and return them with copious notes. George W. Bush’s evolution from dependence on the well-traveled Dick Cheney, in his first term, to more confident control, in his second, has been well chronicled. As for Obama, Paul Triolo told me: “By the end of his eight years, Obama really understood how to get the bureaucracy to do what he wanted done, and how to get the information he needed to make decisions.” The job is far harder than it seems. Donald Trump has been uninterested in learning the first thing about it.

In a situation like this, some of those in the “regular” government decide to struggle on. Others quit—literally, or in the giving-up sense

The ‘process’ is just so chaotic that it’s not a process at all. There’s no one at the desk. There’s no one to read the memos. No one is there.”

“If this could happen to Fauci, it makes people think that if they push too hard in the wrong direction, they’ll get their heads chopped off. There is no reason in the world something called #FireFauci should even exist. The nation’s leaders should maintain high regard for scientific empiricism, insight, and advice, and must not be professionally or personally risk averse when it comes to understanding and communicating messages about public safety and health.”

Over nearly two decades, the U.S. government had assembled the people, the plans, the connections, and the know-how to spare this nation the worst effects of the next viral mutation that would, someday, arise. That someday came, and every bit of the planning was for naught. The deaths, the devastation, the unforeseeable path ahead—they did not have to occur.

The language of an NTSB report is famously dry and clinical—just the facts. In the case of the pandemic, what it would note is the following: “There was a flight plan. There was accurate information about what lay ahead. The controllers were ready. The checklists were complete. The aircraft was sound. But the person at the controls was tweeting. Even if the person at the controls had been able to give effective orders, he had laid off people that would carry them out. This was a preventable catastrophe.”

Think about that: Stop testing. Then we’ll have no knowledge. Then we’ll have no numbers. Then we’ll have no virus. Why didn’t I think of that?

this impugning of scientific methods, this embrace of conspiracy theories, this undermining of truth and data by our president and vice president — this is not happening in other countries. This is not happening in Germany, France, China, South Korea, Denmark, Canada, Israel or Japan. This is a form of American “exceptionalism” that we never imagined possible.

“A prime difference between the Enlightenment and the Dark Ages is respect for knowledge, respect for science. The whole idea of progress requires objectively looking at problems, finding and testing solutions, and then spreading and using the best of them. That’s how we grow, that’s how we learn, that’s how we prosper.”

As for respecting nature, that has two meanings. The first is to respect the power of nature

She doesn’t negotiate. You cannot seduce her or sue her. She does whatever chemistry, biology and physics dictate. Full stop. Which means in a pandemic that she will just keep infecting people — relentlessly, mercilessly, silently and exponentially — until she runs out of people to infect or a vaccine or exposure makes enough of us immune. She also doesn’t keep score. She’ll make you sick and then blow down your house with a tornado.

Respect for nature also means understanding that we live on a hard rock called planet Earth with a thin cover of oceans and topsoil, enveloped by a thin layer of atmosphere. Abuse that soil, junk up those oceans with plastics, distort that atmospheric blanket and we will likely (further) destroy the perfect Garden of Eden that has been the basis of all human civilization.

Respect science, respect nature, respect each other. Biden 2020.

Respect each other? That’s not so easy in the midst of our other pandemic — a pandemic of incivility.

We have a level of inequality that is so endemic that your ZIP code is now a better predictor of life expectancy than your genetic code.

Respecting each other means ensuring each other’s equal access to the American dream — and right now, Black, Hispanic and white Americans are climbing very different housing, education and health care ladders, which simply has to be fixed.

We have so many important issues to discuss among ourselves right now, but for that discussion to be productive we can’t just go from justifiable outrage straight to firings, public shamings or disbanding police departments — without pausing for respectful dialogue and moral distinctions.

The other is getting people out of Facebook and into each other’s faces again — not to shout or denounce, but to listen

It’s even more important what you say when you listen. Listening is a sign of respect. And it is amazing what people will let you say to them if they first think that you respect them. That’s our job.

remember, as bad as this pandemic is, it’s just training wheels for the big, irreversible atmospheric pandemic: climate change.

“Respect science, respect nature, respect each other.”

Biden should highlight his commitment to all three values in every speech and interview he gives. They draw such a clear, simple and easy to remember contrast with Trump.

A different plague strain enters Europe through Genoa, brought by another Caffan ship that docks there. The Genoans attack the ship and drive it away, but they are still infected. Italy faces this second strain while already battling the previous one.

Y. pestis also heads east from Sicily into the Persian Empire and through Greece, Bulgaria, Romania and Poland, and south to Egypt, as well as Cyprus, which is also hit with destruction from an earthquake and deadly tidal wave at the same time.

The plague also moves through Austria and Switzerland, where a fury of anti-Semitic massacres follow it along the Rhine after a rumor spreads that Jews had caused the plague by poisoning wells

The plague awakes an anti-Semitic rage around Europe, causing repeated massacres of Jewish communities, with the first one taking place in Provence, where 40 Jews were murdered.

The plague enters England through the port of Melcombe Regis, in Dorset. As it spreads through the town, some escape by fleeing inland, inadvertently spreading it further.

A group of religious zealots known as the Flagellants first begin to appear in Germany. These groups of anywhere from 50 to 500 hooded and half-naked men march, sing and thrash themselves with lashes until swollen and bloody. Originally the practice of 11th-century Italian monks during an epidemic, they spread out through Europe. Also known for their violent anti-Semitism,

the plague kills 60 percent of the Venetian population.

An English ship brings the Black Death to Norway when it runs aground in Bergen

While waiting on the border to begin the attack, troops became infected, with 5,000 dying. Choosing to retreat, the soldiers bring the disease back to their families and a third of Scotland perishes.

The plague’s spread significantly begins to peter out, possibly thanks to quarantine efforts, after causing the deaths of anywhere between 25 to 50 million people, and leading to the massacres of 210 Jewish communities. All total, Europe has lost about 50 percent of its population.

With the Black Death considered safely behind them, the people of Europe face a changed society

It becomes easier to get work for better wages and the average standard of living rises.

Vaccinations could begin in the second half of December, Fauci said.

Vaccinations are expected to begin with high-risk groups and to be available for the rest of the population next spring

15,000 study participants were given a placebo, which is a shot of saline that has no effect. Over several months, 90 of them developed Covid-19, with 11 developing severe forms of the disease.

The vaccines deliver messenger RNA, or mRNA, which is a genetic recipe for making the spikes that sit atop the coronavirus

A small percentage of those who received it experienced symptoms such as body aches and headaches.

Fauci says he expects the first Covid-19 vaccinations to begin "towards the latter part of December, rather than the early part of December."

Another 15,000 participants were given the vaccine, and only five of them developed Covid-19. None of the five became severely ill.

Pfizer's and Moderna's vaccines have similar results because they use the same technique to activate the body's immune system.

Initially, there won't be enough vaccine for everyone.

No vaccine currently on the market uses mRNA.

"There has always been skepticism about mRNA -- it's brand new and would it work?" Fauci said. "What we saw in the trials is there was no real safety concern, and the efficacy is quite impressive. We saw nearly identical results [with Pfizer and Moderna] and it almost really validates the mRNA platform."

Both vaccines are given in two doses several weeks apart.

While the two vaccines appear to have very similar safety and efficacy profiles, Moderna's vaccine has a significant practical advantage over Pfizer's.

Pfizer's vaccine has to be kept at minus 75 degrees Celsius. No other vaccine in the US needs to be kept that cold, and doctors' offices and pharmacies do not have freezers that go that low.

Moderna's vaccine can be kept at minus 20 degrees Celsius. Other vaccines, such as the one against chickenpox, need to be kept at that temperature.

Another advantage of Moderna's vaccine is that it can be kept for 30 days in the refrigerator, the company announced Monday. Pfizer's vaccine can last only five days in the refrigerator

Masks turned out to be more helpful than Western experts had predicted. Social distancing on an unheard-of scale has been more feasible and effective than anticipated. The difference in danger between an outdoor gathering and an indoor one is greater than expected.

It remains unclear how the virus mutates, or how fast, which makes it impossible to predict how long a possible vaccine might work. More broadly, the pandemic has exposed how little scientists know about coronaviruses, even those that cause the common cold, and especially those that circulate in bats and other animals.

Traditionally, a scientist submits her paper to a journal, which sends it to a (surprisingly small) group of peers for (several rounds of usually anonymous) comments; if the paper passes this (typically months-long) peer-review gantlet, it is published (often behind an expensive paywall). Languid and opaque, this system is ill-suited to a fast-moving outbreak. But biomedical scientists can now upload preliminary versions of their papers, or “preprints,” to freely accessible websites, allowing others to immediately dissect and build upon their results. This practice had been slowly gaining popularity before 2020, but proved so vital for sharing information about COVID‑19 that it will likely become a mainstay of modern biomedical research. Preprints accelerate science, and the pandemic accelerated the use of preprints. At the start of the year, one repository, medRxiv (pronounced “med archive”), held about 1,000 preprints. By the end of October, it had more than 12,000.

The U.S. is now catching up. In April, the NIH launched a partnership called ACTIV, in which academic and industry scientists prioritized the most promising drugs and coordinated trial plans across the country. Since August, several such trials have started.

Researchers have begun to uncover how SARS‑CoV‑2 compares with other coronaviruses in wild bats, the likely reservoir; how it infiltrates and co-opts our cells; how the immune system overreacts to it, creating the symptoms of COVID‑19. “We’re learning about this virus faster than we’ve ever learned about any virus in history,” Sabeti said.

Similar triumphs occurred last year—in other countries. In March, taking advantage of the United Kingdom’s nationalized health system, British researchers launched a nationwide study called Recovery, which has since enrolled more than 17,600 COVID‑19 patients across 176 institutions. Recovery offered conclusive answers about dexamethasone and hydroxychloroquine and is set to weigh in on several other treatments. No other study has done more to shape the treatment of COVID‑19.

SARS‑CoV‑2’s genome was decoded and shared by Chinese scientists just 10 days after the first cases were reported. By November, more than 197,000 SARS‑CoV‑2 genomes had been sequenced. About 90 years ago, no one had even seen an individual virus; today, scientists have reconstructed the shape of SARS‑CoV‑2 down to the position of individual atoms

Respiratory viruses, though extremely common, are often neglected. Respiratory syncytial virus, parainfluenza viruses, rhinoviruses, adenoviruses, bocaviruses, a quartet of other human coronaviruses—they mostly cause mild coldlike illnesses, but those can be severe. How often? Why? It’s hard to say, because, influenza aside, such viruses attract little funding or interest.

COVID‑19 has developed a terrifying mystique because it seems to behave in unusual ways. It causes mild symptoms in some but critical illness in others. It is a respiratory virus and yet seems to attack the heart, brain, kidneys, and other organs. It has reinfected a small number of people who had recently recovered. But many other viruses share similar abilities; they just don’t infect millions of people in a matter of months or grab the attention of the entire scientific community

Thanks to COVID‑19, more researchers are looking for these rarer sides of viral infections, and spotting them.

These factors pull researchers toward speed, short-termism, and hype at the expense of rigor—and the pandemic intensified that pull. With an anxious world crying out for information, any new paper could immediately draw international press coverage—and hundreds of citations.

“There’s a perception that they’re just colds and there’s nothing much to learn,” says Emily Martin of the University of Michigan, who has long struggled to get funding to study them. Such reasoning is shortsighted folly. Respiratory viruses are the pathogens most likely to cause pandemics, and those outbreaks could potentially be far worse than COVID‑19’s.

Their movements through the air have been poorly studied, too. “There’s this very entrenched idea,” says Linsey Marr at Virginia Tech, that viruses mostly spread through droplets (short-range globs of snot and spit) rather than aerosols (smaller, dustlike flecks that travel farther). That idea dates back to the 1930s, when scientists were upending outdated notions that disease was caused by “bad air,” or miasma. But the evidence that SARS‑CoV‑2 can spread through aerosols “is now overwhelming,”

Another pandemic is inevitable, but it will find a very different community of scientists than COVID‑19 did. They will immediately work to determine whether the pathogen—most likely another respiratory virus—moves through aerosols, and whether it spreads from infected people before causing symptoms. They might call for masks and better ventilation from the earliest moments, not after months of debate

They will anticipate the possibility of an imminent wave of long-haul symptoms, and hopefully discover ways of preventing them. They might set up research groups to prioritize the most promising drugs and coordinate large clinical trials. They might take vaccine platforms that worked best against COVID‑19, slot in the genetic material of the new pathogen, and have a vaccine ready within months

the single-minded focus on COVID‑19 will also leave a slew of negative legacies. Science is mostly a zero-sum game, and when one topic monopolizes attention and money, others lose out.

Long-term studies that monitored bird migrations or the changing climate will forever have holes in their data because field research had to be canceled.

negligence has left COVID‑19 long-haulers with few answers or options, and they initially endured the same dismissal as the larger ME community. But their sheer numbers have forced a degree of recognition. They started researching, cataloging their own symptoms. They gained audiences with the NIH and the World Health Organization. Patients who are themselves experts in infectious disease or public health published their stories in top journals. “Long COVID” is being taken seriously, and Brea hopes it might drag all post-infection illnesses into the spotlight. ME never experienced a pivot. COVID‑19 might inadvertently create one

Other epistemic trespassers spent their time reinventing the wheel. One new study, published in NEJM, used lasers to show that when people speak, they release aerosols. But as the authors themselves note, the same result—sans lasers—was published in 1946, Marr says. I asked her whether any papers from the 2020 batch had taught her something new. After an uncomfortably long pause, she mentioned just one.

The incentives to trespass are substantial. Academia is a pyramid scheme: Each biomedical professor trains an average of six doctoral students across her career, but only 16 percent of the students get tenure-track positions. Competition is ferocious, and success hinges on getting published

Conservationists who worked to protect monkeys and apes kept their distance for fear of passing COVID‑19 to already endangered species.

Among scientists, as in other fields, women do more child care, domestic work, and teaching than men, and are more often asked for emotional support by their students. These burdens increased as the pandemic took hold, leaving women scientists “less able to commit their time to learning about a new area of study, and less able to start a whole new research project,

published COVID‑19 papers had 19 percent fewer women as first authors compared with papers from the same journals in the previous year. Men led more than 80 percent of national COVID‑19 task forces in 87 countries. Male scientists were quoted four times as frequently as female scientists in American news stories about the pandemic.

American scientists of color also found it harder to pivot than their white peers, because of unique challenges that sapped their time and energy.

Science suffers from the so-called Matthew effect, whereby small successes snowball into ever greater advantages, irrespective of merit. Similarly, early hindrances linger. Young researchers who could not pivot because they were too busy caring or grieving for others might suffer lasting consequences from an unproductive year. COVID‑19 “has really put the clock back in terms of closing the gap for women and underrepresented minorities,”

In 1848, the Prussian government sent a young physician named Rudolf Virchow to investigate a typhus epidemic in Upper Silesia. Virchow didn’t know what caused the devastating disease, but he realized its spread was possible because of malnutrition, hazardous working conditions, crowded housing, poor sanitation, and the inattention of civil servants and aristocrats—problems that require social and political reforms. “Medicine is a social science,” Virchow said, “and politics is nothing but medicine in larger scale.”

entists discovered the microbes responsible for tuberculosis, plague, cholera, dysentery, and syphilis, most fixated on these newly identified nemeses. Societal factors were seen as overly political distractions for researchers who sought to “be as ‘objective’ as possible,” says Elaine Hernandez, a medical sociologist at Indiana University. In the U.S., medicine fractured.

New departments of sociology and cultural anthropology kept their eye on the societal side of health, while the nation’s first schools of public health focused instead on fights between germs and individuals. This rift widened as improvements in hygiene, living standards, nutrition, and sanitation lengthened life spans: The more social conditions improved, the more readily they could be ignored.

The ideological pivot away from social medicine began to reverse in the second half of the 20th century.

Politicians initially described COVID‑19 as a “great equalizer,” but when states began releasing demographic data, it was immediately clear that the disease was disproportionately infecting and killing people of color.

These disparities aren’t biological. They stem from decades of discrimination and segregation that left minority communities in poorer neighborhoods with low-paying jobs, more health problems, and less access to health care—the same kind of problems that Virchow identified more than 170 years ago.

In March, when the U.S. started shutting down, one of the biggest questions on the mind of Whitney Robinson of UNC at Chapel Hill was: Are our kids going to be out of school for two years? While biomedical scientists tend to focus on sickness and recovery, social epidemiologists like her “think about critical periods that can affect the trajectory of your life,” she told me. Disrupting a child’s schooling at the wrong time can affect their entire career, so scientists should have prioritized research to figure out whether and how schools could reopen safely. But most studies on the spread of COVID‑19 in schools were neither large in scope nor well-designed enough to be conclusive. No federal agency funded a large, nationwide study, even though the federal government had months to do so. The NIH received billions for COVID‑19 research, but the National Institute of Child Health and Human Development—one of its 27 constituent institutes and centers—got nothing.

The horrors that Rudolf Virchow saw in Upper Silesia radicalized him, pushing the future “father of modern pathology” to advocate for social reforms. The current pandemic has affected scientists in the same way

COVID‑19 could be the catalyst that fully reunifies the social and biological sides of medicine, bridging disciplines that have been separated for too long.

“To study COVID‑19 is not only to study the disease itself as a biological entity,” says Alondra Nelson, the president of the Social Science Research Council. “What looks like a single problem is actually all things, all at once. So what we’re actually studying is literally everything in society, at every scale, from supply chains to individual relationships.”

Pfizer’s vaccine also contains nine other ingredients. Four of them are lipids with impossibly complex chemical names: (4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis (ALC-3015); (2- hexyldecanoate),2-[(polyethylene glycol)-2000]-N,N-ditetradecylacetamide (ALC-0159); 1,2-distearoyl-snglycero-3-phosphocholine (DPSC); and cholesterol.

The vaccine also contains four salts: potassium chloride, monobasic potassium phosphate, basic sodium phosphate dihydrate and sodium chloride.

Attempting to ease tensions with China to make cooperation on global public health possible won’t work, partly because Beijing cannot credibly commit to being more transparent and cooperative in the future.

For China’s leaders, the pandemic revealed the inexorable decline of the West, confirmed Beijing’s power and capabilities, and created more latitude for the CCP to do as it wished.

But in case cooperation fails, it must have a backup plan to rally allies and partners to provide a much greater share of global public goods, even if that means shouldering more of the costs.

as a number of U.S. embassy officials told the foreign policy analyst Colin Kahl and me for our book Aftershocks, this team’s cooperation with the Chinese government became more challenging as U.S.-Chinese rivalry intensified, largely because of China’s actions.

When COVID-19 hit, the Chinese Communist Party (CCP) maintained near-absolute secrecy. All channels of communication between Beijing and Washington went silent, as they did between Beijing and other governments. Chinese leaders sought to conceal vital information about the emerging epidemic in China from the rest of the world, even attempting to prevent Chinese scientists from sharing the genetic sequence of the virus with scientists in other countries.

It is impossible to say for certain why the Chinese government behaved the way it did, but secrecy and control make sense in light of what the vast majority of China experts believe to be Xi’s top priority: regime survival.

Xi did not want to facilitate an international response to COVID-19 that could have attributed blame to China or isolated it through travel restrictions, either of which might have damaged the regime’s domestic legitimacy. Instead, Xi leveraged the pandemic to his advantage: China’s suppression of the virus became a matter of national pride, held up by Beijing in sharp contrast to the experience of the United States.

according to the UN, the pandemic could force a total of 490 million people into poverty—defined as the loss of access to clean water, adequate food, or shelter—pushing the global poverty rate to around seven percent by 2030, compared with the pre-pandemic target of three percent. 

Contrary to popular belief, some senior Trump administration officials grasped the national security threat posed by the virus faster than their European counterparts did. Top officials in the National Security Council began focusing on the pandemic in early January, just days after news of the outbreak in Wuhan, China, became public.

ven though Pottinger and other NSC officials were wise to the danger, they ultimately failed to persuade Trump to make the necessary preparations to deal with the pandemic when it inevitably reached the United States. 

As the administration began to formulate its response, those who favored a more comprehensive public health approach both at home and abroad were excluded or marginalized at crucial moments. The result was that the Trump administration focused more on holding China responsible for the outbreak and reducing U.S. reliance on Beijing than on the minutiae of global public health policy or the hard work of rallying the world to tackle the pandemic.

the pandemic and China’s response to it helped unify the administration behind a more comprehensive strategy to push back against Beijing. Between March 2020 and the end of the year, the senior official said, the United States put in place more containment measures than it had in the previous three years, including restrictions on Chinese technology firms, sanctions on Chinese officials, looser regulations on diplomatic contacts with Taiwan, and recognition of the repression in Xinjiang as a genocide. In this sense, the pandemic was a pivotal moment in the U.S.-Chinese rivalry. 

Competition between the two countries overwhelmed everything else, including U.S. cooperation with allies on the pandemic, leaving a global leadership vacuum that no one could fill.

The EU tried to step up by increasing funding for the WHO and for COVAX, the global initiative to share vaccines, but it never came close to organizing a global response. China’s assertive foreign policy, and its attempts to use pandemic assistance to advance its interests, aggravated European leaders and convinced them to harden their positions toward China throughout the course of 2020. 

During this period, there was hardly any international cooperation on vaccine development or distribution, no coordination on travel restrictions or the distribution of medical supplies, and limited cooperation on achieving a cessation of hostilities in conflict zones

The United States needs a strategy to address transnational threats under the conditions of great-power competition. It must aim to cooperate with rivals, especially China, to prepare for future pandemics and to tackle climate change

The economic disruption caused by COVID-19 devastated low-income countries, which received little in the way of international assistance. Especially hard hit were countries, such as Bangladesh, that had made significant development gains in the last two decades and were propelling themselves into the lower tier of middle-income economies.

Pandemics are not the only transnational threat that promises to intensify great-power rivalry and diminish the prospects for much-needed cooperation. Climate change could do the same.

the real challenge is determining what to do when cooperation with China and other rivals falls short of what is required. The United States needs a backup plan to tackle shared challenges through coalitions of the willing.

Countries that aggressively decarbonize could place sanctions and other trade restrictions on countries that do not, leading to counterresponses and new trade wars.

the impediments to cooperation between Europe and China on climate change “are becoming higher” and warn that “decision-makers must not underestimate the highly competitive aspects of how China is changing its energy production and consumption.” 

The United States and Europe will both compete with China for access to raw materials and in developing the technology needed to make their economies carbon neutral: magnets, batteries, high-performance ceramics, and light-emitting diodes, among other things

even if the U.S. government remains broadly aligned with Europe on climate policy, the Europeans could still become disaffected if Congress blocks meaningful climate action, such as commitments to cut carbon emissions or invest in clean technology. This, in turn, could diminish Europe’s willingness to help uphold the U.S.-led international order.

If, on the one hand, they mean softening U.S. rhetoric without conceding much of substance to China, they would do well to look to Europe, where governments were much more inclined than the Trump administration to cooperate with China, but China did not take them up on the offer.

If, on the other hand, they mean unilaterally making major geopolitical concessions to China—on its territorial acquisitions in the South China Sea, for instance, or the status of Taiwan—the United States would not only pay an extremely high price but also likely embolden Beijing further without actually securing cooperation on pandemics or climate change beyond what Beijing has already offered.

There is no getting around strategic competition with Beijing: it is deeply embedded in the international order, mainly because China seeks to expand its sphere of influence in Asia at the expense of the United States and its allies, which are in turn committed to thwarting Beijing’s plans.

The United States and China are also engaged in what Jake Sullivan, Biden’s national security adviser, recently called “a competition of models.” China is seeking to make the world safe for the CCP and to demonstrate the effectiveness of its system. This entails pushing back against what it sees as pressure from liberal democratic countries that could thwart its objectives. For its part, the United States worries about the negative externalities of Chinese authoritarianism, such as censorship of international criticism of Beijing or the export of its tools of repression to other countries.

The United States also worries about what would happen to the military balance of power if China secured an enduring advantage in key technologies.

Even in diplomacy, friction will be endemic to the U.S.-Chinese relationship and will affect the broader international order for the foreseeable future. Outright confrontation can be avoided—but competition cannot. 

This competition places real limits on cooperation. Take the arena of global public health: many studies on how to improve pandemic preparedness call on world leaders to dramatically strengthen the WHO, including by giving it the same power to enforce international health regulations as the International Atomic Energy Agency enjoys with nuclear nonproliferation rules

The problem is getting every government to agree to a universally applicable mechanism for sanctions or some other enforcement mechanism. China will not agree to any reform that would involve intrusive inspections of its scientific research facilities.

The need for cooperation on transnational threats must change how the United States competes with China—not whether it competes.

U.S. officials should not give up on China entirely; instead, they should make a good-faith effort to work with Beijing, both bilaterally and in multilateral settings. Recognizing that there are strict limits on U.S.-Chinese cooperation is not the same as saying that no cooperation is possible.

Rather than unite the world around a common purpose, climate change is likely to deepen competition between major powers, especially as the transition away from fossil fuels creates economic winners and losers.

When it comes to pandemic preparedness, this means fully supporting the WHO (including by pressing for needed reforms) but also forging a coalition of like-minded states: a global alliance for pandemic preparedness that would regularly convene at the head-of-state level and work alongside nongovernmental organizations and the private sector.

Crucially, whenever the WHO declared an international public health emergency, alliance members would coordinate on travel and trade restrictions, as well as on public messaging and financial penalties and sanctions. Those penalties and sanctions would be aimed at those states that failed to provide sufficient access to or fully cooperate with the WHO. The alliance would support, not supplant, the WHO.

Sustained, managed competition with China could potentially help the United States build bipartisan support for investments in clean technology that would prevent Beijing from gaining an enduring advantage in this area.

ut the United States and the European Union will also need to build coalitions of the willing to deal with the international security consequences of accelerated climate change, such as extreme weather events that threaten large numbers of people, and to address the foreign policy dimensions of climate action, including managing the risk that a shift away from fossil fuels could destabilize countries and regions that are dependent on oil exports.

Cooperation across this divide should always be the first choice in times of shared crisis, but as the COVID-19 pandemic has demonstrated, the U.S.-led constellation must always have a backup plan. It did not have one in 2020. It needs one for the next crisis

In the ’90s, when Ericsson looked into the numbers for the two dozen or so clinics that use his process, he discovered, to his surprise, that couples were requesting more girls than boys, a gap that has persisted, even though Ericsson advertises the method as more effective for producing boys. In some clinics, Ericsson has said, the ratio is now as high as 2 to 1.

A newer method for sperm selection, called MicroSort, is currently completing Food and Drug Administration clinical trials. The girl requests for that method run at about 75 percent.

Even more unsettling for Ericsson, it has become clear that in choosing the sex of the next generation, he is no longer the boss. “It’s the women who are driving all the decisions,”

Now the centuries-old preference for sons is eroding—or even reversing. “Women of our generation want daughters precisely because we like who we are,”

what if equality isn’t the end point? What if modern, postindustrial society is simply better suited to women?

Even Ericsson, the stubborn old goat, can sigh and mark the passing of an era. “Did male dominance exist? Of course it existed. But it seems to be gone now. And the era of the firstborn son is totally gone.”

Ericsson’s extended family is as good an illustration of the rapidly shifting landscape as any other. His 26-year-old granddaughter—“tall, slender, brighter than hell, with a take-no-prisoners personality”—is a biochemist and works on genetic sequencing. His niece studied civil engineering at the University of Southern California. His grandsons, he says, are bright and handsome, but in school “their eyes glaze over. I have to tell ’em: ‘Just don’t screw up and crash your pickup truck and get some girl pregnant and ruin your life.’

Man has been the dominant sex since, well, the dawn of mankind. But for the first time in human history, that is changing—and with shocking speed. Cultural and economic changes always reinforce each other

And the global economy is evolving in a way that is eroding the historical preference for male children, worldwide

Over several centuries, South Korea, for instance, constructed one of the most rigid patriarchal societies in the world.

As recently as 1985, about half of all women in a national survey said they “must have a son.” That percentage fell slowly until 1991 and then plummeted to just over 15 percent by 2003. Male preference in South Korea “is over,” says Monica Das Gupta, a demographer and Asia expert at the World Bank. “It happened so fast. It’s hard to believe it, but it is.” The same shift is now beginning in other rapidly industrializing countries such as India and China.

As thinking and communicating have come to eclipse physical strength and stamina as the keys to economic success, those societies that take advantage of the talents of all their adults, not just half of them, have pulled away from the rest. And because geopolitics and global culture are, ultimately, Darwinian, other societies either follow suit or end up marginalized

None of the 30 or so men sitting in a classroom at a downtown Kansas City school have come for voluntary adult enrichment. Having failed to pay their child support, they were given the choice by a judge to go to jail or attend a weekly class on fathering, which to them seemed the better deal.

in the U.S., the world’s most advanced economy, something much more remarkable seems to be happening. American parents are beginning to choose to have girls over boys. As they imagine the pride of watching a child grow and develop and succeed as an adult, it is more often a girl that they see in their mind’s eye.

What if the modern, postindustrial economy is simply more congenial to women than to men?

what if men and women were fulfilling not biological imperatives but social roles, based on what was more efficient throughout a long era of human history? What if that era has now come to an end? More to the point, what if the economics of the new era are better suited to women?

Once you open your eyes to this possibility, the evidence is all around you. It can be found, most immediately, in the wreckage of the Great Recession, in which three-quarters of the 8 million jobs lost were lost by men.

The recession merely revealed—and accelerated—a profound economic shift that has been going on for at least 30 years

Earlier this year, for the first time in American history, the balance of the workforce tipped toward women, who now hold a majority of the nation’s job

With few exceptions, the greater the power of women, the greater the country’s economic success

Women dominate today’s colleges and professional schools—for every two men who will receive a B.A. this year, three women will do the same. Of the 15 job categories projected to grow the most in the next decade in the U.S., all but two are occupied primarily by women

Indeed, the U.S. economy is in some ways becoming a kind of traveling sisterhood: upper-class women leave home and enter the workforce, creating domestic jobs for other women to fill.

The postindustrial economy is indifferent to men’s size and strength. The attributes that are most valuable today—social intelligence, open communication, the ability to sit still and focus—are, at a minimum, not predominantly male. In fact, the opposite may be true

Yes, women still do most of the child care. And yes, the upper reaches of society are still dominated by men. But given the power of the forces pushing at the economy, this setup feels like the last gasp of a dying age rather than the permanent establishment

In his final book, The Bachelors’ Ball, published in 2007, the sociologist Pierre Bourdieu describes the changing gender dynamics of Béarn, the region in southwestern France where he grew up. The eldest sons once held the privileges of patrimonial loyalty and filial inheritance in Béarn. But over the decades, changing economic forces turned those privileges into curses. Although the land no longer produced the impressive income it once had, the men felt obligated to tend it. Meanwhile, modern women shunned farm life, lured away by jobs and adventure in the city

The role reversal that’s under way between American men and women shows up most obviously and painfully in the working class

The working class, which has long defined our notions of masculinity, is slowly turning into a matriarchy, with men increasingly absent from the home and women making all the decisions

“Let’s see,” he continues, reading from a worksheet. What are the four kinds of paternal authority? Moral, emotional, social, and physical. “But you ain’t none of those in that house. All you are is a paycheck, and now you ain’t even that. And if you try to exercise your authority, she’ll call 911. How does that make you feel? You’re supposed to be the authority, and she says, ‘Get out of the house, bitch.’ She’s calling you ‘bitch’!”

Just about the only professions in which women still make up a relatively small minority of newly minted workers are engineering and those calling on a hard-science background, and even in those areas, women have made strong gains since the 1970s.

“Who’s doing what?” he asks them. “What is our role? Everyone’s telling us we’re supposed to be the head of a nuclear family, so you feel like you got robbed. It’s toxic, and poisonous, and it’s setting us up for failure.” He writes on the board: $85,000. “This is her salary.” Then: $12,000. “This is your salary. Who’s the damn man? Who’s the man now?” A murmur rises. “That’s right. She’s the man.”

In 1950, roughly one in 20 men of prime working age, like Henderson, was not working; today that ratio is about one in five, the highest ever recorded.

Men dominate just two of the 15 job categories projected to grow the most over the next decade: janitor and computer engineer. Women have everything else—nursing, home health assistance, child care, food preparation

Many of the new jobs, says Heather Boushey of the Center for American Progress, “replace the things that women used to do in the home for free.” None is especially high-paying. But the steady accumulation of these jobs adds up to an economy that, for the working class, has become more amenable to women than to men.

The list of growing jobs is heavy on nurturing professions, in which women, ironically, seem to benefit from old stereotypes and habits.

The men in that room, almost without exception, were casualties of the end of the manufacturing era. Most of them had continued to work with their hands even as demand for manual labor was declining.

Many professions that started out as the province of men are now filled mostly with women—secretary and teacher come to mind. Yet I’m not aware of any that have gone the opposite way. Nursing schools have tried hard to recruit men in the past few years, with minimal success. Teaching schools, eager to recruit male role models, are having a similarly hard time

The range of acceptable masculine roles has changed comparatively little, and has perhaps even narrowed as men have shied away from some careers women have entered. As Jessica Grose wrote in Slate, men seem “fixed in cultural aspic.” And with each passing day, they lag further behind.

women are also starting to dominate middle management, and a surprising number of professional careers as well. According to the Bureau of Labor Statistics, women now hold 51.4 percent of managerial and professional jobs—up from 26.1 percent in 1980

About a third of America’s physicians are now women, as are 45 percent of associates in law firms—and both those percentages are rising fast.

When we look back on this period, argues Jamie Ladge, a business professor at Northeastern University, we will see it as a “turning point for women in the workforce.”

A white-collar economy values raw intellectual horsepower, which men and women have in equal amounts. It also requires communication skills and social intelligence, areas in which women, according to many studies, have a slight edge. Perhaps most important—for better or worse—it increasingly requires formal education credentials, which women are more prone to acquire,

The men are black and white, their ages ranging from about 20 to 40. A couple look like they might have spent a night or two on the streets, but the rest look like they work, or used to. Now they have put down their sodas, and El-Scari has their attention, so he gets a little more philosophical

Companies began moving out of the city in search not only of lower rent but also of the “best educated, most conscientious, most stable workers.” They found their brightest prospects among “underemployed females living in middle-class communities on the fringe of the old urban areas.” As Garreau chronicles the rise of suburban office parks, he places special emphasis on 1978, the peak year for women entering the workforce. When brawn was off the list of job requirements, women often measured up better than men. They were smart, dutiful, and, as long as employers could make the jobs more convenient for them, more reliable

Near the top of the jobs pyramid, of course, the upward march of women stalls. Prominent female CEOs, past and present, are so rare that they count as minor celebrities,

Only 3 percent of Fortune 500 CEOs are women, and the number has never risen much above that.

What are these talents? Once it was thought that leaders should be aggressive and competitive, and that men are naturally more of both. But psychological research has complicated this picture. In lab studies that simulate negotiations, men and women are just about equally assertive and competitive, with slight variations. Men tend to assert themselves in a controlling manner, while women tend to take into account the rights of others, but both styles are equally effective,

Researchers have started looking into the relationship between testosterone and excessive risk, and wondering if groups of men, in some basic hormonal way, spur each other to make reckless decisions. The picture emerging is a mirror image of the traditional gender map: men and markets on the side of the irrational and overemotional, and women on the side of the cool and levelheaded.

the perception of the ideal business leader is starting to shift. The old model of command and control, with one leader holding all the decision-making power, is considered hidebound. The new model is sometimes called “post-heroic,” or “transformational”

he aim is to behave like a good coach, and channel your charisma to motivate others to be hardworking and creative. The model is not explicitly defined as feminist, but it echoes literature about male-female differences

Most important, women earn almost 60 percent of all bachelor’s degrees—the minimum requirement, in most cases, for an affluent life.

Firms that had women in top positions performed better, and this was especially true if the firm pursued what the researchers called an “innovation intensive strategy,” in which, they argued, “creativity and collaboration may be especially important”

he association is clear: innovative, successful firms are the ones that promote women. The same Columbia-Maryland study ranked America’s industries by the proportion of firms that employed female executives, and the bottom of the list reads like the ghosts of the economy past: shipbuilding, real estate, coal, steelworks, machinery.

To see the future—of the workforce, the economy, and the culture—you need to spend some time at America’s colleges and professional schools

emographically, we can see with absolute clarity that in the coming decades the middle class will be dominated by women.

Women now earn 60 percent of master’s degrees, about half of all law and medical degrees, and 42 percent of all M.B.A.s

“We never explicitly say, ‘Develop your feminine side,’ but it’s clear that’s what we’re advocating,” s

n a stark reversal since the 1970s, men are now more likely than women to hold only a high-school diploma.

ne would think that if men were acting in a rational way, they would be getting the education they need to get along out there,” says Tom Mortenson, a senior scholar at the Pell Institute for the Study of Opportunity in Higher Education. “But they are just failing to adapt.”

I visited a few schools around Kansas City to get a feel for the gender dynamics of higher education. I started at the downtown campus of Metropolitan Community College. Metropolitan is the kind of place where people go to learn practical job skills and keep current with the changing economy, and as in most community colleges these days, men were conspicuously absent.

the tidal wave of women continues to wash through the school—they now make up about 70 percent of its students. They come to train to be nurses and teachers

As for the men? Well, little has changed. “I recall one guy who was really smart,” one of the school’s counselors told me. “But he was reading at a sixth-grade level and felt embarrassed in front of the women. He had to hide his books from his friends, who would tease him when he studied. Then came the excuses. ‘It’s spring, gotta play ball.’ ‘It’s winter, too cold.’ He didn’t make it.”

“The economy isn’t as friendly to men as it once was,” says Jacqueline King, of the American Council on Education. “You would think men and women would go to these colleges at the same rate.” But they don’t.

Men, it turned out, had a harder time committing to school, even when they desperately needed to retool. They tended to start out behind academically, and many felt intimidated by the schoolwork. They reported feeling isolated and were much worse at seeking out fellow students, study groups, or counselors to help them adjust.

Mothers going back to school described themselves as good role models for their children. Fathers worried that they were abrogating their responsibilities as breadwinner.

it began showing up not just in community and liberal-arts colleges but in the flagship public universities—the UCs and the SUNYs and the UNCs.

Guys high-five each other when they get a C, while girls beat themselves up over a B-minus. Guys play video games in each other’s rooms, while girls crowd the study hall. Girls get their degrees with no drama, while guys seem always in danger of drifting away.

realized how much the basic expectations for men and women had shifted. Many of the women’s mothers had established their careers later in life, sometimes after a divorce, and they had urged their daughters to get to their own careers more quickly. They would be a campus of Tracy Flicks, except that they seemed neither especially brittle nor secretly falling apart.

Among traditional college students from the highest-income families, the gender gap pretty much disappears. But the story is not so simple. Wealthier students tend to go to elite private schools, and elite private schools live by their own rules.

Quietly, they’ve been opening up a new frontier in affirmative action, with boys playing the role of the underprivileged applicants needing an extra boost

among selective liberal-arts schools, being male raises the chance of college acceptance by 6.5 to 9 percentage points

the U.S. Commission on Civil Rights has voted to investigate what some academics have described as the “open secret” that private schools “are discriminating in admissions in order to maintain what they regard as an appropriate gender balance.”

To avoid crossing the dreaded 60 percent threshold, admissions officers have created a language to explain away the boys’ deficits: “Brain hasn’t kicked in yet.” “Slow to cook.” “Hasn’t quite peaked.” “Holistic picture.”

Clearly, some percentage of boys are just temperamentally unsuited to college, at least at age 18 or 20, but without it, they have a harder time finding their place these days

“Forty years ago, 30 years ago, if you were one of the fairly constant fraction of boys who wasn’t ready to learn in high school, there were ways for you to enter the mainstream economy,” says Henry Farber, an economist at Princeton. “When you woke up, there were jobs. There were good industrial jobs, so you could have a good industrial, blue-collar career. Now those jobs are gone.”

the disparities start before college. Throughout the ’90s, various authors and researchers agonized over why boys seemed to be failing at every level of education, from elementary school on up

identified various culprits: a misguided feminism that treated normal boys as incipient harassers (Christina Hoff Sommers); different brain chemistry (Michael Gurian); a demanding, verbally focused curriculum that ignored boys’ interests (Richard Whitmire)

t’s not all that clear that boys have become more dysfunctional—or have changed in any way. What’s clear is that schools, like the economy, now value the self-control, focus, and verbal aptitude that seem to come more easily to young girls.

movement is growing for more all-boys schools and classes, and for respecting the individual learning styles of boys

In their desperation to reach out to boys, some colleges have formed football teams and started engineering programs.

allowing generations of boys to grow up feeling rootless and obsolete is not a recipe for a peaceful future. Men have few natural support groups and little access to social welfare; the men’s-rights groups that do exist in the U.S. are taking on an angry, antiwoman edge.

Marriages fall apart or never happen at all, and children are raised with no fathers. Far from being celebrated, women’s rising power is perceived as a threat.

his is the first time that the cohort of Americans ages 30 to 44 has more college-educated women than college-educated men, and the effects are upsetting the traditional Cleaver-family dynamics. In 1970, women contributed 2 to 6 percent of the family income. Now the typical working wife brings home 42.2 percent, and four in 10 mothers—many of them single mothers—are the primary breadwinners in their familie

ncreasing numbers of women—unable to find men with a similar income and education—are forgoing marriage altogether. In 1970, 84 percent of women ages 30 to 44 were married; now 60 percent are.

or all the hand-wringing over the lonely spinster, the real loser in society—the only one to have made just slight financial gains since the 1970s—is the single man, whether poor or rich, college-educated or not. Hens rejoice; it’s the bachelor party that’s over.

The sociologist Kathryn Edin spent five years talking with low-income mothers in the inner suburbs of Philadelphia. Many of these neighborhoods, she found, had turned into matriarchies, with women making all the decisions and dictating what the men should and should not do. “I think something feminists have missed,” Edin told me, “is how much power women have” when they’re not bound by marriage

he women, she explained, “make every important decision”—whether to have a baby, how to raise it, where to live. “It’s definitely ‘my way or the highway,’

Thirty years ago, cultural norms were such that the fathers might have said, ‘Great, catch me if you can.’ Now they are desperate to father, but they are pessimistic about whether they can meet her expectations.” The women don’t want them as husbands, and they have no steady income to provide. So what do they have?

Nothing,” Edin says. “They have nothing. The men were just annihilated in the recession of the ’90s, and things never got better. Now it’s just awful.”

The phenomenon of children being born to unmarried parents “has spread to barrios and trailer parks and rural areas and small towns,” Edin says, and it is creeping up the class ladder. After staying steady for a while, the portion of American children born to unmarried parents jumped to 40 percent in the past few years.

Many of their mothers are struggling financially; the most successful are working and going to school and hustling to feed the children, and then falling asleep in the elevator of the community college.

Still, they are in charge. “The family changes over the past four decades have been bad for men and bad for kids, but it’s not clear they are bad for women,”

Over the years, researchers have proposed different theories to explain the erosion of marriage in the lower classes: the rise of welfare, or the disappearance of work and thus of marriageable men

the most compelling theory is that marriage has disappeared because women are setting the terms—and setting them too high for the men around them to reach.

The whole country’s future could look much as the present does for many lower-class African Americans: the mothers pull themselves up, but the men don’t follow. First-generation college-educated white women may join their black counterparts in a new kind of middle class, where marriage is increasingly rare.

Japan is in a national panic over the rise of the “herbivores,” the cohort of young men who are rejecting the hard-drinking salaryman life of their fathers and are instead gardening, organizing dessert parties, acting cartoonishly feminine, and declining to have sex. The generational young-women counterparts are known in Japan as the “carnivores,” or sometimes the “hunters.”

American pop culture keeps producing endless variations on the omega male, who ranks even below the beta in the wolf pack.

At the same time, a new kind of alpha female has appeared, stirring up anxiety and, occasionally, fear. The cougar trope started out as a joke about desperate older women. Now it’s gone mainstream, even in Hollywood,

the more women dominate, the more they behave, fittingly, like the dominant sex. Rates of violence committed by middle-aged women have skyrocketed since the 1980

Is this fair?

That’s not a rhetorical question—it’s an unanswerable question. Because nothing is fair.It’s not fair that one kid is born in a mansion in Bel-Air, another kid is born in row house in Northeast Philly, and another kid is born in a slum in Mumbai.

Because in some ways we all are. Life is not fair.

It’s not fair that Bill Lumberg is an idiot, but he makes so much money that he drives a Porsche. It’s also not fair when people in Porsches get hit by drunk drivers.

There’s only one measure by which fairness exists in our world: That we’re all God’s children, with dignity and worth simply because we were loved into being.

And that is, ultimately, what I wanted to say about this college admissions story. Are you, personally, getting the short end of the stick? Look, I don’t know you. But yes. In some way you are. Even if you’re in that top 0.1 percent.

It’s not fair that some kids can get 1510 on their SATs and some kids struggle to break 900. It’s not fair that some kids are born with genetic disorders that cut their lives short long before they even know what the SATs are.