Group items tagged

. Roughly 60% of new pathogens come from animals — including those pressured by diversity loss — and roughly one-third of those can be directly attributed to changes in human land use, meaning deforestation, the introduction of farming, development or resource extraction in otherwise natural settings

Today, climate warming is demolishing those defense systems, driving a catastrophic loss in biodiversity that, when coupled with reckless deforestation and aggressive conversion of wildland for economic development, pushes farms and people closer to the wild and opens the gates for the spread of disease.

ignoring how climate and rapid land development were putting disease-carrying animals in a squeeze was akin to playing Russian roulette.

the virus is believed to have originated with the horseshoe bat, part of a genus that’s been roaming the forests of the planet for 40 million years and thrives in the remote jungles of south China, even that remains uncertain.

China for years and warning that swift climate and environmental change there — in both loss of biodiversity and encroachment by civilization — was going to help new viruses jump to people.

until now, the planet’s natural defense systems were better at fighting them off.

Vector-borne diseases — those carried by insects like mosquitoes and ticks and transferred in the blood of infected people — are also on the rise as warming weather and erratic precipitation vastly expand the geographic regions vulnerable to contagion.

Climate is even bringing old viruses back from the dead, thawing zombie contagions like the anthrax released from a frozen reindeer in 2016, which can come down from the arctic and haunt us from the past.

It is demonstrating in real time the enormous and undeniable power that nature has over civilization and even over its politics.

it also makes clear that climate policy today is indivisible from efforts to prevent new infectious outbreaks, or, as Bernstein put it, the notion that climate and health and environmental policy might not be related is “a ​dangerous delusion.”

The warming of the climate is one of the principal drivers of the greatest — and fastest — loss of species diversity in the history of the planet, as shifting climate patterns force species to change habitats, push them into new regions or threaten their food and water supplies

What’s known as biodiversity is critical because the natural variety of plants and animals lends each species greater resiliency against threat and together offers a delicately balanced safety net for natural systems

As diversity wanes, the balance is upset, and remaining species are both more vulnerable to human influences and, according to a landmark 2010 study in the journal Nature, more likely to pass along powerful pathogens.

even incremental and seemingly manageable injuries to local environments — say, the construction of a livestock farm adjacent to stressed natural forest — can add up to outsized consequences.

Coronaviruses like COVID-19 aren’t likely to be carried by insects — they don’t leave enough infected virus cells in the blood. But one in five other viruses transmitted from animals to people are vector-borne

the number of species on the planet has already dropped by 20% and that more than a million animal and plant species now face extinction.

Americans have been experiencing this phenomenon directly in recent years as migratory birds have become less diverse and the threat posed by West Nile encephalitis has spread. It turns out that the birds that host the disease happen to also be the tough ones that prevail amid a thinned population

as larger mammals suffer declines at the hands of hunters or loggers or shifting climate patterns, smaller species, including bats, rats and other rodents, are thriving, either because they are more resilient to the degraded environment or they are able to live better among people.

It is these small animals, the ones that manage to find food in garbage cans or build nests in the eaves of buildings, that are proving most adaptable to human interference and also happen to spread disease.

Warmer temperatures and higher rainfall associated with climate change — coupled with the loss of predators — are bound to make the rodent problem worse, with calamitous implications.

As much as weather changes can drive changes in species, so does altering the landscape for new farms and new cities. In fact, researchers attribute a full 30% of emerging contagion to what they call “land use change.”

only 15% of the planet’s forests remain intact. The rest have been cut down, degraded or fragmented to the point that they disrupt the natural ecosystems that depend on them.

Already, more than one-third of the planet’s land surface, and three-quarters of all of its fresh water, go toward the cultivation of crops and raising of livestock. These are the places where infectious diseases spread most often.

The U.S. Centers for Disease Control and Prevention says that fully three-quarters of all new viruses have emerged from animals

Almost every major epidemic we know of over the past couple of decades — SARS, COVID-19, Ebola and Nipah virus — jumped to people from wildlife enduring extreme climate and habitat strain, and still, “we’re naive to them,” she said. “That puts us in a dangerous place.”

A 2008 study in the journal Nature found nearly one-third of emerging infectious diseases over the past 10 years were vector-borne, and that the jumps matched unusual changes in the climate

Ticks and mosquitoes now thrive in places they’d never ventured before. As tropical species move northward, they are bringing dangerous pathogens with them.

by 2050, disease-carrying mosquitoes will ultimately reach 500 million more people than they do today, including some 55 million more Americans.

In 2013, dengue fever — an affliction affecting nearly 400 million people a year, but normally associated with the poorest regions of Africa — was transmitted locally in New York for the first time.

“The long-term risk from dengue may be much higher than COVID,

As the global population surges to 10 billion over the next 35 years, and the capacity to farm food is stressed further again by the warming climate, the demand for land will only get more intense.

it’s only a matter of time before other exotic animal-driven pathogens are driven from the forests of the global tropics to the United States or Canada or Europe because of the warming climate.

it will also shape how easily we get sick. According to a 2013 study in the journal PLOS Currents Influenza, warm winters were predictors of the most severe flu seasons in the following year

Even harsh swings from hot to cold, or sudden storms — exactly the kinds of climate-induced patterns we’re already seeing — make people more likely to get sick.

The chance of a flu epidemic in America’s most populated cities will increase by as much as 50% this century, and flu-related deaths in Europe could also jump by 50%.

Slow action on climate has made dramatic warming and large-scale environmental changes inevitable, he said, “and I think that increases in disease are going to come along with it.”

By late 2018, epidemiologists there were bracing for what they call “spillover,” or the failure to keep a virus locally contained as it jumped from the bats and villages of Yunnan into the wider world.

In late 2018, the Trump administration, as part of a sweeping effort to bring U.S. programs in China to a halt, abruptly shut down the research — and its efforts to intercept the spread of a new novel coronavirus along with it. “We got a cease and desist,” said Dennis Carroll, who founded the PREDICT program and has been instrumental in global work to address the risks from emerging viruses. By late 2019, USAID had cut the program’s global funding.

The loss is immense. The researchers believed they were on the cusp of a breakthrough, racing to sequence the genes of the coronaviruses they’d extracted from the horseshoe bat and to begin work on vaccines.

They’d campaigned for years for policymakers to fully consider what they’d learned about how land development and climate changes were driving the spread of disease, and they thought their research could literally provide governments a map to the hot spots most likely to spawn the next pandemic.

They also hoped the genetic material they’d collected could lead to a vaccine not just for one lethal variation of COVID, but perhaps — like a missile defense shield for the biosphere — to address a whole family of viruses at once

Carroll said knowledge of the virus genomes had the potential “to totally transform how we think about future biomedical interventions before there’s an emergence.

PREDICT’s staff and advisers have pushed the U.S. government to consider how welding public health policy with environmental and climate science could help stem the spread of contagions.

Since Donald Trump was elected, the group hasn’t been invited back.

What Daszak really wants — in addition to restored funding to continue his work — is the public and leaders to understand that it’s human behavior driving the rise in disease, just as it drives the climate crisis

“We turn a blind eye to the fact that our behavior is driving this,” he said. “We get cheap goods through Walmart, and then we pay for it forever through the rise in pandemics. It’s upside down.”

Infection of apes is a major concern for zoos and conservationists. They easily fall prey to human respiratory infections, and common cold viruses have caused deadly outbreaks in chimpanzees in Africa.

Genome research has suggested that chimpanzees, gorillas and other apes will be susceptible to SARS-CoV-2, the virus that has caused the pandemic.

Scientists are worrying not just about the danger the virus poses to great apes and other animals, but also about the potential for the virus to gain a foothold in a wild animal population that could become a permanent reservoir and emerge at a later date to reinfect humans.

Denmark ended up killing as many as 17 million mink — effectively wiping out its mink farming industry. In the United States, thousands of mink have died, and one wild mink has tested positive for the virus.

Although many animals, including dogs, domestic cats, and big cats in zoos, have become infected by the virus through natural spread, and others have been infected in laboratory experiments, scientists say that widespread testing has yet to find the virus in any animal in the wild other than the one mink.

"Although there are a few reported cases of reinfection, the possibility of co-infection by E484K adds a new factor to the complex interaction between immune response systems and SARS-CoV-2 Spike mutations,"

"Brazil is collapsing,"

drawing a striking contrast to assurances by Brazilian Health Minister Eduardo Pazuello just one day prior. "Our health system is very impacted, but it has not collapsed nor will it collapse," Pazuello had asserted Wednesday, attributing the country's increasing hospitalizations and deaths "mainly to the new variants of the coronavirus."

How long will our economy resist? If it (the economy) collapses it will be a disgrace. What will we have soon? Supermarket invasions, buses on fires, strikes, pickets, work stoppages," he said in a video conference with lawmakers Thursday.

The US Centers for Disease Control and Prevention believes the more transmissible B.1.1.7 variant, which was first identified in the United Kingdom, will be the dominant strain within weeks. There are also concerns about governors and local officials prematurely loosening public health restrictions in a slew of states.

A fourth surge would be the first on President Joe Biden's watch and a major test for the new administration

a half-dozen Biden administration officials told CNN they believe the federal government is better prepared than ever before to handle a surge.

the accelerating pace of vaccinations is helping to head off a potential surge. One in five people in the US have now gotten at least one shot, including nearly 65% of people 65 and older, who account for about 80% of all Covid-19 deaths in the US.

"While many indicators are going in the right direction and more and more people are being vaccinated every day, we need to be ready for wild cards and worsening.

A senior official said one example of this effort would involve vaccinating workers in high-risk settings such as a meat processing plant in areas where cases are beginning to surge.

To that end, the White House has invested hundreds of millions of dollars to boost surveillance testing and close testing supply gaps, including $200 million to boost genomic sequencing to track the spread of variants. The American Rescue Plan, which Biden signed into law on Thursday, invests another $47.8 billion in coronavirus testing measures. The bill also adds $7.66 billion to hire 100,000 public health workers to boost vaccination and contact tracing efforts.

One official said the administration is also considering administering monoclonal antibody treatments -- of which the administration bought another 100,000 doses in February -- in hotspots as a prophylaxis.

"A lot can happen. Conditions can change. The scientists have made clear that things may get worse again as new variants of the virus spread," Biden said during a prime-time address to the nation last Thursday. "If we don't stay vigilant and the conditions change, then we may have to reinstate restrictions to get back on track."

"We have more consistent messaging now around the interventions that we know work: masks, social distancing measures," said Schuchat, who also served as deputy CDC director during the Trump administration. "There's a strong commitment at CDC and in this administration to transparent communication -- if there's bad news, to share it, if there's good news, to be open and honest about it -- to make sure we can communicate clearly and consistently about what we think is going on and what we think needs to be done."

the administration has declined to change the game entirely, rejecting calls to prioritize getting more first doses of two-dose vaccines in Americans' arms and delaying the administration of second doses -- as the UK did.

the White House has prioritized giving full protection to fewer Americans

the White House has sought to work more closely with state and local officials.

Biden officials say they watched as Trump tried and failed to pressure states to adopt or discard certain public health measures and have sought to avoid putting themselves in a similar position

But even as the White House looks to prepare governors for a potential fourth surge, officials are also contemplating the possibility that a fourth surge will not strain hospitals or lead to as many deaths as previous surges."In 2020 we'd say, OK, we see a rising number of cases, we know we're going to see a rising number of hospitalizations and deaths," a senior administration official said. "But today ... it's not a very clear picture."

Recent letters by another group of scientists and international affairs experts argued at length for the relative likelihood of a laboratory leak. Previous statements from other scientists and the W.H.O. report both asserted that a natural origin was by far the most plausible.

The list of signers includes researchers with deep knowledge of the SARS family of viruses, such as Ralph Baric at the University of North Carolina, who had collaborated with the Chinese virologist Shi Zhengli in research done at the university on the original SARS virus. Dr. Baric did not respond to attempts to reach him by email and telephone.

Speaking for himself only, Dr. Relman said in an interview that “the piece that Kristian Anderson and four others wrote last March in my view simply fails to provide evidence to support their conclusions.”

Angela Rasmussen, a virologist at University of Saskatchewan’s Vaccine and Infectious Disease Organization, has criticized the politicization of the laboratory leak theory.

She supports further investigation, but said that “there is more evidence (both genomic and historical precedent) that this was the result of zoonotic emergence rather than a laboratory accident.”

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

“And when I say ‘worst case,’ I’m potentially talking about the most likely case. Let’s not wait until we wrap the car around the tree to start pumping the brakes.”

The coming months are a race between three variables. There is the contagiousness of the virus itself. There are the measures we take to make it harder for the virus to spread, from lockdowns to masking. And there is the proportion of the country with protection against the virus, either because they’ve already caught it or because they’ve been vaccinated. If contagiousness is rising fast (and it is), then the measures we take to stop the spread or the measures we take to immunize the population need to strengthen faster. Romer’s modeling suggests that if we continue on our current path, delivering one million vaccinations a day and growing fatigued of lockdowns and masks, more than 300,000 could die in the coming months.

If you knew, with 100 percent certainty, that the coronavirus would be 50 percent more contagious six weeks from now, what would you recommend we do differently?

It is true things are coming down but we are at a very high level. This is not the time to start letting up. This is the time to hunker down for what is likely to be a very difficult two or three months.

Let’s agree that total lockdown is the most ruinous of all options, and the one we’d like to use least. We have tools we could deploy to avoid it, but we’d need to start quickly.

This is a public health issue and if we don’t empower the public to deal with it we won’t be able to defeat it

The problem here is the Food and Drug Administration. They have been disastrously slow in approving these tests and have held them to a standard more appropriate to doctor’s offices than home testing.

This is crucial, because the virus is mutating, and we need to know how, and where, and we need to know it quickly.

Better masking would also make a difference. Many of us — and I include myself here — are wandering around in cotton masks whose construction we know little about.

That’s better than nothing, but a year into this pandemic, we should have stronger guidance on choosing the most effective masks.

There is an end in sight. But this could end with 300,000 more deaths, or it could end with a fraction of that. What we do these next few months will make all the difference.

instead of allowing it to cement racialized ways of thinking, we can use these tests to highlight how meaningless genetic ancestry is compared with the many other factors that shape our experience of ourselves and our communities.

For most of human history, the concept of peoplehood — of belonging to a group larger than one’s extended family — has been largely determined by shared cultural practices (such as religion, customs and language) or political institutions.

This more capacious notion of belonging is how heritage is lived day to day for most people. I didn’t need a DNA test to identify as a Jew of European ancestry.

race science got a new lease on life when, in the 1950s, scientists discovered the molecular structure of DNA. By the 1980s DNA testing could reliably prove paternity

More than 26 million people are estimated to have taken genealogical DNA tests.

The answer goes back to the 18th and 19th centuries, when European colonialism and the slave trade birthed the modern concept of race.

As societies were built and genocides committed on the basis of racial hierarchy, it became imperative for racists to prove the biological existence of race. And so race “science” emerged, seeking to dislodge cultural heritage as the prime difference between groups of people.

“Aryan” became synonymous with “German,” excluding the many Jewish and Slavic speakers of the language.

et, no matter how strong it was, this sense of cultural heritage didn’t feel like enough for me. In a society that determines so much based on blood — money, connections, assumptions about character — culture by itself felt like an unreliable narrator of my identity.

Ironically, as academics were reaching the consensus that race is a social construct with no basis in biology — about 94 percent of human genetic variation occurs within so-called racial groups, with racial difference accounting for only 6 percent — the popularity of DNA testing was helping undermine that very idea.

almost 53 percent of Americans think biology at least somewhat determines their racial identity

Two-thirds of white Americans believe that their racial identity is determined by their DNA, compared with about half of black, Latino and Asian Americans

Only 35 percent of those surveyed believe that shared history or culture determines their racial identity.

DNA tests merely compare patterns in your genome with those of groups of people who have been identified as belonging to different ethnicities based on traditional genealogical research (vital records, family trees, etc.)

“If your 23andMe test says you’re 29 percent British, it’s because 29 percent of the pieces of your DNA were most likely to have come from a group that 23andMe’s reference library has labeled ‘British.’ ”

This means ethnicity estimates from companies like 23andMe and AncestryDNA tell a much narrower story than consumers — led along by marketing campaigns — read into them

such estimates are only as good as the companies’ pattern-matching algorithms and DNA reference libraries, which can be incomplete and haphazardly assembled

In fact, these companies’ ethnicity estimates for the same person can vary substantially.

In a society that continues to structure lives along the hierarchy of race, it is difficult to leave behind the reassuring neatness of blood ancestry — of, in an age of turbulence and uncertainty, knowing exactly and objectively who we are — for the reality of mixing, moving and contradiction that makes up our history on this planet.

As Chuck Hoskin Jr., then the Cherokee Nation’s secretary of state, wrote in response to Warren’s DNA testing controversy, “We are [tribal] citizens through historical documentation, adopted laws and a shared language and culture that make us unique.” DNA tests, he said, are “useless to determine tribal citizenship.”

more than 77,500 died in December, the country's deadliest month.

The US reported a record 125,379 hospitalized Covid-19 patients nationwide Thursday, according to the Covid Tracking Project. That number dipped slightly Friday, with 125,057 hospitalizations reported -- about an 163% increase from two months ago.

"We're also worried that at some point soon we're going to have a really tough time finding the space and the staff to take care of all the sick patients coming in with Covid-19 who really need our help," said Dr. Nicole Van Groningen of Cedars-Sinai Medical Center in Los Angeles.

Experts fear that in the coming weeks -- following holiday travel and gatherings -- the US could see another surge of cases that could drive hospitalizations and deaths even higher.

Georgia announced Friday a total of more than 8,700 new Covid-19 cases in the state -- a new high. Maryland on the same day reported its second-highest number of daily cases. New York, meanwhile, added nearly 16,500 new cases -- a day after it hit its highest ever one-day case count.

Texas health officials reported record-high Covid-19 hospitalizations across the state for the fifth day in a row, with more than 12,400 patients.

ICU capacity in many parts of the state remains dangerously low. In Southern California and the San Joaquin Valley, zero beds are available. One health official said earlier this week the surge of patients has been pushing hospitals to the "brink of catastrophe."

The variant has been found in at least 30 countries and has also been detected in Colorado, California and Florida.

"The discovery of the additional cases leads county health officials to believe that the new strain of the virus is widespread in the community," a county spokesperson said.The new cases were found in two men in their 40s and a man in his 50s, officials said.

"Currently, the US is doing less sequencing than many other countries -- a recent report from (genomics database) GISAID estimated that the US is sequencing 0.3% of positive cases versus the UK that's at about 7%."

the vaccines approved in the US require two doses based a few weeks apart. And the nation will continue to do it that way and will not follow the UK's decision to potentially delay second doses, Fauci told CNN on Friday.

"The fact is we want to stick with what the science tells us, and the data that we have for both [vaccines] indicate you give a prime, followed by a boost in 21 days with Pfizer and 28 days with Moderna. And right now, that's the way we're going with it, and that's the decision that is made," Fauci said. "We make decisions based on data. We don't have any data of giving a single dose and waiting for more than the normal period of time" to give the second dose, he added.

he made this association: “Censorship does not make us wiser. It does not make us better informed. If it did, we’d be speaking Russian right now. The Soviet Union would run the world; it would have worked. But, instead, the Soviet Union is extinct. It collapsed under the weight of its own absurdities, absurdities abetted by censorship,” he said, working up to this point: “And that’s the most basic lesson of dictatorships, all of them. Anything built on lies falls apart over time.”

Except that’s not true anymore. Lies are working well these days, thanks to all the soft places they have to lay their eggs. As proof, we have Donald Trump, whose lies during the 2016 presidential campaign secured an electoral college victory. We have QAnon, the vile conspiracy-theory community knocking on the door of Congress. And we have “Tucker Carlson Tonight,” a program so stocked with deception and misdirection that it racked up the biggest ratings numbers in cable-news history earlier this year.

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

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

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

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

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

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

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

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

In no other high-income country — and in only a few countries, period — have political leaders departed from expert advice as frequently and significantly as the Trump administration. President Trump has said the virus was not serious; predicted it would disappear; spent weeks questioning the need for masks; encouraged states to reopen even with large and growing caseloads; and promoted medical disinformation.

many agree that the poor results in the United States stem in substantial measure from the performance of the Trump administration.

“As an American, I think there is a lot of good to be said about our libertarian tradition,” Dr. Jared Baeten, an epidemiologist and vice dean at the University of Washington School of Public Health, said. “But this is the consequence — we don’t succeed as well as a collective.”

That tradition is one reason the United States suffers from an unequal health care system that has long produced worse medical outcomes — including higher infant mortality and diabetes rates and lower life expectancy — than in most other rich countries.

First, the United States faced longstanding challenges in confronting a major pandemic. It is a large country at the nexus of the global economy, with a tradition of prioritizing individualism over government restrictions.

The New York Times set out to reconstruct the unique failure of the United States, through numerous interviews with scientists and public health experts around the world. The reporting points to two central themes.

When it comes to the virus, the United States has come to resemble not the wealthy and powerful countries to which it is often compared but instead far poorer countries, like Brazil, Peru and South Africa, or those with large migrant populations, like Bahrain and Oman.

That’s more than five times as many as in all of Europe, Canada, Japan, South Korea and Australia, combined.

Over the past month, about 1.9 million Americans have tested positive for the virus.

one country stands alone, as the only affluent nation to have suffered a severe, sustained outbreak for more than four months: the United States.

Nearly every country has struggled to contain the coronavirus and made mistakes along the way.

it quickly became clear that the United States’ policy was full of holes. It did not apply to immediate family members of American citizens and permanent residents returning from China, for example. In the two months after the policy went into place, almost 40,000 people arrived in the United States on direct flights from China.

On Jan. 31, his administration announced that it was restricting entry to the United States from China: Many foreign nationals — be they citizens of China or other countries — would not be allowed into the United States if they had been to China in the previous two weeks.

A travel policy that fell short

In retrospect, one of Mr. Trump’s first policy responses to the virus appears to have been one of his most promising.

The administration’s policy also did little to create quarantines for people who entered the United States and may have had the virus.

ven more important, the policy failed to take into account that the virus had spread well beyond China by early February. Later data would show that many infected people arriving in the United States came from Europe

South Korea, Hong Kong and Taiwan largely restricted entry to residents returning home. Those residents then had to quarantine for two weeks upon arrival

South Korea and Hong Kong also tested for the virus at the airport and transferred anyone who was positive to a government facility.

“People need a bit more than a suggestion to look after their own health,” said Dr. Mackay, who has been working with Australian officials on their pandemic response. “They need guidelines, they need rules — and they need to be enforced.”

Travel restrictions and quarantines were central to the success in controlling the virus in South Korea, Hong Kong, Taiwan and Australia, as well as New Zealand, many epidemiologists believe. In Australia, the number of new cases per day fell more than 90 percent in April. It remained near zero through May and early June, even as the virus surged across much of the United States.

the tolls in Australia and the United States remain vastly different. Fewer than 300 Australians have died of complications from Covid-19, the illness caused by the virus. If the United States had the same per capita death rate, about 3,300 Americans would have died, rather than 158,000.

there is a good chance that a different version of Mr. Trump’s restrictions — one with fewer holes and stronger quarantines — would have meaningfully slowed the virus’s spread.

travel restrictions had been successful enough in fighting the coronavirus around the world that those views may need to be revisited.“Travel,” he said, “is the hallmark of the spread of this virus around the world.”

Traditionally, public health experts had not seen travel restrictions as central to fighting a pandemic, given their economic costs and the availability of other options, like testing, quarantining and contact tracing

But he added that

By early March, with the testing delays still unresolved, the New York region became a global center of the virus — without people realizing it until weeks later. More widespread testing could have made a major difference, experts said, leading to earlier lockdowns and social distancing and ultimately less sickness and death.

While the C.D.C. was struggling to solve its testing flaws, Germany was rapidly building up its ability to test. Chancellor Angela Merkel, a chemist by training, and other political leaders were watching the virus sweep across northern Italy, not far from southern Germany, and pushed for a big expansion of testing.

By the time the virus became a problem in Germany, labs around the country had thousands of test kits ready to use. From the beginning, the government covered the cost of the tests. American laboratories often charge patients about $100 for a test.

Without free tests, Dr. Hendrik Streeck, director of the Institute of Virology at the University Hospital Bonn, said at the time, “a young person with no health insurance and an itchy throat is unlikely to go to the doctor and therefore risks infecting more people.”

Germany was soon far ahead of other countries in testing. It was able to diagnose asymptomatic cases, trace the contacts of new patients and isolate people before they could spread the virus. The country has still suffered a significant outbreak. But it has had many fewer cases per capita than Italy, Spain, France, Britain or Canada — and about one-fifth the rate of the United States.

One measure of the continuing troubles with testing is the percentage of tests that come back positive. In a country that has the virus under control, fewer than 5 percent of tests come back positive, according to World Health Organization guidelines. Many countries have reached that benchmark. The United States, even with the large recent volume of tests, has not.

In Belgium recently, test results have typically come back in 48 to 72 hours. In Germany and Greece, it is two days. In France, the wait is often 24 hours.

The conflicting advice, echoed by the C.D.C. and others, led to relatively little mask wearing in many countries early in the pandemic. But several Asian countries were exceptions, partly because they had a tradition of mask wearing to avoid sickness or minimize the effects of pollution.

The double mask failure

By January, mask wearing in Japan was widespread, as it often had been during a typical flu season. Masks also quickly became the norm in much of South Korea, Thailand, Vietnam, Taiwan and China.

In the following months, scientists around the world began to report two strands of evidence that both pointed to the importance of masks: Research showed that the virus could be transmitted through droplets that hang in the air, and several studies found that the virus spread less frequently in places where people were wearing masks.

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.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The report was also riddled with discrepancies and apparent errors.

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

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

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

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

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

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

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

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

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

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

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

He has shown flickers of what appears to be doubt.

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

There are three hundred and twenty-one testing locations in the city, and the system is so extensive that in June, when Beijing suffered an outbreak, Wuhan hospitals sent seventy-two staffers to the capital to help with tests.

When Wuhan was sealed, the strategy of isolation was replicated throughout the city. Housing compounds were closed and monitored by neighborhood committees, with residents going out only for necessities.

Toward the end of the first month, the guidelines were tightened further, until virtually all goods were delivered. On February 17th, Fang Fang wrote, “Everyone is now required to remain inside their homes at all times.”

Meanwhile, approximately ten thousand contact tracers were working in the city, in order to cut off chains of infection, and hospitals were developing large-scale testing systems. But isolation remained crucial: patients were isolated; suspected exposures were isolated; medical workers were isolated.

Zhang said the experience of working through the pandemic had left him calmer and more patient. He drove more carefully now; he wasn’t in such a rush.

I often asked Wuhan residents how they had been personally changed by the spring, and there was no standard response. Some expressed less trust in government information; others said they had increased faith in the national leadership.

Wuhan had most recently reported a locally transmitted symptomatic case on May 18th. It’s the most thoroughly tested city in China: at the end of May, in part to boost confidence, the government tried to test every resident, a total of eleven million.

I never met a cabdriver who had been swab-tested less than twice, and a couple had been tested five times. Most of the cabbies had no relatives or friends who had been infected; swabbing was simply required by the city and by their cab companies.

“I tend to take a charitable view of countries that are at the beginning stage of epidemics,” Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Center for Health Security, told me, in a phone conversation. According to her, it’s unrealistic to expect that any country could have stopped this particular virus at its source. “I’ve always believed that this thing was going to spread,” she said

The physician who handled testing told me that, on average, his hospital still recorded one positive for every forty thousand exams. Most of these positives were repeat patients: after having been infected during the initial run of the virus, they recovered fully, and then for some reason, months later, showed evidence of the virus again. So far, most of the positives had been asymptomatic, and the physician saw no indication that the virus was spreading in the city.

In town, there were few propaganda signs about the epidemic, and Wuhan newspapers ran upbeat headlines every morning (Yangtze Daily, August 29th, front page: “STUDENTS DO NOT HAVE TO WEAR MASKS IN SCHOOLS”). Movie theatres were open; restaurants and bars had no seating restrictions. At the Hanyang Renxinghui Mall, I saw barefaced kids playing in what may have been one of the last fully functioning ball pits on earth, a sight that seemed worthy of other headlines (“CHILDREN DO NOT HAVE TO WEAR MASKS IN WUHAN BALL PITS”).

Across town, colleges and universities were in the process of bringing back more than a million students. Wuhan has the second-highest number of students of any city in China, after Guangzhou.

Wuhan memories remained fresh, and the materials of documentation were also close at hand. People sometimes handed over manuscripts, and they took out their phones and pulled up photographs and messages from January and February. But I wondered how much of this material would dissipate over time.

In town, I met two Chinese journalists in their twenties who were visiting from out of town. They had been posted during the period of the sealed city: back then, anybody sent to cover events in Wuhan had to stay for the long haul.

One was a director of streaming media whom I’ll call Han, and he had found that government-run outlets generally wanted footage that emphasized the victory over the disease, not the suffering of Wuhan residents. Han hoped that eventually he’d find other ways to use the material. “It will be in the hard drive,” he said, tapping his camera.

After that, Yin reported on a number of issues that couldn’t be published or completed, and she often talked with scientists and officials who didn’t want to say too much. “One person said, ‘Ten years later, if the climate has changed, I’ll tell you my story,’ ” Yin told me. “He knew that he would be judged by history.” She continued, “These people are inside the system, but they also know that they are inside history.”

Such fare is much more popular in Guangdong, in the far south. It’s possible that the disease arrived from somewhere else and then spread in the wet, cool conditions of the fish stalls. A few Wuhan residents told me that a considerable amount of their seafood comes from Guangdong, and they suggested that perhaps a southerner had unwittingly imported the disease,

When I spoke with scientists outside China, they weren’t focussed on the government’s early missteps

In time, we will learn more, but the delay is important to the Communist Party. It handles history the same way that it handles the pandemic—a period of isolation is crucial. Throughout the Communist era, there have been many moments of quarantined history: the Great Leap Forward, the Cultural Revolution, the massacre around Tiananmen Square. In every case, an initial silencing has been followed by sporadic outbreaks of leaked information. Wuhan will eventually follow the same pattern, but for the time being many memories will remain in the sealed city.

Wafaa El-Sadr, the director of ICAP, a global-health center at Columbia University, pointed out that Chinese scientists had quickly sequenced the virus’s genome, which was made available to researchers worldwide on January 11th. “I honestly think that they had a horrific situation in Wuhan and they were able to contain it,” she said. “There were mistakes early on, but they did act, and they shared fast.”

For much of El-Sadr’s career, she has worked on issues related to AIDS in the United States, Africa, and elsewhere. After years of research, scientists eventually came to the consensus that H.I.V. most likely started through the bushmeat trade—the first human was probably infected after coming into contact with a primate or primate meat.

El-Sadr views the coronavirus as another inevitable outcome of people’s encroachment on the natural world. “We are now living through two concomitant massive pandemics that are the result of spillover from animal to human hosts, the H.I.V. and the COVID pandemics,” she wrote to me, in an e-mail. “Never in history has humanity experienced something along this scale and scope.”

There’s a tendency to believe that we would know the source of the coronavirus if the Chinese had been more forthcoming, or if they hadn’t cleaned out the Huanan market before stalls and animals could be studied properly.

Yiwu He, the chief innovation officer at the University of Hong Kong, told me that the C.N.B.G. vaccine has already been given to a number of Chinese government officials, under an emergency-use approval granted by the authorities. “I know a few government officials personally, and they told me that they took the vaccine,” he said, in a phone conversation. He thought that the total number was probably around a hundred. “It’s middle-level officials,” he said. “Vice-ministers, mayors, vice-mayors.”

Daszak believes the virus probably circulated for weeks before the Wuhan outbreak, and he doubts that the city was the source. “There are bats in Wuhan, but it was the wrong time of year,” he told me. “It was winter, and bats are not out as much.”

His research has indicated that, across Southeast Asia, more than a million people each year are infected by bat coronaviruses. Some individuals trap, deal, or raise animals that might serve as intermediary hosts. “But generally it’s people who live near bat caves,”

Daszak said that he had always thought that such an outbreak was most likely to occur in Kunming or Guangzhou, southern cities that are close to many bat caves and that also have an intensive wildlife trade.

He thinks that Chinese scientists are probably now searching hospital freezers for lab samples of people who died of pneumonia shortly before the outbreak. “You would take those samples and look for the virus,” he said. “They’ll find something eventually. These things just don’t happen overnight; it requires a lot of work. We’ve seen this repeatedly with every disease. It turns out that it was already trickling through the population.”

Daszak is the president of EcoHealth Alliance, a nonprofit research organization based in New York. EcoHealth has become the target of conspiracy theorists, including some who claim that the virus was man-made. Daszak and many prominent virologists say that anything created in a lab would show clear signs of manipulation.

There’s also speculation that the outbreak started when researchers accidentally released a coronavirus they were studying at the Wuhan Institute of Virology. But there’s no evidence of a leak, or even that the institute has ever studied a virus that could cause a COVID-19 outbreak.

“Scientists in China are under incredible pressure to publish,” Daszak said. “It really drives openness and transparency.”

He has spent a good deal of time in Wuhan, and co-authored more than a dozen papers with Chinese colleagues. “If we had found a virus that infected human cells and spread within a cell culture, we would have put the information out there,” he said. “In sixteen years, I’ve never come across the slightest hint of subterfuge. They’ve never hidden data. I’ve never had a situation where one lab person tells me one thing and the other says something else. If you were doing things that you didn’t want people to know about, why would you invite foreigners into the lab?”

In April, President Trump told reporters that the U.S. should stop funding research connected to the Wuhan Institute of Virology. Shortly after Trump’s comments, the National Institutes of Health cancelled a $3.7-million grant to EcoHealth, which had been studying how bat coronaviruses are transmitted to people.

I asked Daszak why, if he has such faith in the openness of his Wuhan colleagues, the Chinese government has been so closed about other aspects of the outbreak. He said that science is one thing, and politics something else; he thinks that officials were embarrassed about the early mistakes, and in response they simply shut down all information.

At the beginning of July, China National Biotec Group, a subsidiary of a state-owned pharmaceutical company called Sinopharm, completed construction of a vaccine-manufacturing plant in Wuhan. The project began while the city was still sealed. “That’s the politically correct thing to do,” a Shanghai-based biotech entrepreneur told me. “To show the world that the heroic people of Wuhan have come back.”

But Peter Daszak, a British disease ecologist who has collaborated with the Wuhan Institute of Virology for sixteen years on research on bat coronaviruses, told me that it’s typical to fail to gather good data from the site of an initial outbreak. Once people get sick, local authorities inevitably focus on the public-health emergency. “You send in the human doctors, not the veterinarians,” he said, in a phone conversation. “And the doctors’ response is to clean out the market. They want to stop the infections.”

Pharmaceutical executives have also been expected to lead the way, like the construction manager who donned P.P.E. in order to escort his workers into the patient ward. “Every senior executive at Sinopharm and C.N.B.G. has been vaccinated,” He said. “Including the C.E.O. of Sinopharm, the chairman of the board, every vice-president—everyone.” The Chinese press has reported that vaccinations have also been administered to hundreds of thousands of citizens in high-risk areas around the world.

In the West, China’s image has been badly damaged by the pandemic and by other recent events. The country has tightened political crackdowns in Hong Kong and Xinjiang, and, in May, after Australia called for an investigation into the origins of the virus, China responded furiously, placing new tariffs and restrictions on Australian goods ranging from barley to beef.

But He believes that the situation is fluid. “All of these feelings can turn around quickly,” he told me. “I think that once China has a vaccine, and if they can help other countries, it can make a huge difference.”

There’s also a competitive element. “China wants to beat America,” He said. He believes that the C.N.B.G. vaccine will receive some level of approval for public use by the end of October. “Chinese officials are thinking that Donald Trump might approve a U.S. vaccine before the election,” he said. “So their goal is to have a vaccine approved before that.”

No matter how quickly the Chinese develop a vaccine, or how effectively they have handled the pandemic since January, it’s unlikely to make Westerners forget the mistakes and misinformation during the pandemic’s earliest phase.

Some of this is due to a cultural difference—the Chinese response to errors is often to look forward, not back. On January 31st, Fang Fang commented in her diary, “The Chinese people have never been fond of admitting their own mistakes, nor do they have a very strong sense of repentance.” It’s often hard for them to understand why this quality is so frustrating for Westerners. In this regard, the pandemic is truly a mirror—it doesn’t allow the Chinese to look out and see themselves through the eyes of others.

The pandemic illuminates both the weaknesses and the strengths of the Chinese system, as well as the relationship between the government and the people. They know each other well: officials never felt the need to tell citizens exactly what happened in Wuhan, but they understood that American-level casualties would have been shocking—given China’s population, the tally would have been more than a million and counting.

In order to avoid death on that scale, the government also knew that people would be willing to accept strict lockdowns and contribute their own efforts toward fighting the virus.

In turn, citizens were skilled at reading their government. People often held two apparently contradictory ideas: that the Party lied about some things but gave good guidance about others. More often than not, citizens could discern the difference. During the pandemic, it was striking that, when the Chinese indulged in conspiracy theories, these ideas rarely resulted in personally risky behavior, as they often did in the U.S.

Perhaps the Chinese have been inoculated by decades of censorship and misinformation: in such an environment, people develop strong instincts for self-preservation, and they don’t seem as disoriented by social media as many Americans are.

Early in the year, I corresponded by WeChat with a Wuhan pharmacist who worked in a hospital where many were infected. On February 26th, he expressed anger about the early coverup. “My personal opinion is that the government has always been careless and suppressed dissent,” he wrote. “Because of this, they lost a golden opportunity to control the virus.”

In Wuhan, we met a few times, and during one of our conversations I showed him what he had written in February. I asked what he would do now if he found himself in Li Wenliang’s position, aware of an outbreak of some unknown disease. Would he post a warning online? Contact a health official? Alert a journalist?The pharmacist thought for a moment. “I would tell my close friends in person,” he said. “But I wouldn’t put anything online. Nothing in writing.”

I asked if such an event would turn out differently now.“It would be the same,” he said. “It’s a problem with the system.”

He explained that, with an authoritarian government, local officials are afraid of alarming superiors, which makes them inclined to cover things up. But, once higher-level leaders finally grasp the truth, they can act quickly and effectively.

years of painstakingly worded treaties, high-level visits and cutting-edge disease surveillance—all meant to encourage good-faith cooperation—have only bitten around the edges of the problem.

“It can’t demand entry into a country because they think something bad is happening.”

Nearly 200 countries were counting on an agency whose budget—roughly $2.4 billion in 2020—is less than a sixth of the Maryland Department of Health’s. Its donors, largely Western governments, earmark most of that money for causes other than pandemic preparedness.

In 2018 and 2019, about 8% of the WHO’s budget went to activities related to pandemic preparedness

It took those experts more than four months to agree that widespread mask-wearing helps, and that people who are talking, shouting or singing can expel the virus through tiny particles that linger in the air. In that time, about half a million people died.

To write its recommendations, the WHO solicits outside experts, which can be a slow process.

the agency’s bureaucratic structure, diplomatic protocol and funding were no match for a pandemic as widespread and fast-moving as Covid-19.

As months rolled on, it became clear that governments were reluctant to allow the U.N. to scold, shame or investigate them.

In particular, The Wall Street Journal found:

* China appears to have violated international law requiring governments to swiftly inform the WHO and keep it in the loop about an alarming infectious-disease cluster

—there are no clear consequences for violations

* The WHO lost a critical week waiting for an advisory panel to recommend a global public-health emergency, because some of its members were overly hopeful that the new disease wasn’t easily transmissible from one person to another.

* The institution overestimated how prepared some wealthy countries were, while focusing on developing countries, where much of its ordinary assistance is directed

Public-health leaders say the WHO plays a critical role in global health, leading responses to epidemics and setting health policies and standards for the world. It coordinates a multinational effort every year to pick the exact strains that go into the seasonal flu vaccine, and has provided public guidance and advice on Covid-19 when many governments were silent.

The world’s public-health agency was born weak, created in 1948 over U.S. and U.K. reluctance. For decades, it was legally barred from responding to diseases that it learned about from the news. Countries were required to report outbreaks of only four diseases to the WHO: yellow fever, plague, cholera and smallpox, which was eradicated in 1980.

SARS convinced governments to retool the WHO. The next year, delegates arrived in the Geneva palace where the League of Nations once met to resolve a centuries-old paradox: Countries don’t report outbreaks, because they fear—correctly—their neighbors will respond by blocking travel and trade.

Nearly three times that amount was budgeted for eradicating polio, a top priority for the WHO’s two largest contributors: the U.S. and the Bill & Melinda Gates Foundation.

“Everybody pushed back. No sovereign country wants to have this.”

China wanted an exemption from immediately reporting SARS outbreaks. The U.S. argued it couldn’t compel its 50 states to cooperate with the treaty. Iran blocked American proposals to make the WHO focus on bioterrorism. Cuba had an hourslong list of objections.

Around 3:15 a.m. on the last day, exhausted delegates ran out of time. The treaty they approved, called the International Health Regulations, imagined that each country would quickly and honestly report, then contain, any alarming outbreaks

In return, the treaty discouraged restrictions on travel and trade. There would be no consequences for reporting an outbreak—yet no way to punish a country for hiding one.

The treaty’s key chokepoint: Before declaring a “public health emergency of international concern,” or PHEIC, the WHO’s director-general would consult a multinational emergency committee and give the country in question a chance to argue against such a declaration.

Delegates agreed this could give some future virus a head start but decided it was more important to discourage the WHO from making any unilateral announcements that could hurt their economies.

Over the next few years, emergency committees struggled over how to determine whether an outbreak was a PHEIC. It took months to declare emergencies for two deadly Ebola epidemics

On Jan. 3, representatives of China’s National Health Commission arrived at the WHO office in Beijing. The NHC acknowledged a cluster of pneumonia cases, but didn’t confirm that the new pathogen was a coronavirus, a fact Chinese officials already knew.

That same day, the NHC issued an internal notice ordering laboratories to hand over or destroy testing samples and forbade anyone from publishing unauthorized research on the virus.

China’s failure to notify the WHO of the cluster of illnesses is a violation of the International Health Regulations

China also flouted the IHR by not disclosing all key information it had to the WHO

The WHO said it’s up to member states to decide whether a country has complied with international health law, and that the coming review will address those issues.

While Chinese scientists had sequenced the genome and posted it publicly, the government was less forthcoming about how patients might be catching the virus.

WHO scientists pored over data they did get, and consulted with experts from national health agencies, including the CDC, which has 33 staff detailed to the WHO.

Then a 61-year-old woman was hospitalized in Thailand on Jan. 13.

The next day, Dr. van Kerkhove told reporters: “It’s certainly possible that there is limited human-to-human transmission.” MERS and SARS, both coronaviruses, were transmissible among people in close quarters. Epidemiological investigations were under way, she said.

On Jan. 22, a committee of 15 scientists haggled for hours over Chinese data and a handful of cases in other countries. Clearly, the virus was spreading between people in China, though there was no evidence of that in other countries. The question now: Was it mainly spreading from very sick people in hospitals and homes—or more widely?

The committee met over two days, but was split. They mostly agreed on one point: The information from China “was a little too imprecise to very clearly state that it was time” to recommend an emergency declaration,

On Jan. 28, Dr. Tedros and the WHO team arrived for their meeting with Mr. Xi

Leaning across three wooden coffee tables, Dr. Tedros pressed for cooperation. In the absence of information, countries might react out of fear and restrict travel to China, he repeated several times throughout the trip. Mr. Xi agreed to allow a WHO-led international team of experts to visit. It took until mid-February to make arrangements and get the team there.

China also agreed to provide more data, and Dr. Tedros departed, leaving Dr. Briand behind with a list of mysteries to solve. How contagious was the virus? How much were children or pregnant women at risk? How were cases linked? This was vital information needed to assess the global risk, Dr. Briand said

Back in Geneva, Dr. Tedros reconvened the emergency committee. By now it was clear there was human-to-human transmission in other countries. When it met on Jan. 30, the committee got the information the WHO had been seeking. This time the committee recommended and Dr. Tedros declared a global public-health emergency.

President Trump and New York Gov. Andrew Cuomo both assured constituents their health systems would perform well. The U.K.’s chief medical officer described the WHO’s advice as largely directed at poor and middle-income countries. As for keeping borders open, by then many governments had already closed them to visitors from China.

The WHO shifted focus to the developing world, where it believed Covid-19 would exact the heaviest toll. To its surprise, cases shot up just across the border, in northern Italy.

the WHO’s health emergencies unit should report to the director-general and not member states, and its budget should be protected so it doesn’t have to compete with other programs for money.