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That’s because the PCR (or “have-you-got-it”) test is based on detecting genetic material from the virus – on its own it does not reveal whether that virus is active, and infectious, or not.

Experts say it is unlikely. “I know some have discussed ‘reactivation’ of virus, but this seems unhelpful and unsupported to me,” said Altmann. “It’s a term that’s borrowed from other viruses, especially the herpes virus family, that can hide in the body in a latent state to reactivate years later. [There is] no evidence of that at all for coronaviruses.”

“[We are] at the beginning of describing what may be a complex picture of chronic disease that may ensue from the initial infection – coming and going in relapsing waves, sometimes almost like a kind of chronic fatigue syndrome,” he said. “[These cases] may reflect examples of virus not fully cleared, or alternatively, some kind of damaging post-hoc disturbance to immune or inflammatory function,” he said.

“In some persons they begin to feel well again and signs and symptoms including fever decrease, but some then go on to develop respiratory distress and must be provided oxygen in hospital,” said David Heymann, professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine. “It appears to be a delayed immune response that is more serious in some persons and that reacts to remaining virus in various organs.”

How long are people with Covid-19 infectious for? A recent study of 60 coronavirus patients in China showed 10 patients tested positive for Covid-19 after discharge from hospital. However, once again, experts say this could be down to the test picking up genetic material from inactive virus, with other studies, including work in South Korea, suggesting those who test positive with Covid-19 after recovering from the disease are not infectious.

“It’s not uncommon to find virus in the nose or throat for up to four weeks after initial infection, but tests to establish whether this is live infectious virus – as opposed to just genetic material detection – are not normally positive for much longer than a week,” said Killingley, adding: “I haven’t come across relapse cases whereby the initial infection acquired weeks ago reignites itself into an infectious case.”

. 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.”

The group’s reopening recommendations include widespread testing, contact tracing and isolation of people who are infected or exposed.

One important factor in transmission is that seemingly benign activities like speaking and breathing produce respiratory bits of varying sizes that can disperse along air currents and potentially infect people nearby.

Health agencies have so far identified respiratory-droplet contact as the major mode of Covid-19 transmission. These large fluid droplets can transfer virus from one person to another if they land on the eyes, nose or mouth. But they tend to fall to the ground or on other surfaces pretty quickly.

Proper ventilation—such as forcing air toward the ceiling and pumping it outside, or bringing fresh air into a room—dilutes the amount of virus in a space, lowering the risk of infection.

An estimated 10% of people with Covid-19 are responsible for about 80% of transmissions, according to a study published recently in Wellcome Open Research. Some people with the virus may have a higher viral load, or produce more droplets when they breathe or speak, or be in a confined space with many people and bad ventilation when they’re at their most infectious point in their illness

that is only a rule of thumb, he cautioned. It could take much less time with a sneeze in the face or other intimate contact where a lot of respiratory droplets are emitted, he said.

When singing, people can emit many large and small respiratory particles. Singers also breathe deeply, increasing the chance they will inhale infectious particles.

Similar transmission dynamics could be at play in other settings where heavy breathing and loud talking are common over extended periods, like gyms, musical or theater performances, conferences, weddings and birthday parties.

The so-called attack rate—the percentage of people who were infected in a specific place or time

additional protocols to interrupt spread, like social distancing in workspaces and providing N95 respirators or other personal protective equipment, might be necessary as well, she said.

Another factor is prolonged exposure. That’s generally defined as 15 minutes or more of unprotected contact with someone less than 6 feet away

The attack rate for Covid-19 in households ranges between 4.6% and 19.3%, according to several studies. It was higher for spouses, at 27.8%, than for other household members, at 17.3%, in one study in China.

The 37-year-old stay-at-home mother was hospitalized with a stroke on April 18 that her doctors attributed to Covid-19, and was still coughing when she went home two days later.

She pushed to get home quickly, she said, because her 4-year-old son has autism and needed her. She kept her distance from family members, covered her mouth when coughing and washed her hands frequently. No one else in the apartment has fallen ill, she said. “Nobody went near me when I was sick,” she said.

Being outside is generally safer, experts say, because viral particles dilute more quickly. But small and large droplets pose a risk even outdoors, when people are in close, prolonged contac

No one knows for sure how much virus it takes for someone to become infected, but recent studies offer some clues

In one small study published recently in the journal Nature, researchers were unable to culture live coronavirus if a patient’s throat swab or milliliter of sputum contained less than one million copies of viral RNA.

“Based on our experiment, I would assume that something above that number would be required for infectivity,” said Clemens Wendtner, one of the study’s lead authors

He and his colleagues found samples from contagious patients with virus levels up to 1,000 times that, which could help explain why the virus is so infectious in the right conditions: It may take much lower levels of virus than what’s found in a sick patient to infect someone else.

Current CDC workplace guidelines don’t talk about distribution of aerosols, or small particles, in a room, said Lisa Brosseau, a respiratory-protection consultan

overall, “the risk of a given infected person transmitting to people is pretty low,” said Scott Dowell, a deputy director overseeing the Bill & Melinda Gates Foundation’s Covid-19 response. “For every superspreading event you have a lot of times when nobody gets infected.”

Some scientists say while aerosol transmission does occur, it doesn’t explain most infections. In addition, the virus doesn’t appear to spread widely through the air.

“If this were transmitted mainly like measles or tuberculosis, where infectious virus lingered in the airspace for a long time, or spread across large airspaces or through air-handling systems, I think you would be seeing a lot more people infected,” said the CDC’s Dr. Brooks.

High-touch surfaces like doorknobs are a risk, but the virus degrades quickly so other surfaces like cardboard boxes are less worrisome,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And that is what is happening.

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

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

The low-income, middle-income and high-income health systems have extremely different problems. You know, in low-income countries, getting to a health post is hard. It’s very expensive. Whereas in rich countries, yes, you can get to your doctor. In low-income countries, the main problems you have is infectious diseases. We’re dealing with countries that in the worst case where kids have death rates of 20 percent and that’s all infectious disease. And nothing else. In the U.S., in terms of kids under 5, other than premature birth, you really don’t have big problems. Kids just don’t die of infectious disease.

in the U.S., what do people die of? From age 5 till age 50, you’ve got suicide, you’ve got traffic accidents. There’s very little cancer and heart disease before age 50.

what’s a year of life worth? They call it a disability-adjusted life year (DALY). When you’re running a poor country health-care system, you can’t treat a year of life as being worth more than, say, $200, $300 or else you’ll bankrupt your health system immediately. So, with very few exceptions, you do nothing for cancer. If you get cancer, you’re going to die. And so none of the stuff that’s going on in the U.S. about $300,000 a year chemotherapy drugs is relevant.

If you spend the less than 2 percent of what the rich countries spend, but you spend it on vaccinations and antibiotics, you get over half of all that healthcare does to extend life. So you spend 2 percent and you get 50 percent. If you spend another 80 percent you’re at over 90 percent.

in rich-world health, innovation is both your friend and your enemy. Innovation is inventing organ replacement, joint replacement. We’re inventing ways of doing new things that cost $300,000 and take people in their 70s and, on average, give them an extra, say, two or three years of life. And then you have to say, given finite resources, should we fire two or three teachers to do this operation? And with chemotherapies, we’ve got things where we’ll spend our dollars on treatments where you’re valuing a life here at over $10 to $20 million. Really big, big numbers, which if you were infinitely rich, of course that would be fine. So most innovations, unfortunately, actually increase the net costs of the healthcare system. There’s a few, particularly having to do with chronic diseases, that are an exception. If you could cure Alzheimer’s, if you could avoid diabetes — those are gigantic in terms of saving money. But the incentive regime doesn’t favor them.

We’re very uncomfortable putting a value on human life. The way I see our health system is we’ve chosen to pay a huge premium in order to avoid these questions. A prerequisite for the kind of cost-cutting innovations you’re talking about it is being willing to make judgments about what a human life is worth, or even what a few months of a human life are worth. Because if you can’t decide that, then of course you just pay for everything. But if you start trying to make those choices, or even get people to think about those choices, people cry “death panels!”

BG. Yes, someone in the society has to deal with the reality that there are finite resources and we’re making trade-offs, and be explicit about that. When the car companies were found to have a memo that actually said, “This safety feature costs X and saved Y lives,” the very existence of that memo was considered damning. It was “Oh, you think human life is only a bank account.” Or when you made it reimbursable for a doctor to ask, “Do you want heroic care at the end-of-life,” that was a death panel. No, it wasn’t a death panel! It was asking somebody to make a decision.

According to Cirium, an aviation-industry consulting firm, more than 200,000 flights in and out of China have been canceled, a 60 percent decline. In 2003, in the midst of SARS, global air travel was down 25 percent.

Fear dissipates eventually, replaced by a more realistic sense of the risks. An epidemic, even one of a disease as seemingly easy to transmit as COVID-19, while burdening public-health systems and potentially deadly for the elderly and those with compromised immune systems, is eminently survivable by the majority of the population

Which brings us to the last stage of epidemic grief: rational response. After denial, panic, and fear, we can finally get down to the business of basic sanitary measures and infection protocols

there are only four things you need to know about a virus: “What is it? What does it do? Where does it come from? And how do you kill it?”

We never did develop a vaccine. With SARS, infections peaked sometime in May 2003, at about 9,000 cases. By then, the daily rate of new infections had dipped below the number declared cured or dead

That is the inflection point of any outbreak, the point at which the worst is over.

Why did the rate of transmission slow? Part of the answer is seasonality: The Northern Hemisphere’s virus season tends to run from winter to mid-spring, perhaps because people aren’t clustered indoors and so are less contagious, or because viruses might weaken in lower relative humidity or direct sunlight. (Nobody actually knows.)

In the antibiotic era, infection control has been largely delegated to IV drips rather than sanitary cordons. With respiratory diseases like SARS, MERS, and COVID-19, 19th-century medical techniques and equipment—masks, gloves, galoshes, sealed wards, quarantines, and ventilation—are what comprise a rational response.

Only 2% of the patients in a review of nearly 45,000 confirmed Covid-19 cases in China were children, and there were no reported deaths in children under 10

Among nearly 6,300 Covid-19 cases reported by the Korea Centers for Disease Control & Prevention on March 8, there were no reported deaths in anyone under 30. Only 0.7% of infections were in children under 9 and 4.6% of cases were in those ages 10- to 19-years-old.

Studies from China show that the rate of deaths for those with cardiovascular issues is 10.5% while it’s 7.3% for diabetes patients and about 6% for those with hypertension or lung and respiratory disease. In cancer patients, it was reported as 5.6%.

Is Covid-19 more contagious than influenza or other viral respiratory diseases? It appears to be. Both are very contagious. The R0—pronounced “R naught”—is an estimate of how many healthy people one contagious person will infect. The R0 for Covid-19 is estimated to be 2.6. “That’s a lot,” says Dr. Schaffner.

In comparison, for influenza the figure is somewhere around 1.2 to 1.8

Are there any precautions or steps different in coronavirus prevention than in influenza prevention? What about treatment? No. Both illnesses are infectious respiratory illnesses caused by different viruses but spread the same way, says Vanessa Raabe, an infectious disease specialist at NYU Langone Health. They are transmitted through droplets from a sick person sneezing or coughing or talking within 2 meters or 6 feet. If such a droplet enters your eyes, mouth or nose, you could become infected.

There is some concern that the new coronavirus can also be transmitted by tiny fine droplets that remain suspended in the area after an ill person leaves, but Dr. Raabe says that it’s not believed to be the main way it’s transmitted and it’s more of a worry in the health care setting.

Do allergy and asthma sufferers have a higher rate of illness contraction? There is no evidence that allergy sufferers have a higher rate of getting the new coronavirus. But asthma suffers do. The groups with the highest risk of fatalities are the elderly and those with diabetes, heart disease, lung disease, including respiratory illnesses, and smokers

When should I go to the hospital? Experts say you should go to a hospital if you’re sick enough that you think you should be admitted. The telltale sign is difficulty breathing or shortness of breath combined with a high fever

shortness of breath and difficulty breathing is a sign that the lungs are being affected and the virus has moved from being an upper tract respiratory illness to a lower tract one. Upper tract illness is usually defined by a runny nose, congestion, and sore threat. Once a virus moves to the lower tract symptoms can include shortness of breath and a lot of coughing that produces mucus

A high fever would be 101 or higher

How do you distinguish the new coronavirus from the flu or the common cold? It’s impossible to do based on symptoms alone, says Dr. Raabe. The main symptoms of the new coronavirus are fever, cough, shortness of breath, and general fatigue and muscle aches. These overlap with the symptoms of the flu or any other respiratory virus. The only way to know for sure is to get tested by a doctor

The variant was detected in about one-quarter of samples analyzed by the two academic groups in mid-February, one led by a group at Caltech, the other by researchers at Columbia University.

Dr. Anthony West, a computational biologist at Caltech, said in an interview on Wednesday that his ongoing research also showed that the B.1.526 variant was “increasing at a considerable pace in New York City” but that it remained “fairly localized” in the area.

“What we’ve seen in Europe when we hit that 50 percent mark, you’ll see cases surge,” said Dr. Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, on NBC’s “Meet the Press” on Sunday. He urged the public not to let up on health measures and to get vaccinated as quickly as possible.

“It’s anybody’s guess, given the vaccine, the competition among the variants and everything we are trying to do to keep the virus low,” he said.

Half of voters, 50 percent, say coronavirus is “not at all” under control, up 17 points from 33 percent who felt that way six months ago (June 2020)

Far more favor how Dr. Anthony Fauci responded to the pandemic than President Donald Trump.  By a 50-point margin, voters approve of Fauci (73 percent approve vs. 23 percent disapprove).  By an 11-point margin, they disapprove of Trump (44-55 percent). 

  The increase toward inoculation comes mostly from women (+11), those ages 65 and over (+14), and Black voters (+25). 

More men (66 percent) than women (57 percent), more Whites (63 percent) than Blacks (52 percent), and more seniors (74 percent) than those under age 35 (49 percent) plan to get the shot. 

Democrats (75 percent) are much more likely than Republicans (49 percent) to report they will get vaccinated

the top reasons include that its development was rushed (23 percent), a lack of trust it will work (21 percent), opposition to vaccines generally (13 percent), distrust of the government (10 percent), and concern about side effects (9 percent).

Views are mixed on the $900 billion dollar coronavirus relief package being considered by Congress.  Twice as many think that is too little (35 percent) as say too much (19 percent).  One-third (33 percent) thinks the amount is “about right.” 

Trump's handling of the coronavirus outbreak remains the backdrop of this year's election.

Trump has proceeded with rallies in states with rampant coronavirus outbreaks, believing his message of reopening will resonate with voters.

Trump has previously claimed Fauci opposed mask wearing earlier in the pandemic, though at the time the administration was concerned about supply levels of medical grade equipment.

Trump's comments about Fauci came a day after the White House unleashed on the doctor, who is the director of the National Institute of Allergy and Infectious Diseases.

Deputy press secretary Judd Deere said Fauci had decided to "make his political leanings known," though acknowledged he "has a duty to express concerns or push for a change in strategy."

While Trump and Fauci put forward a show of cooperation earlier in the pandemic, their relationship has deteriorated significantly. Fauci has said he no longer briefs the President and has been replaced by Dr. Scott Atlas, whom the President has relied on for advice on handling the coronavirus.

In public polls, Americans have said they trust Fauci more than Trump to provide reliable information about the pandemic.

Trump has held off on any major Cabinet shakeups in the leadup to the election, hoping to avoid negative headlines about administration chaos before votes are cast. But how he acts after the election remains an open question; aides said they expected significant changes should Trump win reelection.

Under federal law, Trump doesn't have the power to directly fire Fauci, a career civil servant, and remove him from government. He could try ordering his political appointees to dismiss him, but it would be a time-consuming process that Fauci could appeal.

CNN chief medical correspondent Dr. Sanjay Gupta said that the coronavirus could spread at protests depending on factors like mask-wearing, how closely people gathered, and how long people stayed in close contact.

"It is a contagious virus. People being outside, people wearing masks, people moving by each other more quickly may reduce the likelihood of significant exponential growth. But that's still the concern."

The virus has particularly impacted African-Americans, who make up a disproportionate percentage of Covid-19 cases and deaths.

For one, the textbook combination of identification, isolation and quarantine for contacts helped stop the potential spread of coronavirus an Air Force basic training camp. Military doctors said their approach kept the case count to just five among 10,000 recruits at Joint Base San Antonio-Lackland in Texas in March and April.

The base used techniques including quarantine, social distancing, early trainee screening, rapid isolation and monitored re-entry to slow the transmission, the researchers said in a report published by the US Centers for Disease Control and Prevention Tuesday.

"Climate only would become an important seasonal factor in controlling COVID-19 once a large proportion of people within a given community are immune or resistant to infection," Collins wrote, citing experts in infectious disease transmission and climate modeling.

The US should have 100 million doses of one candidate Covid-19 vaccine by the end of the year, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases (NIAID) and a member of the White House coronavirus task force, said Tuesday.

“Whether the Delta variant is already at that plateau, or whether there’s going to be further increases before it gets to that plateau, I can’t say. But I do think that plateau exists.”

Antibodies, which can prevent the virus from entering our cells, are engineered to latch onto specific molecules on the surface of the virus, snapping into place like puzzle pieces. But genetic mutations in the virus can change the shape of those binding sites.

“It’s hard to imagine that the virus is going to pop into a new species perfectly formed for that species,” said Andrew Read, an evolutionary microbiologist at Penn State University. “It’s bound to do some adaptation.”

But as more people acquire antibodies against the virus, mutations that allow the virus to slip past these antibodies will become even more advantageous.

The good news is that there are many different kinds of antibodies, and a variant with a few new mutations is unlikely to escape them all, experts said.

its sleeve to counteract the evolution of the virus,” Dr. Pepper said. “Knowing that there is this complex level of diversity in the immune system allows me to sleep better at night.”

“It’s a lot harder to evade T cell responses than antibody responses,”

And then there are B cells, which generate our army of antibodies. Even after we clear the infection, the body keeps churning out B cells for a while, deliberately introducing small genetic mutations. The result is an enormously diverse collection of B cells producing an array of antibodies, some of which might be a good match for the next variant that comes along.

Unlike transmissibility or immune evasion, virulence has no inherent evolutionary advantage.

Whether the virus will become more virulent — that is, whether it will cause more serious disease — is the hardest to predict,

Some scientists predict that the virus will ultimately be much like the flu, which can still cause serious illness and death, especially during seasonal surges.

“The virus has no interest in killing us,” Dr. Metcalf said. “Virulence only matters for the virus if it works for transmission.”

So far, studies suggest that our antibody, T cell and B cell responses are all working as expected when it comes to SARS-CoV-2. “This virus is mostly playing by immunological rules we understand,”

Then again, this virus spreads before people become severely ill. As long as that remains true, the virus could become more virulent without sacrificing transmissibility.

Moreover, the same thing that makes the virus more infectious — faster replication or tighter binding to our cells — could also make it more virulent.

Although many possible paths remain open to us, what is certain is that SARS-CoV-2 will not stop evolving — and that the arms race between the virus and us is just beginning.

We lost the first few rounds, by allowing the virus to spread unchecked, but we still have powerful weapons to bring to the fight. The most notable are highly effective vaccines, developed at record speed. “I think there is hope in the fact that the SARS-CoV-2 vaccines at this point are more effective than flu vaccines have probably ever been,”

“I have great faith that we can sort any detrimental evolutionary trajectories out by improving our current or next generation vaccines,”

be you have a re-infection, but it’s relatively mild, which also boosts your immunity,”

rising vaccination rates may already be suppressing new mutations.And the evolution rate could also slow down as the virus becomes better adapted to humans.

“There’s low-hanging fruit,” Dr. Lauring said. “So there are certain ways it can evolve and make big improvements, but after a while there aren’t areas to improve — it’s figured out all the easy ways to improve.”

Eventually, as viral evolution slows down and our immune systems catch up, we will reach an uneasy equilibrium with the virus, scientists predict. We will never extinguish it, but it will smolder rather than rage.

It is too early to say whether SARS-CoV-2 will change in virulence over the long-term. There could certainly be trade-offs between virulence and transmission; variants that make people too sick too quickly may not spread very far.

Others are more optimistic. “My guess is that one day this is going to be another cause of the common cold,”

There are four other coronaviruses that have become endemic in human populations. We are exposed to them early and often, and all four mostly cause run-of-the-mill colds.

much of the world remains unvaccinated, and this virus has already proved capable of surprising us. “We should be somewhat cautious and humble about trying to predict what it is capable of doing in the future,”

While we can’t guard against every eventuality, we can tip the odds in our favor by expanding viral surveillance, speeding up global vaccine distribution and tamping down transmission until more people can be vaccinated

The future, he said, “depends much, much more on what humans do than on what the virus does.”

If no one ever went out to a restaurant or threw a party again, we’d slow the spread of COVID as well as that of plenty of other infectious diseases. But that would be a cure worse than the disease. Like our ancestors, we should prioritize the living of life over the minimizing of mortality.

conscious policy to reintroduce language that was previously not acceptable in debate

To be sure, Mr. Trump’s choice of words drew condemnation from around the world.

But the political reality is that migration has become a salient issue — and not only for right-wing, populist and nativist politicians.

Several European heads of government were proudly xenophobic in their responses to a refugee crisis in 2015, when more than one million asylum seekers arrived by boat on European shores, prompting a surge in support for far-right parties and nativist rhetoric — particularly in Central and Eastern Europe.

While still moderate in tone, some leaders are pursuing policies that are Trumpian in spirit

The Lancet report said the lack of progress “threatens both human lives and the viability of the national health systems they depend on, with the potential to overwhelm health services”

A survey in the report of leaders of almost 500 global cities found half expected their public health infrastructure to be seriously compromised by climate change, meaning systemic failures such as the shutdown of hospitals.

157 million more vulnerable people were subjected to a heatwave in 2017 than in 2000

The Lancet report said 153bn hours of work were lost in 2017 due to extreme heat, 80% of it in agriculture

Almost half the losses were in India, equivalent to 7% of its total working population, while China lost the equivalent of 1.4% of its workers

Relatively small changes in temperatures and rainfall could cause large changes in the transmission of infectious diseases spread via water and mosquitoes. The ability of the dengue fever virus to be transmitted – its “vectorial capacity” – reached a record high in 2016, according to the report, 10% above a 1950s baseline.

Prof Paul Ekins, of University College London, said the health benefits of tackling climate change had long been undervalued, with just 5% of funding for adaptation to global warming being spent on health

“These benefits are enormous, near-term and affect our health immediately,” Ekins said. “If you factor in these benefits, cutting emissions to [keep the temperature rise below] 1.5C is going to be a net benefit to humanity in monetary terms.”

“Never before have so many opportunities existed for pathogens to pass from wild and domestic animals to people,” she told the Guardian, explaining that 75% of all emerging infectious diseases come from wildlife.“Our continued erosion of wild spaces has brought us uncomfortably close to animals and plants that harbour diseases that can jump to humans.”

“There are too many pressures at the same time on our natural systems and something has to give,” she added. “We are intimately interconnected with nature, whether we like it or not. If we don’t take care of nature, we can’t take care of ourselves. And as we hurtle towards a population of 10 billion people on this planet, we need to go into this future armed with nature as our strongest ally.”

Human infectious disease outbreaks are rising and in recent years there have been Ebola, bird flu, Middle East respiratory syndrome (Mers), Rift Valley fever, sudden acute respiratory syndrome (Sars), West Nile virus and Zika virus all cross from animals to humans.

Cunningham said other diseases from wildlife had much higher fatality rates in people, such as 50% for Ebola and 60%-75% for Nipah virus, transmitted from bats in south Asia. “Although, you might not think it at the moment, we’ve probably got a bit lucky with [Covid-19],” he said. “So I think we should be taking this as a clear warning shot. It’s a throw of the dice.”

“The animals have been transported over large distances and are crammed together into cages. They are stressed and immunosuppressed and excreting whatever pathogens they have in them,” he said. “With people in large numbers in the market and in intimate contact with the body fluids of these animals, you have an ideal mixing bowl for [disease] emergence. If you wanted a scenario to maximise the chances of [transmission], I couldn’t think of a much better way of doing it.”

Aaron Bernstein, at the Harvard School of Public Health in the US, said the destruction of natural places drives wildlife to live close to people and that climate change was also forcing animals to move: “That creates an opportunity for pathogens to get into new hosts.”

The billion-dollar illegal wildlife trade is another part of the problem, said John Scanlon, the former secretary general of the Convention on International Trade of Endangered Species of Wild Fauna and Flora.

The Covid-19 crisis may provide an opportunity for change, but Cunningham is not convinced it will be taken: “I thought things would have changed after Sars, which was a massive wake up call – the biggest economic impact of any emerging disease to that date,” he said.

He praised Republican Gov. Mike DeWine for taking bold steps early, including declaring a state of emergency when there were only three reported cases on March 9, four days before the federal government followed suit. Thirty states had declared a state of emergency by the time Trump declared a national emergency on March 13.

“They didn’t move fast enough,” said Crossley, of the federal government. “And what you’ve seen is more local and state officials sounding the alarm. “We needed a national response to this event.”

With seven reported infections in the United States by the end of the day, Health and Human Services Secretary Alex Azar declared a public health emergency on Jan. 31, and Trump announced strict travel restrictions, barring most foreign visitors coming from China. He also imposed the nation’s first mandatory quarantine in 50 years.

Officials spent three hours war-gaming how they would respond. The drill prompted the state to send 300 employees home early to test their remote work capability. That unmasked a serious problem: A quarter of the team could not perform their jobs at home because they needed access to secure computer systems.

Then he heard the news: The United States had identified its first case of person-to-person transmission involving someone who had not traveled overseas. Also, the World Health Organization classified the coronavirus as a public health emergency of international concern.

Chicago Jan. 31: 9,927 cases worldwide, seven cases in the United States

Tallahassee Jan. 30: 8,234 cases worldwide, five cases in the United States

Americans who had visited China’s Hubei province would be forced to quarantine for 14 days, and those who visited other parts of China would be screened for symptoms and asked to isolate themselves for two weeks. Chicago Mayor Lori Lightfoot was caught off guard. The directive came with little guidance. Where were local governments supposed to quarantine the travelers? What would they do if someone refused to quarantine? Who was going to pay for the resources needed to quarantine people?

“In the first few sets of conversations, we were not hearing answers to those questions,” Lightfoot, a Democrat, said of her talks with federal officials. “It was kind of like, either silence, or ‘Do the best you can,’ which was obviously not acceptable.”

she drafted a letter to Trump on behalf of the mayors from Detroit, Los Angeles, New York, San Francisco and Seattle. They insisted on clear, written directions from the federal government, according to the letter, and worried about diverting health-care resources during flu season, when hospitals were already stretched.

“We are concerned about our public health system’s capacity to implement these measures, recognizing they may inadvertently distract us from our ongoing tried-and-true efforts to isolate confirmed cases and closely monitor their contacts,” according to a previously unreported Feb. 6 letter. “We also worry about the potential to again overwhelm laboratory capacity, recognizing that national capacity has not been adequate to quickly test our highest-risk individuals.”

Mount Kisco, N.Y. Feb. 9: 40,150 cases worldwide, 11 cases in the United States

Weeks earlier, Amler had started fitting employees for personal protective equipment and training them on how to use the gear. In January, she watched what was happening in Wuhan with growing concern: “It seemed impossible that it wouldn’t eventually spill out of China into the rest of the world.”

San Francisco Feb. 24: 79,561 cases worldwide, 51 cases in the United States

Trump continued to reassure the public that there was little to worry about. On Feb. 24, he tweeted, “The Coronavirus is very much under control in the USA.”

But Colfax and his public health staff in San Francisco were seeing something else when they studied the “curves” of the pandemic — graphs showing how many cases were reported in other regions over time.

Wuhan’s curve was climbing exponentially, and other countries, such as Italy, were seeing soaring infection rates as well. Colfax noticed that in every infected region, officials were more and more aggressive about restricting their populations

“It became apparent that no jurisdiction that was where the virus was being introduced, was sort of, in retrospect, thinking, ‘Oh, we overreacted,’ ” Colfax said.

On Feb. 24, Colfax and other health officials assembled their research and met with Mayor London Breed. They made an urgent request: Declare a state of emergency

by the end of the meeting, Breed was convinced. They needed to declare a state of emergency so that they could tap into state and federal funds and supplies, and redeploy city employees. The next day, San Francisco became one of the first major cities in the United States to do so, after Santa Clara and San Diego counties did earlier in the month.

It would take another 17 days, as the virus infected people in nearly every state, before Trump declared a national emergency.

In New Orleans, officials moved ahead with Mardi Gras festivities in late February that packed people into the streets. It was a decision the mayor would later defend as coronavirus cases traced to the celebration piled up.

“No red flags were given,” by the federal government, New Orleans Mayor LaToya Cantrell, a Democrat, later said in a CNN interview. “If we were given clear direction, we would not have had Mardi Gras, and I would’ve been the leader to cancel it.

On Feb. 27, at a White House reception, Trump predicted that the coronavirus would disappear. “Like a miracle,” he said.

San Antonio Feb. 29: 86,011 cases worldwide, 68 cases in the United States

The last day of February marked a major turning point for the coronavirus in the United States: The first American who had been diagnosed with the illness died

In a Saturday news conference, Trump described the patient from the Seattle area as a “medically high-risk” person who had died overnight. A CDC official said that the man, who was in his 50s, had not traveled recently — another sign that the virus was snaking through local communities.

During the announcement, Trump asked the media to avoid inciting panic as there was “no reason to panic at all.”

“We’re doing really well,” he said. “Our country is prepared for any circumstance. We hope it’s not going to be a major circumstance, it’ll be a smaller circumstance. But whatever the circumstance is, we’re prepared.”

That same afternoon in San Antonio, the CDC mistakenly released a woman from quarantine who was infected. The woman was one of dozens of evacuees from Wuhan whom the federal government had brought to a nearby military base and then isolated at the Texas Center for Infectious Disease.

the woman had been dropped off at a Holiday Inn near the San Antonio airport and headed to a mall where she shopped at Dillard’s, Talbots and Swarovski and ate in the food court.

As local officials learned details about the infected woman’s movements and how she had been transported at 2 a.m. back to the Texas Center for Infectious Disease, they waited for the CDC to issue a statement. Hours passed, but they heard nothing. “They were like quiet little mouses,” Wolff said. “They were all scared to talk because I think they felt they were going to get in trouble with the president of the United States because he was saying there was not a problem.”

The next day, San Antonio officials declared a public health emergency and filed a lawsuit to prevent the CDC from releasing the 120 people in quarantine until they were confirmed negative for the virus or completed a 28-day quarantine. A judge denied the motion, but the CDC agreed that evacuees must have two consecutive negative tests that are 24 hours apart and that no one with a pending test can be released.

In Oklahoma City, the coronavirus became a reality for Mayor David Holt, a Republican, when the NBA abruptly canceled a Thunder basketball game after a Utah Jazz player tested positive on March 11. Until then, Holt said, the coronavirus felt “distant on many levels.”

Mount Kisco, N.Y. March 3: 92,840 cases worldwide, 118 cases in the United States

When he tried to order more masks, none were immediately available. By then the entire country was scrambling for protective gear.

Through it all, local officials faced backlash from some community leaders who thought they were overreacting.

San Francisco March 5: 97,886 cases worldwide, 217 cases in the United States

Days after San Francisco’s emergency declaration, Breed stood in front of news cameras to announce the city’s first two cases of the coronavirus.

They were not related, had not traveled to any coronavirus-affected areas and had no contact with known coronavirus patients: It was spreading in the community.

By then, Miami Mayor Francis X. Suarez, a Republican, had announced the cancellation of the Ultra Music festival, a three-day celebration that draws about 50,000 people. Miami was the first city to call off a major music festival, and Suarez faced tremendous backlash

Within days, state authorities set up an emergency operations center in New Rochelle and created a one-mile containment zone. Inside the perimeter, schools and community centers shuttered and large gatherings were prohibited.

Days later, Holt huddled on the phone with other leaders from the United States Conference of Mayors. For about 20 minutes, Seattle Mayor Jenny Durkan, a Democrat, detailed the crisis seizing her city

“She sounded like the main character in a Stephen King novel,” Holt recalled. “She had hundreds of cases, she had dozens of deaths.”

“Any struggles that we’re having, whether it be testing or other issues, or even just convincing our public of the seriousness of the matter, there are some roots back to the time period in January and February, when not all national leadership was expressing how serious this was,” Holt said.

While the mayors held their conference call on March 13, Trump declared a national emergency to combat the coronavirus.

By then, Suarez had tested positive for the coronavirus and was in quarantine. As of Sunday, he remained in isolation, leading the city by phone calls and video chats. He wanted to stop flights into Miami and the governor to order residents to shelter in place as California and other states had already done.

“The window of opportunity is still there, but the window of opportunity is narrowing,” WHO Director General Tedros Adhanom Ghebreyesus said on Friday. “We need to act quickly before it closes completely.”

At the beginning of any disease outbreak, public health experts painstakingly trace the contacts of every person who becomes sick. The experts build a family tree of possible illness, with branches that include anyone who might have shaken hands with, or been sneezed on by an infected person

with confirmed infections approaching 80,000 people, contact tracing on a case-by-case basis could soon be impractical.

“What we find is that this virus is going to be very difficult to contain,” said Jeffrey Shaman, an infectious disease researcher at Columbia University and co-author of the study posted Monday. “Personally, I don’t think we can do it.”

The word ‘pandemic’ invokes fear, but it describes how widespread an outbreak may be, not its deadliness.

“I think we should assume that this virus is very soon going to be spreading in communities here, if it isn’t already, and despite aggressive actions, we should be putting more efforts to mitigate impacts,”

The virus would be easier to contain if people who are contagious were obviously so, as was the case with SARS, which started an outbreak that burned itself out in 2003. But the new virus appears to spread among people who in some cases are not noticeably sick.

among the more than 600 passengers from the Diamond Princess cruise ship who have tested positive, about half had no obvious symptoms.

If the coronavirus becomes a true pandemic, a large proportion of the human population — a third, a half, two-thirds even — could become infected

Harvard epidemiologist Marc Lipsitch estimates that 40 to 70 percent of the human population could potentially be infected by the virus if it becomes pandemic. Not all of those people would get sick

The novel coronavirus may be particularly suited for stealth community transmission since its symptoms can be indistinguishable from those of a cold or flu, and testing capabilities are still being ramped up.

Experts estimate it takes about a week for the number of people infected in a given community to double. Based on that, it would likely take several weeks for a new infection cluster to be picked up by a local health department

By mid-March, he estimated, officials should know if there is community transmission and a true pandemic.

“I want to be clear that we are not seeing community spread here in the United States yet,” she said Friday. “But it’s very possible, even likely, that may eventually happen.”

“If a large number of countries are unsuccessful in preventing sustained multi-generation transmissions, then we could witness the next pandemic.”

A pandemic is a line in the sand, and every expert has a slightly different definition for when an outbreak crosses it. Generally, it means that there are self-sustaining lines of infection in multiple countries and continents — where the family tree of possible illness begins to encompass the entire population.

I think we’re not in as dire straits as we might be, and that’s because everyone is pulling together internationally.”

Public health experts are devising strategies on how to conserve N95 respirators, specialized masks that are in a limited supply amid surging demand.

“Extrapolating from some of the numbers we’ve seen on the impact to the health care system in China, it means we’ll have to surge fast.”

“The messaging has been really confusing, and I think that was really unfortunate,” says Petra Klepac, who is also an infectious-disease modeler at the London School of Hygiene and Tropical Medicine. “It’s been a case of how not to communicate during an outbreak,”

critics of the U.K. strategy argue that swift, decisive action matters more than future hypotheticals do. The country’s current caseload puts it only a few weeks behind Italy, where more than 24,000 cases have so overburdened hospitals that doctors must now make awful decisions about whom to treat.

First, we don’t know how long immunity against the new coronavirus, SARS-CoV-2, lasts. When people are infected with OC43 and HKU1—two other coronaviruses that regularly circulate among humans and cause common colds—they stay immune for less than a year. By contrast, immunity against the first SARS virus (from 2003) holds for much longer. No one knows whether SARS-CoV-2 will hew to either of these extremes, and according to one recent study, its behavior could mean anything from annual outbreaks to a decades-long quiet spell.

making a decent long-term strategy is hard when there are still two big unknowns that substantially affect how the pandemic will progress

a more granular analysis across Chinese provinces showed that the virus can still easily spread in humid areas, and a third modeling study concluded that “SARS-CoV-2 can proliferate at any time of year.” The bottom line: There’s a very wide range of possible futures.

South Korea, by contrast, seems to have brought COVID-19 to heel through a combination of social-distancing measures and extensive testing. Hong Kong, Singapore, and Taiwan have been similarly successful.

In a similar letter, more than 500 behavioral scientists called on the government to disclose the evidence behind its contention that the public will experience “behavioral fatigue” if restrictions are put in place too early.

Without strong guidance, British institutions and citizens have begun making their own decisions, going well over what the government recommends. Universities haven’t been told to close, but many have, sending students home, moving classes and exams online, and postponing graduations. Many care homes will not be admitting visitors. Soccer leagues have been suspended. The Queen has canceled public engagements. The Scottish government is planning to close schools and expand testing.

“We really need people to engage and to sustain individual control measures, like social distancing, for months at a time,” Klepac adds. “We’re in this for the long term and we need everyone to do their part. It is a very big ask.