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At Stanford more than elsewhere, the university and business forge a borderless community in which making money is considered virtuous and where participants profess a sometimes inflated belief that their work is changing the world for the better

Faculty members commonly invest in start-ups launched by their students or colleagues. There are probably more faculty millionaires at Stanford than at any other university in the world.

In his twelve years as president, Stanford’s endowment has grown to nearly seventeen billion dollars. In each of the past seven years, Stanford has raised more money than any other American university.

But Stanford’s entrepreneurial culture has also turned it into a place where many faculty and students have a gold-rush mentality and where the distinction between faculty and student may blur as, together, they seek both invention and fortune.

A quarter of all undergraduates and more than fifty per cent of graduate students are engineering majors. At Harvard, the figures are four and ten per cent; at Yale, they’re five and eight per cent.

many students uncritically incorporate the excesses of Silicon Valley, and that there are not nearly enough students devoted to the liberal arts and to the idea of pure learning. “The entire Bay Area is enamored with these notions of innovation, creativity, entrepreneurship, mega-success,” he says. “It’s in the air we breathe out here. It’s an atmosphere that can be toxic to the mission of the university as a place of refuge, contemplation, and investigation for its own sake.”

Stanford is not the only university to adopt this approach to learning—M.I.T., among others, does, too. But Kelley’s effort is widely believed to be the most audacious. His classes stress collaboration across disciplines and revolve around projects to advance social progress. The school concentrates on four areas: the developing world; sustainability; health and wellness; and K-12 education.

Feeling dejected or unhappy in a place like Stanford causes one to feel abnormal and out-of-place, so we may tend to internalize and brood over this lack of happiness instead of productively addressing the situatio

his principal academic legacy may be the growth of what’s called “interdisciplinary education.” This is the philosophy now promoted at the various schools at Stanford—engineering, business, medicine, science, design—which encourages students from diverse majors to come together to solve real or abstract problems. The goal is to have them become what are called “T-shaped” students, who have depth in a particular field of study but also breadth across multiple disciplines. Stanford hopes that the students can also develop the social skills to collaborate with people outside their areas of expertise. “Ten years ago, ‘interdisciplinary’ was a code word for something soft,” Jeff Koseff says. “John changed that.”

Among the bolder initiatives to create T-students is the Institute of Design at Stanford, or the d.school, which was founded seven years ago and is housed in the mechanical-engineering department.

Distance learning threatens one day to disrupt higher education by reducing the cost of college and by offering the convenience of a stay-at-home, do-it-on-your-own-time education. “Part of our challenge is that right now we have more questions than we have answers,” Hennessy says, of online education. “We know this is going to be important and, in the long term, transformative to education. We don’t really understand how yet.”

financial aid has produced a campus of diverse students who are unburdened by student debt—and who thus don’t have to spend the first five years of their career earning as much money as they can.

“The kinds of project we put in front of our students don’t have right and wrong answers,” Greenberg says. “They have good, better, and really, really better.”

he was impressed by “the bias toward action” at the d.school. Newspapers have bureaucracy, committees, hierarchies, and few engineers, he said. At the Post, “diversity” was defined by ethnicity and race. At the d.school, diversity is defined by majors—by people who think different.

Byers has kept in touch with Systrom and Krieger and remembers them as “quiet and quite humble,” by which he means that they were outstanding human beings who could get others to follow them. They were, in short, T-students.

The United States has “two types of college education that are in conflict with each other,” he said. One is “the classic liberal-arts model—four years of relative tranquility in which students are free to roam through disciplines, great thoughts, and great works with endless options and not much of a rationale.” The second is more utilitarian: “A college degree is expected to lead to a job, or at least to admission to a graduate or professional school.” The best colleges divide the first two years into introductory courses and the last two into the study of a major, all the while trying to expose students to “a broad range of disciplines and modes of thought.” Students, he declared, are not broadly educated, not sufficiently challenged to “search to know.” Instead, universities ask them to serve “the public, to work directly on solutions in a multidisciplinary way.” The danger, he went on, is “that academic researchers will not only embrace particular solutions but will fight for them in the political arena.” A university should keep to “its most fundamental purpose,” which is “the disinterested pursuit of truth.

Stanford, along with its peers, is now justifying its existence mostly in terms of what it can do for humanity and improve the world,” he answered. “I am concerned that a research-intense university will become too result-oriented,” a development that risks politicizing the university. And it also risks draining more resources from liberal arts

students spent too much time networking and strategizing and becoming “slaves to the dictates of a hoped-for future,” and too little time being spontaneous. “Stanford students are superb consequentialists—that is, we tend to measure the goodness of actions by their eventual results,

We excel at making rational calculations of expected returns to labor and investment, which is probably why so many of us will take the exhortation to occupy Wall Street quite literally after graduation. So before making any decision, we ask one, very simple question: What will I get out of it?”

“At most great universities, humanities feel like stepchildren,”

The long-term value of an education is to be found not merely in the accumulation of knowledge or skills but in the capacity to forge fresh connections between them, to integrate different elements from one’s education and experience and bring them to bear on new challenges and problems. . . . Yet we were struck by how little attention most departments and programs have given to cultivating this essential capacity. We were also surprised, and somewhat chagrined, to discover how infrequently some of our students exercise it. For all their extraordinary energy and range, many of the students we encountered lead curiously compartmentalized lives, with little integration between the different spheres of their experience.

Instead of erecting buildings, Andreessen says, Stanford should invest even more of its resources in distance learning: “We’re on the cusp of an opportunity to deliver a state-of-the-art, Stanford-calibre education to every single kid around the world. And the idea that we were going to build a physical campus to reach a tiny fraction of those kids was, to me, tragically undershooting our potential.”

In late January, a popular d.school class, Entrepreneurial Design for Extreme Affordability, taught by James M. Patell, a business-school professor, consisted of thirty-seven graduate and three undergraduate students from thirteen departments, including engineering, political science, business, medicine, biology, and education. It was early in the quarter, and Patell offered the students a choice of initial projects. One was to create a monitoring system to help the police locate lost children. Another was to design a bicycle-storage system.

The “key question,” he says, is: “How can we increase efficiency without decreasing quality?”

online education might also disrupt everything that distinguishes Stanford. Could a student on a video prompter have coffee with a venture capitalist? Could one become a T-student through Web chat? Stanford has been aligned with Silicon Valley and its culture of disruption. Now Hennessy and Stanford have to seriously contemplate whether more efficiency is synonymous with a better education.

Likewise, American oil companies like ExxonMobil, Chevron and ConocoPhillips are active in Angola. Groups like the One Campaign have pushed to require international oil companies to disclose sums paid to governments so that the money can be tracked — increasing the chance that it makes it into state coffers and not private pockets. Europe and Canada are requiring their companies to make these disclosures.

But the American Petroleum Institute is lobbying hard to water down disclosure requirements. The oil industry apparently seeks to sustain an opaque system that has allowed the Angolan president’s family to earn billions even as the country ranks No. 1 worldwide in child mortality rates.

The way to help children like Marcelina, or the 150,000 who die each year in Angola, is not just to hand out medicines. It’s to hold Angola’s leaders accountable so that they use oil money to buy deworming medicine and not $2,000-a-bottle Dom Pérignon. It’s to support those brave Angolans like Marques de Morais who are trying to improve governance

Marques de Morais has tracked $3 billion accumulated by President dos Santos’s daughter, the $13 million refurbishment of the presidential palace, the Lexus LX 570 luxury S.U.V.’s given to each member of Parliament — all at a time when children aren’t consistently getting five-cent deworming pills

At least 12 groups are working to develop a vaccine.

European Medicines Agency (EMA), Europe's drugs regulator, said it established an expert task force to advise companies working on Zika vaccines and medicines, mirroring similar action during the two-year-long Ebola epidemic that started in December 2013 and the pandemic flu outbreak in 2009.

There are no vaccines or treatment for Zika and none even undergoing clinical studies. Most infected people either have no symptoms or develop mild ones like fever and skin rashes.

"The good news is this is not like Ebola; people don't die of Zika. A lot of people get it and don't even know that they have it," Obama told CBS News

Most of the money sought by Obama, who faces pressure from Republicans and some fellow Democrats to act decisively on Zika, would be spent in the United States on testing, surveillance and response in affected areas, including the creation of rapid-response teams to contain outbreak clusters.

Much remains unknown about Zika, including whether the virus actually causes microcephaly, a condition marked by abnormally small head size that can result in developmental problems.Brazil is investigating the potential link between Zika infections and more than 4,000 suspected cases of microcephaly. Researchers have identified evidence of Zika infection in 17 of these cases, either in the baby or in the mother, but have not confirmed that Zika can cause microcephaly. 

Obama's funding request to Congress includes $335 million for the U.S. Agency for International Development to support mosquito-control, maternal health and other Zika-related public health efforts in affected countries in the Americas.

Fauci said he anticipated beginning a so-called Phase 1 trial this summer for a Zika vaccine that would take about three months to test if it is safe and induces a good immune response before further studies can be conducted.

The CDC said its Zika emergency operations center, with a staff of 300, has been placed on its highest level of activation, reflecting a need for accelerated preparedness for possible local virus transmission by mosquitoes in the continental United States.

Dr. Anne Schuchat, principal deputy director of the U.S. Centers for Disease Control and Prevention, said she was not expecting "large-scale amounts of serious Zika infections" in the continental United States as warmer months bring larger and more active mosquito populations.

Word that Zika can be spread by sexual transmission and blood transfusions and its discovery in saliva and urine of infected people have added to concern over the virus.

The World Health Organization declared the outbreak an international health emergency on Feb. 1, citing a "strongly suspected" relationship between Zika infection in pregnancy to microcephaly.

Brazil is grappling with the virus even as it prepares to host the Olympic Games in Rio de Janeiro in August, with tens of thousands of athletes and tourists anticipated.The U.S. Olympic Committee has told U.S. sports federations that athletes and staff concerned about their health due to Zika should consider not going to the Olympics.

Former Olympian Donald Anthony, president and board chairman of USA Fencing, said, "One of the things that they immediately said was, especially for women that may be pregnant or even thinking of getting pregnant, that whether you are scheduled to go to Rio or no, that you shouldn't go."

“Many people, I’d argue, are experiencing what I’d call a ‘latent’ form of climate anxiety or dread, in that they may not be talking about it much but they are feeling it.”

“The main thing is that we find ways to talk about what we are experiencing in a safe and nonjudgmental context, and to be open to listening. All too often, when anxiety or fear comes up, we all want to push it away and move into ‘solutions.’

The psychological weight of climate change can lead to feelings of helplessness and fear, and to climate disengagement. Not surprisingly, those directly impacted by climate-augmented disasters fare even worse

Another way I cope is by simply burning less fossil fuel. This eliminates internal cognitive dissonance by aligning my actions with my knowledge.

“It’s important to remember that inaction is rarely about a lack of concern or care, but is so much more complex,”

“Namely, that we westerners are living in a society that is still deeply entrenched in the very practices we now know are damaging and destructive. This creates a very specific kind of situation—what psychologists call cognitive dissonance. Unless we know how to work with this dissonance, we will continue to come up against resistance, inaction, and reactivity.

“we need to be careful not to make assumptions about other people’s relationships with these issues. Even if people may not be showing it, research shows again and again that it’s still on their minds and a source of discomfort or distress.”

There are more people in my life talking openly about climate change. And that helps.

In general, suicide is projected to rise dramatically due to climate change; in addition to the psychological toll, our brains don’t respond well physically to excessive heat.

Finally, I actively work to be hope-oriented

Modern climate change is completely different: It’s 100 percent human-caused, so it’s 100 percent human-solvable

this possibility leaves open a middle path, something between sweeping climate action and an unavoidable planetary collision—a rapid cultural shift, one that we all can contribute to through our conversations and our daily actions. And that’s a very hopeful thing.

Sometimes a wave of climate grief breaks over me. It happens unexpectedly

During these moments, I feel with excruciating clarity everything that we’re losing—but also connection and love for those things

Occasionally, however, I feel something quite different, a paralyzing sense of anxiety. This climate dread can last for days, even weeks. It can come with nightmare

n ever

The data also revealed that the death rate was higher among patients with cardiac injury versus those without: 42 of the patients with cardiac injury, or 51.2%, died versus 15 of those without, or 4.5%.

Also, acute inflammatory responses due to an infection can lead to reduced blood flow in patients with preexisting cardiovascular diseases, the researchers noted. They wrote that "based on these lines of evidence, we hypothesize that an intense inflammatory response superimposed on preexisting cardiovascular disease may precipitate cardiac injury."Investigating inflammation

"Even though they're not dying from that cardiac injury, something about that biomarker is providing some prognostic value beyond other risk factors that were controlled, so it could still be important in terms of identifying high-risk patients that enter the hospital with Covid-19," Gump said.

Inflammation appears to be the mechanism that best explains the association between cardiac injury and Covid-19, said Dr. Mohammad Madjid, a cardiologist and assistant professor at McGovern Medical School at UTHealth in Houston.

The finding's in Wednesday's JAMA Cardiology paper "make a lot of sense," Kevin Heffernan, director of the Human Performance Laboratory at Syracuse University in New York, who was not involved in the study, wrote in an email on Wednesday.

A separate study published in the New England Journal of Medicine in 2018 found a significant association between respiratory infections, especially influenza, and acute heart attack, he said.

To better understand that mechanism, Madjid said that he has looked to flu viruses.

"To date, many patients with COVID-19 are still hospitalized in China and other countries, such as Italy and Iran.

Therefore, we should be ready for the reemergence of COVID-19 or other coronaviruses."

To contain such a pathogen, nations must develop a test and use it to identify infected people, isolate them, and trace those they’ve had contact with. That is what South Korea, Singapore, and Hong Kong did to tremendous effect. It is what the United States did not.

That a biomedical powerhouse like the U.S. should so thoroughly fail to create a very simple diagnostic test was, quite literally, unimaginable. “I’m not aware of any simulations that I or others have run where we [considered] a failure of testing,”

The testing fiasco was the original sin of America’s pandemic failure, the single flaw that undermined every other countermeasure. If the country could have accurately tracked the spread of the virus, hospitals could have executed their pandemic plans, girding themselves by allocating treatment rooms, ordering extra supplies, tagging in personnel, or assigning specific facilities to deal with COVID-19 cases.

None of that happened. Instead, a health-care system that already runs close to full capacity, and that was already challenged by a severe flu season, was suddenly faced with a virus that had been left to spread, untracked, through communities around the country.

With little room to surge during a crisis, America’s health-care system operates on the assumption that unaffected states can help beleaguered ones in an emergency.

That ethic works for localized disasters such as hurricanes or wildfires, but not for a pandemic that is now in all 50 states. Cooperation has given way to competition

Partly, that’s because the White House is a ghost town of scientific expertise. A pandemic-preparedness office that was part of the National Security Council was dissolved in 2018. On January 28, Luciana Borio, who was part of that team, urged the government to “act now to prevent an American epidemic,” and specifically to work with the private sector to develop fast, easy diagnostic tests. But with the office shuttered, those warnings were published in The Wall Street Journal, rather than spoken into the president’s ear.

Rudderless, blindsided, lethargic, and uncoordinated, America has mishandled the COVID-19 crisis to a substantially worse degree than what every health expert I’ve spoken with had feared. “Much worse,”

“Beyond any expectations we had,” said Lauren Sauer, who works on disaster preparedness at Johns Hopkins Medicine. “As an American, I’m horrified,” said Seth Berkley, who heads Gavi, the Vaccine Alliance. “The U.S. may end up with the worst outbreak in the industrialized world.”

it will be difficult—but not impossible—for the United States to catch up. To an extent, the near-term future is set because COVID-19 is a slow and long illness. People who were infected several days ago will only start showing symptoms now, even if they isolated themselves in the meantime. Some of those people will enter intensive-care units in early April

The first and most important is to rapidly produce masks, gloves, and other personal protective equipment

A “massive logistics and supply-chain operation [is] now needed across the country,” says Thomas Inglesby of Johns Hopkins Bloomberg School of Public Health. That can’t be managed by small and inexperienced teams scattered throughout the White House. The solution, he says, is to tag in the Defense Logistics Agency—a 26,000-person group that prepares the U.S. military for overseas operations and that has assisted in past public-health crises, including the 2014 Ebola outbreak.

it would also come at a terrible cost: SARS-CoV-2 is more transmissible and fatal than the flu, and it would likely leave behind many millions of corpses and a trail of devastated health systems.

This agency can also coordinate the second pressing need: a massive rollout of COVID-19 tests.

These measures will take time, during which the pandemic will either accelerate beyond the capacity of the health system or slow to containable levels. Its course—and the nation’s fate—now depends on the third need, which is social distancing.

There are now only two groups of Americans. Group A includes everyone involved in the medical response, whether that’s treating patients, running tests, or manufacturing supplies. Group B includes everyone else, and their job is to buy Group A more time. Group B must now “flatten the curve” by physically isolating themselves from other people to cut off chains of transmission.

Given the slow fuse of COVID-19, to forestall the future collapse of the health-care system, these seemingly drastic steps must be taken immediately, before they feel proportionate, and they must continue for several weeks.

Persuading a country to voluntarily stay at home is not easy, and without clear guidelines from the White House, mayors, governors, and business owners have been forced to take their own steps.

when the good of all hinges on the sacrifices of many, clear coordination matters—the fourth urgent need

Pundits and business leaders have used similar rhetoric, arguing that high-risk people, such as the elderly, could be protected while lower-risk people are allowed to go back to work. Such thinking is seductive, but flawed. It overestimates our ability to assess a person’s risk, and to somehow wall off the ‘high-risk’ people from the rest of society. It underestimates how badly the virus can hit ‘low-risk’ groups, and how thoroughly hospitals will be overwhelmed if even just younger demographics are falling sick.

A recent analysis from the University of Pennsylvania estimated that even if social-distancing measures can reduce infection rates by 95 percent, 960,000 Americans will still need intensive care.

There are only about 180,000 ventilators in the U.S. and, more pertinently, only enough respiratory therapists and critical-care staff to safely look after 100,000 ventilated patients. Abandoning social distancing would be foolish. Abandoning it now, when tests and protective equipment are still scarce, would be catastrophic.

If Trump stays the course, if Americans adhere to social distancing, if testing can be rolled out, and if enough masks can be produced, there is a chance that the country can still avert the worst predictions about COVID-19, and at least temporarily bring the pandemic under control. No one knows how long that will take, but it won’t be quick. “It could be anywhere from four to six weeks to up to three months,” Fauci said, “but I don’t have great confidence in that range.”

there are three possible endgames: one that’s very unlikely, one that’s very dangerous, and one that’s very long.

The first is that every nation manages to simultaneously bring the virus to heel, as with the original SARS in 2003. Given how widespread the coronavirus pandemic is, and how badly many countries are faring, the odds of worldwide synchronous control seem vanishingly small.

The second is that the virus does what past flu pandemics have done: It burns through the world and leaves behind enough immune survivors that it eventually struggles to find viable hosts. This “herd immunity” scenario would be quick, and thus tempting

The U.S. has fewer hospital beds per capita than Italy. A study released by a team at Imperial College London concluded that if the pandemic is left unchecked, those beds will all be full by late April. By the end of June, for every available critical-care bed, there will be roughly 15 COVID-19 patients in need of one.  By the end of the summer, the pandemic will have directly killed 2.2 million Americans,

The third scenario is that the world plays a protracted game of whack-a-mole with the virus, stamping out outbreaks here and there until a vaccine can be produced. This is the best option, but also the longest and most complicated.

there are no existing vaccines for coronaviruses—until now, these viruses seemed to cause diseases that were mild or rare—so researchers must start from scratch.

The first steps have been impressively quick. Last Monday, a possible vaccine created by Moderna and the National Institutes of Health went into early clinical testing. That marks a 63-day gap between scientists sequencing the virus’s genes for the first time and doctors injecting a vaccine candidate into a person’s arm. “It’s overwhelmingly the world record,” Fauci said.

The initial trial will simply tell researchers if the vaccine seems safe, and if it can actually mobilize the immune system. Researchers will then need to check that it actually prevents infection from SARS-CoV-2. They’ll need to do animal tests and large-scale trials to ensure that the vaccine doesn’t cause severe side effects. They’ll need to work out what dose is required, how many shots people need, if the vaccine works in elderly people, and if it requires other chemicals to boost its effectiveness.

No matter which strategy is faster, Berkley and others estimate that it will take 12 to 18 months to develop a proven vaccine, and then longer still to make it, ship it, and inject it into people’s arms.

as the status quo returns, so too will the virus. This doesn’t mean that society must be on continuous lockdown until 2022. But “we need to be prepared to do multiple periods of social distancing,” says Stephen Kissler of Harvard.

First: seasonality. Coronaviruses tend to be winter infections that wane or disappear in the summer. That may also be true for SARS-CoV-2, but seasonal variations might not sufficiently slow the virus when it has so many immunologically naive hosts to infect.

Second: duration of immunity. When people are infected by the milder human coronaviruses that cause cold-like symptoms, they remain immune for less than a year. By contrast, the few who were infected by the original SARS virus, which was far more severe, stayed immune for much longer.

scientists will need to develop accurate serological tests, which look for the antibodies that confer immunity. They’ll also need to confirm that such antibodies actually stop people from catching or spreading the virus. If so, immune citizens can return to work, care for the vulnerable, and anchor the economy during bouts of social distancing.

Aspects of America’s identity may need rethinking after COVID-19. Many of the country’s values have seemed to work against it during the pandemic. Its individualism, exceptionalism, and tendency to equate doing whatever you want with an act of resistance meant that when it came time to save lives and stay indoors, some people flocked to bars and clubs.

“We can keep schools and businesses open as much as possible, closing them quickly when suppression fails, then opening them back up again once the infected are identified and isolated. Instead of playing defense, we could play more offense.”

The vaccine may need to be updated as the virus changes, and people may need to get revaccinated on a regular basis, as they currently do for the flu. Models suggest that the virus might simmer around the world, triggering epidemics every few years or so. “But my hope and expectation is that the severity would decline, and there would be less societal upheaval,”

After infections begin ebbing, a secondary pandemic of mental-health problems will follow.

But “there is also the potential for a much better world after we get through this trauma,”

Attitudes to health may also change for the better. The rise of HIV and AIDS “completely changed sexual behavior among young people who were coming into sexual maturity at the height of the epidemic,”

Pandemics can also catalyze social change. People, businesses, and institutions have been remarkably quick to adopt or call for practices that they might once have dragged their heels on, including working from home, conference-calling to accommodate people with disabilities, proper sick leave, and flexible child-care arrangements.

Perhaps the nation will learn that preparedness isn’t just about masks, vaccines, and tests, but also about fair labor policies and a stable and equal health-care system. Perhaps it will appreciate that health-care workers and public-health specialists compose America’s social immune system, and that this system has been suppressed.

Testing kits can be widely distributed to catch the virus’s return as quickly as possible. There’s no reason that the U.S. should let SARS-CoV-2 catch it unawares again, and thus no reason that social-distancing measures need to be deployed as broadly and heavy-handedly as they now must be.

Years of isolationist rhetoric had consequences too.

“People believed the rhetoric that containment would work,” says Wendy Parmet, who studies law and public health at Northeastern University. “We keep them out, and we’ll be okay. When you have a body politic that buys into these ideas of isolationism and ethnonationalism, you’re especially vulnerable when a pandemic hits.”

Pandemics are democratizing experiences. People whose privilege and power would normally shield them from a crisis are facing quarantines, testing positive, and losing loved ones. Senators are falling sick. The consequences of defunding public-health agencies, losing expertise, and stretching hospitals are no longer manifesting as angry opinion pieces, but as faltering lungs.

After COVID-19, attention may shift to public health. Expect to see a spike in funding for virology and vaccinology, a surge in students applying to public-health programs, and more domestic production of medical supplies.

The lessons that America draws from this experience are hard to predict, especially at a time when online algorithms and partisan broadcasters only serve news that aligns with their audience’s preconceptions.

In 2030, SARS-CoV-3 emerges from nowhere, and is brought to heel within a month.

One could easily conceive of a world in which most of the nation believes that America defeated COVID-19. Despite his many lapses, Trump’s approval rating has surged. Imagine that he succeeds in diverting blame for the crisis to China, casting it as the villain and America as the resilient hero.

One could also envisage a future in which America learns a different lesson. A communal spirit, ironically born through social distancing, causes people to turn outward, to neighbors both foreign and domestic. The election of November 2020 becomes a repudiation of “America first” politics. The nation pivots, as it did after World War II, from isolationism to international cooperation

The U.S. leads a new global partnership focused on solving challenges like pandemics and climate change.

“The transitions after World War II or 9/11 were not about a bunch of new ideas,” he says. “The ideas are out there, but the debates will be more acute over the next few months because of the fluidity of the moment and willingness of the American public to accept big, massive changes.”

On the Global Health Security Index, a report card that grades every country on its pandemic preparedness, the United States has a score of 83.5—the world’s highest. Rich, strong, developed, America is supposed to be the readiest of nations. That illusion has been shattered. Despite months of advance warning as the virus spread in other countries, when America was finally tested by COVID-19, it failed.

Neither the advice nor the science were followed that week. My colleagues, led by Neil Ferguson, published a report on 16 March estimating that without strong suppression, 250,000 people could die in the UK. The government responded that day with a recommendation for social distancing, avoiding pubs and working from home if possible. But there was still no enforcement, and it was left up to individuals and employers to decide what to do. Many people were willing but unable to comply as we showed in a report on 20 March. It was only on 23 March that a more stringent lockdown and economic support was announced.

etween 12 and 23 March, tens, if not hundreds of thousands, of people will have been infected.

The current best estimate is that around 1% of those infected will die.

So where to now? Once again, public health experience, including modelling, leads to some very clear recommendations. First, find cases in the community as well as hospitals and care homes; isolate them, and trace their contacts using a combination of local public health teams and digital tools.

Second, know your epidemic. Track the epidemic nationally and locally using NHS, public health and digital surveillance to see where cases are continuing to spread

Build community resilience by providing local support for vulnerable people affected by the virus and the negative impact of the control measures.

Third, ensure transmission is suppressed in hospitals, care homes and workplaces through the right protective equipment, testing, distancing and hygiene

Fourth, ensure that the most vulnerable, socially and medically, are fully protected through simple access to a basic income, rights for migrants, and safety for those affected by domestic violence.

I am not looking to blame – but for scrutiny so that lessons can be learned to guide our response. We need to avoid further mistakes, and ensure that the government is hearing, and acting on, the best advice.

Since then, Bolsonaro has come under heavy fire from Brazilian media and political opponents for what they call his reckless and inept behaviour.

The news magazine Istoé labelled Bolsonaro an “irresponsible ignoramus”. Writing in the same magazine, Carlos José Marques lamented how Brazil’s presidency was now defined by “moral, intellectual and administrative delinquency”.

“Even if he suddenly says: ‘OK guys – I get it,’ it will be very hard for people not to blame him directly for what will happen – and I think it’s very hard to imagine that this will not be terrible for Brazil.”

“But I think damage has already been done because people will remember – now and forever – how the president behaved as the seriousness of this [pandemic] became clear in Brazil.”

Boghossian said Bolsonaro had long believed his presidency was “bullet-proofed” by expectations that Brazil’s economy would improve under his administration. “The problem is that economic meltdown is [now] inevitable,” he said.

New York is conducting more testing per capita than countries such as South Korea, which may partially explain the spike in numbers.

“We need to be smarter about this … we need the federal help and we need it now,” he said, calling on Donald Trump to utilise the Defense Production Act (DPA) to force companies to produce medical equipment and provide them the necessary financial support to do so. So far, the administration has relied on volunteer efforts that Cuomo said were not appropriate for the urgency of crisis.

“What happens to New York is gonna wind up happening to California, and Washington state and Illinois. It’s just a matter of time. We’re just getting there first,” Cuomo said. “Look at us today … where we are today, you will be in four weeks or five weeks or six weeks. We are your future.”

Speaking later in the day, the vice-president, Mike Pence, said the Federal Emergency Management Agency (Fema) had sent New York 2,000 ventilators and plans to send 2,000 more on Wednesday.

He also rejected the suggestion, floated by the president in recent days, that advice from public health officials could be rowed back in a matter of weeks to protect the US economy, saying that sensible steps in both areas could be made now without increasing risk to more vulnerable people in society.

uomo’s urgent message comes as a spokesperson for the World Health Organization (WHO) warned the US has the potential to become the next global hotspot for the pandemic. The country already has more than 46,000 confirmed Covid-19 cases, resulting in close to 600 deaths, according to Johns Hopkins University School of Medicine.

With cases surging, Cuomo said new projections estimate his state will need 140,000 hospital beds once the crisis reaches its apex, which could happen within 14 to 21 days instead of in May as previously forecast.

The outbreak has led to a dramatic change in America’s social fabric: as of Monday, the New York Times estimated that more than 158 million people in 16 states would soon be under strict orders to stay at home – approaching half of the population.

The shift in messaging came after James Bullard, president of the Federal Reserve Bank of St Louis, predicted unemployment could reach 30% nationwide, according to Bloomberg News, and as negotiations for a coronavirus stimulus package dragged on for days in the US Senate. For weeks, suddenly jobless workers have been imploring the government for help, and Trump is staring down what could become a historic recession during an election year.

Even still, medical experts have cautioned against such an abrupt restart to the economy while the virus continues to spread exponentially. “You can’t call off the best weapon we have, which is social isolation, even out of economic desperation, unless you’re willing to be responsible for a mountain of deaths,” Arthur Caplan, founding head of the division of medical ethics at NYU School of Medicine, told the New York Times. “Can’t we try to put people’s lives first for at least a month?”

“If you ask the American people to choose between public health and the economy, then it’s no contest,” Cuomo said. “No American is going to say, accelerate the economy at the cost of human life, because no American is going to say how much a life is worth.”

the coronavirus more often infects clusters of family members, friends and work colleagues,

“You can contain clusters,” Dr. Heymann said. “You need to identify and stop discrete outbreaks, and then do rigorous contact tracing.”

The microphone should not even be at the White House, scientists said, so that briefings of historic importance do not dissolve into angry, politically charged exchanges with the press corps, as happened again on Friday.

Americans must be persuaded to stay home, they said, and a system put in place to isolate the infected and care for them outside the home

Travel restrictions should be extended, they said; productions of masks and ventilators must be accelerated, and testing problems must be resolved.

It was not at all clear that a nation so fundamentally committed to individual liberty and distrustful of government could learn to adapt to many of these measures, especially those that smack of state compulsion.

What follows are the recommendations offered by the experts interviewed by The Times.

they were united in the opinion that politicians must step aside and let scientists both lead the effort to contain the virus and explain to Americans what must be done.

medical experts should be at the microphone now to explain complex ideas like epidemic curves, social distancing and off-label use of drugs.

doing so takes intelligent, rapidly adaptive work by health officials, and near-total cooperation from the populace. Containment becomes realistic only when Americans realize that working together is the only way to protect themselves and their loved ones.

Above all, the experts said, briefings should focus on saving lives and making sure that average wage earners survive the coming hard times — not on the stock market, the tourism industry or the president’s health.

“At this point in the emergency, there’s little merit in spending time on what we should have done or who’s at fault,”

The next priority, experts said, is extreme social distancing.If it were possible to wave a magic wand and make all Americans freeze in place for 14 days while sitting six feet apart, epidemiologists say, the whole epidemic would sputter to a halt.

The virus would die out on every contaminated surface and, because almost everyone shows symptoms within two weeks, it would be evident who was infected. If we had enough tests for every American, even the completely asymptomatic cases could be found and isolated.

The crisis would be over.

Obviously, there is no magic wand, and no 300 million tests. But the goal of lockdowns and social distancing is to approximate such a total freeze.

In contrast to the halting steps taken here, China shut down Wuhan — the epicenter of the nation’s outbreak — and restricted movement in much of the country on Jan. 23, when the country had a mere 500 cases and 17 deaths.Its rapid action had an important effect: With the virus mostly isolated in one province, the rest of China was able to save Wuhan.

Even as many cities fought their own smaller outbreaks, they sent 40,000 medical workers into Wuhan, roughly doubling its medical force.

Stop transmission within cities

the weaker the freeze, the more people die in overburdened hospitals — and the longer it ultimately takes for the economy to restart.

People in lockdown adapt. In Wuhan, apartment complexes submit group orders for food, medicine, diapers and other essentials. Shipments are assembled at grocery warehouses or government pantries and dropped off. In Italy, trapped neighbors serenade one another.

Each day’s delay in stopping human contact, experts said, creates more hot spots, none of which can be identified until about a week later, when the people infected there start falling ill.

South Korea avoided locking down any city, but only by moving early and with extraordinary speed. In January, the country had four companies making tests, and as of March 9 had tested 210,000 citizens — the equivalent of testing 2.3 million Americans.

As of the same date, fewer than 9,000 Americans had been tested.

Fix the testing mess

Testing must be done in a coordinated and safe way, experts said. The seriously ill must go first, and the testers must be protected.In China, those seeking a test must describe their symptoms on a telemedicine website. If a nurse decides a test is warranted, they are directed to one of dozens of “fever clinics” set up far from all other patients.

Isolate the infected

As soon as possible, experts said, the United States must develop an alternative to the practice of isolating infected people at home, as it endangers families. In China, 75 to 80 percent of all transmission occurred in family clusters.

Cellphone videos from China show police officers knocking on doors and taking temperatures. In some, people who resist are dragged away by force. The city of Ningbo offered bounties of $1,400 to anyone who turned in a coronavirus sufferer.

In China, said Dr. Bruce Aylward, leader of the World Health Organization’s observer team there, people originally resisted leaving home or seeing their children go into isolation centers with no visiting rights — just as Americans no doubt would.

In China, they came to accept it.“They realized they were keeping their families safe,” he said. “Also, isolation is really lonely. It’s psychologically difficult. Here, they were all together with other people in the same boat. They supported each other.”

Find the fevers

Make masks ubiquitous

In China, having a fever means a mandatory trip to a fever clinic to check for coronavirus. In the Wuhan area, different cities took different approaches.

In most cities in affected Asian countries, it is commonplace before entering any bus, train or subway station, office building, theater or even a restaurant to get a temperature check. Washing your hands in chlorinated water is often also required.

The city of Qianjiang, by contrast, offered the same amount of money to any resident who came in voluntarily and tested positive

Voluntary approaches, like explaining to patients that they will be keeping family and friends safe, are more likely to work in the West, she added.

Trace the contacts

Finding and testing all the contacts of every positive case is essential, experts said. At the peak of its epidemic, Wuhan had 18,000 people tracking down individuals who had come in contact with the infected.

Dr. Borio suggested that young Americans could use their social networks to “do their own contact tracing.” Social media also is used in Asia, but in different ways

When he lectured at a Singapore university, Dr. Heymann said, dozens of students were in the room. But just before he began class, they were photographed to record where everyone sat.

Instead of a policy that advises the infected to remain at home, as the Centers for Disease and Prevention now does, experts said cities should establish facilities where the mildly and moderately ill can recuperate under the care and observation of nurses.

There is very little data showing that flat surgical masks protect healthy individuals from disease. Nonetheless, Asian countries generally make it mandatory that people wear them.

The Asian approach is less about data than it is about crowd psychology, experts explained.All experts agree that the sick must wear masks to keep in their coughs. But if a mask indicates that the wearer is sick, many people will be reluctant to wear one. If everyone is required to wear masks, the sick automatically have one on and there is no stigma attached.

Also, experts emphasized, Americans should be taught to take seriously admonitions to stop shaking hands and hugging

Preserve vital services

Only the federal government can enforce interstate commerce laws to ensure that food, water, electricity, gas, phone lines and other basic needs keep flowing across state lines to cities and suburbs

“I sense that most people — and certainly those in business — get it. They would prefer to take the bitter medicine at once and contain outbreaks as they start rather than gamble with uncertainty.”

Produce ventilators and oxygen

The manufacturers, including a dozen in the United States, say there is no easy way to ramp up production quickly. But it is possible other manufacturers, including aerospace and automobile companies, could be enlisted to do so.

Canadian nurses are disseminating a 2006 paper describing how one ventilator can be modified to treat four patients simultaneously. Inventors have proposed combining C-PAP machines, which many apnea sufferers own, and oxygen tanks to improvise a ventilator.

One of the lessons of China, he noted, was that many Covid-19 patients who would normally have been intubated and on ventilators managed to survive with oxygen alone.

Retrofit hospitals

In Wuhan, the Chinese government famously built two new hospitals in two weeks. All other hospitals were divided: 48 were designated to handle 10,000 serious or critical coronavirus patients, while others were restricted to handling emergencies like heart attacks and births.

Wherever that was impractical, hospitals were divided into “clean” and “dirty” zones, and the medical teams did not cross over. Walls to isolate whole wards were built

Decide when to close schools

Recruit volunteers

China’s effort succeeded, experts said, in part because of hundreds of thousands of volunteers. The government declared a “people’s war” and rolled out a “Fight On, Wuhan! Fight On, China!” campaign.

Many people idled by the lockdowns stepped up to act as fever checkers, contact tracers, hospital construction workers, food deliverers, even babysitters for the children of first responders, or as crematory workers.

“In my experience, success is dependent on how much the public is informed and participates,” Admiral Ziemer said. “This truly is an ‘all hands on deck’ situation.”

Prioritize the treatments

Clinicians in China, Italy and France have thrown virtually everything they had in hospital pharmacies into the fight, and at least two possibilities have emerged that might save patients: the anti-malaria drugs chloroquine and hydroxychloroquine, and the antiviral remdesivir, which has no licensed use.

An alternative is to harvest protective antibodies from the blood of people who have survived the illness,

The purified blood serum — called immunoglobulin — could possibly be used in small amounts to protect emergency medical workers, too.

“Unfortunately, the first wave won’t benefit from this,” Dr. Hotez said. “We need to wait until we have enough survivors.”Find a vaccine

testing those candidate vaccines for safety and effectiveness takes time.

The roadblock, vaccine experts explained, is not bureaucratic. It is that the human immune system takes weeks to produce antibodies, and some dangerous side effects can take weeks to appear.

After extensive animal testing, vaccines are normally given to about 50 healthy human volunteers to see if they cause any unexpected side effects and to measure what dose produces enough antibodies to be considered protective.

If that goes well, the trial enrolls hundreds or thousands of volunteers in an area where the virus is circulating. Half get the vaccine, the rest do not — and the investigators wait. If the vaccinated half do not get the disease, the green light for production is finally given.

In the past, some experimental vaccines have produced serious side effects, like Guillain-Barre syndrome, which can paralyze and kill. A greater danger, experts said, is that some experimental vaccines, paradoxically, cause “immune enhancement,” meaning they make it more likely, not less, that recipients will get a disease. That would be a disaster.

One candidate coronavirus vaccine Dr. Hotez invented 10 years ago in the wake of SARS, he said, had to be abandoned when it appeared to make mice more likely to die from pneumonia when they were experimentally infected with the virus.

Reach out to other nations

The allowance for surgical masks made more sense when scientists initially thought the virus was spread by large droplets. But a growing body of research shows that it is spread by minuscule viral particles that can linger in the air as long as 16 hours.

A properly fitted N95 respirator will block 95% of tiny air particles – down to 0.3 micron in diameter, which are the hardest to catch – from reaching the wearer’s face. But surgical masks, designed to protect patients from a surgeon’s respiratory droplets, aren’t effective at blocking particles smaller than 100 microns, according to the mask maker 3M. A Covid-19 particle is smaller than 0.1 micron, according to South Korean researchers, and can pass through a surgical mask.

The CDC’s recent advice on surgical masks contrasts with another CDC web page that says surgical masks do “NOT provide the wearer with a reliable level of protection from inhaling smaller airborne particles and is not considered respiratory protection”.

A 2013 Chinese study found that twice as many health workers, 17%, contracted a respiratory illness if they wore only a surgical mask while treating sick patients, compared to 7% who continuously used an N95, per a study in the American Journal of Respiratory and Critical Care Medicine.

Earlier this month, the national Teamsters Union reported that 64% of its healthcare worker membership – which includes people working in nursing homes, hospitals and other medical facilities – could not get N95 masks.

said Katie Scott, an RN at the hospital and vice-president of the Michigan Nurses Association. Employees who otherwise treat Covid-19 patients receive surgical masks.

That matches CDC protocol, but leaves nurses like Scott – who has read the research on surgical masks versus N95s – feeling exposed.

At Michigan Medicine, employees are not allowed to bring in their own protective equipment, according to a complaint the nurses’ union filed with the Michigan Occupational Safety and Hazard Administration. Scott said friends and family have mailed her personal protective equipment (PPE), including N95 masks. It sits at home while she cares for patients.

“To think I’m going to work and am leaving this mask at home on my kitchen table, because the employer won’t let me wear it,”

News reports from Kentucky to Florida to California have documented nurses facing retaliation or pressure to step down when they’ve brought their own N95 respirators.

In New York, the center of the US’s outbreak, nurses across the state report receiving surgical masks, not N95s, to wear when treating Covid-19 patients, according to a court affidavit submitted by Lisa Baum, the lead occupational health and safety representative for the New York State Nurses Association (NYSNA).

White House to invoke the Defense Production Act, a Korean war-era law that allows the federal government, in an emergency, to direct private business in the production and distribution of goods.

provide health care workers with protective equipment, including N95s masks, when they interact with patients suspected to have Covid-19.

“Nurses are not afraid to care for our patients if we have the right protections,” said Bonnie Castillo, the executive director of National Nurses United, “but we’re not martyrs sacrificing our lives because our government and our employers didn’t do their job.”

"We can't claim victory prematurely," he said. "Everybody, including myself, has some degree of Covid-19 fatigue, but the thing we try and emphasize is that this will end."

The agency said it still advises fully vaccinated people to wear masks outdoors and to take precautions until more is known about how vaccines protect against coronavirus.

Fauci's comments echoed those of President Joe Biden from earlier this week. Biden said Monday that "now is not the time" to ease social restrictions

People who have had both Covid-19 shots can gather indoors without wearing masks, meaning that the celebration can be held with some semblance of normality.

The spike is causing tension between the White House and some state governors who are pushing ahead with relaxed restrictions. Arkansas Gov. Asa Hutchinson said Tuesday he was lifting the state's mask mandate, while Alabama's Kay Ivey plans to do the same next week. New Orleans city leaders said Wednesday that they were relaxing capacity limit caps on gatherings. Meanwhile, Florida has welcomed crowds of spring breakers -- many of whom are unvaccinated and maskless.

The protection offered by the Pfizer and Moderna coronavirus vaccines is likely to last longer than six months, and maybe even years, vaccine experts told CNN, after data was released showing good protection half a year after people were inoculated.

The British medicines watchdog has identified 30 cases of rare blood clots in people who have received the AstraZeneca Covid-19 vaccine -- 25 more than previously reported -- but none with the Pfizer/BioNTech shot.

the UK's Medicines and Healthcare products Regulatory Agency (MHRA) said it received 22 reports of cerebral venous sinus thrombosis and eight reports of other thrombosis events, out of a total of 18.1 million doses of the vaccine

The MHRA said people should continue to get the AstraZeneca vaccine, because the benefits greatly outweigh the risks.

Germany has this week limited the AstraZeneca vaccine to people over 60, following reports of a rare blood clot in the brains of 31 people who had received a first dose in the country.

Side effects from Covid-19 vaccines won't last long

ast summer hospitals said it was too hard to comply with the new rule while they were dealing with the pandemic. They still managed to continue the appeal of their lawsuit against the measure, which failed in December. The rule took effect, but the penalty for not complying is just $300 a day — a pittance for hospitals — and there is no meaningful mechanism for active enforcement. The hospitals have asked the Biden administration to revise the requirement.

In September his health secretary, Alex Azar, certified that importing prescription medicine from Canada “poses no additional risk to the public’s health and safety” and would result in “a significant reduction in the cost.” This statement, which previous health secretaries had declined to make, formally opened the door to importing medication. Millions of Americans, meanwhile, now illegally purchase prescription drugs from abroad because they cannot afford to buy them at home.

The Trump administration’s attempted market-based interventions shined some light on dark corners of the health market and opened the door to some workarounds. They are not meaningful substitutes for larger and much-needed health reform. But as Americans await the type of more fundamental changes the Democrats have promised, they need every bit of help they can get.

Finally, shortly before the election, Mr. Trump issued an executive order paving the way for a “most favored nation” system that would ensure that the prices for certain drugs purchased by Medicare did not exceed the lowest price available in other developed countries. The industry responded with furious pushback, and a court quickly ruled against the measure.

Biden may want to continue the previous administration’s efforts to lower drug prices and make medical costs transparent.

But the Trump administration did attempt to rein in some of the most egregious pricing in the health care industry. For example, it required most hospitals to post lists of their standard prices for supplies, drugs, tests and procedures. Providers had long resisted calls for such pricing transparency, arguing that this was a burden, and that since insurers negotiated and paid far lower rates anyway, those list prices didn’t really matter.

ut the drug lobby will no doubt prove a big obstacle: The Pharmaceutical Research and Manufacturers of America, an industry trade group, filed suit in federal court in November to stop the drug-purchasing initiatives. The industry has long argued that importation from even Canada would risk American lives.

A study by the C.D.C., published in February, examined the Pfizer-BioNTech and Moderna vaccines and found that 79 percent of the reports to the agency of side effects came from women, even though only 61 percent of the vaccines had been administered to women.

The best evidence that we do have is the observable track record of the foundation, both good and bad. Ultimately, any organization’s most senior management is responsible for its operations — and that includes Melinda. So when the foundation pours nonrepayable, tax-privileged grants on the world’s wealthiest pharmaceutical companies, or when it defends a global patent system that makes lifesaving medicines needlessly expensive in both poor and rich nations, the buck doesn’t just stop with Bill, but with Melinda too.

his deal-making left many people aghast. It seemed to conflict with the Gates Foundation’s stated mission to improve global access to medicines, but it’s not surprising to those who’ve long followed the foundation’s proclivity to lend big pharma a helping hand. Recently, Melinda told The Times that vaccine makers like Pfizer and AstraZeneca “should make a small profit, because we want them to stay in business.”

A cascade of countries — Italy, France and Spain — soon joined the decision to suspend AstraZeneca, dealing a significant blow to Europe’s already shaky inoculation drive despite a lack of clear evidence that the vaccine had caused any harm.

“There is an emotional situation that is the fallout from this case that started in Germany,” Giorgio Palù, the president of Italy’s Medicines Agency said on Tuesday. He said: “There is no danger. There is no correlation at the epidemiological level.”

The agency’s director was more explicit.

But for now, the suspensions seem certain to have had the opposite effect, further delaying Europe’s stumbling rollout and perhaps putting at risk hundreds or thousands more lives.

goal of vaccinating 70 percent of residents by September, and raise pressure on governments to secure vaccines that have not yet been authorized by the bloc’s regulators.

Suspending use of the vaccine is a “temporary precaution” while countries wait for the European Medicines Agency’s assessment, the statement said.

But Monday’s decisions may have already set back Europe’s vaccination campaign at a perilous moment of the pandemic, as the continent confronts a third wave of infections driven by new variants.

It is not yet known whether those conditions were related to vaccines, either.

European countries have not been weighing a decision about just any vaccine. Their concerns center on AstraZeneca, a company with which they have had poisonous relations since it drastically scaled back projected vaccine deliveries for the early part of 2021.

That decision may come back to haunt European lawmakers: Britain, which has given the vaccine to all adults, has since showed that a first dose substantially reduced the risk of older people becoming ill with Covid-19.

Just as European Union member states broke with the bloc’s centralized drug regulator in initially restricting the vaccine to younger people, they split with regulators a second time in pausing rollouts altogether this week. Analysts said that reflected a growing impatience with the bloc’s bureaucracy in the midst of a disastrously slow vaccine rollout.

There was a case of thrombosis detected in Spain last weekend, and some regions had stopped distributing a batch of AstraZeneca vaccines, amid safety concerns.

But the chief motivation was political.

When Mr. Speranza brought the issue to Prime Minister Draghi, he noted the unbearable public pressure Italy would face if it alone used a vaccine considered too dangerous for Europe.

As the damage of the delays became clear on Tuesday, European officials tried to play down the disruption. They said they were only waiting for European regulators to complete a fast review of the problems before they began vaccinating people with the AstraZeneca shot again.

“It’s right regulators investigate safety signals,” said Michael Head, a senior research fellow in global health at the University of Southampton. “But pausing a vaccine rollout during a pandemic, when there’s a lot of Covid-19 around, is quite a dramatic decision to make — and I’m not seeing why you would do it.”