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U.S. life expectancy has been below that of other advanced countries for a long time.

The death gap has, however, widened considerably in recent years as a result of increased mortality among working-age Americans. This rise in mortality has, in turn, been largely a result of rising “deaths of despair”: drug overdoses, suicides and alcohol. And the rise in these deaths has led to declining overall life expectancy for the past few years.

In 1990, today’s red and blue states had almost the same life expectancy. Since then, however, life expectancy in Clinton states has risen more or less in line with other advanced countries, compared with almost no gain in Trump country.

blue-state residents can expect to live more than four years longer than their red-state counterparts.

Consider our four most populous states. In 1990, Texas and Florida had higher life expectancy than New York and almost matched California; today, they’re far behind.

there has been a striking divergence in behavior and lifestyle that must be affecting mortality. For example, the prevalence of obesity has soared all across America since 1990, but obesity rates are significantly higher in red states.

the facts are utterly inconsistent with the conservative diagnosis of what ails America.

The secularist assault on traditional values, Barr claims, lies behind “soaring suicide rates,” rising violence and “a deadly drug epidemic.”

But European nations, which are far more secularist than we are, haven’t seen a comparable rise in deaths of despair and an American-style decline in life expectancy

within America these evils are concentrated in states that voted for Trump, and have largely bypassed the more secular blue states.

But I do think it’s going to be a while before this virus becomes completely normal. And I’ve never been convinced that this current generation of elderly people will ever get to a place where it is completely normal. If you’re 65 or 75 or even older — it’s really hard to teach an immune system new tricks if you’re that age

And so while we may see excess mortality in the elderly decline somewhat, I don’t think we’ll see it ever disappear for this generation who was already old when the pandemic hit. Many will never develop that robust, long-term immunological memory we would want to see — and which happens naturally to someone who’s been exposed hundreds of times since they were a little baby.

There’s a similar story with measles. There is no routine later-life sequelae, like shingles, for measles. But what we do see is that, in measles outbreaks today, there are some people who were vaccinated who get it anyway. Maybe 5 to 15 percent of cases are not immunologically naïve people, but vaccinated people.

Is it really the case that, as babies, we are fighting off those viruses hundreds of times?The short answer is yeah. We start seeing viruses when we’re 2 months old, when we’re a month old. And a lot of these viruses we’ve seen literally tens, if not hundreds of times for some people by the time we’re adults. People tend to think that immunity is binary — you’re either immune or you’re not. That couldn’t be farther from the truth. It’s a gradient, and your protection gets stronger the more times you see a virus.

We used to think we just had this spectacular immune response when we first encountered the virus at, say, age 6, and that the immune response lasted until we were 70. But actually what we were seeing was the effect of an immune system being retrained every time it came into contact with the virus after the initial infection — at 6, and 7, and 8, and so on. Every time your friend got chickenpox, or your neighbor, you got a massive boost. You were re-upping your immune response and diversifying your immunological tools — potentially multiple times a year, a kind of natural booster.

But now, in America, kids get chickenpox vaccines. So you don’t have kids in America getting chickenpox today, and never will. But that means that older Americans, who did get it as kids, are not being exposed again — certainly not multiple times each year. And it turns out that, in the absence of routine re-exposures, that first exposure alone isn’t nearly as good at driving lifelong immunity and warding off shingles until your immune system begins to fall apart in old age — it can last until you’re in your 30s, for example but not until your 70s.

With Covid, when it infects you, it can land in your upper respiratory tract and it just start replicating right there. Immediately, it’s present and replicating in your lungs and in your nose. And that alone elicits enough of an immune response to cause us to feel really crappy and even cause us to feel disease.

But we could have just set the narrative better at the beginning: Look, you might get sick again, but your risk of landing in the hospital is going to be really low, and if you get a booster, you might still get sick again, but your risk of landing in the hospital is going to be even lower. That’s something I think humans can deal with, and I think the public could have understood it.

But it’s why we don’t see the severe disease as much, with a second exposure or an exposure after vaccination: For most people, it’s not getting into the heart and the liver and stuff nearly as easily.

But it doesn’t have to. It’s still causing symptomatic disease. And maybe mucosal vaccines could stop this, but without them we’re likely to continue seeing infections and even symptomatic infections.

through most of 2020 and into 2021, though. Back then, I think the conventional wisdom was that a single exposure — through infection or vaccination — would be the end of the pandemic for you. If this is basic virology and immunology, how did we get that so wrong?

The short answer is that epidemiologists are not immunologists and immunologists are not virologists and virologists are not epidemiologists. And, in general, physicians don’t know anything about the details.

But this failure had some pretty concrete impacts. When reinfections first began popping up, people were surprised, they were scared, and then, to some degree, they lost trust in vaccines. And the people they were turning to for guidance — not only did they not warn us about that, they were slow to acknowledge it, as well.

It had dramatic impacts and ripple effects that will last for years to limit our ability to get populations properly vaccinated.

the worst thing we can do during a pandemic is set inappropriately high expectations. These vaccines are incredible, they’ve had an enormously positive impact on mortality, but they were never going to end the pandemic.

And now, there’s a huge number of people questioning, do these vaccines even do anything?

For babies born today, though, I really think they’re not going to view Covid as any different than other viruses. By the time they are 20, it will be like any other virus to them. Because their immune systems will have grown up with it.

Instead, we set society up for failure, since people feel like the government failed everyone, that biology failed us, and that this was a crazy virus that has broken all the rules of our immune system, when it’s just doing what we’ve always known it would do.

How do you wish we had messaged things differently? What would it have meant to communicate early and clearly that Covid was a textbook virus, as you say?I think the biggest thing would have been just to say, we understand the enemy.

To say that this is a textbook virus, it doesn’t mean that it’s not killing people. Objectively, it’s still killing more people than any other infectious disease

What it means is that we could’ve taken action based on what we knew, rather than waiting around to prove everything and publish papers in Nature and Science talking about things we already knew.

We could have prepared for November and December of 2020 and then for November and December of 2021. But everyone kept saying, we don’t know if it’s going to come back. We knew it was going to come back and it makes me want to cry to think about it. We did nothing and hundreds of thousands of people died. We didn’t prepare nursing homes because we all got to the summer of 2020 and we said, cross our fingers.

We knew how tests worked. We knew about serial testing and why it was important for a public health approach. We knew that vaccines could have really good impacts once they were around. And if you were looking through the correct lens, we even knew that they weren’t going to stop transmission.

We didn’t have to live in a world where we were flying blind. We could have lived in a world where we’re knowledgeable. But instead, we chose almost across the board to will ourselves into this state of fear and anxiety.

And that really started in the earliest days. Almost the first experience I had was a lot like that movie with Jennifer Lawrence —Don’t Look Up.

none of this was complicated. You just had to ask a simple question: what would happen if you took away all immunity from an adult? Well, once you control for no immunity, adults are going to get very, very sick.

Of course, by and large, babies didn’t get very sick from this disease.Babies are immunologically naïve, but they are also resilient. A virus can tear up a baby, but a baby can repair its tissue so fast. Adults don’t have that. It’s just like a baby getting a cut. They’ll heal really quick

An adult getting a cut — you go by age, and every decade of age that you are, it’s going to take exponentially longer for that wound to heal. Eventually get to 80 or 90 and the wound can’t even heal. In the immunology world, this is called “tolerance.”

why are all these organ systems getting damaged when other viruses don’t seem to do that? It’s natural to think, it’s Covid — this is a weird disease. But it’s much more a story about immunity and how it develops than about the virus or the disease. None of our organ systems had any immune defenses around to help them out. And I think that the majority of post-acute sequelae and multi-organ complications and long Covid — they are not the result of the virus being a crazy different virus, but are a result of this virus replicating in an environment where there were such absent or exceedingly low defenses.

Is it the same whenever we encounter a virus for the first time?Think about travelers. Travelers get way more sick from a local disease than people who grew up with that virus. If you get malaria as a traveler, you’re much more likely to get really sick. You don’t see everyone in Nicaragua taking chloroquine every day. But you definitely see travelers taking it, because malaria can be deadly for adults.

What about, not severity, but post-acute complications — do we have long malaria? Do we have liver complications from dengue?

The really hard part of answering that question is there’s just not enough data on the frequency of long-term effects, because nothing like this has ever happened at such scale. It’s like everyone in Europe and North America suddenly traveled to a country where malaria was endemic.

Or think about H.I.V. It essentially kills your immune system, and once the immune barriers are down, other viruses that used to infect humans would get into tissues that we didn’t like them to get into. If there wasn’t such a clear signal of a loss of CD-4 T cells to explain it, people might still be scratching their heads and going, man, I wonder why all these patients are getting fungal infections. Well, there’s a virus there that’s depleting their immune system.

Covid is absolutely waking the world up to this — to the fact that there are really weird long-term sequelae to viruses when they infect organ systems that would normally be protected. And I think we’re going to find that more and more cancers are being attributed to viral infections.

It wasn’t that long ago that we first learned that most cases of cervical cancer were caused by H.P.V. — I think the 1980s. And now we have a vaccine for H.P.V. and rates of cervical cancer have fallen by two-thirds.

what about incidence? We’ve talked at a few points about how important it is to think about all of these questions in terms of the scale. What is the right scale for thinking about future long Covid, for instance, or other post-acute sequelae?

I think the absolute risk, per infection, is going down and down and down. That’s just true.

he U.K.’s Office of National Statistics, which shows a much lower risk of developing long Covid now, from reinfection, than from an initial infection earlier in the pandemic.

the worst is definitely behind us, which is a good thing, especially for people who worry that the problems will keep building and a lot of people — or even everyone — will get long Covid symptoms. I don’t think there’s a world where we’re looking at the babies of today dealing with long Covid at any meaningful scale.

a lot of the fear right now comes from the worst cases, and there’s a lot of worst cases. Even one of the people that I know well, I know in their mind they’re worried that they’ll never recover, but I think objectively they are recovering slowly. It might not be an eight month course. It might be a year and a half. But they will get better. Most of us will.

consider extreme poverty. It too has reached a record low, affecting a bit more than 8 percent of humans worldwide,

All these figures are rough, but it seems that about 100,000 people are now emerging from extreme poverty each day — so they are better able to access clean water, to feed and educate their children, to buy medicines.

If we want to tackle problems — from the war in Gaza to climate change — then it helps to know that progress is possible.

Two horrifying diseases are close to eradication: polio and Guinea worm disease. Only 12 cases of wild poliovirus have been reported worldwide in 2023 (there were also small numbers of vaccine-derived polio, a secondary problem), and 2024 may be the last year in which wild polio is transmitted

Meanwhile, only 11 cases of Guinea worm disease were reported in humans in the first nine months of 2023.

the United States government recently approved new CRISPR gene-editing techniques to treat sickle cell disease — and the hope is that similar approaches can transform the treatment of cancer and other ailments

Another landmark: New vaccines have been approved for R.S.V. and malaria

Blinding trachoma is also on its way out in several countries. A woman suffering from trachoma in Mali once told me that the worst part of the disease wasn’t the blindness but rather the excruciating pain, which she said was as bad as childbirth but lasted for years. So I’m thrilled that Mali and 16 other countries have eliminated trachoma.

The rate of firearm homicides was 20 times higher in the United States than in the other countries, according to the report, which cited a 2011 study of 23 countries. And though suicide rates were lower in the United States, firearm suicide rates were six times higher.

Panelists were surprised at just how consistently Americans ended up at the bottom of the rankings. The United States had the second-highest death rate from the most common form of heart disease, the kind that causes heart attacks, and the second-highest death rate from lung disease, a legacy of high smoking rates in past decades. American adults also have the highest diabetes rates.

Youths fared no better. The United States has the highest infant mortality rate among these countries, and its young people have the highest rates of sexually transmitted diseases, teen pregnancy and deaths from car crashes. Americans lose more years of life before age 50 to alcohol and drug abuse than people in any of the other countries.

The United States is a bigger, more heterogeneous society with greater levels of economic inequality, and comparing its health outcomes to those in countries like Sweden or France may seem lopsided. B

the U.S. ranked near and at the bottom in almost every heath indicator. That stunned us.”

The panel sought to explain the poor performance. It noted the United States has a highly fragmented health care system, with limited primary care resources and a large uninsured population. It has the highest rates of poverty among the countries studied.

In the other countries, more generous social safety nets buffer families from the health consequences of poverty, the report said.

Could cultural factors like individualism and dislike of government interference play a role? Americans are less likely to wear seat belts and more likely to ride motorcycles without helmets.  

Americans also had the lowest probability over all of surviving to the age of 50. The report’s second chapter details health indicators for youths where the United States ranks near or at the bottom. There are so many that the list takes up four pages.

the panelists point out that this country spends more on health care than any other in the survey. And as recently as the 1950s, Americans scored better in life expectancy and disease than many of the other countries in the current study.

What is a reasonable “income floor” above which we should hope all people worldwide live? At the moment, we define $1.25 as extreme poverty and $2 as poverty, plain and simple.

Pritchett suggests the global floor should be something closer to the poverty lines of rich countries—around $15 per day. Other economists have suggested the “global middle class” bottoms out at an income of around $10 per day.

those living on more than $2 a day in developing countries see infant mortality rates five times those of the poorest and most deprived areas of rich countries. It’s possible to reduce death rates considerably using very cheap techniques, from bed nets to vaccines, but at some point the approaches start getting more expensive. 

The global median income is around $3 to $4 a day. Despite the fact that 50 percent of the population of the planet lives on less than that today, that’s still an insufficient floor.

Worldwide, somewhere shy of 2 billion make it over the $10 line. But only about two percent (PDF) of sub-Saharan Africa lives on more than $10 a day, compared with 51 percent who live at more than $1.25 a day

until you get above $10 per day, high-income economies still see a very small proportion of their population in “global poverty.”

According to the World Bank, current world GDP is about $76.4 trillion, of which about 62 percent is consumed by households. If all 7 billion people on the planet lived on $10 a day, that would take $26 trillion, or (give or take) a $41 trillion global economy

If it weren’t for the incredible size of global income disparities, you could shrink the world’s economy, reduce our environmental footprint, and still get everyone over the poverty line.

There’s a lot more to quality of life than income. In fact, the greatest development success of the past 60 years has been to make the quality of life cheaper. 

As Watts puts the point, the principal purpose of his book is to allow “readers to better appreciate the serious problems that result both from politicians who breach a republic’s political norms and from citizens who choose not to punish them for doing so.

In Watts’s telling of the Roman Republic’s agonizing death, slow-moving structural transformations gradually sowed the seeds of demise.

As the population exploded and the economy became ever more sophisticated, the growing share of poor citizens started to demand redress. But since the institutions of the republic were dominated by patricians who had much to lose from measures like land reform, they never fully addressed the grievances of ordinary Romans.

With popular rage against increasingly dysfunctional institutions swelling, ambitious patricians, determined to outflank their competitors, began to build a fervent base of support by making outsize promises. It was these populares — populists like Tiberius Gracchus and his younger brother Gaius — who, in their bid for power, first broke some of the republic’s most longstanding norms.

The transformation of Rome’s army compounded the challenge of growing inequality. In the early days of the republic, soldiers thought of their participation in military service as a civic duty. Commanders hoped to win great honors and perhaps to attain higher office

But by the late second century B.C., the army had essentially been privatized. Commanders knew that the plunder of new lands could garner them vast riches. Their soldiers signed up for the ride in the hope of gaining a generous allotment of land on which to start a farm.

It took a long time for these tensions to build. But once they reached a critical point, Rome’s descent into chaos and dysfunction was astonishingly swift.

During the century and a half between the days of Pyrrhus and the rise of Tiberius Gracchus, there had not been a single outbreak of large-scale political violence. Then Tiberius pushed through land reforms in defiance of the Senate’s veto. In the ensuing fracas, he and hundreds of his followers were murdered. The taboo on naked power politics had been broken, never to recover

“Within a generation of the first political assassination in Rome, politicians had begun to arm their supporters and use the threat of violence to influence the votes of assemblies and the election of magistrates. Within two generations, Rome fell into civil war.”

If we are to avoid the fate that ultimately befell Rome, Watts cautions, it is “vital for all of us to understand how Rome’s republic worked, what it achieved and why, after nearly five centuries, its citizens ultimately turned away from it and toward the autocracy of Augustus.”

the sheer repetitiveness of the calamities that befell Rome only serves to underline the book’s most urgent message.

Like the original populist, Trump was propelled to power by the all-too-real failures of a political system that is unable to curb growing inequality or to mobilize its most eminent citizens around a shared conception of the common good.

And like Gracchus, Trump believes that, because he is acting in the name of the dispossessed, he is perfectly justified in shredding the Republic’s traditions.

Far from single-handedly destroying our political system, he is the transitional figure whose election demonstrates the extent to which the failings of our democracy are finally starting to take their toll

The bad news is that the coming decades are unlikely to afford us many moments of calm and tranquillity.

If the central analogy that animates “Mortal Republic” is correct, the current challenge to America’s political system is likely to persist long after its present occupant has left the White House.

Mr. Obama’s reading lists are peppered with science and science fiction titles such as Elizabeth Kolbert’s “The Sixth Extinction,” Atul Gawande’s “Being Mortal” and Liu Cixin’s “The Three-Body Problem.”

But Mr. Obama’s grasp of real science before becoming president was sketchy. He once admitted to a room full of scientists to not doing “well enough in chemistry or physics to impress you much on those topics.” And some scientists who met Mr. Obama before the presidency said they were not wowed by his grasp of their fields.

“He’s an academic, he’s one of us,” Dr. Varmus said. “He’s a rational, levelheaded guy who makes decisions based on the evidence. Now, that might actually be a deficiency as a politician.”

Many individuals who get coronavirus will experience nothing worse than seasonal flu symptoms, but the overall profile of the disease, including its mortality rate, looks more serious. At the start of an outbreak the apparent mortality rate can be an overestimate if a lot of mild cases are being missed. But Bruce Aylward, a WHO expert, who led an international mission to China to learn about the virus and the country’s response, said this has not been the case with Covid-19. The evidence did not suggest that we were only seeing the tip of the iceberg. If borne out by further testing, this could mean that current estimates of a roughly 1% fatality rate are accurate. This would make Covid-19 about 10 times more deadly than seasonal flu, which is estimated to kill between 290,000 and 650,000 people a year globally.

For flu, some hospital guidelines define exposure as being within six feet of an infected person who sneezes or coughs for 10 minutes or longer. However, it is possible to be infected with shorter interactions or even by picking the virus up from contaminated surfaces, although this is thought to be a less common route of transmission.

Scientists were quick out of the gates in beginning development of a vaccine for the new coronavirus, helped by the early release of the genetic sequence by Chinese researchers. The development of a viable vaccine continues apace, with several teams now testing candidates in animal experiments. However, the incremental trials required before a commercial vaccine could be rolled out are still a lengthy undertaking – and an essential one to ensure that even rare side-effects are spotted. A commercially available vaccine within a year would be quick.’

Multiple times throughout Friday's press briefing, the President claimed the current situation was unprecedented and unforeseen. According to Trump, "nobody was prepared for this," not even past presidents. He added, "In all fairness to all of the former presidents, none of them ever thought a thing like this could happen."

This is false. The US intelligence community and public health experts had warned for years that the country was at risk from a pandemic. Experts had also warned that the country would face shortages of critical medical equipment, such as ventilators, if a pandemic occurred.

Trump said of the coronavirus: "You can call it a germ, you can call it a flu, you can call it a virus, you know you can call it many different names. I'm not sure anybody even knows what it is."

You cannot accurately call the coronavirus "a flu." They are, simply, different viruses with different characteristics, though they share some symptoms the coronavirus has a much higher mortality rate.

it's significantly more serious" -- with a mortality rate approximately 10 times higher than the 0.1% for the flu. It's also obviously untrue that there is not "anybody" who knows what the coronavirus is.

In fact, it appears, the data suggest, the overall battle-death toll in modern organized societies is exponentially higher than in hunter–gatherer societies surveyed during the past 200 years.

compared annual war deaths for 11 chimpanzee communities, 24 hunter–gatherer or other nonstate groups and 19 and 22 countries that fought in World Wars I and II, respectively

People, their data show, have evolved to be more violent than chimps. And, despite high rates of violent death in comparison with population size, nonstate groups are on average no more or less violent than those living in organized societies.

The outsize rise in total war-related deaths associated with larger groups of people may be due, in part, to the advances in weaponry and military strategy that come with increased communication and collaboration: A similar degree of violent behavior enacted by a similar number of people just does more damage on a nuclear scale than it ever could with axes and spears

Pinker points out many anthropologists are committed to some version of the noble savage theory—the idea that in the wild humans are innately good, only to be corrupted by society and civilization. Falk acknowledges this, in part, motivated her to undertake the study. “As anthropologists we were primarily concerned about the negative portrayal of small-scale societies as more violent than “civilized” state dwellers.”

Pinker cites a number of trends through history he feels support the idea that despite the seemingly continual carnage in the world, we have actually inched toward a more civil society. Our transition from hunter–gatherers to farmers is thought to have reduced violent death fivefold; between the Middle Ages and the 20th century, Europe saw a 10- to 50-fold drop in murder; and in the 70-plus years since World War II warring among the leading powers has for the most part stopped, a first in the history of civilization.

None of this gives Falk much comfort when it comes to mass-scale war and mortality, given that modern weaponry can inflict sky-high total death counts. Astronomical death tolls can be tallied in a matter of days, even minutes, not decades. “All it would take is for one homicidal leader—who we know exists—to unleash a weapon of mass destruction,” she warns. “The 70-odd years that have transpired since World War II is a proverbial drop in the bucket compared with the five [million] to seven million years humans and our ancestors have been around. The probability of World War III is not negligible.”

Case and Deaton report that poor health is becoming more common for each new generation of middle-aged, less-educated white Americans. And they are going downhill faster.

Case said the new research found a “sea of despair” across America. A striking feature is the rise in physical pain.

The nation’s obesity epidemic may be another sign of stress and physical pain, she continued: “People may want to soothe the beast. They may do that with alcohol, they may do that with drugs, they may do that with food.”

white men today are about twice as likely as they were in 1999 to die from one of the “diseases of despair,” while women are about four times as likely.

ess-educated white Americans tend to be strikingly pessimistic when interviewed about their prospects.

“It’s just a background of continuous decline. You’re worse off than your parents,” Lleras-Muney said. “Whereas for Hispanics, or immigrants like myself” — she is from Colombia — “or blacks, yes, circumstances are bad, but they’ve been getting better.”

declining health of white, working-class Americans suggests that Republican plans to replace the Affordable Care Act are akin to bleeding a sick patient. As he put it, “Treat the fever by causing an even bigger fever.”

Graphs accompanying the new paper suggest that death rates for blacks with only a high school education began rising around 2010 in many age groups, as if following the trend that began about a decade earlier among whites.

Deaton cited suicide as an action that could be triggered not by a single event but by a cumulative series of disappointments: “Your family life has fallen apart, you don’t know your kids anymore, all the things you expected when you started out your life just haven’t happened at all.”

white mortality rates fell in the biggest cities, were constant in big-city suburbs and rose in all other areas. The Washington Post’s analysis published last year highlighted the same geographical signature, with a break in death rates between the two most urban classifications (big cities and big-city suburbs) and the four less urban classifications, which The Post described as an urban-rural divide.

That urban-rural divide appears to have widened, particularly in recent years, the CDC reported.

Fifteen years ago, middle-aged whites in the United States were neck and neck with their German counterparts. Now, middle-aged white Americans are 45 percent more likely to die than middle-aged Germans.

the gap in mortality between white middle-aged Americans and middle-aged Germans is about 125 deaths per 100,000 people now. Every year, of 100,000 Germans between the ages of 45 and 54, about 285 die. In the United States, it's more than 410.

Most of the increase in white deaths is concentrated among those who never finished college. These are the same people who have been pummeled by the economy in recent decades. It’s gotten more difficult for them to find jobs, and what jobs they do come across nowadays don’t pay as well.

Other companies, including Comcast NBCUniversal and Disney, opted last year to release films directly to online streaming as theaters were closed.Movie theater revenues were battered by the pandemic. A number of big movies have been delayed from 2020 or early 2021 openings, including Dune, Jurassic World: Dominion and the next James Bond installment, No Time to Die.

“What is paradoxical is the fact that the UK has punched well above its weight in its epidemiology, in its vaccine development and in understanding the virus – yet we have the worst per capita mortality for Covid-19 in the developed world. The eventual public inquiry will have a very mixed bag of conclusions to make about our handling of Covid.”

A major problem for the UK – and for much of Europe – has been the assumption that controlling the virus is a matter of having a trade-off between the economy and imposing lockdowns. “That is a false dichotomy,” says Ferguson. “If you act early when you impose lockdowns and other restrictions, you don’t just minimise deaths, you minimise economic disruption because you can lift lockdown so much earlier.”

As to the differential impact of the disease on society, Ferguson is unequivocal. “The poor have been worst affected in multiple ways. They have the lowest job security and have the least ability to work from home. They tend to work in frontline professions where they are more exposed to the virus. They also tend to have poorer health and have more co-morbidities so that they get more severe reactions to Covid and suffer higher mortality rates.

the pandemic killed about one in every 400 people in Russia, compared with one in every 600 in the United States.

In the United States, with more than twice the population of Russia, such “excess deaths” since the start of the pandemic have numbered about 574,000

a far different story is told by the official statistics agency Rosstat, which tallies deaths from all causes. Russia saw a jump of 360,000 deaths above normal from last April through December, according to a Times analysis of historical data. Rosstat figures for January and February of this year show that the number is now well above 400,000.

The low official toll has contributed to the obliviousness of Russians to the virus’s dangers in some cases — and to their profound distrust of the government’s messaging regarding the pandemic in others

Last October, a poll found that most Russians did not believe the government’s tally of coronavirus cases: Half of those who did not believe the tally thought it was too high, while half thought it was too low.

In February, another poll found that 60 percent of Russians said they were not planning to get Russia’s Sputnik V coronavirus vaccine, and that most believed the coronavirus to be a biological weapon.

one thing was certain, she said: She will not get vaccinated, even after seeing Covid’s devastation up close. After all, if she cannot trust her mother’s state-issued death certificate, why should she trust the Russian government about the safety of the vaccine?

For all the death, there has been minimal opposition in Russia — even among Mr. Putin’s critics — to the government’s decision to keep businesses open last winter and fall. Some liken it to a Russian stoicism, or fatalism, or the lack of an alternative to keeping the economy running given minimal aid from the state.

“This nation has seen so many traumas,” Mr. Raksha said. “A people that has been through so much develops a very different relationship to death.”

Mr. Raksha, the demographer, noted that the elevated mortality that accompanied the chaos and poverty of the 1990s, after the collapse of the Soviet Union, was deadlier than the overall toll of the pandemic.

“You can choose between continuing to live your life, carefully, or to wall yourself up and stop living,” Mr. Dolonko said. “Unlike you” — Westerners — “Russians know what it means to live in extreme conditions.”

The deaths during the pandemic have been tragic, he said, but he believes they have mostly occurred in people who were of a very advanced age or had other health problems, and were not all related to the virus. Mr. Dolonko, 62, says he wears a mask in crowded places and frequently washes his hands — and regularly goes to gallery openings and shows

A website tracking coronavirus deaths in the Orthodox Church lists seven members of the clergy in the Samara region; Father Sergiy knew several of them well. He said he figured Russia had lifted its coronavirus restrictions because there was no end in sight to the pandemic. He quoted Dostoyevsky: “Man grows used to everything, the scoundrel!”“We are growing used to living in a pandemic,” Father Sergiy said. “We are growing used to the deaths.”

About all this there is no essential disagreement. The most hideous enemy of native Americans was not the white man and his weaponry, concludes Alfred Crosby,"but the invisible killers which those men brought in their blood and breath." It is thought that between 75 to 90 percent of all Indian deaths resulted from these killers.

As an example of actual genocidal conditions, Stannard points to Franciscan missions in California as"furnaces of death."

The missionaries had a poor understanding of the causes of the diseases that afflicted their charges, and medically there was little they could do for them. By contrast, the Nazis knew exactly what was happening in the ghettos, and quite deliberately deprived the inmates of both food and medicine; unlike in Stannard’s"furnaces of death," the deaths that occurred there were meant to occur.

True, too, some colonists later welcomed the high mortality among Indians, seeing it as a sign of divine providence; that, however, does not alter the basic fact that Europeans did not come to the New World in order to infect the natives with deadly diseases.

But Chardon's journal manifestly does not suggest that the U.S. Army distributed infected blankets, instead blaming the epidemic on the inadvertent spread of disease by a ship's passenger. And as for the"100,000 fatalities," not only does Thornton fail to allege such obviously absurd numbers, but he too points to infected passengers on the steamboat St. Peter's as the cause. Another scholar, drawing on newly discovered source material, has also refuted the idea of a conspiracy to harm the Indians.

Similarly at odds with any such idea is the effort of the United States government at this time to vaccinate the native population. Smallpox vaccination, a procedure developed by the English country doctor Edward Jenner in 1796, was first ordered in 1801 by President Jefferson; the program continued in force for three decades, though its implementation was slowed both by the resistance of the Indians, who suspected a trick, and by lack of interest on the part of some officials. Still, as Thornton writes:"Vaccination of American Indians did eventually succeed in reducing mortality from smallpox."

The disparity in estimates is enormous. In 1928, the ethnologist James Mooney proposed a total count of 1,152,950 Indians in all tribal areas north of Mexico at the time of the European arrival. By 1987, in American Indian Holocaust and Survival, Russell Thornton was giving a figure of well over 5 million, nearly five times as high as Mooney’s, while Lenore Stiffarm and Phil Lane, Jr. suggested a total of 12 million. That figure rested in turn on the work of the anthropologist Henry Dobyns, who in 1983 had estimated the aboriginal population of North America as a whole at 18 million and of the present territory of the United States at about 10 million.

Still, even if up to 90 percent of the reduction in Indian population was the result of disease, that leaves a sizable death toll caused by mistreatment and violence. Should some or all of these deaths be considered instances of genocide?

Despite the colonists' own resort to torture in order to extract confessions, the cruelty of these practices strengthened the belief that the natives were savages who deserved no quarter

A second famous example from the colonial period is King Philip’s War (1675-76).

The war was also merciless, on both sides. At its outset, a colonial council in Boston had declared"that none be Killed or Wounded that are Willing to surrender themselves into Custody."

But these rules were soon abandoned on the grounds that the Indians themselves, failing to adhere either to the laws of war or to the law of nature, would"skulk" behind trees, rocks, and bushes rather than appear openly to do" civilized" battle. Similarly creating a desire for retribution were the cruelties perpetrated by Indians when ambushing English troops or overrunning strongholds housing women and children.

Before long, both colonists and Indians were dismembering corpses and displaying body parts and heads on poles. (Nevertheless, Indians could not be killed with impunity. In the summer of 1676, four men were tried in Boston for the brutal murder of three squaws and three Indian children; all were found guilty and two were executed.)

In 1704, this was amended in the direction of"Christian practice" by means of a scale of rewards graduated by age and sex; bounty was proscribed in the case of children under the age of ten, subsequently raised to twelve (sixteen in Connecticut, fifteen in New Jersey). Here, too, genocidal intent was far from evident; the practices were justified on grounds of self-preservation and revenge, and in reprisal for the extensive scalping carried out by Indians.

To force the natives into submission, Generals Sherman and Sheridan, who for two decades after the Civil War commanded the Indian-fighting army units on the Plains, applied the same strategy they had used so successfully in their marches across Georgia and in the Shenandoah Valley. Unable to defeat the Indians on the open prairie, they pursued them to their winter camps, where numbing cold and heavy snows limited their mobility. There they destroyed the lodges and stores of food, a tactic that inevitably resulted in the deaths of women and children.

As the United States expanded westward, such conflicts multiplied. So far had things progressed by 1784 that, according to one British traveler,"white Americans have the most rancorous antipathy to the whole race of Indians; and nothing is more common than to hear them talk of extirpating them totally from the face of the earth, men, women, and children."

To understand all is hardly to forgive all, but historical judgment, as the scholar Gordon Leff has correctly stressed,"must always be contextual: it is no more reprehensible for an age to have lacked our values than to have lacked forks."

According to Article II of the convention, the crime of genocide consists of a series of acts" committed with intent to destroy, in whole or in part, a national, ethnical, racial, or religious group as such" (emphases added). Practically all legal scholars accept the centrality of this clause.

During the deliberations over the convention, some argued for a clear specification of the reasons, or motives, for the destruction of a group. In the end, instead of a list of such motives, the issue was resolved by adding the words"as such"—i.e., the motive or reason for the destruction must be the ending of the group as a national, ethnic, racial, or religious entity. Evidence of such a motive, as one legal scholar put it,"will constitute an integral part of the proof of a genocidal plan, and therefore of genocidal intent."

The crucial role played by intentionality in the Genocide Convention means that under its terms the huge number of Indian deaths from epidemics cannot be considered genocide.

y contrast, some of the massacres in California, where both the perpetrators and their supporters openly acknowledged a desire to destroy the Indians as an ethnic entity, might indeed be regarded under the terms of the convention as exhibiting genocidal intent.

the convention does not address the question of what percentage of a group must be affected in order to qualify as genocide. As a benchmark, the prosecutor of the International Criminal Tribunal for the Former Yugoslavia has suggested"a reasonably significant number, relative to the total of the group as a whole," adding that the actual or attempted destruction should also relate to"the factual opportunity of the accused to destroy a group in a specific geographic area within the sphere of his control, and not in relation to the entire population of the group in a wider geographic sense."

If this principle were adopted, an atrocity like the Sand Creek massacre, limited to one group in a specific single locality, might also be considered an act of genocide.

Applying today’s standards to events of the past raises still other questions, legal and moral alike. While history has no statute of limitations, our legal system rejects the idea of retroactivity (ex post facto laws).

No doubt, the 19th-century idea of America’s"manifest destiny" was in part a rationalization for acquisitiveness, but the resulting dispossession of the Indians was as unstoppable as other great population movements of the past. The U.S. government could not have prevented the westward movement even if it had wanted to.

Morally, even if we accept the idea of universal principles transcending particular cultures and periods, we must exercise caution in condemning, say, the conduct of war during America’s colonial period, which for the most part conformed to thenprevailing notions of right and wrong.

The real task, then, is to ascertain the context of a specific situation and the options it presented. Given circumstances, and the moral standards of the day, did the people on whose conduct we are sitting in judgment have a choice to act differently?

Finally, even if some episodes can be considered genocidal—that is, tending toward genocide—they certainly do not justify condemning an entire society

Guilt is personal, and for good reason the Genocide Convention provides that only"persons" can be charged with the crime, probably even ruling out legal proceedings against governments.

noncombatants incidentally and accidentally, not purposefully." As for the larger society, even if some elements in the white population, mainly in the West, at times advocated extermination, no official of the U.S. government ever seriously proposed it. Genocide was never American policy, nor was it the result of policy.

The violent collision between whites and America's native population was probably unavoidable.

Genocide? These actions were almost certainly in conformity with the laws of war accepted at the time. The principles of limited war and of noncombatant immunity had been codified in Francis Lieber's General Order No. 100, issued for the Union Army on April 24, 1863. But the villages of warring Indians who refused to surrender were considered legitimate military objectives.

In the end, the sad fate of America's Indians represents not a crime but a tragedy, involving an irreconcilable collision of cultures and values.

efforts of well-meaning people in both camps, there existed no good solution to this clash. The Indians were not prepared to give up the nomadic life of the hunter for the sedentary life of the farmer. The new Americans, convinced of their cultural and racial superiority, were unwilling to grant the original inhabitants of the continent the vast preserve of land required by the Indians’ way of life.

To fling the charge of genocide at an entire society serves neither the interests of the Indians nor those of history.

"I would classify this as a silver lining to what has been quite a hard time for many people,"

Doctors around the country say that they're doing a lot of things differently in the fight against COVID-19 and that treatment is improving. "In March and April, you got put on a breathing machine, and we asked your family if they wanted to enroll you into some different trials we were participating in, and we hoped for the best," says Khalilah Gates, a critical care pulmonologist at Northwestern Memorial Hospital in Chicago. "Six plus months into this, we kind of have a rhythm, and so it has become an everyday standard patient for us at this point in time."

Horwitz believes that mask-wearing may be helping by reducing the initial dose of virus a person receives, thereby lessening the overall severity of illness for many patients.

And Mateen says that his data strongly suggest that keeping hospitals below their maximum capacity also helps to increase survival rates.

Gates adds that the takeaway definitely should not be to cast the mask aside. There is still no cure for this disease, and even patients who recover can have long-term side effects. "A lot of my patients are still complaining of shortness of breath," she says. "Some of them have persistent changes on their CT scans and impacts on their lung functions."

"I do think this is good news," Horwitz says of her research findings, "but it does not make the coronavirus a benign illness."

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The rejection of science has also exacerbated polarization and tribalism

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

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

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

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

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

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

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