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Patients were streaming in nonstop, she said, coughing and sweating, with fevers and "fear in their eyes." The nurse wrote that she cried in the bathroom during her break, peeling off the PPE that left indentations in her face.

The nurse, who said she works in a Covid-19 triage area, said the previous night was "so far the worst I have seen."

'I cried the entire ride home'

"What's very devastating for me is some people we know will not survive," he said, "and since they're not allowed to have visitors, I may be the last face they see and voice they hear ever as I put them to sleep (general anesthesia) prior to being on a ventilator.

Deburghgraeve shared a video with CNN of him donning his PPE, putting on gloves, a protective gown, a face mask and then another mask that looks like a space helmet.

Dr. Cory Deburghgraeve, an anesthesiologist at the University of Illinois in Chicago, said he's working 94 hours this week. He's the designated "airway anesthesiologist" giving coronavirus patients breathing tubes in a procedure called intubation.

A physician assistant working in an emergency room in Queens, New York, told CNN there was an "every man for themselves" mentality when it came to the PPE at the hospital.

"You have people out on the streets that have masks and meanwhile the hospitals are all running out of masks," said the physician assistant, who CNN is not naming because they feared repercussions for speaking to the media.

The physician assistant said they were told they would have to make their N95 mask last for five days. The PPE is being prioritized, the physician assistant said, for staff working with intubated patients, who are most at risk of infection.

"There's patients everywhere," the physician assistant said

An emergency room physician at a hospital in the New York borough of Queens said doctors and nurses must deal with cramped spaces.

"Stretchers are packed in metal-to-metal, stacked three deep head to toe, with no space ... to walk to patients," the physician said. "When patients deteriorate, you hope you see them from across the room and hope you can move enough stretchers out of the way to get that person to a critical care area."

"I don't have the support that I need, and even just the materials that I need physically to take care of my patients," Smith said. "And it's America and we're supposed to be a first-world country."

Hoegl was caught when a nurse saw that a patient previously stable had developed an irregular heartbeat. He was already in the room when the patient had to be resuscitated and the nurse found empty medication containers in the waste bin, Der Spiegel says.

Hoegl said that each time someone had died, he had resolved never to do it again but his determination would then slowly fade.

A quick succession of sexual harassment claims against Cuomo in the ensuing weeks has knocked him from his political perch

Trump might be in even greater peril. Since 2019, James’s office has been conducting an investigation of business practices inside the Trump Organization and family. Trump has fought fiercely in court, but month after month, James has succeeded in unearthing financial records that appear to be adding up to a giant legal hazard for the former president, analysts say.

The Trump case and the Cuomo nursing home scandal have generated a torrent of national attention for James, with people outside New York politics wondering how a single state officer could make such big legal waves.

she argues that “the law should be a tool for social change”

“I see the law both as a shield and as a sword,” she said in a public discussion last year about Black leadership. “And so I wake up every day with a fire in my belly, and I march into the office – well, I actually march into my kitchen – and the question is, what can I do today to make a difference in the life of somebody? Who can I sue?”

As state attorney general, James has aggressively pursued a full catalogue of progressive causes.She sued the police department over brutality against people of color, blocked unlawful evictions during the pandemic, won a major sexual harassment settlement for women in the construction industry, filed an amicus brief before the supreme court opposing a rushed census, and sued to dissolve the National Rifle Association.She also sued Amazon for allegedly failing to protect workers, sued Facebook as an alleged monopoly and investigated Google on similar grounds. She has asked federal regulators to clamp down on toxins in baby food and called for student debt relief

“When I looked around the courtroom, all the defendants and all the family members looked like me, but everyone in a position of power did not, and there was something really unbalanced about that and unfair about that,” James told Miller

Before her election to the New York city council in 2003, James worked as a public defender, as counsel to the speaker of the state assembly and as an assistant attorney general for Brooklyn, where she targeted predatory lenders, advocated for working families and brought the first case against the New York City police department for so-called stop-and-frisk abuses.

“She told us that she would be independent of the governor and I think she’s proven that,” he said.

“I think she wants to be governor, I think that’s clear, and she’d be a formidable candidate,” said Albro.“I think she’d be a formidable candidate because she is very well liked and known in the city and that’s a big chunk of the vote.”

As three women stepped forward with claims of sexual harassment and other unwanted advances by Mr. Cuomo, the most visible governor in America effectively went dark.

Now he is at the whims of often-fickle public opinion, fuming legislators and investigations.

As the allegations unfolded, Mr. Cuomo’s team denied wrongdoing and issued statements, but a number of leading lawmakers in Albany and Washington did not hear from the governor on the matter.

Indeed, the public outcry and the dearth of vocal defenders illustrate both the complexities of the problems Mr. Cuomo faces and how little he has invested in building mutually respectful relationships in politics. As with other New York politicians in times of extreme crisis, it is a dynamic that is haunting him now.

“When the investigation concludes, Democrats, I believe, will coalesce around doing the right thing,” Mr. Jacobs said. “We have to let the chips fall where they may, but I don’t see the value in a rush to judgment. I only see the potential cost.”

“C.M.S. recognizes the psychological, emotional and physical toll that prolonged isolation and separation from family have taken on nursing home residents and their families,” he said.

So-called compassionate care visits — when a resident’s health has severely deteriorated — should be allowed regardless of vaccination status or the county’s positivity rate, the guidance said.

Republicans decry its cost and argue that much of what the proposed American Jobs Plan contains, including the emphasis on home-based care, doesn't count as real infrastructure.

Medicare covers home-based health care services only for older adults and people with severe disabilities who are homebound and need skilled services from nurses and therapists. It does not pay for 24-hour care or care for personal aides or homemakers. In 2018, about 3.4 million Medicare members received home health services.

doesn't address the full extent of care needed by the nation's rapidly growing older population. In particular, middle-income seniors won't qualify directly for programs that would be expanded. They would, however, benefit from a larger, better paid, better trained workforce of aides that help people in their homes — one of the plan's objectives.

This reflects a sobering reality: for most individuals and families paying for long-term care services is even more expensive than providing the care themselves.

Home and community-based services help people who need significant assistance live at home as opposed to nursing homes or group homes.

Medicaid — the federal-state health program for 72 million children and adults in low-income households — can be an alternative, but financial eligibility standards are strict and only people with meager incomes and assets qualify.

Biden's proposal doesn't specify how the $400 billion in additional funding would be spent, beyond stating that access to home and community-based care would be expanded and caregivers would receive "a long-overdue raise, stronger benefits and an opportunity to organize or join a union."

If restrictions are eased, should I visit right away?

Dr. von Preyss-Friedman recommends waiting at least two weeks after the second shot to have a visit.

ideally, the visitor would also be vaccinated as well. Since shots won’t be widely available for a few months, it may be best to wait until you get your vaccine. Until then, she believes nursing homes should consider visits on a case-by-case basis.

Would visitors still need to wear a mask?Absolutely, medical experts said. This is particularly true if they are not vaccinated, but even after they are vaccinated “until rates in the community go down,”

They were able to finance the product, which went through 30 prototypes and iterations, with grants and personal money as well as funding from start-up accelerators and awards

However, it has features that distinguish it from others on the market, including different light modes — blue, red and white.

Red light, which has a long wavelength, can help promote alertness, while blue light, which has a shorter wavelength, tends to do the same while also suppressing melatonin, a hormone that helps regulate sleep, she said.

“It’s the tool that you didn’t know that you needed until it’s right on your scrub top, and you’re like, ‘Oh my gosh, where has this been this whole time?’” Ms. Mancillas said. “It makes life so much easier.”

More than 400 nurses have tested the uNight Light, and more than 90 percent said it was helpful, the inventors said. They have received 1,500 orders and will start shipments next month.

after Gov. Doug Burgum, a Republican, used an executive order on Nov. 13 to institute precisely such a mandate, a poll showed that a significant majority of North Dakotans favored it.

the state definitely should have taken that step last spring or summer — before the number of coronavirus cases skyrocketed, before hospitals were so overrun that sick North Dakotans had to be sent to neighboring states and before his own mother tested positive and died in early October.

Until recently, Governor Burgum was loath to exert much pressure on North Dakotans and steered clear of the social-distancing orders put in place by so many other states. But he did invest heavily in testing and never merrily shrugged off the threat of the coronavirus the way his Republican counterpart in South Dakota, Gov. Kristi Noem, did.

South Dakota, in contrast, was No. 1. Still no mask mandate there, and no leadership at all from Noem, who didn’t just welcome but beckoned President Trump to Mount Rushmore for that enormous Independence Day rally, the one at which his perpetually maskless entourage clustered near a similarly maskless crowd

Just before Thanksgiving, Noem announced the passing of her 98-year-old grandmother, one of 13 residents of a South Dakota nursing home who died in a two-week period. The home’s administrator told The Daily Beast that the other 12 residents, along with many of the nursing home’s workers, had tested positive for the coronavirus, but not Noem’s grandmother. (Hmmm …) While Noem publicly mourned her lost family member, she drew no particular attention to Covid-19’s rampage among her grandmother’s companions.

wrote to him to share a famous quotation from Benjamin Franklin: “Those who would give up essential liberty to purchase a little temporary safety deserve neither liberty nor safety.”

They “scream at you for a magic medicine” and warn that Joe Biden will ruin America even as they’re “gasping for breath,” she wrote. She added: “They call you names and ask why you have to wear all that ‘stuff’ because they don’t have Covid because it’s not real.”

“They stop yelling at you when they get intubated,” she wrote. “It’s like a horror movie that never ends.”

The truth is that the Dakotas are as emblematic as they are exceptional

In resisting the lockdowns, slowdowns and sacrifices that many other states committed to, they indulged and encouraged a selective (and often warped) reading of scientific evidence, a rebellion against experts and a twisted concept of individual liberty that was obvious all over the country and contributed mightily to our suffering.

“North Dakotans will come to each other’s aids in a heartbeat, but when asked to give up personal freedom for an amorphous common good — that’s difficult,

When I said “horror story,” I was cribbing. That was a description used in a series of mid-November tweets from a South Dakota emergency room nurse, Jodi Doering, that went viral. Doering was reeling from tending to dying Covid-19 patients who continued to insist that the coronavirus was some kind of hoax.

“We maybe believed that our rural nature sheltered us from what cities like yours were experiencing,” Carson said. “Then we found out, very brutally, that was wrong.”

we can’t simply replace one simplistic narrative, about the super power of mitigation policy, for another, focused only on the burdens it imposed and not at all on the costs of doing much less — or nothing at all.

Let’s start with the title. What is the big failure, as you see it?

McLean: I think it gets at things that had happened in America even before the pandemic hit. And among those things were, I think, a failure to recognize the limits of capitalism, a failure of government to set the right rules for it, particularly when it comes to our health care system; a focus on profits that may have led to an increase in the bottom line but created fragility in ways people didn’t understand; and then our growing polarization that made us incapable of talking to each other

How big is the failure? When I look at The Economist’s excess mortality data, I see the U.S. had the 53rd-worst outcome in the world — worse than all of Western Europe, but better than all of Eastern Europe.

McLean: I think one way to quantify it is to take all those numbers and then put them in the context of our spending on health care. Given the amount we spend on health care relative to other countries, the scale of the failure becomes more apparent.

o me, the most glaring example is the schools. They were closed without people thinking through the potential consequences of closing down public schools, especially for disadvantaged kids.

to compound it, in my view, public health never made the distinction that needed to be made between the vulnerabilities of somebody 70 years old and the vulnerabilities of somebody 10 years old.

In the beginning of the book you write, in what almost feels like a thesis statement for the book: “A central tenet of this book is that we could not have done better, and pretending differently is a dangerous fiction, one that prevents us from taking a much needed look in the mirror.”

This claim, that the U.S. could not have done any better, runs against your other claim, that what we observed was an American failure. It is also a pretty extreme claim, I think, and I wanted to press you on it in part because it is, in my view, undermined by quite a lot of the work you do in the book itself.

Would the U.S. not have done better if it had recognized earlier that the disease spread through the air rather than in droplets? Would it not have done better if it hadn’t bungled the rollout of a Covid test in the early months?

McLean: Everything that you mentioned — the point of the book is that those were set by the time the pandemic hit.

in retrospect, what we were doing was to try to delay as much spread as we could until people got vaccinated. All the things that we did in 2020 were functionally serving or trying to serve that purpose. Now, given that, how can you say that none of that work saved lives?

McLean: I think that the test failure was baked into the way that the C.D.C. had come to operate

But the big question I really want to ask is this one: According to the C.D.C., we’ve had almost 1.2 million deaths from Covid. Excess mortality is nearly 1.4 million. Is it really your contention that there was nothing we might’ve done that brought that total down to 1.1 million, for instance, or even 900,000?

McLean: It’s very — you’re right. If you went through each and every thing and had a crystal ball and you could say, this could have been done, this could have been moved up by a month, we could have gotten PPE …

When I came to that sentence, I thought of it in terms of human behavior: What will humans put up with? What will humans stand for? How do Americans act? And you’ve written about Sweden being sort of average, and you’ve written about China and the Chinese example. They lock people up for two years and suddenly the society just revolts. They will not take it anymore. They can’t stand it. And as a result, a million and a half people die in a month and a half.

Well, I would tell that story very differently. For me, the problem is that when China opened up, they had fully vaccinated just under two-thirds of their population over 80. So to me, it’s not a failure of lockdowns. It’s a failure of vaccinations. If the Chinese had only achieved the same elderly vaccination rate as we achieved — which by global standards was pretty poor — that death toll when they opened up would have been dramatically lower.

What do you mean by “lockdown,” though? You use the word throughout the book and suggest that China was the playbook for all countries. But you also acknowledge that what China did is not anything like what America did.

Disparities in health care access — is it a dangerous fiction to think we might address that? You guys are big champions of Operation Warp Speed — would it not have been better if those vaccines had been rolled out to the public in nine months, rather than 12

. But this isn’t “lockdown” like there were lockdowns in China or even Peru. It’s how we tried to make it safer to go out and interact during a pandemic that ultimately killed a million Americans.

McLean: I think that you’re absolutely right to focus on the definition of what a lockdown is and how we implemented them here in this country. And I think part of the problem is that we implemented them in a way that allowed people who were well off and could work from home via Zoom to be able to maintain very much of their lives while other people couldn’t

And I think it depends on who you were, whether you would define this as a lockdown or not. If you were a small business who saw your small business closed because of this, you’re going to define it as a lockdown.

n the book you’re pretty definitive. You write, “maybe the social and economic disasters that lockdowns created would have been worth it if they had saved lives, but they hadn’t.” How can you say that so flatly?

I think there are still open questions about what worked and how much. But the way that I think about all of this is that the most important intervention that anybody did anywhere in the world was vaccination. And the thing that determined outcomes most was whether your first exposure came before or after vaccination.

Here, the shelter-in-place guidelines lasted, on average, five to seven weeks. Thirty nine of the 40 states that had issued them lifted them by the end of June, three months in. By the summer, according to Google mobility data, retail and grocery activity was down about 10 percent. By the fall, grocery activity was only down about 5 percent across the country

Nocera: Well, on some level, I feel like you’re trying to have it both ways. On the one hand, you’re saying that lockdowns saved lives. On the other hand, you said they weren’t real lockdowns because everybody was out and about.

I don’t think that’s having it both ways. I’m trying to think about these issues on a spectrum rather than in binaries. I think we did interrupt our lives — everybody knows that. And I think they did have an effect on spread, and that limiting spread had an effect by delaying infections until after vaccination.

Nocera: Most of the studies that say lockdowns didn’t work are really less about Covid deaths than about excess mortality deaths. I wound up being persuaded that the people who could not get to the hospital, because they were all working, because all the doctors were working on Covid and the surgical rooms were shut down, the people who caught some disease that was not Covid and died as a result — I wound up being persuaded about that.

We’re in a pandemic. People are going to die. And then the question becomes, can we protect the most vulnerable? And the answer is, we didn’t protect the most vulnerable. Nursing homes were a complete disaster.

There was a lot of worry early on about delayed health care, and about cancer in particular — missed screenings, missed treatments. But in 2019, we had an estimated 599,600 Americans die of cancer. In 2020, it was 602,000. In 2021, it was 608,000. In 2022, it was 609,000.

Nocera: See, it went up!But by a couple of thousand people, in years in which hundreds of thousands of Americans were dying of Covid.

Nocera: I think you can’t dispute the excess mortality numbers.I’m not. But in nearly every country in the world the excess mortality curves track so precisely with Covid waves that it doesn’t make sense to talk about a massive public health problem beyond Covid. And when you add all of these numbers up, they are nowhere near the size of the footfall of Covid. How can you look back on this and say the costs were too high?

Nocera: I think the costs were too high because you had school costs, you had economic costs, you had social costs, and you had death.

McLean: I think you’re raising a really good point. We’re making an argument for a policy that might not have been doable given the preconditions that had been set. I’m arguing that there were these things that had been put in place in our country for decades leading up to the pandemic that made it really difficult for us to plant in an effective way, from the outsourcing of our PPE to the distrust in our health care system that had been created by people’s lack of access to health care with the disparities in our hospital system.

How would you have liked to see things handled differently?Nocera: Well, the great example of doing it right is San Fran

I find the San Francisco experience impressive, too. But it was also a city that engaged in quite protracted and aggressive pandemic restrictions, well beyond just protecting the elderly and vulnerable.

McLean: But are we going to go for stay-at-home orders plus protecting vulnerable communities like San Francisco did? Or simply letting everybody live their lives, but with a real focus on the communities and places like nursing homes that were going to be affected? My argument is that we probably would’ve been better off really focusing on protecting those communities which were likely to be the most severely affected.

I agree that the public certainly didn’t appreciate the age skew, and our policy didn’t reflect it either. But I also wonder what it would mean to better protect the vulnerable than we did. We had testing shortages at first. Then we had resistance to rapid testing. We had staff shortages in nursing homes.

Nocera: This gets exactly to one of our core points. We had spent 30 years allowing nursing homes to be owned by private equity firms that cut the staff, that sold the land underneath and added all this debt on

I hear you saying both that we could have done a much better job of protecting these people and that the systems we inherited at the outset of the pandemic would’ve made those measures very difficult, if not impossible, to implement.

But actually, I want to stop you there, because I actually think that that data tells the opposite story.

And then I’m trying to say at the same time, but couldn’t we have done something to have protected people despite all of that?

I want to talk about the number of lives at stake. In the book, you write about the work of British epidemiologist Neil Ferguson. In the winter of 2020, he says that in the absence of mitigation measures and vaccination, 80 percent of the country is going to get infected and 2.2 million Americans are going to die. He says that 80 percent of the U.K. would get infected, and 510,000 Brits would die — again, in the abs

In the end, by the time we got to 80 percent of the country infected, we had more than a million Americans die. We had more than 200,000 Brits die. And in each case most of the infections happened after vaccination, which suggests that if those infections had all happened in a world without vaccines, we almost certainly would have surpassed two million deaths in the U.S. and almost certainly would’ve hit 500,000 deaths in the U.K.

In the book, you write about this estimate, and you endorse Jay Bhattacharya’s criticism of Ferguson’s model. You write, “Bhattacharya got his first taste of the blowback reserved for scientists who strayed from the establishment position early. He co-wrote an article for The Wall Street Journal questioning the validity of the scary 2 to 4 percent fatality rate that the early models like Neil Ferguson’s were estimating and that were causing governments to panic. He believed, correctly as it turns out, that the true fatality rate was much lower.”

Nocera: I know where you’re going with this, because I read your story about the nine pandemic narratives we’re getting wrong. In there, you said that Bhattacharya estimated the fatality rate at 0.01 percent. But if you actually read The Wall Street Journal article, what he’s really saying is I think it’s much lower. I’ve looked at two or three different possibilities, and we really need some major testing to figure out what it actually is, because I think 2 percent to 4 percent is really high.

He says, “if our surmise of 6 million cases is accurate, that’s a mortality rate of 0.01%. That is ⅒th the flu mortality rate of 0.1%.” An I.F.R. of 0.01 percent, spread fully through the American population, yields a total American death toll of 33,000 people. We have had 1.2 million deaths. And you are adjudicating this dispute, in 2023, and saying that Neil was wrong and Jay was right.

hird, in the Imperial College report — the one projecting two million American deaths — Ferguson gives an I.F.R. estimate of 0.9 percent.

Bhattacharya’s? Yes, there is some uncertainty around the estimate he offers. But the estimate he does offer — 0.01 percent — is one hundred times lower than the I.F.R. you yourselves cite as the proper benchmark.

Nocera: In The Wall Street Journal he does not say it’s 0.01. He says, we need to test to find out what it is, but it is definitely lower than 2 to 4 percent.

Well, first of all, the 2 percent to 4 percent fatality rate is not from Neil Ferguson. It’s from the W.H.O.

But I think that fundamentally, at the outset of the pandemic, the most important question orienting all of our thinking was, how bad could this get? And it turns out that almost all of the people who were saying back then that we shouldn’t do much to intervene were extremely wrong about how bad it would be

The argument then was, more or less, “We don’t need to do anything too drastic, because it’s not going to be that big a deal.” Now, in 2023, it’s the opposite argument: “We shouldn’t have bothered with restrictions, because they didn’t have an impact; we would have had this same death toll anyway.” But the death toll turned out to be enormous.

Now, if we had supplied all these skeptics with the actual numbers at the outset of the pandemic, what kind of audience would they have had? If instead of making the argument against universal mitigation efforts on the basis of a death toll of 40,000 they had made the argument on the basis of a death toll of more than a million, do you think the country would’ve said, they’re right, we’re doing too much, let’s back off?

McLean: I think that if you had gone to the American people and said, this many people are going to die, that would’ve been one thing. But if you had gone to the American people and said, this many people are going to die and a large percentage of them are going to be over 80, you might’ve gotten a different answer.

I’m not arguing we shouldn’t have been trying to get a clearer sense of the true fatality rate, or that we shouldn’t have been clearer about the age skew. But Bhattacharya was also offering an estimate of fatality rate that turned out to be off by a factor of a hundred from the I.F.R. that you yourselves cite as correct. And then you say that Bhattacharya was right and Ferguson was wrong.

And you, too, Joe, you wrote an article in April expressing sympathy for Covid skeptics and you said ——Nocera: This April?No, 2020.Nocera: Oh, oh. That’s the one where I praised Alex Berenson.You also cited some Amherst modeling which said that we were going to have 67,000 to 120,000 American deaths. We already had, at that point, 60,000. So you were suggesting, in making an argument against pandemic restrictions, that the country as a whole was going to experience between 7,000 and 60,000 additional deaths from that point.

when I think about the combination of the economic effects of mitigation policies and just of the pandemic itself and the big fiscal response, I look back and I think the U.S. managed this storm relatively well. How about each of you?

in this case, Congress did get it together and did come to the rescue. And I agree that made a ton of difference in the short term, but the long-term effects of the fiscal rescue package were to help create inflation. And once again, inflation hits those at the bottom of the socioeconomic distribution much harder than it does those at the top. So I would argue that some of what we did in the pandemic is papering over these long-term issues.

I think as with a lot of the stuff we’ve talked about today, I agree with you about the underlying problems. But if we take for granted for a moment that the pandemic was going to hit us, when it did, under the economic conditions it did, and then think about the more narrow context of whether, given all that, we handled the pandemic well. We returned quickly to prepandemic G.D.P. trends, boosted the wealth of the bottom half of the country, cut child poverty in half, pushed unemployment to historical lows.

What sense do you make of the other countries of the world and their various mitigation policies? Putting aside China, there’s New Zealand, Australia, South Korea — these are all places that were much more aggressive than the U.S. and indeed more than Europe. And had much, much better outcomes.

Nocera: To be perfectly honest, we didn’t really look, we didn’t really spend a lot of time looking at that.

McLean: But one reason that we didn’t is I don’t think it tells us anything. When you look at who Covid killed, then you have to look at what the pre-existing conditions in a country were, what percentage of its people are elderly. How sick are people with pre-existing conditions?

I just don’t think there’s a comparison. There’s just too many factors that influence it to be able to say that, to be able to compare America to any other country, you’d have to adjust for all these factors.

But you do spend a bit of time in the book talking about Sweden. And though it isn’t precisely like-for-like, one way you can control for some of those factors is grouping countries with their neighbors and other countries with similar profiles. And Sweden’s fatality rate in 2020 was 10 times that of Norway, Finland and Iceland. Five times that of Denmark. In the vaccination era, those gaps have narrowed, but by most metrics Sweden has still done worse, overall, than all of those countries.

On the matter of omniscience. Let’s say that we can send you back in time. Let’s put you both in charge of American pandemic response, or at least American communication about the pandemic, in early 2020. What would you want to tell the country? How would you have advised us to respond?

McLean: What I would want is honesty and communication. I think we’re in a world that is awash in information and the previous methods of communication — giving a blanket statement to people that may or may not be true, when you know there’s nuance underneath it — simply doesn’t work anymore

o I would’ve been much more clear — we think masks might help, we don’t know, but it’s not that big of an ask, let’s do it. We think the early data coming out of Italy shows that these are the people who are really, really at risk from Covid, but it’s not entirely clear yet. Maybe there is spread in schools, but we don’t know. Let’s look at this and keep an open mind and look at the data as it comes in.

Meanwhile, partly by necessity, working-class families often take a more hands-off attitude to child-raising.

some of the most cost-effective antipoverty programs are aimed at the earliest years. For example, the Nurse-Family Partnership has a home-visitation program that encourages new parents of at-risk children to amp up the hugging, talking and reading. It ends at age 2, yet randomized trials show that those children are less likely to be arrested as teenagers and the families require much less government assistance.

Or take Head Start. Critics have noted that the advantage its preschoolers gain in test scores fades by third grade, but scholars also have found that Head Start has important impacts on graduates, including lessening the chance that they will be convicted of a crime years later.

James Heckman, a Nobel Prize-winning economist, argues that the most crucial investments we as a country can make are in the first five years of life, and that they pay for themselves. Yet these kinds of initiatives are underfinanced and serve only a tiny fraction of children in need.

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 US has lost more than 529,000 people to the virus, Johns Hopkins University data shows. It's more than the number of Americans killed in World War I and World War II combined. And the death toll is rising by the thousands each week.

Now, the country is at a pivotal point.

"While these trends are starting to head in the right direction, the number of cases, hospitalizations and deaths still remain too high and are somber reminders that we must remain vigilant as we work to scale up our vaccination efforts across this country," Walensky said.

So far, almost one in 10 Americans have been fully vaccinated -- a number that is still too low to suppress the spread of the virus. And some experts have warned another possible surge could be weeks away, fueled by a highly contagious variant spreading across the country.

"We must continue to use proven prevention measures to slow the spread of Covid-19," Walensky added. "They are getting us closer to the end of this pandemic."

For Americans who have been fully vaccinated, the new guidance released by the Centers for Disease Control and Prevention earlier this week marks a small first step toward a return to pre-pandemic life, the agency's director and other colleagues wrote in a JAMA Viewpoint article published Wednesday.

"What we have seen is that we have surges after people start traveling. We saw it after July 4, we saw it after Labor Day, we saw it after the Christmas holidays," Walensky said in the briefing. "Currently 90% of people are still unprotected and not yet vaccinated. So we are really looking forward to updating this guidance as we have more protection across the communities and across the population."

"With high levels of community transmission and the threat of SARS-CoV-2 variants of concern, CDC still recommends a number of prevention measures for all people, regardless of vaccination status," they wrote.

"As vaccine supply increases, and distribution and administration systems expand and improve, more and more people will become fully vaccinated and eager to resume their prepandemic lives," Walensky and CDC officials Drs. Sarah Mbaeyi and Athalia Christie wrote.

More than 62 million Americans have received at least one dose of a Covid-19 vaccine, CDC data shows. Roughly 32.9 million are fully vaccinated.

As vaccination numbers climb, more state leaders are loosening the requirements for who can get a shot.

At least 47 states plus DC are allowing teachers and school staff to receive Covid-19 vaccines. By next Monday, teachers will be eligible in all 50 states.

In Georgia, officials announced the state will expand its vaccine eligibility starting March 15 to include people 55 and older as well as individuals with disabilities and certain medical conditions.

"Provided supply allows, vaccine eligibility is expected to open to all adults in April," Gov. Brian Kemp's office said in a statement.

Other states also announced expanded vaccine eligibility this week, including Alaska, who took it the furthest by making vaccines available to everyone living or working in the state who is at least 16. It's the first state in the nation to do so.

The guidance allows for indoor visitation regardless of the vaccination status of the resident or visitor, with some exceptions.

For example, visitations may be limited for residents with Covid-19 or who are in quarantine or for unvaccinated residents living in facilities where less than 70% of residents are fully vaccinated, in a county that has a Covid-19 positivity rate greater than 10%.

"CMS recognizes the psychological, emotional and physical toll that prolonged isolation and separation from family have taken on nursing home residents, and their families," CMS Chief Medical Officer Dr. Lee Fleisher said in a statement.

"That is why, now that millions of vaccines have been administered to nursing home residents and staff, and the number of COVID cases in nursing homes has dropped significantly, CMS is updating its visitation guidance to bring more families together safely."

In the current wave, fewer patients recovering from Covid are being taken to nursing homes, such as Mr. Padgham’s, where they have a dedicated floor. The risks remain steep.

Under the government’s new changes — set to take effect on March 8, one week before Mother’s Day in Britain — his charges would be allowed visits by a family member under strict conditions. No hugs. No kisses. But hand-holding is OK.

Inevitably, those on the front lines — funeral workers, doctors and nurses — are often most exposed. So are their kin.

Now, even in the pandemic's deadliest days, Mobley says many people in her community haven't changed their attitudes or behaviors.

"You know, we see these commercials — 'Thank you health care heroes' — or see these billboards, and then you go to the grocery store, the gas station when you have to, and you see people not wearing masks. And then you go to work and you watch people die."

"I think if the public really wants to thank us, that they will start taking things seriously and just start wearing their masks and start social distancing,"

Although the initial distribution of the country's first coronavirus vaccines gave Mobley hope at first, her optimism has since faded as she watches what she describes as a "poorly managed" rollout.

This week, the Trump administration revised its vaccine distribution strategy in an attempt to accelerate a vaccination campaign that's been criticized for its sluggish pace.

In order to inoculate more Americans more quickly, the administration is now calling on states to administer a first dose to all people 65 and older and to those with underlying health conditions.

"By the time of my second vaccine I felt a lot less hope because, yes, I have my doses but none of my family or friends have theirs yet," says the ICU nurse. "It makes me mad that, we have all these doses, we should be a lot farther ahead of where we are and we're not."

That’s an astonishing failure — one that stands out in a year of astonishing failures. The situation is made grimmer by how familiar the underlying narrative is: Poor coordination at the federal level, combined with a lack of funding and support for state and local entities, has resulted in a string of avoidable missteps and needless delays.

The implementation of these shots is complicated by a number of factors, including cold-storage requirements, which in turn necessitate special training for nurses and doctors. Training takes time and money, both of which are in short supply in most states. Some hospitals have said they don’t know which vaccine they are going to receive, or how many doses, or when.

In late February, there were just a few dozen known cases in the United States, most of them linked to travel. But by summer, the virus had torn through every state, infecting more people than the combined populations of Connecticut and Oklahoma. And in the fall, the national death toll exceeded 230,000, more than the population of Boise, Idaho.

American life has been fundamentally reordered because of the virus. Concerts, parades and high school football games continue to be called off. Countless people have found themselves jobless and struggling to afford housing. Many schools and colleges have held few or no in-person classes this fall. More than 214,000 cases have been linked to colleges and universities over the course of the pandemic. Thousands more cases have been identified in elementary, middle and high schools.

The Times’s data collection for this page is based on reports from state and local health agencies, a process that is unchanged by the Trump administration's requirement that hospitals bypass the Centers for Disease Control and Prevention and send all patient information to a central database in Washington.

The Northeast experienced the worst this spring, as temporary morgues were deployed in New York City. Over the summer, cases spiked across the Sun Belt, prompting many states to tighten restrictions just weeks after reopening. By fall, the virus was filling rural hospitals in the Midwest and West as it devastated communities that had for months avoided the pandemic’s worst.

In Cook County, Ill., which includes Chicago, more than 5,400 people have died. In Los Angeles County, Calif., more than 300,000 people have had the virus, more than in most states. And in New York City, about one of every 352 residents has died.

Coronavirus cases have been reported in more than 23,000 nursing homes and other long-term care facilities, according to data collected by The New York Times from states, counties, the federal government and facilities themselves. More than 581,000 residents and employees of those homes have been infected, and more than 87,000 have died. That means more than 35 percent of deaths from the virus in the United States have been tied to nursing homes and other long-term care facilities.

In July, the Centers for Disease Control and Prevention reported more than 16,000 infections and 86 deaths tied to meat and poultry processing. But those numbers are almost certainly an undercount. Only 28 states provided data to the C.D.C., and many states and food processing companies have refused to provide case totals. Other large outbreaks have emerged on farms, in fruit or vegetable processing facilities and at plants where pet food is made.

this month that about 400 investigations had been opened into networks of people suspected of providing the fake passes, including some connected to health professionals.

a nurse injecting vaccine doses into a gauze pad and then pretending to inject the contents of empty syringes into people’s arms.

Eight other people are thought to have been falsely vaccinated at the Palermo hub, according to Francesco Lo Voi, the local prosecutor. He said an initial investigation suggested that other health workers at the center had been unaware of the fraud.