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The plan was published Sunday by the American Enterprise Institute. Its lead author — Scott Gottlieb, former Food and Drug Administration commissioner in the Trump administration

“The goal is to outline a plan that will allow a gradual return to a more normal way of life without increasing the risk” that the epidemic will resurge.

Most economists and health experts say there is no way to restart the economy without addressing the underlying problem of the coronavirus. As long as the pandemic continues to spread, the markets will be in turmoil and any businesses will struggle to stay open, they say.

instead of giving false reassurances and deadlines, the White House should tell people the hard truth about the current situation and a coherent strategy they can work toward. “The social distancing, being stuck at home, the deaths we’re going to be seeing. People want to know what it’s for. That there’s a plan.”

the road map Gottlieb’s group outlined stresses the need to move away from the current decentralized system and “toward more coordinated execution of response.”

The plan divides coming months into four phases and sets “triggers” for states to move from one phase to the next.

The latest proposal is a 19-page plan with a step-by-step timeline, with clear benchmarks states and regions would need to meet to safely move forward to the next step

With most of the nation now in phase one of the epidemic, the goal should be a sharp increase in hospital critical care beds and an increase of testing to 750,000 people a week to track the epidemic — a number Gottlieb said could be achieved in the next week or two.

For a state to move to phase two, it should see a sustained reduction in new cases for at least 14 days, and its hospitals need to be able to provide care without being overwhelmed.

“The reason we set it at 14 days is that’s the incubation period of the virus,” said Rivers of Johns Hopkins. “That way you know the downward trend is certain and not because of a holiday or blip or some other delay in reported cases.”

States that have moved into phase two would begin gradually lifting social distancing measures and opening schools and businesses, while increasing surveillance.

The key goals thereafter would be accelerating the development of new treatments and deploying tests to determine who has recovered from infection with some immunity and could rejoin the workforce.

Phase 3 occurs when the nation has a vaccine or drugs to treat covid-19 in place and the government launches mass vaccinations

For weeks, World Health Organization officials have stressed such lockdowns are only helpful for slowing down the virus and buying time to deploy more targeted and comprehensive measures, which the U.S. has not yet done.

Trump has repeatedly returned to strategies of bans and movement restriction

Phase 4 involves rebuilding the nation’s capacity to deal with the next pandemic by building up its scientific and public health infrastructure.

Mike Ryan, WHO head of emergency programs, recently urged countries to focus on finding and isolating infected people and their contacts. “It’s not just about physical distancing, it’s not just about locking down,”

Many experts’ recent proposals for a U.S. strategy have similar stressed the importance of large-scale contact tracing — because it was a cornerstone for successful efforts like South Korea and Singapore.

as countries have shown success with it against this coronavirus, that thinking has changed.

such contact tracing is “impractical now in many places but more practical once case numbers have been reduced and testing scaled up” and “could alleviate the need for stringent social distancing to maintain control of the epidemic.”

Rapidly building up that capacity — either with community volunteers or short-term hires — will be crucial in coming months, said Rivers of Johns Hopkins. “If you build capacity up and bring cases down, it starts looking a lot more possible.”

Many proposals tackle the problem of the tanking economy.

Gottlieb-Johns Hopkins plan, for example, calls for widespread use of blood tests to identify people who have had the infection and now are immune — called serology testing

People who are immune could return to work, or take on high-risk roles in the health care system and help people, especially the elderly, who are still quarantined at home.

Such serology tests have not been deployed before like this on such a large scale

during Ebola outbreaks in Africa, survivors were often the ones who provided care, watched over the children of sick patients and buried the dead.

One challenge unaddressed by most proposals and op-eds, however, is how to get such detailed plans adopted by the White House, whose response has weighed down by infighting and unclear leadership ping-ponging in recent weeks among Trump, Pence and health advisers like Anthony S. Fauci and Deborah Birx and others.

Health officials and scientists involved in the federal response, especially from the Centers for Disease Control and Prevention, have fought to be heard while straining to avoid offending Trump, who bristles at being publicly contradicted, undercut or overshadowed by praise for ideas or people beside himself, according to people who spoke on the condition of anonymity about sensitive deliberations.

On Thursday, Trump unveiled a plan of his own, though scarce in detail. He said he planned to help communities ease their restrictions and reopen for business by using on “robust” surveillance and categorizing counties across America into three “risk levels” — low, medium and high. More details are likely in coming days, White House officials said.

we need to see the course of this crisis in three parts.

First is the initial outbreak which we hope we’re getting some handle on. But there won’t be a return to a real normal until there’s a widely available vaccine or very effective treatments for COVID-19

in the best case scenario we face what I’ll call Phase Two of the crisis – a lengthy period after the initial outbreak in which the challenge will be to get back to an Interim New Normal until vaccines or treatments come online

The third phase will be the arrival of an effective vaccine that can finally in some sense end at least the epidemiological crisis.

So Phase One: Initial Outbreak. Phase Two: Sustaining an Interim New Normal. Phase Three: Vaccines and/or robust Treatments arrive and the crisis ends.

Another key concept: Testing isn’t all the same. One form of testing is diagnostic, tests you give to a particular person to guide their treatment.

The other is surveillance testing, testing to measure and manage the prevalence of the diseas

You can’t go back to even a semblance of normal economic and social life until you have an integrated, national system of surveillance testing in place that will give us a good shot at avoiding a rolling series of outbreaks and lockdowns for another year.

A great system in one state and a crappy one next door won’t cut it.

some building blocks are clear. The first is building a robust and vast system of testing across the country, both testing for infection and testing for antibodies

You also need a system of data collection and analysis that allows all those tests to be analyzed to granularly measure the prevalence and possible spread of the disease, both nationally and on the local level

You also need to keep the scale of infection low enough that contact tracing of new infections is at all possible.

Conventional contact tracing alone with armies of disease detectives probably isn’t up to the challenge, at least not on its own. That is why there’s already extensive discussions of using big data and geolocation tracking on cell phones to do some of this work at scale

A lot of that discussion has focused on taking something China did with mobile applications and adapting it to our social mores and laws. Put simply, you download an app. You say you’re healthy. If you get sick and test positive you tell the app. The app has recorded your movements over the last two weeks and a lot of other peoples. Once I test positive, the people who’ve been in close proximity to me get alerted and told they should get tested.

This is a very blunt instrument version of contact tracing. But unlike conventional contact tracing which operates with disease detectives, phone calls and interviews it can potentially be done at scale and almost instantaneously.

Ezra Klein published a look at a number of the proposed plans for this Phase Two/Interim New Normal and he found all of them almost totally unworkable. They all involve levels of technical capacity, privacy intrusion and political will that seem almost fantastical

we’ll either do one of these plans or all stay in our houses for a year or engage in the truly fantastical approach of going about life as usual while hundreds of thousands of Americans are dying and our national health care system collapsing around us.

The reality is that we’ll likely get some mix of all three. But knowing the alternatives helps focus our attention not on the seeming impossibility of these strategies but the fact that we need to get down to the business of planning and implementing them.

Phase Two is much more complicated. It is what everyone involved in any sort of public policy needs to be focusing on right now. Unfortunately the federal government has shown very, very little ability to mount any kind of coherent, national response.

And the President is focused on finding a date and calling an all clear as soon as possible.

New York City, which is set to enter phase one of reopening on Monday, and is not among the regions where outdoor dining can resume this week.

He noted that Trump did not read any passages from the Bible at his photo session at St. John’s Episcopal Church.

“The president held up the Bible the other day in Washington, D.C. Here in New York we actually read the Bible,” Cuomo told a briefing before reading some passages.

“You can’t use the military as a political weapon,” Cuomo said.

Cuomo said protesters in New York City were mainly peaceful on Tuesday and praised the police department’s handling of the events. A day earlier the governor had criticized the NYPD and the mayor.

“New York City last night was much better,” Cuomo told the briefing. “The protesters were mainly peaceful, the police officers had the resources and the capacity to do their job.”

When England started its first phase five days earlier on 13 May, new daily cases had fallen but were still about 75% of its late-April to early-May peak.

On Monday, when Ireland started phase one of its gradual easing, new daily cases had tumbled to about 11% of the country’s late April peak.

he UK appeared to lack sufficient testing and contact-tracing capacity for such a surge, said L’Estrange. “Perhaps they can get it up and running quickly. But they’re behind the curve and playing catch-up. You have to have sufficient testing and contact-tracing capacity ready to go before you ease restrictions. They’ve put the cart before the horse. They released the virus without having the apparatus in place to control it, and they’ve released it at a high level.”

Ireland’s lockdown easing started after England’s and is scheduled to go more cautiously and slowly, with the last phase starting on 10 August, and schools opening in September. England’s plan envisages schools starting to open on 1 June and the final phase of lifting starting on 4 July.

the decision about schools was political. “It is not a scientific decision. Scientists can offer some advice.”

An editorial in the British Medical Journal this week excoriated the UK’s record on testing and tracing. “Meaningless political soundbites promising to recruit 18,000 contact tracers, test 200,000 people a day, or invest in unjustified contact tracing apps, divert focus and could lead to more deaths. These headline grabbing schemes should be replaced by locality-led strategies rooted in communicable disease control,” it said.

COVID-19 translational research is moving science from the bench preclinical stage of cell and animal research and rapidly through three phases of clinical trials. We can anticipate vaccines being at the patient/population “bedside” in the next few months.

Delaware has created a framework for COVID-19 vaccine distribution when it becomes available which can be found on coronavirus.Delaware.gov. Delaware’s distribution will have three phases

The state will begin with healthcare workers and those caring for vulnerable populations and other first responders and critical infrastructure workers. The second phase will vaccinate vulnerable persons: people over 65, those with chronic health conditions, homelessness and other vulnerabilities.Lastly, the rest of our Delaware population of more than 970,000 will be vaccinated.

And sadly, Black and Brown communities have been disproportionately infected and affected by COVID-19 here in Delaware and throughout the U.S. These communities remain vulnerable.

When COVID-19 vaccines become available, Black and Brown communities must be given equitable access to the vaccine.

The disproportionate effects of the COVID-19 pandemic on Black and Brown communities has pulled back a curtain of silence on the systemic racism in the health and healthcare systems in Delaware and across the United States.

American officials are sweeping aside objections from Turkey and moving forward with plans to rely on a ground fighting force that includes Kurdish militia fighters in Syria.

Kurdish militia fighters will be a part of the ground force used to isolate Raqqa.

An American military official said the Raqqa operation would take place in roughly three phases.

Kurdish militia will make up the bulk of the operation, General Townsend said many of the more than 300 American Special Operations forces now in Syria would help recruit, train and equip local forces in and around Raqqa who are predominantly Syrian Arabs.

neither the Turks nor the Syrian Kurds view the recapture of Raqqa as one of their top priorities — unlike Washington.

American military officials say the Y.P.G. personnel are the best fighters they have.

begin within weeks.

Phase one, he said, is what the American-led coalition fighting the Islamic State has been doing for months:

Phase two, to begin in the coming weeks, will be to isolate Raqqa with the available forces

Phase three will be the fight for Raqqa itself, which American officials say they hope will be conducted mostly by Syrian Arabs, given that the city is majority Sunni Arab.

Manbij was the last stop on the route out of Syria for Islamic State militants headed to Europe.

Coming out of Manbij, we found links to individuals and plot streams to France, the United States, other European countries,” he said.

The Raqqa fight will take place even as the fight for Mosul, next door in

Iraq, is continuing, American military planners say.

ealth Minister Marisol Touraine, who was heading for Rennes on Friday, pledged to "get to the bottom... of this tragic accident".

The study was a Phase I clinical trial, in which healthy volunteers take the medication to evaluate the safety of its use, the ministry said.

Phase I tests for safety. A small number of people, sometimes healthy, and sometimes with a medical condition, are given a tiny dose of the drug under careful supervision, not to test if the drug works, but in order to check for any side effects Phase II sees the drug given to people who have a medical condition to see if it does indeed help them Phase III trials are only for medicines or devices that have already passed the first two stages, and involve them being compared to existing treatments or a placebo. The trials often last a year or more, involving several thousand patients

Clinical trials are the key to getting that data - and without volunteers to take part in the trials, there would be no new treatments for serious diseases such as cancer, multiple sclerosis and arthritis.

They worried that a vaccine would initially elude scientists, that weary citizens would abandon restrictions despite the risks, that the virus would be with us from now on.

Most experts believed that once the crisis was over, the nation and its economy would revive quickly. But there would be no escaping a period of intense pain.

Exactly how the pandemic will end depends in part on medical advances still to come. It will also depend on how individual Americans behave in the interim. If we scrupulously protect ourselves and our loved ones, more of us will live. If we underestimate the virus, it will find us.

More Americans may die than the White House admits.

The epidemiological model often cited by the White House, which was produced by the University of Washington’s Institute for Health Metrics and Evaluation, originally predicted 100,000 to 240,000 deaths by midsummer. Now that figure is 60,000.

The institute’s projection runs through Aug. 4, describing only the first wave of this epidemic. Without a vaccine, the virus is expected to circulate for years, and the death tally will rise over time.

Fatality rates depend heavily on how overwhelmed hospitals get and what percentage of cases are tested. China’s estimated death rate was 17 percent in the first week of January, when Wuhan was in chaos, according to a Center for Evidence-Based Medicine report, but only 0.7 percent by late February.

Various experts consulted by the Centers for Disease Control and Prevention in March predicted that the virus eventually could reach 48 percent to 65 percent of all Americans, with a fatality rate just under 1 percent, and would kill up to 1.7 million of them if nothing were done to stop the spread.

A model by researchers at Imperial College London cited by the president on March 30 predicted 2.2 million deaths in the United States by September under the same circumstances.

China has officially reported about 83,000 cases and 4,632 deaths, which is a fatality rate of over 5 percent. The Trump administration has questioned the figures but has not produced more accurate ones.

The tighter the restrictions, experts say, the fewer the deaths and the longer the periods between lockdowns. Most models assume states will eventually do widespread temperature checks, rapid testing and contact tracing, as is routine in Asia.

In this country, hospitals in several cities, including New York, came to the brink of chaos.

Only when tens of thousands of antibody tests are done will we know how many silent carriers there may be in the United States. The C.D.C. has suggested it might be 25 percent of those who test positive. Researchers in Iceland said it might be double that.

China is also revising its own estimates. In February, a major study concluded that only 1 percent of cases in Wuhan were asymptomatic. New research says perhaps 60 percent were.

The virus may also be mutating to cause fewer symptoms. In the movies, viruses become more deadly. In reality, they usually become less so, because asymptomatic strains reach more hosts. Even the 1918 Spanish flu virus eventually faded into the seasonal H1N1 flu.

The lockdowns will end, but haltingly.

it is likely a safe bet that at least 300 million of us are still vulnerable.

Until a vaccine or another protective measure emerges, there is no scenario, epidemiologists agreed, in which it is safe for that many people to suddenly come out of hiding. If Americans pour back out in force, all will appear quiet for perhaps three weeks.

The gains to date were achieved only by shutting down the country, a situation that cannot continue indefinitely. The White House’s “phased” plan for reopening will surely raise the death toll no matter how carefully it is executed.

Every epidemiological model envisions something like the dance

On the models, the curves of rising and falling deaths resemble a row of shark teeth.

Surges are inevitable, the models predict, even when stadiums, churches, theaters, bars and restaurants remain closed, all travelers from abroad are quarantined for 14 days, and domestic travel is tightly restricted to prevent high-intensity areas from reinfecting low-intensity ones.

In his wildly popular March 19 article in Medium, “Coronavirus: The Hammer and the Dance,” Tomas Pueyo correctly predicted the national lockdown, which he called the hammer, and said it would lead to a new phase, which he called the dance, in which essential parts of the economy could reopen, including some schools and some factories with skeleton crews.

Even the “Opening Up America Again” guidelines Mr. Trump issued on Thursday have three levels of social distancing, and recommend that vulnerable Americans stay hidden. The plan endorses testing, isolation and contact tracing — but does not specify how these measures will be paid for, or how long it will take to put them in place.

On Friday, none of that stopped the president from contradicting his own message by sending out tweets encouraging protesters in Michigan, Minnesota and Virginia to fight their states’ shutdowns.

China did not allow Wuhan, Nanjing or other cities to reopen until intensive surveillance found zero new cases for 14 straight days, the virus’s incubation period.

Compared with China or Italy, the United States is still a playground.Americans can take domestic flights, drive where they want, and roam streets and parks. Despite restrictions, everyone seems to know someone discreetly arranging play dates for children, holding backyard barbecues or meeting people on dating apps.

Even with rigorous measures, Asian countries have had trouble keeping the virus under control

But if too many people get infected at once, new lockdowns will become inevitable. To avoid that, widespread testing will be imperative.

Reopening requires declining cases for 14 days, the tracing of 90 percent of contacts, an end to health care worker infections, recuperation places for mild cases and many other hard-to-reach goals.

Immunity will become a societal advantage.

Imagine an America divided into two classes: those who have recovered from infection with the coronavirus and presumably have some immunity to it; and those who are still vulnerable.

“It will be a frightening schism,” Dr. David Nabarro, a World Health Organization special envoy on Covid-19, predicted. “Those with antibodies will be able to travel and work, and the rest will be discriminated against.”

Soon the government will have to invent a way to certify who is truly immune. A test for IgG antibodies, which are produced once immunity is established, would make sense

Dr. Fauci has said the White House was discussing certificates like those proposed in Germany. China uses cellphone QR codes linked to the owner’s personal details so others cannot borrow them.

As Americans stuck in lockdown see their immune neighbors resuming their lives and perhaps even taking the jobs they lost, it is not hard to imagine the enormous temptation to join them through self-infection

My daughter, who is a Harvard economist, keeps telling me her age group needs to have Covid-19 parties to develop immunity and keep the economy going,”

It would be a gamble for American youth, too. The obese and immunocompromised are clearly at risk, but even slim, healthy young Americans have died of Covid-19.

The virus can be kept in check, but only with expanded resources.

Resolve to Save Lives, a public health advocacy group run by Dr. Thomas R. Frieden, the former director of the C.D.C., has published detailed and strict criteria for when the economy can reopen and when it must be closed.

once a national baseline of hundreds of thousands of daily tests is established across the nation, any viral spread can be spotted when the percentage of positive results rises.

To keep the virus in check, several experts insisted, the country also must start isolating all the ill — including mild cases.

“If I was forced to select only one intervention, it would be the rapid isolation of all cases,”

In China, anyone testing positive, no matter how mild their symptoms, was required to immediately enter an infirmary-style hospital — often set up in a gymnasium or community center outfitted with oxygen tanks and CT scanners.

There, they recuperated under the eyes of nurses. That reduced the risk to families, and being with other victims relieved some patients’ fears.

Still, experts were divided on the idea of such wards

Ultimately, suppressing a virus requires testing all the contacts of every known case. But the United States is far short of that goal.

In China’s Sichuan Province, for example, each known case had an average of 45 contacts.

The C.D.C. has about 600 contact tracers and, until recently, state and local health departments employed about 1,600, mostly for tracing syphilis and tuberculosis cases.

China hired and trained 9,000 in Wuhan alone. Dr. Frieden recently estimated that the United States will need at least 300,000.

There will not be a vaccine soon.

any effort to make a vaccine will take at least a year to 18 months.

the record is four years, for the mumps vaccine.

for unclear reasons, some previous vaccine candidates against coronaviruses like SARS have triggered “antibody-dependent enhancement,” which makes recipients more susceptible to infection, rather than less. In the past, vaccines against H.I.V. and dengue have unexpectedly done the same.

A new vaccine is usually first tested in fewer than 100 young, healthy volunteers. If it appears safe and produces antibodies, thousands more volunteers — in this case, probably front-line workers at the highest risk — will get either it or a placebo in what is called a Phase 3 trial.

It is possible to speed up that process with “challenge trials.” Scientists vaccinate small numbers of volunteers, wait until they develop antibodies, and then “challenge” them with a deliberate infection to see if the vaccine protects them.

Normally, it is ethically unthinkable to challenge subjects with a disease with no cure, such as Covid-19.

“Fewer get harmed if you do a challenge trial in a few people than if you do a Phase 3 trial in thousands,” said Dr. Lipsitch, who recently published a paper advocating challenge trials in the Journal of Infectious Diseases. Almost immediately, he said, he heard from volunteers.

The hidden danger of challenge trials, vaccinologists explained, is that they recruit too few volunteers to show whether a vaccine creates enhancement, since it may be a rare but dangerous problem.

if a vaccine is invented, the United States could need 300 million doses — or 600 million if two shots are required. And just as many syringes.

“People have to start thinking big,” Dr. Douglas said. “With that volume, you’ve got to start cranking it out pretty soon.”

Treatments are likely to arrive first.

The modern alternative is monoclonal antibodies. These treatment regimens, which recently came very close to conquering the Ebola epidemic in eastern Congo, are the most likely short-term game changer, experts said.

as with vaccines, growing and purifying monoclonal antibodies takes time. In theory, with enough production, they could be used not just to save lives but to protect front-line workers.

Having a daily preventive pill would be an even better solution, because pills can be synthesized in factories far faster than vaccines or antibodies can be grown and purified.

Goodbye, ‘America First.’

A public health crisis of this magnitude requires international cooperation on a scale not seen in decades. Yet Mr. Trump is moving to defund the W.H.O., the only organization capable of coordinating such a response.

And he spent most of this year antagonizing China, which now has the world’s most powerful functioning economy and may become the dominant supplier of drugs and vaccines. China has used the pandemic to extend its global influence, and says it has sent medical gear and equipment to nearly 120 countries.

This is not a world in which “America First” is a viable strategy, several experts noted.

“If President Trump cares about stepping up the public health efforts here, he should look for avenues to collaborate with China and stop the insults,”

If we alienate the Chinese with our rhetoric, I think it will come back to bite us,” he said.“What if they come up with the first vaccine? They have a choice about who they sell it to. Are we top of the list? Why would we be?”

Once the pandemic has passed, the national recovery may be swift. The economy rebounded after both world wars, Dr. Mulder noted.

In one of the most provocative analyses in his follow-up article, “Coronavirus: Out of Many, One,” Mr. Pueyo analyzed Medicare and census data on age and obesity in states that recently resisted shutdowns and counties that voted Republican in 2016.

He calculated that those voters could be 30 percent more likely to die of the virus.

In the periods after both wars, Dr. Mulder noted, society and incomes became more equal. Funds created for veterans’ and widows’ pensions led to social safety nets, measures like the G.I. Bill and V.A. home loans were adopted, unions grew stronger, and tax benefits for the wealthy withered.

If a vaccine saves lives, many Americans may become less suspicious of conventional medicine and more accepting of science in general — including climate change

The W.H.O. emergency use approval allows the Sinopharm vaccine to be included in Covax, a global initiative to provide free vaccines to poor countries. The possible inclusion in Covax raises hopes that more people — especially those in developing nations — will get access to shots at a crucial moment.

“This should be the golden time for China to practice its vaccine diplomacy. The problem is, at the same time, China itself is facing a shortage,”

“The whole world is short of this vaccine,” said a Sinovac spokesman, Pearson Liu. “The demand is just too great.”

Andrea Taylor, who analyzes global data on vaccines at the Duke Global Health Institute, called the potential addition of two Chinese vaccines into the Covax program a “game changer.”

“The situation right now is just so desperate for low and lower middle income countries that any doses we can get out are worth mobilizing,” Ms. Taylor said. “Having potentially two options coming from China could really change the landscape of what’s possible over the next few months.”

China’s vaccines have been rolled out to more than 80 countries, but they have faced significant skepticism, in part because the companies have not released Phase 3 clinical trial data for scientists to independently assess the vaccines’ efficacy rates. An advisory group to the W.H.O. published the data this week.

The Sinopharm vaccine developed with the Beijing Institute of Biological Products has an efficacy rate of 78.1 percent, according to the W.H.O. advisory group.

The Sinovac vaccine has varying efficacy rates of between 50 percent to 84 percent, depending on the country where Phase 3 trials were conducted.

for China’s leaders, the W.H.O. approval can still be seen as a badge of honor. Xi Jinping, China’s top leader, has pledged to make a Covid-19 vaccine a “global public good.”

After India announced export restrictions on vaccines last month, Indonesia and the Philippines said they would turn to China for help. Last week, China’s foreign minister offered to help South Asian nations get access to vaccines.

Indonesia said it would get additional doses from Sinovac after President Joko Widodo held talks with Mr. Xi. In a speech the same week, President Rodrigo Duterte of the Philippines said he owed “a debt of gratitude” to China for its vaccines.

“They don’t like to subsume their generosity in their products under some U.N. brand,” said J. Stephen Morrison, director of the global health policy center at the Center for Strategic and International Studies. “They are in a historic phase,” he said. “They want the recipients to know that this is China delivering.”

But the F.D.A. advisory committee, along with an independent think tank and several prominent experts — including some Alzheimer’s doctors who worked on the aducanumab clinical trials — said the evidence raised significant doubts about whether the drug is effective.

The F.D.A. authorized the drug under a program called accelerated approval, which has been applied to therapies for some cancers and other serious diseases for which there are few, if any, treatments.

The risks with aducanumab involve brain swelling or bleeding experienced by about 40 percent of Phase 3 trial participants receiving the high dose. Most were either asymptomatic or had headaches, dizziness or nausea. But such effects prompted 6 percent of high-dose recipients to discontinue. No Phase 3 participants died from the effects, but one safety trial participant did.

About two million Americans may fit the description of the patients the drug was tested on: people in the early stages of Alzheimer’s or the stage just before that, Alzheimer’s-related mild cognitive impairment. About six million people in the United States and roughly 30 million globally have Alzheimer’s, a number expected to double by 2050. Currently, five medications approved in the United States can delay cognitive decline for several months in various Alzheimer’s stages.

The crux of the controversy over aducanumab involved two Phase 3 trials with results that contradicted each other: One suggested the drug slightly slowed cognitive decline while the other trial showed no benefit. The trials were stopped early by a data monitoring committee that found aducanumab didn’t appear to be showing any benefit. Consequently, over a third of the 3,285 participants in those trials were never able to complete them.

Aducanumab, a monoclonal antibody, targets a protein, amyloid, that clumps into plaques in the brains of Alzheimer’s patients and is considered a biomarker of the disease. One thing both critics and supporters of approval agree on is that the drug substantially reduces levels of amyloid, and the F.D.A. said that the drug’s effect on a biomarker qualified it for the accelerated approval program.

He estimates 25 to 40 percent of the clinic’s roughly 3,000 patients might be eligible, but it doesn’t have enough neurologists.

Not everyone applauded the deal, with Senate Minority Leader Chuck Schumer expressing skepticism.“If I sound frustrated and angry, it’s because I am. President Trump’s ‘Phase 1’ trade deal with China is an extreme disappointment. He’s conceding our leverage for vague, unenforceable ‘promises’ China never intends to fulfill,” he said in the Senate.

While the vaccine had promising results in the lab, it's not known if it will protect people in the real world. The US Food and Drug Administration has cleared the company to begin Phase 2 trials, which typically involve several hundred of people, and Moderna plans to start large-scale clinical trials, known as Phase 3 trials, in July, which typically involve tens of thousands of people.

"We've demonstrated that these antibodies, this immune response, can actually block the virus," Zaks said. "I think this is a very important first step in our journey towards having a vaccine."

"It shows that not only did the antibody bind to the virus, but it prevented the virus from infecting the cells," said Dr. Paul Offit, a member of the NIH panel that's setting a framework for vaccine studies in the US.

In the Moderna study, three participants developed fever and other flu-like symptoms when they received the vaccine at a dose of 250 micrograms. Moderna anticipates the Phase 3 study on dosage will be between 25 and 100 micrograms.

So far, the Moderna study subjects who were vaccinated even at 25 and 100 micrograms achieved antibody levels similar to or even higher than people who naturally became infected with coronavirus.

The Fast Start plan will require extensive coordination between city, state and federal officials,  Weaver said. She was joined Tuesday by retired National Guard Brig. Gen. Michael McDaniel, who said he thinks the project can be done within a year by 32 crews.

McDaniel — who is assisting in coordinating activities between the city, the Lansing Board of Water and Light, state and federal agencies, and other stakeholders -- said the project could begin within the next month. But McDaniel reiterated the plan is still in its early phases and much of it is based on "assumptions."

The preliminary project scope developed by the BWL shows that up to 15,000 lead pipes could be removed in one year "under optimal conditions," Weaver said.McDaniel noted that while it took the BWL 10 years to remove 13,500 pipes, he thinks they can move quicker in Flint because they've perfected the process. McDaniel and Weaver said Flint crews would also be involved in the project.

The project would be done in two phases, with the first targeting high-risk households of children under the age of 6, children with elevated blood-lead levels, pregnant women, senior citizens, residential day care facilities, people with compromised immune systems and households where water tests indicate high levels of lead at the tap.

The project will not immediately address schools, businesses and other locations in Flint, according to a document released by the city detailing the plan. The city said most large facilities are served by "high-capacity cast iron water services," and not the typical lines found in residential water services.

the document states. "For institutional entities like schools and businesses, bottled water can continue to provide for their short-term needs."

Phase two of the program would ramp up to a "full-scale operation" that would bring in 32 crews and a "robust administration and logistics support team to meet the one-year goal," Weaver said.

McDaniel said the costs in the projected $55-million effort could fluctuate because of  the architecture and condition of the water distribution system. The estimated cost per line is $3,670, according to a city document. Of the $55 million, about $1.5 million will go toward administration and logistics, according to the city, which said personnel costs are estimated at $900,000 and operations costs are projected to be $600,000. According to the city, the bulk of the cost — $36 million — will go toward the labor and about $9.7 million will go toward the materials.

According to the city, the Fast Start program will remove and replace the lines at no cost to the homeowner. However, homeowners will be required to sign an agreement that authorizes Flint to remove and replace the portions of the lines on their private property and allow access to the meter inside the home.Lead lines will be replaced with new copper lines and a water filter will be installed at the kitchen tap for three months as a precaution, city officials said.

Flint's drinking water became contaminated with lead in April 2014 after the city, while under the control of a state-appointed emergency manager, switched its source to the Flint River as a temporary cost-cutting move and the state Department of Environmental Quality failed to require the addition of needed corrosion-control chemicals. As a result, corrosive water caused lead to leach from pipes, joints and fixtures, causing many citizens to receive water with unsafe lead levels. The state has told residents not to drink the water without filtering and says it is treating all Flint children as having been exposed to unsafe levels of lead

The FBI is now investigating the contamination of Flint’s drinking water amid a growing public outcry. U.S. Rep. Candice Miller, R-Harrison Township, proposed an emergency $1-billion grant to be authorized through the Environmental Protection Agency, and two Democratic U.S. senators and U.S. Rep. Dan Kildee, D-Flint Township, proposed up to $400 million in dollar-for-dollar matching funds from the state to do much the same thing.

The U.S. Attorney's Office announced Jan. 5 that it was assisting the EPA in the investigation

Several lawsuits have been filed in connection with the crisis.

When asked at the news conference whether she thinks Snyder will support the plan, Weaver said the city can no longer afford to wait."We’re putting forward our plan and we cannot wait for that," Weaver said. "We don’t trust that and we deserve new pipes. That’s the only way this community is going to be confident and people will stay here and people will come. I cannot imagine that he would not support this plan. If he doesn’t, shame on him."

An administration official told CNN that CDC leadership had not seen the draft document before it was leaked, and there were two concerns when it reached the task force. It was "overly prescriptive" because "guidance in rural Tennessee shouldn't be the same guidance for urban New York City," and the recommendations in the document did not fit the "phases" that had already been outlined by the task force.

The draft document included specific guidance for six categories: child care programs; schools and day camps; communities of faith; employers with vulnerable workers; restaurants and bars; mass transit administrators. For each category, the draft document notes reopening in phases.

"This is a governor-led effort. The President has said that governors make the decisions as to move forward and we encourage them to follow our phased approach," McEnany said.

"The CDC, the White House task force and White House principles were in disagreement on how strongly a public health response should still be in place," said the official.

"In the absence of law, it's regulation, and in the absence of regulation, it's recommendations. They think it's left too much open to be interpreted by the courts if something happens on the job. It doesn't matter if (the Occupational Safety and Health Administration) is playing ball or not," the CDC source said.

While the Committee of Public Safety wasn't an executive government—on August 1st, 1793, the Convention refused a motion calling for it to become the provisional government; it was the closest France had to anyone being in overall charge, and it moved to meet the challenge with utter ruthlessness.

It also presided over the bloodiest period of the revolution: The Terror.

many French citizens

only the extreme use of the guillotine against traitors, suspects, and counter-revolutionaries would solve the country's problems.

They felt terror was necessary—not figurative terror, not a posture, but actual government rule through terror. 

The Convention deputies increasingly heeded these calls.

a demonstration for more wages and bread was quickly turned to the advantage of those calling for terror

Convention agreed, and in addition voted to finally organize the revolutionary armies people had agitated for over previous months to march against the hoarders and unpatriotic members of the countryside

The sansculottes had once again forced their wishes onto and through the Convention; terror was now in force.

Law of Suspects was introduced allowing for the arrest of anyone whose conduct suggested they were supporters of tyranny or federalism, a law which could be easily twisted to affect just about everyone in the nation.

the laws passed during the Terror went beyond simply tackling the various crises.

The Bocquier Law of December 19th, 1793 provided a system of compulsory and free state education for all children aged 6 – 13

Homeless children also became a state responsibility, and people born out of wedlock were given full inheritance rights.

universal system of metric weights and measurements was introduced

an attempt to end poverty was made by using ‘suspects’ property to aid the poor.

However, it is the executions for which the Terror is so infamous

The Committee of Public Safety's counter-offensive took the terror deep into the heart of the Vendée.

However, this early phase of the terror was not, as legend recalls, aimed at nobles, who made up only 9% of the victims; clergy were 7%. Most executions occurred in Federalist areas after the army had regained control and some loyal areas escaped largely unscathed. It was normal, everyday people, killing masses of other normal, everyday people. It was civil war, not class.

During the Terror, deputies on mission began attacking the symbols of Catholicism: smashing images, vandalizing buildings, and burning vestments.

The Committee of Public Safety grew concerned about the counter-productive effects, especially Robespierre who believed that faith was vital to order. He spoke out and even got the Convention to restate their commitment to religious freedom, but it was too late. Dechristianization flourished across the nation, churches closed and 20,000 priests were pressured into renouncing their position.

14 Frimaire. This law was designed to give the Committee of Public Safety even more control over the whole of France by providing a structured 'chain of authority' under the revolutionary government and to keep everything highly centralized. The Committee was now the supreme executive and no body further down the chain was supposed to alter the decrees in any way

the law of 14 Frimaire aimed to institute a uniform administration with no resistance, the opposite of that to the constitution of 1791

It marked the end of the first phase of the terror

Robespierre, who had argued against dechristianization, had tried to save Marie Antoinette from the guillotine

He wanted a 'cleansing' of the country and committee and he outlined his idea for a republic of virtue while denouncing those he deemed non virtuous, many of whom, including Danton, went to the Guillotine.

began a new phase in the Terror, where people could be executed for what they might do, not had done, or simply because they failed to meet Robespierre's new moral standard, his utopia of murder.

The Republic of Virtue concentrated power at the Centre, around Robespierre

The Terror was now almost class based rather than against counter-revolutionaries.

Children and adult dependents would be eligible for the full $1,400.

Enhanced unemployment benefits totaling $300 a week are set to expire on March 14, creating a de facto deadline for Congress to act. Senate Democrats struck a last-minute agreement Friday to set federal unemployment benefits at $300 a week, down from the $400 passed by the House, but extend their duration by a month, through September. In addition, the first $10,200 of the benefits for 2020 wouldn’t be taxable.

the restaurant industry will receive $25 billion in relief targeted at small and midsize restaurants and chains.

It allocates $8.75 billion to federal, state, local, territorial and tribal public-health agencies for distributing, administering and tracking vaccinations, with some funds specially dedicated to making sure the vaccination process reaches underserved communities.

While the package would make the child tax-credit changes only for one year, it is broadly expected that Democrats will seek to make them permanent in the future.

allow federal workers, including postal workers, to take as many as 600 hours of emergency paid leave related to Covid-19.

Vaccine development would also get a boost, with around $20 billion going to federal biomedical research for vaccine and therapeutic manufacturing and procurement, along with around $3 billion for a strategic national stockpile of vaccines. Another $25 billion would be spent on testing, contact tracing and reimbursing hospitals for lost revenue related to the pandemic.

Senate Democrats added a provision that would make much student-loan forgiveness free from income taxes, creating an exception from 2021 through 2025 to the normal rule that canceled debt is income

Not likely. Republicans see the bill as too large, saying it sprawls beyond pandemic aid and instead is a wish list of liberal priorities.

Republicans have used the budget-resolution amendment process to inflict political damage on Democrats and expose their differences on issues like providing aid to undocumented immigrants and raising the minimum wage. But they have been unable to strike many blows against support for the overall package, which enjoys strong approval in polls and has so far kept congressional Democrats united on its top-line priorities.

Anaxagoras came to believe that the moon was a rock, not totally unlike the Earth, and he even described mountains on the lunar surface.

While Anaxagoras was not the first to realize that moonlight is reflected light from the sun, he was able to use this concept to correctly explain additional natural phenomena, such as eclipses and lunar phases.

Although many Greek philosophers of the sixth and fifth centuries B.C. believed in one or a few fundamental elements—such as water, air, fire and earth—Anaxagoras thought there must be an infinite number of elements.

He noted that when the moon is on the opposite side of the Earth than the sun, the full face is illuminated, “[producing] a model of the heavens that predicts not only phases of the moon, but how eclipses are possible.”

he philosopher also realized that the occasional darkening of the moon must result from the moon, sun and Earth lining up such that the moon passes into the Earth’s shadow—a lunar eclipse.

Anaxagoras also wrestled with the origins and formation of the moon, a mystery that still challenges scientists today.

Though his life was spared, the philosopher who questioned the divinity of the moon found himself in exile in Lampsacus at the edge of the Hellespont. But his ideas regarding eclipses and lunar phases would live on to this day, and for his recognition of the true nature of the moon, a lunar crater, visited by orbiting spacecraft some 2,400 years later, bears the name Anaxagoras.

Democratic presidential nominee Joe Biden, a former longtime senator and Senate Judiciary Committee chair, called on Republicans in the Senate "who know deep down what is right for the country — not just for their party" to vote against a Trump nominee.

Let the people speak. Cool the flames that have been engulfing our country."

"If an opening comes in the last year of President Trump's term, and the primary process has started, we'll wait to the next election," Republican Sen. Lindsey Graham said in 2018 at a panel hosted by The Atlantic.

There has certainly been very little consistency among Republicans on this.

It's called delay, delay, delay."

It's not OK for Obama to do it, because it's bad for my side. But it's OK for me to do it, because it is good for my side. This is all about political power.

"character" and "temperament."

"When we weigh the equities, defending our democracy requires us to use every arrow in our quiver."

passing statehood for Washington, D.C., to likely give Democrats two more senators;

If blowing up the filibuster for Supreme Court nominees was "going nuclear," we might be about to enter a phase of "post-apocalyptic" governance in Washington.