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They blamed Italy’s high number of infections on aggressive testing of people without symptoms in the north, which they argued only created hysteria and tarnished the country’s image abroad.

Even once the Italian government considered a universal lockdown necessary to defeat the virus, it failed to communicate the threat powerfully enough to persuade Italians to abide by the rules, which seemed riddled with loopholes.

Still, he acknowledged that the health minister had struggled to persuade his government colleagues to move more quickly and that the difficulties of navigating Italy’s division of powers between Rome and the regions resulted in a fragmented chain of command and inconsistent messages.

For the coronavirus, 10 days can be a lifetime.

Politicians across the spectrum worried about the economy and feeding the country, and found it difficult to accept their impotence in the face of the virus.

Most importantly, Italy looked at the example of China, Ms. Zampa said, not as a practical warning, but as a “science fiction movie that had nothing to do with us.” And when the virus exploded, Europe, she said, “looked at us the same way we looked at China.”

A day later, on March 9, when the positive cases reached 9,172 and the death toll climbed to 463, Mr. Conte toughened the restrictions and extended them nationally.

But he also had not had any direct contacts with China, and experts suspect he contracted the virus from another European, meaning Italy did not have an identifiable patient zero or a traceable source of contagion that could help it contain the virus.

The virus had already been active in Italy for weeks by that time, experts now say, passed by people without symptoms and often mistaken for a flu

“Who we call ‘Patient One’ was probably ‘Patient 200,’ ” said Fabrizio Pregliasco, an epidemiologist.

Mr. Fontana, who had been pressing the central government for tougher action, agreed. He said that the mixed messages from Rome and the easing of restrictions had led Italians to believe “that everything was a joke, and they kept living as they used to.”

“They were convinced that the situation was less serious and they did not want to hurt our economy too much,”

the nation became divided between those who saw the threat and those who didn’t.

some regional governors independently ordered people coming from the newly locked-down area to self quarantine. Others didn’t.

Mr. Ricciardi said Italy had the bad luck of having a super spreader in a densely populated and dynamic area who went to the hospital not once, but twice, infecting hundreds of people, including doctors and nurses.“He was incredibly active,” Mr. Ricciardi said.

Italy is still paying the price of those early mixed messages by scientists and politicians. The people who have died in staggering numbers recently — more than 2,300 in the last four days — were mostly infected during the confusion of a week or two ago.

Roberto Burioni, a prominent virologist at the San Raffaele University in Milan, said that people had felt safe to go about their usual routines and he attributed the spike in cases last week to “that behavior.”

Leaders in the north are desperate for the government to crack down harder.

On Friday, Mr. Fontana complained that the 114 troops the government deployed were insignificant, and that at least 1,000 should be sent. On Saturday, he closed public offices, work sites and banned jogging. He said in an interview that the government needed to stop messing around and “apply rigid measures.”

“At least this slows down the virus’ speed,’’ Mr. Zaia said, arguing that testing helped identify potentially contagious people without symptoms. ‘‘And slowing down the virus’ speed allows the hospitals to breathe.’’

Dr. Venturi said those tests were essentially “useless” because they did not describe whether a person had the right level of antibodies and because no one knew yet how long they lasted.

Instead, he said, Italy’s reopening phase needs to rely on uninfected people, which he considered to be 90 percent of the population, and on social distancing and other protective measures.

In theory, even those lucky few would not need to wait for two consecutive negative swab tests — which sometimes take months — before being released from quarantine and allowed back to work. “It would be like a negative test result,” he said.

In the meantime, though, Dr. Venturi said it was impossible to consider a work force made up only of people showing neutralizing antibodies.

Results will take weeks more, but if confirmed, he said, it would show that people who test positive for an adequate level of neutralizing IgG antibodies do not pose a danger of contagion.

“I did it to free myself of this doubt,” said Mr. Passaggio, who last month showed Covid-19 symptoms, including a low fever. Unable to get tested for the virus, as swabs are generally reserved for the hospitalized, he took precautions to avoid contaminating others, including staying isolated for weeks.

Last Tuesday he got the results: high levels of immunoglobulin G, or IgG, antibodies. Mr. Passaggio said he understood from doctors on television that it meant a degree of immunity, confidence he was not a danger to others and that he could possibly “go to work before someone else.”

Mr. Francese said that a month ago, 50 people in the town showed clear symptoms of the virus, but that the health authorities failed to test them. They got sick, and then their relatives got sick and cases kept building.

The town, out of desperation, tracked down serological tests offered by a Chinese factory that the mayor said had an 96 percent accuracy rate, and which he said Italy’s national research center had approved.

Robbio has already tested about half of its residents and found and isolated many positive cases, about half of whom had symptoms, he said. He also said that the tests had shown 12 percent had IgG antibodies.

He said he considered those people “immune and thus would be eligible” for an eventual immunity license, despite health experts’ doubts.

In the new study, Dr. López-Medina and his colleagues randomly assigned more than 400 people who had recently developed mild Covid-19 symptoms to receive a five-day course of either ivermectin or a placebo.

“There’s been a lot of conflicting views on this, sometimes extreme conflicting views,” said Dr. Carlos Chaccour, a researcher at the Barcelona Institute for Global Health who was not involved in the new study.

They found that Covid-19 symptoms lasted about 10 days, on average, among people who received the drug, compared with 12 days among those who received the placebo, a statistically insignificant difference.

The researchers did find that seven patients in the placebo group deteriorated after enrolling in the trial, compared to four in the ivermectin group, but the numbers were too small to draw a meaningful conclusion.

Bigger trials, which are currently underway, could provide more definitive answers, said Dr. Rabinovich, who noted that she was “totally neutral” on ivermectin’s potential usefulness.

Malala, a 2014 Nobel Peace Prize winner (at 17, she was the youngest recipient to receive the prize), began using her voice at the age of 10, standing up to the Taliban in Pakistan and advocating for the rights of girls to receive a safe, free quality education.

During a call with reporters, the director of the CDC talked about the need to strengthen systems that monitor fo respiratory illnesses.

The study was posted on the pre-print server MedRXiv.org, which means it wasn't peer reviewed or published in a medical journal.

But later in the call, he added that the surveillance systems that were in place "really did give us eyes on this disease as it began to emerge" and that his agency was "never blind when it came to surveillance for coronavirus 19."

"The disease spread under the radar," study author Alessandro Vespignani, director of the Network Science Institute at Northeastern University in Boston, said at the time.

"When we've heard about the number of diagnosed cases, we have to be mindful that the number of people who contracted SARS-CoV-2 is actually going to be much larger than that," Holtgrave said.

Some infected people may have had no symptoms, or only mild symptoms, and so never went to the doctor. Others might have wanted to get tested but couldn't find a doctor to test them, given the shortage of tests in February and March. It was winter virus season, and so some people who actually had Covid might have been diagnosed with the flu or another illness. Still others might have been suffering Covid symptoms but didn't go to the doctor because they feared catching the virus there.

"may not be out of the woods yet."

just because he's going home, he's not completely out of the woods,

some of these patients have long-term lung impact

Trump's oxygen levels were healthy and he was breathing well, but he declined to answer a reporter question about whether there is evidence of pneumonia on the President's lung scans

Masud notes that recovering COVID-19 patients who were hospitalized need to be closely monitored in case they get worse, especially older adults.

It's a good sign that he was well enough to be discharged

"Individuals that have mild disease to start out with, just mild symptoms, they can in a week or so feel worse, worse enough to be in an ICU," she says.

most people with mild symptoms don't get the kind of aggressive treatment that Trump received. He's received an experimental antibody treatment, a course of remdesivir and the steroid dexamethasone, all treatments generally reserved for patients hospitalized with severe symptoms.

The President did have a fever, fatigue and a mild cough late last week, but hasn't had fever in 72 hours, his doctors said.

he'll be getting his vitals checked at least every day or every couple times a day in order to make sure nothing is happening." He will also need to complete his course of medications — the Remdesivir and dexamethasone

"It's possible that [the interventions] could make him better sooner," she says. "[But] we don't know really what happens to people that have mild disease and then get treatment with antibody medications, antivirals or steroids. I think we're sort of a little bit in a data-free zone, where we're not sure."

confusion, issues with memory, fatigue and not being able to catch their breath

Though Trump is not on oxygen now, his physicians did disclose he had "several little temporary drops in his oxygen" and took supplemental oxygen twice.

Masud says if he had a patient with Trump's profile — male, over 70 years and overweight — who was hospitalized for a few days and received aggressive treatments, he would want to monitor the patient's oxygen levels closely even after they went home.

We like to watch them for a day or two to make sure there's no relapse because we've had patients who relapsed also and required oxygen, especially when they become active ... they get tired and they can't catch their breath."

also monitor markers of inflammation

When speaking with reporters, Conley said the President would be closely monitored by the medical team at the White House at least through the weekend. "If we can get through Monday with him remaining the same or improving, better yet, then we will all take that final, big sigh of relief," he said.

one of the key things which has been shown to help patients recover is having good sleep, long duration of sleep

With a grueling election season ahead of him, lack of sleep and adequate breaks could hurt Trump's recovery, he adds.

Dr. Shi’s group was fascinated by how coronaviruses jump from species to species. To find viruses, they took samples from bats and other animals, as well as from sick people living near animals carrying these viruses or associated with the wildlife trade. Much of this work was conducted in partnership with the EcoHealth Alliance, a U.S.-based scientific organization that, since 2002, has been awarded over $80 million in federal funding to research the risks of emerging infectious diseases.

Their research showed that the viruses most similar to SARS‑CoV‑2, the virus that caused the pandemic, circulate in bats that live roughly 1,000 miles away from Wuhan. Scientists from Dr. Shi’s team traveled repeatedly to Yunnan province to collect these viruses and had expanded their search to Southeast Asia. Bats in other parts of China have not been found to carry viruses that are as closely related to SARS-CoV-2.

When the Covid-19 outbreak was detected, Dr. Shi initially wondered if the novel coronavirus had come from her laboratory, saying she had never expected such an outbreak to occur in Wuhan.

The SARS‑CoV‑2 virus is exceptionally contagious and can jump from species to species like wildfire. Yet it left no known trace of infection at its source or anywhere along what would have been a thousand-mile journey before emerging in Wuhan.

The year before the outbreak, the Wuhan institute, working with U.S. partners, had proposed creating viruses with SARS‑CoV‑2’s defining feature

The laboratory pursued risky research that resulted in viruses becoming more infectious: Coronaviruses were grown from samples from infected animals and genetically reconstructed and recombined to create new viruses unknown in nature. These new viruses were passed through cells from bats, pigs, primates and humans and were used to infect civets and humanized mice (mice modified with human genes). In essence, this process forced these viruses to adapt to new host species, and the viruses with mutations that allowed them to thrive emerged as victors.

Worse still, as the pandemic raged, their American collaborators failed to publicly reveal the existence of the Defuse proposal. The president of EcoHealth, Peter Daszak, recently admitted to Congress that he doesn’t know about virus samples collected by the Wuhan institute after 2015 and never asked the lab’s scientists if they had started the work described in Defuse.

By 2019, Dr. Shi’s group had published a database describing more than 22,000 collected wildlife samples. But external access was shut off in the fall of 2019, and the database was not shared with American collaborators even after the pandemic started, when such a rich virus collection would have been most useful in tracking the origin of SARS‑CoV‑2. It remains unclear whether the Wuhan institute possessed a precursor of the pandemic virus.

In 2021, The Intercept published a leaked 2018 grant proposal for a research project named Defuse, which had been written as a collaboration between EcoHealth, the Wuhan institute and Ralph Baric at the University of North Carolina, who had been on the cutting edge of coronavirus research for years. The proposal described plans to create viruses strikingly similar to SARS‑CoV‑2.

Coronaviruses bear their name because their surface is studded with protein spikes, like a spiky crown, which they use to enter animal cells. The Defuse project proposed to search for and create SARS-like viruses carrying spikes with a unique feature: a furin cleavage site — the same feature that enhances SARS‑CoV‑2’s infectiousness in humans, making it capable of causing a pandemic. Defuse was never funded by the United States.

owever, in his testimony on Monday, Dr. Fauci explained that the Wuhan institute would not need to rely on U.S. funding to pursue research independently.

While it’s possible that the furin cleavage site could have evolved naturally (as seen in some distantly related coronaviruses), out of the hundreds of SARS-like viruses cataloged by scientists, SARS‑CoV‑2 is the only one known to possess a furin cleavage site in its spike. And the genetic data suggest that the virus had only recently gained the furin cleavage site before it started the pandemic.

Ultimately, a never-before-seen SARS-like virus with a newly introduced furin cleavage site, matching the description in the Wuhan institute’s Defuse proposal, caused an outbreak in Wuhan less than two years after the proposal was drafted.

When the Wuhan scientists published their seminal paper about Covid-19 as the pandemic roared to life in 2020, they did not mention the virus’s furin cleavage site — a feature they should have been on the lookout for, according to their own grant proposal, and a feature quickly recognized by other scientists.

At the Wuhan Institute of Virology, a team of scientists had been hunting for SARS-like viruses for over a decade, led by Shi Zhengl

In May, citing failures in EcoHealth’s monitoring of risky experiments conducted at the Wuhan lab, the Biden administration suspended all federal funding for the organization and Dr. Daszak, and initiated proceedings to bar them from receiving future grants. In his testimony on Monday, Dr. Fauci said that he supported the decision to suspend and bar EcoHealth.

Separately, Dr. Baric described the competitive dynamic between his research group and the institute when he told Congress that the Wuhan scientists would probably not have shared their most interesting newly discovered viruses with him. Documents and email correspondence between the institute and Dr. Baric are still being withheld from the public while their release is fiercely contested in litigation.

In the end, American partners very likely knew of only a fraction of the research done in Wuhan. According to U.S. intelligence sources, some of the institute’s virus research was classified or conducted with or on behalf of the Chinese military.

In the congressional hearing on Monday, Dr. Fauci repeatedly acknowledged the lack of visibility into experiments conducted at the Wuhan institute, saying, “None of us can know everything that’s going on in China, or in Wuhan, or what have you. And that’s the reason why — I say today, and I’ve said at the T.I.,” referring to his transcribed interview with the subcommittee, “I keep an open mind as to what the origin is.”

The Wuhan lab pursued this type of work under low biosafety conditions that could not have contained an airborne virus as infectious as SARS‑CoV‑2.

Labs working with live viruses generally operate at one of four biosafety levels (known in ascending order of stringency as BSL-1, 2, 3 and 4) that describe the work practices that are considered sufficiently safe depending on the characteristics of each pathogen. The Wuhan institute’s scientists worked with SARS-like viruses under inappropriately low biosafety conditions.

​​Biosafety levels are not internationally standardized, and some countries use more permissive protocols than others.

In one experiment, Dr. Shi’s group genetically engineered an unexpectedly deadly SARS-like virus (not closely related to SARS‑CoV‑2) that exhibited a 10,000-fold increase in the quantity of virus in the lungs and brains of humanized mice. Wuhan institute scientists handled these live viruses at low biosafety levels, including BSL-2.

Even the much more stringent containment at BSL-3 cannot fully prevent SARS‑CoV‑2 from escaping. Two years into the pandemic, the virus infected a scientist in a BSL-3 laboratory in Taiwan, which was, at the time, a zero-Covid country. The scientist had been vaccinated and was tested only after losing the sense of smell. By then, more than 100 close contacts had been exposed. Human error is a source of exposure even at the highest biosafety levels, and the risks are much greater for scientists working with infectious pathogens at low biosafety.

An early draft of the Defuse proposal stated that the Wuhan lab would do their virus work at BSL-2 to make it “highly cost-effective.” Dr. Baric added a note to the draft highlighting the importance of using BSL-3 to contain SARS-like viruses that could infect human cells, writing that “U.S. researchers will likely freak out.”

Years later, after SARS‑CoV‑2 had killed millions, Dr. Baric wrote to Dr. Daszak: “I have no doubt that they followed state determined rules and did the work under BSL-2. Yes China has the right to set their own policy. You believe this was appropriate containment if you want but don’t expect me to believe it. Moreover, don’t insult my intelligence by trying to feed me this load of BS.”

SARS‑CoV‑2 is a stealthy virus that transmits effectively through the air, causes a range of symptoms similar to those of other common respiratory diseases and can be spread by infected people before symptoms even appear. If the virus had escaped from a BSL-2 laboratory in 2019, the leak most likely would have gone undetected until too late.

One alarming detail — leaked to The Wall Street Journal and confirmed by current and former U.S. government officials — is that scientists on Dr. Shi’s team fell ill with Covid-like symptoms in the fall of 2019. One of the scientists had been named in the Defuse proposal as the person in charge of virus discovery work. The scientists denied having been sick.

The hypothesis that Covid-19 came from an animal at the Huanan Seafood Market in Wuhan is not supported by strong evidence.

In December 2019, Chinese investigators assumed the outbreak had started at a centrally located market frequented by thousands of visitors daily. This bias in their search for early cases meant that cases unlinked to or located far away from the market would very likely have been missed

To make things worse, the Chinese authorities blocked the reporting of early cases not linked to the market and, claiming biosafety precautions, ordered the destruction of patient samples on January 3, 2020, making it nearly impossible to see the complete picture of the earliest Covid-19 cases. Information about dozens of early cases from November and December 2019 remains inaccessible.

A pair of papers published in Science in 2022 made the best case for SARS‑CoV‑2 having emerged naturally from human-animal contact at the Wuhan market by focusing on a map of the early cases and asserting that the virus had jumped from animals into humans twice at the market in 2019

More recently, the two papers have been countered by other virologists and scientists who convincingly demonstrate that the available market evidence does not distinguish between a human superspreader event and a natural spillover at the market.

Furthermore, the existing genetic and early case data show that all known Covid-19 cases probably stem from a single introduction of SARS‑CoV‑2 into people, and the outbreak at the Wuhan market probably happened after the virus had already been circulating in humans.

Not a single infected animal has ever been confirmed at the market or in its supply chain. Without good evidence that the pandemic started at the Huanan Seafood Market, the fact that the virus emerged in Wuhan points squarely at its unique SARS-like virus laboratory.

With today’s technology, scientists can detect how respiratory viruses — including SARS, MERS and the flu — circulate in animals while making repeated attempts to jump across species. Thankfully, these variants usually fail to transmit well after crossing over to a new species and tend to die off after a small number of infections

investigators have not reported finding any animals infected with SARS‑CoV‑2 that had not been infected by humans. Yet, infected animal sources and other connective pieces of evidence were found for the earlier SARS and MERS outbreaks as quickly as within a few days, despite the less advanced viral forensic technologies of two decades ago.

Even though Wuhan is the home base of virus hunters with world-leading expertise in tracking novel SARS-like viruses, investigators have either failed to collect or report key evidence that would be expected if Covid-19 emerged from the wildlife trade. For example, investigators have not determined that the earliest known cases had exposure to intermediate host animals before falling ill.

No antibody evidence shows that animal traders in Wuhan are regularly exposed to SARS-like viruses, as would be expected in such situations.

In previous outbreaks of coronaviruses, scientists were able to demonstrate natural origin by collecting multiple pieces of evidence linking infected humans to infected animals

In contrast, virologists and other scientists agree that SARS‑CoV‑2 required little to no adaptation to spread rapidly in humans and other animals. The virus appears to have succeeded in causing a pandemic upon its only detected jump into humans.

it was a SARS-like coronavirus with a unique furin cleavage site that emerged in Wuhan, less than two years after scientists, sometimes working under inadequate biosafety conditions, proposed collecting and creating viruses of that same design.

a laboratory accident is the most parsimonious explanation of how the pandemic began.

Given what we now know, investigators should follow their strongest leads and subpoena all exchanges between the Wuhan scientists and their international partners, including unpublished research proposals, manuscripts, data and commercial orders. In particular, exchanges from 2018 and 2019 — the critical two years before the emergence of Covid-19 — are very likely to be illuminating (and require no cooperation from the Chinese government to acquire), yet they remain beyond the public’s view more than four years after the pandemic began.

it is undeniable that U.S. federal funding helped to build an unprecedented collection of SARS-like viruses at the Wuhan institute, as well as contributing to research that enhanced them.

Advocates and funders of the institute’s research, including Dr. Fauci, should cooperate with the investigation to help identify and close the loopholes that allowed such dangerous work to occur. The world must not continue to bear the intolerable risks of research with the potential to cause pandemics.

A successful investigation of the pandemic’s root cause would have the power to break a decades-long scientific impasse on pathogen research safety, determining how governments will spend billions of dollars to prevent future pandemics. A credible investigation would also deter future acts of negligence and deceit by demonstrating that it is indeed possible to be held accountable for causing a viral pandemic

Last but not least, people of all nations need to see their leaders — and especially, their scientists — heading the charge to find out what caused this world-shaking event. Restoring public trust in science and government leadership requires it.

Researchers expected the details in the study to dispel doubts about the likelihood that many years of head trauma can lead to C.T.E. The growing connections between head trauma and contact sports, though, have led some nervous parents and coaches to assume that any concussion could lead to long-term impairment. Some doctors say that oversimplifies matters. Rather, the total amount of head trauma, including smaller subconcussive hits, as well as how they were treated, must be considered

Some of our greatest music was written under the influence: would David stop that? Jazz might not exist without it. All of our recent presidents were stoners at some point - and the current president in his teens was an enthusiast even by Hawaii standards in the 1970s. Does David think that the man who wrote Dreams From My Father suffered from impaired memory? Does he believe that Michael Phelps who smoked pot and became the most decorated Olympian of all time didn't do one of those two things? Can we not discuss drugs rationally, rather than with this vast super-structure of boomer-era culture-war synapses attached to it?

Here's the "drug abuse" site's description of how dreadful canabis dependency can be: Long-term marijuana abusers trying to quit report withdrawal symptoms including: irritability, sleeplessness, decreased appetite, anxiety, and drug craving, all of which can make it difficult to remain abstinent. These symptoms begin within about 1 day following abstinence, peak at 2-3 days, and subside within 1 or 2 weeks following drug cessation. How many alcoholics would kill for a two-week readjustment period after using a drug for a lifetime?

In saying his core point is to protect the vulnerable and poor, he also fails inexplicably to note how enforcement of petty marijuana possession laws in urban centers needlessly ruins countless lives, and does so with a racial disparity that is simply staggering. The first thing you'd do to improve the prospects of the young black men David rightly cares about is to stop incarcerating the black pot-smokers at rates white kids and their parents would not tolerate for a milli-second.

cities also break traditions and fracture families, and they breed psychiatric illness. In a city you are more likely to be depressed, to fall ill with schizophrenia, and to use alcohol and drugs. Poverty and rapid urbanization sharpen these effects.

We know that social position affects both when you die and how sick you get: The higher your social position, the healthier you are. It turns out that your sense of relative social rank — where you draw a line on an abstract ladder to show where you are with respect to others — predicts many health outcomes, including depression, sometimes even more powerfully than your objective socioeconomic status.

What has exploded in India over the past few decades, but also everywhere else in the world, is information about other people. As we watch television, surf the Internet and follow events around the world, we become intimately aware of other ways of living and of others who are richer and more powerful. We place ourselves in a vast social order in which most of us are ants. It may truly be a depressing reflection.

Some of these figures might simply reflect more willingness to label an experience as a symptom. For example, until recently, most Japanese understood intense fatigue as sacrifice for one’s work and suicide as an act of reasoned will. In her book “Depression in Japan,” the anthropologist Junko Kitanaka writes that partly as a result of aggressive pharmaceutical marketing, many Japanese began to think of their fatigue and suicidal thoughts as symptoms created by a disease. The number of diagnoses of depression in that country more than doubled between 1999 and 2008.

Meanwhile, the top banks and law firms, along with other high-paying employers, recruit almost exclusively from a few elite colleges.

Hardworking outsiders no longer enjoy genuine opportunity. According to one study, only one out of every 100 children born into the poorest fifth of households, and fewer than one out of every 50 children born into the middle fifth, will join the top 5 percent

Absolute economic mobility is also declining—the odds that a middle-class child will outearn his parents have fallen by more than half since mid-century—and the drop is greater among the middle class than among the poor.

because meritocratic inequality does not in fact serve anyone well, escaping meritocracy’s trap would benefit virtually everyone.

Nearly three-fifths of Republicans believe that colleges and universities are bad for America

Outrage at nepotism and other disgraceful forms of elite advantage-taking implicitly valorizes meritocratic ideals. Yet meritocracy itself is the bigger problem, and it is crippling the American dream. Meritocracy has created a competition that, even when everyone plays by the rules, only the rich can win.

Even meritocracy’s beneficiaries now suffer on account of its demands. It ensnares the rich just as surely as it excludes the rest, as those who manage to claw their way to the top must work with crushing intensity, ruthlessly exploiting their expensive education in order to extract a return.

But what, exactly, have the rich won

Meritocracy frames this exclusion as a failure to measure up, adding a moral insult to economic injury.

Wealthy students show higher rates of drug and alcohol abuse than poor students do. They also suffer depression and anxiety at rates as much as triple those of their age peers throughout the country

Where aristocratic children once reveled in their privilege, meritocratic children now calculate their future—they plan and they scheme, through rituals of stage-managed self-presentation, in familiar rhythms of ambition, hope, and worry.

Elite middle and high schools now commonly require three to five hours of homework a night; epidemiologists at the Centers for Disease Control and Prevention have warned of schoolwork-induced sleep deprivation.

education—whose benefits are concentrated in the extravagantly trained children of rich parents—must become open and inclusive. Private schools and universities should lose their tax-exempt status unless at least half of their students come from families in the bottom two-thirds of the income distribution

A recent study of a Silicon Valley high school found that 54 percent of students displayed moderate to severe symptoms of depression and 80 percent displayed moderate to severe symptoms of anxiety.

Elite universities that just a few decades ago accepted 30 percent of their applicants now accept less than 10 percent.

Parents—sometimes reluctantly, but feeling that they have no alternative—sign their children up for an education dominated not by experiments and play but by the accumulation of the training and skills, or human capital, needed to be admitted to an elite college and, eventually, to secure an elite job

A person whose wealth and status depend on her human capital simply cannot afford to consult her own interests or passions in choosing her job. Instead, she must approach work as an opportunity to extract value from her human capital, especially if she wants an income sufficient to buy her children the type of schooling that secured her own eliteness. She must devote herself to a narrowly restricted class of high-paying jobs, concentrated in finance, management, law, and medicine

In 1962, when many elite lawyers earned roughly a third of what they do today, the American Bar Association could confidently declare, “There are … approximately 1,300 fee-earning hours per year” available to the normal lawyer.

In 2000, by contrast, a major law firm pronounced with equal confidence that a quota of 2,400 billable hours, “if properly managed,” was “not unreasonable,” which is a euphemism for “necessary for having a hope of making partner.” Because not all the hours a lawyer works are billable, billing 2,400 hours could easily require working from 8 a.m. until 8 p.m. six days a week, every week of the year, without vacation or sick days

Today, the higher a person climbs on the org chart, the harder she is expected to work. Amazon’s “leadership principles” call for managers to have “relentlessly high standards” and to “deliver results.” The company tells managers that when they “hit the wall” at work, the only solution is to “climb the wall.”

Americans who work more than 60 hours a week report that they would, on average, prefer 25 fewer weekly hours. They say this because work subjects them to a “time famine” that, a 2006 study found, interferes with their capacity to have strong relationships with their spouse and children, to maintain their home, and even to have a satisfying sex life.

The capacity to bear these hours gracefully, or at least grimly, has become a criterion for meritocratic success

Meritocracy traps entire generations inside demeaning fears and inauthentic ambitions: always hungry but never finding, or even knowing, the right food.

As the meritocracy trap closes in around elites, the rich themselves are turning against the prevailing system. Plaintive calls for work/life balance ring ever louder. Roughly two-thirds of elite workers say that they would decline a promotion if the new job demanded yet more of their energy

it is simply not possible to get rich off your own human capital without exploiting yourself and impoverishing your inner life, and meritocrats who hope to have their cake and eat it too deceive themselves

Building a society in which a good education and good jobs are available to a broader swath of people—so that reaching the very highest rungs of the ladder is simply less important—is the only way to ease the strains that now drive the elite to cling to their status

The University of Chicago admitted 71 percent of its applicants as recently as 1995. In 2019 it admitted less than 6 percent.

How can that be done

A parallel policy agenda must reform work, by favoring goods and services produced by workers who do not have elaborate training or fancy degrees

For example, the health-care system should emphasize public health, preventive care, and other measures that can be overseen primarily by nurse practitioners, rather than high-tech treatments that require specialist doctors

In finance, regulations that limit exotic financial engineering and favor small local and regional banks can shift jobs to mid-skilled workers.

The main obstacle to overcoming meritocratic inequality is not technical but political. Today’s conditions induce discontent and widespread pessimism, verging on despair.

In his book Oligarchy, the political scientist Jeffrey A. Winters surveys eras in human history from the classical period to the 20th century, and documents what becomes of societies that concentrate income and wealth in a narrow elite. In almost every instance, the dismantling of such inequality has been accompanied by societal collapse, such as military defeat (as in the Roman empire) or revolution (as in France and Russia).

Rebuilding a democratic economic order will be difficult. But the benefits that economic democracy brings—to everyone—justify the effort. And the violent collapse that will likely follow from doing nothing leaves us with no good alternative but to try.

“In reality there’s not much empathy,” he said. “It’s not a caring tone they’re using. It’s a warning tone. I don’t feel very comfortable about it.”

China has a major incentive to track down potential carriers of the disease. The coronavirus outbreak has put parts of the country under lockdown, brought the world’s second-largest economy to a virtual standstill and erected walls between China and the rest of the world.

Still, even some government officials called for understanding as concerns about prejudice spread. Experts warned such marginalization of an already vulnerable group could prove counterproductive, further damaging public trust and sending those who should be screened and monitored deeper underground.

While networks of volunteers and Christian groups have been vocal about offering help, many local leaders have focused efforts on finding and isolating people from Hubei. On big screens and billboards, propaganda videos and posters warn people to stay inside, wear masks and wash hands.

In the northern province of Hebei, one county offered bounties of 1,000 yuan, or about $140, for each Wuhan person reported by residents. I

In the eastern province of Jiangsu, quarantine turned to imprisonment after authorities used metal poles to barricade shut the door of a family recently returned from Wuhan. To get food, the family relied on neighbors who lowered provisions with a rope down to their back balcony

“They’re only working to separate Wuhan people from Nanjing people,” Mr. Li said. “They don’t care at all if Wuhan people infect each other.”

Across the country, the response from local authorities often resembles the mass mobilizations of the Mao era rather than the technocratic, data-driven wizardry depicted in propaganda about China’s emerging surveillance state. They have also turned to techniques Beijing used to fight the outbreak of SARS, another deadly disease, in 2002 and 2003, when China was much less technologically sophisticated.

Checkpoints to screen people for fevers have popped up at tollbooths, at the front gates of apartment complexes and in hotels, grocery stores and train stations. Often those wielding the thermometer guns don’t hold them close enough to a person’s forehead, generating unusually low temperature readings. Such checks were worthless, for instance, against one man in the western province of Qinghai, whom police are investigating on suspicion that he covered up his symptoms to travel.

“I feel that the villagers are ignorant and the government isn’t helping; instead it’s leaking the information everywhere without telling them that I don’t have any symptoms,”

All vaccines work according to the same basic principle. They present part or all of the pathogen to the human immune system, usually in the form of an injection and at a low dose, to prompt the system to produce antibodies to the pathogen. Antibodies are a kind of immune memory which, having been elicited once, can be quickly mobilised again if the person is exposed to the virus in its natural form.

Cepi’s original portfolio of four funded Covid-19 vaccine projects was heavily skewed towards these more innovative technologies, and last week it announced $4.4m (£3.4m) of partnership funding with Novavax and with a University of Oxford vectored vaccine project. “Our experience with vaccine development is that you can’t anticipate where you’re going to stumble,” says Hatchett, meaning that diversity is key. And the stage where any approach is most likely to stumble is clinical or human trials, which, for some of the candidates, are about to get under way.

An illustration of that is a vaccine that was produced in the 1960s against respiratory syncytial virus, a common virus that causes cold-like symptoms in children. In clinical trials, this vaccine was found to aggravate those symptoms in infants who went on to catch the virus. A similar effect was observed in animals given an early experimental Sars vaccine. It was later modified to eliminate that problem but, now that it has been repurposed for Sars-CoV-2, it will need to be put through especially stringent safety testing to rule out the risk of enhanced disease.

Once a Covid-19 vaccine has been approved, a further set of challenges will present itself. “Getting a vaccine that’s proven to be safe and effective in humans takes one at best about a third of the way to what’s needed for a global immunisation programme,” says global health expert Jonathan Quick of Duke University in North Carolina, author of The End of Epidemics (2018). “Virus biology and vaccines technology could be the limiting factors, but politics and economics are far more likely to be the barrier to immunisation.”

Because pandemics tend to hit hardest those countries that have the most fragile and underfunded healthcare systems, there is an inherent imbalance between need and purchasing power when it comes to vaccines. During the 2009 H1N1 flu pandemic, for example, vaccine supplies were snapped up by nations that could afford them, leaving poorer ones short. But you could also imagine a scenario where, say, India – a major supplier of vaccines to the developing world – not unreasonably decides to use its vaccine production to protect its own 1.3 billion-strong population first, before exporting any.

• This article was amended on 19 March 2020. An earlier version incorrectly stated that the Sabin Vaccine Institute was collaborating with the Coalition for Epidemic Preparedness Innovations (Cepi) on a Covid-19 vaccine.

he defended the decision not to implement the tighter restrictions seen in Denmark, France and the UK. “We all, as individuals, have to take responsibility. We can’t legislate and ban everything,” he said. “It is also a question of commonsense behaviour.

The best explanation for why Sweden is such an outlier centres on the unusual level of independence given to government agencies such as Tegnell’s, and the reluctance of politicians to override them.

His team at the Public Health Agency of Sweden is critical of the Imperial College paper that warned this month that 250,000 people in the UK would die if the government failed to introduce more draconian measures.

“We have had a fair amount of people looking at it and they are sceptical,” says Tegnell. “They think Imperial chose a number of variables that gave a prognosis that was quite pessimistic, and that you could just as easily have chosen other variables that gave you another outcome. It’s not a peer-reviewed paper. It might be right, but it might also be terribly wrong. In Sweden, we are a bit surprised that it’s had such an impact.”

“As long as the Swedish epidemic development stays at this level,” he tells the Observer, “I don’t see any big reason to take measures that you can only keep up for a very limited amount of time.”

“They’re listening to the health department; they’re listening to the experts they have on hand.”

More than 2,000 Swedish university researchers published a joint letter on Wednesday questioning the Public Health Agency’s position, while the previous week saw leading epidemiologists attack the agency in emails leaked to Swedish television.

“How many lives are they willing to sacrifice so as not to lockdown and risk greater effects on the economy?”

Tegnell argues that because in Sweden there are almost no stay-at-home parents, closing schools would have knocked out at least a quarter of doctors and nurses, crippling the health service

Tegnell even questions whether stopping the progress of the virus is desirable. “We are just trying to slow it, because this disease will never go away. If you manage, like South Korea, to get rid of it, even they say that they count on it coming back

While Tegnell understands that he will be blamed if Sweden ends up in a similar situation to that of Italy, he refuses to be panicked. “I wouldn’t be too surprised if it ended up about the same way for all of us, irrespective of what we’re doing,” he says. “I’m not so sure that what we’re doing is affecting the spread very much. But we will see.”

Researchers believe the incubation period before symptoms is roughly five days on average. In studying the pattern of illness, epidemiologists have made the dismaying discovery that people start shedding the virus — potentially making others sick — in advance of symptoms.

The bulldozer nature of coronavirus means widespread severe illnesses and deaths from covid-19 can happen with terrifying speed.

a large percentage of the world’s population, potentially billions of people, could become infected within the next couple of years. Frantic efforts to develop a safe and effective vaccine are likely to take a year or more.

covid-19 may be many times as lethal for an infected person as seasonal flu.

the virus has a gift for stealth transmission. It seeds itself in communities far and wide,

But on Jan. 23, China imposed extreme travel restrictions and soon put hundreds of millions of people into some form of lockdown as authorities aggressively limited social contact. The R0 plummeted below 1, and the epidemic has been throttled in China, at least for now.

R0, pronounced “R naught.” That is the average number of new infections generated by each infected person.

he R0 is not an intrinsic feature of the virus. It can be lowered through containment, mitigation and ultimately “herd immunity,”

In the early days in China, before the government imposed extreme travel restrictions in Wuhan and nearby areas, and before everyone realized exactly how bad the epidemic might be, the R0 was 2.38, according to a study published in the journal Science. That is a highly contagious disease.

The pandemic appears to be largely driven by direct, human-to-human transmission. That is why public health officials have told people to engage in social distancing

its ability to spread depends also on the vulnerability of the human population, including the density of the community.

Without a vaccine or a drug to stop infections, the best hope is to break the chain of transmission one infection at a time

“Social distancing is building speed bumps so that we can slow the spread of the virus. We have to respect the speed bumps,”

the efficacy of social distancing “is the million-dollar question right now.”

She compared the current public measures to what happened during the 1918 influenza pandemic that killed an estimated 675,000 people in the United States, and in which some cities were more careful than others about enforcing social distancing.

“The USA is currently in a natural experiment of sorts, which each state implementing their own version of social distancing,” she said. “We will be able to compare the efficacy of these various public health policies, but not until more time has passed.”

Not only must people limit their direct contact, they need to limit the amount that their paths overlap, because the virus can linger on surfaces.

The virus degrades outside a host because of exposure to moisture and sunlight, or from drying out

in pristine laboratory conditions, some SARS-CoV-2 particles can remain potentially viable on metal or plastic for up to three days.

Absent hard data, limiting contact with shared surfaces, such as door handles or checkout machines, and frequent hand-washing is highly advisable.

people have some innate, mechanical defenses against viruses just like they do against pollen and dust, Taubenberger noted. Cells in the respiratory tract have tiny hairlike projections, called cilia, that move mucus toward the throat in a manner that helps clear invasive particles. This is not our body’s first viral rodeo.

. “So-called low-risk areas are not to be believed. Bureaucrats everywhere have already begun covering up,” another said.

Such patients, usually found by tracing the contacts of confirmed cases, are quarantined for 14 days and released if they do not show any symptoms. But the number of reports of new cases has started to worry the public.

Documents seen by the South China Morning Post reportedly showed more than 40,000 asymptomatic patients that would not have been included in China’s total number of infections of more than 80,000.

the financial news magazine Caixin called on the government to publish data on asymptomatic carriers. “Within China, transmission caused by asymptomatic infections has occurred many times. The number needs to be made public as soon as possible. Investigation and and research is needed to raise the public’s alertness,” it said.

Last week, authorities formally arrested a man in Beijing who was diagnosed as an asymptomatic carrier in mid-February. He repeatedly visited grocery stores, pharmacies and other public places against regulations. His mother has been infected and 20 other close contacts have now been quarantined.

China’s top respiratory disease expert Zhong Nanshan told the state broadcaster CGTN that while asymptomatic patients who have been in close contact with confirmed patients can be “very infective”, he did not believe they posed a “big problem” in China.

Last week, the premier, Li Keqiang, called on health officials to investigate whether asymptomatic people were contagious, in order to help the country’s ongoing prevention plans, and ordered officials “not to cover up” cases.

But the infectious disease expert Zhang Wenhong, said at a symposium on Friday that asymptomatic carriers would continue to pose a major risk, even as China took measures, such as temporarily banning foreigners from entering the country.

“Now, we only allow Chinese people to come back. But when our country’s doors open again, there will be large numbers coming in. When they are asymptomatic, the risk is great.”

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

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

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