Group items tagged

COVID-19 testing has been an unmitigated failure in this country.

Rather than growing rapidly—as all experts think is absolutely necessary—the daily number of tests administered in some jurisdictions has even decreased. In New York, for instance, 10,241 tests were performed on April 6, but supply limits forced a huge drop a few days later to 25 total tests.

Quest Diagnostics, one of the two biggest firms that run tests, just furloughed 9 percent of its workforce. In addition, news reports suggest that, as of last week, 90 percent of the 15-minute tests developed by Abbott Laboratories are idle due to a lack of necessary reagents and qualified personnel

How many tests do we need in order to safely relax social-distancing measures, reopen nonessential businesses and schools, and allow large gatherings

we should be conducting a minimum of 500,000 tests a day.

Paul Romer, has called for the capacity to run 20 million to 30 million tests a day

Even this has been criticized as insufficient for the task of identifying enough of the asymptomatic spreaders to keep the pandemic in check.

Current guidelines from the Centers for Disease Control and Prevention give priority first to hospitalized patients and symptomatic health-care workers, then to high-risk patients

ptomatic individuals are not tested, even if they had contact with people who tested positive.

This is an enormous mistake. If we want to control the spread of COVID-19, the United States must adopt a new testing policy that prioritizes people who, although asymptomatic, may have the virus and infect many others.

We should target four groups. First, all health-care workers and other first responders who directly interact with many people

Second, workers who maintain our supply chains and crucial infrastructure, including grocery-store workers, police officers, public-transit workers, and sanitation personnel.

The next group would be potential “super-spreaders”—asymptomatic individuals who could come into contact with many people. This third group would include people in large families and those who must interact with many vulnerable people, such as employees of long-term-care facilities

The fourth group would include all those who are planning to return to the workplace. These are precisely the individuals without symptoms whom the CDC recommends against testing.

Not testing suspected COVID-19 patients will not harm those patients

Symptomatic patients should be tested only in the rare case where a positive test would meaningfully change what type of care is delivered.

To shift the focus of testing away from the sickest patients and toward the people most likely to spread the coronavirus, we will have to conduct millions of tests a day.

How can we close this gap between our needs and current capacity? We need a national strategy over the next 10 weeks, one that draws on the many strengths of our research system

We also need to encourage rapid adoption of the saliva test that now has an emergency approval from the FDA and expedite the approval of tests that require fewer reagents and staff.

Another promising pathway is to pool many tests and run them together. If a pooled sample tests negative, everyone in the pool is negative. If it is positive, the members of the pool can be tested individually

A more sophisticated version of this approach uses genetic “bar codes” that make it possible to trace back which of the many samples in a pool was the one that had RNA from the virus, without any retesting.

How can we get this testing capacity up and running? One idea is for Congress to award in the next stimulus bill, say, $150 million in unrestricted research funds to the first five universities that can process 10 million tests in a week or less

Another catalyst could be to subsidize businesses that agree to test all their employees as they return to work

When someone tests positive, officials should identify close contacts, find them, and test them. To do the tracing, we may need to hire 100,000 to 200,000 additional public-health workers.

This type of voluntary contact tracing is labor-intensive and requires some training, but it does not require highly specialized skills

If we adopt and follow a coherent plan, we can have a testing regime that keeps us safe without compromising our freedoms

“What we’ve learned is that every variant seems to have its own characteristics, and it’s important that we not be locked into thinking we know everything based on what we’ve learned from the last variant,” he said

“The virus grows in your nose and throat and somewhat at different time scales,” Michael Mina, chief science officer for the biotech software company eMed, who was an assistant professor of epidemiology at the Harvard T.H. Chan School of Public Health, said at a testing technology news briefing this week.

“The agency recommends that individuals closely follow the tests’ instructions,” FDA spokesperson Jim McKinney told NBC News in an email.

Dr. Jonathan Li, an infectious disease physician at the Brigham and Women’s Hospital in Boston, cautions against altering the testing strategy that has been validated and authorized by the FDA.

The United Kingdom’s National Health Service recommends swabbing both the nose and the throat when using a rapid antigen, or later flow, Covid test, the kind used at home.

Before advocating the altered approach, Li said, he would need to see data that showed it was effective. User error will likely be higher with self-administered throat swabs compared with nasal swabs, he said.

“The nose and the throat have different pH levels and we have seen people take Coke or coffee and put it in an antigen test and had a line to appear,” she said. “We don’t know exactly why this happens, but the hypothesis is acidity.” 

Miller notes that a small preprint paper out of South Africa, which has not yet been peer-reviewed, suggested that more detectable virus may reside in the throat than in the nose when a person is infected with omicron compared to the delta variant, though the study compared PCR to antigen, or rapid, tests, which are not the same type of tests. 

Miller said that although she would not be surprised if omicron indeed does show up in the throat before it does in the nose, that concrete data has yet to be shown. 

According to Matt Binnicker, director of clinical virology at the Mayo Clinic, the fact that positivity rates are soaring in the U.S. is a testament to how well Covid tests are still working.

According to Miller, it’s best to take a rapid test on day one, day two and day three of symptoms if you are testing negative but your symptoms persist. You should also isolate. “If you have symptoms, you have Covid until proven otherwise,” she said. 

But only a handful of cancers—of the breast, lung, colon and cervix—have screening tests recommended by the U.S. Preventive Services Task Force

Many companies are developing blood tests that can detect cancer signals before symptoms occur, and Grail’s is the most advanced. A study found it can identify more than 50 types of cancer 52% of the time and the 12 deadliest cancers in Stages I through III 68% of the time.

There’s a hitch. The test costs $949 and isn’t covered by Medicare or most private insurance.

The trouble is that this cancer is almost never caught early. There’s no routine screening for it, and symptoms don’t develop until it is advanced. Mr. Royse, 64, had no idea he was sick until he took a blood test called Galleri, produced by the Menlo Park, Calif., startup Grail. He had surgery and chemotherapy and is now cancer-free.

Mr. Royse visited Grail’s website, which referred him to a telemedicine provider who ordered a test. Another telemedicine doctor walked him through his results, which showed a cancer signal likely emanating from the pancreas, gallbladder, stomach or esophagus.

An MRI revealed a suspicious mass on his pancreas, which a biopsy confirmed was cancerous. Mr. Royse had three months of chemotherapy, surgery and another three months of chemotherapy, which ended last February. Because pancreatic cancer often recurs, he gets CT and MRI scans every three months. In addition, he has signed up for startup Natera’s Signatera customized blood test, which checks DNA specific to the patient’s cancer and can signal its return before signs are visible on the scans

Grail’s test likewise looks for DNA shed by cancer cells, which is tagged by molecules called methyl groups that are specific to a cancer’s origin. Grail uses genetic sequencing and machine learning to recognize links between DNA methyl groups and particular cancers

The test “is based on how much DNA is being shed by tumor,” Grail’s president, Josh Ofman, says. “Some tumors shed a lot of DNA. Some shed almost none.

ut slow-growing tumors typically aren’t shedding a lot of DNA.” That reduces the probability that Grail’s test will identify indolent cancers that pose no immediate danger.

Grail’s test has a roughly 0.5% false-positive rate, meaning 1 in 200 patients who don’t have cancer will get a positive signal

Its positive predictive value is 43%, so that of every 100 patients with a positive signal, 43 actually have cancer

the legislation’s price tag could reduce political support. According to one private company’s estimate, the test could cost the government $39 billion to $145 billion over a decade. Mr. Goldman counters that analysts usually overestimate the costs and underestimate the benefits of medical interventions.

Because Grail uses machine learning to detect DNA-methylation cancer linkages, the Grail test’s accuracy should improve as more tests and patient data are collected

regulators may balk at approving the test, and insurers at covering it, until it becomes cheaper and more reliable.

How would the FDA weigh the risk that a false positive on a test like Grail’s could require invasive follow-up testing against the dire but hard-to-quantify risk that a deadly cancer wouldn’t be caught until it’s much harder to treat? It’s unclear.

some experts urge the FDA to require large randomized controlled trials before approving blood cancer tests. “Multicancer screening would entail tremendous costs and potentially substantial harms,” H. Gilbert Welch and Tanujit Dey of Brigham and Women’s Hospital wrote

Dr. Welch and Mr. Dey also suggested that companies should be required to prove their tests reduce overall mortality, even though the FDA doesn’t require drugmakers to prove their products reduce deaths or extend life. Clinical trials for the mRNA Covid vaccines didn’t show they reduced deaths.

One alternative is to rely on real-world studies, which Grail is already doing. One study of patients 50 and older without signs of cancer showed that the test doubled the number of cancers detected.

One recurring problem he has seen: “Epidemiologists are always getting cancer wrong,” he says. “Epidemiologists a decade ago said U.S. overtreats cancers. Well, no, the EU undertreats cancer.”

A 2012 study that he co-authored found that the higher U.S. spending on cancer care relative to Europe between 1983 and 1999 resulted in significantly higher survival rates for American patients than for those in Europe

By his study’s calculation, U.S. spending on cancer treatments during that period resulted in $556 billion in net benefits owing to reduced mortality.

He expects Galleri and other multicancer early-detection tests to reduce deaths and produce public-health and economic benefits that exceed their monetary costs

Expanding access to multicancer early-detection tests could also help solve the chicken-and-egg problem of drug development. Because few patients are diagnosed at early stages of some cancers, it’s hard to develop treatments for them

the positive predictive value for some recommended cancer screenings is far lower. Fewer than 1 in 10 women with an abnormal finding on a mammogram are diagnosed with breast cancer.

Mr. Royse makes the same point with personal force. “I would be dead right now if not for multicancer early-detection testing,” Mr. Royse told an FDA advisory committee last fall. “The longer the FDA waits, the more people are going to die. It’s that simple.”

Tests are perfect, in Trump’s mind, when they tell you what you want to hear — but not so great when they deliver bad news.

But if a test is going to produce an unwelcome result, why do it?

Numbers are crucial to the way Trump sees the world.

He cares passionately that people believe his claims that he has billions of dollars. He considered his (partly) abandoned nightly crisis briefings as TV shows whose success should be judged by the only metric for such events that matters to him: ratings. He began his presidency with an insanely obsessive row about how many people attended his inauguration. He understands the economy solely through the vicissitudes of the stock market

From the beginning of the coronavirus crisis, Trump has been primarily concerned less with protecting lives and more with projecting positive statistics.

According to the book “Fear,” by Washington Post associate editor Bob Woodward, Trump’s main concern in internal discussions about tax cuts was to have memorable figures: “I like those big round numbers. Ten percent, 20 percent, 25 percent.”

Today, Trump is caught in a contradiction he cannot resolve: He likes the number of tests performed to go higher and higher but refuses to acknowledge the implications of their results.

His fury arose from the basic premise of the question: What the reporter was implying was that there is supposed to be a relationship between testing on the one side and reality on the other

when Katie Miller, Vice President Pence’s press secretary, tested positive for the virus: Trump said the result illustrated why “the whole concept of tests aren’t necessarily great.”

What Trump stopped short of saying is that a “good” test suddenly turns “bad” when it produces the “wrong” result

His ambivalence about testing — love the statistics, hate the results — leads him into wild inconsistency. Today he takes credit for the large numbers of tests done nationally (“nearly double the number of any country”), yet only a month ago he said flatly that governors were “responsible for testing”

those obstinate tests do have results, and they show a country with 5 percent of the global population having a third of the world’s known cases of covid-19

The government hopes to use the findings to unravel a riddle that will allow Germany to move securely into the next phase of the pandemic: Which of the far-reaching social and economic restrictions that have slowed the virus are most effective and which can be safely lifted?

Other countries like Iceland and South Korea have tested broadly for infections, or combined testing with digital tracking to undercut the spread of the virus. But even the best laid plans can go awry; Singapore attempted to reopen only to have the virus re-emerge.

President Trump is in a hurry to restart the economy in an election year, but experts warn that much wider testing is needed to open societies safely.

Both Britain and the United States, where some of the first tests were flawed, virtually forfeited the notion of widespread testing early in their outbreaks and have since had to ration tests in places as they scramble to catch up

Germany, which produces most of its own high-quality test kits, is already testing on a greater scale than most — 120,000 a day and growing in a nation of 83 million.

Merkel, a trained scientist, said this week that the aim was nothing less than tracing “every infection chain.”

Every 10 people infected with the virus now pass it to seven others — a sharp decline in the infection rate for a virus that has spread exponentially.

The generosity and solidarity on such striking display inside of Europe’s largest and richest economy have been missing in Germany’s response to poorer European nations in the south, which were hit hardest by the virus.

the chancellor’s mixture of calm reassurance and clear-eyed realism — as well as her ability to understand the science and explain it to citizens — has been widely praised and encouraged Germans to follow social distancing rules. Her approval ratings are now higher than 80 percent.

That broad confidence in government has given Germany a tremendous advantage. It is much of the reason a knock on the door by a police officer and strangers dressed like aliens asking for blood can engender good will rather than alarm

“We are leading the thinking of what to do next.”

Its most ambitious project, aiming to test a nationwide random sample of 15,000 people across the country, is scheduled to begin next month.

“In the free world, Germany is the first country looking into the future,”

Nationally, the Robert Koch Institute, the government’s central scientific institution in the field of biomedicine, is testing 5,000 samples from blood banks across the country every two weeks and 2,000 people in four hot spots who are farther along in the cycle of the disease.

In Gangelt, a small town of about 12,000 in northwest Germany, tests of a first group of 500 residents found that 14 percent had antibodies to the virus. Another 2 percent tested positive for the coronavirus, raising hopes that about 15 percent of the local population may already have some degree of immunity.

“The process toward reaching herd immunity has begun,”

t may hold valuable insights for places that lag behind as the pandemic runs its course.

The mortality rate in the town, for example, turned out to be 0.37 percent, much lower than the national rate of 2.9 percent which is calculated based only on detected infections.

“We are at a crossroads,” said Mr. Hoelscher, the professor. “Are we going the route of loosening more and increasing immunity in the summer to slow the spread of this in the winter and gain more freedom to live public life? Or are we going to try to minimize transmissions until we have a vaccine?

“This is a question for politicians, not for scientists,” he added. “But politicians need the data to make an informed risk assessment.”

“I thought to myself if we’re going into lockdown, we need to start working on an exit strategy now,”

The next day, he said he wrote a short pitch to the Bavarian government. Six hours later, he had the green light. It took another three weeks until the test kits had arrived, a new lab was opened and teams of medics started fanning out across the city.

Six days after they first rung his doorbell, a doctor and two medical students came back to Mr. Germann’s apartment, household number 420 out of 3,000.They put on disposable protection suits, gloves and goggles and one of them sat down on a plastic stool they had brought along to take a small vial of his blood. Then they removed and bagged their suits, disinfected the stool and any surface they had touched and left. It took all of 10 minutes.

The world may be paying for those missteps right now. Testing is central to the effort to fight the spread of the virus. Countries that test widely can isolate infected people and prevent or slow new infections. Without early and widespread testing, health officials and policymakers will be flying blind, epidemiologists say.

“Y​ou cannot fight a fire blindfolded,” said Tedros Adhanom Ghebreyesus, W.H.O.’s director general. “And we cannot stop this pandemic​ i​f we don’t know who is infected.”

As the virus reached into the United States in late January, President Trump and his administration spent weeks downplaying the potential for an outbreak. The Centers for Disease Control opted to develop its own test rather than rely on private laboratories or the World Health Organization.

The outbreak quickly outpaced Mr. Trump’s predictions, and the C.D.C.’s test kits turned out to be flawed, leaving the United States far behind other parts of the world — both technically and politically.

In Britain, as in many other countries, the virus is circulating so quickly that it is no longer possible to test people and investigate whom they may have infected, said David McCoy, a public health professor at Queen Mary University in London

“The window of opportunity to contain the epidemic has now shut,” Mr. McCoy said.

France says that it is able to test 2,500 cases daily, though officials won’t say how many people they have tested. The United States has run about 25,000 tests. Neither country has contained the virus or tested aggressively for it. Korea and Singapore have so far been able to do both.

“We were not just looking at having a very good diagnostics test. That’s kind of a given. You can’t do anything without that,” said Dr. Sidney Yee, the chief executive of Singapore’s Diagnostics Development Hub. “We were also looking at getting people prepared and getting accurate messages out.”

national leaders set the tone. “What you’re seeing today is the impact of those earlier comments, and that earlier attitude,”

With no treatment for the disease, many countries are telling sick people to stay home unless they become seriously ill. Hospitals cannot afford to be overwhelmed by nervous people asking for tests.

But patients who self-quarantine likely won’t ever be tested, making it difficult to know the true scope of the disease. And as the disease spreads, the practicality of testing declines, as does its value.

“Testing of contacts, I believe, will be totally out of control very soon,”

In no other high-income country — and in only a few countries, period — have political leaders departed from expert advice as frequently and significantly as the Trump administration. President Trump has said the virus was not serious; predicted it would disappear; spent weeks questioning the need for masks; encouraged states to reopen even with large and growing caseloads; and promoted medical disinformation.

many agree that the poor results in the United States stem in substantial measure from the performance of the Trump administration.

“As an American, I think there is a lot of good to be said about our libertarian tradition,” Dr. Jared Baeten, an epidemiologist and vice dean at the University of Washington School of Public Health, said. “But this is the consequence — we don’t succeed as well as a collective.”

That tradition is one reason the United States suffers from an unequal health care system that has long produced worse medical outcomes — including higher infant mortality and diabetes rates and lower life expectancy — than in most other rich countries.

First, the United States faced longstanding challenges in confronting a major pandemic. It is a large country at the nexus of the global economy, with a tradition of prioritizing individualism over government restrictions.

The New York Times set out to reconstruct the unique failure of the United States, through numerous interviews with scientists and public health experts around the world. The reporting points to two central themes.

When it comes to the virus, the United States has come to resemble not the wealthy and powerful countries to which it is often compared but instead far poorer countries, like Brazil, Peru and South Africa, or those with large migrant populations, like Bahrain and Oman.

That’s more than five times as many as in all of Europe, Canada, Japan, South Korea and Australia, combined.

Over the past month, about 1.9 million Americans have tested positive for the virus.

one country stands alone, as the only affluent nation to have suffered a severe, sustained outbreak for more than four months: the United States.

Nearly every country has struggled to contain the coronavirus and made mistakes along the way.

it quickly became clear that the United States’ policy was full of holes. It did not apply to immediate family members of American citizens and permanent residents returning from China, for example. In the two months after the policy went into place, almost 40,000 people arrived in the United States on direct flights from China.

On Jan. 31, his administration announced that it was restricting entry to the United States from China: Many foreign nationals — be they citizens of China or other countries — would not be allowed into the United States if they had been to China in the previous two weeks.

A travel policy that fell short

In retrospect, one of Mr. Trump’s first policy responses to the virus appears to have been one of his most promising.

The administration’s policy also did little to create quarantines for people who entered the United States and may have had the virus.

ven more important, the policy failed to take into account that the virus had spread well beyond China by early February. Later data would show that many infected people arriving in the United States came from Europe

South Korea, Hong Kong and Taiwan largely restricted entry to residents returning home. Those residents then had to quarantine for two weeks upon arrival

South Korea and Hong Kong also tested for the virus at the airport and transferred anyone who was positive to a government facility.

“People need a bit more than a suggestion to look after their own health,” said Dr. Mackay, who has been working with Australian officials on their pandemic response. “They need guidelines, they need rules — and they need to be enforced.”

Travel restrictions and quarantines were central to the success in controlling the virus in South Korea, Hong Kong, Taiwan and Australia, as well as New Zealand, many epidemiologists believe. In Australia, the number of new cases per day fell more than 90 percent in April. It remained near zero through May and early June, even as the virus surged across much of the United States.

the tolls in Australia and the United States remain vastly different. Fewer than 300 Australians have died of complications from Covid-19, the illness caused by the virus. If the United States had the same per capita death rate, about 3,300 Americans would have died, rather than 158,000.

there is a good chance that a different version of Mr. Trump’s restrictions — one with fewer holes and stronger quarantines — would have meaningfully slowed the virus’s spread.

travel restrictions had been successful enough in fighting the coronavirus around the world that those views may need to be revisited.“Travel,” he said, “is the hallmark of the spread of this virus around the world.”

Traditionally, public health experts had not seen travel restrictions as central to fighting a pandemic, given their economic costs and the availability of other options, like testing, quarantining and contact tracing

But he added that

By early March, with the testing delays still unresolved, the New York region became a global center of the virus — without people realizing it until weeks later. More widespread testing could have made a major difference, experts said, leading to earlier lockdowns and social distancing and ultimately less sickness and death.

While the C.D.C. was struggling to solve its testing flaws, Germany was rapidly building up its ability to test. Chancellor Angela Merkel, a chemist by training, and other political leaders were watching the virus sweep across northern Italy, not far from southern Germany, and pushed for a big expansion of testing.

By the time the virus became a problem in Germany, labs around the country had thousands of test kits ready to use. From the beginning, the government covered the cost of the tests. American laboratories often charge patients about $100 for a test.

Without free tests, Dr. Hendrik Streeck, director of the Institute of Virology at the University Hospital Bonn, said at the time, “a young person with no health insurance and an itchy throat is unlikely to go to the doctor and therefore risks infecting more people.”

Germany was soon far ahead of other countries in testing. It was able to diagnose asymptomatic cases, trace the contacts of new patients and isolate people before they could spread the virus. The country has still suffered a significant outbreak. But it has had many fewer cases per capita than Italy, Spain, France, Britain or Canada — and about one-fifth the rate of the United States.

One measure of the continuing troubles with testing is the percentage of tests that come back positive. In a country that has the virus under control, fewer than 5 percent of tests come back positive, according to World Health Organization guidelines. Many countries have reached that benchmark. The United States, even with the large recent volume of tests, has not.

In Belgium recently, test results have typically come back in 48 to 72 hours. In Germany and Greece, it is two days. In France, the wait is often 24 hours.

The conflicting advice, echoed by the C.D.C. and others, led to relatively little mask wearing in many countries early in the pandemic. But several Asian countries were exceptions, partly because they had a tradition of mask wearing to avoid sickness or minimize the effects of pollution.

The double mask failure

By January, mask wearing in Japan was widespread, as it often had been during a typical flu season. Masks also quickly became the norm in much of South Korea, Thailand, Vietnam, Taiwan and China.

In the following months, scientists around the world began to report two strands of evidence that both pointed to the importance of masks: Research showed that the virus could be transmitted through droplets that hang in the air, and several studies found that the virus spread less frequently in places where people were wearing masks.

with Germany now carrying out about 50,000 coronavirus tests per day. Britain’s chief medical officer Chris Whitty on Tuesday said the United Kingdom had “a lot to learn” from Germany, which had “got ahead” in mass testing.

European governments are mulling the introduction of what have been dubbed “immunity passports” to let individuals who have had the virus return to a more normal life.

German scientists caution that this stage of the response is still a long way off. There remain crucial questions over how long someone’s immunity might last and at what level, and there are concerns about tests producing false positives and insufficient capacity for widespread testing

there needs to be more validation of the test and there needs to be science on how long immunity lasts.”

“This is one of many tools to address coronavirus, but it may be a very important one,”

antibody testing studies could provide an indication of how many people have been infected and thus help governments assess the risk of easing restrictions.

In Germany, studies already underway or planned over the coming months involve a sampling of roughly 100,000 people

Knowing the level of infection among the population and particular risk groups could also let the government determine whether it can be “a little bit more relaxed” during a potential second wave of infections

One by the University of Bonn will study 1,000 people from the hard-hit town of Heinsberg. Another in Munich will repeat tests on the same sample group regularly to monitor the spread.

Merkel, who has been tight-lipped on Germany’s strategy for lifting restrictions, says she doesn’t want to raise the population’s hopes prematurely. “We would be a bad government if we weren’t thinking about an exit strategy,”

it might take two years for the population to achieve herd immunity — meaning that so many people have been infected that the number of those still susceptible is no longer enough to sustain further spread of the virus.

the number of people infected could be as much as 10 times greater than now thought.

“If you want to assess the real danger and the real mortality, you have to know the number of people who have had the disease,”

knowing who is immune could be “extremely effective,” he said, for instance by helping identify which front-line workers are immune and do not need protective gear.

Testing accuracy also remains a concern. Some tests are overly sensitive, reacting to other types of coronaviruses and producing false positives. Errors could be particularly problematic when testing those who have not shown symptoms

Another concern is that tests are most effective several weeks after infection. So the timing of wide-scale studies is important,

“The question is, if someone tests for the antibody, what does that mean? Immunity? Part immunity? For how long?” he said. “If someone asked me, ‘What can I do with the results?’ I wouldn’t be able to answer.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Years of isolationist rhetoric had consequences too.

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

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

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

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

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

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

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

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

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

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

But with 1,295 deaths, Germany’s fatality rate stood at 1.4 percent, compared with 12 percent in Italy, around 10 percent in Spain, France and Britain, 4 percent in China and 2.5 percent in the United States. Even South Korea, a model of flattening the curve, has a higher fatality rate, 1.7 percent.

There are several answers experts say, a mix of statistical distortions and very real differences in how the country has taken on the epidemic.

The average age of those infected is lower in Germany than in many other countries. Many of the early patients caught the virus in Austrian and Italian ski resorts and were relatively young and healthy, Professor Kräusslich said.“It started as an epidemic of skiers,

“The reason why we in Germany have so few deaths at the moment compared to the number of infected can be largely explained by the fact that we are doing an extremely large number of lab diagnoses,”

Another explanation for the low fatality rate is that Germany has been testing far more people than most nations. That means it catches more people with few or no symptoms, increasing the number of known cases, but not the number of fatalities.

But there are also significant medical factors that have kept the number of deaths in Germany relatively low, epidemiologists and virologists say, chief among them early and widespread testing and treatment, plenty of intensive care beds and a trusted government whose social distancing guidelines are widely observed.

TestingIn mid-January, long before most Germans had given the virus much thought, Charité hospital in Berlin had already developed a test and posted the formula online.

By the time Germany recorded its first case of Covid-19 in February, laboratories across the country had built up a stock of test kits.

the average age of contracting the disease remains relatively low, at 49. In France, it is 62.5 and in Italy 62, according to their latest national reports.

Medical staff, at particular risk of contracting and spreading the virus, are regularly tested. To streamline the procedure, some hospitals have started doing block tests, using the swabs of 10 employees, and following up with individual tests only if there is a positive result.

Early and widespread testing has allowed the authorities to slow the spread of the pandemic by isolating known cases while they are infectious. It has also enabled lifesaving treatment to be administered in a more timely way.

At the end of April, health authorities also plan to roll out a large-scale antibody study, testing random samples of 100,000 people across Germany every week to gauge where immunity is building up.

If it slows a little more, to between 12 and 14 days, Professor Herold said, the models suggest that triage could be avoided.

One key to ensuring broad-based testing is that patients pay nothing for it, said Professor Streeck. This, he said, was one notable difference with the United States

“A young person with no health insurance and an itchy throat is unlikely to go to the doctor and therefore risks infecting more people,” he said.

Tracking

In most countries, including the United States, testing is largely limited to the sickest patients, so the man probably would have been refused a test.

Not in Germany. As soon as the test results were in, the school was shut, and all children and staff were ordered to stay at home with their families for two weeks. Some 235 people were tested.“Testing and tracking is the strategy that was successful in South Korea and we have tried to learn from that,” Professor Streeck said.Germany also learned from getting it wrong early on: The strategy of contact tracing should have been used even more aggressively, he said.

All those who had returned to Germany from Ischgl, an Austrian ski resort that had an outbreak, for example, should have been tracked down and tested, Professor Streeck said

A Robust Public Health Care System

Before the coronavirus pandemic swept across Germany, University Hospital in Giessen had 173 intensive care beds equipped with ventilators. In recent weeks, the hospital scrambled to create an additional 40 beds and increased the staff that was on standby to work in intensive care by as much as 50 percent.

“We have so much capacity now we are accepting patients from Italy, Spain and France,”

All across Germany, hospitals have expanded their intensive care capacities. And they started from a high level. In January, Germany had some 28,000 intensive care beds equipped with ventilators, or 34 per 100,000 people

By comparison, that rate is 12 in Italy and 7 in the Netherlands.

By now, there are 40,000 intensive care beds available in Germany.

The time it takes for the number of infections to double has slowed to about eight days

By now, Germany is conducting around 350,000 coronavirus tests a week, far more than any other European country

Trust in Government

many also see Chancellor Angela Merkel’s leadership as one reason the fatality rate has been kept low.

Ms. Merkel has communicated clearly, calmly and regularly throughout the crisis, as she imposed ever-stricter social distancing measures on the country.

The restrictions, which have been crucial to slowing the spread of the pandemic, met with little political opposition and are broadly followed.

“Maybe our biggest strength in Germany,” said Professor Kräusslich, “is the rational decision-making at the highest level of government combined with the trust the government enjoys in the population.”

Dr. Atlas’s position has been challenged by medical advisers around him who have backgrounds in infectious disease response, revealing a significant rift in the White House over the right approach. Dr. Deborah L. Birx, the White House’s coronavirus response coordinator, has pushed for aggressive, broad testing even among young and healthy people, often clashing with Dr. Atlas in meetings.

“I would always be happy if we had 100 percent of students tested weekly,” Dr. Birx said on Wednesday in an appearance at Penn State University, “because I think testing changes behavior.”

Dr. Atlas at one point influenced the administration’s efforts to install new Centers for Disease Control and Prevention guidance that said it was not necessary to test people without symptoms of Covid-19 even if they had been exposed to the virus, upsetting Dr. Birx and Dr. Robert R. Redfield, the C.D.C. director

The administration’s efforts to fund federal and state testing have long been fraught. In July, as administration officials and top Senate Republicans clashed over the contours of their initial $1 trillion proposal, the White House initially balked at providing billions of dollars to fund coronavirus testing and help federal health agencies.

Since the early days of the pandemic, Mr. Romer has argued for a wide-scale testing program, costing as much as $100 billion. He had hoped to persuade Dr. Atlas that if officials could quickly identify and isolate people carrying the virus, they would slow its spread and allow normal economic activity to resume more quickly.

In his email, sent to Dr. Atlas’s personal account, Mr. Romer proposed additional testing and isolation efforts that could allow far more Americans to return to work and shopping, generating economic activity that would be 10 or 100 times larger than the cost of the testing program itself.

Dr. Atlas replied that the push for such testing was the result of “a fundamental error of the public health people perpetrated on the world.”Mr. Romer said he was taken aback by the answer: “Atlas just responded in a way that just honestly made it seem like he was in over his head,” he said.

Clinton did not mention Gabbard by name but said she believes one candidate is "the favorite of the Russians."

Clinton was referring to the GOP grooming Gabbard, not Russians.

Gabbard reacted by tweeting that Clinton is “the queen of warmongers, embodiment of corruption, and personification of the rot that sickened the Democratic Party for so long."

Trump attacked Clinton for the suggestion earlier this week, and said Clinton and other Democrats claim everyone opposed to them is a Russian agent.

ratic presidential candidate Tulsi Gabbard said Thursday that she will not run for re-election for her U.S. representative seat, saying she wants to focus on trying to secure her party’s nomination to challenge President Donald Trump.Gabbard, who represents Hawaii, made the announcement in a video and email to supporters."I believe that I can best serve the people of Hawaii and our country as your president and commander-in-chief," Gabbard said in the video.Let our news meet your inbox. The news and stories that matters, delivered weekday mornings.Sign UpThis site is protected by recaptcha Privacy Policy | Terms of Service She also expressed gratitude to the people of Hawaii for her nearly seven years in Congress.In January, Hawaii state Sen. Kai Kahele, a Democrat, said he would run for Gabbard's seat, NBC affiliate KHNL of Honolulu reported.An Iowa Democratic caucus poll out this week put Gabbard at 3 percent, with former Vice President Joe Biden, Massachusetts Sen. Elizabeth Warren, and South Bend, Indiana, Mayor Pete Buttigieg in the top three spots.She is in a crowded field of Democrats seeking the nomination to run for president. Another candidate, U.S. Rep. Tim Ryan, D-Ohio, ended his long-shot presidential campaign Thursday.RecommendedvideovideoMcConnell: If the House impeaches Trump, Senate will hold trial 'until we finish'2020 Election2020 ElectionTim Ryan drops out of presidential raceHillary Clinton recently suggested that she believed Republicans were grooming one of the Democrats for a third-party candidacy. Clinton did not mention Gabbard by name but said she believes one candidate is "the favorite of the Russians."

The rules almost certainly mean that the United States is still greatly understating the number of people nationwide who are sick with COVID-19, experts say. There are more than 1,800 discovered coronavirus cases in the United States, but estimates of the outbreak using statistical and genetic models suggest that thousands of people are already sick.

The CDC guidelines—which do not carry legal force—allow for testing a wider array of patients than is currently allowed under many state-level rules. Under guidelines updated earlier this week, the agency noted that “priorities for testing” may include severely ill hospitalized patients with no other diagnosis; symptomatic adults who are older or who have a complicating factor, such as heart disease or a suppressed immune system; and any patient who had close contact with a “suspect or laboratory-confirmed” COVID-19 patient.

But the guidelines may also keep doctors from understanding the “local epidemiology”—that is, the extent of the coronavirus’s spread—in their own region.

Most state guidelines do not apply to tests conducted by private laboratory firms that do routine medical testing, such as Quest Diagnostics and LabCorp. Those firms say they can test 5,000 people a day, combined, but they take three to four days to deliver results, compared with 24 hours for a state public-health or on-site hospital lab test.

Within a week of its first confirmed case, South Korea’s disease control agency had summoned 20 private companies to the medical equivalent of a war-planning summit and told them to develop a test for the virus at lightning speed. A week after that, the first diagnostic test was approved and went into battle, identifying infected individuals who could then be quarantined to halt the advance of the disease.

Some 357,896 tests later, the country has more or less won the coronavirus war. On Friday only 91 new cases were reported in a country of more than 50 million.

The US response tells a different story. Two days after the first diagnosis in Washington state, Donald Trump went on air on CNBC and bragged: “We have it totally under control. It’s one person coming from China. It’s going to be just fine.”

Though the decision to allow private and state labs to provide testing has increased the flow of test kits, the US remains starkly behind South Korea, which has conducted more than five times as many tests per capita. That makes predicting where the next hotspot will pop up after New York and New Orleans almost impossible.

Today, 86,012 cases have been confirmed across the US, pushing the nation to the top of the world’s coronavirus league table – above even China.

Most worryingly, the curve of cases continues to rise precipitously, with no sign of the plateau that has spared South Korea.

Jeremy Konyndyk, who led the US government’s response to international disasters at USAid from 2013 to 2017, frames the past six weeks in strikingly similar terms. He told the Guardian: “We are witnessing in the United States one of the greatest failures of basic governance and basic leadership in modern times.”

It was not until 29 February, more than a month after the Journal article and almost six weeks after the first case of coronavirus was confirmed in the country that the Trump administration put that advice into practice. Laboratories and hospitals would finally be allowed to conduct their own Covid-19 tests to speed up the process.

If Trump’s travel ban did nothing else, it staved off to some degree the advent of the virus in the US, buying a little time. Which makes the lack of decisive action all the more curious.

In the absence of sufficient test kits, the US Centers of Disease Control and Prevention (CDC) initially kept a tight rein on testing, creating a bottleneck. “I believe the CDC was caught flat-footed,” was how the governor of New York, Andrew Cuomo, put it on 7 March. “They’re slowing down the state.”The CDC’s botched rollout of testing was the first indication that the Trump administration was faltering as the health emergency gathered pace. Behind the scenes, deep flaws in the way federal agencies had come to operate under Trump were being exposed.

In 2018 the pandemic unit in the national security council – which was tasked to prepare for health emergencies precisely like the current one – was disbanded. “Eliminating the office has contributed to the federal government’s sluggish domestic response,” Beth Cameron, senior director of the office at the time it was broken up, wrote in the Washington Post.

It was hardly a morale-boosting gesture when Trump proposed a 16% cut in CDC funding on 10 February – 11 days after the World Health Organization had declared a public health emergency over Covid-19.

The Food and Drug Administration (FDA), which regulates the diagnostic tests and will control any new treatments for coronavirus, has also shown vulnerabilities. The agency recently indicated that it was looking into the possibility of prescribing the malaria drug chloroquine for coronavirus sufferers, even though there is no evidence it would work and some indication it could have serious side-effects.

As the former senior official put it: “We have the FDA bowing to political pressure and making decisions completely counter to modern science.”

Trump has designated himself a “wartime president”. But if the title bears any validity, his military tactics have been highly unconventional. He has exacerbated the problems encountered by federal agencies by playing musical chairs at the top of the coronavirus force.

The president began by creating on 29 January a special coronavirus taskforce, then gave Vice-President Mike Pence the job, who promptly appointed Deborah Birx “coronavirus response coordinator”, before the federal emergency agency Fema began taking charge of key areas, with Jared Kushner, the president’s son-in-law, creating a shadow team that increasingly appears to be calling the shots.“There’s no point of responsibility,” the former senior official told the Guardian. “It keeps shifting. Nobody owns the problem.”

So it has transpired. In the wake of the testing disaster has come the personal protective equipment (PPE) disaster, the hospital bed disaster, and now the ventilator disaster.Ventilators, literal life preservers, are in dire short supply across the country. When governors begged Trump to unleash the full might of the US government on this critical problem, he gave his answer on 16 March.In a phrase that will stand beside 20 January 2020 as one of the most revelatory moments of the history of coronavirus, he said: “Respirators, ventilators, all of the equipment – try getting it yourselves.”

In the absence of a strong federal response, a patchwork of efforts has sprouted all across the country. State governors are doing their own thing. Cities, even individual hospitals, are coping as best they can.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The crisis would be over.

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

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

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

Stop transmission within cities

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

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

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

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

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

Fix the testing mess

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

Isolate the infected

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

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

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

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

Find the fevers

Make masks ubiquitous

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

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

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

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

Trace the contacts

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

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

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

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

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

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

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

Preserve vital services

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

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

Produce ventilators and oxygen

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

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

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

Retrofit hospitals

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

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

Decide when to close schools

Recruit volunteers

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

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

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

Prioritize the treatments

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

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

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

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

testing those candidate vaccines for safety and effectiveness takes time.

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

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

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

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

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

Reach out to other nations