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Find everyone they interact with by deploying contact tracing on a scale America has never attempted before.

focus restrictions more narrowly on the infected and their contacts so the rest of society doesn’t have to stay in permanent lockdown.

Instead, the president and his top advisers have fixated almost exclusively on plans to reopen the U.S. economy by the end of the month, though they haven’t detailed how they will do so without triggering another outbreak

Administration officials, speaking on the condition of anonymity to describe internal deliberations, say the White House has made a deliberate political calculation that it will better serve Trump’s interest to put the onus on governors — rather than the federal government — to figure out how to move ahead.

without substantial federal funding, states’ efforts will only go so far

The next failure is already on its way, Frieden said, because “we’re not doing the things we need to be doing in April.”

In recent days, dozens of leading voices have coalesced around the test-trace-quarantine framework, including former FDA commissioners for the Trump and George W. Bush administrations, Microsoft founder Bill Gates and top experts at Johns Hopkins, Columbia and Harvard universities.

On Wednesday, former president Barack Obama weighed in, tweeting, “Social distancing bends the curve and relieves some pressure … But in order to shift off current policies, the key will be a robust system of testing and monitoring — something we have yet to put in place nationwide.”

And Friday, Apple and Google unveiled a joint effort on new tools that would use smartphones to aid in contact tracing.

What remains unclear is whether this emerging plan can succeed without the backing of the federal government.

“It’s mind-boggling, actually, the degree of disorganization,” said Tom Frieden, former Centers for Disease Control and Prevention director. The federal government has already squandered February and March, he noted, committing “epic failures” on testing kits, ventilator supply, protective equipment for health workers and contradictory public health communication.

In South Korea, Taiwan, China and Singapore, variations on this basic strategy were implemented by their national governments, allowing them to keep the virus in check even as they reopened parts of their economy and society

In America, testing — while still woefully behind — is ramping up. And households across the country have learned over the past month how to quarantine. But when it comes to the second pillar of the plan — the labor-intensive work of contact tracing — local health departments lack the necessary staff, money and training.

Experts and leaders in some states say remedying that weakness should be a priority and health departments should be rapidly shored up so that they are ready to act in coming weeks as infections nationwide begin to decrease

In a report released Friday, the Johns Hopkins Center for Health Security and the Association of State and Territorial Health Officials — which represents state health departments — estimate 100,000 additional contact tracers are needed and call for $3.6 billion in emergency funding from Congress.

“We can’t afford to have multiple community outbreaks that can spiral up into sustained community transmission,” he said in the interview.

Unless states can aggressively trace and isolate the virus, experts say, there will be new outbreaks and another round of disruptive stay-at-home orders.

“All people are talking about right now is hospital beds, ventilators, testing, testing, testing. Yes, those are important, but they are all reactive. You are dealing with the symptoms and not the virus itself,”

“You will never beat a virus like this one unless you get ahead of it. America must not just flatten the curve but get ahead of the curve.”

Testing on its own is useless, Nyenswah explained, because it only tells you who already has the virus. Similarly, tracing alone is useless if you don’t place those you find into quarantine. But when all three are implemented, the chain of transmission can be shattered.

Until a vaccine or treatment is developed, such nonpharmaceutical interventions are the only tools countries can rely on — besides locking down their cities.

to expand that in a country as large as the United States will require a massive dose of money, leadership and political will.

“You cannot have leaders contradicting each other every day. You cannot have states waiting on the federal government to act, and government telling the states to figure it out on their own,” he said. “You need a plan.”

When Vermont’s first coronavirus case was detected last month, it took two state health workers a day to track down 13 people who came into contact with that single patient. They put them under quarantine and started monitoring for symptoms. No one else became sick.

He did the math: If each of those 30 patients had contact with even three people, that meant 90 people his crew would have to locate and get into quarantine. In other words, impossible.

Since 2008, city and county health agencies have lost almost a quarter of their overall workforce. Decades of budget cuts have left the them unable to mount such a response. State health departments have recently had to lay off thousands more — an unintended consequence of federal officials delaying tax filings until July without warning states.

In Wuhan, a city of 11 million, the Chinese had 9,000 health workers doing contact tracing, said Frieden, the former CDC director. He estimates authorities would need roughly one contact tracer for every four cases in the United States.

“In the second wave, we have to have testing, a resource base, and a contact-tracing base that is so much more scaled up than right now,” he said. “It’s an enormous challenge.”

Gov. Charlie Baker (R) partnered with an international nonprofit group based in Boston

The nonprofit Partners in Health quickly put together a plan to hire and train 1,000 contact tracers. Working from their homes making 20 to 30 calls a day, they could cover up to 20,000 contacts a day.

The group is paying new hires roughly the same salary as census takers, more than $20 an hour. As of Tuesday — just four days after the initial announcement — the group had received 7,000 applicants and hired 150.

“There’s a huge untapped resource of people in America if we would just ask.”

“There needs to be a crash course in contact tracing because a lot of the health departments where this is going to need to happen are already kind of flat-out just trying to respond to the crisis at hand,”

Experts have proposed transforming the Peace Corps — which suspended global operations last month and recalled 7,000 volunteers to America — into a national response corps that could perform many tasks, including contact tracing.

On Wednesday, the editor in chief of JAMA, a leading medical journal, proposed suspending the first year of training for America’s 20,000 incoming medical students and deploying them as a medical corps to support the “test, trace, track, and quarantine strategy.”

The national organization for local STD programs says $200 million could add roughly 1,850 specialists, more than doubling that current workforce.

Technology could also turn out to be pivotal. But the invasive nature of cellphone tracking and apps raises concerns about civil liberties.

Such technology could take over some of what contact tracers do in interviews: build a contact history for each confirmed patient and find those possibly exposed. Doing that digitally could speed up the process — critical in containing an outbreak — and less laborious.

In China, authorities combined the nation’s vast surveillance apparatus with apps and cellphone data to track people’s movements. If someone they came across is later confirmed as infected, an app alerts them to stay at home.

In the United States, about 20 technology companies are trying to create a contact tracing app using geolocation data or Bluetooth pings on cellphones

As restrictions here are lifted, Chancellor Angela Merkel has singled out tracking infection chains as the key, above “all else.” Germany aims to have five contact tracers for every 25,000 people — or about 16,000 for its population of 83 million.

Privacy concerns — which run strong in Europe and particularly deep in Germany, with its not-so-distant memories of fascism and communism — have limited the potential of contact-tracing apps. So the tracing is largely a case of calling the recently diagnosed patient and asking his or her movements.

The whole conversation lasts just over 10 minutes. It’s a simple case, but that’s been normal since social distancing restrictions, health workers here say. Someone from the health department will call him daily to check in on his symptoms.

Germany’s trace-and-quarantine approach is by no means flawless. In about 65 percent of the cases here, health authorities have no idea how a person was infected. Asymptomatic carriers are no doubt falling through the cracks.

He contends that contact tracing and quarantines have been more important to containing the virus than the more widely lauded testing program.

“There are two things: the contact tracing and the quarantine,” Larscheid said. In Germany, the contacts of a positive coronavirus case are not generally tested unless they have symptoms.

“Testing is nice, but if you’re tested or not tested and are in quarantine, it makes no difference,” Larscheid said. Testing could also lull someone into a false sense of security, he said — a negative result might mean it’s just too early for an infection to register on a test.

Reinickendorf began to build its contact tracing team in March, as an outbreak in a kindergarten went beyond the capacity of the usual contingent of health officials. Workers were moved from parts of the local administration for which the outbreak had caused work to slow.

They say the numbers are distorted by isolated outbreaks in several nursing homes and a meatpacking plant. In Berlin, where there’s no requirement to wear a mask, there are only a few dozen new cases a day. Parks and markets have remained busy throughout the pandemic.

With the tool, people infected with the coronavirus would notify a public health app that they have it, which would then alert phones that had recently come into proximity with that person’s device. The companies would need to get public-health authorities to agree to link their app to the tool.

There are already third-party tools for contact tracing, including from public health authorities and the Massachusetts Institute of Technology. In March, the government of Singapore introduced a similar coronavirus contact-tracing app, called TraceTogether, that detects mobile phones that are nearby.

One challenge for third-party apps is that they must run constantly — 24 hours a day, seven days a week — to be effective. Google said some Android smartphone manufacturers shut down those applications to save battery life.

Apple and Google said their tool would also constantly run in the background if people opt to use it, logging nearby devices through the short-range wireless technology Bluetooth. But it would eat up less battery life and be more reliable than third-party apps, they said.

“This data could empower members of the general population to make informed decisions about their own health in terms of self-quarantining,” said Dr. Reid. “But it doesn’t replace the public health imperative that we scale up contact tracing in the public health departments” around the world.

Other phones will constantly check those servers for the broadcast beacons of devices they had come near in the past 14 days. If there is a match, those people will receive an alert that they had likely come into contact with an infected person.

Apple and Google said they were discussing how much information to include in those alerts with health officials, aiming to strike a balance between being helpful while also protecting the privacy of those who have the coronavirus.

Once someone reports his or her infection to a public-health app, the tool will send the phone’s so-called broadcast beacons, or anonymous identifiers connected to the device, to central computer servers.

Apple and Google said they would make the tool’s underlying technology available to third-party apps by mid-May and publicly release the tool “in the coming months.” The companies said the tool would not collect devices’ locations — it only tracked proximity to other devices — and would keep people anonymous in the central servers.

The European Commission, the executive of the 27-nation bloc, said on Wednesday that “a fragmented and uncoordinated approach risks hampering the effectiveness” of such apps.

“The danger is, as you roll out these voluntary solutions and they gain adoption, it’s more likely that they are going to become compulsory,” said Mr. Soltani, a former chief technologist for the Federal Trade Commission.

“I guess an email is notification of exposure,” said Erin Sanders, a nurse practitioner and certified contact tracer in Boston. “But that is not contact tracing,” she said, “and not how a responsible public health agency handles a super-spreading cluster of a deadly virus.”

an internal C.D.C. email on Friday asked the agency’s scientists to be ready to go to Washington for contact tracing, but a request from the White House for assistance never came, according to two senior C.D.C. scientists.

Experts at the C.D.C. could have immediately put in place contact tracing for President Trump and others who have been infected, working with health departments of the states to which Mr. Trump and others have traveled. But regulations require that the C.D.C. be asked to step in.

During the 48-hour window before Mr. Trump’s diagnosis that White House contact tracers are focusing on, the president debated former Vice President Joseph R. Biden Jr. in Cleveland; traveled to a rally of thousands in Minnesota; met with supporters and donors at his golf club in Bedminster, N.J.; and conferred with dozens of aides at the White House, all while not wearing a mask.

The timing of the diagnosis of Mr. Trump’s illness makes it highly likely that he and the others became infected on Saturday, medical experts said. Symptoms typically appear around five days after exposure to the virus; Mr. Trump began showing symptoms on Thursday, “right smack dab in the day” he would be expected to, Dr. Maldonado said.

“Staff should not go to the White House Medical Unit clinic for any Covid-19 testing inquiries,” the memo said. But some officials have continued to go to work.

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

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

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

More Americans may die than the White House admits.

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

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

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

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

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

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

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

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

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

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

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

The lockdowns will end, but haltingly.

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

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

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

Every epidemiological model envisions something like the dance

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

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

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

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

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

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

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

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

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

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

Immunity will become a societal advantage.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Still, experts were divided on the idea of such wards

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

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

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

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

There will not be a vaccine soon.

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

the record is four years, for the mumps vaccine.

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

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

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

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

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

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

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

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

Treatments are likely to arrive first.

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

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

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

Goodbye, ‘America First.’

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

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

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

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

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

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

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

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

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

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

The study reveals, for the first time, the genetic sequence of the virus that may have infected Mr. Trump and dozens of others, researchers said.

Viruses constantly mutate, picking up tiny, accidental alterations to their genetic material as they reproduce. Few mutations alter how a virus functions. But by comparing patterns of mutations across many genetic sequences, scientists can construct family trees of a virus, illuminating how it spreads.

The genomes believed by these researchers to be connected to the White House outbreak do not identify a recent geographic source, in part because they are unusual.

The results show that even weeks after it was identified, the White House outbreak would be better understood by sequencing samples of more people who were infected.

In a study released on Thursday, the C.D.C. cited genetic sequencing and intensive contact tracing that documented an super-spreading event at a high school retreat in Wisconsin.

But the Trump administration is not known to have conducted its own genetic analysis of people infected in the outbreak. The White House declined to respond to questions on genetic sequencing of Mr. Trump and the cluster of aides and officials who tested positive or became ill.

Scientists not involved in the research who reviewed the results agreed with the conclusion that the two samples sharing rare mutations strongly suggested they are part of the same outbreak.

“These genomes are probably going to be identical or nearly identical to the genome that infected the president,” said Michael Worobey, head of the department of ecology and evolutionary biology at the University of Arizona.

For months, the White House minimized the threat of the virus and eschewed basic safety precautions at official events, like wearing a mask or keeping people six feet apart.

At least 11 people who attended a Rose Garden celebration on Sept. 26 for Judge Barrett, which included an indoor event without masks, became infected with the coronavirus, including Mr. Trump.

The work is convincing, and it is the best way to piece together the progression of such an outbreak, said David Engelthaler, head of the infectious disease branch of the Translational Genomics Research Institute in Arizona, where he and colleagues have sequenced thousands of genomes to track the spread of the coronavirus, including devastating outbreaks at Native American reservations in the state.

in a pandemic, encouraging the sick to haul themselves into work can be disastrous. The plan backfired. Hundreds of Smithfield employees were infected, forcing the plant to shut down for more than three weeks. If we stay the current course, we risk repeating the same mistake across the whole economy.

The economy consists of people who have hopes and fears. As long as they are afraid of a lethal virus, they will avoid restaurants, travel and workplaces.

The only way to restore the economy is to earn the confidence of both vulnerable industries and vulnerable people through testing, contact tracing and isolation.

To pull off this balancing act, the country should be divided into red, yellow and green zones. The goal is to be a green zone, where fewer than one resident per 36,000 is infected.

Here, large gatherings are allowed, and masks aren’t required for those who don’t interact with the elderly or other vulnerable populations.

Two weeks ago, a modest 1,900 tests a day could have kept 19 million Americans safely in green zones. Today, there are no green zones in the United States.

A disease prevalence greater than 1 percent defines red zones.

even in yellow zones, the economy could safely reopen with aggressive testing and tracing, coupled with safety measures including mandatory masks.

Today, 30 million Americans live in such hot spots — which include Detroit, New Jersey, New Orleans and New York City.

Most Americans — about 298 million — live in yellow zones, where disease prevalence is between .002 percent and 1 percent

In addition to the yellow-zone interventions, these places require stay-at-home orders.

by strictly following guidelines for testing and tracing, red zones could turn yellow within four weeks, moving steadfastly from lockdown to liberty.

Getting to green nationwide is possible by the end of the summer, but it requires ramping up testing radically. The United States now administers more than 300,000 tests a day, but according to our guidelines, 5 million a day are needed (for two to three months)

Researchers estimate that the current system has a latent capacity to produce 2 million tests a day, and a surge in federal funding would spur companies to increase capacity. The key is to do it now, before manageable yellow zones deteriorate to economically ruinous red zones.

States can administer these “test, trace and supported isolation” programs — but Congress would need to fund them. The total cost, we estimate, is $74 billion, to be spent over 12 to 18 months

That amount is a lot, but not compared to the cost of a crippled economy. In Congress’s latest relief package, $75 billion went to struggling hospitals alone, $380 billion to help small businesses and $25 billion toward testing.

Economists talk about “multipliers” — an injection of spending that causes even larger increases in gross domestic product. Spending on testing, tracing and paid isolation would produce an indisputable and massive multiplier effect.

Nations that have invested the most in disease control have suffered the least economic hardship: Taiwan grew 1.5 percent in the first quarter, whereas the United States’ gross domestic product contracted by 4.8 percent

Looking forward, we will see stark economic contrasts across states, depending on their investment in disease control.

When local and state governments become accountable for adopting strategies that work, we can expect more innovation.

How do we know that testing, tracing and supported isolation would work? It already has worked in New Zealand, South Korea and Taiwan

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The TraceTogether smartphone app and token are used by 78% of the people in Singapore, a country of 5.7 million. Balakrishnan called it "perhaps the most successful contact-tracing program in the world."

He said contact-tracing data have been used once so far, in a murder case, according to The Straits Times.

Eugene Tan, a law professor at Singapore Management University and a former nominated member of Parliament, told The Straits Times that the government's backtracking on privacy assurances undermines trust and credibility. "This damage could undermine its future efforts, given its reiteration that Singapore has only managed to keep COVID-19 under control due to the people's trust in the government's measures," he told the paper.

In a sign that European governments remain concerned about a jump in new infections, masks in the continent are increasingly becoming obligatory. In France and the U.K., masks will be mandatory in public enclosed spaces from next week. In Germany, Italy and much of Spain, they already are. Austria is considering reinstating its indoor-mask order following a recent rise in infections.

“When I look at Europe, there is no single, best way: There are lots of ways,” he adds. “There is no magic formula, but they all begin with taking the virus seriously and not having debates about inane things.”

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

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

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

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

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

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

What will be so cruel about this American version of Russian roulette is how unfair it will be

This is the state of play when you have a president who one minute is responsibly issuing sober guidelines for when and how people should go back to work, and the next minute is telling states that they are responsible for getting the testing, tracking and tracing units that we need in place and then, in the third minute, is inciting people on Twitter to “liberate” their workplaces, cities and beaches — even though none of the conditions are in place to do so safely.

“Liberate”? Think about the use of that word. We were not in jail! We were not doing something wrong! We were doing what our president, governor, mayor, and national epidemic experts told us to do: behave responsibly and shelter in place to break the transmission of this virus.

Is there anything more irresponsible that this president could do, after weeks of complimenting the American people for how they pulled together and sacrificed to shelter in place — patriotically doing their part to bend the curve of this virus?

When the president is calling on governors to “let their people go” before comprehensive testing facilities are in place, he is basically saying that, until there is a vaccine, we are betting on herd immunity. Achieving herd immunity requires that more than two-thirds of a community be immune, a process that could involve many more deaths, if proper preparations are not in place.

That may work out for some places and people. It may not.

First, this is the bet Trump is urging you to make in his “liberate” tweets — when he should be ordering out the National Guard and mobilizing American industry to get testing everywhere.

Second, this bet will fall very unfairly and unevenly in our society, when so little testing and tracing is in place.

third, if this is the future, every business, restaurant, hotel, theater, sporting facility, factory, nonprofit and government office needs to ask itself: What does my business look like when, on the best days, the responsible people coming to my door will be wearing a mask, gloves, distancing six feet apart and volunteering to have their temperature taken before they enter, and the irresponsible ones won’t be? How do I handle that?

Bottom line, my fellow Americans: Your president is telling you that you’re on your own to make these decisions. And if this strategy works, you can be sure that he will take credit. And if it doesn’t, you can be sure that he will tweet that it was all Anthony Fauci’s idea.

The Chinese dictator has repeatedly proclaimed his confidence in "a China solution to humanity's search for better social systems." By that, he presumably meant an authoritarian model replicating Beijing's blend of capitalism, state control and barely-existent political rights.

Strengthening American democracy for the sake of protecting democracy around the world is the kind of mission that should unify the country -- it's not a Democrats versus Republicans goal. But in the current venomous environment, it's hard to persuade American politicians to come together, and even harder to convince many Republicans to align behind this major goal of the Biden administration.

One of these groups can be traced as far back as 35,000 years, thanks to a skeleton discovered at a site in Belgium called Goyet. The Goyet-related people spread across Europe, only to be replaced on much of the continent near the end of the Ice Age by a genetically distinct population. The earliest sign of the second group appears 14,000 years ago, known to researchers by DNA in a skeleton at an Italian site called Villabruna.

the Goyet and Villabruna people coexisted. Hunter-gatherers across the peninsula had a mixture of ancestry from the two peoples.

But whatever solitude Iberia might have offered came to an end about 7,500 years ago, when new people arrived with crops and livestock. These first farmers, originally from Anatolia, brought with them a distinctive genetic signature.

Ninety percent of the DNA from the later skeletons derives from the Anatolian farmers; 10 percent comes from the hunter-gatherers.

Starting about 6,000 years ago, Dr. Olalde and his colleagues found, hunter-gatherer ancestry in Iberian farmers actually increased to 20 percent.

A skeleton from an elaborate grave in central Spain about 4,400 years old belonged to a man whose ancestry was 100 percent North African

findings suggest that people were moving into Iberia from Africa more than 3,000 years before the rise of the Roman Empire. “These are cosmopolitan places,”

About 4,500 years ago, still another wave of people arrived, profoundly altering the makeup of Iberia.A few centuries earlier, nomads from the steppes of what is now Russia turned up in Eastern Europe with horses and wagons. They spread across the continent, giving up nomadic life and intermarrying with European farmers.

DNA from the men, however, all traced back to the steppes. The Y chromosomes from the male farmers disappeared from the gene pool.

When they finally reached Iberia, these people spread out far and wide. “They really have an impact on the whole peninsula,”

To archaeologists, the shift is a puzzle.“I cannot say what it is,

he ruled out wars or massacres as the cause. “It’s not a particularly violent time,”

Iberian farmers originally lived in egalitarian societies, storing their wealth together and burying their dead in group graves.

over several centuries, palaces and fortresses began to rise, and power became concentrated in the hands of a few. Dr. Risch speculated that the cultural shift had something to do with the genetic shift

The Bronze Age in Iberia was followed by the Iron Age about 2,800

Iron Age Iberians could trace some of their ancestry to new waves of people arriving from northern and Central Europe, possibly marking the rise of so-called Celtiberian culture on the peninsula.

scientists found a growing amount of North African ancestry in skeletons from the Iron Age. That may reflect trade around the Mediterranean, which brought North Africans to Iberian towns, where they settled down.

North African ancestry increased in Iberia even more after Romans took control. Now the peninsula was part of an empire that thrived on widespread trade. At the same time, people from southern Europe and the Near East also began leaving an imprint

The Basque speak a language that is unrelated to other European tongues. Some researchers have speculated that they descended from a population that had been distinct since the Bronze Age or earlier.Genetically, at least, that doesn’t seem to be the case. Before the Roman era, the Basque had DNA that was indistinguishable from that of other Iron Age Iberians

After the fall of Rome, ancient DNA in Iberia reflects its medieval history. Skeletons from the Muslim era show growing ancestry from both North Africa and sub-Saharan Africa.

The researchers were also able to group Spaniards into five genetic clusters. On a map, these groups form five strips running north to south. Those strips line up neatly with history.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Trump has repeatedly returned to strategies of bans and movement restriction

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

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

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

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

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

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

Many proposals tackle the problem of the tanking economy.

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

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

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

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

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

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

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

Neither the advice nor the science were followed that week. My colleagues, led by Neil Ferguson, published a report on 16 March estimating that without strong suppression, 250,000 people could die in the UK. The government responded that day with a recommendation for social distancing, avoiding pubs and working from home if possible. But there was still no enforcement, and it was left up to individuals and employers to decide what to do. Many people were willing but unable to comply as we showed in a report on 20 March. It was only on 23 March that a more stringent lockdown and economic support was announced.

etween 12 and 23 March, tens, if not hundreds of thousands, of people will have been infected.

The current best estimate is that around 1% of those infected will die.

So where to now? Once again, public health experience, including modelling, leads to some very clear recommendations. First, find cases in the community as well as hospitals and care homes; isolate them, and trace their contacts using a combination of local public health teams and digital tools.

Second, know your epidemic. Track the epidemic nationally and locally using NHS, public health and digital surveillance to see where cases are continuing to spread

Build community resilience by providing local support for vulnerable people affected by the virus and the negative impact of the control measures.

Third, ensure transmission is suppressed in hospitals, care homes and workplaces through the right protective equipment, testing, distancing and hygiene

Fourth, ensure that the most vulnerable, socially and medically, are fully protected through simple access to a basic income, rights for migrants, and safety for those affected by domestic violence.

I am not looking to blame – but for scrutiny so that lessons can be learned to guide our response. We need to avoid further mistakes, and ensure that the government is hearing, and acting on, the best advice.

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

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.

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

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

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

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.