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The president, though, was slow to absorb the scale of the risk and to act accordingly, focusing instead on controlling the message, protecting gains in the economy and batting away warnings from senior officials.

Mr. Trump’s response was colored by his suspicion of and disdain for what he viewed as the “Deep State” — the very people in his government whose expertise and long experience might have guided him more quickly toward steps that would slow the virus, and likely save lives.

The slow start of that plan, on top of the well-documented failures to develop the nation’s testing capacity, left administration officials with almost no insight into how rapidly the virus was spreading. “We were flying the plane with no instruments,” one official said.

But dozens of interviews with current and former officials and a review of emails and other records revealed many previously unreported details and a fuller picture of the roots and extent of his halting response as the deadly virus spread:

The National Security Council office responsible for tracking pandemics received intelligence reports in early January predicting the spread of the virus to the United States, and within weeks was raising options like keeping Americans home from work and shutting down cities the size of Chicago. Mr. Trump would avoid such steps until March.

Despite Mr. Trump’s denial weeks later, he was told at the time about a Jan. 29 memo produced by his trade adviser, Peter Navarro, laying out in striking detail the potential risks of a coronavirus pandemic: as many as half a million deaths and trillions of dollars in economic losses.

The health and human services secretary, Alex M. Azar II, directly warned Mr. Trump of the possibility of a pandemic during a call on Jan. 30, the second warning he delivered to the president about the virus in two weeks. The president, who was on Air Force One while traveling for appearances in the Midwest, responded that Mr. Azar was being alarmist

Mr. Azar publicly announced in February that the government was establishing a “surveillance” system

the task force had gathered for a tabletop exercise — a real-time version of a full-scale war gaming of a flu pandemic the administration had run the previous year. That earlier exercise, also conducted by Mr. Kadlec and called “Crimson Contagion,” predicted 110 million infections, 7.7 million hospitalizations and 586,000 deaths following a hypothetical outbreak that started in China.

By the third week in February, the administration’s top public health experts concluded they should recommend to Mr. Trump a new approach that would include warning the American people of the risks and urging steps like social distancing and staying home from work.

But the White House focused instead on messaging and crucial additional weeks went by before their views were reluctantly accepted by the president — time when the virus spread largely unimpeded.

When Mr. Trump finally agreed in mid-March to recommend social distancing across the country, effectively bringing much of the economy to a halt, he seemed shellshocked and deflated to some of his closest associates. One described him as “subdued” and “baffled” by how the crisis had played out. An economy that he had wagered his re-election on was suddenly in shambles.

He only regained his swagger, the associate said, from conducting his daily White House briefings, at which he often seeks to rewrite the history of the past several months. He declared at one point that he “felt it was a pandemic long before it was called a pandemic,” and insisted at another that he had to be a “cheerleader for the country,” as if that explained why he failed to prepare the public for what was coming.

Mr. Trump’s allies and some administration officials say the criticism has been unfair.

The Chinese government misled other governments, they say. And they insist that the president was either not getting proper information, or the people around him weren’t conveying the urgency of the threat. In some cases, they argue, the specific officials he was hearing from had been discredited in his eyes, but once the right information got to him through other channels, he made the right calls.

“While the media and Democrats refused to seriously acknowledge this virus in January and February, President Trump took bold action to protect Americans and unleash the full power of the federal government to curb the spread of the virus, expand testing capacities and expedite vaccine development even when we had no true idea the level of transmission or asymptomatic spread,” said Judd Deere, a White House spokesman.

Decision-making was also complicated by a long-running dispute inside the administration over how to deal with China

The Containment IllusionBy the last week of February, it was clear to the administration’s public health team that schools and businesses in hot spots would have to close. But in the turbulence of the Trump White House, it took three more weeks to persuade the president that failure to act quickly to control the spread of the virus would have dire consequences.

There were key turning points along the way, opportunities for Mr. Trump to get ahead of the virus rather than just chase it. There were internal debates that presented him with stark choices, and moments when he could have chosen to ask deeper questions and learn more. How he handled them may shape his re-election campaign. They will certainly shape his legacy.

Facing the likelihood of a real pandemic, the group needed to decide when to abandon “containment” — the effort to keep the virus outside the U.S. and to isolate anyone who gets infected — and embrace “mitigation” to thwart the spread of the virus inside the country until a vaccine becomes available.

Among the questions on the agenda, which was reviewed by The New York Times, was when the department’s secretary, Mr. Azar, should recommend that Mr. Trump take textbook mitigation measures “such as school dismissals and cancellations of mass gatherings,” which had been identified as the next appropriate step in a Bush-era pandemic plan.

The group — including Dr. Anthony S. Fauci of the National Institutes of Health; Dr. Robert R. Redfield of the Centers for Disease Control and Prevention, and Mr. Azar, who at that stage was leading the White House Task Force — concluded they would soon need to move toward aggressive social distancing

A 20-year-old Chinese woman had infected five relatives with the virus even though she never displayed any symptoms herself. The implication was grave — apparently healthy people could be unknowingly spreading the virus — and supported the need to move quickly to mitigation.

The following day, Dr. Kadlec and the others decided to present Mr. Trump with a plan titled “Four Steps to Mitigation,” telling the president that they needed to begin preparing Americans for a step rarely taken in United States history.

a presidential blowup and internal turf fights would sidetrack such a move. The focus would shift to messaging and confident predictions of success rather than publicly calling for a shift to mitigation.

These final days of February, perhaps more than any other moment during his tenure in the White House, illustrated Mr. Trump’s inability or unwillingness to absorb warnings coming at him.

He instead reverted to his traditional political playbook in the midst of a public health calamity, squandering vital time as the coronavirus spread silently across the country.

A memo dated Feb. 14, prepared in coordination with the National Security Council and titled “U.S. Government Response to the 2019 Novel Coronavirus,” documented what more drastic measures would look like, including: “significantly limiting public gatherings and cancellation of almost all sporting events, performances, and public and private meetings that cannot be convened by phone. Consider school closures. Widespread ‘stay at home’ directives from public and private organizations with nearly 100% telework for some.”

his friend had a blunt message: You need to be ready. The virus, he warned, which originated in the city of Wuhan, was being transmitted by people who were showing no symptoms — an insight that American health officials had not yet accepted.

On the 18-hour plane ride home, Mr. Trump fumed as he watched the stock market crash after Dr. Messonnier’s comments. Furious, he called Mr. Azar when he landed at around 6 a.m. on Feb. 26, raging that Dr. Messonnier had scared people unnecessarily.

The meeting that evening with Mr. Trump to advocate social distancing was canceled, replaced by a news conference in which the president announced that the White House response would be put under the command of Vice President Mike Pence.

The push to convince Mr. Trump of the need for more assertive action stalled. With Mr. Pence and his staff in charge, the focus was clear: no more alarmist messages. Statements and media appearances by health officials like Dr. Fauci and Dr. Redfield would be coordinated through Mr. Pence’s office

It would be more than three weeks before Mr. Trump would announce serious social distancing efforts, a lost period during which the spread of the virus accelerated rapidly.Over nearly three weeks from Feb. 26 to March 16, the number of confirmed coronavirus cases in the United States grew from 15 to 4,226

The China FactorThe earliest warnings about coronavirus got caught in the crosscurrents of the administration’s internal disputes over China. It was the China hawks who pushed earliest for a travel ban. But their animosity toward China also undercut hopes for a more cooperative approach by the world’s two leading powers to a global crisis.

It was early January, and the call with a Hong Kong epidemiologist left Matthew Pottinger rattled.

Mr. Trump was walking up the steps of Air Force One to head home from India on Feb. 25 when Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases, publicly issued the blunt warning they had all agreed was necessary.

It was one of the earliest warnings to the White House, and it echoed the intelligence reports making their way to the National Security Council

some of the more specialized corners of the intelligence world were producing sophisticated and chilling warnings.

In a report to the director of national intelligence, the State Department’s epidemiologist wrote in early January that the virus was likely to spread across the globe, and warned that the coronavirus could develop into a pandemic

Working independently, a small outpost of the Defense Intelligence Agency, the National Center for Medical Intelligence, came to the same conclusion.

By mid-January there was growing evidence of the virus spreading outside China. Mr. Pottinger began convening daily meetings about the coronavirus

The early alarms sounded by Mr. Pottinger and other China hawks were freighted with ideology — including a push to publicly blame China that critics in the administration say was a distraction

And they ran into opposition from Mr. Trump’s economic advisers, who worried a tough approach toward China could scuttle a trade deal that was a pillar of Mr. Trump’s re-election campaign.

Mr. Pottinger continued to believe the coronavirus problem was far worse than the Chinese were acknowledging. Inside the West Wing, the director of the Domestic Policy Council, Joe Grogan, also tried to sound alarms that the threat from China was growing.

The Consequences of ChaosThe chaotic culture of the Trump White House contributed to the crisis. A lack of planning and a failure to execute, combined with the president’s focus on the news cycle and his preference for following his gut rather than the data cost time, and perhaps lives.

the hawks kept pushing in February to take a critical stance toward China amid the growing crisis. Mr. Pottinger and others — including aides to Secretary of State Mike Pompeo — pressed for government statements to use the term “Wuhan Virus.”Mr. Pompeo tried to hammer the anti-China message at every turn, eventually even urging leaders of the Group of 7 industrialized countries to use “Wuhan virus” in a joint statement.

Others, including aides to Mr. Pence, resisted taking a hard public line, believing that angering Beijing might lead the Chinese government to withhold medical supplies, pharmaceuticals and any scientific research that might ultimately lead to a vaccine.

Mr. Trump took a conciliatory approach through the middle of March, praising the job Mr. Xi was doing.

That changed abruptly, when aides informed Mr. Trump that a Chinese Foreign Ministry spokesman had publicly spun a new conspiracy about the origins of Covid-19: that it was brought to China by U.S. Army personnel who visited the country last October.

On March 16, he wrote on Twitter that “the United States will be powerfully supporting those industries, like Airlines and others, that are particularly affected by the Chinese Virus.”

Mr. Trump’s decision to escalate the war of words undercut any remaining possibility of broad cooperation between the governments to address a global threat

Mr. Pottinger, backed by Mr. O’Brien, became one of the driving forces of a campaign in the final weeks of January to convince Mr. Trump to impose limits on travel from China

he circulated a memo on Jan. 29 urging Mr. Trump to impose the travel limits, arguing that failing to confront the outbreak aggressively could be catastrophic, leading to hundreds of thousands of deaths and trillions of dollars in economic losses.

The uninvited message could not have conflicted more with the president’s approach at the time of playing down the severity of the threat. And when aides raised it with Mr. Trump, he responded that he was unhappy that Mr. Navarro had put his warning in writing.

From the time the virus was first identified as a concern, the administration’s response was plagued by the rivalries and factionalism that routinely swirl around Mr. Trump and, along with the president’s impulsiveness, undercut decision making and policy development.

Even after Mr. Azar first briefed him about the potential seriousness of the virus during a phone call on Jan. 18 while the president was at his Mar-a-Lago resort in Florida, Mr. Trump projected confidence that it would be a passing problem.

“We have it totally under control,” he told an interviewer a few days later while attending the World Economic Forum in Switzerland. “It’s going to be just fine.”

The efforts to sort out policy behind closed doors were contentious and sometimes only loosely organized.

That was the case when the National Security Council convened a meeting on short notice on the afternoon of Jan. 27. The Situation Room was standing room only, packed with top White House advisers, low-level staffers, Mr. Trump’s social media guru, and several cabinet secretaries. There was no checklist about the preparations for a possible pandemic,

Instead, after a 20-minute description by Mr. Azar of his department’s capabilities, the meeting was jolted when Stephen E. Biegun, the newly installed deputy secretary of state, announced plans to issue a “level four” travel warning, strongly discouraging Americans from traveling to China. The room erupted into bickering.

A few days later, on the evening of Jan. 30, Mick Mulvaney, the acting White House chief of staff at the time, and Mr. Azar called Air Force One as the president was making the final decision to go ahead with the restrictions on China travel. Mr. Azar was blunt, warning that the virus could develop into a pandemic and arguing that China should be criticized for failing to be transparent.

Stop panicking, Mr. Trump told him.That sentiment was present throughout February, as the president’s top aides reached for a consistent message but took few concrete steps to prepare for the possibility of a major public health crisis.

As February gave way to March, the president continued to be surrounded by divided factions even as it became clearer that avoiding more aggressive steps was not tenable.

the virus was already multiplying across the country — and hospitals were at risk of buckling under the looming wave of severely ill people, lacking masks and other protective equipment, ventilators and sufficient intensive care beds. The question loomed over the president and his aides after weeks of stalling and inaction: What were they going to do?

Even then, and even by Trump White House standards, the debate over whether to shut down much of the country to slow the spread was especially fierce.

In a tense Oval Office meeting, when Mr. Mnuchin again stressed that the economy would be ravaged, Mr. O’Brien, the national security adviser, who had been worried about the virus for weeks, sounded exasperated as he told Mr. Mnuchin that the economy would be destroyed regardless if officials did nothing.

in the end, aides said, it was Dr. Deborah L. Birx, the veteran AIDS researcher who had joined the task force, who helped to persuade Mr. Trump. Soft-spoken and fond of the kind of charts and graphs Mr. Trump prefers, Dr. Birx did not have the rough edges that could irritate the president. He often told people he thought she was elegant.

During the last week in March, Kellyanne Conway, a senior White House adviser involved in task force meetings, gave voice to concerns other aides had. She warned Mr. Trump that his wished-for date of Easter to reopen the country likely couldn’t be accomplished. Among other things, she told him, he would end up being blamed by critics for every subsequent death caused by the virus.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.

“Whether the Delta variant is already at that plateau, or whether there’s going to be further increases before it gets to that plateau, I can’t say. But I do think that plateau exists.”

Antibodies, which can prevent the virus from entering our cells, are engineered to latch onto specific molecules on the surface of the virus, snapping into place like puzzle pieces. But genetic mutations in the virus can change the shape of those binding sites.

“If you change that shape, you can make it impossible for an antibody to do its job,”

But as more people acquire antibodies against the virus, mutations that allow the virus to slip past these antibodies will become even more advantageous.

The good news is that there are many different kinds of antibodies, and a variant with a few new mutations is unlikely to escape them all, experts said.

its sleeve to counteract the evolution of the virus,” Dr. Pepper said. “Knowing that there is this complex level of diversity in the immune system allows me to sleep better at night.”

“It’s a lot harder to evade T cell responses than antibody responses,”

And then there are B cells, which generate our army of antibodies. Even after we clear the infection, the body keeps churning out B cells for a while, deliberately introducing small genetic mutations. The result is an enormously diverse collection of B cells producing an array of antibodies, some of which might be a good match for the next variant that comes along.

Whether the virus will become more virulent — that is, whether it will cause more serious disease — is the hardest to predict,

Unlike transmissibility or immune evasion, virulence has no inherent evolutionary advantage.

Some scientists predict that the virus will ultimately be much like the flu, which can still cause serious illness and death, especially during seasonal surges.

“The virus has no interest in killing us,” Dr. Metcalf said. “Virulence only matters for the virus if it works for transmission.”

It is too early to say whether SARS-CoV-2 will change in virulence over the long-term. There could certainly be trade-offs between virulence and transmission; variants that make people too sick too quickly may not spread very far.

Then again, this virus spreads before people become severely ill. As long as that remains true, the virus could become more virulent without sacrificing transmissibility.

Moreover, the same thing that makes the virus more infectious — faster replication or tighter binding to our cells — could also make it more virulent.

Although many possible paths remain open to us, what is certain is that SARS-CoV-2 will not stop evolving — and that the arms race between the virus and us is just beginning.

We lost the first few rounds, by allowing the virus to spread unchecked, but we still have powerful weapons to bring to the fight. The most notable are highly effective vaccines, developed at record speed. “I think there is hope in the fact that the SARS-CoV-2 vaccines at this point are more effective than flu vaccines have probably ever been,”

“I have great faith that we can sort any detrimental evolutionary trajectories out by improving our current or next generation vaccines,”

be you have a re-infection, but it’s relatively mild, which also boosts your immunity,”

rising vaccination rates may already be suppressing new mutations.And the evolution rate could also slow down as the virus becomes better adapted to humans.

“There’s low-hanging fruit,” Dr. Lauring said. “So there are certain ways it can evolve and make big improvements, but after a while there aren’t areas to improve — it’s figured out all the easy ways to improve.”

Eventually, as viral evolution slows down and our immune systems catch up, we will reach an uneasy equilibrium with the virus, scientists predict. We will never extinguish it, but it will smolder rather than rage.

So far, studies suggest that our antibody, T cell and B cell responses are all working as expected when it comes to SARS-CoV-2. “This virus is mostly playing by immunological rules we understand,”

Others are more optimistic. “My guess is that one day this is going to be another cause of the common cold,”

There are four other coronaviruses that have become endemic in human populations. We are exposed to them early and often, and all four mostly cause run-of-the-mill colds.

much of the world remains unvaccinated, and this virus has already proved capable of surprising us. “We should be somewhat cautious and humble about trying to predict what it is capable of doing in the future,”

While we can’t guard against every eventuality, we can tip the odds in our favor by expanding viral surveillance, speeding up global vaccine distribution and tamping down transmission until more people can be vaccinated

The future, he said, “depends much, much more on what humans do than on what the virus does.”

While conspiracy theories might falsely claim the virus was concocted in a lab, the virus’s genome makes clear that it arose in bats.

Sophisticated computer programs can then figure out how all of those mutations arose as viruses descended from a common ancestor. If they get enough data, they can make rough estimates about how long ago those ancestors lived. That’s because mutations arise at a roughly regular pace, like a molecular clock.

Tracking viral mutations demands sequencing all the genetic material in a virus — its genome. Once researchers have gathered the genomes from a number of virus samples, they can compare their mutations.

In January, a team of Chinese and Australian researchers published the first genome of the new virus. Since then, researchers around the world have sequenced over 3,000 more. Some are genetically identical to each other, while others carry distinctive mutations.

The most closely related coronavirus is in a Chinese horseshoe bat, the researchers found. But the new virus has gained some unique mutations since splitting off from that bat virus decades ago.

Dr. Boni said that ancestral virus probably gave rise to a number of strains that infected horseshoe bats, and perhaps sometimes other animals.

It’s entirely possible, Dr. Boni said, in the past 10 or 20 years, a hybrid virus arose in some horseshoe bat that was well-suited to infect humans, too. Later, that virus somehow managed to cross the species barrier.

already, the genomes of the virus are revealing previously hidden outlines of its history over the past few months.

While the coronavirus mutations are useful for telling lineages apart, they don’t have any apparent effect on how the virus works.

The deepest branches of the tree all belong to lineages from China. The Nextstrain team has also used the mutation rate to determine that the virus probably first moved into humans from an animal host in late 2019.

In January, as the scope of the catastrophe in China became clear, a few countries started an aggressive testing program. They were able to track the arrival of the virus on their territory and track its spread through their populations.

But the United States fumbled in making its first diagnostic kits and initially limited testing only to people who had come from China and displayed symptoms of Covid-19.“It was a disaster that we didn’t do testing,”

As new cases arose in other parts of the country, other researchers set up their own pipelines. The first positive test result in New York came on March 1, and after a couple of weeks, patients surged into the city’s hospitals.

Dr. Heguy and her colleagues found some New York viruses that shared unique mutations not found elsewhere. “That’s when you know you’ve had a silent transmission for a while,”

And researchers at Mount Sinai started sequencing the genomes of patients coming through their hospital. They found that the earliest cases identified in New York were not linked to later ones.“Two weeks later, we start seeing viruses related to each other,”

Dr. Gonzalez-Reiche and her colleagues found that these viruses were practically identical to viruses found around Europe.

hey write that the viruses reveal “a period of untracked global transmission between late January to mid-February.”

Dr. van Bakel and his colleagues found one New York virus that was identical to one of the Washington viruses found by Dr. Bedford and his colleagues. In a separate study, researchers at Yale found another Washington-related virus. Combined, the two studies hint that the coronavirus has been moving from coast to coast for several weeks.

Dr. Boni and his colleagues found that the genome of the new virus contains a number of mutations in common with strains of coronaviruses that infect bats.

Some viruses evolve so quickly that they require vaccines that can produce several different antibodies. That’s not the case for Covid-19. Like other coronaviruses, it has a relatively slow mutation rate compared to some viruses, like influenza.

But despite that constant flow of reporting, Trump continued publicly and privately to play down the threat the virus posed to Americans.

Intelligence agencies “have been warning on this since January,” said a U.S. official who had access to intelligence reporting that was disseminated to members of Congress and their staffs as well as to officials in the Trump administration

“Donald Trump may not have been expecting this, but a lot of other people in the government were — they just couldn’t get him to do anything about it,” this official said. “The system was blinking red.”

The warnings from U.S. intelligence agencies increased in volume toward the end of January and into early February, said officials familiar with the reports. By then, a majority of the intelligence reporting included in daily briefing papers and digests from the Office of the Director of National Intelligence and the CIA was about covid-19, said officials who have read the reports.

The surge in warnings coincided with a move by Sen. Richard Burr (R-N.C.) to sell dozens of stocks worth between $628,033 and $1.72 million.

A key task for analysts during disease outbreaks is to determine whether foreign officials are trying to minimize the effects of an outbreak or take steps to hide a public health crisis

At the State Department, personnel had been nervously tracking early reports about the virus. One official noted that it was discussed at a meeting in the third week of January, around the time that cable traffic showed that U.S. diplomats in Wuhan were being brought home on chartered planes — a sign that the public health risk was significant

Inside the White House, Trump’s advisers struggled to get him to take the virus seriously, according to multiple officials with knowledge of meetings among those advisers and with the president.

Azar couldn’t get through to Trump to speak with him about the virus until Jan. 18, according to two senior administration officials. When he reached Trump by phone, the president interjected to ask about vaping and when flavored vaping products would be back on the market

On Jan. 27, White House aides huddled with then-acting chief of staff Mick Mulvaney in his office, trying to get senior officials to pay more attention to the virus

Joe Grogan, the head of the White House Domestic Policy Council, argued that the administration needed to take the virus seriously or it could cost the president his reelection, and that dealing with the virus was likely to dominate life in the United States for many months.

Trump was dismissive because he did not believe that the virus had spread widely throughout the United States.

By early February, Grogan and others worried that there weren’t enough tests to determine the rate of infection, according to people who spoke directly to Grogan

But Trump resisted and continued to assure Americans that the coronavirus would never run rampant as it had in other countries.“I think it’s going to work out fine,” Trump said on Feb. 19. “I think when we get into April, in the warmer weather, that has a very negative effect on that and that type of a virus.”

“The Coronavirus is very much under control in the USA,” Trump tweeted five days later. “Stock Market starting to look very good to me!”

But earlier that month, a senior official in the Department of Health and Human Services delivered a starkly different message to the Senate Intelligence Committee, in a classified briefing that four U.S. officials said covered the coronavirus and its global health implications. The House Intelligence Committee received a similar briefing.

Robert Kadlec, the assistant secretary for preparedness and response — who was joined by intelligence officials, including from the CIA — told committee members that the virus posed a “serious” threat, one of those officials said.

he said that to get ahead of the virus and blunt its effects, Americans would need to take actions that could disrupt their daily lives, the official said. “It was very alarming.”

Trump’s insistence on the contrary seemed to rest in his relationship with China’s President Xi Jingping, whom Trump believed was providing him with reliable information about how the virus was spreading in China, despite reports from intelligence agencies that Chinese officials were not being candid about the true scale of the crisis.

Some of Trump’s advisers told him that Beijing was not providing accurate numbers

Rather than press China to be more forthcoming, Trump publicly praised its response.

“China has been working very hard to contain the Coronavirus,” Trump tweeted Jan. 24. “The United States greatly appreciates their efforts and transparency. It will all work out well. In particular, on behalf of the American People, I want to thank President Xi!”

Trump on Feb. 3 banned foreigners who had been in China in the previous 14 days from entering the United States, a step he often credits for helping to protect Americans against the virus. He has also said publicly that the Chinese weren’t honest about the effects of the virus. But that travel ban wasn’t accompanied by additional significant steps to prepare

As the first cases of infection were confirmed in the United States, Trump continued to insist that the risk to Americans was small.“I think the virus is going to be — it’s going to be fine,” he said on Feb. 10

But I do think it’s going to be a while before this virus becomes completely normal. And I’ve never been convinced that this current generation of elderly people will ever get to a place where it is completely normal. If you’re 65 or 75 or even older — it’s really hard to teach an immune system new tricks if you’re that age

And so while we may see excess mortality in the elderly decline somewhat, I don’t think we’ll see it ever disappear for this generation who was already old when the pandemic hit. Many will never develop that robust, long-term immunological memory we would want to see — and which happens naturally to someone who’s been exposed hundreds of times since they were a little baby.

With Covid, when it infects you, it can land in your upper respiratory tract and it just start replicating right there. Immediately, it’s present and replicating in your lungs and in your nose. And that alone elicits enough of an immune response to cause us to feel really crappy and even cause us to feel disease.

Is it really the case that, as babies, we are fighting off those viruses hundreds of times?The short answer is yeah. We start seeing viruses when we’re 2 months old, when we’re a month old. And a lot of these viruses we’ve seen literally tens, if not hundreds of times for some people by the time we’re adults. People tend to think that immunity is binary — you’re either immune or you’re not. That couldn’t be farther from the truth. It’s a gradient, and your protection gets stronger the more times you see a virus.

We used to think we just had this spectacular immune response when we first encountered the virus at, say, age 6, and that the immune response lasted until we were 70. But actually what we were seeing was the effect of an immune system being retrained every time it came into contact with the virus after the initial infection — at 6, and 7, and 8, and so on. Every time your friend got chickenpox, or your neighbor, you got a massive boost. You were re-upping your immune response and diversifying your immunological tools — potentially multiple times a year, a kind of natural booster.

But now, in America, kids get chickenpox vaccines. So you don’t have kids in America getting chickenpox today, and never will. But that means that older Americans, who did get it as kids, are not being exposed again — certainly not multiple times each year. And it turns out that, in the absence of routine re-exposures, that first exposure alone isn’t nearly as good at driving lifelong immunity and warding off shingles until your immune system begins to fall apart in old age — it can last until you’re in your 30s, for example but not until your 70s.

There’s a similar story with measles. There is no routine later-life sequelae, like shingles, for measles. But what we do see is that, in measles outbreaks today, there are some people who were vaccinated who get it anyway. Maybe 5 to 15 percent of cases are not immunologically naïve people, but vaccinated people.

But we could have just set the narrative better at the beginning: Look, you might get sick again, but your risk of landing in the hospital is going to be really low, and if you get a booster, you might still get sick again, but your risk of landing in the hospital is going to be even lower. That’s something I think humans can deal with, and I think the public could have understood it.

But it’s why we don’t see the severe disease as much, with a second exposure or an exposure after vaccination: For most people, it’s not getting into the heart and the liver and stuff nearly as easily.

But it doesn’t have to. It’s still causing symptomatic disease. And maybe mucosal vaccines could stop this, but without them we’re likely to continue seeing infections and even symptomatic infections.

through most of 2020 and into 2021, though. Back then, I think the conventional wisdom was that a single exposure — through infection or vaccination — would be the end of the pandemic for you. If this is basic virology and immunology, how did we get that so wrong?

The short answer is that epidemiologists are not immunologists and immunologists are not virologists and virologists are not epidemiologists. And, in general, physicians don’t know anything about the details.

But this failure had some pretty concrete impacts. When reinfections first began popping up, people were surprised, they were scared, and then, to some degree, they lost trust in vaccines. And the people they were turning to for guidance — not only did they not warn us about that, they were slow to acknowledge it, as well.

It had dramatic impacts and ripple effects that will last for years to limit our ability to get populations properly vaccinated.

For babies born today, though, I really think they’re not going to view Covid as any different than other viruses. By the time they are 20, it will be like any other virus to them. Because their immune systems will have grown up with it.

And now, there’s a huge number of people questioning, do these vaccines even do anything?

the worst thing we can do during a pandemic is set inappropriately high expectations. These vaccines are incredible, they’ve had an enormously positive impact on mortality, but they were never going to end the pandemic.

Instead, we set society up for failure, since people feel like the government failed everyone, that biology failed us, and that this was a crazy virus that has broken all the rules of our immune system, when it’s just doing what we’ve always known it would do.

The really hard part of answering that question is there’s just not enough data on the frequency of long-term effects, because nothing like this has ever happened at such scale. It’s like everyone in Europe and North America suddenly traveled to a country where malaria was endemic.

To say that this is a textbook virus, it doesn’t mean that it’s not killing people. Objectively, it’s still killing more people than any other infectious disease

What it means is that we could’ve taken action based on what we knew, rather than waiting around to prove everything and publish papers in Nature and Science talking about things we already knew.

We could have prepared for November and December of 2020 and then for November and December of 2021. But everyone kept saying, we don’t know if it’s going to come back. We knew it was going to come back and it makes me want to cry to think about it. We did nothing and hundreds of thousands of people died. We didn’t prepare nursing homes because we all got to the summer of 2020 and we said, cross our fingers.

We knew how tests worked. We knew about serial testing and why it was important for a public health approach. We knew that vaccines could have really good impacts once they were around. And if you were looking through the correct lens, we even knew that they weren’t going to stop transmission.

We didn’t have to live in a world where we were flying blind. We could have lived in a world where we’re knowledgeable. But instead, we chose almost across the board to will ourselves into this state of fear and anxiety.

And that really started in the earliest days. Almost the first experience I had was a lot like that movie with Jennifer Lawrence —Don’t Look Up.

none of this was complicated. You just had to ask a simple question: what would happen if you took away all immunity from an adult? Well, once you control for no immunity, adults are going to get very, very sick.

Of course, by and large, babies didn’t get very sick from this disease.Babies are immunologically naïve, but they are also resilient. A virus can tear up a baby, but a baby can repair its tissue so fast. Adults don’t have that. It’s just like a baby getting a cut. They’ll heal really quick

An adult getting a cut — you go by age, and every decade of age that you are, it’s going to take exponentially longer for that wound to heal. Eventually get to 80 or 90 and the wound can’t even heal. In the immunology world, this is called “tolerance.”

why are all these organ systems getting damaged when other viruses don’t seem to do that? It’s natural to think, it’s Covid — this is a weird disease. But it’s much more a story about immunity and how it develops than about the virus or the disease. None of our organ systems had any immune defenses around to help them out. And I think that the majority of post-acute sequelae and multi-organ complications and long Covid — they are not the result of the virus being a crazy different virus, but are a result of this virus replicating in an environment where there were such absent or exceedingly low defenses.

Is it the same whenever we encounter a virus for the first time?Think about travelers. Travelers get way more sick from a local disease than people who grew up with that virus. If you get malaria as a traveler, you’re much more likely to get really sick. You don’t see everyone in Nicaragua taking chloroquine every day. But you definitely see travelers taking it, because malaria can be deadly for adults.

What about, not severity, but post-acute complications — do we have long malaria? Do we have liver complications from dengue?

How do you wish we had messaged things differently? What would it have meant to communicate early and clearly that Covid was a textbook virus, as you say?I think the biggest thing would have been just to say, we understand the enemy.

Or think about H.I.V. It essentially kills your immune system, and once the immune barriers are down, other viruses that used to infect humans would get into tissues that we didn’t like them to get into. If there wasn’t such a clear signal of a loss of CD-4 T cells to explain it, people might still be scratching their heads and going, man, I wonder why all these patients are getting fungal infections. Well, there’s a virus there that’s depleting their immune system.

Covid is absolutely waking the world up to this — to the fact that there are really weird long-term sequelae to viruses when they infect organ systems that would normally be protected. And I think we’re going to find that more and more cancers are being attributed to viral infections.

It wasn’t that long ago that we first learned that most cases of cervical cancer were caused by H.P.V. — I think the 1980s. And now we have a vaccine for H.P.V. and rates of cervical cancer have fallen by two-thirds.

what about incidence? We’ve talked at a few points about how important it is to think about all of these questions in terms of the scale. What is the right scale for thinking about future long Covid, for instance, or other post-acute sequelae?

I think the absolute risk, per infection, is going down and down and down. That’s just true.

he U.K.’s Office of National Statistics, which shows a much lower risk of developing long Covid now, from reinfection, than from an initial infection earlier in the pandemic.

the worst is definitely behind us, which is a good thing, especially for people who worry that the problems will keep building and a lot of people — or even everyone — will get long Covid symptoms. I don’t think there’s a world where we’re looking at the babies of today dealing with long Covid at any meaningful scale.

a lot of the fear right now comes from the worst cases, and there’s a lot of worst cases. Even one of the people that I know well, I know in their mind they’re worried that they’ll never recover, but I think objectively they are recovering slowly. It might not be an eight month course. It might be a year and a half. But they will get better. Most of us will.

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.

The half-life is a measurement of the time it takes for a given amount of the virus to become reduced by half.

the half-life of the virus, in the absence of sunlight (indoors), lowers from 18 hours to one hour when the temperature rises from around room temperature (70 to 75 degrees) to 95 degrees and the humidity increases from 20 percent to 80 percent.

The laboratory experiment also tested how the virus decays when exposed to various elements while suspended in the air. When the airborne virus at temperatures between 70 and 75 degrees is exposed to sunlight, its half-life decreases from around 60 minutes before exposure to 1.5 minutes after.

The laboratory results show that increases in temperature, humidity and sunlight all can speed up how fast the virus is destroyed, based on measurements of its half-life when exposed to these elements.

The weather is no panacea when it comes to the coronavirus pandemic, considering that warm states, such as Georgia and Florida, already are seeing significant outbreaks, as are warm and humid countries, including Singapore. Even if the virus were to wane during the summer, a dreaded second wave would still be likely in the fall, as has happened with past pandemic flu outbreaks.

A slide presented by Bryan also recommended moving activities outside.

in the real world, the virus on a playground surface exposed to direct sunlight would die quickly, but the virus could survive longer in shaded areas.

If the summer months reduce the transmission rates of the virus, that would help officials’ efforts to squelch its spread without resorting to drastic mitigation measures, such as stay-at-home orders, that have had massive economic repercussions.

“It would be irresponsible for us to say summer will kill the virus,” Bryan said, calling summer conditions “another tool in toolbox” to use against the virus.

“Increasing the temperature and humidity of potentially contaminated indoor spaces appears to reduce the stability of the virus,” he said. “And extra care may be warranted for dry environments that do not have exposure to solar light.”

That report pointed to shortcomings in the studies published so far that trace the spread of the coronavirus and connect the pattern of spread to temperature and humidity, stating they “should be interpreted with caution.”

The NAS report states: “There is some evidence to suggest that SARS-CoV-2 may transmit less efficiently in environments with higher ambient temperature and humidity; however, given the lack of host immunity globally, this reduction in transmission efficiency may not lead to a significant reduction in disease spread” without mitigation measures, such as social distancing

I never met a cabdriver who had been swab-tested less than twice, and a couple had been tested five times. Most of the cabbies had no relatives or friends who had been infected; swabbing was simply required by the city and by their cab companies.

When Wuhan was sealed, the strategy of isolation was replicated throughout the city. Housing compounds were closed and monitored by neighborhood committees, with residents going out only for necessities.

Toward the end of the first month, the guidelines were tightened further, until virtually all goods were delivered. On February 17th, Fang Fang wrote, “Everyone is now required to remain inside their homes at all times.”

Meanwhile, approximately ten thousand contact tracers were working in the city, in order to cut off chains of infection, and hospitals were developing large-scale testing systems. But isolation remained crucial: patients were isolated; suspected exposures were isolated; medical workers were isolated.

Zhang said the experience of working through the pandemic had left him calmer and more patient. He drove more carefully now; he wasn’t in such a rush.

I often asked Wuhan residents how they had been personally changed by the spring, and there was no standard response. Some expressed less trust in government information; others said they had increased faith in the national leadership.

Wuhan had most recently reported a locally transmitted symptomatic case on May 18th. It’s the most thoroughly tested city in China: at the end of May, in part to boost confidence, the government tried to test every resident, a total of eleven million.

There are three hundred and twenty-one testing locations in the city, and the system is so extensive that in June, when Beijing suffered an outbreak, Wuhan hospitals sent seventy-two staffers to the capital to help with tests.

“I tend to take a charitable view of countries that are at the beginning stage of epidemics,” Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Center for Health Security, told me, in a phone conversation. According to her, it’s unrealistic to expect that any country could have stopped this particular virus at its source. “I’ve always believed that this thing was going to spread,” she said

The physician who handled testing told me that, on average, his hospital still recorded one positive for every forty thousand exams. Most of these positives were repeat patients: after having been infected during the initial run of the virus, they recovered fully, and then for some reason, months later, showed evidence of the virus again. So far, most of the positives had been asymptomatic, and the physician saw no indication that the virus was spreading in the city.

In town, there were few propaganda signs about the epidemic, and Wuhan newspapers ran upbeat headlines every morning (Yangtze Daily, August 29th, front page: “STUDENTS DO NOT HAVE TO WEAR MASKS IN SCHOOLS”). Movie theatres were open; restaurants and bars had no seating restrictions. At the Hanyang Renxinghui Mall, I saw barefaced kids playing in what may have been one of the last fully functioning ball pits on earth, a sight that seemed worthy of other headlines (“CHILDREN DO NOT HAVE TO WEAR MASKS IN WUHAN BALL PITS”).

Across town, colleges and universities were in the process of bringing back more than a million students. Wuhan has the second-highest number of students of any city in China, after Guangzhou.

Wuhan memories remained fresh, and the materials of documentation were also close at hand. People sometimes handed over manuscripts, and they took out their phones and pulled up photographs and messages from January and February. But I wondered how much of this material would dissipate over time.

In town, I met two Chinese journalists in their twenties who were visiting from out of town. They had been posted during the period of the sealed city: back then, anybody sent to cover events in Wuhan had to stay for the long haul.

One was a director of streaming media whom I’ll call Han, and he had found that government-run outlets generally wanted footage that emphasized the victory over the disease, not the suffering of Wuhan residents. Han hoped that eventually he’d find other ways to use the material. “It will be in the hard drive,” he said, tapping his camera.

After that, Yin reported on a number of issues that couldn’t be published or completed, and she often talked with scientists and officials who didn’t want to say too much. “One person said, ‘Ten years later, if the climate has changed, I’ll tell you my story,’ ” Yin told me. “He knew that he would be judged by history.” She continued, “These people are inside the system, but they also know that they are inside history.”

In time, we will learn more, but the delay is important to the Communist Party. It handles history the same way that it handles the pandemic—a period of isolation is crucial. Throughout the Communist era, there have been many moments of quarantined history: the Great Leap Forward, the Cultural Revolution, the massacre around Tiananmen Square. In every case, an initial silencing has been followed by sporadic outbreaks of leaked information. Wuhan will eventually follow the same pattern, but for the time being many memories will remain in the sealed city.

When I spoke with scientists outside China, they weren’t focussed on the government’s early missteps

Such fare is much more popular in Guangdong, in the far south. It’s possible that the disease arrived from somewhere else and then spread in the wet, cool conditions of the fish stalls. A few Wuhan residents told me that a considerable amount of their seafood comes from Guangdong, and they suggested that perhaps a southerner had unwittingly imported the disease,

Wafaa El-Sadr, the director of ICAP, a global-health center at Columbia University, pointed out that Chinese scientists had quickly sequenced the virus’s genome, which was made available to researchers worldwide on January 11th. “I honestly think that they had a horrific situation in Wuhan and they were able to contain it,” she said. “There were mistakes early on, but they did act, and they shared fast.”

For much of El-Sadr’s career, she has worked on issues related to AIDS in the United States, Africa, and elsewhere. After years of research, scientists eventually came to the consensus that H.I.V. most likely started through the bushmeat trade—the first human was probably infected after coming into contact with a primate or primate meat.

El-Sadr views the coronavirus as another inevitable outcome of people’s encroachment on the natural world. “We are now living through two concomitant massive pandemics that are the result of spillover from animal to human hosts, the H.I.V. and the COVID pandemics,” she wrote to me, in an e-mail. “Never in history has humanity experienced something along this scale and scope.”

There’s a tendency to believe that we would know the source of the coronavirus if the Chinese had been more forthcoming, or if they hadn’t cleaned out the Huanan market before stalls and animals could be studied properly.

But Peter Daszak, a British disease ecologist who has collaborated with the Wuhan Institute of Virology for sixteen years on research on bat coronaviruses, told me that it’s typical to fail to gather good data from the site of an initial outbreak. Once people get sick, local authorities inevitably focus on the public-health emergency. “You send in the human doctors, not the veterinarians,” he said, in a phone conversation. “And the doctors’ response is to clean out the market. They want to stop the infections.”

Daszak believes the virus probably circulated for weeks before the Wuhan outbreak, and he doubts that the city was the source. “There are bats in Wuhan, but it was the wrong time of year,” he told me. “It was winter, and bats are not out as much.”

His research has indicated that, across Southeast Asia, more than a million people each year are infected by bat coronaviruses. Some individuals trap, deal, or raise animals that might serve as intermediary hosts. “But generally it’s people who live near bat caves,”

Daszak said that he had always thought that such an outbreak was most likely to occur in Kunming or Guangzhou, southern cities that are close to many bat caves and that also have an intensive wildlife trade.

He thinks that Chinese scientists are probably now searching hospital freezers for lab samples of people who died of pneumonia shortly before the outbreak. “You would take those samples and look for the virus,” he said. “They’ll find something eventually. These things just don’t happen overnight; it requires a lot of work. We’ve seen this repeatedly with every disease. It turns out that it was already trickling through the population.”

Daszak is the president of EcoHealth Alliance, a nonprofit research organization based in New York. EcoHealth has become the target of conspiracy theorists, including some who claim that the virus was man-made. Daszak and many prominent virologists say that anything created in a lab would show clear signs of manipulation.

There’s also speculation that the outbreak started when researchers accidentally released a coronavirus they were studying at the Wuhan Institute of Virology. But there’s no evidence of a leak, or even that the institute has ever studied a virus that could cause a COVID-19 outbreak.

“Scientists in China are under incredible pressure to publish,” Daszak said. “It really drives openness and transparency.”

He has spent a good deal of time in Wuhan, and co-authored more than a dozen papers with Chinese colleagues. “If we had found a virus that infected human cells and spread within a cell culture, we would have put the information out there,” he said. “In sixteen years, I’ve never come across the slightest hint of subterfuge. They’ve never hidden data. I’ve never had a situation where one lab person tells me one thing and the other says something else. If you were doing things that you didn’t want people to know about, why would you invite foreigners into the lab?”

In April, President Trump told reporters that the U.S. should stop funding research connected to the Wuhan Institute of Virology. Shortly after Trump’s comments, the National Institutes of Health cancelled a $3.7-million grant to EcoHealth, which had been studying how bat coronaviruses are transmitted to people.

I asked Daszak why, if he has such faith in the openness of his Wuhan colleagues, the Chinese government has been so closed about other aspects of the outbreak. He said that science is one thing, and politics something else; he thinks that officials were embarrassed about the early mistakes, and in response they simply shut down all information.

At the beginning of July, China National Biotec Group, a subsidiary of a state-owned pharmaceutical company called Sinopharm, completed construction of a vaccine-manufacturing plant in Wuhan. The project began while the city was still sealed. “That’s the politically correct thing to do,” a Shanghai-based biotech entrepreneur told me. “To show the world that the heroic people of Wuhan have come back.”

Yiwu He, the chief innovation officer at the University of Hong Kong, told me that the C.N.B.G. vaccine has already been given to a number of Chinese government officials, under an emergency-use approval granted by the authorities. “I know a few government officials personally, and they told me that they took the vaccine,” he said, in a phone conversation. He thought that the total number was probably around a hundred. “It’s middle-level officials,” he said. “Vice-ministers, mayors, vice-mayors.”

Pharmaceutical executives have also been expected to lead the way, like the construction manager who donned P.P.E. in order to escort his workers into the patient ward. “Every senior executive at Sinopharm and C.N.B.G. has been vaccinated,” He said. “Including the C.E.O. of Sinopharm, the chairman of the board, every vice-president—everyone.” The Chinese press has reported that vaccinations have also been administered to hundreds of thousands of citizens in high-risk areas around the world.

In the West, China’s image has been badly damaged by the pandemic and by other recent events. The country has tightened political crackdowns in Hong Kong and Xinjiang, and, in May, after Australia called for an investigation into the origins of the virus, China responded furiously, placing new tariffs and restrictions on Australian goods ranging from barley to beef.

But He believes that the situation is fluid. “All of these feelings can turn around quickly,” he told me. “I think that once China has a vaccine, and if they can help other countries, it can make a huge difference.”

There’s also a competitive element. “China wants to beat America,” He said. He believes that the C.N.B.G. vaccine will receive some level of approval for public use by the end of October. “Chinese officials are thinking that Donald Trump might approve a U.S. vaccine before the election,” he said. “So their goal is to have a vaccine approved before that.”

No matter how quickly the Chinese develop a vaccine, or how effectively they have handled the pandemic since January, it’s unlikely to make Westerners forget the mistakes and misinformation during the pandemic’s earliest phase.

Some of this is due to a cultural difference—the Chinese response to errors is often to look forward, not back. On January 31st, Fang Fang commented in her diary, “The Chinese people have never been fond of admitting their own mistakes, nor do they have a very strong sense of repentance.” It’s often hard for them to understand why this quality is so frustrating for Westerners. In this regard, the pandemic is truly a mirror—it doesn’t allow the Chinese to look out and see themselves through the eyes of others.

The pandemic illuminates both the weaknesses and the strengths of the Chinese system, as well as the relationship between the government and the people. They know each other well: officials never felt the need to tell citizens exactly what happened in Wuhan, but they understood that American-level casualties would have been shocking—given China’s population, the tally would have been more than a million and counting.

In order to avoid death on that scale, the government also knew that people would be willing to accept strict lockdowns and contribute their own efforts toward fighting the virus.

In turn, citizens were skilled at reading their government. People often held two apparently contradictory ideas: that the Party lied about some things but gave good guidance about others. More often than not, citizens could discern the difference. During the pandemic, it was striking that, when the Chinese indulged in conspiracy theories, these ideas rarely resulted in personally risky behavior, as they often did in the U.S.

Perhaps the Chinese have been inoculated by decades of censorship and misinformation: in such an environment, people develop strong instincts for self-preservation, and they don’t seem as disoriented by social media as many Americans are.

Early in the year, I corresponded by WeChat with a Wuhan pharmacist who worked in a hospital where many were infected. On February 26th, he expressed anger about the early coverup. “My personal opinion is that the government has always been careless and suppressed dissent,” he wrote. “Because of this, they lost a golden opportunity to control the virus.”

In Wuhan, we met a few times, and during one of our conversations I showed him what he had written in February. I asked what he would do now if he found himself in Li Wenliang’s position, aware of an outbreak of some unknown disease. Would he post a warning online? Contact a health official? Alert a journalist?The pharmacist thought for a moment. “I would tell my close friends in person,” he said. “But I wouldn’t put anything online. Nothing in writing.”

I asked if such an event would turn out differently now.“It would be the same,” he said. “It’s a problem with the system.”

He explained that, with an authoritarian government, local officials are afraid of alarming superiors, which makes them inclined to cover things up. But, once higher-level leaders finally grasp the truth, they can act quickly and effectively.