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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Trump has repeatedly returned to strategies of bans and movement restriction

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

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

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

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

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

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

Many proposals tackle the problem of the tanking economy.

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

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

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

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

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

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

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

We know now that touching things, being with other people and breathing the air in an enclosed space can be risky. How quickly that awareness recedes will be different for different people, but it can never vanish completely for anyone who lived through this year

The comfort of being in the presence of others might be replaced by a greater comfort with absence, especially with those we don’t know intimately

he paradox of online communication will be ratcheted up: It creates more distance, yes, but also more connection, as we communicate more often with people who are physically farther and farther away—and who feel safer to us because of that distance.

When all is said and done, perhaps we will recognize their sacrifice as true patriotism, saluting our doctors and nurses, genuflecting and saying, “Thank you for your service,” as we now do for military veterans. We will give them guaranteed health benefits and corporate discounts, and build statues and have holidays for this new class of people who sacrifice their health and their lives for ours. Perhaps, too, we will finally start to understand patriotism more as cultivating the health and life of your community, rather than blowing up someone else’s community. Maybe the de-militarization of American patriotism and love of community will be one of the benefits to come out of this whole awful mess.

Plagues drive change. Partly because our government failed us, gay Americans mobilized to build organizations, networks and know-how that changed our place in society and have enduring legacies today. The epidemic also revealed deadly flaws in the health care system, and it awakened us to the need for the protection of marriage—revelations which led to landmark reforms. I wouldn’t be surprised to see some analogous changes in the wake of coronavirus

The second reason is the “political shock wave” scenario. Studies have shown that strong, enduring relational patterns often become more susceptible to change after some type of major shock destabilizes them

But given our current levels of tension, this scenario suggests that now is the time to begin to promote more constructive patterns in our cultural and political discourse. The time for change is clearly ripening.

The COVID-19 crisis could change this in two ways. First, it has already forced people back to accepting that expertise matters. It was easy to sneer at experts until a pandemic arrived, and then people wanted to hear from medical professionals like Anthony Fauci. Second, it may—one might hope—return Americans to a new seriousness, or at least move them back toward the idea that government is a matter for serious people.

The coronavirus pandemic marks the end of our romance with market society and hyper-individualism. We could turn toward authoritarianism.

Religion in the time of quarantine will challenge conceptions of what it means to minister and to fellowship. But it will also expand the opportunities for those who have no local congregation to sample sermons from afar. Contemplative practices may gain popularity. And maybe—just maybe—the culture war that has branded those who preach about the common good with the epithet “Social Justice Warriors” may ease amid the very present reminder of our interconnected humanity.

The first is the “common enemy” scenario, in which people begin to look past their differences when faced with a shared external threat.

COVID-19 will sweep away many of the artificial barriers to moving more of our lives online. Not everything can become virtual, of course. But in many areas of our lives, uptake on genuinely useful online tools has been slowed by powerful legacy players, often working in collaboration with overcautious bureaucrats

The pandemic will shift the paradigm of where our healthcare delivery takes place. For years, telemedicine has lingered on the sidelines as a cost-controlling, high convenience system. Out of necessity, remote office visits could skyrocket in popularity as traditional-care settings are overwhelmed by the pandemic. There would also be containment-related benefits to this shift; staying home for a video call keeps you out of the transit system, out of the waiting room and, most importantly, away from patients who need critical care.

This crisis should unleash widespread political support for Universal Family Care—a single public federal fund that we all contribute to, that we all benefit from, that helps us take care of our families while we work, from child care and elder care to support for people with disabilities and paid family leave. Coronavirus has put a particular national spotlight on unmet needs of the growing older population in our country, and the tens of millions of overstretched family and professional caregivers they rely on. Care is and always has been a shared responsibility. Yet, our policy has never fully supported it. This moment, challenging as it is, should jolt us into changing that.

The humanitarian crisis could culminate in an unparalleled health crisis when COVID-19 reaches Syria's northwest

The Early Warning and Alert Response Network (EWARN), the only disease surveillance group operating in this part of Syria, says that between 40 and 70% of the population could get infected, based on global transmission rates.

In all of opposition-held Syria, only one doctor and one device can carry out tests for the virus.

"The delay in supplying test kits to northwest Syria does not imply any favoring of one side of the conflict over the other, as some may choose to interpret it," Brennan says."We are busting our guts to make sure everything is ready,"

Even in government-controlled parts of Syria, capacity for testing remains low. The country has reported only five confirmed cases, but experts expect a bigger spread.

All of Syria is considered by the WHO to be a very high risk country in the event of the pandemic's outbreak.  It has the largest population of internally displaced people in the world and its war has dealt a major blow to its health sector.

With over 8 million people, New York City is also the largest city in the country. So New York's high number of coronavirus cases is also just a reflection of its size. The state will likely lead the country in coronavirus cases even if its infection rate per person is not the highest, Sepkowitz said.

Another reason why New York has so many confirmed coronavirus cases is because it is looking for them.The US has lagged behind other countries in testing suspected cases, and people across the country have told CNN that they have been unable to get tested.New York, though, has made a dedicated push to ramp up testing at hospitals, labs and drive-through centers specifically set up in the most dense areas. With FDA approval, New York state authorized 28 public and private labs to begin testing for coronavirus on March 13, the first state to do so.

Cuomo said over 100,000 people have been tested for coronavirus in New York. He said Thursday that about 25% of all testing nationwide has been performed by New York.

Cuomo has earned rave reviews for his daily press conferences during the crisis. But both he and de Blasio were slow to aggressively shut schools, events and social gatherings in the early days of the outbreak.

New York City is a world-renowned tourist destination and the most visited destination in the US. As such, Cuomo said that contagious people from countries that had earlier coronavirus outbreaks traveled to the city and spread the virus.

Given all those reasons, New York City was always bound to be a hub of rapidly spreading cases. But it is far from the last.

In a letter to state governors on Thursday, Mr Trump said his team plans to release federal social distancing guidelines that may advise some regions to loosen restrictions.

He said the "new guidelines" would create low, medium and high risk zones that would allow the government to advise on "maintaining, increasing, or relaxing social distancing and other mitigation measures they have put in place".

On 16 March, he set a 15-day period to slow down the spread of Covid-19 by urging all Americans to drastically scale back their public interactions. But those guidelines were voluntary and did not amount to a national order.

The army has been deployed to deep clean hospitals and other facilities as well as some 900 nursing homes, where at least 1,517 deaths have reportedly been recorded.

Meanwhile, the health ministry said some 9,000 rapid diagnostic tests imported from China through a Spanish company had proved defective. It said the kits had European approval and their use had been suspended.

In Italy, the head of the National Health Institute, Silvio Brusafero, said the numbers suggested the rate of new cases was "slowing down", showing that the strict measures implemented across the country were "having their effects".

Sars-CoV-2 shares between 80% and 90% of its genetic material with the virus that caused Sars – hence its name. Both consist of a strip of ribonucleic acid (RNA) inside a spherical protein capsule that is covered in spikes. The spikes lock on to receptors on the surface of cells lining the human lung – the same type of receptor in both cases – allowing the virus to break into the cell. Once inside, it hijacks the cell’s reproductive machinery to produce more copies of itself, before breaking out of the cell again and killing it in the process.

Coronaviruses have caused two other recent epidemics – severe acute respiratory syndrome (Sars) in China in 2002-04, and Middle East respiratory syndrome (Mers), which started in Saudi Arabia in 2012. In both cases, work began on vaccines that were later shelved when the outbreaks were contained.

Though nobody could have predicted that the next infectious disease to threaten the globe would be caused by a coronavirus – flu is generally considered to pose the greatest pandemic risk – vaccinologists had hedged their bets by working on “prototype” pathogens.

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

Some of the Covid-19 vaccine projects are using these tried-and-tested approaches, but others are using newer technology.

Cepi’s original portfolio of four funded Covid-19 vaccine projects was heavily skewed towards these more innovative technologies, and last week it announced $4.4m (£3.4m) of partnership funding with Novavax and with a University of Oxford vectored vaccine project.

Clinical trials, an essential precursor to regulatory approval, usually take place in three phases. The first, involving a few dozen healthy volunteers, tests the vaccine for safety, monitoring for adverse effects. The second, involving several hundred people, usually in a part of the world affected by the disease, looks at how effective the vaccine is, and the third does the same in several thousand people. But there’s a high level of attrition as experimental vaccines pass through these phases.

There are good reasons for that. Either the candidates are unsafe, or they’re ineffective, or both. Screening out duds is essential, which is why clinical trials can’t be skipped or hurried. Approval can be accelerated if regulators have approved similar products before.

No vaccine made from genetic material – RNA or DNA – has been approved to date, for example. So the Covid-19 vaccine candidates have to be treated as brand new vaccines, and as Gellin says: “While there is a push to do things as fast as possible, it’s really important not to take shortcuts.”

It’s for these reasons that taking a vaccine candidate all the way to regulatory approval typically takes a decade or more, and why President Trump sowed confusion when, at a meeting at the White House on 2 March, he pressed for a vaccine to be ready by the US elections in November – an impossible deadline.

In the meantime, there is another potential problem. As soon as a vaccine is approved, it’s going to be needed in vast quantities – and many of the organisations in the Covid-19 vaccine race simply don’t have the necessary production capacity. Vaccine development is already a risky affair, in business terms, because so few candidates get anywhere near the clinic. Production facilities tend to be tailored to specific vaccines, and scaling these up when you don’t yet know if your product will succeed is not commercially feasible. Cepi and similar organisations exist to shoulder some of the risk, keeping companies incentivised to develop much-needed vaccines. Cepi plans to invest in developing a Covid-19 vaccine and boosting manufacturing capacity in parallel, and earlier this month it put out a call for $2bn to allow it to do so.

The problem is making sure the vaccine gets to all those who need it. This is a challenge even within countries, and some have worked out guidelines. In the scenario of a flu pandemic, for example, the UK would prioritise vaccinating healthcare and social care workers, along with those considered at highest medical risk – including children and pregnant women – with the overall goal of keeping sickness and death rates as low as possible. But in a pandemic, countries also have to compete with each other for medicines.

Because pandemics tend to hit hardest those countries that have the most fragile and underfunded healthcare systems, there is an inherent imbalance between need and purchasing power when it comes to vaccines.

Outside of pandemics, the WHO brings governments, charitable foundations and vaccine-makers together to agree an equitable global distribution strategy, and organisations like Gavi, the vaccine alliance, have come up with innovative funding mechanisms to raise money on the markets for ensuring supply to poorer countries. But each pandemic is different, and no country is bound by any arrangement the WHO proposes – leaving many unknowns.

There are more than 52,000 cases in New York.

The state has about half of the total confirmed Covid-19 cases in the entire US.

Mr Cuomo also said he would sue nearby Rhode Island if the authorities there continued targeting New Yorkers and threatening to punish them for failing to quarantine. Skip Twitter post by @RyanWelchPhotog

The CDC then published a statement urging residents of those three states to "refrain" from all non-essential domestic travel for 14 days.

"If you said we were geographically restricted from leaving, that would be a lockdown."

He added later: "I don't know how that can be legally enforceable. And from a medical point of view, I don't know what you would be accomplishing.

New York Governor Andrew Cuomo responded by saying that quarantining the state of New York would be "preposterous" and "anti-American".

On Friday, Rhode Island Governor Gina Raimondo deployed National Guard troops to stop cars with a New York licence plate, to remind them of their state's advice that they quarantine

Soldiers are going door-to-door in coastal vacation communities to ask if any residents have recently visited New York City.

U.S. airlines are set to receive $25 billion in grants to cover payrolls over the next six months

“If the recovery is as slow as we fear, it means our airline and our workforce will have to be smaller than it is today,” United said in a memo to employees.

Airlines say the situation is dramatically different from just four weeks ago and getting worse each day with no end in sight. All are planning continued capacity reductions into the summer.

The industry directly supports 750,000 jobs and has argued that it must have the financial ability to jump-start operations once demand starts to return.

The leaders of American Airlines Group Inc, which has the largest workforce of any U.S. carrier, said late Thursday that they had not decided to apply for federal funds, noting that the terms were still unclear.

Still, Mnuchin insisted on Friday that taxpayers would be compensated. “I’ve been very clear this is not an airline bailout,” he told Fox Business Network.

It doesn’t require, for instance, quickly lifting quarantines based on outlying projections of low fatality rates, as some return-to-normalcy conservatives have been urging in the last week

Rational hope accepts that the situation is genuinely dark, but then it still looks around for signposts leading up and out. It recognizes that things are likely to get worse, but keeps itself alert to the contexts in which they seem to be getting better

three patterns where I’m finding optimism right now.

First, there is modest hope in data compiled by the smart-thermometer company Kinsa, which claims to be able to identify anomalous, unseasonal fever rates using data from its nationwide user base.

Kinsa’s data show a clear February-and-March anomaly across the U.S., especially in areas known to be affected by the coronavirus. But it also shows that anomaly diminishing as lockdowns and social distancing began

the sharp turn suggests that general infection curves can be changed quickly even during a pandemic, and that the policies of the last two weeks might be having a real epidemiological effect.

Second, there is hope in the differing course of the pandemic so far in Greater New York versus the Pacific Coast.

Washington State bent its curve after the initial surge and California’s case rate and death rate trends are a gentle incline — nothing like the New York area’s terrifying spike.

In the most optimistic case, the spike reflects New York’s unique density and heavy reliance on mass transit

maybe some of the divide reflects policy — the fact that West Coast leaders acted ever-so-slightly more swiftly and with more seriousness of purpose than the feckless Bill de Blasio in New York City.

it suggests that even if you initially fail to spot an outbreak, you can still hope to imitate South Korea rather than northern Italy.

the circumstantial evidence of Western versus Asian epidemic curves and the direct evidence of multiple studies suggest that masking works, and that its widespread adoption can change an epidemic’s course.

These three hopeful signs together hint at a path back toward quasi-normalcy. The current shutdown bends infection curves relatively quickly, outside a few major urban outbreaks. That policy response combines with America’s social-distancing sprawl and car culture and younger-than-Europe age profile to compensate for our initial incompetence and natural insubordination. And then the cheapest, lightest-weight means of slowing transmission becomes ubiquitous in U.S. cities by Memorial or Independence Day.

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

First, we need a consistent nationwide approach to shutting down.

Because people can travel freely across state lines, so can the virus. The country’s leaders need to be clear: Shutdown anywhere means shutdown everywhere.

Until the case numbers start to go down across America — which could take 10 weeks or more — no one can continue business as usual or relax the shutdown

Second, the federal government needs to step up on testing. Far more tests should be made available

We should also aggregate the results so we can quickly identify potential volunteers for clinical trials and know with confidence when it’s time to return to normal

the country needs clear priorities for who is tested. First on the list should be people in essential roles

The same goes for masks and ventilators. Forcing 50 governors to compete for lifesaving equipment — and hospitals to pay exorbitant prices for it — only makes matters worse.

Finally, we need a data-based approach to developing treatments and a vaccine

leaders can help by not stoking rumors or panic buying.

We should stick with the process that works: Run rapid trials involving various candidates and inform the public when the results are in

To bring the disease to an end, we’ll need a safe and effective vaccine

To protect Americans and people around the world, we’ll need to manufacture billions of doses.

We can start now by building the facilities where these vaccines will be made

Private companies can’t take that kind of risk, but the federal government can.

In 2015, I urged world leaders in a TED talk to prepare for a pandemic the same way they prepare for war — by running simulations to find the cracks in the system.

Since we’re nowhere close to that point — in particular, testing is still far behind what’s needed — we’re months away from a safe end of the lockdown. This is causing severe hardship for workers, businesses, hospitals and — last but not least — state and local governments, which unlike the federal government must balance their budgets.

Yet at the moment further relief legislation is stalled. And let’s be clear: Republicans are responsible for the impasse.

But the special loan program for small businesses has already been exhausted. State and city governments are reporting drastic losses in revenue and soaring expenses. And the Postal Service is on the edge of bankruptcy.

So we need another large relief package, targeted at these gaps. Where would the money come from? Just borrow it. Right now, the economy is awash in excess savings with nowhere to go. The interest rate on inflation-protected federal bonds is minus 0.56 percent; in effect, investors are willing to pay our government to make use of their money

What policy can and should do is mitigate that hardship. And the last relief package did, in fact, do a lot of the right things. But it didn’t do enough of them.

It’s true that Senate Republicans are trying to push through an extra $250 billion in small-business lending — and Democrats are willing to go along. But the Democrats also insist that the package include substantial aid for hospitals and for state and local governments. And Mitch McConnell, the Senate majority leader, is refusing to include this aid.

Everyone, and I mean everyone, knows what is really happening: McConnell is trying to get more money for businesses while continuing to shortchange state and local governments. After all, “starve the beast” — forcing governments to cut services by depriving them of resources — has been Republican strategy for decades

At a basic level, then, anti-government ideologues are preventing us from responding adequately to the worst economic disaster since the Great Depression.

Their obstructionism will cause vast suffering, as crucial public services are curtailed. It will also compound the economic damage.

In the near future, we’ll see millions of unnecessary job losses as impoverished families cut back spending, as local governments lay off teachers and firefighters, as the post office, if it survives at all, becomes a shadow of its former self.

And many of these job losses will probably persist even after the pandemic subsides.

If there’s a silver lining to all this, it is that the people sabotaging our response to Covid-19 economics may also be sabotaging their own political future. Trump is, after all, counting on rapid economic recovery to erase public memories of his disastrous handling of the pandemic itself. Yet he and his allies in the Senate are making such a recovery much less likely.

Based on this seroprevalence data, the authors estimate that in Santa Clara County the true infection fatality rate is somewhere in the range of 0.12% to 0.2%—far closer to seasonal influenza than to the original, case-based estimates.

In New York City, a study published in the New England Journal of Medicine examined 215 women entering two hospitals to give birth between March 22 and April 4. These patients had a Covid-19 infection rate over 15%. Of expectant mothers who tested positive for active infections, 88% were asymptomatic at the time of admission. That infection rate is about 10 times the rate of known cases in the city

Similar proportions of infections to cases are now being discovered around the world: 30 times in Robbio, Italy; 10 times in Iceland; 14 times in Gangelt, Germany; 27 times in Denmark. Germany and Denmark are now leading Europe in reopening their economies in the coming week

a path forward demands continued monitoring of seroprevalence as well as new case testing, identifying and protecting those most vulnerable to more serious or even fatal infections, and supporting hospital capacity to handle surges of respiratory intensive-care patients.

The science to support better modeling and decision making is rapidly becoming available. One hopes that it will inform better policy decisions.

very conservative voters are more likely to allude to a sense of outrage over having their public conduct restricted, rather than caution about the economic implications of the shutdown.

Republican lawmakers in Michigan, who had backed an earlier, less restrictive executive order, blasted the governor. They moved to strip Ms. Whitmer’s power to declare a state of emergency under a 1945 law.

“Here’s my message today: OUR Governor IS DESTROYING OUR HEALTH BY KILLING OUR LIVELIHOODS!” the State Senate majority leader, Mike Shirkey, tweeted this month.

ew other states outside the northeast have been as hard hit by the virus as Michigan, which recorded 2,226 deaths as of Friday, and where the intersection of race, presidential politics and Ms. Whitmer’s vice-presidential prospects have turned the perennial battleground into a political tinderbox.

the images of nearly all-white protesters demanding the governor relax restrictions while hoisting Trump signs and Confederate battle flags, as the virus disproportionately impacts Michigan’s black residents, will only further cleave the state.

Less noticed is another flash point. A number of white Michiganders — many of them affluent but some firmly in the middle-class — have summer homes “up north,” as the sprawling upper tier of the state’s lower peninsula is called. Ms. Whitmer’s order that people not travel between their residences — meant to protect rural towns and rural hospitals from being overwhelmed with the virus — has particularly inflamed those state residents eager to get to their cottages.

there is no evidence that Wall Street’s mega-expansion made the rest of the economy more efficient. On the contrary, growth in family incomes slowed down as finance rose — although a few people became immensely rich

the famous Bloomberg Terminal, a proprietary computer system that gives subscribers real-time access to large quantities of financial data. This access is incredibly expensive — a subscription costs around $24,000 a year. But it’s a must-have in the financial industry, because traders with Bloomberg Terminals can react to market events a few minutes faster than those without.It’s an extremely profitable business. But is it good for the economy? No

Bloomberg has, in effect, made his billions off a financial arms race that costs vast sums but leaves everyone pretty much back where they started.

Warren had made a name for herself as a crusader against financial industry fraud and excess.It wasn’t just talk. One key piece of the reforms instituted after the 2008 financial crisis, the creation of the Consumer Financial Protection Bureau, was Warren’s brainchild. Furthermore, by all accounts the bureau was wildly successful, saving ordinary families billions, until the Trump administration set about eviscerating it.

I have no idea how or if Wednesday’s debate will affect the Democratic race. But it may have helped remind Democrats that corruption, fraud and the excesses of Wall Street in particular can be potent political issues — especially against a president who is both personally corrupt and so obviously a friend to fraudsters.

The coronavirus—and the measures enacted to stop it—could quickly change the rhythms of Americans’ daily lives.

few Americans’ personal experience gives them any reason to understand how disruptive these changes could be if the epidemic continues to worsen.

A municipal police chief in the Boston area recently urged me to imagine that a school district closed for even three weeks. Take just one child, raised by a single parent who is a police officer. The child is home, so the parent must stay home. Other officers in the same patrol will be affected even if they don’t have kids in school. Shifts will change, nonessential functions will be put off, and the department will have less flexibility to respond to problems unrelated to the epidemic—even as, with more teens unsupervised, rates of car accidents and certain crimes could well increase.

Pence promised 1.5 million coronavirus tests, but The Atlantic reported Friday that, according to all available evidence, fewer than 2,000 had been conducted in the United States. Trump himself is simply lying about basic facts about the COVID-19 response; despite the testing kit shortfall, he has publicly stated that everyone who wants to get tested can get tested.

China’s aggressive containment of the new virus in the early weeks of this year gave other nations time to ready themselves

The United States wasted that opportunity. Trump’s initial impulse to downplay the risk, at least until the stock market took note, wasn’t just fanciful; it was dangerous.

Americans should also understand that even the best preparation humanly possibly wouldn’t be perfect—and that what the United States has done so far falls far short of that. Especially at this point, even a more vigorous response will not preclude a lot of people from getting sick. Preventing all infections is no longer a possibility, and the measure of success is how much public-health authorities can reduce the number of people who die or fall seriously ill.

the mortality rate here is (at time of writing) 7.17% compared with 0.05% in Sweden and 0.2% in Germany

Nor do we understand why the contagion has spread so fast in Italy: the cases per million of the population is, at 250, far higher than anywhere else in the world: Iran stands at 120, China at 56.

Even as this slow-motion, medical tsunami was moving towards the UK, the prime minister, Boris Johnson, was sneering at the need for “draconian” measures. We watched in disbelief as thousands of people travelled to watch horse racing in Cheltenham and 3,500 gathered in Paris dressed as smurfs just to break a world record.

From our lockdown in Italy, it seemed at that time as if the world’s addiction to sport, partying and frivolity was blinding it to the most serious pandemic in our lifetimes.

Because actually Italians are very well-informed (some might even say obsessive) about personal health. They learn about plague and contagion at school because two of the classics of Italy’s literary canon – Alessandro Manzoni’s The Betrothed and Giovanni Boccaccio’s The Decameron, deal with precisely those themes. Italians, on the whole, know far more about hygiene and medicine than their European counterparts