Coronavirus will radically alter the U.S.

three waves — a mild one that spring, the deadliest wave in fall and a final one that winter. With each wave came a cycle of denial, devastation, community response finally kicking into overdrive — followed by finger-pointing and blame among leaders and the public. “Every outbreak is different,” said medical anthropologist Monica Schoch-Spana, who spent months digging through archives to study how 1918 flu played out in Baltimore. Like the coronavirus is likely to do, the 1918 flu overwhelmed hospitals. Unable to get help, desperate families waited outside to beg and try to bribe doctors for treatment. In a three-week period, 2,000 died in Baltimore alone. Mortuaries ran out of caskets. When the bodies finally reached cemeteries, the gravediggers were so ill, there was no one to bury the dead. Economic pressure on business owners and workers caused the public to resist adopting restrictions. The crisis brought out the best in Baltimoreans — with sewing circles churning out gauze masks and hospital bedding, and neighbors donating food and services. But it also brought out the worst — xenophobic conspiracy theories that nurses of “German extraction” were deliberately infecting people. African American patients were kept out of most hospitals under Jim Crow-era segregation. “Pandemics aren’t just physical,” said Schoch-Spana. “They bring with them an almost shadow pandemic of psychological and societal injuries as well.” Stanford virologist Karla Kirkegaard said she has tried to stave off dread from the projected U.S. death tolls with a case study she teaches in her classes: Amid a cholera outbreak in mid-19th century London, as panicked residents fled one hard-hit neighborhood, a doctor named John Snow calmly entered the breach. He deduced that the source of hundreds of deaths was a single contaminated water pump and persuaded authorities to remove the pump’s handle — a strategy that ended the outbreak. Controlling the covid-19 pandemic will take much more than a single water pump, Kirkegaard acknowledged as she sheltered in place at her Bay Area home. But the story, she said, reminds her how powerful the simple act of one individual can be. Ariana Eunjung Cha, Lenny Bernstein and Sarah Kaplan contributed to this report. READ MORE: How long will social distancing for coronavirus have to last? Depends on these factors. This is the coronavirus math that has experts so worried: Running out of ventilators, hospital beds Coronavirus forecasts are grim: ‘It’s going to get worse’


D.C. cases surge, Maryland adds new restrictions as coronavirus reaches grim milestones

Maryland is escalating social-distancing measures after the state’s first covid-19-related death and the first report of a child testing positive. Scores of D.C. emergency personnel are under quarantine, with three firefighters confirmed to be infected. Virginia is easing access to health care during the pandemic and giving residents until June to pay taxes. Two weeks after the first novel coronavirus cases were reported in the Washington region, government leaders, residents and businesses are confronting a hard reality: There’s no immediate end in sight. Maryland Gov. Larry Hogan (R) on Thursday ordered the closure of enclosed shopping malls and entertainment venues, restricted access to Baltimore-Washington International Marshall Airport and prohibited gatherings of more than 10 people. He chastised residents who are not taking the situation seriously. “Unfortunately, we are only at the beginning of this crisis,” Hogan said, citing the state’s first fatality, a Prince George’s County man. “While this is the first death in Maryland, unfortunately it will not be the last.” Disruptions to daily life are likely to stretch at least into April, experts say, with the continued spread of the virus inevitable. Known cases have been doubling roughly every three days, reaching at least 274 in Maryland, the District and Virginia as of Thursday evening. That’s almost certainly an undercount because of limited and delayed testing. In recent days, patients have included first responders, medical staff and residents of senior living facilities. The region has hit grim milestones: the first death in the D.C. suburbs, and reports of infected children. The District saw its highest single-day increase in cases Thursday, nearly doubling its total in one day. Loudoun County Public Schools said a staff member at an elementary school in Northern Virginia had tested positive for the virus. It will take weeks to learn whether the closures of schools, restaurants and entertainment venues have kept the highly contagious virus at bay. The incubation period, which can run as long as two weeks, means confirmed patients have probably infected others who have not yet developed symptoms. “Whatever numbers we are seeing today reflect the transmission that was occurring one to two weeks ago,” said Lucy Wilson, an infectious disease specialist and faculty member at the University of Maryland Baltimore County. “We shouldn’t be surprised by numbers continuing to increase, and we also shouldn’t discredit the effect of social distancing until we’ve given it time to take effect.” D.C. Mayor


State Department warns Americans not to travel abroad amid coronavirus pandemic

The State Department on Thursday warned Americans not to travel internationally and advised those still abroad to either return immediately or prepare to remain in place indefinitely as much of the United States and Europe continued to shut down to stem the worsening global spread of the novel coronavirus. The agency raised its travel advisory for all international travel from 3 to 4, the most serious category, reflecting the difficulty thousands of Americans are having returning to the United States as borders close and airlines cancel flights. “U.S. citizens who live in the United States should arrange for immediate return to the United States, unless they are prepared to remain abroad for an indefinite period,” the State Department advisory said. “Many countries are experiencing COVID-19 outbreaks and implementing travel restrictions and mandatory quarantines, closing borders, and prohibiting non-citizens from entry with little advance notice,” the statement added. Particularly large numbers of American travelers have been stranded in Morocco, Peru, Honduras and Tunisia, where some have complained that U.S. embassies have not provided adequate help in getting them home. The pandemic has forced governments around the world to try to arrange alternative routes for citizens to return home for vacations or work trips. The U.S. advisory warns that Americans should “have a travel plan that does not rely on the U.S. government for assistance.” On Thursday, President Trump told reporters at the White House that the United States was considering calling on the military to help stranded travelers, including hundreds of Americans in Peru, though he did not offer specifics. “We have a group of young people in Peru, and we’re working on taking care of that with the military,” Trump said. “We’re trying to get them out. They got caught. . . . It’s a large group, it’s about 300.” A group of nine Democratic senators sent a letter to Secretary of State Mike Pompeo on Wednesday raising concerns that their constituents stranded in foreign countries were receiving conflicting signals from U.S. embassies about whether Washington would help them return home or if they were on their own. “Americans overseas should have full confidence that the State Department will support them when abroad and facilitate their efforts to return to the United States if they are seeking to evacuate from areas affected by COVID-19,” wrote the senators, who included, Robert Menendez (N.J.), Ben Cardin (Md.), Christopher A. Coons (Del.), Tom


Coronavirus is especially threatening for people with heart disease

As the novel coronavirus spreads around the world, it primarily sickens people by affecting their lungs. But it is now becoming clear that the finishing blow for people who don’t survive might be to the heart. For the more than 120 million American adults living with heart disease, including many of my patients, these are understandably distressing times. The experience of intensive care doctors managing covid-19 points to a dangerous turn many patients take. While the syndrome initially develops slowly, in some vulnerable people it can accelerate quickly, causing respiratory arrest and requiring artificial breathing with mechanical ventilators. Yet the patients who end up dying, says James Town, an intensive care doctor who has been in the thick of it in Seattle, actually die of cardiac rather than respiratory failure. “A few of the patients we’ve had have also developed pretty profound cardiogenic shock, and those are the ones who have passed away so far,” he told NPR’s Lulu Garcia-Navarro. This cardiogenic shock was “more dramatic than just the respiratory failure that we kind of expected to see.” The Centers for Disease Control and Prevention lists older adults and people with heart disease, lung disease and diabetes as the main high risk groups in this pandemic. Data published in the journal Lancet from patients admitted to hospitals in Wuhan with covid-19 shows that while not all patients have damage to the heart, it can be an ominous sign in those who do: evidence of cardiac injury was noted in 59 percent of those who died vs. only 1 percent of survivors. Severe covid-19 infection can cause massive inflammation throughout the body, and if it affects the heart, the consequences can be dire. Fast, abnormal heart rhythms were responsible for 44 percent of Wuhan patients being transferred to the intensive care unit. Laboratory tests of human proteins called troponins, which can indicate damage to heart muscle, can indicate which patients will probably do poorly. While menacing heart complications usually occur late in the course of most patients with covid-19, some rare patients are presenting initially with extensive inflammation of the heart. The CDC recommends that people at high risk, such as those with heart disease, take all the same precautions that apply to everyone right now — stay at home, avoid crowds, clean your hands and your surroundings often — but they should do some additional things: ●Make sure they and


their caregivers have a phone number to access their medical team. For those who don’t have an established relationship with a heart care team, they should call their primary care physician or hospital or public health department hotline. ●Stock up on any medications, and if they’re running short, call the clinic or get your doctor to have refills called or routed in to a pharmacy. ●Make sure that basic medical equipment, such as a thermometer, a blood pressure machine and a weighing scale, is accessible. ●Monitor your body closely for signs and symptoms common in covid-19, including temperatures above 100 degrees, difficult breathing, coughing. A runny nose is much less common and more likely a sign of a cold or allergies. ●Let caregivers and a medical team know about these symptoms — they do not necessarily require going to the emergency room. Danger signs include worsening shortness of breath, chest pain, confusion or drowsiness and bluish lips. If any of these symptoms develop, call 911 or go to the nearest emergency room. Concern has been raised about some common medications used by patients for hypertension or heart disease called angiotensin-converting-enzyme inhibitors, or ACE inhibitors (with names ending in -pril, such as lisinopril), and angiotensin II receptor blockers (ARBs, with names ending in -sartan, such as valsartan). The reason for this concern is that the novel coronavirus attaches to ACE2 proteins on the surface of cells in the airway and lungs, allowing it to then hijack the cell and subsequently use its machinery to make millions of virus copies. In animal studies, ACE inhibitors and ARBs have been shown to increase the expression of ACE2 proteins. That finding has led some to speculate that the medications make patients with heart disease more vulnerable to covid-19 complications. But animal studies often do not translate into humans. And there is also some evidence that the medications might be protective of the lungs, with people taking these drugs having reduced lung injury when infected with other viruses. Given that there is no evidence of harm in covid-19 patients and mountains of evidence about the lifesaving benefit in patients with hypertension and heart disease, the major cardiovascular organizations in the United States and Europe have said these medications should be continued. On the other hand, use of over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, probably should be minimized. The French government recently issued a


as lisinopril), and angiotensin II receptor blockers (ARBs, with names ending in -sartan, such as valsartan). The reason for this concern is that the novel coronavirus attaches to ACE2 proteins on the surface of cells in the airway and lungs, allowing it to then hijack the cell and subsequently use its machinery to make millions of virus copies. In animal studies, ACE inhibitors and ARBs have been shown to increase the expression of ACE2 proteins. That finding has led some to speculate that the medications make patients with heart disease more vulnerable to covid-19 complications. But animal studies often do not translate into humans. And there is also some evidence that the medications might be protective of the lungs, with people taking these drugs having reduced lung injury when infected with other viruses. Given that there is no evidence of harm in covid-19 patients and mountains of evidence about the lifesaving benefit in patients with hypertension and heart disease, the major cardiovascular organizations in the United States and Europe have said these medications should be continued. On the other hand, use of over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, probably should be minimized. The French government recently issued a warning about their use being associated with worse outcomes in all people. Heart patients who take blood thinners are generally advised to avoid such NSAIDs, since they can increase bleeding risk and may cause kidney damage. I have suggested to my patients that they either switch to acetaminophen (such as Tylenol), which is gentler on the kidneys or use the minimum dose of NSAID until we have better information. Many hospitals are moving to cancel nonurgent procedures, tests and clinic visits. Most nonurgent clinic visits are being deferred or instead are being performed over the phone or using video conferencing. This move will both reduce patients’ and their medical team’s risk of acquiring the virus and will help conserve resources in the event of the health system being overrun with covid-19. Virtual visits are most effective when patients have a family member around to coordinate plans, have their pills on hand to confirm what they are taking, and have access to basic information such as their weight and blood pressure, if they have the equipment. For patients with heart disease, virtual connectedness to their health-care staff can be a lifesaver. A similar connection to family and friends can help provide


How coronavirus will affect the US military.

training could be eliminated with little consequence for readiness, other reductions would quickly compound. As one analyst notes, “Artillery school students need to shoot on the ranges. Paratroopers need to jump out of airplanes. If that kind of training stops, units will quickly lose their edge.” Trained personnel cannot fight and equipment breaks down without supplies like food, fuel, ammunition and spare parts. Covid-19 has already disrupted some global supply chains as factories have closed and transshipment has been affected. These problems may worsen if U.S. manufacturers and transporters slow operations. The scale of disruption and size of military stockpiles will determine when these effects are felt, but the deeper the Department of Defense digs into its stockpiles, the longer it will take to rebuild them later. Modern armed forces rely heavily on complex equipment like ships, tanks and aircraft that require significant maintenance to function properly. The “depots” for this deep maintenance are already in poor condition — at some facilities, inexperienced workforces have trouble completing maintenance without widespread delays. Covid-19 could worsen these delays and make depots fall further behind. There is currently little slack when it comes to the readiness of the U.S. maintenance base system. What does this mean for U.S. national security? Fundamentally, military readiness is a means to an end: U.S. security. High readiness can signal capability and resolve and may help assure allies that the United States won’t abandon them. And a fully operational and ready military may deter potential adversaries from taking aggressive action. However, the key ingredients for effective deterrence and assurance remain highly debated in academic international relations, and academics often overlook the specific role of military readiness in deterrence and assurance. Nonetheless, a decline in readiness caused by a pandemic may have less impact on the perceptions and behaviors of allies and adversaries than a similar decline caused by other factors. Here’s why: First, a pandemic-induced readiness decrease is less likely to be interpreted as a weakening in U.S. resolve than a decline in readiness caused by other factors under U.S. control — like budget cuts or deliberate reallocation of resources from one theater to another. Second, adversaries will likely understand that the pandemic would not stop the United States from responding to aggression. Armies have long braved the risks of disease for the sake of battle, and adversaries would likely conclude that concerns about the virus would take


An ancient celebration is about to make Iran’s coronavirus nightmare even worse

Iranians are preparing to celebrate the biggest holiday of the year — even as they confront an expanding coronavirus pandemic. The combination is likely to result in calamity. Nowruz, when Iranians mark the transition from winter to spring, is the equivalent of New Year’s and Christmas rolled into one. Most institutions in the country shut down for two weeks. Those who can afford it usually chose this time to travel. With foreign air routes mostly shut to Iran because of the virus, that travel was already destined to be almost entirely domestic. Many use the opportunity to make religious pilgrimages, which can result in huge crowds congregating at particular sites. Bizarrely enough, while some Iranian authorities are advising people to stay home, little is being done to enforce any limitations — even though a study from Tehran’s Sharif University of Technology, one of the Middle East’s leading centers for scientific research, suggests that more than 3 million people could die in the country if more robust preventative measures aren’t implemented immediately. “We are in a bad situation now. It’s all about Nowruz and the number of pilgrims who will come to Mashhad,” a resident of Iran’s second-largest city told me. Mashhad is home to the country’s most important religious site, making it Iran’s most frequented tourism destination. My source is worried about the influx of potentially infected tourists to his city. Another Nowruz tradition is visiting the homes of your loved ones, starting with the oldest first. You’re supposed to visit as many members of the family as possible. This year, that will have to change. The coronavirus has already cut a wide swath in Iran, in part because of the authorities’ initial and shocking unwillingness to acknowledge the scale of the emergency. The official death toll from covid-19 reached 1,284 on Thursday, although many believe the number is higher. And it’s set to get much worse. Huge crowds of shoppers continue to descend on Tehran’s massive bazaar. Traffic jams are clogging the streets of the city and major national highways as people depart on vacation. These are among the worrying signs that average Iranians are refusing to take social distancing seriously, squandering any chance to contain the outbreak. On Wednesday, The Post published a Persian version of its explainer on how the virus spreads and the best ways to “flatten the curve.” I hope that many people in Iran


The virus has arts groups hanging by a thread. Michael M. Kaiser has ideas about saving them.

If you didn’t know that the country’s 100,000 nonprofit arts and cultural organizations live on the edge, consider these statistics: the average museum and performing arts group operates with less than two months of working capital on hand and the average orchestra has a cushion of just 15 days. Which is why the survival of many of these companies — particularly the wide swath of medium-size groups, with budgets of between about $2 million and $10 million — has arts leaders and patrons so worried. Experts in the field, such as Michael M. Kaiser, former president of the Kennedy Center who chairs the DeVos Institute for Arts Management at the University of Maryland, say the outlook for these groups is increasingly ominous. Covid-19 has shut down the overwhelming majority of arts organizations, which means revenue has stopped cold. With every month of the pandemic that keeps them closed, the prospects of braving the crisis intact diminish, Kaiser says. He has some recommendations for how groups of all sizes might weather this unprecedented threat to their existence, with this alarming caveat: “If this goes on for six months, then all bets are off. Then I think we’re really starting the arts ecology over.” The cellphones of Kaiser and DeVos Institute President Brett Egan have been buzzing like crazy with entreaties for advice from executives of the hundreds of groups with which the institute works. While still at the Kennedy Center, which he headed from 2001 to 2014, Kaiser created a version of the institute, now a consultancy for nonprofit arts managers and trustees. Clients have included orchestras and hip-hop festivals, Utah’s Sundance Institute and New York City’s Apollo Theatre, 9/11 memorial and photography museums, Latinx dance troupes and regional theaters. Surveying the arts landscape, Kaiser, in a phone interview, said there are huge financial challenges across the board, but that he reserves his greatest anxieties for those midsize outfits. The behemoth institutions in many cities, with the wealthiest and most devoted donors, will in all likelihood survive, he said. The smallest companies, the ones accustomed to working with meager resources, may also be well designed for the innovative flexibility required of trying times. “The hardest are those midsize organizations,” he said. These are companies with a substantial payroll to meet and facilities of their own to maintain, or, as Kaiser put it: “That midsize organization which has an overhead — their


The coronavirus is killing far more men than women

With over 200,000 coronavirus cases worldwide and thousands of deaths, a striking pattern is appearing in the hardest-hit countries: more men are dying than women. Nowhere is this trend more pronounced than in Italy. Men make up nearly 60 percent of people with confirmed cases of the virus and more than 70 percent of those who have died of covid-19, according to the country’s main public health research agency. The alarming Italy data have caught the attention of the White House. Ambassador Deborah Birx, the White House’s coronavirus response coordinator, warned Friday that “from Italy we’re seeing another concerning trend, that the mortality in males seem to be twice in every age group of females. This should alert all of us to continue our vigilance to protect Americans who are in nursing homes.” On the other end of the spectrum is South Korea, where about 61 percent of confirmed infections have been in women. Though far fewer patients have died, the majority of fatalities — 54 percent —- were again men. As the pandemic escalates, epidemiologists and public health authorities are scrambling to understand who is most vulnerable and how to protect them. The data from countries such as Italy and South Korea show that the disease can take wildly different paths. Exactly what makes a group vulnerable — and how to protect them — has experts “mystified,” said Carlos del Rio, chair of the department of global health at Emory University. “This difference in mortality is creating a lot of anxiety,” he added. ITALY: An aging country with overwhelmingly male deaths The outbreak of covid-19 in Italy is the deadliest in the world. As of March 17, more than 40,000 people there have been sickened with the virus, and 3,405 have died. That means that, based on these current and unavoidably incomplete figures, 8.2 percent of people infected in the country have died. That is more than double the global figure presented recently by the World Health Organization. Italy’s aging population is probably particularly susceptible to the disease, researchers say. With a median age of 46.5, according to the CIA World Factbook, it is the fifth-oldest country in the world. These elderly citizens are those who have become the sickest: People over age 70 represent more than 87 percent of deaths there. Older people are typically hit harder with respiratory diseases, del Rio said. They are more likely to


study published in the Lancet, meanwhile, the figures were even higher. It found that 80 percent of the deaths were in men and just 20 percent were in women. It is certainly possible that as death tolls rise in other countries, the pattern of greater male deaths seen so far in Italy, China, and South Korea could shift. But so far, this is what the evidence shows in the two countries with the largest death tolls, Italy and China, and in a third country (South Korea) acclaimed for keeping very good tabs on the disease. “The honest truth is that today we don’t know why covid-19 is more severe for men than women or why the magnitude of the difference is greater in Italy than China,” said Sabra Klein, a professor at Johns Hopkins’s Bloomberg School of Public Health. “What we do know is that in addition to older age, being male is a risk factor for severe outcome and the public should be made aware.” The gendered death gap was also seen in the smaller SARS and MERS outbreaks, added Angela Rasmussen, a virologist at Columbia University. “It’s clearly something that has happened consistently with coronaviruses, it could inform clinical practices and improve patient outcomes, and it’s definitely a question worth investigating,” she added. These statistics could be a product of behavior, biology or both, scientists say. For one thing, demographic figures suggest many men have more health risks to begin with. In China, Italy and South Korea, women tend to live longer than men, according to the WHO. Men also drink and smoke more in all of these countries, particularly in China, where 48 percent of men above 15 smoke, compared with just 2 percent of women, according to the WHO. Probably not coincidentally, men in these countries also tend to die more frequently from heart disease, cancer, diabetes and respiratory diseases between ages 30 and 70. But there are also underlying biological differences between men and women that may make covid-19 worse in men, several researchers pointed out. Years of research have found that women generally have stronger immune systems than men and are better able to fend off infections. The X chromosome contains a large number of immune-related genes, and because women have two of them, they gain an advantage in fighting disease, according to a recent study in the journal Human Genomics. Studies have also


The inside story of the CPAC scare: When the coronavirus passed within a handshake of the president, no public health agency took charge

yet prepared to recall specific details. Still coughing frequently while speaking with a Washington Post reporter by phone, he said he was less concerned about who did what or when, and mostly wanted people to think about what precautions they could take going forward. “Every American should take this virus seriously,” said the doctor, who faced anti-Semitic attacks online after his name surfaced in a limited number of media accounts. “I think people who needed to get notified did — that’s it.” Contact tracing is a long-established practice for stopping the spread of infection by identifying and monitoring people who may have been exposed to an infected individual. It allows health officials to encourage those most at risk to enter isolation and, if necessary, access treatment as early as possible. The process was crucial to containing Severe Acute Respiratory Syndrome, or SARS, after it appeared in China in 2002, and it was pivotal to halting outbreaks of Ebola in Africa in 2014 and 2018. On March 1, a day after CPAC concluded, U.S. Health and Human Services Secretary Alex Azar called contact tracing “the basic blocking and tackling” that public health officials were engaged in to prevent the spread of coronavirus. It was a moment when containment of the novel coronavirus in the United States still seemed possible. Known cases appeared geographically isolated, with most centered around a nursing home near Seattle and others near military bases in California that held evacuees from China. In New York, the first case was announced that day: a woman who had recently traveled from Iran. In the D.C. area, as in 47 states, there were still no confirmed cases, although that would soon change. Over the next five days, 17 states would announce cases. Although his case was not yet confirmed, on March 4 the doctor was admitted to a hospital in Englewood, N.J., with flu-like symptoms. Health officials learned that four days before CPAC, he had attended a bar mitzvah at a Jewish temple in New Rochelle, N.Y. A lawyer who attended that celebration had just tested positive. On March 7, Schlapp’s phone rang as he had lunch with his family at a restaurant in Northern Virginia. On the other end of the line was the doctor, delivering the news that he, too, had tested positive. “I quickly felt the information was accurate and that we needed to act,” recalled Schlapp, a


Rural areas may be the most vulnerable during the coronavirus outbreak

resources. And that was before the pandemic raised the threat of overwhelming even the nation’s most advanced hospitals. Flu mortality is very notable for low rates in the warmest states: California and the belt of states from Arizona to Florida. But as Reich said, the flu is not a perfect predictor for covid-19. It’s not known if warm weather will provide protection against the new coronavirus the way it does with the standard flu. The impact of weather is not known, but the threat for older people is clear, with death rates seeming to double with each decade beyond age 50. Florida, Arizona and retirement havens along the coasts have concentrations of the oldest people with dark blue circles in the map below. And because the majority of Americans live in large metro areas, many seniors are congregated in the biggest cities, the dense groups of light blue circles. Appalachia, Western Pennsylvania, Eastern Michigan, and areas to the east and west of St. Louis have concentrated light blue patterns as well. Even among the elderly, covid-19 is deadliest for people who are already ill. There’s no national measure of everyone’s health at any given moment, but the index mapped below creates a score for vulnerability. It starts with the percent of people over age 50, then gradually increases the score for people in their 60s, 70s, 80s and older. It then increases the score again for any older person living in poverty, a relatively small share because of Social Security. The score increases again for seniors in confined institutions, such as nursing homes, because there is a greater likelihood of existing illness. For seniors living in their own homes, the score is increased for people who have challenges getting effective health care because they have no car or no Internet connection or no one in the house who speaks English. This enhanced measure of age-based vulnerability highlights potential risk in retirement areas such as Florida and Arizona, as well as Michigan and Appalachia. The urban areas do not reflect as much risk because the elderly group is diluted by the large population overall. Covid-19’s impact may resemble the vulnerability projections or may be very different depending on how it moves compared with the flu and how people act. Epidemiologists are constantly updating models of the risk and learning more about the pandemic that can more accurately guide planning and response.


U.S. Olympians scrambling to stay in shape after coronavirus closes training facilities

start. For years, Olympic hopefuls have led highly regulated lives, gearing every aspect of their sleep, workouts and meals toward peaking for Tokyo. But as universities, private gyms and indoor pools have shuttered their doors in the interest of public safety, many of these elite athletes are scrambling for alternatives with no clear game plan. Swimmers Katie Ledecky and Simone Manuel, who still train at Stanford despite having turned pro, were among the displaced. They ended up at nearby Menlo Circus Club, best known for its equestrian facilities, as guests of a member. The club has only a short-course pool, and the two Olympic champions were exploring other options by midweek. The immediate pressure is off, however, because an upcoming meet in Mission Viejo, Calif., was canceled this week, meaning they probably won’t compete again until May. The latest blow affected nearly 200 of their peers, when the U.S. Olympic and Paralympic Committee announced Tuesday it was essentially shutting down its two primary training sites in response to escalating health and safety concerns. The shutdown came just two days after U.S. Olympic officials restricted access to its training center in Colorado Springs. On Tuesday, it went further, citing a directive from Colorado Gov. Jared Polis (D) that all gyms, restaurants, bars and many other public places must close to slow the spread of the virus. Athletes got the news via a Team USA communication app informing them that the center’s pool, velodrome, gyms and strength and conditioning areas would be closed and not reopened for at least 30 days. The closure scuttled Modi’s best hope of getting his training back on track after taking a red-eye from San Francisco to his parents’ home in New Jersey. He was among nearly a dozen displaced male gymnasts petitioning for the right to train at the Colorado Springs facility when the closure was announced. Also displaced was former Oklahoma gymnast Colin Van Wicklen, who went on a nomadic odyssey in search of an alternate training home after learning the university was closing its gym. Van Wicklen and three other elite athletes had continued to train at the Sooners’ gym with Coach Mark Williams. With no warning, they all had to scramble for alternatives. Van Wicklen reached out to his former club in Houston, whose owner said he could practice there. So Van Wicklen packed as if that might be his home base until


a gym. “Gymnastics is a very, very finicky sport,” Modi said. “You take two days off, and you really feel like you’re losing your technical ability and the body awareness you need. So taking three, four weeks off is very difficult. It’s pretty bad. I’ll do my best to stay in shape at home, but you can only do so much. My level of routines are many, many times harder than anything I can do at home.” At 24, Modi has eyed the 2020 Olympics as the capstone of his career. It’s an open question whether he can maintain his form throughout whatever delay lies ahead. It’s an even murkier question whether he can reclaim his form if the 2020 Games are delayed six months or pushed back a full year. “This was intended to be my last go at making the Olympics,” Modi said. “If they get pushed back, depending how far, I don’t even know if I would still try to go. I have to come to terms with that.” This week, veteran water polo coach and author Jack Bowen, an alternate goalie on the 2006 Olympic team, offered 10 tips for athletes unable to compete or train because of coronavirus precautions. He cited physical and mental exercises, gave dietary tips and, above all, stressed the importance of outlook and appreciation. Said Bowen, in a telephone interview: “By being forced to step away from your sport — something, by definition, none of these athletes have done for 10 years — you can come back rejuvenated if you really are intentional about it. You can say to yourself, ‘In 30, 60, 90 days, I’m going to come back with double the effort because this is what I really love.’” For Rappaport, the triathlete who has clinched her spot on the 2020 U.S. Olympic team, the challenge of navigating the weeks and months ahead feels similar to transitioning from swimming in pools, as she did as an NCAA standout at Villanova, to swimming amid the open-water chaos of a triathlon start. “You have to be prepared for all kinds of conditions and all kinds of courses,” Rappaport said, “so we as athletes are used to having to make adjustments. I don’t think any of us have ever made adjustments on this scale before. But I think we have all accepted it. It’s just what we’re going to have to do.”


Rocky Mountain animals will move as the climate changes. These corridors could give them a safer path.

At the point where it bends around Elk Mountain, I-80 becomes a roadkill hot spot. There, at Halleck Ridge, a proposed crossing site for deer and elk, the transportation department tallies about 25 roadkill carcasses per year. Wildlife will use some underpasses on I-80. In one of these boxy concrete tunnels, birds made mud nests stuck to the walls. In late January, Nickerson’s cameras recorded a small herd of deer as they marched below the highway. Given the varying lengths of the country’s corridors, scientists are trying to determine whether they provide a way for wild species to outrun the climate crisis. At Georgia Tech, Jenny L. McGuire, an expert in spatial ecology, worked with colleagues to develop a model that divvied up the American landscape into hot and cool habitats. “We said: ‘Okay, what’s the coolest place that something can get to, by moving through connected, adjacent natural land areas?’” McGuire said. They predicted the most sensible paths animals would take to navigate fragmented habitats, avoiding urban areas in favor of land with little or no human development. The researchers reported in a 2016 paper that only 41 percent of the wild habitats in the United States would allow species to maintain their preferred temperatures over the next 100 years of warming, assuming a global increase of 2.7 degrees Celsius over that time period. But, if those habitats were connected by wildlife corridors, 41 percent jumps to 65 percent, McGuire and her colleagues found. North-south movement is critical, but so is elevation. One estimate projects that wildlife would have to travel nearly 250 miles toward the poles to escape an overall 5-degree Fahrenheit temperature increase. Or they could run 500 yards up a mountain. The Nature Conservancy is mapping habitats that, its conservationists predict, will allow Wyoming’s wildlife to move into new ranges as the climate changes. Researchers already know that deer “migrate from low to higher elevation areas every year,” Riginos said. “And, in the future, other species may need to shift their ranges to the same higher elevation areas.” Ecological connections serve two purposes: They allow individuals to survive by providing more space to roam, access to food or a bigger mating pool. And they enable animals to relocate in the long term. “If you establish a permanent corridor, it’s important for both needs,” McGuire said. After linking football-field-size sections of longleaf pine savanna, a rare habitat


Millions of U.S. grandparents care for young kids — and are high risk for covid-19

him at higher risk for a more serious case of the coronavirus. “If Keith were to get sick, I couldn’t go visit him at the hospital,” Edie Lowhorne said. “I’d be here taking care of the kids by myself.” The children have stayed inside since schools closed, but the oldest has ongoing therapy appointments to treat post-traumatic stress disorder and other mental health issues. Edie Lowhorne has called the office begging to do the appointments over the phone, but the office staff has said the child must continue to attend in person. “I’m like, well, do I just strip us down in the garage and wipe us down in hand sanitizer and we both run to different showers?” she said. Grandparents in neighborhoods with limited access to services are at increased risk, said Marla Spindel, co-founder and executive director of DC KinCare Alliance, which advocates for relative caregivers raising at-risk children. Most of the approximately 200 families they serve live in Wards 7 and 8 and face a shortage of grocery stores and gaps in access to health care and pharmacies. “I‘m worried about their ability to get food,” Spindel said. “They don’t necessarily have transportation. A lot of them don’t have cars. They can’t just go to another suburb to see if another grocery store has food.” Her organization pushed for changes to an emergency D.C. Council bill to help with subsidies for grandparents, and waive the six-month eligibility period for the Grandparent Caregiver and Close Relative Caregiver Programs, which provide monthly financial assistance to District residents raising their grandchildren or relatives. But the recommendations were not included in the measure that passed Tuesday. Some grandchildren old enough to understand the gravity of the disease are worried for their grandparents. Dyante Long, 22, of the District is concerned about his 63-year-old grandmother, who helped raise him and took full custody of his 10-year-old brother, Zion, when their mother died two years ago. “She mingles with all the grandparents, and you never know where they’re coming from or who they’re interacting with,” he said, adding that his grandmother has also continued to go into work cleaning a downtown building where there has been talk that people tested positive for the coronavirus. “I probably need to have a conversation with her.” Seventy-two people in the District had tested positive as of Thursday evening; limited information was available on where many of


As coronavirus cancels culture, classical music rises to the occasion

The plan was to spend my first week as The Washington Post’s new classical music critic seeing concerts and shaking hands. (Just typing that makes me want to sanitize.) The goal was to go big, starting on Thursday night with a performance by the Baltimore Symphony Orchestra of Mahler’s Third — a titanic work that lands somewhere between celebration and simulation of nature, its monumental first movement one of the longest on record (where it typically consumes an entire side). Then on Friday, I’d watch Kronos Quartet launch into Terry Riley’s “Sun Rings,” the composer’s 2002 collaborative work for quartet, chorus (in this case, the Choral Arts Chamber Singers) and sounds recorded and beamed back from space by Voyagers 1 and 2. On Saturday afternoon, I’d intended to visit the Kennedy Center for “p r i s m,” the Pulitzer-winning opera from Ellen Reid. Then I’d dart over to the Hirshhorn Museum for the 21st Century Consort’s “Water Music” program, highlighting watery works by composers including Tan Dun, Luciano Berio and Kati Agócs and positioned to complement “Color Wheel,” the museum’s expansive exhibition of Pat Steir paintings. And to finish the weekend, I had devoted all day Sunday to watching and writing about the local debut of Jeanine Tesori and Tazewell Thompson’s sure-to-be-stirring “Blue,” a tragic opera set in Harlem telling the tale of a black family whose teenage son is shot by his father’s white colleague, a police officer. Then came the coronavirus, and the sudden lack of things for a critic to critique seemed the least of our problems. Within one weekend, such terms as “self-quarantine” and “social distancing” wedged themselves into our daily lexicon, and the abundance of caution that prompted the first few institutions to postpone, cancel and close had spiked into something more like a national condition: collective isolation. This disruption of public life qualifies as a novel state for the millions of Americans now withdrawn into ersatz home offices. But music specializes in dissolving notions of private and public. With music, this liminal space between alone and together is something of a sweet spot. Every time we push our ear buds in on the Metro, or fall into silent contemplation among hundreds of fellow listeners in a crowded concert hall, we tap into music’s unique power to blur individual and collective experience. In a way, it’s the original social distancing. And once the outbreak


Schoenberg, Murail, Bartók, Dohnányi and Tchaikovsky. In Boston, the classical radio station WCRB already broadcasts more than 50 performances a year from Symphony Hall. Last week, it announced rescue missions to live-stream potentially canceled concerts, including a dress-rehearsal recording of the Boston Lyric Opera’s production of “Norma.” On Monday, the station will begin broadcasting encore performances from the Boston Symphony Orchestra. Station manager Anthony Rudel hopes the station’s efforts will not only prevent a lot of hard work from going to waste, but also give the music a broader audience than could physically fit in the hall, not to mention a more intimate view than from just about any seat in the house. “You’re looking at it through a screen, but you’re also not 100 feet away in a concert hall,” Rudel says. “There’s a trade-off here.” And from the Bayerische Staatsoper in Munich, pianist Igor Levit — who, if normalcy returns in time, is due at the Kennedy Center in mid-May — offered a lucid, liquid delivery of Beethoven’s Diabelli Variations beneath a single spotlight to an empty theater. (This happened in between Levit’s own daily performances on Twitter.) All music is metaphor — that’s part of its power to unite listeners across space, time and language — but these new views of the classical stage through the protective lab glass of a laptop feel especially loaded. When classical institutions are struggling — even in healthier times — to fill seats, these haunting (and often hauntingly beautiful) performances highlight both the fragility of the ecosystem that sustains this music and the resilience and fortitude of those who work tirelessly to preserve and perform it. For Stephen Marc Beaudoin, the executive director of the Washington Chorus, who has already had to cancel proposed live-stream alternatives — choruses, it turns out, count as large gatherings — these short-term solutions can carry us only so far. “We’re doing Beethoven’s Ninth with the National Symphony in June,” he says, “and I want to make sure we’ve got 128 really healthy singers that can do that show.” But still, this migration to the virtual has its own virtues — offering anyone with a connection the chance to feel connected, even as we shelter in place. “The unknown is disconcerting,” Beaudoin says. “But I do take solace in the fact that all of us in the world today are dealing with the unknown together.” michael.brodeur@washpost.com


The official White House defense of labeling it ‘Chinese’ coronavirus

Reporters asked President Trump on Wednesday why he continues to refer to covid-19 as the Chinese coronavirus. Trump cited a desire for accuracy. “Because it comes from China,” he said. “It’s not racist at all. Not at all. It comes from China. That’s why. I want to be accurate.” The day after, Washington Post photographer Jabin Botsford captured images of the president’s speech showing the word “corona” struck out and replaced with the word “Chinese” by pen. In that Wednesday news conference, Trump was also asked to respond to a reporter’s account that a White House aide used the term “Kung flu,” and whether such language puts Asian Americans at risk. “No, not at all. Not at all,” Trump said. “I think they probably would agree with it 100 percent. It comes from China. There’s nothing not to agree.” Critics say terms such as “Chinese virus” and “Wuhan virus” are inaccurate and unhelpful, because the World Health Organization refers to the pathogen as the coronavirus. While the virus is believed to have originated in the Wuhan metropolitan area of China, critics say associating it too closely with China could downplay just how prevalent coronavirus is in Italy, Iran and other places outside of East Asia. It also has led to incidents of stereotyping and worse for Asian Americans. Visual story Centers for Disease Control and Prevention chief Robert Redfield agreed last week with a member of Congress that it was “absolutely wrong and inappropriate” to call the illness the “Chinese coronavirus." Rep. Judy Chu (D-Calif.), chairwoman of the Congressional Asian Pacific American Caucus, told The Fix last week that the president needs to do away with language that stigmatizes Asian Americans. “He needs to make sure that everyone in this country is safe and secure and that we follow the guidelines of the World Health Organization and cannot create greater stigma and use the official term or covid-19. He seems to not be very concerned that there are these acts of xenophobia and scapegoating against Asian Americans.” Trump has used the phrase frequently as he takes a more somber approach to messaging about the seriousness of the disease. Members of the media have several times asked him to justify using the phrase. For example, he took to Twitter on Tuesday to criticize Gov. Andrew M. Cuomo (D-N.Y.) for how he is handling the outbreak in New York and his criticism


A new chef sharpens the cooking at Napoli Pasta Bar

(Good) Editor’s note: This review was written in advance of restaurant closures in Washington due to novel coronavirus. Napoli Pasta Bar is currently offering a modified take-out menu seven days a week, from 11 a.m. to 9 p.m. The Italian menu, expanded to include sandwiches and bottles of wine at a 30 percent discount, is also available via delivery services including Caviar, Postmates and Uber Eats. To hear where he has been, it’s almost as if Andy Clark is cooking backward in time. While the Maryland native launched his Washington career at the revered Fiola under Fabio Trabocchi, Clark went on to work at far more casual Italian restaurants around town, including the neighborly All-Purpose Pizzeria, Red Hen and San Lorenzo. Since February, Clark, 31, has been making the menu more his own at Napoli Pasta Bar in Columbia Heights. “There’s freedom in a small restaurant,” says the chef, who also appreciates the closer interaction with customers. Anyone interested in his stamp on the shop should try his cod fritters. Before his arrival, customers got pieces of beer-battered fried cod delivered on a rustic, olive-punched tomato sauce. Clark gives the idea a promotion by shaping little balls from mashed fish, potatoes and espelette pepper, frying them and mounting the orbs on a bright parsley pesto sharpened with capers. They come three to an elegant order, but if there are four of you, expect an extra fritter. “I don’t like anyone to feel left out,” says the chef. (Bless him and other chefs who do a head count and apportion accordingly.) Opened two years ago by Naples native Antonio Ferraro, who got his restaurant start at the upscale Cafe Milano, the trattoria is hard to miss from the street. The facade fairly screams its name in big white letters. Napoli Pasta Bar also enjoyed some early attention when the Michelin Guide awarded it a Bib Gourmand, designating “good quality, good value cooking.” In December, after Ferraro placed an online ad looking for a chef to replace two Italian brothers whose work visas were about to expire, the first person to get back to him was Clark. Just before Christmas, the two met at a coffee shop at noon and by 2 p.m. had a handshake deal to work together. If only all job interviews went so smoothly. And if only all relaxed Italian joints served as fine a chicken as this


Mental health experts offer counsel on staying calm during coronavirus pandemic

bring out the best in people. People in the United States have a history of collective action and resilience in hard times. The covid-19 pandemic, however, is unfamiliar to most people, and social distancing runs counter to human nature. Today’s pandemic has to be taken as seriously as the Spanish Flu of 1918 — which is deep in the history books. It’s too early to know how long this crisis will last or what its ultimate toll will be. Experts have suggested it might be comparable to the 1957 influenza pandemic, though it’s not out of the question that it could be as severe as the Spanish Flu. The virus remains enigmatic, its favored modes of transmission still under investigation. Covid-19 can be a mild illness, or a severe one, or even a fatal one. The virus usually spreads from direct person-to-person contact, but it can also remain viable for many hours on surfaces. Thus people must struggle with basic decisions about how to go about their lives. Is it safe to go every so often to the grocery store? Hit the gym? Visit neighbors (staying a few feet apart, of course)? Attend a 12-step meeting? A wedding? “I think a lot of people are pretty freaked out already, anxious and fearful,” Francis Collins, director of the National Institutes of Health, said in an interview with The Post. “As in all things, it comes down to the balance between having a reasonable concern, especially if it’s motivating to take actions that can reduce risk, versus having this take over your entire world to the point where you become paralyzed.” Figuring out what is a reasonable concern is not easy for anyone in a public health crisis like this, which is so full of unknowns. Morganstein said he avoids using the word “anxiety” or “panic” when discussing how people react to a crisis like this because it implies the reaction is excessive or inappropriate. And he cautions that a person in distress does not need to be told to be rational and logical: “Logic is often an ineffective antidote to emotion.” But one thought is comforting: Everyone is affected by this. This is a time for communities to find common purpose, even if people are forced to stay apart. “Understanding and reminding ourselves that we’re all going through something together, sometimes that can help us feel less alone,” he said. joel.achenbach@washpost.com


This virus should be forever linked to the regime that facilitated its spread

But in both cases, the lack of freedom in a distant land created conditions that allowed an unprecedented threat to grow, bringing death and destruction to our country. What Bush called the “freedom agenda” is out of vogue today. But we can now see that caring about freedom is putting America first, because how China treats its people affects the health and security of the American people. The same totalitarian system that lied about putting 1 million Uighurs in concentration camps lied about the outbreak of this virus, creating a global pandemic. If China were an open and transparent society, with an accountable government, Americans might not be on lockdown today. What can we do about it? We obviously can’t turn China into a democracy. But we can hold China accountable for its behavior and put a price on its lies and oppression. We can reaffirm that the advance of freedom, transparency and rule of law are central objectives of U.S. foreign policy, because the lives and safety of our citizens depend on it. And we can lay the blame for this crisis where it belongs: at the feet of the Chinese Communist Party. Once the crisis has passed, President Trump should calculate the damage and demand that Beijing pay for the death and destruction it unleashed on the United States and the world. Some have suggested that calling this pathogen the “Wuhan virus” — or as President Trump recently called it, the “Chinese virus” — is racist. That is absurd. MERS is called the “Middle East Respiratory Syndrome” because that is where it originated. Moreover, the Chinese regime continues to lie, spreading a conspiracy theory that the source of the virus is really the U.S. Army. It is important this virus be forever linked to the brutal regime that facilitated its spread. The virus grew in the cesspool of Chinese Communist tyranny. It’s time to drain the swamp. Read more: Marc Thiessen: It’s time to practice social and economic distancing from China Read a letter in response to this piece: Pandemics require resources and preparation Hugh Hewitt: Senate Republicans must go big and fast in their response to the coronavirus Eugene Robinson: Life in the Time of Covid-19 is totally unprecedented Henry Paulson: How the 2008 financial panic can help us face coronavirus Catherine Rampell: A global recession is likely here. Lawmakers need to do their jobs. Dana Milbank:


Masks don’t help, but tossing salt over the shoulder? Why people want to believe.

can be deadly in others — as when people hoard masks during a pandemic. Researchers have studied myriad ways in which people deploy magical thinking as a protection against harm. During the Gulf War in 1991, social scientist Giora Keinan surveyed 174 Israelis who were living under high and low threat of attack from Iraqi missile strikes. In Tel Aviv and Ramat Gan, the danger was high; in Jerusalem and Tiberias, it was relatively low. Keinan asked all study participants the degree to which they would be likely to (if they had the chance) rip a photograph of Saddam Hussein to pieces during a missile salvo. Or if they would step into their safest, sealed room right foot first — an act thought to bring good fortune. Israelis in the high danger regions endorsed these irrational behaviors 36 percent more strongly compared with Israelis living in safer neighborhoods. Those who were most likely to do such things were the participants who said (in a different part of the study) that they felt uneasy when they could not control events around them. Magical rituals, in short, offered an illusory sense of control. Likewise, during the Ebola outbreak of 2016 in West Africa, in which fatality rates for the infected hovered around 50 percent, sociologist Eric Tenkorang surveyed 800 Ghanaians, and found that they generally knew the sources of transmission (contact with bodily fluids, eating brush meat like antelope), symptoms of Ebola at onset (fever, diarrhea) and effective prevention measures endorsed by the World Health Organization: washing hands with soap and altering funeral practices to avoid contact with the body of someone that had died from Ebola. But they also reported believing that hot saltwater baths acted as an effective preventive vaccine though doctors had told them otherwise — and they took such baths. How, during the current pandemic, can we satisfy our psychological need for control — but in ways that effectively reduce transmission of the virus? We can embrace scientifically validated rituals, such as hand-washing, for one thing. We can choose whether we wash thoroughly every time we use the restroom or touch surfaces like doorknobs. We can control our exposure to others through social distancing. We can choose how we greet others — opting for elbow bumps over handshakes. These are decisions we make consciously, several times a day, and they grant us some sense of self-determination during an


What federal employees should know about the coronavirus and their jobs

or lung disease. “Travel by any Federal employee to or within areas where there is community spread of COVID-19 should only be undertaken when there is an urgent need, such as to protect life and property,” it adds. This primarily applies to domestic travel since federal workers fell under previous general restrictions on international travel. Certain countries or regions within countries have been designated by the State Department as Level 3 (Reconsider Travel) or Level 4 (Do Not Travel). Employees returning from Level 4 places “are advised to stay at home and monitor their health for 14 days after returning to the U.S.” Some agencies have imposed their own separate restrictions, including the Defense Department, the largest employer in the executive branch. Q: A: That’s a local decision made by the agency occupying a building, if there’s only one, or by the building’s facility security committee, for those with more than one agency. That has been done in some places where an employee had worked after being exposed to the virus. In other cases, agencies have been closing offices to the public for at least some services. That includes the Social Security Administration, which on Monday started providing customer service only online or by phone. The Equal Employment Opportunity Commission is doing the same, for example, and the Labor Department has declared a “spring break” through April 14 in its Job Corps Centers. In addition, public access has been restricted at some buildings, including the Pentagon. The National Treasury Employees Union has called on the government to close all buildings with more than 50 employees, following the CDC’s guidance to cancel all gatherings of that size or larger for the next two months. The Office of Personnel Management advises: “If you are a customer or member of the public planning to visit a Federal building, please confirm building/facility status before visiting. Some agency buildings and locations may have select hours, reduced in-person services, or visitor restrictions in place.” Q: A: Q: A: Blue-collar employees may be eligible for a similar program for them called “environmental differential pay.” Q: A: Employees would “have the same burden to establish the basic requirements of coverage as other claimants and must submit medical evidence in support of an identifiable injury in the course of their federal employment and any related period of disability,” according to the Labor Department, which runs the FECA program. eric.yoder@washpost.com


How early decisions on coronavirus testing helped shape a pandemic

When the new coronavirus erupted in China more than three months ago, each country faced a monumental task: manufacturing or acquiring enough tests to track the virus as it spread across its territory and around the globe. Decisions made at those early, pivotal moments determined the course of the pandemic. China, after denial-fueled stumbles, improved its response to the virus by deploying a flurry of rapid-fire tests. South Korea, hit hard in the beginning, mounted a comeback steered by knowledge gained from an avalanche of roadside swabs. In recent weeks, Italy has led the globe in testing, producing results that show the highest caseload and death toll in the world. And Germany cleared regulatory hurdles to allow biotech firms to make tests available on a scale that the country’s government could not. But the United States and Japan stumbled, experts say, by initially shutting out the private sector while proceeding sluggishly with public sector efforts, leaving too few tests to track the extent of the virus’ spread. Now, some experts say, the window for testing as a measure to curb transmission could be closing in many places where the virus is widespread. “Because we didn’t have testing early on, it fatally flawed our covid response,” said Lawrence Gostin, director of the World Health Organization Collaborating Center on National and Global Health Law at Georgetown University. The World Health Organization has said that the gold standard for fighting an outbreak starts with testing. “Test, test, test,” WHO head Tedros Adhanom Ghebreyesus has implored: Test broadly, pick up cases, isolate patients, trace their close contacts and put those people into 14 days of quarantine. “You cannot fight a fire blindfolded,” he said Monday. Many countries do not publicly report covid-19 testing data, and the World Health Organization does not track testing by country. According to an Oxford University-based outfit that aggregates available governmental data, South Korea, Italy, the United Arab Emirates, Russia, Germany and one province in China are among those that have done the most testing. The United States had tested about 50,000 as of Friday, according to the CDC. U.S. lawmakers have pledged to massively amplify testing in the coming days, but epidemiologists say the virus has blazed through American soil, following a troubling community-transmission trajectory similar to Italy’s. “The very honest truth is we have missed the opportunity to really prevent the worst outcomes,” said Gostin, who is studying


fatally flawed our covid response,” said Lawrence Gostin, director of the World Health Organization Collaborating Center on National and Global Health Law at Georgetown University. The World Health Organization has said that the gold standard for fighting an outbreak starts with testing. “Test, test, test,” WHO head Tedros Adhanom Ghebreyesus has implored: Test broadly, pick up cases, isolate patients, trace their close contacts and put those people into 14 days of quarantine. “You cannot fight a fire blindfolded,” he said Monday. Many countries do not publicly report covid-19 testing data, and the World Health Organization does not track testing by country. According to an Oxford University-based outfit that aggregates available governmental data, South Korea, Italy, the United Arab Emirates, Russia, Germany and one province in China are among those that have done the most testing. The United States had tested about 50,000 as of Friday, according to the CDC. U.S. lawmakers have pledged to massively amplify testing in the coming days, but epidemiologists say the virus has blazed through American soil, following a troubling community-transmission trajectory similar to Italy’s. “The very honest truth is we have missed the opportunity to really prevent the worst outcomes,” said Gostin, who is studying the pandemic in Washington. “And now we are at the very last tool in our tool shed, which is: Everybody hunker down at home.” Some are asking whether the time for widespread testing has passed in places where the virus is spreading rapidly. On Friday, the head of Finland’s health security agency questioned the WHO’s advice to test as many people as possible. “We can’t fully remove the disease from the world anymore,” Mika Salminen of the Finnish Institute of Health and Welfare said in an interview with Helsingin Sanomat newspaper. “If someone claims that, they don’t understand pandemics.” Two months ago, as cases climbed in Wuhan, the WHO published instructions from German scientists with the recipe for any nation to create tests. The global health body didn’t talk to the Centers for Disease Control and Prevention about supplying kits to the United States, WHO spokesperson Tarik Jasarevic said. The United States, like other wealthy countries, normally develops its own diagnostic tests, then private companies approved by the Food and Drug Administration produce the kits. But manufacturing problems with the CDC’s initial diagnostic test led to a six-week delay. In a statement announcing coronavirus response legislation, President Trump on Wednesday


Cruise ships kept sailing as coronavirus spread. Travelers and health experts question why.

on a voyage across the Atlantic earlier this month after a woman, later diagnosed as positive for the virus, disembarked with breathing problems. By the time the ship reached a port in France on Thursday, five additional passengers and two crew members had flu-like symptoms. It turned out some of them had contracted the coronavirus: On Friday, an airplane carrying more than 300 Americans and Canadians from the ship landed in Atlanta. The CDC said they included three passengers who had tested positive for covid-19 and a fourth who would be evaluated at a local hospital. “This needs to be investigated — certainly before we even consider an industry bailout,” Ecker said. The cruise industry got an early warning of how easily the virus could spread on its massive ocean liners when the first cases emerged on the Diamond Princess in early February after it left Yokohama harbor. Despite a Feb. 5 quarantine, 700 people aboard eventually tested positive. An initial CDC study published Tuesday found that the virus quickly spread through food service workers, particularly those cooking for other members of the crew. “This investigation underscores the need for swift epidemiologic investigation as soon as a COVID-19 case is detected in an area or group where a large number of persons gather in a closed or crowded setting,” the study said. On Feb. 21, as quarantined passengers were still trying to get off the Diamond Princess, Diane and Steve Houghton of Pleasant Hill, Calif., were eagerly boarding a sister ship, the Grand Princess, on the other side of the Pacific Ocean, for a 15-day cruise to Hawaii. Steve Houghton said the passenger screening in San Francisco was limited. The brief questionnaire handed to passengers as they boarded asked about fever, persistent cough or recent travel to coronavirus hot spots like China. His document went into a stack along with hundreds of others, Houghton said. On his form, Houghton wrote that he coughs all the time and has difficulty breathing due to chronic asthma. “No one asked any questions. They said not a single word,” he said. The ship set sail for Hawaii with roughly 3,500 people aboard. As it passed beneath the majestic Golden Gate Bridge, passengers crammed the decks to take in the view, drinks in hand. Several days of relaxation and merriment followed, with little or no awareness of the virus’s creep around the world, according to


Shut the Olympic Games down, and do it now

down fast enough. We don’t have time for athletes to keep training or meeting with coaches, risking infection or becoming asymptomatic spreaders. We don’t have time for women’s soccer players to go to events such as the one in Dallas on March 11 that may have exposed them. After which they traveled and congregated in training camps with pro teams such as the Washington Spirit, which flew to West Palm Beach, Fla., just over a week ago. USA Swimming has rightly called for postponement because athletes should not be traveling around whole regions looking for an open pool when state governments are ordering citizens to shelter in place. USA Track & Field followed suit with similar argument: There is simply no such thing as a safe training environment right now. Athletes “are willing to push themselves to their athletic limits,” USATF chief Max Siegel said in a letter to the USOPC that recommended postponement. They need the certainty of a shutdown so they can put their focus where it should be, on “taking care of themselves and their families.” The name of the game is to buy a little time — just a little time — so hospitals can prepare and supply or resupply or repurpose. And the way to do that is with shutdowns and social distancing. So that hospitals will not become quite so crushed four months from now and fewer patients will be sentenced to death for lack of beds and ventilators and fewer caregivers will become sick because they lack protective gear. So that other regions don’t experience what’s happening in northern Italy, where physician Marcello Natali died Wednesday after warning recently that medics had run out of latex gloves. A total of 110 doctors out of 600 in the province of Bergamo are apparently sick. “We’re acting like we have time, and we don’t,” my doctor friend says. Shut the Games down, and shut them down now. The IOC and its partner the USOPC are critical messengers with tremendous reach and potential for good — or bad. Messaging matters. When the NBA promptly suspended its season because of Rudy Gobert’s positive test, the audience finally understood the infection threat from a handshake or a shoulder bump was real. When the NCAA canceled March Madness too, it was a vital public service. Anyone who soft sells the message about this pandemic at this point is practicing


Maryland announces second death, D.C. extends restrictions through end of April

Maryland Gov. Larry Hogan on Friday said a second person in the state had died of the novel coronavirus and emphasized the need for residents to take the illness seriously. His announcement came as D.C. officials reported that nine more people in the District had tested positive for the coronavirus. “This is a public health crisis like nothing we have ever faced before — we are all in this together, and we will get through this together,” Hogan said. Hogan said the man, a Baltimore County resident, was in his 60s and suffered from underlying medical conditions. D.C. officials said that three people who tested positive are in their 20s and two are in their 30s. They said a 22-year-old man who tested positive lives in Florida, and a 58-year-old man and a 34-year-old woman have unknown addresses. Mayor Muriel E. Bowser on Friday extended school and restaurant closures and a ban on large gatherings through the end of April, following the first known covid-19 death in the nation’s capital and a spike in coronavirus patients. As of now, similar restrictions in place in Maryland and Virginia are limited to this month. Bowser (D) also closed playgrounds and extended the city’s prohibition of on-site service at restaurants and bars and the closure of theaters, gyms and spas until April 25. The measures underscore a new reality for Washingtonians: No school, church, dining out or visits to the movie theater or gym for at least six weeks. “I cannot stress enough that the threat of this virus poses very serious consequences for our community,” the mayor said. “It does not discriminate based on age, race or gender. Everyone can get it and pass it on.” D.C. officials said the 59-year-old man who died of the novel coronavirus Friday was admitted to a hospital last week with fever, cough and underlying medical conditions. The man may have had contact with a previous patient. A Prince George’s man in his 60s died of the virus earlier this week, and two men in their 70s from eastern Virginia also have died. Bowser said the extension of the District’s public health emergency is necessary to determine if social distancing measures are succeeding. D.C. government will run on limited operations, with most employees working remotely. Recreational centers and libraries will stay closed until April 27, and gatherings of 50 or more are banned. Bowser said she


Coronavirus stay-home orders apply to one in five Americans as confirmed cases are expected to skyrocket

worldwide — but just 12 days to log the next 100,000. In Italy, more than 4,000 people have now died. The country reported its highest daily death total Friday, with 627 people succumbing to the virus in 24 hours. Most of Italy’s deaths have occurred during the past week, as overwhelmed hospitals struggle to deal with the surge of critically sick. Italy is under a complete lockdown, and authorities have cited 9,600 people in one day for violating the order. The numbers of deaths and confirmed cases continue to rise in Iran and Spain, where cases surged 30 percent in a day. Nearly 20,000 Spaniards have tested positive for the virus that causes covid-19, and more than 1,000 people have died. The country also is on lockdown, and all hotels were ordered to close by the end of next week. Most cases are centered in the nation’s capital, Madrid. Hong Kong reported a record jump in new coronavirus cases — with 48 — as the region braces for an uptick in illness involving people who rushed back home to beat widening travel restrictions. One positive tidbit was that for the second day in a row there were no new cases reported in China, where the virus took hold. Further evidence of the United States trying to seal itself off from the outside world came Friday, when the United States and Mexico reached an agreement for a partial closure of the border between the two countries, officials said. Mexican Foreign Minister Marcelo Ebrard, said the border would not be completely closed but “restricted” when it comes to tourism and recreation. Chad Wolf, the acting secretary of Homeland Security, said U.S. authorities would begin “immediately” turning back and deporting migrants who attempt to cross the border illegally, rather than detaining them or putting them into court processes. The United States and Canada jointly agreed earlier this week to close their shared border. Canadian Prime Minister Justin Trudeau said Friday that Canada will send back asylum seekers who attempt to cross the border irregularly. American officials have started to brace for a wave of coronavirus patients, with the government starting to identify hotels, college dormitories and other unused buildings to lease and turn into makeshift hospitals, according to the commanding general of the Army Corps of Engineers. Lt. Gen. Todd T. Semonite said New York will serve as model, with state governments nominating


Franciscan Monastery says member is D.C.’s first known coronavirus death

Dunham added. “It was going to be like a whole new focus and life for him,” he said. “That was to be his new assignment that never quite materialized.” Mayor Muriel E. Bowser (D) announced the news of the first death on Friday, but did not identify Laird-Hammond by name. D.C. officials said the person was admitted to a hospital last week with fever and cough and may have had contact with a previous patient. As of Saturday evening, there were 426 reported cases in the District, Maryland and Virginia. There have been two deaths in Maryland related to the coronavirus, both men in their 60s with underlying medical conditions, and three deaths in Virginia, including two men in their 70s. Officials have closed schools and restaurants across the region and banned large gatherings in an attempt to slow the spread of the virus. The number of cases in the region has roughly doubled every 48 hours. Dunham said that Laird-Hammond had battled leukemia for several years. A few days ago, he said Laird-Hammond sent him a picture of a thermometer showing his temperature: 103.5 degrees. He said that Laird-Hammond often battled nausea after his treatments for leukemia but had seemed in February to be in some of the best health Dunham had seen him in for years. He said he grew worried about a coronavirus diagnosis when he heard Laird-Hammond had been hospitalized and was shocked when he saw the picture of the thermometer. “My knees started to buckle,” Dunham said. “I said, ‘please try to get better.’ . . . He always recovers. He always finds a way. But he didn’t find a way. That’s what I’m really trying to get my head around.” In addition to managing the day-to-day business operations of the monastery, Laird-Hammond was also in charge of collecting Good Friday donations that came in from around the country, Dunham said. He said Laird-Hammond was from Minonk, Ill. Throughout his career, Laird-Hammond was a hard and energetic worker who never complained about his own health problems and instead always “looked out for the little guys, the people who would fall through the cracks,” Dunham said. He helped find housing for people who needed it, made sure food baskets were delivered to families that were struggling on Christmas and once found a dentist for a construction worker who was missing his front teeth, Dunham said. rachel.chason@washpost.com


Goodbye, Tokyo 2020. It’s time to start hoping for 2021.

lockdown by lockdown, it has become clear that proceeding is risky. Trump’s abrupt imposition of travel restrictions, after weeks of nonchalance, has essentially sealed the fate of Tokyo 2020, disrupting preparations, athletes’ training and qualifying events around the globe. Now, the IOC is faced with pulling the plug and figuring out when to reschedule. It should do so sooner than later to give all involved more time to prepare. There are many trade-offs and interlocking parts, but 2021 or 2022 are workable options. Cancellation would be the nightmare scenario for Abe and Olympic sponsors; delay at least offers hope, something currently in short supply. It might also boost sagging consumer confidence, encourage a rebound of inbound tourism and help Japan climb out of a gathering recession. And there is the estimated nearly $30 billion already spent on gearing up for the Games and several billion dollars more in sponsorship at stake. Some suggest an Olympics without spectators, but this is an unlikely and unappealing scenario; watching the ongoing sumo tournament in an empty Osaka arena underscores the importance of fans. There are still hopes to hold the Games later this year, but holding the “Mask Olympics” either in summer or later in 2020 is fraught with moral hazard and a range of uncertainties that can’t be managed. And American television already has a full schedule of fall sporting events. Cluttering that schedule with the Olympics would reduce viewership and the anticipated ad revenue. Moreover, athletes’ training has been disrupted and it remains unclear if all of them will able to travel later this year. The Games have been canceled before, during wartime. Gaffe-prone Deputy Prime Minister Taro Aso vented this week about the 40-year curse, noting the boycott in of the Olympics held in the Soviet Union in 1980 and cancellation of the 1940 Olympics, when Tokyo was supposed to host them for the first time. Of course, there are bigger worries for the world to address right now, health and jobs foremost. Still, as Yale anthropologist William Kelly reminds us, the Games are much more than spectacle and sports. In an article published this month, he explained how the Olympic movement has promoted positive changes in global conversations, norms and values involving diversity, gender and the environment. As this crisis continues, this spirit will be needed more than ever to move beyond the blame game and nurture more effective


ICE said it won’t deport people for seeking medical care. Immigrants won’t believe them.

On March 17, President Trump announced plans to close the southern border to asylum seekers. “We need the Wall more than ever!” Trump tweeted, though the head of the Centers for Disease Control and Prevention noted that physical barriers will not stop the spread of the novel coronavirus, and despite the fact that the United States has more cases per capita than does Mexico. Would the closure stop the spread of the virus? Here’s what we know — and what to look out for. More of the same at the southern border Trump has treated the coronavirus pandemic as a way to extend his broad anti-immigration platform, characterizing the disease as a “foreign virus.” This week, the State Department warned Americans not to travel abroad, and the White House first closed the border with Canada and then with Mexico for nonessential travel. Last week, Trump announced a 30-day ban on travel from most of Europe and soon added more countries to the banned list. These restrictions on otherwise legal travel — whether it be for work, leisure or another reason — use the same legal authority as the series of travel bans started in January 2017. Meanwhile, the United States has announced even stricter policies around stopping immigrants at the southern border, and it continues to detain asylum seekers. Private detention companies hold about 15,000 immigration detainees on any given day, including both recent arrivals and those present in the United States for decades. Those in closed facilities are at particularly high risk should the virus enter the facility, which may happen soon. This week, a corrections officer at a New Jersey jail that houses immigrant detainees tested positive for the coronavirus. To protect detainees nationwide, immigrant advocacy groups have called on the government to close immigration detention facilities. In my own work in the country’s largest family detention center, I have seen families side by side, sharing a space where it would be next to impossible to avoid the virus. I had planned another trip with law students to the detention center this month — but scrapped it rather than risk bringing the virus in. Yet while public agencies such as the New York City Board of Correction are calling for that city’s jail system to rapidly release detainees who aren’t an immediate danger to reduce the risk of a fast-spreading coronavirus outbreak, the federal government is taking a


An educator’s personal story: The year is 1949, not 2020, and the disease is polio, not covid-19

of getting sick. San Angelo is in West Texas, the county seat between Abilene and the Mexican border. Farms, oil wells and cattle ranches fenced with barbed wire dot the county. Blessed with a warm climate and reputation as a healthy place to live, in one year San Angelo added to its reputation in ways that city leaders dreaded.* In mid-spring, the newspaper reported that a local child had come down with a viral disease. Previously, when this disease occurred, it had not spread. This one, however, did. Parents began arriving at Shannon Memorial Hospital with “feverish, aching youngsters in their arms,” the local newspaper reported. Within days these children died: 10-month-old Esperanza Ramirez, 7-year-old Billie Doyle Kleghorn, 4-year-old Susan Barr and others. The city health officer said that an epidemic was occurring. Because the disease had no known cause or prevention or cure, he recommended that San Angelo children avoid crowds, wash their hands regularly and get a lot of rest. A month later, with known cases spiking to over 60, the city council voted to close all indoor meeting places, including theaters and churches. Tourists stopped coming to the city. The economy shrank. One local doctor said, “We got to the point … when people would not even shake hands.” The year is 1949, not 2020. The disease is polio, not covid-19. I got polio in 1944, five years before the epidemic hit San Angelo. But I was lucky. I came out of the disease with only a limp from a destroyed calf muscle. Amid the fears of the coronavirus today, I can now appreciate in a way that I could not as a 10-year-old the dread of the unknown consequences for their son that my parents had after I came down with the “plague,” as it was called at the time. What was true about polio is also true of the novel coronavirus: Experts are not exactly sure how covid-19 began, and testing for the disease continues to be slow in the United States. There are no known medications to ease or a vaccine to prevent it. Even the death rate from the disease is uncertain because of flaws in testing and tardiness in evaluating large numbers of people in China and other countries as the epidemic became a pandemic. Political and medical officials advise Americans to wash their hands often and stay away from crowds. Anxieties


got to the point … when people would not even shake hands.” The year is 1949, not 2020. The disease is polio, not covid-19. I got polio in 1944, five years before the epidemic hit San Angelo. But I was lucky. I came out of the disease with only a limp from a destroyed calf muscle. Amid the fears of the coronavirus today, I can now appreciate in a way that I could not as a 10-year-old the dread of the unknown consequences for their son that my parents had after I came down with the “plague,” as it was called at the time. What was true about polio is also true of the novel coronavirus: Experts are not exactly sure how covid-19 began, and testing for the disease continues to be slow in the United States. There are no known medications to ease or a vaccine to prevent it. Even the death rate from the disease is uncertain because of flaws in testing and tardiness in evaluating large numbers of people in China and other countries as the epidemic became a pandemic. Political and medical officials advise Americans to wash their hands often and stay away from crowds. Anxieties and fears are as contagious as the disease’s spread from its origins in China to the rest of the world. Now as an old man, the fear I have of the coronavirus striking my family friends, and the nation must be close to what my parents must have felt when I got polio three-quarters of a century ago. Polio virus Known for centuries but isolated in the early 1900s, the virus that causes polio had triggered epidemics across the world. Because it was not known why children and adults got sick, became paralyzed and died, prevention was useless. Fear of contagion was rampant wherever cases broke out. Treatment for the disease, often called “infantile paralysis,” was a combination of muscle wrappings and massage of limbs to ease damage to the body that inevitably occurred. In the United States, epidemics occurred periodically, paralyzing children and adults, rich and poor alike. One epidemic in 1916 claimed 27,000 Americans; in New York alone, there were 8,400 cases and 2,400 deaths. Five years later, Franklin Delano Roosevelt came down with the disease at the age of 39 and wore leg braces for the rest of his life including the years he served as U.S.


Communication failures in a pandemic can be catastrophic

The novel coronavirus poses an entirely new threat to Americans. Most of us have never experienced anything like it: sports seasons postponed, Broadway gone dark, and schools, businesses and restaurants shuttered. But as alien as this experience is for us today, our ancestors experienced similar viral epidemics. In September 1485, a strange new illness swept through London. At the time, it was unlike anything Londoners had ever seen — according to several chroniclers, worse even than the bubonic plague. Perfectly healthy people suddenly broke out in a fevered sweat, and within hours, most were dead. Ralphael Holinshed’s “Chronicle of England” described the disease as “so cruel, that it killed some within three hours, some within two hours, some merry at dinner, and dead at supper.” As deaths mounted in London — nearly 15,000 out of an estimated population of 50,000, according to one account — life came to a halt. Fearful of the illness, Henry Tudor postponed his coronation, leaving England without an official ruler. The “sweating sickness” that plagued England in 1485, and again in 1506, 1511, 1517, 1528, and finally, for the last time, in 1552, was probably caused by a novel virus. Modern epidemiologists believe that “the sweat,” as it was known in early modern England, may have been similar to modern hantavirus pulmonary syndrome (HPS), a disease spread via mouse feces that causes respiratory failure. There are obvious similarities between the epidemic facing England in 1485 and the pandemic facing us in 2020, but most troubling of these may be that we are falling prey to the same failures in communication and errors in judgment. Despite all that has changed in 500 years, not least of which is the development of modern medicine, our ability to weather covid-19 may depend on learning from the mistakes of the past. Over the course of five outbreaks, from 1485 to 1528, not a single pamphlet, book, or bill of information on “the sweat” was printed for English people. By contrast, in Italy, cities responded to disease outbreaks by disseminating “plague orders” for quarantine measures and publishing records of who had died, when and where to keep track of the illness’s spread. The printing press arrived in England 10 years before “the sweat,” so royal authorities might have printed recommendations for public health and published information about fatalities. They did not. The only printed reference to the first outbreak in


through Germany, Denmark, Poland and the Baltic region in 1528-29, killing thousands. Among the English, popular opinion held that “the sweat” was a disease of the rich. The illness was often called the “stop-gallant,” a reference to the common belief that the young and wealthy were especially susceptible. Despite the nickname, records from outbreaks in 1509 and 1517 cite thieves dying of “the sweat” in the streets and household servants struck by the illness just as often as their masters. Finally, those in power assumed something of the opposite — that their wealth and privilege would see them through. King Henry VIII’s secretary, Andrea Ammonio, believed he was “well protected against the contagion by his modest manner of life” even though he knew many “whose whole household had suffered.” Sir Thomas More, author of “Utopia,” remembered Ammonio boasting of his invincibility just “hours before he himself was carried off,” another victim of the outbreak of 1517. Like people in 15th- and 16th-century England, Americans are struggling to come to grips with the impact of covid-19 on their lives. Both the federal government and the CDC have failed to communicate clearly to the public, just as English authorities did over 500 years ago. Just as in early modern England, nonexperts have stepped into the gap, with conservative commentators downplaying the risks of the illness and politicians directly contradicting public health experts. As a result of these failures, Americans are just as sure as 15th-century Londoners that covid-19 will only affect other people. Before being closed by authorities, bars and restaurants from New York to Los Angeles were filled with patrons, despite warnings from state and local officials that social distancing is the only way to prevent a serious public health emergency. Reactions to the spread of covid-19 over the past week have demonstrated how little human nature has changed in 500 years. But Americans today, like the English then, are not invincible. The English sweating sickness killed rich and poor, foreign and native. Covid-19 has likewise killed rich and poor in communities across the globe. We are in a unique position to learn from the mistakes of the past, to resist the temptation to deny the serious threat this virus poses and significantly alter the course of covid-19 in our own communities. Covid-19 is not a disease for other people to handle. It is up to all of us to act.


You are not a teetering contraption

and your immune system kills them: “A couple of dozen times a week, well over a thousand times a year, you get the most dreaded disease of our age, and each time your body saves you.” What he calls “three billion years of evolutionary tweaks” have taught your body some neat tricks. Viruses, Bryson says, “bide their time.” A previously unknown one, found in Siberia in 2014 after having been confined in permafrost for 30,000 years, was injected into an amoeba and “sprang into action with the lustiness of youth.” To stave off death from the coronavirus, we diligently scrub our largest organ, our skin, the surface of which, the epidermis, is . . . dead. Bryson says “all that makes you lovely is deceased. Where body meets air, we are all cadavers,” shedding a million dead flakes an hour. Just as well, considering that every square centimeter of your skin contains about 100,000 microbes, and about 200 species of microbes inhabit your skin. Some of the many trillions of living things that call your body home were studied in North Carolina State University’s Belly Button Biodiversity Project, which swabbed the belly buttons of 60 randomly selected Americans and found 2,368 species of bacteria, 1,458 of which were previously unknown to science. The three spongy pounds of mostly water, plus fat and protein, called the brain exist in darkness, yet it tells us everything we know about the world that it has never seen. “Just sitting quietly, doing nothing at all, your brain churns through more information in thirty seconds than the Hubble Space Telescope has processed in thirty years.” A grain-of-sand-sized bit of cortex “could hold two thousand terabytes of information,” enough to store every movie, or 1.2 billion copies of Bryson’s book. Small wonder this 2 percent of body weight uses 20 percent of our energy. The energy expended by the 200 million steps you will take in your lifetime comes from improved modern nutrition that explains why puberty, which began at 16 or 17 five centuries ago, now generally begins at 11. Food, of which Americans consume unhealthy amounts (nearly 25 percent more calories than in 1970, when they already were not svelte), makes this nation simultaneously overfed and nutritionally deficient. Millennials scarf down avocado toast, oblivious of the fact that one avocado has, Bryson says, “five times as much saturated fat as a small bag of