Not everyone in China thought the government could handle the coronavirus

As China emerges from the coronavirus crisis, global health officials suggest the nation has implemented a successful model to manage the pandemic. But what do people in China think about how Beijing managed the crisis? Our research, conducted before and after the outbreak, offers some unique insights into Chinese citizens’ views of their government’s covid-19 response. Contrary to some analyses, the results are less optimistic that the state can manage national disasters and emergencies alone. Rather, Chinese citizens believe assistance from civil society organizations is needed at times of national crisis. Chinese citizens see a role for civil society organizations We conducted two waves of online surveys looking at civic participation. The project surveyed 1,402 urban Chinese residents in October 2018, and 4,999 people during the December 2019 to February 2020 period. This work was supported by internal university grants and conducted by Chinese survey companies. One of our main survey questions asked, “Does the government need help from social organizations for emergency and disaster responses?” We asked people to respond using ranking options between 1 (strongly agree) to 6 (strongly disagree). The average sentiment among respondents in the October 2018 survey round was 4.39, meaning the public generally disagreed with this statement. However, by early 2020, most respondents were in agreement (average sentiment: 1.67) suggesting they increasingly saw a role for civil society in times of crisis. Why the dramatic shift — even before the full onset of covid-19 in China? Since Xi Jinping became China’s leader in 2013, China has made it increasingly difficult for civil society organizations to operate. Yet citizens have become increasingly active in volunteering and donating to a number of causes, such as poverty alleviation, disaster relief and disability assistance. Citizens became frustrated by the government’s inadequacies during coronavirus The timing of our survey serendipitously provided a new perspective on China’s covid-19 response. We collected 3,115 of the second wave sample before Jan. 20 — this was the day the Chinese government first revealed human-to-human contact could spread the coronavirus. And we collected the remaining 1,884 survey responses after that date, as the coronavirus lockdowns began. We see a significant shift in how Chinese citizens perceived the government’s management of the coronavirus crisis, pre-Jan. 20 (average sentiment: 1.70) and after the government announcement (average sentiment: 1.62). In other words, approximately 5 percent more people indicated after the Jan. 20 date that they thought the


provincial health experts knew about an unknown viral illness as early as mid-December 2002 but did not share the news publicly until February 2003. In April 2003, the government arrested journalists and newspaper editors for spreading “rumors” and for publishing official documents related to SARS. Fearing the truth about the disease would damage foreign investors’ confidence as well as the reputation of the Guangdong government, local officials tried to stop the flow of information, despite the public health risk. After the SARS debacle, the Chinese leadership announced new measures to develop an early warning system, albeit with mixed results. Part of this initiative sought to encourage public sharing of information on potential outbreaks. In March, the Chinese leadership, in fact, warned local leaders not to hide new covid-19 cases. Nevertheless, the Chinese government has tried to control the narrative. Between the end of December 2019 and January 2020, the China National Health Commission sent three teams to Wuhan to collect evidence of the new atypical pneumonia. Each team was stymied by local officials seeking to present a good image of their local jurisdiction. Ai Fen, a physician at Wuhan Central Hospital, shared the SARS-like results of her test with hospital authorities on Dec. 30, 2019, but was subsequently reprimanded for “spreading rumors” and “causing social panic.” Hospital leadership and Wuhan public officials denied the possibility of mass human-to-human transmission, as late as Jan. 12. As a result, the novel coronavirus spread quickly across the nation and globe. In this health crisis, as in the previous crises, local authorities tried to restrict information, while the government seeded doubts about the origins of the outbreak. Looking ahead Central to China’s governance strategy is the idea that without the Communist Party’s leadership, China would descend into chaos — and that outside expertise and leadership could undermine the legitimacy of the government. Our survey results suggest that Chinese citizens believe their government cannot successfully respond to this kind of crisis without outside assistance from civil society. We find that citizens in China have an increasing trust and understanding of the role of civil society organizations in effective crisis response. Ironically, the Chinese government has been systematically undermining the role of these organizations over the past few years. The stories from Wuhan in lockdown, however, suggest that civil society can step in to assist with emergency needs the government cannot meet in times of crisis.


Are we seeing the first of the covid-19 orphans?

department bay for hours while health-care workers like us try to distract them with toys or cajole them to stay inside. Often, older children stand against the walls, not saying much, their faces and posture betraying anxiety about their loved ones. Children are assumed to be positive when the caregivers they arrive with are hospitalized for covid-19. To be observed or tested, these children are often admitted to in-patient pediatric floors as “social admissions,” a category typically used for child victims of abuse or non-accidental trauma awaiting placement with local protective agencies. Hospital protocols crafted to minimize contamination prohibit children from visiting covid-19 patients even if the children have been admitted. At best, their hellos — and possibly goodbyes — are communicated through video. When working around children who are isolated but might not be infected, it is hard not to worry that we are seeing the first of the covid-19 orphans. While much coverage of covid-19 understandably involves fatality rates and end-of-life matters, the disease affects all ages and life stages. Hospitals have restricted visitors to minimize infection, leaving many pregnant women without loved ones in the delivery room. Some new mothers have developed signs of coronavirus infection and been whisked, hours after childbirth, from labor and delivery floors to covid-19 surge units or intensive-care units. Newborns of mothers who have tested positive are restricted to nurseries and neonatal ICUs, on a recent recommendation of the American Academy of Pediatrics, meaning they can no longer “room-in” during a crucial period for infant-mother bonding. Alone in hospitals, parents view their newborn on baby monitors that nurses switch on while they care for the infant. Although much has yet to be learned about covid-19, the disease’s psychological impact on patients and their relatives is almost certain to be severe. During the 2003 SARS outbreak, parents and children experienced varying degrees of depression and anxiety as a result of family separation and hospital isolation policies implemented to contain disease spread. The developing neurological pathways in children are particularly susceptible to such stressors; long-term behavioral and psychological issues can result. Failure to provide effective family-centered care options could exacerbate such consequences. After all, children experience the physical manifestations of covid-19 and inherit its burdens. Field hospitals and other isolation facilities such as the Boston Hope Medical Center and the Javits Center in New York that care for recovering covid-19 patients have been designed


on baby monitors that nurses switch on while they care for the infant. Although much has yet to be learned about covid-19, the disease’s psychological impact on patients and their relatives is almost certain to be severe. During the 2003 SARS outbreak, parents and children experienced varying degrees of depression and anxiety as a result of family separation and hospital isolation policies implemented to contain disease spread. The developing neurological pathways in children are particularly susceptible to such stressors; long-term behavioral and psychological issues can result. Failure to provide effective family-centered care options could exacerbate such consequences. After all, children experience the physical manifestations of covid-19 and inherit its burdens. Field hospitals and other isolation facilities such as the Boston Hope Medical Center and the Javits Center in New York that care for recovering covid-19 patients have been designed for adults. These types of facilities lack amenities for children, such as infant cribs and safety gates for beds. Additionally, incorporating pediatric psychologists, social workers and child-life specialists into health-care teams would help mitigate the psychological trauma of covid-19. Increased funding for pediatric care would help distressed hospitals achieve these goals. Ultimately, a vaccine will keep the novel coronavirus at bay. But the traumas inflicted by covid-19 will remain and most likely resurface. We cannot completely shield children from the consequences of this pandemic, but acknowledging its effects on their well-being and taking other meaningful actions might lessen their scars. As health-care providers, we are doing what we can right now: We fight the solitude these children face with our company. We point out murals of athletes, animals and trains on our emergency department walls. We chat about favorite television shows and school subjects. We joke until we belly-laugh together, cutting through the tension heavy in so many hospitals of late. When our shifts end, we update our colleagues so the children can make new friends. We aim to help them understand that regardless of what lies ahead, we will continue to care for them — and that they are not alone. Read more We need smart solutions to mitigate the coronavirus’s impact. Here are 23. The Post’s View: As schools close, we need systemic ways to ease hardships that many children will face Michele L. Norris: My children are now watching me. All day. Every day. Michael J. Petrilli: Schools should consider keeping kids in the same grade this fall


NBA, WNBA selling team-branded face coverings, with proceeds going to charity

The NBA and WNBA began selling team-branded face coverings Friday, with all proceeds going to hunger-relief organizations (Feeding America in the United States and Second Harvest in Canada) amid the novel coronavirus pandemic. The masks are available at the leagues’ online stores. “As a global community, we can all play a role in reducing the impact of the coronavirus pandemic by following the [Centers for Disease Control and Prevention’s] recommendation to cover our nose and mouth while in public,” Kathy Behrens, the NBA’s president for social responsibility and player programs, told ESPN. “Through this new product offering, NBA and WNBA fans can adhere to these guidelines while joining in the league’s efforts to aid those who have been directly affected by covid-19.” The leagues are the first in the United States to offer officially licensed team masks, though nonlicensed products are for sale via online retailers such as Amazon (which was founded by Jeff Bezos, owner of The Washington Post) and Etsy. The NBA and WNBA masks are being made by sports apparel company Fanatics, which last month announced that it halted production of Major League Baseball uniforms at its Pennsylvania factory and will instead use that fabric to make protective masks for medical professionals. The CDC recommends “wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission.” Simple cloth face coverings “slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others,” according to the CDC. A growing number of states and cities have ordered residents to wear some sort of face covering when in public, shopping at grocery stores or using public transportation. Sign up for our weekly NBA newsletter to get the best basketball coverage in your inbox


Mystery maladies that cross the border between mind and body

in his despair, abandoned his faith, which led in turn to the loss of the sense of purpose it had given him. No longer perceiving a reason to continue his life, his patient had ended it. An acute observation, but in a case like this second-guessing just doesn’t cut it. David also admits to being forced to engage in a kind of educated guesswork. Many of his cases present so unusual a confluence of symptoms and syndromes that, search as he may, the medical-psychiatric research literature contains few precedents to guide him. That is what he was up against when he met Jennifer, a 30-something artist whose medications had previously kept her schizophrenia under control, but who had now been hospitalized in a near-catatonic state. A battery of neurological tests suggested that her antipsychotic medications had, in a rare side effect, also triggered the onset of a severe case of Parkinson’s disease. But what was the next step? As David and his colleagues began nudging and tweaking various combinations of medications to treat both conditions at once, not really knowing what might work, he could not disagree with Jennifer’s observation that she had become a human guinea pig. But in time she did recover enough physiological strength and psychological calm to start practicing her art once again. David believes that the neuropsychiatrist’s job requires looking beyond the data, to see the fuller canvas of an individual’s life history and to trace the damaged, tangled threads in need of healing in both mind and body. For him, he writes, “the real challenge is finding the right level of explanation along the biological, psychological and social continuum.” But life’s messiness can make it difficult for patients and their families to discern just how inextricably connected all these components are. With 15-year old Christopher’s autistic younger brother commanding all his parents’ attention, his mother and father at first paid little attention when a chest infection started to morph into a neurological disorder that robbed him of movement in his arms and legs. Then, when an incompetently executed medical procedure seemed to paralyze him completely, his parents were consumed with guilt and brought him home to care for him as devotedly as they did his brother. The problem was that, even though not a single diagnostic or neurological test showed any physical cause for this disability, his parents declined to pursue further treatment. For


¿Supo EE UU del coronavirus y no reaccionó? Entrevista a Juan Manuel Santos. Cómo dormir bien.

Hablamos con Josh Rogin, columnista del Post. Líderes de América Latina llaman la atención del FMI. Un experto cuenta qué tan malo es dormir poco y sugiere el remedio


The Daily 202: Trump’s new guidance makes lack of national coronavirus testing strategy more glaring

one of the first drugs identified as having the potential to impact the virus in lab tests, Stat reports. “In Alabama, officials have ruled that one of every 10 people who died with covid-19 did not die of covid-19. Among those excluded from the numbers reported to the federal government were a bedbound patient with aspiration pneumonia in one lung and a person with a buildup of fluid and partial collapse of one lung,” Emma Brown, Beth Reinhard and Reis Thebault report. “Colorado, by contrast, has included some deaths where the disease caused by the novel coronavirus was deemed probable — based on symptoms and possible exposure — but not confirmed through a test. Health officials in both states say their approach is more accurate. Their divergent methods reflect a national debate over how to count the dead. … The [CDC] updated its website this week to explicitly say that cases where the infection was not confirmed by a test may now be counted. But attributing a death to the virus can be a judgment call, experts say, and potentially a vexing one as indications emerge that the disease damages not just the lungs but also the heart, kidneys and other organs. As a result, the overall tally — a benchmark broadcast constantly on cable news and elsewhere — is a less concrete figure than it appears. The inconsistent counting methods also raise questions about the ability to draw comparisons from state to state, and they play into a political debate about the reliability of the numbers.” “The U.S. surgeon general had warned that last week would be like Pearl Harbor as he attempted to create context for the threat — but it turned out that more than five times as many Americans died from covid-19 last week than were killed in the World War II raid,” Dan Keating and Chiqui Esteban report. “In early and mid-March, when America began widespread closures, quarantines and social distancing, covid-19 caused many fewer deaths than other common causes — fewer in a week than chronic liver disease or high blood pressure, and far fewer than suicide or the common flu. By the end of March, the toll was closer to the average weekly deaths from diabetes and Alzheimer’s disease. Into April, weekly covid-19 deaths climbed past those from accidents and chronic lower respiratory disease. And last week, covid-19 killed more people than normally


Amid international skepticism, China defends its official data after revising Wuhan death toll upward by 50 percent

China revised its official coronavirus death toll in Wuhan, the original epicenter of the outbreak, by around 50 percent more Friday, citing new statistical evidence that has emerged as the city begins to reopen following months of lockdown. The reassessment counted 1,290 more deaths, bringing the death toll in the city where the outbreak was first recorded to 3,869. The revision came amid global efforts to produce more accurate data — and growing suspicions among experts and world leaders over how China’s death toll could remain relatively low even as death counts surge across the United States and Europe. Zhao Lijian, a spokesman for the Chinese Foreign Ministry, insisted Friday that this revision in no way indicated a coverup and is based purely on standard efforts to take into account deaths that were previously miscounted or excluded. But President Trump tweeted Friday that China’s numbers were even higher than officials there have disclosed, saying the deaths are “far higher than the U.S., not even close!” Nationwide, China has reported a total of about 83,760 cases of the coronavirus and 4,632 deaths. Italy has reported a much higher rate of death among those diagnosed with the virus, with more than 172,400 cases and around 22,745 deaths. The United States has reported around 672,000 cases and more than 33,800 deaths. Jude Blanchette, who leads China studies at the Center for Strategic and International Studies, said he doesn’t see it as coincidental that China publicly revised its numbers at a time of extraordinary international skepticism over how the relatively low death count compared to other hot spots around the world. But he also said it is entirely possible that, like officials elsewhere, China is gaining new information about how many deaths previously classified as natural causes were in fact linked to the virus. Even in the United States, major discrepancies have emerged over how different states are counting and classifying deaths of people diagnosed with the virus, and experts say the U.S. death toll and case count are probably widely underestimated. Several other countries have also revised their death tolls as they roll out new methods for counting the dead, expanding from just tallying hospital deaths to also including home deaths and deaths in nursing homes. Testing shortages and deaths of patients who contracted the virus but also had underlying conditions have only added to confusion over accurate counts. “It’s naive to think


NASA sets a date for historic SpaceX launch, the first flight of NASA crews from U.S. in nearly a decade

It’s been nearly 10 years since NASA astronauts launched from U.S. soil — a long, ignominious streak that’s been compounded by delays and technical challenges. But finally, the space agency on Friday set the date for when it will fly its astronauts from the Florida Space Coast again: May 27. While the date could change — in spaceflight they often do — the announcement marks a significant milestone in NASA’s winding, at times tortuous, journey to regain its human-spaceflight wings since it retired the space shuttle in 2011. This time, though, the launch will be markedly different from any other in the history of the space agency. Unlike Mercury, Gemini, Apollo or the space shuttle era, the rocket will be owned and operated not by NASA, but by a private company — SpaceX, the hard-charging commercial space company founded by Elon Musk. For all the company’s triumphs, and its experience flying cargo to the International Space Station for NASA, it has never flown a human into space, a significant and dangerous challenge. NASA has spent years working with the California-based company to ensure its Falcon 9 rocket and Dragon spacecraft can safely deliver astronauts to orbit. And the flight would be the culmination of years of work, which has at times seen setbacks and delays. With a successful launch, SpaceX would accomplish an upset over its rival, Boeing, which also is under contract to fly NASA crews to the space station as part of the agency’s “commercial crew program.” Boeing’s Starliner spacecraft suffered significant setbacks during a test flight without astronauts in December that prevented it from docking with the station and prompted an investigation by NASA. That investigation uncovered numerous flaws, and Boeing recently agreed to refly the mission without astronauts on board before proceeding to a crewed flight. With the reflight to be likely toward the end of this year, a crewed Boeing flight is thought unlikely until next year. The company, reeling from the 737 Max crisis and the corornavirus pandemic, has set aside $410 million to pay for the costs of the investigation and the additional test flight. In 2014, NASA awarded a total of $6.8 billion in contracts to SpaceX and Boeing, which won the larger share of the pot, $4.2 billion, while SpaceX got $2.6 billion for the same work. Last year, SpaceX successfully flew its Dragon to the station, paving the way for


When their teammate got brain cancer, Madison girls’ tennis rallied around her

open a new one each day. They provided updates and reassured her about falling behind in schoolwork. “Everyone on the team is really, really close,” Subramanian said. “And even if you were new to the team, they always made you feel included, and Coach Stacy was really nice about it. It was kind of like a family.” Coach Stacey Reynolds said Subramanian’s absence left “a hole." Though she wasn’t a star and had been on the team for only a few months, “she was so positive and so energetic, she was such a big light, that it was really, really hard at first because that light was gone,” Reynolds said. Subramanian came out of the operating room May 20, two days before the Warhawks’ season ended. She couldn’t walk for two months, slowly graduating from a walker to a cane to just her own feet. The recovery process is ongoing. This year, as a junior, Subramanian gained enough strength to attend more classes rather than strictly being tutored from home. She began jogging and had visions of playing tennis competitively again. But like the rest of the country, the novel coronavirus interrupted her plans. Last month, Virginia Gov. Ralph Northam announced that all public schools would be closed for the remainder of the academic year. For Subramanian, the closure felt like a disappointing culmination of months of hard work to return to class. “Honestly, it was kind of frustrating because I was just starting to feel better and get out of the house,” she said. “So it kind of feels like a step backwards.” Now everyone on the team is confined to their homes. Though the players continue to text and call one another, Subramanian said it doesn’t feel the same. She’s sympathetic to the seniors who have lost their final season. Perhaps, her coach suggested, she’s able to provide insight to her teammates about what it’s like to endure a difficult situation over which they have no control. Read more Instead of lacrosse, two Bullis juniors are making protective masks: ‘We have to do this for people’ Gonzaga’s Terrance Williams signs with Michigan on a unique national signing day This national signing day, Instagram Live and Zoom will be players to watch LSU, Clemson and Maryland among final five for five-star quarterback Caleb Williams Butler basketball emphasizes culture, and Gonzaga’s Chuck Harris seems like a fit Winter All-Mets 2020


The states that Trump wants to ‘liberate’ don’t pass the benchmarks he himself set

(the most recent data available). The CDC has daily data on syndromic illnesses in smaller geographic regions which we don’t, so take that metric with a grain of salt. (Vertical lines on these graphs mark two weeks before the most recent data. The most recent data for ILI is from April 11. For syndromic illnesses, it’s April 4. For cases and tests, it’s April 16.) The daily case totals in a state can vary widely and depend on the number of tests completed. That said, the picture in Minnesota, using data from Johns Hopkins University, doesn’t show a consistent downward trend relative to two weeks ago. Data from the COVID Tracking Project indicates that the percent of tests coming back positive has been trending up. Without hitting one of the two case-total benchmarks, Minnesota fails the test. While these recommendations have the feel of being predicated on hard data, there are clearly some gray areas, even beyond our access to immediate information. Consider Michigan. There, influenza-like illness activity has been flat for two weeks, not down. Is that acceptable if the number is low? If it is, then Michigan would appear to be in decent shape. Confirmed case totals are down in Michigan, meeting that requirement. Syndromic activity is also down — though this is again regional data. Michigan and Minnesota are in the same region, but it’s fair to say that the spread of the virus in the states is not equivalent. (Minnesota has the lowest per capita case total while Michigan has one of the highest.) On paper, Virginia also fails the test. ILI activity is down, as is regional syndromic activity. The number of daily cases is up, though, as is the rate of positive tests in the state. Virginia doesn’t hit the benchmarks. Curious how your state fares? We took state-level data from the above sources and created simple graphs for each state. Again: the CDC data for ILI and syndromic cases is narrower and newer than what’s publicly available. So don’t use these charts to reopen your state, governor. This is a complicated issue, one that requires nuance and thoughtful consideration about how to balance the public health of a state with its economic health. Every governor — every American — wants a return to normal. The White House task force offered its thoughts on how best to get there. And then Trump started tweeting.


Readers critique The Post: Please reconcile conflicting information about the coronavirus — or SARS-CoV-2

Every week, The Post runs a collection of letters of readers’ grievances — pointing out grammatical mistakes, missing coverage and inconsistencies. These letters tell us what we did wrong and, occasionally, offer praise. Here, we present this week’s Free for All letters. Amanda Ripley’s April 7 Tuesday Opinion essay, “Five ways to conquer your covid-19 fears,” counseled that the best defense against the threat of the virus is to boost our immune systems. Michael S. Saag’s April 7 op-ed, “What an epidemiologist learned about the virus — from getting it,” explained that the most dangerous thing about the virus is an “overexuberant” immune response. I searched the pages in vain for a third essay, telling me how to reconcile the first two. Joshua Muravchik ● The Post consistently uses the term “the novel coronavirus” to denote the virus causing the current pandemic. For example, this designation was used four times in the April 4 front-page article “For weeks, scientists’ alarm over flawed test grew.” This term is imprecise and ambiguous. The Centers for Disease Control and Prevention website defines “novel coronavirus” as any coronavirus not previously identified. Thus, if we get hit next year by a different new coronavirus, then that virus will presumably become “the novel coronavirus.” Confusion will reign. The CDC states that the official scientific name of the virus causing this pandemic is “SARS-CoV-2,” a term used twice in the article mentioned above. In the interest of accuracy, I would encourage The Post to use only the correct scientific name for this virus. A bonus advantage is that “SARS-CoV-2” takes up less type space than “the novel coronavirus,” leaving more room in the paper for additional nuggets of information. Allan R. Glass ● The photographs alone in the April 5 special section “24 hours inside the lives upended by a pandemic in the nation’s capital” tell the story of the pervasiveness and insidiousness of covid-19. Jim Gardiner ● The April 6 news article “Coronavirus killing more men than women, data show” speculated that estrogen could be a factor in the difference in outcomes between men and women. Here’s an easy test: Pre- and postmenopausal women have radically different levels of estrogen, with the average age of menopause being 51. How do women of different ages fare compared with men of their own age? Is a typical 35-year-old woman’s advantage over her 35-year-old male counterpart greater than a


typical 65-year-old woman’s advantage over her 65-year-old male counterpart? This could give insight into whether estrogen is a factor in the difference in outcomes observed, and might be a treatment option. And why, in the articles I’ve seen on this issue of sex-differentiated outcomes, has no one raised this question? This postmenopausal woman would like to know that, too. Linda Falcão The April 6 news article The current numbers of those who are dying include only those visible sectors of society that can quickly be measured. Diana J. Fox The writer is chairperson of the Department of Anthropology at Bridgewater State University and founder and editor of the Journal of International Women’s Studies. ● The Post is doing a real disservice to the long-term interests of the country by putting covid-19 coverage so consistently and completely at the top of the front page that it minimizes the many other important things happening in the nation and the world. The most important event of this year — in which readers will have an informed say — will be the November election. The Post should give much more attention to what the Trump administration is doing with regard to the environment, judicial appointments, government integrity and other issues of long-term consequence in addition to covid-19 and to what is happening in the rest of the world. Yes, The Post is covering these issues, but it is treating them as if they are incidental. They are not. The Post’s covid-19 coverage also risks becoming sensationalist, as the paper hypes every little thing coming out of the White House. Can we get just the facts on the virus, its economic and social effects, and much more about what else we need to know about non-covid-19 issues, please? Catherine Brown ● Numerous news reports say doctors, nurses and others are or fear experiencing shortages of respirator masks in the coronavirus pandemic. The March 28 Metro article “Hospitals in danger of being swamped” said, “The Maryland Department of Health urged hospitals to reuse respirator masks whenever possible — a practice sanctioned by the federal Centers for Disease Control and Prevention amid the national shortage, which has seen hospitals in New York, Washington state and elsewhere overwhelmed.” Use of the word “sanction” can create confusion. “Sanction” and its derivatives have opposing dictionary definitions; the word can denote either approval or disapproval. Dictionaries commonly define “sanction” (whether as


The Space Force is ready to launch

and culture of the Air Force. One creative idea is allowing lateral transfers from the space business — recruiting a vice president at a fast-growing technology company, say, to become a part-time colonel, sharing his expertise. The space business is hot right now, with launch costs plummeting and new commercial projects booming. Raymond wants to tap this. The force recently posted an announcement of 53 civilian jobs and received 8,144 applications. Raymond says he wants to be highly selective, “keep our numbers small” and build a “lean, agile service.” The force will probably be 10,000 to 15,000, tiny by comparison with other military services, and many members will be civilians. For a military that is burdened by wildly expensive aircraft carriers and fighter jets, the Space Force is a chance to start from scratch. “The challenge for the Space Force leadership will be to break with the status quo, embrace new ideas and technology, and reimagine how our military operates in space. Raymond gets this. The hardest part is actually doing it,” messaged Christian Brose, the former staff director of the Senate Armed Services Committee and a champion of military modernization. We’re used to thinking of space as a benign, boundless environment, where the biggest danger is that satellites will collide with debris. But Raymond warned Congress in February that China has systems in space “capable of damaging, disrupting or destroying satellites as far out as geosynchronous orbit.” The Chinese also have jammers to disrupt space communications and lasers that can blind U.S. satellite sensors. Goldfein said at a defense forum that the United States needs to “punch back.” The Space Force deployed its first offensive weapon, a jamming system, in March, and is readying a space-based reconnaissance system called Silent Barker that can maneuver among satellites and investigate their capabilities and threats. Space weapons are highly classified, and Raymond wouldn’t discuss how the United States might disable or destroy hostile forces in space. But he said that to deter adversaries, the United States must message its capabilities. “They have to know what you have,” he told me. War in space would be catastrophic. Goldfein said that in every war game that involves space, “we’ve never come out winning.” But this week’s Russian anti-satellite missile, and Saturday’s graduation ceremony, remind us that like it or not, we’re entering a new military era. Read more from David Ignatius’s archive, follow him


As Taiwan shows, the antidote to the virus is freedom

We continue to learn more about the Chinese Communist regime’s lies and culpability in the global coronavirus pandemic. But if you want to see the difference between how a totalitarian and a free Chinese society handles a public health emergency, just contrast the actions of the People’s Republic with those of the Republic of China, Taiwan. One is responsible for unleashing a contagion that has infected more than 2 million people; the other has all but defeated the virus. Taiwan should have seen the second-largest outbreak of covid-19 in the world, according to an analysis published in JAMA, the journal of the American Medical Association. The island is just 81 miles off the coast of China, had 2.7 million visitors from the mainland last year and has about 1.25 million citizens who either reside in or work in China. Yet Taiwan has seen only six people die of covid-19 out of a total of just 393 confirmed cases. Even more amazing, 338 of those cases were individuals infected abroad. In other words, Taiwan has seen just 55 local infections, which means it has effectively eliminated community transmission. Earlier this week, the government reported zero new covid-19 cases in Taiwan. What is most impressive is that Taiwan has done all this without ordering its population to shelter in place or shutting down schools, restaurants, stores and other businesses. As a result, Taiwan’s economy is not experiencing the same economic damage as countries under lockdown. So how did Taiwan succeed where Beijing failed? According to the JAMA study, Taiwan took rapid and specific actions to identify and isolate those who either had the virus or came into contact with those who did. First, Taiwan acted fast. On Dec. 31, while Beijing was still denying the virus was capable of human transmission, Taiwanese officials began boarding planes arriving from Wuhan to identify and isolate passengers with fever or pneumonia before they could deplane. On Jan. 5, they denied entry to any individual who had traveled to Wuhan in the past 14 days and had a fever or respiratory symptoms. On Jan. 30, the government expanded its surveillance system to cover all travelers from China, Hong Kong and Macao. On Feb. 6, all international cruise ships were banned. On Feb. 14, an entry quarantine system was implemented that required all travelers to complete electronic health declarations. Anyone identified as high risk was placed under


Singapore’s new covid-19 cases reveal the country’s two very different realities

Kirsten Han is a journalist and writer in Singapore. Singapore’s government is often praised, domestically and internationally, for its planning and foresight — and, in the past few months, particularly for its response to the coronavirus pandemic. But recent developments have demonstrated that you can’t have foresight for things you refuse to see. A sharp increase in covid-19 cases among the country’s migrant worker population has now forced the government to take drastic measures. On Thursday, Singapore saw its highest number of new cases thus far: 728, the vast majority of which were among migrant workers. Nine dormitories, housing more than 50,000 men, mostly from Bangladesh, India and China, have been declared “isolation areas.” On Tuesday, the government put all dormitories effectively on lockdown, meaning that about 300,000 workers now have restrictions on their movements within their complexes. The government appears to have been blindsided by this turn of events. "Unfortunately, we do not have the luxury of the benefit of hindsight,” Minister for National Development Lawrence Wong said in response to a question at a news conference on April 9. Wong is also the co-chair of a task force put together to lead Singapore’s covid-19 response. He added: “The virus is moving so quickly. If I'd known, I would have done things differently. But no one can tell the next step.” While one can appreciate the number of considerations that the task force has to grapple with, an outbreak of the coronavirus among migrant workers should not have come as such a shock. The country has nearly a million work permit holders, usually referring to low-wage workers such as domestic workers or manual laborers. Though domestic workers are required to live with their employers, those who work at construction sites, shipyards, petrochemical refineries, or even as cleaners in neighborhood estates, live in dormitories, often with about 12 to 20 people in a room. One of the earlier clusters of covid-19 was at a construction site. Migrant labor rights groups have been warning for years that these cramped, crowded conditions were a recipe for disaster. Transient Workers Count Too (TWC2) and the local media reported an outbreak of chickenpox in 2008. The same organization pointed out in 2016 that migrant workers were in need of better housing to protect them from the spread of dengue and Zika. This March, before the outbreak of covid-19 among migrant workers really hit home,


D.C., Virginia and Maryland coronavirus cases double in a week to exceed 20,000

emphasize enough that it’s time we start looking forward and start talking about economic recovery.” Hogan has announced that he will roll out a plan next week to reopen the state, but the plan would not be implemented until the state has widespread testing, an army of contract workers, fully ramped up hospital capacity and dramatically more personal protective equipment. Even as leaders start to offer road maps to an economic reopening, there’s no sign they intend to start lifting restrictions. The pandemic has not slowed enough in the District, Maryland and Virginia, where 67 additional deaths were reported across the three jurisdictions Thursday. There were 459 coronavirus-related deaths in Maryland as of Thursday morning, a jump of 46 from Wednesday. The state is now counting probable deaths, which officials say refer to patients whose death certificates list covid-19, the disease caused by the coronavirus, as the cause of death but whose samples have not been subjected to confirmatory laboratory testing. The Washington Post is including both confirmed and probable deaths in its tally for Maryland. There were 10,791 coronavirus cases reported in Maryland on Thursday, up 753 from Wednesday. The District added 153 confirmed cases, bringing its total to 2,354, while Virginia added 393, bringing its total to 6,919, according to The Post’s tally. Eight additional deaths were reported in the District, bringing its total to 81, and 13 were reported in Virginia, for a total of 210. The death toll includes Michael Miller, 60, who helped to manage the Ride On bus fleet for Montgomery County. He was the local government’s first employee to die of covid-19. Also on Thursday, Bowser urged city residents not to let the epidemic impede democracy or an accurate count in the U.S. Census. City officials encouraged the public to complete census forms online and to request mail-in ballots. In a news conference, Bowser highlighted what she called the District’s “fight for equality,” after it was designated a territory and received less coronavirus relief money in a federal aid package. To address this shortfall, she said, city residents should complete the census. “Our emergency funding is directly tied to the census,” she said. “It is especially important to D.C. residents to complete the census this year.” Andrew Trueblood, the director of the D.C. Office of Planning, said census results are used in formulas determining how much federal relief funding the city receives. The


Meat processing plants are closing due to covid-19 outbreaks. Beef shortfalls may follow.

The coronavirus has sickened workers and forced slowdowns and closures of some of the country’s biggest meat processing plants, reducing production by as much as 25 percent, industry officials say, and sparking fears of a further round of hoarding. Several of the country’s largest beef-packing companies have announced plant closures. Before the coronavirus hit, about 660,000 beef cattle were being processed each week at plants across the United States, according to John Bormann, program sales manager for JBS, the American subsidiary of the world’s largest processor of fresh beef and pork. This week there probably will be around 500,000 head processed at U.S. plants still in operation. That’s 25 percent less beef being produced. Some of the slowdown is because of facility closures. Two of the seven largest U.S. facilities — those with the capacity to process 5,000 beef cattle daily — are closed because of the pandemic. Absenteeism, fewer employees and spreading out those remaining employees to maintain social distance are all also contributing to the slow down. JBS USA first closed its Souderton, Pa., beef plant April 7 and then shuttered its Greeley, Colo., beef facility after at least 50 of its 6,000 plant employees tested positive. All have been urged to self-quarantine. National Beef Packing Co. announced Monday the closure of its Tama, Iowa, facility. And Cargill shuttered production at its Hazleton, Pa., ground beef and pork processing plant, and then reduced production at one of Canada’s biggest beef-packing plants after dozens of workers became infected. The meat supply chain is especially vulnerable to the spread of the coronavirus since processing is increasingly done at a handful of massive plants. Another problem in the beef supply, according to Bormann, is something called carcass utilization — the use of the whole animal. “The first problem is we don’t have enough people to process the animals, and number two is they can’t do carcass balance because restaurants are down,” he said. “What’s selling? Freaking hamburger.” Restaurants typically use the expensive stuff — strips, ribs, tenderloins and sirloin, Bormann said, while retail takes the chucks and rounds and trims. With restaurants mostly shuttered, “all of a sudden 23 percent of the animal isn’t being bought because food service is gone,” he said. Industry experts said that the shutdown of beef processing facilities could prompt another round of hoarding at the grocery stores, as with toilet paper and milk several weeks


have been urged to self-quarantine. National Beef Packing Co. announced Monday the closure of its Tama, Iowa, facility. And Cargill shuttered production at its Hazleton, Pa., ground beef and pork processing plant, and then reduced production at one of Canada’s biggest beef-packing plants after dozens of workers became infected. The meat supply chain is especially vulnerable to the spread of the coronavirus since processing is increasingly done at a handful of massive plants. Another problem in the beef supply, according to Bormann, is something called carcass utilization — the use of the whole animal. “The first problem is we don’t have enough people to process the animals, and number two is they can’t do carcass balance because restaurants are down,” he said. “What’s selling? Freaking hamburger.” Restaurants typically use the expensive stuff — strips, ribs, tenderloins and sirloin, Bormann said, while retail takes the chucks and rounds and trims. With restaurants mostly shuttered, “all of a sudden 23 percent of the animal isn’t being bought because food service is gone,” he said. Industry experts said that the shutdown of beef processing facilities could prompt another round of hoarding at the grocery stores, as with toilet paper and milk several weeks ago. U.S. beef sales reached an all-time high in 2019, with 57.7 pounds consumed per capita. Before the pandemic, the National Cattlemen’s Beef Association anticipated a similar outlook for 2020. “Is there a risk that we go through another round of empty shelves?” asked Don Close, senior animal protein analyst in North America for Rabo AgriFinance. “Yes, that’s a very real risk right now. And we could see higher prices.” He said that meat processing companies could offset the losses due to restaurant closures by increasing exports of premium products. Exports to South Korea have grown sharply in recent months. Sophie Mellet-Grinnell, the protein specialist for food distributor Baldor Specialty Foods, said the disruptions in the beef supply chain could also affect consumer prices. “Certain cuts will get more expensive: the grinds and economical cuts, like anything off the chuck, minute steaks, London broil,” she said. “There are a lot of people out of work, so you’ll see an even bigger pull on chicken and inexpensive proteins.” With restaurants closed, some higher-priced cuts may be sold at a discount, she said, “But you can only sell so much at a lower cost before you lose money, so you freeze it.”


Laredo, a key Texas border crossing, uses strict coronavirus measures as it fears spread to rest of U.S.

consume limited resources and perhaps lead to a devastating shutdown of operations. The lack of testing — less than 1 percent of residents have been tested thus far — and fears of a slow response to the virus in densely populated Mexico create additional concerns. Most of the more than 200 positive cases in Laredo were transmitted locally, said Hector Gonzalez, the director of the city’s health department. He said it is critical for Laredo to get its outbreak under control because of the outsize effect that spread here could have on the country. “We were proactive in doing things that were not being done yet in most of the country because we are trying to prevent this thing from getting out of control and taking more lives,” said Victor Trevino, the Laredo Health Department’s health authority. “We have very few weapons and are making do with what we have to protect our city and the country’s No. 1 land port. We are balancing our health with the business of the country.” While some parts of rural middle America have not yet instituted stay-at-home orders or social distancing, Laredo’s City Council acted as it saw its first cases in late March, implementing curfews and threatening residents with fines of up to $1,000 if they didn’t cover their faces with masks when out in public. Police have been breaking up backyard parties and monitoring homes where too many cars are parked. Truck drivers are no longer permitted to get out of their cabs at U.S. Customs and Border Protection checkpoints, and they drop their cargo in Laredo warehouses without touching the merchandise. Warehouse workers are wearing protective equipment, and companies are staggering shifts to keep a small number of people working at any time. Mayor Pete Saenz Jr. (D) said he sees it all as preventive management. “No one knows where this thing is going to take us,” Saenz said. “The only tool we have is isolation. Once it surpasses us, we’ve lost the battle.” To follow the local mask ordinance, Laredo residents can use any cloth covering, including bandannas or scarves, to cover their nose and mouth if they are going to a grocery store or getting outdoor exercise. Community groups are working to sew homemade masks by the hundreds. Police have issued nearly two dozen citations for those not wearing masks, and they have received complaints that have resulted


shut down the asylum system and immediately eject undocumented people from the country, on average in just more than 90 minutes. So far, truck traffic from Mexico has declined by about 7 percent. But pedestrian traffic has plummeted approximately 50 percent, and U.S. Rep. Henry Cuellar (D), who represents the district that includes his hometown of Laredo, said he wonders if there isn’t more that can be done to screen travelers. The drop in travelers is reassuring for Laredo’s health but it also means significant revenue loss from the bridge fees the city collects. “The numbers have dropped considerably, but people are still coming,” Cuellar said. “If something goes wrong, that affects everything else.” Across the border in Nuevo Laredo, customs officers are taking more aggressive steps to slow down foot traffic into Mexico. They are asking travelers from the United States to justify their trips in detail and are using forehead thermometers to screen for coronavirus symptoms. “If you don’t have a reason to cross, you don’t cross,” said Elia Guevara, a licensed customs broker in Nuevo Laredo. The health crisis has shut down U.S. auto manufacturing plants in Mexico, shifting demand toward medical supplies and food. Everything from toilet paper to brand-name household disinfectants such as Clorox are being loaded onto about 14,000 trucks a day crossing Laredo’s ports of entry, customs broker Arturo Dominguez said. “If we were to collapse, shipments would be delayed tremendously, and whatever the country needs won’t arrive,” Dominguez said. “The rest of the country depends on the health of our port.” Ernesto Gaytan Jr., president of the Laredo Motor Carriers Association, said none of his truckers have fallen ill, but he is bracing for the worst-case scenario. One of his drivers was worried this week because he was transporting a load of transformers to a hospital in New York, where the worst outbreak in the country is ongoing. Gaytan had to reassure him. “This is potentially lifesaving work we are doing here,” Gaytan said. “Giving energy to a hospital that needs the equipment.” City leaders worry that without more help from the state and federal governments, it could miss an opportunity to arrest the spread of the virus because of its lack of testing capabilities. Texas broadly lags behind the rest of the nation in testing. The city has been able to test less than 1 percent of its residents and had


Hogan says now is ‘worst possible time’ to lift restrictions; 177,450 file jobless claims in D.C. region; number of cases passes 20,000

The number of known coronavirus cases in the District, Maryland and Virginia stands at 20,064 on Thursday, with 10,791 cases in Maryland, 6,919 in Virginia and 2,354 in the District. The number of virus-related deaths was 459 in Maryland, 210 in Virginia and 81 in the District, for a total of 750 fatalities. Here are some of the most significant recent developments as the region responds to the pandemic of the novel coronavirus, which causes the disease covid-19: • Fewer residents in the Washington region filed for unemployment benefits last week than the prior week, but the numbers remain sharply higher amid a regional and national economic shutdown. In the District, Maryland and Virginia, 177,450 residents filed for jobless claims in the week that ended April 11. • Gov. Larry Hogan (R) said he is working on a plan to reopen Maryland, but now “would be the worst possible time” to lift restrictions. Hogan’s comments came hours before he was scheduled to have a conference call with President Trump, Vice President Pence and the nation’s governors to discuss federal guidelines to reopen the U.S. economy. • Virginia’s shutdown of nonessential businesses will extend until May 8. The closure of hair salons, movie theaters and other nonessential businesses had been set to expire next week before Gov. Ralph Northam (D) extended it, and his stay-at-home order remains in place until June 10. D.C. Mayor Muriel E. Bowser (D) extended a public health emergency until May 15 that had been set to expire after April 24. What a stay-at-home order means for you


Covid-19 is rapidly becoming America’s leading cause of death

many people die of major causes in a typical week. In early and mid-March, when America began widespread closures, quarantines and social distancing, covid-19 caused many fewer deaths than other common causes — fewer in a week than chronic liver disease or high blood pressure, and far fewer than suicide or the common flu. By the end of March, the toll was closer to the average weekly deaths from diabetes and Alzheimer’s disease. Into April, weekly covid-19 deaths climbed past those from accidents and chronic lower respiratory disease. And last week, covid-19 killed more people than normally die of cancer in this country in a week. Only heart disease was likely to kill more people that week. Some experts had predicted that the deaths could peak last week, but there is no decline this week, with new high tolls Tuesday (2,369) and Wednesday (2,441) and another 2,206 on Thursday. That means covid-19 is on pace to be the largest single killer of Americans this week. Covid-19 is not killing at the same pace everywhere: In the worst-hit areas, it is killing at an unparalleled rate. The weekly total of covid-19 deaths in New York state and New York City has dwarfed the scale of normal causes of death — explaining why hospitals are struggling to cope. And although the outbreaks in other cities aren’t as bad, Louisiana and the District of Columbia also had more covid-19 deaths than any typical cause of death last week. In places that started social distancing and restrictions on businesses earlier, the deaths per week are lower: Washington state suffered an early burst of the disease, but covid-19 did not kill as many people there last week as in other hot spots. California has been spared the intensity of many other states. Covid-19 deaths there last week were well below the national rate. These charts all compare covid-19 deaths with the normal numbers of deaths at this time of year in the country or in each particular state or city, according to the Centers for Disease Control and Prevention. The death counts are averages from that month over the last five years of data. It will take more than a year for epidemiologists and statisticians to calculate the final official toll of covid-19 and put it into perspective. Measured against typical deaths, however, covid-19 is already the greatest killer in many parts of the country.


Hospital relief money slow to reach places that need it most, lawmakers and industry groups say

would get less money. The second tranche of funds will be directed to those facilities, officials have said. But even those hospitals that were assisted in the first tranche didn’t get money based on how many covid-19 patients they treated. “If you had 1,000 covid patients or only had one, you might get the same amount of money,” said John Fox, the president and chief executive of Beaumont Health, the largest hospital system in Michigan.  Beaumont has had on average about 1,200 covid-19 patients in its hospital systems in recent days and is treating about a third of the patient load from the most heavily infected area of the state, Fox said. “If you’re going to help with the pandemic, send it to where the pandemic is,” Fox said. Beaumont received $75 million from the stimulus package, Fox said. But the hospital is losing about $100 million a month, because it had to cancel elective surgeries and pay for more equipment and staffing to handle the surge of coronavirus patients. The federal assistance “is not even close” to covering Beaumont’s losses, Fox said. In a statement this week, Rick Pollack, president and chief executive of the American Hospital Association, urged “prompt release of the remaining funds to aid the facilities most affected by the pandemic” and said he was encouraged by efforts by congressional Democratic leaders to provide more funding for health systems as lawmakers consider a second stimulus. The president of the Greater New York Hospital Association, Kenneth E. Raske, wrote in a memo to members regarding the first tranche of funding that “this distribution methodology is woefully insufficient to address the financial challenges facing hospitals at this time, especially those located in hot spot areas such as the New York City region.” Raske said his group has been “totally engaged with the Trump Administration on this issue.” He said that several member chief executives had spoken with Azar and that he had spoken with White House senior adviser Jared Kushner. “While an exact distribution methodology for the next tranche of funds has not yet been identified, we have been assured that COVID-19 hot spots will be prioritized.” The challenge for the Trump administration as it seeks to get that second tranche out the door will be determining which hospitals need it most, and most urgently. Those decisions will probably be guided by several factors, including how much


U.S. now has 22 million unemployed, wiping out a decade of job gains

slash their spending when they see widespread job losses and pay cuts among their friends and family members, another issue likely to prevent a rapid recovery. “Households are spooked by the idea that they might lose their jobs again or have their hours cut again. They see so many different ways their lives can get disrupted,” said economist Ernie Tedeschi of Evercore ISI, a research firm. “They are not going to be confident that things are back to normal until well after the virus has passed.” Tedeschi, a former Treasury Department official, said the psychological scars of so many job losses are likely to be long-lasting. He pointed to how millennials have been reluctant to buy homes, years after the Great Recession, because they are still spooked by seeing so many family and friends experience foreclosure or personal bankruptcy. The 22 million jobless figure is likely an understatement because most gig workers and temporary employees have not been able to apply for aid yet. “Once one adds in those not captured by the data, we are almost certainly facing a 20 percent unemployment rate now,” said Joseph Brusuelas, chief economist at audit firm RSM. “At this point in the pandemic, roughly one in every seven individuals in the workforce is unemployed.” Only 19 states are accepting applications from gig workers and others who normally don’t qualify for traditional aid but are supposed to get the $600 a week pandemic unemployment that Congress approved in March, according to Employ America, which is tracking the state unemployment office problems closely. The remaining states won’t accept applications until later this month or in May. Amanda Fleming lives in Virginia, which is not accepting unemployment applications yet from self-employed workers. Fleming and her husband run a tree-cutting business. They have not been able to even apply for unemployment. Their Small Business Administration loan has not come through, and they were one of millions of Americans who found out this week that their stimulus check is delayed. “Just any help soon would be nice. My son’s prescriptions are coming up soon for renewal,” said Fleming, who lives in Clintwood, Va. “I know it’s not anybody’s fault, but it’s just a mess.” The Fleming family told their landlord that they would pay the other half of the rent this week after their stimulus check came through, but now they don’t know when the money will arrive.


Future pandemics can be prevented, but that’ll rely on unprecedented global cooperation

In a mere four months, the world has been brought to its knees by a previously unknown virus. But covid-19 won’t be the last, or perhaps even the deadliest, pandemic. An estimated 650,000 to 840,000 unknown viral species capable of infecting humans lurk in wildlife. At the same time, population growth, urbanization, globalization, climate change, the relentless destruction of wildlife habitats and the harvesting of wild species have brought these viruses in closer contact with humans than ever before. Pandemics may become the new normal. But that doesn’t have to be. Pandemics are preventable, and the world can do three things to prevent them. First, we can create a global early warning system. Much like systems for tsunamis and earthquakes, an early warning system could allow for early detection of and rapid response to an outbreak before it spreads. It would gather intelligence through a combination of zoonotic reconnaissance, artificial intelligence (AI) surveillance and outbreak investigation. Pandemics usually begin when a virus or other pathogen jumps from animals to people in what is called a zoonotic spillover. The coronaviruses that caused severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and now covid-19 pandemics all jumped from bats to humans through an intermediary animal host — civets in SARS, camels in MERS and a still unknown intermediary in covid-19. Routine reconnaissance for spillover between these sentinel animals and the people in close contact with them could provide early warning of an impending outbreak. Sleuthing for spillovers across the globe is futile unless you know where to look. AI can help. Using machine learning algorithms to sift through molecular, epidemiologic, ecological and climate data, scientists have mapped out global geographic hotspots most vulnerable to zoonotic spillovers. AI can also help with early warning once an outbreak has occurred. The Global Public Health Intelligence Network, an AI-based surveillance system started by Health Canada and the World Health Organization, analyzes more than 20,000 online news reports in nine languages daily. It was credited with sending the first alerts for SARS and MERS. More recently, a private company, using AI-driven algorithms to scour news reports and airline ticketing data, issued an alert about the coronavirus outbreak in Wuhan, China, a week before the Centers for Disease Control and Prevention or WHO did. Big data alone would cause too many false alarms if not backed up by outbreak investigations on the ground. A global


humans through an intermediary animal host — civets in SARS, camels in MERS and a still unknown intermediary in covid-19. Routine reconnaissance for spillover between these sentinel animals and the people in close contact with them could provide early warning of an impending outbreak. Sleuthing for spillovers across the globe is futile unless you know where to look. AI can help. Using machine learning algorithms to sift through molecular, epidemiologic, ecological and climate data, scientists have mapped out global geographic hotspots most vulnerable to zoonotic spillovers. AI can also help with early warning once an outbreak has occurred. The Global Public Health Intelligence Network, an AI-based surveillance system started by Health Canada and the World Health Organization, analyzes more than 20,000 online news reports in nine languages daily. It was credited with sending the first alerts for SARS and MERS. More recently, a private company, using AI-driven algorithms to scour news reports and airline ticketing data, issued an alert about the coronavirus outbreak in Wuhan, China, a week before the Centers for Disease Control and Prevention or WHO did. Big data alone would cause too many false alarms if not backed up by outbreak investigations on the ground. A global early warning system would require a cadre of well-trained epidemiologists who could be rapidly deployed to investigate and contain an outbreak. Programs conducting zoonotic reconnaissance, AI surveillance and outbreak investigations already exist, but they need to be massively scaled up and integrated into a comprehensive global early warning system. Second, we can prevent future pandemics by strengthening public health. Early warnings would be useless if local, national and global public health systems cannot mount an effective response to an outbreak. Places in the world that have crushed the epidemic curve so far — such as Taiwan, Singapore and South Korea — all have robust public health systems that took early actions, set up a unified command, executed a coordinated and science-based strategy, deployed massive technological and human resources, ramped up testing and contact tracing, and provided trustworthy and transparent information to the public. In contrast, testing remains inadequate throughout the United States, and chronic underfunding has left most state and local public health departments without a sufficient workforce to conduct mass contact tracing. Tragically, despite plenty of early warnings, the federal government was unprepared, misguided and disorganized in its response, leaving the states to fend for themselves. Covid-19 exposes the


Prepare for collateral damage as devastating as the virus

the Global Polio Eradication Initiative says that its resources and assets are being turned to fight the pandemic, and it has recommended that all countries planning vaccination campaigns suspend them until the second half of the year. It makes no sense for polio vaccine campaigners to go door-to-door at the time of a pandemic, and the polio campaign does have significant experience with case detection, contact tracing, laboratory testing and community education. Let’s hope the polio campaigns can return later this year. In the meantime, more children will suffer. The number of cases in the last two remaining countries where wild polio virus is endemic, Afghanistan and Pakistan, was down to 33 in 2018, then climbed to 175 in 2019. With the vaccination campaign suspended, wild polio cases will grow and may spread to other countries. On top of that, polio fighters were struggling with outbreaks of a form of the poliovirus that can emerge in under-immunized populations. In rare cases, the use of the oral polio vaccine, which uses a mixture of live, weakened strains, can revert and spread, causing circulating vaccine-derived polio virus, or cVDPV, which occurred in a number of countries in Africa and Asia last year. A high-level World Health Organization panel warned recently that “the risk of new outbreaks in new countries is considered extremely high, even probable.” Meanwhile, the Measles & Rubella Initative, a global partnership to stop measles, reports that because of the pause in mass vaccination campaigns, more than 117 million children in 37 countries may miss out on receiving the measles vaccine this year. This is a major setback when measles cases have exploded around the world and claimed more than 140,000 lives in 2018, mostly children under the age of 5. At the same time, Post correspondents Max Bearak and Joanna Slater report that in Africa and South Asia, the coronavirus will affect carriers of HIV and tuberculosis disproportionately. Tuberculosis is primarily a respiratory disease, like covid-19, which means that those who suffer from it often have severely diminished lung health. And HIV causes a progressive failure of the immune system, leaving carriers more susceptible to death from other infections. There are also serious concerns that the coronavirus pandemic could disrupt health-care systems and lead to a resurgence in malaria, which killed 405,000 people globally in 2018. One virus is creating so much mayhem that other diseases will flourish, too.


When the coughing stops and the sense of helplessness begins

by the loudspeaker: RESPIRATORY STAT TO THE ER. ANESTHESIA STAT TO THE ER. On repeat. Like the alarms. All day. You approach this new patient. It’s immediately clear how bad this is. He’s breathing 40 times a minute, double the normal. He can hardly speak. His oxygen dips. You put him on a face mask. His oxygen level slowly climbs. You put your hands on him. But the purple gloves feel so cold, so distant. Maybe better not to? You want to tell him it’ll be okay. But you don’t think it will. You want to tell him you’ll help him. But he can’t hear you. The mask muffles your voice; the sibilant hiss of oxygen pouring from face masks all over the ER drowns out your words. You try to look him in the eyes, but your goggles fog. “Hey, is there anyone I can call for you?” You get his wife on FaceTime. She sees her husband of 47 years. Breathing fast. Struggling. Alone. She hears the alarms of patients on life support in the background, struggling to stay alive. She sees you in a mask, gown and gloves. You flash back. You remember: 19 days in isolation when you were treated for Ebola. All that time, all you saw were masks. All you felt were gloves. You felt toxic. No matter what they said. No matter what they did. You felt toxic. This is what they see. This is what they feel. So you try to connect. You want to comfort. But how do you connect when you cannot really touch? How do you comfort when they can hardly see through your foggy goggles? Or when the mask muddles every word? When you end your shift, you walk around. Still so many struggling to breathe. Still so many on life support. You can’t help but wonder. Would they still call us heroes if they knew we felt so helpless? Watch the latest Opinions video: Read more: Read a letter responding to this opinion piece Craig Spencer: What it’s like being a New York ER doctor during this pandemic Tamal Ray: I spend my day working in the hospital. Then I come home and bake. Michael Leonberger: Weathering the coronavirus pandemic with an anxiety disorder Michael Saag: Craig Spencer: How long will we doctors last? ’10 days later, he was gone:’ Readers share their personal stories about covid-19


Virus models predict possible outcomes. We can fight to stop the worst ones.

of previous outbreaks, in the form of numbers of deaths, and fitting those curves to the reported status of the pandemic in different states. But it also makes some odd assumptions. A caveat atop the website says clearly: “COVID-19 projections assuming full social distancing through May 2020.” Yet we are nowhere near “full social distancing.” In fact, an analysis of cellphone data has revealed that in some parts of the United States, people appear to be behaving as though we were not in the midst of the biggest public health crisis of our lifetimes. This could mean the IHME estimates of deaths are too optimistic about the effects of physical distancing. (Asked for comment by The Washington Post, Theo Vos, a senior faculty member working on the IHME model, said the team uses more than 20 locations where daily death rates have peaked to inform the shape of the curve elsewhere. The IHME is “using all available data to estimate how many days after the implementation of social distancing measures we can expect the number of daily deaths to peak,” he said. “This is based on observed data in epidemics around the world — and is not making assumptions about the effectiveness of these measures.” The IHME is now incorporating phone location data that shows that social distancing started informally in many places before authorities ordered restrictions, Vos said: “Over the next couple of days, these findings will be incorporated into our models and will make our expected total estimates come down rather than increase. In other words, we may have been more pessimistic rather than too optimistic.”) As Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, put it last month, “Models are as good as the assumptions you put into them. . . . As we get more data, then you put it in and that might change.” The IHME model relies upon observations from individual states, and individual states vary hugely in their testing capacity and approach. To sidestep this, the model uses covid-19 deaths, on the grounds that these are more likely to be picked up accurately than infections are. But certainly not all deaths are being reported, and in a lot of places, the numbers are still too small to make decent predictions from them about what might happen when the virus spreads more rapidly there. In the early stages of


Instead of lacrosse, two Bullis juniors are making protective masks: ‘We have to do this for people’

Juniors Ethan Till and Tyler Kuehl would normally be competing in games for the Bullis lacrosse team this spring, but with the novel coronavirus pandemic prompting a shutdown of sports across the country, that obviously isn’t happening. Still, the teammates realize there are bigger problems than a lost season, and they’re doing something about it. The two have spent much of their free time making respirator masks with the hope of donating them to nursing homes, firefighters and first responders around the area. They are similar to N95 masks but do not technically qualify as such because they have not been approved by the National Institute for Occupational Safety and Health. “My mom found an article online showing the shortage of masks in hospitals,” Till said. “Me and Tyler basically looked at each other and said, ‘We have to do this for people.’ ” The students, both defensemen for the reigning Geico national champions and both University of Pennsylvania commits, found more than 20 mask designs online before settling on what they wanted to reproduce. Then they emailed Gerald Boarman, head of school at Bullis, to ask for permission to use the Potomac private school’s innovation and technology lab. “They indicated that they could make this happen if they had a 3-D printer,” Boarman said. “I said fine and opened up the lab.” Kuehl and Till went to the lab almost every day during spring break, putting the designs in a computer that’s connected to a 3-D printer. The method was time-consuming; they would wait more than four hours for a single mask to print out. To produce masks more efficiently, lab coordinator Matt Zigler insisted they vacuum form the mask, which allowed them to melt a sheet of plastic over a mold created by the printer. “If we vacuum form the masks, in four hours we can make 20 to 30,” said Zigler, who is also making face shield parts for hospitals in Baltimore. “It’s really at that point about how much supplies we have.” A shortage of personal protective equipment has prompted various industries, including auto racing and sports apparel, to shift gears and contribute supplies during the crisis. Demand keeps increasing; many people have begun wearing masks when leaving the house for essential errands. Till and Kuehl can’t mass-produce the protective gear, but every little bit might help. As of this past weekend, they had made 15


With most trips canceled, here’s what the travel industry is doing to help the coronavirus response

It’s been almost a month since the World Health Organization declared covid-19 a global pandemic, and the travel industry has sputtered to a halt. Airlines are carrying a record low number of passengers. Hotels are nearly empty. Conferences are canceled. Cruise ships aren’t going anywhere. Vacations, for now and for who knows how long, are on hold — which leaves a lot of typically bustling spaces with no bustle left. “This covid-19 worldwide outbreak would qualify as kind of the ultimate demand shock in many ways,” said Nathan Line, an associate professor at Florida State University’s Dedman School of Hospitality. But as coronavirus infections grow, many of the staples of typical travel are being repurposed for these atypical times. Last week, hotels were less than a quarter full across the country; occupancy didn’t quite reach 22 percent, according to data from travel research firm STR. “Hotels are having to get creative, those that have stayed open, to drive any kind of demand,” Line said. Even as hotels emptied out, Chip Rogers had a sense that those empty rooms might find another use eventually. The president and CEO of the American Hotel and Lodging Association said the group was contacted by the Department of Health and Human Services asking to help identify properties that could be used as overflow for full hospitals or quarantine purposes. Then, Rogers said, hotels started noticing demand from medical workers who needed a place to stay in areas where the number of coronavirus cases was high. When the association asked its member businesses if they’d be willing to use their rooms in that way, he expected a couple hundred responses. “Lo and behold, now we’re over 15,000,” Rogers said this week. “The response has been considerable.” Dubbed “Hospitality for Hope,” the initiative is finding properties willing to work with emergency managers, public health agencies and federal authorities. Hotel rooms could be leased either for health-care workers, people who need to quarantine, or for some type of medical care. Hotels being used as medical facilities or for quarantines would need to be used fully for those purposes. “Our hope obviously is that it’s not needed, but if it is, we want to make sure there are enough hotels there,” Rogers said. He said some hotels are being paid their full asking rate, but the majority are leasing rooms at steep discounts. He said there are probably hundreds


With the country distracted, the EPA tees off on the environment

more tons of extra planet-warming carbon dioxide to waft into the atmosphere — akin to opening dozens of coal-fired power plants. While auto sticker prices would be lower, forgone fuel savings would cost consumers over the lives of their vehicles. The rationale for such a massive shift is so lame that the EPA struggled to get its cost-benefit numbers to add up. The agency’s own scientific advisory panel warned that the math underlying the new rule was riddled with weaknesses and improbabilities. The United States would move from a leader to a laggard in auto efficiency, which could also hurt U.S. carmakers’ ability to compete with foreign competitors. Years of litigation over this unjustifiable policy move will add more uncertainty to car companies’ manufacturing decisions. The auto rules rollback is only the most spectacular example of the damage the EPA is wreaking while the country looks elsewhere. The Center for Investigative Reporting noted last month that the administration pressed ahead with hearings on whether to regulate a potentially toxic chemical despite many members of the public — and even some of those on the expert panel that convened to consider research on the chemical — not being free to attend during the covid-19 crisis. Also last month, the EPA issued an unusually permissive memo to the companies it regulates, allowing them to skip routine pollution checks, testing and training if they can claim that covid-19 interrupted their operations. Some leeway may be necessary, particularly on requirements for in-person training. But the memo was so broadly worded and out of step with previous EPA practices that it will likely encourage companies to try to get away with far more than the situation demands, with the pandemic as a handy excuse. The document even raised the possibility that polluters might not be punished for creating “an acute risk or an imminent threat to human health or the environment” if they can argue that their failure was tied to the pandemic. Still on deck for quick action are administration efforts to relax rules on coal ash and mercury emissions. One would imagine that a pandemic — one made worse by government officials ignoring experts for too long — would cause Trump administration leaders some pause. Instead, they seem only more determined The Opinions section is looking for stories of how the coronavirus has affected people of all walks of life. Write to us.


As U.S. coronavirus fatality rate rises to 5 percent, experts are still trying to understand how deadly this virus is

may reflect the disease’s gradual progression, combined with discoveries of additional deaths. Without widespread testing In Michigan “Honestly, we talk about this every day,” said Detroit’s EMS medical director, Robert Dunne. “That’s something we’re all wondering. What’s the actual case fatality rate?” The testing shortfalls and other weaknesses in public health surveillance have also sparked concerns that there are jurisdictions missing large numbers of covid-19 deaths. In some instances, officials have increased their numbers after redefining what counts as a coronavirus-related death. On Friday, China acknowledged that many people in Wuhan died at home from undiagnosed covid-19 in the early days of the outbreak, and the government raised the Wuhan death toll by 50 percent, from 2,579 to 3,869. European countries like France and Spain have noted that “all-cause mortality,” especially in the elderly, has been unusually high during the pandemic. A case fatality rate is the number of deaths divided by the number of confirmed cases. But in this global crisis, both the numerator and the denominator are fuzzy. “You need to do more testing,” said Teena Chopra, professor of medicine at Wayne State University’s division of infectious diseases. Without testing, she said, public health experts are forced “to live in an unknown world, and an unknown environment.” In the early days of the outbreak in China, scientists around the world realized that this was a remarkably contagious virus that could lead to a pandemic. But they were cautious about drawing a parallel with the 1918 influenza pandemic. The two pandemics were caused by completely different viruses, and their deadliness depends on many factors, including the vulnerability of the population. The 1918 pandemic occurred when viral diseases were not well understood, medical interventions remained primitive, and many nations were mired in a terrible, preoccupying war that led to a censoring of news about the contagion. No one knows exactly how many people died of influenza in 1918; estimates range from 15 million to 100 million globally. Historians estimate that the virus killed about 675,000 people in the United States across three waves of the pandemic. In contrast to this current pandemic, older people in 1918 seemed to carry at least partial immunity to the influenza virus, probably from exposure to pandemic flu earlier in their lives. The median age of a victim in 1918 was just 28, according to Cecile Viboud, an epidemiologist at the Fogarty International Center, part


of the National Institutes of Health. Even with these sharp distinctions, the lethality and contagiousness of the novel coronavirus, along with its ability to spread and disrupt economies planetwide, has now made 1918 the inescapable comparison point for infectious disease experts. “If, in fact, the case fatality rate is higher than the 1918 flu, then this one has the potential to kill even more people,” said Donald Forthal, an immunologist at the University of California at Irvine. “There’s been nothing like this in my generation. Or my parents’ generation. It was the generation before that that lived through 1918.” A safe and effective vaccine could be at least a year away. That leaves “mitigation,” such as social distancing, the only currently available tool for fighting the pandemic. A newly published paper in the journal Science argues that some mitigation will probably be necessary until 2022. **** The virus officially named SARS-CoV-2 is not only contagious and deadly, it’s also wildly unpredictable. It can kill a person or leave no mark at all. Most clinical cases are mild to moderate, and people can recover at home. Patients often see symptoms come in waves, and sometimes a patient who seems on the road to recovery will take a drastic turn for the worse. There is concern about long-term effects even among those who recover. Covid-19 is categorized as a respiratory disease, but doctors have found that it can affect many organs, including the heart, liver and kidneys. The “virulence” of the virus — its ability to cause illness — has been steadily coming into focus. The disease is far more likely to cause severe outcomes in older people, with the oldest cohorts the most vulnerable. That said, in every age group — even 85-plus — most people who contract the disease will recover. Preliminary research indicates that the virus is not mutating significantly as it spreads, and so there is no evidence that some countries are dealing with a more virulent strain of SARS-CoV-2. What is sharply different from country to country is the demographic profile. Some European countries with relatively elderly populations — Belgium, France, Italy, the Netherlands, Spain and the United Kingdom — are reporting official figures that equate to fatality rates over 10 percent. There are also European countries that are doing far better, such as Norway and Germany, where the figure is in the 2 to 3 percent


road to recovery will take a drastic turn for the worse. There is concern about long-term effects even among those who recover. Covid-19 is categorized as a respiratory disease, but doctors have found that it can affect many organs, including the heart, liver and kidneys. The “virulence” of the virus — its ability to cause illness — has been steadily coming into focus. The disease is far more likely to cause severe outcomes in older people, with the oldest cohorts the most vulnerable. That said, in every age group — even 85-plus — most people who contract the disease will recover. Preliminary research indicates that the virus is not mutating significantly as it spreads, and so there is no evidence that some countries are dealing with a more virulent strain of SARS-CoV-2. What is sharply different from country to country is the demographic profile. Some European countries with relatively elderly populations — Belgium, France, Italy, the Netherlands, Spain and the United Kingdom — are reporting official figures that equate to fatality rates over 10 percent. There are also European countries that are doing far better, such as Norway and Germany, where the figure is in the 2 to 3 percent range. “Think about Italy and Germany,” said Carlos del Rio, an epidemiologist at Emory University. “They’re pretty close to each other . . . [but] one of the things that is clearly different is the median age of patients in Italy is 63 or 64 years; the median age of patients in Germany is 47. The mortality is much lower [in Germany] because they avoided having the older population affected.” The other major factor in mortality is chronic disease. Most people hospitalized with severe cases of covid-19 have chronic health conditions such as diabetes, lung disease and heart disease. Where there is a high percentage of noncommunicable diseases like high blood pressure, the coronavirus will also be more deadly. This is a critical problem for people of color and those living in low-income communities, who have higher rates of these long-term conditions and often have less access to health care. The fatality rate for African Americans in Detroit, for example, has been significantly higher than for whites in the region. “We haven’t seen [the infection rate] to be materially different, but the fatality rate is running two to three times higher among blacks than whites,” Detroit Mayor Mike Duggan said.


rates — Germany, South Korea, Norway — have very high rates of coronavirus testing. This gave them a better look at the disease within their borders. These disparities can be seen within the United States. John Balmes, a professor at the University of California at San Francisco School of Medicine who is working with covid-19 patients at Zuckerberg San Francisco General Hospital, noted that the hospital nearly tripled the capacity of its intensive care unit by adding doctors, nurses and technicians while the city adopted social distancing measures shortly ahead of New York. “We were ready for a surge that never happened,” Balmes said. “They’re every bit as good as we are in intensive care in New York, but the system was overwhelmed. We did physical distancing just a few days earlier than New York, but it was a few days to the good.” New York state, which has now developed high levels of coronavirus testing, is still reporting an official fatality rate of 5.4 percent. **** Early in the outbreak, China’s case fatality rate was 2.3 percent. That was an alarming figure, suggesting that a global pandemic could kill millions of people. Then on March 3 the head of the World Health Organization, Tedros Adhanom Ghebreyesus, said in a news conference that the global case fatality rate was 3.4 percent. That was treated as a revelation about the innate deadliness of the disease, but in fact was simply the WHO’s crude mortality ratio for confirmed covid-19 cases up to that point in time. President Trump said he believed the 3.4 percent was “a false number,” calling that a “hunch” and saying he’d spoken to many people about it. His view echoed that of top U.S. health officials, who had recently told members of Congress that the fatality rate might be between 0.1 percent and 1 percent. But more than a month later, the WHO number has gone even higher: On April 16, the WHO showed a global fatality rate of 6.6 percent among confirmed cases. Any case fatality rate is, in general, an inaccurate number. And yet in the middle of an epidemic, it is hard to do better. With this coronavirus in particular, the inadequate testing means many infections have been missed. Someone who is asymptomatic or has only a mild case is unlikely to seek a test. That makes a virus appear more deadly than it really


As virus surges in Prince George’s, shuttered Laurel hospital will reopen

told how many patients there have tested positive for the coronavirus in the existing outpatient facility. UMMS spokeswoman Jania Matthews said the system’s policy is that any employee who was not wearing personal protective equipment when they were exposed to a covid-19 patient would have been alerted. Unlike other hospitals, leaders say Laurel is blessed with sufficient supplies of that equipment, in part thanks to community donations. Staffers wore full-body protection when transporting beds from shipping pallets into hospital rooms. Designed specifically for the pandemic, the intensive care units have monitors that allow nurses to check patients’ vital signs without entering the room. “The ability to continuously remotely monitor” is key, Wright said, because covid-19 patients “can decompensate quickly” and need to be moved to intensive care. He was particularly excited to point out a staff innovation already implemented at the hospital in Cheverly — a “serenity room” with relaxing music and low lighting where medical workers can go to decompress. “It’s a key indicator of how the staff is rising,” he said. “They’re going to have to take care of each other through this surge.” Laurel’s hospital was taken over by the University of Maryland Medical System and downsized in 2018, a controversial decision made by then-owner Dimensions Healthcare amid serious financial trouble and declining admissions. The state, which directed the reopening, is paying the bill for the conversion of shuttered floors into a pandemic facility. Medical staff have come to Laurel from parts of the country not hit as hard by the virus; they will spend the weekend running through plans and potential crisis situations. Lisa Brown, an ICU nurse from Dallas, said she drove to Maryland from Texas to be part of the effort, after the heart hospital she normally works at stopped doing surgeries during the pandemic. “I’m respectful of the virus,” Brown said when asked whether she was scared by the prospect of working with covid-19 patients for the first time. “I’m very grateful for the PPE.” Other new staff include traveling nurses who have been fighting the virus in hospitals across the country. Jennifer Sorce came from a covid-19 unit in Pittsburgh, which she said wasn’t as overwhelmed by the pandemic. (Allegheny County has reported 947 cases and 43 deaths.) “I feel honored” to be in a hospital unit focused exclusively on covid-19, Sorce said. “I’m excited to get to use my skills.” rachel.weiner@washpost.com


Stimulus checks and other coronavirus relief hindered by dated technology and rocky government rollout

5 Billion Dollar Obamacare website that should have cost close to nothing!" The White House on Friday defended its rollout, saying of the 80 million payments made this week, all but 1 percent reached their intended recipients. Trump on Friday called the initiative an “incredible success.” “We couldn’t be more proud of what we’ve done,” Treasury Secretary Steven Mnuchin said Friday in an interview. Still, the administration faces a big test as over 70 million additional taxpayers are eligible for relief, and many of those without bank accounts or direct deposit information on file could face lengthy delays. Among the problems taxpayers reported this week were payments being sent to incorrect bank accounts, failures to include $500 checks for children, and not getting money at all due to a technical glitch involving some accounts of people who used tax preparers. For example, the IRS sent 300,000 stimulus payments erroneously to accounts held by the bank MetaBank that no longer exists. These accounts are only used temporarily during tax season to receive refunds and figure out what fees go to the tax preparer and what amount goes back to the taxpayer. The bank sent the money back to the IRS, which is now likely to issue paper checks. The IRS didn’t attempt to send out payments to certain other clients of tax preparers because the system couldn’t find their direct deposit information. The glitch potentially impacts up to 21 million people, according to consumer law expert Vijay Raghavan. The IRS has also used some 2018 taxpayer data, and some people have died or changed banks, further complicating the process. The IRS said it is aware of the problems, but is limited in what it can do to help quickly. Taxpayers trying to sort out why they got an inaccurate check — or nothing at all when they qualified for a payment — are unable to communicate with the IRS. With the tax filing deadline delayed to July 15, the agency closed the last of its service centers — in Ogden, Utah — early last week, and the IRS had not been able to expand a pilot telework program for phone agents because of the pandemic, the agency said. Americans were told to use the “Get My Payment” portal on the IRS website to check on the status of their payment and see if they need to input their bank account information.


Rural areas think they’re the coronavirus exception. They’re not.

and Arkansas, three states that had looked relatively immune, are all now dealing with serious outbreaks. In fact, rural areas have some distinct disadvantages compared with big cities. In the large cities where covid-19 first took hold, it took the handful of initial cases months to double and redouble until the sheer number of infections started to overwhelm hospitals. But in a county of 20,000, a disease that is doubling every three to five days would take less than two months to infect 100 percent of the population. By the time doctors even recognized that the disease had arrived in the area, it might well already be too late to stop the disaster. Those areas don’t have so many of the professional jobs that allow people to work from home, so once the disease does get going, it will be very hard to stamp out. Smithfield, a major pork processor, just had to shut down its South Dakota plant because the facility had become the center of an outbreak, a shutdown that meaningfully impacted not just the local economy but also the country’s supply of pork. The hospital systems in rural areas have nothing like the capacity they would need to cope with that sort of outbreak on a wider scale. More than half of all counties in the United States have no intensive care beds. Yet the citizens of those counties tend to be older and sicker than people in urban areas, meaning that if they contract covid-19, they are more likely to need intensive care. So one can tell a very different story about the nationwide lockdowns, almost the opposite of the one in which less dense areas are being forced to #CancelEverything in order to protect New York. In that story, New York’s experience is protecting them by serving as an early warning while they still have time to avoid that city’s fate — or possibly an even worse one — by shutting down now, and then building up the test-trace-quarantine infrastructure that can keep their region covid-free even when restrictions are lifted. But for this story to have its happy ending, they’ll have to abandon that other narrative and face the unpleasant reality that New Yorkers have belatedly acknowledged: No person or place is really that different from you, and no law of nature will keep this virus in far-off places, killing people you’ve never met.