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How the Pandemic Will End

The U.S. may end up with the worst COVID-19 outbreak in the industrialized world. This is how it’s going to play out.

Joan Wong

Story by Ed Yong

Three months ago, no one knew that SARS-CoV-2 existed. Now the virus has spread to almost every country, infecting at least 446,000 people whom we know about, and many more whom we do not. It has crashed economies and broken health-care systems, filled hospitals and emptied public spaces. It has separated people from their workplaces and their friends. It has disrupted modern society on a scale that most living people have never witnessed. Soon, most everyone in the United States will know someone who has been infected. Like World War II or the 9/11 attacks, this pandemic has already imprinted itself upon the nation’s psyche.

A global pandemic of this scale was inevitable. In recent years, hundreds of health experts have written books, white papers, and op-eds warning of the possibility. Bill Gates has been telling anyone who would listen, including the 18 million viewers of his TED Talk. In 2018, I wrote a story for The Atlantic arguing that America was not ready for the pandemic that would eventually come. In October, the Johns Hopkins Center for Health Security war-gamed what might happen if a new coronavirus swept the globe. And then one did. Hypotheticals became reality. “What if?” became “Now what?”

As we’ll see, Gen C’s lives will be shaped by the choices made in the coming weeks, and by the losses we suffer as a result. But first, a brief reckoning. On the Global Health Security Index, a report card that grades every country on its pandemic preparedness, the United States has a score of 83.5—the world’s highest. Rich, strong, developed, America is supposed to be the readiest of nations. That illusion has been shattered. Despite months of advance warning as the virus spread in other countries, when America was finally tested by COVID-19, it failed.

“No matter what, a virus [like SARS-CoV-2] was going to test the resilience of even the most well-equipped health systems,” says Nahid Bhadelia, an infectious-diseases physician at the Boston University School of Medicine. More transmissible and fatal than seasonal influenza, the new coronavirus is also stealthier, spreading from one host to another for several days before triggering obvious symptoms. To contain such a pathogen, nations must develop a test and use it to identify infected people, isolate them, and trace those they’ve had contact with. That is what South Korea, Singapore, and Hong Kong did to tremendous effect. It is what the United States did not.

The testing fiasco was the original sin of America’s pandemic failure, the single flaw that undermined every other countermeasure. If the country could have accurately tracked the spread of the virus, hospitals could have executed their pandemic plans, girding themselves by allocating treatment rooms, ordering extra supplies, tagging in personnel, or assigning specific facilities to deal with COVID-19 cases. None of that happened. Instead, a health-care system that already runs close to full capacity, and that was already challenged by a severe flu season, was suddenly faced with a virus that had been left to spread, untracked, through communities around the country. Overstretched hospitals became overwhelmed. Basic protective equipment, such as masks, gowns, and gloves, began to run out. Beds will soon follow, as will the ventilators that provide oxygen to patients whose lungs are besieged by the virus.

Partly, that’s because the White House is a ghost town of scientific expertise. A pandemic-preparedness office that was part of the National Security Council was dissolved in 2018. On January 28, Luciana Borio, who was part of that team, urged the government to “act now to prevent an American epidemic,” and specifically to work with the private sector to develop fast, easy diagnostic tests. But with the office shuttered, those warnings were published in The Wall Street Journal, rather than spoken into the president’s ear. Instead of springing into action, America sat idle.

Rudderless, blindsided, lethargic, and uncoordinated, America has mishandled the COVID-19 crisis to a substantially worse degree than what every health expert I’ve spoken with had feared. “Much worse,” said Ron Klain, who coordinated the U.S. response to the West African Ebola outbreak in 2014. “Beyond any expectations we had,” said Lauren Sauer, who works on disaster preparedness at Johns Hopkins Medicine. “As an American, I’m horrified,” said Seth Berkley, who heads Gavi, the Vaccine Alliance. “The U.S. may end up with the worst outbreak in the industrialized world.”

I. The Next Months

Having fallen behind, it will be difficult—but not impossible—for the United States to catch up. To an extent, the near-term future is set because COVID-19 is a slow and long illness. People who were infected several days ago will only start showing symptoms now, even if they isolated themselves in the meantime. Some of those people will enter intensive-care units in early April. As of last weekend, the nation had 17,000 confirmed cases, but the actual number was probably somewhere between 60,000 and 245,000. Numbers are now starting to rise exponentially: As of Wednesday morning, the official case count was 54,000, and the actual case count is unknown. Health-care workers are already seeing worrying signs: dwindling equipment, growing numbers of patients, and doctors and nurses who are themselves becoming infected.

Italy and Spain offer grim warnings about the future. Hospitals are out of room, supplies, and staff. Unable to treat or save everyone, doctors have been forced into the unthinkable: rationing care to patients who are most likely to survive, while letting others die. The U.S. has fewer hospital beds per capita than Italy. A study

released by a team at Imperial College London concluded that if the pandemic is left unchecked, those beds will all be full by late April. By the end of June, for every available critical-care bed, there will be roughly 15 COVID-19 patients in need of one.  By the end of the summer, the pandemic will have directly killed 2.2 million Americans, notwithstanding those who will indirectly die as hospitals are unable to care for the usual slew of heart attacks, strokes, and car accidents. This is the worst-case scenario. To avert it, four things need to happen—and quickly.

The first and most important is to rapidly produce masks, gloves, and other personal protective equipment. If health-care workers can’t stay healthy, the rest of the response will collapse. In some places, stockpiles are already so low that doctors are reusing masks between patients, calling for donations from the public, or sewing their own homemade alternatives. These shortages are happening because medical supplies are made-to-order and depend on byzantine international supply chains that are currently straining and snapping. Hubei province in China, the epicenter of the pandemic, was also a manufacturing center of medical masks.

In the U.S., the Strategic National Stockpile—a national larder of medical equipment—is already being deployed, especially to the hardest-hit states. The stockpile is not inexhaustible, but it can buy some time. Donald Trump could use that time to invoke the Defense Production Act, launching a wartime effort in which American manufacturers switch to making medical equipment. But after invoking the act last Wednesday, Trump has failed to actually use it, reportedly due to lobbying from the U.S. Chamber of Commerce and heads of major corporations.

Some manufacturers are already rising to the challenge, but their efforts are piecemeal and unevenly distributed. “One day, we’ll wake up to a story of doctors in City X who are operating with bandanas, and a closet in City Y with masks piled into it,” says Ali Khan, the dean of public health at the University of Nebraska Medical Center. A “massive logistics and supply-chain operation [is] now needed across the country,” says Thomas Inglesby of Johns Hopkins Bloomberg School of Public Health. That can’t be managed by small and inexperienced teams scattered throughout the White House. The solution, he says, is to tag in the Defense Logistics Agency—a 26,000-person group that prepares the U.S. military for overseas operations and that has assisted in past public-health crises, including the 2014 Ebola outbreak.

This agency can also coordinate the second pressing need: a massive rollout of COVID-19 tests. Those tests have been slow to arrive because of five separate shortages: of masks to protect people administering the tests; of nasopharyngeal swabs for collecting viral samples; of extraction kits for pulling the virus’s genetic material out of the samples; of chemical reagents that are part of those kits; and of trained people who can give the tests. Many of these shortages are, again, due to strained supply chains. The U.S. relies on three manufacturers for extraction reagents, providing redundancy in case any of them fails—but all of them failed in the face of unprecedented global demand. Meanwhile, Lombardy, Italy, the hardest-hit place in Europe, houses one of the largest manufacturers of nasopharyngeal swabs.

Some shortages are being addressed. The FDA is now moving quickly to approve tests developed by private labs. At least one can deliver results in less than an hour, potentially allowing doctors to know if the patient in front of them has COVID-19. The country “is adding capacity on a daily basis,” says Kelly Wroblewski of the Association of Public Health Laboratories.

On March 6, Trump said that “anyone who wants a test can get a test.” That was (and still is) untrue, and his own officials were quick to correct him. Regardless, anxious people still flooded into hospitals, seeking tests that did not exist. “People wanted to be tested even if they weren’t symptomatic, or if they sat next to someone with a cough,” says Saskia Popescu of George Mason University, who works to prepare hospitals for pandemics. Others just had colds, but doctors still had to use masks to examine them, burning through their already dwindling supplies. “It really stressed the health-care system,” Popescu says. Even now, as capacity expands, tests must be used carefully. The first priority, says Marc Lipsitch of Harvard, is to test health-care workers and hospitalized patients, allowing hospitals to quell any ongoing fires. Only later, once the immediate crisis is slowing, should tests be deployed in a more widespread way. “This isn’t just going to be: Let’s get the tests out there!” Inglesby says.

These measures will take time, during which the pandemic will either accelerate beyond the capacity of the health system or slow to containable levels. Its course—and the nation’s fate—now depends on the third need, which is social distancing. Think of it this way: There are now only two groups of Americans. Group A includes everyone involved in the medical response, whether that’s treating patients, running tests, or manufacturing supplies. Group B includes everyone else, and their job is to buy Group A more time. Group B must now “flatten the curve” by physically isolating themselves from other people to cut off chains of transmission. Given the slow fuse of COVID-19, to forestall the future collapse of the health-care system, these seemingly drastic steps must be taken immediatelybefore they feel proportionate, and they must continue for several weeks.

Persuading a country to voluntarily stay at home is not easy, and without clear guidelines from the White House, mayors, governors, and business owners have been forced to take their own steps. Some states have banned large gatherings or closed schools and restaurants. At least 21 have now instituted some form of mandatory quarantine, compelling people to stay at home. And yet many citizens continue to crowd into public spaces.

In these moments, when the good of all hinges on the sacrifices of many, clear coordination matters—the fourth urgent need. The importance of social distancing must be impressed upon a public who must also be reassured and informed. Instead, Trump has repeatedly played down the problem, telling America that “we have it very well under control” when we do not, and that cases were “going to be down to close to zero” when they were rising. In some cases, as with his claims about ubiquitous testing, his misleading gaffes have deepened the crisis. He has even touted unproven medications.

Away from the White House press room, Trump has apparently been listening to Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases. Fauci has advised every president since Ronald Reagan on new epidemics, and now sits on the COVID-19 task force that meets with Trump roughly every other day. “He’s got his own style, let’s leave it at that,” Fauci told me, “but any kind of recommendation that I have made thus far, the substance of it, he has listened to everything.”

But Trump already seems to be wavering. In recent days, he has signaled that he is prepared to backtrack on social-distancing policies in a bid to protect the economy. Pundits and business leaders have used similar rhetoric, arguing that high-risk people, such as the elderly, could be protected while lower-risk people are allowed to go back to work. Such thinking is seductive, but flawed. It overestimates our ability to assess a person’s risk, and to somehow wall off the ‘high-risk’ people from the rest of society. It underestimates how badly the virus can hit ‘low-risk’ groups, and how thoroughly hospitals will be overwhelmed if even just younger demographics are falling sick.

A recent analysis from the University of Pennsylvania estimated that even if social-distancing measures can reduce infection rates by 95 percent, 960,000 Americans will still need intensive care. There are only about 180,000 ventilators in the U.S. and, more pertinently, only enough respiratory therapists and critical-care staff to safely look after 100,000 ventilated patients. Abandoning social distancing would be foolish. Abandoning it now, when tests and protective equipment are still scarce, would be catastrophic.

If Trump stays the course, if Americans adhere to social distancing, if testing can be rolled out, and if enough masks can be produced, there is a chance that the country can still avert the worst predictions about COVID-19, and at least temporarily bring the pandemic under control. No one knows how long that will take, but it won’t be quick. “It could be anywhere from four to six weeks to up to three months,” Fauci said, “but I don’t have great confidence in that range.”

II. The Endgame

Even a perfect response won’t end the pandemic. As long as the virus persists somewhere, there’s a chance that one infected traveler will reignite fresh sparks in countries that have already extinguished their fires. This is already happening in China, Singapore, and other Asian countries that briefly seemed to have the virus under control. Under these conditions, there are three possible endgames: one that’s very unlikely, one that’s very dangerous, and one that’s very long.

The first is that every nation manages to simultaneously bring the virus to heel, as with the original SARS in 2003. Given how widespread the coronavirus pandemic is, and how badly many countries are faring, the odds of worldwide synchronous control seem vanishingly small.

The second is that the virus does what past flu pandemics have done: It burns through the world and leaves behind enough immune survivors that it eventually struggles to find viable hosts. This “herd immunity” scenario would be quick, and thus tempting. But it would also come at a terrible cost: SARS-CoV-2 is more transmissible and fatal than the flu, and it would likely leave behind many millions of corpses and a trail of devastated health systems. The United Kingdom initially seemed to consider this herd-immunity strategy, before backtracking when models revealed the dire consequences. The U.S. now seems to be considering it too.

The third scenario is that the world plays a protracted game of whack-a-mole with the virus, stamping out outbreaks here and there until a vaccine can be produced. This is the best option, but also the longest and most complicated.

It depends, for a start, on making a vaccine. If this were a flu pandemic, that would be easier. The world is experienced at making flu vaccines and does so every year. But there are no existing vaccines for coronaviruses—until now, these viruses seemed to cause diseases that were mild or rare—so researchers must start from scratch. The first steps have been impressively quick. Last Monday, a possible vaccine created by Moderna and the National Institutes of Health went into early clinical testing. That marks a 63-day gap between scientists sequencing the virus’s genes for the first time and doctors injecting a vaccine candidate into a person’s arm. “It’s overwhelmingly the world record,” Fauci said.

But it’s also the fastest step among many subsequent slow ones. The initial trial will simply tell researchers if the vaccine seems safe, and if it can actually mobilize the immune system. Researchers will then need to check that it actually prevents infection from SARS-CoV-2. They’ll need to do animal tests and large-scale trials to ensure that the vaccine doesn’t cause severe side effects. They’ll need to work out what dose is required, how many shots people need, if the vaccine works in elderly people, and if it requires other chemicals to boost its effectiveness.

“Even if it works, they don’t have an easy way to manufacture it at a massive scale,” said Seth Berkley of Gavi. That’s because Moderna is using a new approach to vaccination. Existing vaccines work by providing the body with inactivated or fragmented viruses, allowing the immune system to prep its defenses ahead of time. By contrast, Moderna’s vaccine comprises a sliver of SARS-CoV-2’s genetic material—its RNA. The idea is that the body can use this sliver to build its own viral fragments, which would then form the basis of the immune system’s preparations. This approach works in animals, but is unproven in humans. By contrast, French scientists are trying to modify the existing measles vaccine using fragments of the new coronavirus. “The advantage of that is that if we needed hundreds of doses tomorrow, a lot of plants in the world know how to do it,” Berkley said. No matter which strategy is faster, Berkley and others estimate that it will take 12 to 18 months to develop a proven vaccine, and then longer still to make it, ship it, and inject it into people’s arms.

It’s likely, then, that the new coronavirus will be a lingering part of American life for at least a year, if not much longer. If the current round of social-distancing measures works, the pandemic may ebb enough for things to return to a semblance of normalcy. Offices could fill and bars could bustle. Schools could reopen and friends could reunite. But as the status quo returns, so too will the virus. This doesn’t mean that society must be on continuous lockdown until 2022. But “we need to be prepared to do multiple periods of social distancing,” says Stephen Kissler of Harvard.

Much about the coming years, including the frequency, duration, and timing of social upheavals, depends on two properties of the virus, both of which are currently unknown. First: seasonality. Coronaviruses tend to be winter infections that wane or disappear in the summer. That may also be true for SARS-CoV-2, but seasonal variations might not sufficiently slow the virus when it has so many immunologically naive hosts to infect. “Much of the world is waiting anxiously to see what—if anything—the summer does to transmission in the Northern Hemisphere,” says Maia Majumder of Harvard Medical School and Boston Children’s Hospital.

Second: duration of immunity. When people are infected by the milder human coronaviruses that cause cold-like symptoms, they remain immune for less than a year. By contrast, the few who were infected by the original SARS virus, which was far more severe, stayed immune for much longer. Assuming that SARS-CoV-2 lies somewhere in the middle, people who recover from their encounters might be protected for a couple of years. To confirm that, scientists will need to develop accurate serological tests, which look for the antibodies that confer immunity. They’ll also need to confirm that such antibodies actually stop people from catching or spreading the virus. If so, immune citizens can return to work, care for the vulnerable, and anchor the economy during bouts of social distancing.

Scientists can use the periods between those bouts to develop antiviral drugs—although such drugs are rarely panaceas, and come with possible side effects and the risk of resistance. Hospitals can stockpile the necessary supplies. Testing kits can be widely distributed to catch the virus’s return as quickly as possible. There’s no reason that the U.S. should let SARS-CoV-2 catch it unawares again, and thus no reason that social-distancing measures need to be deployed as broadly and heavy-handedly as they now must be. As Aaron E. Carroll and Ashish Jha recently wrote, “We can keep schools and businesses open as much as possible, closing them quickly when suppression fails, then opening them back up again once the infected are identified and isolated. Instead of playing defense, we could play more offense.”

Whether through accumulating herd immunity or the long-awaited arrival of a vaccine, the virus will find spreading explosively more and more difficult. It’s unlikely to disappear entirely. The vaccine may need to be updated as the virus changes, and people may need to get revaccinated on a regular basis, as they currently do for the flu. Models suggest that the virus might simmer around the world, triggering epidemics every few years or so. “But my hope and expectation is that the severity would decline, and there would be less societal upheaval,” Kissler says. In this future, COVID-19 may become like the flu is today—a recurring scourge of winter. Perhaps it will eventually become so mundane that even though a vaccine exists, large swaths of Gen C won’t bother getting it, forgetting how dramatically their world was molded by its absence.

III. The Aftermath

The cost of reaching that point, with as few deaths as possible, will be enormous. As my colleague Annie Lowrey wrote, the economy is experiencing a shock “more sudden and severe than anyone alive has ever experienced.” About one in five people in the United States have lost working hours or jobs. Hotels are empty. Airlines are grounding flights. Restaurants and other small businesses are closing. Inequalities will widenPeople with low incomes will be hardest-hit by social-distancing measures, and most likely to have the chronic health conditions that increase their risk of severe infections. Diseases have destabilized cities and societies many times over, “but it hasn’t happened in this country in a very long time, or to quite the extent that we’re seeing now,” says Elena Conis, a historian of medicine at UC Berkeley. “We’re far more urban and metropolitan. We have more people traveling great distances and living far from family and work.”

After infections begin ebbing, a secondary pandemic of mental-health problems will follow. At a moment of profound dread and uncertainty, people are being cut off from soothing human contact. Hugs, handshakes, and other social rituals are now tinged with danger. People with anxiety or obsessive-compulsive disorder are struggling. Elderly people, who are already excluded from much of public life, are being asked to distance themselves even further, deepening their loneliness. Asian people are suffering racist insults, fueled by a president who insists on labeling the new coronavirus the “Chinese virus.” Incidents of domestic violence and child abuse are likely to spike as people are forced to stay in unsafe homes. Children, whose bodies are mostly spared by the virus, may endure mental trauma that stays with them into adulthood.

After the pandemic, people who recover from COVID-19 might be shunned and stigmatized, as were survivors of Ebola, SARS, and HIV. Health-care workers will take time to heal: One to two years after SARS hit Toronto, people who dealt with the outbreak were still less productive and more likely to be experiencing burnout and post-traumatic stress. People who went through long bouts of quarantine will carry the scars of their experience. “My colleagues in Wuhan note that some people there now refuse to leave their homes and have developed agoraphobia,” says Steven Taylor of the University of British Columbia, who wrote The Psychology of Pandemics.

But “there is also the potential for a much better world after we get through this trauma,” says Richard Danzig of the Center for a New American Security. Already, communities are finding new ways of coming together, even as they must stay apart. Attitudes to health may also change for the better. The rise of HIV and AIDS “completely changed sexual behavior among young people who were coming into sexual maturity at the height of the epidemic,” Conis says. “The use of condoms became normalized. Testing for STDs became mainstream.” Similarly, washing your hands for 20 seconds, a habit that has historically been hard to enshrine even in hospitals, “may be one of those behaviors that we become so accustomed to in the course of this outbreak that we don’t think about them,” Conis adds.

Pandemics can also catalyze social change. People, businesses, and institutions have been remarkably quick to adopt or call for practices that they might once have dragged their heels on, including working from home, conference-calling to accommodate people with disabilities, proper sick leave, and flexible child-care arrangements. “This is the first time in my lifetime that I’ve heard someone say, ‘Oh, if you’re sick, stay home,’” says Adia Benton, an anthropologist at Northwestern University. Perhaps the nation will learn that preparedness isn’t just about masks, vaccines, and tests, but also about fair labor policies and a stable and equal health-care system. Perhaps it will appreciate that health-care workers and public-health specialists compose America’s social immune system, and that this system has been suppressed.

Aspects of America’s identity may need rethinking after COVID-19. Many of the country’s values have seemed to work against it during the pandemic. Its individualism, exceptionalism, and tendency to equate doing whatever you want with an act of resistance meant that when it came time to save lives and stay indoors, some people flocked to bars and clubs. Having internalized years of anti-terrorism messaging following 9/11, Americans resolved to not live in fear. But SARS-CoV-2 has no interest in their terror, only their cells.

Years of isolationist rhetoric had consequences too. Citizens who saw China as a distant, different place, where bats are edible and authoritarianism is acceptable, failed to consider that they would be next or that they wouldn’t be ready. (China’s response to this crisis had its own problems, but that’s for another time.) “People believed the rhetoric that containment would work,” says Wendy Parmet, who studies law and public health at Northeastern University. “We keep them out, and we’ll be okay. When you have a body politic that buys into these ideas of isolationism and ethnonationalism, you’re especially vulnerable when a pandemic hits.”

Veterans of past epidemics have long warned that American society is trapped in a cycle of panic and neglect. After every crisis—anthrax, SARS, flu, Ebola—attention is paid and investments are made. But after short periods of peacetime, memories fade and budgets dwindle. This trend transcends red and blue administrations. When a new normal sets in, the abnormal once again becomes unimaginable. But there is reason to think that COVID-19 might be a disaster that leads to more radical and lasting change.

The other major epidemics of recent decades either barely affected the U.S. (SARS, MERS, Ebola), were milder than expected (H1N1 flu in 2009), or were mostly limited to specific groups of people (Zika, HIV). The COVID-19 pandemic, by contrast, is affecting everyone directly, changing the nature of their everyday life. That distinguishes it not only from other diseases, but also from the other systemic challenges of our time. When an administration prevaricates on climate change, the effects won’t be felt for years, and even then will be hard to parse. It’s different when a president says that everyone can get a test, and one day later, everyone cannot. Pandemics are democratizing experiences. People whose privilege and power would normally shield them from a crisis are facing quarantines, testing positive, and losing loved ones. Senators are falling sick. The consequences of defunding public-health agencies, losing expertise, and stretching hospitals are no longer manifesting as angry opinion pieces, but as faltering lungs.

After 9/11, the world focused on counterterrorism. After COVID-19, attention may shift to public health. Expect to see a spike in funding for virology and vaccinology, a surge in students applying to public-health programs, and more domestic production of medical supplies. Expect pandemics to top the agenda at the United Nations General Assembly. Anthony Fauci is now a household name. “Regular people who think easily about what a policewoman or firefighter does finally get what an epidemiologist does,” says Monica Schoch-Spana, a medical anthropologist at the Johns Hopkins Center for Health Security.

Such changes, in themselves, might protect the world from the next inevitable disease. “The countries that had lived through SARS had a public consciousness about this that allowed them to leap into action,” said Ron Klain, the former Ebola czar. “The most commonly uttered sentence in America at the moment is, ‘I’ve never seen something like this before.’ That wasn’t a sentence anyone in Hong Kong uttered.” For the U.S., and for the world, it’s abundantly, viscerally clear what a pandemic can do.

The lessons that America draws from this experience are hard to predict, especially at a time when online algorithms and partisan broadcasters only serve news that aligns with their audience’s preconceptions. Such dynamics will be pivotal in the coming months, says Ilan Goldenberg, a foreign-policy expert at the Center for a New American Security. “The transitions after World War II or 9/11 were not about a bunch of new ideas,” he says. “The ideas are out there, but the debates will be more acute over the next few months because of the fluidity of the moment and willingness of the American public to accept big, massive changes.”

One could easily conceive of a world in which most of the nation believes that America defeated COVID-19. Despite his many lapses, Trump’s approval rating has surged. Imagine that he succeeds in diverting blame for the crisis to China, casting it as the villain and America as the resilient hero. During the second term of his presidency, the U.S. turns further inward and pulls out of NATO and other international alliances, builds actual and figurative walls, and disinvests in other nations. As Gen C grows up, foreign plagues replace communists and terrorists as the new generational threat.

One could also envisage a future in which America learns a different lesson. A communal spirit, ironically born through social distancing, causes people to turn outward, to neighbors both foreign and domestic. The election of November 2020 becomes a repudiation of “America first” politics. The nation pivots, as it did after World War II, from isolationism to international cooperation. Buoyed by steady investments and an influx of the brightest minds, the health-care workforce surges. Gen C kids write school essays about growing up to be epidemiologists. Public health becomes the centerpiece of foreign policy. The U.S. leads a new global partnership focused on solving challenges like pandemics and climate change.

In 2030, SARS-CoV-3 emerges from nowhere, and is brought to heel within a month.

ED YONG is a staff writer at The Atlantic, where he covers science.
 

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Left-leaning critics of U.S. President Donald Trump rejected his claims to overseeing unprecedented economic growth in early 2020. Who was right?

Origin

In February 2020, we received multiple inquiries from readers about the veracity of social media posts and news articles which claimed that the U.S. economy had added 1.5 million more jobs during former President Barack Obama’s final three years in office, than it did during President Donald Trump’s first three years.

On Feb. 17, Rep. Carolyn Maloney, D-New York, tweeted that Obama had “created 1.5 million more jobs in his last 3 years than Donald Trump has in his first 3 years.”

Earlier, the left-leaning Democratic Coalition group posted a link to a Yahoo! News article with the headline “Trump’s First 3 Years Created 1.5 Million Fewer Jobs Than Obama’s Last 3,” adding “FACT: New figures from Trump’s own Department of Labor show that 6.6 million new jobs were created in the first 36 months of Trump’s tenure, compared with 8.1 million in the final 36 months of Obama’s ― a decline of 19% under Trump.”

 

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The issue for boomers won’t be ‘aging in place’ The real question will be, ‘How do I get out of this place?’

old woman driving old BMW

You can only do this for so long. (Photo: Mick Tinbergen/Wikimedia Commons)

The oldest baby boomers have just turned 70, and most can drive to their birthday parties. They’re being followed by 70 million other boomers, all happily motoring along. Their parents? Not so good these days. Janet Morrissey of The New York Times looks at the issue of transportation for senior citizens and sees a problem: lack of transportation.

It’s no longer enough to call a taxi or regular car service and hope that frail seniors can get in and out — or through the entrance of a doctor’s office on their own as the driver speeds off. For people requiring oxygen tanks and wheelchairs, it’s an even bigger challenge, and long waiting periods are often required to arrange for specially equipped vehicles.

Morrissey is interviewing people in their 80s and 90s but recognizes that this will be a growing problem.

“It’s going to become a massive phenomena,[sic]” said Ken Dychtwald, founder and chief executive of Age Wave, a consulting firm specializing in age-related issues. “This is an unmet need that’s going to be in the tens of millions of people.”

I read the article with increasing incredulity as she talks about new startups like RoundTrip and Circulation that provide rides. Reading it makes me want to scream in all bold capital letters: THIS ISN’T A TRANSPORTATION PROBLEM. IT’S AN URBAN DESIGN PROBLEM! Only once, in the entire article, did it mention that we are in this mess because of the great suburban experiment of designing our world around cars.

One woman who cannot drive because of a broken elbow complains:

“In the suburbs, there is no public transportation whatsoever,” she said. “When you don’t have access to public transportation and your spouse is working and your children are no longer home, it’s a little difficult to get to your appointments.”

According to Morrissey, 30 percent of patients skip appointments because they can’t get to them, and it costs the health care industry $150 billion per year. And these are serious Greatest Generation seniors, not baby boomers who are coming up next. The next 20 years will be a different story. Why? Because 70 percent of baby boomers live in the suburbs.

“With the population aging, we absolutely see a lot of growth in need,” said Jennifer Hartt, director of investments in health and digital health for Ben Franklin Technology Partners and an early investor in RoundTrip.

My first reaction was “well, duh…”. But baby boomers are dreaming if they think that services like RoundTrip can fill the needs of 70 million aging boomers.

Asking the wrong questions

disability prevalence as you ageWhat goes wrong first when you get old. (Photo: JCHS)

Baby boomers are looking around their houses and thinking “What can I do so that I can age in place?” and investing in renovations, when all the data show that one of the first things go to is the ability to drive — long before the ability to walk. Instead, they should be asking “What can I do to get out of this place? How will I get to the doctor or the grocery?” Every single one of them has to look in the mirror right now and ask themselves, “What do I do when I can’t drive?”

mother in law's houseMy mother-in-law’s house with that rusting Saturn in the driveway. (Photo: Google Maps)

I’ve written before about my late mother-in-law’s experience, about how it won’t be pretty when the boomers lose their cars. I keep going back to it because it was so horrible. In the last few years of my mother-in-law’s life, my wife Kelly spent two hours to take her mother to the doctor or the grocery. Joyce was lucky; Kelly didn’t work and could spend her day taking care of her mom. Not many people can do this. My own mom lived in an apartment in midtown and was within an easy walk (or wheelchair-push in her later years) to her doctor. She also had access to “wheel-trans” or special buses that transport people with disabilities; each ride costs the city $30.79. What happens when 70 million baby boomers start demanding transportation like that?

The problem is that we designed our suburbs and our newer cities around the car, so if you can’t drive, you[re trapped. As Sara Joy Proppe wrote in Strong Towns,

By designing our cities for cars, and consequently neglecting our sidewalks, we have siloed our elders in several ways. Not only does an inability to drive confine many seniors to their homes, but corresponding busy roads and inhumane streetscapes add to the isolating effect by also limiting walkability.

We have time to fix this

In 10 or 15 years, tens of millions of baby boomers will be in that position. That’s actually enough time to fix a lot of this. Walkable cities and towns have a way of turning into NORCs, or Naturally Occurring Retirement Communities. There are enough older people around to provide support services relatively efficiently. There are things for people to do; after my dad died, my mom took up bridge and played for years; she hated cards, but knew she needed to keep doing things, and there were people in the building she could befriend through bridge, so she played cards.

This is why we have to stop thinking of this as a transportation problem; it’s not. It is also why people have to end this fantasy of aging in place in the suburbs, trapped in their own little worlds. Instead they should think about moving to where they can actually get out of their homes and do stuff — meet people, shop or go to the doctor.

If urban planners and the politicians they work for had any sense, they would stop approving any more suburban sprawl and do a big intervention to allow mid-rise apartment construction everywhere in city centers where there is transit and pedestrian infrastructure that lets people get to their doctors and grocers without needing a car. Or they would adopt the principles of New Urbanism and make every new community walkable.

google carGoogle’s cute little self-driving car of the future is no longer a thing; they have moved on. (Photo: Google)

Instead, they either ignore this problem or pronounce, “Self-driving cars, autonomous vehicles will save us!” (In fact, we have said that right here on MNN.)

They won’t; they don’t exist, and the problems with them may be insurmountable. Ultimately, we have to face the fact that this an urban design problem, that our suburbs don’t work for an aging population. Ultimately, we have to build communities for people, not cars, as we have in the past. Most critically, we have to face the inevitability of demographics: Today it’s a problem, but in 10 or 15 years, it’s a disaster.

 

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Michael Bloomberg’s presidential run could be part of a strategy to pay the cheapest rates possible to air anti-Trump ads

Former New York Mayor Michael Bloomberg. 
Associated Press

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  • After weeks of speculation, the billionaire philanthropist and former New York City Mayor Michael Bloomberg officially announced he was jumping into the crowded 2020 Democratic presidential-primary field.
  • Bloomberg is capitalizing on his estimated $52 billion net worth to run a highly unusual campaign, planning to entirely self-fund his campaign and not raise any money through grassroots donations.
  • On Saturday, Bloomberg also announced he was placing an enormous ad buy, spending a record-breaking $31 million on TV ads in 25 media markets over the course of just one week.
  • While Bloomberg’s unusual campaign gives him virtually no chance of winning the nomination, he can pay for TV ads at much lower rates as a presidential candidate than he could through a PAC, for example.
  • If Bloomberg’s top priority in the 2020 cycle is to help beat Trump, using his position as a candidate to air as many TV ads as possible for the best price could achieve a lot toward that end.
  • Visit Business Insider’s homepage for more stories.

After weeks of speculation, the billionaire philanthropist and former New York City Mayor Michael Bloomberg officially announced he was jumping into the crowded 2020 Democratic presidential-primary field.

Compared with the rest of the field, Bloomberg is capitalizing on his wealth to run a highly unusual campaign. He’s planning to entirely self-fund his campaign and not raise any money through grassroots donations, meaning he won’t be able to qualify for any of the Democratic primary debates.

Even more unusually, Bloomberg isn’t filing to appear on the ballot at all in the first four key primary states — Iowa, New Hampshire, Nevada, and South Carolina — and he’s focusing entirely on winning delegate-rich Super Tuesday states, including Texas and California.

This strategy gives Bloomberg virtually no chance of winning the nomination. He would be not only forfeiting the ability to earn any delegates at all during the first four contests, but he also would be giving up the chance to prove to Super Tuesday voters that he is a viable candidate who can actually win elections.

Bloomberg and his advisers are arguing that defeating President Donald Trump should be Democrats’ first priority going into 2020, and they’re not confident the Democratic field is best-poised to do it.

But Bloomberg’s unique strategy might shed light on what his campaign is actually trying to achieve. As opposed to running a campaign based on the traditional methods of retail politics and heavily campaigning in those crucial early states to win the nomination, Bloomberg is using the most important tool at his disposal to shape the race: money.

It’s all about the ads

Bloomberg made an eye-popping debut into the 2020 fray by immediately announcing that he would spend $31 million on television ads for himself to air between November 25 and December 3 in 25 media markets in key primary and swing states, including Florida, California, Texas, Pennsylvania, and Michigan, CNBC reported.

According to Advertising Analytics, the $31 million purchase breaks a record for the most money spent by a presidential campaign on television ads in a week, a distinction previously held by former President Barack Obama, who spent $24.8 million in one week at the end of his 2012 reelection campaign.

For comparison, the amount of money Bloomberg is spending on TV ads in just one week is almost as much as the $33 million Sen. Bernie Sanders reported having in cash on hand in his third-quarter campaign-finance filing — far more cash than any other Democratic candidates reported.

But for Bloomberg, whose estimated net worth comes in at $52.4 billion, the purchase is just a small drop in the bucket.

And despite being the eighth-wealthiest person in the US, Bloomberg — who built a business empire on data analysis — presumably wants to shape the 2020 race in the most cost-effective way possible.

FILE PHOTO: Michael Bloomberg, the billionaire media mogul and former New York City mayor, eats lunch with Little Rock Mayor Frank Scott, Jr. after adding his name to the Democratic primary ballot in Little Rock, Arkansas, U.S., November 12, 2019.  REUTERS/Chris Aluka Berry - RC2V9D9BBJSS/File Photo
Bloomberg. 
Reuters

It actually makes more sense for Bloomberg to buy ads as a candidate instead of through a political action committee

On the surface, it might seem like it would make sense for Bloomberg to just start a PAC to buy ads instead of going through the trouble of running for president.

But for a billionaire who plans to spend exorbitant amounts of money shaping the 2020 race, filing to run as a candidate and pay for ads through a campaign instead of simply starting a political action committee carries some significant financial advantages.

Federal Communication Commission regulations require TV stations and networks to offer a price referred to as the “lowest unit rate” possible to presidential candidates based on the timing of their ad spot and how likely it is to be “pre-empted” or bumped by a higher-paying advertiser during “political protection” periods, which take place 45 days before a primary and 60 days before a general election, according to the veteran TV sales rep Mike Fuhram.

But none of those considerations apply to PACs’ and super PACs’ ad purchases, meaning stations can charge virtually as much as they want to PACs and aren’t required to offer them the lowest price possible in the weeks leading up to an election.

For someone, like Bloomberg, who plans to purchase a lot of anti-Trump ads, this means he could save a lot of money by buying ads as a presidential candidate instead of through a PAC.

If Bloomberg’s top priority in the 2020 cycle is to help beat Trump, using his position as a candidate to air as many TV ads as possible for the best price could achieve a lot toward that end.

Despite the rise and increasing relevance of digital advertising, the Sunlight Foundation said that “television, especially the local newscast, still reaches a particular audience that campaigns want: older Americans who will vote.”

Read more: 

 

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Even If Netanyahu Is Done, His Damage to Israel Will Linger for Years

Israeli Prime Minister Benjamin Netanyahu chairing the weekly cabinet meeting at the Prime Minister's office in Jerusalem on Nov. 3, 2019.

Israeli Prime Minister Benjamin Netanyahu chairing the weekly cabinet meeting at the Prime Minister’s office in Jerusalem on Nov. 3, 2019.
Gundar-Goshen is the winner of the JQ-Wingate Prize for Waking Lions. She is a clinical psychologist, has worked for the Israeli civil rights movement, and is an award-winning screenwriter. Her new novel is The Liar.

For years, Benjamin Netanyahu’s followers used to sing in political gatherings “Bibi King of Israel.” Now, it seems like the king might lose his crown. Israel’s longest-serving leader is indicted for bribery, fraud and breach of trust. Netanyahu becomes first sitting prime minister in Israel’s history to be charged with bribery. While Bibi called the decision “an attempted coup,” his political rivals are celebrating.

However, the Israeli people have no reason to celebrate. Even if Netanyahu goes, the environmental damage he caused is here to stay. During a twenty-year political career, oil tanker “Netanyahu” has docked in the center of the Israeli mainstream, pouring gallons of hate into our water.

Netanyahu’s reaction to the indictment decision was a wild attack against the Israeli law system. While a “witch hunt” is a common, legitimate, metaphor often used by politicians in his situation, Netanyahu didn’t stop with this expression. His accusation of an “attempt coup” could become a real threat to our democracy, when expressed by a sitting prime minister towards the law system. Not many were surprised by this choice of words. The PM’s reaction yesterday fit his entire career. As we look at the rise and fall of leaders, we usually assume that the fall of a leader symbolizes the end of his era. But that’s not necessarily true. A leader can leave the public sphere the way a child leaves the pool after pissing in it.

A few days after the 2015 elections, a White House warning on anti-Arab rhetoric in Israeli elections was published. After all, it’s not every day that a prime minister tries to cast doubt on the right to vote of 20% of his country’s population. After the U.S. denounced his video, the Israeli PM apologized, saying he had been misunderstood.

The delegitimizations of the Arab citizens was followed by attempts to create fake history. During his speech to the Zionist Congress in 2015, Netanyahu claimed that Hitler’s genocide was inspired by the Palestinian leader of Jerusalem at the time, Haj Amin Al-Husseini. His remarks were criticized by prominent Holocaust scholars, and he later corrected himself.

Where there is hate speech by political leaders, sooner or later there will be a hate crime by “extremists” or “loners.” On Netanyahu’s shift, there were quit a few. One of the most shocking was the murder of a 16-year-old boy, Abu Khdeir, as revenge for the kidnapping and murder of three Israeli teens. Netanyahu was one of the first to denounce the murder of the Palestinian boy – yet he also denounced the writers who dared to write a TV series about the case. Netanyahu recently called on Israelis to boycott the Keshet and HBO-produced TV drama Our Boys, calling it anti-Semitic. Death threats to the creators were soon to follow the PM’s statement.

But the peak of Netanyahu’s latest hate campaign was his call to put cameras in polling stations, doubting the integrity of Arab voters. Ironically, it was Netanyahu’s insult that got more Arab citizens to vote.

Even if he loses the trial over bribery, Netanyahu has already won: delegitimization of the Arab minority is no longer limited to the extreme right wing. Netanyahu’s rival, Avigdor Lieberman, now considered “central right,” has refused to even sit in a chair randomly allocated to him in the Parliament, as it was next to the head of the Arab party.

A big part of the election impasse paralyzing the country today is another product of minority hate: Netanyahu sticked with the extreme right-wing parties, and preferred these allies over Gantz’s offer to form a more central coalition. He also rejected the idea of a rotation government in which he will be the second to serve.

Quite a few cheers were heard last evening in Tel Aviv, when the indictment decision was first published. However, If we ever want to recover from twenty years of anti-democratic pollution, we have to first acknowledge the fact that our environment is polluted with hate. We have to purify our society from anti-democratic tendencies. It will take a long time, so the sooner we begin, the better.

 

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Trump accuses Democrats of seeking to obliterate Medicare

 
‘Great healthcare for you’ reads the backdrop as President Trump delivers remarks on Medicare at a performing-arts center in The Villages, Fla.

WASHINGTON (AP) — President Donald Trump on Thursday accused Democrats of an all-out attempt to “totally obliterate Medicare” and portrayed himself as the program’s defender as he took steps to expand Medicare’s private insurance option.

But no Democrat is proposing to take coverage or benefits away, a fact that undercuts Trump’s rhetoric, and Trump did not dwell on his own budget proposals for cuts in Medicare payments to hospitals and other providers.

Trump spoke at The Villages, a community for adults in Central Florida, as he defended himself against House Democrats’ impeachment inquiry. That part of the state overwhelmingly supported Trump in 2016.

Health care has emerged as a central issue for Democrats competing for their party’s 2020 presidential nomination. Much of the debate has centered on Sen. Bernie Sanders’s “Medicare for All” plan, which would cover everyone under a government-run plan and eliminate most private insurance.

“Medicare is under threat like never before,” Trump said. “Almost every major Democrat in Washington has backed a massive government health care takeover that would totally obliterate Medicare.”

Don’t miss: Sanders will participate in Democratic debate Oct. 15, says campaign representative; he’s ‘up and about,’ says wife

Trump signed an executive order directing his administration to pursue changes to Medicare, which covers about 60 million seniors and disabled people. Much of what he has said he wants to do is geared toward enhancing Medicare Advantage, the private insurance option picked by about one-third of seniors.

Medicare Advantage plans offer savings on premiums and an annual limit on out-of-pocket costs. These plans provide one-stop shopping, eliminating the need for separate supplemental insurance. Offered by major insurers, the plans also cover prescription drugs in most cases.

But there are trade-offs. People joining a Medicare Advantage plan generally must accept limits on their choice of hospitals and doctors as well as prior insurer approval for certain procedures. If they change their minds and decide to return to traditional Medicare, they’re not always guaranteed supplemental “Medigap” coverage, which is also private.

The president’s order is basically a to-do list for the Department of Health and Human Services that will require months of follow-up. Among the other priorities are an expansion of telemedicine and changes to avoid overpaying for procedures just because they get done in a hospital instead of a doctor’s office.

Health and Human Services Secretary Alex Azar said Trump’s order directs his department to examine whether its current policies and practices put traditional Medicare ahead of the private Medicare Advantage option. Some advocates for older people say that it’s the other way around and that the administration is trying to put private plans ahead.

The executive order does not involve a major overhaul of Medicare, which would require congressional approval.

So far the debate about Medicare for All has mainly been about its projected costs to the government, estimated at $30 trillion to $40 trillion over 10 years.

The Sanders plan would eliminate most private health insurance, including the Medicare Advantage option. Sanders, who unexpectedly underwent a heart procedure this week, says Medicare for All would nonetheless offer seniors broader benefits and lower costs.

Sanders’ style of single-payer health care has long been popular among liberals. But recent polling has shown that a majority of Democrats and independents who lean Democratic prefer expanding coverage by building on the Affordable Care Act, or the Obama-era health law. Trump is asking federal courts to overturn that law as unconstitutional, after a Republican-controlled Congress failed to repeal it his first year in office.

As a presidential candidate, Trump promised not to cut Medicare. As president, he has avoided calling for privatization of the program, raising the eligibility age beyond 65 or rolling back benefits.

But Trump’s latest budget proposed steep cuts in Medicare payments to hospitals and other service providers, prompting protests from the industry and accusations by Democrats that he was going back on his promises to seniors. The Medicare cuts went nowhere in Congress.

Opinion: The faltering economy is at the mercy of an unpredictable and cornered president

 

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AMERIGEDDON “It’s time we laugh about this s#!t”

What the hell is going on? Hawaii just got an incoming nuclear missile threat and because of our new leader, people believed it. We have lost our way as a country. The world thinks we’re a joke and there’s a joke in the most powerful position in the world. I would give my yakuza pinkie right now for Mitt Romney. All that being said the new show is a killer balance between right and left. Thoughtful conservatives and my Grandma are starting to realize that we made a mistake. AMERIGEDDON is bringing the country together one drunk audience at a time. It’s for all of us because it takes one side, The side of America. Don’t worry about anything people! It’ll be okay, we will survive, or live in a post apocalyptic gasoline fueled thrill ride where tribes fight each other over who should lead…just like now, except we’ll all have Mohawks.

Christopher Titus, January, 2018

 

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