Editor's Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here.
Updated at 11:10 a.m. ET on March 31, 2020.
By all estimates, the novel coronavirus is quickly becoming the most disruptive pandemic in more than a century. New developments and warnings are being issued every day—in the past two weeks, more than 30 states have implemented strict shelter-in-place ordinances. The uncertainty of this moment has also led to abundant misinformation, some coming from the president himself. As you sort through the onslaught, here are some stories to help you make sense of life during a pandemic. The Atlantic is choosing to make these freely available to all readers, even those who don’t subscribe. This list will be updated with our continuing coverage.
The Curve Is Not Flat Enough, by James Hamblin
Many American hospitals still lack the ventilators, protective equipment, and personnel to provide adequate care to the number of sick patients they’re expecting in the coming days and weeks. In New York, the health-care workforce is so thin that medical students are graduating early and retirees are returning to emergency rooms. Meanwhile, hospitals are scrambling to institute guidelines on how to ration resources when there’s not enough of them to go around.
In an attempt to lift some of the burden from individual providers, hospitals around the country are convening emergency meetings to develop guidelines for rationing, according to who is least likely to benefit from treatment. The goal is to make the guidelines objective, accurate, and easy to use, as well as to minimize the waste of resources. The instructions could be as strict as age limits for intensive care, or withholding care from people who have the lowest chance of survival, such as those suffering from heart failure or emphysema. On Thursday, The Washington Post reported that Northwestern University’s medical center, in Chicago, was considering putting every patient with COVID-19 on “do not resuscitate” (DNR) status. This would mean that if their heart stops, no “code blue” would be called; instead, a time of death would be noted.
America Needs Plasma From COVID-19 Survivors Now, by Sarah Zhang
In late March, doctors began to treat COVID-19 patients with infusions of blood plasma from survivors of the disease. The technique, known as convalescent-plasma therapy, has varying success—and requires a constant stream of willing, healthy donors. If the treatment proves to be effective, it could become an important weapon against the coronavirus as more and more people recover from weeks spent sick. But that would require quite a bit of scaling up.
Michael J. Joyner, a doctor at the Mayo Clinic, likened this phase to the “craft brewing” of convalescent-plasma therapy. It’s available at only a few academic centers, and doctors are reliant on personal connections to recruit donors. Getting to the “national-brewery model,” he says, requires involving bigger players. The FDA could help identify donors, and a network of national blood banks could send COVID-19 plasma to hospitals in small cities and towns. Eventually, pharmaceutical companies might be interested in pooling and purifying plasma down to a concentrated dose of antibodies—at which point convalescent plasma truly would be a standardized product you pull off the shelf.
All of this, of course, is contingent on plasma actually working against COVID-19.
My Whole Household Has COVID-19, by Deborah Copaken
Our contributing writer Deborah Copaken has a presumptive case of COVID-19. She sleeps in her own bedroom, isolated from the rest of her family—as do her three children and partner, all of whom are either sick or in quarantine because of travel abroad. “Part of me wants, as soon as we’re better, to grab my three kids and my partner and escape someplace remote,” she writes. “But where? COVID-19 is everywhere.”
I spoke with my daughter yesterday morning from her Airbnb in D.C. She’s not sure where to go after her 14 days of quarantine are over. She’d planned on staying in her post in Cameroon for two years but was able to complete only six months before the emergency evacuation, and she’s not allowed to return. As a Peace Corps volunteer, she’s not eligible for unemployment. She is, at 23, broke, heartbroken, and homeless, which is another reason I’d better not die right now. My son is going stir-crazy all alone in his Airbnb. I haven’t been able to hug him since he got back from Greece. Should he come home on March 31 or pay for another week of the Airbnb, given our illnesses? How long will we remain sick? The World Health Organization says two weeks for a mild case, and three to six weeks for a more serious bout. But that’s just the accepted dogma right now. Tomorrow, those numbers could change.
The Four Possible Timelines for Life Returning to Normal, by Joe Pinsker
American life will start to feel familiar again when we reach the point of “population-level immunity”: when some significant proportion of people, perhaps 70 percent, have resistance to the virus, gained via vaccination or recovery. Once we pass this threshold, restaurants will likely reopen before concert venues, and schools before sports stadiums. But it’s hard to guess how long all that will take. Broadly, there are four possible timelines, ranging from two months (unlikely) to 18 months (most likely).
Amid everything I’ve described so far—the crowd-free baseball games, the bars and restaurants with spaced-out seating, and so on—researchers around the world will have been scrambling to develop a vaccine. Spring 2021 is about the earliest anyone expects one to be available … Vaccines take so long to make because they are difficult to perfect. There are a series of methodical trials done to make sure they don’t harm healthy people, to make sure they generate the desired antibodies, and to make sure those antibodies actually defend against the disease. These aren’t overcautious bureaucratic safeguards; if researchers are making something that’s going to be pumped into the arms of hundreds of millions, probably billions, of people, they want to make sure it’s just right.
I’m Treating Too Many Young People for the Coronavirus, by Kerry Kennedy Meltzer
Early reports that COVID-19 caused only mild symptoms in healthy young people left many Millenials and members of Gen Z worried less about their own health than about the risk the coronavirus posed to their grandparents. Kerry Kennedy Meltzer, a young internal-medicine resident in New York City, insists that those in their 20s and 30s are wrong to feel such a strong sense of personal safety. On one recent overnight shift, Meltzer writes, five out of six patients she saw with COVID-19 symptoms were close to her age or younger—and their cases weren’t all mild.
Late in the night, another young patient came in with a high fever and no underlying health conditions. They’d had a dry cough for the past four days. They’d come to the hospital after finding they were unable to walk a few feet without getting severely short of breath. On their chest X-ray, I saw lungs that were almost completely whited out, indicating a significant amount of inflammation. It was clear how uncomfortable they were, and how desperately they were trying to catch their breath. They were in a different category from the previous patients I’d seen that night. They needed to be admitted. They needed testing. They needed close monitoring.
All the Coronavirus Statistics Are Flawed, by Derek Thompson
Infection rates, unemployment rates, stock prices, and other fragile figures are in an extended period of limbo as the pandemic wears on. Despite experts’ best efforts to collect timely data on how Americans’ lives are changing, it’s still far too early to draw any major conclusions or predict with certainty what will happen next.
Many of us have heard of “the fog of war,” a term coined by the 19th-century Prussian military writer Carl von Clausewitz. It refers to the idea that war is often conducted in a haze of uncertainty: Militaries do not fully understand either their enemy’s threat or their own capacity to combat it.
What we’re experiencing now is the fog of pandemic. The officials tracking COVID-19 are swimming in statistics: infection rates, case-fatality ratios, economic data. But in these early stages of the fight against the coronavirus, these figures each have their own particular limitations. We are already seeing how, in the haze of confusing data, political leaders are trying to marshal that uncertainty to override the advice of public-health experts.
How the Pandemic will End, by Ed Yong
Mere months ago, the United States ranked higher than every other industrialized nation in pandemic preparedness. Today, it’s on track to lose 2.2 million lives to COVID-19 by the fall, in part due to a White House that, our science reporter Ed Yong writes, is “a ghost town of scientific expertise.” Depending on how the next few months play out, America faces multiple possible futures—each bringing integral changes to public life and politics that will last far longer than the pandemic itself.
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.
This Is Just the Beginning, by Yascha Mounk
Public figures, including the president, have begun to advocate for ending the widespread shutdowns and shelter-in-place orders by mid-April in order to avoid the economic catastrophe that could result from continued business closures. But doing so would allow the virus to spread unchecked, effectively ensuring millions of American deaths. An unmoored pandemic and a crippling recession would have grave human consequences—our better option, Yascha Mounk suggests, is to buy ourselves more time to build a solution that avoids both outcomes.
Right now, the number of cases is still exploding. We don’t have the infrastructure for test-and-trace on a grand scale. Our hospitals aren’t ready for the onslaught they are about to face. Our treatment options are dismal. To give up on the fight against the coronavirus at this stage is to condemn an unspeakable number of Americans to death.
But if we take energetic measures to contain the outbreak right now, this picture could change relatively quickly. At that point, the power of these interventions will lie in their combination. Test-and-trace will mean that fewer people get infected with the disease. An expanded medical system will be able to heal more patients. And better treatment options will save a greater portion of the critically ill. Each of these measures will amplify the others.
How the Coronavirus Became an American Catastrophe, by Alexis C. Madrigal and Robinson Meyer
As more and more people have fallen ill in the United States, experts’ fears that the coronavirus’s reach was enabled by asymptomatic carriers have been confirmed. “Every six days that the country did not test, every six days that it did not act, the number of infected Americans doubled,” our reporters write. Many of the COVID-19 cases appearing and worsening now are in people who moved around freely in February and early March, when the CDC’s reported numbers of confirmed cases were low and lagging. Now the country is stuck trying to stop a machine already in motion.
American cities, blinded by the lack of testing data, did little as crucial days went by. On March 7, as the severity of the local outbreak was becoming known, huge events were allowed to go on. More than 30,000 people attended a Seattle Sounders game that night. No one wanted to say what has now become clear: February was our chance to get this right. We lost that entire month. And we now live in a new era of work stoppages, overwhelmed hospitals, dead elders, and a wrecked economy.
You can find your state’s count of coronavirus tests, cases, and deaths—along with The Atlantic’s assessment of how reliable those data are—in our interactive COVID-19 Tracking Project.
What Do You Tell Someone Who Still Won’t Stay Home? by Joe Pinsker and You Should Already Be in Lockdown, by Saahil Desai
Recommendations for extreme social distancing have intensified, but many Americans still struggle or outright refuse to abide by the new rules of everyday life. Trying to persuade someone to stay away from public life can be frustrating, scary, and tense—but according to family psychologists and public-health experts, it’s best done with kindness and understanding. Reminding people of the bigger picture, sharing stories of individual lives already affected by the coronavirus, and suggesting alternative activities are all useful tactics for conveying the urgency of social distancing.
The coronavirus outbreak is a story often told numerically: confirmed cases, fatality rates, hospital-bed capacities, and so on. But most of the time, you’ll probably have better luck persuading someone if you leave out the statistics. “Trying to identify a human face of people who have experienced coronavirus” probably has a better chance of swaying a listener who hasn’t yet seen the catastrophic effects of the virus firsthand, said Rachael Piltch-Loeb, a fellow at the Harvard T. H. Chan School of Public Health.
If you still need help persuading a loved one to stay in place, one of our editors, Saahil Desai, wrote about his own decision, after the pandemic hit the East Coast, to travel to his family’s home in Ohio. Even though he wasn’t defying any quarantine or shelter-in-place orders at the time, he quickly realized that his trip could have dangerous repercussions.
“A lockdown can feel eerily draconian or downright authoritarian, and implementing a countrywide shelter-in-place mandate in the United States would be a legal quagmire. So rather than waiting to see if the federal, state, and local governments demand it, Americans should take on the onus of holing themselves up at home.
Why the Coronavirus Has Been So Successful, by Ed Yong
Understanding what all coronaviruses have in common is much easier than answering the question of what makes this one different. One way the virus that causes COVID-19 seems to be special is that the spikes unique to its surface can be easily split by an enzyme that’s found nearly everywhere in the human body, which gives the virus a fuller run of the respiratory system. And while other coronaviruses infect either the upper or lower airway, this one infects both.
The structure of the virus provides some clues about its success. In shape, it’s essentially a spiky ball. Those spikes recognize and stick to a protein called ACE2, which is found on the surface of our cells: This is the first step to an infection. The exact contours of SARS-CoV-2’s spikes allow it to stick far more strongly to ACE2 than SARS-classic did, and “it’s likely that this is really crucial for person-to-person transmission,” says Angela Rasmussen of Columbia University. In general terms, the tighter the bond, the less virus required to start an infection.
This Is How We Can Beat the Coronavirus, by Aaron E. Carroll and Ashish Jha
A March 16 report from Imperial College London projected that 2.2 million Americans could die of COVID-19 before the pandemic’s end if extreme measures aren’t enacted. Aaron E. Carroll, a pediatric specialist, and Ashish Jha, a global-health scholar, argue that extreme social-distancing measures can flatten the curve of infections, a goal that will above all else buy us time. With that time, standardized testing protocols can be developed, businesses can resume operations, and more complicated (but less extreme) measures—such as reopening community spaces with monitored entry—can be put in place.
Some Americans are in denial, and others are feeling despair. Both sentiments are understandable. We all have a choice to make. We can look at the coming fire and let it burn. We can hunker down and hope to wait it out—or we can work together to get through it with as little damage as possible. This country has faced massive threats before and risen to the challenge; we can do it again. We just need to decide to make it happen.
Should You Take Advil for COVID-19? By Olga Khazan
A fever is part of the body’s retaliation against infection. So while some doctors recommend making yourself comfortable by taking Ibuprofen if you do have a fever, there’s also evidence that reducing fevers with medication can prolong some illnesses. Doctors still don’t know enough about COVID-19 to say definitively whether this is the case. While authorities including the French health minister have urged the public to avoid pain medications including ibuprofen if they suspect they have the coronavirus, others are torn on whether the potential risk is worse than suffering through a fever sans relief.
Multiple studies involving lizards, mice, or dogs, for instance, have found that infected animals that were prevented from having a fever were more likely to die. In one study of critically ill patients, those whose fevers above 101.3 degrees were treated with acetaminophen suffered more infections than those whose fevers went untreated. The study was stopped because seven patients in the treated-fever group had died, compared with just one in the untreated-fever group.
But when this question was asked of a different doctor, Richard Klasco, in a Q&A in The New York Times in 2018, he came to a different conclusion: Treating a fever with painkillers had no effect at all. “Since rigorous clinical trials have shown that these drugs do not worsen outcomes,” Klasco told the Times, “why not make yourself comfortable?” Klasco told Khazan in an interview that he still stands by this advice.
A series of interviews with Daniel Horn, a physician at Massachusetts General Hospital, in Boston, provides a unique window into the fear and determination in America’s hospitals right now. One of Horn’s major concerns is protecting health-care workers so they can continue to treat others, even as protective supplies are running low.
“It would be great to see our collective society, our large corporations, consulting firms, logistics experts like Amazon, be thinking aggressively about how to rapidly either procure or manufacture personal protective equipment for health-care workers. Yes, we moved to social distancing. That is tremendous. The next thing that needs to be solved: We need personal protective equipment for our health-care workers, and then ventilators.
Or, thinking aloud here: Corporations and global communities really ought to stand together to collect all the hoarded personal protective equipment, masks, Purell, surgical masks. In particular, no one in a house needs an N95 mask. They are in short supply. We should find a way to get them back out of houses, and into the hands of health-care workers. I don’t have a plan, and it would need to be a very thoughtful approach. What if a community put all their hoarded supplies on their front porches at the same time, one day during the week? Amazon could set up an operation to gather it. If we designed it right, we could make it safe and get those supplies back into hospitals.”
Trump Leaves States to Fend for Themselves, by Juliette Kayyem
Juliette Kayyem, a national-security expert, argues that since the federal government has done little to prevent the coronavirus from spreading, governors have been the ones to take on the weightiest public-health crisis in a century. The disparities in their approaches are now becoming visible. Testing numbers, hospital preparation, and community guidelines vary widely among the states. The coronavirus isn’t one national problem, Kayyem says: It’s 50 separate problems.
The hard part of homeland security often has less to do with the security than with the homeland. The United States is made up of 50 homelands. Even though the Constitution gives federal authorities more power than the Articles of Confederation did, our governance structure was still designed to limit the role of the central government. The Tenth Amendment reserves powers not specifically listed in the Constitution for the states and, through their constitutions, for local governments. Public health and law enforcement are among those powers. Even when the problem is a pathogen that spreads across state and national borders, the principles of federalism still apply.
NIH Director: ‘We’re on an Exponential Curve’ by Peter Wehner
In a mid-March interview with The Atlantic, Francis Collins, the director of the National Institutes of Health, shared his growing fears about the United States’ coronavirus prognosis. “If you wait until you’ve seen lots of affected cases, you know you’ve waited too late,” he warned.
Here’s what Collins said when asked what surprised him most about the coronavirus:
“The degree to which this is so rapidly transmissible. More so than SARS was. SARS was a terribly scary situation for the world 18 years ago, but it never reached the level of infections or deaths that we have for this coronavirus, because it wasn’t as transmissible. SARS was transmissible but only from people who were really very sick. This one seems to be transmissible from people who have minor illness or maybe no illness at all—which is why it has been so difficult to get control or to know when you should be imposing these stringent measures we’ve been talking about.”
How You Should Get Food During the Pandemic, by Amanda Mull
Even as normal life grinds to a halt in the U.S., Americans still need to consider their most quotidian needs, eating among them. There’s no perfect way to get food without some human contact. If braving the crowded supermarket feels overwhelming, delivery can be a good option, but only if you put careful precautions in place (such as leaving money outside your door) and make ethical choices about when and how you order.
The places people order from make a difference too. A local restaurant is a better choice than a start-up that sends gig workers with no health-care benefits into crowded big-box grocery stores to fight over dried beans on your behalf. The restaurant delivery person interacts with fewer people, lessening his or her individual risk, and the money you pay for the food goes toward keeping a restaurant’s staff employed through a crisis. In Wuhan, local delivery drivers were the city’s lifeline during a lockdown that made venturing out for fresh food difficult.
The Dos and Don’ts of ‘Social Distancing’, by Kaitlyn Tiffany
Social distancing is one of the most important community-wide precautions that healthy people can take to slow or stop the spread of infectious disease, but what exactly that entails can be hard to pin down. Our writer Kaitlyn Tiffany asked three experts about subways and gyms (avoid unless absolutely necessary), meeting up with friends (try a walk in the park, six feet apart), work (do it from home if you can!), and more.
With few exceptions, now is the time to cancel get-togethers. Dating, family visits, house parties, should all be postponed or held virtually if possible. There are personal situations where you must go out for work, for supplies, or to help someone else in need. In those cases, take precautions to keep your distance from others, and wash your hands frequently. If you develop a fever or cough, don’t go out unless it is absolutely necessary or to seek medical care.
What Will You Do If You Start Coughing? by James Hamblin
Preparation and protection is important, but it’s also crucial to know what steps you can take if you start to feel ill. In an ideal outbreak scenario, reliable testing would be available to all, but America’s already-strained public-health system has left many with less serious symptoms waiting for a test for days on end. For now, the most common recommendation is temporary self-isolation—a choice that’s going to be difficult for workers and caretakers to make without community or government assistance. One idea supported by some economists is that “everyone receive cash, immediately.”
People need to feel able to skip work and still make rent and feed their family. They need cash without strings attached, and they need it now, not via a complex omnibus economic stimulus package next month … A pandemic is like a slow-motion hurricane that will hit the entire world. If the same amount of rain and wind is to hit us in any scenario, better to have it come over the course of a day than an hour. People will suffer either way, but spreading the damage out will allow as many people as possible to care for one another.
You’re Likely to Get the Coronavirus, by James Hamblin
COVID-19 is unlikely to kill most people who aren’t in high-risk groups (including the elderly and the immunocompromised). Still, you’re not likely to evade it. The new coronavirus drew early comparisons to 2003’s deadly SARS outbreak, but critical differences soon emerged. COVID-19’s relatively low death rate (which hovers somewhere between 2 and 3.4 percent) means that healthy-seeming people can act as unknowing carriers of the disease, allowing it to spread quickly. And it’s already too late for a vaccine to turn the tide, according to Richard Hatchett, the CEO of the Coalition for Epidemic Preparedness.
“The emerging consensus among epidemiologists is that the most likely outcome of this outbreak is a new seasonal disease—a fifth ‘endemic’ coronavirus. With the other four, people are not known to develop long-lasting immunity. If this one follows suit, and if the disease continues to be as severe as it is now, ‘cold and flu season’ could become ‘cold and flu and COVID-19 season.’”
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