Updated at 2:47 p.m. ET on May 28, 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. 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.
Mistrust of and misinformation about vaccines runs deep in the United States. Though experts hope that widespread fear of falling ill or spreading disease during a global pandemic will be enough to convince skeptics that they’re better off receiving an eventual vaccine, anti-vaccine messaging and existing coronavirus conspiracies could make such cooperation unlikely. And the Trump administration’s inconsistent and faulty statements about public health and vaccine development will only make it more difficult for the scientific community to gain the public’s trust. Zhang lays out several important variables that could affect how receptive America is to a COVID-19 vaccine, including factors as unpredictable as timing:
The vaccine’s timing could affect its reception too. Heidi Larson, whose Vaccine Confidence Project has been regularly surveying people in Europe throughout the pandemic, says the numbers have changed slightly over time: In mid-March, 7 percent said they would refuse to get a COVID-19 vaccine, which dropped to 5 percent two weeks later, when COVID-19 deaths spiked, and rose to 9 percent when talk turned to loosening lockdowns. “The public is in general pretty sensible in how they make their decision, and they are weighing their different perceived risks or benefits,” she says. If the pandemic seems as if it’s waning, fewer will be willing to take a chance on a new vaccine.
Is Everyone Depressed? by James Hamblin
Many of the classic signs of depression—lethargy, social withdrawal, disinterest in activities—suddenly seem like nearly unavoidable side effects of Americans’ daily routines. The coronavirus has rapidly worsened the mental-health crisis in the U.S. At the same time, it’s also made discerning whether depressive feelings are circumstantial or indicative of underlying disorders more difficult. Identifying clinical depression and doling out treatment appropriately is difficult in person, and even harder over video calls. In the absence of methods to easily pinpoint who needs treatment most urgently, ensuring that mental-health resources match the scale of those who need them for any reason could be a better plan.
Just as, in the time of COVID-19, not everyone with a cough can go to the hospital, clinicians are working to identify and prioritize those who truly need in-person mental-health attention. Jennifer Rapke, the head of inpatient consultation at Upstate Golisano Children’s Hospital in New York, has seen a surge in teenagers reporting suicidal ideation and instances of self-harm, so she has been carefully turning away the less severe cases to make sure that inpatient facilities aren’t overwhelmed. “We’re only seeing people who absolutely need to be here,” she says. Meanwhile, those with milder, emerging cases are sometimes left in limbo. “The places we would normally send people, the things we would put in place to address the depression or the anxiety in early phases—they don’t exist or they’re unavailable,” Rapke says.
Social Distancing Is Not Enough, by Derek Thompson
As parts of America slowly begin to reopen, we’re starting to get a sense of what it might take to return to shared indoor spaces. Activities will return, but in altered forms to keep people safe in the great indoors. Sports events could open with limited seating, zero concessions, and staggered admission times. Restaurants might ask customers to order online before arriving. And between-desk barriers could become ubiquitous, along with a slew of other workplace precautions:
Office meetings, once merely obnoxious, are deemed simply noxious. The South Korean government devotes a full page and 12 bullet points to the subject of meetings, but those recommendations can be boiled down to three words that will make meeting-haters rejoice: fewer, smaller, shorter. For meetings that are necessary, large, and long, South Korea recommends masks for all participants and, if possible, open windows. Ventilation, in general, will become a watchword. Many offices may have to overhaul their vent technology or hire professionals to improve airflow throughout the entire office.
“How Could the CDC Make That Mistake?”, by Alexis C. Madrigal and Robinson Meyer
The CDC began releasing nationwide coronavirus testing data in mid-May with little fanfare. But when the COVID Tracking Project at The Atlantic compared the data with numbers put out by individual states, our reporters found dramatic inaccuracies in the agency’s figures, including a complete failure to distinguish at all between viral and antibody tests. That makes the CDC’s testing numbers virtually useless for any attempts at containing the virus.
Viral tests, taken by nose swab or saliva sample, look for direct evidence of a coronavirus infection. They are considered the gold standard for diagnosing someone with COVID-19, the disease caused by the virus: State governments consider a positive viral test to be the only way to confirm a case of COVID-19. Antibody tests, by contrast, use blood samples to look for biological signals that a person has been exposed to the virus in the past.
A negative test result means something different for each test. If somebody tests negative on a viral test, a doctor can be relatively confident that they are not sick right now; if somebody tests negative on an antibody test, they have probably never been infected with or exposed to the coronavirus. (Or they may have been given a false result—antibody tests are notoriously less accurate on an individual level than viral tests.) The problem is that the CDC is clumping negative results from both tests together in its public reporting.
Ed Yong’s fourth deep look at the country’s crisis reveals how federal failures created a dangerous patchwork of viral spread with little oversight. Different cities and rural areas that may think they’ve evaded the virus could still become the next hot spots, he writes. And nearly every feature of the virus helps enable this uneven and staggered movement. Even the spread from person to person can be unpredictable: Consider “super-spreader events,” in which dozens or hundreds of new infections stemming from a single person create entirely new branches of the outbreak.
The COVID-19 pandemic is not a hurricane or some other disaster that will come and go, signaling an obvious moment when recovery can begin. It is not like the epidemics of fiction, which get worse until, after some medical breakthrough, they get better. It is messier, patchier, and thus harder to predict, control, or understand. “We’re in that zone that we don’t see movies made about,” says Lindsay Wiley, a professor of public-health law at American University.
Why the Coronavirus Hits Kids and Adults So Differently, by Sarah Zhang
On the whole, common infectious diseases tend to be most dangerous to children. But coronaviruses, including the one that causes COVID-19, are rarer, and have tended to largely spare children. That might be because, as we age, the variety within our infection-fighting T cells decreases in favor of strengthening our defenses against the illnesses we encounter most. Adults’ immune systems are more practiced at identifying and disarming common infectious agents, while a younger immune system might be better equipped to defend against an obscure intruder.
The two human viruses most closely related to the coronavirus that causes COVID-19 are the ones behind SARS and MERS—both also coronaviruses, a large family that infects many animal species. SARS likely jumped from bats to civet cats to humans in 2002, and MERS from camels to humans in 2012. Both have a much higher fatality rate than COVID-19 and neither exploded into a pandemic on the current scale, giving us smaller numbers from which to draw conclusions. Still, they too seemed to have largely spared children.
Like COVID-19, SARS and MERS were caused by viruses entirely new to humans, and adult immune systems are unused to dealing with entirely new viruses. By and large, the ones that sicken adults year after year are altered versions of viruses they’ve encountered before, such as seasonal flu. Children, on the other hand, are constantly dealing with viruses that are not necessarily novel but are novel to them. “Everything an infant sees, or a young child sees, is new,” says Donna Farber, an immunologist at Columbia University. Thus, their immune system is primed to fight new pathogens in a number of ways.
You’ll Probably Never Know If You Had the Coronavirus in January, by Rachel Gutman
Many Americans are eager to know whether that lingering cough or punishing fever they had back in the winter was in fact COVID-19. The official tally of coronavirus cases in January is certainly an undercount, but all the available evidence suggests that the number of infections in the U.S. that month was still very, very small. Coming up with a precise number will require data about travel, deaths, and blood tests that are currently unavailable or unreliable. It’s possible we’ll arrive at an answer, but even if we do, it will be all but impossible to identify the specific people who were infected.
Unfortunately, experts generally agree that the actual number of Americans carrying the virus by the end of January was nowhere near high enough to support speculation about herd immunity and star-studded superspreader events. Beyond that, the estimates vary widely. Lauren Gardner, an associate professor of engineering at Johns Hopkins University, who created the school’s popular dashboard for tracking coronavirus cases, told me that “there could have been hundreds of cases in the U.S. in January and thousands by the end of February.” Trevor Bedford, a biologist at the Fred Hutchinson Cancer Research Center who has been at the forefront of the genetic study of SARS-CoV-2, says that “more than 10, less than 100 would be my guess.” Caitlin Rivers, a senior scholar at the Johns Hopkins Center for Health Security, told me that she’s “confident it is not zero” and that “it seems like it’s not millions.”
In recent weeks, a popular claim that multiple strains of the coronavirus could be spreading in tandem has sparked fear of a double pandemic, one tamer and one deadly. There is in fact no scientific evidence for this claim, and researchers agree that only one recognizable strain of the virus has surfaced thus far. While small mutations have likely occurred, none have produced especially distinct—or deadly—lineages of the virus.
As an epidemic progresses, the virus family tree grows new branches and twigs—new lineages that are characterized by differing sets of mutations. But a new lineage doesn’t automatically count as a new strain. That term is usually reserved for a lineage that differs from its fellow viruses in significant ways. It might vary in how easily it spreads (transmissibility), its ability to cause disease (virulence), whether it is recognized by the immune system in the same way (antigenicity), or how vulnerable it is to medications (resistance). Some mutations affect these properties. Most do not, and are either silent or cosmetic. “Not every mutation creates a different strain,” says Grubaugh. (Think about dog breeds as equivalents of strains: A corgi is clearly different from a Great Dane, but a black-haired corgi is functionally the same as a brown-haired one, and wouldn’t count as a separate breed.)
Food Banks Can’t Go On Like This, by Conor Friedersdorf
Even before the pandemic, changes to the food supply chain and food assistance policies had driven up costs and complications for food banks. As economic collapse drives more and more Americans to food banks, donations of “rescued” food (think a coffeeshop offloading pastries at the end of the day) have simultaneously dried up. And communities across the country are facing varied challenges in connecting people in need with support systems. Friedersdorf argues that local food banks and those who rely on them should be permitted to bypass some of the hoops they’ve been forced to jump through to ensure everyone gets fed during the pandemic.
Facing Hunger Foodbank in West Virginia used to serve about 129,000 people on a typical day. Its executive director, Cynthia D. Kirkhart, witnessed the same sharp rise in demand after her state issued its stay-at-home order. Then the retail donations that the food bank receives from partners such as Walmart and Kroger shrank by roughly 90 percent, and delivery times for purchased food grew from a week to eight or 10 weeks. “Between March 30 and April 8, I placed orders in excess of $487,000 for food, and some of it won’t be arriving until late June, but at least I’ll have a regular influx coming in,” she told me. “My total budget for this year was about $500,000. My reworked budget is going to look more like $1.2 million to $1.5 million, and that’s with an optimistic outlook for what happens with this pandemic and how long we are in recovery.”
What’s Behind South Korea’s COVID-19 Exceptionalism? by Derek Thompson
South Korea beat the coronavirus by design, not because of millennia-old cultural values. A brush with MERS less than a decade ago inspired the country’s government to revamp and fortify its public-health planning and infrastructure. As a result, thanks to free testing, detailed tracing, and mandatory isolation, South Korea was able to effectively contain the spread of the coronavirus within weeks—something no other large democracy has done as successfully.
“Test, trace, and isolate” is the three-legged stool of South Korean public-health policy. But what keeps the stool upright is the shared confidence between the government and the public. “A delicate balance of trust … drives the entire thing,” the writer Yung in Chae told me.
People trust the government in part because it works to keep raw politics out of public health. South Korea’s Ministry of Health has for months held daily briefings to update the public and convey best practices, such as social distancing and hand-washing.
And the government trusts the public to act as a responsible co-partner in public health. Rather than announcing an official lockdown that would fully close restaurants and businesses and force citizens to stay home, the Korean government has opted to keep more of its economy open. “We were never on lockdown, and we’re still not on lockdown,” Paul Choi, a consultant who lives in Seoul, told me. “But citizens have taken it upon ourselves to stay inside. We’re very careful to wash our hands and keep our distance. Almost everybody is wearing masks. If you don’t wear masks, you get looks on the street.”
Should You Get an Antibody Test? By James Hamblin
Antibody tests have been touted as one of the key tools that will eventually allow people to freely interact with their communities again. But what do these blood tests actually measure, and who (if anyone) should be seeking them out right now? James Hamblin, an Atlantic staff writer and a medical doctor, assembled a basic FAQ of everything you need to know about how your immune system responds to the coronavirus and the current uses of antibody tests. One question he addresses is why antibody testing is receiving so much attention:
Right now, the antibody tests are being used to help map out where the coronavirus has spread, like tracking the footprints it has left. Combined with other types of research, this information will eventually help identify who is most susceptible to infection, and why. Even if we can’t tell individuals that they are totally protected, we could theoretically begin to allocate scarce resources away from a city where 50 percent of people have antibodies to one where only 5 percent of people do.
Georgia’s Experiment in Human Sacrifice, by Amanda Mull
Georgia’s decision to reopen businesses against the advice of public-health experts will kill people, so why is the state proceeding? The decision was made by a state leadership that values its economy over human life, Mull argues. Ultimately, Georgia will end up serving as the country’s canary in the coal mine. The state’s business owners are aware of the role they’re playing, and some aren’t happy about it.
Many Georgians have no delusions about the risks of reopening, even if they need to return to work for financial reasons. Among the dozen local leaders, business owners, and workers I spoke with for this article, all said they know some people who disagreed with the lockdown but were complying nonetheless. No one reported serious acrimony in their communities.
Instead, their stories depict a struggle between a state government and ordinary people. Georgia’s brash reopening puts much of the state’s working class in an impossible bind: risk death at work, or risk ruining yourself financially at home. In the grips of a pandemic, the approach is a morbid experiment in just how far states can push their people.
Why the Coronavirus is so Confusing, by Ed Yong
Even to researchers, much about how the coronavirus operates and spreads is still a mystery. But that’s not cause for alarm: It’s just how the scientific process works. Yong breaks down each of the factors that experts need to investigate—including the disease itself, the public-health messaging, and the flurry of statistics—before the coronavirus can be understood more clearly. He also examines how the mismatched speeds of science and human curiosity can lead nervous people to bad information.
The pandemic’s length traps people in a liminal space. To clarify their uprooted life and indefinite future, they try to gather as much information as possible—and cannot stop. “We go seeking fresher and fresher information, and end up consuming unvetted misinformation that’s spreading rapidly,” Bergstrom says. Pandemics actually “unfold in slow motion,” he says, and “there’s no event that changes the whole landscape on a dime.” But it feels that way, because of how relentlessly we quest for updates. Historically, people would have struggled to find enough information. Now people struggle because they’re finding too much.
Efficiency is Biting Back, by Edward Tenner
High-tech upgrades to health systems, living spaces, travel, and more all likely helped spread the coronavirus, which might have otherwise remained an isolated disease. As Americans imagine the better, more efficient society that could be ushered in after months of living our lives mostly remotely, it’s worth remembering that streamlining daily life can have disastrous consequences.
In practice, the pursuit of efficiency has often resulted in the consolidation of smaller companies and facilities into larger ones; in greater congestion as more people are packed into smaller spaces, whether in office towers or aboard commercial airliners; and in the tight coupling of deliveries and other business processes in ways that, at least when all goes well, speed up production and reduce warehouse inventories. But consolidation, congestion, and tight coupling may also make our economy less efficient in the long run—and our society more vulnerable to outside shocks such as the coronavirus. Efficiency, in fact, can be hazardous to our well-being, and a strategic amount of inefficiency is crucial in keeping society healthy.
Medication Shortages Are the Next Crisis, by Jeremy Samuel Faust
With the United States playing “catch-up” with the coronavirus crisis, emergency physicians such as Faust have wondered whether they should be rationing lifesaving medications more strictly. Many hospitals are running low on the drugs needed to treat COVID-19, endangering both coronavirus patients and people who take the same medications for other conditions. The simplest solution, Faust argues, would be for the federal government to eliminate delays by more closely overseeing the manufacturing and distribution of essential drugs.
Here are steps the federal government can take now to make sure that hospitals are well stocked during the pandemic and after it passes, when doctors turn to operations delayed by the COVID-19 surge. First, it needs to improve data collection to track how manufacturing capacity is stacking up against medical demand. Then, it needs to compel pharmaceutical companies and their suppliers to accelerate the production of needed drugs.
The role that health-care workers are playing right now is not unlike that of the military during wartime. So why, Wood asks, are we not systematizing the work of doctors as we do the work of the military? If we require doctors’ sacrifice in times of public-health catastrophes, we should also require that their safety and equipment become the burden and priority of the rest of us, he argues.
Alex Kon, a physician and bioethicist, says that until about a hundred years ago, doctors regularly fled epidemics. Only since then, after a quasi-military ethos of not abandoning one’s post penetrated the medical profession, did expectations change. Now there is an unwritten “covenant,” Kon says, according to which doctors hold their positions, and society is supposed to reciprocate by equipping them and practicing social distancing (for example) to keep their hospitals from being swamped.
Doctors have abided by that covenant. The rest of us have broken it. We have failed to equip them; we have failed to elect governments that competently manage public health; we have failed to wear masks, avoid crowds, and keep the ERs as empty as possible.
Why It’s Important Not to Drink Bleach, by James Hamblin
The president’s suggestion that cleaning products could serve as a potential medical treatment for COVID-19 is a public-health danger. Agents such as bleach and isopropyl alcohol are poisonous if ingested. The nonchalance with which Donald Trump implied that they might instead be salubrious demonstrates his disregard for the seriousness of the presidential platform, Hamblin writes—especially in light of his backpedaled attempt to pass his statements off as sarcasm.
Trump’s words matter beyond the profound ignorance they betray. Approximately 50,000 Americans have now died of COVID-19. In states of emergency like this, health officials are trained to clearly say what is known and what is unknown, what is actionable and what is not. Trump consistently does the opposite, suggesting something while also saying he is not saying it, making bizarre declarations followed by hedges about how what he just said may or may not be true.
The Scariest Pandemic Timeline, by Olga Khazan
Despite everything that Americans have been through in recent weeks, the worst of the coronavirus pandemic is possibly still months ahead of us. COVID-19 infection numbers are expected to ebb and surge from now until whenever a vaccine becomes available. The pandemic began as the country’s flu season was winding down, but thanks to that ebbing and flowing, a future wave could overlap with the next flu season.
Having to contend with another round of COVID-19 patients while also taking on severe flu cases might cause hospitals to quickly run out of ventilators, beds, or even doctors. Some people might even get infected with both the flu and COVID-19 at the same time. While health experts don’t know exactly how that would make COVID-19 worse, “I can’t imagine that would be good,” Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security, said.
The Real Reason to Wear a Mask, by Zeynep Tufecki, Jeremy Howard, and Trisha Greenhalgh
Face masks can serve two purposes: protecting the wearer by preventing infectious particles from coming in, and protecting those around the wearer by preventing particles from coming out. Homemade masks (think sewing up a cotton bandanna) are not nearly as effective as medical-grade masks at keeping the wearer safe, but they can still keep nearly 99 percent of particles from escaping the mask. That’s why the CDC recommends that Americans wear them outside the home: If just 80 percent of the population protects those around them, the rate at which the coronavirus spreads could be halved.
Think of the coronavirus pandemic as a fire ravaging our cities and towns that is spread by infected people breathing out invisible embers every time they speak, cough, or sneeze. Sneezing is the most dangerous—it spreads embers farthest—coughing second, and speaking least, though it still can spread the embers. These invisible sparks cause others to catch fire and in turn breathe out embers until we truly catch fire—and get sick. That’s when we call in the firefighters—our medical workers. The people who run into these raging blazes to put them out need special heat-resistant suits and gloves, helmets, and oxygen tanks so they can keep breathing in the fire—all that PPE, with proper fit too.
If we could just keep our embers from being sent out every time we spoke or coughed, many fewer people would catch fire. Masks help us do that. And because we don’t know for sure who’s sick, the only solution is for everyone to wear masks. This eventually benefits the wearer because fewer fires mean we’re all less likely to be burned. My mask protects you; your masks protect me. Plus, our firefighters would no longer be overwhelmed, and we could more easily go back to work and the rest of our public lives.
Why Some People Get Sicker Than Others, by James Hamblin
One of the most frightening aspects of the coronavirus is the seemingly random and erratic trajectories it takes. While some people fall ill and slowly recover, others start to feel better before their health takes a nosedive. Even some of the symptoms vary, all without clear patterns or variables. In many cases, steep declines during a COVID-19 infection seem to be caused by an overactive and self-destructive immune response to the illness, specifically an immune event called a cytokine storm. These so-called storms require a careful and difficult balancing act to treat. Understanding why they’re triggered in some people and not others could help make treatment more effective, but depends on research and health-care resources that aren’t available to Americans right now.
Deciding on the precise method of modulating the immune response—the exact drug, dose, and timing—is ideally informed by carefully monitoring patients before they are critically ill. People at risk of a storm could be monitored closely throughout their illness, and offered treatment immediately when signs begin to show. That could mean detecting the markers in a person’s blood before the process sends her into hallucinations—before her oxygen level fell at all.
In typical circumstances in the United States and other industrialized nations, patients would be urged to go to the hospital sooner rather than later. But right now, to avoid catastrophic strain on an already overburdened health-care system, people are told to avoid the hospital until they feel short of breath. For those who do become critically ill and arrive at the ER in respiratory failure, health-care workers are then behind the ball. Given those circumstances, the daily basics of maintaining overall health and the best possible immune response become especially important.
A New Statistic Reveals Why America’s COVID-19 Numbers Are Flat, by Alexis Madrigal and Robinson Meyer
The United States has failed to conduct enough testing to determine exactly how widespread the novel coronavirus is within its borders, but a different statistic, called the “test-positivity rate,” could provide clues to exactly how dire our situation is. New data from The Atlantic’s COVID Tracking Project show that one in five COVID-19 tests conducted in the U.S. have come back positive—a rate one infectious-disease professor called “very high.” To experts, a test-positivity rate this high suggests one important thing: A lot of people have caught the virus and not been tested.
The U.S. did almost 25 times as many tests on April 15 as on March 15, yet both the daily positive rate and the overall positive rate went up in that month. If the U.S. were a jar of 330 million jelly beans, then over the course of the outbreak, the health-care system has reached in with a bigger and bigger scoop. But every day, 20 percent of the beans it pulls out are positive for COVID-19. If the outbreak were indeed under control, then we would expect more testing—that is, a larger scoop—to yield a smaller and smaller proportion of positives. So far, that hasn’t happened.
Is It Ethically Okay to Get Food Delivered Right Now? By Joe Pinsker
There’s no way to get food without interacting with someone else, and many families are struggling to reconcile the danger they may pose to grocery and food-service workers while meeting their own needs. Our writer Joe Pinkser’s guide to ethical consumption addresses the specific fears you might have when going to the grocery store, ordering takeout, or dropping food off for a family member. Among his important findings: One food-science professor reassured Joe that no evidence shows the virus being transmitted via food. Ultimately, there’s no wrong way to stock up, as long as you’re careful, smart, and flexible about it.
So is it morally wrong to order delivery and put workers in that position, or is ordering delivery a good thing because it directs money to restaurants and workers? “Right now, I think workers would largely ask you to please keep ordering,” said Saru Jayaraman, the director of the Food Labor Research Center at UC Berkeley. “It’s essential for these workers to be able to survive. Our industry is definitely worried about people’s safety, including their own, but they’re also worried about survival and feeding their kids … It’s not that they don’t think this is a scary time to be doing delivery, but they also need their jobs.”
Besides, the ethical calculations might not be as simple as they seem at first, because going to the grocery store also puts other people at risk—you could be infected and contagious but not know it. “In a moral sense, that at least makes it more gray,” said Christopher Robichaud, a senior lecturer in ethics and public policy at Harvard’s Kennedy School.
Our Pandemic Summer, by Ed Yong
In March, Ed Yong asked how the pandemic would end. In April, he asked how it will continue through the strange summer that awaits us. Scientists will spend the months ahead processing new insights about the path the virus took through the country and making careful decisions about how to keep it from exploding again. The most crucial thing they need to understand is what proportion of the U.S. population has actually been infected.
If it turns out that, say, 20 percent of the U.S. has been infected, that would mean the coronavirus is more transmissible but less deadly than scientists think. It would also mean that a reasonable proportion of the country has some immunity. If that proportion could be slowly and safely raised to the level necessary for herd immunity—60 to 80 percent, depending on the virus’s transmissibility—the U.S. might not need to wait for a vaccine. However, if just 1 to 5 percent of the population has been infected—the range that many researchers think is likelier—that would mean “this is a truly devastating virus, and we have built up no real population immunity,” said Michael Mina, an epidemiologist and immunologist at Harvard. “Then we’re in dire straits in terms of how to move forward.”
The Best Hopes for a Coronavirus Drug, by Sarah Zhang
Scientists homing in on potential therapies for COVID-19 are focused on the virus’s 29 proteins. Proteins are the mechanisms of action in all cells—in viral cells, they’re the warriors that take over a healthy human body. Proteins in the coronavirus form spikes that latch on to a common receptor in the body, force human cells to replicate viral RNA, and more. Researchers are currently working on drugs to interfere with those processes, but it’s a tricky problem.
One idea is to stop these virus-ordered functions without interfering with a cell’s normal functions. Here, the best analogy for a potential SARS-CoV-2 drug may not be an antibiotic, which kills foreign bacterial cells rather indiscriminately. “I think it’s much more like a cancer therapy,” Kevan Shokat, a pharmacologist at UC San Francisco, told me. In other words, it may be about selectively killing the human cells that have gone haywire. This opens up the possibility of many more drug targets in the host, but it also adds a challenge: It is much easier for a drug to distinguish between human and bacteria than between human and virus-hijacked human.
The Technology That Could Free America From Quarantine, by Derek Thompson
Novel “test and trace” systems are emerging in countries such as China and South Korea, where social-distancing measures ,are beginning to ease up. Using information from sources as varied as cellphone GPS and credit-card purchases, these systems can track citizens’ movements and interactions, identifying and alerting those who have recently come into contact with someone who has tested positive for COVID-19. Such systems—some of which even publicly broadcast the information of infected individuals—run headfirst into issues of privacy, government surveillance, and complicated stigmas surrounding health. But they could be the best way to preserve other democratic values in the face of widespread illness.
The pandemic has already required Americans to embrace extreme behavior in the name of saving lives. Tens of millions of Americans are living under house arrest. Many chief executives and entrepreneurs have said they agree with a government mandate to shut down their businesses. In these strange times, common rights that once seemed nonnegotiable have been suddenly renegotiated. Compared with our life just six weeks ago, smartphone tracing might seem like a violation of our dignity and privacy—and compared with our life six years from now, I hope it will be. But compared with our present nightmare, strategically sacrificing our privacy might be the best way to protect other freedoms.
Don’t Believe the COVID-19 Models, by Zeynep Tufecki
The White House, the CDC, the WHO, and world governments have been flashing infection charts for weeks. But these models aren’t meant to be crystal balls: They represent possibilities, rather than predictions. When you see any projected death toll, pay careful attention to the parameters that come along with it. Is that number indicative of a worst-case scenario—if, say, American hospitals were to all close tomorrow? Or is it a goal we are to work toward, requiring careful action to be taken by all in order to make it a reality?
At the beginning of a pandemic, we have the disadvantage of higher uncertainty, but the advantage of being early: The costs of our actions are lower because the disease is less widespread. As we prune the tree of the terrible, unthinkable branches, we are not just choosing a path; we are shaping the underlying parameters themselves, because the parameters themselves are not fixed. If our hospitals are not overrun, we will have fewer deaths and thus a lower fatality rate. That’s why we shouldn’t get bogged down in litigating a model’s numbers. Instead we should focus on the parameters we can change, and change them.
Everyone Thinks They’re Right About Masks, by Ed Yong
Staying at home is the number-one recommendation to minimize the spread of COVID-19. If you must leave your home, health organizations such as the CDC recommend keeping at least a six-foot distance from other people. But some experts have suggested that coronavirus particles can travel farther than six feet and linger in the air for longer than previously thought. How the virus behaves in air is still a mystery—as is whether masks can protect people.
You could tie yourself in knots gaming out the various scenarios that might pose a risk outdoors, but the environmental engineer Linsey Marr recommends a simple technique. “When I go out now, I imagine that everyone is smoking, and I pick my path to get the least exposure to that smoke,” she told me. If that’s the case, I asked her, is it irrational to hold your breath when another person walks past you and you don’t have enough space to move away? “It’s not irrational; I do that myself,” she said. “I don’t know if it makes a difference, but in theory it could. It’s like when you walk through a cigarette plume.”
Private Labs Are Fueling a New Coronavirus Testing Crisis, by Alexis C. Madrigal and Robinson Meyer
Private companies such as Quest Diagnostics and Labcorp are now leading the country in COVID-19 testing. Tests might be more widely available now, but that hasn’t been matched by increased processing speed. In California alone, more than 57,400 people are currently awaiting the release of their test results, primarily from Quest—and state testing numbers don’t reflect them.
Through BioReference and other commercial companies, as well as its own laboratories, New York now has almost 20 percent of all the completed tests in the United States. As a consequence, the number of confirmed cases has skyrocketed, but at least New York knows the severity of its outbreak.
If New York is on one end of the spectrum, California is on the other. What’s unclear is how common California’s and Quest’s situations are. No other state reports that it has such a huge backlog of tests stuck in private laboratories, but California’s reporting idiosyncrasy likely reflects reality better than other states’ reporting. For example, Illinois Governor J. B. Pritzker tweeted yesterday that private-lab results in his state are taking “4-7 days and sometimes even up to 10 days.”
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.
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.
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.
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.
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.
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.’”