People who think theyve been exposed to the novel coronavirus are clamoring for antibody tests blood screens that can detect who has previously been infected and, the hope is, signal who is protected from another case of Covid-19.
But as the tests roll out, some experts are trying to inject a bit of restraint into the excitement that the results of these tests could, for example, clear people to get back to work. Some antibody tests have not been validated, they warn. Even those that have been can still provide false results. And an accurate positive test may be hard to interpret: the virus is so new that researchers cannot say for sure what sort of results will signal immunity or how long that armor will last.
They caution that policymakers may be making sweeping economic and social decisions plans to reopen businesses or schools, for example based on limited data, assumptions, and whats known about other viruses. President Trump last week unveiled a three-phased approach to reopen the country; he said some states that have seen declining case counts could start easing social distancing requirements immediately. And some authorities have raised the idea of granting immunity passports to people who recover from the virus to allow them to return to daily life without restrictions.
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Before we embark on huge policy decisions, like issuing immunity certificates to get people back to work, I think its good that people are saying, Hold up, we dont know that much about immunity to this virus, said Angela Rasmussen, a Columbia University virologist.
To be clear, most experts do think an initial infection from the coronavirus, called SARS-CoV-2, will grant people immunity to the virus for some amount of time. That is generally the case with acute infections from other viruses, including other coronaviruses.
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With data limited, sometimes you have to act on a historical basis, Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, said in a webcast with JAMA this month. Its a reasonable assumption that this virus is not changing very much. If we get infected now and it comes back next February or March we think this person is going to be protected.
Still, the World Health Organization has stressed that the presumed immunity can only be proven as scientists study those who have recovered for longer periods. The agency is working on guidance for interpreting the results of antibody tests, also called serologic tests.
Right now, we have no evidence that the use of a serologic test can show that an individual is immune or is protected from reinfection, the WHOs Maria Van Kerkhove said at a briefing last week.
Below, STAT looks at the looming questions about antibodies and immunity that scientists are racing to answer.
What are antibody tests? How widely available are they? And how accurate?
The tests look for antibodies in the blood. Because antibodies are unique to a particular pathogen, their presence is proof the person was infected by the coronavirus and mounted an immune response. The hope is that the presence of the antibodies is an indication that the person is protected from another infection.
These are different from the tests used to diagnose active infections, which look for pieces of the virus genome.
Commercial antibody tests are starting to appear on the market, but so far, the Food and Drug Administration has only cleared a few through Emergency Use Authorizations. And already, health regulators are warning that the ones on the market may vary in their accuracy.
I am concerned that some of the antibody tests that are on the market that havent gone through FDA scientific review may not be as accurate as wed like them to be, FDA Commissioner Stephen Hahn said on Meet the Press earlier this month. He added that no test is 100% accurate, but what we dont want are wildly inaccurate tests.
Even the best tests will generate some false positives (identifying antibodies that dont actually exist) and some false negatives (missing antibodies that really are there). Countries including the U.K. have run into accuracy issues with antibody tests, slowing down their efforts for widespread surveys.
The fear in this case with imprecise tests is that false positives could errantly lead people to think theyre protected from the virus when they have yet to have an initial infection.
Serology testing isnt a panacea, said Scott Becker, the CEO of the Association of Public Health Laboratories. When its used, we need to ensure there are good quality tests used.
One specific concern with antibody tests for SARS-CoV-2: they might pick up antibodies to other types of coronaviruses.
Globally, there have only been a few thousand people exposed to the other coronaviruses that have caused outbreak emergencies, SARS and MERS. But there are four other coronaviruses that circulate in people and cause roughly a quarter of all common colds. Its thought that just about everyone has antibodies to some combination of those coronaviruses, so serological tests for SARS-CoV-2 would need to be able to differentiate among them.
What can be gleaned from serological results?
Detecting antibodies is the first step. Interpreting what they mean is harder.
Typically, a virus that causes an acute infection will prompt the bodys immune system to start churning out specific antibodies. Even after the virus is cleared, these neutralizing antibodies float around, ready to rally a response should that virus try to infect again. The virus might infect a few cells, but it cant really gain a toehold before the immune system banishes it. (This is not the case for viruses that cause chronic infections, like HIV and, in many cases, hepatitis C.)
The infection is basically stopped in its tracks before it can go anywhere, said Stephen Goldstein, a University of Utah virologist. But, Goldstein added, the durability of that protection varies depending on the virus.
Scientists who have looked at antibodies to other coronaviruses both the common-cold causing foursome and SARS and MERS found they persisted for at least a few years, indicating people were protected from reinfection for at least that long. From then, protection might start to wane, not drop off completely.
The experience with other viruses, including the other coronaviruses, has encouraged what Harvard epidemiologist Marc Lipsitch summed up as the educated guess in a recent column in the New York Times: After being infected with SARS-CoV-2, most individuals will have an immune response, some better than others. That response, it may be assumed, will offer some protection over the medium term at least a year and then its effectiveness might decline.
But many serological tests arent like pregnancy tests, with a yes or no result. They will reveal the levels (or titer) of antibodies in a persons blood. And thats where things can get a bit trickier. At this point, scientists cant say for sure what level of antibodies might be required for a person to be protected from a second Covid-19 case. They also cant say how long people are safeguarded, though its thought that a higher initial titer will take longer to wane than low levels.
Further investigation is needed to understand the duration of protective immunity for SARS-CoV-2, a committee from the National Academies of Sciences, Engineering, and Medicine wrote in a report this month.
Its not just whether someone is immune themselves. The next assumption is that people who have antibodies cannot spread the virus to others. Again, that hasnt been shown yet.
We dont have nearly the immunological or biological data at this point to say that if someone has a strong enough immune response that they are protected from symptoms, that they cannot be transmitters, said Michael Mina, an epidemiologist at Harvards T.H. Chan School of Public Health.
The challenge, as the National Academies report highlighted, is that no one knew about this virus until a few months ago. That means they havent been able to study what happens to people who recover from Covid-19 and if and how long they are protected for more than a short period of time.
One key uncertainty arises from the fact that we are early in this outbreak and survivors from the first weeks of infection in China are, at most, only three months since recovery, the report said.
What else can antibody tests show?
In addition to identifying those who have been infected, antibody tests can also suggest at a broader level how widely the virus has spread. These data have implications for how severe future outbreaks of cases might be and what kind of restrictions communities might need to live under. If more people have been infected than known a strong likelihood, given the number of mild infections that might have been missed and testing limitations in countries including the United States then more people are thought to be protected going forward.
In the United States, the Centers for Disease Control and Prevention and the National Institutes of Health have both launched serosurveys to assess how many people might have contracted the virus. Even employees of Major League Baseball teams have been enlisted in a study enrolling thousands of patients.
What have data from serosurveys shown thus far about antibody generation?
A number of countries have launched large serosurveys, so hopefully well have a better sense soon of the levels of antibodies being generated by individuals who recover from Covid-19 and among the general population. For now, though, there have only been limited data released from a couple small studies.
Scientists in Europe have pointed to strong antibody production in patients within a few weeks of infection. One study found that people were generally quick to form antibodies, which could help explain why the majority of people do not develop severe cases of Covid-19.
But one preprint released this month complicated the landscape. (Preprints have not been peer-reviewed or published yet in a research journal.) Researchers in Shanghai reported that of 175 patients with confirmed Covid-19, about a third had low antibody levels and some had no detectable antibodies. The findings suggest that the strength of the antibody response could correlate to the severity of infection, though thats not known for sure. They also raised concerns that those with a weaker antibody response might not be immune from reinfection.
But outside researchers have said that conclusions about immunity cant be drawn from what the study found. For one, there are different kinds of antibodies, so some might exist that the test wasnt looking for. Secondly, studies in other coronaviruses have shown that antibody responses vary from person to person, without clear implications for how protected someone is from another infection.
And, researchers say, antibodies are not the only trick the body has to protect itself. Immune cells also form memories after an initial infection and can be rallied quickly should that same pathogen try to strike again, even without antibodies or after antibody levels fade.
People that lose that serum neutralization it doesnt mean necessarily that theyre not going to have some level of immunity, said virologist Vineet Menachery of the University of Texas Medical Branch. Your immune system hasnt forgotten. It may just take them a couple of days to generate that immune response and be able to clear a virus.
He added that its likely that if and when protection starts to wane and people contract the coronavirus a second time, its likely to cause an even milder illness.
Ive heard reports of reinfection or reactivated virus. Whats going on there?
Health officials in some countries have said theyve seen examples of people recovering from Covid-19 only to test positive for the virus again what theyve taken to calling reactivation, to differentiate it from a second infection.
But experts are skeptical that either is occurring.
While no possibility can be eliminated at this early stage of the outbreak, they say that there are more likely explanations for a positive diagnostic test coming after a negative test.
For one: The tests used to diagnose Covid-19 look for snippets of the virus genome, its RNA. But what they cant tell you is if what theyre finding is evidence of live virus, meaning infectious virus. Once a person fights off a virus, viral particles tend to linger for some time. These cannot cause infections, but they can trigger a positive test. The levels of these particles can fluctuate, which explains how a test could come back positive after a negative test. But it does not mean the virus has become active, or infectious, again.
And two: the diagnostic tests typically rely on patient samples pulled from way back in their nasal passages. Collecting that specimen is not foolproof. Testing a sample that was improperly collected could lead to a negative test even if the person has the virus. If that patient then gets another test, it might accurately show they have the virus.
As Jana Broadhurst, the director of the Nebraska Biocontainment Units clinical laboratory, said, garbage in, garbage out.
Sharon Begley contributed reporting.
The nudge came in an email in early March from an Italian friend alarmed by how fast the deadly coronavirus was spreading in his country.
A shortage of ventilators, he told Scott Cohen and Marcel Botha, was a critical problem in Italy, and he warned that it soon would be in the United States, too. He urged the pair to apply their skills to the ventilator challenge.
Both Mr. Cohen, co-founder of a technology center for researchers and start-ups, and Mr. Botha, chief executive of a product design and development company, were skeptical. A standard ventilator, with thousands of parts requiring a complex global supply chain, was hardly a device that could be manufactured quickly and affordably.
I was dismissive at first, said Mr. Botha, whose company is called 10XBeta. It looked impossible.
But they soon found a design for a basic ventilator that could serve as their core technology. Since then, they have orchestrated from New York a far-flung collaboration of scientists, engineers, entrepreneurs, physicians and regulatory experts and accomplished in a month what would normally take a year or more.
The result are machines known as bridge ventilators, or automatic resuscitators, priced at $3,300. They are mainly meant to help less critically ill patients breathe. If patients become sicker, with lung function more compromised by the disease, they still need to be placed on standard ventilators, which typically cost more than $30,000.
On Friday, the Food and Drug Administration approved the new device, the Spiro Wave, to be used on patients in hospitals, under an expedited process called emergency use authorization.
The project was initially targeted at New York City as a stopgap solution for what only a month ago appeared to be a looming, life-threatening shortage of ventilators in the city.
But the urgency has receded for now. While the citys coronavirus death toll continues to mount, hospital admissions are trending down, and intensive-care units seem to have enough ventilators.
But health experts say a machine like the Spiro Wave should be a valuable tool in the arsenal of treatment. It can, they say, expand access to breathing assistance in other parts of the country as the pandemic spreads, and especially to rural communities without major medical centers. And capable, low-cost machines could greatly expand access to treatment in developing countries in Asia, Africa and Latin America.
The New York group has fielded inquiries from across the United States and from companies and governments worldwide. It plans to license its design for free.
The project is one of several pushes in America and abroad to streamline ventilator design and lower costs. This month, Medtronic got F.D.A. approval to offer in the United States a ventilator that it sells in 35 other countries for an average price of less than $10,000. The company is also making the machines blueprint freely available to other manufacturers.
The hurry-up engineering feat relied on human networks; two in particular stand out. The original design came from a classroom project at the Massachusetts Institute of Technology a decade ago. Since the coronavirus outbreak, M.I.T. professors and students have worked to upgrade the design in collaboration with outside groups. And several key contributors to the project are M.I.T. alumni.
The other network is the government and business community of New York, where Mr. Cohen and Mr. Botha are based. The city government took on the role of a risk-taking venture investor, first with a $100,000 research grant and then a nearly $10 million agreement to buy 3,000 of the basic ventilators.
Its essentially a start-up that has made unbelievable progress in a short time, said James Patchett, chief executive of New York Citys Economic Development Corporation, which backed the project.
The New York ventilator effort got underway after widespread warnings of shortages. In mid-March, Mayor Bill de Blasio held a conference call with top staff members. Mr. de Blasio recalled that the looming ventilator shortage was scary as hell. New York had no ventilator producers, but he told his staff to do and spend what it took to solve the problem.
The citys economic development chief, Mr. Patchett, who was on the call, knew Mr. Cohen and his technology center, New Lab, which is in the Brooklyn Navy Yard. Mr. Cohen told him about the ventilator-design project that he was putting together. It sounded promising, and the city made its initial grant.
Later, on March 25, after further development of the M.I.T. design, critical care physicians from citys public hospitals and two private hospitals saw the most recent version of the machine. That evening Mr. Patchett called Dr. Mitchell Katz, who leads the Health and Hospitals Corporation, which operates the citys public hospitals.
We should definitely do this, Dr. Katz recalled telling Mr. Patchett.
The project had launched about 10 days earlier, after Mr. Cohen, on the recommendation of a scientist friend in San Francisco, got in touch with Alex Slocum, a renowned mechanical engineer at M.I.T. whose class created the design in 2010.
A group of faculty and students Mr. Slocum led hardware design, and Daniela Rus, a professor and robotics expert, led software development worked to upgrade the design to help coronavirus patients. The device would have to be able to push air into badly impaired lungs at several times the force used to resuscitate a normal lung.
This was going to take a serious machine, Mr. Slocum recalled.
The New York group began closely collaborating with the M.I.T. team. Dr. Albert Kwon, an M.I.T. graduate and a medical adviser on the project who is an anesthesiologist at the Westchester Medical Center, and Mr. Botha, also an M.I.T. alumnus, and others from New York made several trips to Boston for joint work and testing.
The M.I.T. academics goal has been mainly to develop designs and share information on a website. But the mission for the New York group was to make the low-cost ventilators quickly. The hub of that effort is a former perfume factory in Long Island City, Queens, that is now home to a high-tech manufacturer, Boyce Technologies.
The temperature of everyone who enters the brick building is taken, a precaution against infection. The 100,000-square-foot facility combines engineering and production with robots, a clean room, and circuitry and software design departments.
Manufacturing, engineering and medical experts have worked side by side for three weeks. Dozens of versions of the machine have been carted off to the dumpster, as upgrades and improvements were made. In recent days, M.I.T. engineers traveled to Queens to help with last-minute software tweaks.
Theres a lot you cant see in a model, said Charles Boyce, the founder and chief executive of Boyce Technologies. And if you cant manufacture something at scale, it doesnt matter. Its not going to have an impact.
Producing thousands of machines means lining up sometimes scarce supplies. One of those parts was an air-pressure sensor to ensure that a patients lungs were not overinflated, which could cause damage. Mr. Cohen knew that Honeywell was a leading producer of the sensor, and he tapped his network of personal contacts to secure it in volume.
Late one night, Mr. Cohen called Kathryn Wylde, chief executive of the Partnership for New York City, a business group of the citys top executives. Kevin Burke, a former chief executive of New York-based Con Edison, is a Honeywell board member. Introductions were made, and after a series of calls to Honeywell executives in America and Asia, a supply of the sensors was secured.
The New York ventilator project was intended to address a seemingly urgent need before large-scale initiatives such as a Ford-General Electric partnership began to produce ventilators.
While New Yorks crisis has eased, Dr. Katz cautioned that pandemic viruses are unpredictable and mutate. A later variant, or second wave, in the fall could be less lethal or more, as was the case with the second wave of the 1918 flu pandemic.
This is still a useful option to have, even if there is not the urgency there was, he said.
The low-cost ventilator, Mayor de Blasio said, is an invaluable tool and part of the stockpile of medical equipment and supplies the city needs as insurance against a Phase 2 of the pandemic.
We have to get through this first, he said. But for the future, we have to have an ongoing self-sufficiency effort in New York. What weve gone through should be a never-again moment.
Comprehending the toll the coronavirus has taken is complicated. Its spread may not end for weeks or months more.
The following numbers may help you make sense of it. Here are the ways -- in dollars, percentages and lives -- that coronavirus has knocked the world off its axis.
1
200,000
April 14
1.6 billion
97%
$2 trillion
22 million
0
The investment bank published its grim report less than one month before the World Health Organization declared the coronavirus a pandemic. A steep decline in Chinese economic activity, paired with US businesses that have since halted, could potentially lead to a recession, the company said.
March 16
$-37.63
$225 billion
1 in 3
"They make less money, they have less saved up to weather emergencies and they are at greater risk for displacement and homelessness than homeowners."
20 million
16
READ: How to help - and get help
New York City has never looked so unlike itself. Deserted streets and vacant stores. Essential workers taking to lonely subways. Mandatory face coverings.
But beyond the changes we can see outright are other lifestyle shifts that reflect the struggles and needs that have emerged within the last month.
Unemployment, of course, is up, and the number is staggering. With the states shutdown extended until at least May 15, it is a desperate time for many.
But some of the data shows glimmers of hope. While hundreds of food banks were forced to close, the citys volunteer pool vastly expanded. Air pollution is down. Applications to foster abandoned animals skyrocketed.
Our altered city, by the numbers, is just as complex as the one we remember.
During the week of March 22, nearly 144,000 unemployment claims were made in New York City. That constituted a 2,637 percent increase from last year, when the same time frame yielded about 5,300 claims.
And theres still many who have yet to file as the states system was overwhelmed.
7%Decrease in trash collection in Manhattan
March data from the citys Department of Sanitation shows the amount of refuse collected from Manhattan residences shrank by nearly 7 percent compared to the borough average for that month over the last five years.
The decrease is most likely a reflection of New Yorkers who had the means to relocate.
Greenwich Village, the Upper West Side and the Upper East Side, neighborhoods with some of the highest median incomes in the city, led the way with 11, 10 and 8 percent declines.
The rest of the city saw little change, although Staten Island logged the biggest increase, producing over 7 percent more refuse than usual.
3,000Number of applications to Foster Dogs
Interest in fostering pets has surged in the city, as many New Yorkers find themselves looking for companionship and having more time at home to care for a pet.
Foster Dogs, a nonprofit that works with about 30 shelters and rescue organizations in the New York City area, fielded more than 3,000 applications for fostering in March. Traffic to its website increased 250 percent.
In comparison, Foster Dogs received an average of 140 applications a month in 2019.
It was more interest than weve ever seen before, said Sarah Brasky, who founded the organization.
In March, Muddy Paws Rescue, a New York nonprofit, received seven times the number of applications for dog fostering than it had just two months earlier.
18%Decrease in morning electricity usage
The dip began as workplaces and schools started closing, then accelerated through the rest of March.
By the end of the month, the citys energy use was down by more than 10 percent, according to the New York Independent System Operator, the agency responsible for managing the states electric grid.
The change was most pronounced on weekday mornings, when usage would normally spike as people started their days and businesses opened. With nonessential workers ordered to stay home, it appeared that many were awakening later than usual.
New Yorkers patience with noisy neighbors has run thin, particularly when it comes to blaring televisions, which prompted a 42 percent increase in 311 complaints in March compared to last year, according to NYC Open Data.
Complaints of loud talking and music increased by 12 and 30 percent across the city.
Similarly, residential noise complaints, a broad category thats also one of the most common, rose significantly in every borough, peaking with a 33 percent increase in Staten Island. New Yorkers are especially irritated with helicopter noise; grievances about helicopters have tripled across the city.
90%Decrease in subway ridership
The Metropolitan Transportation Authority has struggled the last three years to improve a crumbling system, even as ridership numbers had been higher than ever. Last year, during one week in mid-April, 34 million swipes were recorded at M.T.A. stations.
That number was whittled down to just 2.5 million rides during the week ending April 11. The steepest declines were in Manhattan, while the Bronx, which has the highest poverty rate of any of the boroughs, saw ridership drop the least.
The M.T.A., which oversees the subways, buses and two commuter rails, has suffered crew shortages as thousands fall sick. So far, the agency has reduced bus service and temporarily eliminated some subway lines. Already deep in debt and heavily reliant on revenue from fares, New York Citys transit faces a tough future.
19.9%Decrease in overall crime as the city shut down
March began with an uptick in major crimes, such as murder and burglary, but there was soon a sharp decline in overall crime in every borough.
From March 12 through March 31, murders decreased by 25 percent when compared with the same period last year, according to the Police Department. Complaints of rape and grand larceny both went down as well.
Reports of domestic violence fell nearly 15 percent. That drop, however, could mean victims have been less able to report abuse.
The virus has put a strain on the department: It must enforce the new restrictive rules while dealing with a diminished force. One out of every six New York City police officers is out sick or in quarantine.
60%Decrease in traffic at the busiest bridges and tunnels
On the first Monday in March, more than 850,000 vehicles traveled across the M.T.A.s nine city crossings, including the Queens-Midtown Tunnel and the Verrazzano-Narrows Bridge. Three weeks later, that number had plummeted to about 351,000.
The less congested roads gave drivers a newfound sense of freedom. The citys automated speed cameras issued nearly 25,000 speeding tickets in a single day at the end of March, double the number from the previous month, according to city data.
Still, the roads have appeared safer. Traffic accidents overall dropped nearly 60 percent, with just over 1,000 motor vehicle collisions reported during the last week in March, according to an analysis of police data by a nonprofit watchdog group.
288%More people signed up to volunteer
Many New Yorkers volunteer each year, but March alone had an increase of almost three times the number of volunteer applications, with 6,500 compared with around 2,400 last year, based on data from New York Cares, an expansive volunteer network, which partnered with the city to coordinate coronavirus relief efforts.
The large spike in those eager to assist their communities was often directed toward food programs and social support for older adults, the primary areas of need across the city.
Theres a huge surge in need for virtual volunteering, to have a friend or neighbor to talk to, said Anusha Venkataraman, the citys chief service officer.
New York Cares reported that its volunteers distributed more than 130,000 meals in March 55,000 more than the previous month.
Despite the increased interest in volunteering, the heightened danger from coronavirus to those over 65 years of age has forced some food bank sites to close, particularly those run by volunteers who are older and retired.
City Harvest and Food Bank for New York City, the two largest food charities in the city, have seen a reduction in the number of soup kitchens and pantries they serve. Nearly 40 percent of Food Banks 800 delivery sites have closed while City Harvest reported that one-third of the 284 sites it serves have closed.
In a twist, the stay-at-home efforts have made it safer to breathe outside.
Air quality has vastly improved, with an average 25 percent decrease in pollution across the city, based on data by state environmental monitors of the levels of particulate matter, a pollutant tied to asthma and lung cancer.
Staten Island showed the most dramatic drop at 35 percent. The borough has long had a reputation for noxious skies from heavy traffic and ferries and barges in New York Harbor.
Reporting was contributed by Winnie Hu, Nikita Stewart, Lindsey Rogers Cook and Ashley Southall.
President Trump and senior members of his administration suggested during Mondays White House briefing that Maryland Gov. Larry Hogan did not need to secure coronavirus tests from South Korea.
Hogan, a Republican, has been pressing the federal government for more coronavirus testing capacity, and announced that the tests had been secured from South Korea earlier Monday.
Admiral Brett Giroir told reporters during the briefing, I dont know what the governor of Maryland is doing in South Korea, but there is excess capacity every day. If he wanted to send 30 or 40,000 tests to LabCorp and Quest, that could be done. That could be done tomorrow.
Vice President Mike Pence said he would follow up with Hogans office. He also pointed to a slide that showed testing facilities just in the state of Maryland.
I dont know when the governor placed the order from South Korea. I wouldnt begrudge him or his health officials for ordering tests. But the capacity for all the different laboratories and number of machines across Maryland is part of what we were communicating today, Pence said, adding that governors were assured access to federal testing facilities.
The President was more pointed in his response to Hogans decision to get tests from South Korea, saying, Take a look at that map. The governor of Maryland could have called Mike Pence, could have saved a lot of money.
I dont think he needed to go to South Korea. I thinkhe needed to get a little knowledge wouldve been helpful, he added.
Following the President's comments, Hogan's spokesperson tweeted a copy of a letter from Hogan, Washington, DC Mayor Muriel Bowser and Virginia Gov. Ralph Northam that "specifically asked for a federal testing site in the region."
Hoganannounced Monday that Maryland took delivery of 500,000 coronavirus tests from South Korea in a deal brokered with help from his South Korean born wife, Yumi.
A Boeing 777 landed at BWI on Saturday, part of whatHogandubbed Operation Enduring Friendship. The coronavirus kits come from LabGenomics andHogansays the half million kits are equal to the total amount of testing which has been completed by four of the top five states in America combined.
I want to sincerely thanks our Korean partners for assisting us in this fight against our common hidden enemy,Hogansaid.
The state of Maryland owes an incredible debt of gratitude to the people of South Korea, he added.
Having monopolized those critical supply chains, the Chinese Communist Party pointed them inward. It ensured that face masks being manufactured in China, for example, went to domestic consumption and their own fight against the virus.
Largely unable to import supplies from China, America has been left scrambling because we by and large lack the ability to make things, as well as the state capacity needed for reorienting production to do so. As a result, doctors are forced to ration supplies and, in some cases, cease using necessary protective equipment.
And while some heroic businesses have shifted production to help fill this gap and produce masks, hand sanitizer and other goods, the nation is still behind.
One reason is that as manufacturers fled to China, our nations economy transformed into one dominated by service industries, which survive on person-to-person transactions like the ones now restricted. And unlike industrial economies, service-based economies lack the flexibility that comes with producing physical goods that can either be sold later or repurposed to meet a sudden shortage. This makes us especially vulnerable to this kind of shock.
A commensurate shift in corporate behavior away from investment in workers, equipment and facilities, and toward churning out short-term financial gains to shareholders has only further sapped our resiliency. Why didnt we have enough N95 masks or ventilators on hand for a pandemic? Because buffer stocks dont maximize financial return, and there was no shareholder reward for protecting against risk. Even in government, we became infatuated with the just in time acquisition model, as opposed to just in case contingency acquisitions.
Today, we see the consequences of this short-term, hyperindividualistic ethos. Americans cannot leave their homes. Neighbors are unable to shake hands. Places of worship are closed. The labor market, especially for working-class Americans in those service industries, is in free-fall.
With the steadfast resolve of American communities and with government support to provide businesses the resources they need to pull through, Americans will overcome the challenge before us. But the society that follows should not be what it was before. We wont properly absorb the lessons from the coronavirus crisis if we fall back into the traditional Republican and Democratic model of politics. We need a new vision to create a more resilient economy.
The virus does not respect social boundaries, and (especially because there are no miracle cures) it strikes people in every class. Tom Hanks and Prince Charles both caught Covid-19 early, and the news includes daily reports of other rich and famous people who are sick or who have died from the disease.
But the social and economic effects of the coronavirus vary markedly by class. The rich retreat to comfortable homes with private gardens, or even to second houses in the country. The rest remain cooped up, often in small apartments in dense neighborhoods, and struggle to find daily necessities. Even in the face of social distancing, the economic essentials of elite life can continue unabated. The rich tend to do jobs that allow for remote work and provide employment security.
Americans with college degrees are three times more likely to be able to work from home than those with no education past high school, while those who earn more than $80,000 per year are over four times as likely to be able to work from home as those who earn less than $33,000. Small wonder, then, that cellphone location data reveal that residents of rich neighborhoods isolated themselves sooner, and have remained isolated longer, than residents of poor ones.
The inequalities among children are especially awful and will reach deep into our future. Rich private schools move online with great success, while public schools, especially in poorer districts, find remote learning much more challenging. Long summer holidays already segregate the rich, whose achievement test scores continue to rise, from the poor, whose reading and math skills fade each summer. Just imagine the unequal effects of a lost semester or, God forbid, two.
An effective, really robust relief package, unconstrained by cost, is in everyones interest. The Cares Acts direct cash payments phase out once households make $150,000 per year and are eliminated for households that earn more than $198,000 per year, but the relief efforts indirect effects extend more widely and reach the rich nonetheless. These programs protect everyones health by making social distancing financially possible for ordinary Americans. They save jobs, prevent bankruptcies and keep the economy afloat, which helps investors. The initial stock-market bump triggered by the Cares Acts passage added more than $4 trillion to the value of equities in the United States, and the richest 10 percent of households, holding 84 percent of American-owned stocks, benefited from this bump to the tune of roughly $2 trillion.
With more countries planning to loosen restrictions imposed due to coronavirus but the UK prime minister, Boris Johnson, and the German chancellor, Angela Merkel, concerned about the potential for a resurgence or second wave, here is what we know from the rest of the world about the risk of Covid-19 coming back.
Epidemics of infectious diseases behave in different ways but the 1918 influenza pandemic that killed more than 50 million people is regarded as a key example of a pandemic that occurred in multiple waves, with the latter more severe than the first. It has been replicated albeit more mildly in subsequent flu pandemics.
Other flu pandemics including in 1957 and 1968 all had multiple waves. The 2009 H1N1 influenza A pandemic started in April and was followed, in the US and temperate northern hemisphere, by a second wave in the autumn.
How and why multiple-wave outbreaks occur, and how subsequent waves of infection can be prevented, has become a staple of epidemiological modelling studies and pandemic preparation, which have looked at everything from social behaviour and health policy to vaccination and the buildup of community immunity, also known as herd immunity.
While second waves and secondary peaks within the period of a pandemic are technically different, the concern is essentially the same: the disease coming back in force.
This is being watched very carefully. Without a vaccine, and with no widespread immunity to the new disease, one alarm is being sounded by the experience of Singapore, which has seen a sudden resurgence in infections despite being lauded for its early handling of the outbreak.
Although Singapore instituted a strong contact tracing system for its general population, the disease re-emerged in cramped dormitory accommodation used by thousands of foreign workers with inadequate hygiene facilities and shared canteens.
With 1,426 new cases reported on Monday and nine dormitories the biggest of which holds 24,000 men declared isolation units, Singapores experience, although very specific, has demonstrated the ability of the disease to come back strongly in places where people are in close proximity and its ability to exploit any weakness in public health regimes set up to counter it.
A small rise late last week in the number of infections in Germany another country credited with handling its outbreak well via extensive testing and tracing has also drawn attention, even as the country moved to loosen restrictions.
And despite Chinas apparent success in bringing the outbreak in Hubei province under control, there has been an increase in cases in the countrys north.
A new cluster of coronavirus cases in the north-eastern city of Harbin near the Russian border has forced authorities to impose fresh lockdowns, after reporting near-zero local transmissions in recent weeks.
All of this raises questions over when, and how, to reduce lockdowns to avoid a second wave or resurgence.
Conventional wisdom among scientists suggests second waves of resistant infections occur after the capacity for treatment and isolation becomes exhausted. In this case the concern is that the social and political consensus supporting lockdowns is being overtaken by public frustration which has triggered protests in the US and elsewhere and the urgent need to reopen economies.
The threat declines when susceptibility of the population to the disease falls below a certain threshold or when widespread vaccination becomes available.
In general terms the ratio of susceptible and immune individuals in a population at the end of one wave determines the potential magnitude of a subsequent wave. The worry right now is that with a vaccine still months away, and the real rate of infection only being guessed at, populations worldwide remain highly vulnerable to both resurgence and subsequent waves.
As Justin Lessler, an associate professor of epidemiology at Johns Hopkins University, wrote strikingly for the Washington Post in March: Epidemics are like fires. When fuel is plentiful, they rage uncontrollably, and when it is scarce, they smoulder slowly.
Epidemiologists call this intensity the force of infection, and the fuel that drives it is the populations susceptibility to the pathogen. As repeated waves of the epidemic reduce susceptibility (whether through complete or partial immunity), they also reduce the force of infection, lowering the risk of illness even among those with no immunity.
The problem is that we do not know how much fuel is still available for the virus.
The New York City subway system rebounded from the 1970s, when the city teetered on the edge of bankruptcy, crumbling cars routinely broke down and rampant crime scared riders away.
It survived the Sept. 11, 2001, terror attacks and Hurricane Sandy in 2012, which led to years of costly rebuilding and service disruptions. And it turned a corner after a spate of meltdowns and accidents in 2017 including a derailment injuring dozens of riders that prompted Gov. Andrew M. Cuomo to declare a state of emergency.
But now, the subway faces its worst financial crisis yet one that threatens to hobble the system and have a lasting impact on the city and region.
As the coronavirus pandemic has shut down New York, over 90 percent of the citys subway ridership has disappeared along with critical fare revenue leaving behind escalating expenses and an uncertain timeline of when and how the citys transit lifeline will recover.
It is unclear what the actual fallout could be. But past crises suggest a potentially grim reckoning for riders: subway and bus lines eliminated, unpredictable wait times for trains as service is slashed, more breakdowns with less money spent on upkeep and steeper fare hikes.
We dont want to turn the clock back to the bad old days of the M.T.A., when state of good repair and system expansion was gutted to balance operating budgets, said Patrick J. Foye, chairman of the Metropolitan Transportation Authority. Weve come too far.
The agency, which operates the citys subways, buses and two commuter rails, faces a shortfall of up to $8.5 billion even after temporarily scaling back service and receiving a $3.8 billion federal bailout, according to transit leaders and fiscal experts.
Financial projections for the next two years also look bleak, making it likely that money meant to be spent on improving the system will have to be used just to keep the subway and buses running.
Its highly likely that the worst-case scenario is the likely scenario, said Nick Sifuentes, the executive director of Tri-State Transportation Campaign, an advocacy group.
Across the country, transit agencies are grappling with plummeting ridership, shrinking revenue and mounting pandemic-related expenses that could plunge public transit systems into financial calamity.
In New York, the epicenter of the coronavirus outbreak, the transit authority has struggled to maintain an already-reduced service schedule as workers fall sick: as of Thursday, 2,400 workers had tested positive for the virus and 4,000 were quarantined. At least 79 workers have died.
M.T.A. officials have made an emergency request for another $3.9 billion in federal money. We need substantially more help and we need it now, Mr. Foye said.
On Friday, a bipartisan group of New York lawmakers sent a letter supporting the M.T.A.s request to congressional leadership.
The M.T.A. is in crisis. This additional funding of $4 billion is absolutely vital, said Representative Jerrold Nadler, a Democrat. Unfortunately with Trump you never know, but we in the delegation will fight tooth and nail to make sure that funding is there.
Senator Chuck Schumer of New York, the minority leader, said he is optimistic the M.T.A. will receive the federal aid, noting that congressional leaders successfully secured the agencys first request for emergency funds in March.
Transit officials did not have an answer for what the agency would do if it failed to secure the additional aid, characterizing it as a critical stopgap measure to keep the system moving.
But the unique nature of this crisis complicates options the transit agency has taken in the past.
With less than a million riders using public transit, raising the fare now would be futile. Cutting service beyond the reduced schedules is complicated by the critical role public transit plays in moving doctors, nurses and other essential workers. And indefinitely delaying long-overdue upgrades and maintenance could set back service for years to come.
The traditional levers we would use in worst-case scenarios are not useful, said Robert E. Foran, chief financial officer at the M.T.A. None of these are now tenable choices.
An analysis of M.T.A. finances by McKinsey & Company projects fare and toll revenue losses up to $5.9 billion and dedicated tax revenue losses as high as $1.8 billion. By the end of the year, the authority will face revenue losses as high as $8.5 billion, officials said.
These losses will cripple the M.T.A.s operating budget: Nearly all of its operating revenue comes from fares and tolls, and taxes and subsidies including payroll, real estate transfer and business taxes that are expected to drop sharply in the coming months.
The agency might have to consider taking drastic measures, transit experts said, including raising tolls and fares beyond two planned fare and toll increases of 4 percent each in 2021 and 2023.
In 2010, the M.T.A. eliminated two subway lines and dozens of bus routes to help close a major budget gap.
Even before the pandemic, some fiscal experts had questioned the M.T.A.s budget, which relies on what some saw as rosy revenue projections.
When people asked me two months ago, I said the M.T.A.s fiscal situation was precarious and that was during the good times, said Andrew Rein, the president of the Citizens Budget Commission, a nonprofit watchdog group.
The financial crisis hits at a critical time for the M.T.A., which has made slow but steady improvements to subway and bus service.
The agency has unveiled a sweeping $54 billion program to transform an antiquated century-old system into a modern network that will be pivotal to New Yorks recovery.
The plan includes replacing signals that date back as far as the 1930s with new signals that will allow trains to run faster and increase capacity. It also calls for adding 70 elevators to improve access for the disabled and extending the Second Avenue subway north into East Harlem.
All the capital projects we have in mind need to be done, said Robert W. Linn, a member of the M.T.A. board.
Underscoring the transit agencys precarious situation, New York lawmakers, acting they said at the insistence of Mr. Cuomo, opened the door for the M.T.A. to help cover its operating costs by tapping revenue that was supposed to be used to make improvements.
That revenue comes from a portion of the sales tax, a new tax on high-end real estates sales and tolls from a hard-fought congestion pricing plan that is expected to start next year.
In normal circumstances, it would have been a move that many organizations opposed, said Kate Slevin, a senior vice president for the Regional Plan Association, a research and advocacy group. But given the circumstances, the M.T.A. has few good alternatives here so we found it acceptable.
Still, Mr. Rein, of the Citizens Budget Commission, said the M.T.A. must strike a careful balance between paying to run the subway and investing in upgrades that will ensure a well-functioning system as the city struggles to return to a semblance of normal life.
Many transit experts said the last time New Yorks subways were anywhere near such a dire financial strait was in the late 1970s, after decades of cost-cutting and deferred maintenance had turned the system into a worldwide symbol of urban decay.
Officials resorted to using federal funding earmarked for capital projects to cover shortfalls in the agencys operating budget to keep the system afloat as ridership and farebox revenue plummeted.
But the financial fallout from the coronavirus pandemic will plunge the M.T.A. into uncharted territory, as it confronts both economic and public health challenges, experts say.
What its facing today is far more serious, said Richard Ravitch, who was chairman of the M.T.A. during the 1970s crisis. If you look at the number of people who are unemployed, if you look at the projections for the citys deficit, if you look at the states deficit, you have to ask yourself: Where is the revenue going to come from to support the M.T.A.?
Beside decimating revenue, the public health crisis has also triggered hundreds of millions in new expenses to protect transit workers and disinfect equipment.
And even when stay-at-home restrictions are eased, some riders may fear returning to crowded subway platforms and cars because of lasting concerns about being exposed to viruses.
How long does this level of ridership stay where it is? Mr. Rein said. Once we start going back to work, what level of ridership comes back? The behavioral impacts of this is still unknown.
Still, experts say an efficient and effective public transit system will be critical to the city and the country the New York region contributes 10 percent of the countrys gross domestic product.
The M.T.A. is the economic engine of the entire region; the economy is built around the spine of the subway, buses and commuter rails, said Lisa Daglian, executive director of the Permanent Citizens Advisory Committee to the M.T.A., a watchdog group.
You cant reopen the economy without the transit system in New York.
Luis Ferr-Sadurn contributed reporting.
US hostility to the World Health Organization scuppered the publication of a communique by G20 health ministers on Sunday that committed to strengthening the WHOs mandate in coordinating a response to the global coronavirus pandemic.
In place of a lengthy statement with paragraphs of detail, the leaders instead issued a brief statement saying that gaps existed in the way the world handled pandemics.
The failure to agree on a statement will underline the extent to which the pandemic has become a theatre for a wider global disagreement between the US and China in which other nation states are finding themselves increasingly forced to take sides.
Donald Trump has suspended US payments to the WHO in protest at what he regards as the bodys China-centric approach, reflected in his view by its failure to challenge China sufficiently over the origins of the Covid-19 outbreak.
Tawfiq Al-Rabiah, the health minister for Saudi Arabia, which was hosting the virtual summit, abruptly cancelled a planned press conference on Sunday, saying he urgently needed to attend a domestic coronavirus taskforce meeting.
A six-paragraph statement made no mention of the WHO, but referred to systemic weaknesses in the way in which the world handled pandemics.
However, an unpublished 52-paragraph draft communique supported and committed to further strengthening the WHOs mandate in coordinating the fight against the pandemic, including the protection of frontline health workers and delivery of medical supplies, especially diagnostic tools, medicines and vaccines.
The draft also expressed concern about the continuity and lack of sustainable funding of the WHOs health emergencies programme. It urged all donors to invest in the fund, saying it is far more cost effective to invest in sustainable financing for country preparedness than to pay to the costs of responding to outbreaks.
Several days before the meeting it had emerged that the US health and human services secretary, Alex Azar, would not be attending as scheduled. Other attendees said they understood that Trump did not want him to participate. Instead, the US was represented by Eric Hargan, Azars deputy, and another US official.
Sherpas for other delegations were also made aware before the meeting of US objections to language relating to the WHO, which was supported by the 19 other countries.
According to those present, many of the representatives at the meeting spoke of the key role being played by the WHO and praised the value of the guidance it has issued during the outbreak.
Sources said that some representatives also made the point that any inquest into the handling of the pandemic by the WHO as demanded by the Trump administration should wait until after the pandemic was brought under control.
When the US delegations turn came to speak, Hargan explained that the US could not endorse the declaration, instead suggesting that a summary be issued in the form of a press release.
The bulk of the draft communique constituted a call for countries to cooperate multilaterally to prevent future pandemics, highlighting the current inequality in health resources and the human suffering the pandemic was causing.
The draft contained no implicit or explicit criticism of Chinas initial handling of the crisis, saying instead all sides were committed to learning lessons from the crisis, including the vulnerabilities exposed by the global response.
Donald Trump last week suspended US payments to the WHO claiming the organisation was too China-centric and accused its leadership of failing to alert the world to the scale of the pandemic that began in Wuhan until it was too late.
The WHO has insisted it acted as soon as it had information from Beijing and stated that it needed Chinese support to gain access to China, and investigate the issue of human-to-human transmission.
David Nabarro, the WHO special envoy, warned on Monday that cutting funding in the midst of the Coronavirus pandemic is like removing the right hand of a surgeon when she is in the middle of a difficult operation.
The US has previously prevented the G7, a smaller group of mainly western industrialised countries, from reaching a joint position when foreign ministers were unable to agree with a US insistence that the virus be described as the Wuhan virus.
The World Health Organization (WHO) was founded on the 7 April 1948, a date celebrated annually as World Health Day. As an agency of the United Nations, the organisation has developed into an international establishment which involves 150 countries and employs 7,000 people. WHO is responsible for the World Health Report and the World Health Survey. Since its establishment it has played a fundamental role in the eradication of smallpox, and currently prioritises diseases including HIV/AIDs, Ebola, Malaria and Tuberculosis.
WHO takes a global responsibility for the co-ordinated management and handling of outbreaks of new and dangerous health threats - like the Covid-19 coronavirus.
The current WHO director general is Dr Tedros Adhamon Ghebreyesus, elected for a five year term in 2017. Prior to his election, Dr Tedros served as Ethiopias minister for foreign affairs. He also served as minister of Health for Ethiopia from 2005-2012 where he led extensive reform to the countrys health system.
WHO's handling of the global pandemic has been criticised by US president Donald Trump, who announced in April that the US will no longer contribute to funding the agency.
Grace Mainwaring and Martin Belam
Saudi Arabia is this years chair of the G20, and the main summit of world leaders is still scheduled to be held in Riyadh in November. In the run-up to that event specialist ministers meet to prepare parts of the final communique.
The US is the second largest contributor to the WHO, and the sudden suspension of US payments for up to 90 days has infuriated other nations health ministries, while easing some of the pressure on China over its handling of the crisis.
The Trump administration has been contacted for comment.
