Will there be a second wave of coronavirus? – The Guardian

On Jan. 22, two days after Chinese officials first publicized the serious threat posed by the new virus ravaging the city of Wuhan, the chief of the World Health Organization held the first of what would be months of almost daily media briefings, sounding the alarm, telling the world to take the outbreak seriously.

But with its officials divided, the W.H.O., still seeing no evidence of sustained spread of the virus outside of China, declined the next day to declare a global public health emergency. A week later, the organization reversed course and made the declaration.

Those early days of the epidemic illustrated the strengths and weaknesses of the W.H.O., an arm of the United Nations that is now under fire by President Trump, who on Tuesday ordered a cutoff of American funding to the organization.

With limited, constantly shifting information to go on, the W.H.O. showed an early, consistent determination to treat the new contagion like the threat it would become, and to persuade others to do the same. At the same time, the organization repeatedly praised China, acting and speaking with a political caution born of being an arm of the United Nations, with few resources of its own, unable to do its work without international cooperation.

Mr. Trump, deflecting criticism that his own handling of the crisis left the United States unprepared, accused the W.H.O. of mismanaging it, called the organization very China-centric and said it had pushed Chinas misinformation.

But a close look at the record shows that the W.H.O. acted with greater foresight and speed than many national governments, and more than it had shown in previous epidemics. And while it made mistakes, there is little evidence that the W.H.O. is responsible for the disasters that have unfolded in Europe and then the United States.

The W.H.O. needs the support of its international members to accomplish anything it has no authority over any territory, it cannot go anywhere uninvited, and it relies on member countries for its funding. All it can offer is expertise and coordination and even most of that is borrowed from charities and member nations.

The W.H.O. has drawn criticism as being too close to Beijing a charge that grew louder as the agency repeatedly praised China for cooperation and transparency that others said were lacking. Chinas harsh approach to containing the virus drew some early criticism from human rights activists, but it proved effective and has since been adopted by many other countries.

A crucial turning point in the pandemic came on Jan. 20, after Chinas central government sent the countrys most famous epidemiologist, Zhong Nanshan, to Wuhan to investigate the new coronavirus racing through that city of 11 million people. Dr. Zhong delivered a startling message on national television: Local officials had covered up the seriousness of the outbreak, the contagion spread quickly between people, doctors were dying and everyone should avoid the city.

Dr. Zhong, an eccentric 83-year-old who led the fight against the SARS outbreak of 2002 and 2003, was one of few people in China with enough standing to effectively call Wuhans mayor, Zhou Xianwang, a rising official in the Communist Party, a liar.

Mr. Zhou, eager to see no disruption in his plans for a local party congress from Jan. 11 to 17 and a potluck dinner for 40,000 families on Jan. 18, appears to have had his police and local health officials close the seafood market, threaten doctors and assure the public that there was little or no transmission.

Less than three days after Dr. Zhongs warning was broadcast, China locked down the city, preventing anyone from entering or leaving and imposing strict rules on movement within it conditions it would later extend far behind Wuhan, encompassing tens of millions of people.

The national government reacted in force, punishing local officials, declaring that anyone who hid the epidemic would be forever nailed to historys pillar of shame, and deploying tens of thousands of soldiers, medical workers and contact tracers.

It was the day of the lockdown that the W.H.O. at first declined to declare a global emergency, its officials split and expressing concern about identifying a particular country as a threat, and about the impact of such a declaration on people in China. Such caution is a standard if often frustrating fact of life for United Nations agencies, which operate by consensus and have usually avoided even a hint of criticizing nations directly.

Despite Dr. Zhongs warning about human-to-human transmission, Tedros Adhanom Ghebreyesus, the W.H.O.s director-general, said there was not yet any evidence of sustained transmission outside China.

That doesnt mean it wont happen, Dr. Tedros said.

Make no mistake, he added. This is an emergency in China, but it has not yet become a global health emergency. It may yet become one.

The W.H.O. was still trying to persuade China to allow a team of its experts to visit and investigate, which did not occur until more than three weeks later. And the threat to the rest of the world on Jan. 23 was not yet clear only about 800 cases and 25 deaths had been reported, with only a handful of infections and no deaths reported outside China.

In retrospect, we all wonder if something else could have been done to prevent the spread we saw internationally early on, and if W.H.O. could have been more aggressive sooner as an impartial judge of the China effort, said Dr. Peter Rabinowitz, co-director of the MetaCenter for Pandemic Preparedness and Global Health Security at the University of Washington.

Amir Attaran, a public health and law professor at the University of Ottawa, said, Clearly a decision was taken by Dr. Tedros and the organization to bite their tongues, and to coax China out of its shell, which was partially successful.

That in no way supports Trumps accusation, he added. The president is scapegoating, dishonestly.

Indeed, significant shortcomings in the administrations response arose from a failure to follow W.H.O. advice.

The Centers for Disease Control and Prevention bungled the rollout of diagnostic tests in the United States, even as the W.H.O. was urging every nation to implement widespread testing. And the White House was slow to endorse stay-home restrictions and other forms of social distancing, even after the W.H.O. advised these measures were working in China.

It is impossible to know whether the nations of the world would have acted sooner if the W.H.O. had called the epidemic a global emergency, a declaration with great public relations weight, a week earlier than it did.

But day after day, Dr. Tedros, in his rambling style, was delivering less formal warnings, telling countries to contain the virus while it was still possible, to do testing and contact tracing, and isolate those who might be infected. We have a window of opportunity to stop this virus, he often said, but that window is rapidly closing.

In fact, the organization had already taken steps to address the coronavirus, even before Dr. Zhongs awful revelation, drawing attention to the mysterious outbreak.

On Jan. 12, Chinese scientists published the genome of the virus, and the W.H.O. asked a team in Berlin to use that information to develop a diagnostic test. Just four days later, they produced a test and the W.H.O. posted online a blueprint that any laboratory around the world could use to duplicate it.

On Jan. 21, China shared materials for its test with the W.H.O., providing another template for others to use.

Some countries and research institutions followed the German blueprint, while others, like the C.D.C., insisted on producing their own tests. But a flaw in the initial C.D.C. test, and the agencys slowness in approving testing by labs other than its own, contributed to weeks of delay in widespread testing in the United States.

In late January, Mr. Trump praised Chinas efforts. Now, officials in his administration accuse China of concealing the extent of the epidemic, even after the crackdown on Wuhan, and the W.H.O. of being complicit in the deception. They say that lulled the West into taking the virus less seriously than it should have.

Larry Gostin, director of the W.H.O.s Center on Global Health Law, said the organization relied too heavily on the initial assertions out of Wuhan that there was little or no human transmission of the virus.

The charitable way to look at this is that W.H.O. simply had no means to verify what was happening on the ground, he said. The less charitable way to view it is that the W.H.O. didnt do enough to independently verify what China was saying, and took China at face value.

The W.H.O. was initially wary of Chinas internal travel restrictions, but endorsed the strategy after it showed signs of working.

Right now, the strategic and tactical approach in China is the correct one, Dr. Michael Ryan, the W.H.O.s chief of emergency response, said on Feb. 18. You can argue whether these measures are excessive or restrictive on people, but there is an awful lot at stake here in terms of public health not only the public health of China but of all people in the world.

A W.H.O. team including two Americans, from the C.D.C. and the National Institutes of Health did visit China in mid-February for more than a week, and its leaders said they were given wide latitude to travel, visit facilities and talk with people.

Whether or not Chinas central government intentionally misstated the scale of the crisis, incomplete reporting has been seen in every other hard-hit country. France, Italy and Britain have all acknowledged seriously undercounting cases and deaths among people who were never hospitalized, particularly people in nursing and retirement homes.

New York City this week reported 3,700 deaths it had not previously counted, in people who were never tested. The United States generally leaves it to local coroners whether to test bodies for the virus, and many lack the capacity to do so.

In the early going, China was operating in a fog, unsure of what it was dealing with, while its resources in and around Wuhan were overwhelmed. People died or recovered at home without ever being treated or tested. Official figures excluded, then included, then excluded again people who had symptoms but had never been tested.

On Jan. 31 a day after the W.H.O.s emergency declaration President Trump moved to restrict travel from China, and he has since boasted that he took action before other heads of state, which was crucial in protecting the United States. In fact, airlines had already canceled the great majority of flights from China, and other countries cut off travel from China at around the same time Mr. Trump did.

The first known case in the United States was confirmed on Jan. 20, after a man who was infected but not yet sick traveled five days earlier from Wuhan to the Seattle area, where the first serious American outbreak would occur.

The W.H.O. said repeatedly that it did not endorse international travel bans, which it said are ineffectual and can do serious economic harm, but it did not specifically criticize the United States, China or other countries that took that step.

Experts say it was Chinas internal travel restrictions, more severe than those in the West, that had the greatest effect, delaying the epidemics spread by weeks and allowing Chinas government to get ahead of the outbreak.

The W.H.O. later conceded that China had done the right thing. Brutal as they were, Chinas tactics apparently worked. Some cities were allowed to reopen in March, and Wuhan did on April 8.

The Trump administration has not been alone in criticizing the W.H.O. Some public health experts and officials of other countries, including Japan's finance minister, have also said the organization was too deferential to China.

The W.H.O. has altered some of its guidance over time a predictable complication in dealing with a new pathogen, but one that has spurred criticism. But at times, the agency also gave what appeared to be conflicting messages, leading to confusion.

In late February, before the situation in Italy had turned from worrisome to catastrophic, Prime Minister Giuseppe Conte and other government officials, citing W.H.O. recommendations, said the regional governments of Lombardy and Veneto were doing excessive testing.

We have more people infected because we made more swabs, Mr. Conte said.

In fact, the W.H.O. had not said to limit testing, though it had said some testing was a higher priority. It was and still is calling for more testing in the context of tracing and checking people who had been in contact with infected patients, but few Western countries have done extensive contact tracing.

But the organization took pains not to criticize individual countries including those that did insufficient testing.

On March 16, Dr. Tedros wrote on Twitter, We have a simple message for all countries: test, test, test. Three days later, a W.H.O. spokeswoman said that there was no one size fits all with testing, and that each country should consider its strategy based on the evolution of the outbreak.

The organization was criticized for not initially calling the contagion a pandemic, meaning an epidemic spanning the globe. The term has no official significance within the W.H.O., and officials insisted that using it would not change anything, but Dr. Tedros began to do so on March 11, explaining that he made the change to draw attention because too many countries were not taking the groups warnings seriously enough.

Reporting was contributed by Selam Gebrekidan, Javier Hernandez, Jason Horowitz, Adam Nossiter, Knvul Sheikh and Roni Caryn Rabin.

LITTLE ROCK, Ark. -- A healthcare worker from Arkansas has died after testing positive for COVID-19.

This is the first reported death of a frontline healthcare worker in state from coronavirus, according to Arkansas Health Department Secretary Dr. Nate Smith.

The healthcare worker was under 65 years old and worked at Jefferson Regional Medlcal Center in Pine Bluff. Officials did not provide any other details.

This was one of two new deaths reported Sunday in Arkansas from COVID-19, raising the state's total to 40.

Additionally, Arkansas Gov. Asa Hutchinson said nearly 1,400 inmates at the Cummins Unit - Arkansas Department of Corrections have been tested for coronavirus.

Among those tests, 348 inmates have tested positive for COVID-19 and three are currently hospitalized. Around 630 tests results have been returned.

State officials also say nearly 2,000 inmates across the state of Arkansas are being reviewed for release amid the pandemic.

Arkansas state leaders released the following updates on the COVID-19 pandemic:

-1,781 cases in the state (40 new)-88 hospitalizations (2 new)-40 reported deaths (2 new)-1,022 active cases-719 recoveries

Watch the latest updates from Gov. Hutchinson on the stream below:

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What You Should Know

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Updated at 6:56 p.m. ET

As of Sunday, nearly three months since the first confirmed case of the coronavirus was reported in the United States, there are over 746,300 confirmed cases of the virus in the country, according to data compiled by Johns Hopkins University.

Cases of COVID-19 have been reported in at least 212 countries and territories, according to the World Health Organization. And according to the Johns Hopkins data, over 2,382,000 people have been infected globally.

The disease has been detected everywhere from remote areas of the Amazon, to the Syrian province of Idlib, which even before the pandemic hit was mired in one of the world's worst humanitarian crises. In the United Kingdom, 596 people died from the virus on Saturday, pushing the nation's death toll above 16,000, according to the Department for Health and Social Care.

In the U.S., which has more cases than any other nation, another 32,491 new confirmed cases of COVID-19 were reported on Saturday and nearly 1,900 more people infected with the virus died.

In some parts of the country, officials have been encouraged by some slowing signs of growth in the number of deaths and new hospitalizations. In New York, the nation's hardest-hit state, Gov. Andrew Cuomo said Sunday that the state is "on the other side of the plateau." Cuomo said that 507 people died Saturday, down 43 from Friday.

People wait for a distribution of masks and food from the Rev. Al Sharpton in Harlem on Saturday after a new state mandate was issued requiring residents to wear face coverings in public due to COVID-19. Bebeto Matthews/AP hide caption

People wait for a distribution of masks and food from the Rev. Al Sharpton in Harlem on Saturday after a new state mandate was issued requiring residents to wear face coverings in public due to COVID-19.

Still, as the number of coronavirus cases continues to mount nationally, President Trump has made clear in recent days his eagerness to reopen the U.S. economy. Some U.S. governors are gradually easing social-distancing restrictions, as is the case in Florida, where some beaches have reopened.

In Maryland, where COVID-19 deaths have spiked in the last week, hundreds of citizens protested coronavirus restrictions this weekend in Annapolis, the state capital. Similar scenes have played out across the U.S., as people protested in Michigan, Minnesota, Utah and Oregon.

As of Sunday afternoon, more than 40,400 American lives have been claimed in the pandemic, according to the Johns Hopkins data. Worldwide, more than 164,000 people have died as a result of the coronavirus. Of those infected globally, more than 611,791 have recovered.

Cuomo says New York may be past the plateau as virus hospitalizations slowly drop.

Gov. Andrew M. Cuomo arrived to his daily coronavirus briefing in Albany, N.Y., on Saturday with cautionary good news: The state has continued to make progress in its battle with a virus that has killed more than 13,000 residents, enough people to populate an upstate small city.

If you look at the past three days, you could argue we are past the plateau and starting to descend, Mr. Cuomo said. So, were not at the plateau anymore, but were still not in a good position.

Mr. Cuomo announced the states daily death toll from the virus had fallen to 540, down from 630 a day earlier. It was the lowest daily number in more than two weeks.

Still, he warned that the health crisis was far from over. On Friday alone, about 2,000 people were admitted to city hospitals with Covid-19 symptoms, a number similar to what hospitals were seeing as the pandemic began to peak in late March.

If it wasnt for the relative context weve been in, this would be devastating news, Mr. Cuomo said.

The number of people needing ventilators to breathe also decreased, which is very good news, the governor said.

Doctors will tell you that the emergency rooms have fewer people in them, Mr. Cuomo said. They were at max capacity for a long time.

The death toll included 504 people who had died in city hospitals and 36 others in nursing homes, which have come under scrutiny for not offering transparency to government officials and families of victims. The homes have struggled with testing and a lack of staffing.

Nursing homes are the single biggest fear in all of this, the governor said. Vulnerable people in one place it is the feeding frenzy for this virus, despite everything we can do and the best efforts of people working in those nursing homes.

Noticeably subdued, Mr. Cuomo on Saturday shied away from conflict with President Trump a day after the two leaders traded barbs over federal aid for the state. The governor underscored the need to work with the Trump administration to implement the widespread testing necessary to reopen New Yorks economy.

In the midst of this, there is no time for politics, Mr. Cuomo said. How does this situation get worse and get worse quickly? If you politicize all that emotion. We cannot go there.

He added: Im not asking the federal government to do more than they need to. But we do need their coordination. We need their partnership.

Gov. Philip D. Murphy of New Jersey said on Saturday that an additional 231 people had died of the coronavirus, pushing the states total to 4,070. More than 40 percent of those deaths have been at long-term care facilities.

Judith Persichilli, commissioner for the states Department of Health, said there had been 1,655 virus-related deaths in the facilities, which have struggled to combat the virus because of a lack of staffing, testing and protective equipment.

Ms. Persichilli said that surveyors from the Centers for Medicare and Medicaid had completed their review of the Andover Subacute and Rehabilitation Center in Andover, N.J., where 17 bodies were found inside a small morgue intended to hold no more than four people.

The owner has been issued numerous citations and has been asked to come up with a correction plan, she said.

The number of total coronavirus cases in New Jersey rose to over 81,420, with 3,026 new cases reported on Saturday. But Mr. Murphy said a three-week review of the statistics showed there has been a plateau in some metrics.

The numbers of new cases and hospitalizations were leveling off, and the number of people in intensive care or critical condition had remained stable, he said.

We are flattening the curve, Mr. Murphy said.

Among the dead mentioned by the governor a ritual he has included in his daily briefings were Alex Ruperto, a 52-year-old Union City police detective from Glen Ridge; Herbert Heaney, who worked as a forensic scientist with the New Jersey State Police; and Richard Campbell, the Edison fire captain.

As New Yorkers love lives adjust to a new normal, virtual dating platforms are quickly pivoting to help quarantined singles. New apps that function like online parties have emerged, and networking events and existing dating apps are tacking on video features and virtual speed dating rounds.

Beckett Mufson, a 27-year-old advertising executive, fled New York City in mid-March to live on a farm upstate. But he was still interested in finding potential partners.

So he tried a virtual gathering hosted by Here/Now, an initiative for hetero, queer, and nonbinary daters. Like other apps, it previously centered around public meet-ups, but recently pivoted to remote video events during the pandemic.

For the hourlong virtual gathering, Mr. Mufson and 11 other singles got to know each other by answering personal questions: If you could build a dream house, which weird or interesting feature would you include? What is one item that means the most to you?

The singles talked as a large group before breaking into smaller conversations of four. Then, they moved on to one-on-one chats.

Afterward, the participants filled out a survey to indicate whom they were interested in. Matches were notified.

It is an entirely possible scenario that this is how we might start, maintain, and end relationships over the next few months, or even a year, Mr. Mufson said. We have to consider that our first one-on-one date might be on Zoom. The first time we have sex might be on Zoom.

And for those who want to take their online love lives to the next level: Gov. Andrew M. Cuomo of New York announced he was issuing an executive order that would allow residents to obtain a marriage license remotely and permit online ceremonies.

When asked what people should do about marriage bureaus on Saturday, he responded jokingly: Marriage bureaus? I think the divorce rate is going up.

Over the past four weeks, about 22 million workers filed jobless claims, including about 1.2 million New Yorkers.

Unemployment systems, some of which rely on an antiquated computer programming language, were not built for such a rush of claimants. They also were not built for a new class of workers independent contractors and the self-employed who are now eligible for assistance during the pandemic.

In New York, the results have been maddening. Many people have had their online applications crash before they could hit submit, requiring them to start from scratch.

They have endured hourslong wait times only to get randomly disconnected, or be connected with representatives who say they cannot fix their issues.

Carly Keohane, who lost her waitressing job in Rochester, N.Y., has been waiting a month to receive $2,124 in unemployment payments as a direct deposit into her bank account.

But the state instead told her that the money had been deposited on a state-issued debit card, which she never received. Ms. Keohane, 31, said she could not get anyone on the phone to find out where it is.

Speaking on Thursday, the secretary to Governor Cuomo, Melissa DeRosa, said the state had been staggering under the weight of the claims for unemployment insurance.

We are going to continue doing everything we can to bring the system up to deal with this scale, she said.

Masks are now mandatory in New York.

From surgeon-quality personal protection to the home-stitched square and the bandits bandanna, New Yorkers pulled on a newly essential accessory and ventured into a landscape that changed yet again on Friday with the mandated wearing of masks in public.

The new rule, which took effect at 8 p.m. Friday, would be striking anywhere, but more so in New York City, where teeming crowds and if-I-can-make-it-there chutzpah are baked into the national imagination.

This is just the next step, said a retired corrections officer, Stanley Woo, 63, sitting down to play chess in a park in Forest Hills, Queens, with his old friends and his new mask.

Nobody likes it, but weve got to do what weve got to do, said Amanda Neville, 43, inside her wine store, Tipsy, in Clinton Hill, Brooklyn.

The measure was intended to further flatten the curve of new coronavirus infections in New York, which has had more than 13,300 deaths because of the virus and more than 236,000 confirmed cases.

Governor Cuomo said on Saturday at his daily briefing that he was following his own guidelines. On Friday night, he said, he began wearing a face mask when taking his dog Captain for a stroll.

When I am in public and Im walking the dog on the street and I cannot main social distancing, I am wearing a mask, Mr. Cuomo told reporters. I think this is a small inconvenience that has a tremendous benefit for people.

Captain, a Siberian-shepherd mix, doesnt wear a mask, he said, because he is not violating anything.

New York is not the only state to make face coverings mandatory: Maryland, New Jersey and Pennsylvania are requiring that masks be worn in stores; likewise in Los Angeles and some surrounding California counties. New Yorks order is the most expansive, requiring face coverings anywhere in the state where two people might come within two yards of each other, though for now there is no fine for disobeying.

New York Citys abrupt switch to remote learning last month created myriad challenges for the nations largest school system. One of the thorniest issues was how to take attendance for 1.1 million public school students who were suddenly at home.

On Friday, the Department of Education provided initial data indicating that most students were still interacting with school: About 84 percent of students signed on in some way during the first week of April. Average daily attendance before the coronavirus pandemic was around 92 percent.

Each of the citys 1,800 schools have created their own attendance plans, meaning that being marked present could include participating at live instruction at one school, and answering a brief question every morning at another school. Attendance during remote learning was higher for younger children, who are typically supervised by parents during the day, and lower for high school students.

About 20 percent of city schools, including some large high schools, have not yet reported their attendance data. The city will release attendance weekly.

As The New York Times follows the spread of the coronavirus across New York, New Jersey and Connecticut, we need your help. We want to talk to doctors, nurses, lab technicians, respiratory therapists, emergency services workers, nursing home managers anyone who can share whats happening in the regions hospitals and other health care centers. Even if you havent seen anything yet, we want to connect now so we can stay in touch in the future.

A reporter or editor may contact you. Your information will not be published without your consent.

Reporting was contributed by Maria Cramer, Melina Delkic, Matthew Haag, Alyson Krueger, Edgar Sandoval, Eliza Shapiro and Michael Wilson.

The government is facing increasingly rigorous scrutiny of its actions in several areas over its preparations for and response to coronavirus. Here are the main areas of criticism:

The most obvious and tragic crisis of all. The UK has now recorded more than 16,000 coronavirus-related deaths in hospitals, and thousands more are believed to have occurred in care homes and elsewhere. This puts the UK on an apparent course to match the very high death rate of places like Italy. The government is, however, urging caution over direct comparisons given the different ways in which statistics are collected across nations, time lags in terms of the outbreak, and demographic differences. At Sundays Downing Street briefing, the deputy chief medical officer for England, Jenny Harries, said a meaningful comparison might not be possible until some months after the pandemic had eased.

The UK remains very low down the international league table for the proportion of the national population tested for the virus, a measure seen as crucial to tracking its spread and thus laying the ground for a gradual end to the lockdown. The government has already missed its target of 25,000 tests a day by mid-April, and remains some way short of its end-of-April goal of 100,000 a day; 21,626 were carried out on Saturday. There is also no sign of the promised millions of simpler antibody tests, as their accuracy remains dubious, even though the government bought 3.5m of one type.

This has proved of the most regularly difficult tasks for the government getting enough PPE to not just hospitals, but also care homes and other settings like prisons and local authorities. On Friday, it emerged that guidance had changed to say NHS staff should use smaller, less effective aprons if, as seemed imminent, stocks of full gowns ran out troubling news for hospital workers amid growing numbers of staff deaths.

A consignment of gowns was due to arrive as part of a shipment of PPE from Turkey on Sunday, but has been delayed. Ministers have pointedly declined to guarantee supplies as needed, saying the situation is very challenging given the massive global demand for supplies. In the meantime, staff have to decide whether to agree to work without proper protection.

On the one hand, despite initial fears, there has not yet been a massive shortage of the complex machines used to help people breathe as their lungs recover from the virus, but even after the UKs target to secure 30,000 was downgraded to 18,000, that figure has still not been met. However, there has been political fallout over the apparent confusion about a plan to get private companies to design and build new models. A Financial Times story talked of companies being confused as to the brief, and of little progress being made. On Sunday the UK government published a highly unusual rebuttal of these claims.

As with ventilators, while there was initial panic at the idea of critical care beds being quickly overwhelmed, this has not been the case. The temporary acquisition of private spaces and the rapid construction of new sites has seen the number of these beds rise from about 4,100 in February to more than 5,500 now, with the occupancy rate falling from 81% to 58%. However, the overall numbers remain below what was pledged.

This might be the big one in terms of future focus. While Boris Johnsons long absence due to coronavirus is bad luck, the news that he missed five meetings of the governments emergency committee while taking a break from No 10 when the virus was first emerging in the UK has prompted condemnation. His ministers insist that Johnson remained in charge.

SARS-CoV-2, the virus that leads to coronavirus disease 19 (COVID-19), has spread rapidly from the first known cases in China in December 2019 to countries around the world.

On March 10, 2020, the World Health Organization (WHO) reported that there were 113,702 confirmed cases of COVID-19 around the world, plus 4,012 deaths.

In response to this global health crisis, researchers are working on developing a coronavirus vaccine as soon as possible.

Learn more about vaccine development and the possible timeline in this article.

Researchers striving to develop a coronavirus vaccine are working with different approaches, including:

The sections below will discuss these approaches in more detail.

Whole virus vaccines use weakened or dead forms of the virus that causes the disease.

They can be effective at providing immunity in the long run, but there is a risk that some people could develop symptoms of the illness due to the vaccination.

Reports state that Johnson & Johnson, Codagenix, and researchers at the University of Hong Kong are working on this kind of vaccine.

Recombinant protein subunit vaccines do not carry the risk of causing an infection in people who receive them, because they do not contain any live pathogens.

Researchers are investigating whether or not they can make a recombinant protein subunit vaccine that targets a protein called spike (S-) protein. The new coronavirus uses the S-protein to attach to and infect cells.

Novavax, Clover Biopharmaceuticals, the University of Queensland, and a consortium led by Texas Childrens Hospital for Vaccine Development are using this approach to develop a coronavirus vaccine.

Other researchers are investigating whether or not they can create a vaccine using antibodies from the SARS outbreak that began in 2002.

SARS has many similarities to COVID-19, as they are caused by related coronaviruses.

So far, scientists have shown that the antibodies that neutralize the SARS-causing virus can also limit how well the new coronavirus infects cells in laboratory studies.

Read more about the development of an antibody vaccine here.

Nucleic acid vaccines inject genetic material, such as DNA or RNA, into a live host. The cells that contain the new nucleic acid then make the proteins that were encoded in the DNA or RNA, which they present to the immune system.

Although the process is complex, nucleic acid vaccines enable the immune system to fight off particular pathogens.

Using nucleic acids such as DNA or RNA to deliver immunity is a promising approach, but to date, it is a technique only available in veterinary medicine.

However, researchers say that three companies are looking to develop a coronavirus vaccine using this approach: Inovio Pharmaceuticals, Moderna Therapeutics, and Curevac.

The CDC recommend that all people wear cloth face masks in public places where it is difficult to maintain a 6-foot distance from others. This will help slow the spread of the virus from asymptomatic people or people who do not know they have contracted the virus. Cloth face masks should be worn while continuing to practice physical distancing. Instructions for making masks at home can be found here. Note: It is critical that surgical masks and N95 respirators are reserved for healthcare workers.

Projections for how long it will take to develop a coronavirus vaccine vary widely, depending on whether the person making the projection is a scientist, politician, or businessperson.

Politicians and manufacturers alike have implied that a coronavirus vaccine could be available within months.

However, based on their knowledge and experience, scientists say that developing a coronavirus vaccine:

If the timeline for the production and distribution of a coronavirus vaccine seems long, that is because there are many steps in place to ensure that it is safe and effective.

Specifically, once researchers create a potential vaccine, prospective producers must submit an Investigational New Drug Application to the Food and Drug Administration (FDA) that describes the product, the manufacturing process, and its effectiveness in animal testing.

In the next phase, a vaccine must successfully complete the following series of clinical trials:

Specific medications to treat COVID-19 do not yet exist. Treatment will focus on alleviating symptoms while a person recovers.

Antibiotics cannot treat COVID-19, as they are meant for bacterial infections and have no affect on viruses such as coronavirus.

However, some researchers are looking at repurposing existing drugs, including antibiotics, as COVID-19 treatments. Learn more here.

Public health experts and medical professionals also recommend that people with the illness try to stay away from others during recovery.

Public health measures that limit the spread of infection include:

Different governments and organizations have taken varying approaches to limiting the spread of coronavirus.

People who think they have been exposed to someone with COVID-19 and develop symptoms such as a fever, cough, or trouble breathing should call their doctor, according to the CDC.

The most important thing that people with mild forms of the disease can do is make sure that they limit contact with others, especially older adults and those with compromised immune systems.

Some people with COVID-19 will require medical treatment, and some may need to stay in the hospital.

Before seeing a doctor or going to the hospital, however, a person should call the facility to alert them to the fact that someone is coming in who may have COVID-19. Also, wear a face mask on the way.

Hospitals are equipped with the medicine and personnel necessary to provide support for the most serious complications, including pneumonia and sepsis.

Vaccines work by prompting the immune system to make antibodies to defend the body against a specific disease, as if they had it.

The key is to do so without actually making the person sick.

After a person receives a vaccination, they develop immunity to the disease, which means that their bodies would be able to fight it off if they ever had exposure to it.

An effective vaccine must stimulate the immune system but not kick it into overdrive. Finding the right balance between an effective vaccine and one that does not cause unwanted side effects is a challenge for all vaccines under development.

During a health emergency, when speed is vital, this part may be the most significant factor to slow down the development of a safe new vaccine.

Vaccines also need to be safe for different groups of people to use, including young children, older adults, healthcare workers, and people with underlying health conditions.

To protect themselves and others from coronavirus, people can try:

COVID-19 is currently a major health challenge as doctors and researchers work to develop effective preventive measures, such as vaccines.

Until a vaccine becomes available, people can protect themselves and others by following guidance from public health and medical experts.

Facing criticism, President Trump both defended current testing capacity and promised to facilitate more.

President Trump on Sunday said the administration was preparing to use the Defense Production Act to compel an unspecified U.S. facility to increase production of test swabs by over 20 million per month.

The announcement came during his Sunday evening news conference, after he defended his response to the pandemic amid criticism from governors across the country claiming that there has been an insufficient amount of testing to justify reopening the economy any time soon.

We are calling in the Defense Production Act, Mr. Trump said. He added, Youll have so many swabs you wont know what to do with them.

He provided no details about what company he was referring to, or when the administration would invoke the act. And his aides did not immediately respond when asked to provide more details.

We already have millions coming in, he said. He added, In all fairness, governors could get them themselves. But we are going to do it. Well work with the governors and if they cant do it well do it.

Public health experts have said testing would need to at least double or even triple to justify even a partial reopening of the countrys economy, and business leaders reiterated that message in a conference call with Mr. Trump last week.

Seema Verma, the Medicaid and Medicare administrator, also announced on Sunday night that the administration was set to release guidelines for reopening the health care system to allow for elective procedures and surgeries.

Not everything can be addressed by telehealth, she said. Maybe a woman who needs surgery for breast cancer. Somebody who has cataracts in their eyes, and sometimes the doctor needs to be able to listen to their patients heart.

She cautioned that every state and local official would have to assess the situation on the ground before reopening.

Those state and local officials have been struggling to balance restrictions meant to curb the spread of the coronavirus against economic damage.

In Maryland and Virginia, governors said stay-at-home orders would remain in effect until they see decreases in the number of Covid-19 cases. And elsewhere in the nation, state officials said were seeking far more testing before easing restrictions, but continue to face shortages of supplies and testing kits.

We are fighting a biological war, Gov. Ralph Northam of Virginia said on the State of the Union program on CNN. He added that governors have been forced to fight that war without the supplies we need.

Mr. Northam, a Democrat, said that Virginia lacked enough swabs for the amount of testing needed.

Gov. Gretchen Whitmer of Michigan, another Democrat, said her state would like to double or triple the current number of tests if we had the swabs or reagents.

And Gov. Larry Hogan, a Maryland Republican, said Its not accurate to say theres plenty of testing out there and the governors should just get it done.

Dr. Deborah Birx, the coronavirus response coordinator for the White House, pushed back against criticism that not enough people were being tested, saying Sunday morning that not every community required high levels of testing. She said on the CBS program Face the Nation that the government was trying to predict community by community the testing that is needed.

There are currently about 150,000 diagnostic tests conducted each day, according to the Covid Tracking Project. Researchers at Harvard estimated last week that in order to ease restrictions, the nation needed to at least triple that pace of testing.

More than 2,000 people gathered at the State Capitol to challenge Washington States stay-at-home mandates. Organizers touted that the gathering was on the anniversary of the shot heard round the world that triggered the Revolutionary War.

The event drew some far-right groups, including the Three Percenters militia, named after the supposed fraction of colonists who took up arms during the war. With signs and speeches, the attendees called on the governor to lift the mandates.

We will not tolerate this as the new normal, said Tyler Miller, who led the gathering. He likened the group to the minutemen.

The Washington State Patrol estimated that 2,500 people attended the gathering. Few attendees wore masks, and many gathered tightly around speakers against the guidance of public health officials who recommend a six-foot distance to limit the spread of the virus.

At least three Republican state lawmakers participated in the events, including Representative Robert Sutherland, who called for revolution if the governor didnt lift mandates. He later said that a violent revolution was not the intention Sunday but that the people have a moral obligation to fight back against abusive government.

Gov. Jay Inslee said that while these have been difficult and frustrating times, he said now was not the time to stop progress in combating the virus.

I support free speech, but crowd counts or speeches wont determine our course, Mr. Inslee said. This isnt about politics. It can only be about doing what is best for the health of all Washingtonians.

The Washington protest is one of several rallies by people opposed to mandatory social distancing. In Denver on Sunday, two health care workers blocked the cars of protesters who had converged on the State Capitol to challenge stay-at-home orders, according to the photojournalist Alyson McClaran, who posted images of the exchange on social media. The workers wore scrubs and N95 masks.

They were blocking the roads until the police force stepped in, Ms. McClaran said. People were putting their cars right up against them.

President Trump on Sunday night again defended protesters in Michigan, Minnesota and Virginia, who have been protesting stay-at-home orders, even as the Democratic governors of those states have been receiving death threats.

They have got cabin fever, Mr. Trump said, denying that he was inciting violence by offering them support online. They want their life back. Their life was taken away from them.

Peter Navarro, the hawkish White House trade adviser, accused China on Sunday of profiting off the coronavirus pandemic by hoarding global supplies of personal protective equipment and selling them at exorbitant prices around the world.

President Trump has put Mr. Navarro, the author of Death by China, in charge of streamlining Americas medical supply chain as the federal government works to distribute masks, medicines and ventilators across the country. The comments, made on the Fox Business Network, represent the latest escalation in the Trump administrations efforts to publicly blame China for the health crisis that has caused thousands of deaths and is crippling the world economy.

China is sitting on that hoard of P.P.E., where it cornered the market, and its profiteering, Mr. Navarro said. I have cases coming across my desk where 50-cent masks made in China are being sold to hospitals here in America for as much as $8.

Mr. Navarro also attempted to stir allegations that China lied about the origins of the coronavirus, which was discovered in Wuhan in December. Health experts have said the virus likely jumped from an animal to a human in a market, but he stoked speculation on Sunday that the virus actually originated in a laboratory.

What we know is that the ground zero for this virus was within a few miles of that lab, Mr. Navarro said of a research lab in Wuhan that studies infectious diseases. If you simply do an Occams razor approach that the simplest explanation is probably the most likely, I think its incumbent on China to prove that it wasnt that lab.

Mr. Trump has also raised the possibility that the origins of the virus in China were not mere happenstance. He suggested that if an investigation found that China has not been forthright with the world, it could face punishment.

A mistake is a mistake, Mr. Trump said at a news conference on Saturday. But if it were knowingly responsible, yeah, then there should be consequences.

Asked on the CBS program Face the Nation on Sunday about the possibility that the virus was the result of a lab accident, Dr. Deborah Birx, the White Houses coronavirus response coordinator, was much more cautious.

I dont have any evidence that it was a laboratory accident, she said. I also dont know precisely where it originated.

The United States has seen a rollout of blood tests for coronavirus antibodies in recent weeks. The tests, which are meant to detect past exposure and possible immunity, not current cases of Covid-19, have been widely heralded as crucial tools in assessing the reach of the pandemic in the United States.

But for all their promise, the tests are already raising alarms. Officials fear the effort may prove as problematic as the deployment of earlier diagnostic tests.

Criticized for a tragically slow and rigid oversight of those tests months ago, the federal government is now faulted by public health officials and scientists for greenlighting the antibody tests too quickly and without adequate scrutiny.

Tests of frankly dubious quality have flooded the American market, said Scott Becker, executive director of the Association of Public Health Laboratories.

Twenty-five youths who are being held at a juvenile detention center in Virginia have tested positive for the coronavirus, officials at the facility recently confirmed.

The outbreak at the Bon Air Juvenile Correctional Center in Richmond is the largest at a youth detention facility in the country, according to criminal justice watchdogs, who have called on the Virginia governor, Ralph S. Northam, to release people from the center to further prevent the spread of the virus.

Dr. Christopher Moon, the chief physician for the Virginia Department of Juvenile Justice, said in a statement on Friday that 21 of the 25 youths who tested positive for the virus did not show any symptoms. He said that the other four people had symptoms no more severe than a cold or flu.

Any resident who tested positive was immediately placed in medical isolation, Dr. Moon said, adding that 13 of the residents were no longer in isolation.

He said that the correctional center, which serves male offenders usually between the ages of 14 to 20 and has a capacity for 284 people, was following the guidelines of the state health department.

Liz Ryan, the chief executive of the Youth First Initiative, a group opposed to juvenile incarceration, called on Mr. Northam on Thursday in a phone message to release the residents at the center. She posted a video on Twitter of her leaving the voice mail for Mr. Northam.

It is really urgent, Ms. Ryan said. Young people are at heightened risk of getting Covid-19 or being exposed to it. Our young people can be safely served in their communities.

A spokeswoman for Mr. Northam said the governor had called on the Department of Juvenile Justice to look at release options for certain offenders.

Many of these children have determinate sentences that cannot be altered by the Department of Juvenile Justice, Alena Yarmosky, Mr. Northams spokeswoman, wrote in an email on Sunday. But she said that Mr. Northam has directed the department to continue to carefully review all cases and release individuals who are eligible, have safe home plans and do not pose a threat to public safety.

Medical officials with the juvenile justice system said that Bon Air residents are screened for the virus twice each day and that anyone who tests positive is placed in isolation in the central infirmary or an alternate medical unit on campus.

All residents must wear masks when outside their rooms and staff members must also wear masks inside the living units or when interacting with residents, officials said.

A month after the Trump administration recommended that all elective medical care be put on hold nationwide because of the coronavirus, it issued guidance Sunday for how hospitals and doctors offices could start offering such care again as part of a phased reopening of the country.

The new guidance, issued by the Centers for Medicare and Medicaid Services, applies only to medical providers in communities that have relatively low and stable numbers of coronavirus cases and otherwise meet the conditions for entering Phase One of a national reopening plan. It says that before resuming nonessential care, medical providers should make sure that they can still address surges of coronavirus patients, screen patients and health care workers for the virus, have appropriate cleaning in place and observe social distancing inside their facilities.

Every state and local official has to assess the situation on the ground, said Seema Verma, the C.M.S. administrator. This wont be like a light switch. It will be like a sunrise, where it will be a gradual process. Health care systems need to decide what services should be made available.

The recommendations to delay all nonessential medical, surgical, and dental procedures, issued on March 18, effectively froze all but the most urgent care as the pandemic took hold. The financial toll on physician practices and many hospitals has been significant, although some have continued conducting appointments by phone or videoconference.

A coalition of physician groups on Friday announced that it, too, was releasing a roadmap for how to resume elective procedures, noting in a statement that patients pent-up demand to resume their elective surgeries will be immense.

Ms. Verma also announced a new requirement that nursing homes inform patients and their families if there are cases of Covid-19 inside their facility, and that they report any such cases directly to the Centers for Disease Control and Prevention.

House Speaker Nancy Pelosi and the Senate minority leader, Chuck Schumer, said on Sunday they were nearing agreement with the White House to break a political logjam and provide more emergency aid for small businesses and hospitals, as well as to expand testing.

Omitted from the bill is any direct aid for states or cities that are struggling to cope with the pandemic, an issue that drew pointed remarks from Mayor Bill de Blasio of New York.

The $349 billion small-business emergency fund ran out of money last week, and Republicans and Democrats have been negotiating over the weekend about the terms for replenishing it. On the ABC program This Week, Ms. Pelosi said the two sides were very close to agreement.

Mr. Schumer said a deal could come as soon as Sunday night. Weve made very good progress, and Im very hopeful we could come to an agreement tonight or early tomorrow morning, Mr. Schumer said on the CNN program State of the Union. He added that many of the Democrats requests, including money for testing and hospitals, theyre going along with, so we feel pretty good.

Treasury Secretary Steven Mnuchin said on CNN Sunday that he was hopeful that the Senate could pass legislation as soon as Monday and that the House would take it up for a vote on Tuesday.

The bill would include $300 billion to replenish the Paycheck Protection Program, $50 billion for the Small Business Administrations disaster relief fund, $75 billion for hospitals and $25 billion for testing. Democrats wanted the plan to also include money for states and municipalities, but Mr. Mnuchin said that would be included in a future relief package.

Mr. de Blasio derided President Trump on Sunday for failing to speak out about federal aid to municipalities.

Whats going on? Cat got your tongue? Mr. de Blasio said during his daily briefing. Youre usually really talkative. You usually have an opinion on everything. How on earth do you not have an opinion on aid to American cities and states?

The mayor, who said earlier in the week that New York City would have to slash more than $2 billion in municipal services over the next year, compared President Trumps silence with President Gerald Fords dismissal of New York Citys plight during the fiscal crisis of the 1970s.

There was that famous Daily News cover that said Ford to City: Drop Dead, Mr. de Blasio said. So my question is, Mr. Trump, Mr. President, are you going to save New York City or are you telling New York City to drop dead? Which one is it?

You are failing to protect the very people you grew up around, Mr. de Blasio added.

As with much of life around the world, film and television production has ground to a halt because of the coronavirus pandemic, leaving actors, stylists, directors, studio chiefs, grips, writers, set builders, trailer cutters, agents and scores of other specialized Hollywood workers at home and confronting the same question: Now what?

Across the industry, shooting is not expected to resume until August a the soonest, in part because of the time it will take to reassemble casts and crews once the coronavirus threat subsides.

That leaves a vast number of people without work. Hollywood supports 2.5 million jobs, according to the Motion Picture Association of America, and many of the workers are freelancers, getting paid project to project.

I keep telling myself, Panicking is not going to help, said Muffett Brinkman, an associate casting director who has been unemployed for more than a month. Hopefully things restart before Im completely financially ruined.

The pandemic has hit Americas biggest cities hard, with the coronavirus finding found fertile ground in their density, just as major urban centers were already losing their appeal for many Americans. Skyrocketing rents and changes in the labor market have been pushing the countrys youngest adults toward suburbs and smaller cities. Will that current turn into a flood?

The countrys three largest metropolitan areas New York, Los Angeles and Chicago have all lost population in the past few years, according to an analysis by William Frey, a demographer at the Brookings Institution. And over all, growth in the countrys major metropolitan areas fell by nearly half over the past decade, Mr. Frey found.

Now, as local leaders contemplate how to reopen, the future of life in Americas biggest, most dense cities is unclear.

Mayors warn of precipitous drops in tax revenue because so many people are now unemployed and so many businesses are closed. Public spaces like parks and mass transit systems, the central arteries of urban life, have become danger zones. And with vast numbers of professionals working remotely, some may reconsider whether they need to live and work in the middle of a big city.

This pandemic has stretched the fabric that was already tearing, said Aaron Bolzle, the executive director of Tulsa Remote, a program that offers $10,000 to remote workers who relocate to Tulsa, Okla.

Of course, the same financial uncertainty that would encourage a move may also make it more difficult. And in general, recessions recent ones, at least have tended to be good for cities. But a pandemic makes the equation different, and hard to predict.

The coronavirus pandemic has hit African-Americans and Hispanics especially hard, including in New York, where the virus is twice as deadly for those populations. So in the midst of a national quarantine, civil rights activists are organizing campaigns at home from their laptops and cellphones.

Collectively, the goals are targeted legislation, financial investments, and government and corporate accountability. The Rev. Jesse Jackson, the longtime civil rights leader, is calling for the creation of a new Kerner Commission to document the racism and discrimination built into public policies that make the pandemic measurably worse for some African-Americans.

Its really hard to overstate the critical moment we are in as a people, given how this virus has ripped through our community, said Rashad Robinson, the president of Color of Change, the nations largest online racial justice organization with 1.7 million members. We know the pain will not be shared equally.

Mr. Robinsons organization and others, such as the National Urban League and the N.A.A.C.P., have hosted telephone and virtual town halls, drafted state and federal policy recommendations and sent letters to legislators.

Smaller local groups are working around social distancing restrictions to rally support. And across the country, individuals are making direct pleas for all to help slow the outbreaks spread.

I am trying to sound the alarm because I see the devastation in the black community, Michael Fowler, the coroner of Dougherty County, said hours after the Georgia countys 91st Covid-19 death. Preachers, a judge, a church choir member, all walks of life are dying. My job is to pronounce death, but I believe in trying to save lives.

The Trump administration said late Sunday that the United States would defer certain tariff payments for 90 days to help some importers who have been hurt by the pandemic.

For weeks, American businesses, trade groups and lawmakers of both parties have lobbied the White House to roll back the tariffs President Trump had placed on hundreds of billions of dollars of foreign products, saying the taxes were compounding financial pain for companies struggling with economic fallout from the virus.

But the deferral will not apply to the tariffs that businesses have criticized the most including those that Mr. Trump has placed on more than $250 billion of Chinese products, as well as on foreign steel, aluminum, washing machines and solar panels. The 90-day delay also excludes a large class of tariffs that the United States levies against foreign producers who receive unfair subsidies or sell their products at unfairly low prices.

Mr. Trump, who has proclaimed himself a tariff man, has frequently rebuffed calls to roll back tariffs, falsely stating that the levies are paid for solely by foreign firms. In fact, numerous studies have shown that American businesses and consumers bear the brunt of the tariffs.

The executive order allows the administration to defer tariff payments for goods imported in March and April. The option will only be available for importers with significant financial hardship, U.S. Customs and Border Protection said in a statement.

India has pursued its lockdown the worlds largest with remarkable zeal.

People arent just dutifully following the law. Many are going above and beyond it. Volunteer virus patrol squads are popping up everywhere, casting an extra net of vigilance over the entire country. Neighborhoods are imposing extra rules and sealing themselves off.

The volunteer efforts could help India protect its people from the pandemic. But theres a downside: concerns about overzealous enforcement targeting the poor and minorities.

Lower castes are being shunned more than usual. The term social distancing plays straight into centuries of ostracism of certain groups who until recently were called untouchable. Muslims, a large minority in a Hindu-dominated land, are facing a burst of bigotry and attacks.

This is one of the problems of overzealousness, said Adarsh Shastri, a politician in the Indian National Congress, the leading opposition party. People get a chance to enforce the laws per their own personal prejudice.

Elsewhere:

At least 40 staff members in Afghanistans presidential palace have tested positive for Covid-19, forcing President Ashraf Ghani to isolate himself and attend events via video conference amid a raging war with the Taliban.

About 100,000 people in Bangladesh ignored a nationwide lockdown to attend the funeral of Maulana Jubayer Ahmed Ansari, a senior member of an Islamist party, amid fears that the virus could spread quickly through the densely populated country.

In France, pride in the countrys aircraft carrier, the Charles de Gaulle, has given way to finger-pointing and investigations over an outbreak that tore through the vessels cramped quarters, infecting more than 1,000 sailors.

Paul McKay, a molecular immunologist at the Imperial College School of Medicine in London, checks a dish of bacteria containing genetic material from the new coronavirus. He and his team are testing a candidate vaccine. Tolga Akmen/AFP via Getty Images hide caption

Paul McKay, a molecular immunologist at the Imperial College School of Medicine in London, checks a dish of bacteria containing genetic material from the new coronavirus. He and his team are testing a candidate vaccine.

Right now scientists are trying to accomplish something that was inconceivable a decade ago: create a vaccine against a previously unknown virus rapidly enough to help end an outbreak of that virus. In this case, they're trying to stop the spread of the new coronavirus that has already infected tens of thousands of people, mainly in China, and given rise to a respiratory condition now known as COVID-19.

Typically, making a new vaccine takes a decade or longer. But new genetic technologies and new strategies make researchers optimistic that they can shorten that timetable to months, and possibly weeks and have a tool by the fall that can slow the spread of infection.

What's the urgency?

"Vaccines are really our most successful tool to prevent an infectious disease," says David Weiner, executive vice president and director of the Vaccine & Immunotherapy Center at the Wistar Institute in Philadelphia.

It used to take a long time to make vaccines, because scientists had to isolate and grow the virus in the lab. But now, it's possible to skip that step altogether and build a vaccine based on a virus' genetic sequence.

Chinese scientists made that genetic sequence from the new coronavirus public in early January, just weeks after the first infections with the virus were reported. That prompted several labs to start work on building a vaccine.

Vaccines work by teaching an individual's immune system to recognize an invading virus and neutralize it. The vaccine that Weiner and his colleagues are developing is what's called a DNA vaccine.

They'll first turn pieces of the new coronavirus' genetic code (which is RNA) into complementary snippets of DNA. These snippets will then be injected into someone's skin, where they will be taken up by skin cells. The skin cells will then turn those DNA sequences into proteins identical to the ones a virus would produce, and those will be what "teaches" the immune system to recognize the new virus.

Weiner and his colleagues are in the process of determining which viral sequences produce the best "teachers."

This isn't Wistar's first stab at rapid vaccine development. Weiner and his team worked on a vaccine for Ebola after an outbreak of that virus in 2014.

Including the initial time needed for animal testing and human safety testing, "We were able to go from no vaccine to a vaccine tested in the clinic in about 18 months 15 to 18 months," he says. They also made a vaccine against the coronavirus that causes Middle East respiratory syndrome, after an outbreak in South Korea. "And we were able to design and develop and move into the clinic in 11 months."

Weiner says he's hoping to halve that time with the vaccine they are making against the new coronavirus.

Keith Chappell at the University of Queensland in Brisbane, Australia, thinks he can do even better. He, too, has a vaccine that's based on the virus' genetic sequence. The Queensland team has come up with an approach it calls the molecular clamp. It works by improving the body's immune response to certain viral proteins.

"Our goal was to be able to hit 16 weeks from sequence information to having a product that is shown to be safe and effective [in lab tests] and is ready for administration to the first humans," Chappell says.

Right now, Chappell and his colleagues are also trying to figure out which genetic sequences will be most effective at helping the immune system recognize the coronavirus.

"Next steps will be moving into animal models for testing and also working out how to scale up to get to the levels that would be required in humans and beyond," he says.

Both Chappell's team in Australia and Weiner's team in Philadelphia, in collaboration with the pharmaceutical company Inovio, are getting financial support from a fairly new organization called CEPI, the Coalition for Epidemic Preparedness Innovations. CEPI is a global partnership of public, private and philanthropic organizations; it's also supporting efforts at the biotech companies Moderna and CureVac.

Ami Patel, a research assistant professor at the Wistar Institute, is working with David Weiner and others on a DNA vaccine against the new coronavirus. The team is in the process of determining which viral sequences produce the best "teachers" to help the human immune system defeat the virus. Darien Sutton hide caption

Among other vaccine efforts worldwide, the pharmaceutical giant Johnson & Johnson is working on a vaccine, and GSK has also offered to help new vaccine efforts. Researchers at Imperial College London have developed a vaccine that's already being tested in animals, and vaccine efforts are also reportedly underway in China.

CEPI CEO Richard Hatchett says the organization was created when people realized that an Ebola vaccine had been under development for a decade and it still took more than a year to get it to people when the 2014 Ebola outbreak occurred in western Africa.

"There were a number of enlightened global public health leaders who said, 'You know, that shouldn't happen. We should have some kind of an organization to develop vaccines against epidemic diseases,'" he says.

Even in the rosiest of scenarios, Hatchett says, once the vaccine is in hand, it still needs to get to the people who need it, and that takes time at least weeks to months, depending on the urgency.

Naturally, public health officials would like to have a vaccine as soon as possible. If the coronavirus outbreak pattern is anything like those of flu outbreaks, it will tend to taper off when the weather gets warmer and pick up as winter approaches and people spend more time indoors.

"We are making very aggressive efforts in the hopes of having a vaccine available some form of vaccine available, potentially, as early as this fall," Hatchett says.

Dr. Sonia Macieiewski (R) and Dr. Nita Patel, Director of Antibody discovery and Vaccine development, look at a sample of a respiratory virus at Novavax labs in Rockville, Maryland. Photo: Andrew Caballero-Reynolds/AFP via Getty Images

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The world is watching the medical science community closer than ever, looking for every morsel of hope as researchers race to develop a treatment for COVID-19. Just this week, the CEO of Moderna, a biotech company with a vaccine that began human trials last month, said that her company could begin distributing its vaccine to health-care workers as soon as this fall. On Thursday, Stat News reported that an antiviral medicine developed by Gilead Sciences is getting positive results in clinical trials on severe coronavirus patients. On Friday, French drugmaker Sanofi said that it could produce 600 million doses of its vaccine next year, if it clears its clinical trials. To sort through all of the news, Intelligencer spoke to Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine and co-director of Texas Childrens Hospital Center for Vaccine Development, where he is developing a coronavirus vaccine.

What do you make of the news that patients in a remdesivir trial are making rapid recoveries?

Remdesivir is an interesting drug because it actually works by inhibiting an enzyme that the virus needs to replicate, so it makes sense that this could have some antiviral activity. This is opposed to things like chloroquine or ivermectin some of the other things youve been hearing about where there would be no specific reason why they would work for COVID-19. Remdesivir is actually designed as an antiviral drug, so the fact that you are seeing some clinical-therapeutic effect is a good sign.

This was a study of about 125 patients with COVID-19. Of those, 113 had severe disease and they were treated with daily infusions of remdesivir. The point is, most of those patients have been discharged and only two of the patients died. Thats a fairly low mortality rate for 113 patients. The problem is, this is not a published study. We dont have a lot of information about what actually happened from these results. Theres some initial promise but, again, were going to need a lot more information before we can say anything definite.

We talk a lot about the timeline of vaccines, what about treatments like remdesivir what kind of role will they play in reducing the death toll of a second wave?

Something like remdesivir, right now, as its currently being looked at, is a treatment for ill patients its not really being used as a preventive. Thats not to say it couldnt one day be advanced as a preventive. What do I mean by preventive? We have, for instance, for HIV/AIDS, things like PrEP. Were not there yet, but there is evidence that this is showing some benefit. Well have to see.

What kind of timeline are we looking at for a treatment like that? Can we look for something in the fall?

Potentially. It all depends on how quickly we can accumulate the data. Right now, the attack rate is pretty high so were going to get a lot more information over the next few weeks. Remember, this may be our one window when well be able to get that information. If everybody practices social distancing, and transmission goes down, it will be more difficult to enroll lots of patients after June.

What do you think of chloroquine as a treatment?

Its not a matter of what I think. I havent seen any large, well-controlled studies that point to its effectiveness. Theres been a couple of small studies with a hint of effectiveness, which have been shown to exhibit replication in the laboratory. But its fairly toxic at high doses and theres no particular reason why the drug would work, other than the fact that it has shown some effects of inhibiting the replication of the virus in the test tube. But it did that for influenza as well and it never really panned out. Given that history, and the fact that weve only really had a few small studies and its fairly toxic at high doses, and theres no particular reason why it should work against the virus, I would put chloroquine at a much lower likelihood.

Are there any other promising treatments in trials right now?

Im a vaccine person, not a small molecule drug person, but there are other antiviral drugs being looked at right now. In fact, theres something that the WHO has called the solidarity study. This is a solidarity clinical trial for treatments. There are 90 countries that are participating and theyre looking at remdesivir, chloroquine, and a combination of antiviral drugs called lopinavir and ritonavir, and then theyre looking at it with an interferon beta.

Earlier this week, Dr. Fauci said that its possible a vaccine could be available sooner than the 12-to-18-month window he and many others have talked about. What do you think accounts for that possibility?

Were making a vaccine and were working late into the night and up early in the morning trying to move this vaccine into clinical trials, trying to meet Dr. Faucis aspirational goal. Were going to do our best but it really depends on how things progress in terms of evidence of safety and also efficacy.

The CEO of Moderna reportedly told Goldman Sachs that the companys vaccine could be available for emergency use on health-care workers as early as this fall. How would a limited roll-out like that work?

I dont know. As it is, 12 to 18 months would be a record. It is possible, after a year or 18 months, to get an efficacy signal that a vaccine shows some effect to prevent the infection? The key is going to be showing that its safe. To show all of those things in a year to 18 months would be unprecedented. I dont know what kind of data hes looking at in particular.

Our vaccine could be ready by the fall as well. Well have up to 200,000 doses. But unless youve shown that it actually works and unless youve shown that its safe, youre not going to do that. Without having the efficacy and safety data, I think you have to be really careful about bold statements like that. As I often like to say, these nucleic acid vaccines have been around for 30 years and they offer great promise, they work in laboratory animals, but, historically, they have not worked well in people. Maybe now theres been modifications to improve that. Lets wait and see.

Should we be concerned that this expediency factor, loosening regulations or foregoing animals trials, might impact public safety?

The biotechs are being very aggressive in their press statements. What theyre doing is talking to their investors. I think you have to filter that away from what the FDA is thinking. A wishlist from the CEO of a biotech or a pharma company means nothing to me. Its what the clinical trialists are finding in collaboration with the FDA that matters.

So theres nothing that the FDA has done to the process that significantly changes the safety standards of these trials.

I dont know. I dont have access to that information. But the branch of the FDA called the Center for Biologics Evaluation and Research has been around for a while and has some of the smartest vaccine scientists that Ive ever worked with. Im fairly confident they would not do anything that would jeopardize the health and safety of Americans. I tend not to pay attention to the statements from the CEOs of biotech and pharma companies. Theyre talking to their shareholders.

Once a vaccine is available, how will it be administered in the United States?

Ultimately, there will be more than one vaccine. There could be several vaccines that have different uses. Some vaccines might be used for older Americans at risk of disease or those with underlying comorbid conditions like diabetes or obesity. There might be some use for younger adults. Maybe some for health-care workers. Same with the other technologies that were talking about, like remdesivir, there may be a prophylactic use for it as well. All of this is being accelerated through a lot of studies in parallel and well have to see how the target product profiles will look.

Is everyone going to go to Walgreens at once? Or will it be gradually expanded by targeting vulnerable populations?

I dont think those kinds of decisions have been made yet. Right now, theres a focus on trying to shape the target product profile on the populations that have to be prioritized. You also have to worry about the fact that COVID-19 is a global health problem. Some of these vaccines are very high tech and may not be available for people in the poorest countries places like India, Bangladesh, and Ecuador. Thats one of the things were trying to do, develop the first global health vaccine

Whats the biggest challenge to doing that?

Let me give you the flip side of that. Our vaccine uses the same technology as the recombinant protein hepatitis B vaccine thats made all over the world. Its made in Brazil, its made in India. We did that deliberately so we could have a global health vaccine that could be made locally. Right now, Im not aware of any capability of that capacity for some of the vaccines now being ruled out. Its not so much that its hard to make a piece of DNA or RNA, its the kind of unique packaging that theyre doing to make it work in people. In the past, RNA and DNA vaccines have worked well in mice, but not well in people. They say they have evidence through the different kinds of the constructs they have in the packaging that it can improve efficacy. How easy it is to scale that up for low and middle income countries, for me, is a total unknown.

Will we experience anything that resembles everyday life before a vaccine is distributed?

I think so. I think what were going to see is, as transmission goes down because of the social distancing and the economy opens up, youll see parts of American life restored to some level of normalcy. It will be different in the sense that well probably have to figure out a way to do testing on a regular basis and then have individuals responsible for tracing down contacts, and the contacts of the contacts of infected individuals. There will need to be some adjustment. And the virus could come back next year or the year after that. Theres some models coming out of Harvard to suggest thats a high probability. Things wont be the same for a couple of years. Its not clear that this virus will be around forever and well have a whole array of new technologies to apply to it.

The one piece that were focusing on that youre not hearing anything about is the fact that were all focused on what to do for the United States. I understand that emphasis, but Im very worried when I hear stories of bodies piling up in Guayaquil, Ecuador. Or how are you going to implement social distancing in the crowded urban areas of Mumbai, Dhaka, or Lagos. Thats where were coming in. Were using our expertise in developing low-cost global health vaccines to see how we can also take on that component of the pandemic. The frustration that we have is that even now were still struggling to raise money to do our clinical trials. Thats unfortunate, even at this stage.

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