HONG KONG For months the Chinese governments propaganda machine had been fending off criticism of Beijings handling of the coronavirus outbreak, and finally, it seemed to be finding an audience. Voices from the World Health Organization to the Serbian government to the rapper Cardi B hailed Chinas approach as decisive and responsible.
But China could not savor the praise for long. In recent days, foreign leaders, even in friendly nations like Iran, have questioned Chinas reported infections and deaths. A top European diplomat warned that Chinas aid to the continent was a mask for its geopolitical ambitions, while a Brazilian official suggested the pandemic was part of Chinas plan to dominate the world."
As the pandemic unleashes the worst global crisis in decades, China has been locked in a public relations tug-of-war on the international stage.
Chinas critics, including the Trump administration, have blamed the Communist Partys authoritarian leadership for exacerbating the outbreak by initially trying to conceal it. But China is trying to rewrite its role, leveraging its increasingly sophisticated global propaganda machine to cast itself as the munificent, responsible leader that triumphed where others have stumbled.
What narrative prevails has implications far beyond an international blame game. When the outbreak subsides, governments worldwide will confront crippled economies, unknown death tolls and a profound loss of trust among many of their people. Whether Beijing can step into that void, or is pilloried for it, may determine the fate of its ambitions for global leadership.
I think that the Chinese remain very fearful about what will happen when we finally all get on top of this virus, and there is going to be an investigation of how it started, said Bonnie Glaser, the director of the China Power Project at the Center for Strategic and International Studies in Washington. Theyre just trying to repair the damage that was done very early on to Chinas reputation.
The crux of Chinas narrative is its numbers. Since late March, the country has consistently reported zero or single-digit new local infections, and on Wednesday, it lifted its lockdown in Wuhan, where the outbreak began. In all, the country has reported nearly 84,000 infections and about 3,300 deaths a stark contrast to the United States, which has reported more than 399,000 infections, and Spain and Italy, each with more than 135,000.
The numbers prove, China insists, that its response was quick and responsible, and its tactics a model for the rest of the world. During a visit last month to Wuhan, Chinas top leader, Xi Jinping, said that daring to fight and daring to win is the Chinese Communist Partys distinct political character, and our distinct political advantage.
Chinese officials have specifically compared their response to that of the United States, which has reported dire shortages of testing kits and ventilators.
While China set an example and bought precious time for the world with huge efforts and sacrifice, as the W.H.O., foreign leaders, experts and media say, did a certain country make full use of the time to enhance preparedness? Hua Chunying, a spokeswoman for Chinas foreign ministry, said last week.
While the numbers are core to Chinas narrative, they have also been perhaps its most vulnerable aspect.
Public health experts agree that China is undercounting its victims. The same is true in the United States, Italy and any country hard-hit by the virus. But concerns about Chinas accuracy are particularly acute, given the governments history of concealing unfavorable news.
Caixin, a respected Chinese newsmagazine, recently reported that a truck driver brought thousands of urns to just one funeral home in Wuhan, though it was unclear if the urns were used for coronavirus victims only, or more broadly.
China for weeks also flouted guidance from the W.H.O., which recommends that countries include asymptomatic patients in their official counts. Officials only began partially reporting them on April 1, bowing to public pressure.
In addition, American news outlets recently reported that the C.I.A. had been warning the White House since at least early February that Chinas infection count was unreliable, though the basis for the C.I.A.s skepticism was unclear. And on Sunday, a spokesman for Irans health ministry joined the chorus, calling Chinas reported numbers a bitter joke.
Chinese officials have called the accusations immoral slanders. They suggested that the United States was casting doubt on China to distract from the fact that American officials had also ignored early warnings from experts.
We sympathize with Americans, as they are facing a severe situation, and I can imagine why some in the United States are trying so hard to shift the blame, Ms. Hua said.
While Chinas propaganda might usually be dismissed as just that, especially in developed, democratic countries, the errors in those countries responses have allowed it to gain more of a toehold than usual, said Yanzhong Huang, who leads the global health center at Seton Hall University in New Jersey.
The complacency, the lack of action, the efforts to downplay the serious of the problem by our own governments weve seen these developments actually help China to make a strong case that they are not the cause of the problem, he said.
It is also true that the Chinese governments strict, top-down response helped stop the outbreak more successfully than in many other countries, experts said.
And some of its efforts to defend its response are justified: When the Wuhan lockdown was first imposed, overseas public health experts and policymakers called it draconian and doomed to fail. But many have since concurred that, in the absence of widespread testing, a cure or a vaccine, harsh restrictions on peoples movement are key to slowing transmission.
Beijing has leaned into that approbation in its propaganda push, saying it promptly alerted the world to the threat of the virus. But its narrative is oversimplified, leaving out the ways in which it played down the epidemic.
In January, Ms. Hua was comparing it to the flu and accusing the United States of fear-mongering when it began evacuating citizens from Wuhan. When Italy suspended flights to and from China, a senior Chinese official summoned the Italian ambassador to criticize the overreaction.
In early February, Ms. Hua was already announcing that China had effectively contained the cross-border spread of the virus, a position echoed by Chinese state media.
Italy and the United States are now among the countries hardest hit by the virus. And China in late March decided to seal its own borders, barring practically all foreigners and leaving even Chinese citizens with little way to get home.
Even some of Chinas less heavy-handed attempts to claim global leadership have drawn scrutiny. Though China says it has supplied medical equipment to 120 countries, officials in Italy have said that many of the so-called gifts are actually exports. Other countries have complained of faulty test kits and masks.
The European Unions top diplomat, Josep Borrell, warned in an unusually blunt blog post that China was seeking to use the politics of generosity to undermine European solidarity.
That Chinas messaging push has drawn such forceful reactions from some world leaders speaks, in part, to its strength. While other countries bungled responses have amplified its message, Chinas global propaganda machine has also grown increasingly sophisticated.
The government has invested billions of dollars into its foreign media presence, producing slick videos that are not obviously the work of the Chinese government. When Cardi B praised Chinas containment measures, she cited a documentary about the lockdown in Wuhan which many have suggested was a piece produced by the state-run China Global Television Network, with English narration and subtitles.
And while Chinas propaganda efforts have drawn criticism from some foreign officials, others have remained silent. Countries may be especially reluctant to antagonize China now, given it is the worlds largest manufacturer of desperately needed medical gear gifted or exported, said Steve Tsang, director of the China Institute at the School of Oriental and African Studies in London.
Some critics have already backtracked: After a furious response from the Chinese ambassador to Iran, the Iranian official who called Chinas numbers a joke tweeted that Chinas support of Iran would never be forgotten. The Brazilian official who accused China of maneuvering for world domination later deleted his Twitter post, which had also mocked Chinese accents, after similar backlash.
China is the biggest trading partner for both Iran and Brazil.
If other countries manage to bring their outbreaks under control, they may begin pushing harder against Chinas narrative, said Professor Huang, from Seton Hall University. But China, recognizing the stakes, is unlikely to back down.
History is unfortunately written by the victor, and the coronavirus outbreak is no exception, he said.
Claire Fu contributed research.
President Trump unleashed a tirade against the World Health Organization on Tuesday, accusing it of acting too slowly to sound the alarm about the coronavirus. It was not the first time in this pandemic that the global health body has faced such criticism.
Government officials, health experts and analysts have in recent weeks raised concerns about how the organization has responded to the outbreak.
In Japan, Taro Aso, the deputy prime minister and finance minister, recently noted that some people have started referring to the World Health Organization as the Chinese Health Organization because of what he described as its close ties to Beijing. Taiwanese officials say the W.H.O. ignored its early warnings about the virus because China refuses to allow Taiwan, a self-governing island it claims as its territory, to become a member.
Critics say the W.H.O. has been too trusting of the Chinese government, which initially tried to conceal the outbreak in Wuhan. Others have faulted the organization and its leader, Dr. Tedros Adhanom Ghebreyesus, for moving too slowly in declaring a global health emergency.
The W.H.O., a United Nations agency, has defended its response, saying on Wednesday that it alerted the world to the threat posed by the virus in a timely manner and that it was committed to ensuring all member states are able to respond effectively to this pandemic.
The agencys defenders say that its powers over any individual government are limited, and that it has done the best it can in dealing with a public health threat with few precedents in history.
There will be time later to assess successes and failings, this virus and its shattering consequences, the United Nations secretary general, Antnio Guterres, said Wednesday in a statement praising the W.H.O. as absolutely critical to vanquishing Covid-19.
Heres why the organization is coming under attack.
When cases of a mysterious viral pneumonia first appeared in Wuhan in December, Chinese health officials silenced whistle-blowers and repeatedly played down the severity of the outbreak.
Even as late as mid-January, as the virus spread beyond Chinas borders, Chinese officials described it as preventable and controllable and said there was no evidence it could be transmitted between humans on a broad scale.
The W.H.O. endorsed the governments claims, saying in mid-January, for example, that human-to-human transmission had not been proven.
Critics say the organizations repeated deference to Beijing exacerbated the spread of the disease. A group of international experts was not allowed to visit Wuhan until mid-February.
They could have been more forceful, especially in the initial stages in the crisis when there was a cover-up and there was inaction, said Yanzhong Huang, a global health expert specializing in China at Seton Hall University.
Mr. Huang noted that during the SARS epidemic in 2002 and 2003, which killed more than 700 people worldwide, the W.H.O. pushed the Chinese government to be more transparent by publicly criticizing it for trying to conceal the outbreak.
At one point during the SARS epidemic, officials at hospitals in Beijing forced SARS patients into ambulances and drove them around to avoid their being seen by a visiting delegation of W.H.O. experts, according to reports at the time.
Even as the virus spread to more than half a dozen countries and forced China to place parts of Hubei Province under lockdown in late January, the W.H.O. was reluctant to declare it a global health emergency.
W.H.O. officials said at the time that a committee that discussed the epidemic was divided on the question of whether to call it an emergency, but concluded that it was too early. One official added that they weighed the impact such a declaration might have on the people of China.
After the United States announced a ban on most foreign citizens who had recently visited China, the W.H.O. again seemed to show deference to Chinese officials, saying that travel restrictions were unnecessary. The group officially called the spread of the coronavirus a pandemic on March 11.
Some experts argue that the institutions delay in making such declarations deprived other countries of valuable time to prepare hospitals for an influx of patients.
It reinforced the reluctance to take early strong measures before the catastrophe had actually landed on other shores, said Franois Godement, senior adviser for Asia at Institut Montaigne, a nonprofit group in Paris. The W.H.O.s tardiness or reluctance to call out the problem in full helped those who wanted to delay difficult decisions."
The W.H.O. defended its actions, saying on Wednesday that it had alerted member states to the significant risks and consequences of Covid-19 and provided them with a continuous flow of information ever since Chinese officials first reported the outbreak on Dec. 31.
Mr. Guterres of the United Nations said, It is possible that the same facts have had different readings by different entities. He added in his statement, Once we have finally turned the page on this epidemic, there must be a time to look back fully to understand how such a disease emerged and spread its devastation so quickly across the globe, and how all those involved reacted to the crisis.
Chinas leader, Xi Jinping, has made it a priority to strengthen Beijings clout at international institutions, including the W.H.O., seeing the American-dominated global order as an impediment to his countrys rise as a superpower.
China contributes only a small fraction of the W.H.O.s $6 billion budget, while the United States is one of its main benefactors. But in recent years, Beijing has worked in other ways to expand its influence at the organization.
The government has lobbied the W.H.O. to promote traditional Chinese medicine, which Mr. Xi has worked to harness as a source of national pride and deployed as a soft-power tool in developing countries, despite skepticism from some scientists about its effectiveness.
Last year, the W.H.O. offered an endorsement of traditional Chinese medicine, including it in its influential medical compendium. The move was roundly criticized by animal rights activists, who argued that it could contribute to a surge in illegal trafficking of wildlife whose parts are used in Chinese remedies.
China has sought to promote traditional Chinese medicine in the treatment of symptoms of the coronavirus both at home and abroad. Last month, the W.H.O. was criticized after it removed a warning against taking traditional herbal remedies to treat the coronavirus from its websites in mainland China.
Chinas role at the W.H.O. will probably continue to grow in the coming years, especially if Western governments retreat from the organization, as Mr. Trump has threatened.
This is part of Chinas efforts to more actively engage in international institutions, said Mr. Huang, the global health expert. It will not please every country or every actor, but its going to affect the agenda of the W.H.O.
Hisako Ueno contributed reporting from Tokyo.
WASHINGTON Members of Congress grappling with how to respond to the coronavirus pandemic have few reasons to smile these days. But House Democrats have found one, and her name is Earnestine.
Earnestine Dawson is kind of a mystery woman, Democrats agree. Most have never seen her, though they all know the sound of her voice. Their spouses and kids adore her. There is talk of sending her flowers (that would be difficult they have no idea where she is), and some have invited her to join them for dinner at the Democratic Club once Covid-19 subsides and such things are possible again.
I dont know where we got Earnestine, confessed Representative Steny H. Hoyer, Democrat of Maryland and the majority leader. Does she work for us?
Yes, Earnestine does work for the party leadership. She is the digital director for the House Democratic Caucus, but better known by lawmakers for her pandemic side-gig as moderator of a seemingly endless series of conference calls that have become the Democrats only means of communication and deliberation during the pandemic.
A Mississippi native who grew up dreaming of a job in Washington, Ms. Dawson, 37, is in charge of shaping social media strategy for House Democrats messaging arm, a relatively obscure position that normally entails little interaction with members of Congress. But in recent weeks, House Democrats have gotten to know her as the cheery master of ceremonies for their private calls, calling on each lawmaker in turn with her signature tag line: Congresswoman So-and-So, you are NOW LIVE!
As people all over the world adjust to living and working in the age of the coronavirus, with its lack of human contact and seemingly endless stream of fear and bad news, rare silver linings appear in surprising ways. For House Democrats, struggling to adapt to life as remote legislators and representatives, one bright spot has been Earnestine.
She has brought them together through tense and serious business: the drafting of three coronavirus relief packages, including the most recent $2 trillion economic stimulus bill, hashed out during a series of calls that typically lasted two hours. With more than 200 members, the caucus is too large to convene by video.
Ms. Dawson has moderated more than a dozen two-hour caucus calls since March 16, facilitating nearly 300 questions from 235 individual lawmakers. Often the calls feature special guests. Janet Yellen, the former chair of the Federal Reserve, briefed Democrats on Monday, and Vice President Mike Pence, Dr. Anthony S. Fauci and other members of the presidents coronavirus task force fielded questions from them on Wednesday.
Ms. Dawson is a constant, telling lawmakers to press star three to ask questions, gently teaching members twice her age how to unmute their phones, and letting them know sounding more like a party D.J. than a telephone operator when they have the floor to speak. She does it all from her desk in the basement of the House Longworth Building across from the Capitol, where she prefers to work rather than being at home.
I dont hear strain, I hear strength, Ms. Dawson said in an interview, her first. I think when they are on these calls together, they pull strength from one another.
But to hear Democrats tell it, the person from whom they are pulling strength is Ms. Dawson.
To Representative Richard Neal, 71, the chairman of the House Ways and Means Committee, Ms. Dawson is a reminder of what radio meant to us in the simpler days of his childhood. To Representative Debbie Dingell of Michigan, 66, Ms. Dawson is a touchstone and a rock the glue that keeps you together in a troubled, uncertain time.
Mr. Hoyer says Ms. Dawson deserves a title: We need to get a name for her, like Conference Queen or something like that. Very few of us know her personally, but we all know her through this phone connection, and shes the connector.
Americans of a certain age (including Mr. Neal, Ms. Dingell and Mr. Hoyer, 80) may remember another telephone operator named Ernestine a character played by the actress Lily Tomlin on Rowan & Martins Laugh-In, a 1960s- and 1970s-era television variety show. Ms. Tomlins Ernestine was nasal-voiced and slightly sarcastic. Ms. Dawson is nothing like her.
She is so sweet and she is so darling, said Representative Kim Schrier, Democrat of Washington, whose district was an early epicenter of the American pandemic. My husband and son love to listen to her say, Congressman Blah Blah Blah, you are now live! I purposely put her on speakerphone, just so they can hear her do the introduction.
A daughter of a bank manager and a corrections officer who worked in a maximum-security prison on death row, Ms. Dawson grew up in Cleveland, Miss., a city of roughly 11,000 people divided by railroad tracks. Blacks, including Ms. Dawsons family, lived in the lowlands east of the tracks. Whites lived on the west side on higher ground. Each side had its own high school, though Ms. Dawson said they have since combined.
I had friends all over the city, she said, but we always knew what that railroad track meant when we crossed it.
Ms. Dawson said she knew early on that she wanted to get away from my small little town, and to serve the people, but her path to Capitol Hill was circuitous. She graduated from Tennessee State University in 2005 with a dream, she said, of becoming the first African-American female senator from Mississippi.
After a stint at a human rights group in her home state, Ms. Dawson grabbed a chance to get to Washington as an intern for a lobbying firm whose Republican politics were antithetical to her own. After a year in law school (I figured out real quickly it was not for me) and a string of jobs, including courtroom clerk and field organizer for President Barack Obamas 2012 re-election campaign, she made her way to Capitol Hill as digital director for Representative Yvette Clarke, Democrat of New York.
Ms. Clarke said Ms. Dawson had a way of making lemonade out of lemons, a trait the congresswoman attributed to her upbringing in a place with the legacy of segregation. Judge Hiram Puig-Lugo, for whom Ms. Dawson clerked when he was the deputy presiding judge of the Family Court division of the superior court in Washington, said the two often spoke about that aspect of her experience and how it shaped her.
When Democrats won control of the House in 2018, Ms. Dawson was hired by another New York Democrat, Representative Hakeem Jeffries, the caucus chairman. In her current post, she has established an informal program to mentor young people of color who want to work in the digital space, in fields where minorities are often underrepresented.
With lawmakers scattered around the country, including some in quarantine, the caucus needed to create a system for communicating that would mimic its in-person meetings, which occur weekly or more often. After a few practice runs, it seemed obvious that Ms. Dawson should manage the calls, said Michael Hardaway, the caucus communications director and Ms. Dawsons boss.
We literally have had to build a virtual Congress for our members, Mr. Hardaway said.
The lawmakers calls have not been without incident. There have been interruptions from doorbells, barking dogs and crying children, as well as the occasional overheard private spousal communications. Members are supposed to keep their comments to a minute, and if someone needs to be cut off, that task falls to Mr. Jeffries.
Last week, after teasing Ms. Dawson about whether she had gotten flowers that were never sent, Representative John Larson, Democrat of Connecticut, invited her to dinner on behalf of himself and a handful of other lawmakers.
She is such an absolute delight and such a break from everything that were going through, Mr. Larson said. We cant wait to take her out if shes willing to go with us.
Ms. Dawson, for the record, did not respond. She does not engage with members on the calls, even when they praise her, but said she tries to remain as invisible as possible out of a sense of respect and a desire to be discreet.
She sees her job, she said, as making sure that all the members have a happy voice on the other end, especially during these hard times.
They are making some very hard decisions for the American people, Ms. Dawson said. Im just someone on the other line, letting them know that its time for them to ask their question or make their comment in a very upbeat way on a topic thats not very upbeat.
BRUSSELS As a poorer, battered south asks a richer, frugal north for solidarity, youd be forgiven for thinking the coronavirus is throwing Europe back into last decades economic catastrophe. Youd be wrong. This time is set to be far worse.
The pandemic and the havoc the coronavirus is wreaking on European economies has echoes of the eurozone debt crisis, but this calamity is hitting everyone, not just smaller wayward nations, and it goes well beyond the economy. It presents a watershed moment for the future shape of the European project.
A growing number of officials and analysts believe the European Union needs an enormous financial response on a scale commensurate with the calamity. Short of that, they warn, the bloc risks inviting an even larger disaster, as well as losing legitimacy.
There are obvious links to the lack of solidarity with the eurozone crisis era of austerity and the handling of the migration crisis, said Janis Emmanouilidis, a senior analyst at the Brussels-based think tank European Policy Center. People now are also asking, What do we have the European Union for?
The very scale of the looming depression is focusing the minds of European leaders, and the fact that this crisis, unlike last time, does not come from some perceived profligacy may ultimately knock down the reluctance to putting up aid. The question is what shape that solidarity will take.
European finance ministers failed to reach an agreement over a list of measures in a marathon meeting that started on Tuesday and broke up Wednesday morning. They will reconvene on Thursday to try to hammer out a consensus on how to stave off the worst of the looming economic maelstrom.
European officials said that there was broad agreement on some measures, for example a loan program valued at 100 billion euros, or $109 billion, that will help member states fund temporary unemployment benefits.
But despite debating for 16 hours, the ministers were unable to reach a consensus on how to use the euro area bailout fund, created to tackle last decades crisis, to distribute loans without the brutal austerity restrictions Greece had to face. The European Investment Bank, it seems likely, will provide billions in support of small businesses.
Once the finance ministers reach an agreement, their bosses, the leaders of the European Union countries, will meet via teleconference to finalize the measures, which in total could amount to hundreds of billions of euros.
But as sweeping as those measures may be, they will disappoint some members.
At least nine of the 19 leaders of the countries in the common-currency bloc, and some leading policymakers in Brussels, believe the euro area needs to issue joint bonds, commonly referred to as Eurobonds or in the context of the current crisis, corona-bonds.
In the acrimonious overnight meeting, finance ministers from those countries demanded at the very least a reference to this approach in any final report, but it proved impossible to get an agreement.
Collective debt would be a first for the bloc, and has been fiercely opposed by wealthier states like Germany and the Netherlands. They argue that, by treaty, every member nation of the European Union is responsible for its own finances. Floating these bonds would also be legally difficult and time-consuming, opponents say.
Each member state has launched its own interventions, and if we aggregate those, were talking about rather big figures, said Paolo Gentiloni, the European commissioner for the economy and a former Italian prime minister, who supports the idea of joint bonds. But we are a union, 19 member states who have a common currency.
It is crucial to have a common fund to face the crisis, and help the recovery, he added. How can you have a common fund? Only by issuing bonds, obviously.
Key to this is a question that has been nagging for nearly two decades: How can 19 of the now 27 European Union countries share a currency, the euro, and not use some, even limited, common debt to weather crises?
And the coronavirus counts as a crisis by any measure. The currency unions third- and fourth-largest economies, Italy and Spain, seem set to shrink by more than 10 percent, while the largest, Germany, could also shrink by 10 percent, unleashing a domino effect. By comparison, the euro area shrank by 4.5 percent in the post-financial crisis recession in 2009.
The stimulus that will be needed because of the damage caused by the epidemic is being estimated at more than 2 trillion, or $2.18 trillion. At stake wont be just the survival and recovery of each individual economy, but potentially the survival of the euro.
Eurobonds are the solution, a serious and efficient response, adapted to the emergency we are living, said Prime Minister Giuseppe Conte of Italy in an impassioned address to the nation on Monday.
Prime Minister Pedro Snchez of Spain, where the death toll has approached 14,000, has called for a new Marshall Aid plan for the reconstruction of Europe.
Without solidarity there can be no cohesion, without cohesion there will be disaffection and the credibility of the European project will be severely damaged, he warned.
Europes de facto top leader, Chancellor Angela Merkel of Germany, this week called the coronavirus outbreak and its aftermath the greatest test for the European Union since its inception.
Germany will only do well in the long run if Europe is doing well, Ms. Merkel told reporters at a news conference. The answer to current events, she said, was more Europe, a stronger Europe and a well-functioning Europe in all its parts, meaning in all its member states.
But Ms. Merkel stopped short of backing joint debt.
For Ms. Merkel, loans with few strings attached and German subsidies for unemployment benefits elsewhere in Europe were already quite brave measures, and as far as she was prepared to go.
She and other northern European leaders have signed off on waiving rules that normally punish European countries for running high deficits.
They have also implicitly backed a decision by the European Central Bank to launch a new bond-buying program that will see it swoop up the debt of eurozone countries, buying time for leaders to work out their next moves.
Joint debt has been a foundational step in the creation of federal states, most notably of the United States in the late 18th century,
In Europe in the age of coronavirus, it has been elevated to an existential question for the future of the bloc.
Why? Because these bonds imply a clear and explicit sharing of the cost incurred to fight the Covid-19 crisis, as a symbol of European solidarity, says Silvia Merler, head of research at the Algebris Policy Forum, the research branch of an investment fund based in Milan.
But they are by no means the only tools on the table, she added.
One key obstacle to joint debt is the scar tissue from the eurozone debt crisis of last decade, in which the bloc paid hundreds of billion of euros to Greece and another four countries, demanding in exchange some of the harshest austerity measures in modern history, to ensure no nation sought such bailouts opportunistically in future.
The wounds of that crisis are still deep, as is the feeling in Italy and Greece that the European Union was also not there to help much with the migration crisis that peaked in 2015-2016.
Mr. Gentiloni and others are keen to stress that, despite a fleeting resemblance, this time is different.
I think it is a completely different crisis, Mr. Gentiloni said. In itself this crisis is an equalizer, it is affecting at different speed and intensity more or less all of Europe, all countries, it is not concentrated like the financial and migration crises were.
And the debate over how to respond is more mature too, experts noted, pointing to the fact that even conservative German economists were no longer talking about solidarity as if it meant charity, as they had in the past.
When the Greek crisis started back at the end of 2009, the question of European solidarity was much more controversial, Ms. Merler said. Back then, policymakers could not even agree among themselves on whether it was legal for euro area countries to help financially a member in distress.
As the debate over assuming joint debt goes on, the European approach in the meantime to fighting the coronavirus will look similar to how Europe tends to respond to crises: a patchwork of imperfect measures.
Theyll build substandard instruments that are not good enough, but do the job at first, and they will keep kicking the can down the road, said Shahin Valle, a French economist who is a senior fellow at the German Council of Foreign Relations, and previously served as a senior adviser to the European Council during the eurozone crisis.
It wont be a make-or-break moment like some predict, Mr. Valle said. Instead well just continue to hobble along on our crutches.
Katrin Bennhold contributed reporting from Berlin, Emma Bubola from Rome and Raphael Minder from Madrid.
BERLIN Austria is allowing small shops to resume business after Easter. Denmark is reopening nurseries and primary schools. The Czech Republic is planning to lift a travel ban.
Gingerly, and with plenty of caveats, some corners of Europe are tiptoeing toward a loosening of the strict lockdown measures that have been in place for close to a month to slow the spread of the coronavirus, idling economies and leaving citizens in an uneasy limbo of social isolation.
But even as the number of new infections appears to be plateauing in several European countries, the message from leaders is clear: The next phase is not a return to normality. It is learning how to live with the pandemic possibly for quite a long time.
Wearing a face mask and speaking behind plexiglass, Chancellor Sebastian Kurz of Austria illustrated what that new normal might look like when he announced a step-by-step resurrection of the economy this week. We are not out of the woods, he said.
Prime Minister Mette Frederiksen of Denmark was more explicit: Its like walking a tightrope, she said. If we stand still, we may fall. If we go too fast, it may soon go wrong. We dont know when well be on firm ground again.
This weeks announcements came as China lifted its lockdown of the city of Wuhan on Wednesday, a powerful symbolic victory for the country and for a world battling a virus that first emerged there.
European governments are eager to give their citizens a sense of hope and to reboot economic activity, too. But overshadowing that desire is the real risk of unleashing a second wave of mass infections and deaths.
How soon is too soon to allow the resumption of some activities and which activities is the overriding question.
While the number of deaths from the disease continues to accelerate in the United States, it has begun stabilizing in parts of Europe and even declined in hard-hit countries like Italy. But the number of new daily infections in major countries like Germany, France and Britain, the three largest on the continent, may peak only after Easter.
Austria, Denmark and the Czech Republic, the three countries that have begun planning an exit from the lockdowns, are all smaller nations that moved early to shut down public life and perhaps as a result have been spared the worst of the fallout from the pandemic.
Many other countries are reluctant to announce a concrete timetable. The European Commission abandoned plans to present a road map for ending restrictions this week after several capitals insisted that such a move would send a dangerous message at a time when they are still asking millions of people to stay at home.
On Wednesday, the World Health Organizations director for Europe, Hans Kluge, warned that despite seeing positive signs, it was too early to roll back containment measures.
Now is not the time to relax measures, he told a news conference. It is the time to once again double and triple our collective efforts to drive toward suppression with the whole support of society.
Instead of searching for a return of normality, many experts warn that living with the virus may be the new normal, at least for months to come. The only time the world could hope to return to anything resembling pre-coronavirus normality was after a vaccine had been found, they said.
This wont go away until we have an effective vaccine, hopefully in 12 months time, said Walter Schachermayer, a professor of mathematics at the University of Vienna who was consulted by Mr. Kurzs team on their exit timetable.
The idea that immunity would rise fast enough in any country to allow social distancing measures to be abandoned before then without paying for it with an exorbitant death toll and overwhelming hospitals was a total illusion, Professor Schachermayer said. There is the constant risk of a second wave.
After the Spanish flu first emerged in 1918, he noted, a second wave killed millions a year. There are already signs of a second wave now building in some East Asian countries that recently ramped up business.
That is why, even as Chancellor Kurzs government announced its tentative opening, it made clear that the situation needed to be constantly monitored and reserved the right to impose restrictions quickly again.
We will very closely monitor the number of new infections and will immediately pull the emergency brake if need be, he said.
That monitoring will require a high volume of testing, Professor Schachermayer said. Its hard to get it right, because everything comes with a delay of two weeks because of the viruss incubation period, he said.
Even so, European leaders and their populations worry that the consequences of not allowing a broader resumption of economic activities could be devastating, too.
As the strain on hospitals intensive care units eases, the conversation has begun shifting from the immediate goal of saving lives to the longer-term goal of saving livelihoods.
Even in Italy, officials have begun talking about phase two of the national shutdown starting next month.
This is an extraordinary result, the countrys health minister, Roberto Speranza, said on Italian television on Tuesday evening after the latest statistics showed that the rate of contagion had decreased from one person infecting around three people to one person infecting only one.
The measures have worked, and we can finally start planning the future, he said.
In Spain, Prime Minister Pedro Sanchez said a ban on all nonessential work might be lifted after Easter, even as he extended the lockdown in his country until April 26. When we have the curve under control, we will shift toward a new normality and toward the reconstruction of our economy, Mr. Sanchez said.
What exactly that new normal will look like is unclear, though it is likely to involve mandatory masks in enclosed public spaces and smartphone apps tracking contact with people who are potentially infected. Going back to work and traveling might be contingent on test results, and potentially the presence of antibodies that might provide a measure of immunity.
Early versions of this new reality will soon be rehearsed in Austria, Denmark and the Czech Republic, all of which moved quickly in response to the pandemic.
It paid off. When Austria went into lockdown in mid-March, the number of infections was doubling every three days. Now, with new infections receding every day over the past week, that period has slowed to two and a half weeks.
Austria acted quicker and more decisively than other countries, Mr. Kurz told The New York Times in emailed comments. We have managed to prevent the worst. This also enables us to get quicker out of the crisis again.
Small shops, hardware stores and garden centers will be allowed to reopen on April 14, followed by other businesses at the end of the month. Restaurants and services that involve close human contact, like gyms and hairdressers, might not get the green light until mid-May or June.
The gradual acceleration of economic activity is accompanied by strict new rules requiring people to cover their nose and mouth in shops and on public transport and many more months of strict social distancing. Overseas travel is off the cards for now, and most schools might remain closed until the fall. In Denmark, day care centers and primary schools are scheduled to reopen on April 15, though that is subject to the number of infections stabilizing.
Every incremental loosening can be reversed at any point.
Denmark has seen daily deaths gradually decline from a peak a week ago. But restaurants and borders will remain closed for now. The government has also banned large gatherings through August.
Meanwhile, the Czech Republic extended a state of emergency until the end of April even as Prime Minister Andrej Babis announced a loosening of travel restrictions from Thursday. Borders will remain closed to foreigners, but Czechs who need to go abroad will be authorized to do so. Small shops are allowed to reopen on Thursday.
We are now able to manage the pandemic relatively well, the Czech health minister, Adam Vojtech, told a recent news conference. Its not the pandemic that is managing us.
If shutting down economies was hard, reopening them will be even harder, officials warn.
The fact that the countries now pioneering the reboot in Europe have chosen such different paths highlights the absence of any clear road map.
We are in uncharted territory, said Prof. Elisabeth Puchhammer-Stckl, the head of virology at the Medical University of Vienna. We have to figure this out as we go along.
Only one thing is certain, said Professor Puchhammer-Stckl, who is a member of the coronavirus task force advising Austrias health minister.
We are still living in a pandemic, she said. This virus is not going anywhere.
Reporting was contributed by Christopher F. Schuetze from Berlin, Hana de Goeij from Prague, Martin Selsoe Sorensen from Copenhagen, and Jason Horowitz from Rome.
Doctors see patients at a New Delhi hospital on 18 March. India recommends hydroxychloroquine for health care workers at risk of COVID-19.
By Kai KupferschmidtApr. 7, 2020 , 3:50 PM
Sciences COVID-19 reporting is supported by the Pulitzer Center.
When malaria researcher Nicholas White saw coronavirus infections picking up around the world 2 months ago, he immediately thought of the impact they could have on poorer countries. In fragile health care systems, if you start knocking out a few nurses and doctors, the whole thing can collapse, says White, who is based at Mahidol University in Bangkok. So we realized that the priority would be to protect them.
White and his colleagues at the Mahidol Oxford Tropical Medicine Research Unit wondered whether widely available drugs could help. They have designed atrialin which 40,000 doctors and nurses in Asia, Africa, and Europe will prophylactically receive chloroquine or hydroxychloroquine, two old drugs against malaria. White hopes the trial will start this month, but its launch has been incredibly difficult because of bureaucratic processes, he says
The international study is one of several in preparation or underway that seek to use drugs for what is called pre-exposure prophylaxis (PrEP), a strategy already widely used against HIV. The Bill & Melinda Gates Foundation is funding plans for another huge study that will test the same two drugs in Africa, North America, and Europe. Separate studies of the same drugs are planned or underway in the United States, Australia, Canada, Spain, and Mexico. Researchers are also considering other potential preventives, including nitazoxanide, a drug used to treat parasitic infections, and the antibody-laden serum from people who have recovered from an infection.
If there was a drug that could prevent infections and that health care workers could take, that would be an enormous public health benefit, says Jeremy Farrar, head of the Wellcome Trust, which is funding Whites effort.
PrEP studies of the malaria drugs could also be the best way to settle the heated debateinflamed by U.S. President Donald Trumps advocacyover whether they are a promising treatment for COVID-19, says virologist Matthew Frieman of the University of Maryland School of Medicine. The weak and equivocal studies so far were mainly done in seriously ill patients. To show an effect you really have to treat early, Frieman says. I dont know any drug that works better late in infection. Giving a drug before exposure is as early as it gets.
White adds that chloroquine and hydroxychloroquine are good choices to test because they are widely availablea major consideration given the huge number of people who might be eligible for any drug that proves its worth. The attraction of these drugs is that they are potentially readily deployable and we know an awful lot about them.
In Whites proposed trial, health care workers in Asia will be randomized to take chloroquine or a placebo for 3 months, while hydroxychloroquine will be used in Africa and Europe. Participants have to take their temperature twice a day and report it, along with any symptoms, through an app or a website. The researchers will compare the number of symptomatic and asymptomatic infections in both groups, as well as the severity and duration of illness in those who become infected.
Meanwhile, a trial of a related approach called postexposure prophylaxis (PEP) started in Barcelona, Spain, in mid-March. The idea behind that study, born before Spains COVID-19 epidemic exploded, is that a short course of a drug might prevent disease or lessen its impact in health care workers, nursing home residents, and household contacts of COVID-19 patients who have already been exposed to the virus. We said, we need something stronger than nonpharmacological interventions like isolation and quarantine, says Oriol Mitj of the Germans Trias I Pujol University Hospital, who leads the study.
In the Spanish trial, people with symptoms who test positive for COVID-19 are treated with the HIV combination drug darunavir/cobicistat plus hydroxychloroquine. Anyone known to have spent more than 15 minutes with them in the previous 5 days is treated with hydroxychloroquine for 4 days. Patients in a control group and their contacts receive no drugthere was no time to prepare an appropriate placebo, Mitj says.
The researchers plan to compare how many new symptomatic infections occur in the two groups after 14 days. More than 1000 contacts have been included already; the first result from that subset should be available around 15 April, Mitj says. Similar studies are underway in Minnesota, Washington, and New York.
Experience with HIV has shown that PrEP and PEP can work to reduce infections. But before large-scale studies in HIV began, scientists had an amazing amount of data from a monkey model and epidemiology studies suggesting the strategies would work, says Steven Deeks, an HIV researcher at the University of California, San Francisco (UCSF). Im not sure any of that applies to whats happening now.
Potential side effects of chloroquine and hydroxychloroquine, including heart arrhythmia, are another concern. The risks that might be acceptable in someone with disease may be much less acceptable when you are treating someone who doesnt have it, says Annie Luetkemeyer, an infectious disease physician at UCSF. And youre very unlikely to be monitoring them in the same way.
Some countries arent waiting for the new trials. India, for instance, has already recommended hydroxychloroquine for health care workers caring for suspected or confirmed COVID-19 cases as well as patients household contacts; Bangladesh has a similar policy. (White says he had to exclude both countries from the international study as a result.) There is no basis for recommending wide use of the drug, many scientists say. The idea that it is better than nothing is not true, White says. It could be worse than nothing.
Thats not just because of the potential side effects. People who think they are protected may also become less cautious and run a greater risk of infection. And broad use of the drugs will make them harder to obtain for other conditions. In addition to curing malaria, chloroquine and hydroxychloroquine are mainstays for patients with lupus and rheumatoid arthritis, Luetkemeyer says. We better be really sure that these drugs are working before we start impacting that drug supply.
Because the demand could be so big, there has been some debate among researchers about which dose to test. White has decided to go with the highest possible dose, to maximize the chance of getting a positive result. But the Gates-funded study plan calls for evaluating medium and low doses as well. If one of those shows an effect, more patients could benefit if supplies are low.
Even if chloroquine works, it is unlikely to confer 100% protectionand a low level of protection may not make the risk of side effects worthwhile. If you were a health care worker and I said, Heres a medicine which you have to take every day and it reduces your risk of getting COVID-19 by 20%, would you take it? White asks. Below that, people probably wouldnt bother, he says.
White hopes to start the international trial on 22 April in the United Kingdom, but he is still navigating the myriad rules, regulations, and sequential hurdles that govern the conduct of clinical trials. No one is acting with ill intent, he adds, but he thinks the emergency warrants faster action. Is it really ethical to take 3 weeks to review an application for a medicine that has been available for 70 years?
On April 3, Iraqi volunteers in full hazmat gear prayed over the coffin of a 50-year-old who died of COVID-19. She was buried at a cemetery specifically opened for such deaths, some 12 miles from the holy city of Najaf. Haidar Hamdani/AFP via Getty Images hide caption
On April 3, Iraqi volunteers in full hazmat gear prayed over the coffin of a 50-year-old who died of COVID-19. She was buried at a cemetery specifically opened for such deaths, some 12 miles from the holy city of Najaf.
For centuries, Hindus gathered to burn corpses on funeral pyres along the Ganges River. Jews received condolences at home during a seven-day mourning period. Muslims huddled together to wash the corpses of loved ones in Iraq and across the Arab world.
But global burial rituals are being dramatically changed by the coronavirus pandemic.
The World Health Organization in its March 24 guidance on burials of COVID-19 victims says dead bodies are generally not infectious. But its recommendations that relatives not touch or kiss the body and government rules on social distancing to prevent the spread of disease have upended important funeral and death rituals in virtually all of the world's faiths.
Just as the United States now restricts gatherings for funerals, so do countries and religious authorities around the world.
Here, some of NPR's foreign correspondents share details of how COVID-19 has changed traditions in the countries they cover.
Iraq: Days of delays for some burials
In Iraq, relatives participate in washing the bodies of their loved ones and preparing them for burial. The dead are buried the same day wherever possible. For both Muslims and Christians, deaths are normally followed by three days of condolences held in large tents or mosques or church halls. With the family surrounded by relatives, friends and neighbors, outpourings of grief are expected and often encouraged.
But with the pandemic, such public gatherings of grief are no longer allowed.
"It took eight days to get the body of my father from the morgue," says Abdul-Hadi Majeed, whose father died of COVID-19 in a Baghdad hospital in March. "It was very difficult arranging the burial."
Majeed, a soldier, says his father's body was among a group of bodies the government intended to bury in a field near Baghdad, outside the city. But tribal leaders refused to allow the bodies to be buried there, mistakenly fearing they could spread disease.
So paramilitary forces in hazmat suits took over the process and conducted the burials according to Islamic rites at a sprawling cemetery in the holy city Najaf, south of Baghdad, in a special section of COVID-19 victims.
India: Empty banks on the Ganges, a controversial call for cremation
In India, where the government has reported 124 COVID-19 deaths (as of April 6), new guidelines for disposal of dead bodies were issued on March 15. Funerals are now limited to 20 or fewer attendees. Gone are the big, public funeral processions that are a key part of mourning for adherents of many faiths across South Asia.
In the Hindu holy city of Varanasi, on the banks of the Ganges River, a lone Hindu priest now recites a truncated daily prayer as a symbolic gesture to the Hindu goddess Ganga, whom faithful believe embodies the river. Thousands of people including tourists used to gather here for sunrise and sunset ceremonies honoring the river goddess. Typically lined with funeral pyres giant piles of wood set alight to burn corpses the riverbanks are now largely empty because of a nationwide lockdown.
Many of India's majority Hindus believe that being cremated next to the Ganges, or having ashes submerged in its waters, ensures salvation. But with limited public transportation and travel curtailed under lockdown, families are unable to transport the bodies or ashes of their loved ones to the river, and there are reports of ashes piling up in crematoriums because families can't come to pick up the ashes.
A major association of Hindu priests is asking mourners to postpone travel to the northern Indian city of Haridwar, another popular pilgrimage site on the Ganges River, citing a shortage of priests to perform rituals again, because of the lockdown.
"After the waiver of the [lockdown] restrictions, one can come to Haridwar for ritual ash immersion," Pradeep Jha, president of the association, called Ganga Sabha, was quoted as saying. "Our [priests] will duly perform the rituals for peace and salvation to the deceased souls."
The Indian central government's new guidelines also prohibit bathing or embalming the corpse of a COVID-19 victim and ban relatives from kissing or hugging the body to avoid any risk of transmitting the virus. The rules are carefully worded, without mentioning any specific religion. But body-washing is typically practiced by Muslims, who number at least 180 million in India, and have faced religious discrimination and attacks in the past.
In the commercial capital Mumbai, municipal authorities announced last month that all COVID-19 bodies must be cremated. The order said the city's burial grounds were in densely-populated areas, which might pose a risk of contamination.
While cremation is most commonly practiced by India's Hindu majority, it is strictly forbidden in Islam.
After a Muslim politician intervened, the order was withdrawn within hours. Muslims can continue to bury their dead, with the order rescinded.
There is one burial tradition in India that doesn't involve crowds, and is thus still allowed: Sky burials. Practiced by Parsis, Zoroastrians and some Tibetan Buddhists, adherents place dead bodies on a high platform or mountaintop, and allow vultures to dispose of the remains.
Pakistan, Turkey and Ireland: Grieving at a distance
In neighboring Pakistan, the most populous province, Punjab, issued guidelines requiring those performing the ritual Islamic washing of bodies to wear appropriate protective gear. A prominent clerical council also called on Pakistani Muslims to practice social distancing as they undertake traditional communal prayers to honor the dead.
It was not immediately clear how widely that is being respected, but one video shared from a remote Pakistani province showed a handful of worshippers standing carefully apart as they prayed for a COVID-19 victim about to be buried.
In Turkey, close farewells have been replaced by distance burials. Only those physically involved in the burial are allowed at the pre-burial body washing ritual normally attended by close family members, and only the closest relatives can attend the burial, with the imam praying from a safe distance away, speaking through a mask. Authorities have forbidden mourners from approaching the coffin for a last look or word.
In Ireland, people are determined to pay their condolences despite new rules. Last week, when an elderly resident died in a village in county Kerry, Catholic parishioners lined a more than mile-long road to the local cemetery socially distanced at several feet from one another in a tribute that was filmed and shared widely on social media.
France and Brazil: No more than 10 funeral guests
Members of the Charitable Brotherhood of Saint-Eloi de Bethune, which first formed during the plague 800 years ago, carry an urn to a family tomb at the cemetery in Bethune, France. The photo was taken on March 18. Pascal Rossignol/Reuters hide caption
Many countries are limiting the number of mourners allowed to attend funerals. In both Brazil and France, authorities urge people to limit funerals to ten attendees. In Brazil, they also specify that mourners must remain about six feet apart a stark contrast from traditional funeral gatherings there, which often last all day and are attended by hundreds of people.
Israel: Goodbyes behind glass, virtual shiva
Some Israeli hospitals, like the Sheba Medical Center, place the body of a person who died of coronavirus in a glass booth. That way, families who weren't able to be with a dying relative can say a last goodbye. Courtesy of Sheba Medical Center hide caption
Some Israeli hospitals, like the Sheba Medical Center, place the body of a person who died of coronavirus in a glass booth. That way, families who weren't able to be with a dying relative can say a last goodbye.
Some Israeli hospitals have offered alternatives to families blocked from coronavirus wards to bid goodbye to a dying loved one. Sheba Medical Center built a glass booth in which to place the body so families may get a last glimpse. Families stand on the other side of a wall and peer through a window to see the deceased.
Burial officials restrict funerals to 20 guests and forbid the custom of passing around a shovel for attendees to scoop dirt into the grave so participants don't touch the same shovel. At some funerals, participants insist on keeping the tradition to honor the dead by scooping up dirt with their bare hands. Coronavirus victims' bodies are wrapped in two plastic body bags to protect those who handle the body, since coffins are not typically used in Jewish burials in Israel and bodies are lowered directly into the grave, wrapped in shrouds.
Israelis may no longer host guests for the shiva, the weeklong mourning gathering for family, friends and well-wishers. The bereaved must grieve at home alone. Some host shiva gatherings by video conference, but many Orthodox Jews must give up reciting the special mourner's prayer, the kaddish, because it requires the physical presence of a quorum of ten. More liberal rabbis have permitted a virtual quorum to gather through video conference for the mourner's prayer.
Some coronavirus victims in parts of Europe have been flown to Israel for burial, following a Jewish custom to be buried in the Holy Land. But not U.S. Jews, an Israeli burial official told NPR. United Airlines, servicing the only remaining direct U.S.-Israel flights, has suspended international funeral shipments, a service airlines provide to transfer the deceased to their desired final resting place. A leading Orthodox rabbi in New York has permitted temporary burial in the U.S. until casket shipments are renewed and the bodies can be exhumed and reburied in the Holy Land.
China: Reserving time slots to pick up ashes
In the city of Wuhan, the epicenter of the virus in China, families under lockdown hadn't been able to pick up the cremated ashes of their loved ones for the last two months, until about late March in the run up to Tomb Sweeping holiday. That traditional Chinese festival, which pays respect to ancestors, was observed this year on April 4.
To prevent large crowds from forming, authorities in Wuhan require families to reserve a time slot to pick up their loved ones' ashes and bury them, while accompanied by a neighborhood official.
Philippines: Cremation within 12 hours, with some exceptions
On April 3, funeral workers in protective suits unloaded the body of a person presumed to have died of the coronavirus, to be cremated at a public cemetery in Manila. Ezra Acayan/Getty Images hide caption
In the Philippines, a government edict has decreed that the remains of a COVID-19 victim should be cremated within 12 hours, with an exception if a religion forbids cremation. If the deceased is a Muslim, for example, the body of the deceased should be placed in a sealed bag and buried in the nearest Muslim cemetery according to Muslim rites, also within 12 hours.
The speedy burials are a disrupting departure from traditional Christian burials in the Philippines, a predominantly Catholic country where the "lamay" or wake can last three to seven days.
NPR international correspondents Diaa Hadid, Emily Feng, Peter Kenyon, Julie McCarthy, Philip Reeves and Eleanor Beardsley contributed to this report from Islamabad, Wuhan, Istanbul, the U.S., Rio de Janeiro and Paris, respectively. NPR producer Sushmita Pathak contributed from Mumbai, and NPR producers Awadh al-Taee and Ahmed Qusay contributed from Baghdad.
In an alternative universe, a new virus emerges in China. The country quickly identifies the pathogen, closes its borders, launches an unprecedented campaign to eradicate the virus, and manages to ensure that very few cases leave the country. The other countries that do report cases such as South Korea, Taiwan, Hong Kong and Singapore rapidly identify those who are infected, trace the people they have contacted, isolate the carriers of the virus and contain its spread. Through this three-pronged strategy test, trace, isolate eradication is successful. Humanity is saved.
In reality, Sars-CoV-2, the novel coronavirus, escaped the public health interventions of the Chinese government and spread across the world. As other governments fumbled in their early responses, the virus silently rippled through communities, infecting many people and hospitalising and killing some. The virus is remarkably dangerous it spreads as easily as a cold or flu, even via individuals who dont have any visible symptoms, and the latest data shows that roughly 5% of people who become infected will require hospitalisation. Among them, 30% will be admitted to ICU. An estimated 0.6-1.4% of those who contract the virus will die.
The world now has more than 1 million confirmed cases of coronavirus. The United States, which has more than 400,000 cases and approaching 13,000 deaths, has overtaken China, where there have been roughly 82,000 cases and 3,000 deaths. Half of all confirmed cases are now in Europe. Low- and middle-income countries are just a few weeks behind. While nations such as Senegal, Liberia and Nigeria have shown themselves aggressively ready to meet this challenge, their governments are constrained by a lack of resources, healthcare and testing capacity. Others, such as Brazil, India and Mexico, seem in denial of what is to come.
We still dont know what percentage of the worlds population has already been exposed to the virus. Without a reliable antibody test that can identify whether someone has had the virus and are likely to be immune, its unclear how many people are carrying the virus but not showing symptoms. The role of children in transmission is also unclear; children are neither immune nor seem to be heavily affected.
So, what now? Based on what Ive learned from published modelling and other countries responses to the virus, there are four possible scenarios for how this might end. One is that governments come together to agree a plan of eradication dependent on a rapid and cheap point-of-care diagnostic. All countries would simultaneously close their borders for an agreed amount of time and mount an aggressive campaign to identify carriers of the virus and prevent transmission.
This approach seems unlikely; the virus has spread aggressively, and some countries have been reticent to cooperate with one another. But it could become more realistic for three reasons: antiviral therapies used to prevent or treat symptoms of Covid-19 may be poor; a vaccine may take decades to produce; and immunity may only be short-term, resulting in multiple waves of infection, even within the same individuals. New Zealand is currently attempting a version of this approach; the country has closed its borders, enforced a lockdown and is rolling out community testing to eradicate the virus.
A second scenario, which seems moderately more likely, is that early vaccine trials are promising. While waiting for the vaccine, countries would try to delay the spread of the virus over the next 12-18 months through intermittent lockdowns. Health authorities would need to anticipate, three weeks in advance, whether there are enough beds, ventilators and staffing to treat those infected. On this basis, governments could decide whether to relax or increase quarantine measures.
But this scenario is far from ideal. Healthcare systems would still be strained, and the economic and social costs of lockdown are high. Repeated lockdowns could lead to mass unemployment, an increase in child poverty and widespread social unrest. In poorer countries, more people could die from the lockdown than from the virus itself: of malnutrition, vaccine-preventable diseases or dehydration from limited access to clean water.
A third and even likelier scenario is that countries follow South Koreas example while they wait for a vaccine: increase testing to identify all carriers of the virus, trace the people they have contacted, and quarantine them for up to three weeks. This would involve large-scale planning, the swift development of a contact-tracing app, and thousands of volunteers to help with swabbing, processing results and monitoring quarantine. More relaxed physical distancing measures could be enforced to prevent the spread of the virus and ease the pressure on healthcare systems.
In the absence of a viable vaccine for the foreseeable future, a final scenario could involve managing Covid-19 by treating its symptoms rather than its cause. Health workers could administer antiviral therapies that prevent patients from deteriorating to the point where they needed intensive care, or preventing them from dying when they reach a critical phase. An even better solution would be using prophylactic therapy to prevent the onset of Covid-19, in combination with rapid diagnostic testing to identify those who have been infected. In countries with the resources, this could be sustainable but for poorer countries this approach would be difficult, if not impossible.
There is no easy solution. The months ahead will involve a fragile balancing act between the interests of public health, society and the economy, with governments more reliant on each other than ever before. While half the battle will be in developing the tools to treat the virus a vaccine, antiviral therapies and rapid diagnostic testing the other half will be manufacturing enough doses, distributing these in a fair and equitable manner, and ensuring they reach individuals across the world.
Coronavirus Live Updates: Trump Threatens to Cut Funding for World Health Organization The New York Times
SAN FRANCISCO Jack Dorsey, the chief executive of Twitter and Square, said on Tuesday that he planned to donate $1 billion, or just under a third of his total wealth, to relief programs related to the coronavirus, in one of the more significant efforts by a tech billionaire to fight the pandemic.
Mr. Dorsey said he would put 28 percent of his wealth, in the form of shares in his mobile payments company Square, into a limited liability company that he had created, called Start Small. Start Small would make grants to beneficiaries, he said, with the expenditures to be recorded in a publicly accessible Google document.
Why now? The needs are increasingly urgent, and I want to see the impact in my lifetime, Mr. Dorsey said in a series of tweets announcing his plans. I hope this inspires others to do something similar.
Mr. Dorsey, 43, joins a growing list of celebrities, world leaders and technologists who are earmarking some portion of their wealth to fighting the spread of the coronavirus and its effects.
Oprah Winfrey has donated more than $10 million of her personal wealth to Covid-19 relief efforts, while other Hollywood personalities including Justin Timberlake, Dolly Parton and Rihanna have also made contributions. Last week, the Amazon chief executive, Jeff Bezos, said he would donate $100 million to American food banks through a nonprofit, Feeding America. And Mark Zuckerberg, chief executive of Facebook, has also organized relief campaigns through Facebook and his own philanthropic organization, the Chan Zuckerberg Initiative.
Even so, Mr. Dorseys contribution stands out for the sum he is putting in and for how much of his net worth that represents.
Square declined a request for an interview with Mr. Dorsey. Twitter declined to comment.
In creating a limited liability company, Mr. Dorsey is following a model that Mr. Zuckerberg has used. In 2015, when Mr. Zuckerberg and his wife, Priscilla Chan, set up the Chan Zuckerberg Initiative, it was organized as an L.L.C., holding much of their wealth to fund charitable causes.
At the time, critics said the vehicle was a self-serving maneuver that allowed Mr. Zuckerberg to engage in private lobbying, for-profit investment and political donations. Mr. Zuckerberg pushed back, saying a limited liability company gave him and his wife more control over how their resources would be put to use.
Mr. Dorsey, who has been criticized in the past for his lack of transparency around philanthropic efforts, said he was creating an L.L.C. for flexibility and pledged to use the Google document to update the public on its latest grants, stock transfers and sales.
He said the first $100,000 donation would be to Americas Food Fund, a high-profile effort committed to feeding the hungry. It was started in a GoFundMe page last week by Leonardo DiCaprio, Laurene Powell Jobs and Apple.
After the most pressing matters of the pandemic are resolved, Mr. Dorsey said, he plans to shift the aim of Start Small to supporting initiatives around universal basic income, under which Americans would get a base level of regular income from the federal government, and womens health and education efforts.
Universal basic income has been a pet issue for some Silicon Valley progressives, made more popular in recent months by the now-ended presidential candidacy of Andrew Yang, a Democrat who ran partly on the idea.
Life is too short, so lets do everything we can today to help people now, Mr. Dorsey tweeted, followed by an emoji of a peace sign hand gesture.
