Health care workers around the world are asking for help. What do you want? PPE. When do you need it? Now. Theyre in desperate need of more PPE, also known as personal protective equipment. Stocks of the critical gear are disappearing during the coronavirus pandemic. Doctors say they are rationing gloves, reusing masks and raiding hardware stores. The C.D.C. has even said that scarves or bandannas can be used as protection as a last resort. Ive met the doctors, and talked with them every day. I think theres an interesting challenge here in that, currently, theres such a need that if they had anything, they would deploy it. The cries for help are mobilizing a wide range of innovators, some of them even joining forces through online messaging platforms like Slack. These are engineers, doctors and even high school students from around the world. They come from all walks of life, but say their goal is the same. Its amazing because no ones asking which country are you from? Theyre just like, how can I help? What do you need? Theyre pitching in by crowdsourcing designs for masks, face shields and even ventilators that could be reproduced around the world. This is Nick Moser. Hes an active player in one of the maker groups. His day job is at a design studio. Now, hes designing replicable face masks. Were focused on three products: a face shield, a cloth mask and an alternative to N95-rated respirators. The face shield is the first line of defense for medical workers. It protects against droplets. If a patient coughs, itll hit the face shield rather than them. Some designs are produced using 3-D printers or laser cutters. There you go. Then, the prototypes are field-tested by health care workers. Even some university labs are experimenting with DIY techniques. A group at Georgia Tech is working with open-source designs from the internet to develop products. My lab works in the area of frugal science, and we build low-cost tools for resource-limited areas. And now, weve realized that I dont have to go that far. Its in our backyard, right? We need it now. So this is a plastic sheet I have not too different from what you would get out from a 2-liter Coke or a soda bottle. I actually bought this from an art store. Its just sheets of PET, so we can cut these out. We are calling this an origami face shield, and its the Level 1 protection. This is one idea. There are multiple different prototypes. This headband can be reused, and a doctor or nurse could just basically tear this off and basically snap another one on. Were hearing that, in some cases, that they go through close to 2,000 of these a day. Because the need is growing so rapidly, the makers are also thinking about how to increase their production. So how do we get from this one that someone made at home on a laser cutter or a 3-D printer, and then get it in the hands of thousands of doctors and front-line workers? Theyre working with mass manufacturers that can take their tested designs, and replicate them at a larger scale. Weve been on the phone talking to a number of suppliers, material suppliers. So I think one of the neat things that weve done is not only the design, proving that you can make it rapidly, but then also trying to secure the entire supply chains. This is Dr. Susan Gunn, whose hospital system in New Orleans has even started its own initiative to 3-D print equipment. So it starts with an idea. We put the idea into place. And then we make sure that its professional-grade first. Infection control is looking at it, and were making sure that were using the correct materials that would be approved by the C.D.C. and the World Health Organization. Dr. Gunn says the gear is a safe alternative for those who might otherwise face a shortage. Were creating face shields and were creating these different PPEs, and were putting them in the hands where people felt like they needed them. Another critical piece of equipment is the N95 mask, and the supply is dwindling fast. Nick and his team are designing a robust alternative for this mask that can hold any filter material, and be mass produced. It is easily printable. This one is used in medical situations where theres an actively infectious patient. So nursing homes or obviously I.C.U. units would be the target to receive these. These are really hard objects to manufacture because youre going to give it to a nurse, and then I want to be really confident that it will not let a virus through, right? This equipment is not approved by federal agencies, but the designers are testing their respirator prototypes for safety. That was basically the first, almost the first question that was asked. Can we do anything thats actually going to be safe and helpful? Some makers are pursuing even more ambitious projects. An engineer named Stephen Robinson in New Haven, Conn., is working on designing ventilators to help patients breathe. Countries are facing a dire shortage of the lifesaving machines. Right now, these DIY ventilators are still prototypes. So really, this should be thought of as the seed of an idea that could potentially be grown with, and absolutely requiring, the medical and the tech communities. But they could become key if critical supplies run out. Were in very uncertain times, and I see explorations and projects as kind of an insurance policy that could potentially be leaned on if there was extreme circumstances. Health care workers are hopeful that these efforts could prevent an even worse outcome. We dont want anybody lets be clear to use a bandanna to protect themselves. I hope it never gets to the point where we have to wear a bandanna. And I dont think, with this initiative that we will get there. For innovators like Saad, the challenge is personal. I just cant stop. I have to do stuff. And then Im currently at a hospital. Thats why I have this uplifting little flower portrait. Were expecting a baby boy, and what do we tell him when he grows up about what we did when society needed us?
Prime Minister Narendra Modi has ordered a lockdown of Indias 1.3 billion citizens to fight the spread of coronavirus, urging people to distance themselves socially and work from home.
But social distancing means hunger for many in India, with a work force heavily dependent on manual labor. It would be an unheard-of luxury for the ragpicker or street vendor who lives day to day.
About 80 percent of Indias 470 million workers are in the informal sector, lacking contracts and unprotected by labor laws. Many are manual laborers in the fields, factories and streets of India.
We asked people how they were making ends meet as the economy grinds to a halt with the coronavirus pandemic. India reported 1,024 cases and 27 dead as of Sunday. Here are some of their stories:
Ashu, 12 | ragpicker
Ashu and his two brothers spend their days at one of Delhis biggest dumps. They are ragpickers scavengers who hunt for scrap metal using a giant, rusted sieve to help them sort through the stinking refuse.
If Ashu works really hard, he can earn 53 cents a day. He and his brothers have been unable to go to the dump regularly since the lockdown was announced because if they are caught by the police, they will be beaten.
I miss my friends, he said, adding that he and four buddies would meet at the dumpsite every morning, work for a few hours and then play with whatever treasures they found broken toy cars, tattered dolls and ripped clothing.
I hear there is a virus from China going around, Ashu said. But Im more afraid of the police and not being able to eat.
When the money dries up, we will have to find a way to come back here again, he said.
Ramchandran Ravidas, 42 | bicycle rickshaw driver
On a Wednesday afternoon, normally peak rush hour in Delhi, Ramchandran Ravidas was bicycling around in big, lazy circles in the middle of a main thoroughfare, boredom, hunger and his empty pockets on his mind.
On a good day, if he has a lot of energy he can make up to 450 rupees, or $6, he said. He lives out of the garage he rents his bicycle rickshaw from and worries that he will be evicted soon; he has had no customers since the lockdown.
If you dont even have a house, how can you work from home? Mr. Ravidas said, worry lines furrowing his face. My home is my work. Today was the first time in my life I had to accept food from a charity.
He said, for him, it was a race between whether the virus or hunger got to him first.
Im not worried about corona; if corona comes to get me, at least this life of misery will be over, Mr. Ravidas said, breaking into a grin as he roared with laughter.
Baudghiri, 60 | sadhu (religious ascetic)
Walking barefoot along Delhis deserted streets, his saffron-colored clothing stained and tattered, Baudghiri said he had not eaten in two days. A sadhu, or religious ascetic, he makes about $1.50 every day by offering prayers to people on the street.
Mr. Baudghiri, who goes by just one name, had never gone hungry a day in his life, he said, and had always found a meal in Hindu temples or gurdwaras, Sikh places of worship. But they have closed since the lockdown started last week.
While he agreed with the prime ministers decision to try to prevent the viruss spread by limiting peoples movement, he was frustrated with the governments lack of planning for the destitute like him.
I do not have a house to practice social distancing in, he said. I go from place to place, temple to temple, to eat. But the entire city is closed.
In all his decades of walking across India, Mr. Baudghiri said he had never seen India so paralyzed.
In every crisis, the gurdwaras, the temples were all open, he said. We were still able to feed ourselves and find shelter. Ive never seen this panic in my entire life.
Raj Kumari | street sweeper
Sweeping leaves and trash off a deserted street and dumping them into her rusted wheelbarrow, Raj Kumari said the silence of the normal cacophony of Delhi was glorious, but eerie.
She used to sweep Delhis streets with her husband, but he died eight years ago. She is now the sole breadwinner for her six children, after her eldest son was laid off from his tech job this past week because of the lockdown.
Its just me and the sewer cleaners out here now, she said.
The lockdown has affected public transportation, and she now walks two hours just to get to work.
This is what I have to do for money, for life, she said. Even if the streets are empty, I have to come out. I dont have the pleasure of staying at home, this is my duty.
The government has never provided Ms. Kumari, who does not know her exact age, with gloves or masks for her job. But one of her daughters forbade her from working without protective gear during the pandemic and gave her a mask that her school had donated to students to protect against Delhis infamous pollution.
Im not afraid of corona, Ms. Kumari said. Why would anyone fear death when it is time for God to take you?
Mohan Singh, 18 | fruit seller
Every morning, Mohan Singh and his father pile their carts with fruit and wheel their loads to work, on a busy neighborhood street corner. Although their jobs are deemed necessary and permissible during the lockdown, they say customers are too afraid to come to their carts. By midmorning, they had served one customer between them.
If we are afraid of this disease, we will die in our homes, Mr. Singh said, adding that he and his father provide for their entire family of six.
Mr. Singh said he was worried that the government was going to help big businesses and that small businesses like his would be overlooked. Although the government announced a $22 billion relief package to support the millions left unemployed because of the crisis, some say people in the informal work force, like Mr. Singh, will have trouble getting help.
They need to help people like us, he said. There are more people working on the streets than Indias biggest companies. If we close, no one can eat.
Arjun Chauhan, 18 | water deliverer
Many Indian homes lack running water or water safe enough to drink, making Arjun Chauhans job a necessity during the lockdown. He zipped across Delhis streets on his moped bike, stacked high with leaking water bottles.
If we stay at home, my family goes hungry and India goes thirsty, Mr. Chauhan said, adding that his parents and five siblings rely on his wages.
Since the lockdown, Mr. Chauhan has seen his daily earnings of about $8 cut in half. He said he had been unable to reach all his customers because the police had prevented him from deliveries and even beat him for being on the streets although under the lockdown rules, deliveries of necessary items like medicine and water are supposed to be allowed.
Chris Cuomo, the CNN anchor and younger brother of Gov. Andrew M. Cuomo of New York, has tested positive for the coronavirus, the network said on Tuesday.
Mr. Cuomo, 49, is feeling well, according to a memo distributed by CNN to staff members, and he plans to continue hosting his prime-time program from a studio in his home basement, where he is in quarantine.
A veteran news personality who joined CNN in 2013, Mr. Cuomo the youngest child of Mario M. Cuomo, the former New York governor is one of the most prominent members of the American media to learn he had the virus so far.
His program, Cuomo Prime Time, is a linchpin of CNNs coverage of the coronavirus pandemic, and he has conducted several remote interviews with his brother on the governors efforts to combat the outbreak in New York.
I have been exposed to people in recent days who have subsequently tested positive and I had fever, chills, and shortness of breath, Chris Cuomo said in a Twitter post on Tuesday, adding that he was hopeful he had not passed on the illness to his wife and children. He joked that the rest of the family seem pleased by his isolation in their basement, writing, We will all beat this by being smart and tough and united!
Governor Cuomo was in the midst of a nationally televised coronavirus briefing when news of his brothers diagnosis became public. The governor said that he had learned of Chris Cuomos illness on Tuesday morning, and that his brother is going to be fine.
Hes young, in good shape, strong not as strong as he thinks but he will be fine, the governor said, wryly. (The Cuomos often engage in on-air brotherly teasing.)
But Governor Cuomo continued at length about the more serious implications of his brothers diagnosis, including his relief that their 88-year-old mother, Matilda Cuomo, had not moved into Chris Cuomos home. The governor said he had told his brother that such a move would be a mistake."
You bring her to your house, you expose her to a lot of things, the governor said. She would have been doing what she wanted to do, he would have been doing what he wanted to do; it would have seemed great and harmless. But now we have a much different situation. Because if he was exposed, chances are she may very well have been exposed, and then we would be looking at a different situation than just my brother sitting in his basement for two weeks.
Andrew Cuomo is not known for public displays of sentiment. But his voice turned contemplative as he spoke about his sibling. Hes combative and hes argumentative and hes pushing people, but thats his job. Thats really not who he is, the governor said. Hes a sweet, beautiful guy, and hes my best friend.
Theres a lesson in this, the governor said. Hes an essential worker, a member of the press, so hes been out there. If you go out there, the chance that you get infected is very high.
Chris Cuomo is the third CNN employee in New York to receive a positive diagnosis. The network said he was last in the networks Manhattan offices on Friday.
Jonah Engel Bromwich contributed reporting.
Then again, the novel coronavirus pandemic is an unusual and strained moment -- one that's scrambling society and people's roles in it."If @NYGovCuomo says we need masks my team will help make some. I have a full sewing team still on staff working from home that can help," the fashion designer Christian Siriano, who won Season 4 of the hit competition series "Project Runway," tweeted a couple weeks ago.
He was responding to Gov. Andrew Cuomo's concern that New York City, which has become the most overwhelmed area in the US, doesn't have enough face masks -- among other supplies, including hospital beds and ventilators -- to effectively confront the escalating crisis.
Another peculiar pairing: Cuomo and Rihanna.
Over the course of about 30 minutes, Fauci answered questions from the basketball player: How is Covid-19 different from the flu? What's your assessment of the testing process? What does it mean to recover -- can you get the virus a second time?
Curry, then, essentially serving as a proxy for America's anxious citizenry, effected a sort of justice: He used his cachet to illuminate vital information.
But this inspiring work also seems a bit sobering, doesn't it?
Indeed, in the absence of consistent, meaningful guidance from federal officials, the governed are attempting to govern themselves.
So what has happened? Well, several different things. From the Wuhan outbreak through somewhere in mid-February, the responses to the coronavirus did seem to correspond very roughly to theories of conservative and liberal psychology. Along with infectious-disease specialists, the people who seemed most alarmed by the virus included the inhabitants of Weird Right-Wing Twitter (a collection of mordant, mostly anonymous accounts interested in civilizational decline), various Silicon Valley eccentrics, plus original-MAGA figures like Mike Cernovich and Steve Bannon. (The radio host Michael Savage, often considered the most extreme of the rights talkers, was also an early alarmist.)
Meanwhile, liberal officialdom and its media appendages were more likely to play down the threat, out of fear of giving aid and comfort to sinophobia or populism. This period was the high-water mark of its just the flu reassurances in liberal outlets, of pious critiques of Donald Trumps travel restrictions, of deceptive public-health propaganda about how masks dont work, of lectures from the head of the World Health Organization about how the greatest enemy we face is not the virus itself; its the stigma that turns us against each other.
But then, somewhere in February, the dynamic shifted. As the disease spread and the debate went mainstream, liberal opinion mostly abandoned its anti-quarantine posture and swung toward a reasonable panic, while conservative opinion divided, with a large portion of the right following the lead of Trump himself, who spent crucial weeks trying to wish the crisis away. Where figures like Bannon and Cernovich manifested a conservatism attuned to external perils, figures like Rush Limbaugh and Sean Hannity manifested a conservatism of tribal denial, owning the libs by minimizing the coronavirus threat.
Now we are in a third phase, where Trump is (more or less, depending on the day) on board with a robust response and most conservatives have joined most liberals in alarm. Polls show a minimal partisan divide in support for social distancing and lockdowns, and some of that minimal divide is explained by the fact that rural areas are thus far less likely to face outbreaks. (You dont need a complicated theory of the ideological mind to explain why New Yorkers are more freaked out than Nebraskans.)
But even now, there remains a current of conservative opinion that wants to believe that all of this is overblown, that the experts are wrong about the likely death toll, that Trump should reopen everything as soon as possible, that the liberal media just wants to crash the American economy to take his presidency down.
Some senators had wanted to put a provision in the coronavirus bill to protect patients from surprise out-of-network billing either a broad clause or one specifically related to coronavirus care. Lobbyists for hospitals, physician staffing firms and air ambulances apparently helped ensure it stayed out of the final version. They played what a person familiar with the negotiations, who spoke on condition of anonymity, called the Covid card: How could you possibly ask us to deal with surprise billing when were trying to battle this pandemic?
Even without an E.R. visit, there are perilous billing risks. Not all hospitals and labs are capable of performing the test. And what if my in-network doctor sends my coronavirus test to an out-of-network lab? Before the pandemic, the Kaiser Health News-NPR Bill of the Month Project produced a feature about Alexa Kasdan, a New Yorker with a head cold, whose throat swab was sent to an out-of-network lab that billed more than $28,000 for testing.
Even patients who do not contract the coronavirus are at a higher risk of incurring a surprise medical bill during the current crisis, when an unrelated health emergency could land you in an unfamiliar, out-of-network hospital because your hospital is too full with Covid-19 patients.
The coronavirus bills passed so far and those on the table offer inadequate protection from a system primed to bill patients for all kinds of costs. The Families First Coronavirus Response Act, passed this month, says that the test and its related charges will be covered with no patient charge only to the extent that they are related to administering the test or evaluating whether a patient needs it.
That leaves hospital billers and coders wide berth. Mr. Cencini went to the E.R. to get a test, as he was instructed to do. When he called to protest his $1,622.52 for hospital charges (his insurers discounted rate from over $2,500 in the hospitals billed charges), a patient representative confirmed that the E.R. visit and other services performed would be eligible for cost-sharing (in his case, all of it, since hed not met his deductible).
This weekend he was notified that the physician charge from Emergency Care Services of New York was $1,166. Though covered by his insurance, he owes another $321 for that, bringing his out-of-pocket costs to nearly $2,000.
By the way, his test came back negative.
When he got off the phone with his insurer, his blood was at the boiling point, he told us. My retirement account is tanking and Im expected to pay for this?
The coronavirus aid package provides a stimulus payment of $1,200 per person for most adults. Thanks to the billing proclivities of the American health care system, that will not offset Mr. Cencinis medical bills.
Elisabeth Rosenthal, a former New York Times correspondent, is the editor in chief of Kaiser Health News, the author of An American Sickness: How Healthcare Became Big Business and How You Can Take It Back and a contributing Opinion writer. Emmarie Huetteman is a correspondent at Kaiser Health News.
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Consumer spending is 70 percent of GDP, said Torsten Slok, chief international economist at Deutsche Bank Securities. An important part of what drives your and my consumer spending is your wealth and whether you have a job.
The decline was not as bad as some economists were expecting consumers were surveyed between March 1 and March 18 but with more than 3 million people joining the unemployment ranks in just one week this month, that number is sure to drop much further.
The survey period is almost entirely before the shutdowns/mass layoffs began, said Megan Greene, an economist at Harvard Kennedy School. I would also expect the next set of consumer confidence numbers to be a whole lot worse.
Consumer confidence was consistently one of the bright spots in the U.S. economy under Trump before the pandemic hit; even when business investment shrank and the manufacturing entered a recession, healthy spending by Americans helped drive unemployment down to lows not seen since the 1960s.
That confidence could be difficult to recover, depending on the effectiveness of the relief measures pursued by Congress and the administration, economists say.
SEOUL, South Korea Shin Dong-yun, a scientist from the North Korean Institute of Virology, rushed to the northwestern border with China in early February. There, he conducted 300 tests, skipping meals to assess a stream of people so that the country is protected from the invasion of the novel coronavirus.
Stories like this, carried in the state-run newspaper Rodong Sinmun, focus attention on one of the stranger oddities surrounding the Covid-19 pandemic: How could North Korea claim to not have a single coronavirus case while countries around the world stagger under the exploding epidemic?
North Korea has taken some of the most drastic actions against the virus and did so sooner than most other nations. It sealed its borders in late January, shutting off business with neighboring China, which accounts for nine-tenths of its external trade. It clamped down on the smugglers who keep its thriving unofficial markets functioning. It quarantined all diplomats in Pyongyang for a month. The totalitarian states singular ability to control the movement of people also bolsters its disease-control efforts.
But decades of isolation and international sanctions have ravaged North Koreas public health system, raising concerns that it lacks the medical supplies to fight an outbreak, which many fear has already occurred.
You can see immediately whats going to happen if you get a surge of Covid-19 patients streaming in, said Dr. Kee B. Park, a lecturer at Harvard Medical School who has worked alongside North Korean doctors to help improve the countrys health system. It will overwhelm the system very quickly.
Many observers of North Korea doubt its claims of not having any coronavirus cases. But a lack of testing equipment may mean it literally has not detected a single case, Dr. Park said.
Its because they may have cases but they just dont know how to detect it, he said. So they can say, We have not confirmed it.
Some accuse North Korea of hiding an outbreak to preserve order.
Its a blatant lie when they say they have no cases, said Seo Jae-pyoung, secretary-general of the Seoul-based Association of North Korean Defectors, who said he heard from his North Korean contact that a family of three and an elderly couple died of the virus in the east coast city of Chongjin in mid-March. The last thing the North wants is a social chaos that may erupt when North Koreans realize that people are dying of an epidemic with no cure.
The Norths leader, Kim Jong-un, is clearly aware of the threat the virus poses to his countrys decrepit health system. Around when Washington announced on Feb. 13 that it would allow coronavirus-related humanitarian shipments, North Korea made a rare request for urgent help from relief groups, including diagnostic kits, according to people familiar with the matter.
In recent weeks, the Norths official media outlets have carried alarming reports detailing the coronaviruss toll around the world: a snowballing caseload in South Korea; bodies piling up in Italy; panicked citizens hoarding guns and ammunition in the United States.
They contrast such reports with pictures of North Korean disease-control officials in full protective gear spraying disinfectant in buses, trams, playgrounds and hotel gyms in Pyongyang, the showcase capital city. Garment factories are shown making masks instead of clothes. There is a national drive to send eggs, meat and fish to those under quarantine.
By its own account, North Korea has quarantined 10,000 people. International disease-control officials have all been amazed how North Korea could have done it, the state-run Rodong newspaper said this month.
But video clips shot in Hyesan, a town on the Norths central border with China, in February and early March depict a far less flattering picture of the Norths disease-control efforts.
A red wooden marker on a sidewalk covered with a dirty slush of ice said disinfection station, according to a clip, which was smuggled to the Rev. Kim Seung-eun, a human rights activist in South Korea, and viewed by The New York Times. A lone official in a green plastic suit with a tank of disinfecting liquid on his back stood idly. A silver van raced through the town blaring the importance of wearing masks. In another clip, a sign saying Quarantined was stuck on the door of what looked like a tenement house where Reverend Kim said people with possible symptoms were kept.
Reverend Kim said one of his North Korean contacts had been unable to return home for a month after visiting another town because the government controlled internal movement. Such restrictions were needed for disease control because of North Koreas crowded public transportation network.
The countrys information blackout and the inability of outside health experts to get into the country leave the rest of the world largely in the dark about how North Korea is coping with the virus.
Last month, Daily NK, a Seoul-based website that hires anonymous informants inside the North, reported the deaths of 200 soldiers, as well as 23 others, who were suspected of contracting the coronavirus. But Kang Mi-jin, a North Korean defector-turned journalist in Seoul, said that no matter how hard they searched, her contacts in the North could not find a death officially ascribed to the coronavirus.
In the past, the country has hushed or played down epidemics, military rebellions, man-made disasters or anything else that could undermine the peoples faith in the government.
But this time, the Norths unusually aggressive moves, as well as its unique ability to detain people, may have prevented a devastating outbreak, said Jung Gwang-il, a North Korean defector who leads No Chain, a North Korean human rights activist group in Seoul. As soon as an outbreak was reported in China, North Korea rounded up all Chinese visitors in its northeastern town of Rason and quarantined them on an island for a month, Mr. Jung said.
Its safe to say that there are cases in North Korea, but I dont think the outbreak there is as large as the ones we have seen in South Korea, Italy and the U.S., said Ahn Kyung-su, the head of the Seoul-based Research Center of DPRK Health and Welfare, which monitors the Norths health system. North Koreans are trained to obey government orders in a shipshape way during crises. But there is the risk of the virus running out of control if it starts spreading among its malnourished people.
Mr. Ahn said testing kits from China were available in big cities like Pyongyang. Telltale evidence came when Kim Jong-un inspected a missile test this month and military officers surrounding him did not wear masks, which Mr. Ahn said would not have happened had they not tested negative.
But the coronavirus has put Mr. Kim between a rock and a hard place, analysts say.
On March 17, he broke ground on a modern Pyongyang General Hospital to be completed by October. But such projects in the North rely on mass mobilizations of soldiers who sleep and eat together for months at a stretch, and raise the risk of mass infections during an epidemic.
By this month, some help began reaching North Korea in its efforts to confront the virus. Russia donated 1,500 test kits. China is also believed to have sent diagnostic tools. The United Nations has begun waiving sanctions for aid groups like the Red Cross to ship testing machines and diagnostic kits, as well as ventilators and protective equipment. But the shipments have been slow.
Given the global shortage of supplies and items being available in different locations, we are still in the process of procuring the items, said Ellie Van Baaren, a Red Cross spokeswoman.
The US is a land divided. Americans have sorted themselves into opposing factions, with different values, sources of authority, and shared understandings. In some ways, there is no longer any meaningful US public, but rather two publics that want and believe different things.
The current state of deep polarization in the US is the subject of a great deal of discussion and research right now, including in an excellent new book by my colleague Ezra Klein. One aspect of it that I have highlighted in a number of posts (start here) is what I call Americas epistemic crisis. Epistemology is the branch of philosophy having to do with knowledge and how we come to know things; the crisis is that, as a polity, we have become incapable of learning or knowing the same things, and thus, incapable of acting together in a coherent fashion.
I have been wondering when that epistemic crisis might spiral out into a full-fledged political crisis. I wondered if it might happen around the Mueller investigation, or when Trump sent 5,000 troops to the southern border to stop a phantom migrant invasion, or when Trump was impeached.
Now the Covid-19 crisis has me wondering again. A new bit of research from three leading political scientists shows pretty convincingly that, in the face of the pandemic, Republicans and Democrats are once again hearing different things, forming different understandings, and reacting in different ways.
But this time, the epistemic gap could have devastating public health consequences.
Voxs Zack Beauchamp, drawing on the work of Tufts University political scientist Brian Schaffner, has written about how partisanship shaped the response to Covid-19 from the very beginning, with Republicans expressing more skepticism and taking fewer precautions, largely following the cues of their political and media leaders (as most people do). Emily Badger and Kevin Quealy at the New York Times recently analyzed data from some similar polls and surveys, finding a wide but closing partisan gap in views.
While suggestive, research thus far cannot precisely isolate partisanships influence from competing explanations like geography, age, or exposure to the virus.
Shana Kushner Gadarian, Sara Wallace Goodman, and Thomas Pepinsky political scientists at Syracuse University, UC Irvine, and Cornell respectively have just released the results of a survey of 3,000 Americans on a wide range of health behaviors, attitudes, and opinions about how to respond to the crisis. (The survey was done March 20-23, a week after the initial declaration of emergency.) Their survey design has allowed them to isolate the effects of different variables on attitudes and behaviors.
Heres how they summarize the results:
Our results collectively describe a broad political divide in reaction to COVID-19: Republicans are less likely than Democrats to report responding with CDC-recommended behavior, and are less concerned about the pandemic, yet are more likely to support policies that restrict trade and movement across borders as a response to it. Democrats, by contrast, have responded by changing their personal health behaviors, and supporting policies that socialize the costs of testing and treatment. Partisanship is a more consistent predictor of behaviors, attitudes, and preferences than anything else that we measure. [emphasis added]
Partisanship shapes everything, even direct experience. What we find is that even when you account for the zip codes people live in, i.e., their actual level of exposure to the disease, Gadarian told me, partisanship still matters. Democrats are more likely than Republicans to wash their hands more often, avoid contact with others, and self-quarantine, more likely to support increased social spending, more likely to worry about getting themselves and others sick, and more convinced that normal life must be temporarily suspended.
Just about the only virus responses that Republicans support more than Democrats are restrictions on movement (closing borders) and trade tariffs policies they support regardless of circumstance.
Disagreements about the wisdom of hand-washing and social distancing are not mere differences of political opinion. They are differences about matters of epidemiology. And in disregarding the reports and recommendations of experts, and trusting Trump and right-wing media instead, Republicans are putting not only themselves but everyone at greater risk.
The spread of a virus can only be stopped by concerted collective action. If a large bloc of the public cannot be convinced of the threat or the need for a response, that bloc can prevent collective action all on its own. It can ensure the virus spreads faster and more widely, no matter what the majority does.
And that, more or less, is what is happening. Americas epistemic crisis is having a direct impact on public health.
This is one survey, a snapshot, so it cannot measure how opinion may be changing. We will do more surveys going forward that track the same respondents, says Pepinsky, and these will allow us to test very conclusively if partisan differences dissipate over time.
In the meantime, surveys up to mid-March analyzed by the New York Times suggest that concern over the virus is rising among Republicans, as do surveys from the Pew Research Center.
One explanation of this shift is that the influence of partisanship, its ability to shelter conservatives from the truth, is waning as the crisis becomes more severe. While the effects of partisanship are incredibly pronounced, Schaffner told the Times, I think they also hit their limits.
Gadarian says that once people become anxious about an issue, they act very similarly in their behaviors and attitudes. In a series of experiments with Bethany Albertson (a political scientist at UT Austin) around the time of the H1N1 scare, they divided students into those who were more and less worried about the virus. The worried group was more likely to trust in health experts to give them information about H1N1, she says, and were slightly more likely to take a hand sanitizer versus a pen on their way out of the lab.
So its at least possible that, as the Covid-19 crisis grows more severe and people become more anxious about it, Republicans will start listening to Dr. Anthony Fauci and the Centers for Disease Control and Prevention (CDC) and will continue to do so going forward, mitigating the damage their irresponsible behavior has already done to public health.
At the risk of being predictable, let me offer a more pessimistic prediction.
Since Covid-19 came on the scene, Americans getting their news from mainstream sources have heard that:
Meanwhile, Republicans who, as a landmark 2017 Harvard study of media consumption found, get their information from a small cluster of ideologically extreme sources, now including the president have heard that:
Republican concern about the virus is increasing, but theres an alternate explanation: The right-wing base is still listening exclusively to conservative political and media elites; its just that those elites have now decided that it is in their best interests to begin acknowledging the threat.
In late March, according to the New York Times, Trump was finally convinced that the data on the coming death toll could not be bent to his will, so he begrudgingly extended social distancing measures through April 30. It wont be long before conservative media is echoing his claim that 100,000 or more US deaths from Covid-19 would be an indicator of his success.
While conservative elites may have changed their tune about the existence and severity of the crisis, they have not ceased searching for a scapegoat against which to turn their credulous followers. Trump and his allies are still blaming the media, blaming China, and blaming Democratic governors. Trump has also floated the idea that New York is spreading the virus and should be isolated.
The details of the dangerous myths being fed to the conservative base are changing, but they are still being fed dangerous myths. They are still disregarding experts and following shifting narratives built around venerating Trump and shielding him from accountability. As they come to believe those myths and act on them, the anti-social nature of their behavior will not be quite so self-evident as their failure to wash their hands, but it will still be anti-social.
Progressive reformers tend to cling to the myth that a sufficiently dramatic shock or disaster will have the effect of dispelling misinformation and propaganda, like a mighty wind blowing dust from all the lenses. I hear it around climate change all the time, the notion that people will wake up to the threat when there is a bad enough storm, or a series of storms.
And Ive heard it about the epistemic crisis again and again. Surely the Iraq War is a big enough disaster to puncture the bubble. Surely the botched response to Katrina. Surely the Great Recession. Surely 10 fruitless investigations of Benghazi. Surely Trumps impeachment. It never happens.
People forget, but the response to H1N1 flu in 2009 was also split along partisan lines it was visible in vaccination rates. So was the response to Ebola in 2014. Conservative political and media elites were spreading misinformation and conspiracy theories then, too. Its just that they werent in charge, so their ability to amplify their message and do real harm to public health was limited.
Now they are running things, spreading misinformation and conspiracy theories live on primetime TV every night, leading the US into a historic catastrophe in which more Americans have already died than died on 9/11. And the death toll seems fated to rise for the foreseeable future.
The epistemic crisis has been underway for many years now. It was inevitable that it would spill over into a full-fledged political and health crisis. If it were not clear before, it has become unmistakably clear now: Right-wing misinformation is a direct and immediate threat to the American public.
Workers at the joint-venture Dongfeng Honda in Wuhan, in Chinas Hubei province, eat lunch while sitting 1.5 meters away from each other.
By Dennis NormileMar. 29, 2020 , 1:00 PM
Sciences COVID-19 reporting is supported by the Pulitzer Center.
Life is almost back to normal in much of China. Shops, restaurants, bars, and offices are open for business. Manufacturing activity is picking up. Traffic once again jams the highways of major cities. Three-quarters of Chinas workforce was back on the job as of 24 March, according to one companys estimate. Wuhan, where the COVID-19 pandemic originated, is lagging, as is the rest of Hubei provincebut even there, the lockdown is set to lift 8 April.
China has done what few believed was possible: Bring a blazing epidemic of a respiratory virus to a virtual standstill. On 18 March, the country reported zero locally transmitted cases of COVID-19 for the first time. Since then, only six of such infections have been reported, only one of them in Wuhan. Now, the key question is: Can China keep it that way?
Public health officials worldwide are watching closely. China is addressing an issue every country and location in the world will eventually face: how to normalize and restore societal activities, while at the same time minimizing disease-related dangers from the outbreak, says epidemiologist Keiji Fukuda of the University of Hong Kong (HKU).
New infections now mostly come from outside: More than 500 cases have been confirmed in incoming air passengers since 18 March. At midnight on Friday, China banned virtually all foreigners from entering the country and required all returning Chinese to be quarantined for 2 weeks, whether coming by air or over land. But there is still danger within the country, as well. The smattering of locally transmitted cases shows severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) isnt entirely gone. And the very low case numbers may be deceptive. In its tally, Chinas National Health Commission does not include people who test positive for the virus but have no symptoms, and local authorities are reportedly suppressing information on new infections to meet the target of zero local cases.
Still, I believe that there are few local cases, says HKU epidemiologist Ben Cowling. But with most of the population still susceptible to infection, fresh outbreaks remain a constant danger.How to balance getting back to work and a normal state versus maintaining the current status [of few new cases] is certainly critical, says Ding Sheng, director of the Global Health Drug Discovery Institute and dean of the School of Pharmaceutical Sciences at Tsinghua University.
Officials are relaxing restrictions very slowly and methodically, Ding says. Many restaurants at first reopened with shortened hours and for a limited number of customers; now, doors are open to all. Primary and secondary schools in several provinces have reopened, but only in communities free of the disease, and schools must check students temperatures and watch for symptoms. Universities, where students from around the country mix, remain closed, with classes taught online. Events that draw crowds are still banned or discouraged. Live music venues and gyms in many cities remain closed. There are temperature checks at subway entrances and factory gates.
A number of local governments had allowed cinemas to reopen, but last week the national government decided it was too early and closed all theaters for the time being. And habits developed during the epidemic persist. Face masks are ubiquitous. People keep their distance in public and at work. Millions continue to work from home.
To guard against flare-ups, investigators trace and quarantine close contacts of every newly confirmed COVID-19 case, including those who may be asymptomatic, Wu Zunyou, an epidemiologist at the Chinese Center for Disease Control and Prevention (China CDC), told the communist party newspaper China Daily earlier this week. In another precaution, everyone visiting fever clinics in Beijing and other major cities is now tested for the virus. And many provinces check the health status of migrant workers and others crossing their borders. Any new transmission will be identified quickly and controlled swiftly, Ding says.
Fridays travel banwhich the government implemented even though it strenuously objected when the United States banned visitors from China in Januaryaddresses the other main risk: reintroduction of the virus from the rest of the world. Flights into China have also been severely curtailed. Chinese citizens who arrive undergo strict screening en route and upon arrival and go into quarantine for 2 weeks.
A European academic who returned to China 1 week before the ban took effect described the process to Science. His temperature was taken twice during the flight and he filled out a form detailing his recent whereabouts, the health status of family members and colleagues, and his use of medications. Another temperature check followed at the Beijing airport, after which the scholarwho asked not to be identifiedwas escorted to his own apartment for a 14-day quarantine. A community official pasted a quarantine notice across the door jamb, which was removed and replaced for grocery deliveries. Authorities ordered him to a quarantine hotel 3 days later, after a fellow passenger on the plane turned positive for COVID-19. The academic remains very understanding, and says he was treated well. (He says he also got a lot of work done on COVID-19related economic studies.)
China is addressing an issue every country and location in the world will eventually face: how to normalize and restore societal activities, while at the same time minimizing disease-related dangers from the outbreak.
Chinas strategy seems to have been effective thus far in preventing a resurgence, says Benjamin Anderson, an epidemiologist at Duke Kunshan University. But with the virus now circulating around the world, repeated importations to China will inevitably lead to local transmission, Cowling says. Authorities will need to get on top of the cases very quickly, he says, in a game of whack-a-mole. Remaining pockets of local infection could be a problem as well, says Ira Longini, a disease modeler at the University of Florida. The models say the disease will come back once the restrictions are lifted. I hope thats not correct, but I cant imagine why it wouldnt be, Longini says.
Much is at stake. Economists predict Chinas gross domestic product may shrink 10% in the first quarter of this year, the worst contraction since 1976. With Europe and the United States wrestling with their own epidemics, demand for Chinas manufactured goods has collapsedaside from masks and medical equipment and supplies. Recurring COVID-19 outbreaks in China would compoundthe damage.
The Chinese strategy is aimed at buying time until a vaccine or drugs are available,says George Gao, director ofChina CDC. A group led by Chen Wei of the Academy of Military Medical Sciences has already started a phase I study of a candidate vaccine, according to China Daily. Trials are expected to last at least through the end of this year. Dozens of other vaccine studies are underway around the world.
Ding, who lived in Beijing through the worst of the crisis, believes China can keep its guard up until these efforts bear fruit. Although minor flare-ups could happen any time, he says, a large-scale reemergence of COVID-19 is very unlikely given what we have learned.
With reporting by Jon Cohen, Martin Enserink, and Bian Huihui.
