https://www.usatoday.com/story/sports/nfl/titans/2020/10/08/tennessee-titans-buffalo-bills-game-postponed-covid-19-coronavirus/5922306002/
Why the NFL needs to immediately end the Titans’ 2020 season
Since last week, the NFL and NFLPA have had representatives in Nashville, investigating why the Tennessee Titans have by far the most positive COVID tests of any NFL team. The organization has had …
touchdownwire.usatoday.com

The Titans’ season should be cancelled. Part of the reason guys like A’Shawn aren’t coming back is because of the positive tests. The rest of the NFL has done amazing.

View: https://elemental.medium.com/a-supercomputer-analyzed-covid-19-and-an-interesting-new-theory-has-emerged-31cb8eba9d63

Earlier this summer, the Summit supercomputer at Oak Ridge National Lab in Tennessee set about crunching data on more than 40,000 genes from 17,000 genetic samples in an effort to better understand Covid-19. Summit is the second-fastest computer in the world, but the process — which involved analyzing 2.5 billion genetic combinations — still took more than a week.

When Summit was done, researchers analyzed the results. It was, in the words of Dr. Daniel Jacobson, lead researcher and chief scientist for computational systems biology at Oak Ridge, a “eureka moment.” The computer had revealed a new theory about how Covid-19 impacts the body: the bradykinin hypothesis. The hypothesis provides a model that explains many aspects of Covid-19, including some of its most bizarre symptoms. It also suggests 10-plus potential treatments, many of which are already FDA approved. Jacobson’s group published their results in a paper in the journal eLife in early July.

According to the team’s findings, a Covid-19 infection generally begins when the virus enters the body through ACE2 receptors in the nose, (The receptors, which the virus is known to target, are abundant there.) The virus then proceeds through the body, entering cells in other places where ACE2 is also present: the intestines, kidneys, and heart. This likely accounts for at least some of the disease’s cardiac and GI symptoms.

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But once Covid-19 has established itself in the body, things start to get really interesting. According to Jacobson’s group, the data Summit analyzed shows that Covid-19 isn’t content to simply infect cells that already express lots of ACE2 receptors. Instead, it actively hijacks the body’s own systems, tricking it into upregulating ACE2 receptors in places where they’re usually expressed at low or medium levels, including the lungs.

In this sense, Covid-19 is like a burglar who slips in your unlocked second-floor window and starts to ransack your house. Once inside, though, they don’t just take your stuff — they also throw open all your doors and windows so their accomplices can rush in and help pillage more efficiently.

The renin–angiotensin system (RAS) controls many aspects of the circulatory system, including the body’s levels of a chemical called bradykinin, which normally helps to regulate blood pressure. According to the team’s analysis, when the virus tweaks the RAS, it causes the body’s mechanisms for regulating bradykinin to go haywire. Bradykinin receptors are resensitized, and the body also stops effectively breaking down bradykinin. (ACE normally degrades bradykinin, but when the virus downregulates it, it can’t do this as effectively.)

The end result, the researchers say, is to release a bradykinin storm — a massive, runaway buildup of bradykinin in the body. According to the bradykinin hypothesis, it’s this storm that is ultimately responsible for many of Covid-19’s deadly effects. Jacobson’s team says in their paper that “the pathology of Covid-19 is likely the result of Bradykinin Storms rather than cytokine storms,” which had been previously identified in Covid-19 patients, but that “the two may be intricately linked.” Other papers had previously identified bradykinin storms as a possible cause of Covid-19’s pathologies.

Covid-19 is like a burglar who slips in your unlocked second-floor window and starts to ransack your house.

As bradykinin builds up in the body, it dramatically increases vascular permeability. In short, it makes your blood vessels leaky. This aligns with recent clinical data, which increasingly views Covid-19 primarily as a vascular disease, rather than a respiratory one. But Covid-19 still has a massive effect on the lungs. As blood vessels start to leak due to a bradykinin storm, the researchers say, the lungs can fill with fluid. Immune cells also leak out into the lungs, Jacobson’s team found, causing inflammation.

Coronavirus May Be a Blood Vessel Disease, Which Explains Everything
Many of the infection’s bizarre symptoms have one thing in common
elemental.medium.com

And Covid-19 has another especially insidious trick. Through another pathway, the team’s data shows, it increases production of hyaluronic acid (HLA) in the lungs. HLA is often used in soaps and lotions for its ability to absorb more than 1,000 times its weight in fluid. When it combines with fluid leaking into the lungs, the results are disastrous: It forms a hydrogel, which can fill the lungs in some patients. According to Jacobson, once this happens, “it’s like trying to breathe through Jell-O.”

This may explain why ventilators have proven less effective in treating advanced Covid-19 than doctors originally expected, based on experiences with other viruses. “It reaches a point where regardless of how much oxygen you pump in, it doesn’t matter, because the alveoli in the lungs are filled with this hydrogel,” Jacobson says. “The lungs become like a water balloon.” Patients can suffocate even while receiving full breathing support.

The bradykinin hypothesis also extends to many of Covid-19’s effects on the heart. About one in five hospitalized Covid-19 patients have damage to their hearts, even if they never had cardiac issues before. Some of this is likely due to the virus infecting the heart directly through its ACE2 receptors. But the RAS also controls aspects of cardiac contractions and blood pressure. According to the researchers, bradykinin storms could create arrhythmias and low blood pressure, which are often seen in Covid-19 patients.

The bradykinin hypothesis also accounts for Covid-19’s neurological effects, which are some of the most surprising and concerning elements of the disease. These symptoms (which include dizziness, seizures, delirium, and stroke) are present in as many as half of hospitalized Covid-19 patients. According to Jacobson and his team, MRI studies in France revealed that many Covid-19 patients have evidence of leaky blood vessels in their brains.

Bradykinin — especially at high doses — can also lead to a breakdown of the blood-brain barrier. Under normal circumstances, this barrier acts as a filter between your brain and the rest of your circulatory system. It lets in the nutrients and small molecules that the brain needs to function, while keeping out toxins and pathogens and keeping the brain’s internal environment tightly regulated.

If bradykinin storms cause the blood-brain barrier to break down, this could allow harmful cells and compounds into the brain, leading to inflammation, potential brain damage, and many of the neurological symptoms Covid-19 patients experience. Jacobson told me, “It is a reasonable hypothesis that many of the neurological symptoms in Covid-19 could be due to an excess of bradykinin. It has been reported that bradykinin would indeed be likely to increase the permeability of the blood-brain barrier. In addition, similar neurological symptoms have been observed in other diseases that result from an excess of bradykinin.”

Increased bradykinin levels could also account for other common Covid-19 symptoms. ACE inhibitors — a class of drugs used to treat high blood pressure — have a similar effect on the RAS system as Covid-19, increasing bradykinin levels. In fact, Jacobson and his team note in their paper that “the virus… acts pharmacologically as an ACE inhibitor” — almost directly mirroring the actions of these drugs.

Medium Coronavirus Blog
A real-time resource for Covid-19 news, advice, and commentary.
coronavirus.medium.com

By acting like a natural ACE inhibitor, Covid-19 may be causing the same effects that hypertensive patients sometimes get when they take blood pressure–lowering drugs. ACE inhibitors are known to cause a dry cough and fatigue, two textbook symptoms of Covid-19. And they can potentially increase blood potassium levels, which has also been observed in Covid-19 patients. The similarities between ACE inhibitor side effects and Covid-19 symptoms strengthen the bradykinin hypothesis, the researchers say.

ACE inhibitors are also known to cause a loss of taste and smell. Jacobson stresses, though, that this symptom is more likely due to the virus “affecting the cells surrounding olfactory nerve cells” than the direct effects of bradykinin.

Though still an emerging theory, the bradykinin hypothesis explains several other of Covid-19’s seemingly bizarre symptoms. Jacobson and his team speculate that leaky vasculature caused by bradykinin storms could be responsible for “Covid toes,” a condition involving swollen, bruised toes that some Covid-19 patients experience. Bradykinin can also mess with the thyroid gland, which could produce the thyroid symptoms recently observed in some patients.

The bradykinin hypothesis could also explain some of the broader demographic patterns of the disease’s spread. The researchers note that some aspects of the RAS system are sex-linked, with proteins for several receptors (such as one called TMSB4X) located on the X chromosome. This means that “women… would have twice the levels of this protein than men,” a result borne out by the researchers’ data. In their paper, Jacobson’s team concludes that this “could explain the lower incidence of Covid-19 induced mortality in women.” A genetic quirk of the RAS could be giving women extra protection against the disease.

The bradykinin hypothesis provides a model that “contributes to a better understanding of Covid-19” and “adds novelty to the existing literature,” according to scientists Frank van de Veerdonk, Jos WM van der Meer, and Roger Little, who peer-reviewed the team’s paper. It predicts nearly all the disease’s symptoms, even ones (like bruises on the toes) that at first appear random, and further suggests new treatments for the disease.

As Jacobson and team point out, several drugs target aspects of the RAS and are already FDA approved to treat other conditions. They could arguably be applied to treating Covid-19 as well. Several, like danazol, stanozolol, and ecallantide, reduce bradykinin production and could potentially stop a deadly bradykinin storm. Others, like icatibant, reduce bradykinin signaling and could blunt its effects once it’s already in the body.

Interestingly, Jacobson’s team also suggests vitamin D as a potentially useful Covid-19 drug. The vitamin is involved in the RAS system and could prove helpful by reducing levels of another compound, known as REN. Again, this could stop potentially deadly bradykinin storms from forming. The researchers note that vitamin D has already been shown to help those with Covid-19. The vitamin is readily available over the counter, and around 20% of the population is deficient. If indeed the vitamin proves effective at reducing the severity of bradykinin storms, it could be an easy, relatively safe way to reduce the severity of the virus.

Other compounds could treat symptoms associated with bradykinin storms. Hymecromone, for example, could reduce hyaluronic acid levels, potentially stopping deadly hydrogels from forming in the lungs. And timbetasin could mimic the mechanism that the researchers believe protects women from more severe Covid-19 infections. All of these potential treatments are speculative, of course, and would need to be studied in a rigorous, controlled environment before their effectiveness could be determined and they could be used more broadly.

Covid-19 stands out for both the scale of its global impact and the apparent randomness of its many symptoms. Physicians have struggled to understand the disease and come up with a unified theory for how it works. Though as of yet unproven, the bradykinin hypothesis provides such a theory. And like all good hypotheses, it also provides specific, testable predictions — in this case, actual drugs that could provide relief to real patients.

The researchers are quick to point out that “the testing of any of these pharmaceutical interventions should be done in well-designed clinical trials.” As to the next step in the process, Jacobson is clear: “We have to get this message out.” His team’s finding won’t cure Covid-19. But if the treatments it points to pan out in the clinic, interventions guided by the bradykinin hypothesis could greatly reduce patients’ suffering — and potentially save lives.

NOTE: This article is pretty dense. I’m happy to answer any questions as best I can or make the appropriate referrals.

If these findings are verified, then it proves WHY athletes who make their living being the best by fractions of a percent are in danger of losing their careers and worse for those with undiagnosed CTE. Even the idea that some player with undiagnosed CTE could get COVID from a careless Titan and have his brain devastated is beyond the pale.

I agree that the Titans should be harshly dealt with up to and including going straight to ownership and letting them know that this is a forced sale level violation if they don’t take every drastic and immediate measure to get into and stay in compliance with all local, state, federal and league rules.

Wrt COVID19, the NFL needs to be the Not Fuckin-around League.

2020 has sucked enough. We don’t need losing football to be the shit cherry on the top of this giant shit sundae of a year…

• This topic was modified 5 years, 5 months ago by Mackeyser.

URL = https://www.sfgate.com/politics/article/California-2020-ballot-measures-propositions-guide-15578295.php

A dummy’s guide to California 2020 ballot measures

By Eric Ting, SFGATE Updated 4:00 am PDT, Monday, September 21, 2020
You’ve seen the ads. But you’re not sure what any of these California ballot measures actually do.
Fear not! Here’s a handy, simple guide to each of the 12 propositions on the California ballot for the November general election. From affirmative action to overturning the highly controversial gig worker bill (AB-5), there are plenty of significant measures California residents will be voting on this fall. This guide is broken into three categories: 1. The big ones that interest groups are dumping millions of advertising dollars into, 2. The criminal justice ones, and 3. The rest.

THE BIG ONES
Proposition 16
What it does: Allows the state and its public universities to discriminate or grant preferential treatment based on race, sex, ethnicity, or national origin in public employment, education, or contracting.
Major players for it: The University of California Board of Regents, Sens. Kamala Harris and Dianne Feinstein, and various Black Lives Matter-related advocacy groups.
Major players against it: A number of Asian American groups and Republicans in the California state Assembly.
Recent polling: 31% support, 47% oppose, 22% undecided (PPIC poll, Sept. 4-Sept 13.)
New poll finds shaky support for Proposition 16 to restore affirmative action in California (LA Times)
Proposition 16: Why some Asian Americans are on the front lines of the campaign against affirmative action (Mercury News)

Proposition 15
What it does: Raises funds for schools and local governments by requiring commercial and industrial properties with more than $3 million in holdings to be taxed based on market value as opposed to purchase price. Does not impact homeowners.
Major players for it: Gov. Gavin Newsom, San Francisco Mayor London Breed, and the California Teacher’s Association.
Major players against it: California Chamber of Commerce, California Small Business Association and several taxpayers’ groups.
Recent polling: 51% support, 40% oppose, 9% undecided (PPIC poll, Sept. 4-Sept 13.)
Prop. 15 could raise billions for California, But who will pay? (NBC San Diego)
Governor’s endorsement of Proposition 15 disappoints Farm Bureau (Lassen County Times)

Proposition 22
What it does: Classifies app-based drivers as independent contractors and not employees, which effectively kneecaps AB5.
Major players for it: Uber, Lyft, DoorDash and other similar services.
Major players against it: Sen. Kamala Harris, Attorney General Xavier Becerra, and several state Assembly Democrats.
Recent polling: 41% support, 26% oppose, 34% undecided (Redfield and Wilton poll, Aug. 9)
Uber and Lyft have poured millions of dollars into a November ballot measure to keep Calif. drivers paid as independent contractors (Business Insider)
Uber analyst expects California’s Prop. 22 to pass based on latest polling (Yahoo Finance)

Proposition 21
What it does: Allows local governments to enact rent control on housing that was first occupied over 15 years ago.
Major players for it: Sen. Bernie Sanders, Democratic Socialists of America, Los Angeles chapter and various tenants’ groups.
Major players against it: Gov. Gavin Newsom, California Apartment Association and construction workers’ unions.
Recent polling: N/A
Bernie Sanders backs rent control, slams greedy landlords in new ‘yes on 21’ spot (Business Wire)
Opponents of rent control initiative say Prop. 21 backers violated Stolen Valor Act in ad (San Diego Union Tribune)

THE CRIMINAL JUSTICE ONES
Proposition 25
What it does: Eliminates cash bail and gives judges the ability to determine whether a defendant should be released prior to a trial.
Major players for it: Gov. Gavin Newsom, several congressional Democrats and civil liberties groups.
Major players against it: Orange County Board of Supervisors and several groups affiliated with the bail bonds industry.
Recent polling: 39% support, 32% oppose, 29% undecided (UC Berkeley Institute of Government Studies poll, Sept. 13-Sept.18)
California’s cash bail system favors the rich. Would replacing it help people of color? (Fresno Bee)
Prop. 25 will replace cash bail with risk assessment, if passed (Daily Cal)

Proposition 17
What it does: Restores voting rights to people with felony convictions who have been released from prison but remain on parole.
Major players for it: Sen. Kamala Harris, the ACLU of California and many state Assembly Democrats.
Major players against it: State Sen. Jim Nielsen (R-4) and the Election Integrity Project California.
Recent polling: N/A
LA County supervisors support proposition restoring voting rights to those on parole (CBS Los Angeles)
Alex Padilla: Why Prop. 17 will strengthen both voting rights and public safety (San Diego Union Tribune)

Proposition 20
What it does: Adds several crimes to the list of violent felonies for which early parole is restricted. Would undo a series of reforms enacted between 2011 and 2016 aimed at reducing the state’s prison population.
Major players for it: Assemblyman Jim Cooper (D-9) and multiple law-enforcement-affiliated groups.
Major players against it: Former Gov. Jerry Brown, the ACLU of California and several criminal justice reform advocacy groups.
Recent polling: N/A
Grocery stores are pushing California to be tougher on crime (LA Times)
Opposition to Prop. 20 increases; opponents charge it’s a step backward for CA (Davis Vanguard)

THE REST
Proposition 19
What it does: Allows homeowners over the age of 55, disabled or victims of a natural disaster to take existing, lower property tax rates to new homes anywhere in the state.
Major players for it: California Realtors Association, California Professional Firefighters and several local real estate groups.
Major players against it: Howard Jarvis Taxpayers Association.

Recent polling: N/A

Links to learn more:
Prop. 19 debate: Funding for fighting wildfires or attack on Prop 13 tax protections? (CBS San Francisco)
Worried about fires? California ballot initiative could help you move to a new city (Sacramento Bee)

Proposition 24
What it does: Expands the state’s consumer data privacy laws by creating a new state agency to enforce privacy laws, empowering consumers to order that businesses not sell their personal information, and increasing financial penalties on those who violate privacy laws.
Major players for it: Former Democratic presidential candidate Andrew Yang and several online privacy groups.
Major players against it: ACLU of California and the Consumer Federation of California.
Recent polling: N/A
Links to learn more:
Andrew Yang takes lead role in California data privacy campaign (Politico)
Prop. 24 seemingly seeks to expand internet privacy, critics say it won’t (Salinas Californian)

Proposition 18
What it does: Allows 17-year-old Californians who will be 18 by the following general election to vote in primaries and special elections.
Major players for it: California Secretary of State Alex Padilla and Assembyman Kevin Mullin (D-22).
Major players against it: The Election Integrity Project California.
Recent polling: N/A
Links to learn more:
Alex Padilla: Vote yes on Prop. 18 to engage, energize and empower the next generation of voters (San Diego Union Tribune)
Thousands of 17-year-olds could vote in California primaries if initiative passes, study says (Sacramento Bee)

Proposition 14
What it does: Issues $5.5 billion in general obligation bonds for the state’s stem cell research institute.
Major players for it: Californians for Stem Cell Research, Treatments & Cures and the University of California Board of Regents.
Major players against it: The Center for Genetics and Society
Recent polling: N/A
Link to learn more:
Prop. 14: There’s much, much more than meets the eye (Capitol Weekly)

Proposition 23
What it does: Places several new regulations on dialysis clinics, including requiring an on-site physician, mandating increased reporting of dialysis-related infections, and not allowing clinics to close before obtaining consent from the state health department.
Major players for it: Californians for Kidney Dialysis Patient Protection
Major players against it: American Legion, California Medical Association and several veterans’ and health groups.
Link to learn more:
Prop. 23: Kidney dialysis clinic rules (Cal Matters)

A Supercomputer Analyzed Covid-19 — and an Interesting New Theory Has Emerged
A closer look at the Bradykinin hypothesis[/b]

https://elemental.medium.com/a-supercomputer-analyzed-covid-19-and-an-interesting-new-theory-has-emerged-31cb8eba9d63

Earlier this summer, the Summit supercomputer at Oak Ridge National Lab in Tennessee set about crunching data on more than 40,000 genes from 17,000 genetic samples in an effort to better understand Covid-19. Summit is the second-fastest computer in the world, but the process — which involved analyzing 2.5 billion genetic combinations — still took more than a week.
When Summit was done, researchers analyzed the results. It was, in the words of Dr. Daniel Jacobson, lead researcher and chief scientist for computational systems biology at Oak Ridge, a “eureka moment.” The computer had revealed a new theory about how Covid-19 impacts the body: the bradykinin hypothesis. The hypothesis provides a model that explains many aspects of Covid-19, including some of its most bizarre symptoms. It also suggests 10-plus potential treatments, many of which are already FDA approved. Jacobson’s group published their results in a paper in the journal eLife in early July.
According to the team’s findings, a Covid-19 infection generally begins when the virus enters the body through ACE2 receptors in the nose, (The receptors, which the virus is known to target, are abundant there.) The virus then proceeds through the body, entering cells in other places where ACE2 is also present: the intestines, kidneys, and heart. This likely accounts for at least some of the disease’s cardiac and GI symptoms.

But once Covid-19 has established itself in the body, things start to get really interesting. According to Jacobson’s group, the data Summit analyzed shows that Covid-19 isn’t content to simply infect cells that already express lots of ACE2 receptors. Instead, it actively hijacks the body’s own systems, tricking it into upregulating ACE2 receptors in places where they’re usually expressed at low or medium levels, including the lungs.
In this sense, Covid-19 is like a burglar who slips in your unlocked second-floor window and starts to ransack your house. Once inside, though, they don’t just take your stuff — they also throw open all your doors and windows so their accomplices can rush in and help pillage more efficiently.
The renin–angiotensin system (RAS) controls many aspects of the circulatory system, including the body’s levels of a chemical called bradykinin, which normally helps to regulate blood pressure. According to the team’s analysis, when the virus tweaks the RAS, it causes the body’s mechanisms for regulating bradykinin to go haywire. Bradykinin receptors are resensitized, and the body also stops effectively breaking down bradykinin. (ACE normally degrades bradykinin, but when the virus downregulates it, it can’t do this as effectively.)
The end result, the researchers say, is to release a bradykinin storm — a massive, runaway buildup of bradykinin in the body. According to the bradykinin hypothesis, it’s this storm that is ultimately responsible for many of Covid-19’s deadly effects. Jacobson’s team says in their paper that “the pathology of Covid-19 is likely the result of Bradykinin Storms rather than cytokine storms,” which had been previously identified in Covid-19 patients, but that “the two may be intricately linked.” Other papers had previously identified bradykinin storms as a possible cause of Covid-19’s pathologies.
As bradykinin builds up in the body, it dramatically increases vascular permeability. In short, it makes your blood vessels leaky. This aligns with recent clinical data, which increasingly views Covid-19 primarily as a vascular disease, rather than a respiratory one. But Covid-19 still has a massive effect on the lungs. As blood vessels start to leak due to a bradykinin storm, the researchers say, the lungs can fill with fluid. Immune cells also leak out into the lungs, Jacobson’s team found, causing inflammation.
And Covid-19 has another especially insidious trick. Through another pathway, the team’s data shows, it increases production of hyaluronic acid (HLA) in the lungs. HLA is often used in soaps and lotions for its ability to absorb more than 1,000 times its weight in fluid. When it combines with fluid leaking into the lungs, the results are disastrous: It forms a hydrogel, which can fill the lungs in some patients. According to Jacobson, once this happens, “it’s like trying to breathe through Jell-O.”
This may explain why ventilators have proven less effective in treating advanced Covid-19 than doctors originally expected, based on experiences with other viruses. “It reaches a point where regardless of how much oxygen you pump in, it doesn’t matter, because the alveoli in the lungs are filled with this hydrogel,” Jacobson says. “The lungs become like a water balloon.” Patients can suffocate even while receiving full breathing support.
The bradykinin hypothesis also extends to many of Covid-19’s effects on the heart. About one in five hospitalized Covid-19 patients have damage to their hearts, even if they never had cardiac issues before. Some of this is likely due to the virus infecting the heart directly through its ACE2 receptors. But the RAS also controls aspects of cardiac contractions and blood pressure. According to the researchers, bradykinin storms could create arrhythmias and low blood pressure, which are often seen in Covid-19 patients.
The bradykinin hypothesis also accounts for Covid-19’s neurological effects, which are some of the most surprising and concerning elements of the disease. These symptoms (which include dizziness, seizures, delirium, and stroke) are present in as many as half of hospitalized Covid-19 patients. According to Jacobson and his team, MRI studies in France revealed that many Covid-19 patients have evidence of leaky blood vessels in their brains.
Bradykinin — especially at high doses — can also lead to a breakdown of the blood-brain barrier. Under normal circumstances, this barrier acts as a filter between your brain and the rest of your circulatory system. It lets in the nutrients and small molecules that the brain needs to function, while keeping out toxins and pathogens and keeping the brain’s internal environment tightly regulated.
If bradykinin storms cause the blood-brain barrier to break down, this could allow harmful cells and compounds into the brain, leading to inflammation, potential brain damage, and many of the neurological symptoms Covid-19 patients experience. Jacobson told me, “It is a reasonable hypothesis that many of the neurological symptoms in Covid-19 could be due to an excess of bradykinin. It has been reported that bradykinin would indeed be likely to increase the permeability of the blood-brain barrier. In addition, similar neurological symptoms have been observed in other diseases that result from an excess of bradykinin.”
Increased bradykinin levels could also account for other common Covid-19 symptoms. ACE inhibitors — a class of drugs used to treat high blood pressure — have a similar effect on the RAS system as Covid-19, increasing bradykinin levels. In fact, Jacobson and his team note in their paper that “the virus… acts pharmacologically as an ACE inhibitor” — almost directly mirroring the actions of these drugs.

By acting like a natural ACE inhibitor, Covid-19 may be causing the same effects that hypertensive patients sometimes get when they take blood pressure–lowering drugs. ACE inhibitors are known to cause a dry cough and fatigue, two textbook symptoms of Covid-19. And they can potentially increase blood potassium levels, which has also been observed in Covid-19 patients. The similarities between ACE inhibitor side effects and Covid-19 symptoms strengthen the bradykinin hypothesis, the researchers say.
ACE inhibitors are also known to cause a loss of taste and smell. Jacobson stresses, though, that this symptom is more likely due to the virus “affecting the cells surrounding olfactory nerve cells” than the direct effects of bradykinin.
Though still an emerging theory, the bradykinin hypothesis explains several other of Covid-19’s seemingly bizarre symptoms. Jacobson and his team speculate that leaky vasculature caused by bradykinin storms could be responsible for “Covid toes,” a condition involving swollen, bruised toes that some Covid-19 patients experience. Bradykinin can also mess with the thyroid gland, which could produce the thyroid symptoms recently observed in some patients.
The bradykinin hypothesis could also explain some of the broader demographic patterns of the disease’s spread. The researchers note that some aspects of the RAS system are sex-linked, with proteins for several receptors (such as one called TMSB4X) located on the X chromosome. This means that “women… would have twice the levels of this protein than men,” a result borne out by the researchers’ data. In their paper, Jacobson’s team concludes that this “could explain the lower incidence of Covid-19 induced mortality in women.” A genetic quirk of the RAS could be giving women extra protection against the disease.
The bradykinin hypothesis provides a model that “contributes to a better understanding of Covid-19” and “adds novelty to the existing literature,” according to scientists Frank van de Veerdonk, Jos WM van der Meer, and Roger Little, who peer-reviewed the team’s paper. It predicts nearly all the disease’s symptoms, even ones (like bruises on the toes) that at first appear random, and further suggests new treatments for the disease.
As Jacobson and team point out, several drugs target aspects of the RAS and are already FDA approved to treat other conditions. They could arguably be applied to treating Covid-19 as well. Several, like danazol, stanozolol, and ecallantide, reduce bradykinin production and could potentially stop a deadly bradykinin storm. Others, like icatibant, reduce bradykinin signaling and could blunt its effects once it’s already in the body.
Interestingly, Jacobson’s team also suggests vitamin D as a potentially useful Covid-19 drug. The vitamin is involved in the RAS system and could prove helpful by reducing levels of another compound, known as REN. Again, this could stop potentially deadly bradykinin storms from forming. The researchers note that vitamin D has already been shown to help those with Covid-19. The vitamin is readily available over the counter, and around 20% of the population is deficient. If indeed the vitamin proves effective at reducing the severity of bradykinin storms, it could be an easy, relatively safe way to reduce the severity of the virus.
Other compounds could treat symptoms associated with bradykinin storms. Hymecromone, for example, could reduce hyaluronic acid levels, potentially stopping deadly hydrogels from forming in the lungs. And timbetasin could mimic the mechanism that the researchers believe protects women from more severe Covid-19 infections. All of these potential treatments are speculative, of course, and would need to be studied in a rigorous, controlled environment before their effectiveness could be determined and they could be used more broadly.
Covid-19 stands out for both the scale of its global impact and the apparent randomness of its many symptoms. Physicians have struggled to understand the disease and come up with a unified theory for how it works. Though as of yet unproven, the bradykinin hypothesis provides such a theory. And like all good hypotheses, it also provides specific, testable predictions — in this case, actual drugs that could provide relief to real patients.
The researchers are quick to point out that “the testing of any of these pharmaceutical interventions should be done in well-designed clinical trials.” As to the next step in the process, Jacobson is clear: “We have to get this message out.” His team’s finding won’t cure Covid-19. But if the treatments it points to pan out in the clinic, interventions guided by the bradykinin hypothesis could greatly reduce patients’ suffering — and potentially save lives.

Rams Head Coach Sean McVay – August 9, 2020

(Opening remarks)
“We had a really good first week, guys have done a great job. Since we’ve spoken last, have placed (DL) A’Shawn Robinson on the NFI (Non-Football Injury List) and really it was a condition that he had. He’s doing really well, he’s going to be able to partake in meetings, get treatments, be around his teammates and then we’ll look forward to being able to get him back at some point this season. When that is – don’t know specifically. I think a lot of positives came out of this, we we’re able to identify something and most importantly, look out for the players best interest, but he’s going to be around and I know that he’ll be excited about when he can return to action. But in the meantime, he’ll take part in meetings and all those good things. I have (OLB) Terrell Lewis back in the building today. I’m looking forward to him getting back into a routine and a rhythm, and if he stays asymptomatic with the next few days, he will be able to return back to everything football related in three days. So, that’s a good thing.”

(On any A’Shawn Robinson’s timeline to return and if it will be this season)
“No, when you place them on the NFI, you’re restricted in terms of the length and longevity that he has to remain off of that. That was what we felt like was the best decision – No. 1 for him and for us. It was a situation where (Vice President, Football and Business Administration) Tony Pastoors and A’Shawn (Robinson’s) agent were able to work something out that was, I think, favorable to both parties – both A’Shawn and our club and that’s a good thing.”

(On the most optimistic return for Robinson)
“I don’t want to place any specifics on it, just because we’ve still have some time to be able to work through that and it was such a recent decision. I think most importantly, he’s in a great place. He’s looking forward to just getting around the guys and partaking in the meetings and in the above-the-neck information that he can do and then we’ll be excited about when he can return to the physical part of it as well.”

(On if Lewis is still on the Reserve/ COVID-19 list)
“Basically, the way that this works, and this is something that is a flexible thing as you guys have seen. Some of the protocols have changed, even since the last week. Where we’re at with him, is that he’s back in the building. If he remains asymptomatic for the next three days with all things that he will be doing, then he’ll be able to return back to full action and be in good shape.”

(On how he will utilize WR Van Jefferson in his offense)
“He’s a really impressive guy. I’ve really been impressed with his maturity just in the week that we’ve been around one another in person. He’s wired the right way, really like his attention to detail in the meetings. And then when you see the guys ready to go out in their strength and conditioning phase of this part of the training camp acclimation period, you can see all the things that we loved so much about him at Florida even going back to some of the stuff that he did at Ole Miss. He is a guy that’s wired to separate, he’s got great body control. You can see his football pedigree. A guy that’s been around the game his entire life with his dad being a coach and then being a baller as a receiver for a long time in the NFL. He just has a natural feel for how to work edges on people, double people up, got good aggressive hands. So, he’s got all those traits and characteristics that you’re looking for. As far as what his role will be, I think that’s really up to the way he continues to compete throughout training camp. We’ve got some guys that will be a great example of epitomizing how you handle yourself in that receiver room. When you look at (WR Robert) Woods, (WR Cooper) Kupp and (WR) Josh Reynolds, and guys that have been in this system for the last three years, with them going into their fourth year and I think he’s done a great job absorbing the information from them and from (Wide Receiver coach) Coach (Eric) Yarber and from (Assistant Wide Receivers Coach) Zac Robinson.”

(On how he classifies A’Shawn Robinson’s injury)
This is just being precautionary with some things that we discovered. He was able really communicate clearly to us, so it was something that recently came about. It’s really not anything that’s too concerning, it’s more just really glad that we were able to get a hold of it early on. I’ve really been pleased with the way that its been handled over the last couple of days. But it was something that kind of surprised us. This wasn’t something that we expected, but based on the on-boarding physical process and all that it entailed we were able to come to some conclusions and learn some things that made this decision come about.”

(On conducting meetings outside under the big tent)
“Yeah, that’s pretty much where everything goes on. A lot of that is due to the things that we’ve learned as far as risk-mitigation. You know, we’ve got a lot of space. That tent is huge, as you can see. We’re cycling guys in and out. We make sure that we have enough time in between transitional meetings to get the cleaning crew and the sanitation (crew) in there. You can social distance, guys can wear their mask and just the airflow in general. You see this building that we’re in, it can be really congested and we want to try and avoid that at all costs. We’ve fortunately had the luxury of being in a great climate, it’s got a nice cool breeze throughout the course of the day. It’s really been a great thing for us this last week and couldn’t have anticipated it going any better thus far. Our indoor facility is basically non-existent, if that’s really what you’re asking. But hey, you know what? All we need is our film and a field.”

(On how deep the team scouted RB Cam Akers)
“He was the top high school recruit as a quarterback coming out. So, his stats are, when you look at them, it’s almost like a ‘Madden’ stat-line when you see the stuff he was doing in high school. We knew about it. I know our personnel staff did a great job of vetting him and going real deep in terms of the background with (Southeastern Area Scout) Michael Pierce and all of those guys. Then when you really start to study him, it shows up, and then they use him. I mean, there are some trick plays where he’s catching a swing pass to his left and flipping his hips and making 50-yard throws down the field. He did some impressive stuff. You never know, we might have a wildcat package coming to a theater near you.”

(On the rapport of WR Robert Woods and WR Cooper Kupp)
“I think it’s vital. We want to make sure that we’re making the defense defend all five eligible (receivers) on every play. We have to be mindful from as a self-scout of getting different guys involved, but understanding that (WR) Robert (Woods) and (WR) Cooper (Kupp) are going to be big parts of our offense. You want to get them their touches. But when you talk about selfless receivers, I’ve just appreciated working with these guys over the last couple of years so much. I think that’s a great reflection of them as human beings, but also (Wide Receivers Coach) Eric Yarber leading that room. I think they also understand, (being) they are such smart football players, that they know if our offense is hitting on all cylinders, they’ll find a way to get their touches as well. I think it’s been reflected in the last couple of years. They just need to continue to grow together. Watching those two and their communication amongst one another or with (QB) Jared (Goff), it’s really impressive. In some instances, it’s good as a coach where you can just step back and let them take that autonomy and ownership, because it’s certainly earned. I know I’ve learned a lot from them as well, just listening to the way they approach the game. You just watch them and that’s what it looks like to do right.”

(On the anticipation level to start the next phase of training camp)
“I think with probably the coaches, we’re sitting there and we can do any coaching. (The players) are able to get a bunch of strength and conditioning work. Get their field work. Get out there in the walk-thru and that’s really the only time we can get out there on the field with them. So, I think the guys have done a great job. One of the things we’ve talked about is just being totally present. Being completely present mentally and physically, and that’s what they’ve done. I think that’s enabled us to really maximize each day. We’ve got eight days in this acclimation period, today represents the sixth day. So, we’ve got three more days in this schedule format, if you will. Then we’ll get into the ‘Ramp Up’ phase. What we’ve really just had guys focus on is maximizing the moment, capitalize on things we can do today. I’ve really been pleased that the way our players have handled that, but we’re certainly excited about when that time will come to be able to practice and do some of these things in a full speed setting once you get to Day 3 of the ‘Ramp Up Phase.’”

(On thoughts about the ‘iron sharpens iron’ relationship between WRs Cooper Kupp and Robert Woods)
“Yeah. I think you (KABC-TV Reporter Curt Sandoval) just said it. I think it’s two guys that are incredible football players, that are incredible people. They have such an appreciation for one another. Their friendship enables them to really push one another in a positive way. I mean they’re pushing each other, don’t get me wrong, but it’s a nice competitiveness, where they are really sharpening one another, as you said. It’s a joy to be around those guys. I think it also takes great security on both their parts to be that way. I mean, they’re truly secure men in themselves. They’re really genuinely happy for one another and especially at that receiver position, where there’s only so many touches to go around, sometimes somebody else’s success means somebody else isn’t getting the most touches and I’ve never felt anything but real, genuine, happiness for one another. I think their success has been reflective of that, because they’ve both equally been extremely productive for us and I think that’s been a huge part of the success of the Rams’ offense each of the last few years, both those two.”

(On if he thought of a contingency plan if he tested positive for COVID-19 or needed to quarantine)
“Well first of all, why would you bring such a scenario up? That sound’s awful (laughs). No, it really is. It is absolutely something we’ve talked about. And you know, the natural kind of trajectory with the offense and the defense, because you have more numbers, where we’ve really had to be intentional, God forbid, if (Special Teams Coordinator) Coach (John) Bonamego or (Assistant Special Teams Coach) Tory Woodbury ended up getting sick, because you only have two guys allocated to your special teams. So, we’ve kind of had some guys that are allocated to each phase. You know you look at (Offensive Coordinator) Kevin O’Connell and (Assistant Quarterbacks Coach) Liam Coen, that are working closely with the quarterbacks, making sure those two are never too close to one another. So, it is a very real thing, but I think the most important thing is, for us, to make sure that in the building, out of the building, we’re making sure that our actions are in alignment to risk mitigate as much as possible. Certain things come up, but those are scenarios. Now, what are the parameters around if that does come up? What can you do? I think we’ll try to make sure that we avoid it, but if it does come up, I would certainly like to stay engaged in any way possible, but I’m not going down that negative route right now. But if we had to get on this Zoom and I’m yelling through an iPhone and somebody is holding it up, you know, maybe that’ll happen. We’ve learned a lot more about technology these last couple months then I think we would of ever learned otherwise. So, I think we’d have to demonstrate some agility. No doubt about it.”

(On feedback from the strength and conditioning coaches during the acclimation period)
“Our guys have come in great shape. I think, really, (Head Strength Coach) Justin Lovett, (Vice President, Sports Medicine and Performance) Reggie (Scott), (Director, Sports Science) Tyler (Williams), (Assistant Director, Strength and Conditioning) Dustin Woods, and Nando (Assistant Strength and Conditioning Fernando Noriega), I mean so many of those guys have done a great job. We’ve really pushed those guys in the weight room. I know guys are good sore right now. So, they’ve been working, they’re getting great work on the field, that are in a lot of instances, some football related drills that are just in the absence of coaches. So, been getting a lot of good, positive feedback, I’ve really been impressed with the way that our players have handled the above-the-neck information when we’ve gone out and done walk-thrus. Really, it’s been a really good thing. I think these first five days and today, we’re in the middle of our sixth day, it’s been a great start and I want to keep it rolling.”

(On if Akers is the emergency QB)
“It’s been Cooper Kupp in the past, but watching Cam whip it around and some of the things he can do, I think we’ll let those guys duke it out if the worst-case scenario comes up. But he certainly is very capable and he hasn’t been shy about telling me he can still spin it either (laughs).”

(On COVID protocols and if they are becoming second nature)
“I think you want to continue to remind them and really, for me too. I mentioned to the players this morning, ‘Hey, let’s not forget,’ because you get into an atmosphere where you get a little bit comfortable, things have gone well and then you tend to say, ‘Okay, in situations where we need to make sure our mask is on, we’re socially distanced, it kind of just falls by the wayside if you’re not mindful of it,’ but I think a lot of the normal, daily rhythm things – filling out our questionnaire, daily COVID testing, all that stuff, that has become a little bit more normalized. I think the key message for us, and it’s as much for everybody that’s involved, it’s not just our players, it’s myself, it’s all of our coaches, our staff, is just continuing to not lose sight. As well as things have gone for us through this point to not lose side of the things that have enabled it to go smoothly with all the things that we’ve kind of been educated on – the social distancing, wearing the mask, washing your hands, all of that stuff and what that entails. Then when you set out onto the field, as long as everybody’s doing everything they can to protect this ecosystem, then you can focus on playing football and you certainly don’t want to minimize the seriousness of what this virus is, but I do think as long as you’re doing all of the right things to put yourself in a position to be keeping that ecosystem clear, if you will, then guys can go out and play with a quieted mind and focus on being the best football players that they can possibly be and not worry too much about some of the things that can be a distraction if you’re not careful and you have to acknowledge that.”

(On if there is anything that he could learn from the slow build up to the season and implement into next season)
“We’ve been able to be a little bit more patient based on the parameters, but then also not having preseason games. That would definitely dictate and determine a different approach if that was the case. It’s been really good because I think for the players when you talk about how to onboard them the right way physically and mentally, this has been a great trajectory up to this point, where you can really get a lot of mental reps, you can slow things down. You’re not rushing to get the amount of volume that you typically would need to get ready for a first preseason game. I go back to last year for us, that was planning practice against the Raiders or a practice against the Chargers, where you want to be able to do a bunch of different situations and you want to have enough volume to be able to have guys go compete and do well in those settings. I think this has been something that we definitely have enjoyed, but a lot of the times the parameters will dictate our availability or ability really in general to be able to do it this way. I think it’s been a really good smooth process and something that we’ve definitely enjoyed, and I think the players would share the same feelings.”

(On the importance of retaining DL Michael Brockers with Robinson on the NFI)
“Thank the Lord. I am so thankful that we got him back in general. In a lot of instances, when you look at it, before we knew we were going to be fortunate enough to get (DL) Michael (Brockers) back, we really liked A’Shawn Robinson but he was kind of the vision before we got Michael back on board that he was going to be able to try to hopefully fill some of those voids left by Brockers. To be able to still have him is huge and it’s not just his production on the field either. I think you guys, from being around each of the last couple of years, watching his growth as a leader and the way guys follow him, the way he goes about his business and everything that the day encompasses, he’s a real joy to be around and I’m very thankful to have Michael back without a doubt.”

(On if Robinson requires a procedure or is in recovery mode)
“He’s in recovery mode. It’s not going to be anything like that, so that’s a good positive thing there.”

(On if the team will withhold payment from Robinson)
“No. That’s not something that we want to be able to do. We wanted to be able to get something worked out where it was good for him, it was good for us and I think that was what it ended up being. Finding out some of that information, we wanted to make sure – No. 1 the concern is with the player, making sure he feels comfortable about it and I think like I mentioned earlier, it’s a great representation of the collaboration between Tony and A’Shawn’s agent to be able to get this worked out and I think A’Shawn feels good about it with all the circumstances as well so we are excited about that.”

(On if OL Andrew Whitworth and OL Brian Allen were impacted or restricted in any way from having COVID-19 in the offseason)
“They aren’t. They aren’t having anything that’s holding them back. They’re in good shape. (OL Andrew) Whitworth is 38 going on 30. He looks good. This guy’s unbelievable. I still can’t believe he’s playing tackle with all these snaps he’s taken. Another one of those guys you feel fortunate to be around.”

—

A New York Times investigation found that surviving the coronavirus in New York had a lot to do with which hospital a person went to.

Our investigative reporter Brian M. Rosenthal pulls back the curtain on inequality and the pandemic in the city.

podcast: https://itunes.apple.com/us/podcast/the-daily/id1200361736?mt=2

==

Reading:

At the peak of New York’s pandemic, patients at some community hospitals were three times more likely to die than were patients at medical centers in the wealthiest parts of the city. Read here: https://www.nytimes.com/2020/07/01/nyregion/Coronavirus-hospitals.html

The story of a $52 million temporary care facility in New York illustrates the missteps made at every level of government in the race to create more hospital capacity. Read here: https://www.nytimes.com/2020/07/21/nyregion/coronavirus-hospital-usta-queens.html

How the Pandemic Defeated America
A virus has brought the world’s most powerful country to its knees.

https://www.theatlantic.com/magazine/archive/2020/09/coronavirus-american-failure/614191/?utm_source=facebook&utm_medium=social&utm_campaign=share&fbclid=IwAR35Z3og9iyq-hvwjT7HPgSw_Nx3S0OpzcLWcfVsQ-ikgquHD-XHXHVSL3U

How did it come to this? A virus a thousand times smaller than a dust mote has humbled and humiliated the planet’s most powerful nation. America has failed to protect its people, leaving them with illness and financial ruin. It has lost its status as a global leader. It has careened between inaction and ineptitude. The breadth and magnitude of its errors are difficult, in the moment, to truly fathom.

In the first half of 2020, SARS‑CoV‑2—the new coronavirus behind the disease COVID‑19—infected 10 million people around the world and killed about half a million. But few countries have been as severely hit as the United States, which has just 4 percent of the world’s population but a quarter of its confirmed COVID‑19 cases and deaths. These numbers are estimates. The actual toll, though undoubtedly higher, is unknown, because the richest country in the world still lacks sufficient testing to accurately count its sick citizens.

Despite ample warning, the U.S. squandered every possible opportunity to control the coronavirus. And despite its considerable advantages—immense resources, biomedical might, scientific expertise—it floundered. While countries as different as South Korea, Thailand, Iceland, Slovakia, and Australia acted decisively to bend the curve of infections downward, the U.S. achieved merely a plateau in the spring, which changed to an appalling upward slope in the summer. “The U.S. fundamentally failed in ways that were worse than I ever could have imagined,” Julia Marcus, an infectious-disease epidemiologist at Harvard Medical School, told me.

Since the pandemic began, I have spoken with more than 100 experts in a variety of fields. I’ve learned that almost everything that went wrong with America’s response to the pandemic was predictable and preventable. A sluggish response by a government denuded of expertise allowed the coronavirus to gain a foothold. Chronic underfunding of public health neutered the nation’s ability to prevent the pathogen’s spread. A bloated, inefficient health-care system left hospitals ill-prepared for the ensuing wave of sickness. Racist policies that have endured since the days of colonization and slavery left Indigenous and Black Americans especially vulnerable to COVID‑19. The decades-long process of shredding the nation’s social safety net forced millions of essential workers in low-paying jobs to risk their life for their livelihood. The same social-media platforms that sowed partisanship and misinformation during the 2014 Ebola outbreak in Africa and the 2016 U.S. election became vectors for conspiracy theories during the 2020 pandemic.

The U.S. has little excuse for its inattention. In recent decades, epidemics of SARS, MERS, Ebola, H1N1 flu, Zika, and monkeypox showed the havoc that new and reemergent pathogens could wreak. Health experts, business leaders, and even middle schoolers ran simulated exercises to game out the spread of new diseases. In 2018, I wrote an article for The Atlantic arguing that the U.S. was not ready for a pandemic, and sounded warnings about the fragility of the nation’s health-care system and the slow process of creating a vaccine. But the COVID‑19 debacle has also touched—and implicated—nearly every other facet of American society: its shortsighted leadership, its disregard for expertise, its racial inequities, its social-media culture, and its fealty to a dangerous strain of individualism.

SARS‑CoV‑2 is something of an anti-Goldilocks virus: just bad enough in every way. Its symptoms can be severe enough to kill millions but are often mild enough to allow infections to move undetected through a population. It spreads quickly enough to overload hospitals, but slowly enough that statistics don’t spike until too late. These traits made the virus harder to control, but they also softened the pandemic’s punch. SARS‑CoV‑2 is neither as lethal as some other coronaviruses, such as SARS and MERS, nor as contagious as measles. Deadlier pathogens almost certainly exist. Wild animals harbor an estimated 40,000 unknown viruses, a quarter of which could potentially jump into humans. How will the U.S. fare when “we can’t even deal with a starter pandemic?,” Zeynep Tufekci, a sociologist at the University of North Carolina and an Atlantic contributing writer, asked me.

Despite its epochal effects, COVID‑19 is merely a harbinger of worse plagues to come. The U.S. cannot prepare for these inevitable crises if it returns to normal, as many of its people ache to do. Normal led to this. Normal was a world ever more prone to a pandemic but ever less ready for one. To avert another catastrophe, the U.S. needs to grapple with all the ways normal failed us. It needs a full accounting of every recent misstep and foundational sin, every unattended weakness and unheeded warning, every festering wound and reopened scar.

A pandemic can be prevented in two ways: Stop an infection from ever arising, or stop an infection from becoming thousands more. The first way is likely impossible. There are simply too many viruses and too many animals that harbor them. Bats alone could host thousands of unknown coronaviruses; in some Chinese caves, one out of every 20 bats is infected. Many people live near these caves, shelter in them, or collect guano from them for fertilizer. Thousands of bats also fly over these people’s villages and roost in their homes, creating opportunities for the bats’ viral stowaways to spill over into human hosts. Based on antibody testing in rural parts of China, Peter Daszak of EcoHealth Alliance, a nonprofit that studies emerging diseases, estimates that such viruses infect a substantial number of people every year. “Most infected people don’t know about it, and most of the viruses aren’t transmissible,” Daszak says. But it takes just one transmissible virus to start a pandemic.

Sometime in late 2019, the wrong virus left a bat and ended up, perhaps via an intermediate host, in a human—and another, and another. Eventually it found its way to the Huanan seafood market, and jumped into dozens of new hosts in an explosive super-spreading event. The COVID‑19 pandemic had begun.

“There is no way to get spillover of everything to zero,” Colin Carlson, an ecologist at Georgetown University, told me. Many conservationists jump on epidemics as opportunities to ban the wildlife trade or the eating of “bush meat,” an exoticized term for “game,” but few diseases have emerged through either route. Carlson said the biggest factors behind spillovers are land-use change and climate change, both of which are hard to control. Our species has relentlessly expanded into previously wild spaces. Through intensive agriculture, habitat destruction, and rising temperatures, we have uprooted the planet’s animals, forcing them into new and narrower ranges that are on our own doorsteps. Humanity has squeezed the world’s wildlife in a crushing grip—and viruses have come bursting out.

Curtailing those viruses after they spill over is more feasible, but requires knowledge, transparency, and decisiveness that were lacking in 2020. Much about coronaviruses is still unknown. There are no surveillance networks for detecting them as there are for influenza. There are no approved treatments or vaccines. Coronaviruses were formerly a niche family, of mainly veterinary importance. Four decades ago, just 60 or so scientists attended the first international meeting on coronaviruses. Their ranks swelled after SARS swept the world in 2003, but quickly dwindled as a spike in funding vanished. The same thing happened after MERS emerged in 2012. This year, the world’s coronavirus experts—and there still aren’t many—had to postpone their triennial conference in the Netherlands because SARS‑CoV‑2 made flying too risky.

In the age of cheap air travel, an outbreak that begins on one continent can easily reach the others. SARS already demonstrated that in 2003, and more than twice as many people now travel by plane every year. To avert a pandemic, affected nations must alert their neighbors quickly. In 2003, China covered up the early spread of SARS, allowing the new disease to gain a foothold, and in 2020, history repeated itself. The Chinese government downplayed the possibility that SARS‑CoV‑2 was spreading among humans, and only confirmed as much on January 20, after millions had traveled around the country for the lunar new year. Doctors who tried to raise the alarm were censured and threatened. One, Li Wenliang, later died of COVID‑19. The World Health Organization initially parroted China’s line and did not declare a public-health emergency of international concern until January 30. By then, an estimated 10,000 people in 20 countries had been infected, and the virus was spreading fast.

The United States has correctly castigated China for its duplicity and the WHO for its laxity—but the U.S. has also failed the international community. Under President Donald Trump, the U.S. has withdrawn from several international partnerships and antagonized its allies. It has a seat on the WHO’s executive board, but left that position empty for more than two years, only filling it this May, when the pandemic was in full swing. Since 2017, Trump has pulled more than 30 staffers out of the Centers for Disease Control and Prevention’s office in China, who could have warned about the spreading coronavirus. Last July, he defunded an American epidemiologist embedded within China’s CDC. America First was America oblivious.

Even after warnings reached the U.S., they fell on the wrong ears. Since before his election, Trump has cavalierly dismissed expertise and evidence. He filled his administration with inexperienced newcomers, while depicting career civil servants as part of a “deep state.” In 2018, he dismantled an office that had been assembled specifically to prepare for nascent pandemics. American intelligence agencies warned about the coronavirus threat in January, but Trump habitually disregards intelligence briefings. The secretary of health and human services, Alex Azar, offered similar counsel, and was twice ignored.

Being prepared means being ready to spring into action, “so that when something like this happens, you’re moving quickly,” Ronald Klain, who coordinated the U.S. response to the West African Ebola outbreak in 2014, told me. “By early February, we should have triggered a series of actions, precisely zero of which were taken.” Trump could have spent those crucial early weeks mass-producing tests to detect the virus, asking companies to manufacture protective equipment and ventilators, and otherwise steeling the nation for the worst. Instead, he focused on the border. On January 31, Trump announced that the U.S. would bar entry to foreigners who had recently been in China, and urged Americans to avoid going there.

Travel bans make intuitive sense, because travel obviously enables the spread of a virus. But in practice, travel bans are woefully inefficient at restricting either travel or viruses. They prompt people to seek indirect routes via third-party countries, or to deliberately hide their symptoms. They are often porous: Trump’s included numerous exceptions, and allowed tens of thousands of people to enter from China. Ironically, they create travel: When Trump later announced a ban on flights from continental Europe, a surge of travelers packed America’s airports in a rush to beat the incoming restrictions. Travel bans may sometimes work for remote island nations, but in general they can only delay the spread of an epidemic—not stop it. And they can create a harmful false confidence, so countries “rely on bans to the exclusion of the things they actually need to do—testing, tracing, building up the health system,” says Thomas Bollyky, a global-health expert at the Council on Foreign Relations. “That sounds an awful lot like what happened in the U.S.”

This was predictable. A president who is fixated on an ineffectual border wall, and has portrayed asylum seekers as vectors of disease, was always going to reach for travel bans as a first resort. And Americans who bought into his rhetoric of xenophobia and isolationism were going to be especially susceptible to thinking that simple entry controls were a panacea.

And so the U.S. wasted its best chance of restraining COVID‑19. Although the disease first arrived in the U.S. in mid-January, genetic evidence shows that the specific viruses that triggered the first big outbreaks, in Washington State, didn’t land until mid-February. The country could have used that time to prepare. Instead, Trump, who had spent his entire presidency learning that he could say whatever he wanted without consequence, assured Americans that “the coronavirus is very much under control,” and “like a miracle, it will disappear.” With impunity, Trump lied. With impunity, the virus spread.

On February 26, Trump asserted that cases were “going to be down to close to zero.” Over the next two months, at least 1 million Americans were infected.

As the coronavirus established itself in the U.S., it found a nation through which it could spread easily, without being detected. For years, Pardis Sabeti, a virologist at the Broad Institute of Harvard and MIT, has been trying to create a surveillance network that would allow hospitals in every major U.S. city to quickly track new viruses through genetic sequencing. Had that network existed, once Chinese scientists published SARS‑CoV‑2’s genome on January 11, every American hospital would have been able to develop its own diagnostic test in preparation for the virus’s arrival. “I spent a lot of time trying to convince many funders to fund it,” Sabeti told me. “I never got anywhere.”

The CDC developed and distributed its own diagnostic tests in late January. These proved useless because of a faulty chemical component. Tests were in such short supply, and the criteria for getting them were so laughably stringent, that by the end of February, tens of thousands of Americans had likely been infected but only hundreds had been tested. The official data were so clearly wrong that The Atlantic developed its own volunteer-led initiative—the COVID Tracking Project—to count cases.

Diagnostic tests are easy to make, so the U.S. failing to create one seemed inconceivable. Worse, it had no Plan B. Private labs were strangled by FDA bureaucracy. Meanwhile, Sabeti’s lab developed a diagnostic test in mid-January and sent it to colleagues in Nigeria, Sierra Leone, and Senegal. “We had working diagnostics in those countries well before we did in any U.S. states,” she told me.

It’s hard to overstate how thoroughly the testing debacle incapacitated the U.S. People with debilitating symptoms couldn’t find out what was wrong with them. Health officials couldn’t cut off chains of transmission by identifying people who were sick and asking them to isolate themselves.

Water running along a pavement will readily seep into every crack; so, too, did the unchecked coronavirus seep into every fault line in the modern world. Consider our buildings. In response to the global energy crisis of the 1970s, architects made structures more energy-efficient by sealing them off from outdoor air, reducing ventilation rates. Pollutants and pathogens built up indoors, “ushering in the era of ‘sick buildings,’ ” says Joseph Allen, who studies environmental health at Harvard’s T. H. Chan School of Public Health. Energy efficiency is a pillar of modern climate policy, but there are ways to achieve it without sacrificing well-being. “We lost our way over the years and stopped designing buildings for people,” Allen says.

The indoor spaces in which Americans spend 87 percent of their time became staging grounds for super-spreading events. One study showed that the odds of catching the virus from an infected person are roughly 19 times higher indoors than in open air. Shielded from the elements and among crowds clustered in prolonged proximity, the coronavirus ran rampant in the conference rooms of a Boston hotel, the cabins of the Diamond Princess cruise ship, and a church hall in Washington State where a choir practiced for just a few hours.

The hardest-hit buildings were those that had been jammed with people for decades: prisons. Between harsher punishments doled out in the War on Drugs and a tough-on-crime mindset that prizes retribution over rehabilitation, America’s incarcerated population has swelled sevenfold since the 1970s, to about 2.3 million. The U.S. imprisons five to 18 times more people per capita than other Western democracies. Many American prisons are packed beyond capacity, making social distancing impossible. Soap is often scarce. Inevitably, the coronavirus ran amok. By June, two American prisons each accounted for more cases than all of New Zealand. One, Marion Correctional Institution, in Ohio, had more than 2,000 cases among inmates despite having a capacity of 1,500. 


Other densely packed facilities were also besieged. America’s nursing homes and long-term-care facilities house less than 1 percent of its people, but as of mid-June, they accounted for 40 percent of its coronavirus deaths. More than 50,000 residents and staff have died. At least 250,000 more have been infected. These grim figures are a reflection not just of the greater harms that COVID‑19 inflicts upon elderly physiology, but also of the care the elderly receive. Before the pandemic, three in four nursing homes were understaffed, and four in five had recently been cited for failures in infection control. The Trump administration’s policies have exacerbated the problem by reducing the influx of immigrants, who make up a quarter of long-term caregivers.

Even though a Seattle nursing home was one of the first COVID‑19 hot spots in the U.S., similar facilities weren’t provided with tests and protective equipment. Rather than girding these facilities against the pandemic, the Department of Health and Human Services paused nursing-home inspections in March, passing the buck to the states. Some nursing homes avoided the virus because their owners immediately stopped visitations, or paid caregivers to live on-site. But in others, staff stopped working, scared about infecting their charges or becoming infected themselves. In some cases, residents had to be evacuated because no one showed up to care for them.

America’s neglect of nursing homes and prisons, its sick buildings, and its botched deployment of tests are all indicative of its problematic attitude toward health: “Get hospitals ready and wait for sick people to show,” as Sheila Davis, the CEO of the nonprofit Partners in Health, puts it. “Especially in the beginning, we catered our entire [COVID‑19] response to the 20 percent of people who required hospitalization, rather than preventing transmission in the community.” The latter is the job of the public-health system, which prevents sickness in populations instead of merely treating it in individuals. That system pairs uneasily with a national temperament that views health as a matter of personal responsibility rather than a collective good.

At the end of the 20th century, public-health improvements meant that Americans were living an average of 30 years longer than they were at the start of it. Maternal mortality had fallen by 99 percent; infant mortality by 90 percent. Fortified foods all but eliminated rickets and goiters. Vaccines eradicated smallpox and polio, and brought measles, diphtheria, and rubella to heel. These measures, coupled with antibiotics and better sanitation, curbed infectious diseases to such a degree that some scientists predicted they would soon pass into history. But instead, these achievements brought complacency. “As public health did its job, it became a target” of budget cuts, says Lori Freeman, the CEO of the National Association of County and City Health Officials.

Today, the U.S. spends just 2.5 percent of its gigantic health-care budget on public health. Underfunded health departments were already struggling to deal with opioid addiction, climbing obesity rates, contaminated water, and easily preventable diseases. Last year saw the most measles cases since 1992. In 2018, the U.S. had 115,000 cases of syphilis and 580,000 cases of gonorrhea—numbers not seen in almost three decades. It has 1.7 million cases of chlamydia, the highest number ever recorded.

Since the last recession, in 2009, chronically strapped local health departments have lost 55,000 jobs—a quarter of their workforce. When COVID‑19 arrived, the economic downturn forced overstretched departments to furlough more employees. When states needed battalions of public-health workers to find infected people and trace their contacts, they had to hire and train people from scratch. In May, Maryland Governor Larry Hogan asserted that his state would soon have enough people to trace 10,000 contacts every day. Last year, as Ebola tore through the Democratic Republic of Congo—a country with a quarter of Maryland’s wealth and an active war zone—local health workers and the WHO traced twice as many people.

Ripping unimpeded through American communities, the coronavirus created thousands of sickly hosts that it then rode into America’s hospitals. It should have found facilities armed with state-of-the-art medical technologies, detailed pandemic plans, and ample supplies of protective equipment and life-saving medicines. Instead, it found a brittle system in danger of collapse.

Compared with the average wealthy nation, America spends nearly twice as much of its national wealth on health care, about a quarter of which is wasted on inefficient care, unnecessary treatments, and administrative chicanery. The U.S. gets little bang for its exorbitant buck. It has the lowest life-expectancy rate of comparable countries, the highest rates of chronic disease, and the fewest doctors per person. This profit-driven system has scant incentive to invest in spare beds, stockpiled supplies, peacetime drills, and layered contingency plans—the essence of pandemic preparedness. America’s hospitals have been pruned and stretched by market forces to run close to full capacity, with little ability to adapt in a crisis.

When hospitals do create pandemic plans, they tend to fight the last war. After 2014, several centers created specialized treatment units designed for Ebola—a highly lethal but not very contagious disease. These units were all but useless against a highly transmissible airborne virus like SARS‑CoV‑2. Nor were hospitals ready for an outbreak to drag on for months. Emergency plans assumed that staff could endure a few days of exhausting conditions, that supplies would hold, and that hard-hit centers could be supported by unaffected neighbors. “We’re designed for discrete disasters” like mass shootings, traffic pileups, and hurricanes, says Esther Choo, an emergency physician at Oregon Health and Science University. The COVID‑19 pandemic is not a discrete disaster. It is a 50-state catastrophe that will likely continue at least until a vaccine is ready.

Wherever the coronavirus arrived, hospitals reeled. Several states asked medical students to graduate early, reenlisted retired doctors, and deployed dermatologists to emergency departments. Doctors and nurses endured grueling shifts, their faces chapped and bloody when they finally doffed their protective equipment. Soon, that equipment—masks, respirators, gowns, gloves—started running out.

In the middle of the greatest health and economic crises in generations, millions of Americans have found themselves impoverished and disconnected from medical care.

American hospitals operate on a just-in-time economy. They acquire the goods they need in the moment through labyrinthine supply chains that wrap around the world in tangled lines, from countries with cheap labor to richer nations like the U.S. The lines are invisible until they snap. About half of the world’s face masks, for example, are made in China, some of them in Hubei province. When that region became the pandemic epicenter, the mask supply shriveled just as global demand spiked. The Trump administration turned to a larder of medical supplies called the Strategic National Stockpile, only to find that the 100 million respirators and masks that had been dispersed during the 2009 flu pandemic were never replaced. Just 13 million respirators were left.

In April, four in five frontline nurses said they didn’t have enough protective equipment. Some solicited donations from the public, or navigated a morass of back-alley deals and internet scams. Others fashioned their own surgical masks from bandannas and gowns from garbage bags. The supply of nasopharyngeal swabs that are used in every diagnostic test also ran low, because one of the largest manufacturers is based in Lombardy, Italy—initially the COVID‑19 capital of Europe. About 40 percent of critical-care drugs, including antibiotics and painkillers, became scarce because they depend on manufacturing lines that begin in China and India. Once a vaccine is ready, there might not be enough vials to put it in, because of the long-running global shortage of medical-grade glass—literally, a bottle-neck bottleneck.

The federal government could have mitigated those problems by buying supplies at economies of scale and distributing them according to need. Instead, in March, Trump told America’s governors to “try getting it yourselves.” As usual, health care was a matter of capitalism and connections. In New York, rich hospitals bought their way out of their protective-equipment shortfall, while neighbors in poorer, more diverse parts of the city rationed their supplies.

While the president prevaricated, Americans acted. Businesses sent their employees home. People practiced social distancing, even before Trump finally declared a national emergency on March 13, and before governors and mayors subsequently issued formal stay-at-home orders, or closed schools, shops, and restaurants. A study showed that the U.S. could have averted 36,000 COVID‑19 deaths if leaders had enacted social-distancing measures just a week earlier. But better late than never: By collectively reducing the spread of the virus, America flattened the curve. Ventilators didn’t run out, as they had in parts of Italy. Hospitals had time to add extra beds.

Social distancing worked. But the indiscriminate lockdown was necessary only because America’s leaders wasted months of prep time. Deploying this blunt policy instrument came at enormous cost. Unemployment rose to 14.7 percent, the highest level since record-keeping began, in 1948. More than 26 million people lost their jobs, a catastrophe in a country that—uniquely and absurdly—ties health care to employment. Some COVID‑19 survivors have been hit with seven-figure medical bills. In the middle of the greatest health and economic crises in generations, millions of Americans have found themselves disconnected from medical care and impoverished. They join the millions who have always lived that way.

The coronavirus found, exploited, and widened every inequity that the U.S. had to offer. Elderly people, already pushed to the fringes of society, were treated as acceptable losses. Women were more likely to lose jobs than men, and also shouldered extra burdens of child care and domestic work, while facing rising rates of domestic violence. In half of the states, people with dementia and intellectual disabilities faced policies that threatened to deny them access to lifesaving ventilators. Thousands of people endured months of COVID‑19 symptoms that resembled those of chronic postviral illnesses, only to be told that their devastating symptoms were in their head. Latinos were three times as likely to be infected as white people. Asian Americans faced racist abuse. Far from being a “great equalizer,” the pandemic fell unevenly upon the U.S., taking advantage of injustices that had been brewing throughout the nation’s history.

Of the 3.1 million Americans who still cannot afford health insurance in states where Medicaid has not been expanded, more than half are people of color, and 30 percent are Black.* This is no accident. In the decades after the Civil War, the white leaders of former slave states deliberately withheld health care from Black Americans, apportioning medicine more according to the logic of Jim Crow than Hippocrates. They built hospitals away from Black communities, segregated Black patients into separate wings, and blocked Black students from medical school. In the 20th century, they helped construct America’s system of private, employer-based insurance, which has kept many Black people from receiving adequate medical treatment. They fought every attempt to improve Black people’s access to health care, from the creation of Medicare and Medicaid in the ’60s to the passage of the Affordable Care Act in 2010.

A number of former slave states also have among the lowest investments in public health, the lowest quality of medical care, the highest proportions of Black citizens, and the greatest racial divides in health outcomes. As the COVID‑19 pandemic wore on, they were among the quickest to lift social-distancing restrictions and reexpose their citizens to the coronavirus. The harms of these moves were unduly foisted upon the poor and the Black.

As of early July, one in every 1,450 Black Americans had died from COVID‑19—a rate more than twice that of white Americans. That figure is both tragic and wholly expected given the mountain of medical disadvantages that Black people face. Compared with white people, they die three years younger. Three times as many Black mothers die during pregnancy. Black people have higher rates of chronic illnesses that predispose them to fatal cases of COVID‑19. When they go to hospitals, they’re less likely to be treated. The care they do receive tends to be poorer. Aware of these biases, Black people are hesitant to seek aid for COVID‑19 symptoms and then show up at hospitals in sicker states. “One of my patients said, ‘I don’t want to go to the hospital, because they’re not going to treat me well,’ ” says Uché Blackstock, an emergency physician and the founder of Advancing Health Equity, a nonprofit that fights bias and racism in health care. “Another whispered to me, ‘I’m so relieved you’re Black. I just want to make sure I’m listened to.’ ”

Rather than countering misinformation during the pandemic, trusted sources often made things worse.
Black people were both more worried about the pandemic and more likely to be infected by it. The dismantling of America’s social safety net left Black people with less income and higher unemployment. They make up a disproportionate share of the low-paid “essential workers” who were expected to staff grocery stores and warehouses, clean buildings, and deliver mail while the pandemic raged around them. Earning hourly wages without paid sick leave, they couldn’t afford to miss shifts even when symptomatic. They faced risky commutes on crowded public transportation while more privileged people teleworked from the safety of isolation. “There’s nothing about Blackness that makes you more prone to COVID,” says Nicolette Louissaint, the executive director of Healthcare Ready, a nonprofit that works to strengthen medical supply chains. Instead, existing inequities stack the odds in favor of the virus.

Native Americans were similarly vulnerable. A third of the people in the Navajo Nation can’t easily wash their hands, because they’ve been embroiled in long-running negotiations over the rights to the water on their own lands. Those with water must contend with runoff from uranium mines. Most live in cramped multigenerational homes, far from the few hospitals that service a 17-million-acre reservation. As of mid-May, the Navajo Nation had higher rates of COVID‑19 infections than any U.S. state.

Americans often misperceive historical inequities as personal failures. Stephen Huffman, a Republican state senator and doctor in Ohio, suggested that Black Americans might be more prone to COVID‑19 because they don’t wash their hands enough, a remark for which he later apologized. Republican Senator Bill Cassidy of Louisiana, also a physician, noted that Black people have higher rates of chronic disease, as if this were an answer in itself, and not a pattern that demanded further explanation.

Clear distribution of accurate information is among the most important defenses against an epidemic’s spread. And yet the largely unregulated, social-media-based communications infrastructure of the 21st century almost ensures that misinformation will proliferate fast. “In every outbreak throughout the existence of social media, from Zika to Ebola, conspiratorial communities immediately spread their content about how it’s all caused by some government or pharmaceutical company or Bill Gates,” says Renée DiResta of the Stanford Internet Observatory, who studies the flow of online information. When COVID‑19 arrived, “there was no doubt in my mind that it was coming.”

Sure enough, existing conspiracy theories—George Soros! 5G! Bioweapons!—were repurposed for the pandemic. An infodemic of falsehoods spread alongside the actual virus. Rumors coursed through online platforms that are designed to keep users engaged, even if that means feeding them content that is polarizing or untrue. In a national crisis, when people need to act in concert, this is calamitous. “The social internet as a system is broken,” DiResta told me, and its faults are readily abused.

Beginning on April 16, DiResta’s team noticed growing online chatter about Judy Mikovits, a discredited researcher turned anti-vaccination champion. Posts and videos cast Mikovits as a whistleblower who claimed that the new coronavirus was made in a lab and described Anthony Fauci of the White House’s coronavirus task force as her nemesis. Ironically, this conspiracy theory was nested inside a larger conspiracy—part of an orchestrated PR campaign by an anti-vaxxer and QAnon fan with the explicit goal to “take down Anthony Fauci.” It culminated in a slickly produced video called Plandemic, which was released on May 4. More than 8 million people watched it in a week.

Doctors and journalists tried to debunk Plandemic’s many misleading claims, but these efforts spread less successfully than the video itself. Like pandemics, infodemics quickly become uncontrollable unless caught early. But while health organizations recognize the need to surveil for emerging diseases, they are woefully unprepared to do the same for emerging conspiracies. In 2016, when DiResta spoke with a CDC team about the threat of misinformation, “their response was: ‘ That’s interesting, but that’s just stuff that happens on the internet.’ ”

Rather than countering misinformation during the pandemic’s early stages, trusted sources often made things worse. Many health experts and government officials downplayed the threat of the virus in January and February, assuring the public that it posed a low risk to the U.S. and drawing comparisons to the ostensibly greater threat of the flu. The WHO, the CDC, and the U.S. surgeon general urged people not to wear masks, hoping to preserve the limited stocks for health-care workers. These messages were offered without nuance or acknowledgement of uncertainty, so when they were reversed—the virus is worse than the flu; wear masks—the changes seemed like befuddling flip-flops.

The media added to the confusion. Drawn to novelty, journalists gave oxygen to fringe anti-lockdown protests while most Americans quietly stayed home. They wrote up every incremental scientific claim, even those that hadn’t been verified or peer-reviewed.

There were many such claims to choose from. By tying career advancement to the publishing of papers, academia already creates incentives for scientists to do attention-grabbing but irreproducible work. The pandemic strengthened those incentives by prompting a rush of panicked research and promising ambitious scientists global attention.

In March, a small and severely flawed French study suggested that the antimalarial drug hydroxychloroquine could treat COVID‑19. Published in a minor journal, it likely would have been ignored a decade ago. But in 2020, it wended its way to Donald Trump via a chain of credulity that included Fox News, Elon Musk, and Dr. Oz. Trump spent months touting the drug as a miracle cure despite mounting evidence to the contrary, causing shortages for people who actually needed it to treat lupus and rheumatoid arthritis. The hydroxychloroquine story was muddied even further by a study published in a top medical journal, The Lancet, that claimed the drug was not effective and was potentially harmful. The paper relied on suspect data from a small analytics company called Surgisphere, and was retracted in June.**

Science famously self-corrects. But during the pandemic, the same urgent pace that has produced valuable knowledge at record speed has also sent sloppy claims around the world before anyone could even raise a skeptical eyebrow. The ensuing confusion, and the many genuine unknowns about the virus, has created a vortex of fear and uncertainty, which grifters have sought to exploit. Snake-oil merchants have peddled ineffectual silver bullets (including actual silver). Armchair experts with scant or absent qualifications have found regular slots on the nightly news. And at the center of that confusion is Donald Trump.

During a pandemic, leaders must rally the public, tell the truth, and speak clearly and consistently. Instead, Trump repeatedly contradicted public-health experts, his scientific advisers, and himself. He said that “nobody ever thought a thing like [the pandemic] could happen” and also that he “felt it was a pandemic long before it was called a pandemic.” Both statements cannot be true at the same time, and in fact neither is true.

A month before his inauguration, I wrote that “the question isn’t whether [Trump will] face a deadly outbreak during his presidency, but when.” Based on his actions as a media personality during the 2014 Ebola outbreak and as a candidate in the 2016 election, I suggested that he would fail at diplomacy, close borders, tweet rashly, spread conspiracy theories, ignore experts, and exhibit reckless self-confidence. And so he did.

No one should be shocked that a liar who has made almost 20,000 false or misleading claims during his presidency would lie about whether the U.S. had the pandemic under control; that a racist who gave birth to birtherism would do little to stop a virus that was disproportionately killing Black people; that a xenophobe who presided over the creation of new immigrant-detention centers would order meatpacking plants with a substantial immigrant workforce to remain open; that a cruel man devoid of empathy would fail to calm fearful citizens; that a narcissist who cannot stand to be upstaged would refuse to tap the deep well of experts at his disposal; that a scion of nepotism would hand control of a shadow coronavirus task force to his unqualified son-in-law; that an armchair polymath would claim to have a “natural ability” at medicine and display it by wondering out loud about the curative potential of injecting disinfectant; that an egotist incapable of admitting failure would try to distract from his greatest one by blaming China, defunding the WHO, and promoting miracle drugs; or that a president who has been shielded by his party from any shred of accountability would say, when asked about the lack of testing, “I don’t take any responsibility at all.”

Trump is a comorbidity of the COVID‑19 pandemic. He isn’t solely responsible for America’s fiasco, but he is central to it. A pandemic demands the coordinated efforts of dozens of agencies. “In the best circumstances, it’s hard to make the bureaucracy move quickly,” Ron Klain said. “It moves if the president stands on a table and says, ‘Move quickly.’ But it really doesn’t move if he’s sitting at his desk saying it’s not a big deal.”

In the early days of Trump’s presidency, many believed that America’s institutions would check his excesses. They have, in part, but Trump has also corrupted them. The CDC is but his latest victim. On February 25, the agency’s respiratory-disease chief, Nancy Messonnier, shocked people by raising the possibility of school closures and saying that “disruption to everyday life might be severe.” Trump was reportedly enraged. In response, he seems to have benched the entire agency. The CDC led the way in every recent domestic disease outbreak and has been the inspiration and template for public-health agencies around the world. But during the three months when some 2 million Americans contracted COVID‑19 and the death toll topped 100,000, the agency didn’t hold a single press conference. Its detailed guidelines on reopening the country were shelved for a month while the White House released its own uselessly vague plan.

Again, everyday Americans did more than the White House. By voluntarily agreeing to months of social distancing, they bought the country time, at substantial cost to their financial and mental well-being. Their sacrifice came with an implicit social contract—that the government would use the valuable time to mobilize an extraordinary, energetic effort to suppress the virus, as did the likes of Germany and Singapore. But the government did not, to the bafflement of health experts. “There are instances in history where humanity has really moved mountains to defeat infectious diseases,” says Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. “It’s appalling that we in the U.S. have not summoned that energy around COVID‑19.”

Instead, the U.S. sleepwalked into the worst possible scenario: People suffered all the debilitating effects of a lockdown with few of the benefits. Most states felt compelled to reopen without accruing enough tests or contact tracers. In April and May, the nation was stuck on a terrible plateau, averaging 20,000 to 30,000 new cases every day. In June, the plateau again became an upward slope, soaring to record-breaking heights.

Trump never rallied the country. Despite declaring himself a “wartime president,” he merely presided over a culture war, turning public health into yet another politicized cage match. Abetted by supporters in the conservative media, he framed measures that protect against the virus, from masks to social distancing, as liberal and anti-American. Armed anti-lockdown protesters demonstrated at government buildings while Trump egged them on, urging them to “LIBERATE” Minnesota, Michigan, and Virginia. Several public-health officials left their jobs over harassment and threats.

It is no coincidence that other powerful nations that elected populist leaders—Brazil, Russia, India, and the United Kingdom—also fumbled their response to COVID‑19. “When you have people elected based on undermining trust in the government, what happens when trust is what you need the most?” says Sarah Dalglish of the Johns Hopkins Bloomberg School of Public Health, who studies the political determinants of health.

“Trump is president,” she says. “How could it go well?”

The countries that fared better against COVID‑19 didn’t follow a universal playbook. Many used masks widely; New Zealand didn’t. Many tested extensively; Japan didn’t. Many had science-minded leaders who acted early; Hong Kong didn’t—instead, a grassroots movement compensated for a lax government. Many were small islands; not large and continental Germany. Each nation succeeded because it did enough things right.

Meanwhile, the United States underperformed across the board, and its errors compounded. The dearth of tests allowed unconfirmed cases to create still more cases, which flooded the hospitals, which ran out of masks, which are necessary to limit the virus’s spread. Twitter amplified Trump’s misleading messages, which raised fear and anxiety among people, which led them to spend more time scouring for information on Twitter. Even seasoned health experts underestimated these compounded risks. Yes, having Trump at the helm during a pandemic was worrying, but it was tempting to think that national wealth and technological superiority would save America. “We are a rich country, and we think we can stop any infectious disease because of that,” says Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “But dollar bills alone are no match against a virus.”

COVID‐19 is an assault on America’s body, and a referendum on the ideas that animate its culture.
Public-health experts talk wearily about the panic-neglect cycle, in which outbreaks trigger waves of attention and funding that quickly dissipate once the diseases recede. This time around, the U.S. is already flirting with neglect, before the panic phase is over. The virus was never beaten in the spring, but many people, including Trump, pretended that it was. Every state reopened to varying degrees, and many subsequently saw record numbers of cases. After Arizona’s cases started climbing sharply at the end of May, Cara Christ, the director of the state’s health-services department, said, “We are not going to be able to stop the spread. And so we can’t stop living as well.” The virus may beg to differ.

At times, Americans have seemed to collectively surrender to COVID‑19. The White House’s coronavirus task force wound down. Trump resumed holding rallies, and called for less testing, so that official numbers would be rosier. The country behaved like a horror-movie character who believes the danger is over, even though the monster is still at large. The long wait for a vaccine will likely culminate in a predictable way: Many Americans will refuse to get it, and among those who want it, the most vulnerable will be last in line.

Still, there is some reason for hope. Many of the people I interviewed tentatively suggested that the upheaval wrought by COVID‑19 might be so large as to permanently change the nation’s disposition. Experience, after all, sharpens the mind. East Asian states that had lived through the SARS and MERS epidemics reacted quickly when threatened by SARS‑CoV‑2, spurred by a cultural memory of what a fast-moving coronavirus can do. But the U.S. had barely been touched by the major epidemics of past decades (with the exception of the H1N1 flu). In 2019, more Americans were concerned about terrorists and cyberattacks than about outbreaks of exotic diseases. Perhaps they will emerge from this pandemic with immunity both cellular and cultural.

There are also a few signs that Americans are learning important lessons. A June survey showed that 60 to 75 percent of Americans were still practicing social distancing. A partisan gap exists, but it has narrowed. “In public-opinion polling in the U.S., high-60s agreement on anything is an amazing accomplishment,” says Beth Redbird, a sociologist at Northwestern University, who led the survey. Polls in May also showed that most Democrats and Republicans supported mask wearing, and felt it should be mandatory in at least some indoor spaces. It is almost unheard-of for a public-health measure to go from zero to majority acceptance in less than half a year. But pandemics are rare situations when “people are desperate for guidelines and rules,” says Zoë McLaren, a health-policy professor at the University of Maryland at Baltimore County. The closest analogy is pregnancy, she says, which is “a time when women’s lives are changing, and they can absorb a ton of information. A pandemic is similar: People are actually paying attention, and learning.”

Redbird’s survey suggests that Americans indeed sought out new sources of information—and that consumers of news from conservative outlets, in particular, expanded their media diet. People of all political bents became more dissatisfied with the Trump administration. As the economy nose-dived, the health-care system ailed, and the government fumbled, belief in American exceptionalism declined. “Times of big social disruption call into question things we thought were normal and standard,” Redbird told me. “If our institutions fail us here, in what ways are they failing elsewhere?” And whom are they failing the most?

Left: Protesters at the Minneapolis intersection where George Floyd was killed by police. Right: Protesters in Manhattan’s Washington Square Park in June. (Brandon Bell; Mel D. Cole)
Americans were in the mood for systemic change. Then, on May 25, George Floyd, who had survived COVID‑19’s assault on his airway, asphyxiated under the crushing pressure of a police officer’s knee. The excruciating video of his killing circulated through communities that were still reeling from the deaths of Breonna Taylor and Ahmaud Arbery, and disproportionate casualties from COVID‑19. America’s simmering outrage came to a boil and spilled into its streets.

Defiant and largely cloaked in masks, protesters turned out in more than 2,000 cities and towns. Support for Black Lives Matter soared: For the first time since its founding in 2013, the movement had majority approval across racial groups. These protests were not about the pandemic, but individual protesters had been primed by months of shocking governmental missteps. Even people who might once have ignored evidence of police brutality recognized yet another broken institution. They could no longer look away.

It is hard to stare directly at the biggest problems of our age. Pandemics, climate change, the sixth extinction of wildlife, food and water shortages—their scope is planetary, and their stakes are overwhelming. We have no choice, though, but to grapple with them. It is now abundantly clear what happens when global disasters collide with historical negligence.

COVID‑19 is an assault on America’s body, and a referendum on the ideas that animate its culture. Recovery is possible, but it demands radical introspection. America would be wise to help reverse the ruination of the natural world, a process that continues to shunt animal diseases into human bodies. It should strive to prevent sickness instead of profiting from it. It should build a health-care system that prizes resilience over brittle efficiency, and an information system that favors light over heat. It should rebuild its international alliances, its social safety net, and its trust in empiricism. It should address the health inequities that flow from its history. Not least, it should elect leaders with sound judgment, high character, and respect for science, logic, and reason.

The pandemic has been both tragedy and teacher. Its very etymology offers a clue about what is at stake in the greatest challenges of the future, and what is needed to address them. Pandemic. Pan and demos. All people.

TRANSCRIPT: Rams Head Coach Sean McVay – August 2, 2020

(On how it feels going into this training camp)
“It feels a lot different. First of all, I think everybody’s excited to be able to get the opportunity to get started, so there’s a lot of excitement. I know our players and coaches are kind of just chomping at the bit to even get our players in here at any capacity where we can meet with them in person, we can do walk-thrus and then the other stuff is just restricted to strength and conditioning on the field and then in the weight room with our guys. Anything is better than nothing. We’re certainly excited about it. It will be newer challenges, things that we’ve never navigated through, but I am very confident with the plan that we have in place. I can’t say enough about the amount of work that’s gone on behind the scenes with (Vice President, Sports Medicine & Performance) Reggie Scott. So many people have been instrumental in just developing our IDER (Infectious Disease Emergency Response) plans and getting everything organized in a manner that’s going to allow us to get this thing going and really, tomorrow represents the start of it. We’ve had some Zoom meetings and different things like that, and they’ve extended physicals over about what feels like two months. We are just glad to get that process through and get started, even if it is in an acclimation period.”

(On if this will be his most challenging training camp)
“I don’t know that I would say that. I think it’s challenging in terms of just things that we’ve never navigated through before. We’re going to have a lot of time before September 13th comes around to get a lot of good, competitive work against one another. If anything, the monotony of not going against the same scheme that we’ve had the last handful of years will serve us well and then some of the perimeters around which we can just practice in general will allow us to really stress guys above the neck in the early phases of training camp and then really for us, August 15th will represent the first opportunity for us to kind of practice in a setting where you can go defense versus offense in that third day of the ramp-up phase. We will think about it and I think I would probably be better equipped to answer the question once we actually get into it but I know that the logistics, schedule and all of the things like that, there’s been some challenges there. I don’t even want to say challenges, but it’s been different, but we feel really good about our plan.”

(On the running back corps)
“It’s something we are very excited about. I remember a couple of years ago studying (RB) Darrell (Henderson Jr.) coming from Memphis, a versatile back. His production speaks for itself at Memphis and then when he did get some opportunities, I think you saw the flashes of why we feel some confident in him. It’s a lot of the same with (RB) Cam (Akers), very excited to get those guys in the building. (RB) Malcolm Brown is a guy that I think’s going to do a great job of setting the tone for that room, in terms of being a pro’s pro. He’s done everything we’ve asked. I think he’s done an excellent job kind of in a back-up role to (former Rams RB) Todd (Gurley II) over the last couple of years and I’ve mentioned it a handful of times, we’ve got a new running back coach this year in Thomas Brown who’s a star. I’ve learned a lot from him and we’re really just excited to see how that room expresses itself as we really get into it, but very confident some young players, that they’ll do their thing, and they’ll get plenty of opportunities to do that.”

(On setting the roster and preparing players for Week 1 without the preseason)
“The thing that’s tough about this is that with a lot of those guys, I think of (WR) Nsimba Webster for us last year who did a great job of truly earning a spot the way he competed in those preseason games. So, I think it’s on us to not allow that to be an excuse. We’ve got to really develop all of our roster – from one through 80 when we ended up cutting it down to that. Create competitive situations and scenarios when basically the schedule allows. We’ll have a couple of scrimmages over at SoFi (Stadium). I think with some of those guys that would typically be playing a lot of the reps in preseason games, we’ll look in to maybe tackling and playing some full-speed football. We still want to be mindful of the guys we’re really counting on to be core starters on September 13 against the (Dallas) Cowboys. But, I think that the way the schedule sets itself up – it’s not going to be an excuse. We want to make sure we create as many of competitive opportunities as possible once we’re able to get going and evaluate the entirety of the roster. Especially, because you can have 69 guys when they’ve expanded practice squad. Really looking at it in its entirety will be something that will be a fluid situation. We’ll do a good job of making sure we handle it the right way.”

(On any skepticism towards playing football in 2020)
“I feel a lot better now having a little bit more knowledge and understanding of it – it’s really about the risk mitigation. Keeping our ecosystem clear on that front. I think there is a level of responsibility that coaches, players and everybody in our building will have outside of the ecosystem to make sure there is a consideration. It’s not just about what you’re doing here (at the facility) – it’s about understanding how important the ramifications can be if you make bad decisions outside of that with who you’re exposed to. It’s about educating our guys on how they can risk-mitigate – wearing masks, social distancing when appropriate, washing your hands. But, with the testing being every day, especially with the first couple of weeks, I think you can really establish a good ecosystem and identify possible people that if they do test positive – let’s get them out of there. Let’s allow them to recover and return whenever is appropriate based on the parameters that the league has set. So, we’re still going to play football. I think there is a better understanding of how we apply those risk-mitigation practices. I made the comment about social distancing – we’re not going to do that on the field, but in those meeting settings when you can do that and you’re wearing your masks, those are the times we’re going to do that. I think it is a fine balance of making sure you’re not speaking out of both sides of your mouth, so we can educate our guys, but not make them afraid to go compete and play football. I think that comes from the trust that the ecosystem is right, so that they can feel comfortable to do that.”

(On if he is anticipating putting anyone on the PUP list and how he is planning to avoid adding players to the PUP list)
“I think the first thing, I am not anticipating putting anybody on the PUP list. Then the next thing is, really with the way we have to operate it kind of takes care of itself. We have August third through the seventh for those first five days, we will be off, and then we will finish it up on the ninth, 10th, and 11th. Then we will actually give our guys off on the 12th as well. So, you’re talking about the 13th is really the first opportunity, and that’s when that ‘Ramp-Up’ phase starts. We’ll be limited in a phase two type of setting, where they still can’t go against one another. So for us, August 17th is really going to represent the first true practice where guys are going against one another outside of a walk-thru setting. Then we’ll do a great job with (Vice President, Sports Medicine & Performance) Reggie (Scott) and his group, and (Head Strength Coach) Justin Lovett, and our strength staff of making sure we get the right physical assessment so we’re not pushing guys too early. But in a lot of instances, the things that have been agreed upon, kind of take care of themselves with on-boarding guys in a smart manner.”

(On how Vice President, Sports Medicine & Performance Reggie Scott is being resourceful to Justin Lovett who is in his first season as an NFL head strength & conditioning coach)
“Justin has had a lot of experience. You know, he’s been in the league before. He’s been a head strength coach, and then we’ve got some great coaches that will be working alongside him that have experience with us in (Assistant, Strength & Conditioning Conditioning) Fernando (Noriega) and (Assistant Director, Strength & Conditioning) Dustin Woods. But Reggie Scott, his leadership has really been instrumental on a lot of this stuff. I mean, I rely on him so heavily and I’ve really been impressed with Justin (Lovett). I think he’s got a great plan, and really it’s been a great collaboration. I think whether it’s his first year or not, it’s all about everybody working in unison and I feel really good about where we are at – really as a performance staff as a whole because it all kind of goes together, with strength and conditioning, and then Reggie and his group. And their ability to collaborate has been special and I think it is going to be one of our edges.”

(On RB Cam Akers skillset and how he fits the system, and the difficulty of playing right away with the unusual offseason)
“Well, I think he’s a guy that, just the demeanor and the way that he has handled himself in these virtual settings, it definitely doesn’t seem like it’s going to be too big for him. He is very smart. I’ve been really impressed with his ability to give us some feedback. When we ask him questions, he’s on the screws with all those answers. Then, really in terms of what he can do, I mean there’s not anything he can’t do, that’s why we liked him so much. I mean the versatility, the overall athleticism, the toughness, he can really run any scheme, he can take a handoff from the off-set gun or if he’s in the dot. So, that’s what you just liked about him, was the body of work and the versatility, the ability to create plays on his own. We will have a good opportunity in these early phases to get these guys trained above the neck, so that when we can start competing physically, they are going to get a lot more reps, even though it’s not in a full-speed setting that they normally would. So, I think in a lot of instances, if we do it the right way and we allocate the appropriate amount of time for meetings and walk-thrus and different things like that – I think it will give rookies, actually, a better opportunity to not be as stressed and overwhelmed mentally when the full speed reps start, just based on that eight-day acclimation period that I keep on referring to.”

(On contract updated for CB Jalen Ramsey, WR Cooper Kupp, or S John Johnson III)
“Nothing on that front. Obviously, those guys are instrumental parts of what we want to do. I’m just making sure I know what the heck I’m doing next after this right now, negotiating through the days. August 3rd can’t come soon enough, especially through these physicals where we can at least get some sense of normalcy with the schedule. Those guys are important, but there is no updates on that front.”

(On if he was confident Ramsey was going to report to camp)
“Yeah, you (ESPN Reporter Lindsey Thiry) asked him earlier in the offseason, he said he wasn’t going to hold out and I believed him. We’ve had great communication and dialogue. He is here and I know he’s just ready to play some football.”

(On how he feels about the outside edge rush position)
“I am very excited about a guy in (OLB) Leonard Floyd, who has had a lot of rush production in this league. He has got some experience in the system. (OLB) Samson Ebukam is a guy who has also had success when given his opportunities, when you are just talking about our guys coming off the edges. We have got some young players in (OLB Jachai) Polite and (OLB) Obo (Okoronkwo), who have great rush ability. I think it is going to be exciting just to see how they continue to mature and how they handle things. Not only in just the rush, but as they develop as players, playing in both phases – the run and the pass. Excited about that I think it is something that is going to be a big thing that we are going to be looking at very closely as we get close to that September 13th date. But, those guys have done a nice job in what we can control in the off season settings.”

(On how Hard Knocks experience has been so far)
“It has been good, I got a couple robo-cameras following me right now, every move I make in my office, so I have zero privacy. So, time that I would probably allocate at my home office otherwise, to try and get some of that privacy. I can’t say anything without feeling like I am going to get in trouble.”

(On if he knows when to expect OLB Terrell Lewis back)
“I don’t. He’s (OLB Terrell Lewis) going to follow the protocols. Right now, he’s placed on the COVID/IR (Reserve/COVID-19) and we’ll anxiously await his return whenever he checks all the boxes on those things.”

(On when the first day will be to physically be in front of the 80-man roster)
“Tomorrow will represent that first day. We’ve tried to keep our rookies and our vets on the same schedule, if you will. August 3 can’t come soon enough, which I believe that’s tomorrow.”

(On the location of the first team meeting)
“The tent is going to be really instrumental for us because of understanding some of the things I’ve learned about the air particles and the air flow. That will really serve as an all-encompassing meeting area and team meeting area. The tent is huge. Like (Director of Football Operations) Sophie (Harlan) and (Manager of Facility Operations) Chris Hawes, so many people have people done a great job getting that up and rolling. Today represents the finality of that. That will be where we spend a large portion of our time just as we’ve learned about the best ways to risk-mitigate. If it’s a little hot, it’s a lot better than having the potential bad particles swirl in the ‘trailers’ or whatever you want to call the facilities here.”

(On if he anticipates any additional players to opt out of this season)
“I’m not. I think it’s been really important that we have that clear, open and honest dialogue with those guys. We’re asking the questions and it’s something that I’ve never experienced before as a coach, because we care about these guys. If there’s a legitimate safety and health concerns, we’re going to do nothing but support these guys. They have a different way that it resonates with them.

Chandler Brewer’s situation – you’re almost saying when you understand the ramifications and some of the things that his doctors have told him. In knowing about what he’s overcome, you are almost relieved that he was able to make that decision, as tough as it was on him, because you want to help protect him. Each of our players have different approaches. Not anticipating that (any additional players will opt out), but it is something that is an ongoing dialogue because it’s not exclusive to just the players. A lot of these guys that you’ve seen opt out, their family and things like that, those are things you would never question. It’s about putting your arm around guys. And in a lot of instances, it’s about being empathetic and understanding and making sure they know we support them. I also think it’s our job to provide them with the right resources and the right information to make an educated decision based on all the medical parameters. In a lot of instances, what’s so unique about this is – we’re learning on the fly. When you think about just about the amount of time that’s typically allocated resource-wise to apply some of the things you know about viruses – we just don’t have enough time. So, there’s still things we’re learning every day and a lot of instances, most of this is trends.”

(On how he plans to keep QB Jared Goff healthy and germ free)
“Yeah, I think you want to be really smart about that, but not at the expense that it totally inhibits your ability to operate and go play football. I think what I’m still working through, is that fine line of acknowledging how serious this is. Acknowledging the steps that we need to take to keep that ecosystem, if you will, clean. What can we do to continue risk mitigate, but also allow us to go play football? You know, I don’t want guys on the field worrying about social distancing, and the Kinexon red light beeping and stuff like that. We’ve still got to go play football at the end of the day. I think sometimes when you’re going and getting out on the grass that’ll represent a relief from all the other things that (inaudible)…Those are things that I am continuing to work through and figure out the best way to message to the guys day in and day out.”

(On how he stresses safety precautions to players given the MLB Miami Marlins’ situation)
“You hate to see it affecting baseball and how quickly it can spread throughout a team if you aren’t following those things outside the building (inaudible). One of the things I think is really important for us, is as coaches, are we demonstrating the things that we’re asking of our players? And then them understanding the responsibility that we all have outside the framework of our normal scheduled day throughout the course of training camp and really throughout the year. I think guys are chomping at the bit to get back and understand that’s going to be part of how we have a successful season, is guys successfully handling themselves in the right way with regards to the risk of mitigation. We’ve always just talked about handling yourself in a professional manner outside the building for just good decision making and now that’s an added part of it as we navigate through this.”

(On if he plans to put added precautions in place for players beyond the practice facility to minimize risk)
“I think what you want to do is you want to make sure you’re educating them on how to risk mitigate. With a lot of these restaurants that are open, if you go where there’s an outdoor setting, you’re far enough away, you’re with a group that you know is making smart decisions. You’ve got to allow guys to live, but I think it’s our job to really educate them with the information and avoid some of the things that can really lead to the (Miami) Marlins situation. And some of these other things that each sport can serve as a great guideline of, ‘Hey this is how they’re doing it right and then these are some instances that let’s make sure we try not to do it in a way that’s cost some people.’”

(On the use of two fields and making up reps)
“We will definitely do that in the early parts when we walk-thru, where you have two separate fields. It gives a great opportunity for a lot of guys to accumulate reps that they wouldn’t otherwise, and it really gives everybody a chance to coach. Some of our younger coaches get a chance to coach on another field, so we will definitely explore that once we get into those competitive situations, but it is something that you still want to be mindful of the balance between the volume and the intensity in their workload. Especially in these early settings where it’s not as physically tolling, we’ll absolutely have kind of two fields going on at once and whether we implement that approach in practice I think will be determined at a little bit later date but we will definitely explore that for sure.”

(On his patience being put to the test because of the limitations this season)
“Yeah, I think you know me well enough to know the answer’s probably yes to that. I think that what you want to make sure that you’re doing, is that you’re patient with the process. I think where I’m impatient is just the opportunity to get a chance to go play real football and practice and compete. So, I’ve got to be patient. When you’re excited to finally get back with your guys and then you’re saying, ‘Okay, what are the ramifications or the parameters around ways we can even interact with these guys?’ Certainly something is better than nothing. I am just excited to see these guys in person and be able to have a meeting and go out and walkthrough. Now, would I like to be able to practice a little bit sooner than mid-August? Yeah, of course but everybody’s got to follow these guidelines and I think it’s going to be really important for us to do a great job of sequencing the way that we build up, ultimately leading to that September 13th game in SoFi against the Cowboys.”