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.”

Link: https://www.genengnews.com/news/sars-cov-2-lurked-for-decades-where-others-like-it-lurk-still/

Future pandemics—and suffering of the kind inflicted by COVID-19—could be avoided if we troubled ourselves to see where dangerous pathogens lie in wait. We could, two unrelated studies suggest, save ourselves untold woe and conserve our fortunes if we were to look into matters geographic, zoologic, and genomic. More specifically, we need to keep our eyes wide open when we venture into the planet’s last wild places. There, we may run into wild animals that are infected with pathogens harboring wild genetic traits—which is to say, genetic traits that evolved naturally, beyond our gaze, and that waited patiently, perhaps decades, for a chance to strike.

Recognizing the potential for outbreaks

According to an international research team of Chinese, European, and U.S. scientists, the SARS-CoV-2 lineage responsible for the COVID-19 pandemic has been circulating in bats for 40–70 years and likely includes other viruses with the ability to infect humans. This finding, which is derived from a newly constructed evolutionary history of SARS-CoV-2, has implications for the prevention of future pandemics stemming from this lineage.

To put together SARS-CoV-2’s evolutionary history, the scientists had to account for recombination events, which occur frequently in coronaviruses and which complicate inquiries into a pathogen’s origins.

“Coronaviruses have genetic material that is highly recombinant, meaning different regions of the virus’s genome can be derived from multiple sources,” explained Maciej Boni, associate professor of biology at Penn State and the lead author of a study that appeared July 28 in Nature Microbiology. “This has made it difficult to reconstruct SARS-CoV-2’s origins. You have to identify all the regions that have been recombining and trace their histories. To do that, we put together a diverse team with expertise in recombination, phylogenetic dating, virus sampling, and molecular and viral evolution.”

The study, titled “Evolutionary origins of the SARS-CoV-2 sarbecovirus lineage responsible for the COVID-19 pandemic,” described how the team used three different bioinformatic approaches to identify and remove the recombinant regions within the SARS-CoV-2 genome. The article also detailed how the team reconstructed phylogenetic histories for the nonrecombinant regions and compared them to each other to see which specific viruses have been involved in recombination events in the past.

“We find that the sarbecoviruses—the viral subgenus containing SARS-CoV and SARS-CoV-2—undergo frequent recombination and exhibit spatially structured genetic diversity on a regional scale in China,” the article’s authors wrote. “SARS-CoV-2 itself is not a recombinant of any sarbecoviruses detected to date, and its receptor-binding motif, important for specificity to human ACE2 receptors, appears to be an ancestral trait shared with bat viruses and not one acquired recently via recombination.”

The authors maintained that the results generated by the three bioinformatic approaches were consistent with Bayesian evolutionary rate and divergence date estimates as well as with two different prior specifications of evolutionary rates based on HCoV-OC43 and MERS-CoV. In addition, the authors estimated that divergence dates between SARS-CoV-2 and the bat sarbecovirus reservoir were 1948 (95% highest posterior density (HPD): 1879–1999), 1969 (95% HPD: 1930–2000), and 1982 (95% HPD: 1948–2009).

These findings led the scientists to conclude that viruses closely related to SARS-CoV-2 have been circulating in horseshoe bats for many decades. The scientists added, “The unsampled diversity descended from the SARS-CoV-2/RaTG13 common ancestor forms a clade of bat sarbecoviruses with generalist properties—with respect to their ability to infect a range of mammalian cells—that facilitated its jump to humans and may do so again.”

The team found that one of the older traits that SARS-CoV-2 shares with its relatives is the receptor-binding domain (RBD) located on the spike protein, which enables the virus to recognize and bind to receptors on the surfaces of human cells.

The team emphasized that preventing future pandemics will require better sampling within wild bats and the implementation of human disease surveillance systems that are able to identify novel pathogens in humans and respond in real time.

“The key to successful surveillance is knowing which viruses to look for and prioritizing those that can readily infect humans,” said the article’s senior author, David L. Robertson, PhD, professor of computational virology, MRC-University of Glasgow Centre for Virus Research. “We should have been better prepared for a second SARS virus.”

“We were too late in responding to the initial SARS-CoV-2 outbreak,” added Boni, “but this will not be our last coronavirus pandemic. A much more comprehensive and real-time surveillance system needs to be put in place to catch viruses like this when case numbers are still in the double digits.”

Investing in prevention

A surveillance system of the kind suggested by Boni is in line with recommendations from another recent study, one that argues for investments in preventive efforts. The study, prepared by scientists from Boston University, Princeton University, Duke University, Conservation International, and other institutions, indicated that “preventive efforts would be substantially less than the economic and mortality costs of responding to these pathogens once they have emerged.”

The scientists assessed the cost of monitoring and preventing disease spillover that is driven by the unprecedented loss and fragmentation of tropical forests and by the burgeoning wildlife trade. They discovered that significantly reducing transmission of new diseases from tropical forests would cost, globally, between $22.2 and $30.7 billion each year.

In stark contrast, they found that the COVID-19 pandemic will likely end up costing between $8.1 and $15.8 trillion globally—roughly 500 times as costly as what it would take to invest in proposed preventive measures. To estimate the total financial cost of COVID-19, researchers included both the lost gross domestic product and the economic and workforce cost of hundreds of thousands of deaths worldwide.

These findings appeared in Science, in a policy brief titled, “Ecology and economics for pandemic prevention.” The brief emphasized that “we invest relatively little toward preventing deforestation and regulating wildlife trade, despite well-researched plans that demonstrate a high return on their investment in limiting zoonoses and conferring many other benefits.”

For decades, scientists and environmental activists have been trying to draw the world’s attention to the many harms caused by the rapid destruction of tropical forests. One of these harms is the emergence of new diseases that are transmitted between wild animals and humans, either through direct contact or through contact with livestock that is then eaten by humans. The SARS-CoV-2 virus—which has so far infected more than 15 million people worldwide—appears to have been transmitted from bats to humans in China.

“Much of this traces back to our indifference about what has been occurring at the edges of tropical forests,” said Les Kaufman, PhD, one of the article’s co-authors and a Boston University professor of biology.

To reduce disease transmission, Kaufman and his collaborators propose expanding wildlife trade monitoring programs, investing in efforts to end the wild meat trade in China, investing in policies to reduce deforestation by 40%, and fighting the transmission of disease from wild animals to livestock.

The researchers also propose to increase funding for creating an open-source library of the unique genetic signatures of known viruses, which could help quickly pinpoint the source of emerging diseases and catch them more quickly, before they can spread.

“The pandemic gives an incentive to do something addressing concerns that are immediate and threatening to individuals, and that’s what moves people,” argued Kaufman. “There are many people who might object to the United States fronting money, but it’s in our own best interest. Nothing seems more prudent than to give ourselves time to deal with this pandemic before the next one comes.”

Some news you haven't seen anywhere else:

New campaign finance data show Chuck Schumer's political machine spent $15 million to crush progressive candidates & tilt primaries to candidates who pledge to block Medicare for All and a Green New Deal. https://t.co/N8D4fGepQu

— David Sirota (@davidsirota) July 16, 2020

from link above

===

Senate Democrats’ political machine has spent more than $15 million to help more moderate Senate candidates defeat progressive primary challengers in the 2020 election cycle.

With the help of the party, its major donors, and the Senate Majority PAC (SMP) — a super PAC funded by labor unions, corporate interests and Wall Street billionaires — candidates endorsed by Senate Minority Leader Chuck Schumer’s Democratic Senatorial Campaign Committee have won contested primaries in four battleground states.

While the DSCC’s chair, Nevada Sen. Catherine Cortez Masto, said last year the party would support progressive incumbent Massachusetts Sen. Ed Markey if he faced a primary challenger, he hasn’t seen any outside help yet from the DSCC or SMP in his tough battle with Rep. Joseph Kennedy III.

Colorado was the most emblematic example of the party putting its thumb on the scale against progressives: There, former Gov. John Hickenlooper cruised to a primary victory over former Colorado House Speaker Andrew Romanoff. In the final weeks of the race, SMP spent $1 million to boost Hickenlooper, after he spent his failed presidential campaign attacking key tenets of progressives’ legislative agenda, including Medicare for All and the Green New Deal.

At the time of the cash infusion, Hickenlooper was losing ground in the polls and engulfed in scandals: He had just been fined by Colorado’s Independent Ethics Commission for violating state ethics law as governor, the local CBS station uncovered evidence of his gubernatorial office raking in cash from oil companies, and a video circulated showed Hickenlooper comparing his job as a politician to a slave on a slave ship, being whipped by a scheduler.

With the help of SMP and the endorsement of the DSCC, Hickenlooper held off the more progressive Romanoff to win a 17 point primary victory.

Unions, Billionaires, and Corporate Interests
SMP is led byformer top staffers at the DSCC. The super PAC has raised a staggering $118 million this cycle, pooling cash from both organized labor and business titans to promote corporate-aligned candidates over more progressive primary challengers.

Working for Working Americans, a super PAC funded by the United Brotherhood of Carpenters and Joiners, has donated $5 million. The Laborers’ International Union of North America’s super PAC has given $1.5 million. The International Brotherhood of Electrical Workers’s political action committee has chipped in $1.3 million. SMP has received also big donations from groups affiliated with labor unions like the Service Employees International Union ($1 million), the National Association of Letter Carriers ($750,000), and Communications Workers of America ($500,000).

Overall, the top donor to SMP so far this cycle has been Democracy PAC — a super PAC that’s bankrolled by billionaire George Soros and the Fund for Policy Reform, a nonprofit funded by Soros. Democracy PAC has contributed $8.5 million to SMP.

Other donors from the financial industry include: Renaissance Technologies founder and billionaire Jim Simons ($3.5 million) and billionaire D. E. Shaw & Co. founder David Shaw ($1 million).

Some major donors have financial stakes in current and future legislation.

For instance: SMP received a $1 million donation from billionaire Jonathan Gray, an executive at Blackstone, which owns the hospital staffing chain, TeamHealth. SMP also received $2 million from the Greater New York Hospital Association.

In late 2019, Schumer helped stall Senate legislation that would have kept patients from receiving “surprise medical bills,” the hefty charges that occur when they visit hospitals that are in their insurance network but are unknowingly treated by providers who are considered out-of-network.

SMP is affiliated with Majority Forward, a dark money group focused on attacking Republican Senate candidates. Majority Forward received $450,000 in 2018 from pharmacy giant CVS Health — which also owns health insurer Aetna. The group also received $300,000 from the American Health Care Association (AHCA), a trade association that represents the nursing home industry.

The Democratic primary candidates backed by the DSCC have expressed reservations about Medicare for All, arguing they believe people should be allowed to keep their private health insurance if they want it. Many of the DSCC’s favored candidates do support creating a public health insurance option.

Meanwhile, the Real Estate Roundtable, a trade group for real estate investors, donated $50,000 to Majority Forward. Schumer and Senate Democrats recently helped Republicans unanimously pass pandemic relief legislation that included a special, little-noticed provision that amounted to $170 billion worth of new tax breaks for wealthy real estate investors.

Deciding Primaries
In addition to the Colorado race, SMP has waded into at least three other Senate primaries this year.

In North Carolina, SMP funded Carolina Blue, a super PAC that spent $4.5 million to help veteran and former state senator Cal Cunningham win the primary in March. Cunningham handily defeated his chief opponent, state senator Erica Smith, who was running to his left. (Republicans, for their part, also tried to influence the primary, spending $2.7 million to boost Smith.)

In Iowa, SMP spent nearly $7 million to promote real estate developer Theresa Greenfield. She easily bested her two primary opponents, including progressive Kimberly Graham, who campaigned in support of Medicare for All and the Green New Deal.

SMP has already spent more than $2 million in Maine, including nearly $500,000 to promote House Speaker Sara Gideon in the Democratic primary. Some of the group’s advertising against Republican Senator Susan Collins was also designed to boost Gideon.

On Tuesday, Gideon won the primary decisively, defeating two candidates, including Betsy Sweet, a former lobbyist for progressive advocacy groups who supported the Green New Deal and Medicare for All.

It was his dream job. He never thought he’d be bribing doctors and wearing a wire for the feds.
In an exclusive interview, the man behind a $678 million whistleblower settlement says “drastic action” was needed to shake up the pharmaceutical industry.

https://www.nbcnews.com/business/economy/it-was-his-dream-job-he-never-thought-he-d-n1232971

On July 1, Ozzie Bilotta’s years long effort to blow the whistle at Novartis paid off. The Justice Department announced a $678 million settlement with the company over improper inducements it made to doctors to prescribe 10 of the company’s drugs, including the anti-hypertension drug Lotrel. The deal represents the biggest whistleblower settlement under the federal anti-kickback law, Bilotta’s lawyer said.

“I felt like you needed to take drastic action to turn this system upside down and make it more legit,” Bilotta, 57, said in an exclusive interview with NBC News. “The whole system needed to be blown up and pieced together in a fair way — fair for taxpayers and good for patients.”

Although the payout Bilotta will get under federal whistleblower laws hasn’t been determined, he could receive a pretax sum of $75 million through the settlement, his attorneys said.

In the settlement, Novartis admitted to “certain conduct” alleged by the government and will sharply curtail practices exposed by Bilotta that gave doctors incentives to prescribe its drugs. Novartis derived at least $40 million as a result of the conduct, money that was paid by federal health care programs, the government said.

“For more than a decade, Novartis spent hundreds of millions of dollars on so-called speaker programs, including speaking fees, exorbitant meals, and top-shelf alcohol that were nothing more than bribes to get doctors across the country to prescribe Novartis’s drugs,” said Audrey Strauss, the acting U.S. attorney for southern New York, whose office prosecuted the case.

Chief Executive Vas Narasimhan said in a statement that Novartis is committed “to resolve and learn from legacy compliance matters. We are a different company today — with new leadership, a stronger culture, and a more comprehensive commitment to ethics embedded at the heart of our company.”

A Novartis spokesman declined to comment on Bilotta.

Bilotta, a Novartis sales representative for the eastern end of Long Island, filed his suit in January 2011 under the False Claims Act, detailing remuneration to physicians, such as lavish dinners at restaurants; costly tickets to sporting events and entertainment, including a trip to a Manhattan strip club; gift cards; and catering for events in the lives of doctors’ children, such as graduations or bar mitzvahs.

On behalf of the government and to prove his case, Bilotta secretly recorded himself making cash payments to two doctors and got confirmation from four others of having accepted prior remuneration.

The government and New York state took up his case in 2013. It covers activities at Novartis that took place from January 2002 until November 2011. In addition to Bilotta’s evidence, the government interviewed 350 witnesses, he said. The anti-hypertensive drug Valturna and the anti-diabetes drug Starlix were among the 10 or so drugs involved in the kickbacks.

The federal government’s anti-kickback statute is a criminal law barring remuneration to health care providers for patient referrals or other business involving goods and services covered by health care programs such as Medicare and Medicaid. Kickbacks can result in higher health care costs, overuse of drugs or services and improper patient steering.

The company’s doctor speaker programs took place at luxury restaurants in New York City, Miami, Chicago and San Francisco where physicians were supposed to educate other practitioners about Novartis’ drugs. Over the period, one doctor received over $320,000 in honoraria and wrote more than 8,000 prescriptions for the company’s drugs, the government said. None of the doctors were identified by the government.

Bilotta, a child of immigrants from southern Italy, said he felt he had made it when he got the job at Novartis. “The positions are very competitive — they have thousands of applicants per job,” he said. “You felt almost honored to have gotten the position.”

Right away, however, some things seemed off, Bilotta said. He recalled one doctor presenting him with a page listing 10 patients’ names on his first day visiting doctors’ offices. Confused, he asked what it was. “I was told, ‘Once we get to 10 patients on this drug, we get a $100 gift certificate to a restaurant,'” he said.

Bilotta said that when he asked about it, his manager didn’t seem concerned and didn’t follow up. Novartis’ ethics policy stated that it was a criminal offense to offer payments or inducements to prescribe its drugs, according to the settlement.

Keeping high-prescribing doctors happy was an intense focus at Novartis, Bilotta said. At meetings with higher-ups, sales representatives would get hundreds of dollars in American Express gift checks to present to doctors.

As the years progressed, talk grew among pharmaceutical sales representatives about other drug companies’ buying big-ticket items for doctors — covering the cost of a swimming pool was one rumor Bilotta recalled. Some physicians started asking for more — a television for the waiting room, a donation to a child’s graduation. A top prescriber demanded that Novartis hire his son, which it did. The son didn’t last long on the job, Bilotta said.

“I saw things evolve,” Bilotta said. “We went from a strictly product focus to one that is more about incentivizing.”

In the mid-2000s, Novartis began ramping up its doctor speaker programs, at which the company paid physicians to educate other practitioners about a drug’s merits. But some of the drugs Bilotta sold had been around for years and were well-known, making it clear to him that the events were simply a payment system, he said. At the vast majority of the programs, small talk dominated and the drugs weren’t mentioned, Bilotta added.

“They wanted to have the veneer of conveying medical knowledge,” he said. “But how much education on these old drugs do you need? I’d be stunned if 10 percent of the programs were legitimate.”

According to the Justice Department, Novartis “hosted tens of thousands of speaker programs and related events under the guise of providing educational content, when in fact the events served as nothing more than a means to provide bribes to doctors.”

Novartis would repeatedly host the same doctors at promotional programs for the same drugs, the government said. Company records show that “more than 19,235 doctors attended programs with the exact same title three or more times in a six-month period,” the government said.

In Rockford, Illinois, for example, Novartis held 124 speaker programs over eight years with the same 10 doctors, or a subset, as the only people attending. Novartis paid one doctor to speak at 102 of the events.

Novartis created a compliance department in 1999, the government said, but until 2001 it had only one person on staff. The company didn’t conduct a full-blown audit of speaker events until 2008, the settlement said, but its compliance training materials discouraged sending emails about the activities, in part, because they put Novartis at risk. The settlement noted that Novartis’ chief compliance officer told company trainees in presentations: “If you don’t have to write it, don’t. Consider using the phone.”

Every quarter, Novartis would require its sales representatives to spend a budgeted amount, say, $5,000 apiece, on doctor speaker programs, Bilotta said. The funds were allocated immediately.

But finding enough practitioners to attend the programs was difficult, and sometimes money allotted for the programs wasn’t spent. Then there’d be hell to pay, Bilotta said.

“I had situations where my sales were good and for some reason I didn’t spend all my money and they would threaten my job,” he said. “They had a specific return on investment they attached to the money they spent.”

The government said one set of speaker programs generated a 1,200 percent return on investment among the doctors who attended.

Occasionally, Bilotta had interactions with patients, in a doctor’s waiting room for example, and they’d complain about the high costs of their medications. The conversations upset him, he said, given what he knew about Novartis’ payoffs to doctors and how they increased health care costs. “It was depressing,” he said. “You felt like you were hurting patients.”

In the mid- to later 2000s, he said, the situation became untenable. “By 2008, I saw this was just a bunch of schemes,” he said. He contemplated leaving Novartis, but job prospects were few during the Great Recession.

In 2010, Bilotta went to a manager and told him that he had evidence of fraud. He said the manager replied: “I’m sure we could find something on you.”

“I had to do something, but I didn’t feel there was any avenue,” he said.

Later that year, he saw a fraud case against another big pharmaceutical company and decided to contact whistleblower lawyers. By early 2011, he’d been debriefed by law enforcement, and before he filed suit, he began wearing a wire to record conversations with six doctors in his territory. Two took $500 each in cash, and the others confirmed receiving prior inducements or being willing to do so in the future.

Law enforcement was “stunned to hear that doctors were taking cash bribes,” Bilotta said. “They asked: ‘Can you get this on tape?’ I paused momentarily — that’s when the nature of the case really revealed itself to me.”

At first the case was under seal, but when Bilotta’s name emerged, he started to get death threats and online taunts. He felt he had to move his family out of the New York area, but he said the support he got from peers and strangers far outpaced the criticism. After taking medical retirement from Novartis in 2013 because of Meniere’s disease, he began living on a partial salary and medical insurance.

Under its settlement with the government, Novartis has agreed to make significant changes to its doctor speaker programs. Going forward, the programs will be in a virtual format only. They may not take place in restaurants, and alcohol can’t be offered. Future programs may occur only for the first 18 months after a new drug or a new indication is approved by the Food and Drug Administration, and the company is limited to paying a total of $100,000 to all speakers for each drug or indication, or $10,000 per physician.

The changes signify the impact of the Novartis case, said one of Bilotta’s attorneys, James E. Miller, a partner at Shepherd Finkelman Miller & Shah.

“These limits, as opposed to the tens of millions of dollars often spent by pharmaceutical companies on speaker programs, will substantially diminish the opportunity for a physician’s prescription-writing to be influenced by the payments the physician is receiving from pharmaceutical companies,” Miller said. “We hope that this settlement will serve as a model on how to put a stop once and for all to the mischief and illegal behavior that we believe is rife in pharmaceutical speaker programs — despite the industry’s persistent claims to the contrary.”

Bilotta said that with the settlement finalized, he wants to work to change health care practices and laws that harm patients and taxpayers. Allowing the reimportation of drugs and letting the government negotiate drug prices would save taxpayers tens of billions of dollars, he said, and he plans to work on promoting those changes.

“My intention is to keep this good momentum up and benefit the taxpayers,” he said.

While Bilotta’s decision to blow the whistle at Novartis has yielded positive results, he said the process isn’t for everyone.

“It is not an easy road — it’s very psychologically taxing,” Bilotta said. “You have to be very sincere in what you’re doing and be prepared to be opened up to a tremendous amount of scrutiny. Go with your convictions, but if you’re doing it for financial gain, it’s a mistake.”

URL = NYTIMES.com

transcript was exported on Jun 15 2020 – view
Speaker 1:
( silence)

Speaker 1:
Before they drive off, he’s parked righthere, its a fake bill from

Kueng:
The driver in there ?

Lane: The blue Benz?

Speaker 1:
Which one?

Speaker 3 :
That blue one over there .

Kueng
Which one?

Lane:
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yup-yup Justhead back in. They’re moving around alot. Letmesee yourhands. George Floyd:
Hey,man.I’m sorry! Lane:
Stayinthe car,letmeseeyourotherhand. George Floyd:
I’m sorry,I’m sorry! Lane:
Letmeseeyourother hand! George Floyd:
Please, Mr.Officer. Lane:
Both hands. George Floyd:
I didn’t do nothing. Lane:
Put your fuckinghandsup rightnow ! Letme see your other hand. Shawanda Hill:
lethim seeyourotherhand George Floyd :
All right.WhatIdothough?WhatwedoMrOfficer? Lane:
Putyourhand up there.Putyour fuckinghandupthere! Jesus Christ,keep your fucking handson the wheel
George Floyd:
got Lane:
Axon
crosstalk 00:02:00).
EXHIBIT
Defense 2
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the Gentlemen , sorry.

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Keep your fucking hands on thewheel. George Floyd:
Yes, sir. I’m sorry , officer crosstalk 00:02:03) Lane:
Who else is in the ? George Floyd:
Thismy friend. Lane:
Put your foot back in George Floyd:
I’m sorry, so sorry.Goddangman.Man, got,i shotthesamewayMrOfficer,before. Lane:
Okay. Wellwhen I say “Letmesee yourhands,” youput yourfucking handsup. George Floyd :
Iam sosorry,Mrofficer.Dangman. Lane:
You got him ? Put your hands on top ofyour head. George Floyd :
Lasttime gotshotlikethatMrOfficer itwasthesamething Lane:
Filedin DistrictCourt State ofMinnesota 7/7/2020 11:00 AM
Handsontopofyourhead.Handson topofyearhead.Stepoutofthevehicle,andstepawayfromme, allright?
George Floyd:
Yes, sir. Lane:
Step out and face away. Step outand face away . George Floyd:
Okay,Mr.Officer,pleasedon’tshootme. Please,man. Lane:
I’m not going to shoot you. Step out and away George Floyd:
I’lllookatyou eye-to-eyeman.Pleasedon’tshootme,man. Lane:
I’m notshootingyou,man. George Floyd
I justlostmymom ,man. Lane
320 were taking one out. Step out and face away . George Floyd:
Man, I’m so sorry. Lane
Step out and face away .
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George Floyd:
Pleasedon’tshootme,Mr.Officer.Please, don’tshootmeman.Please. Can younotshootme,man? Lane:
Step out and faceaway. I’m not shooting. Step out and face away. George Floyd:
Okay, okay, okay. Please. Please, man. Please. Please. I didn’tknow man. Lane:
Get outofthe car. George Floyd:
I didn’tknow,ididn’tknowMr.Officer. ShawandaRenee Hill
Stop resisting Floyd! Lane:
Put your fucking hands behind yourback. Putyour handsbehind your back rightnow ! Kueng:
Stopmoving. Stop! Put your handsbehind your back then ! Lane
Filedin DistrictCourt State ofMinnesota 7/7/2020 11:00 AM
Get his other arm George Floyd:
I’m notgoingtodonothing. Kueng:
Hey you come back ! Stay in the car! George Floyd
00:03:24.
I’m sorryMr.Officer, Shawanda Renee Hill
What did you say sir? George Floyd:
On man Kueng
Stop resisting then . George Floyd:
I’m not Kueng:
Yes, you are. George Floyd
getonmykneeswhatever.
Ididn’t donothingwrongman.[inaudible00:03:38]. Kueng
Stand up! George Floyd
Please, please,man. Lane:
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Against thewall. Shawanda Renee Hill
Whome? Lane:
Yes.
Shawanda Renee Hill
What I do ? Lane:
We’re figuring out what’s going on Drop the bag. ShawandaRenee Hill:
Figure out what’s going on 00:03:54 . Lane:
What’s the problem ? Shawanda Renee Hill:
Somebody said something to him , it ain’t us. Speaker 7:
Wewas getting aride, sir. Shawanda Renee Hill:
just gotmy phone fixed. crosstalk 00:04:00 ). Speaker 7:
You can ask Adam about us, Adam know me. Lane:
Are you good? crosstalk 00:04:06 ]. You got ID Shawanda Renee Hill
Come and getme, girl they going took Floyd to Jail, guna take Floyd to jail.
Comeandgetme Speaker 7:
YoucanaskMr.Adamaboutussir.YoucanaskMrAdamaboutme, coo.l Lane:
DoyouhaveID? Shawanda Renee Hill:
I’m on 38th and Chicago. 38th and Chicago. Lane:
320 for code four Speaker 7
YoucanaskMr.Adam aboutme,sir.Ijustcameandboughtatablet.AndwhenIboughtthetablet,it didn’twork orwhatever.
Shawanda Renee Hill:
OhmyGod,hedidn’t evendonothing. Speaker 7
Here you go sir. Lane:
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Do you haveID ShawandaRenee Hill
No I don’t.Myname’s Shawanda ReneeHill. Fuck, no. Lane :
Okay . Speaker 7:
Sirher andi were justgetting aride, MrAdam ,MrAdam knowsmeman. Shawanda Renee Hill
justcameovertogetmyphone.Yousee don’thaveapurseornothing,andmydaughterisonher wayto getme
Lane:
What’s his deal? Shawanda Renee Hill:
I don’tknow Speaker 7
Mr.Adam knowsme,sir. crosstalk 00:04:50 Shawanda Renee Hill:
That’smyex. Idon’tknow . Lane:
Why’shegetting allsquirrelly and not showing us his hands, and justbeingallweird like that ? Shawanda Renee Hill:
i have no clue, because he’s been shot before . Lane:
Well get that,butstillwhen officers say,”Getoutofthe car.” Ishedrunk, isheonsomething? Shawanda Renee Hill:
No,hegotathinggoing on,I’m tellingyouaboutthepolice. Lane:
What does thatmean ? Shawanda Renee Hill
Hehave problems all the timewhen they come, especially when that man put that gun likethat. It’s been one.
Filedin DistrictCourt State ofMinnesota 7/7/2020 11:00 AM
Lane:
What’s your firstname? Shawanda Renee Hill:
His name isGeorge Floyd. Lane:
What isit? Speaker 7
He’s a good guy. George Floyd she said. Lane:
Can you spell that? Speaker 7:
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I don’tknow how to spellGeorgesir. Lane:
Hername. ShawandaReneeHill
Ohmyname? Lane:
Yeah , yeah ShawandaReneeHill:
ShawandaReneeHil.l Lane:
Can you spell it? Shawanda ReneeHill
S-H-A-W -A-N-D-A. Lane:
S-H-A-W ShawandaReneeHill
A-N-D-A. Speaker 7
Heallrightsir.Like said,butMr.Adams ShawandaReneeHill
Yeah, heok. Lane:
Kueng,justputhim in thecar.Shawandawhat? ShawandaRenee Hill
Hill,orRenee, R-E-N-E-E. Lane:
What’syourlastname? ShawandaRenee Hill
Hill, H-I-L-L. Lane:
And your date of birth ? Shawanda Renee Hill
isya’llcomingto getme. 1/27/75. Okay. Lane:
– view latest version here.
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Okaywellso here’sthething, someonepasseda fakebillin there.Wecomeoverhere,he starts grabbingforthekeysandallthatstuff, startsgettingweird,notshowingushishands.Idon’tknow
what’s goingon, so you’re comingoutofthe car. So, just hang tightrighthere. Stayright here, please. George Floyd:
Ouch, ouchman! Lane:
What areyou on somethingrightnow ? George Floyd
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No, nothing. Kueng:
Because you acting a little erratic. Lane:
Let’s go. Let’s go George Floyd:
I’m scared ,man Lane:
Let’s go Kueng:
You got foam around yourmouth , too ? George Floyd:
Yes, I was just hooping earlier . Lane:
Let’s go George Floyd:
Man,allrightletmecalm downnow.I’m feelingbetternow. Lane :
Keep walking . George Floyd:
Can youdomeonefavorman? Lane:
No, when we get to the car. Let’s get to the carman, comeon. Kueng:
Stopmoving around George Floyd:
man,Goddon’tleavememan.Pleaseman,pleaseman. Lane:
Here.Iwanttowatch thatcartoo, so justgethim in. Kueng:
Standup,stopfallingdown!Standup Stayonyourfeetandfacethecar door! George Floyd:
Im claustrophobic man, please man , please . Lane
you get a search on him Kueng
No,notyet. George Floyd:
just want totalk toyouman.Please,letmetalk to you.Please. Lane
Kueng
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You ain’t listening to nothing we’re saying. George Floyd
know Speaker 8
So we’re not going to listen to nothing you saying. Lane:
Can you watch thatcar? Just make sure no one goes in it. George Floyd
Im claustrophobic . Kueng:
hear you, but you are going to face this door right now . Lane:
Listen up, stop! George Floyd:
illdoanything,illdoanythingy’alltellmetooman.I’m notresistingman.I’mnot!I’mnot!Youcanask him , they know me.
Lane:
check that side. George Floyd :
Godman, won’t do nothinglike that.Why is this going on like this? Look at mywrist Mr.Officer, I’m not thatkind ofguy
Lane:
Check the other side. George Floyd:
Mr.Officer,MrOfficer,I’m notthatkindofguy. Lane:
Stop
George Floyd:
Please, I’m not that kind of guy,Mr.Officer. Please! Lane:
Just face away George Floyd:
Please,man. Don’t leavemebymyselfman, please, I’m just claustrophobic that’s it. Lane:
Well, you’re still going in the car. Kueng
Anything sharp on you? George Floyd:
Iwon’t donothing to hurt you,MrOfficer. Kueng
Do you have anything sharp on you ? George Floyd:
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No, sir. Kueng:
Not even like a comb or nothing George Floyd:
Filedin DistrictCourt State ofMinnesota 7/7/2020 11:00 AM
I don’thavenothing. Why y’alldoingmelikethis Mr.Officer? Please crack thewindow formeandstuff.
am claustrophobicfor rea,lMr.Officer. Lane:
You got him ? George Floyd:
Could you please crack it for me, please? Lane:
Yes, I’llcrack it.Iwill George Floyd
Pleasestaywithmeman,thankyou.God,man.Ididn’tknow allthiswasgoingtohappenman.Please
man 00:08:05 . I don’t want to do nothing to y’allman, nothing. Lane:
You gotit? Kueng:
yougettheinsideinnerpocketrealquickon yourside.I’m listening. George Floyd:
understandthatpeopledo stuff,and Lane:
Allright,he’sgood. justlookingforguns and whatever. George Floyd:
Okay, okay, okay. Lane:
grab aseat. George Floyd:
Okay. Kueng:
Why are you having trouble walking George Floyd:
Because officer, inaudible 00:08:31]. Lane:
I’llrollthe windowsdown, okay ? George Floyd:
Please man, please don’t do this! Kueng:
Take a seat! George Floyd
I’m going in,Mr.Officer, I’m going in .
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Kueng:
No, you’renot! George Floyd:
I’m gunagoin! Kueng:
Take a seat! Lane:
Grab a seat,man. George Floyd
Why don’t y’all believeme, Mr.Officer? Kueng:
Take a seat ! George Floyd:
I’mnotthatkindofguy!I’m notthatkindofguy,man! Kueng:
Takea seat! George Floyd
Y’all goingto dieinhere! goingto die,man! Kueng:
You need to take a seat right now ! George Floyd:
And I just had man, don’t want to go back to that. Lane:
Okay, rollthe windowsdown.Hey, listen ! George Floyd:
Dang, man Lane:
Listen ! George Floyd:
I’m notthatkindofguy. Lane:
I’llrollthewindowsdownifyouputyour legsin allright? George Floyd:
[ inaudible 00:08:57 ] look at that , look at that . Look at it ! Speaker 8
putthe air on.
You’re not even listening.Wecan fix it, butnotwhile you’re standing out here. George Floyd:
Okay,man.God,y’alldomebadman.Man, I don’twant to try to twin to try to win.
Speaker 9
Quit resistingbro. George Floyd:
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I don’t want to win . I’m claustrophobic, and i gotanxiety, I don’twant to do nothing to them ! Lane
I’llroll window down. George Floyd:
Man, I’m scared as fuckman . Speaker 9
That’s okay, 00:09:12 . George Floyd:
inaudible 00:09:12 ]when I startbreathing it’s going to go off onme,man. Lane:
Filedin DistrictCourt State ofMinnesota 7/7/2020 11:00 AM
Pullyourlegsin George Floyd :
Okay, okay, letme countto three. Letme count to three andthen Speaker 9:
going in, please.
You can’t win ! George Floyd:
I’m not trying to win! man, he know it
Lane:
I’llgo to the other side inaudible 00:09:21 George Floyd:
Heknow ittooMr.Officerdon’tdomelikethat,man. Kueng
Getin the car.
George Floyd :
Can Italk to youplease? Kueng
Ifyougetin this car,wecan talk! George Floyd:
I’m claustrophobic Kueng
I’m hearingyou,butyou’renotworkingwithme! George Floyd:
God, claustrophobic. Lane:
Plant your butt overhere, Kueng:
Get in the car ! George Floyd:
CanIgetin thefront,please? Kueng
No, you’re not getting in the front.
Axon_Body_3_Video_2020-05-25_2008
get on the ground , anything. I’ll get crosstalk 00:09:14 I can’t stand this shit
going to pullyou in.
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George Floyd:
I’m claustrophobic,Mr.Officer. Kueng
Getin the car! George Floyd:
Okay,man,okay!I’m notabadguyman! Kueng:
Get in the car ! George Floyd:
I’m nota bad guy! Man, [inaudible 00:10:02 . Please, Mr.Officer! Please ! Kueng:
Take a seat ! George Floyd :
Please! Please! No, inaudible 00:10:10 . Kueng:
Take a seat. George Floyd:
I can’t choke,Ican’t breatheMr.Officer!Please! Please! Kueng:
Fine.
George Floyd
Filedin DistrictCourt State ofMinnesota 7/7/2020 11:00 AM
Mywrist,mywristman. Okay, okay. I want to layon the ground.I want to layon the ground. I want to layon the ground!
Lane:
your getting in the squad. George Floyd :
want to lay on the ground ! I’m going down, Kueng:
Take asquat George Floyd
I’m going down Speaker 9
going down, I’m going down.
Bro, you about tohave aheartattack and shitman,get in the car! George Floyd:
I know I can’t breathe. I can’t breathe crosstalk 00:10:18 ] . Lane:
Get him on the ground . George Floyd:
Let go ofmeman , I can’t breathe. I can’t breathe. Lane:
Take a seat George Floyd:
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Please,man. Please listen to me. Chauvin :
Ishegoingto jail? George Floyd: Pleaselisten to me.
Kueng
He’s under arrest rightnow for forgery. George Floyd:
Forgery forwhat? for what ? Lane:
Let’stakehim outandjustMRE. George Floyd:
can’t fucking breatheman.I can’t fucking breathe. Kueng:
Here, Comeon out! George Floyd:
inaudible 00:11:10) thank you. Thank you. Thao:
Justlayhim ontheground. Lane:
Can you just get up on the, I appreciate that, I do. Chauvin :
Do you got your ah, restraint, Hobble? George Floyd:
I can’tbreathe. I can’t breathe. I can’t breathe. Lane:
Jesus Christ. George Floyd:
can’t breathe. Lane:
Thank you. George Floyd:
I can’tbreathe. Kueng
Stop moving George Floyd:
Mama,mama, mama, mama. Kueng:
[inaudible 00:11:45] one of the frontpouches George Floyd:
Mama,mama, mama. Kueng:
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…on my right side bag. George Floyd:
Mama,mama,mama. Lane:
320 Can we get EMScode2, for one bleedingfrom themouth. Chauvin :
Filedin DistrictCourt State ofMinnesota 7/7/2020 11:00 AM
Your under arrest guy. George Floyd:
Allright, allright. OhmyGod. I can’tbelievethis.I Chauvin :
So your goingto jai.l Lane:
Affirm . George Floyd:
believe this.
I can’t believe this man. Mom , I love you. [ Reese 00:12:09] I love you. Lane:
You got 00:12:10). George Floyd:
TellmykidsIlovethem.I’m dead Lane:
Mine’sinmy side,it’s listed, it’s labeled. Itsays hobble, it’s in the top. George Floyd:
Ican’tbreatheornothingman.Thiscold bloodedman.Ah- Chauvin :
You’re doing a lotoftalking,man . George Floyd
Mama, I love you. I can’t do nothing. Kueng:
EMSison their way
welldo you wantahobbleatthis point then? Lane:
!Ah-Ah!Ah-Ah!
Um ok , allriggt George Floyd:
Myface is gone.
can’t breathe. Lane:
Can you getupon the sidewalkplease, onesideorthe other please? George Floyd:
Myface is getting it bad. Lane:
Here, should we gethis legs up, or is this good?
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00:12:33 . I can’t breathe man. Please! Please, letmestand. Please,man
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Chauvin
Leave him Kueng:
Just leave him yep Chauvin :
Just leave him Lane:
Filedin DistrictCourt State ofMinnesota 7/7/2020 11:00 AM
Allright.HopefullyPark’sstillsitting onthecar.Theywere,Hewasactingrealshadylikesomething’sin there .
Thao
Ishehighon something? Lane:
I’m assuming so Kueng:
Ibelieve so,we found a pipe. Lane:
Hewouldn’t get outof the car. He wasn’t following instructions. [crosstalk 00:13:10). Yeah, it’s across the street Park’s watching it, two other people with him .
George Floyd:
Please, I can’tbreathe. Please,man. Pleaseman! Thao:DoyouhaveEMScoming code3?
Lane:
Ahcode2,wecanprobably stepitupthen. Yougotit?(crosstalk00:13:29 . George Floyd:
Please ,man ! Thao:
Relax! George Floyd:
can’t breathe. Kueng
You’re fine, you’re talking fine. Lane:
Your talken , Deep breath . George Floyd:
I can’t breathe. Ican’t breathe. Ah! I’llprobably just die this way. Thao:
Relax
George Floyd :
can’t breathemy face. Lane :
He’s got to be on something. Thao
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What areyou on? George Floyd :
breathe.Please, inaudible00:14:00 Speaker 9
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breathe.Shit.
Filedin DistrictCourt State ofMinnesota 7/7/2020 11:00 AM
Wellgetup andgetin thecar,man.Getupandgetinthecar. George Floyd:
I will I can’tmove. Speaker 9:
Lethim getinthecar. Lane :
Wefoundaweed pipeonhim,theremightbesomethingelse,theremightbelikePCPorsomething.Is that the shaking of the eyesrightis PCP ?
George Floyd :
Myknee,myneck. Lane:
Where their eyes like shakeback and forth really fast? George Floyd:
Im through, through. I’m claustrophobic. Mystomach hurts. Myneckhurts. Everythinghurts. Ineed
somewater or something, please. Please ?I can’t breathe officer. Chauvin :
Then stop talking, stop yelling. George Floyd:
You’re going to killme,man. Chauvin :
Then stop talking, stop yelling, it takes a heck of a lot of oxygen to talk . George Floyd:
Comeon,man.Oh, oh. crosstalk 00:15:03].I cannotbreathe.I cannotbreathe. Ah! They’llkillme. They’ll killme. I can’t breathe. I can’tbreathe. !
Speaker 8
We tried that for 10minutes. George Floyd :
Ah! Ah! Please. Please. Please. Lane:
Shouldwerollhim on hisside? Chauvin
No,he’s stayingputwherewegothim . Lane:
Okay. justworry aboutthe excited delirium orwhatever. Chauvin
Well that’s why wegot the ambulance coming. Lane:
Okay, isuppose.
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Speaker 13:
Filedin DistrictCourt State ofMinnesota
7/7/2020 11:00 AM
Gethim offtheground,bro.Gethim offtheground crosstalk00:16:16.Heain’tdoanyofthatshit.He a fuckingbum bro, he enjoyingthat shit rightnow bro. You couldhavefuckingputhim in the car by
now,bro.He’snotresistingarrestornothing. inaudible00:16:48] bodylanguageiscrazy. crosstalk
00:16:48] dudes at the academybro. you know thatbogusrightnow bro. Youknow it’sbogus. Youcan’t
even look atmelike amanbecauseyou now bro.
ShawandaReneeHill:
He’s aboutto passout. Lane:
I thinkhe’spassingout. Speaker 13
He’snotevenbreathingright 00:16:58]
Chauvin :
you guys alright though ? Lane:
00:16:48] bro. He’s not even resistingarrest right
He’s breathing Kueng
He’s breathing. crosstalk 00:17:26). Chauvin :
Don’t comeover here. Don’t comeover here. Lane:
Up on the sidewalk! Kueng :
Weneedyoutokeepsomedistance. Speaker 14
Ishe responsive? Chauvin :
yea, we have an ambulance coming Speaker 14
Doeshehave a pulse? Speaker 8
Get off crosstalk 00:17:42 . Lane:
Should we rollhim on his side? Speaker 13
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bro, you thinkthat’scool?Youthinkthat’scoo,lright?[crosstalk
Yeah, Imeanmykneemightbea little scratched,butI’llsurvive. Speaker 13
You’re a bum bro, you’re a bum for that. Can’t you be aman and see here he’s notbreathing rightnow . Lane:
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He’s notresponsive rightnow, bro. Speaker 14
Doeshe have a pulse? Speaker 13
No, bro . Look at him , he’snot responsive right now , bro. Bro, are you serious? Lane:
you gotone? Speaker 14:
Letme see a pulse. Kueng
i couldn’t fine one Speaker 13
Filedin DistrictCourt State ofMinnesota 7/7/2020 11:00 AM
Is he breathingright now ? Check his pulse. Check his pulse. Check his pulse. inaudible 00:18:19 check
hispulse. crosstalk 00:18:19). Check hispulse, bro. inaudible 00:18:21] drugs bro. What you think that is? crosstalk 00:18:25). Youcallwhat youdoingokay?[inaudible00:18:25 .
Speaker 14
Yes, I am from Minneapolis. Speaker 15
Okay, get off the sidewalk . Speaker 14:
Showmehispulse. Check itrightfucking now . Speaker 15:
Getback on the sidewalk. [crosstalk 00:18:33). Speaker 14
He’s notmoving! Speaker 13:
Bro, you’re a bum bro. You’re a bum bro. Speaker 14
Checkhispulserightnow andtellmewhatitis. Tellmewhathispulseisrightnow. Speaker 13:
Check his pulse. Bro, he has not moved ( crosstalk 00:19:43). Lane:
What ?
Dispatch: Squad 330 EMSis at Portland and 36th theywere advised of code 3. Lane:
Therewere advisedwhat?
Kueng
Ofcode 3 Chauvin :
Acknowledge that Dispatch:
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Copy i was just giving you their updated location, they are en route. Lane:
Filedin DistrictCourt State ofMinnesota 7/7/2020 11:00 AM
Therewego. Speaker 13
Bro , he was just moving when I walked up
[inaudible 00:19:43 ]. Speaker 16:
crosstalk 00:19:43 ]. Bro, he’s not fucking moving! Bro
Get the fuck off of him what are you doing? crosstalk 00:19:43 . dying bro, what are you doing ? Lane:
He’s not responsive right now , you guys probably want to crosstalk 00:19:44 ]. Yeah. Speaker 16
Get off him ! crosstalk 00:19:53 . Lane:
Should we get another car?Another car just for the crowd. inaudible 00:20:06 ) Chauvin :
Let’s get him on inaudible 00:20:11 . Speaker 13
inaudible 00:20:14 bro inaudible 00:20:16] like that. inaudible 00:20:17 thatman in front ofyou, bro ?He’s noteven fuckingmoving rightnow,bro. crosstalk 00:20:23).
Lane:
yourlightson again Speaker 17
Youguys can get out oftheway. [crosstalk 00:21:11.
Lane:
Youwantoneofusto ridewith? Kueng:
Yeah . Lane :
Ridewith? Okay. Idon’t havemyphone so I’llbeBaker (crosstalk 00:21:48].What’sthat? Chauvin:
Gelt them belted Down Kueng:
Help getbelted down. Chauvin :
Getbelted down Lane:
yup, where we going ? Speaker 17
We’re justgoing to be downthe street. Lane :
Okay
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Speaker 17
You guyswantto shutthedoors, getout ofhere, andwe’re goingtogodownthe street. Lane:
Filedin DistrictCourt State ofMinnesota 7/7/2020 11:00 AM
Doyouwanthere orno? Speaker 17:
Yeah , go to something, 40th , Tell fire where to go . Lane:
Okay.Doyouwantmein thereorno? Speaker 17
yea. Lane:
Allright. Oops. Speaker 17:
You’re fine. Kueng:
Lane ? Lane :
Yep Kueng:
This yours ? Lane:
Yeah,nope. Speaker 17:
All rightwhatwas going on ? Lane:
Itwas forgery report Speaker 17:
Yep Lane:
And he was just notcompliant with getting outof the car. Speaker 17
Okay Lane:
Weweretryingtogethim inthebackofthesquad,andhe Speaker 17:
Yep. Lane:
justbasicallyresisting.
Hewasn’tshowingushishandsatfirst.Thenweweretryingto gethim intothesquad,hekickedhis way out,he was kickingon there. And we cameout the other side, and hewas fighting us, andwewere
justbasicallyrestrainedhim untilyouguysgot . Speaker 17
Okay . You do CPR
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Lane:
Allright. You wantmedoing just compressions? Speaker 17:
Just compressions for now please, thank you. Speaker 17:
Okay.slide under. All right, keep doing compressions. Lane:
Keep checking airway or just constant Speaker 17:
Constant compressions. Lane:
Constant compressions, all right. Speaker 17
I can do an airwaycheckifyouwant inaudible00:23:53].Hehadtobedetained,physicalforce,and inaudible 00:24:05 .
Lane:
You got his arm in it? You good? Speaker 17
Yep, just getthis bar uphere. Pullitout, inaudible00:24:41] there you go. Lane:
Filedin DistrictCourt State ofMinnesota 11:00 AM
Wantmetopullitout?Whatdoyouneed?Ithinkit’sthecloth which waydoesithook?Therewego, therewego. Fuck,sorry
Speaker 17
You told inaudible 00:24:54 right? Thank you. [ inaudible 00:24:54 . Lane:
Should i still be touching him , or is that going to, electric go . Speaker 17
Tell him to come code three we’re working an arrest. Do you need inaudible00:26:10 location 00:26:11].
Dispatch:
Squad 320 , if you would let know that EMS, Fire needs to go to Park and 36th, patient in full arrest now .
Speaker 17:
I told her. Oh (inaudible 00:26:34 Lane:
Yeah Dispatch:
320 Lane:
320 . Dispatch:
Canyouadvisethe
department inaudible00:26:49).
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Lane:
Filedin DistrictCourt State ofMinnesota
7/7/2020 11:00 AM
320BakertoAble,canyou,ifyou’restillonscene, withEMS,canyouadviseFire?Youguysneedme to do anything?
Speaker 17
You’re good, glove up why don’t you. Lane:
Yeah. Youneedme to hold his airway or? Speaker 17
No, onesecond Lane
Okay . Speaker 17
Okay, do this about every Lane:
One pump? Speaker 17
Every time this lights up give it a squeeze. Lane:
One pump? Speaker 17
Yep . Lane:
All right Speaker 17
Washe fighting with you guys for a long time? Lane :
No.Imean littlebit,butnotalongtime,maybeaminuteortwo.Wewerejusttryingtogethim inthe
squad, and then he cameout the other end, so wewere likewe’lljustwait. Speaker 17:
A lot of activity prior? Lane:
It took a bit to get him , I mean we got him out of the car and handcuffed him , and were walking him over there,walkingacrossthestreet. Youneedmeto trade places?
Speaker 17
Yeah inaudible 00:29:28 Lane:
You guysneedmehere stiller? Speaker 17
You’re good,we’re good thankyou. Lane:
Okay . Speaker 17:
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There’s abagover Lane:
320 Baker to Able, Speaker 19:
00:30:09
Lane:
Oh. That’s fine, that’s good. Speaker 19
Okay. inaudible 00:30:27 . So whathappened,more drama at Cup Foods? Lane:
Cup Foods, yeah . It was just a forgery report, and that was the guy that they said was the person that had given them a fake bill. Wewent over there , and yeah just …
Speaker 19:
Wentbananas? Lane:
be at Park and 36 when you’re done there. What’s that?Okay
watch the foot pedal it’s down there [ inaudible 00:30:22 .
Yeah.Imeanhewas… weretryingtogethim outofthecar,hekepthishandlikethisbasically, wasn’t showingmehis hands. So I’m like, “Letmesee yourother hand ” I gave him a couple commands forthat,hewouldn’tdoit,andthenhefinallydid.Sothenwe’relikeallrightwe’regoingtogethim out
ofthecarrightnow.Becausehekeptlookingforthekey,Ithoughthewasgoingtotry anddriveoff. Speaker 19:
geez. Lane :
Yep . Speaker 19
Man. Yeah, wedidn’t understand because itwas like come to the, so we’re there and the officers there are likenonono, andyeah, the crowdwasa little, yeah.
Lane:
Yeah Speaker 19
Man, yuck. Lane:
Notsure ifmycohort is cominghere. I gavemylocation. Otherwise, Imightjust ridewith them them there.
Speaker 19
Okay, Yeah. Lane:
Was there a big crowd there then ? Speaker 19
and help
Yeah,moreinside.Wewaited…ournewSOPsareto ,towaitlikeifihavecootiesgoingon,solike captainusuallygoesinandmaybebringstherookie,itkindofdepends.Andthen 00:31:49]
yeah we just waited because itwas like
sitting here I’m like now it says code three, I just don’t understand. And then we figured outwhere it
00:31:54] code2mouthinjury.Andthen aswe’re wasso,andthen one ofyourofficerswaslikehey,heyding-dongs,you’re atthewrongspot.”
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Filedin DistrictCourt StateofMinnesota
7/7/2020 11:00 AM
I’m notsureifhe’scomingherebut,ohyouguysstillhavetherolldown. Speaker 19
Oh yeah, you know . Lane:
Nice. Speaker 19:
Nothing but the best. Yeah . Yeah , so he crashed in the inaudible 00:32:22 ] . I wonder what he was on . Lane:
Not sure, but yeah he seemed very agitated and paranoid. Speaker 19
That’s a shame. Lane:
Yeah. Speaker 19
Itseemslikeifit’switnessed, theresultscanbeprettygoodifthey’redoingCPRrightaway,sothat’s
good. Because they get stuff going so quickly , … Lane
Yeah . Speaker 19
But yeah, they need more hands, that’s why . Dispatch :
inaudible 00:33:25 ] please return to Cup foods inaudible 00:33:25 ] firefighter
there. Check in with hermake sure she’s okay (inaudible 00:33:25 . Lane:
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• This topic was modified 5 years, 9 months ago by joemad.

I copied and pasted the article below but it looks wonky. The link has interactive graphics so that is the best way to read the article. ..

https://www.nytimes.com/interactive/2020/04/30/opinion/coronavirus-covid-vaccine.html

A vaccine would be the ultimate weapon against the coronavirus and the best route back to normal life. Officials like Dr. Anthony S. Fauci, the top infectious disease expert on the Trump administration’s coronavirus task force, estimate a vaccine could arrive in at least 12 to 18 months.

The grim truth behind this rosy forecast is that a vaccine probably won’t arrive any time soon. Clinical trials almost never succeed. We’ve never released a coronavirus vaccine for humans before. Our record for developing an entirely new vaccine is at least four years — more time than the public or the economy can tolerate social-distancing orders.

But if there was any time to fast-track a vaccine, it is now. So Times Opinion asked vaccine experts how we could condense the timeline and get a vaccine in the next few months instead of years.

Here’s how we might achieve the impossible.

Assume We Already Understand the Coronavirus
Options to shorten the timeline
Start trials early
Rely on work from studying SARS and MERS to shorten preparations before clinical trials
Click to turn on
Don’t wait for academic research
Skip to clinical phases using what we know about the coronavirus so far
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Normally, researchers need years to secure funding, get approvals and study results piece by piece. But these are not normal times.

There are already at least 254 therapies and 95 vaccines related to Covid-19 being explored.

“If you want to make that 18-month timeframe, one way to do that is put as many horses in the race as you can,” said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine.

Companies with vaccine trials underway
Dozens of vaccines are starting clinical trials. Many use experimental RNA and DNA technology, which provides the body with instructions to produce its own antibodies against the virus.

Select vaccines by clinical trial start date

RNA and DNA vaccines

Other vaccine types

2020

Feb.

March

April

May

June

July

Aug.

Sept.

Oct.

Nov.

Dec.

CanSino and the A.M.M.S.

Moderna

BioNTech and Pfizer

Inovio Pharmaceuticals

Sinovac

Wuhan Institute and Sinopharm

U. of Oxford

Uses 1 microgram of

mRNA, meaning it

could be more easily

mass produced

Imperial College

Novavax

CureVac

Sanofi and GSK

Exploring a new form of

oral vaccine, which has

never been licensed

Vaxart

Altimmune

Janssen

Note: Clinical trial start dates are approximate. Compiled by Robert van Exan.
Despite the unprecedented push for a vaccine, researchers caution that less than 10 percent of drugs that enter clinical trials are ever approved by the Food and Drug Administration.

The rest fail in one way or another: They are not effective, don’t perform better than existing drugs or have too many side effects.

Less than 10 percent of drug trials are ultimately approved
Probability of success at each phase of research

37% fail

Phase 1

69% fail

Phase 2

42% fail

Phase 3

15% fail

New Drug

Application

Approved

Note: Between 2006 and 2015. Source: Biotechnology Innovation Organization, Biomedtracker, Amplion.
Fortunately, we already have a head start on the first phase of vaccine development: research. The outbreaks of SARS and MERS, which are also caused by coronaviruses, spurred lots of research. SARS and SARS-CoV-2, the virus that causes Covid-19, are roughly 80 percent identical, and both use so-called spike proteins to grab onto a specific receptor found on cells in human lungs. This helps explain how scientists developed a test for Covid-19 so quickly.

There’s a cost to moving so quickly, however. The potential Covid-19 vaccines now in the pipeline might be more likely to fail because of the swift march through the research phase, said Robert van Exan, a cell biologist who has worked in the vaccine industry for decades. He predicts we won’t see a vaccine approved until at least 2021 or 2022, and even then, “this is very optimistic and of relatively low probability.”

And yet, he said, this kind of fast-tracking is “worth the try — maybe we will get lucky.”

Years and years, at minimum
The vaccine development process has typically taken a decade or longer.

Varicella

28 years

FluMist

28

Human papillomavirus

15

Rotavirus

15

Pediatric combination

11

Covid-19 goal

18 months

Note: Rotavirus and HPV vaccines include time from filing of the first investigational new drug to approval. Source: “Plotkin’s Vaccines” (7th edition)
The next step in the process is pre-clinical and preparation work, where a pilot factory is readied to produce enough vaccine for trials. Researchers relying on groundwork from the SARS and MERS outbreaks could theoretically move through planning steps swiftly.

Sanofi, a French biopharmaceutical company, expects to begin clinical trials late this year for a Covid-19 vaccine that it repurposed from work on a SARS vaccine. If successful, the vaccine could be ready by late 2021.

Move at ‘Pandemic Speed’ Through Trials
Options to shorten the timeline
Use ‘pandemic speed’ timeline
Start subsequent steps before previous phases are completed
Push to large-scale tests sooner
Move more swiftly to Phase 3 trials by combining phases
Use emergency provision
Vaccinate front-line and essential workers early
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As a rule, researchers don’t begin jabbing people with experimental vaccines until after rigorous safety checks.

They test the vaccine first on small batches of people — a few dozen during Phase 1, then a few hundred in Phase 2, then thousands in Phase 3. Months normally pass between phases so that researchers can review the findings and get approvals for subsequent phases.

But “if we do it the conventional way, there’s no way we’re going to be reaching that timeline of 18 months,” said Akiko Iwasaki, a professor of immunobiology at Yale University School of Medicine and an investigator at the Howard Hughes Medical Institute.

There are ways to slash time off this process by combining several phases and testing vaccines on more people without as much waiting.

Last week the National Academy of Sciences showed an overlapping timeline, describing it as moving at “pandemic speed.”

It’s here that talk of fast-tracking the timeline meets the messiness of real life: What if a promising vaccine actually makes it easier to catch the virus, or makes the disease worse after someone’s infected?

That’s been the case for a few H.I.V. drugs and vaccines for dengue fever, because of a process called vaccine-induced enhancement, in which the body reacts unexpectedly and makes the disease more dangerous.

Researchers can’t easily infect vaccinated participants with the coronavirus to see how the body behaves. They normally wait until some volunteers contract the virus naturally. That means dosing people in regions hit hardest by the virus, like New York, or vaccinating family members of an infected person to see if they get the virus next. If the pandemic subsides, this step could be slowed.

“That’s why vaccines take such a long time,” said Dr. Iwasaki. “But we’re making everything very short. Hopefully we can evaluate these risks as they occur, as soon as possible.”

This is where the vaccine timelines start to diverge depending on who you are, and where some people might get left behind.

If a vaccine proves successful in early trials, regulators could issue an emergency-use provision so that doctors, nurses and other essential workers could get vaccinated right away — even before the end of the year. Researchers at Oxford announced this week that their coronavirus vaccine could be ready for emergency use by September if trials prove successful.

So researchers might produce a viable vaccine in just 12 to 18 months, but that doesn’t mean you’re going to get it. Millions of people could be in line before you. And that’s only if the United States finds a vaccine first. If another country, like China, beats us to it, we could wait even longer while it doses its citizens first.

You might be glad of that, though, if it turned out that the fast-tracked vaccine caused unexpected problems. Only after hundreds or thousands are vaccinated would researchers be able to see if a fast-tracked vaccine led to problems like vaccine-induced enhancement.

“It’s true that any new technology comes with a learning curve,” said Dr. Paul Offit, the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. “And sometimes that learning curve has a human price.”

Start Preparing Factories Now
Options to shorten the timeline
Make vaccines early
Build and manufacture early, anticipating that factories will be useful for a future vaccine and that the product will clear regulatory hurdles
Take a bet on a successful mRNA vaccine
This experimental technology may be faster to produce than traditional vaccines
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Once we have a working vaccine in hand, companies will need to start producing millions — perhaps billions — of doses, in addition to the millions of vaccine doses that are already made each year for mumps, measles and other illnesses. It’s an undertaking almost unimaginable in scope.

Companies normally build new facilities perfectly tailored to any given vaccine because each vaccine requires different equipment. Some flu vaccines are produced using chicken eggs, using large facilities where a version of the virus is incubated and harvested. Other vaccines require vats in which a virus is cultured in a broth of animal cells and later inactivated and purified.

Those factories follow strict guidelines governing biological facilities and usually take around five years to build, costing at least three times more than conventional pharmaceutical factories. Manufacturers may be able to speed this up by creating or repurposing existing facilities in the middle of clinical trials, long before the vaccine in question receives F.D.A. approval.

“They just can’t wait,” said Dr. Iwasaki. “If it turns out to be a terrible vaccine, they won’t distribute it. But at least they’ll have the capability” to do so if the vaccine is successful.

The Bill and Melinda Gates Foundation says it will build factories for seven different vaccines. “Even though we’ll end up picking at most two of them, we’re going to fund factories for all seven, just so that we don’t waste time,” Bill Gates said during an appearance on “The Daily Show.”

In the end, the United States will have the capacity to mass-produce only two or three vaccines, said Vijay Samant, the former head of vaccine manufacturing at Merck.

“The manufacturing task is insurmountable,” Mr. Samant said. “I get sleepless nights thinking about it.”

Consider just one seemingly simple step: putting the vaccine into vials. Manufacturers need to procure billions of vials, and billions of stoppers to seal them. Sophisticated machines are needed to fill them precisely, and each vial is inspected on a high-speed line. Then vials are stored, shipped and released to the public using a chain of temperature-controlled facilities and trucks. At each of these stages, producers are already stretched to meet existing demands, Mr. Samant said.

It’s a bottleneck similar to the one that caused a dearth of ventilators, masks and other personal protective equipment just as Covid-19 surged across America.

If you talk about vaccines long enough, a new type of vaccine, called Messenger RNA (or mRNA for short), inevitably comes up. There are hopes it could be manufactured at a record clip. Mr. Gates even included it on his Time magazine list of six innovations that could change the world. Is it the miracle we’re waiting for?

Rather than injecting subjects with disease-specific antigens to stimulate antibody production, mRNA vaccines give the body instructions to create those antigens itself. Because mRNA vaccines don’t need to be cultured in large quantities and then purified, they are much faster to produce. They could change the course of the fight against Covid-19.

“On the other hand,” said Dr. van Exan, “no one has ever made an RNA vaccine for humans.”

Researchers conducting dozens of trials hope to change that, including one by the pharmaceutical company Moderna. Backed by investor capital and spurred by federal funding of up to $483 million to tackle Covid-19, Moderna has already fast-tracked an mRNA vaccine. It’s entering Phase 1 trials this year and the company says it could have a vaccine ready for front-line workers later this year.

“Could it work? Yeah, it could work,” said Dr. Fred Ledley, a professor of natural biology and applied sciences at Bentley University. “But in terms of the probability of success, what our data says is that there’s a lower chance of approval and the trials take longer.”

The technology is decades old, yet mRNA is not very stable and can break down inside the body.

“At this point, I’m hoping for anything to work,” said Dr. Iwasaki. “If it does work, wonderful, that’s great. We just don’t know.”

The fixation on mRNA shows the allure of new and untested treatments during a medical crisis. Faced with the unsatisfying reality that our standard arsenal takes years to progress, the mRNA vaccine offers an enticing story mixed with hope and a hint of mystery. But it’s riskier than other established approaches.

Speed Up Regulatory Approvals
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Fast-track federal approvals
Shorten approval window from a year to six months
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Imagine that the fateful day arrives. Scientists have created a successful vaccine. They’ve manufactured huge quantities of it. People are dying. The economy is crumbling. It’s time to start injecting people.

But first, the federal government wants to take a peek.

That might seem like a bureaucratic nightmare, a rubber stamp that could cost lives. There’s even a common gripe among researchers: For every scientist employed by the F.D.A., there are three lawyers. And all they care about is liability.

Yet F.D.A. approvals are no mere formality. Approvals typically take a full year, during which time scientists and advisory committees review the studies to make sure that the vaccine is as safe and effective as drug makers say it is.

While some steps in the vaccine timeline can be fast-tracked or skipped entirely, approvals aren’t one of them. There are horror stories from the past where vaccines were not properly tested. In the 1950s, for example, a poorly produced batch of a polio vaccine was approved in a few hours. It contained a version of the virus that wasn’t quite dead, so patients who got it actually contracted polio. Several children died.

The same scenario playing out today could be devastating for Covid-19, with the anti-vaccination movement and online conspiracy theorists eager to disrupt the public health response. So while the F.D.A. might do this as fast as possible, expect months to pass before any vaccine gets a green light for mass public use.

At this point you might be asking: Why are all these research teams announcing such optimistic forecasts when so many experts are skeptical about even an 18-month timeline? Perhaps because it’s not just the public listening — it’s investors, too.

“These biotechs are putting out all these press announcements,” said Dr. Hotez. “You just need to recognize they’re writing this for their shareholders, not for the purposes of public health.”

What if It Takes Even Longer Than the Pessimists Predict?
Covid-19 lives in the shadow of the most vexing virus we’ve ever faced: H.I.V. After nearly 40 years of work, here is what we have to show for our vaccine efforts: a few Phase 3 clinical trials, one of which actually made the disease worse, and another with a success rate of just 30 percent.

Deaths per year
The number of deaths from Covid-19 in 2020 has surpassed the number of deaths per year from H.I.V./AIDS during the height of the crisis in the 1990s.

60k deaths

Deaths from

Covid-19 in

the U.S.

50k

40k

Deaths from

H.I.V./AIDS

in the U.S.

30k

20k

10k

0

1990

2000

2010

2020

Note: No H.I.V. death data available after 2018. Covid-19 deaths as of April 29. Source: Mortality Informatics and Research Analytics.
Researchers say they don’t expect a successful H.I.V. vaccine until 2030 or later, putting the timeline at around 50 years.

That’s unlikely to be the case for Covid-19, because, as opposed to H.I.V., it doesn’t appear to mutate significantly and exists within a family of familiar respiratory viruses. Even still, any delay will be difficult to bear.

But the history of H.I.V. offers a glimmer of hope for how life could continue even without a vaccine. Researchers developed a litany of antiviral drugs that lowered the death rate and improved health outcomes for people living with AIDS. Today’s drugs can lower the viral load in an H.I.V.-positive person so the virus can’t be transmitted through sex.

Therapeutic drugs, rather than vaccines, might likewise change the fight against Covid-19. The World Health Organization began a global search for drugs to treat Covid-19 patients in March. If successful, those drugs could lower the number of hospital admissions and help people recover faster from home while narrowing the infection window so fewer people catch the virus.

Combine that with rigorous testing and contact tracing — where infected patients are identified and their recent contacts notified and quarantined — and the future starts looking a little brighter. So far, the United States is conducting fewer than half the number of tests required and we need to recruit more than 300,000 contact-tracers. But other countries have started reopening following exactly these steps.

If all those things come together, life might return to normal long before a vaccine is ready to shoot into your arm.

Stuart A. Thompson is a writer and the graphics director for Times Opinion.

Source: Clinical trial medians from “Development Times and Approval Success Rates for Drugs to Treat Infectious Diseases”

Stuart A. Thompson is a writer and the graphics director for Times Opinion.

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• This topic was modified 5 years, 10 months ago by nittany ram.

‘Like leaning into a left hook’: coronavirus calamity unfolds across divided US
In a week that saw the worst day on record for new cases, Trump shrugs as experts warn Americans not to follow his lead

https://www.theguardian.com/world/2020/jun/27/coronavirus-cases-us-trump-politics-masks

A disaster is unfolding in Montgomery, Alabama, where Martin Luther King preached and where Rosa Parks was arrested for refusing to give up her seat on the bus. Hospitals are running short of drugs to treat Covid-19, intensive care units are close to capacity, and ventilators are running short.

Between 85% and 90% of the very sick and dying are African American.

Amid this gathering storm, the city council met to decide whether to require people to wear masks, a basic protection the US Centers for Disease Control and Prevention (CDC) strongly recommends. Doctors lined up to plead their case.

“This is beyond an epidemic in this area,” said the pulmonologist Bill Saliski. “Our units are full of critically ill covid patients. We have to slow this down.”

His colleague, Nina Nelson-Garrett, described watching undertakers carrying out corpses, 30 minutes apart.

“Something as simple as a mask can save someone’s life,” she said.

Dr Kim McGlothan recounted how she was frequently stopped by white people asking, “Is the media sensationalizing this, is it really as bad as they are making out?”

McGlothan told the council: “People don’t believe the hype. Until you mandate masks, we won’t be able to stop this – we just won’t.”

Then a black resident stood up. Six of his relatives had died from Covid-19. His brother was on a ventilator. “This is not about masks,” he said. “The question on the table is, ‘Do black lives matter?’ I lost six of my family to Covid. How would it feel if it was your family?”

The council debated for two hours. White council members asked if young children could get carbon monoxide poisoning from masks – no, the doctors firmly told them – and spoke portentously about individual rights.

“At the end of the day,” said councilman Brantley Lyons, “if a pandemic comes through, we do not throw our constitutional rights out the window.”

When the vote was called, it divided on largely racial lines. Black members voted for masks, in order to prevent more families losing six loved ones. White members voted against masks, to preserve the fundamental right not to attach a cloth to your face.

In a 4-4 tie, the ordinance failed. As he left the chamber, Dr Saliski uttered just one word: “Unbelievable.”

Unbelievable accurately describes America today. The country is on the brink of a huge surge of Covid-19, as the virus tears through the heartlands while the president praises himself for having done “a great job” and blithely predicts the scourge will “fade away”.

Ask Alabama whether the virus is fading away. Or Arizona, Florida, South Carolina or Texas. The disease is venting its fury on these states, which all reopened their economies – with Donald Trump’s avid blessing – before the contagion was contained.

“Opening while cases are increasing is like leaning into a left hook,” said Tom Frieden, a former CDC director. “You are basically asking to get hit – and that’s what these states did.”

Alabama is enduring a pummeling. It has recorded 32,000 cases and its curve is on a steep upward path.

The Republican governor of Texas, Greg Abbott, who ushered in one of the earliest and most aggressive reopenings, insisted a few days ago that his state “remains wide-open for business”. Yet he has been unable to ignore reality: that the virus has spread its lethal tentacles to every corner of the state overwhelming hospitals to the point that Houston medical centers are running out of ICU beds. Now, once again, Texas’ bars are closing. One town, near Houston, has even brought in a curfew.

The Lone Star state recorded 6,584 cases on Wednesday alone – a heart-sinking figure that makes its curve look almost vertical.

Florida’s malaise would be wryly amusing were so many lives not at stake. On 20 May the conservative magazine the National Review ran the gloating headline: “Where Does Ron DeSantis Go to Get His Apology?” The article scolded liberal critics of the Republican governor’s lax approach to coronavirus – he famously allowed beaches to remain open in spring break and has permitted shops and restaurants to get back to business – for having got it wrong: there was no spike in Florida.

On 20 May, Florida’s daily infection load stood at 527 new cases. Five weeks later, it reported a record 8,942 on Friday and broke the record again on Saturday with 9,585.

‘It’s getting worse, not better’

Though states such as Florida and Texas are bearing the brunt of the beating, this is not a catastrophe that can be dismissed as the problem of just a few places. Across the nation, at terrifying speed, a similar picture is revealing itself.

Every important data point, including positivity rates and hospitalizations, is surging across most states. A map produced by a team of epidemiologists and health experts, Covid Act Now, shows only four states, all in the north-east, including New York, which used to be at the center of the pandemic but has wrestled it under control, as being on track to contain the disease. Twenty-one states are at risk or facing active or imminent outbreaks.

It is troubling enough that the US now has 2.4m confirmed cases – double the number of the next highest country in the world, Brazil, and almost certainly a huge underestimate. The death toll has passed 125,000, with another 20,000 at least expected this month.

The death rate is still trending downwards – one bit of positive news in this sorry picture. But deaths lag behind confirmed cases by a month, and that spells trouble ahead.

One crumb of comfort had been that for almost three months the daily rate of new infections held steady at around 20,000 cases a day. Then, two weeks ago, the monster began to stir.

The tally of new cases ticked upwards, and on Thursday it reached a stomach-churning 40,000 – the worst day on record since the pandemic began.

“It’s getting worse, not better,” said Frieden, who now heads the global health initiative Resolve to Save Lives. “The contrast with other countries is striking. South Korea had 30 cases a day and they flipped out. The US now has 30,000 cases a day and there are people shrugging and saying ‘It’s no big deal’.”

Trump is shrugger-in-chief. When the president lured thousands of non-mask wearing supporters to a viral incubation party – he called it a rally – in Tulsa, Oklahoma, last Saturday, he told them that in his view testing for coronavirus was a “double-edged sword… When you do testing you are going to find more cases. So I told my people, slow the testing down.”

Despite White House efforts to pass the comment off as a joke, it encapsulates the Trump administration’s approach towards this devastating crisis. Early on, Trump failed to marshal the full weight of the most powerful government on Earth against the virus. He lost six critical weeks.

Even today, the 500,000 tests being carried out each day falls woefully short of the scale needed. Contact tracing – another crucial tool – is patchy at best, with signs that a growing number of Americans are unwilling to cooperate.

Leading public health experts have watched aghast as Trump has done exactly what he said he would: put a dampener on data-driven efforts that could, over the course of the pandemic, potentially save hundreds of thousands of lives.

“Everybody agrees we need a lot more testing,” said Ashish Jha, director of the Harvard Global Health Institute. “But when the conversation turns to, ‘Why can’t we ramp up the testing?’ there’s always the sense that the White House is not going to be happy to do what’s necessary. There’s real pushback against scientific leaders calling for action.”

Evidence for such a pushback isn’t hard to find. There’s this week’s announcement that the Trump administration will soon end federal funding for 13 testing sites – seven in ravaged Texas.

Then there’s the ghostlike absence of the CDC, one of the world’s leading public health agencies, which has fallen mute at the moment it is most needed. Frieden has become so frustrated by the booming silence of the institution he led for almost eight years, until Trump entered the White House, he has taken to publicising CDC research himself, in a desperate attempt to fill the void.

When the Guardian put it to him that this was an extraordinary state of affairs, Frieden replied: “It feels a bit like North Korea, doesn’t it?”

The most worrying aspect of the tone being set by Trump is that it is starting to shift the mindset of ordinary Americans. Everywhere you look there are anecdotal signs of people falling in line with the president – shrugging and saying it’s no big deal.

That trend is very visible in Montgomery. In the end, the town’s African American mayor, Steven Reed, overruled the city council’s white members and introduced mandatory mask-wearing by executive fiat.

But it will be an uphill battle persuading white townsfolk to abide by the ordinance. Brad Harper, a reporter with the Montgomery Advertiser, says he is struck whenever he goes into a Target or Walmart that almost all white shoppers go unmasked while black shoppers have their faces covered.

On social media, people rant about masks as “muzzles” and “badges of submission”. “People get really angry about it, resisting even their doctors asking them to wear it,” Harper said. “They don’t see a protective device, as something that can save the people around you, they see it as an instrument of control.”

All across the country, similar acts of personal rebellion are playing out. Residents of Palm Beach, Florida, erupted in anger against a mandatory mask order, calling it the “devil’s law” and an affront to “God’s breathing system”.

Further up the Florida coast, in Jacksonville Beach, 16 friends decided to have a night out at an Irish pub – the entire group came down with the virus, as well as seven bar workers. A surprise birthday party in Texas led to 18 members of one family being infected.

Crowds of unmasked people have been gathering in Las Vegas’s reopened casinos, and Covid-19 cases have soared. In Arizona, the Republican sheriff of Pinal county vowed not to enforce the lockdown on grounds of individual liberty, and promptly contracted the disease himself. Not to mention Cruisin’ Chubbys Gentleman’s Club, a strip club in Wisconsin that had its very own outbreak.

‘If you divide people, you allow divide and conquer’

Everywhere you look there are indications America’s social contract – the idea that if we stand united we can defeat this terrible affliction – is breaking down.

“If you divide people, you allow divide and conquer,” Frieden said. “This is us against them, humans against microbes. The more we are divided, the more microbes will conquer.”

Wändi Bruine de Bruin, provost professor of public policy, psychology and behavioral science at the University of Southern California, has been tracking the changing public response since March. Through a rolling survey of 7,000 adults, she has found that most Americans – about 71% – still say they avoid public spaces and crowds. But the proportion is falling, fast, down from 92% in April.

She puts the slide down to unclear messaging. “Messages and policies are no longer consistent. Some businesses are allowed to open, others not, and it’s not clear why. That leads to confusion, and anger. Some people start to think it’s not fair, others start to assume it’s not that important.”

Jha said it was vital to acknowledge that most Americans, including many Republicans, have so far been compliant with stay-at-home orders. But he frets that a mindset is taking hold that the virus is somebody else’s problem.

“I worry that it will take large numbers of people getting very sick, the hospitals filling up, for people to realise this is a pandemic, not a disease outbreak in New York or New Orleans. I hope it doesn’t come to that. I worry that it will.”

The Guardian asked whether he was concerned about possible public resistance to renewed lockdown orders, should some states be forced back into extreme measures in the face of a Covid-19 explosion.

“I do fear that,” he said. “For months there has been a concerted effort by a small minority to argue that this is overblown or a hoax. It will be difficult for Republican leaders to get people to change their views on this.”

Jha checked himself, then added: “It’s a tiny minority. Unfortunately, it includes the president of the United States.”

The good news is that scientists are very clear about what needs to be done. Frieden calls it the three Ws – wear a mask, wash your hands, watch your distance – combined with aggressive testing, contact tracing and isolation of the sick.

If such measures can be introduced concertedly and quickly, both at federal and state level, public health experts are confident that all is not lost. The contagion could be contained and the economy slowly and relatively safely rebooted.

But time is running out for America.

“This is a long war and we are losing a lot of battles right now, because we are not fighting them,” Frieden said. “We are going to be paying for the mistakes we make today for months, or even years, to come.”