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Westlake Legal Group > Posts tagged "China"

How Much Should the Public Know About Who Has the Coronavirus?

SAN JOSE, Calif. — When the first case of the coronavirus in Silicon Valley was discovered in late January, health officials were faced with a barrage of questions: What city did the patient live in? Who had he come in contact with? Which health clinic had he visited before he knew he was infected?

Dr. Sara Cody, the chief health officer for Santa Clara County, which has a population of two million across 15 cities, declined to give details.

“I can’t give the city,” she said, adding “we are not going to be giving out information about where he sought health care.”

As the coronavirus spreads across the United States the limited disclosure of data by officials would seem to be a footnote to the suffering and economic disruptions that the disease is causing.

But medical experts say that how much the public should know has become a critical question that will help determine how the United States confronts this outbreak and future ones.

Residents are clamoring to see whether the virus has been detected in their neighborhoods so they can take more steps to avoid any contact. American researchers are starved for data, unlike their colleagues in other countries who are harnessing rivers of information from their more centralized medical systems. And local politicians complain that they cannot provide basic information on the spread of the virus to their constituents.

In the perennial tug-of-war between privacy and transparency in the United States, privacy appears to be winning in the coronavirus pandemic.

ImageWestlake Legal Group merlin_170521239_a1f693b5-e179-4617-a50f-c47988c8ac74-articleLarge How Much Should the Public Know About Who Has the Coronavirus? Singapore Quarantines Privacy Coronavirus (2019-nCoV) China California
Credit…Glenn Chapman/Agence France-Presse — Getty Images

The bare-minimum approach to public disclosures in places like the San Francisco Bay Area are common across the United States. Armed with emergency powers in many areas, public health officers have vast discretion over what information they want, and do not want, to release to the public. Coronavirus cases in California are often listed by county, generally with very little additional information — such as gender, city of residence or age — provided.

Critics of the threadbare public reporting say it is striking that even in Silicon Valley, which is home to leading technology companies that thrive off the collection of data, residents are given very little information about the movement and dynamics of the virus.


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California, which has more than 4,600 cases, is a microcosm for how inconsistent the distribution of information has been during the pandemic. Los Angeles county provides a rough age distribution of patients and breaks down the cases into more than 140 cities and communities. On Friday, for example, the county reported 21 cases in Beverly Hills, 28 in the city of Santa Monica and 49 in the neighborhood of Melrose.

Across the United States there is even less consistency. New York is listing cases by age bracket, gender and borough despite calls for more localized reporting. Connecticut lists data by town. Florida provides its residents with a wealth of data on the pandemic. The state’s Department of Health has a detailed dashboard and reports showing the spread of the virus — rich with data on the cities affected, the number of people tested, the age brackets of patients, whether they are Florida residents, and the number of cases in nursing homes.

Health departments in the Bay Area make the case that releasing more granular data could heighten discrimination against certain communities where there might be clusters. The first cases in the Bay Area were among ethnic Chinese residents returning from trips to China.

“Pandemics increase paranoia and stigma,” said Dr. Rohan Radhakrishna, the deputy health officer of Contra Costa County, across the Bay from San Francisco, which provides only the total number of cases in the county on its website. “We must be extra cautious in protecting individuals and the community.”

In Santa Clara, health officials say they cannot disclose how many cases are found in each city because of the nation’s strict medical privacy law, the Health Insurance Portability and Accountability Act, or HIPAA, signed by President Bill Clinton in 1996.

But that law was designed for the protection of personal data at doctors’ offices and in hospitals and includes provisions for the release of otherwise protected information during emergencies.

Using the law as a justification for limiting the release of aggregate data about the coronavirus is “ridiculous,” according to Arthur L. Caplan, a professor of bioethics at the N.Y.U. School of Medicine in New York City.

Prof. Caplan is among many experts who say the coronavirus is likely to spur a reassessment of medical privacy laws. Already, the Trump Administration waived some provisions of the law this month.

“HIPAA was written for a time when there were paper charts,” Prof. Caplan said. The coronavirus, he said, “will cause us to rethink a lot of things.”

“We will also have to plan for better data exchange and testing,” he said.

The U.S. approach contrasts sharply with that of Singapore and Taiwan, whose fights against the virus have been praised as among the most effective. Both governments make public the suspected linkages of cases, anonymized by numbers. In Singapore the authorities sometimes list neighborhoods where patients lived, their workplaces and churches or mosques that they attended.

I. Glenn Cohen, an expert in bioethics at Harvard Law School, says the guiding principle during this crisis should be sharing more rather than less.

“Public health depends a lot on public trust,” he said. “If the public feels as though they are being misled or misinformed their willingness to make sacrifices — in this case social distancing — is reduced.”

“That’s a strong argument for sharing as much information as you can,” he said.

Experts also point out that it was the government’s suppression of information about the virus in China that allowed it to spread quickly before measures were taken to stem it.

On Friday the health authorities in Santa Clara, which has more than 590 cases and is home to the headquarters of companies like Google and Apple, added a dashboard that charts the number of daily cases and other metrics.

But the county’s public information office says it will not publicly disclose the number of cases in each city because doing so could make individuals more easily identifiable.

In a sign of how contested the question of public disclosure is, disagreement exists even within the Santa Clara County government.

Dr. Jeffrey V. Smith, the county executive, who is both a medical doctor and a lawyer, argues that more precise geographical information about the spread does not help combat the virus because it is already widespread.

“Reporting positive tests with a census tract or a city name provides data that is not helpful,” Dr. Smith said. “In fact, such data has the risk of stigmatizing areas and regions of the country in a way that does not help.”

But David Cortese, a member of the county’s board of supervisors, says that the public has the right to know more and that a patient’s identity is unlikely to be revealed by giving a breakdown of cases by city.

“I think when people can’t get information they freak out, they think something is being hidden from them, conspiracy theories grow, suspicions grow,” he said. “I think it’s always better to be as truthful, calmly, and transparent with the public as you can be.”

As an example, Mr. Cortese says he is alarmed that health officers have not made more information public on the coronavirus-related death of a homeless man in the county. Given the medical vulnerabilities of that population, doctors and advocates of homeless people have called his office demanding to know in which encampment the man lived so that they could advise other homeless people in the area to be more vigilant. The county, which refused to disclose that information, said in a statement that health officials screened 60 members of the “specific community” and tested nine symptomatic individuals for the coronavirus. All nine tests were negative, the county said.

Mr. Cortese says it is obvious to him that more information on the spread of the pandemic should be shared.

“At the height of the information age in Silicon Valley we have stumbled and fallen flat in terms of our ability to use the tools and resources that we have to get necessary information out to the people we serve,” Mr. Cortese said.

Frustration over the dearth of data also extends to epidemiologists trying to understand the dynamics of the spread of the virus.

Joseph Lewnard, a professor of epidemiology at the University of California, Berkeley School of Public Health, says researchers are hamstrung in the United States by the lack of specific data on testing and on the symptoms patients show.

To make up for the lack of public data, researchers are scraping information on cases from news outlets and other media accounts, he said. They are mainly relying on data from South Korea, China and Italy to try to predict the spread of the virus.

“We are right now learning and trying to project what is happening here in the United States almost entirely based on observations from these other countries,” Prof. Lewnard said.

Moritz Kraemer, a scholar at Oxford University who is leading a team of researchers in mapping the global spread of the coronavirus, says China’s data “provided incredible detail,” including a patient’s age, sex, travel history and history of chronic disease, as well as where the case was reported, and the dates of the onset of symptoms, hospitalization and confirmation of infection.

The United States, he said, “has been slow in collecting data in a systematic way.”

Dr. C. Jason Wang, a researcher at Stanford University, who has studied how Taiwan handled the coronavirus outbreak, says some of the measures taken in Taiwan would most likely not be accepted in the United States given privacy concerns. The government, for example, merged the airport immigration database with the national medical database so that doctors could immediately see if a patient had traveled out of the country.

But Dr. Wang says the proactive approach that Taiwan took to the virus, including aggressive tracing of cases, has helped keep the total number of confirmed infections — 283 on Saturday — much lower than experts initially expected. By comparison, the borough of Queens in New York City, with one-tenth the population of Taiwan, has 10,000 cases.

Some of the information being released to the public in Taiwan and Singapore would most likely be uncontroversial in the United States, he said. Taiwanese authorities, for example, have pointed out linkages between anonymized cases, including family clusters, in an effort to warn the public how easily the virus is transmitted within households.

Prof. Caplan of the N.Y.U. School of Medicine says it is paradoxical that the United States is providing less precise information to its citizens on the outbreak than Singapore, which puts limits on the spread of information through internet controls.

“Here we expect to get information so we have our choices and we make our decisions,” he said. “Our notion is information is the oxygen for democracy. Wouldn’t we want to receive more information than them?”

Real Estate, and Personal Injury Lawyers. Contact us at: https://westlakelegal.com 

The Lost Month: How a Failure to Test Blinded the U.S. to Covid-19

Westlake Legal Group the-lost-month-how-a-failure-to-test-blinded-the-u-s-to-covid-19 The Lost Month: How a Failure to Test Blinded the U.S. to Covid-19 World Health Organization White House Building (Washington, DC) United States Politics and Government United States Tests (Medical) SARS (Severe Acute Respiratory Syndrome) Regulation and Deregulation of Industry Redfield, Robert Quarantines Qiagen NV Pence, Mike National Center for Immunization and Respiratory Diseases Medicine and Health Health and Human Services Department Hahn, Stephen M (1960- ) Giroir, Brett P Food and Drug Administration Fauci, Anthony S Coronavirus (2019-nCoV) Chinese Centers for Disease Control and Prevention China Centers for Disease Control and Prevention BioFire Defense LLC Azar, Alex M II

WASHINGTON — Early on, the dozen federal officials charged with defending America against the coronavirus gathered day after day in the White House Situation Room, consumed by crises. They grappled with how to evacuate the United States consulate in Wuhan, China, ban Chinese travelers and extract Americans from the Diamond Princess and other cruise ships.

The members of the coronavirus task force typically devoted only five or 10 minutes, often at the end of contentious meetings, to talk about testing, several participants recalled. The Centers for Disease Control and Prevention, its leaders assured the others, had developed a diagnostic model that would be rolled out quickly as a first step.

But as the deadly virus from China spread with ferocity across the United States between late January and early March, large-scale testing of people who might have been infected did not happen — because of technical flaws, regulatory hurdles, business-as-usual bureaucracies and lack of leadership at multiple levels, according to interviews with more than 50 current and former public health officials, administration officials, senior scientists and company executives.

The result was a lost month, when the world’s richest country — armed with some of the most highly trained scientists and infectious disease specialists — squandered its best chance of containing the virus’s spread. Instead, Americans were left largely blind to the scale of a looming public health catastrophe.

The absence of robust screening until it was “far too late” revealed failures across the government, said Dr. Thomas Frieden, the former C.D.C. director. Jennifer Nuzzo, an epidemiologist at Johns Hopkins, said the Trump administration had “incredibly limited” views of the pathogen’s potential impact. Dr. Margaret Hamburg, the former commissioner of the Food and Drug Administration, said the lapse enabled “exponential growth of cases.”

And Dr. Anthony S. Fauci, a top government scientist involved in the fight against the virus, told members of Congress that the early inability to test was “a failing” of the administration’s response to a deadly, global pandemic. “Why,” he asked later in a magazine interview, “were we not able to mobilize on a broader scale?”

Across the government, they said, three agencies responsible for detecting and combating threats like the coronavirus failed to prepare quickly enough. Even as scientists looked at China and sounded alarms, none of the agencies’ directors conveyed the urgency required to spur a no-holds-barred defense.

Dr. Robert R. Redfield, 68, a former military doctor and prominent AIDS researcher who directs the C.D.C., trusted his veteran scientists to create the world’s most precise test for the coronavirus and share it with state laboratories. When flaws in the test became apparent in February, he promised a quick fix, though it took weeks to settle on a solution.

ImageWestlake Legal Group merlin_169661985_f0a9537e-3c7e-4bfa-83bd-af48456415be-articleLarge The Lost Month: How a Failure to Test Blinded the U.S. to Covid-19 World Health Organization White House Building (Washington, DC) United States Politics and Government United States Tests (Medical) SARS (Severe Acute Respiratory Syndrome) Regulation and Deregulation of Industry Redfield, Robert Quarantines Qiagen NV Pence, Mike National Center for Immunization and Respiratory Diseases Medicine and Health Health and Human Services Department Hahn, Stephen M (1960- ) Giroir, Brett P Food and Drug Administration Fauci, Anthony S Coronavirus (2019-nCoV) Chinese Centers for Disease Control and Prevention China Centers for Disease Control and Prevention BioFire Defense LLC Azar, Alex M II
Credit…Anna Moneymaker/The New York Times

The C.D.C. also tightly restricted who could get tested and was slow to conduct “community-based surveillance,” a standard screening practice to detect the virus’s reach. Had the United States been able to track its earliest movements and identify hidden hot spots, local quarantines might have confined the disease.

Dr. Stephen Hahn, 60, the commissioner of the Food and Drug Administration, enforced regulations that paradoxically made it tougher for hospitals, private clinics and companies to deploy diagnostic tests in an emergency. Other countries that had mobilized businesses were testing tens of thousands daily, compared with fewer than 100 on average in the United States, frustrating local health officials, lawmakers and desperate Americans.

Alex M. Azar II, who led the Department of Health and Human Services, oversaw the two other agencies and coordinated the government’s public health response to the pandemic. While he grew frustrated as public criticism over the testing issues intensified, he was unable to push either agency to speed up or change course.

Mr. Azar, 52, who chaired the coronavirus task force until late February, when Vice President Mike Pence took charge, had been at odds for months with the White House over other issues. The task force’s chief liaison to the president was Mick Mulvaney, the acting White House chief of staff, who was being forced out by Mr. Trump. Without high-level interest — or demands for action — the testing issue festered.

At the start of that crucial lost month, when his government could have rallied, the president was distracted by impeachment and dismissive of the threat to the public’s health or the nation’s economy. By the end of the month, Mr. Trump claimed the virus was about to dissipate in the United States, saying: “It’s going to disappear. One day — it’s like a miracle — it will disappear.”

By early March, after federal officials finally announced changes to allow more expansive testing, it was too late to escape serious harm.

Now, the United States has more than 100,000 coronavirus cases, the most of any country in the world. Yet even with deaths on the rise, cities shuttered, the economy sputtering and everyday life upended, many Americans who come down with symptoms of Covid-19 still cannot get tested.

In a statement, Judd Deere, a White House spokesman, said that “any suggestion that President Trump did not take the threat of Covid-19 seriously or that the United States was not prepared is false.” He added that at Mr. Trump’s direction, the administration had “expanded testing capacities.”

Dr. Bruce Aylward, a senior adviser at the World Health Organization, led an expert team to China last month to research the mysterious new virus. Testing, he said, was “absolutely vital” for understanding how to defeat a disease — what distinguishes it from others, the spectrum of illness and, most important, its path through populations.

“You want to know whether or not you have it,” Dr. Aylward said. “You want to know whether the people around you have it. Because you know what? Then you could stop it.”


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“You can’t stop it,” he warned, “if you can’t see it.”

The first time Dr. Robert Redfield heard about the severity of the virus from his Chinese counterparts was around New Year’s Day, when he was on vacation with his family. He spent so much time on the phone that they barely saw him. And what he heard rattled him; in one grim conversation about the virus days later, George F. Gao, the director of the Chinese Center for Disease Control and Prevention, burst into tears.

Dr. Redfield, a longtime AIDS researcher, had never run a government agency before his appointment to lead the C.D.C. in 2018. Until then, his biggest priorities had been fighting the opioid epidemic and the spread of H.I.V. Suddenly, a man who preferred treating patients in Haiti or Africa to being in the public glare was facing a new pandemic threat.

At first, Dr. Redfield’s agency moved quickly.

On Jan. 7, the C.D.C. created an “incident management system” for the coronavirus and advised travelers to Wuhan to take precautions. By Jan. 20, just two weeks after Chinese scientists shared the genetic sequence of the virus, the C.D.C. had developed its own test, as usual, and deployed it to detect the country’s first coronavirus case.

“That’s our prime mission,” Dr. Redfield said later in an interview, “to get eyes on this thing.”

Assessing the virus would prove challenging. It was so new that scientists had little information to work with. China provided limited data, and rebuffed an early attempt by Mr. Azar and Dr. Redfield to send C.D.C. experts there to learn more. That the virus could cause no symptoms and still spread — something not initially known — made it all the more difficult to understand.

To identify the virus, the C.D.C. test used three small genetic sequences to match up with portions of a virus’s genome extracted from a swab. A German-developed test that the W.H.O. was distributing to other countries used just two, potentially making it less precise.

But soon after the F.D.A. cleared the C.D.C. to share its test kits with state health department labs, some discovered a problem. The third sequence, or “probe,” gave inconclusive results. While the C.D.C. explored the cause — contamination or a design issue — it told those state labs to stop testing.

The startling setback stalled the C.D.C.’s efforts to track the virus when it mattered most. By mid-February, the nation was testing only about 100 people per day, according to the C.D.C.’s website.

Dr. Redfield played down the problem in task force meetings and conversations with Mr. Azar, assuring him it would be fixed quickly, several administration officials said.

With capacity so limited, the C.D.C.’s criteria for who was tested remained extremely narrow for weeks to come: only people who had recently traveled to China or had been in contact with someone who had the virus.

The lack of tests in the states also meant local public health officials could not use another essential epidemiological tool: surveillance testing. To see where the virus might be hiding, nasal swab samples from people screened for the common flu would also be checked for the coronavirus.

The C.D.C. announced a plan on Feb. 14 to perform the screening in five high-risk cities: New York, Chicago, Los Angeles, San Francisco and Seattle. An agency official said it could provide “an early warning signal to trigger a change in our response strategy.” But most of the cities could not carry it out.

“Had we had done more testing from the very beginning and caught cases earlier,” said Dr. Nuzzo, of Johns Hopkins, “we would be in a far different place.”

The consequences became clear by the end of February. For the first time, someone with no known exposure to the virus or history of travel tested positive, in the Seattle area, where the U.S.’s first case had been detected more than a month earlier. The virus had probably been spreading there and elsewhere for weeks, researchers later concluded. Without a more complete picture of who had been infected, public health workers could not do “contact tracing” — finding all those with whom any contagious people had interacted and then quarantining them to stop further transmission.

The C.D.C. gave little thought to adopting the test being used by the W.H.O. The C.D.C.’s test was working in its own lab — still processing samples from states — which gave agency officials confidence. Dr. Anne Schuchat, the agency’s principal deputy director, would later say that the C.D.C. did not think “we needed somebody else’s test.”

And the German-designed W.H.O. test had not been through the American regulatory approval process, which would take time.

Throughout February, Dr. Redfield shuttled between Atlanta, where the C.D.C. is based, and Washington, holding multiple calls every day with Mr. Azar and participating in the coronavirus task force.

Mr. Azar’s take-charge style contrasted with the more deliberative manner of Dr. Redfield, who lacked the kind of commanding television presence that impressed Mr. Trump. He was “a consensus person,” as one colleague described him, who sought to avoid conflict. He relied heavily on some of the C.D.C.’s career scientists, like Dr. Schuchat and Dr. Nancy Messonnier, the director of the agency’s National Center for Immunization and Respiratory Diseases.

Under scrutiny from Congress, Dr. Redfield offered reassurances. Responding on Feb. 24 to a letter from 49 members of Congress about the need for testing in the states, he wrote, “CDC’s aggressive response enables us to identify potential cases early and make sure that they are properly handled.”

Days later, his agency provided a workaround, telling state and local health department labs that they could finally begin testing. Rather than awaiting replacements, they should use their C.D.C. test kits and leave out the problematic third probe.

Meanwhile, the agency’s epidemiologists were growing more concerned as the virus spread in South Korea and Italy. On Feb. 25, Dr. Messonnier gave a briefing with a much blunter warning than usual. “Disruption to everyday life might be severe,” she said.

Mr. Trump, returning from a trip to India, was furious, according to senior administration officials. Later that day, Mr. Azar seemed to be tamping down the level of concern. All Dr. Messonnier had meant, he said at a news conference, was that people should “start thinking about, in their own lives, what that might involve.”

“Might,” Mr. Azar repeated emphatically. “Might involve.”

Dr. Stephen Hahn’s first day as F.D.A. commissioner came just six weeks before Mr. Azar declared a public health emergency on Jan. 31. A radiation oncologist and researcher who helped turn around MD Anderson in Houston, one of the nation’s leading cancer centers, Dr. Hahn had come to Washington to oversee a sprawling federal agency that regulates everything from lifesaving therapies to dog food.

But overnight, his mission — to manage 15,000 employees in a culture defined by precision and caution — was upended. A pathogen that Mr. Trump would later call the “invisible enemy” was hurtling toward the United States. It would fall to the newly arrived Dr. Hahn to help build a huge national capacity for testing by academic and private labs.

Instead, under his leadership, the F.D.A. became a significant roadblock, according to current and former officials as well as researchers and doctors at laboratories around the country.

Private-sector tests were supposed to be the next tier after the C.D.C. fulfilled its obligation to jump-start screening at public labs. In other countries hit hard by the coronavirus, governments acted quickly to speed tests to their populations. In South Korea, for example, regulators in early February summoned executives from 20 medical manufacturers, easing rules as they demanded tests.

But Dr. Hahn took a cautious approach. He was not proactive in reaching out to manufacturers, and instead deferred to his scientists, following the F.D.A.’s often cumbersome methods for approving medical screening.

Even the nation’s public health labs were looking for the F.D.A.’s help. “We are now many weeks into the response with still no diagnostic or surveillance test available outside of C.D.C. for the vast majority of our member laboratories,” Scott Becker, chief executive of the Association of Public Health Laboratories, wrote to Mr. Hahn in late February. “We believe a more expeditious route is needed at this time.”

Ironically, it was Mr. Azar’s emergency declaration that established the rules Dr. Hahn insisted on following. Designed to make it easier for drugmakers to pursue vaccines and other therapies during a crisis, such a declaration lets the F.D.A. speed approvals that could otherwise take a year or more.

But the emergency announcement created a new barrier for hospitals and laboratories that wanted to create their own tests to diagnose the coronavirus. Usually, they faced minimal federal regulation. But once Mr. Azar took action, they were subject to an F.D.A. process called an “emergency use authorization.”

Even though researchers around the country quickly began creating tests that could diagnose Covid-19, many said they were hindered by the F.D.A.’s approval process. The new tests sat unused at labs around the country.

Stanford was one of them. Researchers at the world-renowned university had a working test by February, based on protocols published by the W.H.O. The organization had already delivered more than 250,000 of the German-designed tests to 70 laboratories around the world, and doctors at the Stanford lab wanted to be prepared for a pandemic.

“Even if it didn’t come, it would be better to be ready than not to be ready,” said Dr. Benjamin Pinsky, the lab’s medical director.

But in the face of what he called “relatively tight” rules at the F.D.A., Dr. Pinsky and his colleagues decided against even trying to win permission. The Stanford clinical lab would not begin testing coronavirus samples until early March, when Dr. Hahn finally relaxed the rules.

Executives at bioMérieux, a French diagnostics company, had a similar experience. The company makes a countertop testing system, BioFire, that is routinely used to check for the flu and other respiratory illnesses in 1,700 hospitals around the country. It can provide results in about 45 minutes.

“A lot of us said, you know, your typical E.U.A. is just much too demanding,” said Dr. Mark Miller, the company’s chief medical officer, referring to the emergency approval. “It’s going to take much too much time. And can’t you do something to shorten that?”

Officials at the F.D.A. tried to be responsive, Dr. Miller said. But rather than throw out the rules, the agency only modified the regulatory requirements, still requiring weeks of discussions and negotiations.

After conversations with the F.D.A. in mid-February, the company received emergency approval for its BioFire test on March 24. (The company also began talking to the F.D.A. in January about another type of test, but decided not to pursue it in the United States for now.) Dr. Miller said that while he was ultimately satisfied with the F.D.A.’s actions, the overall response by the government was too slow, especially when it came to logistical questions like getting enough testing supplies to those who needed them.

“You’ve got other countries — and I’m sorry, unfortunately, the U.S. is one of those — where they’ve been slow, disorganized,” he said. “There are still not enough tests available there to test everybody who needs it.”

In an emailed statement, Dr. Hahn maintained that his agency had moved as quickly as it safely could to ensure that tests would be accurate. “Since the early days of this pandemic,” he said, “the F.D.A.’s doors have always been and still remain open to test developers.”

Alex Azar had sounded confident at the end of January. At a news conference in the hulking H.H.S. headquarters in Washington, he said he had the government’s response to the new coronavirus under control, pointing out high-ranking jobs he had held in the department during the 2003 SARS outbreak and other infectious threats.

“I know this playbook well,” he told reporters.

A Yale-trained lawyer who once served as the top attorney at the health department, Mr. Azar had spent a decade as a top executive at Eli Lilly, one of the world’s largest drug companies. But he caught Mr. Trump’s attention in part because of other credentials: After law school, Mr. Azar was a clerk for some of the nation’s most conservative judges, including Justice Antonin Scalia of the Supreme Court. And for two years, he worked as Ken Starr’s deputy on the Clinton Whitewater investigation.

As Mr. Trump’s second health secretary, confirmed at the beginning of 2018, Mr. Azar has been quick to compliment the president and focus on the issues he cares about: lowering drug prices and fighting opioid addiction. On Feb. 6 — even as the W.H.O. announced that there were more than 28,000 coronavirus cases around the globe — Mr. Azar was in the second row in the White House’s East Room, demonstrating his loyalty to the president as Mr. Trump claimed vindication from his impeachment acquittal the day before and lashed out at “evil” lawmakers and the F.B.I.’s “top scum.”

As public attention on the virus threat intensified in January and February, Mr. Azar grew increasingly frustrated about the harsh spotlight on his department and the leaders of agencies who reported to him, according to people familiar with the response to the virus inside the agencies.

Described as a prickly boss by some administration officials, Mr. Azar has had a longstanding feud with Seema Verma, the Medicare and Medicaid chief, who recently became a regular presence at Mr. Trump’s televised briefings on the pandemic. Mr. Azar did not include Dr. Hahn on the virus task force he led, though some of the F.D.A. commissioner’s aides participated in H.H.S. meetings on the subject.

And tensions grew between the secretary and Dr. Redfield as the testing issue persisted. Mr. Azar and Dr. Redfield have been on the phone as often as a half-dozen times a day. But throughout February, as the C.D.C. test faltered, Mr. Azar became convinced that Dr. Redfield’s agency was providing him with inaccurate information about testing that the secretary repeated publicly, according to several administration officials.

In one instance, Mr. Azar appeared on Sunday morning news programs and said that more than 3,600 people had been tested for the virus. In fact, the real number was much smaller because many patients were tested multiple times, an error the C.D.C. had to correct in congressional testimony that week. One health department official said Mr. Azar was repeatedly assured that the C.D.C.’s test would be widely available within a week or 10 days, only to be given the same promise a week later.

Asked about criticism of his agency’s response to the pandemic, Dr. Redfield said: “I’m personally not focused on whether they’re pointing fingers here or there. We’re focused on doing all we can to get through this outbreak as quickly as possible and keep America safe.”

For all Mr. Azar’s complaints, however, he continued to defer to the scientists at the two agencies, according to several administration officials. Mr. Azar’s allies said he was told by Dr. Redfield and Dr. Fauci that the C.D.C. had the resources it needed, that there was no reason to believe the virus was spreading through the country from person to person and that it was important to test only people who met certain criteria.

But even in the face of a crescendo of complaints from doctors and health care researchers around the country, Mr. Azar failed to push those under him to do the one thing that could have helped: broader testing.

In a statement, Caitlin Oakley, Mr. Azar’s spokeswoman, said that the secretary had “empowered and followed the guidance of world-renowned U.S. scientists” on the testing issue. “Any insinuation that Secretary Azar did not respond with needed urgency to the response or testing efforts,” she said, “are just plain wrong and disproven by the facts.”

By Feb. 26, Dr. Fauci was concerned that the stalled testing had become an urgent issue that needed to be addressed. He called Brian Harrison, Mr. Azar’s chief of staff, and asked him to gather the group of officials overseeing screening efforts.

Around noon on Feb. 27, Dr. Hahn, Dr. Redfield and top aides from the F.D.A. and H.H.S. dialed in to a conference call. Mr. Harrison began with an ultimatum: No one leaves until we resolve the lag in testing. We don’t have answers and we need them, one senior administration official recalled him saying. Get it done.

By the end of the day, the group agreed that the F.D.A. should loosen regulations so that hospitals and independent labs could move forward quickly with their own tests.

But the evening before, Mr. Azar had been effectively removed as the leader of the task force when Mr. Trump abruptly put Mr. Pence in charge, a decision so last-minute that even the top health officials in the White House learned of it while watching the announcement.

Previous presidents have moved quickly to confront disease threats from inside the White House by installing a “czar” to manage the effort.

During an outbreak of the Ebola virus in 2014, President Barack Obama tapped Ron Klain, his vice president’s former chief of staff, to direct the response from the West Wing. Mr. Obama later created an office of global health security inside the National Security Council to coordinate future crises.

“If you look historically in the United States when it is challenged with something like this — whether it’s H.I.V. crises, whether it’s pandemic, whether it’s whatever — man, they pull out all the stops across the system and they make it work,” said Dr. Aylward, the W.H.O. epidemiologist.

But faced with the coronavirus, Mr. Trump chose not to have the White House lead the planning until nearly two months after it began. Mr. Obama’s global health office had been disbanded a year earlier. And until Mr. Pence took charge, the task force lacked a single White House official with the power to compel action.

Since then, testing has ramped up quickly, with nearly 100 labs at hospitals and elsewhere performing it. On Friday, the health care giant Abbott said it had received emergency approval for a portable test that could detect the virus in five minutes.

The president boasted on Tuesday that the United States had “created a new system that now we are doing unbelievably big numbers” of tests for the virus. The U.S., he said, had done more testing for the coronavirus in the last eight days than South Korea had done in eight weeks.

Yet hospitals and clinics across the country still must deny tests to those with milder symptoms, trying to save them for the most serious cases, and they often wait a week for results. In tacit acknowledgment of the shortage, Mr. Trump asked South Korea’s president on Monday to send as many test kits as possible from the 100,000 produced there daily, more than the country needs.

Public health experts reacted positively to the increased capacity. But having the ability to diagnose the disease three months after it was first disclosed by China does little to address why the United States was unable to do so sooner, when it might have helped reduce the toll of the pandemic.

“Testing is the crack that split apart the rest of the response, when it should have tied everything together,” said Dr. Nahid Bhadelia, ​the medical director of the Special Pathogens Unit at Boston University School of Medicine.

“It seeps into every other aspect of our response, touches all of us,” she said. “The delay of the testing has impacted the response across the board.”

Eric Lipton contributed reporting from Washington and Choe Sang-Hun from Seoul, South Korea.

Real Estate, and Personal Injury Lawyers. Contact us at: https://westlakelegal.com 

The Lost Month: How a Failure to Test Blinded the U.S. to Covid-19

WASHINGTON — Early on, the dozen federal officials charged with defending America against the coronavirus gathered day after day in the White House Situation Room, consumed by crises. They grappled with how to evacuate the United States consulate in Wuhan, China, ban Chinese travelers and extract Americans from the Diamond Princess and other cruise ships.

The members of the coronavirus task force typically devoted only five or 10 minutes, often at the end of contentious meetings, to talk about testing, several participants recalled. The Centers for Disease Control and Prevention, its leaders assured the others, had developed a diagnostic model that would be rolled out quickly as a first step.

But as the deadly virus from China spread with ferocity across the United States between late January and early March, large-scale testing of people who might have been infected did not happen — because of technical flaws, regulatory hurdles, business-as-usual bureaucracies and lack of leadership at multiple levels, according to interviews with more than 50 current and former public health officials, administration officials, senior scientists and company executives.

The result was a lost month, when the world’s richest country — armed with some of the most highly trained scientists and infectious disease specialists — squandered its best chance of containing the virus’s spread. Instead, Americans were left largely blind to the scale of a looming public health catastrophe.

The absence of robust screening until it was “far too late” revealed failures across the government, said Dr. Thomas Frieden, the former C.D.C. director. Jennifer Nuzzo, an epidemiologist at Johns Hopkins, said the Trump administration had “incredibly limited” views of the pathogen’s potential impact. Dr. Margaret Hamburg, the former commissioner of the Food and Drug Administration, said the lapse enabled “exponential growth of cases.”

And Dr. Anthony S. Fauci, a top government scientist involved in the fight against the virus, told members of Congress that the early inability to test was “a failing” of the administration’s response to a deadly, global pandemic. “Why,” he asked later in a magazine interview, “were we not able to mobilize on a broader scale?”

Across the government, they said, three agencies responsible for detecting and combating threats like the coronavirus failed to prepare quickly enough. Even as scientists looked at China and sounded alarms, none of the agencies’ directors conveyed the urgency required to spur a no-holds-barred defense.

Dr. Robert R. Redfield, 68, a former military doctor and prominent AIDS researcher who directs the C.D.C., trusted his veteran scientists to create the world’s most precise test for the coronavirus and share it with state laboratories. When flaws in the test became apparent in February, he promised a quick fix, though it took weeks to settle on a solution.

ImageWestlake Legal Group merlin_169661985_f0a9537e-3c7e-4bfa-83bd-af48456415be-articleLarge The Lost Month: How a Failure to Test Blinded the U.S. to Covid-19 World Health Organization White House Building (Washington, DC) United States Politics and Government United States Tests (Medical) SARS (Severe Acute Respiratory Syndrome) Regulation and Deregulation of Industry Redfield, Robert Quarantines Qiagen NV Pence, Mike National Center for Immunization and Respiratory Diseases Medicine and Health Health and Human Services Department Hahn, Stephen M (1960- ) Giroir, Brett P Food and Drug Administration Fauci, Anthony S Coronavirus (2019-nCoV) Chinese Centers for Disease Control and Prevention China Centers for Disease Control and Prevention BioFire Defense LLC Azar, Alex M II
Credit…Anna Moneymaker/The New York Times

The C.D.C. also tightly restricted who could get tested and was slow to conduct “community-based surveillance,” a standard screening practice to detect the virus’s reach. Had the United States been able to track its earliest movements and identify hidden hot spots, local quarantines might have confined the disease.

Dr. Stephen Hahn, 60, the commissioner of the Food and Drug Administration, enforced regulations that paradoxically made it tougher for hospitals, private clinics and companies to deploy diagnostic tests in an emergency. Other countries that had mobilized businesses were testing tens of thousands daily, compared with fewer than 100 on average in the United States, frustrating local health officials, lawmakers and desperate Americans.

Alex M. Azar II, who led the Department of Health and Human Services, oversaw the two other agencies and coordinated the government’s public health response to the pandemic. While he grew frustrated as public criticism over the testing issues intensified, he was unable to push either agency to speed up or change course.

Mr. Azar, 52, who chaired the coronavirus task force until late February, when Vice President Mike Pence took charge, had been at odds for months with the White House over other issues. The task force’s chief liaison to the president was Mick Mulvaney, the acting White House chief of staff, who was being forced out by Mr. Trump. Without high-level interest — or demands for action — the testing issue festered.

At the start of that crucial lost month, when his government could have rallied, the president was distracted by impeachment and dismissive of the threat to the public’s health or the nation’s economy. By the end of the month, Mr. Trump claimed the virus was about to dissipate in the United States, saying: “It’s going to disappear. One day — it’s like a miracle — it will disappear.”

By early March, after federal officials finally announced changes to allow more expansive testing, it was too late to escape serious harm.

Now, the United States has more than 100,000 coronavirus cases, the most of any country in the world. Yet even with deaths on the rise, cities shuttered, the economy sputtering and everyday life upended, many Americans who come down with symptoms of Covid-19 still cannot get tested.

In a statement, Judd Deere, a White House spokesman, said that “any suggestion that President Trump did not take the threat of Covid-19 seriously or that the United States was not prepared is false.” He added that at Mr. Trump’s direction, the administration had “expanded testing capacities.”

Dr. Bruce Aylward, a senior adviser at the World Health Organization, led an expert team to China last month to research the mysterious new virus. Testing, he said, was “absolutely vital” for understanding how to defeat a disease — what distinguishes it from others, the spectrum of illness and, most important, its path through populations.

“You want to know whether or not you have it,” Dr. Aylward said. “You want to know whether the people around you have it. Because you know what? Then you could stop it.”


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“You can’t stop it,” he warned, “if you can’t see it.”

The first time Dr. Robert Redfield heard about the severity of the virus from his Chinese counterparts was around New Year’s Day, when he was on vacation with his family. He spent so much time on the phone that they barely saw him. And what he heard rattled him; in one grim conversation about the virus days later, George F. Gao, the director of the Chinese Center for Disease Control and Prevention, burst into tears.

Dr. Redfield, a longtime AIDS researcher, had never run a government agency before his appointment to lead the C.D.C. in 2018. Until then, his biggest priorities had been fighting the opioid epidemic and the spread of H.I.V. Suddenly, a man who preferred treating patients in Haiti or Africa to being in the public glare was facing a new pandemic threat.

At first, Dr. Redfield’s agency moved quickly.

On Jan. 7, the C.D.C. created an “incident management system” for the coronavirus and advised travelers to Wuhan to take precautions. By Jan. 20, just two weeks after Chinese scientists shared the genetic sequence of the virus, the C.D.C. had developed its own test, as usual, and deployed it to detect the country’s first coronavirus case.

“That’s our prime mission,” Dr. Redfield said later in an interview, “to get eyes on this thing.”

Assessing the virus would prove challenging. It was so new that scientists had little information to work with. China provided limited data, and rebuffed an early attempt by Mr. Azar and Dr. Redfield to send C.D.C. experts there to learn more. That the virus could cause no symptoms and still spread — something not initially known — made it all the more difficult to understand.

To identify the virus, the C.D.C. test used three small genetic sequences to match up with portions of a virus’s genome extracted from a swab. A German-developed test that the W.H.O. was distributing to other countries used just two, potentially making it less precise.

But soon after the F.D.A. cleared the C.D.C. to share its test kits with state health department labs, some discovered a problem. The third sequence, or “probe,” gave inconclusive results. While the C.D.C. explored the cause — contamination or a design issue — it told those state labs to stop testing.

The startling setback stalled the C.D.C.’s efforts to track the virus when it mattered most. By mid-February, the nation was testing only about 100 people per day, according to the C.D.C.’s website.

Dr. Redfield played down the problem in task force meetings and conversations with Mr. Azar, assuring him it would be fixed quickly, several administration officials said.

With capacity so limited, the C.D.C.’s criteria for who was tested remained extremely narrow for weeks to come: only people who had recently traveled to China or had been in contact with someone who had the virus.

The lack of tests in the states also meant local public health officials could not use another essential epidemiological tool: surveillance testing. To see where the virus might be hiding, nasal swab samples from people screened for the common flu would also be checked for the coronavirus.

The C.D.C. announced a plan on Feb. 14 to perform the screening in five high-risk cities: New York, Chicago, Los Angeles, San Francisco and Seattle. An agency official said it could provide “an early warning signal to trigger a change in our response strategy.” But most of the cities could not carry it out.

“Had we had done more testing from the very beginning and caught cases earlier,” said Dr. Nuzzo, of Johns Hopkins, “we would be in a far different place.”

The consequences became clear by the end of February. For the first time, someone with no known exposure to the virus or history of travel tested positive, in the Seattle area, where the U.S.’s first case had been detected more than a month earlier. The virus had probably been spreading there and elsewhere for weeks, researchers later concluded. Without a more complete picture of who had been infected, public health workers could not do “contact tracing” — finding all those with whom any contagious people had interacted and then quarantining them to stop further transmission.

The C.D.C. gave little thought to adopting the test being used by the W.H.O. The C.D.C.’s test was working in its own lab — still processing samples from states — which gave agency officials confidence. Dr. Anne Schuchat, the agency’s principal deputy director, would later say that the C.D.C. did not think “we needed somebody else’s test.”

And the German-designed W.H.O. test had not been through the American regulatory approval process, which would take time.

Throughout February, Dr. Redfield shuttled between Atlanta, where the C.D.C. is based, and Washington, holding multiple calls every day with Mr. Azar and participating in the coronavirus task force.

Mr. Azar’s take-charge style contrasted with the more deliberative manner of Dr. Redfield, who lacked the kind of commanding television presence that impressed Mr. Trump. He was “a consensus person,” as one colleague described him, who sought to avoid conflict. He relied heavily on some of the C.D.C.’s career scientists, like Dr. Schuchat and Dr. Nancy Messonnier, the director of the agency’s National Center for Immunization and Respiratory Diseases.

Under scrutiny from Congress, Dr. Redfield offered reassurances. Responding on Feb. 24 to a letter from 49 members of Congress about the need for testing in the states, he wrote, “CDC’s aggressive response enables us to identify potential cases early and make sure that they are properly handled.”

Days later, his agency provided a workaround, telling state and local health department labs that they could finally begin testing. Rather than awaiting replacements, they should use their C.D.C. test kits and leave out the problematic third probe.

Meanwhile, the agency’s epidemiologists were growing more concerned as the virus spread in South Korea and Italy. On Feb. 25, Dr. Messonnier gave a briefing with a much blunter warning than usual. “Disruption to everyday life might be severe,” she said.

Mr. Trump, returning from a trip to India, was furious, according to senior administration officials. Later that day, Mr. Azar seemed to be tamping down the level of concern. All Dr. Messonnier had meant, he said at a news conference, was that people should “start thinking about, in their own lives, what that might involve.”

“Might,” Mr. Azar repeated emphatically. “Might involve.”

Dr. Stephen Hahn’s first day as F.D.A. commissioner came just six weeks before Mr. Azar declared a public health emergency on Jan. 31. A radiation oncologist and researcher who helped turn around MD Anderson in Houston, one of the nation’s leading cancer centers, Dr. Hahn had come to Washington to oversee a sprawling federal agency that regulates everything from lifesaving therapies to dog food.

But overnight, his mission — to manage 15,000 employees in a culture defined by precision and caution — was upended. A pathogen that Mr. Trump would later call the “invisible enemy” was hurtling toward the United States. It would fall to the newly arrived Dr. Hahn to help build a huge national capacity for testing by academic and private labs.

Instead, under his leadership, the F.D.A. became a significant roadblock, according to current and former officials as well as researchers and doctors at laboratories around the country.

Private-sector tests were supposed to be the next tier after the C.D.C. fulfilled its obligation to jump-start screening at public labs. In other countries hit hard by the coronavirus, governments acted quickly to speed tests to their populations. In South Korea, for example, regulators in early February summoned executives from 20 medical manufacturers, easing rules as they demanded tests.

But Dr. Hahn took a cautious approach. He was not proactive in reaching out to manufacturers, and instead deferred to his scientists, following the F.D.A.’s often cumbersome methods for approving medical screening.

Even the nation’s public health labs were looking for the F.D.A.’s help. “We are now many weeks into the response with still no diagnostic or surveillance test available outside of C.D.C. for the vast majority of our member laboratories,” Scott Becker, chief executive of the Association of Public Health Laboratories, wrote to Mr. Hahn in late February. “We believe a more expeditious route is needed at this time.”

Ironically, it was Mr. Azar’s emergency declaration that established the rules Dr. Hahn insisted on following. Designed to make it easier for drugmakers to pursue vaccines and other therapies during a crisis, such a declaration lets the F.D.A. speed approvals that could otherwise take a year or more.

But the emergency announcement created a new barrier for hospitals and laboratories that wanted to create their own tests to diagnose the coronavirus. Usually, they faced minimal federal regulation. But once Mr. Azar took action, they were subject to an F.D.A. process called an “emergency use authorization.”

Even though researchers around the country quickly began creating tests that could diagnose Covid-19, many said they were hindered by the F.D.A.’s approval process. The new tests sat unused at labs around the country.

Stanford was one of them. Researchers at the world-renowned university had a working test by February, based on protocols published by the W.H.O. The organization had already delivered more than 250,000 of the German-designed tests to 70 laboratories around the world, and doctors at the Stanford lab wanted to be prepared for a pandemic.

“Even if it didn’t come, it would be better to be ready than not to be ready,” said Dr. Benjamin Pinsky, the lab’s medical director.

But in the face of what he called “relatively tight” rules at the F.D.A., Dr. Pinsky and his colleagues decided against even trying to win permission. The Stanford clinical lab would not begin testing coronavirus samples until early March, when Dr. Hahn finally relaxed the rules.

Executives at bioMérieux, a French diagnostics company, had a similar experience. The company makes a countertop testing system, BioFire, that is routinely used to check for the flu and other respiratory illnesses in 1,700 hospitals around the country. It can provide results in about 45 minutes.

“A lot of us said, you know, your typical E.U.A. is just much too demanding,” said Dr. Mark Miller, the company’s chief medical officer, referring to the emergency approval. “It’s going to take much too much time. And can’t you do something to shorten that?”

Officials at the F.D.A. tried to be responsive, Dr. Miller said. But rather than throw out the rules, the agency only modified the regulatory requirements, still requiring weeks of discussions and negotiations.

After conversations with the F.D.A. in mid-February, the company received emergency approval for its BioFire test on March 24. (The company also began talking to the F.D.A. in January about another type of test, but decided not to pursue it in the United States for now.) Dr. Miller said that while he was ultimately satisfied with the F.D.A.’s actions, the overall response by the government was too slow, especially when it came to logistical questions like getting enough testing supplies to those who needed them.

“You’ve got other countries — and I’m sorry, unfortunately, the U.S. is one of those — where they’ve been slow, disorganized,” he said. “There are still not enough tests available there to test everybody who needs it.”

In an emailed statement, Dr. Hahn maintained that his agency had moved as quickly as it safely could to ensure that tests would be accurate. “Since the early days of this pandemic,” he said, “the F.D.A.’s doors have always been and still remain open to test developers.”

Alex Azar had sounded confident at the end of January. At a news conference in the hulking H.H.S. headquarters in Washington, he said he had the government’s response to the new coronavirus under control, pointing out high-ranking jobs he had held in the department during the 2003 SARS outbreak and other infectious threats.

“I know this playbook well,” he told reporters.

A Yale-trained lawyer who once served as the top attorney at the health department, Mr. Azar had spent a decade as a top executive at Eli Lilly, one of the world’s largest drug companies. But he caught Mr. Trump’s attention in part because of other credentials: After law school, Mr. Azar was a clerk for some of the nation’s most conservative judges, including Justice Antonin Scalia of the Supreme Court. And for two years, he worked as Ken Starr’s deputy on the Clinton Whitewater investigation.

As Mr. Trump’s second health secretary, confirmed at the beginning of 2018, Mr. Azar has been quick to compliment the president and focus on the issues he cares about: lowering drug prices and fighting opioid addiction. On Feb. 6 — even as the W.H.O. announced that there were more than 28,000 coronavirus cases around the globe — Mr. Azar was in the second row in the White House’s East Room, demonstrating his loyalty to the president as Mr. Trump claimed vindication from his impeachment acquittal the day before and lashed out at “evil” lawmakers and the F.B.I.’s “top scum.”

As public attention on the virus threat intensified in January and February, Mr. Azar grew increasingly frustrated about the harsh spotlight on his department and the leaders of agencies who reported to him, according to people familiar with the response to the virus inside the agencies.

Described as a prickly boss by some administration officials, Mr. Azar has had a longstanding feud with Seema Verma, the Medicare and Medicaid chief, who recently became a regular presence at Mr. Trump’s televised briefings on the pandemic. Mr. Azar did not include Dr. Hahn on the virus task force he led, though some of the F.D.A. commissioner’s aides participated in H.H.S. meetings on the subject.

And tensions grew between the secretary and Dr. Redfield as the testing issue persisted. Mr. Azar and Dr. Redfield have been on the phone as often as a half-dozen times a day. But throughout February, as the C.D.C. test faltered, Mr. Azar became convinced that Dr. Redfield’s agency was providing him with inaccurate information about testing that the secretary repeated publicly, according to several administration officials.

In one instance, Mr. Azar appeared on Sunday morning news programs and said that more than 3,600 people had been tested for the virus. In fact, the real number was much smaller because many patients were tested multiple times, an error the C.D.C. had to correct in congressional testimony that week. One health department official said Mr. Azar was repeatedly assured that the C.D.C.’s test would be widely available within a week or 10 days, only to be given the same promise a week later.

Asked about criticism of his agency’s response to the pandemic, Dr. Redfield said: “I’m personally not focused on whether they’re pointing fingers here or there. We’re focused on doing all we can to get through this outbreak as quickly as possible and keep America safe.”

For all Mr. Azar’s complaints, however, he continued to defer to the scientists at the two agencies, according to several administration officials. Mr. Azar’s allies said he was told by Dr. Redfield and Dr. Fauci that the C.D.C. had the resources it needed, that there was no reason to believe the virus was spreading through the country from person to person and that it was important to test only people who met certain criteria.

But even in the face of a crescendo of complaints from doctors and health care researchers around the country, Mr. Azar failed to push those under him to do the one thing that could have helped: broader testing.

In a statement, Caitlin Oakley, Mr. Azar’s spokeswoman, said that the secretary had “empowered and followed the guidance of world-renowned U.S. scientists” on the testing issue. “Any insinuation that Secretary Azar did not respond with needed urgency to the response or testing efforts,” she said, “are just plain wrong and disproven by the facts.”

By Feb. 26, Dr. Fauci was concerned that the stalled testing had become an urgent issue that needed to be addressed. He called Brian Harrison, Mr. Azar’s chief of staff, and asked him to gather the group of officials overseeing screening efforts.

Around noon on Feb. 27, Dr. Hahn, Dr. Redfield and top aides from the F.D.A. and H.H.S. dialed in to a conference call. Mr. Harrison began with an ultimatum: No one leaves until we resolve the lag in testing. We don’t have answers and we need them, one senior administration official recalled him saying. Get it done.

By the end of the day, the group agreed that the F.D.A. should loosen regulations so that hospitals and independent labs could move forward quickly with their own tests.

But the evening before, Mr. Azar had been effectively removed as the leader of the task force when Mr. Trump abruptly put Mr. Pence in charge, a decision so last-minute that even the top health officials in the White House learned of it while watching the announcement.

Previous presidents have moved quickly to confront disease threats from inside the White House by installing a “czar” to manage the effort.

During an outbreak of the Ebola virus in 2014, President Barack Obama tapped Ron Klain, his vice president’s former chief of staff, to direct the response from the West Wing. Mr. Obama later created an office of global health security inside the National Security Council to coordinate future crises.

“If you look historically in the United States when it is challenged with something like this — whether it’s H.I.V. crises, whether it’s pandemic, whether it’s whatever — man, they pull out all the stops across the system and they make it work,” said Dr. Aylward, the W.H.O. epidemiologist.

But faced with the coronavirus, Mr. Trump chose not to have the White House lead the planning until nearly two months after it began. Mr. Obama’s global health office had been disbanded a year earlier. And until Mr. Pence took charge, the task force lacked a single White House official with the power to compel action.

Since then, testing has ramped up quickly, with nearly 100 labs at hospitals and elsewhere performing it. On Friday, the health care giant Abbott said it had received emergency approval for a portable test that could detect the virus in five minutes.

The president boasted on Tuesday that the United States had “created a new system that now we are doing unbelievably big numbers” of tests for the virus. The U.S., he said, had done more testing for the coronavirus in the last eight days than South Korea had done in eight weeks.

Yet hospitals and clinics across the country still must deny tests to those with milder symptoms, trying to save them for the most serious cases, and they often wait a week for results. In tacit acknowledgment of the shortage, Mr. Trump asked South Korea’s president on Monday to send as many test kits as possible from the 100,000 produced there daily, more than the country needs.

Public health experts reacted positively to the increased capacity. But having the ability to diagnose the disease three months after it was first disclosed by China does little to address why the United States was unable to do so sooner, when it might have helped reduce the toll of the pandemic.

“Testing is the crack that split apart the rest of the response, when it should have tied everything together,” said Dr. Nahid Bhadelia, ​the medical director of the Special Pathogens Unit at Boston University School of Medicine.

“It seeps into every other aspect of our response, touches all of us,” she said. “The delay of the testing has impacted the response across the board.”

Eric Lipton contributed reporting from Washington and Choe Sang-Hun from Seoul, South Korea.

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Garvan Walshe: South Korea, Taiwan and Germany gained from mass testing. Why have we been so slow?

Garvan Walshe is a former national and international security policy adviser to the Conservative Party.

Yesterday, Greg Clark held a masterful session of the Science and Technology Committee hearing into the UK’s response to the coronavirus. This was democratic deliberation at its best. Careful posing of questions designed to elicit information, informed contributions by the MPs present (who observed social distancing guidelines), free of the grandstanding to which these committee’s are prone.

Some of this has to do with the seriousness of the moment; the rest down to Clark’s serious and empirical personality. At a time of emergency like this, his talents should be deployed in government fighting this epidemic; though it is partial compensation that he has been able to shed light on an area where policy has shifted, communication has been less than transparent and, it appears, vital time has been lost.

The implications of that time being lost were set out by Neil Ferguson of Imperial college, who gave evidence at the hearing. Now that the lockdown has been imposed in the UK, he told the committee that deaths from the coronavirus were “unlikely to exceed 20,000”.

While this is a huge improvement on the 200,000 to 500,000 deaths that his model predicted, had the Government continued with its previous policy that classified a 60 per cent infection rate as “desirable”, it needs to be put in perspective.

Total deaths in Hubei, China, which has about the same population as the UK have so far been recorded as being about 3,100. Italy, with about the same population as the UK, but with a significantly greater acute bed capacity, has so far recored 6,000 deaths.

Now that Italy has been under lockdown for between two and three weeks, the rate of transmission of infection there has slowed, and the epidemic there may well have peaked. If it declines at the same rate it grew (a reasonable, though not always correct, assumption), a rough estimate of about 12,000 deaths there would be expected.

It is not unreasonable to conclude that the UK could be on track for an Italian-style scenario, in which overall intensive care capacity is sufficient, but it is not located in the right places, producing real pressure in places where demand is high and capacity low. This was entirely avoidable.

The evidence presented at the committee points to a number of serious errors of judgement made in the UK in its response to the outbreak. To see which, it is necessary to identify the constraints on a response to a disease for which there is no vaccine or treatment.

Two kinds of measures are required to combat the epidemic: supportive care to keep patients alive while their immune system fights off the infection, and the reduction of opportunities for the infection to spread. The constraint on the former is the health system’s capacity to provide that care: in this case, intensive care capacity that keeps people breathing even as the virus attacks their lungs.

On the latter, it is the ability to identify people with the virus so they can be cared for and isolated: in short, venitlators and testing. If the former capacity is exceeded, doctors are unable to treat everyone who need intensive care, and are forced to make agonising choices about who is to be left to die, as is happening in Bergamo. If the latter capacity is exceeded, then mass social distancing measures are needed, as is happening in most of Europe and parts of the United States.

South Korea and Taiwan, which built up experience from their own failures in the SARS epidemic, were ready with testing and tracking sytems that have contained the spread of the virus, even though, because of proximity, they had huge exposure to China. In Europe, Norway and Germany were able to expand their testing capacity in time, which has slowed down the spread of the disase and have kept fatality rates low (because they identify a greater number of cases).

A study by the scientists at the London School of Hygiene and Tropical Medicine, for example, estimates the UK is only reporting six per cent of all cases, compared to Germany’s 69 per cent. If these figures are accurate, the total number of cases in the UK would be around 130,000 (compared to about 8000 detected at time of writing).

While limited testing capacity explains why the UK is confining testing to hospitals, and the SARS experience explains why South Korea and Taiwan responded so quickly, neither of these factors explain why the UK was not able to grow coronavirus testing capacity as quickly as, for instance, Germany, has. Overall, Britain’s performance is on a par with Spain’s and Italy’s. Why?

The second matter was the decision to delay the introduction of social distancing measures until this week. A major factor revealed by yesterday’s testimony was the desire to avoid a second wave of infections as measures imposed early were then relaxed.

But so too, and it featured in communications from the Chief Scientific Officer, was the notion that the severity of this second wave could be reduced by failing to suppress the epidemic through social distancing measures. This policy was changed following Professor Ferguson’s report, but why was it necessary to wait for it, when the evidence from Italy was that even detected cases in the thousands could overwhelm the health system of Lombardy, one of the richest regions of Europe?

It seems that Britain’s system of public health policymaking is at last doing the right thing, and adopting international best practice, but it cannot afford to take so long to incorporate international lessons as the epidemic progresses. Crucial weeks have been wasted already. It’s vital no more are.

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Daniel Hannan: The virus. Our instincts are likelier to push us into over-reacting than the reverse.

Daniel Hannan is a writer and columnist. He was a Conservative MEP from 1999 to 2020, and is now President of the Initiative for Free Trade.

In a crisis, we reach for whatever feels most comforting. As the Titanic sank, its band leader, Wallace Hartley, played the hymn his father had introduced to the chapel where he had sung as a boy, “Nearer my God to Thee”.

More prosaically, a thousand pundits and politicians have responded to the COVID-19 outbreak by saying, in effect, “This just goes to show that we need to do whatever I happened to be banging on about before”. Anti-globalisers say that it proves we are too reliant on international trade. China hawks say we must ban Huawei. The GMB rails against the use of private hospital beds. Jeremy Corbyn blames Boris Johnson.

There was an eco-activist on the radio yesterday saying it proved the urgency of cutting carbon emissions – though I’m pretty sure that is already happening. Anti-Brexiteers demand an extension of the transition period. People who dislike capitalism argue that we mustn’t waste a good crisis.

The EU, too, has reverted to its most elemental impulses. In an extraordinary video clip, the President of the European Commission, Ursula von der Leyen, insisted that the Single Market be preserved while at the same time (and evidently oblivious to any contradiction) announcing an export ban on some forms of medical equipment. We’re all in this together; but only if we’re in the EU.

A visibly shaken Aleksandar Vučić, the President of Serbia, responded to Ms von der Leyen’s announcement with a televised statement in which he told his countrymen that China was their true friend. The EU, he said, having for years set conditions that effectively forced Serbia to bid for European rather than non-European contracts, had now thrown his country over. Only the Chinese would send medical equipment.

Now it is possible that Vučić, too, is reverting to his primal instincts. He started out as a hardline nationalist, though he is now a goody-goody EPP member. And it is equally possible that I am doing the same, identifying what I see as a clear case of EU hypocrisy but others might see as a justified response. All human beings suffer from confirmation biases.

There is nothing we can do about our neural wiring; but we can at least try to identify and allow for the various cognitive glitches that become especially pronounced when there is an elevated stress level.

For example, our instincts are likelier to push us into over-reacting than the reverse. When the UK government, acting in line with advice, responded in a phased and measured way to the outbreak, there was a general demand that it do more. I was reminded of a line from Harold Nicolson’s diary at the height of the 1938 Czech crisis: “Several people ring me up begging me ‘to do something’. They have no idea what they want me to do, but they are getting hysterical, and it is some relief to them to bother others on the phone”. For phone, these days, read social media.

One of the most dangerous sequences in politics goes like this. “Something must be done. Here’s something. Let’s do it.” It leads to all manner of needless and counterproductive decisions.

For example, it is hard to see any medical case for countries banning international travel, as the EU has just done – especially from places with infection rates similar to or less than their own. Nor can I see much rationale for closing schools and sending children, who seem mercifully to be the least at risk from the disease, into the care of their grandparents. But, as always in a crisis, people want action – big, visible, dramatic action. So my guess (and, I could, as I say, be subject to cognitive bias) is that governments the world over are doing more rather than less than is strictly demanded by the science.

What of the disease itself? Is it likely to be better or worse than the forecasts suggest? Obviously, it is impossible to know. When even my friend Matt Ridley – the brilliant Matt, who has made a career out of wisely and successfully debunking scare stories – says that this is the big one, there is plainly a genuine menace. Still, it is worth noting that the forecasts for both bird ’flu and swine ’flu were far too pessimistic. When I say “forecasts”, I mean the predictions of WHO officials, the Chief Medical Officer and the US government – the headlines, naturally, were even more wildly out.

Our pessimism has a solid evolutionary basis. Trusting and cheerful early hominids tended not to have as many surviving offspring as their suspicious kindred, and we carry the gloomy genes of the survivors. Pessimism has its uses; but we should be aware of how our instincts can mislead us.

It is at least possible that we will avoid some or most of the predicted catastrophes. The WHO says the illness has peaked in parts of East Asia, and the Chinese President has visited Wuhan without protective clothing. We need to think, not just about getting through the coming weeks, but about what comes afterwards.

It is inevitable that we will emerge from the crisis poorer, more indebted, with many businesses destroyed and with something close to a wartime command economy. But how high those costs are is at least partly discretionary. We – or at least our leaders – can dial them up or down. It is a hard thing, in politics, to act proportionately when public opinion demands drastic action. But doing so is the essence of statecraft.

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Coronavirus Fight Lays Bare Education’s Digital Divide

Westlake Legal Group 17china-divide-1-facebookJumbo Coronavirus Fight Lays Bare Education’s Digital Divide Teachers and School Employees Smartphones Rural Areas Quarantines homework Education (K-12) E-Learning Coronavirus (2019-nCoV) Computers and the Internet China

BEIJING — Like hundreds of millions of other children worldwide, Liu Chenxinhao and Liu Chenxinyuan were getting used to doing class work online. After their elementary school closed because of the coronavirus outbreak, the brothers received their homework through a smartphone app.

Then their schooling screeched to a halt. Their father, a builder, had to go back to work in a neighboring province of China. He took his phone with him.

Now the only device on which the boys can watch their school’s video lessons is 300 miles away. Their grandmother’s $30 handset only makes calls.

“Of course it will have an effect” on their education, said their father, Liu Ji, 34. “But I can’t do anything about it.”

For all of China’s economic advancements in recent decades, the rudiments of connected life — capable smartphones, reliable internet — remain out of reach for large segments of the population. As the virus has turned online conveniences into daily necessities, these people, most of whom live in China’s rural hinterland, have been cut off from their regular lives, especially when it comes to education.

The epidemic’s disparate impact on rich and poor, city and country, is a reality that more of the rest of the world is fast beginning to confront. More than 770 million learners worldwide are now being affected by school and university closures, according to the United Nations.

In China, many parents cannot afford to buy multiple devices for themselves and their children, even though many of the world’s cheapest smartphones — and most of the fanciest ones, too — are made in China. The nation is blanketed in 4G service, yet the signal is spotty in parts of the countryside. Home broadband can be expensive outside big cities.

Between 56 million and 80 million people in China reported lacking either an internet connection or a web-enabled device in 2018, according to government statistics. Another 480 million people said they did not go online for other reasons — for instance, because they didn’t know how.

It is one thing for this digital divide to prevent people from streaming movies or ordering barbecue during the coronavirus. It is another for it to disrupt young learners’ educations.

Students in some places have hiked for hours and braved the cold to listen to online classes on mountaintops, the only places they can get a decent cell signal, according to Chinese news reports. One high schooler in Sichuan Province was found doing homework under a rocky outcropping. Two little girls in Hubei Province set up a makeshift classroom on a wooded hillside.


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For children of the millions of migrant laborers who work far from home to keep China’s cities cleaned and fed, another problem is a lack of supervision. These “left-behind children,” as they are called in China, are raised mostly by their grandparents, who are often illiterate and cannot help with homework even when it is not delivered via smartphone app.

Wang Dexue, an elementary school principal in hilly Yunnan Province, said that in some classes, half the students cannot participate in online lessons because their families lack the necessary hardware.

For households that can connect, parents are not always invested in helping their children with remote learning, Mr. Wang said. His teachers are still figuring out how to teach with video apps. “Teaching progresses much more slowly sometimes,” Mr. Wang said.

The virus has come at a delicate moment for China’s efforts to help its least fortunate. This is the year the Communist Party has vowed to eradicate extreme poverty. The country’s top leader, Xi Jinping, has held fast to that goal despite the public health emergency. But raising people’s incomes above the level of deprivation was never going to be as tough as providing them with better educational opportunities.

China ordered all schools shut in late January, as coronavirus infections began spreading quickly. The authorities have not required schools to hold online classes in the interim. But they have encouraged it, starting all-day TV broadcasts of state-approved lessons in math, language, English, art and even physical education. The official mantra: “Stop classes but don’t stop learning.”

With no common standards for that learning, however, the results have varied wildly. Teachers have experimented with apps and formats — live streams, prerecorded lessons or a mix. Many teachers are holding web classes now but plan to go over the same material a second time when normal classes restart. For some students, distance learning means switching to different class materials than they had been using before.

“It’s a big mess, that’s all I can say,” said Huang Ting of PEER, an educational nonprofit.

This month, schools are beginning to reopen in parts of China, mostly in the country’s more sparsely populated west, where the outbreak is deemed to be under control.

For students like the Liu brothers, the disruption has been profound. They are among the best students in their class, their father says proudly.

Like many other adults in rural Anhui Province, Mr. Liu and his wife work far from home most of the year. Mr. Liu can afford another smartphone, he said, but he doesn’t want to get his sons hooked on video games. Installing home broadband so the boys can watch classes on their television, as their teacher suggested, seems like a wasteful luxury.

Still, Mr. Liu regrets that he cannot do more to help his sons learn. When he called them at home recently, he urged them to read more and practice their penmanship.

Li Xingpeng teaches at a village elementary school in the remote northwestern province of Gansu. With his phone mounted on a wobbly plastic holder and its camera pointed at a notebook, Mr. Li has been holding classes via group video chats on DingTalk, a messaging app owned by the e-commerce giant Alibaba. The experience, it is fair to say, has been mixed.

On a recent morning, Mr. Li’s 9 a.m. fourth-grade English class began with a quiz. He read out vocabulary words in Chinese, and his eight or so students wrote them down in English.

He had just read out the third word — chufang, or kitchen — when a loud conversation drifted into the call.

“Hey, whose family is watching TV?” Mr. Li said. “Turn the volume down.”

When the quiz was over, he asked the students to check their answers then read them aloud, causing the group chat to erupt in a cacophony of vocabulary: HOUSElivingroomREADeatcooklistenSITBEDROOM.

At one point, one student disappeared from the call. She later messaged the group to say her phone had crashed. But by then, class was over.

Fifth-grade math was next. As Mr. Li went through the multiples of two and five, the video chat was filled with loud scraping sounds and electronic buzzing. He explained odd and even numbers to a screen full of bored stares. One student experimented with turning his webcam on and off, on and off, on and off.

Mr. Li knows that some of his students use such lousy phones that the video chats are a fog of pixels. But the deeper problem, he said, might be that many parents do not care about their young ones’ schooling. That goes for poorer families and better-off ones alike.

Some parents, he said, are even annoyed that their children use their phones to join online classes. Why? Because they — the parents — cannot spend as much time on Douyin, the Chinese version of TikTok.

In the mountains of Gansu, the parenting tends to be “free range,” Mr. Li said. He sighs.

Recently, Mr. Li became concerned when one of his fifth-graders, a boy named Xie Dong, didn’t join his online classes two days in a row.

Mr. Li first called Dong’s grandmother to ask after his whereabouts, but she didn’t pick up her phone. The boy’s mother works in Xi’an, a city 180 miles to the east. Eventually, Mr. Li found out through a neighbor that Dong had grown frustrated trying to download DingTalk on his family’s $100 smartphone and gave up.

Of all Mr. Li’s students, Dong worries him the most.

“If he doesn’t do better in school and doesn’t have anybody watching over him, just think of how bad things could get in the future,” Mr. Li said.

Wang Yiwei contributed research.

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The revolt over Huawei is bigger than it looks. It spells trouble for Johnson over security defence and veterans

With the news dominated by the coronavirus, Rishi Sunak’s budget and the Prince Harry leak, one significant story ended up buried this week – even though it has huge implications for Britain’s future.

As many will know, the Tories have been battling it out for months over whether to allow Huawei, the Chinese technology company, to control the country’s 5G networks. 

The project was given the go ahead earlier this year, but on Tuesday, 38 MPs staged one of the biggest rebellions yet against its roll-out – backing an amendment to end Huawei’s participation in Britain’s networks by the start of 2023.

The rebels include former cabinet ministers Sir Iain Duncan Smith, Liam Fox, David Davis, Esther McVey and two select committee chairman; Tom Tugendhat and Tobias Ellwood, Chair of the Defence Select Committee, who said: “the Government should be on warning… that this House believes that we need to wean ourselves off Huawei.”

With Johnson’s “stonking majority” in December, it was easy to believe that these sort of tensions couldn’t happen in 2020. But they are a massive wake-up call as to how serious the Huawei issue is – and it seems fractures are only going to get worse.

The Conservatives have always known that allowing Chinese technology providers to build Britain’s networks would be controversial, hence the amount of provisions they have made each step of the way to convince parliament that this is what we need.

Some of this has been done by way of legal assurances. For instance, the contract was signed off on the condition that Huawei kept out of Britain’s most sensitive security areas. And, anticipating the revolt, the Government claimed there would be a new bill to address concerns around how long Huawei can manage our networks.

None of this stopped Tuesday’s events, however, and MPs have called it merely a “first showing” in the war against Huawei. Culture Minister Matt Warman responded that the rebel warnings had been heard “loud and clear”. “Loud” is certainly what we can expect much more of, as there will be future attempts to push a bill through.

What’s most interesting about the Huawei fight is that it exposes how much matters of defence and security can throw into jeopardy the Tories’ majority, not least because the substantial numbers of backbenchers with military backgrounds (Duncan Smith, Davis and Ellwood, for instance). If the government does not address their objections sensibly, it is not immune to defeat.

The events have also highlighted potential problems for trade agreements, with some MPs worried that Huawei has isolated us from major allies such as Canada, America, Australia and New Zealand (all of which have banned Huawei and condemned the UK’s decision to use the technology). Duncan Smith complained “[w]e have no friends out there any more on [the Huawei] issue, and he is probably right.

The worst international outcome, of course, is the impact of Huawei on the UK’s “special relationship” with America. Trump consistently told Boris Johnson not to move ahead with the contract, and was apparently apoplectic when he ignored this advice. Can the damage be undone with a new bill? One suspects not; that Trump will punish us for what he perceives as a monumental betrayal.

This battle will continue to play out, though may not get the coverage it fully deserves – as coronavirus absorbs the nation’s attention. The matter is one of utmost importance, however, as to our future safety and economic performance. It will exacerbate Tory tensions and showcase any weaknesses in the UK’s knowledge around technology (hence why we had to use Huawei in the first place). But the Tories will plough on, perhaps having invested too much physical and political capital to step back, and take stock of the situation.

As Paul Goodman put it in his January article, it is difficult to know whether Huawei is good for the country; “[w]e don’t have the technical knowledge – and doubt whether the politicians who sound off on the matter one way or the other do so either”. Personally, I find it incredibly hard to imagine what this technology is going to look like, and when I have asked others I have only got vague responses about “the internet of things” and “driverless cars” – the latter of which begs the deeper question of whether humanity needs all of this.

At the very least, given the increasing dominance of China on the world stage, as well as its terrible treatment of Uighur Muslims, we cannot simply go blind into the Huawei issue. Troublemaking Tories are no bad thing.

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Coronavirus Live Updates: China’s Xi Jinping Visits Outbreak’s Center in Sign of Confidence

Here’s what you need to know:

ImageWestlake Legal Group merlin_170226627_36615882-5b56-4c5c-a175-fe2c07b1613c-articleLarge Coronavirus Live Updates: China’s Xi Jinping Visits Outbreak’s Center in Sign of Confidence Xi Jinping Wuhan (China) Trump, Donald J Coronavirus (2019-nCoV) China

Xi Jinping, the Chinese leader, visiting a lab in Beijing last week. He had led efforts to control the outbreak from the capital, only visiting Wuhan on Tuesday.  Credit…Ju Peng/Xinhua, via Associated Press

The Chinese leader Xi Jinping arrived on Tuesday in Wuhan, visiting the center of the global coronavirus epidemic for the first time since the outbreak began and sending a powerful signal that the government believes the worst of the national emergency is over.

Mr. Xi’s visit was reported in a brief bulletin from Xinhua, the main official news agency, which said he met with front-line medical workers, military personnel, community workers, police officers and officials.

His trip is sure to be seen as a sign that China’s leaders believe that a series of draconian restrictions, including the lockdown of hundreds of millions of people starting in late January, have brought the outbreak under control.

According to official data, coronavirus infections have recently receded in China, falling to a few dozen new cases every day, nearly all of them in Wuhan, the provincial capital.

On Tuesday, China said it recorded 19 new infections from the coronavirus, and 17 deaths, in the past 24 hours. All but two of the newly confirmed infections were in Wuhan, the central Chinese city where the virus originated. The remaining two infections were people who contracted the virus after traveling abroad.

Wuhan remains the source of most new infections, even as the overall number of cases has fallen. More than three quarters of the 3,136 deaths recorded in China were in the city of 11 million people.

In Wuhan, most residents remain under heavy restrictions. But growing numbers of neighborhoods across the city have been declared free of new infections, and officials have said that the last two makeshift isolation centers for patients with mild cases of coronavirus infection would close.

The Italian government on Monday night extended restrictions on personal movement and public events to the entire country in a desperate effort to stem the coronavirus outbreak — an extraordinary set of measures in a modern democracy that values individual freedoms.

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Prime Minister Giuseppe Conte announced in a prime-time news conference that public gatherings were banned and that people would be allowed to travel only for work or for emergencies.

Those restrictions had been placed on the “red zone” created in northern Italy, covering about 16 million people, but Mr. Conte extended them to an entire nation of 60 million.

“We all have to renounce something for the good of Italy,” said Mr. Conte, saying that the government would enact more stringent rules over the entire Italian peninsula.

Italy has recorded more than 9,000 coronavirus infections and 463 deaths — well over half the toll for Europe — and the numbers continue to climb fast.

While the coronavirus prompts shutdowns and economic alarm across the world, the Chinese province where the epidemic began announced that it would — ever so carefully — restart business and manufacturing.

Leaders in Hubei Province, the source of the global outbreak, laid out plans on Monday after the province recorded a significant fall in the daily number of new infections and deaths from Covid-19, the disease caused by the virus.

Ying Yong, the province’s highest-ranking official, said the government would lift travel restrictions in areas of low risk to allow workers to get to their jobs. The risk level for each area of the province would be rated and those in low-risk areas would soon be allowed to travel.

Since January, much of Hubei has been under a lockdown that has deterred tens of millions of residents from moving around, or even leaving their homes.

“Currently, epidemic containment in Hubei Province has been shown promising developments and a sustained positive momentum, but the tasks of prevention and control remain arduous,” Mr. Ying told officials, according to the official Hubei Daily on Tuesday.

At the same time, Mr. Ying added, the province would “advance the planning so that people can move around in a safe and orderly way and enterprises can revive production.”

Mr. Ying did not spell out what would happen in Wuhan, the provincial capital, but his wording suggested that the city would remain cordoned off for now, even if the rest of Hubei loosened up.

President Trump has been promising the imminent arrival of a vaccine to halt the spread of the coronavirus.

Federal health officials have repeatedly pointed out that his timetable is off — it will take at least a year — but Mr. Trump’s single-minded focus on warp-speed production of a new vaccine represents a striking philosophical shift.

For years, he was an extreme vaccine skeptic who not only blamed childhood immunizations for autism — a position that scientists have forcefully repudiated — but once boasted he had never had a flu shot.

At least a decade before Mr. Trump was elected president, with responsibilities that would include nominating experts to lead the nation’s health centers, the hotelier and commercial developer was holding forth with great confidence about medical topics. When an interviewer would note that physicians disagreed with the dim view he took of vaccines, Mr. Trump remained ever ebullient, impervious and dismissive of scientific authority.

Now, as his federal health agencies tackle the rapidly morphing coronavirus epidemic and he and his administration come under fire for serious missteps in managing it, Mr. Trump has had to adjust his messaging. He is now all in on a vaccine and the sooner the better, says the man who in 2015 said that he didn’t “like the idea of injecting bad stuff in your body.”

Europe had already been teetering toward trouble.

Even before the coronavirus outbreak quarantined the industrial heart of Italy and emptied the teeming streets of Venice, before France banned public gatherings and major trade shows were canceled in Germany and Spain, economists were openly warning about the prospect of an economic downturn across the continent.

Now, Europe is almost certainly gripped by a recession, amplifying fears that the global economy could be headed that way, too.

“It seems pretty difficult to avoid a recession in the first half of the year,” said Ángel Talavera, head of European economics at Oxford Economics in London. “The spread of the disease in Europe is a game changer. The question is how deep it will be, and how long it will last.”

As the world absorbs the consequences of Europe sinking into a slump just as China suffers a profound downturn, the sense of alarm is heightened by another question with no obvious answer: Can European leaders transcend their often-bitter differences to forge an effective response — especially when this crisis may be beyond traditional economic policy prescriptions?

The sudden upheaval in the oil markets may claim victims around the world, from energy companies and their workers to governments whose budgets are pegged to the price of crude.

The fallout may take months to assess. But the impact on the American economy is bound to be considerable, especially in Texas and other states where oil drives much of the job market.

With the coronavirus outbreak slowing trade, transportation and other energy-intensive economic activities, demand is likely to remain weak. Even if Russia and Saudi Arabia resolve their differences — which led the Saudis to slash prices after Russia refused to join in production cuts — a global oil glut could keep prices low for years.

Many smaller American oil companies could face bankruptcy if the price pressure goes on for more than a few weeks, while larger ones will be challenged to protect their dividend payments. Thousands of oil workers are about to receive pink slips.

The battle will impose intense hardship on many other oil-producing countries as well, especially Venezuela, Iran and several African nations, with political implications that are difficult to predict.

The only winners may be drivers paying less for gasoline — particularly those with older, less fuel-efficient cars, who tend to have lower incomes.

“This is a clash of oil, geopolitics and the virus that together have sent the markets spiraling down,” said Daniel Yergin, the energy historian. ”The decline in demand for oil will march across the globe as the virus advances.”

Reporting was contributed by Jan Hoffman, Peter S. Goodman and Clifford Krauss.

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In Coronavirus Fight, China’s Vulnerable Fall Through the Cracks

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Lucifer Zhang, who is deaf and cannot speak, was able to get by on her $140 monthly stipend from the government. Then China locked down her home city, Wuhan, in late January to contain the coronavirus outbreak.

Now she has to buy face masks and disinfectants. And since Wuhan residents aren’t allowed out of their apartment compounds, Ms. Zhang, 32, and her mother, a retiree, can no longer scavenge the nearby markets for bargains. Groceries have to be ordered online and delivered, adding to prices that have already been driven up by scarcity.

Tomatoes, for example, cost three to four times what they did before the lockdown. Ms. Zhang and her mother haven’t eaten meat in over a month.

“Life is too tough,” Ms. Zhang wrote on Weibo, the Twitter-like social media platform. “I want to jump from the balcony.”

The outbreak has affected just about all of China’s 1.4 billion people. Even the rich and the powerful have to follow quarantine rules, which often means staying home.

But it’s the most vulnerable — the poor, the disabled, the very old and the very young — who have been hit hardest. The coronavirus is exposing the breadth of China’s wealth gap and the holes in its social safety net.

A 16-year-old with cerebral palsy in a village in Hubei Province, where Wuhan is the capital, starved to death days after his father was taken to a hospital. A 6-year-old boy was found in an apartment in Shiyan, also in Hubei, alone with the body of his grandfather; he told community workers that he hadn’t gone out to ask for help because his grandfather told him the virus was outside.

A young couple, both migrant workers, left their newborn son at a Guangdong Province hospital last month because they were out of money and, with the economy at a standstill, couldn’t find work. In Henan Province, state media reported that a ninth-grade girl attempted suicide after her school shut down and she couldn’t take online classes, because her family had to share a single mobile phone.

China is one of the most unequal countries in the world. It has more billionaires than the United States. But though hundreds of millions of its people have risen out of poverty over the past few decades, about 400 million were living just above the poverty line in 2015, according to the World Bank.

China has expanded medical coverage and made poverty eradication a top priority. Yet it still lags behind some other emerging economies, let alone the world’s richest countries, in public spending on education, health care and social assistance.

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Social spending accounted for 8 percent of China’s economic output in 2016, compared with an average of 22 percent for nations in the Organization for Economic Cooperation and Development, the global club of developed countries. The United States spends the equivalent of one-fifth of its output on health care and other social programs; China’s social spending was on par with Mexico’s, and lower than South Africa’s.

In recent years, China has expanded social services meant to help older and disabled people in their daily lives, but they still aren’t as widespread as in more developed countries. For most Chinese people, their families are their safety net.

In Wuhan, social services essentially stopped when the city was locked down. Many neighborhoods were deprived of medical care, food supplies and social assistance. People were left to fend for themselves.

Volunteer groups said local officials were too overwhelmed by the outbreak to make sure that the needs of older and disabled people were met.

For example, the Wuhan government made no announcements about the epidemic in sign language, said Cui Jing, an organizer for a group supporting deaf people in the city. On Jan. 23, the day the city was locked down, some deaf residents didn’t find out about it until they had trouble taking public transportation, Ms. Cui said.

Many older deaf people have trouble reading, so much information about the outbreak’s seriousness did not reach them. Some kept getting together to play mahjong, despite a ban on such gatherings. After the city forbade residents to leave their compounds in February, Ms. Cui’s 66-year-old aunt, who is also deaf, sneaked out, only to find the shops and markets closed.

When deaf residents became sick, they found it hard to communicate with medical workers. Most Chinese hospitals are unable to provide sign-language services, even when they are not as strained as the Wuhan and Hubei hospitals have been.

Amy Ye, the organizer of a volunteer group for disabled people in Wuhan, said that as soon as Wuhan was locked down, her organization asked local community workers to look out for disabled people. But they were too overwhelmed. The volunteers tried to help disabled residents themselves, but gave up because public transportation had been shut down.

“The whole city was paralyzed,” Ms. Ye said.

Like Ms. Zhang, Ms. Ye, who uses a wheelchair, lives on a monthly government stipend. She spends nearly a fifth of it, about $30, on prescription drugs for her high blood pressure, the cheapest she can find. And food costs have soared. A cucumber costs nearly $1 now, and the price of pork has tripled since a year ago.

“My family has always been treading on thin ice financially,” she said. “I want this to be over as soon as possible.”

Community workers in many neighborhoods in Hubei have turned to mobile apps to share information and organize grocery shopping for residents. The most widely used app is the social messaging service WeChat, which hundreds of millions of Chinese use to communicate, pay and shop.

But many older people aren’t familiar with WeChat or fluent in all of its functions. Many are lost when they have to use their phones to shop for food.

Hu Jing, a Wuhan resident who has been doing volunteer work over the past month, said that in one six-hour shift at an apartment compound, about a dozen older people came to her complaining that groceries were too expensive, or that they didn’t know how to order them online.

A volunteer group started a social media campaign last week asking for information about seniors in Wuhan who needed help buying groceries. Within a week, they received more than 1,300 requests from children and neighbors of isolated older residents. The group has arranged to help dozens of them, said Jackie Yu, a volunteer.

For people like Ms. Zhang and Ms. Ye, the most disheartening thing has been the lack of empathy shown by some people who are better off. On Weibo, a woman in Wuhan who described being caught in the epidemic with scant savings was called a loser. People who complained about food prices and empty stomachs were dismissed as liars and rumormongers.

It isn’t uncommon for social media users to accuse the poor and less fortunate of not trying hard enough. “They have no sympathy until they’re in our situation,” said Ms. Ye. “Otherwise, they’ll just laugh at you.”

She and Ms. Zhang each received a $72 emergency subsidy from the Wuhan government, and both said the money would make a difference. Ms. Zhang said she had ordered pork and couldn’t wait for it to be delivered.

Ms. Zhang has never had medical insurance or a chance to go to school. She learned reading and basic math on her own. Her introduction on her WeChat account reads, “All that’s wonderful in life has nothing to do with me.”

(I asked her on WeChat if she knew that Lucifer, her chosen English name, was another name for Satan. She replied that she knew but thought it was cool.)

Ms. Zhang has had her own problems finding empathy. When she complained about grocery prices in a neighborhood chat group, a member snapped that poor people could move to the countryside. They’ll be happy there, the neighbor wrote — they can grow their own vegetables.

Ms. Zhang understood that her neighbor was worried that the grocer would stop delivering to their compound if they complained about prices. But the neighbor could be a little more thoughtful, she wrote to me.

“There are many poor people in the world,” she wrote. “But when the others question why you are so poor, you have no way to explain.”

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China May Be Beating the Coronavirus, at a Painful Cost

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BEIJING — As the new coronavirus races around the world, tanking markets, cutting off global travel and suspending school for hundreds of millions of children, governments are desperate for ways to contain it.

China, the place where it first appeared, says it has the answers.

To the surprise of some, the country that concealed and mismanaged the initial outbreak appears to be bringing it under control, at least by its own official figures. The number of new cases reported has fallen dramatically in recent days even as infections are surging in other countries. The World Health Organization has praised Beijing’s response.

Officials reported only 99 new cases on Saturday, down from around 2,000 a day just weeks ago, and for the second day in a row, none were detected in Hubei Province outside of its capital, Wuhan, the center of the outbreak.

China says the trend proves that its containment measures — which include a lockdown on nearly 60 million people in Hubei and strict quarantine and travel restrictions for hundreds of millions of citizens and foreigners — are working. And it has begun trying to promote its efforts as successful in propaganda at home and abroad.

The rest of the world, much of it fearfully confronting its first cases, has taken note. But there is also concern that China’s numbers may be flawed and incomplete. The real test will be whether the virus flares again when children return to classrooms and workers to factories, and commuters start taking buses and subways.

China’s blunt force strategy poses deeper questions for other countries. Its campaign has come at great cost to people’s livelihoods and personal liberties. Even countries that could copy China still have to ask whether the cure is worse than the disease.

“I think they did an amazing job of knocking the virus down,” said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “But I don’t know if it’s sustainable. What have the Chinese really accomplished? Have they really contained the virus? Or have they just suppressed it?”

Elsewhere, Italy, South Korea and Iran are struggling to control the spread of the virus. In the United States, where there are now more than 400 confirmed cases, the government has been criticized for fumbling its rollout of test kits and allowing the virus to spread in vulnerable communities like a nursing home in Seattle. The outbreak now threatens global growth and is intensifying a backlash against immigration and globalization.

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Countries studying China’s approach would need to consider how it has upended nearly every corner of Chinese society.

The economy has ground to a near standstill, and many small businesses say they may soon run out of cash. Patients with critical illnesses are struggling to find timely care, and some have died. Hundreds of millions of people have been placed in some form of isolation. As of Friday, about 827,000 people remained under quarantine in Beijing, according to the state-run China Daily newspaper.

“I have been worried about all the focus on just controlling the virus,” said Dr. Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security. She recommended a more measured response, such as that taken by the governments in Hong Kong and Singapore. Officials there enacted targeted quarantines but did not shut down workplaces altogether, allowing their respective economies to continue operating while so far successfully containing the virus.

“We have to take a broad view of the impact on society,” Dr. Nuzzo said, “and do a better accounting for the social tolls of these measures that is not just focused on the numbers.”

For China, the numbers are key.

The number of cases reported on Saturday was a substantial decline from two and a half weeks ago, when China was recording around 2,000 new infections and as many as 100 deaths a day. Twenty-eight new deaths were reported on Saturday, all in Hubei.

By comparison, Italy reported 49 deaths from the virus on Friday.

Outside of Wuhan, the spread has effectively stopped, according to the official figures. All but one of the 99 new cases reported on Saturday were in Wuhan or were people who had traveled to China from abroad.

The World Health Organization says China’s containment measures may have saved hundreds of thousands of people from infection. Its efforts show that uncontrolled spread of the virus “is not a one-way street,” Dr. Tedros Adhanom Ghebreyesus, the group’s director general, said on Thursday.

“This epidemic can be pushed back,” Dr. Tedros said, “but only with a collective, coordinated and comprehensive approach that engages the entire machinery of government.”

W.H.O. experts sent to China have also highlighted clinics that could diagnose hundreds of cases a day with CT scans and laboratory tests, and the mass isolation centers in stadiums in Wuhan that separated people who had mild infections from their families.

“There’s no question that China’s bold approach to the rapid spread of this new respiratory pathogen has changed the course of what was a rapidly escalating and continues to be a deadly epidemic,” Dr. Bruce Aylward, the leader of the W.H.O. team that visited China, told reporters in Beijing late last month.

The numbers suggest that aggressive quarantine measures, when fully enforced, could choke the spread of the virus, said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University.

“This is the largest public health experiment in the history of humankind,” Dr. Schaffner said. “They can’t turn it off, but they did turn it down. And it did provide the rest of the world with some extra time.”

Still, the total number of infections in China, at more than 80,000, is staggering. And there are reasons to doubt the official figures.

In the early days of the outbreak, a shortage of test kits and hospital beds meant that many were not able to get tested. Many mild infections are likely going undetected. The government has changed how it counts cases several times in recent weeks, prompting large fluctuations in the reported figures, though experts say such adjustments are not unusual.

Medical experts say that there have been few signs that the government has aggressively tested for the coronavirus outside of medical facilities in Hubei. Until they broaden the scope of testing, experts say, it will be impossible to determine the true extent of the epidemic because those who have mild infections might not see a doctor.

“At the moment we are focused on the tip of the iceberg,” said David Hui, the director of the Stanley Ho Center for Emerging Infectious Diseases at the Chinese University of Hong Kong.

The ruling Communist Party hails the slowdown of the outbreak as a sign of the superiority of its authoritarian, top-down political system that gives officials nearly unchecked power. But its heavy-handed measures are testing the patience of its citizens, many of whom think such a clampdown could have been avoided if officials had not first hid the scale of the outbreak and silenced whistle-blowers.

The impact of the restrictions has been felt most acutely in Hubei, where 56 million people have been effectively penned in since January. For more than five weeks, the typically bustling hub of universities, commerce and transportation has been transformed into a collection of ghost towns as the virus has ravaged communities, ensnared entire families and infected thousands of medical workers.

China’s experience combating the virus has also highlighted the risk of family transmission if hospitals run out of beds and testing kits, as they did in Wuhan, where for weeks, many who were sick were sent home and infected their relatives.

Roadblocks have sealed off cities, public transportation has been shut down and private cars have been mostly banned from the roads. In Wuhan, restrictions on individual movement have been stepped up in recent weeks, with residents now mostly barred from leaving their homes.

Among residents in Hubei, there are signs that anger and frustration are mounting. Chinese social media sites are flooded with posts from residents saying they have lost their jobs because of the extended lockdown, making it difficult to make payments on mortgages and loans. Others have described food shortages in their communities.

On Thursday, in a rare public rebuke of the government, disgruntled people in a residential community in Wuhan heckled high-level officials as they walked through the neighborhood on an inspection.

“Fake! Everything is fake!” shouted one resident at the delegation, which included Sun Chunlan, a vice premier leading the central government’s response to the outbreak.

The state-run People’s Daily newspaper later said that the accusations were aimed at local neighborhood officials who had “faked” delivery of vegetables and meat to residents. Ms. Sun ordered an immediate investigation into the issue.

Wang Zhonglin, the party secretary of Wuhan, announced plans on Friday to teach the city’s residents to be grateful to the party, a move that was quickly met with derision and anger on Chinese social media.

Relationships are also fraying as families are forced to live for extended periods in confined spaces. Guo Jing, a feminist activist in Wuhan, said she and other volunteers had fielded a number of requests for help from residents reporting physical abuse by their family members at home.

“Under these circumstances, it’s really difficult for them to find help during the epidemic,” said Ms. Guo. “It’s so difficult to leave the house.”

Fang Fang, a writer who has been keeping a widely read — and often-censored — online journal of life in Wuhan, said that the lockdown was exacting a psychological toll on residents.

“Ordinary people have no source of income and lack a sense of certainty even about when they’ll be able to go out,” she wrote in a recent entry. “When you can’t feel the ground or you lose control over a situation, it’s easy to lose the most basic sense of security.”

Outside of Hubei, China wants to fire up its economy, but local officials are also under immense pressure to take no risks in order to reduce the number of infections. Even as provinces have lowered their alert levels for the virus, many companies are choosing to err on the side of caution. Some have even faked electricity consumption rates in order to hit stringent back-to-work targets, according to a recent report by Caixin, an influential Chinese magazine.

Some experts are increasingly wondering if China’s lockdown will become pointless the more widespread the virus becomes. Given the global spread of the virus and the difficulty of spotting mild cases, they say, it is unlikely that it will ever be completely eliminated — even in China.

“I do think the declining case numbers likely mean that all these incredible measures that have been taken are probably having an effect,” said Marc Lipsitch, an epidemiologist at the Harvard T.H. Chan School of Public Health. “But I don’t think zero is zero.”

Donald G. McNeil Jr. contributed reporting from New York. Zoe Mou contributed research from Beijing.

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