Six months into the US response to the Covid-19 pandemic, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, remains one of the most visible and steadfast defenders of science in an increasingly politicized environment.

On Thursday, Vox and Today, Explained host Sean Rameswaram spoke to Fauci about calling out Sen. Rand Paul at a Wednesday Senate hearing; his projections for when vaccines may be ready to distribute; his concerns about public mistrust in the vaccine approval process; and telling political appointees at the Centers for Disease Control and Prevention to “take a walk.” He also detailed who the real enemy is and what he would ask for if he could wave a magic wand right now.

“The public health response and the public health activities, in fact, have become politicized, which is so unfortunate,” he told Rameswaram.

The transcript has been edited for clarity and length.

To hear Today, Explained’s full conversation with Fauci, listen to the episode below or wherever you get your podcasts, including Apple Podcasts, Google Podcasts, Spotify, and Stitcher.

The University of Washington’s Covid-19 model is now saying we may see nearly 400,000 deaths by the end of the year. Is that a realistic estimate?

Anthony Fauci

We really have got to be careful because those are models. Models are based on the assumptions that you make to put into the model. Certainly if things go poorly — if, in fact, we do not get control and people do not cooperate in some of the public health measures — that could happen.

Hopefully, as we get toward the end of the year, we’ll know that we have a vaccine, or more than one vaccine, that’s safe and effective. So if we could start vaccinating at least the high-risk people, as well as the front-line responders, by the end of this calendar year and into 2021, we could prevent that surge that everyone is concerned about.

But we can’t just rely on a vaccine. We’ve got to rely on [people’s adherence] to the simple recommended public health measures, particularly mask-wearing when you’re inside and may not be able to keep the physical distance that we’d like to see.

Sean Rameswaram

What is the latest on a vaccine being available in the United States? What do you think the timeline is?

Anthony Fauci

We don’t know. So when you hear people make projections, they are merely projections. The vaccines that are currently in advanced trials — the Pfizer, Moderna, and now the JNJ Janssen products — are in play. (A fourth [AstraZeneca] is on hold because of an adverse event that took place.)

They have anywhere from 30,000 to 60,000 people [enrolled] per trial. And given the enrollment and the number of infections, I would project … that by the end of the year, let’s say November or December, we will know whether the vaccines, plural, are safe and effective.

It could be earlier. I mean, if there are enough infections in the trial and you could distinguish between the placebo and the vaccine limb of the trial, you may be able to make a determination early. But let’s assume that it’s November and December.

You could ask, what do you think the chances are of it being safe and effective? The first honest thing to say is that you don’t know. But based on the preliminary data that we’ve seen in animal studies, as well as in the phase 1 studies, the vaccines appear to induce a response that’s comparable to a good response to natural infection, which traditionally is always a good sign that you’re going in the right direction.

But the proof of the pudding is going to be the result of the [phase 3] trials. Now, if, in fact, it shows to be safe and effective and you start vaccinating people, you could do that as early as the end of this year.

We’ve taken a major financial risk of producing vaccines even before we know that they work, which means if they do work, you saved a lot of months. If they don’t work, the only thing you’ve lost is money. And right now, we feel that the investment is really worth the risk financially, because we want to do things as safely but as quickly as possible.

Sean Rameswaram

Once we have a vaccine in the United States, do we have a plan for how it will be distributed across the country?

Anthony Fauci

Yes, yes. Traditionally, the final decision on that is with the CDC … and they rely heavily on the advice of a committee called the Advisory Committee on Immunization Practices. With regard to Covid-19 vaccines, we’ve added an extra layer to that. The National Academy of Medicine is putting together a group of scientists, ethicists, and others to map out what we think is the most appropriate, fair, and ethical way to distribute vaccines in a greater fashion.

Traditionally, you start off vaccinating the health care providers and front-line individuals who are putting themselves at risk to take care of sick patients. The other [group] is those at high risk, such as the elderly, those who have underlying conditions and people like that. The final determination has not been made, but that will be coming very soon.

Sean Rameswaram

How worried are you about faith in the vaccine? Are you concerned that people might not trust a vaccine produced in this country?

Anthony Fauci

I am very concerned about that. And that’s the reason why I’m right here talking with you. I’m trying to make sure that we can reach out to the community and explain the process,

Because when you look at the decisions about whether a vaccine is safe and effective — we spoke about this in detail at the Senate hearing yesterday that many people tuned in to — at least I gathered that from a lot of the tweets following that hearing …

Sean Rameswaram

I thought you weren’t on Twitter?

Anthony Fauci

I’m not. But my staff sends me these emails that say, you got to look at this.

The situation is that people need to understand that an independent body, the Data and Safety Monitoring Board [DSMB], is beholden to no one, not to the president, not to the vaccine companies, not to the FDA [Food and Drug Administration]. Not to me.

They are an independent group of established scientists, ethicists, and statisticians. They are the only ones that have access to the data because it’s a double-blind study. And a vaccine has a predetermined set of criteria to determine if it works or not. And the DSMB intermittently looks at that.

When they feel it’s reached that point, they will then notify the company. Then the company has the option, which they will certainly do, of presenting it to the FDA either for an emergency use authorization or directly for what we call a BLA, or a biological license application, which essentially is a license.

FDA scientists will look at that. Then they will consult with another advisory committee called the Vaccines and Related Biological Products Advisory Committee [VRBPAC], who are, again, advisory to the FDA. Those data will become public so that scientists like myself and my colleagues will have access.

Everybody’s worrying that someone is going to make an end run around that and try to get a vaccine out for political reasons. Well, that will not happen, but if it does … it will be really transparent. Because the scientists will see the data.

The FDA has pledged publicly multiple times that they will not approve a vaccine unless they’ve established that nonpolitical scientists agree that it’s safe and effective. And we’ve got to keep getting that message out because it’s totally understandable giving the mixed messages that are coming out that the public might be skeptical about vaccines.

And if it turns out somebody tries to force it out, I tell you, I will be one of the first ones that will object to that.

Sean Rameswaram

So you’ll be out there saying this is not the vaccine we should trust?

Anthony Fauci

Yeah, I would say that the process is not the right process to do this, and we really need to go back to the right process.

Sean Rameswaram

Are you worried about how this whole coronavirus pandemic has shaken faith in these institutions that previously had this sort of bulletproof reputation?

Anthony Fauci

Yeah.

Sean Rameswaram

Institutions like the CDC.

Anthony Fauci

Yes, that is unfortunate. There have been some unfortunate things that have happened. There have been people within agencies that have tried unsuccessfully to influence the CDC.

In one situation, not to mention any names, one of those individuals tried to influence what I said, which is really a fool’s errand, because I essentially told them to go take a walk. Those people are not there anymore.

I can tell you, quite frankly, that I have been in intensive discussions with the director of the CDC and the director of FDA and I really, truly believe that you can trust them. And besides the core people, the career scientists at the CDC and the FDA — they do this for a living. They are apolitical and completely devoted to the health of our nation. And those are the people that will speak out.

Sean Rameswaram

Your Wednesday appearance before the Senate sort of blew up on Twitter. Was it that people finally saw you lose your patience with Sen. Rand Paul? I know from watching you over the past six or seven months how hard you’ve tried to remain above the political fray. And I wonder, six, seven months into it, isn’t it wearing on you?

Anthony Fauci

Well, the answer is it is certainly possible, and I have been doing this not only over the last six months, but, like, for 40 years.

I do have a great deal of respect for the institution of the Senate, and I do have respect for Sen. Rand Paul. But he was saying things that were not true. And, well, I just couldn’t let that stand because there we were on national TV with a lot of cameras. And I just had to call him on that.

I think people are giving him information. It is what’s called cherry-picking information out there. He was saying things that were not compatible with the scientific data. So what the audience saw me do was say, “Whoa, wait a minute, time out. You really can’t say that.”

I wasn’t disrespectful at all. I think I was quite respectful. But it isn’t a question of politics because he was saying what he thought was the right thing. And I disagreed with that.

Sean Rameswaram

Is it impossible to remain above the politics when this pandemic has been so politicized?

Anthony Fauci

We’re in a highly charged political season with big-time, high-stakes elections. The public health response and the public health activities, in fact, have become politicized, which is so unfortunate. We’ve lost sight of the fact that the bad guy here is the virus. The bad guy is not one side or the other.

Public health measures should be the gateway and the vehicle to getting the country’s economy back and opening up the country. And yet there are some who interpret that as an obstacle. It isn’t the obstacle. It’s the solution.

So we’ve got to keep hammering that message home: We’re all in this together. And when you have some groups of society who make it a political issue, it makes it very complicated to get a uniform, consistent approach in our country.

Sean Rameswaram

If you could wave a magic wand over the United States and change one thing tomorrow to improve the trajectory of this pandemic, what would it be?

Anthony Fauci

I think apart from a vaccine, which we’ll have to wait a few months for, if I were to wave a wand now, it would be to get the entire country uniformly pulling together in a public health way to get these cases down. A couple of days after 9/11, we didn’t have any political arguing about what we needed to do, or, you know, December 1941 after Pearl Harbor. Everybody was in it together.

That’s really what we’re dealing with. I don’t want to get too melodramatic, but we are at war with a virus. We are not at war with each other. So my magic wand would be … a spirit of pulling together.

For Today, Explained’s full conversation with Fauci, listen to the episode wherever you get your podcasts, including Apple Podcasts, Google Podcasts, Spotify, and Stitcher.

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This story is part of Covering Climate Now, a global journalism collaboration strengthening coverage of the climate story.

The oil and gas industry has found itself under a harsh spotlight as concern over climate change increases across the world. Lately, oil and gas majors have responded to the scrutiny with a series of pledges, plans, and press releases on the subject of global warming. The big five oil giants — Exxon and Chevron (US), BP (UK), Total (France), and Shell (the Netherlands) — have all pledged, with varying degrees of ambition, to reduce their emissions.

The industry has clearly gotten the memo that climate policy is happening. And it wants to be at the table rather than on the menu.

But do these pledges pass muster? Are they in line with a 1.5° Celsius scenario, or even close? The general consensus seems to be no. The International Energy Agency said, upon this year’s release of its “Oil and Gas Industry in Energy Transitions” report, “there are few signs of the large-scale change in capital allocation needed to put the world on a more sustainable path.” In other words, show me the money.

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There are other ways of assessing these plans outside of their total dollar amounts. Do they rely on carbon offsets or carbon capture plans of dubious value? Do they signal a change in lobbying, advertising, and political participation? Do they account for climate justice?

In an attempt to bring some rigor to these assessments, the nonprofit Oil Change International (OCI) has released a report that lays out a set of necessary-but-not-sufficient “minimum criteria” that oil company plans must meet “to have the possibility of being 1.5°C-aligned.”

How do the plans measure up? Well, they all fail — none are aligned with 1.5°. BP is doing the best, but none are particularly close to clearing the bar.

Before getting into the criteria OCI uses and what they say about oil company pledges, let’s run through a little background.

The fossil fuel industry is struggling with low prices, oversupply, and political pressure

As I wrote in some detail earlier this year, the fossil fuel industry is a mess. It was facing difficult cross-pressures even before the Covid-19 lockdown hit it in the gut.

Fracking operations have been losing money for years. Overproduction and overinvestment have created a supply glut that was suppressing oil prices even before the virus struck. Renewables are skyrocketing and electric vehicles (EVs) are poised for enormous growth, both of which will cut into future oil demand.

Oil majors have been writing down assets, financial institutions are turning away from oil investments, and plastics are likely to substantially underperform the industry’s rosy projections. All the while, customers, corporate partners, investors, shareholders, and activists are putting ever-increasing pressure on oil and gas companies to begin planning seriously for climate change.

This was all going on when the coronavirus hit and cratered demand, which still hasn’t recovered and may never fully recover. Some analysts are speculating that 2019 will turn out to be the global peak in fossil fuel demand. “Could it be peak oil?” speculated BP CEO Bernard Looney. “Possibly. I would not write that off.”

Meanwhile, the decline continues. This is the context in which these commitments are being released: Oil and gas companies are somewhat desperate, unusually weak, and badly need social capital.

To limit global temperatures to 1.5°, most oil and gas must stay in the ground

Previous OCI research has compared known fossil fuel reserves to the carbon budget permitted by a 1.5° scenario. The situation is stark.

Fossil fuel companies have what are called “proved reserves,” which are fields that can be reasonably expected to produce in current economic conditions, and “developed reserves,” which are fields that are currently producing, through existing mines or wells.

If fossil fuel companies develop all their proved reserves, the 2° carbon budget would be blown many times over. In fact, as the graph below shows, developed reserves alone would blow the 2° budget. In fact, if every coal mine in the world vanished overnight, the developed reserves of oil and gas would still push past the 1.5° budget.

Developed reserves are what analysts call “carbon lock-in” — the carbon hasn’t been emitted yet, but investments in infrastructure, equipment, and labor make it extremely difficult, politically and economically, to prevent it from happening.

Every bit of new fossil fuel exploration and development, every new mine or well, is an increment of carbon lock-in. And since there’s no carbon budget left over, the only way to truly get on a 1.5° path is to cease exploring or developing new reserves entirely.

That is the baseline: The growth of fossil fuels is incompatible with solving global warming. Acknowledging that basic fact is the beginning of any serious plan for oil and gas companies.

With that in mind, let’s take a look at OCI’s assessment.

Oil companies are doing a fraction of what they need to do to get in line with 1.5°

OCI lays out 10 minimal conditions that must be met for a plan to be aligned with 1.5°, which it applies to eight of the biggest integrated oil and gas companies in the world: BP, Chevron, Eni, Equinor, ExxonMobil, Repsol, Shell, and Total.

The conditions fall under the headings Ambition (1-5), Integrity (6-8), and Transition Planning (9-10). We’ll walk through them and cite companies (if any) that are meeting them.

1. Stop exploration: no more finding new fields. BP is the only company that has agreed to this, and only in new countries.
2. Stop approving new extraction projects. No company has pledged this.
3. Decline oil and gas production by 2030. BP has said it will reduce production 30 percent by 2030; Eni has said it will plateau in 2025, but only oil will decline. Other companies have said nothing.
4. Set long-term phase-out plan aligned with 1.5°C. BP, Eni, and Repsol have plans OCI deems insufficient; the rest have none.
5. Set absolute target covering all oil and gas extraction, including scope 3 emissions. Where scope 1 and 2 emissions are direct energy use by a company, scope 3 emissions encompass the entire supply chain through which the company’s products are produced and used — in this case, the carbon emitted by burning fossil fuels. Eni and Repsol are good on this. Equinor, Shell, and Total cover scope 3 emissions, but only through carbon intensity targets rather than absolute reductions. BP is good on the surface, except it contains some pretty big loopholes. Its pledge “excludes more than 40 percent of its oil production and 15 percent of the gas that come from its stake in the Russian energy giant, Rosneft,” Nicholas Kusnetz reports for Inside Climate News. “It also excludes all the oil and gas that BP’s refineries and service stations buy from other producers before selling it to customers.” Plus, BP recently announced that it’s selling a large chunk of oil and gas assets, which will get them off BP’s books, but will not shut them down.
6. Do not rely on carbon sequestration or offsets. They all do, though.
7. Be honest about fossil (“natural”) gas as high carbon. None of them are, though. Lots of them are still passing it off as a “low-carbon” shift.
8. End lobbying and ads that obstruct climate solutions. Here, BP, Eni, Equinor, Repsol, Shell, and Total have all made vaguely positive noises that OCI deems insufficient.
9. Commit to explicit end date for oil and gas extraction. None of them have.
10. Commit plans and funding to support workers’ transition into new sectors. None of them have.

Here’s the visual — if you can’t read it, just note all the red, which means “grossly insufficient.”

One thing worth noting: The only two companies with solid red all the way down are Exxon and Chevron, the US companies. They, like the country they call home, are laggards on climate.

While almost all the companies are planning increases in oil production, Exxon and Chevron are planning the most:

Exxon and BP are planning the biggest increases in gas production:

In general, the European oil and gas majors are farther ahead on climate change, likely because the political context in which they operate takes climate change more seriously. But none of the majors are even beginning to make the enormous near-term shifts in investment that will be required to hit their long-term targets.

The oil majors have a long journey ahead

OCI’s criteria are quite strict and no oil and gas major is anywhere close to meeting them. There is an entire section of the report on the various loopholes the majors are using to diminish or minimize accountability, from ignoring scope 3 emissions (side-eye at Exxon) to making unreasonably big bets on unproven carbon capture technologies to measuring carbon intensity rather than absolute emissions.

And of course, the fossil fuel companies, despite their rhetoric, continue to put their lobbying power behind campaigns and trade groups that oppose climate action.

“In 2018, for example, BP played a central role in blocking the adoption of a carbon tax in Washington State, spending $13 million to help defeat the effort,” Kusnetz writes. “BP, Chevron and [the American Petroleum Institute, an industry trade group] all supported the Trump administration’s weakening of regulations limiting methane emissions from oil and gas operations. The institute has also pressed lawmakers and governors to eliminate incentives for electric vehicles, policies that are among the few in the United States that encourage a shift away from oil.”

During the pandemic, the industry has lobbied furiously for special breaks and favors to boost production and prices. And it has largely received them, especially from Trump. A recent Morning Consult analysis found that the US “has committed more to fossil fuel companies through federal and state policies than any other Group of 20 member has directed to all energy types — fossil and renewable combined — since the start of the pandemic, both through relief packages and other, ostensibly unrelated, policy changes.”

By and large, fossil fuel companies are fighting for their narrow interests within the system they find themselves, which is pretty much what you’d expect them to do.

A few of the European majors are beginning to budge. Here’s Kusnetz again:

BP and Shell insist they are now aligning their lobbying with their net-zero goals. Shell, at least, has begun to back this up: The company opposed the Trump administration’s methane regulation roll-back and the loosening of fuel efficiency standards for cars. Shell and BP also have announced they will leave the American Fuel and Petrochemical Manufacturers, a trade group, because of its opposition to carbon taxes and its failure to support the Paris Agreement. In February, BP said it would end its “corporate reputation” advertising, and that any future campaigns would “push for progressive climate policy; communicate our net zero ambition; invite ideas; or build collaboration.”

That’s a good start, but there’s a long way to go and a lot of companies that aren’t yet on board.

OCI’s criteria, if met, would effectively amount to the rapid managed phase-out of enormous assets by the industry that controls the assets, a transition not every company, or even most of them, would survive. That is not something that typically happens. A moment’s consideration leads to the conclusion that headlines the final section of the report: “Oil and gas companies will not manage their own decline.”

In that sense, the report is something of a thought experiment, meant to reveal what ought to be obvious, as OCI says: “Governments must step in to manage the decline in fossil fuel production and secure a just transition.”

Ultimately this is a matter for public policy. The system in which oil and gas companies operate must be changed, to channel investment away from fossil fuels into alternatives and affected communities. That will happen, if at all, through organization, democratic pressure, and changes in legislation and regulation — not through voluntary pledges.

SARS-CoV-2, the virus that causes Covid-19, can float in the air. In particular, it can linger in poorly ventilated indoor spaces, spreading farther than 6 feet from its source. These indoor public spaces are high risk and should be avoided while the virus is still spreading.

But, increasingly, people are returning to those spaces: Bars and restaurants are operating in limited capacity in some places, and are fully reopened in others. Some schools and universities have resumed in-person classes, and mayors are allowing some live entertainment venues to host events.

With the weather growing colder, experts fear indoor gatherings in these and private spaces could spark new outbreaks. Already, cases are increasing nationwide, and experts are growing more concerned about a potential fall-winter Covid-19 surge.

To make indoor communal spaces safer, experts keep stressing that they need to be “well-ventilated.” But what does that mean? In conversations with several air quality experts and engineers, I found ventilation to be simple in concept and potentially fraught in execution.

“It’s a huge engineering problem,” Shelly Miller, an environmental engineer at the University of Colorado Boulder, says. “We don’t have the systems in place for many buildings to be operated appropriately during a pandemic.”

As Derek Thompson observes in the Atlantic, a lot of places have put on a big show about cleaning surfaces — what he calls “hygiene theater” — though surface contamination is not thought to be a large source of Covid-19 transmission.

Making places safer, instead, should mean improving air quality. But “have you ever heard a restaurant reopening announce they’ve improved ventilation or increased ventilation?” Lidia Morawska, an engineer and the director of the International Laboratory for Air Quality and Health at Queensland University of Technology, recently told me. “No.”

Ventilation concerns are not limited to restaurants and schools. Recently, a report from the University of California San Francisco noted “exceedingly poor ventilation” at the San Quentin State Prison, which saw a huge outbreak of more than 2,200 cases.

Ventilation efforts could easily fall into the “hygiene theater” trap if not done well. So here’s a guide for how to think about safer — but not necessarily “safe” — indoor air, and all the hurdles that may get in the way. We need to think about controlling the source of the virus indoors, about mixing more outdoor air with indoor air, and about air filtration and cleaning devices.

The experts I spoke with agreed: We can’t ventilate and air purify our way out of the need to wear masks, reduce occupancy in indoor spaces (or just avoid many of them all together), and physically distance. The indoor space that can’t enforce these measures, or allow activities that involve mask removal — like bars and restaurants — probably shouldn’t be open. And, still, the most important way to make indoor spaces safer is to decrease community Covid-19 spread as much as possible. It may not be easy for all spaces to achieve ideal ventilation.

There are no perfectly safe indoor environments during the pandemic, but there are clear goals to have in mind when trying to make them safer with ventilation. Here’s where to start.

First: Limit the amount of virus in the air in the first place

Intuitively, I think we all know how to think about cleaning surfaces: Wipe them down with a disinfectant, or scrub with good old soap and water. Cleaning the air is an entirely different challenge. You can’t just spray it with chemicals and call it a day.

“Cleaning the air is at least as important as cleaning surfaces, but you do it very differently,” says Linsey Marr, a Virginia Tech engineer who studies the airborne spread of viruses. “We end up having to breathe whatever it is we spray. And if it’s harmful to the virus, it’s likely it’s also harmful to us. So we need to take a totally different approach.”

There are other challenges to cleaning the air, too. One big one: Floating particles can move. If you clean one section of air in a space, new dirty air can move in and replace it. Also, air cleaning needs to be continuous in the spaces we inhabit. As long as there are living, breathing people in a space, we’re potentially contaminating it with virus.

The first thing to do in thinking about cleaning the air, says Jeffrey Siegel, an air filtration expert at the University of Toronto, is to think about limiting the source of the contagion in the first place (i.e., living, breathing people). There’s an old saying in his line of work: “If you’ve got the odor of manure, don’t try and ventilate to get rid of it, get rid of the manure,” he says. “That’s the exact idea, right? Get rid of the source or manage that source.”

SARS-CoV-2 gets into the air via human breath. So we should start by reducing the number of humans in a space, masking those who have to enter, and limiting activities like singing or shouting that can propel even more virus-laden particles into the air.

From contact tracing studies, we know the virus spreads most readily through close contact, with the risks increasing with the amount of time spent in close proximity. However, there are some situations in poorly ventilated indoor spaces where the virus may be able to float in the air for an extended period (tens of minutes or more), or spread in a gaseous cloud over an area larger than 6 feet (some of that long-range floating virus may still be able to infect people, some of it may not). Ventilation may help decrease the chances of transmission in these indoor environments.

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“Ventilation may be able to help reduce indoors transmission, but it’s never going to be as effective as simply not having lots of people in a single indoor space,” Boston University epidemiologist Eleanor Murray says in an email. “If a workplace can function with employees working remotely, then it will be safer for them to do so than to have all employees come back to work even with better ventilation. But there may be a few employees who would be better served by being at the office, and for those, improving ventilation will help make the office as safe as possible.”

Second: Ventilate

Outside of source control, there are three basic ways to clean the air and reduce the concentration of airborne virus. The first is to simply ventilate, or increase the amount of outdoor air in indoor spaces, and to make sure the inside air is replaced by outside air several times per hour.

“So the air in your home probably changes over once every hour or two hours,” Marr says. “We’re aiming for an air exchange rate of, like, six per hour.” That recommendation, she says, comes from studies of tuberculosis transmission. (Tuberculosis is not SARS-CoV-2. TB is much more contagious and is thought to be able to spread farther and stay longer in the air.)

It’s important to remember, too, that scientists still don’t really have a specific figure on what amounts to a dangerous, infectious concentration of virus in the air. “There’s no perfectly ‘safe’ level of ventilation because we don’t actually know what ‘safe’ is, since we don’t know how much exposure leads to transmission,” Angela Rasmussen, a Columbia University virologist, says in an email.

Six air changes an hour is a baseline. “If you want the risk down to zero, you’ve got to get to an infinite number of air changes per hour,” Marr adds. Which is impossible.

Again, more ventilation may be “safer,” but it’s not “safe.”

The easiest way to increase ventilation: open windows. This will increase the amount of outside air (which does not have virus in it) coming in to dilute indoor air (which may have virus in it). The less concentrated the virus is in the air, the less likely it is to infect people.

It seems simple, but it’s not foolproof. There are some specific scenarios where opening windows can be counterproductive and yield unpredictable effects, as Siegel explains.

Let’s say you have a bathroom. It would be a good idea to keep the bathroom air in the bathroom. After all, many types of viruses can spread in bathrooms, and in the case of Covid-19, it’s possible for the virus to be sent into the air via toilet flushes (though it’s less clear if someone can be infected this way). So it’s ideally best to not let that bathroom air get out into other spaces.

To keep the air in the bathroom in the bathroom, it needs what engineers call “negative pressure,” meaning that air can flow into the bathroom but not out.

“And then you open a window in the room beside the bathroom,” Siegel says. “And once you open windows, you give up on any idea of controlling pressurization or depressurization.” When this happens, the potentially contaminated air in the bathroom will start flowing out.

The point of this example isn’t to make people scared of opening windows. It’s just that indoor spaces are complicated, and airflow can be hard to predict.

“No one I know — even some of the best building modelers in the world — can accurately model a building with open windows,” he says. “It’s just way too dynamic of a system. We know that, in general, ventilation rate increases. And I’m not going to tell anyone not to open the windows. But really we can’t tell you what it’s doing to airflow in the space.”

This is one of the potential pitfalls with ventilation: “Ventilation pathway matters too,” Siegel explained on Twitter. If a fan meant to increase ventilation ends up blowing virus across people’s faces, it’s self-defeating. This is what’s believed to have happened in a restaurant in China, where people sitting in the path of an air conditioning fan got sick. Later, researchers also said that the restaurant A/C system pulled in no outdoor air, and the air in the restaurant wasn’t replaced even once in an hour, let alone six times, which likely contributed to the outbreak there.

How to monitor ventilation

So how do you know if you’re doing ventilation right? Is there any way to monitor your airflow and know the air exchange rate? Here, things get tricky. One indirect way to do this is to purchase a carbon dioxide detector (which are around $100 online) to give you a rough sense of air quality. When we exhale, we exhale CO2. “How much CO2 is in an indoor space is basically a metric of how much air other people have expelled in that space,” Jose-Luis Jimenez, a chemistry professor at the University of Colorado Boulder, says. So high and rising CO2 levels in a space can be a sign it’s not properly ventilated.

“The relationship between CO2 and outside air ventilation is really complicated and not something I’m advocating the public try to figure out,” Miller says. But, as a general benchmark, the average C02 concentration of outdoor air is around 400 ppm (parts per million). So indoor spaces should ideally have a CO2 concentration of under 500 or 600 ppm in a room where people are breathing. That will tell, roughly, whether outdoor air is being mixed with indoor air at a reasonable level.

Building managers, though, shouldn’t depend entirely on a CO2 monitor. Again, it’s an indirect measure. If there are only a few people in a space, they may not generate enough CO2 to make the sensor rise that much even in a stagnant environment. And it only takes one person to start an outbreak.

(There’s also some room for commonsense measurements, too: Use your nose. If you can smell odors wafting through a building coming from indoor sources, the space may not be adequately ventilated. “If you walk into a place and it feels stuffy and the windows aren’t open, then that’s an indicator that there’s not good ventilation there,” Marr says.)

In commercial settings, some building operators might be able to adjust the amount of fresh air pumped into a building’s ventilation system. During the pandemic, they should do this. But, as Miller explains, “many [commercial HVAC] systems don’t run on 100 percent outside air.” It’s too energy-intensive. “You can’t provide air conditioning and heat with 100 percent outside air,” she says. So, in some cases, there is a limit to how much outside air an HVAC system can mix into a building.

Other systems might be in disrepair and unable to ideally ventilate buildings, even if their systems are cranked up. Particularly in schools, ventilation systems can be old and in disrepair. In June, the Government Accountability Office published a survey of 65 school districts that receive aid from the federal government. It found 41 percent of the districts needed to update HVAC equipment in half of their schools. Separately, in New York City, a Daily News investigation found that “roughly 650 of the 1,500 buildings surveyed in 2019 by city inspectors had at least one deficiency in their exhaust fans.”

A huge part of the challenge of increasing ventilation is that different buildings, built in different eras for different purposes, will need potentially different solutions. Older buildings might not have any central HVAC systems at all. And some with HVAC systems may operate well for some rooms but less well in others.

“When I think about my daughter’s school,” Siegel says, “I don’t worry about the school as a whole as much as I worry about that classroom where they can’t open the windows because there’s a construction site right nearby.”

It’s important to know here that ventilating schools has benefits that are broader than its pandemic applications. Kids need to breathe healthy air (the dangers of air quality for children’s’ health and cognitive well-being are as clear and critical as ever). And allowing them to do so will require huge investments.

“We can’t even get the Congress to allocate, you know, $600 a week in unemployment, let alone a billion dollars to schools to upgrade their HVAC,” Miller says.

“We have systematically neglected our HVAC systems for a very, very long time,” Siegel says. “Schools are one classic example of that. But also every building. And so now all of a sudden, we’ve got a pandemic, and we say, well, we want to increase ventilation … you don’t get there without some amount of investment.”

(Hospitals, you might be curious to know, already have extensive requirements in place for ventilation. So which comes at a great cost and takes lots of energy to use.)

Air filters can work too — if used properly

The goal in ventilation is to replace potentially virus-laden air indoors with virus-free air. One way to do this is to bring more outdoor air inside. But this isn’t always doable. You can’t easily open windows for ventilation when there’s a lot of hazardous pollution outside (like wildfire smoke). So, the other way is to filter the indoor air itself.

This also is simple in theory, but the implementation can be tricky.

It starts with getting a good air filter. For this, the American Society of Heating, Refrigerating, and Air-Conditioning Engineers suggests using filters with a MERV-13 designation or higher. Or use a portable HEPA filter (there are some DIY versions you can try on the cheap).

MERVs are based on a filter’s performance in filtering out particles between 0.3 and 10 microns. SARS-CoV-2 could very well be found in respiratory droplets in this size range; the higher the MERV number, the higher the probability that the filter will remove these droplets.

HEPA filters, more common in portable air filters, are slightly different. The “HEPA” designation means they filter out at least 99.97 percent of particles that are 0.3 microns. Which is to say, they filter out practically everything. (A quirk of the physics of filtration is the very smallest particles are actually easier to filter out than the 0.3 micron ones. The smallest particles get pushed toward filter fibers because of their collisions with gas molecules in the air, Siegel explains.)

But installing higher-quality filters isn’t enough.

“I can’t just tell you in good conscience, ‘This is the filter you should use to protect against Covid-19 transmission,’ because it really depends how you use that filter,” Siegel says. “We much more often have an implementation problem than a lack of technology problem.”

Often, he says, in buildings, a filter will be improperly sealed so that some unfiltered air sneaks past it and recirculates in the building; this downgrades its filtering ability. Also, not all systems can run these higher-efficiency filters, which can be quite dense. They often require more powerful fans to push air through.

For instance, Siegel says that, typically, home window AC units don’t operate with very powerful fans. So if you put a good filter in the unit, “you would not move any air, your air conditioner would cease to perform as an air conditioner, the coil would ice up very rapidly, and you’d have a nice block of ice with no air blowing across it.”

The other consideration: These higher-quality filters need to be replaced more frequently as they “fill up” with more stuff more quickly and it becomes harder to push air through the filter. Also (this list of caveats and considerations is getting long, right?) you need to buy a unit that’s sized correctly for the space you are in. The filtering unit should ideally, along with ventilation, lead to six or more air exchanges per hour.

“You want something that’s good for the size of your room or bigger; bigger will give you better cleaning power,” Marr says. “But, you know, even if you get something that’s smaller, it’s not going to harm you.” She adds that you also need to be careful when changing the filters because they could be contaminated with virus.

And finally: Air filters have to be constantly running to work.

“Forced air systems [like centralized heating and cooling] in most residential contexts and in some commercial context only come on when there’s a need for conditioning,” Siegel says. That is, they only turn on when it gets too cold or too hot. For a filter to work at its best, air needs to be constantly running through it. Some systems may need to be tinkered with to get this to happen.

Again, it’s hard to know, exactly, what impact air purifiers will have on transmission. “My main concern with these ventilation systems is that we do not know really whether they will decrease transmission risk substantially,” Muge Cevik, a physician and virology expert at the University of St. Andrews, says in an email. After all, there aren’t randomized controlled studies of using air cleaners during this pandemic to decrease transmission.

In theory, air purifiers should help. “It’s not rocket science,” Jimenez, who strongly advocates for their use, says. “If you pass air through the filter, it will catch the particles.”

Watch out for snake oil air-cleaning products

There’s yet another option for removing virus from the air: killing it with ultraviolet lamps. That said, Miller — who specializes in studying devices that do this sort of thing — doesn’t recommend these for the average consumer.

“While they can be effective, there is not enough testing/certification for these devices,” she says. “These are pretty complex, and there are a lot of great applications and some really good companies that can help with design and install.” But, she says “there are also a lot of bad lamp manufacturers and people selling devices that don’t work. Best left to engineers and reputable companies to support these installations.”

If you look at air cleaning products, you’ll find a lot of gimmicks: ionizers, plasma generators that claim to amp up the power of filters. “There’s very little science behind them,” Siegel says. “It’s not only that the devices are ineffective and maybe lull people into a false sense of security, but in some cases they’re actually harmful.”

Watch out, in particular, for machines that can generate ozone. Ozone is a pollutant that can interact with a lot of different products in your home and create harmful chemicals to breathe in. “It reacts with carpets and skin oil and all kinds of things inside of buildings,” Siegel says, “forming all kinds of harmful byproducts, ultra-fine particles, formaldehyde, all kinds of other things that we would worry about indoors.”

So stick with HEPA or MERV-13+ rated filters. Or just open windows.

Remember: Hygiene theater is possible when it comes to air quality as well. If a school or any indoor space says it has improved ventilation, ask how. Marr suggests asking building operators what the air exchange rate is (if they don’t know it, maybe be wary about the space). Ask about what filters have been put in place. Ask if their HVAC systems have been routinely maintained.

“Even if you can’t reach the target — six air changes per hour — if you can improve, that will still be helpful,” Marr says. “Do what you can, because that will reduce the risk of transmission. Don’t give up.”

We need to invest in cleaner air, period. Pandemic or not.

There are no risk-free situations in a pandemic. Again, good ventilation needs to take place alongside other precautions. The hope is “if we can take this whole suite of stopgap measures from the ventilation standpoint and add it to masks, social distancing, reduced occupancy, limited time indoors, the whole package could reduce our risk substantially to help get the case rates down,” Miller says.

This is particularly important heading into the fall and winter seasons, when more people will be spending more time indoors in potentially risky environments.

Experts also worry that the US Centers for Disease Control and Prevention is not being helpful enough in its air quality recommendations. For instance, the CDC recommends that schools “ensure ventilation systems operate properly and increase circulation of outdoor air as much as possible, for example by opening windows and doors.” But they don’t even weigh in on the merits of putting a HEPA air purifier in each classroom.

“It would carry more credibility,” Jimenez says, if the CDC would discuss their use rather than leave the conversation in the hands of independent scientists speaking for themselves. “When I was talking to a school district, they were all saying, ‘Well, the CDC doesn’t recommend air cleaners.’” In Jimenez’s mind, air cleaners are essential. But it’s hard to get the message across without a huge institution like the CDC echoing it.

So much of the pain of the pandemic builds on preexisting problems. Too many schools and other buildings have overlooked their ventilation and indoor air quality to begin with. Addressing ventilation can’t just be a one-time Band-Aid during the pandemic. It’s an investment. And not just for future pandemics but for our overall health.

“The best possible case is that you reduce risk of Covid-19 and you make your indoor air quality better,” Siegel says. “The worst possible case is that you make indoor air quality better but don’t appreciably change Covid-19 risk.”

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If Joe Biden beats Donald Trump this November and ends up in the Oval Office in January, he’ll quickly face one of the gravest challenges any president has seen in the modern era: Hundreds of thousands of Americans will be dead from Covid-19. Public trust in scientific and government institutions will be depleted. If the fall and winter goes as badly as some experts fear, coronavirus outbreaks may be at a new peak. And if a vaccine gets approved, it will still need to be distributed to hundreds of millions of Americans quickly and equitably.

Biden’s immediate job would be fixing the mess left behind by his predecessor — one that’s left America with one of the worst coronavirus outbreaks in the world and, as of September, more daily Covid-19 deaths than all but two developed countries.

Experts say these problems are fixable, but fixing them will largely come down to political will. The policy solutions are things that we’ve all heard about throughout the pandemic: aggressive testing and tracing to contain new outbreaks. Mask-wearing to slow the spread of the coronavirus. Economic support for those affected by the epidemic, at once providing financial support and making social distancing more feasible.

“It’s not rocket science. It’s not that we need some new thing that hasn’t been thought of before,” Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, told me. “There are things that have been done in some cases, or can be done. But if there was a stronger, coordinated federal role … that could really make a difference. It’s happened in other countries.”

Another part of Biden’s job will be to, in effect, repair Americans’ trust in science — bolstering public health institutions like the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA), widely considered the gold standard of public health agencies in the world before the pandemic.

Biden will also have to prepare the country for the rollout of a coronavirus vaccine that could take months if not years. The challenge here isn’t just discovering a safe and effective vaccine; many experts, in fact, are hopeful the world will do that by the end of 2020. The difficulty will be figuring out how to quickly produce and distribute up to hundreds of millions of doses of the vaccine to the general public — an unprecedented effort. That will also require persuading the public to take the vaccine, which could be particularly challenging coming off the heels of a highly contentious presidential election.

Biden, for his part, has vowed to do much of this. His website promises to adopt a masking mandate and boost testing and tracing. His campaign has vowed to “listen to science” and “restore trust, transparency, common purpose, and accountability to our government.” And he’s promised to “plan for the effective, equitable distribution of treatments and vaccines.”

Trump could do all of this, too. But there’s very little faith among experts that Trump will change his current approach to the pandemic, especially if he wins reelection. Instead, he’ll likely continue doing what he’s done: deliberately downplaying the pandemic, demanding states reopen far too quickly, punting testing and tracing to local and state governments with more limited resources, mocking masking, and continuing to try to politicize the CDC and FDA.

That failed response helps explain the US’s current Covid-19 outbreak, leading the country to more than 200,000 deaths from the disease — by far the highest recorded death toll in the world. When controlling for population, the US hasn’t had the highest death rate for Covid-19, but it’s among the top 20 percent for developed nations, and has seven times the death rate as the median developed country. If the US had the same Covid-19 death rate as, say, Canada, more than 120,000 more Americans would likely be alive today.

That damage can’t be reversed. Those 200,000 deaths are on the US’s record forever. But Biden, at least, could take actions that would help prevent America’s outbreak from getting even worse.

1) Implement policies we know work: Testing, tracing, masks, and social distancing

There are problems in the world with really difficult or unknowable answers. That’s not as true for Covid-19: While there’s a lot about the coronavirus we’re still learning, there are many policy approaches that we know work and the US hasn’t really embraced. This is, then, more a matter of will than knowledge — which is something that Biden, especially if he has a sympathetic Democrat-controlled Congress, could address.

Testing is among those proven policy approaches. When paired with contact tracing, more testing can help public health officials detect outbreaks, get the infected to isolate and the infected’s close contacts to quarantine, and use broader public health measures as needed. This is an approach that has worked well in many other developed countries, from Germany to South Korea to New Zealand.

The US, however, has struggled to build up its testing capacity. It’s made big improvements since the start of the pandemic, but testing hasn’t increased above 1 million tests a day — far lower than experts say is needed, given the country’s large epidemic overall. As a result, the percentage of tests coming back positive, which experts use to measure testing capacity, stubbornly remains at 5 percent or more; it should be, experts suggest, far below 5 percent and preferably below even 3 percent. It can still take days to get test results back, and that can spike to weeks if demand, due to a new outbreak, is high.

According to experts, part of the problem is the US never fundamentally fixed supply line problems — with shortages popping up for swabs, reagents, testing kits, and other needed equipment throughout the pandemic. There was also an economic disincentive to building out capacity too much: If a lab, for example, massively scales up its coronavirus testing, but the pandemic is over in a few years, it will be left with a lot of infrastructure it doesn’t use or get revenue from, a huge money sink.

A Biden administration could address these problems, using the powers of the federal government to coordinate the supply line, maintain its stability, and guarantee that any businesses and organizations will be made whole for investments into coronavirus testing. To do all of that, the country needs a national plan — which it currently lacks.

There’s a chance the supply problem fixes itself. With the development and mass production of new antigen tests that don’t have to go through a lab and hospitals, Americans could get access to many more tests that also return results within minutes instead of hours or days. Compared to the hold-ups with the current PCR tests that go through labs or hospitals, it would be a welcome change.

Still, there would be remaining questions about how to deploy and distribute those new tests based on equity and need — questions that a national plan could address.

After that, the US would still face another problem: how to actually use those tests. That’s where contact tracing comes in, as “disease detectives” track down newly infected people and their close contacts to convince them to isolate and quarantine. Earlier this year, Crystal Watson, senior scholar at the Johns Hopkins Center for Health Security, projected that the US would need at least 100,000 contact tracers. She estimated the US still has fewer than half of that number.

Since Watson’s original estimate, Covid-19 outbreaks in the US have also gotten much worse and more widespread. That presents two major problems: First, the US now needs even more contact tracers than she originally estimated. Second, it’s now likely impossible for contact tracing to really bring down the epidemic on its own, because there are just way too many cases for even a massive team of tracers to track down and contain.

So while a large federal investment in a contact tracing workforce and equipment could help, it probably won’t be enough. “We really have to take other measures to bring down transmission in order for contact tracing to be effective,” Watson told me.

Among the other measures: masks. The scientific evidence for masking has gotten much stronger since the start of the coronavirus pandemic, with multiple studies linking the widespread use of masks and new mask mandates to drops in Covid-19 cases and deaths. One study in Health Affairs suggested that, with caveats that this is just an approximation, “230,000-450,000 COVID-19 cases may have been averted on the basis of when states passed these mandates.” If mandates were nationwide instead of left to a minority of states at the time, it stands to reason the impact would have been much bigger.

Whether the federal government could impose a mask mandate on its own gets into legally dicey territory. But a Biden administration and Congress could use financial incentives to encourage cities and states to adopt masking mandates and provide extra resources to enforce them. That could get the remaining 16 states without a mask mandate, or at least some of the municipalities in those states, to adopt the policy.

Just having a president who is unequivocal about the benefits of masking and consistently wears a mask in public, experts claimed, would also signal to the rest of the country that this is the right thing to do. It’s “just the public image of a responsible adult doing what they’re supposed to do,” Cedric Dark, an emergency medicine physician at the Baylor College of Medicine, told me.

Even with all these measures in place, the US will have to continue social distancing to some degree. No one wants this, but, depending on how bad fall and winter outbreaks get, some cities, counties, and states may have to bring back lockdowns.

The federal government can provide clearer guidance on how and when to do this. It can also, with Congress’s backing, pass legislation that financially supports people affected by lockdowns. A commonly cited idea is a bailout for bars, restaurants, and other businesses, which would not only help keep these employers and their employees afloat but make the negatives of closing down much more tolerable and, therefore, make closing down easier and more likely if it’s deemed necessary to fight the coronavirus.

Ultimately, this could benefit the economy by mitigating the need for such harsh social distancing efforts. A preliminary study from the 1918 flu pandemic found that cities that took more aggressive action against outbreaks back then emerged stronger economically. Germany and others have similarly seen their restaurant businesses recover by controlling the coronavirus. As Watson put it, “In order for our economy to recover, we really do need to resource our public health response more effectively.”

Again, none of this is really new. The experts I spoke with often joked that we were having the exact same conversations now that we had back in the spring and summer. But the US hasn’t fully committed to these kinds of policies — and a Biden administration could.

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2) Rebuild trust in science and public health institutions

Under Trump, and particularly throughout this pandemic, trust in many institutions has dwindled. This has applied even to American institutions that were in the past considered the best of the best in the world for public health, such as the CDC and FDA.

The country needs “a long campaign to get people to trust science again,” Dark said. “My colleagues don’t trust anything coming out of the CDC now, due to how politicized it’s been.”

A report from the Covid-19 Consortium for Understanding the Public’s Policy Preferences Across States, based on a 50-state survey on Covid-19, captured the trends: Across the country, trust in “doctors and hospitals,” “scientists and researchers,” and especially the CDC has fallen. Trust in all of these is still relatively high — much higher than trust in either Biden or Trump — but it’s a concerning trend. Among different political and demographic groups, trust can be even lower, too.

“Six months ago, the FDA and CDC were shorthands for gold-standard scientific advice,” Ashish Jha, dean of the Brown University School of Public Health, told me. That’s changed, he lamented.

Some of this reflects genuine failures by these institutions. The CDC and FDA both played roles in the US’s testing problems — the CDC by botching its tests, and the FDA dragging its feet in approving more testing from private and independent labs — leading to what’s been widely called a “lost month” for testing in February. The CDC was also slow to recommend masks, then failed to admit to messing up and explain its about-face on the issue. The FDA, meanwhile, has acted in ways that seem politically motivated rather than based on rigorous evidence, such as when it allowed, before warning against, hydroxychloroquine, which was always unproven but Trump spoke favorably about.

Although the CDC and FDA are supposed to stand above partisan politics to help maintain their credibility, Trump and his administration have actively meddled in their affairs and work. Trump and his political cronies have, for example, repeatedly pushed the CDC to do things solely to support Trump’s unproven claims about Covid-19 — forcing the agency to briefly recommend less testing, loosen its guidelines for reopening, and delay studies that contradict the president. All of that has called into question just how independent the CDC truly is.

Fixing this will take time, but it’s fairly straightforward: Biden and the political actors in his administration should back off, allowing scientists to take a leading role in these agencies and the US’s Covid-19 response in general.

Carlos del Rio, executive associate dean of the Emory University School of Medicine, put this simply: “Pay attention to science. Let the science guide the response, not the politics.”

That includes giving these institutions control of the public messaging. While Trump appointed Vice President Mike Pence to lead the White House’s coronavirus task force, Biden could put a scientist or public health official in charge. While Trump sidelined the CDC after Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, warned in February that “disruption to everyday life might be severe” due to Covid-19, Biden could allow the agency and its experts to speak plainly and truthfully to the public.

That should also translate to the policy level. When the CDC makes recommendations, the Biden administration shouldn’t, as Trump has, undermine the guidelines or force the agency to change them. When scientists are recommending a pivot in the country’s approach, that should be seriously considered, even if it contradicts what the administration said or did in the past, while clearly and transparently explaining why a change is needed.

“The CDC has the expertise to lead us in this pandemic,” Jorge Salinas, an epidemiologist at the University of Iowa, told me. “We just need to ask them.”

The idea is to prove to the public time and time again that the country’s response to Covid-19 isn’t driven by politics but by science. It’s an admittedly difficult task for a country that’s consumed by politics and polarization at every level, but it’s something, experts said, that’s simply necessary to improve America’s response to the coronavirus.

3) Prepare the country for a months-long rollout of a vaccine

If we get a little lucky, there’s a chance that the world will finally have a proven, safe, and effective coronavirus vaccine by the end of the year. It would be an incredible achievement — the fastest turnaround on a vaccine for a major disease in human history.

But that won’t be the end. After a vaccine makes it through the last rounds of research necessary to get FDA approval, it’ll have to be distributed to potentially more than 300 million people in the US alone. Given that some of these vaccines will require two doses, that means manufacturing hundreds of millions of doses of the medication — something that the country simply hasn’t done at the scale and speed that the pandemic demands.

There’s already a lot of work, from both governments and private actors like Bill Gates, to manufacture all those doses. It’s possible, even likely, that the current work isn’t enough — and that will demand more action and more funds by a Biden administration.

After that, there will be tough questions about who gets priority. There’s a consensus that first responders and health care workers, at least, should get a vaccine first. Beyond that, there are genuinely difficult questions: Should older adults get priority because they’re more vulnerable? Should essential workers? What about younger people, who seem to be behind the country’s most recent large outbreaks? “It gets complicated,” Jha acknowledged.

Another element will be persuading the public to actually take a vaccine. If a vaccine is 50 to 70 percent effective, as appears likely at first, experts argue that close to 100 percent of the population will need to take one to reach true herd immunity. That will be a tall order as the country deals not just with traditional, unscientific anti-vaxxer sentiments but also more nuanced concerns about whether the current politicized, fast process coronavirus vaccines are going through can really test adequately for safety. Different surveys have found a third to half of Americans don’t plan to or don’t know if they’ll get a coronavirus vaccine.

“It does seem like there has been less of a push to actually come up with a really good communications plan,” Watson said, “but also to just have a general dialogue with people as you go along about what the process has been like for creating a vaccine, what standards have been upheld, and the results of the safety and efficacy trials.”

Breaking through those concerns will require research and surveys to subsequently build a massive communications campaign that will try to push people to get vaccinated. This will be a huge undertaking, and it might not even work, depending on if a new administration can rebuild trust in science and depoliticize its public health institutions.

All of this could take a long time. Experts were unanimous in arguing that getting a vaccine by the end of 2020, should that happen, won’t be the end of the pandemic. They said that getting a vaccine out there could take at least months. Some spoke in terms of years, well into 2022 or 2023. “President Biden and Vice President [Kamala] Harris, should they be in office, should understand they will be dealing with Covid for much of their first term,” Jha said. “It will continue to come up as an issue in the next midterms. It’s not going away.”

To put it another way: If Biden takes office, it’s possible a vaccine will finally present some kind of finish line in this pandemic. But we might quickly realize that the finish line is still a few months or years away. And that will make the work of preparing the country for a vaccine — and all the other steps needed to contain Covid-19 in the months and years ahead — necessary. With hundreds of thousands of Americans already dead, it’s the most important task Biden should prepare for right now.

Mushrooms that don’t brown. A treatment for sickle-cell anemia. Driving malaria-carrying mosquitoes to extinction. Resurrecting the woolly mammoth. Editing genes in human embryos to make them less susceptible to HIV. These are just a handful of the possibilities of the versatile gene editing tool known as CRISPR that scientists have explored in the few years since its discovery.

On Wednesday, the 2020 Nobel Prize in chemistry was awarded to the pair of scientists who discovered the CRISPR gene-editing mechanism, also known as CRISPR/Cas9. It acts as a pair of “genetic scissors” to precisely make cuts and insertions in genomes, creating the possibilities of treating genetic maladies, as well as introducing new heritable traits into living organisms.

Emmanuelle Charpentier, director of the Max Planck Unit for the Science of Pathogens in Berlin, Germany, and Jennifer Doudna, a professor at the University of California, Berkeley, will split the $1.1 million prize evenly, marking the first time two women scientists have been awarded the chemistry Nobel without a male collaborator.

“This year’s prize is about rewriting the code of life,” Göran K. Hansson, Secretary General of the Royal Swedish Academy of Sciences said on Wednesday.

It’s hard to overstate the impact of Charpentier and Doudna’s discovery. In 2011, there were fewer than 100 published papers on CRISPR. In 2020, there were more than 35,000. Dozens of companies have sprung up to develop products from this technique, from therapies for genetic diseases to engineered crops. Scientists have even developed a CRISPR-based test to detect SARS-CoV-2, the virus that causes Covid-19.

All this from an ancient defense mechanism found in common bacteria.

The CRISPR/Cas9 technique has managed to simultaneously improve the precision and speed of genome editing, while also lowering the cost of this manipulation. Despite all the progress to date, there may be many more discoveries built on this foundation that lie ahead.

With the Covid-19 pandemic raging around the world, Charpentier and Doudna will not be able to accept their prizes in person this year and will instead participate in a digital ceremony in December. “I can guarantee you that Doctors Charpentier and Doudna will receive their awards before the end of the year, and that they will be our guests of honor next time we can celebrate Nobel week with the traditional festivities here in Stockholm,” Hansson said.

How CRISPR sequences and the Cas9 enzyme work to edit genomes

The roots of the discovery date back to 1987, when Japanese researchers looking at E. coli found a strange section of DNA in the bacteria. There were short, repeating clusters of the DNA sequence that could be read in the same way forward and backward, forming palindromes.

They named these sequences Clustered Regularly Interspaced Short Palindromic Repeats, or CRISPR, but the scientists at the time didn’t know what purpose they served.

Then in 2007, researchers studying the Streptococcus bacteria used to make yogurt discovered these sequences are part of how bacteria resist infections from viruses.

When a bacterium fights off a virus, it keeps a small section of the virus’ genetic material as a souvenir, storing the information from the fragment in the spaces between CRISPR segments in its own genome.

If a similar virus attacks again, the bacteria produces an enzyme called Cas9. It uses the stored bits of viral genetic material in CRISPR spaces as sort of a mugshot. When it identifies a matching strand, it cuts it into pieces. This thwarts a virus from replicating.

In 2011, Charpentier and Doudna figured out that they could replace the template that Cas9 uses to snip genetic material with a synthetic code of their choosing. The enzyme then would search for a match to the new template and cut that out instead. This demonstrated that they could harness this mechanism to make cuts in a genome at any place they wanted.

The researchers published their findings in a 2012 paper in the journal Science.

The science of gene editing is advancing much faster than the ethics

While genetic-editing techniques have been around for decades, the CRISPR/Cas9 system introduced a new level of precision. It’s also fast and cheap, condensing genetic manipulation that previously took months and cost thousands of dollars into a system that can work in hours from a kit that you can buy online for less than $200 (“you don’t need anything else but water and a microwave,” it advertises).

The potentially lucrative applications of CRISPR/Cas9 have fueled an ongoing patent dispute between a team at the Broad Institute led by Feng Zhang and Doudna’s team at Berkeley. In 2013, Zhang, showed in a paper in Science that CRISPR/Cas9 could be used to edit the genomes of cultured mouse cells or human cells.

The growing use of such a sophisticated genetic manipulation tool has also proven controversial, especially as a small number of scientists have pushed forward with using it in human embryos despite an international consensus that it was too soon (outside of a serious medical need). In 2018, He Jiankui, a researcher in China, announced that he had already used CRISPR to edit the genomes of the embryos of a pair of twin girls, marking the first time human embryos have been genetically edited.

The story generated international outcry and calls for stricter regulations on using this kind of genetic manipulation. He was later sentenced to three years in prison by Chinese authorities for forging ethics review documents and misleading the doctors involved about the nature of his experiment.

In a 2018 statement responding to He’s announcement, Doudna called for constraints on how CRISPR is used in humans. “The work as described to date reinforces the urgent need to confine the use of gene editing in human embryos to cases where a clear unmet medical need exists, and where no other medical approach is a viable option, as recommended by the National Academy of Sciences,” she wrote.

The National Academy of Sciences in September put out a report assessing the state of genetic manipulation and concluded that such techniques are still not ready for use in humans.

“No attempt to establish a pregnancy with a human embryo that has undergone genome editing should proceed unless and until it has been clearly established that it is possible to efficiently and reliably make precise genomic changes without undesired changes in human embryos,” according to the report. “These criteria have not yet been met and further research and review would be necessary to meet them.”

Further reading about the 2020 Nobel Prizes:

• Andrea Ghez and Reinhard Genzel shared the Nobel Prize in physics for leading teams who made revolutionary observations of black holes.
• Harvey J. Alter, Michael Houghton, and Charles M. Rice shared the Nobel Prize in medicine for discovering hepatitis C.

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Researchers at the University of Nevada have reported that a 25-year-old man was reinfected in June with SARS-CoV-2, the virus the causes Covid-19. He joins a handful of other confirmed cases of reinfection in people without immune disorders — in Belgium, the Netherlands, Hong Kong, and Ecuador — where researchers have demonstrated that the genetic signature of the second infection did not match that of the first.

According to a new study on the Nevada case, published in The Lancet Infectious Diseases journal, the patient first tested positive in April, and then tested negative for the virus twice. In June, 48 days later, “the patient was hospitalized and tested positive for a second time,” according to the authors, and he experienced severe symptoms. There were major genetic differences between the two infections, suggesting that the patient got the virus twice. (Since then, the patient has recovered.)

The report is in line with what immunity experts have been telling us is possible with this virus: that reinfection is possible and, to some extent, expected, with a coronavirus. But it also shows us how much we still have to learn: about how much protection a single infection can confer, about what exactly a robust long-duration immune response looks like, and about what determines the severity of disease in a second infection.

“Does immunity protect an individual from disease on reinfection?” writes Yale immunobiology researcher Akiko Iwasaki in an accompanying editorial in The Lancet Infectious Diseases. “The answer is not necessarily, because patients from Nevada and Ecuador had worse disease outcomes at reinfection than at first infection.”

The Nevada case is an important finding, since in the two other confirmed cases of reinfection, the patients had mild disease or were asymptomatic. Scientists still don’t know how common reinfection is (it may well be very rare), nor can they determine an individual’s chances of getting infected again.

They do know there are many, many components of our immune system that work together to fight the coronavirus, and immunity doesn’t mean one single thing. And while we’re waiting for scientists to figure it all out, everyone, including those who’ve already had the virus, should still try to avoid getting infected at all.

The new study “strongly suggests that individuals who have tested positive for SARS-CoV-2 should continue to take serious precautions when it comes to the virus, including social distancing, wearing face masks, and handwashing,” said Mark Pandori, of the Nevada State Public Health Laboratory at the University of Nevada Reno School of Medicine and lead author of the study, in a statement.

Let’s walk through the basics of immunity, and what we’re learning about reinfection.

There are no simple stories about immunity and Covid-19

The immune system is profoundly complicated, and “immunity” can mean many different things. A lot of this nuance gets lost in headlines about immunity.

For instance: Previous research has shown that neutralizing antibodies — immune system proteins that latch onto pathogens and prevent them from infecting cells — can wane in the months after a Covid-19 infection, particularly when the initial infection was mild. Some wondered if that meant the end of herd immunity hopes.

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In the Nevada case, we know that “the patient had positive antibodies after the reinfection, but whether he had pre-existing antibody after the first infection is unknown,” writes Iwasaki.

But what’s often misunderstood is that antibodies are only one component of the immune system, and losing them does not leave a person completely vulnerable to the virus.

In fact, there are several parts of the immune system that may contribute to lasting protection against SARS-CoV-2.

One is killer T-cells. “Their names give you a good hint what they do,” Alessandro Sette, an immunologist at the La Jolla Institute for Immunology, told me in July. “They see and destroy and kill infected cells.”

Antibodies, he explained, can clear virus from bodily fluids. “But if the virus gets inside the cell, then it becomes invisible to the antibody.” That’s where killer T-cells come in: They find and destroy these hidden viruses.

While antibodies can prevent an infection, killer T-cells deal with an infection that’s already underway. So they play a huge role in long-term immunity, stopping infections before they have time to get a person very sick.

And it’s not just killer T-cells and antibodies. There are also helper T-cells, which facilitate a robust antibody cell response. “They are required for the antibody response to mature,” Sette says.

Some proportion of the population (perhaps 25 to 50 percent of people) seems to have some preexisting T-cells (of both varieties, but the helper kind have been more commonly observed) that respond to SARS-CoV-2, despite these people never having been exposed to SARS-CoV-2. The hypothesis is that these people may have acquired these T-cells from being infected with other strains in the coronavirus family of viruses. Researchers still don’t really understand what role these preexisting T-cells play in preventing or attenuating infection (if any).

But wait, there’s more! There’s another group of cells called memory B-cells. B-cells are the immune system cells that create antibodies. Certain types of B-cells become memory B-cells. These save the instructions for producing a particular antibody, but they aren’t active. Instead, they hide out — in your spleen, in your lymph nodes, perhaps at the original site of your infection — waiting for a signal to start producing antibodies again.

All the things “immunity” can mean

All these different components of the immune system mean “immunity” isn’t just one thing.

Immunity could mean a strong antibody response, which prevents the virus from establishing itself in cells. But it could also mean a good killer T-cell response, which could potentially stop an infection very quickly: before you feel sick and before you start spreading the virus to others.

“In many infections, the virus does reproduce a little bit, but then the immune response stops this infection in its tracks,” Sette explains. Also possible: “You do get infected, you do get sick, but your immune system does enough of a job curbing the infection, so you don’t get as sick.”

Immunity might also result from an awakening of memory B-cells. If an individual has memory B-cells and is exposed to the virus again, “that infection will stimulate a much faster antibody response to the virus, which would, theoretically lead to faster clearance of the virus and potentially less severe infection,” Elitza Theel, the director of the infectious diseases serology laboratory at the Mayo Clinic, said in a July interview.

In general, scientists believe, the stronger the infection (and immune response) that occurs during an initial infection, the longer immunity will last.

So reinfection may still be possible, but it may not mean severe illness. When a virus invades a body, generally, the body remembers.

Could asymptomatic infections spread the virus? Unclear.

It’s still not known what the latest reinfection study means for how long the pandemic will last. If reinfections happen regularly (and we have no idea how common they might be), then it might take longer to achieve herd immunity without a vaccination (which is an un-ideal, and cynical, goal to begin with). How long immunity lasts, on average, and how common reinfection is are key unknown variables in figuring out how long the pandemic may last in the absence of an effective vaccine or treatment.

“Reinfection cases tell us that we cannot rely on immunity acquired by natural infection to confer herd immunity; not only is this strategy lethal for many but also it is not effective,” Iwasaki wrote in the editorial. “Herd immunity requires safe and effective vaccines and robust vaccination implementation.”

We also have much more to learn about how often reinfections lead to more clusters of cases. Recently, I asked Shane Crotty, an immunologist at the La Jolla Institute for Immunology, about this very scenario.

“Could there be an ‘immunity’ scenario,” I asked, “where, after having recovered from Covid, a person could get infected again but not feel sick at all, and also be able to spread it?”

“It is a good question, and the answer is that no one knows,” Crotty replied. “There are cases with other diseases where asymptomatic immune people can be infectious. There is definitely a lot to learn still about immunity to SARS-CoV-2.”

Much ink has been spilled over the “replication crisis” in the last decade and a half, including here at Vox. Researchers have discovered, over and over, that lots of findings in fields like psychology, sociology, medicine, and economics don’t hold up when other researchers try to replicate them.

This conversation was fueled in part by John Ioannidis’s 2005 article “Why Most Published Research Findings Are False” and by the controversy around a 2011 paper that used then-standard statistical methods to find that people have precognition. But since then, many researchers have explored the replication crisis from different angles. Why are research findings so often unreliable? Is the problem just that we test for “statistical significance” — the likelihood that similarly strong results could have occurred by chance — in a nuance-free way? Is it that null results (that is, when a study finds no detectable effects) are ignored while positive ones make it into journals?

A recent write-up by Alvaro de Menard, a participant in the Defense Advanced Research Project’s Agency’s (DARPA) replication markets project (more on this below), makes the case for a more depressing view: The processes that lead to unreliable research findings are routine, well understood, predictable, and in principle pretty easy to avoid. And yet, he argues, we’re still not improving the quality and rigor of social science research.

While other researchers I spoke with pushed back on parts of Menard’s pessimistic take, they do agree on something: a decade of talking about the replication crisis hasn’t translated into a scientific process that’s much less vulnerable to it. Bad science is still frequently published, including in top journals — and that needs to change.

Most papers fail to replicate for totally predictable reasons

Let’s take a step back and explain what people mean when they refer to the “replication crisis” in scientific research.

When research papers are published, they describe their methodology, so other researchers can copy it (or vary it) and build on the original research. When another research team tries to conduct a study based on the original to see if they find the same result, that’s an attempted replication. (Often the focus is not just on doing the exact same thing, but approaching the same question with a larger sample and preregistered design.) If they find the same result, that’s a successful replication, and evidence that the original researchers were on to something. But when the attempted replication finds different or no results, that often suggests that the original research finding was spurious.

In an attempt to test just how rigorous scientific research is, some researchers have undertaken the task of replicating research that’s been published in a whole range of fields. And as more and more of those attempted replications have come back, the results have been striking — it is not uncommon to find that many, many published studies cannot be replicated.

One 2015 attempt to reproduce 100 psychology studies was able to replicate only 39 of them. A big international effort in 2018 to reproduce prominent studies found that 14 of the 28 replicated, and an attempt to replicate studies from top journals Nature and Science found that 13 of the 21 results looked at could be reproduced.

The replication crisis has led a few researchers to ask: Is there a way to guess if a paper will replicate? A growing body of research has found that guessing which papers will hold up and which won’t is often just a matter of looking at the same simple, straightforward factors.

A 2019 paper by Adam Altmejd, Anna Dreber, and others identifies some simple factors that are highly predictive: Did the study have a reasonable sample size? Did the researchers squeeze out a result barely below the significance threshold of p = 0.05? (A paper can often claim a “significant” result if this “p” threshold is met, and many use various statistical tricks to push their paper across that line.) Did the study find an effect across the whole study population, or an “interaction effect” (such as an effect only in a smaller segment of the population) that is much less likely to replicate?

Menard argues that the problem is not so complicated. “Predicting replication is easy,” he said. “There’s no need for a deep dive into the statistical methodology or a rigorous examination of the data, no need to scrutinize esoteric theories for subtle errors — these papers have obvious, surface-level problems.”

A 2018 study published in Nature had scientists place bets on which of a pool of social science studies would replicate. They found that the predictions by scientists in this betting market were highly accurate at estimating which papers would replicate.

“These results suggest something systematic about papers that fail to replicate,” study co-author Anna Dreber argued after the study was released.

Additional research has established that you don’t even need to poll experts in a field to guess which of its studies will hold up to scrutiny. A study published in August had participants read psychology papers and predict whether they would replicate. “Laypeople without a professional background in the social sciences are able to predict the replicability of social-science studies with above-chance accuracy,” the study concluded, “on the basis of nothing more than simple verbal study descriptions.”

The laypeople were not as accurate in their predictions as the scientists in the Nature study, but the fact they were still able to predict many failed replications suggests that many of them have flaws that even a layperson can notice.

Bad science can still be published in prestigious journals and be widely cited

Publication of a peer-reviewed paper is not the final step of the scientific process. After a paper is published, other research might cite it — spreading any misconceptions or errors in the original paper. But research has established that scientists have good instincts for whether a paper will replicate or not. So, do scientists avoid citing papers that are unlikely to replicate?

This striking chart from a 2020 study by Yang Yang, Wu Youyou, and Brian Uzzi at Northwestern University illustrates their finding that actually, there is no correlation at all between whether a study will replicate and how often it is cited. “Failed papers circulate through the literature as quickly as replicating papers,” they argue.

Looking at a sample of studies from 2009 to 2017 that have since been subject to attempted replications, the researchers find that studies have about the same number of citations regardless of whether they replicated.

If scientists are pretty good at predicting whether a paper replicates, how can it be the case that they are as likely to cite a bad paper as a good one? Menard theorizes that many scientists don’t thoroughly check — or even read — papers once published, expecting that if they’re peer-reviewed, they’re fine. Bad papers are published by a peer-review process that is not adequate to catch them — and once they’re published, they are not penalized for being bad papers.

The debate over whether we’re making any progress

Here at Vox, we’ve written about how the replication crisis can guide us to do better science. And yet blatantly shoddy work is still being published in peer-reviewed journals despite errors that a layperson can see.

In many cases, journals effectively aren’t held accountable for bad papers — many, like The Lancet, have retained their prestige even after a long string of embarrassing public incidents where they published research that turned out fraudulent or nonsensical. (The Lancet said recently that, after a study on Covid-19 and hydroxychloroquine this spring was retracted after questions were raised about the data source, the journal would change its data-sharing practices.)

Even outright frauds often take a very long time to be repudiated, with some universities and journals dragging their feet and declining to investigate widespread misconduct.

That’s discouraging and infuriating. It suggests that the replication crisis isn’t one specific methodological reevaluation, but a symptom of a scientific system that needs rethinking on many levels. We can’t just teach scientists how to write better papers. We also need to change the fact that those better papers aren’t cited more often than bad papers; that bad papers are almost never retracted even when their errors are visible to lay readers; and that there are no consequences for bad research.

In some ways, the culture of academia actively selects for bad research. Pressure to publish lots of papers favors those who can put them together quickly — and one way to be quick is to be willing to cut corners. “Over time, the most successful people will be those who can best exploit the system,” Paul Smaldino, a cognitive science professor at the University of California Merced, told my colleague Brian Resnick.

So we have a system whose incentives keep pushing bad research even as we understand more about what makes for good research.