As America, and even his own administration, woke up to the threat of Covid-19, President Donald Trump still didn’t seem to get it. Within weeks of suggesting that people social distance in mid-March, the president went on national TV to argue that the US could reopen by Easter Sunday in April. “You’ll have packed churches all over our country,” Trump said in March. “I think it’ll be a beautiful time.”

The US wasn’t able to fully and safely reopen in April. It isn’t able to fully and safely reopen in September.

The virus rages on, affecting every aspect of American life, from the economy to education to entertainment. More than 200,000 Americans are confirmed dead. Many schools are closing down again after botched attempts to reopen — with outbreaks in universities and K-12 settings. America now has one of the worst ongoing epidemics in the world, with the second most daily new Covid-19 deaths among developed nations, surpassed only by Spain.

America does not have the most Covid-19 deaths per capita of any rich country, but it’s doing worse than most. The US reports about seven times the Covid-19 deaths as the median developed country, ranking in the bottom 20 percent for coronavirus deaths among wealthy nations. Tens of thousands of lives have been needlessly lost as a result: If America had the same death rate as, for example, Canada, about 120,000 more Americans would likely be alive today.

The Easter episode, experts said, exemplified the magical thinking that has animated Trump’s response to the Covid-19 pandemic before and after the novel coronavirus reached the US. It’s a problem that’s continued through September — with Trump and those under him flat-out denying the existence of a resurgence in Covid-19, falsely claiming rising cases were a result of more tests. With every day, week, and month that the Trump administration has tried to spin a positive story, it’s also resisted stronger action, allowing the epidemic to drag on.

A pandemic was always likely to be a challenge for the US, given the country’s large size, fragmented federalist system, and libertarian streak. The public health system was already underfunded and underprepared for a major disease outbreak before Trump.

Yet many other developed countries dealt with these kinds of problems too. Public health systems are notoriously underfunded worldwide. Australia, Canada, and Germany, among others, also have federalist systems of government, individualistic societies, or both — and they’ve all fared much better.

Instead, experts said, it’s Trump’s leadership, or lack thereof, that really sets the US apart. Before Covid-19, Trump and his administration undermined preparedness — eliminating a White House office set up by the previous administration to combat pandemics, making cuts across other key parts of the federal government, and proposing further cuts.

Once the coronavirus arrived, Trump downplayed the threat, suggesting that it would soon disappear “like a miracle.” The Centers for Disease Control and Prevention (CDC) took weeks to fix botched tests, and the administration actively abdicated control of issues to local, state, and private actors.

“There was a failure to realize what an efficiently spreading respiratory virus for which we have no vaccine and no antiviral meant,” Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, told me. “From the very beginning, that minimization … set a tone that reverberated from the highest levels of government to what the average person believes about the virus.”

Several developed countries — including Belgium, France, Italy, and Spain — were caught off-guard by the pandemic and were hit hard early, suffering massive early outbreaks with enormous death tolls. But most developed countries took these crises seriously: adopting lengthy and strict lockdowns, widespread testing and contact tracing, masking mandates, and consistent public messaging about the virus. (Though parts of Europe are now seeing second waves, seemingly because they prematurely relaxed social distancing measures.)

America did not take the steps necessary, even after an outbreak spiraled out of control in New York. So the US suffered a wave of huge cases over the summer that other developed nations generally avoided, leading to new and continued surges in both cases and deaths. And while other developed countries have seen spikes in cases as fall neared, America also has seen cases start to rise once again.

“If George W. Bush had been president, if John McCain had been president, if Mitt Romney had been president, this would have looked very different,” Ashish Jha, dean of the Brown University School of Public Health, told me, emphasizing the failure to act after Covid-19 hit the US hard was a phenomenon driven by Trump.

Experts worry that things will again get worse: Colder weather is coming, forcing people back into risky indoor environments. So are holiday celebrations, when families and friends will gather from across the country. Another flu season looms. And Trump, experts lamented, is still not ready to do much, if anything, about it.

The White House disputes the criticisms. Spokesperson Sarah Matthews claimed Trump “has led an historic, whole-of-America coronavirus response” that followed experts’ advice, boosted testing rates, delivered equipment to health care workers, and remains focused on expediting a vaccine.

She added, “This strong leadership will continue.”

The US wasn’t prepared for a pandemic — and Trump made it worse

During the 2014 Ebola outbreak, President Barack Obama’s administration realized that the US wasn’t prepared for a pandemic. Jeremy Konyndyk, who served in the Obama administration’s Ebola response, said he “came away from that experience just completely horrified at how unready we would be for something more dangerous than Ebola,” which has a high fatality rate but did not spread easily in the US and other developed nations.

The Obama administration responded by setting up the White House National Security Council’s Directorate for Global Health Security and Biodefense, which was meant to coordinate the many agencies, from the CDC to the Department of Health and Human Services to the Pentagon, involved in contagion response.

But when John Bolton became Trump’s national security adviser in 2018, he moved to disband the office. In April 2018, Bolton fired Tom Bossert, then the homeland security adviser, who, the Washington Post reported, “had called for a comprehensive biodefense strategy against pandemics and biological attacks.” Then in May, Bolton let go the head of pandemic response, Rear Adm. Timothy Ziemer, and dismantled his global health security team. Bolton claimed that the cuts were needed to streamline the National Security Council, and the team was never replaced.

In the months before the coronavirus arrived, the Trump administration also cut a public health position meant to detect outbreaks in China and another program, called Predict, that tracked emerging pathogens around the globe, including coronaviruses. And Trump has repeatedly called for further cuts to the CDC and National Institutes of Health, both on the front lines of the federal response to disease outbreaks; the administration stood by the proposed cuts after the pandemic began, though Congress has largely rejected the proposals.

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The Trump administration pushed for the cuts despite multiple, clear warnings that the US was not prepared for a pandemic. A 2019 ranking of countries’ disaster preparedness from the Johns Hopkins Center for Health Security and Nuclear Threat Initiative had the US at the top of the list, but still warned that “no country is fully prepared for epidemics or pandemics.”

A federal simulation prior to the Covid-19 pandemic also predicted problems the US eventually faced, from a collapse in coordination and communication to shortages in personal protective equipment for health care workers.

Bill Gates, who’s dedicated much of his Microsoft fortune to fighting infectious diseases, warned in 2017, “The impact of a huge epidemic, like a flu epidemic, would be phenomenal because all the supply chains would break down. There’d be a lot of panic. Many of our systems would be overloaded.”

Gates told the Washington Post in 2018 he had raised his concerns in meetings with Trump. But the president, it’s now clear, didn’t listen.

There are limitations to better preparedness, too. “If you take what assets the United States had and you use them poorly the way we did, it doesn’t matter what the report says,” Adalja said, referring to the 2019 ranking. “If you don’t have the leadership to execute, then it makes no difference.”

As Covid-19 spread, Trump downplayed the threat

On February 25, Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, told reporters that Americans should prepare for community spread of the coronavirus, social distancing, and the possibility that “disruption to everyday life might be severe.”

Six months later, Messonnier’s comments seem prescient. But soon after the briefing, she was pushed out of the spotlight — though she’s still on the job, her press appearances have been limited — reportedly because her negative outlook angered Trump. (Messonnier didn’t respond to a request for comment.)

The CDC as a whole has been pushed to the sidelines with her. The agency is supposed to play a leading role in America’s fight against pandemics, but it’s invisible in press briefings led by Trump, Vice President Mike Pence, advisers, and health officials like Anthony Fauci and Deborah Birx who are not part of the organization. CDC Director Robert Redfield acknowledged as much: “You may see [the CDC] as invisible on the nightly news, but it’s sure not invisible in terms of operationalizing this response.”

University of Michigan medical historian Howard Markel put it in blunter terms, telling me the US has “benched one of the greatest fighting forces against infectious diseases ever created.”

Meanwhile, the president downplayed the virus. The day after Messonnier’s warning, Trump said that “you have 15 people [with the coronavirus], and the 15 within a couple of days is going to be down to close to zero.” This type of magical thinking appears to have driven Trump’s response to Covid-19 from the start, from his conviction that cases would disappear to his proclamation that the country would reopen by Easter.

This was deliberate. As Trump later acknowledged in recorded interviews with journalist Bob Woodward, he knew that the coronavirus was “deadly stuff,” airborne, more dangerous than the flu, and could afflict both the young and old. Yet he deliberately downplayed the threat: “I wanted to always play it down,” he told Woodward on March 19. “I still like playing it down, because I don’t want to create a panic.”

Trump has long said he believes in the power of positive thinking. “I’ve been given a lot of credit for positive thinking,” he told Axios reporter Jonathan Swan during a wide-ranging discussion about Covid-19 in July. “But I also think about downside, because only a fool doesn’t.” Pressed further, he added, “I think you have to have a positive outlook. Otherwise, you have nothing.”

The concern, experts said, is the signal this messaging sends. It tells the staffers under Trump that this issue isn’t a priority, and things are fine as they are. And it suggests to the public that the virus is under control, so they don’t have to make annoying, uncomfortable changes to their lives, from physical distancing to wearing masks.

It creates the perfect conditions for a slow and inadequate response.

The CDC botched the initial test kits it sent out, and it took weeks to fix the errors. The Food and Drug Administration (FDA) also took weeks to approve other tests from private labs. As supply problems came up with testing kits, swabs, reagents, machines, and more, the Trump administration resisted taking significant action — claiming it’s up to local, state, and private actors to solve the problems and that the federal government is merely a “supplier of last resort.”

South Korea, which has been widely praised for its response to coronavirus, tested more than 66,000 people within a week of the first community transmission within its borders. By comparison, the US took roughly three weeks to complete that many tests — in a country with more than six times the population.

Asked about testing problems in March, Trump responded, “I don’t take responsibility at all.” In June, Trump claimed that “testing is a double-edged sword,” adding that “when you do testing to that extent, you’re going to find more people — you’re going to find more cases. So I said to my people, ‘Slow the testing down, please.’”

The testing shortfall was a problem few thought possible in the wealthiest, most powerful nation on earth. “We all kind of knew if a biological event hit during this administration, it wasn’t going to be good,” Saskia Popescu, an infectious disease epidemiologist, told me. “But I don’t think anyone ever anticipated it could be this bad.”

Trump also consistently undermined the advice of experts, including those in his administration. When the CDC released reopening guidelines, Trump effectively told states to ignore the guidance and reopen prematurely — to “LIBERATE” their economies. When the CDC recommended masks for public use, Trump described masking as a personal choice, refused to wear one in public for months, and even suggested that people wear masks to spite him. While federal agencies and researchers work diligently to find effective treatments for Covid-19, Trump has promoted unproven and even dangerous approaches, at one point advocating for injecting bleach. Trump’s allies have even held up CDC studies that could contradict the president’s overly optimistic outlook.

The most aggressive steps Trump took to halt the virus — travel restrictions on China and Europe imposed in February and March, respectively — were likely too limited and too late. And to the extent these measures bought time, it wasn’t properly used.

The federal government is the only entity that can solve many of the problems the country is facing. If testing supply shortfalls in Maine are slowing down testing in Arizona or Florida, the federal government has the resources and the legal jurisdiction to quickly act. Local or state offices looking for advice on how to react to a national crisis will typically turn to the federal government for guidance.

But the inaction, contradictions, and counterproductive messaging created a vacuum in federal leadership.

In the months after Trump’s prediction that coronavirus cases would go down to zero, confirmed cases in the US grew to more than 160,000. As of September 22, they stand at more than 6.8 million.

Months into the pandemic, Trump has continued to flail

After the initial wave of coronavirus cases began to subside in April, the White House stopped its daily press briefings on the topic. By June, Trump’s tweets and public appearances focused on Black Lives Matter protests and the 2020 election — part of what Politico reporter Dan Diamond described, based on discussions with administration officials, as an “apparent eagerness to change the subject.”

Then another wave of coronavirus infections hit beginning in June, peaking with more than 70,000 daily new cases, a new high, and more than 1,000 daily deaths.

America’s response to the initial rise of infections was slow and inadequate. But other developed countries also struggled with the sudden arrival of a disease brand new to humans. The second surge, experts said, was when the scope of Trump’s failure became more apparent.

By pushing states to open prematurely, failing to set up national infrastructure for testing and tracing, and downplaying masks, Trump put many states under enormous pressure to reopen before the virus was under control nationwide. Many quickly did — and over time suffered the consequences.

Rather than create a new strategy, Trump and his administration returned to magical thinking. Pence, head of the White House’s coronavirus task force, wrote an op-ed titled “There Isn’t a Coronavirus ‘Second Wave’” in mid-June, as cases started to increase again. Internally, some of Trump’s experts seemed to believe this; Birx, once a widely respected infectious disease expert, reportedly told the president and White House staff that the US was likely following the path of Italy: Cases hit a huge high but would steadily decline.

Trump trotted out optimistic, but misleading, claims and statistics. He told Axios reporter Jonathan Swan in July that the US was doing well because it had few deaths relative to the number of cases. When Swan, clearly baffled, clarified he was asking about deaths as a proportion of population — a standard metric for an epidemic’s deadliness — Trump said, “You can’t do that.” He gave no further explanation.

Seemingly believing its coronavirus mission accomplished, the Trump administration, the New York Times reported, moved to relinquish responsibility for the pandemic and leave the response to the states — in what the Times called “perhaps one of the greatest failures of presidential leadership in generations.”

“The biggest problem in the US response is there is not a US response,” Konyndyk, now a senior policy fellow at the Center for Global Development, told me. “There is a New York response. There’s a Florida response. There’s a Montana response. There’s a California response. There’s a Michigan response. There’s a Georgia response. But there is not a US response.”

When the coronavirus first hit the US, the country struggled with testing enough people, contact tracing, getting the public to follow recommendations such as physical distancing and masking, delivering enough equipment for health care workers, and hospital capacity. In the second wave, these problems have by and large repeated themselves.

Consider testing: It has significantly improved, but some parts of the country have reported weeks-long delays in getting test results, and the percentage of tests coming back positive has risen above the recommended 5 percent in most states — a sign of insufficient testing. The system once again appeared to collapse under the weight of too much demand, while the federal government failed to solve continuing problems with supply chains. Months after Congress approved billions of dollars in spending to deal with testing problems, the Trump administration has not spent much of it.

Some of Trump’s people seemed to listen to his calls to slow down testing: On August 24, the CDC updated its guidelines to suggest people exposed to others with Covid-19 don’t necessarily have to get tested — a move for effectively less testing that experts described as “dangerous” and “irresponsible.” Only after weeks of criticism did the CDC back down and, on September 18, once again call for testing people without symptoms.

Mask-wearing also remains polarized. While surveys show that the vast majority of Americans have worn masks in the past week, there’s a strong partisan divide. According to Gallup’s surveys, 99 percent of Democrats say they’ve gone out with a mask in the previous week, compared to 80 percent of Republicans. Leveraging surveys on mask use, the New York Times estimated that the percentage of people using masks in public can fall to as low as 20, 10, or the single digits — even in some communities that have been hit hard. Anti-mask protests have popped up around the country.

Testing and mask-wearing are two of the strongest weapons against Covid-19. Testing, paired with contact tracing, lets officials track the scale of an outbreak, isolate those who are sick, quarantine their contacts, and deploy community-wide efforts as necessary to contain the disease — as successfully demonstrated in Germany, New Zealand, and South Korea, among others. There’s also growing scientific evidence supporting widespread and even mandated mask use, with experts citing it as crucial to the success of nations like Japan and Slovakia in containing the virus.

It’s not that other developed nations did everything perfectly. New Zealand has contained Covid-19 without widespread masking, and Japan has done so without widespread testing. But both took at least one aggressive action the US hasn’t. “While there’s variation across many countries, the thing that distinguishes the countries doing well is they took something seriously,” Kirsten Bibbins-Domingo, an epidemiologist at the University of California San Francisco, told me.

One explanation for the shortfalls in the US response is Trump’s obsession with getting America, particularly the economy, back to normal in the short term, seemingly before Election Day this November. It’s why he’s called on governors to “LIBERATE” states. It’s why he’s repeatedly said that “the Cure can’t be worse than the problem itself.” It’s one reason, perhaps, he resisted embracing even very minor lifestyle changes such as wearing a mask.

The reality is that life will only get closer to normal once the virus is suppressed. That’s what’s working for other countries that are more earnestly reopening, from Taiwan to Germany. It’s what a preliminary study on the 1918 flu found, as US cities that emerged economically stronger back then took more aggressive action that hindered economies in the short term but better kept infections and deaths down overall.

“Dead people don’t shop,” Jade Pagkas-Bather, an infectious diseases expert and doctor at the University of Chicago, told me. “They can’t stimulate economies.”

The window to avert further catastrophe may be closing

As cases and deaths climbed over the summer, and as the November election neared, Trump at times appeared to spring back into action — bringing back coronavirus press conferences and briefly changing his tone on masks (before going back to mocking them).

But Trump still seems resistant to focusing too much on the issue. He’s tried to change the subject to former Vice President Joe Biden’s supposed plans to destroy the “Suburban Lifestyle Dream.” He’s continued to downplay the crisis, saying on July 28, as daily Covid-19 deaths once again topped 1,000, “It is what it is.” His Republican convention continued to diminish the risks of Covid-19 and exaggerate Trump’s successes in fighting the virus. At a campaign rally in Ohio on September 21, Trump claimed the virus “affects virtually nobody.”

So while combating Covid-19 aligns with Trump’s political incentives (it remains Americans’ top priority), he and his administration continue to flounder. And White House officials stand by their response so far, continually pushing blame to local and state governments.

“There’s no national plan to combat the worst pandemic that we’ve seen in a century,” Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, told me.

The summer surge of Covid-19 has calmed now, although cases across the US flattened out at a much higher level than they were in the spring, likely a result of cities, counties, states, and the public taking action as the federal government didn’t. Still, cases have started to pick back up again.

Experts now worry that the country could be setting itself up for another wave of Covid-19. Schools reopening across the country could create new vectors of transmission. The winter will force many Americans indoors to avoid the cold, while being outdoors in the open air can hinder the spread of the disease. Families and friends will come together from across the country to celebrate the holidays, creating new possibilities for superspreading events. And in the background, another flu season looms — which could limit health care capacity further just as Covid-19 cases spike.

“The virus spreads when a large number of people gather indoors,” Jha said. “That’s going to happen more in December than it did in July — and July was a pretty awful month.”

There are reasons to believe it might not get so bad. Since so many people in the US have gotten sick, that could offer some element of population immunity in some places as long as people continue social distancing and masking. After seeing two large waves of the coronavirus across the country, the public could act cautiously and slow the disease, even if local, state, and federal governments don’t. Social distancing due to Covid-19 could keep the spread of the flu down too (which seemed to happen in the Southern Hemisphere).

But the federal government could do much more to push the nation in the right direction. Experts have urged the federal government to provide clear, consistent guidance and deploy stronger policies, encouraging people to take Covid-19 as a serious threat — now, not later.

“I’m really concerned that the window might be closing,” Kates said.

Without that federal action, the US could remain stuck in a cycle of ups and downs with Covid-19, forcing the public to double down on social distancing and other measures with each new wave. As cases and deaths continue to climb, America will become even more of an outlier as much of the developed world inches back to normal. And the “beautiful time” Trump imagined for Easter will remain out of reach.

Tropical Storm Laura, which has been downgraded from a hurricane, made landfall early Thursday morning in Cameron, Louisiana — just 35 miles east of the Texas-Louisiana border — as a Category 4 storm with 150 mph winds.

Already, pictures and videos of the storm from Lake Charles, Louisiana, a town about 50 miles north of Cameron, show torn-off roofs, downed power lines, blown-out windows, and dozens of trees ripped from the ground.

Louisiana Gov. John Bel Edwards said he’d received a report Thursday morning of the first American fatality from Laura, a 14-year-old girl from Vernon Parish who died when a tree fell on her home. Edwards later said a total of four people in his state have died — all as a result of fallen trees. Laura was also responsible for at least 23 deaths in Haiti and the Dominican Republic earlier this week.

There has been no official word of other injuries or deaths in the US since the storm made landfall. What we know is that about 20 million people reside in the path of the storm and 500,000 have been ordered to evacuate, a task complicated by the Covid-19 pandemic.

And so far, more than 740,000 homes and businesses are without power in Texas and Louisiana.

Louisiana and Texas residents were warned the storm surge could be “unsurvivable”

As a Category 4 hurricane, Laura reportedly became the strongest storm on record to make landfall along the western Louisiana and northern Texas coast. Although the storm has weakened since moving inland, prompting its downgrade from hurricane status, it is still sustaining winds of 52 mph.

Hurricane-force winds can cause normally dry areas near the coast to be flooded by rising waters. The National Hurricane Center (NHC) predicted that this phenomenon, referred to as “storm surge,” could result in up to 20 feet of flooding in places within 40 miles of shoreline where Laura made landfall, rendering some areas “unsurvivable” and resulting in “catastrophic damage.” However, it appears as if a slight change in wind direction may have spared the worst-hit areas from the feared 20-foot surge.

The NHC said Thursday the worst of the initial storm surge hit communities directly east of Cameron, which are experiencing surge of around 9 feet.

Some meteorologists, however, warn against jumping to premature conclusions about the extent of storm surge from Hurricane Laura, considering the limited number of data points currently available.

Heavy rain is also predicted to be widespread across the west-central Gulf Coast, with 5 to 10 inches falling over a broad area, and up to 18 inches locally. And this rain is expected to result in flash flooding throughout the region.

After making landfall Thursday morning, Laura tracked north across Louisiana throughout the day, and its center is expected to move into Arkansas overnight. The storm will then move through the Tennessee Valley and the mid-Atlantic from Friday into Saturday. As of now, the NHC predicts the storm will continue to give off heavy rain and sustain winds between 30 and 40 mph.

One of the most powerful storms in US history

Meteorologists categorize hurricanes based on the intensity of storms’ maximum sustained winds:

• Category 1: 74-95 mph (a storm with winds below 74 mph is classified as a “tropical storm,” and below 38 mph is a “tropical depression”)
• Category 2: 96-110 mph
• Category 3: 111-129 mph
• Category 4: 130-156 mph
• Category 5: 157 mph or higher

Laura’s 150 mph winds at landfall made it a Category 4 hurricane and one of the most powerful in US history — as powerful as Hurricane Charley in 2004 and slightly less powerful than Hurricane Michael in 2018, but far more powerful than Hurricane Katrina (which clocked in at 125 mph at landfall) in 2005.

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These categorizations are important in terms of assessing potential damage to life and property. From 1900 to 2005, US hurricanes that clocked in at category 3, 4, and 5 at landfall have been responsible for 85 percent of total hurricane damage, despite making up around a quarter of total hurricanes. That’s because relatively small changes in wind speeds can lead to exponentially more damage. For instance, hurricanes like Laura that make landfall at around 150 mph cause, on average, 256 times more damage than hurricanes less than half their speed, at 75 mph, would.

But wind speed alone doesn’t determine how deadly a hurricane will be. As my colleagues Brian Resnick and Eliza Barclay explain, storm surge, the coastal flooding that occurs when a storm’s winds push water onshore several feet above the normal tide, is particularly dangerous. Severe storm surge — like that expected with Laura — can trap people in their homes, wash away houses, and make rescue missions harrowing and slow.

So far, we don’t know what the damage from Tropical Storm Laura will be, but we do have reference points. Hurricane Rita, which hit the same area as Laura in 2005, produced up to 15 feet of storm surge, had Category 3 winds of 115 mph, and resulted in 97 to 125 deaths and $18.5 billion in damage. By comparison, Laura made landfall with Category 4 winds of 150 mph and is predicted to produce up to 20 feet of storm surge.

A record season for hurricanes

Laura is the 12th of as many as 25 named storms that the National Oceanic and Atmospheric Administration (NOAA) has predicted would form this hurricane season (which lasts from June 1 to November 30); seven to 11 of those storms, including Laura, were expected to become hurricanes. If NOAA’s predictions are correct, this will be a record-breaking season for hurricanes.

“This is one of the most active seasonal forecasts that NOAA has produced in its 22-year history of hurricane outlooks. NOAA will continue to provide the best possible science and service to communities across the Nation for the remainder of hurricane season to ensure public readiness and safety,” said Commerce Secretary Wilbur Ross, who oversees the agency. “We encourage all Americans to do their part by getting prepared, remaining vigilant, and being ready to take action when necessary.”

There are a few explanations for this record-breaking season, but chief among them are the above-average sea surface temperatures in the tropical Atlantic Ocean and Caribbean Sea, particularly in the region between West Africa and the Leeward Islands, which tends to be a prime development region for hurricanes.

These warmer-than-average waters are, in part, the result of climate change. A new study published earlier this year in the Proceedings of the National Academy of Sciences by a group of NOAA and University of Wisconsin Madison researchers found that from 1979 to 2017, the odds that a given tropical cyclone would become a Category 3, 4 or 5 hurricane increased about 8 percent per decade as the planet has warmed.

This finding builds on lots of previous research — like multiple academic studies demonstrating that Hurricane Harvey’s record-blasting rains were likely amplified by climate change.

“We’ve just increased our confidence of our understanding of the link between hurricane intensity and climate change,” James Kossin, the lead author of the new study, told the Washington Post. “We have high confidence that there is a human fingerprint on these changes.”

In other words, Laura might be the most recent of the major hurricanes to reach US shores, but it certainly won’t be the last.

How to follow Tropical Storm Laura:

• The National Hurricane Center provides updates every few hours, with projections and important warnings. Take a look here.
• The National Hurricane Center’s Twitter account has similar updates, as well as the latest on forecast changes and public safety concerns.
• Meteorologist and journalist Eric Holthaus has compiled a Twitter list of weather experts that’s a valuable repository of forecasts, data, and useful information on hurricanes in general.

Correction, August 26: An earlier version of this story misstated the relative strength of Hurricanes Michael and Charley.

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President Donald Trump’s speech on Thursday — and the events surrounding the Republican National Convention in general — at times came off as a celebration: a series of rhetorical monuments to a president who, based on what he and his supporters said, had triumphantly carried America through one of its best periods.

It’s an image that’s been hard to reconcile with Trump’s actual record. Under Trump, the economy is tanking. The country is in the throes of widespread unrest, as Black Lives Matter protests and related riots continue. The murder rate in large cities has spiked, and the opioid epidemic continues.

And more than 180,000 Americans have so far died from Covid-19.

The contradiction was perfectly captured by this photo posted on Twitter by USA Today reporter Matt Brown, in which protesters pointing out America’s massive Covid-19 death toll stood in front of the Republican convention’s fireworks show:

It’s a moment that encapsulates what amounted to a week of gaslighting on Covid-19 by Trump and the Republican convention — an attempt to make America think that a president who had so clearly failed had in fact won a victory for the US.

Experts, and the data, tell a very different story than what Trump tried to suggest.

For one, Trump’s performance on Covid-19 really has been a disaster. When the coronavirus first reached America, Trump was slow to react, instead suggesting that the virus would suddenly disappear “like a miracle.” Once states began locking down, Trump pushed them to reopen too early and too quickly — to “LIBERATE” themselves from economic calamity. His administration was slow to expand the US’s testing capacity, instead punting the issue to local, state, and private actors. As his administration suggested people wear masks in public, Trump said it was a personal choice, refused to wear a mask himself, and claimed people wear masks to spite him. Instead of offering calm, collected messaging during a crisis, Trump was erratic — at one point musing about people injecting bleach to treat Covid-19.

The result: America stands out as the one developed country, with the possible exception of Spain, that not only failed to prevent a massive coronavirus outbreak when it first arrived in the spring, but has continued to struggle deep into the summer. So while many other developed nations, from Germany to South Korea, see their lives inch back to normal, America continues to see high numbers of Covid-19 cases and deaths.

It’s a uniquely bad position, as this chart of Covid-19 deaths in developed nations shows:

That failure on Covid-19 “begins in many ways, and you could argue it ends in many ways, with the Trump administration,” Ashish Jha, faculty director of the Harvard Global Health Institute, told me. “If George W. Bush had been president, if John McCain had been president, if Mitt Romney had been president, this would have looked very different.”

But in a reelection campaign, Trump wants to do everything he can to mask his failure. So we get a strangely celebratory convention when there isn’t much to celebrate in America.

For more on Trump’s failure on Covid-19, read Vox’s full explainer.

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In the spring, we launched a program asking readers for financial contributions to help keep Vox free for everyone, and last week, we set a goal of reaching 20,000 contributors. Well, you helped us blow past that. Today, we are extending that goal to 25,000. Millions turn to Vox each month to understand an increasingly chaotic world — from what is happening with the USPS to the coronavirus crisis to what is, quite possibly, the most consequential presidential election of our lifetimes. Even when the economy and the news advertising market recovers, your support will be a critical part of sustaining our resource-intensive work — and helping everyone make sense of an increasingly chaotic world. Contribute today from as little as $3.

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Earth is now in the middle of a mass extinction, the sixth one in the planet’s history, according to scientists.

And now a new study reports that species are going extinct hundreds or thousands of times faster than the expected rate.

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The researchers also found that one extinction can cause ripple effects throughout an ecosystem, leaving other species vulnerable to the same fate. “Extinction breeds extinctions,” they write in their June 1 paper in the Proceedings of the National Academy of Sciences.

With the accelerating pace of destruction, scientists are racing to understand these fragile bits of life before they’re gone. “This means that the opportunity we have to study and save them will be far greater over the next few decades than ever again,” said Peter Raven, a coauthor of the study and a professor emeritus of botany at Washington University in St. Louis, in an email.

The findings also highlight how life can interact in unexpected ways and how difficult it can be to slow ecological destruction once it starts. “It’s similar to climate change; once it gets rolling, it gets harder and harder to unwind,” said Noah Greenwald, the endangered species director for the Center for Biological Diversity, who was not involved in the study. “We don’t know what the tipping points are, and that’s scary.”

It’s worth pausing to reflect on what “extinction” means: a species completely and forever lost. Each one is an irreparable event, so the idea that they are not only happening more often but also might be sparking additional, related extinctions is startling. And these extinctions have consequences for humanity, from the losses of critical pollinators that fertilize crops to absent predators that would otherwise keep disease-spreading animals in check.

So researchers are now looking closely at which animals are teetering on the edge of existence to see just how dire the situation has become, and to figure out what might be the best way to bring them back.

Hundreds of animals are on the brink of extinction over the next two decades

There is tremendous biodiversity on earth right now. The number of species — birds, trees, ferns, fungi, fish, insects, mammals — is greater than it ever has been in the 4.5 billion-year existence of this planet. But that also means there is a lot to lose.

The new study examined 29,400 species of vertebrates that live on land — mice, hawks, hippos, snakes, and the like. These species from all over the world were cataloged by the International Union for Conservation of Nature.

Out of those examined, 515 species — 1.7 percent of those studied — were found to be on the brink of extinction, meaning fewer than 1,000 individuals were left alive. These species include the vaquita, the Clarion island wren, and the Sumatran rhino. And half of these 515 species have fewer than 250 individuals left. If nothing is done to protect them, most of them will go extinct over the next 20 years.

But these species on the precipice of the abyss are not spread evenly across the world; they’re concentrated in biodiversity hotspots like tropical rainforests. That makes sense because tropical forests have the most variety of species to begin with and they have the highest rate of habitat destruction. “About two-thirds of all species are estimated to occur in the tropics, and we know less about them than those in other parts of the world,” said Raven. “[Y]et more than one-quarter of all tropical forests have been cut in the 27 years since the ratification of the Convention on Biological Diversity.”

Losing one endangered species can endanger many others

The species teetering on the edge of eternal loss often live alongside other endangered species, even if they are present in greater numbers. The species on the brink then serve as loud sirens of the possible bigger threat to other life in their environs. As species within a pond, forest stand, or watershed die off, others soon follow.

In many cases, species interact with others in complicated and often unforeseen ways that aren’t recognized until they are gone. For example, if a plant-eating insect dies off, the plants it eats could run rampant and choke off other vegetation. Meanwhile, the birds that feed on the insect could be without an important food source. Each of these subsequent changes could have myriad other impacts on distant species, and so on and so on. The disruption can continue until the ecosystem is hardly recognizable.

Scientists have observed these kinds of rippling disruptions in ecosystems for decades in places like the Amazon rainforest, watching what happened when species went extinct in a given area or when a habitat fractured into pieces.

As these ecosystems degrade or collapse, humans stand to lose a lot of functions from nature they take for granted, like forests that generate rainfall for aquifers or mangroves that shield coasts from erosion. Many land vertebrates, for instance, are critical for spreading the seeds of trees. Without them, the makeup of a forest could transform.

Even if a less diverse prairie, forest, or desert were to remain, it would be more vulnerable to shocks like fires and severe weather. Diverse ecosystems act as buffers against environmental extremes, and without them, humans will face more risks of phenomena such as heat waves without vegetation to cool the air, or they may suffer more coastal inundation without mangroves to absorb waves.

And as humans build closer to areas that were once wild, they face higher risks of exposure to threats such as animal-borne disease and wildfire. So the economic and health costs of runaway extinctions could be immense.

Humans are the problem, and humans are the solution

The new study is part of a steady stream of grim news for endangered species. In 2019, the United Nations’ Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES) released a massive 1,500-page report on global biodiversity. The report concluded that up to 1 million species are at risk of extinction, including 40 percent of all amphibian species, 33 percent of corals, and about 10 percent of insects.

And a unifying theme among the various studies of extinctions is that humans are to blame.

Through destroying habitats, spreading disease, raising livestock, dumping waste, overharvesting, overfishing, and climate change, the 7.5 billion humans on this planet have become their own force, unlike any that exists in nature.

“We are in no sense simply a part of the global ecosystem anymore, living in a broad, wide world,” said Raven. “[W]e are one species, totally dominant, among the millions of others that exist.”

It’s true that species do go extinct naturally, but the rate of extinction now is thousands of times higher than the expected background rate. It can be difficult to tease out whether an organism disappeared as a direct consequence of human activity or because a species it depended on was wiped out by people, but both types of losses stem from humanity. “We can’t easily reverse the trend but can learn as much as we can in the time we have left,” Raven said.

However, the fact that human activity is driving the vast majority of these extinctions means that changing human activity can help pull back vulnerable species from annihilation.

Conservation policies have already proven effective at thwarting some permanent losses, like the Endangered Species Act in the United States. It’s even spurring the recovery of several species, like the bald eagle. And there is still time to rescue other species that are on the brink. But saving what’s left will require concerted action, and time to act is running out.

“You do not want to get into a deep depression. You want to get involved and do the very easy things we can do to prevent us from destroying the planet,” said Stuart Pimm, a professor of conservation at Duke University and president of Saving Nature, an environmental conservation nonprofit. “The important story is there is a lot we can do about it.”

Since humans are causing most of the destruction that is driving extinctions, humans can change their behaviors in ways to protect life. One of the most effective steps people can use to protect endangered species is to protect the environments where they live, shielding them from mining, drilling, development, and pollution.

“We can definitely make a difference. We can slow the pace of extinction,” Greenwald said. “We know how to do that. We can set aside more area for nature.”

Another tactic is building corridors for connecting fragmented ecosystems, creating larger contiguous areas. That can allow the synergy between species to grow and build a more resilient ecosystem that could better withstand the disappearance of a species and restore those in decline.

However, the threats to so many species have been building for years and they can’t be reversed overnight. It will take a sustained global conservation effort to protect the precious few and restore them to the multitudes that once swam, flew, and walked the earth.

The World Health Organization (WHO) on Friday announced changes to its guidelines on who should wear a mask during the Covid-19 pandemic and where they should wear it.

The new guidance recommends that the general public wear cloth masks made from at least three layers of fabric “on public transport, in shops, or in other confined or crowded environments.” It also says people over 60 or with preexisting conditions should wear medical masks in areas where there’s community transmission of the coronavirus and physical distancing is impossible, and that all workers in clinical settings should wear medical masks in areas with widespread transmission.

It’s a major update to the agency’s April 6 recommendations, which said members of the general public “only need to wear a mask if you are taking care of a person with Covid-19” or “if you are coughing or sneezing.” And it’s important advice for countries around the world battling the virus, especially those in South America, the Middle East, and Africa, where the rate of Covid-19 transmission appears to be accelerating.

At a WHO press conference on June 3, Michael Ryan, an infectious disease epidemiologist and the executive director of the WHO’s Health Emergencies Programme, said WHO still believes that masks should primarily be used “for purposes of source control — in other words, for people who may be infectious, reducing the chances that they will infect someone else.”

And on Friday, WHO Director-General Tedros Adhanom Ghebreyesus offered a few words of warning as part of the announcement: “Masks can also create a false sense of security, leading people to neglect measures, such as hand hygiene and physical distancing. I cannot say this clearly enough: Masks alone will not protect you from Covid-19.”

But the changes finally bring the WHO in line with many countries around the world that have made masks mandatory in crowded public spaces, including Cuba, France, Cameroon, Vietnam, Slovakia, and Honduras. While it has not made masks a requirement, the US Centers for Disease Control and Prevention (CDC) has since April 3 suggested “wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain.”

Many health experts have wondered why it’s taken this long for the WHO to update its mask guidelines, given the accumulation of evidence that they may be helpful and have few downsides.

Eric Topol, a research methods expert and director of the Scripps Research Translational Institute, calls WHO’s delay “preposterous.” He adds, “I have great respect for the World Health Organization — but they got the mask story all wrong, and we have lost people because of it.” Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University, agrees, saying, “Everyone should be wearing a mask.”

Here’s what the research suggests and why experts think WHO has now revised its guidelines.

Why wear a mask?

The WHO didn’t cite any particular research for its dramatic change, noting only that it “developed this guidance through a careful review of all available evidence and extensive consultation with international experts and civil society groups.”

But there have been a number of recent studies that experts point to as the best evidence for mask use in the general public to reduce Covid-19 transmission. And a growing number of doctors, scientists, and public health experts have been calling for universal masking in indoor public spaces and crowded outdoor spaces.

One meta-review published in Lancet waded through 172 studies on Covid-19, SARS, and MERS, from 16 countries and six continents. Its authors determined that masks — as well as physical distancing and eye protection — helped protect against Covid-19.

The studies reviewed evidence both in health care and non-health care settings and then adjusted the data so they could be directly compared. The researchers found that your risk of infection when wearing a mask was 14 percent less than if you weren’t wearing a mask, although N95 masks “might be associated with a larger reduction in risk” than surgical or cloth masks.

Other literature reviews have not been as favorable. Paul Hunter, professor in medicine at the University of East Anglia, coauthored one such preprint review in early April. “In evidence-based medicine, randomized-controlled trials are supposed to trump observational studies,” he says, “And randomized-controlled trials have all been pretty much negative on face masks in the community.” The Lancet piece, he notes, gives more consideration to observational studies with surgical masks.

A few recent observational studies on mask use by the public in this pandemic, however, support general mask usage to prevent the spread of Covid-19. One from Hong Kong concluded, “mass masking in the community is one of the key measures that controls transmission during the outbreak in Hong Kong and China.” Another concluded that if 80 percent of a population were to wear masks, the number of Covid-19 infections would drop by one-twelfth, or about 8.3 percent, based on observations from several Asian countries where mask-wearing is common.

There’s been some debate over the efficacy of homemade cloth masks and surgical masks (especially compared to N95 masks, which have more evidence behind them) for the general public. But one recent article, published in the Annals of Internal Medicine, found that even cloth masks block some viral particles from escaping.

The general consensus is that masks are better at keeping your viral particles from spreading to others than keeping someone else’s from spreading to you. Catherine Clase, the lead author of the Annals of Internal Medicine piece and an associate professor of medicine at McMaster University, says one study she reviewed found even a single layer of cotton tea towel tested against a virus aerosol reduced transmission of the virus by 72 percent. “One thing to remember,” she says, “is that a mask doesn’t need to be perfect” to bring down the average number of people being infected by one sick person. “It just has to reduce the probability of transmission to some degree.”

William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center, notes that previous data on masks and viruses came out of the SARS and MERS epidemics, which involved viruses that weren’t as transmissible. “Masks were thought of then as more personal protection as opposed to community protection,” he said, helping explain why masks weren’t widely regarded as particularly effective.

But with Covid-19, the rate of asymptomatic patients may be as high as 40 percent, requiring a shift in thinking about masks from protecting the wearer to protecting the community. Clase concludes that while cloth masks may not protect you from inhaling someone else’s germs, “the evidence that they reduce contamination [from sick people] of air and surfaces is convincing, and should suffice to inform policy decisions on their use in this pandemic.”

Clase adds, “The pandemic is not going particularly well. So this is probably worth employing now and doing the additional research later.”

Why the WHO may have had trouble reaching consensus on universal masking

The WHO generally does rigorous reviews of evidence, as the whole world’s health rides on their recommendations. This may explain their delay in recommending the general public wear masks.

The agency used to largely base its decisions around expert advice, says Hunter. “They would get together a group, and they would use these experts to drive WHO guidelines.” But in 2007, a Lancet paper criticized the agency for not following evidence-based medicine, which prioritizes randomized controlled trials.

As a result, Hunter says, “WHO went through a major upheaval in its guideline development practices. Now, it has to base its recommendations on systematic reviews,” and its guideline development committees now have methodologists.

“I think [the delay] reflects a general principle often followed by scientists, which is not to change practice until the evidence is strong and definitive,” Trish Greenhalgh, a professor of primary care sciences at the University of Oxford, wrote in an email interview. “Whilst many people (including me) believe that is already the case, some scientists on WHO committees have been waiting for additional evidence to strengthen the case.”

Greenhalgh argued in early April that it was time to apply the precautionary principle to pandemic response and that the public should wear masks “on the grounds that we have little to lose and potentially something to gain.”

But David Heymann, a professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine and a member of WHO’s Strategic and Technical Advisory Group for Infectious Hazards (STAG-IH) advisory board, says the agency “is very cautious to only use evidence when we have it. We don’t make any precautionary measures if we don’t have any contributing evidence.”

STAG-IH was asked to look into the evidence for and against mask use in early May and compiled a report for the WHO that was made public on May 25. The finding “supports mask use by the general public in the community to decrease the risk of infection,” the WHO said in a statement to Vox, noting that in updating their guidance, they took the STAG-IH advice into consideration.

Cliff Lane, the clinical director at the National Institute of Allergy and Infectious Diseases at the National Institutes of Health and another member of STAG-IH, says the WHO is ”very good at trying to get a diverse set of opinions before making recommendations.” But he admits he doesn’t know why the WHO has timed its recommendations for masks the way it has.

He is one of many experts Vox interviewed who said it’s difficult to conduct a randomized, double-blind controlled study of mask use in the general public. Because of ethics and practicality, “much of the epidemiologic data on the impact is inferred,” he says. This magnifies a general problem he sees: “Any guideline you make does an assessment of risk and benefit, and you want to get as much information as you can.” For example, if wearing a mask provides a sense of false security and encourages people to stop social distancing, then consequences may not be worth it. “It’s not a trivial decision,” he says.

Heymann says the WHO’s delay in recommendation comes in part from needing to consider evidence from around the world. “WHO takes longer because there’s a need to obtain consensus from global experts and inform six regional offices.”

Hunter added that nation-states can make decisions based in part on politics or educated guesses. “But WHO cannot take political decisions like that. It has to try to get consensus opinion among scientists, because people look to WHO to make decisions on hard evidence wherever possible.”

As Heymann sees it, “WHO is just the gold standard. Countries many times are ahead of WHO — there’s no need for them to wait for WHO to make recommendations.”

Topol, on the other hand, says the best reason he can think of for the WHO not recommending everyone wear masks is because of the worry over a global shortage of masks, particularly in the US. Perhaps, he says, “They didn’t want to have masks maldistributed, because of the dire need for, and lack of, PPE for health care personnel.”

But, he adds, “That’s not the reason to say you don’t need masks — that’s the reason to say we desperately need to make masks.”

“The world needs the WHO — and it needs it now more than ever”

The WHO has been under a lot of scrutiny since the beginning of the pandemic. And it recently got worse: At the end of May, President Trump announced that the US would pull out of the WHO altogether, potentially withdrawing a significant portion of the agency’s funding.

But the WHO isn’t alone in being slow to suggest mask use. Countries like Venezuela made masks mandatory on March 14, and the Czech Republic made the move on March 18. But the US CDC also originally recommended against masks for the public, only changing its guidance to universal masking on April 3.

Richard Besser, president of the Robert Wood Johnson Foundation and former acting director of the CDC, explains that during an emergency, experts have to look at new information and evaluating decisions. He led the emergency planning and response at the CDC for four years, and says, “When guidance went up, it was always interim. Early on, what you don’t know always exceeds what you do know, and as you learn more, you make changes.”

Sometimes those changes are minor, and sometimes, as in the case of the CDC’s mask guidance, they are significant. “In order for that to make sense to the public, you need to have something that we’re lacking right now: direct communication,” Besser says. “That’s valuable because it engenders trust in settings of crisis, where there are things people should do to protect their health. They’re much more likely to do them if they trust the messenger.”

Unlike the CDC, which has been roundly criticized for its lack of press briefings, the WHO is still holding daily conference calls during the pandemic.

“The WHO, like the CDC, is far from perfect, and is flawed in many ways,” says Gostin, the Georgetown public health law expert. “Having worked with WHO for 30 years, I can say they can be maddeningly bureaucratic and unresponsive. But the world needs the WHO — and it needs it now more than ever.”

Lois Parshley is a freelance investigative journalist and the 2019-2020 Snedden Chair of Journalism at the University of Alaska Fairbanks. Follow her Covid-19 reporting on Twitter @loisparshley.

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As someone with asthma, Meredith Blake was very worried about getting sick in the pandemic. With Covid-19 spreading across America, she stayed inside her home in Boston for 12 weeks, isolating from others as much as possible.

Her self-quarantine ended on June 1. After George Floyd’s killing at the hands of police in Minneapolis, she was compelled to march in the streets with a large crowd of other Bostonians, in close proximity. She wore a face mask and used lots of hand sanitizer wipes.

“I was definitely a little nervous,” about catching Covid-19 in the crowd, says Blake, a researcher at the Harvard Humanitarian Initiative. But showing up and speaking out was more important to her in this moment: “I have a vested interest in the protection of black and brown people, not only professionally, but personally,” she says. She felt like she could no longer prioritize her personal safety from the coronavirus.

Blake works with public health professionals and ER doctors every day, and knew joining a crowd was dangerous — for both herself and the community. But she made a careful calculation: Covid-19 is a huge risk, and to her, the protests were worth it.

On the right, some commentators have accused public health experts of hypocrisy around the protests, for endorsing them after months of telling people to stay home to prevent the spread of the coronavirus.

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Some of those commentators asked: Is it fair if the grieving can’t hold funerals for loved ones while others are marching en masse? Why should businesses stay closed when several high-profile experts say the protests are worthwhile? Author J.D. Vance, for one, fears public health expert endorsements of the protests will erode trust in expert opinion. “I’m still amazed at how quickly the moral scolding ceased as soon as elite-favored protests began taking place,” Vance tweeted.

I’ve talked to several public health experts who support the protests — both black and white — asking them what they wish people like Vance could accept.

Here’s what they say: Protesters are more afraid of doing nothing in the aftermath of George Floyd’s killing than the pandemic. And centuries of systemic racism, lifetimes of discrimination, and years of watching black people die needlessly drive those fears.

“It is hard for me as a public health professional, who also knows my history, to blanketly tell someone to take all these people off the street when they are protesting against 400 years of a different pandemic that happens to not be infectious,” Zinzi Bailey, a social epidemiologist at the University of Miami, says. “It’s not something that potentially a white person is going to catch. Right?”

People are going out into the streets because they feel like their lives depend on it, because one in every 1,000 black men could die at the hands of police. Because they fear an officer of the state will kill them for something petty, like being suspected of possessing a counterfeit $20 bill, as Floyd was. They are going out because of the systemic reasons Covid-19 has harmed black people in higher numbers, and because black people are more likely to suffer the worst course of illness.

“People are in the streets because they have to be,” Rhea Boyd, a pediatrician who works in California’s Bay Area, says. “Because that is how dire things are. Even in the setting of a pandemic, where it seems like being out there risks your life. There are so many risks on your life. You’ve got to be out there to try to protect it. People need, and black folks in particular, need a ton of changes to happen immediately.”

Missing a funeral is painful. Keeping a business closed is painful and causes real harm. No one doubts that. The question is: Can you live with the consequences?

And what if on the other hand, you feel like your life, and the lives of people you care for, depend on protesting?

Make no mistake: Protesting during a pandemic can spread Covid-19

Many protesters are following public health advice while demonstrating: wearing masks, distancing, using hand sanitizer, and getting tested for Covid-19. But it also must be said that there’s no perfectly safe way to demonstrate in huge gatherings during a pandemic, and the threat of new waves of Covid-19 is still very real.

New cases of Covid-19, nationally, have been declining from a peak, but the national numbers obscure smaller outbreaks that are on the rise in some areas. Things may be looking better, but there are still around 20,000 new Covid-19 cases each day. And that’s just the people who are getting tested. According to Ashish Jha, a professor of global health at Harvard, the real number of new daily infections in the US may be closer to 125,000.

The protests are also occurring at a deeply uncertain time during the pandemic. The overall situation appears to be improving, but a new wave could be brewing under the surface as states reopen. The incubation period of the virus, combined with limited resources for testing, means people can’t have real-time knowledge of the state of the outbreak.

No one knows what’s going to happen next, or how big the next wave might be. There are so many unknowns about how the virus will spread in a country with a patchwork system of response and varying levels of adherence to social distancing and mask-wearing.

That said, the virus’s deadly potential is still great. We’re still looking at dealing with Covid-19 on a timescale of months, if not years.

We also know mass gatherings are risky, even if people take precautions. Yes, it’s safer that the protests are outside (there are very few documented cases of outdoor coronavirus transmission). Yes, it’s safer when people wear masks; it’s safer when people try to distance themselves from one another. But there’s no such thing as zero risk with this virus. And the math of exponential growth means it doesn’t take a big spark to create an outbreak that numbers in the thousands.

“I get very concerned, as do my colleagues in public health, when they see these kinds of crowds,” Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases and a top White House adviser on the pandemic, told WTOP on Friday. “There certainly is a risk. I can say that with confidence.”

It’s possible Covid-19 will spread among those marching, shouting out respiratory droplet-laden cries for justice. It’s also possible Covid-19 will spread due to the law enforcement response, throwing tear gas into crowds, making people cough, forcing them into smaller and smaller spaces, and then arresting them and confining them in small jail cells. It’s possible the infection will spread both ways.

This is not lost on the public health experts, nor is the fact that the next wave of cases may disproportionately impact the minority communities protesting. They’re more likely to get sick, more likely to be labeled essential workers if new lockdown orders come.

“I definitely worry about the potential spread of SARS-CoV-2 and how the protests that are going on may contribute to a second wave of Covid-19, which would be disproportionately affecting the black community again,” Jaime Slaughter-Acey, an epidemiologist at the University of Minnesota, says. “Being a black epidemiologist … the way that I see this is that those who are out there protesting are saying that the life of George Floyd, that black lives, matter, and that they’re prioritizing black life over their own individual life. And there is nothing more unselfish than that.”

Why some public health experts say the protests are “essential”

Some journalists have smelled a whiff of hypocrisy in epidemiologists endorsing the protests. These same public health experts did not support anti-lockdown protesters who were arguing for reopening the economy. They decried mass gatherings of people in a large swimming pool. The argument is that health experts have been changing their recommendations, now that there’s a protest that aligns with their social justice politics.

“One thing I’ve been telling people is that the guidance hasn’t really changed from a public health perspective,” Eleanor Murray, a Boston University epidemiologist, says. “It’s always been ‘stay home as much as possible, except for essential activities.’ But the definition of essential is not a scientific one — it’s a sociological one. … Protesting police violence is an essential activity for a lot of people.”

(It’s not surprising a lot of epidemiologists feel this way. When not dealing with a pandemic, they often study societal inequities and the social determinants of health. Because of this work, we now know a lot about systemic racism and its impacts on health.)

Alison Bateman-House, a medical ethicist at NYU, says we need to think carefully about the costs and benefits of each type of protest.

“Your desire for a haircut is not sufficient to counterbalance the potential of harm that you are imposing on others” during a pandemic, Bateman-House says. It’s also true that the stifling of the economy during the pandemic has made life worse for a lot of people. But opening the economy back up was never the only answer. The government could have been more generous in its support for people out of work.

Now think about the costs and benefits of the mass racial justice protests.

“For people of color and black folks, their cost of not doing something is a lot greater than potentially getting a virus,” says Aisha Langford, a health communications researcher at NYU. “I could die as a black person in America — literally just living as a black person in America is a risk factor for dying, potentially at the hands of police, and potentially on national TV. And history has shown that a lot of times, people [the perpetrators] aren’t even brought to justice. So it’s almost like your life is discarded. If I’m quiet, and I do absolutely nothing, I could die because I exist.”

As Boyd put it in a recent American Medical Association panel, “Protest saves lives. The Black liberation movement, queer liberation movement, women’s liberation movement — all built on protest.”

If you believe the protests are essential, “then I would say your social priority is to do harm reduction,” Bateman-House says. For protesters, that means wearing masks and eye protection, avoiding shouting, keeping distance from others, and being tested for Covid-19 (if possible) after returning from the protests, and maintaining social distance in other aspects of life.

Law enforcement could do harm reduction too, as these crowds don’t appear to be going away. That means not using tear gas and not placing people in crowded holding cells, as we know confined indoor spaces are the greatest place of risk of all. In New York, Gothamist reports, hundreds of protesters were locked up for more than a day in cramped cells — a perfect place for the coronavirus to spread. BuzzFeed has estimated at least 11,000 have been arrested nationwide during the protests.

What’s worse: More people dying of Covid-19, or sustained systemic racism?

The debate about pandemic protests raises a question: What is the greater cost to society: exacerbating the spread of Covid-19 or not protesting for racial justice in this moment?

“I would say is that that is the wrong question to be asking, and that is almost a distraction,” Bailey says. “A lot of people are thinking on a very short time horizon. The protesters are not there just for themselves. They’re there for generations to come. They’re there for their children and grandchildren to live in a different society. Right? So I don’t think that it is a distraction to try to quantify what that looks like.” She worries that people who are bringing up Covid-19 risks are really just trying to silence the protest movement.

It’s difficult to make a direct comparison of the two threats, of racism, and of new Covid-19 cases.

Epidemiologists can model what happens when people get closer together during a pandemic. They can tell us Covid-19 is more likely to spread when people convene, that more infections and deaths may result. But they can’t easily model what happens to disparities in society, when a mass protest movement changes anti-racist attitudes for the better.

The protest is fueled by the faith that it will be worth it: that forcing a reckoning on society will be enough to save more lives in the future. And not just saving lives but easing the burden of systemic racism at all levels in society.

“If there are places that immediately are divesting in their police force, I think that makes it worth it,” Boyd, the pediatrician, says. She mentions how Lego has pulled its marketing of police-themed playsets. “And I think that is huge — that there’s a cultural shift about how we think about policing, that it’s not a toy, that it’s a very lethal and dangerous system we’ve built that has racist implications in our society,” she says.

And already, the protests may have had an impact on racial attitudes in America. Support for Black Lives Matter is at an all-time high, according to the survey company Civiqs.

What is the worth of that cultural change compared to the pandemic? What is the worth of all the Instagram posts I’ve been seeing, of white people sharing guides for other white people to talk to their families about systemic racism? What is the worth of this protest movement and its potential impact on the November elections? What is the worth of showing how law enforcement can confront peaceful protesters with brutal means on live television? Might all of this jolt society into taking the health and well-being of black people and minorities more seriously?

Already there have been some changes. Minneapolis is dismantling its police department and transforming it. Voter registrations are surging. But the larger cultural shifts are harder to quantify, harder to know how, if, and when they could make life better for black communities, and save lives.

This is the problem: How can we really compare the death and destruction of the pandemic with all that? They don’t operate in the same dimensions. Yes, both racism and the pandemic could lead to death. But comparing deaths to deaths feels off. Racism is so much more multidimensional, and harming in a baffling array of ways.

Just look at the pandemic and how it has disproportionately impacted black and minority communities. There are structural reasons for this.

Many racial and ethnic minorities, law professors Ruqaiijah Yearby and Seema Mohapatra explain, have been classified as “essential workers” and are unable to work from home, leave their job, or access paid sick leave. They live in denser housing and more often polluted communities than whites — a result of years of racist housing policy that puts them at greater risk during a pandemic. And when they do get sick, their access to health care is often limited (as is their ability to pay for it).

“Especially in the beginning of this pandemic, in order to get tested, you needed a referral in a lot of places from a primary care physician,” Mohapatra says. “And many people of color, because of where they live, and you can trace it back to redlining … really don’t have access.” That’s just one example of how structural racism is a superseding problem that is made clear when a pandemic arrives.

In the face of the worst-case Covid-19 scenario, the protest movement shows there’s hope for a better America

It’s easy to think about the worst-case scenarios.

The protests could spread Covid-19, and since many protesters are black, it could exacerbate the toll on black communities. The protesters could embolden others to stop social distancing. The protests could continue to hurt the pandemic response; already some testing sites have closed amid the unrest.

If Covid-19 cases spike some weeks after the protests, we won’t immediately know why — was it the police tactics, the tear gas? Was it simply the crowds? Was it the jailing? Was it the general “reopening” of our economy that is occurring at the same time? Before and during the protests, states were reopening without adequate measures like testing and contact tracing in place. It’s possible that many locations were set up for a new wave of infections, protests or not.

In the absence of clear information, fingers will point. People will blame the new wave on whichever group they like the least. The discourse will grow more polarized. It’s possible the credibility of public health professionals will be strained, as conservatives blame them for giving the green light to the protests.

I’m scared about the pandemic. I’m scared about a new wave exploding. But as a white man of some privilege, I feel it’s not for me to judge if the protests are worth it.

There are real, deadly risks. But these protests aren’t about cowering in fear of risks. They’re about hope for change. Hope is hard to quantify and hard to dismiss.

“It’s hope that this type of mass movement has the same impact of other civil rights actions,” Blake says. “I hope that policymakers, legislators, elected officials are paying attention to the calculated risk a lot of us are making, because it would be tragic, not only if there was a spike in Covid infections and deaths, but also if no policies were changed after this.”

When states had strict stay-at-home orders and lockdowns in place, many decisions about the risk of getting the coronavirus were simple. People didn’t have to think about whether dining in a restaurant is safe if the restaurant was closed.

Now, that states are opening up — with varying degrees of precautions and adherence in place — individuals will need to weigh some risks on their own.

It isn’t easy; information about what’s safe, and what’s not, can be contradictory and confusing. A state may allow restaurants to reopen and concerts to resume, but should you really go? Is it safer if people are only allowed to dine outside?

The hunger for guidance is clear: On May 6, infectious disease expert Erin Bromage posted a blog post summarizing the evidence of coronavirus transmission risks, and 17 million people have since read it, he says. The CDC didn’t post its own updated guidance for individuals and events venturing out into a post-lockdown world until June 12. Perhaps a bit too late, as new cases and hospitalizations are currently rising in several states.

As Bromage conveys, the scientific understanding of how the virus transmits in public is improving. Contact tracing studies around the world have taken a magnifying glass to the “superspreading” events, where one person ends up infecting dozens of others. These studies shine a light on the key risk factors that create dangerous situations.

From these studies, one thing is clear: The main way people are getting sick with SARS-CoV-2 is from respiratory droplets spreading between people in close quarters. The risk of catching the coronavirus, simply put, “is breathing in everybody’s breath,” says Charles Haas, an environmental engineer at Drexel University. Droplets fly from people’s mouths and noses when they breathe, talk, or sneeze. Other people can breathe them in. That’s the main risk, and that’s why face masks are an essential precaution (they help stop the droplets from spewing far from a person’s mouth or nose).

The Centers for Disease Control and Prevention (CDC) emphasizes the risk of close contact over other modes of transmission. “The virus does not spread easily in other ways,” the CDC writes. It’s still possible that a person can catch it from touching a contaminated surface (more on that below.). But it’s “not thought to be the main way the virus spreads,” the CDC states.

As Bromage put it in his piece, “We know most people get infected in their own home,” from housemates or family members who caught the virus in the community.

So how can we assess the risk of going places outside the home?

The story is a little more complicated than the simple “stay 6 feet away” guidelines. Coronavirus risk is simply not one-dimensional. We need to think about risk in four dimensions: distance to other people, environment, activity, and time spent together.

Let’s walk through them.

A simple suggestion: Imagine people are smoking, or farting really bad, and try to avoid breathing it in

It’s easy to get into the weeds talking about the risk of catching and spreading the coronavirus as people reenter communal spaces in society. We can talk about the number of viral-laden droplets expelled by a single breath (a lot, perhaps 100 or more), by a person talking (10 times more than breathing), about how far a sneeze can propel those droplets (much farther than 6 feet), how long those viral droplets linger in the air (around eight to 14 minutes, at least in a controlled indoor lab setting).

But really, what all this means is that the greatest Covid-19 risk is being around breathing, laughing, coughing, sneezing, talking, people.

It’s still hard to visualize the risk, though, as the respiratory droplets are invisible to our eyes.

Perhaps helpful: Imagine everyone is smoking, as Ed Yong reported in the Atlantic, and you’d like to avoid inhaling as much smoke as possible. In a cramped indoor space, that smoke is going to get dense and heavy fast. If the windows are open, some of that smoke will blow away. If fewer people are in the space, less smoke will accumulate, and it might not waft over to you if you’re standing far enough away. But spend a lot of time in an enclosed space with those people, and the smoke grows denser.

The denser the smoke, the more likely it is to affect you. It’s the same with this virus: The more of it you inhale, the more likely you are to get sick.

An alternative image to thinking about this risk: “With my kids, I just sort of joke around that if you can smell their farts, you need to move farther apart,” Bromage says. So if not smoking, imagine everyone is farting. Keep this in mind and surely you’ll realize outdoor activities are better than indoor ones. “This tells you the gradient of risk,” Bromage says. “The closer you are, the more it’s gonna smell, the more dangerous it is.“

At a barbecue, you can still imagine being close enough to people to smell their farts. So even in outdoor spaces, we need to limit our contacts.

A crowded indoor place, then, with poor ventilation, filled with people talking, shouting, or singing for hours on end will be the riskiest scenario. A sparsely populated indoor space with open windows is less risky (but not completely safe). Running quickly past another jogger outside is on the other end of the spectrum; minimal risk.

There are many scenarios in between. “In general, outdoors is lower risk,” Muge Cevik, a physician and virology expert at the University of St. Andrews, says. But “if you have a gathering or a barbecue outside, and you spent all day together with your friends, your risk is still higher.”

What recent contact tracing studies can teach us about risk

Scientists pointed out a few recent contact tracing studies that nicely illustrate the dimensions of Covid-19 risk.

In China, 8,437 shoppers and employees of a supermarket were tracked in late January after one of the employees was confirmed positive with Covid-19 while working in the store.

The risk for infection was much higher for the workers than for the shoppers. Around 9 percent of the supermarket employees (11 out of 120 employees) got sick as a result. But just 0.02 percent of the shoppers (2 out of 8,224 shoppers) got sick.

What does this show?

The employees are at a much larger risk due to the time they spent working in the store. Both the employees and shoppers were in the same physical space, but their risk was not the same. (The study did not note whether the shoppers and customers were wearing masks in the store.) The employees may have interacted more with their colleagues, but they also had a greater chance of breathing in the virus.

What we should learn from this: If we have to spend time with people indoors, try to make it quick.

Another recent study out of China investigated an outbreak that started at a Buddhist temple event.

Two buses brought people to the function. On one of the buses, there was a person who later tested positive for the coronavirus who had not yet started to feel symptoms. The other bus was free of infected people.

Both buses brought people to the same temple, where they mixed and mingled outdoors*. But who was most at risk of getting sick? Those who rode the bus with the infected person. Twenty-four out of 67 people on that bus got sick. No one on the other bus did. The event was attended by another 172 people who arrived by other transportation. Only seven of these people got sick.

The lesson? The confines of a bus are a much riskier environment for viral spread than a larger outdoor space, like at the temple. The risk at the temple was not zero. But it was much reduced compared to the confines of the bus. And it appears those who were exposed at the temple were in close contact with the infected person.

“When you look at public transport, work spaces, restaurants — places where we’re just trying to fit many people in a small confined space — respiratory viruses like those spaces,” Cevik says. It’s “just common sense.”

There’s no set time that’s safe to be in these places. “Generally, for droplet transmission, we say 15 minutes,” Cevik says. “So if you spend 15 minutes face to face with somebody, you’re close contact [and at high risk], but that doesn’t mean if you spend 14 minutes your risk is zero.” And if you have to choose between a big open indoor space and a smaller one, choose the larger one, where people can spread out.

It’s not just the location or the time spent together: The activity people are engaged in matters, too.

In Washington state, a person with the virus attended a choir practice, and more than half of the other singers subsequently got sick. This was labeled a “superspreading” event, as one infection led to 32 others. Why was this so risky?

“The superspreading event is about the behavior of the person involved,” Cevik says. There are many reasons why a person could become a “superspreader”: Some people shed more of the virus than others, and it appears people shed most of it when they are just starting to feel symptoms.

But what made this event so risky was the convergence of many risk factors: the singing activity (during which the infected person released viral particles into the air), the time spent together (the practice was 2.5 hours), and the interaction between the choir members in an enclosed space (not only did they all practice together, they also split up into smaller groups and shared cookies and tea).

In a new paper published by CDC, researchers in Japan identified 61 clusters (five or more cases stemming from a common event) of Covid-19 cases. The researchers found most commonly the clusters originated in health care facilities. But outside of that they note “many Covid-19 clusters were associated with heavy breathing in close proximity, such as singing at karaoke parties, cheering at clubs, having conversations in bars, and exercising in gymnasiums,” the scientists wrote.

Notably, too, were the ages of the people who instigated spread outside of the health care settings. “Half … were 20–39 years of age,” the report finds. Which is a reminder: younger people can catch the virus, survive, but at the same time spread it to others who may die from it.

What about touching something with infected droplets? Is that still a risk?

According to the CDC, the coronavirus does not often spread from people touching surfaces. That is, if someone with Covid-19 touches a hand railing, does that make that hand railing dangerous for other people to touch? The CDC is now saying that such events are not a huge risk for Covid-19 transmission.

But, there’s a catch: It is still the case that surface transmission is possible. Scientists believe the virus can remain viable on a hard, non-porous surface like plastic or steel for around three days, and a rough surface like cardboard for about a day. You could, conceivably, touch a contaminated surface, and then touch your face, and get sick. (The good news is that even though some virus can remain on a surface for a day or more, the amount of virus on a given surface drops by half after several hours, and then continues dropping.)

Bromage cautions it’s just really hard to study surface transmission. In contact tracing studies, it’s much easier to ask people who they’ve been in contact with than to have them remember every surface they’ve touched.

“I agree with this [CDC] statement,” Cevik says, agreeing that surfaces aren’t the most significant mode of transmission. “But this does not mean it does not happen.” Cevik points me to a contact tracing study that suggests (with a good deal of uncertainty) that some people caught the infection in a mall via the restroom. “Bottom line,” she says, “it’s still important to maintain personal hygiene and wash hands.”

Also consider how scientists recently found live Covid-19 virus in feces. So good bathroom hygiene is still as important as ever.

There are no magic numbers to eliminate risk

It would be great if there were very specific numbers and guidelines we could follow to minimize coronavirus risk to zero.

But there aren’t. While 6 feet away from another person, it’s not like the virus will immediately decide to drop dead. That’s why we need to think of risk in terms of many dimensions: so we can each think critically and not fall back on rules that are too simplified.

“When I first said restaurants were risks, people interpreted that as ‘every restaurant is a risk,’” Bromage says. “Each restaurant has its own unique environment, its own unique challenges that need to be worked out. If you’ve got a large open-seating area, and you can open up the windows and doors … the risk there is much lower than a boutique restaurant with five tables that creates that really intimate atmosphere.”

When we venture out into the world, we need to remember we can reduce risk, but never eliminate it.

“Wearing a mask is not going to completely reduce your risk, hand-washing is not going to completely reduce your risk, and staying a distance away from people in an enclosed space is not going to completely reduce your risk,” Haas, the Drexel professor, says. “But the concurrent use of all those strategies will hopefully reduce your risk down to a lower level. We can never get to zero. There’s no such thing as zero risk.”

And we still need more data, and follow-up on potential exposures. A hair salon in Missouri made headlines when a couple of their hair stylists were reportedly back at work after testing positive for Covid-19. Both hairdressers wore masks, and so did their clients, and a follow-up investigation by their county health department revealed no new infections among the 140 clients they saw.

This data point is a bit anecdotal. “I think they got lucky,” Bromage says. “But it does highlight the importance of masks.” Perhaps more data will reveal that getting a haircut while everyone is wearing a mask is a low-risk activity.

Contact tracing studies have taught us a lot so far. But as of now, most of this work has been done in Asian countries, which may have different expectations around mask-wearing, among other differences.

“Contact tracing, testing, isolating — these are the building blocks to understand where the transmission is occurring,” Cevik says. And the more we learn, the more power we have to stop the spread of this pandemic.

*This piece was updated to clarify the temple event occured outdoors.

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Several states are now seeing a surge in new Covid-19 coronavirus infections and hospitalizations. And the states with more alarming outbreaks — Arizona, North Carolina, South Carolina, Texas, Utah, Arkansas, Florida, and Tennessee — generally saw few cases early in the pandemic.

Many of these states have started to relax the restrictions on movement, businesses, and public gatherings that were meant to control the spread of Covid-19. But with infections rising, there will be more illnesses, deaths, and financial hardships for people who have already suffered immensely from this pandemic.

If cases continue to rise and threaten to overwhelm the health system, officials may be faced with a daunting prospect: another round of shutdowns, requiring businesses that have reopened to close, public gatherings to be banned again, and stay-at-home orders to go back in effect.

Some local officials are already talking about this possibility. The city of Houston, Texas, for instance, is weighing another stay-in-place order. (It may ultimately be prohibited from having stricter rules than the state government.)

Thanks to several studies, including two recent scientific papers in the journal Nature, there’s now more certainty these measures dramatically lower the case count and save lives. However, the shutdowns also drove a massive spike in unemployment and caused huge social strains as people were forced to stay apart.

Asked about the prospect of further lockdowns, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Science Friday last week it depends on how well other public health strategies are deployed.

“Whether those infections turn into a real resurgence of infections and a rebound will depend on how effectively we’re able to identify, isolate, and contact trace,” Fauci said.

Other public health experts are debating the viability of additional lockdowns, noting it may be harder for leaders to muster the political will for them now, and that citizens may be less likely to comply with them.

What’s clear is that it will be difficult to get quick, satisfying results from shutdowns at this stage of the pandemic. And while there are other ways to protect public health that don’t require such sacrifices from the public, they require investment, coherent public messaging, and political will. Unfortunately, it doesn’t appear every state has these elements in place.

The US is in a much different place than it was at the start of the Covid-19 pandemic

The United States is now the epicenter of Covid-19, with 2.16 million confirmed cases and 118,000 deaths as of June 16.

This growth is evident in states like Arizona, now a hot spot for the virus with daily cases climbing rapidly in the last two weeks. Will Humble, former director of the Arizona Department of Health Services, said the shutdowns worked when they were implemented on March 31. Arizonans largely complied with stay-at-home orders. Businesses closed. People maintained social distance.

But there was little transmission at that point. “The first stay-at-home order was done when we just had a couple hundred cases a day,” Humble said. Then on May 15, Arizona Gov. Doug Ducey allowed the order to expire, replacing it with an executive order that suggested guidelines for how people should behave, but no enforcement. It’s likely that this relaxation contributed to the rise in cases.

“We’re blowing the doors off now with 1,500. … We’d be going into a stay-at-home order under very different circumstance than back in April,” Humble said.

A reimposition of shutdown measures at this point, if they were obeyed, would still reduce the number of new infections. But that reduction would be in proportion to a higher baseline. New cases would drop, but it would take much longer to reach the levels seen after the first round of shutdowns.

When starting from a higher number of cases, there is more transmission baked in. For instance, there will likely be more cases of household spread among family members under a stay-at-home order. And when there are a higher number of overall infections, there are likely to be even more undetected infections that may continue to worsen the pandemic.

And as states saw during their first brush with shutdowns, it can take a while for pandemic control policies to show up in the data. “We can expect those lags and timings would operate in a similar way,” said Joshua Salomon, a professor of medicine at the Stanford University School of Medicine who studies disease models and public health interventions. “It takes a few weeks after you change people’s interactions and contacts for that to translate into a reduction in the number of cases.”

Perhaps the biggest unknown for a second shutdown is how well people will adhere to the orders. Already, people in some parts of the country are gathering en masse, flocking to reopened businesses, and flouting guidance to wear masks in public places.

“We are starting to notice a lot of people across South Carolina are not doing the social distancing or not avoiding group gatherings and wearing masks in public the way, especially, that they were earlier on,” Brannon Traxler, the physician consultant for the South Carolina state health department, told ABC News. Public officials are also facing intense political pressure to ease restrictions.

Hannah Druckenmiller, a doctoral student at the University of California Berkeley, co-authored a recent paper looking at the effectiveness of shutdown measures. She and her team found that across the US, such tactics averted 4.8 million more confirmed cases of Covid-19 and up to 60 million infections in total.

But the results also showed that these policies had different effects in different parts of the world because some governments took the policies more seriously than others.

“This is likely a result of the fact that populations have different cultures and governments enforced the policies to varying degrees,” said Druckenmiller, in an email. “One interpretation of this result is that if a second round of lockdowns was less strictly enforced and had lower levels of compliance, these containment measures may not be as effective as they were in March and April.”

With states taking so many different approaches to the pandemic, however, the US is likely to experience a patchwork of different outcomes from further school closures, public gathering bans, and shelter-in-place orders.

There are alternatives to shutdowns, but the US hasn’t invested in them enough

Economic and social shutdowns are effective, but they’re expensive. They weren’t meant to stay in place indefinitely, but were aimed at slowing the spread of the virus to prevent hospitals from being overwhelmed with patients.

The more targeted strategy for containing Covid-19 is testing, tracing, and isolation. With a robust system of testing, health officials can identify people who are infected and spreading the disease, even before they feel sick. Then they can trace the contacts of the infected to test other people who may have been exposed. And the people who test positive can be directed to isolate themselves. All the while, the general public should maintain social distance and minimize exposure as they take calculated risks in going about their lives.

Such an approach would break the chain of transmission of the virus. It would also only require a handful of people to stay home rather than large swaths of the population. But it demands a lot of infrastructure to deploy tests and trace contacts, and it takes time to set up.

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“Shutdowns really had two goals. One was to stop the uncontrolled spread, which they did,” said Salomon. “The other was to try to buy us time to set up the public health infrastructure to do testing and tracing and isolation at scale. And we really failed to make use of that time.”

Another round of closures and stay-at-home orders could still be availed to build up the testing and tracing capacity. The more testing and tracing is available, the less strict shutdowns need to be. And building a system for testing millions of people would still be cheaper than an indefinite pause of the economy.

At this point in the pandemic, public health officials also have a better understanding of the spectrum of risk for the virus. Rather than issuing blanket orders to stay home, more nuanced guidance about what kinds of public spaces are safe and what precautions are necessary could ease the acceptance of pandemic control measures. But that requires careful and nuanced public messaging, and given the mixed messages the public has received on tactics like wearing masks, health officials would have to rebuild trust.

“What we really want to do is get as much benefit as we can from lockdowns in a way that’s more targeted and doesn’t demand as much sacrifice,” Salomon said. He added that policies like paid sick leave and building up work-from-home capabilities would also be important steps to helping people avoid unnecessary exposure to Covid-19.

As for when states can relax, that remains a fraught question. Some of the guidelines from the federal government for reopening have been confusing, and some states have gone ahead and established their own.

More recently, the Centers for Disease Control and Prevention put out a list of best practices to reduce Covid-19 risk as shutdowns relax. Measures include wearing masks and maintaining distance from other people.

However, with cases spiking in several states, it may still be too soon to think about relaxing, and efforts may still be needed for containment. But with the most blunt yet effective public health tool losing strength, it’s more urgent than ever to fight the pandemic without such drastic measures.

Texas broke records for Covid-19 hospitalizations six times last week, including a record 2,504 hospitalizations in a single day on June 10.

South Carolina, North Carolina, Alaska, Florida, Mississippi, and Arkansas have also all broken records of new cases reported in a single day. Alabama saw a 92 percent increase in its seven-day average of new cases, and more than a quarter of Arizona’s total Covid-19 cases have been reported in the last week. Overall, 21 states have seen an increase in their daily average cases.

As these states have loosened lockdowns and people have come back into close contact, the virus is spreading rapidly again, and hospital ICUs are filling up. And public health experts say health care providers and essential workers remain at high risk of infection for the same reason they have since March: there’s a shortage of critical supplies, including personal protective equipment (PPE).

As of April 14, the Centers for Disease Control and Prevention (CDC) estimated that 9,200 medical professionals had been infected in the US; it’s not known how many have died.

An ongoing problem with PPE is that supplies still aren’t being distributed equally around the country and even within hot spots. Better-resourced hospitals have more supplies while other facilities struggle to find enough.

The federal Centers for Medicare and Medicaid say that one in five Florida nursing homes do not have a one-week supply of gowns or the N95 masks needed to care for Covid-19 patients and prevent transmission. According to WCNC Charlotte, North Carolina ran perilously low on gowns and masks in May even before its recent surge in cases, receiving only 99,000 of the 27 million N95 masks it had ordered. An internal report from the Federal Emergency Management Agency (FEMA) suggests “[t]he demand for gowns outpaces current U.S. manufacturing capabilities” and that the government plans to continue to ask medical staff to reuse N95 masks and surgical gowns intended to be disposed of after one use into July.

Val Griffeth is an emergency and critical care physician in Oregon and the co-founder of Get Us PPE, a grassroots organization that finds and donates PPE to health care workers who don’t have enough. (Project N95 is another organization that works with institutions who can afford to buy supplies but are having trouble procuring them.) Griffeth says Get Us PPE has seen a recent uptick in requests, particularly for gowns and gloves.

“I worry there hasn’t been a true fix to the supply-chain issues,” Griffeth says. “Our government has basically said that we’re going to allow the free economy to fix the issues. Unfortunately, it takes time and capital to ramp up production, and because the government has not devoted capital to helping solve the situation, we’re seeing a delay in its resolution.”

Griffeth argues the Defense Production Act (DPA), which Trump has deployed selectively, could be used more broadly to increase production of essential protective gear. The lack of federal leadership and coordination, the lack of a central agency prioritizing distribution based on need, Griffeth says, has led to difficulty procuring supplies, with states and hospitals often bidding against each other and elevating prices.

Now, as cases surge in several states, grassroots efforts are filling the vacuum. Here’s a closer look at a few of the country’s hot spots, and the people organizing to try to help protect their communities.

Why is PPE important?

A May preprint study, conducted by researchers at Massachusetts General Hospital, King’s College London, and Zoe Global Ltd., looked at data from the Covid Symptom Tracker app. It found that front-line health care workers were at nearly 12 times higher risk of testing positive for Covid-19 compared with members of the public, and those workers with inadequate access to PPE had an even higher risk.

“The limited availability of adequate PPE, such as masks, gowns, and gloves, has raised concerns about whether our health care system is able to fully protect our health care workers,” said senior author Andrew Chan, chief of the Clinical and Translational Epidemiology Unit at Mass General, in a statement.

Carri Chan, an associate professor at the Columbia Business School and an expert in hospital operations management, explains that PPE is essential not just to reduce transmission in hospital settings but because studies have shown that in a respiratory disease pandemic, trained health care workers are the bottleneck. If they get sick, patient care suffers. “You can have all the ventilators in the world, and if you don’t have specially trained people to provide care, it doesn’t matter how many machines you have,” she says.

It’s not only hospitals that need more staff and PPE; many other areas of health care do too, including primary care facilities, homes for the disabled, and nursing homes — a fifth of which reported at the end of May that they had less than a week’s supply of critical PPE. Chan notes that other essential workers, including grocery store clerks, delivery workers, and those “who don’t have the luxury to work from home” also need PPE to protect themselves and others.

Because a large portion of the masks, gowns, and gloves the US uses come from China, and because of the overnight global demand, supply chains have been disrupted. “Due to limited access, as hot spots grow, some more underserved communities could be again hit disproportionately,” she says.

This is yet another area where the lack of federal leadership hindered the Covid-19 response. As a New York City resident, Chan compares Elmhurst — a hospital in Queens that saw “apocalyptic conditions” — to better-resourced and well-connected facilities in other parts of the city, saying that “because of the decentralized manner in which PPE procurement occurred, some [hospitals] were much worse off than others.”

In her hospital, Griffeth is currently given one N95 respirator mask and one face shield per day. She wears the face shield both as eye protection and to decrease droplets contaminating the respirator. N95s are placed in a paper bag between uses while face shields are cleaned with sanitizing wipes between patients. Best practices would involve using a new mask and face shield with each potentially infectious patient. “Both masks and respirators continue to be an issue,” she says, “despite falling out of the nightly news cycle.”

Chan says, so far, there have been few national efforts to ensure PPE is distributed equally. “At Elmhurst, people were dying just waiting to get access to care. There’s a lot of imbalances about the way the system is set up.”

Florida: “Left out to the wolves”

Rebekah Jones, a scientist and former manager of data and surveillance at Florida’s Department of Health, says that, back in January, the CDC told the department it needed to prepare for a widespread pandemic.

Jones was in charge of the state’s public tracking of Covid-19 cases until May 19, when she allegedly refused a superior’s request to alter numbers so that the coronavirus positivity rating would drop below the state’s threshold to reopen. Before she was fired, Jones says she saw requests for PPE rolling in from around the state — requests for shoe covers and hand sanitizer and masks — suggesting many places in Florida still didn’t have the equipment they needed to stay safe. Since mid-May, 24 health care workers in St. Petersburg have been infected, prompting at least one nurse to quit, and firefighters and first responders in Immokalee recently reported they are running out of PPE.

Desiree Ann Wood, a truck driver and founder and president of Real Women In Trucking, says that Florida’s need for PPE extends far beyond hospital doors. She’s been organizing donations of PPE for truck drivers, who have struggled to maintain the country’s supply chains during lockdown.

Wood reports that rest stops truckers normally rely on to go to the bathroom, sleep, and eat have been closed, and many drivers are no longer allowed inside the places they deliver. “You’re like a social pariah,” she says, but “we are part of the logistical supply chain, and no one’s thought that the people restocking shelves are being left out of the equation.” She says with the temporary suspension of regulations limiting long-haul driving hours, “Drivers can drive more for less money, and for less services, and no one ever thought, ‘What about them?’ It doesn’t even occur to you to give them a mask, too.”

Wood started handing out donated masks in early March. “I couldn’t get permission initially. I’d just show up at a truck stop and pass masks out till I was asked to leave.” But though she’s met skepticism — truckers “assume I’m going to hassle them, or I’m a working girl in the parking lot” — the Real Women in Trucking network has now handed out more than 8,000 masks, gloves, and bottles of hand sanitizer.

Thanks in part to a donation by Uber Freight, as well as donated supplies and a cash donation from the freight company DDC FPO, Wood is now handing out PPE in Florida, Kentucky, Mississippi, Iowa, Georgia, and Michigan.

Jones, the former Florida state data scientist, has also developed her own dashboard, which, unlike the state’s, shows the total number of positive cases for everyone tested in Florida regardless of their legal address. “If you live here and are sick here and die here, your information should be included,” she says.

Wood agrees that it doesn’t seem as though the state is considering everyone. “We see this over and over again,” she says. “We’ve really been left out to the wolves.”

Georgia: “We’re not united anymore.”

On June 11, Georgia saw a single-day increase in Covid-19 cases of more than 26 percent. The increase in cases isn’t surprising to Edward Aguilar, Shourya Seth, and Manu Suresh, juniors in high school in a suburb of Atlanta. They’ve been busy after school, building software to get PPE to hospitals that needed it.

“It’s been frustrating seeing cases rise, and the lack of government response,” says Aguilar. “It really does point out the weak points of the whole supply chain,” Seth says. “It’s almost like a confederacy. We’re not united anymore.”

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After talking to Seth’s cousin who works at Emory University Hospital, the teens called five maker spaces — collaborative workspaces that often have shared tools — in early March to see if they could find a way to get additional PPE to medical workers. They created a grassroots organization, Paralink, and since April 1 have delivered donated PPE supplies, primarily face shields, to health care providers around the South. “FEMA has delivered 180,000 face shields to Georgia,” says Aguilar. “We’ve delivered 190,000.”

At first, the teens were calling hospitals to make a list of who needed what, but now the group uses Get Us PPE’s database to prioritize shipments. It’s been a crash course in logistics: Paralink now coordinates more than 50 maker spaces to 3D-print face shields, and relies on 150 volunteer drivers to distribute them.

Aguilar recalled one shipment of 3,000 face shields that urgently needed to get to Albany, New York; within a day, they used Facebook groups to find seven volunteers, who each drove the shipment for several hours in a human chain between Georgia and New York.

As they’ve scaled up, the teens have run into some of the same stop-and-go problems as larger corporations. While Georgia was locked down, there was a drop in requests for PPE, so Paralink called some of the volunteers to tell them their help was no longer needed making face shields. “Now we need to call back and say we need more,” Aguilar says. “We’ve had some really tough conversations.”

Paralink’s requests for face shields have recently doubled. “It’s scary to see we’re not able to keep up production — and we know we can move faster than the federal government. What happens when the government has to make these phone calls to massive companies? How do you tell [manufacturers] that after retooling, they have to stop, or then start again? The backlash won’t be in favor of the manufacturers,” says Aguilar.

“People call us and say we’re inspiring — and it’s scary. The focus, as it should be, has been on health care workers, but a lot of [them] are in the same position now and aren’t getting any help,” Aguilar says. “It’s not just people in hospitals. Everyone needs this protection.”

Arizona: “It’s been heartbreaking”

Over the last week, Arizona’s Covid-19 cases surged by 54 percent. Saskia Popescu, a senior infection prevention epidemiologist at the University of Arizona, says she was “surprised and deeply worried when the state opened so prematurely. We’re seeing the fallout of that right now.”

Northern Arizona in particular has been hard-hit, seeing hospitals approach capacity, and the largest care system in the state, Banner Health, warned that the number of patients on ventilators has quadrupled since May 15. The Arizona Department of Health Services told hospitals to “fully activate” their emergency plans.

Because it’s so hot in Arizona — it hit 112 degrees Fahrenheit in Phoenix twice in late May after the stay-at-home order lifted — it’s more difficult to follow recommendations to socialize outside instead of inside. That may help explain why Arizona’s case numbers have been spiking after lockdown was lifted, says Popescu.

But it’s not just increased transmission that’s putting a strain on the state’s PPE supplies. The Arizona Department of Health Services has recently allowed elective surgeries to restart, adding traffic to hospitals and creating what Popescu calls “a perfect storm for rapid case growth, and a very stressed health care system.”

Popescu says that she’s seen a widespread shortage of even basic supplies like disinfecting wipes, as well as disposable stethoscopes and laryngoscope blades — “things people don’t think are big deals, but that show that the supply chain problem is not resolved.”

Watching people become increasingly lax about prevention while knowing that hospitals are increasingly full has “been heartbreaking,” Popescu says.

Lois Parshley is a freelance investigative journalist and the 2019-2020 Snedden Chair of Journalism at the University of Alaska Fairbanks. Follow her Covid-19 reporting on Twitter @loisparshley.

The Centers for Disease Control and Prevention (CDC) on Friday reversed changes to its Covid-19 testing guidelines, once again recommending that people without symptoms get tested for the coronavirus if they have come into close contact with someone known to be infected.

The CDC’s new guidelines now state, “If you have been in close contact, such as within 6 feet of a person with documented SARS-CoV-2 infection for at least 15 minutes and do not have symptoms. You need a test. … Because of the potential for asymptomatic and pre-symptomatic transmission, it is important that contacts of individuals with SARS-CoV-2 infection be quickly identified and tested.” It also calls for such people to self-isolate for 14 days, even if the test comes back negative.

Recent guidelines suggested that people without symptoms who have come into close contact with others known to be infected “do not necessarily need a test.” The new guidance, in effect, returns the CDC to a recommendation for more testing.

Public health experts and officials criticized the previous revisions. They noted that people without symptoms can still spread the coronavirus, and, in fact, people may be at greatest risk of spreading the virus before they develop symptoms. For those without symptoms, the test may be the only way to confirm an infection — and, as a result, get people to isolate to stop further spread of the disease.

The previous changes to not recommend testing, however, appeared to be politically motivated. President Donald Trump, arguing that more tests make the US look bad by exposing more Covid-19 cases, previously said that he told his people to “slow the testing down, please.” Media reports confirmed the White House and Trump’s Department of Health and Human Services forced and oversaw the previous changes to recommend less testing — even as CDC officials objected. That fell into broader efforts by the Trump administration to muzzle and warp the CDC to downplay Covid-19 and Trump’s botched response.

The latest revisions to the guidelines amount to the CDC rebuking Trump and his officials’ politically motivated efforts.

Since the start of September, the number of people getting tested for Covid-19 in the US has stalled out and even fallen. Some experts said that the previous revisions to the CDC guidelines were partly to blame.

Testing is crucial to stopping Covid-19 outbreaks. When paired with contact tracing, tests allow officials to isolate the sick, track down close contacts and get them to isolate as well, and deploy other public health measures as necessary. Aggressive testing and tracing were key to controlling Covid-19 outbreaks in other countries, such as Germany and South Korea.

The US, however, has struggled to build up its testing capacity. In the spring, the country was slow to do so due to a mix of federal screw-ups and bureaucratic hurdles, resulting in a “lost month” for confronting Covid-19. In the months after, testing did increase. But then, when cases started to spike nationwide in the summer, there were more testing shortages as some labs reported delays for results as long as weeks. Starting this month, testing appeared to decline again.

The testing failures are one reason the US, which is now nearing 200,000 confirmed Covid-19 deaths, has struggled so much to contain the virus. While the US hasn’t seen the most coronavirus deaths of wealthy nations, it’s in the bottom 20 percent for deaths since the pandemic began, and reports seven times the deaths as the median developed country. If the US had the same death rate as, say, Canada, 115,000 more Americans would likely be alive today.

The recent drop in testing is particularly concerning now: The fall and winter threaten another wave of rising Covid-19 cases — as people return to school, the holidays bring families and friends close together, the cold pushes people into indoor spaces where the virus is more likely to spread, and a flu season looms.

At least with its new guidance, the CDC is pushing for the kind of testing that could help America get control over future outbreaks and, hopefully, prevent them from becoming dire.

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