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Dr. Alveda King on Trump's presidency: 'When something is winning for you, keep the victory going'

Alveda King, the niece of Dr. Martin Luther King Jr., reacted to former South Bend, Ind., Mayor Pete Buttigieg’s statement that African-Americans are experiencing “pain” living under Trump’s presidency, saying on Sunday, “People are not suffering."
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A Son In Wuhan Wants A Moment Alone With His Father's Remains. The Government Says No
Zhang Hai's father died of the coronavirus on Feb. 1 and was cremated. Ashes can now be picked up but the government requires a chaperone for visits to the crematorium as well as for burials.
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npr.org
Coronabonds and Cancellation of Nazi-Era War Debts Fuel Debate Around $540B EU Pandemic Relief Deal
Italian Prime Minister Giuseppe Conte warned that divisions revealed in the negotiations may spell the end of cooperation among eurozone countries.
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newsweek.com
99-year-old WWII veteran who survived coronavirus gets guard of honor from nurses
Albert Chambers, 99, was given a guard of honor by nurses as he was discharged from hospital in Doncaster, northern England.
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edition.cnn.com
99-year-old WWII veteran who survived coronavirus gets guard of honor from nurses
A 99-year-old World War II veteran who survived the coronavirus has been given a guard of honor by nurses as he was discharged from hospital.
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edition.cnn.com
Europe has a rescue package. But who's going to pay for its coronavirus recovery?
EU finance ministers have approved €500 billion in stimulus measures designed to cushion the blow to their economies from the coronavirus pandemic, while leaving open the difficult question of how to pay for the region's recovery.
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edition.cnn.com
Philadelphia black communities hit hard by coronavirus pandemic
Philadelphia health commissioner Dr. Thomas Farley shared new data Thursday that said African Americans are the most at-risk for COVID-19 as the city raised alarm bells over its mounting virus cases. The White House said the city could be a new pandemic hot spot, and city leaders are working to flatten the curve disproportionately affecting minority neighborhoods. Errol Barnett speaks to city and community leaders about the disturbing trend and how they are looking to overcome it.
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cbsnews.com
Doctor explains need for widespread virus testing infrastructure
President Trump said in a Thursday press conference that widespread coronavirus testing may not be necessary. That goes against the word of health experts who say adequate testing infrastructure is critical to researching the disease and making informed decisions on how to mitigate the virus' spread. Dr. David Agus joins "CBS This Morning" to discuss why testing is critical and what valuable data can be learned.
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cbsnews.com
Cowboys stars Ezekiel Elliott, DeMarcus Lawrence giving back to community amid coronavirus pandemic
Dallas Cowboys stars Ezekiel Elliott and Demarcus Lawrence announced this week they were trying to provide some relief to Texas communities amid the coronavirus pandemic.
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foxnews.com
Day 30 without sports
What have we missed during a month without sports? And what kind of impact will the shutdown have on the future of the games we love?       
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usatoday.com
Max Lucado: Coronavirus can’t cancel Easter – nothing can, even when churches are closed
Church buildings will be vacant this Sunday. That is true. But since the tomb of Christ is vacant, Easter cannot be canceled. Ever.
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foxnews.com
Nailed It! Is the Radically Kind Show to Cure What Ails You
The Netflix baking competition sets contestants up for failure, and then embraces it.
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slate.com
Coronavirus is not just a tragedy. It’s an opportunity to build a better world.
Nekima Levy Armstrong helped pass out masks to residents of Minneapolis on April 8. | Jerry Holt/Star Tribune via Getty Images “Coronavirus is a great moral drama taking place before our eyes. And the script has not yet been written.” “Epidemic diseases are not random events that afflict societies capriciously and without warning,” writes Yale historian Frank Snowden. “On the contrary, every society produces its own specific vulnerabilities. To study them is to understand that society’s structure, its standard of living, and its political priorities.” Today’s tragedy can be, sometimes, tomorrow’s possibility. According to Snowden, pandemics don’t only reflect a society’s existing vulnerabilities — they present an unprecedented opportunity for transformational change. In his new book, Epidemics and Society, Snowden explores how infectious diseases across time have altered the outcomes of wars, inspired political reform, demolished revolutions, transformed entire societies’ relationships with God, and fundamentally changed the course of human history. According to Snowden, we face a “fork in the road” as a species. We could either use coronavirus as a justification to retreat into xenophobia, ethnonationalism, and tribalism — as we’ve already seen in many places; or we could use it as an opportunity to build a better, more just world. Epidemic diseases throughout history have prompted both sets of responses, but the history of this moment is not yet written. How we respond to coronavirus will be one of the most important choices of our lifetimes. I spoke with Snowden by phone. A lightly edited transcript of our conversation follows. Roge Karma Something you discuss in the book is that epidemic diseases, whether it’s bubonic plague or smallpox or Ebola, do not afflict societies in completely random ways. If the impact of epidemic diseases isn’t random, what factors explain how they impact societies? Frank Snowden The world of microbes is populated with an infinite number of species, all of which are in constant evolution. Each has its own qualities and therefore can find environmental niches to exploit that are quite different. Societies get the diseases that they have created the channels and the pathways for. Epidemics tend to reach our greatest vulnerabilities and exploit them. Asiatic cholera of the 19th century is the classic disease of industrialization. Society at the time was rampantly, suddenly, and chaotically urbanizing. There is no sanitation. The air is filled with foul odors. There are no sewers or toilets or guaranteed clean water. It’s in that kind of environment that a disease transmitted through the contamination of food and water with human fecal matter is able to flourish. And that’s what typhoid and Asiatic cholera were at the time. Today, in New York or in Rome or London, we don’t need to fear Asiatic cholera because we’ve had a sanitary revolution. We have sewer systems. We have water that’s pure and safe to drink. We have sanitary customs, we have paved streets, we have whitewashed buildings, we’ve got building codes. So we’re not vulnerable to that kind of disease. But that doesn’t mean that now we’re invincible — that bulwarks of civilization protect us against the natural world. Roge Karma What are the social conditions that made us vulnerable to coronavirus? Frank Snowden We’ve created a different kind of world — the world of globalization. That’s very different from the age of industrialization, and it creates different vulnerabilities. Globalization encompasses enormous population growth. We’re now approaching 8 billion people as a species, and that is accompanied by an enormous density of population. We also have a myth of infinite economic growth although the planet has finite resources. And that forms our relationship with the environment. We’re constantly invading and destroying great swaths of animal habitat. That brings us into contact with animals that we didn’t encounter very often in the past. Therefore, we are exposed to the infinite reservoirs of microbes that they carry and there is a spillover of diseases we never encountered before. Avian flu is a spillover from wild fowl. Ebola is a spillover from bats. MERS is the same story. And coronavirus today is once more a spillover via the wet markets in a place like Wuhan [the Chinese city where the coronavirus outbreak originated]. We’ve also created mass air travel — millions of people travel on a daily basis. So a disease that breaks out in Jakarta in the morning can easily begin its course in London or Paris or Mexico City in the evening. Those links make us enormously vulnerable to diseases that can travel on airplanes with us and then begin fresh in our overcrowded, teeming cities. Roge Karma I want to follow up on something you said there. Clearly, globalization has a lot to do with the spread of coronavirus. But I’m wondering if the problem is globalization itself, or if a deeper problem is the gap between the reality of globalization and the myths we still tell ourselves about national borders and nation-states being wholly separate entities. Right now, we don’t only have a more interconnected world; we have an interconnected world full of nationalist leaders who deny that interconnection. I wonder if that combination of a truly interconnected world and resurgent nationalism is part of what stops us from addressing global problems, like a pandemic, in a coordinated, global way. Frank Snowden I entirely agree. What is happening is not something that is ordained to happen: The ideas in people’s heads make an enormous difference. Just because we have these vulnerabilities in a globalized world doesn’t mean we have to succumb to them. There is a bright side to this story, which is that it is possible to manage this global world that we’ve created in ways that are different from those we have established. It’s true that the ideas in our heads haven’t yet caught up with the reality in which we live. You mention, for example, the idea of national boundaries. If there’s one thing that this pandemic seems to be teaching, it’s the eerie lack of reality of national borders. A disease transmitted by the air like coronavirus simply has no respect for borders — it has no respect for walls. I’m hoping that the Trumpian wall will not become the metaphor for our age because that will disarm us and make us much more vulnerable to different microbes or a resurgence of this one — all of which is more or less inevitable in our future. The most dangerous thing right now would be the triumph of the idea that the European Union should be dismantled. Coronavirus has shown that what we need is more collective action. The tragedy was not that Europe wasn’t divided into little pieces, but that it didn’t succeed in having a common response. This isn’t a disease that is affecting just part of the global world as we’re seeing now — it’s a disease of humanity. It’s going to involve everyone. And I think we need to have a consciousness that keeps up with the reality that we’re actually facing and proposes solutions that deal with the real problem. Denigrating entire ethnic groups takes us nowhere in terms of dealing with factual biological reality. Roge Karma I think what you’re getting at is that coronavirus seems to have brought us to a kind of global fork in the road. On the one hand, coronavirus could affirm the nationalist sentiment that we need a more closed world, that we need to build walls, that all of our forays into globalization were wrong. Or we could begin to recognize that a globalized world requires more global cooperation. On this point, there’s a line from the book that’s been stuck in my head ever since I read it: “One of the horrors of an epidemic of plague was that it broke the common bonds of humanity.” Is this the norm? Do epidemics tend to bring divided communities together under a banner of solidarity, or do they tend to further exacerbate existing divisions and break societies apart? Frank Snowden It’s a terrible worry. I use the analogy of epidemics as mirrors that reflect who we are back upon us. I find that helpful and also scary. It’s helpful because it does allow us to tease out what it is that we’re seeing in that mirror. It’s scary because it means that we see both our darker and our brighter selves. That does give us hope in one sense: Our destiny is what we are wise enough, collaborative enough, and willing enough to create. We have a choice here. You’re right that we’ve come to a fork in the road with coronavirus. We’re going to have a miserable, deadly period for some months now. But after that, we will have a chance to construct a better world that’s more scientific, more rational, more humane, more international. Or we can adopt pseudo-solutions that will condemn us to repeating this awful experience that we’re now going through. My hope is that our brighter selves will prevail. My fear is that there are many interested parties working day and night to make certain that we will have a more divided and hateful world. Right now, large sectors of the conservative right in our country reject the scientific explanations for Covid-19 and claim instead that this is something else — something foreign. That leads to violence and ethnic conflict. “Societies get the diseases that they have created the channels and the pathways for” Roge Karma What does it actually look like when our darker selves prevail? Frank Snowden In the era of the bubonic plague, as you mentioned, one sees this tension between pseudo-ideas and ideas that were a way forward. The pseudo-ideas included, once again, divisiveness, xenophobia, witch-hunting, blaming, finding a guilty party — the great “other” that we can attack. In Strasbourg, France, the citizens of Strasbourg rounded up the community of 200,000 Jews, brought them to the Jewish cemetery, and said that it was their religion that was leading them to poison the wells where Christians drank — and that was the source of the bubonic plague. They had either to renounce their religion or be killed on the spot. Half of the Jews held to their religion, and they were burned alive at that very moment, that very day. This is part of the violence or the divisiveness, the xenophobia that can emerge from a time of epidemic plague. The reason being that these are events that touch the depths of our psyches as human beings. They reach down and pose the questions of, what are we as mortals? What about our death? What about our bonds to our fellow human beings, to our families, our communities, our friends? What authority do we give to the political and sanitary officials who are dealing with this? All of these things are revealed by plagues and create enormous anxieties; therefore, they bring out these extraordinary responses. Either we can respond with immediate fear and anxiety or we can use our intelligence to see that if we’re going to survive, we’re each dependent on one another and we have to figure scientifically, how does this work? What are its mechanisms? That seems to me the opportunity offered by each pandemic. The history of epidemic diseases is not all doom and despair because people haven’t always chosen to go down the wrong fork. Although there have been these outbursts of horrors during times of pandemics, it’s the history of pandemic that has left enormous positive [impact]. Modern public health is something that was developed during the centuries of bubonic plague, and we’re still dependent on it today. It’s saving our lives as we speak. The potential for progress is really there. But it’s a choice that we have before us. We’re at a fork in the road. Where will we go? Coronavirus is a great moral drama that’s taking place right before our eyes. And the script has not yet been written. Roge Karma What does it look like when we choose to write that script in a positive way? Could you talk about a society that, when faced with a horrible epidemic, chose their better selves? Frank Snowden A powerful example is the sanitary movement of the 19th century, which was a real attempt to deal with the extraordinary mortality of the age of the Industrial Revolution. At the time, people in London or Manchester or Paris or Naples or New York were living in enormous, unplanned, filthy, overcrowded urban centers. There was the [emergence] of the idea that this didn’t need to result in mass death and disability, that something could be done about it. Top medical doctors started thinking about correlations between the patients they saw and the social conditions in which they lived. They began with the idea of “social medicine”: that medicine was not just about individuals, [but] also the social factors that caused the illness. This idea was channeled by the sanitary movement. They set up enormous investigation into how people live throughout Britain. Physicians went to every community and wrote back about what the exact conditions were in the places they inhabited. You had a central board of health that put it together and developed an enormous series of ways to reform this chaotic and unplanned society. Just imagine the scale of this project. It meant retrofitting every place in Britain with sewers, with clean water, with clean houses, regulated houses. For the first time, we see the state insisting on sanitary rules, on building codes, on maximum occupation requirements. It took two-thirds of a century to carry out at enormous cost. And I would argue it saved millions of lives in Britain in the 19th century. People in Britain became much healthier. And so astonishing was this example, this way of thinking about disease, that it was taken up in France. And then it spreads to Belgium and the Netherlands and United States and Italy. This was an amazing moment to which we owe broad boulevards, urban parks, all kinds of aspects of the world in which we live. I think this was our brighter angels. And it was the reaction to the legacy that was created by typhoid and cholera. Roge Karma When these European societies faced this fork in the road, I’m curious about what factors make the difference between choosing their better or worse selves. Was it leadership from the top? Was it demand from below? What was it that made the difference? Frank Snowden It needed not only cooperation from below but leadership from the top. One of the legacies of these epidemic diseases has been the molding of the modern state. Epidemic diseases required health authorities. They required great taxation. They required legislative authorities. They required administrative census data. They required hospitals. They required a navy to quarantine ships. They required police powers to quarantine people by land. We see this in the political thought at the time through the writings of people like Thomas Hobbes and John Locke, the founders of modern liberalism. They argued that life was nasty, brutish, and short, as indeed it was during the time of plague, and that you needed to create an authority to make people safe. The sanitary movement helped sculpt a modern state with enormous new powers that could be used in beneficent ways. Of course, power has its own problems — it can have negative results. But we can’t survive without political power, without states, and without sanitary authorities. They’re part of our survival kit. And I think the coronavirus shows how quickly life could once again become nasty, brutish, and short without them. Roge Karma That’s interesting because a core part of our national mythos in the United States since the 1980s has been the idea that government is the problem. In the 1990s, Bill Clinton, a Democrat, got up and pronounced that “the era of big government is over.” I’ve been thinking of those words a lot today in the wake of coronavirus as the death counts continue to rise exponentially, as states bet against one another for health care resources, as we still lack a federally coordinated plan for addressing the epidemic. If anything is going to shatter that anti-government paradigm, maybe it is a global pandemic of this scale. Frank Snowden I think there is a libertarian streak in the US that’s having catastrophic effects on health. The United States had no national plan. It had refused to listen to the scientists who said that a new pandemic was an inevitability in our future. It trimmed the national government’s health budgets. So our coronavirus response has resembled the cacophonous noise that comes from a symphony with no director — in which every instrument player decides to make his own different music. The national government says one thing. Governors in states say another. The CDC says a third thing. Municipal governments have their own sound. School boards intervene in ways that are their own. It’s mayhem and pandemonium. We tend not to realize just how much we need the state until it abdicates its responsibility to keep us safe. Now, we’ve seen that. This administration’s response has been like going back to the pre-Hobbesian days of the war of all against all. I think the lack of preparedness is the great tragedy that we’re experiencing today. And that’s not just about having more ventilators, although that’s included. It really is about our minds, our hearts, and our intellects. Change has to begin there. If we try to dismantle the World Health Organization and put walls up, I think we’ll find that when the next disease comes, we could experience an even greater catastrophe than this one. Roge Karma What should we do? What does the road map after coronavirus look like? Frank Snowden We need a huge rethinking collectively, not by any single person. If anyone presents you with a blueprint saying “I know the answer,” I think we should all run as fast as we can from that person. That’s not what I’m thinking. I’m thinking we need to put our heads together collectively and devise a society that works in a different way: [one] that is prepared, that rethinks our relationship with climate, with our great cities, and rethinks this myth that we can grow infinitely in our numbers and in our economic systems until there’s only standing room and nothing but smog to breathe. That’s a mammoth collective project. It’s not doom and gloom, though. I think this actually holds its excitement — it’s inspiring. We can build a different world, a better world, a world where our grandchildren can live better. Support Vox’s explanatory journalism Every day at Vox, we aim to answer your most important questions and provide you, and our audience around the world, with information that has the power to save lives. Our mission has never been more vital than it is in this moment: to empower you through understanding. Vox’s work is reaching more people than ever, but our distinctive brand of explanatory journalism takes resources — particularly during a pandemic and an economic downturn. Your financial contribution will not constitute a donation, but it will enable our staff to continue to offer free articles, videos, and podcasts at the quality and volume that this moment requires. Please consider making a contribution to Vox today.
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vox.com
UFC 249 postponed indefinitely after Dana White told to 'stand down'
The highly-anticipated UFC 249 will not happen on April 18 as previously scheduled after UFC president Dana White said he was told to "stand down."
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edition.cnn.com
Thailand's most popular island goes into lockdown as Covid-19 cases surge
Kritchai Rojanapornsatit has lived in Phuket for most of his life.
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edition.cnn.com
The week in pictures, April 4 - April 10
Here's a selection of some of the most poignant images in the past seven days, as the coronavirus pandemic continues to ravage the world.
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foxnews.com
Kudlow says senators should be 'significantly punished' if they engaged in insider trading
Kudlow said on a tele-town hall hosted by Sen. Martha McSally, R-Ariz., that if any of senators are found guilty, the justice system should come down hard on them.
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foxnews.com
OnPolitics: The 2020 presidential race is officially set
Sen. Bernie Sanders bowed out of the Democratic race, and now it's all Joe Biden vs. Donald Trump.       
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usatoday.com
Fear in salons and barber shops as Japan deems haircuts "essential"
"However scrupulous our sanitation, don't they understand we can't completely guard against infection?" said one nervous barber.
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cbsnews.com
Eye Opener: Health experts say virus pandemic curve is flattening
Health experts are hopeful that the coronavirus pandemic curve is flattening as less people are being admitted to hospitals in hard-hit areas, though they warn that it's critical to not let up on mitigation efforts. Also, New York has reported a record high number of coronavirus deaths and plans to bury unclaimed victims in a mass grave. All that and all that matters in today's Eye Opener. Your world in 90 seconds.
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cbsnews.com
U.S. prisons' virus-related release policies prompt confusion
‘It’s crazy how they’re doing this,’ one inmate’s spouse said.
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politico.com
Notre Dame Cathedral opens briefly for Good Friday ceremony
Amid a strict lockdown due to the coronavirus pandemic, Notre Dame Cathedral in Paris rose from the ashes — albeit just briefly — Friday by opening to a tiny group of people for Easter. Only seven people were allowed inside the fire-ravaged landmark to attend a Good Friday ceremony. “This message of hope is especially...
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nypost.com
Ian Poulter 'sad' Masters not happening in spring
Ian Poulter, like many professional golfers this time of year, is missing the Masters.
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foxnews.com
Trump speaks of images he’s ‘never seen before.’ But they’ve existed — we just refused to look.
One early victim of the coronavirus is our old sense of safety.
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washingtonpost.com
Kansas Gov. Laura Kelly sues GOP lawmakers for revoking her order limiting church gatherings
It's the latest chapter in the escalating conflict between public health and religion, coming to a head just before Easter.
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washingtonpost.com
Joe Burrow believes he can win wherever he goes: 'I'm not a loser'
All Joe Burrow is focused on is winning.
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foxnews.com
Aldon Smith details long journey that led him to Cowboys: 'I was in a really dark place'
Dallas Cowboys defensive end Aldon Smith detailed his journey back to the NFL on Thursday.
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foxnews.com
Fact check: Trump lies about voter fraud while states
President Donald Trump this week opened a new front in his campaign of lies about voter fraud in US elections, this time falsely claiming that voting-by-mail is "corrupt" and "dangerous," even while states embrace it as a safe alternative during the pandemic.
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edition.cnn.com
Coronavirus live updates: No travel for Good Friday, Easter; when are stimulus checks coming?; Boris Johnson needs to 'rest up'
New York reported record-breaking number of deaths, travelers are being cautioned to stay home for Good Friday, and more news about the coronavirus.       
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usatoday.com
'Fortnite' Now Playing Lobby Streams Free 'Punk'd' Episodes Every Hour
"Fortnite '' has a new Now Playing lobby streaming episodes of "Punk'd." Here's what we know about it.
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newsweek.com
Cities and states launch emergency rent relief programs
State and city governments have started announcing efforts to funnel millions of dollars into new rental assistance programs aimed at dealing with unpaid rent amid the economic downturn resulting from the coronavirus pandemic.
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edition.cnn.com
Jameis Winston responds to criticism over workout: 'Reach out to help or mind your own business'
NFL quarterback Jameis Winston struck back at criticism over his training while he attempts to latch onto a team for the 2020 season.
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foxnews.com
How Colleges Are Grading Students During Coronavirus
As colleges shift to online classes, many schools are beginning to reevaluate how they grade students. One common option: going pass-fail.
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npr.org
Miss England 2019 is reporting for hospital duty. She’s a respiratory specialist.
Bhasha Mukherjee, 24, packed up her crown and gowns and flew home to Britain, where she is now in quarantine until early next week, when she reports to the hospital for work.
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washingtonpost.com
In Oaxaca, this scientist is a hometown boy made good. The U.S. says he's a Russian spy
Héctor Alejandro Cabrera Fuentes, an acclaimed microbiologist from southern Mexico, is charged in the U.S. with gathering information for Russia on a secret informant.
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latimes.com
Andrew McCarthy: Coronavirus stimulus watchdog – Trump's call to make, despite media shrieking
Another media non-story shows the double standard of presidential appointments for Republicans vs. Democrats.
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foxnews.com
We can't shelter in place forever: How the coronavirus lockdown might end
The coronavirus changed our lives. Health experts discuss how we might get back to normal.
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latimes.com
Marvel at These 10 Freaks of Nature
The world is filled with unique, breathtaking natural wonders—from boiling craters to caves full of luminescent glowworms. These 10 sites are a great place to start when looking for hope in some of Mother Nature's greatest offerings.
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newsweek.com
States do battle for coronavirus protective gear in a market driven by chaos and fear
Left to fend for themselves, states and cities scramble to buy masks, other medical supplies from middlemen and foreign manufacturers they barely know.
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latimes.com
CBS poll: Americans fear outbreak will leave U.S. in recession
But those most concerned about losing work, including those who already have, are the most likely to say the U.S. is headed for a recession, or even depression.
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cbsnews.com
The coronavirus may trigger tribal instincts. In times of crisis, people want strong leaders.
The pandemic might lead to increased xenophobia.
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washingtonpost.com
CBS poll: Views of Trump's handling of outbreak slip again
He has comparably better marks for his handling of the economic impact of the coronavirus pandemic.
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cbsnews.com
Help! I Pretended My Wedding Ring Was a Family Heirloom. Now My Stepson Wants to Propose With It.
It’s actually from a pawn shop.
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slate.com
Travel bailouts: Airlines, hotels and travel agents all got them. Shouldn't the public?
The travel industry can't just pick up where it left off when the outbreak started. Customers deserve to be treated with respect, now more than ever.       
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usatoday.com
What to watch with your kids: ‘Strike,’ ‘Shaun the Sheep: Adventures From Mossy Bottom’ and more
Here’s what parents need to know.
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washingtonpost.com
New movie to stream this week: ‘Love Wedding Repeat,’ ‘Tigertail’ and more
Watch these new movies from home.
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washingtonpost.com
Biden's Candidacy About Nothing
So much for imagination, it would seem. The Democratic Party electorate has chosen as its presidential nominee Joe Biden, a solid but unremarkable vice president for eight years, a man who has been running for this nomination on and off since 1988. He has defeated opponents calling for a universal basic income, Midwestern common sense, generational transition, plans upon plans upon plans, and, finally, “political revolution.” He has done so, remarkably, without calling for much of anything himself. Victory, it seems, has gone to the candidacy of nothing.That might sound like an insult, but I do not mean it that way. The imagination phase of the 2020 presidential campaign was interesting, but so too might be the ascent of Bidenesque minimalism. It might be just what American politics needs. It might even be good for the imagination of the American left.Shadi Hamid: [The coronavirus killed the revolution]What is a president for? Think about that word, president. When the authors of the Constitution decided on that word for the country’s chief executive, they lived in a world of kings and queens, regents and emperors. These were people who had to be addressed as your majesty. and other such contrivances. Yes, the Framers needed a strong federal government, but not too strong. When they agreed to address America’s chief executive as Mr. President, it was something close to an insult: The person who merely presides—who sits at the head of the table and sets the appropriate tone while others actually get things done. The authors of the Constitution had only recently won an anti-royalist war and did not want another king.Now, look where America finds itself. The presidency hardly presides anymore; instead, it consumes us. The office, and particularly its present occupant, is a black hole that pulls inexorably on the public’s attention. We got here step by step: with Andrew Jackson’s media-savvy populism, with Franklin Roosevelt’s “fireside chats” through people’s living room radios, with the nuclear football putting the option of world annihilation in the hands of a single person—the “leader of the free world,” he was called. Barack Obama modeled the use of executive orders for doing the work that Congress once did, and the embrace of executive power is on the rise in the judiciary. Once it was appalling for a president to travel to a disaster zone, for fear of distracting from the relief work; now, it is appalling if the president is anywhere else. The public’s attention is fixated on him, so if he fails to visit the scene, would we be allowed to notice it?Kim Wehle: [For Trump, power is for self-preservation only]Joe Biden offers a different sort of presidency. He is not a small-government conservative, by any means—although his version of big-government liberalism might seem modest in comparison to Trump’s rampant deficit spending. Biden offers, rather, the possibility of a presidency one can finally turn away from, a presider who will leave enough room for others to set the agenda. If Biden wins, and if his presidency is anything like his candidacy, Americans can expect a future of mild, friendly, adviser-powered competence, with just enough gaffes to remind us that the man at the top is still around.I did not vote for Biden in my state’s primary, nor would I have bet on him to emerge as the Democratic nominee. But I find myself admiring the electorate’s instincts. The usual suspicion is that Democratic primary voters tabled their own progressive hopes to choose the centrist white guy because they judged him more likely to win over some allegedly racist, sexist Trump voters. I have an alternative interpretation: What if the absence of hope-stirring progressivism from Biden and his virtual nonexistence on social media are actually his appeal? What if the American public is once again ready, finally, for a president who keeps himself to presiding? I am willing to have been wrong about Biden if that interpretation is right.Biden’s candidacy of nothing may be especially helpful for confronting a global crisis like COVID-19. The most effective responses to this crisis have been in places with less theatrical leaders—places like South Korea, Taiwan, and Germany. In contexts like that, genuine experts can be more easily heard. Expertise is important in addressing a problem as complex as a pandemic. The same is true with respect to reversing climate change and assembling a decent healthcare system. These are all systemic challenges that require, above all, an appetite for collaboration and patience. An attention vacuum at the top also leaves space for less powerful people to organize, make themselves heard, and build strength.Rebecca L. Spang: [The revolution is under way already]If Democrats are to campaign now for the restoration of a presidency that merely presides, they should be sure that American society is ready for it. A quieter president will require a stronger society, one capable of relying on networked coordination—rather than someone’s iron will—to achieve great things. This means regaining long-lost skills for self-governance and mutual support—translating the old town meeting to the Internet. This also means developing a new relationship with America’s much-maligned cadres of experts—trusting them with what they know, while also putting power in the hands of workers, patients, and others who don’t usually get credit for their expertise.Progressive visionaries and activists have tended to support candidates more aggressive and attention-getting than Biden—candidates offering to back their agendas with the full might of executive overreach. But a Biden presidency could embolden activists even more by clearing space for them to advance their goals through their own power. The candidacy of nothing could lead to a presidency less centered on itself.
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theatlantic.com
The Two Pandemics
Editor’s Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here. Viruses aren’t picky. They tear through neighborhoods and nations, infecting whomever they can, and the new coronavirus is no exception: The pain of the present pandemic will be felt—is already being felt—by just about everyone in the United States and all over the world, in one way or another. After the pandemic has run its course, no one will be wholly untouched.At the same time, there will be stark disparities in how certain segments of the American population experience this crisis. Some of these disparities will be the result of luck or coincidence—a matter of where someone happened to travel, what line of work they chose, or what city they live in. But in a country that was highly unequal in so many ways well before it had a confirmed case of COVID-19, other disparities will be sadly predictable, falling along racial and class lines, as well as other fateful divides.In the coming months and years, there will really be two pandemics in America. One will be disruptive and frightening to its victims, but thanks to their existing advantages and lucky near misses with the virus, they will likely emerge from it relatively stable—physically, psychologically, and financially. The other pandemic, though, will devastate those who survive it, leaving lasting scars and altering life courses.Which of these two pandemics any given American will experience will be determined by a morbid mix of a sort of demographic predestination—shaped strongly by inequality—and purely random chance.When someone dies, there are three ways to think about what caused it, according to Scott Frank, a professor at Case Western Reserve University’s School of Medicine. The first is the straightforward, “medical” cause of death—diagnosable things like heart disease or cancer. The second is the “actual” cause of death—that is, the habits and behaviors that over time contributed to the medical cause of death, such as smoking cigarettes or being physically inactive. The third is what Frank refers to as the “actual actual” cause of death—the bigger, society-wide forces that shaped those habits and behaviors.In one analysis of deaths in the U.S. resulting from “social factors” (Frank’s “actual actual” causes), the top culprits were poverty, low levels of education, and racial segregation. “Each of these has been demonstrated to have independent effects on chronic-disease mortality and morbidity,” Frank said. (Morbidity refers to whether someone has a certain disease.) He expects that the same patterns will hold for COVID-19.[Read: The four timelines for life returning to normal]To begin with, the physical effects of COVID-19 are far worse for some people than others. There are two traits that seem to matter most.The first is age. Older people are at greater risk of experiencing the more devastating version of the pandemic, in part because the immune system weakens with age. Early data from the Centers for Disease Control and Prevention indicate that, in the U.S., the risk of dying from the disease begins to climb at around age 55, and is especially acute for those 85 and older. “I think the pattern we’re going to see clearly is an age-related pattern” of mortality, Andrew Noymer, a public-health professor at UC Irvine, said. (Younger people aren’t invulnerable to the disease, though; the CDC found in mid-March that 20-to-54-year-olds had accounted for almost 40 percent of hospitalizations known to have been caused by the disease.)The second trait that puts someone at increased risk is having a serious health condition such as diabetes, heart disease, or lung disease. These conditions seem to make cases of COVID-19 more likely to be severe or fatal, and the risks rise considerably for older adults who have any of these conditions, Frank told me.But while everyone ages, rich and poor alike, these health conditions are not evenly distributed throughout the population. They’re more common among people with less education, less money, and less access to health care. “We know these social and economic conditions have a profound effect on chronic disease,” Frank said, “and then chronic disease has a profound effect on the mortality related to COVID.”When we someday tally up all the casualties of the coronavirus, the high number of older Americans among the dead will reflect the sad, universal fact of physical decline. But for many of those who had underlying health conditions, inequality will be the actual actual cause of death.Since some minority groups have a higher prevalence of certain health conditions, like diabetes or high blood pressure, COVID-19 will likely affect them more intensely. “We may not see it now, but when we look back at who was the sickest, who had the most complications, where there were excess deaths, it’s likely that we might see those coming down along racial lines,” Hedwig Lee, a sociologist at Washington University in St. Louis, told me in mid-March.This pattern is already starting to emerge in early data from places that include information about race in their reports on the local impact of the virus. In Chicago, where less than one-third of the population is black, more than two-thirds of the 86 people killed by COVID-19 as of last weekend were black—and four in five of those black patients had high blood pressure and/or diabetes. The state of Michigan and the Wisconsin county that contains Milwaukee have also had a disproportionate number of black residents die from the disease. A similar pattern was borne out in a recent CDC cross-country snapshot of hospitalizations in parts of 14 states during the month of March; black people accounted for 33 percent of hospitalizations for which racial data was available, despite making up only 18 percent of the population in the areas surveyed.[Read: What the racial data show]Lower-income people, in addition to any other risk factors they may have, are also at increased risk because their finances might change the way they seek treatment for the disease if they come down with it. When lower-income people get sick, “they oftentimes delay going to the doctor, not because they don’t want to get well, but because they simply don’t have the money,” Rashawn Ray, a fellow at the Brookings Institution, said. “They wait until the last minute to go get help, like when they are literally about to die or when something catastrophic is happening.” And forgoing a doctor’s guidance until the late stages of an illness—COVID-19 or not—could be especially dangerous during a pandemic.Americans’ health varies along racial and economic lines in the best of times. That will probably make the outcomes just as uneven, if not more, in the worst of times.Two important predictors of an American’s well-being right now, other than whether that person has COVID-19, are the answers they and others in their household would give to two questions: Are you still able to work? And if so, can you work without risking exposure to the virus?For a rapidly growing portion of the country, the answer to the first question is no. Three weeks ago, some 3.3 million Americans filed for unemployment benefits in a single week, a record-breaking total that was nearly five times as large as the previous recorded high. The following week, the number of new claims was twice as high—6.9 million. Still another 6.6 million claims were filed last week, bringing the recent three-week total to nearly 17 million—an enormous figure that likely still understates how many Americans are actually out of work right now.While few sectors of the economy have been spared by the pandemic, the businesses that have so far been hit particularly hard are the ones premised on physical presence and face-to-face interactions, such as retail stores, restaurants and bars, and hotels. “If we think about those industries, they have a lot of low-wage and part-time workers,” many of whom live paycheck to paycheck, said Susan Houseman, the director of research for the nonprofit Upjohn Institute for Employment Research. “We worry about them in every single recession, and here they’re just being slammed.”[Read: America’s restaurants will need a miracle]In this realm, too, racial minorities tend to be more vulnerable. Houseman noted that African American and Hispanic workers are usually disproportionately likely to lose their job during downturns. That was true during the Great Recession, and so far appears to be true of this economic crisis: According to the Pew Research Center, as of late March, 29 percent of white Americans said someone in their household was out of work or had received a pay cut because of the pandemic, while 36 percent of black Americans and 49 percent of Hispanic Americans said the same. (Separately, a recent study also suggested that women may be more likely to lose their job than men.)Of course, still having a job is not an unalloyed good; for much of America’s current workforce, earning a paycheck means exposing oneself to the virus. There is a portion of the population, though, who are able to safely work without going outside and risking infection. For them, this period is generally more bearable. The Bureau of Labor Statistics estimates that less than 30 percent of American workers are able to do their jobs from home, and finds that this is much more likely to be the case for people who have at least a bachelor’s degree. Remote workers’ relative safety may persist even once life starts returning to normal, if people who are able to work from home choose to continue to do so, out of caution.But because of the nature of the pandemic, the danger of a job doesn’t map entirely neatly onto income and education levels. Yes, it’s the case that many truck drivers, grocery-store workers, and delivery people are still out in the world and risking exposure to the virus, but so are doctors, nurses, and pharmacists. The industry in which one happens to work is another point at which class and chance intersect.During milder economic downturns, people who lose their job may be able to find work in another industry. But because such a wide range of businesses have scaled back or shut down operations, job hopping is harder to pull off now, Houseman said. It's also riskier: Grocery stores and delivery companies are hiring ambitiously, but for jobs that will put workers in greater danger of viral exposure.[Read: Denmark’s idea could help the world avoid a Great Depression]The answers to each of these two questions—whether someone still has a job, and whether they can do it safely—strongly predict how any given American household is faring right now. To illustrate this, Rashawn Ray, the Brookings fellow, talked me through the probable realities of people who can do their job from home and people who are currently out of work.The former group is likely to be salaried, and can limit their trips outside the house. They may have children to look after and stress over, but, barring any health concerns, they’re doing fine. “Their job is safe, their salary and wages are safe, their mortgage and house is safe … and they’re able to go to the grocery store and load up on a whole bunch of groceries,” Ray said. Maybe they even choose to have the groceries delivered.The latter group “is living a completely different life right now,” Ray told me. Perhaps they were already living paycheck to paycheck, but now that they’ve been laid off or furloughed, they’re not sure how they’ll be able to pay their usual expenses, let alone stock up on food and supplies. “A lot of people who don’t have money coming into the household are worried about losing their apartment or house, they’re worried about the fact that they can’t get access easily to the food they need, and now they’re sitting at home with families, with children, trying to figure out what’s happening,” Ray said.Andrew Noymer, the public-health professor, put it more concisely: “Someone is at home wondering how he’s going to make rent and feed his family,” he said. “And someone else is wondering if they can binge-watch the first season of The Sopranos or whatever.”The uncertain duration of this period makes getting through it even more difficult. “I think that even a month of this could have devastating effects for many of our most vulnerable” people, said Beth Mattingly, an assistant vice president in regional and community outreach at the Federal Reserve Bank of Boston. “The longer it goes, the more concerned I am, and probably my concern grows exponentially, not linearly.”Whenever it does end, Ray’s first group will likely have a relatively smooth transition back into the office: They’ll throw their laptops into their bags, drop their kids off at school or daycare, and resume whatever projects they were working on the previous day from home.But the second group probably won’t be able to get back to work so quickly. Houseman likened the post-pandemic bout of rehiring to “a game of musical chairs,” because many businesses could go under between now and then. “Some will start hiring again, but there will be more workers for the jobs they have than they can hire,” she said. “The longer [closures] persist, the more businesses are likely to go bankrupt, and the slower the recovery will be.”One thing that can provide a buffer from labor-market turbulence is having savings to draw on. No amount of cash can grant someone immunity from the virus itself, but wealth can prevent the pandemic from leaving deep financial scars. “If you think about the possibility that people have to declare bankruptcy or foreclose on their house or lose their car, that takes a long time to recover from,” said Vida Maralani, a sociologist at Cornell University who studies inequality. “If you have to use up all your wealth, that’s really different than ‘Gee, I lost the money [I put down] on a summer Airbnb and now I can’t vacation.’”Life in America is always hard without cash reserves, but it’s especially hard now. One 33-year-old woman in a small town in Texas told a New York Times reporter, “I’m not going to let my kids go hungry. If I have to just eat once a day, that’s what I have to do.” She’s disabled and doesn’t work, and her husband, a carpenter, has had fewer jobs lately.[Read: When middle-class values determine what’s essential]According to the Federal Reserve, just under 40 percent of American adults wouldn’t have enough cash on hand to cover an unexpected $400 expense, and that was before the pandemic cut off so many workers’ earnings. Having even a few thousand dollars saved up can make this time less stressful, Maralani said. It can be the difference between being able to cover a couple months’ expenses, like rent or car payments, and wondering where the money for them will possibly come from.The federal government is attempting to address household-budget shortfalls. Late last month, Congress passed and President Donald Trump signed a $2.2 trillion economic relief package that included $300 billion to go directly to American households. Most adults will get $1,200 each, plus $500 per child (though they may not receive it until weeks or months from now). Beth Mattingly, of the Boston Fed, told me she thinks the relief package will “provide significant help,” though “those who become unemployed or see their work hours reduced may still need more assistance.”Even if Americans receive help from the government, Rashawn Ray foresees lasting financial consequences for people who aren’t able to pay their bills now. “If they are in a position where they have taken on a sizable amount of debt, [maybe] through payday loans, now they have added economic stressors that they’ll have to deal with,” he said. Additionally, even if landlords or lenders allow people to delay their rent or mortgage payments, that doesn’t mean those people won’t have to make those payments eventually. “If this lasts 90 days, that’s three months of rent they have to make up,” Ray said.[Read: We need to start tossing money out of helicopters]And in households across the country, regardless of wealth and income, COVID-19 will kill now-unknown numbers of people who support their families financially, Houseman noted. Their deaths will be painful personal losses for their families, who will also suffer economic consequences.But in keeping with the often dystopian nature of American inequality, some households may, amid the tragedy, come out ahead. “I think there are also going to be some people who are saving money in this,” Mattingly said. “Their income hasn’t changed, but they aren’t going out to eat, they’re not driving, they’re not going to work in the office.” They may not emerge from the pandemic completely unscathed, but they will have a much easier time transitioning back to normal once the crisis wanes.As health-care workers confront the coronavirus on the front lines of hospitals, the home front of this pandemic is literally the home. That’s where many Americans are dutifully spending their days, and the conditions and location of one’s housing have significant bearing on how one weathers a pandemic. Living in a cramped apartment with lots of relatives is risky on top of being uncomfortable; sharing a spacious, well-appointed house with few other people makes it safer and easier to ride out a lockdown.In fact, some people may be thinking to themselves, as they hunker down with their work laptops, Netflix queues, and lack of social commitments, that pandemics aren’t so bad. Those people likely don’t have serious health conditions or jobs that require them to leave home. They probably also don’t have small children. For parents with kids at home, “you suddenly have a very different act to juggle than you had before,” Vida Maralani, the Cornell sociologist, said. Many parents who are able to work from home, especially mothers, are stretched as they try to do their jobs while looking after their children all day. Meanwhile, many parents who are struggling to make ends meet have those same child-care responsibilities on top of the stress of continuing to work outside of the house, out of necessity.[Read: The coronavirus is a disaster for feminism]Kids themselves will experience the pains of the pandemic unevenly, as keeping children out of school for several weeks or months may widen existing educational disparities. Many students from lower-income households simply aren’t logging on for their school’s online classes to begin with, sometimes because they don’t have a good internet connection at home. Maralani speculates that children whose parents have more time and resources may receive more and better home instruction than their peers, which may produce short-term or possibly even long-term learning gaps. Those are likely the same children who, even in the absence of their school’s usual art or music programs, are still attending their violin lessons or karate classes over videochat.The stress of managing a home can increase when older relatives are present. According to the latest data from the Pew Research Center, 20 percent of Americans live in households with two or more adult generations or with grandparents and grandchildren; Asian, Hispanic, and black Americans are more likely to live in multigenerational households than white ones.This household arrangement is especially fraught in a pandemic, when every present body is another potential distributor, or recipient, of the virus. In February, a research team led by the World Health Organization estimated that transmission between people living in the same household was responsible for 78 to 85 percent of some 350 clusters of infections in two provinces in China. This is concerning for larger households around the world, and additionally so when they include older relatives, who tend to be at higher risk.American families, whether big or small, are riding out this pandemic with varying degrees of comfort. As my colleague Megan Garber recently noted, the unpleasantness of staying indoors is related to “how much room you have, how many rooms you have, whether you have a dishwasher or a washing machine or internet, whether you have an area in which to exercise or be alone or be together or cook or get fresh air.” The distinguishing features of a living space, Garber argued, take on magnified importance when its occupants are there more or less around the clock.[Read: Homes actually need to be practical now]The physical spaces where people are enduring lockdown capture the full range of American inequality. Some affluent urbanites, finding their primary residences dissatisfactory, have retreated to their vacation homes; at least one billionaire has been sheltering in place in the Caribbean on his yacht. Meanwhile, some people without a place to live recently gathered in a makeshift shelter in a parking lot in Las Vegas without walls or a roof; across the country, groups that provide support to people without a home are scaling back or shutting down their operations, for fear of spreading the disease. “I do worry about them,” Andrew Noymer said of homeless people, noting that the virus could spread quickly among those who live in close proximity to one another. Prisons and jails, too, seem to be tragically conducive to the spread of disease.Beyond the four walls (or no walls) of any particular living space, some neighborhoods will probably be more vulnerable to the virus than others. “Communities of color, areas that are highly segregated in terms of race or income, are going to be the places where we would see, in all likelihood, clusters of illness,” Scott Frank, the Case Western professor, said. In neighborhoods like these, people may have larger households and smaller living spaces, and may not be able to afford to stay home, putting themselves at risk each day while continuing to work.Frank’s grim prediction, made when I spoke with him in mid-March, is already coming true. According to recent data from health officials in New York City, several neighborhoods with the lowest median household incomes were among those with the highest number of confirmed cases of COVID-19. This is terrible for the residents of those neighborhoods, but it may also be bad for everyone: One study in Delhi, India, found that outbreaks of influenza in the poorest parts of the city propelled the spread of the disease more widely.Moreover, the long-standing, intractable problems in many lower-income areas, whether urban or rural, won’t be put on hold during a pandemic. “A lot of communities are already dealing with things like being over-policed, police violence, excess pollution exposure, and unemployment,” Hedwig Lee, the sociologist, said. “There are other [things] that have been impacting communities in a large-scale, wholesale way—some currently and some for many generations—and that makes this even scarier in terms of what it will look like once we get through this storm.”[Read: The coronavirus’s unique threat to the South]Among these large-scale problems is the unevenness of internet access in some areas. As of 2017, something like 30 percent of American households didn’t have a broadband internet connection, and millions of people only connect to the internet through their phones, frequently with meager data plans. “With this particular pandemic, the guidelines are changing so quickly that immediate access to good information is absolutely required and absolutely at risk with access issues and not being online permanently,” Mark Cameron, a medical professor at Case Western, said.The fates of different places are not predetermined, though—city- or statewide public-health orders matter a lot. One telling example comes from autumn 1918, when American cities responded to the flu pandemic with many of the same social-distancing measures that are now in place across the U.S. Infamously, Philadelphia hosted a patriotic wartime parade with some 200,000 attendees (more than a tenth of the city’s population) a week and a half after confirming its first case of influenza, and didn’t close down schools or forbid public gatherings until another five days after the event. St. Louis, meanwhile, canceled most public gatherings and had flu patients isolate themselves just two days after detecting its first case. During the four-month stretch of the pandemic at the end of the year, Philadelphians were, by one study’s accounting, roughly twice as likely as St. Louisans to die from it. A separate 2007 study looking at 43 cities’ pandemic-fighting strategies 100 years ago found that “early, sustained, and layered application” of measures such as social distancing and public-event bans was associated with reducing the impact of the outbreak.As Ronald Brownstein has written in The Atlantic, many state governments’ responses to the present crisis have differed along political lines, with liberal leaders generally taking swifter action than conservative ones. At least partly as a result of local leaders’ directives, there was a pronounced difference in how many Americans in different states stayed home in the month of March. And that may go on to play a role in the toll the pandemic takes in different areas.The many divides in American society that will shape people’s experience of the pandemic don’t exist in isolation. Instead, they compound and overlap, increasing the risk that certain people will endure the more devastating of the two pandemics.Some of that interplay may be a matter of bad luck. Perhaps you’re more vulnerable to COVID-19 because you have asthma, and your partner happens to work at a hospital and might bring the virus back home. But some of these patterns are not a product of chance. People with less money are likelier to have chronic health conditions, and also to live near one another, making residents of many lower-income neighborhoods doubly vulnerable. In this way, American inequality produces clusters of disadvantage, not unlike a disease.The coronavirus will be indiscriminate, harming some Americans unpredictably, regardless of race or class or any other category. But at the same time, much of the harm it brings—far too much—will be predictable.
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theatlantic.com
How the Richest Country on Earth Started Running Out of Masks
Editor’s Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here. Of all the coronavirus-induced problems facing America, the mask shortage might be the most baffling. Masks are now so hard to find that health-care workers are reusing theirs multiple days in a row. Grocery-store workers, who are at high risk of contracting the virus, have been denied masks for months. Everyday people are making their own out of fabric scraps.One reason the U.S. ran short of masks is that many of them are manufactured in China; the country slowed mask manufacturing and stopped shipping them to the U.S. during its own coronavirus outbreak. But America was supposed to have its own supply of masks in the Strategic National Stockpile, a secretive stash of emergency supplies held in an undisclosed number of warehouses around the country. As of April 1, it was almost out.The stockpile has been a consistent target of criticism throughout the COVID-19 pandemic, and there’s an obvious logic to that criticism: How did the richest country on Earth fail to hoard enough masks for a pandemic flu? One reason is that the Strategic National Stockpile distributed 85 million N95 respirators during the 2009 swine flu pandemic, along with millions of other protective masks. That distribution effort contributed to what is largely seen as a successful federal response to that outbreak. But those masks were never replenished.[Read: Everyone thinks they’re right about masks]At the beginning of the coronavirus outbreak, the stockpile contained only about 12 million of the 3.5 billion N95 masks that federal officials estimated the health-care system would need to fight this pandemic back in March. “I’m not aware of a major effort to restock the stockpile with N95 respirators after the 2009 drawdown,” Charles Johnson, the president of the International Safety Equipment Association, told me.But the stockpile was never intended to be the nation’s great savior. It wasn’t supposed to provide all of the nation’s medical-supply needs for a multi-month pandemic. Congress never doled out enough money for it to do so. Instead, the officials who monitored the national stockpile were hopeful that hospitals were making their own stockpiles. But to save money, they largely weren’t. In that context, the skimpy mask supply in the Strategic National Stockpile is not the thing that derailed the American response to COVID-19. Rather, it’s one of a series of planning failures that created the crisis we’re in today.Just like everything else in the government, the Strategic National Stockpile is funded through congressional appropriations. That means there’s a limited amount of money to be spent, and the people in charge of the stockpile have to decide how to spend it. Officials bought millions of N95 masks and other flu-type preparations with supplemental congressional funding that trickled in from 2005 to 2007, says Greg Burel, who was the director of the stockpile from 2007 until January 2020. But then that supplemental money dried up.With the remaining money, the officials in charge of the stockpile had to decide whether they wanted to plan for a hurricane, flood, tornado, pandemic, or terrorist threat. All of those disasters require the stockpile to be stocked with different stuff. “It isn’t like comparing apples and oranges,” says Tara O’Toole, a former homeland-security official who chaired an advisory committee on the stockpile and who is now executive vice president at In-Q-Tel. “It’s like comparing apples and Volkswagens and bird food.”[Wajahat Ali: Where are the masks?]After 9/11, the people in charge of the stockpile were concerned about bioterrorism—threats like anthrax—and sudden, mass-casualty events like, say, a bombing at the Super Bowl. This made some sense, but in the process officials took their foot off the pandemic-preparedness gas pedal. The response to the 2009 swine-flu pandemic was seen as a success, and the stockpile-minders moved on to the next item on their disaster checklist. “I think as human beings, we sometimes, not that we get complacent, but it’s like, Oh, we’ve got this. And we did. We had it,” says Deborah Levy, who oversaw the stockpile as acting division director for the Centers for Disease Control and Prevention in 2013 and 2014, while Burel was in another role.Because officials weren’t as worried about pandemic flu, they stocked fewer basic medical supplies, like masks, that would come in handy during an infectious-disease outbreak. Officials thought the stockpile should have bioweapon antidotes and other drugs that aren’t easily available on store shelves, rather than common items you can buy at CVS. “The Strategic National Stockpile was built to respond primarily to chemical, biological, radiological, and nuclear events, whether by a terrorist, or a state actor, or something that might happen along those same lines that was accidental,” Burel told me.Since then, other changes to the stockpile might have made it less capable to handle crises like the one we’re living through. In 2018, the stockpile was moved out of the jurisdiction of the CDC and into a different domain of the Health and Human Services Department—the assistant secretary for preparedness and response. While some of the experts I spoke with saw this as a harmless change, most worried that institutional memory was lost in the process. The CDC, they say, was better at doing operational things like mobilizing a stockpile. Having it at the CDC “puts everybody who’s working on different aspects of being prepared and able to respond together,” Levy said. (HHS did not immediately respond to a request for comment, and I will update this story if I hear back.)Still, the fundamental mission of the stockpile remained the same: A stopgap, not a safety net. Jared Kushner drew opprobrium last week for appearing to say that the states were on their own when it comes to medical supplies. “The notion of the federal stockpile was, it’s supposed to be our stockpile. It’s not supposed to be states’ stockpiles that they then use,” he said.[Conor Friedersdorf: The government is failing by doing too little, and too much]Although Kushner’s wording was undeniably inartful, the former stockpile directors said he sort of has a point. “Kushner doesn’t know exactly how to phrase it, but the stockpile was never designed to be for everybody all at once, anything that you might need for as long as you need,” Levy said.The stockpile, Burel and Levy told me, was never meant to provide masks for the entire nation for months at a time. The idea was instead that hospitals and states would create their own stockpiles, and under extenuating circumstances—when they ran out of supplies, or if they were incapacitated for some reason—they could fall back on the national stockpile.One could argue that we are living through just such an extenuating circumstance—states are running out of supplies, after all. But the former stockpile directors I talked to said that if anything, governors and hospitals should have been warned sooner about how few masks were in the national stockpile and told to make their own arrangements. “It was never viewed as something that would supply the whole nation with medical supplies for a long period of time,” said Richard Besser, who led the CDC office that oversaw the stockpile during Hurricane Katrina. “If you just look at the number of masks and gowns the nation is churning through, it would be impossible and cost-prohibitive to store that in perpetuity for a global pandemic.”Hospitals, too, could have been keeping their own stockpiles. But Burel and others told me that rather than keep stockpiles, hospitals have what’s called “just in time” stock, in which supplies are delivered right as they’re needed. So do the distributors. And so do the manufacturers. It’s cheaper that way, because you don’t need space to store extra supplies or to test the masks to be sure they’re not expired. Hospitals stay open and pay their staff by staying profitable, and they do that by not spending money on a big room full of unused masks. One could say that hospitals should focus less on amenities and big salaries than pandemic preparedness, but this has not, historically, been a compelling argument to most businesses. To save lives, hospitals ultimately have to stay afloat. “We’ve made health care into a business where cost and profit matters more than the capacity to surge,” O’Toole told me.[Read: What’s actually wrong with the U.S. health system]When reached for comment, a spokesman for the American Hospital Association said, “In addition to our just-in-time inventory to cover day-to-day operational needs and consumption, hospitals and health systems also have surge inventories, which typically contain one to four months of supplies that would likely be needed during localized man-made or natural disasters. However, just-in-time inventory and surge inventory are unable to provide long-term support during a global pandemic such as COVID-19.”The mask shortage is just another example of America’s failure to invest in pandemic preparedness, former stockpile officials say. Everything in our health-care system runs with just enough resources, and we have reached a point where “just enough” isn’t enough. “Public health is not well funded at the state level, the locality level, or at the federal level in the United States,” Burel told me. “It is a chronic problem.”There are, of course, lessons we could take from this debacle. The federal government could move the manufacturing of crucial medical supplies like masks back to the U.S. Congress could fund all types of public-health efforts, including the stockpile, more generously. Johnson suggested the government could pay manufacturers to maintain stockpiles of various items, including masks. Rather than sending them to sit in a government warehouse, mask-makers could keep thousands of masks on hand, allow them to gradually get used up, and replenish them as they expire.But any of these steps would require taking the threat of pandemic flu seriously, and spending money on it accordingly. And that isn’t something the U.S. has been doing, with the stockpile or otherwise.
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theatlantic.com