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8 Lessons We Can Learn From the COVID-19 Pandemic

BY KATHY KATELLA May 14, 2021

Note: Information in this article was accurate at the time of original publication. Because information about COVID-19 changes rapidly, we encourage you to visit the websites of the Centers for Disease Control & Prevention (CDC), World Health Organization (WHO), and your state and local government for the latest information.

The COVID-19 pandemic changed life as we know it—and it may have changed us individually as well, from our morning routines to our life goals and priorities. Many say the world has changed forever. But this coming year, if the vaccines drive down infections and variants are kept at bay, life could return to some form of normal. At that point, what will we glean from the past year? Are there silver linings or lessons learned?

“Humanity's memory is short, and what is not ever-present fades quickly,” says Manisha Juthani, MD , a Yale Medicine infectious diseases specialist. The bubonic plague, for example, ravaged Europe in the Middle Ages—resurfacing again and again—but once it was under control, people started to forget about it, she says. “So, I would say one major lesson from a public health or infectious disease perspective is that it’s important to remember and recognize our history. This is a period we must remember.”

We asked our Yale Medicine experts to weigh in on what they think are lessons worth remembering, including those that might help us survive a future virus or nurture a resilience that could help with life in general.

Lesson 1: Masks are useful tools

What happened: The Centers for Disease Control and Prevention (CDC) relaxed its masking guidance for those who have been fully vaccinated. But when the pandemic began, it necessitated a global effort to ensure that everyone practiced behaviors to keep themselves healthy and safe—and keep others healthy as well. This included the widespread wearing of masks indoors and outside.

What we’ve learned: Not everyone practiced preventive measures such as mask wearing, maintaining a 6-foot distance, and washing hands frequently. But, Dr. Juthani says, “I do think many people have learned a whole lot about respiratory pathogens and viruses, and how they spread from one person to another, and that sort of old-school common sense—you know, if you don’t feel well—whether it’s COVID-19 or not—you don’t go to the party. You stay home.”

Masks are a case in point. They are a key COVID-19 prevention strategy because they provide a barrier that can keep respiratory droplets from spreading. Mask-wearing became more common across East Asia after the 2003 SARS outbreak in that part of the world. “There are many East Asian cultures where the practice is still that if you have a cold or a runny nose, you put on a mask,” Dr. Juthani says.

She hopes attitudes in the U.S. will shift in that direction after COVID-19. “I have heard from a number of people who are amazed that we've had no flu this year—and they know masks are one of the reasons,” she says. “They’ve told me, ‘When the winter comes around, if I'm going out to the grocery store, I may just put on a mask.’”

Lesson 2: Telehealth might become the new normal

What happened: Doctors and patients who have used telehealth (technology that allows them to conduct medical care remotely), found it can work well for certain appointments, ranging from cardiology check-ups to therapy for a mental health condition. Many patients who needed a medical test have also discovered it may be possible to substitute a home version.

What we’ve learned: While there are still problems for which you need to see a doctor in person, the pandemic introduced a new urgency to what had been a gradual switchover to platforms like Zoom for remote patient visits. 

More doctors also encouraged patients to track their blood pressure at home , and to use at-home equipment for such purposes as diagnosing sleep apnea and even testing for colon cancer . Doctors also can fine-tune cochlear implants remotely .

“It happened very quickly,” says Sharon Stoll, DO, a neurologist. One group that has benefitted is patients who live far away, sometimes in other parts of the country—or even the world, she says. “I always like to see my patients at least twice a year. Now, we can see each other in person once a year, and if issues come up, we can schedule a telehealth visit in-between,” Dr. Stoll says. “This way I may hear about an issue before it becomes a problem, because my patients have easier access to me, and I have easier access to them.”

Meanwhile, insurers are becoming more likely to cover telehealth, Dr. Stoll adds. “That is a silver lining that will hopefully continue.”

Lesson 3: Vaccines are powerful tools

What happened: Given the recent positive results from vaccine trials, once again vaccines are proving to be powerful for preventing disease.

What we’ve learned: Vaccines really are worth getting, says Dr. Stoll, who had COVID-19 and experienced lingering symptoms, including chronic headaches . “I have lots of conversations—and sometimes arguments—with people about vaccines,” she says. Some don’t like the idea of side effects. “I had vaccine side effects and I’ve had COVID-19 side effects, and I say nothing compares to the actual illness. Unfortunately, I speak from experience.”

Dr. Juthani hopes the COVID-19 vaccine spotlight will motivate people to keep up with all of their vaccines, including childhood and adult vaccines for such diseases as measles , chicken pox, shingles , and other viruses. She says people have told her they got the flu vaccine this year after skipping it in previous years. (The CDC has reported distributing an exceptionally high number of doses this past season.)  

But, she cautions that a vaccine is not a magic bullet—and points out that scientists can’t always produce one that works. “As advanced as science is, there have been multiple failed efforts to develop a vaccine against the HIV virus,” she says. “This time, we were lucky that we were able build on the strengths that we've learned from many other vaccine development strategies to develop multiple vaccines for COVID-19 .” 

Lesson 4: Everyone is not treated equally, especially in a pandemic

What happened: COVID-19 magnified disparities that have long been an issue for a variety of people.

What we’ve learned: Racial and ethnic minority groups especially have had disproportionately higher rates of hospitalization for COVID-19 than non-Hispanic white people in every age group, and many other groups faced higher levels of risk or stress. These groups ranged from working mothers who also have primary responsibility for children, to people who have essential jobs, to those who live in rural areas where there is less access to health care.

“One thing that has been recognized is that when people were told to work from home, you needed to have a job that you could do in your house on a computer,” says Dr. Juthani. “Many people who were well off were able do that, but they still needed to have food, which requires grocery store workers and truck drivers. Nursing home residents still needed certified nursing assistants coming to work every day to care for them and to bathe them.”  

As far as racial inequities, Dr. Juthani cites President Biden’s appointment of Yale Medicine’s Marcella Nunez-Smith, MD, MHS , as inaugural chair of a federal COVID-19 Health Equity Task Force. “Hopefully the new focus is a first step,” Dr. Juthani says.

Lesson 5: We need to take mental health seriously

What happened: There was a rise in reported mental health problems that have been described as “a second pandemic,” highlighting mental health as an issue that needs to be addressed.

What we’ve learned: Arman Fesharaki-Zadeh, MD, PhD , a behavioral neurologist and neuropsychiatrist, believes the number of mental health disorders that were on the rise before the pandemic is surging as people grapple with such matters as juggling work and childcare, job loss, isolation, and losing a loved one to COVID-19.

The CDC reports that the percentage of adults who reported symptoms of anxiety of depression in the past 7 days increased from 36.4 to 41.5 % from August 2020 to February 2021. Other reports show that having COVID-19 may contribute, too, with its lingering or long COVID symptoms, which can include “foggy mind,” anxiety , depression, and post-traumatic stress disorder .

 “We’re seeing these problems in our clinical setting very, very often,” Dr. Fesharaki-Zadeh says. “By virtue of necessity, we can no longer ignore this. We're seeing these folks, and we have to take them seriously.”

Lesson 6: We have the capacity for resilience

What happened: While everyone’s situation is different­­ (and some people have experienced tremendous difficulties), many have seen that it’s possible to be resilient in a crisis.

What we’ve learned: People have practiced self-care in a multitude of ways during the pandemic as they were forced to adjust to new work schedules, change their gym routines, and cut back on socializing. Many started seeking out new strategies to counter the stress.

“I absolutely believe in the concept of resilience, because we have this effective reservoir inherent in all of us—be it the product of evolution, or our ancestors going through catastrophes, including wars, famines, and plagues,” Dr. Fesharaki-Zadeh says. “I think inherently, we have the means to deal with crisis. The fact that you and I are speaking right now is the result of our ancestors surviving hardship. I think resilience is part of our psyche. It's part of our DNA, essentially.”

Dr. Fesharaki-Zadeh believes that even small changes are highly effective tools for creating resilience. The changes he suggests may sound like the same old advice: exercise more, eat healthy food, cut back on alcohol, start a meditation practice, keep up with friends and family. “But this is evidence-based advice—there has been research behind every one of these measures,” he says.

But we have to also be practical, he notes. “If you feel overwhelmed by doing too many things, you can set a modest goal with one new habit—it could be getting organized around your sleep. Once you’ve succeeded, move on to another one. Then you’re building momentum.”

Lesson 7: Community is essential—and technology is too

What happened: People who were part of a community during the pandemic realized the importance of human connection, and those who didn’t have that kind of support realized they need it.

What we’ve learned: Many of us have become aware of how much we need other people—many have managed to maintain their social connections, even if they had to use technology to keep in touch, Dr. Juthani says. “There's no doubt that it's not enough, but even that type of community has helped people.”

Even people who aren’t necessarily friends or family are important. Dr. Juthani recalled how she encouraged her mail carrier to sign up for the vaccine, soon learning that the woman’s mother and husband hadn’t gotten it either. “They are all vaccinated now,” Dr. Juthani says. “So, even by word of mouth, community is a way to make things happen.”

It’s important to note that some people are naturally introverted and may have enjoyed having more solitude when they were forced to stay at home—and they should feel comfortable with that, Dr. Fesharaki-Zadeh says. “I think one has to keep temperamental tendencies like this in mind.”

But loneliness has been found to suppress the immune system and be a precursor to some diseases, he adds. “Even for introverted folks, the smallest circle is preferable to no circle at all,” he says.

Lesson 8: Sometimes you need a dose of humility

What happened: Scientists and nonscientists alike learned that a virus can be more powerful than they are. This was evident in the way knowledge about the virus changed over time in the past year as scientific investigation of it evolved.

What we’ve learned: “As infectious disease doctors, we were resident experts at the beginning of the pandemic because we understand pathogens in general, and based on what we’ve seen in the past, we might say there are certain things that are likely to be true,” Dr. Juthani says. “But we’ve seen that we have to take these pathogens seriously. We know that COVID-19 is not the flu. All these strokes and clots, and the loss of smell and taste that have gone on for months are things that we could have never known or predicted. So, you have to have respect for the unknown and respect science, but also try to give scientists the benefit of the doubt,” she says.

“We have been doing the best we can with the knowledge we have, in the time that we have it,” Dr. Juthani says. “I think most of us have had to have the humility to sometimes say, ‘I don't know. We're learning as we go.’"

Information provided in Yale Medicine articles is for general informational purposes only. No content in the articles should ever be used as a substitute for medical advice from your doctor or other qualified clinician. Always seek the individual advice of your health care provider with any questions you have regarding a medical condition.

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• Remarks by Commissioner Stephen Hahn, M.D. — The COVID-19 Pandemic — Finding Solutions, Applying Lessons Learned - 06/01/2020

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Event Title Remarks by Commissioner Stephen Hahn, M.D. — The COVID-19 Pandemic — Finding Solutions, Applying Lessons Learned June 1, 2020

The COVID-19 Pandemic — Finding Solutions, Applying Lessons Learned

(Remarks as prepared for delivery.  The text and video of this speech are slightly, though not substantively different from the version presented by Dr. Hahn on June 1 to the Alliance for a Stronger FDA, via audio broadcast only.  Because of evolving scheduling challenges, it was not clear whether Dr. Hahn would be able to present the speech live and so it was recorded by video earlier.  Ultimately, he did give the speech live to the Alliance, but only via an audio link. Given the minimal changes in the live version, we are posting the video version and the accompanying text.)

One of the most frustrating challenges each of us can face is the inability to control the events that affect our lives.  Often, we are thrust into situations not of our own making.  It’s no surprise that one of the most familiar adages concerns the best laid plans of mice and men going awry.

And yet, to borrow another often-used saying, necessity is the mother of invention.  History teaches us that crises often lead to accelerated change and innovations and new discoveries. 

This dynamic has been on my mind a great deal recently.  It wasn’t too long ago – last December, to be exact -- that I had the distinction of being confirmed as the 24th Commissioner of the Food and Drug Administration. 

This is the greatest honor of my life.  I have long cherished the critical role the FDA plays in protecting and promoting the public health, and I’ve relied on the Agency’s expertise throughout my professional life.

So, I eagerly embraced my new responsibilities and the chance to make a real difference in public health.  I was especially conscious that we live in a time of extraordinary scientific achievement, especially in oncology, with unprecedented opportunities to help make the lives of American patients and consumers healthier and safer. 

I quickly immersed myself in the Agency’s broad and complex responsibilities, seizing every opportunity to learn about the FDA, both those areas with which I’d previously had minimum involvement, such as food policy, and those with which I had more familiarity, like cancer treatments and innovative clinical trial design.

I began to work with, and learn from, the agency’s extraordinary leadership team.  I learned very quickly that the principles that have guided me throughout my life, such as my commitment to relying only on the best medical science and most rigorous data in support of advancing innovation and discovery, and my fundamental belief in promoting integrity and transparency in the scientific process, are the same principles that guide the FDA in both science and regulation.

So, I was in the midst of transitioning from being Chief Medical Executive at MD Anderson Cancer Center to being Commissioner of FDA when our entire world was turned upside down with the appearance of the novel COVID-19 coronavirus.

I certainly did not anticipate a public health emergency of this magnitude when I joined the agency.  And I could not have imagined how significantly my new role would change and be shaped by this pandemic.  I definitely could not have known that discussions about personal protective equipment (or PPE) or face masks or nasal swabs would be central to my work as Commissioner.

One thing was apparent: I would need to manage this evolving situation even as I was still learning about FDA.

From the very start I knew that even in a crisis situation – or perhaps especially because we are in a crisis situation – it is imperative that we maintain FDA’s high standards for evaluating products and making sure that the benefits outweigh potential harms.

To maintain our standard, I pledged to myself and emphasized to my new colleagues at FDA that our decisions would always be rooted in science.  Having spent my entire career as a physician and scientist caring for patients with cancer, I’ve always valued highly a commitment to good data and sound science.  I feel comfortable working with the scientists at FDA because I know they not only share that value, that commitment, but that they will tolerate nothing less. So, it was critical to me, as the pandemic escalated that this be reinforced as the guidepost for all of our decisions.   

It may have been trial by fire, but I have the good fortune to work with an enormous number of talented individuals and teams who are helping guide us through this crisis. Every day they show extraordinary expertise, commitment, and resilience.

I also was able to call on many from outside the agency, including former FDA leaders as well as colleagues from the medical community. 

What struck me was the uniformity of their advice.  Those who formerly worked at FDA urged me to rely upon the FDA staff, many of whom have the experience to help manage a pandemic. My friends from outside the agency urged that we move quickly to make decisions, set direction and to be transparent about what we are doing. I have tried to follow all of this excellent advice. 

Protecting the Food Supply

Since this crisis and the actions of the FDA have evolved so rapidly, let me summarize what we have done.  I am confident that the FDA has measured up to this unprecedented challenge.

I want to start with the first word in the FDA’s name – food.  Most of us take food safety for granted.  But it takes a lot of hard work to maintain a safe food supply.  This was true even before the COVID-19 pandemic but is especially challenging during an ongoing international crisis. 

During the pandemic, through the collaboration of the FDA, the food industry and our federal and state partners, we have been able to maintain the safety of the nation’s food supply.  Our Coordinated Outbreak Response and Evaluation team remained on the job, monitoring for signs of foodborne illness outbreaks and prepared to take action when needed.

And along with our federal partners, including CDC and USDA, we also have provided best practices for food workers, industry, and consumers on how to stay safe and keep food safe.

Diagnosing and Developing Treatments

On the medical side, we immediately committed to facilitating efforts to develop diagnostic tests, treatments and vaccines for the disease. We have helped facilitate increases in our national testing capacity, have helped ensure continued access to necessary medical products, and have sought to prevent the sale of fraudulent products.  

If there’s one thing that’s been reaffirmed during this crisis, it’s the essential role of medical devices, including diagnostics, to countering this pandemic.

From the earliest days of our response, we worked to ensure that we had the essential medical devices, including personal protective equipment, to help treat those who are ill and to ensure that health care workers and others on the front line are properly protected.

To be sure, there were bumps along the road, but today we have an adequate supply of the devices that have been in unprecedented high demand such as PPE, ventilators, and others. 

We’ve reviewed and issued emergency use authorizations for medical devices for COVID-19 at an incredibly fast pace.

And we’ve worked closely with many companies that don’t regularly make medical products but wanted to pitch in by making hand sanitizer, ventilators, or PPE.

There was a special focus on the development and availability of accurate and reliable COVID-19 tests. We need to know who has the disease and who has had it. This is essential if we are to understand this virus and return to a more normal lifestyle. 

Since January, we’ve worked with hundreds of test developers, many of whom have submitted emergency use authorization requests to FDA for tests that detect the virus or antibodies to the virus.

As you have seen reported, early in the crisis we provided regulatory flexibility for developers with validated tests as outlined in our policies because public health needs dictated that we do as much testing as possible.  But as the process has matured, we have helped increase the number of authorized tests, and we have adapted some of our policies to best serve the public need. 

Today, if evidence arises that raises questions about a particular test’s reliability, we will take appropriate action to protect consumers from inaccurate tests.   This is a dynamic process that is continually being informed by new data and evidence.  

We’ve used a similar dynamic process in the search for therapeutic treatments and vaccines. 

We are working closely with partners throughout the government and academia, and with drug and vaccine developers to explore, expedite, and incentivize the development of these products.

More than 90 drugs are being studied, and FDA is actively working with numerous vaccine sponsors, including three sponsors who have announced they have vaccine candidates that are now in clinical trials in the U.S.  More than 144 clinical trials have been initiated for therapeutic agents, with hundreds more in the pipeline.  We don’t have a cure or vaccine yet, but we’re on our way, at unprecedented speed.

Ultimately, of course, the way we’ll eventually defeat this virus is with a vaccine.  FDA is working closely to provide technical assistance to federal partners, vaccine developers, researchers, manufacturers, and experts across the globe and exploring all possible options to advance the most efficient and timely development of vaccines, while at the same time maintaining regulatory independence.

Communicating and Educating

There is much more to do going forward, and that includes research, exploration and discovery, and communicating what we know.

As the country starts to reopen, it’s essential that the public understands what they need to do to continue to protect themselves. There has been a proliferation of information, and misinformation, on the internet and in other sources. Consumers need to understand that this virus is still with us and that we, as individuals and communities working together, need to take steps to continue to contain its spread.

The FDA has an important part to play in communicating public information to all populations in the U.S. FDA has increased outreach by developing and disseminating COVID-19 health education materials for consumers in multiple languages to diverse communities and the public overall. Everyone should have a clear understanding of why hand-washing and social distancing remain essential. Consumers need to think about how to shop for food safely.  People need to know when to call their doctors and when to ask about getting tested. Health care professionals need to know how to manage their patients in this new environment, and how best to apply telemedicine, the use of which is rapidly accelerating. 

I want the FDA to serve as a national resource for the public and health care community.  I regard educating the public and providing accurate, reliable, up-to-date information as not just an Agency priority, but one of my own personal responsibilities as Commissioner.  I will be out in public and in the media talking about how individuals can help us contain and conquer this virus. 

I believe my personal experience with being self-quarantined will make me a better communicator. Being quarantined for 14 days in May was certainly no fun, but because we at FDA were already functioning very effectively virtually, I was able to continue to be fully engaged, and provide direction and leadership. And it made me even more focused on making sure consumers have all the information they need about self-protection.

We now need to look forward. A major strength of the FDA is not just in our response to a crisis, but in our ability to learn from the work we do and apply that experience in the future. 

As this pandemic evolved, it was clear that some FDA processes needed to be adjusted to accommodate the urgency of the pandemic.  I think the entire FDA team has now seen first-hand that we need to look at some of our processes and policies.  I have instructed my staff to identify the lessons learned from this pandemic and what adjustments may be needed, not just to manage this or future emergencies, but to make FDA itself more efficient in carrying out our regulatory responsibilities.

I am committed to making sure that some of the lessons learned from managing this pandemic will lead to permanent improvements at the FDA in processes and policies.

For example, in facilitating the development of new treatments, we streamlined some of our processes.  

We have taken a fresh look at how clinical trials should be designed and conducted.  In a pandemic we knew we needed to get answers more quickly. For instance, early on, the FDA, National Institutes of Health, and industry worked together to facilitate the implementation of a “master protocol” that can be used in multiple clinical trials and allows for the study of more than one promising new drug for COVID-19 at a time. And we have used expanded access to meet the needs of patients who are not eligible or who are unable to participate in randomized   clinical trials.

Many of the permanent changes that we will implement really represent an acceleration of where we were headed before.   For example, the concept of decentralized clinical trials, in which trial procedures are conducted near the patient’s home and through use of local health care providers or local laboratories has been discussed before, and laid the foundation for some of the trials for COVID-19 products.  

Another area where our pre-COVID work has informed our response to the pandemic involves the use of Real World Evidence (RWE).

In recent years, the agency has taken steps to leverage modern, rigorous analyses of real-world data—such as data from electronic health records, insurance claims, patient registries and lab results. 

As the pandemic brought an urgency to these efforts, the FDA advanced collaborations with public and private partners to collect and analyze a variety of real-world data sources, using our Sentinel system and other resources.

Evaluation of real-world data has the potential to provide a wealth of rapid, actionable information to better understand disease symptoms, describe and measure immunity, and use available medical product supplies to help mitigate potential shortages. These data can also inform ongoing work to evaluate potential therapies, vaccines or diagnostics for COVID-19.  The more experience we have with real world evidence, the more confidence we will have in using it for product decisions.

I mention real world evidence, but in reality, we have so many examples of how lessons learned from the pandemic will affect FDA in the future.  

To the extent that the innovations and adaptations we implemented during the pandemic crisis worked and would be appropriate to implement outside of a pandemic situation, we will incorporate them into standard FDA procedures.   And to the extent that we identified unnecessary barriers, we will remove them. This is one of my top priorities. Permanent change where needed will take place, and will make FDA an even stronger agency.    

As I mentioned before, anything that enables quicker reviews and authorizations we will seek to make permanent.

But make no mistake. We will not cut corners on safety or effectiveness.  I said this before, and I say it again.  Good science as the basis for decision making has been a hallmark of my career, and is a value that I hold deeply. The American public must have confidence in the products regulated by the FDA.

Speed is important, but so are safety, accuracy and effectiveness.

FDA’s commitment to good science and rigorous data is unwavering, even as we look at how we can learn from this pandemic.

I am hopeful that this is a once-in-a-lifetime experience for all of us.  An unprecedented historic event that has required an unprecedented response from us and everyone around the world.

That said, I am pleased that throughout this crisis the rest of the FDA’s work has continued, with relatively few interruptions. New drugs and devices have been authorized.  Our food safety surveillance has adapted and our outbreak response resources have been maintained. Our oversight of tobacco products, including e-cigarettes, has gone on. The Agency has measured up to the challenge in all ways.

And we are well positioned as we move into a new phase, that is, transitioning back to what has come to be known as the “new normal.”  Our staff has done a phenomenal job of adapting to this new normal.    And I am confident that they are ready to deal with any additional upcoming challenges. 

I will close with something I’ve seen reaffirmed time and time again over the past few months. That is the essential role that the FDA plays in consumer protection and beyond in advancing public health. 

Before coming to the FDA, I had heard about the extraordinary dedication of the agency’s workforce.  Working side by side with my colleagues in response to this pandemic, I’ve seen that characterization validated over and over.

It is my great honor to serve with so many highly skilled and committed professionals.  And the American people can be assured that this agency is working around the clock for them, doing whatever is necessary to fulfill our mission to protect and promote the health of the American public. 

I encourage you all to stay safe, aware, and focused as we continue to respond to the challenges of this public health emergency.

I Thought We’d Learned Nothing From the Pandemic. I Wasn’t Seeing the Full Picture

M y first home had a back door that opened to a concrete patio with a giant crack down the middle. When my sister and I played, I made sure to stay on the same side of the divide as her, just in case. The 1988 film The Land Before Time was one of the first movies I ever saw, and the image of the earth splintering into pieces planted its roots in my brain. I believed that, even in my own backyard, I could easily become the tiny Triceratops separated from her family, on the other side of the chasm, as everything crumbled into chaos.

Some 30 years later, I marvel at the eerie, unexpected ways that cartoonish nightmare came to life – not just for me and my family, but for all of us. The landscape was already covered in fissures well before COVID-19 made its way across the planet, but the pandemic applied pressure, and the cracks broke wide open, separating us from each other physically and ideologically. Under the weight of the crisis, we scattered and landed on such different patches of earth we could barely see each other’s faces, even when we squinted. We disagreed viciously with each other, about how to respond, but also about what was true.

Recently, someone asked me if we’ve learned anything from the pandemic, and my first thought was a flat no. Nothing. There was a time when I thought it would be the very thing to draw us together and catapult us – as a capital “S” Society – into a kinder future. It’s surreal to remember those early days when people rallied together, sewing masks for health care workers during critical shortages and gathering on balconies in cities from Dallas to New York City to clap and sing songs like “Yellow Submarine.” It felt like a giant lightning bolt shot across the sky, and for one breath, we all saw something that had been hidden in the dark – the inherent vulnerability in being human or maybe our inescapable connectedness .

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But it turns out, it was just a flash. The goodwill vanished as quickly as it appeared. A couple of years later, people feel lied to, abandoned, and all on their own. I’ve felt my own curiosity shrinking, my willingness to reach out waning , my ability to keep my hands open dwindling. I look out across the landscape and see selfishness and rage, burnt earth and so many dead bodies. Game over. We lost. And if we’ve already lost, why try?

Still, the question kept nagging me. I wondered, am I seeing the full picture? What happens when we focus not on the collective society but at one face, one story at a time? I’m not asking for a bow to minimize the suffering – a pretty flourish to put on top and make the whole thing “worth it.” Yuck. That’s not what we need. But I wondered about deep, quiet growth. The kind we feel in our bodies, relationships, homes, places of work, neighborhoods.

Like a walkie-talkie message sent to my allies on the ground, I posted a call on my Instagram. What do you see? What do you hear? What feels possible? Is there life out here? Sprouting up among the rubble? I heard human voices calling back – reports of life, personal and specific. I heard one story at a time – stories of grief and distrust, fury and disappointment. Also gratitude. Discovery. Determination.

Among the most prevalent were the stories of self-revelation. Almost as if machines were given the chance to live as humans, people described blossoming into fuller selves. They listened to their bodies’ cues, recognized their desires and comforts, tuned into their gut instincts, and honored the intuition they hadn’t realized belonged to them. Alex, a writer and fellow disabled parent, found the freedom to explore a fuller version of herself in the privacy the pandemic provided. “The way I dress, the way I love, and the way I carry myself have both shrunk and expanded,” she shared. “I don’t love myself very well with an audience.” Without the daily ritual of trying to pass as “normal” in public, Tamar, a queer mom in the Netherlands, realized she’s autistic. “I think the pandemic helped me to recognize the mask,” she wrote. “Not that unmasking is easy now. But at least I know it’s there.” In a time of widespread suffering that none of us could solve on our own, many tended to our internal wounds and misalignments, large and small, and found clarity.

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I wonder if this flourishing of self-awareness is at least partially responsible for the life alterations people pursued. The pandemic broke open our personal notions of work and pushed us to reevaluate things like time and money. Lucy, a disabled writer in the U.K., made the hard decision to leave her job as a journalist covering Westminster to write freelance about her beloved disability community. “This work feels important in a way nothing else has ever felt,” she wrote. “I don’t think I’d have realized this was what I should be doing without the pandemic.” And she wasn’t alone – many people changed jobs , moved, learned new skills and hobbies, became politically engaged.

Perhaps more than any other shifts, people described a significant reassessment of their relationships. They set boundaries, said no, had challenging conversations. They also reconnected, fell in love, and learned to trust. Jeanne, a quilter in Indiana, got to know relatives she wouldn’t have connected with if lockdowns hadn’t prompted weekly family Zooms. “We are all over the map as regards to our belief systems,” she emphasized, “but it is possible to love people you don’t see eye to eye with on every issue.” Anna, an anti-violence advocate in Maine, learned she could trust her new marriage: “Life was not a honeymoon. But we still chose to turn to each other with kindness and curiosity.” So many bonds forged and broken, strengthened and strained.

Instead of relying on default relationships or institutional structures, widespread recalibrations allowed for going off script and fortifying smaller communities. Mara from Idyllwild, Calif., described the tangible plan for care enacted in her town. “We started a mutual-aid group at the beginning of the pandemic,” she wrote, “and it grew so quickly before we knew it we were feeding 400 of the 4000 residents.” She didn’t pretend the conditions were ideal. In fact, she expressed immense frustration with our collective response to the pandemic. Even so, the local group rallied and continues to offer assistance to their community with help from donations and volunteers (many of whom were originally on the receiving end of support). “I’ve learned that people thrive when they feel their connection to others,” she wrote. Clare, a teacher from the U.K., voiced similar conviction as she described a giant scarf she’s woven out of ribbons, each representing a single person. The scarf is “a collection of stories, moments and wisdom we are sharing with each other,” she wrote. It now stretches well over 1,000 feet.

A few hours into reading the comments, I lay back on my bed, phone held against my chest. The room was quiet, but my internal world was lighting up with firefly flickers. What felt different? Surely part of it was receiving personal accounts of deep-rooted growth. And also, there was something to the mere act of asking and listening. Maybe it connected me to humans before battle cries. Maybe it was the chance to be in conversation with others who were also trying to understand – what is happening to us? Underneath it all, an undeniable thread remained; I saw people peering into the mess and narrating their findings onto the shared frequency. Every comment was like a flare into the sky. I’m here! And if the sky is full of flares, we aren’t alone.

I recognized my own pandemic discoveries – some minor, others massive. Like washing off thick eyeliner and mascara every night is more effort than it’s worth; I can transform the mundane into the magical with a bedsheet, a movie projector, and twinkle lights; my paralyzed body can mother an infant in ways I’d never seen modeled for me. I remembered disappointing, bewildering conversations within my own family of origin and our imperfect attempts to remain close while also seeing things so differently. I realized that every time I get the weekly invite to my virtual “Find the Mumsies” call, with a tiny group of moms living hundreds of miles apart, I’m being welcomed into a pocket of unexpected community. Even though we’ve never been in one room all together, I’ve felt an uncommon kind of solace in their now-familiar faces.

Hope is a slippery thing. I desperately want to hold onto it, but everywhere I look there are real, weighty reasons to despair. The pandemic marks a stretch on the timeline that tangles with a teetering democracy, a deteriorating planet , the loss of human rights that once felt unshakable . When the world is falling apart Land Before Time style, it can feel trite, sniffing out the beauty – useless, firing off flares to anyone looking for signs of life. But, while I’m under no delusions that if we just keep trudging forward we’ll find our own oasis of waterfalls and grassy meadows glistening in the sunshine beneath a heavenly chorus, I wonder if trivializing small acts of beauty, connection, and hope actually cuts us off from resources essential to our survival. The group of abandoned dinosaurs were keeping each other alive and making each other laugh well before they made it to their fantasy ending.

Read More: How Ice Cream Became My Own Personal Act of Resistance

After the monarch butterfly went on the endangered-species list, my friend and fellow writer Hannah Soyer sent me wildflower seeds to plant in my yard. A simple act of big hope – that I will actually plant them, that they will grow, that a monarch butterfly will receive nourishment from whatever blossoms are able to push their way through the dirt. There are so many ways that could fail. But maybe the outcome wasn’t exactly the point. Maybe hope is the dogged insistence – the stubborn defiance – to continue cultivating moments of beauty regardless. There is value in the planting apart from the harvest.

I can’t point out a single collective lesson from the pandemic. It’s hard to see any great “we.” Still, I see the faces in my moms’ group, making pancakes for their kids and popping on between strings of meetings while we try to figure out how to raise these small people in this chaotic world. I think of my friends on Instagram tending to the selves they discovered when no one was watching and the scarf of ribbons stretching the length of more than three football fields. I remember my family of three, holding hands on the way up the ramp to the library. These bits of growth and rings of support might not be loud or right on the surface, but that’s not the same thing as nothing. If we only cared about the bottom-line defeats or sweeping successes of the big picture, we’d never plant flowers at all.

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Presidential Speeches

September 9, 2021: remarks on fighting the covid-⁠19 pandemic, about this speech.

September 09, 2021

As the Delta variant of the Covid-19 virus spreads and cases and deaths increase in the United States, President Joe Biden announces new efforts to fight the pandemic. He outlines six broad areas of action--implementing new vaccination requirements, protecting the vaccinated with booster shots, keeping children safe and schools open, increasing testing and masking, protecting our economic recovery, and improving care of those who do get Covid-19. 

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THE PRESIDENT: Good evening, my fellow Americans. I want to talk to you about where we are in the battle against COVID-19, the progress we’ve made, and the work we have left to do.

And it starts with understanding this: Even as the Delta variant 19 [sic] has—COVID-19—has been hitting this country hard, we have the tools to combat the virus, if we can come together as a country and use those tools.

If we raise our vaccination rate, protect ourselves and others with masking and expanded testing, and identify people who are infected, we can and we will turn the tide on COVID-19.

It will take a lot of hard work, and it’s going to take some time. Many of us are frustrated with the nearly 80 million Americans who are still not vaccinated, even though the vaccine is safe, effective, and free.

You might be confused about what is true and what is false about COVID-19. So before I outline the new steps to fight COVID-19 that I’m going to be announcing tonight, let me give you some clear information about where we stand.

First, we have cons—we have made considerable progress

in battling COVID-19. When I became President, about 2 million Americans were fully vaccinated. Today, over 175 million Americans have that protection. 

Before I took office, we hadn’t ordered enough vaccine for every American. Just weeks in office, we did. The week before I took office, on January 20th of this year, over 25,000 Americans died that week from COVID-19. Last week, that grim weekly toll was down 70 percent.

And in the three months before I took office, our economy was faltering, creating just 50,000 jobs a month. We’re now averaging 700,000 new jobs a month in the past three months.

This progress is real. But while America is in much better shape than it was seven months ago when I took office, I need to tell you a second fact.

We’re in a tough stretch, and it could last for a while. The highly contagious Delta variant that I began to warn America about back in July spread in late summer like it did in other countries before us.

While the vaccines provide strong protections for the vaccinated, we read about, we hear about, and we see the stories of hospitalized people, people on their death beds, among the unvaccinated over these past few weeks. 

This is a pandemic of the unvaccinated. And it’s caused by the fact that despite America having an unprecedented and successful vaccination program, despite the fact that for almost five months free vaccines have been available in 80,000 different locations, we still have nearly 80 million Americans who have failed to get the shot. 

And to make matters worse, there are elected officials actively working to undermine the fight against COVID-19. Instead of encouraging people to get vaccinated and mask up, they’re ordering mobile morgues for the unvaccinated dying from COVID in their communities. This is totally unacceptable.

Third, if you wonder how all this adds up, here’s the math: The vast majority of Americans are doing the right thing. Nearly three quarters of the eligible have gotten at least one shot, but one quarter has not gotten any. That’s nearly 80 million Americans not vaccinated. And in a country as large as ours, that’s 25 percent minority. That 25 percent can cause a lot of damage—and they are.

The unvaccinated overcrowd our hospitals, are overrunning the emergency rooms and intensive care units, leaving no room for someone with a heart attack, or pancreitis [pancreatitis], or cancer.

And fourth, I want to emphasize that the vaccines provide very strong protection from severe illness from COVID-19. I know there’s a lot of confusion and misinformation. But the world’s leading scientists confirm that if you are fully vaccinated, your risk of severe illness from COVID-19 is very low. 

In fact, based on available data from the summer, only one of out of every 160,000 fully vaccinated Americans was hospitalized for COVID per day.

These are the facts. 

So here’s where we stand: The path ahead, even with the Delta variant, is not nearly as bad as last winter. But what makes it incredibly more frustrating is that we have the tools to combat COVID-19, and a distinct minority of Americans –supported by a distinct minority of elected officials—are keeping us from turning the corner. These pandemic politics, as I refer to, are making people sick, causing unvaccinated people to die. 

We cannot allow these actions to stand in the way of protecting the large majority of Americans who have done their part and want to get back to life as normal. 

As your President, I’m announcing tonight a new plan to require more Americans to be vaccinated, to combat those blocking public health. 

My plan also increases testing, protects our economy, and will make our kids safer in schools. It consists of six broad areas of action and many specific measures in each that—and each of those actions that you can read more about at WhiteHouse.gov. WhiteHouse.gov.

The measures—these are going to take time to have full impact. But if we implement them, I believe and the scientists indicate, that in the months ahead we can reduce the number of unvaccinated Americans, decrease hospitalizations and deaths, and allow our children to go to school safely and keep our economy strong by keeping businesses open.

First, we must increase vaccinations among the unvaccinated with new vaccination requirements. Of the nearly 80 million eligible Americans who have not gotten vaccinated, many said they were waiting for approval from the Food and Drug Administration—the FDA. Well, last month, the FDA granted that approval.

So, the time for waiting is over. This summer, we made progress through the combination of vaccine requirements and incentives, as well as the FDA approval. Four million more people got their first shot in August than they did in July. 

But we need to do more. This is not about freedom or personal choice. It’s about protecting yourself and those around you—the people you work with, the people you care about, the people you love.

My job as President is to protect all Americans. 

So, tonight, I’m announcing that the Department of Labor is developing an emergency rule to require all employers with 100 or more employees, that together employ over 80 million workers, to ensure their workforces are fully vaccinated or show a negative test at least once a week.

Some of the biggest companies are already requiring this: United Airlines, Disney, Tysons Food, and even Fox News.

The bottom line: We’re going to protect vaccinated workers from unvaccinated co-workers. We’re going to reduce the spread of COVID-19 by increasing the share of the workforce that is vaccinated in businesses all across America.

My plan will extend the vaccination requirements that I previously issued in the healthcare field. Already, I’ve announced, we’ll be requiring vaccinations that all nursing home workers who treat patients on Medicare and Medicaid, because I have that federal authority.

Tonight, I’m using that same authority to expand that to cover those who work in hospitals, home healthcare facilities, or other medical facilities–a total of 17 million healthcare workers.

If you’re seeking care at a health facility, you should be able to know that the people treating you are vaccinated. Simple. Straightforward. Period.

Next, I will sign an executive order that will now require all executive branch federal employees to be vaccinated—all. And I’ve signed another executive order that will require federal contractors to do the same.

If you want to work with the federal government and do business with us, get vaccinated. If you want to do business with the federal government, vaccinate your workforce. 

And tonight, I’m removing one of the last remaining obstacles that make it difficult for you to get vaccinated.

The Department of Labor will require employers with 100 or more workers to give those workers paid time off to get vaccinated. No one should lose pay in order to get vaccinated or take a loved one to get vaccinated.

Today, in total, the vaccine requirements in my plan will affect about 100 million Americans—two thirds of all workers. 

And for other sectors, I issue this appeal: To those of you running large entertainment venues—from sports arenas to concert venues to movie theaters—please require folks to get vaccinated or show a negative test as a condition of entry.

And to the nation’s family physicians, pediatricians, GPs—general practitioners—you’re the most trusted medical voice to your patients. You may be the one person who can get someone to change their mind about being vaccinated. 

Tonight, I’m asking each of you to reach out to your unvaccinated patients over the next two weeks and make a personal appeal to them to get the shot. America needs your personal involvement in this critical effort.

And my message to unvaccinated Americans is this: What more is there to wait for? What more do you need to see? We’ve made vaccinations free, safe, and convenient.

The vaccine has FDA approval. Over 200 million Americans have gotten at least one shot. 

We’ve been patient, but our patience is wearing thin. And your refusal has cost all of us. So, please, do the right thing. But just don’t take it from me; listen to the voices of unvaccinated Americans who are lying in hospital beds, taking their final breaths, saying, “If only I had gotten vaccinated.” “If only.”

It’s a tragedy. Please don’t let it become yours.

The second piece of my plan is continuing to protect the vaccinated.

For the vast majority of you who have gotten vaccinated, I understand your anger at those who haven’t gotten vaccinated. I understand the anxiety about getting a “breakthrough” case.

But as the science makes clear, if you’re fully vaccinated, you’re highly protected from severe illness, even if you get COVID-19. 

In fact, recent data indicates there is only one confirmed positive case per 5,000 fully vaccinated Americans per day.

You’re as safe as possible, and we’re doing everything we can to keep it that way—keep it that way, keep you safe.

That’s where boosters come in—the shots that give you even more protection than after your second shot.

Now, I know there’s been some confusion about boosters. So, let me be clear: Last month, our top government doctors announced an initial plan for booster shots for vaccinated Americans. They believe that a booster is likely to provide the highest level of protection yet.

Of course, the decision of which booster shots to give, when to start them, and who will give them, will be left completely to the scientists at the FDA and the Centers for Disease Control.

But while we wait, we’ve done our part. We’ve bought enough boosters—enough booster shots—and the distribution system is ready to administer them.

As soon as they are authorized, those eligible will be able to get a booster right away in tens of thousands of site across the—sites across the country for most Americans, at your nearby drug store, and for free. 

The third piece of my plan is keeping—and maybe the most important—is keeping our children safe and our schools open. For any parent, it doesn’t matter how low the risk of any illness or accident is when it comes to your child or grandchild. Trust me, I know. 

So, let me speak to you directly. Let me speak to you directly to help ease some of your worries.

It comes down to two separate categories: children ages 12 and older who are eligible for a vaccine now, and children ages 11 and under who are not are yet eligible.

The safest thing for your child 12 and older is to get them vaccinated. They get vaccinated for a lot of things. That’s it. Get them vaccinated.

As with adults, almost all the serious COVID-19 cases we’re seeing among adolescents are in unvaccinated 12- to 17-year-olds—an age group that lags behind in vaccination rates.

So, parents, please get your teenager vaccinated.

What about children under the age of 12 who can’t get vaccinated yet? Well, the best way for a parent to protect their child under the age of 12 starts at home. Every parent, every teen sibling, every caregiver around them should be vaccinated. 

Children have four times higher chance of getting hospitalized if they live in a state with low vaccination rates rather than the states with high vaccination rates. 

Now, if you’re a parent of a young child, you’re wondering when will it be—when will it be—the vaccine available for them. I strongly support an independent scientific review for vaccine uses for children under 12. We can’t take shortcuts with that scientific work. 

But I’ve made it clear I will do everything within my power to support the FDA with any resource it needs to continue to do this as safely and as quickly as possible, and our nation’s top doctors are committed to keeping the public at large updated on the process so parents can plan.

Now to the schools. We know that if schools follow the science and implement the safety measures—like testing, masking, adequate ventilation systems that we provided the money for, social distancing, and vaccinations—then children can be safe from COVID-19 in schools.

Today, about 90 percent of school staff and teachers are vaccinated. We should get that to 100 percent. My administration has already acquired teachers at the schools run by the Defense Department—because I have the authority as President in the federal system—the Defense Department and the Interior Department—to get vaccinated. That’s authority I possess. 

Tonight, I’m announcing that we’ll require all of nearly 300,000 educators in the federal paid program, Head Start program, must be vaccinated as well to protect your youngest—our youngest—most precious Americans and give parents the comfort.

And tonight, I’m calling on all governors to require vaccination for all teachers and staff. Some already have done so, but we need more to step up. 

Vaccination requirements in schools are nothing new. They work. They’re overwhelmingly supported by educators and their unions. And to all school officials trying to do the right thing by our children: I’ll always be on your side. 

Let me be blunt. My plan also takes on elected officials and states that are undermining you and these lifesaving actions. Right now, local school officials are trying to keep children safe in a pandemic while their governor picks a fight with them and even threatens their salaries or their jobs. Talk about bullying in schools. If they’ll not help—if these governors won’t help us beat the pandemic, I’ll use my power as President to get them out of the way. 

The Department of Education has already begun to take legal action against states undermining protection that local school officials have ordered. Any teacher or school official whose pay is withheld for doing the right thing, we will have that pay restored by the federal government 100 percent. I promise you I will have your back. 

The fourth piece of my plan is increasing testing and masking. From the start, America has failed to do enough COVID-19 testing. In order to better detect and control the Delta variant, I’m taking steps tonight to make testing more available, more affordable, and more convenient. I’ll use the Defense Production Act to increase production of rapid tests, including those that you can use at home. 

While that production is ramping up, my administration has worked with top retailers, like Walmart, Amazon, and Kroger’s, and tonight we’re announcing that, no later than next week, each of these outlets will start to sell at-home rapid test kits at cost for the next three months. This is an immediate price reduction for at-home test kits for up to 35 percent reduction.

We’ll also expand—expand free testing at 10,000 pharmacies around the country. And we’ll commit—we’re committing $2 billion to purchase nearly 300 million rapid tests for distribution to community health centers, food banks, schools, so that every American, no matter their income, can access free and convenient tests. This is important to everyone, particularly for a parent or a child—with a child not old enough to be vaccinated. You’ll be able to test them at home and test those around them.

In addition to testing, we know masking helps stop the spread of COVID-19. That’s why when I came into office, I required masks for all federal buildings and on federal lands, on airlines, and other modes of transportation. 

Today—tonight, I’m announcing that the Transportation Safety Administration—the TSA—will double the fines on travelers that refuse to mask. If you break the rules, be prepared to pay. 

And, by the way, show some respect. The anger you see on television toward flight attendants and others doing their job is wrong; it’s ugly. 

The fifth piece of my plan is protecting our economic recovery. Because of our vaccination program and the American Rescue Plan, which we passed early in my administration, we’ve had record job creation for a new administration, economic growth unmatched in 40 years. We cannot let unvaccinated do this progress—undo it, turn it back. 

So tonight, I’m announcing additional steps to strengthen our economic recovery. We’ll be expanding COVID-19 Economic Injury Disaster Loan programs. That’s a program that’s going to allow small businesses to borrow up to $2 million from the current $500,000 to keep going if COVID-19 impacts on their sales. 

These low-interest, long-term loans require no repayment for two years and be can used to hire and retain workers, purchase inventory, or even pay down higher cost debt racked up since the pandemic began. I’ll also be taking additional steps to help small businesses stay afloat during the pandemic. 

Sixth, we’re going to continue to improve the care of those who do get COVID-19. In early July, I announced the deployment of surge response teams. These are teams comprised of experts from the Department of Health and Human Services, the CDC, the Defense Department, and the Federal Emergency Management Agency—FEMA—to areas in the country that need help to stem the spread of COVID-19. 

Since then, the federal government has deployed nearly 1,000 staff, including doctors, nurses, paramedics, into 18 states. Today, I’m announcing that the Defense Department will double the number of military health teams that they’ll deploy to help their fellow Americans in hospitals around the country. 

Additionally, we’re increasing the availability of new medicines recommended by real doctors, not conspir-—conspiracy theorists. The monoclonal antibody treatments have been shown to reduce the risk of hospitalization by up to 70 percent for unvaccinated people at risk of developing sefe-—severe disease. 

We’ve already distributed 1.4 million courses of these treatments to save lives and reduce the strain on hospitals. Tonight, I’m announcing we will increase the average pace of shipment across the country of free monoclonal antibody treatments by another 50 percent.

Before I close, let me say this: Communities of color are disproportionately impacted by this virus. And as we continue to battle COVID-19, we will ensure that equity continues to be at the center of our response. We’ll ensure that everyone is reached. My first responsibility as President is to protect the American people and make sure we have enough vaccine for every American, including enough boosters for every American who’s approved to get one. 

We also know this virus transcends borders. That’s why, even as we execute this plan at home, we need to continue fighting the virus overseas, continue to be the arsenal of vaccines. 

We’re proud to have donated nearly 140 million vaccines over 90 countries, more than all other countries combined, including Europe, China, and Russia combined. That’s American leadership on a global stage, and that’s just the beginning.

We’ve also now started to ship another 500 million COVID vaccines—Pfizer vaccines—purchased to donate to 100 lower-income countries in need of vaccines. And I’ll be announcing additional steps to help the rest of the world later this month.

As I recently released the key parts of my pandemic preparedness plan so that America isn’t caught flat-footed when a new pandemic comes again—as it will—next month, I’m also going to release the plan in greater detail.

So let me close with this: We have so-—we’ve made so much progress during the past seven months of this pandemic. The recent increases in vaccinations in August already are having an impact in some states where case counts are dropping in recent days. Even so, we remain at a critical moment, a critical time. We have the tools. Now we just have to finish the job with truth, with science, with confidence, and together as one nation.

Look, we’re the United States of America. There’s nothing—not a single thing—we’re unable to do if we do it together. So let’s stay together.

God bless you all and all those who continue to serve on the frontlines of this pandemic. And may God protect our troops.

Get vaccinated.

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Read these 12 moving essays about life during coronavirus

Artists, novelists, critics, and essayists are writing the first draft of history.

by Alissa Wilkinson

The world is grappling with an invisible, deadly enemy, trying to understand how to live with the threat posed by a virus . For some writers, the only way forward is to put pen to paper, trying to conceptualize and document what it feels like to continue living as countries are under lockdown and regular life seems to have ground to a halt.

So as the coronavirus pandemic has stretched around the world, it’s sparked a crop of diary entries and essays that describe how life has changed. Novelists, critics, artists, and journalists have put words to the feelings many are experiencing. The result is a first draft of how we’ll someday remember this time, filled with uncertainty and pain and fear as well as small moments of hope and humanity.

• The Vox guide to navigating the coronavirus crisis

At the New York Review of Books, Ali Bhutto writes that in Karachi, Pakistan, the government-imposed curfew due to the virus is “eerily reminiscent of past military clampdowns”:

Beneath the quiet calm lies a sense that society has been unhinged and that the usual rules no longer apply. Small groups of pedestrians look on from the shadows, like an audience watching a spectacle slowly unfolding. People pause on street corners and in the shade of trees, under the watchful gaze of the paramilitary forces and the police.

His essay concludes with the sobering note that “in the minds of many, Covid-19 is just another life-threatening hazard in a city that stumbles from one crisis to another.”

Writing from Chattanooga, novelist Jamie Quatro documents the mixed ways her neighbors have been responding to the threat, and the frustration of conflicting direction, or no direction at all, from local, state, and federal leaders:

Whiplash, trying to keep up with who’s ordering what. We’re already experiencing enough chaos without this back-and-forth. Why didn’t the federal government issue a nationwide shelter-in-place at the get-go, the way other countries did? What happens when one state’s shelter-in-place ends, while others continue? Do states still under quarantine close their borders? We are still one nation, not fifty individual countries. Right?

• A syllabus for the end of the world

Award-winning photojournalist Alessio Mamo, quarantined with his partner Marta in Sicily after she tested positive for the virus, accompanies his photographs in the Guardian of their confinement with a reflection on being confined :

The doctors asked me to take a second test, but again I tested negative. Perhaps I’m immune? The days dragged on in my apartment, in black and white, like my photos. Sometimes we tried to smile, imagining that I was asymptomatic, because I was the virus. Our smiles seemed to bring good news. My mother left hospital, but I won’t be able to see her for weeks. Marta started breathing well again, and so did I. I would have liked to photograph my country in the midst of this emergency, the battles that the doctors wage on the frontline, the hospitals pushed to their limits, Italy on its knees fighting an invisible enemy. That enemy, a day in March, knocked on my door instead.

In the New York Times Magazine, deputy editor Jessica Lustig writes with devastating clarity about her family’s life in Brooklyn while her husband battled the virus, weeks before most people began taking the threat seriously:

At the door of the clinic, we stand looking out at two older women chatting outside the doorway, oblivious. Do I wave them away? Call out that they should get far away, go home, wash their hands, stay inside? Instead we just stand there, awkwardly, until they move on. Only then do we step outside to begin the long three-block walk home. I point out the early magnolia, the forsythia. T says he is cold. The untrimmed hairs on his neck, under his beard, are white. The few people walking past us on the sidewalk don’t know that we are visitors from the future. A vision, a premonition, a walking visitation. This will be them: Either T, in the mask, or — if they’re lucky — me, tending to him.

Essayist Leslie Jamison writes in the New York Review of Books about being shut away alone in her New York City apartment with her 2-year-old daughter since she became sick:

The virus. Its sinewy, intimate name. What does it feel like in my body today? Shivering under blankets. A hot itch behind the eyes. Three sweatshirts in the middle of the day. My daughter trying to pull another blanket over my body with her tiny arms. An ache in the muscles that somehow makes it hard to lie still. This loss of taste has become a kind of sensory quarantine. It’s as if the quarantine keeps inching closer and closer to my insides. First I lost the touch of other bodies; then I lost the air; now I’ve lost the taste of bananas. Nothing about any of these losses is particularly unique. I’ve made a schedule so I won’t go insane with the toddler. Five days ago, I wrote Walk/Adventure! on it, next to a cut-out illustration of a tiger—as if we’d see tigers on our walks. It was good to keep possibility alive.

At Literary Hub, novelist Heidi Pitlor writes about the elastic nature of time during her family’s quarantine in Massachusetts:

During a shutdown, the things that mark our days—commuting to work, sending our kids to school, having a drink with friends—vanish and time takes on a flat, seamless quality. Without some self-imposed structure, it’s easy to feel a little untethered. A friend recently posted on Facebook: “For those who have lost track, today is Blursday the fortyteenth of Maprilay.” ... Giving shape to time is especially important now, when the future is so shapeless. We do not know whether the virus will continue to rage for weeks or months or, lord help us, on and off for years. We do not know when we will feel safe again. And so many of us, minus those who are gifted at compartmentalization or denial, remain largely captive to fear. We may stay this way if we do not create at least the illusion of movement in our lives, our long days spent with ourselves or partners or families.

• What day is it today?

Novelist Lauren Groff writes at the New York Review of Books about trying to escape the prison of her fears while sequestered at home in Gainesville, Florida:

Some people have imaginations sparked only by what they can see; I blame this blinkered empiricism for the parks overwhelmed with people, the bars, until a few nights ago, thickly thronged. My imagination is the opposite. I fear everything invisible to me. From the enclosure of my house, I am afraid of the suffering that isn’t present before me, the people running out of money and food or drowning in the fluid in their lungs, the deaths of health-care workers now growing ill while performing their duties. I fear the federal government, which the right wing has so—intentionally—weakened that not only is it insufficient to help its people, it is actively standing in help’s way. I fear we won’t sufficiently punish the right. I fear leaving the house and spreading the disease. I fear what this time of fear is doing to my children, their imaginations, and their souls.

At ArtForum , Berlin-based critic and writer Kristian Vistrup Madsen reflects on martinis, melancholia, and Finnish artist Jaakko Pallasvuo’s 2018 graphic novel Retreat , in which three young people exile themselves in the woods:

In melancholia, the shape of what is ending, and its temporality, is sprawling and incomprehensible. The ambivalence makes it hard to bear. The world of Retreat is rendered in lush pink and purple watercolors, which dissolve into wild and messy abstractions. In apocalypse, the divisions established in genesis bleed back out. My own Corona-retreat is similarly soft, color-field like, each day a blurred succession of quarantinis, YouTube–yoga, and televized press conferences. As restrictions mount, so does abstraction. For now, I’m still rooting for love to save the world.

At the Paris Review , Matt Levin writes about reading Virginia Woolf’s novel The Waves during quarantine:

A retreat, a quarantine, a sickness—they simultaneously distort and clarify, curtail and expand. It is an ideal state in which to read literature with a reputation for difficulty and inaccessibility, those hermetic books shorn of the handholds of conventional plot or characterization or description. A novel like Virginia Woolf’s The Waves is perfect for the state of interiority induced by quarantine—a story of three men and three women, meeting after the death of a mutual friend, told entirely in the overlapping internal monologues of the six, interspersed only with sections of pure, achingly beautiful descriptions of the natural world, a day’s procession and recession of light and waves. The novel is, in my mind’s eye, a perfectly spherical object. It is translucent and shimmering and infinitely fragile, prone to shatter at the slightest disturbance. It is not a book that can be read in snatches on the subway—it demands total absorption. Though it revels in a stark emotional nakedness, the book remains aloof, remote in its own deep self-absorption.

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In an essay for the Financial Times, novelist Arundhati Roy writes with anger about Indian Prime Minister Narendra Modi’s anemic response to the threat, but also offers a glimmer of hope for the future:

Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next. We can choose to walk through it, dragging the carcasses of our prejudice and hatred, our avarice, our data banks and dead ideas, our dead rivers and smoky skies behind us. Or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it.

From Boston, Nora Caplan-Bricker writes in The Point about the strange contraction of space under quarantine, in which a friend in Beirut is as close as the one around the corner in the same city:

It’s a nice illusion—nice to feel like we’re in it together, even if my real world has shrunk to one person, my husband, who sits with his laptop in the other room. It’s nice in the same way as reading those essays that reframe social distancing as solidarity. “We must begin to see the negative space as clearly as the positive, to know what we don’t do is also brilliant and full of love,” the poet Anne Boyer wrote on March 10th, the day that Massachusetts declared a state of emergency. If you squint, you could almost make sense of this quarantine as an effort to flatten, along with the curve, the distinctions we make between our bonds with others. Right now, I care for my neighbor in the same way I demonstrate love for my mother: in all instances, I stay away. And in moments this month, I have loved strangers with an intensity that is new to me. On March 14th, the Saturday night after the end of life as we knew it, I went out with my dog and found the street silent: no lines for restaurants, no children on bicycles, no couples strolling with little cups of ice cream. It had taken the combined will of thousands of people to deliver such a sudden and complete emptiness. I felt so grateful, and so bereft.

And on his own website, musician and artist David Byrne writes about rediscovering the value of working for collective good , saying that “what is happening now is an opportunity to learn how to change our behavior”:

In emergencies, citizens can suddenly cooperate and collaborate. Change can happen. We’re going to need to work together as the effects of climate change ramp up. In order for capitalism to survive in any form, we will have to be a little more socialist. Here is an opportunity for us to see things differently — to see that we really are all connected — and adjust our behavior accordingly. Are we willing to do this? Is this moment an opportunity to see how truly interdependent we all are? To live in a world that is different and better than the one we live in now? We might be too far down the road to test every asymptomatic person, but a change in our mindsets, in how we view our neighbors, could lay the groundwork for the collective action we’ll need to deal with other global crises. The time to see how connected we all are is now.

The portrait these writers paint of a world under quarantine is multifaceted. Our worlds have contracted to the confines of our homes, and yet in some ways we’re more connected than ever to one another. We feel fear and boredom, anger and gratitude, frustration and strange peace. Uncertainty drives us to find metaphors and images that will let us wrap our minds around what is happening.

Yet there’s no single “what” that is happening. Everyone is contending with the pandemic and its effects from different places and in different ways. Reading others’ experiences — even the most frightening ones — can help alleviate the loneliness and dread, a little, and remind us that what we’re going through is both unique and shared by all.

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“Now is the time for unity”

About the author, antónio guterres.

António Guterres is the ninth Secretary-General of the United Nations, who took office on 1st January 2017.

The Covid-19 pandemic is one of the most dangerous challenges this world has faced in our lifetime. It is above all a human crisis with severe health and socio-economic consequences. 

The World Health Organization, with thousands of its staff, is on the front lines, supporting Member States and their societies, especially the most vulnerable among them, with guidance, training, equipment and concrete life-saving services as they fight the virus.  

The World Health Organization must be supported, as it is absolutely critical to the world’s efforts to win the war against Covid-19.

I witnessed first-hand the courage and determination of WHO staff when I visited the Democratic Republic of the Congo last year, where WHO staff are working in precarious conditions and very dangerous remote locations as they fight the deadly Ebola virus. It has been a remarkable success for WHO that no new cases of Ebola have been registered in months. 

It is my belief that the World Health Organization must be supported, as it is absolutely critical to the world’s efforts to win the war against Covid-19.  

This virus is unprecedented in our lifetime and requires an unprecedented response. Obviously, in such conditions, it is possible that the same facts have had different readings by different entities. Once we have finally turned the page on this epidemic, there must be a time to look back fully to understand how such a disease emerged and spread its devastation so quickly across the globe, and how all those involved reacted to the crisis. The lessons learned will be essential to effectively address similar challenges, as they may arise in the future. 

But now is not that time. Now is the time for unity, for the international community to work together in solidarity to stop this virus and its shattering consequences.   

S7-Episode 2: Bringing Health to the World

“You see, we're not doing this work to make ourselves feel better. That sort of conventional notion of what a do-gooder is. We're doing this work because we are totally convinced that it's not necessary in today's wealthy world for so many people to be experiencing discomfort, for so many people to be experiencing hardship, for so many people to have their lives and their livelihoods imperiled.”

Dr. David Nabarro has dedicated his life to global health. After a long career that’s taken him from the horrors of war torn Iraq, to the devastating aftermath of the Indian Ocean tsunami, he is still spurred to action by the tremendous inequalities in global access to medical care.

“The thing that keeps me awake most at night is the rampant inequities in our world…We see an awful lot of needless suffering.”

:: David Nabarro interviewed by Melissa Fleming

Brazilian ballet pirouettes during pandemic

Ballet Manguinhos, named for its favela in Rio de Janeiro, returns to the stage after a long absence during the COVID-19 pandemic. It counts 250 children and teenagers from the favela as its performers. The ballet group provides social support in a community where poverty, hunger and teen pregnancy are constant issues.

Radio journalist gives the facts on COVID-19 in Uzbekistan

The pandemic has put many people to the test, and journalists are no exception. Coronavirus has waged war not only against people's lives and well-being but has also spawned countless hoaxes and scientific falsehoods.

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It doesn’t quite feel real, but it’s been more than a year since the world’s first lockdown in Wuhan, China, to help stop the spread of the COVID-19 pandemic.

An awful lot has happened since then: 145 million cases, 3 million deaths worldwide, and a whole heap of questions from people looking for the best, most reliable answers.

Like, when will this all end? Is COVID-19 treatable yet? And is it dangerous to use public toilets now?

There’s no such thing as a stupid question. We don’t all have as many degrees as Chris Whitty — the UK’s acronym-happy chief medical officer — and we all want answers. But with so much information flowing, it might sometimes feel embarrassing to ask a question it feels like everyone but you knows the answer to. 

So from the absolute basics to some of the more complicated stuff, we’ve collated a bunch of the key questions people are asking about the pandemic, COVID-19 vaccines, and more — and answered as many as we could with the most trusted sources from around the world.

From ways to prevent yourself catching the virus, to how the world is making moves to eliminate it, here’s the latest on what the science has to say on the questions we're all asking.

1. Should I wash my shopping with soap and water?

Although the virus can reportedly survive for up to 24 hours on cardboard and 72 hours on plastics, according to the New England Journal of Medicine, the risk of infection from virus particles on those surfaces decreases over time.

That’s why the US Centers for Disease Control (CDC) has advised that shoppers do not need to clean and disinfect their food packaging. Instead, it recommends washing your hands after handling products you suspect have been touched by others. 

"There is currently no confirmed case of COVID-19 transmitted through food or food packaging,” said the World Health Organization (WHO). 

Did you know COVID-19 can live on cardboard for 24 hours? The lifespan of COVID-19 depends on the surface it’s on. Here are some common surfaces and the lifespan for each. pic.twitter.com/7qJ5xqClyJ — University Health System (@UnivHealthSys) March 23, 2020

2. How much time does this virus stay alive on surfaces?

Beyond cardboard and plastics, that same study said that the virus was still detectable in the air after 3 hours, on copper after 4 hours, and after 72 hours on steel. 

Here’s how you might catch the virus via surfaces: you’re out in public, you touch a surface that’s been touched by loads of other people before you, and then you touch your face. So avoid “high-touch” surfaces, like supermarket shelves and door handles, as much as possible — and wash your hands thoroughly and regularly.

One expert from the University of Florida added that many household cleaning products wouldn’t do too well against coronavirus anyway. You’re better off just practicing good personal hygiene, he told the New Scientist. Here’s a list from the CDC of products that would do the job.

3. Does a reusable face mask work better than a single-use mask? 

The easy answer is: from a health perspective, it doesn’t really matter.

However, there are other advantages to wearing masks you can simply wash clean. It will save you money from having to repeatedly purchase more single-use masks, it’s much better for the environment, and you could even make them yourself.

Whatever you do, make sure you follow the WHO guidelines on how to use them — like how to take them on and off again without touching your face — and, once again, wash your hands before and after. 

The most important thing? Keep those masks on whenever you have to enter public places like supermarkets, and it's a good idea to wear your mask whenever you leave the house.

4. Could someone get infected by sitting on a public toilet like in a store? 

Well first you’ve got to find an open public toilet. In London, they’re like unicorns.

Public toilets are a risky business for a few reasons — though not necessarily just from all the squatting. Although not specific to coronaviruses, researchers at the University of Connecticut and Quinnipiac University in 2018 found that hand dryers massively multiplied bacteria in the air. It’s not entirely clear if this applies to the virus — but it doesn’t hurt to look instead for touchless paper dispensers to dry your hands instead.

Similarly, with all their confined spaces and side-by-side sinks and urinals, public toilets make social distancing difficult. Indeed, some experts in Australia have called for changes in the way public bathrooms are designed in the future to avoid physical contact entirely — for example, with self-cleaning cubicles, sensor-activated taps, and automatic doors at entrance and exits. 

For that reason, avoid touching things as much as possible. But most importantly, remember to follow the WHO guidelines when you wash your hands: once you’re done, use a paper towel to turn off the tap.

And when it comes to the toilet itself: although some early research from China suggested that the virus might be able to be transmitted from fecal matter, the CDC has said there’s no evidence that anybody has actually contracted the virus this way, and based off similar viruses like SARS, assume that the risk is “low”.

However, you should still beware "aerosolized feces" — particles which, according to 2013 research from the Association for Professionals in Infection Control and Epidemiology, lift into the air from the toilet as you flush. But it’s easy to avoid most of that ickiness by closing the lid before flushing to stop about 80% of the particles. 

In your own home, take a more attentive approach to sanitizing your surfaces. In general, try to avoid public toilets. Pee at home if you can!

5. Will cold (refrigerator or freezer) kill the virus?

To put it simply: we don’t really know. But probably not.

The WHO has clarified that there is no data that suggests the virus can be killed by cold or heat. Although freezing can slow the spread of bacteria , there is zero evidence right now that it stops the transmission of COVID-19. Basically, we need more research. 

But if you’re worried about COVID-19 on your food, there’s two things you can do. Although your fridge and freezer might not kill the virus, cooking food thoroughly will — and it’s always good practice to wash your food before eating.

And without wanting to sound like a broken record: wash your hands after handling food too.

6. Is a closed air-conditioned office more prone to contamination even while maintaining social distance?

The real question here is: do aerosols — the tiny droplets that come out when we cough or breathe that can carry virus particles — get further spread by air conditioning?

Again, there isn’t enough data to draw complete conclusions one way or another. But although it’s very unlikely that air conditioning moves those droplets over long distances, like across an entire supermarket, it might allow virus particles to carry over shorter distances, surviving for longer than might have happened without it.

For example, one study of a restaurant in China between January and February found that three separate families contracted the virus on one night, reportedly because one asymptomatic, COVID-19 positive diner was sitting in front of an air conditioning unit that could carry larger droplets further than one meter.

But although an expert confirmed the validity of this theory to HuffPost , he was quick to emphasize that this “does not, in any way, imply [COVID-19] is spread by air conditioning”. However, the statement that a closed air-conditioned office is more prone to contamination is invariably true if droplets do indeed travel slightly further through the air that way — even though that difference might be tiny.

7. How does testing actually help prevent the virus?

Before vaccines started rolling out, comprehensive COVID-19 testing was one of the best weapons we had against the virus. And as evident in countries like South Korea , aggressive testing can lead to a plummeting death rate: despite hundreds of daily cases in March 2020, South Korea managed to report zero new infections by April 30.

It’s not just about the individual, it’s about the community : if an entire population can access testing, it helps health services adapt to demand and informs government guidelines. If you test widely, you can find the virus before symptoms develop, immediately self-isolate, and prevent it from infecting others.

That’s why Imperial College London — the university that influenced the UK government’s shift in strategy from herd immunity to lockdown in March 2020 with its virus modelling — has insisted that all health care workers have access to test results, irrespective of symptoms, while the London School of Hygiene & Tropical Medicine has suggested trialing a universal testing process.

“We cannot stop this pandemic if we do not know who is infected,” said the WHO’s director general Dr. Tedros Adhanom Ghebreyesus. 

8. Are all tests the same? What actually happens when you get tested?

It’s pretty simple in the UK right now, for example: you get a swab up your nose and in the back of your throat — either with a home testing kit, or via a mobile testing unit, an NHS facility, or a drive-through. These “viral tests” are the most popular globally, but they only tell you if you have the virus at the moment you take the test. A version of this is the “lateral flow” test: a rapid response that can get you an answer within 30 minutes.

There’s another type of test you might have heard about: the antibody test. It’s a blood test that looks for the proteins used by your immune system to fight off the virus, meaning it can reveal whether you’ve had it in the past. But the CDC says it can take 1-3 weeks after infection to release those antibodies — and on May 27, updated its guidance to reveal that those tests can be wrong up to half of the time.

The key issue is access. According to the Africa Centres for Disease Control and Prevention (Africa CDC), just 1.3 million tests had been carried out across the entire continent by the middle of May 2020 — less than in the UK on its own — because, like we’re seeing with vaccines now, richer countries were reportedly  pushing to be first in the queue. 

So although cases on the continent have been relatively low, there are fears that many cases are going undetected. And while there have been more deaths in the UK than across the whole of Africa, a report from Boston University School of Public Health published Dec. 24, 2020, has suggested that a lack of death registrations means the real number of deaths on the continent could be higher.

That’s why organizations like the Foundation for Innovative New Diagnostics ( FIND ) have been working with the WHO and others to ramp up testing in the world’s poorest countries.

➡️This week our CEO @BoehmeCatharina spoke at @EU_Commission 's Coronavirus Global Response pledging event, calling on key stakeholders to support this landmark collaboration & provide the necessary resources for #COVID19 diagnostics & testing. #UnitedAgainstCoronavirus 🇪🇺 https://t.co/NKifIps20S — FIND (Foundation for Innovative New Diagnostics) (@FINDdx) May 7, 2020

9. Can you catch COVID-19 twice?

A recent report from Public Health England (PHE) has suggested that if you get the virus, you should be immune for at least five months afterwards. 

To be specific: if you were previously infected, you have an 83% lower risk of getting the virus — a higher number than some approved vaccines. 

That doesn’t mean you can move through the world any differently though. You should still stay home and follow local guidelines. The PHE report found that those previously infected can still carry the virus in their nose and throat. So there’s still a good chance that you could transmit the virus to others without developing COVID-19 symptoms yourself.

You might be able to catch the virus again. But the chances of that are seemingly slim.

Two studies in monkeys offer some of the first scientific evidence that surviving COVID-19 may result in immunity from reinfection https://t.co/1Ro8VxoIcq pic.twitter.com/yt8Z3G1W6X — Reuters (@Reuters) May 20, 2020

10. Will we ever be able to eradicate the virus?

Now there’s a vaccine, anything is possible.

But according to the BMJ, a medical journal, there is a difference between possible and achievable. Even with a vaccine, new strains from different countries would mean that anything close to eradication might mean permanently restricted borders. 

It could also mean a vaccine strategy similar to the flu, where every year new vaccines are created to replicate the evolution of the virus. 

However, even if it isn’t completely eradicated, we could get life back on track with a combination of herd immunity from an effective vaccination rollout and treatments that reduce the number deaths from people with COVID-19. What that does mean, though, is that we need the whole world to be able to access vaccines and treatments.

That's not an easy task when, as of February 2021, just one of the 29 poorest countries in the world has received any vaccines. That was Guinea, which had 55 donated by Russia.

However, there are organizations working on plans to distribute the vaccine fairly. Donor countries including the UK have been funding COVAX — a scheme that aims to deliver 2 billion vaccine doses to low-income countries in 2021. It’s one part of the ACT-Accelerator , a collaboration of international organizations set up to ensure that the tools to end the pandemic are equitably distributed.

Meanwhile, Gavi, the Vaccine Alliance, has spent the last 20 years building supply chains to distribute and stockpile vaccines to reach the world’s poorest communities, while driving down its price to make them affordable to all.

And the Coalition for Epidemic Preparedness Innovations (CEPI), a partnership between public, private, philanthropic, and civil organizations that’s funding vaccine development projects across the world, has written in agreements to all its partners that include equitable access provisions. Any successful vaccine on a CEPI-funded project will also be manufactured across multiple countries too, so global distribution in that instance is assured.

11. With so much misinformation out there, how can I know what to believe?

The WHO has described the sheer volume of fake news out there as an “infodemic”, undermining the health services fighting the pandemic on the front lines and frustrating coordinated global efforts to communicate the right information to people.

Whether that misinformation is social media posts that perpetuate untrue vaccine myths or false accusations that hospitals are empty of COVID-19 patients, the WHO has one clear message: “misinformation costs lives” . This is especially true among ethnic minority communities, as is emerging in countries around the world.

It comes down to this: if you see a post online that does not come from a trusted source, or does not have verifiable information, do not share it. Information that comes from international organizations that are staffed by world-leading experts such as the WHO, the US Centers for Disease Control and Prevention, and the London School of Hygiene and Tropical Medicine are reliable.

Be careful with first-person accounts that are put forward as evidence of a wider pattern. Head here  to find a larger list of sources you can trust.

12. What is being done to find treatments?

In a word, lots!

A good example to bear in mind when it comes to the importance of treatments beyond vaccines is the HIV/AIDS crisis. After 40 years, a vaccine is still yet to be found. But HIV/AIDS has been brought under control in many parts of the world precisely because testing and treatment has become more widely available. 

Likewise for COVID-19, if we can find effective treatments, in addition to a vaccine, we’ll be able to make progress with far greater speed. It’s something international organizations have been working towards since the start of the pandemic.

Take, for instance, the COVID-19 Therapeutics Accelerator : a collaborative effort to research, develop, and produce effective treatments for the virus as quickly as possible with the Bill & Melinda Gates Foundation, the Wellcome Trust, and the UK’s Foreign, Commonwealth, and Development Office (FCDO).

The Accelerator will also work to ensure that as the right medicines are discovered — like antiviral drugs that help people fight off the flu — those treatments are made accessible to all countries equally. 

“The only way to treat a viral infection, such as COVID-19, is with antiviral drugs,” wrote Mark Suzman, CEO of the Bill & Melinda Gates Foundation. “Right now, we can only treat the symptoms since there simply aren’t antiviral medications that can treat a range of conditions in the same way that antibiotics do for bacterial infections.”

13. What is long COVID?

For many people, the symptoms of the virus can last weeks. For others, it can stretch on for months.

This is what’s known as “long COVID”, officially defined as problems, such as exhaustion, that persist for at least 12 weeks after infection. Other known symptoms include shortness of breath, coughing, and aches and pains. There are lots of theories on why this happens, but nothing concrete just yet. 

It is certain, however, that it’s real: an article published in the Journal of the American Medical Association found that 87% of 143 people needing hospital treatment due to the virus in Rome still reported symptoms two months after being discharged. Meanwhile a study in Dublin found half of those surveyed had fatigue 10 weeks after infection. 

If you have more questions, there are lots of sources out there for answers — but, as we highlighted above, it's important that you're getting your information from trusted sources. You can find a list here of lots of places — from the NHS to the CDC — to find answers to your questions, that are supplied by medical professionals and experts. 

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Introduction - Pandemic Preparedness | Lessons From COVID-19

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On December 31, 2019, the World Health Organization (WHO) contacted China about media reports of a cluster of viral pneumonias in Wuhan, later attributed to a coronavirus, now named SARS-CoV-2 . By January 30, 2020, scarcely a month later, WHO declared the virus to be a public health emergency of international concern (PHEIC)—the highest alarm the organization can sound. Thirty days more and the pandemic was well underway; the coronavirus had spread to more than seventy countries and territories on six continents, and there were roughly ninety thousand confirmed cases worldwide of COVID-19, the disease caused by the coronavirus.

The COVID-19 pandemic is far from over and could yet evolve in unanticipated ways, but one of its most important lessons is already clear: preparation and early execution are essential in detecting, containing, and rapidly responding to and mitigating the spread of potentially dangerous emerging infectious diseases. The ability to marshal early action depends on nations and global institutions being prepared for the worst-case scenario of a severe pandemic and ready to execute on that preparedness The COVID-19 pandemic is far from over and could yet evolve in unanticipated ways, but one of its most important lessons is already clear: preparation and early execution are essential in detecting, containing, and rapidly responding to and mitigating the spread of potentially dangerous emerging infectious diseases. The ability to marshal early action depends on nations and global institutions being prepared for the worst-case scenario of a severe pandemic and ready to execute on that preparedness before that worst-case outcome is certain.

The rapid spread of the coronavirus and its devastating death toll and economic harm have revealed a failure of global and U.S. domestic preparedness and implementation, a lack of cooperation and coordination across nations, a breakdown of compliance with established norms and international agreements, and a patchwork of partial and mishandled responses. This pandemic has demonstrated the difficulty of responding effectively to emerging outbreaks in a context of growing geopolitical rivalry abroad and intense political partisanship at home.

Pandemic preparedness is a global public good. Infectious disease threats know no borders, and dangerous pathogens that circulate unabated anywhere are a risk everywhere. As the pandemic continues to unfold across the United States and world, the consequences of inadequate preparation and implementation are abundantly clear. Despite decades of various commissions highlighting the threat of global pandemics and international planning for their inevitability, neither the United States nor the broader international system were ready to execute those plans and respond to a severe pandemic. The result is the worst global catastrophe since World War II.

The lessons of this pandemic could go unheeded once life returns to a semblance of normalcy and COVID-19 ceases to menace nations around the globe. The United States and the world risk repeating many of the same mistakes that exacerbated this crisis, most prominently the failure to prioritize global health security, to invest in the essential domestic and international institutions and infrastructure required to achieve it, and to act quickly in executing a coherent response at both the national and the global level.

The goal of this report is to curtail that possibility by identifying what went wrong in the early national and international responses to the coronavirus pandemic and by providing a road map for the United States and the multilateral system to better prepare and execute in future waves of the current pandemic and when the next pandemic threat inevitably emerges. This report endeavors to preempt the next global health challenge before it becomes a disaster.

A Rapid Spread, a Grim Toll, and an Economic Disaster

On January 23, 2020, China’s government began to undertake drastic measures against the coronavirus, imposing a lockdown on Wuhan, a city of ten million people, aggressively testing, and forcibly rounding up potential carriers in makeshift quarantine centers. 1 In the subsequent days and weeks, the Chinese government extended containment to most of the country, sealing off cities and villages and mobilizing tens of thousands of health workers to contain and treat the disease. By the time those interventions began, however, the disease had already spread well beyond the country’s borders.

SARS-CoV-2 is a highly transmissible emerging infectious disease for which no highly effective treatments or vaccines currently exist and against which people have no preexisting immunity. Some nations have been successful so far in containing its spread through public health measures such as testing, contact tracing, and isolation of confirmed and suspected cases. Those nations have managed to keep the number of cases and deaths within their territories low.

More than one hundred countries implemented either a full or a partial shutdown in an effort to contain the spread of the virus and reduce pressure on their health systems. Although these measures to enforce physical distancing slowed the pace of infection, the societal and economic consequences in many nations have been grim. The supply chain for personal protective equipment (PPE), testing kits, and medical equipment such as oxygen treatment equipment and ventilators remains under immense pressure to meet global demand.

If international cooperation in response to COVID-19 has been occurring at the top levels of government, evidence of it has been scant, though technical areas such as data sharing have witnessed some notable successes. Countries have mostly gone their own ways, closing borders and often hoarding medical equipment. More than a dozen nations are competing in a biotechnology arms race to find a vaccine. A proposed international arrangement to ensure timely equitable access to the products of that biomedical innovation has yet to attract the necessary support from many vaccine-manufacturing nations, and many governments are now racing to cut deals with pharmaceutical firms and secure their own supplies.

As of August 31, 2020, the pandemic had infected at least twenty-five million people worldwide and killed at least 850,000 (both likely gross undercounts), including at least six million reported cases and 183,000 deaths in the United States. Meanwhile, the world economy had collapsed into a slump rivaling or surpassing the Great Depression, with unemployment rates averaging 8.4 percent in high-income economies. In the second quarter of 2020, the U.S gross domestic product (GDP) fell 9.5 percent, the largest quarterly decline in the nation’s history. 2

Already in May 2020, the Asia Development Bank estimated that the pandemic would cost the world $5.8 to 8.8 trillion, reducing global GDP in 2020 by 6.4 to 9.7 percent. The ultimate financial cost could be far higher. 3

The United States is among the countries most affected by the coronavirus, with about 24 percent of global cases (as of August 31) but just 4 percent of the world’s population. While many countries in Europe and Asia succeeded in driving down the rate of transmission in spring 2020, the United States experienced new spikes in infections in the summer because the absence of a national strategy left it to individual U.S. states to go their own way on reopening their economies. In the hardest-hit areas, U.S. hospitals with limited spare beds and intensive care unit capacity have struggled to accommodate the surge in COVID-19 patients. Resource-starved local and state public health departments have been unable to keep up with the staggering demand for case identification, contract tracing, and isolation required to contain the coronavirus’s spread.

A Failure to Heed Warnings

• Institute of Medicine, Microbial Threats to Health (1992)
• National Intelligence Estimate, The Global Infectious Disease Threat and Its Implications ...

This failing was not for any lack of warning of the dangers of pandemics. Indeed, many had sounded the alarm over the years. For nearly three decades, countless epidemiologists, public health specialists, intelligence community professionals, national security officials, and think tank experts have underscored the inevitability of a global pandemic of an emerging infectious disease. Starting with the Bill Clinton administration, successive administrations, including the current one, have included pandemic preparedness and response in their national security strategies. The U.S. government, foreign counterparts, and international agencies commissioned multiple scenarios and tabletop exercises that anticipated with uncanny accuracy the trajectory that a major outbreak could take, the complex national and global challenges it would create, and the glaring gaps and limitations in national and international capacity it would reveal.

The global health security community was almost uniformly in agreement that the most significant natural threat to population health and global security would be a respiratory virus—either a novel strain of influenza or a coronavirus that jumped from animals to humans. 4 Yet, for all this foresight and planning, national and international institutions alike have failed to rise to the occasion.

• National Intelligence Estimate, The Global Infectious Disease Threat and Its Implications for the United States (2000)
• Launch of the U.S. Global Health Security Initiative (2001)
• Institute of Medicine, Microbial Threats to Health: Emergence, Detection, and Response (2003)
• Revision of the International Health Regulations (2005)
• World Health Organization, Global Influenza Preparedness Plan (2005)
• Homeland Security Council, National Strategy for Pandemic Influenza (2005)
• U.S. Department of Health and Human Services, National Health Security Strategy of the United States of America (2009)
• U.S. Director of National Intelligence, Worldwide Threat Assessments (2009–2019)
• World Health Organization, Report of Review Committee on the Functioning of the International Health Regulations (2005) in Relation to Pandemic (H1N1) 2009 (2011)
• Pandemic and All-Hazards Preparedness Reauthorization Act of 2013
• Launch of the Global Health Security Agenda (2014)
• Blue Ribbon Study Panel on Biodefense (now Bipartisan Commission on Biodefense) (2015)
• National Security Strategy (2017)
• National Biodefense Strategy (2018)
• Crimson Contagion Simulation (2019)
• Global Preparedness Monitoring Board, A Work at Risk: Annual Report on Global Preparedness for Health Emergencies (2019)
• CSIS Commission, Ending the Cycle of Crisis and Complacency in U.S. Global Health Security (2019)
• U.S. National Health Security Strategy, 2019–2022 (2019)
• Global Health Security Index (2019)

Further Reading

Health-Systems Strengthening in the Age of COVID-19

By Angela E. Micah , Katherine Leach-Kemon , Joseph L Dieleman August 25, 2020

What Is the World Doing to Create a COVID-19 Vaccine?

By Claire Felter Aug 26, 2020

What Does the World Health Organization Do?

By CFR.org Editors Jun 1, 2020

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The Coronavirus Crisis

Reflections on a lost senior year with hope for the future.

Diane Adame

Elissa Nadworny

East Ascension High School Valedictorian Emma Cockrum at her home in Prairieville, La., on June 1, 2020. Emily Kask for NPR hide caption

East Ascension High School Valedictorian Emma Cockrum at her home in Prairieville, La., on June 1, 2020.

Emma Cockrum was in her second week of quarantine when her father discovered an old bike behind their house.

And that bicycle turned out to be a gift: With school closed at East Ascension High School in Gonzales, La., bike riding for Emma became a way of coping with the loss of the rest of her senior year.

"I would say the first two to three weeks we were out of school, I was not the most fun person to be around. I was a ticking time bomb," says the 18-year-old, who's headed to Northwestern State University in the fall. "One minute, I would be fine and dandy, and then the next minute, I would be crying."

As she pedaled through her neighborhood each day, those bike rides forced her to stop and take in the world around her — and they became the inspiration behind these words in her valedictorian speech:

"I got to see life happening. I saw families spending time together, like children playing basketball on their driveways, or fathers teaching their own kids to ride bikes. When we stop to observe our surroundings, we are oftentimes provided with new perspectives on our situations."

Dear Class Of 2020: Graduation Messages From Frontline Workers

The coronavirus pandemic has caused many high school graduations to be replaced with virtual, drive-in and other alternative ceremonies. And so, the tradition of valedictorians and salutatorians addressing their classmates at this huge moment in their young lives is a little different this year.

NPR spoke with a few student leaders about their speeches and how a not-so-typical senior year inspired their words for the class of 2020.

Emma Cockrum

Valedictorian, East Ascension High School, Gonzales, La.

East Ascension High School Valedictorian Emma Cockrum with her dog Hercules in front of her old play house at her home in Prairieville, La. Emily Kask for NPR hide caption

East Ascension High School Valedictorian Emma Cockrum with her dog Hercules in front of her old play house at her home in Prairieville, La.

Aside from her bike rides, Cockrum was also inspired by a few words from Sol Rexius, a pastor at The Salt Company Church of Ames in Iowa. She says Rexius uses the analogy of a dump truck full of dirt being emptied all over their senior year. Here's how she put it in her address to her classmates:

This may sound harsh, but it's not untrue to how some of us feel. It is easy to feel buried by our circumstances. However, he [the pastor] goes on to paint a picture of a farmer planting a seed. Did the farmer bury the seed? Well, yes, but he also planted it. Instead of feeling buried by our situation, we must realize that the pain and heartache that has been piled upon us is not meant to bury, but to plant us in a way that will allow us to grow and prosper into who we are meant to be. As you stop and take in the circumstances around you, will you allow yourself to be buried or to be planted? 

As we move on from this place and embark on the next big journey of life, whether that's college, the workforce or something else, life will at some point begin to feel like it's going too fast. My bike rides have taught me a new way to handle these times because they allow me to exercise and be among the beauty of nature, which are things that cause me to slow down. When life becomes too much like a race for you, it may not be riding a bike. It may be playing an instrument, sport, creating art or something else entirely. I encourage you to find that one thing that allows you to unwind and refocus when life seems too much to handle.  Now, I'd like to take you on a bike ride with me as we share this experience together in our faces, something that is both exciting and terrifying: freedom. We sit atop our bikes of life as high school graduates and now have the freedom to choose who we are and where we will go.  

Salutatorian, Paducah Tilghman High School, Paducah, Ky.

Chua says he wanted to make his speech something that would provide some happiness to people, even if only be for a little while. Before offering some advice, he began his speech with a personal take on the famous line from Forrest Gump : "Life is like a box of chocolates."

"Life is like a fistful of Sour Patch Kids," Chua says in his speech, recorded on video from his home in Paducah. "Right now things are sour, but eventually they will turn sweet."

The sharing of knowledge is just as important as receiving it because, without sharing, knowledge has no value. The first piece of advice I want to share is to always try new things and challenge yourself, even if you think it's a bad idea in the process. Always attempt to answer questions and solve problems. Find new ways to do the same tasks. Wear all white to black out. Take that ridiculously difficult course load. Buy that oversized $30 pack of UNO that is literally impossible to shuffle just so you can say you own it. Just spend responsibly, kids. All in all, just make life spicy. Make life something you want to reminisce on.  The second lesson is simple. Just be nice to people. Trust sows the seeds of freedom, and a little respect truly does go a long way. It could even solve a few of the world's problems. You never know when you'll need to fall back on someone, so build strong connections early and maintain them.  Lastly, the phrase "I don't know" is powerful. By admitting ignorance, you are asking to learn. Inevitably, I know I will come upon a hard stop, and I hope that when I do, I'll remind myself to pause and ask for a hand of enlightenment, so that I might come back from that hard experience knowing more than when I started. Life rarely hands you a golden opportunity, so make one. Just as the tornado creates a path in the wake of its destruction, this class of 2020 will, too, create their own, hopefully without the whole destruction part.

Kimani Ross

Valedictorian, Lake City High School, Lake City, S.C.

Valedictorian Kimani Ross leads the Lake City High School parade through downtown Lake City, SC. Taylor Adams/SCNow hide caption

Ross says she wanted to remind her class that they can get through any obstacle. She recalls the adversities they've gone through together — like the death of a beloved coach — and the people that doubted her.

Ross says she'll attend North Carolina A&T State University in the fall, where she plans to study nursing.

Many people didn't, and probably still don't believe that I have worked hard enough to be where I am now. I've had people tell me that I don't deserve to be where I am now, and that really made me contemplate, "Do I really deserve this? Should I just give up and let them win?" But look at where I am now. I'm glad that I didn't stop. I'm glad that I didn't let them get to me.  I'm especially glad that I earned this position so that all of the other little girls around Lake City and surrounding areas can look and say that they want to be just like me. I want those little girls to know that they can do it if no one else believes in them, I will always believe in them. Classmates, when we're out in the real world, don't get discouraged about the obstacles that will approach you. As Michelle Obama once said, you should never view your challenges as a disadvantage. Instead, it is important for you to understand that your experience facing and overcoming adversity is actually one of your biggest advantages.

Valedictorian Kimani Ross and her family at the Lake City graduation in Lake City, SC. Taylor Adams/SCNow hide caption

Valedictorian Kimani Ross and her family at the Lake City graduation in Lake City, SC.

Lindley Andrew

Salutatorian, Jordan-Matthews High School, Siler City, N.C.

Andrew says her mind flooded with high school memories as she tried to write her speech. This inspired her to get her fellow seniors involved. With the help of her class, she strung together a timeline of national events and local victories.

"Sometimes it's the small, seemingly pointless experiences that leave the most lasting and impactful memories," she says.

Some of us lost our senior sports seasons, our chances to be captains and team leaders. Some lost our final chances to compete for clubs that we've given our all to for the last four years. Some of us lost our final opportunities to perform or display our art, and all of us lost the chance to have all of the fun and closure that we were promised would come in the last three months of our senior year.  Losing the last third of our senior year to a virus was not what we had planned, but it's definitely an experience that will affect our lives forever and a memory that we will never, ever forget. We are made up of our experiences and memories. All of the things that we have been through up to this point make us who we are, and the best part is, we're not done yet. We'll continue to experience things and make memories every day that mold us here and there and to who we truly are and who we are meant to become.  What kind of experiences will you create for yourself? What kind of memories will you make? When things don't go quite as planned, like our senior year, how you handle the disappointments and challenges that you face will determine the experience that you have and the memory you walk away with. 

Favio Gonzalez

Valedictorian, Central Valley High School, Ceres, Calif.

Gonzalez says there were many other events besides the pandemic that helped his class develop their character. In his speech, he highlights the election of President Donald Trump and the prevalence of school shootings. Despite what was happening in the world, he says his class never victimized themselves.

Gonzalez will be attending the University of California, Riverside, where he plans to study biology.

The real test came our senior year with the current pandemic. Although society has developed a higher level of understanding, comprehension and acceptance in years prior, self-victimization has become a common occurrence and is a major impediment in achieving our goals. We expect others to find the solutions to our problems and to provide excessive help, since we truly are powerless in stopping the external factors that impact us constantly, whether it'd be natural disasters, terrorism or disease.  Yet, what many people don't realize is that the impact these unfortunate events have on our lives can be nullified by the effort we place in improving our condition. Learning this from past experiences, our class did not victimize itself. Studying and mastering new material is difficult enough with the help of our amazing teachers, with the added responsibilities of helping more at the house, working an essential job and other challenges that come with being at home, it seemed impossible to keep up with schoolwork. We had to face a multitude of barriers with our unrelenting will to succeed. Standing here today, despite all of the setbacks and obstacles, because of our drive, our perseverance, our willpower to endure is stronger than any deterrent.  Now, as we step into adulthood and start to reach our goals, there will be harder challenges to overcome. But our willpower has been proven irrevocable. Never forget classmates, that as long as you use your unrelenting well, you're an unstoppable force.

Barrie Barto

Valedictorian, South High School, Denver

Barto says when her school closed, she tried ignoring some of the emotions she was processing. "I realized that you need to take the time to acknowledge what we have lost and celebrate how we have grown and how this is going to change us as a class," she says.

This inspired her to write the speech she felt that she needed to hear.

To be honest with everyone, when I sat down to write this speech, I really wanted to avoid talking about everything we miss as a class. It would be way easier to reminisce about when the homecoming bonfire was in the back parking lot. But when people told me they were sorry that my whole senior year was turned upside down, I shrugged it off and said it's not a big deal. It's a hard thing to talk about, and not talking about it seems less painful. But it is a big deal. We missed senior prom and graduation and our barbecue and awards. I would even go back for one more class meeting in the auditorium just to sit in South for one more Thursday. This pandemic was not the defining event for our class. Don't let it be. We had monumental events occur every year we were at South. We have supported our teachers when they rallied for themselves. They've supported us when walking into school was harder than it was any other day. We supported each other through the pains of block day, and air conditioning only working in the winter time, but also shifts in friendships and hard times with family. South brought us all together to teach us something about ourselves that we didn't know before.

Haylie Cortez

Valedictorian, Bartlett High School, Anchorage, Alaska

Cortez says she feels lucky to still be able to give a message and was inspired by what has been helping her cope.

"One of the things that pushes me through everything is knowing that things will go on and stuff will change," she says. "I just want to remind everyone that the future is still there and it's still coming to us."

Cortez plans on attending the University of Alaska Fairbanks in the fall, where she wants to study civil engineering.

We all deserve to celebrate and be proud of ourselves. It's upsetting that we won't have a traditional graduation ceremony and sadly, we cannot control the circumstances that we face today.  What we can do is choose how we respond to it as we take these next steps in life. It can be hard to imagine what life could look like as time progresses. The only certainty we have is that time goes on and the future will arrive. We can use the pandemic as an excuse for why we can't move on in life, or we can use it as a motivator to find our purpose. Whether we plan to go to college, trade school, the military or straight into the workforce, there is no denying that society will gain something worthwhile. The situation we are living through shows how valuable everyone in society is. The world is finally realizing the importance of the jobs of janitors, cashiers, teachers, politicians, first responders and more. Whatever we plan on doing after we graduate, it will impact society. I invite everyone to look to who you can't thank, and take your time to do so, although the door for high school has abruptly shut for us. I would like to remind everyone that another has opened and we can do with it what we want.

Lockdown Poems from Children Across the World Experiencing Life During COVID-19

Since March 2020, the lives of billions of children been turned upside down due to the Coronavirus pandemic . Today, children around the world are still out of school and experiencing the effects of remote learning, lockdown and other "new normals".

To capture their experiences, Save the Children invited children from countries around the world to write short poems about COVID-19, life under lockdown, and how the pandemic has changed their lives. 

From Italy, Mexico , United Kingdom, Nigeria and the Democratic Republic of Congo , their lockdown poems bring to life the experiences of children living through this pandemic. Despite their differences, their struggles are shared and they remain united in their hope for a brighter future.

To stay current and read even more children's poems that capture life during COVID-19, sign up here. 

By providing my mobile phone number, I agree to receive recurring text messages from Save the Children (48188) and phone calls with opportunities to donate and ways to engage in our mission to support children around the world. Text STOP to opt-out, HELP for info. Message & data rates may apply. View our Privacy Policy at savethechildren.org/privacy.

5 COVID-19 Poems from Children About Life During Lockdown

Vilma*, 10 from Mexico

Before the virus, I went to school, everything was happy. Now I see people with face masks and few cars but I am happier to have more time with my mom and I have more days to play. I’m afraid that my family and friends will get sick. I miss playing with my friends at school. I miss visiting my grandparents at their house. I dream about seeing my best friend and then us going to the beach. While this [lockdown] happens, I draw pictures, I play and I do homework. I hope that this ends so I can go back to seeing my friends. When all this ends, I will go to the park to skate. All this will pass, we will be fine, if we take care of ourselves [and] wash our hands, the virus will die. Stay at home so we can go out.

Learn more about our work in Mexico .

Gradi*, 14 from the Democratic Republic of Congo

Confinement Once, we used to live well. Meeting with my loved ones, our families and my friends. Today, we are forced to remain confined to our home. No schools, no churches, no meetings. Everyone is obliged to wear a mask and respect the prevention tips in order to fight against this disease which is called coronavirus.

Learn more about our work in the Democratic Republic of Congo .

Lincoln*, 11, from the United Kingdom

Life was always fast-paced, we never slowed down, Until everything stopped when Corona came to town. Now all is quiet and there’s peace all around, We’ve looked in our hearts and kindness we’ve found. We learn now with mum, this is a new feature, But we can’t wait to get back to our teacher. I miss Sea Cadets, school, my friends and my dad, I miss sharing the fun times and that makes me sad. We’ve had social distancing picnics, social distancing walks, Social distancing hugs and social distancing talks. I’m looking forward to getting away, The beach, the hotel and a perfect holiday. When it is? I’ll throw my arms open wide, And shout to the world, WE CAN ALL GO OUTSIDE! Don’t give up hope, the end is in sight, If we all stick together, we’ll all win this fight.

Purity*, 14 from Nigeria

Oh cry the best you can cry; I can feel the hold as it holds You put our health at risk and our education has been halted by you We can longer go to school, we want to be in a learning environment We find it hard to eat, street children, poor homes, suffering, fending for themselves We wish you no successes every day running lives across the nation You’ve become a thorn in our flesh Our fears keep us awake a night, seeing and hearing new cases every day, putting us in a state of total confusion, not knowing what’s going to happen next. We’re here to support each other, as children we can lead to our capacity so stay safe by adhering to the preventative measures, each day will pass, we will walk together -in love, no matter what comes our way. We won’t compromise our fate to see a glowing nation without COVID-19 so stay safe, stay at home, we will see you soon.

Learn more about our work in Nigeria .

Leonardo*, 14 from Italy

Freedom This quarantine makes me think, while I just want to drown in those thoughts that today more than yesterday, remind me of its purity its euphoria I seem to be on the other side, dreaming of my freedom.

*Names have been changed

Because of the COVID-19 crisis, children’s lives and futures are on the line

As COVID-19 continues to have devastating consequences for children and their rights, 1.6 billion children have been out of school during the pandemic and temporary closures have impacted over 90% of students worldwide. Never before have so many children been out of school at the same time .

“These powerful poems show the enormous impact coronavirus has had on children’s lives, as well as their strength, resilience, and hopes for the future,” said Yolande Wright, Save the Children’s Director of Inclusion. “It is so important we listen to children directly during these unprecedented times—we are not all affected equally , and children can be particularly vulnerable.

"This is not just a health crisis, but a threat to children’s rights. Over 1.5 billion of the world’s children have been out of school for significant periods of time and millions are being driven into extreme poverty and face a very uncertain future. We’ve made huge progress in the last twenty years on children’s rights and COVID-19 risks reversing this progress.”

Support our Children’s Emergency Fund help to address the immediate and long-term threats of COVID-19.

LEARN MORE ABOUT COVID-19 AROUND THE WORLD

The 6 Biggest Challenges Facing Children in 2022

How Learning Loss Due to COVID Is Impacting America’s Kids

In Photos: A Timeline of the War in Syria

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How Is the Coronavirus Outbreak Affecting Your Life?

How are you staying connected and sane in a time of social distancing?

By Jeremy Engle

Find all our Student Opinion questions here.

Note: The Times Opinion section is working on an article about how the coronavirus outbreak has disrupted the lives of high school students. To share your story, fill out this form .

The coronavirus has changed how we work , play and learn : Schools are closing, sports leagues have been canceled, and many people have been asked to work from home.

On March 16, the Trump administration released new guidelines to slow the spread of the coronavirus, including closing schools and avoiding groups of more than 10 people, discretionary travel, bars, restaurants and food courts.

How are you dealing with these sudden and dramatic changes to how we live? Are you practicing social distancing — and are you even sure what that really means?

In “ Wondering About Social Distancing? ” Apoorva Mandavilli explains the term and offers practical guidance from experts:

What is social distancing? Put simply, the idea is to maintain a distance between you and other people — in this case, at least six feet. That also means minimizing contact with people. Avoid public transportation whenever possible, limit nonessential travel, work from home and skip social gatherings — and definitely do not go to crowded bars and sporting arenas. “Every single reduction in the number of contacts you have per day with relatives, with friends, co-workers, in school will have a significant impact on the ability of the virus to spread in the population,” said Dr. Gerardo Chowell, chair of population health sciences at Georgia State University. This strategy saved thousands of lives both during the Spanish flu pandemic of 1918 and, more recently, in Mexico City during the 2009 flu pandemic.

The article continues with expert responses to some common questions about social distancing. Here are excerpts from three:

I’m young and don’t have any risk factors. Can I continue to socialize? Please don’t. There is no question that older people and those with underlying health conditions are most vulnerable to the virus, but young people are by no means immune. And there is a greater public health imperative. Even people who show only mild symptoms may pass the virus to many, many others — particularly in the early course of the infection, before they even realize they are sick. So you might keep the chain of infection going right to your own older or high-risk relatives. You may also contribute to the number of people infected, causing the pandemic to grow rapidly and overwhelm the health care system. If you ignore the guidance on social distancing, you will essentially put yourself and everyone else at much higher risk. Experts acknowledged that social distancing is tough, especially for young people who are used to gathering in groups. But even cutting down the number of gatherings, and the number of people in any group, will help. Can I leave my house? Absolutely. The experts were unanimous in their answer to this question. It’s O.K. to go outdoors for fresh air and exercise — to walk your dog, go for a hike or ride your bicycle, for example. The point is not to remain indoors, but to avoid being in close contact with people. You may also need to leave the house for medicines or other essential resources. But there are things you can do to keep yourself and others safe during and after these excursions. When you do leave your home, wipe down any surfaces you come into contact with, disinfect your hands with an alcohol-based sanitizer and avoid touching your face. Above all, frequently wash your hands — especially whenever you come in from outside, before you eat or before you’re in contact with the very old or very young. How long will we need to practice social distancing? That is a big unknown, experts said. A lot will depend on how well the social distancing measures in place work and how much we can slow the pandemic down. But prepare to hunker down for at least a month, and possibly much longer. In Seattle, the recommendations on social distancing have continued to escalate with the number of infections and deaths, and as the health system has become increasingly strained. “For now, it’s probably indefinite,” Dr. Marrazzo said. “We’re in uncharted territory.”

Abdullah Shihipar writes in an Opinion essay, “ Coronavirus and the Isolation Paradox ,” that while social distancing is required to prevent infection, loneliness can make us sick:

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• Iran J Med Sci
• v.45(4); 2020 Jul

A Narrative Review of COVID-19: The New Pandemic Disease

Kiana shirani, md.

1 Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Erfan Sheikhbahaei, MD

2 Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Zahra Torkpour, MD

Mazyar ghadiri nejad, phd.

3 Industrial Engineering Department, Girne American University, Kyrenia, TRNC, Turkey

Bahareh Kamyab Moghadas, PhD

4 Department of Chemical Engineering, Shiraz Branch, Islamic Azad University, Shiraz, Iran

Matina Ghasemi, PhD

5 Faculty of Business and Economics, Business Department, Girne American University, Kyrenia, TRNC, Turkey

Hossein Akbari Aghdam, MD

6 Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Athena Ehsani, PhD

7 Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran

Saeed Saber-Samandari, PhD

8 New Technologies Research Center, Amirkabir University of Technology, Tehran, Iran

Amirsalar Khandan, PhD

9 Department of Electrical Engineering, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran

10 0Technology Incubator Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran

Nearly every 100 years, humans collectively face a pandemic crisis. After the Spanish flu, now the world is in the grip of coronavirus disease 2019 (COVID-19). First detected in 2019 in the Chinese city of Wuhan, COVID-19 causes severe acute respiratory distress syndrome. Despite the initial evidence indicating a zoonotic origin, the contagion is now known to primarily spread from person to person through respiratory droplets. The precautionary measures recommended by the scientific community to halt the fast transmission of the disease failed to prevent this contagious disease from becoming a pandemic for a whole host of reasons. After an incubation period of about two days to two weeks, a spectrum of clinical manifestations can be seen in individuals afflicted by COVID-19: from an asymptomatic condition that can spread the virus in the environment, to a mild/moderate disease with cold/flu-like symptoms, to deteriorated conditions that need hospitalization and intensive care unit management, and then a fatal respiratory distress syndrome that becomes refractory to oxygenation. Several diagnostic modalities have been advocated and evaluated; however, in some cases, diagnosis is made on the clinical picture in order not to lose time. A consensus on what constitutes special treatment for COVID-19 has yet to emerge. Alongside conservative and supportive care, some potential drugs have been recommended and a considerable number of investigations are ongoing in this regard

What’s Known

• Substantial numbers of articles on COVID-19 have been published, yet there is controversy among clinicians and confusion among the general population in this regard. Furthermore, it is unreasonable to expect physicians to read all the available literature on this subject.

What’s New

• This article reviews high-quality articles on COVID-19 and effectively summarizes them for healthcare providers and the general population.

Introduction

A pathogen from a human-animal virus family, the coronavirus (CoV), which was identified as the main cause of respiratory tract infections, evolved to a novel and wild kind in Wuhan, a city in Hubei Province of China, and spread throughout the world, such that it created a pandemic crisis according to the World Health Organization (WHO). CoV is a large family of viruses that were first discovered in 1960. These viruses cause such diseases as common colds in humans and animals. Sometimes they attack the respiratory system, and sometimes their signs appear in the gastrointestinal tract. There have been different types of human CoV including CoV-229E, CoV-OC43, CoV-NL63, and CoV-HKU1, with the latter two having been discovered in 2004 and 2005, respectively. These types of CoV regularly cause respiratory infections in children and adults. 1 There are also other types of these viruses that are associated with more severe symptoms. The new CoV, scientifically known as “SARS-CoV-2”, causes severe acute respiratory syndrome (SARS). 2 A newer type of the virus was discovered in September 2012 in a 60-year-old man in Saudi Arabia who died of the disease; the man had traveled to Dubai a few days earlier. The second case was a 49-year-old man in Qatar who also passed away. The discovery was first confirmed at the Health Protection Agency’s Laboratory in Colindale, London. The outbreak of this CoV is known as the Middle East Respiratory Syndrome (MERS), commonly referred to as “MERS-CoV”. The virus has infected 2260 people and has killed 912, most of them in the Middle East. 3 - 5 Finally, in December 2019, for the first time in Wuhan, in Hubei Province of China, a new type of CoV was identified that caused pneumonia in humans. 6 SARS-CoV-2 has affected 5404512 people and killed more than 343514 around the world according to the WHO situation report-127 (May 26, 2020). 3 , 7 - 10 The WHO has officially termed the disease “COVID-19”, which refers to corona, the virus, the disease, the year 2019, and its etiology (SARS-CoV-2). This type of CoV had never been seen in humans before. The initial estimates showed a mortality rate ranging from between 1% and 3% in most countries to 5% in the worst-hit areas ( Figure 1 ). 9 Some Chinese researchers succeeded in determining how SARS-CoV-2 affects human cells, which could help to develop techniques of viral detection and had antiviral therapy potential. Via a process termed “cryogenic electron microscopy (cryo-EM)”, these scientists discovered that CoV enters human cells utilizing a kind of cell membrane glycoprotein: angiotensin-converting enzyme 2 (ACE2). Then, the S protein is split into two sub-units: S1 and S2. S1 keeps a receptor-binding domain (RBD); accordingly, SARS-CoV-2 can bind to the peptidase domain of ACE2 directly. It appears that S2 subsequently plays a role in cellular fusion. Chinese researchers used the cryo-EM technique to provide ACE2 when it is linked to an amino acid transporter called “B0AT1”. They also discovered how to connect SARS-CoV-2 to ACE2-B0AT1, which is another complex structure. Given that none of these molecular structures was previously known, the researchers hoped that these studies would lead to the development of an antiviral or vaccine that would help to prevent CoV. Along the way, scientists found that ACE2 has to undergo a molecular process in which it binds to another molecule to be activated. The resulting molecule can bind two SARS-CoV-2 protein molecules simultaneously. The scientists also studied different SARS-CoV-2 RBD binding methods compared with other SARS-CoV-RBDs, which showed how subtle changes in the molecular binding sequence make the coronal structure of the virus stronger.

Most cases with SARS-CoV-2 are asymptomatic or have mild clinical pictures such as influenza and colds. This group of patients should be detected and isolated in their homes to break the transmission chain of the disease and adhere to the precautionary recommendations in order not to infect other people. The screening process will help this group and suppress the outbreak in the community. Patients with the confirmed disease who are admitted to hospitals can contaminate this environment, which should be borne in mind by healthcare providers and policymakers.

Transmission

While the first mode of the transmission of COVID-19 to humans is still unknown, a seafood market where live animals were sold was identified as a potential source at the beginning of the outbreak in the epidemiologic investigations that found some infected patients who had visited or worked in that place. The other viruses in this family, namely MERS and SARS, were both confirmed to be zoonotic viruses. Afterward, the person-to-person spread was established as the main mode of transmission and the reason for the progression of the outbreak. 11 Similar to the influenza virus, SARS-CoV-2 spreads through the population via respiratory droplets. When an infected person coughs, sneezes, or talks, the respiratory secretions, which contain the virus, enter the environment as droplets. These droplets can reach the mucous membranes of individuals directly or indirectly when they touch an infected surface or any other source; the virus, thereafter, finds its ways to the eyes, nose, or mouth as the first incubation places. 11 - 15 It has been reported that droplets cannot travel more than two meters in the air, nor can they remain in the air owing to their high density. Nonetheless, given the other hitherto unknown modes of transmission, routine airborne transmission precautions should be considered in high-risk countries and during high-risk procedures such as manual ventilation with bags and masks, endotracheal intubation, open endotracheal suctioning, bronchoscopy, cardiopulmonary resuscitation, sputum induction, lung surgery, nebulizer therapy, noninvasive positive pressure ventilation (eg, bilevel positive airway pressure and continuous positive airway pressure ), and lung autopsy. In the early stages of the disease, the chances of the spread of the virus to other persons are high because the viral load in the body may be high despite the absence of any symptoms ( Figure 2 ). 11 - 13 The person-to-person transmission rates can be different depending on the location and the infection control intervention; still, according to the latest reports, the secondary COVID-19 infection rate ranges from 1% to 5%. 13 - 23 Although the RNA of the virus has been detected in blood and stool, fecal-oral and blood-borne transmissions are not regarded as significant modes of transmission yet. 19 - 26 There have been no reports of mother-to-fetus transmission in pregnant women. 27

SARS-CoV-2 mode of transmission and clinical manifestations are illustrated in this figure. The potential source of this outbreak was identified to be from animals, similar to MERS and SARS, in epidemiologic studies; nonetheless, person-to-person transmission through droplets is currently the important mode. After reaching mucous membranes by direct or indirect close contact, the virus replicates in the cells and the immune system attacks the body due to its nature. Afterward, the clinical pictures appear, which are much more similar to influenza. However, different patients will have a spectrum of signs and symptoms.

Source Investigation

Recently, the appearance of SARS-CoV-2 in society shocked the healthcare system. 28 - 32 Veterinary corona virologists reported that COVID-19 was isolated from wildlife. Several studies have shown that bats are receptors of the CoV new version in 2019 with variants and changes in the environment featuring various biological characteristics. 33 - 36 The aforementioned mammals are a major source of CoV, which causes mild-to-severe respiratory illness and can even be deadly. In recent years, the virus has killed several thousands of people of all ages. 37 - 39 The mutated alternative of the virus can be transmitted to humans and cause acute respiratory distress. 40 , 41 One of the main causes of the spread of the virus is the exotic and unusual Chinese food in Wuhan: CoV is a direct result of the Chinese food cycle. The virus is found in the body of animals such as bats, 42 and snake or bat soup is a favorite Chinese food. Therefore, this sequence is replicated continuously. Almost everyone who was infected for the first time was directly in the local Wuhan market or had indirectly tried snake or bat soup in a Chinese restaurant. An investigation stated that the Malayan pangolin (Manis javanica) was a possible host for SARS-CoV-2 and recommended that it be removed from the wet market to prevent zoonotic transmissions in the future. 43 , 44

Pathogenesis

The important mechanisms of the severe pathogenesis of SARS-CoV-2 are not fully understood. Extensive lung injury in SARS-CoV-2 has been related to increased virus titers; monocyte, macrophage, and neutrophil infiltrations into the lungs; and elevated levels of pro-inflammatory cytokines and chemokines. Thus, the clinical exacerbation of SARS-CoV-2 infection may be in consequence of a combination of direct virus-induced cytopathic and immunopathological effects due to excessive cytokinesis. Changes in the cytokine/chemokine profile during SARS infection showed increased levels of circulating cytokines such as tumor necrosis factor-α (TNF-α), C–X–C motif chemokine 10 (CXCL10), interleukin (IL)-6, and IL-8 levels, in conjunction with elevated levels of serum pro-inflammatory cytokines such as IL-1, IL-6, IL-12, interferon-gamma (IFN-γ), and transforming growth factor-β (TGF-β). Nevertheless, constant stimulation by the virus creates a cytokine storm that has been related to acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndromes (MODS) in patients with COVID-19, which may ultimately lead to diminished immunity by lowering the number of CD4+ and CD8+ T cells and natural killer cells (crucial in antiviral immunity) and decreasing cytokine production and functional ability (exhaustion). It has been shown that IL-10, an inhibitory cytokine, is a major player and a potential target for therapeutic aims. 45 - 51 Severe cases of COVID-19 have respiratory distress and failure, which has been linked to the altered metabolism of heme by SARS-CoV-2. Some virus proteins can dissociate iron from porphyrins by attacking the 1-β chain of hemoglobin, which decreases the oxygen-transferring ability of hemoglobin. Research has also indicated that chloroquine and favipiravir might inhibit this process. 52

Clinical Manifestations

SARS-CoV-2, which attacks the respiratory system, has a spectrum of manifestations; nonetheless, it has three main primary symptoms after an incubation period of about two days to two weeks: fever and its associated symptoms such as malaise/fatigue/weakness; cough, which is nonproductive in most of the cases but can be productive indeed; and shortness of breath (dyspnea) due to low blood oxygenation. Although these symptoms appear in the body of the affected person over two to 14 days, patients may refer to the clinic with gastrointestinal symptoms (nausea/vomiting-diarrhea) or decreased sense of smell and/or taste. More devastatingly, however, patients may refer to the emergency room with such coagulopathies as pulmonary thromboembolism, cerebral venous thrombosis, and other related manifestations. The WHO has stated that dry throat and dry cough are other symptoms detected in the early stages of the infection. 53 , 54 The estimations of the severity of the disease are as follows: mild (no or mild pneumonia) in 81%, severe (eg, with dyspnea, hypoxia, or >50% lung involvement on imaging within 24 to 48 hours) in 14%, and critical (eg, with respiratory failure, shock, or multiorgan dysfunction) in 5%. In the early stages, the overall mortality rate was 2.3% and no deaths were observed in non-severe patients. Patients with advanced age or underlying medical comorbidities have more mortality and morbidity. 55 Although adults of middle age and older are most commonly affected by SARS-CoV-2, individuals at any age can be infected. A few studies have reported symptomatic infection in children; still, when it occurs, it has mild symptoms. The vast majority of cases have the infection with no signs and symptoms or mild clinical pictures; they are called “the asymptomatic group”. These patients do not seek medical care and if they come into close contact with others, they can spread the virus. Therefore, quarantine in their home is the best option for the population to break the transmission of the virus. It should be considered that some of these asymptomatic patients have clinical signs such as chest computed tomography scan (CT-Scan) infiltrations. Similar to bacterial pneumonia, lower respiratory signs and symptoms are the most frequent manifestations in serious cases of COVID-19, characterized by fever, cough, dyspnea, and bilateral infiltrates on chest imaging. In a study describing pneumonia in Wuhan, the most common clinical signs and symptoms at the onset of the illness were fever in 99% (although fever might not be a universal finding), fatigue in 70%, dry cough in 59%, anorexia in 40%, myalgia in 35%, dyspnea in 31%, and sputum production in 27%. Headache, sore throat, and rhinorrhea are less common, and gastrointestinal symptoms (eg, nausea and diarrhea) are relatively rare. 7 , 42 , 43 , 45 - 48 , 56 , 57 According to our clinical experience in Iran, anosmia, atypical chest pain, diarrhea, nausea/vomiting, and hemoptysis are other presenting symptoms in the clinic. It should be noted that COVID-19 has some unexplained potential complications such as secondary bacterial infections, myocarditis, central nervous system injury, cerebral edema, MODS, acute demyelinating encephalomyelitis (ADEM), kidney injury, liver injury, new-onset seizure, coagulopathy, and arrhythmias.

Laboratory data : Complete blood counts, which constitute a routine laboratory test, have shown different results in terms of the white blood cell count: from leukopenia and lymphopenia to leukocytosis, although lymphopenia appears to be the most common. Fatal cases have exhibited severe lymphopenia accompanied by an increased level of D-dimer. Liver function enzymes can be increased; however, it is not sufficient to diagnose a disease. The serum procalcitonin level is a marker of infection, especially in bacterial diseases. Patients with COVID-19 who require intensive care unit (ICU) management may have elevated procalcitonin. Increased urea and creatinine, creatinine-phosphokinase, lactate dehydrogenase, and C-reactive protein are other findings in some cases. 7 , 56 , 57

Imaging studies : Routine chest X-ray (CXR) is widely deemed the first-step management to evaluate any respiratory involvement. Although negative findings in CXR do not rule out the viral disease, patients without common findings do not have severe disease and can, consequently, be managed in the outpatient setting. 58 , 59 Another modality is chest CT-Scan. It can be ordered in suspected cases with typical symptoms at the first step, or it can be performed after the detection of any abnormalities in CXR. The most common demonstrations in CT-Scan images are ground-glass opacification, round opacities, and crazy paving with or without bilateral consolidative abnormalities (multilobar involvement) in contrast to most cases of bacterial pneumonia, which have locally limited involvement. Pleural thickening, pleural effusion, and lymphadenopathy are less common. 58 - 61 Tree-in-bud, peribronchial distribution, nodules, and cavity are not in favor of common COVID-19 findings. Although reverse transcriptase-polymerase chain reaction (RT-PCR) is used to confirm the diagnosis, it is a time-consuming procedure and has high false-negative/false-positive findings; hence, in the emergency clinical setting, CT-Scan findings can be a good approach to make the diagnosis. It is deserving of note, however, that false-positive/false-negative cases were reported by one study to be high and other differential diagnoses should be in mind in order not to miss any other cases such as acute pulmonary edema in patients with heart disease.

Suspected cases should be diagnosed as soon as possible to isolate and control the infection immediately. COVID-19 should be considered in any patient with fever and/or lower respiratory tract symptoms with any of the following risk factors in the previous 2 weeks: close contact with confirmed or suspected cases in any environment, especially at work in healthcare places without sufficient protective equipment or long-time standing in those places, and living in or traveling from well-known places where the disease is an epidemic. 61 - 66 Patients with severe lower respiratory tract disease without alternative etiologies and a clear history of exposure should be considered having COVID-19 unless confirmed otherwise. According to the Centers for Disease Control and Prevention (CDC), sending tests to check SARS-CoV-2 in suspected cases is based on physicians’ clinical judgment. Although there are some positive cases without clinical manifestations (ie, fever and/or symptoms of acute respiratory illness such as cough and dyspnea), infectious disease and control centers should take action in society to limit the exposure of such patients to other healthy individuals. The CDC prioritizes the use of the specific test for hospitalized patients, symptomatic patients who are at risk of fatal conditions (eg, age ≥65 y, chronic medical conditions, and immunocompromising conditions) and those who have exposure risks (recent travel, contact with patients with COVID-19, and healthcare workers). 61 - 66 Although treatment should be started after the confirmation of the disease, RT-PCR for highly suspected cases is a time-consuming test; accordingly, a considerable number of clinicians favor the use of a combination of clinical manifestations with imaging modalities (eg, CT-Scan findings) and their clinical judgment regarding the probability of the disease in order not to lose more time. 61 - 66

Treatment of COVID-19

There is no confirmed recommended treatment or vaccine for SARS-CoV-2; prevention is, therefore, better than treatment. Nevertheless, the high contagiousness of COVID-19, combined with the fact that some individuals fail to adhere to precautionary measures or they have significant risk factors, means that this infectious disease is inevitable in some people. Beside supportive treatments, many types of medications have been introduced. These medications come from previous experimental studies on SARS, MERS, influenza, or human immunodeficiency virus (HIV); hence, their efficacy needs further experimental and clinical approval. Patients with mild symptoms who do not have significant risk factors should be managed in their home like a self-made quarantine (in an isolated room); still, prompt hospital admission is required if patients exhibit signs of disease deterioration. 25 , 67 , 68 Isolation from other family members is an important prevention tip. Patients should wear face masks, eat healthy and warm foods similar to when struggling with influenza or colds, do the handwashing process, dispose of the contaminated materials cautiously, and disinfect suspicious surfaces with standard disinfectants. 69 Patients with severe symptoms or admission criteria should be hospitalized with other patients who have the same disease in an isolated department. When the disease is progressed, ICU care is mandatory. 25 , 67 , 68 SARS-CoV-2 attacks the respiratory system, diminishing the oxygenation process and forcing patients with low blood oxygen saturation to take extra oxygen from different modalities. Nasal cannulae, face masks with or without a reservoir, intubation in severe cases, and then extracorporeal membrane oxygenation in refractory hypoxia have been used; however, the safety and efficacy of these measures should be evaluated. As was mentioned above, impaired coagulation is one of the major complications of the disease; consequently, alongside all recommended supportive care and drugs, anticoagulants such as heparin should be administered prophylactically ( Table 1 ). Although it is said that all the clinical signs and symptoms of COVID-19 are induced by the immune system, as other research on influenza and MERS has revealed, glucocorticoids are not recommended in COVID-19 pneumonia unless other indications are present (eg, exacerbation of chronic obstructive pulmonary disease and refractory septic shock) due to the high risk of mortality and delayed viral clearance. Earlier in the national and international guidelines, nonsteroidal anti-inflammatory drugs such as naproxen were recommended on the strength of their antipyretic and anti-inflammatory components; however, the guideline has been revised recently and acetaminophen with or without codeine is currently the favored drug in patients with COVID-19. 25 , 67 , 68 According to the pathogenesis of the disease, whereby cytokine storm and immune-cell exhaustion can be seen in severe cases, selective antibodies against harmful interleukins such as IL-6 and IL-10 or other possible agents can be therapeutic for fatal complications. Tocilizumab, an IL-6 inhibitor, albeit with limited clinical efficacy, has been introduced in China’s National Health Commission treatment guideline for severe infection with profound pulmonary involvement (ie, white lung). 70 , 87

Summary of possible anti-COVID-19 drugs

mg, Milligrams; BD, Every 12 hours; RdRP, RNA-dependent RNA polymerase; TDS, Every 8 hours; IV, Intravenous; IL, Interleukin; μg, Micrograms

RNA synthesis inhibitors (eg, tenofovir disoproxil fumarate and 2’-deoxy-3’-thiacytidine [3TC]), neuraminidase inhibitors (NAIs), nucleoside analogs, lopinavir/ritonavir, atazanavir, remdesivir, favipiravir, INF-β, and Chinese traditional medicine (eg, Shufeng Jiedu and Lianhuaqingwen capsules) are the major candidates for COVID-19. 26 , 70 , 85 , 88 - 96 Antiviral drugs have been investigated for various diseases, but their efficacy in the treatment of COVID-19 is under investigation and several randomized clinical trials are ongoing to release a consensus result on the treatment of this infectious disease. Moderate-to-severe SARS-CoV-2 disease needs drug therapy. Favipiravir, a previously validated drug for influenza, is a drug that has shown promising results for COVID-19 in experimental and clinical studies, but it is under further evaluation. 70 , 79 , 80 Remdesivir, which was developed for Ebola, is an antiviral drug that is under evaluation for moderate-to-severe COVID-19 owing to its promising results in in vitro investigations. 70 , 73 - 75 , 81 Remdesivir was shown to have reduced the virus titer in infected mice with MERS-CoV and improved lung tissue damage with more efficiency compared with a group treated with lopinavir/ritonavir/INF-β. 67 , 70 Another investigation studied the potential efficacy of INF-β-1 in the early stages of COVID-19 as a potential antiviral drug. 86 Although there is some hope, an evidence-based consensus requires further clinical trials. 70 , 77 A combined protease inhibitor, lopinavir/ritonavir, is used for HIV infection and has shown interesting results for SARS and MERS in in vitro studies. 73 - 75 The clinical effectiveness of lopinavir/ritonavir for SARS-CoV-2 was also reported in a case report. 70 , 71 , 74 , 76 Atazanavir, another protease inhibitor, with or without ritonavir is another possible anti-COVID-19 treatment. 77 , 78 NAIs, including oseltamivir, zanamivir, and peramivir, are recommended as antiviral treatment in influenza. 68 Oral oseltamivir was tried for COVID-19 in China and was first recommended in the Iranian guideline for COVID-19 treatment; nevertheless, because of the absence of strong evidence indicating its efficacy for SARS-CoV-2, it was eliminated from the subsequent updates of the guideline. 85 RNA-dependent RNA polymerase inhibitors with anti-hepatitis C effects such as ribavirin have shown satisfactory results against SARS-CoV-2 RNA polymerase; however, they have limited clinical approval. 82 - 84 The well-known drugs for rheumatoid arthritis, systemic lupus erythematosus, and an antimalarial drug, chloroquine 71 and hydroxychloroquine 21 are other potential drugs for moderate-to-severe COVID-19 but with limited or no clinical appraisal. Hydroxychloroquine has exhibited better safety and fewer side effects than chloroquine, which makes it the preferred choice. 70 Furthermore, the immunomodulatory effects of hydroxychloroquine can be used to control the cytokine precipitation in the late phases of SARS-CoV-2 infections. There are numerous mechanisms for the antiviral activity of hydroxychloroquine. A weak base drug, hydroxychloroquine concentrates on such intracellular sections as endosomes and lysosomes, thereby halting viral replication in the phase of fusion and uncoating. Additionally, this immunosuppressive and antiparasitic drug is capable of altering the glycosylation of ACE2 and inhibiting both S-protein binding and phagocytosis. 72 A recent multicenter study showed that regarding the risks of cardiovascular adverse effects and mortality rates, hydroxychloroquine or chloroquine with or without a macrolide (eg, azithromycin) was not beneficial for hospitalized patients, although further research is needed to end such controversies. 97

Disease Duration

It is not easy to quarantine the patients who have fully recovered because there is evidence that they are highly infectious. 81 The recovery time for confirmed cases based on the National Health Commission reports of China’s government was estimated to range between 18 and 22 days. 73 As indicated by the WHO, the healing time seems to be around two weeks for moderate infections and 3 to 6 weeks for the severe/ serious disease. 75 Pan Feng and others studied 21 confirmed cases with COVID-19 pneumonia with about 82 CT-Scan images with a mean interval of four days. Lung abnormalities on chest CT showed the highest severity approximately 10 days after the initial onset of symptoms. All patients became clear after 11 to 26 days of hospitalization. From day zero to day 26, four stages of lung CT were defined as follows: Stage 1 (first 4 days): ground-glass opacities; Stage 2 (second 4 days): crazy-paving patterns; Stage 3 (days 9–13): maximum total CT scores in the consolidations; and Stage 4 (≥14 d): steady improvements in the consolidations with a reduction in the total CT score without any crazy-paving pattern. 74 Nevertheless, there are also rare cases reported from some studies that show the recurrence of COVID-19 after negative preliminary RT-PCR results. For example, Lan and othersstudied one hospitalized and three home-quarantined patients with COVID-19 and evaluated them with RT-PCR tests of the nucleic acid. All the patients with positive RT-PCR test results had CT imaging with ground-glass opacification or mixed ground-glass opacification and consolidation with mild-to-moderate disease. After antiviral treatments, all four patients had two consecutive negative RT-PCR test results within 12 to 32 days. Five to 13 days after hospital discharge or the discontinuation of the quarantine, RT-PCR tests were repeated, and all were positive. An additional RT-PCR test was performed using a kit from a different manufacturer, and the results were also positive. Their findings propose that a minimum percentage of recovered patients may still be infection carriers. 76

Supplements for COVID-19

Since the appearance of SARS-CoV-2 in Wuhan, China, there have been reports of the unreliable and unpredictable use of mysterious therapies. Some recommendations such as the use of certain herbs and extracts including oregano oil, mulberry leaf, garlic, and black sesame may be safe as long as people do not utilize their hands for instance. 98 According to data released by the CDC, vitamin C (VitC) supplements can decrease the risk of colds in people besides preventing CoV from spreading. The aforementioned organization states that frequent consumption of VitC supplements can also decrease the duration of the cold; however, if used only after the cold has risen, its consumption does not influence the disease course. VitC also plays an important role in the body. One of the main reasons for taking VitC is to strengthen the immune system because this vitamin plays a significant part in the immune system. Firstly, VitC can increase the production of white blood cells (lymphocytes and phagocytes) in the bone marrow, which can support and protect the body against infections. Secondly, VitC helps immune cells to function better while preserving white blood cells from damaging molecules such as free oxidative radicals and ions. Thirdly, VitC is an essential part of the skin’s immune system. This vitamin is actively transported to the skin surface, where it serves as an antioxidant and helps to strengthen the skin barrier by optimizing the collagen synthesis process. Patients with pneumonia have lower levels of VitC and have been revealed to have a longer recovery time. 69 , 99 In a randomized investigation, 200 mg/d of VitC was applied to older patients and resulted in improvements in the respiratory symptoms. Another investigation reported 80% fewer mortalities in a controlled group of VitC takers. 73 However, for effective immune system improvement, VitC should be consumed alongside adequate doses of several other supplements. Although VitC plays an important role in the body, often a balanced diet and the consumption of fresh fruits and vegetables can quickly fill the blanks. While taking high amounts of VitC is less risky because it is water-soluble and its waste is eliminated in the urine, it can induce diarrhea, nausea, and abdominal spasms at higher concentrations. Too much VitC may cause calcium-oxalate kidney stones. People with genetic hemochromatosis, an iron deficiency disorder, should consult a physician before taking any VitC supplements as high levels of VitC can lead to tissue damage. Some studies have evaluated the different doses of oral or intravenous VitC for patients admitted to the hospital for COVID-19. Although they used different regimens, all of them demonstrated satisfactory results regarding the resolution of the compilations of the disease, decreased mortality, and shortened lengths of stay in the ICU and/or the hospital. 100 , 101 Immunologists have also recommended 6 000 units of vitamin A (VitA) per day for two weeks, more than twice the recommended limit for VitA, which can create a poisoning environment over time. According to the guidance of the National Institutes of Health (NIH), middle-aged men and women should take 1 and 2 mg of VitA every day, respectively. The safe upper limit of this vitamin is 6000 mg or 5000 units, and overdose can have serious outcomes such as dizziness, nausea, headache, coma, and even death. Extreme consumption of VitA throughout pregnancy can lead to birth anomalies.

Similar to VitC, vitamin D (VitD) has antioxidant, anti-inflammatory, and immune-modulatory effects in our body such as reducing pro-inflammatory cytokines and inhibiting viral replication according to experimental studies. 83 The VitD state of our body is checked through 25 (OH) VitD in the serum. VitD deficiency is pandemic around the world due to multifactorial reasons. It has been shown that VitD deficient patients are prone to SARS-CoV-2 and, accordingly, treating VitD deficiency is not without benefits. Grant and others recommended 10 000 units per day for two weeks and then 5 000 units per day as the maintenance dose to keep the level between 40 and 100 ng/mL. 102 VitD toxicity causes gastrointestinal discomfort (dyspepsia), congestion, hypercalcemia, confusion, positional disorders, dysrhythmia, and kidney dysfunction.

James Robb, 103 a researcher who detected CoV for the first time as a consultant pathologist with the National Cancer Institute of America, suggested the influence of zinc consumption. Oral zinc supplements can be dissolved in the nback of the throat. Short-term therapy with oral zinc can decrease the duration of viral colds in adults. Zinc intake is also associated with the faster resolution of nasal congestion, nasal drainage, sore throats, and coughs. Researchers 104 , 105 have warned that the consumption of more than 1 mg of zinc a day can lead to zinc poisoning and have side effects such as lowered immune function. Children and old people with zinc insufficiency in developing nations are extremely vulnerable to pneumonia and other viral infections. It has also been determined that zinc has a major role in the production and activation of T-cell lymphocytes. 106 , 107

And finally, for high-risk people or those who work in high-risk places such as healthcare providers, hydroxychloroquine has been mentioned to be effective as a prophylactic regimen ( Table 2 ). Although different doses have been investigated so far, Pourdowlat and others recommended 200 mg daily before exposure, and for the post-exposure scenario, a loading dose of 600-800 mg followed by a maintenance dose of 200 mg daily. 74

Possible prophylactic regimens against SARS-CoV-2 infection

IU, International unit; mg, Milligrams; kg, Kilograms; ICU, Intensive care unit; g, Grams; IV, Intravenous; Vit, Vitamin; ng, Nanograms; mL, Milliliter

COVID-19 Kits and Deep Learning

COVID-19 has threatened public health, and its fast global spread has caught the scientific community by surprise. 108 Hence, developing a technique capable of swiftly and reliably detecting the virus in patients is vital to prevent the spreading of the virus. 109 , 110 One of the ways to diagnose this new virus is through RT-PCR, a test that has previously demonstrated its efficacy in detecting such CoV infections as MERS-CoV and SARS-CoV. Consequently, increasing the availability of RT-PCR kits is a worldwide concern. The timing of the RT-PCR test and the type of strain collected are of vital importance in the diagnosis of COVID-19. One of the characteristics of this new virus is that the serum is negative in the early stage, while respiratory specimens are positive. The level of the virus at the early stage of the illness is also high, even though the infected individual experiences mild symptoms. 111 For the management of the emerging situation of COVID-19 in Wuhan, various effective diagnostic kits were urgently made available to markets. While a few different diagnostics kits are used merely for research endeavors, only a single kit developed by the Beijing Genome Institute (BGI) called “Real-Time Fluorescent PCR” has been authenticated for clinical diagnostics. Fluorescent RT-PCR is reliable and able to offer fast results probably within a few hours (usually within two hours). Besides RT-PCR, China has successfully developed a metagenomic-sequencing kit based on combinatorial probe-anchor synthesis that can identify virus-related bacteria, allowing observation and evaluation during the transmission of the virus. Furthermore, the metagenomic-sequencing kit based on combinatorial probe-anchor synthesis is far faster than the abovementioned fluorescent RT-PCR kit. Apart from China, a Singapore-based laboratory, Veredus, developed a virus detection kit (Vere-CoV) in late January. It is a portable Lab-On-Chip used to detect MERS-CoV, SARS-CoV, and SARS-CoV-2, in a single examination. This kit works based on the VereChip™ technology, the lines of code (LOC) program incorporating two different influential molecular biological functions (microarray and PCR) precisely. Several studies have focused on SARS-CoV diagnostic testing. These papers have presented investigative approaches to the identification of the virus using molecular testing (ie, RT-PCR). Researchers probed into the use of a nested PCR technique that contains a pre-amplification step or integrating the N gene as an extra subtle molecular marker to improve on the sensitivity. 112 - 115 CT-Scan is very useful for diagnosing, evaluating, and screening infections caused by COVID-19. One recommendation for scanning the disease is to take a scan every three to five days. According to researchers, most CT-Scan images from patients with COVID-19 are bilateral or peripheral ground-glass opacification, with or without stabilization. Nowadays, because of a paucity of computerized quantification tools, only qualitative reports and sometimes inaccurate analyses of contaminated areas are drawn upon in radiology reports. A categorization system based on the deep learning approach was proposed by a study to automatically measure infected parts and their volumetric ratios in the lung. The functionality of this system was evaluated by making some comparisons between the infected portions and the manually-delineated ones on the CT-Scan images of 300 patients with COVID-19. To increase the manual drawing of training samples and the non-interference in the automated results, researchers adopted a human-based approach in collaboration with radiologists so as to segment the infected region. This approach shortens the time to about four minutes after 3-time updating. The mean Dice similarity coefficient illustrated that the automatically detected infected parts were 91.6% similar to the manually detected ones, and the average of the percentage estimated error was 0.3% for the whole lung. 116 , 117

Prevention Considerations

In the healthcare setting, any individual with the manifestations of COVID-19 (eg, fever, cough, and dyspnea) should wear a face mask, have a separate waiting area, and keep the distance of at least two meters. Symptomatic patients should be asked about recent travel or close contact with a patient in the preceding two weeks to find other possible infected patients. The CDC and WHO have announced special precautions for healthcare providers in the hospital and during different procedures. Wearing tight-fitting face masks with special filters and impermeable face shields is necessary for all of them. 11 , 18 , 65 , 66 , 76 , 118 - 124 Other people should pay attention to the CDC and WHO preventive strategies, which recommend that individuals not touch their eyes, mouth, and nose before washing or disinfecting their hands; wash their hands regularly according to the standard protocol; use effective disinfection solutions (ie, containing at least 60% ethylic alcohol) for contaminated surfaces; cover their mouth when coughing and sneezing; avoid waiting or walking in crowded areas, and observe isolation protocols in their home. Postponing elective work and decreasing non-urgent visits and traveling to areas in the grip of COVID-19 may be useful to lessen the risk of exposure. If suspected individuals with mild symptoms are managed in outpatient settings, an isolated room with minimal exposure to others should be designed. Patients and their caregivers should wear tight-fitting face masks. 11 , 18 , 65 , 66 , 76 , 118 - 124 Substantial numbers of individuals with COVID-19 are asymptomatic with potential exposure; accordingly, a screening tool should be employed to evaluate these cases. In addition to passport checks, corona checks have been incorporated into the protocols in airports and other crowded places. The use of a remote thermometer to measure body temperature leads to an increase in the number of false-negative cases. It is, thus, essential that everyone pay sufficient heed to the WHO and CDC recommendations in their daily life. Traveling is not prohibited, but it should be restricted and passengers from any country should be monitored. 11 , 18 , 65 , 66 , 76 , 118 - 124

SARS-CoV-2 is the new highly contagious CoV, which was first reported in China. While it had a zoonotic origin in the beginning, it subsequently spread throughout the world by human contact. COVID-19 has a spectrum of manifestations, which is not lethal most of the time. To diagnose this condition, physicians can avail themselves of laboratory and imaging findings besides signs and symptoms. RT-PCR is the gold standard, but it lacks sufficient sensitivity and specificity. Although there are some potential drugs for COVID-19 and some vitamins or minerals for prophylaxis, the best preventive strategies are quarantine (staying at home) and the use of personal protective equipment and disinfectants.

Acknowledgement

The authors express their gratitude toward the Supporting Organizations for Foreign Iranian Students, Islamic Azad University Isfahan (Khorasgan) Branch, and Isfahan University of Medical Sciences.

Conflict of Interest: None declared.

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WHO Director-General's keynote speech at the Global Pandemic Preparedness Summit

Good morning, everyone. It’s a real pleasure to be back in London, of course I consider myself as a Londoner because I studied here, and to see so many friends and colleagues again in person.

My thanks to CEPI and to the Government of the United Kingdom for your hospitality, and for your support – not just for this event, but for global health. 

I remember coming here to the Science Museum when I was a student at the London School of Hygiene and Tropical Medicine more than 30 years ago.

As it did then, this museum continues to tell a powerful story – the story of how science, research and innovation have transformed our world, and enabled millions of people to live longer and healthier lives. 

Perhaps no single innovation has done that more powerfully than vaccines.

Almost 200 years since the death of Edward Jenner, we all continue to benefit from the incredible gift he gave the world – a gift that has changed the course of history and changed the course of the COVID-19 pandemic.

I’m particularly delighted that Dame Sarah Gilbert is with us today. Dame Sarah, thank you for your life of science and service, and thank you for the lives you and your colleagues have helped to save in this pandemic. My respect and appreciation.

Today, on International Women’s Day, I also want to acknowledge the many women who have made such an incredible contribution to science and health, starting from our own Chief Scientist, Soumya Swaminathan, who is here with us today. 

In the wake of the West African Ebola epidemic, there was a collective realization that the world needed a much more robust approach to research and development of countermeasures against pathogens with epidemic and pandemic potential. 

The WHO Research and Development Blueprint was born: a global strategy for fast-tracking the development of tests, vaccines and medicines during epidemics. 

WHO developed research roadmaps, target product profiles and trial designs to evaluate tools for a set of priority diseases, including two coronaviruses – those that cause MERS and SARS – and an as-yet unidentified disease – which we called Disease X. 

There was also the recognition that this effort would need to be supported by significant investments, and so CEPI was born two years later.

Little did we know then that Disease X was just around the corner, in the form of a new coronavirus.

The collaboration between WHO, CEPI and other partners under the R&D Blueprint helped give vaccine development for COVID-19 a head-start once we had the sequence of SARS-CoV-2. 

And CEPI’s partnership in the ACT Accelerator has been vital in supporting the rapid development of multiple vaccines, including three that have received WHO Emergency Use Listing.

But of course, COVID-19 will not be the last Disease X.

Epidemics and pandemics are a fact of nature, exacerbated in our time by urbanization, encroachment on habitats, the climate crisis and insecurity.

There can be no health without peace, and no peace without health – and that is true everywhere, from Ethiopia to Syria, Yemen and Ukraine. 

As we speak, WHO is working to deliver humanitarian assistance in Ukraine, but the real solution to this crisis is peace. What’s happening in Ukraine is beyond heart-breaking. 

So, I call on the Russian Federation to commit to a peaceful resolution of this crisis, and to allow unhindered access to humanitarian assistance for those in need. A peaceful resolution is possible. Let’s give it a chance.

Dear colleagues and friends,

It’s right that we are here to think about the future, and how to prevent, prepare for respond rapidly to future pandemics.

At the same time, we must remain focused on ending the pandemic we are in. 

This pandemic is not over anywhere until it is over everywhere. 

I am often asked what the lessons of the pandemic are. 

Of course, as you know, there are many.

Several of them were mentioned yesterday: the historic under-investment in public health; the infodemic of mis- and disinformation; and the deficit of trust.

But let me highlight three specific lessons as they relate to CEPI, our CEPI. 

First, a commitment to science and research.

The pandemic has taught us the incredible power of surveillance, genomics, diagnostics, vaccines and therapeutics.

But it has also exposed gaps and weaknesses in the global ecosystem.

WHO is working with our Member States and partners to fill some of those gaps, including through the new WHO Hub for Epidemic and Pandemic Intelligence in Berlin, the WHO BioHub System for sharing pathogens in Geneva, and the soon-to-be-launched Global Genomics Surveillance strategy for pathogens with pandemic and epidemic potential. 

We also welcome the International Pathogen Surveillance Network, initiated under the UK’s G7 Presidency.

But it’s clear that we also need to strengthen efforts to develop, evaluate and distribute vaccines, tests and treatments as rapidly and equitably as possible when a new pathogen emerges.

That’s why I welcome CEPI’s 100 Days Mission and urge donors to fully fund CEPI’s 3.5 billion US dollar investment case. 

But the pandemic has also taught us that science can actually serve to widen inequalities rather than narrow them, which leads me to my second lesson: a commitment to equity.

As we speak, 83% of the population of Africa is yet to receive a single dose of vaccine, and there is an even wider discrepancy in access to tests.

This was a problem we saw coming, which is why we established the ACT Accelerator, which includes COVAX, almost two years ago.

More recently we have also established the mRNA Technology Transfer Hub in South Africa, which has now developed its own vaccine candidate, and 13 countries have been approved to receive technology from the Hub.

We have shown that these mechanisms work, but it has also become obvious that equity cannot be left to market forces, or goodwill, or shifting geopolitical currents.

Which brings me to the third lesson: a commitment to partnership.

In the face of a global threat, no single country, organization or agency can go it alone.

Responding quickly and effectively requires close collaboration between partners, leveraging their collective strength.

There is now a strong global consensus on the need for an enhanced global health architecture for pandemic prevention, preparedness and response, with an empowered and sustainably financed WHO at its core, playing the leading, coordinating and normative role on which so many countries and partners depend.

As you know, WHO’s Member States are now negotiating a new international accord, to establish the rules of the road for a more cohesive and harmonised global response to future epidemics and pandemics – including the equitable sharing of countermeasures.

Ahead of the World Health Assembly in May, WHO’s Member States have tasked me with making a set of proposals on what that architecture should look like.

And it’s clear that a fully funded CEPI, working closely with WHO and other partners, must be part of it. 

A commitment to CEPI is a commitment to science;

A commitment to CEPI is a commitment to equity;

A commitment to CEPI is a commitment to partnership.

And financing, fully-funding CEPI is a commitment for a better future.

I look forward to our continued partnership as we work together for a healthier, safer, fairer future. But if that’s going to happen, we ask you, on WHO’s behalf, and on behalf of all the ACT-A partners and beyond, to fully fund CEPI. US$ 3.5 billion compared to what we lost due to the pandemic, some finance ministers call it a rounding error, or peanuts. But I will not undermine it as such, but I can argue that it is worth the investment, and please support CEPI, which has already made us proud and will continue to make us proud. 

Thank you so much and very glad to be with you. Thank you.

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The White House 1600 Pennsylvania Ave NW Washington, DC 20500

Remarks by President   Biden on Fighting the COVID- ⁠ 19   Pandemic

5:02 P.M. EDT THE PRESIDENT:  Good evening, my fellow Americans.  I want to talk to you about where we are in the battle against COVID-19, the progress we’ve made, and the work we have left to do. And it starts with understanding this: Even as the Delta variant 19 [sic] has — COVID-19 — has been hitting this country hard, we have the tools to combat the virus, if we can come together as a country and use those tools. If we raise our vaccination rate, protect ourselves and others with masking and expanded testing, and identify people who are infected, we can and we will turn the tide on COVID-19. It will take a lot of hard work, and it’s going to take some time.  Many of us are frustrated with the nearly 80 million Americans who are still not vaccinated, even though the vaccine is safe, effective, and free. You might be confused about what is true and what is false about COVID-19.  So before I outline the new steps to fight COVID-19 that I’m going to be announcing tonight, let me give you some clear information about where we stand. First, we have cons- — we have made considerable progress in battling COVID-19.  When I became President, about 2 million Americans were fully vaccinated.  Today, over 175 million Americans have that protection.  Before I took office, we hadn’t ordered enough vaccine for every American.  Just weeks in office, we did.  The week before I took office, on January 20th of this year, over 25,000 Americans died that week from COVID-19.  Last week, that grim weekly toll was down 70 percent. And in the three months before I took office, our economy was faltering, creating just 50,000 jobs a month.  We’re now averaging 700,000 new jobs a month in the past three months. This progress is real.  But while America is in much better shape than it was seven months ago when I took office, I need to tell you a second fact. We’re in a tough stretch, and it could last for a while.  The highly contagious Delta variant that I began to warn America about back in July spread in late summer like it did in other countries before us. While the vaccines provide strong protections for the vaccinated, we read about, we hear about, and we see the stories of hospitalized people, people on their death beds, among the unvaccinated over these past few weeks.  This is a pandemic of the unvaccinated.  And it’s caused by the fact that despite America having an unprecedented and successful vaccination program, despite the fact that for almost five months free vaccines have been available in 80,000 different locations, we still have nearly 80 million Americans who have failed to get the shot.  And to make matters worse, there are elected officials actively working to undermine the fight against COVID-19.  Instead of encouraging people to get vaccinated and mask up, they’re ordering mobile morgues for the unvaccinated dying from COVID in their communities.  This is totally unacceptable. Third, if you wonder how all this adds up, here’s the math:  The vast majority of Americans are doing the right thing.  Nearly three quarters of the eligible have gotten at least one shot, but one quarter has not gotten any.  That’s nearly 80 million Americans not vaccinated.  And in a country as large as ours, that’s 25 percent minority.  That 25 percent can cause a lot of damage — and they are. The unvaccinated overcrowd our hospitals, are overrunning the emergency rooms and intensive care units, leaving no room for someone with a heart attack, or pancreitis [pancreatitis], or cancer. And fourth, I want to emphasize that the vaccines provide very strong protection from severe illness from COVID-19.  I know there’s a lot of confusion and misinformation.  But the world’s leading scientists confirm that if you are fully vaccinated, your risk of severe illness from COVID-19 is very low.  In fact, based on available data from the summer, only one of out of every 160,000 fully vaccinated Americans was hospitalized for COVID per day. These are the facts.  So here’s where we stand: The path ahead, even with the Delta variant, is not nearly as bad as last winter.  But what makes it incredibly more frustrating is that we have the tools to combat COVID-19, and a distinct minority of Americans –supported by a distinct minority of elected officials — are keeping us from turning the corner.  These pandemic politics, as I refer to, are making people sick, causing unvaccinated people to die.  We cannot allow these actions to stand in the way of protecting the large majority of Americans who have done their part and want to get back to life as normal.  As your President, I’m announcing tonight a new plan to require more Americans to be vaccinated, to combat those blocking public health.  My plan also increases testing, protects our economy, and will make our kids safer in schools.  It consists of six broad areas of action and many specific measures in each that — and each of those actions that you can read more about at WhiteHouse.gov.  WhiteHouse.gov. The measures — these are going to take time to have full impact.  But if we implement them, I believe and the scientists indicate, that in the months ahead we can reduce the number of unvaccinated Americans, decrease hospitalizations and deaths, and allow our children to go to school safely and keep our economy strong by keeping businesses open. First, we must increase vaccinations among the unvaccinated with new vaccination requirements.  Of the nearly 80 million eligible Americans who have not gotten vaccinated, many said they were waiting for approval from the Food and Drug Administration — the FDA.  Well, last month, the FDA granted that approval. So, the time for waiting is over.  This summer, we made progress through the combination of vaccine requirements and incentives, as well as the FDA approval.  Four million more people got their first shot in August than they did in July.  But we need to do more.  This is not about freedom or personal choice.  It’s about protecting yourself and those around you — the people you work with, the people you care about, the people you love. My job as President is to protect all Americans.  So, tonight, I’m announcing that the Department of Labor is developing an emergency rule to require all employers with 100 or more employees, that together employ over 80 million workers, to ensure their workforces are fully vaccinated or show a negative test at least once a week. Some of the biggest companies are already requiring this: United Airlines, Disney, Tysons Food, and even Fox News. The bottom line: We’re going to protect vaccinated workers from unvaccinated co-workers.  We’re going to reduce the spread of COVID-19 by increasing the share of the workforce that is vaccinated in businesses all across America. My plan will extend the vaccination requirements that I previously issued in the healthcare field.  Already, I’ve announced, we’ll be requiring vaccinations that all nursing home workers who treat patients on Medicare and Medicaid, because I have that federal authority. Tonight, I’m using that same authority to expand that to cover those who work in hospitals, home healthcare facilities, or other medical facilities –- a total of 17 million healthcare workers. If you’re seeking care at a health facility, you should be able to know that the people treating you are vaccinated.  Simple.  Straightforward.  Period. Next, I will sign an executive order that will now require all executive branch federal employees to be vaccinated — all.  And I’ve signed another executive order that will require federal contractors to do the same. If you want to work with the federal government and do business with us, get vaccinated.  If you want to do business with the federal government, vaccinate your workforce.  And tonight, I’m removing one of the last remaining obstacles that make it difficult for you to get vaccinated. The Department of Labor will require employers with 100 or more workers to give those workers paid time off to get vaccinated.  No one should lose pay in order to get vaccinated or take a loved one to get vaccinated. Today, in total, the vaccine requirements in my plan will affect about 100 million Americans –- two thirds of all workers.  And for other sectors, I issue this appeal: To those of you running large entertainment venues — from sports arenas to concert venues to movie theaters — please require folks to get vaccinated or show a negative test as a condition of entry. And to the nation’s family physicians, pediatricians, GPs — general practitioners –- you’re the most trusted medical voice to your patients.  You may be the one person who can get someone to change their mind about being vaccinated.  Tonight, I’m asking each of you to reach out to your unvaccinated patients over the next two weeks and make a personal appeal to them to get the shot.  America needs your personal involvement in this critical effort. And my message to unvaccinated Americans is this: What more is there to wait for?  What more do you need to see?  We’ve made vaccinations free, safe, and convenient. The vaccine has FDA approval.  Over 200 million Americans have gotten at least one shot.  We’ve been patient, but our patience is wearing thin.  And your refusal has cost all of us.  So, please, do the right thing.  But just don’t take it from me; listen to the voices of unvaccinated Americans who are lying in hospital beds, taking their final breaths, saying, “If only I had gotten vaccinated.”  “If only.” It’s a tragedy.  Please don’t let it become yours. The second piece of my plan is continuing to protect the vaccinated. For the vast majority of you who have gotten vaccinated, I understand your anger at those who haven’t gotten vaccinated.  I understand the anxiety about getting a “breakthrough” case. But as the science makes clear, if you’re fully vaccinated, you’re highly protected from severe illness, even if you get COVID-19.   In fact, recent data indicates there is only one confirmed positive case per 5,000 fully vaccinated Americans per day. You’re as safe as possible, and we’re doing everything we can to keep it that way — keep it that way, keep you safe. That’s where boosters come in — the shots that give you even more protection than after your second shot. Now, I know there’s been some confusion about boosters.  So, let me be clear: Last month, our top government doctors announced an initial plan for booster shots for vaccinated Americans.  They believe that a booster is likely to provide the highest level of protection yet. Of course, the decision of which booster shots to give, when to start them, and who will give them, will be left completely to the scientists at the FDA and the Centers for Disease Control. But while we wait, we’ve done our part.  We’ve bought enough boosters — enough booster shots — and the distribution system is ready to administer them. As soon as they are authorized, those eligible will be able to get a booster right away in tens of thousands of site across the — sites across the country for most Americans, at your nearby drug store, and for free.  The third piece of my plan is keeping — and maybe the most important — is keeping our children safe and our schools open.  For any parent, it doesn’t matter how low the risk of any illness or accident is when it comes to your child or grandchild.  Trust me, I know.  So, let me speak to you directly.  Let me speak to you directly to help ease some of your worries. It comes down to two separate categories: children ages 12 and older who are eligible for a vaccine now, and children ages 11 and under who are not are yet eligible. The safest thing for your child 12 and older is to get them vaccinated.  They get vaccinated for a lot of things.  That’s it.  Get them vaccinated. As with adults, almost all the serious COVID-19 cases we’re seeing among adolescents are in unvaccinated 12- to 17-year-olds — an age group that lags behind in vaccination rates. So, parents, please get your teenager vaccinated. What about children under the age of 12 who can’t get vaccinated yet?  Well, the best way for a parent to protect their child under the age of 12 starts at home.  Every parent, every teen sibling, every caregiver around them should be vaccinated.   Children have four times higher chance of getting hospitalized if they live in a state with low vaccination rates rather than the states with high vaccination rates.  Now, if you’re a parent of a young child, you’re wondering when will it be — when will it be — the vaccine available for them.  I strongly support an independent scientific review for vaccine uses for children under 12.  We can’t take shortcuts with that scientific work.  But I’ve made it clear I will do everything within my power to support the FDA with any resource it needs to continue to do this as safely and as quickly as possible, and our nation’s top doctors are committed to keeping the public at large updated on the process so parents can plan. Now to the schools.  We know that if schools follow the science and implement the safety measures — like testing, masking, adequate ventilation systems that we provided the money for, social distancing, and vaccinations — then children can be safe from COVID-19 in schools. Today, about 90 percent of school staff and teachers are vaccinated.  We should get that to 100 percent.  My administration has already acquired teachers at the schools run by the Defense Department — because I have the authority as President in the federal system — the Defense Department and the Interior Department — to get vaccinated.  That’s authority I possess.  Tonight, I’m announcing that we’ll require all of nearly 300,000 educators in the federal paid program, Head Start program, must be vaccinated as well to protect your youngest — our youngest — most precious Americans and give parents the comfort. And tonight, I’m calling on all governors to require vaccination for all teachers and staff.  Some already have done so, but we need more to step up.  Vaccination requirements in schools are nothing new.  They work.  They’re overwhelmingly supported by educators and their unions.  And to all school officials trying to do the right thing by our children: I’ll always be on your side.  Let me be blunt.  My plan also takes on elected officials and states that are undermining you and these lifesaving actions.  Right now, local school officials are trying to keep children safe in a pandemic while their governor picks a fight with them and even threatens their salaries or their jobs.  Talk about bullying in schools.  If they’ll not help — if these governors won’t help us beat the pandemic, I’ll use my power as President to get them out of the way.  The Department of Education has already begun to take legal action against states undermining protection that local school officials have ordered.  Any teacher or school official whose pay is withheld for doing the right thing, we will have that pay restored by the federal government 100 percent.  I promise you I will have your back.  The fourth piece of my plan is increasing testing and masking.  From the start, America has failed to do enough COVID-19 testing.  In order to better detect and control the Delta variant, I’m taking steps tonight to make testing more available, more affordable, and more convenient.  I’ll use the Defense Production Act to increase production of rapid tests, including those that you can use at home.  While that production is ramping up, my administration has worked with top retailers, like Walmart, Amazon, and Kroger’s, and tonight we’re announcing that, no later than next week, each of these outlets will start to sell at-home rapid test kits at cost for the next three months.  This is an immediate price reduction for at-home test kits for up to 35 percent reduction. We’ll also expand — expand free testing at 10,000 pharmacies around the country.  And we’ll commit — we’re committing $2 billion to purchase nearly 300 million rapid tests for distribution to community health centers, food banks, schools, so that every American, no matter their income, can access free and convenient tests.  This is important to everyone, particularly for a parent or a child — with a child not old enough to be vaccinated.  You’ll be able to test them at home and test those around them. In addition to testing, we know masking helps stop the spread of COVID-19.  That’s why when I came into office, I required masks for all federal buildings and on federal lands, on airlines, and other modes of transportation.   Today — tonight, I’m announcing that the Transportation Safety Administration — the TSA — will double the fines on travelers that refuse to mask.  If you break the rules, be prepared to pay.  And, by the way, show some respect.  The anger you see on television toward flight attendants and others doing their job is wrong; it’s ugly.  The fifth piece of my plan is protecting our economic recovery.  Because of our vaccination program and the American Rescue Plan, which we passed early in my administration, we’ve had record job creation for a new administration, economic growth unmatched in 40 years.  We cannot let unvaccinated do this progress — undo it, turn it back.  So tonight, I’m announcing additional steps to strengthen our economic recovery.  We’ll be expanding COVID-19 Economic Injury Disaster Loan programs.  That’s a program that’s going to allow small businesses to borrow up to $2 million from the current $500,000 to keep going if COVID-19 impacts on their sales.  These low-interest, long-term loans require no repayment for two years and be can used to hire and retain workers, purchase inventory, or even pay down higher cost debt racked up since the pandemic began.  I’ll also be taking additional steps to help small businesses stay afloat during the pandemic.  Sixth, we’re going to continue to improve the care of those who do get COVID-19.  In early July, I announced the deployment of surge response teams.  These are teams comprised of experts from the Department of Health and Human Services, the CDC, the Defense Department, and the Federal Emergency Management Agency — FEMA — to areas in the country that need help to stem the spread of COVID-19.  Since then, the federal government has deployed nearly 1,000 staff, including doctors, nurses, paramedics, into 18 states.  Today, I’m announcing that the Defense Department will double the number of military health teams that they’ll deploy to help their fellow Americans in hospitals around the country.  Additionally, we’re increasing the availability of new medicines recommended by real doctors, not conspir- — conspiracy theorists.  The monoclonal antibody treatments have been shown to reduce the risk of hospitalization by up to 70 percent for unvaccinated people at risk of developing sefe- — severe disease.  We’ve already distributed 1.4 million courses of these treatments to save lives and reduce the strain on hospitals.  Tonight, I’m announcing we will increase the average pace of shipment across the country of free monoclonal antibody treatments by another 50 percent. Before I close, let me say this: Communities of color are disproportionately impacted by this virus.  And as we continue to battle COVID-19, we will ensure that equity continues to be at the center of our response.  We’ll ensure that everyone is reached.  My first responsibility as President is to protect the American people and make sure we have enough vaccine for every American, including enough boosters for every American who’s approved to get one.  We also know this virus transcends borders.  That’s why, even as we execute this plan at home, we need to continue fighting the virus overseas, continue to be the arsenal of vaccines.  We’re proud to have donated nearly 140 million vaccines over 90 countries, more than all other countries combined, including Europe, China, and Russia combined.  That’s American leadership on a global stage, and that’s just the beginning. We’ve also now started to ship another 500 million COVID vaccines — Pfizer vaccines — purchased to donate to 100 lower-income countries in need of vaccines.  And I’ll be announcing additional steps to help the rest of the world later this month. As I recently released the key parts of my pandemic preparedness plan so that America isn’t caught flat-footed when a new pandemic comes again — as it will — next month, I’m also going to release the plan in greater detail. So let me close with this: We have so- — we’ve made so much progress during the past seven months of this pandemic.  The recent increases in vaccinations in August already are having an impact in some states where case counts are dropping in recent days.  Even so, we remain at a critical moment, a critical time.  We have the tools.  Now we just have to finish the job with truth, with science, with confidence, and together as one nation. Look, we’re the United States of America.  There’s nothing — not a single thing — we’re unable to do if we do it together.  So let’s stay together. God bless you all and all those who continue to serve on the frontlines of this pandemic.  And may God protect our troops. Get vaccinated. 5:28 P.M. EDT

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Coronavirus Disease 2019

The coronavirus speech i’d give, realistic reasons for hope..

Posted March 21, 2020 | Reviewed by Jessica Schrader

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Updated: Apr. 24, 2020

The media’s core message on the coronavirus is that even if we behave, coronavirus will change life as we know it for years to come: massive job loss, disease, and yes, death, rivaling the Spanish Flu, which killed 50 to 100 million people.

Perhaps a perspective from someone with little to gain from sensationalism nor from political blaming might replace some of the fear with realistic hope.

There are at least three reasons for realistic hope that the coronavirus problem will be satisfactorily addressed than is feared:

1. A simpler, faster test is here: Abbott Laboratories have developed a COVID-19 test that produces the results in five minutes, onsite, and the FDA has just authorized the first at-home swab test.

2. As of April 6, there were more than 200 coronavirus vaccines and treatments in development. It would seem that with some of the world's greatest minds working tirelessly, one will be developed, again, sooner than later. The WHO says that an effective treatment is likely just weeks or months away.

3. Social distancing works and in the U.S. compliance has risen to over 90 percent as of April 15, and since then, subjectively, I've noted ever greater compliance.

So live your life. Sure, practice social distancing, wear a mask in stores, and wash your hands often, but also take advantage of the slowed economy to do things you had wished you had time to do: Speak with friends, do a hobby, do volunteer work by phone or on the internet. Upgrade your skills and networking connections so when the economy and job market improves, you'll be ready. Love more.

Society will survive the coronavirus pandemic, not just because of improved preparedness for an epidemic but because we’ll live with a greater sense of perspective and appreciation of life’s small pleasures: from that first bite of food to the beauty of your loved ones to more present conversations with friends and family. Don’t let coronavirus deprive you of life's wonders. Live.

For some silver linings in the coronavirus situation, you might want to read my previous post, " My Shelter Diary ," including the excellent comment by "Your Reader in Pennsylvania."

I read this aloud on YouTube.

Marty Nemko, Ph.D ., is a career and personal coach based in Oakland, California, and the author of 10 books.

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August 26, 2020

The Pandemic’s Effect on the Economy and Banking

Governor Michelle W. Bowman

At the Kansas Bankers Association CEO and Senior Management Forum/Annual Meeting, Topeka, Kansas (via webcast)

Good afternoon. It's great to be with you, and I look forward to our discussion. As you all know, the COVID-19 pandemic has caused significant disruption and hardship in nearly every aspect of our lives, and it continues to weigh heavily on our national economy, which is why it will be the central focus of my remarks here today. Let me set the stage for our discussion by outlining the economic effects of the pandemic most relevant to the banking sector, describing the Federal Reserve's response to the crisis, and then making some observations about conditions for smaller banks.

The Pandemic's Effects on the Economy and Banking We began this year with the economy in excellent shape—by some measures the strongest in decades. From my seat as a monetary policymaker, we appeared to be in a good position regarding both legs of our dual mandate, which are maximum employment and stable prices.

But that picture was dramatically altered with the onset of the COVID-19 pandemic. Efforts to contain the spread of the virus caused a sudden stop in economic activity during March and April. While the extent of the closures and shutdowns varied widely throughout the country, the sudden loss of employment and the contraction in output were like nothing our nation has experienced before.

The decline in activity was mostly due to temporary business closures, and the economy has bounced back noticeably in recent months as businesses reopen and fiscal support was distributed to many Americans. Even so, the economy is still far from back to normal. The future course and timing of the recovery is still highly uncertain, and its pace and intensity are likely to vary across areas of the country—heavily influenced by the decisions of state and local governments. That speaks to another aspect of this episode that is unusual—how the timing and severity of the pandemic's impact seem to differ greatly from one area to the next.

Among Kansas's major industries, oil and gas production and equipment manufacturing have been hurt by the worldwide slump in energy demand. Aviation manufacturing has been hit hard by the downturn and by the uncertainty over the recovery in air travel. Agriculture continues to face challenges but is faring somewhat better than many sectors of the economy. Ag producers are still facing tough financial conditions, including the low commodity price environment. While most indications are that agriculture land prices continue to hold fairly steady, I have seen some reports that less-productive land has been showing some hints of cracks in valuations.

Turning to employment, nationwide, we know that the initial job losses were heavily concentrated among the most financially vulnerable, including lower-wage workers, young people, women, and minority groups. According to the Fed's latest Report on The Economic Well-Being of U.S. Households , 20 percent of people surveyed in April reported a recent job loss. Among those surveyed who live in households with annual incomes below $40,000, the reported job loss was nearly double that, at around 40 percent. 1 That said, both of those figures are likely to include a number of layoffs due to pandemic-related shutdowns of businesses that were hopefully only temporary.

Households were in a generally strong financial position at the beginning of this year, but the restrictions implemented to fight COVID-19 resulted in an unprecedented spike in unemployment, which likely led to a number of families finding it difficult to keep up with their payment obligations. That is especially true for lower-income households, which may have had much less of a financial cushion before the onset of the crisis. Along with our monetary policy actions, stimulus checks and enhanced unemployment benefits provided in the CARES Act have been a substantial and timely source of financial support to households during this difficult time.

Understanding the financial stress this could place on many borrowers, the Fed and other federal regulators implemented guidance to encourage banks to work with their borrowers. By mid-July, only around 8 percent of outstanding residential mortgage loans were in forbearance, well below what many industry observers had feared. It remains possible that the economic challenges will persist beyond the forbearance time period provided in the CARES Act, and if so, we would almost certainly see some of these loans transition into longer-term delinquency status or enter into renewed deferment periods. Thus far, however, the data have been encouraging.

Turning to the impact on businesses, we know the effects have been most severe in the services sector, especially travel, leisure, and hospitality. To give some sense of the losses, employment in the leisure and hospitality sectors nationwide was down nearly 40 percent in the 12 months through May and still down about 25 percent through July. Retail employment fell 15 percent over March and April, though it has recovered substantially since then, and in July it was 6 percent below the pre-COVID level.

It is encouraging to see that even those sectors most heavily affected by the crisis are finding ways to innovate. Stores are adjusting hours and ramping up delivery, restaurants are changing menus and creating outdoor space, distilleries shifted from making bourbon to hand sanitizers, and independent businesses that hadn't previously relied heavily on technology are now using it to stay connected to customers and regulate workflow.

Timely and supportive fiscal and monetary policy measures also have helped, but with the progress of the recovery still tentative, I expect that many businesses will continue to fight for survival in the months ahead, with the support of their lenders and communities.

Looking ahead, the economic outlook will continue to evolve quickly. We experienced a pronounced and very welcome bounceback in national retail spending and housing activity over the early summer months. We also saw positive news on progress toward a vaccine and in the effective treatment of patients. Even so, positive cases and hospitalizations have risen in some areas and continue to weigh on some regions and the overall economy. As Chair Powell has noted, the timeline for the recovery is highly uncertain and will depend heavily on the course of the pandemic. We must therefore recognize that progress toward a full recovery in economic activity may well be slow and uneven

The Fed's Response to the Pandemic Now let me turn to the Federal Reserve's role in the government's response to the pandemic. During the initial phase of the crisis, we took a number of actions to stabilize financial markets that came under intense stress, including purchasing sizable amounts of Treasury and mortgage-backed securities. To support households and businesses, the Fed quickly lowered our target for the federal funds rate, which has helped to lower borrowing costs but created a different challenge for financial institutions—depressed net interest margins. The Fed has also supported actions by Congress and the administration by creating a number of new emergency lending programs. These programs were designed to restore and sustain proper functioning in certain financial markets that had seized up in March and to facilitate the continued flow of credit from banks to households and businesses.

One federal stimulus program that relied heavily on the participation and expertise of community bankers is the Paycheck Protection Program (PPP). Working through banks, the PPP program has delivered more than $500 billion to small businesses to help them weather the storm. Community bankers played a crucial role in getting these funds to businesses that needed it, showing once again how essential community banks are to the customers they serve. And in response to feedback we received from a number of community bankers, the Fed created the PPP lending facility to alleviate balance-sheet capacity issues for banks that otherwise would not have been able to provide PPP loans to their small-business customers.

The PPP was created to help small businesses keep their employees on staff, and the Main Street Lending program is designed to support lending to mid-sized businesses through the recovery. The Federal Reserve has not engaged in lending directly to businesses before, but it was a step that seemed appropriate considering the breadth and depth of the challenges we face. We continue to solicit feedback and make adjustments to the program based on the suggestions received from bankers and other stakeholders, and we continue to welcome your thoughts and ideas on how we can make Main Street more effective. I would be interested to visit with those who may already have experience with this new loan program, and I would also be interested to hear about how you plan to use it to meet the needs of your business customers.

Together, these policy actions have helped stabilize financial markets, boost consumer and business sentiment, and assist millions of households and thousands of businesses harmed by the response to the pandemic. Credit markets, which had seized up earlier this year, have resumed functioning.

In our other role as a prudential regulator and bank supervisor, the Federal Reserve took several steps intended to reduce burden on banks and help them focus on the needs of their customers and communities.

Together, with our fellow federal regulators, we delayed the impact of the CECL accounting standard in our capital rules and temporarily eased the leverage ratio requirement for community banks. We also delayed reporting dates for Call Reports and other data collections. In addition, to address concerns about real estate appraisal delays, we provided temporary relief from certain appraisal requirements.

From a supervisory perspective, beginning in late March the Fed paused examinations for most small banks and took steps to lengthen remediation timeframes for outstanding issues. We considered the exam pause an important step to provide bankers time to adjust operations to protect the health of customers and employees, to prioritize the financial needs of their customers and communities, and to play an essential and vital role in implementing critical relief programs like the PPP.

As we continue to support the recovery and work to ensure that supervision and examination is as effective and efficient as possible, I think it's important to hear directly from you, who are actually working in the economy, about the conditions facing your communities and any challenges impeding your ability to meet the needs of your customers. In addition to my regular outreach to community banks, I am currently engaged in an effort to speak with every CEO of the more than 650 community banks supervised by the Fed. I want to hear directly from bankers about what you are seeing and your thoughts and ideas about the recovery. These conversations are incredibly valuable to me as a bank regulator and policymaker. They give context to the mountains of data we analyze and a unique perspective with real-world local examples to a complex and dynamic economic picture. For those of you from Fed member banks who I have not yet had the opportunity to meet or speak with by phone in these times of COVID, I look forward to our conversation. Your local Reserve Bank will be in contact to find a convenient time for us to meet.

Conditions for Smaller Banks This audience knows better than most that smaller banks entered the pandemic in strong condition. At the end of 2019, over 95 percent of community and regional banks supervised by the Fed were rated a 1 or 2 under the CAMELS rating system. After coming through the last financial crisis in generally stronger condition than larger banks, smaller institutions had strengthened their capital positions and substantially improved asset quality in the years since, leaving them better positioned to deal with the current stress related to the pandemic. Likewise, credit concentrations, especially in construction and commercial real estate, were lower for smaller banks than at the outset of the last financial crisis, and risk management of concentrations improved over the last decade. Smaller banks also entered the pandemic with high levels of liquidity, and this liquidity has further improved with deposit inflows associated with pandemic-related stimulus programs.

Overall, community and regional banks remain well positioned to continue to extend credit and play an essential role in supporting our nation's recovery from the effects of COVID-19.

With this in mind, on June 15 the Federal Reserve announced our plan to resume bank examinations. We recognize the unique and challenging conditions under which the industry has been operating, and we will certainly consider that as we resume examinations. Our initial focus will be to assess higher risk banks, particularly those with credit concentrations in higher risk or stressed industries. Finally, we will continue to be sensitive to the capacity of each bank to participate in examinations and strive to prevent undue burden on banks struggling with crisis-related operational challenges.

The Road Ahead Like many native Kansans, I am an eternal optimist, so let me end my formal remarks on a hopeful note. While the road ahead is highly uncertain, and we don't yet know when the economy will return to its previous strength, America will recover from this crisis, as it has from all of our past challenges. Our economic fundamentals are strong, and we have the solid foundation of the entrepreneurial spirit and resiliency of the American people. For its part, the Federal Reserve will continue to monitor progress and respond promptly and flexibly to support the recovery. We will closely watch economic and financial conditions, and we will use our monetary policy tools to respond as appropriate to pursue our dual mandate of maximum employment and price stability. We will also remain open to further adjustments to supervisory schedules and expectations, as needed.

Thank you for the opportunity to speak with you today. I look forward to our discussion.

1. Board of Governors of the Federal Reserve System, Report on the Economic Well-Being of U.S. Households in 2019 - May 2020 (Washington: Board of Governors, May 2020). Return to text

Guterres highlights Timor-Leste’s ‘growing international influence’

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The UN Secretary-General continued his historic visit to Timor-Leste on Thursday, emphasising the positive role the country can play on the regional stage to help resolve the crisis in war-wracked Myanmar.

António Guterres is there to take part in celebrations to mark 25 years on Friday since the country’s vote for independence, which was organised by the UN mission in what was then East Timor.

Independence duly came in 2002 following months of violence and destruction that ended years of rule by first Portugal and then Indonesia, which annexed the country in 1975.

Tribute to Timorese leader

On the second day of his official visit to Timor-Leste, the UN Secretary General held a meeting with Prime Minister Xanana Gusmão, paying an “emotional tribute” to the former resistance leader for the “sacrifices he made to achieve the independence of his country and his people”.

Mr. Gusmão – who served as the first president of the newly-independent nation, was imprisoned for six years in Indonesia and only released when the occupation ended in 1999.

Voice for the future

Speaking to journalists at the Government Palace in Dili, the UN chief highlighted Timor-Leste's record in strengthening democracy and human rights, as well as its “growing international influence”.

Mr. Guterres recalled that the Asian nation is the founder of the G7+, a group of States emerging from conflict, and will soon join the ASEAN regional bloc. The Secretary-General said he was counting on Timor-Leste to take a leading role in supporting a future peace process in Myanmar, which has spiralled into chaos since the military coup of 2021 ousted the democratically-elected government.

He told the veteran Timorese leader that he was counting on the country's voice at the Summit of the Future in September, to build “a world in which the United Nations Charter is respected”.

Leading Portugal

The Secretary-General also visited the Timorese Resistance Archive and Museum in the capital Dili, where he was shown around the permanent exhibition “resisting is winning”.

As a former Prime Minster of Portugal from 1995 until the year of Timor-Leste’s independence, Mr. Guterres saw himself featured in some of the archive on display.

He was able to confirm the historical accuracy of one exhibit which stated that Portugal threatened to withdraw its forces from Bosnia and Kosovo - and leave the North Atlantic Treaty Organization, NATO.

The appeal was made at a time when several leaders were calling for immediate intervention by peacekeeping forces to protect the people of Timor-Leste from the violence that erupted after the referendum.

The UN chief also visited a replica of a hideout used by Timorese resistance fighters.

Meeting women of the resistance

Afterwards, Mr. Guterres visited the “Women of Timor-Leste” exhibition, organized by gender equality agency, UN Women , which portrays the life stories of resistance veterans and rights defenders.

He was received and accompanied by Hilda da Conceição, who during the years of resistance had the code name Lalo Imin, a combination of her grandmother's name and an acronym that means “independence or death, integration never”.

Another veteran represented in the exhibition was Maria Domingas “Mikato”, who organized the first Timor-Leste Women's Congress, held before the 1999 referendum. She is credited with being the driving force behind the decision in that vote to allocate some 30 per cent of political representation to women.

According to UN Women, Timor-Leste's electoral law established that 33 per cent of political party lists must be made up of women. Currently, 38 per cent of seats in the National Parliament are occupied by women - the highest rate in the Asia-Pacific region.

Reflections on Gaza and Ukraine

The UN chief rounded of his day firmly in the present, with an appearance on “The President Horta Show”, broadcast on national television. The recording was also attended by Prime Minister Gusmão.

Mr. Guterres highlighted the role he played leading Portugal in support of independence in East Timor.

According to him, the factors that made the referendum and peaceful transition to independence possible were the “collective affirmation of the people with total determination, which could not fail to triumph”, together with the fact that there were no fundamental geopolitical divisions between power blocs at that time, as exist today.

Furthermore, the UN leader expressed his continuing concern over Russia’s on-going full-scale invasion of Ukraine, which represents a violation of the UN Charter and international law by a permanent member of the Security Council .

The Secretary-General also addressed the war in Gaza, as an example of the Security Council's limitations amid internal division.

To applause from the audience, the UN chief said that as with Timor-Leste, the Palestinian people also have the right to self-determination and their own secure nation, in line with the UN-backed two-State solution .

Power of reconciliation

The Prime Minister highlighted that during his imprisonment in Indonesia he had seen the suffering first hand and come to the conclusion that the problem was not with Indonesians themselves, but with the political regime in charge.

President José Ramos Horta - who won the Nobel Peace Prize in 1996 - emphasized how he had used the lessons learned from Timor-Leste's process of reconciliation in offering perspective on other post-conflict situations, such as Colombia’s on-going peace and reconciliation process.

He recalled that during the many years of armed struggle in Timor-Leste, there were never kidnappings or attacks against Indonesian civilians. 

Prime Minister Gusmão stated that often in the context of the conflict, the guerrillas commanded by him provided medical care to injured Indonesian soldiers, something he himself claimed to have done twice.

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