Why the Infamous Drug Thalidomide Is Being Considered as a COVID-19 Treatment Thalidomide infamously caused thousands of birth defects to babies who were exposed to the drug after their mothers took it to treat morning sickness between 1958-1962. by Neil Vargesson

In the midst of the coronavirus pandemic, researchers have turned to existing medicines to see whether they can be repurposed to treat COVID-19. 

Antiviral medicines such as remdesivir and favipiravir that prevent the virus from reproducing itself are amongst many medicines being tested. Some cough syrups are even being investigated.

And surprisingly, the drug thalidomide is also being tested as a potential treatment for COVID-19. Thalidomide infamously caused thousands of birth defects to babies who were exposed to the drug after their mothers took it to treat morning sickness between 1958-1962.

Despite its dark past, the drug has been repurposed in recent years, and is an approved treatment for multiple myeloma (a type of blood cell cancer) and complications of leprosy.

Thalidomide was originally used as a sedative, and was later found to also be useful for treating severe morning sickness in the 1950s and 1960s. Tragically its use resulted in severe and rare birth defects in children, particularly to the limbs, but also damaged many other parts of the body.

Yet thalidomide has many different effects within the body – which is why researchers are looking at it as a potential COVID-19 treatment. For example, it can inhibit the immune system’s inflammatory response, making it effective against inflammatory conditions, including leprosy. It can also inhibit new blood vessel formation, making thalidomide potentially effective against cancers. It is currently approved to treat multiple myeloma.

The drug can also protect the lungs, and has been effective in treating idiopathic pulmonary fibrosis. This is a life-threatening condition where the alveoli (which exchange oxygen and carbon dioxide molecules in the bloodstream) of the lungs are damaged, thickened and hardened, preventing them from working correctly. This leaves patients short of breath and with a persistent cough.

Thalidomide has been shown to reduce the persistent cough and reduce the lung damage, improving patient life quality. It appears able to do this by blocking the inflammatory response.

Thalidomide also appears to help relieve lung damage caused by the herbicide Paraquat. High doses of it can be toxic and result in lung inflammation, which causes scarring and reduced function. Animal studies suggest thalidomide can reduce the inflammatory response in lung tissue.

Thalidomide has been found to protect against lung infections caused by the H1N1 virus in mice. H1N1 caused the 2009 flu pandemic. The study found that thalidomide improves the chances of survival for mice infected with H1N1 by reducing the body’s inflammatory response.

Evidence shows thalidomide could protect the lungs by reducing the body’s inflammatory response, preventing damage of lung tissues and controlling the immune system. We know the coronavirus affects the lungs, causing pneumonia-like symptoms that result in inflammation, difficulty breathing and transporting oxygen around the body.

Several research groups wonder if thalidomide’s ability to protect the lungs against other diseases could make it a potential treatment for COVID-19. Repurposing this existing drug to treat a new condition also means the dosage and potential side effects are already known.

Remaining cautious

Preliminary evidence has found that using thalidomide in combination with glucocorticoids (which reduce immune response and inflammation pathways in the body) was able to successfully treat a patient suffering with pneumonia-like symptoms caused by COVID-19. However, this study is yet to be peer-reviewed.

A clinical trial is also underway to investigate if thalidomide could be used to treat moderate and severe COVID-19 induced pneumonia in China. Patients testing positive for COVID-19 will be given thalidomide or a placebo medicine. The placebo should have no effect on COVID-19 progression and will then be compared with the thalidomide-exposed patients. It will still be some time before researchers know whether thalidomide is effective in treating some COVID-19 patients.

However, thalidomide still has the ability to cause serious side effects. Thalidomide exposure during pregnancy can still harm the developing baby, something that happened recently in Brazil.

Clinical use of thalidomide can also cause many other side-effects which include peripheral neuropathy in patients. This causes damage to the nerves in the body’s extremities, causing pain. While such side-effects are usually associated with long-term use, any use of thalidomide needs to be carefully overseen by medical professionals.

Using thalidomide in the treatment of COVID-19 might also give researchers a better understanding of the drug’s effect in the body, and what other clinical conditions it could be useful for. Such work could also result, one day, in making safer forms of the drug that are an effective treatment without harmful side effects. However, it remains too early to determine its effectiveness in treating COVID-19.

Does Language Spark Discrimination During the Coronavirus Pandemic? In the coronavirus pandemic, we have seen discrimination against people who speak a language or dialect associated with an epicenter of infection. by Stanley Dubinsky, Kaitlyn E. Smith and Michael Gavin

As the coronavirus spreads around the globe, it’s being characterized by media and politicians alike as an “invisible enemy.” People are afraid others may carry the virus but not show symptoms of the disease it causes – especially strangers, who may or may not have taken proper precautions against spreading the disease. It is this fear of strangers that causes people to be on heightened alert for anyone who might be somehow different. 

In some cases, the differences are visible, matters of physiological appearance and perhaps dress, leading to the racism and general fear of foreigners that has seen Asians attacked in Australia and the United States, and Africans kicked out of their homes in China.

As researchers of people’s language differences, we find that our preliminary research and anecdotal evidence reveal another sort of discrimination, which happens when people’s differences are audible, not visible. Studies have shown that the language or dialect a person speaks is far and away the most important marker of group and national identity, and is the means by which people can immediately and accurately recognize strangers among them. In the coronavirus pandemic, we have seen discrimination against people who speak a language or dialect associated with an epicenter of infection.

People speaking differently have been denied restaurant service or lodging, lost access to public transportation, and even been physically assaulted. Those targeted have included Chinese people who speak with a Wuhan accent who are in other areas of China; people who speak Mandarin, the official language of the mainland, in Hong Kong, where Cantonese is more common; Italians in other countries; people who speak Italian dialects while traveling outside of their home provinces – and even Americans traveling in their own country.

In work initiated by Kathryn Watson, an undergraduate at the University of South Carolina and a staff researcher in the university’s Language Conflict Project, we have begun a more extensive effort to collect data on linguistic discrimination during the coronavirus pandemic. We do expect language and dialect prejudice will be less prevalent than racism, but we don’t think it should be ignored.

Overhearing New Yorkers

In popular vacation destinations in New England, fear of the virus has made locals hesitant to welcome New Yorkers fleeing the pandemic’s U.S. epicenter, and they have urged wealthy out-of-towners, who are mostly white, to stay away. As a result, New Yorkers seeking refuge face backlash from local residents, who have no trouble picking them out and turning them away.

In some places, police have contacted people driving cars with out-of-state license plates, but when people aren’t in their cars, it can come down to how someone talks. As one Cape Cod store manager pointed out, New Yorkers’ unmistakable accents can be “very different from the New England accent.”

Concern about just this sort of prejudice silenced a University of South Carolina student from Connecticut in March. Southern attitudes toward Northerners aren’t always favorable, and the coronavirus outbreak in New York City hasn’t helped.

The student was in a Myrtle Beach, South Carolina, convenience store when a local man declared to the cashier that state troopers should be stationed at the state line, prepared to shoot anyone trying to enter the state with a “Yankee” license plate. The student told researcher Watson he feared his accent might incite violence, so he remained silent until the man had left.

Not from around here

In Hong Kong, around 90% of the population speaks Cantonese. Many of the city’s natives already viewed Mandarin, China’s official language, as an outsiders’ tongue.

Now the city’s residents have explicitly linked Mandarin with a threat to public health. More than 100 restaurants have begun refusing service to Mandarin speakers. Many Hong Kong residents, already upset with the Chinese Communist Party’s crackdown on the city’s democracy movement and wanting to keep mainland Chinese people out, “have joined together in calling for the border’s closure” entirely.

Even within China itself, The New York Times reports, “people listen for accents distinctive to Hubei Province, the center of the outbreak, and shun residents: avoiding them on public transportation and denying them entry to restaurants and other public spaces.”

In Europe’s biggest virus hot spot, Italy is equally divided. When the government announced new restrictions at the beginning of March, throngs of southern Italians living in the north attempted to flee to their family homes in the country’s rural south, potentially bringing disease with them. Our research has found that some of these people attracted the authorities’ attention by posting on social media – speaking with obvious southern accents – that they had escaped from Milan to be back with “mamma in Sicily.”

At the same time, some Italians from the north who dared to venture abroad risked assault if they spoke their native language. A man from Trieste, Andrea Premier, slipped over the border to Ljubljana, Slovenia, for a weekend back in March. When locals heard him speaking Italian, they shouted “Italiano coronavirus” while beating and robbing him.

As the virus spreads, so will fear of people from hotspots. We expect incidents like these will continue.

How Recovery From Coronavirus Can Rebuild Cities Cities are going to be reshaped by the coronavirus pandemic, which has closed public parks, decreased traffic and put pressures on housing. by Jill L. Grant

For decades, epidemiologists have warned of the risks of new pandemics in our world of stressed natural environments, densely populated cities and global travel networks. The history of the relationship between cities, the environment and disease shows that cities and civilizations have always been vulnerable to the rapid spread of infections: what the ancients called plagues. 

While societies often rebounded from such catastrophes, outbreaks set the stage for subsequent social and political change. For instance, plague during the third century helped undermine the Roman Empire not only by decimating the population but also by weakening the economic, cultural and religious underpinnings of urban and state structures.

As recovering Romans increasingly converted to Christianity, they refused to contribute to maintaining temples and fountains associated with pagan gods. Grand cities began to decline.

In the 14th century, the Black Death killed a third to a half of Europeans. In the aftermath, towns that in previous years had expanded their walls to accommodate growth found themselves with open space that Renaissance aristocrats and their urban designers subsequently transformed into parks, urban squares and promenades that now grace the great cities of Europe.

How recovery built cities

Waves of epidemics following European contact in the 15th century devastated cultures across the Americas, leaving towns emptied and sophisticated knowledge lost.

Cholera and other outbreaks in the crowded and unsanitary cities of the 19th century led not only to major sanitary reforms but to the institutionalization of public health measures and town planning practices. The desire for ventilation and daylight that Victorian-era epidemics reinforced influenced the streets, parks, urban spaces and homes we planned and built through the 20th century.

History reminds us that civilizations and cities create the conditions within which diseases rise and spread; pandemics in return can change important features of cities and civilizations.

Cities challenged by the pandemic

In his 1912 pamphlet “Nothing gained from overcrowding”, the British town planner Raymond Unwin advocated a maximum of 12 houses per acre. By the 1990s, the planning preference for relatively low urban densities, which contributed to sprawl and suburbanization, was replaced in many Western nations with policies encouraging high densities, mixed use and transit-oriented development thought to enhance the efficiency of infrastructure and services.

The current pandemic challenges contemporary planning prescriptions for urban livability and economic vitality. Cities face significant risks during density-susceptible epidemics, with numbers of cases and death rates linked to population density and city size.

Many cities have closed the green spaces intended to provide recreation for the residents of dense neighbourhoods, leaving home-bound residents of small units feeling trapped, especially if they have children to keep active and engaged. The poorest urban residents lack adequate shelter and sanitation to stay safe and socially distanced.

Essential transit systems, often feared as nodes and corridors for virus spread, are operating below capacity. Mixed-use zones with concentrations of cafes, fitness studios and restaurants are struggling to survive as the “third places” valued for social interaction have had to go virtual.

Higher death rates among racialized populations and racist attacks against Asian residents threaten planning’s commitment to diversity and integration. The usual strategies for designing cities may need to be reconsidered.

What can cities learn from lockdown?

What lessons can cities draw from this crisis to inform future planning? We may need to reconsider the push for higher urban densities. Crowded housing increases contagion risks.

After being cooped up in towers for months on end, urban dwellers may begin to look at suburban lots more longingly than they did in past: living preferences may change. Everyone needs some access to outside space for mental health and exercise. We may want to consider broader park paths or longer benches that enable physical distancing, or better strategies for managing who uses space when. Those who can walk to work or to shop are appreciating that ability during these times, but we need to ensure that more have that choice.

The pandemic has brought inequality into stark relief. Everyone needs a living income to keep us all safe. Governments need to plan decent housing for all, not only for social justice reasons but for public health.

Although it’s too early to predict the long-term impacts of the pandemic on our cities, our societies and ourselves, we know that things will never be quite the same again. We need to learn the lessons of our current difficulties and plan effectively to meet the challenges ahead.

Why Higher CO2 Levels Isn't Necessarily Good for the Planet At first sight, it seems more CO₂ can only be beneficial to plants, but things are a lot more complex than that. by Sebastian Leuzinger

Climate Explained is a collaboration between The Conversation, Stuff and the New Zealand Science Media Centre to answer your questions about climate change. 

If you have a question you’d like an expert to answer, please send it to climate.change@stuff.co.nz

If carbon dioxide levels were to double, how much increase in plant growth would this cause? How much of the world’s deserts would disappear due to plants’ increased drought tolerance in a high carbon dioxide environment?

Compared to pre-industrial levels, the concentration of carbon dioxide (CO₂) in the atmosphere will have doubled in about 20 to 30 years, depending on how much CO₂ we emit over the coming years. More CO₂ generally leads to higher rates of photosynthesis and less water consumption in plants.

At first sight, it seems more CO₂ can only be beneficial to plants, but things are a lot more complex than that.

Let’s look at the first part of the question.

Some plants do grow faster under elevated levels of atmospheric CO₂, but this happens mostly in crops and young trees, and generally not in mature forests.

Even if plants grew twice as fast under doubled CO₂ levels, it would not mean they strip twice as much CO₂ from the atmosphere. Plants take carbon from the atmosphere as they grow, but that carbon is going straight back via natural decomposition when plants die or when they are harvested and consumed.

At best, you might be mowing your lawn twice as often or harvesting your plantation forests earlier.

The most important aspect is how long the carbon stays locked away from the atmosphere - and this is where we have to make a clear distinction between increased carbon flux (faster growth) or an increasing carbon pool (actual carbon sequestration). Your bank account is a useful analogy to illustrate this difference: fluxes are transfers, pools are balances.

The global carbon budget

Of the almost 10 billion tonnes (gigatonnes, or Gt) of carbon we emit every year through the burning of fossil fuels, only about half accumulates in the atmosphere. Around a quarter ends up in the ocean (about 2.4 Gt), and the remainder (about 3 Gt) is thought to be taken up by terrestrial plants.

While the ocean and the atmospheric sinks are relatively easy to quantify, the terrestrial sink isn’t. In fact, the 3 Gt can be thought of more as an unaccounted residual. Ultimately, the emitted carbon needs to go somewhere, and if it isn’t the ocean or the atmosphere, it must be the land.

So yes, the terrestrial system takes up a substantial proportion of the carbon we emit, but the attribution of this sink to elevated levels of CO₂ is difficult. This is because many other factors may contribute to the land carbon sink: rising temperature, increased use of fertilisers and atmospheric nitrogen deposition, changed land management (including land abandonment), and changes in species composition.

Current estimates assign about a quarter of this land sink to elevated levels of CO₂, but estimates are very uncertain.

In summary, rising CO₂ leads to faster plant growth - sometimes. And this increased growth only partly contributes to sequestering carbon from the atmosphere. The important questions are how long this carbon is locked away from the atmosphere, and how much longer the currently observed land sink will continue.

The second part of the question refers to a side-effect of rising levels of CO₂ in the air: the fact that it enables plants to save water.

Plants regulate the exchange of carbon dioxide and water vapour by opening or closing small pores, called stomata, on the surface of their leaves. Under higher concentrations of CO₂, they can reduce the opening of these pores, and that in turn means they lose less water.

This alleviates drought stress in already dry areas. But again, the issue is more complex because CO₂ is not the only parameter that changes. Dry areas also get warmer, which means that more water evaporates and this often compensates for the water-saving effect.

Overall, rising CO₂ has contributed to some degree to the greening of Earth, but it is likely that this trend will not continue under the much more complex combination of global change drivers, particularly in arid regions.

Coronavirus Lockdowns Are Allowing Chloroquine Counterfeiters To Run Rampant As supply chains become more stretched, gaps will be filled by suppliers of bogus products. by Roger Bate

Original research has found fake chloroquine products in Africa and India. These products have also been found for sale on websites in the United States. 

While speaking with counterfeit investigators this past week, I learned several important points. New networks are not the ones supplying the surge in demand for chloroquine products; existing smuggling and counterfeiting networks are. These networks are doing what they always do: taking advantage of new demands and changing circumstances to make money and increase influence. They are simply either stealing, or buying stolen, chloroquine products and hence illegally supplying demand. As that supply dwindled due to high demand, they increasingly turned to making fake versions of chloroquine products.  

During the coronavirus shutdown, all businesses wanted to be considered essential so they could keep working. I know the CEO of one printing business in the Philadelphia area who does some work for a local hospital, and he was able to keep working to satisfy this customer. However, his business is a rare exception, and most printing businesses are sitting idle. Packaging is the single most important component of fake medicine. If you can make the packaging look real, most patients won’t bother to even look at the pills closely. Undoubtedly, midnight shifts making packaging for bogus medicines are occurring, as some desperate businesses are happy to do any work.

As supply chains become more stretched, gaps will be filled by suppliers of bogus products. Since the FDA does not do any meaningful batch testing of products on the market, many of these bogus products will not be found.

How Coronavirus Will Change Our Working Environment Whether it changes for the better will be up to us. by Rachel Morrison

As lockdowns are relaxed around the world and people return to their workplaces, the next challenge will be adapting open office spaces to the new normal of strict personal hygiene and physical distancing.

While the merits and disadvantages of open plan and flexible workspaces have long been debated, the risk they posed of allowing dangerous, highly contagious viruses to spread was rarely (if ever) considered.

But co-working spaces are characterised by shared areas and amenities with surfaces that need constant cleaning. Droplets from a single sneeze can travel over 7 metres, and surfaces within pods or booths, designed for privacy, could remain hazardous for days.

Even in countries such as Australia and New Zealand where efforts to “flatten the curve” have been successful and which have relatively easily controlled borders, it’s fair to ask whether communal workspaces might be a thing of the past.

Perhaps – if vigilant measures are in place – some countries can continue to embrace collaborative, flexible, activity-based workplace designs and the cost savings they represent. But this is unlikely to be the case in general in the coming years. Even if some organisations can operate with minimal risk there will be an expectation they provide virus-free workplaces should there be future outbreaks.

Working from home

Worldwide, there will undoubtedly be fewer people in the office – now workers have tried working from home, they may find they like it. And organisations may have little choice but to limit the numbers of workers on-site. Staggered shifts, enforced flexitime, and 24/7 operations may become the norm, along with working remotely.

The open plan model has been criticised for everything from lowered productivity, less interpersonal interaction, antisocial behaviour, reduced well-being, too much distraction, a lack of privacy, and making workers feel exposed and monitored.

But it has also been shown to improve cooperation and communication. Whether these innovative spaces are within a large organisation or are communal workspaces where start-ups, freelancers, and contractors can sit together (such as GridAKL in Auckland or The Commons in Sydney), their popularity is undeniable. The sense of community and the ability to share knowledge and ideas are key attractions of co-working.

Riding the shared/flexi-space wave have been companies such as WeWork – popularising communal tables within co-working hubs and providing “pods” for private conversations. But there is now little doubt WeWork will be an early casualty of COVID-19. Already in financial trouble before the pandemic, WeWork will cut more than 1,000 jobs this month.

But what about the thousands of organisations that retooled their densely populated work environments to encourage flexibility, activity-based work, and movement within and between spaces?

James Muir, CEO of sustainability start-up Crunch and Flourish has no doubt using co-working offices in central Auckland has been a positive: “We benefited from the great community at GridAKL,” he says. “And before long we were collaborating with other start-ups on marketing and design as well as getting great advice from more experienced entrepreneurs.”

Missing social cues online

Those fortuitous conversations and information exchanges will inevitably become rarer as we avoid the risk of interpersonal contact - and they are almost impossible to mimic online. Personal interaction (even within the office) will be replaced with the already familiar virtual video meeting - or even, as TIME magazine reports, holograms and avatars.

However, communication is more challenging when conducted remotely. We are more persuasive in person, particularly if we know the person. Being on a video call is more draining than a face-to-face chat because workers must concentrate harder to process non-verbal cues such as tone of voice and body language. Anxiety about technology is another barrier, and some find lack of eye contact in virtual meetings (mimicked by staring at the “dot” of your own camera) disquieting.

New norms of hand sanitising, cleaning equipment and wearing masks will emerge. Handshaking or friendly pecks on the cheek may soon be things of the past, as will family photos and mementos on desks, if they prove too difficult to sanitise.

Aside from behaviours, policies, and attitudes, the physical office will need to change. Already, a company in the Netherlands has coined the term the “6 feet office”, aiming to redesign workspaces to help workers maintain social distancing at work.

We may even see the return of the high-walled cubicle, and the introduction of wide corridors and one-way foot traffic, already found in some hospitals. Activity-based work and hot-desks (which oblige people to move throughout the day) could be replaced by assigned desk arrangements where workers sit back to back.

New builds might incorporate touch-free technology such as voice-activated lifts, doors and cabinets, touchless sinks and soap dispensers, improved air venting and UV lights to disinfect surfaces overnight.

In the meantime, will James Muir resume running Crunch and Flourish from his co-working office after the pandemic? “Yes,” he says, “once the risk of any new cases is under control.”

The Rest of the World Is Laughing at Trump The president created a leadership vacuum. China intends to fill it. by Anne Applebaum

It looks, at first, like one of a zillion unfunny video clips that now circulate on the internet: “Once Upon a Virus” features cheap animation, cheesy music, and sarcastic dialogue between China—represented by a Lego terra-cotta warrior with a low, masculine voice—and the United States, represented by a Lego Statue of Liberty with a high, squeaky voice. They “speak” in short sentences:

“We discovered a new virus,” says the warrior. “So what?” says the Statue of Liberty.

“It’s dangerous,” says the warrior. “It’s only a flu,” says the Statue of Liberty.

“Wear a mask,” says the warrior. “Don’t wear a mask,” says the Statue of Liberty.

“Stay at home,” says the warrior. “It’s violating human rights,” says the Statue of Liberty

The dialogue goes on like that—“It will go away in April,” the Statue of Liberty says at one point—until it ends, finally, with the statue on an intravenous drip making wild and contradictory statements while the warrior jeers at her.

Although this looks like an I’m-bored-at-home amateur production, it is not: The video was published on April 30 by Xinhua, the official Chinese news agency. It has since been promoted by Chinese diplomats and watched, as of yesterday afternoon, by more than 1.6 million people around the world.

It has also been mocked and denounced as crude propaganda—which, of course, it is. Crude propaganda is what China’s leaders do, both at home and abroad, and since the pandemic began they have stepped up their efforts. But even those who are mocking should beware: Anybody who knows any history will be aware that propaganda—even the most obvious, most shameless propaganda—sometimes works. And it works not because people necessarily believe that all of it is true, but because they respect the capabilities or fear the power of the people who produced it.

Propaganda also works best in a vacuum, when there are no competing messages, or when the available alternative messengers inspire no trust. Since mid-March, China has been sending messages out into precisely this kind of vacuum: a world that has been profoundly changed not just by the virus, but by the American president’s simultaneously catastrophic and ridiculous failure to cope with it.

The tone of news headlines ranges from straight-faced in Kompas, a major Indonesian news outlet—Trump Usulkan Suntik Disinfektan dan Sinar UV untuk Obati Covid-19, or “Trump Proposes Disinfectant Injection and UV Rays to Treat COVID-19”—to snide, from Le Monde in France—Les élucubrations du « docteur » Trump, or “The Rantings of ‘Doctor’ Trump.” The incredulous first paragraph of an article in Sowetan, from South Africa, declares that “US President Donald Trump has again left people stunned and confused with his bizarre suggestion that disinfectant and ultraviolet light could possibly be used to treat Covid-19.” El Comercio, a distinguished Peruvian newspaper, treated its readers to photographs of Deborah Birx, the White House coronavirus-response coordinator, grimacing as the president asked her whether the injection of disinfectant might be a cure.  

Quotations from the president’s astonishing April 23 press conference have appeared on every continent, via countless television channels, radio stations, magazines, and websites, in hundreds of thousands of variations and dozens of languages—often accompanied by warnings, in case someone was fooled, not to drink disinfectant or bleach. In years past, many of these outlets presumably published articles critical of this or that aspect of U.S. foreign policy, blaming one U.S. president or another. But the kind of coverage we see now is something new. This time, people are not attacking the president of the United States. They are laughing at him. Beppe Severgnini, one of Italy’s best-known columnists, told me that while Italians feel enormous empathy for Americans who have suffered as they have, they feel differently about Trump: “In this time of darkness and depression, he keeps us entertained.”  

But if Trump is ridiculous, his administration is invisible. Carl Bildt—a Swedish prime minister in the 1990s, a United Nations envoy during the Bosnian wars, and a foreign minister for many years after that—told me that, looking back on his 30-year career, he cannot remember a single international crisis in which the United States had no global presence at all. “Normally, when something happens”—a war, an earthquake—“everybody waits to see what the Americans are doing, for better or for worse, and then they calibrate their own response based on that.”

This time, Americans are doing … nothing. Or to be more specific, because plenty of American governors, mayors, doctors, scientists, and tech companies are doing things, the White House is doing nothing. There is no presidential leadership inside the United States; there is no American leadership in the world. Members of the G7—the U.S. and its six closest allies—did meet to write a joint statement. But even that tepid project ended in ludicrous rancor when the American secretary of state, Mike Pompeo, insisted on using the expression “Wuhan virus” and the others gave up in disgust. Not only is the president talking nonsense, not only is America absent, but the nation’s top diplomat is a caricature of a tough guy—someone who throws around insults in the absence of any capacity to influence events.

Others are drawing even more radical conclusions, and with remarkable speed. The “disinfectant” comments—and the laughter that followed—mark not so much a turning point as an acceleration point, the moment when a transformation that began much earlier suddenly started to seem unstoppable. Although we are still only weeks into this pandemic, although the true scale of the health crisis and the economic catastrophe is still unknown, the outline of a very different, post-American, post-coronavirus world is already taking shape. It’s a world in which American opinions will count less, while the opinions of America’s rivals will count more. And that will change political dynamics in ways that Americans haven’t yet understood.

Look beyond the Lego video at China’s more serious public-relations campaign: the stunts at airports around the world, from Pakistan to Italy to Israel, designed to mark the arrival of Chinese aid—masks, surgical gowns, diagnostic tests, and sometimes doctors. These events all have a similar script: The plane lands; the receiving nation’s dignitaries go out to meet it; the Chinese experts emerge, looking competent in their hazmat gear; and everyone utters words of gratitude and relief. Of course some of this, too, is propaganda.

In reality, some of the equipment billed as aid has been purchased, not donated. Some of it, especially the diagnostic tests, has turned out to be defective. Some of those who receive these goods also know perfectly well that they are designed to silence questions about where the virus came from, why knowledge of it was initially suppressed, and why it was allowed to spread around the world. If, in these circumstances, the propaganda “works,” that’s because those who receive it have made a calculation: Pretending to believe it is a way of acknowledging and accepting Chinese power—and, perhaps, a way of expressing interest in Chinese investment.

In the Western world, this dynamic has played itself out with striking success in Italy. Flattened by the virus and depressed by the lockdown, Italians are deeply divided by years of conspiratorial social-media campaigns, some with Russian backing, that have attacked Italy’s traditional alliances, NATO as well as the European Union. China has added its own unsubtle social-media campaign. Bots have been promoting Chinese-Italian-friendship hashtags (#forzaCinaeItalia) and thank-you-China hashtags (#grazieCina). But there is another, less visible layer of activity, too.

A year ago, Italy became the core European member of the Belt and Road Initiative, the Chinese trade-and-infrastructure project designed to create deeper links across Eurasia and to provide an alternative to the transatlantic and Pacific trade pacts quashed by Trump. Foreign Minister Luigi Di Maio, until recently the leader of Italy’s anti-EU Five Star Movement, has cultivated links to China too. Chinese investment has gained importance. Already, a Chinese oligarch has bought the Inter Milan soccer club; Chinese banks already own big stakes in Italian companies like Eni and Fiat.

Thanks to the economic havoc created by the coronavirus, China’s efforts in Rome may now bear fruit. Maurizio Molinari, the editor of La Repubblica, told me that Chinese businessmen are right now building on their contacts, looking for companies and properties to buy, scouting out factories that are suddenly bankrupt and entrepreneurs who want to sell out. I asked him what the source of China’s appeal was right now: “Money,” he replied. By contrast, the most conspicuous gesture that the U.S. administration has made in Italy’s direction since the pandemic began was Trump’s abrupt decision to ban flights. Apart from a modest and belated aid package, little in the way of friendship came from the United States.  

Chinese propaganda may find unexpectedly fertile ground elsewhere too. Chinese aid has also been delivered to Japan and South Korea, two U.S. allies who have sought close relationships with Trump and have received, in exchange, demands that they pay more for American bases. As close neighbors and former foes, both countries have many reasons to be wary of China. But now that Trump is a laughingstock, now that America is absent from the game, some in both Tokyo and Seoul may conclude that they should start hedging bets. China has also offered major assistance to Iran, a country that had already been given a major role as a Belt and Road hub. Iranian leaders now have extra reasons to hope they can outlast sanctions if the American president calling for them need not be treated as a serious person.  

China’s relationships with the Arab world have also deepened during the pandemic. Qatar, Saudi Arabia, and Kuwait sent aid to Wuhan during the earlier part of the crisis; later, China reciprocated. The foreign minister of the United Arab Emirates has described China as the role model to follow in this crisis. On March 8, Chinese medical workers arrived in Baghdad—an advance team, perhaps, poised to take advantage of the inevitable American retreat. In each one of these places, America is absent, distracted, stumbling—and laughable.

To be absolutely crystal clear: I am not praising China’s efforts. I am simply calling attention to the fact that, in a world where people laugh at the American president, they might succeed. Inside the bubble of officials who surround Pompeo, it may well seem very brave and cutting-edge to use the expression “Wuhan virus” or to call for bigger and bolder rhetorical attacks on China. But out there in the real world—out there in the world where Pompeo’s boss is perceived as a sinister clown, and Pompeo himself as just the sinister clown’s lackey—not very many people are listening. Once again: A vacuum has opened up, and the Chinese regime is leading the race to fill it.

Judging from their own recent statements, Trump-administration officials do not yet understand the significance of the chaos they have created in place of what used to be American foreign policy. Pompeo has spent time in recent days trying to organize sanctions on Iran, as if Russia and China or even European allies were still willing to follow his lead. Philip Reeker, assistant secretary of state for Europe (or rather, acting assistant secretary of state for Europe, because the Trump administration is in constant chaos) was recently asked by French journalists whether the coronavirus crisis could repair the poor state of transatlantic relations. His pompous response made him sound like a member of the Soviet nomenklatura at the end of the 1980s: “I don’t agree with the premise of your question,” Reeker said, before claiming that transatlantic engagement, and particularly Franco-American cooperation, is “remarkable.” Yes, it’s remarkable—remarkably invisible.

Even the more learned analyses of U.S.-China relations suddenly look out of sync with reality. It’s all very well for think-piece authors or former Trump-administration officials to suggest that a post-pandemic America must change its relationships with China, rally its allies to defy China, and rewrite the rules of commerce to exclude China. But when Trump seeks to lead the world against China, who will follow? Italy might refuse outright. The European Union could demur. America’s close friends in Asia might feel nervous, and delay making decisions. Africans who are furious about racism in China—African students have been the focus of heavy discrimination in the city of Guangzhou—might well do a quick calculation and seek good relations with both sides.

I wish I could say for certain that a President Joe Biden could turn this all around, but by next year it may be too late. The memories of the prime minister at the airport, welcoming Chinese doctors, will remain. The bleach jokes and memes will still cause the occasional chuckle. Whoever replaces Pompeo will have only four short years to repair the damage, and that might not be enough.

And if Trump wins a second term? Any nation can make a mistake once, elect a bad leader once. But if Americans choose Trump again, that will send a clear message: We are no longer a serious nation. We are as ignorant as our thoughtless, narcissistic, ignorant president. Don’t be surprised if the rest of the world takes note of that, too.