How To Keep the World Free From China After Coronavirus The global pandemic demonstrated the catastrophic consequences of leaving Beijing unchecked. Just as we need a vaccine to deal with COVID-19, we need a prophylaxis to deal with a belligerent, uncooperative Chinese Communist Party.

Let’s be realistic. No consensus exists on the future of relations between China and the West. Yet, clearly that is changing. 

Previously, many looked at Beijing as little more than a “checkbook,” an opportunity to make a quick buck and buy cheap stuff. That is quickly becoming the minority view. Even those still anxious to continue to engage know we are heading into troubled waters.

Left unaddressed, the influence of China’s communist government will threaten the freedom, prosperity, and security of the transatlantic community. Only together can the U.S., Canada, and its European partners ensure a stable future that allows free nations to thrive.

It is also not realistic to think the world will harden into new Cold War camps. We live in an interconnected world; a world of independent nations doing business around the clock; where the “freedom of the commons,” including the freedom to cross the seas and transit the skies, is a right.

That means the future is going to be messy. We can’t just wish China away.

To get through this, the family of free nations in the transatlantic community can’t be neutral in our approach to global affairs and China’s role. After all, we believe in popular sovereignty, human rights, and free enterprise. The Chinese Communist Party does not. If we do not stand together and defend these equities, we will lose the world we love.

Increasingly, leaders in Europe and the United States recognize that doing business as usual with China is risky business. So what do we do?

In part, the issue of China has come to the forefront because of the appalling behavior of the Chinese Communist Party in responding to the outbreak in Wuhan of COVID-19, the disease caused by the new coronavirus. No question, the Chinese government allowed people to travel internationally, knowing they had the potential to be highly contagious.

Further, China delayed reporting under international health regulations and did not provide live samples of the coronavirus to other countries for research and vaccine development. The regime’s behavior is not an aberration. China has a long history of bad behavior.

The global pandemic demonstrated the catastrophic consequences of leaving Beijing unchecked. Just as we need a vaccine to deal with COVID-19, we need a prophylaxis to deal with a belligerent, uncooperative Chinese Communist Party. Let’s get to it.

NATO is vital. The alliance needs to take the China threat seriously. Chinese actions and power could well erode NATO’s capacity to exercise self-defense.

From telecommunications to industrial control systems, from space and cyberspace to bridges, railroads, and ports, China already has a heavy footprint presence throughout the transatlantic community. NATO will need all this infrastructure to deter conflict and defend itself.

Yet if China controls the off switch or has the capacity to conduct malicious or denial activities, NATO’s capacity for self-defense will be severely compromised. NATO must be willing to prevent China from having the capacity to interfere in the defense of the alliance’s area of responsibility.

NATO nations all must continue to demonstrate the capacity for self-defense against other external threats.

The U.S. is a global power with global interests and responsibilities; in addition to participating in protecting the transatlantic community, the U.S. must face China in the Indo-Pacific and achieve a stable Middle East. For the U.S. to do all three well, NATO must do its part—particularly in dealing with the great external threats to European security.

NATO’s top priority must be countering the destabilizing activities of Russia. The second major threat is that the problems of the Middle East may spill over into and destabilize Europe. To confront all those very real possibilities, NATO needs to have the capacity and capability to look and act south toward the Middle East.

In short, a strong NATO allows the U.S. to focus more on responding to the global China challenge.

The European Union has a role. In addressing the destabilizing China threat to Europe, the EU is America’s other indispensable partner.

European leaders have seen in the past how China has used its relationships with individual European states to divide and conquer, play one country off against another, and undermine European solidarity to act in its own self-interest. 

Further, the EU manages many of the competencies required to restrain Chinese predatory behavior, particularly in the areas of trade, finance, and investment.

Another area where EU-U.S. cooperation is vital is in taking on the challenges in Africa. Some African nations face a diversity of challenges, from human rights and lack of economic freedom to terrorism and environmental and public health issues, complicated by poor governance and public safety.

China’s incursions into Africa have served only to exacerbate all these problems. The Chinese have enabled corruption, employed predatory lending practices, and spread disinformation. The EU could be a partner for tackling many of these challenges together.

International organizations. Joint U.S.-European efforts to bring greater transparency and accountability in international organizations is also important.

For years, the Chinese Communist Party aggressively has attempted to inject staff and leaders into international organizations who are beholden to the Beijing regime. The World Health Organization is an ice shaving on the tip of the iceberg. The U.S. needs partners to tackle this threat.

U.S.-Europe economic recovery. The U.S. and Europe can’t handle China if our economies are not strong and resilient. The economic recovery of the transatlantic community is intertwined.

We need a joint U.S.-European economic recovery program. This program would not consist of traditional foreign aid but instead rely on investment and partnership engaging the private sector. 

The United States and Europe need each other more than ever. It is time for leaders on both sides of the Atlantic to invest in strengthening the world’s most important partnership.

Coronavirus Vaccine in 2020? Don't Get Too Excited Good research takes time. by Simon Kolstoe

Donald Trump may be “very confident” we will have a vaccine for COVID-19 by the end of the year, but the rest of us should be more cautious. Billions of dollars are being spent trying to develop vaccines and treatments as a more permanent solution to the crisis than the lockdowns currently being enforced around the world. 

As of May 2020 there are 182 treatments and 99 different vaccines being developed globally. But, based on recent history, only one or two are likely to be transformative, a couple may be partially helpful, some will be shown as downright dangerous, and the majority will have conflicting evidence as to their effectiveness.

This is because medical research is a slow and painstaking process. It is also very complicated and easy to come to the wrong conclusions.

Trusting the experts

One good thing to have come out of the coronavirus pandemic seems to be a renewed trust in experts. The routine presence of scientists at government briefings seems to recognise that rather than deserving our suspicion, we need these people to beat the virus.

But more trust in experts means more scrutiny of science as it happens – the latest studies showing promising results are now headline news. This can be worrying because, while there is no doubt that treatments for COVID-19 will eventually be found, it is easy for enthusiasm to turn into cynicism if expectations are not met as quickly as the public and politicians may hope.

There seems to be little recognition that, while thousands of drugs have shown promise in early animal or clinical tests – for example, the vaccine trials at the University of Oxford – the vast majority that show early promise will never make it into routine clinical use. On average it takes 12 years and over US$1 billion (£805 million) to get a drug to market.

Good research takes time

I chair research ethics committees. Over the last few years I have reviewed thousands of research protocols representing the very best, and occasionally some quite poor, examples of medical research.

Good research is defined as rigorous and reliable, producing results that are not only interesting, but are practical, useful and in some cases transformative. They are also reported clearly, transparently and in the context of previous studies. This is precisely the type of research we need to address the COVID-19 crisis.

But such good research comes at a cost. Much of society thinks of cost in terms of dollars and pounds, and indeed mindful of our own survival, scientists and researchers are of course always going to lobby for more investment. While it is very helpful to have the funds to order any chemical that is needed, access highly specialised equipment, or pay others to conduct experiments and analyse results quickly, we must take care never to underestimate the importance of taking time to think carefully about what results actually mean.

It is only once researchers have taken the time to understand the context of results that they can start turning them into effective applications or treatments. The real cost of good research is therefore time.

The frustrating truth about medical research is that the majority of experiments appear not to work because the subject being studied is so horrendously complex. In fact, rather than “not working”, many experiments are simply inconclusive. To make progress you have to slow down, look at the evidence and take time to think very carefully about what the results might mean.

The thinking needed for this takes years. I was involved with one project that was delayed for almost ten years while the team tried to work out why a single animal showed cardiovascular complications. Another project I worked on showed promise reducing an Alzheimer-like pathology in mice, yet 18 years later similar effects have yet to be conclusively shown in humans. Commendably, the team is still working on it.

The reality is that the long road to a vaccine or drug for any disease is littered with trials that did not lead to expected results. Even when a study is successful, it takes a long time to go from the lab to the general public.

The pressure to find a cure

One worrying aspect of the current situation is the pressure on researchers to work quickly and come up with solutions for COVID-19 almost immediately. For perhaps the first time, financial resources are not a limiting factor, and so politicians and the public are expecting researchers to take the cash and provide the answers. This has been coupled with significant pressure on regulators to streamline or even suspend some of the normal processes so that treatments can get to the clinic as quickly as possible.

Lured by promises of unlimited funding, and perhaps fame should their chosen idea work, some researchers may be tempted to engage in questionable research practices. History shows that whenever a large amount of money is involved, the temptation to commit, fraud, misconduct or other questionable practices increase. The UK spent more than £400 million during the 2009 swine flu outbreak stockpiling a drug whose effectiveness had been inflated by the manufacturers due to publication bias – where negative or inconclusive results from a trial are not published in scientific journals, but positive results are.

Without appropriate scrutiny there is a real risk that ineffective, or even harmful, treatments begin to get used. This may be considered an acceptable risk in the current crisis, but if so, it is important that any new treatments are monitored very closely and withdrawn without hesitation if the harms mount up.

Given time – maybe two, three or perhaps even ten years – researchers will be able to take stock of the evidence from experiments and trials, perform a meta-analysis and systematic review, hold international conferences, and then, following careful thought, tell the world what the best treatment for COVID-19 is.

The world clearly needs scientific and medical answers to the current pandemic as soon as possible, but we need to recognise that initially we may only find partial or tentative answers. Instead of a quick vaccine that completely prevents COVID-19, a variety of partial successes will be combined until eventually a full solution is found.

There may even be some blind alleys with promising, but ultimately futile, treatment ideas. This is not a failure of research, or misuse of resources. Above all, researchers need to be supported to work with integrity, and not be made scapegoats for the challenges that undoubtedly lie ahead.

The Coronavirus Is Changing How the War in Afghanistan Is Being Waged The pandemic has caused the Taliban to shift its tactic from mainly targeting densely populated cities to attacking rural areas. This shift in strategy is likely due to the Taliban strategizing to avoid exposure to the virus by steering away from the cities that have been hit the hardest by it. by Sabera Azizi

As the coronavirus continues to spread in Afghanistan in April, Gen. Austin Scott Miller, the head of NATO’s Resolute Support Mission and United States Forces–Afghanistan, and Zalmay Khalilzad, Washington’s Special Representative for Afghanistan Reconciliation, met with the Taliban in Qatar.

The purpose of the meeting was to discuss the increased attacks carried out by the Taliban in Afghanistan—a violation of the deal signed between Washington and the Taliban. Since the signing of the deal, the Taliban has carried out more than 2,162 attacks across Afghanistan. The Taliban’s insistence on posing as a security threat led Washington to retaliate by carrying out an airstrike against the Taliban just days after the signing of the agreement.

Despite the increased pressure from Washington, the Taliban continues to launch attacks throughout the country. However, the pandemic is changing the dynamics of the war.

The coronavirus outbreak has caused the Taliban to shift its tactic from mainly targeting densely populated cities to attacking rural areas. This shift in strategy is likely due to the Taliban strategizing to avoid exposure to the virus by steering away from the cities that have been hit the hardest by it. Instead, the terror group has focused on attacking areas with low numbers of reported coronavirus cases.

Despite the Taliban’s rejection of the Afghan government’s call to a ceasefire for the month of Ramadan, it has also expressed an interest in halting violence due to the coronavirus. Zabihullah Mujahed, the Taliban’s spokesperson, told the Associated Press that “If, God forbid, the outbreak happens in an area where we control the situation then we will stop fighting in that area.” What’s apparent is that the Taliban’s willingness to agree to a ceasefire will be a calculated decision based on its interests via the threat of an outbreak in its areas. Although the Taliban has yet to implement a ceasefire, a glimmer of hope for reduced violence remains.

As much as the Afghan government and the Taliban disagree on key elements of the peace process, the coronavirus outbreak could increase cooperation between the Afghan government and the Taliban. The Taliban expressed a willingness to cooperate with government health-care workers and nonprofit organizations to assist populations in need. Additionally, the Taliban has launched initiatives, such as distributing guidelines and launching workshops in its controlled-areas to prevent the spread of the virus. The Taliban, too, is taking social-distancing seriously. A civilian told Al Jazeera, “They have cancelled all public gatherings, weddings and have asked people to pray at home instead of the mosques.” Even though such deliberate measures are intended to prevent the spread of the virus to the ranks of the Taliban and to neighboring countries who provide safe havens for the Taliban—it has led to a rare readiness by the Taliban to cooperate with Kabul.

Khalilzad has previously used the coronavirus to push the Afghan government and the Taliban toward the prisoner exchange process. This, he argued, would prevent a humanitarian disaster in overcrowded jails due to the high risk of contagion. Thus, with Washington’s support, both sides have released prisoners. Despite the hurdles involved, these exchanges are likely to continue until the agreed threshold in the peace deal has been met. That threshold consists of five thousand Taliban prisoners and one thousand Afghan security force personnel.

Additionally, Washington began the process of troop withdrawal soon after signing the deal on February 29. Currently, there are about twelve thousand U.S. troops in Afghanistan. According to the agreement, approximately thirty-four hundred American soldiers would withdraw from Afghanistan within 135 days. However, the coronavirus complicates the withdrawal process. Although the Pentagon has halted U.S. troop movements overseas for sixty days, Afghanistan remains an exception. The Defense Department underscored that the drawdown would continue. Yet, Miller noted that in some cases U.S. troops in Afghanistan will remain “beyond their scheduled departure dates to continue the mission” due to the pause on troop rotations.

As of late March, four coalition troops tested positive for the coronavirus, with thirty-eight other service members having flu-like symptoms. In Afghanistan, there are more than 784 confirmed cases of the coronavirus. Should the virus rapidly spread across the country and exacerbated by Kabul’s inefficient measures and lack of resources, then it’s likely that congressional pressure would compel the Pentagon to expedite the withdrawal process to protect the wellbeing of its soldiers.

That said, a troop withdrawal wouldn’t indicate that the United States is abandoning Afghanistan. Washington continues to support the Afghan government and the U.S. army’s spokesperson for Afghanistan has made it clear on numerous instances that the United States will defend the Afghan army when needed. Further, during Secretary of State Michael Pompeo’s surprise visit to Kabul, he offered $15 million in aid to assist the Afghan government in tackling the coronavirus.

Secretary Pompeo emphasized that “We will constantly re-evaluate our posture with respect to Afghanistan, not only the security assistance and humanitarian aid and assistance we provide to them.” Although the pandemic is severely affecting the American economy, it’s highly unlikely that Washington will pull the plug on its financial assistance to the Afghan government due to its strategic importance. The United States has invested significant resources to ensure that the Afghan government remains intact to protect America’s interests and uses its aid as leverage accordingly. Since less than 1 percent of America’s GDP is expended on foreign aid, it’s probable that Washington will continue to finance the Afghan government, who’s more than 75 percent of its budget depends on foreign aid.

The coronavirus adds complexities to the peace deal and intensifies Afghanistan’s challenges. Since 9/11, Washington has assisted the Afghan government in alleviating political crises. Now, as the world faces a global health crisis, and as Washington and Kabul are both impacted by the virus, the pandemic tests the enduring partnership between Washington and Kabul.

Why the Coronavirus Won't Transform International Affairs Like 9/11 Did Have we entered into a “new era” in international affairs? Will March 2020—specifically 9/11, the day in which the United States began to reconfigure its domestic social and economic structures to cope with the coronavirus pandemic—become this generation’s 9/11 moment? The answer is likely “no.” by Nikolas K. Gvosdev

Have we entered into a “new era” in international affairs? Will March 2020—specifically 3/11, the day in which the United States began to reconfigure its domestic social and economic structures to cope with the coronavirus pandemic—become this generation’s 9/11 moment? 

Over the past month, there has been a plethora of pieces arguing that the coronavirus crisis has changed everything and that this modern-day plague marks a bright dividing line between the uncertain present and the preceding “post–9/11” era. Just as Derek Chollett and James Goldgeier coined the “11/9 to 9/11” tag to describe the period between the Fall of the Berlin Wall (the end of the Cold War) and what George Will famously described as the end of America’s “holiday from history,” does the coronavirus mark a similar sharp break? In the future, for instance, when we resume flying, will screen at the airport be less concerned about three ounces of liquids and gels and more focused on whether we are wearing masks, with body scanners reconfigured to detect temperatures and health conditions rather than concealed weapons?

In the weeks following the September 11 attacks, including at a special symposium held at the National Interest, the question was raised as to whether the fight against Al Qaeda and international terrorism would become the new central organizing principle of U.S. foreign policy. After all, Osama bin Laden’s rash strike and his penchant for making enemies had produced a rare convergence where, in the remaining months of 2001, the United States, its NATO allies and its partners in East Asia, but also Iran, Russia, China, India, and Saudi Arabia were all on the same page regarding the threat posed by Al Qaeda. At least for a time, bin Laden had ameliorated great-power competition. 

In talking about the pandemic, Bill Gates could repurpose statements made by President George W. Bush and simply substitute “coronavirus” for terrorism. Gates believes that the threat of this pandemic unites all countries in a common fight and that eradicating this scourge ought to become the central task of every country’s foreign policy. If, over the last several years, the fight against terrorism was losing its luster and the post–9/11 proviso that the United States was threatened more by problems emanating from weak states than strong ones was being replaced by a return to competition among the great powers, then will the coronavirus cause countries to disavow power politics and place a greater emphasis on health and human security?

Make no mistake, the coronavirus is having an impact. It is testing existing alliance relationships and causing fractures in the current setup of globalization. It is challenging the wisdom of over-relying on a single great global-market continuum to provide goods and services necessary both for prosperity and security. But we have not had that one single shock, as in 9/11, which leads to a pause. The coronavirus has not led North Korea to cease its provocations across the DMZ or to stop missile testing; it has not induced the Islamic Republic of Iran to abandon its nuclear program; it has not paused Chinese efforts to create a “new normal” in the South China Sea nor caused Russia to disgorge Crimea. Coronavirus is not becoming the central organizing principle but rather one more factor that countries must deal with in charting their foreign policies.

Nor is it automatic that the damage caused by the pandemic is viewed equally by all states. What we have seen instead is a mix of cooperation and confrontation, based on how each power assesses its interests. China and Russia will not hesitate to take advantage of any openings that are created by the friction that coronavirus has created in the U.S. relationship with its allies, while the United States will not be disappointed if the challenges of coping with the pandemic create serious strains for Xi Jinping or Vladimir Putin in terms of their domestic governance. China has made its opening bid to encourage Europe to distance itself from the United States, while the U.S. hopes that the aftermath of the pandemic will strengthen calls for decoupling between the West and China.

So, I am skeptical that we are on the verge of a massive shift in international affairs. The coronavirus was a “gray swan”—for years we have expected that a massive infectious disease event with global reach might occur, even if the specific cause and timing were unknown. If we are in a new period of global affairs, and if we are no longer in a post–9/11 world, then that shift has been gradually occurring. The pandemic is not going to end competition within an anarchic global system—it will just become another factor.

Japan's New Weapon Against Coronavirus: Robots In an effort to lessen the burden on the nation’s medical system, Japan is now using more than 10,000 hotel rooms to accommodate patients with lighter COVID-19 symptoms, in which hospitalization is not needed. And that's not all. by Ethen Kim Lieser

In an effort to lessen the burden on the nation’s medical system, Japan is now using more than 10,000 hotel rooms to accommodate patients with lighter COVID-19 symptoms, in which hospitalization is not needed. 

But when these patients arrive at one of these hotels, they won’t experience your more typical greeting—this mundane task is now being handled by a robot.

One hotel is using a well-known robot named “Pepper,” which wears a protective mask like the patients. It can remind people by saying, “Please, wear a mask inside. I hope you recover as quickly as possible.”

Other uplifting messages include: “I pray the spread of the disease is contained as soon as possible” and “Let’s join our hearts and get through this together.”

Pepper, which has been around since 2014, has been deployed to several office buildings across the world to greet visitors. This particular robot features facial recognition software that enables it to identify individuals and even detect emotion via voice patterns and facial expressions.

In addition to Pepper, another hotel is utilizing the services of another high-tech robot, and its chief function is to clean. Armed with the latest AI skills, this robot can clean “red-zone” areas of the hotel that are deemed too risky for the on-site staff to take on.

There is even another robot—called LightStrike—that has recently made waves with its capability to use ultraviolet light to disinfect hospitals. More importantly, it has been shown to neutralize the novel coronavirus in only two minutes, providing a potentially effective method of eliminating the virus from high-risk public areas.

Texas-based Xenex Disinfection Services has already announced a successful test of the robot against COVID-19. LightStrike, which is sold in Japan by the medical equipment maker Terumo, is designed to be able to emit light at wavelengths between 200 and 315 nanometers.

Ultraviolet light has shown to be highly efficient in decontaminating furniture, doorknobs and other often-used surfaces. Just two or three five-minute rounds of ultraviolet light on surfaces can leave viruses too damaged to function.

Japan has more than 14,000 COVID-19 cases, along with about 450 deaths, according to Reuters. 

New Survey Finds That a Majority of the UK Public Supports Long Coronavirus Lockdown The people have spoken. by Gabriel Recchia

Government ministers in the UK are reportedly in disagreement over whether to lift lockdown restrictions in May, or to keep these measures in place until the summer. Onlookers ranging from journalists to Conservative MP Liam Fox have presumed that British people want the lockdown to end “as quickly as possible”. But the results of a recent survey my team ran indicate the opposite. 

We found that 87% believed the lockdown should continue for at least another three weeks (with 6% unsure and 7% disagreeing). A similarly whopping 89% said they supported the government policy of requiring all non-essential workers to stay at home. The survey involved 2,502 UK residents through two panels on April 9-11. The proportion of respondents with different ages and genders mirrored the UK population as a whole.

Throughout the pandemic, governments have been keen to hint at their plans in ways that give their population some sense of what is coming without boxing themselves into particular timelines. On April 9, the day our survey opened, Foreign Secretary Dominic Raab summarised the UK’s near-term plans by saying “the measures will have to stay in place until the evidence shows we have moved beyond the peak”.

When asked their opinion on whether the UK’s plans over the next few weeks were “not firm enough with restrictions on people” or were “putting too many restrictions on people”, roughly a fifth said they didn’t know what the plans were. Of the rest, 56% felt they were not firm enough, while 19% felt that they imposed too many restrictions. (The remaining 25% did not lean one way or the other.)

Perhaps more surprising is that when asked how they felt about the UK government’s plans over the next few months, which have been sketchy at best, only one fifth said they didn’t know what the government’s plans were. Of the rest, 51% felt they knew enough to say the government would not be firm enough in terms of restrictions, while 22% felt that it would impose too many. Many survey respondents left comments outlining additional steps that they felt the UK should be taking, such as expanded testing, travel restrictions, stricter enforcement of existing measures or mandating mask-wearing.

If UK residents seem to have a greater tolerance for lockdown than their neighbours across the pond – where there have been numerous protests against state lockdowns – keep in mind that Britons’ level of concern about COVID-19 may be uniquely high. Our recent analysis of data from a similar poll from March, recently accepted for publication by the Journal of Risk Research, found that the UK had the highest levels of perceived risk out of the ten countries surveyed: Australia, Germany, Italy, Japan, Mexico, South Korea, Spain, Sweden, the United Kingdom and the United States.

But worries were high across the board – even in the US. Similarly, a recent study from Yale University found that over 80% of Americans believe that stopping the spread of the coronavirus is more important than stopping the country’s economic decline, protests notwithstanding.

What this means

We also asked respondents to indicate whether they felt they had enough information from the government to take the necessary actions to minimise their risk from coronavirus on a sliding scale from “not at all” to “very much”. The proportion of respondents who felt they had enough information (those on the “very much” half of the scale) rose from 64% in March 19-20 to about 80% in our April survey. This is a major improvement, but 10% felt the opposite, with the remaining ~10% squarely in the middle. This indicates that the UK government still has some way to go to ensure everyone has the information they need.

If ministers’ proposals to end the lockdown sooner rather than later are arising partly from a perception that people are itching for an immediate end to the current policy, these concerns are misplaced. That said, government would do well to keep its pulse on nationally representative public opinion polls on this issue, as this is likely to change over time.

The high levels of concern among the British public also suggest that turning the economic tap back on may be more challenging than anticipated. For example, if people remain unwilling to patronise pubs, restaurants and retail outlets, then continued economic support for these industries may be necessary for a long time to come.

Assuaging public fears will not be as easy as simply telling people that the danger has passed. Thankfully, most UK residents in our April surveys indicated high levels of trust in the UK’s national scientific and medical advisers, with over 90% placing as much or more trust in them than in the country’s politicians.

But to preserve that trust, and to avoid having to make the sorts of policy u-turns we experienced in early March, scientific models and modelling assumptions should be transparent and shared widely with relevant experts, so that shaky assumptions can be corrected before they become baked into policy. Furthermore, scientists should be open about their uncertainties – research suggests that the public can handle the truth. In the words of the UK Statistics Authority’s principal adviser on the assessment of official statistics, “being trustworthy depends not on conveying an aura of infallibility, but on honesty and transparency”.

It remains unclear at what point UK residents will feel that the pain of lockdown exceeds the benefits, and we do not envy the difficult decisions that policymakers will have to take with limited information. But we can only hope they will do so with a clear-eyed attention to the science, as well as the concerns and needs of the British public.

Why the World Health Organization Must Strike a Fine Line on the Coronavirus A tough tightrope to walk. by Andrew Lakoff

The Trump administration recently declared, in the midst of the coronavirus emergency, that it would suspend the United States’ financial support for the World Health Organization, a United Nations agency that coordinates a wide range of international health efforts. The United States typically contributes more than US$400 million per year to the organization, roughly 15% of its annual budget. 

In announcing the suspension of U.S. funding, Secretary of State Mike Pompeo claimed that WHO had failed to provide “real information about what’s going on in the global health space.” President Trump suggested that the agency had colluded with the Chinese government in withholding information about the nature of the outbreak: “I have a feeling they knew exactly what was going on,” he said. And he sought to deflect blame for his administration’s disorganized response by pinning responsibility on global health officials: “So much death has been caused by their mistakes.”

To assess these claims, it is important to understand the context in which WHO officials make critical decisions at the early stages of a disease outbreak. As I explore in my recent book, “Unprepared: Global Health in a Time of Emergency,” WHO is constrained in its ability to gather knowledge about disease outbreaks and to intervene in national settings. It must rely on national governments for information about an outbreak and for permission to send investigators to learn more details. The agency’s power is limited to providing technical assistance and issuing recommendations.

Critical moments of decision

In January 2020, infectious disease experts scrambled to understand key aspects of the novel coronavirus, such as its rate of transmission and its severity. At that point, it was not yet possible to know exactly what was going on with the disease. Nonetheless, WHO officials had to make urgent decisions – such as whether to declare a global health emergency – in a situation of uncertainty.

More generally, much critical information about what is happening in the global health space can be known only in retrospect, once data on the event has been gathered, analyzed and disseminated by the scientific community.

Two other recent global health emergencies are instructive: the 2009 H1N1 influenza pandemic and the 2014 Ebola epidemic. In the aftermath of each of these outbreaks, WHO was sharply criticized for its early response.

When a novel strain of H1N1 influenza was first detected in the spring 2009, global health officials feared that it could spark a catastrophic pandemic. Within weeks of the virus’s appearance, WHO officially declared a global health emergency. The declaration urged countries to put their existing pandemic preparedness plans into action. In response, a number of national governments implemented mass vaccination campaigns, making advanced purchases of millions of doses of H1N1 vaccine from pharmaceutical companies.

Over the next several months, as the vaccine was manufactured and vaccination campaigns were implemented, epidemiological studies revealed that H1N1 was a relatively mild strain of influenza, with a case fatality ratio similar to that of seasonal flu.

In many countries, when the H1N1 vaccine finally became available in the fall 2009, there were few takers. National governments had spent hundreds of millions of dollars on campaigns that immunized, in some cases, less than 10% of the population.

Critics in Europe accused WHO of having exaggerated the pandemic threat in order to generate profits for the pharmaceutical industry, pointing to consulting arrangements that the agency’s influenza experts had with vaccine manufacturers. According to one prominent critic, the WHO declaration of a health emergency in response to H1N1 was “one of the greatest medical scandals of the century.”

A later investigation exonerated the WHO experts from wrongdoing, noting that the severity of the disease had not yet been determined when vaccine orders were made, and that “reasonable criticism can be based only on what was known at the time and not on what was later learnt.”

Retrospective criticism

Five years later, in the aftermath of the Ebola epidemic in West Africa, WHO officials again found themselves under sharp attack for their initial response to a disease outbreak. This time, officials were accused not of acting too hastily but rather of having failed to act in time.

At the earliest stages of the epidemic, in Spring 2014, the agency’s experts did not consider the event to be a “global emergency.” Based on prior experience, they felt that Ebola, while dangerous, was easily containable – the disease had never killed more than a few hundred people, and had never spread much beyond its initial site of occurrence. “We know Ebola,” as one expert recalled the early stages of response. “This will be manageable.”

It was not until August 2014, well after the epidemic had spun out of control, that WHO officially declared a global health emergency, seeking to galvanize international response. By this point it was too late to avoid a region-wide catastrophe, and multiple critics assailed the agency’s slow response. “WHO’s response has been abysmal,” as one commentator put it. “It’s just shameful.”

Whose failure?

Today, as the world confronts the coronavirus pandemic, the agency finds itself again under a storm of criticism, now with its very financial survival under threat. To what extent can we say that the agency did not provide adequate information in the early stages of the pandemic – that it failed to “do its job,” in Secretary of State Pompeo’s scolding words?

It is worth remembering that we are still in the early stages of the event as it unfolds, still seeking answers to critical questions such as how quickly the virus spreads, what its severity is, what proportion of the population has been exposed to it, and whether such exposure confers immunity. We also do not yet know whether the Chinese government fully informed global health officials about the seriousness of the initial outbreak. We do know, however, that while WHO made its most urgent call for vigilance by national governments in late January, with the declaration of a global health emergency, it was not until nearly two months later that the U.S. began – haltingly – to mobilize in response.

Not Showing Symptoms? Here's What You Need to Know About Asymptomatic Coronavirus A physician answers 5 questions. by William Petri

Blood tests that check for exposure to the coronavirus are starting to come online, and preliminary findings suggest that many people have been infected without knowing it. Even people who do eventually experience the common symptoms of COVID-19 don’t start coughing and spiking fevers the moment they’re infected. 

William Petri is a professor of medicine and microbiology at the University of Virginia who specializes in infectious diseases. Here, he runs through what’s known and what isn’t about asymptomatic cases of COVID-19.

How common is it for people to contract and fight off viruses without knowing it?

In general, having an infection without any symptoms is common. Perhaps the most infamous example was Typhoid Mary, who spread typhoid fever to other people without having any symptoms herself in the early 1900s.

My colleagues and I have found that many infections are fought off by the body without the person even knowing it. For example, when we carefully followed children for infection by the parasite Cryptosporidia, one of the major causes of diarrhea, almost half of those with infections showed no symptoms at all.

In the case of the flu, estimates are that anywhere from 5% to 25% of infections occur with no symptoms.

For the most part, symptoms are actually a side effect of fighting off an infection. It takes a little time for the immune system to rally that defense, so some cases are more aptly considered presymptomatic rather than asymptomatic.

How can someone spread coronavirus if they aren’t coughing and sneezing?

Everyone is on guard against the droplets that spray out from a coronavirus patient’s cough or sneeze. They’re a big reason public health officials have suggested everyone should wear masks.

But the virus also spreads through normal exhalations that can carry tiny droplets containing the virus. A regular breath may spread the virus several feet or more.

Spread could also come from fomites – surfaces, such as a doorknob or a grocery cart handle, that are contaminated with the coronavirus by an infected person’s touch.

What’s known about how contagious an asymptomatic person might be?

No matter what, if you’ve been exposed to someone with COVID-19, you should self-quarantine for the entire 14-day incubation period. Even if you feel fine, you’re still at risk of spreading the coronavirus to others.

Most recently it has been shown that high levels of the virus are present in respiratory secretions during the “presymptomatic” period that can last days to more than a week prior to the fever and cough characteristic of COVID-19. This ability of the virus to be transmitted by people without symptoms is a major reason for the pandemic.

After an asymptomatic infection, would someone still have antibodies against SARS-CoV-2 in their blood?

Most people are developing antibodies after recovery from COVID-19, likely even those without symptoms. It is a reasonable assumption, from what scientists know about other coronaviruses, that those antibodies will offer some measure of protection from reinfection. But nothing is known for sure yet.

Recent serosurveys in New York City that check people’s blood for antibodies against SARS-CoV-2 indicate that as many as one in five residents may have been previously infected with COVID-19. Their immune systems had fought off the coronavirus, whether they’d known they were infected or not – and many apparently didn’t.

How widespread is asymptomatic COVID-19 infection?

No one knows for sure, and for the moment lots of the evidence is anecdotal.

For a small example, consider the nursing home in Washington where many residents became infected. Twenty-three tested positive. Ten of them were already sick. Ten more eventually developed symptoms. But three people who tested positive never came down with the illness.

When doctors tested 397 people staying at a homeless shelter in Boston, 36% came up positive for COVID-19 – and none of them had complained of any symptoms.

In the case of Japanese citizens evacuated from Wuhan, China and tested for COVID-19, fully 30% of those infected were aymptomatic.

An Italian pre-print study that has not yet been peer-reviewed found that 43% of people who tested positive for COVID-19 showed no symptoms. Of concern: The researchers found no difference in how potentially contagious those with and without symptoms were, based on how much of the virus the test found in indiduals’ samples.

The antibody serosurveys getting underway in different parts of the country add further evidence that a good number – possibly anywhere from around 10% to 40% – of those infected might not experience symptoms.

Asymptomatic SARS-CoV-2 infection appears to be common – and will continue to complicate efforts to get the pandemic under control.