This piece was originally published in HuffPost and appears here as part of our Climate Desk Partnership.

Seeking firmer assurances, advocates urged the Tennessee Valley Public Power Association, the consortium that represents the TVA’s local distributors, to call for a blanket moratorium on shutoffs. But the group refused, claiming it “would be intruding on local control to issue such a recommendation,” said Bri Knisley, the Tennessee coordinator at Appalachian Voices, a regional environmental and anti-poverty nonprofit. 

As rates of infection from the novel coronavirus continue to spike, so too do concerns over medical resources. The US now has nearly 20,000 deaths and 500,000 cases, with a disproportionate number of them in New York, California, and Louisiana. Officials there are warning that hospitals are dangerously low on material supplies, like ventilators and masks, but also there’s a shortage of healthcare workers to attend to the sick.

On March 30, New York governor Andrew Cuomo called on the nation’s health care workers to “help New York,” and from all over the country doctors, nurses, and others responded. But hospital workers are also falling ill. At Ochsner Medical Center in New Orleans, which is also experiencing a severe outbreak, 60 employees have tested positive for COVID-19, the disease caused by the new coronavirus, and another 300 workers are in quarantine. To meet the demand nationally, medical workers from parts of the country that have not yet experienced an outbreak are going to work in hospitals where the epidemic has become severe.

But a vast patchwork of state healthcare regulations has made moving some of these workers across state lines complicated—especially for highly trained nurse practitioners. With few national licensing standards in place, healthcare workers who may want to lend a hand in other states, often find their efforts stymied by regulatory road blocks. “Any time you have multiple states creating laws, rules, and regulations through legislative process it’s going to look different [by state],” says Melody Wilkinson, a family nurse practitioner and program director for Georgetown’s School of Nursing & Health Studies. “That creates challenges and barriers.”

Leslie Sharpe, a practitioner who teaches at University of North Carolina School of Nursing put it another way: “There are these ridiculous state restrictions that are not enhancing patient safety in any way shape or form.”

That’s not true for all medical specialties. Thanks to a compact among 30 states, licenses for registered nurses are recognized by most jurisdictions, which means that most of the 3.8 million RNs in the US can travel from state to state and immediately join frontline efforts—and many have.

On the other hand, nurse practitioners—who are certified to offer a wider breadth of services than registered nurses—are another story. To become a nurse practitioner, one must earn a master’s or doctoral-level degree. It’s not uncommon for NP’s to offer similar services as physicians: providing physical examinations, offering diagnoses, interpreting test results, even prescribing medications. But for the nearly 300,000 nurse practitioners, their “scope of practice…is determined by the state, rather than by the education and training,” says Wilkinson, which explains why this group of health care practitioners now find themselves mired in restrictions should they want to serve outside their local communities during a global pandemic.

Two major barriers stand between nurse practitioners and intra-state practice. First, states  have no uniform standard for license recognition, like the compact for RNs. The result is that nurse practitioners are only permitted to work in their home states. Also, in 28 states, in order to provide services at all, NPs are required to maintain an administrative relationship with a physician. Depending on how restrictive state laws are, everything from prescriptions to basic care require a doctor’s supervision. That makes emergency mobilization nearly impossible.

Even if all states dropped the licensure restrictions, many states require practitioners to strike up collaborative practice agreements—which is different from the administrative relationship—with in-state physicians, another requirement that becomes particularly difficult during an emergency. “This is creating a challenge for nurse practitioners to respond at the top of their ability to deal with the COVID-19 crisis,” Tay Kopanos, vice president of government affairs at the American Association of Nurse Practitioners, says.

The inconsistent role of nurse practitioners across jurisdictions has been a long-standing issue for the profession. In 2010, the Institute of Medicine, an influential healthcare non-government organization, released a report entitled, “The Future of Nursing: Leading Change, Advancing Health,” which recommended standardizing the nurse practitioner role and allowing them to “practice to the full extent of their education and training.” That education and training is consistent nationally; all nurse practitioners carry the same practice certification. But how much of that training they’re permitted to use in a clinical setting “looks different in each state, because the state sets a scope of practice for nurse practitioners,” says Wilkinson. In 22 states and Washington, DC, nurse practitioners can offer healthcare services that reflect the full scope of their qualifications. In the other 28, that ceiling is lowered, and practitioners still are required to report to a physician.  

Even for practitioners moving to hotspots within their own state, collaborative practice agreements create a challenge. In North Carolina, for example, which has more than 4,000 official cases of COVID-19 and almost 90 deaths from the virus, NPs must get permission from their physician to practice in a new location. Assisting at a different facility essentially requires finding an entirely new sponsoring physician. “They’re left trying to find someone they don’t know on the other side of the state,” says Leslie Sharpe, a practitioner who teaches at University of North Carolina School of Nursing. “If I wanted to work in a mobile van during a hurricane to provide basic primary care—not trying to do surgery—I couldn’t do it unless I could find a supervising physician,” she says.

On March 26, secretary of Health and Human Services Alex Azar recommended that  states relax those rules and allow nurse practitioners to cross state lines and skip the process of tracking down a sponsoring physician. Governors in 45 states—including New York and California—have ordered their healthcare systems to recognize out-of-state licenses. Meanwhile, 18 states—North Carolina is not among them—have relaxed their practice agreements. A number of other states are also accepting the licenses of retired and inactive nurse practitioners.

While nurse practitioners say that will bring relief to strained healthcare systems, some are wondering why it took so long? “I think this is somewhat long overdue,” says Wilkinson, “If it’s safe for us to practice during a state of crisis, it’s safe all of the time.” 

On Tuesday, March 31, Louisiana officially relaxed regulations in order to bring out of state practitioners who can get to work without a supervising physician. According to Kathy Baldridge, a nurse practitioner and president of the Louisiana Association of Nurse Practitioners, the change didn’t come a moment too soon. Earlier in the month, an Arkansas nurse practitioner travelled to Ochsner Medical Center in New Orleans, one of the worst-hit hospitals in the country. Baldridge notes that at that point, it was still necessary to have a collaborative physician’s agreement, a difficult relationship to strike up in the midst of the crisis. As a result, the colleague had to operate as a registered nurse, restricted from providing care at the level of an NP, despite having the qualification. With an executive order, state governor John Bel Edwards lifted those restraints, allowing Baldridge’s colleague to offer the same care she was providing over the state line in Arkansas.

The days between January 19 when COVID-19 first appeared in Washington state and the when executive orders for practitioners were instituted could have been spent organizing much-needed care. “If those laws were already taken care of,” Baldridge says, “then you could have worried about the emergency at hand and not the executive order. So the medical staff who are out there can function to the top of their license and education.” 

On Sunday, President Trump took to Twitter to urge governors to buck up and start testing residents for the coronavirus. “No excuses!” he wrote.

Governors, get your states testing programs & apparatus perfected. Be ready, big things are happening. No excuses! The Federal Government is there to help. We are testing more than any country in the World. Also, gear up with Face Masks!

— Donald J. Trump (@realDonaldTrump) April 12, 2020

There’s a lot to unpack in this latest presidential deflection of responsibility. The failure to make coronavirus tests widely available months ago is perhaps the most colossal mistake among the Trump administration’s many bungled coronavirus responses. To date, there have been 2.8 million coronavirus tests administered in the United States, according to the COVID Tracking Project. That’s less than 1 percent of the population—a lower per capita rate than other countries. So while it’s technically true that the US has tested more people than other countries, the suggestion that we’re leading the world in testing rates—something Trump has repeated—is not. 

Even members of Trump’s administration agree that national surveillance testing hasn’t gone well: Asked by Science Magazine what went wrong in the US response, Dr. Anthony Fauci said, “Obviously, testing is one clear issue that needs to be relooked at. Why were we not able to mobilize on a broader scale?” Last week, the Trump administration announced plans to pull back funding for testing centers across the country, prompting bipartisan uproar and a reversal of the plan. 

The tweet comes a day after a bombshell New York Times story details the many ways in which top administration officials attempted to sound the alarm bells and urged the president into action in January and February.

As for gearing up with face masks, it’s unclear where the president expects this protective equipment to be coming from: just last week the administration informed Congress that the the federal government’s emergency stockpile was depleted and states wouldn’t be receiving more shipments of personal protective gear. 

On Friday, Trump announced that the administration was now encouraging the use of non-medical face masks, and then clarified, “I don’t think I’m going to be doing it.” He went on, “Wearing a face mask as I greet presidents, prime ministers, dictators, kings, queens—I just don’t see it.”

Italian opera singer Andrea Bocelli just delivered an audience-free Easter concert to promote “love, healing and hope to Italy and the world,” and it’s a real tear-jerker. Head to 18:30 for “Amazing Grace” performed solo in front of Milan’s iconic Duomo cathedral.

Dr. Anthony Fauci said on Sunday that the nation likely “could have saved lives” by acting earlier on the coronavirus outbreak.

“Obviously, if we had, right from the beginning, shut everything down, it may have been a little bit different,” the director of the National Institute of Allergy and Infectious Diseases told Jake Tapper on CNN’s State of the Union.

He continued: “But there was a lot of pushback about shutting things down back then.”

The admission from Fauci follows yesterday’s bombshell New York Times story finding Fauci and other top administration officials urged Trump to take aggressive action weeks before he did. “We look at it from a pure health standpoint” Fauci said on Sunday. “We make a recommendation. Often the recommendation is taken. Sometimes it’s not.”

"We make a recommendation," said Dr. Anthony Fauci, when asked by @JakeTapper about reports that he and other top officials called for social distancing in February. "Often the recommendation is taken. Sometimes it's not. But it is what it is. We are where we are right now." pic.twitter.com/sw8xYZILB4

— State of the Union (@CNNSotu) April 12, 2020

While President Trump has said he is eager to lift stay-at-home restrictions, Fauci continued to voice caution: Lifting the measures shouldn’t be an “all or none” proposition, but should be a gradual process that could “probably start, at least in some ways, maybe next month.” He warned that lifting the restrictions too abruptly could make things worse: “If all of a sudden we decide, ‘OK, it’s May, whatever,’ and we just turn the switch on, that could be a real problem.”

Asked about whether Americans would be able to go to the polls in November, Fauci said: “I hope so.” He continued: “There is always the possibility, as we get into next fall and the beginning of early winter, that we could see a rebound.”

This piece was originally published in High Country News and appears here as part of our Climate Desk Partnership.

Rafters floating the silty waters of the Colorado River thousands of feet below the Grand Canyon’s rim can feel like they’re drifting through an alternate reality. Absent cell service or internet, they’re utterly disconnected from the world above.

At journey’s end, after more than 200 river miles, boaters are generally greeted by an outfitting service’s employees. Logistically, these folks are tasked with ferrying rafts, people, gear and human waste back to town. But they also help reorient dreamy-eyed rafters to above-the-rim existence. And these days, that means an abrupt introduction to a startling new reality.

When I took out from an 18-day trip on March 26, I was filthy and happy and oblivious. Nate Alvord, an employee at Ceiba, a Grand Canyon outfitter, greeted us. “Welcome back to a new world,” he said. “Sorry to be the bearer of bad news.”

Suddenly, we learned that just about everyone in the country had been ordered to stay at home. Everything, everywhere, was closed. Hardest of all, the 15 of us—a crew who’d grown close, bonded by group back rubs and shared meals—now had to keep our distance from others. It was Nate’s job to make sure we understood the new rules. A few days after my return, I caught up with him and his wife, Carolyn Alvord, who also works for Ceiba, to find out how they’ve handled this shift in responsibility.

This conversation has been edited for length and clarity.

What makes rafting the Grand Canyon such a special experience?

Carolyn: It’s a life-changing experience, going down through the canyon. I think it opens up a different part of your brain that might be suppressed because everybody’s busy and hurried. Everything slows down in the canyon, and you’re out of reach of everything, which is why people get so surprised when they come back off these trips.

When I took out, Nate, you were helping us take everything off our rafts, and Carolyn, you were helping the group right next to us. You were our introduction to this new world, shattering the idyllic reality of the river. And you’re doing this for group after group, day after day. What’s that like?

Carolyn: When Nate came home after his last trip, the first thing that he said was, “I hate doing that. I hate reintroducing the people to a world that’s not the way it was when they went down.” I was like, somebody has to do it.

Nate: It’s a harsh ending to a pretty wonderful experience.

In the car on the way home, someone said, “It always feels like the world has changed after a big trip like this. But usually, it’s you that’s changed. This time, it really is the world that’s totally different.”

Nate: Yeah, it is usually only the individual that changes on these trips and usually for the best. It’s always interesting to come upon a group of strangers, and just observe how they interact. But then, when you throw in this big bomb of anxiety, you can really see the wheels starting to turn as people figure out how they’re going to deal with this once they get home.

For my group, the seriousness of the news took a while to sink in. You told us we had to stand six feet apart now, but all we wanted was a big group hug. How are people taking in this new reality?

Nate: A lot of people ask if there’s still gas and if there’s still beer. If I say, “Yes,” to those things, people figure things haven’t changed that much. (Laughter.)

One of the common reactions has been people saying, “What are the chances that we would have gone on the river and missed the whole apocalypse?” It’s as if they think they’re coming back to a world that’s going back to normal. I think people were hoping that the whole thing would happen faster than it has, that they would come back to a world that was already in healing rather than one in which this virus is just beginning to escalate.

Carolyn: To me, the people on the river are the lucky ones. They’ve been isolated. They’re not the ones I’m afraid of; I’m afraid of me maybe infecting them. That’s the hardest thing to get across. They shouldn’t get as close to me as they think they can. But when you feel like you’re threatened, you want to be close to people. It’s a really rude awakening.

The river was closed to new launches on March 24. What’s this mean for your work? 

Carolyn: All of our trips that are supposed to be putting in are canceled. We’re still just taking up the last few that are left on the river. Then, that’s it for us. Ceiba is closing down on April 10, and we’re not sure exactly what we’re going to do.

We’re coming up on peak season, where, between commercial and private trips, more than 150 people a day can be launching into the canyon. But now, the canyon is going to be empty, probably for the first time in decades.

Carolyn: That’s for sure; this is a first, where it’s been closed for this long a time. It’s really giving the canyon a chance to rejuvenate and refresh itself. Which isn’t all that bad. 

Nate: I like to tell people as they get off a river trip that the river will always be there and that serenity will always be there, even when you’re not there to perceive it. And I think that’s even more true and important now. Nobody’s there scouting Lava Falls (the canyon’s most notorious rapid) today, nobody’s hiking up Havasu Creek (a popular side-canyon) today. It’s kind of nice to think about.

The same day President Donald Trump claimed to have the coronavirus outbreak “very much under control in this country,” his top disaster response official at the Department of Health and Human Services sent an email that should have been the White House’s holy-shit moment.

A New York Times investigation on Saturday reveals how, in late February, the White House’s coronavirus task force had shifted to preparing for the virus’ inevitable spread inside the United States. 

Two days after that meeting, a task force member, HHS official Dr. Robert Kadlec, read an alarming email from a researcher at the Georgia Institute of Technology about how asymptomatic cases were helping spread the virus:

A 20-year-old Chinese woman had infected five relatives with the virus even though she never displayed any symptoms herself. The implication was grave — apparently healthy people could be unknowingly spreading the virus — and supported the need to move quickly to mitigation.

“Is this true?!” Dr. Kadlec wrote back to the researcher. “If so we have a huge whole on our screening and quarantine effort,” including a typo where he meant hole. Her response was blunt: “People are carrying the virus everywhere.”

Here’s the full email, per the Times:

Kadlec and others presented Trump with a plan, “Four Steps to Mitigation.”

We know Trump didn’t follow their advice, instead spending the next days and weeks minimizing the coronavirus by claiming the flu was deadlier and attacking Democrats and the media for their supposed politicization of the crisis. While Washington state was battling the worst of its outbreak, Trump called Democratic Gov. Jay Inslee “a nasty person.” Trump said he wanted governors to be “appreciative” of his aid. 

On March 10, Trump said, “we’re prepared, and we’re doing a great job with it. And it will go away. Just stay calm. It will go away.” 

Now a month later, the United States has reached a grim milestone, passing Italy on Saturday as the world leader in deaths from the virus. More than 20,000 people have died in the country.

The New York Times has the receipts on Trump’s inept response to coronavirus:

A few religious leaders plan on defying social distancing orders by hosting crowds for services on Easter, relying only on the intervention from God to avoid sickening their congregations.

Many US churches, synagogues, and mosques have complied with local orders as the country, now with more than 500,000 cases and nearly 20,000 dead, faces its toughest weeks of the coronavirus outbreak yet.

But a pastor of a megachurch near Baton Rouge, Louisiana, expects more than 2,000 people to gather on Sunday. “Satan and a virus will not stop us,” the Rev. Tony Spell, pastor of the evangelical Life Tabernacle Church, told Reuters. “God will shield us from all harm and sickness. We are not afraid. We are called by God to stand against the Antichrist creeping into America’s borders. We will spread the Gospel.”

This is not how viruses work. Churches—like any other places where crowds might gather—can seed outbreaks of the coronavirus, the CDC demonstrated in one case study. In Chicago, at least 15 cases were traced back to a man who attended a dinner, a funeral, and a birthday party; three of those cases then went on to sicken more people at church services.

Religious leaders who haven’t complied with local and state orders have found some obstacles placed in their path.

Last week, a pastor of the Cross Culture Center in Lodi, California, planned on holding services, but the congregants found themselves locked out and police waiting at the door. According to Reuters, the pastor plans on meeting at another undisclosed site this weekend with about 80 members. 

Another pastor in Florida, Rodney Howard-Browne, was arrested in late March for holding services for hundreds of people despite an order limiting gatherings to no more than 10 people. He caved after his insurance company dropped his megachurch from its plan and now plans on holding Easter services online, 

Ammon Bundy, a rancher who led an armed occupation of an Oregon federal wildlife refuge in 2016, also told CNN he plans to gather several hundred people at an undisclosed location in Idaho, saying he’s unconcerned if he catches or spreads the virus. “Our goal is to get enough people together and secure our rights….We are not trying to provoke, we want people to be able to worship,” Bundy said.

Kentucky’s Democratic governor, Andy Beshear, has mandated a 14-day self-quarantine for any churchgoers on Sunday. As of Friday, he said at least seven churches were still undecided on services.

“I hope everybody knows that even on a weekend like this we cannot have in-person gatherings of any type,” Beshear said, according to NBC. “We absolutely cannot bring people together in one building like that because that is how the coronavirus spreads, and that’s how people die.”

This piece was originally published in the Guardian and appears here as part of our Climate Desk Partnership.

The environmental changes wrought by the coronavirus were first visible from space. Then, as the disease and the lockdown spread, they could be sensed in the sky above our heads, the air in our lungs and even the ground beneath our feet.

While the human toll mounted horrendously from a single case in Wuhan to a global pandemic that has so far killed more than 88,000 people, nature, it seemed, was increasingly able to breathe more easily.

As motorways cleared and factories closed, dirty brown pollution belts shrunk over cities and industrial centers in country after country within days of lockdown. First China, then Italy, now the UK, Germany and dozens of other countries are experiencing temporary falls in carbon dioxide and nitrogen dioxide of as much as 40 percent, greatly improving air quality and reducing the risks of asthma, heart attacks and lung disease.

For many experts, it is a glimpse of what the world might look like without fossil fuels. But hopes that humanity could emerge from this horror into a healthier, cleaner world will depend not on the short-term impact of the virus, but on the long-term political decisions made about what follows.

After decades of relentlessly increasing pressure, the human footprint on the earth has suddenly lightened. Air traffic halved by mid-March compared with the same time last year. Last month, road traffic fell in the UK by more than 70 percent, to levels last seen when the Beatles were in shorts. With less human movement, the planet has literally calmed: seismologists report lower vibrations from “cultural noise” than before the pandemic.

Key environmental indices, which have steadily deteriorated for more than half a century, have paused or improved. In China, the world’s biggest source of carbon, emissions were down about 18 percent between early February and mid-March—a cut of 250 million tons, equivalent to more than half the UK’s annual output. Europe is forecast to see a reduction of around 390m tonnes. Significant falls can also be expected in the US, where passenger vehicle traffic – its major source of CO₂—has fallen by nearly 40 percent. Even assuming a bounce back once the lockdown is lifted, the planet is expected to see its first fall in global emissions since the 2008-9 financial crisis.

Fossil fuels

There is no doubt that these lockdowns are hitting the fossil fuel industry. With fewer drivers on the roads and planes in the air, the price of oil has slumped almost two-thirds since last year. Car sales fell by 44 percent in March, with motorway traffic down 83 percent. So many more people are learning to teleconference from home that the head of the Automobile Association in the UK advised the government to switch infrastructure investment from building new roads to widening internet bandwidth.

This is potentially good news for the climate because oil is the biggest source of the carbon emissions that are heating the planet and disrupting weather systems. Some analysts believe it could mark the start of a prolonged downward trend in emissions and the beginning of the end for oil. Others strike a more cautious note about the fuel that has dominated our lives and polluted our atmosphere for the past century.

“The drop in emissions is global and unprecedented,” Rob Jackson, the chair of Global Carbon Project said. “Air pollution has plunged in most areas. The virus provides a glimpse of just how quickly we could clean our air with renewables.” But he warned that the human cost was too high and the environmental gains could prove temporary. “I refuse to celebrate a drop in emissions driven by tens of millions of people losing their jobs. We need systemic change in our energy infrastructure, or emissions will roar back later.”

Hopes that the pandemic will accelerate the transition to a cleaner world are already running into a political wall: the “shock doctrine” of disaster capitalism outlined by the author and activist Naomi Klein. In her book of the same name, the Canadian writer describes how a powerful global elite exploits national crises to push through unpopular and extreme measures on the environment and labour rights.

This is what is happening in the United States and elsewhere. Oil company executives have lobbied Donald Trump for a bailout. Under the cover of the crisis, the White House has rolled back fuel-economy standards for the car industry, the Environmental Protection Agency has stopped enforcing environmental laws, three states have criminalized fossil fuel protesters and construction has resumed on the KXL oil pipeline. The US government’s massive economic stimulus bill also included a $50 billionn bailout for aviation companies. Environmental groups are urging the UK and European Union not to do the same.

If governments prime the economic pumps with the intention of a return to business as usual, environmental gains are likely to be temporary or reversed. China provides some indication of what can be expected. With no new cases in Wuhan, the lockdown is being eased and energy use and air pollution have been rising since the end of March.

Wildlife and biodiversity

Nevertheless, while our species is in temporary retreat during the lockdowns, wildlife has filled the vacuum. This year will almost certainly see a much lower toll for roadkill by cars and trucks, which—in the UK alone—annually takes the lives of about 100,000 hedgehogs, 30,000 deer, 50,000 badgers and 100,000 foxes, as well as barn owls and many other species of bird and insect. Many councils have delayed cutting the grass on roadside verges—one of the last remaining habitats for wildflowers – which should bring a riot of color to the countryside this summer and provide more pollen for bees.

Coyotes, normally timid of traffic, have been spotted on the Golden Gate Bridge in San Francisco. Deer are grazing near Washington homes a few miles from the White House. Wild boar are becoming bolder in Barcelona and Bergamo, Italy. In Wales, peacocks have strutted through Bangor, goats through Llandudno and sheep have been filmed on roundabouts in a deserted playground in Monmouthshire.

This is presented as the comedy in our tragedy. Cartoonists have depicted throngs of tourist animals gawping through city windows at humans under lockdown. Commentators are even talking of the “post-human” era—a mocking rejoinder to the idea that we live in Anthropocene, a period of human domination that is reshaping the planet. Humor does not get much blacker. We are laughing at our own decline – and assuming that nature will be the beneficiary.

Environmental campaigners say that is a dangerous misconception. The picture is different across our unequal world. Rich, industrialized nations are seeing a temporary recovery of nature because there is so little of it in the first place. Poorer countries, on the other hand, especially in the southern hemisphere, fear an increased threat to wildlife because the pandemic means they have less money and personnel with which to conserve endangered species and habitats.

In the Amazon rainforest, environmental authorities are reining in monitoring and protection operations. In the Masai Mara and Serengeti, nature reserves are taking less tourist revenue, which means they are struggling to pay rangers. Conservation groups fear this will open the door to more illegal poaching, mining and logging, especially now that local people are losing income and need new ways to feed their families.

“In the short term it would be dangerous to think that a downturn in economic activity is a benefit to nature,” said Matt Walpole of Fauna and Flora International. “There are significant risks.”

Potentially offsetting this is reduced demand for many natural resources, but it remains to be seen whether home isolation of half the world’s population affects the appetite for consumer goods.

A new future?

The respite for nature will be less important than what follows. That is already being decided in closed meetings while the public is locked down at home. Meanwhile, global conferences intended to find solutions to environmental problems, such as the Cop26 UN climate talks originally scheduled for Glasgow at the end of this year, have been postponed.

UN leaders, scientists and activists are pushing for an urgent public debate so that recovery can focus on green jobs and clean energy, building efficiency, natural infrastructure and a strengthening of the global commons.

“This is the big political battle,” said Laurence Tubiana, CEO of the European Climate Foundation and an architect of the Paris agreement. Leading scientists have jointly signed an open appeal for governments to use recovery packages to shift in a greener direction rather than going back to business as usual.

Ultimately, the most important environmental impact is likely to be on public perceptions. The pandemic has demonstrated the deadly consequences of ignoring expert warnings, of political delay, and of sacrificing human health and natural landscapes for the economy. Of new infectious diseases, 75 percent come from animals, according to the United Nations Environment Programme. Compared with the past, they pass more rapidly to humans through wildlife trafficking and deforestation and then spread across the globe through air travel and cruise-ship tourism. China – the world’s biggest market for wild animals—appears to have recognised this by banning the farming and consumption of live wildlife. There are growing calls for a global ban on “wet markets”.

The pandemic has also shown that pollution lowers our resistance to disease. More exposure to traffic fumes means weaker lungs and greater risk of dying from Covid-19, according to scientists at Harvard University. As the UN’s environment chief, Inger Andersen, put it, nature is sending us a message that if we neglect the planet, we put our own wellbeing at risk.

Since the start of the pandemic, it is not just from space that the world looks different. The unthinkable is now thinkable. Positions are shifting. Libertarian governments are curtailing freedoms more drastically than wartime leaders. Austerity conservatives are approving trillions of dollars for healthcare and emergency spending. Small-state advocates are being forced into massive interventions. Leading business publications are calling for a deep reform of capitalism. Most importantly, the political focus has shifted from individual consumption to collective wellbeing.

These 100 days have changed the way we think about change. Ultimately, whether this pandemic is good or bad for the environment depends not on the virus, but on humanity. If there is no political pressure on governments, the world will go back to unsustainable business as usual rather than emerge with a healthier sense of what is normal.

For the French philosopher Bruno Latour, one thing we have learned is that it is possible in a matter of weeks to slow the economy, which until now had been considered inconceivable due to the pressures of globalization.

“The incredible discovery is that there was in fact in the world economic system, hidden from all eyes, a bright red alarm signal, next to a large steel lever that each head of state could pull at once to stop ‘the progress train’ with a shrill screech of the brakes,” he writes.

This makes ecological calls to move off a path of endless resource consumption more realistic, maybe even more desirable. But Latour warns that this unforeseen pause could easily allow powerful interests to seize more control ahead of the bigger battles looming over the climate and biodiversity. “This is where we must act,” he says. “If the opportunity works for them, it works for us too.”

As Jared Kushner has set himself a prominent role in the administration’s coronavirus response, there’s been a growing chorus of questions about what, exactly, he’s up to and how much the public will ever find out about it. Today, a trio of lawmakers are demanding answers from Jared Kushner about work his public-private taskforce has reportedly been doing with a “range of technology firms” to “establish a far-reaching public health surveillance system” in response to the pandemic.

Democratic senators Mark Warner of Virginia and Richard Blumenthal of Connecticut, along with Rep. Anna Eshoo of California, wrote a letter to Kushner on Friday asking about the issue three days after Politico reported that Kushner’s shadow task force had “reached out to a range of health technology companies about creating a national coronavirus surveillance system” that would give government “a near real-time view” of patients seeking treatment. Even though Politico cited interviews with “seven tech executives, government officials and other people familiar with its contours,” a White House spokesperson denied to the news outlet that Kushner had any knowledge of such plans.

“Your office’s denial of the existence of this effort, despite ample corroborating reporting, only compounds concerns we have with lack of transparency,” the lawmakers wrote in the April 10 letter, which expressed fears that such a system “could undermine the confidentiality and security of our health information and become the new status quo.”

The lawmakers’ concerns about transparency echo previous worries that Kushner’s taskforce is operating outside of normal government procedure, perhaps to the point of breaking the law. (Kushner has said that President Trump instructed him to “knock down every barrier needed” and “make sure that the government is doing things that the government doesn’t normally do, where we’re stretching, where [we] are acting very quickly.”) 

On March 27, Noah Bookbinder, the executive director of the watchdog group Citizens for Responsibility and Ethics in Washington, wrote a letter to White House Counsel Pat Cipollone asking him to ensure that Kushner’s working group “fully comply with all laws,” specifically citing provisions of the Presidential Records Act and and Federal Advisory Committee Act that bar or limit the use of private email accounts for government business.

On Friday, Anne Weismann, CREW’s chief FOIA counsel, told Mother Jones that the organization was still working to get its arms around the full scope of Kushner’s activities and had yet to receive a response to its letter. But with the federal government spending trillions in response to the coronavirus , she says Kushner’s secret work with a range of often unnamed private officials was especially troubling, especially if they are conducting business in a way that evades oversight.

“Given the amount of money at stake, there is significant possibility that these people are also trying to leverage their position for their own personal profit, or profit for their companies,” she said. “We should have assurances that people who are given such enormous power and responsibility are acting in the interest of the nation.”

Doctors Uché and Oni Blackstock have spent the majority of their professional lives as rarities. For starters, they’re Black women; only 2 percent of physicians identify as Black and female. They’re also fraternal twins. The story of the Blackstock sisters has been the stuff of plenty of feel-good profiles over the years: In 2006, for instance, the New York Times ran a piece in the real estate section on their hunt for separate apartments in the city’s notoriously competitive real estate market. But now, the sisters have yet another thing that binds them together: They’re both on the front lines of New York City’s fight against the coronavirus pandemic.

Dr. Uché Blackstock is a board-certified emergency medicine physician who is the founder of Advancing Health Equity, a racial equity consulting practice that helps train health care organizations in unconscious and structural racism. She also works part-time at an urgent care facility in central Brooklyn. Dr. Oni Blackstock is an assistant commissioner with the New York City Department of Health and Mental Hygiene, where she oversees the city’s HIV intervention work.

“Our experiences definitely complement each other,” Uché told me this week. “I’m on the ground, whereas my sister is at the policy-making table.” “I see patients as well,” Oni told me in a separate phone call. “But because I’m involved in our health department’s response, I’m working from home and doing televisits.”

The sisters are also doing critical work to shape how the city responds to a virus that is disproportionately infecting and killing people of color: 34 percent of fatalities in New York have been Latinos, who make up just 29 percent of the population, while 28 percent of fatalities have been Black New Yorkers, though they make up just 22 percent of residents. Across the country, places like Chicago and St. Louis have also reported disproportionate rates of death among people of color. As the Blackstock sisters see it, COVID-19 is as a “pandemic of inequality.”

Thinking about the parallels between #HIV & #COVID19 and what is most similar is:

HIV = “epidemic of inequality”
(quoting Dr. @watkinshayes)

COVID19 = pandemic of inequality

Remembering that “epidemics track along the fissures of society” paraphrasing @DrMaryTBassett

— Dr. Oni Blackstock (@DrOniBee) April 7, 2020

“We usually see patients with mild symptoms—cuts, chest pain—but the severity of those symptoms have definitely increased,” Uché explained to me, “and nearly all of the patients I’m seeing are Black and Brown.” 

The twins were exposed early in life to the tragedy of long-standing racial disparities in health care. They were raised in Brooklyn by their mother, Dale Gloria Blackstock, a physician at SUNY Downstate who graduated from Harvard Medical School in 1976—an early participant in the school’s affirmative action program, Uché later wrote in the Chicago Tribune.

The day almost escaped me….Happy #WomenPhysiciansDay!

On this day, I honor all the women physicians who have come before me, like my mama.

Here’s a pic circa 1978 at our baptism. Our exhausted mama, then an Internal Medicine resident, holding @DrOniBee and me. 🙏🏿 pic.twitter.com/cs8NyUvemi

— uché blackstock (@uche_blackstock) February 4, 2020

“We wanted to be just like her,” Uché later told Harvard Magazine. “We knew that she was very dedicated to her patients and that she really reaped a lot of joy from being a physician. It was impossible for that not to rub off on us.”

One of my favorite pictures of all time. Our mother signed us up for Suzuki violin class when we weren’t even 3 years old yet. She even took lessons herself to play with us. I still get teary-eyed thinking about how she wanted us to have experiences that she never had. pic.twitter.com/2moGRBKgMf

— uché blackstock (@uche_blackstock) December 6, 2019

The sisters attended the competitive Stuyvesant High School, earned undergraduate degrees at Harvard, then spent a year apart, teaching in different cities—Oni in Washington and Uché in Chicago. Then they both enrolled in their mom’s alma mater, Harvard Medical School.

They’ve watched as the United States confronts the devastating reality of the coronavirus pandemic, and racial disparities in mortality and treatment continue to rise. In Louisiana, 70 percent of the people who’ve died from COVID-19 have been African American. In Milwaukee, Black people have tested positive for the virus at double the rate of white people. And in Chicago, 72 percent of people who’ve died of the virus have been Black. Meanwhile, officials in some of the hardest hit states—California, Washington, New York—have yet to release statewide data on the race of its coronavirus patients, according to the New York Times.

Uché knew early on that the guidance issued by the Centers for Disease Control and Prevention to medical professionals on the coronavirus wouldn’t be enough to protect her mostly Black patients. The CDC initially discouraged doctors from testing every patient who exhibited symptoms of the virus—fever, cough, difficulty breathing—if they had not recently traveled to a COVID-19 hotspot, which until early March only included China, Italy, and Washington state. Uché recently told Slate that most people who answered “yes” to the question of having traveled were white. Making matters worse, Uché explained in that interview, is the deep-rooted mistrust of medicine in Black communities, thanks in part to instances like the Tuskegee experiment, a once-secret government study in which doctors purposefully withheld treatment to study the long-term effects of syphilis. In her interview with Slate, Uché described her heartbreaking interactions with patients: “What I often tell my patients is, ‘Please, if your symptoms worsen, anything changes, please come back,’ because I also know that they probably are used to clinicians not taking their concerns very seriously.”

Meanwhile, Oni has been crafting public-facing policy on how to slow the spread of the virus, including a sex-in-the-time-of-coronavirus tip sheet that went viral. 

Read our updated @nycHealthy tips on #sex in the time of #COVID19

✅You are your safest sex partner; next safest is a partner you live with

✅Wash hands & sex toys b4 & after

✅Kissing easily spreads #COVID19

✅Rimming has the potential to spreadhttps://t.co/gf53mHI5hP pic.twitter.com/cLsA4ZJroq

— Dr. Oni Blackstock (@DrOniBee) March 21, 2020

Now, the twins are bringing a career’s worth of experience in health care and fighting racial inequities to bear on the coronavirus—and they are relying on each other to get through. “We’re having some similar experiences but also very different experiences,” Oni told me. “And I think my role is really to try to hold space for her because there’s a lot of trauma that she’s experiencing just seeing patients coming in very acutely ill.”

“If you don’t protect the most vulnerable people of your society, then everyone will be negatively affected by COVID-19,” Uché told Slate. 

During his daily coronavirus task force briefing on April 6, President Trump tried to push back against reports that COVID-19 tests remain hard to get and that the United States is still lagging behind other countries in testing. “It’s going up at a rapid rate,” he said, referring to the bar chart behind him. “Nobody has done more testing.”  

A quick look at the chart suggested that the number of tests being given in the United States has shot up dramatically over the past month—and Trump’s gloss on the numbers implied the same. Yet as cartoonist Ruben Bolling pointed out on his Instagram feed, the chart showed the cumulative number of tests, which obscured whether the number of daily tests is going up rapidly, as Trump had boasted. Bolling helpfully remade the chart to show the less impressive number of tests actually being done day to day:

As you can see in the chart below, the number of daily coronavirus tests has remained relatively small—around 162,000 on April 9, according to data from the COVID Tracking Project. Yet the overall numbers keep rising even when the number of daily tests drops. In the week before Trump displayed his chart, the number of daily tests ranged from around 107,000 to a one-day spike of 229,000. 

Daily vs. total COVID-19 tests in the United States

As of April 6, just 0.6 percent of the US population had gotten a coronavirus test. Exactly a month earlier, Trump had gushed, “Anybody that needs a test, gets a test. They’re there. They have the tests. And the tests are beautiful.” Even a big beautiful bar chart can’t bend the curve of the disappointing reality.

An occasional series about stuff that’s getting us through a pandemic.

As Instagram tells it, we bake sourdough in silk pajamas. We’re taking deluxe baths and lighting up Diptyque candles. Tins of imported anchovies are the new beans—the ideal pairing for your freshly baked, gorgeous sourdough. All while exercising live, meditating in face masks, and chugging Moon Juice.

Meanwhile in my living room: PCOS-related cystic acne has started to make a furious comeback. My rotting brain is increasingly unable to pinpoint my last shower. Glasses of wine are turning into buckets that no longer do the trick. I’m struggling to write for a living while feeling like a boring disaster with nothing to say.

It was in this state last week that I received the following update from a group text:

“I pooped during a conference call today,” a friend, who will remain anonymous, divulged.

In normal times, such an unprompted, objectively gross disclosure would seem confusing. But these are not normal times. Within minutes, replies of solidarity trickled in.

“I’ve done that before when I thought I was gonna shit myself and prayed that the mute button actually works.”

“I haven’t wiped my butt in months. #BidetLife.” *

“Deodorant is a social construct.” 

I suddenly felt alive.

For millennials like me who spent the past decade conditioning ourselves with #goals that a post-recession fantasy life could be achieved, I aspire to the lack of aspiration in these refreshing, disgusting revelations. Here, there are no preening goals baked into coping mechanisms. No clout is being chased. My gross friends are not influencers looking to “expand their content cross-category and lean into performance-based compensation” to bring me life-affirming LOLs and sympathetic nods of #same. Here is, in every sense, the real shit.

We’re closing in on roughly a month of self-isolation. In that time, many of the comforts we’ve adopted have already been refracted through the lens of Instagram and Into the Gloss-esque guides that dramatically fail to read the room. With alarming speed, social media turned quarantine into a performance like anything else, eclipsing the real coping mechanisms and attention to mental health this moment needs. 

From here on out, then, I want nothing but disgusting, unhinged confessions to guide me through this pandemic. I don’t want acai bowls and sun-drenched makeshift yoga rooms hoping to inspire my dead soul into productivity. I want frank admissions of dumb and relatable things. I’ll return the favor with an update on my 1-inch leg hair challenge and we’ll both feel better together.

*This is a plastic, attachment bidet. Not a fancy one.

Last month, a city council meeting in Lake Worth Beach, Florida, went viral after an angry city commissioner began shouting at the mayor about the city’s lack of preparedness for the novel coronavirus pandemic that was just beginning to hit the state. “We cut off people’s utilities this week and made them pay what could have been their last check—to us—to turn their lights on in a global health pandemic,” city commissioner Omari Hardy said during the heated argument, which was captured in a two-minute video.

Eventually, Mayor Pam Triolo ended the discussion and the meeting by walking away, and the city of 38,000, which controls its own utilities, issued refunds to those whose electricity had been shut off. This contentious meeting may seem like an unusual event, but the situation Hardy described is becoming more common across the country, where the large number of chronically energy insecure people are now joined by the unprecedented ranks of the newly unemployed. Because utility companies vary from state to state, sometimes from locality to locality, there is no comprehensive approach to addressing what advocates fear could soon exacerbate the health effects of the already deadly epidemic. 

“It’s really shameful these are not considered human rights,” Jean Su, the director of the Energy Justice Program at the Center for Biological Diversity says. Energy insecurity—which disproportionately affects communities of color, rural neighborhoods, and the elderly—is defined by a household’s inability to meet their electricity or gas needs, whether from not being able to afford bills, or keeping a home at an unsafe temperature in order to to pay them. 

It’s a widespread problem that has not attracted much attention until now. Even though none of the coronavirus relief packages have addressed the issue, at the end of March, eight senators led by Sen. Ed Markey (D-Mass.) introduced a resolution that would ensure that no household would lose electricity or natural gas during the crisis, and that reasonable efforts would be made to reconnect those who had lost service. The method of shutting off services varies widely, from the ability to do it remotely from a computer to sending a service worker to physically flip a switch. The lawmakers also proposed that late fees and other penalties be waived for the duration of the crisis. But the measure gained no traction. Still, advocates say, Congress must act immediately, or the pandemic will likely create even more energy insecure households, and that could add to the number of people who get ill. 

According to a 2015 Energy Information Administration survey, 1 in 3 households in the United States were energy insecure, meaning they struggled to regularly pay their electricity bill. Approximately 20 percent of households had to forgo food or medicine in order to pay an energy bill, 14 percent said they had received a disconnection notice, and 11 percent said they’d kept their home at an unhealthy temperature in order to reduce their energy bills.  

The new coronavirus has officially infected nearly 460,000 people in the United States and has killed over 16,000. The true human toll remains unknown, however, because of a testing shortage and misattributions at death. In an effort to slow down the spread of the virus, wide swaths of the economy have been shut down leading to historic job losses and an economic collapse not seen since the Great Depression. In the last three weeks, 16 million people filed jobless claims. “When the economy was doing much better, 37 million households experienced energy insecurity,” Diana Hernandez, a public health professor at Columbia University, says. “Now, that number is definitely going to go up.”

As temperatures rise in the coming weeks, energy insecure households must worry about keeping their homes at reasonable temperatures. Heat can exacerbate the type of preexisting conditions—like chronic lung disease and other respiratory illnesses—that make people more susceptible to severe illness from COVID-19. “The consequences are mental, physical, and they’re fatal,” Hernandez explains. In 2018, a 72-year-old Arizona woman died after her utility service cut her electricity off when it was more than 100 degrees outside. That same year a 68-year-old woman died in New Jersey after her power company cut her service over unpaid bills.

For those experiencing poverty, deciding how to spend money is a constant battle among the basic needs of food, shelter, health, and utilities. A problem made devastatingly acute by the pandemic. “Are you going to try to get medication because you got coronavirus or pay utilities?” Su asks. “It’s just these impossible choices that people have to make.”

Absent a federal response, protection from utility shut-offs is being carried out state-by-state. Seventy-two percent of energy utility companies are private, while the remaining are publicly-owned or managed by non-profit membership-run cooperatives. Many states and other local governments have imposed moratoria on power and gas companies turning off utilities during the pandemic, and some private companies have also voluntarily suspended shut offs. “The quality of the moratoria vary widely,” Su explains. “And some of them are not good enough.” For example, as HuffPost reported earlier this month, North Carolina ordered the state utilities to halt shut-offs, but a rural electric co-op, which doesn’t fall under the same jurisdiction, did not have to follow the state’s orders. The result was that many households had their power cut off in the middle of a global pandemic.

Another utility service that has come into the spotlight is water. The Centers for Disease Control and Prevention has advised that frequent hand-washing with warm water and soap is one of the most effective ways to kill the virus. But for the 14 million households who struggle to pay their water bills and are subject to shut offs, it’s not an easy task. Like with energy utilities, states have issued separate moratoriums on water shut-offs during the practice, while advocates call for Congress to act.

Advocates believe the freezes may be the right approach but don’t go far enough; pausing utility payments will only mean that the bill will come due eventually. “By the end of this crisis, you’re going to be crippled by debt,” Su says about low-income households. Advocates urge using this crisis as an opportunity to find different ways to end the problem of energy insecurity once and for all by guaranteeing basic utility services to everyone. This pandemic has exposed many of the failures of the current system, Hernandez says, adding, “Maybe now there’s room for the idea that we don’t need to shut off [utilities] at all.” Su believes it’s time for a revamp of the entire system as well. “We need to rethink how our entire utility services systems work,” she says. “They need to be guaranteed human rights.”

A few weeks ago, a thought woke Camara Jones up in the middle of the night. It was about the coronavirus. That’s commonplace these days, but Jones is a family physician and epidemiologist who worked at the Centers for Disease Control and Prevention, where among other things she studied racial bias in the medical system. Her thoughts on a pandemic are anything but commonplace.

The coronavirus had revealed something essential about the workings of race in America. “The thought that woke me up,” she told me over the weekend, “is that the most profound aspects of racism operate without bias and without stigma.” What she means is that racism in its most pernicious form slides by on deniability, without any of the telltale oafishness with which more ordinary forms of prejudice announce themselves. Left in its wake are lopsided outcomes that are made to look like the natural order of things.

Nothing illustrates that dynamic better than a pandemic that is wrongly said to be “the great equalizer.”

“This disease,” she says, “is not an equal-opportunity disease.” Black people are contracting the coronavirus and dying from the disease at higher rates than other people. This disproportionate effect is a social issue in the guise of an epidemiological one. Black Americans, particularly in the Southern states that have not expanded Medicaid under the Affordable Care Act, are more likely to be uninsured. They’re more likely to work a low-paying job. They’re more likely to suffer from heart disease, asthma, cancer, and other conditions, not—as Jones takes pains to emphasize—because of biology. It’s because of straightforward social choices such as where toxic dumps get sited, where new highways get built, and where Black people have historically been permitted to live.

It will be hard to fully grasp the scale of disparities in coronavirus outcomes. Cities and states thus far have been slow to collect data by race and ethnicity. From what we know now, though, the pattern is troubling. In Chicago, for instance, 69 percent of people who have died from the coronavirus as of April 8 are Black, even though they make up 32 percent of the city’s population. In Michigan, where an outbreak has gripped Detroit and where Black people make up 14 percent of the population, they represent 40 percent of deaths. In Louisiana, where an outbreak has rattled the New Orleans area, 70 percent of those who have died are Black. In Alabama, Black people make up 27 percent of the state’s population but 52 percent of those who have died from coronavirus. In Mississippi, where Black people make up 38 percent of the population, they make up 56 percent of coronavirus infections and 72 percent of deaths. And as ProPublica reported, Black residents in Milwaukee County, who make up 26 percent of the county’s population, constitute half of its COVID cases and 81 percent of its deaths. 

In New York City, Black residents make up 22 percent of the population and 28 percent of deaths. In Los Angeles, though early data is limited, Los Angeles County public health director Barbara Ferrer reports that Black people “have a slightly higher rate of death than other races.”

Jones sees the effects of racism everywhere in the coronavirus outbreak. She points to the way the disease has ravaged jails and prisons, which are disproportionately Black because of disproportionate policing. In Chicago, for instance, 238 inmates and counting at Cook County Jail have contracted the disease. In Louisiana, five people have died of coronavirus as 42 inmates and staffers have contracted the disease. At the jail complex in New York’s Rikers Island, more than 160 inmates have contracted the disease, including one who died while serving a parole violation.

I spoke to Jones over the weekend about how the coronavirus has pulled the cover off the preexisting condition of American racism. The transcript below has been lightly edited for length and clarity.

What has stood out to you so far as we’ve watched the coronavirus pandemic unfold?

What the COVID-19 pandemic is unveiling is the structural racism, which is why we see people of color and poor people more profoundly impacted. This virus is an equal-opportunity virus, but this disease is not an equal-opportunity disease, and it’s manifesting itself more severely in people of color who’ve been historically oppressed and disinvested.

So the way that you need to talk about racism in this time is to explain, to make it clear to everybody looking at this, that it’s not some kind of inherent weakness of African Americans that’s making them die more frequently of the disease than other people in Milwaukee, in Detroit. That is an impact of racism, so what we need to do is un-invisiblize structural racism and say this structural racism and the historical federal partitioning of our cities into racially segregated neighborhoods, the disproportionate placement of toxic dump sites, that stuff which is giving us more asthma, more lung disease, or the HIV epidemic—these are the old aspects of racism showing up during this pandemic.

We have already seen some of those in terms of the stigmatization of Asian people. But as anti-racist activists, this is the time for us to say that what has previously been invisible to many is now manifest. It’s not a result of poor people being weaker than, having bad habits, being stupid or lazy or anything. This is racism showing up. We need to name what we are starting to show in our statistics. We need to label the racism that it is.

How do you public health officials go about doing that?

By talking about the racial/ethnic health disparities that many people in this country aren’t even aware of. Many are not aware that Black people are more likely to have heart disease and kidney disease and be obese and have diabetes. So to talk about the so-called preexisting conditions that are putting people at higher risk—that these things are because of the conditions of our lives. It just so happens that people of color have more of these diseases, and that they are having worse outcomes, but there’s nothing biological about race. Race is the social interpretation of how we look in a race-conscious society, and racism is the system that operates on that so-called race to structure opportunity and to assign value.

To what extent have you seen public health officials address this racism?

I know that Barbara Ferrer, when she was here in Boston, we worked together a lot and she was very much anti-racist. When she was the head of the Boston Public Health Commission, every single employee went through anti-racism training. Every single training was half people from the health department and half community people. It took a long time, but her commitment to having people understand racism as a root cause of racial health disparities was clear. So I don’t know what she’s doing. I don’t know [if] she’s naming racism yet or she’s being very clear about collecting and showing data by race/ethnicity. That would be one way that a health director would do it. It doesn’t just happen that Milwaukee had the statistics and reported the statistics. Two years ago, Milwaukee County declared racism to be a public health crisis. The health department did that because the Wisconsin Public Health Association did that, and the Wisconsin Public Health Association did that because, when I was president of the American Public Health Association, I launched our association on a national campaign against racism and I went around to 25 of our 54 state affiliates talking about that. The Wisconsin Public Health Association said that racism was a public health crisis and then Milwaukee County took that.

That is why Milwaukee was the first one to put these data up. A health department person who has never said the word racism, they are not in this crisis all of a sudden going to jump all the way to understanding that racism is at the root of disparate outcomes, disparate testing, disparate hospitalizations, disparate access to ventilators. They may not have that. But the people who understand how racism works and that racism is a root cause, a fundamental cause of our so-called racial health disparities, now understand that the health disparities are really disadvantaging people in two ways. It’s making them get the disease worse, and then at the point where there’s gonna be rationing decisions made, God forbid, those same comorbidities, preexisting conditions might disqualify those people who have greater need from getting access to the life-saving therapies that they need. That was certainly the case in Italy, where I believe that they were using age and comorbidities as rationing criteria.

So I’m understanding what you’re saying here: There’s a fear there that because of these preexisting conditions, folks who disproportionately have those conditions, which are people of color and poor folks, that that could play into the ultimate decision-making of who lives and who dies.

Right. It’s playing in two ways. It’s making people sicker. You know, some people get the virus and don’t even experience symptoms, and some people get the virus and they get very sick. And people who have preexisting conditions are more likely to get very sick. So now they go to the hospital. The fear is, and in Italy, the reality was, that the very fact that they have diabetes or they have chronic lung disease or hypertension or some other kind of heart issue, that those things are going to be counted against them if a decision has to be made of which of these patients get the last ventilator.

So it’s a double whammy that we cannot let be. If you were to disqualify people or even ding them a little bit in terms of a priority- based on preexisting conditions, that will systematically disadvantage people of color in this country. That will be the ultimate expression of racism in the distant, hands-off kind of way. So it’s not about the stigma. It’s going to perhaps be about the criteria. We’re applying these criteria evenly to everybody, but without recognizing that the historical injustices that have made themselves evident in people’s health status is not evenly distributed.

The most important ways that racism is showing, has always shown up, and will continue to show up in this pandemic is not about stigma or name-calling or any of that. It’s about life-and-death decisions. It’s about historical disadvantages that we as a nation haven’t even recognized because we’re ahistorical. We act as if people have equal opportunity. We act as if the present, we’re disconnected from the past. I have seven different barriers like that, that I have distilled as barriers to achieving health equity. All of these are manifesting big time in this pandemic, and they don’t require interpersonal expressions of bias or discrimination. They’re baked into the system.

[Jones later emailed me her seven “societal” or “cultural” barriers to achieving health equity. They are: a “narrow focus on the individual,” an “ahistorical stance,” the “myth of meritocracy,” the “myth of a zero-sum game,” a “limited future orientation,” the “myth of American exceptionalism,” and “white supremacist ideology.”]

So scapegoating would manifest itself in devaluing somebody’s life when you have to make a life-or-death decision about them: When you have to decide as an EMT whether or not you are going to put this person in your ambulance and take them to the hospital, when you have to decide in the emergency department if you’re even going to intubate that patient and send them up to the ICU or not. So the scapegoating and the stigma also are going to be manifest through individual decisionmaking, where how an individual values the other person is going to play a part. But what I keep getting back to is that that’s going to play a much smaller part than all of the structural racism that is written into our bodies.

How are you seeing that structural racism play out as you think about the early data. You pointed to the ProPublica story. Are there particular places or ways that you’re seeing this structural racism play out?

Yeah, in the jails and prisons. Many people are held in jails because they can’t make bond and so then there’s a big push right now for decarceration But also in the prisons, where people of color are hugely overrepresented and the prisons are crowded. That’s another manifestation of structural racism categorically putting some populations at higher risks than others.

It’s not even the preexisting conditions anymore. It’s the housing or lack thereof. It’s the detention and detention centers and the like, and the disregard. That has to do with the values piece. It’s not a new values piece. It’s as if people do not recognize the genius that is locked away in our prisons and in our detention centers, so we don’t value those people and we’re just locking them away as if they could do very well without those people. Now we’re acting as if there’s a big epidemic inside a prison, oh well. That is a values piece that is becoming more vivid when we know that just one guard needs to come in there with COVID-19 asymptomatic and everybody’s going to be harmed. Then when you think about housing—again the structural racism is not just how it has made us have more preexisting conditions; it’s also where we find ourselves. Do we find ourselves unhoused? Do we find ourselves incarcerated? Do we find ourselves crowded in living quarters? Do we find ourselves with very tenuous jobs? Do we find ourselves with the jobs of home health aides continuing to take care of elderly people and the like, and needing those jobs? Do we find ourselves with the low-paid health worker jobs in the hospitals? Do we find ourselves cleaning up the rooms and the ICUs? Do we find ourselves taking the recently deceased bodies to the refrigerator truck? So it’s not just about what happens in individual bodies, but also where do we find our bodies?

What have you noticed in this pandemic, given the messaging from Washington? What have you noticed in terms of whether federal health officials are paying mind to all sorts of communities?

It’s rough. I don’t know what’s going on over there at the CDC. It is mind-boggling. [Laughs.] I mean, this is what we’re supposed to be leading. I mean, Tony Fauci is fabulous. He’s NIH, infectious diseases. But the whole approach to this pandemic in the US has been a very clinical approach narrowly focused on the individual and not at all the kind of public health population-based approach that we need, especially when it comes to testing. Maybe it was two weeks ago—I think it was two Sundays ago—I was listening to one of the shows, you know, the show that comes on every afternoon. You know what I’m talking about? [Laughs.]

I know exactly which one.

And I believe that the president said something like, they were about to announce that they were going to restrict testing to only those who are already hospitalized and maybe frontline people. They loosened that up again, but at that time they were saying that unless you were sick enough to already be hospitalized, you would not be able to get a test.

That is exactly the wrong approach. What that does is set a narrow, individually focused clinical approach where what you’re trying to confirm is a diagnosis that you already highly suspect. And confirming a diagnosis is good because if somebody doesn’t have COVID-19, if they have bacterial pneumonia, you want to treat them for bacterial pneumonia, and if they don’t have COVID, you don’t have to waste your precious personal protective equipment when you go into that person’s room. That’s important. But that is only going to be documenting the course of the epidemic. It’s never going to equip us to change the course of the epidemic, and a public health approach to testing is all about surveillance.

Which means that, sure, you can test all of the people who are symptomatic, but you also have to test at least a sample of people who are not symptomatic. You need to do that to know how widespread is the infection in our community today, which will equip you to plan what health resources you’re going to need in two weeks. Then it also helps you identify previously unknown infected people and to have them isolate themselves and then to also ask them, who did you get in contact with in the past six, seven days? And then you do that contact testing, you get other people early on in their infections, and then you isolate them. This is how you change the course of the epidemic as opposed to just documenting the epidemic.

The CDC is the nation’s lead public health agency. There are many brilliant people at CDC who know that what I’m saying is absolutely the truth, and they are not satisfied, I’m sure, with just the clinical use of the testing to document the course of the pandemic. They want to influence the course of the pandemic, but we cannot do that without a public health surveillance approach to testing. Why CDC is not making a bigger noise about that, I have no idea. Who put the muzzle on whom? Because there are smart people there. They know this. This is not some aha.

What’s the impact when you have a president who calls the virus a “Chinese virus” and starts to label the virus based on geographic reasoning?

It’s horrible. It has a very bad effect. It makes [Asian Americans] scared, and it makes them understand that they are purposely being made vulnerable, that they are purposely being scapegoated in the same way that he scapegoats Muslims, in the same way that he scapegoats Mexicans. It’s another othering. It’s another part of his effort to make America white again.

How does the labeling affect the work of public health officials who have to go out there and combat the epidemic?

I haven’t heard anybody saying it is not the Chinese virus or President Trump is wrong to call it the Chinese virus. I think that they just themselves do not call it that, but perhaps the stronger response would be to defy the president in that labeling.

How does this labeling create fear among those who are labeled?

On the ground, public health folks know that before December of 2019 there was no person on this Earth who was immune to this virus. So public health people understand that we are all vulnerable. I don’t think public health workers are confused about that—all of humanity is at risk, and it’s not because of any particular part of humanity. It’s because of bats and pangolins. [Laughs.]

Right.

So public health people on the ground and public health leadership are so far away from the president’s frame that maybe they should get a little bit closer to actively defy that frame. But he’s stopped doing that now. But I would have to say that public health people who stood up to the president and actively defied him might find that their public health departments or their states were punished. So maybe not defying the labeling is a strategic thing because people know that they need tests and that they need ventilators and PPE.

What does an anti-racist initiative look like? How does the strategy around combating that sentiment evolve as the disease evolves, as what we know about the disease evolves?

Now it’s not the “Chinese virus.” Now it’s New Yorkers going down to Florida. So the xenophobia has shifted. Now it’s about, “Don’t let those New Yorkers come into your state,” and the whole 24-hour threat of quarantine, of an active military imposition of a quarantine on New York. So it’s about blaming and it’s about othering because the president and his supporters do not want to have any blame come back to them. So I would say that the president is racist. He has used many racist tropes before, and so when he would call it the Chinese virus, those were racist tropes again. But as it becomes clear that it can affect anybody, he has moved to the urban trope. You know, “Okay, New Orleans and Detroit and New York, you don’t want those people coming near you, but yes, we can let things open in the Midwest because those kinds of people aren’t here and so the virus will never come here” type of thing. It’s going to put his supporters at a severe disadvantage because if they’re still thinking this is some kind of hoax, this doesn’t mean they should go to as many parties as they want or barbecues or church next Sunday—they’re gonna get very sick.

But he’s always deflecting blame. He’s loosened up the Chinese part of it. Now that there’s going to be data out there about how people of color are overrepresented in terms of stats and all that, who knows, he might start blaming Black folks and Latinx folks. “You don’t want them to come into your neighborhood.” That’s all because he cannot understand that his sluggishness, his lack of future orientation, his narcissism, all of that has made him not act in a time of need. He still isn’t fully acting in a time of need but he will never blame himself. The thing he’s going to say, I already hear it—the low projections of 1.2 to 2.2 million Americans dying, right? Say that is not the 100,000 to 150,000, say it’s 500,000. He is still going to say, “Oh, because of our actions, we prevented the 2.2 million.” So he’s gonna always play this as a win even though his sluggishness and inaction in the face of need has caused already too many Americans to die. These people did not have to die.

So in Chicago, 70 percent of the people who have died from COVID are Black. What do you make of that?

Two things: that we started out sicker, probably in more crowded conditions and not able to work at home. Still have to be Uber driving. Still have to be delivering food to other people. Still have to be at the grocery store. Still have to be the home health aides and the nurses and doctors. I haven’t seen these data, but perhaps because of the profound residential segregation by race, which then segregates health resources and the like, they may find themselves in hospitals that don’t have enough of what’s needed. So it’s the three things: worse baseline health, the conditions of our lives and our work, and our access to sufficient health care.

How does that fit into what we’re seeing in other cities?

This is the distinction that needs to be made. The coronavirus does not discriminate in terms of whom it infects. But the disease discriminates in how profoundly those people are affected. All this did was pull the covers off.

The coronavirus pandemic and the catastrophic unemployment it sparked have put economic policy front and center. To many progressive economists and advocate, the CARES Act, the $2 trillion aid package that moved through Congress last month, put too much emphasis on bailing out corporations and not enough on helping people, especially those who were already struggling before the virus’s spread.

With lawmakers now assembling a second major aid package, the leaders of several progressive economic, research, policy, and advocacy groups released a statement of principles on Thursday urging Congressional leaders to shift priorities to help the most vulnerable, including communities of color. The guidelines laid out are largely targeted at Democrats, whose control of the House of Representatives gives them leverage to shape future bailouts.

“The economic crisis sparked by coronavirus has exposed major structural flaws in our economy that made this crisis far worse than it needed to be,” the statement begins. “It is clearer than ever that we need major government intervention to stabilize the economy and put us on a long-term path to resiliency.”

The statement came out of conversations among the leaders of multiple progressive policy shops about how they could persuade Congress to respond not just with BandAids but with “structural changes.” It also signals a hope Congress will learn from its mistakes in responding to the 2008 financial crisis. “During the last recession, corporations received massive bailouts while continuing the risky behavior that caused the economy to collapse,” the statement reads, still free to act in ways “which made recovery more difficult, particularly in low-income and communities of color.”

As the next package comes together, Democrats are likely to have a long list of demands that includes, as the statement’s authors detail, more aid to people, small businesses, and frontline workers, but also universal mail balloting to preserve Americans’ right to vote during the November elections. 

Read the full statement:

“The economic crisis sparked by coronavirus has exposed major structural flaws in our economy that made this crisis far worse than it needed to be, and it is clearer than ever that we need major government intervention to stabilize the economy and put us on a long-term path to resiliency.

“We urge Congress to move quickly to pass additional legislation adhering to the following principles to prioritize aiding families and communities, especially Black and brown people who are disproportionately harmed by both the public health and economic crises, and making the structural changes needed to make our economy more resilient in the long term.

“Build Economic Resilience for the Long Term. This crisis has laid bare that decades of rampant inequality, attacks on public institutions, and blind faith in markets to solve public problems has left our economy deeply vulnerable. This crisis is acute in part because millions of families lack good jobs and adequate healthcare—especially the Black and brown families and women who are filling what are only now deemed essential roles in our economy—and because government agencies tasked with pulling people from the brink are operating on threadbare budgets. Congress must address the underlying structural weaknesses in our economy that helped propel this crisis and ensure that the investments made now are durable enough to prevent future crises.

“Reinforce essential responders, including workers, small businesses, and state and local governments. This crisis confirms how workers in traditionally low-paid jobs like warehouse workers, grocery clerks, farm workers, and child care workers are—like health care professionals—essential responders. These workers, disproportionately women and people of color, are risking their lives each day, yet lack basic protections to keep them safe and healthy. State and local governments are similarly pushing their resources to the brink to support their residents, and are in desperate need of federal government relief. Half measures to aid those we all rely on most in this crisis will not be sufficient. Congress must provide substantial and sustained relief to state and local governments and directly to all workers on the front lines. 

“Repair the Economy by Helping People. This crisis will only be solved by investing in people, first and foremost. Saving our economy from total collapse will require major investments in the health and economic well-being of the workers, small businesses, families and communities who drive our economy, and in order to be effective, must be inclusive of workers who are typically excluded, like restaurant workers, immigrants, and people of color. Instead of hoping that jobs and economic health will trickle down from corporations and the rich, Congress must prioritize getting substantial aid to the people who need it the most.

“Prevent Further Accumulation of Corporate Power. During the last recession, corporations received massive bailouts while continuing the risky behavior that caused the economy to collapse. Corporations, private equity, and payday lenders also moved quickly to profit off of the suffering of millions of families, which made recovery more difficult, particularly in low-income and communities of color. Left unchecked, they will again extract from the public good and exploit marginalized people, which will leave the economy less stable overall — and will likely allow them to concentrate their power as smaller businesses fail. Congress must prioritize shoring up small businesses and institute strong accountability mechanisms and regulations to prevent large corporations from using this moment of crisis to further concentrate economic and political power.”

The statement was signed by the following organizational leaders:

Neera Tanden, Center for American Progress
Eileen Applebaum, Center for Economic and Policy Research
Brian Kettenring, Center for Popular Democracy
Dorian Warren, Community Change
Sabeel Rahman, Demos
Thea Lee, Economic Policy Institute
Chris Hughes, Economic Security Project
Natalie Foster, Economic Security Project
Taylor Jo Isenberg, Economic Security Project
Indi Dutta-Gupta, Georgetown Center on Poverty and Inequality
Michael Linden, Groundwork Collaborative
Fatima Goss Graves, National Women’s Law Center
Felicia Wong, Roosevelt Institute
Heather Boushey, Washington Center for Equitable Growth

Perhaps you’ve seen this recent viral video: In an hourlong Zoom video call posted to Vimeo, Cornell Weill Medical Center pulmonologist Dr. David Price assures viewers that the coronavirus isn’t nearly as contagious as we’ve been led to believe. The video, which has amassed nearly 5 million views and was touted by Fox News commentator Jesse Watters, includes one particularly empowering tip: You can’t get the coronavirus unless you’ve had sustained, close contact with someone who has been infected.

While the advice may comfort viewers at a time of uncertainty, the truth is more complicated. We broke down the science behind some of the assertions in the video.

“The thought at this point is that you actually have to have very long, sustained contact with someone—and I’m talking about over 15 to 30 minutes in an unprotected environment, meaning you’re in very closed room without any type of mask—for you to get it that way.”

Not exactly. Dr. Jill Weatherhead, an assistant director of infectious disease at Baylor College of Medicine, explained that sustained contact with an infected person may indeed increase a person’s likelihood of contracting the virus. “That’s why we talk about physical distancing, because the closer you are in contact with somebody in terms of your physical distance—and for a longer period of time, where you’ll be exposed to more of those particles—the more likely you will contract the virus.” But the idea of setting a time limit of 15 or 30 minutes isn’t based on science. It’s entirely possible for someone to become infected within a much shorter timeframe.

“The overwhelming majority of people are getting this by physically touching someone who has this disease or will develop it in the next one to two days and then touching their face.”

Actually, we’re not sure how exactly the majority of people are contracting coronavirus—that would be almost impossible to prove. “Those risks are really difficult to quantify,” said Dr. Angela Rasmussen, a virologist and associate research scientist at Columbia University’s Center for Infection and Immunity. “The droplet transmission depends on so many different variables.”

“We know that if you keep your hands clean, that you’re not gonna get this.”

Dr. Joshua Petrie, a research assistant professor in the Department of Epidemiology at the University of Michigan’s School of Public Health, points out this claim is “somewhat in contradiction to the earlier [point] that you have to have direct contact with people.” He adds, “Hand washing is also important, but social distancing is definitely the most important thing to be doing.”

What’s more, it’s impossible to know exactly how effective hand-washing is in curbing the spread of the disease without knowing how commonly people get sick from touching contaminated surfaces—though they likely pose less of a threat than infected people.

“What are the chances that you are going to touch exactly that site that has the most virus on it and then touch your nose, and how much of that virus was transferred from that surface, to your hand, to your nose?” Rasmussen said. “These things are really difficult to put numbers to, but that’s why the risk of fomite (surface) transmission is probably much lower than for respiratory droplets.”

“When you know that the only way you’re gonna get this disease is if your hands are dirty, and that if you touch your face, and that if you are way too close to that person, that becomes incredibly liberating. All of a sudden, the person at the store is not your enemy. They’re someone who’s going through this with you.”

It’s a little more complicated than that. Petrie describes essential activities like going to the grocery store or pharmacy, when done cautiously and infrequently, as “relatively low risk.” That’s largely because the virus is not thought to spread through aerosols—infectious particles smaller than droplets that can linger in the air. Instead, is spreads through heavier viral droplets that quickly fall to the ground. But it’s unclear how far those infectious droplets can spread. 

“Any time that you’re going to be in crowds and public spaces, there’s always going to be a risk of viral transmission between people,” Weatherhead says. “When you’re doing those activities, you still need to have stringent protocols that you’re following. When you go in, you’re washing your hands. You’re trying to keep distance between people while you’re there.”

Of course, your risk depends on how long you spend at the store, and how many people you interact with there. Since the video was made, several grocery store workers across the country have died of COVID-19 and many more have been infected, the Washington Post reports.

Cornell Weill Medical School did not respond to Mother Jones‘ request for comment on the assertions in the video. 

“I just caution people to think about what we do know, but also keep an open mind that we may have to change our views on how we’re managing every every aspect of this crisis, based on the evidence as it comes in,” says Rasmussen.  “The real take home message of all this is there’s a lot more that we don’t know than what we know.”

On April 8, the number of COVID-19 cases in the United States hit a new high with more than 395,000 people reported to be sick. Yet many communities have yet to feel the full impact of the coronavirus. That impact could be especially heavy in vulnerable counties concentrated in the South, according to new research from the Surgo Foundation, a British nonprofit that uses data science to address global development and health care issues. 

Data scientists at the foundation have developed a new metric called the COVID-19 Community Vulnerability Index that is designed to capture where the impact of the virus will be most severe. It looks at 34 socioeconomic and epidemological factors such as residents’ poverty and income, age, race, and ethnicity, as well as their disabilities and underlying health issues and transportation, housing, and health care system capacity in their county. The index builds upon the Center for Disease Control’s social vulnerability index, which quantifies a community’s ability to cope with disasters in general.

Which counties are the most vulnerable when COVID-19 hits?

This index isn’t meant to predict which communities or individuals are most likely to be infected by the coronavirus. It is designed to capture where the impact of the virus will be the most severe given how quickly the virus is spreading across the country.

Most COVID-vulnerable states

1. Mississippi (90% of Mississippi’s counties are highly vulnerable)
2. Louisiana
3. Arkansas
4. Oklahoma
5. Alabama
6. West Virginia
7. New Mexico
8. North Carolina
9. South Carolina

“We thought it’s really important to look at COVID from the lens of vulnerability. And so this is not saying who is likely to get infected,” said Sema Sgaier, the executive director of the Surgo Foundation and an adjunct professor at Harvard University’s school of public health. Rather, the index is meant to answer the question, “Is that community able to cope in an adequate manner once COVID enters that community?” she says. “And if not, why? How can how can we upfront plan and allocate resources in a way that’s really going to allow that to happen?”

Data scientists at the foundation suggest that lawmakers and the media should pay closer attention to smaller, rural communities in the South that are highly vulnerable to the coronavirus but don’t have the resources to respond to the pandemic. For example, South Carolina’s Sumter County, which has a vulnerability score of 0.89 (on a scale of 0 to 1 with 1 being the most vulnerable), had 90 cases as of April 6, or around 83 cases per 100,000 people. Compare that with Santa Clara County (vulnerability score: 0.07) in California’s Silicon Valley, which experienced one of the earliest outbreaks in the country and currently has an infection rate of 63 cases per 100,000 people. The number of cases in Sumter is doubling every three days. Nearly half of its population is Black, 13 percent is uninsured (versus around 7 percent nationally) and nearly 19 percent are in poverty (versus the national average of around 12 percent).

According to Surgo’s analysis, regions such as New York, California, and Washington that have been hotbeds of the pandemic are not the most vulnerable areas. The vulnerable regions are beginning to catch up and more and more are seeing an outbreak now. It has also found that the virus is spreading 11 percent faster in vulnerable communities than in less vulnerable ones. As we have reported, some states, particularly in the South, have been slow to adopt public health policies that might have slowed the outbreak. And Mother Jones‘ Becca Andrews has explained how structural and socio-economic inequality have made it harder to practice social distancing in the South.

The foundation hopes that the index will help lawmakers anticipate the kinds of resources their states and counties will need as the coronavirus continues to spread. “We’ve been hearing stories, obviously, of New York and California and San Francisco and Seattle and Washington,” Sgaier said. “Those are not the highly vulnerable communities. It’s just now that the most vulnerable communities are actually experiencing COVID..and that requires a whole different set of attention, speed, and resource allocation.”