By BY DONALD G. MCNEIL JR. from NYT en Español https://ift.tt/34VMO6q
Coronavirus is spreading
from the largest cities in the United States to its suburbs and has begun to
break into the nation's rural regions. The virus is believed to have
infected millions of citizens and has claimed the lives of more than 34,000.
However,
last week, President Donald Trump proposed guidelines to reopen the economy and
suggested that part of the United States would soon return to something akin to
normalcy. For several weeks now, the government's outlook on the crisis
and our future has been more optimistic than that of its own medical advisers
and scientists in general.
The
truth is that no one knows for sure where this crisis will take us. More
than twenty experts in public health, medicine, epidemiology and history shared
their views on the future in detailed interviews. When can we leave our
homes? How long will it realistically take before I have a treatment or a
vaccine? How will we keep the virus at bay?
Some
believe that American ingenuity, once engaged, could produce breakthroughs to
ease the burdens. The path to follow depends on factors that are difficult
but doable, they said: a carefully phased approach to reopening, widespread
testing and surveillance, treatment that works, adequate resources for
healthcare providers, and ultimately an effective vaccine.
ADVERTISEMENT
Still,
it was impossible to avoid bleak forecasts for the coming year. Most
experts agree that the scenario Trump has described in his daily press reports
is a fantasy: he has said that the confinements will cease soon, that a
protection pill is almost at hand, that the stadiums of soccer and restaurants
will soon be full.
"A
bleak future awaits us," said Harvey V. Fineberg, former president of the
National Academy of Medicine.
·
Help us
report in critical moments.
He,
along with other experts, glimpses a sad population, trapped indoors for
months, and, the most vulnerable, perhaps for much longer. They expressed
concern that scientists would not be able to find a vaccine soon, that
exhausted citizens would ignore the restrictions despite the risks, and that
the virus would become part of our lives from now on.
"My
optimistic side says that the virus will drop in the summer and that a vaccine
will come to the rescue," said William Schaffner, a preventive medicine
specialist at Vanderbilt University School of Medicine. "But I am
learning to protect myself from my optimistic nature."
Most
experts opined that when the crisis ended, the nation and its economy would
quickly reactivate. However, it would be inevitable to go through a period
of intense pain.
ADVERTISEMENT
The
exact way in which the pandemic will end will depend, in part, on future
advances in medicine. It will also depend on how Americans behave in the
meantime. If we scrupulously protect ourselves and our loved ones, most of
us will live. If we underestimate the virus ,
it will find us.
More Americans may die than the
White House admits .
Refrigerated trucks were used as mobile morgues on Randall
Island in New York. Credit ...Misha Friedman for The New York
Times
COVID-19,
the disease causing coronavirus, arguably is the leading cause of death in the United
States at this time. The virus has killed more than 1,800
Americans almost daily since April 7, and the official figure may be an underestimate of
the actual.
In
contrast, heart disease typically causes 1,774 deaths a day in the United
States, while cancer causes 1,641.
True,
the coronavirus curves are stabilizing. In New York, the epicenter of the
epidemic, fewer people are being admitted to hospitals and there are fewer
COVID-19 patients in intensive care units. The daily total of victims is
still discouraging, but it is no longer increasing.
The epidemiological model often cited by the
White House , which was produced by the University of
Washington Institute for Health Measurement and Assessment, originally
predicted that there would be 100,000 to 240,000 deaths by mid-summer. Now
that number is 60,000.
While
this is encouraging news, it masks some important concerns. The
institute's projection runs until August 4, and describes only the first wave
of this epidemic. Without a vaccine, the virus is expected to circulate
for years and the death toll will increase over time.
ADVERTISEMENT
The
progress that has been made to date has been thanks to the emergency closure in
the country, a situation that cannot continue indefinitely. The
"gradual" reopening plan put forth by the White House will
undoubtedly increase the number of victims, no matter how carefully
implemented. The greatest hope is that deaths are minimal.
Reliable
long-term projections of how many Americans will die vary, but they are all
bleak. Several experts consulted in March by the Centers for Disease
Control and Prevention (CDC) predicted that the virus could
eventually reach 48 to 65 percent of Americans, with a death rate. just under 1
percent, and that it would kill an estimated 1.7 million people if nothing were
done to prevent the spread.
A
model of researchers from Imperial College London, quoted by
the American president on March 30, predicted 2.2 million deaths in the country
by September, under the same circumstances.
In comparison, around 420,000 Americans
died in World War II.
China's
limited data is even more disappointing. Its epidemic stopped, for the
time being, and virtually all the people infected in the first wave died or
recovered.
China
has officially reported nearly 83,000 cases and 4,632 deaths ,
representing a death rate of more than five percent. The Trump
administration has questioned the figures ,
but has not produced more precise ones.
Mortality
rates depend largely on how overwhelmed hospitals
are and what percentage of cases are tested. According to a report from the Center for
Evidence-Based Medicine , China's calculated death rate was 17
percent the first week of January, when Wuhan was in chaos, but only 0.7
percent in late February.
In
this country, hospitals in several cities, including New York, reached the
limit of chaos. This week, officials in both Wuhan and New York had to adjust
their death counts upward when they realized that many people had died at the
COVID-19 home, from strokes, heart attacks or other causes, or because
ambulances never came for them.
ADVERTISEMENT
In
dizzying epidemics, far more victims arrive at hospitals or die at home than
doctors can test; at the same time, mild or asymptomatic patients are never
tested. These two factors distort the true mortality rate in opposite
ways. If you don't know how many people are infected, you don't know how deadly a virus is .
Only
when tens of thousands of antibody tests are performed will we know how many
silent carriers there can be in the United States. The CDC has suggested that it could be 25 percent of
those who test positive. Researchers in Iceland say it could be double that .
China
is also reviewing its own calculations. In February, a large study concluded that
only 1 percent of cases in Wuhan were asymptomatic. New research says perhaps 60 percent were . Our
knowledge gaps remain wide enough to make epidemiologists cry.
"All
models are just that," said Anthony S. Fauci, science adviser to the White
House coronavirus special team. "When you get new data, you make
changes to it."
There
may be good news hidden in this inconsistency: the virus may be mutating to
cause fewer symptoms. In movies, viruses become more
deadly. Actually, they generally become less, because asymptomatic strains
reach more hosts. Even the 1918 Spanish flu virus finally faded into seasonal H1N1 flu .
At
the moment, however, we don't know exactly how transmissible or lethal the
virus is. But refrigerated trucks parked outside hospitals tell us
everything we need to know: It's much worse than a bad seasonal flu.
ADVERTISEMENT
The confinements will end, but
with difficulty.
Travelers on the Staten Island CreditFerry ...Misha
Friedman for The New York Times
No
one knows the exact percentage of Americans who have been infected so far —
estimates have ranged from 3 to 10 percent — but at least 300 million of us are
likely to remain vulnerable.
Updated 18m ago
Until
a vaccine, or some other protective measure, emerges, epidemiologists agree
that there is no way for all of these people to take to the streets
safely. If the Americans return by force, everything will seem calm for
about three weeks.
Then the emergency rooms will be busy
again.
"There
is this magical thought that we are all going to resist for a while and then
the vaccine we need is going to be available," said Peter J. Hotez, dean
of the National School of Tropical Medicine at the Baylor School of Medicine.
In
his famous article, “Coronavirus: the hammer
and the dance” , published on March 19 in Medium (on March
22 in Spanish ),
Tomás Pueyo correctly predicted the national closure, which he referred to as
the hammer, and He said it would take us to a new phase, which he called dance,
in which essential parts of the economy could be reactivated, such as some
schools and some factories with the minimum necessary personnel.
All
epidemiological models pose something similar to dance. Everyone assumes
that the virus will resurface every time too many carriers emerge and force
another emergency shutdown. Then the cycle repeats. On the
models, the kill rise and fall
curves look like a row of sharp teeth.
Models
predict spikes are inevitable, even if stadiums, churches, theaters, bars, and
restaurants are closed, everyone arriving from abroad is under 14-day
quarantine, and domestic travel is rigorously restricted to prevent areas of
high intensity reinfect those of low intensity.
Experts
say the tighter the restrictions, the fewer the deaths and the longer the
periods between confinements. Most models assume that states will
eventually carry out widespread temperature measurements, rapid tests, and
contact tracing, as is customary in Asia.
ADVERTISEMENT
Even
the "Opening America Again"
guidelines that Trump unveiled on April 16 have three levels of
social distancing, and it is recommended that vulnerable Americans remain
hidden. The plan supports testing, isolation, and contact tracing, but
does not specify how those measures will be paid for or how long it will take
to implement them.
On
April 17, none of that prevented the President from contradicting his own
message by posting tweets that encouraged
protesters in Michigan, Minnesota and Virginia to fight against
their state closings.
China
did not allow the reopening of Wuhan, Nanjing and other cities until intensive
surveillance found zero new cases for 14 consecutive days, the
incubation time for the virus . Compared to China or
Italy, the United States is still a playground.
Americans
can take domestic flights, drive wherever they want, and hit the streets and
parks. Despite the restrictions, everyone seems to know someone who
discretely organizes children's play dates, roasts in their backyard, or meets
people they've met on dating apps.
As
a result, the country has registered up to 30,000 new cases of infections a day . "People
have to realize that it's not safe to play poker with your face covered in a
bandana," said Schaffner.
Even
with stringent measures, Asian countries have struggled to keep the virus under
control.
China,
which has reported 100 new infections a day, recently closed all theaters in the
country again. Singapore has closed all non-essential
schools and workplaces . Japan recently declared a state of emergency . (South
Korea has also had problems ,
but on Sunday it reported only eight new cases, the first single-digit increase
in two months.)
ADVERTISEMENT
Resolve
to Save Lives, a public health support group led by Thomas R. Frieden , a
former CDC director, published a series of
detailed and strict criteria on when the
economy can reopen and
when it should remain closed .
The
reopening requires a decrease in cases in a period of 14 days, monitoring of 90
percent of contacts, a halt to contagions among health sector workers, recovery
sites for minor cases and many other difficult to achieve objectives.
"We
have to reopen the faucet bit by bit, not letting out jets of water all at
once," Frieden explained. "This is the time to work so that day
comes sooner."
Immunity will become a social
advantage.
Officials from Nido de Esperanza, a nonprofit organization,
bring food to families with young children in the Washington Heights
neighborhood of Manhattan. Credit
...Misha Friedman for The New York Times
Imagine
the United States divided into two classes: those who have recovered from coronavirus infection ,
and could be defined as immune to the virus, and those who remain vulnerable.
"It
will be a chilling schism," predicted David Nabarro, special commissioner of
the World Health Organization for COVID-19. "Those who have the
antibodies will be able to travel and work and the rest will be discriminated
against."
Today,
people with suspected immunity are in great demand, as they are asked to donate blood with
antibodies, and some carry out risky medical work without fear.
ADVERTISEMENT
The
government will soon have to invent a way to certify who is really
immune. An immunoglobulin G (IgG) test, which occurs when immunity is
established, could work, said Daniel R. Lucey, a pandemic expert at Georgetown
Law School. Many companies are producing them.
Dr.
Fauci has said that the White House was discussing
certificates such as those proposed in
Germany. China uses QR codes on cell phones linked
to the owner's personal data, so that others cannot borrow it.
California's
adult film industry pioneered a similar idea a decade ago . Actors
use a cell phone application to demonstrate that they have tested negative for
HIV in the past 14 days, and producers can verify information on a
password-protected website.
According
to experts' predictions, as homebound Americans see their immune neighbors
resume their activities - and perhaps even take the jobs they lost - it's not
hard to imagine the enormous temptation to join them through
autoinfection. Younger citizens, in particular, are going to reckon that
risking serious illness may be a better option than impoverishment and
isolation.
"My
daughter, who is an economist at Harvard University, always tells me that her
age group has to organize COVID-19 parties to develop immunity and help keep
the economy going," said Michele Barry , director
of the Center. of Global Health Innovation from Stanford University.
It
has happened before. In the 1980s, Cuba successfully contained its small AIDS
epidemic by brutally imprisoning all who tested
positive. Inside, however, residents had their own bungalows, food, medical care, salaries,
theater groups, and art classes .
Dozens
of homeless young Cubans were infected deliberately through
sex or blood injections to gain entry, says Jorge Pérez Ávila, an AIDS
specialist who is the Cuban version of Dr. Fauci. Many died before
antiretroviral therapy was introduced.
ADVERTISEMENT
It
would also be a bet for the American youth. The obese and
immunocompromised are clearly at risk, but even healthy, skinny youth have died
from COVID-19.
Sign
up to receive an email when we publish a new story about the coronavirus outbreak.
Sign
up
The virus can be kept under
control, but only with amplified resources.
A health worker checks her protective gear in a mirror in
Central Park, New York. Credit ...Misha Friedman
for The New York Times
Experts
say the next two years will go by in stumbles. The more immune people
return to work, the more the economy will recover.
However,
if too many people are infected at the same time, it will be inevitable to
carry out new emergency closings. To avoid that, it will be imperative
that testing be done across the board.
Fauci
said "the virus will tell us" when it is safe. What it means is
that, when a national standard of hundreds of thousands of tests performed
daily across the country is established, any viral spread can be detected when
the percentage of positive results increases.
Detecting
fevers on the rise as Kinsa smart thermometers map can
give an early signal, Schaffner said.
However,
diagnostic testing has been a problem from the beginning . Despite
White House claims, doctors and patients continue to complain about its shortages
and delays.
ADVERTISEMENT
To
keep the virus under control, several experts have insisted that the country must
start isolating all the sick, even the mildest cases.
In
this country, patients who test positive are asked to stay at home but isolated
from their families.
Television
news has been filled with recovering celebrities, such as CNN's Chris Cuomo,
sweating alone in his basement as his wife left the food at the top of the
stairs, her children waved, and the dogs waited.
But
even Cuomo ended up illustrating why the WHO strongly opposes isolation at
home.
On Wednesday, he revealed that his wife had
the virus.
"If
I were forced to choose just one intervention, it would be the rapid isolation
of all cases," said Bruce Aylward, who led the WHO observer team in
China .
In
China, anyone who tested positive, no matter how mild their symptoms, had to be
admitted immediately to a nursing-type hospital, usually installed in a gym or
community center equipped with oxygen tanks and CT scanners.
There,
they recovered under the supervision of the nurses. That reduced families
'risk, and being with other victims eased some patients' fears. The nurses
even gave dance classes and
exercises to lift spirits and help victims clear their lungs
and maintain muscle tone.
ADVERTISEMENT
However,
the opinions of the experts were divided regarding this type of
facility. Fineberg co-wrote an Opinion article in The New York Times in
which he called for mandatory, but "compassionate" quarantine
processes.
On
the other hand, Marc Lipsitch ,
an epidemiologist at the TH Chan School of Public Health at Harvard University,
opposed the idea, saying: "I do not trust our government to forcibly
separate people from their families."
Finally,
deleting a virus requires testing all contacts for
each known case. But the United States is a long way from that goal.
Someone
who works in a restaurant or factory may have tens or even hundreds of
contacts. In the Chinese province of Sichuan, for example, each known
case had an average of 45 contacts.
The
CDC has around 600 contact
trackers and, until recently, around 1,600 state
and local health departments employed it ,
primarily to track cases of syphilis and tuberculosis.
China
hired and trained 9,000, only in Wuhan . Frieden recently calculated that the United States will need at
least 300,000.
There will be no vaccine so soon.
A patient arrives at the New York Presbyterian Hospital in
Manhattan. Credit ...Misha Friedman for The New York
Times
ADVERTISEMENT
Although
human clinical trials have already begun on three candidates - two here and one
in China - Fauci has repeatedly said that any effort to make a vaccine will
take at least a year to 18 months.
All
experts familiar with vaccine production agreed that even that time scale is
optimistic. Paul Offit, a vaccinologist at the Children's Hospital of
Philadelphia, said the record is four years for
the mumps vaccine.
The
researchers clearly disagreed on what needs to be done to speed up the
process. The modern biotechnology techniques using
RNA or DNA platforms make it possible to develop vaccine candidates faster
than ever.
However,
clinical trials take time, in part because there is no way to rush the
production of antibodies in the human body.
Likewise,
for unclear reasons, some candidate vaccines to combat previous coronaviruses
such as SARS have caused an "antibody-dependent boost", making
recipients more susceptible to infection, not less. In the past, HIV and
dengue vaccines unexpectedly did the same.
Typically,
a new vaccine is first tested on fewer than 100 young, healthy volunteers. If
it looks safe and produces antibodies, thousands more volunteers - in this
case, perhaps the most at-risk workers on the battlefront - get the vaccine or
a placebo in what's called a Phase 3 study.
This
process can be accelerated with “challenge trials”. Scientists vaccinate a
small number of volunteers, wait until they develop antibodies, and then
"challenge" them with deliberate infection to see if the vaccine
protects them.
ADVERTISEMENT
Challenge
trials are used only when a disease is fully curable, such as malaria or typhoid fever . Normally,
it is ethically unthinkable to challenge subjects with an uncured disease, such
as COVID-19.
But
in these abnormal times, several experts argued that putting some Americans at
high risk for faster results could be more ethical than leaving millions at
risk for years.
"Less
harm is done if you do a challenge trial on a few people than if you do a Phase
3 trial in thousands," said Lipsitch, who recently published an article advocating
challenge trials in the Journal of Infectious
Diseases. Almost immediately, he said, volunteers appeared.
Others
were deeply uncomfortable with that idea. "I think it's very
unethical, but I can't see how we could do it," says Lucey.
The
hidden danger of challenge trials, vaccinologists explained, is that they
recruit too few volunteers to show if a vaccine creates improvement, which can
be a rare but dangerous problem.
"Challenge
trials won't give you a safety answer," said Michael T. Osterholm,
director of the Center for Infectious Disease Research and Policy at the
University of Minnesota. "It can be a big problem."
W.
Ian Lipkin, a virologist at Columbia University's Mailman School of Public
Health, suggested an alternative strategy. Choose at least two candidate
vaccines, briefly test them in humans, and do challenge trials in
monkeys. Start by having an immediate winner, even as you expand human
trials for hidden problems.
ADVERTISEMENT
While
testing a vaccine is an arduous task, producing hundreds of millions of doses
is even more complicated, experts warned.
Most
American vaccine plants produce only about five to ten million doses a year,
needed for the four million babies who are born and the four million people who
turn 65 each year, says R. Gordon Douglas Jr. , former president of Merck's
vaccine division.
But
if they invent a vaccine, the United States may need 300 million doses, or 600
million, if two vaccinations are needed. And the same number of syringes.
"People
have to start thinking big," said Douglas. "With that volume,
you should start producing them very soon."
Flu
vaccine plants are large, but those that grow vaccines on chicken eggs are not
suitable for modern vaccines, which grow in cell broths, he said.
European
countries have plants but they will need them for their own
citizens. China has a large vaccine industry, which could expand in the
coming months. Experts said it could make vaccines for the United
States. But captive customers must pay the seller's asking price, and the
safety and efficacy standards of some Chinese companies are flawed .
India
and Brazil also have large vaccine industries. If the virus moves rapidly
through its crowded populations, they may lose millions of citizens but achieve
widespread immunity before the United States does. In that case, they may
have reserve capacity in their vaccine plants.
ADVERTISEMENT
Alternatively,
suggested Arthur M. Silverstein, a retired medical historian from the Johns
Hopkins School of Medicine, the government could take and sterilize liquor or
beer plants that have large fermentation tanks.
"Any distillery could be
transformed," he said.
There are
likely to be treatments first.
Coronavirus samples to analyze at Mirimus, a medical research
company in Brooklyn Credit ...Misha Friedman for The New York
Times
In
the short term, experts were more optimistic about treatments than about
vaccines. Several of them opined that "convalescent plasma"
could work.
This
basic technique has been used for more than a century: blood is taken from
people who have recovered from an illness, then filtered to remove everything
except the antibodies. Antibody-rich immunoglobulin is injected into
patients.
The
obstacle is that there are now relatively few survivors from whom blood can be
collected.
In
prevalent times, antibodies were "grown" in horses and
sheep. But that process was difficult to keep sterile, and animal proteins
sometimes triggered allergic reactions.
The
modern alternative is monoclonal antibodies. According to experts,
these treatment regimens , which recently
came very close to ending the
Ebola epidemic in eastern Congo, are likely to change the game in the short
term.
ADVERTISEMENT
The
most effective antibodies are chosen, and the genes that produce them are
linked into a benign virus that will grow in a cell broth.
But,
as with vaccines, the growth and purification of monoclonal antibodies takes
time. In theory, with enough production, they could be used not only to
save lives but to protect front-line workers.
Antibodies
can last for weeks before breaking down, time depends on many factors,
Silverstein noted, and they cannot kill the virus that is already hidden inside
cells.
Taking
a daily preventative pill would be a much better solution, as the pills can be
synthesized in factories much faster than vaccines, or antibodies can be developed
and purified.
However,
even if one were to be invented, production would have to be doubled until it
was as ubiquitous as aspirin, so that 300 million Americans could take it
daily.
Trump
has mentioned hydroxychloroquine and azithromycin so often that his press conferences sound like
infomercials . But all experts agree with Dr. Fauci that
no decision should be made until clinical trials are completed .
Some
recall that in the 1950s inadequate tests for thalidomide caused thousands of
children to be born with malformed limbs . More
than one study of hydroxychloroquine was stopped after patients who received
high doses developed abnormal heart rhythms .
ADVERTISEMENT
"I
doubt anyone will tolerate high doses, and there are vision problems if it
accumulates," said Barry. "But it would be interesting to see if
it could work as a drug similar to PrEP," he added, referring to the pills
used to prevent HIV.
Others
were tougher, especially on Trump's idea of combining chloroquine with
azithromycin.
"It
is silly," said Luciana Borio, former director of medical preparedness and
biodefense at the National Security Council. "I told my family, if
you give me the COVID, don't give me that combo."
Chloroquine
may protect hospitalized pneumonia patients from lethal cytokine storms because
it dampens immune reactions, several doctors said.
However,
that doesn't make it useful for preventing infections, as Trump has implied ,
because it has no known antiviral properties.
Several
antivirals — including remdesivir, favipiravir, and
baloxavir — are being tested against the coronavirus; the last two are flu
drugs.
Trials
of various combinations in China will issue results for next month, but they
will be small and possibly inconclusive because doctors were left without
patients to test. The end dates for most trials in the United States have
not yet been established.
ADVERTISEMENT
Goodbye to 'America first'.
A church in Washington Heights collects food and other donated
goods for Nido de Esperanza, the non-profit organization. Credit ...Misha Friedman for The New York Times
Previously
unthinkable social changes have already taken place. Schools and
businesses have closed in every state, and tens of millions have applied for
unemployment aid. Taxes and mortgage payments were delayed and
foreclosures are prohibited.
Stimulus
checks, meant to offset the crisis, began hitting checking accounts this week,
turning much of the United States, temporarily, into a welfare state. Food banks are opening across the country
and large lines have formed.
A
public health crisis of this magnitude requires international cooperation on a
scale that has not been seen in decades. However, Trump is taking steps to withdraw funding from WHO ,
the only organization capable of coordinating a response like that.
In
addition, it spent most of this year opposing China, which now has the world's
most powerful functioning economy and may become the dominant provider of drugs
and vaccines. China has used the pandemic to spread its global influence,
and says it has shipped medical clothing and equipment to nearly 120 countries.
A
major recipient is the United States, through Project Airbridge, an air cargo
operation overseen by Trump's son-in-law, Jared Kushner.
Several
experts have pointed out that "America first" is not a viable
strategy in this world.
ADVERTISEMENT
"If
President Trump wants to step up public health efforts here, he should look for
ways to collaborate with China and let go of the insults," said Nicholas
Mulder, economics historian at Cornell University. He has called Kushner's
project “Loan-Lease Reverse,” in reference to US military aid to other
countries during World War II.
Osterholm
was even more direct. "If we alienate the Chinese with our rhetoric,
I think they will bite us again," he said.
"What
happens if they create the first vaccine? They can choose who to sell it
to. Are we first on the list? Why would we be? "
When
the pandemic is over, the national recovery may be swift. Mulder noted
that the American economy recovered from the two world wars.
Psychological
side effects will be more difficult to measure. The isolation and poverty
caused by a long period of confinement could increase the rates of domestic violence , depression and suicide .
Even
political perspectives can change. At first,
the virus hit Democratic cities like Seattle, New York and Detroit
hard. But as it spreads across the country, it won't spare anyone.
Even
voters in Republican states who don't blame Trump for America's lack of preparedness or limiting access to health
insurance can change their minds if they see friends and family
die.
ADVERTISEMENT
In
one of the most provocative analyzes in his follow-up article, " Coronavirus: Out of Many,
One, " Pueyo analyzed Medicare and census data on age
and obesity in states that recently resisted confinement and
in counties. who voted for Republicans in 2016.
He
calculated that those voters could be 30 percent more likely to die from the
virus.
Mulder
mentioned that in the periods after both world wars, society and income became
more equitable. Funds created for veterans and widows pensions fostered
social safety nets, measures such as the Veterans Aid Act or GI (to finance
demobilized soldier studies) and mortgage loans from the Department of Veterans
Affairs were taken. , unions strengthened, and budget benefits for the wealthy
waned.
Experts
suggested that if a vaccine does save lives, many Americans may be more
confident in conventional medicine and more receptive to science in general,
including on issues like climate change.
The
clear skies that have shone in American cities during this era of confinement
could even become permanent.
No comments:
Post a Comment