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COVID-19 has killed hundreds of thousands of people worldwide, but beyond lives lost, it has exposed massive and long-concealed gaps in health systems around the world — especially in the United States. These gaps, and how countries value public health and the systems delivering it, must be addressed now, because another pandemic is all but a certainty. Doing so is well within the capacity of the United States. Clinicians have already established that COVID-19 preys on the most vulnerable patients. Data from China, France, the United States, and elsewhere show those with preexisting conditions such as cardiovascular disease, diabetes, cancer, or pulmonary disease are more likely to die from the coronavirus than healthier people. (Vanessa Kerry, 5/21)

In the early days of the stay-at-home orders, one of the arguments used to press for a quick and nearly full reopening of the country was that COVID-19 wasn’t that dangerous. Why be so upset about the novel coronavirus, some critics asked, when flu kills more people? That talking point was squashed when, within three months of the pandemic’s start, the coronavirus killed more Americans than the last flu season did in six-plus months. COVID-19 has now killed almost 50% more Americans (about 93,000) than the highest estimate of the season’s flu toll (about 62,000). The new argument is that the coronavirus is dangerous just to the elderly and people with certain underlying conditions. Those people should stay at home, the reasoning goes, while the rest of the nation goes about business as usual. (5/21)

One of the most frustrating and terrifying things about this pandemic is its unpredictability. From its effects to how it spreads, it keeps surprising us, usually in unpleasant ways. News out of China suggesting the coronavirus may have mutated in a new wave there is the latest example — though it could also be an example of the misinformation and conclusions-jumping the disease’s mysterious nature inspires. Even our responses have been hard to read. Elaine He charted the results of the various pandemic-fighting efforts across Europe and came up with a plate of spaghetti. Some countries with strict lockdowns (think Italy) suffered more deaths than those with more-relaxed policies (think Sweden). The poor U.K. has just been a shambles no matter what it does. (Mark Gongloff, 5/20)

Horrific stories are emerging of children developing rashes, cardiac abnormalities and other inflammatory symptoms that are linked to the novel coronavirus. Parents and public health officials are understandably worried, but some perspective is in order given the virus’s apparent overall low risk to children. The Centers for Disease Control and Prevention reported last week that 15 children under age 15 in the U.S. have died of Covid-19 since February compared to about 200 who died of the flu and pneumonia. Children represent 0.02% of virus fatalities in the U.S., and very few have been hospitalized. (5/20)

If there is a silver lining to the flawed U.S. response to the coronavirus pandemic, it is this: The relatively high number of new cases being diagnosed daily — upward of 20,000 — will make it easier to test new vaccines. To determine whether a vaccine prevents disease, the study’s subjects need to be exposed to the pathogen as it circulates in the population. Reopening the economy will likely result in faster spread of the coronavirus and therefore more opportunities to test a vaccine’s efficacy in trial subjects. (Arthur Allen, 5/21)

The need to rapidly develop a vaccine against SARS-CoV-2 comes at a time of explosion in basic scientific understanding, including in areas such as genomics and structural biology, that is supporting a new era in vaccine development. Over the past decade, the scientific community and the vaccine industry have been asked to respond urgently to epidemics of H1N1 influenza, Ebola, Zika, and now SARS-CoV-2. An H1N1 influenza vaccine was developed relatively rapidly, largely because influenza-vaccine technology was well developed and key regulators had previously decided that vaccines made using egg- and cell-based platforms could be licensed under the rules used for a strain change. Although a monovalent H1N1 vaccine was not available before the pandemic peaked in the Northern Hemisphere, it was available soon afterward as a stand-alone vaccine and was ultimately incorporated into commercially available seasonal influenza vaccines. (Nicole Lurie, Melanie Saville, Richard Hatchett, and Jane Halton, 5/21)

Here’s an unjust fact: Some of the frontline health care workers we’ve been celebrating with social media likes, sidewalk chalk, and asynchronous concerts are getting pay cuts and losing their jobs. And here’s an unwelcome observation: A word that’s increasingly being used during this pandemic is making their lives even harder. (Matthew Lewis, Zac M. Willette and Brian Park, 5/21)

President Trump’s revelation this week that he’s taking hydroxychloroquine to ward off Covid-19 sent shivers down my spine and the spines of many others living with lupus because we actually need this problematic medication. His hype will almost certainly make the drug more difficult to get. (Camela Thompson, 5/20)