Disorders of oxygen transport are commonly attributed to inadequate carrying capacity (anemia) but may also relate to inefficient gas exchange by red blood cells (RBCs), a process that is poorly characterized yet assumed to be rapid. Without direct measurements of gas exchange at the single-cell level, the barriers to O2...

Background and Objectives:

The goal of this study was to decrease admission and readmission rate for the 2296 Medicaid patients in our clinic. Our focus was to eliminate patient identified barriers to care that led to decreased quality of care. The identified barriers for our clinic included distance to care, poor same-day access, communication, and fragmented care. A team-based, collaborative approach using members from all aspects of patient care.

Kathryn Knight

Kelsey L. Jones, Rahmatollah Rajabzadeh, Guncha Ishangulyyeva, Nadir Erbilgin, and Maya L. Evenden

Flight polyphenisms naturally occur as discrete or continuous traits in insects. Discrete flight polyphenisms include winged and wingless morphs, whereas continuous flight polyphenisms can take the form of short- or long-distance fliers. The mountain pine beetle (Dendroctonus ponderosae) exhibits polyphenic variation in flight distance but the consequences of this flight variation on life history strategies of beetles is unknown. This study assessed the effect of flight on two particular aspects of beetle biology: (1) an energetic trade-off between flight distance and host colonisation capacity; and (2) the relationship between flight distance and pheromone production. A 23-h flight treatment was applied to a subset of beetles using computer. After flight treatment, both flown and unflown (control) beetles were given the opportunity to colonise bolts of host trees, and beetles that entered hosts were aerated to collect pheromone. A trade-off occurred between initiation of host colonisation and percent body weight lost during flight, which indicates energy-use during flight affects host acceptance in female mountain pine beetles. Furthermore, production of the aggregation pheromone trans-verbenol by female beetles was influenced by both percent weight lost during flight and flight distance. Male production of exo-brevicomin was affected by beetle condition following flight but not by the energy used during flight. These novel results give new insight into the polyphenic flight behaviour of mountain pine beetles. Flight variation is adaptive by acting to maintain population levels through safe and risky host colonisation strategies. These findings suggest mechanisms that facilitate the extremities of the continuous flight polyphenism spectrum. These opposing mechanisms appear to maintain the high variation in flight exhibited by this species.

At the time of this writing, healthcare systems are facing worldwide the pandemic of the coronavirus severe acute respiratory coronavirus 2 (SARS-COV-2) and its associated disease, named cronavirus disease 19 (COVID-19). This virus is a new human pathogen, and currently, there are no specific treatment options.¹ COVID-19 mostly affects the respiratory system, ranging from mild flu-like symptoms to severe pneumonia, but extrarespiratory multisystemic involvement has also been reported.² Li et al.³ recently described the neuroinvasive potential of COVID-19, but, to our knowledge, no case of acute dysimmune neuropathy has been described so far. Here, the authors report the case of an acute and severe peripheral nervous system disorder possibly related to COVID-19 infection.

Alemtuzumab is approved for the treatment of relapsing-remitting MS and is used off-label for patients with chronic lymphocytic leukemia and as induction and antirejection therapy in kidney transplant recipients.¹ Guillain-Barré syndrome (GBS) or chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) complicating alemtuzumab treatment was reported in 9 patients with hematologic malignancy or MS.^1–3 The risk of GBS or CIDP in solid organ transplant recipients treated with alemtuzumab is unknown.

Serological testing for nasopharyngeal carcinoma (NPC) has recently been reinvigorated by the implementation of novel Epstein-Barr virus (EBV)-specific IgA and IgG antibodies from a proteome array. Although proteome arrays are well suited for comprehensive antigen selection, they are not applicable for large-scale studies. We adapted a 13-marker EBV antigen signature for NPC risk identified by proteome arrays to multiplex serology to establish an assay for large-scale studies. Taiwanese NPC cases (n = 175) and matched controls (n = 175) were used for assay validation. Spearman’s correlation was calculated, and the diagnostic value of all multiplex markers was assessed independently using the area under the receiver operating characteristic curve (AUC). Two refined signatures were identified using stepwise logistic regression and internally validated with 10-fold cross validation. Array and multiplex serology showed strong correlation for each individual EBV marker, as well as for a 13-marker combined model on continuous data. Two refined signatures with either four (LF2 and BGLF2 IgG, LF2 and BMRF1 IgA) or two (LF2 and BGLF2 IgG) antibodies on dichotomous data were identified as the most parsimonious set of serological markers able to distinguish NPC cases from controls with AUCs of 0.992 (95% confidence interval [CI], 0.983 to 1.000) and 0.984 (95% CI, 0.971 to 0.997), respectively. Neither differed significantly from the 13-marker model (AUC, 0.992; 95% CI, 0.982 to 1.000). All models were internally validated. Multiplex serology successfully validated the original EBV proteome microarray data. Two refined signatures of four and two antibodies were capable of detecting NPC with 99.2% and 98.4% accuracy.

Impaired baroreflex sensitivity (BRS) predicts cardiovascular mortality and is prevalent in long-term diabetes. We determined spontaneous BRS in patients with recent-onset diabetes and its temporal sequence over 5 years by recording beat-to-beat blood pressure and R-R intervals over 10 min. Four time domain and four frequency domain BRS indices were computed in participants from the German Diabetes Study baseline cohort with recent-onset type 1/type 2 diabetes (n = 206/381) and age-matched glucose-tolerant control subjects (control 1/control 2: n = 65/83) and subsets of consecutive participants with type 1/type 2 diabetes who reached the 5-year follow-up (n = 84/137). Insulin sensitivity (M-value) was determined using a hyperinsulinemic-euglycemic clamp. After appropriate adjustment, three frequency domain BRS indices were reduced in type 2 diabetes compared with control 2 and were positively associated with the M-value and inversely associated with fasting glucose and HbA_1c (P < 0.05), whereas BRS was preserved in type 1 diabetes. After 5 years, a decrease in one and four BRS indices was observed in patients with type 1 and type 2 diabetes, respectively (P < 0.05), which was explained by the physiologic age-dependent decline. Unlike patients with well-controlled recent-onset type 1 diabetes, those with type 2 diabetes show early baroreflex dysfunction, likely due to insulin resistance and hyperglycemia, albeit without progression over 5 years.

Advances in small RNA sequencing have revealed the enormous diversity of small noncoding RNA (sRNA) classes in mammalian cells. At this point, most investigators in diabetes are aware of the success of microRNA (miRNA) research and appreciate the importance of posttranscriptional gene regulation in glycemic control. Nevertheless, miRNAs are just one of multiple classes of sRNAs and likely represent only a minor fraction of sRNA sequences in a given cell. Despite the widespread appreciation of sRNAs, very little research into non-miRNA sRNA function has been completed, likely due to some major barriers that present unique challenges for study. To emphasize the importance of sRNA research in cardiometabolic diseases, we highlight the success of miRNAs and competitive endogenous RNAs in cholesterol and glucose metabolism. Moreover, we argue that sequencing studies have demonstrated that miRNAs are just the tip of the iceberg for sRNAs. We are likely standing at the precipice of immense discovery for novel sRNA-mediated gene regulation in cardiometabolic diseases. To realize this potential, we must first address critical barriers with an open mind and refrain from viewing non-miRNA sRNA function through the lens of miRNAs, as they likely have their own set of distinct regulatory factors and functional mechanisms.

First Person is a series of interviews with the first authors of a selection of papers published in Biology Open, helping early-career researchers promote themselves alongside their papers. Sonu S. Baral is first author on ‘Nucleolar stress in Drosophila neuroblasts, a model for human ribosomopathies’, published in BiO. Sonu conducted the research described in this article while a PhD student in Patrick J. DiMario's lab at Louisiana State University, Baton Rouge, LA, USA. She is now a R&D scientist at Thermo Fisher Scientific, Santa Clara, CA, USA, investigating various genetic disorders relevant to reproductive health and newborn screening.

BackgroundAutistic people are at increased risk of developing mental health problems. To reduce the negative impact of living with autism in a non-autistic world, efforts to improve take-up and access to care, and support in early years, which will typically start with a GP appointment, must be grounded in the accounts of autistic young adults.AimTo explore how autistic young adults understand and manage mental health problems; and to consider help seeking as a focus.Design and settingA cross-sectional, qualitative study. Autistic participants were purposively selected to represent a range of mental health conditions including anxiety and depression. A subsample were recruited from a population cohort screened for autism in childhood. The study concerns access to primary care.MethodNineteen autistic young adults without learning disabilities, aged 23 or 24 years, were recruited. In-depth, semi-structured interviews explored how they understood and managed mental health problems. Data were analysed thematically.ResultsYoung adults preferred self-management strategies. Multiple factors contributed to a focus on self-management, including: beliefs about the aetiology of mental health difficulties and increased vulnerability with the context of a diagnosis of autism, knowledge of self-management, and a view that formal support was unavailable or inadequate. Families had limited awareness of professional support.ConclusionYoung autistic adults without learning disabilities, and their families, may hold erroneous beliefs about autism and mental health. This may affect help seeking and contribute to an exacerbation of symptoms. GPs need to be alert to the fact that autistic young adults in their care may be experiencing mental health difficulties but may not recognise them as such.

BACKGROUND AND PURPOSE:

Anoxic brain injury is a result of prolonged hypoxia. We sought to describe the nonquantitative arterial spin-labeling perfusion imaging patterns of anoxic brain injury, characterize the relationship of arterial spin-labeling and DWI, and evaluate the normalized diffusion-to-perfusion ratio to differentiate patients with anoxic brain injury from healthy controls.

Ironbark is one of 2020’s anticipated movies. Benedict Cumberbatch plays the MI6 handler of a Russian spy who may have helped prevent nuclear war

Sonos has been busy these past few months.

Tottenham will need to be creative in the transfer market this summer.

The Justice Department's move was the latest example of the attorney general's effort to chisel away at the special counsel investigation and emphasize an alternate narrative.

The Rossoneri icon has sought to talk up the importance of defenders in any ambitious side, with those at Anfield having found one of real “quality”

Samuel Umtiti injured his right calf during Barcelona's second training session since being allowed to return to club facilities.

The legendary Bafana Bafana striker has backed the Amakhosi midfielder, who is facing stiff competition in midfield

Robert De Niro, Joaquin Phoenix, Juliette Binoche, and Cate Blanchett have signed an op-ed in French newspaper Le Monde.

In a Fox News interview Friday, President Trump was noncommittal on whether FBI Director Christopher Wray would remain in the job following the Justice Department’s decision to drop its case against Michael Flynn.

There is absolutely no legitimate basis in law or in fact to dismiss Flynn’s guilty plea.

Arc brings a new design and feature set, while the Play:5 is now just the Five.

Read our live updates on coronavirus HERE Coronavirus: The symptoms

Former US president Barack Obama given Joe Biden his endorsement for the 2020 presidential election.

Follow our live coronavirus updates here Coronavirus: the symptoms

An Essex man has appeared in court accused of fatally running over a woman after a row about a minor collision.

The Royal Navy is investigating reports that a nuclear submarine crew held a party after returning to their UK base while the rest of the country was under coronavirus lockdown.

The southern Italian region of Calabria has given the go-ahead for pizzerias, bars and restaurants with open-air tables to reopen, sparking a rift today with the central government.

"He pushed one of the police officers on the ground and I think he was about to lunge at another one of the police with the knife, that's what it looked like to me.

Two brothers who preyed on women leaving bars and nightclubs before carrying out sexual assaults have been convicted.

Australia's Great Barrier Reef has experienced its third coral bleaching event in five years, according to researchers who blamed the rapid warming of the planet due to human emissions.

Campaign launched to increase threshold on rateable value to help struggling businesses

Two 20-year-old men were arrested on suspicion of public order offences

Extinction Rebellion activists have sprayed fake oil over the Barclays head office in an apparent breach of lockdown rules.

Pianist-singer behind “Tutti Frutti,” “Good Golly Miss Molly” and “Long Tall Sally” set the template that a generation of musicians would follow

The post Little Richard, Founding Father of Rock Who Broke Musical Barriers, Dead at 87 appeared first on My Site.

The 89-year-old naturalist and broadcaster is brimming with enthusiasm for his latest TV series, Great Barrier Reef, and the wonder of filming underwater in a submarine. The first of three shows starts on BBC1 on 30 December

The first time I visited the Great Barrier Reef was in 1957 when I was on my way to New Guinea. In those days, television didn’t have a lot of money so, when you got to the other side of the world, you took advantage of it as you never knew when you were going to get back again, and so I took in the Barrier Reef on the way.

It was right at the beginning of the era of underwater swimming. There had been a Viennese pair, Han and Lotte Hass, who had a show underwater called Diving to Adventure. Those of us who had television sets – our jaws dropped! This wonderful girl in this white costume just knocking sharks on the head with the camera. Amazing!

UK scientists provide a new estimate for the amount of space rock falling to Earth each year.

WASHINGTON -- Shortly after admitting guilt to a federal judge in December 2017 for lying to the FBI, Michael Flynn issued a statement saying what he did was wrong, and "through my faith in God, I am working to set things right."It turns out that the only higher power that Flynn needed was Attorney General William Barr.Barr's extraordinary decision to drop the criminal case against Flynn shocked legal experts, won President Donald Trump's praise and prompted a career prosecutor to quit the case. It was the latest in Barr's steady effort to undo the results of the investigation by Robert Mueller, the special counsel. Barr has portrayed his effort as rectifying injustice, and the president more bluntly as an exercise in political payback.In his decisions and public comments over the past year, Barr has built an alternate narrative to the one that Mueller laid out in his voluminous report. Where the special counsel focused on Russia's expansive effort to interfere in the 2016 election, the Trump campaign's openness to it and the president's determination to impede the inquiry, Barr has focused instead on the investigators. He has suggested that they were unleashed by law enforcement and intelligence officials bent on bringing political harm to Trump.Barr has also mischaracterized the findings of the Mueller investigation, questioned why it began in the first place, used legal maneuvers to undo its courtroom successes and opened his own investigation by a hand-picked prosecutor that could bring criminal charges against former U.S. officials who played a part in setting the original inquiry into motion. Mueller and Barr, once close friends, have been like two students standing shoulder to shoulder at a blackboard: What one has diligently written down, the other has tried to steadily erase.In an interview Thursday with CBS News, Barr said he considered the Flynn case to be "part of a number of related acts -- and we're looking at the whole pattern of conduct." (The same day, Trump called it "just one piece of a very dishonest puzzle.")Recent disclosures about the FBI's handling of the Flynn case raise questions about why the bureau's leadership sent agents to interview Flynn without coordinating with top Justice Department officials, the latest in a series of revelations about FBI abuses in politically charged investigations in recent years. Barr, however, even suggested that a theory of the case embraced by Mueller and his team might have made them blind to the facts."One of the things you have to guard against, both as a prosecutor and I think as an investigator, is that if you get too wedded to a particular outcome and you're pursuing a particular agenda, you close your eyes to anything that sort of doesn't fit with your preconception," he said. "And I think that's probably the phenomenon we're looking at here."But when Mueller made his findings public, many criticized him for doing the opposite. His conclusions, especially about whether Trump had committed any obstruction of justice offenses by impeding the inquiry, were dense, burdened by legalese and appeared to reflect a tortured debate among the special counsel's team. They delivered no easy sound bite that the president's opponents could seize upon -- allowing Trump to distort the judgments by calling them a vindication of his behavior.The Mueller report "bends over backwards" to show that the special counsel's team considered all of the legal and political ramifications of investigating a sitting president, said Matthew J. Jacobs, a former federal prosecutor and now a partner at Vinson & Elkins."It gives the benefit of the doubt to the subject of the investigation that in any quote-unquote normal criminal case doesn't happen and wouldn't exist," said Jacobs, who once worked for Mueller at the U.S. attorney's office in San Francisco.Barr's decision to drop the charges against Flynn was "unlike anything I've seen before," Jacobs said, adding that he saw no evidence whatsoever "that Gen. Flynn was set up or entrapped."In an unsolicited memo he wrote to the White House while still a lawyer in private practice in 2018, Barr unspooled his thoughts about what he called a "fatally misconceived" obstruction of justice theory the special counsel was reportedly pursuing as part of his investigation. Trump named him attorney general months later, but during his confirmation hearing, he pledged not to interfere with the work of Mueller and his team.Barr drew criticism for the way he characterized Mueller's findings last year in a four-page letter that -- for weeks -- served as the public's only picture of Mueller's 22-month investigation. Mueller privately wrote to the attorney general, saying he had mischaracterized the findings -- a letter Barr described as "snitty" -- and over time, Barr has repeatedly tried to emphasize the harm done to the investigative targets of the FBI and the special counsel's office.Barr's handling of the Mueller findings prompted a stinging rebuke in March from a Republican-appointed federal judge, who said the attorney general put forward a "distorted" and "misleading" account of the findings and lacked credibility on the topic.Barr has long insisted that he works independently of the White House, and in February, he said that Trump's public comments about the Justice Department sometimes made it "impossible" for him to do his job. Those comments came after Barr and other top department officials intervened to try to reduce a prison sentence in another case brought during the Mueller investigation: That of Roger Stone, a longtime friend of the president's who was convicted of lying to Congress, witness tampering and obstruction of justice in a bid to thwart a congressional inquiry that threatened Trump.The president has made it clear both to aides and foreign officials that he sees Barr as a crucial ally in the grinding battle against his perceived enemies. Last July, the day after Mueller's congressional testimony seemed to lower the curtain on a more than two-year drama that had imperiled the Trump presidency, Trump was on the phone with President Volodymyr Zelenskiy of Ukraine asking him to assist the attorney general in an investigation "to get to the bottom of" how the Russia investigation began."As you saw yesterday, that whole nonsense ended with a very poor performance by a man named Robert Mueller," the president said. The requests to Zelenskiy helped form the basis of an impeachment case against Trump in the ensuing months.Weeks after that phone call, Barr was on a plane to Rome with John Durham -- the prosecutor leading the Justice Department's investigation into the origins of the Russia investigation -- to seek evidence from Italian officials that might bolster a conspiracy theory long held by Trump: That American intelligence and law enforcement officials plotted with American allies to try to prevent him from winning the presidency in 2016.They did not appear to find any evidence. It remains uncertain, however, what Durham will find over his investigation, expected to finish sometime this year, and what effect it will have on the legacy of the Mueller investigation.The president, of course, has not waited to pass judgment. He has long publicly complained that the Flynn case was a product of a cabal of former officials conspiring against him, and he seems certain to promote its collapse as he ramps up his campaign for reelectionOn Thursday, the day the Justice Department dropped the criminal charges against Flynn -- the first top White House official to have been ensnared in the Russia investigation -- Trump was on the phone with President Vladimir Putin of Russia to celebrate the 75th anniversary of the end of World War II in Europe.Trump boasted that the call came at an opportune time. Things are "coming in line showing what a hoax this whole investigation was -- it was a total disgrace.""I wouldn't be surprised," he said he told Putin, "if you see a lot of things happen over the next number of weeks."This article originally appeared in The New York Times.(C) 2020 The New York Times Company

Welcome to the real sharing economy. Friends and neighbors set up trades on Facebook and Nextdoor for household essentials like toilet paper, eggs and bread.

The star will read the entire Tolkien book from start to finish with no breaks.

When life is necessarily small, the more negative feelings we’ve managed to keep in abeyance can loom large, says Annalisa Barbieri

I had adjusted to living alone after I was widowed six years ago, and since the lockdown friends have telephoned frequently and I chat to neighbours at a distance.

Although I feel I am one of the lucky ones and should be fine, I miss, above all, hugs and physical closeness. I have also started to resent people with partners, children or cuddly pets (which I have not done before).

The EU's chief negotiator has branded progress in post-Brexit talks disappointing and warned the "clock was ticking".

Like most of us, Adam Tooze is stuck at home. The British-born economic historian and Columbia University professor of history had been on leave this school year to write a book about climate change. But now he’s studying a different global problem. There are more than 700,000 cases of COVID-19 in the United States and over 2 million infections worldwide. It’s also caused an economic meltdown. More than 18 million Americans have filed for unemployment in recent weeks, and Goldman Sachs analysts predict that U.S. gross domestic product will decline at an annual rate of 34 percent in the second quarter.

Tooze is an expert on economic catastrophes. He wrote the book Crashed: How a Decade of Financial Crises Changed the World, about the 2008 economic crisis and its aftermath. But even he didn’t see this one coming. He hadn’t thought much about how pandemics could impact the economy—few economists had. Then he watched as China locked down the city of Wuhan, in a province known for auto manufacturing, on January 23; as northern Italy shut down on February 23; and as the U.S. stock market imploded on March 9. By then, he knew he had another financial crisis to think about. He’s been busy writing ever since. Tooze spoke with Nautilus from his home in New York City.

What do you make of the fact that, in three weeks, more than 16 million people in the U.S. have filed for unemployment?

The structural element here—and this is quite striking, when you compare Europe, for instance, to the U.S.—is that America has and normally celebrates the flexibility and dynamism of its labor market: The fact that people move between jobs. The fact that employers have the right to hire and fire if they need to. The downside is that in a shock like this, the appropriate response for an employer is simply to let people go. What America wasn’t able to do was to improvise the short-time working systems that the Europeans are trying to use to prevent the immediate loss of employment to so many people.

The disadvantage of the American system that reveals itself in a crisis like this is that hiring and firing is not easily reversible. People who lose jobs don’t necessarily easily get them back. There is a fantasy of a V-shaped recovery. We literally have never done this before, so we don’t know one way or another how this could happen. But it seems likely that many people who have lost employment will not immediately find reemployment over the summer or the fall when business activity resumes something like its previous state. In a situation with a lot of people with low qualifications in precarious jobs at low income, the damage from that kind of interruption of employment in sectors notably which are already teetering on the edge—the chain stores, which are quite likely closing anyway, and fragile malls, which were on the edge of dying—it’s quite likely that this shock will also induce disproportionately large amounts of scarring.

What role has wealth and income inequality played during this crisis?

The U.S. economic system is bad enough in a regular crisis. In one like this, where you shut the entire economy down in a matter of weeks, the damage is barely conceivable. There are huge disparities, all of which ultimately are rooted in social structures of race and class, and in the different types of jobs that people have. The profound inequality in American society has been brought home for us in everyone’s families, where there is a radical disparity between the ability of some households to sustain the education of their children and themselves living comfortably at home. Twenty-five percent of kids in the United States appear not to have a stable WiFi connection. They have smartphones. That seems practically universal. But you can’t teach school on a smartphone. At least, that technology is not there.

Presumably by next year something like normality returns. But forever after we’ll live under the shadow of this having happened.

President Trump wants the economy to reopen by May. Would that stop the economic crisis?

Certainly that is presumably what drives that haste to restart the economy and to lift intense social distancing provisions. There is a sense that we can’t stand this. And that has a lot to do with deep fragilities in the American social system. If all Americans live comfortably in their own homes, with the safety of a regular paycheck, with substantial savings, with health insurance that wasn’t conditional on precarious employment, and with unemployment benefits that were adequate and that were rolled out to most people in this society if they needed them, then there wouldn’t be such a rush. But that isn’t America as we know it. America is a society in which half of families have virtually no financial cushion; in which small businesses, which are so often hailed as the drivers of job creation, the vast majority of owners of them live hand-to-mouth; in which the unemployment insurance system really is a mockery; and with health insurance directly tied to employment for the vast majority of the people. A society like that really faces huge pressures if the economy is shut down.

How is the pandemic-induced economic collapse we’re facing now different from what we faced in 2008?

This is so much faster. Early this year, America had record-low unemployment numbers. And last week or so already we probably broke the record for unemployment in the United States in the period since World War II. This story is moving so fast that our statistical systems of registration can’t keep up. So we think probably de facto unemployment in the U.S. right now is 13, 14, 15 percent. That’s never happened before. 2007 to 2008 was a classic global crisis in the sense that it came out of one particular over-expanded sector, a sector which is very well known for its volatility, which is real estate and construction. It was driven by a credit boom.

What we’re seeing this time around is deliberately, government-ordered, cliff edge, sudden shutdown of the entire economy, hitting specifically the face-to-face human services—retail, entertainment, restaurants—sector, which are, generally speaking, lagging in cyclical terms and are not the kind of sectors that generate boom-bust cycles.

Are we better prepared this time than in 2008?

You’d find it very hard to point to anyone in the policymaking community at the beginning of 2020 who was thinking of pandemic risk. Some people were. Former Treasury Secretary and former Director of the National Economic Council Larry Summers, for example, wrote a paper about pandemic flu several years ago, because of MERS and SARS, previous respiratory illnesses caused by coronaviruses. But it wasn’t top of stack at the beginning of this year. So we weren’t prepared in that sense. But do we know what to do now if we see the convulsions in the credit markets that we saw at the beginning of March? Yes. Have the central banks done it? Yes. Did they use some of the techniques they employed in ’08? Yes. Did they know that you had to go in big and you had to go in heavy and hard and quickly? Yes. And they have done so on an even more gigantic scale than in ’08, which is a lesson learned in ’08, too: There’s no such a thing as too big. And furthermore, the banks, which were the fragile bit in ’08, have basically been sidelined.

You’ve written that the response to the 2008 crisis worked to “undermine democracy.” How so, and could we see that again with this crisis?

The urgency that any financial crisis produces forces governments’ hands—it strips the legislature, the ordinary processes of democratic deliberation. When you’re forced to make very dramatic, very rapid decisions—particularly in a country as chronically divided as the U.S. is on so many issues—the risk that you create opportunities for demagogues of various types to take advantage of is huge. We know what the response of the Tea Party was to the ’08, ’09 economic crisis. They created an extraordinarily distorted vision of what had happened and then rode that to see extraordinary influence over the Republican party in the years that followed. And there is every reason to think that we might be faced with similar stresses in the American political system in months to come.

The U.S. economic system is bad enough in a regular crisis. In one like this, where you shut the entire economy down in a matter of weeks, the damage is barely conceivable.

How should we be rethinking the economy to buffer against meltdowns like this in the future?

We clearly need to have a far more adequate and substantial medical capacity. There’s no alternative to a comprehensive publicly backstopped or funded health insurance system. Insofar as you haven’t got that, your capacity to guarantee the security in the most basic and elementary sense of your population is not there. When you have a system in which one of the immediate side effects, in a crisis like this, is that large parts of your hospital system go bankrupt—one of the threats to the American medical system right now—that points to something extraordinarily wrong, especially if you’re spending close to 18 percent of GDP on health, more than any other society on the planet.

What about the unemployment insurance system?

America needs to have a comprehensive unemployment insurance system. It can be graded by local wage rates and everything else. But the idea that you have the extraordinary disparities that we have between a Florida and a Georgia at one end, with recipiency rates in the 11, 12, 13, 14, 15 percent, and then states which actually operate an insurance system, which deserve the name—this shouldn’t be accepted in a country like the U.S. We would need to look at how short-time working models might be a far better way of dealing with shocks of this kind, essentially saying that there is a public interest in the continuity of employment relationships. The employer should be investing in their staff and should not be indifferent as to who shows up for work on any given day.

What does this pandemic teach us about living in a global economy?

There are a series of very hard lessons in the recent history of globalization into which the corona shock fits—about the peculiar inability of American society, American politics, and the American labor market to cushion shocks that come from the outside in a way which moderates the risk and the damage to the most vulnerable people. If you look at the impact of globalization on manufacturing, industry, inequality, the urban fabric in the U.S., it’s far more severe than in other societies, which have basically been subject to the same shock. That really needs to raise questions about how the American labor market and welfare system work, because they are failing tens of millions of people in this society.

You write in Crashed not just about the 2008 crisis, but also about the decade afterward. What is the next decade going to look like, given this meltdown?

I have never felt less certain in even thinking about that kind of question. At this point, can either you or I confidently predict what we’re going to be doing this summer or this autumn? I don’t know whether my university is resuming normal service in the fall. I don’t know whether my daughter goes back to school. I don’t know when my wife’s business in travel and tourism resumes. That is unprecedented. It’s very difficult against that backdrop to think out over a 10-year time horizon. Presumably by next year something like normality returns. But forever after we’ll live under the shadow of this having happened. Every year we’re going to be anxiously worrying about whether flu season is going to be flu season like normal or flu season like this. That is itself something to be reckoned with.

How will anxiety and uncertainty about a future pandemic-like crisis affect the economy?

When we do not know what the future holds to this extent, it makes it very difficult for people to make bold, long-term financial decisions. This previously wasn’t part of the repertoire of what the financial analysts call tail risk. Not seriously. My sister works in the U.K. government, and they compile a list every quarter of the top five things that could blow your departmental business up. Every year pandemics are in the top three. But no one ever acted on it. It’s not like terrorism. In Britain, you have a state apparatus which is geared to address the terrorism risk because it’s very real—it’s struck many times. Now all of a sudden we have to take the possibility of pandemics that seriously. And their consequences are far more drastic. How do we know what our incomes are going to be? A very large part of American society is not going to be able to answer that question for some time to come. And that will shake consumer confidence. It will likely increase the savings rate. It’s quite likely to reduce the desire to invest in a large part of the U.S. economy.

Max Kutner is a journalist in New York City. He has written for Newsweek, The Boston Globe, and Smithsonian. Follow him on Twitter @maxkutner.

Lead image: Straight 8 Photography / Shutterstock

Cosby's representative claims that the sex offender qualifies for early release due to his vulnerability to the illness

'If you are less scared because this is mostly killing disabled people then shame on you,' said Bafta-winning writer

'My blood could save a life, but instead it's over here boiling'