The Fed’s independence helped it save the US economy in 2008 – the CDC needs the same authority today

https://theconversation.com/the-feds-independence-helped-it-save-the-us-economy-in-2008-the-cdc-needs-the-same-authority-today-142593

Centers for Disease Control and Prevention

The image of scientists standing beside governors, mayors or the president has become common during the pandemic. Even the most cynical politician knows this public health emergency cannot be properly addressed without relying on the scientific knowledge possessed by these experts.

Yet, ultimately, U.S. government health experts have limited power. They work at the discretion of the White House, leaving their guidance subject to the whims of politicians and them less able to take urgent action to contain the pandemic.

The Centers for Disease Control and Prevention has issued guidelines only to later revise them after the White House intervened. The administration has also undermined its top infectious disease expert, Dr. Anthony Fauci, over his blunt warnings that the pandemic is getting worse – a view that contradicts White House talking points.

And most recently, the White House stripped the CDC of control of coronavirus data, alarming health experts who fear it will be politicized or withheld.

In the realm of monetary policy, however, there is an agency with experts trusted to make decisions on their own in the best interests of the U.S. economy: the Federal Reserve. As I describe in my recent book, “Stewards of the Market,” the Fed’s independence allowed it to take politically risky actions that helped rescue the economy during the financial crisis of 2008.

That’s why I believe we should give the CDC the same type of authority as the Fed so that it can effectively guide the public through health emergencies without fear of running afoul of politicians.

 

The paradox of expertise

There is a paradox inherent in the relationship between political leaders and technical experts in government.

Experts have the training and skill to apply scientific knowledge in complex biological and economic systems, yet democratically elected political leaders may overrule or ignore their advice for ill or good.

This happened in May when the CDC, the federal agency charged with controlling the spread of disease, removed advice regarding the dangers of singing in church choirs from its website. It did not do so because of new evidence. Rather, it was because of political pressure from the White House to water down the guidance for religious groups.

Similarly, the White House undermined the CDC’s guidance on school reopenings and has pressured it to revise them. So far, it seems the CDC has rebuffed the request.

The ability of elected leaders to ignore scientists – or the scientists’ acquiescence to policies they believe are detrimental to public welfare – is facilitated by many politicians’ penchant for confident assertion of knowledge and the scientist’s trained reluctance to do so.

Compare Fauci’s repeated comment that “there is much we don’t know about the virus” with President Donald Trump’s confident assertion that “we have it totally under control.”

 

Experts with independence

Given these constraints on technical expertise, the performance of the Fed in the financial crisis of 2008 offers an informative example that may be usefully applied to the CDC today.

The Federal Reserve is not an executive agency under the president, though it is chartered and overseen by Congress. It was created in 1913 to provide economic stability, and its powers have expanded to guard against both depression and crippling inflation.

At its founding, the structure of the Fed was a political compromise designed make it independent within the government in order to de-politicize its economic policy decisions. Today its decisions are made by a seven-member board of governors and a 12-member Federal Open Market Committee. The members, almost all Ph.D. economists, have had careers in academia, business and government. They come together to analyze economic data, develop a common understanding of what they believe is happening and create policy that matches their shared analysisThis group policymaking is optimal when circumstances are highly uncertain, such as in 2008 when the global financial system was melting down.

The Fed was the lead actor in preventing the system’s collapse and spent several trillion dollars buying risky financial assets and lending to foreign central banks – decisions that were pivotal in calming financial markets but would have been much harder or may not have happened at all without its independent authority.

The Fed’s independence is sufficiently ingrained in our political culture that its chair can have a running disagreement with the president yet keep his job and authority.

 

Putting experts at the wheel

A health crisis needs trusted experts to guide decision-making no less than an economic one does. This suggests the CDC or some re-imagined version of it should be made into an independent agency.

Like the Fed, the CDC is run by technical experts who are often among the best minds in their fields. Like the Fed, the CDC is responsible for both analysis and crisis response. Like the Fed, the domain of the CDC is prone to politicization that may interfere with rational response. And like the Fed, the CDC is responsible for decisions that affect fundamental aspects of the quality of life in the United States.

Were the CDC independent right now, we would likely see a centralized crisis management effort that relies on the best science, as opposed to the current patchwork approach that has failed to contain the outbreak nationally. We would also likely see stronger and consistent recommendations on masks, social distancing and the safest way to reopen the economy and schools.

Independence will not eliminate the paradox of technical expertise in government. The Fed itself has at times succumbed to political pressure. And Trump would likely try to undermine an independent CDC’s legitimacy if its policies conflicted with his political agenda – as he has tried to do with the central bank.

But independence provides a strong shield that would make it much more likely that when political calculations are at odds with science, science wins.

 

 

 

 

Making coronavirus testing easy, accurate and fast is critical to ending the pandemic – the US response is falling far short

https://theconversation.com/making-coronavirus-testing-easy-accurate-and-fast-is-critical-to-ending-the-pandemic-the-us-response-is-falling-far-short-142366

Making coronavirus testing easy, accurate and fast is critical to ...

For many people in the U.S., getting tested for COVID-19 is a struggle. In Arizona, testing sites have seen lines of hundreds of cars stretching over a mile. In Texas and Florida, some people were waiting for five hours for free testing.

The inconvenience of these long waits alone discourages many people from getting tested. With the surge in cases, many public testing sites have been reaching maximum capacity within hours of opening, leaving many people unable to get tested for days. Those that do get tested often face a week-long wait to get their test results.

Every person who isn’t tested could be spreading COVID-19 unknowingly. These overstretched testing programs are a weak link in the U.S. pandemic response.

study public health policy to combat infectious disease epidemics. The key to overcoming this pandemic is to slow transmission of the virus by preventing contagious people from infecting others. A widespread quarantine would accomplish this, but is economically and socially burdensome. Testing offers a way to identify contagious people so they can be isolated to prevent the spread of the disease. This is especially important for COVID-19 because an estimated 40% or more of all people infected with SARS-CoV-2 have few or no symptoms so testing is the only way to identify them.

Some states are doing much better than others. But as a whole, the U.S. is falling far short of the amount of testing needed to control the pandemic. What are the challenges the U.S. is facing? And what is the way forward?

Testing should be free, easy, fast and accurate

The ultimate goal of testing is for everyone, regardless of symptoms, to know at all times whether they are infected with the coronavirus. To achieve this level of testing, tests should be free, very easy to perform and provide accurate results quickly.

Ideally, free COVID-19 tests would be delivered to everyone directly. The tests would be simple to perform – like a saliva test – and would give a perfectly accurate result within minutes. Everyone could test themselves weekly or anytime they were going to be in close contact with other people.

In this ideal scenario, most, if not all, contagious people would be detected before they could spread the virus to others. And because of the rapid results, there would be no burden of quarantining between doing the test and getting the result.

Researchers are working on better-quality tests, but access is a problem of infrastructure, not science. Right now, nowhere in the U.S. comes close to meeting surging demand for testing.

One of the worst cases: Texas

The difficulty of getting a COVID-19 test varies by state, but currently, people in Texas face some of the biggest obstacles, which results in far fewer tests being done than is needed to control the pandemic.

First, Houston – which is experiencing a surge in cases – and many testing sites across the state recommend or offer testing only to people who have symptoms, were exposed to a COVID-19 case or are a member of a high-risk group.

Even people recommended for testing still face challenges. It is possible to request an appointment for a free COVID-19 test, but testing facilities can handle only so many patients a day and testing slots fill up quickly. Even if someone gets an appointment, they may face an hours-long wait at the testing site.

Finally, public health experts recommend that people who may have been exposed to COVID-19 should quarantine at home for 14 days or until they receive a negative test result. In Texas, patients are supposed to get results through an online portal in three to five days, but many labs have been taking seven to nine days to return results. These long delays mean people face a much higher burden of quarantining while waiting for results.

All of these challenges make it clear that Texas is simply not testing enough people to keep the spread of COVID-19 in check.

To gauge the success of COVID-19 testing programs, epidemiologists use a measure called test positivity. This is simply the percentage of tests that come back positive. The lower the test positivity, the better, because that means very few cases are going undetected. A high test-positivity rate is usually a sign that only the sickest people are getting tested and many cases are being missed.

The World Health Organization guidelines say that if more than 1 out of 20 COVID-19 tests comes back positive – a test positivity of more than 5% – this is an indication that a lot of cases are not diagnosed and the epidemic is not under control. 

Texas currently has a test-positivity of around 16%, which means that a lot of infected people are not getting tested and may be unknowingly spreading the disease.

One of the best cases: New Mexico

In stark contrast to Texas is New Mexico, which has one of the strongest testing programs in the U.S.

First, public health officials there encourage everyone to get tested for COVID-19 regardless of symptoms or exposure. The state has also prohibited health providers from charging patients for tests. People seeking a test have the option to walk in or to make an appointment ahead of time, whichever is more convenient.

All of this relatively good access to testing has resulted in one of the highest per capita testing rates in the country, at over 20,000 tests per 100,000 people, and test-positivity rate of around 4%. New Mexico’s testing program is diagnosing a relatively high proportion of cases despite the state experiencing a recent surge.

New Mexico still has room for improvement. Long lines, wait times and limited capacity are becoming more common as cases surge, but the foundation of a strong testing program has helped the state cope with the increase in cases.

 

The big-picture problems

The pre-pandemic infectious disease testing capabilities in the U.S. are clearly unable to meet the current demand. A nationwide response is needed, and there are three things that Congress, the federal government and local governments can do to help ensure COVID-19 tests will be easy to get, fast and accurate.

First, Congress can provide funding to stimulate the testing supply chain, scale up existing testing programs and promote innovation in test development.

Second, governments can improve the management and coordination of testing programs to more efficiently use existing resources.

And third, innovative testing methods that reduce the need for lab capacity – like paper-strip tests and pooled testing – need be approved and implemented more quickly.

Every little improvement in testing capabilities means more COVID-19 cases can be caught before the virus is transmitted. And slowing the spread of the virus is the key to overcoming the pandemic.

 

 

 

 

Test positivity rate: How this one figure explains that the US isn’t doing enough testing yet

https://theconversation.com/test-positivity-rate-how-this-one-figure-explains-that-the-us-isnt-doing-enough-testing-yet-143340

Test positivity rate: How this one figure explains that the US isn ...

The U.S. has performed more coronavirus tests than any other country in the world. Yet, at the same time, the U.S. is notably underperforming in terms of suppressing COVID-19. Confirmed cases – as well as deaths – are surging in many parts of the country. Some people have argued that the increase in cases is solely due to increased testing.

I am a statistician who studies how mathematics and statistics can be used to track diseases. The claim that the increase in cases is only caused by increases in testing is just not true. But how do public health officials know this?

Testing, confirmed cases and total cases

COVID-19 testing has two purposes. The first is to confirm a diagnosis so that medical treatment can be appropriately rendered. The second is to do surveillance for tracking and disease suppression – including finding those who may be asymptomatic or only have mild symptoms – so that individuals and public health officials can take actions to slow the spread of the virus.

At a White House briefing on July 13, the president said, “When you test, you create cases.”

The problem with this statement is that anyone who is infected with the coronavirus is, by definition, a case. Since taking a COVID-19 test does not cause a person to get coronavirus, just like taking a pregnancy test does not cause one to become pregnant, the president’s claim is false. Testing does not create cases.

However, because many COVID-19 cases are asymptomatic, many people are infected and don’t know it. What COVID-19 testing does do is identify unknown cases. And thus it does increase the number of cases that are known, or otherwise called the confirmed case count.

Finding unknown cases is good, not bad, because identifying those who are COVID-19-positive allows individuals and public health officials to take actions that slow the spread of the disease. When public health officials find cases, they can begin contract tracing. When a person finds out they are infected, they will know to quarantine.

Since the beginning of the pandemic, the U.S. has performed more total tests and more tests per capita than any other country, though as of late July the U.K., Russia and Qatar were performing more tests per capita per day. But counting the total number of tests or the tests per capita is not the right way to judge success of a testing program.

As it says on the Johns Hopkins testing comparison page, a country’s “testing program should be scaled to the size of their epidemic, not the size of the population.” Sure, the U.S. might have a big testing program, but it has a massive epidemic. The U.S. needs an equally massive testing program if health officials want to have an accurate picture of what’s really going on.

Test positivity rate

So how do public health officials know if they are doing enough testing?

Better than simply counting total number of tests, the test positivity rate is a useful measure of whether enough tests are being done. The test positivity rate is simply the fraction of tests that come back positive. It is calculated by dividing the number of positive tests by the total number of tests. Generally, a lower test positivity rate is good.

A good way to think about test positivity is to think about fishing with a net. If you catch a fish almost every time you send the net down – high test positivity – that tells you there are probably a lot of fish around that you haven’t caught – there are a lot of undetected cases. On the other hand, if you use a huge net – more testing – and only catch a fish every once in a while – low test positivity – you can be pretty sure that you’ve caught most of the fish in the area.

According to the World Health Organization, before a region can relax restrictions or begin reopening, the test positivity rate from a comprehensive testing program should be at or below 5% for at least 14 days.

There are two ways to lower a test positivity rate: either by decreasing the number of positive tests or by increasing the total number of tests. A comprehensive testing program does both. By conducting a large number of tests, most cases in the community are detected. Then, individual and government actions can be taken that contain the virus. This results in a declining number of positive tests.

Returning to the fishing metaphor, the goal of a comprehensive testing program is to use a huge net to overfish in the coronavirus lake until there are very few COVID-19 cases left. Using the test positivity rate as a measure of success helps ensure that a testing program is appropriately scaled to the size of an epidemic.

As of July 27, the U.S. as a whole had a test positivity rate of 10%. States where testing programs are robust and the virus is fairly well controlled have test positivity rates well below 5%, like Massachusetts at 2.68% and New York at 1.09%. In places like Mississippi and Arizona that are experiencing large outbreaks, test positivity rates are above 20%.

The right amount of testing

The increases in confirmed cases aren’t occurring just because there is more testing. The high test positivity rates in some locations show that the virus is in fact spreading and growing so testing needs to grow with it. I believe that if the U.S. wants to beat back this virus, one of the first things that needs to happen is to increase testing. We need to deploy larger nets to catch more fish. Yes, we’ll find more cases, but that’s the point.

 

 

 

 

Most Americans Still Aren’t Wearing Face Masks Outdoors, Poll Finds

https://www.forbes.com/sites/alisondurkee/2020/08/07/most-americans-still-arent-wearing-face-masks-outdoors-poll-finds/#16327ed43349

Why do so many Americans refuse to wear face masks? Politics is ...

TOPLINE

Even as the surging Covid-19 pandemic has inspired a broad majority of Americans to start wearing face masks indoors, the practice still remains rare outside, with a new Gallup poll finding that fewer than half of Americans wear face masks outside in non-socially distanced settings, despite many mask-wearing mandates now requiring them to do so.

KEY FACTS

While 81% of poll respondents say they always or usually wear a mask indoors when social distancing isn’t possible, only 47% say they wear a face mask outdoors when they cannot socially distance.

29% say they “always” wear a mask outdoors and 18% say they “usually” do.

The practice is more common among Democrats, with 64% saying they wear a mask outdoors as compared with 43% of Independents and only 23% of Republicans.

Midwesterners are the least likely to wear masks outside; only 37% in the Midwest region wear masks outside, versus 55% in the Northeast, 47% in the South and 49% in the West.

Research has shown that Covid-19 appears to be more easily transmitted indoors, though outdoor settings still pose some risk, and Gallup notes the poll findings “could indicate a potential for increased spread of the disease” in outdoor venues like beaches.

Many state or local mask-wearing mandates include outdoor settings where social distancing isn’t possible, and multiple areas, including New Jersey and Oregon, have also imposed additional orders specifying masks must be worn outdoors in many circumstances.

CRUCIAL QUOTE

“We know this virus is a lot less lethal outdoors than indoors, but that does not mean it is not lethal,” New Jersey Gov. Phil Murphy said in a statement about his July executive order requiring masks outdoors. “The hotspots we’re seeing across the nation and certain worrisome transmission trends in New Jersey require us to do more.”

BIG NUMBER

66,740: The number of lives that could be saved in the U.S. by December 1 if 95% of people “were to wear masks when leaving their homes,” as projected Thursday by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine. The IMHE’s model projects 295,011 deaths by December, which would drop by 49% to 228,271 with “consistent mask-wearing.”

KEY BACKGROUND

Mask wearing has become a major point of contention as Covid-19 has rapidly spread across the U.S. Though many states and localities have imposed mask-wearing mandates, the orders have been resisted by many GOP governors, including in states like Florida that have been particularly hard-hit by the virus. While President Donald Trump initially made mask-wearing a partisan debate through his refusal to don a mask, the president has shifted to promoting the practice in recent weeks, tweeting a photo of himself in a mask that called mask-wearing “patriotic” and urging supporters to wear a mask in a recent campaign email. Prominent Republicans including Senate Majority Leader Mitch McConnell have also vocally advocated for mask-wearing, with McConnell saying Thursday on CNBC that wearing a mask is “the single most significant thing everybody in the country can do to help prevent the spread.”

 

 

 

 

69% Of Americans Are Concerned That The U.S. Is Reopening Too Quickly Amid The Coronavirus Pandemic

https://www.forbes.com/sites/mattperez/2020/08/06/69-of-americans-are-concerned-that-the-us-is-reopening-too-quickly-amid-the-coronavirus-pandemic/#719b3e2523f3

69% Of Americans Are Concerned That The U.S. Is Reopening Too ...

TOPLINE

Some 69% of Americans believe that state governments have eased restrictions too soon amid the Covid-19 pandemic, as opposed to opening too slowly, according to a new Pew Research study published on Thursday, as the U.S. grapples with a still-uncontrolled outbreak of the coronavirus.

KEY FACTS

While the Trump administration pushed for states to lift stay-at-home orders throughout the spring to help the battered economy, governors are now being forced to pause or restore some restrictions after a surge in cases this summer.

Around seven-in-ten people believe the most effective way to help economic recovery is to significantly reduce infections across the country, according to the study, and while Trump continues his argument that the U.S. leads the world in cases due to an increase in testing, 60% of Americans believe it’s primarily due to more new infections.

A majority of Democrats and Republicans believe the main reason the outbreak in the U.S. has continued is due to the lack of social distancing and mask wearing, while 58% of adults surveyed believe it’s due to early lifting of restrictions.

A number of wealthy nations that experienced severe outbreaks early in the pandemic have exited their first waves and have less cases than states like California and Florida, with 62% of Americans believing the U.S. response to the coronavirus trails other affluent countries.

The survey comes as the Trump administration continues to pressure Democratic-led states to ease restrictions and demand schools reopen for in-person instruction, even threatening to withhold federal funding if they don’t.

CRUCIAL QUOTE

Dr. Anthony Fauci, the government’s lead infectious disease expert, commented on the rise of infections across the nation: “In the attempt to reopen in some situations states did not abide strictly by the guidelines that the task force and the White House has put out. And others that even did abide by it, the people in the state actually were congregating in crowds and not wearing masks.”

KEY BACKGROUND

While initial hotspots like New York and New Jersey were able to lower the infection rate throughout the spring, cases began exploding in southern and western states before the country as a whole could exit the first wave of its outbreak. Cases are now trending down after a record high of 74,818 on July 24, according to the Centers for Disease Control and Prevention, though deaths have been over 1,000 daily the past week and there are still tens of thousands of cases each day. The U.S. leads all other countries in cases with 4.87 million, as well as reported deaths with 159,864.

 

 

 

 

Fauci says family has faced threats, harassment amid pandemic

Fauci says family has faced threats, harassment amid pandemic

Fauci says family has faced threats, harassment amid pandemic ...

Dr. Anthony Fauci, the nation’s top infectious disease expert, said he and his family are getting death threats because people don’t like what he says about COVID-19.

“Getting death threats for me, and my family, and harassing my daughters, to the point where I have to get security is just — I mean, it’s amazing,” Fauci said during an interview with CNN’s Sanjay Gupta on Wednesday.

“I wouldn’t have imagined in my wildest dreams that people who object to things that are pure public health principles, are so set against it and don’t like what you and I say, namely in the world of science, that they actually threaten you.”

He noted that crises like COVID-19 has brought out the best of people but also the worst of people.

Fauci’s notoriety has been elevated by COVID-19, as he is often on TV offering a blunt portrayal of the state of the pandemic in the U.S.

Fauci, 79, is one of the world’s most respected infectious disease experts, having advised six presidents on HIV/AIDS, Ebola, Zika and other health crises. He has earned a reputation for being blunt and willing to correct the president.

Fauci has had a security detail since at least April.

Fauci also reflected on what he says is a degree of “anti-science” sentiment in the U.S. that is making it difficult to get people to do things to slow the spread of COVID-19 like wearing masks.

“There is a degree of anti-science feeling in this country, and I think it is not just related to science. It’s almost related to authority and a mistrust in authority that spills over,” he told Gupta.

“Because in some respects, scientists, because they’re trying to present data, may be looked upon as being an authoritative figure, and the pushing back on authority, the pushing back on government is the same as pushing back on science.”

He said the scientific community should be more transparent and reach out to people to underscore the importance of science and evidence-based policy.

“I know when I say that if we follow these five or six principles, we can open up we don’t have to stay shut…There are some people that just don’t believe me or don’t pay attention to that. And that’s unfortunate because that is the way out of this,” he said.

President Trump has repeatedly undermined Fauci, questioning the White House coronavirus task force member on Twitter and in interviews with the media.

Over the weekend, Trump tweeted out a video of a portion of Fauci’s testimony explaining why the U.S. has recorded more cases than European cases and called it “wrong.” Trump has falsely claimed several times that the U.S. has more cases because it is doing more testing.

Trump has also retweeted multiple messages that question Fauci’s expertise, including one last week that said he had “misled the American public.”

 

Photo of COVID-19 victim in Indonesia sparks fascination—and denial

https://www.nationalgeographic.com/photography/2020/07/covid-victim-photograph-sparks-fascination-and-denial-indonesia/?cmpid=org=ngp::mc=crm-email::src=ngp::cmp=editorial::add=SpecialEdition_20200724&rid=C1D3D2601560EDF454552B245D039020

Photo of COVID-19 victim in Indonesia sparks fascination—and denial

Coronavirus victim wrapped in plastic shows what many didn’t want the populace to see.

Photojournalist Joshua Irwandi shadowed hospital workers in Indonesia, taking a striking image of a plastic-wrapped body of a COVID-19 victim while making sure not to reveal distinguishing characteristics, or even gender.

The image, taken for Nat Geo as part of a National Geographic Society grant, struck a chord in the nation of 270 million people. Indonesia had been slow to fight the global pandemic, with President Joko “Jokowi” Widodo touting an unproven herbal remedy in March. Some of the reactions to Irwandi’s image, which humanized the suffering from the virus, have been hostile.

Irwandi’s photograph has been displayed on television news and shared by the spokesperson for the nation’s coronavirus response team. The image was widely screen-grabbed and republished without Irwandi’s consent by Indonesian media. More than 340,000 people have “liked” the image on his Instagram page, which he posted after the Nat Geo story published on July 14. More than 1 million people also liked it in its first few hours on Nat Geo’s Instagram.

“It’s clear that the power of this image has galvanized discussion about coronavirus,” Irwandi said from his home in Indonesia. “We have to recognize the sacrifice, and the risk, that the doctors and nurses are making.”

There’s no question the photograph broke through, agreed Fred Ritchin, dean emeritus of the International Center of Photography: “Here we have a mummified person. It makes you look at it, feel terror.”

At the same time, there is distance, Ritchin said. “To me, the image was of someone being thrown out, discarded, wrapped in cellophane, sprayed with disinfectant, mummified, dehumanized, othered … It makes sense in a way. People have othered people with the virus because they don’t want to be anywhere near the virus.”

After Irwandi posted the photograph, a popular singer with a massive following accused the photographer of fabricating the news, said COVID-19 wasn’t so dangerous, and opined that a photojournalist shouldn’t be allowed to take a photograph in a hospital if the family could not see the victim. The singer’s followers erroneously charged Irwandi with setting up the photo with a mannequin, and called him “a slave” of the World Health Organization. The 28-year-old photographer’s ethics were questioned by the government this week, which also suggested the name of the hospital, which was not disclosed in the photograph, should be revealed, CNN Indonesia reported.

”Details of my private life have been published without my permission,“ Irwandi said. ”We’ve gone really astray from the photojournalistic intent of my photograph.“

However, he has gotten support from the nation’s association of photojournalists. They countered that the image met journalistic standards—and demanded the singer apologize, which he subsequently did.

Irwandi says some government officials have said the nation should take COVID-19 more seriously. As of Tuesday, the Johns Hopkins University Coronavirus Tracker had reported 4,320 COVID-19 deaths and 89,869 cases from Indonesia, although the count is believed to be vastly underreported. Many people aren’t practicing social distancing, and hordes have not been wearing masks. Large-scale social restrictions began fading last month.

His hope is that the image encourages Indonesians to take precautions—and save lives. He cited a challenge to photojournalists given in May by Harvard professor Sarah Elizabeth Lewis: to move beyond statistics and show how COVID-19 is affecting people. Other photographers, such as Lynsey Addario, have been motivated to do the same thing. (Addario also has been supported by a National Geographic Society fund for COVID-19 reporting.)

So, what are Irwandi’s next steps?

He paused a moment.

“I think I’m going to stay low for a time,” he said.