vox--2020-02-19--Opening a Pandora’s box of truths about rape kits

Part of the Gender Issue of The Highlight , our home for ambitious stories that explain our world .
Aliza Shvarts first became fascinated with rape kits a decade ago as a graduate student at New York University .
In her research , Shvarts focused heavily on speech act theory — a field that looks at the way words can be used to create realities , altering the world around us through speech .
She was also watching a lot of Law & Order : Special Victims Unit , and her professional studies began bleeding into the way she consumed @ @ @ @ @ @ @ ’ s most common tropes centered on the rape kit .
Without one , survivors would find themselves vilified and disbelieved .
But once their kits had been collected and processed , they had power and credibility , ultimately winning their cases .
“ The thing that makes you matter all of a sudden is the empirical object that corroborates your testimony , ” says Shvarts .
The idea of a concrete object that could render the truth unimpeachable was deeply appealing , particularly when it came to a disputed and seemingly unknowable @ @ @ @ @ @ @ kits — known alternately as sexual assault forensic exam ( SAFE ) kits , sexual offense evidence collection kits , physical evidence recovery kits , sexual assault kits , and sexual assault evidence collection kits — loom large in the public imagination .
On procedural shows such as Law & Order : SVU , they ’ re often presented as the difference between a rapist ’ s conviction or acquittal .
In the real world , rape kits also highlight how our criminal justice system routinely fails survivors .
Advocates frequently use the @ @ @ @ @ @ @ s estimated that hundreds of thousands of kits go unprocessed and untested after they ’ ve been collected — as an entry point for exploring the low priority that sexual assault cases are given by law enforcement , as well as the stress and trauma of reporting a sexual assault .
Kits are often the only physical evidence a survivor can present in court , but they ’ re frequently lost in the system ; because many states don ’ t require them to be logged or tracked , it ’ s both @ @ @ @ @ @ @ impossible to know precisely how many untested kits there are .
And yet for all our conviction that rape kits are the key to justice for sexual assault survivors , most of us do not know what these kits contain , or even what purpose they serve in the criminal justice process .
Despite her obsession with the role rape kits played on Law & Order , “ I didn ’ t really know what they looked like , ” says Shvarts .
Determined to demystify them , Shvarts purchased a few from @ @ @ @ @ @ @ she had one in her hands , she was surprised to find not some high-tech forensic device but a simple cardboard box full of paper envelopes and instruments for collecting debris , skin cells , hair samples , clothing , and other items used by forensic examiners to document evidence of an assault and potentially identify a perpetrator through DNA evidence .
The SAFE kit began to seem less like unassailable proof and more like one more way of taking control away from survivors .
“ Certainly [ the kit ] does a @ @ @ @ @ @ @ collecting physical evidence , ” says Shvarts .
But at the same time , she says , there ’ s a crucial piece of evidence that can not be documented through a rape kit examination .
“ A rape kit can never discover the presence or absence of consent .
That ’ s something only the survivor can really testify to.
” Even at a passing glance , Anthem makes clear that not all rape kits are created equal .
That a rape kit could somehow reveal a nonconsensual experience is rooted in @ @ @ @ @ @ @ Consensual sex can leave injuries , ” says Maggie von Dolteren , a victim ’ s advocate at West Virginia ’ s Rape and Domestic Violence Information Center .
“ And the injuries that are associated with sexual assault are just not as violent as some people expect them to be.
” As helpful as rape kits can be in reconstructing the details of an assault , the key factor that distinguishes sexual assault from consensual sex can ’ t be documented by swabs , slides , or photographs of bruises .
Shvarts @ @ @ @ @ @ @ , incorporating the kits into her performance pieces , and , as her work evolved , eventually treating the kits as a form of sculpture .
In 2018 , Shvarts exhibited all the kits that were publicly available for purchase in a piece called Box Choreographies , inviting viewers to examine the range of ways a SAFE kit could be constructed — to understand the kits not as a fixed authority , but as inconsistent , works in progress , still being refined .
Soon , Shvarts began reaching out to various state @ @ @ @ @ @ @ .
If the six kits included in Box Choreographies already showcased a diverse range of shapes , sizes , and procedures , what would dozens of them , displayed side by side , show the world about how we talk about rape ?
Last January , Shvarts debuted a new work at SculptureCenter , a museum in Long Island City , Queens .
The artwork , Anthem , invited viewers to make their way down a long , concrete hallway , its arched ceiling lending the scene a somewhat Gothic effect .
On @ @ @ @ @ @ @ boxes and envelopes , recreations of the dozens of rape kits that Shvarts had collected from forensic examiners , sexual assault nurse examiners , and other sexual assault response experts from across the country , displayed in alphabetical order by state .
Shvarts didn ’ t manage to secure kits from all 50 states .
In the original version of Anthem , 28 states were represented .
( Since Anthem ’ s debut at SculptureCenter , Shvarts has received kits from Delaware and North Dakota , which are being added to the collection @ @ @ @ @ @ @ Art in General in Brooklyn . )
Even at a passing glance , Anthem makes clear that not all rape kits are created equal .
The boxes come in a wide variety of sizes ; in some cases , they ’ re not boxes at all , but oversized paper envelopes .
Glancing inside the kits reveals more differences .
In some states , examiners only have seven steps to go through ; in others , there are more than 20 separate tasks on the checklist .
The language states use to direct @ @ @ @ @ @ @ themselves to medical or legal language , others are more colloquial in their terminology .
In Florida , examiners collect underwear , while in Washington , they request a survivor ’ s underpants ; in Louisiana , panties .
The Virginia kit lists various sexual acts on the evidence collection envelopes , distinguishing between swabs that collect evidence of forced cunnilingus and those that indicate forced anal penetration ( or , as the kit refers to it , buggery ) .
Anthem ’ s viewers see not just the stark differences between kits @ @ @ @ @ @ @ may have at the emergency department .
These kits reflect the piecemeal way the country understands and addresses sexual assault — and how far we are from a national consensus on how to respond to rape .
“ A lot of visitors were looking at kits from states that they had been to or had lived in , trying to see whether their sense of that state ’ s awareness of the gravity and importance of addressing sexual assault was reflected in the [ kit ’ s design ] , ” says Gee @ @ @ @ @ @ @ SculptureCenter who worked with Shvarts on the project ’ s debut .
In many instances , Wesley says , visitors left Anthem more “ attuned to the unevenness of access ” to quality care for survivors .
Shvarts hopes audiences will also develop a deeper understanding of the fundamental limitations of these kits — that they ’ re simply one more imperfect way to help a survivor make their case .
Anthem isn ’ t the only way Shvarts is reassessing rape kits .
This spring , a follow-up project titled Anatomy will @ @ @ @ @ @ @ .
Where Anthem offers a broad and comprehensive view of SAFE kit variation , Anatomy hones in on one specific aspect of the kits : the diagrams provided to examiners to document the locations of injuries .
Though they ostensibly represent a universal body , more often than not they read as white , cis , and female .
“ If you are a black trans woman , and a nurse is trying to diagram your injuries , one of these diagrams would not allow for an accurate representation of your assault , @ @ @ @ @ @ @ kit is meant to embody the voice of a survivor ; it ’ s meant to speak on your behalf , ” Shvarts says .
Through her work , Shvarts highlights what a complicated , and perhaps impossible , mission that truly is .
She hopes more of us will begin to question why we put more faith in a small cardboard box full of envelopes , swabs , and DNA than we do in the testimony of a person .
Anthem can be viewed at Art in General ( 145 Plymouth St @ @ @ @ @ @ @ 9 .
Anatomy can be viewed at The 8th Floor ( 17 W 17th St , New York , NY ) April 16–July .
Lux Alptraum ’ s writing has been featured in publications including the New York Times , New York magazine , Wired , Cosmopolitan , and Hustler .
Her first book , Faking It : The Lies Women Tell About Sex — And the Truths They Reveal , explores our cultural obsession with feminine deceit .

Part of the Gender Issue of The Highlight, our home for ambitious stories that explain our world.
Aliza Shvarts first became fascinated with rape kits a decade ago as a graduate student at New York University. In her research, Shvarts focused heavily on speech act theory — a field that looks at the way words can be used to create realities, altering the world around us through speech. She was also watching a lot of Law & Order: Special Victims Unit, and her professional studies began bleeding into the way she consumed the show.
One of the show’s most common tropes centered on the rape kit. Without one, survivors would find themselves vilified and disbelieved. But once their kits had been collected and processed, they had power and credibility, ultimately winning their cases.
“The thing that makes you matter all of a sudden is the empirical object that corroborates your testimony,” says Shvarts. The idea of a concrete object that could render the truth unimpeachable was deeply appealing, particularly when it came to a disputed and seemingly unknowable subject such as sexual assault.
Rape kits — known alternately as sexual assault forensic exam (SAFE) kits, sexual offense evidence collection kits, physical evidence recovery kits, sexual assault kits, and sexual assault evidence collection kits — loom large in the public imagination.
On procedural shows such as Law & Order: SVU, they’re often presented as the difference between a rapist’s conviction or acquittal.
In the real world, rape kits also highlight how our criminal justice system routinely fails survivors. Advocates frequently use the rape kit testing backlog — it’s estimated that hundreds of thousands of kits go unprocessed and untested after they’ve been collected — as an entry point for exploring the low priority that sexual assault cases are given by law enforcement, as well as the stress and trauma of reporting a sexual assault. Kits are often the only physical evidence a survivor can present in court, but they’re frequently lost in the system; because many states don’t require them to be logged or tracked, it’s both easy for kits to be misplaced and impossible to know precisely how many untested kits there are.
And yet for all our conviction that rape kits are the key to justice for sexual assault survivors, most of us do not know what these kits contain, or even what purpose they serve in the criminal justice process. Despite her obsession with the role rape kits played on Law & Order, “I didn’t really know what they looked like,” says Shvarts.
Determined to demystify them, Shvarts purchased a few from websites selling SAFE kits. But once she had one in her hands, she was surprised to find not some high-tech forensic device but a simple cardboard box full of paper envelopes and instruments for collecting debris, skin cells, hair samples, clothing, and other items used by forensic examiners to document evidence of an assault and potentially identify a perpetrator through DNA evidence.
The SAFE kit began to seem less like unassailable proof and more like one more way of taking control away from survivors.
“Certainly [the kit] does a lot of important work in terms of collecting physical evidence,” says Shvarts. But at the same time, she says, there’s a crucial piece of evidence that cannot be documented through a rape kit examination. “A rape kit can never discover the presence or absence of consent. That’s something only the survivor can really testify to.”
Even at a passing glance, Anthem makes clear that not all rape kits are created equal.
That a rape kit could somehow reveal a nonconsensual experience is rooted in some persistent myths about rape. “Consensual sex can leave injuries,” says Maggie von Dolteren, a victim’s advocate at West Virginia’s Rape and Domestic Violence Information Center. “And the injuries that are associated with sexual assault are just not as violent as some people expect them to be.”
As helpful as rape kits can be in reconstructing the details of an assault, the key factor that distinguishes sexual assault from consensual sex can’t be documented by swabs, slides, or photographs of bruises.
Shvarts began exploring this tension in her artwork, incorporating the kits into her performance pieces, and, as her work evolved, eventually treating the kits as a form of sculpture. In 2018, Shvarts exhibited all the kits that were publicly available for purchase in a piece called Box Choreographies, inviting viewers to examine the range of ways a SAFE kit could be constructed — to understand the kits not as a fixed authority, but as inconsistent, works in progress, still being refined.
Soon, Shvarts began reaching out to various state agencies to request samples of their kits. If the six kits included in Box Choreographies already showcased a diverse range of shapes, sizes, and procedures, what would dozens of them, displayed side by side, show the world about how we talk about rape?
Last January, Shvarts debuted a new work at SculptureCenter, a museum in Long Island City, Queens. The artwork, Anthem, invited viewers to make their way down a long, concrete hallway, its arched ceiling lending the scene a somewhat Gothic effect. On the walls of the hallway were small boxes and envelopes, recreations of the dozens of rape kits that Shvarts had collected from forensic examiners, sexual assault nurse examiners, and other sexual assault response experts from across the country, displayed in alphabetical order by state.
Shvarts didn’t manage to secure kits from all 50 states. In the original version of Anthem, 28 states were represented. (Since Anthem’s debut at SculptureCenter, Shvarts has received kits from Delaware and North Dakota, which are being added to the collection for its next showing this February at Art in General in Brooklyn.)
Even at a passing glance, Anthem makes clear that not all rape kits are created equal. The boxes come in a wide variety of sizes; in some cases, they’re not boxes at all, but oversized paper envelopes. Glancing inside the kits reveals more differences. In some states, examiners only have seven steps to go through; in others, there are more than 20 separate tasks on the checklist.
The language states use to direct examiners also varies widely. Some limit themselves to medical or legal language, others are more colloquial in their terminology. In Florida, examiners collect underwear, while in Washington, they request a survivor’s underpants; in Louisiana, panties. The Virginia kit lists various sexual acts on the evidence collection envelopes, distinguishing between swabs that collect evidence of forced cunnilingus and those that indicate forced anal penetration (or, as the kit refers to it, buggery).
Anthem’s viewers see not just the stark differences between kits and the broad range of experiences survivors may have at the emergency department. These kits reflect the piecemeal way the country understands and addresses sexual assault — and how far we are from a national consensus on how to respond to rape.
“A lot of visitors were looking at kits from states that they had been to or had lived in, trying to see whether their sense of that state’s awareness of the gravity and importance of addressing sexual assault was reflected in the [kit’s design],” says Gee Wesley, a former curatorial fellow at SculptureCenter who worked with Shvarts on the project’s debut. In many instances, Wesley says, visitors left Anthem more “attuned to the unevenness of access” to quality care for survivors.
Shvarts hopes audiences will also develop a deeper understanding of the fundamental limitations of these kits — that they’re simply one more imperfect way to help a survivor make their case.
Anthem isn’t the only way Shvarts is reassessing rape kits. This spring, a follow-up project titled Anatomy will debut at the 8th Floor in Manhattan. Where Anthem offers a broad and comprehensive view of SAFE kit variation, Anatomy hones in on one specific aspect of the kits: the diagrams provided to examiners to document the locations of injuries. Though they ostensibly represent a universal body, more often than not they read as white, cis, and female. “If you are a black trans woman, and a nurse is trying to diagram your injuries, one of these diagrams would not allow for an accurate representation of your assault,” Shvarts says.
“A rape kit is meant to embody the voice of a survivor; it’s meant to speak on your behalf,” Shvarts says. Through her work, Shvarts highlights what a complicated, and perhaps impossible, mission that truly is. She hopes more of us will begin to question why we put more faith in a small cardboard box full of envelopes, swabs, and DNA than we do in the testimony of a person.
Anthem can be viewed at Art in General (145 Plymouth St, Brooklyn, NY) February 21–May 9. Anatomy can be viewed at The 8th Floor (17 W 17th St, New York, NY) April 16–July.
Lux Alptraum’s writing has been featured in publications including the New York Times, New York magazine, Wired, Cosmopolitan, and Hustler. Her first book, Faking It: The Lies Women Tell About Sex — And the Truths They Reveal, explores our cultural obsession with feminine deceit.


vox--2020-02-19--Life in between: Nonbinary adults, in portrait

Part of the Gender Issue of The Highlight , our home for ambitious stories that explain our world .
Bobbi Ullinger was browsing an online support group when she first saw the word bi-gendered .
“ It was like the lightbulbs went on , the choir of angels was singing , and the light was shining down on me , ” said Ullinger , 64 .
“ And that was really the first inkling that I had of the gender spectrum , that you didn ’ t have to be one or the other .
You can be both or @ @ @ @ @ @ @ in visibility for people who identify as nonbinary , meaning their gender is neither male nor female but somewhere in between , fluid , both , or neither .
Thirteen states now offer a nonbinary gender option for driver ’ s licenses , and stars such as singers Sam Smith and Janelle Monáe and Queer Eye ’ s Jonathan Van Ness have come out as nonbinary or gender-fluid in recent months .
They/them pronouns have entered the national conversation , and the dictionary .
Much of the focus from lawmakers and the media @ @ @ @ @ @ @ into a neat gender box has centered on young people , in part because today ’ s youth are simply more likely to know somebody who uses gender-neutral pronouns — 35 percent of 13- to 21-year-olds , compared with 16 percent of Gen Xers and 12 percent of boomers , according to a 2018 Pew study .
Left out of the conversation is how older nonbinary people , many with already established lives , are navigating an increasingly accepting world .
Photographer Annie Tritt traveled across the country to explore the lives of @ @ @ @ @ @ @ mentioned finally having the words to describe their experience .
Others expressed sadness over the years or sometimes decades spent hiding a part of themselves .
“ If I had discovered this freedom and clarity in my 20s , or if I was 20-something now , I would have a completely different outlook , ” said TL Thompson , 42 .
“ This young generation of queers were socialized very early in their development [ to understand ] that they could be whatever they wanted to be.
” For the adults interviewed for @ @ @ @ @ @ @ later in life added complications to their established careers and relationships with partners , children , and their communities .
Yet the stories that emerged were ultimately about resilience and love .
I can remember when I was little , really little , I would go to bed at night and say a prayer that I would wake up as a girl in the morning , and when I woke up in the morning , I ’ d be very disappointed that I wasn ’ t a girl .
But there were also @ @ @ @ @ @ @ my prayer was not answered , because I still wanted to be a boy , too .
I went through cycles where I would sneak into my mom ’ s closet .
I would feel good dressing in her clothes , and then I would feel very ashamed and swear that I was never going to do it again .
That went on for years — for most of my life .
Even up until the time that we [ Bobbi and her wife , Cathy ] were married .
In the early @ @ @ @ @ @ @ just bulletin boards .
Doing any kind of rudimentary search with the terms that I knew — cross-dresser or transvestite , transexual — even after the internet started to come around , all you would get was page after page of pornography .
I knew that wasn ’ t me , and that put me further in the closet .
And then came the movie The Silence of the Lambs .
It was about a guy who ’ s transgender , but the way he expresses himself is by killing women , skinning @ @ @ @ @ @ @ to make his own .
And all I could think of is , this is what people think that I am .
If I ever get caught , that ’ s what they think I ’ m going to be : a monster , a freak .
That put me in total denial .
It wasn ’ t until I was in my mid-40s that I finally found a website called GRITS , which is an acronym for Girls Raised in the South .
On there were stories of people , stories that @ @ @ @ @ @ @ And that was really the first time that I knew I wasn ’ t the only person like this in the world , that I was not some terrible freak .
From that website , I found another called Gender Tree , run by a trans woman named Sandra Stewart , and she was at the time in seminary .
And she would take these verses that Christians used to clobber us over the head and tell us we ’ re going to go to hell , she would break these Scriptures down @ @ @ @ @ @ @ mean what they were being used for .
That was my first inkling that maybe this is okay with God , that I ’ m not going to be condemned to hell .
So I ended up making a deal with God : This was okay to do , as long as it didn ’ t interfere with my relationship with my wife , Cathy , and my family , and with God .
And like most of those kinds of deals with God , it lasted about six months or so before @ @ @ @ @ @ @ this thing from her .
The first thing [ my wife ] said [ when I told her ] was , if this has been going on for that long , then it ’ s obvious it ’ s not going to stop .
So let ’ s figure out how to work through it .
We had been married for 30 years .
I originally identified as a cross-dresser .
It was in an online support group for other cross-dressers that somebody used the word bi-gendered .
And it was like the @ @ @ @ @ @ @ angels was singing , and the light was shining down on me .
That ’ s what I am .
I feel both masculine and feminine .
That was really the first inkling that I had of the gender spectrum , that you didn ’ t have to be one or the other .
You can be both or neither .
When I ’ m talking to a group of people , that ’ s how I identify myself : “ I ’ m Bobbi , and my preferred pronouns at this point @ @ @ @ @ @ @ s because right now I am presenting as Bobbi 99 percent of the time .
But for a long time — and I still am comfortable presenting in the middle — for my preferred pronouns , I had two asterisks and would say , it ’ s contextual .
If I ’ m presenting masculine , he/him ; if I ’ m presenting feminine , she/her ; if I ’ m presenting in between , they/them .
As far as being gender-fluid , I still have those shifts , and I have no @ @ @ @ @ @ @ just kind of pop up no matter how I ’ m presenting or the circumstances that I ’ m in .
And I guess the best way that I can describe it is like a mental itching powder .
It can really throw me off balance ; it catches me by surprise .
One time in particular was really very awkward .
I was dressed to the nines .
Cathy and I were going to a small cabaret-style theater up in Cleveland .
We walked in , got a glass of wine , @ @ @ @ @ @ @ sudden I ’ m feeling very , very macho and very masculine .
I had a hard time really enjoying the play , because that was preoccupying my mind .
There have been other times when I have been doing very manly , macho work and all of a sudden felt very demure and very feminine .
I ’ ve gotten better at being able to focus through that .
And that ’ s kind of how I work my way through it — just really focusing on what I ’ m doing @ @ @ @ @ @ @ my aunt to get perms , or she would straighten my hair on the stove with an iron .
She was really invested in making me the woman that she had grown up to be .
This is what you do with your daughter , she probably thought .
And I was just like , I love you , Mom , but I can ’ t .
So at 11 or 12 , I shaved my head .
I was a little fearless and reckless in weird ways .
I loved Dirty Dancing @ @ @ @ @ @ @ I would act it out in my room .
I was like , “ Oh , my God , I can do that .
I can act like I would want my life to be onstage in front of people .
This is amazing .
And you ’ ll pay me ?
” My mind was blown .
I come with a socialized female experience , and I think the combination of that experience , and the way that I look , and — people have said this to me before — the @ @ @ @ @ @ @ interesting thing to watch .
As an actor , I ’ ve done roles where I ’ m wearing heels and a dress , and I ’ m a water nymph , and it ’ s like , yes , this feels right .
I just did this web series called These Thems , and I play a DJ named TI , and they ’ re this smooth , nonbinary person that loves love and loves sex and is poly .
And that feels good , too .
That feels right , that @ @ @ @ @ @ @ more specifically nonbinary roles now , the roles that I have traditionally gone for , the call sheet said female .
I can play a small guy , maybe a scrappy guy , maybe the mischievous one .
But I ’ m not going to be the leading football player dude .
I ’ m never going to be that guy .
Men have a really hard time placing value on what trans masculine and nonbinary people are .
They can ’ t get things from us that they would normally want from @ @ @ @ @ @ @ is less than — it ’ s less than male , it ’ s less than female .
So of course we ’ re not in media .
Of course no one ’ s writing roles for us .
If I had discovered this freedom and clarity [ to be nonbinary ] in my 20s , or if I was 20-something now , I would have a completely different outlook .
This young generation of queers were socialized very early in their development [ to understand ] that they could be whatever they @ @ @ @ @ @ @ not .
I was at the end of the generation that had to work very hard to even be acknowledged as queer or nonbinary .
In my day , you were butch or you were femme .
There wasn ’ t even language in the mainstream that gave voice to the nuances in sexuality .
I come from the generation of trans performers that had to pick a gender where roles were concerned .
I believe that the arts are a way to make social change .
There ’ s so much beauty @ @ @ @ @ @ @ so much joy in a song .
So much activism in theater .
It ’ s always been that way .
From the time we could tell stories , that ’ s the way that we change .
And I think that ’ s absolutely why I ’ m an artist .
That ’ s how you change the world , baby !
I didn ’ t know I was a girl until the age of 5 , when I went to kindergarten .
My parents never , for whatever reason , had @ @ @ @ @ @ @ gender or my sexual choices .
I don ’ t have one of those sad stories of being judged and oppressed .
I grew up in a great family that allowed me to live my life like me .
When I was 54 , I guess I came out in a different way .
Because I found out then that my grandmother was Seminole Indian , and that ’ s why she used to call me “ two-spirit.
” At the time , I thought she meant I ’ m a Gemini .
@ @ @ @ @ @ @ Easter , they used to always have a party and all the little girls would be dressed in little bonnets .
I was always playing with the little pigs [ at their house ] .
My aunt used to say it ’ s disgusting , but my grandmother used to always say , you just need to leave that child alone .
She ’ s two-spirit , and she ’ s going to do well .
I grew up in a little tiny town , with only , like , 12 kindergartners .
@ @ @ @ @ @ @ phys-ed .
The teacher said , “ We ’ re going to play dodgeball , ” so all the little boys lined up over here and all the little girls lined up over there .
It was the most defining moment in my entire life .
I ran over to where all the little boys were .
I ’ ll never forget it : The teacher walked over to me , grabbed me by the arm , and said , “ Kathy , you ’ re over here.
” And she took me @ @ @ @ @ @ @ girls .
And I thought , these are not my people .
They called my dad to come to the school .
When I went to the principal ’ s office , my dad was sitting there , his arms crossed .
The principal said to my dad , we have a situation with your daughter .
She refuses to play with the little girls .
She ’ s always with the little boys .
I ’ m going to have to request that tomorrow , and from then on , your daughter @ @ @ @ @ @ @ , which is dresses down to knee length .
My dad stood up — I ’ ll never forget it — and just said , “ Come on , we ’ re going home.
” He looked at the principal and goes , “ That ’ s not likely to happen.
” And I never wore a dress to school again .
In a small town like that , where everybody knows everything , nobody wants a hassle .
I really wasn ’ t judged much until I had my breasts removed [ @ @ @ @ @ @ @ community tried to put pressure on me to make a decision about changing my gender , taking testosterone , and declaring who I was .
I didn ’ t have much relationship with the community before surgery , except for a few trans friends .
After surgery , there was a lot of pressure from certain patients to declare my gender and also about my non-use of testosterone .
I think using they/them pronouns is still really hard for people .
Using they/them doesn ’ t make any sense to country folks .
@ @ @ @ @ @ @ .
But you ’ re in New York ?
Okay , well , that ’ s completely different .
I think that acting somewhere in between a man and a woman , it ’ s still just inconceivable for more than 50 percent of the populace .
It doesn ’ t make sense to them .
For law school , I started out at CUNY , then transferred to the University of Pennsylvania .
About 30 percent of the time , I was wearing dresses and skirts .
At CUNY , people were @ @ @ @ @ @ @ supportive , almost a little bit oppressive .
And then at Penn , there was a small group of people who were really supportive in a cool way and then everybody else was just civil .
Once I graduated and worked at a law firm , I would trot out my dresses every now and then , but it became less and less .
I put them in the back of my closet .
I went to some interviews wearing a professional skirt and jacket , and I didn ’ t get any @ @ @ @ @ @ @ or maybe it was just my own awareness , but I really shied away from [ wearing dresses ] throughout much of my career .
Then , five years ago , I started reintroducing women ’ s clothes into my wardrobe .
It was maybe about two and a half years ago when I started wearing it [ when I was teaching at ] law school .
There was an incident where this anti-trans activist from the Federalist Society came to debate me at school about bathrooms .
And it felt like I @ @ @ @ @ @ @ represent .
The first time I wore [ women ’ s clothes ] to teach broke it open for me .
And I did it more and more frequently .
But I realize that my body is a man ’ s body .
I ’ m not under any impression that people think that I pass as a woman .
It means people probably think of me as a man wearing women ’ s clothes .
I think of myself as more gender-fluid or nonbinary .
My daughter , I think a part @ @ @ @ @ @ @ and that ’ s who I am .
And she sees me in a context where I am treated as completely normal for dressing this way .
But I do think kids who are 10 are very aware of what ’ s normal for themselves and for their families .
And so 10 is the age kids become very embarrassed of their parents all the time — and not just when their parents are gender-nonconforming .
So whatever resistance she has is really just age-appropriate .
But I know that she knows that @ @ @ @ @ @ @ she ’ s playful about it and supportive about it in her own way .
It ’ s not ever , “ I wish you wouldn ’ t dress like that.
” I do think there ’ s more freedom for people today to be themselves at work and dating than I had when I was their age .
That makes me happy .
Although I should say , there ’ s a little sadness too , because I feel like being [ LGBTQ ] is so normalized now that there ’ s @ @ @ @ @ @ @ to be when I came out .
You would see somebody who was visibly gay , there would be a sort of smile that you would share , and you would greet each other .
And now that sort of doesn ’ t happen so much anymore .
I wear what I want , and I feel very feminine in what I wear , and I enjoy that .
And that ’ s why I feel like “ gender-fluid ” might be more appropriate than “ nonbinary , ” but I don ’ @ @ @ @ @ @ @ think there ’ s some value in it , but the label isn ’ t a core part of what I ’ m doing .
When I was 21 , I officially came out as nonbinary .
Dating for me was incredibly hard .
I just saw this post the other day saying that straight privilege is being able to date in middle and high school .
I completely agree .
I feel like at 27 years old , I ’ m still learning how to make friends , and how to have @ @ @ @ @ @ @ to not only navigate all that queerphobia and transphobia , but also so much social anxiety .
I ’ ve had to unlearn really toxic and unhealthy representations of the community .
Until just this past year , I didn ’ t have a beard , and I presented in a way that many people would read as a trans woman .
I was very feminine .
I tried dating apps , like OkCupid , and if I put things like nonbinary on my profile , I would get so many questions , @ @ @ @ @ @ @ sending me horrible messages .
Questions like , do you have a penis or vagina ?
What are you , male or female ?
A couple guys were interested in me , but they didn ’ t really want to take me out on a date .
They just wanted to hook up .
So I felt a lot of shame around who I was , because I felt that the only type of love or attraction that I was capable of receiving was if I was seen as a sexual object .
@ @ @ @ @ @ @ going to be capable of dating .
Then I met Ethan , and everything kind of changed .
He taught me that I ’ m worthy of love and affirmation beyond just being treated as a hookup .
Which is how I ’ ve gotten to the point of really embracing my expression that I have now .
For the longest time , I felt I had to keep shaving my beard and keep plucking my beard to get rid of it .
And it didn ’ t really align with what I @ @ @ @ @ @ @ that I had to do it .
I had to do it to be attractive .
I had to do it to be accepted .
I had to do it in order to be palatable .
About a year ago , I started growing out my beard , and it was probably the most exciting thing that I had done in a long time .
I felt that I was going against the norm and I was paving my own path .
I had a lot of resistance .
I felt it from @ @ @ @ @ @ @ trans women , who were my mentors and whom I looked up to .
I ’ ve learned so much .
I ’ ve grown a thicker skin now more than ever to people ’ s reactions , but I ’ m still really vulnerable .
When Ethan and I got married in July , we went to Puerto Rico for our honeymoon .
We had been talking about how I should look , not because it was uncomfortable but as a matter of “ How should we navigate this in order to @ @ @ @ @ @ @ I needed to remove my beard .
My beard grows in extremely fast .
Knowing that , and knowing we were outside of our home city , knowing that if I don ’ t blend in and look like a cisgender woman , we felt that I may experience violence .
I ended up plucking my entire beard .
It took me about four hours to do , and my face was extremely puffy .
Something that I talk about with other queer and trans people is just how fear can sometimes control @ @ @ @ @ @ @ in a place and in a time in an era where it ’ s a lot safer to be who I am today .
Yes , there ’ s a lot more visibility , and with visibility comes violence , but I need to sometimes just learn to enjoy the moment and be present — be present with my fellow community members , with my siblings , with my family , with my partner , with my friends , and in the world .
We ’ re nothing new .
We ’ ve @ @ @ @ @ @ @ and we ’ re not going anywhere .
Annie Tritt is a New York-based photographer who seeks to create spaces where viewers have the potential to experience transformation .
They have previously photographed and interviewed nonbinary youth for Vox , and their work has appeared in the New York Times , Wall Street Journal , Billboard , and Variety , among other outlets .

Part of the Gender Issue of The Highlight, our home for ambitious stories that explain our world.
Bobbi Ullinger was browsing an online support group when she first saw the word bi-gendered. “It was like the lightbulbs went on, the choir of angels was singing, and the light was shining down on me,” said Ullinger, 64. “And that was really the first inkling that I had of the gender spectrum, that you didn’t have to be one or the other. You can be both or neither.”
The past decade has ushered in visibility for people who identify as nonbinary, meaning their gender is neither male nor female but somewhere in between, fluid, both, or neither. Thirteen states now offer a nonbinary gender option for driver’s licenses, and stars such as singers Sam Smith and Janelle Monáe and Queer Eye’s Jonathan Van Ness have come out as nonbinary or gender-fluid in recent months. They/them pronouns have entered the national conversation, and the dictionary.
Much of the focus from lawmakers and the media around those who don’t fit into a neat gender box has centered on young people, in part because today’s youth are simply more likely to know somebody who uses gender-neutral pronouns — 35 percent of 13- to 21-year-olds, compared with 16 percent of Gen Xers and 12 percent of boomers, according to a 2018 Pew study.
Left out of the conversation is how older nonbinary people, many with already established lives, are navigating an increasingly accepting world.
Photographer Annie Tritt traveled across the country to explore the lives of five nonbinary and gender-fluid adults. Many mentioned finally having the words to describe their experience. Others expressed sadness over the years or sometimes decades spent hiding a part of themselves.
“If I had discovered this freedom and clarity in my 20s, or if I was 20-something now, I would have a completely different outlook,” said TL Thompson, 42. “This young generation of queers were socialized very early in their development [to understand] that they could be whatever they wanted to be.”
For the adults interviewed for this project, coming into their identities later in life added complications to their established careers and relationships with partners, children, and their communities. Yet the stories that emerged were ultimately about resilience and love.
Bobbi Ullinger, 64, audio technician in Kent, Ohio
I can remember when I was little, really little, I would go to bed at night and say a prayer that I would wake up as a girl in the morning, and when I woke up in the morning, I’d be very disappointed that I wasn’t a girl. But there were also times I would be very relieved that my prayer was not answered, because I still wanted to be a boy, too.
I went through cycles where I would sneak into my mom’s closet. I would feel good dressing in her clothes, and then I would feel very ashamed and swear that I was never going to do it again. That went on for years — for most of my life. Even up until the time that we [Bobbi and her wife, Cathy] were married.
In the early days of the internet, there were just bulletin boards. Doing any kind of rudimentary search with the terms that I knew — cross-dresser or transvestite, transexual — even after the internet started to come around, all you would get was page after page of pornography. I knew that wasn’t me, and that put me further in the closet.
And then came the movie The Silence of the Lambs. It was about a guy who’s transgender, but the way he expresses himself is by killing women, skinning them, and sewing their skin together to make his own. And all I could think of is, this is what people think that I am. If I ever get caught, that’s what they think I’m going to be: a monster, a freak. That put me in total denial.
It wasn’t until I was in my mid-40s that I finally found a website called GRITS, which is an acronym for Girls Raised in the South. On there were stories of people, stories that sounded a lot like my story. And that was really the first time that I knew I wasn’t the only person like this in the world, that I was not some terrible freak.
From that website, I found another called Gender Tree, run by a trans woman named Sandra Stewart, and she was at the time in seminary. And she would take these verses that Christians used to clobber us over the head and tell us we’re going to go to hell, she would break these Scriptures down and show that they didn’t mean what they were being used for. That was my first inkling that maybe this is okay with God, that I’m not going to be condemned to hell.
So I ended up making a deal with God: This was okay to do, as long as it didn’t interfere with my relationship with my wife, Cathy, and my family, and with God. And like most of those kinds of deals with God, it lasted about six months or so before I started to feel guilty about keeping this thing from her.
The first thing [my wife] said [when I told her] was, if this has been going on for that long, then it’s obvious it’s not going to stop. So let’s figure out how to work through it. We had been married for 30 years.
I originally identified as a cross-dresser. It was in an online support group for other cross-dressers that somebody used the word bi-gendered. And it was like the lightbulbs went on, the choir of angels was singing, and the light was shining down on me.
That’s what I am. I feel both masculine and feminine. That was really the first inkling that I had of the gender spectrum, that you didn’t have to be one or the other. You can be both or neither.
When I’m talking to a group of people, that’s how I identify myself: “I’m Bobbi, and my preferred pronouns at this point are she/her/hers,” although that’s because right now I am presenting as Bobbi 99 percent of the time.
But for a long time — and I still am comfortable presenting in the middle — for my preferred pronouns, I had two asterisks and would say, it’s contextual. If I’m presenting masculine, he/him; if I’m presenting feminine, she/her; if I’m presenting in between, they/them.
As far as being gender-fluid, I still have those shifts, and I have no control over it. And it can just kind of pop up no matter how I’m presenting or the circumstances that I’m in. And I guess the best way that I can describe it is like a mental itching powder. It can really throw me off balance; it catches me by surprise.
One time in particular was really very awkward. I was dressed to the nines. Cathy and I were going to a small cabaret-style theater up in Cleveland. We walked in, got a glass of wine, sat down, and all of a sudden I’m feeling very, very macho and very masculine. I had a hard time really enjoying the play, because that was preoccupying my mind. There have been other times when I have been doing very manly, macho work and all of a sudden felt very demure and very feminine.
I’ve gotten better at being able to focus through that. And that’s kind of how I work my way through it — just really focusing on what I’m doing.
TL Thompson, 42, actor in New York City
My mom always took me to my aunt to get perms, or she would straighten my hair on the stove with an iron. She was really invested in making me the woman that she had grown up to be. This is what you do with your daughter, she probably thought. And I was just like, I love you, Mom, but I can’t. So at 11 or 12, I shaved my head. I was a little fearless and reckless in weird ways.
I loved Dirty Dancing. I was totally Patrick Swayze when I would act it out in my room. I was like, “Oh, my God, I can do that. I can act like I would want my life to be onstage in front of people. This is amazing. And you’ll pay me?” My mind was blown.
I come with a socialized female experience, and I think the combination of that experience, and the way that I look, and — people have said this to me before — the openness in my spirit makes it an interesting thing to watch.
As an actor, I’ve done roles where I’m wearing heels and a dress, and I’m a water nymph, and it’s like, yes, this feels right. I just did this web series called These Thems, and I play a DJ named TI, and they’re this smooth, nonbinary person that loves love and loves sex and is poly. And that feels good, too. That feels right, that feels true.
But while there are more specifically nonbinary roles now, the roles that I have traditionally gone for, the call sheet said female. I can play a small guy, maybe a scrappy guy, maybe the mischievous one. But I’m not going to be the leading football player dude. I’m never going to be that guy.
Men have a really hard time placing value on what trans masculine and nonbinary people are. They can’t get things from us that they would normally want from a feminine body, so our value is less than — it’s less than male, it’s less than female. So of course we’re not in media. Of course no one’s writing roles for us.
If I had discovered this freedom and clarity [to be nonbinary] in my 20s, or if I was 20-something now, I would have a completely different outlook. This young generation of queers were socialized very early in their development [to understand] that they could be whatever they wanted to be, more often than not.
I was at the end of the generation that had to work very hard to even be acknowledged as queer or nonbinary. In my day, you were butch or you were femme. There wasn’t even language in the mainstream that gave voice to the nuances in sexuality. I come from the generation of trans performers that had to pick a gender where roles were concerned.
I believe that the arts are a way to make social change. There’s so much beauty in a painting. There’s so much joy in a song. So much activism in theater. It’s always been that way. From the time we could tell stories, that’s the way that we change. And I think that’s absolutely why I’m an artist. That’s how you change the world, baby!
Leland Koble, 62, retired nurse in White Haven, Florida
I didn’t know I was a girl until the age of 5, when I went to kindergarten. My parents never, for whatever reason, had judgment, or asked me about my gender or my sexual choices. I don’t have one of those sad stories of being judged and oppressed. I grew up in a great family that allowed me to live my life like me.
When I was 54, I guess I came out in a different way. Because I found out then that my grandmother was Seminole Indian, and that’s why she used to call me “two-spirit.” At the time, I thought she meant I’m a Gemini. My grandparents were wealthy, and on Easter, they used to always have a party and all the little girls would be dressed in little bonnets. I was always playing with the little pigs [at their house]. My aunt used to say it’s disgusting, but my grandmother used to always say, you just need to leave that child alone. She’s two-spirit, and she’s going to do well.
I grew up in a little tiny town, with only, like, 12 kindergartners. Everything was fine until we went to phys-ed. The teacher said, “We’re going to play dodgeball,” so all the little boys lined up over here and all the little girls lined up over there. It was the most defining moment in my entire life. I ran over to where all the little boys were. I’ll never forget it: The teacher walked over to me, grabbed me by the arm, and said, “Kathy, you’re over here.” And she took me over to these screaming, giggling little girls. And I thought, these are not my people.
They called my dad to come to the school. When I went to the principal’s office, my dad was sitting there, his arms crossed. The principal said to my dad, we have a situation with your daughter. She refuses to play with the little girls. She’s always with the little boys. I’m going to have to request that tomorrow, and from then on, your daughter comes in dressed in the dress code, which is dresses down to knee length.
My dad stood up — I’ll never forget it — and just said, “Come on, we’re going home.” He looked at the principal and goes, “That’s not likely to happen.” And I never wore a dress to school again.
In a small town like that, where everybody knows everything, nobody wants a hassle. I really wasn’t judged much until I had my breasts removed [at age 54]. The transgender community tried to put pressure on me to make a decision about changing my gender, taking testosterone, and declaring who I was. I didn’t have much relationship with the community before surgery, except for a few trans friends. After surgery, there was a lot of pressure from certain patients to declare my gender and also about my non-use of testosterone.
I think using they/them pronouns is still really hard for people. Using they/them doesn’t make any sense to country folks. And they’re not having it. But you’re in New York? Okay, well, that’s completely different.
I think that acting somewhere in between a man and a woman, it’s still just inconceivable for more than 50 percent of the populace. It doesn’t make sense to them.
Darren Rosenblum, 50, law professor in New York City
For law school, I started out at CUNY, then transferred to the University of Pennsylvania. About 30 percent of the time, I was wearing dresses and skirts. At CUNY, people were really, really supportive, like vocally supportive, almost a little bit oppressive. And then at Penn, there was a small group of people who were really supportive in a cool way and then everybody else was just civil.
Once I graduated and worked at a law firm, I would trot out my dresses every now and then, but it became less and less. I put them in the back of my closet. I went to some interviews wearing a professional skirt and jacket, and I didn’t get any callbacks. Maybe it was that, or maybe it was just my own awareness, but I really shied away from [wearing dresses] throughout much of my career.
Then, five years ago, I started reintroducing women’s clothes into my wardrobe. It was maybe about two and a half years ago when I started wearing it [when I was teaching at] law school. There was an incident where this anti-trans activist from the Federalist Society came to debate me at school about bathrooms. And it felt like I really had to wear a skirt to represent.
The first time I wore [women’s clothes] to teach broke it open for me. And I did it more and more frequently. But I realize that my body is a man’s body. I’m not under any impression that people think that I pass as a woman. It means people probably think of me as a man wearing women’s clothes. I think of myself as more gender-fluid or nonbinary.
My daughter, I think a part of her thinks that this is natural and that’s who I am. And she sees me in a context where I am treated as completely normal for dressing this way. But I do think kids who are 10 are very aware of what’s normal for themselves and for their families. And so 10 is the age kids become very embarrassed of their parents all the time — and not just when their parents are gender-nonconforming. So whatever resistance she has is really just age-appropriate. But I know that she knows that this is who I am, and she’s playful about it and supportive about it in her own way. It’s not ever, “I wish you wouldn’t dress like that.”
I do think there’s more freedom for people today to be themselves at work and dating than I had when I was their age. That makes me happy. Although I should say, there’s a little sadness too, because I feel like being [LGBTQ] is so normalized now that there’s not that kind of camaraderie there used to be when I came out. You would see somebody who was visibly gay, there would be a sort of smile that you would share, and you would greet each other. And now that sort of doesn’t happen so much anymore.
I wear what I want, and I feel very feminine in what I wear, and I enjoy that. And that’s why I feel like “gender-fluid” might be more appropriate than “nonbinary,” but I don’t care about the labels. I think there’s some value in it, but the label isn’t a core part of what I’m doing.
Addison Rose Vincent, 27, activist in Los Angeles
When I was 21, I officially came out as nonbinary. Dating for me was incredibly hard. I just saw this post the other day saying that straight privilege is being able to date in middle and high school. I completely agree. I feel like at 27 years old, I’m still learning how to make friends, and how to have a relationship. I’ve had to not only navigate all that queerphobia and transphobia, but also so much social anxiety. I’ve had to unlearn really toxic and unhealthy representations of the community.
Until just this past year, I didn’t have a beard, and I presented in a way that many people would read as a trans woman. I was very feminine. I tried dating apps, like OkCupid, and if I put things like nonbinary on my profile, I would get so many questions, and so many people invalidating me, sending me horrible messages. Questions like, do you have a penis or vagina? What are you, male or female? A couple guys were interested in me, but they didn’t really want to take me out on a date. They just wanted to hook up.
So I felt a lot of shame around who I was, because I felt that the only type of love or attraction that I was capable of receiving was if I was seen as a sexual object. It made me feel I was never going to be capable of dating.
Then I met Ethan, and everything kind of changed. He taught me that I’m worthy of love and affirmation beyond just being treated as a hookup. Which is how I’ve gotten to the point of really embracing my expression that I have now. For the longest time, I felt I had to keep shaving my beard and keep plucking my beard to get rid of it. And it didn’t really align with what I really truly wanted. But I felt that I had to do it. I had to do it to be attractive. I had to do it to be accepted. I had to do it in order to be palatable.
About a year ago, I started growing out my beard, and it was probably the most exciting thing that I had done in a long time. I felt that I was going against the norm and I was paving my own path. I had a lot of resistance. I felt it from people within the community, especially older trans women, who were my mentors and whom I looked up to. I’ve learned so much. I’ve grown a thicker skin now more than ever to people’s reactions, but I’m still really vulnerable.
When Ethan and I got married in July, we went to Puerto Rico for our honeymoon. We had been talking about how I should look, not because it was uncomfortable but as a matter of “How should we navigate this in order to be safe?” I decided that I needed to remove my beard.
My beard grows in extremely fast. Knowing that, and knowing we were outside of our home city, knowing that if I don’t blend in and look like a cisgender woman, we felt that I may experience violence. I ended up plucking my entire beard. It took me about four hours to do, and my face was extremely puffy.
Something that I talk about with other queer and trans people is just how fear can sometimes control our lives. But I’m in a place and in a time in an era where it’s a lot safer to be who I am today. Yes, there’s a lot more visibility, and with visibility comes violence, but I need to sometimes just learn to enjoy the moment and be present — be present with my fellow community members, with my siblings, with my family, with my partner, with my friends, and in the world.
We’re nothing new. We’ve been around for thousands of years, and we’re not going anywhere.
Annie Tritt is a New York-based photographer who seeks to create spaces where viewers have the potential to experience transformation. They have previously photographed and interviewed nonbinary youth for Vox, and their work has appeared in the New York Times, Wall Street Journal, Billboard, and Variety, among other outlets.
CREDITS
Editors: Karen Turner, Jessica Machado
Visuals editor: Kainaz Amaria
Copy editors: Tanya Pai, Tim Williams
Design: Amanda Northrop


vox--2020-02-19--11 questions about the Covid-19 coronavirus outbreak, answered

The coronavirus outbreak , centered in China , keeps evolving at a dizzying speed .
With the case toll rising steeply ( reaching over 75,000 on February 19 ) , face masks flying off store shelves , and businesses , cruise ships , and entire cities upended by the virus — it ’ s no wonder questions and fears are swirling about Covid-19 , as the disease is known .
For most people in the US , however , there ’ s no reason to worry : Ninety-nine percent of cases are happening in China .
But that may shift @ @ @ @ @ @ @ are detected in other countries .
Here are answers to your most burning questions about the new coronavirus and its risks .
1 ) What is this new coronavirus and where did it come from ?
Coronaviruses are a large family of viruses that typically attack the respiratory system .
The name comes from the Latin word corona for crown and the Ancient Greek korōnè , meaning garland or wreath , because of the spiky fringe encircling these viruses .
Most coronaviruses infect animals , such as bats , cats , and birds @ @ @ @ @ @ @ SARS , and MERS , are known to infect humans .
SARS is thought to have evolved from infecting bats to civet cats to humans in China ; MERS evolved from bats to camels to humans in the Middle East .
No one knows precisely where Covid-19 came from , though the leading hypothesis is that bats were once again the original source : they spread the virus to pangolins , and pangolins to humans .
2 ) What are the symptoms ?
Two of the seven coronaviruses that infect humans , SARS @ @ @ @ @ @ @ and even death in 10 and more than 30 percent of cases , respectively .
But the others lead to milder symptoms , like a common cold .
At the moment , we know Covid-19 can cause pneumonia and that it too can kill — but while it seems to be less deadly than SARS and MERS , it ’ s not yet clear by how much .
Some of the best evidence on the question comes from a February 16 China CDC report looking at the outcomes of the first 72,314 patients @ @ @ @ @ @ @ China .
It ’ s the largest such analysis to date .
And it found an overall case fatality rate of 2.3 percent — lower than both SARS and MERS .
( The case fatality rate , or CFR , is the proportion of deaths a disease causes within a group of people who have the disease . )
The researchers also discovered a huge variation in the case fatality rate by age group .
In short , the virus appears to be more deadly in people with each passing decade .
You @ @ @ @ @ @ @ from the study : Overall , the researchers characterized 81 percent of the cases as mild , and 19 percent as severe or critical .
One major caveat , though : This data comes from mainland China , where all but a few of the 2,012 deaths have occurred .
And for reasons no one understands , the case fatality rate has been lower outside of mainland China .
At the same time , there ’ s also evidence of asymptomatic cases .
And it ’ s possible that as we discover more @ @ @ @ @ @ @ more like seasonal flu than like SARS .
That ’ s because infectious diseases typically look more severe when they ’ re first discovered , since the people showing up in hospitals tend to be the sickest .
As for symptoms : According to the Centers for Disease Control and Prevention , most patients start with a fever , cough , and shortness of breath .
A report , published in The Lancet , provided more detailed information .
It looked at a subset of the first 41 patients with confirmed Covid-19 in @ @ @ @ @ @ @ city of 11 million where the outbreak is believed to have started .
The most common symptoms were fever , cough , muscle pain , and fatigue ; less common were headache , diarrhea , and coughing up mucus or blood .
All had pneumonia and lung abnormalities on CT scans .
As for the disease severity : 32 percent were admitted to an ICU , and 15 percent died .
By January 22 , most ( 68 percent ) of the patients had been discharged from the hospital .
We don ’ @ @ @ @ @ @ @ , but we do have a lot of data on how MERS , SARS , and other respiratory viruses move from person to person .
And that ’ s mainly through exposure to droplets from coughing or sneezing .
So when an infected person coughs or sneezes , they let out a spray , and if these droplets reach the nose , eyes , or mouth of another person , they can pass on the virus , said Jennifer Nuzzo , an infectious disease expert and senior scholar at the Johns Hopkins Center @ @ @ @ @ @ @ , a person might catch a respiratory disease indirectly , “ via touching droplets on surfaces — and then touching mucosal membranes ” in the mouth , eyes , and nose , she added .
That ’ s why hand-washing is an important public health measure — all the time , and especially in an outbreak .
4 ) Should I travel while this outbreak is going on ?
Both the CDC and the State Department have issued their highest-level travel alerts for China , advising Americans to avoid traveling there for the @ @ @ @ @ @ @ to change as the outbreak evolves , so keep checking them . )
And that ’ s not only because there ’ s a risk of catching this new virus .
Right now , numerous airlines are canceling or scaling back flights to China , in part because of decreased demand .
Countries are also forcing returning visitors from China into quarantines .
“ I ’ m more concerned about the unpredictability of the [ outbreak ] response at this point , ” Nuzzo said .
“ It would not be fun to @ @ @ @ @ @ @ somehow .
And coming back , you ’ ll be subject to additional screening [ or quarantines ] .
” But people worried about travel should remember that these advisories focus on China , where the epidemic is currently playing out .
Of the cases right now , 99 percent are in mainland China .
And more than half of those are in Hubei .
“ The risk of acquiring this infection outside of Hubei and , truly , outside of China is remarkably low , ” said Isaac Bogoch , a professor @ @ @ @ @ @ @ how air travel influences the dynamics outbreaks — including the new coronavirus infection .
What if you have to travel and you ’ re seated near someone who is sick ?
That ’ s not time to panic , either .
“ There has been some work looking into the risk of acquiring infectious diseases through air travel , ” Bogoch said .
“ The risk of acquiring a respiratory infection through air travel is still extraordinarily low.
” The risk does go up if you happen to be seated within six feet @ @ @ @ @ @ @ .
But even there , simple proximity doesn ’ t necessarily mean you ’ ll catch anything .
Instead , the more infectious the person is , and the longer you sit near them , the higher your risk .
If you ’ re not near the person for very long , or they ’ re not very infectious , the risk is lower .
And again , it ’ s unlikely that sick person has the coronavirus .
5 ) I ’ m still worried about the new coronavirus .
What should @ @ @ @ @ @ @ a face mask ?
In the US , the risk to the public is currently deemed low .
And just about every health expert Vox has spoken to has said there ’ s little evidence to support the use of face masks for preventing disease in the general population .
Masks are only useful if you have a respiratory infection already and want to minimize the risk of spread to others , or if you ’ re caring for someone who is sick or working in a hospital in direct contact with people @ @ @ @ @ @ @ , there are reports of runs on masks and other supplies health workers need to stay safe . )
That ’ s why the CDC advises against the use of masks for regular Americans .
“ The virus is not spreading in the general community , ” Nancy Messonnier , director of the CDC ’ s National Center for Immunization and Respiratory Diseases , reasoned in a press briefing on January 30 .
But people are hoarding them anyway , and for the wrong reasons .
The best thing you can do to @ @ @ @ @ @ @ said , is “ wash your hands , cover your cough , take care of yourself , and keep alert to the information that we ’ re providing.
” 6 ) What about the cases of people spreading the virus before they show symptoms ?
Isn ’ t that worrisome ?
The best evidence that the virus can spread before a person has symptoms came from Germany .
But there were problems with the initial analysis .
The outbreak there was first identified in Bavaria on January 27 , when a German businessman @ @ @ @ @ @ @ meetings with a female colleague who was visiting from Shanghai and had the virus but didn ’ t know it .
The woman , according to a New England Journal of Medicine case report , only began to feel symptoms — such as fever and a cough — after she left Germany , and days after meeting with the German businessman .
This suggests she may have transmitted the virus to the man before knowing she was sick .
If this were true , it ’ d throw a wrench in the attempts @ @ @ @ @ @ @ since it suggests people who don ’ t even know they ’ re infected can spread the disease .
But it turns out the researchers published this report without having spoken to the woman .
And within days of publication , the Robert Koch Institute — Germany ’ s public health agency — wrote a letter to NEJM about an error in the study , according to Science ’ s Kai Kupferschmidt , who broke the story .
The public health researchers followed up with the woman and found out she actually did @ @ @ @ @ @ @ “ felt tired , suffered from muscle pain , and took paracetamol , a fever-lowering medication , ” Kupferschmidt explained .
This doesn ’ t mean that we won ’ t still find out people can spread the virus asymptomatically .
More evidence could still surface , and some believe it will .
However , Bogoch said , “ even if there have been cases of asymptomatic transmission of this infection , those will be typically rare cases , and with just about every other respiratory tract infection known to humankind , those @ @ @ @ @ @ @ an epidemic.
” 7 ) Is this going to become a deadly pandemic ?
For now , the CDC and WHO are still calling this an outbreak .
Very soon , though , health experts may determine that there are enough cases in China to officially call the outbreak an epidemic .
And if the disease continues to spread locally in other countries , it could turn into a pandemic ( which is defined as an epidemic that ’ s spread to two or more regions of the world ) .
On February @ @ @ @ @ @ @ general , Dr. Tedros Adhanom Ghebreyesus , flicked at that possibility .
He noted there were cases outside of China , which included “ concerning instances of onward transmission from people with no travel history to China.
” These “ could be the spark that becomes a bigger fire.
” But a disease can spread widely , and become a pandemic , without being particularly severe .
And no one knows yet what a Covid-19 pandemic would look like — mostly because we don ’ t yet know precisely how lethal this disease @ @ @ @ @ @ @ number of deaths and divide it by the number of known cases , “ the case fatality is 2 percent — and it ’ s gone down from 3 percent in the early days , ” said University of Michigan ’ s Howard Markel , who studies outbreaks .
“ And if it goes really , really low , we ’ ll probably say — like we did in Mexico in 2009 with [ H1N1 ] swine flu — that it ’ s something very similar , if not less deadly , [ @ @ @ @ @ @ @ once more of these mild cases are discovered , this virus could look a lot less deadly .
“ We live [ with ] and tolerate a whole lot of respiratory viruses , ” Nuzzo said , “ some of which are even more transmissible than the estimates people have come out with for this one — but they don ’ t make the headlines.
” 8 ) Is my city at risk of an outbreak ?
Some of the best research on that question comes from Bogoch and his colleagues .
They @ @ @ @ @ @ @ couple of weeks on the cities most vulnerable to novel coronavirus infections .
What ’ s the big takeaway ?
It ’ s really East Asia and Southeast Asia that are most at risk .
The researchers — from the University of Oxford , University of Toronto , and London School of Medicine and Tropical Hygiene — used 2019 data from the International Air Transport Association to find all the cities in China that received at least 100,000 airline passengers from Wuhan during February through April .
They then modeled how the disease @ @ @ @ @ @ @ experienced local outbreaks .
Here are 15 of the top 50 destinations that might see outbreaks ( also pay attention to the IDVI — the Infectious Disease Vulnerability Index — number .
It ’ s a measure of a country ’ s ability to manage an infectious disease .
Scores closer to zero mean they ’ re less prepared . )
“ By no means would anybody be surprised if there are more cases exported to Europe and the US , ” Bogoch said .
“ But the places that are going to @ @ @ @ @ @ @ infections exported would be to East Asian and Southeast Asian centers.
” 9 ) So what might happen next ?
If China contains the virus , and the outbreaks in other countries don ’ t blow up , we might see the case count start to fall and the public health emergency fizzle out .
But there are already so many cases across China , as well as the very real possibility that the virus is circulating , undetected , in other countries — especially those with with weak health systems — that @ @ @ @ @ @ @ likely by the day .
If Covid-19 is not contained , “ if it continues to accelerate , we very well may have a pandemic , ” said Tony Fauci , the head of the National Institute of Allergy and Infectious Diseases .
That would mean more sickness and deaths not only in China , but also in other countries around the world , as cases grow from one-off travelers or small clusters to full-blown outbreaks .
In this scenario , he added , “ you don ’ t try to control [ @ @ @ @ @ @ @ already everywhere.
” So public health officials would move from attempting containment of the virus to mitigating its impact — setting up hospitals to isolate and care for patients , making recommendations for “ social distancing ” ( like canceling public events ) , and coming up with triaging protocols for the many people who might need hospital care .
But again , even if this virus moves around the world , it may not do much harm .
In the best-case scenario , this outbreak might look more like H1N1 swine flu @ @ @ @ @ @ @ 2009 and spread around the world , there were major concerns about its lethality .
US schools closed , people from North America were quarantined when they arrived in other countries , flights were canceled .
Not only did those measures fail to contain the virus , Nuzzo said , it turned out H1N1 wasn ’ t all that deadly .
“ Now we ’ re still living with that virus — it ’ s one that circulates with every flu season , ” Nuzzo explained .
10 ) How is the world @ @ @ @ @ @ @ 30 , the WHO declared the outbreak a global public health emergency .
Though it advised countries not to put in place travel or trade restrictions against China , several — including Russia and Singapore — have already sealed their borders .
Meanwhile , the US government dramatically escalated its response — issuing its highest-level travel advisory , quarantining citizens evacuated from China , and temporarily banning foreign nationals who have recently been to the East Asian country from coming in .
These extreme measures can be explained , in part , by @ @ @ @ @ @ @ : leaders are taking extreme precautions for fear Covid-19 is very deadly and can spread very far .
The measures can also be explained by the fact that we have no enforceable international law governing outbreak responses .
So countries can basically do what they want in response to pandemic threats without getting penalized , even if the WHO advises against whatever actions they ’ re taking .
That appears to be the case in China , where the most dramatic — and unprecedented — response is currently playing out .
“ China @ @ @ @ @ @ @ [ or quarantine ] in the history of humankind , ” Lawrence Gostin , a global health law professor at Georgetown University , told Vox .
“ They ’ ve restricted movements , caused fear and panic .
They ’ ve violated human rights.
” Authorities there have also censored information and silenced the whistleblowers who tried to sound the alarm sooner than Chinese authorities were willing , and kicked out foreign journalists critical of China ’ s outbreak response .
But again , because of the weakness of global health law , @ @ @ @ @ @ @ about these actions .
11 ) How might this end ?
There are a few ways this outbreak could end , as my colleague Brian Resnick explained .
Perhaps public health measures — identifying cases fast , putting infected people in isolation — will stop the spread of this coronavirus .
( That ’ s what stopped the spread of SARS in 2003 . )
Because this is a zoonotic disease , meaning it came from an animal , finding and eliminating that source would also help .
Or maybe a vaccine or @ @ @ @ @ @ @ a broader epidemic ( though that ’ ll likely take years ) .
The coming seasons of warmer weather could also play a role in at least slowing the virus down .
“ Coronaviruses are winter viruses , ” Fauci said .
“ When the weather is warm and moist , these viruses don ’ t spread as well as when the weather is cold and dry.
” Finally , there ’ s the possibility the virus will simply die out .
“ Disease outbreaks are a bit like fires , ” Resnick @ @ @ @ @ @ @ flame .
Susceptible people are the fuel .
Eventually a fire burns itself out if it runs out of kindling .
A virus outbreak will end when it stops finding susceptible people to infect.
” A SARS-like virus has sickened thousands in China , and made its way to the United States .
Vox ’ s Julia Belluz explains what ’ s known and what ’ s next .
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Editor’s note, April 2: There have been significant developments in the coronavirus pandemic since this story was last updated. Here is our latest information on the big questions about the coronavirus, as of this writing. For our most up-to-date coverage, visit our coronavirus hub.
The coronavirus outbreak, which began in China, keeps evolving at a dizzying speed. With the global case toll rising steeply, face masks flying off store shelves, borders around the world closing, and meetings, cruise itineraries, and the global economy upended by the virus, it’s no wonder questions and fears are swirling about Covid-19, as the disease is known.
On March 11, the WHO declared the outbreak a pandemic, a new disease that has spread around the world. Many countries have seen reported cases of the virus rise within their borders — and that includes the US.
“We will see more cases, and things will get worse,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told members of the House Oversight Committee on March 11. “How much worse … will depend on our ability to do two things: to contain the influx in people who are infected coming from the outside and the ability to contain and mitigate within our own country.”
Spread of the virus and the slow rollout of testing mean reported case numbers are changing quickly. Meanwhile, outbreaks have been surging in South Korea, Italy, and Iran. With the new virus continuing its tour around the world, here are answers to your most burning questions.
1) What is this new coronavirus, and where did it come from?
Coronaviruses are a large family of viruses that typically attack the respiratory system. The name comes from the Latin word corona, for crown, and the ancient Greek korōnè, meaning garland or wreath, because of the spiky fringe encircling these viruses. Most coronaviruses infect animals, such as bats, cats, and birds. Only seven, including Covid-19, SARS, and MERS, are known to infect humans.
SARS is thought to have evolved from infecting bats to civet cats to humans in China; MERS evolved from bats to camels to humans in the Middle East. No one knows precisely where Covid-19 came from, though a leading hypothesis is that bats were once again the original source: They spread the virus to another animal species, possibly a pangolin, where it jumped to humans.
2) What are the symptoms and death rate?
Two of the seven coronaviruses that infect humans, SARS and MERS, can cause severe pneumonia and even death in 10 and more than 30 percent of cases, respectively. But others lead to milder symptoms, like a common cold. The most common symptoms of Covid-19 are fever and dry cough.
No one knows the precise incubation period for the virus, but symptoms can show up anywhere from one day to two weeks after exposure, according to a WHO report on China’s response.
At the moment, we know Covid-19 can cause pneumonia and that it too can kill — but while it seems to be less deadly than SARS and MERS, it’s not yet clear by precisely how much.
Some of the best evidence on the question comes from a February 16 China Center for Disease Control report looking at the outcomes of the first 72,314 patients with confirmed or suspected Covid-19 in mainland China. It’s the largest such analysis to date, and it found an overall case fatality rate of 2.3 percent — lower than both SARS and MERS. (The case fatality rate, or CFR, is the proportion of deaths a disease causes within a group of people who have the disease.)
The researchers also discovered a huge variation in the case fatality rate by age group. In short, the virus appears to be deadlier in people with each passing decade. You can see the trend in this graph:
Overall, the researchers characterized 81 percent of the cases as mild and 19 percent as severe or critical.
One major caveat, though: This data comes from mainland China. And the case fatality rate has been different outside of China.
At the same time, there’s also evidence of asymptomatic cases. And it’s possible that as we discover more of these cases, Covid-19 will look less deadly. That’s because infectious diseases typically look more severe when they’re first discovered since the people showing up in hospitals tend to be the sickest. Disease modelers who account for this under-counting of cases currently estimate an overall case fatality rate of just over 1 percent.
As for symptoms: Fever, dry cough, and fatigue are more common, while thick mucus from coughs, shortness of breath, sore throat, and headache are less common, according to China’s data.
But the picture might change as data on symptoms emerge from other countries. For example, a yet-to-be published German paper looked at some of the country’s earliest confirmed Covid-19 patients. Researchers found symptoms in this small sample often resembled a cold. So only two of the nine patients had a fever, and seven had a cough, but just as common were symptoms like stuffy nose, runny nose, and sneezing.
3) What should I do if I think I have Covid-19?
If you’re in a high-risk group — over the age of 60 with an underlying health condition — seek medical treatment immediately, and let your hospital or health care provider know you suspect Covid-19 before showing up.
Otherwise, stay at home and call a health professional, Vox’s Umair Irfan explained: “They will work with your local health department and figure out whether you need to get tested or get treatment. Doctors and health officials advise not to go to the emergency room if your symptoms do not appear to be life-threatening.” There’s a good chance you’ll recover with nothing more than rest and fluids. But you will need to self-isolate while sick to avoid spreading the disease to others, including any people in your home. Here’s how to do it.
The CDC and the WHO recommend several basic measures to help prevent the spread of Covid-19: Wash your hands often for at least 20 seconds.
Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
Clean and disinfect frequently touched objects.
Practice social distancing, and stay home when you are sick.
Contact a health worker if you have symptoms; fever and a dry cough are most common. Guidance may change. Stay informed, and stay safe, with Vox’s coronavirus coverage hub.
And if you are healthy, here are some ways you can help vulnerable people in your community.
4) How do coronaviruses spread?
We don’t yet know exactly how SARS-CoV-2 — the virus that causes the Covid-19 disease — spreads, but we do have a lot of data on how MERS, SARS, and other respiratory viruses move from person to person. And that’s mainly through exposure to droplets from coughing or sneezing.
So when an infected person coughs or sneezes, they let out a spray, and if these droplets reach the nose, eyes, or mouth of another person, they can pass on the virus, said Jennifer Nuzzo, an infectious disease expert and senior scholar at the Johns Hopkins Center for Health Security. In rarer cases, a person might catch a respiratory disease indirectly, “via touching droplets on surfaces — and then touching mucosal membranes” in the mouth, eyes, and nose, she added.
There’s also emerging evidence showing that SARS-CoV-2 may spread through poop — known as the “fecal-oral” route of disease transmission. Researchers are on the lookout for potential airborne transmission, too, and there’s a lot of speculation about whether inanimate objects — like door handles — can pass on the virus.
In the case of airborne transmission, a person would get infected by directly inhaling droplets suspended in the air from an infected individual. With “fomites” — objects that can transmit infections — droplets from an infected person would end up on surfaces another person touches. “So far, there is no conclusive evidence of that,” wrote Megan Murray, a Harvard Infectious Disease specialist, in a coronavirus explainer, “although that is challenging to prove one way or the other.”
What we do know: More and more research is piling up to suggest people who have only mild symptoms, or no symptoms at all, can test positive for Covid-19 disease. The virus also appears to be present in the body at very high levels early on in an illness, when people are still going to work or traveling.
“We still don’t know to what extent people without symptoms can infect,” Nuzzo cautioned. And Isaac Bogoch, a professor at the University of Toronto told Vox, “even if there have been cases of asymptomatic transmission of this infection, those will be typically rare cases, and with just about every other respiratory tract infection known to humankind, those are not the people who are driving an epidemic.”
Even so, if this virus can spread from people with no or mild symptoms, it might help explain why it’s so contagious. Researchers currently believe one person with Covid-19 generally infects two to more than three others, which would make the new coronavirus more transmissible than seasonal flu, SARS, and MERS. That’s why social distancing measures are so important.
5) What should I do to protect myself? Buy a face mask?
In the US, just about every health expert Vox has spoken to has said there’s little evidence to support the use of face masks for preventing disease in the general population.
Masks are only useful if you have a respiratory infection already and want to minimize the risk of spread to others, or if you’re caring for someone who is sick or working in a hospital in direct contact with people who have respiratory illnesses. (Plus, there are reports of runs on masks and other supplies that health workers need to stay safe. If they can’t get them and start walking off the job, we’re all in trouble.)
Related How soap absolutely annihilates the coronavirus
That’s why the CDC advises against the use of masks for regular Americans. The best thing you can do to prevent all sorts of illnesses, CDC’s Nancy Messonnier said, is “wash your hands, cover your cough, take care of yourself, and keep alert to the information that we’re providing.”
Individuals at a higher risk of developing severe disease — the elderly, people with underlying health conditions — should take additional precautions: avoiding crowds and contact with people who are sick, and stocking up on medicines and groceries, Messonnier said.
6) Is this a deadly pandemic?
The WHO has officially declared the outbreak a pandemic, with the disease in more than 100 countries and major epidemics in several regions of the world.
That means containing the virus — fully halting its spread — is no longer the goal but rather mitigation of fast spread and harm reduction.
Keep in mind, the p-word doesn’t say anything about the severity of Covid-19. A disease can spread widely and become a pandemic without being particularly severe. And no one knows yet what the ultimate effects of this pandemic will look like — mostly because we don’t yet know precisely how lethal the disease is.
There was a time when it seemed possible that China might contain the virus and the outbreaks outside of China would fizzle out, spelling the end of this public health emergency.
But there are now so many around the world, and the very real possibility that the virus is circulating, undetected, in even more countries — especially those with weak health systems — that containment appears out of reach.
This means we’re likely to see more sickness and death in many countries as cases grow from one-off travelers or small clusters to full-blown outbreaks.
In this scenario, the NIH’s Fauci said, “you don’t try to control [the virus] because it’s already everywhere.”
Health officials are now in the mitigation phase of the response strategy. This involves a focus on social distancing to slow the speed of the outbreak and avoid overwhelming health systems. It also involves ramping up public health communications to inform the public about the disease, testing of potential cases to find sick people and their contacts, and capacity in hospitals.
So hospitals need to be ready with Covid-19 protocols so the disease doesn’t spread from them, and health care workers need to be protected with access to protective equipment such as face masks so they can keep doing their jobs. Countries also need plans in place for maintaining supply chains and carrying on with travel and trade.
The slow rollout of testing in the US, in particular, has made slowing the spread of the virus more difficult.
An investigation led by the Atlantic and independent researchers found that a little more than 7,000 people in the US had been tested as of March 11 — putting the US far behind other developed countries. (The Covid Tracking Project team is now gathering test counts daily.)
Slowing epidemics is critical in preventing more deaths, as it reduces stress on hospitals and health centers, which can only treat a certain number of patients at a time. That’s why “flattening the curve” of the pandemic through social distancing measures is so important.
As Eliza Barclay and Dylan Scott wrote for Vox: “A disastrous inundation of hospitals can likely be averted with protective measures we’re now seeing more of — closing schools, canceling mass gatherings, working from home, self-quarantine, self-isolation, avoiding crowds — to keep the virus from spreading fast.”
In the best-case scenario, which has become less likely, this outbreak might look more like H1N1 swine flu. When H1N1 was first recognized in 2009 and spread around the world, there were major concerns about its lethality. US schools closed, people from North America were quarantined when they arrived in other countries, flights were canceled. Not only did those measures fail to contain the virus, Nuzzo said, but it also turned out H1N1 wasn’t all that deadly.
“Now we’re still living with that virus — it’s one that circulates with every flu season,” Nuzzo explained.
7) Are there any places I shouldn’t go during this outbreak?
The CDC has issued its highest-level travel alerts for Italy, Iran, South Korea, and China, advising Americans to avoid traveling in these places for the moment. These are the countries with the largest known coronavirus outbreaks. On March 11, President Donald Trump issued a ban on travel from most of Europe for 30 days.
But just because a country you plan to visit isn’t on the list right now doesn’t mean it won’t be there tomorrow. The outbreak is evolving rapidly, and these advisories are likely to change in the coming days, so keep checking in with the CDC. This map and list of travel restrictions from the Council on Foreign Relations is another good resource.
As Nuzzo told Vox: “I’m more concerned about the unpredictability of the [outbreak] response at this point. It would not be fun to go to China and get stuck there somehow. And coming back, you’ll be subject to additional screening” or quarantines.
What if you decide to travel and you’re seated near someone who is coughing or sneezing? That’s not very reassuring, but it’s not time to panic, either. “The risk of acquiring a respiratory infection through air travel is still extraordinarily low,” Bogoch, who studies how air travel influences the dynamics of outbreaks — including the new coronavirus infection.
The risk does go up if you happen to be seated within six feet of a person with a respiratory infection. But even there, simple proximity doesn’t necessarily mean you’ll catch anything. Instead, the more infectious the person is, and the longer you sit near them, the higher your risk. If you’re not near the person for very long or they’re not very infectious, the risk is lower.
Also keep in mind: The travel warnings are not entirely driven by the risk of catching this new virus. Airlines have been canceling or scaling back flights, trains have been halted, and countries have been imposing quarantines on travelers and citizens.
8) How is the world responding to this crisis?
On January 30, the WHO declared the outbreak a global public health emergency, and about a month later said it had become a pandemic.
A dramatic — and unprecedented — response played out in China, the country with the most Covid-19 cases. “China has implemented the most extensive cordon sanitaire [or quarantine] in the history of humankind,” Gostin told Vox. “They’ve restricted movements, caused fear and panic. They’ve violated human rights.” But they also managed to get more control over the outbreak, and cases are now declining.
Italy has adopted quarantine measures that are similar to China — first locking down some 16 million people in the country’s north, where the virus has been spreading, and then extending restrictions on movement to the entire country.
Some governments have so far been able to halt the spread of coronavirus within their borders, seemingly through quick action. In Taiwan, a small island close to mainland China, testing for Covid-19 began in late December, even as China was just beginning to discover cases and ramp up its response. The Taiwanese government also emphasized public education about curbing the disease’s spread. Taiwan has only reported one death from the virus, as of March 11.
In recent weeks, the US government dramatically escalated its response: issuing its highest-level travel advisories, quarantining citizens evacuated from China, and banning foreign nationals who have recently been to China from coming in, as well as travelers from Iran. On March 11, Trump announced a 30-day travel ban from most of Europe to the US (excluding the UK).
The CDC warned, on February 25, there may be a lot more to come; “disruption to everyday life might be severe.” This means Americans can expect more cancellations, quarantines, and social distancing efforts. (To read more about those, see this explainer.)
The severe measures can be explained by the fact that there’s still a lot we don’t know about this new virus and health officials are taking drastic actions. There’s also no enforceable international law governing outbreak responses, so countries can basically do what they want in response to pandemic threats without getting penalized, even if those actions are proportional or science-based, and the WHO is advising against them.
9) How might this end?
There are a few ways this outbreak could end, as Vox’s Brian Resnick explained. Perhaps public health measures — identifying cases fast, putting infected people in isolation — will slow the spread of this coronavirus. (That’s what stopped the spread of SARS in 2003.)
“If we slow it so that infections happen over 10 or 12 months instead of over one month, that’s going to make a big difference as far as how many people seriously infected, how many people may end up hospitalized, and how many they end up dying,” said Tara Smith, a Kent State University epidemiologist. “We talk about it as ‘flattening the epidemic curve’ — so that it’s not a big, sudden peak in cases, but it’s a more moderate plateau over time.”
Because this is a zoonotic disease, meaning it came from an animal, finding and eliminating that source would also help.
Or maybe a vaccine or antiviral will be invented quickly to curb a broader epidemic (though a vaccine is expected to take at least a year).
Related A simple guide to the vaccines and drugs that could fight coronavirus
The coming seasons of warmer weather could also play a role in at least slowing down the virus. “Coronaviruses are winter viruses,” Fauci said. “When the weather is warm and moist, these viruses don’t spread as well as when the weather is cold and dry.”
Covid-19 could also keep spreading at a high rate and become endemic — regularly infecting humans, like the common cold.
Either way, “it’s going to have tremendous — really negative and lasting effects — for the most vulnerable people who are either medically or economically vulnerable in our society,” Angela Rasmussen, a Columbia virologist, told Vox.
Correction March 3: A graphic in this piece previously misstated the percentage of cases in China that were not linked back to the Wuhan area. The graphic has been updated with the correct figure, 14 percent.
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