Elaine Thompson/AP

Respiratory therapist Lee Philips is assisted with a face shield before going into a patient's room in the COVID-19 Intensive Care Unit at Harborview Medical Center Friday, May 8, 2020, in Seattle.

Dr. Hala Sabry tried to stay composed as she looked down at the woman lying in the bed beside her. The patient was a mother in her early 40s. “The same as me,” Dr. Sabry thought.

An emergency medicine physician, she has learned to bridle her emotions when death draws near. This time, as her patient slipped away, the tears fell.

Dr. Sabry grieved for the woman and her loved ones, none of whom were allowed in the hospital room to comfort her. In an almost unconscious act, the doctor and her medical team gathered around her, joining gloved hands in silent prayer.

Before this year, before the onset of COVID-19, Dr. Sabry felt prepared for the intense vagaries of her work. She seldom considered her job a threat to her life or her family. Now, splitting time between two hospitals outside Los Angeles, she traverses the uncharted extremes of the pandemic.

“There’s still so much we don’t know about what we’re up against,” says Dr. Sabry, who lives with her husband and their five children. The questions extend from the medical to the familial. When she leaves home for her next shift, she wonders, “What if I die? What will my kids do?”

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She has countered the uncertainty, in part, with a private Facebook group she started for health care providers to support each other and share information as they confront an unrelenting fight to save lives.

An offshoot of the Physician Moms Group, an online community Dr. Sabry founded in 2014 for women juggling medical careers and family duties, the COVID-19 subgroup has attracted more than 37,000 members around the world. She gains strength from the solidarity as much as the exchange of details on treatments, scientific articles, and initial studies.

“We run toward patients with the disease, and when you see other people doing the same, it’s invigorating,” Dr. Sabry says. “The sense of community reminds us continually about our purpose. You don’t feel alone.”

The demands of responding to the crisis consumed Dr. Lorna Breen, an emergency room physician in New York who treated coronavirus patients and contracted the illness. Her suicide last month brought into focus the mental and emotional toll of the pandemic on doctors, nurses, and other practitioners amid the rising number of deaths, shortages of protective equipment, and lack of proven remedies.

The collective strain has moved health care workers to launch social media efforts to reassure and inform their own and magnified the importance of peer support programs that can alleviate their internal burdens. In illuminating that hidden struggle, wellness experts explain, the outbreak presents a chance to address the mental health needs of providers – needs neglected long before COVID-19 – and fortify their resilience to persevere in the moment and beyond.

“This is an opening to try new things,” says Dr. Anne Browning, who helps manage the peer support program for University of Washington Medicine, a health care network in Seattle. “It’s an opening to ask, ‘How can we support our people in managing this hardship and not have them go back to just white-knuckling it?’”

A different approach

Health care workers tend to adhere to a code of silence about their mental health for fear of ostracism by colleagues and the potential impact on their medical licensure and careers. Research has found that an aversion to self-care contributes to high levels of burnout and post-traumatic stress disorder among doctors and nurses, whose suicide rates run well above national averages.

Studies in Canada, China, and other countries show escalating rates of anxiety and depression among front-line responders treating coronavirus patients. In the United States, where almost 9,300 providers were diagnosed with COVID-19 through mid-April, health care networks have turned to various strategies to aid them, including meditation and sleep apps, crisis lines, and online counseling. Some hospitals have set up “recharge rooms” with soothing lights and music.

The American Medical Association lists peer support among the resources and recommendations for assisting providers. In a quirk of timing, UW Medicine established its program in January, only days before the country’s first coronavirus case surfaced in a Seattle suburb.

The peer model emphasizes informal, confidential conversations to reduce the reticence of caregivers and the pervasive stigma against seeking help. Providers who volunteer as peer specialists receive training to recognize signs of stress, emotional fatigue, and burnout. They learn to point colleagues toward methods for coping that range from exercise, cooking, and gardening to self-help books and clinical counseling.

“The program allows people to decide if they want to talk and also to be more supportive of one another,” Dr. Browning says. “It creates openness.” Most health care systems have yet to embrace peer support. She expects that to change as medical workers contend with a deepening sense of helplessness.

“This unprecedented event has shown folks that they have to pay attention to well-being in a way they haven’t previously,” she says. “A different approach is way overdue.”

The safety concerns and social restrictions that await providers outside the hospital erase the line between work and home, compounding their distress. Many worry about exposing family members to illness or live apart from them to avoid the risk.

Talking with colleagues can act as a release valve for practitioners and recalibrate their emotional balance. “When people experience hard events and don’t get enough support, it leads to burnout,” says Dr. Kiran Gupta, medical director of the peer support program at University of California, San Francisco Health. “That’s what we want to prevent.”

The hospital system formed its program three years ago and has shifted individual and group sessions to Zoom during the pandemic. Volunteers from the network’s pool of behavioral health clinicians have joined the effort as demand rises for peer services.

The program’s webinar series on mental health has proven useful for Dr. Rima Bouajram, a critical care pharmacist. As hospitals prohibit families from visiting loved ones dying from the virus, providers fill the void, comforting patients in their last moments. Dr. Bouajram’s training as a peer supporter has made her more inclined to ask co-workers about their mood, to take time to listen to their frustrations and console them in their despair.

“We don’t usually talk about our feelings in the intensive care unit,” she says. “But we need to be there for each other. Everybody is affected.”

The people behind the masks

The Instagram page Frontline COVID-19 shares the stories of practitioners from inside the pandemic. Drs. Jessica Lu and Sandra Truong, colleagues at UW Medicine, created the project to unite providers across the country and enlighten the public about their daily reality.

A recent post from an ICU nurse in Atlanta captured her mix of emotions after a 12-hour shift. “I do have a sense of pride knowing that I am actually able to make a positive impact in someone’s life in a time of crisis – that’s a huge reason why I became a nurse,” Gabi Naumann wrote. “But also I am tired, and sad, and angry, and anxious about what the future holds.”

The anecdotes reveal the people behind the masks and the invisible weight they carry. Dr. Lu recalls losing one of her patients, a nursing home resident she saw for regular checkups and who remained in good health until she contracted the coronavirus.

“She was such a bright light in my patient experience. I think of her blue sweater, her pink nail polish,” says Dr. Lu, a second-year family medicine resident. She received the news of the woman’s death in a phone alert. “Not being able to be by her side, not seeing her again – that was really difficult in a different way.”

Behavioral health researchers warn that the emotional fallout from the outbreak’s first wave could reverberate for months and even years for front-line responders. The potential fallout concerns Dr. Wendy Dean, a psychiatrist and co-founder of the nonprofit group Moral Injury of Healthcare, who advocates for protecting providers.

Staving off burnout among them will require hospital networks to devote greater resources to preserving their mental and physical health, including psychological first aid and adequate personal protective equipment.

“Health care organizations need to listen to their workers,” Dr. Dean says. “They will need a chance to process what they’ve been through, to get right with what they’ve seen and had to do. You can’t heal the health care system without healing them.”

The pandemic has laid bare that system’s numerous deficiencies. At the same time, the ordeal has strengthened providers’ camaraderie, seeding hope among them that a spirit of shared empathy will outlast the coronavirus.

“This is a chance to change the culture of health care,” says Dr. Jina Sinskey, a UCSF Health anesthesiologist and trained peer supporter. “It’s a chance to show compassion for others and for yourself, and to recognize we’re in this together.”

The bond with colleagues – along with frequent walks with her dog – sustains Dr. Lu as the outbreak stretches from weeks to months. She weathers the loss of patients by cherishing the triumphs of others.

She recounts the first meal request of a man after he moved out of the ICU while recovering from the coronavirus. He mentioned a craving for chicken tostadas from his favorite restaurant. “Your wish is our command,” Dr. Lu told him. She laughs at the memory.

“It’s important for all of us to remember that people do get better. It’s not all death and despair,” she says. “There is still joy and gratification.”

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When the “most hated man in Washington” suddenly gains 20 new co-sponsors for his bill, it must signal a pressing need. And among the countless problems created or exacerbated by the COVID-19 pandemic, perhaps one of the most urgent has been the strain on America’s meat supply chain. 

With dozens of meat plants temporarily shut down, farmers across the country have had to euthanize tens of thousands of animals, and face the wrenching prospect of far larger culling. Meanwhile, U.S. weekly red meat production has dropped by as much as 34.9% compared with last year, causing prices to surge and grocery store shelves to lie empty.

The crisis has lately prompted nearly two dozen lawmakers to add their names to legislation put forward by Rep. Thomas Massie of Kentucky, an MIT-educated Republican who owns 63 cattle and became persona non grata among his colleagues in the early weeks of the pandemic after he forced them all to come back to the nation’s capital for a key vote.

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Five years ago, he and Democratic Rep. Chellie Pingree of Maine first introduced the PRIME Act, designed to create more flexibility and resiliency in the meat supply system. The bill would allow smaller meat producers to utilize local butchers and sell their products directly to consumers, restaurants, and grocery stores, rather than getting funneled through USDA-inspected facilities and the handful of corporations that make up 80% of America’s meat market.

“What you’re seeing right now is not the result of an efficient capitalist system,” says Representative Massie, who faults U.S. regulations for creating a “monopoly” of big meat companies. He says removing some of the red tape will enable their competition to flourish, paving the way for shuttered or new local butchers to open and existing ones to expand to meet growing consumer demand for locally raised meat. 

The bill, which now has 42 co-sponsors from libertarians to progressives, is one of a growing number of alternative models to industrial meat production that have been gaining traction in recent years, driven by everything from animal welfare and “eat local” movements to constitutional concerns about federal overreach. Now, COVID-19’s intense strain on the supply chain is generating wider interest in rethinking the system. Representative Massie admits the bill’s chances at passing were slim five years ago, but says they have “increased exponentially” this month as consumers learn more about how the food supply pipeline works. “Because the people are now interested, the congressmen are getting interested,” he says. 

Still, it’s unclear how much such initiatives would alleviate the current bottlenecks, with many local butchers already booked into 2021 and freezer space largely maxed out. And while federal inspection is undoubtedly more burdensome for smaller producers and processors, it’s just one aspect of a larger equation involving economies of scale. Above all, America has spent years building a sterling reputation for meat safety among its trade partners – and some say it would be shortsighted to undermine in any way the federal oversight on which that trust is founded. 

“Am I in favor of less red tape that would add flexibility to the supply chain? Yes,” says Glynn Tonsor, a professor of agricultural economics at Kansas State University in Manhattan, Kansas. He says the PRIME Act would help, but cautions, “It’s not a magic bullet.”

Teddy Roosevelt’s run-in with rotten beef

If the U.S. Army hadn’t served rotten beef to Teddy Roosevelt when he was a colonel in the Spanish-American War, perhaps he wouldn’t have pressed as hard for Congress to pass the Meat Inspection Act during his presidency.

The rotten beef scandal precipitated a series of hearings on meat safety, federal inspection practices (or lack thereof), and unsanitary conditions in meatpacking plants, further exposed in Upton Sinclair’s 1906 novel “The Jungle.”

Sinclair, who sought to spark a socialist movement in support of plant workers, instead galvanized public demands for increased government regulation to ensure meat safety. “I aimed at the public’s heart,” he wrote, “and by accident I hit it in the stomach.” 

Roosevelt, after sending investigators to the packinghouses to verify Sinclair’s depiction, used the ensuing report to push the stalled Meat Inspection Act through Congress in 1906.

Under that law, all meat sold across state lines must be processed in a USDA-inspected facility, where an inspector is on hand at all times to examine livestock, ensure humane slaughtering practices, and observe the processing of meat. Meat for sale within a state can be processed at a state-inspected facility, provided its standards are at least as stringent as the U.S. Department of Agriculture’s. Currently, the only exemption to that inspection regime is for owners of livestock who get meat processed at custom processors for their own consumption, or to share with family, employees, and nonpaying guests.

With a limited number of USDA-inspected facilities, smaller producers often have to drive their livestock hundreds of miles to get their meat processed, adding substantially to the cost and running the risk that their product could be mingled with industrially produced meat.

This spring, Wyoming passed a pioneering law that would allow ranchers to sell meat to their neighbors – while the cattle are still alive. By buying shares in a herd, customers would be considered “owners” at the time of slaughter and thus allowed to consume the meat without inspection by the USDA.

“I don’t think [the USDA is] this nefarious organization plotting in the deep state or trying to prevent grandmothers from buying T-bone steaks from their next-door neighbors,” says state Rep. Tyler Lindholm, who spearheaded the bill. But, he adds, citing the 10th Amendment of the Constitution, “What authority do you have to tell Wyoming citizens that [they] can’t sell steak to each other?”

The PRIME Act, short for Processing Revival and Intrastate Meat Exemption, seeks to go one step further than Wyoming’s law by giving states the option of permitting custom-slaughtered meat to be sold not only to individual consumers but also to restaurants, grocery stores, and other outlets within their borders.

Introduced in May 2019 for the third time in four years, the bill has yet to move forward. In a May 14 letter, Representative Pingree urged Speaker Nancy Pelosi to take up the bill in response to the current processing and supply shortages.

“I am not advocating for relaxing the standards that the USDA has set,” wrote the Maine congresswoman, an organic farmer who raises vegetables, pigs, and chickens. “I am simply asking that we address the needs of communities in a way that supports them both economically and morally during this unprecedented time, by allowing America’s family farms to do what they do best – feed their neighbors.”

Still, many in the meat industry caution against such a move.

Colin Woodall, CEO of the National Cattlemen’s Beef Association, says the association opposes the PRIME Act because of how it could undermine years of investment in making USDA-inspected meat the “gold standard” around the globe. “If there is a food safety issue that breaks out ... that’s not going to be the problem of Johnny’s local [meat] locker; that’s a beef industry problem,” he says.

Founding Fathers vs. the WTO

A central aspect of the debate is about who is responsible for ensuring safety. Advocates of less regulation say that greater transparency in packaging, such as where meat was raised and processed, could give consumers the opportunity to make informed decisions about the food they’re purchasing, rather than depending solely on the government.

“Our founders never intended government to be so ingrained in our life that it became ... the preserver of safety,” says Ben Adams, a Marine running for the Idaho state legislature as a Republican, who has been in touch with state Representative Lindholm about using Wyoming’s new law as a model for his state.

Critics of federal regulations also call into question aspects of USDA inspection they see as excessive – such as a requirement that all USDA inspectors be furnished with an office and a bathroom for their exclusive use. Many also see the current rules as arbitrary.

“Right now, I could step out on my deck and butcher 1,000 chickens on my deck ... and I could sell those directly to consumers without any inspection, labeling, or licensing. But I can’t sell one T-bone steak,” says state Representative Lindholm in Wyoming. “It’s not actually about safety anymore; it’s about protecting a monopoly.”

Others say only the federal government is in a position to guarantee consistency of standards and comprehensive oversight, both of which are key for trade relationships.

Darci Vetter, who grew up eating uninspected meat on her family farm in Nebraska and served as chief agricultural negotiator for the U.S. trade representative under President Barack Obama, says it’s vital not to put exports at risk. As of 2017, the United States exported nearly 13% of the beef and 27% of the pork it produced, with market development activities in more than 80 countries.

“From a former trade negotiator perspective, what we don’t want is for a major destination for U.S. meat to say, ‘Hey, wait a minute, ... How do I know if the rules are actually being followed?’” says Ms. Vetter, now the vice chair for food and agriculture at Edelman North America.

The 2003 outbreak of BSE (popularly referred to as mad cow disease) in the U.S. prompted nearly all international markets to stop accepting American beef, incurring losses of $16 billion over a decade. “It’s 17 years later, and we can still feel the effects from those markets being closed to us. You can understand the hesitation,” she says.

In addition, the World Trade Organization prohibits member nations from creating preferential markets for domestic products. If local producers are seen as gaining an advantage over foreign exporters of meat to the U.S., such as being exempted from the cost of USDA inspection, that could run afoul of WTO rules.

Some cattlemen say the system is stacked against them. But Trent Loos, a sixth-generation farmer in Nebraska and radio show host with a wide following out West, says that while deep-pocketed corporations have a greater ability to hire lobbyists, he doesn’t buy the idea that American cattlemen are disadvantaged.

“I just think we’re not loud enough. I think we gotta get louder,” says Mr. Loos, before meeting with a Nebraska state senator interested in Wyoming’s model. 

The Walden Meat model

Even under the current USDA inspection regime, some local meat markets are finding ways to thrive. Walden Meat, which delivers locally raised meat to customers across New England and New York, has seen a tenfold increase in the rate of new customer sign-ups over the past couple of months.

They co-own and operate a regional slaughterhouse in Vermont, and everything they sell is USDA-inspected, which CEO Charley Cummings says lends their product a certain credibility.

“We really value the USDA as a partner in that regard, and see them as playing a really important role in establishing universal standards,” he says. “We have not found it overly constraining to the viability of a farm-to-consumer business.” He notes, however, that such a model wouldn’t be workable in a less densely populated area like Wyoming.

Mr. Cummings says Walden Meat, which aims to price its products at 10% to 15% less than Whole Foods, delivers 55 cents to farmers and butchers per dollar of meat sold, compared with 10 to 11 cents in the commodity world.

“We’re all for everything that delivers more dollars to farmers’ pockets,” he says. “What this crisis has laid bare is that we have prioritized efficiency in meat production above all else – animal welfare, environment, farmers, processors, and employees in every step of that value chain.”

As customers have increasingly sought local meat, whether out of animal welfare concerns or nutritional considerations, they have found creative ways to work within the USDA law – such as going in with a friend on a pig or a cow before it’s slaughtered, and then splitting the meat. Wyoming’s state Representative Lindholm has made that somewhat easier with his herd share law, which allows an unlimited number of people to “own” the animal.

But Representative Massie says such workarounds are cumbersome. Plus, he says, the USDA exemption is regressive; not everyone has $1,000 or the necessary freezer space. He argues there’s an untapped potential for local producers to make a far greater contribution, and bring local meat within the reach of average Americans.

“You’re forcing people that should be able to engage in legitimate commerce to come up with these crazy constructs to do it,” he says. “You shouldn’t feel like you’re exploiting a loophole to sell your neighbor a hamburger.”

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Fernando Carranza/Reuters

An employee of the clothing brand El Chapo 701, owned by Alejandrina Gisselle Guzmán, daughter of the convicted drug kingpin Joaquín "El Chapo" Guzmán, hands out a box of basic supplies during the COVID-19 pandemic, in Guadalajara, Mexico, April 16, 2020.

“We’re not on vacation, we’re in quarantine,” an announcement blasted from a car-mounted megaphone, bidding residents of a crowded Rio favela to remain indoors after 7:30 p.m. Thousands of miles north in the Mexican state of Guerrero, a banner told people to stay home: “If we find you outside, we’ll pick you up.”

Similar messages have been broadcast over the past two months in vulnerable communities across Latin America, from Colombia to El Salvador, Venezuela to Honduras. But these aren’t government PSAs. Leaders in Mexico and Brazil, in particular, have been late to react to the pandemic, and have denied its seriousness.

Local gangs and organized crime are taking advantage of government leadership vacuums, sometimes playing up their roles as pseudo-caretakers of forgotten citizens in marginalized neighborhoods. From setting curfews and enforcing them to handing out boxes of food and face masks, the criminal underworld – long thriving here – is positioning itself to come out of this pandemic with increased control over territory, and more deeply entrenched loyalty from locals, experts say.

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Criminal groups are known for persecuting the communities where they operate, extorting businesses and exerting violence on civilians. But they also frequently cast themselves as protectors. As government lockdowns stomp out informal employment, erase incomes, and slow remittances, state attention is increasingly focused on the pandemic – creating openings for criminals to step in and try to win over more hearts and minds.

Not all groups are looking for the same results. Even in places like Brazil, where gangs quickly rolled back initial preventive measures in many Rio favelas, COVID-19 is highlighting the underlying dynamics among governments, organized crime, and citizens across the region.

“In some territories where crime is a powerful actor, these [criminal] groups have taken advantage of the moment to press themselves on local communities as the real guardians and providers,” says Ivan Briscoe, the International Crisis Group’s program director for Latin America and the Caribbean. “It can provide a veneer of responsible public service. And it’s a real factor of control.” 

Mexico: Gangs press their advantage

Latin American gangs have diversified and fragmented since the 1980s and ’90s. They increasingly rely on businesses beyond drugs, like extortion, kidnapping, and human trafficking, which arguably hit local businesses and communities hardest. But they still need social support – key in incentivizing locals to turn a blind eye to illegal activities.

In Mexico, winning that support might mean large-scale parties with big-ticket gifts. Or, in the wake of natural disasters, handing out cooking supplies. In April, the Gulf cartel in northern Mexico not only distributed boxes of basic goods stamped with its name, but also seemed to run a public relations campaign. Videos and photos were disseminated online and to local media, showing towers of boxes filled with aid. Cartels around the country orchestrated similar productions, a shift from past handouts that were typically carried out more quietly. The daughter of convicted drug trafficker “El Chapo” Guzmán appeared in videos on Facebook pulling together “El Chapo” care packages, reportedly delivered in multiple Mexican states, including one controlled by a major rival cartel.

“They often move faster than the government” when delivering aid, says Juan Cedillo, author of “The Hidden Narco Wars,” who covers organized crime in Mexico for a national newsmagazine. COVID-19 has been no different. The rush to acknowledge the difficult situation “allows them to maintain control of the region and ingratiates the population,” Mr. Cedillo says. “They don’t do it out of the kindness of their hearts. It ... creates a circle of safety where they can conduct their illegal business without people reporting them.”

For decades, the Mexican government has fought unsuccessfully to quash organized crime. Instead, groups have expanded their territories, and confrontations have led to an increasingly lethal landscape. 2019 was Mexico’s deadliest year, with some 34,500 people killed. President Andrés Manuel López Obrador came into office promising to address the root causes of organized crime, like poverty and lack of opportunity. But he’s been criticized for leaning on a militarized approach similar to his predecessors’. 

Now with coronavirus in the mix, Mexico is diverting money earmarked for police training to the purchase of medical supplies, and the newly formed National Guard was moved to hospitals to protect medical professionals, opening up more opportunities for criminal groups to operate unchecked.

“Most people would prefer to have the government supporting them,” says Mr. Cedillo. What’s at risk when it pulls back during COVID-19 is that small businesses are more likely to turn to criminals for financial lifelines. “They will end up in the hands of the crime bosses, who will consolidate their power and come out on top,” Mr. Cedillo says. “Without a doubt organized crime is taking advantage of this moment.”

In many countries homicide and robbery rates are on the decline amid lockdowns. But most analysts agree organized crime will emerge more powerful, even if border closures and curfews have weakened their business models. This is a moment when nations struggling to overcome organized crime should be doubling down, according to Alejandro Hope, a security specialist in Mexico. But for the most part, “they are not even trying,” he wrote in an April 20 opinion piece for the Financial Times.

Brazil: Business as usual

The first coronavirus case in Rio’s City of God favela was registered in late March. Soon after, residents got clear messages from drug lords via WhatsApp audio messages, banners on the street, and a truck blasting a recording: Stay inside after dark – or face consequences.

Brazil’s president, Jair Bolsonaro, has stood out globally for his blasé approach to the pandemic, which he’s referred to as “a little cold.” Brazil has more than 250,000 confirmed cases of COVID-19, and more than 16,000 deaths – one of the highest tallies in the world.

But despite the initial efforts – and scare tactics – in City of God, the gang-imposed measures didn’t last. They continued for “a week or two, maximum. After that ... people went back out on the street,” says Mayara, a resident who, like others in this story, asked to be identified only by her first name for security.

The owner of a barbershop continued trimming hair and shaping beards without a mask, a resident says. A sweets vendor carried on selling sticky cakes on a busy street corner. Bars and stores remained open, with dozens of people weaving through the favela’s narrow streets.

“Enforcing a lockdown doesn’t make any governing authority popular,” formal or otherwise, says Benjamin Lessing, a professor and researcher who studies criminal governance in Rio’s favelas. He says the crisis has brought into “sharp relief the places where gang governance is strong and state governance is weak.”

In some favelas, criminal groups quickly returned to business as usual – with a discount. In Rocinha, one of Latin America’s largest favelas, motorcycle taxis, widely used to scale the steep streets, now pay roughly $10 in extortion payments per week instead of the usual $17.

“Everything is as normal,” says José, a Rocinha resident. “They’re charging for a cut of the gas; they are charging the mototaxis; they’re charging the vans. ... And I see nothing here that has been done by the traffickers against coronavirus.”

In Brazil, many favelas already have a deeply entrenched criminal presence, which may mean gangs don’t need to solidify their hold through acts of leadership or goodwill, says Gabriel Feltran, author of a book about Primeiro Comando da Capital, Brazil’s largest criminal organization. In other parts of the region, turf battles are frequently the norm, leading to more creative efforts to win civilians over. Even in favelas that are under strong gang control, there’s traditionally some state presence. Gangs rarely get involved in health care – why start now?

Meanwhile, the gap is being plugged by residents and activists, Mr. Feltran says.

In Santa Marta, a favela that sits in the shadow of the Christ the Redeemer statue, a community organization is supporting needy families with food and monthly allowances. In Rocinha, residents donated hundreds of masks to a government-run health clinic, reversing expected leadership roles by providing help to the state.

The pandemic is doing one thing universally, says Mr. Briscoe: exposing inequality. Whether it’s access to medical attention or economic safety nets, the inequity put on display right now “fundamentally explains the ability to recruit and operate criminal groups,” even before COVID-19.

There’s a realization that “no country can ever claim to fully control the virus until the poorest, most vulnerable populations are also protected,” he says.

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Jeff Chiu/AP

Rachel Keenan takes a live class online at her home in San Francisco on March 19, 2020. Some educators expect remote learning to be included in return-to-school plans in the fall.

What will K-12 schools look like when their doors eventually reopen? Education leaders in the United States are planning multiple options for the fall, ranging from all students returning to buildings to continuing fully remote learning. What schools decide will vary based on guidance from local and state officials. Various approaches are already being seen as some schools reopen in Europe. France has already had to reclose some schools. A number of issues will inform the decisions of school officials.

How will K-12 schools look different when they reopen?

Promoting social distancing, hygiene, and heightened cleanings are top priorities for schools. A report on reopening from the American Enterprise Institute, a Washington think tank, recommends face masks worn by staff and students, frequent temperature checks and hand-washing, and desks placed 6 feet apart. This week, the Centers for Disease Control and Prevention in the U.S. also updated suggestions for schools. Other ideas include lunch in classrooms, closed playgrounds, and no all-school assemblies. 

“I think the real question is what will [students and staff] not find changed,” says Robert Hull, president and CEO of the National Association of State Boards of Education. 

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Curtis Jones, superintendent of the Bibb County Public School District in Macon, Georgia, which serves about 21,000 students, says he’s planning on various scenarios for schools to reopen in August, including students coming to school for two or three days and learning remotely the other days, as well as developing a full online curriculum for students who choose not to return. He thinks some students will return full time, but classes will be smaller.

“I see this as a transition period,” says Dr. Jones. “I think this will give us an opportunity to make a transition to the next phase of what public education looks like.” 

In Reno, Nevada, schools in Washoe County School District will see more frequent cleanings, protective equipment for all employees, hand sanitizer stations, and social distancing measures once reopened, says Superintendent Kristen McNeill. She’s also considering installing plexiglass in front offices and additional buses to space out kids in the district of about 64,000 students.

Will remote learning continue? 

Remote learning plays a key part in reopening plans and public education going forward, educators say. The Maryland State Department of Education recovery plan, for instance, suggests options such as alternating weeks of in-person and remote instruction. 

One key concern is that millions of students who lack access to devices and the internet could be left out of remote learning.

“Home internet access for every student has to be a given moving forward, otherwise this remote learning will not work and we essentially will be denying many children their free, appropriate education which they are entitled to in this country,” says Susan Enfield, superintendent of the Highline Public Schools district in Burien, Washington, just south of Seattle. 

Dr. Enfield estimates 2,500 students in her district are still without internet connectivity and calls it the biggest barrier for remote learning, which she believes will be a part of how schools operate going forward. 

Staff in the district are working with teachers and families to find out what has worked and what needs to be changed with remote learning and are developing plans to have more “synchronous” remote learning in the future where teachers and students are online together for a class session. 

How will schools accommodate varying comfort levels?

School leaders acknowledge that many parents and school staff may not feel comfortable returning to school under social distancing guidelines, or without a COVID-19 vaccine. 

An early May poll of 500 parents from the National Parents Union found that 67% supported keeping schools closed until officials are certain reopening won’t pose a health risk. Many teachers, janitors, bus drivers, and other school staff are above the ages considered higher risk and teachers unions have cautioned against opening schools too soon. 

Dr. Jones says schools in Bibb County have technology in all classrooms, so there are ways for teachers to join students from a remote location while a substitute is in the classroom. That option for at-risk educators was also included in a plan published in late April by one union, the American Federation of Teachers. Washoe County School District already runs a virtual K-12 school and Dr. McNeill is considering expanding its capacity. 

Mr. Hull, of the school board association, recommends school leaders ask parents and community members what their biggest concerns are and work together toward finding solutions. “There’s a lot of fear and a lot of concern,” he says, “and the way you handle that is by being methodical, by being strategic, and being open and transparent and including everyone in the conversation.”

Editor’s note: This story has been updated to include the latest guidance from the Centers for Disease Control and Prevention. As a public service, all our coronavirus coverage is free. No paywall. 

AP

Interior designer Stephanie Jones at the design firm Bergmeyer puts up a safe distancing reminder at the company's offices in Boston.

The office is a place where people display their second selves. They dress differently from home and think about topics unlike those spoken around the kitchen table. It’s a place to join a different “family” pursuing its own goals.

But now after COVID-19 lockdowns pushed many people to work at home, the line between those personal and public selves is looking fuzzier than ever. The nature of office work may change forever, but the changes are still hard to predict.

Early reports are surprisingly positive. Many companies find they can function just fine with employees logging in from home (or elsewhere). And workers have seen benefits, too, such as saving the time and cost of commuting. One recent survey found nearly half of the people now working from home say they would like to continue to do so.

What might this mean? As large numbers of workers remain at home, what happens to big cities and their office towers? One survey of corporate real estate users revealed that nearly 7 out of 10 thought companies will be using less real estate in the future because of remote work. Office vacancies in the United States (now 16.8%) will rise to 19.4% by the end of the year, research firm REIS estimates.

Some companies may abandon a central headquarters altogether. But not every business (or every worker) wants to walk away from the communal office. Companies that want or need at least some employees on-site are expected to ease them back to their desks slowly and safely, a few at a time. It’s a job that will need to be done sensitively, lest workers sense their bosses care more about the bottom line than about their health.

All sorts of new ways are being imagined to make workplaces safer, from limiting the number of people in elevators to one-way hallways, touchless door openers, and a return to high-walled cubicles.

After the 9/11 disaster at New York’s twin towers, some predicted the demise of the office skyscraper. They reasoned that workers would be afraid to enter big buildings. But that hasn’t happened. And the extra security put into public places (video cameras, body scanners, more visible guards) no longer seems alarming. New measures meant to ensure office buildings are “healthy” may eventually have the same effect.

Making workplaces safe is still a work in progress. Those who’ve kept going to workplaces all along, such as at Amazon warehouses and post offices, haven’t always felt their safety has been top of mind. More than 13,600 complaints and referrals related to COVID-19 have been filed with the federal Occupational Safety and Health Administration. They include being forced to work next to sick co-workers and not being provided with adequate safety equipment.

The key to a new and safe workplace is strong mutual trust between companies and their employees. “The hope is that the pandemic will have shown managers that workers can be trusted to do their jobs without constant supervision,” says Kate Lister, president of Global Workplace Analytics. In return, employers must keep the welfare of employees atop their list of priorities.