The headlines about the United States and China have been dominated by the spread of COVID-19 and trade deal negotiations. Experts in U.S.-China relations have warned against preemptive disengagement in a time of increased need for international cooperation and coordination, even as tensions between the two countries continue to escalate in the media.

From Adam Segal's perspective, as an expert in security issues, technology development, and Chinese domestic and foreign policy at the Council on Foreign Relations, one of the emerging considerations that will prominently affect the tone and timbre of the relationship between the United States and China in the coming years is how the two nations compete with one another in technological and scientific research and innovation. He delved further into this topic in a lecture as part of the China Program's winter/spring colloquia series.

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As Segal and others describe, both the United States and China benefitted immensely from the globalization of scientific research and collaboration, but in recent years, both have also become wary of sharing talent and resources too broadly or across too many sectors. As a result, each country has taken various measures in an attempt to gain and regain perceived advantages over the other.

As China has tried to move up the so-called economic value chain from being an overwhelmingly manufacturing and heavy industry-based economy to being a leader in tech and digital economies, it has simultaneously tried to wean itself from a dependence on foreign technological infrastructure. In its efforts to create indigenous innovation and technological growth, it has openly tried to court talent and intelligence from overseas. To the United State's rising concern, however, the Chinese government has been less open about the means used to accomplish this aim.

On its part, the United States has upped its efforts to expand cybersecurity research and initiatives. The Trump administration has very vocally critiqued companies such as Huawei and urged allies to step back from business with the telecom and networking giant. Similarly, allegations of espionage against native Chinese and Chinese-American scientists and academics have escalated in recent months.

Segal argues that these simmering tensions signify the growing awareness each country has of the other's increasing capabilities in the cybersphere, as well as a heightened understanding and awareness of the shortcomings of their own systems.

"I think technology, which had usually been a fifth, sixth, seventh on the agenda in the U.S.-China relationship, is going to continue to be one of the defining issues that structure the relationship, and increasingly is one not just about concerns about national security, but about values and how we think about how technology is applied, and governance issues."

To watch Segal's full lecture, click the video below or find it on our YouTube channel. A transcript of his remarks is available

“Accommodate a despotic ruler if you have to,” says Stephen Krasner, a Senior Fellow at Stanford University’s Freeman Spogli Institute for International Studies in his forthcoming book How to Make Love to a Despot: An Alternative Foreign Policy for the Twenty-first Century  (Liveright, 2020). Krasner suggests that by embracing rational choice institutionalism, the U.S. should be working with the elites the way they are, rather than expecting them to abide by our standards; aiming for not more and not less than “good enough governance.” We talked with Professor Krasner in more detail about his “third approach.”

Q: Your book How to Make Love to A Despot is coming out in April. The main takeaway is that the United States is permanently oscillating between two bad foreign policies and you are suggesting a third way. You say that the United States lives in a delusion that the rest of the world can and should be like us?

Krasner: I think the problem is that the United States has assumed that every other country could be a consolidated democracy. I think the clearest example of that is China. The assumption was that China would get richer, would have a large middle class, and it would become democratic. They'd be just like us. In the 20th century the United States, basically since it entered World War One, and then later through Vietnam, Iraq, Afghanistan, etc. wanted to turn the world into a set of consolidated democracies. That has worked sometimes but most of the time it hasn't worked. What I suggest in the book is what we should aim for is good enough governance that may turn into consolidated democracy at some point in the future, or it may not. It requires luck for that to happen, not just having the right conditions. But at least we wouldn't be inhibiting consolidated democracy from ultimately emerging.

Q: I can't resist but to ask about these examples you mentioned: Vietnam, Afghanistan, Iraq, these are all countries where the US has intervened with military force. So, when you say democracy promotion, what do you mean by it? Does this entitle military interventions too?

Krasner: I don't think it entitles a military intervention. Most of our military interventions have failed. I worked in the Bush administration, I think that President George W. Bush definitely believed that if you invaded Iraq and you demonstrated the benefits of democracy, that people would become democratic. And I think the fallacy here is that it was a kind of naturalness that if we intervene, we will be successful. I think the problem with active efforts at democracy promotion is that most of the time having a consolidated democracy means that you'll undermine the position of the traditional elite or the ruling elite. And they were not going to accept that. And they know more about the country than we do. So even things that are very well funded, have very well intentions, very well designed, often fail.

Q: So, do you honestly believe that the tendency of war in Iraq was democracy promotion?

Krasner: I do. I honestly believe that. I was in the administration at the time and I completely believe it. I think that Bush really believed that if we took the sewer cover off in Iraq, that that freedom would spring forth. In fact, that's not what sprang forth. I think that we did believe that it was relatively easy. When you're rationalizing why you're doing things in the rest of the world, why you're intervening in other parts of the world the standard American line would be that we're intervening to promote consolidated democracy, which actually turns out to be extremely difficult.

Q: From all the reasons that you just mentioned, you're suggesting the third course, with an awareness that we can't fix the world the way it is, but we can't ignore it either. So, in which way do you suggest that the United States should interact with the world? And how deep should it go and for how long?

Krasner: I think the problem is that we have entered a world in which in the near future it will be relatively easy to create malicious germs, nuclear weapons, etc. At this point, we kind of assumed that more information was better, and great information would rise to the top. That hasn't necessarily been the case. So, we can't detach ourselves from the rest of the world because even non-state actors with relatively limited capabilities, which is what Al-Qaeda was, are able to use weapons against the thousands or hundreds of thousands or even millions of Americans. So, I don't think we can ignore the world. What we can do is to aim for good enough governance. The first thing is that you must be supported by national elites. Even if those national elites are autocratic. I think that way we could provide better security. We can provide some improvement in services, especially in health, which has been a big, big success story since 1945. We also must accept that the idea that we can eliminate corruption is entirely impossible. As you know, patronage is better than stealing a $100 million and moving it outside of the country. But that's the best that we can hope to do.

Q: So, the question is—how do you create this index of what is going to be tolerated and what is not going to be tolerated? What is good enough governance in practice?

Krasner: I don't have a clear answer to that. Good enough governance has to mean that we're trying to create a security environment in other countries, where governments are capable of policing their own territory, which might not always be possible. I don't think we can eliminate, but certainly, try to minimize threats that might arise elsewhere. The problem would be if the government is so repressive that it engenders a large-scale domestic reaction. Now, for the most part, you have to be really, really repressive and really stupid to have that happen, but it does happen sometimes, as it did in Sudan. Ideally, we should try and find government leaders who are inclusive enough that they'll be able to support and maintain the support of backers, necessary to keep them in power. And that's a part I'm uncertain about. I don't have a general rule for that. I think you'd just have to look at a particular situation.

Q: You must agree that there are many regions of the world where many countries are actually relying heavily on the help from the outside and count on active engagement with the U.S.?

Krasner: Yes. So, let me say something which I have to say I'm not certain about. I think acting because we assume that there are some things that are morally intolerable to people who lead the revolution is in general a mistake. Most of the time, if the government is able to keep a relatively stable situation and people are able to satisfy the material resources, I don't think they're likely to revolt. Now, if you look at the bigger revolts we've had, I mean, for instance, the revolt in Russia that led to the Soviet Union, the Romanovs were pretty inefficient and pretty ineffective. They were able to carry on a war for three years until the regime finally collapsed. But it took a lot of fairly bad policies to make that happen. So, what I'm arguing is that in general, I think that we assume that you can't have lasting peace unless you have a peace that's morally sustainable. I am, I should say assuming, because I haven't really done the empirical work in this, but assuming that people are willing to tolerate a lot of things that they consider immoral provided that the government provides them with some basic level of services including security.

Q: When you rely on local elites, as you say in your book, and they always serve their own interests, what would be the foreign policy mechanisms to limit how far that can go? Since the ramifications could be serious and lead the countries deeper into corruption and partocracy.

Krasner: I think that there is no formula for that. We've engaged, we've spent a lot of money directly on democracy promotion. Often the money is basically undermined. Azerbaijan, in the last election, had 50 election observers. 49 said the elections were okay. Only one, which was in the European Union, said the elections were corrupt. If you looked at CICIG in Guatemala, here was an organization that was set up by an agreement between the Guatemalan government and the secretary-general of the United Nations. What are the results? CICIG was disbanded within the last year and the effort to create something like CICIG in Honduras basically failed. In some cases, domestic leaders may misunderstand how threatening some of these organizations are and you have to assume that they know more about their country than we do. And they're not going to accept things which would result in their losing power, possibly being killed, possibly being exiled.

Q: In your book, you’re criticizing modernization theory saying that it just assumes that democracy and welfare can be attained relatively easily. You are also not so sure that putting an effort into building institutional capacity in those countries is enough. Still, in many cases, education on building institutional capacity dramatically helped in reforms.

Krasner: It may work, and it may not. I'm not saying I'm opposed to doing these things, but we shouldn't assume that they're going to easily lead to a consolidated democracy in the end. Hobbes, Samuel Huntington, they both say that you need institutional capacity, but the problem is what is going to prevent leaders who have lots of institutional capacity from acting in ways that serve their own interests, opposed to interests of a population? You're not going to be able to build institutions if they threaten the local political elite. If you look historically only for a relatively short period of time, generously the last couple of hundred years, have you had consolidated democracies in which the political elite could lose power as a result of decisions that were taken by the electorate and most of the world. It's pretty unusual. It’s happened in North America, Western Europe, and East Asia. It hasn't happened in other parts of the world. We shouldn't assume then it's kind of the natural order of things. If you look at recent developments in the United States, it is important that rulers have a set of norms in which they value the foundational values of the country. But if you get a ruler who isn't very interested in those norms, you can have a lot of bad things happen.

Q: The theory that you suggest and call rational choice institutionalism relies on the elites and it stresses that elites will be willing to tie their own hands and adopt policies that benefit the population as a whole only under certain conditions. But when we take a step back and we do look at consolidated democracies, we see that many of the values in those societies are actually the foundation for the policies in those countries. And these values were nurtured over time.

Krasner: I agree with that. In consolidated democracies people have the elite, the political leaders adopted a set of values. It's true in most of the United States, it's true in the American military, it's true in parts of Western Europe in which people do actually cherish these values. But I think often they came later, and they weren't necessarily there in the beginning. I also think religion is one set of values that really matters to people. You have these Evangelical Christians in the United States who, you know, they see Trump, I think they see Trump as being a sinful individual, but they see him as the best bet to defend values that they endorse. Many people in the rest of the United States, they're looking around and seeing a world in which their material wellbeing has just deteriorated for 30 or 40 or 50 years, whether there’s Democrats or Republicans in office, they don't have any belief in anything anymore. Also, if you look at race relations in the United States, they are very troubled. They have been troubled for 300 years.

Q: So, does this mean that your overall understanding of the world today is that it's so bad that the United States should focus on self-preservation and just look at how to protect our safety?

Krasner: So, I think we should do two things. First of all, I think we should be concerned with how well our own society is functioning. In this sense, I think Donald Trump isn't so, isn't to the extent that he's tapping into that, is not wrong. I think there are always things that we can do internationally, but we shouldn't expect that if we do these things, we're going to have great outcomes. We may make things a little better. There are things that we can do at the international level, but not expect that everyone's going to be just like us.

Living and studying all over East Asia, some of Hannah Kim’s most favorite activities were to meet and talk to diverse people from different backgrounds. Those conversations sparked her interest in how public opinion and perceptions of democracy differ across societies — a question that turned into the focus of her doctoral dissertation, which she completed last year at the University of California, Irvine.

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We sat down with Hannah to talk about her current work and her plans for future projects.

Q: As you’ve been here at APARC researching your book, what kinds of relationships have you found between the middle classes of East Asia and their perceptions of a democratic society?

Middle-class groups in many East Asian countries are significantly different than those in other regions because they are newer and smaller. They also tend to be much more dependent on the state, and this state dependency has led to fundamentally different views of democracy than we see in other places.

Modernization theory — which is one of the most prominent theories in comparative politics — contends that higher levels of economic growth lead to a rise of a middle class. This middle class then becomes a driving force for democracy. In East Asian countries, however, state-led economic growth played a central role in the creation and development of middle-class groups, which fostered a dependent and mutually supportive relationship between middle-class groups and the state. This suggests that middle-class groups may prefer a stronger role of the state and be less likely to support liberal democracy relative to other groups.

Q: What research findings surprised you about the relationship between the middle class and democracy?

There have been a number of unexpected results. For one, middle-class East Asians are more likely to support good governance ahead of freedom and liberty, which is often reversed among middle-class groups in Western democracies. I’ve found that many East Asian middle-class citizens view democracy more illiberally and prefer a political system that has a mix of democratic and autocratic properties — a hybrid regime — rather than a liberal democracy.

For example, the most recent wave of the World Values Survey (2010-14) shows that 62% of Taiwanese respondents, 31% of Chinese respondents, 29% of Japanese respondents, and 49% of South Korean respondents stated that it is “Very good” or “Fairly good” to have a strong leader who does not have to bother with parliament and elections. This indicates a culture of implicit support for an authoritarian-like leader. Recent studies also show that there is a negative correlation between the middle class and support for democracy in China.

Q: You have also been doing work that looks at democratization and gender in East Asia. How do gender, gender roles, and traditional culture impact the progress and perception of democratization?

Even though there are three full-fledged democracies in East Asia – namely, Japan, South Korea, and Taiwan – their citizens’ views on gender equality remain far from liberal. A majority of respondents to surveys in those democracies support the ideas that men should have more employment and education opportunities than women, and that men make better political and business leaders than women. This may be in part due to the historically patriarchal culture that continues to legitimize these views. However, in my study, I suggest that culturally democratic citizens are more likely to break away from these traditional patriarchal norms and challenge gendered practices within these societies. Increasing democratic citizenship, therefore, may enhance support for gender equality and other liberal values.

Q: What pressing challenges do you see facing Asia’s democratic societies?

The last ten years have been described as a decade of decline for liberal democracies worldwide and public opinion data further shows that support for democracy is rapidly declining. East Asian democracies, many of which democratized during the so-called second and third waves of that trend in the late twentieth century, are no exception to this democratic recession. While there are many institutional limitations, the biggest challenge for East Asian democracies may come from authoritarian legacies that encourage middle-class citizens to support traditional values that often go against liberal democracy. While East Asian democracies may not necessarily evolve towards autocracy, it may be a while before the middle class and the general public in East Asian countries fully support liberal democratic values and help democracies overcome this democratic recession.

Q: What’s next on your research agenda?

After my fellowship with APARC concludes, I will be moving to Omaha, Nebraska, where I’ll be working as an assistant professor of political science at the University of Nebraska. I’m scheduled to teach Asian politics there this coming fall, which I am really looking forward to. My immediate research goal is to continue working on my book, but I would also like to start pursuing research on gender and political behavior in South Korea.

Controversies over the lack of diagnostic testing for the COVID-19 virus have dominated U.S headlines for weeks. Technical challenges with the first test developed by the Centers for Disease Control and Prevention (CDC) left the nation with minimal diagnostic capacity during the first few weeks of the epidemic, according to a new paper published today in the Journal of the American Medical Association by Michelle Mello, a professor of medicine at Stanford Health Policy and professor of law at Stanford Law School.

On February 29, the Food and Drug Administration (FDA) began allowing high-complexity labs across the country to use tests they developed in-house. On March 5, the Stanford Clinical Virology Lab deployed its own test for patients at Stanford Health Care and Stanford Children’s Health.

We asked Mello to answer some questions about the federal rollout of diagnostic testing.

You write that in the early stages, COVID-19 “spread beyond the nation’s ability to detect it.” Is there anything the U.S. government could or should have done weeks ago to get out ahead of the spread?

Adopting broader testing criteria and allowing use of a wider range of tests would have been helpful in identifying the first U.S. cases and containing the spread. Manufacturing problems like the one that arose with CDC’s test are always a risk, but the fact that CDC put all its eggs in that one basket made the manufacturing snafu highly consequential.

Also, the public messaging from Washington about the seriousness of the problem has been neither consistent nor accurate, and I worry it may have led Americans to take fewer steps to prevent community transmission than we should have. Containment was not “pretty close to airtight.” A vaccine was never going to be ready in “three to four months,” as the Trump administration claimed. The case fatality rate is not “way under 1 percent.” Part of the problem here is that as the stock market continues to plunge, the president and the task force he appointed appear to be more concerned about calming investors than stopping the virus.

We seem to be between a rock and a hard place: You write that remedying gaps in testing is imperative, yet “more testing is not always better.” How do we determine the happy middle ground?

First, the testing criteria have to be calibrated to our actual testing capacity. You can’t announce that any American who wants a coronavirus test can get one and then, within hours, announce that there aren’t enough test kits to make that possible. High priorities for testing include patients with serious, unexplained respiratory illness and contacts of known cases. From there, testing can be expanded, beginning with other high-risk groups, as capacity permits.

Second, we should consider unintended side effects of mass testing. The problem with this virus is that it doesn’t have signature symptoms. It looks like the common cold or the flu. If everyone with a cough or fever, or who has been around someone with a cough or fever, shows up in their doctor’s office demanding a test, it will quickly overwhelm care facilities that should be focusing on patients with a higher likelihood of being infected or and those who are infected and are seriously ill. It may also work against the social distancing measures that public health officials are trying to encourage, because crowded waiting rooms may spread the virus.

The CDC announced Monday it now has the testing capacity in 78 state and local public health labs across 50 states to test for the virus. There are now 75,000 lab kits cumulatively to test for COVID-19 with more coming on board by mid-March. But is there anything we could have done to roll this out earlier?

The alternative would have been to allow laboratories to deploy their own tests from the beginning, using the primers and protocols made publicly available by the World Health Organization. That’s what other countries have done. RT-PCR is a mature technology and high-complexity labs around the country are well-qualified to conduct this type of testing.

There is a public health argument for not going that route: perhaps those labs wouldn’t have done as good a job as CDC’s own lab and the state labs that it handpicked early in the outbreak. What if there were erroneous test results? We could miss cases, or we could put people into isolation, with huge social consequences, based on false-positive results. There is also a worry that some labs aren’t consistent about reporting positive test results to CDC, and underreporting could compromise disease surveillance efforts.

The counterargument is that high-complexity labs have that certification for a reason—they’re good at what they do. And of course, surveillance is also compromised when you miss cases because you don’t test.

You write in your paper that testing for COVID-19 “highlights a controversial area of public policy—the regulation of laboratory-developed tests—in which there has long been tension between the goals of access and quality.” Who should be in charge of regulating these tests?

Laboratory-developed tests are largely unregulated outside of emergencies. The FDA proposed draft guidance in 2014 that, if implemented, would have required labs to make certain showings to FDA about tests they developed in-house, with the particular evidence calibrated to the risks involved in having a wrong test result. Contrary to President Trump’s claim that an Obama-era policy constrained coronavirus testing, the guidance did not relate to emergency situations. During declared emergencies, another statute and set of regulations apply, and the FDA has broad discretion to allow or disallow use of novel diagnostics and therapies as emergency countermeasures.

As a general matter, it makes good sense to require labs to submit evidence that their in-house tests work. It’s odd that laboratory-developed tests are carved out of requirements that apply to other kinds of medical devices. It’s also sensible that our legal framework allows FDA’s regular rules to be relaxed during emergencies so we can tailor our response to the difficult and changing circumstances.

You write that diagnostic testing is critical to an effective response to the novel coronavirus. What sort of policies and guidelines should be put into place to prevent such a sluggish rollout during an emerging epidemic the next time one comes around?

The legal framework for an effective emergency response is in place. Because giving agency heads the discretion to act as potentially unforeseeable circumstances require is a linchpin of this legal framework, it only works if leaders make smart choices. Every emergency is different, and there is a danger of Monday-morning quarterbacking. But we should learn from every misstep we make, and I think the lesson here is to make better use of already developed networks of highly qualified labs to make sure we have adequate testing capacity to isolate cases and trace their contacts very early in an outbreak.

What are some innovative approaches we could be taking to speed up testing for those who really need it?

The South Koreans have set up drive-through testing stations in parking lots to avoid concentrating crowds of people indoors. Of course, that requires that you have plenty of test kits, which we don’t yet – but we should also be thinking about creative ways to address the epidemic. For example, how could video calls be used to monitor the health of people confined at home after being exposed to the virus? How can social media be used to connect neighbors to help one another when some are isolated at home? Hopefully we can find new ways for technology to bring us together when pathogens drive us apart.

A primary goal of SPICE is to support educators who wish to infuse their teaching with global perspectives. One of the most important ways in which we strive to do this is through our collaboration with Stanford Global Studies (SGS) on the U.S. Department of Education’s Title VI-funded Education Partnership for Internationalizing Curriculum, also known as EPIC. EPIC is coordinated by Denise Geraci, SGS’s Outreach and Academic Coordinator.

Each year, EPIC accepts up to ten community college instructors to participate in a one-year fellowship program aimed at internationalizing the community college curriculum. The program commences with a three-day institute at Stanford University that includes lectures, workshops, presentations, and meetings with faculty and staff from multiple disciplines and organizations at Stanford. Following the institute, the fellows return to their home institutions to work on their EPIC projects alongside their regular teaching duties. Over the following months, the Stanford-based EPIC staff meets regularly with the fellows online to discuss their projects, offer feedback, and facilitate collaboration. At year’s end, the fellowship program culminates in an all-day symposium for community college instructors during which the fellows present their work to their colleagues and peers.

Working with community college instructors is one of the most rewarding aspects of my job. As a former public high school teacher, I am familiar with the challenges and rewards of teaching students of diverse socio-economic and ethnic backgrounds, which often typifies the community college classroom. Add to that a significant proportion of international students—many of whom are learning English for the first time—and you start to get a sense of the true diversity of student experiences, needs, and goals that community college instructors have to take into account in their teaching.

Over the years of working with EPIC fellows, I consistently find myself in awe of their pedagogical expertise and dedication to their students, and this year is no different. For the 2019–2020 EPIC fellowship program, I have had the pleasure of working with the following five exceptional community college instructors and their unique EPIC projects: Lauren Arenson, Professor of Anthropology and Humanities, Pasadena City College, and her project on environmental justice and social equity from a global perspective; Dana Grisby, Professor of African American Studies, Laney College, and her project on internationalizing her African American Studies course with diaspora dialogues; Humberto Merino-Hernandez, Adjunct Economics Instructor, Cerritos College, and his project on global financial crises; Soraya Renteria, Art History Instructor, Las Positas College, and her project on creating a global introduction to Art History; and Citali Sosa-Riddell, History Instructor, Pierce College, and her project on connecting American myths with global myths.

The 2020 EPIC Symposium will take place on May 16th at Stanford University. The symposium is an opportunity for community college faculty and administrators from across California to discuss strategies for preparing students for a globalized world. In addition to the EPIC fellows’ presentations of their projects, there will also be presentations from Stanford faculty and roundtable discussions for participants. If you are a community college instructor interested in internationalizing the curriculum, I hope to see you there.

To stay informed of SPICE-related news, join our email list and follow SPICE on Facebook, Twitter, and Instagram.

Related articles:

• SPICE’s Jonas Edman Meets with New EPIC Fellows
• Symposium Focuses on Incorporating Global Themes into the Curriculum at Community Colleges
• The Stanford EPIC Fellowship for Community College Instructor

Deputy Director of APARC and Director of the Asia Health Policy Program Karen Eggleston recently spoke to Bloomberg Markets about the new cases and the further spread of the COVID-19 coronavirus in the United States.

"There has been widespread international collaboration on the scientific side to try and get ready for a vaccine and for therapies, but that takes time. In the meantime, you have to rely on tried and true public health measures."

Eggleston stressed the importance of people remaining calm and avoiding both complacency and panic in response to the growing public health crisis. Instead, being proactive, science-based, and utilizing clear, organized communications channels are the keys to protecting individuals and communities and in making timely, informed, effective decisions about future steps as the outbreak continues. Typical practices for flu season such as frequent handwashing, staying away from public spaces when ill, and following recommended self-quarantine guidelines are all measures people can take to support their well-being and the health of those around them.

"It's important to remember that both the transmissibility and the fatality rate [of COVID-19] can be changed by the way we respond. The way we trace the contacts and isolate can reduce the transmissibility. And the resilience of our public health system and investment in prevention and supporting our healthcare workers — and having the right equipment in place for the severe cases — can affect the fatality rate and protect people."

Watch the full interview below to hear more recommendations on how to prepare.

A task force of national health experts recommends clinicians screen all adults 18 to 79 for the hepatitis C virus (HCV), noting that the viral infection is now associated with more deaths in the United States than the top 60 reportable infectious diseases combined.

Many people are unaware they are carrying the viral infection.

“People with hepatitis C do not always feel sick and may not know they have it,” says chair of the U.S. Preventive Services Task Force Douglas K. Owens, M.D, M.S. “Screening is key to finding this infection early, when it’s easier to treat and cure, helping reduce illnesses and deaths.”

Screening involves testing a blood sample to see whether it contains antibodies (disease-fighting proteins) that react specifically to the hepatitis C virus. This test is followed by a second test that determines the level of virus in the blood. When used together, these two tests accurately identify whether a person has hepatitis C infection, according to the Task Force.

An estimated 4.1 million people in the United States are carrying HCV antibodies; about 2.4 million are living with the virus, according to the Task Force. The HCV infection becomes chronic in 75% to 85% of cases and some of those people develop symptoms such as chronic fatigue and depression, and liver diseases that can range from cirrhosis to liver cancer.

Approximately one-third of people ages 18 to 30 who inject drugs are infected with the virus; 70% to 90% of older injection-drug users are infected.

Owens, who is the director of Stanford Health Policy and the Henry J. Kaiser, Jr., Professor of Medicine, said the opioid epidemic now plays an important role in the prevalence of HCV. There are more than three times the number of acute HCV cases than a decade ago, particularly among young, white, injection drug users who live in rural areas. Women aged 15 to 44 have also been hit hard by the virus that is spread through contaminated blood.

“The opioid epidemic has added fuel to the HCV fire, substantially increasing transmission,” said Owens. “HCV is now an enormous public health problem, affecting a much broader age range of people than before. Fortunately, we have the tools to identify people and treatment is now successful in the vast majority of patients, so screening can prevent the mortality and morbidity from HCV.”

The U.S. Preventive Services Task Force is an independent panel of national experts in prevention and evidence-based medicine whose recommendations are followed by primary care clinicians nationwide. It has recommended people who are at high risk be tested for hepatitis C, as well as “baby boomers” born between 1945 and 1965, but now recommends screening all adults age 18 to 79, and younger or older patients if they are at high risk of acquiring HCV.

Hepatitis C is primarily spread when blood from an infected person enters the body of someone who is not infected. There currently is no vaccine for hepatitis C although research in the development of a vaccine is underway. But there are effective oral direct-acting antiviral (DAA) medications that can clear the virus from the body, particularly if caught early.

“Hepatitis C affects millions of people across the country,” says Task Force member Michael J. Barry, M.D. “We recommend screening all adults regardless of their risk because new evidence shows that more people can benefit from this service than even before.”

The Task Force’s final recommendation statement and corresponding evidence summary have been published online in the Journal of the American Medical Association, as well as on the Task Force website at http://www.uspreventiveservicestaskforce.org. 

While everyone was distracted with Justice Department controversies and the New Hampshire primary, a senior Huawei official has conceded that the company can clandestinely access users’ mobile networks. 

On Feb. 11, the Wall Street Journal ran a story citing U.S. officials who claimed that Huawei can “covertly access mobile-phone networks around the world through ‘back doors’ designed for use by law enforcement.” In other words, these officials claimed that Huawei can exploit backdoors intended for law enforcement in order to access user data without the permission of either users or the network operator. The Journal also quoted National Security Adviser Robert O’Brien as saying, “We have evidence that Huawei has the capability secretly to access sensitive and personal information in systems it maintains and sells around the world.”

Read the Rest at Lawfare