She was rushed to the hospital with a high fever and, she says, spent a week there unconscious. By May, some 18 of her co-workers had died. Before she was allowed to go home, K.G.B. agents took her a document to sign, prohibiting her from talking about the events for 25 years.

At Sverdlovsk’s epidemiological service, the epidemiologist Viktor Romanenko was a foot soldier in the cover-up. He says he knew immediately that the disease outbreak striking the city could not be intestinal, food-borne anthrax as the senior health authorities claimed. The pattern and timing of the cases’ distribution showed that the source was airborne and a one-time event.

“We all understood that this was utter nonsense,” said Dr. Romanenko, who went on to become a senior regional health official in post-Soviet times.

But in a Communist state, he had no choice but to go along with the charade, and he and his colleagues spent months seizing and testing meat. K.G.B. agents descended on his office and took away medical records. The Soviet Union had signed a treaty banning biological weapons, and national interests were at stake.

“There was an understanding that we had to get as far away as possible from the biological-weapons theory,” Dr. Romanenko recalled. “The task was to defend the honor of the country.”

There were even jitters at the Evening Sverdlovsk, a local newspaper. A correspondent from The New York Times called the newsroom as the outbreak unfolded, recalls a journalist there at the time, Aleksandr Pashkov. The editor in chief told the staff to stop answering long-distance calls, lest anyone go off-message if the correspondent called again.

“He who can keep a secret comes out on top,” Mr. Pashkov said.

As the Soviet Union crumbled, so did its ability to keep secrets. For a 1992 documentary, Mr. Pashkov tracked down a retired counterintelligence officer in Ukraine — now a different country — who had worked in Sverdlovsk at the time. Telephone intercepts at the military lab, the officer said, revealed that a technician had forgotten to replace a safety filter.

Soon, Mr. Yeltsin — who himself was part of the cover-up as the top Communist official in the region in 1979 — admitted that the military was to blame.

“You need to understand one simple thing,” Mr. Pashkov said. “Why did all this become known? The collapse of the Union.”

The husband-and-wife team of Dr. Meselson and Dr. Guillemin visited Yekaterinburg several times in the 1990s to document the leak. Interviewing survivors, they plotted the victims’ whereabouts and investigated weather records, finding that Dr. Meselson and others had been wrong to give credence to the Soviet narrative.

Dr. Meselson said that when he contacted a Russian official in the early 1990s about reinvestigating the outbreak, the response was, “Why take skeletons out of the closet?”

But he said that determining the origins of epidemics becomes more critical when geopolitics are involved. Had he and his colleagues not proved the cause of the outbreak back then, he said, the matter might still be an irritant in the relationship between Russia and the West.

The same goes for the investigation into the source of Covid-19, Dr. Meselson said. As long as the pandemic’s source remains a matter of suspicion, he said, the question will continue to raise tensions with China, more so than if the truth were known.

“There’s a huge difference between people who are still trying to prove a point against emotional opposition and people who can look back and say, ‘Yeah, yeah, I was right,’” Dr. Meselson said. “One of them fuels wars. The other is history. We need to get all these things solved. We need history, we don’t need all this emotion.”

Unlike Covid-19, anthrax does not easily pass from human to human, which is why the Sverdlovsk lab leak did not cause a broader epidemic. Even the Sverdlovsk case, however, has not been fully solved. It remains unclear whether the secret activity at the factory was illegal biological weapons development — which the Soviet Union is known to have performed — or vaccine research.

Under President Vladimir V. Putin, revealing Russian historical shortcomings has increasingly been deemed unpatriotic. With the government mum on what exactly happened, a different theory has gained currency: Perhaps it was Western agents who deliberately released anthrax spores to undermine the Communist regime.

“The concept of truth, in fact, is very complicated,” said Lev Grinberg, a Yekaterinburg pathologist who secretly preserved evidence of the true nature of the outbreak in 1979. “Those who don’t want to accept the truth will always find ways not to accept it.”

Oleg Matsnev contributed research.

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What Can and Can’t Be Learned From a Doctor in China Who Pioneered Masks

In late 1910, a deadly plague started spreading in the northeast reaches of China, reaching the large city of Harbin. Tens of thousands of people coughed up blood; their skin pruned and turned purple. They all died.

This outbreak sent the Qing government into a tailspin: They didn’t know what illness was causing these deaths, let alone how to control it. So they brought in one of the best trained doctors in Asia at the time, Dr. Wu Lien-Teh. After performing autopsies, Dr. Wu found Yersinia pestis, a bacterium similar to the one that had caused bubonic plague in the West. He recognized Manchuria’s plague as a respiratory disease and urged everyone, especially health care professionals and law enforcement, to wear masks.

Chinese authorities, heeding his call, coupled masking with stringent lockdowns enforced by the police. Four months after the doctor was summoned, the plague ended. Although often overlooked in Western countries, Dr. Wu is recognized in world history as a pioneer of public health, helping to change the course of a respiratory disease spread by droplets that could have devastated China in the early 20th century, and perhaps spread far beyond its borders.

While the Chinese of that era complied with these strategies, public health professionals in the United States and other Western countries have struggled to get people to listen to them during the Covid-19 pandemic. China, too, ran into challenges early on, but the country’s institutional memory from previous viral outbreaks helped turn the tide. And as many Americans abandon masking, push to restore normality in places where risks of infection remain high and hesitate to get vaccinated, some public health experts have looked to Dr. Wu’s success, seeking lessons on handling not only Covid, but also future epidemics.

masks became a political flash point in the United States and elsewhere during the Spanish flu pandemic, the idea of using them persisted in China, and gauze masks became an important tool in the political agenda of the Nationalist Party when it took over in 1928. Public health officials recommended all citizens wear gauze masks in public spaces during outbreaks of meningitis or cholera.

Kyle Legleiter, the senior director of policy advocacy at The Colorado Health Foundation.

Another factor that might have contributed to Dr. Wu’s success in China would be the reverence residents and officials had for him as a figure of authority, Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations, said.

In some ways, Dr. Anthony Fauci, the chief medical adviser on Covid to President Biden and a prominent public health figure since the 1980s, served in a role similar to the one Dr. Wu played in China, Dr. Huang said. But, his message perhaps didn’t always get through because Americans are more polarized in their political identities and beliefs.

Dr. Legleiter added that public health messaging only penetrates if the public identifies with or trusts that figure of authority.

“An individual person is a stand-in for a broader set of institutions or systems that they’re speaking on the behalf of,” Dr. Legleiter said. Those who lean conservative, for instance, may put Dr. Fauci and other scientists in the category of “the elites.” As such, they’re more likely to flout public health policies that such authority figures promote, and comply with proclamations from individuals they identify with the most.

Others say that public health is intrinsically tied to the legitimacy of the state promoting it. At the turn of the 20th century, China was in distress, Dr. Hanson said. Dr. Wu helped bring China out of a tumultuous period, and the enforcement of public health measures gave the country more legitimacy.

Similarly, because the current pandemic has laid bare shortcomings in the public health systems in the United States, Britain and other Western countries, some experts believe it can be a catalyst for change.

“Since the mid-19th century, the West has generally seen its ability to control infectious disease as a marker of their civilizational superiority over much of the rest of the world,” Dr. White said. While China was seen as the sick man of the world then, some commentators in China now attempt to brand the United States with that label.

Ruth Rogaski, a medical historian at Vanderbilt University who specializes in studying the Qing dynasty and modern China, believes that the coronavirus crisis similarly offers an opportunity for reflection, which can be very motivating.

“Epidemics can serve as inflection points,” Dr. Rogaski said. “Opportunities to rethink, retool and even revolutionize approaches to health.”

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Businesses Offer Perks to Vaccinated Customers

At Fort Bragg, soldiers who have gotten their coronavirus vaccines can go to a gym where no masks are required, with no limits on who can work out together. Treadmills are on and zipping, unlike those in 13 other gyms where unvaccinated troops can’t use the machines, everyone must mask up and restrictions remain on how many can bench-press at one time.

Inside Dodgers Stadium in Los Angeles, where lines not long ago snaked for miles with people seeking coronavirus vaccines, a special seating area allows those who are fully inoculated to enjoy games side by side with other fans.

When Bill Duggan reopens Madam’s Organ, his legendary blues bar in Washington, D.C., people will not be allowed in to work, drink or play music unless they can prove they have had their shots. “I have a saxophone player who is among the best in the world. He was in the other day, and I said, ‘Walter, take a good look around because you’re not walking in here again unless you get vaccinated.’”

Evite and Paperless Post are seeing a big increase in hosts requesting that their guests be vaccinated.

actually doughnuts, beers and cheesecake — to prod laggards along. Some have even offered cold hard cash: In Ohio, Gov. Mike DeWine this week went so far as to say that the state would give five vaccinated people $1 million each as part of a weekly lottery program.

On Thursday, federal health officials offered the ultimate incentive for many when they advised that fully vaccinated Americans may stop wearing masks.

Now, private employers, restaurants and entertainment venues are looking for ways to make those who are vaccinated feel like V.I.P.s, both to protect workers and guests, and to possibly entice those not yet on board.

Come summer, the nation may become increasingly bifurcated between those who are permitted to watch sports, take classes, get their hair cut and eat barbecue with others, and those who are left behind the spike protein curtain.

for children ages 12 through 15.

But even without a mandate, a nudge can feel like a shove. The military has been strongly encouraging vaccines among the troops. Acceptance has been low in some branches, like the Marines, with only 40 percent having gotten one or more shots. At Fort Bragg, one of the largest military installations in the country and among the first to offer the vaccine, just under 70 percent have been jabbed.

podcast designed to knock down misinformation — a common misbelief is that the vaccines affect fertility — plays around the base. In addition to their freedom gym, vaccinated soldiers may now eat in groups as they please, while the unvaccinated look on as they grab their grub and go.

With soldiers, experts “talk up to decliners versus talk down,” said Col. Joseph Buccino, a spokesman at Fort Bragg.

promoting inoculations, and stadiums have become a new line of demarcation, where vaccinated sections are highlighted as perks akin to V.I.P. skyboxes.

In Washington, Gov. Jay Inslee recently announced that sporting venues and churches would be able to increase their capacity by adding sections for the vaccinated.

Some businesses — like gyms and restaurants — where the coronavirus was known to spread easily are also embracing a reward system. Even though many gyms have reopened around the country, some still haven’t allowed large classes to resume.

Others are inclined to follow the lead of gyms like solidcore in Washington, D.C., which seeks proof of inoculation to enroll in classes listed as “Vaccine Required: Full Body.” “Our teams are now actively evaluating where else we think there will be client demand and will be potentially introducing it to other markets in the weeks ahead,” said Bryan Myers, chief executive officer of the national fitness studio chain, in an email.

specific invitation designs with the inoculated in mind, vaccinated only please RSVP.

Not everyone endorses this type of exclusion as good public policy. “I worry about the operational feasibility,” said Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Coronavirus Resource Center. “In the U.S., we don’t yet have a standard way to prove vaccination status. I hope we’ll see by fall such low levels of infection in the U.S. that our level of concern about the virus will be very low.”

But few dispute that it is legal. “Having dedicated spaces at events reserved for vaccinated people is both lawful and ethical,” said Lawrence O. Gostin, an expert in health law at Georgetown Law School. “Businesses have a major economic incentive to create safer environments for their customers, who would otherwise be reluctant to attend crowded events. Government recommendations about vaccinated-only sections will encourage businesses and can help us back to more normal.”

so far to impose vaccine mandates for workers, especially in a tight labor market. “Our association came out in favor of masks,” said Emily Williams Knight, president of the Texas Restaurant Association. “We probably will not be taking a position on mandates, which are incredibly divisive.”

But some companies are moving that way. Norwegian Cruise Line is threatening to keep its ships out of Florida ports if the state stands by a law prohibiting businesses from requiring vaccines in exchange for services.

Public health mandates — from smoking bans to seatbelt laws to containing tuberculosis outbreaks by requiring TB patients to take their medicines while observed — have a long history in the United States.

“They fall into a cluster of things in which someone is essentially making the argument that what I do is only my business,” said Dr. Frieden, who is now chief executive of Resolve to Save Lives, a program designed to prevent epidemics and cardiovascular disease. “A lot of times that’s true, unless what you do might kill someone else.”

Dr. Frieden was the main official who pushed for a smoking ban in bars and restaurants in 2003 when he was the New York City health commissioner under former Mayor Michael R. Bloomberg. Other senior aides at the time felt certain the ban would cost Mr. Bloomberg a second term. “When I was fighting for that, a City Council member who was against the ban said of bars, ‘That is my place of entertainment.’ And I said, ‘Well, that’s someone’s place of employment.’ It did have impact.”

Mr. Duggan, the bar owner in Washington, said protecting his workers and patrons are of a piece. “As we hit a plateau with vaccines, I don’t think we can sit and wait for all the nonbelievers,” he said. “If we are going to convince them, it’s going to be through them not being able to do the things that vaccinated people are able to do.”

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Experts Call for Sweeping Reforms to Prevent the Next Pandemic

Some countries were not even aware that the regulations existed, his group reported. Others lacked laws vital to responding to outbreaks, such as those authorizing quarantines.

Changing those regulations would require “negotiations for years,” Dr. Wieler said, noting that the latest set took a decade to finalize. Instead, one of his committee’s major recommendations was to increase countries’ accountability for their obligations, including though a pandemic treaty and a periodic review of their preparedness that would involve other countries.

The independent panel also proposed creating an international council led by heads of state to keep attention on health threats and to oversee a multibillion-dollar financing program that governments would contribute to based on their ability. It would promise quick payouts to countries contending with a new outbreak, giving them an incentive to report.

“There’s only going to be the political will to create those things when something catastrophic happens,” said Dr. Mark Dybul, one of the panel members. These recommendations stemmed in part from his experience leading the President’s Emergency Program for AIDS Relief, known as Pepfar, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, he said.

But Dr. Wieler, who led the other international review, said that in general, creating new institutions rather than focusing on improving existing ones could increase costs, complicate coordination and damage the W.H.O.

The recommendations of panels after global emergencies have sometimes been embraced. The Ebola outbreak of 2014 and 2015 led to the creation of the W.H.O.’s health emergencies program, aimed at boosting the agency’s role in managing health crises as well as providing technical guidance. A report released this month noted that the new program had received “increasingly positive feedback” from countries, donors and partner agencies as it managed dozens of health and humanitarian emergencies.

The W.H.O. before the Ebola outbreak and after it are “two different agencies basically,” said Dr. Joanne Liu, a former international president of Doctors Without Borders and a member of the independent panel. Dr. Liu was one of the W.H.O.’s most trenchant critics during the Ebola response, and she noted a “marked improvement” in how quickly the agency had declared an international emergency this time.

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