Pre-existing inequalities are shaping the course of the pandemic just as the pandemic is creating new inequalities and changing old ones. This is true both within countries—and here I focus mostly on the US, but with some attention to other countries—and between countries, where the pandemic will affect patterns of trade and international relations. In the US, we have another epidemic, of deaths of despair, separating those with a four-year college degree from those without. The pandemic will likely widen the mortality gaps between the less and more-educated, as well as their earnings gaps, already at historical highs. Poor countries are likely to suffer more than rich countries. Globalisation will slow. Income inequalities within countries are likely to rise, as markets reward those who can provide e-services of all kinds, but may narrow as globalisation retreats.