SUNDAY, MARCH 29, 2020
. IN COLLABORATION WITH
ABCDE National Weekly
the coronavirus pandemic
The crisis escalates
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The Fix
Poll reflects upended lives BY
D AN B ALZ AND E MILY G USKIN
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he coronavirus pandemic has brought massive and sudden disruption to the daily lives of most Americans amid rapidly rising fears that they could become ill with the covid-19 disease, according to a Washington Post-ABC News poll. Almost overnight, the threat from the virus has changed habits and lifestyles. Roughly 9 in 10 say they are staying home “as much as possible” and are practicing social distancing to lessen the risk of getting the virus. Nearly 9 in 10 say they have stopped going to bars and restaurants. About 6 in 10 say they have stockpiled food and household supplies at home. On the political front, President Trump narrowly wins approval for his handling of the outbreak, and his overall approval rating has grown five percentage points since February, to 48 percent, even as most Americans say he was too slow to take action in the early days of the virus’s spread. The rise in Trump’s approval rating, however, is far smaller than some other presidents have experienced in times of national crisis. The change in Americans’ lives has been swift and dramatic. Less than two weeks ago, a survey by the Kaiser Family Foundation (KFF) found 40 percent saying their lives had been disrupted and only 16 percent calling those disruptions significant. In the Post-ABC poll, more than 3 in 4 say their lives have been disrupted by the coronavirus outbreak, with half the population saying there has been “a lot” of disruption. Stress levels appear to be higher today than they were during the Great Recession that followed the financial collapse of 2008, with 7 in 10 Americans citing the virus outbreak as a source of that stress and 1 in 3 saying it caused
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Melina Mara/The Washington Post
San Franciscans ride an eerily quiet Bart Transportation system this month after stayat-home orders were implemented.
“serious” stress. During the deep recession in early 2009, fewer than 6 in 10 said the economy was a source of stress. Women and those with children at home are some of those most likely to feel additional pressure, with about three-quarters of each group saying the outbreak has caused them stress, and over 4 in 10 describing it as “serious.” One source of their stress: women are more likely than men to say they or a family member lost their job or had hours or pay cut because of the coronavirus. Nearly 7 in 10 Americans say they are worried they or someone in their immediate family might catch the disease. Asked to rate their personal risk of getting sick from the virus, 56 percent say they feel at risk, with 20 percent saying they believe they are at high risk. At this point, about 1 in 10 say they know someone who has been diagnosed with the virus, but about four times as many say people
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in their community have been diagnosed. Confidence in state governments and local hospitals and health agencies is higher than it is for the federal government when it comes to an effective coronavirus response. Almost 8 in 10 say they are confident in the states and in local hospitals and health agencies, compared with about 2 in 3 who express confidence that the federal government will be able to handle the crisis. Partisanship colors those findings, with just over half of Democrats but more than 8 in 10 Republicans saying they have confidence in the federal government. Some changes in habits, however, are nearly universal, from maintaining distance from others when out in public to adjusting to life spent at home and mostly indoors. Medical experts have said frequent and thorough hand-washing is one preventive step that everyone should be taking and the poll finds that over 8 in 10 Americans say they are doing that, though almost 2 in 10 are not washing their hands more than usual. Other changes are not as universal but appear to be growing. About half of all adults say they have canceled travel plans. When the KFF poll asked about that in mid-February, only 13 percent said yes. Beyond the businesses that have shut down, many offices have asked their workers to shift to telework. The latest poll finds that 20 percent report teleworking during the past week, including 15 percent saying they have just started working from home or are doing it more often. The Post-ABC poll was conducted by telephone from March 22-25 among a random national sample of 1,003 adults, 75 percent of whom were reached on cellphones and 25 percent on landlines. Overall results have a margin of sampling error of plus or minus 3.5 percentage points. n
Contents the coronavirus 4 Books 18 Opinion 20 Five Myths 23
On the cover Healthcare workers dealing with the coronavirus crisis look through the windows of a hospital in Spain on Thursday. Photo by MIGUEL RIOPA through AFP/Getty Images
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the coronavirus pandemic
Closed businesses open a debate
Jeenah Moon for The Washington Post
President advocates for restarting the economy, a position at odds with health experts BY W ILLIAM W AN, R EED A LBERGOTTI AND J OEL A CHENBACH
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ith President Trump saying he wants “the country opened” by Easter to salvage the U.S. economy, a fierce debate is now raging among policymakers over the necessity of shutting down vast swaths of American society to combat the novel coronavirus. Health experts point to overwhelming evidence from around the world that closing businesses
and schools and minimizing social contact are crucial to avoid exponentially mounting infections. Ending the shutdown now in America would be disastrous, many say, because the country has barely given those restrictions time to work and because U.S. leaders have not pursued alternative strategies used in other countries to avert the potential deaths of hundreds of thousands. But in recent days an increasing number of political conservatives have argued that the economic cost is too high. Mutiple times this
past week, Trump suggested dire consequences if at least some economic sectors aren’t restored. “You’re going to lose more people by putting a country into a massive recession or depression,” Trump said at a televised town hall Tuesday. “. . . You’re going to have all sorts of things happen, you’re going to have instability.” Speaking of the economy, he said, “The faster we go back, the better it’s going to be.” The stance has many worried, including some in the president’s own party. “There will be no nor-
Only a few people traverse a usually bustling Times Square in New York on Tuesday.
mally functioning economy if our hospitals are overwhelmed and thousands of Americans of all ages, including our doctors and nurses, lay dying because we have failed to do what’s necessary to stop the virus,” Rep. Liz Cheney (Wyo.), the House’s highest-ranking Republican woman, wrote in a Tuesday tweet. But the greatest alarm has come from scientists, epidemiologists and health experts who have spent the past three months studying the new coronavirus and have witnessed the destructive,
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The coronavirus pandemic contagious swath it has cut through other countries. “To be a week into these restrictions and already be talking about abandoning them is irresponsible and dangerous,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security. Removing restrictions now would allow the virus, he said, to “spread widely, rapidly, terribly, and could kill potentially millions in the year ahead with huge social and economic impact.” State leaders say the simplistic debate — pitting the health of America’s economy against the health of its citizens — has also laid bare the pressing need for the federal government to develop a long-term national strategy, which by all public indications does not yet exist. New York Gov. Andrew M. Cuomo (D) said that Trump’s framing of the situation as a choice between saving businesses or saving lives was unhelpful. “You have to walk and chew gum in life,” Cuomo said. No executive “has the luxury of being one-dimensional.” To ease current restrictions even slightly without a massive increase in the U.S. death toll, some epidemiological models show, the country must first put in place other strategies — like the large-scale contact tracing of infections being done in South Korea, which local health departments simply do not have the capacity to do. There would also need to be widespread testing, which remains limited, to understand the scope of the problem and to give economists and epidemiologists data they lack to analyze the costs and benefits of such decisions. Novel alternatives could also prove essential, like blood tests to identify people who have already recovered from infection and gained immunity, because those people could provide a workforce to restart the economy. “We don’t have the strategy or tools we need to be talking about ‘relax restrictions,’ ” said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. “We need to be trying to get them as fast as possible. That’s why you have a federal government.” ‘Worse than the problem’? Trump’s argument comes down to this: No matter how many people may die because of the coronavirus, millions more face ruin if
Jabin Botsford/The Washington Post
the economy does not run. “We cannot let the cure be worse than the problem,” he said at one news conference. Already, America’s shift to social distancing has caused widespread layoffs, from restaurants to hotels to the oil industry. Unemployment has health consequences as well as economic consequences, economists have noted. Forecasters on both sides of the debate are trying to weigh these losses against deaths from the coronavirus as well as other medical emergencies that won’t be treated properly if the health-care system becomes overrun with covid-19 patients. “One of the bottom lines is that we don’t know how long social distancing measures and lockdowns can be maintained without major consequences to the economy, society, and mental health,” John Ioannidis, a medical and epidemiology expert at Stanford University, wrote in an essay. “I am deeply concerned that the social, economic and public health consequences of this near total meltdown of normal life . . . will be long lasting and calamitous, possibly graver than the direct toll of the virus itself,” David L. Katz, a preventive-medicine specialist at Yale University, wrote this past weekend. “. . . The unemployment, impoverishment and despair likely to result will be public health scourges of the first order.” Such arguments raise important points about the full impact of the current strategy, said Inglesby, the infectious-disease expert at Johns Hopkins. But those are long-term scenarios, he pointed
President Trump, flanked by the White House’s coronavirus task force, speaks during a briefing about the coronavirus on Monday. Trump has said he wants “the country opened” by Easter.
out. “What social distancing does is buy us time to replenish supplies like masks and ventilators, deal with the immediate crisis in hospitals and come up with additional strategies.” Some business leaders have voiced a more nuanced point — that there should at least be a plan for eventually getting workers back into offices. Lloyd Blankfein, a former chairman and chief executive of Goldman Sachs, said that U.S. leaders should begin work to identify which milestones would allow the economy, perhaps in stages, to move back toward normalcy. On Thursday, Trump sent a letter to governors outlining a plan that would allow the federal government to categorize counties by risk, presumably aimed at allowing him to rescind some social-distancing measures. Even in a hypothetical world where the economy was valued above human life, many economists say it wouldn’t necessarily make sense to sacrifice the elderly, abruptly send everyone back to work and allow the virus to run its course. Restarting international flights, for example, wouldn’t mean consumers would buy tickets. And the shock from the spreading infections and mounting deaths would make any sense of normalcy hard to maintain. Worse than it seems Epidemiologists say any debate today — on the economy, the effect of restrictions and dwindling hospital capacity — is already behind the curve by two weeks. “By the time someone arrives at the hospital and is severely ill, you can assume they were infected two to three weeks ago,” said Natalie Dean, a biostatistician at the University of Florida. That’s why we don’t know to what extent recent lockdowns and stay-at-home orders have slowed America’s exponential increase in infections. “As bad as things already seem in New York, for example, if you look at the rising numbers, there’s much worse coming,” said Dean, who is working on coronavirus vaccine evaluations with the World Health Organization. “So to be talking about backing off now feels premature and dangerous. Because of the time lag, the risk of underreacting early on versus overreacting
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is not proportional.” There are signs that the U.S. outbreak is outpacing the rate of infections in even the world’s worst-hit countries. Despite limited testing, there are now more new cases per day in America than in any other nation. Public policy — in America especially — has always been a mixture of health, politics, commerce, competing interests and the question of what is in service of the greater good. But health experts argue that in this case, the scale is tilted to their side given the scope of the crisis, with worst-case scenarios projecting more than 1 million deaths. Rather than debating whether to continue restrictions, U.S. leaders should be asking whether enough is being done because there are alarming indications to the contrary, said K.J. Seung, a doctor and project director for Partners in Health in Boston. “When you compare what [the] U.S. is doing with countries in Asia that have been successful, we are not doing half the measures they are,” said Seung, who has spent years combating tuberculosis and other infectious diseases in developing countries. What allowed South Korea to keep parts of its economy functioning and Singapore to keep its schools open was combining social distancing with tools like large-scale contact tracing — retracing a confirmed patient’s movements to find and quarantine those they had contact with. South Korea had already honed this ability during an 2015 outbreak of the deadly MERS coronavirus. Singapore deployed its police force to do the work, drawing on digital footprints in security camera footage and credit card records. In America, that task has fallen to county health departments — weakened by decades of budget cuts and lacking the staffing to mount such a response. “But that’s a solvable problem. We should be building that capacity with short-term hires or [a] volunteer force from all those people now laid off or just stuck at home right now,” said Rivers of Johns Hopkins. “If we want to shift away from quarantines and closures and toward economic recovery, this is the kind of thing we need.” n
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the coronavirus pandemic analysis
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Massive relief bill may not be enough BY
H EATHER L ONG
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he Senate passed a $2.2 trillion relief package for the economy— the biggest in U.S. history — by a unanimous vote this past week. The House was expected to approve it Friday, and President Trump is eager to sign it. The good news is that the majority of the money will go to laid-off workers, small-business owners, hospitals, and state and local governments. The bad news is that it won’t be enough to stop a recession. And it’s an open question whether the nation can avoid an economic depression, the likes of which haven’t been seen since the 1930s. Economists say Congress’s response was too slow, too stingy and too focused on big Wall Street firms during the Great Recession, and that prevented a faster turnaround. Many analysts say Congress deserves some credit for doing better this time. This relief package is more than double the $830 billion measure that Congress passed in 2009. It came together in a few days, and it is far more targeted at Main Street. Middle-class and low-income Americans are slated to receive $1,200 checks (more for people with children). Small-business owners will soon have access to $10,000 emergency grants and millions in loans. And additional money is set aside for the unemployed. Only about a quarter of the money will go to large companies this time, including billions earmarked for Boeing and airlines. But economists say two key problems remain: fixing the health crisis and getting money to people in time. Constance Hunter, chief economist at KPMG, predicts that it will take at least six to 10 weeks for the government to disburse a significant amount of the money. That’s a long time for laid-off workers and small-business owners with no money coming in to wait. It makes it less likely that they will bounce back quickly. “There isn’t some magic restart
Melina Mara/The Washington Post
$2.2 trillion stimulus will help broad segments of economy, but still won’t hold off a recession button for the economy,” Hunter said. “Before the money arrives, there will be a lot of collateral damage to the economy. That’s going to make restarting it difficult.” James Bullard, a noted economist and head of the Federal Reserve Bank of St. Louis, put out a chilling forecast of what’s ahead for the nation in the coming months: He expects 46 million Americans to be unemployed (30 percent of workers) and an unprecedented 50 percent decline in economic output. Trump has floated the idea of getting people back to work by April 12. Yet public health officials say that they do not think that is realistic and that going back too soon could cause a second spike in coronavirus cases and deaths, forcing more shutdowns. The nation is choosing to shut down much of the economy to save lives, maybe as many as hundreds of thousands, according to one estimate. The United States has to get the pandemic
under control before daily life and business can go back to anything remotely normal. Majority Leader Mitch McConnell (R-Ky.) declared on the Senate floor Wednesday that “this is not even a stimulus package; it is emergency relief.” Economists agree. This $2 trillion isn’t about boosting the economy; it’s about trying to compensate people for what could be $2.5 trillion in lost business and wages in the coming weeks. And that’s a best-case scenario. Losses will be deeper if the pandemic lasts into the summer. To prevent a depression, the relief payments have to get to workers and business owners fast enough to prevent a chain reaction of pain where one person goes out of business and that triggers other failures. Bullard, the St. Louis Fed president, is optimistic that the economy will bounce back in the second half of 2020. He compares this to driving a car 70 miles per hour on the highway and then having to slow to a crawl for a
Kitchen staff take a break outside of Nico’s Restaurant in San Francisco on March 20. Through the relief bill, smallbusiness owners will have access to $10,000 emergency grants and millions in loans.
construction zone. The hope is that the car can regain speed quickly, after exiting the construction zone, but it’s not a given. “It’s not enough to have Congress pass something or to have the Fed put new programs into place to preserve liquidity. It’s actually the execution of those programs” that matters, he said. To get a reality check on what’s happening to the U.S. economy, call a small-business owner. Nearly all will tell you that business is severely down — or closed — and that they have no clue when that will change. In recent days, most of these owners have talked to anyone they can think of about getting a loan or aid. But everyone is waiting to see what Congress does first, leaving business owners fearful they will run out of money before help arrives. John Russell started the small tech company Webconnex in 2008, but he says this crisis is even harder to navigate than the Great Recession, because it’s so uncertain when it will end or whether the recovery will be fast or slow. His company makes affordable software for fundraising and events and processed about $1 billion in credit card payments last year. Now most of their 2020 events are canceled, leaving almost no money coming in. “If we don’t get relief from this bill in Congress, we have no choice but to do massive layoffs,” said Russell, a co-founder of Webconnex, which employs 41 people. “Our team is like our family. For us, 100 percent of our focus is on saving those jobs.” If he has to do layoffs, like so many restaurants and hotels have, Russell knows the pain will escalate. But taking on a hefty loan right now feels risky, given the uncertainty. There is no economic playbook for how to handle this health crisis. Congress and the White House have taken a first attempt at aid, but most economists anticipate more will be needed. And the only thing that will truly turn this around is ending the pandemic. n
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The coronavirus pandemic
Soldiers’ new mission: Lockdowns BY
K EVIN S IEFF
A
round the world, as a consensus has formed around the need for quarantine and social distancing to fight the coronavirus, a more delicate question has emerged: How do you enforce those new rules? In every region, under all kinds of political systems, governments are turning to increasingly stringent measures — and deploying their armed forces to back them up. Countries as varied as China, Jordan, El Salvador and Italy have sent service members into the streets. Guatemala has detained more than 1,000 people. In Peru, those who flout government restrictions can be jailed for up to three years. In Saudi Arabia, it’s five. At no time since World War II have so many nations wrestled with what it means to be in a state of emergency and how to impose fundamental and sudden changes in human behavior. Deploying troops is a startling but often effective way to keep people indoors, but its impact could ripple well beyond the end of the coronavirus, as countries decide when — and if — to cede the powers endowed by a global pandemic. In Lebanon, Chile and Hong Kong, beset for months by protests, fear of the coronavirus has allowed the state to ban public gatherings without overtly violating civil liberties. In several countries, leaders have used the public health crisis to suppress freedom of speech and other constitutional protections. “It’s really easy to ratchet up these kinds of powers and really hard to ratchet them back down,” said Juliette Kayyem, an assistant secretary of homeland security during the Obama administration. “Once the military is seen as a solution to a public health problem, it’s hard to get the military out of the way.” The United States, where troops have been limited to missions such as disinfecting public
Altaf Qadri/Associated Press
More nations are using their militaries to keep people indoors spaces, is increasingly an exception in its refusal to use them to back up new public health restrictions. “No prime minister wants to enact measures like this,” said Britain’s Boris Johnson. He said Monday that people who violated a nationwide lockdown would be fined. “We are at war,” said France’s Emmanuel Macron, who deployed 100,000 police officers. Senegalese President Macky Sall ordered “the defense and security forces to be ready for the immediate and strict execution of the measures decreed throughout the national territory.” Those leaders were tapping into a complicated history of
security forces responding to pandemics. As 17th-century Britain struggled against the bubonic plague, it imposed selective quarantines on some of its most vulnerable people, perpetuating deep class divisions. The 1918 influenza pandemic began largely in U.S. Army camps. Instead of containing the virus, deployed troops helped spread it. That was the last time the federal government imposed a large-scale quarantine. During the 2014 Ebola outbreak, the Liberian military set up a cordon around Monrovia’s West Point slum, considered to be the epicenter of the outbreak. Several residents were shot in clashes with soldiers. Many oth-
Soldiers stand guard as authorities clear the Shaheen Bagh protest site on Tuesday in New Delhi.
ers slipped through checkpoints undetected. The strategy was eventually abandoned. Now, as some countries threaten detention and jail time for those who violate lockdowns, public health experts have raised concern about the inherent risk in forcing yet more people into enclosed spaces — an ironic and potentially deadly punishment. In El Salvador and Guatemala this past week, photos circulated of police loading people accused of breaking the rules into pickup trucks. The officers and detainees were clustered together with almost no social distance. In Jordan, where people are no longer permitted to step outside their front doors, the govern-
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the coronavirus pandemic ment has promised its own set of harsh punishments. “We won’t be lenient with anyone who violates the law,” Interior Minister Salameh Hammad told a local news channel. Public health experts are advising reducing prison populations during the pandemic, not increasing them. “In cases where people weren’t taking the public health guidance seriously, the military adds this level of gravity,” said Sarah Parkinson, an assistant professor of international relations and political science at Johns Hopkins University. “But if you’re going to arrest hundreds of people and put them in prison, there’s a huge public health risk to that, too.” In some communities, in the midst of war, the idea of soldiers becoming involved in yet another aspect of their daily lives is haunting. “We may end up having more deaths and injuries from military brutality than the feared coronavirus,” said Ibrahim Sadiq, a 33-year-old manager at a flour supplier in the Nigerian city of Maiduguri. The city has been targeted by the militant Islamist group Boko Haram for more than a decade, and residents have suffered well-documented human rights abuses at the hands of the army. But if the virus spreads in Nigeria, officials have said, the use of the military is “on the table.” In Rwanda this past week, police shot and killed two young men found violating lockdown orders, authorities said. As quarantines stretch into weeks or months, it is unclear the role security forces will play. Will soldiers continue to enforce rules articulated by civilian leadership? Or will their charge evolve? Already in some parts of the world, military officials have begun not just implementing public health directives but creating them. In Ecuador, which has the highest per capita incidence of covid-19 in Latin America, the hard-hit province of Guayas has been declared a “zone of national security.” “Operational planning is in the hands of the Armed Forces,” Interior Minister María Paula Romo told La Hora newspaper this past week.
Weekly
The claps heard ’round the world
Such moves are not uncommon, said Adam Isacson, the director of defense oversight at the Washington Office on Latin America. “It happens frequently during these crises that civilian capacity is overwhelmed,” Isacson said. “In the Latin American context, the concern is that this could become a more permanent role for the military because of where they are put in the chain of command, and who gets to use resources without consulting anyone. In some places, it can end up supplanting the health ministry.” Elsewhere, the threat of armed force during the pandemic was more oblique — and not specifi-
BY W ILLIAM B OOTH, K ARLA A DAM AND P AMELA R OLFE in London
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Antonio Calanni/Associated Press
cally licensed by the state. Grand Ayatollah Ali Sistani, the top Shiite Muslim cleric in Iraq, decreed that those who infected others with the virus could be made to pay “blood money.” Hezbollah’s leader, Hassan Nasrallah, said, “The virus can be defeated if everyone takes responsibility and plays their part.” For those who study the role of the state in modern life, and consider what a legitimate use of force is meant to look like in the 21st century, the pandemic poses a massive, unforeseen test. “There’s a lot of talk about the emergence of a progressive globe after this virus ends, where we care about health care and shift our priorities,” said Kayyem, who now lectures at Harvard. “But it’s just as likely that the new world is one in which more centralized authority is viewed as the norm.” n
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Italian soldiers patrol Milan last Sunday for people who may be flouting the government’s lockdown measures.
lapping is now a big thing. Stir-crazy in their lockeddown homes, the phenomenon of stepping onto the balcony in the evening, flinging open the windows, to applaud health-care workers fighting coronavirus on the front lines has gone global. Part balm, part defiance, part celebration — we’re still here! — the practice has migrated, alongside the virus and enforced quarantine, from the Chinese epicenter of Wuhan to the medieval villages of Lombardy, from Milan to Madrid, onto Paris, and now London. There have been standing ovations, too, in Istanbul, Atlanta, Buenos Aires and Tamil Nadu, India. In Britain, droves of people are expected to come out this evening to cheer the staff of the country’s beloved National Health Service, whose intensive-care units and Arrivals and Emergency wings are bracing for an explosion in cases, as already exhausted nurses, some wearing garbage bags, are begging for more and better protective equipment. The phenomenon began in mid-January in shutdown city of Wuhan in China, where the first social media posts recorded anonymous voices in the night, shouting from their high-rise apartment buildings, a cry of ‘ji yóu! — which literally means “add oil,” but translates to “keep up the fight.” The practice took off in Italy, where the shut-ins first emerged to bang on pots, play accordions, wave flags. And, being Italians, they sang. Arias from opera stars. Soccer chants. By mid-March, the first flash mobs promoted by social media in Italy began to call for group applause for the doctors and nurses risking their lives in the virus wards.
But be warned. In Italy, the applause is being muted, and less regular, as the lockdown has dragged into its third week. The city of Florence last week put a stop of the ovations out of respect for the dead, in solidarity for people who are suffering and mourning, according to the Corriere della Sera newspaper. Facing a surging caseload and body count, Spaniards in lockdown are sharing online classes, yoga by Zoom, balcony Bingo and House Party app get-togethers. But perhaps the highlight every day is at 8 p.m. sharp, when people lean out their windows to celebrate the “heroes,” as they are broadly called, the country’s health workers and security forces. “The applause at 8 p.m. serve as an oasis for those of us who have been indoors for 13 days and counting,” said Emanuel Diaz, who lives in the center of Madrid’s historic area. “I can honestly say that I look forward to them every single day.” For Diaz and others, the nightly moment gives them a sense of community. “It’s weird to live in a place without actually knowing the people in that place. I was a ghost on my street until I started going to the balcony and establishing relationships with my neighbors,” he said. “My neighbor on the front balcony told me last night: ‘After this is all over, I can’t wait to go to the street to finally meet you and have a drink together.’” Two nights ago, police and ambulances joined in the moment flashing their siren lights in front of Madrid’s ice skating rink, which is now serving as the city morgue. In Paris, the sound of cheers can be deafening — it resonates down wide boulevards, through thick stone walls and into quiet inner courtyards, where Parisians still gather to applaud, even if their apartments do not face the street. n
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the coronavirus pandemic
In Japan, a ‘model’ of containment BY S IMON D ENYER AND A KIKO K ASHIWAGI
in Tokyo
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t’s being called in Japan the “Wakayama model” — how one district broke with the government, adopted its own strict coronavirus testing policies and managed to win a local battle against the global pandemic. It’s a lesson in how nimble thinking and concerted action can beat back the novel virus and break its chain of transmission. As the coronavirus strains governments and medical networks around the world, the stand in Wakayama underscores some of the core elements in the fight: quick, well-targeted testing and contact tracing. First one. Then four more. A doctor in the southern Japanese prefecture of Wakayama started feeling unwell Jan. 31. He didn’t think too much of it. At the time, the coronavirus was mostly spreading among people who had been to China or knew someone who had. For three days, he took pills to keep his fever down and kept going to work in the small town of Yuasa. There were — as always — a long line of patients waiting to see him. But the doctor, who cannot be named under Japanese guidelines to protect the privacy of infected people, soon realized he didn’t have a typical case of flu. He stayed home. A chest X-ray showed a shadow on his lung. Before long, four more people in Yuasa had fallen ill, including three patients and another doctor at the hospital. This was looking bad. Could this be an outbreak of the coronavirus in a hospital, among staff tending the sick and elderly? Japanese government guidelines at the time were clear. Coronavirus tests known as PCR, or polymerase chain reaction, were in short supply in Japan and reserved mostly for people who had been to China recently or been in contact with another confirmed case.
Naoya Azuma/Associated Press
A region’s decisive game plan offers lessons in defeating virus None of the sick people in Wakayama met these criteria. Japanese bureaucrats are famous for following the rules. But Japan’s southwestern region of Kansai is a bit different, a place where people take pride in their independence. Wakayama prefecture has an independent politician in the governor’s office, Yoshinobu Nisaka, who said he doesn’t follow government guidelines and prefers to take an “original approach.” Wakayama — renowned for winding mountain paths, Buddhist pilgrimage trails and picturesque ports — is one of the nation’s spiritual heartlands. It also found its own voice in how to confront one of the greatest health threats in generations. “In this prefecture, we had de-
cided to respond to the situation flexibly, thinking that solely focusing on those who had previous contact with Chinese would make it difficult to discover infected cases,” said Takako Nojiri, who runs the prefecture’s health department and had the crucial say in who could be tested for the coronavirus. Even before these cases emerged, “we’d decided to rely on the opinion of the doctors on the front line,” she said. And that opinion was clear. This was “pneumonia with unknown causes.” She gave the green light. First, the doctor who first fell ill was tested for the coronavirus. And then the other four people. The doctor’s test came back positive.
A sightseeing area in the town of Yuasa went quiet after local measures were put in place to fight the coronavirus. “The first lesson is to take goal-oriented action; the second is to do so at very high speed,” said Yoshinobu Nisaka, the governor of Wakayama prefecture.
Everyone would be tested Even as the other tests were coming in, Nisaka called a news conference Feb. 13, the first of many he would hold on the virus. Everyone the doctor had been in contact with would be traced, he said. The news sent shock waves through the medical community in Tokyo. Suddenly, Japan had a homegrown coronavirus problem, a case with no obvious link to China. Infectious disease specialists call it “an invisible chain of transmission.” Japan’s Health Ministry was already under intense pressure to expand testing of suspected coronavirus patients. On Feb. 17, it relaxed the rules, announcing that
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the coronavirus pandemic Workers block the entrance the hospital in the Japanese town of Yuasa on Feb. 16 after a doctor there was confirmed to have been infected with coronavirus. By March 4, the hospital was reopened to outpatients to help test potential new coronavirus cases.
Naoya Azuma/Kyodo/associated press
doctors could refer anyone with worrying symptoms to have a PCR test, regardless of previous contacts or travel history. In the meantime, Wakayama was not done bending the rules. Under the Health Ministry’s approach at the time, not everyone who had been in close contact with an infected person was being tested. Many such people were simply told to stay home and monitor their health. The hospital in Yuasa had been closed to outpatients after the tests, but Nisaka and his health department knew they needed it working again, and fast. Everyone who might have been infected needed to be tested. “We had to return the hospital to how it was as soon as possible,” Nisaka said in an interview. Officials started to track down everyone who could have been in contact with the doctors — nurses, part-time staff, patients, family members, even workers at small businesses supplying goods to the hospital. “It was hard,” the health department chief, Nojiri, said. “The first challenge was to grasp the entire picture, which took time. Just to see how many people to target — it is not as though there were directories [of how to find them].” Staff at public health centers
Nagoya 2.3 million Ise Bay
JAPAN Tokyo
HONSHU ( J A PA N )
DETAIL Osaka Pop.: 2.7 million
P a c i f i c O c e a n
Osaka Bay
Shingu
Kansai Int’l Wakayama
W a k a y a m a P r e f e c t u r e Tanabe
Yuasa A town of more than 12,000 was the center for widespread coronavirus testing. Note: Yuasa population based on 2015 census data. Distance from Kansai Airport to Yuasa is about 37 miles.
interviewed people to find out who could have been in contact with the virus. It took three days to trace everyone and up to 11 more days to get specimens for testing, she said. The contact list reached 470 The list had swelled to roughly 470 people, an enormous number at a time when Japan was doing
NO RT H
THE WASHINGTON POST
only a few hundred tests a day, outside the Diamond Princess cruise ship under quarantine in Yokohama. So Nisaka had to take up the challenge himself, convincing Tokyo to send the chemicals necessary to conduct hundreds of tests. He personally went to the neighboring prefecture of Osaka and convinced the governor there, an-
KLMNO Weekly
other independent-minded politician, to open his labs for 150 tests. The rest were carried out in Wakayama. Medical staff in Wakayama and Osaka worked around the clock to analyze test results. “It couldn’t have been done any faster,” Nojiri said. By Feb. 25, everyone had been tested, and 10 more coronavirus patients were found. By March 4, the Yuasa hospital, cleaned and cleared of the virus, was reopened to outpatients. In the prefecture, no fresh cases had been seen for two weeks, and the rest of Japan began to look on admiringly at Wakayama’s experience and wonder what lessons it could learn. “The first lesson is to take goal-oriented action; the second is to do so at very high speed,” Nisaka said. “Action has to be logical, it has to be thorough, and it has to be fast.” A ‘ferocious’ test blitz But Wakayama’s vigil against the coronavirus is far from over. In early March, a large, new cluster of infections was spotted in Osaka among people who attended a live music venue. By March 5, a woman from Wakayama who had been at the club tested positive. Nisaka and his team swung into action again. Wakayama city and prefecture officials worked “at ferocious speed” to trace everyone who had been in contact with the infected person and everywhere she had been. Japan’s railway stations were disinfected in Wakayama. In another decision that broke with Japan’s privacy rules, the governor named the employer of the new Wakayama patient and made sure all her colleagues were tested. All were negative but have still been asked to avoid public transportation and work from home for four weeks. “We will remain at maximum vigilance,” Nisaka wrote in a message to the people of Wakayama. “If we see another case, we must join hands and work together with our full force, just as we did before. Even then, don’t we have this? The hope that we’ve won after our fierce efforts.” On Thursday, another person tested positive in Wakayama, a man in his 50s. n
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The coronavirus pandemic
‘We’re being sort of forgotten’ BY
P ETER J AMISON
A
ll day, most days, for $10 an hour, Marley Brownlee comes and goes from the homes of the old and the
weak. She has almost none of the equipment that could protect her vulnerable clients — or herself — from the deadly virus that has transformed life across the United States. No masks, goggles or gown. She takes what precautions she can using gloves, hand sanitizer and disinfectant wipes. Her hands are raw from washing, and last week she considered spraying herself down with Lysol between appointments. Brownlee is one of the millions of health-care workers whose challenges have been largely overlooked in America’s halting mobilization against the novel coronavirus: The personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes. At least 12 million people in the United States depend on such services every year, according to the National Association for Home Care and Hospice, many of them older or coping with severe disabilities. It is a sprawling sector of the U.S. health-care delivery system — and one whose fortunes could be critical in efforts to contain covid19, the deadly lung disease caused by the coronavirus. With nursing homes across the country locked down and hospitals preparing for an onslaught of covid-19 patients, many who require medical services or help with the basic tasks of daily living are likely to be confined to their homes in the weeks and months ahead. Yet the providers of those services say they are unprepared to step into the breach, hamstrung by regulations ill-suited to the current pandemic and unable to access protective gear that could shield workers and clients alike from infection. “There’s no doubt that we’re being sort of forgotten in all this, and I fear that mentality is going to eventually come back and punish us,” said Joe Russell, executive
Photos by Dustin Franz for The Washington Post
Unprotected and unprepared, home health aides care for sick, elderly director of the Ohio Council for Home Care and Hospice. “If we’re carrying this disease from household to household, these people are just as vulnerable as anybody in a hospital or a nursing home." He added, “I fear that without additional support, and additional support very soon, you’re going to start to see the system sort of fall apart in front of our eyes.” Such concerns are being pressed in states across the country and in Washington, where home-care industry leaders are pleading with Trump administration officials and members of Congress not to exclude their providers from the nation’s belated efforts to launch a coherent policy response to the pandemic. They have two primary re-
quests: an adequate supply of protective equipment — including the scarce N95 masks that are most effective in preventing transmission of the coronavirus — and increased flexibility in Medicare regulations that govern person-toperson contact at patients’ homes. Medicare does not reimburse home-care providers for appointments conducted remotely by phone or video, impeding efforts to keep face-to-face interactions to a minimum and practice the social distancing recommended for slowing the spread of the virus. Electronic record-keeping rules adopted several years ago further require patients to verify their caretakers’ visits using a smartphone or tablet that is passed back and forth — a potential source of
Marley Brownlee, a nurse aide in Akron, Ohio, changes Virginia Shaffer’s socks at Shaffer’s home in Wadsworth. Brownlee has almost none of the equipment that could protect her and her clients from covid-19.
contagion from a virus that can survive extended periods on hard surfaces. The prospects for the industry’s appeals are uncertain. Amid a dire shortage of protective equipment for medical workers, supplies that become available will likely be directed to the doctors and nurses treating the worst cases of covid19 in hospitals. And federal officials’ stance on reimbursing “telemedicine” appointments for home care has been noncommittal. Bill Dombi, president of the National Association for Home Care and Hospice, said that in the absence of decisive action from the Centers for Medicare and Medicaid Services, he and others have been pressing Congress to include such a measure in pending coro-
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the coronavirus pandemic navirus legislation. The home care industry lacks the prominence and cachet of American hospitals, especially its most celebrated medical centers. No agency that sends workers into houses to help a stroke victim learn to mount the stairs again or assist a patient with a wheelchair in the bathroom vies for recognition with Johns Hopkins Hospital or the Cleveland Clinic. Yet home care has grown into a pillar of the medical and senior-care systems, serving older clients who wish to avoid nursing homes — now more than ever — and people with disabilities, who in previous decades were often clustered in large institutions. Tim Rogers, who heads the Association for Home and Hospice Care of North Carolina, said there are home-care agencies in his state with a daily caseload of 5,000 patients — far exceeding the capacity of even the largest hospitals. Home health aides are the country’s third-fastest-growing occupation, according to the U.S. Bureau of Labor Statistics. The industry embraces a wide range of skill sets and qualifications and includes medical professionals whose credentials rival those of their counterparts in hospitals. But many positions require little training and offer low pay. In 2018, the median annual earnings of a home health aide were less than $25,000, according to federal data. Often they are hourly workers at or just above minimum wage. It is a situation primed for hard decisions as caregivers balance the safety of their clients, their families and themselves against the need for a paycheck. Brownlee, who works as a nurse aide in Akron, Ohio, said she fears she could soon confront such choices. The 34-year-old is potentially more susceptible to the virus as a Type-1 diabetic. She is also the mother of 8-year-old twins who were born prematurely and still have compromised immune systems. “Someone could sneeze in a room, and a day later my twins are sick with something,” she said. Unprotected as she ventures from house to house, Brownlee now comes into her home after work through her basement, removing her work clothes before joining the rest of her family. She is scared. So are her clients. A few weeks ago, she cooked spaghetti,
“I don’t want my clients to get sick, and I don’t want to get my children sick.” Marley Brownlee, a nurse aide
pork chops and rice for one person who ordinarily loves takeout but fears that the bags carrying the food she orders could be contaminated with the novel coronavirus. “I don’t want my clients to get sick, and I don’t want to get my children sick,” Brownlee said. “It’s, like, a battle. Do I stay home? Do I
go to work? I know that my clients depend on us, so I kind of just have to bite the bullet and take what precautions I can.” Her boss, Eric Bloniarz of FirstLight Home Care, said some of his employees have begun staying home out of fear of the virus, putting added pressure on those,
Top: Marley Brownlee faces additional risk from the coronavirus because of her Type 1 diabetes. Her 8year-old twins also have compromised immune systems. Shelves that normally hold cleaning and sanitizing supplies at a Target in Wadsworth, Ohio, sit nearly empty on Monday.
KLMNO Weekly
like Brownlee, who continue to work. To pick up the slack, he has started recruiting new aides from the growing ranks of workers laid off from struggling bars and restaurants over the past two weeks. Bloniarz said he has tried to procure protective equipment for his staff, but it has been impossible to find N95 masks, and even new supplies of gowns and sanitizer could be a long time coming. “Everything’s on back-order till mid-April,” he said. “And the initial shipment that comes in, everything’s allocated to hospitals.” Those concerns are shared among more highly skilled home health workers, including professionals who provide services — such as wound care or physical therapy — that in the past might only have been available in a hospital or doctor’s office. “I’m not scared. I have been a nurse for 12 years, and so everything that we were trained to do is just what we’re doing. I’ve taken care of patients with every disease you can think of,” said Amber Lutman, a registered nurse and home care case manager who lives in Warren, Ohio. The company she works for, Patriot at Home, has laid in a stock of the precious N95 masks, as well as other protective equipment. “But what if this continues and things run out?” Lutman said. “What do you do?” Greg Davis, owner of Patriot, said his business has surged as patients who need less intensive forms of care are discharged by hospitals trying to free up beds for anticipated covid-19 cases. Home care providers could play a crucial role in lightening the pressure on American hospitals as the pandemic advances, he said, both by handling those discharges and treating less serious coronavirus infections in patients who can remain quarantined in their homes. It’s appropriate that hospital workers fighting to save covid-19 patients on the brink of death are now the focus of policymakers trying to shore up the U.S. medical system, Davis said. But the resources and resolve of the system as a whole are likely to be tested as the pandemic advances. “The acute care hospital system is number one right now. They’re the front line,” Davis said. “But we’re standing right behind them. And so I think they really need to take a look at us.” n
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The coronavirus pandemic
Hikers are kindly given the boot BY H EATHER R OCHFORT
B ALOGH
J
osh Berman, a Spanish teacher from Boulder, Colo., had been looking forward to his rafting trip with his 12-year-old for more than a year. As a father of three daughters, he annually alternates taking each one on an outdoor adventure. This year’s 45-mile rafting trip on the Green River from Colorado to Utah was easily the most off-the-grid excursion yet, and he and his daughter could barely contain their excitement. But when the coronavirus pandemic hit, Berman immediately pulled out of the trip. He knew they would be traveling through tiny communities scattered around Colorado’s Dinosaur National Monument, and he did not want to take the chance of bringing harm to them. “I look at it this way: Instead of thinking about whether or not you’ll get infected, consider whether or not you’ll infect someone else,” he says of his decision. As the coronavirus rips across the country like wildfire, it’s easy to be lured by Mother Nature’s charms. And, why not — health experts and government officials have endorsed hiking’s healing power during these trying times. A few weeks ago, Secretary of the Interior David Bernhardt directed all national parks to waive their entrance fees until further notice. “This small step makes it a little easier for the American public to enjoy the outdoors . . . to recreate, embrace nature, and implement social distancing,” Bernhardt said. But as with all things during the age of covid-19, nothing is as it seems. In this case, walking into the wild can be irresponsible — and not the safety net we need it to be. For one thing, yours is not the only stir-crazy family considering a road trip to your favorite public lands for some social distancing in the backcountry: Hordes of people have been spotted everywhere from California’s Point Reyes National Seashore to
iStock
Communities near national parks urge nonresidents to stay away Maine’s Acadia National Park. More importantly, the small gateway communities outside the national parks and popular public lands cannot handle your visit. Despite a lack of a federal mandate, some are asking everyone to go home. Earlier this month, the Southeast Utah Health Department ordered the closure of all campgrounds and lodging facilities around Moab, the gateway community to Arches and Canyonlands national parks. The mandate was directed toward recreational visitors who don’t reside within city limits. Before the order, the sleepy outdoor community had been expecting nearly 10,000 visitors — almost double the town’s population. This is
standard for spring in Moab, but this year is obviously different. “Our local health-care system is built to handle the day-to-day needs of our resident community along with the occasional surges that comes from tourist events like bike races or marathons,” said Bradon Bradford, director of the department. “We don’t have the beds and we don’t have the equipment here to handle more than that, and especially not the type of patients the virus would bring.” Moab isn’t the only community asking people to stay away. On March 16, Gunnison County in Colorado — home to Crested Butte and adjacent to the Black Canyon of the Gunnison National Park — issued a public order that mandated nonresidents return
All campgrounds and lodging facilities around Moab, Utah, have been ordered to close.
home immediately. Nonresidents who own second homes in the county were “strongly encouraged” to leave and return to their permanent residence. “It’s simple: We’re closed for your hiking business right now,” said Andrew Sandstrom, public information officer for the Gunnison County Incident Command Team. The closures keep coming. On March 20, Yosemite, Sequoia & Kings Canyon, and Rocky Mountain National Park (RMNP) all closed until further notice. On March 21, the San Juan County Sheriff’s Office in Colorado implemented a “locals only” order that prohibits nonresidents from backcountry skiing or recreating on any of San Juan County lands.
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The coronavirus pandemic
Ted S. Warren/Associated Press
A day later, Hawai’i Volcanoes National Park closed all trails, public areas, roads, campgrounds and the backcountry. On Tuesday, Great Smoky Mountains National Park announced the closure of all park areas, except the Foothills Parkway and the Spur, through April 6. In response to questions about the waived fees and closures, the National Park Service’s Office of Media Affairs sent an email stating: “As states and local governments announce further efforts to combat COVID-19, decisions on modifications to park operations are being made on a park-by-park basis. Visitor services, other than those of public and resource protection (such as law enforcement and trash removal), will be limited or suspended.” It added that parks would remain open and entrance-fee-free “where it is possible to adhere to federal, state, and local health guidance” and urged visitors to follow social dis-
Above: A sign in front of an information station at Mount Rainier National Park in Washington state gives instructions for visitors to practice social distancing if they have questions for a park ranger. Left: On March 20, Yosemite National Park was closed until further notice.
iStock
KLMNO Weekly
tancing and other measures to prevent the spread of the virus. Many outdoor enthusiasts find the closures confusing, if not extreme, especially in light of Bernhardt’s recent announcement. A quick scroll on RMNP’s Facebook page shows comments like, “This is insane, we’re shutting down the outdoors now!” But Katie Boué believes most hikers and campers just don’t realize their impact. “A lot of us don’t fully understand all those touch points we hit along the way,” said the founder of the Outdoor Advocacy Project, a benefit corporation (a for-profit business committed to creating public benefit) designed to empower the outdoor community to do good. “You touch your car and then the handle on the gas pump, and then you get to the park and grab a pamphlet from the donation box that may or may not have been put back by the previous user, and then you drink from your water bottle. All those touch points add up and that’s how the virus spreads.” Frank Zadravecz, an epidemiologist and emergency medicine resident physician at the University of Utah, agrees with Boué. With packed trails and parks comes a higher risk of infection, thanks to the virus’s ability to live on various surfaces for extended periods of time. According to Zadravecz, a recent study showed that SARS-CoV-2 remains viable in aerosols for up to three hours. However, he says it is unlikely that you’ll just walk through an infected air cloud while out hiking. “More likely, [the virus] is being transmitted by droplets with coughs or sneezes, and they only travel a short distance before being forced by gravity to land on surfaces,” he says. “Contact with the virus that has been spread from droplets on many types of shared public surfaces may actually present more of a threat than aerosols.” Zadravecz adds that hiking itself is fine, but it’s the ripple effect that concerns him. “We need to keep those gateway communities as burden-free as possible,” he says. The bottom line is this: Don’t use the coronavirus as an excuse to take a quarantine vacation. “We’ll be here when you come back later,” Bradford said. “But now is the time to find a gem in your own backyard.” n
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Opinions
A day in the life of a New York ER doctor Craig Spencer is the director of global health in emergency medicine at New York Presbyterian/Columbia University Medical Center.
NEW YORK — Wake up at 6:30 a.m. Priority is making a big pot of coffee for the whole day, because the place by the hospital is closed. The Starbucks, too. It’s all closed. On the walk, it feels like Sunday. No one is out. Might be the freezing rain. Or it’s early. Regardless, that’s good. ¶ Walk in for your 8 a.m. shift: Struck by how the calm of the early morning city streets is immediately transformed. The bright fluorescent lights of the ER reflect off everyone’s protective goggles. There is a cacophony of coughing. You stop. Mask up. Walk in. You take sign-out from the previous team, but nearly every patient is the same, young and old: cough, shortness of breath, fever. The staff is really worried about one patient. Very short of breath, on the maximum amount of oxygen we can give, but still breathing fast. You immediately assess this patient. It’s clear what this is and what needs to happen. You have a long and honest discussion with the patient, and with her family over the phone. It’s best to put her on life support now, before things get much worse. You’re getting set up for that when you’re notified of another really sick patient coming in. You rush over. He’s also extremely sick, vomiting. He needs to be put on life support as well. You bring them back. Two patients, in rooms right next to each other, both getting a breathing tube. It’s not even 10 a.m. For the rest of your 12-hour shift, nearly every hour, you get paged: Stat notification: Very sick patient, short of breath, fever. Oxygen 88 percent. Stat notification: Low blood pressure, short of breath, low oxygen. Stat
notification: Low oxygen, can’t breathe. Fever. All day . . . Sometime in the afternoon, you recognize that you haven’t drunk any water. You’re afraid to take off the mask. It’s the only thing that protects you. Surely you can last a little longer — in West Africa during Ebola, you spent hours in a hot suit without water. One more patient . . . By late afternoon, you need to eat. The restaurant across the street is closed. Right, everything is closed. But thankfully the hospital cafeteria is open. You grab something, wash your hands (twice), cautiously take off your mask and eat as fast as you can. Go back. Mask up. Walk in. Nearly everyone you see today is the same. We assume everyone is infected. We wear gowns, goggles and masks at every encounter. All day. It’s the only way to be safe. Where did all the heart attacks and appendicitis patients go? It’s all covid-19. When your shift ends, you sign out to the oncoming team. It’s all covid-19. Over the past week, we have all learned the signs — low oxygen, abnormally low lymphocytes,
Mary Altaffer/associated Press
A pair of ambulances outside Elmhurst Hospital Center on Tuesday in Queens. Hospitals in New York are nearing capacity and running out of ventilators as the number of covid-19 patients skyrockets every day.
elevated protein fragments known as D-dimer. You trade messages with doctor friends throughout the city without PPE, personal protective equipment. Hospitals running out of ventilators. Before you leave, you wipe everything down. Your phone. Your badge. Your wallet. Your coffee mug. All of it. Drown it in bleach. Everything in a bag. Take no chances. Still, you aren’t sure you got it all. Wipe it down again. Can’t be too careful. You walk out and take off your mask. You feel naked and exposed. It’s still raining, but you want to walk home. It feels safer than the subway or bus, plus you need to decompress. The streets are empty. This feels nothing like what is happening inside. Maybe people don’t know? You get home. You strip in the hallway. (It’s okay, your neighbors know what you do.) Everything in a bag. Your wife tries to keep your toddler away, but she hasn’t seen you in
days, so it’s really hard. Run to the shower. Rinse it all away. Never happier. Hospitals are nearing capacity. We are running out of ventilators. Ambulance sirens don’t stop. Everyone we see today was infected a week ago, or more. The numbers will undoubtedly skyrocket overnight, as they have every night the past few days. More will come to the ER. More will be “stat” notifications. More will be put on a ventilator. We were too late to stop this virus. Full stop. But we can slow its spread. The virus can’t infect those it never meets. Stay inside. Social distancing is the only thing that will save us now. I don’t care as much about the economic impact as I do about our ability to save lives. You might hear people saying it isn’t real. It is. You might hear people saying it isn’t bad. It is. Do your part. Stay home. Stay safe. And every day, I’ll come to work for you. n
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Opinions
KLMNO Weekly
Tom Toles
Putting lives ahead of money Sally Jenkins is a Washington Post sports columnist.
The combination of money and fear can create a weird, immoral calculus. In place of that, try to hold a good vision in your head: thousands of athletes, radiant with good health, reconvening a year later to celebrate the end of the novel coronavirus pandemic at the Olympics, where everyone can breathe free and move free again with no lockdowns or sequesters or quarantines. The Tokyo Games are a heartbreak right now, but in time they just might be the most unfeigned celebration in Olympic history. So much of the time, the Olympic “movement” is sham salesmanship, but there was nothing insincere about Japanese Prime Minister Shinzo Abe’s promise to host the Olympics in 2021 as “a testament to victory over the infection.” One can only imagine how much it cost and pained Japanese organizers to postpone: The economic and collateral toll will be in the billions of dollars. It’s a sickness in and of itself, the damage. But they and the International Olympic Committee did the right thing for the world, the thing that others in authority are having so much trouble doing at the moment: They put lives ahead of money. They deserve all kinds of credit for that. As late as last Sunday, IOC President Thomas Bach was still doing the distasteful calculus. In a
letter to athletes, he declared that a decision to postpone “would still be premature.” He suggested there had been “significant improvements in Japan” that might allow them to hold the Games on time in July “with certain safety restrictions,” though he admitted the outbreaks on multiple continents were accelerating. The IOC needed another month to evaluate all scenarios because of the costs and logistics, he suggested. But another month would have been irresponsible, even dangerous. And the IOC had already been irresponsible. In early March, Bach urged athletes to keep training “full steam.” And so runners and swimmers were struggling to train when they should have been sheltering. As late as mid-March, some were even traveling, and courting illness.
You wonder how long the IOC would have hesitated if whole countries and federations had not begun to rebel. Canada announced it would not send a team to Tokyo, and Australia told athletes to prepare for the Games in 2021. USA Swimming and USA Track & Field wrote letters urging postponement. The foot dragging was apparently caused by fears over liability and cost. There are reports that the IOC wanted Tokyo organizers to be the ones to pull the ripcord, to protect itself with insurers and in case of any potential litigation. The IOC, perhaps understandably, wanted to insulate itself and partners such as NBC as much as possible from lasting financial damage over an event estimated to cost $25 billion. But the messaging mattered. Whatever the public sees elite athletes do, it is likely to do as well. They are some of our chief influencers, the makers of manners. The longer the IOC stalled, the more it seemed to softpedal the threat. There was just one plain speaker in the IOC, longtime executive Dick Pound, and he deserves deep respect for it. I have had vehement differences with Pound, but he has a reflexive outspokenness you have to
admire. And he was an honest and candid messenger right from the start. “This is the new war, and you have to face it,” he told the Associated Press back in February. “ … I’d say folks are going to have to ask, ‘Is this under sufficient control that we can be confident about going to Tokyo or not?’ ” No. It is not under sufficient control. There was no option. Even supposing enough countries around the globe could get a grip on the pandemic in the next few weeks — a ludicrous supposition given that India is going into lockdown and the World Health Organization projects the United States will become a new epicenter — did the IOC seriously propose to gather thousands of athletes, coaches and staff into a close Olympic Village setting? Talk about liability. For whatever reason, the IOC shifted the burden of postponement to Japanese organizers. It could not act, Bach said, without their “full cooperation.” Abe and the Tokyo committee gave the IOC the out it wanted. And they gave athletes in countries around the world the release they needed to take care of themselves and their families. They put lives ahead of the math. n
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