Testing: Who’s Getting It? Almost invariably, the only people getting tested are the patients getting hospitalized. Craig Spencer MD MPH@Craig_A_SpencerNYC ER doctor | #Ebola Survivor | Director of Global Health in Emergency Medicine @ColumbiaMed/@NYPhospital

Excuse our arrogance as New Yorkers — I speak for the mayor also on this one — we think we have the best health care system on the planet right here in New York, so, when you’re saying, what happened in other countries versus what happened here, we don’t even think it’s going to be as bad as it was in other countries. Governor Andrew Cuomo on March 2nd (223,699 cases in New York this morning with 15,405 deaths).

Michele and I self quarantined on March 11th, so it’s been over a month since we lived a normal life. Back then, we still had five days before the Bay Area shut down and it would still be over a week before Newsom shut the state down. Back then the Trump Administration, backed by Fox News – or, as is more likely, influenced by Fox News – was still telling us not to worry, it will not be a problem, in fact, the flu is a bigger problem. But it wasn’t just Trump who couldn’t imagine the coming reality, lots of Democrats, like Cuomo and de Blasio couldn’t either. In late January, early February, the New York Times was saying that democracies couldn’t impose the draconian measures that South Korea or Singapore were imposing and inferred that we didn’t need to. Today, the United States with a little more than four percent of the world’s population has close to 30 percent of the total identified coronavirus infections and we’re still not testing as much as most industrial countries so these numbers are undoubtedly low. For reference, South Korea with about 14% of our population has fewer than two percent of our cases. Today, we are doing what a hundred days ago was thought impossible, everybody who can stay at home in the United States is staying at home, most stores are closed, and the economy is tanking.

One of my doctors sent out an email that included some useful information from NPR on how to treat our groceries. It says that the big problem is contamination from other people and the risk of getting COVID-19 from a grocery bag is minimal. Still, this seems to be a scary numbers game. Every interaction with the outside world involves risk assessment. Michele went to the butcher for lamb chops for easter and what are the chances that the wrapping paper is infected? the lamb chops? More than zero, that is for sure but I don’t think they are likely to be infected. After all, we trust the butcher to give us clean meat, they are familiar with good hygiene. It is safer to assume that the wrapping paper is infected so I crumble it up and put it in the trash then I wash my hands. But I touched the trash pail with a potentially contaminated hand, so I have to disinfect the trash container top and wash my hands again. What about lettuce? Whoever picked it could very well be infected. It is probably less likely from a small, organic, farm but people picking lettuce are usually undocumented, untested, and need to work because they are not eligible for unemployment (except in California where they will get $600 if they are off work). I assume the outer leaves are infected and the inner leaves are safe, but that is, really, just a hopeful guess. The choice is always between feeling slightly unsafe or curling up into a ball and going hungry. And the choices go on and on and on. What about all the magazines we get? Is it safe to assume that they are safe to read if I tear the cover off (and put it in the trash and wash my hands)?

Stalin is reputed to have said “When one man dies it’s a tragedy. When thousands die it is a statistic.” and it feels that way when I read that, as of today, there are 37,730 coronavirus related deaths in the United States. These deaths are taking place out of my sight and I don’t know anybody who has died from COVID19 and it takes a conscious effort to turn them into real people who are dying with real families devastated by their losses.

I’ve been wondering if the coronavirus – or SARS-CoV-2 if you prefer the official name – will change our world like the depression changed my grandparent’s world. At first, I was sure that it would for all kinds of reasons but mostly because, going in, governments all over the world have been willing to shut their countries down to save lives. Putting lives over business still seems impossible (and it may not last). But even before the virus, we seemed to be on the threshold of change with Bernie and The Squad, among many others, pushing the country towards a kinder, more people-focused, world with a renewed concern for the disenfranchised. Now, I worry that that concern for the disenfranchised in both political parties is a ruse and nothing will change. Still, lots of things will change even if politicians don’t want them to. More people and more companies will learn how to work from home, which means less office space demand; people will shop over the internet at an increasing rate, making Amazon – and Wallmart et al – bigger and richer and the need for retail space will continue to decline; and people will watch more movies from home; for example. These may not seem like transformative changes. Still, change is change, it isn’t just good or just bad it is – always both – and small, superficial changes have a way of rippling into big changes.

One thing that I have been very reminded of, on a daily basis, is that I do much better in a structured environment. I read about people deep cleaning their house, landscaping their backyard, or finally rebuilding an old car, with envy while I spend much of my time obsessing over the latest numbers (California numbers, National Numbers by county).

Michele tried making her own mask from a Washington Post pattern and, a couple of nights ago, about 3/4s of the way through but stalled out, she began to wonder if the mask pattern was an April Fools joke. Much of our new daily life seems like a bad April Fool’s joke; the sickness and the deaths are only visible in the news and then as charts and graphs with the action line trending towards straight up. It can’t be true that over a thousand people have died in California and the only signs are that traffic is better and the sky is bluer. The whole concept of sheltering at home, or being in quarantine, is like an awful shaggy dog story that goes on and on. Maybe we are the only people doing it, maybe life is normal just outside my vision. But, we are told, if we don’t shelter in place there will be the disaster of an unimaginable culling of the population. Paradoxically, if we do everything right and stay home, it will seem like we overreacted and more people will want to go out which will prove to be a mistake. No wonder some people believe this isn’t real.

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