Tag Archives: Pandemic

“Patchwork Pandemic” – confusing layers of information, spread and regulation

America’s Patchwork Pandemic Is Fraying Even Further

The coronavirus is coursing through different parts of the U.S. in different ways, making the crisis harder to predict, control, or understand.

A U.S. map shaded in with coronavirus particles
A U.S. map shaded in with coronavirus particles. Joan Wong
The Atlantic, by Ed Yong, May 20, 2020

There was supposed to be a peak. But the stark turning point, when the number of daily COVID-19 cases in the U.S. finally crested and began descending sharply, never happened. Instead, America spent much of April on a disquieting plateau, with every day bringing about 30,000 new cases and about 2,000 new deaths. The graphs were more mesa than Matterhorn—flat-topped, not sharp-peaked. Only this month has the slope started gently heading downward.

This pattern exists because different states have experienced the coronavirus pandemic in very different ways. In the most severely pummeled places, like New York and New Jersey, COVID-19 is waning. In Texas and North Carolina, it is still taking off. In Oregon and South Carolina, it is holding steady. These trends average into a national plateau, but each state’s pattern is distinct. Currently, Hawaii’s looks like a child’s drawing of a mountain. Minnesota’s looks like the tip of a hockey stick. Maine’s looks like a (two-humped) camel. The U.S. is dealing with a patchwork pandemic.

The patchwork is not static. Next month’s hot spots will not be the same as last month’s. The SARS-CoV-2 coronavirus is already moving from the big coastal cities where it first made its mark into rural heartland areas that had previously gone unscathed. People who only heard about the disease secondhand through the news will start hearing about it firsthand from their family. “Nothing makes me think the suburbs will be spared—it’ll just get there more slowly,” says Ashish Jha, a public-health expert at Harvard.

Meanwhile, most states have begun lifting the social-distancing restrictions that had temporarily slowed the pace of the pandemic, creating more opportunities for the virus to spread. Its potential hosts are still plentiful: Even in the biggest hot spots, most people were not infected and remain susceptible. Further outbreaks are likely, although they might not happen immediately. The virus isn’t lying in a bush, waiting to pounce on those who reemerge from their house. It is, instead, lying within people. Its ability to jump between hosts depends on proximity, density, and mobility, and on people once again meeting, gathering, and moving. And people are: In the first week of May, 25 million more Americans ventured out of their home on any given day than over the prior six weeks.

I spoke with two dozen experts who agreed that in the absence of a vaccine, the patchwork will continue. Cities that thought the worst had passed may be hit anew. States that had lucky escapes may find themselves less lucky. The future is uncertain, but Americans should expect neither a swift return to normalcy nor a unified national experience, with an initial spring wave, a summer lull, and a fall resurgence. “The talk of a second wave as if we’ve exited the first doesn’t capture what’s really happening,” says Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security.

What’s happening is not one crisis, but many interconnected ones. As we shall see, it will be harder to come to terms with such a crisis. It will be harder to bring it to heel. And it will be harder to grapple with the historical legacies that have shaped today’s patchwork.

I. The Patchwork Experience

A patchwork pandemic is psychologically perilous. The measures that most successfully contain the virus—testing people, tracing any contacts they might have infected, isolating them from others—all depend on “how engaged and invested the population is,” says Justin Lessler, an epidemiologist at Johns Hopkins. “If you have all the resources in the world and an antagonistic relationship with the people, you’ll fail.” Testing matters only if people agree to get tested. Tracing succeeds only if people pick up the phone. And if those fail, the measure of last resort—social distancing—works only if people agree to sacrifice some personal freedom for the good of others. Such collective actions are aided by collective experiences. What happens when that experience unravels?

“We had a strong sense of shared purpose when everything first hit,” says Danielle Allen, a political scientist at Harvard. But that communal mindset may dissipate as the virus strikes one community and spares another, and as some people hit the beaches while others are stuck at home. Patchworks of risk and response “will make it really hard for the public to get a crisp understanding of what’s happening,” Rivers says.

In one future scenario, the nation splinters. When national news diverges from local reality, “suspicions about whether the epidemic was a hoax will find fertile ground in places with a more ambiguous experience of the disease,” says Martha Lincoln, a medical anthropologist at San Francisco State University. Confused people will retreat to the comfort of preexisting ideologies. The White House’s baseless attempts to claim victory will further divide the already fragmented states of America. “In the face of medical uncertainty, people make decisions by returning to their own groups, which are very polarized,” says Elaine Hernandez, a sociologist at Indiana University Bloomington. “They’ll want to avoid being stigmatized, so they’ll follow what people in their networks are doing [even if] they don’t really want to go out.”

Prevention is physically rewarding in the long term, but not emotionally rewarding in the short term. People who stay home won’t feel a pleasant dopamine kick from their continued health. Those who flock together will feel hugs and sunshine. The former will be tempted to join the latter. The media could heighten that temptation by offering what Lincoln calls “disparity in spectacle.” Fringe exceptions like anti-lockdown protests and packed restaurants, she says, are more dramatic and telegenic than people responsibly staying at home, and so more likely to be covered. The risk is that rare acts of incaution will seem like normal behavior.

“There’s a natural saturation point for images of health systems in crisis,” Lincoln adds, and newly overwhelmed hospitals might be ignored in favor of fresher narratives. The local media are better positioned to pick up the nuances of a patchwork story, but of the counties that had reported cases of COVID-19 by early April, 37 percent had lost their local newspaper in the past 15 years. If the virus does indeed resurge and states need to shut down again, people may not comply, because they’ll be misinformed and distrustful.

A second future is also possible. “When this outbreak began in China, everyone said, Thank God it’s not here,” Jha says. “It moved to Western Europe and people said, They have government-run health care; that won’t happen here. Then it hit New York and Seattle, and people said, It’s the coasts. At every moment, it’s more tempting to define the other who is suffering, as opposed to seeing the commonalities we all share.” But as the virus spreads, Americans may run out of others to discriminate against. “Crises are political only until they are personal,” wrote the journalist Elaina Plott, in a piece about a Louisiana woman who convinced her conservative friends to take the coronavirus seriously after her own husband fell sick. Similarly, President Donald Trump’s claims that the virus will go away on its own will ring false to supporters who know someone fighting for breath.

There are signs that this is happening. While Trump’s popularity predictably surged during the crisis, his “rally around the flag” boost was a blip compared with the prolonged peaks of other leaders. Polls have also shown that pandemic partisanship is narrowing, with Democrats and Republicans more united in how seriously they view the threat. Beth Redbird, a sociologist at Northwestern University, has been surveying 200 people a day since mid-March, and “70 to 75 percent of people support most social-distancing measures,” she says. “Those are really large numbers in a society where 52 percent is often viewed as huge support. We rarely see that outside of authoritarian polling. Americans are by and large reading information in a very similar way.”

Economic indicators support this view. Even in conservative states, activity plummeted before leaders closed businesses, and hasn’t rebounded since restrictions were lifted. As such, Redbird doesn’t share the widely held fear that Americans have become inured to social distancing and will refuse to suffer through it again. The bigger risk, she says, is that demoralizing bouts of shutdowns and reopenings will nix any prospect of economic recovery. “You only get to say Go out, trust me once,” she says. “They won’t believe you the second time.”

Both possible futures are confounded by three aspects of COVID-19 that make the pandemic hard to grasp, and that are amplified by the patchwork effect. First, the disease progresses slowly. It seems to take an average of four or five days, and a maximum of 14, for an infected person to show symptoms. Those symptoms can take even longer to become severe enough for a hospital stay, and longer still to turn fatal. This means that new infections can take weeks to manifest in regional statistics. May’s declining cases are the result of April’s physical distancing, and the consequences of May’s reopenings won’t be felt until June at the earliest. This long gap between actions and their consequences makes it easy to learn the wrong lessons.

Second, the pandemic is shaped by many factors. Social distancing matters, but so do testing capacity, population density, age structure, wealth, societal collectivism, and luck. Many countries that successfully controlled the coronavirus used masks; New Zealand did not. Many had decisive leaders; Hong Kong did not. It is easy to look at a patchwork and create just-so stories about why one place succumbed while another triumphed. But no single factor can explain differences across nations or regions.

Third, the disease spreads unevenly. Some cases infect no one, and others infect many. In Washington State, a choir member infected 51 fellow singers during a few hours of rehearsal. In Ghana, a worker in a fish factory infected 533 colleagues. These “super-spreader events,” which are rare but pivotal, become especially important when cases dip. They mean that an untroubled region may continue that way for some time, but that once cases start growing, they can really grow.

If a state reopens and sees no immediate spike in cases, is that because it was justified, because insufficient time has passed, because other things went right, or because unlucky super-spreader events haven’t yet happened? In a patchwork, these questions will be asked millions of times over, and many answers will be wrong.

The COVID-19 pandemic is not a hurricane or some other disaster that will come and go, signaling an obvious moment when recovery can begin. It is not like the epidemics of fiction, which get worse until, after some medical breakthrough, they get better. It is messier, patchier, and thus harder to predict, control, or understand. “We’re in that zone that we don’t see movies made about,” says Lindsay Wiley, a professor of public-health law at American University.

II. The Patchwork Response

A patchwork was inevitable, especially when a pandemic unfolds over a nation as large as the U.S. But the White House has intensified it by devolving responsibility to the states. There is some sense to that. American public health works at a local level, delivered by more than 3,000 departments that serve specific cities, counties, tribes, and states. This decentralized system is a strength: An epidemiologist in rural Minnesota knows the needs and vulnerabilities of her community better than a federal official in Washington, D.C.

But in a pandemic, the actions of 50 uncoordinated states will be less than the sum of their parts. Only the federal government has pockets deep enough to fund the extraordinary public-health effort now needed. Only it can coordinate the production of medical supplies to avoid local supply-chain choke points, and then ensure that said supplies are distributed according to need, rather than influence. Instead, Trump has repeatedly told governors to procure their own tests and medical supplies.

Michael Kilkenny of the Cabell-Huntington Health Department, in West Virginia, says his state found itself short on swabs, disinfectant, and protective equipment; unable to compete in the global market; and abandoned by the White House. “It felt terrible,” he says. “We’ve been making homemade masks, or using bleach solutions. We had to fend for ourselves.” While reporting on pandemics in the Democratic Republic of Congo in 2018, I heard health-care workers repeatedly joke that the 15th article of the country’s constitution is “Débrouillez-vous”—French for “Figure it out yourself.” It’s a droll resignation that when resources are scarce, the government won’t fix your problems, and it’s on you to make do. The U.S., a country that’s more than 400 times wealthier, has seemingly adopted “Débrouillez-vous” as national policy.

Even health officials in well-off states aren’t comfortable with a situation in which preparedness has more to do with wealth and connections than need. “We have everything we need,” says Angela Dunn, the state epidemiologist for Utah, where Governor Gary Herbert moved quickly to buy and secure tests and supplies. “But we did it in a very capitalistic way, and that’s not the best way to deal with a pandemic.” States have tried to level the playing field on their own. Wyoming ended up with few cases but a glut of testing reagents, which it provided to Colorado and Utah when those states saw spikes, Dunn says. “There’s a small barter system, but it’s not sustainable and it doesn’t work at scale,” she says. “I don’t know if Colorado is lacking supplies. If they have a huge spike, that’ll impact Utah. It’s in our interests to make sure everyone’s protected, and without federal coordination, that’s hard to do.”

In some cases, the federal government has actively undermined the states. Charlie Baker, the Republican governor of Massachusetts, tried to buy protective equipment, but was thrice outbid by the federal government; he ended up using the New England Patriots’ jet to fly 1.2 million masks over from China, many of which turned out to be faulty. When Larry Hogan, Maryland’s Republican governor, procured 500,000 tests from South Korea, he kept them guarded in an undisclosed location so they wouldn’t be seized by the feds. This is not federalism working as intended, where different tiers of government work together. Instead of devolving control to the states, the Trump administration has ceded the U.S. to the virus.

The U.S. now heads into summer only slightly more prepared to handle the pandemic that cost it so dearly in the spring. According to the COVID Tracking Project at The Atlantic, the U.S. is now testing 366,000 people a day—a record high. But experts estimate that the country needs 500,000 to several million daily tests. Here, too, a patchwork is apparent. An analysis by NPR and Harvard’s Global Health Institute showed that in early May, only nine states were doing sufficient testing, and another 31 weren’t even halfway to their requisite threshold.

“I would have hoped for more, considering the cost of that time,” says Natalie Dean, a statistician at the University of Florida. Stay-at-home orders were necessary but ruinous, economically and emotionally. Their purpose was to buy time for the country to catch its breath, steel its hospitals, and roll out a public-health plan capable of quashing the virus. Many such plans exist. Umpteen think tanks and academics have produced their own road maps for dialing society back up. These vary in their details, but are united in at least having some. By contrast, the Trump administration’s guidelines for “opening up America again” are so bereft of operational specifics that they’re like a cake recipe that simply reads, “Make cake.”

The Centers for Disease Control and Prevention prepared a more detailed guide but was blocked from releasing it by the White House, according to an Associated Press report. The guidance it has released seems carefully worded to avoid the term guidelines, as if it’s “trying to fly under the radar,” Wiley says. “The abdication of federal responsibility has left states with little choice but to ease the most disruptive physical-distancing measures without the testing data that would make us more confident that cases won’t rapidly surge.” (The CDC finally and quietly released a slightly abridged version of its fuller report on Tuesday.)

The Trump administration “isn’t known for consistency of messaging, so we’ll never put our full faith in that,” says Kilkenny of West Virginia. “We pretty much ran our own state here.” At the time of this writing, only five states and the District of Columbia are still under some form of lockdown. A few, such as Alaska, Hawaii, and Montana, eased restrictions after their caseloads had fallen to low single digits. Idaho is reopening cautiously, despite being one of the less affected states.

Georgia went all in on April 24, reopening gyms, restaurants, theaters, salons, and bowling alleys at a point when it had five of the 10 counties with the highest COVID-19 death rates nationwide, and was testing just a fifth as many people as it needed to. By contrast, Utah revived businesses a week later, when it had more than enough tests for everyone with symptoms, all their contacts, high-risk groups, and even random slices of the populace. Still, Dunn, the state epidemiologist, is nervous. “If we could stick it out for even a couple more months of stricter social distancing, it would do us a world of benefit,” she says. “There are embers everywhere, and they could ignite any moment.” Some states never put their fires out at all: Texas, Alabama, Kansas, Arizona, Mississippi, North Carolina, Wisconsin, and others all reopened while cases were still rising.

“It’s inevitable that we’ll see stark increases in infections in the next weeks,” says Oscar Alleyne of the National Association of County and City Health Officials. The experiences of other countries support that view. Success stories like South Korea, ChinaSingapore, and Lebanon all had to renew or extend social-distancing measures to deal with new bursts of cases. And they had all restrained the virus to a much greater extent than the U.S., which despite having just 4 percent of the world’s population has 31 percent of its confirmed COVID-19 cases (1.5 million) and 28 percent of its confirmed deaths (92,000).

In a connected country, flare-ups that begin in reckless states can easily spread into more cautious ones. Cellphone data, for example, reveal that after Georgia businesses revved back into action, more than 60,000 extra visitors poured in from neighboring states every day. Genetic studies show the risks of such movements. By using patterns of mutations to reconstruct the pandemic’s path, researchers have shown that most of New York’s cases likely stemmed from one introduction from Europe in mid-February. Most of Louisiana’s cases arose from just a couple of introductions from within the U.S. Just a few travelers can spark substantial outbreaks in new places.

To mitigate such risks, about two dozen states have asked out-of-town arrivals to self-quarantine for 14 days. But tighter restrictions would be a logistical and legal nightmare. States can regulate what happens within their borders, but have limited powers to control travel across them. Congress could potentially do so, but it’s unclear if the courts would uphold any restrictions. The right to travel is supported by Supreme Court precedents, but in 1965, the Court ruled that said right “does not mean that areas ravaged by flood, fire or pestilence cannot be quarantined” if unlimited travel would jeopardize the safety of the nation.

Legality aside, domestic-travel bans are of limited use. Even China’s extraordinary quarantine of Wuhan merely delayed the virus from reaching other parts of the mainland by three to five days. Much like social distancing, such measures only buy time. The better strategy is not to try and prevent the virus from traveling, but to build a public-health system nimble enough to catch it when it arrives. Don’t build one big wall; instead, ready a thousand nets.

In this, the U.S. is also behind. Prevented health threats are less visible than present ones, which means that successful public-health departments tragically make the case for their own diminishment. Since 2008, underfunded local departments have lost more than 50,000 jobs. Even now, Cincinnati’s health department has furloughed 36 percent of its staff. “How can you have a system that’s meant to be at the front line of the defense while it’s losing the staff it needs?” Alleyne asks.

Some states are trying to make up for these losses by hiring battalions of contact tracers. These people will call every infected person, talk through their needs, ask for names of anyone they’ve had close or prolonged contact with in the past two days, and call those contacts, too. The process isn’t complicated, but it is laborious. Experts have estimated that the U.S. needs 100,000 to 300,000 contact tracers, and the nation has been slow to recruit them. Selena Simmons-Duffin of NPR reported that only North Dakota had recruited enough as of May 7, although six more states and the District of Columbia were set to.

Things are improving, though. When Danielle Allen of Harvard canvassed several mayors in mid-April, they weren’t taking contact tracing seriously. When she spoke with them again in May, “they were on top of it,” she says. “I was blown away by how much changed in three weeks.” New York State alone is planning to hire 6,000 to 17,000 contact tracers, while California is aiming for 20,000. “This really is the best tool we have to manage the pandemic until we have a safe and effective vaccine,” says Crystal Watson at the Johns Hopkins Center for Health Security.

Will this system, combined with mask wearing and hand-washing, be enough to contain a patchwork pandemic? Complicating matters, people with COVID-19 can spread the coronavirus before showing symptoms. And yet, that hasn’t fazed other countries. South Korea has been rightly praised for its success, and though one nightclub-goer recently sparked a surge of at least 168 cases, the country seems to have contained this new outbreak too. Basic public-health measures have similarly worked in countries as diverse as Iceland, Jordan, Singapore, Germany, and New Zealand. And they have suppressed epidemics of the past, from smallpox in the 19th century to Ebola in 2014. “Some silver bullet isn’t going to save us. We can save ourselves,” says Gregg Gonsalves, an epidemiologist at Yale. “We have very old-school tools that beat fucking smallpox.”

But those very old-school tools must also contend with old-school problems, which are difficult to recognize, let alone beat.

III. The Patchwork Legacy

The current patchwork is not random. Nor is it solely the consequence of America’s actions in 2020. It has emerged from a much older, deeper patchwork.

U.S. policies that evicted Native Americans from their own lands have long left indigenous peoples with insufficient shelter, water, and resources, making them vulnerable to infectious diseases like smallpox, cholera, malaria, dysentery, and now COVID-19. Up to 40 percent of the 170,000-person Navajo (Diné) Nation have no running water; they can’t effectively wash their hands. About 30 percent have no power; they burn coal or wood for heat, resulting in irritated lungs that are vulnerable to a respiratory pandemic—a problem exacerbated by uranium mining on their lands. Chronic underfunding has saddled them with crowded living conditions through which the virus easily spreads, dispersed health-care facilities that are low on beds and ventilators, and high rates of chronic conditions that increase the odds of dying from COVID-19. “The lack of basic services on the reservation isn’t due to our choosing to live this way,” wrote Wahleah Johns, a Diné woman, in The New York Times. “It’s because treaties and federal policies dictate how we live.”

Thanks to traumas that accrued over generations and stressors that accrue over individual lives, the Navajo Nation has more per capita cases of COVID-19 than any U.S. state and nine times as many per capita deaths as neighboring Arizona. While Arizona has loosened its distancing restrictions, the Navajo Nation has been forced to tighten its orders.

Black Americans have fared little better. After the Civil War, white leaders deliberately kept health care away from black communities. For decades, former slave states wielded political influence to exclude black workers from the social safety net, or to ensure that the new wave of southern hospitals would avoid black communities, reject black doctors, and segregate black patients. “Federal health-care policy was designed, both implicitly and explicitly, to exclude black Americans,” wrote the journalist Jeneen Interlandi for The New York Times’ 1619 Project.

This is one reason why the U.S. still relies on employer-based insurance, which black people have always struggled to access. Such a system “was the only fit for a modernizing society that could not abide black citizens sharing in societal benefits,” wrote my colleague Vann Newkirk II. Over the past century, every move toward universal health care, and thus toward narrower racial inequities, was fiercely opposed. The Affordable Care Act, which almost halved the proportion of uninsured black Americans below the age of 65, was most strongly fought by several states with large proportions of black citizens.

Last year, when the Global Health Security Index graded every country on its pandemic preparedness, the United States had the highest overall score, 83.5. But on access to health care specifically, it scored just 25.3. (Out of 195 countries, it tied with The Gambia for 175th place.) That is at least partly the consequence of letting segregationist tenets influence the allocation of health care. “The resulting arrangement all but guarantees an inadequate national response to a national crisis,” wrote Amy Kapczynski and Gregg Gonsalves of Yale.

In almost every state, COVID-19 disproportionately infects and kills people of color—a pattern that Ibram X. Kendi has called “a racial pandemic within the viral pandemic.” Pundits have been quick to blame poor health or unsafe choices, without considering the roots of either. Racism in policing means that many black people don’t feel safe wearing the masks that would protect their neighbors. Racism in medicine means that black patients receive poorer health-care than white ones. Racism in policy has left black neighborhoods with less healthy food and more pollution, and black bodies with higher rates of diabetes, heart disease, stress, and what the demographer Arline Geronimus calls “weathering”—poor health that results from a lifetime of discrimination and disadvantage. “When America catches a cold, black people get the flu,” says Rashawn Ray, a sociologist at the University of Maryland. “In 2020, when America catches COVID-19, black people die.”

These inequities will likely widen. Even before the pandemic, inequalities in poverty and access to health care “were concentrated in southern parts of the country, and in states that are politically red,” says Tiffany Joseph, a sociologist at Northeastern University. Not coincidentally, she says, those same states have tended to take social-distancing measures less seriously and reopen earlier. The price of those decisions will be disproportionately paid by black people.

Vulnerability to COVID-19 isn’t just about frequently discussed biological factors like being old; it’s also about infrequently discussed social ones. If people don’t have health insurance, or can afford to live only in areas with poorly funded hospitals, they cannot fight off the virus as those with more advantages can. If people work in poor-paying jobs that can’t be done remotely, have to commute by public transportation, or live in crowded homes, they cannot protect themselves from infection as those with more privilege can.

These social factors explain why the idea of “cocooning” vulnerable populations while the rest of society proceeds as normal is facile. That cocooning already exists, and it is a bug of the system, not a feature. Entire groups of people have been pushed to the fringes of society and jammed into potential hot zones. Of the 100 largest clusters of COVID-19 in the U.S., nearly all have occurred in prisonsmeatpacking plantsnursing homes, and psychiatric or developmental-care facilities. (The only exceptions are a naval vessel and three power plants; the infamous Grand Princess cruise is only No. 148 on the list.)

These places, along with homeless shelters and immigrant detention centers, are hubs for outbreaks that can easily spread to the surrounding communities. Prisons and nursing homes have staff and visitors who live in nearby towns. Large prisons, in particular, are usually situated in rural areas with small community hospitals that can be easily overrun by an outbreak. And many employees in nursing homes and meatpacking plants are immigrants who care for the nation’s elderly and process its steaks while also being cut off from health care by the Trump administration’s policies. They are both more likely to get sick, and less likely to get better.

This point cannot be overstated: The pandemic patchwork exists because the U.S. is a patchwork to its core. New outbreaks will continue to flare and fester unless the country makes a serious effort to protect its most vulnerable citizens, recognizing that their risk is the result of societal failures, not personal ones. “People say you can’t fix the U.S. health system overnight, but if we’re not fixing these underlying problems, we won’t get out of this,” says Sheila Davis of Partners in Health. “We’ll just keep getting pop-ups.”

Leaders can specifically place testing sites in poor, black, and brown communities, rather than the rich, white areas where they tend to be concentrated. New York Governor Andrew Cuomo, for example, is turning 24 churches in low-income areas into testing centers, while Maryland Governor Larry Hogan placed a testing facility in the heart of the predominantly black Prince George’s County. Officials can remove people from risky environments: Leann Bertsch, who directs the North Dakota Department of Corrections, has argued that prisoners should be freed if they are over 50, have serious illnesses, or are within two years of parole or release. A bipartisan group of 14 senators has made a similar call for decarceration.

Policies can also support people in protecting themselves. Essential workers earn low hourly wages and cannot afford to miss a shift, even if they have symptoms. “The only way to prevent them from going to work is to give them paid sick leave,” Ray says. The same goes for a minimum living wage, hazard pay, universal health care, stipends for people who are self-isolating, debt moratoriums, rent freezes, food assistance, and services to connect people with existing support.

The pandemic discourse has been dominated by medical countermeasures like antibody tests (which are currently too unreliable), drugs (which are not cure-alls), and vaccines (which are almost certainly at least a year away). But social solutions like paid sick leave, which two in three low-wage workers do not have, can be implemented immediately. Imagine if the energy that went into debating the merits of hydroxychloroquine went into ensuring hazard pay, or if the president, instead of wondering out loud if disinfectant could be injected into the body, advocated for health care for all? “We have decades of social-science research that tells us these things work,” says Courtney Boen, a sociologist at the University of Pennsylvania. “It’s a question of political will, not scientific discovery.”

And while a vaccine will protect against only COVID-19 (if people agree to take it at all), social interventions will protect against the countless diseases that may emerge in the future, along with chronic illnesses, maternal mortality, and other causes of poor health. “This pandemic won’t be the last health crisis the U.S. faces,” Boen says. “If we want to be on better footing the next time, we want to reduce the things that put people at risk of being at risk.”

Of all the threats we know, the COVID-19 pandemic is most like a very rapid version of climate change—global in its scope, erratic in its unfolding, and unequal in its distribution. And like climate change, there is no easy fix. Our choices are to remake society or let it be remade, to smooth the patchworks old and new or let them fray even further.

ED YONG is a staff writer at The Atlantic, where he covers science.

NYTimes: Lockdown Delays Cost at Least 36,000 Lives

Even small differences in timing would have prevented the worst exponential growth

New York Times, by James Glanz & Campbell Robertson, May 20, 2020
CLICK TO ENLARGE – By Lazaro Gamio | Source: “Differential Effects of Intervention Timing on COVID-19 Spread in the United States,” by Sen Pei, Sasikiran Kandula and Jeffrey Shaman, Columbia University

If the United States had begun imposing social distancing measures one week earlier than it did in March, about 36,000 fewer people would have died in the coronavirus outbreak, according to new estimates from Columbia University disease modelers.

And if the country had begun locking down cities and limiting social contact on March 1, two weeks earlier than most people started staying home, the vast majority of the nation’s deaths — about 83 percent — would have been avoided, the researchers estimated.

Under that scenario, about 54,000 fewer people would have died by early May.

The enormous cost of waiting to take action reflects the unforgiving dynamics of the outbreak that swept through American cities in early March. Even small differences in timing would have prevented the worst exponential growth, which by April had subsumed New York City, New Orleans and other major cities, the researchers found.

“It’s a big, big difference. That small moment in time, catching it in that growth phase, is incredibly critical in reducing the number of deaths,” said Jeffrey Shaman, an epidemiologist at Columbia and the leader of the research team.

How Earlier Control Measures Could Have Saved Lives


By Weiyi Cai·Source: “Differential Effects of Intervention Timing on COVID-19 Spread in the United States,” by Sen Pei, Sasikiran Kandula and Jeffrey Shaman, Columbia University

The findings are based on infectious disease modeling that gauges how reduced contact between people starting in mid-March slowed transmission of the virus. Dr. Shaman’s team modeled what would have happened if those same changes had taken place one or two weeks earlier and estimated the spread of infections and deaths until May 3.

The results show that as states reopen, outbreaks can easily get out of control unless officials closely monitor infections and immediately clamp down on new flare-ups. And they show that each day that officials waited to impose restrictions in early March came at a great cost.

After Italy and South Korea had started aggressively responding to the virus, President Trump resisted canceling campaign rallies or telling people to stay home or avoid crowds. The risk of the virus to most Americans was very low, he said.

“Nothing is shut down, life & the economy go on,” Mr. Trump tweeted on March 9, suggesting that the flu was worse than the coronavirus. “At this moment there are 546 confirmed cases of CoronaVirus, with 22 deaths. Think about that!”

In fact, tens of thousands of people had already been infected by that point, researchers later estimated. But a lack of widespread testing allowed those infections to go undetected, hiding the urgency of an outbreak that most Americans still identified as a foreign threat.

In a statement released late Wednesday night in response to the new estimates, the White House reiterated Mr. Trump’s assertion that restrictions on travel from China in January and Europe in mid-March slowed the spread of the virus.

On March 16, Mr. Trump urged Americans to limit travel, avoid groups and stay home from school. Bill de Blasio, mayor of New York City, closed the city’s schools on March 15, and Gov. Andrew M. Cuomo issued a stay-at-home order that took effect on March 22. Changes to personal behavior across the country in mid-March slowed the epidemic, a number of disease researchers have found.

But in cities where the virus arrived early and spread quickly, those actions were too late to avoid a calamity.

In the New York metro area alone, 21,800 people had died by May 3. Fewer than 4,300 would have died by then if control measures had been put in place and adopted nationwide just a week earlier, on March 8, the researchers estimated.

All models are only estimates, and it is impossible to know for certain the exact number of people who would have died. But Lauren Ancel Meyers, a University of Texas at Austin epidemiologist who was not involved in the research, said that it “makes a compelling case that even slightly earlier action in New York could have been game changing.”

“This implies that if interventions had occurred two weeks earlier, many Covid-19 deaths and cases would have been prevented by early May, not just in New York City but throughout the U.S.,” Dr. Meyers said.

The fates of specific people cannot be captured by a computer model. But there is a name, a story and a town for every person who was infected and later showed symptoms and died in March and early April. Around the country, people separate from this study have wondered what might have been.

Rushia Stephens, a music teacher who had become a county court records technician in an Atlanta suburb, collapsed on her bedroom floor, unable to breathe, and died on March 19. Adolph Mendez, a businessman in New Braunfels, Texas, was confined to his own bedroom as his terrified family tended to him until he died on March 26. Richard Walts, a retired firefighter in Oklahoma, was ferried to a hospital in an ambulance and died two weeks later, on April 3.

Mr. Mendez’s widow, Angela Mendez, said she still couldn’t say for sure whether action should have been taken earlier. It didn’t matter now anyway, not for her husband.

“They probably could have had earlier a better way to not let this pandemic go that far,” she said. “But they didn’t.”

Official social distancing measures don’t work unless people follow them. While the measures have enjoyed generally widespread support among Americans, the findings rely on the assumption that millions of people would have been willing to change their behavior sooner.

People are apt to take restrictions much more seriously when the devastation of a disease is visible, said Natalie Dean, an assistant professor of biostatistics at the University of Florida who specializes in emerging infectious diseases. But in early March, there had been few deaths, and infections were still spreading silently through the population.

“If things are really taking off, people are likely to clamp down more,” Dr. Dean said. “Do people need to hear the sirens for them to stay home?”

Dr. Shaman’s team estimated the effect of relaxing all control measures across the country. The model finds that because of the lag between the time infections occur and symptoms begin emerging, without extensive testing and rapid action, many more infections will occur, leading to more deaths — as many as tens of thousands across the country.

The timing and circumstances of those who were infected in March raise haunting questions.

It was a Friday night in mid-March when Devin Taquino began feeling sick. Neither he nor his wife was thinking at all about the coronavirus. There were already more than 200 cases in the state by that time, but most of those cases were in the eastern part of the state, not in the small city of Donora, south of Pittsburgh.

Plus, Mr. Taquino did not fit the profile: he was only 47 years old with no underlying conditions and his main symptom — diarrhea — was not something broadly associated with the disease. He was planning to work a Saturday morning overtime shift at a call center half an hour away, but he called in sick. Offices all over the area were asking people not to come in, but Mr. Taquino’s had not taken that step.

He worked on Monday, but on Tuesday he returned home sick from work, passed out in bed and didn’t wake up for 16 hours. The next morning, his wife, Rebecca Taquino, 42, woke him up and told him they needed to get tested. She didn’t think he had the virus, but she thought it was the smart thing to do.

Without primary care doctors, they went to a nearby urgent care clinic, where they learned that his blood oxygen level was very low. The people at the clinic offered to call an ambulance, but fearing the cost, and still skeptical that this was that serious, the Taquinos chose to drive to an emergency room.

At the hospital, he was given an X-ray and diagnosed with pneumonia. He stayed, kept in an isolation unit just in case, and she returned home. The next evening, March 26, he called her with two developments. One: his work had emailed with the news that someone at the call center, where the work stations sat about a foot apart, had tested positive for the virus. The other bit of news was that he had tested positive.

There has been a lot for Ms. Taquino to think about in the weeks since that phone call, including the long days during which she never left the house and her husband’s situation got more horrifyingly worse.

Should the call center have sent the employees home earlier? When she called the center on Friday to report his condition, it was already empty: the workers had been sent home. Did they act too late?

“I kind of tossed that one back and forth myself,” she said. “I really want to blame it on them, I really do.”

Could she know definitively where he got it? It was hard to say for sure. Still, given that email the day of his diagnosis, it seemed by far the most likely possibility that he got it at work.

After three weeks of agony, Mr. Taquino died on April 10. Whether he was one of the thousands of people who might be alive if social distancing measures had been put in place a week earlier can never be known.

Ms. Taquino said officials should have known.

“If it’s spreading that fast you have to know it would have come here,” Ms. Taquino said. “They should have been implementing programs. I think it was a giant lapse in our country. There was no way to think that we were going to be spared from this.”

‘Stealth Bailout’ Shovels Millions of Dollars to Oil Companies – Valero gets $110 million in pandemic giveaway

Photographer: Vincent Mundy / Bloomberg

Bloomberg News, By Jennifer A Dlouhy, May 15, 2020

  •  Stimulus tax change helps translate losses into instant cash
  •  Oil companies are uniquely poised to benefit, analysts say

As it headed toward bankruptcy, Diamond Offshore Drilling Inc. took advantage of a little-noticed provision in the stimulus bill Congress passed in March to get a $9.7 million tax refund. Then, it asked a bankruptcy judge to authorize the same amount as bonuses to nine executives.

The rig operator is one of dozens of oil companies and contractors now claiming hundreds of millions of dollars in tax rebates. They are employing a provision of the $2.2 trillion stimulus law, called the CARES act, that gives them more latitude to deduct recent losses.

“This is a stealth bailout for the oil and gas industry,” said Jesse Coleman, a senior researcher with Documented, a watchdog group tracking the tax claims. It’s geared to companies “that have been losing money over the last few years — and now they get that money back as a check from the taxpayers. That’s exactly what the oil industry has been doing.”

relates to ‘Stealth Bailout’ Shovels Millions of Dollars to Oil Companies
Electronic drilling with cyber chairs Source: Diamond Offshore Drilling Inc.

The change wasn’t aimed only at the oil industry. However, its structure uniquely benefits energy companies that were raking in record profits in 2018 as crude prices reached $76.41 per barrel, only to see their fortunes flip a year later.

More than $1.9 billion in CARES Act tax benefits are being claimed by at least 37 oil companies, service firms and contractors, according to a Bloomberg News review of recent filings with the Securities and Exchange Commission. Besides Diamond Offshore, which declined to comment, recipients include oil producer Occidental Petroleum Corp. and refiner Marathon Petroleum Corp.

Read More: Occidental Seeking Federal Lifeline For U.S. Oil Industry

Other oil companies say they didn’t lobby Congress for the change, which is widely available across all industries. “We did not request any benefit, but we are obligated to follow the tax laws as passed by Congress, which apply to all corporate manufacturers nationwide,” said Jamal Kheiry, a spokesman for Marathon, which got a $411 million benefit.

Congress embedded the tax change governing losses in the stimulus measure early on, as lawmakers moved rapidly in March to steer trillions of dollars in aid to coronavirus-ravaged workers and companies. Alongside expanded unemployment payments and payroll loan programs, lawmakers saw an opportunity to harness the tax code to help get cash flowing to companies struggling to pay rent, workers and insurance.

It “was sold as help for the little guy — help for small business,” said Steve Rosenthal, a senior fellow with the Urban-Brookings Tax Policy Center. “In the name of ‘small business,’ we’re shoveling out billions of dollars to big corporations and rich guys.”

The provision loosened rules governing how businesses deduct net operating losses — incurred when deductible expenses exceed gross income. For years, companies were able to apply those net operating loss deductions to previous tax returns as well as going forward — but Congress ruled out retroactive relief as part of the 2017 tax cut law.

Tax Law Changes May Limit Benefits of New Loss Carryback Perk

That new forward-focused approach works well when the economy is expanding, but the promise of using today’s losses as tomorrow’s deductions isn’t much help to coronavirus-battered companies with no guarantee they will survive long enough to claim them. So in the stimulus package, Congress gave businesses the chance to carry back all their losses — and claim immediate tax refunds — for five years from 2018, 2019 and 2020.

“The thought was temporarily we should bring them back so that firms that are seeing significant losses in the next year or over the past year or two can carry those back and get some short-term liquidity,” said Garrett Watson, a senior policy analyst at the Tax Foundation, a non-profit that supports pro-growth tax policies.

Traditionally, the ability to deduct net operating losses is meant to ensure companies get fair tax treatment even amid volatility, Watson said — a plus for the notoriously boom-and-bust oil industry. “You are going to see the biggest benefits for firms like oil and gas that are seeing volatile profits — and now, of course, extreme losses,” he said.

The combination of big losses now and the congressional tax changes mean it may be years before some oil companies have to pay corporate income taxes at all.

“We’re going to have some large losses this year,” ConocoPhillips Executive Vice President Don Wallette said in an April 30 earnings call. The company is in “a zero-tax-paying position in the U.S. and expect to remain there for quite some time,” Wallette said.

There’s no limit on how the new refunds can be used — and even bankrupt firms can get them.

Oil for Less Than Nothing? Here’s How That Happened: QuickTake

Consider Diamond Offshore. Once one of the world’s largest drilling rig contractors, it filed for Chapter 11 bankruptcy protection on April 26 after crude prices plunged along with demand for its high-tech drillships.

In a first quarter filing, Diamond, which is majority owned by Loews Corp., said it had recognized a tax benefit of $9.7 million as a result of the carryback change. In an emergency motion filed with a federal bankruptcy court May 1, the company asked for the freedom to dole out $16.7 million in cash incentives to 85 of its 2,300 full-time employees, including as much as $9.7 million for nine senior executives.

The company said at the time that deteriorating market conditions and the collapse of Diamond’s stock had made its existing equity-based bonus program “largely worthless.” The tax filing did not specify how the $9.7 million would be used.

Dozens of other oil businesses have reported reaping the benefits, including $55 million for Denver-based Antero Midstream Corp., $41.2 million for supplier Oil States International Inc. and $96 million for Oklahoma-based producer Devon Energy Corp.

Occidental Petroleum, which enlisted its employees to ask Congress to “provide liquidity to the energy industry,” said it now anticipates a cash refund of about $195 million as a result of the carryback provision and a separate change in the stimulus bill that allows the immediate refund of unused alternative minimum tax credits. An Occidental spokesperson declined to comment.

Millions in Refunds
National Oilwell Varco Inc., a manufacturer of oil and gas equipment, expects a $123 million refund by carrying back its 2019 losses and applying them to its 2014 tax filing.

San Antonio-based refiner Valero Energy Corp. recognized an extra $110 million by carrying back losses to 2015 — when the corporate tax rate was 35% instead of the current 21%.

Valero spokeswoman Lillian Riojas said that is tied to tax losses generated in the first quarter, since the company did not generate a net operating loss for federal income tax purposes in 2018 or 2019. And she said the actual refund will be dependent “not only on the company’s performance for the remainder of the year, but also on the impact” of other tax provisions.

The benefits are “turbo-charged,” said Rosenthal, with the Urban-Brookings Tax Policy Center. That’s because businesses can carry back losses to offset income at a higher corporate tax rate of 35%, before the 2017 tax cut law lowered it 14 points. “Getting those losses at 35% is very, very favorable — especially in 2020 when the losses are going to be devastatingly large.”

The filings themselves reveal only part of the picture. Private companies are able to generate tax refunds too — without disclosing it to the SEC. And while some public companies said they benefited from the tax break, they didn’t reveal by how much.

For instance, refiner Phillips 66 boasted an effective income tax rate of just 2% for the first quarter — well below the federal statutory income tax rate of 21% — partly because of the carryback. But the company did not specify the amount of its expected refund.

House Democrats Unveil $3 Trillion Aid Bill With Cash for States

Dennis Nuss, a spokesman for Phillips 66, declined to comment when reached by phone Thursday. Representatives for Oil States, National Oilwell Varco, Antero and Devon didn’t respond to messages seeking comment.

The importance of the provision hasn’t been lost on President Donald Trump’s administration. Energy Secretary Dan Brouillette recommended oil companies consider taking advantage of the expanded deduction in an April 21 interview with Bloomberg TV, calling it one of several “important liquidity tools that are going to help the industry.”

Congressional tax analysts initially estimated that the expanded loss carryback provision would cost $25 billion over 10 years — just when used by corporations. Now, some are questioning whether the final pricetag could be much higher, and Democrats are seeking to limit the value of the tax break after raising concerns it overwhelmingly helps corporations and the wealthy.

In a new stimulus bill advanced Tuesday, House Democrats proposed scaling back the provision so companies could only apply losses back to 2018. Their plan also would prevent companies with “excessive” executive compensation or stock buybacks from claiming the tax break — a change that would be retroactive back to March.

Rosenthal stressed that it was logical for Congress to help businesses that were profitable before the pandemic. “But the CARES Act goes too far, tilting its benefits overwhelmingly to the wealthiest Americans,” he said in an essay. “I think Congress did not know the extent of what it was doing.”

— With assistance by Ari Natter, Laura Davison, David Wethe, Kevin Crowley, Leslie Pappas, and Rachel Adams-Heard

April was death. April was hope. April was cruel.

April’s coronavirus death toll surpassed the Vietnam War’s, and it tested almost everyone, yet Americans found ways to come together.

The Washington Post, by Marc Fisher, Abigail Hauslohner, Hannah Natanson and Lori Rozsa, May 2, 2020

April was death. Bodies stacked, mothers and fathers discarded in bags piled onto refrigerator trucks in hospital parking lots, dumped into mass graves. People leaving this life without farewells, without a last look of love, without a touch.

April was hope. A frenzy of purposeful energy, scientists and doctors and nurses searching for patterns that might lead to answers. People without fancy degrees snapped on gloves, tied on masks and prayed that the help they gave to people they would never know might not lead also to their own demise.

April was cruel. There have been worse months in the history of human beings, but not many. An average of 446,000 people died each month from August to October in 1942 during Germany’s mania of industrialized murder, the Holocaust. In the United States, the deadliest month was October 1918, when about 200,000 people succumbed to the flu.

The new virus is a swift executioner. In the war in Vietnam, 58,209 Americans were killed between 1960 and 1975. In the battle against the novel coronavirus, 58,760 Americans died in April alone. Both crises leeched into existing fissures, exacerbating political and social divisions. But the war analogy goes only so far; in this conflict, we have no big guns, no ready defense. All we can do at this stage is hide and try to manage the damage.

April 11: U.S. death toll becomes highest in the world (20,429)
April 20: U.S. death toll doubles in 9 days (42,128)
April 29: U.S. death toll now surpasses nation’s Vietnam War casualties from 1960 to 1975 (58,209)
April 30: 62,557 total U.S. covid-19 deaths

The virus that changed America in April is an invisible and insidious killer, aimed at no one in particular and at everyone at once. This disease, covid-19, has the power to cause searing pain, to turn our bodies against us, to rob us of the thing we take most for granted, the air we breathe. It also steals jobs and money and food and the simplest of gestures — a smile now hidden under a mask, a glance that doesn’t happen because you’re stuck at home, a handshake that now shivers with danger.

By the end of the month, more than 2,000 Americans were dying each day and more than 1 million had confirmed infections — about one in every 325 people in the country.

Kathleen Kelly, an emergency room physician at Reston Hospital Center in Northern Virginia, seen outside her home in Alexandria, Va., on April 27. “It’s just like nothing anybody’s seen,” she said of the covid-19 crisis overwhelming many hospitals. (Alyssa Schukar/for The Washington Post)

A desperate month

April was a frantic blur, at hospitals, in makeshift wards in hallways and closets, in formless days as nurses tried to salve gasping patients. After 12 hours of tending to people for whom they had no answers, doctors stole a few moments to trade stories in their Facebook groups, telling what they had seen and what they had tried. Somehow, they hoped, their collective anecdotes might add up to something useful.

“There’s no consensus on what’s the right thing to do,” said Kathleen Kelly, an emergency room physician at Reston Hospital Center in Northern Virginia. “It’s just like nothing anybody’s seen.”

Put the patients on their bellies, give them high-flow nasal oxygen, try this, try that, anything to help them draw air. People came in with breathing so labored that nurses could hear them clear across the ER.

There was no such thing as dropping by to check on a patient. Everything was an ordeal, a detailed process designed to keep health-care workers going beyond where they ever thought they would go.

It took five pairs of gloves just to safely remove one set of protective gear (mask and face shield and gloves and gown and booties): Clean an area, remove the gloves, dump them in a paper bag, put on another pair, clean an area, repeat. It took five minutes to prep for each bedside visit.

“But these people need you in there right now,” Kelly said. “We’re used to running to colleagues for advice, but now, nobody can run in to check with anyone.”

There were so many questions, so few answers. Where, for example, were all the other patients — the heart attacks and cooking burns and car crash injuries? (Okay, that last disappearance was explainable: Hardly anybody was driving.) Were people suffering at home, too scared to come to the hospital? Even the neonatologists wondered: Where are people delivering their babies?

When people did arrive, their situation was bad.

“Heart attacks are coming in too late, and they’re ending up with long-term cardiac damage,” said Kelly, who is 63 and started her career during the first big wave of HIV cases. “You protected yourself then, but it was nothing like this. This is so infectious, and we don’t understand it. I don’t know how I’ll know when to take the mask off.”


A hunger for air

April was a scary quest for air, a hunger for the very stuff of life.

Shani Evans, 50, thought it was just menopause. Hot flashes, chills. Then, after two days, the sore throat, headache, and dry cough. Uh-oh.

But she had a job interview — she was in the process of switching from one Lowe’s store to another, where she would be working in the lawn and garden department — and the teledoctor she called told her she probably just had a seasonal allergy.

Then everything got worse. The symptoms stacked up — add nausea and fever to the mix. She called in sick and drove from her home in Harpers Ferry, W.Va., to an urgent care clinic 15 minutes away in Charles Town, where they told her she didn’t meet the criteria for getting a coronavirus test. They gave her cough medicine and sent her home.

Then the virus took her breath away.

“I was never sicker,” Evans said. Thirteen days into the suffering, her boyfriend, Ronald Grey, drove her to the ER at Jefferson Medical Center. She was gasping for air.

On the third try at the hospital, Evans said, a staffer decided she needed help and rustled up a wheelchair.

Pete Paganussi, a doctor in the ER, saw Evans. “He was so nice,” Evans said. “He stayed with me for hours.”

Paganussi explained that the best thing he could do for her breathing was to intubate her — put her on a ventilator.

“I explained it, and she got up and ran out,” Paganussi said.

Evans said she refused the treatment because “I’m a strong person, maybe stubborn, too. I was scared to go on the ventilator because I didn’t want to lose control. I wanted to keep my lungs moving.” (In a study of covid-19 patients in New York, 88 percent of those who were put on ventilators died.)

Evans went home. The hours crawled by. She drank tea, used an inhaler. She did whatever she could to avoid lying down, because that’s when the cough intensified. She vacuumed the floor, dusted, anything to keep active, keep her lungs going. Not normally given to anxiety, she was scared beyond imagining. Time became a blur. For seven days, she barely slept, getting just minutes of rest at a time because the coughing would wake her.

“I was in and out of my mind,” she said. “It was really weird.”

She tried to watch TV. She put CNN, Fox News and MSNBC on split screens and she had no idea what to believe. “Everybody says different things, and I don’t know what to do with it,” she said. “Fox plays it down and CNN takes it more serious, and I can’t get anywhere with it.”

Paganussi kept calling from the hospital and leaving messages. No answer.

“I was afraid she’d died,” the doctor said.

On the third day after the hospital visit, her breathing eased. She called the doctor back. She was okay, she said.

“It’s been a long month,” Evans said. “A very long month.”

The sickness lifted. The cough lingered, then resolved. But the anxiety remained, even after her employer paid her for her time in quarantine. Her boyfriend is okay, and she’s back at work, but “mentally, I’m changed,” Evans said. “I don’t know how I’m going to go back to going places.”

Her doctor shares her anxiety. “I’ve been a doc since 1985, and I’ve never been afraid to walk into a room,” Paganussi said. “This virus scares me.”

Before every shift, he reads the 91st Psalm to the nurses: “You will not fear the terror of night, nor the arrow that flies by day, nor the pestilence that stalks in the darkness, nor the plague that destroys at midday. A thousand may fall at your side, ten thousand at your right hand, but it will not come near you.”

When he finishes, the nurses break into applause.


Silent and eerie

April was still. Silent schools and eerily empty highways, shuttered shops and deserted offices. Outside their homes, many people were muffled — masked, gloved, fearful, possible vectors of a contagion that knew no bounds.

Even death seemed more still than usual. No bedside farewells, no last hugs, no comforting gatherings of loved ones.

From their homes in the Boston area, Shannon, Jean and Kellie Lynch could only listen on the phone to the beeping monitors in their mother’s Florida hospital room. A nurse propped the phone on Carol Lynch’s pillow at the Villages Regional Hospital.

“We love you,” said Kellie, 59, the eldest. “Mom, if this is too much and you can’t do this, you can let go.”

And then, Kellie said, “all of a sudden, the beeping stopped.”

Carol Lynch was 84 when she died of covid-19. She died alone, and that is not how the Lynches pass from this world.

“In our family,” said the middle sister, Jean, 56, “we’re all there by their side when they die.”

They were there, at home, when their father, James, succumbed to a stroke, in 1999.

“I administered his last dose of morphine,” said Jean, a real estate agent who lives in Chelmsford, Mass.

When the fourth sister, Susan, died of leukemia at 23, her parents were by her side.

Now, Carol was gone.

“Can you imagine being surrounded by people with face masks, no one you know?” Jean said.

Carol Lynch, second from left, with her daughters, from left, Kellie, Shannon and Jean celebrating Shannon’s birthday in 2018. (Family Photo/Family Photo)

Their mother had suffered from occasional bronchitis but was otherwise healthy. When the virus struck, Carol thought it was her usual ailment. The daughters persuaded her to see a doctor, who said she had “a teeny bit of pneumonia,” Kellie said. Carol wanted to charge ahead with planning her birthday party. Her daughters told her to cancel it because of the virus.

“They get their news from Fox down there,” Kellie said. “They believe what Trump tells them. She said she had a lot of shopping to do for the party. I said ‘No, you’re not.’ She grumbled and complained, but she canceled the party.”

The decline came swiftly. One day, Carol was cooking up a storm, making beef stew and meatballs for her friends. The next day, she was delirious, with a high fever.

Kellie — who owns a fitness studio in Cohasset, Mass., where the youngest daughter, Shannon, 50, also works — went down to Florida to bring their mother home. But when Kellie arrived, hospital staffers wouldn’t let her into her mother’s room.

A few days after Carol died, Kellie received a box containing their mother’s ashes.

“I just kept moving it around the house,” Kellie said. “Finally, my girls were like, ‘Mom, you have to open the box.’ When they unpacked the urn, I started to shake all over.”

She put it in the living room, near a picture of her mother.

There could be no family gathering. “No big funeral, no wake, no ritual,” Shannon said. “There’s a lot to be said for having your people around you, where you can express your pain and cry your eyes out.”

The daughters hope to arrange a small family funeral in May, as well as a celebration of Carol’s life in June in Florida.

Jean said she has been “crying so hard that it actually hurt me. I couldn’t hold a thought. I was like, what the hell is wrong with me? Why do I feel so heavy? I called a friend, and she said, ‘That’s grief.’”


A rain of blows

April was punch after punch, a beating that knocked some families down, then slammed them again.

Miguel and Maria Hernandez were inseparable. Their love came late — they were already in their 40s when they met in a shopping mall — and endured through civil war in El Salvador, migration to a new country, and years of troubled health.

In Elizabeth, N.J. — where the couple settled and raised their son — Miguel, 77, and Maria, 80, were rarely seen apart.

“If people saw one of them alone, they’d be like ‘Where’s your husband?’ ‘Where’s your wife?’” said their son, Jose. “They were attached at the hip.”

Miguel and Maria lived upstairs in the family’s main house; Jose, now 36 and married, with one son, lived in the apartment below.

In recent years, Miguel had battled prostate cancer, and then heart problems. He had a pacemaker installed. He was shocked with a defibrillator twice.

When the epidemic began, the family was cautious. But, as March ended, Miguel fell ill. For many years an active bicyclist, he stopped eating, struggled to climb stairs, lost his balance. He grew confused and dehydrated.

At the beginning of April, Jose, Maria and Miguel donned masks and drove to the hospital.

Almost as soon as Miguel was admitted, Maria, who had long suffered from asthma, began to cough. They both tested positive for the virus, and Jose shuttled them back and forth to the hospital.

With his mother hospitalized and his father at home, Jose juggled his hopes and his emotions, his duties to Miguel upstairs and his concern about his wife, Kimberly, and their 5-year-old son, Marius, downstairs. Jose wore a mask and a separate set of clothes to feed and bathe his father.

Miguel and Maria Hernandez with their grandson, Marius. “They loved every single minute with their grandson,” their son, Jose, said. (Family Photo/Family Photo)

Miguel couldn’t sleep. He struggled to pull in air. “He would close his eyes, start to drift off, but he wasn’t breathing right,” Jose said. “He’d open his eyes, startled.”

Jose called an ambulance. The paramedics showed up looking like first responders at a chemical spill.

At the hospital, Miguel was placed on a ventilator. Within three days, he died in his sleep.

Jose couldn’t tell Maria. He knew it would break her heart.

But then Jose got an urgent call from the hospital. As doctors prepared to intubate Maria, too, they asked Jose whether they should start chest compressions if her heart stopped — as it would — warning that performing CPR on an 80-year-old in her condition might break her ribs and cause serious harm.

Jose thought of what his mother had told him a few years earlier when his grandmother died: “I don’t want them keeping me alive when I’m not really alive.” Now, Jose told the doctor: No chest compressions.

Just like that, his parents were gone. Married for 37 years, dead within three days.

On top of the loss, Jose faced the sudden cost of two funerals — $12,450 for two plots, two caskets, two services.

Miguel had worked hard his whole life, doing maintenance in warehouses. And Jose had a full-time job as a supermarket security guard. But money to cover the cost of dying simply didn’t exist.

Jose’s aunt — Miguel’s sister — and her children set up a GoFundMe appeal. They posted pictures of the man who played the guitar and loved mariachi bands, who regaled relatives with stories of the old days, who was always up for a game of checkers.

The money arrived in 500 donations — $10 here, $100 there.

“No one should have to worry about funeral expenses while mourning such a painful loss,” one man wrote.

Jose would have to wait for the funeral. For now, at home in a house left only half full, he and Kimberly searched for a Disney movie that might help explain the death of a loved one to a 5-year-old. The only one that came to mind was “The Lion King,” in which the father lion is killed, but it didn’t seem quite right.

Jose and Kimberly put off telling Marius about what had happened to the grandparents he had visited every day, with whom he played and watched cartoons. But he soon began asking. Where were they? Were they feeling better?

Niche farmer Yiling Cui prepares garlic chives and tiny carrots for sale at her farm, Everlasting Garden, in Hollister, Calif., on April 16. With the closure of most high-end restaurants, which are Cui’s primary customers, the business is reeling financially. (Melina Mara/The Washington Post)

Plunged into crisis

April was lost — jobs evaporated, bank accounts run dry. Liquor sales soared, as did prescriptions for anti-anxiety medications and calls to suicide hotlines. Food lines and empty grocery shelves became commonplace in a nation accustomed to a life of plenty.

In the California valley that prides itself on being the nation’s salad bowl, Yiling Cui named her farm Everlasting Garden, and for more than two decades, the name seemed accurate. She grew tiny French breakfast radishes and lemon grasses and six kinds of basil for high-end San Francisco restaurants.

Like many other business owners across the country, Cui saw the impact of stay-at-home orders almost overnight. With restaurants closed, she went from 55 clients to none. Cui was left with five acres of food she couldn’t give away.

She tried to shift to serving her neighbors. She tore out those specialty crops and planted foods people needed now that they were cooking at home: baby carrots, scallions, fava beans.

Cui, 67, put notices on Facebook and went to farmers markets. While locals were happy to buy some greens — they drove up, popped their trunks, and Cui deposited a box of produce — the revenue was a tiny portion of what she usually brought in.

She had no work for her two seasonal employees. She and her partner did all the labor now — mostly sad work, plowing in plants that used to end up on $30 plates in Bay Area eateries.

“Every day now, we just try to figure out tomorrow,” she said. “I just try to keep going. At least we can eat what we grow.”

At Andrea Osorio’s house in San Antonio, they planted seeds for beans, tomatoes and squash in the front yard and started building a chicken coop in the back.

It’s not enough. After she chastises her sons for eating more than two eggs, after she calculates how much she owes the bill collectors, and after she feeds the men in her life frijoles — refried beans — for the fifth night in a row, Andrea retreats to a corner of her living room to cry.

The panic felt tighter each April day without work, without a way to buy food. On this night, the worry left her breathless.

Before the pandemic, Osorio, 46, did not have to ration. The undocumented domestic worker found a way to provide for her Mexican American family. If work was slow, the mother of four pushed harder. She usually made nearly $500 a week cleaning houses in San Antonio, bolstering her husband’s construction wages.

Before, Osorio’s 75-year-old father, Victorio, did odd jobs to help bring in money. Before, her youngest, Osvaldo, a plump 10-year-old, would sneak snacks and his mother would let it go. Before, Osorio sent what money she had left over to her mother in Mexico.

Now, the mother eyes her son warily in the kitchen. Now, the old man stands at attention after each dinner to deliver a formal thank you to his daughter.

“At the beginning, I thought I could do this,” Osorio said. “But two weeks became three and then four and now who knows when I can work again? I cry, but never in front of them. I wait until they go to sleep and I’m alone.”

Her husband, Oscar Sanchez Sr., leaves every morning before 7 to finish off the roof of a resort home miles away. At least they have that, Andrea said.

They are paying their bills in bits and pieces. Ten dollars toward the monthly car payment. One hundred for the taxes. Twenty bucks for the water and electricity. Undocumented families don’t get stimulus checks. They can’t apply for unemployment. With so little money coming in, they emptied their freezer for the first time.

While her husband works, Andrea struggles to assist her youngest son with homework. He receives special help at school and attends a tutoring program. But his parents had to stop payments for the tutor.

Andrea came to San Antonio from Mexico as a teenager, learned some English, graduated from high school and wanted more. But not having papers meant not having chances, she said. She married, escaped an abusive ex-husband shortly after becoming a mother and saw her two oldest children go to college. Her daughter’s college diploma is the first thing on display inside the family’s front door.

For Andrea, April has meant tears, often shed alone in the living room. But not every day was bleak. Oscar Sanchez’s boss paid him a bit extra. The other day, a man called offering Andrea some work. And Oscar found an envelope stuffed with $240 in their mailbox.

For the first time in April, the family had meat for dinner.

Laura Simons, a high school physics teacher, with her son, Oliver, 17 months, at their home in Springfield, Va., on April 28. Simons’s 5-year-old daughter, Chloe, looks on from inside. (Alyssa Schukar/for The Washington Post)

Lost lessons

April was families forced into close quarters, roles reordered — parents becoming teachers, students left to learn on their own, rites of passage skipped over.

Laura Simons held her 5-year-old daughter’s hand in her left palm as she scrolled through slides of physics equations with her right.

On the child’s laptop, set up next to Mom’s, a teacher sang “Days of the week, days of the week!” The singer asked her pixilated pre-kindergarteners to cheer because “yesterday was Thursday,” meaning today was Friday.

Chloe Simons yanked her mother’s hand. Chloe said she did not understand: “Why are they cheering?”

Laura had an hour and 44 minutes before she had to log in to Zoom to teach her AP Physics 1 class. But she pulled away from her preparations to peer at her daughter’s screen.

“Well, normally when you go to school,” Laura told her daughter, “you get to stay home on Saturday and Sunday.”

Had Chloe forgotten weekends already? Weekends no longer really existed here. The line between school and their home in Springfield, Va., between work and family — a line she’d fought to find through her decade in Alexandria City Public Schools — had vanished, too.

Throughout April, Laura, 37, had led online classes in the kitchen on weekday mornings, with Chloe underfoot and her 17-month-old son, Oliver, on her lap.

Laura’s 109 physics students knew by now that Oliver liked to dump anything in the lowest kitchen drawers onto the floor. That Chloe spilled Cheerios and pretzels. Laura had canceled class once when her children dissolved into simultaneous meltdowns.

She spent weekends in her basement — drawing up lesson plans, evaluating student work — while her husband, a bridge engineer also working from home, focused on the children.

How much longer, Laura wondered, could she keep this up?

She picked up her son’s fidget spinner — hardly a good replacement for how she would usually teach that day’s lesson on angular momentum. She should have been asking her students to step onto turntables. She should have been handing them spinning bicycle wheels. She should have been laughing at their shock when they, too, began to spin.

Thankfully, the AP test had been adjusted, like everything else in Laura’s life, and would no longer focus as heavily on rotation. But things still didn’t feel right.

She had added two questions to a recent online assignment: “How are you doing?” “How’s life?”

“I miss school so much,” one student wrote, adding, “never thought I’d say that.”

“The middle of the night,” wrote another, “is my most productive time.”

The middle of the night was when Laura awakened now, her dreams colored by the fears she represses by day: Worry for her 70-year-old mother, who is prediabetic. Terror over what would happen to Chloe and Oliver if she and her husband caught the virus and died. And constant anxiety: How can she possibly teach next year’s physics students if school doesn’t reopen in the fall?

Better, she told herself, to focus on this year’s class. Forty students joined her Zoom session. Laura whipped the fidget spinner to a frenzy, then flipped it over. “It feels weird, it fights you,” she said, “and this is angular momentum.”

One 12th-grader’s eyes widened. Another threw his hands above his head.

Laura laughed: “I see your little brains breaking on your faces. I miss that look.”


Heartbreak and hope

April was boredom and heartbreak, sports unplayed and sweethearts unkissed. With schools closed and games canceled, the embers of teamwork could be tended only from afar.

As the month began, Cy Harwood, a star infielder at Huntingtown High in southern Maryland, was not ready to concede his senior season. He pushed himself with the possibility that everything might return to normal. He lifted weights in his basement, did throwing drills with his father in the driveway and went on long runs through his neighborhood, still driven by the dream of returning to his friends and their mission to win a state championship.

But in mid-April, Maryland’s governor extended at-home learning through May 15. Harwood took out his phone and crafted a message to his team’s group chat.

“This is obviously the worst news ever,” he wrote. “I wish we could have our season and our chance to win it all. I’ll always be here for every single one of you no matter what.”

That last part was hard. He was one of the team’s captains and had known some of the other players since he was 6 years old. And this was supposed to be the year they broke through.

Harwood had a shot at setting some school records at the plate this season — at-bats, hits and RBIs, his coach said. Harwood had committed last summer to play baseball after graduation at Salisbury University, a Division III program two hours from home. But some other colleges had shown interest last fall, and in early March, Harwood called Salisbury to de-commit. That had been a long, hard conversation with the head coach.

Three weeks later, after the coronavirus pandemic wreaked havoc, sending high school recruits across the country scrambling for opportunity, Harwood called Salisbury back for a harder conversation: He told the coach he was sorry, he’d made a mistake and now he was again excited to be a Sea Gull. They took him back.

Harwood ended the month at home, playing baseball video games, watching sports documentaries, spending at least three hours a day on his craft — lifting, throwing and sprinting with an eye toward college.

A crater had opened in the part of his existence where Huntingtown baseball once thrived.

“It’s not the same when you’re not out there,” he said. “There’s just been no way around that. We have to accept it.”

Seven hundred miles away, in Sparta, Mich., April was spring. Birds beckoned and flowers bloomed, and many who were stuck inside found ways to plant seeds of hope.

Kendyl Bjorkman’s spring was a quest for new diversions. She and her two sisters baked and cooked and played cards — Garbage and Exploding Kittens — escaping from remote school into their yard as often as possible.

Kendyl is 14, a freshman at Sparta High School and determined to get through this without wallowing in the unfairness or the boredom.

Kendyl Bjorkman, 14, at her family’s home in Sparta, Mich. (Evan Cobb/For The Washington Post)

“The month was so long and lonely,” she said. But she didn’t want to look back 10 years from now and “say I spent all that time watching YouTube.”

She and her sisters, who are 17 and 9, wrote and recorded song parodies about the epidemic.

“Stay at home, stay at home, can’t go to school anymore,” they sang, to the tune of “Let It Go” from the Disney film “Frozen.” “Stay at home, stay at home, soccer season is no more.”

The order had come seemingly out of the blue. “It was just one Thursday and then you never go back to school again,” Kendyl said. “I don’t think it’s going to be back to normal for a long time.”

She does an hour or two of school work each morning, but it’s busy work, mostly. To make the new life palatable, you have to create your own satisfaction.

“You have to enjoy each other’s presence,” she said. Her family — her mother is a teacher, now working from home, and her father still goes to the office, at the local health department — plays games. The girls go outside. “It’s good to be in your yard because it can get sad in the house,” Kendyl said.

She wakes these days around 8 or 9 — a welcome respite from the usual 6 a.m. school day alarm — puts on her running shoes, and takes off, flying along empty streets, training for cross-country meets that will not happen.

No school, no church, friends are only images on a screen, so Kendyl sings: “Stay at home, stay at home, will I ever be set free?”

Eugene “Gene” Campbell, 89, who became ill with covid-19 at Life Care Center of Kirkland, leaves Swedish Edmonds hospital in Washington state on April 20 after six weeks in treatment. (Lindsey Wasson/Reuters)

A yearning for recovery

April was a prayer, a yearning for recovery.

Eugene “Gene” Campbell learned he had covid-19 days after he turned 89. Everyone feared that was the end.

He was one of more than 120 mostly sick and elderly residents infected with the coronavirus at the Life Care Center of Kirkland, a nursing home near Lake Washington, northeast of Seattle, site of the first major coronavirus outbreak in the United States. More than 40 people died.

Campbell had arrived in February for two weeks of rehabilitation after a stroke. But fever and cough soon racked his body, and an ambulance took him to the hospital.

At the Swedish Edmonds emergency room, his frightened sons could only watch through glass doors as their father shook, hacking.

“He just seemed so alone,” said Todd Campbell, one of Gene Campbell’s three sons.

Within days, the symptoms faded, and U.S. Surgeon General Jerome Adams hailed Campbell at a White House briefing as proof that even the elderly could vanquish the virus.

But in April, Campbell was still confined to a hospital room with a bed, television and an empty chair. He needed two negative coronavirus tests to return home to his wife, Dorothy, 88, known as “Doe,” at Vineyard Park, an assisted-living facility in nearby Bothell.

“I just want to get out of here,” Campbell would say.

He endured multiple invasive nasal swabs, but never got consistent results. In early April, after a sixth swab came back positive, he began to refuse the tests.

“This is your ticket out,” Todd told his father. “If you don’t do it, you are stuck there.”

Nobody could remember a time when Campbell had been sick — or alone.

He had been student body president of Lynden High School’s class of 1949. He sang in the choir and captained the football team. The yearbook called him “a born executive.” He finished college, was drafted into the Army, married Dorothy, and taught their three sons to clean their plates, work hard and save their money. He worked his way up to president of a textbook distributor — a job he didn’t like — to provide for his family.

“His number one priority as a father was to teach us how to survive,” said Todd, 59, an industrial engineer.

Gene Campbell spoke through his actions; he never told his boys, “I love you.”

When he arrived at Life Care, his sons told him they loved him, and they prodded him to say it back.

“He’d say ‘Yeah, okay,’” said son Charlie, 61, a retired registered nurse. Their father would wave them off with a smile.

Then the virus invaded. Barred from visiting, his sons could be with him only by phone.

Campbell told his sons one night that he had decided to refuse meals. He said his “quality of life going forward wouldn’t be worth living.” His sons hung up and cried.

But by the next morning, Campbell cheerily reported that he had just finished breakfast and the eggs were a little cold.

As April crawled by, with tests both positive and negative for the virus, Campbell seemed to change: At the end of each call, he told his sons, “I love you, too.”

Finally, on April 17, Campbell got the word: He had received two negative test results in a row.

Smiling behind face masks, his boys picked him up outside the hospital on April 20, hugged him and helped him into Todd’s SUV.

In all its complexity, in all its despair, in all its glory, April was life.

Campbell still faced two more weeks of quarantine at home, but first he had 30 minutes in the car with Todd and Charlie. Now they could envision another Christmas together, maybe another Seattle Mariners game, certainly another phone call to tell their dad they love him. And to hear him say it back.

Rozsa reported from Central Florida. Arelis R. Hernández in San Antonio and Michael Errigo, Ellen McCarthy and Maria Sacchetti contributed to this report.
Design and development by Joanne Lee. Graphics by Joe Fox. Photo editing by Haley Hamblin. Copy editing by Gilbert Dunkley.
Weekly unemployment claims from the Department of Labor. Cause of death data from the CDC.