newyorker--2020-03-24--Why Widespread Coronavirus Testing Isn’t Coming Anytime Soon

This past Thursday , Donald Trump visited the National Response Coordination Center for a teleconference with the nation ’ s governors about how to handle the COVID-19 pandemic .
The center , which is situated inside the headquarters of the Federal Emergency Management Administration , in Washington , is designed , in the agency ’ s words , to coördinate “ the overall Federal support for major incidents and emergencies.
” Trump—along with Mike Pence , and several other Cabinet and sub-Cabinet officials—sat around a table in a gray-walled conference room , while the governors were patched in from around @ @ @ @ @ @ @ states needed personal protective equipment ( P.P.E . )
for health-care workers , ventilators for patients , block grants for their balance sheets , and the National Guard to build hospitals and distribute food .
They also needed tests .
Kristi Noem , of South Dakota , said that her state ’ s public-health laboratory—the only lab doing COVID-19 testing in the state—had so much trouble securing reagents that it was forced to temporarily stop testing altogether .
“ We , for two weeks , were requesting reagents for our public-health lab from @ @ @ @ @ @ @ suppliers , who kept cancelling orders on us , ” she said .
In order to get her public-health lab the reagents it needed , Noem said , “ we had to get a little pushy with a few people.
” Trump and his team sought to reassure the governors .
Admiral Brett Giroir , an assistant secretary at the Department of Health and Human Services , who was appointed two weeks ago to coördinate the federal effort to get testing back on track , said , “ We ’ re very effectively @ @ @ @ @ @ @ components of our American health-care system , including C.D.C .
and the state public-health labs , health care and hospitals , and large commercial labs.
” Giroir told the governors that , in the twelve days between March 2nd and March 14th , more than ten million tests had been made available in the U.S. And , citing numbers from the F.D.A.
, he suggested that another seventeen million would be added by March 28th .
“ We have plenty of tests on the back side .
We have plenty of supplies on @ @ @ @ @ @ @ .
Pence , too , emphasized that “ now tens of thousands of more tests are being performed literally every day , ” while Trump , responding to Noem ’ s difficulties securing reagents , told her not to be concerned .
“ We got you , Kristi , ” he said .
“ There is tremendous supply.
” The next day , the Association of State and Territorial Health Officials , the Association of Public Health Laboratories , and the Council of State and Territorial Epidemiologists—which , together , represent virtually the @ @ @ @ @ @ @ public-health infrastructure—issued a joint statement warning about “ widescale shortages of laboratory supplies and reagents ” for COVID-19 testing .
Because of these shortages , the statement said , testing ought to be reserved for three groups of suspected cases : health-care workers and first responders ; the elderly , especially those who live in nursing homes and other group settings ; and people for whom a confirmed COVID-19 diagnosis had the potential to meaningfully change their treatment plan , such as those with underlying health conditions .
An alert sent out earlier @ @ @ @ @ @ @ ’ s Department of Health and Mental Hygiene was even more dire .
Mildly or moderately ill people seeking COVID-19 tests , the D.O.H.M.H .
warned , posed a serious infection risk for hospitals and clinics , and were creating a run on the city ’ s extremely limited P.P.E .
stocks and testing supplies .
For that reason , the department was “ directing healthcare facilities to IMMEDIATELY STOP TESTING NON-HOSPITALIZED PATIENTS FOR COVID-19 unless test results will impact the clinical management of the patient.
” Even health-care workers and first responders @ @ @ @ @ @ @ but did not have symptoms would no longer be tested .
As the alert went on to warn , again in bold capital letters : “ COVID-19 testing is only indicated for HOSPITALIZED PATIENTS.
” In late February , nearly three weeks after the first batch of C.D.C .
test kits that was shipped to state and local labs proved faulty , the Trump Administration pushed through a series of regulatory moves to expand the nation ’ s test capacity .
On February 29th , the F.D.A .
allowed so-called high-complexity labs to @ @ @ @ @ @ @ Starting on March 12th , the F.D.A .
issued a series of Emergency Use Authorizations to commercial test companies , which allowed those companies to manufacture and distribute tests without going through the agency ’ s normally onerous approval process .
And , last Monday , the F.D.A .
announced a new policy that allows state and territorial public-health laboratories to authorize tests at other labs without the need for additional federal approval .
In effect , the policy pushed regulatory authority for COVID-19 testing out of the federal government and down to @ @ @ @ @ @ @ ’ s changes succeeded in clearing away many of the regulatory obstacles to new testing .
And yet they did little to solve what now appears to be the major bottleneck in deploying widespread testing across the United States .
No longer do we need to worry about a single authorized test protocol , or a limited number of laboratories that are allowed to carry out that test .
The current trouble is a critical shortage of the physical components needed to carry out tests of any variety .
Among these components are @ @ @ @ @ @ @ used to stabilize a specimen as it travels from patient to lab ; extraction kits , which isolate viral RNA from specimens once they reach the lab ; and the reagents that do the actual work of determining whether the coronavirus that causes COVID19 is present in the sample .
Perhaps the most prosaic shortage , but also the most crucial , is a lack of test swabs , which look like glorified Q-tips .
Specially designed to preserve viral specimens , they ’ re what a doctor sticks up your nose or @ @ @ @ @ @ @ biological material .
The swab shortage is happening for the same reason that all the other test components are limited—namely , a global pandemic has created a global demand for them—but it is subject to a further complication .
Copan , one of the major manufacturers of the sort of swabs needed for COVID-19 tests , has its headquarters and manufacturing facilities in Lombardy , Italy , which has been hit particularly hard by the disease .
A spokesperson for the company says that the national lockdown in Italy has not affected production @ @ @ @ @ @ @ the U.S. Air National Guard had to use one of its C-17 cargo planes to bring an order of eight hundred thousand swabs back to the U.S .
According to Defense One , the plane flew on Monday from the Aviano Air Base , in Italy , not far from the headquarters of Copan , to Memphis , where a FedEx distribution center is situated ; the Times later reported that the airlift had been arranged by Peter Navarro , a Presidential trade adviser , and that the Administration hoped similar efforts would @ @ @ @ @ @ @ every week .
On Saturday , a company spokesperson told me that Copan did not make “ special deals ” with governments but was “ shipping to the U.S.A. the maximum amount that we are capable of , on a best effort basis ” through its usual distributors .
The shortage of testing components is having its most drastic effects in the parts of the country that are seeing the highest prevalence of COVID-19 .
According to Deborah Birx , the response coördinator for the White House Coronavirus Task Force , more than @ @ @ @ @ @ @ the disease have been found in just ten counties , in three states—Washington , New York , and California .
In New York City , as of Monday , some fifteen thousand cases have been confirmed , about a third of the country ’ s total .
( Given the testing deficit , the actual prevalence may be several times that . )
According to Jennifer Rakeman , the director of the city ’ s public-health laboratory , “ There ’ s widespread community transmission in New York City.
” What that means @ @ @ @ @ @ @ said , is that “ if you have symptoms of influenza—like a cough , shortness of breath , fever , sore throat—the pre-test probability that you have COVID-19 is very , very high .
”

This past Thursday, Donald Trump visited the National Response Coordination Center for a teleconference with the nation’s governors about how to handle the COVID-19 pandemic. The center, which is situated inside the headquarters of the Federal Emergency Management Administration, in Washington, is designed, in the agency’s words, to coördinate “the overall Federal support for major incidents and emergencies.” Trump—along with Mike Pence, and several other Cabinet and sub-Cabinet officials—sat around a table in a gray-walled conference room, while the governors were patched in from around the country. The governors said their states needed personal protective equipment (P.P.E.) for health-care workers, ventilators for patients, block grants for their balance sheets, and the National Guard to build hospitals and distribute food. They also needed tests. Kristi Noem, of South Dakota, said that her state’s public-health laboratory—the only lab doing COVID-19 testing in the state—had so much trouble securing reagents that it was forced to temporarily stop testing altogether. “We, for two weeks, were requesting reagents for our public-health lab from C.D.C., who pushed us to private suppliers, who kept cancelling orders on us,” she said. In order to get her public-health lab the reagents it needed, Noem said, “we had to get a little pushy with a few people.”
Trump and his team sought to reassure the governors. Admiral Brett Giroir, an assistant secretary at the Department of Health and Human Services, who was appointed two weeks ago to coördinate the federal effort to get testing back on track, said, “We’re very effectively transitioning to large-scale testing by leveraging all components of our American health-care system, including C.D.C. and the state public-health labs, health care and hospitals, and large commercial labs.” Giroir told the governors that, in the twelve days between March 2nd and March 14th, more than ten million tests had been made available in the U.S. And, citing numbers from the F.D.A., he suggested that another seventeen million would be added by March 28th. “We have plenty of tests on the back side. We have plenty of supplies on the front side,” Giroir said. Pence, too, emphasized that “now tens of thousands of more tests are being performed literally every day,” while Trump, responding to Noem’s difficulties securing reagents, told her not to be concerned. “We got you, Kristi,” he said. “There is tremendous supply.”
The next day, the Association of State and Territorial Health Officials, the Association of Public Health Laboratories, and the Council of State and Territorial Epidemiologists—which, together, represent virtually the whole of the country’s state-level public-health infrastructure—issued a joint statement warning about “widescale shortages of laboratory supplies and reagents” for COVID-19 testing. Because of these shortages, the statement said, testing ought to be reserved for three groups of suspected cases: health-care workers and first responders; the elderly, especially those who live in nursing homes and other group settings; and people for whom a confirmed COVID-19 diagnosis had the potential to meaningfully change their treatment plan, such as those with underlying health conditions.
An alert sent out earlier in the day by New York City’s Department of Health and Mental Hygiene was even more dire. Mildly or moderately ill people seeking COVID-19 tests, the D.O.H.M.H. warned, posed a serious infection risk for hospitals and clinics, and were creating a run on the city’s extremely limited P.P.E. stocks and testing supplies. For that reason, the department was “directing healthcare facilities to IMMEDIATELY STOP TESTING NON-HOSPITALIZED PATIENTS FOR COVID-19 unless test results will impact the clinical management of the patient.” Even health-care workers and first responders who had been exposed to infected patients but did not have symptoms would no longer be tested. As the alert went on to warn, again in bold capital letters: “COVID-19 testing is only indicated for HOSPITALIZED PATIENTS.”
In late February, nearly three weeks after the first batch of C.D.C. test kits that was shipped to state and local labs proved faulty, the Trump Administration pushed through a series of regulatory moves to expand the nation’s test capacity. On February 29th, the F.D.A. allowed so-called high-complexity labs to develop and run their own tests. Starting on March 12th, the F.D.A. issued a series of Emergency Use Authorizations to commercial test companies, which allowed those companies to manufacture and distribute tests without going through the agency’s normally onerous approval process. And, last Monday, the F.D.A. announced a new policy that allows state and territorial public-health laboratories to authorize tests at other labs without the need for additional federal approval. In effect, the policy pushed regulatory authority for COVID-19 testing out of the federal government and down to the states and territories.
The F.D.A.’s changes succeeded in clearing away many of the regulatory obstacles to new testing. And yet they did little to solve what now appears to be the major bottleneck in deploying widespread testing across the United States. No longer do we need to worry about a single authorized test protocol, or a limited number of laboratories that are allowed to carry out that test. The current trouble is a critical shortage of the physical components needed to carry out tests of any variety. Among these components are so-called viral transport media, which are used to stabilize a specimen as it travels from patient to lab; extraction kits, which isolate viral RNA from specimens once they reach the lab; and the reagents that do the actual work of determining whether the coronavirus that causes COVID19 is present in the sample. Perhaps the most prosaic shortage, but also the most crucial, is a lack of test swabs, which look like glorified Q-tips. Specially designed to preserve viral specimens, they’re what a doctor sticks up your nose or down your throat to collect the necessary biological material.
The swab shortage is happening for the same reason that all the other test components are limited—namely, a global pandemic has created a global demand for them—but it is subject to a further complication. Copan, one of the major manufacturers of the sort of swabs needed for COVID-19 tests, has its headquarters and manufacturing facilities in Lombardy, Italy, which has been hit particularly hard by the disease. A spokesperson for the company says that the national lockdown in Italy has not affected production at its factories, but last week the U.S. Air National Guard had to use one of its C-17 cargo planes to bring an order of eight hundred thousand swabs back to the U.S. According to Defense One, the plane flew on Monday from the Aviano Air Base, in Italy, not far from the headquarters of Copan, to Memphis, where a FedEx distribution center is situated; the Times later reported that the airlift had been arranged by Peter Navarro, a Presidential trade adviser, and that the Administration hoped similar efforts would bring 1.5 million swabs into the country every week. On Saturday, a company spokesperson told me that Copan did not make “special deals” with governments but was “shipping to the U.S.A. the maximum amount that we are capable of, on a best effort basis” through its usual distributors.
The shortage of testing components is having its most drastic effects in the parts of the country that are seeing the highest prevalence of COVID-19. According to Deborah Birx, the response coördinator for the White House Coronavirus Task Force, more than fifty per cent of confirmed cases of the disease have been found in just ten counties, in three states—Washington, New York, and California. In New York City, as of Monday, some fifteen thousand cases have been confirmed, about a third of the country’s total. (Given the testing deficit, the actual prevalence may be several times that.) According to Jennifer Rakeman, the director of the city’s public-health laboratory, “There’s widespread community transmission in New York City.” What that means for residents of the city, she said, is that “if you have symptoms of influenza—like a cough, shortness of breath, fever, sore throat—the pre-test probability that you have COVID-19 is very, very high.”
Rakeman’s lab, on First Avenue across from Bellevue Hospital, has been running tests for COVID-19 since March 2nd, a few days after it was sent a new set of reagents to replace the first faulty kit it received from the C.D.C. At ordinary peak times, she told me, the lab operates one shift a day, five days a week. Since the outbreak hit the U.S., however, the lab’s staff has been working two shifts a day, seven days a week. By Monday, according to Andrew Cuomo, labs in the state of New York had tested nearly eighty thousand people, and were now processing sixteen thousand tests a day, a quarter of all tests nationwide. But that capacity has been threatened by what Rakeman describes as “critical” shortages of test components, including an enzyme called TaqPath, about which Rakeman said, “There are labs that are running out and begging other labs for a single tube so that they can get another day’s worth of testing done.”
Rakeman told me that, after only ten days of using the C.D.C.-provided tests, her lab was down to its final two extraction kits. On March 12th, she sent members of the city’s Health Department to Albany, to pick up a batch of reagents that had been manufactured for a new test, based on the C.D.C. protocol but developed by New York State’s Wadsworth Laboratory, which would allow the city to use a wider range of extraction kits. “The car pulled into the lab at four o’clock in the afternoon,” she said. “Within minutes, those reagents were in the lab, and the lab started doing the validation and verification of that test. We ran that overnight, and finished it up on the morning of the 13th. That morning, we ran the last batch of specimens on the C.D.C. assay, finished up the last drop of our extraction kits for that test, and then immediately were able to switch over to the Wadsworth test.”
In states with far less prevalence of COVID-19 than New York, the shortages are hampering the ability to keep the outbreak under manageable control. By Monday afternoon, the state of Minnesota had confirmed fewer than three hundred cases of the disease. Joanne Bartkus, the director of the state’s public laboratory, told me that she and her staff are capable of processing five hundred tests a day, but shortages of reagents and other test components have caused that number to drop as low as two hundred. “It really is a day-to-day thing as to how many we can test,” she said. When Bartkus’s lab started testing, at the beginning of March, demand was low. “We got five samples in the first day, and then maybe seven the next,” she said. But within days of the President’s announcement, on March 6th, that anyone who wanted a test could get a test, that trickle became a flood. “We started getting four hundred, six hundred, eight hundred, a thousand samples a day.” The influx of specimens created a backlog in the lab that only eased last week, after the Mayo Clinic in Rochester, Minnesota, was able to begin testing.


newyorker--2020-03-24--Returning Once More to a “Little House in the Big Woods”

My fourteen-year-old son is a good five inches taller than me , with a voice deeper than that of his father , but the other evening , when I went to his bedroom to wish him good night , I saw a child ’ s face looking up at me from the pillow , and I was moved to ask him something that I haven ’ t in years : Would he like me to read aloud to him ?
Earlier that evening , Boris Johnson , the British Prime Minister , had appeared at a Downing Street briefing to @ @ @ @ @ @ @ in two days ’ time , owing to the spread of the coronavirus .
By that point , my husband and I had already decided that our son had spent his last day in the classroom , which had been emptying of students since the start of the week , and where teachers were assigning work from Netflix instead of from textbooks .
My son got the news of the closure from Instagram before he got it from us , while texting friends he wouldn ’ t see , it was beginning to @ @ @ @ @ @ @ From now on , it would just be the three of us , home alone together .
When , in the spring of 2018 , we packed up the contents of the house in Brooklyn in which my son had so far spent his childhood , he hadn ’ t been able to conceive of a future self who wouldn ’ t want his picture books and young-reader chapter books on his shelves , and a lot of them went into moving boxes to come with us across the ocean .
It took @ @ @ @ @ @ @ succession of short-term rentals before we were settled in our new home , in London , where my son ’ s bedroom is smaller than his room had been in Brooklyn , and has fewer bookshelves .
By then , he ’ d become a teen-ager , with a Spotify account and a new circle of London friends—awkward , good-natured adolescents whom he would bring back home after school on Fridays to kick back on the living-room couch , playing video games and eating entire packets of chocolate digestives .
The moving boxes @ @ @ @ @ @ @ mostly unopened , stacked in the corner of a closet .
The unimaginable transition had been made , and my son didn ’ t need those books now .
One book we had unpacked , though , was “ Little House in the Big Woods , ” by Laura Ingalls Wilder , and it was that volume I reached for when he told me that , yes , he would like me to read aloud .
It ’ s an edition from 1953 , illustrated by Garth Williams , which my late mother-in-law @ @ @ @ @ @ @ in Boston .
She was a New Englander through and through , although when she married she moved all over to be with my father-in-law , a geologist turned diplomat , living in Colorado , Canada , and Chile before eventually settling outside Washington , D.C .
There , she raised their four children , reading Laura Ingalls Wilder aloud to them .
The eldest , my husband , read from the same volume to his three older sons , my stepsons—the “ big boys , ” as we call them .
The @ @ @ @ @ @ @ in their twenties and thirties , living their own lives in the States .
Only an uncomfortable six hours in economy class away : that ’ s what my husband and I told ourselves when we decided to move to the U.K. , leaving our large American family behind .
We ’ ll go back regularly ; they ’ ll come to us .
We can always get on a plane .
Our son wasn ’ t yet four years old when my husband first read “ Little House in the Big Woods @ @ @ @ @ @ @ that age , he was rapt .
No wonder ; although the book is an autobiographical account of Ingalls Wilder ’ s childhood , in the forests of Wisconsin , it is set in a folk-story realm and is written in the cadences of a fairy tale , even beginning with the phrase “ Once upon a time.
” There are wolves that will eat little girls like Laura and her sisters , and panthers of supernatural force that can chase and fell a man on horseback .
At night in the little @ @ @ @ @ @ @ of the wind whistling through trees that extend as far as a rider can go in a month .
“ There were no houses .
There were no roads .
There were no people .
There were only trees and the wild animals who had their homes in them , ” I read to my son , who lay listening beneath his favorite blanket , a fake-fur throw I had bought at a Target in Brooklyn , a ten-minute walk from our old home .
If “ Little House in the Big Woods @ @ @ @ @ @ @ Brothers Grimm , I realized as I read aloud , it was also , effectively , a manual for self-sufficient social isolation .
Laura ’ s father , Pa , didn ’ t need Target : he could make a real fur blanket , from the skin of a bear he ’ d killed with a bullet he ’ d cast himself from molten lead .
Before the end of the first chapter , we ’ d learned how to preserve venison , by salting the meat on a board and then smoking @ @ @ @ @ @ @ fragrant hickory chips .
We ’ d read about braiding together the onions and peppers and squashes of summer , to hang them in the attic for winter .
We ’ d read in detail about how to slaughter the hog that ran wild in the woods , eating acorns and roots , and what a butcher ’ s shelf of products the animal could be turned into : spare ribs and hams and lard and headcheese and sausages , with even its bony tail roasted and salted for a child ’ s @ @ @ @ @ @ @ out the light , my son was in a survivalist reverie .
Life in the Big Woods sounded hard and dangerous , but also kind of fun , he said , what with the wild animals and the guns and the larder full of good smoked bacon .
I could tell that he was thinking of his old summer camp in Vermont .
There , he ’ d slept in a three-sided log cabin , learned how to build a campfire on an overnight mountain trek , and mastered the skill of hammering @ @ @ @ @ @ @ a shingled wall .
I was thinking of supermarket shelves that were already emptied of fresh produce , and of pharmacies stripped of Tylenol and hand sanitizer .
Pa would have known what to do ; I felt helpless .
The next morning , at breakfast , my son had a suggestion for me and my husband : we should dig up the planters on our roof terrace and grow our own vegetables , like in “ Little House in the Big Woods.
” That way , we won ’ t need shops @ @ @ @ @ @ @ , I agreed—though , with the limited space we have , we ’ ll be lucky to get one serving of salad from them .
Still , it will be something to do—something that will get us out in the fresh air—while the three of us learn to live close within the walls of our own little house in London .
We finished breakfast and made plans for the first day of my son ’ s stay-at-home life : a few hours of homework , some exercise , and later some PlayStation time @ @ @ @ @ @ @ now sitting on their own couches in their own homes , instead of ours .
Let ’ s also try to FaceTime with the big boys , my husband said , and my son and I agreed : let ’ s definitely do that .
The youngest , a paramedic with the New York City Fire Department , in Brooklyn , works erratic hours ; he ’ s always hard to reach , and now more than ever .
We read the news of the virus ’ s spread in New York and @ @ @ @ @ @ @ .
The middle one can ’ t work from home , either : he ’ s a social worker in a psychiatric hospital in Austin , where he spends his days in close proximity with other staff , tending to patients from whom it ’ s impossible to maintain a social distance .

“Little House in the Big Woods,” an account of Laura Ingalls Wilder’s childhood in the Wisconsin forests, is a manual for self-sufficient social isolation. Photograph by John D. Ivanko / Alamy
My fourteen-year-old son is a good five inches taller than me, with a voice deeper than that of his father, but the other evening, when I went to his bedroom to wish him good night, I saw a child’s face looking up at me from the pillow, and I was moved to ask him something that I haven’t in years: Would he like me to read aloud to him? Earlier that evening, Boris Johnson, the British Prime Minister, had appeared at a Downing Street briefing to announce that all U.K. schools would close in two days’ time, owing to the spread of the coronavirus. By that point, my husband and I had already decided that our son had spent his last day in the classroom, which had been emptying of students since the start of the week, and where teachers were assigning work from Netflix instead of from textbooks. My son got the news of the closure from Instagram before he got it from us, while texting friends he wouldn’t see, it was beginning to dawn on him, for months. From now on, it would just be the three of us, home alone together.
When, in the spring of 2018, we packed up the contents of the house in Brooklyn in which my son had so far spent his childhood, he hadn’t been able to conceive of a future self who wouldn’t want his picture books and young-reader chapter books on his shelves, and a lot of them went into moving boxes to come with us across the ocean. It took almost a year of living in a succession of short-term rentals before we were settled in our new home, in London, where my son’s bedroom is smaller than his room had been in Brooklyn, and has fewer bookshelves. By then, he’d become a teen-ager, with a Spotify account and a new circle of London friends—awkward, good-natured adolescents whom he would bring back home after school on Fridays to kick back on the living-room couch, playing video games and eating entire packets of chocolate digestives. The moving boxes filled with children’s classics stayed mostly unopened, stacked in the corner of a closet. The unimaginable transition had been made, and my son didn’t need those books now.
One book we had unpacked, though, was “Little House in the Big Woods,” by Laura Ingalls Wilder, and it was that volume I reached for when he told me that, yes, he would like me to read aloud. It’s an edition from 1953, illustrated by Garth Williams, which my late mother-in-law bought at the Bay Colony Bookshop, in Boston. She was a New Englander through and through, although when she married she moved all over to be with my father-in-law, a geologist turned diplomat, living in Colorado, Canada, and Chile before eventually settling outside Washington, D.C. There, she raised their four children, reading Laura Ingalls Wilder aloud to them. The eldest, my husband, read from the same volume to his three older sons, my stepsons—the “big boys,” as we call them. The big boys are grown up now, in their twenties and thirties, living their own lives in the States. Only an uncomfortable six hours in economy class away: that’s what my husband and I told ourselves when we decided to move to the U.K., leaving our large American family behind. We’ll go back regularly; they’ll come to us. We can always get on a plane.
Our son wasn’t yet four years old when my husband first read “Little House in the Big Woods” aloud to him—and, even at that age, he was rapt. No wonder; although the book is an autobiographical account of Ingalls Wilder’s childhood, in the forests of Wisconsin, it is set in a folk-story realm and is written in the cadences of a fairy tale, even beginning with the phrase “Once upon a time.” There are wolves that will eat little girls like Laura and her sisters, and panthers of supernatural force that can chase and fell a man on horseback. At night in the little log cabin, there is the sound of the wind whistling through trees that extend as far as a rider can go in a month. “There were no houses. There were no roads. There were no people. There were only trees and the wild animals who had their homes in them,” I read to my son, who lay listening beneath his favorite blanket, a fake-fur throw I had bought at a Target in Brooklyn, a ten-minute walk from our old home.
If “Little House in the Big Woods” offered the spine-chilling pleasures of the Brothers Grimm, I realized as I read aloud, it was also, effectively, a manual for self-sufficient social isolation. Laura’s father, Pa, didn’t need Target: he could make a real fur blanket, from the skin of a bear he’d killed with a bullet he’d cast himself from molten lead. Before the end of the first chapter, we’d learned how to preserve venison, by salting the meat on a board and then smoking it inside a hollow tree trunk with fragrant hickory chips. We’d read about braiding together the onions and peppers and squashes of summer, to hang them in the attic for winter. We’d read in detail about how to slaughter the hog that ran wild in the woods, eating acorns and roots, and what a butcher’s shelf of products the animal could be turned into: spare ribs and hams and lard and headcheese and sausages, with even its bony tail roasted and salted for a child’s treat.
By the time I turned out the light, my son was in a survivalist reverie. Life in the Big Woods sounded hard and dangerous, but also kind of fun, he said, what with the wild animals and the guns and the larder full of good smoked bacon. I could tell that he was thinking of his old summer camp in Vermont. There, he’d slept in a three-sided log cabin, learned how to build a campfire on an overnight mountain trek, and mastered the skill of hammering nails into planks, to fix up a shingled wall. I was thinking of supermarket shelves that were already emptied of fresh produce, and of pharmacies stripped of Tylenol and hand sanitizer. Pa would have known what to do; I felt helpless. The next morning, at breakfast, my son had a suggestion for me and my husband: we should dig up the planters on our roof terrace and grow our own vegetables, like in “Little House in the Big Woods.” That way, we won’t need shops. We should dig up the planters, I agreed—though, with the limited space we have, we’ll be lucky to get one serving of salad from them. Still, it will be something to do—something that will get us out in the fresh air—while the three of us learn to live close within the walls of our own little house in London.
We finished breakfast and made plans for the first day of my son’s stay-at-home life: a few hours of homework, some exercise, and later some PlayStation time, connecting remotely with friends who are now sitting on their own couches in their own homes, instead of ours. Let’s also try to FaceTime with the big boys, my husband said, and my son and I agreed: let’s definitely do that. The youngest, a paramedic with the New York City Fire Department, in Brooklyn, works erratic hours; he’s always hard to reach, and now more than ever. We read the news of the virus’s spread in New York and tremble for him, a first responder. The middle one can’t work from home, either: he’s a social worker in a psychiatric hospital in Austin, where he spends his days in close proximity with other staff, tending to patients from whom it’s impossible to maintain a social distance.
The oldest is usually the easiest to reach, at least when his sometimes-sketchy Internet connection is functioning. A few years ago, he and his partner left their tiny studio apartment in Brooklyn for upstate New York. They bought an old hunter’s cabin deep in the countryside, on twelve acres of wooded land with a pond and a stream. My stepson, who taught himself woodworking when he still lived in Brooklyn and has been learning stonemasonry upstate, renovated the cabin himself, with the help of YouTube videos and the sweat labor of visiting friends. He sends us videos of his remarkable progress, including one in which, with the use of a number of car jacks, he had lifted his home entirely off the ground while he laid a new concrete foundation underneath. Last summer, he built a Scandinavian-style Airbnb cabin on the bank of the stream, which, I can tell from checking the Airbnb site, has all five-star reviews and has been getting a lot of views lately from would-be city escapees. Whenever we speak to my oldest stepson via the camera on his laptop, we’re in awe of what he’s made with his own hands: how competent he is, how satisfied he seems.
When next we talk to him, he’ll be sitting on his couch, with the bookshelves he’s built lining the wall behind him, and his partner smiling by his side. On my stepson’s lap will be their year-old son: the three of them, home alone together. My husband will make funny faces, trying to make his first grandson laugh from thousands of unbridgeable miles away, in lieu of sitting the baby on his own lap and reading aloud to him from a picture book, as he did with his children and his mother did with him. My husband had been planning a visit to the States earlier this month—he should have been there now—but his trip has been postponed, for how long we have no idea. The baby is just learning to walk, my stepson has told us by e-mail. If we’re lucky and the Internet connection holds, we’ll get to see him stand up and stagger wide-legged across the floor, finding his feet for the first time in the little house in the big woods.


newyorker--2020-03-24--“It Spreads Like Wildfire”: The Coronavirus Comes to New York’s Prisons

Last week , Adam Roberts , who has been incarcerated in New York State since 1999 , began to prepare for the arrival of COVID-19 , the respiratory infection caused by the novel coronavirus , at Fishkill Correctional Facility , in Beacon .
He began washing his hands more often and keeping his distance from men in the mess hall ; he noticed someone in a common area using a TV remote through a plastic bag .
Roberts has an intolerance to dairy and worries about losing access to foods he can eat , so he planned to buy as @ @ @ @ @ @ @ , peanut butter , and tea from the commissary as he could .
“ It seems like things are slowly shutting down , ” he told me on Thursday .
“ Funny that prison may be safer than the outside—until , that is , COVID inevitably finds its way in here .
At which point it spreads like wildfire.
” The coronavirus has now found its way into New York ’ s prison system .
On Sunday , the state ’ s Department of Corrections and Community Supervision , or D.O.C.C.S.
, confirmed @ @ @ @ @ @ @ had tested positive for COVID-19 .
( One of them , according to multiple reports , is the former movie producer Harvey Weinstein , who was sent to the facility only recently after being convicted of rape . )
Health officials in Cayuga County announced that the coronavirus had infected a man who had been incarcerated at Auburn Correctional Facility .
D.O.C.C.S .
has also confirmed three cases of COVID-19 in its ranks : one officer at Sing Sing Correctional Facility , another at Shawangunk Correctional Facility , and one civilian staff member @ @ @ @ @ @ @ impossible to practice social distancing in prison , ” Laron Rogers , who is serving twenty-five years to life at Sing Sing , wrote to me on Wednesday , a day after officials confirmed that the Sing Sing officer had tested positive for COVID-19 .
Rogers learned about the positive test from his peers , not the prison administration .
“ As you might imagine , we are extremely concerned with the lack of information concerning a contingency plan , ” he said .
“ We all feel like it is only a @ @ @ @ @ @ @ and spreads rapidly in here.
” At the time , Rogers said , many correctional officers were not wearing rubber gloves , even when collecting large numbers of I.D .
cards or patting men down for contraband .
( The D.O.C.C.S .
did not respond to a request for comment on this matter . )
Preparations for the coronavirus have now seeped into nearly every aspect of life in state prisons , according to about a dozen incarcerated sources in five different facilities .
Ten days ago , D.O.C.C.S .
closed all its @ @ @ @ @ @ @ legal visits—and issued each prisoner five postage stamps , two electronic messages , and one free phone call per week .
( Roberts had been expecting a visit from his cousins , their first in more than a year . )
Prisons are distributing bleach and have been posting memos that encourage hand washing .
But experts say that none of these measures can prevent a widespread outbreak of COVID-19 .
“ It ’ s nearly impossible to provide infection control in these settings , ” Gregg Gonsalves , an epidemiology professor at @ @ @ @ @ @ @ has researched access to treatment for hepatitis C in state prisons , told me .
“ If you wanted to set up a situation that would promote rapid transmission of a respiratory virus , you would say prison : it ’ s close quarters , unsanitary , individuals in frequent contact.
” Across the state , prisoners are trying to stand a few feet apart in long lines and crowded mess halls ; educational and vocational programs have been cancelled—though some jobs have not .
“ All programs have been cancelled except the @ @ @ @ @ @ @ who has been incarcerated for forty-three years , wrote to me from Great Meadow Correctional Facility , in Comstock .
Earlier this month , about a week after New York reported its first case of COVID-19 , and when stores were beginning to run out of toilet paper and hand sanitizer , Governor Andrew Cuomo announced that incarcerated workers had begun producing a state-branded hand sanitizer , called NYS Clean .
The soap shop is part of Corcraft , a state entity that pays workers between sixteen and sixty-five cents per hour , @ @ @ @ @ @ @ at Great Meadow .
“ There are major complaints about the conditions men are being forced to work under as well as pay , ” Allah told me .
He said that men are working eight-hour shifts and have been promised letters of commendation from the Governor .
Allah also alleged that some workers have been unable to punch time cards , to record their hours worked , have worked double shifts , or have worked on the expectation of future pay .
Until recently , alcohol-based hand sanitizer was not available in @ @ @ @ @ @ @ who produced it ; late last week , a journalist asked Cuomo about the issue , and D.O.C.C.S .
announced that it would begin to distribute sanitizer in common areas .
Victor Garcia , who is also incarcerated at Great Meadow , serving fifty-five years to life , told me that fears of an outbreak have grown by the day .
He wrote that staff members had distributed spray bottles of bleach and extra bars of soap ; only two men were allowed to sit at mess-hall tables that were previously used for @ @ @ @ @ @ @ department is doing everything in its power to keep the virus from entering and spreading , ” he said .
Still , he has been alarmed by news reports about the rapid spread of COVID-19 , and worries about his family , especially his ninety-six-year-old grandmother .
“ I have never experienced this level of panic coming from our families , corrections staff , government , and the media , ” he told me .
At Bedford Hills Correctional Facility , the state ’ s largest women ’ s prison , officials have @ @ @ @ @ @ @ wash their hands , avoid groups and sick people , and cough into a tissue ; movement between housing units was cut off on March 17th , according to Misha Louis , a member of the prison ’ s Inmate Liaison Committee .
The restrictions initially caused an uproar , Louis said , and some women experienced anxiety attacks .
“ We are keeping each other strong , ” she told me .
Another woman at the prison , who earns about a quarter per hour distributing bleach , said on March 20th @ @ @ @ @ @ @ general medical appointments had not stopped , and that incarcerated women were still working at a D.M.V .
call center located at the prison .
She had been working overtime every day for a week .
“ I ’ m tired but I love my job , ” she told me .
Women were eager to protect themselves by cleaning their living spaces , the woman said , but some officers were allegedly hoarding the bleach that her crew was distributing .
“ There ’ s an unspoken understanding amongst us as inmates @ @ @ @ @ @ @ were to fall terribly ill , precious resources may not be ‘ wasted ’ to save one of our lives , ” she said .
When I asked D.O.C.C.S .
about preparations for the coronavirus , a spokesperson told me that every facility has an emergency control plan , and that state prisons were used to dealing with infectious diseases , such as tuberculosis , hepatitis , influenza , and H.I.V./AIDS .
( All of these infections spread in different ways and at different rates than the coronavirus , and can be treated @ @ @ @ @ @ @ times , D.O.C.C.S .
retains supplies , equipment and other resources that can be readily available , if needed , to those impacted in correctional facilities during the spread of an infectious disease , ” the spokesperson said .
“ Additionally , the Department has medical staff specially trained in infection control employed in facilities across the state.
” According to the Correctional Association of New York , which oversees D.O.C.C.S.
, emergency control plans are considered security directives and are not available to the public .
( The association shared a hundred @ @ @ @ @ @ @ infectious diseases , meant to guide employees on such practices as personal hygiene , infection surveillance , disinfection and decontamination , and the use of personal protective equipment .
It lists policies for the control of about twenty specific diseases . )

Last week, Adam Roberts, who has been incarcerated in New York State since 1999, began to prepare for the arrival of COVID-19, the respiratory infection caused by the novel coronavirus, at Fishkill Correctional Facility, in Beacon. He began washing his hands more often and keeping his distance from men in the mess hall; he noticed someone in a common area using a TV remote through a plastic bag. Roberts has an intolerance to dairy and worries about losing access to foods he can eat, so he planned to buy as much instant ramen, tuna, mayonnaise, peanut butter, and tea from the commissary as he could. “It seems like things are slowly shutting down,” he told me on Thursday. “Funny that prison may be safer than the outside—until, that is, COVID inevitably finds its way in here. At which point it spreads like wildfire.”
The coronavirus has now found its way into New York’s prison system. On Sunday, the state’s Department of Corrections and Community Supervision, or D.O.C.C.S., confirmed that two prisoners at Wende Correctional Facility had tested positive for COVID-19. (One of them, according to multiple reports, is the former movie producer Harvey Weinstein, who was sent to the facility only recently after being convicted of rape.) Health officials in Cayuga County announced that the coronavirus had infected a man who had been incarcerated at Auburn Correctional Facility. D.O.C.C.S. has also confirmed three cases of COVID-19 in its ranks: one officer at Sing Sing Correctional Facility, another at Shawangunk Correctional Facility, and one civilian staff member in Albany.
“It is absolutely impossible to practice social distancing in prison,” Laron Rogers, who is serving twenty-five years to life at Sing Sing, wrote to me on Wednesday, a day after officials confirmed that the Sing Sing officer had tested positive for COVID-19. Rogers learned about the positive test from his peers, not the prison administration. “As you might imagine, we are extremely concerned with the lack of information concerning a contingency plan,” he said. “We all feel like it is only a matter of time before this virus enters and spreads rapidly in here.” At the time, Rogers said, many correctional officers were not wearing rubber gloves, even when collecting large numbers of I.D. cards or patting men down for contraband. (The D.O.C.C.S. did not respond to a request for comment on this matter.)
Preparations for the coronavirus have now seeped into nearly every aspect of life in state prisons, according to about a dozen incarcerated sources in five different facilities. Ten days ago, D.O.C.C.S. closed all its prisons to visitors—with the exception of non-contact legal visits—and issued each prisoner five postage stamps, two electronic messages, and one free phone call per week. (Roberts had been expecting a visit from his cousins, their first in more than a year.) Prisons are distributing bleach and have been posting memos that encourage hand washing. But experts say that none of these measures can prevent a widespread outbreak of COVID-19. “It’s nearly impossible to provide infection control in these settings,” Gregg Gonsalves, an epidemiology professor at Yale School of Public Health, who has researched access to treatment for hepatitis C in state prisons, told me. “If you wanted to set up a situation that would promote rapid transmission of a respiratory virus, you would say prison: it’s close quarters, unsanitary, individuals in frequent contact.” Across the state, prisoners are trying to stand a few feet apart in long lines and crowded mess halls; educational and vocational programs have been cancelled—though some jobs have not.
“All programs have been cancelled except the Soap Shop,” Shakim Allah, who has been incarcerated for forty-three years, wrote to me from Great Meadow Correctional Facility, in Comstock. Earlier this month, about a week after New York reported its first case of COVID-19, and when stores were beginning to run out of toilet paper and hand sanitizer, Governor Andrew Cuomo announced that incarcerated workers had begun producing a state-branded hand sanitizer, called NYS Clean. The soap shop is part of Corcraft, a state entity that pays workers between sixteen and sixty-five cents per hour, and has been operating around the clock at Great Meadow. “There are major complaints about the conditions men are being forced to work under as well as pay,” Allah told me. He said that men are working eight-hour shifts and have been promised letters of commendation from the Governor. Allah also alleged that some workers have been unable to punch time cards, to record their hours worked, have worked double shifts, or have worked on the expectation of future pay. Until recently, alcohol-based hand sanitizer was not available in state prisons, even to the workers who produced it; late last week, a journalist asked Cuomo about the issue, and D.O.C.C.S. announced that it would begin to distribute sanitizer in common areas.
Victor Garcia, who is also incarcerated at Great Meadow, serving fifty-five years to life, told me that fears of an outbreak have grown by the day. He wrote that staff members had distributed spray bottles of bleach and extra bars of soap; only two men were allowed to sit at mess-hall tables that were previously used for four. “It seems like the department is doing everything in its power to keep the virus from entering and spreading,” he said. Still, he has been alarmed by news reports about the rapid spread of COVID-19, and worries about his family, especially his ninety-six-year-old grandmother. “I have never experienced this level of panic coming from our families, corrections staff, government, and the media,” he told me.
At Bedford Hills Correctional Facility, the state’s largest women’s prison, officials have been distributing bleach and telling women to wash their hands, avoid groups and sick people, and cough into a tissue; movement between housing units was cut off on March 17th, according to Misha Louis, a member of the prison’s Inmate Liaison Committee. The restrictions initially caused an uproar, Louis said, and some women experienced anxiety attacks. “We are keeping each other strong,” she told me. Another woman at the prison, who earns about a quarter per hour distributing bleach, said on March 20th that most programs had closed but that general medical appointments had not stopped, and that incarcerated women were still working at a D.M.V. call center located at the prison. She had been working overtime every day for a week. “I’m tired but I love my job,” she told me. Women were eager to protect themselves by cleaning their living spaces, the woman said, but some officers were allegedly hoarding the bleach that her crew was distributing. “There’s an unspoken understanding amongst us as inmates, too, that, if we were to fall terribly ill, precious resources may not be ‘wasted’ to save one of our lives,” she said.
When I asked D.O.C.C.S. about preparations for the coronavirus, a spokesperson told me that every facility has an emergency control plan, and that state prisons were used to dealing with infectious diseases, such as tuberculosis, hepatitis, influenza, and H.I.V./AIDS. (All of these infections spread in different ways and at different rates than the coronavirus, and can be treated with medication.) “At all times, D.O.C.C.S. retains supplies, equipment and other resources that can be readily available, if needed, to those impacted in correctional facilities during the spread of an infectious disease,” the spokesperson said. “Additionally, the Department has medical staff specially trained in infection control employed in facilities across the state.” According to the Correctional Association of New York, which oversees D.O.C.C.S., emergency control plans are considered security directives and are not available to the public. (The association shared a hundred and seventy-five page D.O.C.C.S. manual on infectious diseases, meant to guide employees on such practices as personal hygiene, infection surveillance, disinfection and decontamination, and the use of personal protective equipment. It lists policies for the control of about twenty specific diseases.)
On Friday, I summarized my reporting for Gregg Gonsalves, the epidemiologist, and asked him whether he considered the prison system’s preparations sufficient. “You have a gaping wound and you’re giving a Band-Aid,” he replied. Although the U.S. as a whole may be able to flatten the curve of the outbreak through social distancing, Gonsalves said, he expected to see in prisons, jails, and immigration detention centers a largely “uncontrolled, unflattened curve,” even if the incarcerated try to practice social distancing and have constant access to soap and hand sanitizer. Oluwadamilola Oladeru, a resident at the Harvard Radiation Oncology Program, who co-authored an op-ed, with Gonsalves, on the threat that COVID-19 poses to those who are incarcerated, pointed out that, if the health system is overwhelmed, people in prison may not only get sick from the coronavirus but may also lose access to ongoing care for chronic conditions, such as diabetes and respiratory illnesses. The U.S. prison population currently includes more than a hundred and seventy thousand people over the age of fifty-five, an age group that is particularly vulnerable to COVID-19.


newyorker--2020-03-24--Trump Invokes Defense Production Act to Mass-Produce Gallons of Spray Tan

WASHINGTON ( The Borowitz Report ) —At long last invoking the Defense Production Act , Donald J. Trump has ordered @ @ @ @ @ to begin mass-producing gallons of spray tan .
Speaking at the White House on Tuesday @ @ @ @ @ because millions of Americans have been forced to remain indoors , the country ’ s @ @ @ @ @ fallen to “ dangerously low ” levels .
“ I sent Mike Pence out to @ @ @ @ @ he went to store after store and they were all out , ” Trump said @ @ @ @ @ a disgraceful situation.
” Trump said that , although he had been reluctant to invoke @ @ @ @ @ are going to lose their tans within days if nothing is done.
” Under the @ @ @ @ @ of spray tan that Trump has demanded will be pumped out by retrofitted factories that @ @ @ @ @ White House sources confirmed that Trump has also invoked the Defense Production Act to manufacture @ @ @ @ @ , and one eighteen-hole indoor golf course .

WASHINGTON (The Borowitz Report)—At long last invoking the Defense Production Act, Donald J. Trump has ordered the nation’s factories to begin mass-producing gallons of spray tan.
Speaking at the White House on Tuesday, Trump said that, because millions of Americans have been forced to remain indoors, the country’s stockpiles of fake-tan reserves have fallen to “dangerously low” levels.
“I sent Mike Pence out to buy some yesterday, and he went to store after store and they were all out,” Trump said. “It’s a disgraceful situation.”
Trump said that, although he had been reluctant to invoke the D.P.A., “People are going to lose their tans within days if nothing is done.”
Under the order, the specific hue of spray tan that Trump has demanded will be pumped out by retrofitted factories that normally manufacture orange paint.
White House sources confirmed that Trump has also invoked the Defense Production Act to manufacture Sharpies, yellow hair dye, and one eighteen-hole indoor golf course.


newyorker--2020-03-24--My Failed Attempts to Hoard Anything at All

It used to be that nobody ever called me .
I ’ d get lonely notices on my phone , reading , “ Last week you had one minute and twelve seconds of screen time.
” Now , though , with the coronavirus pandemic , I ’ m Mr. Popular .
The first person I usually hear from is my sister Lisa , who will start with an update from her local Costco , in Winston-Salem .
“ They announced a new delivery of toilet paper , but it was gone by the time Bob and I got there.
” @ @ @ @ @ @ @ came for dinner and showed me a Rolling Stone photo essay on shoppers hoarding at superstores .
Because everything ’ s sold in such great quantities , the carts look miniature .
“ Gun sales have gone up , as well , ” Hugh said .
Amy put her phone away .
“ So people can protect their toilet paper.
” Our friend Cristina was at the table , too , and we told her how bad we are at hoarding .
“ You have to understand , I grew up shopping with @ @ @ @ @ @ @ “ With a professional.
” I remembered him during the oil crisis of 1973 , heading to the Shell station with empty cans and getting in line at 4 a.m. All our cars had full tanks , but he needed the next guy ’ s ration , as well .
I didn ’ t even drive , but , still , he taught me how to siphon .
I remember the shock of a mouthful of gasoline , spitting it onto the street and thinking , Someone could have used that .
“ @ @ @ @ @ @ @ ?
” I said to Amy .
“ He ’ d be out there every day , buying pallets of fruit cocktail .
And toilet paper—he ’ d have a forest ’ s worth under the tarp in the back yard .
If rats chewed holes in the plastic and it got rained on , he ’ d stick the rolls in the oven , or go at them with a hair dryer.
” How can we—his children—be so bad at the kind of shopping he prided himself on ?
I tried to @ @ @ @ @ @ @ , and came away with two steaks and a pouch of dried coconut .
“ Coconut ?
” Hugh said when I got home .
“ What am I going to do with that ?
” That night , at Morton-Williams , I tried again , and returned home with a package of Ball Park hot dogs , a pint of buttermilk , and some taco shells .
Oh , but I haven ’ t .
Amy and I went to Eataly the next day , determined .
Twice we were scolded by @ @ @ @ @ @ @ the person ahead of us , at the butcher and at the freshly-made-pasta counter .
“ We have the floor taped so you ’ ll know what distance you should keep , ” the woman who did the scolding said .
It helps to look at which shelves are bare .
That teaches you , I suppose , what you should be hoarding .
Most of the people I see in lines these days aren ’ t real cooks .
I noticed at my neighborhood stores that all the canned spaghetti sauces were @ @ @ @ @ @ @ like ketchup , as well as the frozen pizzas and burritos—stuff we never eat .
Toilet paper is gone , too , of course , as are paper towels .
I ’ ve started watching YouTube videos by a conspiracy-theory influencer , a QAnon guy who sees a correlation between epidemics and election years , and suggests that we “ connect the dots.
” When Trump said , “ We are fighting an invisible enemy , ” the influencer knew he was talking about the deep-state cabal and not the coronavirus .
“ @ @ @ @ @ @ @ ” I said to Hugh .
Then I blew my nose into a scrap of fabric I ’ ve been carrying around .
Good luck finding Kleenex anymore .
Tissues and napkins are the new alternative to toilet paper .
A drugstore in my neighborhood had hand sanitizer the other day .
There was a sign in the window announcing it , and a number of people looking at the sign and waiting for someone to open the door .
That happens a lot now .
No one wants to touch the handle @ @ @ @ @ @ @ say .
“ I ’ ll do it.
” Then I have to stand there and let thirty people through .
The drugstore had big bottles of hand sanitizer , but I couldn ’ t see the little ones , and couldn ’ t bring myself to ask where they were , as I didn ’ t want to look like I was panicked .
I guess that ’ s what makes for a successful crisis shopper .
Like my dad standing in the dark with his empty gas cans , these people @ @ @ @ @ @ @ like .
It doesn ’ t matter if they get glared at .
Hidden as they are behind an eight-foot tower of toilet paper , they ’ re never going to register it , anyway .
“ That ’ s the spirit !
” I can imagine my father saying as they unload their carts in the parking lot , filling every cubic centimetre of their massive S.U.V.s .
A quick stop home to drop off the frozen stuff , then it ’ s back to the store for thirty jugs of bleach @ @ @ @ @ @ @ , from responding to a sick housemate to the pros and cons of ordering food .
• How people cope and create new customs amid a pandemic .
• What it means to contain and mitigate the coronavirus outbreak .
• How much of the world is likely to be quarantined ?
• Donald Trump in the time of coronavirus .
• The coronavirus is likely to spread for more than a year before a vaccine could be widely available .
• We are all irrational panic shoppers .
• The strange terror @ @ @ @ @ @ @

It used to be that nobody ever called me. I’d get lonely notices on my phone, reading, “Last week you had one minute and twelve seconds of screen time.” Now, though, with the coronavirus pandemic, I’m Mr. Popular. The first person I usually hear from is my sister Lisa, who will start with an update from her local Costco, in Winston-Salem. “They announced a new delivery of toilet paper, but it was gone by the time Bob and I got there.”
In New York, my sister Amy came for dinner and showed me a Rolling Stone photo essay on shoppers hoarding at superstores. Because everything’s sold in such great quantities, the carts look miniature.
“Gun sales have gone up, as well,” Hugh said.
Amy put her phone away. “So people can protect their toilet paper.”
Our friend Cristina was at the table, too, and we told her how bad we are at hoarding. “You have to understand, I grew up shopping with my father,” Amy said. “With a professional.”
I remembered him during the oil crisis of 1973, heading to the Shell station with empty cans and getting in line at 4 a.m. All our cars had full tanks, but he needed the next guy’s ration, as well. I didn’t even drive, but, still, he taught me how to siphon. I remember the shock of a mouthful of gasoline, spitting it onto the street and thinking, Someone could have used that.
“Can you imagine dad twenty years younger?” I said to Amy. “He’d be out there every day, buying pallets of fruit cocktail. And toilet paper—he’d have a forest’s worth under the tarp in the back yard. If rats chewed holes in the plastic and it got rained on, he’d stick the rolls in the oven, or go at them with a hair dryer.”
How can we—his children—be so bad at the kind of shopping he prided himself on? I tried to hoard at Whole Foods the other day, and came away with two steaks and a pouch of dried coconut.
“Coconut?” Hugh said when I got home. “What am I going to do with that?”
That night, at Morton-Williams, I tried again, and returned home with a package of Ball Park hot dogs, a pint of buttermilk, and some taco shells.
“I give up,” Hugh said.
Oh, but I haven’t. Amy and I went to Eataly the next day, determined. Twice we were scolded by staff members for standing too close to the person ahead of us, at the butcher and at the freshly-made-pasta counter. “We have the floor taped so you’ll know what distance you should keep,” the woman who did the scolding said.
It helps to look at which shelves are bare. That teaches you, I suppose, what you should be hoarding. Most of the people I see in lines these days aren’t real cooks. I noticed at my neighborhood stores that all the canned spaghetti sauces were gone, the horrible ones that taste like ketchup, as well as the frozen pizzas and burritos—stuff we never eat. Toilet paper is gone, too, of course, as are paper towels.
I’ve started watching YouTube videos by a conspiracy-theory influencer, a QAnon guy who sees a correlation between epidemics and election years, and suggests that we “connect the dots.” When Trump said, “We are fighting an invisible enemy,” the influencer knew he was talking about the deep-state cabal and not the coronavirus.
“Where do people get this stuff?” I said to Hugh. Then I blew my nose into a scrap of fabric I’ve been carrying around. Good luck finding Kleenex anymore. Tissues and napkins are the new alternative to toilet paper.
A drugstore in my neighborhood had hand sanitizer the other day. There was a sign in the window announcing it, and a number of people looking at the sign and waiting for someone to open the door. That happens a lot now. No one wants to touch the handle. “Fine,” I always say. “I’ll do it.”
Then I have to stand there and let thirty people through.
The drugstore had big bottles of hand sanitizer, but I couldn’t see the little ones, and couldn’t bring myself to ask where they were, as I didn’t want to look like I was panicked. I guess that’s what makes for a successful crisis shopper. Like my dad standing in the dark with his empty gas cans, these people don’t care what they look like. It doesn’t matter if they get glared at. Hidden as they are behind an eight-foot tower of toilet paper, they’re never going to register it, anyway. “That’s the spirit!” I can imagine my father saying as they unload their carts in the parking lot, filling every cubic centimetre of their massive S.U.V.s. A quick stop home to drop off the frozen stuff, then it’s back to the store for thirty jugs of bleach.
A Guide to the Coronavirus


newyorker--2020-03-24--A Washington Heights Bar Closes Down, with Echoes for All Small Businesses

On Friday , March 13th—now as remote as the Pliocene—I dropped into Coogan ’ s , an Irish bar and restaurant in Washington Heights , for an afternoon drink .
I wanted to check in with the owners , Dave Hunt , Tess O ’ Connor McDade , and Peter Walsh .
Hunt and Walsh are in their early seventies , McDade a generation younger .
They were unavailable , engaged in what McDade described as “ an emergency strategy meeting ” to deal with the effects of the COVID-19 pandemic on their small business .
It was happy hour @ @ @ @ @ @ @ and only three of the twenty-four tables in the dining room were occupied .
At the rectangular bar , half a dozen drinkers , well-spaced , exchanged can-you-believe-this looks with one another .
On the TV screens , where March Madness and spring-training baseball should have been , the President was declaring a national emergency .
Walsh emerged from the backroom strategy session to deliver some change to the bartender , Belgica Borges .
“ It feels like a storm ’ s coming , ” he said .
“ It ’ s going @ @ @ @ @ @ @ ’ ll see what ’ s standing afterwards.
” Coogan ’ s , which opened in 1985 , has weathered many storms : the crack epidemic , the 1992 Washington Heights riots , the September 11th attacks , the 2008 financial crash , and a staggering rent increase , two years ago , that nearly forced it to close .
All of that seems to belong to another existence now .
Like many other small-business owners around the country , Hunt , McDade , and Walsh are uncertain whether their bar and restaurant @ @ @ @ @ @ @ meeting , the partners planned to reduce their pay , trim employee hours , and cut every nonessential expense , in the hopes of staying afloat .
That plan lasted until Monday , March 16th , when Governor Andrew Cuomo ordered all bars and restaurants in New York to close to the public , at 8 p.m. , and shift to providing only takeout and delivery service .
Steve Simon , a longtime Coogan ’ s regular and a member of the local community board , was the last customer to eat a @ @ @ @ @ @ @ room before it closed .
“ I felt obligated to be here , ” he said .
“ It ’ s very sad .
We depend on Coogan ’ s , which is a center of community life in Washington Heights.
” Coogan ’ s was ill prepared for this sudden new reality .
Although it has long provided catering and takeout service , delivery has never been a big part of its bottom line .
The bar is beloved as a hangout , a place to meet face to face .
It @ @ @ @ @ @ @ arrangement with Uber Eats or DoorDash , no squad of bicycle couriers to dispatch meals .
“ It ’ s not our business model , ” Hunt said .
“ Food is a little less than ten per cent of our profits .
We make our money from booze.
” The booziest , busiest day of the year at Coogan ’ s is St. Patrick ’ s .
This year had the potential to be especially crowded .
“ Middle of the week and rainy , ” Walsh said .
“ Rain chases @ @ @ @ @ @ @ would have been the biggest day for us.
” Normally , a staff of forty would have been on hand to serve the boisterous clientele .
On Tuesday morning , there were five employees , plus the owners .
Workers from the nearby New York-Presbyterian medical center showed up , wearing masks , to collect lunch orders .
McDade was helping staff file for unemployment .
Down in the office , Hunt was cajoling vendors into allowing him to return unopened cases of liquor and other nonperishable goods .
“ I don ’ @ @ @ @ @ @ @ napkins on hand right now , ” he said .
They had stocked up on everything in anticipation of the higher volume that March usually brings .
The shutdown came at a particularly unlucky moment for Coogan ’ s .
On March 16th , the owners made their monthly sales-tax payment .
( Failure to do so would have incurred stiff penalties . )
And , at midnight on the 17th , the place ’ s insurance policy came up for renewal , with a substantial premium due and significant fines if it @ @ @ @ @ @ @ requested a three-month extension of the previous policy from their insurer , but were turned down .
“ Two monster payments going out the door , ” Walsh said .
“ That ’ s cash we could have used.
” All of this left their coffers depleted .
“ We know we can go to this week .
We probably can go to next week , but after that .
.
.
.
” None of them questioned the drastic actions that government leaders were taking .
“ Everything is secondary to fighting @ @ @ @ @ @ @ But their shared sense of loss was palpable .
“ The big , raucous community of Coogan ’ s is now just four walls and forty-two hundred square feet of empty space , ” Hunt said .
Later , just as the place would normally have been filling up with revellers decked out in green , McDade texted me a photograph of the dining room , which was strung with Guinness and Bud Light banners and decorated with cardboard shamrocks .
All the chairs were turned upside down on the tables .
Not @ @ @ @ @ @ @ “ Saddest St. Patrick ’ s Day ever , ” she wrote .
On Friday , March 20th—exactly a week after the emergency strategy meeting—Coogan ’ s shuttered its doors .
The restaurant did about two hundred dollars ’ worth of takeout and delivery business on Wednesday .
On Thursday , it took in eleven hundred dollars , with sales boosted by a charitable customer who ’ d bought twenty boxed lunches for the emergency-room staff at New York-Presbyterian .
Some of McDade ’ s friends had also ordered cases of wine , @ @ @ @ @ @ @ , to the Hudson Valley .
Despite the bump , the economic reality was irrefutable .
Preparations began immediately .
Ice machines were emptied and drained .
Beer lines were disconnected and cleaned .
Anheuser-Busch , Coors , and other distributors came to pick up untapped kegs of beer .
Those credits to the bar ’ s accounts helped it meet payroll for this final week .
“ We are going to run out of money , ” Hunt said .
“ But , hopefully , we will run out of money when @ @ @ @ @ @ @ were instructed to come in on Friday morning to pick up their checks .
Arrival times were staggered to avoid close contact .
First came the kitchen workers and porters ; then the waiters , runners , and busboys ; and finally the bartenders .
All the perishable food in the house was laid out on tables in the dining room : carrots , eggs , milk , apples , onions , potatoes , and greens—a momentary cornucopia .
Once they ’ d received their checks and unemployment letters , employees were invited @ @ @ @ @ @ @ as they could carry .
Whatever was left over would be donated to a local charity .
It was a strange farewell .
The employees had all worked long hours in close quarters together , and now they couldn ’ t hug one another or even shake hands to say goodbye .
Several were too cautious to leave their homes and asked that checks be mailed .
Those who did come choked back tears or went through the motions in a kind of stupefied trance .
Walsh told them all , “ We @ @ @ @ @ @ @ Let us know how you ’ re doing .
We ’ ll help if we can.
” The last to arrive was Borges , who has worked at Coogan ’ s since 2002 .
She said she would apply for unemployment the next day .
In the meantime , she was sending money to family in Aruba and the Dominican Republic , where the virus ’ s spread was just beginning .
“ I hope we ’ ll be back by April , ” she said .
“ You ’ ll be the @ @ @ @ @ @ @ , ” Walsh replied .
As Borges left , the news broke that the governor was ordering all nonessential businesses to close and that all gatherings of any size would be banned .
That included the four of us standing around in the empty dining room at Coogan ’ s .
The owners fretted about what would become of the neighborhood during the weeks ahead .
“ A lot of businesses aren ’ t going to make it , ” Hunt said .
“ The streets are beginning to feel very threatening now @ @ @ @ @ @ @ McDade said .
They were adamant that they wouldn ’ t board up their windows .
“ We didn ’ t board up for the riots ; we ’ re not boarding up for this , ” Hunt said .
Walsh added : “ We ’ re New Yorkers .
We ’ re getting through this .
And , when we reopen , we ’ ll have our own St. Patrick ’ s Day parade around the block , with bagpipes , salsa , and merengue.
” In the meantime , the shamrocks @ @ @ @ @ @ @ of Coogan ’ s , anticipating the celebration and the return of community life .

On Friday, March 13th—now as remote as the Pliocene—I dropped into Coogan’s, an Irish bar and restaurant in Washington Heights, for an afternoon drink. I wanted to check in with the owners, Dave Hunt, Tess O’Connor McDade, and Peter Walsh. Hunt and Walsh are in their early seventies, McDade a generation younger. They were unavailable, engaged in what McDade described as “an emergency strategy meeting” to deal with the effects of the COVID-19 pandemic on their small business. It was happy hour, St. Patrick’s season, and only three of the twenty-four tables in the dining room were occupied. At the rectangular bar, half a dozen drinkers, well-spaced, exchanged can-you-believe-this looks with one another. On the TV screens, where March Madness and spring-training baseball should have been, the President was declaring a national emergency. Walsh emerged from the backroom strategy session to deliver some change to the bartender, Belgica Borges. “It feels like a storm’s coming,” he said. “It’s going to blow over us, and we’ll see what’s standing afterwards.”
Coogan’s, which opened in 1985, has weathered many storms: the crack epidemic, the 1992 Washington Heights riots, the September 11th attacks, the 2008 financial crash, and a staggering rent increase, two years ago, that nearly forced it to close. All of that seems to belong to another existence now. Like many other small-business owners around the country, Hunt, McDade, and Walsh are uncertain whether their bar and restaurant will survive. Out of that Friday meeting, the partners planned to reduce their pay, trim employee hours, and cut every nonessential expense, in the hopes of staying afloat. That plan lasted until Monday, March 16th, when Governor Andrew Cuomo ordered all bars and restaurants in New York to close to the public, at 8 p.m., and shift to providing only takeout and delivery service. Steve Simon, a longtime Coogan’s regular and a member of the local community board, was the last customer to eat a meal in the bar’s dining room before it closed. “I felt obligated to be here,” he said. “It’s very sad. We depend on Coogan’s, which is a center of community life in Washington Heights.”
Coogan’s was ill prepared for this sudden new reality. Although it has long provided catering and takeout service, delivery has never been a big part of its bottom line. The bar is beloved as a hangout, a place to meet face to face. It had no online-ordering system, no existing arrangement with Uber Eats or DoorDash, no squad of bicycle couriers to dispatch meals. “It’s not our business model,” Hunt said. “Food is a little less than ten per cent of our profits. We make our money from booze.”
The booziest, busiest day of the year at Coogan’s is St. Patrick’s. This year had the potential to be especially crowded. “Middle of the week and rainy,” Walsh said. “Rain chases people into restaurants and bars. This would have been the biggest day for us.” Normally, a staff of forty would have been on hand to serve the boisterous clientele. On Tuesday morning, there were five employees, plus the owners. Workers from the nearby New York-Presbyterian medical center showed up, wearing masks, to collect lunch orders. McDade was helping staff file for unemployment. Down in the office, Hunt was cajoling vendors into allowing him to return unopened cases of liquor and other nonperishable goods. “I don’t need to have ten thousand paper napkins on hand right now,” he said. They had stocked up on everything in anticipation of the higher volume that March usually brings.
The shutdown came at a particularly unlucky moment for Coogan’s. On March 16th, the owners made their monthly sales-tax payment. (Failure to do so would have incurred stiff penalties.) And, at midnight on the 17th, the place’s insurance policy came up for renewal, with a substantial premium due and significant fines if it failed to pay. The owners had requested a three-month extension of the previous policy from their insurer, but were turned down. “Two monster payments going out the door,” Walsh said. “That’s cash we could have used.” All of this left their coffers depleted. “We know we can go to this week. We probably can go to next week, but after that. . . . ”
None of them questioned the drastic actions that government leaders were taking. “Everything is secondary to fighting this disease,” Walsh said. But their shared sense of loss was palpable. “The big, raucous community of Coogan’s is now just four walls and forty-two hundred square feet of empty space,” Hunt said. Later, just as the place would normally have been filling up with revellers decked out in green, McDade texted me a photograph of the dining room, which was strung with Guinness and Bud Light banners and decorated with cardboard shamrocks. All the chairs were turned upside down on the tables. Not a soul was in the picture. “Saddest St. Patrick’s Day ever,” she wrote.
On Friday, March 20th—exactly a week after the emergency strategy meeting—Coogan’s shuttered its doors. The restaurant did about two hundred dollars’ worth of takeout and delivery business on Wednesday. On Thursday, it took in eleven hundred dollars, with sales boosted by a charitable customer who’d bought twenty boxed lunches for the emergency-room staff at New York-Presbyterian. Some of McDade’s friends had also ordered cases of wine, which she delivered on her way home, to the Hudson Valley. Despite the bump, the economic reality was irrefutable. Preparations began immediately. Ice machines were emptied and drained. Beer lines were disconnected and cleaned. Anheuser-Busch, Coors, and other distributors came to pick up untapped kegs of beer. Those credits to the bar’s accounts helped it meet payroll for this final week. “We are going to run out of money,” Hunt said. “But, hopefully, we will run out of money when we run out of bills.”
Staff were instructed to come in on Friday morning to pick up their checks. Arrival times were staggered to avoid close contact. First came the kitchen workers and porters; then the waiters, runners, and busboys; and finally the bartenders. All the perishable food in the house was laid out on tables in the dining room: carrots, eggs, milk, apples, onions, potatoes, and greens—a momentary cornucopia. Once they’d received their checks and unemployment letters, employees were invited to help themselves to as much food as they could carry. Whatever was left over would be donated to a local charity.
It was a strange farewell. The employees had all worked long hours in close quarters together, and now they couldn’t hug one another or even shake hands to say goodbye. Several were too cautious to leave their homes and asked that checks be mailed. Those who did come choked back tears or went through the motions in a kind of stupefied trance. Walsh told them all, “We love you. Keep in touch. Let us know how you’re doing. We’ll help if we can.” The last to arrive was Borges, who has worked at Coogan’s since 2002. She said she would apply for unemployment the next day. In the meantime, she was sending money to family in Aruba and the Dominican Republic, where the virus’s spread was just beginning. “I hope we’ll be back by April,” she said. “You’ll be the first one we call when we reopen,” Walsh replied.
As Borges left, the news broke that the governor was ordering all nonessential businesses to close and that all gatherings of any size would be banned. That included the four of us standing around in the empty dining room at Coogan’s. The owners fretted about what would become of the neighborhood during the weeks ahead. “A lot of businesses aren’t going to make it,” Hunt said. “The streets are beginning to feel very threatening now that there are fewer pedestrians,” McDade said. They were adamant that they wouldn’t board up their windows. “We didn’t board up for the riots; we’re not boarding up for this,” Hunt said. Walsh added: “We’re New Yorkers. We’re getting through this. And, when we reopen, we’ll have our own St. Patrick’s Day parade around the block, with bagpipes, salsa, and merengue.” In the meantime, the shamrocks will continue to hang in the windows of Coogan’s, anticipating the celebration and the return of community life.


newyorker--2020-03-24--What It’s Like to Be a Pregnant Physician During the Coronavirus Outbreak

As of late last week , the pediatrics ward in the hospital where I work , in San Antonio , Texas , remains an island of calm , careful effort .
Every morning , I bicker lightly with the charge nurse , who has been tasked with distributing masks for everyone on this floor , since some masks have disappeared from the cabinets where we usually keep them .
The charge nurse reminds me not to waste masks ; I tell her that I need them for my team ; she tells me that I ’ d better not be @ @ @ @ @ @ @ I tell her I am taking measures to limit exposure , but I need some masks so we can see our patients ; finally , she gives me masks , making sure to include a few with the annoying ties that add twenty seconds to the process of donning them .
We respect each other , and this argument feels comfortable—familiar , even , as the week wears on , and our rooms continue to fill and empty , fill and empty , with the usual cycle of small children struggling to breathe @ @ @ @ @ @ @ , human metapneumovirus , adenovirus , rhinovirus , or the strains of coronavirus that I now think of as the “ old-timey coronavirus ” —our intimate friend and enemy , the common cold .
Here in my pediatrics ward , as of this writing , we have not yet had a confirmed case of the novel coronavirus that causes the disease COVID-19 .
We blow oxygen into our patients ’ tiny mouths and noses , suck out their mucus , use medicines and tubes to make them continue breathing if we must .
@ @ @ @ @ @ @ usually the ones who were born prematurely , or who are very small or sick from other problems , move along to the I.C.U.
, then return to us after they have begun to recover .
“ See , your kind are resilient , ” I say to the boy in my uterus , whose movements I can not yet feel .
At night , I lie quietly in bed , trying to feel him ; during the day , I move from infected child to infected child , counting the number of @ @ @ @ @ @ @ suppose that another mother might see all these babies struggling for breath and learn not that they are resilient but that they are vulnerable .
She would be right , in her way—but I am a pediatrician , in a well-equipped American hospital , and I know that I can make these babies breathe .
A paper was released this week from the journal Pediatrics analyzing 2,143 cases of the novel coronavirus in Chinese children aged eighteen and younger .
Only one child , a fourteen-year-old , died .
Just under six per @ @ @ @ @ @ @ require hospital care .
Preliminary numbers coming from the U.S. show that around two per cent of COVID-infected kids here have required hospitalization .
While the lack of pediatric deaths is reassuring , this rate of hospitalization should still alarm us .
It is much higher than that for typical respiratory infections—even influenza leads to hospitalization in far fewer than one per cent of cases .
The Centers for Disease Control has not yet documented any increased risk for pregnant people or fetuses exposed to the novel coronavirus .
Very small studies have @ @ @ @ @ @ @ the influenza virus is more likely to kill pregnant women than others , as are the older , severe coronaviruses that cause SARS and MERS , this one has not been shown to do so .
A small study from China showed a possible increased risk for preterm labor among pregnancies affected by COVID-19 , but these data have not been replicated , and neither the C.D.C .
nor I yet believe it .
Privately , like other pregnant physicians and nurses , I fret about the unknown .
Other viruses , like @ @ @ @ @ @ @ can seriously harm babies in the womb—sometimes in ways that are not immediately evident at birth .
So far , the new coronavirus does not seem to be passing through the placenta .
There is no evidence of it harming fetuses , but we will not be able to rule that possibility out for a long time .
Many babies have to be born to mothers who were infected during pregnancy for scientists to generate strong data and answer this question .
Practically speaking , however , isolating pediatricians from children with the @ @ @ @ @ @ @ Children are often asymptomatic or have very mild disease symptoms , such as a runny nose .
They may be infected with multiple viruses at once , and so even a test identifying another viral cause of a child ’ s symptoms does not rule out coinfection with SARS-COV2 .
Where I practice , in San Antonio , testing is still limited to those with known exposure or severe symptoms ; hospitalized children who have tested positive for another virus are not eligible for COVID testing .
( This changes on a daily @ @ @ @ @ @ @ to make more extensive testing available . )
My colleagues are shielding me from taking extra shifts in the hospital so far , and I know my boss would keep me home completely if she could ( or needed to ) .
But , so far , the best evidence suggests that I should take the same precautions as other health-care workers , with one addition : avoiding high-risk procedures like suctioning patients ’ noses or putting in breathing tubes .
The best I can say for now is that things are uncertain @ @ @ @ @ @ @ wash my hands .
I know my son is turning because I saw him do it , once , on an ultrasound .
But is that latest flutter him moving within me ?
I know the virus is out there , in my community , and likely even in my hospital .
But is it in me ?
Is it already passing from the air I breathe into my bloodstream , and through my blood to him ?
In medical school , I learned that physicians have a moral duty to continue our @ @ @ @ @ @ @ We might send our families away , but we must stay where we are and tend to the ill and suffering .
Respecting this duty , my Chinese and Italian colleagues have sacrificed their own health to care for others .
In Italy , as of March 15th , 2,026 of the 22,512 cases of COVID-19 were among health-care workers .
A recent article by Italian physicians in the Lancet suggested that twenty per cent of health-care workers in Lombardy had become infected .
In Albert Camus ’ s “ The Plague , @ @ @ @ @ @ @ is separated from his wife throughout the book .
She is hospitalized outside the city of Oran , for an unrelated illness , and after the city gates are closed Rieux is unable to see her for the duration of the plague .
She dies there , and he learns of her death by telegram .
Rieux survives .
In his “ Hiroshima Diary , ” the Japanese physician Michihiko Hachiya walks through his devastated city to his hospital in the hours after the 1945 atomic bombing .
In a building where the @ @ @ @ @ @ @ are limited , he acts “ more as a comforter than a physician ” for patients with burns and injuries .
Hachiya also begins to document the slower deaths from radiation poisoning , and is among the first to comprehend the nature of the mysterious illness that ultimately kills him , too .
But even after he knows that people are dying from the lingering effects of radiation exposure , and that radiation continues to surround him , he does not flee .

As of late last week, the pediatrics ward in the hospital where I work, in San Antonio, Texas, remains an island of calm, careful effort. Every morning, I bicker lightly with the charge nurse, who has been tasked with distributing masks for everyone on this floor, since some masks have disappeared from the cabinets where we usually keep them. The charge nurse reminds me not to waste masks; I tell her that I need them for my team; she tells me that I’d better not be bringing extra people into the room; I tell her I am taking measures to limit exposure, but I need some masks so we can see our patients; finally, she gives me masks, making sure to include a few with the annoying ties that add twenty seconds to the process of donning them. We respect each other, and this argument feels comfortable—familiar, even, as the week wears on, and our rooms continue to fill and empty, fill and empty, with the usual cycle of small children struggling to breathe through a typical respiratory virus: influenza, human metapneumovirus, adenovirus, rhinovirus, or the strains of coronavirus that I now think of as the “old-timey coronavirus”—our intimate friend and enemy, the common cold. Here in my pediatrics ward, as of this writing, we have not yet had a confirmed case of the novel coronavirus that causes the disease COVID-19. We blow oxygen into our patients’ tiny mouths and noses, suck out their mucus, use medicines and tubes to make them continue breathing if we must. Generally, they recover. Some, usually the ones who were born prematurely, or who are very small or sick from other problems, move along to the I.C.U., then return to us after they have begun to recover.
“See, your kind are resilient,” I say to the boy in my uterus, whose movements I cannot yet feel. At night, I lie quietly in bed, trying to feel him; during the day, I move from infected child to infected child, counting the number of breaths each takes per minute. I suppose that another mother might see all these babies struggling for breath and learn not that they are resilient but that they are vulnerable. She would be right, in her way—but I am a pediatrician, in a well-equipped American hospital, and I know that I can make these babies breathe.
A paper was released this week from the journal Pediatrics analyzing 2,143 cases of the novel coronavirus in Chinese children aged eighteen and younger. Only one child, a fourteen-year-old, died. Just under six per cent of children became ill enough to require hospital care. Preliminary numbers coming from the U.S. show that around two per cent of COVID-infected kids here have required hospitalization.
While the lack of pediatric deaths is reassuring, this rate of hospitalization should still alarm us. It is much higher than that for typical respiratory infections—even influenza leads to hospitalization in far fewer than one per cent of cases.
The Centers for Disease Control has not yet documented any increased risk for pregnant people or fetuses exposed to the novel coronavirus. Very small studies have been reassuring: whereas we know that the influenza virus is more likely to kill pregnant women than others, as are the older, severe coronaviruses that cause SARS and MERS, this one has not been shown to do so. A small study from China showed a possible increased risk for preterm labor among pregnancies affected by COVID-19, but these data have not been replicated, and neither the C.D.C. nor I yet believe it.
Privately, like other pregnant physicians and nurses, I fret about the unknown. Other viruses, like cytomegalovirus, Zika, and rubella, can seriously harm babies in the womb—sometimes in ways that are not immediately evident at birth. So far, the new coronavirus does not seem to be passing through the placenta. There is no evidence of it harming fetuses, but we will not be able to rule that possibility out for a long time. Many babies have to be born to mothers who were infected during pregnancy for scientists to generate strong data and answer this question.
Practically speaking, however, isolating pediatricians from children with the SARS-COV2 infection may not be happening. Children are often asymptomatic or have very mild disease symptoms, such as a runny nose. They may be infected with multiple viruses at once, and so even a test identifying another viral cause of a child’s symptoms does not rule out coinfection with SARS-COV2. Where I practice, in San Antonio, testing is still limited to those with known exposure or severe symptoms; hospitalized children who have tested positive for another virus are not eligible for COVID testing. (This changes on a daily basis, and we are working hard to make more extensive testing available.)
My colleagues are shielding me from taking extra shifts in the hospital so far, and I know my boss would keep me home completely if she could (or needed to). But, so far, the best evidence suggests that I should take the same precautions as other health-care workers, with one addition: avoiding high-risk procedures like suctioning patients’ noses or putting in breathing tubes.
The best I can say for now is that things are uncertain. I go to work; I wash my hands. I know my son is turning because I saw him do it, once, on an ultrasound. But is that latest flutter him moving within me? I know the virus is out there, in my community, and likely even in my hospital. But is it in me? Is it already passing from the air I breathe into my bloodstream, and through my blood to him?
In medical school, I learned that physicians have a moral duty to continue our work in times of epidemic disease. We might send our families away, but we must stay where we are and tend to the ill and suffering. Respecting this duty, my Chinese and Italian colleagues have sacrificed their own health to care for others. In Italy, as of March 15th, 2,026 of the 22,512 cases of COVID-19 were among health-care workers. A recent article by Italian physicians in the Lancet suggested that twenty per cent of health-care workers in Lombardy had become infected.
In Albert Camus’s “The Plague,” the protagonist, Dr. Rieux, is separated from his wife throughout the book. She is hospitalized outside the city of Oran, for an unrelated illness, and after the city gates are closed Rieux is unable to see her for the duration of the plague. She dies there, and he learns of her death by telegram. Rieux survives.
In his “Hiroshima Diary,” the Japanese physician Michihiko Hachiya walks through his devastated city to his hospital in the hours after the 1945 atomic bombing. In a building where the roof has been blown off and supplies are limited, he acts “more as a comforter than a physician” for patients with burns and injuries. Hachiya also begins to document the slower deaths from radiation poisoning, and is among the first to comprehend the nature of the mysterious illness that ultimately kills him, too. But even after he knows that people are dying from the lingering effects of radiation exposure, and that radiation continues to surround him, he does not flee.
To have a duty is a beautiful thing, and I have found my life in medicine very beautiful because it has made me useful to mankind. I have imagined being a Rieux or a Hachiya—cultivating that intoxicating blend of service and self-annihilation that medicine allows—staying present for my patients even if my family flees. My husband knows this about me, and I believe he understands it, although it is not his favorite quality of mine. “I knew I was marrying a doctor,” he says, when I apologize for my long hours or my late nights.
Now I am becoming a mother, and the difficulty is that I cannot send my son away. I cannot heed the advice I give to other parents and shelter him; instead, I carry him to the hospital, in and out of rooms where other children pant, where mothers weep and wait.
In another place, the stakes would be different. Forty-two patients in Hong Kong tested positive for COVID-19 in January and early February, but extensive safety and monitoring protocols led to zero health-care workers catching the infection. Strong investment in public-health infrastructure and early aggressive intervention helped contain the disease there, as it has in South Korea and Japan. If our country had acted similarly—if our scientists and public-health professionals were well-funded, trusted, and believed at the highest levels of government—practicing medicine here might not carry so much risk.
Pregnancy puts me in a high-risk category because the exact level of risk for pregnant women infected with SARS-COV2 is unknown, but many doctors have known risk factors for severe illness. My colleagues and friends include intensive-care doctors in their seventies, pediatricians on immunosuppressive drugs, internal-medicine doctors who themselves have had organ transplants. None of them are fleeing. I worry for these friends as I worry for my son.
But, in my heart, I understand them. I do not want to stop trying to be of service during this pandemic—what service I can, as my small patients are less likely to suffer severe illness than adults. Does this desire to continue practicing medicine make me less of a mother?
“What do you hope for, for your son?” my friend Tanner asked me this week.
I answer honestly, without thinking. “I hope for him to make it to term,” I say, “and then survive birth without major complications.” Tanner is visibly disturbed by my answer, and I remember that most Americans live lives in which it is possible to imagine that children are always safe, their health somehow inevitable or guaranteed. I do not wish to perturb this illusion for those who enjoy it, so I pivot to T-ball.
“T-ball,” I say, “is mandatory,” and then our conversation is able to begin again.
Early in my pregnancy, before the new virus was known to exist, I asked my father to take pictures of me surfing. (I could still fit in a wetsuit then.) I wanted my child to have a certain vision of me, a young and able mother striding over waves.
Now that I am visibly pregnant and the world is convulsing in the grip of this pandemic, I imagine my son one day seeing a picture of me in my P.P.E.—gown, gloves, mask, eye protection—with a protruding belly. I want him to know that, while he breathed through me, I was working to help other children breathe. While he was forming, cell by cell, doctors and nurses across the world risked their lives to help strangers. Even when our societies did not take the steps needed to protect us, we did not abandon the sick. I want my son to know that certain moral duties are worth risking death—though, certainly, I hope not to die—and that the kind of life where you have such a duty is, finally, a life worth living.
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