Merely a Flesh Wound

A city is not a body. The body politic is an illusion. And yet, in imagining a city as a body, it would seem natural to equate the healthcare system of the one with the immune system of the other. We even use the same word – system – to categorize both; however, for my own convenience, here, I’m going to imagine that the healthcare system of New York City is the foot of this not-body politic.

What then? I’m coming to the fundamental error into which we lapsed – anyone familiar with the chemistry concept of the limiting reagent already understands it well. Imagine a person – an actual body – has become ill. The foot of the body of this person has become gangrenous after a long-festering wound became infected, and in visiting the doctor, this person learns that the foot will have to be amputated, lest the gangrene prove fatal.

Now imagine the person’s response is: “Oh! But thank goodness there’s no threat to my head from this infection.”

Can we amputate the foot that is our healthcare system? A body can live without a foot, after all, if not so well as with one, and as we started off by acknowledging: A city is not a body, and yet such is the fallacious, exclamatory thinking into which we entered – and perhaps here, I should say they, because I’m talking primarily of the people who saw no risk in this pandemic to themselves and so carried on business-us-usual (as some of them still do) as the crisis deepened – when we committed ourselves to a path that guaranteed the implosion of our healthcare system. Water systems, food systems, energy systems, sanitation systems – these are the truly foundational infrastructures which we can’t live without, at least not well and not for long; healthcare, essential as it is when you need it, remains somewhat secondary, which is exactly why millions of people across the City, State, country, and world who have the privilege of sheltering safely in place in relative comfort (myself included) can largely go on living our lives as usual, save for the adjustment that we no longer go outside. If any of the four listed systems – food, water, energy, or sanitation – failed us, however, (if the hardworking people who keep these systems running ceased to keep them running), most of us would very rapidly cease to enjoy the luxury of staying at home.

They haven’t failed us, though, and – at least in New York City – I don’t foresee they will, but because a city is not a body, and even if it was, we couldn’t amputate the foot that is not its hospital system, we arrive at our current impasse. Like the person with potentially fatal gangrene condemned to lose an appendage, we’ve been wounded – if not mortally, then quite deeply – as a metropolis, and if we rejoice in the fact that the head, gut, and torso which constitute our “essential” systems remain intact, then we celebrate the sort of not-even-Pyrrhic victory that was won by the Knight from Monty Python, a paraphrase of whose famous declaration gives this piece its title.

In a pandemic, the healthcare system is the limiting reagent, and here in New York, ours is rapidly running out. Still, it is nothing short of incredible to see the resources being mobilized to shore it up as it falters. The Army Corps (which, I recently learned, relies entirely on private contractors for its construction work) has built a 1,000-bed hospital in the Javits Center with another 1,500 beds coming; the USNS Comfort (1,000 beds) is docked off the Upper West Side; the 11 NYC Health + Hospital facilities around the City are adding beds (~750) and converting existing beds to ICU beds (~3,000);  a good-sized field hospital is coming up at the Billie Jean King National Tennis Center in Queens (350 beds); an NYC Health + Hospitals facility on Roosevelt Island is adding beds (350, but unclear if this is included in the ~750 total above); a fundamentalist Christian organization is setting up a small field hospital (68 beds) in Central Park; and to top it all off, the City recently announced plans to convert rooms in 20 hotels into ~10,000 additional beds (which may also help prevent these hotels from lapsing into insolvency, and echoes my partner’s Plan for Alternative Birthing Sites in NYC During the COVID-19 Pandemic, which I encourage you all to read and throw your support behind). Rounding, it seems that all of the initial efforts will add around 5,000 beds, bringing the total, including hotel hospital rooms, to 15,000 new beds in all. (Not sure exactly where NY1 gets the much higher numbers referenced in this article, but they may know something I don’t.)

The Mayor (who is still around) has been saying that from our city-wide baseline of ~20,000 beds (I think the actual number may be closer to 18,000), we are projected to need ~65,000 beds at “the peak,” though, obviously, these numbers have been moving targets, and no one actually knows – the experts included – exactly how this will play out. We only know that it will play out badly.

This may not be quite Arsenal of Democracy- or Chinese Communist Party-level mobilization of state power, but it is impressive, and should serve (along with the recent massive bailout-disguised-as-relief-bill from DC) as a reminder of our governments’ immense capacities for action when there is will to act. The claim regarding public impotence has always been a canard, but – as our Governor’s simultaneous willingness to “move mountains” when he deems it necessary, and his utter unwillingness to consider raising taxes on the rich in view of a projected state budget shortfall of billions (perhaps even tens of billions) of dollars makes clear – the power of the state is not mobilized for just anyone. The crisis must be confronted, but it will be our schools and, shockingly, our public hospitals, which will eventually pay the price.

Say that the United States does succeed in defending its citadel to some extent though – that New York is spared the worst of this catastrophe through a mobilization of City, State, and Federal resources that almost beggars belief: What, then, of the rest of the country? As I’ve written previously, it’s highly likely that the months of April and May will witness New York-style crises (our crisis itself having been a Lombardy-style crisis which followed in the path of the initial crisis in Wuhan) unfolding simultaneously across much of the United States.

Governor Cuomo has valiantly declared on Twitter, in calling for healthcare workers to come to New York’s aid: “We will return the favor in your hour of need.”

But, numerically, even a populous and powerful state like New York simply does not have the resources or person-power to come to the aid of dozens of other states simultaneously, especially when New York State and City alike will be dealing with the long tail of our own crises for months to come. In this sense, we are lucky to have been the first / most prominent to have already slid into this morass. One need look no farther than Louisiana to understand what I mean.

There is little doubt that Mardi Gras celebrations in February were the proximate cause of the COVID-19 outbreak centering in New Orleans; just briefly comparing numbers, we see that Louisiana has 9,150 confirmed cases and 310 confirmed deaths, while New York State has, at last count, 92,381 confirmed cases and 2,373 confirmed deaths. Computing a case fatality rate (one of the many concepts we’ve all learned at COVID U. in recent weeks), we can see that Louisiana’s is ~3.4% while New York’s is ~2.6%. This spread could be explained by many factors – including underlying differences in the health of the populations and the environmental risk factors to which they’re subjected (eg, proximity to Cancer Alley) and differences in the states’ approaches to and capacity for testing – and, indeed, the spread is a relatively modest one. Both states, in fact, deserve credit for having ramped up their testing capacities significantly, and both are currently among the national leaders in COVID-19 testing rates (this graph is dated, but using numbers from the COVID Tracking Project and the two states‘ populations, I calculated that both states have currently conducted ~10,000 tests per million residents with New York having only a very slight edge); however, while immense resources and attention have been brought to bear in and on New York, I don’t believe the same can rightly be said of Louisiana. As a New Yorker, my attention is also disproportionately focused here (in particular, in my apartment, which I rarely leave), so I’d welcome reports and evidence to the contrary, but fear that, as situations deteriorate across the country, we’ll see a sharp divergence in outcomes between richer and poorer states, cities, and areas.

Already, the United States has more than twice as many confirmed cases as the next country (with, at the time of this writing, ~240,000 to Italy’s ~115,000), and yet Italy has recorded ~14,000 deaths, while the US has, so far, recorded less than 6,000. Perhaps the Italians are simply older, sicker, and more susceptible to this disease than we are here (or perhaps it’s their single-payer healthcare system, which Joe Biden so shamefully and dishonestly critiqued on multiple occasions, that made them so vulnerable to this horrible disease; he’ll have to eat those words soon enough if he lives through this), or perhaps we should be very, very afraid about what we’ve already locked in for our immediate futures.

New York City was laggard in sharing, publicly, data on the pandemic’s impacts here, but it has now, at last, created a COVID-19 data portal, and to complement this, a number of news outlets, big and small, are providing useful resources. Most striking, in my view, is the map that the City released showing confirmed COVID-19 cases by ZIP Code: It reads like a wealth map of the City, because, in a way, it is. The west side of Prospect Park looks very different than the east, and Far Rockaway stands out like a deep purple bruise at the tip of that otherwise pale barrier island. There are exceptions, of course, but the pattern is striking, and it is in the patterns that we can hope to discern the truth – multiple truths, in fact, about who is most at risk from this virus and what the future of the country holds. Social distancing is a privilege, as are self-isolating and working from home / taking time off.

It is the poor – the global majority – who are most threatened by COVID-19, and yet, it seems, increasingly, that it is the rich –business travelers and vacationers, from or transiting through Europe on transcontinental flights – who bear the deepest responsibility for the disease’s spread (if we can talk, without causing undue harm, of the responsibility of mostly unwitting disease vectors), just as it is primarily the rich who have sought to profit off this crisis – say, through the aforementioned bailout or the export, in the midst of pandemic, of critical medical supplies.

We have to look to the patterns to make sense of where things are headed, at the probabilities and statistics. In New York City, it’s not uncommon to hear sirens, and perhaps for that reason, it took a few days for me to register that it had been days – perhaps a week even – since I’d been out and not heard them. My walks are short, but the sound of sirens has become a constant. For a few days, it hardly felt like a break from the familiar pattern at all, but now each wailing ambulance registers as another sign of the new abnormal into which we’ve entered.

I’d hoped to talk a little about hospitals and hospital capacity here, but haven’t found the time; I’ll try to do that tomorrow. In the meanwhile, I was moved by what Jeremy Scahill’s podcast, Intercepted, is doing, and am copying verbatim below from their website:

“If you or someone you know needs emotional support or is contemplating suicide, resources include the Crisis Text Line, the Suicide Prevention Lifeline, the Trevor Project, or the International Association for Suicide Prevention.”