The Next Pandemic

Preface: Sorry, this turned out a little long. It may be the best thing you read all day, so I encourage you to go ahead and read the whole piece, but just in case, the tl;dr is roughly: It’s hard work to stop a pandemic. We have no alternative but to actually do the well-understood hard work. The piece is largely about rejecting laziness and apathy in the face of this generational challenge (just as we must in the face of the civilizational challenge of climate crisis), so it would be extra ironic if you lacked the fortitude to read on…

A friend invited me to join him for a socially-distant walk this morning, and I can’t tell you how good it felt to see the river again. More than a month ago, in view of the deepening crisis in the City, and the widespread negligence around social distancing, I left off my daily visits to the water, and since, a particular ache in my heart has been filling the void left by the sound of the estuarial lapping and the expanse of the harbor.

It was also very nice to have my friend’s company, and, on our walk, our conversation revolved, inevitably, around the pandemic. How we and ours have been doing, the headshaking political news, all the rest until, shortly before we parted ways, my friend posed the question – regarding the reopening conundrum, and having pointed out, with understatement only a climate scientist could muster under these circumstances, “It’s a tough problem” – “I mean, what would you do?”

As my recent posts make clear, already this question has been much on my mind (as it’s on the minds of almost all New Yorkers), and its answers appear at once impossible to imagine and yet overwhelming obvious to outline. As has increasingly been my practice of late, I’ll proceed here mostly by way of reference.

Yesterday, I wrote about my belief that New York – having learned tough lessons and now headed by politicians who are taking COVID-19 seriously – will come through the pandemic in better shape than many other cities and states around the US, but that our recovery here is menaced by dangerous policies elsewhere. Today, I’ll start by pointing – somewhat in the reverse direction – to reportage from The New York Times on new research which suggests that nearly two-thirds of all cases across the United States can be traced back to travel from New York City. As the Times piece lays out:

New York City’s […] outbreak grew so large by early March that the city became the primary source of new infections in the United States […] as thousands of infected people traveled from the city and seeded outbreaks around the country.

And:

Now that infections are dispersed around the country, travel from New York is no longer a main factor shaping the progression of the epidemic […].

But that:

As states around the nation begin to relax their restrictions, the findings demonstrate that it is difficult, if not impossible, to prevent those actions from affecting the rest of the nation.

Here’s me – mentioning in early and mid-April – the extent to which the flight of (rich) New Yorkers from the City must have inevitably spread the disease, and while the research mentioned above encompasses business and recreational travel as well, I think special attention should be paid to the at least tens of thousands of people who vectorized themselves at the peak of infection in NYC by heading off to family or vacation homes all across the country. (To be fair, I know a number of them, and can attest that some people were at pains to relocate in a fashion as conscientious as was possible.) As we’re now menaced in New York by insane, premature, homicidal reopenings elsewhere, I’m not suggesting there’s justice in our current predicament, but it does seem we now risk reaping what we sowed.

Moving along, the indefatigable Sean Petty – “a pediatric emergency room nurse at Jacobi Medical Center in the Bronx and the southern regional director for the New York State Nurses Association” – is quoted in this Indypendent piece as follows on the subject of New York’s reopening:

First and foremost is not opening any part of the non-essential economy until there is full-scale ability for the public health entities to widely test, contact-trace and comfortably isolate and treat individuals who contract COVID. That’s the public health prime directive in my view.

Almost impossible to imagine at scale right now, and yet overwhelmingly obvious. Here’s a snippet from a Washington Post article on “Iceland’s success” which it attributes:

partly […] to its tiny population — just 360,000 people. But it also reflects decisive action by authorities, who used a rigorous policy of testing and tracking to find and isolate infected people, even when they had no symptoms.

Pretty consistent – it seems to boil down to testing, contact tracing, case isolation, and quarantine for those with potential exposure. These methods have been well understood for at last a hundred years, in fact, and no amount of mostly puffy hype around the Apple-Google API (regarding which, see Ali Alkhatib‘s excellent critique which I referenced on Monday) can replace the need to do the fundamental, hard public health work on the ground in our communities. As Dr. Jim Kim opined in this interview (which I also linked to Monday), rolling out a COVID-19 suppression effort across the US would be at once among the largest public health efforts ever undertaken, and likely the only way to bring the disease under control in this country in the foreseeable future.

As my friend the climate scientist pointed out this morning – like with climate crisis, so too with the pandemic – it’s easy to give up on all other forms of action and just wait around for a technological solution – a “tech fix,” he called it, in pointing out that some people seemed resigned to just waiting for a vaccine. On yesterday’s Democracy Now!, Laurie Garrett – whom the Times surfaced yesterday as having “Predicted the Coronavirus,” and whom Democracy Now! featured on February 2nd in a two-part interview in which Garrett explicitly warned that the pandemic was likely to hit the United States and that, if it did, we were utterly unprepared (DN! scooping the Times by three months on anything that actually matters being a regular occurrence) – but yesterday, Garrett predicted that, in a best-case scenario, the virus would be with us, globally, for 36 months, and that the challenge of vaccinating the entire human population of Earth would dwarf any public health undertaking (including the eradication of smallpox and the near eradication of polio) in history.

Okay, so maybe just waiting for a vaccine isn’t such a good idea? But then, that means we actually just have to do the work? It’s an internal negotiation that we’ve all had with ourselves and that any current or former schoolkid understands intimately. Do I cut corners now, and pay the price later? Or do I do the hard work now, and reap the future benefits? (Incidentally, here’s me making more or less the same case on March 11th.)

Steve Randy Waldman has a great piece up (to which I came through David Dayen’s daily COVID-19 newsletter to which I came through Democracy Now!) that preempts, as follows, another problematic and flawed line of reasoning:

Segregation is affluent America’s go to coping mechanism. […] As families –– if we are affluent, especially if we are white — we understand that we are protected by more subtle boundaries. Maybe that’s a sad injustice, maybe it’s because we’ve earned it, choose your poison and your political party. But whatever it is, we are used to it. It’s not surprising, when we read that COVID-19 has hit poorer communities, black communities, immigrant communities disproportionately. It may not be right, but it’s the way of the world, and whatever our political or ethical attitude, affluent Americans tacitly rely upon it. Manhattan, denser but whiter and richer, has less than half the COVID infection rate as the Bronx.

But the segregation that so often protects affluent America this time cannot free it. Remember how herd immunity works? […] But if the population is segmented, segregated, stratified, that won’t be true at all [that herd immunity is evenly distributed throughout the entire population]. Herd immunity might be achieved in the Bronx, but over in Manhattan, most of the privileged will remain immunologically naive. If you want to ride out the epidemic without exposure, it’s not enough to be in the top 25% to 33% of the most diligent isolators in the United States, or even in New York City. You have to be one of the top 25% to 33% of diligent isolators in your own community, among the people you interact with. […] Months or years after the transit workers have taken their punch, your little world could still be ripe for an outbreak, if you all come out to play. So you won’t, not until there’s a vaccine or you are compelled by circumstance. Segregation will have helped to protect you, as it usually does. But this time, it will also imprison you.

Damn. So it’s looking increasingly like we may actually just have to do the hard work?

It gets worse though, because this isn’t just any country; as Childish Gambino has pointed out, “This Is America,” and in this country – which out of respect for the rest of the Western Hemisphere, I’ll call the United States – we have roughly 4% of the world’s population, and roughly 20% of its incarcerated people. As The Intercept lays out in two separate pieces on COVID-19 and mass incarceration in the US, first, carceral facilities are engines of disease transmission:

But mass incarceration is not only causing people to die of Covid-19 behind bars. As corrections facilities become hot spots, the virus is also rapidly spreading into the surrounding communities. A new model released in April by the American Civil Liberties Union [to which I linked last week] suggests that when jails are accounted for, estimates of the death toll are off by at least 100,000. And that’s for jails alone — not prisons or immigration detention facilities.

And second, that the rural United States is particularly menaced by this grim phenomenon:

For the past several decades, rural America’s economic lifeline has been the construction and operation of prisons and immigrant detention centers, both public and for-profit. […] But those lifelines have transformed into vectors for coronavirus, putting rural communities at risk of outbreaks. […] Those jobs that made the [carceral] campuses so attractive to local communities are staffed by people who go in and out each day — and what they bring with them could make all the difference in communities where hospitals were already shutting down, a trend exacerbated by Covid-19.

Very little of what was outlined two weeks ago in this bro-ishly named NEJM piece, “Ten Weeks to Crush the Curve,” has yet been accomplished in this country, but perhaps as “Red State” residents – so potential voters of relevance to the President – start to die in larger numbers, the President will slightly shift focus from the twin pillars of his non-response to date: Denial and cronyism. (Racism should also be on that list.)

Right now, after bungling everything he’s touched to date, the President’s incompetent son-in-law has been given a still larger mandate; the US Postal Service is under siege by privatizers; mega-corporations are using the chaos brought on by the pandemic to assail organized (healthcare) labor; Governor Cuomo seems intent on further undercutting NYC’s public transportation; Mayor de Blasio has cut all funding for composting from the NYC budget; states are striving to force workers back on the job every which way while taking few steps to protect those workers; and immigrants detained in private immigration jails are being pepper sprayed for asking for medical attention, all while no meaningful action happens at the federal level to stop the spread of COVID-19 in the US and states pursue willfully harmful policies that are almost guaranteed to prove self-defeating.

So what do we do now, from the pits of such despair? The hard work, of course. It’s obvious. We know how to do it, and, in fact, here in New York, we even helped lead the world in figuring out how it is done.

So what we do is the hard work. Now. There’s no other option. That’s how we overcome this pandemic, and it’s how we’ll avoid the next one.

Postscript: Oh! And if you’re looking for something more immediate to do than stopping the pandemic through massive, necessary collective and governmental action, please also consider supporting, as we have, two beloved West Village institutions: Casa Magazines and the diner, La Bonbonniere.