Commentary: If we want schools and the economy to restart, we’ve got to accept some facts and deal with them
In reporting on the coronavirus since January, I’ve interviewed dozens of infectious-disease researchers, epidemiologists and other scientists and health experts, and this much is crystal clear: The terrible situation we’re in now was widely, loudly and frequently predicted since very early on. Many U.S. political leaders didn’t listen then. If they don’t listen now, it will just get worse. At least, that’s what the experts say. Here’s a review of lessons not learned, the foibles that got us here, and the sad fact about who must take responsibility to change the course of the growing pandemic.
1: We knew in early February that this already was or would soon be a global pandemic. And we knew then that the handful of U.S. cases were just a prelude…
“It’s very, very transmissible, and it almost certainly is going to be a pandemic.”
—Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, February 2, 2020
“We are preparing as if this were the next pandemic.”
— Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC), said February 3, 2020
“It appears we are currently in the early stages of a mild pandemic.”
— Dr. Amesh Adalja, an infectious disease expert at the Center for Health Security at Johns Hopkins University, February 5, 2020
But from the beginning, the experts were ignored and the reality distorted…
“It’s an unforeseen problem.”
— President Donald Trump, March 6, 2020
“It’s something that nobody expected.”
— President Donald Trump, March 14, 2020
“Nobody could have predicted something like this.”
— President Donald Trump, March 30, 2020
2: We knew in early April, when New York City was in the midst of its crisis, that the disease would spread across the country. “Every state will experience their own curve and their own peak,” Mark Cameron, PhD, an immunologist and medical researcher in the School of Medicine at Case Western Reserve University in Ohio, said on April 4, joining a chorus of experts predicting same.
3: Three months later, after economically and socially brutal shutdowns, every measure of the Covid-19 pandemic is now going in the wrong direction nationwide: New cases are soaring, hospitalizations are rising, and deaths, which lag behind both of those metrics, are starting a long-predicted uptick.
4: Like few other threats to the health of American people and the economy, the response to the Covid-19 pandemic nationally and in several states is marked not by missteps but by outright refusal to listen to health experts and accept established science. From Feb. 10 through July 1, President Trump has predicted at least 19 times that the coronavirus would just go away, including claiming that “like a miracle, it will disappear.” The White House has silenced the CDC repeatedly and announced the U.S. will withdraw from the World Health Organization. Mind you, these are the two top health organizations in the world when it comes to pandemic response. This is, plain and simple, antiscience.
5: The lack of a national plan, of leadership from the top, and the White House’s outright dismissal of advice from health experts, are the main reasons that the United States leads the world in Covid-19 deaths, with 24% of the global total despite having just 4.2% of the world’s population. You don’t become №1 in deaths by doing more testing.
6: We can’t get the U.S. economy going or safely restart schools without healthy people — workers, teachers, parents and kids. We won’t have healthy people if we don’t stamp out the pandemic. “States that opened without controlling Covid had to close,” Dr. Tom Frieden, former head of the CDC, tweeted today. “It’s 100% predictable: schools that open with either extensive spread or without careful planning will have to close. It’s SO important that our kids get back to school. That’s why it’s so important we do so thoughtfully.” (Here’s what educators and scientists say is needed, and here’s why federal funding for school reopenings would make sense.)
7:Without serious effort, the pandemic could get much worse this fall. And it will be around for years to come, barring a vaccine, which so far is still at least months away and may never happen (successful vaccines are really hard to do). And no, natural herd immunity is not the answer, unless you just get a kick out of a million or more Americans dying.
8:The virus spreads incredibly easily, mostly through the air when people are within 6 feet of each other for some length of time, and especially indoors, and double especially if they’re not wearing masks. If that sounds like a rally, it is. We know this. We’ve known this for months. Any confusion over the value of masks has been cleared up for weeks.
9:The virus does not respect borders. It goes where people go. One state’s vigilance can be nullified by another state’s ambivalence, by one traveler, one ember.
10: The lockdowns were totally squandered, by opening back up too quickly and too widely and not requiring masks in public, and failing to limit large indoor gatherings.
11: The reopening of bars and indoor dining and large indoor gatherings should have been on a delay, allowed only after evidence showed that other reopenings were not causing outbreaks.
12: The party atmosphere that was fostered with total lifts of lockdowns helped wipe out all the gains, the flattening of the curve, and in fact caused a surge in infections among younger adults, which is partly behind the soaring number of cases now.
13: The more the virus spreads, the harder it will be to bring under control. Contact tracing, which can work early on in smaller outbreaks to get isolate people who might have been exposed, is near impossible to conduct when you have 60,000 new cases daily. Every new case, meanwhile, represents greater odds of additional infections.
14:There is no question that a serious, national strategy should have been, and still should be, put in place to fight this pandemic, just as nearly every other nation on the planet has done. There is no indication that will happen. But we should not throw up our hands.
15: Nothing should be more important for the White House and the nation’s governors right this moment than getting this pandemic under control. “This should be our number one national priority right now,” Caitlin Rivers, PhD, an epidemiologist at the Johns Hopkins Center for Health Security and assistant professor at the Johns Hopkins Bloomberg School of Public Health, said June 26. “We are headed in the wrong direction at top speed.”
16: The science and on-the-record evidence on all the above is solid. We are where the scientists predicted we would be, where all of them hoped we would not be. Anyone who says “Who knew this would happen?” was simply ignoring the evidence that was everywhere, in the media and in verbal and written briefings to top officials (and even a White House pandemic playbook created by the previous administration).
17: Yes, science is not perfect, and we can quibble about some details, the fumbles of communication, the uncertainties and evolving understanding of a novel virus, the late-coming advice on masks. But epidemiologists and other health experts have been remarkably prescient about the risk and the need for a national plan, and if we don’t listen to their advice now, they’ll tell you to expect 1 million or more American deaths before this is over.
18: People who don’t wear masks when around other people in public are either ignorant of the facts or self-centered and uncaring of their fellow humans. Some say shaming doesn’t work, but that’s not shaming, it’s just facts. We cover our genitals in public. We don’t smoke in restaurants anymore. We make our kids wear seatbelts. We stay at home when we have the flu. We get vaccines. We do things for the good of public health. Mask refusal is not about liberty. It’s about death.
19: Even without state or national leadership, there are three selfless and highly effective things we can all do toward the goal of making the nation, and the economy, healthier, and hopefully getting kids back to schools so parents can go back to work: Avoid large indoor crowds, keep distance, wear masks. The pandemic response should not have to be planned by the people, but it seems to have been left to us.
It takes a special kind of inattention to human suffering to not notice how unfortunate it is that people have been left to face death alone
By Zeynep Tufekci
Of all the wrongdoings of this pandemic, the one that haunts me most is how people are left to die alone. Health-care workers have been heroic throughout all this, but they do not replace the loved ones whom the dying need to be with, and speak with, even if only one last time.
A hallmark of COVID-19 has been the speed with which some patients have crashed, going from feeling only a little sick to being unable to breathe, sometimes in the space of a few hours. Such a crash often necessitates intubation, a process that then renders one incapable of speaking. Many people on ventilators are also heavily sedated and unconscious, to keep them from pulling out the invasive tubes going down their throat. Thus, sometimes with little warning, all communication is lost, and more often than not, a patient is without family or loved ones when this happens.
Early in the pandemic, patients were left alone precisely because the crisis was so dire. Many hospitals outright banned visitors — often even to non-COVID-19 patients. They did not have enough protective gear for the health-care workers, let alone anyone else. Many COVID-19 patients were transported solo in ambulances, and family and friends were unable to join them at the hospital once they had arrived. Others were dropped off by loved ones who were then turned away. Patients sat in their rooms, waiting. If they experienced dyspnea, the acute shortness of breath known as “air hunger,” they crashed alone and terrified.
Sometimes, a nurse or doctor managed to connect the patient with their loved ones before the tube went in. But dyspnea is a medical emergency, after all, so in many cases there was simply no time for that last call, or anyone available to arrange it. As the disease progressed, families were left clustering around a phone as a hospital worker held up the device for a final goodbye on FaceTime. Often, the family could talk to their loved one, but not vice versa. That’s not enough. What the dying have to say must be heard.
The paramount importance of dying words has long been recognized across cultures. “When a bird is about to die, his song is sad,” Master Tseng, a Confucian leader, says in the more than two-millennia-old Analects of Confucius. “When a man is about to die, his words are true.” In Plato’s Phaedo, Socrates notes how swans sing most beautifully just as they are about to die. That concept of the swan song — one’s last, most beautiful expression — also comes up in Aesop’s fables and in Aeschylus’s Agamemnon, and was already a proverb by the third century b.c. In Shakespeare’s Richard II, a dying John of Gaunt, hoping the king will come to hear his last words, says:
O, but they say the tongues of dying men
Enforce attention like deep harmony.
Where words are scarce they are seldom spent in vain,
For they breathe truth that breathe their words in pain
Last words, or “dying declarations” as they are sometimes called, have long been recognized in jurisprudence as out of the ordinary, with known cases going back as early as 1202. That’s why statements uttered by people aware of their impending death can potentially be accepted in court without being subject to “hearsay” restrictions, which ordinarily exclude from evidence assertions made by those not in court to testify in person. In the Middle Ages, it was presumed that people alert to their immediate death would not dare lie, knowing they were about to meet their maker. Death was also seen as removing motives to lie: In a 1789 court case in England, which forms the basis of the modern hearsay exception, the court admitted a woman’s dying words — that her husband was her murderer — as evidence, noting that “when every hope of this world is gone: when every motive to falsehood is silenced,” then “the mind is induced by the most powerful considerations to speak the truth.”
The clarity that can come from those facing death is also integral to many modern traditions and philosophies, including the existentialist and psychotherapy schools of thought, which emphasize that death, meaning, loneliness, and freedom are core axes of our lives, and that making all these existential considerations explicit can be key to a good life. The Holocaust survivor Viktor Frankl talks about how these “primordial facts” of existence, including our mortality, help us realize and appreciate what truly brings meaning to our lives. The existential psychotherapist Irvin Yalom, who specializes in treating people with terminal illnesses, says that terminal cancer, as terrible as it is, gives patients clarity that they did not always have before: “What a pity I had to wait till now, till my body was riddled with cancer, to learn how to live,” a patient lamented to him. Yalom advocates listening to the dying and their wisdom even before we ourselves face our final stretch.
It’s also not just that the dying deserve to be heard or that their wisdom is valuable, but that the living need to have the chance to hear them — to let go on their own, mutual terms. That was something I learned the hard way, when my mother died unexpectedly in her 50s. There is no good way to lose a mother, but my loss was compounded by how complicated our relationship had been as she spiraled into alcoholism later in life. Her drunk version was mean, terrifying, and vicious, although when she was sober, she remained the loving, funny, if quirky, parent I knew as a child. When I moved to the United States, most of our conversations took place over the phone, and I became a human Breathalyzer via voice — a sad talent, I suspect, that I share with other children of alcoholics. Before she even finished saying “Hello,” I knew exactly how drunk she was, and if it was Jekyll-time, I just hung up without fanfare. It never went well if I didn’t.
Then my phone rang early one morning. I jumped out of bed to learn that she had died, without apparent reason — just dropped dead. My mind raced with only one thought: What was our last conversation? Had I hung up on her?
Losing an alcoholic parent can be marked by the same grief anyone feels after losing a parent, especially under tragic circumstances. But it’s also full of regret and guilt in its own ways. The regret is obvious: There is no longer a chance for a final, redemptive chapter. The guilt is layered: Was there anything else one could have done? One more intervention, despite the futility of all the others? And what to do with the feeling of relief from avoiding other, even more feared futures that tangles up with the loss?
In this knot of confusing feelings, though, it was that last conversation that my mind kept circling around for the next many months. The last time my mother called me, she was not only sober; she was in a reflective mood — something that did not happen a lot. She apologized, sort of, for all her drinking and said she was very proud of me. We had a pleasant, lengthy conversation, a rarity that year. She wanted to talk about the latest books she was thinking of translating. She rambled about all the good times, and came back to how happy she was that I was her daughter. It was as close to closure as one could hope for. Intellectually, I knew that it didn’t matter much and that even if I had hung up on her the last time — as I had so many times before — I could have tried to focus on some other good conversation or experience we had shared. I knew it was a stroke of luck that this just happened to be our final conversation. It’s not logical, but that’s how grief works; in the thick of it, the last conversation feels like the truest word.
It’s been six months since the world began battling COVID-19. Coronavirus cases are now surging across the Sun Belt, and hospitals are filling up again. Immediately, some reacted by restricting visitors. Many places had never lifted their restrictions in the first place. Those facing the worst moment of their life still aren’t being treated as a priority.
That dying alone has been normalized, as if it were a small matter, is frightening and inhuman. The panic of the early days of the crisis could be seen as a temporary, terrible compromise. Since then, though, airlines have been bailed out to the tune of many billions of dollars, while there has been no rush to build more negative-pressure rooms, designed to circulate air out, at hospitals, which would allow for much safer visits. We still haven’t developed the infection-control protocols for visitors and built up supplies of personal protective equipment in ways that would avoid the need to completely isolate patients in the days and months ahead.
Even without all the wisdom of the ages, it takes a special kind of inattention to human suffering to not notice how unfortunate this is, that people have been left to face death alone. Some have come to fear dying alone more than the coronavirus itself.
In the years after my mother’s death, I managed to move my focus away from the last conversation and take stock of the good and the bad. I regained perspective, and now I would be at peace with whatever had transpired the last time we spoke, even if I had indeed hung up on her. After a bit of time, I am able to broaden out and consider everything, not just that one last conversation. But that certainly wasn’t always the case. The adage is true: Time has its own healing powers. But that’s not what the people who have lost loved ones to this pandemic should be left with, that time will help with the injustice of having been separated from them at the very end. If society seems to have lost perspective about both compassion and death, all that may be left for us is to reclaim what perspective we can, as best we can.