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The Coronavirus Catastrophe is Man-made, And So Will the Way it is Remembered

In the first two months of 2020, I watched with alarm as a cordon sanitaire descended on Wuhan. I lived there as an anthropologist completing my research on Chinese medicine in 2017. Friends from Wuhan — most of them doctors — were suddenly describing scenes out of a dystopian nightmare.

The same nightmare is currently playing out in New York City, a place I moved to nine months ago to work as a doctor and where I hope to make my home for some time to come. With growing concern, friends in Wuhan are now calling me to inquire about the condition of my health and of our hospitals.

As the coronavirus spreads across the world, invading into every nook and crevice of our lives, a sense of common destiny might be unprecedented in our lifetime. Soon enough, friends and colleagues in Chicago and Los Angeles, Sao Paulo and Tokyo may discover what Wuhan experienced in January and February and what New York is going through in March and April.

While the virus that circulates might be the same, the degrees to which people’s lives transform are defined more by their local social and political response than by our species biology. We may be living in a planetary historical moment, but its experience is far from uniform. I work as a doctor in a busy hospital in New York City where a television crew seems permanently parked outside the entrance. Images from inside hospitals like mine have dominated the airtime on U.S. television networks, already setting the tone for how the pandemic will be remembered.

The Wuhan-based author Fang Fang, whose “quarantine diary” was read by millions in China as a firsthand report from the frontlines, wrote movingly in her February 2 entry, “the dust of an era weighs a mountain when it falls on an individual.” Residents of Wuhan and New York might look back to the early months of the coronavirus outbreak and relate the myriad minutiae that have become mountains, be they the virus infiltrating the lungs of their loved ones or the social order that constricts their livelihood. It is their daily battles that make up the invisible frontline of this pandemic.

Extraordinary sacrifices have become ordinary. Fang Fang described expecting mothers anxiously looking for an admitting hospital, a child with cerebral palsy left behind to starve when his parents were taken into quarantine, a father who died of a stroke while looking for an accepting emergency room. Those were the weeks when it felt as if Wuhan was being sacrificed for the preservation of the rest of China.

In the interstices of our daily struggles, Fang Fang bids us to ask, how did a virus smaller than a speck of dust cause a global catastrophe? Dust conjures up those barely visible things that swirl past our awareness.

But from the beginning, there were those who noticed the threat posed by what might pass as insignificant specks of dust and tried to send out warnings. Li Wenliang, a young ophthalmologist at Wuhan Central Hospital and the prophet turned martyr of the pandemic, warned his colleagues and those who paid attention on December 31, 2019 of a new SARS-like illness. Warnings like his should have been heeded by the authorities that societies have empowered to monitor existential threats. This pandemic had been detectable for weeks before Chinese authorities finally admitted that there was widespread human-to-human transmission on January 20, 2020.

For “all those criminals” who prioritized their careers over public welfare, Fang Fang has this message: “the victims of the disaster are not only the dead and the dying, every ordinary person is paying a price for this manmade catastrophe.” On February 6, news of Li Wenliang’s death roiled through a nation. Fang Fang recalls that at noon on the day following Li’s death, a shout pierced through a city under lockdown, “the children and relatives of Li Wenliang will be Wuhan’s to support!” A chorus of assent followed.

Wuhan’s government bear a great deal of blame for the cover-up and initially sluggish response. Governments and authorities around the world in turn shoulder the responsibility of heeding Wuhan’s lessons. Those charged with safeguarding my home, New York City, responded with its own sequence of mistakes tantamount to criminal negligence.

The quarantine of Wuhan came at the end of January, almost two months after the first recorded case of the coronavirus on December 1, 2019. Yet, it was not until late March in New York, almost two months after the quarantine of Wuhan, that leaders inside governments and hospitals seemed fully cognizant of the reality that the coronavirus was far more deadly than the seasonal influenza. In the interim, crucial opportunities to avoid the present disaster was lost. Now, in the words of Fang Fang, “every ordinary person is paying a price for this manmade catastrophe.”

How was it that 430,000 travelers who landed in the United States from China from January to early-April were only haphazardly monitored for symptoms after their arrival? How was it that after seeing the policies of China, Hong Kong, Singapore, Taiwan and South Korea with regards to mask-wearing in public, U.S. guidelines did not recommend wearing masks until early April? Why did it take until March 16 for the U.S. government to limit social gatherings to groups of ten or less? How did hospitals run dangerously low or even out of personal protective equipment within days after? How did a third of doctors and nurses at one hospital in Brooklyn end up calling out sick two weeks later? Why are symptomatic patients, including health care workers who could infect other patients, still not able to get tested promptly? Why was it that before protecting existing healthcare workers, politicians looked to medical students still paying tuition and retired physicians who have been out of practice to volunteer?

As the Governor of New York, Andrew Cuomo, begged for more ventilators, I was incredulous. Does he really think that thousands of ventilators will mitigate this crisis? Does he not realize that those who need to go on a ventilator has about a 50 percent chance of making it out alive? Haven’t we missed a few crucial steps before asking for ventilators?

We scoff at Trump for downplaying the risks of the infection, but he was not alone in fumbling with the cruel calculus of lives lost versus money made. We can easily find video footages of Bill de Blasio, the Democrat mayor of New York, calling the increase in COVID-19 cases in early March to be not much more worrisome than the flu. Cuomo delayed closing down the city two days after de Blasio announced the plan on March 18, 2020. As the nation rushes past the point of containment before collective awareness even caught on to the unfolding disaster, we have lost all opportunity to imagine any other ceiling to the pandemic than the number of ventilators available.

Suddenly, it seems like rationing ventilators is the nail on the coffin that we have to avoid at all cost. For politicians who speak for the public, the message is, “Let’s not deprive the dying of their one last chance at life!” The subtext: it’s the last thing they can expect from us. Having enough ventilators eases the conscience of doctors who have to make the decision of who gets a ventilator and who doesn’t, a scenario that to my knowledge has yet to happen in New York City. But there is nothing more iconic of courageous futility than intubating someone on death’s doorstep.

More so than flashy machinery, policies that ensure the sustainability of social distancing could have more effectively averted a disaster. Collective social life, and not hospitals, form the true battlefront of this pandemic.

In New York, the sanitation workers, delivery persons, warehouse stockers, store clerks and first responders continue to expose themselves to COVID-19 while keeping the city on life support. Their line of work is suddenly hailed as “essential,” yet they do not see their compensation or protection go up in proportion to the value of their work. As they thread through the streets of New York, they make the city livable for those who have the choice to stay home.

While overall subway ridership in New York City fell by 87 percent by the end of March, stations in low-income neighborhoods have seen largely unabated crowds. The close correlation between low income and high COVID-19 case burden across different zip codes in New York City comes as no surprise to those who staff the public hospitals in the hardest-hit neighborhoods. Chronic neglect have made hospitals such as Elmhurst Hospital Center in Queens strained to handle the disproportionately large surge of critically ill patients while hospitals in Manhattan have a surplus of beds.

Is it any wonder that the predominantly black and brown working class who lack health insurance, cannot afford to stop working, live in close quarters, and have fewer hospital beds per person in their neighborhood are twice as likely to die from the coronavirus?

The dust of this era have weighed on them like a mountain for a long time.

There is much speculation on the veracity of the data released by Chinese health authorities, but these doubts should not erase lessons that can be learned from the experience of Wuhan. By late February in Wuhan, as the number of new cases continued to rise and only the grocery stores remained open as a place of social gathering, the decision was made to shut down all operations except bulk delivery. Individual orders were no longer accepted. Neighborhood committees — the lowest rung of the communist party organization — had the responsibility of ordering and distributing food supplies for all residents in their jurisdiction. As recounted in Fang Fang’s diary, residents volunteered in distributing food to the elderly and vulnerable among them. If centralized authority organized the containment effort in Wuhan, it was not possible without plenty of mutual aid.

Sensible social policies, not ventilators, are what will save us. The sum of small regularities like traveling to and from our homes, sharing space with others where we live, learn and work, and procuring essential supplies make up the conduits of the coronavirus. Telling people that they have to drastically change how they go about these ordinary activities without giving them the means to do so will only allow the virus to propagate. New York has paid a dear price for making this mistake. It is the task of the living to remember.

Image credit: Pandemic by Dan Gaken is licensed under CC BY 2.0.

Miao J. Hua, MD, PhD Miao J. Hua, MD, PhD (2 Posts)

Resident Physician Contributing Writer

Mount Sinai Hospital

Miao Jenny Hua is a first year internal medicine resident at the Mount Sinai Hospital in Manhattan. She also has a PhD in anthropology from the University of Chicago. Her dissertation on the integrated Chinese and Western health care system in China took her to spend over a year in Wuhan, China from 2016-2017. Since the lockdown of Wuhan on January 23, 2020, she has been in regular communication with her physician friends at the epicenter of the COVID-19 pandemic.