What Sept. 11 Taught Us About Confronting Catastrophe

https://www.nytimes.com/2020/03/29/nyregion/coronavirus-nyc-sept-11.html

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From careful planning and much drilling, medical workers knew without being told that they should roll a fleet of gurneys and wheelchairs onto the sidewalk outside St. Vincent’s Hospital in Greenwich Village on the morning of Sept. 11, 2001, New York’s last mortal catastrophe.

But there they remained, empty.

Nothing spoke louder than those mute, unused stretchers. People got out of the World Trade Center mostly intact or not at all. For days, thousands of fliers were taped around hospitals with pictures of those who had not made it home, or even as far as any gurneys.

Two decades later, the coronavirus pandemic has turned that moment inside out: We have more sick people than beds to put them in. Hospital morgues are oversubscribed.

Suzanne Pugh, the manager of emergency services at St. Vincent’s on 9/11, now does the same job at NewYork-Presbyterian Queens in Flushing, one of many hospitals where people sick with coronavirus seek help.

“Some of my staff were very young 19 years ago,” Ms. Pugh, 60, said. “I speak on disaster preparedness, and sometimes I have to shake my head — ‘Oh, yeah, you were 5 years old when this happened.’”

New York is living the coronavirus disaster a few days ahead of most states on the epidemiological curve, so it offers a cram course on getting ready. It is as if the towers were falling in slow motion. As of Sunday, just under 60,000 people in the state had tested positive, and 1,000 have died.

The United States government can print infinite money; no one can fabricate experience. Knowing what has been done right and wrong in New York might save lives as the crisis spreads from the coasts to the center of the country.

About 360 patients a day have been coming to the emergency room at Ms. Pugh’s hospital. Of those, she said, roughly 75 are admitted. The rest are sent home.

“The overwhelming number are relatively well, with none to minimal symptoms,” Ms. Pugh said. “But they are worried.”

The hospital initially triages patients just past the front door, and then in more depth under a tent. At a command center, administrators handle logistics like bed control, food for staff, parking spots. “The people on the front lines don’t have to figure this out,” Ms. Pugh said.

The new coronavirus, like any virus, is a snippet of chemical memory that will repeat itself quadrillions of times, telling the same story until it is muted by other forces. It is simple. Far more complex are social calamities that survive as memories only for as long as there are people around to tell about them.

“I lived through the beginnings and peaks of the AIDS epidemic,” said Ms. Pugh, who graduated from nursing school in 1979. “And the 1993 bombing at the World Trade Center.”

Six people died in that attack, three miles from St. Vincent’s. The ambitions of the bombers were to kill thousands. A generation of emergency medical leaders in New York rewrote mass disaster plans.

Updated June 5, 2020

So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.

The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.

“By the time I got to St. Vincent’s in 1995, they were having incredibly realistic drills, where people were called upon to act out the scenarios, so on 9/11 you didn’t see people running around saying, ‘Where do I go, what do I do?’” Ms. Pugh said.

She added: “Every secretary had registered a mock patient at some point; every doorman, every transporter, every engineer, had been a deputy security person during a drill. Everyone knew where they were supposed to go and what they were supposed to do. Every single bed had a nurse and a doctor, we had treatment spaces set up, satellite areas already set up.”

A few severely injured patients arrived in the early going. Then the walking wounded came by the hundreds, many spitting out fragments of the pulverized buildings, their eyes needing a wash. But the expected masses of badly hurt people did not turn up. The gurneys went unused.

No one ever faulted St. Vincent’s, which closed in 2010, or other hospitals for being too ready.

As Gov. Andrew M. Cuomo and his team search for thousands of ventilators based on projections by infectious disease experts of the number of people who may become grievously ill, President Trump has scoffed. “I don’t believe you need 40,000 or 30,000 ventilators,” Mr. Trump said.

That would be a pandemic milder than forecasts, a cause for jubilation. “You don’t need 140,000 beds today, of course not,” Mr. Cuomo said Sunday. “We need them at the apex.”

No two mass emergencies demand identical responses, but they seem to be met by familiar drives and passions. Just before Ms. Pugh started a 12-hour shift this weekend in Queens, she spoke about that long day at St. Vincent’s in 2001.

“I would’ve given anything,” she said, “to see 3,000 more patients.”

And if the empty stretchers of Sept. 11 have a message for these times, it surely is not that it was wrong to have more than what was needed to keep people alive. They tell us how precious every chance is.