the tris mccall report

There was good reason to have faith in ventilators. They help doctors treat pneumonia, and pneumonia is one of the worst conditions associated with this virus. The ventilator count was a main concerns in March: would we have enough to accommodate all of the people who were bound to develop critical symptoms? Did we have a stockpile that might save lives?

We now know that most of the people put on ventilators because of the coronavirus won’t come off alive. This was dispiriting news to me — I’d hoped, as I’m sure that many did, that the ventilator would prove to be a reliable line of last resort. Enough patients do recover that the ventilator isn’t going anywhere; they’re going to be part of the medical arsenal as long as the virus is with us. But it’s clear that the standard medical protocol is shifting along with the facts, and it’s going to need to shift more before we reach any kind of stability or predictability.

When we go to the doctor, we want a treatment that aligns with our specific physiology and our particular complaint. We’re looking for something bespoke. What I’ve learned the hard way is that medicine doesn’t work like that. Public medicine will not treat me as a unique animal with a singular set of problems. Instead, the doctor thinks about thresholds, benchmarks, and percentages. If seventy five per cent of male humans in my age group respond well to a particular pill, I’m going to get that pill. If the doctor is good, she’ll examine me for signs that might suggest I belong to the other twenty-five per cent. But chances are, the doctors won’t know why the pill doesn’t work for everybody, and given their caseload, they’re not going to take the time to make a pharmaceutical experiment out of me. They’re going to hope that I’m somewhere in the majority and send me home with a prescription.

The call for ventilators is, in part, based on an established benchmark. When blood oxygen drops below a certain level, patients require medical intervention. When that initial intervention doesn’t work, doctors turn to the ventilator. One of the devilish things about the coronavirus is its tendency to depress oxygen to levels that doctors and nurses rarely see — levels that, according to protocol, suggest that intubation is necessary. Yet many of those those patients are still ambulatory, and this may be because their lungs are still capable of processing carbon dioxide. Intubation, I’ve learned, is a serious thing — a patient on a ventilator is essentially knocked out, sometimes for weeks, so that the machine can do his breathing for him. Even in optimal conditions, disconnecting from the device isn’t easy. If some coronavirus patients could be treated with CPAPs or BiPAPs instead, it might not just save time. It could save lives, too.

Because this pathogen is new, doctors have been forced to revise their protocols on the fly. This isn’t something that doctors are good at. For understandable reasons, they like to stick to things that have worked in the past. Learning from precedent and applying those lessons to new cases: that’s how the doctor moves, deliberately and carefully, with a suspicious eye on departures from orthodoxy. Even during desperate hours, they’re unlikely to chuck random medications at patients on a “what have you got to lose” basis — that’s just not how they think. The reason that chloroquine is even part of the conversation is because it was used to treat SARS, which was also caused by a coronavirus. Remdesivir, which is actually an antiviral medication (it was tried, unsuccessfully, against Ebola and Marburg), may appeal to skeptical doctors a little more than plaquenil does. Expect to hear that name a lot in coming days, and avoid the ventilators if you can. I promise to try to stay off of them if you do.

Municipal parks have been closed for a long time. Yesterday the Governor announced that state greenspace is out of bounds, too. This is meant to limit congregations of people who might be passing around the pathogen, but it also prohibits us from taking refuge in wide open spaces. Liberty State Park doesn’t tend to be very crowded. For as long as I can remember, it’s been an optimal spot for social distancing. Now it’s off limits.

We still need to get exercise. Last year at this time, we took long walks and tried our luck on the machines at local gyms. We did this no matter how Hilary was feeling: we knew we had to push through the anxiety and the exhaustion to give her body an opportunity to heal itself. But all the gyms have been closed, and the roads aren’t too welcoming. Out on the street, our primary concern is for our neighbors: we want to give them as much space as possible, and that means stopping in our tracks or ducking into a driveway. I suggested a drive to South Mountain and a walk through the woods. We may still do that. Or we might take a bicycle ride — one without a destination.

Discouragement of physical activity comes with its own risks. It isn’t good for people to be sedentary. I’ve tried to do my push-ups and squats right here in our bedroom — there’s even a little wall chart for us to keep track of our progress — but there’s really no substitute for the kind of healthy activities that parks permit. I’ve always argued, hard, against helmet rules for the simple reason that the helmet is a constant reminder of the cyclist’s vulnerability, and thus it makes her disinclined to get on a bicycle. I believe that the safety measure has a suppressive effect on the thing it’s supposed to protect. We’re seeing the same thing happen with antiviral face masks. The mask is message from the wearer to herself that she’s existing in a hostile environment, and her best option for self-preservation is to stay at home where she won’t have to wear one. Every time she passes a masked neighbor, that message is reinforced. Eventually, there’s nobody left on the street.

In early April of the plague year, that may be exactly what we need to do. Allow me, though, to worry about the physical and psychological effects of how we’re living — and whether they’ll be easily reversed when the warnings are lifted (when?). Everybody who lived through 9/11 and its aftermath knows that restrictions, once put in place, don’t budge easily. We get accustomed to altered states with alarming speed. I’m sure you’ve seen efforts to turn the mask into a fashion accessory — masks with messages, or masks made by famous stylists, or masks stitched from cleverly re-purposed materials. It’s all well-meaning, and I appreciate the way in which the homemade mask industry signals that those involved in it are taking the coronavirus seriously and doing what little they can. But it’s still a wide open question whether homemade masks are even capable of blocking this pathogen.

Regardless, by the Governor’s decree, masks are now mandatory in grocery stores. Paranoid though I am, I recognize that this is not an authoritarian plot. I know we don’t have the luxury to play around. By and large, my neighbors realize this, and they’re masking themselves voluntarily. But we’ve learned over the years that authoritarianism never comes from the authorities alone. It is the product of a complex interaction between citizens who prioritize safety and the police, who have to make a judgement about the popular acceptance of every restriction they put in place. Turn the screws too tight, and, inevitably, laws backfire, no matter what the penalties for breaking them are. We don’t know all the ways in which this public health crisis is disturbing the equilibrium between authorities and ordinary citizens, but it’s pretty clear that it’s creating conditions that authoritarians can exploit, and softening our defenses against them.

For now, I recognize that Trenton has a brutal job to do, and limited latitude for doing it. The Governor needs to make life as easy for medical personnel as he can. In response to a stir-crazy public that demands answers, we’re getting projections about peaks: peaks in cases, peaks in deaths, plateaus, surges, waves, various metaphors for inundation and terrifying altitudes. It’s all guesswork. Testing has been sporadic, and official counts are blunt instruments. There’s no way anybody can predict the exact course of the crisis, or the challenges that the next weeks will bring. Clearing the streets and parks is the strategy for today; tomorrow, people may lose their patience and demand a more liberal interpretation of public health and essential services. One of the new restrictions, I notice, bans construction work on residential buildings. Jersey City without residential construction: that’s like Philly without cheese steaks, or Tatooine without moisture farms. All over the neighborhood, I can hear the racket of desperate contractors and their teams. They’re getting in their last hammer blows, their last saw-scrapes, their last blasts of steam from private generators before the padlock clicks shut.

After her admission to the hospital, my cousin was treated with plaquenil. That’s the trade name for hydroxychloroquine, the milder version of the chloroquine medication that the White House seems determined to make famous. I’m pretty sure she wasn’t asked if she wanted it; she was just given it, in the same way that she was given oxygen and water. If you, God forbid, should find yourself in the hospital tomorrow, you, too, might become acquainted with plaquenil.

Morristown Hospital is not staffed by witch doctors. If they gave my cousin plaquenil, that’s a pretty good indication that belief in its potential usefulness has penetrated the medical mainstream. It is not by nature an antiviral medication — as you probably know, it’s used to treat malaria, lupus, and rheumatoid arthritis. But as I’ve learned over the past two years, drugs often have powerful secondary effects. If one of those incidental effects slows the progression of the respiratory symptoms that accompany the coronavirus, that’d be a wonderful thing.

Yet at the risk of ruining a perfectly good placebo, I admit I’m not sold. This not entirely because of the somewhat unconvincing arguments made by the thoroughly unconvincing people pushing the drug. It’s also because I’ve become painfully familiar with the way that medical trials work, and the evidence that’s required by scientists before a treatment is accepted as justifiable, let alone helpful. Sometimes epidemiologists really do locate a magic bullet — the mold on the bread that becomes the penicillin that stops the bacterium in its tracks. More often, especially with antiviral medications, results are inconclusive, and hyperbole only serves to confuse and disorient the public. Especially in a crisis, the burden of proof always rests on the shoulders of those raising expectations.

The biggest problem with the chloroquine hypothesis isn’t the lack of clinical trials. It’s that an inadvertent test has already occurred. If plaquenil had an ameliorative effect, we’d expect it to protect lupus and arthritis sufferers — those already on chloroquine, in other words — from the effects of the coronavirus. That hasn’t happened. Those on plaquenil are still getting sick. It’s possible that a course of hydroxychloroquine taken upon admittance to the hospital might help a patient who’d never taken the medicine before, but now we’re twisting ourselves into logical pretzels to help the drug that ought to be helping us.

It also isn’t too comforting that nobody can explain what it is about plaquenil that might make it effective against the coronavirus. Some supporters have hazarded guesses that hydroxychloroquine’s suppressive effect on the immune system might calm the cytokine storms — the overactive immune responses, in other words — that do immense damage to human respiratory systems. But hospitalized people are privy to infections. A drug that alters the immune systems of the seriously ill is a tough pill to swallow.

The Kiryas Joel doctor most closely associated with chloroquine likens his protocol, which also includes zinc and an antibiotic, to battlefield medicine: in a warzone, doctors don’t have time to conduct trials, and must rely on their intuitions instead. I understand that, and I can sympathize with his urgency. But I notice that that same doctor was, not so long ago, a crisis minimizer — one of the many pushing those black-letter memes on social media meant to deflect blame for America’s slow response from the current administration. Meaningfully, at least for me, Dr. Fauci has been skeptical about chloroquine, and has thrown cold water on some of the President’s overheated rhetoric. In general, the minimizers have been wrong, and Fauci has been right.

Fauci’s skepticism has gotten him in hot water with the venomous fringe of the administration’s loyalists. Some of them have decided that he’s part of a nebulous plot against chloroquine, and he’s dedicated himself to obstructing the rollout of a medication that he knows is effective. There are those who believe that the coronavirus was cooked up in a lab by 1.) Chinese bio-warriors hellbent on the destruction of America, or 2.) Bill Gates, who is poised to roll out a proprietary vaccine that will be made mandatory by evil governments. If hydroxychloroquine plus zinc plus zithromax is a winning combination, that means Gates is out of luck; therefore he and Fauci and other deep-state operatives are trying to expunge the remedy from popular consciousness.

The people — and there are many of them — who hold these opinions tend to be absolutely certain, so I’m not inclined to try to bring them around. Instead, I’ll just point out that nothing about the coronavirus seems lab-made. It isn’t a combination of known viruses spliced together and artificially forced to mutate. It’s novel, and that’s exactly what makes it so scary. If it’s a bioweapon, it’s a poor one; one that acts randomly, and can’t easily be contained or aimed at enemies, one capable of sending world leaders to the ICU. Its unpredictability belies claims of its human authorship.

I am old enough to remember the early years of the AIDS crisis, and the constant claims of miracle breakthroughs that were about to send HIV into a tailspin. Megadoses of Vitamin C, we were told in the late ’80s, might turn the trick; soon, we could all return to our promiscuous ways. There were reports of drugs in development, pharmaceutical wizardry in the pipeline, palliatives and knockout punches to be delivered. Yet HIV is still with us. Viruses, it turns out, aren’t easy to eliminate. I hope, desperately, that the doctor in Kiryas Joel is right, and his fans in the administration and mass media are justified in their near-superstitious belief in chloroquine, and we can start clearing the pneumonia from the lungs of the sick, and restart American society. A more likely outcome: a class-action suit, right in the laps of the executives at Fox News.

This week, Jersey City reinstated parking regulations. They aim to sweep. More than two weeks of trash — cups, cans, rubber gloves, urban confetti — has collected at curbside. A few days ago, a deliveryman spilled a gallon of milk on the street. Luckily for us, it rained the next day.

The municipal government announced their intentions by tweet. Not everybody on my block got the message. By the time the sweeper came through in the afternoon, only half of the cars had moved. Ticketing would have been a cruel thing to do. I’m glad they refrained. We’ll try again today.

Hilary was one of those who listened and complied. She’d moved her little green car from the south side of the street to the north on Sunday, and moved it back on Monday. I came along for the joyride. It was a beautiful day, and I suggested we proceed to Mexico City, or perhaps Antarctica. Reasonably, Hilary wanted to stick closer to home. We decided to take a short walk in the neighborhood.

Agitation ruled the day. Three quarters of the people we passed were thoroughly masked, heads down, trying to get to their destinations as quickly as possible. Many of them carried grocery bags. The other quarter consisted of people blowing off frustrations, riding dirt bikes on the sidewalk, or accompanying children on hoverboards, meeting bad air with bravado. In teams, construction workers continue to apply themselves to private projects. The modern Jersey City Downtown was built on a condominium boom. Long ago, the municipal government designated this the most essential of local activities, and they’re not changing their tunes now.

We came home to the news that we’d lost a City Councilman. Michael Yun was a good-government type — he was the closest thing that reform organizations had to a sympathetic ear. He was also, as many of the online postmortems noted, among the best-dressed politicians in Jersey City. This was not immaterial. It reflected his attention to detail and his disinclination to tolerate sloppiness of any kind. Yun was a scourge of litterbugs. The half-hearted attempt to clean the streets yesterday felt like a tribute of sorts, albeit one done, in typical Jersey City style, in incomplete fashion.

Yun, who was 65, was an immigrant from Korea who ran the Garden State News store on Central Avenue in the Heights for decades. This, I was told as a child, was the very promise of America: unlike other countries where outsiders were unwelcomed, we took in those who wanted to be part of our experiment. If they dedicated themselves to the polis, they might even become leaders. That version of America might have always been mostly aspirational, but it existed, and it was meaningful to me. I don’t know where it went. Regardless, I’ll try to stay true to it. Also, I’ll try to keep the street clean for the Councilman. Rest in peace.

This is Wilson.

We met Wilson on the street. He was alone, flung from a stroller perhaps, right in the middle of the sidewalk. I’m sure he wouldn’t admit it now, but he looked bewildered. You would be, too, if you were fallen and unclaimed. You might wonder a bit about what the future might bring.

Hilary had just completed a long course of radiation, and she’d begun oral chemotherapy. The treatments made her tired. She liked to push through it and take walks anyway. She’d been warned by the doctors not to pick up objects on the street. So after she dusted Wilson off and placed him up on the fence so that anybody looking for him could see him, she hand-sanitized.

The next day we had an appointment with the oncologist. We spent the evening in the city and returned home exhausted. Hilary slept in, or tried to. The drugs gave her intense physical sensations that she found difficult to describe. She didn’t feel up to a walk. I decided to go to the store and get her a few things she wanted.

On the way back from the grocery, I passed by the spot where we’d walked two days prior. To my surprise, there was Wilson, still on the fence, still staring out toward the street. I admitted that I’d quite forgotten about him. We fell into conversation. Wilson asked if I was in need of a quality guard dog. I told him that I would consider it. Overhead, the skies were darkening. It was going to rain. I went home.

Later that day, Hilary steadied herself and got up. She folded the laundry and read her book, and made something to eat. She checked in with the hospital and filled out their daily survey. Then she opened the door. There in the hall was Wilson. He was reporting for duty.

As guard dogs sometimes do, he’d gone ahead and assigned himself a tough case. Using context clues, he’d determined to his own satisfaction that his talents were required here. We invited him in. We were both a little too wiped out and worried that day to be effusive, but I recall that we were overjoyed to see his fuzzy face.

We initially feared that a watchdog, squared away and regular as they are, would have a hard time acclimating to our peculiarities. I am sure that Wilson found us eccentric at first. But if he was never a full participant, he soon he became an enthusiastic observer of our customary fun and games. He quickly realized that he’d committed to guarding a house where playful activity was the rule, and as such, he was here to guard us as we played, and make sure we were always as safe as we could be under the circumstances.

Wilson has now been with us for over a year. He has had work to do, hard, scary work. But he has never once complained or shirked his responsibilities. He was the first one to greet Hilary after her second surgery, up on the hospital tray table, examining her for signs of distress. He was there through the convalescence, presiding over the medications, making sure we never took too much or too little, always as exact and precise as we needed him to be. He has peeked between the straps of Hilary’s bag during every doctor’s appointment, and listened carefully to each recommendation, even at times when we’ve both been too tired, confused, and apprehensive to pay close attention. Wilson has watched over us during many sleepless nights when comfort has been hard to find. When I have been frightened and helpless and ready to give up, he gives me a hard stare, and I catch myself, and I find my footing, and I carry on.

I recently asked Wilson whether he could ever have expected that our recovery would be interrupted by a pandemic. I meant it as a kind of joke, bleak humor to break the tension. But Wilson, true to form, told me that a guardian takes all threats, small and large, as seriously as conditions warrant. The world, he tells us, is always changing; it has sharp edges, and a good guard dog must stand ready to blunt each one of them as they approach. Right now, as I type this, Wilson is on duty. Hilary is baking a banana bread. He’ll watch out for the peels.

It is not in the nature of guard dogs to seek publicity. They do what they do because of who they are, not because they expect a reward. If Wilson knew I was writing this, I think he’d be awfully embarrassed. But our watchdog has reinforced the lessons that tweepop taught me long ago: tenacity is never a matter of physical strength, and guardianship of that which is precious is always worthwhile. When they have to be, the plush are often the most ferocious. It’s not the size of the dog in the fight, it’s the… well, you know the rest.

The vigilance of our guard dog has been unwavering. His comradeship has been indispensable. We are grateful for our good fortune. We’re so glad he found us.

Thank you, Wilson.

We wake up to a grocery delivery. Greens, beans in cans, a pineapple, some berries, toilet paper, a block of unsalted Kerrygold butter, other stuff. Our order includes a big bag of masa for tamales, but we haven’t been able to find corn husks. Getting it all upstairs is tricky. The bags are heavy and a little slick from the rain. The brown paper has been folded tight across the top; this ought to be reassuring, but the practical downside is that it’s hard to grab them from the top without tearing them. Inside the apartment, Hilary disinfects everything, item by item. From the upstairs window, she calls to the deliveryman and tells him to stay safe.

I wonder if he can. Every revision in the transmission model makes the virus seem scarier than we originally thought it was. At first we were told that masks weren’t going to be necessary. Now it seems like scientists have changed their minds. There’s no consensus about the the concentration of virus that would have to be present for airborne infection, or whether the virus can exist in aerosols at all. Nevertheless, I think we can conclude that if you’re in close contact with somebody who’s got it — even someone asymptomatic — all the hand-washing in the world isn’t going to help. You won’t need to get coughed or sneezed on. A regular friendly conversation might be enough to turn you into a new host.

We weren’t talking to each other in 2019. By necessity, in 2020, we’ve turned further inward. We cross the street when somebody else is coming. Some of you have been dismayed by the party-hearty who aren’t taking social distancing recommendations seriously. I haven’t really seen that; not much of it, anyway. In my town, we’ve slipped into a new model of sociability. The virus is accelerating a transition that was already happening: more indoor living, less physical contact with our neighbors, habitual hiding behind masks of different kinds, a sharper wedge driven between those who deliver the packages and those who receive them.

I’m not sure there’s any going back. Those of us who make it through this storm may find ourselves permanently disinclined to interact with strangers. Videoconferencing is not going to save the body politic, which needs vigorous, physical, in-person exercise. Part of the reason that we’ve been unable to respond to this challenge with the unity that the moment demands is that we were already dangerously fragmented. We’d already decided that our neighbors were our enemies, and that listening to them wasn’t important. We’ve replaced human relationships with digital simulations of them. Even as those simulations reveal their insufficiency, we keep getting angrier, and drifting farther apart. It may not be just the widespread use of masks that has helped South Korea flatten its curve. It might also be that they lack the American affliction — one that predates the coronavirus by many years, and shows no sign of dissipating on the breeze.

When I heard the bad news about Adam Schlesinger yesterday, I was nearly wrecked by it. I know there’ll be much more horror and loss to come, and I need to steel myself, but it still shook me. I wasn’t ready. He was, as you’ve probably read, 52 years old. I’d expected many more wonderful stories from him before he hung up his guitar. The appropriate reaction would be to listen to some Fountains Of Wayne, but I don’t think I can do it: it’s too soon. The virus seems to be picking on lyricists: Schlesinger, Scarface, Jackson Browne, and John Prine, whose condition is serious. I hope Randy Newman is in bubble wrap somewhere.

The sun came out yesterday, so we rallied and took a walk, checking first whether Hilary’s little green car would start. It did. She hadn’t turned the engine over in more than two weeks, and she worried she’d need a jump that wouldn’t be forthcoming. The car is parked right outside the bay window, and it’s been a comfort seeing it there; I haven’t minded at all that we haven’t moved it. But Jersey City needs to clean the streets. The gutters are messier than usual: rubber gloves, stray paper, lots of little liquor bottles. We’ve got to get the car to a Tuesday spot by Monday. Maybe we’ll take a short ride somewhere tomorrow; treat the weekend as if it’s still something meaningful.

Our walk took us to Lafayette. Many Downtown pedestrians were masked. The revised recommendations seem to have been taken seriously. A week ago, we were laboring under a widely publicized misapprehension (?) that masks wouldn’t do any good. Mixed messaging from authorities continues to be a major problem. Many of our current elected officials have made ignorance part of their brand: they’re just plain folks, like us, and therefore true representatives of a confused and non-scientific people. The global crisis may help expose populism for the intellectual dead end that it is, but we’ve got a long way to go. This morning, the governor of Georgia, an aw-shucks type of the worst kind, claimed that until yesterday, he didn’t know that asymptomatic people could be virus transmitters. In a sane society, a confession of incompetence like that would prompt an immediate resignation or recall. In America, which is not at all sane, I doubt his popularity will even take a hit.

New York friends have reported sirens everywhere. We didn’t hear that. There were quite a few ambulances on the street, and the scene outside the medical center on Grand was harried and hectic. We hope we won’t have to see the inside of that building any time soon. Yesterday we also learned that Sloan Kettering is prohibiting all visitors. Only patients are allowed to enter the hospitals. This is absolutely understandable, but still upsetting for us. Hilary and I were together for every chemotherapy and radiation treatment, and this was encouraged by doctors and hospital staff members who want cancer patients to be surrounded by support. An infusion — not chemotherapy, mind you — that she’d scheduled for April has been pushed back until late June. By then, will I be able to sit by her side, read to her, and give her a fig newton?

Last night I did something that I don’t ordinarily do: I prayed aloud. Usually I keep it to myself. Sometimes, in the waiting rooms at Sloan Kettering, I did nothing but pray silently, not just for Hilary, but for everybody else queued up for treatment, frightened and determined to make it through the day. I didn’t want to make anybody’s apprehensions worse than they already were. On my knees, I saw those women again: some young, some old, some drawn, some defiantly hale, all facing their mortalities with the sort of courage I wish I could locate in my own tremulous soul. I prayed for those who will have to endure the agony of treatment without the buffer of a partner or buddy by their side. I prayed I might find the bravery that Hilary deserves from me. I prayed for my cousin, who is still in the hospital. And I prayed for Adam Schlesinger, a marvelous and deeply human songwriter whose music has brought us great joy, and who is, like far too many already, gone too soon.