Spring cleaning

Hilary woke up and began to put the flat back together. She swept and washed the floors, cleaned the inside of the stove, applied a coat of polish to our table. She gently encouraged me to think about things that I hadn’t thought about in awhile; for instance, why has there been a big stack of compact discs on the floor near the compact disc collection for months? I suppose I’d been waiting for the day when it was clear to bring them to Tunes in Hoboken. Now, I’m just hoping that Tunes sees fit to re-open.

Together we tackled my closet. With nowhere in particular to go, I haven’t dug too deeply into my piles of t-shirts or pants; I’ve felt like whatever is on top is crisp enough to meet the moment. I’ve been wearing the same stuff in a seven-day rotation since late February. It was nice to re-engage with the clothing I’ve got, and remember that the clothes at the bottom of the closet have just as much right to be put on as the ones at the top. We said goodbye to a few shirts that I’d worn out, including some that have been lurking in the shadows since the 1990s. It’s very difficult for me to part with anything made of cotton. Each article of clothing feels like an unambivalent expression of love. Presents given to me by Hilary — shirts, bathing suits, pajamas — need to be torn in half before I’ll give up on them. There are things completely beyond repair that are still on hangers because they’re comforting to see in my little closet. Before I place an article of clothing in the rag basket, I like to clip out a square of fabric and place it in a small wooden box. I call this the Shirt Museum, but there’s more than the ghosts of buttoned-down shirts in there: we’ve got a swatch from Hilary’s old plaid robe, a skirt she wore to class, a bit of a floral-patterned umbrella, the “J” decal from a Loud Family concert tee, a hieroglyph from an Egyptian-themed towel that was the first one we ever shared, many years ago.

Straightening up is a hopeful thing to do. In it is the faith that the next day we have together, and the day after that, will be beautifully ordinary: we’ll sit in our usual chairs, play a game on the table, open the windows, make a salad, enjoy the prettiness of our place, without fear of alarm, or sudden misfortune, or any other sharp turn of fate that will demand all of our attention. It’s possible to be clean and disordered, which, to us, isn’t much more comforting than orderly cleanliness. There is a tonal difference, we’ve learned, between the panicked disinfecting of surfaces that might have been touched by the coronavirus and the leisurely resetting of parts of the house that have gotten scrambled up by circumstances. When you really love your home, every spatula has its special place, and restoring them to where they belong is an act of grace.

Personal grooming is another thing altogether. For my own sanity, I try to avoid my reflection, because I never like what I see, but in recent weeks, it’s been downright horrifying. It’s a relief, in a way, to go outside masked, because it means I don’t have to confront my neighbors with my terribly unsatisfactory face. Public demand for haircuts has been a leitmotif of the last month or so — it’s been given by the unscrupulous as a reason for breaking quarantine and premature reopening. I don’t get it. Haircuts are going to do nothing for our haunted expressions. Beauty comes from peace, alacrity, and self-possession, all of which are in short supply at the moment. Our intention today is to pay our first social call since a party we went to in early March: it’s Steven’s birthday, and we’re planning to meet him by the East River. I’ll be masked, but I’ll still want to be vaguely presentable — I’ll find a shirt that’s pressed, and a pair of pants with some definition, and shoes suitable for a walk. Maybe I’ll put a flower in my hair. That’s better than a cut, anyway. It shouldn’t be too hard to find a suitable blossom. It’s May, after all.

Chloroquine revisited

It is hard to overestimate how wonderful it would be if hydroxychloroquine worked. The long search for a pharmaceutical intervention in the progress of the coronavirus would come to an end, not with a new compound that’s difficult to manufacture, but through the re-purposing of a fairly simple one that’s already in wide use. It would be an epidemiologist’s dream come true: a cheat code to the pandemic, a plot twist at the end of a feel-good movie. We already know what the drug does, we know its risks, and we know it’s pretty well tolerated. Hydroxychloroquine can be dangerous, but it’s not the sort of pharmaceutical that turns the patient inside out in order to cure her. It’s cheap, and, like all treatments administered by pill, it’s quick and easy to administer. There’s not a doctor alive who wouldn’t be delighted to share the good news with her patients.

Unfortunately, there’s still no evidence that it does any of the things that its proponents say it does, and there’s mounting evidence that it doesn’t. The latest medical publication to cast doubt on the usefulness of hydroxychloroquine is the Lancet, which just published a large observational study about the drug. The doctors who ran the study looked at hydroxychloroquine taken in isolation, and hydroxychloroquine taken with azithromycin, an antibiotic that has also been anecdotally linked to the alleviation of coronavirus symptoms. The bottom line: neither approach worked. Patients given hydroxychloroquine, in any combination, had significantly poorer outcomes than those who weren’t.

Hydroxychloroquine enthusiasts responded as they always do: angrily, and with absolute conviction that they know how to run medical studies better than those trained to do just that. The study was too big, or it wasn’t wide enough, or the timing was all wrong, or they didn’t give the proper combination of supplementary drugs in the proper sequence, or the results are automatically disqualified because the Lancet is in the pocket of a pharmaceutical industry looking to push vaccines instead. The theory among those who take a ride-or-die view of hydroxychloroquine is that the drug creates conditions under which other drugs — zinc, in particular — can interfere with the replication of the coronavirus, but if that process is started too late, the progress of the pathogen becomes irreversible and no amount of medicine can help. A study that focuses on people who’ve already been hospitalized isn’t useful. They’re too far gone. The hydroxychloroquine needs to be given during the first stages of illness, or even prophylactically, in order for it to do any good.

For researchers who want to take hydroxychloroquine seriously, this creates a methodological problem. Early-stage or asymptomatic studies aren’t easy to conduct. The coronavirus is a very dangerous pathogen, and case fatality rates and hospitalization rates continue to be scarily high, but most of the people who get sick aren’t going to die, and they aren’t going to be hospitalized, either. Most of them are going to recover on their own. Patients who never get seriously ill may attribute their recoveries to hydroxychloroquine; they might just as well put it down to prayer, or fresh air, or a lucky rabbit’s foot. This puts those who are committed to touting hydroxychloroquine in an unassailable position. If a patient takes the drug and dies, well, too bad, that meant he started too late. Only those who take it and survive are worthy to be counted, and when they’re counted, their recovery is attributed to the drug.

Logic like that might be gratifying to entertain, but it’s medically useless. It generates the sort of tautology that I associate with the Catholic Church at its worst. If a patient recovers, that proves faith in the drug is properly placed, and if she doesn’t, she must have done the drug wrong. Humans are faulty; only the drug is unquestionable. Those doctors and researchers who doubt the power of hydroxychloroquine aren’t just incorrect, they’re downright evil: they’re participants in a grand global scheme to suppress a cure.

Is this possible? Sure it is; the history of the world is full of examples of large groups of people doing pernicious things. But I do wish that the many who commit acts of casual calumny against the Lancet, and other publications like it, would understand the breadth of the accusation they’re making. They’re not merely accusing doctors, researchers, and drug companies of conspiring to kill millions. They’re suggesting that people who are actively involved in the treatment and attenuation of the pandemic would be unwilling to take a simple measure to check its spread, thereby putting themselves at greater risk of catching the coronavirus and dying horribly. I am a paranoid cuss, but that’s a bridge too far for me.

I don’t believe the burden of proof always falls on the skeptics. I just think that if you’re going to make a world-shattering claim in the face of good evidence to the contrary, gathered by professional evidence-collectors, you ought to have the common courtesy to back it up with something substantial. Anecdotal accounts from country doctors aren’t going to cut it. We’re all frightened, and we’ve got good reason to be; we’re going to be rummaging through the ammunition drawer for magic bullets. Alas, viruses are rarely defeated outright by a pharmaceutical. Even vaccines are only partially effective. The way we beat this thing is by putting in the work — wearing masks, and keeping our distance and behaving responsibly, reconfiguring workspaces and redefining the idea of work, improving ventilation, and making sacrifices to drive the reproductive rate of the coronavirus down to zero. None of that has been fun, and the things we’re going to have to do in immediate future won’t be fun, either. But it’s all necessary. And I can’t help but notice that some of the loudest advocates for hydroxychloroquine have been people who don’t like to put in work — lazy people, ones who’ve made careers out of cutting corners and chasing easy solutions for complicated problems. I don’t expect them to back off any of their claims, because that would require them to think, and act, and those are two things they’re always reluctant to do. Just remember when you hear them talk: if they were right about the game-changing powers of hydroxychloroquine, the pandemic would be over by now.

The mayor and the governor

Columbia University came down hard on Andrew Cuomo and Bill DeBlasio on Wednesday night. I only wonder what took them so long. Their report reveals that the Governor and the Mayor dithered in the face of the crisis, and suggests that if they’d acted sooner, they could have saved more than fifteen thousand lives. I was right here in the New York metro in early March, and I can confirm: dithering happened. I believe that Cuomo and DeBlasio feel worse about this than the President does about his own inaction. Right now, though, I’m not too concerned about anybody’s feelings. It’s all the same to me. They can take it up with their psychotherapists if they’d like to.

The Governor and Mayor have excuses at their disposal that the President doesn’t, and they’ve been availing themselves of them. Nothing they’re saying in their own defenses is inaccurate. The state of New York has no central intelligence agency (although I wouldn’t be surprised if one was getting put together right now) and no access to the sort of classified analysis that comes across the desk of the chief executive in Washington each morning. We don’t expect Albany to keep spies in Wuhan. New York received no guidance from the federal government until it was far too late, and even then, the official response was confused and flailing at best. A national crisis plan never came.

None of that gets Cuomo or DeBlasio off the hook. Risk assessment is the chief executive’s primary responsibility. He’s there to cushion the shocks and smooth the path so that the rest of society can function. That’s his main role as a public servant; everything else is secondary. Neither the governor nor the mayor anticipated or managed risks well, and yes, the incoherence of the administration in Washington was, and is, absolutely one of those risks. The governor of New York has had three years to study the Trump White House. He could not have seriously thought that help would be coming in a crisis. The moment he heard about a breakout in China — December 2019, surely — he needed to swing into action. That goes double for DeBlasio, because there are few places on earth as vulnerable to pandemics as the five boroughs. He had to make sure that New York City was supplied and ready.

When the mayor and the governor attempt to reassign blame to the President, they don’t sound all that different than the President does when he tries to reassign blame to the Chinese Communist Party. They’re looking to distract you from the gamble they made — a gamble that has blown up spectacularly in their faces. They knew that a lockdown would damage their popularity, and for a modern public figure, popularity is everything. We already know that the President is willing to chuck everything into the fire in order to ensure his re-election; that’s been established dozens of times over, and only a sucker or a cultist would have expected responsible behavior during a global health crisis. Cuomo and DeBlasio play the statesman better than Trump ever could, but neither passed the guts test. It would have been brutally difficult to put the squeeze on New York in February. We would have hated them for it. But that’s what we elected them for: they’re there to absorb that hate. They’re there to do the right thing, at all times, including times when the right thing is hard to do.

New York is the world’s capital of commerce, and those chosen to lead the city are representatives of the commercial sector as surely as they’re representatives of ordinary residents. I get it, and I understand that neither Cuomo nor DeBlasio wanted to piss off the captains of industry in Manhattan who were, and are, determined to stay open for business. But regardless of whether we measure the bottom line in dollars or human lives, inaction is going to prove much more costly than a heavy hand would have. Cuomo has been discouraging hindsight, as you might imagine he would, and as a chief executive in a time of crisis who is not actively encouraging his constituents to drink Clorox, he’s kept his approval rating high. Nevertheless, just as America leads the world in cases, hospitalizations, and deaths, New York leads the nation. Those are rude facts, and they aren’t budging. Eventually, there’s going to have to be a reckoning.

Testing, and the tested

In Manhattan and Jersey City the government now offers tests to anybody who wants them. Only a few weeks ago, faced with shortages, municipalities were reluctant to test people who weren’t exhibiting symptoms. Some very sick people were sent away. Our friend never went to a clinic, but he certainly didn’t feel himself. His ears and eyes burned. At night, he’d sweat straight through his shirt and soak his sheets. He’d been out in city bars in early March, during a time when we know the virus was transmitting rapidly. He didn’t think he had it, except for the times he was sure he did.

Two days ago, he queued up to get tested. The antigen swab, he told us, was every bit as uncomfortable as he was told it would be — a stick so far up his nose that he felt it was probing the underside of his eyeball. The test for antibodies was easier to endure, but just as complicated to think about. Even a positive result, he told himself, would provide some clarity. A positive result on an antibody test might suggest that he had acquired some immunity to future waves of the coronavirus. A positive result on the antigen test would dispel the mystery of the symptoms that had been troubling him since late winter.

The doctor administering the test told our friend that his symptoms were consistent with coronavirus infection. The two-week period, he said, was just an educated guess, and one that no longer corresponds to facts on the ground: people are getting sick and staying sick, and might remain carriers for a long time. Our friend was warned not to see us, or anybody else who might be immunocompromised. Stay inside, keep calm, wait for a call in five to seven days.

I told him what I knew, and what I didn’t. Antibodies might confer immunity on those who have them, but then again, they might not. The World Health Organization warned us not to assume that seroconversion would be automatic, or lasting, or consequential. Recent studies from South Korea suggest that reinfection is unlikely, and that those who test positive weeks after coming down with symptoms are shedding inactive virus. Nevertheless, we all know people who can’t seem to kick the thing, and whose road to recovery has been a perilous zigzag. The early euphoria about antibodies — our belief that some of us would be able to return to normal activities with “immunity passports” in hand — has given way to a grim recognition that the long-term effects of coronavirus infection are consequential. That which appears asymptomatic could cause trouble down the road. Our best bet is still not to get it.

Fear of mutation nags at the city. We all know that viruses change from host to host; will this one shuffle its spike proteins so efficiently that our efforts to detect it, treat it, and immunize against it will prove useless? Will we recover from one strain only to be hit by another? All of that antibody manufacture wasted on a passé brand of coronavirus: a persistent worry in a town obsessed with fashion and the latest tech. If New York City was in the blast radius of a more explosive variant of virus than that which had reached Florida, that might account for the relative severity of the crisis we’ve faced.

It’s still too early to know for sure, but current opinions held by scientists ought to ease your mind. The coronavirus has mutated, as all viruses do, but it’s unlikely to change in a way that would allow it to evade its capture by antibodies. Should you fall ill and recover, your immune system ought to recognize the next coronavirus antigen you come across, no matter what its new ensemble is. The version of the virus we’re struggling with in America isn’t meaningfully different from the one that plagued Asia and other parts of the globe. If our outcomes are unlike theirs, I’m afraid that’s attributable to the way we’ve handled the crisis. Florida, like many other places, is underreporting. And our friend got a call from the city yesterday afternoon. He tested negative for the antigen and the antibodies. That may raise more questions than it answers, but it’s a relief nonetheless.

INXS

There are people in America who fear that a coronavirus vaccine will be spiked with silicon tracking devices that will record every step they take. Yet they already carry objects in their pockets which do exactly that. Technically, they could leave their phones behind when they go out, but do they ever? A few manage to disable or scramble the homing signal, and if you’re one of them, my hat is off to you for your ideological consistency. I get it; I really do. In the midst of a pandemic, I can’t say I sympathize, but I know where you’re coming from. The rest of you: I don’t get it.

Whether the government keeps a file on you is debatable. We know they’ve got the technology, but can they acquire the inclination? If they outputted your data from the corporate mainframes where it’s stored, would they even know what to do with it? I’ve always felt that if those in power really wanted to screw with me, they wouldn’t bother to assemble a dossier: they’d just do it, and they’d worry about justification later on. That’s the way that the authorities operate, I’ve noticed — they go ahead and do what they want to do, and send in the clean-up teams later if they have to. Generally they don’t have to. There we are, flat on the macadam with the bulldozer treads in our backsides, and in no position to lead the resistance. KRS-ONE explained all of this to us in the late ’80s, and in rhyming verse, no less. Thirty years on, I’ve seen no indication that anything he told us was inaccurate.

No, data, like everything else, is only the authority’s friend when it can be marshaled to support what the authority is up to. When it can’t, it’s just drowned out. Executive regimes, I notice, are hanging on to the massive power they’ve accrued by their fingertips, and with gritted teeth, and public relations is an indispensable ingredient in the binding agent that keeps the governed stuck to the governors. For instance, it’s almost certainly true that the State House in Tallahassee has suppressed the number of Floridians who’ve died from coronavirus complications. The chief medical examiner even said so earlier this month. Now we learn that they’ve canned the woman who operates the dashboard of their virus website. She wouldn’t cook the books for them. She’ll be replaced by someone who will.

The minimizers — and they’re legion — accuse New York and New Jersey of inflating our death counts. We’re electorally insignificant, so they don’t mind kicking us while we’re down. We who live here don’t need to be told anything about the severity of the crisis. But it certainly seems possible that our governors are ginning up the numbers in one direction or another. How can we know for sure that they aren’t?

It turns out there’s a pretty easy way to check. The severity of medical conditions may be disputed and caseloads can be fudged by clinics, but death is tough to misinterpret, and bodies, as every Raymond Chandler fan knows, are hard to hide. Deaths can be safely predicted — there are entire industries that are predicated on expected fatality rates — because they tend to be consistent from year to year. If many more people died in April 2020 than they did in prior Aprils, in the absence of another variable, it’s a cinch that the spike can be attributed to the coronavirus. Epidemiologists even have a name for this. They call it excess mortality, and it’s one of the simplest and clearest ways to measure what’s going on and where it’s happening.

Alas, it is very hard to find excess mortality counts. Governments don’t want you to see them, and why would they?, people are scared enough as it is. It’s up to journalists to gather this data from available public sources. There’s only one newspaper I know that’s been putting in the work and collating what they’ve found; luckily for us, it’s the very best periodical in the English language. I could go on for awhile about why The Economist is so much better than any other magazine, and I may do just that in a future dispatch. For today, I hope it suffices for me to assure you that my faith in The Economist has little to do with its editorial outlook, which I broadly disagree with, and everything to do with the diligence with which the editors put the publication together. When you get a page of facts from The Economist, you know it hasn’t been pulled from a think tank or copied from a PR office or thrown onto the Internet in the chase for clicks. That’s not how they operate. They’re the real deal — maybe the last real deal around.

The Economist‘s tracker is consistent, and what it reveals isn’t pretty. Excess deaths are up, all around the globe, in numbers that will make your stomach turn. In places like New York City, the number of reported fatalities tracks pretty well with the mortality spike; even here, we appear to be underreporting, but not by all that much. In other parts of the world where testing is sporadic and medical services are hard to come by, the variance is startling. Jakarta has only attributed 14% of its excess deaths to the coronavirus. That’s the big city in Indonesia; further into the country, they don’t have much capability to confirm cases. They just have the coffins.

New York City has attributed more than fourteen thousand deaths to the coronavirus. The city is running about sixteen thousand fatalities above the expected baseline, which, to my non-trained eye, looks like it’s within the bounds of acceptable error (the statistics, I mean; there’s nothing acceptable about the deaths). What this means — and it means it conclusively — is that we aren’t exaggerating, and those who accuse us of exploiting the crisis are every bit the heartless jerks that it seems like they are. That doesn’t tell us why the case fatality rate in New York City has been so high, or how it spread so fast and with such lethal consequences. Nobody is off the hook. Once we get to the other side, whenever that may be, there’ll have to be a reckoning. But we aren’t lying outright about the body count. That’s more than the authorities in some other parts of the country can say.

Insaneball

If I could hit a 95 mph fastball, I imagine I’d be itching to get back out on a baseball field, too. Lockdowns are hard on everybody, but they’ve got to be particularly difficult for athletes. If you’re born to run around on the grass in the summer, and catch, and throw, and swing as thousands cheer for you, there’s not much inside the house that can satisfy your deepest desires. Giants shortstop Brandon Crawford has been running crowdsourced single-elimination tournaments on Twitter; yesterday, he was playing off candy bars in order to determine the best (Twix is his #1 seed). He’s having the fun that he can have. I’m sure there’s not much he wouldn’t give for a few hard ground balls in the hole.

Municipal Fourth of July fireworks are cancelled. Taylor Swift postponed the Lover festival. If you were planning an event, you’ve probably rescheduled, too. While the world has zagged, Major League Baseball is preparing to zig. The league refuses to ice the season. They absolutely intend to play ball this summer.

This doesn’t exactly thrill me. I’m not sure what shape baseball is going to take when it returns, but I’ll bet that the game will feel quite alien to those of us accustomed to its verities, and who, each summer day, set our clocks by the league schedule. Plans under discussion include games played in empty ballparks, which feels antithetical to the communal spirit of the game. If we can’t go to the park — and nobody is seriously suggesting that ordinary spectators will be allowed through the gates — we may as well be watching a computer simulation. Crowd shots were absolutely central to the experience of watching the San Francisco Giants during the championship years: participation in the rituals of fandom, sign-waving and kiss-camming, and scrambling for foul balls, singing “Lights” in the late innings in an open declaration of love for the entire Bay Area. It’s hard to imagine a broadcast without them. Every ballpark has its own distinctive personality, and most of that personality comes from the people who crowd in, and shout their heads off for the players.

And that’s only how baseball during the pandemic would feel strange to me. For the players, and the coaches, and members of the large support staffs that follow each club, it’s going to be downright bizarre. Under the plan that looks likely to be put in place, high-fiving, butt-patting, and fist-bumping is going to be prohibited. Batters are likely to wait their turns in the stands, spaced out from teammates, rather than the dugouts, which aren’t going to be used. There’ll be restrictions on behavior between the lines, too. First basemen are going to be encouraged to stay as clear of baserunners between pitches as they can manage. Baseball isn’t a contact sport, but anybody who has ever tried to turn a double play knows that bodies tend to get tangled up. It’s impossible to keep players from sharing air without creating some major distortions in the game.

To compensate, teams are promising to take their players’ temperatures between innings. Field personnel will effectively be quarantined between games; in order to ward against contingency at an uncertain time, teams will carry large taxi squads. That’s a lot of people to swab. MLB assures us that they’re going to be constantly monitoring its workforce, which feels rather Antoinette-ish, given that testing in many parts of the country is still grossly inadequate. It’s worth asking: if professional baseball can afford to test everybody, all the time, why can’t the United States government do the same?

All of this presupposes absolute antigen testing accuracy, which we don’t have. Should a player test negative but get sick anyway, everybody on his team — and the teams he’s played against — would likely need to be quarantined. An already makeshift schedule would need to be ripped up and rewritten on the fly, possibly several times. The long-term risks of getting infected still aren’t known, but the virus seems to stay in the systems of its hosts for longer than we originally thought it did. Those who develop serious symptoms don’t recover easily, and the daily respiratory demands on a professional baseball player are greater than those of us who earn money by plunking words and figures into fields on computer screens. Tampa Bay Rays starter Blake Snell was widely pilloried for speaking out against the pay cut that players would take during a shortened season, but I think he’s got a point. I imagine he’s worried about more than just his future earnings potential.

I don’t want to see any ballplayer sent to the disabled list with coronavirus. The suspension of worry and the peculiar ripple in time that baseball, at its best, is able to generate for viewers won’t be available to this dedicated fan during this pandemic, and I doubt I’m alone. I’ll constantly be aware of the ways in which the players on the field are putting each other in danger. The virus has turned us all into reflexive evaluators of the social-distancing practices of the people we see, and we’ve become on-the-fly risk assessors, too. One of the lessons we’ve learned: if you’ve got to radically alter the non-essential thing that you’re doing in order to make it fit into the world as it is, that’s a pretty good indication that you shouldn’t be doing that thing in the first place. I’ll still be a fan of Taylor Swift in 2021, and I’ll still be a fan of baseball, too, whether there are any MLB games this summer or not. There’s no need for anybody to push it. We’ve all got our hands full already.

The old folks

A close friend just got the message we’ve long feared he’d get. His father has tested positive for the virus. He hadn’t been sick: he was tested as a precaution, along with the other residents of the nursing home where he lives. Neither my friend nor his siblings have been able to see him. Instead, he’s going to be transported to a different nursing home within the same system — one outfitted to handle cases of coronavirus. I imagine he’ll be isolated and watched closely. Life in a nursing home is difficult enough as it is. Life in a nursing home during a pandemic has got to be terrifying, and lonely, especially for those who’ve been infected.

Testing positive without symptoms is better than testing positive with a cough and a fever. It’s possible that my friend’s father will never get sick: some people in every group won’t, and that includes elderly people with scary underlying conditions. We don’t know when or how he caught the virus, and we’ll probably never know. There’ve been other cases in the same nursing home, and my friend has been getting automated alerts by text from the care center: 3 people infected with the virus, 0 precious lives lost. Those aren’t illuminating; mostly, they’re just creepy.

In New Jersey, the coronavirus has killed ten thousand people. More than half of those — 5,376, and counting — were residents of long-term care facilities. Over 500 homes have reported infections. The scale of this disaster is breathtaking, but it wasn’t unanticipated. We always knew that senior housing was full of kindling for the blaze. In the middle of February, our friend Amy ventured into the online wilderness to warn whoever she could reach about the need to contain the coronavirus before it reached nursing homes. She blew the whistle until she was red in the face. She was right to sound the alarm. I wish we’d listened better.

Those of us who live in New Jersey are painfully aware that the coronavirus doesn’t skip over younger people. We all know people in the primes of their lives who’ve become seriously sick. But almost eighty per cent of those who’ve died from the virus are over the age of 65 — and getting a public health message to our elders can be a challenge. Many of our friends are up against the steely recalcitrance of parents, and aunts, and uncles, and older friends, some of whom are determined to get their news from dodgy sources. The father of someone close to me recently forwarded her a scare article, straight from a clickbait mill, about the neurological hazards of wearing masks. She wrote back a kind and measured response. She hasn’t heard anything from him since.

I consider myself lucky that my parents have taken this crisis seriously. They live in Chester, a small town on the periphery of the metro, which is a good thing: they’re out of the way of most of the state’s major transportation corridors. They don’t have to go anywhere if they don’t want to. That said, their house is part of a development reserved for those aged 55 and older. Nearly half of the township is over 45. That doesn’t put them in the line of fire, necessarily: part of what people are paying for when they move to places like Morris County is permanent social distance. But when there’s so much virus — and so much misinformation — flying around the Eastern seaboard, it’s hard not to worry. It’s a small relief to know that Hilary’s mother is ensconced in the mountains of Vermont. It becomes less comforting when I think about what she does all day: she’s a nurse in a prison. It’s a tough job that somebody has to do, and I’m grateful that she’s doing it. So far, they haven’t reported any cases there. Keep your fingers crossed.

Time bomb

In my late twenties, I broke a tooth. Second molar from the back on the upper left side— an important one, I’d learn. It’s hard to chew without it. My then-dentist recommended a root canal. About ten years later, my current dentist declared that root canal inexpertly done, and re-did it. By then, I’d sunk a lot of money into that twenty millimeter area of my face.

After the second root canal, I figured that was that: the tooth was dead, sealed, and stuffed with inorganic material. I didn’t realize that the tooth could still be a problem. My last visit to the dentist was an utter disaster — he found problems all over my mouth, once that he felt had been exacerbated by the elevated stress I’d been living with for the prior eighteen months. Right in that same troublesome molar, he found an infection brewing, a black spot on the x-ray where all had been pleasantly white in the days before Hilary’s diagnosis. This, he told me, was a matter of some urgency. He recommended extraction and a dental implant.

Implants are expensive. They also take a long time to finish. First, there’s an extraction, and then a post needs to be cemented in place, and only after you’ve healed from that does the dentist begin to build the new tooth. Hilary has been through it, and so has my mother; if you haven’t had one, I recommend you take preventative measures to avoid getting one. After the dentist caught the infection, I’d resigned myself to joining the club. But for insurance reasons, I didn’t want to do it immediately. I thought that if I held off for a little while, I could time things so that the dental visits could be minimally distracting from the rest of my life. We threw the dice.

Sometimes after an errant roll, the dice are easily retrieved; sometimes they bounce under the washing machine and can’t be picked back up without tearing the house down. Once I was ready to schedule the extraction, I couldn’t. All non-emergency dental procedures were scratched from the planner by the coronavirus. If I’d wanted to push it, I’m sure I could have convinced my dentist to squeeze me in before he ceased daily operations, but then I’d be sitting here in the middle of a pandemic with a hole in my mouth. My desire to undergo lengthy dental procedures — mouth open and throat receptive — during an outbreak of a contagious respiratory illness is about what you’d think it would be. I’d like to avoid getting into that chair for as long as I can, and I suspect my dentist feels the same way. He doesn’t want to trade breaths any more than I do.

It has now been exactly six months since I was told I needed a dental implant. My tooth didn’t hurt on the day I got that x-ray, and it doesn’t hurt now. If it wasn’t for the imaging tools at the dentist’s office, I’d have no idea there was even a problem. Since I haven’t developed any pain or inflammation, I’ve tried to convince myself that I’ve kept the infection in check by brushing and flossing, even though I know there’s no way that it works like that. It’s kind of like how I’ll reflexively wash my hands to protect myself from a virus that may well have already infected me. I don’t think that’s likely, but I didn’t think there was a problem with my root canal tooth, either.

Just writing this post feels like a jinx. But I’ve made it this far without a return trip to the dentist’s chair, and there’s a part of me that’d like to see how much longer I can hold the symptoms of the infection at bay. Semi-consciously, I’ll bet that the bacteria in my jaw is a figure for the virus at large, and if I can suppress the former, that means I’m fit enough to dodge the latter. That’s absurd, and stupidly magical, but so many of my woolier thoughts are. My anxieties, though, are real. Every night since March, I go to bed wondering if I’ll wake up with a fever from the coronavirus, or an abscess in my face that needs an emergency treatment. Every morning, I’ve been reasonably okay. I’ll keep praying for you if you keep praying for me.

A quick story

I dreamed I was at a family gathering. We were indoors, in the New Jersey suburbs, in the den of the house where my cousin lives. This is the cousin who was hospitalized in March, and both of her daughters were there: the one who first contracted the virus at a business conference in Colorado, and her younger sister, who has never been tested, and has never gotten sick. Hilary was with me. Other family members were there, too, but their faces were diffuse; for the purposes of the dream-narrative, they were treated by my unconscious as bystanders. Food covered the kitchen table. People were eating and talking. I remember thinking it was a little stuffy.

A bug on the wall of the kitchen tipped the party straight into chaos. The insect was big and caramel-brown, and it scurried fast. This was the sort of bug that you hate to look at too close, so you squint, and hold your breath, and try not to have your primal fears awakened by the feelers, and the tendrils, and the compound eyes. We all ran into the den. But the younger sister wasn’t afraid of the insect. She leaned over and picked it up. I was happy she did: I didn’t think that squashing it with a shoe was a good idea. She’d bring it over to the window and set it free.

Instead she carried it to the middle of the den and let it go. In a blur of bug-wings, it flew directly at the opposite wall, hovered, dove, and began running fast across the carpeted floor. It was at that moment that I realized I’d broken my glasses. The lens was shattered and one of the arms was bent. I didn’t want Hilary to see. She’d insist on going into Manhattan to get it fixed. I couldn’t run that risk — not with a virus on the loose.

I woke to a very nice day and began working. I had something to write in the morning, and another thing to write in the afternoon, and some additional work arriving in the evening. I tried to set aside dreams and fears. Before the day had gotten any traction, our buzzer rang. Hilary leaned out the window and saw a group of policemen in our small front yard. They’d opened the gate and poured themselves in. At first she thought we must have parked the car in an illegal spot. But they didn’t want us to go outside. They wanted to get inside.

From behind his mask, the biggest policeman shouted up to us. A truck, he said, had backed into one of the wires and torn it from a supporting pole. It either needed to be re-attached, or he’d have to snip it altogether and leave us without cable service. They’d need to get access to the far unit on the second floor of our building. From the window, I could see the dangling wire. It looked more like a great untied shoelace than a public hazard.

The usual occupants of the apartment on the second floor haven’t been around in weeks. They fled Jersey City during the early days of the crisis, and they haven’t even been back to pick up their mail. We’re the longest-tenured residents of this building, and by accident and attrition, we’ve come into possession of the master keychain. Hilary found it, put on her mask, and went straight downstairs. I followed after her.

The policemen were already inside. Our neighbor on the first floor let them in, and immediately fled back to the safety of his flat. We’ve all heard about the prevalence of coronavirus in the city police force, and although the main man was masked, that didn’t make me feel any better. His presence felt less like an affront than a scientific impossibility — just something that didn’t compute, and shouldn’t, couldn’t be, a rip in the fabric of expectation. Nobody but the residents have crossed our threshold since March ended. Have I unfit myself for visitors? If a friend were to come over, would it seem just as incongruous?

He could see we weren’t too happy. Through his mask, he told us that he wouldn’t come in any further if we didn’t want him to, but then he’d have to cut the wire. This felt like a bit of a backhanded threat, but by usual police standards, it wasn’t all that aggressive. We opened the second floor for him. One of his partners followed. I became conscious of their breaths, filtered through their masks, but still joining the rest of the air in our small stairwell. The equilibrium of microbes that we’d all carefully cultivated over the past few months was disturbed. What a ridiculous thing to be concerned about!, what an absurd thought to have, how inevitable it was, given everything that we’ve been through, that we’d be so preoccupied with the invisible.

Back upstairs in our flat, we graded ourselves on our crisis performance and found it wanting. Yes, we’d solved the problem and kept the cable on, but our alienated reaction to a stranger in the house alarmed us. For years, I was the guy who didn’t even want a front door; come on in, world, say hello, stay awhile, play a few games, touch all the surfaces. Now here I was with a mask on, my expression unreadable, bothered by the imposition of another masked face belonging to someone who was here to help. If we’d been bare-faced and able to gauge the intent behind our expressions, perhaps we would have acquitted ourselves better. Probably not, though. I’ve learned to fear my neighbor. For my own sake, and for the sake of the stranger, I need to unlearn that as soon as I can.

The doctor’s dilemma

Doctors don’t like to explain things. They know what they’re looking for, and there’s never any time to tarry. They might talk a little, but usually, they’d rather not be distracted from their incipient diagnosis by their patient. At first, I found this off-putting; honestly, I still do, but I think I understand it better now. They didn’t go to medical school to learn the Socratic method, and they don’t get graded on their bedside manners. A few of them develop it, but some really good ones never do. Hilary’s second surgeon is extraordinarily well regarded. If we ever were able to coax a complete sentence out of that guy, that would’ve been an unusually interactive day.

This means that doctors who do know how to communicate are now extraordinarily valuable — so valuable that I’ll gladly watch their narrowcasts wherever they happen to post them. By many orders of magnitude, they’ve been more helpful than the news. I’ve already written about Dr. John Campbell, who continues to put scary numbers in context without sugarcoating or sensationalizing anything; his daily dispatches have been a lifeline for me. YouTube made a deserving star out of the epidemiologist Kim Woo-Joo, whose late March interview on Asian Boss feels, in retrospect, like a turning point in the public understanding of transmission. Dr. Kim’s quiet but absolute incredulity at Western governments’ refusal to recommend mask-wearing was some desperately needed straight talk at a moment when Americans simply weren’t getting any. You’ll recall that in March, our authorities were, on the basis of nothing in particular, still assuring us that masks wouldn’t do any good. They were wrong, and the doctor was right. Eventually we’ve come around to his perspective. We should have deferred to him in the first place.

For his pains, and probably because of his skin color, too, Dr. Kim was accused of being in the thrall of the Chinese government. On its face, that seems like an absurd accusation to level at a South Korean scientist, but apophenia does create some crazy distortions in the minds of sufferers. Yesterday, Kim Woo-Joo went back on Asian Boss to dispel rumors, and address conspiracy theories head on. He made a persuasive case for a natural origin for the pandemic, and explained why the genetic sequence of the coronavirus ought to dispel any suspicion that it was lab-made. Dr. Kim likened misinformation-spreaders to climate change deniers, and, as scientists do, he stoically suggested that we should all be listening to scientists. Toward the end of the forty minute interview, he arrived at a moment of self-reflection, and he conceded that doctors can be abstruse. With the sort of absolute faith in the persuasive power of expertise that only good-hearted academics ever seem to possess, he told his interviewer that if we laid out the facts in the language of the common man, the public would come around.

Meanwhile, over on Dr. Campbell’s channel, the actual dynamics of common-man discourse in a media landscape dominated by click-driven tech companies was playing out. If you’ve followed my advice and watched Dr. Campbell’s videos, the YouTube algorithm has pushed you in the direction of wilder, more sensationalistic, and more partisan video channels — I’m not going to name any names, but you’ve seen the headlines by now. This is how social media companies work, and how they guarantee more time and attention spent on their sites: they start you off in the shallows, and then they let the rip currents of your own curiosity drag you out to sea. You think you’re going deeper, but really, you’re just farther from shore, and probably drowning. Anyway, Dr. Campbell’s comment section was overwhelmed by an army of enraged emigres from the audience of an irresponsible but very popular YouTube channel. Campbell’s offense: he’d reported on a New England Journal of Medicine study that had demonstrated that hydroxychloroquine was ineffective in the treatment of hospitalized coronavirus patients. He’d accidentally triggered a crowd who’ve maintained a near-religious devotion to the powers of hydroxychloroquine, even as the White House has, quite conspicuously, stopped talking about it. These self-appointed virologists threw stones at the study (useless, timed wrong, conducted improperly), the New England Journal of Medicine (a mouthpiece for the vaccine industry/big Pharma), epidemiologists in general (blind to the truth, haven’t watched Plandemic), and John Campbell (a dupe, or a plant, or worse).

Dr. Campbell was visibly stung by the criticism. It honestly broke my heart to see him on video the next day, attempting to direct his measured, reasoned, teacherly approach toward viewers who’ve got no interest in experiencing anything of the sort — people who’ve got it all figured out, and aren’t interested in changing their minds. Campbell, who has done nothing for months but make humble public service announcements, and who always posts verification links for everything he reports, tried his best to explain that he was merely relaying the findings of a medical journal. He was even generous enough to illustrate how hydroxycloroquine might interfere with the progress of the coronavirus: the chemical opens a gateway in the cell wall for zinc to penetrate, and the zinc blocks the pathogen from reproducing. Of course, he also had to point out that there’s no evidence yet that this works. I believe Dr. Campbell when he says that he’d like nothing better than for hydroxycloroquine to stop or slow the coronavirus; I feel the exact same way. But he’s not going to say it does until it’s proven that it does, because a real scientist never would.

I am not a scientist, but I am a science fan, and as a concerned fan, I’ve begun to wonder whether there is any room in the arena left for voices like Dr. Campbell’s, or Dr. Kim’s, or any other smart, compassionate medical worker who might demonstrate initiative and a similar facility with the camera. As the political argument rises in pitch, the good public health communicators are getting drowned out. The apparatus we’ve created — social media, I mean — is designed to suppress reasonable voices; it’s an outrage-fueled engine, and our crisis clicking has reinforced its efficacy. In March, social media provided platforms for reasonable people providing useful information about the pandemic. But once those first videos went viral, if you’ll pardon an expression that I hope we’ll now retire, the algorithms began pushing us toward outrageous expressions of similar ideas, baseless theories, casual calumny, whatever you’ve got. It’s been an accelerated version of the same phenomenon that has made rational discourse impossible and driven civil society into a ditch. If you’re going to use these services at all, please pick your spots wisely. Doctor’s orders, which in this case means it’s my order on behalf of the doctors.