NEW YORK — Leora Horwitz has seen other disasters. Now the director of the Center for Healthcare Innovation and Delivery Science at New York University Langone Medical Center, she was a resident in a New York intensive care unit on Sept. 11, 2001, and chief resident during the blackout two years later. But working in the hospital to fight the novel coronavirus that has stopped the U.S. economy is like nothing she has ever experienced.
Normally transferring a single patient to the intensive care unit, or watching one die, is enough to ruin her week. Now, she is transferring one patient in five. “That’s just not normal,” said Horwitz. What’s worse is that to protect others from infection, patients are kept alone. “We’re setting up Skype so that they can see their actual faces and not just talk on the phone. We’re doing whatever we can, but they’re basically still alone.”
It’s difficult to think of the situation in New York City, where Horwitz is practicing, without casting back over the last four months to try and understand what went wrong. There are some 69,000 confirmed cases in the city, and 2,700 deaths — a fifth and a quarter of the national total, respectively. Looking at daily surveillance data, you can see cases of pneumonia crashing into the city’s emergency rooms at an unprecedented and terrifying rate. The city has sent out refrigerated trailers to keep up with the bodies. And the official counts of both cases and deaths are almost certainly low.
Another New Yorker, cancer researcher and Pulitzer Prize-winning author Siddhartha Mukherjee, is unsparing when he talks about the U.S. response. “We started with a D-,” Mukherjee said. “And we slowly are climbing back to a non-failing grade.”
Mukherjee, who is doing publicity for the two-part PBS special based on his book, “The Gene,” gives a now familiar list of stumbles. Diagnostic testing for the virus needed to start on a widespread basis in January or February, as it did in South Korea, so that the U.S. could understand how fast the novel coronavirus, SARS-CoV-2, was spreading. Instead, testing ramped up in March. At the same time, protective gear for health care workers should have been brought to hospitals in areas that were looking as if they might become hot spots. And steps to create social distancing — closing schools, stopping travel, preventing the spread of the virus — all needed to occur much sooner.
“If you wind the clock backwards, you can see at every step how this economic catastrophe could have been avoided,” Mukherjee said.
The U.S. is like a champion runner who forgot to tie his shoes. An otherwise world-class diagnostic testing industry wasn’t brought to bear until it was too late. When it was, there were supply problems that might have been prevented. And all of us were held back by the sense that this just can’t be happening. Even New York Gov. Andrew Cuomo, who has emerged as one of the nation’s leading voices on the coronavirus response, probably waited too long to take on dramatic steps such as school closures.
“What’s been shocking, really, has been that it’s made us realize that all of these mechanisms were made or left extremely vulnerable in the last four to five years,” Mukherjee said. “And because of these vulnerabilities in each of these mechanisms, we have a situation where we’re suddenly seeing a pandemic in the United States [that] could have been controlled much, much better in its early phases.”
What’s missing is an appreciation of the value of data, and humanity’s mastery of it, as the one weapon we have against an out-of-control virus. The desire to ignore the epidemic and the one to embrace would-be treatments before they’re proven boils down to the same thing: the desire to believe that you can force the world into being fixed without understanding it first. There is no debate that medicines are needed, but we need to make sure we find the right ones.
Another example: the simple face mask, used to prevent infection. Initially, many experts said masks should be reserved for health care workers. On Twitter, Mukherjee has become an evangelist for the idea, now popular, that everyone should wear one. But there’s a problem. Which masks?
“Because there is no central masking authority, as it were, no one knows which ones work and which ones don’t work and which ones are made of what material and who’s decontaminating them,” Mukherjee said. “Because there’s no place to go to find out.”
Whether a mask made from a T-shirt prevents infection is a scientifically testable hypothesis. But we need to conduct the tests. What we’ve been missing throughout this terrible battle is information — data, well-analyzed.
It’s a lesson we could learn from Horwitz, the ER doctor, too. At NYU, she said, she’s being spared some of the worst depravations of the pandemic. She herself works on the project to keep track of protective masks and other gear. In other places, doctors are reporting that it can take days to get a Covid-19 test result back. At NYU, Horwitz said, the tests are done in-house and come back within hours.
Of course, it’s still not enough. Almost every patient she sees has Covid-19, with the same syndrome: low fevers that slowly creep up to become unrelenting, low blood oxygen that leads patients to pass out, and a dry, raspy cough. It’s not anything like the flu.
“We don’t really know if anything is effective,” she said. “The severity of illness, the sort of obviousness of some patients that they’re going to get worse, coupled with your inability to do anything about it, that’s what really makes it hard. It’s sad and you feel helpless.”
For now, the only thing most people can do to slow the spread is to stay home, and she asks everyone to do that. But the next phase in this battle will involve making sure that we make better decisions, based on better information, than we have so far.