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Coronavirus (19): Reality Check

As many readers know, I have a whole lot of pre-existing medical conditions, including a lifelong congenital intestinal disorder. To enumerate all of the pre-existing medical problems, it would take up a bit more of this post than is necessary. But I am taking two prescribed drugs to control high blood pressure, and on that count, I'm doing quite well. And yet, though there has been no noticeable spike in my blood pressure, I have to say that there are fewer things that make my blood boil than the ongoing stream of naysayers who seem to be completely blind to the stubborn facts of the current Coronavirus pandemic.

The CDC is now combining confirmed Coronavirus deaths and probable deaths related to COVID-19 in its total casualty count. Some of the naysayers argue that this is artificially inflating the numbers.

I can only speak to the situation in New York state, with nearly 270,000 confirmed cases of Coronavirus. It is the state with which I am most familiar, because I've lived here my whole life. If anything, from what I see, the number of cases is vastly underestimated. It is highly likely that most people are asymptomatic. And while many businesses have closed---having a disastrous effect on the local and national economy---most people seem to be acting quite rationally in the current context. Most of those who are symptomatic are voluntarily self-quarantining and practicing social distancing. Indeed, to my knowledge, nobody is being arrested in NY state for coming out of their homes whether they are symptomatic or asymptomatic. New Yorkers are taking the most prudent actions, under extremely stressful, extraordinary circumstances, without anybody putting a gun to their heads. This is clearly having an effect on slowing the spread of the virus. The state reached a plateau of over 700 deaths per day and for the last few days, there has been an average of 400+ confirmed cases of Coronavirus-related deaths per day.

But there is growing evidence that the number of confirmed cases vastly underestimates (rather than inflates) the number of those who have been infected with the virus. A new random statistical survey of people out and about in public, typically coming in and out of grocery stores, was conducted in New York state, and it is reported that 13.9% of those tested had antibodies for Coronavirus. Some have suggested that up to 2.7 million people in New York may have become infected with this virus. If one could find a silver lining in the cloud hanging over us, that's actually a "good" statistic. It means that the great bulk of people who have been infected are either asymptomatic or have not had symptoms severe enough to require hospitalization. Perhaps some kind of "herd immunity" will eventually arise, but that remains to be seen. There is still no "cure" for this virus and no vaccine.

It should be noted, however, that up to this point, New York state hasn’t been doing much mass testing (though New York City is finally opening testing centers in some hot spots, especially in minority communities). Tests have been conducted almost exclusively on people who are symptomatic---but many of those who are symptomatic don’t even get tested. Their voluntary self-quarantine typically allows the virus to run its course---or not. The "not" refers to those who never make it to a medical facility---and who die at home. They may never have been tested for the virus; hence, they are counted by the CDC as among the "probable" deaths from COVID-19.

What kills me, no pun intended, about the naysayers who doubt the extent of the death and destruction of this pandemic is that even if there are significant pre-existing conditions that predispose many folks to becoming infected with---and dying of---the virus, something about this virus therefore becomes a crucial factor that has led to a horrifying spike in the number of deaths being recorded in the state of New York. Perhaps it becomes the straw that breaks the camel's back, so-to-speak, for people who would not have died otherwise.

So the naysayers need to explain why in hell there have been 20,000+ deaths in less than two months in my home town. Why are so many people dropping dead at the same time? If not COVID-19, then WTF! I'm all ears.

It is almost irrelevant at this point how accurate the statistics are. You cannot deny the evidence of your senses. This is beyond belief. As a resident of what has become the epicenter of this disease in the United States (and certainly one of the hottest spots in the entire world), I feel like I'm living in some sick surreal apocalyptic sci-fi movie or some new incarnation of an epic Biblical film. Indeed, as a fan of "Ben-Hur," I've started referring to this place as the Valley of the Lepers [YouTube link] and to Brooklyn as one of the five Leper Colonies of New York City. (And before the epidemiologists start jumping all over me: Yes, I know the difference between an infectious bacterial disease such as leprosy and a viral infection, such as COVID-19. It's just a metaphor in the spirit of gallows humor.)

But let me speak a bit anecdotally for just a moment.

Due to that lifelong congenital intestinal illness I mentioned above, I had to be rushed to Emergency Rooms five times between December 7th and February 29th. My hospital of choice for such visits has been Mount Sinai Brooklyn, closest to my home in the Gravesend section of the County of Kings.

While ERs are typically overcrowded with people suffering from all sorts of illnesses and accidents, there was a distinct difference between my first visit to Mount Sinai Brooklyn in December and my last visit on the afternoon of February 29th. On that Leap Year Day, the ER was utterly insane, completely inundated by an astounding inflow of patients. It was as if some earthquake had struck, and the place was being flooded by survivors in need of immediate medical attention. I was stuck in there for nearly six hours, even though I'd been rushed passed triage and right into the ER proper. I couldn’t believe what was going on around me. It was, ironically, the day before the first confirmed COVID-19 related case was reported in New York state and fourteen days before its first reported death. But something was clearly wrong.

Most of the incoming ER patients were suffering from acute respiratory distress. The hard-working EMTs, nurses, and doctors I spoke with that night were telling me that they’d never seen anything like this in their lives. That was then. But this is now---and that Mount Sinai ER, like virtually every ER across the tri-state area looks like a battle zone. Just check out the observations of Dr. Peter Shearer at Mount Sinai Brooklyn, way back on March 26th. Since then, the situation has only gotten worse. Yes, the rate of hospitalizations are going down throughout the state. But this is mass death on a scale that none of us has seen in our lifetimes.

So let's return to those controversial numbers of "confirmed" versus "probable" deaths from the virus. From New York magazine:

As of Thursday morning [23 April 2020], there have been more than 263,754 confirmed cases of the coronavirus in New York, including more than 138,435 in New York City. More than 15,740 people with COVID-19 have died in the state, not including the deaths of people with probable cases.

The CDC lists 20,000+ COVID-19-related deaths here in New York state, so let’s just throw out the 4,000+ "probable" (rather than confirmed) deaths from the virus here in New York. And I mean that with the utmost respect to the families whose 4,000+ loved ones have died suddenly and without full confirmation of cause of death. We’re still talking about close to 16,000 confirmed deaths related to Coronavirus infection, in less than two months. I won't even address this issue globally. So what in hell could possibly account for this spike in mass death in this state?

I have read some persuasive theories about what may have happened here in New York though I know that it is going to be a very long time before this crisis can be fully understood on any number of levels, from the epidemiological to the political to the economic. There is growing evidence that the virus was most likely manifested here as far back as January. And that would make some sense. After all, from mid-December until mid-January, New York City in particular typically attracts millions upon millions of tourists from all over the world. They come here to see the Christmas Tree in Rockefeller Center or to see the Ball Drop in Times Square (and I'm not even considering the possibility of the millions of folks who came to NYC at the end of November for the Thanksgiving Day weekend). And most of them make use of a mass transit system that typically transports over five million people per day. I can't think of a more perfect petri dish for the transmission of an infectious disease. In fact, Dr. Jeffrey E. Harris maintains in a new study (pdf document) that the subways most likely became a key component in the deadly spread of COVID-19 throughout New York City and the tri-state area.

I already know too many people who have been infected by this disease and several who have died, including one of my sister's former students. My immediate family remains okay, but I would not be surprised if we all test positive for antibodies at some point. Neighbors to the right of me, neighbors to the left of me, remain on ventilators in Intensive Care Units in various local hospitals. We may have reached a plateau. And we will surely come out of this pandemic better than before.

But this "reality check" remains a sobering reminder that something terrible has impacted too many lives.

Postscript (24 April 2020): I wanted to thank Irfan Khawaja for linking to this entry on his Policy of Truth blog. He states there, in an installment of his "Coronavirus Diary (51): Reality Check with Chris Sciabarra":

As philosophers from Plato to Popper have argued, there's enormous value in the dialectical clash of divergent opinions: we learn, and arguably converge on the truth, through the process of disagreement. But there's also something to be said for the solidarity produced by agreement on basic facts and values, as well as a sense of shared purpose. Throughout the COVID-19 crisis, I've relied on different people for one or both of those things, but relied consistently on Chris Sciabarra for the latter: for whatever reason, Chris and I basically agree on how to think about the COVID-19 crisis, as well as what to do about it.
To that end, I highly recommend his most recent blog post (the nineteenth in his series), Reality Check, on life and death in New York as a result of COVID-19. And check out the links, especially the paper near the end by Jeffrey Harris of the National Bureau of Economic Research, "The Subways Seeded the Massive Coronavirus Epidemic in New York City." Arguably, the problems Harris describes there haven't yet been resolved, and won't be until New Yorkers deal with the problems of homelessness and housing in their city---yet another indication of the interconnectedness of what are often thought of as discrete "topics." Among other things, Harris’s paper raises a practical question for me: what do I do with my old MTA subway cards? Get them the hell out of my house, or donate them to science?
I have two maps on my office wall, one of Palestine and one of the New York-New Jersey metro area; I think of both, in some sense, as "maps of home." I've often found myself musing on the fact that the one-horse "transit hub" where I live in Jersey, Whitehouse Station, is located at almost exactly the same latitude on the map as Sciabarra's neighborhood in the Gravesend part of Brooklyn. I don't know that that really explains anything, but as far as COVID-19 is concerned, it’s a metaphor that captures what matters.

And while you're at it, check out Ilana Mercer's newest column, "The Ethics of Social Distancing: A Libertarian Perspective."

Postscript: On another thread I posted the following comment:

All crises are used by governments to expand power over our lives---including nightmarish events, like 9/11, which also struck my hometown in a way that made our everyday lives into a total nightmare for months on end... and for years on end---for those who are still dying from diseases contracted while working on "The Pile" at Ground Zero. I've had disagreements with people on this very thread about how the US government used 9/11 as a pretext to make some of the worst foreign policy mistakes in the history of this country---coupled with a never-ending attack on our liberties at home.
Still, for the benefit of those who are reading this thread, several things need to be acknowledged:
First, though flu and pneumonia have killed people in NY state (as they do every year in every state), they have never taken this many lives in this short a period of time the way COVID-19 has done. And in my post, I'm fully cognizant of the fact that people who have pre-existing medical conditions are particularly susceptible to this virus, and that it may be just the "straw that breaks the camel's back" for such individuals. Regardless: The hospitals almost reached the breaking point here in trying to meet the overwhelming flow of patients into emergency rooms. The flu and pneumonia don't even register as a BLIP on the radar compared to what has happened here in the past two months.
Second: I clearly recognize that One Size Does Not Fit All. I do not recommend that Alaska (with 339 cases and 9 deaths) follow the same social distancing policies as New York. In this state, and especially in this city, I am hunkered down in my apartment to preserve my very life---and I'd venture to say that most people are doing this voluntarily and willingly. In my own neighborhood, I don't know a single family that has not been affected: Every person knows somebody who is sick, dying, or dead.
Finally, this crisis does not give local, state, or federal authorities a license to take away any of my rights to liberty, property, or the pursuit of happiness---and there is not a liberty-minded person among us who should not remain vigilant against the very real threats to our freedoms that a crisis like this has ignited.
But at this time I'm far more concerned with preserving the most basic right of all: my right to live. And I'm trying to preserve that the best way I know how.

Postscript (5 May 2020): Thanks to Amir Abbasov for translating this blog essay into Azerbaijanian and to Jean-Etienne Bergemer for translating this blog essay into French.