Chronology of a Tragedy.

By 20 April 2020, 773,000 people in the United States had tested positive for the coronavirus.  Of these, 247,543 were in New York, mostly in New York City and its suburbs.  New Jersey had 88,806 confirmed cases.  That works out to about 32 percent of the cases being located in New York City and its immediate area.  If you include New Jersey’s 88,000, then New York is the center of about 43 percent of the cases.[1]

How did New York City come to be the present American epicenter of the coronavirus pandemic?[2]

“From the earliest days of the crisis, state and city officials were also hampered by a chaotic and often dysfunctional federal response, including significant problems with the expansion of testing, which made it far harder to gauge the scope of the crisis.”  The same was true of every part of the country, so that doesn’t explain why New York got hit hardest by far.

“Epidemiologists have pointed to New York City’s [population] density and its role as an international hub of commerce and tourism to explain why the coronavirus has spread so rapidly.  And it seems highly unlikely that any response by the state or city could have fully stopped it.”  The same seem likely to be true of the national government.  The question is how much government action could have limited the damage.

Nevertheless, in the view of Dr. Thomas Frieden, former head of the Centers for Disease Control and Prevention, closing the schools, stores, restaurants, and other public venues one to two weeks earlier could have reduced the death toll in New York by 50 to 80 percent.

 

January-February 2020: coronavirus “devastates” China and Europe.

 

21 January 2020: first confirmed case in the United States, in Seattle, Washington.

 

23 January 2020: Chinese government seals off Wuhan.

 

30 January 2020: WHO declares a global health emergency.

 

31 January 2020: US bars entry for any foreign national who had traveled to China in the previous 14 days.

 

It now appears that coronavirus was present in New York City before the first person tested positive for it.  Infectious disease specialists had known for weeks that the federal tests were defective and that infected people were almost certainly present and circulating.  One specialist in infectious diseases for a New York hospital group said later than it was apparent by late January 2020 that cases would soon appear in the United States.

 

2 February 2020: first coronavirus death outside China—in the Philippines.

 

5 February 2020: Japanese government quarantines a cruise ship which carried passengers infected during the trip.

 

7 February 2020: Infectious disease specialists and other doctors confer on federal criteria from the CDC for testing.  The guidelines were too strict and limiting on who could be tested.  According to one of those present, “It was at that moment that I think everybody in the room realized, we’re dead.”

 

Early February 2020: Dr. Oxiris Barbot, NYC Health Commissioner states that “this is not something you’re going to contract in the subway or the bus.”

 

14 February 2020: France announces first coronavirus death.

 

19 February 2020: first two cases in Iran announced.

 

23 February 2020: Italy sees surge in cases in Lombardy.

 

24 February 2020: passenger already infected by coronavirus arrives at JFK on a flight that originated in Iran.

 

24 February 2020: Trump administration asks Congress for $1.25 billion for coronavirus response.  US has 35 cases and no deaths.

 

28 February 2020: number of cases in Europe rises sharply.

 

Late February 2020: Mayor Bill de Blasio tells a news conference that “We can really keep this thing [coronavirus] contained.”

 

29 February 2020: first US death, in Seattle.

 

1 March 2020: the passenger from Iran tests positive for the coronavirus, making her the first identified case in New York City.

 

2 March 2020: Governor Andrew Cuomo and Mayor de Blasio address a news conference.  Cuomo says “Everybody is doing exactly what we need to do.  We have been ahead of this from Day 1.”  Cuomo told the conference that “Out of an abundance of caution we will be contacting the people who were on the flight with her from Iran to New York.”  Then everyone would be traced and isolated.  According to the NYT, this didn’t happen because the CDC would not authorize an investigation.

 

3 March 2020: lawyer in New Rochelle tests positive.  He had not travelled to any affected country, so there was reason to suspect he had contracted the virus in New York.  City health investigators traced his travels and contact to Manhattan, but the state of New York put a “porous” containment line around New Rochelle.

 

3 March 2020: US government approves widespread testing.

 

5 March 2020: New York City mayor Bill de Blasio said that “You have to assume that it could be anywhere in the city.”  However, he also said that “We’ll tell you the second we think you should change your behavior.”

 

If Dr. Frieden is correct that the city should have shut down one to two weeks before it did, then that date would have been sometime between 8 and 15 March 2020.

 

About 7 March 2020: city hospitals start reporting a sharp increase in influenza-like cases and the NYPD reported increased numbers of officers calling in sick and of 911 calls for coughs and fevers.

 

Second week in March 2020: De Blasio wanted widespread testing, but the city’s Health Department urged a public information campaign to tell those with mild symptoms to self-isolate at home, rather than infect others at testing centers.  De Blasio blocked the public information campaign for about a week.

 

At some point not stated by the NYT, de Blasio did urge New Yorkers to practice social distancing and working from home where possible; and de Blasio and Cuomo had both ordered occupancy limits on bars and restaurants.  These limits were broadly ignored.

 

Moreover, de Blasio resisted closing the schools.  The schools provide nutritious meals and a safe space, and not in some touchy-liberal sort of way either, for their students.[3]

 

11 March 2020: US bars most travelers from Europe.

 

12 March 2020: San Francisco closed the schools when 18 cases had been confirmed; Ohio closes the schools when 5 cases had been confirmed.

 

12 March 2020: At a meeting chaired by de Blasio, City Health Commissioner Barbot told a meeting of business executives that 70 percent of the city’s population could become infected.  De Blasio “stared daggers at her.”

According to one person present at the meeting, de Blasio rejected closing restaurants.  “I’m really concerned about restaurants; I’m really concerned about jobs.”  It was a legitimate concern from one perspective.  According to one estimate, tourism accounts for 300,000 jobs in New York City.  This is twice as many as does the tech jobs and vastly more than the jobs linked to the financial services industry.[4]  Closing down restaurants, bars, tourist activities, hotels, and sporting events would hammer the incomes pf poor people much than the incomes of rich people.  He appears to have thought that New York City would never have to close.  In reality, it was a choice between closing the city earlier or later.  However, in the event, the virus spread rapidly.  The health burden has not been shared equally between different social groups.[5]

 

13 March 2020: Trump declares national emergency.

 

13 March 2020: Los Angeles closes its schools after 40 cases had been confirmed.  New York City had almost 160 confirmed cases.

 

15 March 2020: City health officials give de Blasio a grim warning about the number of infections and deaths if the schools—and most businesses—weren’t closed immediately.

 

15 March 2020: De Blasio closes the schools when 329 cases had been confirmed.

 

15 March 2020: CDC recommends no gatherings of more than 50 people.

 

17 March 2020: seven California counties around San Francisco issued stay at home orders.

 

17 March 2020: France orders national lock-down.

 

19 March 2020: California issues state-wide stay at home order with 675 confirmed cases.  New York then had 4,152 cases.

 

20 March 2020: New York State issues state-wide stay at home order, effective 22 March 2020.  On 20 March, the state had more than 7,000 confirmed cases.

 

Recently, the New York Times ran a piece considering the long-term consequences of the pandemic’s impact on New York.[6]  Much of the economic basis of the city may be hollowed out.  This is particularly true if a vaccine is not developed and mass-produced very soon.  Tourists may shrink from visiting a densely-crowded city.  Tourist amenities from theaters to museums to restaurants to public transportation systems may impose social-distancing regimes that capsize the business model of the industry.  Both the financial services and technology sectors may extend their work-from-home adaptations, while many workers may decide that the home from which they are working might as well be somewhere other than high-price New York.  Demand for office and residential space could fall, clobbering the construction industry.  The city’s budget would have to deal with a huge fall in revenue.  Services to the poor would fall.

Sometimes Tragedy is born of the collision of two Goods.

 

[1] “Tracking an Outbreak,” NYT, 21 April 2020, p. A4.

[2] J. David Goodman, “How Outbreak Kept New York A Step Behind,” NYT, 8 April 2020.

[3] See: Andrea Elliott, “Invisible Child.  Girl in the Shadows: Dasani’s Homeless Life,” NYT, 9 December 2013.  http://www.nytimes.com/projects/2013/invisible-child/index.html#/?chapt=1

[4] J. David Goodman, “It Could Be Years Before New York Regains Its Glory,” NYT, 21 April 2020.

[5] For one example, see: John Eligon et al, “Black Americans Bear The Brunt As Virus Spreads,” NYT, 8 April 2020.

[6] J. David Goodman, “It Could Be Years Before New York Regains Its Glory,” NYT, 21 April 2020.

Vaccination 16 October 2019.

Some diseases can be transmitted from one person to another person or from other sources to humans.  These “transmissible” diseases include HIV/AIDS, tuberculosis, malaria, measles, pertussis/whooping cough, syphilis,[1] Hepatitis B, pneumonia, influenza, a host of tropical diseases, and smallpox,  .

Fortunately, the human body has a defense system called the immune system.  Unfortunately, it isn’t always strong enough to resist diseases, especially “new” diseases that a community has not encountered before.  The body has to develop immunities over time.  For thousands of years, people have known that people who have been sick with a disease and survived, then don’t catch it again in the future.  They are immune.

Sometime between 900 and 1000 AD, a Chinese doctor wondered if giving somebody a very mild case of an infectious disease could make them immune to the more severe version.  Basically, make a small cut, pour in some infected material,[2] bandage up the cut, and wait for the patient to get not-as-sick.  Over time, this important knowledge migrated westward from China to India to the Ottoman Empire in the Middle East.

From 1716 to 1718, Sir Edward Wortley-Montagu (1678-1761)—a very rich British aristocrat—served as ambassador in the Ottoman Empire.  He took along his wife, Lady Mary Wortley-Montague.  She was beautiful, intelligent, and very independent minded.  Her younger brother had died of smallpox and she had lived through a case herself.  When she accompanied her husband to Istanbul, her inquiring mind vacuumed-up information.  One thing she picked up was that the Turks had a method for preventing full-blown smallpox.  She had it applied to their young son.  Back in England, she became a strong advocate for this method, called inoculation.

It didn’t catch on entirely because the risk of developing full-blown smallpox.  Then, in 1796, Dr. Edward Jenner tried inoculating a patient with the related, but far less dangerous, disease called cowpox.  This worked very well without running any grave risks.  The Latin word for cow is “vacca,” so Jenner’s method came to be called “vaccination.”

In the 20th Century, the American medical researcher, Dr. Maurice Hilleman (1919-2005) discovered vaccines for forty diseases.[3]  He saved more lives than any medical researcher in the Twentieth Century.  For much of his career, he worked for Merck in Montgomery County, Pennsylvania.

Since 1945, the World Health Organization of the United Nations has sponsored vaccination programs around the world.  Especially in the “developing world” these efforts have massively reduced childhood deaths.  In 1990, there were 93 deaths per 1000 live births; in 2017, there were 39 deaths per 1000 live births.  If you don’t want to do the math yourself, this is 1 in 11 children dying before reaching age 5 in 1990; versus 1 in 26 children dying before reaching age 5 in 2017.  Anyway you cut it, this is a great story of human progress.[4]  Not that it will appear on the nightly news.

[1] When my Dad was in the Army, guys with syphilis used to say that they must have caught the disease in a bathroom.  Doctors often asked “Wasn’t the tile floor cold?”

[2] The powdered scab of smallpox patients, for example.  I never said it would be pretty.

[3] Including those for measles, mumps, chickenpox, influenza, pneumonia, meningitis, and Hepatitis A and B.

[4] See: “The Man Who Saved a Billion Lives.”