Started coughing a bit on Saturday. Alarming, naturally. I’d come to believe, all those years ago (Saturday) that there was and could be no other disease left on earth—just the one. But it’s now Wednesday, and still no fever: I seem to be on the mend. Seems to be a regular cold, a bit snotty. So, not coronavirus?
But what if I have had an anomalous case of the coronavirus (COVID-19, rather, the name of the disease)? Fever is not always present, seemingly. So just in case, I’ve stayed holed up at home since Saturday, venturing out for walks only to the park with my husband, where I can be sure of not getting near anyone. (Six feet! and no petting dogs!) We’ve been subsisting luxuriously on the stores I’d been slowly squirreling away. Sadly, these include irresistible heaps of this salty, delicious dark chocolate with almonds.
But this morning I realized with a jolt that I have no earthly idea of when it will really be safe for us to go back out, even just to buy food. When will I know I’m “well”? What if I’ve had a mild case of COVID-19 and still am infectious? What if O. is infectious just from being near me? So I phoned public health expert Dr. James Hamblin, who wrote the seminal piece about coronavirus at The Atlantic hundreds of years ago (February 24th), to find out how best to proceed.
What I learned was shocking. We already know that the federal government utterly botched the response to the pandemic by failing to organize mass testing. So my thought since Saturday had been well, eventually there will be enough tests, maybe in some weeks, and then I can get one, and when I’m in the clear I can at least go to the market once in a while?
That was my first question for Dr. Hamblin. (This conversation has been edited for brevity and clarity.)
If you have a cold and you never had a fever or anything and you’ve decided to stay home, should you wait and just continue to stay home until you can get tested?
That is a question that has been on my mind for the last month… I’ve been looking into the sensitivity of the tests. The problem is that we have so few tests, so for now they only need to be used where they would really make a big difference.
But even when we have more, there will be difficulty in telling you definitively that you don’t have it. If it’s positive and you’re sick, that’s a 99.9% [indication] that indeed, you’re sick from that virus; but if you’re feeling moderately bad, and then you get a negative test? It can’t definitively say that you don’t have it. And that’s what we really need it for, because if we could tell you and acknowledge that you definitely don’t have this, you’re safe to go out, that would be really valuable. But the current test won’t be able to do that.
[So there’s no way yet to know, absolutely and for sure, that you are not a carrier of the new coronavirus.
We’ve already seen what happened as this thing quietly spread for weeks in Seattle. To say nothing of Italy, where the attempt at containment came far too long after the period of silent dissemination. Which means I’ll have to order in a lot more supplies, it looks like.
I want to overreact, especially in the absence of federal leadership. I plan to do what the government won’t tell us to do. Stay home. No public transport, no travel, no close contact even with my kids in case I’m contagious. Everyone can limit contact, all contact if you can manage it, and it will help.]
We went on to talk about risks, and mitigation, and what people can do for one another.
There’s people in Italy being treated in the freaking hallways!?
Right, and that’s what I’ve been trying to warn against. What we need are local triage facilities and clear directives on when to go, and when not to go… We should be planning for triple capacity.
When a disease starts killing or extremely sickening younger, healthier people who don’t usually die of the flu, that is what gets people really panicked and scared: A break from the “normal” “accepted” loss level. That’s a crass way of putting it. But that’s what we have here, you have a few young doctors, you know, and healthier people [who’ve fallen gravely ill or even died], and suddenly there’s a realization that no one is free of this, it’s not just about spreading it, and that’s what gets people to care.
Which is sad. You should care just because you’re a vector.
Given that the government response has been so shambolic, what is the best thing to do?
Yeah… yeah. I’ve actually felt this real sense of purpose right now. There’s an opportunity for everyone to commit to helping someone—everyone knows someone whom you can help to prepare, or who doesn’t yet have that sense of urgency. A neighbor or contact who may end up having to do self-quarantine—helping everyone else around you to prepare for different contingencies. To kind of feel that you’re making a difference, and that there’s something purposeful you’re doing. Kind of a grassroots thing.
How do we amplify the grassroots thing?
Paul Farmer alerted me to something that happens in these moments, when everyone has a common concern, or a common enemy, and that can be really unifying. Like everyone’s really sad right now, and would like to do something productive, and feels a little helpless and a little uncertain. I think people are hungry for that reminder, that message, that there are clear, concrete things that you can do to help other people.
Yeah! like stay home, if you can.
Yeah, and reach out to whoever might benefit from getting checked in on.
Because in ten days, what are we looking at? We’re already in a different world, for sure.
Oh yeah, no. Totally. Everything’s gonna change.
Update, 19 March 2020: all mended, and also under ‘shelter-in-place’ orders here in the Bay Area.