Refrigerated trucks for covid-19 victims will be the symbol of this age

It’s 4:30 in the morning and I’ve stepped out of my Manhattan ER for a quick “mask break.” After carefully unwrapping my face, I walk down the ramp into the cool night air. The street, which is normally bustling, even at this hour, is quiet. Very still — except for the steady hum of the refrigerator truck parked hastily between the garbage bins. Every disaster has its images, its symbols. For covid-19, it might just be the refrigerator truck. It’s our overflow morgue, holding the patients we could not save.

Death is part of what I do: I’m an emergency room doctor. I chose the job; death comes with it. But death isn’t supposed to be like this. I’ve always thought that it’s a privilege to take care of people in the ER. It’s a privilege to help them on their worst days, and it’s a privilege to help them and their loved ones on their last days. But the coronavirus changes that. We can’t allow visitors. They carry the disease. Families are forced to be socially distant even in tragedy. Death is quiet now, lonely, steady and impersonal.

It’s easy to be overwhelmed by the scale of this disaster. Understanding a catastrophe is difficult. Even now, five states don’t have stay-at-home orders. Three more have only partial orders. If you live in one of these places, please understand our story. And then take steps. Test so that the path of the virus can be mapped, and shelter in place so that it can be blocked on its lethal journey down that infinitely branching path.

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In New York, in early March, we received reassuring advice from our public health authorities. We only have a handful of cases and we’re prepared. Go to work, travel, everything is fine. But everything wasn’t fine. The virus was already spreading in the community. People were reassured that a 1 percent fatality rate wasn’t that bad. It turns out that 1 percent is a horrifically perfect number. It’s low enough for the disease to avoid detection, but large enough to kill millions of people if left unchecked. Diseases with high fatality rates, like Ebola, announce themselves when sick patients arrive at hospitals in increased numbers. One percent buys covid-19 time. The virus spreads in the community before health officials even know it’s there. A handful of known cases indicates several hundred infections, which is why the prevalence grows exponentially. On March 16, New York diagnosed 235 cases. Two days later, on March 18, New York confirmed 789 cases. On March 20, that number was 2,945 cases. If you’re reassuring yourself that your region only has a couple cases, you’re wrong. Lock down now! That’s the math of 1 percent.

The linchpin of our undoing has been testing. If you don’t test, you don’t know you have a problem and you won’t have the political will to act. This problem quickly becomes so big that you can’t test everyone with symptoms. That’s a paradox of pandemic proportions. Most large urban public health departments have responded to testing shortages by not testing outpatients. The logic goes something like this: If people are practicing social distancing, a test won’t make a difference. But it does make a difference. Patients with positive tests will take measures to protect their families. Patients who don’t get a test in one place will stand in line somewhere else.

There is a public health solution. Freeze the swabs. If you’re running short of lab reagents or lab personnel, swab anyway. In a couple of weeks, you can run these swabs and reveal the archaeology of the epidemic. It’s like being able to look back in time, so you can understand where the epidemic is headed.

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The coronavirus has been worse in the United States because of our politicization and division. The United States and South Korea each diagnosed their first covid-19 cases on the same day in January. Since then, 211 South Koreans have died of covid-19 compared with 19,000 Americans. To get this under control, we all have to do the same thing at the same time. If we don’t, we might stamp out the virus in one part of the country only to have the epidemic reignited by a traveler from some other part of the country. The governors of Utah, Wyoming, Oklahoma, Nebraska, North Dakota, South Dakota, Iowa and Arkansas need to issue stay-at-home orders. Division is dangerous for all Americans and particularly lethal for those of us risking our lives on the front line. If we stay fractured and our response remains divided, we, our loved ones, our friends, our neighbors and strangers will share the same fate met by too many of my patients — the refrigerator truck.

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