The Plague Year: America in the Time of Covid

by Lawrence Wright

The researchers estimate that the Biogen outbreak may have been responsible for more than 300,000 cases worldwide.

WHO had repeatedly proclaimed that large respiratory droplets—as from a sneeze or cough—drove the spread. This conclusion wasn’t based on data about the new virus, Lemieux said. “It was received wisdom on how previous respiratory viruses had behaved.”

Guinea pigs are the only rodent that can cough and sneeze, which makes them ideal for respiratory experiments.

In the case of the Diamond Princess, a single infected passenger spread the disease to 687 of the 3,711 passengers and crew—at the time, the largest outbreak outside of China. Researchers were stunned that 18 percent of the passengers who were infected showed no symptoms at all.

That percentage would prove to be far lower than in the general population because the passengers tended to be older and more likely to become extremely ill. Later studies determined that most of the spread of the infection was through aerosol droplets that could float through the air—down hallways, lingering in bathrooms, drifting through the dining halls. The infection rate of the disease on the Diamond Princess was eventually put at 19.2 percent; on some vessels, it reached 60 percent.

Five million people had left Wuhan before Chinese authorities locked the city down. From December to March, there were 3,200 direct flights from China to the U.S., arriving mainly in Los Angeles, San Francisco, and New York. Sixty percent of flights from Italy to the U.S. landed in New York. They brought a new mutation of SARS-CoV-2 that would prove to be even more contagious than the Chinese original.

The next day, the WHO finally declared a pandemic. By that time there were more than 100,000 cases in 114 countries, and 4,291 had lost their lives. “It will go away,” the president remarked. “Just stay calm. It will go away.”

On March 6, on his way to play golf at his resort in Palm Beach, Mar-a-Lago, the president stopped off at CDC headquarters in Atlanta. There were no more dire warnings from this quarter; the CDC was now a captive agency. The object of the president’s visit was to publicize the fact that the revised CDC test was finally ready. The president claimed to feel right at home in the laboratory because of his innate understanding of medicine. “My uncle was a great person,” he said. “He taught at MIT for, I think, like a record number of years. He was a great super genius. Dr. John Trump.*1 I like this stuff. I really get it. People are surprised that I understand it. Every one of these doctors said, ‘How do you know so much about this?’ Maybe I have a natural ability.”

I don’t watch CNN. That’s why I don’t recognize you.” “Oh, okay. Well, nice to meet you.” “I don’t watch CNN because CNN is fake news.”

Insurrection was afoot. There was talk of delivering an ultimatum to the mayor: “Either pivot to pandemic planning today or they start to deal with a health department that won’t follow his orders.” Mayor Bill de Blasio was under the spell of an email from Mitchell Katz, the CEO of New York’s sprawling municipal healthcare system, who counseled the mayor to keep the city open. “Canceling large gatherings gives people the wrong impression of this illness,” Katz wrote. “If it is not safe to go to a conference, why is it safe to go to the hospital or ride in the subway?” He argued, on the one hand, that the “terrible problem” in Italy was unlikely to happen in New York and, on the other, that many New Yorkers were going to get infected anyway. “Greater than 99 percent will recover without harm. Once people recover they will have immunity. The immunity will protect the herd.” The mayor then went on Morning Joe and said a number of things he would soon regret, starting with his pledge to keep the schools open, even if students fell ill. “If you’re under fifty and you’re healthy, which is most New Yorkers, there’s very little threat here.”

Hayek’s 1945 article “The Use of Knowledge in Society,” which argues that central planning can never replace market forces, which reflect the sum total of the “decentralized knowledge” available to a society. Jimmy Wales has said that he read Hayek’s article as an undergraduate and it was central to his decision to create Wikipedia.

Hubbard was involved in that discussion in Washington. As policymakers addressed the greatest economic crisis in nearly a century, Hubbard warned them that it was more dire than they imagined. “I and other economists had been worried about a doom loop since the beginning of the pandemic,” Hubbard recalled. A doom loop is a term in modern economics that means a cycle of negative feedback. When the pandemic hit, the world suffered a supply shock: trade was disrupted, factories closed, stores shuttered. If workers didn’t start earning again soon, the supply shock could turn into a demand shock, which would further weaken supply, which would increase unemployment and further diminish demand. The doom loop.

With the Democrats fully on board, Congress soon approved the Coronavirus Aid, Relief, and Economic Security (CARES) Act. It included $260 billion in increased unemployment benefits, $300 billion in one-time cash payments to citizens, and $350 billion in forgivable loans to small business, a figure that would be substantially increased in subsequent legislation. “We went from ‘We don’t know what to do,’ to nine hundred pages and $2.2 trillion in about ten days,” Delaware senator Chris Coons marveled. “I’ve never seen anything like it. This will be the biggest bill in our lifetime.” It passed the Senate on March 25, with a vote of 96–0. The president signed it into law two days later. “Nothing like a big shock to help people become more bipartisan,” Glenn Hubbard observed.

“We oversimplify, as if the average person is infecting 1.1 other persons, when in fact one out of twenty people is infecting twenty or thirty people and the other people are infecting zero to one people.” There was no way to identify who the superspreaders are. “You gotta pounce on cases quickly,” Frieden said, “and with that you can find superspreading events early and stop them.”

Social scientists have pointed out the decline of membership in clubs, unions, civic organizations, scouting, and churches; the bonds of community have been fraying for decades as people retreat into their virtual lives and politics becomes the main source of identity.

A dozen ships made it to Sicily, in October 1347. The plague traveled with them. Sicilians were appalled to find dead men still at their oars. Other sailors, dead or barely alive, were in their bunks, riddled with foul-smelling sores. The horrified Sicilians drove the ships back to sea, but it was too late. Rats and fleas, the carriers of Yersina pestis, the bacterium that causes the plague, quickly infested the port of Messina. By January, Italy was engulfed. Incoming ships were required to sit at anchor for quaranta giorni—forty days, which is where the term “quarantine” comes from.

Non-Covid patients in intensive care were shuttled to the post-operative surgical unit, which was available because elective surgeries were canceled. That freed up fifty-six ICU beds. Carpenters and plumbers moved in, redesigning the units, installing HEPA filters and creating negative pressure in each room, so that infected air would not escape into the hospital. Within a week and a half every cubicle on the ICU floor became a Covid-safe room, while the endoscopy suite and ambulatory surgery unit were converted into ICUs.

The typical mortality rate in the ICU was far lower than for Covid, so even critical-care staff, like Uppal, who see death all the time, were taken aback by the pace. Such doctors knew instinctively how to click into emergency mode. Before Covid, that might last thirty or forty minutes—say, with a patient who has a heart attack. If there is a bus wreck or a mass casualty event, emergency mode could last all day. But with Covid, it was day after day for weeks on end. Emotions were deferred, but they clawed deep scars.

Doctors were finding Covid pneumonia even in patients they didn’t suspect were ill—a gunshot victim, an old person who had fallen—some of whom had never reported feeling shortness of breath, but X-rays revealed lungs stuffed with fluid or pus. It is called “silent hypoxia.” They were dying, many of them, in imperceptible increments.

In the middle of the surge, when Bellevue’s doctors were at their lowest ebb, reinforcements arrived. Hospital workers from other states flooded into New York to help shoulder the load. According to Governor Cuomo, 30,000 people responded to the city’s call for aid. It was a rare glimpse of national unity. “Half the people in the ICU had southern accents,” Link said. “That’s what saved us.”

On a normal day in New York, an average of twenty-five people die outside of the healthcare system. At the peak of the contagion, in April, ten times that many were dying at home or elsewhere.

At a press briefing, he said of the virus, “It’s something we have tremendous control over.” Dr. Fauci corrected him, observing that the worst days lay ahead, noting, “It is how we respond to that challenge that’s going to determine what the ultimate endpoint is going to be.” Trump reluctantly issued the guidelines.

The following day he had a conference call with governors around the country, reporting progress on the creation of a vaccine and therapeutics. “We’re marshalling the full power of the federal government,” he said. “We’re backing you one hundred percent.” Then he explained what he actually meant. “We’re backing you in terms of equipment and getting what you need. Also, though, respirators, ventilators, all the equipment—try getting it yourselves. We will be backing you but try getting it yourselves….Much more direct.” It took a moment for this to sink in. Most governors had assumed that, just as in the event of a natural disaster—a hurricane or a forest fire—the federal government would rush to help. Federal agencies would be enlisted. FEMA would swing into action. The doors of the national stockpile would be thrown open and emergency equipment would be quickly dispersed. The governors had become aware of the shortages that might endanger the lives of their citizens—not enough ventilators, N95 masks, nasal swabs—vital weapons in the war against this virus. They expected the president to invoke the Defense Production Act, forcing private industry to produce whatever was needed. Surely, there was a national plan.

there were only twelve million N95 masks in reserve, a fraction of what was needed. There had been more than a hundred million in the stockpile, but many were used during the 2009 H1N1 flu pandemic, and the supply was never replenished.

It was a national problem, but there would be no national plan. The pandemic was broken into fifty separate epidemics and dumped into the reluctant embrace of the surprised and unprepared governors.

Charlie Baker, the state’s Republican governor, arranged to buy three million N95 masks from China, but federal authorities seized them at the Port of New York, paying the supplier a premium and keeping the equipment.

Some Democratic governors, including Laura Kelly of Kansas and Gretchen Whitmer of Michigan, complained that their supply orders were purposely blocked by the White House. “Vendors with whom we had contracts are now being told not to send stuff to Michigan,” Whitmer said. “We’ve been told they’re going first to the federal government.” After Whitmer voiced her complaint on a Detroit radio station, Trump said at a press conference that he had instructed Vice President Pence, “Don’t call the woman in Michigan.”

“Look at the bizarre situation we wind up in,” Governor Cuomo fumed at a briefing. “Every state does its own purchasing….So you have fifty states competing to buy the same item. We all wind up bidding up each other.” Medical devices and protective equipment were essentially being auctioned. “You now literally will have a company call you up and say, ‘California just outbid you.’

Rhode Island was wedged between two epicenters, New York and Boston. “I spent hours and hours of my days and nights scouring the earth to find PPE for my state,” Governor Gina Raimondo said. “I’d call FEMA and say, ‘Uh, can we tap into our national stockpile?’ And I’d just constantly get the runaround.” Finally, the federal agency promised that a truck full of PPE was on its way. “Tell me the time, I’ll check on it myself,” she said. She was told 7:00 p.m. Finally at 9:00 p.m., she got a text from FEMA saying the truck had arrived. “Hallelujah! I called my director of health. ‘Great news, the truck is finally here!’ She says, ‘Governor, it’s an empty truck. They sent an empty truck.’ ”

“You’ve suggested that some of these governors are not doing everything they need to do,” a reporter asked Trump at a news briefing. “What more, in this time of a national emergency, should these governors be doing?” “Simple,” said Trump. “I want them to be appreciative.”

Governor Cuomo was desperate for ventilators, and the impact team had a lead. An electrical engineer in Silicon Valley, Yaron Oren-Pines, had no experience in healthcare but he had recently posted a tweet claiming he could supply them. New York took the bait and paid $69 million for 1,450 ventilators, which was at least three times the market price. There were no ventilators. The federal government awarded another contract, for $55.5 million, to purchase N95 masks from a tactical training company in Virginia, one of the largest orders for masks by the federal government. Not only did the company have no experience in making masks, or anything, it was also bankrupt and had no employees.

Kushner promised a nationwide network of thousands of testing sites, but only seventy-eight were ever set up. A proposed screening website never happened. He redirected purchasing orders that had already been promised to certain states, telling FEMA to send them to other states whose governors had called him personally. The White House had turned aid to states and hospitals into a form of patronage.

The next day, at a press conference, President Trump said he had ordered the FDA to fast-track approval of chloroquine and hydroxychloroquine. “It’s been around for a long time, so we know that if it—if things don’t go as planned, it’s not going to kill anybody.” It was Trump’s first mention of the drugs, which would become an obsession for him. Echoing Ingraham, Trump labeled them “a game changer.” Fox News drove the story relentlessly. During the two weeks between March 23 and April 6, Fox hosts and their guests promoted hydroxychloroquine nearly three hundred times.

That was probably Hilton’s first Covid patient, but there was no way to know. Like many states, Virginia had barely any tests in early March. There was, however, a sharp rise in pneumonias—doubling in some states, tripling in others—that were suspicious but not yet ascribed to Covid. It will never be clear how many people perished of the disease before widespread testing began to take hold.

We know their chances of going to prison are based on their third-grade reading exam. And then you have to go back and ask, why is it this third-grader can’t read? Is it possibly the fact that he was born prematurely, because the mother did not have access to prenatal care?” She pointed out that in South Carolina, one in every five counties doesn’t have a hospital; eleven counties don’t have a single ob/gyn. “The net has a big hole in it.”

For every 10,000 Americans, there were 38 coronavirus cases; however, for whites, the number was 23; for Blacks, it was 62; and for Hispanics, it was 73.

People of color were also more likely to be exposed because so many are essential workers. “Only one in five African-Americans can work remotely,” she said. “Only one in six Hispanics can work from home. So they were having to go out into the community, face-to-face with the virus.”

Virginia senator Mark Warner told me that Hispanics in his state accounted for 45 percent of the Covid cases, although they make up only 8 percent of the population.

“For the next four weeks, until the end of March, we made the biggest downward revisions to our growth forecasts that we’ve ever made,” said Hatzius. “We began the deepest contraction in the global economy on record.”

“Markets very often get talked about as though they’re some kind of giant casino. But they actually have a deep economic function, which is to move capital, both equity and debt, from businesses that no longer serve a purpose to businesses we need today.”

One such question is why government policy has failed to narrow the jobs gap—the gap between the jobs people want and those that are actually available. Globalization and technological change have led to higher standards of living, but that is of little comfort for people whose jobs have been displaced. “Part of the political failure around globalization was an inability to understand how badly some people were being hurt even as society as a whole did better,” Strongin said. “Dealing with that pain should have been a major focus of policy; instead, policy tried to pretend it could make the pain go away with a few training courses.”

After years of studying markets, Strongin has learned that “the secret for success is to stop doing things that are not working. Everything you do that doesn’t work prevents you from doing something that might. It’s the core of the capitalist economic system: we don’t prop up failures.” He added: “The U.S. will come out of this notably stronger as long as we learn this lesson instead of trying to reinforce the past.”

Initially, the economists expected that, as with previous recessions, the impacts would be concentrated on less-affluent areas, but the data surprised them. Workers were more likely to have lost their jobs in places like Manhattan’s Upper East Side, which lost nearly 90 percent of small business revenue—the restaurants and shoe stores and boutiques that had flourished in the wealthy ecosystem—than in the Bronx, where businesses lost only about 30 percent of their revenue. Chetty concluded that the decline in consumer spending wasn’t driven by the absence of money, it was driven by affluent Americans who didn’t want to take the risk of leaving their homes because of the contagion. The result was massive unemployment among lower-income workers who once served drinks at the Caledonia Bar or sold sweaters and jeans at J. Crew.

By April 14, the stimulus checks of up to $1,200 for more than eighty million Americans were deposited; the 21 percent surge in spending that followed was spent on durable goods, like microwaves ordered from Walmart, but spending on in-person services only rose 7 percent, doing little to repair the holes in the economy. Small businesses had lost 40 percent of their jobs.

The $500 billion Paycheck Protection Program was meant to plug the employment drain, but when Chetty and his colleagues calculated the increase in employment, it was only 2 percent. They figured that each job saved cost taxpayers about $375,000. In part, this was because checks went to companies that weren’t planning to lay off many workers anyway. But according to the Small Business Administration, there were also indications of widespread fraud, including businesses that suddenly popped up after the pandemic started. The FBI opened hundreds of investigations. Among the ironies was the fact that more than $850,000 went to five anti-vaccine groups.

“The whole political reality on the ground changed when Trump singled me out,” Whitmer said. “Up until that point I had pretty good support out of my legislature, which is totally Republican controlled. And when that happened, they stopped extending the state of emergency, they started suing me, they threatened to impeach me.” Protesters not only continued to besiege the Capitol, they showed up at the Governor’s Mansion with assault weapons, wearing tactical gear. Whitmer was inside with her husband and two teenage daughters. “I called the leader of the Michigan senate,” Whitmer said, referring to Mike Shirkey, who represents Jackson, Michigan, one of the spots that lays claim to being the birthplace of the Republican Party. She left a message on his cell phone. “We need to bring the heat down,” she said. “I need your help.” She told him that there had been death threats against her and her family. “He didn’t even return my phone call,” she said.

Pottinger felt sure he had the data on his side. He argued that whenever a large majority of people wore masks, it stopped contagion “dead in its tracks.” He pointed to the success in Taiwan, which was manufacturing ten million masks per day for a population of twenty-three million. It was almost untouched. Hong Kong was one of the most densely populated cities in the world, but there was no community spread of virus because nearly everyone wore masks.

No one in the White House wore a mask until Pottinger donned one, in the middle of March. Entering the West Wing, he felt as if he were wearing a clown nose. People gawked. The president asked if he was ill. Pottinger replied, “I don’t want to be a footnote in history—the guy who knocked off a president with Covid.”

Taiwan’s president donated half a million masks to the U.S., via diplomatic pouch. Pottinger took 3,600, for the NSC staff and the White House medical unit, and sent the rest to the national stockpile.

One anecdotal study out of China reported on an infected traveler who took two long bus rides. He began coughing on the first ride, then purchased a face mask before boarding a minibus. Five passengers on the first ride were infected, and no one on the second.