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About a year ago my older son saw a new doctor. He was 2 or 3 then; he’s almost 4 now. This doctor wasn’t new to her profession — it was our family who was new to her, and that newness is probably what caused her to react the way she did. He was skinny, way too skinny, she made clear, and if we didn’t get his weight up, his chronic illness could escalate an ordinary illness. She didn’t quite say we should be afraid, but all her recommendations seem to strongly suggest the situation warranted more vigilance and at least a little fear.
Handwashing was her other main emphasis, and she spent time going over a specific method with our preschooler. In my memory, the steps sound like a jumbled children’s story. First, you wet your hands and add soap. Then you cycle through different scrubbing positions: prayer, butterfly, milk the cow, pet the dog, “tickle tickle.” As alarm about the novel coronavirus (now called COVID-19) mounts, the first item on that list is what I keep thinking about.
More than 80,000 cases of COVID-19 have been recorded so far. Of those 80,000 people, almost 3,000 have died. The virus’s mortality rate is about 2 percent — more than double the flu’s (which, at less than one percent, is responsible for about 400,000 deaths a year worldwide). Chinese citizens, especially in Wuhan, where the outbreak originated, have weathered unprecedented efforts at containment. Airlines suspended flights to the area, and the government forbid people from leaving their houses. Drones patrolled open areas, chastising people who went outside.
Despite those efforts, the virus has spread across Europe and the Middle East. On Wednesday morning, Latin America’s first case was confirmed in Brazil. More than 50 cases have been confirmed in the United States. On Tuesday, the Centers for Disease Control and Prevention said Americans should be ready for the virus to disrupt our lives. Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases, told the New York Times: “We are asking the American public to prepare for the expectation that this might be bad.”
In a plainspoken and devastating piece, The Atlantic’s James Hamblin explained the unique challenges of preventing the spread of COVID-19. The good-bad news is that the virus doesn’t seem to be making most people as sick as other infectious diseases. COVID-19 can be lethal, but it’s not as lethal as SARS or MERS (the two previous novel coronavirus outbreaks, which had fatality rates of about 10 percent and 34 percent, respectively). Less-extreme symptoms is bad news, however, for efforts at containment.
Earlier this month, 14 Americans on a cruise ship tested positive for the virus, even though they felt okay. But feeling fine, Hamblin emphasized, is both counterintuitively and exactly what we should worry about. “Ultimately, SARS and MERS each killed fewer than 1,000 people,” he pointed out. “COVID-19 is already reported to have killed more than twice that number.”
The possibility of mild symptoms is precisely what makes COVID-19 terrifyingly easy to spread (that, and the reality that developing a vaccine is optimistically expected to take at least 12 to 18 months — if everything goes perfectly). The ordinary cold you wouldn’t think twice about could very well be just that. Or, in the age of COVID-19, it could be a virus capable of causing an international health crisis.
There are plenty of bad things to worry or think about, if you’re looking, and most bads present themselves through no effort of your own. Which is what can make preparing for a public-health emergency so difficult, and so essential. People who can, will have to preemptively disrupt their own relatively easy lives to help those whose lives would be made the most difficult. That’s a lot easier to write than to do: Earlier this week my younger son woke up with a sheen of mucus on his upper lip and a crackly, adorable baby cough. I did not keep him home, knowing full well I probably should have and that it’s people like me who inflict damage on those who are more vulnerable.
Along with only about 70,000 people worldwide, my older son has the genetic disease cystic fibrosis. CF is the reason his bones poke out his back; it’s the reason he spends a few hours every day on medical treatments that try to prevent the formation of mucus in his lungs. While his immune system is fine in a certain way, the mucus means things that you don’t want to stick around the lungs — such as any form of respiratory illness — can and do.
Our household, like many with young children and overwhelmingly like those with vulnerable ones, features giant jugs of hand sanitizer. Travel-size versions rattle in my pockets and at the bottom of all my bags. Perhaps you’ve come across someone like me before: I am the uptight playground mother who lunges to intercept a cheese puff, rummaging for the sanitizer and muttering something about how we need to “do your hands” first. But seemingly no matter what I do or don’t, the biological consequences of winter and places crowded with children — contagious coughs, bubbly trails of juvenile snot — frequently extend my son’s daily medical routines by an hour or two.
On Wednesday, my husband and I tried to restock our usual 64-ounce containers of hand sanitizer. Almost everywhere was sold out.
Welcome to my world, a friend whose child also has cystic fibrosis wrote to me after the media first started to cover the novel coronavirus outbreak. She said the fear of germs and constant handwashing described by those reporting on the outbreak from China felt familiar to her everyday experience as a parent. Earlier this week we exchanged texts again, this time about which N95 masks to buy and how to prepare for the possibility of removing our children from school. (Currently, the World Health Organization recommends masks only for people who are coughing or sneezing, or are taking care of someone with COVID-19.)
“Luckily” I live in Northern California and own ten N95 masks already. In late 2018, smoke from the Camp fire made the air quality in San Francisco so bad that the public schools closed. We were outside the acute devastation of the fires (in Paradise, an estimated 80 to 90 percent of students lost their homes), but the air quality was impossible to ignore, even as you counted yourself lucky in comparison. The city’s offices filled up with kids, or encouraged people to attempt working from home while watching their children. Many who could — including my family — left the city altogether. Vigilance and fear felt less the affair of those who regularly navigate vulnerable health conditions and more like a societal situation.
In the time since I started writing this, the mayor of San Francisco declared a state of emergency (while there are no known cases yet, having the declaration in place is considered an act of preparation). Eighty-three people in suburban New York agreed to voluntary isolation because they might have been exposed to the virus (officials say no cases from this group have been confirmed). A resident of Northern California tested positive for COVID-19 and might be the first person in the United States to be infected through “community spread” — the first case without a known connection to a recent trip abroad or contact with a known patient. This suggests that the virus is already circulating in the U.S.
On Thursday morning, the prime minister of Japan called for all of the country’s elementary, middle, and high schools to shut down for one month.
My son’s doctors’ gave us their current recommendation, which is mainly to use common sense. He can go to school, but we should avoid crowds. We should wash our hands and wash them well. The protocol is subject to change as soon as the city has confirmed cases.
What’s the best way to prevent the spread of germs and disease? First, you wet your hands and add soap. Then you cycle through different scrubbing positions: prayer, butterfly, milk the cow, pet the dog, “tickle tickle.” This is something all people should do, every time. I admit that I do not, at least not as much as I should.
To see whether I was remembering right, I tried to find an online version of this handwashing technique. My husband doesn’t remember the prayer part that I do, but we all, our son included, remember the rest. I haven’t found anything that matched exactly, and I’m still not sure the prayer part is accurate. It would be kind of a strange, religious overtone for a doctor to take — I can’t really imagine that happening, despite how clear the evocation of some kind of metaphysical bargaining seemed to me. Perhaps, in the face of mortal vigilance, it was my own desperate insertion all along.