14 THENEWYORKER,APRIL20, 2020
for—designated groups of people such
as doctors and bioethicists who would
essentially decide who lives and who
dies. They talked about social justice;
Gorovitz suggested that any newly avail-
able funding or equipment be distrib-
uted in a way that favors poorer, under-
resourced hospitals. People liked this
idea, but a clinician noted that some of
the best-equipped hospitals serve the
state’s most vulnerable patients, and that
it might therefore be better to think
about distribution in terms of patient-
population vulnerability. Gorovitz said
that the draft guidelines proposed a “lot-
tery” when, for example, two patients
who were the same age and who had
similar health prospects needed a ven-
tilator. “I said, ‘O.K., that’s good, but it’s
not sufficiently specific, because lotter-
ies can be biased. What kind of lottery?’”
Before the call ended, a health-de-
partment official said that the state’s
guidelines “would be revised substan-
tially in light of this conversation,” Go-
rovitz recalled. The updated draft would
be presented to a group of clinicians
later that afternoon, before the proto-
col was finalized. “We anticipated that
it would be made public in some final
version within a day or two,” he said.
“But nothing since. Zero.” Two weeks
later, Gorovitz e-mailed the Depart-
ment of Health to ask what was going
on. “Not even an acknowledgment on
the inquiry,” he said.
Meanwhile, other states, such as Mas-
sachusetts and Pennsylvania, have an-
nounced their plans. Both have adopted
a point system that prioritizes patients
by calculating their likelihood of benefit-
ting from I.C.U. care, and which does
not use exclusion criteria to disqualify
patients from the outset. (Alabama has
removed its ventilator plan from the In-
ternet.) Tia Powell, a physician and a
bioethicist who worked on the original
guidelines, said that the state has put
its health-care workers in a bad posi-
tion by not issuing any formal proto-
cols. The 2015 guidelines are not bind-
ing, which allows for a situation in which
NewYork-Presbyterian plays by differ-
ent rules than Mount Sinai. And, al-
though some hospital systems, such as
Northwell Health, which has twenty-
three hospitals across the state, have said
that they will adopt the guidelines if
they run out of equipment, COVID-
is an illness that the task force did not
anticipate. Its original guidelines sug-
gest moving a ventilator from one pa-
tient to the next after a hundred and
twenty hours—but some coronavirus
patients take longer than that to recover.
“There have been efforts in every
single facility across the state of New
York to devise their own guidance doc-
uments,” Powell said. “This is an in-
credible waste of expertise and time—
all because of the failure to release a
unified guidance document.” She added
that, although the state has not yet run
out of ventilators, front-line staff are
making difficult decisions every day
when caring for COVID-19 patients. “I
feel personally that I’ve let them down,
because I haven’t been able to sway the
powers that be that they have an obli-
gation to provide guidance to the peo-
ple who are doing that care.”
Will New York release a plan even-
tually? “I’ll just say that it apparently has
been a choice not to release any guid-
ance,” Powell said. (“We have no guide-
lines,” Gary Holmes, a spokesman for
the state’s Department of Health, wrote
in an e-mail this past Friday.) But, even
if the state does, one day, release a plan,
this period of uncertainty has already
had an impact. Powell explained that
doctors have been trying to support pa-
tients who have little chance of recov-
ery, such as those who have gone into
cardiac arrest. “We’re still making at-
tempts for that, because of the lack of
guidance from New York State,” she said.
“It doesn’t save a life. It puts our staff at
risk. And if the person is in cardiac ar-
rest on a ventilator, if they can still feel
something, then they’re likely to feel
pain. So it creates a bad death.”
—Tyler Foggatt
1
DEPT.OFRESILIENCE
PR AYMOREF
ather George R. Stewart, the pas-
tor of St. Augustine-Our Lady of
Victory Roman Catholic Church, in
the South Bronx, knew when he was
in the second grade that he would be
a priest. He came to this church, whosename can be confusing if you don’t no-
tice the hyphen, almost five years ago.
Two churches merged to make this
one, in 2012. It holds services in Span-
ish and English, and sometimes partly
in Garifuna, the language of an ethnic
group of the same name whose prin-
cipal ancestors were shipwrecked Af-
rican captives and Caribbean native
people. Sometimes when Father Stew-
art gives a sermon in English, he keeps
it short, because when he gets to the
end he takes a deep breath and repeats
it all in Spanish, or the other way
around. Everybody in the church, in-
cluding the Garifuna members and a
large contingent of Nigerians, speaks
Spanish or English or both. About
sixty per cent of the church’s members
are Spanish speakers, and, of those,
about sixty per cent are from the Do-
minican Republic.
Public services have been cancelled,
but the church is open from six in the
morning to four in the afternoon every
day. It’s an Italianate brick building
with an intricate rose window above
the front doors, flanked by two smaller
windows shaped like crosses. Signs ask
parishioners to keep twenty feet apart
when they come in to pray. Father Stew-
art cleans the church three times a day.
He disinfects the pews and prayer rails
and rubs the door handles with sani-
tizer. Every evening, he performs Mass
online, from his study. “It’s been very
frustrating,” he told a caller who fol-
lows his homilies, which are posted on
the church’s Web site. “I would say that
a third of my parishioners are on the
front line in this plague, as nurses, hos-
pital workers, or home health aides.
But as a priest I am not allowed to take
all the risks they’re exposed to. I visit
the sick at home, in protective gear, but
I can’t comfort the ones in hospitals or
give last rites to the dying—no visitors
are allowed.”
He went on, “But last Sunday morn-
ing—Palm Sunday—I was in the rec-
tory next door, where I live, and I heard
a lot of commotion, and when I went
outside my nose told me there was a
fire. The building just behind us was
burning. People had rushed out into
the street in whatever they had on. The
women were without coats, some of
the kids were wearing pajamas. I didn’t
know what to do, but it was cold out-