The Washington Post - 18.03.2020

A12 eZ sU THE WASHINGTON POST.WEDNESDAy, MARCH 18 , 2020

A few minutes later, a doctor in

anti-contamination gear came in

to test Howard for the coronavi-

rus, taking swabs f rom her throat

and nose. Six hours after arriving

at the hospital, she drove home.

over the weekend, she left her

apartment only to walk her Shih

Tz u, Cooper.

“Don’t get on the elevator with

me!” she warned a neighbor

when the door slid open on

another floor.

She struggled to breathe. Her

head ached. She longed for her

son and daughter.

on Sunday, her fever dropped

to 99.

Her phone rang monday at

7:30 a.m.

“You probably already know

the results are positive,” the in-

fectious disease specialist an-

nounced.

Around noon, Howard posted

a letter on facebook, reporting

what had transpired and that “it

is important for people to share

their experiences with this ill-

ness.” She asked that everyone

try “to refrain from spreading

fear.”

She felt lonely, but fortunate to

have a phone and a computer

and friends and family nearby.

She tries to remain positive. The

sick can get better, she tells

herself. Soon, she will feel stron-

ger.

How soon?

on Tuesday morning, she felt

well enough to take a shower,

make her bed and fold clothes.

By noon, her temperature was

100.2. She felt dizzy. Breathing

was more difficult.

It was time to lie down again

and be still.

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patients. She felt dizzy and ex-

hausted. Her cough was unceas-

ing. Somehow, she drove herself

to Sibley memorial Hospital,

where an emergency room atten-

dant gave her a mask and told her

to wait for a chest X-ray and tests

for strep and the flu.

An elderly woman in a wheel-

chair struggled to breathe. Sever-

al other patients complained of

coughs and fatigue. At one point,

Howard overheard a doctor tell a

colleague, “If someone comes in

with a fever and coughing with a

fever, we assume it’s corona.”

“Why aren’t they testing me

for corona right now?” Howard

thought.

After her strep and flu tests,

she waited for results in the

reception area, where a couple of

dozen people were seated, some

wearing masks, some not.

“I’m sitting right next to peo-

ple and coughing,” she recalled.

After three hours, she was led

to a room where the sign on the

door read, “Airborne Illness.” An-

other patient there was talking

on her cellphone to her mother in

Chinese.

The woman’s cough reminded

Howard of her own.

“What’s going to happen?” she

asked Howard.

“We’re going to get tested,”

Howard answered. “If we’re posi-

tive, we have to self-quarantine.”

The woman repeated How-

ard’s answer in Chinese to her

mother before asking, “What

about treatment?”

“There is no treatment,” How-

ard said.

“No treatment,” the woman

told her mother, only now in

English. The woman began to

cry.

groceries at the Whole foods in

Te nleytown. The next day, she

saw eight patients, including five

in a group session.

Two days later, Howard said,

she felt a “slight tickle” in her

throat, which she attributed to

allergies. She saw nine patients

before attending a gathering of

the “Existential Book Club,” an

assembly of 20 or so therapists

who discussed Virginia Woolf’s

“mrs. Dalloway.”

Her throat was still scratchy

on Wednesday last week, only

now she also felt periodic chills

as she saw six more patients.

That night, as she spent time

with her kids, Howard took her

temperature, which was normal.

Her daughter grabbed the ther-

mometer, quickly wiped it on a

bedsheet and took her own tem-

perature.

“What did you just do?” How-

ard said, horrified.

“It’ll be fine, mom,” she said.

on Thursday night, as her

symptoms worsened, Howard

contacted everyone she recalled

encountering in the previous

days, along with eight patients

she was scheduled to see friday.

She told them that she may have

been exposed to the virus and

that they would have phone ses-

sions instead of meeting face-to-

face.

By the next morning, her fever

was 101.3. Between patients, she

called her doctor. After describ-

ing her symptoms, she was told

someone from the District’s De-

partment of Health would come

to her apartment to test her. If

not, she would need to go to an

emergency room.

By 4 p.m., she was too weak to

work and canceled her last two

The coronavirus outbreak

best decisions that we could with

the information we had at the

time.”

“A t the same time,” t hey added,

“we deeply regret that our meet-

ing may have contributed to

peoples’ exposure and vulnera-

bility to this illness.”

Howard said she attended the

conference without worry.

“The people who w ere organiz-

ing the conference gave us the

same spiel — that we should be

careful about washing hands,”

she said. “But when you’re at one

of these conferences, it’s easy to

let your guard down. None of us

wanted to believe we were at

risk.”

Cathi Cohen, a Northern Vir-

ginia therapist who is friendly

with Howard and also attended

the conference, said there was no

obvious reason to be concerned

about exposure.

“I didn’t see anyone with a

sniffle,” Cohen, 59, said. “I saw

one person in a mask. Everyone

was in the restaurants and acting

like everything was fine.”

The pandemic’s s hifting reality

— abrupt and jarring — is chal-

lenging for therapists trying to

help patients “separate out

what’s real from what’s anxiety-

based,” Cohen said.

That Howard has the virus

only adds a stunning personal

twist, Cohen said, “because she’s

young, healthy and in great

shape.”

“If she can get sick, anyone can

get sick.”

After returning to Washington

on march 8, Howard bought

Perhaps she caught the virus,

she said, when she joined hun-

dreds at a conference-sponsored

dance at a Sheraton hotel near

Times Square. or maybe it oc-

curred when she took a break

and walked through the metro-

politan museum of Art; or when

she visited the top of rockefeller

Center and a stranger sneezed on

her.

It was only after she came

home, as she felt symptoms she

initially associated with allergies,

that she read on the association’s

Internet mailing list that a num-

ber of therapists had reported

not feeling well or had tested

positive for the virus.

The outbreak echoed what oc-

curred in Boston in february,

when more than 100 people were

infected at a meeting hosted by

Biogen, a biotechnology compa-

ny.

Diane feirman, a spokeswom-

an for the psychotherapy associa-

tion, s aid 19 people who attended

the conference had tested posi-

tive for the virus as of Tuesday,

with “probably an equal n umber”

reporting symptoms and either

awaiting test results or trying to

get tested. The conference drew

therapists from two dozen coun-

tries, including Italy, Spain and

Singapore.

In an email to members, asso-

ciation president molyn Leszcz

and chief executive marsha Block

said “there have been under-

standable expressions of anger”

that the conference was held “in

the current environment.” The

association, they said, made “the

en marylanders who traveled on
a Nile river cruise ship; an
American University student; the
head of Gonzaga College High
School; doctors and staff from
the National Institutes of Health,
Johns Hopkins Hospital and the
United medical Center.
As of monday night, the re-
gion’s two fatalities were men in
their 70s f rom V irginia’s Peninsu-
la region. Both died of respirato-
ry failure.
As she lies listless in her
Cathedral Heights apartment,
Howard thinks about whom she
could have unwittingly infected:
a patient with a heart condition;
the pregnant woman who sat
next to her at b ook g roup; her son
and daughter, both of whom are
now staying with her ex-hus-
band.
“I’m feeling so responsible,”
she said in a phone interview, at
moments tearful. “When I look
back at everything, I didn’t have
any idea what was going to
happen.”
Her week-long passage from
perfect health to the grip of a
ferocious virus is emblematic of
what government officials fear
awaits tens of thousands of
Americans now ordered to re-
main at home.
While she does not know how
she became infected, Howard
suspects it was while she was in
New Yo rk in early march, attend-
ing a conference of the American
Group Psychotherapy Associa-
tion.

PAtIent from A

From perfect health to quarantined

BY GRIFF WITTE,

KATIE ZEZIMA,

ARIANA EUNJUNG CHA

AND TIM CRAIG

mark Estee spent his Tuesday
laying off 100 cooks, waiters and
dishwashers, having been forced
by city decree in reno, Nev., to
close two restaurants that had
been thriving j ust days a go.
Less than an hour down the
road, in Nevada’s Carson Valley,
the threat of c oronavirus had in-
spired no such restrictions. Estee’s
three other restaurants were pre-
paring to serve dinner, a hearty
mix of pasta, burgers and beer.
Such is the state of America’s
patchwork response to the virus
sweeping the globe. In some plac-
es, governors, mayors and county
leaders have instituted aggressive
action that is changing the fabric
of life: orders to stay at home,
business bans and school clo-
sures. In other spots, authorities
have b een far m ore lenient, allow-
ing routines to carry on more or
less as normal.
The divide in responses showed
some s igns of narrowing Tuesday:
Nevada’s governor a nnounced t he
shutdown of restaurants, bars and
casinos late Tuesday evening. The
governor of West Virginia did the
same, and he appeared chastened
as he announced t hat his state had
become the 50th to record a coro-
navirus case.
West Virginia Gov. Jim Justice
(r) had downplayed the risk as
late as monday night, saying at an
evening news conference that “if
you want to go to Bob Evans and
eat, go t o Bob Evans and e at.”
In s tates that had already taken
tough measures, the response
only escalated: North Carolina’s
outer Banks announced it was
setting up checkpoints to keep
nonresidents out of the popular
barrier islands. New York’s mayor
said he was considering ordering
the city’s nearly 9 million people
to stay at home, as San francisco
did a day earlier.
But in o ther states, another day
passed without the sort of robust
action that public health officials
say is needed to stem the virus’s
spread.
The disparities across t he c oun-
try set the U.S. response apart
from that of nations that have
moved in a unified way to try to
tamp down outbreaks. The gaps
are increasingly d rawing the ire of
state and local officials who have
acted decisively to halt the spread,
but worry that their efforts will be
for naught if their neighbors don’t
follow suit — and if Washington
doesn’t a ct m ore proactively to set
the tone.
“I’m disappointed,” said reno
mayor Hillary Schieve, who decid-
ed to shut down her city’s restau-
rants after hearing horror stories
about the virus’s impact from the

mayors of Seattle and New York.

Her neighboring jurisdictions

have not done the same. “We can

do this, but we all have to be

working t ogether,” s he said.

Some have appealed directly to

the White House to take com-

mand. In private conversations

with the Trump administration,

New York Gov. Andrew m. Cuomo

(D) and his deputies have empha-

sized the n eed for a strong, coordi-

nated federal response like those

in China, South Korea and Italy.

“This can’t be a national policy

of every state does its own thing,”

he said at a news conference over

the weekend. “You can’t have a

patchwork quilt of policies.”

If New York closes stores and

New Jersey doesn’t, Cuomo said,

his decree has done little to slow

down the v irus — b ut instead “ just

sent thousands of vehicles over to

New Jersey, f looding stores.”

As of Tuesday, 38 states had

completely shut d own their p ublic

schools for the near future; Kan-

sas Gov. Laura Kelly (D) an-

nounced Tuesday that the state’s

schools would close for the rest of

the academic year. In the other 12

states, some individual districts

had decided to close. There was no

state in which all schools were

open, according to tracking by

Education Week.

In oklahoma — where Gov.

Kevin Stitt (r) faced ridicule and

criticism a fter tweeting a photo of

himself a nd his family at a packed

restaurant Saturday — officials

declared a state of emergency

Sunday and on monday ordered

all schools closed.

The state has not taken the

more drastic measure of closing

restaurants and bars, despite the

urging of the oklahoma State

medical Association. But Norman

and several other cities h ave.

Jeffrey Klausner, an infectious-

disease s pecialist at t he University

of California at Los Angeles

School of Public Health, said the

United States is so vast and so

diverse that there is an argument

to be made for more-targeted and

local approaches. “one of my con-

cerns is we’re taking a sledgeham-

mer approach, and that’s an over-

reaction in some areas,” h e said.

Klausner, a former Centers for

Disease Control and Prevention

epidemiologist, explained t hat

different ages, professions or sub-

groups — such as smokers —

might be affected in different

pa rts of the country. Broad mea-

sures, such as closing down parts

of the economy, might do little to

help t hem.

ohio, led by a republican gov-

ernor, has been perhaps the most

forward-leaning state in enacting

restrictions. But many other G oP-

led states lag behind as polls show

a significant share of republican

voters doubting the severity o f the

coronavirus outbreak. Some lead-

ers say they are taking their cues

from P resident Trump, w ho has at

times downplayed the risk posed

by the v irus.

In West Virginia, Justice said

monday night that he thought it

was premature to order bars and

restaurant to shut down. The re-

publican repeatedly noted that

the federal government had not

ordered states to act. “We’ve got to

keep on some way living, and do-

ing what we are doing,” h e said.

His tone was markedly differ-

ent late Tuesday, after the state’s

first diagnosis. “If by chance I left

a stone unturned and at t he end of

the day, in trying to do something

to cure an inconvenience, or cure

an economic issue, I exposed oth-

ers to a situation where you lost a

loved one, how do we overcome

that? How do you replace that? It

just can’t b e done,” h e said.

In some republican-run states,

governors have resisted restric-

tive action while allowing mayors

to take their own initiative. In

Te nnessee, Gov. Bill Lee (r) has

not ordered restaurants and bars

to shut d own, but N ashville mayor

John Cooper closed b ars in t he city

and reduced restaurant capacity.

Layla Vartanian, owner of Lay-

la’s Honky To nk on Nashville’s

iconic Broadway, closed monday

night. The bar had been open

under Nashville rules limiting res-

taurant capacity but closed after

the CDC urged canceling gather-

ings of more than 10 people. Varta-

nian s aid all bars o n Broadway a re

shut, with just a smattering of

restaurants offering carryout.

The mixed signals from leaders,

she said, have been frustrating.

“We would like to let the state

and the city be on the same page,”

Vartanian said. “Every day it

changes, day by day, so what is it

going to be tomorrow? Two peo-

ple? Why don’t w e just shut every-

body down and carry on with our

lives a few weeks from n ow?”

Beyond the city’s limits, it’s a

very different story. Natasha Hen-

drix, the owner of mcCreary’s

Irish Pub and Eatery in franklin,

Te nn., said about 40 people were

in the bar’s dining room for St.

Patrick’s Day lunch, eating a

corned beef and cabbage special

and drinking green beer. Hendrix

is sure a lot of the clientele came

from Nashville.

“The funny thing is most people

don’t seem to care for some rea-

son. They think the virus is taking

a break t oday,” s he said.

John Wittman, a spokesman for

Te xas Gov. Greg Abbott (r), said

the state has restricted visitation

at hospitals, senior centers, jails

and day-care centers in an effort

to protect the most vulnerable.

But Te xas has otherwise allowed

municipalities to decide when

and whether to shut things down.

Austin, Dallas and Houston have

closed most bars, limited restau-

rants and barred large gatherings.

“The reality is this: the local

governments are doing a very

good job right now of listening to

their local health departments

and following their guidance,”

Wittman said. “What is right in

those big metro areas might not

be right in Amarillo and Abilene.

Te xas is just a massive state.”

Some officials who had earlier

resisted tough action were catch-

ing up Tuesday — and suggested

even more drastic measures were

still to come. In South Carolina,

Gov. Henry mcmaster (r) ordered

the state’s bars and restaurants to

close “dine-in service.” mcmaster

also announced he was mobiliz-

ing the National Guard so it can

support the n eeds of hospitals.

“The enemy we face, the enemy

of this virus, is bigger than any

sort of irritation or inconvenience

that any of u s could have,” m cmas-

ter said. “We are asking people to

stick together, understand that we

are in a crisis and we need to take

these measures.”

Asked whether he was consid-

ering even more dramatic steps

such as a statewide curfew, mc-

master said that “all such mea-

sures are options that are on the

table.”

Even as some restrictions tight-

ened, however, others appeared to

be loosening. After international

travelers faced long lines and ex-

tensive checks while entering U.S.

airports over the weekend, at-

tempts to screen passengers at

some of the nation’s busiest air-

ports, including Chicago’s o’Hare

and Hartsfield-Jackson in Atlan-

ta, appeared to be relatively mini-

mal Tuesday, with some interna-

tional passengers breezing

through customs without health

checks.

In Nevada, Gov. Steve Sisolak

(D) said late Tuesday that all state

residents should stay h ome if at a ll

possible, and he ordered all gam-

ing operations in the state to cease

business at midnight. “This is af-

fecting the lives of our citizens.

People are dying,” he said. “It’s

incumbent upon the p eople of this

state to take this seriously.”

Just hours earlier, authorities

in Carson Valley had s aid they had

no immediate plans to enact clo-

sures on their own, absent evi-

dence that t he virus was being

transmitted locally.

Schieve, the reno mayor, said

she concluded over the weekend

that waiting to take action was n ot

an option. Through the U.S. Con-

ference of mayors, she had heard

from the leaders of Seattle and

New York about just how damag-

ing the virus could be if left un-

checked. She understood the eco-

nomic damage that a shutdown

would cause. But she feared inac-

tion e ven more.

“It’s gut-wrenching,” she said.

“This is an absolute economic di-

saster. But if health care f ails, then

we’re in the biggest predicament

we could possibly be i n.”

Estee, the restaurateur, said he

was inclined to agree. As painful

as it was to shutter his two reno

restaurants, he was prepared to

close the three Carson Valley ones

as well if it would help the United

States pull out of the crisis. To

delay, he said, would just post-

pone the i nevitable.

“Let’s rip the Band-Aid off

quick,” he said. “If we flatten the

curve, we can move o n. If we don’t,

we’re going to be in this for a long

time.”

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Arelis Hernández in san Antonio and

laura Meckler in Washington and

freelance journalists gregory scruggs

in seattle, shawn Mulcahy in Chicago

and Khushbu shah in Atlanta

contributed to this report.

Across the nation, disparity in containment policy is vast

JeNNA sCHoeNefeld for tHe WAsHINgtoN Post

A popular shopping area in Santa Monica, Calif., is nearly deserted tuesday. In other U.S. localities. life has gone on almost normally.

Absent federal mandates,

states, counties, cities are

making their own calls