Two emergency room doctors, Dr. Tsion Firew in New York and Dr. Cedric Dark in Houston, discuss their cities’ coronavirus outbreaks — and responses. (Columbia University Irving Medical Center; Baylor College of Medicine)
Health workers across the country looked on in horror when New York became the global epicenter of the coronavirus. Now, as physicians in cities such as Houston, Phoenix and Miami face their own COVID-19 crises, they are looking to New York, where the caseload has since abated, for guidance.
The Guardian sat in on a conversation with two emergency room physicians — one in New York and the other in Houston — about what happened when COVID-19 arrived at their hospitals.
Dr. Cedric Dark, Houston: When did you start worrying about how COVID-19 would impact New York?
Dr. Tsion Firew, New York: Back in February, I traveled to Sweden and Ethiopia for work. There was some sort of screening for COVID-19 in both places. On Feb. 22, I came to New York City, and nothing — no screening. At that point, I thought, “I don’t think this country’s going to handle this well.”
Dark: On Feb. 26, at a department meeting, one of my colleagues put coronavirus on the agenda. I thought to myself, “Why do we even need to bother with this here in Houston? This is in China; maybe it’s in Europe?”
Firew: On March 1, we had our first case in New York City, which was at my hospital. Fast-forward 15 days and I get a call saying, “Hey, you were exposed to COVID-positive patients.” I was told to stay home.
Dark: My anxiety grew as I saw what was happening in Italy, a country I’ve visited several times. I remember seeing images of people dying in their homes and mass graves. I started to wonder, “Is this what we’ll see over here? Are my colleagues going to be dying? Is this something that’s going to get me or my wife, who’s also an ER doctor? Are we going to bring it home to our son?”
In March, we repurposed our urgent care pod, which has eight beds, into our coronavirus unit. And for a while, that was enough.
Firew: In late March, health workers without symptoms were told to come back to work. It felt like a tsunami hit. I’ve practiced in very low-resource settings and even in a war zone, and I couldn’t believe what I was witnessing in New York.
The emergency department was silent — there were no visitors, and patients were very sick. Many were on ventilators or getting oxygen. The usual human interactions were gone. Everybody was wearing a mask and gowns and there were so many people who came to help from different places that you didn’t know who was who. I spent a lot more time on the phone talking to family members about end-of-life care decisions, conversations you’d normally have face-to-face.
In New York, the severity of the crisis really depended on what hospital you were at. Columbia has two hospitals — one at 168th and one at 224th — and the difference was night and day. The one on 224th is smaller and just across the bridge from the Bronx, which was hit hard by the virus.
There, people were dying in ambulances while waiting for care. The emergency department was overwhelmed with patients who needed oxygen. Its hallways were crowded with patients on portable oxygen tanks. We ran out of monitors and oxygen for the portable tanks. Staff members succumbed to COVID-19, exacerbating shortages of nurses and doctors.
My friends who work in Lower Manhattan couldn’t believe some of the things we saw.
Dark: I went to medical school at NYU and have a lot of friends in New York I was checking in with at the time. I thought that in Houston, a city that’s almost as big, we had the conditions for a similar crisis: It’s a large city with an international airport, it attracts a lot of business travelers, and thousands of people come here each March for the rodeo.
In late March, a guy about my age came into the hospital. It was the first day we got coronavirus tests. A few days later, a nurse texted me that the patient had tested positive. He hadn’t traveled anywhere — it was proof to me that we had community transmission in Houston before any officials admitted it.
You became infected, right?
Firew: In early April, I became sick, along with my husband. I never imagined that in 2020 I would be writing out a living will detailing my life insurance policy to my family. Walking from my bed to the kitchen would make my heart race; I often wondered: Is this when I drop dead like my patient the other day?
A few days before I got sick, the president had said that anybody who wanted a test could get one. But then I was on the phone with my workplace and with the department of health begging for a test.
It was also around that time that a brown-skinned physician who was about my age died from COVID-19. So I knew being in my mid-30s wouldn’t protect me. I was even more worried when my husband became ill because, as a Black man, his chances of dying from this disease were much higher than mine. We both recovered, but I still have some fatigue and shortness of breath.
When did cases pick up in Houston?
Dark: We saw a gradual increase in cases throughout April, but it stayed relatively calm because the city was shut down. The hospital was kind of a ghost town because no one was having elective procedures. Things were quiet until Texas reopened in May.
I remember when I lost my first COVID patient. He started to crash right in front of me. We started CPR and I ran the algorithms through my mind trying to think how we could bring him back, but kept ending up at the same conclusion: This is COVID and there’s nothing I can do.
It’s like serving on the front lines of a war. We initially struggled to find our own personal protective equipment while the hospitals worked to secure the supply chain. Although that situation has stabilized, a lot of patients who come in for non-COVID reasons wind up testing positive. COVID is everywhere.
Our patient population is heavily Latino and Black and, for a time, our hospital had some of the highest numbers of COVID cases among the nearly two dozen hospitals in the Texas Medical Center network. It’s revealed the fault lines of a preexisting issue in terms of inequities in health care.
As area hospitals fill up, they reallocate additional floors to COVID patients. Who knows, if we don’t get this under control, maybe one day the whole hospital will be COVID.
Firew: Now I’m just chronically angry. The negligence came from the top all the way down. Our leaders do not lead with evidence — we knew what was going to happen when states reopened so quickly.
Dark: Yeah, this was completely avoidable, had the governor [Texas Gov. Greg Abbott] decided not to open up the economy too fast.
How are things in New York now?
Firew: There have been several days where I’ve seen zero COVID cases. If I do see a case, it’s usually someone who has traveled from abroad or other states.
People are coming in for non-COVID reasons. Recently, a woman in her early 40s came in with a massive lesion on her breast. She’d started experiencing some pain three months ago, during the peak of the pandemic, and was too frightened to come to the hospital. To make matters worse, she didn’t have insurance and couldn’t afford the telehealth that many had access to.
By the time she made it to our hospital, the mass had metastasized to her spine and lungs. Even with aggressive treatment, she likely only has a few months to live. This is one of the many cases we’re seeing now that we are back to “normal” — complications of chronic illnesses and delayed diagnoses of cancer. The burden of the pandemic layered with a broken health care system.
Dr. Tsion Firew is an assistant professor of emergency medicine at Columbia University and special adviser to the minister of health of Ethiopia.
Dr. Cedric Dark is an assistant professor of emergency medicine at Baylor College of Medicine and a board member for Doctors for America.
This conversation was condensed and edited by Danielle Renwick.
Newark school workers have managed to keep a weekly vegetable distribution going even during the pandemic. From left: Marquise Singleton, the parent liaison at Hawthorne Avenue School; Erica Walker, an early childhood social worker; and Dwayne Tatum, parent liaison at George Washington Carver School. Courtesy of Marquise Singleton
On any given Friday before the pandemic, families across Newark would flock to their local school to fetch fresh vegetables.
“Zucchini, carrots, onions, potatoes, sweet potatoes, broccoli, green beans, Brussels sprouts — the list goes on,” said Dwayne Tatum, the parent liaison at George Washington Carver Elementary, one of dozens of district schools that gave donated produce to families each week. “Any vegetable you can think of has passed through us.”
Then came the coronavirus, which shuttered Newark schools last month and left the free vegetable giveaway that had been available at more than 30 city schools in limbo. The disruption could not have come at a worse time. The pandemic has kept many residents out of work and short on food. Meanwhile, many food pantries are struggling to meet the surging demand.
So school employees who ran the weekly vegetable distribution came up with a solution: They moved their operations to nearby church lots, where residents now can walk up or drive through to pick up the produce. Tatum and other volunteers are even delivering the vegetables to families who can’t leave their homes.
“Whenever we hear about a family that needs food, we make sure they get it,” said Tatum, who loads leftover vegetables into his large pick-up truck and delivers them to families identified by the school social worker.
The volunteer effort to keep the produce giveaway going is just one example of school workers improvising in order to maintain the critical services that schools provide even when buildings are closed and students are stuck at home. Attendance workers are still tracking down missing students, counselors continue to offer social-emotional support, and teachers and still assigning work and giving lessons — though all those efforts now happen remotely, through phone calls, texts, and video chats.
But making sure children and families are fed is paramount in a city where more than 80% of district students qualify for free or reduced-price lunch at school and more than 28,000 children live in households that receive food assistance.
One of the groups supplying food to Newark is Table to Table, a New Jersey-based nonprofit that collects excess produce, meat, and bread from supermarkets and food-distribution companies and delivers it to homeless shelters and soup kitchens. Last year, the organization delivered enough donated food for 26 million meals.
More than half of its shipments go to Newark, where there is an abundance of need — along with groups eager to help, said Julie Kinner, the organization’s director of recipient relations and community affairs.
“It’s incredible to me how often I hear from people in Newark,” she said. “Not from individuals needing food, but from people who can serve it.”
For several years, Table to Table has sent donated food to Newark schools that act as distribution sites. One of the people who hatched the partnership was Joan-Marie Foushee’, a support staffer at Central High School who also leads a South Ward nonprofit. Every Friday for the past four years, Central has given out the fresh produce to community members, students, and staffers. As word got out and other schools asked to join, Foushee’ agreed to share the vegetables on one condition.
“If you want us at your school, you have to adopt three other schools,” she said. Before long, other schools were acting as distribution hubs, giving portions of their Table to Table shipments to other schools so that the giveaway kept growing.
When the pandemic shut down school buildings, Foushee’ and others were determined not to let the vegetable distribution vanish. Several local churches agreed to let the volunteers set up makeshift pantries on their sites. Central moved to Pleasant Grove Baptist Church, Mount Vernon School relocated to Cornerstone Baptist Church, and Carver shifted to Community Church of God.
LeKeshea Brooks-Wertz is a school social worker who helped run the vegetable distribution at John F. Kennedy School, which enrolls students with multiple disabilities. When the coronavirus struck, she wasn’t sure how her work could continue.
“When they said school was closing, I was like, ‘What’s my role? What am I going to do to be helpful?’” she said. She decided to start loading up her truck with grab-and-go meals from schools and delivering them to homebound families. On Fridays, she includes vegetables from Pleasant Grove church.
“God didn’t bless me with this car for myself,” she said. “He blessed me so I could help other people.”
At the Community Church of God, a small army of volunteers gathers each Friday to unload and bag Table to Table’s shipments, which have included pallets of fresh produce, hundreds of gallons of milk from Barlett Dairy, and meal kits from HelloFresh. Community members can pick up food bags themselves, or register online for a home delivery by Douglas and Maggie Freeman, siblings and South Ward community activists who have helped spearhead the vegetable distribution.
Along with Tatum and the Freemans, one of the site leaders is Singleton, the parent liaison at Hawthorne Avenue School. Before the pandemic, Singleton organized a vegetable giveaway at his school on Fridays — sometimes with help from his mother and grandmother, who live in the neighborhood — and a “Parent Cafe” on Mondays with donated pastries from a Panera Bread in Clifton, about 15 miles from Hawthorne.
Singleton picked up the vegetables and pastries in his Volkswagen Jetta, which he calls “The Hawthorne Car” because he uses it so frequently for work. Now he uses it to deliver vegetables to families who can’t leave their homes, along with Chromebook laptops to students who need them for virtual learning.
“I maybe bit off more than I can chew, but I’ll take care of it,” he said. “Just to see the smiles — that’s what keeps me going.”
Singleton has recruited a crew of parent volunteers for the Friday food giveaway, which he asked Hawthorne teachers to advertise to families on Google Classroom and in messaging apps. One of the volunteers is Andria Belcher, who has five children, including two who attend Hawthorne.
After losing her job at Newark Liberty International Airport due to the shutdown, Belcher relies on the vegetables to help feed her own family. Yet she also wanted to help her neighbors.
“There’s so many of us that are struggling,” she said. So when Singleton invited her to volunteer at the church, she didn’t hesitate. “Every Friday, I’m there.”
The free vegetable distribution happens each Friday at Pleasant Grove Baptist Church (198 Chadwick Ave.) from 9 a.m. to 12 p.m. and at Community Church of God (13 Grant Ave.) from 9 a.m. to 11 a.m. For more info, email [email protected].
Chalkbeat is a nonprofit news site covering educational change in public schools.
COVID-19 is likely to disrupt ongoing peace processes, worsen existing conflicts and generate new conflicts. But it may also offer opportunities for ceasefires and peace agreements.
The measures taken to contain the spread of the virus are, unfortunately, also affecting the mobility of peacemakers, peacekeepers and peacebuilders.
At least 22 African countries are experiencing political violence. Countries like Nigeria, Cameroon, Somalia, Libya, South Sudan, and DR Congo are experiencing high intensity armed conflicts between armed opposition groups and national governments.
There are peacebuilding efforts in most of the countries that are currently experiencing armed conflict and that have recorded cases of COVID-19. These efforts variously involve the support of international donors, nongovernmental organisations and national governments.
The secretary-general of the United Nations recently called for a unilateral ceasefire in ongoing conflicts.
But achieving a multilateral ceasefire might be difficult. Some warring factions will seize the opportunity to gain an advantage. The challenges are immense. The pandemic could worsen the conflict situation and undermine ongoing peacebuilding efforts.
On the other hand disasters can transform conflict dynamics. Research shows that disasters such as COVID-19 can create opportunities for peace in conflict countries. For one, they can undermine the ability of conflict entrepreneurs to access conflict areas. This reduces incidents of violence.
They can also create the conditions necessary for advancing peacebuilding processes in local communities. To achieve this outcome peacebuilders need to engage with local actors.
The global response to COVID-19 in the African countries affected by conflict is hampering the movement of international and national peacebuilders. These professionals have been unable to travel to conflict zones. International organisations have placed movement restrictions on their staff. Many of them have returned to their home countries.
At the national level, restrictions have prevented people from congregating and limited their ability to travel.
Peacebuilding requires sustained efforts towards reconciliation and reintegration. Actors must address the impact of conflict and the causes of conflicts. This process often requires physical meetings and events that are designed to bring conflict actors together towards sustainable peace.
Retreating peacebuilding activities during this period portends a great danger for societies affected by violent conflicts. One likely consequence is that non-state armed groups will use the opportunity to expand their frontiers, thus undermining ongoing peace processes.
It also opens up the possibility of increased mortality in the context of violent conflicts. Hence, it is important that stakeholders adopt mechanisms that will sustain peacebuilding efforts in communities affected by violent conflicts during this pandemic.
Local actors that are embedded in communities can continue to work on sustaining peace processes even when professional peacebuilders are unable to gain access. For any peace process, what is important is that people keep communication open and sustained even during the pandemic.
And international peacebuilders can continue providing support to their local counterparts. This can be through funding to facilitate activities in local communities.
International peacebuilders can also provide remote mentoring and capacity building. There is technological capacity for peacebuilders to receive coaching in the most remote areas affected by conflict in Africa. International peacebuilders should also remain available to brainstorm with nationals when challenges are encountered.
Local peacebuilders can be enlisted to stop the spread of the pandemic through their existing networks and knowledge of community relations to coordinate preventive responses. These resources can also be used to reinforce the expertise of public health workers in local communities.
Local actors involved in peacebuilding already have experience translating complex messages into local languages. This skill is very relevant in the fight against the pandemic in communities.
With the right information, local conflict actors can be persuaded to accept the UN’s call for a ceasefire. But this won’t happen unless local actors are involved in crafting the right messages.
Empowering local actors will not only sustain peace processes, but also contribute to the fight against the spread of COVID-19.
To sustain peace, we would need to find new ways of working, by meaningfully including national and local capacities for peace.
It had been two weeks since Terri Anderson, a teacher at The Oaks Academy in Indianapolis, had seen her 19 prekindergarten students in person. But on a recent Friday, they met virtually for the first time on Google Hangouts. The result: a cacophony of 4- and 5-year-olds on unmuted microphones.
“It was the best sound I had heard since all this had happened,” she said.
As the COVID-19 pandemic has upended the educational system nationwide, even preschool has gone online. But school closures threaten to undo some of the progress that Indiana has made toward improving pre-K access for low-income families to help bridge critical early learning gaps.
Many pre-K classrooms have temporarily closed alongside K-12 schools to curb the spread of the coronavirus. Meanwhile, demand has waned at some Indiana child care centers as more families are keeping their children home. The loss of pre-K classrooms has consequences: First, education advocates fear that school closures will worsen the disparities for students across all grades who don’t have access to technology and whose families have fewer resources to support learning at home. Second, families could find themselves without child care as they continue to work during the pandemic in roles such as health care workers, grocery store clerks, delivery drivers, and custodians.
“One of the most important things children learn in a pre-K classroom is how to do school, how to behave with other children, how to self-regulate and be ready to learn,” said Maureen Weber, president and CEO of Early Learning Indiana, a nonprofit that provides and advocates for early education. “That’s one of the things that’s going to be harder for families to achieve independently.”
Because Indiana families have a lot of choices for where to go for preschool — districts, private schools, centers, homes, child care ministries — providers are tackling the challenge in different ways, both online and off-line.
At The Oaks, Anderson wanted the recent video meeting to be a joyful reunion for her pre-K class. She incorporated pieces of their daily routine, such as taking attendance with popsicle sticks that each had a student’s name. When she drew a student’s popsicle stick, she asked them to show the class a toy or something they had made at home, giving each a turn to speak “on the big screen.”
Anderson had them all hug their computers and give themselves hugs, too, wrapping their arms around their own shoulders.
“They need to be nurtured,” Anderson said. “They need a touch. They need a hug.”
Moving pre-K classrooms into the home also means teachers are supporting parents so they don’t feel stressed about their children “losing ground,” Anderson said. Teachers and instructional assistants regularly check in with individual students and families. The Oaks gives preschoolers 1-2 hours of learning each day, and more important than completing the work is instilling a sense of normalcy, she added. A lot of the key lessons are simple: Listen, follow directions, pay attention.
At first, parent Kelly McGary was worried when her son Sam’s preschool, Cooperative Play Academy on the city’s southside, closed its doors in early March. Sam had just learned to hold a pencil properly.
But now she’s less concerned after watching him video conference with his preschool class twice a week, and do engaging homework assignments, such as nature walks.
“I just have to put it in perspective. He’s 3½, he’ll be fine,” said McGary, a public health nurse. “Even if it lasts a few more months, we’re still interacting with him and providing for him. He has a safe place to play. I think he just misses his friends.”
At the Edna Martin Christian Center in Martindale-Brightwood, the approach to at-home learning has evolved over the last few weeks since the child care ministry temporarily closed its doors, said Alexandra Hall, director of early childhood education.
Teachers started by sending food home with students on the first day. Then, they started sharing learning resources. They gave students kits filled with art supplies, reusable writing worksheets, stories, and bubbles. Later, they decided they wanted to find a way to stay in touch with students in a dynamic, interactive way.
That’s how they started a series of 30-minute Zoom sessions throughout the day, mimicking a regular school routine.
“We figured if it works for adults, why wouldn’t it work with kids?” Hall said.
They hold virtual circle time and snack time. Families all gather for the video call with a healthy snack to show and share.
“That is what has just truly been a godsend during this time — to be able to look at people, even though you can’t touch them,” Hall said.
The online setting still allows teachers to be responsive to students. Just like in the classroom, “sometimes you have to throw your plan out the window,” Hall said — like when a student joined the video call in a superhero costume, prompting a show-and-tell that overshadowed the scheduled science lesson.
Even when e-learning isn’t as accessible, pre-K classrooms are finding ways to keep learning. For the five Indianapolis sites of St. Mary’s Child Center, where 93% of children come from low-income families, administrators are mostly focused on basic needs, such as directing families toward food resources.
Teachers are posting videos where they read stories, sing songs, or go on scavenger hunts. They’re encouraging families to find “teachable moments” but aren’t stressing academics.
“Children are such natural learners,” said Diane Pike, director of outreach and professional development. “If they are allowed to explore and communicate and ask questions and have that support at home, they’re going to be OK for kindergarten.”
To fight the spread of coronavirus, government officials have asked Americans to swallow a hard pill: Stay away from each other.
In times of societal stress, such a demand runs counter to what evolution has hard-wired people to do: Seek out and support each other as families, friends and communities. We yearn to huddle together. The warmth of our breath and bodies, of holding hands and hugging, of talking and listening, is a primary source of soothing. These connections are pivotal for responding to and maximizing our survival in times of stress.
But as with any pill, there are side effects. As psychologicalscientists at the University of Washington’s Center for the Science of Social Connection, our lab studies social connectedness, why it is important and how to maximize its benefits. Our clinical and research experiences help us understand the side effects of social distancing and suggest strategies for addressing them.
For those who must be quarantined because they are infected with the virus, this research has one important implication: Depriving the sick of social connection and physical closeness unfortunately may make it harder for them to defeat infection. For example, lonely college students respond more weakly to influenza vaccinations than do non-lonely students.
There are other costs. Loneliness makes people feel more vulnerable and anxious in social interactions. An official mandate to socially distance and isolate may increase what psychologists call intergroup anxiety, the natural threat and distrust people feel when interacting with those who are different.
While social distancing and isolation are in effect, there are things everyone can do to mitigate their downsides.
Now is the time to reach out to friends and family and connect with them however you can. Let people know how much you care about them. While live human connection is best, a phone call, with a real voice, is better than text, and a videochat is better than a phone call.
We believe such social technology-faciliated connections will aid all of us in staying as healthy as possible during this time. Although research on this is not comprehensive, we think it’s valuable to use social technology to mitigate the effects of loneliness and isolation for those who are sick.
What you say when connecting also matters. If you are stressed and upset, talking about your feelings can help. You may or may not feel better, but you will feel less alone. If you’re on the receiving end of this kind of sharing, resist the impulse to dismiss, debate or tell the other person not to worry. Your task is to listen and convey that you understand their feelings and accept them. This process – one person sharing something vulnerable, and the other responding with understanding and care – is the basic dance step of good, close relationships.
Human touch is also vital for well-being. If you are distancing with people who are close to you and healthy, don’t forget the positive impact of a gentle hug, or holding someone’s hand. Safe, mutually consenting physical touch leads to the release of oxytocin. Sometimes called the “love hormone,” oxytocin helps regulate your fight or flight system and calms your body in times of stress.
Other actions can help boost your and others’ well-being as you’re adapting to a world of social distancing.
Embrace others, figuratively. Be aware of your tendency to circle the wagons around your group. Importantly, even though it doesn’t always feel this way, you’re not born with a fixed group that you trust and fixed groups that you distrust. These feelings and associations are flexible and change with context. Imagine, for example, who feels safe and familiar to you when at work versus at a family dinner versus at a football game. Now is the time to expand how you define your group identities. This is a global pandemic. Human beings are in, the coronavirus is out.
Be generous. The practical side of this idea of expanding your identities is an encouragement to be generous, broadly speaking. Giving to others in times of need not only helps the recipient, it enhances the giver’s well-being, too. If you feel compelled to go to the grocery store to stock up on toilet paper, consider checking in with people you know who are more vulnerable and see what they might need. Give them some of that toilet paper. Help others around you, including neighbors you may not know well, people with whom you don’t usually feel a sense of kinship and people experiencing homelessness. Doing so combats the impulse to build walls. It puts you in touch with the better angels of your nature, and gives these angels voice and purpose.
Finally, remember to breathe. In this moment, with all the stress and anxiety, many people feel overwhelmed and disconnected. But you’re still here and those around you are in this chaos with you, too. A few conscious, gentle breaths can restore that connection, slow your mind and give you clarity, at least for a moment or two.
This coronavirus crisis may not end soon. Things may get worse. As people hunker down, the negative side effects of social distancing and isolation will shift and evolve. What feels manageable today may not feel manageable tomorrow.
As psychologists, we are concerned that the lack of social connections, increased stress, disruptions and losses of livelihoods and routines will tip some people toward depression. We are concerned about increased family conflict as people are forced to navigate unusual amounts of time together, many in confined spaces.
Flexibility is adaptive. Building a foundation of healthy coping, maintaining awareness of the side effects of our necessary societal changes, and staying connected to our values and to each other are imperative. Human beings have great capacity for empathy and caring in times of suffering. Maintaining social distance doesn’t need to change that.