It’s been two long and lonely months since the coronavirus pandemic shut down most of America: two months of crowded emergency rooms and empty schools, of avoiding one another at the grocery store and waiting in mile-long lines for donated food. Normal life already seems a distant memory.
Amid this darkness, there are people working to light a path through.
They are immigrants and the children of immigrants, public servants, people on their second careers. They are planners and problem-solvers. What they lack in swagger they make up for in empathy, skill and statistical rigor. Their greatest power is their ability to learn from the mistakes of the past.
They are the right people in the right place at the right moment, like researcher Andre Kalil, a veteran of past epidemics trying to find a cure for this pandemic, and Anar Yukhayev, a New York obstetrician-gynecologist who was severely ill with COVID-19 when he enrolled in a clinical trial for an untested treatment.
"If there was any chance it could potentially help someone," Yukhayev said, "it was the least I could do."
They don't offer easy answers or miracle cures; they know there is no resurrecting the lives they once had. Still, they're giving what they can to a moment that demands it. When it is most difficult to imagine the world getting better, they've summoned the creativity - and the courage - to invent the world anew.
‘You have to be prepared’
Scientists have a word for populations threatened by a virus they’ve never seen before: naive. It describes patients whose immune systems lack the tools to fight off the pathogen, whose bodies are caught unaware. How quickly those patients can muster their biological defenses determines whether they survive.
Society, too, has been caught off guard. In a matter of months, a virus one-thousandth the width of a human eyelash has emptied the national medical stockpile, shattered the health system and brought the global economy to a standstill. Now, matters of life and death depend on the speed with which people rise to the occasion.
Some people, such as emergency management specialist Kristina Laboy, 29, have spent their careers bracing for moments such as this. She holds two master's degrees in crisis management and last year led a major rewrite of the 188-page pre-disaster recovery plan for Montgomery County in suburban Maryland.
After reviewing the document she and her colleagues carefully crafted, "it feels really good knowing we've done the prep work," Laboy said. "We've tried so hard to set the county up for success, and now we're in a position to see how it works."
But there is more than one way to be prepared.
There's the grace and grit that grow out of struggle. Yukhayev credits his mother, who worked as a midwife in her native Azerbaijan, with teaching him to serve others. After he immigrated to Brooklyn at age 7, encounters with injustice made him more determined to contribute good to the world.
A childhood lived below the poverty line - and an adulthood spent responding to disaster - shaped Oscar Baez, a care resource coordinator for the Massachusetts nonprofit Partners in Health, who is assisting the state's contact tracing efforts. His parents, immigrants from the Dominican Republic, worked long hours as a janitor and day-care provider to give Baez many of the opportunities he has had. He has studied 10 languages and worked for the State Department. Ten years ago, he traveled to Haiti - where Partners in Health got its start - to assist earthquake victims. He was stationed in Jerusalem when the novel coronavirus hit.
Back home in Boston to fight the pandemic, 33-year-old Baez finds himself serving people in the same neighborhoods where he grew up. He sees the disproportionate toll the virus has taken on immigrants, people of color and low-income communities. He understands what's needed to assuage their fears.
The pandemic, Baez said, "has solidified that there's always a need for someone to have that empathy and that local perspective."
There is the strength that comes from community, years of hard-earned goodwill coming due. There are letters like the one sent to Tampa Bay restaurateurs Roger and Suzanne Perry from two states away. Inside a card inscribed with a Winston Churchill quote about "stiff upper lips" was a worn $5 bill and instructions to buy kibble for Cheeto, the office cat.
A couple of days before, an anonymous well-wisher purchased the Perrys' prized 25-year-old bottle of Pappy Van Winkle bourbon for double the $20,000 asking price. That was $40,000 the couple could use to bring back some of the 700 Datz Restaurant Group employees they were forced to lay off when Florida shut down.
Then there is the steely sense of purpose born of long-nurtured regret, the determination to do better this time that can exist only in someone who has seen failure.
Kalil, an infectious-disease clinician at the University of Nebraska Medical Center, knows that feeling all too well.
His university is home to the National Quarantine Center, the only federally funded containment unit of its kind. During the Ebola outbreak in West Africa in 2014, three infected Americans were evacuated to the center for treatment. One of them didn't survive.
Kalil, 54, is still haunted by what he considers an inadequate response from the medical community to the Ebola crisis, which killed more than 11,000 people. Pharmaceutical companies and doctors tried a multitude of drugs on thousands of severely sick and dying patients - some of them the same therapies being tested in patients with COVID-19, the disease caused by the novel coronavirus. But the experiments were haphazard and hampered by their lack of a control group.
"You wind up with a situation where certain drugs are being given, and no one knows if they work or not," said Kalil, a native of Brazil.
By the time a large team of doctors, including Kalil, launched a rigorously controlled clinical trial for a drug called ZMapp, it was too late, Kalil said. The epidemic subsided, and there were no more sick patients.
This time, he and his colleagues, as well as officials at the National Institutes of Health, went into a full-on sprint at the first sign of another viral outbreak with global implications. By early February, they were drawing up protocols and applying for approvals from ethics boards for a rigorously controlled clinical trial of an experimental antiviral therapy called remdesivir.
Weeks later, when 13 people from the Diamond Princess cruise ship off the coast of Japan were brought to the national quarantine unit, one of the passengers became the trial's first patient.
Kalil recalled entering the patient's room wearing full protective gear, including a fan-powered respirator that fully enclosed the top of his head and face and made it difficult to communicate. In a muffled voice, he said, he guided the patient through the consent forms, described the clinical trial regimen, and explained how remdesivir would be administered and the risks of side effects.
To avoid removing potentially contaminated documents from the containment room, Kalil then held each of the completed consent forms up, one by one, while another member of the medical team documented them with a camera.
By the end of April, the remdesivir trial had enrolled about 1,000 patients at 68 sites around the world.
"You have to be prepared not only for the outbreak itself ... you have to be prepared to start your clinical trials immediately,"' Kalil said. Moving fast - without taking shortcuts that could undermine the results - is "the only way to really save lives."
'We’re here to try’
In this uncertain era, terror takes the form of questions with no good answers, queries we’ve typed so often that search engines can complete them on their own: Do I have the virus? Where is my stimulus check? What can I do to make things better? When will all this awfulness end?
"Maybe, on a smaller scale, the uncertainty of not knowing what's going to happen when you're lying in a hospital when you're sick is like the uncertainty people feel about what's going to happen in the world," said Yukhayev, the New York-based obstetrician-gynecologist.
When he was hospitalized at Long Island Jewish Medical Center, five floors above the maternity ward where he usually works, Yukhayev, 31, surveyed his symptoms with a growing sense of dread. His whole body burned with fever. He had to gasp to get air into his drowning lungs.
He tried to tell himself what he usually told his patients: Hang on. Have faith. The only way out is through.
"But after a while, you start to ask yourself: Is this really true?" he said. "Maybe I will never get better."
Yukhayev had been sick for a week when infectious-disease expert Prashant Malhotra and critical-care doctor Negin Hajizadeh offered him a choice. They were running a clinical trial for sarilumab, a drug that blocks the "cytokine storm" of immune proteins associated with some of the worst forms of the virus. The drug was taken as an injection by rheumatoid arthritis patients but had never been administered intravenously. Yukhayev could be one of the first COVID-19 patients to try it.
He understood the risks better than most people. He knew the drug might not work. He knew he could suffer serious side effects: Sarilumab can weaken the immune system and form holes in the stomach wall. He knew he might not even get the medication; 20 percent of patients in the trial would receive a placebo.
Yet his scientific training had taught him the importance of these experiments, and his work as a doctor had fostered a willingness to take risks for the greater good.
Yukhayev said yes.
But a day after Yukhayev received his dose of sarilumab, his condition had gotten so bad doctors transferred him to intensive care. He would probably have to be put on a ventilator - something Yukhayev described as his worst fear.
He called his brother. "They're going to intubate me," he said. "I don't know when I'm going to talk to you again."
Studies like the one Yukhayev enrolled in, or the one Kalil is running in Omaha, are the "gold standard" for drug testing, Kalil said. The inclusion of a placebo allows doctors not just to measure effectiveness but also to see quickly whether there are dangerous side effects. Double-blind trials, in which neither patients nor doctors know who is getting the real drug, produce the most reliable results.
The rapidly assembled remdesivir trial bore its first results in late April when Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said the drug shortened the time to recovery for hospitalized patients by 31 percent, although it did not significantly reduce deaths.
The results gave doctors hope remdesivir will become an ingredient to help reopen society and rebuild the economy. It also could help doctors prepare for a second wave of the pandemic if COVID-19, as expected, makes a resurgence in the fall. The next step for Kalil and others running the trials is to test remdesivir in combination with anti-inflammatory drugs to see whether double-teaming the disease will have a stronger effect.
That possibility propels Kalil through his long days, which begin with a predawn run and end at 1 a.m. in front of his home computer. He and his team scour the University of Nebraska Medical Center computer system multiple times a day and roam the floors looking for novel coronavirus cases. They approach the patients and family members and recruit them for the trial.
"This is the way I would do it for myself and do it for members of my own family," Kalil tells each prospective patient.
He has found they usually agree once they understand the process. Armed with information, reassured by a compassionate expert, most people are willing to take a chance.
Until scientists identify a treatment or a vaccine, public health measures are the nation's only bulwark against the coronavirus. That means staying inside. And when staying inside becomes untenable, it means finding out who is sick and making sure their infections do not spread.
Determining who may be infected is a herculean task, not only for a country of 330 million people but also for a single state. Massachusetts, in collaboration with Partners in Health, is hiring 1,000 people in hopes of finding a way to identify those who may be infected and ultimately lift its quarantine.
The goal is for each new case - of which there are hundreds every day - to trigger a series of phone calls. One contact tracer makes sure the person is aware of the diagnosis and encourages that person to quarantine for at least 14 days; another reaches out to people who may have been exposed.
In April, when Partners in Health was hiring and training staff for the project, 36,302 people applied to help.
Coordinators like Oscar Baez are called in when people need help getting through their quarantines. He reassures people worried about being evicted during the pandemic. He gets groceries to families who are turning to food banks for the first time. He had a long call with a lonely woman whose husband had been hospitalized with COVID-19 and who was infected herself.
On the news, every infection seems like a statistic, Baez said. But in his job, he clicks on a case number and sees details about the person behind that number. He hears their fears and anxieties but also glimmers of hope as their conditions improve.
"We can't promise that we're going to meet all of their needs; it's impossible," Baez said. "But just the effort that we're here to try - that is uplifting. I've ended many conversations more uplifted than not."
In New York, Yukhayev's doctors prepared to move him onto a ventilator - then stopped. His oxygen levels were creeping back up. His inflammation waned.
The next day, Yukhayev felt so good he was able to shower. A nurse brought him comfort food sent over by his mother - stuffed grape leaves and chicken noodle soup - and colleagues taped encouraging notes to the glass of his hospital room. A friend reminded him of a teaching from the Talmud: Sickness is an opportunity to recognize what sustains you - the loved ones who surround you, the strength that runs deep.
Yukhayev can't say what sparked his recovery. The trial he was part of was amended after drugmakers found sarilumab did not help severely ill patients like him. But he hoped his experience might help others struggling with fear.
"To anyone who can't see the light at the end of the tunnel," he said, "I want to spread a message of positivity."
Hang on. Have faith. The only way out is through.
‘You don’t want to just get back to normal’
Biology dictates that the pandemic can’t last forever. Public health measures will start working. A vaccine will be developed. Humans, hopefully, will become immune. There is a world on the other side of this crisis.
Kristina Laboy and her Montgomery County colleagues meet daily to discuss what that world might be like. Over Zoom calls and in long email chains, they map out the complex process of rebuilding their community. It's a government-wide operation that will last months, if not years.
"We're looking at long-term economic recovery happening at the same time as a restructuring of public health and services," Laboy said at one meeting. "It's nothing we've ever seen."
The long-term toll of the outbreak on their suburban county of 1 million will be profound. There are the deaths, of course - 262 in the first two months of the pandemic. But there are also the psychological effects of isolation and instability. There's the grief of families who lost relatives without getting to say goodbye. There are small businesses that cannot restart without financial assistance. There are parents who will not be able to return to work until schools reopen. There are disparities in the health system and holes in the social safety net that must be mended before the next wave of illness lands.
In almost any other crisis, a community like Montgomery County would be able to call on outside support. Medics might drive in from another locality; emergency equipment could be shipped from overseas. But with the whole world stricken by the coronavirus, few places have resources to spare. The answers to Montgomery's problems must come from within.
Like architects faced with a house in disrepair, Laboy and her colleagues are excited by what they see as opportunities to rebuild and reshape, to draw blueprints for a stronger home.
"You don't want to just get back to normal," said Lisa Crow, 33, an emergency management specialist on Laboy's team. "Right now is when we're deeply learning what we need to pay attention to and what we can fix."
The county's food security task force, which started a month ago as a group of four people, has ballooned into a team of more than 50 public and private partners. Planners are collaborating with restaurants to turn their ad hoc food donations and volunteer efforts into programs that can feed people long-term. Public libraries and police departments are offering more services online than ever before. And the multilingual team assembled to translate public health messages will keep working to reach Montgomery's 300,000 or so foreign-born residents even after the pandemic is over.
Netta Squires, 36, works with the county's community organizations and is thinking about how to transition the county's growing population of mask makers, grocery shoppers and other volunteers into a cadre of residents supporting recovery operations.
"We have the attention and the investment," Squires said. "Of everything, the one thing we're sure of is that we're going to come out stronger."
In Florida, restaurateurs Roger and Suzanne Perry also have been trying to picture their business in the post-COVID-19 era. Among the changes: Disinfectant wipes everywhere and no more sharing condiment containers. Roger, 70, wants a "hands-free" bathroom with automatic paper towel dispensers. Suzanne, 54, is "re-engineering" menus for the new economy and poring over profit-and-loss reports and supply-chain charts.
The Perrys have always been innovators. In his first career, Roger expanded his family's animal feed business into 31 superstores he eventually sold to PetSmart. After moving to Tampa and being disappointed by the shortage of good delis, they opened Datz and became famous for dishes like mac and cheese stuffed meatloaf.
But this time is frustrating, Suzanne said. How are you supposed to plan for the future if you don't know what's coming? How can you reopen a restaurant when it's not clear whether anyone will come to eat?
Still, the restaurant received more than $1 million in federal and state loans for small businesses. Then, Gov. Ron DeSantis announced businesses like theirs could open up on May 4.
The Perrys hired 40 people, then 75, no one in the same jobs they had before. Chip fryers started glazing doughnuts, baristas were printing and passing out sales fliers. Busers ripped out the old carpet, and bartenders painted the walls. The Perrys made plans for off-site kitchens and improved customer loyalty programs. They ordered new uniforms, everything spotless and pristine.
Since the state has advised restaurateurs to use as much outdoor space as possible, Datz locations will set up tables in parking lots and on grass medians. "And maybe the guy across the street's parking lot, too," Suzanne joked.
She lay awake late one night listening to a much larger restaurant group's podcast about getting through the pandemic. "We are doing every single thing he is doing and more," she thought to herself. Maybe things would work out.
Because things can still work out. About a week after Yukhayev was discharged from the hospital, he learned one of his patients required an emergency C-section. Since she had tested positive for COVID-19, she would be giving birth in isolation.
Yukhayev hadn't planned on going back to work so soon. He was still weak from his illness; his uncle had died of the virus just days before. But a test showed he was not contagious, and he wanted to be there for his patient. He understood what it meant to be sick and alone.
A few hours later, Yukhayev was holding a tiny, healthy baby girl. Though the surgery taxed his battered lungs, leaving him winded and weary, he felt happier than he'd been in a long time.
The newborn reminded him that “there are good things around us continuing to happen,” he said. “It gave me a breath of hope.”