china's gift

The world watches as a plague rages through the urban streets of central China. Nearly 90 people died on Saturday, bringing the total death toll to at least 813. The number of confirmed cases of 2019-novel Coronavirus, a disease so new that it doesn’t yet have a name, has risen to over 27,000 in Hubei province alone. Thousands of patients are packed into hospitals, with weary doctors and nurses working around the clock and sleeping on floors.

Americans are concerned, of course, especially parents with young children. But we remain hopeful. “Wuhan is different,” we tell ourselves, and some experts agree. Reports coming out of Hubei suggest that there could be local risk factors-such as high population density, air pollution or heavy smoking habits-that explain why the outbreak has been so intense there.

Disaster professionals have a phrase for this kind of argument. We call it “talking away the job” and we are seeing people all over the country using them, along with random posts and tweets of information and misinformation, to build mental walls around their fear. They hide behind these brick walls of hope to deny the reality that is before their eyes.

In New York City, we are having a different conversation. Over the past twenty years, a series of disasters, from 9/11 to Superstorm Sandy, have destroyed our illusions. We see this threat for what it is, even halfway around the world. So instead of debating probabilities, we are concentrating on consequences.

We are putting ourselves in the job so that we can know what we will do. The job for us looks like a second wave of independent, self-sustaining outbreaks in major cities-including New York-emerging over the next several weeks. Unlike in Hubei, the ability of government to lock these down will be limited, but the impacts of the outbreaks will not. 

Schools will close. Subways and buses will operate but riders will be required to wear masks. Offices will close too, doing as much as they can remotely. Workplaces that remain open will be missing a quarter of their workers on any given day: due to illness, the need to care for ill relatives, or fear of becoming infected. Hospitals will be overwhelmed with the worried well. During the peak, police and fire services will be limited by personnel shortages, and absenteeism at utility companies will lead to power, water and telecommunications outages. Supplies of food, fuel, and medical supplies will be disrupted as truck drivers become ill or stay home. In some areas, grocery store shelves will be empty and long lines will form where food and gasoline are available. Elderly patients with chronic, unstable medical conditions will stay home for fear of becoming ill. Public gatherings will be cancelled and the flow of tourist will slow to a trickle.

If there is any good news in all of this, it is that we can see it coming. Chinese authorities have moved quickly to contain the outbreak, with close to 60 million people under lockdown. WHO Director-General Tedros has praised China’s response, saying that “its actions actually helped prevent the spread of coronavirus to other countries”. Its effort has been nothing less than heroic. So rather than blame the Chinese, we must admire them. For their bravery in the face of this threat, and for giving us the gift of time.

My organization performs world-class patient care, education, and research in the heart of New York. With a major hospital and family health clinics located across the Brooklyn neighborhood of Sunset Park, the so-called “Beijing of America”, we are on the front lines of the outbreak

And we have been working the job since its first days. Task forces that span the enterprise are making sure we are doing everything humanly possible to prepare for an influx of worried well into our emergency departments and a surge in absenteeism among our staff. Some people ask why we are working so hard now, wearing ourselves out, when the pandemic is not even here. The answer is that when a tsumani of worried well breaks over us, our options will be limited. This is the most important phase of the incident and we are thinking three steps ahead to be ready.

The nature of catastrophes is that they affect everybody all at the same time. As they are doing in Wuhan, we will have to fight a worst-case outbreak with the army that we have. Our opportunity to build that army, adjust our process with thoughtfulness and supplement our resources, is now.

Here in New York, we will have no regrets. In the face of this unpredictable crisis, instead of waiting, we are using our gift of time. Instead of being shocked when it happens, we are doing everything possible to be ready to confront the disaster. This is what we must do, for our patients, our families and ourselves.

Kelly McKinney is the Senior Director of Emergency Management + Enterprise Resilience for NYU Langone Health in New York City and the former Deputy Commissioner for Preparedness at the New York City Office of Emergency Management. He is the author of Moment of Truth: The Nature of Catastrophes and How to Prepare for Them that was released last July by Post Hill Press