The Shock Wave of COVID-19

Summary

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The New Yorker Radio Hour

Episode: The Shock Wave of COVID-19
Date: March 20, 2020
Host: David Remnick (The New Yorker / WNYC Studios)

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Overview

This episode captures the early shockwaves of the COVID-19 pandemic in March 2020, as experienced across America. Host David Remnick speaks with frontline medical professionals, individuals affected by isolation and visitation bans, public health ethicists, economists, and essential workers. Through intimate stories and expert insights, the episode illustrates the profound disruptions—medical, personal, and economic—wrought by the virus, exploring the uncertainty and emotional toll of the crisis as it unfolds.

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Key Discussion Points & Insights

1. The Strain on Hospitals and Healthcare Workers

Guest: Dr. Aria Neshat, ER Doctor, Portland, Oregon
Timestamps: 01:10 – 06:46

• State of Preparedness:
  • The calm before the storm: Oregon ERs are bracing for a surge seen in neighboring Washington.
  • Limited testing: Only the acutely ill are tested due to shortages.

    "We are expecting the rush to come in probably in the next five to ten days. Right now it feels very much like the calm before the storm." — Dr. Neshat [01:21]

• Equipment Shortages:
  • Nationwide lack of masks, gowns, and PAPRs (powered air purifying respirators); only 10% of federal requests for gear filled.

    "You're asking frontline docs...to take care of a highly infectious disease...without having the right gear to protect ourselves and our colleagues." — Dr. Neshat [02:12]

• Personal Anxiety:
  • Balancing duty with personal risk—as a single parent with asthma, facing the prospect of falling ill is traumatic.

    "I can’t put myself in a position where I orphan my children. And that's a really tough place to be." — Dr. Neshat [04:25]

• Evolving Guidelines & Leadership Frustration:
  • Confusion from rapidly changing protocols and federal missteps.

    "Obviously, the federal government has failed miserably in preparing the country for this pandemic, and for months was saying, this isn't a problem." — Dr. Neshat [05:27]

• Community Response:
  • Frustration at neighbors’ lack of seriousness about social distancing.

    “I was pretty mad when I got home last night, and I had observed in my own neighborhood a group of approximately 10 people congregating...it almost feels oblivious.” — Dr. Neshat [06:19]

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2. Isolation, Vulnerability, and Unbearable Goodbyes

Guest: Jiayang Fan, New Yorker Staff Writer
Timestamps: 06:53 – 15:44

• Personal Story of Visitation Ban:
  • Fan's mother with advanced ALS is locked down in a care facility—no visitors allowed.
  • The emotional agony of being separated, possibly permanently, and relying on aids and technology (alphabet blinking chart, FaceTime with the help of private aide) for basic communication.

    "If I don't get to see her again...I should try to write something good." — Jiayang Fan, relaying her mother’s message [12:38]

• Coping Mechanisms and Guilt:
  • Fan describes the weight of missed opportunities and the surreal transformation of daily routines.
• Lingering Uncertainty:
  • “I never thought that I would not be there to say goodbye to her, that I wouldn't be holding her hand at her bedside when she goes.” — Jiayang Fan [13:18]
  • Balancing how much to communicate the outside crisis to her mother, given her mom’s physical isolation and vulnerability.

    “Her entire life has been a hospital bed she hasn’t left for years...when I tell her the world is coming apart outside her bedroom, I’m not sure if she’s fully able to grasp the significance.” — Jiayang Fan [13:55]

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3. The Ethics of Scarcity and Triage

Guest: Dr. Philip Rossoff, Professor of Medicine and Bioethics, Duke University
Timestamps: 17:13 – 32:28

• Nightmare Decisions:
  • Hospitals in Italy are forced to ration ventilators, confronting “who shall live and who shall die.”
  • The need for institutional triage guidelines—choice should not be left to on-the-spot judgement.

    “The way not to make this decision is...arbitrarily, capriciously, unilaterally, and at the bedside in the moment.” — Dr. Rossoff [18:27]

• American System Unpreparedness:
  • Guidelines exist but are inconsistent state-to-state, creating disparities.
  • The US medical system, run on "just-in-time" logistics for cost efficiency, is fundamentally unprepared for a surge.

    "Our healthcare system is a $3 trillion business, and I want to emphasize business." — Dr. Rossoff [24:57]

• Emotional Toll on Caregivers:
  • Extraordinary “moral distress” for those who must decide on withdrawing care.

    “We need to put into place support systems for people in those situations.” — Dr. Rossoff [23:10]

• Lessons from Scarcity:
  • Calls to avoid exacerbating existing inequalities; allocate resources openly and based on clinical benefit.
• Vaccine Caution:
  • Dr. Rossoff warns against assuming a vaccine will provide a quick resolution; interim planning is critical.
• Hope and Shame:
  • Cites the duality of past crises: the potential for both “medical and moral victories” or “shame.”

    “My hope is that when we come out of this, we will have medical and moral victories rather than medical and moral shame.” — Dr. Rossoff [30:46]

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4. The Economic Shockwave

Guest: John Cassidy, New Yorker Staff Writer
Timestamps: 33:47 – 42:49

• Unprecedented Contraction:
  • Economists predict consumer spending may drop by a third; unemployment could hit 20% within months—faster than during the Great Depression.

    “...the economic impact of the COVID-19 virus is likely to be bigger than the Great Depression in the initial stages, at least.” — John Cassidy, quoting historian Barry Eichengreen [34:14]

• Sectors Most at Risk:
  • “Consumer-facing” workers (gig workers, airlines, hotels) hit first and hardest.
• Comparison to Previous Crises:
  • 2008 was a financial crisis—this is a government-mandated economic shutdown for public health, an unprecedented maneuver.

    "I think it's a sort of economic life support operation. It's what we need." — John Cassidy [37:48]

• Government Response:
  • Initial response was inadequate, but government pivoted to a $1 trillion stimulus including direct payments to citizens and loans to businesses.

    “What the Federal Reserve did over the weekend was very important just to prevent a full-on financial crash.” — John Cassidy [37:57]

• Universal Basic Income Proposal:
  • Cassidy advocates for a temporary universal basic income to provide support equitably and win political buy-in for other measures.
• Corporate Bailouts, Controversy, and Conditions:
  • Acknowledges airline bailouts are necessary, but should be structured to protect taxpayers with secured loans, echoing approaches from the Great Depression.

    “The loans should be secured on the assets of the companies…if they can't repay these loans, the taxpayer would then seize the...assets.” — John Cassidy [42:43]

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5. The Dignity of Essential Work

Guest: Aaron Meyer, San Francisco Sanitation Worker
Timestamps: 44:00 – 47:30

• Daily Life on Lockdown:
  • Meyer’s tweet goes viral, highlighting the quiet perseverance of essential workers who cannot “shelter in place.”

    “Right now I am feeling an extra sense of pride and purpose as I do my work. I see the people...peeking out their windows at me. They're scared. We're scared. Scared, but resilient.” — Aaron Meyer (quoted from tweet) [44:00]

• Risks and Routines:
  • Fear of bringing the virus home to immunocompromised family; extra sanitation steps after each shift.

    "When I get home...I go straight into the garage and just strip off my...uniform...because I don't want to bring anything into the house." — Aaron Meyer [46:20]

• Community and Camaraderie:
  • Pride in work, camaraderie with colleagues, and a sense of unity and optimism.

    "I'm just one person, but there's a lot of other people out there who are in the same situation as me...we'll pull together and we'll get through this." — Aaron Meyer [47:30]

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Notable Quotes

• Dr. Aria Neshat:

  “Just like you wouldn’t ask a fireman to run into a building without protective gear, it’s feeling very uneasy for us...we have a really good chance of getting [the virus]” [02:12]

• Jiayang Fan:

  "I never thought that I would not be there to say goodbye to her, that I wouldn't be holding her hand at her bedside when she goes." [13:18]

• Dr. Philip Rossoff:

  "Having empty hospital beds is a waste of money...we have cut the system to maximum efficiency. Bone." [25:21]

• John Cassidy:

  “Effectively we've got a government-imposed shutdown of, you know, 50% of the economy. Maybe we'll go up to even more than that.” [36:35]

• Aaron Meyer:

  “We’re scared. Scared, but resilient. Us garbage men are going to keep collecting the garbage. Doctors and nurses are going to keep doctoring and nurserying.” [44:00]

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Timestamps for Important Segments

• Intro and context: 00:16 – 01:10
• ER perspective (Dr. Neshat): 01:10 – 06:46
• Family separation (Jiayang Fan): 06:53 – 15:44
• Triage and healthcare ethics (Dr. Rossoff): 17:13 – 32:28
• Economic crisis (John Cassidy): 33:47 – 42:49
• Essential workers (Aaron Meyer): 44:00 – 47:30

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Tone & Takeaways

The episode weaves urgency, vulnerability, candor, and hope through firsthand stories and expert commentary. Listeners are drawn into the personal anxieties of healthcare providers, the heartbreak of family separation, the ethical calculations in resource scarcity, the economic unmooring of society, and the resilience of workers who keep cities clean and running. The stakes are immense and immediate, but the concluding voices offer reminders of collective strength and the possibility of rising to meet this unprecedented challenge.

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For further reading and regular updates, visit newyorker.com.

Transcript

[A]

This is the New Yorker Radio Hour, a co production of WNYC studios and the New Yorker.

[B]

Welcome to the New Yorker Radio Hour. I'm David Remnick. We're broadcasting from my place this week and just like millions of people, we're working from home and we're the lucky ones. Closures and quarantines have absolutely swept the nation. Last week, schools, restaurants, small businesses, you name it. Many are already out of work and many more are worried about being out of work soon. And in so many industries, people are working at jobs where they don't necessarily feel safe. Hospitals across the world are already beginning to come under tremendous strain as the number of cases goes up and up. And although the United States is behind China and Italy in some places, we're beginning to feel the strain already. Dr. Aria Neshat is an ER doctor in Portland, Oregon, preparing for the flood of COVID 19 patients they've been seeing in neighboring Washington. Dr. Neshat, hello. How are you?

[C]

I'm good. Thanks so much for calling.

[B]

Well, we're reaching you early in the morning on the West Coast. What's it like to be working in an ER right now?

[C]

Well, to be honest, we are expecting the rush to come in probably in the next five to ten days. Right now it feels very much like the calm before the storm.

[B]

And what kind of preparations do you make during the calm before the storm? What can you do?

[C]

Well, the data from China and Italy is obviously very disturbing. And the number one thing that Americans can do right now is shelter in place. We know that people are walking around and are probably COVID positive and don't even realize it because they either have no symptoms or have very mild symptoms. Right now in Oregon, we're very limited in terms of our testing capabilities. Everybody is trying to ramp that up. But right now we're only able to test those people who are truly acutely ill and hospitalized.

[B]

Are you talking to colleagues in Washington state, which has been really hard hit, and what are you hearing there?

[C]

I'm hearing that they are definitely seeing the surgery. They are ramping up all of their services, ER services, ICU services, ventilators. And they are very concerned. They are not sure how bad it's going to get. It just started there in the last week or so in lower Washington and I think they're struggling to keep up. And I think one of the big issues for us on the, on the front lines is we don't have enough personal protection equipment across the nation. And Oregon sent out a notice saying we have two weeks supply, essentially and they're asking for the feds to resource us better. And we've gotten only about 10%, apparently of the ask from the federal government. And so you're asking frontline docs like myself, like other physicians, to be there for our patients, which is what we train to do. It's what we're excellent at, it's what we're prepared for. But just like you wouldn't ask a fireman to run into a building without protective gear, it's feeling very uneasy for us that we're being asked to take care of a highly infectious disease that we have a really good chance of getting doing procedures like intubation without having the right gear to protect ourselves and our colleagues.

[B]

What is it that you're short on? Masks, Disposable gowns?

[C]

We're short on N95 masks. We're short on surgical masks, we're short on gowns, we're short on papr, which is basically a self contained device, so that nothing that is aerosolized in the air, which commonly when someone is coughing, they're aerosolizing the infectious agent. We don't have enough PAPRs to go around. And I think the ask that the medical community has is really for industry to step up. We know that PAPRs exist in research labs. They exist in other settings where there's research and development going on, whether it's in the pharmaceutical industry and technology. We need those devices made available to frontline healthcare providers right now.

[B]

This has gotta make you very anxious about your own health. Being in a frontline medical position, knowing that the onslaught is invariably coming very.

[C]

Soon, it's definitely nerve wracking. I will be honest, I initially was like, okay, I can handle this. I'm an ER doc. I've been doing this for almost 20 years. And yesterday one of my colleagues was like, wow, you seem more stressed than usual. And it kind of occurred to me that, yeah, I am more stressed than usual. I'm a single parent, I have two very young children. I have underlying asthma. I can't put myself in a position where I orphan my children. And that's a really tough place to be. Between knowing your professional duty and knowing that you want to be there and stand side by side with your colleagues because we are the experts in how to manage crisis and at the same time weighing the implications of what if I do get sick? What are the implications for my family?

[B]

There seems to be a number of evolving guidelines for doctors. What's it like to practice medicine under those really unsure circumstances?

[C]

Well, I would say we're all obsessively checking our phones and we're all obsessively talking to each other within private channels, chat groups amongst the physicians. But it is confusing. We get different messaging depending on the day, the hour. Obviously, the federal government has failed miserably in preparing the country for this pandemic, and for months was saying, this isn't a problem. And so there are people who, you know, driving home from the hospital yesterday, were congregating, and granted, most of them were in groups of less than 10, but there's this atmosphere of, oh, we're off from school, we're off from work, and some people really aren't taking it seriously and aren't social distancing, and we're not going to be able to flatten the curve that way.

[B]

That must make you apoplectic.

[C]

Yeah, it does. I was pretty mad when I got home last night, and I had observed in my own neighborhood a group of approximately 10 people congregating and laughing and joking around and. And part of me is like, am I overreacting? You know, it's a group of less than 10. They've been told that they can congregate. I think because we are so mindful of what's coming, it almost feels oblivious.

[B]

Dr. All I can do is say I wish you the very, very best. Thank you so much.

[C]

I appreciate it.

[B]

Dr. Aryan Neshat in Portland, Oregon. This is the New Yorker Radio Hour. The loss of human contact that's come with quarantine and social distancing can either be a mere colossal inconvenience or it can be truly heartbreaking. Jiang Fan is a staff writer for the New Yorker, and her mother is in an elder care facility which now has a visitor ban to protect the vulnerable population. And that has Jang quite worried. Jiang, hi. How you doing?

[D]

I am trying to hang in there. It's very strange. In the last 10 years, I don't think I have been away from my mother for longer than a week.

[B]

Well, let's begin by your describing your mother's situation. You came here when you were a little girl, when you were eight years with your mom from China.

[D]

Yes.

[B]

And her health deteriorated when she was.

[D]

Diagnosed with als, the neurodegenerative disease that kind of progressively paralyzes you until it takes away your ability to breathe and is 100% fatal. She was diagnosed with ALS in 2011, and she when on a ventilator. I mean, she lost her ability to breathe in 2014, and she's been living at her present facility since 2014. I've been told that we've been living a single life for some time. For better or for worse. I'm not sure it's the healthiest thing, but that's been the case.

[B]

What do you mean? What do you mean by a single life?

[D]

I think my mother is an immigrant and so am I. And I understand that she has been living much of her life for me for the past several decades. And when she was diagnosed, I felt not only out of obligation but just out of the sense that of course, this is the time for me to be living my life, partly to keep her alive.

[B]

How often do you normally see her?

[D]

I see her every day. I see her. Unless I have been in a different country for a reporting trip, I see her every day. That's why I chose my apartment to be within a five minute walk.

[B]

When's the last time you were able to see her?

[D]

The last time I saw her was last. Last Tuesday. And I hate myself for having skipped Wednesday because thought that I should start stocking up on supplies and getting ready for what might be coming next. I thought, well, on Thursday I'm going to come and I'm going to have sometimes, if in a pretty rare event that I ever skip a day, I make sure I'm there for four hours, five hours the next day. And on Thursday morning, due to all this anxiety and due to my fears of what precautions might be in place in the hospital, I rushed over in the morning and I was greeted with these two huge cardboard signs.

[B]

What did they say?

[D]

They said that new rules restricting visitation have been implemented immediately to protect the family. They've been implemented this morning. There were other upset relatives and friends who were also coming to that realization. Next to me. We were all reading the signs together.

[B]

Have you had any communication with her from outside the hospital since it's been impossible to get in.

[D]

She's. She's been, she spells with her eyes and writes notes that my aide there, there's a private health aide that I hire to ensure mother's quality of life and ALS is such a cruel disease that she would be completely locked in if she didn't have a person tending to her almost on a, on a minute to minute basis. And that aide walked in on Tuesday morning thinking that her shift would end on Friday and has been, has been been imprisoned in there with her. And she's heroic to me because she has agreed to stay in there at least the next week to care for my mother. But anyway, she's the one who allows me to facetime my mother for a few minutes a day, and she's the one who takes dictations from my mother's eyes. So I have an Alphabet chart. It has abcdfg. And she. I will hold that chart up and go through the letters, and she will blink when I get to the right letter. So she uses the chart, she writes down the jumble of letters, and then she uses WeChat to send those messages to me. But I've been discouraging my mom from spelling too much because it's very, very exhausting for the aid.

[E]

And.

[B]

Can I ask what she said?

[D]

She told me to stock up. She told me all the Chinese seaweed and dried mushrooms and canned goods that. That I should stock up on. And she also told me that if she didn't, if I don't get to see her again, which we both know is a possibility and a high possibility, that I should try to write something good.

[B]

You always do. Are you worried that you won't be able to say goodbye to her in person? This is what you put out on Twitter?

[D]

Very much so. You know, David, I always knew that my mother had a fatal illness. And as impossible and unbearable it is to me, I knew that I would have to say goodbye to her at some point and likely some point soon. I never thought that I would not be there to say goodbye to her, that I wouldn't be holding her hand at her bedside when she goes.

[B]

Have you been able to send messages back to her? Have you been able to say anything to her?

[D]

Yeah, over FaceTime. I'll also just leave audio messages for her over WeChat, just assuring her that I am okay on the outside and that I'm doing the best that I can to try to see her as soon as it's safe to do so, but that I am devastatingly useless at this point because I. I don't think I've told her that. I don't think the entire world knows what is doing and what is coming. Her entire life has been a hospital bed that she hasn't left for years. So when I tell her that the world is coming apart outside her bedroom, I'm not sure if she's fully able to grasp the significance of that because the world has been so abstract to her for so long.

[B]

Do you want her to grasp it?

[D]

I go back and forth. I think that when she says, maybe I'll never see you again, I don't know how seriously she herself understands the possibility of that in the coming days. And I don't think that it's fair for me to drive that message home for her, even as I wish I could prepare her in some way for what's coming.

[B]

Cheng, thank you so much, and I really do hope you get to see your mom soon. I hope I see you soon, too.

[D]

Thanks so much.

[F]

David.

[B]

Jiang Fan is a staff writer for the New Yorker. This is the New Yorker Radio Hour. More in a moment. This is the New Yorker Radio Hour. I'm David Remnick. In northern Italy, doctors were forced to begin rationing ventilators and other equipment, scarcity of essential supplies, decisions about who gets resources and who won't. It's a nightmare scenario, and it could come true here, too. Last week, New York Governor Andrew Cuomo demanded that the Army Corps of Engineers begin building field hospitals in New York, essentially repurposing existing buildings, all out of the fear that ICUs in New York could soon be overwhelmed. Dr. Philip Rossoff is a professor of medicine at Duke University, and he specializes in bioethics. Dr. Rostoff, we've been watching as the Italian healthcare system has been absolutely overwhelmed by COVID 19. What kinds of choices are doctors there having to make when faced with so many patients in critical condition?

[E]

Well, a typical scenario would be having a finite number of intensive care unit beds, a finite number of mechanical ventilators or artificial breathing machines, and also, by the way, a finite number of doctors and nurses and respiratory therapists who. Who know how to operate these machines and having to make a decision about who should get put on a machine. The other wrenching decisions I think that they have to make is when they have the ICU filled with people potentially still having some sort of hope of getting better, but you have a line of people waiting to get in there. If somebody is in the ICU and not getting better, do you take them off the ventilator and make room for somebody who potentially could benefit more?

[B]

These are horrible questions to ask, but in the calculus of who shall live and who shall die, who prevails? The younger patient, the healthier one, the one that may know the cure to cancer, how do you make these decisions?

[E]

Well, I can tell you how not to make these decisions. That's probably an easier answer to go with. First, the way not to make this decision is to make it arbitrarily, capriciously, unilaterally, and at the bedside in the moment. If we're smart, we would have institutional guidelines and plans in place ahead of time.

[B]

Well, do we have such guidelines?

[F]

Sort of.

[E]

There are guidelines that have existed since 2007 to 2009 that were originally created in anticipation of a bird flu pandemic. They have been dusted off and updated, but there are lots of them. There are many individual state plans. There are many individual hospital plans. The problem exists certainly in this country, that depending upon what state you're in, where you get very sick and might need these resources, you might get treated differently than if you were someplace else.

[B]

Give us a sense of the priorities, the way triage is done in the most basic way.

[E]

So I think that some of the origins of triage are from emergency or disaster medicine. One of the classic triage situation is on the battlefield, you have two wounded soldiers who come in and you only have one surgeon or one bed. And how do you prioritize which soldier to take care of first? That has been adopted with multiple changes, of course, to the emergency room setting for various disasters. Mass casualty incidents from mass shootings, for instance, or mass car accidents on the highway. But those are one and done situations. Applying that upstairs from the emergency department to the ICU is a radically different medical and psychological situation. We are a society of go for broke. A lost life is when we've lost the battle. I mean, those types of language exist throughout medicine, and we are not accustomed to making these kinds of rationing decisions openly and certainly not as a society.

[B]

You've recently retired and I wonder if in your long career you've ever been in a situation even remotely like this, where there simply aren't enough resources to go around and you have to make decisions.

[F]

Yes.

[E]

So I can think of a couple. There is an ongoing crisis which only every once in a while reaches the level that people in the media pay attention to it, of critical drug shortages. And 10 years ago, we were, I believe, the first institution in the country, and we published this about how to go about effectively, fairly and openly rationing these drugs that were scarce. And so I dealt with that for 10 years and it actually worked out quite well.

[B]

Well, how did you work it out? How did you make your decision?

[E]

Well, we created a policy that was open and available to everyone. We decided that the first order of priority should be that any allocation of drugs should should be based upon proven clinical efficacy. So to the analogy would be to a ventilator, you don't give a ventilator to somebody who's clearly dying and can't benefit from it. You give it to somebody who potentially has the ability to benefit from it. Same thing with drugs. The second thing is it was open and transparent. The third thing was that we decided that clinical, clinically similar patients should be treated the same so that there were no both, There were neither VIPs or what we also called VUPs or very unimportant people. We did not wish to use scarcity or the necessity to ration as a mechanism to exacerbate existing disparities and inequalities in our society and in our healthcare system.

[B]

Do you have advice for doctors who have to deliver this kind of news to patients and say, look, we have to, we have to let your mother go because we don't have a ventilator for the person three beds down?

[E]

I think that is an extraordinarily good point that is often overlooked, is that we assume that once we have rules and guidelines, let's assume for the sake of argument that we actually have these rules and guidelines, that it should be relatively easy. It's actually not easy even under normal circumstances when somebody is clearly not benefiting from advanced care and everybody's on the same page to have someone die or turn off a ventilator. But under these circumstances, what is now what is called moral distress of doctors and nurses and respiratory therapists and other people involved in caring for these patients, either saying no to somebody up front, we're not going to start this, or after somebody is getting treatment, saying, we're going to stop. The amount of moral distress and emotional psychological distress that could pile up on people at the front lines should not be underestimated. And I think we need to put into place support systems for people in those situations.

[B]

I think a lot of people don't understand, certainly I don't understand why the richest country in the world is going to find itself short by thousands of ventilators and other equipment. I mean, I know some really, really well who's an emergency room doctor, and he's telling me that already he's worried that he's going to have to use disposable masks all day instead of change with each pillar patient that just ordinary things are in short supply. What is going on?

[E]

Well, our healthcare System is a $3 trillion business, and I want to emphasize business. And the way places stay in business is by controlling expenses and maximizing intake of money. Having empty hospital beds is a waste of money. Having too many doctors and nurses sitting around waiting for patients to come in.

[F]

Is a waste of money.

[E]

It's an inefficiency. And so we have cut the system to maximum efficiency. Bone. Here's another example. Just like any other business that relies on continuing use of consumables, we our healthcare system, hospitals particularly Run on just in time ordering. So they have computerized system. And when your level of, let's say face masks gets to a certain level, a computer signal goes out to one of the healthcare supply places, Cardinal or McKesson or one of these big places, and they deliver the mask the next day. They don't have huge backlogs either. And so then they put it in order to wherever they get their mask from, et cetera.

[B]

But this is outrageous. We, we have been reading books, studying history. We know that pandemics are not a remote possibility, but I'm afraid to say an inevitability. And sometimes you get away lucky as we have. We did maybe 2007, 2008. But luck runs out.

[E]

Yes, it does. And people play the odds. I think, you know, this is not just profit. By the way, you can take a look at socialized medical systems or public, private universal health care systems in Europe and they have just the same problem. France has an excellent medical system which is socialized medicine. But they are not going to be able to afford to have an ICU just in case there's a pandemic at some point. Have an ICU with 50% of the beds unoccupied all the time.

[B]

Now, Tony Fauci says that a vaccine is at least a year away, but when it does come, and hopefully it'll come soon, who should be the first to get it?

[E]

Okay, so do you mind if I pop somebody's balloon? I was talking about with my wife this morning about this very same thing. I'm old enough that I remember who Margaret Heckler was. Remember her?

[B]

I do.

[E]

Okay, so Margaret Heckler was. She was the Secretary of Health and Human Services when HIV AIDS first hit the fan.

[B]

Under Ronald Reagan.

[E]

Under Ronald Reagan in the mid-1980s. And she got up with a press conference and I believe it was Bob Gallo, co discoverer of the HIV virus and promised a vaccine, and I believe it was in a couple of years as well as a cure. We know where that went. I am not saying that COVID 19 is the same thing as HIV, but I think banking everything on a vaccine would be unwise. Putting off current planning because a vaccine is going to happen at some point. And I would listen to Fauci about when a vaccine might be available versus his boss. And I'm not talking, I'm not talking.

[F]

About his boss at the nih.

[E]

I'm talking about his boss. Boss. Yeah, I think it's very hopeful. There was a great article in the Times about this international collaboration of hundreds of Scientists looking to see if there are potentially already available drugs or soon to be available drugs that could have activity against this virus. I think that would be fantastic. If we found something that we could pull off the shelf, particularly if it wasn't very toxic to be used to intervene and perhaps stop transmission of the virus, as well as to treat people who are already sick, that would be great.

[B]

Now many people, under the best case scenario, are going to die. From COVID 19 and end of life hasn't always been a priority for doctors or hospitals. What should they be doing?

[E]

So I actually wrote a couple of papers about this 10 years ago, and I asked the question then, hypothetical, if we can't save everybody, who possibly could be saved? What do we owe those who can't be saved? Taking a patient who is in respiratory distress in front of us and saying, I don't have enough ventilators, what do I do for you? One of the things I argued 10 years ago was that we need to prepare for this. We need to have medications like morph morphine and benzodiazepines like Lorazepam and Diazepam, Valium, Ativan, those kinds of drugs to relieve respiratory distress at the end of life.

[B]

Now, given how bleak the situation is, do you see any reason for hope here?

[E]

It depends on what you hope for. In past crises that threaten national integrity, if not international integrity, we have seen both rising to the challenge and leaving us proud of how we acted, as well as moments of despicable behavior when decisions were made out of desperation and in crisis. My wife is Japanese American. Her parents were born in this country. But after December 7, 1941, when that infamous order from President Roosevelt was issued, they were ripped from their homes. My father in law was taken out of graduate school one month short of getting his degree and locked up in internment concentration camps. That is a sad, sad reaction to a crisis. My hope is that when we come out of this, we will have medical and moral victories rather than medical and moral shame.

[B]

Dr. Rostov, thank you so much.

[E]

Mr. Remnick, thank you very much.

[F]

This has been a real privilege, a.

[B]

Pleasure to talk to you, sir. And we may darken your doorstep again soon. All right. You be well.

[E]

Good luck.

[B]

Thank you.

[E]

Take care.

[B]

Take care.

[F]

Bye.

[B]

Dr. Philip Rossoff is a professor of pediatrics and medicine at Duke University. He's a resident scholar of the School of Medicine's Trent center for Bioethics, Humanities and History of Medicine. This is the New Yorker Radio Hour. More to come. This is the New Yorker Radio Hour. I'M David Remnick. We're talking this hour about the Coronavirus COVID 19 and how it is ripping through every facet of our world. And alongside the risk of infection or even death, the pandemic is causing shockwaves throughout the world economy. So many people have already lost their jobs and many, many more are likely to lose them in the weeks ahead. On the other side of this pandemic, whenever we get there, our world may look very different indeed. Staff writer John Cassidy covers economics and politics for the New Yorker. Hi, John.

[F]

Hi, David.

[B]

John well, first I should ask, how's your family? How's everybody doing?

[F]

Everything is good at the moment. Thank you very much for asking.

[B]

Good. Now, I know this is early days, but is there any back of the envelope calculation about how many people are likely to lose their jobs because of this situation? This Treasury Secretary Steven Mnuchin has said could go up to 20%.

[F]

The way economists are looking at this, I've been speaking to them in the last couple of days, they think that because of the lockdowns and all the other impacts, consumer spending could fall by as much as a third in the next few months. And if you feed that through the economy, consumer spending is about two thirds of the entire economy, but that's a huge hit. And if you just feed that through into employment decisions, you get some very large unemployment numbers. As you said, mnuchin's talking about 20% unemployment. He backtracked that a bit, saying it was only a mathematical calculation. But I spoke to an economic historian yesterday, Barry Eichengreen over at Berkeley, who's an expert on the Great Depression, and he told me that the economic impact of the COVID 19 virus is likely to be bigger than the Great Depression in the initial stages, at least in the Great depression, it took three or four years to get up to 25% unemployment. If we're talking about going to 20% unemployment in a few months here, that really is something completely out of the order of anything we've seen in the past.

[B]

Who's going to get hit the hardest? What sectors of the economy are likely to be hit really especially hard?

[F]

Well, everybody is at risk ultimately if the economy totally spirals down. But in the first instance, it's what they call a consumer facing industries, because consumers are basically going to be locked in their apartments in a lot of in a lot of our cities for the foreseeable future, and only essential consumption, food and drink and things like that will even be open.

[E]

So it looks like gig workers, airline.

[F]

Workers, anybody in Transportation, anybody in hotels. That entire sector looks like it's going to be devastated. In fact, already is being devastated.

[B]

Have any modern economies ever had to grapple with the vast majority of, of business essentially seizing up, stopping in whole regions of the country for weeks at a time?

[F]

No. I asked that question to Barry Eichengreen, an economic, very prominent economic historian at Berkeley yesterday, and he said he couldn't think of any precedent whatsoever for what we're going through now. People point to the Black Death, but as Eichengreen said, there was a very different type of economy, much more rural and different time completely.

[B]

How does it compare to 2008?

[F]

This is much bigger than 2008. In 2008, we had a shock in the financial system, you'll recall. Basically the banks seized up, but the consumer sector did start to fall, did start to falter, and firms start to lay people off. There was a big increase in unemployment in late 2008 and early 2000, and the unemployment rate went up to 10% eventually. But, you know, that's nothing like what we're seeing now. Effectively we've got a government imposed shutdown of, you know, 50% of the economy. Maybe we'll go up to even more than that. And, you know, closing down the economy is a deliberate strategy here. It's not bad, it's not necessarily a bad thing. We have to close down the economy to some extent in order to get a handle on the virus. Then once we get a handle on the virus, virus, we can reopen things and theoretically, you know, the comeback could be relatively rapid. So the government's role is to basically keep everybody and all the businesses and people on life support while we're in this sort of intensive care unit. And then when we get out the other side, we can repay some of the loans, we can, you know, get things back to normal. But it's really a completely unprecedented situation. As I say, I think it's a sort of economic life support operation. It's what we need.

[B]

What's your level of confidence in the economic minds that are running things in Washington?

[F]

That's a bit of a loaded question. Obviously, the initial reaction was terrible. I mean, up until last week, they were just talking about a sort of $8 billion stimulus, which in a $21 trillion economy is absolutely nothing. I think the collapse in the markets and what, what we've seen in Italy has concentrated mines. And over the last few days we're starting to see some real progress in economic thinking. At least what the Federal Reserve did over the weekend was very important just to prevent a full on financial crash. They basically rolled out a lot of the lending programs they introduced in 2008. People don't like the side of the Fed lending unlimited amounts of money to the banks and big financial institutions. But it really is necessary in a, in a situation like this, otherwise the financial markets will just seize up. And then the other side of things is the fiscal side. And the White House has basically done a 180U turn over the last few days and is now proposing a trillion dollar stimulus, including sending checks of at least $1,000 to people, providing some sort of help to small businesses who can't make their payrolls, bailing out the airlines with loans or whatever. And it's a reasonable sized package. A trillion dollars. It's about the same, slightly larger than the Obama stimulus in 2009. My own feeling is that's not going to be sufficient either, but at least it's the first step.

[B]

What about the guy who's got a gig job and loses it? What about people that are put out of work very quickly because they have a four day a week job at an airport or an Uber driver? What can the government do for ordinary people who are hugely and immediately affected economically by this crisis?

[F]

Well, I've written an article saying we should adopt Andrew Yang's universal basic income for a few months and just send people, everybody in the country, a check for $1,000 every month or maybe every head of household a check for $1,500 or whatever.

[B]

Everybody or based on need?

[F]

No, I. Well, the administration is now proposing $1,000 which I don't think will be sufficient and they're cutting it off at a million people who earn a million dollars a year. If you want to cut it off, they're fine. I think it has to be pretty universal in order to help everybody. And also it's to get universal political support. I think the idea of the economy, of the, the government supporting everybody would be politically popular and would also help to get support for the other nasty but sort of necessary things which are going to have to be done, including providing financial support to big corporations.

[B]

As you remember well, John, there was a lot of political backlash to the bailouts that took place in the last financial crisis. What will be the politics of, of economic policy going forward?

[F]

The Trump administration is going to bail out some of the big corporations, including the airlines. You're already seeing quite a lot of backlash towards that. People are pointing out that over the last 10 years the airlines have made a heck of a Lot of money. And they've used a lot of it to buy back their own stock, which benefits their CEOs and senior executives who have large stock executive compensation packages. So why the heck should we buy, should we bail out these scoundrels? The answer, as I said, is that when Beyond Economy reopens in whenever September, we're going to need airlines. And if the airlines are bankrupt, it's going to take a long time to sort of reorganize and set up, etc. So I think there's going to have to be some bailouts. The question is, how are they structured? So I think a lot of it's going to depend on how these bailout packages are structured. Can be airlines, for example, in their request, which they've submitted to the administration, are asking for unconditional loans, I.e. loans not secured by any assets, which, as you know, anybody knows who tries to get a loan from the bank that's very difficult to get, I think that would be completely unreasonable to do that. The loans should be secured on the assets of the companies, of the airlines, I.e. their planes and their landing spots, etc. So if they can't repay these loans, the taxpayer would then seize the underworld assets and there'd be some degree of safety there. That actually is what happened during the Great Depression. The Reconstruction Finance Corporation, which Herbert Hoover initially set up and then Franklin Delano Roosevelt, expanded greatly lend a lot of money to the banks, which were in terrible trouble, and to the railroads, which were the airlines at the time. But it secured those loans on the rolling stock and the tracks, et cetera, of the railroads. So there was some degree of security there. I think it's just the right thing to do. And I think in order to get public support, that's what we're going to have to go down that route this time, I think.

[B]

John, thank you so much. And thank you so much for all your writing. Keep it up. I'll give you a call soon.

[F]

Yep.

[B]

Take care.

[F]

You too. You too.

[E]

Bye.

[F]

Bye.

[E]

Bye.

[B]

John Cassidy is a staff writer here at the New Yorker, and we spoke on the phone just a few days ago. You can read [e-mail] and subscribe to his newsletter. Now, before we go, I should say that we've recorded this program in my apartment with our technical director running the computer remotely. Social distancing in action. A little complicated, but we did it and everybody's safe. But if you're an essential worker, waiting it out at home is not an option. Aaron Meyer works in sanitation in San Francisco. And a few days ago, his Twitter feed went absolutely viral when he wrote, right now I am feeling an extra sense of pride and purpose as I do my work. I see the people, my people of my city peeking out their windows at me. They're scared. We're scared. Scared, but resilient. Us. Garbage men are going to keep collecting the garbage. Doctors and nurses are going to keep doctoring and nurserying. And soon he got about a half million likes. Producer Rhiannon Corby reached Aaron Meyer a little after 5am on his route.

[G]

So, my name is Aaron Meyer and I've worked here in San Francisco now for nine years as a garbage man.

[H]

And tell me what. Well, first of all, I guess tell me where you are right now. I mean, you're on a shift right now.

[G]

Yeah, I am. Yeah. And I just stopped in the middle of the street right here. You know, the streets parked are pretty wide out here in the Richmond, so there's plenty of room if anybody needs to get by, but there's nobody out, so it's like it's just dead. The city's just dead.

[E]

And yeah, normally there would be.

[G]

There would be cars moving around and people heading to work and starting to get their kids ready for school, and none of that is happening today.

[H]

What was your first thought when you guys got the shelter in place order yesterday?

[G]

Yeah, that was interesting. I was a little worried and my wife brought it up to me that where they even let me drive from home because I live in San Jose. I'm 50 miles away to get to work. But there was no. There was no issue this morning. I drove right here. It's not like there's a barricade to stop people from moving around, but. And then my second thought was, well, my coffee shop is going to be closed, and that's a bummer.

[H]

Yeah. Was there any. I mean, how does it feel, feel to have the whole rest of the. I mean, not just the city, but the whole area shut down and you're still heading into work?

[G]

Well, I mean, I'm kind of, you know, proud and I feel good that I'm able to keep working. It's a little scary, you know. I'm not gonna lie that I'm out here and possibly exposed. Not so much for me. I mean, I'm not that worried that I'll, you know, get sick from the coronavirus, but I have loved ones and I don't want to bring it to them, you know what I mean? And Our son is 14 years old and he's, he has a. Like, he's immunocompromised. He has like an autoimmune disorder. Not, not terribly immunocompromised, but there's, you know, potential for him potentially at risk. Yeah, like, when I get, when I get home now, like, I go straight into the garage and I just strip off my, like my work uniform and it goes straight into the wash because I don't want to bring anything into the house that might get all my clothes. You know what I mean?

[H]

What's. I mean, I guess you work probably mostly by yourself, but do you talk to your colleagues about how they're feeling? What are those conversations like?

[G]

Yeah, yeah, they have their concerns too, but same as mine, pretty much. Although a couple of them, they. My tweet and they, and they came over to talk to me just yesterday. They got a selfie with me. So there's also some upbeat. They're like, hey, you're famous, right?

[E]

So, yeah.

[H]

So tell me about the. Tell me about the tweet.

[F]

What.

[H]

Tell me for people who haven't seen it, what you said in it.

[G]

Well, so basically I said I just was feeling a particularly particular sense of pride and purpose that I, while I was doing my job last week while all this was going on, and, and I. And doing that made me feel kind of, kind of upbeat about the situation. Like there's more. I'm just one person, but there's a lot of other people out there who are in the same situation as me and I think we'll. We'll pull together and we'll get through this.

[B]

Aaron Meyer, a sanitation worker in San Francisco. Look for him on Twitter esterd. He spoke with Rhiannon Corby of the Radio Hour. I'm David Remnick and please take care of yourself and let's try to take care of each other the very best we can. We'll be back with more of the New Yorker Radio Hour next week. Thanks for listening.

[A]

The New Yorker Radio Hour is a co production of WNYC Studios and the New Yorker. Our theme music was composed and performed by Meryl Garbus of Tune Yards, with additional music by Alexis Cuadrado. This episode was produced by Alex Barron, Emily Bottin, Ave Carrillo, Rhiannon Corby, Calla Leah, David Krasnow, Gofen Mputubwele, Louis Mitchell, Michelle Moses and Stephen Valentino, with help from Allison McAdam, Morgan Flannery, Danny Bonner, Meng Fei Chen and Emily Man. The New Yorker Radio Hour is supported in part by the Cherina Endowment Fund.

[E]

SA.