Physical distancing, battlefield triage and moral reckoning: Life in the time of coronavirus

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I have a slight tickle at the back of my throat, a little soreness that never lasts past morning. Nothing out of the ordinary. I wouldn’t even mention it, except that now I am afraid it might be a symptom of COVID-19. I want to be a decent citizen and not infect anyone else. I also don’t want to overtax an already screaming system, even though I am 66, and “older,” and therefore statistically more at risk.

So I have decided to stay home and work from my dining room, practising “physical distancing,” which the experts say is essential if we are to keep the pandemic in manageable check.

But maybe I should take my temperature, to obtain a second indicator of my healthiness. Alas, I can’t remember the last time I used our thermometer; the children are in their 20s now. I find it under a drawer full of bandages and makeup pads.

The under-the-tongue device clicks on like a long-forgotten friend and tells me my temperature is 35.1 C. This is more than one degree colder than the low end of the normal range for human beings. I may not have the coronavirus, because I may already be dead.

The other thermometer, also electronic, jabs in the ear. It needs new batteries. But to get batteries, I have to go to the drugstore, thereby increasing the odds that I might get infected, or spread my infection, if I have any infection. Of course, if I could get tested, I could go out, or stay in, with confidence. But Toronto’s public-health office said in an e-mail to me that “testing is not for everyone with symptoms,” and that “judicious use of tests is also important to ensure we have enough test kits for those who really need testing.”

This is just one dilemma we face in the dark and deadly early days of the coronavirus, a global catastrophe the likes of which no one on Earth has experienced before.

This is all new. How do you think we’ll do?

If I go to the drugstore, I have to remember not to go near anyone – the Centers for Disease Control and Prevention recommends six feet of separation – and to use the self-checkout scanners. Politically, I am against self-checkout because the practice eliminates jobs. But there is no conceivable way I am going anywhere near the stainless-steel checkout that my infected/uninfected fellow citizens use. Then again, the self-checkout screen is a killing field of microbes on its own. I must remember to wash my hands for two minutes as soon as I get back home. You have to remember a lot of details in a pandemic.

Tom Hanks has the virus! So does his wife, Rita Wilson. (They were in Australia, where it’s easy to get tested.) So does Sophie Grégoire Trudeau, the Prime Minister’s wife.

I wish them all well, but the news makes me feel slightly better. If even Tom Hanks, a hero to millions, can get it, the randomness of the virus’s assaults is undeniable. COVID-19 makes us all the same, and makes us equal. For all the trials it is putting us through, for all the pain and bottomless grief it will cause, its democratic impulse is weirdly bracing.

Two Saturdays ago, we played host to a birthday dinner for my daughter and 10 of her friends: young, talented men and women in their 20s. Several are in the TV and movie business, where productions are closing faster than poked clams. Public-health experts say dinners of 10 are marginally okay if no one has symptoms.

“Are you worried about the coronavirus?” I asked one of the young women. She’s 28, smart, compassionate, funny.

“I’m not,” she said. “It’s not going to affect people my age as much.”

Wars are usually fought by the young on behalf of the old. The coronavirus reverses that order. Some days it feels like generational revenge. Okay, boomer: You left us with climate change? Here’s your karmic reward: a 10-per-cent greater chance of dying of COVID-19 if you’re over 70, 20 per cent if you’re 80 or older. For 70 years, we have all lived without any world war, without any global moral reckoning to teach us the price of freedom. Now, we face one.

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It’s pleasant (and lucky) not to have to go into the office to work, not to have to ride the subway, all for the cause of physical distancing. If you can drive, the experts say, you should, because that reduces congestion and the chance of infection for those who have to take the subway. But ridership on subways and trains, which hauled two million Torontonians a day before the virus hit the city, is down by nearly half anyway.

There are only two downsides to physical distancing by staying home: snacking, which is incessant, and proximity to my laptop, a spigot of alarming coronavirus news.

My anxiety took full flight on Wednesday, with news from Italy. Two weeks ago, Italy had 322 confirmed cases of coronavirus. Today, the count is more than 21,000. It changes by the hour.

Ten per cent of the stricken Italians need ventilation machines, which in turn require dedicated hospital staff, neither of which Italy has enough of. As a result, the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care has published guidelines doctors and nurses can follow to determine who gets a machine and who doesn’t – who lives and who dies. Doctors and nurses no longer have to make harrowing case-by-case judgments: at least part of the triage is preordained.

I download the guidelines. They’re in Italian, so I translate them on Google. The pawky English didn’t make them any less grave.

The dilemma, the guidelines point out, is “an enormous imbalance between the real clinical needs of the population and the actual availability of intensive-care resources.”

Hence Italy’s new rules.

Do no harm is no longer a principle of triage; neither is first come, first served. Instead, there is an age limit on who gets respiratory help. If you are over a certain age – somewhere between 75 and 85 seems to be the average – you’re out of luck. Ditto if you have co-morbidities (diabetes, cancer, transplants).

The other purpose of the rules is to conserve beds and breathing machines for “those who are primarily more likely to survive” and “those who can have more years of life saved.” It’s one of the starker documents I’ve ever read.

I call Alison Thompson, an ethicist and public-­­health expert at the Leslie Dan Faculty of Pharmacy at the University of Toronto. She predicts Ontario will publicize similar guidelines, possibly this week.

What we will see, she says, is the ethic of battlefield triage: “We’re trying to fix up the people who can go out there and fight some more.” She has a high, laughing voice that belies the deadly systematic logic of what she was saying. She’s 48.

The new rules are no surprise to her because they are based on the pandemic influenza guide adopted by the World Health Organization in 2006 after the SARS scare and Hurricane Katrina. Its ethical precepts were developed by the Joint Centre for Bioethics at the University of Toronto. Dr. Thompson helped create them.

During the Katrina crisis, helicopter pilots saved women and children, while doctors saved the sickest. Those divergent priorities hindered emergency management. During SARS, doctors and nurses were forced to decide – in circumstances that threatened their own health – who to save and not save on a case-by-case basis.

The emotional trauma shattered their composure and threatened treatment. The COVID-19 emergency triage rules “want to reduce mortality, but they also want to make sure society can keep functioning,” Dr. Thompson tells me.

I am outraged, but there is no point being outraged: Those rules govern intensive-care units at every hospital in Canada, most of which operate at capacity. “I don’t think people know we’re doing this all the time now,” Dr. Thompson points out. But the live-or-let-die decision will be made incessantly in the oncoming tide: “It’s that flip into a more utilitarian system. Questions such as ‘Have you had a chance to live a good life?’ get weighed against ‘We’re going to maximize the resources and not squander them on people who might not survive the often traumatic experience of a ventilator bed.' ”

I interject: “Someone who is 40 already has a much better chance of surviving the coronavirus than a 75-year-old.”

“I think the age is a little arbitrary,” she agrees. But if two people need ventilation, the mask goes to the likeliest survivor. The current cutoff age in Ontario when ventilators are scarce tends to be 85, Dr. Thompson tells me as we say goodbye. As of next week, she says, “we may or may not see that number drop down.”

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I read that we must learn how to stock a larder, so we can stay out of public places: long and short pasta, all rices, stocks and broths. Radishes: They last forever. The checkout lines at my local grocery ran to the back of the store midweek. But the panics, such as the number of people on the sidewalk on a given afternoon, seem to ebb and flow. On Saturday morning, the joint was empty. The boxed-pasta shelf was still ravaged, however. And what’s with hoarding toilet paper?

On the other hand, the guy stacking the mushrooms seemed to have a dry cough. How long can COVID-19 live on a mushroom? Rogue fears such as this run across the floor of my brain like a cable news crawl.

I’m not the only one. My friend Marni Jackson, a writer, delivered a package to an emergency room last week. “There’s a domino factor,” she says on the phone afterward. “Once your awareness alights on contagion, there’s no end to seeing it. I stopped for gas on my way home, and the gas pump handle looked like a cobra.” The debit machine felt radioactive: “You don’t know how many hands have been wrapped around it.” She’s in her 70s now, which in Italy is beyond ventilation. She paused for a moment. “It’s the culling,” she says. “It’s how nature deals with old people.”

“It’s not fair,” I say.

“No, but since when is life fair? This is like nature writ large.”

Earlier in the week she’d been to choir practice. For the 10th time that day the words I wonder if that’s a smart move pass through my mind. Dr. Eileen de Villa, Toronto’s Chief Medical Officer, says “COVID-19 spreads through the direct contact of the respiratory droplets, cough or sneeze, of someone who is infected with the virus. This usually happens when a person spends 15 minutes or more with an infected person within six feet.” Subways, ball games, bars, cafés (even in France), gyms, libraries, meetings, movies. Choirs.

E-mails appear in my inbox from CN, Air Canada, Hilton Hotels, Hertz Rental Cars: They all plan to do a lot more cleaning during the COVID-19 crisis, as does Cineplex, which has embraced “enhanced cleaning protocols ... with particular focus on high traffic and high contact areas.” I miss going to the movies. I miss art galleries (closed until at least April). But I’m thrilled to see actual humans pass by on the street, through my window. They seem so exotic now.

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I keep fixating on numbers. Patty Hajdu, Canada’s Health Minister, warns that between 30 per cent and 70 per cent of Canadians could end up contracting the virus. Let’s say half do. That’s 19 million people. If 1 per cent of them die, that’s 190,000 dead. The 1918 Spanish flu killed about 50,000 Canadians. But there are 10 times as many people over 65 today, 30 times as many over 85. In a normal year in Canada, about 275,000 people die. That is a lot of extra funerals. Will funerals be allowed? They’re banned in Italy.

If 10 per cent of those cases need to be hospitalized, that’s 1.9 million people, of whom 190,000 might need ventilators. A 2009 study of critical care in Canada found there were about 3,200 critical-care hospital beds and 5,000 ventilators in 286 hospitals in Canada. There are another 209 ventilators stockpiled in Ontario. The calamity seems unavoidable.

The way to reduce triage tragedies is to “flatten the curve” – this is the latest watchword – of the rate of infection, thereby putting less demand on the country’s intensive-care wards. Hence physical distancing, staying out of each other’s aura of contact. This will make for a longer but less severe outbreak.

“If we can slow it down, we won’t have to use triage so much. So there’s going to have to be some decisions made,” Dr. Thompson told me. “But if we don’t make a decision, it’s still a decision.” This is the inflexible calculus that makes the pandemic so bewildering, so destabilizing. Wider degrees of mercy are now beyond our reach.

But if you stay inside, and distance yourself, and stay uninfected for as long as possible, the odds improve of avoiding at least some tragedy.

Outside, the experts say, we have to keep our distance. Dating someone you don’t know is not recommended. Can you take a taxi? Not without wiping down the Uber. Can you visit your mother in the seniors’ residence? Potentially fatal. Can I get a haircut? Chanel Cezair, who cuts mine, is bullish. “If anything, the hair salon is one of the most disinfected places in the world. Here we’re washing people all day long.” Touching another human being already seems ... daring, like something we did before we became modern.

Most days, the latest shocking developments are like incoming ack-ack fire. Doctors in British Columbia are being called out of retirement. Italy has abolished weddings. The NBA and the NHL and MLB are MIA. One of the many days the Dow dropped like a stone – the day of its worst fall since 2008, now far surpassed – my brother called to tell me he was $40,000 poorer than he had been the day before. Another friend’s morning Alcoholics Anonymous meeting was cancelled indefinitely. A young pal went to her Pilates class and discovered that, instead of towels and essential oils, the owners were suddenly using paper towels and disinfectant to wipe down mats. “It makes you question how unsanitary sustainable practices can be,” she sniffed. People in Denver waited in line for three hours for a drive-up coronavirus test. A couple in Vancouver made $100,000 selling $20 six-packs of Lysol wipes from Costco for $89 on Amazon; they described themselves as “hustlers.” A man on CNN said he had been in quarantine for 28 days. He was still in a good mood. He was alive.

On Friday, on my solitary walk around the block, rigorously maintaining my physical distance, I ran into a friend who works in a large government-funded organization. She has been deeply involved in tracking the coronavirus crisis in a professional capacity. She sends updates to her friends, who seem to appreciate them. “Do you think I can go on a ski trip at the end of March?” I asked. We were speaking at regulation distance, the length of one human being from each other.

“No,” she said, scornfully. “You have to keep up with what’s going on.” I heard that irritability all day, everywhere. A minute later, she started to cry. She didn’t stop talking; the tears simply leaked out of her as she proceeded.

I asked what’s wrong.

“It’s the kids,” she said. “This is going to set them all back so far, economically, in their careers.”

It wasn’t just the children, of course. The virus has instantly destroyed any illusions we had that we are wise and powerful and accomplished, and is now demonstrating that we have very little control over what happens to us. It is as if the gravity of the human condition – that we are born to die, that we embrace this lovely world only to be forced to leave it, and the people we love, behind – has suddenly stepped out of the shadow of our unconsciousness and is now walking down the street beside us, an unignorable monster, reminding us how precious each step was.

Maybe that will be the more persistent challenge with COVID-19, once we figure out how to kill the fucker, or at least put it in its place: to find some value in the mountains of lasting chaos it is throwing up everywhere around us.

In the early 1950s, at the height of the Cold War, while the Soviets tested hydrogen bombs, a group of Canadian scientists conducted a study of the effectiveness of air-raid sirens as a warning system. To their surprise, only 8 per cent of us thought we could survive a nuclear attack. Everyone else ignored the whoops, because they couldn’t see the point of doing otherwise.

In those days, of course, we blamed the Russians for our fears, and they blamed us. We have all of us been blaming each other for everything ever since – by nation, by gender, by faith, by politics, by generation. The coronavirus is the first foe we have faced together, for which none of us can be blamed: Our enemy in this case is just nature, a biological survival mechanism. I imagine that is why people are so keen to look at each other when they venture out into the emptying streets these days. Have you noticed that? If we somehow make it through this gracefully, intelligently, co-operatively, kindly, those who do – at any rate – will be able to remember the unexpected beauty of our alliance.

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Editor’s note: Marni Jackson did not, as originally stated, attend choir practice after visiting an emergency room, but beforehand.