Who Do We Expect to Sacrifice?

A medical professional helps another professional put on a mask.
What is the price of their lives? ER Productions Limited/DigitalVision via Getty Images Plus.

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On March 16, days before several governors would take drastic stay-at-home actions, a nurse posted an incantatory pep talk called “There is no emergency in a pandemic” to a medical forum. It was posted when things were about to get really bad, and it articulated the parameters around which lifesaving work could and would be done. It’s a “put on your own oxygen mask first” piece of conventional wisdom, but it goes harder. Here’s a bit of it:

People are going to die. Do not become one of them.

There is no emergency in a pandemic.

During the Ebola outbreak, people were dying. But at no point did we rush in, we took the 10 minutes to put on our PPE with our spotter. If we didn’t have proper PPE we did NOT go in.

There is no emergency in a pandemic.

You may work in long term care, and want to rush in to save a patient you have had for years. Do not go in without your PPE

There is no emergency in a pandemic.

You may have a survivor in the room, screaming at you to come in because their mother is crashing. Do not go in without your PPE.

There is no emergency in a pandemic.

This was what I’d gone to that medical forum to witness: the grim rehearsals. The mental preparations. I’d hoped to take comfort from it. A disaster was coming and at least someone was sorting it out in advance, even if the White House was advising people to go on cruises, comparing COVID-19 to the flu, and promising it would all go away.

For years I have done this, lurking on medical forums where health workers shoot the shit with each other. I have watched nurses exchanging tips, residents venting about bad shifts and bad pay, medical students agonizing over debt and discussing specific rotations. It was a window into a different life—one that was so matter-of-fact about life and death that it was a daily escape from the political miasma. In mid-March, a lifetime ago, these hardened folks were preparing for the worst, and, mentally, they could program themselves to abide by rules like these. You don your PPE like a suit of armor and then you go to work. You test and take precautions accordingly.

You know how this story goes: There wasn’t enough PPE, and despite warning signs, state and local authorities hadn’t fixed it. There weren’t enough COVID-19 tests, and while South Korea had successfully used the World Health Organization’s test widely, the U.S. had elected to make its own and failed. The ventilator shortage wasn’t being adequately addressed by the administration—in fact, a contract dispute meant that the federal government stopped maintaining the ventilators it had stockpiled and only began doing so again in January, meaning that many of the ventilators it shipped out arrived broken. The drive-thru testing sites the president announced didn’t materialize. Neither did the website he announced Google was building.

The incantatory quality of “no emergency in a pandemic” started to feel like a curse. Without PPE, the sensible instructions to protect yourself first no longer made sense. Without PPE, the lifesavers were being asked to hurl themselves at the problem unprotected—in its very earliest days! The structures that made the coming sacrifices manageable were collapsing under the discovery that the front line might not be supplied with much in the way of armor at all. “We are re-using N95s for multiple days and cover them with a face-shield surgical mask which keeps the N95 ‘clean,’ ” one person posted. “The only people that get N95s are anesthesia personnel. The face shields are going to be out soon so goggles/helmets brought from home Depot are what’s been ‘advised.’ ” Medical professionals on the internet were debating wearing scarves over their faces. “I mean, I get OP’s point,” one wrote, “but the reality is, while we SHOULD have access to PPE, many of us DON’T, and need to look into alternative measures. It’s not right, but it’s reality.” Another posted a video on how to use one ventilator for four patients—hoping it might work. (It wouldn’t, several members felt.) One ER doctor had driven all over town collecting N95 masks for his underlings and was then told by the hospital he would not be allowed to bring outside gear in.

“I’m an ER nurse and I’m scared,” a nurse posted on March 23. “Drove home this morning and cried in my car. We’re starting to see COVID-19. We are a small hospital. We have to re use our masks and place them in a bag (I had to use a cup) all day. The elastic got loose and I had gaps when I went into the room of a presumptive positive. … If I get on quarantine I will lose pay. I live paycheck to paycheck and I have two very small children.”

What became clear, in these forums I’ve spent so long watching, was that the last resort somehow came at the beginning. People were “making do” at stages when there should have been abundance. Instead, they were operating from a position of scarcity from the get-go. “After yesterday’s shift, I figure I’ve got only a few more days before I start getting symptoms,” one poster said.

There were only emergencies in a pandemic, it turned out. At least in the United States.

This country has now deposited its massive, collapsing weight on a small, utterly unsupported group called the “essential workers.” It includes the health care personnel I’ve shyly stalked for all these years. It includes others too: home care and assisted-living health workers who keep the elderly and infirm alive for minimal pay. Underpaid grocery store workers, some of whom are pressured by management not to wear masks or gloves because customer comfort matters more than employee death. Amazon workers are laboring under conditions that do not prioritize their safety. Farmworkers—the very immigrants federal policy has worked to keep out—are laboring in fields with little protection (let alone social distancing) so that the “nonessential” among us can eat fresh strawberries at home.

It’s a curious feature of this virus-convulsed world that the people classified as essential are being treated as expendable. So-called essential workers—most of whom do not have employer health care—are having to risk infection by taking the subway for long commutes while less “essential” people get to remain safely at home. (The public transit workers are “essential” too—you can tell because as of Monday seven of New York’s MTA workers had died, 333 workers had tested positive, and 2,700 were in quarantine. Soon, the best measure of how “essential” any group was will be the death count.) It’s become the brutal and telling euphemism of our era: The labor is essential. The lives, it seems, are not.

This is ugly but not unprecedented. Many will say that this is the core of capitalism, and that’s largely true. But there is an even more obvious system that praises expendability: war. Any time a group is hailed as “heroes,” you’re hearing a costless effort to elevate that group into an exalted category in payment for their lives—as we do to soldiers before sending them off. This unilateral contract depends on one side not getting to have needs and the other having too many. We require your service with the minimal possible provisioning. Should you die, we’ll laud your sacrifice after the fact.

Unsurprisingly, the military is also not exempt from the pandemic: Capt. Brett Crozier risked his career to write a four-page letter begging Navy leadership to do something to protect 4,000 sailors aboard the USS Theodore Roosevelt, an aircraft carrier with 150 to 200 infected sailors on board and insufficient means to isolate them. “We are not at war. Sailors do not need to die. If we do not act now, we are failing to properly take care of our most trusted asset—our sailors,” Crozier wrote. The secretary of defense claimed not to have read it. Crozier has since been relieved of his command; the official reason given was “a loss of trust and confidence.” In an interview, Donald Trump’s acting Navy secretary said it was for “extremely poor judgment”—not on the merits but because it “creat[ed] a ‘firestorm.’ ” A former high-ranking officer even proposed in the Stars and Stripes that these sailors be used without their consent as an experiment in “herd immunity.”

Crozier’s sacrifice mattered. Sailors are now being removed from the Theodore Roosevelt, but this was a disorienting controversy if you’re accustomed to hearing about the importance of the troops. Any illusion that they were considered worth protecting deflated. American lives do not appear to matter more to the powers that be than the functions they serve—except insofar as enough loss of life might result in a political consequence. For the president, the gamble is that they won’t. The hedge is announcing, as Trump did Tuesday, that losing “only” 100,000 Americans will be not just a triumph but a testament to his acumen and stewardship. (It’s also a decent side bet that Americans won’t notice that South Korea has achieved a dramatically better outcome despite finding its first case on the exact same day we did.)

What I’m getting at is the matter-of-factness with which the Republican officials of the administration, senior Republican senators, and many though not all Republican governors have made a disturbingly easy peace with mass death in America. As of this writing, every state still lacking a statewide stay-at-home policy has a Republican governor, and the rhetoric about freedom and the economy positions the latter as the living thing truly under threat. Just before issuing a stay-at-home order effective Saturday, Alabama Gov. Kay Ivey had maintained she “would look out for people’s safety while keeping government from choking the life out of business and commerce.”

The coronavirus was always going to take some American lives. But the South Korea comparison proves, as do the administration’s repeated failures to act, that the scale of the disaster was not inevitable: Specific choices were made. Those choices gambled casually with the lives of Americans. They treated them, and treat them still, as disposable. “We happen to think that [Cuomo’s] well served with ventilators. We’re gonna find out,” Trump said Friday as the city reeled under one of the biggest outbreaks in the world. There is no other way to read “we’re gonna find out” than “if I’m wrong, people will die,” but the message is delivered with extraordinary unconcern.

One can’t help but wonder if that cavalier attitude toward American deaths has something to do with who will die the most: this underclass of essential workers—many of whom are shamefully underpaid, medical residents included—being forced to risk their lives. “We’re not getting nothing—no type of compensation, no nothing, not even no cleanliness, no extra pay,” Kendaliyn Granville, who worked at a poultry processing plant and led a strike, told the New York Times. “We’re up here risking our life for chicken.” The workers know the Orwellian move being made here: Essential equals expendable. Absent any tangible effort to keep them safe, why wouldn’t workers at Amazon, Instacart, and elsewhere demand that their “essential” work be compensated accordingly? We must be simultaneously horrified and grateful, I suppose, that University of Chicago economists released a study suggesting not only that “a regimen of moderate social distancing, like what many areas of the country are doing now, has the potential to save well over a million lives,” but that “those saved lives are worth $8 trillion to the U.S. economy.”

And so we’re living through traumatic juxtapositions. There are no words for the otherworldly experience of watching (from a distance, for those of us lucky to do so) as health care workers scavenge for supplies absent sufficient support from the country they’re trying to save. This is not a war, but if it were, it’s one where the United States, the richest country in the world, is making its troops scavenge for boots, beg for helmets, and ration bullets. Many front-line workers are rising to the challenge and trying to do the impossible, at great risk, because life in America is an emergency by design. As they do so, the president tries to get as much credit as he can by giving as little as possible. Of course he’s agitating for his signature (rather than the usual functionary’s) to appear on relief checks Congress voted to send to the American people. Of course, while people risk their literal all, he’s boasting that he’s No. 1 on Facebook. The desperate day-to-day work that allows us to eat, to remain safe in our homes, and to survive if we fall ill will get done by others—by workers so essential and so demoralized that they know by now not to expect sufficient help.

The thing about living in a state of scarcity is that it’s human nature to get used to it. And without a disciplined, incantatory reminder of our own, to ourselves and each other, that it didn’t have to be this way, the ranks of the expendable will always be ground under the status quo. Never mind that the United States appears to be on track to have the worst response in the industrialized world. It’s easy, in a country as large and violent as this one, for a fatalism to set in, a conviction that this is the only approximate way things could be. Less than a month ago, the medical communities I frequent thought they could afford to think there was no emergency in a pandemic. They expected they’d at least have the bare minimum of what they need—gloves, masks, gowns. But one adapts. I’ve acclimated along with them to the cruel state of emergency in which they reside. And once they start succumbing to the disease (it’s happening now), and the staff shortages mount such that there aren’t enough people to manage even the insufficient number of ventilators—once, in other words, the front line falls—the question will be if we can resist thinking that this is normal too.

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