Again, in retrospect it is easy to see how dysfunctional the federal situation was. Their own projections of potential hospitalizations would have panicked any rational federal official. The president was in denial about his own experts’ projections. On March 6, he said, “It’ll go away,” and later, after Dr. Fauci testified to Congress that the country was “failing” when it came to testing, Trump said of the virus, “We stopped it.”
We needed to know the realistic range for New York so I could understand what we were really dealing with. The best estimates suggested that the state would need 110,000 to 140,000 total hospital beds in a day at the apex. I was shocked, because in total New York State has only 53,000 hospital beds and 3,000 ICU beds. The nightmare scenario was overwhelming the hospital system, and that’s what we were watching on the nightly news in Italy, where people were dying in the street unable to access medical care, morgues were overwhelmed, and coffins were stacked in churches awaiting lonely burials after funerals were declared illegal. I knew that once the hospital systems became overwhelmed, lives that could have been saved would be lost. Compounding this was the concern that if the hospital system was overwhelmed, people suffering normal health emergencies, such as heart attacks and strokes, could not be treated.
There was no way that we could dramatically increase the number of hospital beds, although we were trying. I posed another option to the experts: What if we were more effective in changing human behavior? Could we reduce the number of those being hospitalized? But the experts did not believe it was possible to change social behavior quickly enough to make a real difference in the numbers. The news was so bad that it was almost inconceivable. I was stunned.
I called the president and explained the scenario. He was pleasant enough, but he just didn’t want to hear it.
The truth is, I didn’t want to hear it either, but I did. I met with my team every afternoon as soon as the briefings were over, and we went over dozens of what-if scenarios. It was clear we had to try to reduce the transmission rate, and at the same time we had to figure out a way to build hospitals in three weeks.
I was beginning to understand that this conversation with the people of my state was different from any conversation had in generations. This was not about normal government issues of budgets, taxes, roads, and bridges. This was about life and death. This was as real as it gets. No one knew the future, and no one knew how many would die.
I had an interesting conversation with a woman who had been watching the briefings. She said she was taken with the fact that I was “unflappable.” “Unflappable” is a word that can mean totally different things to different people, so I asked what she meant. She said that I didn’t seem “scared” about COVID.
“I don’t mean to disappoint you,” I said, “but you couldn’t be more wrong.”
She was surprised.
“I am more frightened about COVID than almost anything in my life,” I said. I once had a serious health scare with Mariah when she was severely burned as a toddler, but second to that I have never been more frightened.
I had already been thinking about what dimension of the COVID crisis frightened me most. I think it was the “fear of the unknown known,” as the expression goes. There were existing facts about this virus that we just didn’t know yet, but I was sure that we would know in the future. Then, with the advantage of hindsight, we will say we should have made different decisions, such as asking people to wear masks sooner. A factor driving the fear for me was that the “facts” were already changing. The worst was the reversal on the belief that asymptomatic people couldn’t spread the virus. We would have operated much differently if we had known that earlier. What else will we find out six months down the road?
The former defense secretary Robert McNamara talked about the “fog of war” in explaining his actions during Vietnam. What would the “fog of COVID” turn out to be? Will the antibodies have a secondary effect on people who were infected? Was there a drug that could have helped? Will the virus mutate and come back like the 1918 flu pandemic? Will a second wave be even worse?
I had this conversation with my daughters one evening while sitting around the dinner table. They asked me how I seemed so calm at the briefings when they knew how anxious I was. I said to them, you can feel fear, but acting on fear is different. Even being governed by the fear is different. I think it is disingenuous when people say they weren’t afraid in a situation that would normally trigger fear. Fear is a normal and healthy response to the appropriate stimulus. If you don’t feel fear, you don’t appreciate the consequences of the circumstance. I told them to confront the worst-case scenario and make peace with it. Resolve the anxiety. I understood the projection models. I knew how bad it could be. The questions are what do you do with the fear and would you succumb to it. I also told my daughters that there are little things you can do to help with the fear when you are speaking in public. Control your breathing by taking long deep breaths. Fill your stomach when you inhale. Don’t drink coffee. I would not allow the fear to control me. The fear kept my adrenaline
