As a New York City physician, I was dismayed by the recent report of the closure of the Brooklyn field hospital authorized by New York Mayor Bill de Blasio. The New York Post has reported that amid the pandemic, a $21 million Brooklyn field hospital never saw a patient. This followed on the heels of New York City officials closing the 470-bed field hospital set up at a tennis center.

Regardless of political orientation, leadership and reporters appear intentionally to be ignoring risks of neglecting CDC and state recommendations. This not only prolongs the severe economic damage and long-term consequences of the closure, but puts more lives at risk.

The empty bed capacity of the USNS Comfort hospital ship, the field hospital set up in Central Park by the Samaritan’s Purse Evangelical organization led by Rev. Franklin Graham, as well as these Brooklyn and Queens field hospitals could have served as vital reserve capacity to allow for reserve beds counted to meet this threshold. Instead, the ship was sent away because it was perceived as no longer needed, and the Samaritan’s Purse organization was maligned in the New York Times in a style unique to the leadership and media of New York City (“Franklin Graham Is Taking Down His N.Y. Hospital, but Not Going Quietly”), and the city is closing down field hospitals under its authority. 

Allowing these hospitals with “empty beds” to close in the wake of the first wave of the tragedy of COVID-19 represents a failure of foresight, leadership, and the complete dereliction of duty by our elected leaders and city government. 

Rather than focusing their efforts on the “chutzpah” of criticizing those who have come to help us motivated by their religious beliefs or inflating the list of pandemic victims by printing the names of those we have lost to causes other than COVID-19, media such as the New York Times and the elected local leadership need to focus on achieving the metrics necessary both to reopen the economy and preserve lives.

As Governor Andrew M. Cuomo has stated, “We must make reopening decisions based on fact. No politics. No spin. No Emotion. No conspiracies. Just the facts and the data and the science.” 

In order to reopen, the governor says, “The health care system has the capacity to absorb a potential resurgence in new cases.” We now know that while New York City health authorities with the help of media such as the Times were fictionally and intentionally inflating the number of cases and deaths, and misrepresenting old cases as current to inflate the tally of newly diagnosed cases. 

Meanwhile, those authorities and their media allies attacked Evangelicals for their religious beliefs, jeopardizing their presence to absorb potentially real “new cases.”

While New York City could and should already have opened had they focused on measures that needed to be done according to the CDC, WHO and the governor’s office, the city remains closed—based on assumptions repeated day after day by the media that New York City was far above the threshold of new cases needed to reopen, assumptions that were simply fictional. 

The problem now is a lack of empty bed capacity, and with the city closing yet another empty field hospital, New York City remains shy of the available bed requirement to reopen. New York City has myopic leadership and a deluded press corps that feed off each other, which results in the impoverishment of the people of the city and may cost many their lives as they play politics. 

Many Americans were shocked when the demands for social distancing, slavish public masking, and lockdowns to combat the global coronavirus pandemic—backed by social shaming, arrests, fines, and even jail time—were suddenly dropped. Just like that, the scourge of COVID-19 seemed to be over, ending not with a whimper but with a literal bang—nationwide riots.

Our abrupt about-face regarding measures to combat coronavirus is instructive; in fact, it reveals the fundamental soundness of the lockdown skeptics’ position.

Why have we suddenly and dramatically distanced ourselves from things like social distancing? Does COVID-19 not spread in tightly packed, so-called righteous protests? Did Black Lives Matter secretly develop a vaccine that allows them to gather without masks? Has COVID-19 disappeared overnight, perhaps prompted, strangely, by the killing of George Floyd?

Of course not.

It’s just finally dawned on the lockdown fetishists that a meaningful human existence requires acknowledging and pursuing a diverse array of human goods, of which a preserve-mere-human-life-at-any-cost mentality is a deadly enemy. In other words, those who now don’t mind that viral-control protocols are being flouted with impunity by “anti-racist” demonstrators have come to their senses, once again recognizing that there are competing goods at stake in all this madness.

They’re not hypocrites; they’re human beings.

We All Have a Sense of What We’re Willing to Die for

Recall that before the riots broke out in earnest, many—usually, but not exclusively, those identified as “conservative”—insisted that the draconian measures instituted to combat the spread of COVID-19 had real costs, even if they did save lives. Basically, the argument was that there were other important goods—cultivating friendships, engaging in meaningful work to feed one’s family, recreation, pursuing healthy balance to stave off pathological temptations, having funerals to mourn the dead, worshipping God, and so on—that needed to be attended to in the anti-pandemic battle plan. They understood that the myopic attempt to reduce the entire, complex web of issues to a vapid slogan—“If it saves even one life, we must do it!”—was disingenuous and manipulative.

Now?

Pro-protest folks are saying the same thing!

The basic argument goes something like the following: There is a grave, festering injustice in the country, of which George Floyd’s killing is but a particularly visceral symptom. Yes, COVID-19 still lingers; we know the risks. But you know what? This issue is far too important to sideline for who knows how many months until we get a handle on COVID-19, and besides, the raw number of lives saved can’t be the only important good—there are others at stake, like striving toward a more just, humane society.

But don’t just take my word for it. Here’s someone making exactly that argument:

People are asking how I could be so pro-quarantine and now pro-protest. I’ll put it like this: 

If the bus driver tells you to put on your seatbelt, you absolutely should. If the bus driver starts shooting passengers, it’s probably worth unbuckling.

For the trolls: I know it’s not a perfect analogy, because there’s a lot of nuance here. Protestors should wear masks and socially distance. But the point is there are causes for which it is worth taking on risk. Eating at restaurants is not one. Stopping police brutality is. [Emphasis added]

And here’s another, from NeverTrumper Amanda Carpenter, author at The Bulwark: “I realize there is [a] lot of scolding of protesters in regards to the pandemic but consider the possibility the protesters think the cause is important enough that they are willing to risk COVID. . . .”

This is precisely why people who were skeptical of our manic posture regarding COVID-19 were deeply frustrated, and why their frustration has both deepened and intensified.

Just a couple weeks ago (doesn’t it feel like a lifetime ago?), blue state governors and other members of the leftist ruling class, especially its intellectuals, not-so-subtly implied that those who were skeptical of shutting down the entire country for two-plus months were literal grandma killers. Or bloodthirsty human sacrificers—oops! (Here’s a list of such examples, which are legion.)

In reality, however, the lockdown skeptics were simply reasoning honestly, as human beings do, about the messiness of life—namely, its costs and benefits, and its myriad trade-offs, which all need to be accounted for in an environment shot through with systemic uncertainty.

These people—and I proudly count myself among them—recognized that there were lots of human goods at play wrapped up in our plans to respond to COVID-19, and we tried to articulate our belief that every single one of them was being ignored—all except the crazed struggle to preserve bare human life by “flattening the curve” at any cost. We did all this while also trying to navigate a minefield littered with bad-faith detractors who insisted that we were not-so-secretly putting our personal comfort ahead of their beloved relatives’ very lives.

And now, everyone who opposed the radical anti-pandemic response—showcased most clearly by states headed by Democratic governors—is appalled that doctors and experts suddenly support tossing aside their prior public-health recommendations and guidance for the sake of advancing these protest-riots. They cite politically-inflected thinking as the unsavory, cynical reason for the shift.

Their anger at this latest reversal is understandable, but they should take it as a win. They’ve actually been vindicated. This is exactly what we’ve been saying the whole time.

It’s Impossible to Erase Politics from Societal Deliberation

The decisions to shut down the country, lock people in their homes, and then open up (to whatever degrees states have done so), in the final analysis, were solidly based on politics—that is, a concern for the whole of the community.

Were many of those judgments regarding the pandemic partisan, politicized judgments—that is to say, not properly political? Yes. Can the same be said of the judgments regarding the protest-riots? Again, yes.

But that’s the whole point. It is foolish in the extreme to pretend that politics—in the high sense of the word, i.e., concern for the whole polity—can be excised from major, governmental action, as with COVID-19 and the riot-protests. Politics, properly understood, cannot be separated from such decisions; it is endemic to public life.

And the protest-riots ought to prove it for any who were in doubt about that back when COVID-19 came a-knockin’.

Nature is healing, as they say. Politics is at play once again.

The current crisis makes it clear that the lessons of national security we learned very painfully through 9/11 and its aftermath were disregarded by the Obama Administration in approaching emerging biological threats. In 2015, after seven years of President Obama, a blue-ribbon bipartisan commission on biodefense warned, “the Nation lacks the leadership, coordination, collaboration and innovation necessary to respond” to a biological attack.

The commission recommended restoring funding for state and local public health emergency cooperative agreements to the levels the Bush Administration instituted in response to the 2001 anthrax attacks. But the warning and recommendation went unheeded. President Obama and Vice President Biden chose to follow a course dependent upon building international institutions, such as the World Health Organization (WHO), rather than building stronger federal coordination of epidemic prevention and preparedness. As more details emerge regarding the failures of the WHO’s response to the COVID-19 epidemic, the danger of subordinating our national security to global interdependence has become starkly apparent.

Post 9/11 Unity and Fraying

To better understand how far off course Obama and Biden led our national security policy, let us look back at where we were right after 9/11. In addition to dealing with immediate loss of lives and the aftershocks caused by the anthrax threat, Congress and the Bush Administration assessed what had allowed the attacks to occur and a consensus developed that our intelligence agencies and domestic law enforcement agencies needed the authority to work together in the interest of national security if we were to prevent the next attack.

Within a month, the notorious Patriot Act became law. What was controversial about the Patriot Act, and rightly so, was the degree to which the civil liberties of U.S. citizens were infringed. What was not controversial at the time, across the political spectrum, was the idea that U.S. national security was an appropriate, justifiable, and worthwhile goal. In the spirit of national unity that emerged in the wake of the attacks it was not only felt but also expressed, time and again in our politics and in our culture, that we have something special in this country that is worth protecting.

It wasn’t long before the edges were fraying on that national unity, fraying largely in dissent over preemptive wars in Iraq and Afghanistan. But it is one thing to question the morality, necessity or wisdom of sacrificing American lives in foreign conflicts—always a difficult issue of balancing security interests. It is another thing altogether to question whether our nation is exceptional at all, whether there is or ever was anything about the United States that is inherently and objectively worth protecting.

While much of the thoughtful resistance to the Bush-era policies in the War on Terror was grounded in a belief that domestic spying and an interventionist military went against all that had made America great, the critics today of President Trump’s prosecution of the battle against the CCP virus question and even threaten the very basis of our Republic. The eight years of Obama-Biden policies have brought us to a place where many question whether preserving our American way of life is worthwhile.

Leftist Response to American Exceptionalism

The illogical view from the political Left that protecting American interests is not the appropriate objective of our national government came into full view soon after President Obama was inaugurated. In early 2009, he went on an “apology tour” of Europe and refused to express any recognition of American exceptionalism, saying “the Brits believe in British exceptionalism and the Greeks in Greek exceptionalism.” The natural extension of this ambivalent view of American greatness translated into a foreign policy that put globalist interests ahead of our own national security.

It is a view that led President Obama to issue a National Security Strategy (NSS) in May 2010 that called for embracing a new multilateral order in which “our own interests are bound to the interests of those beyond our borders.” The same month, Vice President Biden in remarks at the U.S. Naval Academy, claimed that defeating threats such as pandemic disease and terrorism which “have no respect for borders” would require new international rules and “that other nations, along with us, enforce those rules of conduct.”

The implications of this approach were exemplified soon after by a State Department spokeswoman expressing the opinion that ISIS terrorists just needed jobs, and that the way to defeat terrorism would be to help foreign governments build their economies. This was no rogue spokesperson—the statement is one of a piece with remarks made by then-Senator Biden, who in 2007 said “Our counterterrorism authorities should not only thwart attacks; these authorities should also strengthen international coalitions, draw Muslim populations around the world closer to us, and deprive terrorists of a recruitment narrative.”

In the 2010 NSS, the Obama-Biden Administration acknowledged the threat of pandemics and infectious diseases, yet claimed that our ability to prepare for and respond to such threats was inherently dependent upon the rights, interests and willing cooperation of other nations’ governments. The effect was that protecting the lives and safety of Americans against biological threats took a backseat to global health initiatives. The Obama-Biden strategy was “that providing assistance to address the immediate problems of global health now will yield more capable and willing partners to work on biodefense-related issues later.” As stated in a 2012 report in International Affairs, the Obama Administration believed that “improving public health in developing nations can influence the intent of would-be bioterrorists.”

While the Obama Administration focused on improving public health in developing countries, China continued developing so-called “dual use” capabilities, allowing them to disguise bioweapons research beneath the veil of biodefense work. A 2015 report in the Journal of Defence Studies concluded that China had developed advanced methods of deploying and dispersing aerosolized biological weapons. That same year, China established its first biosafety level 4 (BSL-4) lab at the Wuhan Institute of Virology. As defined by the U.S. Department of Health and Human Services, BSL-4 facilities “are applicable for work with dangerous and exotic agents that pose a high individual risk of life-threatening disease, which may be transmitted via the aerosol route and for which there is no available vaccine or therapy.”

Moving Forward in the Current Crisis

In the present crisis, no one can yet say with certainty that we have been intentionally attacked by a foreign adversary or that the virus originated in a Wuhan laboratory. Yet, it is apparent that the Chinese government, by definition the Chinese Communist Party (CCP), either negligently mishandled an outbreak of a naturally occurring virus, or the CCP intentionally developed and/or released the virus. What does this mean for our response going forward? It means that, much as we were after 9/11, we must be unified in putting the safety and security of American citizens first. It means that we should work in cooperation with our allies, each putting the security of its own citizens foremost, and work together to clearly define the nature of our mutual adversary. Most importantly, it means the United States must lead, even when leading means going against the conventional wisdom of the internationalist crowd.

In 2018, President Donald Trump adopted a National Biodefense Strategy to begin to reverse the dangerous Obama-Biden era policies. This aligned with his overall 2018 National Security Strategy, and central to both is a call for protecting “the American people, the homeland, and the American way of life.” His then-National Security Advisor John Bolton reorganized the NSC to combine various Directorates and better coordinate biodefense into our overall efforts on counterproliferation and national defense. Predictably, allies of former vice president and  now presidential candidate Biden embarked on a campaign of disinformation earlier this year, falsely claiming that President Trump, by reorganizing and combining directorates, had “dissolved the office” responsible for pandemic response. As the former Senior Director of that office, Tim Morrison, wrote in the Washington Post, “if anything, the combined directorate [for counterproliferation and biodefense] was stronger because related experience could be commingled.”

The Trump Biodefense Strategy enabled the Administration quickly to identify the threat caused by the Chinese coronavirus and respond appropriately by shutting down travel from China, at a time when his liberal critics called such a move xenophobic. But by that time the proverbial bat was out of the barn at the Wuhan Institute of Virology. The American Left, rather than working together in coordinated fashion with the administration to repel the attack, devolved into an unhelpful combination of politically-correct virtue signaling and finger pointing.

But the American people know that this is a great and moral nation worth protecting and preserving, and we deserve leaders who understand that as well. So, while our nation’s focus is now appropriately on reopening our economy as we learn to live with—and work to defeat—this virus, President Trump’s biodefense strategy puts us in a better position to discover the precise nature and intent of the attack, and to hold China appropriately accountable. He and his Administration deserve bipartisan support—from the country and from the Congress—to give him every available tool to ensure that response strengthens our national security.

Every day seems to bring some new, unexpected, unpleasant revelation about the SARS-CoV-2 and the illness it causes, COVID-19. 

The infection has a long, often asymptomatic incubation period, high transmissibility, the ability to infect many human tissues, and, frequently, rapid deterioration of the clinical course. Some curious aspects of the infection, such as long duration of symptoms, multi-organ involvement, blood clots, and patients’ ability to tolerate extremely low blood oxygen levels have put critical care doctors on a steep learning curve, trying to understand how best to keep patients from falling off a cliff.

If the clinical aspects of the disease have been difficult to catalog and manage, the public health considerations have been equally vexing. We know enough now, however, to offer improved guidance for setting public health policy. Rather than using projections of cases and fatalities to guide policy decisions, the focus should be on the granular level of how the virus physically spreads. It is time to relegate the COVID-19 epidemiological models primarily to projecting required hospital and ventilator capacity and supplies of personal protective equipment.  

Based on a survey recently in New York, it appears that a very high percentage of new cases can be traced to individuals’ homes and to care facilities such as nursing homes. The survey found that 83 percent of new cases came from unemployed or retired individuals who are largely sheltered in place, while almost a quarter (22 percent) of these cases originated in long term care facilities. In the nation overall, 11 percent of COVID-19 cases have occurred in long-term care facilities, while deaths from the infection in long-term care facilities account for more than one-third of the country’s pandemic fatalities.

We are also learning more about the role of children in spreading COVID-19 from an analysis just released by the Netherlands’s National Institute for Public Health and the Environment:

Worldwide, relatively few children have been reported with COVID-19. Data from the Netherlands also confirms the current understanding: that children play a minor role in the spread of the novel coronavirus. The virus is mainly spread between adults and from adult family members to children. The spread of the virus among children or from children to adults is less common.

With sufficient resources, there are measures available to mitigate institutional spread that must be more widely and aggressively applied. There are limited controls available within households, however, so the main objective there needs to be eliminating the introduction of infection and performing contact tracing once that bubble has been pierced.

More new information from recently updated CDC guidelines: COVID-19 “does not spread easily” by touching contaminated surfaces or objects, by animal-to-human contact, or vice versa. The CDC continues to warn “that the main way the virus is spread is through person-to-person contact, even among those who are not showing any symptoms,” and that “the main way to prevent infection” is social distancing, handwashing with soap, and “cleaning and disinfecting frequently touched areas.”

Those findings are consistent with an excellent article by University of Massachusetts immunologist Erin Bromage that explores the math of virus transmission. It strongly suggests that most forms of short-lived, non-intimate contact have little chance of transmitting a sufficient load of the virus to infect anyone except the immunologically compromised. Outdoors, the probability becomes even lower, because of air movement and dilution, and the consequent dissipation of viral particles. In short, the science suggests that outdoor activities with prudent distancing pose very low risk.

The same analysis shows that in indoor environments, the key physical factors are the rate of air exchange and the overall volume of air in the space. So, for example, a big-box store with effective air conditioning (ideally, with HEPA filters) is far less favorable to transmission than, say, a small boutique. This also explains why crowded restaurants and bars and homes and non-hospital care facilities are so conducive to contagion.

The second critical consideration is the number and distribution of virus particles emanating from a person who is infected. A cough projects far more virus a greater distance than breathing, and a sneeze is still worse. At least 44 percent of all infections are transmitted by people without any symptoms (asymptomatic or pre-symptomatic people), who can be shedding the virus into the environment for up to five days before symptoms begin.

Although no prescription for behavior can be perfect, we can offer some guidance. 

First and foremost, people with known exposure to COVID-19 or with fever and cough or sneezing should not go out in public, and should wear a mask if they must leave isolation. (If there were to be any basis for strict enforcement, we believe this should be it.) They must isolate as much as possible, preferably somewhere with effective air exchange and filtering to avoid infecting family and anyone else in close proximity.

The second relatively obvious policy prescription is to permit outdoor activities where reasonable distancing is possible. That will make most parks and beaches accessible, provided the capacity is policed to avoid overly close spacing. Surfaces will probably be a minimal source of transmission except for picnic tables and the like. Sensible restrictions like those contrast with ludicrous prohibitions, such as against power boating (in Michigan, since removed) and against fishing (Washington).

Along similar lines, indoor capacity controls should be tailored to the type of space and efficiency of ventilation. Roping off sections of a big box store is senseless, compared to overall capacity management and requiring that staff and customers wear masks. One logical government program might be to subsidize the installation of HEPA filtering and HVAC systems that can move greater volumes of air.

Because infections will still occur, contact tracing becomes very important. A high priority should be placed on testing of households where infections may have spread before the onset of symptoms in the first case.

Although we know that pre-symptomatic people can spread the virus, it is less clear how capable of spreading infection are individuals who are known to have been infected but remained asymptomatic. For that reason, it is critical to continue extensive population screening with accurate (validated) antibody tests, in order to assess the magnitude and importance of asymptomatic infection.

Taken together, these considerations suggest logical guidelines. It is clearly past time to rein in the baseless, arbitrary restrictions that have been imposed by some politicians, as they can only inspire non-compliance and contempt. Predicating policy on transmission dynamics can clear away the miasma of regulation based on macro trends and guesswork. We still need continued research on how the SARS-CoV-2 virus can most effectively be prevented from spreading from person to person.

Social distancing, testing, and the wearing of masks in relevant settings should be continued, along with contact tracing. The improvement of HVAC systems is less obvious, but also critical. Keeping the most dangerous—i.e., potentially most prolific—sources of spread contained should be the focus of enforcement.

None of what we have suggested eliminates the risks for those who do become infected, although there is some evidence that exposure to larger amounts of virus leads to worse outcomes. We need effective drugs and better clinical management practices. In the meantime, we believe that dispensing with unnecessary and unscientific restrictions on our behavior and the economy will go a long way toward safely returning the nation to some semblance of normality.