This series is devoted to reporting on the experience of doctors at the frontlines of the battle against coronavirus, as we endure what are likely to be some of the deadliest weeks in the history of the United States. Some doctors interviewed will remain anonymous (though their identities are known to the editors), so that they do not face repercussions for sharing frank truths about practicing medicine in the midst of this crisis.
On the evening of April 18, the day after the mayor of Jacksonville, Florida, ordered beaches to be reopened, Dr. Q looked around her neighborhood with alarm bordering on panic. At least three of the houses on her own street were hosting backyard parties. Pools were full of splashing children and adults, and the noise of it all filtered through the windows into her own quiet house where the lockdown was still real. In truth, she tells me, the lockdown had never really been practiced with any consistency in South Florida. Even after schools were closed in early March, she says, “the play-dates have been going on—they’ve just never stopped.”
It’s not just the play dates and parties, though; the laissez-faire attitude toward the pandemic in Florida appears to be pervasive. Florida was one of the last states to enact a lockdown, with its Governor Ron DeSantis waiting all the way until April 1 to finally order “all Floridians to limit movements and personal interactions outside the home to only those necessary to obtain or provide essential services or essential activities.”
Dr. Q, who runs her own practice but also consults with patients at area hospitals, had already shut her office down by that point. “I did not have enough PPE for my staff,” she says (referring to personal protective equipment), “and of course when we ran out it was impossible to order any.” She still had to see patients at the hospital, and for that, she needed N-95 masks. Those, too, appeared to be impossible to get. Eventually her husband managed to locate a man who was selling some on Craigslist, but they were all sold out by the time the seller got to their email. The next seller they found was through eBay. He did not have the medical N-95 masks, but he did have ten of the kind used by construction workers. He wanted to sell them for $80. Jittery from having lost out on the earlier deal, the two agreed to drive out to his place and get the masks. “It was a surreal experience,” Dr. Q recalls. The masks were unpackaged, so there was no way to tell if they had been used. Standing outside the man’s trailer, she handed him the money in a Ziploc bag, took the ten disposable masks, and drove home.
“I try to make every mask last as long as I can,” she tells me, “but it’s really hard. If you drop it on the floor in the hospital it’s done, if you touch it with your hands while taking it off it’s done, and eventually it’s done because it’s made to be used just one time and then thrown out.” She only has five masks left.
One evening last week, wearing one of the precious masks and pairs of gloves, she arrived at one of the hospitals to see a patient. “I walked in the staff entrance as I always do,” but before she knew it a guard—not the usual receptionist who scans temperatures—“jumped out in front of me.” Then, standing a few inches from her face and without a mask, he nonchalantly started chatting with her and scanning her forehead for her temperature. “I was so upset, I was shaking, just shaking. This man is one of the most exposed people in this facility, in charge of scanning everyone, and he is standing mere inches from me, without a mask and chatting away. If hospital employees are not taking things seriously, then who else will?”
Other doctors, she knows, are facing worse conundrums. One friend called her crying because the one N-95 mask her employer, a large hospital corporation, had provided her with had disappeared from her office. She did eventually get a new mask but not without providing an exhaustive explanation. Yet another friend, who works in a rural hospital, ordered Covid-19 tests on a number of patients who were showing symptoms. Before long, she received a phone call from the hospital CEO, telling her that she was required to get permission from hospital administrators before ordering the tests. “It’s probably because admitting they have Covid-19 patients means that they have to invest resources, provide staff PPE, create negative pressure rooms so that air does not circulate out, isolate the patients, isolate the staff,” she said.
Florida may have the advantage of sunshine—more of that UV light recently touted by the president—but the state also has a huge elderly population.
Like Tennessee (discussed here last week), Florida has seen rural hospitals close as they struggle to make a profit. With a dearth of resources and the Florida state government looking askance at Covid-19 precautions, some hospitals may decide that the way forward for them is to skimp on tests even if they are actually available. Undoubtedly, scores of U.S. hospitals have furloughed workers in the past few weeks because the losses are piling up. Some, like Appalachian Regional Healthcare, have furloughed about 500 of their employees, while Mountain Health Network has cut 550 of their workforce. Others, like one in Bradenton, Florida, have sent only “a portion” of their staff away.
Florida may have the advantage of sunshine—more of that UV light recently touted by the president—but the state also has a sizable elderly population. Census estimates from 2018 rank Florida as the second most elderly state in the union, slightly behind Maine, with more than 20 percent of the population age sixty-five or older. News reports suggest the number of cases in long-term care facilities doubled in one week in April, to more than 1,500. But many such facilities have been reluctant to test and to report cases. In much of Florida, as in most of the rest of the rural United States, the tests are still largely carried out by county health laboratories, and the well-documented test shortages may be difficult to disaggregate from failures to actually request tests. In either case, the numbers of reported cases would not reflect the true extent of the virus in the state.
Not far from where Dr. Q lives is the vast retirement community The Villages, where more than a hundred thousand well-heeled residents spend their time attending daily concerts, partying in the many restaurants, and driving around their gated enclave in gussied-up golf carts. On April 20, President Trump congratulated the community on “having done so well” against Covid-19. The congratulations were perhaps premature: on April 22, Sumter County, where The Villages are located, continued to see an increase in cases, the total rising to 164.
The night after the incident with the guard, Dr. Q drove back to her neighborhood. Some of the parties were still going on as she followed the ritual she has developed to try to limit the risk of exposure for her husband and two young daughters. In the garage, away from the family, she carefully removed her mask and undressed, placing all her clothes in a bag. She took off her shoes to be wiped down with bleach. As she showered, she thought about the risks she could face. The next day, she decided she would put herself in further quarantine from her family, seeing them only at a distance and living in a separate bedroom. That very night, she also wrote a letter to the administration of the hospital, relating her interaction with the guard and the pressing need to train staff in the serious nature of the distancing requirements.
The next morning, her daughter, finishing her home-school assignments, wanted help with her algebra homework. She told her that she would help her but over Zoom from her separate bedroom. “I didn’t want to be close to her and sit next to her. I was just too afraid. When you’ve seen people die and suffer from this, you don’t want to take chances with your children.” When she was done, she looked out her window to the sunny Florida day, and a group of kids on bikes raced through the streets. The play dates were on and in full-swing.
It makes sense perhaps that Florida would be this way, resolutely ignoring the shadow of death and disease that hangs over the country. It is, after all, the place where America shelves the old and eventually dying so that the places where they once lived are not burdened by their deaths. Maybe it’s because of this that Floridians are experts at looking away, carrying on, despite the creeping, encroaching shadows of death falling over the state.