Notes from a coronavirus refugee

the Spanish Steps under lockdown

On April 14^th, 2010, the Eyjafjallajökull volcano in Iceland spewed out a giant cloud of ash that grounded airplanes across Europe. That day my husband Alvin Curran and I happened to be in Valencia, a charming Spanish coastal city whose historic center you can walk across in an hour. Train seats to Rome were snapped up before we caught on, and it took three days until we managed to hop on a plane. Our first lesson in being a refugee: if you can’t leave, even the loveliest town is equivalent to Hades.

Ten years later here we are again, only worse. Alvin and I came to California on March 4^th so I could attend the 700-strong medical conference I’ve been going to every year since 1988, where I was to give a presentation of my memoir Dottoressa: An American Doctor in Rome to my scientific colleagues, and fit in another three book readings around the US as long as I was there. Days later the coronavirus crisis hit in force, and we were sent scrambling. My conference was cancelled at the last minute, then my two presentations in New York, then all air travel to Italy. We decided reluctantly that it wasn’t wise to bring our over-70 bodies to our beloved New York – try social distancing on the subway. Instead we cast our net in search of refuge in the Bay Area, until at least the end of April when Rome-bound planes may start flying again. 

After offers of hospitality poured in from friends and relatives, we’ve landed in a comfortable “mother-in-law apartment” in North Berkeley donated by friends who usually rent it out on airbnb.

As soon as we’d unloaded our bags in that high-end refugee camp we headed off to the splendid Monterey Market, a few blocks away, to stock our refrigerator. Only after we got back to the apartment did it register, with horror, that after washing our hands a hundred times a day, and greeting friends with namaste instead of kisses, we’d just finished voluntarily spending an hour cheek to jowl with hundreds of Berkeleyites pushing past each other to score rice, blueberries, and kale.

In the meanwhile our adoptive country, Italy, is under rigorous lockdown, with everything from schools to restaurants to churches shuttered, and a three-foot distance enforced even between pedestrians on the street. 

Italians are great at handling emergencies, their national character being blessed with both resourcefulness and good cheer. The way Alvin and I got out of Valencia in 2010 was by sprinting across the airport on a tip from an Italian. Another time, when a cancelled flight left me and hundreds of others stranded at the New Orleans airport, all the Americans wandered around grousing. A party of Italians assessed the situation, decided there was no way to change it, and broke out some champagne. So it’s no surprise that quarantined Italians are socializing by singing from their balconies. For the national anthem, though, they needed help from a recording – nobody knows the words (watch half the Italian Olympic team fake it). 

housebound Romans sing the national anthem from their balconies

There are hints that the Italian lockdown may already be bearing fruit, with a slight slowdown in the rate of new cases. Austria, Denmark, France, Greece, and Spain have now decided to follow the Italian approach.

When oh when will the United States do the same? The occupant of the White House remains more concerned about the state of the stock market than about his citizens’ health (or even his own, he claims). You’d want to laugh at his wooden, self-aggrandizing, xenophobic Oval Office address about the coronavirus pandemic if its failure to provide any solutions weren’t so potentially lethal. 

Even the great Anthony Fauci is pussyfooting around. He does tell some version of the truth, that the epidemic is going to get worse before it gets better and that testing has been failing, but he offers virtually no guidance. The nation needs to hear from him who exactly should be tested, whether the US will accept the test kits they’ve been offered by China, how exactly to carry out “containment and mitigation.” When pressed Fauci said it wouldn’t be a good idea for basketball games to be played to full stadiums, but he didn’t suggest how large public or private gatherings should be, or whether schools, restaurants, or bars should be closed. He’s said nothing that I know of to promote the vital politicies of teleworking, universal sick leave, or free medical care for all coronavirus patients including the undocumented.

Fauci’s colleagues have suggested to the journal Science that he is “trying to walk a fine line, being honest to the public and policymakers but not so openly critical that he loses influence by being ignored or forced to resign.” I suspect this adds up to his still being muzzled by Pence for political purposes.

Even CNN, for all its justified criticsm of the President, has spread misinformation. I have heard their experts suggest variously that possible coronavirus patients head for Emergency Rooms (possibly spreading the virus around the waiting room), that people in self-isolation can go out to shop, and that family members of coronavirus patients don’t need to self-isolate (Justin Trudeau has stepped forward as a counter-example). And unfortunately Rep. Katie Porter, during her fantastic hatchet job on the head of the CDC, confused influenza tests with coronavirus tests. 

So far the decisions about concrete steps – limiting public gatherings, closing schools, encouraging people to work from home – have been left entirely to State and local governments and to organizations from the NBA to Amazon. Many more Americans will die from covid-19 whatever we do or don’t do, but if the United States takes rapid action as a nation, hundreds of thousands if not millions of lives can be saved. Anyone who is not yet convinced of the need to immedicately adopt aggressive measures should look at this brilliant piece in the NY Times. 

In case you’re curious, I did manage to do one book reading last Tuesday, to an audience of 50 at Moe’s Books in Berkeley, and on Saturday Alvin pulled off his scheduled house concert with Willie Winant to a similar-size group. Who knows when we’ll get to attend gatherings like that again.

Alvin Curran and William Winant in house concert, SL at Moe's

Corona

The coronavirus with its spiky crown (artist's image)

Rome’s streets are empty, the supermarket shelves loaded with food. My fellow denizens, for once free of the tourist hordes, are enjoying their lives in a state of limbo, waiting for coronavirus to come crashing down around their heads before they start stocking their larders and hunkering down.

At least that’s what things were like yesterday. I can’t say about today, because I just arrived in San Francisco to begin a two-week book tour cum working vacation scheduled months before that damned virus jumped the species barrier deep into China. We were biting our nails until the last moment – would the Americans impose a 15-day quarantine on all travellers from Italy? – and felt some relief at getting away, like Boccaccio’s fictional pals who fled to the hills outside Florence to escape the Black Death. But the first New York Times headline I see on landing is California Declared a State of Emergency, and it’s entirely possible that all the events we’ve come for will be cancelled in the spreading panic. 

When Covid-19, coronavirus disease, struck northern Italy in February like a bolt from the blue, the authorities got their act together surprisingly fast. They isolated the worst-affected areas, set up national and regional telephone hotlines, called in medical trainees and retirees to man them, planned dedicated wards in infectious disease hospitals, instructed practicing physicians in telephone triage, and broadcast two concepts to the general public: people leaving an epidemic area should self-isolate for two weeks even if they have no symptoms, and if you have cough, body pain, or fever you should pick up the phone rather than heading for doctors’ offices or emergency rooms where they might infect the sick and vulnerable. 

Anyone with suspected coronavirus is tested in isolation in the emergency room, if they’re sick enough to be there, or in their own homes by a hazmat team sent by the Health Department to take the swab. Testing is free, preliminary results are available and public within hours, anyone who needs to stay home gets paid sick leave, and under the Italian National Health Service nobody pays a penny for doctors, Emergency Rooms, or intensive care.

Human beings being imperfect, implementation has had some hiccups. A Rome policeman developed a cough on February 28^th after hosting a houseguest from Lombardy, the northern region where coronavirus disease is most rampant. Instead of calling his doctor or the hotline he went to an emergency room, where the ER staff left him to stew in the regular waiting room, where he infected at least 15 fellow patients in addition to his wife and children. Not clear who was dumber, the doctors or the cop.

Italy’s response capacity is also hamstrung by its chronic and ever-worsening underfunding. If even wealthy Scandinavia will have trouble rounding up enough ventilators and intensive care unit beds if a true pandemic develops, imagine where Italy will be with half the resources.

And how about on the other side of the Atlantic? How will the United States succeed in handling an epidemic that seems increasingly likely to hit big, either soon or in the fall? 

My guess is badly. As a haven of rugged individualism and for-profit medicine, the US is far less equipped than Europe to mount an adequate response.

To start with, a third of Americans have no paid sick time at all, and few have as much as two weeks. Which means that many people mildly ill from coronavirus will keep going to work, putting everybody around them at risk.

And as we all know, US is one of the few countries where access to medical care depends on access to money. Between deductibles and co-pays even insured Americans often find it hard to afford doctors’ visits, medications, and hospital care. Which means that many who should be tested for coronavirus are likely to skip it in order to avoid starting a chain reaction of medical expenses – some are even being charged for the test itself. Not to speak of the 27 million citizens who have no insurance at all, or the millions of undocumented immigrants who steer clear of hospitals for fear of hovering ICE agents, all primed to swell the pool of infected people who may soon be mingling with the crowds on American streets, subways, stores, classrooms, and baseball stadiums.

Even stocking up on medications in case of preventive quarantine can be impossible in the American context – insurance companies don’t allow it.

In Italy about 30,000 people have been tested for the novel coronavirus, versus only a few hundred people in the vastly larger US. The lag is largely because every test needed advance approval from the Centers for Disease Control; broader testing is set to start now. 

Italy is notorious for disorganization, and has neglected epidemic preparedness. But this time it’s bested the US, which has been unable thus far to enact some obvious measures for containing the coronavirus. The Italian authorities tell a Neapolitan businessman who was obliged to spend a day in Milan for a meeting that he should stay home for two weeks when he gets back. When I landed at San Francisco Airport today the border police chatted me up about my life in Rome, and wanted to know whether I was carrying any cigarettes, but didn’t even ask when I had last been in northern Italy. Scary.

Then there’s the politics of an election year. Our real experts on the science and the handling of epidemics, such as Dr. Anthony Fauci, are being sidelined and even muzzled, while the coronavirus task force is run by Vice-President Mike Pence, who as governor of Indiana suggested the best response to the state’s HIV epidemic was prayer. And while President Trump runs off at the mouth about how a vaccine is at hand and how the coronavirus is just another Democratic hoax. 

Obviously the situation in both my countries is evolving not just day by day but hour by hour, and much of what I’m writing today may be out of date tomorrow. But having scribbled these musings, mostly on the plane, I thought I'd offer them to you anyway. 

Nilotic Jeopardy: Finale

our escort paddling across the Nile

When my Italian ex and I were visiting the Sudan in 1979, word had it that one of the few tourist destinations in the South was the Nimule game park, within range of the regional capital Juba, and that foreigners couldn’t go there without a permit. The number of interlocutors, rubber stamps, and banknotes we went through to obtain one in Khartoum made Italian bureaucracy seem like child’s play.

When we eventually made it to Juba and handed over the hard-earned permit to a government official, he tore it up. The guerilla war of the black South against the Arab North had nominally ended seven years earlier, but for all practical purposes Sudan was already two countries joined at the waist (their divorce finalized in 2011). Another round of stamp-wielding bureaucrats, another wad of dough, another permit.

Our next problem was how to get to Nimule. At that particular moment, this was a non-trivial issue. All of Juba’s fuel was trucked in from Uganda, and the border had been closed for months, so gasoline was a mirage. But perseverence – and perhaps bribery, I can’t remember now – succeeded in landing us a jeep complete with a driver, a hanger-on, and some kind of liquid in its tank. 

The first minutes of our Nimule safari provided an unexpected sartorial lesson. From our daily treks to the market we thought we knew the local costume: a draping of cloth or animal skin ample enough to cover the vital parts, topped off by a necklace of glass or blue plastic beads. But when we crossed the river heading southeast out of town, around 9 am, we encountered some market sellers who had cleared their merchandise early and were changing out of their work clothes. We stopped to watch. Each removed his piece of drapery, folded it, placed it on his head to double as a support to balance his market basket, and walked off still wearing his necklace but otherwise stark naked, penis swinging.

Between the nearly impassable rocky road, one flat tire, and several mechanical breakdowns, it was dark before we were deposited at the official Nimule lodge 120 miles away, a sub-basic establishment perched on a small hill just outside the game park entrance. 

At dawn we tromped into the park on foot, in the company of a guide with a rifle slung around his neck whose stride was twice mine and who never let up for a moment. After a couple of debilitating hours without seeing a hint of wildlife, we reached the bank of the Nile. The river was wide but full to the brim, and frighteningly swift. Andrea, the guide, and I piled into a dugout canoe with two paddlers, and a small boy climbed into another one, alone. The river was rushing by so fast that the oar-wielders had to angle their canoes’ noses upstream at a good 70º and then paddle like mad, in order to reach the bank just opposite our starting point . . .

 . . . but, as it turned out, not quite. When we emerged from the fast-moving part of the river to where the water was still and full of rushes, about 50 yards from shore, the guide motioned for us to take off our shoes and wade the rest of the way. As a doctor I knew this was a bad idea. Still water full of rushes means one thing in Africa: bilharzia, a/k/a schistosomiasis. Wade in that water and the snails clinging to the rushes will pour out myriad tiny parasites whose life’s mission is to crawl through your skin, work their way into either your urinary tract or your intestines depending on whether they’re named Hematobium or Mansoni – in Southern Sudan both types are rampant – and destroy your kidneys, liver, brain, or all three, causing agonizing pain as they go. We begged, we pleaded, but the boatsmen refused to take us closer to land. I’m sure they had no idea what we were complaining about, since for them schistosomiasis was just part of normal life – in that area, it still is. So it was wade in the water or give up on seeing any of that game we had come all this way for. In the end what we did was take off our shoes but leave on our socks, then splash through the stagnant water as fast as we could, trying to outrace the little buggers.

Yet another entry to add to my incubation period countdown, and a long one: you can’t be sure you’ve escaped schistosomiasis until you’ve made it six months without symptoms.

As far as wild animals were concerned the expedition was a total wash: all we saw was a single family of warthogs. At least we got an adrenalin rush out of them, when mama pig, papa pig, and a pack of piglets dashed precipitously, tails in the air, out of a hidey-hole under our noses so close that the guide pointed his rifle. 

How come a game park had no animals? Our hotel manager let us in on the secret: they had all been killed and eaten by guerilla fighters during the war.

The reverse Nile crossing was uneventful, as would have been the hike back to the lodge if we hadn’t run prematurely out of water. It was still the middle of the day and I lagged farther and farther behind Andrea and the guide, exhausted and shriveling in the sun. At the foot of our hotel’s little hill I admitted defeat and lay down in the dust, curled up in the rudimentary shade of a thorn tree.  

For a half hour or so with nobody coming to my rescue I worked on gathering my dehydrated strength. When it it started to look like I had been permanently abandoned to my fate, I struggled up the hill on two and four limbs, only to find my husband swigging beer with the hotelier and claiming, unpersuasively, that he had been about to go fetch me. Too dazed and sick from heat exhaustion to properly express my fury, I instead vomited a couple of times, drank a vast quantity of water, and passed out on the mattress. Andrea had the nerve to complain, years later, that I’d been a wimp.

Next day at dawn we headed back to Juba. The vehicle crept along without much mishap until well after nightfall, when it died some six miles outside of town. Despite our protests the driver wouldn’t even make a stab at fixing it – we suspected he had his own nefarious reasons for staying put. But the wheels were totally in his power so our only option was to set off on foot. Musically, at least, that hike was memorable – the silence of the moonlit night periodically broken by drumming that would reach us from a far-off Dinka cattle camp, fade away, then return as another camp came within earshot. 

back from Nimule, dusty and famished

Back at the hotel, hours into the night and well past dinner hour, we plunked ourselves down at a table hungrily anticipating the dozen gristly bits of mystery meat that every day of our stay thus far had been the restaurant’s unvarying entree, morning noon and night. But what arrived on our plates this time was white instead of the usual grey-brown. We were thrilled – fish!

One bite banished the thrill. The white morsels weren’t fish at all but chunks of fat, left over after the restaurant ran out of meat. If you don’t count a cup of milky tea, we went to bed without supper.

Nowadays, they say, the Nimule game park is easier to reach, and teeming with elephants. But apparently unexploded landmines and the like make it an even more dubious destination today than it was four decades ago, when the worst thing we risked was a case of schistosomiasis.