Victor Grech: The Battle for New York: Disaster Movies and the Ongoing COVID-19 Onslaught

New York City ... the splendor, picturesqueness, and oceanic amplitude and rush of these great cities ... costly and lofty new buildings ... the tumultuous streets, Broadway, the heavy, low, musical roar, hardly ever intermitted, even at night ... the assemblages of the citizens in their groups, conversations, trades, evening amusements ... these, I say, and the like of these, completely satisfy my senses of power, fulness, motion.

—Walt Whitman (1819–1892)

Introduction

In a previous paper, I outlined the events that have led to the current pandemic (Grech “Pandemics”). This essay briefly describes the propensity of science fiction authors to unleash disasters on New York City and then goes on to outline events currently unfolding in the United States in relation to COVID-19, with particular emphasis on New York City.

Manhattan

The city of New York is epitomized by Manhattan, its most densely populated borough and historical birthplace, cultural identifier, economic and administrative center. Moreover, Manhattan has been described as the cultural, financial, media, and entertainment capital of the world. New York County is the United States’s second smallest county by area and one of the most densely populated regions in the world. Many districts and landmarks in Manhattan are iconic, such as Times Square, the Empire State and Chrysler Buildings, and Central Park. Manhattan has the highest per capita income in the country. For all of these reasons, Manhattan is depicted as the heart of America and a symbol of modernity. Any disaster that befalls Manhattan is arguably a signifier, a veritable blow to mankind.

Science Fiction and Disaster in New York

Any science fiction movie wishing to mete destruction on the United States or humanity appears to have Manhattan in its sights. Indeed, the city has been attacked/destroyed in myriad ways in a plethora of disaster movies and only one example in each trope will be given. These include natural events such as tsunamis in The Day After Tomorrow (2004), a sudden ice age in 2012: Ice Age (2011), storms in NYC: Tornado Terror (2008), seismic disturbances in Earthquake New York (1998), a volcano in Disaster Zone: Volcano in New York (2006), meteor strikes in Armageddon (1998), rampaging monsters in King Kong, (1933) and nature rebelling against humanity in The Happening (2008). Invasions are also common, as in alien invasion as in The Avengers (2012) and epidemic plague that also turns a few of the survivors into vampiric creatures in I Am Legend (2007).

The most plausible viral epidemic scenario is played out in the movie Contagion (2011). As the the disease there spreads widely despite quarantines, the rule of law breaks down, and desolation overtakes New York.

COVID-19

The current pandemic disease, COVID-19, is caused by a novel coronavirus, SARS-CoV-2 (Zhu et al.). At the time of writing, global spread is following an approximately exponential curve: 67 days to reach the first 100,000 cases, 11 more days to reach 200,000, four more to reach 300,000 cases, another 6 days (March 27) to double to 600,000 cases and another 9 days (April 5th) to double to 1.2 million (Benjamin Zammit, Onest Data, personal communication). This virus’s lethality lies in its stealth: it spreads silently with an incubation period of weeks, and doubles quickly, but it kills slowly, weeks after infection, typically with severe pneumonia (Luan et al.). All health care workers “grudgingly respect our enemy’s tenacity. Unseen, ruthless, random.... We stand between the patient and the enemy. We are the front line” (Hannah-Clark).

Notwithstanding pandemic preparedness at national, international, and global levels, and in spite of admonitions by virologists, epidemiologists, and science fiction authors, humanity has failed miserably in containing loss and quality of life in this evolving human tragedy (Fehr and Perlman; Fineberg). Furthermore, additional warnings have been amply given by witnesses of the ongoing horrendous and tragic situation in northern Italy’s evolving health care debacle, where hospitals are completely inundated and overwhelmed by the sick and dying, with doctors having to triage patients to ventilation or painful demise as in the absence of enough ventilator beds (due to sheer number of viral pneumonias), a trial of ventilation is impossible—and tantamount to a death sentence (Remuzzi and Remuzzi).

COVID-19 in New York

In the meantime, politicians dither and sway, playing for popularity and votes, with arguably the extreme being United States President Donald Trump, who went from initially denying the existence of any form of public health problem from COVID-19, to asserting that the increasingly alarmed and strident public health warnings were a conspiracy against him, to proposing tax cuts and improved health insurance coverage, to claiming to intend to remove restrictions and reopen the economy in the next few weeks (Tanne; Dyer; Dyer).

After Italy and Spain, the next country facing the strain is the United States. Figure 1 from the Washington Post shows confirmed cases comparing the US with Western Europe—the US is only a week or two behind (Cohn).

Figure 2 from the Post also shows that the rate of growth of cases (and hence, rate of spread) is faster in the US (Cohn). Clearly “[t]he United States is on the worst trajectory of any advanced country—yes, worse than Italy at the same stage of the pandemic—with confirmed cases doubling every three days” (Krugman).

The next disaster area is New York, one of the new disease epicenters. This is because the States mishandled the crisis not only politically, but also from a public health perspective, from nonfunctional and inadequate viral testing kits to underfunded hospitals (Madrigal and Meyer), with little impediment to “the inexorable march of contagion” (Feuer). In an earlier study, data from China was used to estimate hospitalizations, intensive care admissions, and deaths for the author’s country, Malta (Grech, “COVID-19”). The same methodology is used for New York state, and the death count is non-trivial even in best case scenarios of 20% infection rates.

The application of an early, strict, and prolonged lockdown in order not to flood hospitals is vital (Emanuel). On 24 March 2020, New York Gov. Andrew Cuomo sounded his most dire warning yet: “we are not slowing it.... One of the forecasters said ... we were looking at a freight train ... We’re now looking at a bullet train” (Hill et al.). The state could reach 40,000 people in intensive care, when there are only 3,000 intensive care unit beds state-wide, with a projected peak in 2–3 weeks. In terms of numbers, the State is trying to double bed capacity to 110,000 beds, but 140,000 may be needed. Similarly, there are 7,000 ventilators but 20,000 will be needed in a matter of weeks (Emanuel).

At the time of writing, New York’s death toll has exceeded 3,000. [Editor’s note: This article was written the first week of April. As of April 15, the New York death toll is around 12,000.] Cuomo candidly but realistically stated that “if a person comes in and needs a ventilator and you don’t have a ventilator, the person dies.... That’s the blunt equation here. And right now we have a burn rate that would suggest we have about six days in the stockpile,” with that sixth day being April 4, 2020 (Zoellner).

The medical community however is constituted of scientists, and no matter how prominent or shrill the utterings of politicians, scientific cognizance of the true state of play combined with a grimly realistic attitude can be summed up by the (admittedly apocryphal) Galilean saying: “eppur si muove.” Full-scale preparations for a flood of admissions are under way in New York (Hasan and Narasimhan; Sommer et al; White and Lo), as well as attempts to “flatten the curve” (Gunner et al) not only here, but worldwide, since failure to adequately prepare for this pandemic may lead to almost a quarter of a billion deaths (Grech “Unknown”). And yet, in the face of this emergency, “N.Y. Hospitals Face $400 Million in Cuts Even as Virus Battle Rages”—bafflingly and almost parodically paradoxical (Ferré-Sadurní and McKinley), while inexplicably, “Holdout States Resist Calls for Stay-at-Home Orders” in the South and Midwest (Mervosh and Healy).

It is almost as if we are all collectively and unwillingly participating in a dystopian science-fiction movie, with no end in sight. We can only hope and wish our beleaguered colleagues in the States well while waiting for the ax to fall in our respective countries.

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Victor Grech is a consultant cardiology pediatrician at Mater Dei Hospital, Malta.

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