Interviewer(s): Henry
Interviewee(s): Paul

Paul: As long as you don't hold my bank account, I'm.

Henry: No bank account number.

Paul: And no Social Security number. That's fine.

Henry: If I have a quote from you in the final paper, you'll be pseudonymized, and your organizations will not be mentioned by name.

Paul: That's fine.

Henry: OK.

Paul: I'm easy.

Henry: OK.

Would you like a preamble, or should we just get started?

Paul: Just get started.

Henry: Sure. OK, good. Uh, first of all, what's your name?

Paul: [Name], M.D..

Henry: And how old are you?

Paul: Oh, God. 68. khkhkhkh

Henry: And where are you located?

Paul: The clinic or the home?

The clinic is in the Bronx. Clinic is in the Bronx. At [system name].

Henry: In the New York City area.

Paul: Yeah. Born in the Bronx. And raised.

Henry: So what was your job in- What's your job right now?

Paul: I'm the medical director of an outpatient clinic. That specializes in substance abuse and medical care.

Henry: And what was your job in January of 2020?

Paul: Same thing. I've had the same job for 37 years.

Henry: Okay.

When did you first hear about Covid?

Paul: In January of 2020, I guess. On CNN with everybody else.

Henry: You heard it from the news?

Paul: Yes. Initially, yes. The news.

Henry: And did you discuss this with anyone?

Paul: Sure. My family. Coworkers, of course. Yeah. Because it was potentially devastating. We knew it was potentially devastating. And we were we were wondering why no one was doing anything about it.

Henry: Why did you think that?

Paul: Because it was in China and in Italy. In Europe, and Trump had not shut Trump had not shut down the borders much, much earlier. He thought that closing the border to China was going to do the trick, which was the stupidest thing on Earth because it was already in Europe. And Italy. So he should have shut us down in November because he knew about it in November.

So it created a lot of. As far as as far as I know, you know, anxiety and really hatred for the guy, that he knew about in November and didn't close the borders in November.

Henry: He knew about it in November?

Paul: He knew about it in November. Yeah.

Henry: Where did you hear that?

Paul: Probably in a newsletter. Look, if we found out about it on CNN on January, I think it's safe to say that the government knew about it before January.

Henry: I don't disagree, but…

Paul: I mean, I don't have it. I don't have it. The reference for you.

Henry: Okay.

Wait, so what were your- So you've just kind of answered this, but what were your initial thoughts? You saw this on CNN. And what did you think?

Paul: Right. That this was going to be a pandemic because it had spread so widely and so quickly in Wuhan, wherever it was. And my my my greatest concern was that it would not be contained properly. And it wasn't.

Henry: So did you share these concerns with anybody?

Paul: Yeah, with family and friends and and colleagues at work. We all had the same concern. Our initial concern wasn't about management, it wasn’t about treatments, it wasn't about selection of medications. It was about containment and the lack thereof, for sure.

Henry: And did everybody share this perception?

Paul: No.

I would say about half of the people I talked [with], especially family members, were not really in tune with containment; they were more worried about what was going to happen to the family members and whether it could be treated. I think the medical professionals that I work with, all of our first thought was was containment before it, before it even spilled out into the realm of treatment and management.

We all wanted it contained, so it wouldn't start hurting us in the first place.

Henry: But. OK, so you said that the containment, you saw that the containment would fail pretty early, correct?

Paul: Right. And it did, right? Sure. Yes.

Henry: So you saw it failing. And what were you thinking then?

Paul: [REDACTED] Trump and people in the, you know, the World Health Organization and the CIA. I mean, my impression was that this was widely known in the upper, you know, upper echelons of government and that no one did what was appropriate to protect this population. So I think my, my first reaction was… was frustration and anger with those who was supposed to protect us, whether is the World Health Organization or the CDC or the CIA or the president.

I mean, it was not contained. And it was. It was and people were aware of it. And I'm I'm still frustrated and saddened by that, that so many people had to die when conceivably the situation could have been contained more like, you know, was done with Ebola and SARS to certainly to a greater extent but there was no there was no effort at containment whatsoever.

So that was very frustrating. And it actually made me pretty angry. And in addition to feeling sorry for the people who suffered and died.

Henry: You were working during the original SARS then, correct?

Paul: I was working? Yes, OK. I never took a day off. And I was one of the people that stayed on station. Yeah.

Henry: What would you say the differences were between SARS one and SARS two in terms of response?

Paul: I think the there was there was no one that was the difference in this. The difference is there was no one trying to hide SARS1 or SARS2, or Ebola. There was no one trying to hide it. I mean, it was out there in the public, a lot of resources being poured into it. Everyone knew that containment was needed.

They would great efforts at containment early on. It would So it was it was being managed as appropriately as possible and efforts at containment as appropriately as possible, which is completely the opposite, because COVID wasn't wasn't managed in terms of containment at all. So really, two completely different strategies were involved in these cases. And one turned out to be far more deadly than than the rest of them combined.

Right. And if Ebola hadn't been contained it would have been worse for sure. But it was just you know, it was contained and and Covid wasn't. I'm still disappointed and frustrated by it.

Henry: What about HIV?

Paul: What about it?

Henry: In terms of containment and response, especially in the early days?

Paul: In the early days, the there was no containment in response until the gay population finally got politically motivated. The earliest the early I remember the earliest reports in the literature - This is when I was an intern in 1980 1981 - the very earliest reports were… were almost minimizing and and making light of this as a gay problem, as a gay related immunogen.

You probably remember this or maybe you don't, I don't know when you were born –

Henry: ’91.

Paul: OK. the first, the first publications. Okay, so this was a little bit before it. The first publications were small studies from Boston in Cincinnati, eight cases, nine cases of gay individuals who were presenting with these horrible opportunistic infections like PCT and CNS Toxo. And they were small papers, they were small groups of patients, but it was almost, it was almost like a humorous parody and criticism that, look, what these five gay guys and we made one gay related immune deficiency, but it's their problem.

It was really hard in the way it was initially presented. So and containment and research, it really wasn't addressed at all until almost in 1984 in 1985 is when Fauci and the NIH first started getting involved to try to get the sequence of this thing. But for the first several years it was only a small gay community in in the West Village I believe that was trying to call attention to this and HIV was completely ignored for the first three, four, five years. So worse than covid you might say, absolutely worse than Covid, in terms of attempts at containment there were none.

The people who had it would made fun of. It was horrible.

Henry: Would you say that there are any similarities between the AIDS response- or the HIV response and the COVID response?

Paul: The COVID response is as poor as it was, at least when it when it kicked into high gear, let's say in February, when people really started getting scared, and then March, we had the shutdown. Right. That was a couple of months. OK, so the shutdown was a couple of months since we all became aware of COVID. In HIV there was no shutdown and real and no great concern for who was getting hurt for probably six or seven years. OK, So, yeah, it's interesting that you bring that out. I never actually gave this any thought. But as I think about it now, the HIV response was was exponentially less robust than the COVID response was.

Henry: There's not so many pandemics, so small n.

Paul: Right, right.

Henry: OK, so back to COVID. You said you saw this on CNN in January.

Paul: Right.

Henry: And the first wave hit hit New York let’s say early to mid-March, right?

Paul: Yeah.

Henry: Did your perception change over time at all, during that timespan?

Paul: My perception was it went from it went from horrible to devastating. Yeah. It got, as I say, exponentially worse as days and weeks went by. Of course. Of course. There's the parking lots the hospitals began to fill with refrigerated trucks for the dead bodies like ours did, as as the medical wards were turned into ICUs with patients dying by the thousands in New York every day.

Oh, yeah. It got exponentially worse.

Empty streets. Like it was like the apocalypse. The streets were empty, the parkways were empty. It was it was a stunning version of the apocalypse, not to be believed. I'm still incredulous now, that the streets were empty and the supermarkets were empty. And the shopping- And I was I was considered an essential worker, right? Of course, the physicians.

So we were out and to to witness an apocalyptic quiet through New York City was just the most unimaginable thing and the most stunning thing that I ever experienced to this day. It's still unimaginable. That we were locked down like that, shut in our house like that. Still unimaginable. And we're still doing it now and we still got masks now.

Henry: So did you have any kind of oh, shit moment.?

Paul: Any kind of what moment?

Henry: Pardon my French. Real scientific term here. An Oh, shit moment.

Like a eureka, moment.

Paul: Yeah, I think when when the city when we had the the, the closed when the city was closed down on March 13th or March 20th and only essential workers were allowed out, I think that was the big oh shit moment, when you looked at the streets of Manhattan and the streets of Manhattan were empty, Times Square was empty. That was like, oh shit, this could be the end of the world.

You know, this really could be apocalyptic. The end. Nothing like that had ever happened before. It looked like the nukes were on the way you know? the way the streets were empty so, yeah, I, I think the the shots of Manhattan with empty streets for the first time, like ever. That was my biggest oh, shit moment. That this was a serious offense against humankind.

And I started calling Covid the anti-human to the people in the clinic, the people around us, and in the evening, the first few days, the first few weeks of the shutdown, people really weren't wearing masks. They didn't have these plastic barriers. I don't know if you remember all that. We were still we were still having group meetings. It was it was it it took it took way more time than it should had to really completely shut down and get us to wear masks and really institute isolation.

I remember because it was impossible to get N95 masks. I don't know if you're aware of that. It was impossible. And I knew someone in the construction business that worked with chemicals and, you know, the lawns and the dust and all that. And he had a box of 50 N95 masks. And I remember that was the only place I could find them, was a friend in the construction industry, and I brought them to work and I handed them out to the nurses in the past, and the nursing supervisor told the nurses not to wear them because that would scan the patients.

And this is at [hospital] of early, early on in the. But during the shutdown, it was scary, but the nurses put the masks on anyway. And I asked my staff that PAs and the doctors, I gave them the N95 and I said, please don't leave your office without this mask. And we still weren't wearing masks getting to be in.

You know, the mask thing didn't catch on right away. And if you remember, it's it took some weeks for the mask thing to catch on, and the response of the PAs and the MDs to me were all right, it sounds like a good idea that we should put a mask on before we leave our office. But if I'm just running to the bathroom, you know, or just, you know, to the front desk to get some paperwork, I may not need to have my mask on and that that was sorely wrong.

And soon after, you know, soon after the, the shutdown occurred, people, people weren't budging without their masks on. So it really took a long time to get everybody on board with safety. It took way too long.

Henry: Why do you think that is? Or was.

Paul: Because, you know, I think the apocalypse is is is something that's easy to deny. I think this is a worldwide pandemic and it's killing people by the tens of thousands. You know, I think there's an element of denial like that's not going to happen. To me. It's going to happen to somebody else. So and medical staff particularly, I think there might be an element of invulnerable ability or invincibility because, you know, we're medical staff and we have the power to prescribe.

We have the power to delegate. We have the power to heal. And so medical care may have been a little more reluctant in the very, very beginning to use masks because of our sense of a misguided sense of invulnerability.

But that stopped, and that's that when the dead bodies started piling up.

Henry: You know, my dad said something similar. Do you think it's like how AIDS and hep C were transmitted?

Paul: Excuse me one second.

I'm sorry, AIDS and HEP-C were what?

Henry: Well, my dad my dad said something similar about this feeling of, as a doctor, you're invulnerable, you're protected somehow, right?

And the pandemics he cited were HIV and hepatitis C.

Paul: Mm hmm.

Henry: Neither of which is airborne.

Paul: Right. Exactly. I was just going to say that. that's the difference yet between Sars and Ebola. That's correct.

Henry: Do you think this experience was part of the feeling of invulnerability?

Paul: I think this experience dissipated completely my sense of vulnerability. Absolutely. If that didn't knock me down a few notches and put me on the ground with everything else, I don't know what did. But yeah, that that decimated my sense of being a medical professional who was invulnerable or superior, so to speak, to others in terms of the powers we had being medical providers.

So that was that that that went up in smoke. Now, just everyone else… honestly.

Henry: OK, so it seems like you realized this was going to be bad pretty early on.

Paul: Yeah

Henry: Way earlier than most. but you still had two months before the first wave really hit. So during that time, did you do anything personally to prepare?

Paul: OK, yes. At home, especially when we were hearing a lot about what was happening in Italy, right. And when the the population was being decimated, they would having two patients on a respirator. And we knew a bunch of my colleagues and myself, we knew that was coming here, OK? And I didn't want to really believe it. You know, there was a certain sense of denial but it actually did come.

It's hard to believe, but it but it actually happened. But what I did myself was, the whole thing with the masks, I actually ordered five or 600 masks, you know, surgical masks early on. And they were all made in China. And they all… ironically enough. I began giving out masks to my family members and my friends, and my oldest son, [name], who lives outside of [City], I was sending him boxes of masks and hand sanitizer, which you couldn't get anywhere, and toilet paper which you couldn't get anywhere.

I was sending [my oldest son] masks and hand sanitizer and toilet paper to at least protect himself and urging others to, you know, sort of do the same thing where they masks, use hand sanitizer and but [organization] was was pretty quick to step up and give continuous announcements about what COVID looked like. And how we should approach the patients.

But but for the first three or four weeks, I would say [organization] was still focused on travel to China which now we know is absurd. So someone came in with [organization] protocol in the first couple of weeks was if you see a patient that's sick and they have a fever, the first question you ask, did they have any travel to China?

And if they have no travel to China, well, it's OK. You can just deal with them as a regular patient if they're returning from China, like, give me a break. How many people in the North Bronx are returning from China? And if they weren't returning from China, that you didn't have to be that careful. But that that soon changed.

And, you know, when the at the end of the third of the beginning of the fourth week, that soon changed to travel everywhere but so my nephew tried to keep up with those masking and but they were a little sluggish at that at that, too. So nobody believed that this was going to be as as massive an apocalyptic event as it really turned out to be.

And we are invulnerable medical providers. And I think a lot of a lot of medical providers were stripped of that by covid. Absolutely.

Henry: Just to clarify, when you say three to four weeks after the start when they changed these screening protocols.

Paul: Yeah.

Henry: You’re referring to mid-April, by that point?

Paul: Yeah. That's yeah, that sounds about right. And a little earlier, probably with the with the shutdown was March 30. I don't remember exactly March 13, March 15th whenever the shutdown was, I would still say it was still another two or three weeks before [organization] fully latched on to the isolation and the masks and the hand sanitizer, it was a little and I think it was until the end of April or the beginning of May, that [organization] started handing out N95 masks.

You had to walk up the block to the hospital to [hospital], near [Hesh work location] and they would be handing out masks in the lobby of the hospital every morning. And that was then in March or April, that was probably the beginning of May, they started handing out N95 masks. So there was yeah, around that time.

It was definitely a lag even in the big medical centers, as they had to take care of their own people.

Henry: So as as an organization, what did your organization do to prepare?

Paul: Well, they didn't they didn't prepare. They they handled the they handled the patients that came in crashing off of the ambulances and simultaneously, the patients were admitted by the hundreds, [organization] responded, You know, at the moment. It wasn't it there wasn't a period of time with two months ahead of time, where [organization] said OK, this this pandemic is coming here.

We have to convert the cafeterias into, you know, hospital wards. We had to convert, you know, the pediatrics into medical wards and get rid of all the kids. So I'm that stuff happened as the epidemic was hitting was hitting us. So I would say [organization]’s was more of a a a response to the the the wave that was hitting it at the time, rather than preparation ahead of time.

And part of the reason was, I think, that a. was that none of us knew how devastating this was going to be here. None of us knew that, you know, we were going to have refrigerated trucks in the parking lots, for God's sake. No one could have predicted that that was going to happen and that the wards would be packed full of dying patients on ventilators so fast within days.

It was stunning. It was absolutely stunning how fast this happened and [organization] rather than they just didn't have the time to be proactive because it just hit so fast. So hard. So at the time, the patients were coming in and being being admitted at this, at the same time, the wards are being converted and the cafeterias were being converted.

This was happening as the epidemic was increasing, not months ahead of time, which is sad, which is sad. But in their defense, no one had any idea that it would it would arrive on our shores so quickly and so vastly and be so overwhelming. Who could possibly predict that, you know?

Henry: Well, you saw I mean, you said you saw these news items in January right.

Paul: And we saw what was happening in Italy. Right. So you think that we would have been packed with ventilators and packed, but none of the hospitals in New York really were. It was it was it was a delayed response. It was delayed for months or many weeks. But it was it was certainly certainly wasn't proactive beforehand, because I don't think anybody realized I don't think anybody believe that what we all saw happening in Italy.

I don't think and I don't think anybody really believed that that could possibly happen here, that we would need one ventilator for two patients and bodies would be piled up outside the hospital. I don't think anybody believed that would happen in the United States. So I don't think the response was as proactive as it as it could have been.

I think that delayed the response. And again, the just the feeling we’re United States we're we're wealthy to a certain extent. That makes us invincible. That makes us invulnerable. We're not Italy when that China. Yeah, but unfortunately, it did work against- not being proactive enough. Certainly worked against us. I mean, you don't get a million people dead because you were proactive enough, right?

So that's my take on it.

Henry: Did you did you have any meetings or group discussions, though, about this? Like….

In like from January up until March, private? You're being proactive?

Paul: No. What happened was [Hospital] would… hold on, I'll show you. [papers shuffling]

The way [hospital] handled this epidemic- OK here's September 2021, October 2020 [organization] disseminated its information about COVID, about the global response, about how to care for COVID patients. About how we should be behaving with each other in the clinic in terms of protecting ourselves, identifying patients who need to be hospitalized. The [SP]o2 less than 93 with pulmonary symptoms, you know, criteria for admission treatment protocols, you know dexamethasone in the beginning or remdesivir in the beginning.

So how do we know about all that? We have meetings? no. Did we have Zoom? No. Zoom hadn't even been established. I mean, you know, the epidemic later on established Zoom has a very significant part of our lives right before.

Henry: Skype before, right?

Paul: Right. How did, how did [hospital] communicate to us about what to do with the patient and ourselves and protection? This is how [hospital] did it. with emails see with the covid title on this, is a COVID title and top covid announcement whatever it is, I'll read it to you. COVID19 update. OK? So we would get one or two pages, see?

A two page COVID19 update to two or three times a week and this is how we all found out about what kind of mask we should wear and when we should wear the mask, and who should be admitted, and we should be in our office with that doors closed to take the mask off, and the mask should be a well-fitting N95.

Everything you can imagine about how to protect ourselves and how to deal with patients and who goes to the emergency room? Everything was done not by direct communication, but by these COVID19 updates sent by [hospital] to all of us two or three times a week. Well, I have a whole I have a whole folder. I kept them.

I did. I kept them all.

Henry: What do you remember when they started sending those?

Paul: Yeah, probably in early- in late February or early March.

Henry: OK. So was anyone trying to push for more of a proactive response?

Paul: At [organization] that would be out of my wheelhous. I'm not sure what. On an on the ground where I in which is an outpatient clinic and people walk in from the streets or whatever and we send people to the emergency room as a freestanding outpatient medical clinic we were so overwhelmed with dealing with our daily activities and taking care of our patients and making sure we were safe and we had patients going to isolation rooms and did we have enough gowns?

Did we have enough masks? We were so preoccupied with taking care of ourselves here that there wasn't there wasn't even an initial thought about bringing something up to [organization] that we that we would want, or participating in the [organization] plans. we would just so tied up and caught up in our own business day after day.

Henry: And this would have been- is that- are you talking about after it really started hitting?

Paul: I'm talking about throughout the entire period. It was really never I never had it there was never a time when I said, OK, let me take up the phone. I have an idea that the head of the department should know about.

Henry: What about in like January or February?

Paul: That was in and in February. Late February is when we started seeing problems, I believe.

Henry: OK, so you've covered this a little bit, but what do you wish your hospital system had done differently.

Paul: Well, I wish that they you know, not for myself, but for the patients who were admitted and the patient and all the patients that died… I wish they had had more space. That they had dedicated more space and prepared more space to take care of ICU patients. Much earlier than they did. Whenever that was. Speaker 3 OK.

I mean, I'm not I'm not sure what else they think they could have done other than make room for more, but then make room for more people.

They were involved somewhat in trying out medications. You know, with the steroids and the remdesivir. But a lot of that was coming from from other places. I know the hospitals, they tried stuff and I suppose [organization], could have been more proactive with with trying out different treatments. But, you know, it's hard to say when you're in the middle of something like that, you can't just start throwing different medications at people without some kind of formal, you know, research criteria going on.

So I suppose more research could have been done, more space could have been found to take care of patients. And those are probably and more more supplies. But this is a definite: more protective gear for staff, way earlier. Way earlier. Would have been a big step to help us way earlier. I remember walking in in 95 masks in the Einstein hospital and the weather was beautiful.

The weather was perfectly warm, so it must have been May by the time I could do that. So we weren't getting shipments of boxes of masks and gowns, you know, in February and March that wasn't happening. So protecting its own staff. Outside of the hospital, the the inpatient staff definitely were protected way faster than the outpatient staff, OK and people in the hospital which which is as appropriate, I suppose because that's where the patients were, with the highest viral loads.

The patients who were excreting virus. I mean, look, they were on the wards, right? They were in the ICU so the phlebotomist and the nurses, then the doctors and they all should have on, you know, two N95s or whatever it was. Right. So all of the protective equipment for the first several weeks and month or two of the pandemic were going to the hospitals, not to the outpatient staff. We were told in fact that we had to make an N-95 mask last a week out here a week, which is absurd.

Which is absurd because in the hospital they were changing them every 8 hours. Right. OK, so we got we got like three masks for the month. We had to use the mask all week. So how do you like that? It's hard to believe right now. But then I'm sure you knew that was true. A mask a week. so they could have taken care of the outpatient providers a lot better.

That's what that's what that that's that's what that summarizes. Yeah.

Henry: And is there anything you would have done differently personally as an individual?

Paul: Um, yeah, I would’ve. I will say that that I did not adhere to full PPE the way I should have in the beginning because we had patients coming in sick. And I'd be lying if I said that I gowned up and I put on a N95 and a face mask and goggles and gloves. I'd be lying if I said I did that with every patient that I saw.

OK, I definitely put on a N95 for sure. And my glasses as you can see, and gloves, but it was so many patients to see in the outpatient setting. I will say that I probably did not all the time that I should have had on full PPE I probably did not. And that was just in an effort to get through the patients, to get the patients done.

I will say this though, if a patient was obviously respiratory illness and obviously was coughing, I mean. Yeah, then I would then I would have gowned up on. But for that for for the patient that we follow up, hypertension and diabetes and asthma, you know, I wasn't I wasn't gowning up for every patient for sure. For sure. I was probably only really gowning up with a very sick patients.

And we know that. And everybody was spreading it. So I probably dealt with more more. The patient that I saw who were not sick, they probably were covid infected then in the patients I did see that were sick. So I probably did not protect. I think that goes for all of us in the outpatient setting. We probably did not PPE as good as we should have in the beginning.

Henry: But I did the same. I was dealing with two very, very sick covid patients and I used despite having a box of masks there, I used zero PPE. So OK, so now a few wrap up questions. So again, we've covered this or you've covered this a little bit, but what would you like to tell me about the way you were feeling between-.

Paul: Oh, I was, I I was terrified. Absolutely. I was terrified. And I was really concerned that this might be it, that this might be, you know, the end of the world, that everybody was going to die at the hands of COVID. I was afraid for my family that they were going to get sick and my friends, they were going to get sick.

And many of them did. Many of them did. So I was really afraid that there was a possibility like when we set up the first atom bomb in 1945, that there was a possibility, a small possibility that the entire atmosphere would catch fire and kill us all right? You're aware of that, right? in my mind say that there was a small possibility that this really was it, that this pandemic, it was finally here.

The thing that was going to kill everybody was finally here, it was like the asteroid and the dinosaurs, right? That's the thing that frightened me the most, that this really was the apocalypse. It really was the end and the thing that frightened me second most is just that so many people were getting sick and dying and, and I would like for that not to happen to my family.

And friends, which is probably a little greedy and a little unfair and a lousy thing to say. But I didn't want anybody to get sick. Of course, no one wants anybody to get sick.

So does that it does that answer your question? Yeah.

Henry: Yes. Thank you.

Paul: Sure.

Henry: OK, now are there any questions that you think I should have asked that I didn't yeah.

Paul: You might want to ask about providers- to start with providers- about the emotional challenges we faced in terms of depression, suicidality, anxiety. Yeah. So in other words, the psychiatric issues that providers had had to deal with… I fortunately was was too busy hkhkhkh. I was too busy to even be aware of anxiety and depression. But a lot of people around me had troubles with it.

So that might be something you might want to think about as an emergency.

Henry: You it sounds like these- do you know anyone facing these psych issues before the first wave? so in the January to March period?

Paul: You broke up on the whole last sentence. What was that again.

Henry: You know, of anyone facing these psych issues during the January to March period?

Paul: Oh, yeah, definitely. Sure. I know a number of people who were very depressed so and so anxious that they couldn't leave their house, that kind of thing. They were just walking around terrified that they were going to get sick and die where impeded their daily functions that impeded their ability to go out shopping or go to the gas station.

Or, you know, to be with their family. They stayed isolated and locked up before that.

Henry: This is before the first wave?

Paul: This is during the first wave.

Henry: OK.

Paul: I know… before before the first wave, if anything, there was a heightened level of anxiety. And I don't think anybody believed that there was going to be much of a problem because we were America. Right. And it was really after the first wave. It was really after the first wave hit us that our emotional issues began. So what [organization] did with one of these, you know, they told us probably after the first several weeks that the psychiatric issues were being reported that the psychiatric health of all minor for your employees, including myself, was very important to Manipur and that if any of us felt any depression or anxiety, we should talk to our supervisors immediately.

And that progressed over the next several weeks to [organization] actually sending mental health workers around to to the outpatient units to the inpatient units. They had circulating psychiatric providers, whether they were PAs or a psychiatrist, just sort of asking people, are you OK? Are you OK? They had this roving psychiatric service looking for people that were in trouble? And that was actually pretty admirable.

But that that came along later, too. But, you know, you could whatever good they did, you can always say it was too late. Right? I really don't want to do that. I really don't want to do that. You know, because when the problems arose, [organization] did something. And maybe they didn't do it as fast as I would have liked, but they actually did something and a lot of places made no provisions for the mental health of their staff.

which is pretty horrible, which is pretty horrible. But that could there be another topic that you might want to ask about, which I'm sure you already know.

Henry: The mental health issues surrounding this are very important, And I you know, I am very interested in the psychological aspects of this psychiatric aspect of this for this project specifically. But this project is more focused on.

Paul: Its a different kind of-

Henry: The pre crisis conditions or, you know, like what once people knew about it, but before it hit. So we only have a few minutes left for the Zoom meeting ends automatically. Is there anything else that you would like to tell me?

Paul: And does my intense hatred of Trump count?

Henry: Yeah.

Paul: Honestly, the way the political system let us down and didn't put up the borders and keep the virus from coming here in the first place, that's as as a non-medical issue, as a societal issue, as a moral issue, as an ethical issue. The fact that the borders weren't closed down early enough to stop the devastation is the thing that bothers me the most.

Because we know as an example, in South Korea, I believe when they shut down the borders very tightly very soon, they had a handful of deaths and that was it. Right. OK, so we should have been able to do this. And Taiwan also, I believe. Right. They shut down the borders very tight, very early, and they didn't have the epidemic that we had.

And um, my personal belief is that Trump had everything to do with that.

Henry: That cruise ship that-

Paul: Yeah. In California. Yeah.

Henry: And there was no quarantine protocol for that cruise ship.

Paul: Who knew? Right. Who knew? See, but Trump knew somewhere. He mentioned that somebody mentioned, either Fauci here or somebody that in in November is when the Wuhan people started dropping like flies in November and that we knew about it. The World Health Organization, I mean, maybe you could look into this, that it was known that this was going to be a pandemic in November.

And Trump just kept his mouth shut and said to everybody, as you remember, oh, it's not a problem. There's only one case. We're not going to worry about it. You know, people from China aren't going to come here anymore. When it was in Europe, I mean… I'm sure there were many months wasted where we could have shut, we could have shut the US down, but we didn't.

That's probably the thing that bothers me the most about this.

Henry: OK. Do you remember, you remember during the Ebola crisis, during Ebola that nurse came back the nurse flew back from New Jersey and Chris Christie tried to improvise a quarantine protocol for her and they put her in a tent at the airport. Do you remember that?

Paul: Vaguely, yeah. Yeah. I do. I remember the tent, khkhkh in the parking lot or something. Yeah, I do remember that. Vaguely, yes. What about it?

Henry: You know, just one would think that there would have been a warning sign that we needed more of a quarantine protocol.

Paul: Yeah, right. For other viruses. Sure. Yeah, yeah, yeah. Who knew? Who knew me? You?

Henry: OK, I'm going to stop the recording now.

Paul: Ok.