Interviewer(s): Henry
Interviewee(s): Cynthia

Henry: And just so you know, your real name will not be used and any references to your organization. They won’t - It won't be named directly.

Cynthia: OK, great.

Henry: OK, so I guess start… How old are you?

Cynthia: [Mid 40s]

Henry: And where are you located?

Cynthia: I'm in [location] outside of New York City. The main practices were located in New York City, though, in Jackson Heights and Corona.

Henry: Is that where you work now?

Cynthia: [PII redacted]

Henry: What's your position.

Cynthia: Nurse practitioner.

Henry: And was that what you were doing in January 2020.

Cynthia: In January of 2020. I was four days a week in [Queens neighborhood].

Henry: as a nurse practitioner?

Cynthia: Yes.

Henry: What kind of facility?

Cynthia: Oh, it's a Medicaid clinic, so it's an article 28 facility. And we thought that they'd probably lean on us. No, not at all.

That was the original intent on paper of those facilities.

Henry: What's Article 28.

Cynthia: Eight? It meant that it's actually regulated by the New York State Health Department, so that we're supposed to be a community outreach.

Oh, yes. So we thought that we would never close during any crisis, which we didn’t. We stayed open, but they didn't really need us for anything. They took over other facilities. They took over surgical facilities to use their space but they did nothing with us.

So, yeah.

Henry: So you’re an LPN-

Cynthia: A nurse practitioner.

Henry: Nurse practitioner at these clinics.

Cynthia: Clinics that. Yes, essentially they end up being like multi-specialty clinics that cater to Medicaid people.

Henry: OK. So how many patients do you have.

Cynthia: Not a lot. Couple of hundred. Yeah. The the clinic predated the change in the neighborhood. So the neighbor has been gentrified. But remember, we still have patients, but they're kind of they're traveling into us now.

The other office, I probably have more now. Yeah.

Henry: I thought you worked at [Assisted Living Facility].

Cynthia: [Assisted Living Facility]. One morning a week.

Henry: So so when did you first hear about COVID?

Cynthia: Probably around the time that they diagnosed the guy in Seattle. So I want to say that was around the end of January 2020.

Henry: Can you tell me some more about that?

Cynthia: It seemed like it was going to be a problem, to be honest. And our some patients were getting nervous and everybody had an upper respiratory infection at that point, which turned out to be nothing. But they were really quite concerned. We ended up we were having a somewhat awkward flu season that year to begin with. In December we ended up with a bunch of hospitalized upper respiratory infections and all of their liver enzymes went out which had seemed abnormal to everybody.

So by the time we heard about COVID, everybody was already curious. I didn't think it was going to be as bad as it was in January.

Henry: But it seemed like it was going to be a problem. You said.

Cynthia: Oh, yeah. There was no way that it's not going to be a problem.

You know, like, you could hope that it was going to be like, SARS or MERS, but things just spread, there’s too much travel now. And once, once we started getting hints that China was building really rapid medical facilities, you knew that there was something there And I was jealous because we would never be able to build a really rapid medical facility.

Henry: OK, thank you. That OK? Yes. That was exactly the logic I had at the time.

Cynthia: So, yeah. Yes.

Henry: So did you discuss this with anyone?

Cynthia: My boss at the time is Dr. [name], who actually ended up dying of COVID, who did not believe in COVID here. He got it in the first wave. The whole time I said it was coming. He really didn't think it was going to be a big deal. It was just amazing. And then he caught it then then he knew.

And then he actually didn't want me leaving the office to go to any of the facilities because he's like, you don't want this. Yeah.

Henry: So what were those conversations like?

Cynthia: Hold on, let me just grab a power cord.

I wanted more masks.

And we were getting worried. [Assisted Living Facility] started preparing for COVID before the health department did And they wanted to lock everybody in their rooms. I'm actually in the health department originally. Wouldn't give them permission to do that. You actually have regulations that everybody had to come down for two meals a day, which makes sense, except if you suddenly don't want anyone interacting. So we were worried about that.

We also stopped going into [Assisted Living Facility] because he was being exposed. We figured at another facility and we didn't want to bring it in, because even before any cases were diagnosed in our circle, we were suspecting. and he had a patient who'd spent like a week in the hospital severely ill, and they didn't end up diagnosing him until right before he died.

But by then, everybody had already spent ten days interacting with the guy Yeah.

Henry: Sorry. Go ahead.

Cynthia: Oh, before it actually hit, though, we had managed to order a decent number of regular masks and gowns from the supplier The.

Henry: Who's the we?

Cynthia: Oh, uh Him and myself.

Henry: OK. So you convinced him.

Cynthia: He was reluctant, but he was probably shy and shut me up. Okay. He had two offices to run, and he didn't want them out of commission. I mean, just from a business point of view, if his office is closed in the middle of something happening, he was going to lose money.

Henry: Was his position that the masks were ineffective? or was that COVID was not a threat.

Cynthia: He believed we were all overreacting.

Henry: Did he say why?

Cynthia: He was getting WhatsApp discussions. Like there were WhatsApp threads where everybody was insisting that they'd spoken to their colleague in China - this was all a physician thing. They spoke to their colleague in China. It's not a big deal. As soon as the weather gets warm, we'll be fine. I mean, it was amazing.

All of the main talking points were on his WhatsApp feed before they really became talking points.

And nobody trusted China. But in a sense, why would somebody lie and say they had something worse? You know?

Henry: Yeah. Yeah. OK. So they said on the WhatsApp threads that there would be that they had colleagues in China who said it wasn't that bad. While China was locking down.

Cynthia: Yes.

Huh.

Henry: It's interesting. I haven't heard that one before.

Cynthia: Oh, yeah.

Henry: But yeah.

Cynthia: And on those same WhatsApp things, when we had to reuse the masks, they were telling us, oh, just put them out in the sun for half an hour. So like that that whole feed was like, OK, well, just stick on your dashboard for half an hour. You'll be good to go.

Henry: The UV, right? Khkhkh. OK, so this is this is all happening in January and February, correct?

Cynthia: Yeah, I'm going to say February by that point. OK.

Henry: So you said it seemed like it was going to be a problem and you've had this weird flu season with the liver enzymes and then… can you describe how you were feeling around this time?

Cynthia: I wasn't that anxious about it. I didn't envision the mass death Like, New York really got hit harder. And I think it was just a series of unfortunate things that all came together at the same time. But I think it was just the volume of the patients. But in leading up to it, I didn't think that many people were going to die.

So I wasn't too concerned. And at that point, I wasn't concerned that I'd be really in any danger. You know.

Henry: Did you have a eureka moment or an oh shit moment when you realized how bad it was going to be.

Cynthia: When they started to lockdown Italy. When they started the lockdown? Well, because suddenly it was another country. I mean, halfway around the world, they were locking down They were- we had much more media coverage from Italy than we did from China. And those providers really looked quite unhappy.

And I want to say, by the time they locked down Italy, they had relaxed a lot of the copyright or whatever it is on medical journals. But you could see everything. Pre-print, by the time Italy was coming around So suddenly you could Google and find out an awful lot about a virus that no one knew anything about. And you still didn't get great information, but you got people's opinions Like, even at that time, Italy was saying that you wanted to treat it more like an altitude sickness.

And that struck me because it seemed like then they were confused how to treat and they knew it was going to be a giant problem.

I think that's when I got nervous OK. Thank you.

Henry: So this is I mean, you've covered this already, but this could you summarize how your position changed on this before the first wave.

Cynthia: Yes. I actually became much more concerned about it. And bothered to stockpile stuff, which I never do Yes.

Henry: So you said you stockpiled the masks and the gowns.

Cynthia: Mask the gowns. And I actually started preparing the house. I mean, I normally run the house like I run out of milk and I have to get the supermarket, paper towels... And I got things more ready in case we were going to be locked down. I didn't think it was going to be a disaster, but I thought we could potentially be locked in our houses for a few weeks.

Henry: So you got your bean stockpile?

Cynthia: Oh, yes. I did pasta, everything. But now, by the time I wanted to stockpile everybody and their mother had already bought out the Clorox wipes. Yes.

Henry: Do you change your behavior at all?

Cynthia: Not of that point, really. I mean, we were still seeing patients. I was wearing. I'm trying to think I think I moved to an N95 before the city got locked down.

Maybe by about a week. I mean, it wasn't super early, but yeah, we'd actually gotten them from a paint store.

Henry: And what did your organization do or your employer do to prepare for this?

Cynthia: He talked to the labs to get all the swabs so that we could get he wanted to swab for PCRs. He was still looking to make money. But yes, he was on top of that. By the time it really hit, we actually had lab contacts and hundreds upon hundreds of PCR swabs. There's a certain irony because the lab that had agreed to do it was not up and running with it by the time it hit.

Which is unfortunate. So then we sent everything to Quest, and at that point they had like an eight day turnaround time There's a lot of preparing for nothing, but there was preparing.

Henry: It was a little ironic too that he would have to wait a long time for the test.

Cynthia: Oh, yeah.

Henry: So aside from the meetings with him that you've mentioned before, with any any other meetings or group discussions about this.

Cynthia: The, uh, I'm trying to remember what her role was… Essentially, we had a consultant that would create policy. She had a more official title than that.

But we did meet with her. And by the time, obviously before the city was locked down, we had a written policy about what we were going to do about COVID. But look, OK, the volume was so severely misjudged. So inside the facility, we actually have one negative pressure room So, yes, in our minds, we were going to be able to run life based on this one negative pressure room.

They'd be triage. They'd go right in there Yeah.

Yeah. We were positive to be very end. But there was there was a rather elaborate policy that looking back on, it made no sense. But yeah.

Henry: Why is it to elaborate? Why didn't it make sense?

Cynthia: Because we couldn't run with one room. Okay. So the original policy is that you have this negative pressure room. You put your patient in there, and then you leave that room vacant for 4 hours for all the air to cycle through. I mean, it's fine. If you were going to get two patients a day. Yeah.

Henry: So why do you think you guys misjudged the volume?

Cynthia: It was unthinkable that this would have happened and for years, everybody's been asking us to prepare for things like Ebola, which never materialized. And you sort of just let your guard down Now.

Henry: So was H1N1 similar?

Cynthia: H1N1 I remember… It wasn't such- the problem. OK, so there's a big psychological difference with the flu. One people are vaccinated, so the mortality is lesser. And two, we have antivirals. So we whenever we think we're having a bad flu season, we can prophylaxis entire facilities with antiviral meds OK, they take them at half the dose until seven days after the last case.

So you really can successfully tamp out an outbreak. And even for people in the community, if somebody comes in and they're vulnerable and they have the flu, their wife is often you're spouse is often treated prophylactically. So you can actually mitigate the risk with something like the flu. So we never had to really panic in the past.

It’d probably be more like working in the days before antibiotics you know, like where something comes in, there's literally nothing you could do for people other than say, all right, drink some fluids. I think hubris. We never imagined that we'd be in a position where we wouldn't be able to control everything.

Henry: Was anyone sounding the alarm?

Cynthia: Yes and no. I mean, we're getting vague alarms like the health department was saying, you know, this is out there. but they weren't sounding an alarm with guidance of how to prepare you know, like in case you turn on a television, this is coming. OK, great.

The person who most sounded the alarm was actually our salesman from the medical supply company. Who warned really early on that the supply chain was going to fail.

Because they'd already - China had already stopped shipping supplies out. And he noticed first I'm going to say that was probably like February because we actually started getting some of our stuff from a dental supply company because we were using McKesson, which is pretty much like the second largest medical supplier. And they were already having supply problems.

Henry: OK. I mean, could you prepare for this type of volume?

Cynthia: No, I don't think we really could’ve.

Henry: I mean, anything that- I’m sorry lemme just go back for a sec - The salesman sounds this alarm, this because he saw the supply chain problems. And then what happens?

Cynthia: That was when we switched to buying our masks from a dental supplier. OK, so we ended up with masks like the just the regular surgical mask from a dental supplier. The eye protection, which was stupid from the get go. But whatever we did it, were like sending goggles from Home Depot. I mean, everything gets so pieced together. Yes.

I mean, in retrospect, we could have kept stuff on hand. I don't know why we would have ever, but I believe going forward, we would. like there's a healthy supply of PPE everywhere I go now, and I don't know how long it's going to be before people are calm enough that we're not keeping that lying around. I don't think we realized that we didn't manufacture anything which is an actual problem. Even when you get to the point of the vaccine rollout, when part of our issue was that there weren't going to be enough glass vials to hold the vaccine.

I mean, that's just absurd. Look at the year. Look at the technology. You could create a vaccine, but now you're beginning impediment to delivery is going to be a glass vial. like all of those things have to be. Yeah.

Henry: Wasn't there some issue with I.V. tubing after Hurricane Maria?

Cynthia: Yes, there's always an issue, but we refuse to learn, which is a problem. And then it actually becomes quite depressing. We could learn from these mistakes, but we don't. So with H1N1, there was a mask company in Texas that manufactured the N95s for Obama. OK, Once H1N1 tamped down, the administration canceled their contracts and almost put the guy out of business.

So when COVID came, he wanted a pre- a pre filled contract. the administration wouldn't go for that. So he ended up not ramping up his production as much as he could have. OK, Because he would have had to take all of his factories out of mothballs. A company in Florida stepped in and started making the masks, OK. But now they were not previously making N95s.

So by the time they got up and running, they sort of missed that whole first wave. OK, By the time they got up and running, nobody wanted their masks because their masks are still running at $3 apiece. And by the time they were up and running, China was back. So then this company was actually stuffed with masks. It became a thing in the Times.

So now they're stuck with masks. I mean, unless we actually do something to protect them on some level so that we have our own supply of things we need. Every time this happens, we're going to hit the same wall. And these things really can be stored for very long. But going into this OK, so as late as February of 2020, I want to say I believed that there was a national stockpile I really did.

Henry: Of N95s?

Cynthia: Of everything! I mean, not enough to cover the entire nation. I mean, the scope of this was just unreal. But I would have thought that they could have gotten like the major cities through a couple of weeks I mean, in the event that there's ever an attack, I don't think there's anything in that stockpile now. but I used to believe that there was a significant amount of stuff in the stockpile.

But no. we could produce stuff if we want it, but we don't want to.

Henry: And it would take a few weeks at minimum.

Cynthia: Or at minimum, we'd have to start now. I mean, if we want to avoid this again, we have to change our behavior now so that we can prepare because this is going to keep happening. There's no way with air travel. First, this is not going away. I mean, it's just not. And if it continues to mutate and becomes less significant, we're OK.

But if it mutates to something more deadly, where are we It's almost like we've learned nothing other than now we have vaccines, but on a behavioral level, I don't think we've changed.

Henry: So, I mean, so looking back, I mean, is there anything you would have done differently as an individual?

Cynthia: I probably would have forced myself into an N95 earlier but ended up being a moot point for me. But that is so OK. So we had two offices at the time that other office all got copied it ended up shut down for easily six weeks. We lost some of our employees quit out of anger at having gotten COVID because they were running around.

That office was still running around in the surgical masks at the time.

Yeah.

Henry: I've heard some places tried to ban their employees wearing N95 masks.

Cynthia: They weren't trying to ban them, but they didn't want to share them. They were really being cheap at that point. And at that point all of our N95s really did come from Sherwin-Williams, and we were getting them at like less than $2 apiece. So, I mean, you really didn't have to be cheap about it, but they had the supply of them, but they didn't want to open the supply at that point.

I think they sort of thought that was going to come with a giant banner announcing its arrival, and it infected the entire office before the city even locked down. You know, And at that point, I was in another office dressed like a Martian. But yeah.

Henry: Do you think that I mean, what do you wish that these offices had done differently?

Cynthia: I wish that other offices have protected themselves, but the doctors were just so stubborn they weren't going to. I mean, so you had two different offices and you had two different offices. Dress differently. One office, all that infected the other office never got infected. Yeah.

Henry: I mean, one. One offices, right? One offices wrong. Right. I mean, even at the time, you can see that. So why do you think the doctors were so stubborn?

Cynthia: It was a combination of things. One, seriously cheap. We're just cheap, cheap people. Two, he really was a Trump supporter had actually flown down to Mar a Lago. While the crisis was brewing. Before the crisis was present in the city.

Yeah, And just very dismissive of the whole thing. And it's going to be fine. China's lying, you know, didn't take it seriously at all.

Didn't take it seriously until he got infected.

And then suddenly. Yeah. But by the time that happened, I mean, it was all over the news that we were running out of hospital beds. They were bringing in the U.S.S Comfort like Yeah.

Henry: Did the Comfort ever really get used?

Cynthia: No.

Henry: I mean, it is it is a sign, you know, it's like it's a sign that things are not exactly going well. So I imagine that people would see that and start taking it a little seriously.

Cynthia: Well, yes. So the Comfort didn't get used. You could almost envision why it didn't get used. They didn’t think they were ever going to be able to clean it.

Henry: That that's.

Cynthia: That was their logic, that they couldn't infect it because they were never going to be able to get a clean. So which is fascinating. But the bigger problem with all those things here was they never use any of the ancillary things they built. They had actually built a spill over at the U.S. Javits Center that was under utilized as well.

They let the 911 system continue to operate under its old rules, which accidentally or deliberately diverted all the patients away from everything that was recently built because these extra facilities were just simply not on the list of places people could bring the patients. So they kept bringing patients to these packed emergency rooms while ancillary facilities sat empty.

Yeah, if you really need the Times archives has all of it, because people eventually people eventually just left these ancillary facilities because medical providers had come to New York and then sat in a parking lot doing nothing during a crisis.

Henry: That makes sense.

OK, so so just a few wrap up questions. Um, so what would you like to tell me about the way you felt in early 2020.

Cynthia: I probably wasn't worried enough but I was, I certainly wasn't having anxiety about it.

I thought it was going to be unpleasant, but I didn't anticipate what it was. Even at the lockdown to flatten the curve, I thought we could flatten the curve. I didn't think it was going to take us two weeks. I thought it would take us more like six, but I truly believed that we could flatten the curve Yeah, I was still optimistic. I really was.

Henry: Me too.

Cynthia: Yeah.

Henry: Okay. Is there any question that you think I should have asked that I didn't.

Cynthia: Know the No. What is your Master’s in again?

Henry: Societal resilience.

Cynthia: Okay.

I mean, OK, we are much more resilient than I thought we were going to be.

Henry: We shrugged off a million deaths.

Cynthia: We really did. Yes. I was very concerned. When we locked down. When we locked down. I really thought New York in particular, was going to have more problems than it did. Well, OK. So the rest of the world, I mean, they lock people in their house and say what you will about domineering governments. They deliver people food. I mean, if if we hadn't given people money, we'd have a problem.

But I mean, you can't just lock people in their houses with no backup plan. So we dump tons of cash on everybody. And then everybody was resilient. But if you looked at the rest of the world, like South America got hit because they couldn't afford to stay home. Yeah.

But we did better than I thought we would do.

Yeah.

But people don't care. That's the problem. Now you have a million deaths, and you'd be amazed how many people like. Well, nobody I know. All right, good for you.

Henry: Well, I mean, my first thought is nobody I know. And then I have to think a little bit, and it's like, oh, yeah. Wait.

Cynthia: Yeah.

Henry: But so it's funny that you bring this up because, you know, like, we have, you know, say we say we're resilient. I mean, we had a summer of riots and not to get too political but we had a summer of riots and a coup attempt. So it’s still better than we expected.

Cynthia: It is still better than we expected.

I mean, I really thought we'd just break into all out violence in New York. I really did.

Henry: I mean, when when were you thinking that?

Cynthia: Oh, no, at that point of initial lockdown.

Henry: OK, so much Yeah.

Cynthia: I was concerned about what people were going to do. I mean, not that I don't trust my fellow New Yorkers. But, you know, we tend to be a bit headed and stubborn and then everybody has to stay home and they closed everything. I didn't think it was actually going to be an economic driver. I thought we would just rebel. but I think a lot of the gun violence is a result of - I don't think society has benefitted from this health disaster.

Like, I think a lot of the gun violence is directly related. I think people are still depressed. I mean, even if you look at [Assisted Living Facility], so [Assisted Living Facility] is up and running now. Okay. And the good old rule that you must leave your room for two meals a day is back in effect. Do you know the people won’t come to the activities?

They really don't. They do not want to. They're very content to sit in their room- like they're going back to their old marketing points, you know, like they go out to restaurants they go on trips to Broadway, yada, yada. Nobody wants to go. There... I mean, some of it's laziness, but I think some of it is a risk calculation.

Like, a lot of these people still feel vulnerable, which is amazing because they can be more vaccinated if they tried. But they're really not pushing the envelope on it.

Yeah, there's a lot of depression that's been untapped. And then in so in the Forest Hills Clinic, OK, there's a decently unvaccinated population in that neighborhood.

They're just never going to change their minds. They're really not. But they came in this past week because they had between Easter and Passover, everybody attempted to get back to normal. And even the vaccinated people managed to test positive after these gatherings. I mean, they're very defeated. They really are. They're coming in and they just tired and broken.

Now we have antivirals, which I'm not going to lie. I'm afraid to give like I do a little mental calculation to see if I think you're more at risk of death from COVID, even though you're vaccinated. If you're unvaccinated, I'll throw an antiviral at you. But yeah.

Henry: That’s interesting.

Cynthia: I never anticipated this large scale resistance to vaccination. Suddenly we became people who don't believe in science. We don't believe in math.

We just don't believe in anything anymore. Like, there's some sort of fundamental loss of trust. And I don't know that we're ever going to get that back.

Henry: You think this happened because of COVID or was this before COVID?

Cynthia: No, I had these feelings before COVID. But I think I think you didn't see it. I don't - because I don't think it was as obvious. Like, I'm not in the middle age crowd. There aren't too many vaccines that I'm trying to give people. I mean, there have always been those people that are not going to take the flu shot. I never really question that.

I mean. All right. But this has become so polarizing and fascinating. I mean, on a worldwide level, the whole world's decided they're really going to make an issue of this. It's just I think it pre-dated COVID. I think there's been a whole alternative set of facts that everybody agreed to. But I think that I was blissfully unaware of this.

Henry: In the scale or - the scale of this problem was also unexpected, right?

Cynthia: Yeah. I think it pushed people into their corners. And I don't know how we're going to get out of their corners.

Henry: That’s why it’s called a crisis.

Cynthia: Yes.

Henry: OK, so yeah, we're getting up there in time. So anything else you'd like to tell me?

Cynthia: No, Good luck with your project.

Henry: Thanks. I know you've been - this has been incredibly helpful the way you like. Describe the logic of like why people perceived the things the way they did was really incredibly useful for me. So thank you very much for that.

Cynthia: Thank you. All right.

Henry: Okay. Let me turn off the recording.