Interviewer(s): Henry
Interviewee(s): Nicholas

Henry: Just to be clear, I will not use your real name. You'll be pseudonymized, and any references to your organization will just be the - it won't be named directly. Is that OK?

Nicholas: That's fine.

Henry: So I think my father told you what this was about. Would you like more of a preamble or should we get into it?

Nicholas: I mean, I just know that it’s about Covid and I guess how we reacted to it.

Henry: Yes. It's about how we reacted and more so why we reacted in the way we did, why it caught us flat footed despite a pretty long waiting period before it actually hit our shores.

So I'm looking so specifically this interview - Oh, there you are.

Nicholas: There we are. Now, of course, I can. I can see you. There we go. It just the picture came up with a little unlock. I could see it finally. OK.

Henry: OK.

Obviously what happened after March has great relevance to to this interview, but this is going to focus on the around the December, January to March period and how we were considering the impending crisis.

Nicholas: All right. Whether I can remember Timeline one was December one was January and may be a problem for me, but. All right. OK, All right.

Henry: So how old are you?

Nicholas: 66.

Henry: And where are you located?

Nicholas: New York. New York. I live in the but I work in the Bronx, New York. OK.

Henry: And what's your position?

Nicholas: Physician assistant.

Henry: In the clinic in an E.R…?

Nicholas: Clinic.

Henry: [clinic]?

Nicholas: That's correct. OK.

Henry: And is that where you were working in January? 2020?

Nicholas: Yes.

Henry: Do you have any other jobs?

Nicholas: None.

Henry: So can you tell me about when you first heard about COVID?

Nicholas: I guess you know that it was taking place in China the virus was in China. It was, I guess, spreading. That was my first information that I can remember.

Henry: Can you tell me about what you thought at first?

Nicholas: You know, I probably thought I was hopeful it would never get here. Or be like some of the other viruses that would be limited and that spread to the United States.

I was I'm sure I was cavalier.

Henry: You weren't the only one.

So do you remember why you thought that.

Nicholas: You know, I think it maybe because some of the other virus like Zika, you know, hadn't really spread to the United States.

And I think, you know, psychologically, I think there's also a component of not of of not really wanting to say something so negative. I mean, it's a combination, you know, to pick out the things and pass histories that didn't affect us. That was somewhat similar for us. You know, a general bias not to want to say something that's negative.

Henry: Have you seen that with other diseases?

Nicholas: I'm sorry?

Henry: Have you seen that with other diseases?

Nicholas: Yeah, I think there's some truth to that. I mean, not all, but I think the ones especially things that are more unknown and that you haven't faced, I think probably, you know, I have a bias to be to be little, you know, not not reactive and not not sensitive to the real risks.

Henry: So is this something you saw before COVID?

Nicholas: Is iy something that I saw… Yeah. I mean, there's probably other other things that like SARS virus, you know, that I just didn't think would get here or wouldn't be serious. I mean, there are other viruses that weren't so, you know, there's some basis in it, but there was no reason to believe some of the other viruses would have spread here either.

Probably We just got lucky.

Henry: And with COVID, did you see this among your colleagues?

Nicholas: Oh, oh, I can't remember, to tell you the truth. You know, what was at what point? You know, people people began to take it more seriously.

You know, in the timeline.

Henry: You know, the timeline can be hazy.

Nicholas: So it's all hazy. I mean, for me, it's completely hazy.

Henry: but people started to take it more seriously?

Nicholas: At some point. Yeah. It was like, though, you know, I took it seriously when everyone took it seriously and then took it very seriously, but probably later than I should have.

Henry: Why later than you should? Why do you say later than you should have?

Nicholas: Because it was serious earlier and there was reasons You know, I mean, looking backwards, it's much easier to see like you should take it seriously at the very beginning, because things panned out.

Henry: Did you have a eureka moment when you realized how bad it would be?

Nicholas: Oh, you know, I guess it's you know, it's hazy. I mean, I know there was at some point I realized, you know, this is going to be a big problem. I had a child like you who is overseas. You know, I decided she had to come home. But that, you know, all that was later. You know, there was stuff that was done to the clinic, you know, a head of the institution, you know, which wasn't prepared to deal with, which we dealt with.

I mean, we were sort of ahead of the institutional changes, but we were so late I can't remember. I can't help you with the timeline. I'm sorry. You know, when it was.

Henry: It’s OK, I don't I don't need so much of a timeline. I'm more interested in the psychological mechanisms.

Nicholas: Yeah. And I can't remember what it was that other than, you know, it was actually spreading, you know, but that that was probably, you know, you know, when people were starting to get sick and starting to die, you know, it was just… I mean, I flew. I remember I think, you know, in January or February, you know, when I probably should know, you know, when people knew already.

I mean, like, the person next to me, you know, was wiping the seat down with alcohol, you know, had a mask on or whatever.

Henry: Where'd you go?

Nicholas: Florida.

Henry: And where was your kid?

Nicholas: England.

Henry: Well, look, I flew in. I flew back here in back of the back to the U.S. in March. And I remember being on line in the airport in in Boston Customs. And, I mean, I had my mask and some people were wearing the the eye coverings from the plane over their nose and mouth.

Nicholas: Yeah.

Henry: And the customs agent wasn't wearing anything.

Nicholas: Yeah. And I'm sure that was probably, you know, it was right before they closed the borders, you know, in England, so I must've been March, you know, when my kid came back.

Henry: What do you think the clinic was ahead of the institution?

Nicholas: I think it was able to to move quicker. I mean, the institution we- like some of the things we did. It's like we got hold of N-95 masks and distributed them. I got hold of some and distributed to the nurses and the medical professionals before the institutions had them or was willing to. in fact, the institutions said the nurses couldn't use them because they were saving them essentially for for the docs, which was ridiculous because they were the ones who were seeing patients you know, they distributed the methadone to the patients, the nurses, not the docs or the VA's.

So and they wouldn't let them wear the N95 masks. And then we put up plexiglass in for the at the Medicaid windows, which we got a hold of it. When they drilled that in, they yelled at us for destroying the, the, you know, the counters or that where they went to get medicated because we drilled into the wood. you know, we put tape down on the ground to keep people six feet apart, you know, colored masking tape, things like that, you know, that the staff did themselves, where the institution hadn't reacted yet.

Henry: Did you do anything personally to react or change your behavior?

Nicholas: Yeah, I started wearing the masks at one point. I also, since I really wasn't aware of how serious things were being and I we weren't 100% sure on transmission, I moved out of the house where I was living, because I didn't want to bring COVID home to my partner or my kid who had come home from England for a couple of weeks.

And then I then I moved back. But for two weeks, I just moved out of the house.

Henry: Because you were afraid of bringing it back from the clinic?

Nicholas: Yeah, because we weren't sure, you know, the mode of transmission, how, you know, how easily you know, I was being exposed at work, how well the masks were going to work.

Henry: So at work, were there any meetings or group discussions.

Nicholas: Oh, I think mostly we you know, we got edicts, I think from the institution on occasion, but basically at the very beginning, um, you know, it was mostly following the CDC.

Henry: Was anyone trying to push for early action? Or raising the alarm early?

Nicholas: you know, I don't think we acted early. You know, we acted quickly quicker than the institution once the guidelines were laid down. Right. So that we could adhere to them but I don't know that we acted much quicker. We you know, the institution had shortage of supplies and was trying to make rules so that people who, who they felt were biggest risk would get the supplies, I think, was their reasoning.

I mean, I don't know this for a fact for not letting you know, the nurses were in N95s and if they brought it themselves. So we district you know, it was the staff distributed it to them. I distributed to them because I had a bunch of them from construction.

Henry: Was there like a memo saying nurses know N95 like someone.

Nicholas: Making so there was a memo on who could wear I mean because the nurses said they that the the head of nursing wouldn't let them wear ‘em after we distributed.

Henry: So what happened? They pulled them off their faces or they told.

Nicholas: Me yeah most of them just regular masks, not N95 they didn't wear gloves.

Henry: Is that something that you think the institution should have done differently?

Nicholas: Yeah. I mean, in retrospect, if someone had access to an N95, you know, to, to make them withhold it, it wasn't the institution that was distributing it.

And to what end? I'm not sure what they were trying to do except, you know, obviously conserve resources, you know, internally. I guess they wanted everybody to be treated the same some way. I mean, I'm not sure what their reasoning is 100%. I mean, I know they had a shortage, so they couldn't give it to all the nurses possibly.

And they felt they were second in line to receive them.

At least at our clinic.

Henry: So anything else like that where you're really unsure of what the logic was?

Nicholas: Well, I think, you know, other that was I think I'm guessing because there was a shortage and that's how they decided, you know, to control at least the men in the institution distributing things. You know, they set a hierarchy and kept at it. Why they they forbid I mean, it could have been just the a decision made by the head of nursing at that particular location and a poor one; I'm not sure, you know, if it was an institutional decision or or a local decision.

Henry: So is there anything that you would have done differently as an individual?

Nicholas: You know, I mean, knowing what I know now or yeah, I guess try to do some of the things that we did earlier, maybe put up a bigger stink regarding people who are who are clearly at risk, probably the highest risk, you know, getting better protection I wouldn't waste little time like cleaning things when I came into the house, when food came into the house or something, you know, but washing it down. you know, I think at some point when you don't really know, you know, you are on the side of caution.

When you realize there's a serious problem. first you have to realize it's a serious problem. And then when you don't have the full information, you know, it probably pays to are on the side of caution.

Henry: Well, yes. But…

Nicholas: You know, the psychological kind of why you know, why you're less risk averse, more risk averse. I you know, what's that about? I guess it's partially your personal history of adverse events, right? It probably plays a huge role.

Henry: Your fear of physical harm is fear.

Nicholas: I mean, like my family, I probably wouldn't walk wash down food that came in the house, but my family members would were, you know, risk averse. So they were washing everything down.

Henry: But I mean, you're in the medical field. You're used to operating under uncertainty, right?

Nicholas: I guess you don't have to be in the medical field to be used to operating under uncertainty. I mean, that's I think that's part of life right? I don't think that's something we're special about. You, do you think medical people are more risk averse or less risk averse?

Henry: Well, from what what my dad has said, probably less, actually. I mean, you've said I mean, you used the word cavalier so did he.

Nicholas: Yeah. Yeah, I think to some extent, maybe. But, you know, I don’t think everybody was. Some of my colleagues… I don't think everyone is as cavalier. I think there's probably a cross section much I don't think as a profession, people are less risk averse because they're in medicine. But you're the one who's interviewing all these people's medicine.

You tell me.

Henry: Well, it seems like some people are risk averse. You know, I feel I think you're right. I think it depends on your personal characteristics.

Nicholas: Right.

Henry: But I mean but you said, though, that, you know, when it's uncertain, you know, you want to err on the side of caution. Right? But also, you know, you also say that psychologically speaking, you don't want to face something so negative.

Nicholas: Yeah, that's true. So, you know, just like many humans, I guess I'm not consistent, you know, what you probably should want to do and what you do are probably always the same thing. But I think that and why you swing on one issue one way and another issue another way, I'm not so sure I know why.

Henry: Well, people are inconsistent, I suppose. Yeah.

Nicholas: Yeah.

I agree. I'm sure I'm inconsistent, too. But at some point, you know, I think obviously when you start to see people get sicker it's more palpable. Right. And you get more cautious. You know, it's hard to be cavalier when facts are thrown in front of you and you experience, your experiences dictate, You know, often I think, you know, your reactions, your personal experience is that the overall statistics disproportionately affect how you react.

Henry: As a society or on a larger level, yeah. I mean, we had plenty of unknowns in plenty of facts in early in 2020 before the wave hit us, with plenty of facts in January and February. And I mean, so what I, what I'm really trying to get at is why didn't we err on the side of caution?

Why were we taken by surprise?

Nicholas: And not wanting to to face negative negative facts, you know, not giving them their full due because of the psychological, psychological tendency, I think not to wanna face negative facts and discounting them more. You know, I don't know when we all did this. I mean, you've interviewed other people's from my institution and they may be better on the timing.

You know, like I know you.

Henry: I mean, I think to be honest, the time the timelines are fairly consistent.

Nicholas: Yeah.

Henry: They see the news out of China. They're a little worried. They put it in the back of their minds. They see the news out of Italy. They freak out.

Nicholas: Right.

Henry: They don't freak out. But they're like, uh oh.

Nicholas: Yeah.

Henry: They then they see the visible disruption coming to New York and then they freak out.

Nicholas: Yeah.

Henry: But none of those points is that does it seem like there's and maybe I'm interviewing the wrong people, but it none of those points does seem like there's any concern. It doesn't translate into planning. It doesn't translate into behavioral change or pushing for organizational action.

Nicholas: Yeah, I think that's true. I mean, I think only when it was thrown in your face, you know, that that we and then I think we leapt into action quickly, you know, when it became apparent. But of course, you know, in some some sense, the the cow had gotten out of the barn before we we reacted. But once we saw the cow out of the barn, we you know, that's when we jumped into action, so to speak.

Yeah. I don't know. And to tell you is really the doc one of the docs in our office, you know, who is the prime mover of a lot of these things, you know, putting up the plexiglass, you know, and all this stuff. I mean, he was the one you know, who sort of took things in under, you know, made the decisions to do things. I mean, that wasn't my decision.

That was his- other than bringing in masks as the only thing to distribute to the nurses because I've seen, you know, I had access to, you know, early. I mean, I really personally did, you know, made no decisions. I mean, I supported, helped did things that other people said we should do, which made a lot of sense.

But I wasn't the the force, you know what I'm saying? To do it and take take control. It was really the doc I worked with.

Henry: How do you make those decisions? How did he make those happen?

Nicholas: Well, I mean, he bought Plexiglas. We screwed it in you know, we all he called this. You have tape. We all had tape. We put tape on the floor and outside front of a clinic where people used to line up to get in, you know, and the masks I had, you know, that I did sort of on my own because I worked at a nonprofit that did construction.

I knew we had the basement. You know, it was a bunch of N-95 masks. So I brought in a couple of boxes, you know, to distribute. That was you know, the only things I did at work, really, and try to keep people, you know, like I would walk into the clinic early before it opened. I'd see people very close to each other.

I’d try to get them to separate, you know, for the first several weeks but that's probably, you know, all I did. I did nothing else.

Henry: Did you get sick?

Nicholas: No, I never got sick.

Henry: So something worked.

Nicholas: Yeah. Yeah. Or mask, did I never? You know, it's funny. There there when it was very early, I was in the laundry room with someone in the building, you know, and this is before people were being careful, those wearing masks. And he was one of the early people. I mean, there was he was written up the times he was on a respirator for 56 days, you know, and survived.

I mean, they were going to pull the plug on him, you know, and I was in the laundry room the day before he went to the hospital or two, you know, so, you know, why things happen. You know, you get lucky, though, in those either so.

Henry: You know, just a few rapid questions because you're getting up there on time.

Nicholas: OK? Do you have a theory in your study?

Henry: I do get this. I guess that after these questions.

Nicholas: Yeah, yeah. Citizen, finish what you have to do first.

Henry: Though, what would you like to tell me about the way you felt? In early 2020?

Nicholas: Well, I like to tell you I mean, I've told you sort of what I mean in retrospect, you know, I guess you know, I would have been more forceful, particularly for the nurses, you know, and should have should have done something about that.

I mean, that probably is the thing I regret the most.

Henry: But emotionally?

Nicholas: Emotionally, I probably should have made my kid come home earlier from England but that's not emotionally. That's just you know.

Henry: It's I mean, like, were you curious? You scared? Were you excited? Oh.

Nicholas: Yeah. I mean, I got scared as time went on. I mean, you know, I, I was living on the east side of the park and my family was living on the west side of the park. And I walk, you know, in front of the field hospital later, you know, when they set it up in Central Park, you know, every day, you know, and I'd see, you know, I'd see the trucks in front of the hospital morgue because they couldn't fit enough people in them, you know, they didn't have room in the morgue, you know, seeing a hospital in the middle of Central Park, which is usually for poor, undeveloped countries that are facing a crisis

you know, it was very sobering you know, it was sort of that was scary to some extent. And that was that was probably the most sobering thing to see some volunteer agency setting up a field hospital in Central Park for me.

Henry: OK, so actually that brings that is something that is very important for my so I'll go into I can do that now if you'd like. Yeah. So I mean, like I said, the timeline was pretty the timeline was pretty consistent, has been pretty consistent for people see this news out of China. And quite frankly, the numbers don't add up you know, there's there's a cold logic to it where the Chinese government would not do this action if it was not necessary.

They did this action too late. It spread outside China and we do not have the governmental capacity to do something equivalent. So that logic existed. Now what prevent people from taking this logic to its conclusion - And I'm not saying I followed this logic; I only followed this logic part way, I did not comprehend the scale of this or the duration,

I thought we'd be done by now, but the use of heuristics. So sociopolitical heuristics. So this is America. This doesn’t happen in America. It's not going to come through American soil. And if it does, we have institutions, we have organizational hierarchies. That are designed to respond appropriately, quickly, accurately, and where's the other thing… The other one is I mean, the other one is sort of normalcy bias is.

Nicholas: I'm sorry.

Henry: Normalcy bias.

Nicholas: Yeah.

Henry: So I mean, it's the idea that things are going to stay relatively the same. And with medical workers, this has been, you know, this is kind of influenced by the experience of SARS and which never really came to America. All right. H1N1, Ebola you know, all H1N1 Ebola and swine flu all caused fear. Well, they never really disrupted, they didn’t have that level of disruption that Covid did.

And then once people see this visible disruption, you know, they see the morgue trucks, they see the tents, they realize that this is real. This is a thing happening in America.

But I still feel like I'm missing something.

Nicholas: Sensitivity when I had a spy phone going off. Go ahead. I I.

Henry: Go, that's my work. That's my theory. It's these you know, they see the they have this informational input coming from overseas and they use- And the power of these heuristics, this distrust in the hierarchy organizations and the global see that those somehow outweigh the, you know, the risk, the desire to do the numbers, the impetus to assess risk rationally working here.

Nicholas: I think that's true. Yeah.

I think, you know, and only when it's thrown in your face, you know, do you really look, you know, even at the end, our own government, if you listen to Trump right? based on this, is all going to be over.

Well.

Henry: That's another thing.

Nicholas: You listen to that. It's just it does go to the same feelings, you know, that the you know, we can take care of our stuff and, you know, we'll take care of it.

You know, we didn't do so well in 1917 or 1914, whatever it was. Uh, yeah, let's look at that. 1918 right I mean obviously you know, we have more armaments than, than they did at that time, but you know, it's sort of playing out, I suspect in some ways the same way as the flu epidemic.

Henry: Well I read this fascinating book called Journal of the Plague Year about the plague in London in 1666. And the parallels are incredible. I mean you have these people saying, oh well it's in, it's over there, but it's not over here. And then you have people saying, oh, when it comes to wonder, they say, Oh, it’s in that neighborhood?

In this neighborhood like that matters. At that point and then, you know, you have people trying to sanitize their house by fumigating it. And then they blow up the house. They put in, they only have coins, so they put the coins in vinegar to sanitize them. So a lot of parallels. So maybe part of this is just human nature.

Nicholas: Excuse me?

Henry: Maybe it's just human nature. You know, maybe it's some kind of hard coded pandemic response.

Nicholas: I think, you know, I don't know. It's not everyone, but I think certainly there's a large group, right? It's like anything. There's probably some bell curve where most people fall in the middle. And that's the common reaction. And then there's outliers on both sides. I mean, right. You still have people who will wear masks, you know, even late into the epidemic.

Henry: OK. So is there any question that you think I should ask that I didn't.

Nicholas: Yeah, I don't you know, if you're trying to I guess you just try to figure out what are thinking, why react, why we reacted the way we did. And when we reacted, I mean, that's the goal, right? I mean, I'm trying to figure out what your goal is. Then I can maybe come up with a question that you left out I'm not.

So I'm still not clear on what what you're what you're trying to find out.

Henry: Well, I'm trying to find out why we were so surprised why we had this information in really in January. The logic existed, and yet we did not act on it until it was in our faces in March.

Nicholas: Yeah. I mean, I think we may have it was before March that we acted. I don't think it was that late because I remember it was pretty damn cold outside when people were lining up, you know, and we were doing stuff. So I think we reacted before March, but it was still late, you know, it feels like even though we reacted, it was late. I don't know if it was quite March, but it was late.

And you spoke to other people, institutions. They may be better on the timeline, but in thinking about it only based on the weather, I think it was earlier than March, but but I could be wrong. It was late in any event.

Henry: Like I was in Bangkok through this whole chunk of time. So I can't speak as to weather.

Nicholas: But I mean, Bangkok, I mean, people in Asia, I mean, they were taking temperatures of people before they walked into, you know, buildings. Right. And they were way ahead of us. I mean, they may not have been right, but they were more cautious than us in a lot of ways.

Henry: I mean, we were all wearing masks on the subway in Bangkok.

Nicholas: Right? Yeah. Well, people in Asia were wearing masks before there was government. I mean, you'd see them at least in New York, right? I mean, it's part of the culture because of the other viruses probably that have gone through there. So they're more sensitive to it.

Henry: I mean, I think that's when it was really thrown in my face, you know, I mean, the fear was palpable.

Nicholas: Yeah.

Henry: All right. So anything else you'd like to tell me?

Nicholas: I think that's it. I got I got no more help for you. I'm sorry. Khkhkh

Henry: No, no. You were really very helpful. And you really like your explicit mentions of the, you know, like people not wanting to face these negative things. That that's very helpful. Yeah. So thank you for that. And also the Central Park Field Hospital, the field. I forgot about that. But.

Nicholas: Yeah, I mean, that to me was probably you know, of all the things, you know, I mean, I that was, that was that was scary.

And that was really just, you know, literally, I had to walk by it every day because my partner and I, we'd meet in the park like an Orthodox couple walk around and hold hands and then separate.

Henry: The old times then, huh?

Nicholas: Yeah.

Henry: OK, so thank you very much for this. Know, this was really very helpful. Seriously.

Nicholas: Well, that's good. And how many people are you interviewing?

Henry: You’re number 11.

Nicholas: How many do you plan to interview?

Henry: I just told my advisor 20.

Nicholas: You're halfway there.

Henry: We’ll see what actually happens.

I have one that I'm really looking forward to on Thursday. And hopefully get her and her husband, because I think they're going to have a pretty different perspective on things.

Nicholas: Well, I mean, if you get an E.R. doc or you know someone, right. You're going to get different perspectives, I'm sure, as well. Yeah.

Henry: Well, I have had an ER doc, and he was very, we had his own perspective. He was a I mean, his own perspective, but also not really, you know, he had the same timeline as everyone. And, you know, he talked about his e.R. Response. He's very proud of his organizational response.

Nicholas: Right. That's, you know, you have the same intonations as your father when you speak.

Henry: I know I also have a really nasty tendency to start sentences four or five times.

Nicholas: That I didn't notice. But it just, you know, the way you're phrasing your intonation, your pace is just it's like listening to your dad.

Henry: Thank you. I guess I'm also trying to make a deliberate effort to get my sentences out on the first try too. I really don't like how I look on the transcripts.

Nicholas: Yeah, well, you know, you sound great. You don't have to worry. Thank you. Thank you. Um.

Henry: OK, on that note, let me stop recording.