‘Channel anxiety into vigilance’: Tips from a top health official at the center of New York’s coronavirus fight

New York state has more than 37,000 confirmed coronavirus cases, nearly 10 times the number in neighboring New Jersey, the state with the next-highest count. New York City, with the majority of the state’s cases, represents the center within the center.

Daskalakis, who has worked to curb the spread of HIV in New York, spends all day every day focused on coronavirus. “I dream about health care issues now,” he told The Washington Post in an interview this week. “That’s where I am.”

Excerpts of the interview, condensed and edited for clarity:

Q: Vice President Pence has told the country that New Yorkers, if they leave the state, should self-isolate for 14 days. What do you make of that message?

A: We’re telling New Yorkers that they should assume that everyone has been exposed to covid-19.

Our message isn’t very far off from that message. We want everyone in the city to be monitoring our health in a more enhanced a way, to make sure that if we even feel a little punky rather than being tough, we stay home to prevent forward transmission.

Q: Is there any concern that, because New York is so hard hit by this, people who travel elsewhere might be seen as pariahs?

A: We have to just be honest with ourselves and realize that diseases, infections always come with stigma. A lot of New Yorkers aren’t used to that. Right now we have to be hyper-aware that we don’t stigmatize each other

People may look at us and say there’s a lot going on in New York. And the truth is, there is.

Q: As for enhanced monitoring — is that taking stock of your symptoms, taking your temperature?

A: We don’t want people to be obsessed with their temperature. If they have a thermometer, that’s great. If they don’t have a thermometer, if they feel feverish, they just don’t feel well, that’s a good trigger to stay home. Anything that looks like a respiratory illness should be a reason to stay home.

Q: When I read the loss of the sense of smell was a symptom, I went around my apartment sniffing different candles to see if I could still smell. Do you have any advice on managing anxiety?

A: You can channel that anxiety into vigilance, that’s my advice. Everyone I know, including myself, we’re all either anxious or vigilant. [Vigilance, Daskalakis said, includes good hand hygiene and checking for symptoms.]

The truth is, it’s hard to say don’t be anxious. There’s going to be a lot of folks who have symptoms and who are sick and there are going to be some folks who get very sick. We’re going into a little bit of a great unknown. We’ve not had a pandemic like this for a century.

Q: What is New York doing for the mental health burdens of isolation?

A: One of the most important distinctions — and I really like it — is that we start to not think of this as social distancing, but physical distancing. … Six feet is the new mask.

I’ve noticed in New York walking around when I see people that there is this new buffer of space around New Yorkers. That’s a lot different than it was before.

Q: New York Gov. Andrew Cuomo said Wednesday that the peak in cases is anticipated in about three weeks. What will that look like for the city?

A: We are looking at the future, not where this starts to get better, but where it starts to ramp up.

Whether it’s in two, three, four, five, six weeks — there’s a lot of models — we have to be prepared to deal with the fact that this is going to be a challenge to the health care system that it’s never experienced.

It’s a sobering moment in New York City because, A, the city has gone on pause; and, B, this is like sitting here waiting for the hurricane to hit. It’s coming.

Q: There are other international cities in the United States. Why is New York the epicenter? Is this is a factor of testing or concentration or something else?

A: There is a testing phenomenon. [This includes earlier in the pandemic, he said, when people with very mild or asymptomatic cases received tests. Tests in New York hospitals are now generally given only to at-risk patients who have symptoms.] That is at least part of why our numbers are higher. Also the reality is that we do have a high population density.

If there’s to be an effect of all of these amazing physical distancing interventions that have been put into place in New York, you’d expect to see that a couple of weeks after their implementation. The hope is that the work … to encourage social distancing, including like school closures and all of the other pieces, will result in flattening the curve as we approach a peak.

Q: There’s also the suggestion that, where New York is, other communities in the U.S. will go in the coming weeks. How are you sharing what you learn?

A: We’re in very close contact with a lot of other departments of health through multiple channels, through the CDC, through also our big cities coalition where we are talking about our best practices.

One of the benefits of being New York is that everyone watches. And we tend to be very open about sharing. I guess it’s: Watch this space. There’s more to come.

Q: Last week there was a big concern about protective equipment, and now stocks are being refilled. When Cuomo talked about supplies this week, his focus was on, “ventilators, ventilators, ventilators.” What’s the situation there?

A: I don’t want to be falsely optimistic and say that we got it. I don’t think we got it.

What we’re getting is what we need. We just need to keep getting more of it. All of the advocacy about getting more ventilators, all of the advocacy to get more [personal protective equipment], whether new sources or stockpiled, all of that is critical.

Q: Do you still see people who aren’t complying with social distancing?

A: I do. I’ve already lost a friend to this.

Use your phone. Use social media. Use everything that you already know how to use so well. Check on your neighbor — just pop on by, knock on the door, say “Hello,” stand six feet away, make sure they’re okay.

Looking out for each other means doing something that New Yorkers are not used to doing, which is to stay a little bit away and be less social. Let’s get through this. There’s plenty of time for social interaction later.

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