From a front-line physician in a major East Coast city:

In medical education, we stress to residents that they should avoid cognitive biases and heuristics that replace measured clinical reasoning. For example, we harp on “anchoring bias:” once a diagnosis gains momentum, it can be easy to “anchor” on it and discard alternatives.

I’ve seen “normalcy bias” mentioned in your posts by other physicians: this consists of the false notion that things will generally remain the way they have, despite evidence to the contrary. That cognitive bias was easier to shed than anticipated. At least since Mid-February, it’s been clear that things will not be normal – in or out of the hospital – for the foreseeable future. At our hospital, I’ve been fortunate to have colleagues who have likewise thought, “it’s coming, it’s coming.”

What’s harder is reconcile is the apparent need to embrace another bias, the “availability bias.” This is also described as the “recent case bias.” This entails considering only diagnoses that appear readily available – whether due to personal experience or disproportionate attention paid by media, medical literature, etc. – to the exclusion of other explanations. For example, in 2014 the overwhelming majority of US patients with a fever did not have Ebola, a readily-available consideration. Physicians who looked for Ebola in every patient would have been chided for their cognitive bias.

As I said, though, it seems like we now have to embrace this bias. For context, I’m screening our admitted patients for COVID this week at our hospital. We’ve admitted more than 50 patients with symptoms of LRTI (lower respiratory tract infection) in less than a week for confirmatory testing, oxygen support, or other reasons. Even when I try being measured with each patient that has a fever or a cough – “What if this was the flu,” “Bacterial infections are still statistically possible,” “This young patient doesn’t fit the illness script” – the evidence is still mounting to suggest a high volume of COVID. More and more have lymphopenia, ground glass opacities, new hypoxia, etc.; they keep testing negative for other infections. The COVID testing is coming back slowly, but the positives are beginning to amass. It was easy to think, “it’s coming, it’s coming:” it’s harder to adjust to, “it’s here, it’s here.”

From Norfolk, Virginia:

Hey Rod, wow has life changed. It feels like we’re in the apocalypse (coronapocalypse? Forgive my sense of humor making up words). But I think, at the very least, this is an opportunity to take up the cross and follow Christ.

I’m 30 and work for a major company and an eastern rite Catholic, although most of my friends are Orthodox (as there isn’t much for young catholic adult groups in town, and culturally and theologically I’m Orthodox in all but name). I’ve been reading your blog for a few years now, and thank you for warning us all about this. I’m well stocked and safe, and was able to pick up some supplies for our parish (which, though closed to public liturgies, will still be streaming private liturgies for people to watch). Here is how my life has changed, my emotional response, and the things I’m doing to live out that mission to pick up our crosses and follow Chrisr.

Work: We’re all working from home, but unfortunately that means the cafeteria staff were laid off. I was one of the first to bring sanitizer to my desk and stop shaking hands. My colleagues thought I was overreacting. I wish I was! We had a scare (false alarm) last thursday, someone thought to have had it (they didn’t). I think that put the fear in them, because the office has been empty since. My last day at the office was Monday. I said good by to our small park that I loved walking in everyday, praying the Jesus prayer on my Chotki. It couldn’t have been a prettier day, it was like the park itself was also saying farewell to me, for awhile. Working from home has been an adjustment. I don’t think we’ll have to layoff fulltime employees or our contractors given our industry, but I’ve been working very hard to not ever be on the chopping block. I am supposed to receive another promotion (2nd in two years), we’ll see if that’s put on hold.

I went to the gym twice this week. Only 10 people are allowed to workout at a time (and this is being strictly enforced). I was worried about our gym closing, it’s a small business and that gym is like a family to me. Members of that gym are much more dedicated to the sport of weightlifting than you’d see at a “normal gym”, and many have stories as to why. Weightlifting and God saved me from a deep depression years ago, and I don’t want to lose either. I wouldn’t be surprised if many at the gym, especially men, had similar stories. We asked the staff to set out a tip jar, both as a thanks for staying open and, perhaps, because we don’t want to lose this second family we all share. It is already a blow to not have my friends there. That gym is like a little family of unusually bug and strong people.

I’m single (so let your lady readers know), but dating has been canceled for me. Perhaps that’s good. Finding a wife has been a big part of my life. Last year I probably went on 20 first dates. This year, I doubt I’ll go on more than the 4 or so I’ve already went on. It’s sad to know I’ll have to wait at least a year before I can even date again. I feel very lonely, being at home for 90% of the day, aside from working out and helping a few people who need supplies. I’d been praying for things to line up for so long, but a few days ago I got a much different feeling. I had a strong sense of mission welling up in me: this is my time to live and serve as a Christian man. And I began asking myself, what all can I do to help people who need it most?

This week I made alot of phone calls, mostly to the widows at our parish. I let them know liturgy had been cancelled, and asked them if they needed someone (me) to pick up groceries, prescriptions, etc, or someone to help them set up liturgy streaming (thank God, many have EWTN), or just someone to talk to. Most have someone helping them, some I can help, ALL greatly appreciated the call: I could tell.

I received my annual bonus last week from work, and I was excited because it was big. I had so many plans: buy a grill, travel to CO for a friend’s graduation from medical school (it’s been canceled), and to help with a down payment for house. Now I’m thinking that bonus isn’t for me. I’m going to help a few people who were laid off make rent, and save the rest to weather the storm.

Divine Liturgy it being streamed, our first digital liturgy (digiturgy?). I am fortunate, as the token young person at my small parish, I’m the one who knows how to make this stuff happen, so I’ll be able to attend and record it. The practical logistics I’m working on. I did a test run with our reader, a man whom has been possibly my greatest mentor and example since I moved Norfolk 3 years ago. He’s older, and healthy, but I’m still concerned.

Anyways, this is overlong, so I’ll wrap it up with this last story. My coptic orthodox friends had their first online young adults meeting. The two Abounas (“Father’s) spoke about the adoration of the cross. Two verses came up, “pick up your cross and follow me” and “I have been crucified with Christ and I no longer live, but Christ lives in me. The life I now live in the body, I live by faith in the Son of God, who loved me and gave himself for me.” They talked about how there are two sides to this: the suffering of carrying one’s cross, but also the joy. I think I’ve started to feel abit of both this week. The suffering of leaving things I wanted (dating, beers with friends, seeing my colleagues) and the joy of doing things I think I’m called to do at this moment (helping the vulnerable, keeping my parish going, talking to folks I hadn’t spoken to in years, comforting the distressed). So, I know there’s alot of fear and sorrow, but there is also much hope and joy we can still find, and ways we can live out our mission.

God bless you and your blog, Rod.

From Tampa, Florida:

I work for a major university. I’ve just concluded my first week of working from home. Fortunately, I can do my job from anywhere I can connect to wifi. A lot of people can’t.

I know that we’re all supposed to socially distance. But I still go out to Walmart every day at around noon, to get whatever I want to eat for dinner. I’m in and out very quickly, and I use the self-checkout. I tell myself that that makes it okay. But many of the shelves are still empty, and I swear I see some of the same people every day, with full shopping carts, as if they’re panic-buying day after day. I don’t know how they afford it. Maybe they can’t. Maybe they’re borrowing against an uncertain future. I suppose people who do that will pay, one way or another. But the sight is shocking to me.

For my own part, I have tried to make a routine. Prepare breakfast in the morning. I never ate breakfast when I was working in the office, but now I have time to make something. I set aside times for making a cup of coffee, going out on my balcony, and taking a brief walk. I’ve always called my mom every day, for ten years now — but I do so with a little extra apprehension these days. Both my parents are “old,” now, in high-risk groups, and West Virginia has the fewest cases in the nation, but I still worry for them. They’re FOX News people, and I wish they were more scared.

I wonder what everything — all of this — will do to people. Especially young people. My generation got hammered by the Great Recession, and we were just now getting established in life. Our younger siblings and cousins, they’re gonna go through the same thing. Maybe worse. Nobody knows.

I know the point of the Pandemic Diary is to document what we’re doing in this unique time. I’m not doing anything profound, honestly. I’m just waiting, like I think most people are just waiting. In America, at least, this feels like the moment between the plane hitting the first tower and the plane hitting the second tower. We know something terrible has happened, but we don’t know if it is “normal bad,” or “life-changing bad.”

We hold our breath, collectively, and wait for the foundation of our world to crumble, or not.

The virus might be deadly. But it’s the waiting that kills our souls.

From South Carolina:

I’m writing mostly because what I’m seeing in my area of the country is so different from what I’m reading in these diaries you’re posting. I am in the upstate of South Carolina. I am a food delivery person for a company that delivers from hundreds of restaurants in this area.

Restaurants are closed to everything but drive thru and pick up. Some restaurants are making people wait outside for their order. Most times, though, we all just open the doors and walk in. Most of the people tend to bunch right by the counter…. few around here seem concerned with any 6 foot rule. I edge away, but as more arrive I start to get too far from the front to be noticed by the server getting my order.
Our popular main street still has a lot of people on it, even with the restaurants and stores mostly closed to them. There is a lot of outdoor seating, and it is all full this Friday evening. People are eating and chatting, laughing. Everyone is talking about the virus. No one seems concerned. Well, they are worried about the restaurants. Lots of large tips are being handed out to help the sufferers. Otherwise, I hear words like, “this is nuts/crazy/stupid.” Everyone is expecting it’s not that big of a deal, just more over-hyped fear from the media and the liberals.

I should mention: the everyone here I am talking about, 90 percent of those waiting in restaurants or hanging around outside, are either Boomers or young…younger than middle-aged almost 40 me. The Boomers think this is all fake. The kids think they are immune.

My husband, despite being neither a Boomer or a Gen Z, tends to agree with them. I’m doing stealth prepping, which is depressing and feels like a terrible half-measure.

My kids don’t notice a huge change. We’re homeschoolers, and neither my husband or I have lost our jobs yet. They miss our regular playdates. My graduating senior is fretting over the loss of her senior trip and concern over her graduation and prom. My oldest child works for UPS, and has no concerns about losing that job.

No one I know is sick, or even impoverished. Yet. I know it’s coming. My husband thinks it will be over by the end of April. I don’t want to terrify my kids. I feel lonely in my fear, and I realize how weak my faith is. Well, I guess this is a great time to work on that.

From Manitoba, Canada:

I feel as though we are still about 500 m away from the cliff but being dragged ever closer to the realities of what community transmission will bring. Our three children have been home for a week of homeschooling. They wake each morning, eat breakfast and then ask to begin. They crave routine. We live in a rather remote area. Our children go sledding in the creek, snowmobiling and snow shoeing. We are thankful for daily tasks such as feeding livestock. But yet, temptation to be lax at this point is never silent, always calling us out and about.

My friend from our main centre has free time as her university has close. She is working with my one gelding as a way to block up her time. And I’m tempted to go, to participate in his training process, read his movements and reactions to a blanket, saddle and first ride. But I cannot go. It opens us up to accusations of not self-isolating as we struggle to underscore its importance to my father-in-law. He’s travelling to cities for unnecessary medical appointments for his not-live-in girlfriend, selling parts for snowmobiles, heading out for coffee. And then comes into our home, invited or not and seats himself. We are torn between respect for an elder, self-protection and a civic duty to stay home and thereby allow a necessary resilience level to remain in our publicly funded health care system.

Gratitude arrived today as the province has declared a statement of emergency despite only 17 total cases, all travel-related. It gives us traction in our resolution to remain at home and to stay away from others.

In the meantime, as we make decisions by the day, by the hour, we are thankful the snow remains, that spring has not yet arrived with its muddy moats and the opportunity to be together.
Stay well. Thank you for the diaries. They are one point of connection, something I’m yearning for even as I go into my province-sanctioned, deep introversion, lol.

From Marina del Rey, California:

I’m writing to you from Marina del Rey, CA (Los Angeles) with a report on the quiet before the storm, as we aren’t yet seeing what is happening in Seattle, New York and other hot spots. But the storm is coming, I have no doubt.

We are in our mid 60s relatively healthy. We have both worked from home for years (I am a freelance software guy and she is an accountant) so that part of our life hasn’t changed much.

We are relying on grocery delivery services but in any case, we won’t starve. We just will get tired of beans and rice, pasta and canned meat. So compared to many we are well off and reasonably well situated. We basically have not gone anywhere for the past three weeks, except walks in the neighborhood.

We live is a townhome community of about 1600 homes that is a fairly close community. What keeps me awake at night is the knowledge that we will most certainly lose some (or a lot) of our neighbors. We have a couple of widows in their 90’s and maybe another half dozen people in their 80s in our complex or 40 odd townhomes alone and many more on the street. I am not worried so much about myself (though I probably should be) but I also have nightmares about my wife getting a bad case needing a ventilator and there are none to be had.

The waiting for the shoe to drop is the really nerve wracking part. We’ve lived with idea of “The Big One” earthquake for our 35 years here, but it doesn’t weigh on you day to day — you do your prep and hope that is enough. I remember reading “On the Beach” by Nevil Shute back in high school during the height of the Cold War and this feels like that. Not that it is the end of the world, but something bad (and invisible) is coming and there is little we can do to stop it and all we can do is wait.

And when this is all over, I still have two bottles of Nursia Extra from last year’s case that I will share with as many neighbors as I can.

From Las Vegas:

Life is normal in Sin City, except that it isn’t. I am an attorney here and Vegas gets hit hard with every downturn.

After 9/11, my wife was one of many laid off (she wasn’t in a casino job, even). The employers just get worried. The Great Recession almost killed Vegas and almost everyone, rich or poor, has a hard luck story about losing everything from that.

Vegas was finally back. Wages were finally climbing and housing was finally back to where it was in 2006.

And it is gone. I will probably have a lot of business and my home I bought not long ago will likely be worth less than half what I paid for it in a few months. But I am one of the lucky ones.

On Friday the 13th, we had our first real run on supplies. Schools hadn’t closed yet. The Courts were still open, but we realized they might be postponed. The casinos were still open and the restaurants.

And now it is all gone. Vegas can’t survive closed.

They closed the schools last Sunday. Nonessential businesses were closed later. Lawyers are a grey area, so we are still partially open.

My boss lost everything in the Great Recession and built back his practice so that we were just about to double the firm in this next year. Now he tells us that he will try his best, but that we all might be laid off soon.

People are still out shopping and going around. Our official number of infected is pretty low, but we can’t get more tests. We probably have thousands infected. My source at a large suburban hospital says they are getting more and more patients. And they don’t have supplies.

I was shocked when they closed the casinos. But the governor kept open the marijuana dispensaries. There is going to be a lot of work with bankruptcies if the country survives.

Vegas has no natural food supply. Everything is imported. Vegas is very vulnerable. For all Vegas is Sin City, it is also a city of many good people. I expect many will flee the city.

I am reminded of a couple of men I met a year ago on a consult. They both had been fighting a wrongful foreclosure since 2008. They were still in their homes, but were all out of options and came to me for one last chance. Both were emotionally broken. I helped them move on and let the fight go.

We are going to get millions more like that across the country and many here. How many will kill themselves or drink or drug themselves to death?

The worst part for me is I have lost most of my hope. I was finally getting ahead. I had a real plan to actually build towards an eventual retirement. I was finally back on track. No more…..

From Amsterdam:

Apart from the fact that this is the greatest crises in modern times, this is also the time when all human idiosyncrasies and qualities are magnified. The people who used to shout ‘it’s just a flu’ and ‘the fake-media are hyping things up’ are the same people who are now demanding a total lock down and accusing the government of murder.

It’s the perfect time to critically review and clean up your friends list on Facebook.

At the same time you see beautiful things happen. In the Netherlands we have a constitutional monarchy. The king is the head of state, but this is mainly ceremonial. He has zero power. But he does have great connecting and comforting power. Especially the elderly in our society take comfort in the words and messages of the Royal family in these dark days. Even hard line republicans recognize this and praise the king, the queen and their daughters.

Our Prime Minister, Mark Rutte, has the highest approval numbers ever. His calm but firm way of leading the country, based mainly on scientific insights, commands respect. In parliament, he is supported by both the right-wing and the left-wing parties, with the exception of the extreme left and the extreme right. But those parties always have the same mantra: We disagree.

For most of us however, yesterday it became clear again how much our government has the best intentions for the country. The Secretary of Health turned out to be totally overworked. He collapsed during a speech in parliament. In the evening he tweeted from his bed that he would be fine again tomorrow. Unfortunately, he overestimated his health. The government elected a new Secretary. That in itself is not special because the country must be governed.

But what was very special, and testified to great insight and leadership, is that the government chose someone from the opposition. A man who had served as Secretary of Health in a previous government. The current government considered it more important to appoint an experienced person who knows the Health Department than to appoint someone from their own party without experience. I can hardly imagine that Trump would appoint someone from the Obama administration. So looking at this from a political perspective it shows that this is already an extraordinary step. But for me it mainly indicates that the government wants to seriously combat this crisis. No matter what it takes. That it is not about egos, but that the national interest is paramount. That offers comfort and hope.

The Dutch are known for being stubborn and blunt. But I think the very way the government is now running the country will make people do what the authorities tell them to do. Not because of the law but through common sense and trust. I also know that when the crisis is over the government will be accused of all kinds of things again, but it is nice to see that cynicism has disappeared for a while.

To give a nice example of how the Dutch treat each other in these days: The Prime Minister said in his weekly press conference: “Please stop hoarding toilet paper. We have enough paper to poop for another 10 years.”

Keep these coming. I’ll post a second round tonight. Send to rod — at — amconmag — dot — com; put “PANDEMIC DIARIES” in the subject line, and don’t forget to say from where you are writing (at least the state or country).

UPDATE: From Lisbon:

American expats, currently living in Lisbon, Portugal. Changes to the city became apparent over the last week and a half. Cafes, restaurants, etc., began to close well before the formal emergency declaration. People have not hoarded much (to my knowledge). I attribute that to greater cultural cohesion here, and the fact that most people have small apartments and storage units. (With a very small freezer, where does one stash 47 pizzas?)

The was a sale on gin at the local store recently. That I must confess we did hoard, knowing cocktail hour will become increasingly crucial in the days ahead.

I find the most significant aspect of the virus is how we weigh risk. We have an elderly couple and their disabled son who live in the apartment above ours. They go (went) to the café around the corner every day, and were regularly out and about on the street socializing with neighbors. The virus has of course curtailed that part of their lives.

We are lucky to have a large outdoor terrace/patio space; the elderly couple do not. We have been socially isolating for a week and have no symptoms; the same is true of the upstairs neighbors. We have invited them to sit on our terrace to at least get some sun, fresh air, and a view beyond their walls. My concern is for them, but Is that the right decision? Even if we are healthy and maintain social distance? Unsure.

We thought of going back to the USA to be nearer family during this crisis. That said, our supplemental traveler’s insurance only covers us for a few weeks, and not for Covid-19! We felt it too risky to return to the States now. Is that the right decision, with elderly parents and in the scheme of things? Unsure.

One can find regular joys, however. Things are beginning to bloom, and the sky is a deeper blue here. A neighbor’s cats regularly hop the wall to visit, when on break from their daily mouse patrol. We certainly have time to focus upon our creative pursuits, bake bread, read, paint, write and cook. We are able to take walks, also – the weather is warm, the few people about maintain more than enough distance.

I leave you with the following: this is a picture of the portal at the Church of Our Lady of Mercy. For people unfamiliar: On the morning of November 1, 1755, a massive earthquake struck the city of Lisbon (currently estimated to have been as high as 9.2 magnitude.) A 20-foot high tsunami later inundated the city and many coastal areas. After, massive fires broke out, as churches had lit their candles for services, and numerous cooking hearths were stoked in preparation for the upcoming feasts. The fires went on for weeks.

At the time of the disaster, Lisbon was one of the wealthiest, cosmopolitan cities in Europe. After 1755, with its capital city completely destroyed and about 30% of its GDP wiped out, Portugal very quickly became a lesser power in world affairs.

When it comes to the American empire, might the virus be our own earthquake? Who can possibly predict? At this point, the only certainty appears to be long term social and economic consequences.

Whatever comes, we must take heart, if not be of good cheer. The Church of Our Lady of Mercy portal survived the quake, the flood, and the fire. We must keep faith that some things will last and endure.