I’m getting an induction in the hopes of avoiding a Covid-19 health care catastrophe.
Editor’s note, March 18: The author, who submitted this story on Monday, delivered a healthy baby boy in Vienna on Tuesday.
VIENNA — I’m nearly 40 weeks pregnant and being induced tonight, Monday, five days ahead of my due date. It’s not for medical reasons, but because of the Covid-19 pandemic.
Like most women, I hoped to avoid any unnecessary interventions associated with childbirth. Then today, my doctor recommended an induction as soon as possible as the safest course. “Things are changing by the half-hour,” he said.
Normally, my husband and I would want to pause — read the research, weigh the risks and benefits, and maybe get a second opinion before making such a major health choice. But with cases doubling in Austria every two and a half days — one of the fastest rates in the European Union — the probability of an outbreak in our hospital increases, as does the chances that it’ll have to shut down. (Another Vienna maternity ward already has.)
With every passing day, there’s also a greater risk my husband or I get the virus, or someone in my family or network tests positive; with that comes higher odds we’ll have to be quarantined in labor and potentially separated from the baby at birth. And we already know getting full postpartum and pediatric care will be challenging in the months ahead: Some doctors are already opting to meet patients online, and midwives are being told not to enter people’s homes right now.
So we’re betting that delivering sooner is the safest choice — at least the hospital system isn’t yet overwhelmed.
I don’t know if this is the right choice. I am not sure of anything right now. I’ve covered health for more than a decade — long enough to know that viruses have peculiar ways of catching people and societies off guard. This one, however, has been even more of a Rubik’s cube than the others. Despite devoting much of my time in the past few months to talking to scientists, epidemiologists, and front-line health workers, trying to anticipate the curves of this pandemic and uncover patterns, I’ve had little success.
What I do know: Our baby will be part of a group of kids whose first days outside the womb collide with a fast-spreading, deadly scourge — like the kids born during the 1918 Spanish flu pandemic a century ago. We’ll be talking about, and studying, this pandemic and its life-altering effects for decades. I also know my husband and I are privileged to live in a country with universal health care and a functioning health system. While I haven’t fully processed what’s happening — it’s unfolding too fast — this would certainly be more frightening in a place where people have to wonder how they’ll access or pay for their health care in a crisis.
Over the past 72 hours, life in Vienna, where I’ve been living since August, has changed dramatically. People are being asked to stay home for all but essential work and to buy basic necessities, such as food or medicines. We’re only to have contact with others in our household. Police can fine people up to 3,600 euros for violating the new rules.
The government has also mobilized the army to support the police and the health care sector in this period of enforced social distancing.
So there are few people or cars in the streets, and few kids outside (schools and playgrounds are closed). Restaurants, which were already under curfew as of Friday, shut down Tuesday. Pharmacies are asking people to line up outside and use hand sanitizer upon entering. Watching public life grind to a standstill is strange in a moment when I’ve never felt more full of life.
This has meant we don’t know when we’ll see our families again, when they’ll meet our child: We’d be fined for meeting with my father-in-law in Vienna. My parents, who live in Canada, are currently barred from entering the EU due to travel restrictions. Again, all this wasn’t true a week ago.
The support system we’d set up for after the birth has also fallen apart because of the new pandemic rules, which change by the day. Our midwife told us to pack extra clothes: There’s no going in and out of the hospital for now, so once we enter, we can’t leave.
When we first heard about the lockdown on Friday, we dashed out to buy a crib. On Sunday, we ordered the last of the baby’s necessities online, hoping they’ll arrive in time. I also threw in a few stuffed animals; they looked comforting at a time when everything feels very uncertain.
A distant threat closing in
When I first learned about the outbreak, it was New Year’s Day. I was on holiday, reading about a mysterious, viral pneumonia spreading in China. I started to report on Covid-19 shortly after that, and for a while, the outbreak seemed a distant threat — a crisis Asia had to grapple with.
In those early days, the virus that causes Covid-19 didn’t have a name (now, it’s SARS-CoV-2), and it wasn’t yet clear that it could spread person to person. China emphasized that cases had been linked to a food market there, suggesting only those who had contact with infected animals were getting sick. The infectious disease experts I spoke to early on also tried to tamp down worry, saying that the risk of contracting Covid-19 was concentrated in China and travel outside the hot zone was completely acceptable. Perhaps they too couldn’t imagine how disruptive Covid-19 would become.
Within a month of China’s reporting, the outbreak had managed to spread to more than 100 countries and infect at least 174,000 people. For me, a turning point was the cruise ship quarantined off the coast of Japan in February. By the end of a distressing public health experiment, in which Japanese officials forced passengers to stay on board to minimize spread on the mainland, more than 700 people were infected and eight had died. If we didn’t already know it, this showed just how effective the virus was at spreading fast and killing some.
Yet, even then, the threat continued to feel distant, and that’s despite the years of warnings that a respiratory virus might emerge exactly as this one did, and travel around the world, taking life in its path. I also couldn’t imagine Austria going the way of China in its response — shutting down the country with enforced social distancing.
That changed when Italy’s crisis began to unfold. We live 250 miles from the Italian border, where a national coronavirus emergency has been playing out for several weeks. The country was the first Western democracy to see the virus spread on an alarming scale — and the first to impose mass quarantines and travel restrictions. It’s a desperate attempt to slow the movement of a pathogen that had spread for weeks, unbeknownst to health officials, eventually crippling the country’s health system in the north and forcing doctors to ration care.
The more I read about Italy and talked to people there, the more I thought that what’s happened in Italy could happen anywhere. The region at the center of the crisis, Lombardy, is one of the wealthiest in Europe, with a robust public health system and no shortage of doctors. It seems the Italians were simply caught off guard by Covid-19 spread within their borders.
Our complacency likely stemmed from the fact we’d been “lucky” so many times: the viruses that have reached epidemic or pandemic levels and caused pain and suffering en masse in recent years haven’t been as effective as Covid-19 in transmitting worldwide. Their destruction was relatively circumscribed.
Zika, which dispersed wildly through South America and tormented mothers with the birth defects it can cause, required mosquitoes to transmit and eventually fizzled out. Ebola, which killed thousands in West Africa, needs close contact to spread — it doesn’t have the deftness of a respiratory disease like Covid-19, which can move with a mere cough or sneeze. Pretty early on in the swine flu pandemic of 2009, it became clear the virus wasn’t very deadly; it now it circulates in the mix of seasonal flu pathogens.
Covid-19 is something entirely different. We still don’t know exactly how deadly it is, or the range of symptoms it causes, but we know it’s much more severe than seasonal flu (which has a death rate of 0.1 percent), for example.
The case fatality rate for Covid-19 is estimated around 1 percent at the moment, and about 5 to 10 percent of confirmed cases need intensive care to stay alive. Some 80 percent of cases are milder, and scientists are still trying to determine the risk for children and babies. While the worst outcomes seem to disproportionately affect older adults and those with chronic illnesses, there are rare cases of young, otherwise healthy adults dying from the disease. No one fully understands why.
One guess is that death from this coronavirus is often preceded by acute respiratory distress syndrome (ARDS), just like the 1918 flu and SARS. Anything that severely damages the lungs can cause ARDS — from smoke inhalation to a car accident or drowning. When viruses cause it, though, they send the immune system into overdrive — but instead of attacking the foreign invader, the immune system manages a “virtual scorching of lung tissue,” as John M. Barry so vividly writes in his history of Spanish flu, The Great Influenza.
There is also no way to stop this process once it sets in, he continues: “The only care is supportive, keeping the victim alive until he or she can recover.” This is why intensive care units — the ones that are overrun now in Italy — are so important right now. Without them, among the most serious cases in the ICU, “the mortality rate would approach 100 percent,” Barry writes, as oxygen in a patient’s body depletes and the organs begin to fail or breathing becomes too challenging.
A disease’s severity — its death and attack rates — differs wildly by country and place. Averages can hide variation. What happens in one city or country may not happen in another. Ditto for what works to control a virus. It will likely take years to fully understand this disease and many months to develop a drug or vaccine against it. But even with the health uncertainties, Covid-19’s effects on social life and the economy are clear: It’s capable of mass destruction.
Life after Covid-19
As borders close around the world, and more and more countries implement social distancing measures, there has also been unprecedented cooperation in the scientific field. Journals are sharing information via open access; scientific teams that weren’t otherwise affiliated are joining forces to accelerate our understanding of this coronavirus. This is happening at a level we’ve never seen before.
Maybe the Covid-19 pandemic will make this collaboration the new normal. And maybe countries will see you can’t only invest in research and preparedness for pandemics when they’re already happening, then abandon the effort in between. It’s a cycle that in the US long predates President Trump, even if the administration’s reaction has been particularly weak and marred by outright lies.
I’m wondering what kind of world my baby will grow up in: one where pandemics, climate devastation, and financial crises that seemed far-fetched only weeks ago will be the norm, or one where the intelligence and good in society — the spirit of cooperation — will prevail, and we finally start preparing long before a new, deadly pathogen emerges. In the latter version, we get ready and implement evidence-based measures to deal with these broadly predictably risks of globalization before they happen. I’m hoping desperately for that reality.
Maybe it’s already happening. On Friday evening, a neighbor who lives alone called to ask that we don’t forget her in the coming days and to offer help with anything we need for the baby. In the past few days, we’ve never talked more to friends and family. Among all the surprises of the pandemic, this closeness and neighborliness — at a time we’re supposed to be isolated from each other — is the feeling I’ll bring to the maternity ward tonight.
Author: Julia Belluz