A woman she had befriended at a camp for children with Type I diabetes was dead – along with her baby. Everyone suspected the coronavirus, which can have more adverse symptoms for diabetics. Messages streamed into Sweezy’s phone from people she had met as a camp resident and counselor, some sharing pictures of their friend – including one that included Sweezy, as a dark-haired teenager, grinning.

“It was just Wednesday, she was posting about some drama with Amazon,” said Sweezy, 24, who just moved from New York to Florida last year. She was aghast that someone her age, from the same area of upstate New York, could have been felled by this disease. “There are pictures of us at the summer camp dance. . . . I’m watching someone who’s very much like me – someone in my same situation – die with her baby in her arms. It’s so hard to not panic.”

Soon after sending her condolences to the woman’s family, Sweezy scoured her apartment: washing both sides of her front door and all the metal doorknobs, spraying sanitizer on her debit card, sprinkling peroxide on her toothbrush and dipping her keys in bleach.

She pulled out a calendar and thought about every time she had come into contact with another person, filling in those squares with the word “exposed.”

As millions of Americans distance themselves from one another in an attempt to stop the spread of the coronavirus, the struggle is particularly acute for those whose existing ailments can be fatally exacerbated by the disease – people whose lungs have been compromised by pulmonary disorders, whose immune systems have been suppressed by chemotherapy or whose blood sugar spikes dangerously as their bodies fight even common colds.

They have become the most stringent of the social distancers, filling refrigerators and medicine cabinets and hoping that supplies last until the worst is over.

Wary of hospital waiting rooms filled with coughing people, when they get sick, they are turning to self-diagnosis and, at times, simply guessing.

And they clean. A lot.

Dan Downs had planned to spend this week on a cruise ship threading its way through the Hawaiian islands. Instead, he has been fortifying and disinfecting his shrinking world, hoping to avoid the deadly coronavirus at all costs.

The 71-year-old retired educator has chronic obstructive pulmonary disease, which has left him with 50% of his lung capacity and an increased risk of dying of the coronavirus. He spends most of each day tethered to a breathing tube attached to an oxygen concentrator. The most dire coronavirus warnings, he realizes, are aimed directly at him.

“I’m pretty sure if I get this stuff it’s going to kill me,” he said. “I used to laugh at people who washed their hands after, say, touching a doorknob. Now, it’s like everything is radioactive. . . . I hate thinking about dying, but I know I’m in a high-risk group. Double-high risk. Triple.”

As the coronavirus ravaged Italy and the first cases cropped up in the United States, Downs and his wife approached life with the compulsiveness of germaphobic doomsday preppers. They stocked up on groceries – using a supermarket service that delivered straight to their car, not risking a trip inside. They arranged to have everything else they and their two Australian shepherds need delivered to their porch in Colonial Heights, Virginia.

They washed their produce in the kitchen sink with soap and water, and scrubbed the containers the other groceries arrived in, letting it all air dry on the front porch. They’ve revived the ancient art of canning. Perishables that can’t be crammed into jars are stuffed into the freezer.

Downs has not read a completely dry newspaper in weeks. Every morning, just after unwrapping it with gloved hands, he blasts it with disinfectant spray.

Even with the extreme antimicrobial measures, he worries about things beyond his control. His home is stocked with medicine and machines to help him breathe. But soon, he believes, a lot more people will need that medicine and those machines. If his oxygen concentrators break or his breathing tubes wear out, will he be able to get replacements? What if the factories that make his medications close because too many people are sick?

“The things that worry me the worst, mostly, is probably catching it,” he said. “But after that, supply chain disruptions. I can see, in the foreseeable future, problems up and down the supply chain. Not just my strawberries and my ice cream. Who’s going to drive the trucks that deliver the medicine?”

He estimates he has bought his family 90 days in isolation, but has no idea whether that will be enough.

“I think in three months, things are going to be a lot worse,” he said. “That’s when there are going to be problems. And that’s when I’m going to have to venture out of my house.”

Last week, Lidia Vitale, of Flemington, New Jersey, was certain the pain and swelling in her leg was caused by a blood clot. She’d had them before, and she had been a doctor for decades, before her career was sidelined by two bouts of lung cancer.

The last time she felt the leg pain, in November, she limped to the hospital and got an ultrasound for confirmation. But last week, she weighed a nearly impossible choice: complications from a blood clot or a hospital waiting room that suddenly has been rendered hostile.

“I don’t want to be at the hospital,” she said. “I can’t be anywhere near it.”

She texted her doctor for advice, and he agreed with her worries.

So she went to her medicine cabinet and grabbed some leftover anti-clotting medication, then swallowed a few pills.

Ill strangers at the hospital aren’t the only people she has been trying to avoid. Nearly a month ago, her two children went on spring break with her estranged husband. When they came back, both teens had sniffles and her ex had a hacking cough.

“On the one hand, I want to see my kids. I want to be with them,” she said. “But am I putting myself more at risk just being near them?”

Instead, she sits in her house alone, trying to stick to a schedule. Her ability to exert herself is already hampered by her compromised lung capacity, but she knows she needs to move to avoid blood clots.

After the doctor sent a new prescription for blood clot medication to her pharmacy, she drove to the pickup window to get the medication.

On the way back, she decided to take one of the biggest risks in several isolated weeks: She went to see her mother.

“I called her and I said, ‘Mom, it’s so beautiful out. I can’t come inside, but we can sit outside.’ ” she said. “We sat on the porch, six feet away, and had a conversation.”

Some states are keeping negative tests secret while others are not. Some track state lab results, while ignoring test results from private companies. Some restrict the availability of tests, while others test widely.

New York has detected 780 positive tests per million people, at a rate of 1 in 4 tests administered. Ohio has 30 positive results per million people, at a rate of 3 in 4 testing positive, according to analysis of data from the Covid Tracking Project, a group that tracks testing numbers released by each state’s health department. The data runs through Sunday.

Ohio’s ratio seems high because its website stopped reporting negative tests after March 15. So doctors cannot tell whether New York is the epicenter of the disease or whether places such as Ohio are harboring similar numbers of carriers of the virus and have not done enough testing or have not disclosed enough to uncover potential cases. No state has reported fewer positive test results per million residents than Ohio.

“We have no systematic strategy to do the kind of surveillance necessary to understand the chain of transmission,” said Harlan Krumholz, a cardiologist at Yale University’s school of medicine and an expert on analyzing the outcomes of a broad range of medical treatments. “We’re basically flying blind because we have so little idea about its penetration into our society and the number of people affected.”

About eight states are reporting positive results only, including Ohio and Maryland, which switched from reporting the figures. Texas and Pennsylvania are among states that started out reporting positives only but switched to more robust figures and now include negative results as well.

“I think a lot of time people don’t realize the importance of negative results,” said Justin Lessler, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health and lead writer on a study estimating the incubation period of the coronavirus.

By including statistics on negative test results, researchers and health officials can tell whether the increasing numbers are a result of an epidemic or indicative of testing expansion.

Melanie Amato, press secretary for the Ohio Department of Health, said last week that the department received four test kits from the Centers for Disease Control and Prevention, each of which can test 300 to 400 people. So far, she said, Ohio has been able to test everyone who meets state guidelines: people who are hospitalized, first responders, health care workers, and those who have been in contact with a confirmed case of the virus.

But those categories do not include everyone who might be infected – and contagious.

Alabama has not reported any deaths and has one of the lowest rates of positive test results per capita, but as a result of shortages, it also has one of the lowest rates of administering the tests. It has tested at a rate less than a tenth that of Washington state, where the virus first appeared in the United States.

Don Williamson, the president of the Alabama Hospital Association and previously the state’s health commissioner for more than two decades, said regions where limited testing has happened so far are exactly where capacity should be ramped up, perhaps even more than in places where the outbreak already is widespread.

“If you want to get ahead of the disease, you have to know where the disease is going,” Williamson said.

He noted that of Alabama’s official count of 81 covid-19 cases, many were not linked to travel, signaling that the disease already is spreading within local communities. Despite that, large swaths of the state have no reported cases. Covid-19 is the disease caused by the novel coronavirus.

“I don’t for a minute believe there is no disease in those parts of the state,” Williamson said. “We just simply don’t have a good handle on how much of the disease is actually out there. . . . It’s hard for people to understand why social distancing is so important if there are no cases in your community, if you have no visible evidence there is disease.”

Williamson said the state’s lab in Montgomery has the ability to process tests from other parts of Alabama, but the challenge has been the same as in so many other corners of the country: a shortage of supplies.

In Alabama’s case, he said, that has meant a “consistent and perpetual” shortage of swabs and the materials needed to transport viral specimens safely.

Williamson relayed how state officials in recent days placed an order through commercial suppliers for supplies they desperately needed, only to find the order had been canceled so the products could be diverted to the Strategic National Stockpile.

He said state officials delivered the right messages on social distancing, and Alabama still has an opportunity to bend the curve of infections in the right direction.

“But it would be very helpful to be able to show that progress,” he said. “Right now, the longer we go without testing large numbers of people, the less data we have to guide that social distancing. . . . You need to know your starting point.”

Texas is another example of statistical uncertainty. The state has over 9 million more residents than New York. But New York has processed seven times as many tests as Texas.

“I think that in Texas it’s mostly the availability of tests,” said John Henderson, president and chief executive of the Texas Organization of Rural and Community Hospitals. But as commercial enterprises enter the supply chain for tests, that is expected to change soon. New York is a hot spot, he said. Texas is not.

In a group-text conversation Monday, Henderson questioned the need for tests, given how much time has gone by. But rural hospital directors taking part told him their staffs wouldn’t be safe without tests.

“They have to know who’s positive so they can do a quarantine,” Henderson said. “It’s less about knowing whether your community has it and more about protecting the front-line staff.”

That’s especially true of the deadly new coronavirus that has brought global society to a screeching halt. It’s little more than a packet of genetic material surrounded by a spiky protein shell one-thousandth the width of an eyelash, and leads such a zombie-like existence, it’s barely considered a living organism.

But as soon as it gets into a human airway, the virus hijacks our cells to create millions more versions of itself.

There is a certain evil genius to how this coronavirus pathogen works: It finds easy purchase in humans without them knowing. Before its first host even develops symptoms, it is already spreading its replicas everywhere, moving onto its next victim. It is powerfully deadly in some, but mild enough in others to escape containment. And, for now, we have no way of stopping it.

As researchers race to develop drugs and vaccines for the disease that has already sickened 200,000 and killed more than 8,700 people, and counting, this is a scientific portrait of what they are up against.

– – –

Respiratory viruses tend to infect and replicate in two places: In the nose and throat, where they are highly contagious, or lower in the lungs, where they spread less easily but are much more deadly.

This new coronavirus, SARS-CoV-2, adeptly cuts the difference. It dwells in the upper respiratory tract, where it is easily sneezed or coughed onto its next victim. But in some patients, it can lodge itself deep within the lungs, where the disease can kill. That combination gives it the contagiousness of some colds along some of the lethality of its close molecular cousin SARS, which caused a 2002-2003 outbreak in Asia.

Another insidious characteristic of this virus: By giving up that bit of lethality, its symptoms emerge less readily than SARS, which means people often pass it to others before they even know they have it.

It is, in other words, just sneaky enough to wreak worldwide havoc.

Viruses much like this one have been responsible for many of the most destructive outbreaks of the past 100 years: the flus of 1918, 1957 and 1968; and SARS, MERS and Ebola. Like the coronavirus, all these diseases are zoonotic – they jumped from an animal population into humans. And all are caused by viruses that encode their genetic material in RNA.

That’s no coincidence, scientists say. The zombie-like existence of RNA viruses makes them easy to catch and hard to kill.

Outside a host, viruses are dormant. They have none of the traditional trappings of life: metabolism, motion, the ability to reproduce.

And they can last this way for quite a long time. Recent laboratory research showed that, although SARS-CoV-2 typically degrades in minutes or a few hours outside a host, some particles can remain viable – potentially infectious – on cardboard for up to 24 hours and on plastic and stainless steel for up to three days. In 2014, a virus frozen in permafrost for 30,000 years that scientists retrieved was able to infect an amoeba after being revived in the lab.

When viruses encounter a host, they use proteins on their surfaces to unlock and invade its unsuspecting cells. Then they take control of those cells’ own molecular machinery to produce and assemble the materials needed for more viruses.

“It’s switching between alive and not alive,” said Gary Whittaker, a Cornell University professor of virology. He described a virus as being somewhere “between chemistry and biology.”

Among RNA viruses, coronaviruses – named for the proteins spikes that adorn them like points of a crown – are unique for their size and relative sophistication. They are three times bigger than the pathogens that cause dengue, West Nile and Zika, and capable of producing extra proteins that bolster their success.

“Let’s say dengue has a tool belt with only one hammer,” said Vineet Menachery, a virologist at the University of Texas Medical Branch. This coronavirus has three different hammers, each for a different situation.

Among those tools is a proofreading protein, which allows coronaviruses to fix some errors that happen during the replication process. They can still mutate faster than bacteria, but are less likely to produce offspring so riddled with detrimental mutations that they can’t survive.

Meanwhile, the ability to change helps the germ adapt to new environments, whether it’s a camel’s gut or the airway of a human unknowingly granting it entry with an inadvertent scratch of her nose.

Scientists believe the SARS virus originated as a bat virus that reached humans via civet cats sold in animal markets. This current new virus, which can also be traced back to bats, is thought to have had an intermediate host, possibly an endangered scaly anteater called a pangolin.

“I think nature has been telling us over the course of 20 years that, ‘Hey, coronaviruses that start out in bats can cause pandemics in humans, and we have to think of them as being like influenza, as long term threats,'” said Jeffery Taubenberger, virologist with the National Institute of Allergy and Infectious Diseases.

Funding for research on coronaviruses increased after the SARS outbreak, but in recent years that funding has dried up, Taubenberger said. Such viruses usually simply cause colds and were not considered as important as other viral pathogens, he said.

– – –

Once inside a cell, a virus can make 10,000 copies of itself in a matter of hours. Within a few days, the infected person will carry hundreds of millions of viral particles in every teaspoon of their blood.

The onslaught triggers an intense response from the host’s immune system: Defensive chemicals are released. The body’s temperature rises, causing fever. Armies of germ-eating white blood cells swarm the infected region. Often, this response is what makes a person feel sick.

Andrew Pekosz, a virologist at Johns Hopkins University, compared viruses to particularly destructive burglars: They break into your home, eat your food and use your furniture, and have 10,000 babies. “And then they leave the place trashed,” he said.

Unfortunately, humans have few defenses against these burglars.

Most antimicrobials work by interfering with the functions of the germs they target. For example, penicillin blocks a molecule used by bacteria to build their cell walls. The drug works against thousands of kinds of bacteria, but because human cells don’t use that protein, we can ingest it without being harmed.

But viruses function through us. With no cellular machinery of their own, they become intertwined with ours. Their proteins are our proteins. Their weaknesses are our weaknesses. Most drugs that might hurt them would hurt us too.

For this reason, antiviral drugs must be extremely targeted and specific, said Stanford virologist Karla Kirkegaard. They tend to target proteins produced by the virus (using our cellular machinery) as part of its replication process. These proteins are unique to their viruses. This means the drugs that fight one disease generally don’t work across multiple ones.

And because viruses evolve so quickly, the few treatments scientists do manage to develop don’t always work for long. This is why scientists must constantly develop new drugs to treat HIV, and why patients take a “cocktail” of antivirals that viruses must mutate multiple times to resist.

“Modern medicine is constantly needing to catch up to new emerging viruses,” Kirkegaard said.

SARS-CoV-2 is particularly enigmatic. Though its behavior is different from its cousin SARS, there are no obvious differences in the viruses’ spiky protein “keys” that allow them to invade host cells.

Understanding these proteins could be the key to developing a vaccine, said Alessandro Sette, head of the Center for Infectious Disease at the La Jolla Institute for Immunology. Previous research has shown that the spike proteins on SARS are what trigger the immune system’s protective response. In a paper published this week, Sette found the same is true of SARS-COV2.

This gives scientists reason for optimism, according to Sette. It affirms researchers’ hunch that the spike protein is a good target for vaccines. If people are inoculated with a version of the spike protein, it could teach their immune system to recognize the virus and allow them to respond to the invader more quickly.

“It also says the novel coronavirus is not that novel,” Sette said.

And if SARS-CoV-2 is not so different from its older cousin SARS, then the virus is likely not evolving very fast, giving scientists developing vaccines time to catch up.

In the meantime, Kirkegaard said, the best weapons we have against the coronavirus are public health measures like testing and social distancing and our own immune systems.

Some virologists believe we have one other thing working in our favor: the virus itself.

For all its evil genius and efficient, lethal design, Kirkegaard said, “The virus doesn’t really want to kill us. It’s good for them, good for their population, if you’re walking around being perfectly healthy.”

Evolutionary speaking, experts believe, the ultimate goal of viruses is to be contagious while also gentle on its host – less destructive burglar and more of a considerate house guest.

That’s because highly lethal viruses like SARS and Ebola tend to burn themselves out, leaving no one alive to spread them.

But a germ that’s merely annoying can perpetuate itself indefinitely. One 2014 study found that the virus causing oral herpes has been with the human lineage for 6 million years. “That’s a very successful virus,” Kirkegaard said.

Seen through this lens, the novel coronavirus now killing thousands across the world is still early in its life. It replicates destructively, unaware that there’s a better way to survive.

But bit by bit, over time, its RNA will change. Until one day, not so far in the future, it will be just another one of the handful of common cold coronaviruses that circulate every year, giving us a cough or sniffle, and nothing more.

The Rev. Jadon Hartsuff, 42, an Episcopal priest in Washington, D.C., felt drained after a Sunday service on Feb. 23. He took a nap. No big deal – the service can be tiring. The next day at the gym, his muscles ached. He became fatigued, feverish, slightly dizzy. “I kept telling people I felt spongy,” he recalls. “Like a kitchen sponge.”

Mike Saag, 64, an infectious disease doctor in Alabama, developed a cough, like a smoker’s hack. He was bone-tired, his mind foggy. About five days in, the misery intensified. “This is not something anybody wants to go through,” he said Saturday. “I implore everyone to stay at home!”

These stories were offered in recent days by people in the U.S. who now know the new coronavirus and the disease it causes intimately. In sharing their experiences, they are helping to demystify this alarming contagion.

Covid-19 can be a severe illness, even deadly. But it varies from person to person, and most people with a confirmed infection do not require hospitalization.

It can induce intense fatigue and trigger a recurring cough and intermittent fever. This is a slow-developing illness, and it lingers, the whole process typically playing out in weeks rather than days.

Patients with covid-19 report a psychological toll. This disease is unfamiliar. It’s a pandemic virus that has alarmed the entire planet. A natural reaction is anxiety.

Jim, a 34-year-old from Long Island who asked that his full name be withheld, had mild symptoms for several days and then abruptly developed shortness of breath, fever and chest pains.

“The fear is real,” he said. “It’s impossible not to be scared at times that it’s just going to take this insane turn into uncontrollably bad.”

Saag, the doctor, teaches at the University of Alabama at Birmingham and fully understands the biological processes that take place when a virus invades the body. He knows, for example, that his immune system generates the symptoms – things like fever. He became sick after a long drive from the Northeast back to Alabama, and on Monday night, he experienced rigors – his body shaking uncontrollably.

“It was my immune system saying, ‘Hey, let’s fight this sucker off.’ ”

Still, even with his medical background, he had to suppress the natural fear any person would feel. His advice to other covid-19 victims: “Stay calm. Monitor yourself. The No. 1 thing to keep an eye on is breathing. If it becomes difficult to breathe, you should really get to a facility.”

As for fear and anxiety, “We got a disease that’s kind of scary, and anxiety is part of the equation. That’s why I started with ‘stay calm.’ ”

Torres, the youngest member of the New York City Council, tested positive for the coronavirus Monday after his chief of staff tested positive the previous weekend. Torres is under quarantine at his Bronx apartment. Busy with his job on the council and his campaign for the 15th congressional district’s open seat, he was unable to stockpile supplies as the contagion hit the city. He has been asking deliverers to drop off his meals at a safe distance.

“To feel so helplessly dependent is a painful adjustment for me,” he said. “The virus preys upon our need to be human, our need for social and physical affection. I struggle with depression, and the virus has left me struggling even more so.”

He added, “If you are young and a millennial and healthy, it is tempting to feel a false sense of security. That delusion could not be farther from the truth.”

Mark and Jerri Jorgensen and their friend Carl Goldman were among the passengers on the ill-fated voyage of the Diamond Princess. Jerri, 65, a former high school volleyball and track coach from St. George, Utah, tested positive after the ship docked in Yokohama, Japan, and was placed in quarantine. Authorities took her off the ship and placed her in isolation, but she never felt any symptoms.

“I never had a sore throat or headache or anything,” she said. She stayed in a hospital for 14 days until she tested negative twice. She spent her days doing Pilates via FaceTime with friends back home at 1 a.m. in the morning Japan time.

“I would do planks, push-ups and put my headphones on, and I’d have really good ’80s rock ‘n’ roll and just dance in the room,” she recalled.

Goldman, 67, who owns a radio station in Santa Clarita, California, tested negative while on the ship, but on the State Department-sponsored evacuation flight home, he fell asleep and woke up with a 103-degree fever. He was quickly quarantined in the back of the plane with plastic sheeting between him and the other passengers. By the time they landed in the States about eight hours later, his fever was gone.

“I had no headache, no sore throat, no sneezing, no dripping of the nose, no body aches. Just a dry cough,” he said. He had some shortness of breath for three or four days while walking around or talking, but nothing that required treatment. The cough persisted for two weeks.

He was taken to the University of Nebraska for treatment. He and 12 other covid-19 patients were isolated from one another, but they had a group “town hall” conference call each day with the doctors.

Goldman, who left on Monday, was one of the last to be discharged.

“We would cheer when they finally tested someone negative,” he said.

He was treated with a bit of ibuprofen at the beginning and told to drink a lot of Gatorade. (“The white blue is the bomb, and stay away from grape – it’s nasty.”)

Mark Jorgensen, 55, tested positive while in quarantine on Feb. 22.

“When they told me, I felt like, ‘Are you kidding me?’ I felt fine,” he recalled. They flew him to a hospital in Salt Lake City, where he continued to feel fine the whole time.

“It was kind of bizarre. I was perfectly healthy, but I was taking up this biocontainment unit, and they were all coming in hazmat suits and this whole bit,” he said.

Jorgensen is a two-time kidney transplant recipient taking immunosuppressants. As of this week, he said, he was still testing positive for the coronavirus, but the hospital released him to home quarantine.

A Syracuse, New York, woman in her 20s, who spoke to The Washington Post on the condition of anonymity, said her first symptom was shortness of breath. She went shopping with her mother in New York City on Saturday and began to cough and feel tired, as though she’d just finished a sprint.

“I feel like, because I’m so young my symptoms weren’t that big – but it definitely caught me off guard,” she said. “I haven’t felt anything like it. I’ve never had the flu before.”

On Sunday, in New York City, an urgent care facility declined to give her a test. “I got tremendously worse,” she said. Her temperature rose to 101, along with a headache that she described as “the worst part of my entire experience.”

Her mother drove her to Syracuse, in upstate New York, where Monday morning a physician’s office agreed to give her a test. The clinicians directed her through the back of the building, gave her a mask and had her wait in a disused room.

When a doctor in protective gear entered, the other clinicians stood outside the door. “They were kind of freaking out because they’re like, oh my God, it’s in Syracuse!” the woman said.

When the test results came back positive, the young woman became the third confirmed coronavirus case in New York’s Onondaga County. The health commissioner there ordered the family to quarantine at home.

Hartsuff, the priest, did not realize he had covid-19 until news broke on March 8 that a fellow priest in Washington, the Rev. Timothy Cole, had tested positive. They’d seen each other at a conference more than two weeks earlier. Hartsuff quickly informed his church that he’d been sick and was getting a test. The positive result came back three days later.

He doesn’t know whether he transmitted the infection to anyone at his church, but he’s feeling guilty that he didn’t self-quarantine earlier.

“I wasn’t staying home, I wasn’t staying away from church, and I have a lot of guilt around that,” he said by phone from his apartment, where he is feeling much better, symptom-free, but remains in self-quarantine.

“I’m trying to encourage people, and encourage myself, to differentiate between this whole thing being something that is very serious and something that is very scary. There is a very fine line between the two,” he said.

Now more than two weeks after his symptoms began, Jim from Long Island is still having difficulty breathing. He’s gone to urgent care twice and has been in communication with the health department but has been told he should just treat himself at home. He’s been living in the guest room downstairs while his wife and two children live upstairs. They leave him food at the door.

“I felt like I was raising the alarm everywhere I went, saying, ‘I think I have this!’ and being largely ignored,” he said.

Alison McGrath Howard, a Washington clinical psychologist with covid-19, said of her illness, “I’ve never had anything like this. The symptoms feel unfamiliar to me, and therefore I don’t know how to mentally make sense of them.”

The symptoms come and go. She feels better – for a while.

“And then I take my dog outside and feel like I’m going to fall down,” she said. “And my fever is gone, and then it comes back. And while I have been sicker with other things like bronchitis or stomach viruses or really bad colds, this feels like a constant fatigue. It’s the weirdest thing.”

Anne Kornblut, 47, a Facebook executive and former reporter and editor for The Post, suddenly developed a headache March 11, not long after she returned to her home in California after a trip to New York City.

“I had to get in bed and go to sleep. It hit me like a truck,” she said.

Her symptoms came and went. At times, she felt just “under the weather.” Although she didn’t think she had covid-19, she managed to get a test and was on the treadmill Sunday, feeling better, when her doctor called and said she was positive.

She posted her story on Facebook, and described the uncertainty that everyone is facing, including health officials: “The health department called to inform me to stay away from everyone, including my children. So who should take care of them if my husband tests positive, too? ‘We haven’t had that scenario yet,’ the public health nurse said, offering to call me back.”

By late Friday, her fever had spiked again, and she had another terrible headache. And her husband had tested positive.

Still, even that hasn’t been enough.

A month after first cases exploded into view in northern Italy, the coronavirus has killed more than 4,000 Italians, including 627 reported on Friday alone. It has sickened tens of thousands more, and swiftly rendered the country unrecognizable – somber, desolate and scared. But for all the life-disrupting measures Italy has taken to slow the virus, it continues to spread and kill at an alarming clip.

The feeling is that battle against the virus, brutal and consuming as it has been, is only beginning.

As the first Western country to deal with a major outbreak, Italy has become a grim symbol of the virus’ dangers and the difficulty of contending with it. While other European countries and some U.S. states have borrowed Italy’s stay-home strategy, Italy is learning that the strategy does not work quickly, even when broadly adhered to.

Ten days since the beginning of a strict nationwide lockdown, the number of known coronavirus cases continue to rise some 15 percent every day. While that is shy of exponential growth, it is enough to overwhelm hospitals and morgues. More people are getting sick than can be cared for.

The lockdown, which included restrictions on travel and the closure of most stores aside from supermarkets and pharmacies, was initially put in place through April 3. But Prime Minister Giuseppe Conte made it clear in an interview with the Corriere della Sera that the measures would go on longer.

Conte said the “restrictions are working.” But even once the pace of transmission starts to wane – hopefully days from now, he said – “we won’t be able to immediately resume life as it was.”

Some politicians in Italy’s northern provinces have pressed for even harsher measures. They want narrower hours for supermarkets, a wider closure of factories and a mass-scale military deployment to keep people off the streets. Several leaders in the north have turned their ire toward people who continue to exercise outdoors, and have called on Conte to place a ban on jogging.

In an interview, the vice governor of the Lombardy region, Fabrizio Sala, said anonymized data provided by telecommunications companies indicated that 60 percent of all movement in the region had stopped, compared to a normal period before the virus. But even so, he said, too many people were leaving the house.

“People should stay at home more,” he said.

Polls indicate that the lockdown has wide support, and many of the Italians leaving their homes are doing so for essential work. Still, tens of thousands have been cited by police for breaking the lockdown rules.

In recognition of the limits on how democracies can contend with the virus, Italy has not used some of the more heavy-handed or invasive tools used successfully by China – including sustained monitoring outside apartment complexes and apps that log location and body temperature.

Italy’s biggest mistake, virologists say, was not instituting the nationwide lockdown more swiftly.

It is unclear if such a move, made weeks earlier, would have been as widely accepted – because the horrors of the virus had not yet come fully into view. Still, by the time Conte formally made his decree on March 10, the virus’s explosive growth had been set in motion.

“That move should have come from the beginning,” said Giorgio Palù, a professor of microbiology and virology at the University of Padova and the former president of the European and Italian Society for Virology.

Instead, when Italy was learning about the first burst of locally transmitted cases, it put only a fraction of the country – 50,000 people, in 11 towns – in strict lockdown. People in those towns were banned from exiting or entering, barring emergencies, and they were tested rigorously.

Experts say the disaster was likely set in motion weeks earlier, with people transmitting the virus well before officials realized there was any problem. The epicenter of the outbreak was Italy’s richest region, but also one of the oldest areas in a nation that has the world’s second-highest proportion of seniors. Because older people are more vulnerable to the coronavirus, Italy has been hit particularly hard. Among the people who have died, the median age is 80, according to Italy’s national health service.

Some initial signs suggest the localized lockdowns may have helped. Ten of those towns were in the Lombardy province of Lodi, where the pace of cases has risen at a rate far below other areas in the region. In a sealed-off town in a separate region further to the east, Vo’, the transmission of the illness has nearly stopped.

“You always pay a price for being first,” said Giuliano Martini, the Vo’ mayor. “But the others had time to act based on our experience, looking at the situation on the ground. They could’ve predicted it.”

Now under nationwide lockdown, all of Italy resembles Vo’ from several weeks ago. People stress about the economic cataclysm that is waiting the country, but those fears compete for more foundational concerns: about elderly parents, about the inability to see loved ones. In many neighborhoods across the country, stir-crazy Italians go to their balconies at night and either sing or open their windows and play music. At other times in the day, one of the public radio stations has started playing songs about the locked-down life. (“We are all cooks,” one lyric said.)

The moments are levity are fleeting, though, and there is widespread agreement that the country is facing its gravest challenge since at least World War II. This week, Italy surpassed China for the largest number of coronavirus-related deaths. Each of the last six days, the country has announced at least 300 dead. In Bergamo, the hardest-hit cities, military trucks have started lining up outside a hospital, to take the dead away to farther-away crematoriums.

On Friday, Sky News published footage from inside the main public hospital in Bergamo depicting a wrenching crisis: patients on gurneys struggling to breathe, including in the hallways, and exhausted-looking doctors and nurses without proper protective gear. In a public plea posted on the hospital’s Facebook page, the director of the department of medicine, Stefano Fagiuoli, said the facility was in “full emergency.”

“We are in desperate need of both nurses and physicians, together with ventilators” and protective equipment, he said.

He issued what amounted to an open call for nurses and doctors who wanted to come to Bergamo.

“If you are a health personnel, you are more than welcome to join us in fighting the coronavirus,” Fagiuoli said.

The situation is most dire in the north, but cases are increasing rapidly in most parts of the country, and authorities have been responding to a growing number of local hotspots. Some of the cases were transmitted by people who fled Lombardy and returned to their southern hometowns before travel restrictions were put in place. This week, authorities closed off a town of some 40,000 two hours south of Rome, after seeing a spike in cases. A new decree prevents people from leaving even for work purposes.

The spike had reportedly been triggered by a festival three weeks earlier.

Since then, according to the text of the restrictions place on the town, the increase in cases had been “remarkable.”

– – –

– Jan. 31: Italy confirms coronavirus in two Chinese tourists visiting Rome. The government declares a six-month state of emergency and becomes the first European country to suspend flights from China.

– Feb. 21: Italy reports its first cases of apparent community transmission and its first coronavirus death, a 78-year-old man from Vo, in the Veneto region.

– Feb. 22: Italy announces a lockdown affecting 50,000 people in the northern Lombardy and Veneto regions.

– March 4: With more than 2,500 cases confirmed, Italy announces closure of schools and universities.

– March 8: With nearly 5,900 cases confirmed, Italy orders a lockdown for 16 million people in the north, while also closing museums and theaters nationally.

– March 10: With nearly 7,400 total cases, the lockdown is extended to the rest of the country, limiting travel abroad and across regions.

– March 11: With nearly 12,500 cases confirmed, the government halts nearly all commercial activity aside from supermarkets and pharmacies.

– March 19: Italy surpassed China as the country with the most reported coronavirus deaths.

Gabriel Santos, a homeless-outreach worker, had waked with cold symptoms. Not wanting to expose his clients to illness, he reached for the mask. It would be better this way, he thought. But now, as he approached the woman sheltering outside a building, its other effects became clear.

“Don’t come over here with no mask on,” shouted Debra, a chronically homeless woman who sat bundled in a winter coat, a black-and-white blanket pulled over her lap. “I said don’t you come over here!”

Santos pulled the mask down, hoping she would recognize his face. A senior outreach coordinator with the nonprofit Bethesda Cares, Santos sees her often on his morning patrols of suburban Silver Spring, Maryland. But it was no use.

“I don’t care who you are!” she shouted again. “Don’t come over here with no mask!”

News of the rapidly spreading coronavirus, which as of Thursday had killed more than 170 people in the United States, has reached America’s homeless. But protocols meant to keep the public safe may do little to protect those without homes to shelter in – and could expose some of society’s most vulnerable people to even greater risk.

From San Francisco to Chicago to Washington, best practices are meeting harsh realities in a patchwork of responses that vary state by state, city by city.

Several local and state governments this week have ordered restaurants, coffee shops, libraries and other public gathering places to close – cutting off access to places where homeless people on the street can go to use the bathroom and wash their hands.

Recommendations from the Centers for Disease Control and Prevention say to limit gatherings to 10 people and practice “social distancing,” keeping at least six feet from others. Implementing such guidelines at an emergency shelter meant to house dozens of homeless adults can be impossible.

Covid-19, the disease caused by the coronavirus, hits people over 60 and those with preexisting health conditions hardest. The virus is easily spread through touch and by lack of proper hygiene.

People experiencing homelessness are increasingly older and sicker. Many have underlying health conditions but lack access to primary-care physicians or preventive health screenings. They struggle to find public bathrooms to maintain basic hygiene. Those who live in tent encampments or crowded shelters might be unable to keep their distance from others or self-isolate if they show symptoms.

Even their fiercest advocates – experts who have long served the homeless in their communities – worry about inadvertently putting their clients’ health at risk by simply showing up and doing their jobs.

“The education we’re giving our staff going out and working with this population is they’re not the ones you have to worry about being a possible carrier of this virus right now – you are,” said Betsy Bowman, director for adult and community services at EveryMind, a nonprofit organization that works with the homeless in suburban Montgomery County, Maryland. “You’re the one who went to church and saw your friend who just got back from overseas. It’s more likely that you’re going to give it to them. And if an infection gets into that population, it’s going to be devastating.”

The U.S. Interagency Council on Homelessness estimates there are 567,700 homeless people in the country. The most underserved live in parts of Washington, California, Maine, Oregon and Washington state, according to a Washington Post analysis of data from the U.S. Health Resources and Services Administration.

In the nation’s capital, homeless shelters announced they would stay open around the clock, instead of the usual 12 hours, and emergency measures will allow Mayor Muriel Bowser, D, to temporarily house homeless families for up to 60 days.

Bowser said city officials are working to ensure any homeless person showing symptoms gets appropriate treatment – but what that looks like in practice is not clear.

“If we have a person who is experiencing homelessness who needs to quarantine, we will make sure this happens,” she said.

Wayne Turnage, the city’s deputy mayor for health and human services, said homeless residents are being given hand sanitizer while encampment cleanups – which typically force residents to move their tents before streets are power-washed – have been limited to trash pickups.

Those who stay in Washington shelters are being screened before entering, and residents are required to stay in the same bed in the same shelter to limit movement between facilities. The city’s guidance for homeless-service providers includes checking clients for fever, encouraging hand-washing, staggering bathing and meal times, and moving beds at least three feet apart.

Laura Green Zeilinger, director of the D.C. Department of Human Services, said it’s not known whether anyone in the city’s homeless population has tested positive because the city doesn’t report results based on housing status. She said the city has found space where up to 200 people could self-quarantine if they’re otherwise unable.

Shelter environments do not naturally lend themselves to social distancing behaviors, experts say.

In some shelters, people share rooms and sleep in bunk beds. In others, mats line the floor of empty rooms to squeeze in as many people as possible during the cold winter months. Meals are served and consumed in large cafeterias. Recreation rooms, bathrooms and laundry facilities are shared.

Many shelters do not have room to isolate someone for an extended period. Some already are running low on cleaning supplies, hand sanitizer, food and volunteers to relieve overworked staff. Others have told volunteers to stay home – an effort to limit the number of people in and out of shelters at a time when experts say even asymptomatic people can spread the coronavirus.

“Our homeless services here are countercyclical, so when all these services are shutting down, we have to be in ramp-up mode,” said Shannon Steene, executive director of Carpenter’s Shelter in suburban Alexandria, Virginia, which serves families with children. “The thought of a potential self-quarantine with everyone in the shelter at one time, that is very sobering for me.”

The homeless are exempt from a public health order to “shelter in place” in seven Northern California counties, but officials encouraged them to seek shelter. For many of that region’s most vulnerable residents, it isn’t an option.

The San Francisco Bay area, home to some of the biggest names in the technology sector, also struggles with one of the biggest homelessness crises in the country.

There were more than 8,000 homeless people in San Francisco last year, according to city estimates based on a single night. By other city measurements, the number is more than 17,000.

“When you layer on top of that the coronavirus and mass vulnerability, we’ve moved beyond crisis to something bigger,” said Karen Hanrahan, chief executive of the Glide Foundation, a nonprofit that provides services to the homeless.

San Francisco Mayor London Breed, D, announced a $5 million emergency fund and public health order earlier this month to help vulnerable populations, including the homeless. The money will pay for roving cleaning crews to minimize contagion and support expanded daytime hours at shelters.

Local outreach teams run by nonprofits and the city are offering hand sanitizer and information on how to stay healthy. San Francisco also has deployed additional hand-washing stations on the streets.

The city plans to offer temporary housing to help people exposed to covid-19 who can’t self-isolate, including dozens of recreational vehicles placed in neighborhoods. In its ongoing search for quarantine housing, the city is also looking at unoccupied residential properties and vacant hotel rooms.

Sarah Owens, a spokeswoman for Breed, declined to say how many additional spaces are still needed or whether testing for coronavirus is being done in vulnerable populations, citing patient privacy.

Jennifer Friedenbach, executive director of the nonprofit Coalition on Homelessness, estimated there are about 40,000 people in San Francisco who cannot self-quarantine, because their housing situation does not allow it, including people living on the streets or in shelters, jails or single-room-occupancy hotels.

In a region where many homeless people sleep in tents beneath overpasses, on sidewalks and in parks, Friedenbach said the city’s effort to protect vulnerable populations must include a moratorium on removing tents from encampments.

“I feel like the city is working really hard and trying to come up with stuff as fast as they can,” Friedenbach said. “I don’t think $5 million is going to get us to the place where we’re preventing the spread.”

In the Seattle area, where the first domestic coronavirus case was reported, care providers have been working on social distancing in shelters. Seattle city officials also are funding emergency hotel rooms for the homeless, said Daniel Malone, executive director of the Downtown Emergency Service Center, a homeless outreach organization.

Because testing for the coronavirus remains limited, city spokesman Scott Thomsen, Seattle has focused on spreading its homeless population out as much as possible.

No cases of coronavirus have been reported among Seattle’s homeless, said Malone, who added that the city was in need of additional tests for the homeless.

Tests have remained hard to get, even for those with health insurance and demonstrable symptoms. Shelters and homeless advocacy organizations said they are waiting – just like everyone else – for test kits to be more widely available.

“They’re asking me: ‘What if I want to get tested? Where do I go?’ ” said Kasia Shaw, a nurse practitioner with Arlington Homeless Services Center in Virginia. “I tell them: ‘Well, there are not enough tests. You’re more than welcome to call the emergency room, but they’re going to ask you screening questions, and if you don’t meet the criteria, then they’re just going to tell you to self-isolate.’ ”

Doug Schenkelberg, executive director of the Chicago Coalition for the Homeless, said the homeless population in the Windy City has been “way undertested.” He said a large proportion of Chicago’s homeless live not on the street but in small apartments with many other people.

“These are folks that don’t have stable housing, likely in crowded environments,” he said. “How do you provide support to them? They’re not as easily found as folks on the street or in the shelter system.”

To many advocates for the homeless, the North Star in this health crisis remains the same as it ever was – finding people stable housing.

Michael Clark, 35, has been staying at the men’s shelter in Montgomery County for three months. Though he is taking warnings about the coronavirus seriously, he said he feels as if it is a distraction from his most immediate needs.

“My goal here is to get my life on track,” Clark said. “If it’s not helping me move forward, then I just can’t have anything to do with it.”

Many shelters have begun to formulate no-contact supply drops and lunch donations. Workers and volunteers who assist the homeless are also increasingly anxious about their own safety.

“We have staff coming to work and handling business as usual, but we have volunteers saying, ‘I’m not sure I want to be there. It’s going to be more than 10 people,’ which is true,” said Pam Michell, executive director of New Hope Housing in suburban Virginia. ” ‘It’s really hard to be six feet away,’ which is true.”

Some homeless communities have started to self-police.

Shelter workers said grown men are following one another out of bathroom stalls, shouting to one another to wash their hands. Clients are staggering meal times and taking smoke breaks farther apart.

Washington’s largest homeless encampments are centered around Union Station, where people huddle in tents under two railroad underpasses.

Michele Hydier and her partner often sleep beneath the underpass after a day of panhandling. Business has been slow – on a recent day, she earned $1 and a fruit cup instead of the $20 she normally takes in.

Many stores in the area that encampment residents rely on for bathrooms, for Internet access and to charge their phones are closed. Residents are still leaving food and supplies for those in the encampments – just less of it.

“It’s like people are scared of us,” Hydier said.

Back in Silver Spring, five miles from the National Institutes of Health, a team of street outreach workers were handing out supplies – socks, snacks, a poncho. They did not have hand sanitizer to give. They were out of bottled water.

When Santos, the homeless-outreach worker, reached to hand Debra a bar of soap, she pushed it away.

“What the hell am I going to do with that?” she asked.

“I know they’re closing things down,” said Deborah Taylor, programs director at Bethesda Cares. “I want to make sure you have somewhere to go, to use the bathroom, wash your hands.”

The woman shrugged, her face shrouded by an oversize furry hood.

“I probably don’t,” she said.

Just 11 weeks into a pandemic crisis expected to last months, the nightmare of medical equipment shortages is no longer theoretical. Health-care workers, already uneasy about their risk of infection amid reports of colleagues getting sick and new data showing even relatively young people may become seriously ill, are frustrated and fearful.

“That has really freaked everybody out,” said Elissa Perkins, an emergency medicine physician at Boston Medical Center.

President Donald Trump responded to the growing crisis Wednesday by invoking the Defense Production Act to mobilize war-scale manufacturing for critical items, and federal health officials have announced plans to buy 500 million N95 respirators over the next 18 months.

Also, Vice President Mike Pence said legislation signed Wednesday gives manufacturers protection against lawsuits when selling N95 masks to health-care workers, freeing producers such as 3M and Honeywell to sell tens of millions more per month. But it’s unclear how long it will take get the equipment to the front lines, and many worry that lives may be lost before such efforts catch up to a virus spreading exponentially across the country.

Few hospitals have experienced a crush of coronavirus patients. But many of the supplies have been used up during routine care over the past few weeks, with no more on the way amid global hoarding and the shutdown of equipment factories in China and elsewhere.

Chief among the concerns is the limited supply of personal protective equipment, especially the fitted face masks known as N95 respirators that are able to filter out extraordinarily small particles like viruses. Guidance from the Centers for Disease Control and Prevention previously called for using N95 masks whenever seeing a patient suspected of having covid-19, the disease caused by the novel coronavirus. But last week, the agency changed course as it became clear that demand for N95s would outstrip the nation’s small supply. Now, the CDC says that nurses and doctors only need to wear N95s when performing procedures that might cause the patient to cough or otherwise “aerosolize” the virus, sending it into the air in small particles.

Jordan Asher, a senior vice president at Sentara Healthcare, based in Virginia Beach, said such steps are necessary to stretch out existing stockpiles as long as possible.

“In medicine, we have what is optimal and what is good but still standard of care,” he said. Right now, he said, there aren’t enough resources to be optimal.

But many health-care professionals wonder whether the looser-fitting surgical masks are adequate. Although the CDC and the World Health Organization have said the virus is not airborne, a paper published in the New England Journal of Medicine this week showed that in laboratory conditions where it is aerosolized – similar to what can happen in a hospital when a patient is intubated – the virus may remain infectious in the air for a half-hour.

More than 85,000 health-care providers have signed a Change.org petition that urges the Trump administration to do more to get the critical supplies. Recommendations, they wrote, “should not be based on what’s available; availability should be based on what is necessary.”

Health officials said part of the reason for the shortage relates to the expansion of testing. Some testing sites are using excessive numbers of N95 masks, gowns, gloves and eye protection for simple swab tests. Workers decked out in full head-to-toe protective gear may make for dramatic images in news photos and on TV, they said, but it’s unnecessary.

The gear “is being wasted testing outpatients,” said Demetre Daskalakis, deputy commissioner for the Division of Disease Control at the New York City Health Department.

In a departure from the latest CDC guidance, the city is recommending that only hospitalized patients receive coronavirus tests to preserve masks and other protective equipment. Even with stringent conservation measures, he said, some providers in the city could begin running out of N95 masks and other personal protective equipment in a matter of weeks.

Darrell Pile, CEO of the Southeast Texas Regional Advisory Council, which is responsible for distributing resources to local health providers from the Strategic National Stockpile, said the amount they had received so far is “horribly inadequate to meet existing demand.”

“For those that received them, it might last a week or two,” Pile said, noting that some emergency medical services crews and other health providers had run out of gloves as well as N95 masks. He says he has already doled out all the supplies he received Sunday night, “and the requests just keep coming in.”

Nisha Mehta, a doctor who runs two Facebook communities for physicians with a total of 65,000 members, said many doctors are frustrated with new procedures put in place to conserve equipment.

“We’re normally not supposed to reuse masks from patient to patient,” said Mehta, a radiologist in Charlotte, North Carolina. “But a lot of people are posting that they are getting one for the entire day, if they even have one.”

Kristin Annis, a 36-year-old nurse anesthetist in Northern Virginia, said she understands the need for adjustments as a result of shortages but is concerned for her in-laws who care for her child. “I’m petrified I’m going to bring it home,” she said. “The problem is, this is spreading rapidly. We know we’re not near the peak yet. We know some of these patients are going to be bringing it with them even if they don’t have symptoms.”

Jeffrey Silberzweig, chief medical officer for the Rogosin Institute, which has nine facilities in the New York City area and provides dialysis for 1,400 patients with end-stage kidney disease. He said he has tried everything possible to find more masks, which are used by patients as well as doctors and staff, but will run out of supplies in three to five days. The centers plan to start using face shields along with bandannas as a substitute – a setup recommended by the CDC as “a last resort.”

“It is far from ideal but it is better than no solution at all,” he said.

Perkins, the emergency medicine physician, said Boston Medical Center still has a six-week supply of N95s, but doctors and nurses have been told they must conserve them by restricting their use to aerosolizing procedures. That leaves health-care workers potentially exposed not only when examining people with flu-like symptoms but also those with completely unrelated symptoms who might nevertheless have the virus, she said.

“We are being asked to conserve our best [personal protective equipment] now for more dangerous situations later on, but that is exposing us to dangerous situations now,” Perkins said.

Asher said he has hope that old-fashioned American ingenuity will help us out of this situation. Wednesday morning, he reviewed draft plans for homemade equipment shared by hospitals on the West Coast, and he has been following the large, open-source efforts by engineers and hackers to create new products to make up for the shortfalls.

“This country has been incredible about producing new equipment in the past . . . I think we need to stay positive,” he said.

One of the most creative efforts occurred at Providence St. Joseph Health, which has 51 hospitals in several states. Using a face shield design found online by their top infection control executive, Becca Bartles, and materials that quality control overseer Jennifer Bayersdorfer purchased at retail outlets, they fashioned 500 masks to distribute to doctors and nurses Tuesday night.

Amy Compton-Phillips, chief clinical officer for Providence, said the hospital system has been emailing the design to other health-care centers and ordinary people across the country who want to help:

“I feel like it’s a way to knit your socks like in World War II,” she said. “Until we can get supply lines up and running, this will be a way for Americans to contribute to the war against covid.”

So they’re fleeing to their country homes. Chartering private jets. Putting their doctors on speed dial and getting home visits. They have pantries full of food and toilet paper. None of these is a guarantee against contracting a deadly disease, but it reduces their exposure and allows them to get treatment sooner.

It’s been this way throughout history. The rich have always fared better during a public health crisis. The poor are exposed at greater rates, get sicker because often they aren’t as healthy to begin with and have higher mortality rates.

“The wealthy have often done better than the poor when faced with epidemics and pandemics because they tend to be resilient as a function of having greater resources,” says Richard Keller, a professor of medical history and bioethics at the University of Wisconsin-Madison.

So it was, so it is, so it always will be. When President Donald Trump was asked Wednesday why athletes and other well-connected people are getting tested before everyone else, he said, “Perhaps that’s been the story of life.”

Will it be any different this time?

– – –

The streets of Palm Beach are empty. The boat show is canceled, as is this weekend’s International Red Cross Ball, one of the season’s leading social events.

The exclusive Florida enclave is home to some of the richest people in the country and some of the oldest. Last week, a man infected with conoravirus flew from New York to West Palm Beach, causing a quiet freakout among the regulars on the island. So the sidewalks in front of the beautiful mansions on this man-made paradise have proverbially rolled up.

“People are staying in place,” says Shannon Donnelly, longtime social editor of the Palm Beach Daily News. “Everything has been canceled.”

The wealthy are hunkering down in their very big houses, and telling staff to stay home or work half days. They’ve just discovered home grocery delivery. Prices are high – as usual – but not out of control. High-end stores are open, but who is going out?

“There’s not a bottle of Purell in Tiffany’s window – yet,” says Donnelly.

One business-as-usual site had been Mar-a-Lago, where Trump and his family celebrated together less than two weeks ago, when some thought coronavirus was still something to joke about. Now club regulars are staying home because the virus doesn’t care how rich or powerful you are.

Not everyone can stay in place. For those who want or need to fly, demand for private jets has soared.

“We have seen a substantial increase in the desire to fly private,” says Stephanie Chung, president of JetSuite, a top luxury rental company. “In the past few weeks and particularly this past week we have seen an uptick of about 5 to 10 percent in new inquiries from travelers that have not flown private in the past.”

New customers include families traveling for spring break and corporate clients restricted from flying commercially who are able to spend up to $7,000 an hour for a charter flight. And this isn’t just about the plane: Many clients have expressed fear of traveling through large airports, especially after seeing news reports of crowds crammed into Chicago’ O’Hare and New York’s JFK. Most private planes fly out of small terminals reserved for VIP customers.

Chung’s current sales pitch is anti-virus focused: “For those that are looking to minimize mass public exposure, private jet travel allows passengers to avoid crowds in security lines and large waiting areas as boarding is often conducted immediately upon arrival at the airport. Furthermore, our aircraft have significantly fewer guests per flight and are regularly cleaned with solvents that target the coronavirus. There are ample hand sanitizers and other options to maintain maximum hygiene while onboard our aircraft.”

On Friday, supermodel Naomi Campbell shared a video of her commercial flight from Los Angeles to New York City wearing a white hazmat suit, safety goggles, a medical face mask and purple gloves. “We have to do what we have to do,” she explained to her fans. Before the flight, Campbell had acupuncture on her ears to “reset the nervous system.” Other celebrities have posted photos of themselves wearing designer protective masks that retail for hundreds of dollars.

Campbell did not share where she was headed, but many of the wealthy residents of Manhattan have already fled to their country or beach homes. The theory is that they’re less likely to be exposed to coronavirus in smaller communities, and self-isolation has historically proved to be a survival strategy for the rich. Unless, of course, they’re already exposed and carrying the virus to those very same communities.

One wealthy Washington,D.C., woman, who discussed her plan for dealing with the pandemic on the condition of anonymity, is considering decamping to her second home located in a small town of less than 10,000 in upstate New York. “Because it’s such a rural community with so few people, there are no reports of covid-19 so far,” she explained. On paper, that sounds good: She and her husband are both older than 65 with underlying medical issues, which puts them at high risk. The down side: Rural communities have fewer Level One trauma centers, which means that they have fewer options should either of them get sick.

Which is why doctors with concierge service are suddenly in high demand. The idea is simple. Clients pay an annual fee which allows the doctors to spend more time with fewer patients. It’s the modern version of the small-town general physician who’s been taking care of families for decades.

Jim Long, who has a solo practice in Fairfax, Virginia, has spent most of the past couple weeks talking calls. “I’m spending a lot of time on the phone and texts,” he says. “Having access in real time provides a kind of reassurance and an added sense of security. I’ve had to quell the hysteria.”

Long’s practice isn’t just for the rich, but his clients – about 60 percent are older than 60 – pay about $2,000 a year for the personal attention and access a concierge physician can provide. He started sending email blasts to his patients two weeks ago and gives everyone masks before they enter his office.

Last week, he got 10 coronavirus testing kits. “We don’t get them faster than anyone else,” says Long. One of his patients wanted the test so he could visit his elderly mother; he was asymptomatic and didn’t get a test. The only patient who’s been tested so far was a robust man with a severe fever and cough who tested negative for flu. The novel coronavirus results are pending.

Some concierge services are even more exclusive. Clients with MD2, which has practices in New York, Beverly Hills, McLean, Virginia, and other high-income locations, pay $15,000-$25,000 annually for doctors who serve only 50 families. The headquarters is just outside of Seattle, where the fear is even greater and their doctors are making house calls wearing protective suits and masks.

“A lot of people want tests,” says JoAnn Ollila, director of marketing. But MD2, like most other practices, is using the coronavirus tests for patients who show symptoms. Instead, they’re urging patients to call doctors at any time to assess their risk and help everyone stay calm. “Everyone’s greatest fear is being alone at their greatest time of need.”

– – –

Throughout history, scholars, scientists and philosophers have wrestled with the stark fact that the most of the rich survive plagues and pandemics while the poor die cruelly.

“The Decameron,” set in 1348, is a masterpiece of classical early Italian prose by Giovanni Boccaccio. You probably studied it in school: Seven women and three men tell 100 witty tales while staying at a secluded villa outside of Florence. In the fictional account, the 10 had fled to the villa to escape the Black Death. The plague ravaged the Italian city, with bodies piled up in the streets. About half of the population died.

Historians believe the disease killed about 75 million people, a third of Europe’s population overall, and most of the victims were poor. “Plague is primarily an urban phenomenon,” says Keller. As with most pandemics, the disease spread quickly among those living in close quarters, catching the blood-borne bacteria from fleas that fed off infected rats and then bit humans.

The rich fled to the country side – their own homes or that of relatives – sometimes escaping the plague but occasionally carrying it with them in their textiles or food supplies. Mortality demographics are hard to pinpoint before the 19th century, but it is believed that the wealthy fared far better because they were better fed and healthier to begin with.

Cholera is the “health and wealth story of the 19th century,” explains Keller. The first pandemic began in Jessore, India, in 1817 – where hundreds of thousands died – and reached Europe by 1831, killing 6,500 in London and 18,000 in Paris. Almost all of these deaths occurred in the poorest, most-crowded sections of the cities, the product of contaminated food or water.

But tuberculosis was the deadliest disease in that century, especially in France, where it killed about 100,000 annually. “The rich were able to send a sick relative to a sanitarium to live in isolation,” says Keller. “Population density was really the critical issue: It killed the poor in far greater numbers than the rich.”

The last time Americans faced a global pandemic was 1918, when Spanish flu ravaged the globe. Health-care systems, already crippled by soldiers returning from World War I, were overwhelmed by the fast-moving influenza. Transmitted by soldiers returning from World War I, it affected families up and the social strata – even President Woodrow Wilson was infected. The death toll in the United States was 675,000; historians believe the worldwide toll was 50 million.

– – –

In 1842, Edgar Allan Poe wrote “Masque of the Red Death.” The short story, one of Poe’s best, is set in a fictional country where a gruesome disease called the Red Death has ravaged the land. (Sounds familiar? Roger Corman made it into a 1964 horror film starring Vincent Price.)

The ruler, Prince Prospero, is not afraid. He closes his palace to all except a thousand of his favorite knights and ladies, then welds the doors shut. “With such precautions the courtiers might bid defiance to contagion,” writes Poe. “The external world could take care of itself. In the meantime it was folly to grieve or to think. The prince had provided all the appliances of pleasure. There were buffoons, there were improvisatori, there were ballet-dancers, there were musicians, there was Beauty, there was wine. All these and security were within. Without was the ‘Red Death.'”

One night, the prince decides to host a masquerade ball for his friends. At midnight, a guest arrives wearing a mask of a corpse and a costume like a funeral shroud. Prospero is furious at the tasteless display; his guests shrink away. The prince confronts the figure and immediately dies.

You can guess what happens next: Everyone else in the castle dies. “And Darkness and Decay and the Red Death held illimitable dominion over all,” concludes Poe.

It’s fiction, of course.

“My front-line providers – we were speaking about it in the situation report that night, and their voices cracked,” Christie said on Wednesday. They saw how quickly the surge would overwhelm the system, forcing doctors to make impossible choices – which patients would get ventilators and beds, and which would die.

“They were terrified. And that was the best-case scenario.”

Experts around the country have been churning out model after model – marshaling every tool from math, medicine, science and history – to try to predict the coming chaos unleashed by the new coronavirus and to make preparations.

At the heart of their algorithms is a scary but empowering truth: What happens next depends largely on us – our government, politicians, health institutions and, in particular, 327 million inhabitants of this country – all making tiny decisions on an daily basis with outsize consequences for our collective future.

In the worst-case scenario, America is on a trajectory toward 1.1 million deaths. That model envisions the sick pouring into hospitals, overwhelming even makeshift beds in parking lot tents. Doctors would have to make agonizing decisions about who gets scarce resources. Shortages of front-line clinicians would worsen as they get infected, some dying alongside their patients. Trust in government, already tenuous, would erode further.

That grim scenario is by no means a foregone conclusion – as demonstrated by the less dire death counts in countries such as Germany that have taken aggressive steps to bolster their health system.

If Americans embrace drastic restrictions and school closures, for instance, we could see a death toll closer to thousands and a national sigh of relief as we prepare for a grueling but surmountable road ahead.

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Doing that will require Americans to “flatten the curve” – slowing the spread of the contagion so it doesn’t overwhelm a health-care system with finite resources. That phrase has become ubiquitous in our national conversation. But what experts have not always made clear is that by applying all that downward pressure on the curve – by canceling public gatherings, closing schools, quarantining the sick and enforcing social distancing – you elongate the curve, stretching it out over a longer period of time.

Success means a longer – though less catastrophic – fight against the coronavirus. And it is unclear whether Americans – who built this country on ideals of independence and individual rights – would be willing to endure such harsh restrictions on their lives for months, let alone for a year or more.

This month began with U.S. officials recommending actions such as hand-washing and social distancing. By Sunday, the Centers for Disease Control and Prevention was warning against gatherings of 50-plus people. By Monday, President Donald Trump had made an abrupt turn from encouraging Americans to go on with their lives, to urging them to work from home, not meet in groups of more than 10, and calling on local officials to close schools, bars and restaurants. (Getting the public to comply has been alarmingly difficult. Young revelers from Bourbon Street to Miami have ignored those pleas, as have some elderly, who are at highest risk.)

Trump’s sudden shift was driven by an alarming new scientific model, developed by British epidemiologists and shared with the White House. The scientists bluntly stated the coronavirus is the most serious respiratory virus threat since the Spanish Flu of 1918. If no action to limit the viral spread were taken, as many as 2.2 million people in the United States could die over the course of the pandemic, according to epidemiologist Neil Ferguson and others at the Imperial College Covid-19 Response Team.

Adopting some mitigation strategies to slow the pandemic – such as isolating those suspected of being infected and social distancing of the elderly – only cuts the death toll in half to 1.1 million, although it would reduce demand for health services by two-thirds.

Only by enacting an entire series of drastic, severe restrictions could America shrink its death toll further, the study found. That strategy would require, at minimum, the nationwide practice of social distancing, home isolation, and school and university closures. Such restrictions would have to be maintained, at least intermittently, until a working vaccine is developed, which could take 12 to 18 months at best.

The report’s conclusion: This is “the only viable strategy.”

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Here is another thing that hasn’t been spelled out in our national conversation about flattening the curve: There will probably be more than one curve.

If we’re lucky, the coming months will probably look more like string of hilly bumps, say epidemiologists. If authorities ease some measures in coming months or if we start letting them slip ourselves, that hill could easily turn right back into the exponential curve that has cratered Italy’s health system and that U.S. officials are desperately trying to avoid replicating.

Climbing this first bump is in many ways the most challenging because it involves persuading people to change their individual behaviors for an abstract larger good – and because no one knows how far we actually are from the peak.

On Tuesday morning, New York Gov. Andrew Cuomo, a Democrat, said infections in his state are expected to peak in 45 days – at the start of May. The state has roughly 53,000 hospital beds, including 3,000 intensive-care beds – way short of the projected need for as many as twice that number of beds and as many as 11 times the number of ICU beds.

A day earlier, Northwell Health – whose 23 hospitals and 800 outpatient centers make up New York’s largest health system – canceled all elective surgeries in its hospitals to free up staff and space. It has 5,500 beds.

“We’re looking at Italy, which is currently 10 days ahead of us, and what they’ve had to do,” said Maria Carney, Northwell’s chief of geriatrics. Carney was health commissioner for New York’s Nassau County during the 2009 H1N1 outbreak and has worked furiously on Northwell’s plans to prepare for the coming tsunami.

One reason she and others are alarmed: In China, the fatality rate in Wuhan, the raging epicenter, was 5.8%. But in all other areas of the country it was 0.7% – a signal that most deaths were driven by an overwhelmed health system.

And U.S. hospitals are pinched as it is, with some already running at 95% capacity pre-coronavirus, Carney noted. As cases surge, Northwell plans to place multiple beds in single rooms. Its ambulances will also shuttle patients to less crowded satellite sites. Those suffering from ordinary emergencies – strokes, heart attacks, car accidents – may find themselves routed to other facilities away from ERs to avoid transmission.

But it’s unclear if it will be anywhere near enough.

Staffing shortages are already developing: As of Tuesday, 18 Northwell employees had already tested positive for the coronavirus. More than 200 were self-quarantined as a result of potential exposures, foreshadowing what is likely to come.

If the numbers next month get truly crazy, cities may look to convert stadiums into isolation wards, as in Wuhan. Cuomo has talked of turning the six-block-long Javits Convention Center on New York City’s west side into a medical surge facility. Others might take Italy’s approach and split hospitals into those treating coronavirus and those treating all other medical problems, to reduce transmission.

In San Francisco, we may see coronavirus patients put into RVs. In Takoma Park, Maryland, the old Washington Adventist Hospital site, which shuttered in 2019, could suddenly find its doors reopened.

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As America enters this utterly unfamiliar territory, some experts have turned to history for glimpses of what to expect in the months ahead.

Initially leery of alarming the public, they have increasingly compared this pandemic to the 1918 Spanish flu, the deadliest in modern history. It infected roughly a third of the world’s population and killed at least 50 million people, including at least 675,000 in the United States.

Like the hilly bumps experts foresee in coming months, the 1918 pandemic hit America in three waves – a mild one that spring, the deadliest wave in fall and a final one that winter.

With each wave came a cycle of denial, devastation, community response finally kicking into overdrive – always followed by finger-pointing and blame among leaders and the public.

“Every outbreak is different,” said medical anthropologist Monica Schoch-Spana, who spent months digging through archives to study how Spanish flu played out in Baltimore.

Like coronavirus is likely to do, the 1918 flu overwhelmed hospitals. Unable to get help, desperate families waited outside to beg and try to bribe doctors for treatment. In a three-week period, 2,000 died in Baltimore alone. Mortuaries ran out of caskets. When the bodies finally reached cemeteries, the gravediggers were so ill, no one could bury the dead.

Economic pressure on business owners and workers caused public resistance to adopt – and stick with restrictions. The crisis brought out the best in Baltimoreans – with sewing circles churning out gauze masks and hospital bedding, and neighbors donating food and services.

But it also brought out the worst – xenophobic conspiracy theories that nurses of “German extraction” were deliberately infecting people. African American patients were kept out of most hospitals under Jim Crow-era segregation.

“Pandemics aren’t just physical,” said Schoch-Spana. “They bring with them an almost shadow pandemic of psychological and societal injuries as well.”

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Stanford virologist Karla Kirkegaard said she has tried to stave off dread from the projected U.S. death toll with a case study she teaches in her classes:

Amid a cholera outbreak in mid-19th century London, as panicked residents fled one hard-hit neighborhood, a doctor named John Snow calmly entered the breach. He deduced that the source of hundreds of deaths was a single contaminated water pump and persuaded authorities to remove the pump’s handle – a strategy that ended the outbreak.

Controlling the covid-19 pandemic will take much more than a single water pump, Kirkegaard acknowledged as she sheltered in place at her Bay Area home.

But the story, she said, reminds her how powerful the simple act of one individual can be.