Yanti Turang, an emergency room nurse at a New Orleans hospital, walked out into the car park in full protective gear early this month to meet a woman with flu-like symptoms who had just returned home after a layover in South Korea. The woman was immediately taken to an isolation room.
Around the same time, a man who had never left the country and had been in New Orleans throughout the just-concluded Mardi Gras season, showed up at the ER with a high fever and a dry cough. He was placed in a neighboring room and cared for by hospital workers without any special gear.
To everyone's relief, the woman who had travelled through Asia tested positive for the standard flu. The man, however, did not, Turang said. His symptoms improving but his diagnosis unclear, he was told to take Tylenol and get some rest. And he was sent back out into the city.
Turang does not know what became of that man, but he was on her mind two days later when the first confirmed case of the novel coronavirus was announced in Louisiana – another person, at another hospital. The coronavirus had been in the city all along. Since then, the outbreak in the state has become one of the most explosive in the country.
According to one study, Louisiana, with more than 2,300 cases as of Thursday afternoon, is experiencing the fastest growth in new cases in the world. State governor John Bel Edwards said on Tuesday that the current trajectory of case growth in Louisiana was similar to those in Spain and Italy.
This week, US president Donald Trump approved the governor's request for a major disaster declaration, which unlocks additional federal funding to combat the outbreak.
Overwhelmed
The situation in and around New Orleans is particularly acute, with the city reporting 997 confirmed cases as of Thursday afternoon, more than the total number of cases in all but 13 states. Hospitals are overwhelmed and critical safety gear is running low.
Orleans Parish, which shares its borders with the city of New Orleans, has suffered the highest number of deaths per capita of any county in the nation. Of the parish's 46 deaths – more than double the death toll of Los Angeles County – 11 are from a single retirement home, where dozens more residents are infected.
In a grim irony, there is a rising suspicion among medical experts that the crisis may have been accelerated by Mardi Gras, the weeks long citywide celebration that unfolds in crowded living rooms, ballrooms and city streets, which this year culminated February 25th.
It is the city's trademark expression of joy – and an epidemiologist's nightmare. "I think it all boils down to Mardi Gras," said Dr F Brobson Lutz Jr, a former health director of New Orleans and a specialist in infectious disease. "The greatest free party in the world was a perfect incubator at the perfect time."
The feeling is at once familiar and distinct for a city whose history is punctuated with epic disasters, including the deadly yellow fever outbreaks of 1853 and 1905, and Hurricane Katrina in 2005. Once again, New Orleanians are afraid they could be neglected by national leaders, only this time because the coronavirus is a worldwide calamity.
“This hurricane’s coming for everybody,” said Broderick Bagert, an organiser with the community group Together Louisiana.
Edwards, who, like most other Louisiana governors, has extensive experience dealing with hurricanes, said the state was struggling to confront this new kind of disaster. “We don’t really have a playbook on this one,” he said. “If you have a flood or a hurricane it’s only a small part of the country that’s affected, so you can get the full attention of the federal government and you can get a lot of help from sister states. That’s not possible right now because this is in every state in our country.”
Silent clubs
As a kind of ghostliness settles over a locked-down nation, the effect of social distancing feels particularly jarring in New Orleans, a city that runs on intimacy – from the deep webs of kinship and geography that connect families and neighbourhoods to the fleeting threads that bind strangers and regulars in storied restaurants and packed, sweaty clubs.
Now the grand restaurants are offering takeout, if they are open at all. The clubs are silent. Bourbon Street is just another lonely street, its only crowds the hordes of rats that have become increasingly brazen in their hunt for food.
Dr Catherine S O'Neal, an infectious disease specialist and chief medical officer at Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana, compared this year's Mardi Gras to the infamous 1918 "Liberty Loan" parade in Philadelphia. That gathering took place in the midst of an influenza pandemic, packed 200,000 people on to city streets and likely contributed to Philadelphia's grisly death toll, with more than 12,000 people dying within a six-week period.
But O'Neal blamed no one for failing to take action to limit Mardi Gras festivities. At the time, no cases of the virus had been identified in Louisiana and there were fewer than 50 known cases in the United States. "We were still talking about hand-washing," she said.
Dr Susan Hassig, an epidemiologist and associate professor at the Tulane University School of Public Health and Tropical Medicine, said there were other likely reasons, beyond Mardi Gras, that may explain why New Orleans has been so hard-hit – the dense, compact nature of the city; its tourism industry; its port, which connects it to the world; and the way people connect culturally.
“Everybody talks to everybody, which means you stop and you have a conversation and then you move on and have a conversation with somebody else,” said Hassig, who rode in a Mardi Gras parade with the Krewe of Muses this year.
‘Blindsided’
Turang, the emergency room nurse, who worked in Sierra Leone during the Ebola epidemic in 2015, said doctors and nurses now talk of the patients who had shown up to hospitals between Mardi Gras and the announcement of that first case on March 9th, people with moderate flulike symptoms who had tested negative for the flu.
“We were blindsided,” she said, “by the fact that it was actually here in New Orleans already.”
That first confirmed case in Louisiana was announced less than two weeks after shrove Tuesday. Around the same time, reports had begun popping up around the South – Tennessee, Arkansas, Texas – of people who had tested positive after recently returning from New Orleans.
The first people to test positive in New Orleans, according to Dr Jennifer Avegno, the city's health director, had not recently returned from anywhere. But their array of unusual symptoms had troubled doctors. "They just had a sense that something wasn't right," Avegno said. "It became clear pretty quickly that there was community spread, that the cases were not directly linked to each other."
Within days, the state’s schools were shut down and large public gatherings in New Orleans were banned – including the huge annual St Patrick’s Day parade, though enough people came out anyway that Saturday to draw the police. A week after the first case was announced, the governor issued an order closing restaurant dining rooms and bars, some of which had to call carpenters to install locks on doors that had not been secured for years.
Edwards also limited gatherings to fewer than 50 people. But some have remained defiant, including Tony Spell, pastor at Life Tabernacle Church outside of Baton Rouge, where, according to reports, hundreds of people have been gathering to pray without observing social distancing rules. Spell has called the virus "spiritually motivated" and said that he would heal infected members of his flock by laying hands on them and praying.
Surge in cases
As testing ramped up, the number of cases in Louisiana surged. A medical worker at the city jail tested positive, as did a founder of the Grammy-winning Rebirth Brass Band. Sean Payton, the coach of the New Orleans Saints, announced that he had tested positive. The archbishop of New Orleans did, too.
The growth rate of new infections in Louisiana was the fastest in the world when comparing areas during the two weeks that followed their first confirmed diagnosis, according to a recent study by Gary A Wagner, an economics professor at the University of Louisiana at Lafayette. In a small and close city like New Orleans, that means that nearly everyone knows someone who has been infected.
"One of my members, Sister Monica, is on a ventilator," said Tyrone Jefferson (46), pastor of a church in the city's St Roch neighborhood. "Another rushed to a hospital yesterday. Two are at home with it."
Doctors and nurses at city hospitals, like hospital workers all over the country, describe a dire shortage of critical protective gear. The Cajun Navy, one of the informal Louisiana volunteer brigades famous for rescuing people from floodwaters, and the Cajun Army have delivered several boxes of masks and gallons of hand sanitiser to medical workers.
But the deluge of patients keeps coming. Edwards, a moderate Democrat in his second term, has always been careful about criticising the Trump administration for both political and practical reasons: After a hurricane, there is little use in picking a fight with a federal government that holds the key to disaster relief.
On Tuesday, however, Edwards said he would like to see the White House get more involved in the coronavirus response in a way that prioritised harder-hit areas. Ventilators and personal protection equipment should be allocated, he said, "based upon demonstrated need, as opposed to the current situation, where every state, every health care provider, is working the best they can but independent from one another".
Economic devastation
As the disease spreads and sickens those fighting it, a potential shortage of medical workers, particularly nurses and respiratory therapists, is for many the biggest worry. For now, many exposed health care workers – a description that accounts for more than half of the city’s emergency medical technicians – are wearing masks and checking their temperatures but, as long as they are not showing symptoms, staying on the job.
The attendant tragedy of the pandemic – economic devastation to a city that lives on tourism and good times – has been following close behind. Most of the city’s tens of thousands of hotel and restaurant jobs do not pay enough for workers to have sufficiently saved for weeks on lockdown, but they pay better than nothing at all.
“Our food banks say they’ll be out of food by next week,” said New Orleans mayor LaToya Cantrell, adding that the city was estimating a budget deficit of at least $100 million (€91 million) next year, given the vanishing sales tax revenues. “And,” the mayor continued, “we have hurricane season coming in June.”
In his request for a federal emergency declaration, Edwards said that projected hospitalisations would exceed the state’s capacity by April 4th, and that the state had begun contracting to “build out hotels” to provide additional hospital beds. Three state parks have also been outfitted with mobile homes to house more than 300 patients.
If hospitals hit capacity, state officials are considering housing noncritical patients at the New Orleans Ernest N Morial Convention Center, which housed thousands of residents who were forced from their homes by Katrina’s floodwaters, and became a symbol of the chaotic response to that disaster.
Death toll
For now, the death toll continues its steady climb. A well-known 44-year-old DJ who championed the city’s bounce music scene. A 53-year-old man who drove for Uber and Lyft at Mardi Gras. On Thursday, health department officials reported the death of the state’s youngest known victim, a 17-year-old in Orleans Parish.
Ellis Joseph was friends with Oliver Stokes, the DJ, and also with Ronald Lewis, a New Orleans cultural icon who died on Friday of the coronavirus, as a test would posthumously confirm. In another time, Joseph would have walked with his bass drum behind the coffin at Lewis's funeral procession, leading a brass band in the traditional dirge "Just a Closer Walk With Thee." Hundreds if not thousands of people would have followed or lined the streets.
“I’m going to say a silent prayer for Mr Ronald now and roll for him later,” said Joseph, who is now trying to avoid even going to the store. The funeral was on Monday. In accordance with the current regulations, it was limited to a pastor and nine others. – New York Times
