How to stay safe. How to protect others. How much risk to take when the smallest act can be a risk: touching a doorknob, buying milk. Whether or not the virus has reached your neighborhood, what’s swept into everyone’s lives is a set of confounding dilemmas.
So send your questions to us, at dilemmas@nytimes.com. There’s a saying in journalism: The solution is always more reporting. And that’s what we’ll do in coming weeks in this new column.
Leaving Town, and Putting Others at Risk
I was just at Target in Honolulu, it’s full of crisis tourists from the mainland talking about how they came to Hawaii to isolate from coronavirus, and I’m enraged. This is the perfect storm about to hit Hawaii. We have a doctor shortage, and many of our doctors are elderly. We have a weak social safety net and an economy overly dependent on tourism. These outsiders could push us over the edge, especially because tourists are often prioritized at the expense of local residents.
KHARA TAPAY JABOLA-CAROLUS, Honolulu, Hawaii
Tensions over this question are rising by the hour. Wary of a long, confined spring, city dwellers are fanning out to vacation rentals, their own second homes, or anywhere else they can find. Airbnb bookings by urban customers traveling to nonurban areas are surging, according to a spokesman. “I can’t just imagine staying in an apartment with a dog and a child when there’s a lawn and space upstate,” said Natasha Schull, 48, a cultural anthropologist at New York University who left Manhattan on Thursday for her home in Delaware County. Worried about a medical condition that predisposes her to pneumonia, she checked the number of ventilators available at the hospital there: 12.
It’s an instant national ethical dilemma, exacerbating already-tense relationships between rich and poor, urban and rural, and, in the case of Hawaii, largely white outsiders and more diverse locals. Who gets to shelter where? Or take the last sack of flour at a small supermarket, or one of those precious upstate ventilators?
Destinations known for welcoming visitors are now closing themselves off. After Ms. Jabola Carolus wrote, Hawaii announced a mandatory 14-day quarantine for all incoming travelers. Southeast Utah has prohibited lodging for nonessential visitors, and Colorado has announced it doesn’t want tourists either. The Outer Banks of North Carolina are shut to nonresidents. The Maine island of North Haven went even further, barring all visitors, including seasonal residents.
History shows that may be the correct call. During the 1918 influenza pandemic, Gunnison, Colo., erected barricades over its highways (“against the world,” in the words of a county physician) and quarantined anyone who entered. Neighboring towns were decimated, but Gunnison’s losses were low. Yerba Buena, an island in San Francisco Bay with a military base and a population of 5,000, locked down for two months with similar results.
Projections of the virus’s spread show the brutal truth: Fellow city dwellers, we pose a threat to everyone else.
But these remote locations are already flooded with visitors who may not be going home for months. Some sort of compact will be necessary, according to interviews with officials in rural and resort towns, second-home owners and coronavirus expatriates.
So, before relocating, consider whether farther truly equals safer, especially if you’ll be far from the kind of vast medical corps found in major cities, as well as friends and neighbors to count on in an emergency.
Lise King, a Select Board member in Provincetown, the summer arts haven at the outer tip of Cape Cod, Mass., posted a Facebook message on Thursday that she found painful to write. She thinks of her town as welcoming, and is proud of its history as a refuge for gay men who fell ill during the AIDS crisis. But that day, she had heard reports about plane after plane touching down at the tiny Provincetown airport.
“TO ANYONE THINKING ABOUT COMING TO PTOWN,” she started. “PLEASE make yourself aware of our circumstances and make an informed choice,” she said. “If you come here and fall ill you are taking a risk that we won’t have the capacity to help you.” By Sunday night, Provincetown had two confirmed cases of the virus, a shelter-in-place order and a parking ban for nonresidents.
For the same reasons, day trippers looking for bucolic, socially distanced hikes are no longer welcome in the ski town of Hunter N.Y., said Sean Mahoney, a councilman. He has shut down the handful of Airbnb properties he manages, though the revenue loss is painful, and he has asked others to do the same.
If you do relocate, drive directly to the house and quarantine in place to avoid inadvertently spreading the disease, Ms. Schull suggested. Bring what you need, so that you don’t take groceries from locals. “We have one supermarket in our town that serves five towns,” Mr. Mahoney said.
Finally, find a way to help. Give to local charities. Ask what officials on the ground need. In recent days, Ms. King has been assembling a volunteer corps, and one of her conscripts is Dr. Scott Adelman, a second-home owner who is a recently retired cardiologist.
“Maybe I’ll backfill shifts at local clinics,” Dr. Adelman said, “or run medical supplies.”
“If we’re going to get through this as a society, everyone’s got to take a piece,” he said. “No one is prepared for this, and no one can do it by themselves.”
‘I Break the Rules Sometimes’
My mom just started chemotherapy a month ago, so she is severely immunocompromised. Our dilemma is figuring out how to protect her from exposure while still caring for her. Do we stay distant from her when she already has so much mental burden from chemo?
MEAGAN WILKINSON, Mission Viejo, Calif.
The Wilkinson family — two parents and four teenage-to-20-something children — all live in the same house. They’re so close that, in ordinary times, their idea of fun is to all pile onto Mom and Dad’s bed to watch “The Bachelor.”
But in late January, Diana, a 56-year-old math teacher, learned she had a rare, aggressive form of endometrial cancer and a 50/50 chance of survival. Her husband and children have been told to keep their distance, because chemotherapy has left her vulnerable to infection. The family is especially jittery because one daughter recently returned from Italy after her study abroad program skidded to a halt. Another is a U.S. Marine who spends weekdays on a base where others have tested positive for coronavirus. Meagan has become the enforcer, telling her mother to separate herself. Mrs. Wilkinson feels hurt. Meagan feels guilty.
So the Wilkinsons are living a more acute version of our collective dilemma: longing for connections they once took for granted, terrified of making mistakes and unsure how to get through the coming months.
“I break the rules sometimes,” Mrs. Wilkinson confessed, choking back tears. “‘Just put on some clean clothes and lie down next to me,’” she said she tells her children when she can no longer bear being several feet away.
To seek help for the Wilkinsons, and the rest of us, I turned to authorities on how to cope with social distancing: therapists who advise cancer patients and their families, including during treatments like stem-cell transplants, which can involve prolonged isolation and other measures to guard against infection.
Ian Sadler, a psychologist at Columbia University Medical Center, gently dismissed Meagan Wilkinson’s fear that she would damage her mother by not hugging her. Distancing can be an act of care, he said. A lack of embrace is now an embrace.
Allison Applebaum, a psychologist at Memorial Sloan Kettering Cancer Center in Manhattan, worried about the burden on the Wilkinson children. Maintaining complete distance and cleanliness, monitoring contact and food, is “an enormous source of anxiety,” she said, for them and now everyone else. “You can’t do it perfectly a hundred percent of the time.” Note to everyone who is wiping, washing and Clorox-ing these days: in some cancer caregivers, the responsibility of constantly trying to eliminate germs contributes to post-traumatic stress symptoms, she said.
To find a substitute for cuddling, Dr. Applebaum suggested an exercise she does with her patients. If a father longs to play ball outside with his son, she asks him: “What was it about playing ball in the backyard that was meaningful? Was it about the ball, or was it connecting with him?” The goal is to find an alternate activity that delivers similar satisfaction.
Some of her current patients have only a few months to live and, because of the virus, are now being forced to cancel final-wish, bucket-list trips they had planned to take this spring. She asks them: “What is it about going to Paris that’s so special? Is it the physical act of getting on the plane, or is it a memory you wanted to recreate in Paris?”
After hearing that advice, Mrs. Wilkinson said she was trying to find new ways to be with her children, and to feel less wounded when they step away. As her family watches movies in the living room, she does too, from a balcony above them. Last weekend, she was content to watch as they played music and joked in the sun.
But as Dr. Applebaum suggested, perfect adherence is elusive. Sometimes Tommy Wilkinson, the youngest, swoops in for a furtive hug. “Nobody’s looking,” he says.
Grace Ashford contributed research.
Please send your dilemmas, or suggestions for this column, to dilemmas@nytimes.com.
