These are the best of times for Bernard Kruger, the co-founder of Sollis Health, a concierge medical company in Manhattan that offers house calls for members willing to pay at least $5,000 a year to avoid crowded hospitals.
As coronavirus spreads through New York City, Dr Kruger is doing a roaring trade. “This last month has just been insane,” he said. “I’m getting 75 calls a day, asking: ‘Do I quarantine myself in the Hamptons? Do I stay in the city?’”
Some are willing to pay for more elaborate measures. “The people who are really well-off are saying, ‘Let me establish my own [intensive care unit] in my home’,” Dr Kruger said. “I’ve been called by some people [asking], ‘Can you tell me where to get a ventilator and can you help me set it up?’”
As with so much else in this age of inequality, the rich and the poor have vastly different options as they respond to the lethal threat of a global pandemic. As cases have surged in the US, the wealthiest New Yorkers have sought refuge in second homes in places such as the Hamptons, Aspen, St Bart’s and Palm Beach.
Many are fleeing on private jets, sparing them from crowded airports where they risk infection. “The demand is ridiculous. It is Super Bowl times 10!” said Ricky Sitomer, chief executive of Star Jets International. For a mere $15,900 to $18,900, Mr Sitomer estimated he could whisk a family of four from New York to Florida. “They don’t want to fly commercial,” he said.
By contrast, less affluent New Yorkers were suddenly dealing with challenges like finding childcare on short notice after the nation’s largest public school system shut down on Monday for at least a month, and possibly the rest of the year.
For the working poor, there is the anxiety of deciding whether to heed medical advice and self-quarantine at home or report to work for a pay cheque. And for the 30m Americans without health insurance, there is the risk that coronavirus will saddle them with ruinous medical bills long after it has passed.
“As a general rule, the poor always suffer in crisis,” said David Blumenthal, president of the Commonwealth Fund, a health and social policy philanthropy, and a former professor at Harvard Medical School. While the specifics differ, Dr Blumenthal noted, the health choices of the less fortunate frequently become between the lesser of evils in all crises.
“I suspect that people paid by the hour will be less likely to self-isolate and therefore may be more likely to expose themselves to the virus,” he said, pointing to nursing home attendants and other workers with little fiscal room for error. “This is going to last for months and I’m not hearing that months of paid sick-leave is being discussed [in Congress],” he added.
In some ways, the coronavirus is also proving to be a great — and terrible — leveller. It has infected stars like Tom Hanks and Idris Elba, who may have been vulnerable precisely because of their jet-set lives. It has hit clusters of executives who have attended business conferences in places such as New York and Boston.
Lucian Grainge, the chairman of Universal Music and the most powerful figure in the music industry, was hospitalised this week with Covid-19. In the Hamptons, where fever-reducing Tylenol has become a precious commodity, much of the weekend talk was about a billionaire close to President Donald Trump who is said to have nearly died from it. Those over 70 were particularly terrified.
“You can try to run off to another country but that might not be safe, either,” said William Haseltine, the Harvard biologist who did path-breaking work on HIV. “Where would you go?”
The great vulnerability for the affluent, Dr Haseltine argued, is that they still rely on the working poor. “Wealthy people aren’t just going to isolate themselves and do their own laundry and dishes,” he explained.
Andrew Carmellini, one of New York City’s top restaurateurs, said people in the Hamptons, where many businesses are closed during the winter months, were calling him to see if he could deliver to their homes hours from Manhattan.
In some Park Avenue coop buildings, residents were drawing up rotas to deal with absent superintendents, and panicking at the discovery that a single inhabitant was infected.
“Epidemic diseases have always been social levellers,” said David Rosner, a public health historian at Columbia University. “In some sense, no one escapes.”
A 1832 cholera outbreak led to the establishment of New York’s Greenwich Village, as those with means fled downtown ports for safer ground. From those days on, there has been a stubborn belief that sickness is unnatural to America, and brought to its shores by outsiders — be they Irish or Jews or Haitians or Chinese.
At the moment, Mr Rosner said, wealthy New Yorkers — crammed into apartment buildings and sharing elevators — were engaging in a sort of “magical thinking” about who posed a threat, and who did not.
The wealthiest Americans may separate themselves through concierge healthcare services like the one operated by Dr Kruger. They can provide instant access to primary care physicians in luxurious settings and, he claims, a test for coronavirus — although not one using one of the government’s officially-authorised kits. Not unlike private jets, they may also allow the wealthy to bypass crowded emergency rooms and so reduce their risk of infection.
But once they are sick, it is not clear that such services will spare them from the same public health maths to which everyone else is now subject. (The equation might be even worse in a place like Aspen, which is now suffering its own outbreak but has limited healthcare facilities.)
At that point, patients will require hospitalisation in an intensive care unit, and possibly a ventilator to help them breathe. With the rarest of exceptions in America, that is still determined by medical need. “Once you are sick and in the hospital,” said Dr Blumenthal, “whether you have concierge medicine or not is not relevant.” Given the shortages of hospital beds and medical equipment being forecast by authorities, money may not much matter.
“You can’t find . . . ventilators no matter how much you’re willing to pay right now,” said Andrew Cuomo, the New York governor.
If and when a vaccine or an effective treatment for coronavirus becomes available, that may change. Those with resources are more likely to have access to better and faster treatment, say experts.
In the meantime, the wealthy are being guided by their own wits and jittery intuition, as one fund manager recently discovered after he and his family fled to their New England farm. So, too, they discovered, did a bunch of other New Yorkers. Soon a community of exiles formed.
“We’re getting invites to dinner parties,” the fund manager recalled. Then he realised that they were importing the dangers to the countryside that they were fleeing in the city. “I’m like, ‘Guys, pull your heads out of your ass!’,” he said. “It would be different if you hadn’t just been in New York City. But you have. We’re up here for a reason.”
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