Last Friday the 13th, my neighbor passed away. Gary had a weakened immune system, contracted influenza followed by pneumonia, survived on a ventilator for several days and finally died.

I became profoundly mournful after hearing the news. First and foremost, I’d known Gary to be a good, kind and generous man in the 10 years I’ve lived across the street from him. He regularly helped me with DIY projects, most recently securing the handrail going up my front steps last fall.

Gary spent decades as his mother’s caregiver until she recently moved into an assisted living facility. He always had scrap metal lying around his yard for one welding project or another.

Mario Nicolais

And for me, Gary served as a harbinger of the darkest days still ahead for our country during the current coronavirus pandemic. 

Over the past few months, people have grasped for comparisons to other infectious diseases to understand this one. MERS, Ebola and SARS – which is technically accurate as the disease COVID-19 is caused by a severe acute respiratory syndrome virus, SARS-CoV-2 – have all been compared and contrasted. But no infectious disease has been as readily invoked as the flu.

Up until a week ago, any reference to the flu equated to an attempt to minimize the impact of the coronavirus. As the argument went, the flu kills tens of thousands of Americans annually while the coronavirus has infected only a fraction of that number, much less killed them.

I worked in health care for years, so the flu comparison had the opposite effect on me. The flu claims so many lives precisely because it is so easily transmitted throughout communities. People with few to no symptoms may be unwitting, life-threatening hazards to those around them.

Combined with higher incubation times, hospitalization and case fatality rates, the potential of the coronavirus to spread as far and wide as the flu should terrify everyone. And right now, that potential not only exists, but is playing out in real time.

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The current coronavirus has a slightly higher transmission or reproduction rate, Ro in scientific parlance, than the flu. That is a big reason we see the raw number of new infections jumping every day

The New York Times recently published a morbid graphic that allows readers to compare coronavirus to other diseases in terms of raw deaths. The infection and fatality rates of coronavirus can be adjusted to see the effect on overall deaths. At a 4% infection rate and a fatality rate of 0.5%, both conservative, the coronavirus will kill more Americans than influenza this year.

At 20% infection and 1.0% fatality rates, it ties heart disease as the country’s top killer.

And neither of those scenarios account for the number of deaths caused by an overburdened health care system. Which brings me full circle and thinking about Gary.

Gary at least had a chance. He had an ICU bed and a ventilator. He had healthy staff with adequate time and resources to devote to him. Gary died despite the best health care he could get, not because he was denied it.

But the denial of care is exactly what we potentially face in coming months. Shortages of masks, gowns and other personal protective gear have already affected doctors and nurses. Others have begun to get sick themselves.

The worst will come if the need for ventilators surges past the available supply, an eventuality that may already be reality in places such as New York City. Even if public officials haven’t gotten there yet, hospitals have already begun talking about the ethics of care and how to prioritize patients.

Those are literal life and death choices.

I’m going to miss my neighbor Gary. But at least he had every chance our health care system had available for him. I can’t imagine how people will feel in the coming months if the people they care for don’t.

Mario Nicolais is an attorney and columnist who writes on law enforcement, the legal system, health care and public policy. Follow him on Twitter: @MarioNicolaiEsq

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