Surviving at the Center of Coronavirus
Since New York City became the center of this Covid-19 pandemic, we have been uplifted by your messages of concern and well wishes. Truly, deeply thank you.
(Morning by Alvis Upitis)
Coronavirus has impacted our family, our team, our business intimately and in unpredictable ways. We are fortunate to have survived, but many did not. Social distancing is keeping us all so isolated from one another at a time we most need the support. For me, reading stories about other people’s experiences has been helpful in giving me perspective and making me feel less alone. I have been quiet for some time and am finally ready to talk about why.
For over a month I have struggled to write this story, unsure if I should share and how much of my story to tell. None of us were prepared for the magnitude of this coronavirus crisis, and it is far from over yet. I share my personal experience here in the hope that it may help us all stumble forward with a bit more understanding, caution, and empathy.
(New York Times)
Coronavirus in New York
Memorial Sunday, the New York Times dedicated its front page as a tribute to the ~100,000 lives lost to coronavirus in the United States. Just two months ago, Americans were horrified when the national death toll surpassed one thousand. Against this devastating backdrop, Covid-19 has hit New York City especially hard. The reasons for this are not yet clear. Of the roughly 350,000 coronavirus deaths recorded to date worldwide, one out of every eight killed by the virus lived in the New York tri-state area.
Covid-19 Statistics Underestimate Actual Death Toll
Covid-19 is believed to have killed over 22,000 people in New York City alone. Only ~17,000 fatalities are officially listed as “confirmed or probable” Covid-19 deaths, but there is little doubt that these numbers significantly underestimate the actual death toll of the virus—not just here in NYC, but across the globe. The gross inadequacy of testing and diagnosis capacity led to thousands of deaths being hastily miscategorized with uncertain causes listed on death certificates and therefore undercounting of viral victims. Instead, tracking increases in average population death rates may be a simple way to estimate the pandemic’s actual death toll. In April 2020, the number of overall deaths in NYC was over six times normal.
The CDC now acknowledges 5,293 more deaths in New York City not previously counted were likely directly or indirectly caused by the virus. The actual numbers are almost certainly even higher but will never be precisely known. Pandemic statistics can seem abstract until they suddenly touch your own life. Thousands more deaths due to Covid19 may never be counted in coronavirus tracking statistics. One of the uncounted was my father, who died at home on April 13 at the apex of the crisis here in NYC. April showers that day gave way to a double rainbow over Manhattan at dusk.
My father
Takashi Yonetani, immigrated from Japan to the US as a young man to complete his PhD research and pursue a scientific career. He was deeply devoted to his work and eventually became a respected research professor at the University of Pennsylvania, where his laboratory studied how iron-binding heme proteins like hemoglobin change their shape and functionality in the body. He also raised me alone for the better part of my young life.
After recently retiring, he moved from Philadelphia to New York to spend more time with me and my family. In good health, my father took up residence in an independent elder living community in upper Manhattan, an easy subway ride from my home. The coronavirus lockdown led to choices that dilated the distance between us.
Though he was just three miles away, I last saw my father in mid-March, as the emerging pandemic was finally declared a national emergency. At that time, there were 1,701 known cases and 40 deaths associated with Covid-19 in the US. Less than two weeks later, those figures had grown exponentially to 82K confirmed and over 1K fatalities, bringing the US to lead the world in Covid cases.
In retrospect, it is easy to see how different decisions early on could have saved lives. But for most of us in February and early March, it was hard to comprehend the magnitude of the threat coming our way. We did our best with the information that we had to choose the safest and most beneficial path forward for our family, our team, and our customers. The reality of this pandemic is that any viable protection strategy has its vulnerabilities, negative consequences and limits in sustainability.
Covid-19 Took Us By Surprise
For five days before he died, my Dad had a mild fever. My immediate reaction was that it couldn’t be Covid-19 because he didn’t reveal his experience of other problems or potential symptoms. In our lockdown situation, I was not able to see for myself. I informed the residential staff that he had a slight fever, so that they were aware and could keep an eye on his well being. Greater transparency from care staff at that point would have changed how I spent my father’s last days, but I’m not sure it would have changed the outcome. On the day of his death, I still did not want to believe that he had been infected.
Covid-19 is not mentioned anywhere on my father’s death certificate because the only screening he had was a medical examiner, asking me by phone in the middle of the night, whether he had Covid-19. I had not seen him in person for over a month and knew only what he told me. I responded honestly, “He’d had a low grade fever for several days, but I was not aware that he did.” Today I would answer differently. It seems absurd that my own judgement determined how my father’s death was recorded.
The overwhelming rate of deaths in New York in April was more than the system could bear. Around 800 people were dying each day, and bodies whisked away without family viewing were accumulating so fast there was no place to put them. Funeral homes and morgues were stretched beyond capacity. Temporary banks of refrigerator trucks were stationed around the city to house the backlog of corpses awaiting processing. My own father was put in such storage while on an outsourcing waiting list for cremation out of state in Connecticut. It was a full month of indefinite waiting before I finally received my father’s cremains, still in lockdown without the chance to honor or ritualize the experience in usual ways with a circle of support from friends and family.
Without Testing, Cases with Unusual Covid-19 Symptoms Evaded Diagnosis
Many coronavirus deaths are elusive because they manifested in diverse symptoms not yet widely recognized as presentations of Covid-19. Early on, fever and breathing problems were considered standard hallmarks of this disease. But it is becoming clear that some patients may never exhibit febrile or respiratory symptoms at all. Instead many people manifest in entirely different ways, many of which are shown in the table above. Gastrointestinal distress—diarrhea and vomiting—turn out to be extremely common in Covid patients. Some people show neurological disturbance in the form of distress in altered senses of taste/smell, loss of appetite, excessive sleep, mental confusion, disorientation and withdrawal. Both GI and atypical behavioral presentations may be particularly common in elderly patients.
I know now that my father was not open with me about how ill he may have been. I think I understand that he knew he was sick and wanted to see it through on his own because he did not want to die alone in a chaotic Covid-ravaged hospital. I wish I had known earlier, but I am not sure what anyone could have done at that time to change the outcome.
I realize now, that I saw evidence of many “atypical” symptoms in FaceTime calls in his last days. His texts became hard to decipher, full of mistyping not typical of him. I thought this might be a consequence of the noticeable increase in his hand tremors. There was confusion and difficulty remembering. He did appear to be sleeping much of the day, suddenly dispensing with grooming and dressing as he usually would even when staying at home. Individually these observations could have other explanations, not the least of which is natural deterioration of one’s physical and emotional state after being forced into solitary confinement for many weeks. It was not until two weeks later, when I understood that he had been living in the middle of a major Covid-19 outbreak.
More than a third of US coronavirus deaths have been in elder long term care communities. These facilities bring together many risk factors—large groups of vulnerable individuals, in enclosed spaces with shared facilities, services and staff with inadequate protective equipment, sanitation, training or testing resources to identify and contain cases. To make matters worse, New York state government policy allowed and even required the acceptance of Covid-19 patients into nursing care facilities to keep hospital beds open. “It was a fatal error” that likely fueled the spread of infection among these sensitive populations throughout the state. Several thousands of lives may have been ended early because of this policy choice, which was only revoked on May 10.
My father resided independently in his own apartment at the Isabella Geriatric Center in a building that also housed a huge nursing care facility. Since late March, no visitors were allowed at the center and independent residents encouraged to stay self-isolating in their individual apartments with contactless doorway meal delivery. I believed my father was safer at home; I was wrong.
It broke my heart to learn about the coronavirus outbreak at Isabella from the news. This is the largest known outbreak in any single location known to date. For weeks, the center had maintained closed walls and delayed disclosure of ~100 coronavirus deaths that had taken place inside. Two weeks after his death, when I was finally permitted to enter the facility, a refrigerated trailer truck morgue was parked in the back of the building. This had sadly become a familiar sight at hospitals around the city, but it was the first time I’d seen one at a residential location.
The lights and TV in his apartment were still on. No one had entered his room during the two week “quarantine” period. My father was an obsessively organized person, and his living space usually reflected this. An accumulation of untouched meal trays and soiled clothing and sheets revealed that my father had experienced loss of appetite and gastrointestinal distress in his last days. As I cleaned up the mess and emptied the refrigerator, I finally understood how my father had died.
It’s hard not to look back on a loved one’s death by a chance encounter (such as a viral infection) without thinking of all the ways it might have been avoided. These are demons that having the company of others, the solace of routine or distraction of outlet activities or travel can normally help to heal. During this pandemic lockdown, most of us who are grieving have had scarce access to any of these tools. Looking back, there are many things that I wish I could have said or asked of my father. However, with the big decisions about how to best protect my father, children, staff, customers and business, I believe we did the best we could with the information we had.
The impacts of this coronavirus pandemic have been so profound, it is difficult to separate the personal from professional. The nature of lockdown, the constraints put upon all of us to better protect ourselves, blurred the lines between normally compartmentalized facets of life. Here in NYC, most people I know have been touched personally by tragedy caused by Covid-19. While, the impact on other regions may never be as severe, it is rising in other parts of the country where others may yet experience some version of what we have.
Business Continues: A Look Back at the Past Three Months
The disruption of normal life rhythms caused by the global coronavirus lockdown have deeply confused the passage of time. These past three months seem to have simultaneously dragged on interminably and chaotically raced by in an instant. As our family dealt with the passing of my father, business pressed on amidst the challenges of working under lockdown.
The Ides of March
America finally awoke and rushed to catch up to the reality of the coronavirus threat in March. In New York, the progress of dramatic public policy changes felt swift but was in fact too little too late. Within ten days, life went from normal to lockdown.
March 11: NYC declares state of emergency (100 NYC cases)
March 13: Covid-19 declared a US “national emergency”
March 16: all NYC schools close
March 17: all NYC restaurants & bars close/ stop on-site service
March 20: NYC Shelter-in-Place Lockdown
March 22: All NY state “non-essential” businesses close
Food Shortages and Surges
Essential to basic survival of any society, the food system had to remain functional. The pandemic has been a deadly blow to so many in the food industry, affecting the restaurant and food production sectors in very different ways. The lockdown has been most uniformly devastating to restaurants, businesses that often operate on very thin margins even at the best of times. Pivoting to take-out and delivery failed to help most restaurants, actually increasing both financial losses and exposure risk. As the months of lockdown have continued, many of our favorite independent venues are unlikely to reopen. While restaurants and their suppliers saw their business evaporate overnight, those of us who support the grocery food sector experienced huge and often capricious fluctuations in demand determined by Covid-19 dynamics.
As a company, we faced tough decisions—whether to continue making natto and if so, how best to do so safely. We firmly believe that natto brings benefits to those who consume it and that it is exactly the kind of healthful, nutrient-dense, probiotic food we need more access to, now more than ever. We decided that we can do more good for public health by continuing to provide our natto.
We and other workers in essential industries faced a very different experience from those able to “work from home”. Our natto production depends on the health and happiness of our NYrture team. We were committed to doing our best to keep our people safe and employed. Everyone on our team chose to keep going, to keep coming to work throughout the pandemic. As the level of viral threat grew exponentially in NYC, the everyday risk felt palpably real. I am so grateful to each and every one of our team for their commitment, courage, and hard work. As things turned out, we’ve been working harder than ever during this pandemic to meet the growing demand for natto and to overcome multiplying logistical challenges.
The Kids are Not All Right
With less than a day’s notice, the entire NYC school system shut its doors on March 16. My sons (9 & 12) were suddenly homebound; at first for a projected five weeks, but then extended indefinitely for the foreseeable future. For all working parents, it has been tough juggling full time childcare, education, and family entertainment while trying to get work done in lockdown.
The online learning programs that teachers had to pull together overnight are mostly busywork that may keep even the most motivated kids occupied for a few hours a day at best. These platforms also require that each child have internet access and a device appropriate for utilizing the various programs needed to complete assignments; which is not even a possibility for many children. Even with all the right tools in hand, navigating between the many different platforms is complicated and for young kids, requires a fair amount of assistance and encouragement. This is not how kids are used to learning, without physical contact with teachers or classmates. After nearly three months of virtual learning, all parties are fatigued. Not to mention, our rambunctious boys are bouncing off the walls of our small NYC-size apartment day after day!
Work-Life Choices
The work-life balance is an even tougher puzzle for essential workers continuing to labor outside the home. My husband Zach (and company co-founder) and I have been lucky to be able to trade off mutual childcare and business responsibilities. Even so, the calculus of keeping our business viable, nurturing our kids through a difficult time, and minimizing Covid-10 exposure risk for all parties involved was complex.
Thinking through the possibilities rationally and relying on the available data in March, we came up with a plan. Since March, the only solution we could find was for me and my husband to alternate days at home juggling online schooling children with days commuting to work at our natto facility in Brooklyn.
Within my immediate family in NYC, it was my Dad who was the most vulnerable among us and whom I was most worried about. I knew that if any of us became infected and even sick with Covid-19, the odds were that our children were very likely to be fine and also the least likely to exhibit symptoms. For the last few years, my father had often helped me by picking up my kids from school. Because of the growing threat in NYC, I had asked him to stay home and away from us in early March because I felt, with us continuing to work and commute by subway, that visiting our family posed the biggest exposure risk to my father. I was mistaken.
Protecting our Natto
There is no evidence of Covid-19 transmission through food or food packaging. However, our understanding of novel coronavirus biology is still at an early stage and continuously evolving. So at this stage, I think we can say with confidence that the risk of Covid-19 infection directly through food is extremely low. I can also assure you that we have been using every precaution to protect our products from any possibility of viral exposure.
Keeping any microbes other than our probiotic cultures out of our natto is at the core of our manufacturing practice. Even before Covid-19, we had always used extremely high sanitary standards throughout our natto production process, above and beyond health safety requirements. For example, wearing medical-grade personal protective equipment (gloves, face-masks & head coverings) during food production is normal standard practice for us. All food handling is performed in an air-filtered “clean” room where all outside footwear and clothing never enter and work surfaces & equipment are sterilized constantly. Unlike many food manufacturing processes, all our production methods were consciously designed to maximize protection from microbial contamination.
When we decided as a team to keep producing natto through the pandemic, we implemented many additional precautions to protect our staff and facility. Hourly hand washing, daily temperature checks, and paid leave for staff with any hint of unwellness. As a small team, we are able to organize our workflow to accommodate 6-foot social distancing for virtually every part of our process. During processes when we are working more closely for brief periods, we always wear personal protective gear. Now more than ever, our natto operations adhere to the sanitary safety standards of a laboratory rather than a kitchen.
Our team was able to limit the level of Covid-19 risk inside our facility, but we had little control over what was happening outside in the city at large. For example, we couldn’t avoid the exposure risks of commuting to and from work by subway every day, the way many of us do in typical New York fashion. NYC’s public subway system may have been a major transmission vehicle for Covid-19, accelerating its spread throughout the population in March. Back then, confused messaging about the utility of mask-wearing and use of other protective gear had millions of New Yorkers completely exposed and mingling in crowded, enclosed subway cars daily. In this crowded city, there are many more daily points of contact and risk that are difficult to avoid completely while continuing to work outside the shelter of home.
Need Natto?
March brought a wave of panic shopping, as people rushed to stock up on groceries and emergency supplies. Toilet paper, batteries, pasta, eggs, but natto? Despite our own convictions that natto fills a very important set of nutritional needs, we honestly were not certain how far up your priority list natto would remain. In Japan, natto was among the leading pandemic grocery items disappearing from store shelves. As the crisis unfolded here, we saw many of our friends and colleagues in the food business experience unpredictable feast or famine. Thanks to you, our customers, for showing us loud and clear that the need for natto was stronger than ever. Gratefully, in March we had the biggest surge in natto demand we had ever seen.
April Showers
In April NYC became a ghost town. Millions of New Yorkers were staying home; while others who could, had fled town for more spacious shelters. City subways were empty except for commuting workers, notably, overwhelmingly persons of color supporting all of our essential services. Outside, other than the few commuters, streets and public spaces were eerily vacant but for those who had nowhere safer to go.
New York City had always felt safe to me because one is constantly surrounded by a diverse crowd of people. Suddenly that human safety net all but disappeared. The empty streets and subways became home to many more of the already disenfranchised and marginalized who were only further challenged and facing more desperate needs as a consequence of lockdown restrictions. For the first time in all the years that I’ve lived here, I felt ill at ease walking around on my own. Adding to the stress of the lockdown in the face of a microbial threat, we also faced greater risks to personal safety.
The New York subway system, normally packed with people, echoed with emptiness and reeked of excrement. No surprise since ~20% of the transportation and NYPD workforce were out sick or in quarantine, unable to maintain a safe and clean environment. In April, one of our team was harassed and stalked by a stranger on her way home at 5pm on a subway. Fortunately, she was unharmed and had the presence of mind to bravely confront the person and use words to compel the man to leave her without incident. She was naturally quite shaken up, so we instituted a subway buddy system by which we would travel to and from work in pairs. Deeply concerned for our team’s safety and peace of mind, we went through some work to acquire personal pepper spray and electric tasers for protection. Never before, have I considered using these tools of self defense, but during the darkest days of April I kept them close at hand as we were working around the clock.
Covid-19 trickle down effects challenged us each week in unpredictable ways. We were working seven days a week, to keep up with the demand for natto, but each week, demand shifted as a consequence of viral dynamics and human responses to it across the country. In March, as in Japan, natto was flying off store shelves on the East and West coasts. Stores where virus spread and panic shopping were gaining most momentum, were needing far more natto than usual. In March, FreshDirect, one of the largest grocery delivery services ion the region, began selling our New York Natto Original and allowed us to reach a huge new audience. This partnership was fortuitous in timing, because as March drew to a close, the retail grocery landscape shifted again dramatically.
A Rapidly Changing Retail Landscape
Overnight, grocery stores had become the primary source of food. During the first critical weeks of the pandemic, grocery store workers were swamped with unprecedented sales leaving shelves stripped bare. In this period, grocery staff and cashiers were frontline essential workers providing service to hundreds of customers daily without PPE. As coronavirus cases and deaths grew exponentially, it is no surprise that many of these grocery staff became ill and/or quarantined themselves. Employee infections resulted in many sudden quarantine closures of small, independent stores who, unlike larger chain stores, do not have the additional staff or resources to remain open. In other cases, small specialty food shops found that the lockdown and local exodus in certain neighborhoods had simply reduced customer traffic too much to remain open. Most of these older, family-run stores also didn’t have well developed websites in place to allow them to transition to online commerce with delivery or pickup. The majority of our local retailers in the New York area are stores of this kind, so our hometown retail landscape has fluctuated unpredictably.
In stores that did remain open, new standards of social distancing dramatically changed the way we shop. Stores and homes in New York City generally do not have a lot of room to spare. Creating appropriate social distance has meant severely limiting customer entry, creating long lines and wait times at popular stores. Many of our most beloved retailers (e.g. Park Slope Food Coop) had to find ways of better protecting their customers by reducing the number of items crowded together on store shelves. Also, inventory streamlining was necessary to accommodate shortages in operational staff everywhere. Customers were not browsing, looking for unusual items, most were spending minimal time in stores quickly gather standard staples. It was not possible to predict how store demand would fluctuate. Some of our best stores trickled to a halt, perhaps because much of their clientele had left town. Other smaller stores had far higher demand for natto than before, perhaps because other sources, both domestic and imported, had become less available.
As the weeks passed, empty store shelves began to reflect breakdowns in the food supply chain more than overwhelming demand (with the exception of toilet paper!) People were getting sick in greater numbers, leading to even more quarantine absences in every sector globally, and this was starting to affect the availability of items and, further down, the materials needed to manufacture those items. Distributors and store staff were also stretched thin; even the biggest operations were overwhelmed by the sudden changes in supply and demand. Even Fresh Direct was unprepared for the combination of surging delivery demands and severe staffing shortages that came at once. After a successful debut on FreshDirect, they were forced to temporarily reduce complexity and simplify their inventory, which meant discontinuing specialty items sourced from individual producers like us. In the month of April, and for reasons could not be helped, we lost business from the majority of our retail outlets. All of them apologetic, wishing that they could do otherwise, but we were all doing our best to survive a set of circumstances none were prepared for.
When it Rains
Coronavirus illness and absences affected every type of essential business trying to remain operational, including our own. In the interest of transparency as well as to share evidence that our safety practices are effective, I will share our own company’s story. We are confident that we did our best to instill safest practices for all our team at work and provided them with PPE to use outside. Yet, one of our team, we’ll call “B”, fell ill, calling in sick with a fever. Luckily, because we had all been putting in irregular schedules of weekend and overtime hours, she had last reported to work four days prior. The same day B fell ill, my father died.
According to the latest CDC and clinical research understanding of Covid-19’s incubation and transmission behavior, there is general agreement that the primary transmission risk occurs after symptom onset and typically declines over the course of 7-14 days. Some researchers also believe that viral shedding may take place during a short period of 1-3 days prior to symptoms in some individuals. So we felt reasonably confident that the risk of transmission within the workplace was relatively low, even without the stringent use of PPE and other precautionary measures we had in place.
The state of emergency in NYC was so high, it took the better part of the day to get a response from her physician, who could only assist her remotely. She could not be tested; there were none available. But her developing symptoms were mostly typical of Covid-19—high fever, extreme fatigue, increasing difficulty breathing, and a strange metallic taste that didn’t leave her for many weeks—such that she received her Covid-19 diagnosis by inference. For over two weeks, she battled and thankfully overcame the virus at home. Though, weeks later, the fatigue and strange metallic taste lingered with her.
We were faced with another difficult decision of how to proceed and asked the opinion of everyone on our team. One person, who lived with a high-risk family member, chose to quarantine and do what work she could from home for two weeks. Our remaining team committed to keeping our ship afloat, while adhering strictly to all our safety procedures and vigilantly monitoring for symptoms each day. Reeling from the temporary loss of two workers and the permanent loss of my father, we worked through our toughest month ever without any more apparent illness. This gave us confidence that the safety practices we followed were effective.
May Flowers
By May, the coronavirus situation showed signs of approaching control in NYC and our full staff returned to work. But many of the aftereffects of the pandemic are still playing out now, as the virus continues its spread across the country and globe. Outbreaks and business closures or slow-downs have affected the supply and distribution of every kind of product. Since the pandemic began, we’ve experienced unexpected shortages and delivery delays in virtually all of our key ingredients, glass jars, PPE, packaging materials, shipping supplies. Each of our shipping carriers, especially USPS, have had breakdowns in service as system-wide staff shortages due to isolated local outbreaks at various distribution centers. It has become a joke at work to anticipate what the new “crisis of the week” will be. It has been a terribly challenging spring, but we are truly grateful to have made it to the other side.
It was you who came to our rescue over the last couple of months and told us that it was worth it. As the physical act of shopping became more fraught, stressful and time-consuming so many of you turned to sourcing the foods you care about directly from producers like us. It will be interesting to see how this shift towards contactless delivery will affect the food industry long term. In April and May, it was your direct support and requests for our natto that kept us going! And the daily 7 o’clock cheer was a bright spot each evening, when citizens have opened their windows to let out cheers of gratitude for our essential workers and hope for the future.
Looking Forward
As America begins to reopen, I am at once at once filled with optimism and apprehension. Ending our national pause is an inevitable necessity; we cannot handle living in a state of emergency much longer economically, socially, physically nor emotionally. Like other coronaviruses before it, Covid-19 is not going away anytime soon. Our best defensive strategic options—vaccines or natural herd immunity—may take years to develop and implement. We need to find a way to live well and more safely with it.
It would be impossible not to acknowledge the other great change of late, the tragedy of George Floyd’s murder, which tipped off an explosive social uprising. Protests across the nation are releasing years of frustration and anguish against the injustices of a system stacked against racial lines. Perhaps this pandemic has unmoored the established system just enough for a path to real reforms to seem possible. We are thinking hard about how our company can participate and contribute towards positive change. The Covid-19 crisis has disproportionately affected communities of color all across America and we have pledged to donate 10% of all natto sales in June towards helping the effort to bring better testing, healthcare and other forms of coronavirus support to African-American communities through the BET + United Way COVID-19 Relief Fund.
As the coronavirus crisis is waning in New York, we’re seeing it surging in other parts of the country, I share this story in hopes that it may help us all stumble forward with a bit more understanding, caution, and empathy. Please take precautions, protect yourselves, and others. Ironically, it will take all of us to come together to get through this, while we are physically apart.
Wishing you all well,
Ann
