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On the evening of March 4, James Cai, a 32-year-old physician assistant, was languishing on a cot, isolated in a small, windowless room on the emergency-room floor of Hackensack University Medical Center, when the television news caught his attention. Before that moment, Cai had been in a strange medical limbo, starting midday on March 2, when he left a medical conference in Times Square because he had a bad cough. Instead of heading to his home in Lower Manhattan, he texted his wife that he was going to spend the night at his mom’s place in New Jersey. His mother was out of town, and if he had the flu, he could spare his wife and their daughter, a cheerful 21-month-old who clung to him when he was home, the risk of catching whatever it was. That was Cai: cautious, a worrier, overprotective, the kind of medical professional who liked to rule out the worst-case scenarios first.
At his mother’s home that evening, he waited until about 8 o’clock., when he thought the urgent-care facility nearby would be relatively empty, then headed over for a flu test. If it was not flu, he could think about going home. He put on a mask before the doctor examined him and learned that his heart rate was elevated, which did not surprise him: He could feel the palpitations. He got a flu
and a strep test and asked for a Covid-19 test as well, only because they might as well be exhaustive; but the doctor told him he did not have the test, and neither of them thought much about it after that.
On March 2, many doctors on the East Coast still saw Covid-19 as an ominous but distant threat. Although several elderly people had died by then of complications from coronavirus in Washington State, the outbreak seemed mostly contained to that part of the country. Only two people on the East Coast had tested positive: a health care worker from Iran and a lawyer from New Rochelle, N.Y., whose results were reported the same day Cai went to the doctor. At the urgent-care center, the doctor reported that his chest X-ray looked normal, and the flu and strep tests came back negative. But the doctor was worried that Cai’s symptoms — that cough, surprisingly powerful for something that had kicked in so recently, and an elevated heart rate — were consistent with a possible pulmonary embolism, a clot in an artery in his lung that could prove fatal. He advised him to go immediately to the nearest emergency room, H.U.M.C., where they could give him a CT scan, which would provide a more detailed picture. Cai drove to the hospital and waited for his scan on a cot in a hallway. Not long after, he was moved to the small, windowless room, where he started to feel even worse: short of breath, feverish. He had diarrhea, and the brief walk to the bathroom nearby left him exhausted. He took a video of himself to show his wife, and in it he looks a little wild-eyed; he is breathing fast, as if he has just been chased and whatever was chasing him is right outside the door.
The next morning, March 3, not long after his CT scan, a nurse came to give him a Covid-19 test. The nurse was wearing full
James Cai, 32, in his primary care office in Flushing, Queens, before he fell ill Credit...From James Cai