RUTHFULLY YOURS

In 1976, the artist Saul Steinberg drew a cover for The New Yorker — “View of the World from Ninth Avenue” — that became an instant classic. You know the one: Manhattan heavily in the foreground, the Hudson River, a brownish strip called “Jersey,” the rest of the America vaguely in the distance.

It could almost be a map of the coronavirus epidemic in the United States.

Even now, it is stunning to contemplate the extent to which the country’s Covid-19 crisis is a New York crisis — by which I mean the city itself along with its wider metropolitan area.

As of Friday, there have been more Covid-19 fatalities on Long Island’s Nassau County (population 1.4 million) than in all of California (population 40 million). There have been more fatalities in Westchester County (989) than in Texas (611). The number of Covid deaths per 100,000 residents in New York City (132) is more than 16 times what it is in America’s next largest city, Los Angeles (8). If New York City proper were a state, it would have suffered more fatalities than 41 other states combined.

It isn’t hard to guess why. New York has, by far, the highest population density in the U.S. among cities of 100,000 or more. Commuters crowd trains, office workers crowd elevators, diners crowd restaurants. No other American city has the same kind of jammed pedestrian life as New York — Times Square alone gets 40 million visitors a year — or as many residents packed into high-rises. The city even has a neighborhood called Corona, which, it turns out, has among the highest rates of coronavirus infections.

Consider a thought experiment in which metropolitan New York weren’t just its own state, but its own country. What would the crisis for what remained of America look like, then? In this slightly smaller nation of a little more than 300 million people, the death toll would amount to about 7.5 per 100,000, slightly above Germany’s levels.

No wonder so much of America has dwindling sympathy with the idea of prolonging lockdown conditions much further. The curves are flattening; hospital systems haven’t come close to being overwhelmed; Americans have adapted to new etiquettes of social distancing. Many of the worst Covid outbreaks outside New York (such as at Chicago’s Cook County Jail or the Smithfield Foods processing plant in Sioux Falls, S.D.) have specific causes that can be addressed without population-wide lockdowns.

Yet Americans are being told they must still play by New York rules — with all the hardships they entail — despite having neither New York’s living conditions nor New York’s health outcomes. This is bad medicine, misguided public policy, and horrible politics.

On Friday, I spoke with Tomislav Mihaljevic, C.E.O. of the widely admired Cleveland Clinic, and an advocate of the need to use “tailored and discriminating solutions” that also recognize regional differences. At the moment, he says, “We’re using the methodology from the 14th century to combat the biggest pandemic of the 21st century.” It can’t go on.

Dr. Mihaljevic acknowledges the necessity of the lockdowns to contain the virus, along with the urgent need for ramped-up testing and ongoing monitoring. But, he adds, “we cannot hold our breath forever.” The U.S. will not soon be able to test 330 million people. Effective therapies or vaccines may be long in coming. Covid-19 will be “a disease we have to learn to live with.”

That means accepting that the immediate goal of public policy cannot be to eliminate the risk of Covid-19. It is to mitigate, manage and frame expectations for it — while not losing sight of other priorities. In Ohio Dr. Mihaljevic says that Covid patients take up just 2 percent of hospital capacity, and the curve of new infections has been flat for more than two weeks. Yet there has been a dramatic decline in people seeking care for heart attacks, strokes, or new cancers, presumably out of fear of going to hospital.

“The public conversation needs to be about the value of human life in its totality,” Dr. Mihaljevic says. That includes fewer restrictions on activity for people at the low end of the risk spectrum, while taking additional care of those on the high end.

Right now, there’s a lot of commentary coming from talking heads (many of them in New York) about the danger of lifting lockdowns in places like Tennessee. Perhaps the commentary needs to move in the opposite direction. Tennesseeans are within their rights to return to a semblance of normal life while demanding longer restrictions on New Yorkers.

I write this from New York, so it’s an argument against my personal interest. But I don’t see why people living in a Nashville suburb should not be allowed to return to their jobs because people like me choose to live, travel and work in urban sardine cans.

Gina Raimondo, the Rhode Island governor, was on to something when, a few weeks ago, she wanted to quarantine drivers arriving from New York. The rest of America needs to get back to life. We New Yorkers prefer our own company, anyway.

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