By April 1, the country had effectively shut down.  New York City was in full surge, as healthcare providers around the country were following New York’s plight, including shortages of PPE and struggles to meet ICU resource demand. Several New York healthcare providers were journaling about their experiences, moral distress, and essentially combat fatigue (see, for example, ). For those who had missed the March 31st briefing about predicted death tolls, Americans woke up to headlines like this in the Washington Post:

In solidarity, “Flatten the Curve” became the mantra, as economic experts, public health experts and bioethicists began to openly debate the risks and harms of economic shutdown, job loss, and other consequences versus the casualties of opening up “blind” without adequate testing and tracing protocols in place.  New York Governor, Andrew Cuomo’s daily briefings became a national leadership touchstone, and most governors began their own daily briefings by then. Although the first case of Covid-19 in New York City was detected March 1, by April, New York City’s casualties hit 1400; by April 15, New York City’s casualties hit 10,000 and continued to rise, evoking a crisis not seen in that city since 9/11. By the end of April, the city’s casualties hit 18,000, six times the casualties on 9/11. 

The White House Task Force briefings continued through most of April. But when they clearly attracted a large viewership, the briefings had devolved into a daily spectacle as President Trump decided to usurp the airtime, playing a more central role in fielding the questions instead of the health experts. Many of the briefings dissembled into a de facto “Trump Rally”; frequently, they were vehicles to attack the press, contradict the facts, and promote unproven conspiracy theories, while Drs. Birx and Fauci would practice their best neutral faces as the President confused and gaslighted the public.  

By April 3, after several public health experts provided evidence that mask-wearing reduced infection, the CDC reversed itself about masks. Initially, in an effort to ration PPE and prevent public stockpiling of medical masks, the agency did not recommend masks to the public for those who were not infected. In April, the CDC suggested the public should now consider wearing masks for protection. ( However, when President Trump made clear that he would not wear a mask, while conservative media began to eschew it as a fear-based reaction and an infringement on civil liberties, this critical public health tool morphed into a partisan issue that persisted, helping to distinguish the United States as a failed state with respect to setting public health standards to combat the growing pandemic. By April 4th, this analysis laid bare that the U.S. was amidst a manmade disaster of coronavirus denialism that exacerbated our ability to deal with the pandemic:

Meanwhile, President Trump was encouraging re-opening by Easter weekend 2020, wanting “packed churches” an aspiration completely untethered to reality. Nonetheless, he began tweeting to his base to protest in states with stay-at-home orders and encouraging them to resist mitigation (See: On April 23, during a White House Task Force briefing, President Trump actually suggested the American public might consider drinking or injecting bleach to combat Covid-19. (See:, while Deborah Birx barely contained a look of horror. At that juncture, the White House daily briefings ceased.  

In April, we were in economic free-fall; hospitals were emptied of all non-emergent patients and facing serious budget shortfalls. Most endocrinologists established telehealth clinics, while many endocrine surgeons were home without cases. 

By April 28, more Americans had died from Covid-19 than in the entire Vietnam War. (See: ) As Americans began to applaud their healthcare heroes and essential workers at their grocery stores, the country still remained without a clear plan for testing and tracing that would sound re-opening protocols; PPE was still a problem, an empty and shut down New York City looked like an apocalyptic dystopia, as the country realized it was “every State for itself” without a comprehensive national plan or strategy. Bioethicists by the end of April began to offer frameworks and ethical rationale for re-opening, balancing the harms of mitigation and shutdown itself. In a Hastings Center essay, bioethicists note: “…The question of when and how to reopen the nation is on everyone’s mind. Do we open quickly in an effort to kick-start the economy? Or do we remain under lockdown as long as possible to stop the spread of the virus?  (See: For many, April 30 felt like “March 70th”, a slow-moving disaster.