When I first spoke with Thomas in February, before New York had a single confirmed case, he told me his chief concern: “ICU beds will be limited, and that will mean rationing of expertise in the intensive-care setting. That’s a whole different type of medicine than most of us are used to practicing.” Thomas had spent 20 years in the Army developing “medical countermeasures” against infectious diseases, and, like other military experts who plan for disaster scenarios, he sounded coolheaded in talking about the looming catastrophe. He remained so when he told me on March 16 that his hospital had gotten its first case. At 10 p.m. that day, he emailed and said it had gotten its second. By March 20 he had seven. On Tuesday afternoon he wrote, “We are doing ok. Running out of PPE and trying to build a reliable supply chain.”

When we spoke by phone late Tuesday night, as he was driving home from the hospital, he sounded tired. I asked him to think back to the Disease X war game. The coronavirus “is much worse than what I had envisioned,” he said. “You never think the planets are going to align. You get used to the near misses. I’m taken aback by the scope, the speed, and how relentless it is. It’s amazing.”

Many doctors are nonetheless being asked to operate as usual. Last week an internal-medicine physician with whom I trained in residency told me she’d been chastised by the head of her department for wearing a surgical mask at work. She feels unsafe without one, given the lack of certainty about who has the virus—not to mention the worry that she herself could be an asymptomatic carrier.

Wajahat Ali: Where are the masks?

Across the world, people are implored to avoid contact with anyone outside a small circle of family members or cohabitants. In clinics and hospitals, doctors aren’t doing their job if they are unwilling to get within inches of people, many of whom are in high-risk groups, and often do so without any protection. “This week we got an order that no masks are allowed for routine care and just walking around inside the hospital,” John Mandrola, a cardiologist in Kentucky, told me. He said his initial reaction was opposition, but he has now accepted that shortages demand rationing.

In fact, taking the standard precautions—using fresh masks and gowns—has become impossible in hospitals in the hardest-hit areas, even when treating people with florid cases of COVID-19. One New York doctor told me she keeps her mask in a brown paper bag until it is time to put it on again, though other doctors at her hospital leave theirs lying out on a countertop. Another physician has been taking his mask home and “sterilizing” it in his oven at night.

This reuse of equipment is a form of rationing, though it may not usually be considered as such. It began weeks ago, when the U.S. surgeon general urged people not to buy face masks. It continued last week when the New York Department of Health implored residents to “only seek health care if you are very sick.” It continues in New York with the cancellation of “elective surgeries,” which now include even cancer treatments that can reasonably be postponed. Many if not most sick people are not getting tested, and not everyone will be treated by the doctor they might expect. Deciding who gets to see the chief of infectious diseases and who is relegated to the retired ophthalmologist will involve rationing via triage.