Three months ago, no one knew that SARS-CoV-2 existed. Now the virus has spread to almost every country, infecting at least 446,000 people whom we know about, and many more whom we do not. It has crashed economies and broken health-care systems, filled hospitals and emptied public spaces. It has separated people from their workplaces and their friends. It has disrupted modern society on a scale that most living people have never witnessed. Soon, most everyone in the United States will know someone who has been infected. Like World War II or the 9/11 attacks, this pandemic has already imprinted itself upon the nation’s psyche.

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A global pandemic of this scale was inevitable. In recent years, hundreds of health experts have written books, white papers, and op-eds warning of the possibility. Bill Gates has been telling anyone who would listen, including the 18 million viewers of his TED Talk. In 2018, I wrote a story for The Atlantic arguing that America was not ready for the pandemic that would eventually come. In October, the Johns Hopkins Center for Health Security war-gamed what might happen if a new coronavirus swept the globe. And then one did. Hypotheticals became reality. “What if?” became “Now what?”

The new coronavirus has brought American life to a near standstill, closing businesses, canceling large gatherings, and keeping people at home. All of those people must surely be wondering: When will things return to normal?

The answer is simple, if not exactly satisfying: when enough of the population—possibly 60 or 80 percent of people—is resistant to COVID-19 to stifle the disease’s spread from person to person. That is the end goal, although no one knows exactly how long it will take to get there.

There are two realistic paths to achieving this “population-level immunity.” One is the development of a vaccine. The other is for the disease to work its way through the population, surely killing many, but also leaving many others—those who contract the disease and then recover—immune. “They’re just Teflon at that point,” meaning they can’t get infected again and they won’t pass on the disease, explains Andrew Noymer, a public-health professor at the University of California at Irvine. Once enough people reach Teflon status—though we don’t yet know if recovering from the disease confers any immunity at all, let alone lifelong immunity—normalcy will be restored.

For his entire adult life, and for his entire presidency, Donald Trump has created his own alternate reality, complete with his own alternate set of facts. He has shown himself to be erratic, impulsive, narcissistic, vindictive, cruel, mendacious, and devoid of empathy. None of that is new.

But we’re now entering the most dangerous phase of the Trump presidency. The pain and hardship that the United States is only beginning to experience stem from a crisis that the president is utterly unsuited to deal with, either intellectually or temperamentally. When things were going relatively well, the nation could more easily absorb the costs of Trump’s psychological and moral distortions and disfigurements. But those days are behind us. The coronavirus pandemic has created the conditions that can catalyze a destructive set of responses from an individual with Trump’s characterological defects and disordered personality.

In the emergency-department waiting room, 150 people worry about a fever. Some just want a test, others badly need medical treatment. Those not at the brink of death have to wait six, eight, 10 hours before they can see a doctor. Those admitted to the hospital might wait a full day for a bed.

I am an emergency-medicine doctor who practices in both Manhattan and Queens; at the moment, I’m in Queens. Normally, I love coming to work here, even though in the best of times, my co-residents and I take care of one of New York City’s most vulnerable, underinsured patient populations. Many have underlying illnesses and a language barrier, and lack primary care.

I can pinpoint the exact moment I started feeling off. My partner, Will, and I were on a bike ride on the afternoon of Wednesday, March 18, to escape our apartment and get some exercise. This was back when leaving a New York City apartment to get some exercise was still okay, or at least that’s what we’d read, or at least that’s what we thought? If the coronavirus pandemic has taught us anything, it’s that what is considered dogma today might change tomorrow.

Ten minutes into our bike ride, I was overcome by an intense fatigue. “I think I have to go back,” I said.

Back home, I felt chilled. Took my temperature: 99.1. I’m normally 97.1, but still, not a huge deal. We’d been so careful about wiping down doorknobs, washing our hands, and keeping everyone except for our family out of our apartment. I’d been ambiently worried enough that my 13-year-old son could be a silent carrier of the virus that I’d yanked him out of his public middle school and off the crowded subways four days before Mayor Bill de Blasio pulled the plug– (far too belatedly, in my opinion). I was getting over a urinary-tract infection, so my fever, I thought, must be from that.

By now, the global timeline of the coronavirus’s development has been well established: The first case reportedly appeared in mid-November; in December, the Chinese government was still attributing hospitalizations to a peculiar form of pneumonia; through January and February, the outbreak began spreading around the world; and its epicenter is today firmly in Europe and the United States.

Throughout, another set of events were occurring here in India. Late last year, Prime Minister Narendra Modi’s Hindu-nationalist government introduced and passed a controversial new law, ostensibly in support of minorities in neighboring countries, that in fact openly discriminated against Muslims and undermined India’s secular foundations. Then, early this year, protests over that new law snowballed into a pogrom in which dozens of people—mostly Muslims—have been killed.

Two weeks ago, a man came to an emergency room in New York with pain in the lower-right quadrant of his abdomen. A CT scan showed inflammation around a fingerlike projection at the base of his colon. Combined with a fever, this was a classic case of appendicitis. Surgeons took the man to the operating room and removed his appendix.

The next day, recovering upstairs, the man still had a fever. Doctors ordered a test for the coronavirus. A day later, his results came back positive.

Under usual circumstances, a person with a dangerous, infectious respiratory disease such as COVID-19 requires special precautions in a hospital. Everyone who enters the patient’s room—even to ask how they’re doing or to pick up a lunch tray—is required to don a fresh gown, gloves, and a mask. If the worker must get in close contact with the patient, the mask has to be an N95 respirator, and a face shield is required to guard the eyes. Without exception, every piece of this gear must be discarded in a biohazard dispenser upon leaving the room. An errant mask or glove or gown, coated in virus, can become lethal.

Hello fellow New Yorkers. You want to leave. So badly. I know. Me too. But don’t. Don’t do it.

It is absurd at this point that it’s even your choice. The bridges should be closed to all but essential traffic. The airports should be shuttered. Instead, Hertz is still renting cars at its 17 Manhattan locations, AirBnB is listing “Corona free” homes in New Jersey, and airlines are offering (apocalyptically cheap) tickets from all three New York airports to Anywhere But Here.

I know all that because I spent one morning this week Googling a dozen possible escapes, in a moment of claustrophobia and panic. I share 900 square feet with two kids and a dog. My wife is a physician who is still seeing patients. And even though I trust her precautions and protocols, I can’t shake the feeling of dread. Mixed in with the uncertainty is the certainty that everything is going to get much, much worse, as the cases spike and people I love or know or admire begin to die. My impulse is to do something—to move, to flee. I’m sure virtually everyone else in the city feels the same way.

In times of upheaval or natural catastrophe, the State Department often advises Americans to avoid some of the world’s poorest nations. When ISIS took over large parts of Syria and Mali descended into civil war, the federal government implored Americans not to go to those countries. One of the pieces of advice it offers to those who insist on visiting them anyway is rather blunt: “Draft a will.”

These warnings speak to a set of assumptions so obvious, they seem almost silly to spell out. America is a rich and stable country. So long as U.S. citizens stay home—or restrict their travel to other developed nations—they are likely to remain safe. Travel warnings tend to flow from north to south, rich to poor, democracy to dictatorship.

Between the time this sentence was written and the time this article is published, hundreds more Americans will likely have died from COVID-19. Hundreds or perhaps thousands more people will have been hospitalized, and certainly tens of thousands more will have tested positive for the coronavirus. At this point, making predictions about the pandemic is like riding a barrel over Niagara Falls: We can only guess how it ends, but we do know things are going down.

Here’s another prediction that’s safe to make: The city of New Orleans—and, potentially, all of Louisiana—is going to become the next front in the fight against the pandemic. Even as national attention is justifiably focused on the aggressive outbreak in Washington State and the mounting pressures on New York City’s hospitals, the virus’s advance in Louisiana has shaken local officials and doctors, and the state is already approaching a similar burden of infections and deaths as the crises to the north. There’s good reason to believe that this southern outbreak will be even more difficult to contain, and is perhaps a better harbinger of what’s to come as the pandemic spreads across the country.