When Karli Stahl first moved to Nantucket, she stood on the beach, sand between her toes, and wondered whether she’d made a terrible mistake. There was water as far as she could see, churning and cresting for 30 miles before lapping up against the shores of the Massachusetts mainland. Nantucket had no 24-hour pharmacy. No 24-hour anything. In 2009, Stahl was a new mom, with a baby and a toddler. She'd sequestered herself from her family, her friends and her child care.
“I remember thinking, ‘What the hell have I done?’”
Stahl is precisely the kind of person who most needs to avoid contracting covid-19. She calls herself a “triple-threat”: She’s a diabetic with Stage 4 colorectal cancer in the lungs, currently undergoing her third round of chemotherapy. She also lives in a “medical desert,” according to Nantucket Cottage Hospital CEO Gary Shaw. The first confirmed case of coronavirus on the island was announced Sunday, and more will likely follow. With 17,000 year-round residents, Shaw estimates the island could eventually have as many as 1,700 infected patients, 350 of whom would require hospitalization.
“Well I have 14 beds and three ventilators,” said Shaw. The hospital also has a shortage of doctors, and no intensive care units. “It’s straight math.”
Nantucket is a storied holiday destination for the East Coast elite, its population swelling to approximately 50,000 at the peak of the summer season. In the past two weeks, summer residents have streamed onto the island, retreating to second homes to wait out the virus, straining a medical system already incapable of treating coronavirus for the people who live there year-round.
Nantucket’s only hospital is built for basic care: routine outpatient visits, a broken arm, a birth. If a patient comes in with something more serious, they board a helicopter bound for Massachusetts General Hospital in Boston, where some of the best doctors in the world will be waiting to receive them. But that door will likely close in the thick of a pandemic: Even if the hospital had the capacity to airlift everyone, Shaw said, he suspects the Boston facilities will be too full to take them in.
“If we don’t flatten the curve … we’ll have a situation on Nantucket where we have to make an ethics decision on who will live and who will die,” said Shaw. He has already started discussing strategies for triage with his staff, anticipating the difficult decisions facing doctors in Italy and Spain. He recently turned on the refrigerators at the island morgue, and counted the number of body bags. The hospital probably won’t have enough beds for everyone, he said.
Stahl first noticed her fever as she was getting ready for bed one night last week. Her daughters, now 11 and 14, were climbing into a sheet fort they’d constructed on her bedroom floor, happily settling into the “little slumber party” Stahl had allowed every night since her husband moved out. He was a builder, still meeting with clients and employees. They decided it was too risky for him to sleep by her side.
But now it was 10 p.m., and Stahl was alone with a 100-degree fever and a cough, two symptoms of coronavirus. She emailed her doctor, panicked. She knew the hospital had limited ventilators. And with all her other conditions, she said, she worried she wouldn’t get one.
“I mean, I’d be screwed.”
Two days later, Stahl drove to the emergency room, where a nurse came outside to swab the inside of her nose. They’d send the sample up to Boston, she said.
It would take between 48 and 72 hours for the results to come back.
On Nantucket, there are “year-rounders” and there are “summer people.” The year-rounders are quick to say the two groups are very different.
“It’s an extremely wealthy community, but that’s the summer people,” said Stahl. In July and August, families from New York and Connecticut open the French doors of their vacation homes, enjoying beach barbecues, sandy flip-flops, and homemade ice cream for seven dollars a scoop.
Year-round residents welcome this summer crowd. Their money fuels the island’s economy through the rest of the year, supporting the service workers and small business owners who live on the island full-time. Still, they’re not quite “islanders,” year-rounders say. They’ve probably never seen Main Street when it’s flooded by a nor’easter. They don’t hunker down for months in the winter, when the bars and restaurants board up their windows and ferries sometimes don’t run for days at a time.
“The year-round community — we’re not faint of heart,” said Terry Sutherburg, a contractor and caretaker who has lived on Nantucket for 23 years. “We get a lot of heavy wind out here, and we don’t even pay attention unless they say it’s going to blow over six feet.”
Thirty miles out to sea, with all that wind, you really get to know your neighbors. In February and March, Stahl said, the island population shrinks enough that you recognize pretty much every face you see.
On a typical run to the liquor store, you’ll bump into “Wes the coffee guy” and “Cole from the brewery,” said Rebecca Chapa, 48, who owns the beachside restaurant The Hungry Minnow. “We’re very tightknit.”
It didn’t take long for the year-rounders to notice the new arrivals. The first sign of summer residents is always the license plates, said Chapa. Last weekend, she said, she started seeing BMWs from New York, Mercedes-Benzes from Connecticut. Then she drove by the airport and saw the line of private jets.
Sutherburg has been asked to “open up” half of the summer homes he manages, turning on the water and testing the plumbing before the owners arrive. Town Select Board member Matt Fee, who owns Something Natural, a popular sandwich shop, said there has been a spike in what he calls “the bread index.”
“A ton of people have come to the island in the past seven days,” he said at a meeting on Wednesday. “I think we’re probably at 25,000 or 30,000 [people], based on the number of loaves of bread I’m selling.” (Ferries and airports report approximately the same, or a slightly lower, number of passengers arriving on Nantucket compared with this time last year, despite the fact that coronavirus has halted much of the regular travel, like school sports teams ferrying on and off the island.)
“They are coming to our screening areas, telling us they’ve been exposed to people who are now positive,” said Shaw, who on Friday urged visitors to “stay off the island.”
“I won’t say which states they’re coming from, but they don't need to be here.”
Stahl understands the impulse to retreat to Nantucket. If she had a summer home here, she said, she’d probably want to come, too. Of course it’s more comfortable to socially isolate in a big house by a deserted beach, rather than a New York City apartment, she said. But summer residents need to consider the year-rounders whose health they might be jeopardizing.
“God forbid they get sick. They are taking up the very limited respirators that we have,” Stahl said. “People are thinking, ‘It’s the perfect place to escape.’ Well, it could be a disaster.”
Nantucket Cottage Hospital was rebuilt in 2019, a project that cost $89 million. Before the hospital started releasing information in response to coronavirus, Stahl said, “I think people just assumed we are now like any other hospital.” Many were surprised to hear about the lack of beds and ventilators. (The hospital has five ventilators in total, but two are reserved for emergency surgeries.)
But it never made sense for Nantucket Cottage Hospital to be bigger than it is now, said Shaw. Intensive care units are extraordinarily expensive, he said — and the hospital has never had a problem airlifting patients who need treatment beyond what they are able to provide.
There’s a running joke about this on Nantucket, Sutherburg said.
“If anyone gets a hangnail, they get shipped off to Boston.”
The hospital changes in the summer. To care for the roughly 33,000 additional people on the island, the hospital brings in doctors from the mainland. But that’s unlikely to happen now, Shaw said, even though there are significantly more people on the island than is typical for March: Hospitals everywhere need more doctors.
Laurie Richards, who manages Core, a Pilates studio on Nantucket, doesn’t blame the hospital.
“No one really expected a global pandemic. And without a pandemic, the hospital is just the right size.”
When she thinks about the situation on Nantucket, Richards said, she has a hard time breathing. She’s only 53, but she can’t stop thinking about all the older people on the island. As soon as her son and daughter arrived home from college, she deployed them to the grocery store, advertising free grocery pick up and delivery services to anyone on Nantucket who doesn’t feel comfortable going themselves.
Chapa, the owner of The Hungry Minnow, has been feeling anxious, too. She follows all the Nantucket Facebook groups and reads every update. She’s terrified that she’ll need treatment, and won’t be able to get it.
When she went out scalloping this week, she said, she suddenly felt like she couldn’t breathe, carrying the box of scallops back to her car.
“It was this sheer moment of panic. What if I have it? And I’m out here? I’m isolated, on the beach, on an island. And if something happens to me, I know I’m going to have to take care of myself.”
Now the big question is whether to restrict access to the ferries, preventing the summer residents from boarding the boats. On Friday, Nantucket police chief Bill Pittman urged Massachusetts Gov. Charlie Baker (R) to limit ferry service to cargo and essential travel.
“Everyone on the island needs to contact the governor’s office tomorrow, Sunday and Monday and every day that Gov. Baker fails to listen to the pleas of our island’s health care professionals to shut down the influx of refugees from virus-infected areas of the country,” Pittman posted on Facebook.
Everyone on the island has an opinion on the issue, said Tobias Glidden, co-owner of ACK Smart, a solar energy company. Glidden, whose family has lived on Nantucket for decades, said he welcomes summer residents who “seek out Nantucket as a place of refuge.” As long as they stay home, only surfacing to stock up at the grocery store, they should be able to come, he said.
“Are we going to be a community that turned on itself — turned on its visitors who were looking for a safe place? Or are we a community that understands that, even though they brought disease and didn’t know it, we came together and we helped them?”
Year-rounders should remember the island’s history, Glidden says: Centuries ago, when white settlers first arrived on the island, they brought a virus that wiped out Native Americans.
“We’re sitting here talking here about invaders bringing viruses,” said Glidden. “We were those invaders.”
Stahl’s test came back on Friday: She doesn’t have coronavirus. Still, she knows she’s hardly in the clear.
Her husband will continue living a few minutes down the road, dropping groceries off on her porch to be disinfected with Clorox wipes. They’ll try to walk together every day, one behind the other, at least 10 feet apart.
For Stahl, good days are when the sun is shining. She’ll drive to a beach where there are no other cars, hopping out and letting her dog run free off the leash.
As scared as she is to be here right now, she’s never thought about leaving.
Whatever comes, Stahl will “stay in place,” she said.
“This is my home.”
