A Boston Hospital Nears Its Limits

Paramedics rush a patient to an emergency room in Boston, where the intensity of covid-19
has surprised even the most experienced doctors.

The system is coping, but the intensity of COVID-19 has surprised even experienced doctors.

As the coronavirus spreads in all fifty states, it’s becoming clear that not all places are experiencing the pandemic the same way. Dense urban areas, such as New York and New Orleans, have been hit hardest; less dense cities, like Seattle, and cities that enforced social distancing earlier, like San Francisco, have seen their numbers rise more gradually. Demographics may play a role: the prevalence of diabetes in New Orleans is more than double that in King County, Washington, where Seattle is situated. Other chronic problems that seem to make covid-19 more dangerous, such as high blood pressure, are also unevenly distributed.

We don’t yet know what will happen in Boston, where I live. At the beginning of last week, I reported to work at my hospital’s E.R. expecting the worst; sure enough, we were inundated with sick patients by noon. Some were brought in by the usual car accidents and heart attacks, but many others, judging by their symptoms and X-rays, seemed to have covid-19. After my shift ended, I thought the floodgates had opened. But then, on Tuesday, the emergency department slowed. Although there were spikes in covid admissions throughout the week, the momentum never held. We started wondering whether social distancing might have slowed the spread of the virus. For now, Boston remains one of the cities that hasn’t yet seen an overwhelming surge in covid cases.

That’s not to say that the caseload isn’t increasing. The number of deaths from covid-19 in Massachusetts has doubled every two or three days since March 21st. When incoming ambulance crews call in on the radio, their reports are always the same: “Fever, cough, difficulty breathing. Requesting isolation precautions.” So far, we’ve been able to handle the volume of covid patients; everyone who has needed a ventilator and an I.C.U. bed has gotten one. But the hospital is steadily filling up. The patients we already have don’t seem to be getting better quickly enough to free beds and ventilators for the new arrivals.

This disease is different from what we typically see, and its severity has unsettled even our most experienced doctors. One man arrived and had to be intubated immediately; his blood-oxygen level, thirty-eight per cent, was the lowest any of us had ever seen. (Greater than ninety-five per cent is normal; eighty per cent is alarming.) We have seen other patients with levels in the sixties or seventies. Another patient’s levels plummeted to below twenty per cent in the few seconds it took us to connect him to a ventilator. Not long ago, one of our physicians started wearing a new fitness tracker that purports to measure stress levels; when it recognizes high stress, it vibrates and displays messages, like “Relax” and “Take a break.” During a recent shift, it buzzed almost continuously.

N95 respirators staged for decontamination in the Battelle Critical Care Decontamination System

Our supply of personal protective equipment, or P.P.E., appears to be holding. Judicious rationing is helping our stockpiles last longer, and the hospital is investigating whether radiation or ultraviolet light could be used to sterilize N95 respirators and other equipment after it’s been used. I’ve been disinfecting my plastic face shield by cleaning it with bleach wipes. The ambulance crews seem to be in worse shape. I’ve seen medics wearing non-medical respirators, probably purchased at Home Depot or donated; others have no masks at all. One crew transported a patient who was breathing with the help of a cpap machine—a device often used by those with sleep apnea, which delivers breathing support through a tight-fitting mask. Because air sometimes leaks around the mask, the machine can become a leaf blower full of virus if the patient is infected. The medics transporting him had no P.P.E. “We haven’t received any instructions or guidance from our bosses,” they told me. Another medic I know said that transporting a covid patient was “so much worse than a bad trauma,” during which blood can splatter all over the back of an ambulance. “With a trauma, at least you can see where the blood is,” he said. “With the virus, you can’t see it at all.”

The virus has changed how we think, feel, and interact. My colleagues and I all seem to be paying more attention to our own bodies. We wonder if our headaches are a symptom of covid or just allergies, or if we’re starting to develop sore throats. Recently, I noticed that I now grip door handles with just two or three fingers. With everyone wearing masks, it’s become more difficult to pick up on emotions and moods. As compensation, I’ve registered, for the first time, the eye colors of people with whom I’ve worked for years.

I find it hard not to feel superstitious. There’s a playground near my house, now closed with a padlock and chains. The magnolias and forsythia planted there have taken advantage of the mild weather and are now sprouting buds. The forsythia in particular have seemed portentous: their blazing yellow flowers are a symbol of spring; in Chinese herbal medicine, they’re a tonic for fever, sore throat, and cough. Last week, it was snowing as I left the hospital. I caught myself worrying about the forsythia, and wondering what lies ahead.In the last few days, palliative-care doctors, who specialize in well-being and decision-making at the end of a patient’s life, have started joining us in the E.R. Before the sickest patients are intubated, the specialists, wearing full P.P.E., enter their rooms to discuss the options. Because it can take more than a day for results from a covid test to arrive, patients may find themselves contemplating intubation without knowing for sure that they have the coronavirus. If they have it, the prognosis can be grim; if they turn out to be suffering from some non-covid disease—ordinary pneumonia, or heart failure—they may be more likely to recover. Some patients choose not to be intubated. Others decide that they want to move forward, but determine in advance that, if their covid tests come back positive, they will undergo a terminal extubation in the I.C.U. Some conclude, courageously, that they’d rather free up the ventilator for other, younger patients—a form of self-triage.

If our patient load increases, we may not be able to leave these decisions entirely to patients and their families. Earlier this month, on Twitter, an Italian physician reported that at his overwhelmed hospital patients older than sixty-five or with serious medical problems were no longer being considered for I.C.U. beds or ventilators. A document published recently by the Italian College of Anesthesia, Analgesia, Resuscitation, and Intensive Care notes that age limits may become necessary “as a way to provide extremely scarce resources to those who have the highest likelihood of survival.” Reports out of New York suggest that hospitals there are dangerously close to this scenario already. At Columbia University’s Irving Medical Center, operating rooms that have been converted into I.C.U.s are already filling up with intubated patients—including the first pair to share a single ventilator. A friend of mine in New York told me that one of her co-workers intubated seventeen people in a single overnight shift; arriving at one bedside, she was aghast to find that the patient was one of her colleagues.

Advice on Quarantine Cooking and Other Quandaries

I’m a college student who mostly has existed off of Trader Joe’s frozen meals, but I’m isolated with my friend who can really cook. I have cooked one meal by myself for her, and cooked a few meals with her, but she’s been doing the heavy lifting. I’m trying to make sure that I’m not being a mooch. What’s a good way to make cooking equitable in our apartment? —Siri C., Brooklyn, New York

If you don’t want to cook, or if your roommate prefers to do more cooking than you do, why force an unnecessary equity when you can pull your weight in other ways? For instance, take an hour (or a couple of hours) to write up an inventory of your pantry, fridge, and freezer—noting expiration dates—so that your roommate knows exactly what ingredients she has on hand. If she asks you what you want to eat, be ready with real answers—don’t leave her to do all the work of choosing how to feed you. If you’re healthy, offer to be the one who makes the weekly grocery run. Make sure you’re kicking in at least half of all the food costs, and maybe cover a little more than your share of the booze and other staples. (On that note, learning to make a killer cocktail is a lot easier than learning how to make a paella, and goes a long way toward insuring the good will of one’s friends and neighbors.) Most of all, take a few minutes to talk to her directly about this unevenness in your skills and labor. Let her know that you see it, let her know that you want to find ways to pitch in, and make sure she knows that you don’t expect her to churn out high-effort meals every day.

Last but not least, I’m assuming that when she cooks you clean, right? If you’re not the one cooking, you’re doing all the dishes, and cleaning the counters, too.

What is the best potato-soup recipe for filling the chasm of existential dread where my chest cavity once existed, and can I make it in a Crock-Pot? —Evan R., Portland, Oregon

I know of exactly two potato soups that don’t instantaneously fill me with a soul-deadening sense of boredom (which I know, from experience, is a condition that compounds existential dread). So, please, only make potato soup if you absolutely have to, and if you have the materials on hand to make it great.

The first soup, luxuriously simple and absolutely absurd: use an abundance of meat bones and scraps—especially turkey or duck, if you have them—to make a stock, then turn that into a double stock, and then (bear with me here) a triple stock. When you have a quart or two of the densest, richest, meatiest stock in the world, scrub and dice two pounds of potatoes (for soups, I prefer Yukon golds) and add them to the stock. Simmer the potatoes until they’re soft, then use an immersion blender to purée the whole thing, or purée it in small batches in a blender. (It’s hot, be careful!) Stir in a full cup of heavy cream, a generous blizzard of salt, about twenty grinder rounds of black pepper, and a pinch of cayenne. If you have chives or scallions to top it off, go for it, but don’t worry if you don’t; this obscenely rich liquid velvet stands alone.

The second soup, if you’re a normal person who doesn’t have ten to fifteen pounds of poultry scraps in your freezer, operates on a similar principle. Start the whole thing off by sautéeing as much chopped onion and garlic as you can manage in a huge hunk of butter, plus a tablespoon or so of curry paste, or a savory masala blend if you have one that you like. Then add your diced potatoes and simmer the whole thing in regular chicken or veggie stock (or water with a splash of soy sauce and a splash of wine). At the end, stir in the cream. (You can’t skip this step, I’m sorry; the secret of any good potato soup is that it’s actually heavy-cream soup with some potatoes in it.) Add salt, pepper, and something with a bit of heat, like cayenne, Aleppo pepper, or a dash of hot sauce, and then, at the very end, add a few fistfuls of shredded cheese—any kind, though sharp cheddar is best.

You can make pretty much any soup in a Crock-Pot. Just don’t add the cream (or anything that comes after) until the very end.

My family loves bread. All the bread in stores is gone. I do not have a bread machine. I do not have a stand mixer. I just want to make some good, simple white bread that doesn’t involve becoming obsessed with a sourdough starter—but not focaccia, because I want something I can slice for toast and sandwiches. Bonus points if I can toss it together with the kids in the morning, or throw the ingredients together and let it rise in the fridge overnight. I tried to make no-knead bread a few months ago, and it came out all flat and terrible. —Anne A., Manhattan, New York

If no-knead didn’t work out for you last time, one of two things is to blame. One, you may have been using dead yeast. Most official recipes for no-knead bread ask you to first combine the indicated quantities of flour, salt, and yeast in a medium bowl, and then add 1⅓ cups of cool water. Do me a favor and don’t do that. Instead, put 1⅓ cups of warm water (about 95-100 degrees Fahrenheit, or the same temperature as the inside of your wrist) in that medium bowl, and sprinkle the yeast on top. (Do this even if you’re using instant yeast, which supposedly can never be a dud but, in my experience, still sometimes is.) Wait three minutes, maybe five: the bowl of yeasty water should now be foamy. If not, you’ve got a yeast problem.

If your yeast is good, and your dough rises glorious as the dawn, but the bread still emerges from your oven in a flat, depressing disc, it might be that you’re baking it in a pot that’s too large. Serious physical kneading develops gluten in the dough, which is what gives bread its structural integrity; the long rising time in no-knead recipes accomplishes the same thing, but not to the same degree—hence the need for a relatively narrow, high-walled Dutch oven, which slows the outward spread of the dough once it hits the heat of the oven. If your pot is wider than eleven inches, you’re likely to end up with something closer to a Frisbee than a proud, domed loaf.

If it’s still not working after these fixes, you might just be bread-cursed. I’m not a superstitious person, but there are some people for whom beautiful loaves of bread just don’t like to work. In that case, maybe reconsider your opposition to focaccia.

How do I deal with having SO MANY DISHES TO DO now that I’m eating in a hundred per cent of the time? —Whit R., Brooklyn, New York

In “At Home in the World,” the monk and activist Thich Nhat Hanh writes, “I enjoy taking my time with each dish, being fully aware of the dish, the water, and each movement of my hands. . . . The dishes themselves and that fact that I am here washing them are miracles.” That’s nice for him. For the rest of us, washing dishes is a chore and an irritation; I don’t like it, and you don’t have to, either. You don’t need to find it meditative, or creatively stimulating, or a small and lovely pattern of human input and visible output. You just have to do it. Whether you’re in the habit of letting them pile up and then plowing through a whole sinkful at once or you’re an acolyte of the Holy Church of Clean as You Go, you’ve just got to snap on some rubber gloves, clamp your teeth down on a leather strap, and get ’er done.

How do I deal with the crippling wave of self-doubt that hits me every time I even think about approaching the act of writing, and also how do I balance out acidity in my tomato sauce? —Joannes B., Mexico City

Try a stiff drink. For the sauce, add a little bit of sugar—but not too much. Maybe half a teaspoon.

Helen Rosner


New York’s Art World Faces the Coronavirus Shutdown

The Metropolitan Museum of Art will reportedly only meet its payroll through the first week of April,
which will make layoffs inevitable.

Art offers a refuge in times of crisis. But what happens when the refuge goes dark?
Among the many incomprehensible victims of the coronavirus are New York City’s museums and galleries, all of which are now closed until further notice.

The first to shut down was the city’s largest, the Met. On March 12th, the museum announced that it was temporarily closing all three of its branches—the Beaux-Arts headquarters on Fifth Avenue, the Cloisters, and the Met Breuer—to help flatten the curve of the pandemic. Worse news arrived on March 18th, when the Times leaked a letter to the museum’s senior staff, from Max Hollein and Daniel H. Weiss, the director and the president and C.E.O., about a new plan to keep its doors closed until July, to help stave off financial disaster. The projected losses in revenue to the institution are a staggering hundred million dollars. One sad irony about this unimaginable moment is that those of us who have spent recent years complaining that talk of money has hijacked conversations about art now have no choice but to see numbers.

Of course, the Met’s closure is devastating in terms of cultural deprivation. In a perfect world, I’d be quarantined in one of the period rooms, curled up with a book on that comfy-looking white sofa in the opulent boudoir of the eighteenth-century Hôtel de Crillon. (The bed that Claudia slept on in “From the Mixed-up Files of Mrs. Basil E. Frankweiler” is in storage.) But it’s hard to focus on aesthetics alone when, with the Met as a bellwether, the economic implications for other precincts of the New York art world are so catastrophic. The Met, which has an endowment of roughly three billion dollars, even accounting for current market turmoil, is unlikely to face total collapse before it can reopen. 

Smaller institutions may face bigger challenges. The Tenement Museum, on the Lower East Side, has closed its doors and reduced its full-time and part-time staff from a hundred and thirty-eight people to five. 

The Alliance of American Museums is lobbying Congress for a four-billion-dollar relief package, citing the estimated fifty billion dollars a year that arts and history institutions contribute to the U.S. economy, not to mention the twelve billion dollars in tax revenue. 

(On Tuesday morning, the Met announced #CongressSaveCulture, a campaign to support the measure.) The A.A.M. is also seeking a short-term “universal charitable deduction” tax incentive to encourage donations; such solicitations are a tough ask in the best of times, let alone in a climate of panic. But the patrons of New York City have already taken action: on March 20th, eighteen New York-based philanthropies banded together to create a seventy-five-million-dollar “NYC COVID-19 Response & Impact Fund” for the city’s arts and social-services nonprofits.

As vital as cultural institutions are to the life of this city, it’s the living artists who are its heart. When I learned that the Met will reportedly only meet its payroll through the first week of April, which will make layoffs inevitable, I thought of all the artists who might lose their jobs. Many of the rank-and-file employees at any museum make art themselves; even Jeff Koons once manned the ticket booth and then the membership desk at the moma. For those artists who are lucky enough to support themselves with their art alone, it’s commercial galleries, not museums, that provide revenue. The big international chains (Gagosian, Zwirner, Hauser & Wirth) may grab most of the headlines, but some of the city’s most exciting young spaces (Bureau, Lomex, Situations) operate on a relative shoestring.

These are small businesses, some so small that their staff consists of a part-time assistant (if that) and a network of freelancers—art handlers, graphic designers, archivists, database managers, electricians, conservators, photographers, and Ph.D. candidates who moonlight writing press releases. But this nimble model makes such galleries ineligible for the emergency-relief measures that the city put in place for small businesses earlier this month, when the pandemic began taking its toll. What’s more, many of those contracted workers are self-employed and not incorporated, meaning that they don’t qualify for relief, either.

Amid the unprecedented uncertainty of this emergency, there is one comforting fact: artists don’t stop making art. The Met is a monument to that persistence, stocked with five thousand years’ worth of evidence. It will reopen, and the city’s gallery scene will survive, too, however battered and reconfigured. While the Met is closed, there are any number of ways to find shelter there from afar. A time-lapse video of the Egyptian Temple of Dendur, which has survived since 15 B.C., compresses an entire day, from dawn to twilight, into two fleeting minutes. As the scene shifts from tranquil to bustling, it feels like both an endorsement of solitude and a reassurance of collective pleasures.

Andrea K. Scott


Not wearing masks to protect against coronavirus is a ‘big mistake,’ top Chinese scientist says

Chinese scientists at the front of that country’s outbreak of coronavirus disease 2019 (COVID-19) have not been particularly accessible to foreign media. Many have been overwhelmed trying to understand their epidemic and combat it, and responding to media requests, especially from journalists outside of China, has not been a top priority.

Science has tried to interview George Gao, director-general of the Chinese Center for Disease Control and Prevention (CDC), for 2 months. Last week he responded.

Gao oversees 2000 employees—one-fifth the staff size of the U.S. Centers for Disease Control and Prevention—and he remains an active researcher himself. In January, he was part of a team that did the first isolation and sequencing of severe acute respiratory syndrome 2 (SARS-CoV-2), the virus that causes COVID-19. He co-authored two widely read papers published in The New England Journal of Medicine (NEJM) that provided some of the first detailed epidemiology and clinical features of the disease, and has published three more papers on COVID-19 in The Lancet.

His team also provided important data to a joint commission between Chinese researchers and a team of international scientists, organized by the World Health Organization (WHO), that wrote a landmark report after touring the country to understand the response to the epidemic.

First trained as a veterinarian, Gao later earned a Ph.D. in biochemistry at the University of Oxford and did postdocs there and at Harvard University, specializing in immunology and virology. His research specializes in viruses that have fragile lipid membranes called envelopes—a group that includes SARS-CoV-2—and how they enter cells and also move between species.

Gao answered Science’s questions over several days via text, voicemails, and phone conversations. This interview has been edited for brevity and clarity.

Q: What can other countries learn from the way China has approached COVID-19?

A: Social distancing is the essential strategy for the control of any infectious diseases, especially if they are respiratory infections. First, we used “nonpharmaceutical strategies,” because you don’t have any specific inhibitors or drugs and you don’t have any vaccines. Second, you have to make sure you isolate any cases. Third, close contacts should be in quarantine: We spend a lot of time trying to find all these close contacts, and to make sure they are quarantined and isolated. Fourth, suspend public gatherings. Fifth, restrict movement, which is why you have a lockdown, the cordon sanitaire in French.

Q: The lockdown in China began on 23 January in Wuhan and was expanded to neighboring cities in Hubei province. Other provinces in China had less restrictive shutdowns. How was all of this coordinated, and how important were the “supervisors” overseeing the efforts in neighborhoods?

A: You have to have understanding and consensus. For that you need very strong leadership, at the local and national level. You need a supervisor and coordinator working with the public very closely. Supervisors need to know who the close contacts are, who the suspected cases are. The supervisors in the community must be very alert. They are key.

Q: What mistakes are other countries making?

A: The big mistake in the U.S. and Europe, in my opinion, is that people aren’t wearing masks. This virus is transmitted by droplets and close contact. Droplets play a very important role—you’ve got to wear a mask, because when you speak, there are always droplets coming out of your mouth. Many people have asymptomatic or presymptomatic infections. If they are wearing face masks, it can prevent droplets that carry the virus from escaping and infecting others.

Q: What about other control measures? China has made aggressive use of thermometers at the entrances to stores, buildings, and public transportation stations, for instance.

A: Yes. Anywhere you go inside in China, there are thermometers. You have to try to take people’s temperatures as often as you can to make sure that whoever has a high fever stays out.

And a really important outstanding question is how stable this virus is in the environment. Because it’s an enveloped virus, people think it’s fragile and particularly sensitive to surface temperature or humidity. But from both U.S. results and Chinese studies, it looks like it’s very resistant to destruction on some surfaces. It may be able to survive in many environments. We need to have science-based answers here.

Q: People who tested positive in Wuhan but only had mild disease were sent into isolation in large facilities and were not allowed to have visits from family. Is this something other countries should consider?

A: Infected people must be isolated. That should happen everywhere. You can only control COVID-19 if you can remove the source of the infection. This is why we built module hospitals and transformed stadiums into hospitals.

Q: There are many questions about the origin of the outbreak in China. Chinese researchers have reported that the earliest case dates back to 1 December 2019. What do you think of the report in the South China Morning Post that says data from the Chinese government show there were cases in November 2019, with the first one on 17 November?

A: There is no solid evidence to say we already had clusters in November. We are trying to better understand the origin.

Q: Wuhan health officials linked a large cluster of cases to the Huanan seafood market and closed it on 1 January. The assumption was that a virus had jumped to humans from an animal sold and possibly butchered at the market. But in your paper in NEJM, which included a retrospective look for cases, you reported that four of the five earliest infected people had no links to the seafood market. Do you think the seafood market was a likely place of origin, or is it a distraction—an amplifying factor but not the original source?

A: That’s a very good question. You are working like a detective. From the very beginning, everybody thought the origin was the market. Now, I think the market could be the initial place, or it could be a place where the virus was amplified. So that’s a scientific question. There are two possibilities.

Q: China was also criticized for not sharing the viral sequence immediately. The story about a new coronavirus came out in The Wall Street Journal on 8 January; it didn’t come from Chinese government scientists. Why not?

A: That was a very good guess from The Wall Street Journal. WHO was informed about the sequence, and I think the time between the article appearing and the official sharing of the sequence was maybe a few hours. I don’t think it’s more than a day.

Q: But a public database of viral sequences later showed that the first one was submitted by Chinese researchers on 5 January. So there were at least 3 days that you must have known that there was a new coronavirus. It’s not going to change the course of the epidemic now, but to be honest, something happened about reporting the sequence publicly.

A: I don’t think so. We shared the information with scientific colleagues promptly, but this involved public health and we had to wait for policymakers to announce it publicly. You don’t want the public to panic, right? And no one in any country could have predicted that the virus would cause a pandemic. This is the first noninfluenza pandemic ever.

"Infected people must be isolated. That should happen everywhere."
George Gao, Chinese Center for Disease Control and Prevention

Q: It wasn’t until 20 January that Chinese scientists officially said there was clear evidence of human-to-human transmission. Why do you think epidemiologists in China had so much difficulty seeing that it was occurring?

A: Detailed epidemiological data were not available yet. And we were facing a very crazy and concealed virus from the very beginning. The same is true in Italy, elsewhere in Europe, and the United States: From the very beginning scientists, everybody thought: “Well, it’s just a virus.”

Q: Spread in China has dwindled to a crawl, and the new confirmed cases are mainly people entering the country, correct?

A: Yes. At the moment, we don’t have any local transmission, but the problem for China now is the imported cases. So many infected travelers are coming into China.

Q: But what will happen when China returns to normal? Do you think enough people have become infected so that herd immunity will keep the virus at bay?

A: We definitely don’t have herd immunity yet. But we are waiting for more definitive results from antibody tests that can tell us how many people really have been infected.

Q: So what is the strategy now? Buying time to find effective medicines?

A: Yes—our scientists are working on both vaccines and drugs.

Q: Many scientists consider remdesivir to be the most promising drug now being tested. When do you think clinical trials in China of the drug will have data?

A: In April.

Q: Have Chinese scientists developed animal models that you think are robust enough to study pathogenesis and test drugs and vaccines?

A: At the moment, we are using both monkeys and transgenic mice that have ACE2, the human receptor for the virus. The mouse model is widely used in China for drug and vaccine assessment, and I think there are at least a couple papers coming out about the monkey models soon. I can tell you that our monkey model works.

Q: What do you think of President Donald Trump referring to the new coronavirus as the “China virus” or the “Chinese virus”?

A: It’s definitely not good to call it the Chinese virus. The virus belongs to the Earth. The virus is our common enemy—not the enemy of any person or country.

Jon Cohen
Jon is a staff writer for Science.

The secret history of Monopoly: the capitalist board game’s leftwing origins

‘Hepeating‘ might be a new word, but the concept it represents is tried and tested. Woman comes up with great idea. Man takes it and passes it off as his own. Man receives great acclaim. Woman doesn’t make a fuss. Add in a dinner party ending in a broken friendship, a courtroom revelation, and escaping prisoners of war, and you have the story of one of the world’s most popular board games, Monopoly.

In 1903, a leftwing feminist called Lizzy Magie patented the board game that we now know as Monopoly – but she never gets the credit. Now a new book aims to put that right.

One night in late 1932, a Philadelphia businessman named Charles Todd and his wife, Olive, introduced their friends Charles and Esther Darrow to a real-estate board game they had recently learned. As the two couples sat around the board, enthusiastically rolling the dice, buying up properties and moving their tokens around, the Todds were pleased to note that the Darrows liked the game. In fact, they were so taken with it that Charles Todd made them a set of their own, and began teaching them some of the more advanced rules. The game didn’t have an official name: it wasn’t sold in a box, but passed from friend to friend. But everybody called it ‘the monopoly game’.

Together with other friends, they played many times. One day, despite all of his exposure to the game, Darrow – who was unemployed, and desperate for money to support his family – asked Charles Todd for a written copy of the rules. Todd was slightly perplexed, as he had never written them up. Nor did it appear that written rules existed elsewhere.

In fact, the rules to the game had been invented in Washington DC in 1903 by a bold, progressive woman named Elizabeth Magie. But her place in the game’s folk history was lost for decades and ceded to the man who had picked it up at his friend’s house: Charles Darrow. Today, Magie’s story can be told in full. But even though much of the story has been around for 40 years, the Charles Darrow myth persists as an inspirational parable of American innovation – thanks in no small part to Monopoly’s publisher and the man himself. After he sold a version of the game to Parker Brothers and it became a phenomenal success, eventually making him millions, one journalist after another asked him how he had managed to invent Monopoly out of thin air – a seeming sleight of hand that had brought joy into so many households. “It’s a freak,” Darrow told the Germantown Bulletin, a Philadelphia paper. “Entirely unexpected and illogical.”

To Elizabeth Magie, known to her friends as Lizzie, the problems of the new century were so vast, the income inequalities so massive and the monopolists so mighty that it seemed impossible that an unknown woman working as a stenographer stood a chance at easing society’s ills with something as trivial as a board game. But she had to try.

Night after night, after her work at her office was done, Lizzie sat in her home, drawing and redrawing, thinking and rethinking. It was the early 1900s, and she wanted her board game to reflect her progressive political views – that was the whole point of it.

The descendant of Scottish immigrants, Lizzie had pale skin, a strong jawline and a strong work ethic. She was then unmarried, unusual for a woman of her age at the time. Even more unusual, however, was the fact that she was the head of her household. Completely on her own, she had saved up for and bought her home, along with several acres of property.

By Drawing for a Game Board, 01/05/1904. This is the printed patent drawing for a game board invented by Lizzie J. Magie. From the U.S. National Archives. Public domain.

She lived in Prince George’s county, a Washington DC neighbourhood where the residents on her block included a dairyman, a peddler who identified himself as a “huckster”, a sailor, a carpenter and a musician. Lizzie shared her house with a male actor who paid rent, and a black female servant. She was also intensely political, teaching classes about her political beliefs in the evenings after work. But she wasn’t reaching enough people. She needed a new medium – something more interactive and creative.

There was one obvious outlet. At the turn of the 20th century, board games were becoming increasingly commonplace in middle-class homes. In addition, more and more inventors were discovering that the games were not just a pastime but also a means of communication. And so Lizzie set to work.

She began speaking in public about a new concept of hers, which she called the Landlord’s Game. “It is a practical demonstration of the present system of land-grabbing with all its usual outcomes and consequences,” she wrote in a political magazine. “It might well have been called the ‘Game of Life’, as it contains all the elements of success and failure in the real world, and the object is the same as the human race in general seem[s] to have, ie, the accumulation of wealth.”

Lizzie’s game featured play money and deeds and properties that could be bought and sold. Players borrowed money, either from the bank or from each other, and they had to pay taxes. And it featured a path that allowed players to circle the board – in contrast to the linear-path design used by many games at the time. In one corner were the Poor House and the Public Park, and across the board was the Jail. Another corner contained an image of the globe and an homage to Lizzie’s political hero, the economist Henry George, whose ideas about putting the burden of taxation on wealthy landowners inspired the game: “Labor upon Mother Earth Produces Wages.” Also included on the board were three words that have endured for more than a century after Lizzie scrawled them there: GO TO JAIL.

Lizzie drew nine rectangular spaces along the edges of the board between each set of corners. In the centre of each nine-space grouping was a railroad, with spaces for rent or sale on either side. Absolute Necessity rectangles offered goods like bread and shelter, and Franchise spaces offered services such as water and light. As gamers made their way around the board, they performed labour and earned wages. Every time players passed the Mother Earth space, they were “supposed to have performed so much labor upon Mother Earth” that they received $100 in wages. Players who ran out of money were sent to the Poor House.

Players who trespassed on land were sent to Jail, and there the unfortunate individuals had to linger until serving out their time or paying a $50 fine. Serving out their time meant waiting until they threw a double. “The rallying and chaffing of the others when one player finds himself an inmate of the jail, and the expressions of mock sympathy and condolence when one is obliged to betake himself to the poor house, make a large part of the fun and merriment of the game,” Lizzie said.

From its inception, the Landlord’s Game aimed to seize on the natural human instinct to compete. And, somewhat surprisingly, Lizzie created two sets of rules: an anti-monopolist set in which all were rewarded when wealth was created, and a monopolist set in which the goal was to create monopolies and crush opponents. Her vision was an embrace of dualism and contained a contradiction within itself, a tension trying to be resolved between opposing philosophies. However, and of course unbeknownst to Lizzie at the time, it was the monopolist rules that would later capture the public’s imagination.

After years of tinkering, writing and pondering her new creation, Lizzie entered the US Patent Office on 23 March 1903 to secure her legal claim to the Landlord’s Game. At least two years later, she published a version of the game through the Economic Game Company, a New York–based firm that counted Lizzie as a part-owner. The game became popular with leftwing intellectuals and on college campuses, and that popularity spread throughout the next three decades; it eventually caught on with a community of Quakers in Atlantic City, who customised it with the names of local neighbourhoods, and from there it found its way to Charles Darrow.

"In total, the game that Darrow brought to Parker Brothers has now sold hundreds of millions copies worldwide, and he received royalties throughout his life."

Lizzie was paid by Parker Brothers, too. When the game started to take off in the mid-1930s, the company bought up the rights to other related games to preserve its territory. For the patent to the Landlord’s Game and two other game ideas, Lizzie reportedly received $500 — and no royalties.

At first, Lizzie did not suspect the true motives for the purchase of her game. When a prototype of Parker Brothers’ version of the Landlord’s Game arrived at her home in Arlington, she was delighted. In a letter to Foster Parker, nephew of George and the company’s treasurer, she wrote that there had been “a song in my heart” ever since the game had arrived. “Some day, I hope,” she went on, “you will publish other games of mine, but I don’t think any one of them will be as much trouble to you or as important to me as this one, and I’m sure I wouldn’t make so much fuss over them.”

Eventually, though, the truth dawned on her – and she became publicly angry. In January of 1936 she gave interviews to the Washington Post and the Washington Evening Star. In a picture accompanying the Evening Star piece, she held up game boards from the Landlord’s Game and another game that had the word MONOPOLY written across its center four times in bold black letters; on the table in front of her was the now-familiar “Darrow” board, fresh out of the Parker Brothers box. The image of Lizzie painted by the reporter couldn’t have been clearer. She was angry, hurt and in search of revenge against a company that she felt had stolen her now-best-selling idea. Parker Brothers might have the rights to her 1924-patented Landlord’s Game, but they didn’t tell the story of her game invention dating back to 1904 or that the game had been in the public domain for decades. She had invented the game, and she could prove it.

The Evening Star reporter wrote that Lizzie’s game “did not get the popular hold it has today. It took Charles B Darrow, a Philadelphia engineer, who retrieved the game from the oblivion of the Patent Office and dressed it up a bit, to get it going. Last August a large firm manufacturing games took over his improvements. In November, Mrs Phillips [Magie, who had by now married] sold the company her patent rights.

“It went over with a bang. But not for Mrs Phillips … Probably, if one counts the lawyers’, printers’ and Patent Office fees used up in developing it, the game has cost her more than she made from it.” As she told the Washington Post in a story that ran the same day: “There is nothing new under the sun.”

It was to little avail. Much to Lizzie’s dismay, the other two games that she invented for Parker Brothers, King’s Men and Bargain Day, received little publicity and faded into board-game obscurity. The newer, Parker Brothers version of the Landlord’s Game appeared to have done so as well. And so did Lizzie Magie. She died in 1948, a widow with no children, whose obituary and headstone made no mention of her game invention. One of her last jobs was at the US Office of Education, where her colleagues knew her only as an elderly typist who talked about inventing games.

As Charles Darrow reaped the rewards of the game’s success, Lizzie Magie’s role in the invention of Monopoly remained obscure. But in 1973, Ralph Anspach, a leftwing academic who was under legal attack from Parker Brothers over his creation of an Anti-Monopoly game, learned her story as he researched his case, seeking to undermine the company’s hold on the intellectual property. The case lasted a decade, but in the end, Anspach prevailed, in the process putting Magie’s vital role in the game’s history beyond dispute – and building up an extraordinary archive of material, which forms the backbone of this account.

But Hasbro, the company of which Parker Brothers is now a subsidiary, still downplays Magie’s status, responding to a request for comment with a terse statement: “Hasbro credits the official Monopoly game produced and played today to Charles Darrow.” And even in 2015, on Hasbro’s website, a timeline of the game’s history begins in 1935. Over the years, the carefully worded corporate retellings have been most illuminating in what they don’t mention: Lizzie Magie, the Quakers, the dozens, if not hundreds or thousands, of early players, Ralph Anspach and the Anti-Monopoly litigation. Perhaps the care and keeping of secrets, as well as truths, can define us.

And so the beloved Darrow legend lives on. It only makes sense. The Darrow myth is a “nice, clean, well-structured example of the Eureka School of American industrial legend,” the New Yorker’s Calvin Trillin wrote in 1978. “If Darrow invented the story rather than the game, he may still deserve to have a plaque on the Boardwalk honoring his ingenuity.” It’s hard not to wonder how many other unearthed histories are still out there –stories belonging to lost Lizzie Magies who quietly chip away at creating pieces of the world, their contributions so seamless that few of us ever stop to think about their origins. Commonly held beliefs don’t always stand up to scrutiny, but perhaps the real question is why we cling to them in the first place, failing to question their veracity and ignoring contradicting realities once they surface.

Above all, the Monopoly case opens the question of who should get credit for an invention, and how. Most people know about the Wright brothers – who filed their patent on the same day as Lizzie Magie – but don’t recall the other aviators who also sought to fly. The adage that success has many fathers, but we remember only one, rings true – to say nothing of success’s mothers. Everyone who has ever played Monopoly, even today, has added to its remarkable endurance and, on some level, made it their own. Games aren’t just relics of their makers – their history is also told through their players. And like Lizzie’s original innovative board, circular and never-ending, the balance between winners and losers is constantly in flux.