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The Untold Story of the Birth of Social Distancing The Untold Story of the Birth of Social Distancing
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WASHINGTON — Fourteen years ago, two federal government doctors, Richard Hatchett and Carter Mecher, met with a colleague at a burger joint in suburban Washington for a final review of a proposal they knew would be treated like a piñata: telling Americans to stay home from work and school the next time the country was hit by a deadly pandemic.WASHINGTON — Fourteen years ago, two federal government doctors, Richard Hatchett and Carter Mecher, met with a colleague at a burger joint in suburban Washington for a final review of a proposal they knew would be treated like a piñata: telling Americans to stay home from work and school the next time the country was hit by a deadly pandemic.
When they presented their plan not long after, it was met with skepticism and a degree of ridicule by senior officials, who like others in the United States had grown accustomed to relying on the pharmaceutical industry, with its ever-growing array of new treatments, to confront evolving health challenges.When they presented their plan not long after, it was met with skepticism and a degree of ridicule by senior officials, who like others in the United States had grown accustomed to relying on the pharmaceutical industry, with its ever-growing array of new treatments, to confront evolving health challenges.
Drs. Hatchett and Mecher were proposing instead that Americans in some places might have to turn back to an approach, self-isolation, first widely employed in the Middle Ages.Drs. Hatchett and Mecher were proposing instead that Americans in some places might have to turn back to an approach, self-isolation, first widely employed in the Middle Ages.
How that idea — born out of a request by President George W. Bush to ensure the nation was better prepared for the next contagious disease outbreak — became the heart of the national playbook for responding to a pandemic is one of the untold stories of the coronavirus crisis.How that idea — born out of a request by President George W. Bush to ensure the nation was better prepared for the next contagious disease outbreak — became the heart of the national playbook for responding to a pandemic is one of the untold stories of the coronavirus crisis.
It required the key proponents — Dr. Mecher, a Department of Veterans Affairs physician, and Dr. Hatchett, an oncologist turned White House adviser — to overcome intense initial opposition.It required the key proponents — Dr. Mecher, a Department of Veterans Affairs physician, and Dr. Hatchett, an oncologist turned White House adviser — to overcome intense initial opposition.
It brought their work together with that of a Defense Department team assigned to a similar task.It brought their work together with that of a Defense Department team assigned to a similar task.
And it had some unexpected detours, including a deep dive into the history of the 1918 Spanish flu and an important discovery kicked off by a high school research project pursued by the daughter of a scientist at the Sandia National Laboratories.And it had some unexpected detours, including a deep dive into the history of the 1918 Spanish flu and an important discovery kicked off by a high school research project pursued by the daughter of a scientist at the Sandia National Laboratories.
The concept of social distancing is now intimately familiar to almost everyone. But as it first made its way through the federal bureaucracy in 2006 and 2007, it was viewed as impractical, unnecessary and politically infeasible.The concept of social distancing is now intimately familiar to almost everyone. But as it first made its way through the federal bureaucracy in 2006 and 2007, it was viewed as impractical, unnecessary and politically infeasible.
“There were two words between ‘shut’ and ‘up’” initially, said Dr. Howard Markel, who directs the University of Michigan’s Center for the History of Medicine and who played a role in shaping the policy as a member of the Pentagon research team. “It was really ugly.”“There were two words between ‘shut’ and ‘up’” initially, said Dr. Howard Markel, who directs the University of Michigan’s Center for the History of Medicine and who played a role in shaping the policy as a member of the Pentagon research team. “It was really ugly.”
Dr. Mecher was there when Dr. Hatchett presented government public health experts the plan that the two of them and Dr. Lisa M. Koonin of the Centers for Disease Control and Prevention had reviewed over burgers and beer.Dr. Mecher was there when Dr. Hatchett presented government public health experts the plan that the two of them and Dr. Lisa M. Koonin of the Centers for Disease Control and Prevention had reviewed over burgers and beer.
“People could not believe that the strategy would be effective or even feasible,” Dr. Mecher recalled.“People could not believe that the strategy would be effective or even feasible,” Dr. Mecher recalled.
But within the Bush administration, they were encouraged to keep at it and follow the science. And ultimately, their arguments proved persuasive.But within the Bush administration, they were encouraged to keep at it and follow the science. And ultimately, their arguments proved persuasive.
In February 2007, the C.D.C. made their approach — bureaucratically called Non-Pharmaceutical Interventions, or NPIs — official U.S. policy.In February 2007, the C.D.C. made their approach — bureaucratically called Non-Pharmaceutical Interventions, or NPIs — official U.S. policy.
Following a five-year review by the Obama administration, the strategy was updated in a document published in 2017. And after long delays in which President Trump played down the threat from Covid-19, the disease caused by the coronavirus, and failed to heed warnings about it from inside his own government, it was used to encourage the states to lock down as confirmed cases and deaths shot up.Following a five-year review by the Obama administration, the strategy was updated in a document published in 2017. And after long delays in which President Trump played down the threat from Covid-19, the disease caused by the coronavirus, and failed to heed warnings about it from inside his own government, it was used to encourage the states to lock down as confirmed cases and deaths shot up.
The effort began in the summer of 2005 when Mr. Bush, already concerned with bioterrorism after the Sept. 11, 2001, attacks, read a forthcoming book, “The Great Influenza,” by John M. Barry, about the Spanish flu outbreak of 1918.The effort began in the summer of 2005 when Mr. Bush, already concerned with bioterrorism after the Sept. 11, 2001, attacks, read a forthcoming book, “The Great Influenza,” by John M. Barry, about the Spanish flu outbreak of 1918.
Mr. Bush’s concern was elevated by a string of new outbreaks caused by infectious diseases transferring from birds and other animals to humans, including an avian flu outbreak that year in Vietnam. Because there was no vaccine for these new threats, they could spread rapidly.Mr. Bush’s concern was elevated by a string of new outbreaks caused by infectious diseases transferring from birds and other animals to humans, including an avian flu outbreak that year in Vietnam. Because there was no vaccine for these new threats, they could spread rapidly.
“A pandemic is a lot like a forest fire,” Mr. Bush said in a speech at the National Institutes of Health. “If caught early it might be extinguished with limited damage. If allowed to smolder, undetected, it can grow to an inferno that can spread quickly beyond our ability to control it.”“A pandemic is a lot like a forest fire,” Mr. Bush said in a speech at the National Institutes of Health. “If caught early it might be extinguished with limited damage. If allowed to smolder, undetected, it can grow to an inferno that can spread quickly beyond our ability to control it.”
To develop ideas, the Bush administration enlisted Dr. Hatchett, who had served as a White House biodefense policy adviser, and Dr. Mecher, who was a Veterans Affairs medical officer in Georgia overseeing care in the Southeast.To develop ideas, the Bush administration enlisted Dr. Hatchett, who had served as a White House biodefense policy adviser, and Dr. Mecher, who was a Veterans Affairs medical officer in Georgia overseeing care in the Southeast.
“‘Someone from the White House is on the phone,’” Dr. Mecher, then 49, recalled his secretary telling him in the fall of 2005, her voice expressing some disbelief.“‘Someone from the White House is on the phone,’” Dr. Mecher, then 49, recalled his secretary telling him in the fall of 2005, her voice expressing some disbelief.
A blunt-speaking, Chicago-born intensive care physician, Dr. Mecher had almost no pandemic policy expertise. Instead, he was recruited because they needed someone who understood how a hospital actually worked, said Dr. Rajeev Venkayya, who was a special assistant to Mr. Bush for biodefense.A blunt-speaking, Chicago-born intensive care physician, Dr. Mecher had almost no pandemic policy expertise. Instead, he was recruited because they needed someone who understood how a hospital actually worked, said Dr. Rajeev Venkayya, who was a special assistant to Mr. Bush for biodefense.
Dr. Koonin, who worked on preparedness planning at the C.D.C., also played a key role.Dr. Koonin, who worked on preparedness planning at the C.D.C., also played a key role.
“Strategic, out-of-the-box thinkers,” is how Dr. Venkayya, who now oversees vaccine production at Takeda, a Japan-based pharmaceutical company, described what he was looking for.“Strategic, out-of-the-box thinkers,” is how Dr. Venkayya, who now oversees vaccine production at Takeda, a Japan-based pharmaceutical company, described what he was looking for.
Given the increased danger from new strains of influenza and the reality that existing antiviral drugs like Tamiflu did not work against all contagious diseases, Drs. Hatchett and Mecher and their team began exploring other ways to combat a large-scale contagion.Given the increased danger from new strains of influenza and the reality that existing antiviral drugs like Tamiflu did not work against all contagious diseases, Drs. Hatchett and Mecher and their team began exploring other ways to combat a large-scale contagion.
It was about that time that Dr. Mecher heard from Robert J. Glass, a senior scientist at Sandia in New Mexico who specialized in building advanced models to explain how complex systems work — and what can cause catastrophic failures.It was about that time that Dr. Mecher heard from Robert J. Glass, a senior scientist at Sandia in New Mexico who specialized in building advanced models to explain how complex systems work — and what can cause catastrophic failures.
Dr. Glass’s daughter Laura, then 14, had done a class project in which she built a model of social networks at her Albuquerque high school, and when Dr. Glass looked at it, he was intrigued.Dr. Glass’s daughter Laura, then 14, had done a class project in which she built a model of social networks at her Albuquerque high school, and when Dr. Glass looked at it, he was intrigued.
Students are so closely tied together — in social networks and on school buses and in classrooms — that they were a near-perfect vehicle for a contagious disease to spread.Students are so closely tied together — in social networks and on school buses and in classrooms — that they were a near-perfect vehicle for a contagious disease to spread.
Dr. Glass piggybacked on his daughter’s work to explore with her what effect breaking up these networks would have on knocking down the disease.Dr. Glass piggybacked on his daughter’s work to explore with her what effect breaking up these networks would have on knocking down the disease.
The outcome of their research was startling. By closing the schools in a hypothetical town of 10,000 people, only 500 people got sick. If they remained open, half of the population would be infected.The outcome of their research was startling. By closing the schools in a hypothetical town of 10,000 people, only 500 people got sick. If they remained open, half of the population would be infected.
“My God, we could use the same results she has and work from there,” Dr. Glass recalled thinking. He took their preliminary data and built on it by running it through the supercomputers at Sandia, more typically used to engineer nuclear weapons. (His daughter’s project was entered in the Intel International Science and Engineering Fair in 2006.)“My God, we could use the same results she has and work from there,” Dr. Glass recalled thinking. He took their preliminary data and built on it by running it through the supercomputers at Sandia, more typically used to engineer nuclear weapons. (His daughter’s project was entered in the Intel International Science and Engineering Fair in 2006.)
Dr. Mecher received the results at his office in Washington and was amazed.Dr. Mecher received the results at his office in Washington and was amazed.
If cities closed their public schools, the data suggested, the spread of a disease would be significantly slowed, making this move perhaps the most important of all of the social distancing options they were considering.If cities closed their public schools, the data suggested, the spread of a disease would be significantly slowed, making this move perhaps the most important of all of the social distancing options they were considering.
“Targeted social distancing strategies can be designed to effectively mitigate the local progression of pandemic influenza without the use of vaccine or antiviral drugs,” concluded a study that Dr. Glass published in the Emerging Infectious Diseases journal. Laura, then a high school junior, got a credit.“Targeted social distancing strategies can be designed to effectively mitigate the local progression of pandemic influenza without the use of vaccine or antiviral drugs,” concluded a study that Dr. Glass published in the Emerging Infectious Diseases journal. Laura, then a high school junior, got a credit.
Drs. Hatchett and Mecher and their team soon found themselves measuring the width of the standard school bus seat and the average classroom size in the United States, calculating how closely spaced students are and agreeing that any plan would have to feature closing schools.Drs. Hatchett and Mecher and their team soon found themselves measuring the width of the standard school bus seat and the average classroom size in the United States, calculating how closely spaced students are and agreeing that any plan would have to feature closing schools.
At the same time, they were circling in on another fundamental challenge: If a government was going to rely on the blunt instrument of social distancing to prevent widespread death, how early would it have to act?At the same time, they were circling in on another fundamental challenge: If a government was going to rely on the blunt instrument of social distancing to prevent widespread death, how early would it have to act?
Dr. Markel had spent his career studying contagious disease outbreaks. Recently, he had been working on a related assignment from the Pentagon, which had a narrower but equally urgent concern: the vulnerability of U.S. military personnel to a viral health threat.Dr. Markel had spent his career studying contagious disease outbreaks. Recently, he had been working on a related assignment from the Pentagon, which had a narrower but equally urgent concern: the vulnerability of U.S. military personnel to a viral health threat.
Asia was hit in 2005 by a bird flu that crossed over to humans and spread to locations where the United States had forces stationed, including the Philippines. That led Dr. Markel to propose — after consulting a dictionary and thesaurus — what he called “protective sequestration,” like keeping military personnel in mass isolation on docked ships.Asia was hit in 2005 by a bird flu that crossed over to humans and spread to locations where the United States had forces stationed, including the Philippines. That led Dr. Markel to propose — after consulting a dictionary and thesaurus — what he called “protective sequestration,” like keeping military personnel in mass isolation on docked ships.
The bird flu, while often fatal, did not continue to cross over in large numbers to humans, and the steps he was proposing turned out to be unnecessary. But the work led him to think about the need for a large-scale isolation plan for the United States.The bird flu, while often fatal, did not continue to cross over in large numbers to humans, and the steps he was proposing turned out to be unnecessary. But the work led him to think about the need for a large-scale isolation plan for the United States.
Dr. Markel had published a book, “When Germs Travel,” in 2004 that examined six major epidemics since 1900 and how they had traveled across the United States. He decided to work with Dr. Martin S. Cetron, the director of the C.D.C.’s quarantine division, to look more closely at the lessons of the Spanish flu of 1918.Dr. Markel had published a book, “When Germs Travel,” in 2004 that examined six major epidemics since 1900 and how they had traveled across the United States. He decided to work with Dr. Martin S. Cetron, the director of the C.D.C.’s quarantine division, to look more closely at the lessons of the Spanish flu of 1918.
Updated June 5, 2020Updated June 5, 2020
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
The research started with St. Louis, which had moved relatively quickly to head off the spread of the flu, and Philadelphia, which waited much longer and suffered far more.The research started with St. Louis, which had moved relatively quickly to head off the spread of the flu, and Philadelphia, which waited much longer and suffered far more.
Officials in Philadelphia did not want to let the flu disrupt daily life, so they went ahead in September 1918 with a long planned parade that drew hundreds of thousands of spectators to promote war bonds.Officials in Philadelphia did not want to let the flu disrupt daily life, so they went ahead in September 1918 with a long planned parade that drew hundreds of thousands of spectators to promote war bonds.
In St. Louis, by contrast, the city health commissioner quickly moved to close schools, churches, theaters, saloons, sporting events and other public gathering spots.In St. Louis, by contrast, the city health commissioner quickly moved to close schools, churches, theaters, saloons, sporting events and other public gathering spots.
Dr. Markel and his team set out to confirm just how important a role timing had played in reducing deaths. They gathered census records and thousands of other documents detailing the date of the first infection, the first death, the first social distancing policies and how long they were left in place in 43 American cities.Dr. Markel and his team set out to confirm just how important a role timing had played in reducing deaths. They gathered census records and thousands of other documents detailing the date of the first infection, the first death, the first social distancing policies and how long they were left in place in 43 American cities.
Separately, Dr. Mecher and his team looked at the experience of 17 cities, using newspaper clips and other sources.Separately, Dr. Mecher and his team looked at the experience of 17 cities, using newspaper clips and other sources.
Both teams came to the same conclusion and published papers on their findings within months of each other in 2007. Early, aggressive action to limit social interaction using multiple measures like closing schools or shutting down public gatherings was vital to limiting the death toll, they found.Both teams came to the same conclusion and published papers on their findings within months of each other in 2007. Early, aggressive action to limit social interaction using multiple measures like closing schools or shutting down public gatherings was vital to limiting the death toll, they found.
“It’s like treating heart-attack patients,” Dr. Mecher said. “Timing matters.”“It’s like treating heart-attack patients,” Dr. Mecher said. “Timing matters.”
After decades of advances by the nation’s pharmaceutical companies — finding treatments or vaccines for major illnesses, including H.I.V. and smallpox — Americans by the early 21st century had a built-in expectation that no matter what the ailment, there must be some kind of available fix. Locking your family inside your home seemed backward, and encouraging people not to go to work economically disastrous.After decades of advances by the nation’s pharmaceutical companies — finding treatments or vaccines for major illnesses, including H.I.V. and smallpox — Americans by the early 21st century had a built-in expectation that no matter what the ailment, there must be some kind of available fix. Locking your family inside your home seemed backward, and encouraging people not to go to work economically disastrous.
The idea of forcibly limiting public assembly or movement had also long been seen as legally and ethically questionable.The idea of forcibly limiting public assembly or movement had also long been seen as legally and ethically questionable.
So the considerable skepticism among local officials, public health experts and policymakers in Washington was not surprising.So the considerable skepticism among local officials, public health experts and policymakers in Washington was not surprising.
One particularly vociferous critic was Dr. D.A. Henderson, who had been the leader of the international effort to eradicate smallpox and had been named by Mr. Bush to help oversee the nation’s biodefense efforts after the 2001 terrorist attacks.One particularly vociferous critic was Dr. D.A. Henderson, who had been the leader of the international effort to eradicate smallpox and had been named by Mr. Bush to help oversee the nation’s biodefense efforts after the 2001 terrorist attacks.
Dr. Henderson was convinced that it made no sense to force schools to close or public gatherings to stop. Teenagers would escape their homes to hang out at the mall. School lunch programs would close, and impoverished children would not have enough to eat. Hospital staffs would have a hard time going to work if their children were at home.Dr. Henderson was convinced that it made no sense to force schools to close or public gatherings to stop. Teenagers would escape their homes to hang out at the mall. School lunch programs would close, and impoverished children would not have enough to eat. Hospital staffs would have a hard time going to work if their children were at home.
The measures embraced by Drs. Mecher and Hatchett would “result in significant disruption of the social functioning of communities and result in possibly serious economic problems,” Dr. Henderson wrote in his own academic paper responding to their ideas.The measures embraced by Drs. Mecher and Hatchett would “result in significant disruption of the social functioning of communities and result in possibly serious economic problems,” Dr. Henderson wrote in his own academic paper responding to their ideas.
The answer, he insisted, was to tough it out: Let the pandemic spread, treat people who get sick and work quickly to develop a vaccine to prevent it from coming back.The answer, he insisted, was to tough it out: Let the pandemic spread, treat people who get sick and work quickly to develop a vaccine to prevent it from coming back.
Caught in the middle, C.D.C. leaders decided to conduct more research and survey community leaders around the country.Caught in the middle, C.D.C. leaders decided to conduct more research and survey community leaders around the country.
The administration ultimately sided with the proponents of social distancing and shutdowns — though their victory was little noticed outside of public health circles. Their policy would become the basis for government planning and would be used extensively in simulations used to prepare for pandemics, and in a limited way in 2009 during an outbreak of the influenza called H1N1.The administration ultimately sided with the proponents of social distancing and shutdowns — though their victory was little noticed outside of public health circles. Their policy would become the basis for government planning and would be used extensively in simulations used to prepare for pandemics, and in a limited way in 2009 during an outbreak of the influenza called H1N1.
Then the coronavirus came, and the plan was put to work across the country for the first time.Then the coronavirus came, and the plan was put to work across the country for the first time.
Dr. Mecher was a key voice on the “Red Dawn” email chain of public health experts in raising early warnings this year about the coronavirus outbreak and Mr. Trump’s reluctance to embrace shutdowns and social distancing. The shutdown this year is much bigger than Dr. Mecher and others imagined would be necessary or practical. Testing has been limited and some states issued social distancing orders even before confirming the coronavirus was spreading within their borders.Dr. Mecher was a key voice on the “Red Dawn” email chain of public health experts in raising early warnings this year about the coronavirus outbreak and Mr. Trump’s reluctance to embrace shutdowns and social distancing. The shutdown this year is much bigger than Dr. Mecher and others imagined would be necessary or practical. Testing has been limited and some states issued social distancing orders even before confirming the coronavirus was spreading within their borders.
Dr. Markel called it “very gratifying to see our work used to help save lives.” But, he added, “it is also horrifying.”Dr. Markel called it “very gratifying to see our work used to help save lives.” But, he added, “it is also horrifying.”
“We always knew this would be applied in worst-case scenarios,” he said. “Even when you are working on dystopian concepts, you always hope it will never be used.”“We always knew this would be applied in worst-case scenarios,” he said. “Even when you are working on dystopian concepts, you always hope it will never be used.”