COVID-19: A Tale of Two Cities

The Center for Disease Control and Prevention in Atlanta runs a training program called the Epidemic Intelligence Service (EIS).  Those who emerge from this training generally assume roles in health programs at governmental agencies, both national and international.  They refer to themselves as “disease detectives.”  They are intended to be the people one goes to when health threats arise generating a need for investigative efforts and emergency responses.  There is a specific protocol that is recommended when a situation such as presented by COVID-19 arises.  Charles Duhigg tells his readers about that protocol and about two cities/states that made different decisions when the health emergency struck.  His article appeared in The New Yorker as Seattle’s Leaders Let Scientists Take the Lead. New York’s Did Not (as The Pandemic Protocol in the paper version of the magazine).

Duhigg provides this background on the EIS.

“The Epidemic Intelligence Service was founded in 1951, when American troops in Korea began experiencing fevers, aches, vomiting, and fatal hemorrhages. Some three thousand soldiers fell ill, leading military leaders to conclude that Chinese-backed Communists had weaponized bacteria. ‘The planning of appropriate defensive measures must not be delayed,’ an epidemiologist at a new federal agency, the Communicable Disease Center, declared. He proposed a new division, named to evoke the Central Intelligence Agency. But when the first class of E.I.S. officers landed in Korea they found that the fevers were not caused by a crafty enemy. Soldiers, it turned out, had been accidentally consuming rodent feces. In later conflicts, generals were instructed to use thicker food-storage bags and to set more rat traps.”

Despite this humble beginning, those trained in the EIS program would contribute to health-care activities across the globe.

“E.I.S. alumni went on to take powerful health-care jobs across the country. ‘Nearly ninety per cent of E.I.S. graduates embark on public-health careers at the local, state, federal or international level,’ a 2001 study found. Four former C.D.C. directors are E.I.S. alumni; half a dozen graduates have served as the U.S. Surgeon General.”

The protocol developed by the EIS to deal with situations such as COVID-19 calls for a scientist to be the spokesperson for communication with the public.  It is natural for a politician to wish to play that role, but given the nature of our politics, any politician is likely to have a problem gaining the trust of about half the people.  In addition, the instincts of a politician are at odds with what is needed to counter an epidemic.  The traditional role for a politician would be to reassure people that eventually all will be well.  But what is needed is someone to frighten people into action.  A politician will tend to wait until drastic measures can be justified.  The scientist knows that if the need for drastic measures is apparent, then it is already too late.

“Epidemiology is a science of possibilities and persuasion, not of certainties or hard proof. ‘Being approximately right most of the time is better than being precisely right occasionally,’ the Scottish epidemiologist John Cowden wrote, in 2010. ‘You can only be sure when to act in retrospect.’ Epidemiologists must persuade people to upend their lives—to forgo travel and socializing, to submit themselves to blood draws and immunization shots—even when there’s scant evidence that they’re directly at risk.”

“The C.D.C.’s Field Epidemiology Manual, which devotes an entire chapter to communication during a health emergency, indicates that there should be a lead spokesperson whom the public gets to know—familiarity breeds trust. The spokesperson should have a ‘Single Overriding Health Communication Objective, or SOHCO (pronounced sock-O),’ which should be repeated at the beginning and the end of any communication with the public. After the opening SOHCO, the spokesperson should “acknowledge concerns and express understanding of how those affected by the illnesses or injuries are probably feeling.” Such a gesture of empathy establishes common ground with scared and dubious citizens—who, because of their mistrust, can be at the highest risk for transmission. The spokesperson should make special efforts to explain both what is known and what is unknown. Transparency is essential, the field manual says, and officials must ‘not over-reassure or overpromise’.”

At the end of February, political leaders in the Seattle area were made aware that COVID-19 was loose in the area.  Within a few days the lead politician, Dow Constantine, King County Executive, was working with the health experts on how to proceed.  It was agreed that the scientists would take the lead, and that extreme social distancing would be necessary as soon as possible.  But this was before there were any signs that the public could consider in order to feel such a move was necessary.  The trick was to convince people of the seriousness of the situation before the seriousness became obvious.  They began by getting both Microsoft and Amazon, two huge employers in the area, to tell their employees to stay home and work remotely if they could.  They also floated the idea that schools would have to shut down.  This managed to convey the direness of the epidemic and gave people the nudge to begin their individual assessments and to begin to change their habits.  By the time the actual regulations were implemented, and the schools were officially closed, many people had already gone into the shelter-at-home mode on their own.  The Seattle area would experience an initial surge in cases and fatalities due to outbreaks in local nursing homes, but after that brief period, it and Washington state have been effective in keeping the disease from getting out of control.

COVID-19 cases were making an appearance in the New York City area about the same time as near Seattle.  However, the response was quite different.  In New York, the politicians took the lead.  In particular, the Mayor of New York City, Bill de Blasio, and the Governor, Andrew Cuomo, two people who don’t particularly like each other, both tried to be spokespersons communicating with the public.  And both hesitated to send the message that great sacrifices would have to be made.

“In early March, as Dow Constantine was asking Microsoft to close its offices and putting scientists in front of news cameras, de Blasio and New York’s governor, Andrew Cuomo, were giving speeches that deëmphasized the risks of the pandemic, even as the city was announcing its first official cases. De Blasio initially voiced caution, saying that ‘no one should take the coronavirus situation lightly,’ but soon told residents to keep helping the city’s economy. ‘Go on with your lives + get out on the town despite Coronavirus,’ he tweeted on March 2nd—one day after the first COVID-19 diagnosis in New York. He urged people to see a movie at Lincoln Center. On the day that Seattle schools closed, de Blasio said at a press conference that ‘if you are not sick, if you are not in the vulnerable category, you should be going about your life.’ Cuomo, meanwhile, had told reporters that ‘we should relax.’ He said that most infected people would recover with few problems, adding, ‘We don’t even think it’s going to be as bad as it was in other countries’.”

“De Blasio and Cuomo kept bickering. On March 17th, de Blasio told residents to ‘be prepared right now for the possibility of a shelter-in-place order.’ The same day, Cuomo told a reporter, ‘There’s not going to be any “you must stay in your house” rule.’ Cuomo’s staff quietly told reporters that de Blasio was acting ‘psychotic.’ Three days later, though, Cuomo announced an executive order putting the state on ‘pause’—which was essentially indistinguishable from stay-at-home orders issued by cities in Washington State, California, and elsewhere.”

The net result was that New Yorkers began changing their habits later in the process than those in the Seattle area.  It would make a great difference.

“According to data collected by Google from cell phones, nearly a quarter of Seattleites were avoiding their workplaces by March 6th. In New York City, another week passed until an equivalent percentage did the same. Tom Frieden, the former C.D.C. director, has estimated that, if New York had started implementing stay-at-home orders ten days earlier than it did, it might have reduced COVID-19 deaths by fifty to eighty per cent.”

There are reasons why the virus should be more deadly in New York City than near Seattle.  New York is considerably more densely populated and crowding in public transit is more common.  Health experts were well aware of how dangerous the virus could be for New Yorkers.  It’s a shame they didn’t have more influence.

Data on the pandemic can be found at the Worldometers site.  This link provides a state-by-state comparison of case numbers and fatalities.  From there one can link to country comparisons and a range of other data.  At this time in the United States, New York is first in number of COVID-19 cases, while Washington state is eighteenth.  In fact, New York state has experienced more cases than any other country on Earth. Deaths per million of population provides a direct comparison of the fatality levels in the two states.  In Washington it is 114, the number for New York is 1227.

Duhigg also considers Trump’s behavior as the coronavirus scenario plays out.  Luckily, most responsible people have ignored him as much as possible.