March 3, 2022

In The Premonition published in 2021 author Michael Lewis introduced me to some talented people who tried to make a difference during the years leading up to and continuing during the current pandemic. Lewis profiles the personalities and work of a few unique individuals who predicted what was coming and developed simple strategies that might have mitigated the number of lives lost and the repetitive crushing blows to the world economy. But the few prescient individuals were not able to influence power sources that might have promoted their recommendations.

Their recommendations were developed assuming that a new infectious agent would emerge and no vaccine would be immediately available. An initial conception grew out of a junior high student’s science project. Her father, a computer savant, helped her build a model of how a disease that is transmitted from humans to humans could spread exponentially and soon overwhelm the entire world. After President George H. W. Bush read John Barry’s book The Great Flu, he was alarmed and assembled a small White House task force to develop a pandemic response strategy. Two former ER doctors and a few others were recruited to draft a plan. They drew upon the exponential spread model and refined it.

The concepts of social distancing, case finding by testing, case isolation and contact tracing all became part of the plan. Each of these simple measures had been part of epidemiology basics for generations. But the authors methodically advanced the models and adjusted the fundamental measures. They dug deeply into the pandemic flu of 1918 and found there was still plenty to be learned. For example, the death rate was much higher in Philadelphia where city officials were late to disallow large public gatherings. St. Louis had acted much earlier to the warnings and the death tolls were dramatically lower in the Missouri city. The planner’s human interactions models suggested that closing schools was the single most effective policy that could reduce human to human disease transmission. One task force member sought to comprehend this intuitively inexplicable forecast by visiting his children’s school. He quickly relearned there is a dramatic difference in personal space limits tolerated by children compared with adults. His observations helped confirm the model’s extrapolation. Task force members also learned that people do not interact randomly, but instead interact predominantly in social groupings that sociologists term homophilys. That is, we tend to more often closely interact with other people who are similar to us.  

After the novel disease emerged, the small team connected with a MacArthur Genius grant recipient who had developed a brilliant method to rapidly identify viral genomes. He and his group quickly developed the capacity to test and track pathways that the virus traversed. From this information the discovery of “superspreaders” who were responsible for much the viral transmissions emerged. The combinations of testing, finding cases and isolating superspreaders could have made the measures more acceptable to the general public and limited the economic impact of the pandemic.

However, for the most part, such refined simple measures were never effectively implemented in the US. The recent Olympics in China demonstrated that these fundamental measures could have been successful. The relentless testing, isolating, masking and social distancing were aggravating to athletes and reporters, but they were undeniably effective. In the US people with a plan and advanced knowledge were not able to connect with people in power. Even if they had had the ear of government, it is likely that our public would not have complied. One of the individuals in the task force’s communication circle suggested that public health measures would never be accepted in our culture unless there was a large financial reward that would incentivize entrepreneurs. We spent money on business shutdowns, hospital expansions and ventilators. But we enacted few of the more precise fundamental measures that might have impeded the viral spread.

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