I May Have Lost My Temper (7-29-21)

00:00 I lost my temper during a Covid debate and later experienced a spiritual epiphany, https://lukeford.net/blog/?p=141500
01:00 Modafinil Is The Official Drug Of The Rationalist Movement, https://lukeford.net/blog/?p=137046
05:00 Dr. David Gorski on the latest viral COVID-19 disinformation, https://respectfulinsolence.com/2020/08/31/only-six-percent-gambit-latest-viral-covid-19-disinformation/
12:00 A brief history of social distancing shows it is Biblical, https://lukeford.net/blog/?p=141576
16:00 Where Do Public Health Officials Get The Authority To Lock Us Down?, https://lukeford.net/blog/?p=141566
18:00 Julius Ruechel: The Lies Exposed by the Numbers: Fear, Misdirection, & Institutional Deaths (An Investigative Report), https://lukeford.net/blog/?p=141564
22:00 Where Did The Social Distancing Strategy Come From?, https://lukeford.net/blog/?p=141534
24:00 Average Covid Death Costs 16 Years Of Life, https://lukeford.net/blog/?p=141514
40:00 Whiteshift: Populism, Immigration, and the Future of White Majorities, https://lukeford.net/blog/?p=141443

Bud: Did you curse him out? Call him a moron? How bad did it get? I’m not upset Luke, I’m just disappointed. You need more Fred Luskin. The dark side of Crystal Lite. Consider 12-steps.
It could be the apathy inducing darkside of Modaf — a toxic cocktail of modafinil, tums and crystal lite can turn the most godly men into uncaring beasts.

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A History Of Social Distancing

According to Wikipedia: In public health, social distancing, also called physical distancing,[2][3][4] is a set of non-pharmaceutical interventions or measures intended to prevent the spread of a contagious disease by maintaining a physical distance between people and reducing the number of times people come into close contact with each other.[2][5] It usually involves keeping a certain distance from others (the distance specified differs from country to country and can change with time) and avoiding gathering together in large groups.[6][7]

By minimising the probability that a given uninfected person will come into physical contact with an infected person, the disease transmission can be suppressed, resulting in fewer deaths.[2] The measures may be used in combination with others, such as good respiratory hygiene, face masks and hand washing.[8][9] To slow down the spread of infectious diseases and avoid overburdening healthcare systems, particularly during a pandemic, several social-distancing measures are used, including the closing of schools and workplaces, isolation, quarantine, restricting the movement of people and the cancellation of mass gatherings.[5][10] Drawbacks of social distancing can include loneliness, reduced productivity and the loss of other benefits associated with human interaction.[11]

Social distancing measures are most effective when the infectious disease spreads via one or more of the following methods, droplet contact (coughing or sneezing), direct physical contact (including sexual contact), indirect physical contact (such as by touching a contaminated surface), and airborne transmission (if the microorganism can survive in the air for long periods). The measures are less effective when an infection is transmitted primarily via contaminated water or food or by vectors such as mosquitoes or other insects.[12] Authorities have encouraged or mandated social distancing during the COVID-19 pandemic as it is an important method of preventing transmission of COVID-19. COVID-19 is much more likely to spread over short distances than long ones. However, it can spread over distances longer than 2 m (6 ft) in enclosed, poorly ventilated places and with prolonged exposure.[13]

Although the term “social distancing” was not introduced until the 21st century,[14] social-distancing measures date back to at least the 5th century BC. The Bible contains one of the earliest known references to the practice in the Book of Leviticus 13:46: “And the leper in whom the plague is… he shall dwell alone; [outside] the camp shall his habitation be.”[15] During the Plague of Justinian of 541 to 542, Emperor Justinian enforced an ineffective quarantine on the Byzantine Empire, including dumping bodies into the sea; he predominantly blamed the widespread outbreak on “Jews, Samaritans, pagans, heretics, Arians, Montanists and homosexuals”.[16] In modern times, social distancing measures have been successfully implemented in several epidemics. In St. Louis, shortly after the first cases of influenza were detected in the city during the 1918 flu pandemic, authorities implemented school closures, bans on public gatherings and other social-distancing interventions. The influenza fatality rates in St. Louis were much less than in Philadelphia, which had fewer cases of influenza but allowed a mass parade to continue and did not introduce social distancing until more than two weeks after its first cases.

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Where Do Public Health Officials Get The Authority To Lock Us Down?

From Michael Lewis’s superb 2021 book, The Premonition: A Pandemic Story:

* Charity had taken away other lessons from Dr. [Stephen] Hosea.
The simplest explanation is usually the best. If the patient turns up with two separate symptoms—say, a fever and a rash—the cause is more likely than not a single underlying disease.
If there is the faintest possibility of a catastrophic disease, you should treat it as being a lot more likely than it seems. If your differential diagnosis leads to a list of ten possibilities, for instance, and the tenth and least likely thing on the list is Ebola, you should treat the patient as if she has Ebola, because the consequences of not doing so can be calamitous.
When something doesn’t quite seem right about your diagnosis, respect the feeling, even if you can’t quite put your finger on why the diagnosis might be wrong. A lot of people had died because doctors had allowed their minds to come to rest before they should.
A doctor needed to be a detective for the patient: that was Dr. Hosea’s big message. Charity had grafted it onto her job as health officer. Her patient was Santa Barbara County. To keep it healthy, she needed to think about it the way Stephen Hosea thought about his patients. She needed to keep her hands on it. To be its detective.

* She watched Dr. [Charity] Dean tell this important doctor, on the spot, that she was issuing a health order to shut him down.

* At which point Charity needed to let the California Department of Public Health and the Centers for Disease Control in Atlanta know what she’d done. That was the moment she sensed just how far out on a limb she had climbed. “The CDC was aghast,” she said. “They were aghast that I hadn’t asked their opinion. They said no local health officer in the history of local health officers has ever issued an order to close down a doctor’s office based on a suspicion.” They tried to argue that, as a mere local health officer, she lacked the authority to close a doctor’s practice. Charity didn’t understand, first, that the CDC could not know just how broad her authority was—but then she too had only just learned that the power in most of the rest of the United States resided with the state health officer rather than the local ones. California was unusual in having conferred on its county health officers the same powers that, say, Texas and Mississippi reserved for their state health officers. Yet even after the CDC people conceded her authority, they refused to condone how she’d used it. “They told me that if I’m wrong I’m going to get fired,” she said.
That threat actually wasn’t all that original. As Kat DeBurgh, head of the Health Officers Association of California, put it, “To do the job of local public-health officer, you basically always need to be willing to lose your job.” To be a public-health officer—to really own the role—you needed to be prepared for your only appearance on the front page of the local newspaper to be in a story about a call you got wrong. That might be the only time anyone ever looked up and noticed who you were: the moment they chopped off your head.
Apart from the uninsured poor she treated in the clinics and homeless shelters, few citizens had any clue what Charity did—until she did something that infuriated them. “Rich white people would look at me like I was a relic from the past when I explained my role,” she said. “Like they’d stumbled across a candelabra from the Titanic . How lovely—but what does one need it for today?” The illness you prevented, and the lives you saved, went unnoticed by the people sitting on top of society. That’s why her role was, every year, less well funded than the year before. The fax machine was the new tech in the office that still kept its records on paper and filed the paper in red manila envelopes. “If I wanted to send a letter, I needed to fill out a form, and the form had to be approved—all to use a county-funded stamp,” said Charity. “I was the county health officer, and I wasn’t allowed to use a stamp. But that’s okay! I learned to live within the system.”
That system was the front line of defense against disease, not just in the county but in the whole country. Seventy percent of Santa Barbara’s cases of communicable disease came through one of its five public-health clinics, overseen by the health officer. The math was the same everywhere. But because people who had health insurance thought it had nothing to do with them—that it was just government —the society had starved the system of resources. “People don’t realize what it is until something bad happens,” said Charity. “It’s protecting the entire society, the whole economy.” The economy, for its part, understood her role only in its own narrow financial terms. “I learned the way to make the argument to elected officials for money for disease control was not ‘It is the right thing to do to take care of the most vulnerable in our community,’ ” she said. “Rather, make the case of the dollar return on investment to prevent the disease from spilling over into the rest of the community.” Yet even then—even after she showed a return—the investment often went unmade. It had taken years to get the money to buy a machine that allowed her to test quickly for tuberculosis, and to prevent some number of new cases. “The cost of a single TB case is between thirty and a hundred thousand dollars,” she said. “Higher if it is drug-resistant TB. So why are we haggling over a seventy-two-thousand-dollar machine?”

* Charity expected the state medical board to dig deeper. They never did. “I called them and said, ‘We thought you were launching an investigation.’ They said, ‘We are. But it consists of you telling us what you’ve found.’ ” The subsequent report by the Medical Board of California explained that Dr. Thomashefsky had violated a great many standard operating procedures. The state of California stripped him of his license to practice medicine, and he eventually was asked to close his practice in Oregon. With that, his career in medicine ended.
By then Charity Dean knew that, in her quest to stop the spread of disease, she was more or less on her own. She had her friends and allies. The public-health nurses, for example, who were among the more impressive human beings she had ever known. She was also growing to adore Santa Barbara’s chief counsel, who kept handing her enough rope to hang herself, by confirming that, yes, the law allowed her to do whatever the hell she thought needed doing to protect the public. She felt a deep connection to the fifty-seven other California county health officers—though they were, she had to admit, a mixed bag. Some were ancient doctors who viewed the job as a sinecure; some were part-timers who didn’t even seem all that interested in the job. “There’s no defined career path to becoming a public-health officer, and that’s a problem,” she said. “You get the retired anesthesiologist who is spending most of his time as a professional dog breeder.” But some of her fellow local health officers, like Charity herself, were so deeply committed to the job that they experienced it more as a mission. These people she loved best. But their needs and issues were too diverse for them to function as a single, powerful unit. And they weren’t in a position to have her back in a crisis.
The larger apparatus of American public health was very different on the inside from how Charity had imagined it from the outside. The Centers for Disease Control, the apex authority, wasn’t of much practical use to her. The distance they had put between themselves and her when she closed Thomashefsky’s clinic was of a piece with their general behavior. She’d repeatedly seen the tendency to flee when conflict arose.

* Charity instructed the Santa Barbara medical community to test any young person who turned up with a low-grade fever. “It’s not those people with mild symptoms you worry about,” she said. “It’s the people they infect, and the exponential growth.” As the CDC dithered, three more UCSB students tested positive for meningococcal disease. Each case presented differently. One student, with only a rash, had been diagnosed initially with chicken pox; the other two had slight fevers and had been initially misdiagnosed as having nothing special. “None of them lived together,” recalled Dr. Ferris, UCSB’s medical director. “It was really sort of hard to understand why we had these random cases.” Within days the school had set up hotlines to field calls from panicked parents, along with complaints from citizens of Santa Barbara who thought that the school’s twenty thousand students should be confined to their rooms.
Charity stayed up nights staring at the whiteboards in her office, on which she had charted the social relationships of the infected UCSB students. At the top of the board she had written “Cross-Pollination,” a term of art she’d picked up from Dr. Hosea. “It’s when you don’t want to say ‘he had sex with her’ and what kind of sex they had,” she said. “But I was basically trying to figure out who had shared saliva with whom, and where they’d shared it.” All signs pointed to the Greek system. She decided to shut down the college sororities and fraternities and give the twelve hundred students in them a prophylactic drug.
“With meningitis B you have a very narrow window to give the prophylaxis,” she explained, “and it was a weekend. You had to do it fast and all at once, or else the pathogen just keeps circulating.”
She got on the phone with the main guy at the CDC and his silent crowd. The guy strongly disagreed with her doing anything. “What he actually said,” recalled Charity, “was, ‘That decision is not supported by the data.’ I said, ‘Oh, really—there is no data.’ ” She outlined a plan she’d created: thin out the dorms by moving some of the students into hotel rooms; shut down the intramural sports teams; and administer a vaccine that had been approved in Europe but that the FDA had not yet signed off on. “The CDC guy said, ‘We’re not going to do any of that, and if you do that, we’re going to put it in writing that it was your decision and we disagreed with it,’ ” Charity recalled.
There followed other calls with the CDC, each more dismissive of her than the last. After one of them, Paige Batson turned to her boss and said, “Dr. Dean, I’ve never heard anyone at the CDC speak to someone like that!” But in the end the campus ignored the CDC and did everything Dr. Dean recommended. “It was kind of a stern order,” said Dr. Ferris, “and it had never been done before. But after she stopped all the parties and administered the prophylaxis, we had no more cases.” From start to finish, what Dr. Ferris and everyone noticed was that, as Dr. Ferris put it, “the CDC wasn’t pleased with her. The CDC kept saying, ‘There is no evidence to back it up.’ They didn’t have any evidence, because there is only one case every four years.”
The root of the CDC’s behavior was simple: fear. They didn’t want to take any action for which they might later be blamed. “The message they send is, We’re better than you and smarter than you, but we’re letting you stick your neck out to take the risk,” said Charity. “They would argue with me about how kids behave in fraternities and sororities. And I had been president of Kappa Delta!” In the middle of the crisis, Charity figured out what it would take to appease the nation’s highest authority on infectious disease. “It was when they said, ‘If any of this works, you won’t know which one worked,’ ” she recalled. “They said, ‘You need to do these things one at a time and gather evidence.’ They wanted to learn from this meningitis outbreak, and I wanted to stop it. My goal was to stop it, and that was not their goal. They wanted to observe it as if it were a science experiment on how meningitis moves through a college campus. And I was like, ‘Are you kidding me: a kid just lost his feet.’ ”
Charity never would know which of the measures she took had controlled the disease; she knew only that all of them together had. To her, all that really mattered was that the disease had been contained. The job of the public-health officer—or at least her job as the public-health officer—was a series of intense firefights. There was no standard operating procedure for many of the situations in which she found herself: usually, they were sufficiently different from anything that had ever before happened. If she waited until she had enough evidence to publish in a scientific journal, the battle would be over, and she’d have lost. Kids would lose limbs, or die. The decisions she was forced to make were less like, say, those made by a card counter at a blackjack table, and more like the ones made by a platoon leader in combat. She never had all the data she wanted or needed when making her decisions—enough so that afterward she could defend them by saying, “I just did what the numbers told me to do.”
The hard truth was that there was never time to wait for more data. The moment an infectious disease appeared, decisions cried out to be made. The longer you waited, the more likely it was that people would die waiting for you to decide—or waiting for you to gather the data you needed to cover your ass if your decisions proved wrong.
Two years after the UCSB meningitis outbreak, the CDC finally published a report on how to deal with a meningitis outbreak on a college campus. On its list of best practices were most of the things Charity had done at UCSB. After that, from time to time, someone would call her from the CDC and ask her if she’d please get on the phone with some college health officer somewhere in the United States and describe how she handled the UCSB outbreak. But by then Charity had washed her hands of the CDC. “I banned their officers from my investigations,” she said. The CDC did many things. It published learned papers on health crises, after the fact. It managed, very carefully, public perception of itself. But when the shooting started, it leapt into the nearest hole, while others took fire. “In the end I was like, ‘Fuck you,’ ” said Charity. “I was mad they were such pansies. I was mad that the man behind the curtain ended up being so disappointing.”
In theory, the CDC sat atop the system of infectious-disease management in the United States. In practice, the system had configured itself to foist the political risk onto a character who had no social power. It required a local health officer to take the risk and responsibility, as no one else wanted to. Charity could see that the CDC’s strategy was politically shrewd. People were far less likely to blame a health officer for what she didn’t do than what she did. Sins of commission got you fired. Sins of omission you could get away with, but they left people dead. The health officer’s job was to choose, all by herself, the direction in which to err: do too much, or too little? “I did not sign up to be that kind of brave,” said Charity. “That wasn’t my plan. I was always saying to the CDC, ‘This is your job! Do your job!’ But after the UCSB outbreak, my motto was, ‘Stop waiting for someone to come and save you. Because no one is coming to save you.’”

* Inside Casa Dorinda, Charity had thirty minutes. “I knew what I had to do,” she said. “I didn’t want to do it. I was asking myself: Is there any way out of this?” The answer came back: no. She looked around and found that the fire sprinklers didn’t work—and that alone, she told the medical director, was grounds for shutting the place down. “I told them, ‘We can do this the easy way or the hard way,’ ” said Charity. “They were very upset, but they decided to do it voluntarily. Sure enough, there were seven deaths. Their medical director sent me a scathing email saying, ‘Their deaths are on you.’ He was right.” The second mudslide never came.

* The most disorienting aspect of the job by far was her new boss. Charity had assumed that she herself would replace her old boss, Dr. Karen Smith, whenever Dr. Smith stepped down. That’s why Dr. Smith had brought her in in the first place. Dr. Smith had left in June 2019, and for the next few months Charity had filled her shoes—but then, in October, she was returned to her original position. The new governor, Gavin Newsom, broke with the tradition of naming a former local California health officer to run the state when he instead brought in Sonia Angell, a former CDC employee in the agency’s Noncommunicable Disease Unit. Angell had experience in neither California nor communicable disease. Her most recent job had been working on heart disease in New York City’s health department. Only later, in August 2020, at the press conference where he announced Angell’s abrupt resignation—without going into why she was resigning so abruptly—would Newsom explain why, in part, she’d been recruited by his administration: her work in righting racial injustice in health care. Charity was later told that she herself had never been a serious candidate. “It was an optics problem,” says a senior official in the Department of Health and Human Services. “Charity was too young, too blond, too Barbie. They wanted a person of color.” Sonia Angell identified as Latina.

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Julius Ruechel: The Lies Exposed by the Numbers: Fear, Misdirection, & Institutional Deaths (An Investigative Report)

One thing that intrigued me from a deep Google search of Julius Ruechel is that nobody has bothered to critique his work. How important is it if nobody has bothered to push against it?

A friend sent me this link to Ruechel’s 115 page expose.

Julius writes: “Having a severe pre-existing health condition or a severely compromised immune system are necessary pre-requisites before you have cause to worry.”

That does not seem to square with this Feb. 18, 2021 Nature magazine study showing the average Covid death costs 16 years of life.

I find the Nature report more compelling. It strikes me as judicious while Ruechel’s style is hyperbolic.

Julius writes: “a full 97% of outbreak-related deaths are in long-term care & hospitals/healthcare!”

He doesn’t footnote the claim. It does not jive with other things we know about Covid deaths, including the Nature study.

Julius writes: “The pie chart demonstrates that this is a crisis that affects people with extremely serious pre-existing health conditions and compromised immune systems. And almost no-one else.”

That does not seem to square with this Feb. 18, 2021 Nature magazine study showing the average Covid death costs 16 years of life. Somebody is wrong here.

Julius writes: “Which means that, despite all the shaming about our desire to have a BBQ in our backyards with our friends, 98.6% of outbreak-linked deaths are from infections caught and spread inside the walls of tightly controlled institutional environments, not out in the community.”

He is on to something here as we have no evidence of substantial Covid transmission outside.

I find Ruechel’s rhetorical style too shouty to endure for long.

“When you overstate, readers will be instantly on guard, and everything that has preceded your overstatement as well as everything that follows it will be suspect in their minds because they have lost confidence in your judgment or your poise. Overstatement is one of the common faults. A single overstatement, wherever or however it occurs, diminishes the whole, and a single carefree superlative has the power to destroy, for readers, the object of your enthusiasm.” (Strunk & White)

Julius writes: “98.6% of all outbreak-linked deaths are the result of infections caught inside these institutional barriers. Only 1.4% are linked to outbreaks in the community at large.”

I’m skeptical. Where’s the footnote for this claim?

Julius writes that “many COVID deaths are deaths with but not from COVID.”

As soon as I hear this argument, my brain shuts off because I know I’m dealing with someone who doesn’t know much on the topic and does not think clearly with the little knowledge they do have. When I compare Julius’s arguments with Dr. David Gorski’s arguments on this matter, I find the surgeon more convincing. A pandemic that kills people at a median length of time of 18 days seems likely to be the underlying cause of death for most people who die with Covid. Covid, like AIDS, is never the proximate cause of death. Instead it will be something like organ shutdown or respiratory failure.

I don’t have the energy right now to survey the literature on the utility of face masks and social distancing to reduce an influenza pandemic. On the other hand, to me, just because some politicians and health officers used the justification of “two weeks [of lockdown] to flatten the curve” is not strong evidence that lockdowns don’t provide benefits that might outweigh the costs in some circumstances. Also, just because politicians and health officers reversed themselves quickly on the efficacy of face masks to reduce the spread of an influenza pandemic is not strong evidence that face masks are not useful in some contexts.

It makes sense to me that leaders would want to reduce the Rt (a measure of how quickly the virus is spreading), and when it goes above 1, they would have incentives to promote social distancing and when it goes well below 1, they might ease up on social distancing.

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Where Did The Social Distancing Strategy Come From?

I just read Michael Lewis’s superb 2021 book, The Premonition: A Pandemic Story.

He writes:

* The problem, as he [Richard Hatchett in 2005] framed it for the Pentagon, was how to slow the spread of a communicable disease until you can produce a vaccine. As communicable disease spreads through social networks, Richard reasoned, you had to find ways to disrupt those networks. And the easiest way to do that was to move people physically farther apart from each other. “Increasing Effective Social Distance as a Strategy,” he called it. “Social distance” had been used by anthropologists to describe kinship, but he didn’t know that at the time, and so he thought he was giving birth to a phrase. (“But I don’t think I turned it into a gerund,” he’d later say.) What he also didn’t realize was that he was giving new life, to a dead idea: that apart from isolating people who were ill, you needed to do anything you could to slow the spread of a disease before you had drugs to help. “I was this emergency room doctor,” he said. “I didn’t know that people said all this stuff had been tried in 1918 and it hadn’t worked. I wasn’t rejecting anything. I just didn’t know any better.”

* There was, most importantly, a passage that suggested what the federal government might do, at the start of a pandemic, before a vaccine was available. It would, they’d written, “provide guidance, including decision criteria and tools, to all levels of government on the range of options for infection control and containment, including those circumstances where social distancing measures, limitations on gatherings or quarantine authority may be an appropriate public health intervention.”
It was hard to imagine anyone wading into that passage voluntarily, much less giving it a second thought. The words mattered less for what they said than for what they could be made to say. Like the words in the Holy Bible or the U.S. Constitution, they invited the problem of how they might be interpreted, and by whom, and for what purposes. As read by Richard Hatchett and Carter Mecher, those words gave them cover to answer the most important medical question they’d ever faced: How do you save lives in a pandemic before you have the drugs and vaccines to do it?

* The graph illustrated the effects on a disease of various crude strategies: isolating the ill; quarantining entire households when they had a sick person in them; socially distancing adults; giving people antiviral drugs; and so on. Each of the crude strategies had some slight effect, but none by itself made much of a dent, and certainly none had the ability to halt the pandemic by driving the disease’s reproductive rate below 1. One intervention was not like the others, however: when you closed schools and put social distance between kids, the flu-like disease fell off a cliff. (The model defined “social distance” not as zero contact but as a 60 percent reduction in kids’ social interaction.) “I said, ‘Holy shit!’ ” said Carter. “Nothing big happens until you close the schools. It’s not like anything else. It’s like a phase change. It’s nonlinear. It’s like when water temperature goes from thirty-three to thirty-two. When it goes from thirty-four to thirty-three, it’s no big deal; one degree colder and it turns to ice.”

* In the end he plotted both the deaths [in the 1918 Spanish Flu] and the restrictions imposed to prevent them, and saw that the earlier the restrictions imposed in any given outbreak, the fewer the deaths. In the case of Philadelphia, he wrote, “the closing of schools and churches, banning of public meetings, and banning of large public gatherings occurred relatively late into the epidemic”—nearly one month after the outbreak began and just a week before its peak. He wondered if other cities had reacted more quickly, and if their specific reactions might explain the huge variation in the death rates from city to city.

…“Others use the stories in Barry’s book to support the position that the infection control and social distancing measures would probably be ineffective,” he wrote. “On the flight back to Atlanta I went thru Barry’s book carefully and tried to reconstruct the events in a particularly hard hit city—Philadelphia . . . The bottom line is that anyone using the 1918 Philadelphia experience to argue that infection control and social distancing measures would be of little help needs to recognize how ineffective the overall response was in Philadelphia and how late the measures were instituted (within one week of the epidemic peak and after tens of thousands and perhaps hundreds of thousands were already ill).”

* It took just a few months for them to piece together what had actually happened in 1918. Their paper appeared in the May 2007 issue of the Proceedings of the National Academy of Sciences . A coauthor and friend, the Harvard epidemiologist Marc Lipsitch, did the statistical work and the other stuff that made it seem as if it were written by proper scholars. § Titled “Public Health Interventions and Epidemic Intensity during the 1918 Influenza Pandemic,” the piece revealed, for the first time, the life-or-death importance of timing in the outcomes of 1918. Cities that intervened immediately after the arrival of the virus experienced far less disease and death. The first reported flu cases in Philadelphia had been on September 17. The first case wasn’t spotted in St. Louis until October 5—which also happened to be the day the United States surgeon general, Rupert Blue, finally acknowledged the severity of the disease and recommended that local leaders take action. The death rate in St. Louis was half that of Philadelphia because St. Louis’s leaders used the cover provided by the federal government to distance its citizens from one another.
That didn’t mean that everyone in St. Louis appreciated what had happened. “We’re reading the newspapers in St. Louis,” said Richard, “and they know for a fact that they are having a better experience than other cities, and they still couldn’t keep their interventions in place for more than four to six weeks.” The paper analyzed the effects of that inability, and showed that American cities that caved to pressure from business interests to relax their social distancing rules experienced big second waves of disease. American cities that didn’t did not. The paper offered a real-world confirmation of what Bob Glass and the other mathematical modelers had discovered in their fake worlds. However you felt about the strategy of Targeted Layered Containment, you could no longer say there was no data to show that it had any effect. “Until then, the people who hated our ideas could throw up smoke screens about modeling,” said Richard. “They couldn’t throw up smoke screens about what had happened in 1918.”
The paper’s more subtle message appeared between its lines: people have a very hard time getting their minds around pandemics. Why was it still possible, in 2006, to say something original and important about the events of 1918? Why had it taken nearly a century to see a simple truth about the single most deadly pandemic in human history? Only after three amateur historians studied the various interventions, and the various death tolls in individual American cities, did the importance of timing became obvious. Carter wondered why this had been so hard to see. A big part of the answer, he decided, was in the nature of pandemics. They were exponential processes. If you took a penny and doubled it every day for thirty days, you’d have more than five million dollars: people couldn’t imagine disease spread any better than they could imagine a penny growing like that. “I think it’s because of the way our brains are wired,” said Carter. “Take a piece of paper and fold it in half, then fold it in half again, for a total of 50 times folding it in half. If a piece of paper is 0.004 inches thick to begin with, by the time you fold it 50 times, it is more than 70 million miles thick.” Again, it feels impossible. The same mental glitch that leads people to not realize the power of compound interest blinds them to the importance of intervening before a pathogen explodes.
It was seven months before the United States public-health system fully bought into the power of social distancing. The story of those months was dear to Lisa Koonin. She saved every email and every version of the fifty or more presentations she and Carter made—to everyone from the Department of Education to state and local public-health officers who filled hotel ballrooms. She thought she might one day write a book about it.
The big theme of her book would be the power of storytelling. It had taken Lisa, Richard, and Carter some time to see that they were in a war of competing narratives, and that whoever had the best narrative would win. Public-health people who did not actually know all that much about the subject, for instance, would insist that if you closed schools, all sorts of bad things would happen: crime would rise with kids on the streets; the thirty million kids in the school-lunch program would lack nutrition; parents wouldn’t be able to go to work; and so on. American society now leaned on schools to care for children in a way that would have bewildered Americans of an earlier age, as that other institution, the family, was failing at the job. “The sub-rosa conversation was that families weren’t safe places for children,” said Lisa.
To refute knee-jerk arguments about the costs of social distancing, Carter had marshaled so much data from so many corners of the U.S. government that a senior public-health official who passed through the White House called him Rain Man. He’d show his critics that crime rates actually fell on weekends, for instance, when kids were out of school. The FBI keeps all these stats, he’d say. Juvenile crime peaks at 3:30 p.m. on weekdays. Because they’ve been cooped up all day and they’re just going nuts. He’d show his critics exactly how many households would need help minding their children—and it was not nearly as many as they had assumed. During the summers, only 2.6 million kids used the school-lunch program: Did that not suggest that the number of kids without access to proper nutrition was far smaller than the number of kids using the program? He showed them a survey that Lisa Koonin commissioned, of parents with children who used it: just one in seven, or 2.8 million, said they’d have trouble feeding their children if schools could not. If schools were closed, Carter concluded, the problem was not 30 million kids but fewer than 3 million; they could be fed with supplemental food stamps.

* Carter sat at a desk and, consulting with Richard over the phone, wrote the CDC’s new policy, which called for social distancing in the event of any pandemic. The nature of the interventions would depend on the severity of the disease, of course. The CDC recommended that schools close, for instance, only when some new communicable disease was projected to kill more than 450,000 Americans. But school closure and social distancing of kids and bans on mass gatherings and other interventions would be central to the future pandemic strategy of the United States—and not just the United States. “The CDC was the world’s leading health agency,” said Lisa. “When the CDC publishes something, it is not just the CDC talking to the U.S. but to the entire world.”

* Two months after the CDC published its new pandemic strategy, Laura Glass, now sixteen years old, returned to Washington, DC, for her final science competition. The Young Epidemiology Scholars Competition, this new contest was called. Her mom had somehow found out about it and suggested she enter her science fair project and make a trip of it. On her giant foam boards, she’d honed her mission statement. “Could the oldest of strategies, social distancing, be designed to target specific age groups and zones of high infectious contact within a social contact network and thus limit the spread of disease?” she’d written. On her boards, she walked the science fair judges through all the work she had done. She explained the computer model she had helped to build, the surveys she’d done of the citizens of Albuquerque, New Mexico, and the insights that her work had led to, with the help of the model. “I found that if schools are closed AND preschoolers, children and teens are restricted to the home epidemics that would have infected 65% of the population COULD BE REDUCED BY NEARLY 80%,” she wrote. “If adults also restrict their contacts within non-essential work environments epidemics from such highly infective strains can be ENTIRELY THWARTED!”

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