Medical Examiner

What Seattle Did Right, and Where New York Went Wrong

An overhead view of streets and buildings in Seattle
A downtown street view in Seattle, seen on March 12. John Moore/Getty Images

The coronavirus outbreaks in Seattle and New York happened at roughly the same time, but the virus hit the Washington metropolis hard from the get-go and established it as the country’s initial epicenter. Time has passed, and the story now looks very different. NYC is now the epicenter, and Seattle is on its way to flattening the curve. This isn’t a coincidence—one city did the right things and moved quickly, while the other stalled and suffered. So what can we learn from these major cities’ diverging pandemic paths?

On Wednesday’s episode of What Next, I spoke about outbreak responses with Charles Duhigg, who hosts the Slate podcast How To! and reported on the two cities for the New Yorker. Our conversation has been edited and condensed for clarity.

Mary Harris: Seattle identified its first case of coronavirus in late January. The patient zero had just returned from visiting family in Wuhan, China. But as the infection spread, Seattle’s public health officials realized that thinking of COVID-19 as an illness that was being imported to the U.S. was giving them tunnel vision.

Charles Duhigg: During the initial outbreak in Seattle, the first hot spot was a nursing home. As a result, it was very easy to detect the coronavirus because you don’t expect to see a lot of a novel infectious disease in that setting. Plus, there’s this group called the Seattle Flu Study that basically—against the CDC’s rules—started testing these swabs that they had collected for influenza for the coronavirus. And it found a high school student with a positive hit who hadn’t come into contact with anyone who, as far as they could tell, had been to China. So Seattle knew very early that it had community spread.

Community spread turned out to be only part of the problem. Public health officials immediately knew they were going to have a messaging issue to deal with too. So for Seattle, this meant thinking about what officials could say to prime the public for the much larger changes to come soon.

It’s just really hard for humans to wrap our brains around exponential growth. What exponential growth means is that, at the beginning of a pandemic, you can go from a very small number of cases to an immense number of cases so quickly, because you’re just doubling every single day.

One of the most important things the city did was send these signals to make clear to people that something important was happening here. So there was a big push to close the schools because not only did closing them mean that kids weren’t spreading the disease and their parents had to stay home, but it also sent a signal of the importance: You have to pay attention to this.

The other thing that happened is that Dow Constantine, who’s the executive—like the mayor—of King County, he called Brad Smith, the president of Microsoft, and said, Look, I know you haven’t had any cases of COVID-19 among your employees. But will you do me a favor and ask everyone to work from home? And Brad Smith agreed. Then Amazon did the exact same thing. As a result, you woke up one morning and, like, 100,000 fewer cars were on the road. One Seattle resident I spoke to said, I was driving to work and the roads were just empty. That’s how I knew something serious was going on.

It wasn’t like health officials called Microsoft and said, “Why don’t you guys shut down?” It was Microsoft that made the decision. I thought that was particularly interesting, because it means that the people in charge were kind of playing chess and gathering these allies, making these invisible reinforcements around the work they had to do.

A health department doesn’t have the power to force Microsoft to shut down. So leaders want it to seem like Microsoft has made this decision by looking at the evidence. The people I talked to described it to me sort of as a game, like, what’s the most extreme thing we can say today that people will actually listen to, that they won’t scoff at? What’s the most extreme thing we can say tomorrow so that four days from now we don’t regret not having said something? You’re trying to persuade people to do something that seems nuts, that seems like it’s not in their own interests, when, again, there is no clear evidence that they can see around them that they’re at risk.

Many of the health officials calling the shots in Seattle had been through the same training program under the CDC’s Epidemic Intelligence Service, which had prepared them for exactly this moment. Can you tell me a little bit about what the service is and what it does?

It’s a great program that was started in 1951. What it does is bring in between 50 to 100 people per year—it’s highly selective, more so than Harvard—to become EIS officers and train them for two years. And as part of the training, not only do you learn about how to fight an epidemic, but you also become the front line for whenever an outbreak occurs. The CDC sends EIS officers into the field to fight the disease and figure out what’s going on. Many of the graduates stay with the CDC, but those who leave, about 91 percent of them go on to work for public health departments in cities, states, and counties. As a result, most of the major health departments across the nation are run by EIS alumni.

And both New York City and Seattle have people in their health departments who have been trained by the EIS. But the alliances with political actors are really different.

In Seattle and in Washington state, many of the EIS officers and alumni are in very prominent positions. In New York, they’re in slightly less prominent positions, although New York has one of the best public health departments in the world. But most importantly, there’s this long history of tension between City Hall and Mayor Bill de Blasio and his own health department. When a number of EIS officers and public health epidemiologists came to City Hall and said, Look, you need to act quickly, we need to start saying things today to get everyone ready to stay home tomorrow, the mayor’s office essentially said to them, We think you’re politically naïve. We don’t trust you. We think you’re overstepping your bounds and giving in to panic. It got so bad that that two of the top health officials in New York City threatened to resign if de Blasio didn’t start moving faster to shut things down.

Seattle went to school closures first. In NYC, de Blasio for weeks was saying that keeping the schools open was a pillar of his coronavirus response. It shows you what de Blasio was doing: looking at his relationships with the education unions and nurses unions. When you look at it from a political perspective, you might not make the choice that will actually be the best one in a pandemic.

In de Blasio’s favor, one of the things he was arguing was, If we shut down our schools, it’s going to disproportionately affect our most vulnerable residents. That was absolutely true. Schools exist to give free lunches and breakfasts to students who have no food at home, who live in places where there’s more poverty and neglect. Schools are oftentimes the one stable thing in their environment. Wealthy parents are able to home-school their kids better than poor parents are. So when you close down those schools, you are in effect punishing the poorest and the most disadvantaged students in New York. I think he was saying very legitimately, If we close down these schools, maybe it’ll stop the spread of the coronavirus, but it’s going to hurt a lot of people too. And by the way, in Seattle, even though it closed down the schools quickly, what has happened since has been a little bit of a less clear-cut victory. People weren’t doing remote learning because they couldn’t ensure that all students would have access to tablets or computers or technology devices.

Nearly two months later, when you compare these cities, the numbers are stark. Seattle has suffered about 500 coronavirus deaths, but New York’s tally is more than 12,000. We’re at this moment now where we could see more cases again. What are you looking for from public officials to show they’ve learned the lessons of what’s happened?

There is definitely going to be a second wave—we just know that that’s the nature of a pandemic. There is a mathematical certainty that as people start leaving their homes, as they start interacting with each other more, they will see a reemergence and a growth, again, of the coronavirus. And so what we should do is look to history: During the 1918 flu outbreak, in San Francisco, more people died in the second wave of infections than in the first. The reason why is, when the flu started spreading, officials said go into your homes and wear masks, and people listened. Things got better and started gradually reopening. Then a second wave began and the public health officials said, once more, go into your homes, wear masks. And people said they didn’t want to wear masks anymore. In fact, there were anti-mask riots in San Francisco.

So just because we’re opening things now doesn’t mean we’re going to stay open forever. And the next time officials say that you need to go shelter in your home again because the coronavirus is reemerging, the more we explain to people why we’re saying that, the more compliance we will have.

The danger right now is we’re not educating people. A pandemic is not only about a disease spreading. It’s about a population becoming more sophisticated in understanding what that disease is. If they haven’t become more sophisticated, they just stop listening altogether because they think you’re saying contradictory things, that you’re confusing. They don’t trust you anymore. In the fall—and Anthony Fauci has said this—there are going to be a lot more deaths. We are going to see the second wave of the coronavirus, particularly in those places that have not been hard hit so far. And in large part, it’s going to be because people spent a month or six weeks in their homes and then they were told, It’s OK to leave now but be wary and ready to go back inside. And they’re going to say, I don’t trust you. Unless you’re prepared, people are going to get sick and die.

Listen to the full episode using the player below, or subscribe to What Next on Apple Podcasts, Overcast, Spotify, Stitcher, or wherever you get your podcasts.