What Seattle Got Right

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S1: Over the last few weeks, reporter Charles Du HIG has been obsessing over one thing how to change the odds when it comes to the Corona virus. He lives in Brooklyn, has gotten used to the sounds of sirens whizzing by his house. It got him wondering how a place like New York might turn things around. Which is when he started researching a place that had already done just that, Seattle.

S2: What’s interesting is it’s very unusual for a place to be the epicenter of an outbreak and then stop being the epicenter. And that’s exactly what happened in Seattle. So in 1918, if you’ll remember, Philadelphia was one of the first very public outbreaks of the disease in a large number of of debt.

S3: And you can see these pictures of like them digging trenches for graves in Philadelphia.

S2: Absolutely. Absolutely. And and in the case of Philadelphia, it’s because the leaders responded so poorly. Right. They they still had this huge parade even that when they knew that the influenza, the 1918 influenza was spreading. But what’s interesting is that Philadelphia remained somewhat of an epicenter throughout the entire pandemic. I wanted to understand, what did Seattle do that caused us to suddenly stop referring to it as the epicenter of this disease?

S3: Why did you want to compare Seattle and New York in particular?

S2: What was really interesting is that the outbreaks in Seattle and New York happened at roughly the same time. And the fact that there was such a different outcome in New York and Seattle suggested to me that if we look at what happened, it might suggest what causes this disease to spread and what doesn’t.

S1: For Charles, the story he’s about to tell is a tale of two cities, one that saw a pandemic coming and listen to it scientists and one that saw the same thing and decided to wait and see.

S4: There is a playbook on how to do this correctly. There’s a playbook on how to communicate with people so that they understand the risks so that they they choose to distance socially and in as as people who know that playbook and have been trained in that playbook and have used the playbook as they watch other people fumble this response. I think they’re really uncomfortable and want to draw attention to the fact that, look, there’s a better way of doing this and if you follow the better way, you’re going to save lives.

S5: Today on the show, the inside story of what Seattle did right and what New York got wrong. Mary Harris, you’re listening to what next? Stick with us.

S1: Seattle identified its first case of Corona virus in late January. This patient Zero had just returned from visiting family and Wu Hahn. But Charles Du Haeg says that as the infection spread, Seattle’s public health officials, they realized that thinking of Cauvin, 19, as an illness that was being imported to the U.S. was giving them tunnel vision.

S2: So there’s sort of two things that Seattle benefits from in this kind of horrific way. The first is that the initial outbreak in Seattle, the first sort of hotspot, is a nursing home. And so as a result, it’s very easy to detect because you don’t expect to see a lot of a novel infectious disease in a nursing home. Secondarily, there’s this group called the Seattle Flu Study that basically against the CDC rules started testing these swabs that they had collected for influenza for the corona virus. And they find this one teenager, the high school students, that it has a positive hit for Corona virus who hasn’t come into contact with anyone that they can tell who’s been to China.

S3: So Seattle knows very early that they have community spread because in the nursing home, those people haven’t left necessarily. And so there’s no. Oh, they went to Wu and they got it there. And with the high school student, it’s the same thing. That’s exactly right.

S1: Community spread turned out to be only part of the problem. Public health officials immediately knew they were gonna have a messaging issue to deal with, too.

S2: I mean, I think the best way of explaining that is something that Mary Bassett said. Former New York Department of Health commissioner and who’s now at Harvard. And she said the thing is that it’s just really hard for humans to wrap our brains around exponential growth and 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, like there’s that old that old story about like someone who makes a a deal with that or know some king or something like that, that they’re going to put one grain of rice on the first square of a chessboard and two grains on the second and then four grains on the third and eight grains on the on the fourth. And that the king has to pay him whatever is ends up on the last square of the chessboard. And of course, it’s like more rice than has ever been produced in the history of humanity. And that’s kind of a good example that like that seems like a deal that all of us would take when we’re looking at the first four or five squares on that chessboard, because we have a really hard time thinking in terms of exponential growth.

S4: And that’s why at the beginning, it matters so much what you say, because literally hours and days can make the difference for Seattle.

S1: This meant thinking about what officials could say to prime the public for the much larger changes to come.

S2: One of the most important things that they did is that they they tried to send these signals to make clear to people that something had changed. Something important was happening here. And so there was a big push to close the schools for exactly that reason, because not only is closing the schools means that kids aren’t spreading the disease in, their parents have to stay home. And so their parents aren’t spreading the disease. But it also sends a signal, right. If you if if they tell you all the schools are shut down, it makes you say, oh, my gosh, something important is going on here. Like, I got to pay attention to this. The other thing that happened is the Dow Constantine, who’s the executive, which is like the the mayor of King County, he called Brad Smith, who is the head the president of Microsoft and Microsoft, remember, is based there. I was at a Seattle. And he said that Brad Smith look, I know that you guys haven’t had any cases of covered or any cases of coronavirus among your your employees. But we you do me a favor. And when you ask everyone to work from home. And Brad Smith was like, sure, if you’re asking me to do this, I’ll ask everyone to work from home. You know, it’s sort of maybe even seemed like an overreaction at that moment. But but Brad Smith said, yes, I will do this. And then Amazon did the exact same thing. They asked many of their employees to work from home because Amazon is also based in Seattle at their headquarters. And as a result, you wake up one morning and 100000 fewer cars are on the road. And so one person was talking to a Seattle resident said, you know, I was just driving to work and I knew everything had changed. Like, the roads were just empty. I was used to, you know, that drive that usually takes 45 minutes. Took me 13 minutes. And so I knew, like, something is going on, something serious.

S3: Part of what I thought was so interesting was that I went back and looked at the press coverage of Microsoft shutting down and the press coverage from last month. I guess it it wasn’t like the Department of Health called Microsoft and said, why don’t you guys shut down? It was Microsoft makes the decision to shut down. And why did they do that? And I thought that was particularly interesting because in a way, it means that the Department of Health was kind of playing chess and gathering these allies and making these kind of invisible reinforcements around the work they had to do.

S2: Absolutely. Absolutely. Because. What Seattle didn’t do know what the King County government didn’t do is say we asked Microsoft to shut down because what they wanted to seem like and which is accurate, right. Because they don’t have the power to force Microsoft to shut down. If they wanted to seem like Microsoft has made this decision by looking at the evidence and has decided we ought to shut down. This is a chess game. Right. And and the people I talked to, they would talk about it that way. There was described to me sort of as a game like what’s the most extreme thing that we can say today that people will actually listen to that they won’t scoff at? And given what we think is going to be happening four days from now. What’s the most extreme thing we can say tomorrow so that four days from now we don’t regret not having said something? It is a game.

S4: It’s a game of psychology where you’re trying to persuade people basically to do something that, like, seems nuts. That seems like it’s not in their own interests. When, again, there’s no clear evidence that they can see around them that there are risks.

S3: So the world around you is like reinforcing this idea that something’s chance and something important is happening.

S2: That’s exactly right. And that’s critical because, again, what you’re if this works, what you’re doing is you’re asking people to make huge sacrifices for a disease that they cannot see. And if it works, that they will not see. If I do see that, then I’m in danger. And so what you have to do is you have to try and convince people to behave when you can’t prove to them that they are at risk in the way that you do. That is by changing the environment, by keeping people home from school, by keeping old people home from work, so that when you look around, you say, man, something feels off. I just I’m there right. To be telling me that we need to stay home, because when I walk outside, it feels scary and different.

S1: The health officials calling the shots in Seattle, many of them had been through the same training program that had prepared them for exactly this moment. They’d been part of CDC as Epidemic Intelligence Service.

S3: Can you tell me a little bit about who the Epidemic Intelligence Service is and what they do?

S2: Yeah, it’s it’s a great program. And it was started in 1951. It’s actually harder to get into right now than Harvard. Is a lower acceptance rate. And what they do is they they get hundreds and hundreds, sometimes thousands of applications every year. And they usually choose between 50 to 100 people per year to become E.S. officers and their their physicians and their veterinarians. And they are public health PGD and their statisticians. And they bring them in and they train them for two years. And as part of the training, what happens is that not only do you learn all of the knowledge of the CDC about how to fight an epidemic, but you also become the front line for whenever an outbreak occurs, they send E.S. officers into the field to go and kind of man the the frontline to try and fight, fight the disease and figure out what’s going on. And it’s a really wonderful organization. And what’s most important and most interesting about it is that it’s only two years long. Many of the graduates, they stay with the CDC and they’re actually referred to as A.I.S officers because they actually receive a military commission when they’re in the service. But those who leave the E.S., about 91 percent of them go on to work for public health departments in cities and states and in counties. And as a result, most of the major health departments across the nation are run by.

S3: Yeah, I.S. alumni and both New York City and Seattle have people in their departments of health who have been trained by the Epidemic Intelligence Service. But how they were designated by their political actors is really different.

S2: Yeah. And in Seattle and in Washington state, many of the the Epidemic Intelligence Service, ISI 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 LA’s long history of tension between City Hall and Mayor de Blasio and his own health department. For years, they’ve kind of been at each other’s throats. And this is true for the de Blasio administration with many of his agencies. And as a result, when a number of the E.S. officers and public health epidemiologists came to city hall and they said, look, you need to act quickly, they said the same thing that people were saying in Seattle. We need to start saying things right today to get everyone ready to stay home tomorrow. The mayor’s office essentially said to them, we think you’re politically naive. We don’t trust you. We we we think you’re overstepping your bounds and that you’re giving into panic. It got so bad that two of the top health officials in New York City had to threaten to resign if de Blasio didn’t start moving faster to shut things down.

S6: When this ultimatum was initially reported, the mayor denied that anyone had threatened to resign. But according to Charles, the Department of Health officials eventually reached a compromise with the mayor about their demands.

S3: When I read your article, I really thought about how how Seattle and New York City dealt with school closures showed the real difference in their reaction because Seattle, Seattle went to school closures first. They saw it as a symbol to say to people, this is important. Your kids are at home now. You have to be at home with them and we’re going to make the whole city look different. So people click in with what we need them to do. In New York City, Mayor de Blasio for weeks was saying keeping the schools open was a pillar of his coronavirus response and that he really didn’t want to close schools. But it shows you how when you look at these things from a political perspective, which de Blasio was doing, looking at his relationships with the union, looking at his relationships with nurses unions, too, because the nurses unions and the doctors, they needed the schools open so they could report to work. When you look at it from that perspective, you might not make the choice that will actually be the best one in an epidemic and in de Blasio, as you know, in his favor.

S4: One of the things he was arguing was, look, if we shut down our schools, it’s going to disproportionately negatively impact our most vulnerable residents. Right. Is true. I mean, yeah, it’s absolutely true.

S2: Schools exist to give free lunches and breakfasts to students who don’t have enough food at home in those homes where where there’s more poverty and where there’s more neglect. Schools are oftentimes the one stable thing in their environment. Wealthy parents are able to homeschool their kids better than than poor parents are. And so when you closed down those schools, you are, in effect, punishing the poorest and the most disadvantaged students in New York. And so I think he was saying very legitimately, look, if we closed down these schools, maybe it’ll stop the spread of Corona virus. But it’s going to hurt a lot of people, too. And by the way, in Seattle, even though they closed down the schools quickly, what has happened since they closed it down has been a little bit of a less clear cut victory for a longtime. They weren’t doing remote learning because they couldn’t ensure that all students would have access to tablets or computers or technology devices. And because there was going to be inequity, they just decided not to educate anyone, which is a questionable choice also.

S3: Yeah, I mean, you make this interesting point, an article where you talk about how actually responding to a pandemic is turning political instinct upside down because your natural instinct is going to be wrong and you’re going to have to make these decisions that seem kind of crazy and also seem against your interest. But you’re gonna have to make them really fast.

S4: I mean, I think the point is that all of these all these are really hard choices. And setting aside what’s happening right now with the president, it’s not like anyone is just making dumb choices because they’re not thinking about it.

S2: There’s always good reasons to act or to not act or to take more time or to act quickly. And they’re hard choices. And during a pandemic, everything is different. Everything has changed. Instead of instead of tamping down panic and comforting people, oftentimes you want to inflame panic, to convince people to to behave differently. And so it’s it’s not so much a criticism as it is an observance that it’s been over 100 years since we had a widespread pandemic like this. We have forgotten a lot of the lessons that we knew after 1918. And so a lot of the politicians made bad choices, but they didn’t make bad choices because they’re evil or malicious. It’s because we’re out of practice.

S7: Nearly two months later, when you compare these cities, the numbers are stark. Seattle suffered more than 500 coronavirus deaths. But New York’s tally is more than 22000.

S3: We’re at this really particular moment where states and cities are talking about opening back up. I remember really early on I was speaking to a scientist. I used to work in the White House who was laying out the fact that we were all talking about flattening the curve. But really what was gonna happen was that we would flatten the curve a little bit and then things would open up and then we’d begin to see things rise a little bit and we’d have to clamp down again. And so we’re at this moment now where we could see more cases again. We don’t really know because things are opening up. And I wondered, given all the reporting you’ve done about what happened the last time we were in this situation, sort of looking at a wave that might be coming. What are you looking for from public officials to show they’ve learned the lessons of what happened last time?

S4: Well, let me just clarify. There is definitely going to be a second wave, like we just know that that’s that is the nature of a pandemic. There’s a a mathematical certainty that as people start leaving their homes, as they start interacting with each other more, that will see a re-emergence in a growth, again, of the corona virus. And so what we should do is we should look to history, you know, in 1918 when the flu outbreak occurred in San Francisco. More people died in the second wave of infections, which happened in the fall than died in the first wave. When the flu first emerged. And the reason why is because San Francisco and the flu started spreading, said, go into your homes and wear masks and people listen to them and things got better. And they said, OK, we can start gradually reopening. And then a second wave began. And that the public health officials said once more, go into your homes, most importantly, wear masks. And people said, I don’t want to wear masks anymore. We did this once before and it worked. Like, I’m sick of this. In fact, there were there were anti mask riots in San Francisco and far more people died in the second wave in the fall of 1918 than died in the first wave because compliance went down significantly. So this is what we know is that we know that the more we tell that story, the more we educate people, that just because we’re opening things right now doesn’t mean we’re going to stay open forever.

S8: And the next time we say to you, you need to go shelter in your home again because that the Corona Viser is reemerging. The more we explain to them why we’re saying that, the more compliance will have. And the danger right now is that we’re not educating people. You know, a pandemic is not only about a disease spreading, it’s about a population becoming more sophisticated in understanding what that disease is.

S2: So that the first time you give them advice, it takes four or five days for people to listen to it. And then the next time you give them advice, it only takes four days. And then and then hopefully six months later, when you give them advice, they listen within 12 hours. But if they haven’t become more sophisticated, then not only do they not listen within 12 hours, they just stop listening altogether because they think that you’re saying you’re saying contradictory things that you’re confusing.

S4: They don’t trust you anymore. So in the fall in Dr. FOUT, she has said this, everyone is said this. In the fall, there are going to be a lot more deaths. We are going to see the second wave of 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.

S8: But but be wary. Be ready to go back inside. And they’re going to say, I don’t believe you. I don’t trust you. When you tell me to go inside, I’m going to stay outside because in America, we can’t really force anyone to stay inside. Every single person I speak to says there are going to be waves of this. And unless you’re prepared, people are going to get sick and they are going to die.

S9: Charles Duhigg, thank you so much for joining me. Thanks for having me. Charles Du Hege writes for The New Yorker.

S1: He also hosts the Slate podcast, How to Wear One of the things they’re helping listeners navigate. Is this funny pause. We’re all finding ourselves in. He’s got a segment called Quarantine Q&A, and he is taking your questions. If you haven’t checked out how to go do that. Maybe start with how to actually enjoy working from home.

S9: That’s their latest episode. And you can email the show. Quarantine questions and anything else. And how to at Slate dot com.

S1: Here. What next? We have been hearing from you all, too, about what it’s like living in this state of unknowing with so much up in the air. I heard from a listener named Matt the other day, and I wanted to share what he told me because it might resonate with you, make you feel less alone.

S10: Hey, Mary, this is Matt calling from Atlanta, Georgia, the day before recess to re-open the economy. I was just feeling a little like it because I have a brother that is serving time in a state prison. And they woke up to a message from him that said, I love you all. The camp has gotten really sick overnight. They’re moving all of us to a gym. Tell me what I’ll be able to call them. I love you all. Keep the paperwork going. Kiss the babies for me. I’ll be OK.

S11: God got me. I love you all very much. And I just hope I get the rain from. Thank you to yourself and all of the Latin emperor telling important stories, you’ve definitely made me feel less so. Have a good day, everyone. Stay there.

S7: Matt. I really hope you and your brother are staying safe. What next is hosted by me, Mary Harris, and produced by Daniel Hewitt, Mara Silvers, Mary Wilson and Jason de Leon. I am so heartbroken to say this, but it is Mara’s last day with the show. She’s headed to the Montana Free Press. She’s gonna be a fantastic reporter there. Look out for her. All right. That’s the show. We’ll catch you back here tomorrow.