Pandemic & Protest

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S1: Dr. Howard Markel studies the history of medicine at University of Michigan. But right now, he’s probably better known for the work he did with the CDC a few years back. He’s one of the doctors who came up with the idea of social distancing. Yeah, that’s my baby. Did you ever expect that these recommendations would be implemented in your lifetime? Well, I hope they wouldn’t. Dr. Martell’s recommendations, they were made official U.S. policy back in 2007, which is how so many states ended up locking themselves down this spring.

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S2: We only suggested the four worst case scenarios like 1918 or today with covered a very deadly veracious viral pandemics. And I felt very proud of that work. And I still am. And I’m incredibly gratified that social distancing has become, you know, a major means of saving lives.

S3: But at the same time, I’m horrified because I had never wanted us to implement these measures because who wants a pandemic? Nobody.

S1: I wanted to talk to Dr. MARKELLE because it seems like his big idea for squashing a pandemic is coming to a dramatic end. States are reopening and protesters are filling the streets, many of them in masks. Sure. But very few of them are standing six feet apart. This weekend, the pictures that captivated me were images of sheer volume. Thousands of people peacefully streaming down streets all across the country. I mean, for you as a doctor and as someone very concerned with transmission of Cauvin 19, I wonder if you maybe see those videos a little bit differently than I do.

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S4: Well, I do, because as a doctor who studies and worries and stays up late at night thinking about pandemics, this is a nightmare.

S5: Dr. MARKELLE is not trying to be a scold here. He supports the protests. He respects the centrality of the cause. He calls racism and police violence a pandemic as sinister as any virus. But he worries about these crowds.

S4: It’s the opposite of social distancing. You don’t know who’s next to you. You don’t know if they’re ill. You don’t know if they’re incubating covered. All of these issues worry me greatly that we will see a spike in cases because of the protests. So it’s a real quandary.

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S5: It’s a real quandary today on the show. What these protests could mean for the pandemic. Dr. Howard Markel trumped up social distancing by looking back at 1918. It turns out that outbreak. It offers lessons for what might happen now, too. I’m Mary Harris. You’re listening to what next? Stick with us.

S1: So Dr. Howard Markel, who is something of a godfather of social distancing as a concept. He’s also a historian. And I wondered if past could be prologue here. What could his years of research into public health tell us about this particular moment? How is it originally envisioned when you made these recommendations of how to implement social distancing? How is it originally envisioned that social distancing would end?

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S3: This was just to be one lane of a multi lane expressway that was run by the federal government. OK. So you would also have training of people to contact, trace or take care of these patients. You would have a hospital lane. So they were well stocked to prepare to see these patients. You would have a vaccine production lane, antiviral lane, all these lanes. And the federal government would hopefully coordinate that because they have the resources today. Really, it’s just been social distancing. And we hope those labs that are making vaccines will be successful and quick about it. But ending it is, you know, the multi-million dollar question, because it’s not a matter of ways. And I’m actually been rethinking, you know, waves of influenza or even ways of Koven. The virus is still circulating. It’s still out there. We had 24000 cases just today in new cases in the United States on June four. So it’s still there. And once you come out of hiding, if you’re susceptible because you have not yet had the infection, you are at risk of contracting it. So how you end the hiding is a very difficult thing to do.

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S1: Yeah, I think it’s interesting that you’re talking about waves and rethinking waves because it sounds like what you’re saying is, is that it’s not just the waves. It’s the fact that we’re at high tide. Yeah, the water’s everywhere. And yes, there’s a wave, but so what?

S3: There’s another one covered right after that. Exactly. I mean, we’re in the middle of the ocean.

S1: I mean, to use another keep using water metaphors in Minnesota where, of course, the protests began. I read that they had their highest covered death toll just a week or two ago. And, of course, that’s where many protests are happening right now. I wonder if, looking back at the 1918 pandemic, there’s a historical precedent that gives you special pause here.

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S3: Well, there is. People love to talk about Philadelphia, which was the second worst city in terms of cases and deaths during the 1918 19 flu pandemic. Actually, Pittsburgh was the worst. And there was a Liberty Bond parade there. And there’s a great picture, the National Archives of all sorts of people lining up to see floats and wish there are many young men going off to war, the doughboys. But there were there were Liberty Bond parades in many cities that year, by the way. And there are other parades and gatherings when soldiers went off by train to their camps. And also when they went to the East Coast to go by steamship to the European theater.

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S1: So what does that tell you? That many cities had these parades, but really it was Philadelphia that got so hard hit?

S6: Well, Philadelphia got hard hit for a lot of reasons. The parade itself didn’t help, to be sure. There were people who got sick in some cities, by the way, like St. Louis canceled their parade. And that was probably the wise choice to make. But in Philadelphia, as in Pittsburgh, there was great dissent between the mayor and the health commissioner. The school board didn’t agree with either one of them. And they were also fighting with the governor of the state of Pennsylvania. All of this infighting and internecine battling, inconsistent messaging, not rolling out these social distancing measures quickly enough and not using them long enough. All contributed. It was a multifactorial, epic fail for Philadelphia and cities like that. I feel like we’re all living in Philadelphia now. Yeah. Yeah, I. We are off. We’re all Philadelphia. I mean, you don’t have to be a professor or a rocket scientist to say that, you know, these crowds are not a good idea in terms of the COVA advisers. They are a very good idea in terms of registering your complaint with how this poor man was treated and others are treated every day.

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S1: Yeah, I mean, in the last week, a number of doctors have signed a letter where they’ve said that they endorse these protests even though they know the risks involved. I’m wondering if you’ve read that letter. Or thought about signing it. I did.

S6: And it’s very interesting, particularly some of the statistics that have been presented. You know, the the odds of a young African-American man getting severely hurt and or killed by a police officer. OK, the percentages are actually very high and risky and they are almost comparable to the risk of a young man dying of kov it.

S7: So you, in a way, you you pick your pandemic. What is worse for my community? What is more deadly? And everyone has the right to weigh those risks and benefits and react accordingly. I did not sign the letter because I really, really worry about these public gathering bans. What I have done is work with and join in my medical students who have created a virtual protest on Zoome.

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S1: How does that work? Well, you know, it was kind of neat.

S8: There were speakers and, you know, you listened and you watched and you were still with the safety of your own home. So for me, I felt that was a good compromise. But I’m a white Jewish, 60 year old male, and I have a different experience and perspective of the world than, say, some of my young African-American students or patients. So I get it. I understand it. But the doctor said to me, look, I’ve been working on pandemics for more than half of my life, and this one is particularly scary and feisty and difficult to understand. So as a doctor, I always take the better be safe than sorry approach to disease.

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S1: I wonder if we can break down all the different risks of protesting right now. Like, I don’t know if you look at the images and you think, oh, that’s another way that someone’s at risk, that they might not even know because so many of the protesters are wearing masks and trying to, you know, do their best to keep some kind of social distance. But I wonder about all the different risk points that people just may not even be thinking about.

S8: Yeah, well, you know, the mask are funny because how long are you wearing the mask? What is it made out of cloth mask. By the way, are notorious for what? As you breathe, you make a little tiny holes in the weave of the fabric. You can’t really see them, but they’re there. And don’t forget, viruses are really small. So how long you’ve worn it? And have you reused it? Have you washed it? All sorts of things matter in terms of your face mask. Just because you’re wearing a face mask doesn’t mean you’re immune to contracting the virus.

S4: Excessive policing, the use of crowd dispersal tools such as tear gas and pepper sprays will make people cry, obviously, but also drip from their nose and mouth. It produces a great deal of mucus. So that adds to the nightmare, because if you’re infectious and coughing that stuff, it’ll be easily spread to others.

S8: And if you’re you’re caught after curfew, you know, we’re reading in The New York Times about a technique called kettling, where people are surrounded in a small area. And when they try to get out because curfew has been sounded, they get arrested. Well, then you’re put in a small van crowded with other people who may be put in a holding cell that’s filled stem to stern with, you know, people. Some are criminals, some are protesters. And you are exposed to things that you don’t even know about. So it’s all an odds game. You know, will you meet that microbe enough microbe to get you sick? So it’s very hard for me to quantify it. But I can tell you personally and for my family and my friends, I have prescribed social distancing and have practiced it pretty assiduously.

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S1: I mean, some protesters have been quoted saying they were aware of a coded risk, but they were making this choice the sort of calculus in their head. I wonder how you think people’s understanding of Kofod risk might be impacted by their sort of virtuous intentions? The idea that I’m doing something good and so it’s probably going to be fine.

S2: That’s the wrong calculus. It should be. I’m doing something good, but I am risking getting sick.

S8: So you have to understand, if you participate in those very noble exercises, you are increasing your risk by how much? I can’t tell you. I’m not a mathematical modeler. But, you know, I know it’s greater than the risk I have sitting in my study and talking to you on a computer.

S2: As somebody who works in public health, the advice I’m giving is that I would suggest for four people in the high risk groups, these virtual protests are safer than the physical ones. You should know if you go there, you’re you know, you are risking infection. You know what else? So if you go to these protests, you’re risking getting beaten on the head by a billy club. You know, that’s a risk.

S1: We’ve seen people hurt that way, even if there isn’t a second wave in a week and a couple of weeks. I wonder if you think there’s a chance that the protests and the police response to them will keep transmission levels high enough that then come fall? We’re going to see something much worse than we might have.

S2: I worry about that. I do worry about, you know, the the operative word of this infection is it’s a novel corona virus. We’ve never seen it before. It is, you know, a nightmare of a newly emerging contagious disease. So it’s hard to predict the future. And as a historian of medicine, I avoid the future by profession. I don’t think about the future all that much. But as a doctor, I make prognoses all the time and I don’t think we’re out of the woods yet. Now, if I’m wrong, I hope you come back three or four weeks from now and chastise me and say, Dr. MARKELLE, you are colossally wrong. And I’ll say thank God.

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S1: Something else that stood out to me about your research into 1918 and thinking about now is that you found that once the social distancing was lifted and people were sort of back to normal, it was very difficult to clamp down again. The politicians worried they just didn’t have the political will. And so you kind of got one shot at this thing. And it seems like right now we opened back up quite quickly. And we’re experiencing all these protests. And I wonder a little bit if we need to close down again. Are we going to do it?

S2: Yeah. You know, I have a colleague at Harvard, Mark Lipsett, who predicted that several months ago and said that we would need several shut downs, basically. He’s a very smart guy. So I didn’t distrust his data. But I worried about the likelihood of that happening even in the which is a very different time and place, smaller country, different federal government was very small, local and state governments. Then, as now, that part of the state’s rights doctrine have first dibs on public health. And people were very patriotic and a lot of the flu work, a lot of the social distancing was commingled with their patriotic duty to support the war. But it was very hard in many cities to reinstitute a shutdown because they had already experienced it. And and look at our contemporary society where, you know, the slightest drift from a statement by a politician is called waffling. You said this. No, you said that. And so when you keep changing things, people tune you out. Now in public health or in medicine, you change your mind all the time. If I saw you as a patient and I looked at your blood count, your pulse and everything looked good in the morning, I’d say, wow, well, she’s doing great. And then if I went back in the evening and you were white as a ghost and your pulse was thready and it looked like from your blood count that you had lost a lot of blood, I would change my diagnosis and say we need to give you a transfusion and we have to find that source of bleeding. That’s a change. And public health is really the doctor patient relationship writ large. So as you get more information and more understanding, you might say social distancing one day and you might say opening the next, it doesn’t mean you’re waffling. It means you’re using your judgment over the new data. But if we get more new data where there are more cases, I predict that it won’t be warmly welcomed.

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S1: Yeah, I mean, you know what I think about a lot, if there is no spike in a couple weeks, folks will be mad because they’ll feel lied to. The social distancing wasn’t a thing. We didn’t need to do it. And then if there is a spike. I think it was a sheesh jar. This Harvard researcher who said, I can just imagine people blaming the protesters and saying, you brought this on us. And it feels a little bit like we’re caught.

S8: Yeah, it’s it’s it’s a no win situation. Someone will blame the protesters or someone will blame the police or, you know, there’s lots of blame to go around, you know, and that, too, doesn’t help cooperation.

S1: If we do see a spike, will you point at a particular group of people?

S2: No, I won’t. A lot of my work has been about disenfranchised groups that have been stigmatized and blamed for epidemics. I cut my medical teeth during the beginning of the AIDS epidemic and treated a lot of AIDS patients when we had no real treatments and the frequently died. And that’s where I got interested in epidemics and the concept of quarantine. And then I began studying it. How these measures were inappropriately applied to immigrants, you know, so-called dirty, unkempt immigrants that nobody liked or wanted in our country. And so I studied that not just among, you know, East European Jewish immigrants, but among Mexican workers, among AIDS patients, gay men, intravenous drug users, lots of stigmatized groups. And I think I ended one of my books by saying, you know, blaming is is a pointless thing. The burden of the disease is enough for that individual. And so, you know, epidemics and pandemics are large social living laboratories. And you don’t know what the results are going to be. Once it is unleashed. But blaming people doesn’t help. This is a huge enough problem without the.

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S9: Dr. Howard Markel, thank you so much for joining me. Thank you.

S5: Dr. Howard Markel is a psychiatrist and professor of the history of medicine at University of Michigan School of Public Health.

S1: Before we go, last week, I asked all of you to call in, tell me your own experiences of the protests, which is how I heard from Catherine. She lives less than a mile from where the riots took place in St. Paul, Minnesota. She’s been helping distribute food in the area.

S10: I have also been making it a daily practice to show up at a rally of some kind or a protest or a sit in. And I was on the bridge, the 35 bridge the other day.

S1: That’s the bridge where a tanker truck drove into a crowd of protesters.

S10: Something like that has ever happened to me in my whole life. I’ve never seen a crowd of people in front of me. Turnaround’s looks of tear on their face and start running toward me. I’ve learned a lot and I passed things in my backpack I never packed before I a helmet. I have no magnesium mixed with water and a water bottle. I have bandaids that have. I wish I was a medic, but I’m not. But I have things to take care of me and to care people who are with me. Thanks for listening. Thanks for doing great reporting. And don’t stop covering this, can’t stop. We just can’t. I’m not stopping it.

S1: You can call and tell your story to reach us at two zero two eight eight eight two five eight eight. What next is produced by Mary Wilson, Jason de Leon and Daniel Hewitt. We get help every day from Alicia Montgomery and Allison Benedikt. I’m Mary Harris. I’ll be back here tomorrow.