By Steve Kelman

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Where did the ideas for shutdowns and social distancing come from?

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The New York Times recently ran on its front page (some blog readers may remember that I am a dinosaur who still reads a newspaper in hard copy – even more so now with so much time at home to peruse it while drinking my breakfast coffee) a story about how shutdowns and social distancing emerged as the preferred strategy for dealing with a disease outbreak like the coronavirus.

The story begins in 2005 with President George W. Bush. Already concerned about bioterrorism after 9/11, Bush in 2005 read a new book about the Spanish flu epidemic. This was the time of the avian flu outbreak in Asia, a disease spreading from animals to humans where there was no vaccine. Bush set in motion an effort to come up with ideas for dealing with a similar problem at home, convening an advisory group that included a White House bioterrorism advisor and a Department of Veterans Affairs doctor.

This group developed a proposal for an idea that, the Times article says, “they knew would be treated like a piñata … telling Americans to stay home from work and school the next time the country was hit by a deadly pandemic.”

The conventional wisdom at the time was that “after decades of advances by the pharmaceutical companies… no matter what the ailment there must be some kind of available fix. Locking your family inside your home seemed backward, and encouraging people not to go to work economically disastrous.”

Not surprisingly, when the idea came out there was also significant pushback, with one doctor involved in the effort arguing the government should “tough it out” and work quickly to develop a vaccine. “Caught in the middle,” the article states, Centers for Disease control officials “decided to conduct more research and survey community leaders around the country.”

That further work led to the CDC back in 2007 endorsing the distancing/shutdown approach, dubbed “non-pharmaceutical interventions,” as official government policy. After a five-year review within the Obama administration – which was absolutely not asleep at the pandemic wheel; that contention applies instead to the current administration – this policy was updated and reaffirmed.

I see four distinct lessons in this story. First, we had a president, George W. Bush, who cared about something besides headlines and quick hits. Especially given the attacks at the time on Bush’s intelligence – and the view that presidents care only about the immediate and the short term -- this is a very reassuring statement about the commitment of many presidents to the public good. (Bush even, contrary to the characterizations at the time, read some nerdy books.) Critics of democracy around the world say that our political system won’t generate such individuals at the top. That’s not what happened here.

The second lesson – which I had highlighted in an earlier blog post about ventilators – is that one of the many things a good career civil service provides is a cadre of experts who are thinking about low-visibility problems when few others are. This again happened here. At the time of the effort, a pandemic was a low-visibility problem, though the avian flu meant it wasn’t totally off the radar. The Bush administration brought in a VA doctor and a White House biodefense advisor to head the effort.

The third lesson is that expertise is extremely helpful. The advisors “soon found themselves measuring the width of the standard school bus seat and the average classroom size in the United States.” This led them to conclude that ­­­­ schools would need to close to inhibit spread. The doctors involved in the effort did research on the 1918 pandemic to look at the relationship between the extensiveness and timing of shutdown efforts and the death toll. Both “came to the same conclusion and published papers on their findings within months of each other in 2007. Early, aggressive action to limit social interactions…was vital to limiting the death toll.”

The fourth lesson is that, contrary to the assumptions of many, groupthink did not prevail here. Despite initial skepticism, advocates of the crazy new approach persisted with their views. The article notes that the Bush administration encouraged those promoting the new idea “to keep at it and follow the science.”

As with my earlier story about ventilators (though for a different reason), this story did not have happy ending. Sadly, the Trump administration delayed much too long in following the suggestion of the experts, making our slow response a laughingstock around the world. That response not only has resulted in unnecessary deaths but also severely damaged the worldwide credibility of the U.S.

China, by contrast, has gained credit for a forceful response despite initial delays due to a coverup of early information about the virus, because China's effort was delayed much less than ours and did prove successful. It wasn’t for lack of trying by our experts.

Posted by Steve Kelman on Apr 28, 2020 at 7:17 AM


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