The Quiet Before, page 25
And yet, if the alt-right had been looking to bring their ideas into the mainstream, they were rewarded with the equivocating words of the president in the days following the rally when he held an impromptu news conference in the marbled lobby of Trump Tower. “I think there is blame on both sides,” he told reporters. When he was asked again whether neo-Nazis weren’t at fault for being the ones to organize the event in Charlottesville, he went even further. “Excuse me, they didn’t put themselves down as neo-Nazis, and you had some very bad people in that group. But you also had people that were very fine people on both sides.” And if there was one thing they kept telling themselves on the server, one concept they hoped would break through, it was just that: that they were very fine people.
Chapter 9
THE VIRUS
New York City, 2020
EVA LEE CAN SEE VIRUSES, and not in the way an epidemiologist or a virologist or an ER doctor might. She can see them before they manifest themselves in a cough or as red blotches on a face. An applied mathematician with a specialty in disaster, Lee has an ability to plot the path of contagion and then design systems for disseminating cures. She’s been much in demand over the past fifteen years, deployed by the Centers for Disease Control and Prevention and the Food and Drug Administration, and as a consultant to both George W. Bush’s and Barack Obama’s administrations. She was in Japan after the Fukushima nuclear disaster in 2011 and with the marines in West Africa in 2014 for Ebola. When the H1N1 pandemic hit the United States in 2009, it was Lee who was called to Washington, D.C., to figure out a delivery system for the vaccine.
She loves algorithms and the two hundred modeling computers in her lab at Georgia Tech, but also calls herself “highly emotional.” It was her sister’s death by stomach cancer and her mother’s suffering with sclerosis that turned her attention to solving public health problems. The cold abstraction and deep empathy can be a combustible mix. It makes her seem sometimes on the verge of bursting out of her skin—her two favorite adverbs, generously sprinkled, are “crazily” and “beautifully.” She is petite and speaks quickly in an accent inflected by her youth in Hong Kong, flitting rapidly from topic to topic. There is an incongruousness to her, pieces that don’t seem to fit, like her girlishly curly locks. Even though she specializes in the fine-tuning of large-scale operations—her best-known course when she taught at Columbia University was Facility Layout and Design—she is easily overwhelmed by the practical matters of daily life. Her emails are riddled with typos because she uses only one finger on each hand to peck out messages. She once optimized FedEx’s worldwide system of courier delivery, but she’s never come close to driving a car.
All of which is to say that when Lee began picking up bits of information in January 2020 about a new coronavirus spreading through the Chinese city of Wuhan, she was primed, in skill and personality, for a single-minded crusade.
Not long after January 21, when the CDC confirmed its first American case, Lee received an email with an unusually dramatic subject line: “Red Dawn.” The reference was to a 1984 movie starring a young Patrick Swayze and Charlie Sheen. In an imagined America under Soviet occupation, a rambunctious group of high school students, who call themselves the Wolverines, mount a resistance to the Evil Empire. The playful subject line signaled a very informal chat, even if Lee could see immediately that it was a serious bunch assembled there—about a dozen infectious disease doctors, medical experts, and a few local public health officers. Among them, too, though they remained quiet and were sometimes left off the emails, were high-profile figures like Robert Redfield, then the head of the CDC, and Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, along with a bevy of second- and third-tier administration officials mostly from the Department of Health and Human Services. This all gave the distinct impression that whatever the group discussed would find a way up the chain of command. It was just the sort of outlet Lee was looking for.
The official who initiated Red Dawn was Duane Caneva, the chief medical officer at the Department of Homeland Security, who in an early email described the group’s purpose as an “opportunity to provide thoughts, concerns, raise issues, share information.” But as the threads grew longer, split off, and became more dire—“Red Dawn Rising” and then “Red Dawn Raging”—a few of the participants came to find in this private channel more than just casual conversation among peers. It was a refuge where they could size up the virus coming into view and begin furiously planning while the rest of the world seemed to continue spinning unfazed. There were no filters here. Lee, like many in the group, knew some of the others from real life and past emergencies. It was, as one participant in the chain put it, like “a large group of friends cleared to carpool confidential level.”
Lee immediately took to it. “We were able to talk about facts, talk about what was going on without thinking about politics at all, which I don’t have any head for,” she told me. “It allowed us to be quite blunt.” She assumed that there were at least an equal number of Democrats and Republicans, if perhaps even more Republicans, appointees in the Trump administration, but the messages were nonpartisan. What the group shared was a faith in public health as a discipline and a sober attitude when it came to the virus.
Familiar as they all were with outbreaks, they began to collectively read the sparse data that was available. On January 23, China began locking down the province of Hubei, where fifty-seven million people lived, creating what would be a massive quarantine. This was a pretty big warning sign, and in one of the earliest emails a participant began spitballing the possibilities. “Am going through an interesting exercise now of the ‘what will you wish you would have done if…’.” They considered two scenarios. Could this be just like “a bad flu year,” as someone else wondered, more like H1N1 of a few years earlier, or would it be like the 1918 pandemic, which ended up taking the lives of fifty million people worldwide? One of the most active members on the email chain, aside from Lee, was Carter Mecher, a senior medical adviser at the Department of Veterans Affairs who described himself to the group as “certainly no public health expert (just a dufus from the VA).” “I wish there was some better way of figuring this out quicker,” Mecher wrote on January 29. “I just am not smart enough to see how. The uncertainty and the fog are like the air around us—it is just a part of it all.”
The privacy and intensity of the email chain—Lee said she would stay up until three or four in the morning tapping out message after message—were made for this level of uncertainty. It allowed the Wolverines to be vulnerable together in their lack of hard data or much other information from inside China. They all knew that this was the moment, before they could really see the pandemic, that demanded they seek out the faintest signs of its progression. It was helpful to share a space with like-minded people who also knew how to look for those signs.
What made the fog clear a bit in early February was the story of the Diamond Princess cruise ship. After one passenger fell ill with the virus, the ship docked in the port of Yokohama, Japan, and over the next two weeks 691 others on board would come down with it as well, turning it into a floating petri dish—and a useful case study. The rate of infection was “unbelievable,” as one participant put it. Carter Mecher did some simple math, using the 1,045 crew aboard the ship as “a proxy for a young healthy population” and the 2,666 passengers as a proxy for “the population we see in a nursing home or residential care facility.” One of the concerns, he wrote, was “how a ‘remake of this movie’ could play out in similarly confined populations of elderly frail Americans.” Lee was doing her own extrapolations. The cruise ship was “the worst form of social gathering,” she wrote. But these conditions were not unique. “Why would it be so different than a mall with everyone walking around for 3–6 hours, eating, drinking, touching everything? Or at school enclosed in classrooms for multiple hours? Or at work enclosed in cubicles for 8 hours?” She was thinking like a modeler: “The health system burden can not be overemphasized. Just think about 1% infection in Georgia, and out of that 20% requires medical attention. That is over 18,000 people. Can we handle these extra people in the hospitals?”
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ALL THEY NEEDED was the Diamond Princess to understand what they were facing, and this at a time, in mid-February, when President Trump was saying about the coronavirus, “Looks like by April, you know in theory when it gets a little warmer, it miraculously goes away!” There was something else, too. They were beginning to see the virus’s stealthiness. On February 23, Lee reported to the group that a study by the American Medical Association found that a twenty-year-old woman from Wuhan managed to infect five family members without ever getting sick herself and even testing negative at first. “So spreading and its wide scope is unavoidable because there exists these very healthy individuals who can spread effectively—even during incubation period.” The implications were enormous. If asymptomatic people could be contagious, then stamping the virus out quickly would be nearly impossible. This ominous insight led to one of the few times an official with the president’s ear chimed in. Robert Kadlec, the head of the virus response effort at the Department of Health and Human Services, seemed genuinely shocked by what he was learning on Red Dawn. “Eva is this true?!” he asked Lee, in an email to the group. “If so we have a huge whole [sic] on our screening and quarantining effort.”
The emails coalesced around a single imperative: start the interventions and now. For all the uncertainties about this particular virus, a well-established playbook existed. With no vaccine in sight, there would have to be widespread testing, contact tracing, and then quarantining. Because the CDC had made major mistakes in February in developing its testing kit, the country would have to go maximal in its preemptive measures, spreading an enormous net: shutting down schools and businesses, wearing masks, and socially distancing. In the language of public health, these are called NPIs—non-pharmaceutical interventions—and as soon as the shape of COVID-19 became clear to the Red Dawn group, there was consensus that every one of them had to be applied at once. “We cannot prepare for the future by acting in the future, we must be rolling it out now,” Lee wrote as early as February 10. “There’s no harm in doing it, but there will be a lot of regret if we don’t.”
This was the hardest part. It demanded not just scientific knowledge. It demanded imagination. No leader wants to shut down parts of the economy or mandate extreme changes in behavior when no one is dying, when the disease is effectively invisible. The extent of this particular challenge, the fact that their sense of urgency might not be appreciated, was evident to them by the end of February, when Nancy Messonnier, the then director of the CDC’s National Center for Immunization and Respiratory Diseases, faced serious blowback simply for warning, in a briefing to journalists, that “we will see community spread,” and that it was only a question of “how many people in the country will have severe illnesses.” She relayed a conversation with her family she’d had that morning: “I told my children that while I didn’t think that they were at risk right now, we as a family need to be preparing for significant disruption of our lives.” The stock market dropped precipitously, and President Trump, who was returning that day from an overseas trip to India, was furious. From that point on, the CDC, which would normally speak for the government in a health crisis, was effectively muzzled.
Beginning with their earliest emails, the members of Red Dawn proceeded as if they had some authority—as if they could make things happen. They came up with proposals for how to organize what were sure to be overcrowded hospitals weeks before anyone wanted to consider this eventuality. They dreamed up a potential triage protocol. They debated when exactly the trigger should be pulled on closing schools or businesses. How many days after the first case was detected? They devised ideas for messaging. Lee described in detail how to persuade foreign students returning to the United States from abroad to get tested. “My feeling is that we can frame the message in a positive way (as a means to protect their health).” Another participant wondered if they could use the cruise ship statistics to drive the point home: “It might be eye opening for Seattle to simply overlay the cruise ship data atop their population age >60 and assume everyone under 60 has mild disease and even use an attack rate of 20%. Easy enough to do that for them.”
As the administration continued to sideline the CDC and play down the virus’s possible impact, the gulf separating what the group felt needed to be done and what was actually being done grew wider. “The unknown is what we’ve been planning for all these years,” Lee wrote on February 28. “Everyone has to step up now.” The inaction, the basic failure to see, despite Red Dawn’s best efforts to show exactly what would happen—what was indeed happening “by the book,” as Lee put it in one email—drove her mad.
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THE MOST DESPERATE VOICES on the chain were those of local public health officials, people who respected the science and whose job it was to prepare their cities or states for what was coming. They wanted help conjuring the problem for their superiors. David Gruber, who was managing Texas’s response, pleaded, “As a state public health official who is in agreement that NPIs must be strongly enacted early, I’m looking for help from this group that makes the case for NPIs. The target audience is those outside health.” Another official, Eric McDonald, the medical director of San Diego County, complained that he needed more data to understand what he should be doing to prepare. “Frustrating doesn’t capture it.”
The Red Dawn members scrambled for solutions. “Maybe we should use a hurricane analogy that many understand,” wrote one. Another suggested, “We should be treating this like we treat stroke and acute coronary syndromes where time = tissue. In this case time = transmission.” Lee had her own visual aid for convincing decision makers. As she wrote on March 5, “I think a tree with the contact rate would be great to show the policy makers so they know how many of the elderly infected would end up in hospital beds and we can even show the queues!”
They were becoming the resistance to an occupation, just as their silly name implied, but it was an occupation of science by politics. Misinformation was invading reality just as the virus was finally revealing itself. On February 29 came the first announced death in the United States, a Washington State man in his fifties. The following day, New York State had its first positive case. Shutting down was really the only option. Red Dawn continued to be a space for thinking seriously about the implications. “I ran a few models for school closures and business tele-work for Santa Clara and King County and I want to share some graphs here,” Lee wrote on March 3. Data about the accumulating American cases was coming in at a faster pace now. They had more to work with. “I really learn a lot from all of you,” Lee wrote. “I found that you are all very mathematical:). Now I will go back to my equations again to see which cities are still in good shape to contain successfully.”
By the middle of March, the World Health Organization made it official: this was a pandemic. The number of daily cases in the United States began to climb over five hundred, and ten deaths quickly became a hundred a day and more. A national emergency was declared on March 13. In a last attempt to be heard beyond their closed circle, the members of Red Dawn rehearsed for each other what they would say to political leaders, imagining these messages might somehow still reach them. “I notice a lot of HHS email addresses on this email group and you all have been quiet for most of the discussion over the past several weeks,” one member of the chain whose name has been redacted wrote. “History will long remember what we do and what we don’t do at this critical moment. It is the time to act, and it is past the time to remain silent. This outbreak isn’t going to magically disappear on its own. If that is the conclusion some are taking, they are misinformed and dead wrong.” Mecher from the VA wrote, “I don’t think it would be prudent to play it cute and try to play chicken with this virus and hold out to the last moment to pull the trigger. It is like thinking you can time the market. You don’t do that when thousands of lives potentially hang in the balance. That is what I would tell my mayor, or my governor, or my President.”
But by then the hurricane had made landfall. The stroke was in progress. The tree was sprouting branches. Eva Lee kept a constant vigil at a laptop in her kitchen, surrounded by her many giant ficus plants and cages filled with dozens of birds she and her husband had rescued and raised over the years. She began to lose hope that anyone was listening. “Those were private emails, so I had no problem being direct,” she said. “I always asked, ‘Why is it that nobody’s doing anything? Why is it that there’s no action? And who is in charge?’ ” But the group also acknowledged just how hard it was to persuade political leaders and the public “to take action before the storm arrived and when the sun was shining,” as Mecher put it. They were left to watch as the virus began thrashing its way from city to city—a story, he wrote, that was “unfolding and writing itself in real time.”
