The Quiet Before, page 26
In the beginning, the Red Dawn participants had pictured themselves as an early warning system, but now there was a shift: they knew they had to monitor and analyze and digest the data and make recommendations, even if no one was drawing on their knowledge—they acted “as if.” And doing it together, in addition to making them more productive, allowed them to feel as though they weren’t alone in their total commitment to science. The email chain provided the conditions for this feeling, for this work, in much the same way the Chronicle had allowed Soviet dissidents to document human rights abuses that would never be redressed. One of the more active Red Dawn participants was James Lawler, an infectious disease doctor at the University of Nebraska who had served in the White House under George W. Bush and as an adviser to Obama. He had even gone to Japan in February to help repatriate American passengers from the Diamond Princess. “We all used to be in a position where we could have had more direct influence,” Lawler told me. “And now we no longer were. So we were using what tools we had.”
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RED DAWN WAS a sanctuary at a moment of confusion and dread—a place to talk honestly and away from the public, to prepare a strategy, a battle plan. But it was not the only such forum. Many channels opened up in those spring weeks when COVID first struck, when the virus could be felt in New York City hospital wards filled with the rhythmic sucking sound of ventilators. In the absence of much official guidance or a national plan, these private networks activated like new radio frequencies, suddenly crackling with concern and advice. The experts used apps like Signal for highly encrypted group chatting, or WhatsApp, or even the direct message function of Twitter, which could allow multiple participants to sneak away together from the speed and noise of the public feed. The quiet felt necessary and useful because, just as for the Red Dawn participants, so much was unsure and they needed a way to develop their thinking.
Excerpts of the Red Dawn emails, meant to be kept confidential, were published by a handful of newspapers in April 2020, the result of a Freedom of Information Act request initiated by Kaiser Health News. When Esther Choo, an ER doctor in Portland, Oregon, read through the exchanges from just a month earlier, in March, it felt to her as if she were looking at a transcript of her own online chats. “I was like, I totally see what’s happening here,” she told me. “This feeling of knowing it’s coming and you almost don’t know how to express it to the public, that helplessness and increasingly a feeling that, with all haste, we have to communicate this. I know this well, how they sorted through the data and expressed frustration. That’s exactly what we sounded like behind the scenes.”
For ER doctors like Choo, who were heading into battle every day in respirators and plastic shields and surgical gowns to care for patients who were reduced to wheezing and coughing alone in hospital rooms, these online chats became a way to speak with others who might understand, who could offer practical tips and empathy after soul-sapping twenty-four-hour shifts in the company of death.
Craig Spencer, an ER doctor in New York City who began sharing information on a number of private WhatsApp groups, told me these became “a hotbed of activity”: “Like, ‘Hey, I’ve got this patient, with this, this, and this. What have you guys been doing that’s been helping?’ ” From these group chats, he learned about early advances in care—like proning, or turning people over on their stomachs. “All of that stuff was coming in via my WhatsApp. That’s where people I knew and trusted were.”
Pretty soon, these doctors with social media presences were receiving dozens of daily requests to go on television and speak about what they were seeing in the ER. Someone had to be straight with the public about the knowns and the unknowns and provide some direct answers. The CDC seemed to be out of the picture. The nightly coronavirus updates, now dominated by the president, were driven not by the latest science but by a need to project blind optimism (“Just stay calm. It will go away,” he said on March 10). So it was the doctors whose counsel was being sought out, often on cable news channels. “As the pandemic went on, we were asked so much more,” Choo said. “Why is face mask wearing so important? What do we need in terms of personal protective equipment? It was much more than just ‘Tell us anecdotally what is happening.’ ” The private groups took on a more important function: the doctors needed to band together even more tightly so they could coordinate their messaging.
Social media and the direct access it offered to an enormous audience made it only more urgent to navigate what could be said out loud. Craig Spencer, who worked the emergency room at Columbia University Medical Center, had about 580 followers on Twitter when he took to the site on March 23 to describe a day in his life. “The bright fluorescent lights of the ER reflect off everyone’s protective goggles,” he wrote. “There is a cacophony of coughing. You stop. Mask up. Walk in.” It was a war zone. “You’re notified of another really sick patient coming in. You rush over. They’re also extremely sick, vomiting. They need to be put on life support as well. You bring them back. Two patients, in rooms right next to each other, both getting a breathing tube. It’s not even 10am yet.” And yet he emerged from the ER to find empty but otherwise seemingly normal streets. “Maybe people don’t know???”
Spencer said his phone “had a seizure for two days” as the thread was shared by tens of thousands of people, including Barack Obama. Within a few months he had almost 200,000 followers. Esther Choo, the ER doctor who was working at Oregon Health & Science University’s hospital in Portland, had also built an unlikely fan base on the platform. It began for her in 2017 after the Charlottesville protests when she tweeted about her experiences with patients who refused to be treated by her because of her race—she was born in Cleveland, the daughter of Korean immigrants—and what it felt like to cut open a patient’s shirt on an operating table to discover a swastika tattoo. She had become an expert Twitter user, achieving that winning mix of earnest confession and witty repartee, with the occasional cute animal meme. She wore her black hair back in a sensible ponytail, and in on-camera interviews she was authoritative and in control—a feat in itself, considering her four young children were with her at home.
Choo and Spencer and about a dozen other doctors connected through Twitter DM groups—they called one of them the Brain Trust—and started to use them as their “back channel.” As Spencer put it, “This is where we would develop a strategy for all the prime-time cable news programs so that we could tell people the truth at a time when the government was downplaying the virus.” Mostly they conveyed to an anxious nation what the Red Dawn group had been saying privately since late January, that without widespread testing or a vaccine the only way to combat the virus was through methods that had proven useful since 1918. But if they agreed about listening to the science, there was still plenty they argued about.
One of the contentious issues in those first weeks was face masks. There was no doubt that these were effective for limiting the spread, but in March there was a shortage of masks, especially the N95 respirators that emergency rooms needed. The doctors worried that if they proclaimed masks a necessity, it would cause a run on what was a dangerously low supply. “We had many conversations behind the scenes about this,” Choo said. “People were divided. And we went back and forth a ton. But that was certainly one where, after all that debate, when we decided to go for it, we went for it.” Having agreed to promote masking—all while the CDC waffled in its recommendation—they then turned to language, how to distinguish between the kind of hospital-grade face covering that was needed for first responders and what people could make at home. They didn’t have the vocabulary at first, so they workshopped, looking for the words that might stick. “Social distancing” was another example. It was a phrase they thought might confuse people and lead to mental health issues. What they really meant was “physical distancing,” so that’s the language they decided to promote, even though the term never stuck.
The doctors described this Twitter DM group to me as a “sounding board” or a “staging ground.” “We fought a lot, which was why I think I valued the group,” Choo said. But as the weeks went on and New York City in particular became a hot zone with hundreds of dead every day, it felt more and more important that they consult with one another before they went public. Choo estimated that three-quarters of their time was spent conferring on private networks. Only a fraction of their ideas would later appear on social media or cable news.
Among the biggest challenges they confronted, right away, was misinformation. The fact that the Trump administration was keeping public health officials from the microphones and CDC scientists from offering more full-throated recommendations meant that conspiratorial voices proliferated. Some insisted that the virus wasn’t any more dangerous than the seasonal flu, that it was really a biological weapon deployed by the Chinese, that masks actually made you sick. It was endless, the amount of rampant fiction. And it came from the president as well. In late March, Trump started touting the antimalarial drug hydroxychloroquine as a miracle cure for COVID based on little more than, as he put it in a March 20 briefing, “a feeling.” Then he took to Twitter and told his eighty-four million followers that the drug was “one of the biggest game changers in the history of medicine.” By March 28, the FDA, at Trump’s urging, had approved an emergency use authorization. Meanwhile, there was no real scientific evidence showing that hydroxychloroquine had any effect on COVID, and one man in Arizona even died after ingesting a form of chloroquine used to clean fish tanks (his wife recalled their reasoning: “Hey, isn’t that the stuff they’re talking about on TV?”).
Twitter was a main vector for these speculative theories and outright lies. Looking at the platform’s data from January 16 to March 15, one survey revealed that sites trafficking in fake news were shared at about the same rate as credible ones, like the CDC’s. Another analysis examined 200 million tweets about the pandemic from January to May and discovered that 62 percent of the top 1,000 retweeters were bots, spreading more than a hundred different varieties of false information about the virus.
What had started as an ad hoc emergency response now became “a long-term project against disinformation,” said Dara Kass, an ER doctor at Columbia University Medical Center and another member of the Brain Trust. They had to quickly separate what was useful from what was spurious. They spent two days, for example, deliberating about what to say when asked about a French study that suggested Motrin, the painkiller, wasn’t safe to use for coronavirus sufferers—it was not worth listening to, they concluded. “You’re asking me how does a bill become a law or how does an egg get fertilized and become a baby, I can give you this play-by-play without checking with anyone else,” Kass told me. “If you’re asking me whether or not the new trial on the Moderna vaccine, what does it mean for it to be 94.5 percent effective? A lot of these things had to be digested by our little focus group in order to come across with the best and most accurate talking points.”
They weren’t the only ones engaged in this effort. Scientists, too, had taken to Twitter to wage war against the fantasies and distortions. Some epidemiologists and virologists had acquired enormous platforms on the site, jumping from a couple hundred followers to tens of thousands over the course of the pandemic. It’s strange to think a place so reductive and loud could be amenable to science, but it was, allowing these experts to explain the facts as they understood them, to unpack new studies in long tweet threads, and to offer recommendations. “It’s a remarkable mismatch between medium and message,” Carl Bergstrom told me. He’s an evolutionary biologist at the University of Washington who in recent years has become an expert in the ways that misinformation and disinformation spread.
What people wanted in those first months was a binary certainty. Is it dangerous or not? Will I get sick or not? Should schools stay open or closed? And scientists do not work like this. The scientific method is about being wrong so that adjustments can be made. It’s about tweaking a hypothesis by a few degrees. And the only way, many of these experts told me, to respect that process, while also providing useful information to the public, was to come together, like the ER doctors in their DM groups, in a closed network with people they trusted. “You do need the space apart to think through whether these strongly held positions are reasonable,” Bergstrom said. “It allows you to question and develop your ideas, just finding out what you need to know.” He could remember many times when he turned to these groups—when he wanted to question the CDC’s recommendation to not test college students returning to school or when he wanted to propose that perhaps container laws should be dropped so that people could drink outside and not congregate in bars. “The audience that you’re reaching is sizable, and you don’t want to be giving bad advice for that reason,” he said. “And there’s such a deluge of information that’s coming in, and it is easy to misread things or misinterpret things. And so it’s really helpful to triangulate with a few other people that you trust.”
In those first months of the pandemic, science was happening very publicly. Starting in the 1990s, in the field of physics, researchers in an increasing number of fields had been posting their papers to special online servers before they went through the peer-review process, which could take months. The pressures of a pandemic and the need to rapidly share new information made it even more necessary for research to get out before undergoing the strict vetting of a top-tier journal. And prestige publications like Science and Nature didn’t want to look as if they were holding back important findings, so even they began asking their contributors to post on these online repositories first to give the public and other scientists immediate access. And still it didn’t seem quick enough—there could be a week’s lag time after submitting—so some scientists were just sharing their papers directly on Twitter. This is how, on February 29, the first sequencing of a COVID-19 genome in the United States came to be presented to the world: as a tweet.
All of this new research and the need to digest it only increased the demand for small groups that could exist alongside the larger Twitter conversation. Without peer review, scientists combed through the data together and decided what they could trust before they amplified it. This also led to cross-pollination, with experts from different but related fields checking each other. Angela Rasmussen, then a virologist at Columbia University whose following jumped from 200 in January 2020 to 180,000 by the end of that year, told me about her seven Twitter friends who have been on the same DM group since March. “There’s been a ton of misinformation,” she said. “But, you know, I’m a biologist, I’m not an epidemiologist, I’m not a statistician.” Twitter had become a resource for meeting colleagues who did specialize in those areas. But they then needed their “staging area” to work through the new research and data on their own before making any pronouncements.
Esther Choo and Craig Spencer and their Brain Trust felt this burden many times over. Their platform was even bigger than Twitter. They were speaking to tens of millions of Americans on television every night. As March turned into April, New York City was like the set of a horror movie, with crematories now given permission to work around the clock, a fleet of forty-five new mobile morgues set up to handle the overflow. It was a city that was running out of body bags. These overworked doctors increasingly became the nation’s advice givers. And they felt they had to rise to the challenge. “We didn’t want to be the people who are like, let us crush your hopes and dreams, because people so needed hope,” Choo said. “At the same time, it was so important to bring a measured voice.”
The essence of their message—to take the virus seriously—seemed to be getting through. By the end of March, most of the country’s 56.4 million school-age children and roughly 3 million teachers had moved to remote learning; on April 7, according to cellphone data, Americans stayed home for 93 percent of their day versus 72 percent on March 1. When a large-scale survey of new habits was conducted at the end of April, 96 percent of people claimed to be regularly and vigorously washing their hands, 88 percent were disinfecting surfaces, and 75 percent wore a mask when stepping outside—a major shift in norms.
But for every new helpful intervention imposed, there seemed to be another setback, like the president declaring that the pandemic would be over by Easter. And then there were moments like April 23, when Trump stood behind a lectern at the nightly coronavirus briefing and free styled, suggesting that the best way to fight the disease might just be to ingest or inject bleach. “I reached out to the group, and I was like, what are we gonna say about this?” Esther Choo remembered. “One of the doctors told me, ‘Just bring your truest self to this, Choo. Don’t overprocess this because your gut reaction is the right one.’ So when I went on TV that day, I said, ‘I don’t even know how to react to this. It’s such a ridiculous and horrible message that somebody is going to get hurt.’ ”
What was most disturbing to the members of the Brain Trust, the feeling they kept returning to among themselves, was the strange fact that this had become their responsibility, that they had to be the ones working out a message for the public. “When Ebola happened, nobody was asking Esther Choo, random doctor in the ER, for her opinion,” she said. “Nobody needed that. Because there were experts doing it. And so it was completely shocking to be driving the conversation.”
By the time the first wave of the virus peaked in the state of New York around mid-April, with nearly a thousand deaths a day, the wrung-out ER doctors had been intensely communicating with each other for weeks. After waiting for “the cavalry to arrive,” as Choo put it, they had more or less accepted that they would have to take on this role, as representatives of science and public health, worriers for the collective who had to push against strong forces more interested in pretending the virus would just leave on its own. On their DM chats, they felt like “surprised and reluctant dissidents,” Choo said. For months, they had told themselves they’d be able to stop once the government stepped in. “And it was one of the most sickening things for that never to happen.”
