The Quiet Before, page 27
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UNLIKE THE DOCTORS, the Red Dawn group didn’t have the ability to broadcast their opinions to a wider world. They watched helplessly as New York City was overtaken by the virus in March and April. Eva Lee found herself crying for hours when she saw it all come to pass. She said the chain even went quiet for a bit. “Everybody was silent; you could feel the mourning,” she said. The United States hit a cumulative twenty thousand deaths on April 11, quickly surpassed by thirty thousand deaths four days later, and reaching fifty thousand on April 24.
When the Red Dawn chain was revealed to the public in April—Lee was mostly embarrassed by her typos; a reporter even asked her if she really knew English—the group switched to a more secure server, though pretty hurriedly reverted back to email as the most convenient way to talk and exchange information. Lee shared with me hundreds of these messages, picking up where the earlier, exposed back-and-forth had ended (she anonymized people’s names before handing over the correspondence). The group had moved beyond frustration to resignation, finally accepting that no unified, federal response was forthcoming. Everything would be fragmentary, fractal even, dependent on the decision of each locality. States would inhabit wholly different realities. In South Dakota, the governor was announcing a “Back-to-Normal Plan” the same week that some counties in California were legally enforcing the wearing of masks.
Strangely, this created an opening for the group. Now that each municipality, each individual school, and each corner bar was desperate for specific guidelines, the ideas generated on the forum could prove useful. When Lee modeled what the impact of the virus would be with and without various interventions in a city of 3.3 million people—a number she chose because it represented 1 percent of the U.S. population—the emergency director of San Diego, also in the group, piped up and asked if he could use it, because that happened to be the exact population of his county. One participant on the chain prefaced his request “Questions for the Smart People.” The focus shifted from national policy to local needs, which suited their detail-obsessed brains.
Lee hardly slept anymore, churning out dozens of responses every day. And the email chain gained extra significance for her because she was doubly isolated. Not only was she stuck at home like everyone else in lockdown, but she was coming to terms with the fact that she had just been convicted of a felony. It was her messiness that had gotten her into trouble. Lee was charged with falsifying information on a forty-thousand-dollar-a-year federal grant her lab had received from the National Science Foundation. Its terms demanded a certain level of financial participation from partnering institutes, and Lee says she had misunderstood how to calculate the contribution, putting down a uniform amount each year without checking. She then also lifted a signature of a Georgia Tech grants administrator from an earlier document so she could quickly finish up her paperwork. A federal investigation was launched, and in December 2019 Lee found herself in front of a judge tearfully pleading guilty. Her many defenders said this was simply a case of a person not well suited to or just uninterested in handling administrative tasks, whose only crime was her inattention (something she was never accused of in her work). In one article, her graduate school adviser testified that Lee had difficulty tying her own shoelaces or working a copier. She hadn’t benefited personally from the fraud at all. But the mistake, if that’s all it was, was a stain.
When Red Dawn’s call to arms first arrived in her in-box, she was awaiting her sentencing—the U.S. attorney was looking for eight months of home confinement—but in the meantime Georgia Tech had suspended her as a professor. And now she was feeling the loss. The university had denied her remote access to her lab’s many computers and the patented modeling software she had created for them. The solitude of the pandemic, compounded by the alienation from her academic community, was “painful,” she said. And being separated from her tools had real consequences. “If I were not shut out, I would have written maybe ten times as many emails on Red Dawn because I could have done so much more analysis,” she said. “My little laptop is so crazily slow and clearly can’t model the entire United States rapidly.”
But she was able to do a lot in those dazed spring months, when half the country worried that the worst was yet to come and the other half decided that the wearing of masks was a violation of their individual liberty. On Red Dawn, all that mattered, and had ever really mattered, was epistemology: What did they know about the virus, how did they know it, and what did it mean for actual communities? “Do you have any additional detail regarding hospital surge re-organization/facility layout guidance?” A barrage of emails would follow, with specific suggestions for setting up various zones and who should go in them. “Use notepad and stick them to the wall next to the patient indicating days since arrival. Big enough so you can see them from a distance.” Another inquiry about pregnant women and how they could avoid contracting the virus once they entered the hospital to give birth developed into a whole set of protocols.
Lee was concerned early on that people with mild cases of the virus would be turned away from the hospital, only to infect family members and then possibly the other people in their apartment building. Before anyone thought to come up with solutions for these potential vectors of infection, the group was in the weeds with a range of practical proposals, including housing those with relatively mild symptoms in nearby colleges or sports stadiums. A specialist in optimizing space, Lee thought of repurposing hotels. “Eva makes a very good point,” RH, one of the Red Dawn members, wrote. “We do have a lot of empty hotels right now.” But then how should these hotels be set up? Everything from hygiene issues to airflow was discussed. One participant shared how hotels in Wuhan had been reorganized for safety: “We also now have a series of floor plans allowing for HVAC airflow from hall to room which reduced droplets.” It’s hard to tell if Red Dawn was the source, but by the end of April, New York City had put in place a program that looked very much like the one the group had envisioned.
They became a subterranean factory for producing this sort of precise advice. How many people should be allowed to sit at a restaurant table? “The 4-max model per table in Hong Kong seems to work rather well. We CANNOT afford to have 10 people at a table. Contact tracing is a 3-generation effort. So, 4x4x4 is a good size to track, but 10x10x10 is far too big.” Should servers wear gloves? There was some debate about this. “One question I have in the note below is related to your mention of the use of gloves in restaurants,” wrote WL. “That is becoming an expectation, but I don’t see the science of it.” There were suggestions about hair salons and tattoo parlors and the optimal way to stagger desks in a classroom. In one set of emails, Lee got into a protracted exchange about how to handle clothes once they had been tried on at a boutique: “I don’t know what the current practice is, but as I model it, 30 minutes from one person to the next is a very bad idea,” she wrote to the group.
Lee would run models, using the data at hand, and then deliver the numbers. Others would challenge them, or doubt the feasibility of a specific proposal, at which point modifications would be made. It’s not that they always arrived at the truth (we now know, for example, that transmission via clothes is rare), but that was never really the objective. Esther Choo described a similar process among the ER doctors. “You have to unequivocally advocate for things where the data is equivocal,” she said. This happens in public health all the time. If you stop smoking, no one can promise that you won’t still get cancer, she said. Same with wearing a seat belt in a car. You could still die in a crash. But it is the job of experts to sift through the data and decide, on balance, what to recommend to keep people safe. Red Dawn was intent on doing this, meticulously, with what seemed at times like a blind faith that someone, somewhere, was listening.
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ON THE FACE OF IT, there wouldn’t appear to be anything subversive about the sorts of instructions that were bubbling up from the email chain, except that the CDC was being silenced for saying the very same things. On May 1, after their own internal deliberations, the agency was set to publish a seventeen-page report titled “Guidance for Implementing the Opening Up America Again Framework,” a detailed checklist for business owners and local officials and religious leaders. The Trump administration quashed it. And when the Associated Press purloined a copy, their article ran with the words of an anonymous CDC scientist who said the White House told the agency that their booklet “would never see the light of day.”
In the battle between science and politics—politics here meaning Trump’s insistence that life and business would continue uninterrupted—science was outgunned. The CDC had no independent outlet for addressing the public. Its guidance, when not suppressed, was heavily edited. The agency’s chief of staff, Kyle McGowan, later described how, for example, when the CDC wanted to recommend six feet of distance between restaurant diners, the White House budget director objected because it would be too economically onerous. The compromise—one that would have driven Lee and the Red Dawn experts insane in its vagueness—was to simply advise restaurants to implement “social distancing” without specifying what that meant. Months after he left the agency, McGowan concluded, “Every time that the science clashed with the messaging, messaging won.”
Red Dawn persisted meanwhile with its tighter focus. “If asking for a national strategy is too much, then at least each county, each city, each jurisdiction…must have a strategy that is holistic where actions are all complementary to one another so that they can optimize the achievement of goals and the outcomes,” Lee wrote to the group in July.
And this is where their impact began to be felt. The local leaders on the chain—the California deputy emergency response director, the Texas, San Diego, and Maryland COVID-19 incident commanders—took what was generated among the group and put it into practice. Lee would occasionally receive follow-up emails from local public health officials who had been sent her directives. She got a call from officials in New York in mid-April. The Maryland governor, Larry Hogan, announced that schools would be closed on March 12. His was one of the first states to take this step, and Lee later learned it was a direct result of Red Dawn’s call for interventions. One congressman would email her “done” for every one of their suggestions his state had put in place.
Lee pointed me to Washington State, and King County, which includes Seattle, in particular, as a place that seemed to take Red Dawn’s warnings seriously and reaped the benefits, avoiding the fate of New York City. The early blows of the coronavirus were felt in Washington—both the first confirmed case in the United States and the first announced death at the end of February. Until early April, when New York surged, Washington had the highest number of cases per capita of any state in the nation. But it quickly put in place extreme measures. On March 12, the state was one of the first to close schools and public venues. It limited gatherings to two hundred fifty people on March 11 and then fifty people a few days later. And on March 23, the governor ordered a strict lockdown. Like the leaders of a few other states that day, he prohibited people from “leaving their homes,” even banning assembling for religious reasons. By early April, the decreased numbers told the story, as King County averted the escalation of cases seen in other metropolitan areas and the feared hospital overloads. Lee was in touch with local officials who told her that their decision-making had been shaped by Red Dawn and Lee’s models. Even though I pressed Lee to give me evidence of Red Dawn’s impact, she was not particularly interested in taking credit or drawing these causal lines. “People did listen, and they did take actions. I don’t know everything, since I don’t ever ask people about it. I just focused on the work, which is what I am good at.”
They did what they could. No one was getting burned at the stake for delivering hard truths, but there were consequences for public health officials who dared to simply wonder out loud about the administration’s priorities. In late April, Rick Bright, the official leading the federal effort to develop a vaccine, was removed from his job when he questioned Trump’s endorsement of hydroxychloroquine. He gave testimony in Congress on May 14, imploring lawmakers to change their approach and warning that “our window of opportunity is closing,” that the failure to put in place widespread testing and the absence of basic PPE in hospitals all had cost lives. Bright was attacked by the administration, and the president dismissed him in a tweet as “a disgruntled employee, not liked or respected by people I spoke to and who, with his attitude, should no longer be working for our government!”
This was the cost of speaking out when wishful thinking seemed to be the government’s main strategy. Four hundred years after Peiresc had deployed his letters to nurture the development of the scientific method, there was still a need for a private space where this work could happen, where the pursuit of observable truth could proceed safely away from the centrifugal force of politicization and demagoguery.
Eva Lee continued to send a barrage of emails every day to the Red Dawn group through the spring and into the summer. And on August 12, she logged on to Zoom to attend her sentencing hearing in front of a U.S. district judge, Steve Jones. Dozens of public health officials had written letters of support, including Duane Caneva, the chief medical officer for the Department of Homeland Security, who had initiated the Red Dawn chain. Lee pleaded with the judge, weeping, worried that her inability to access her computers and chart potential infection rates would cost lives. “So my punishment means punishing all these people and it feels horrible to me,” she said.
Rather than admonishing Lee for her crime, the judge heaped praise on her. “You are one of the most brilliant people I’ve ever read about,” Jones told her. He couldn’t bring himself to accept the government’s sentencing recommendation if it would take her away from her work. “We need you in America for the next few months and the rest of your life to help us,” Jones told Lee. “From what I’ve read and seen, you’ll play a major part in how America will come out of this coronavirus.” This was not how judges typically addressed convicted felons. He gave her sixty days of home confinement, but delayed its start until the spring of 2021, when the worst of the virus would hopefully be over.
Georgia Tech, on the other hand, refused to reinstate her as a professor. The university stuck with its original logic that unless Lee was involved in the official government response to the pandemic, there was no reason to make an exception for her. Her role seemed to be, as the university characterized it, contributing to “an ad hoc consortium of researchers via e-mail.” Red Dawn was a little brain trust, they implied, but it was peripheral, just scientists, far from any podium, chatting together. Though that’s precisely what made it so meaningful.
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IN THE FALL OF 2020, as COVID deaths reached into the hundreds of thousands, I had a conversation with William Foege, who ran the CDC from 1977 to 1983. The Lancet once called Foege “the gentle giant of public health.” He is six feet seven, which meant Obama practically had to stand on his tiptoes when he awarded him the Presidential Medal of Freedom. Foege was credited with the global eradication of smallpox in the 1970s (“2 million died each year of smallpox,” his citation read, “a decade later, that number had dropped to zero”), and when I reached him, he was hiding out from this new pandemic in the north Georgia woods, leaving his house only once a week to buy the Sunday New York Times. At eighty-four his voice was shaky. Foege had watched with growing unease the way his old agency, and science itself, had been sidelined. He knew that the people who worked at the CDC had prepared their whole careers for just such a moment, and he was now seeing them rendered powerless. It took him a long time, he said, to accept just how bad it was and to try to do something. He didn’t want to intervene. But Foege had been active on his own email chains and LISTSERVs throughout 2020, listening to and joining in with former and current CDC scientists who, like those on Red Dawn, were alternately dismayed and desperate to find solutions. It was the existence of these channels that gave him confidence, he said, to do something he never thought he would.
Foege wrote an emotional, forceful email to the then head of the agency, Robert Redfield, imploring him to get himself fired. He was sympathetic to the challenges Redfield faced and told me also that he’s not sure what he would have done in the director’s shoes, but he was unsparing about what had happened since the spring. “The biggest challenge in a century and we let the country down,” he wrote. “The public health texts of the future will use this as an example of how not to handle an infectious disease pandemic.” The reasons were by then well known: the total absence of a national plan, an administration in denial. “The prime lesson of ‘Know the Truth’ has been so obscured by the White House that the people and the media go to the academic community for truth, rather than the CDC.” Foege was acknowledging those who had done the work the CDC was prevented from doing. The only solution, as he saw it, was for Redfield to plainly lay out what had gone wrong and apologize for his own part in it. “The White House will, of course, respond with fury,” Foege concluded. “But you will have right on your side. Like Martin Luther, you can say, ‘Here I stand. I cannot do otherwise.’ ”
