WASHINGTON — Fourteen years in the past, two federal authorities docs, Richard Hatchett and Carter Mecher, met with a colleague at a burger joint i
WASHINGTON — Fourteen years in the past, two federal authorities docs, Richard Hatchett and Carter Mecher, met with a colleague at a burger joint in suburban Washington for a last evaluation of a proposal they knew can be handled like a piñata: telling Individuals to remain residence from work and faculty the following time the nation was hit by a lethal pandemic.
Once they offered their plan not lengthy after, it was met with skepticism and a level of ridicule by senior officers, who like others in the US had grown accustomed to counting on the pharmaceutical trade, with its ever-growing array of recent therapies, to confront evolving well being challenges.
Drs. Hatchett and Mecher had been proposing as an alternative that Individuals in some locations may need to show again to an method, self-isolation, first broadly employed within the Center Ages.
How that concept — born out of a request by President George W. Bush to make sure the nation was higher ready for the following contagious illness outbreak — grew to become the guts of the nationwide playbook for responding to a pandemic is likely one of the untold tales of the coronavirus disaster.
It required the important thing proponents — Dr. Mecher, a Division of Veterans Affairs doctor, and Dr. Hatchett, an oncologist turned White Home adviser — to beat intense preliminary opposition.
It introduced their work along with that of a Protection Division workforce assigned to an identical job.
And it had some sudden detours, together with a deep dive into the historical past of the 1918 Spanish flu and an necessary discovery kicked off by a highschool analysis undertaking pursued by the daughter of a scientist on the Sandia Nationwide Laboratories.
The idea of social distancing is now intimately acquainted to nearly everybody. However because it first made its manner by means of the federal paperwork in 2006 and 2007, it was considered as impractical, pointless and politically infeasible.
“There have been two phrases between ‘shut’ and ‘up’” initially, stated Dr. Howard Markel, who directs the University of Michigan’s Center for the History of Medicine and who played a role in shaping the policy as a member of the Pentagon research team. “It was really ugly.”
Dr. Mecher was there when Dr. Hatchett presented government public health experts the plan that the two of them and Dr. Lisa M. Koonin of the Centers for Disease Control and Prevention had reviewed over burgers and beer.
“People could not believe that the strategy would be effective or even feasible,” Dr. Mecher recalled.
But within the Bush administration, they were encouraged to keep at it and follow the science. And ultimately, their arguments proved persuasive.
In February 2007, the C.D.C. made their approach — bureaucratically called Non-Pharmaceutical Interventions, or NPIs — official U.S. policy.
The effort began in the summer of 2005 when Mr. Bush, already concerned with bioterrorism after the Sept. 11, 2001, attacks, read a forthcoming book, “The Great Influenza,” by John M. Barry, about the Spanish flu outbreak of 1918.
Mr. Bush’s concern was elevated by a string of new outbreaks caused by infectious diseases transferring from birds and other animals to humans, including an avian flu outbreak that year in Vietnam. Because there was no vaccine for these new threats, they could spread rapidly.
To develop ideas, the Bush administration enlisted Dr. Hatchett, who had served as a White House biodefense policy adviser, and Dr. Mecher, who was a Veterans Affairs medical officer in Georgia overseeing care in the Southeast.
“‘Someone from the White House is on the phone,’” Dr. Mecher, then 49, recalled his secretary telling him in the fall of 2005, her voice expressing some disbelief.
A blunt-speaking, Chicago-born intensive care physician, Dr. Mecher had almost no pandemic policy expertise. Instead, he was recruited because they needed someone who understood how a hospital actually worked, said Dr. Rajeev Venkayya, who was a special assistant to Mr. Bush for biodefense.
Dr. Koonin, who worked on preparedness planning at the C.D.C., also played a key role.
“Strategic, out-of-the-box thinkers,” is how Dr. Venkayya, who now oversees vaccine production at Takeda, a Japan-based pharmaceutical company, described what he was looking for.
Given the increased danger from new strains of influenza and the reality that existing antiviral drugs like Tamiflu did not work against all contagious diseases, Drs. Hatchett and Mecher and their team began exploring other ways to combat a large-scale contagion.
It was about that time that Dr. Mecher heard from Robert J. Glass, a senior scientist at Sandia in New Mexico who specialized in building advanced models to explain how complex systems work — and what can cause catastrophic failures.
Dr. Glass’s daughter Laura, then 14, had done a class project in which she built a model of social networks at her Albuquerque high school, and when Dr. Glass looked at it, he was intrigued.
Students are so closely tied together — in social networks and on school buses and in classrooms — that they were a near-perfect vehicle for a contagious disease to spread.
Dr. Glass piggybacked on his daughter’s work to explore with her what effect breaking up these networks would have on knocking down the disease.
The outcome of their research was startling. By closing the schools in a hypothetical town of 10,000 people, only 500 people got sick. If they remained open, half of the population would be infected.
“My God, we could use the same results she has and work from there,” Dr. Glass recalled thinking. He took their preliminary data and built on it by running it through the supercomputers at Sandia, more typically used to engineer nuclear weapons. (His daughter’s project was entered in the Intel International Science and Engineering Fair in 2006.)
Dr. Mecher received the results at his office in Washington and was amazed.
If cities closed their public schools, the data suggested, the spread of a disease would be significantly slowed, making this move perhaps the most important of all of the social distancing options they were considering.
“Targeted social distancing strategies can be designed to effectively mitigate the local progression of pandemic influenza without the use of vaccine or antiviral drugs,” concluded a study that Dr. Glass published in the Emerging Infectious Diseases journal. Laura, then a high school junior, got a credit.
Drs. Hatchett and Mecher and their team soon found themselves measuring the width of the standard school bus seat and the average classroom size in the United States, calculating how closely spaced students are and agreeing that any plan would have to feature closing schools.
At the same time, they were circling in on another fundamental challenge: If a government was going to rely on the blunt instrument of social distancing to prevent widespread death, how early would it have to act?
Dr. Markel had spent his career studying contagious disease outbreaks. Recently, he had been working on a related assignment from the Pentagon, which had a narrower but equally urgent concern: the vulnerability of U.S. military personnel to a viral health threat.
The bird flu, while often fatal, did not continue to cross over in large numbers to humans, and the steps he was proposing turned out to be unnecessary. But the work led him to think about the need for a large-scale isolation plan for the United States.
Dr. Markel had published a book, “When Germs Travel,” in 2004 that examined six major epidemics since 1900 and how they had traveled across the United States. He decided to work with Dr. Martin S. Cetron, the director of the C.D.C.’s quarantine division, to look more closely at the lessons of the Spanish flu of 1918.
Officials in Philadelphia did not want to let the flu disrupt daily life, so they went ahead in September 1918 with a long planned parade that drew hundreds of thousands of spectators to promote war bonds.
In St. Louis, by contrast, the city health commissioner quickly moved to close schools, churches, theaters, saloons, sporting events and other public gathering spots.
Dr. Markel and his team set out to confirm just how important a role timing had played in reducing deaths. They gathered census records and thousands of other documents detailing the date of the first infection, the first death, the first social distancing policies and how long they were left in place in 43 American cities.
Separately, Dr. Mecher and his team looked at the experience of 17 cities, using newspaper clips and other sources.
“It’s like treating heart-attack patients,” Dr. Mecher said. “Timing matters.”
A High-Stakes Showdown
After decades of advances by the nation’s pharmaceutical companies — finding treatments or vaccines for major illnesses, including H.I.V. and smallpox — Americans by the early 21st century had a built-in expectation that 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.
So the considerable skepticism among local officials, public health experts and policymakers in Washington was not surprising.
Dr. Henderson was convinced that it made no sense to force schools to close or public gatherings to stop. Teenagers would escape their homes to hang out at the mall. School lunch programs would close, and impoverished children would not have enough to eat. Hospital staffs would have a hard time going to work if their children were at home.
The answer, he insisted, was to tough it out: Let the pandemic spread, treat people who get sick and work quickly to develop a vaccine to prevent it from coming back.
The administration ultimately sided with the proponents of social distancing and shutdowns — though their victory was little noticed outside of public health circles. Their policy would become the basis for government planning and would be used extensively in simulations used to prepare for pandemics, and in a limited way in 2009 during an outbreak of the influenza called H1N1.
Then the coronavirus came, and the plan was put to work across the country for the first time.
Dr. Mecher was a key voice on the “Red Dawn” email chain of public health experts in raising early warnings this year about the coronavirus outbreak and Mr. Trump’s reluctance to embrace shutdowns and social distancing. Others involved in development of the policy watched with mixed feelings as their policy was put into action.
Dr. Markel called it “very gratifying to see our work used to help save lives.” But, he added, “it is also horrifying.”
“We always knew this would be applied in worst-case scenarios,” he said. “Even when you are working on dystopian concepts, you always hope it will never be used.”