On February 29th, Constantine held a press conference. He had asked Riedo, Duchin, and Kathy Lofy—another E.I.S. alum and the state’s top health officer—to play prominent roles. Duchin spoke first, and it was as if he had prepared his remarks with the Field Epidemiology Manual in hand. “I want to just start by expressing our deep and sincere condolences to the family members and loved ones of the person who died,” he said. He explained what scientists knew and did not know about the coronavirus, and noted, “We’re in the beginning stages of our investigation, and new details and information will emerge over the next days and weeks.” He predicted that “telecommuting” was likely to become mandatory for many residents, and repeated several times an easy-to-remember SOHCO: “more hand washing, less face touching.” Duchin told me that his words had been chosen carefully: “You have to think about managing the public’s emotions, perceptions, trust. You have to bring them along the path with you.” Since then, Washington State politicians have largely ceded health communications to the scientists, making them unlikely celebrities. “Hey people!! Jeff Duchin is the real deal,” one fan tweeted. A newspaper hailed him as “a bespectacled, calming presence.”
Constantine told me that he understands why politicians “want to be front and center and take the credit.” And he noted that Seattle has many of “the same problems here you see in Congress, with the partisanship and toxicity.” But, he said, “everyone, Republicans and Democrats, came together behind one message and agreed to let the scientists take the lead.”
By the time Seattle’s schools were formally closed, on March 11th, students and teachers were already abandoning their classrooms. The messaging had worked: parents were voluntarily keeping their kids home. Cell-phone tracking data showed that, in the preceding week, the number of people going to work had dropped by a quarter. Within days, even before Washington’s governor, Jay Inslee, issued official work-from-home orders, almost half of Seattle’s workers were voluntarily staying away from their offices. When bars and restaurants were officially closed, on March 15th, many of them were already empty. Constantine himself had been working from home for a week. He was giving interviews all day, and always underscored to reporters that he was speaking from his bedroom, and that the noises in the background were coming from his child, who was home from school. After he heard that the county’s basketball courts were still being heavily used, he ordered them closed.
The county had bought a motel to house homeless residents who tested positive for the coronavirus. When one homeless man at the motel, who was asymptomatic, left to buy a beer, Constantine immediately went to court, so that police could arrest him the next time he went out. The man’s actions had posed little risk: he had gone to a gas station across the street, then returned. But, Constantine told me, “the fact is some people are not going to follow the rules—and we need to show everyone there are consequences.”
Today, Washington State has less than two per cent of coronavirus cases in the U.S. At EvergreenHealth, hospital administrators have stopped daily crisis meetings, because the rate of incoming patients has slowed. They have empty beds and extra ventilators. The administrators remain worried, but are cautiously optimistic. “It feels like we might have stopped the tsunami before it hit,” Riedo told me. “I don’t want to tempt fate, but it seems like it’s working. Which is what makes it so much harder when I look at places like New York.”
The Epidemic Intelligence Service was founded in 1951, when American troops in Korea began experiencing fevers, aches, vomiting, and fatal hemorrhages. Some three thousand soldiers fell ill, leading military leaders to conclude that Chinese-backed Communists had weaponized bacteria. “The planning of appropriate defensive measures must not be delayed,” an epidemiologist at a new federal agency, the Communicable Disease Center, declared. He proposed a new division, named to evoke the Central Intelligence Agency. But when the first class of E.I.S. officers landed in Korea they found that the fevers were not caused by a crafty enemy. Soldiers, it turned out, had been accidentally consuming rodent feces. In later conflicts, generals were instructed to use thicker food-storage bags and to set more rat traps.
E.I.S. officers became known as “disease detectives.” In 1952, one of them studied a group of children in a Chicago slum who had all developed similar symptoms—muscle weakness, spasms, joint pain—but had tested negative for likely diseases. When the E.I.S. officer visited one of the children’s homes, he noticed a toddler chewing on chips of paint that had flaked off a windowsill. The paint chips were soft because they contained lead, which is toxic. A year later, that E.I.S. officer helped found the country’s first poison-control program, which taught parents that the first principle of safety was communication. The program advised parents to tell their children not to put paint chips in their mouths, and to signal the dangers of bleach, insecticide, and cleaning chemicals by storing them on high shelves.
E.I.S. alumni went on to take powerful health-care jobs across the country. “Nearly ninety per cent of E.I.S. graduates embark on public-health careers at the local, state, federal or international level,” a 2001 study found. Four former C.D.C. directors are E.I.S. alumni; half a dozen graduates have served as the U.S. Surgeon General.
When the coronavirus pandemic started, E.I.S. alumni began working non-stop, with some setting up cots inside their offices. While the virus remained overseas, the C.D.C. led communications, scrupulously following E.I.S. protocols. But soon after the coronavirus landed on American shores the White House took over. E.I.S. officers were dismayed to see the communication principles that the C.D.C. had honed over the years being disregarded, and sometimes turned on their head. A Coronavirus Task Force, led by Vice-President Mike Pence, was formed, excluding everyone from the C.D.C. except its director, Dr. Robert Redfield. “The C.D.C. was ordered into lockdown,” a former senior official at the agency told me. “They can’t speak to the media. These are people who have trained their entire lives for epidemics—the finest public-health army in history—and they’ve been told to shut up!”
Since then, the primary spokesperson during the pandemic has been not a scientist but President Donald Trump—a politician notoriously hostile to science. Further complicating matters, Trump has highlighted a rotating cast of supporting characters, including Pence; Dr. Anthony Fauci, from the National Institutes of Health; Dr. Deborah Birx, from the State Department; and the President’s son-in-law, Jared Kushner. “When there are so many different figures, it can cause real confusion about whom to listen to, or who’s in charge of what,” Dr. Tom Inglesby, the director of the Center for Health Security, at Johns Hopkins, said. “And, if the response becomes political, it’s a disaster, because people won’t know if you are making recommendations based on science or politics, and so there’s the risk they’ll start to tune out.”
Already, it’s clear that some confusion has taken hold. Though the C.D.C. formally recommended, in mid-March, that Americans practice social distancing, governors in five states have refused to order residents to stay home. (One of those states, South Dakota, is now contending with a major outbreak.) Federal leaders have given shifting advice—initially, Americans were told that they did not need to wear masks in public, but on April 3rd, at a White House press briefing, masks were recommended—and this has risked undermining public confidence. Trump announced the change by saying, “You don’t have to do it. I’m choosing not to do it.” Had the C.D.C. been in charge of communicating about masks, the agency surely would have used the change in guidance as a teaching opportunity, explaining that scientists had come to understand that people infected with the coronavirus can be contagious but asymptomatic for longer than originally thought—which means that we need to be more careful when we cough, even if we feel healthy or just have seasonal allergies. Trump’s daily briefings, however, are chaotic and contradictory. Within the span of a few days, Trump threatened to quarantine New York City, then reversed himself; soon after declaring that he intended to “reopen” the U.S. economy within two weeks, he called for thirty additional days of social distancing. Such inconstancy from a leader is distracting in the best of times. It is dangerous in a pandemic. “Right now, everyone is so confused by all the conflicting messages that, each time the guidance evolves, fewer and fewer people might follow it,” Besser, the former C.D.C. director, said. “We’re going backward in our sophistication.”