Pandemic History Repeats Itself

I’m going to confess something that you probably have already intuited if you have followed this newsletter for more than a week: I’m skeptical about how much policy can impact COVID spread.

It is an epidemiological tautology that reduced human contact will mean reduced spread. That simply *must* be true for any virus that is spread by human contact. Therefore social distancing and quarantine *must* reduce spread simply because they reduce human contact.

The question then becomes “why does this thing keep spreading if we have policies in place to mandate those things”? And the answer could actually be a lot of things. It could be that it’s spreading less than it would, it’s just super contagious. It could be that people are ignoring the policy recommendations.

This “ignoring” possibility is actually a really interesting one because it is an issue of debate in pandemic management. You want to give people the best advice that they will adhere to… and nothing more. It turns out if you tell people to wear masks and social distance and not go to school and not go to church and not see their loved ones and lock themselves in a room for 3 weeks, there’s a good chance that you’ve pushed them to a point where they have no context for which things to make the most sense. Once you cross the threshold of what people will accept, they just throw up their hands and say “screw it” and stop listening.

But if you give people specific advice that they can consistently follow, they are far more likely to adhere to it.

That’s something I learned alongside both the big topics for today.

• Pandemic History Repeats Itself

• The Purdue Approach to COVID

• Disney Shorts: The Cookie Carnival

Pandemic History Repeats Itself

Kelley Krohnert, who runs covid-georgia.com, pointed me to this absolutely stunning paper, Disease Mitigation Measures in the Control of Pandemic Influenza published in 2006, discussing the possibility of a flu pandemic similar to the 1918 pandemic (which was by far the most lethal pandemic in recent history).

This paper walks through the expectations of a highly contagious, rapidly spreading virus, how we should manage it, what the best steps are for mitigation, isolation, and quarantine. And it is eerily relevant to this crisis.

It walks through a dozen possible mitigations (home isolation of the sick, antivrial medications, hand washing and respiratory etiquette, masks, social distancing, school closures, travel restrictions, banning public gatherings, large scale quarantines) and talks about the usefulness and possible adverse consequences of these choices.

What is most interesting to me is the timeline given. The authors note that there were only two communities who managed to fully escape the 1918 influenza pandemic and they were places who completely cut themselves off from the outside world for months. When that is not a plausible option, they note that any given community will tend to run through an infection in about 8 weeks and, given the size of the country, it would likely take about 8 months for the infection to run its course.

The whole thing reads like it could be written in the future. And one of the authors was DA Henderson, the guy who led the WHO program to eradicate smallpox.

(pictured: some nerd who saved millions of lives)

All the mitigation discussions that Henderson recommends are centered on keeping normal life flowing along as much as possible, identifying and isolating the hospitalized sick so that they don’t infect the rest of the hospital. When the infection surges in a given community, implementing some of the more stringent mitigations (like school closures) for as short a time as possible. It advises against border screening, school closures, cancelling events, large scale quarantines. It is pro-vaccination, isolation of infected patients, hand-washing, and (above all) it emphasizes the importance of communicating clear strategy and planning, with public official working through civic leaders, churches, schools, and businesses.

This latter point, the point of clear communication, clear planning, and clear strategy is the thing I find most often missing in our approaches to COVID mitigation.

The Purdue Approach to COVID

My family knows a freshman heading to Purdue University this fall and heard about his experience heading to a campus that was working to open in the midst of this pandemic.

I decided to look up what Purdue was doing in detail and was extremely impressed with their plan. The number one item they stress is personal responsibility, that every student needs to follow the guidelines as a matter of honor and respect for their university and fellow students.

They’ve gone to enormous effort to de-densify the campus, shifting the cafeteria to carry-out, reducing occupancy for classrooms, pulling together a program that is guiding faculty in the optimal ways to redesign their courses to be able to be more flexible with in-person instruction. They even have a program in which medically vulnerable students can be paired with a roomate who has already recovered from COVID, a concept I found particularly original.

But Purdue’s real focus is on flexibility and communication. They are talking to their professors, their administrators, they are reaching out fraternities and sororities, to student landlords. It’s everything that I read about in Henderson’s paper, including the focus on getting back to the job of teaching students.

Their goal is getting back to normal where normal doesn’t mean everything is exactly like it was before the crisis. Normal means we work hard so that we aren’t disrupting the important parts of life. As he wrote:

Experience has shown that communities faced with epidemics or other adverse events respond best and with the least anxiety when the normal social functioning of the community is least disrupted.

Disney Short: The Cookie Carnival

This is one of my favorite early color Silly Symphonies. It employs the the sumptuous fantasy visuals and silliness that work so perfectly in the best of the early color cartoons. The character animation is incredibly rich and the story moves from one fantastic visual to another at a breakneck pace.

The land of sweets is having a parade to determine who will be the Cookie Queen. One elaborate sweet confection after another rolls down the street until we see a young pauper cookie weeping because she can’t possibly enter the parade in her drab gingerbread outfit. A kindly hobo cookie dresses her up in frosting and candies and leads her float past the judges.

Of course, the judges instantly choose her as the winner, enthrone her, and demand that she immediately choose a husband, calling quickly into question the alarming nature of this particular monarchy. This leads us into the second half of the cartoon where we cycle through possible suitor cookies before she chooses the kindly hobo as her spouse.

This short is the simplest possible narrative but just barrels along with creativity and beauty that holds us captivated with what can be done with drawn animation.