Comparing the Pandemic Responses in New York and Seattle

CHRISTIANE AMANPOUR: Charles Duhigg is a contributor for “The New Yorker,” and he’s been comparing the pandemic response in New York and Seattle. Both cities were hit by the outbreak at around the same time, from late February to early March. But, today, more than 30 percent of all U.S. coronavirus deaths are in New York and less than 2 percent in Washington state. Duhigg speaks to Michel Martin from Brooklyn about it.

(BEGIN VIDEOTAPE)

MICHEL MARTIN: Charles Duhigg, thank you so much for speaking with us.

CHARLES DUHIGG, “THE NEW YORKER”: Thanks for having me.

MARTIN: I have to say that your piece raises a really uncomfortable question, which is, Seattle was so much in the news at the beginning of this outbreak. I mean, we were seeing pictures on the news every day from this one nursing facility right outside of Seattle. But now, these months later, New York is the epicenter of this. There are hundreds of thousands of confirmed COVID cases in New York. There are tens of thousands — I mean, what, how many deaths so far, in the 20,000 range, I believe And Seattle has — and Washington state, on the whole, Seattle in particular, has a fraction of that. What happened? What did you find out?

DUHIGG: Well, what we have found is that Seattle put its public health officials, its scientists, in front of the cameras, and they relied on a communications playbook that the CDC has polished for over 50 years about how to talk to the public to convince them to stay home. In New York, the politicians took the lead. And the messages that they sent were much more muddied and much more confusing, particularly initially. And the weird thing about a pandemic is that what you do in those first early days can matter disproportionately, because, once the virus is out of the gate, it begins expanding exponentially. And that’s the mistake that New York made. It was only four or five days behind Seattle, but those four or five days made all the difference.

MARTIN: Tell me a little bit more about this playbook, the CDC playbook that you say Seattle followed, but New York didn’t.

DUHIGG: So, the CDC since the 1950s has had a division known as the Epidemic Intelligence Service. And what they do is, they take a new class every single year, for two years, they train them how to become essentially the shock troops, the front line in an epidemic response. And, oftentimes, those people go out, as alumni, and they become the commissioner of health of Los Angeles and Philadelphia and Chicago. And this playbook that they give them, that they train them, which is actually available online, anyone can go look at it, it’s known as the CDC’s Field Epidemiology Manual. It tells them exactly how to communicate. And it has a couple of rules. The first rule is, you must maintain trust with the audience, because we know that advice is going to change over the course of an epidemic. And whoever the spokesperson is speaking to the public, they need to be able to convince people to do things like stay home or avoid going to work, even when that advice might change, even when conditions might change. Another big piece of advice is that it’s generally thought to be better for a scientist to be the head of public health messaging than a politician, because, as one former CDC director told me, the problem with a politician is that half the nation might just do the opposite of what they’re saying, because they didn’t vote or trust for the guy. And so it’s really important to use these principles to maintain this trust, because, ultimately, a pandemic is as much a communications emergency as it is a health emergency.

MARTIN: Is there one crucial decision you think Seattle made early on that made the difference? I know you said put the scientists first, but is there some way that you — is there something you can sort of pinpoint that say, this is the crucial difference here?

DUHIGG: Seattle moved very quickly to close it schools and to ask companies to close their workplaces.

MARTIN: Right.

DUHIGG: So, literally just days after the first fatality in Seattle, the first fatality in the entire nation, one of the top politicians, a guy named Dow Constantine, called Brad Smith, the president of Microsoft, which is located nearby. And he asked him to tell all of his employees to stay home from work. He did the same thing at Amazon. So, as a result, what one Seattle resident told me was, he woke up on Tuesday morning and suddenly 100,000 cars were missing from the roads, because all the Amazon and Microsoft employees were staying home. And he said, you knew that something important had happened. You knew that something scary was going on because the roads were suddenly empty. And that’s kind of the point, is that it’s not enough for a leader to simply say something, even if it’s a scientific leader. You have to create an atmosphere that convinces people to move fast, because we can’t order — we can order them to stay home, but they don’t have to. We’re a nation where people do whatever they want. And so what we have to do is, we have to persuade them.

MARTIN: Well, what made the officials in Seattle so willing to do that? I think people who are in the New York area may remember that New York didn’t close the schools, for, what, for at least, what, a couple of days after that. And then when did New York close their schools?

DUHIGG: New York closed their schools in early March. And there was a long delay in which mayor — the New York City mayor, Mayor Bill de Blasio, sort of publicly had this indecision about whether he ought to close the schools. And he was making a legitimate argument .One of the things he said is, look, if you close the schools, it disproportionately impacts our most vulnerable, right? There’s kids who rely on schools for meals. There’s health providers who they can’t go to work unless their kids are in school, because they don’t have day care. Now, at the time, de Blasio was getting recommendations from his own health officers to close the schools and restaurants. In fact, two of de Blasio’s top health officers came to him and threatened to resign unless he closed the schools and bars and restaurants. But it is a difficult choice. And one of the things that’s interesting — and this is one of the things that the CDC and the Epidemic Intelligence Service teaches — is that almost all the normal rules that apply to a politician suddenly become reversed when you’re in a pandemic, right? As a politician, our instinct is always to calm, to avoid panic, to reassure citizens. But, in a pandemic, what you actually want to do is you want to foster a little bit of panic, because you’re trying to convince people to do things that are really hard before they can see the evidence of the disease around them. And panic does a pretty good job of convincing us to choose to change our behavior.

MARTIN: Maybe people outside of New York might not remember this, but I know that the mayor, Bill de Blasio, came under some criticism for going to the gym right before he — just as he was urging other people to stop going to the gym. You might think, oh, that’s kind of petty. Everybody wants to do what they want. But why does something like that matter?

DUHIGG: It matters enormously, because the consistency in messaging is key to persuading people what to do. In a moment of panic, when someone’s asking you to do something like stay in your house, what you’re saying is, like, A, I want to find an excuse to ignore them, and, B, I want to understand what’s going on. And so if, for instance, as in this case, Governor Andrew Cuomo of New York state says, I’m going to close down all the gyms, and then mayor Bill de Blasio of New York City, asks his driver to take him to a gym that’s nine miles away, so he can work out, then the average viewer, they’re saying, who am I supposed to listen to? Am I supposed to be like the mayor and go outside, or am I supposed to listen to the governor and stay inside? Any time you have any conflicting information, particularly in an emergency, when people are scared and they don’t know what to listen to, it’s really, really dangerous. You can’t have these distractions during a pandemic. They become deadly.

MARTIN: What about Governor Cuomo? Well,

DUHIGG: Well, initially, Governor Cuomo, similar to Mayor de Blasio, was saying, look, you don’t need to be concerned about this. Like, their instinct is to reduce panic, which is usually a pretty good instinct. It’s just not the right instinct in a pandemic. And, now, I will say both of them, compared to, say, federal leaders, did get on the horse pretty quickly and start saying, look, this is something to take seriously. We need to be concerned about this. But those four or five lost days matter a lot. Dr. Tom Frieden, who used to be a commissioner of public health in New York, and was the director of the CDC, he actually estimates that, if New York had moved about 10 days faster to shut things down, we would have seen 50 to 80 percent fewer fatalities in New York. And that’s a big deal.

MARTIN: That’s remarkable.

DUHIGG: It’s huge.

MARTIN: Wait. Wait. That’s remarkable. You’re saying that just those couple of days, maybe a week, could have saved thousands of lives?

DUHIGG: Absolutely, because, remember, a virus moves in an exponential manner, right? So, if you have one case, and then two cases the next day, and then four and then eight, it doesn’t take that long until you get to 100,000 cases, and then the next day 200,000 cases. Those initial days matters so much, because that’s when you can mitigate. That’s when you can stop the virus in its tracks. Once it’s escaped, once it’s spreading to thousands of — tens of thousands of people, then you really don’t have that many tools to stop the spread, except for completely drastic reactions, like telling everyone to stay inside.

MARTIN: Let me ask you a hard question, though. Is this a question of sort of the political leadership in Seattle and in Washington state kind of got their act together sooner, were more willing to listen to the scientific authorities, or are just the circumstances of life so different? I mean, the fact that Seattle is a lot less dense, it’s a lot less diverse, Washington state is a lot less dense, it’s a lot less diverse, there’s a lot less international travel, I mean, so — I mean, I’m asking you a hard question, but was this a leadership issue, or is this a facts-on-the-ground issue, in your — based on your reporting?

DUHIGG: At the end of the day, it’s almost impossible to answer that precisely. But let me say this. You’re exactly right that New York has some conditions that Seattle doesn’t that would have made the spread easier here, but mainly population density and the fact that we use public transit so much. But, in addition to that, leadership does matter. In Seattle, you had this situation where all of the political leaders were generally aligned. And in addition, these graduates of the Epidemic Intelligence Service, they were in powerful positions. It’s a network. They had been working with each other for years. And so when they needed to respond, and they went to the governor, and they went to the mayor and county executive, they could speak with one voice, and those politicians were primed to listen. In New York, although conditions were different, and, obviously, there’s a chance of luck, an element of luck in every pandemic, in New York, we had the opportunity to respond quickly, but, instead, what we had was a situation where Bill de Blasio, the mayor of New York, was, frankly, fighting with his own health department. He was not listening to the advice. There was a history of bad relationships there. And, more importantly, there was an ongoing feud between Mayor de Blasio and Governor Andrew Cuomo, the governor of the state of New York. And that fight, that feud has meant that communications have been muddied. They have fought in public about who has the right to close down the schools, what kind of advice should be given out. It’s impossible to say, if we could rewind the clock, that just changing the leadership would have changed the outcome of the — and the course of this pandemic, but, certainly, in New York, the fact that we are now the epicenter, that we are the epicenter of the entire world and have tens of thousands of deaths, some of that must be laid at the feet of our political leadership and the fact that, frankly, they weren’t ready for this, and they weren’t listening to the people who were ready and trained about how to communicate during a pandemic.

MARTIN: Were you able going to ask each of them why they didn’t listen, or why they didn’t follow the same playbook, at which — you point out is on the Internet? You can read it for yourself, which was news to me. Were you able to ask either of them why they didn’t follow that playbook?

(CROSSTALK)

DUHIGG: Governor Cuomo and Bill — and Mayor Bill de Blasio both declined to speak with me. They did not want to. And, look, we’re in the middle of an emergency, right? And they have a lot of stuff going on. And I will say that, in the last few weeks, once it became clear exactly what was happening, both of them did move very actively to start putting in social distancing measures. But they also continued fighting with each other. Even just as recently as last week, they were battling in the press over who has the right to decide — to determine when the schools will reopen.

MARTIN: I can’t help but notice that Governor Cuomo, as we are speaking, very recently has expressed some regret about the way he has handled his role here. He says that he wished that he had sounded the bugle earlier, meaning, I think, raised the alarms about the seriousness of this earlier. What do you make of that?

DUHIGG: I think it’s great that he is now recognizing, that Andrew Cuomo is now recognizing that the cautions should have been made earlier, that they didn’t respond fast enough. I obviously don’t know what the governor knew, but I do know what people around him and what epidemiologists were saying at the time. Now, perhaps those people weren’t shouting loudly enough at Andrew Cuomo. Perhaps he wasn’t — they weren’t in the room with him. But it’s unequivocal that, in retrospect, we are going to look back and we are going to say, Andrew Cuomo and Bill de Blasio in New York state, that they didn’t act fast enough, that the warnings were out there, that everyone should have known, as soon as Seattle started having massive numbers of deaths and massive numbers of cases, that we had to respond immediately, and assume that coronavirus was moving through our communities.

MARTIN: You talked about the importance of being consistent. In fact, you used an interesting phrase in your piece about the need for officials to ostentatiously model the behavior that they need people to see. And yet we see that President Trump is refusing to wear a mask. He exactly said at a briefing, I’m not going to. Often at the White House briefings, very rarely is anyone wearing a mask. I may have seen one, say, public service announcement by the surgeon general where the people around him were wearing a mask. But I haven’t — as a consistent factor, I haven’t seen anybody, including the doctors, wearing masks. I mean, what should we draw from this?

DUHIGG: It’s a terrible trend. And it’s — it’s going to kill people. In the 1950s, when the polio vaccine was discovered, there was a huge outcry of people saying that they didn’t want to get it, that they actually — they actually thought that it was going to give people polio, that it was all a hoax. And so the commissioner, the New York commissioner of health, who was actually this woman who was married to the founder of the Epidemic Intelligence Service, she put on a series of public events where people could get shots in public. She would take cameras into schools so that you could see kids getting the shots. She asked Elvis to come and get his shot in front of reporters and in front of TV cameras. And the reason why is because she knew you have to ostentatiously demonstrate this stuff, right? During the H1N1 outbreak, you saw public health officials who at were no risk of being infected — they were inside an office building where nothing was ever going to get — they would wash their hands in public, they would wear masks. When President Trump announces that the guidance has changed, and that the CDC is asking us to wear masks in public now at this point, for good reason, with scientific basis, and then he says, you can do it if you want, I’m not going to do it, I’m not going to wear a mask, at best, it’s just confusing. And this is a terrible time to have anything confusing going on, because, when people get confused, they don’t make good choices.

MARTIN: I can imagine that people would be reading this and would be very angry to discover that this is a well-established, as you pointed out, half-a-century’s worth of knowledge about how to handle an epidemic, and that previous leaders have followed it, and other jurisdictions have followed it, with important results, and they didn’t. Do you have a sense of — do you have an opinion about what should happen as a consequence of this?

DUHIGG: Absolutely. I mean, in the near term, what we ought to do is, we should listen to that same advice about reopening the economy and reopening societies. There’s very clear criteria about when we ought to reopen. We need to have 14 days in a city or a given area of declining case counts of COVID-19 before we reopen that area, because, without that, we know that the virus is expanding, rather than contracting. And when we do reopen, we should reopen gradually. And at the first sign the virus is beginning to tick up, we should reclose, right? It’s a process, a series of waves of reopening and then closing down again. We know that from 1918. More people died in San Francisco in 1918 in the fall, during the second wave of the influence epidemic, than the first. And the reason why more people died is because they got tired of wearing their masks. So, when the city said, you can take your masks off, and then a couple months later said, put your masks back on, people didn’t put them back on. And so thousands more people died. So that’s — in the near term, that’s what we ought to do, is, we should just listen to the advice that is out there. We know how to do this. But then the second thing that we should do is, we should really think about what this means when we’re in the ballot box, right? If anything of the last eight years has shown, leadership matters. Who you shoes matters a lot in what happens. If you have good leaders, you can escape situations like this. If you have leaders who don’t listen to experts, who are not on message, who give in to petty disputes, who give in to their own instincts, rather than listening to the better advice of others, you can see the consequences in our graveyards and in our economy.

MARTIN: Charles Duhigg, thank you so much for joining us.

DUHIGG: Thanks for having me.