INSIDER TODAY: What happens if we reopen too early? Let’s look at 1918.

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Women working for the Red Cross make masks during the pandemic flu in 1918. Bettmann Archive/Getty Images

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-Henry Blodget ([email protected]) and David Plotz ([email protected])

SUMMARY:
What happens if we reopen too early? We might have to close down again and stay under lockdown for twice as long. How coronavirus spreads in restaurants. More bad news for Trump’s miracle drug. The Senate finds no evidence that the Russia investigation was a deep-state conspiracy. When it comes to disaster response, the more things change, the more politics stays the same.

What happens if we reopen too early? Let’s look at 1918…

As debates rage about whether we should prioritise health or the economy – and about when and how to reopen – we should keep this in mind.

Studies of the “Great Influenza” of 1918 concluded that cities that adopted “non-pharmaceutical intervention” measures earlier and kept them in place for longer did better, both health-wise and economically. Specifically, they had fewer deaths and their economies recovered faster.

In other words, in 1918 it wasn’t health or the economy. It was health and the economy.

Different cities approached the 1918 epidemic differently, as a 2007 study from Howard Markel, Harvey Lipman, and J. Alexander Navarro shows. The varying experiences include a warning about what could happen if we reopen too early.

St. Louis, Denver, and San Francisco, for example, adopted “distancing” measures early, which helped mitigate the initial epidemic wave. All three cities, however, then relaxed their measures early … and then saw second waves. In St. Louis and Denver, these second waves were worse than the first. As the second waves took hold, the cities reimplemented distancing measures, but it was too late.

St. Louis flu deaths 1918
Deaths attributed to the flu epidemic in St. Louis in 1918-19. Markel, Lipman, and Navarro, 2007.

Denver flu deaths 1918
Deaths attributed to the flu in Denver in 1918-19. Markel, Lipman, and Navarro, 2007.

The same thing happened in San Francisco, as Insider’s Katie Canales shows in a vivid photo essay.

In 1918 – just as in 2020 – San Francisco was one of the first cities to shut down, and it got the epidemic under control. However, five weeks later, with cases declining, the city declared victory too early and reopened too fast. (Literally. As Katie reports, “a whistle blew and people poured out into the streets in celebration, tossing their masks in the process.”)

A few weeks later, cases started climbing again. San Francisco tried to shut down again, but many frustrated citizens resisted the orders. The second wave continued for months, as this chart from National Geographic shows.

Meanwhile, other cities took a different approach, keeping their initial restrictions in place for longer. New York City issued basic isolation and quarantine rules earlier than other cities and then kept them in place until its death rate returned to a very low rate. The city saw only one major wave of infections, and its total death rate was at the lower end of the US range.

Importantly, despite having its initial rules in place for longer, New York’s restrictions were only in place for about half the total time as those in St. Louis and Denver. The rush to reopen in those cities, in other words, led to second shutdowns that lasted about as long as the first.

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Another lesson from the 1918 experience is that restrictions are not “all or nothing.” There are different measures and approaches, of varying degrees of severity. So as some states begin to roll back some restrictions, we should probably stop acting as though the decision is binary. -HB

How coronavirus spread in a restaurant

While we’re thinking about when and how to reopen, here’s a fascinating study of how coronavirus spread in a restaurant. It holds both good and bad news for restaurant reopenings.

As Insider’s Bill Bostock reports, a letter from researchers in China that was published by the CDC traced an infection that spread one afternoon in late January among three families sitting near each other in a large restaurant in Guangzhou.

During this meal, a woman who had just arrived from Wuhan and was still asymptomatic apparently spread the virus to nine other diners nearby. The woman developed symptoms later that day. The others did within the next week to 10 days.

An annotated diagram showing the location of the AC in the restaurant in Guangzhou, China.
The location of the AC in the restaurant in Guangzhou, China. CDC EID Journal

It’s frightening – and it’s bad news for restaurants – to realise that one asymptomatic person can spread the virus to nine other people eating nearby. But the study also contained additional insights. Everyone who got infected in the restaurant was in the same airflow of an air-conditioner. Other diners nearby, despite being just as close to the infected person, did not get sick. The professor and journalist Zeynep Tufekci theorizes that this supports the idea that the coronavirus spreads via “micro-droplets” but does not fully “aerosolize.”

Regardless, this study should sober up anyone hoping to eat out or open their restaurant anytime soon. Yes, wearing masks would probably help. But it’s hard to eat while wearing a mask.-HB

Hydroxychloroquine isn’t a miracle drug. Here’s what that mistaken hope cost us.

Hope, like toilet paper, is in short supply these days. So it’s not surprising that we cling to any seeming bit of good news. But there’s a cost to misplaced hope, and we’re seeing it with the deflated enthusiasm for the drug hydroxychloroquine.

Remember hydroxychloroquine? Just two weeks ago, President Donald Trump and a choir of others were touting it as a “game changer” for COVID-19, pointing to claims by a French doctor – let’s be blunt, an eccentric, Trumpish French doctor – that he had cured 100% of his COVID patients with it.

Fox News went gaga over this apparent wonder drug. So did Dr. Oz. And doctors began prescribing it. The FDA gave emergency approval to use it on American COVID-19 patients. And tests of it alone, and in conjunction with the antibiotic azithromycin, were started.

Alas, so far, no good news.

On Tuesday, the National Institutes for Health recommended against using hydroxychloroquine in COVID-19 patients outside clinical trials, citing a heart risk. The same day, a retrospective study of 368 veterans found higher death rates in patients treated with hydroxychloroquine and no reduction in the risk of ending up on a ventilator. This followed a French study also showing no benefit to using the drug for COVID-19. And Trump, Dr. Oz, and Fox have all finally stopped hyping it.

It’s still possible that hydroxychloroquine might help against COVID-19. There haven’t been any randomised controlled trials disproving its effectiveness. But there also hasn’t been any clear evidence that it works.

So what’s the harm in all the hype about it? As Trump said, “What do you have to lose?”

Well, several things.

The optimism fanned by Fox News and Trump had costs. It caused a shortage of the drug for the lupus and arthritis patients who need it. Hydroxychloroquine overdoses doubled over the same period last year. An Arizona man died when he self-medicated by taking a related chemical used to clean fish tanks.

The hydroxychloroquine hype also distorted medical care around the country for a few critical weeks. The president threw the weight of the federal government – and an FDA emergency action – into a drug that may not help at all, much less be a miracle.

It’s not that we shouldn’t be testing hydroxychloroquine – of course we should! – but the presidential and media hype caused an over-investment of time and mental energy, and took effort and intellect away from testing other therapies.

The hydroxychloroquine-hype machine also spent down one of most precious commodities we have: public trust. Every miracle cure that raises – then dashes – hope increases scepticism, and makes it less likely that Americans will trust the doctors and public health authorities later, when we’re asked to get a vaccine or take a prophylactic medicine.

The latest casualty of the president’s brief hydroxychloroquine obsession appears to be Dr. Rick Bright, the director of the Biomedical Advanced Research and Development Authority, who says he was ousted after resisting pressure to hype and fund it. The administration disputes this characterization. -DP

While we’re paying attention to the pandemic …

The Republican-led Senate Intelligence Community released a unanimous report concluding that the intelligence community’s investigation into Russia’s interference in the 2016 election was analytically sound, justified by the evidence, and conducted professionally.

“The committee found no reason to dispute the intelligence community’s conclusions,” chair Sen. Richard Burr, a Republican from North Carolina, said.

During the Mueller investigation and impeachment, Trump said the investigations were corrupted by “deep state” interference, malevolent manipulation by President Barack Obama, and overreliance on the Steele dossier. The Senate committee found none of that. -DP

The more things change, the more politics stays the same

“Even now, nearly two months after disaster first struck, the federal response remains inadequate and disorganized. Americans are rightly angry about this failure of government.”

Marking the 10th anniversary of the Deepwater Horizon oil well disaster in the Gulf of Mexico, John Dickerson of “60 Minutes” excavated some of the Republican (and Democratic) responses to the Obama administration’s handling of it. They sound surprisingly familiar.

What did now-Vice President Mike Pence say back then, for example?

“The American people want answers … The American people know this was a slow response.”

Indeed. -DP

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