16 THENEWYORKER,M AY4, 2020
Seattle’s approach to COVID-19 mirrored E.I.S.’s guidelines. New York’s did not.
ANNALS OFEPIDEMIOLOGY
THE PANDEMIC PROTOCOL
The Epidemic Intelligence Service knows what to tell the public in an outbreak.BY CHARLES DUHIGG
ILLUSTRATION BY JAVIER JAÉN
T
he first diagnosis of the corona
virus in the United States occurred
in midJanuary, in a Seattle suburb not
far from the hospital where Dr. Fran
cis Riedo, an infectiousdisease spe
cialist, works. When he heard the pa
tient’s details—a thirtyfiveyearold
man had walked into an urgentcare
clinic with a cough and a slight fever,
and told doctors that he’d just returned
from Wuhan, China—Riedo said to
himself, “It’s begun.”
For more than a week, Riedo had
been emailing with a group of col
leagues who included Seattle’s top
doctor for public health and Washing
ton State’s senior health officer, as well
as hundreds of epidemiologists from
around the country; many of them, like
Riedo, had trained at the Centers for
Disease Control and Prevention, in At
lanta, in a program known as the Epi
demic Intelligence Service. Alumni of
the E.I.S. are considered America’s shock
troops in combatting disease outbreaks.
The program has more than three thou
sand graduates, and many now work in
state and local governments across the
country. “It’s kind of like a secret soci
ety, but for saving people,” Riedo told
me. “If you have a question, or need
to understand the local politics some
where, or need a hand during an out
break—if you reach out to the E.I.S.network, they’ll drop everything to help.”
Riedo is the medical director for in
fectious disease at EvergreenHealth, a
hospital in Kirkland, just east of Seat
tle. Upon learning of the first domestic
diagnosis, he told his staff—from emer
gencyroom nurses to receptionists—
that, from then on, everything they said
was just as important as what they did.
One of the E.I.S.’s core principles is that
a pandemic is a communications emer
gency as much as a medical crisis. Mem
bers of the public entering the hospital,
Riedo told his staff, must be asked if
they had travelled out of the country; if
someone had respiratory trouble, staff
needed to collect as much information
as possible about the patient’s recent in
teractions with other people, including
where they had taken place. You never
know, Riedo explained, which chance
encounter will shape a catastrophe. There
are so many terrifying possibilities in a
pandemic; information brings relief.
A national shortage of diagnostic kits
for the new coronavirus meant that only
people who had recently visited China
were eligible for testing. Even as Ever
greenHealth’s beds began filling with
cases of flulike symptoms—including a
patient from Life Care, a nursing home
two miles away—the hospital’s doctors
were unable to test them for the new
disease, because none of the sufferers
had been to China or been in contact
with anyone who had. For nearly a
month, as the hospital’s patients com
plained of aches, fevers, and breathing
problems—and exhibited symptoms as
sociated with COVID19, such as “glassy”
patches in Xrays of their lungs—none
of them were evaluated for the disease.
Riedo wanted to start warning people
that evidence of an outbreak was grow
ing, but he had only suspicions, not facts.
At the end of February, the C.D.C.
began allowing the testing of patients
with unexplained respiratorytract in
fections or “fever and/or symptoms of
acute respiratory illness.” Riedo called
a friend—an E.I.S. alum at the local de
partment of health. If he sent her swabs
from two patients who had needed
ventilators but had tested negative for
influenza and other common respira
tory diseases, would she test them for
COVID19? At that point, there had been
only sixteen detections of the corona
virus in the U.S., and only the one in PHOTOGRAPHS (FROM TOP TO BOTTOM): RANTA IMAGES / GETTY; GETTY