THENEWYORKER,M AY4, 2020 17
Washington State. “I can’t remember
why we picked those two patients,”
Riedo told me. “I was sure they’d be
negative. But we thought it would be
good to start collecting data, and it was
a way to make sure the testing lab was
working.” The health official told him
to send the samples to her lab.
Riedo remembered that other local
researchers had been conducting a proj-
ect called the Seattle Flu Study. For
months, they had collected nasal swabs
from volunteers, to better understand
how influenza spread through the com-
munity. During the previous few weeks,
the researchers, in quiet violation of
C.D.C. guidance, had jury-rigged a
coronavirus test in their lab and had
started using it on their samples. They
had just found a positive hit: a high-
school student in a suburb twenty-eight
miles from Seattle, with no recent his-
tory of foreign travel and no known in-
teractions with anyone from China. The
boy wasn’t seriously ill; if the research-
ers hadn’t done the test, the infection
probably never would have been de-
tected. The genetic sequence of the boy’s
virus was unnervingly similar to that of
the man with the first known case, even
though the researchers couldn’t find any
connections between them. The fright-
ening implication was that the corona-
virus was already so widespread that
contagion was passing invisibly among
community members.
At seven-forty that evening, Riedo
got a call from his friend at the public-
health lab. Both of the samples he had
sent were positive. Riedo sent over swabs
from nine other EvergreenHealth pa-
tients. Eight were positive. Riedo grabbed
the patients’ charts and saw that seven
of them had come from the Life Care
nursing home. It didn’t make any sense:
nursing-home residents don’t travel,
and interact mainly with just family
members and staff.
Riedo sent in more samples. Most
of the patients tested positive, includ-
ing a woman who had been told that
she had pneumonia, another woman
who had complained of sweating and
clammy hands, and a man in his fifties
with serious respiratory problems. For
three days, dozens of that man’s family
members had sat at his bedside in the
hospital, coming in and out of the build-
ing and going from home to work, vis-
iting restaurants and shaking people’s
hands, inadvertently exposing them-
selves and others to COVID-19.
At that moment, there were no known
U.S. coronavirus fatalities. Schools, res-
taurants, and workplaces were open.
Stock markets were near all-time highs.
But when Riedo stopped to calculate
how many of his hospital employees had
been exposed to the coronavirus he had
to quit when his list surpassed two hun-
dred people. “If we sent all of those work-
ers home for two weeks, which is what
the C.D.C. was recommending, we’d
have to shut down the entire hospital,”
he told me. He felt like a man who, hav-
ing casually swatted at a buzzing insect,
suddenly realized that he was beneath
a beehive.
The next day, the man with all the
family visitors died. It was America’s
first known COVID-19 death. Riedo called
his wife. “I told her I didn’t know when
I would be coming home,” he said to
me. “And then I started e-mailing ev-
eryone I knew to say we were past con-
tainment. It had already escaped.”E
pidemiology is a science of pos-
sibilities and persuasion, not of
certainties or hard proof. “Being ap-
proximately right most of the time is
better than being precisely right occa-
sionally,” the Scottish epidemiologist
John Cowden wrote, in 2010. “You can
only be sure when to act in retrospect.”
Epidemiologists must persuade people
to upend their lives—to forgo travel and
socializing, to submit themselves to
blood draws and immunization shots—
even when there’s scant evidence that
they’re directly at risk.
Epidemiologists also must learn how
to maintain their persuasiveness even as
their advice shifts. The recommenda-
tions that public-health professionals
make at the beginning of an emer-
gency—there’s no need to wear masks;
children can’t become seriously ill—often
change as hypotheses are disproved, new
experiments occur, and a virus mutates.
The C.D.C.’s Field Epidemiology Man-
ual, which devotes an entire chapter to
communication during a health emer-
gency, indicates that there should be a
lead spokesperson whom the public gets
to know—familiarity breeds trust. The
spokesperson should have a “Single
Overriding Health Communication Ob-jective, or SOHCO (pronounced sock-O),”
which should be repeated at the begin-
ning and the end of any communica-
tion with the public. After the opening
SOHCO, the spokesperson should “ac-
knowledge concerns and express under-
standing of how those affected by the
illnesses or injuries are probably feeling.”
Such a gesture of empathy establishes
common ground with scared and dubi-
ous citizens—who, because of their mis-
trust, can be at the highest risk for trans-
mission. The spokesperson should make
special efforts to explain both what is
known and what is unknown. Transpar-
ency is essential, the field manual says,
and officials must “not over-reassure or
overpromise.”
The lead spokesperson should be a
scientist. Dr. Richard Besser, a former
acting C.D.C. director and an E.I.S.
alumnus, explained to me, “If you have
a politician on the stage, there’s a very
real risk that half the nation is going to
do the opposite of what they say.” During
the H1N1 outbreak of 2009—which
caused some twelve thousand Ameri-
can deaths, infections in every state, and
seven hundred school closings—Besser
and his successor at the C.D.C., Dr. Tom
Frieden, gave more than a hundred press
briefings. President Barack Obama spoke
publicly about the outbreak only a few
times, and generally limited himself to
telling people to heed scientific experts
and promising not to let politics distort
the government’s response. “The Bush
Administration did a good job of creat-
ing the infrastructure so that we can re-
spond,” Obama said at the start of the
pandemic, and then echoed the SOHCO
by urging families, “Wash your hands
when you shake hands. Cover your
mouth when you cough. I know it sounds
trivial, but it makes a huge difference.”
At no time did Obama recommend par-
ticular medical treatments, nor did he
forecast specifics about when the pan-
demic would end.
Whereas the C.D.C. protocol en-
courages politicians to practice restraint,
it invites the lead scientific spokesper-
son to demonstrate his or her advice os-
tentatiously, and to be a living example
of the importance of, say, wearing a mask
or getting a shot. When polio inocula-
tions began, in the nineteen-fifties, many
people worried that they were unsafe,
so New York City’s commissioner of