18 THENEWYORKER,M AY4, 2020
This advice struck Constantine as pos-
sibly crazy. There were only two dozen
COVID-19 diagnoses in the entire na-
tion. Life looked normal. How could
people be persuaded to stop going to
bars, much less to work, just because a
handful of old people were sick?
Constantine told me, “Jeff recognized
what he was asking for was impracti-
cal. He said if we advised social distanc-
ing right away there would be zero ac-
ceptance. And so the question was: What
can we say today so that people will be
ready to hear what we need to say to-
morrow?” In e-mails and phone calls,
the men began playing a game: What
was the most extreme advice they could
give that people wouldn’t scoff at? Con-
sidering what would likely be happen-
ing four days from then, what would
they regret not having said?
Even for public-health profession-
als, the trade-offs were painful to con-
template. At a meeting of public-health
supervisors and E.I.S. officials in Seat-
tle, an analyst became emotional when
describing the likely consequences of
shutting Seattle’s schools. Thousands of
kids relied on schools for breakfast and
lunch, or received medicine like insulin
from school nurses. If schools closed,
some of those students would likely go
hungry; others might get sick, or even
die. Everyone also knew that, if the city
shut down, domestic-violence incidents
would rise. And what about the medi-
cal providers who would have to stop
working, because they had to stay home
with young kids? “It was overwhelm-
ing,” one E.I.S. official told me. “Every
single decision had a million ripples.”
Yet the burdens caused by closing
the schools could make an enormous
difference in curtailing the spread of the
virus: all kinds of parents would have to
stay home. In 2019, Seattle had closed
schools for five days after a series of
snowstorms. Afterward, the Seattle Flu
Study discovered that traffic in some
areas had nearly disappeared, public-
transit use had tumbled, and the trans-
mission of influenza had dropped.
Constantine thought that announc-
ing school closings was a potent com-
munication strategy for reaching even
people who weren’t parents, because it
forced the community to see the corona-
virus crisis in a different light. “We’re
accustomed to schools closing when
health—who happened to be married
to the E.I.S.’s founder—invited report-
ers to watch schoolchildren getting in-
jections. She also enlisted Elvis to pub-
licly get his shot.
E.I.S. personnel in the field have car-
ried boxes of masks and gloves to dis-
tribute to pilots, flight attendants, jour-
nalists, and health workers—supplies
that may not be needed by the recipi-
ents but emphasize how important uni-
versal compliance is. When Besser gave
briefings during the H1N1 pandemic,
he sometimes started by describing how
he had recently soaped up his fingers,
or pointedly waited until everyone was
away from the microphone before tak-
ing the stage. At the time, there was
almost no chance that Besser and his
colleagues were at immediate risk of
contracting H1N1. “To maintain trust,
you have to be as honest as possible, and
make damn sure that everyone walks
the walk,” Besser told me. “If we order
people to wear masks, then every C.D.C.
official must wear a mask in public. If
we order hand washing, then we let the
cameras see us washing our hands. We’re
trying to do something nearly impossi-
ble, which is get people to take an out-
break seriously when, for most Ameri-
cans, they don’t know anyone who’s sick
and, if the plan works, they’ll never meet
anyone who’s sick.”
Public-health officials say that Amer-
ican culture poses special challenges.
Our freedoms to assemble, to speak our
minds, to ignore good advice, and to
second-guess authority can facilitate the
spread of a virus. “We’re not China—we
can’t order people to stay inside,” Besser
said. “Democracy is a great thing, but it
means, for something like COVID-19, we
have to persuade people to coöperate if
we want to save their lives.”
O
n February 28th, around the time
that Riedo learned of the COVID-
cluster at the Life Care nursing home,
the news was also relayed to another
E.I.S. alum, Dr. Jeff Duchin, the top
public-health physician for Seattle and
surrounding King County. To Duchin,
the cluster suggested that there was al-
ready an area-wide outbreak. He told
Dow Constantine, the King County
Executive, that it was time to start con-
sidering restrictions on public gather-
ings and telling residents to stay home.
something really serious happens,” Con-
stantine told me. “It was a way to speed
up people’s perceptions—to send a mes-
sage they could understand.”
While the logistics of classroom
closures were being worked out, Con-
stantine contacted Brad Smith, the pres-
ident of Microsoft—which is headquar-
tered in Redmond, east of Seattle—and
asked him to consider ordering employ-
ees to work from home. “Microsoft is a
big deal here,” Constantine told me. “I
thought if they told everyone to stay
home it could shift how the state was
thinking—make the pandemic real.” Mi-
crosoft, as a tech company, was poised
to switch quickly to remote work, and
could demonstrate to other businesses
that the transition could occur smoothly.
On March 4th, with only twelve known
COVID-19 fatalities across the nation and
no diagnoses among Microsoft work-
ers, the company told employees to stay
home if they could. Smith told me, “King
County has a strong reputation for ex-
cellent public-health experts, and the
worst thing we could have done is sub-
stitute our judgment for the expertise of
people who have devoted their lives to
serving the public.” Amazon, which is
also headquartered in the area, told many
of its local employees to work from home
as well. “That’s a hundred thousand peo-
ple suddenly staying home,” one Seat-
tle resident told me. “From commute
traffic alone, you knew something big
had happened.”
On February 29th, Constantine held
a press conference. He had asked Riedo,
Duchin, and Kathy Lofy—another E.I.S.
alum and the state’s top health officer—
to play prominent roles. Duchin spoke
first, and it was as if he had prepared his
remarks with the Field Epidemiology
Manual in hand. “I want to just start by
expressing our deep and sincere condo-
lences to the family members and loved
ones of the person who died,” he said.
He explained what scientists knew and
did not know about the coronavirus, and
noted, “We’re in the beginning stages of
our investigation, and new details and
information will emerge over the next
days and weeks.” He predicted that “tele-
commuting” was likely to become man-
datory for many residents, and repeated
several times an easy-to-remember
SOHCO: “more hand washing, less face
touching.” Duchin told me that his words
