How the man who eradicated smallpox would have handled coronavirus

Whether we realize it or not, we have all been part of a grand experiment.  Never before have we had a national lockdown and mass quarantines of healthy people in response to a pandemic.  Not during the 1918 Spanish flu, the 1957 Asian flu, or the 1968/69 Hong Kong flu.  Even the concept of social distancing is a modern one.  We have implemented many of those things before to varying degrees, but never on a national scale.  The end result has had huge economic and social consequences.  

According to an article from the New York Times, it came about during the Bush Jr. administration.  Then-president George W. Bush wanted to ensure that the nation was better prepared for the next pandemic.  It was purposed in conjunction with the Defense Department that Americans should isolate themselves during the next outbreak.  Two government doctors, Richard Hatchett, an oncologist turned White House adviser, and Carter Mecher, a Department of Veterans Affairs physician, were tasked with setting up the National Strategy for Pandemic Influenza Writing and Implementation Team.

This is where it takes a strange turn.  A 2006 paper titled "Targeted Social Distancing Designs for Pandemic Influenza" was used in advocating for the lockdowns.  Its primary author was complex system analyst Robert J. Glass.  His 14-year-old daughter, Laura M. Glass, is also listed on the paper.  As it turns out, the paper was partly based on his daughter's high-school experiment.  Laura, with a little help from her dad, made a computer simulation of how people interact in social situations.  That's right: you can credit the lockdowns in part to a teen girl's science project.

This is where the renowned doctor and epidemiologist Donald Henderson comes in.  Dr. Henderson was involved in a 10-year international effort to eradicate smallpox throughout the world.  Smallpox is the first human disease ever to be eradicated.  Dr. Henderson passed away in 2016.  In 2006, he and three other professors from Johns Hopkins wrote a paper responding to the Glass paper.  As you might have guessed, they strongly disagreed with Robert Glass.  They believed that such extreme measures would have severe social and economic consequences.  The following mitigation measures are how Dr. Henderson believed that a pandemic or epidemic should be handled.

Dr. Henderson was a big proponent of vaccinations and believed that working on a vaccine for the virus was paramount.

Pre-planning and preparation are essential.  A Regional Health Care Operations Committee should be established to assure collaboration and cooperation across the community (hospitals, medical care providers, Red Cross, law enforcement, media, and others.)

Those who are sick should be isolated at their home or in the hospital, but everyone else should be encouraged to come to work so that essential services can be sustained.

It might be necessary for schools in many communities to be closed 10–14 days at the beginning of an epidemic.  However, longer periods in hopes of mitigating the epidemic among students would not be warranted.

Everyone should be encouraged to practice good hygiene.  That includes hand-washing and covering the mouth when coughing or sneezing.

Canceling or postponing meetings or events involving large numbers would be helpful in mitigating the effects of an epidemic.  However, canceling or postponing large gatherings would not likely have any significant effect.

There is no basis for recommending quarantines either of groups or of individuals.  Such measures would have possible adverse consequences, such as loss of public trust in government, and would stigmatize those quarantined.

Screening passengers at borders or closing air or rail hubs is not effective and not recommended.

Masks should be worn primarily by those who work in hospitals.  Studies have shown that surgical masks do little because the pores in the mask become blocked by moisture from breathing, and the airstream simply diverts around the mask.  There are few data available for N95 or surgical masks outside a health care setting, and N95 masks need to be fit-tested to be effective.

In short, Henderson's strategy was to tough it out.  Let the pandemic burn itself out, treat the sick, and work on developing a vaccine as quickly as possible.  Henderson believed that the best response to a pandemic is to let society function as normal.  Strong political and public health reassurance is also necessary to ensure that the needed medical care services are provided when needed.  If either is seen to be less than optimal, then a manageable epidemic could move toward catastrophe.

Whether we realize it or not, we have all been part of a grand experiment.  Never before have we had a national lockdown and mass quarantines of healthy people in response to a pandemic.  Not during the 1918 Spanish flu, the 1957 Asian flu, or the 1968/69 Hong Kong flu.  Even the concept of social distancing is a modern one.  We have implemented many of those things before to varying degrees, but never on a national scale.  The end result has had huge economic and social consequences.  

According to an article from the New York Times, it came about during the Bush Jr. administration.  Then-president George W. Bush wanted to ensure that the nation was better prepared for the next pandemic.  It was purposed in conjunction with the Defense Department that Americans should isolate themselves during the next outbreak.  Two government doctors, Richard Hatchett, an oncologist turned White House adviser, and Carter Mecher, a Department of Veterans Affairs physician, were tasked with setting up the National Strategy for Pandemic Influenza Writing and Implementation Team.

This is where it takes a strange turn.  A 2006 paper titled "Targeted Social Distancing Designs for Pandemic Influenza" was used in advocating for the lockdowns.  Its primary author was complex system analyst Robert J. Glass.  His 14-year-old daughter, Laura M. Glass, is also listed on the paper.  As it turns out, the paper was partly based on his daughter's high-school experiment.  Laura, with a little help from her dad, made a computer simulation of how people interact in social situations.  That's right: you can credit the lockdowns in part to a teen girl's science project.

This is where the renowned doctor and epidemiologist Donald Henderson comes in.  Dr. Henderson was involved in a 10-year international effort to eradicate smallpox throughout the world.  Smallpox is the first human disease ever to be eradicated.  Dr. Henderson passed away in 2016.  In 2006, he and three other professors from Johns Hopkins wrote a paper responding to the Glass paper.  As you might have guessed, they strongly disagreed with Robert Glass.  They believed that such extreme measures would have severe social and economic consequences.  The following mitigation measures are how Dr. Henderson believed that a pandemic or epidemic should be handled.

Dr. Henderson was a big proponent of vaccinations and believed that working on a vaccine for the virus was paramount.

Pre-planning and preparation are essential.  A Regional Health Care Operations Committee should be established to assure collaboration and cooperation across the community (hospitals, medical care providers, Red Cross, law enforcement, media, and others.)

Those who are sick should be isolated at their home or in the hospital, but everyone else should be encouraged to come to work so that essential services can be sustained.

It might be necessary for schools in many communities to be closed 10–14 days at the beginning of an epidemic.  However, longer periods in hopes of mitigating the epidemic among students would not be warranted.

Everyone should be encouraged to practice good hygiene.  That includes hand-washing and covering the mouth when coughing or sneezing.

Canceling or postponing meetings or events involving large numbers would be helpful in mitigating the effects of an epidemic.  However, canceling or postponing large gatherings would not likely have any significant effect.

There is no basis for recommending quarantines either of groups or of individuals.  Such measures would have possible adverse consequences, such as loss of public trust in government, and would stigmatize those quarantined.

Screening passengers at borders or closing air or rail hubs is not effective and not recommended.

Masks should be worn primarily by those who work in hospitals.  Studies have shown that surgical masks do little because the pores in the mask become blocked by moisture from breathing, and the airstream simply diverts around the mask.  There are few data available for N95 or surgical masks outside a health care setting, and N95 masks need to be fit-tested to be effective.

In short, Henderson's strategy was to tough it out.  Let the pandemic burn itself out, treat the sick, and work on developing a vaccine as quickly as possible.  Henderson believed that the best response to a pandemic is to let society function as normal.  Strong political and public health reassurance is also necessary to ensure that the needed medical care services are provided when needed.  If either is seen to be less than optimal, then a manageable epidemic could move toward catastrophe.