Kyle Phillips/AP Photo
Fans sit in an empty section after the announcement that an NBA basketball game between the Oklahoma City Thunder and Utah Jazz had been postponed, March 11, 2020.
In late September during the 1918 influenza epidemic, Philadelphia held a parade to help raise money for World War I, in spite of warnings that the event should be canceled. One week later, about 4,500 people had died. Municipal officials rushed to close public spaces like schools and churches in early October, but it was already too late. About 12,000 people ultimately succumbed to the disease in the city, the pandemic’s largest death toll in the United States.
One hundred years later, Philadelphia faced an eerily similar choice: Should the city cancel its St. Patrick’s Day parade to stem the spread of COVID-19? “We are absolutely on; If you are a nervous nelly, please do not go to mass, send your kids to school, go to the grocery store or continue living,” one of the Philadelphia parade organizers boasted on Facebook before intense public pressure forced a cancellation of the event.
After much dithering, New York and Chicago finally postponed their St. Patrick’s Day parades. Yet Philadelphia’s experience with the 1918 epidemic figured in Boston officials’ decision days earlier to cancel the city’s St. Patrick’s Day parade, a bacchanalic street festival featuring barhopping and house parties. Mayor Marty Walsh, who is also considering canceling the Boston Marathon in April, pointed out to detractors who complained about lost business that the city just followed the lead of the Irish government, which had cancelled an entire country’s worth of parades.
There is much more to lose than civic pride as the pandemic takes hold in the United States. As public-health officials struggle to scale up testing and scientists toil away on developing effective treatments and vaccines, preventing large numbers of people from congregating in tight spaces indoors and out may end up being the difference between mitigating the outbreak and the collapse of the health care system.
Dr. Dena Grayson, a Florida-based pandemic expert, explained the goal of social distancing. “If you get a bunch of people infected at once, hospitals will get overwhelmed,” she says. “You can’t treat everybody since you don’t have enough [intensive care units] and then people die.” Yet with prohibitions being deployed haphazardly, with some communities implementing bans on large public assemblies and others going about business as usual, a host of life or death decisions await governors, municipal leaders, and public-health officials working to stem the spread of the coronavirus. There have been 29 deaths and 938 confirmed cases in the U.S. as of Wednesday, March 11.
Why the urgency? Consider that in Massachusetts, 70 of 92 coronavirus cases (1 confirmed and 91 presumptive cases as of midweek) have been traced back to a February 26 international conference of about 175 senior managers in Boston held by Biogen, a Cambridge-based multinational biotech firm. That development contributed to Republican Governor Charlie Baker’s decision to declare a state of emergency on Tuesday. A small number of people who attended the American Israel Public Affairs Committee conference (18,000 attendees) have tested positive for the virus, and several people who attended the Conservative Political Action Conference annual conference (more than 10,000 attendees) tested positive. Both multi-day events were held in Washington in late February. Those numbers will likely increase.
“We need to learn more about the Biogen meeting,” says, Marc Lipsitch, director of the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health. In a Wednesday phone conference call with members of the news media, Lipsitch noted, “Close contact clearly spreads infection; that indicates that the is a real danger of accelerating the epidemic if you have large numbers of people together.”
Governors, mayors, municipal leaders, and public-health officials have been at the vanguard of the COVID-19 response efforts.
Meanwhile, some public school districts and universities have switched to online classes. Scores of conferences and non-essential business trips have been cancelled. The March 15 Democratic presidential debate in Phoenix between Joe Biden and Bernie Sanders will take place without an audience.
In Washington state, one of the epicenters, King County which includes Seattle (where there are 267 confirmed cases and 24 deaths as of March 11), along with Snohomish and Pierce counties, have banned gatherings of 250 people or more through the end of March, including concerts, conventions, fundraisers, sporting events, and weddings. Washington’s Democratic Governor Jay Inslee announced the measures Wednesday and said that the ban’s duration and the number of counties could be expanded or reduced depending on the outbreak’s progression. The city and county of San Francisco faces a two-week ban on events and gatherings of 1,000 or more people and the nation’s capital has declared a state of emergency and taken similar steps.
Yet contradictions abound. In Texas, municipal officials have shut down the remaining days of the Houston Livestock Stock Show and Rodeo. Austin’s rodeo was still scheduled, even as South by Southwest, the region’s signature event, had been postponed days earlier. Yet by Thursday evening the rodeo had also been cancelled. And on the East Coast, New Rochelle has implemented a ban on mass gatherings in a containment zone, while just 25 miles away in New York City transit officials are telling commuters: If you don’t have to ride the subway, don’t.
The NBA initially allowed some teams to play without fans in attendance (Golden State Warriors) and others to allow fans in the area (Washington Wizards), but that strategy was quickly abandoned. After Utah Jazz All-Star center Rudy Gobert tested positive for the virus and six teams were ordered to self-quarantine, the NBA suspended the remainder of its season. That may not bode well for the NCAA, which had decided to split the difference for its upcoming “March Madness” tournaments for men’s and women’s basketball, allowing only “essential staff and limited family attendance.” Major League Baseball has so far come up with the strange idea of shuttling teams around the country in order to play before fans instead of empty seats. But by Thursday afternoon, the NCAA cancelled the tournaments and the MLB shut down spring training games and delayed the start of the season by at least two weeks.
U.S. Naval History and Heritage Command via AP
An October 1918 sign from Philadelphia
Private sector companies are proving some of the toughest nuts to crack on responsiveness to public-health recommendations. At the beginning of March, state and local officials in Washington state tried for almost a week to cajole the organizers of the Emerald City Comic Con to call off an event that attracted 98,000 people last year. The organizer, ReedPOP, and Emerald City Comic Con officials asserted that they were following EPA’s Emerging Pathogen Policy and promised enhanced cleaning and sanitation measures. Vendors like DC Comics and Penguin Random House attendees were not persuaded, and pulled out of the event before Mayor Jenny Durkan cancelled it.
Where Seattle had multiple cases prompting more drastic actions, Austin did not have any cases as of March 6 when Mayor Steve Adler cancelled the South by Southwest music and film festival. Adler told City Lab, SXSW “was ultimately canceled because it was a big event with multiple contained and closed venues, with large numbers of people coming from cities with person-to-person spread of the virus.”
Private event organizers have a lot of leeway to make up their own rules. “When parades are involved you can always pull the permit if organizers won’t cooperate,” says Eric McNulty, associate director of the National Preparedness Leadership Initiative, a joint program of the Harvard T.H. Chan School of Public Health and Harvard’s Kennedy School of Government. “If you are a private entity holding a conference or convention in a convention center, it’s much tougher for government to intervene; they can recommend and they can call people into the office and have an intense discussion with them, but it’s limited.”
Of course, one of the key reasons that event organizers resist cancellations is the economic jolt of losing hundreds of millions of dollars. In 2019, the Houston Livestock Show and Rodeo generated nearly $400 million for the local economy; SXSW produced about $360 million for the Austin region. Temporary and low-wage workers like cashiers, cooks, ticket takers, and security guards (who probably were recruited for the Houston event during a February job fair seeking to fill 1,000 positions) will see much-needed income evaporate.
Yet there is another dire threat for states like Texas, where nearly 18 percent of residents lack health insurance, the highest percentage of uninsured residents in the country. Some people who worked poorly paid service jobs at the Houston event may have been put at risk at for contacting COVID-19. If they become ill, these workers, who likely don’t have health insurance or sick time, will probably continue to work at other jobs (thereby putting others at risk); fail to seek medical attention or testing; or resort to more expensive emergency room care, potentially undermining the state’s entire health care infrastructure. Other states with high rates of uninsurance like Georgia, Florida, and Mississippi will face similar challenges.
Governors, mayors, municipal leaders, and public-health officials have been at the vanguard of the COVID-19 response efforts. “In general, our disaster response system is built bottom up,” says Harvard’s McNulty. “A lot of the science and the guidance comes from the Centers for Disease Control and Prevention, [but] a lot of the decisions get made at the state and local level.”
Natural disasters are covered by the Stafford Act, which proscribes a specific set of procedures to speed emergency funding to state and territorial officials once the president declares an emergency. But public-health emergencies are not covered by a similar set of regulations—which means that state officials are still unclear about when they will start receiving their allocation of the $8 billion dollar package of assistance that President Trump signed last week.
It’s already a truism to say that the administration’s response to the pandemic has been disastrous. Trump’s announcement Wednesday night of a 30-day travel ban from the European Union to the U.S. during a nationally televised address (strewn with numerous errors) came as a shock to airlines and American allies who had not been consulted prior to the speech. (The ban also does not apply to the U.K. and Ireland, countries where Trump hotel and golf properties are located.)
Instead of leading a robust federal response prioritizing containment measures like aggressive testing or tracing the people that infected individuals have interacted with, and setting up a quarantine regime, Trump has led Americans straight into an abyss of a pandemic. To compound his poor leadership skills, lies and distortions, and modeling of inappropriate behaviors like handshaking and scheduling campaign rallies, the president has held classified discussions about coronavirus response efforts, limiting access to information for officials without appropriate security clearances.
In a growing catalog of debacles the one of the biggest failures was the absence of any semblance of a testing regime when people were returning from sites of outbreaks in China and Italy. It still remains unclear whether doctors’ orders for patient testing will be fulfilled or even if there sufficient numbers of testing kits available.
“The most important thing in a well-run federal response is the interagency coordination; you have really good people at the CDC and Health and Human Services,” says McNulty. The president’s decision to eliminate the National Security Council’s pandemic advisory group has only served to complicate that coordination.
China recently saw a dramatic reduction in its COVID-19 cases only after it implemented an extreme social distancing regime. In Italy, officials initially adopted a more relaxed regime of controls, which people proceeded to ignore, prompting a second round of closures that have amounted to a countrywide lockdown through April 3. Stores, restaurants, cafes, schools, universities, gyms, theaters, museums, and tourist attractions have been shuttered. Travel has been restricted, with telecommuting instituted for workers who have that option; others can take time off or engage in very limited activities. Banks, post offices, groceries, and pharmacies remain open.
The extreme measures that China implemented, tied intimately to the country’s heavy surveillance and authoritarian rule, could not be attempted in the U.S. However, state and local officials may be ultimately be forced to adopt some or all of the steps that Italy has recently imposed. “We are supposed to be best bio-medical powerhouse in world and yet we are unable to do [testing] that almost every other country is doing on orders of magnitude bigger scale which essentially any graduate student could do,” says Harvard’s Lipsitch. “The fact that we have the kind of pandemic that people have been preparing for years sweep through the world and do so much damage as it seems to be doing in Italy, South Korea, and China—and really not have a good solution—is a sad commentary on the state of preparedness.”
This post has been updated to reflect event cancellations.
