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<v ->Howard Markel, I hope
I'm pronouncing that right,</v>

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is the distinguished professor
of the history of medicine

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and director of the Center
for the History of Medicine

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at the University of Michigan
School of Public Health.

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Did I get that right?

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<v ->University of Michigan Medical School.</v>

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<v ->University of Michigan Medical School.</v>

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Thank you, you have a very long bio.

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<v ->Thank you very much, Isaac.</v>

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Good to see you.

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<v ->You were the lead author on a paper</v>

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about 13 years ago, more
than a dozen years ago,

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about the flu pandemic of
just over 100 years ago,

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1918-1919, which has
some interesting insights

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into things like social distancing
and flattening the curve,

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two phrases we've become
very familiar with.

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So before we talk about Coronavirus

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talk a little bit about that paper

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and what you learned from it.

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<v ->It was right after the
bird flu scare of 2005, 2006.</v>

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Great amount of
conversations were being held

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of what would we do if a
worse case scenario occurred,

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vis-a-vis bird flu.

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Well the worse case scenario on the books

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happens to be the influenza
pandemic of 1918, 1919.

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It is the largest database of this menu

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of social distancing, specifically
quarantine and isolation,

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school closure, and public gathering.

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<v ->So you write, among the 43 cities,</v>

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which you just referred to here,

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that we investigated, neither
the city's population size,

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density, sex distribution,
nor age distribution,

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accounted for the
differences in mortality.

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So then what were the differences?

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<v ->We could measure, week by week,</v>

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from September 1st to about April 1st,

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how many deaths and cases
there were in each city.

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And we simply saw, as I said,

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fewer deaths in those cities that did

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early layered and sustained NPIs,

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not pharmaceutical interventions.

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When the social distancing
measures were on

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flu deaths went down.

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When they were off they
went back up again.

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So it's actually very germane
to the current situation today

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where there's been talk
of releasing the triggers,

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releasing the social distancing measures

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in a week or so when Easter comes.

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<v ->Did people at the time have some sense</v>

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that they had done things
that flatten the curve,

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so to speak, was there
some sense of success?

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Or was the sort of way that the epidemic

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was popularly looked at in
the public consciousness,

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even right after, that this was
just an unmitigated disaster

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and there was no way to
do anything about it?

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<v ->This coincides with end of World War I.</v>

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There was a lot of can-do spirit,

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there was a lot of patriotism.

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And a lot of the public
health announcements

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and suggestions were
conflated with patriotism.

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So people who didn't wear face masks

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in San Francisco were called slackers.

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People who did not do their
part and went to bars,

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or went to the theater, or what have you,

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they were looked upon as
not helping the situation.

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Now, the thing about a
pandemic, then as now,

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when you're in the middle of it

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you're literally in the fog of war.

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You can't see all the results

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and you don't have all the data.

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But, the newspapers were filled with

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influenza material during the pandemic,

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just like our current newspapers today.

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So you had a crude measure of

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were the numbers going up
or were they going down.

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And I think people followed
that pretty closely.

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<v ->One of the sort of
paradoxes of something</v>

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like Coronavirus and
maybe the flu pandemic too

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is that you had a
situation several weeks ago

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where people were going
down to spring break

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to party in Miami, and
there was less kind of

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social pressure of the type
that you're talking about,

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about World War I, to call people slackers

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or to get their act together,
until things get really bad.

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And by the time things
have gotten really bad

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then it's too late and
the pandemic is spread.

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It feels like it didn't
build up this time around

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until things may have been too late.

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<v ->I've had this surreal, almost
Twilight Zone experience,</v>

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of living in my own history books,

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it's a very odd feeling.

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It's almost human nature
to not think about

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a disaster until it's right
in front of your face.

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As the father of two young, not so young,

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a 19 year old and a 15 year old,

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they're used to their dad
talking about pandemics

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so they weren't going on
any wild spring breaks.

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But I must tell you,
when I saw that video,

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I was aghast, what in
god's name are you doing?

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<v ->If I get Corona, I get Corona.</v>

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At the end of the day I'm not gonna let it

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stop me from partying.

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<v ->I think now I doubt there's as much</v>

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spring break activity today
as there was a few weeks ago.

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Or people held off to do it--
[phone ringing]

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I'm sorry.

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Sorry, it's my daughter.

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<v ->She's calling from spring break, yeah.</v>

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[laughing]

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There was definitely
kind of a tipping point

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where I think that
people started to really

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take it seriously,
which of course is good.

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But by then you wish some of the measures

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had been in place before then.

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But again, you can't get them in place

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'cause people don't take it seriously

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'cause not that many people have died.

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<v ->And you can never
really do this too early.</v>

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The problem is that
history is littered with

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public health officers who
took these measures too early

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and then everyone complains,
we're losing money,

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this isn't fun, et cetera.

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A lot of behavioral
psychologists have noted

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is that you probably only have one chance

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to impress upon a citizenry

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that you're going to do these measures.

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And to try to do them two,
or three, or four times

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in rapid succession may
not work all that well,

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people may not listen.

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They may feel that you're crying wolf,

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or you're Chicken Little.

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And so we have to do it for
a period that's lengthy,

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that's the problem.

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And we won't know when it's over

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until long after it's over,

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so it's hard to know when
to release the trigger.

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The key word about this
Coronavirus is novel.

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We don't have any
experience with COVID-19.

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We don't have any data from last year

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that we can compare it to.

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So we are flying by the seat of our pants.

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But this I know, if we release
these measures too early

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we're going to be back
in the same situation

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that we were in terms of cases and deaths,

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or perhaps worse.

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And we will have crippled the economy

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and caused all this social
disruption for nothing.

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So I think we have to stay the
course now that we're in it.

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