While our coronavirus experience seems so novel, in the arc of maritime history, pandemics like this are far from unusual. Actually, the most unusual part of the present pandemic is that we have not had to deal with a pandemic like this for over 100 years.
Taking into account that in those 100 years international travel has exploded, it becomes plain weird that it has taken so long.
In retrospect, it is even more disturbing that we are so poorly prepared for dealing with pandemics in general. Pandemics have long been a worldwide concern and have been a central component of maritime trade for centuries.
A large portion of the US Federal Health Infrastructure was founded to deal with the prevention of the spread of pandemics. In the US it all leads back to the establishment of the Marine Hospitals in 1798. This was a network of hospitals that were tasked to deal with the threat of infectious diseases to the young nation. In 1870, it became the Marine Hospital Service and the US Public Health Service Commissioned Corps was established. This is the service that Dr. Jerome Adams leads as the Surgeon General and the Vice Admiral of the US Public Health Service Commissioned Corps.
Today Dr. Adams hovers sort of in the background of President Trump’s press conferences, but he and his staff are the people that were involved in maritime trade and who performed the health checks of immigrants at Ellis Island and other immigration facilities.
Then came airline travel and none of those measures were observed. When one considers that, with jet travel, international travel increased by orders of magnitude, and that the speed of jet travel does not allow a disease to exhibit itself during the voyage, it should not be a surprise a pandemic is inherently an accident waiting to happen.
While general medical treatment options improved substantially, thereby reducing the lethality of many diseases, the actual risk exposure for a pandemic grew exponentially since the advent of the jet age, and, in hindsight, it has become apparent that the ball was dropped.
The real question is: “Well, what was the ball, and how was it dropped?” The ball was the development of a preventative approach or a remedy for jet travel style pandemics, and it was dropped because nobody modeled the problem to try to determine what type and level of prevention or remedy would be useful.
Some may argue that there was no way to know how Coronavirus would behave and that is a reasonable assumption, but that does not mean that the USPHS should not have a bag of tricks ready and this is where the response gets weird. Today, even as bystander citizens, we could make a list of measures to deal with a random virus. The list is short but it did not exist when Coronavirus was first identified, and the most significant proof is that no mention was made of the use of low tech face coverings to reduce the introduction of aerosols into the environment by infected individuals. In the first month of the response there was almost total focus on the need for N95 masks to prevent uncontaminated individuals from inhaling the airborne virus and no discussion whatsoever about preventing infected individuals from introducing the virus into the atmosphere.
This is a prime indicator of a lack of preparation by those who were tasked with pandemic prevention. Reasonably smart people who, together, study the problem and run through training scenarios, at a certain point, will say: “Wait a minute, why are we focusing on 90% of the population not inhaling a virus when we can more reasonably focus on 10% of the population not spitting the virus into the environment?” I have no training in airborne virus transmission theory, but I have training in aerodynamics and flow physics, and when one considers the problem from that point of view, the ability to reduce contamination risk goes way down when one focuses on reducing introduction of airborne viruses into the air rather than to prevent inhalation.
Consider this; in hazardous gas operations, it is well known that a respirator that does not tightly seal around the face is useless since any gap in the mask seal allows a large amount of unfiltered air to enter the lungs. Surgical masks are far from airtight and even N95 masks are not designed to filter air 100%. They are actually designed to reduce the user from contaminating others. In other words, while these masks are not very good in preventing bad air from entering a person’s lungs, they are pretty good at catching stuff that gets exhaled.
In exhaling, the physics are vastly different. While a poorly fitting mask on a contaminated user will not prevent all of the viruses from entering the atmosphere, two things do occur; the mask will capture a significant portion of moist exhaled air contaminated with the virus (which is why it gets wet) and it will diffuse the stream of air that is exhaled, thereby reducing the chance that exhaled viruses get inhaled by people nearby. While on/off solutions are nice, a large part of the world functions by reduction of risk rather than full cure. I will not engage in the math here, and undoubtedly at some time in the future there will be further studies that will quantify this approach, but why did nobody address this reality in the beginning of the crisis?
Why was there nobody who said: “Hey folks, this is a scary situation, but here is something all of us can do to improve the odds. Find an old T-shirt, tie it around your face, and use it whenever you are outside of your immediate quarantine circle. It ain’t perfect, but it will reduce the problem by X percent if everybody does it, and if you are carrying the virus it will significantly reduce the risk that you contaminate someone else.” Let’s face it, in retrospect this is simple stuff, and simple stuff shows up when smart people sit together and toss a problem around without the risk of getting second guessed or ridiculed. Once the pandemic starts, it becomes much more difficult to engage in brainstorming and deep thought. I am sure such smart people are involved in the present response; but when you are up to your butt in alligators, it is difficult to think of draining the swamp.
What is even more interesting is that once things go bad it is very difficult to get good advice to the people on top because they are swamped with all types of conflicting data and have no time to sort good advice from bad advice. While I do not know who first started pushing the “keep the spit out of the air” approach, almost undoubtedly it took much longer for this good advice to work its way through the noise during the pandemic than it would have before a pandemic.
Frustratingly, I suspect that such stone-cold investigation, analysis, and optimization will not become part of our world. Instead, I expect that somebody is going to introduce legislation that will increase our TSA style bunker mentality and soon there will be lots of complex and marginally effective technology at our airports to prevent something expensively that can also be solved by common sense and relatively minor adjustment by all of us.
Picture credits: Wikipedia