More on this book
Community
Kindle Notes & Highlights
He spent the next year making himself expert on why, and in what circumstances, people learned—and why, and in what circumstances, they did not.
The gist of it was that people don’t learn what is imposed upon them but rather what they freely seek, out of desire or need. For people to learn, they need to want to learn.
“People in an organization learn,” said Carter. “They’re learning all kinds of things. But they aren’t learning what you are teaching them. You go to a formal meeting. The important conversation is not in the meeting. It’s in the halls during the breaks. And usually what’s important is taboo. And you can’t say it in the formal meeting.”
In late November 2005 he went to Washington and, with the six other members of the new team, was installed in a room at the end of a corridor on the fourth floor of the Old Executive Office Building, next door to the White House.
The other doctor in the room, Richard Hatchett, had somehow already been given the job of writing the key chapter in the plan, chapter 6, which would be the strategy for minimizing illness and death in humans. The divvying up of the plan was a bit like musical chairs, and when the music stopped, everyone but Carter had a seat. As he recalled, “Rajeev just said, ‘Richard, you’re going to work on chapter six, and, Carter, you’ll help Richard.’ ”
The bigger obstacle to clear prose was the sheer number of people invited to complain about whatever Richard wrote. Anything that implicated any federal agency had to be sent to that agency for approval. “So we’d send it to, like, the EPA,” said Carter. “And it wasn’t one person at the EPA. It was ten. There were times I had five different comments on the same sentence all wanting me to change the sentence a different way.” The process drove Richard Hatchett nuts. “It just gets dumber and dumber,” he’d say.
What their views had in common, he suspected, was the absence of a magic bullet.
The solution would be a layering of multiple strategies, sort of the way you laid slices of Swiss cheese on a sandwich, so that the holes did not align. He began to write memos to the group about the Swiss cheese strategy.
There was, most importantly, a passage that suggested what the federal government might do, at the start of a pandemic, before a vaccine was available. It would, they’d written, “provide guidance, including decision criteria and tools, to all levels of government on the range of options for infection control and containment, including those circumstances where social distancing measures, limitations on gatherings or quarantine authority may be an appropriate public health intervention.”
As read by Richard Hatchett and Carter Mecher, those words gave them cover to answer the most important medical question they’d ever faced: How do you save lives in a pandemic before you have the drugs and vaccines to do it?
Inside the United States government were all these little boxes. The boxes had been created to address specific problems as they arose. “How to ensure our food is safe to eat,” for instance, or “how to avoid a run on the banks,” or “how to prevent another terrorist attack.”
Each box became its own small, frozen world, with little ability to adapt and little interest in whatever might be going on inside the other boxes.
here was the real waste. One box might contain the solution to a problem in another box, or the person who might find that solution, and that second box would never know about it.
Bob Glass was a gifted thinker whose mind naturally belonged in no one box. Yet by the spring of 2006 he felt trapped. In the two years since its conception, his fifteen-year-old daughter’s science fair project had spun up into this grown-up model of disease control. He’d found data from the long-forgotten flu pandemic of 1957–58, estimated to have killed more than a hundred thousand Americans, and used it to test his model.
Bob Glass had now read enough about epidemiology to know that his daughter’s project was an original contribution to the field. “I asked myself, Why didn’t these epidemiologists figure it out? They didn’t figure it out because they didn’t have tools that were focused on the problem. They had tools to understand the movement of infectious disease without the purpose of trying to stop it.” With the help of the computer programming genius at Sandia Labs, he and Laura had built a tool that might stop a disease.
“Instead of worrying how to stop this thing, they got wrapped up in a thing from outside the country that was coming in. And so they spent all their time talking about closing borders. Which is exactly what does not work. It also immediately shuts down all economic flows.”
He found the names of professional epidemiologists who claimed to be using computer models to study disease spread and sent them his paper, along with a note. “They wouldn’t even return my emails,” he said. “They just didn’t respond. So then I got pissed. I had this fear: a pandemic will occur, and no one would do anything right. I thought I was dead. I thought we were all dead. Then I remembered the guy at the VA.”
A year and a half earlier, Laura had gone to Washington, DC, to visit her aunt. Over dinner one night, she told her aunt’s boyfriend, an infectious-disease specialist who worked for the Department of Veterans Affairs, about her science fair project. “You should write that up and publish it,” he said with enthusiasm.
“But I said, I’m going to do something someone my age never does. I’m going to go around the system. I write him an email and attach the paper and ask: ‘Do you know anyone who needs to see this?’ ” At that point, he’d spent the better part of six months trying to get the attention of experts in disease control. Inside of six hours, he had a call from Richard Hatchett. “He said, ‘We’re in the White House,’ ” recalled Bob Glass. “ ‘When can you come and talk to us?’ ”
Working alone on his spreadsheet, he had one of the most curious experiences of his life. As a small child, he’d suffered a horrific accident; he’d never quite shaken its aftereffects.
Unable to pry open his son’s jaws, he knew to breathe into his nostrils. He did this until Richard once again began to breathe.
Richard heard that story over and over. “It always ended with my parents saying that I had been saved for a reason,” he said, “and I think my father, and maybe my mother as well, actually came to believe it.
“This is it; solving this problem is why I’m here. I’m the only person in the White House who cares about this stuff, and if I don’t pursue this, it won’t happen. And I mean it really hit me like a thunderclap. Like, the only time ever in my life that I had something like that happen.”
A powerful conventional wisdom held that there was only one effective strategy: isolate the ill, and hustle to create and distribute vaccines and antiviral drugs; that other ideas, including social interventions to keep people physically farther apart from each other, had been tried back in 1918 and hadn’t worked.
there was every day fresh evidence that the models inside the minds of experts could be seriously flawed. In professional sports, for example. For decades, former players went unquestioned as experts in the evaluation of both players and strategies. Then came the statistical revolution. Complete outsiders, armed with mathematical models, had made a mockery of the experts. The market forces that punish ignorance were far more intense in pro sports than they were in disease control; the mistakes made by epidemiologists didn’t cause their teams to lose and their bosses to waste tens of millions
...more
Once Carter saw Richard’s enthusiasm, he, too, opened what Bob Glass had sent and started playing around with it. The math he understood. The thinking was clear and simple.
the model’s output was just a bunch of numbers listed in these mind-numbingly long tables. “Most people can’t read tables,” said Carter. “They need to see it graphically.” Carter turned the numbers into a graph. The picture shocked him.
none by itself made much of a dent,
One intervention was not like the others, however: when you closed schools and put social distance between kids, the flu-like disease fell off a cliff. (The model defined “social distance” not as zero contact but as a 60 percent reduction in kids’ social interaction.)
“Nothing big happens until you close the schools. It’s not like anything else. It’s like a phase change. It’s nonlinear. It’s like when water temperature goes from thirty-three to thirty-two. When it goes from thirty-four to thirty-three, it’s no big deal; one degree colder and it turns to ice.”
“What happens if you do nothing but close schools and reduce the social interaction of minors by 60 percent?,” they responded, slowly, but as one: that works.
Carter was bottom-up—there was no fact, and no person, trivial enough to evade his curiosity.
Once they were satisfied that this very simple model somehow captured a lot of truth about the social lives of Americans, and that it generated roughly the same answers even after you tinkered with the specifics, they bombarded it with their full curiosity. What happened when you closed just bars and restaurants? Or just public transportation? Or made people telework? What happened when you combined every possible strategy they could think of, in every possible combination?
Bob Glass installed a bed on stilts beside his computer in a shed in the backyard. Each night in Albuquerque, he ran computer simulations of various pandemics, and various responses to them,
He’d been promoted, basically overnight, from the world’s most ignored pandemic modeler to the world’s most important pandemic modeler.
Everyone could see that kids played a role in disease transmission.
“It showed me where to dig,” said Carter. “I said, ‘I’m going to dig deep right here. Is there something about kids and schools that I don’t know enough about and haven’t thought about?’ ”
In federal databases, he discovered that the majority of Americans employed by state and local government were employed in education,
Twenty-five million rode a bus to school. “I thought, Holy crap, half the kids in the U.S. hop on a school bus.”
five hundred thousand school buses. On an average day, school buses carried twice as many people as the entire U.S. public transportation system.
for every person hopping on public transportation in one day, there are two kids taking the school bus.”
The Department of Education dug out blueprints of America’s schools that enabled Carter to calculate just how much space each kid had. He did some math and reckoned that each elementary school child spent the day in a space with a radius of just three and a half feet, which, when they reached high school, expanded to four.
he asked his wife to arrange a meeting with a teacher while school was in session. That whole day, from the moment they got in the car, he viewed the world through a new lens. Look! he said, as they passed children waiting for the school bus. Look at the way kids stand at the bus stop. When adults stand at a bus stop, they give each other space. Kids are like those close talkers on Seinfeld.
He and Debra entered the school. Look! It’s just a sea of humanity. I could almost walk across their heads! He watched the way they horsed around and jumped on each other’s backs and behaved in ways that he no longer did. Look! They’re so different. They’re not little adults. They have a different sense of space.
As the teacher spoke, he reached out his arms in either direction. Look! he said to himself. It’s three feet. I can touch the person next to me.
Leaving the school, he saw a bus and boarded it, with a tape measure. The seats turned out to be forty inches long. “They estimate kids’ hips are thirteen inches across so they can put them three to a seat,” he said. The aisle was narrower than a normal bus; paramedics knew not to bring a normal-sized stretcher onto a school bus, he later learned, because it wouldn’t fit down the aisle.
