Professor tomes so what are we going to do today . I promised you that i would do show and tell from my own research, and the timing turned out that doing a Historical Perspective on pandemic preparedness might seem like a very interesting topic to discuss. I have been getting a lot of calls from journalists lately, and it is kind of, why in the middle of a pandemic are they calling people like me . So this is a good thing for us to talk about. This is a history methods course, it is about how you become a historian, and what you do for a living. You may remember the first week of class, we talked a little about the reaction you may sometimes get from family members when they hear you are a history major or minor or even taking a history course, that, why is this useful knowledge . Why are you bothering with all this old stuff . I get those questions a lot because of my Research Specialty in the history of health and medicine. Science is so much better today, why should we bother looking at past diseases and how we responded . My goal today is to give you an example of why bother, and why i am proud to be a historian, why i am psyched about what i do. That is objective number one. I said the first week of class, i want to make you proud of being a history major, so here is my way of saying i am proud to what i do. The second goal is to talk specifically about pandemics, in terms of what we have been talking about in this class. How were forms of Public Outreach used to try and contain and mitigate a major epidemic . My work has been on public education, or you might call it propaganda. Can you move over a little bit . There you go. We have talked about the word propaganda. It has a lot of negative associations. For much of the 20th century, it did not have negative associations. Propaganda is often public information. It is trying to get public messages out to people that could help them in a time of emergency. That is what we are going to look at today, the methods of outreach that were available in probably the most significant Global Pandemic of the 20th century. I know a lot if you saw 1917, the movie about world war i, and that was a routable war, with war with the trench warfare. A lot of people died. The film is an amazing recreation of conditions in wartime. You remember world war i is the first world war, in that combatants spend multiple continents, and it inspired kinds of propaganda. Remember draft posters we looked at from both the british and the u. S. Side, uncle sam for example . What you are less likely to know is that as that war around to ground to its horrible close, a terrible influenza pandemic broke out. It is still not clear where it came from, but it spread quickly, first to troops and then civilians, and it ultimately killed more people than did world war i. Just to give you a sense of comparison, we were able to isolate, the h1n1 novel form from the spanish flu pandemic. World war i combat deaths, 8. 5 million. Thats bad. But look at the influenza death toll. 50 million is now the estimate. It could be even higher than that. More lives lost in the influence influenza pandemic that were lost in world war i, and as a point of comparison, in our lifetime, hivaids has been a tremendous killer, killing nearly 2 million during the course of the aids epidemic. Influenza, and publichealth circles, they still refer to it as the big one because the death tolls were so hot. So high. You may think, that was a sad story and lots of people died, but that is the point of but what is the point of studying an old pandemic . After all, science is so much better today. We can just find a cure. Right . How are we doing with curing the coronavirus . No, we are not doing so well, in part because this is Mother Nature issuing a major challenge to us, as a new virus forms that people dont have immunity to. The coronavirus and the response to it in many ways is revisiting a lot of the same issues that came up with the world war i pandemic. And the reasons we are having trouble with coronavirus today are very similar to problems they encountered with this new influenza in 1918 and 1919. But here is a stranger fact. And that is that the methods we use today to control coronavirus are drawn from the same Public Health playbook they used in 19181919. The basics are the same. We have not evolved from what was available in the world war i era. And it is precisely because the methods are the same that there has been a growing interest in the history of the 19181919 pandemic. It was not always that case that the case that people played much attention to this pandemic. Paid much attention to this pandemic. Let me show you this book called americas forgotten pandemic was published in 1987. There is very little historical work. He talked about amnesia, that no one talked about it anymore. I am here to tell you that, especially in the last 20 years, it is forgotten no more. There is an upsurge in research and interest in this pandemic, out of an impulse to try to learn how to manage current epidemics more effectively. In other words, our Public Health folks are now preparing for a new pandemic by looking back, it is called a look back, a methodology look methodology used in public a look back at previous pandemics to seek what worked and what didnt work. Probably Health Emergency preparedness has become a major subfield in Public Health. It has grown a lot since 9 11. You may remember some bioterrorism involved in 9 11, but it also reflects the gradual recognition that, for a variety of both economic factors and environmental factors, we are getting more and more novel diseases emerging. This has a lot to do with the ecology between people and animals. This also has a lot to do with global transportation, meaning that a novel disease that breaks out in wuhan can travel very quickly through not just trains and cars, but airplanes now can travel very quickly. This is a list of major Public Health concerns just in the past 20 years, sars, mers, ebola, zika and covid19. Starting with sars, there was a growing sense among policy leaders that they needed to start planning ahead, thinking that, if a novel pandemic breaks out, how are we going to control it, especially if it spreads very fast and has a high mortality rate . So agencies like the centers for disease control, even the department of defense, started spending money to hire historians and other rto archeovirologists to get them to investigate the pandemic im going to talk about today. People go back and look at the bubonic plague in 14th century europe, they look at initial disease exchange with native peoples when the europeans came with columbus, but of all they cks, the one on the influenza pandemic has probably gotten the most attention. Because in many ways, it is the first modern, Global Pandemic in the sense of what we are experiencing today. One of the historians who got invited to participate in this look back was me. I want to be clear, i have been a bit player in this. Other historians have been much more at the forefront of organizing this. I would call out my colleagues at the university of michigan, Howard Markel and alexander stern, as leading this team, but they invited me in to help because of my historical specialization in popular publicHealth Education. That is my book. In some circles i am known as the germ lady. One reason i get calls from journalists is they will google germs, and the gospel of germs comes up. What was this book about . I wrote it a long time ago, 1998, it has been in print ever since. I was interested in how ordinary people came to believing the existence of something they couldnt see, a germ, a microbe, and then to alter the way they behaved, like not shaking hands, the kinds of stuff we are now doing. How did they learn to do that . They were very purposeful in publichealth campaigns to teach people how to avoid giving each other germs, and treating Communicable Diseases. What i call the gospel of germs in this book is in many ways the foundation of containment actresses we still use today. How do you minimize the sharing of microbes between human beings . I always like to give students something a fancy phrase so you can sound really smart when youre talking to other people. Nonpharmaceutical interventions, npi, and publichealth circles anything that doesnt involve a vaccine or drug is a nonpharmaceutical intervention. So all the stuff i was looking at, and by the way there are no antibiotics and relatively few vaccines in this time period, that way you avoid getting sick was by practicing good habits. Easier to say is the phrase social distancing measures. You go online or read the newspaper and they are talking about that all the time now. When they tell us not to shake hands or sneeze into your elbow, that is a social distancing method, exactly the same stuff they were telling americans to do at the turn of the last century. Why is this important . Because even though we have made astounding improvements in health sciences, we still cannot cure a virus. There are limited medications to this day to slow down a viral and action. So when we are faced with a novel virus, using these tactics is one of the most important ways we have to keep able from getting sick and dying. So if you have a highly contagious epidemic on your hands, your best at is to try to your best bet is to try and slow its spread, and these techniques are very, very valuable. That was a lesson publichealth experts learned in world war i that still use today. My work has been studying, first just basic germ education, then specifically world war i and how they tried to ramp up like Health Education in the face of the pandemic. That is what i am going to show you more of. Let me give you a quick overview of the 19181919 pandemic. It started in fall 1918. There were outbreaks in different parts of the world. It is still not clear which one is first. There is a lot of arguing about that. What we are sure of is that it did not start in spain. It became nicknamed the spanish flu not because it started in spain, but because spain was not a combatant in world war i, so their newspapers werent being as careful about reporting early stages of the pandemic. They ran a story about it and somehow got associated, it is the spanish flu. It spread first among troops and jumped into civilian populations. It was compared to the normal flu, and they understood there was an influenza just like we have that comes every year at a certain point, this particular flu was much scarier. It was very contagious, spread easily from person to person, and its death rate was higher than the usual flu. Also, the normal influenza usually kills fragile people that can be very young or very old, people who already had systems under stress. The spanish flu was terrifying, because it killed people your age. It did not concentrate just on the very young and very old. In Public Health circles, they talk about the dreaded w shape. That is the w. You can see the normal influenza pattern is a u shape, the very young, the very old. Look at 1918, a big spike up that could change Life Expectancy in the United States, because so many young people had their lives shortened dramatically as a result of the influenza pandemic. This just gives you, this is from publichealth report, published after. You see the extraordinary spike in death rates due to this pandemic. What did publichealth experts know about influenza in 1918 . Compared to the last big influenza epidemic in the 1890s, they learned a lot. For one thing, they had convincing Laboratory Proof of something you may have heard of as the germ theory of disease, the idea that Communicable Diseases are caused by microbes, bacteria and viruses. A lot of work shows that it is not some mysterious thing in the air that made you sick, it is this microorganism that, in the case of bacteria, they could see under a microscope and prove ties to specific diseases, a huge step forward toward understanding what the nature of specific disease was. They were able to see with the current microscopes of the time see a bacteria, but they were not able to see a virus. The difference, let me show you this very quickly, a little contagion 101, viruses are tiny compared to bacteria. The analogy is that a virus is the size of a mouse and a bacteria is the size of a person. Viruses are more primitive but more deadly in that they insert their cells into your cells and replicate. They mutate quickly, one reason they are so difficult to control. Even to this day, we have limited pharmaceutical treatment for viral diseases. We can slow some of them down, but we are not able to cure the flu. And today we rely on vaccines to control things like the flu. Bacteria are much bigger and they are a singlecell microorganism, they can do incredible damage to the body, but eventually, effective drug treatments were found for biotic for bacteria. Antibiotics only work for bacteria, they dont work for viruses. They are easier to disrupt their machinery. To go back to what they knew in 19181919, they had a suspicion there was an infective particle smaller than a bacteria but couldnt see it under the microscopes of the day. They did experiments to prove that it was there. I can go into how they figured it out. They didnt know whether influenza was caused by a bacteria or a virus. They had a lot of scientists try to figure out what was the x germ causing the influenza pandemic. They failed. The candidates they came up with turned out not to be the real h1n1. Not until electron microscopes were invented in the 1930s could you actually see a virus under a microscope. And it wasnt until the 1990s that our tools of extracting the influenza virus and replicating it dna, that our tools were good enough that we could actually extract it and replicate it dna. So we know a lot more about it now than they did back then. There is a cool story there about archeovirology, how they got samples from people who died about the flu, it is really creepy. But interesting, i could tell you on another occasion. What did they know then . They knew it was communicable. They are sure it is a germ disease, they just dont know if it is a bacteria or virus. They would love to know but they dont find out in the end, it doesnt make a lot of difference, because the way you protect against a bacteria and protect against a virus are basically the same. So the social distancing methods that, as the pandemic spread, people were supposed to use to keep from catching it, were essentially the same ones used for any upper respiratory infection by this time. They understood that influenza as an upper respiratory infection with spread through coughing, sneezing, spitting. Men spit a lot back during the state. That is a habit that we have thankfully given up. They spit a lot. Also, if you shared glasses or utensils, sometimes that is called fomite. Its an object that carries that is a really weird word, like if i had coronavirus and you touch my phone, that is fomite. You should not mess with another persons phone right now, you should know that. So a virus can live temporarily on a surface and be transmitted that way, and various kinds of casual contact. You all are hearing now, dont touch your face, dont touch your nose. They basically had figured out that this stuff is getting on your hands and that could make you sick, so try to practice careful hygiene so you are not spreading germs. And they already had this idea not just about influenza, but about a lot of other diseases. One thing they realized soon, remember that w i showed you, is that this 1918 strain of influenza seemed much more deadly than the usual, annual influenza. And experts today are still arguing. They have reconstructed the virus they got out of people who died from the spanish flu, and some say there is nothing particularly scary about this, it looks like ordinary flu. It wasnt the virus, it was the social context that this was wartime, people were malnourished. Remember 1917 . You would get a lot of icky stuff in those trenches, and wartime hygiene made a lot of people vulnerable and perhaps that is why it was so deadly. That argument is ongoing. I am a historian and not a virologist. I dont know. My guess is they are never going to firmly determine why this virus caused that w shape. Yes . Is there a specific reason it was affecting people in their 20s and 30s compared to the normal flu . Professor tomes i dont know, and that is the puzzle of this. That is so unlike the normal flu. That age group, we now, would have been the military, the young men and troops. We also, in the civilian population, killed a lot of young people as well. Maybe the nutrition overall, even though it was the home front, maybe people werent fed as well, but i am not sure they have really come up with a good answer yet for why it took that w shape. And the uncertainty about this carries over into other nuances. There is always this worry it is going to happen again, and we dont know why. Fortunately, it does not appear in the coronavirus to be doing that w shape so far. Whatever the cause, we dont know. What is it was it the mutation that made it so bad or was it the underlying wartime conditions . What we do know is that compared to the annual influenza, the 1918 version was really, really scary in its symptomology. People would come down with an extremely high fever, they would develop a really severe upper respiratory infection, often compounded by nausea and diarrhea. In the worst cases, it was such a devastating assault on the lungs that lung tissue was destroyed, and essentially people were dying from the fact they could not get enough oxygen into their lungs, their lungs were that damaged. There was also a secondary problem, and this is true with flu this day. The virus weakens you and then a bacteria comes along. In the case of the influenza pandemic, it was pneumonia. I have other viral or bacterial either viral or bacterial would come in and if the flu hadnt killed you, that pneumonia would do it. Yes. Can you hold on a second . Were there any immunities to this virus . Professor tomes a very good question. When you do have a virus, you may then have an immunity to it. One of the theories about why this was so bad is that in fact it had been almost 20 years. The one in the early 1890s may have been this strain, and then the people who had that immunity either lost it or died off, so it was basically a virgin population that had not an ex posed to this particular flu, so you would not have good immunity from having been exposed. That is my possible explanation as to why a lot of people didnt have immunity to this particular strain. It is hard to exaggerate how scary this epidemic became very, very quickly. Im just going to talk about the United States, but it was in fact a Global Pandemic. The first cities hit were boston and philadelphia, in part because they had illiterate camps that jumped to the civilian population. Military camps that jumped to the civilian population. They were caught unawares by the speed and the deadliness of the pandemic. And by the time they started to put those distancing, quarantining, isolating measures in place, the epidemic was already out in the general population and very hard to shut down. In boston, the center of infection was camp devon. There were 14 military camps. 14,000 cases of influenza, 757 deaths. In philadelphia, it was the navy yard that became the focal point for the spread. So many people were dying in philadelphia, they were having to take cold storage plants that they used for other purposes and turn them into morgues. The death tolls of the original pandemic in those two cities were really staggering. Seeing what was happening in boston and philadelphia, everybody else could say this looks really bad, we need to start getting ready. Let me read you the description from september 1918 from thenUnited StatesSurgeon General rupert blue. People are stricken on the streets or while at work, first there is a chill, then fever with temperatures from 101 to 103, headaches, backaches, red eyes, pains all over the body and general prostration. Should go at home at once, get into bed without delay and call a physician, but there werent enough doctors to go around to take care of all the people going home with this disease. One of the differences between that 1893 influence epidemic and this one was the degree to which newspapers had grown, and carried this story. So you could see in realtime what was happening, and what was coming toward you. Yes. Did the virus mutate when it was present during this time, since you talked about how viruses usually mutate . Professor tomes my understanding is, whatever mutating it had done, it had already done. There were some early outbreaks of the flu that may have been the milder form that then turned into the more lethal form, but by the time it got to boston and philadelphia, it was the lethal kind. Did that happen in that space of months where it was going back and forth . There is still a lot of speculation, because our methods are not that good. When it comes to telling people to stay home in the newspapers, how did that figure it would work with the military . Is that why the situation got so bad . Professor tomes in terms of going home and going to the doctor is when it got into the civilian side. In terms of the timing, fall 1918, i know i have some military historians in here. What is going on in the war in the fall of 1918 . When is the war over . The war is basically almost over. The armistice is in november, so troops are already being brought home on troop ships with the sickness, then they are put into barracks sick and then he jumps and then it jumps into the civilian population. They certainly try in the military. Military medicine really understood the need to isolate, but it was so overwhelming, similar to stories we hear, they didnt have enough doctors and nurses and then the doctors and nurses got sick, so it was an overwhelming of that available resources. So this is happening in boston and philly and meanwhile, the stories are a shortage of doctors and nurses developing. This is a newspaper outside boston from from brookline, massachusetts. In the early months there was a lot of war news that tended to get to the top. This stuff is definitely creeping in around that. Pandemic, there is an epidemic, it is looking very, very scary. In many ways, this is the first mass mediated pandemic in modern history, because so many newspapers were able to cover these kind of stories. I want to get us to think for a minute about what you did if you were not in boston or philadelphia. You could see this coming. What tools could you put at your command to try to protect your people against this invading epidemic . You had time to prepare. What should you do . Here is where we come back to those nonpharmaceutical interventions. They had a very clear game plan. They knew what they should do. They needed to set up facilities so that people who were sick could be isolated and taken care of. They didnt want them to die, trying to give them the best chance to live, but in the meantime, keep them away from the well people. So you need to spot them and isolate them as soon as possible. You can put them in a special hospital or try isolation at home. You can encourage or increasingly force Healthy People to limit their activities so they stayathome as well, so you are preventing the spread by getting everyone to stayathome. You can encourage people to stay home by closing schools, closing places of entertainment, shut down the movie theaters, we had those by then, shut down broadway shows. Then people cant go out because these places are closed. And finally, you could get out there and try to give people a refresher course on the gospel of germs, here is how you need try to give people a refresher course on the gospel of germs, here is how you need to behave as a responsible person. What of everything i said here is not going on on march 10, 2020 . Anything . Yes. They are starting to close schools and move things online, a lot of events have shut down already, st. Patricks day parade, everyone is shutting down and whatnot. Professor tomes yes. Basically we are watching all of this unfold. If you look at what wuhan did and now italy has done is the extreme version of this, but we are starting to see in new york the beginnings, it is a spectrum of how much you encourage people to isolate themselves. So we are definitely headed in the right direction. It is weird for me to get up every morning and feel like it is deja vu all over again, an homage to yogi berra, the uncanny similarities to the research that i did as boston and philadelphia were trying to figure out what to do. As i said before, the playbook now is the playbook they were using during the great influenza, and how well did it work . How did they go about trying to get people to cooperate with all these techniques . Here is where we get to the subject of our class. I use the term propaganda here, you might want to call it public information, public education, it doesnt sound quite so bad as propaganda, but essentially, part of the playbook in world war i was to try to get propaganda out there to tell people what they needed to do. And the techniques used Public Health experts were taken from other forms of messaging at this time. I am going to show you some of the messaging, and ask you to look at it through the eyes and analyses we have cultivated in this class, looking at different forms of advertising and propaganda. Let me just step back a minute and ask you to think about what you remember. In 1918, what kinds of outreach mechanisms did they have available in the United States . Think back to the book we read. If you wanted to get the message out, how would you do it . A big way is newspapers, because that was the yellow journalism time. Putting out articles about all the flu spreading would get peoples attention and scare people. Professor tomes absolutely. Bingo. Newspapers definitely come but there was another tack, another formula they were starting to use. Another tactic, another format they were serving to use. This is probably not one that would immediately come to mind, thats why we are talking about, newspapers. And newspapers at this time could be really snarky about political stuff, but in terms of conveying epidemic information, if the Public HealthDepartment Said please tell people x, they would tell people x. There wasnt a lot of backbiting about doing it right or whatever. The newspaper is a really important way for Public Health departments to get out there and say here is the threat, you need to do something about it. This is a newspaper from seattle, and you can see churches, schools, shops closed. The one on the right is from washington dc. It shows nurses making gauze masks to protect people from the infection. So yes, newspapers were a very important source of messaging about pandemic preparedness. The other type of media they used, you are familiar with, remember we looked at all those posters used to advertise all kinds of products . Well, the Public Health people solve those purchasers all those posters and said, we are saw those posters and said we could make those two. We are going to make posters about Infectious Diseases and make people learn how to guard against them. The big show in town in 1918 was not influenza, it was tuberculosis, much more of a chronic infection, hard to spread from persontoperson, lasted longer, killed a whole lot of people. But ironically, the way you prevent the spread of tuberculosis are essentially the same way as you are going to prevent spread of the influenza germ, coughing, spitting, all those things i mentioned, people had already said you need to be very careful how you cough and sneeze because you dont want to get tuberculosis. They basically took that message and layered in influenza, they changed tuberculosis and putting influenza and basically sent out the same message. I am going to show you a selection of influenzarelated messaging material. We are going to do what we have done with other and and propaganda analyses other ad and propaganda analyses. I am going to show you text and images, and i want you to think to yourself, what does this remind me of that we have already looked at . What are they borrowing from . But i also want you to think about the story they are telling. What values are they drawing on to get people to act in a careful way about influenza . So what is the big picture of, do this because, filling the blank. I will do this and see what you come up with. One way to go about this was to put up these Public Notices in public places. People took trolleys back in the day in cincinnati. They called it a car card that told people to keep their windows open to prevent tuberculosis and influenza. On the right is a poster that was developed for use by the Chicago Department of health specifically to be used in theaters that gave people basic information about what to do if they were not feeling well, and what they should do to stay safe. This kind of very textbased, here it is, here is what you need to do, very common during this time. I was working on this over the weekend and went into new york city and was sitting on a relatively new subway car, and what was scrolling . Covid19, do this and this and this, first in english and then in spanish and i am thinking, it is a digital car card, much more sophisticated but the basic concept is very, very similar. Messaging at your place of work. Remember, navy yards, places where military supplies were being made, had been a real breeding point. So they are going to put up signs saying, please be careful. So that is the workplace. And then you had posters, posters that look at how remember how we looked at as with no pictures, and they started to get that in Public Health, maybe if you put a picture, that is worth 1000 words. So the one on the left is from the antituberculosis society and again, they are basically taking images they had for tb and retrofitting them for influenza. This is from Rensselaer County in new york, where troy, new york is, telling people to be careful from coughing and sneezing. This was kind of hard to tell, but who are these people . Can you tell by the way they are dressed . It is not a random group of individuals. This is not a good reproduction. Yes . Is it military . Because of the hats. Professor tomes absolutely. You probably have seen them in the movies with the little dome hats. Those are soldiers they are showing you. And then they begin to experiment with cartoons. In the golden age of newspapers, cartoons became very exciting. In the golden age of newspapers some of you may have heard that yellow journalism really was a term that came from a cartoon strip everybody became wild about. It was about the yellow kid. I think pulitzer had it, hearst stole it, pulitzer tried to get it back, people bought newspapers because they wanted to read the cartoons. So Public Health folks start realizing, if we want people to pay attention, we should try more cartoon figures as well. Both of these are from the United StatesPublic Health service in 1918. You have seen them now. Talk to me about what scenes you see and hear . How is pandemic being pitched to get people to cooperate . I noticed on the second one at the bottom, it says spread of influenza menaces, im sorry, the second one that was on that slide. It was one of the posters. It said maybe influenza menaces war production. Professor tomes bingo, youve got it. There it is. It is the last one. It is definitely being linked to being supportive of the war effort. Does anybody remember posters we looked at from world war ii, about the slacker . When i was looking at this, i thought of that, the guy who is in bed and has been drinking and is not going to work, that he is letting down the whole american people. Same idea here, you need to be careful with coughing and sneezing as part of the war effort. What else do you know about the intended audience here . This is something that hit me, especially in the pictures. Look at the pictures. Men specifically . Professor tomes yes. Because every poster is about men, about soldiers and whatnot. And it is also like, dont spread this to other people, so it is the actions that you are taking, so instead of ways to not get it, it is ways to not give it. Professor tomes yes. I was two thirds through my research before i realized i had yet to see a drawing of a woman in any of this influenza pandemic stuff. Yes . Could part of that been because women had typically been in the home . Professor tomes yes, i think that is part of. And also, when you think about, even today, which of the two genders is thought to be more Health Conscious . Isnt it usually going to be a woman, compared to a man . I can also tell you because i have done all this, that a lot of Health Education was focused on children by their mothers and their teachers. So there was an association of hygiene education with women and girls, and the sense was that somehow the guys just hadnt gotten the message yet. I mentioned the spitting. Spitting was associated with chewing tobacco, which was not something normally women did much of, so men were seen as the source of the spitting problem rather than women. So clearly targeting them. I think those are all likely explanations, men out and about, going to the navy yard while the women are back at home, but there is also a suspicion that macho whatever, that they may not be as tuned into the finer points of not spitting, or coughing on people, then might the grandma or their mom. You can see how much they were drawing from other forms of advertising and propaganda from the same time period to get their message across. Compared to previous pandemics, this effort was pretty sophisticated, and they got this message up to a lot of different places very quickly. It is not easy to do. And remember, they had to print all that stuff up, they couldnt just go post it on the internet. That said, it is one thing to get the information out there, it is another thing to get people to act on it. I what to talk about resistance. When we talked about the rulebook, we talked about the resistance people developed to all these measures. You hear it so much, you just turned it off or you listen and think, i cant do that or i dont want to do that. Very similar to these messages, in that these ideas with ideas being put out there were difficult to implement. Then as now, here is where you see similarities to what is happening today. Lets see they come to you tomorrow and say, we have to shut down stony brook, we have to shut down all the Public Schools in suffolk county, we have to stop people from going to wall street to run the stock exchange. How are people going to respond . Businesses dont want to close. They realize the economic harm done through closures. Workers dont want to stay home because they wont get paid. There is no sick pay during this time. The number of conversations from people i have heard from here, talking about what we are going to do if we stay home and dont get paid. Many of these people lived paycheck to paycheck, and you might get influenza, but you might starve if you werent going to work and getting money. This one keeps coming back to me because i read all these accounts of why it was a bad idea to close down Public Schools. And the idea was that a lot of these parents worked, so the kid is going to be alone or more likely running around the streets of new york, in this case, and they are more likely to get influenza running around than if we stick them in school and keep an eye on who is sneezing, and make them practice social distancing also. So there was strong pushback, even in the face of the w curve, of people saying we cant do this, we dont think it is a good idea, we cant get with the program. I dont care how many car cards you put up, this isnt making sense. One of the arguments you see from Public Health experts, they spend spectrum, some saying, i span the spectrum of some i dont care, stay home, i dont care, youve got to do it. And then you have other Public Health experts who say, i get your point, i get your point, and some say the economic disruption from forcing everybody to stay home is a Public Health problem, so maybe we need a more moderate approach. And the other thing they talk about is morale. If you scare people and they have to stay home and they cant go to baseball games or the theater, their morale is down, and even though they didnt understand the psychological , they deftly had a sense that if people are depressed, they might be more likely to catch something. So there were some strong voices, including in the Public Health community, saying we dont want to do the extreme shut down, we want to do something moderate. A case in point is new york city. This is a really interesting story. You would think boston, philly, new york, it is coming at you, that new york would have taking would have taken a very hardline and closed down. No. And a lot of this depends on who is in charge at the time. The commissioner of Public Health listened to these arguments and he decided to take a more moderate route. He said i am not going to close schools. What i am going to do is instead ask everyone to stagger opening and closing times, and the theory here is that everybody wouldnt be on the subway or trolley at the same time. He decided no, we are not going to shut down broadway in movie theaters because that would make new yorkers too depressed. And we are keeping kids in school and keeping an eye on them. He said, i dont want hundreds of thousands of Public School kids running in the streets of new york city, talk about a Public Health crisis. So he took this more moderate view of yes, making accommodations, but not going toward total isolation