Image: Angus Mordant/Bloomberg via Getty Images
In the early days of the coronavirus pandemic, many public health experts were sure that the virus could be beaten before it had a disastrous impact: as long as testing was robust, and the systems in place functioned properly, America would pull through relatively unscathed.They may have been right, but we’ll never know, because testing has not been robust, and the systems in place have all failed miserably.One expert I spoke with in late February was Theresa MacPhail, a medical anthropologist, Assistant Professor at Stevens Institute of Technology, and author of the book The Viral Network: A Pathology of the H1N1 Influenza Pandemic. MacPhail worked with the CDC in 2009 as a volunteer intern as part of its Global Disease & Detection unit, taking part in global conference calls on the H1N1 pandemic and seeing how the organization is structured. She was in Hong Kong during its H1N1 outbreak.In late February, she spoke optimistically with me about America’s ability to handle the coming Covid-19 outbreak. In early March, she got sick with what she believes to be Covid-19. She reached out to me recently, insisting to go on the record again to say that she was wrong, and that she put too much faith in the CDC and America’s ability to manage the crisis.How are you feeling?
I feel guilty. I feel like I should have known better.What was it about our previous conversation that made you feel guilty?
I made a lot of assumptions and didn’t think twice about having made them. I know I’m not alone, I’m just one of the only people that is saying publicly, "Well, I got this completely wrong."I think it was overconfidence. I feel like what we're seeing is a bit of hubris. We're basically suffering, partially, because there was no plan for when the [Center for Disease Control] fucked up, because they don't fuck up, or they haven't in the past. They don't have a protocol for when they can't do an assay. And that's exactly what happened. Their assays didn't work. And there was no plan for that.What do you mean by an assay?
I just assumed that the US system would be a little bit better, would be a little bit more robust and do more testing and containment than China was able to do, and I just couldn't have been more wrong.When we talked, I was still so confident that this response was gonna look like the 2009 [H1N1] pandemic response, which was a good response. Initially, it had some problems… but once they realized what was going on, they kicked into gear and everything went pretty well.One thing that's super different is that the CDC in 2009 provided central leadership. They were proactively reaching out to state, regional, and local Health officials saying, ‘Here's what you need to be doing. Here's what this should look like.’ And people did it.I am scared and enraged because there's no central authority here. I don't understand what's going on. The CDC isn't giving press briefings. They're just absent. And that could be because the administration is muzzling them. Or it could mean that there's disarray inside the CDC. And I guess all of that will come out.But I feel guilty because I knew them. So it's a bit like not wanting to think your Uncle Bob did something wrong or was capable of doing something wrong. That's why I feel bad, because I just assumed that this response would look like the old response. And it doesn't at all, and I just feel so awful.I wasn't one of those people sounding the warning alarm. I really felt like we had a shot at containing [it]. But that meant that we had to have tests. I didn’t realize what 10 years of underfunding public health had done.You got sick after we spoke last, right?
I was never tested, but if I had to lay bets I would say I have it. I’m still sick now. I’m on day 25. I got sick on March 1. It was the classic sore throat, feeling a little bit disgusting, and then at day five or six my fever started to spike. It got as high as 102.5 and never went below 100, despite taking massive amounts of fever reducer.I started having tightness in my chest. I had a dry cough. I went to the ER on March 9. They put me in a separate room. Before all this went down, I had been contacted to go to Washington to the House of Representatives and give a public statement before Congress about what we’ve learned in pandemics past. Of course, that all got shot out of the water.I asked the ER doctor, “Can you tell me in your professional opinion, are you prepared for this?” He said, "Absolutely not." He had been doing this for 12 years. He was there for the 2009 pandemic. He said in 2009 they were overprepared. They had extra flu kits, they had extra supplies, they were ready. They had been prepared by the Department of Health. The communication had been clear. He said, "I hate to tell you this but we’re underprepared now. We don’t have extra supplies. We don’t have any tests." That’s when I started to think, "This is serious."The only way we get out of this, the only way we return to a semblance of normal, is massive testing. And I’m starting to get worried because when are we doing that? It’s mind boggling.You’ve mentioned a few times that past responses were better. What do you mean?
After SARS [in 2003], everyone got real serious for a minute. And there was a lot of funding going into public health surveillance and response because the world got a little preview of what could happen, what was possible. And I feel like maybe that's also why 2009 went better. It was only six years after SARS, people had been drilling, and they had been planning, and they had been prepping. And they had a little bit more money because of SARS.Why do you think this happened and how do we make sure it doesn’t happen again?
We’ve been too successful. It’s the same story with vaccinations. As a culture, we have no institutional or cultural memory anymore of what it’s like to live with microbes. This is a crash course. It’s a wake up call. My hope is, the only thing that keeps me going, is maybe we’ll learn a lesson from this.Fund public health. Maybe we’ll change our culture so that it’s not expected or brave of you to go to work sick. Maybe we’ll start to protect each other the way Asian cultures do. It’s pretty normal in Asian societies to wear a mask when you’re sick when you go out in public and to stay home if you can. We are the exact opposite. We wear masks to protect ourselves and we feel free to show up at a meeting when we have a fever.The CDC has to be cut free of political influence. I can’t believe the agency is a federally-appointed administration. Everytime the administration changes, the leadership of CDC changes and that’s insane. We need to find a way to give places like the CDC and [National Institute of Health] autonomy with oversight.How are you processing your guilt?
I have made a resolution that going forward, I will not make the same mistake twice. I will not be so certain about what I know in the future. And I will do more due diligence on trying to figure out what the current situation is. And as a second thing that I'm doing with my guilt is I'm being extremely honest with my students and with my colleagues.
Advertisement
I feel guilty. I feel like I should have known better.What was it about our previous conversation that made you feel guilty?
I made a lot of assumptions and didn’t think twice about having made them. I know I’m not alone, I’m just one of the only people that is saying publicly, "Well, I got this completely wrong."I think it was overconfidence. I feel like what we're seeing is a bit of hubris. We're basically suffering, partially, because there was no plan for when the [Center for Disease Control] fucked up, because they don't fuck up, or they haven't in the past. They don't have a protocol for when they can't do an assay. And that's exactly what happened. Their assays didn't work. And there was no plan for that.
Advertisement
I just assumed that the US system would be a little bit better, would be a little bit more robust and do more testing and containment than China was able to do, and I just couldn't have been more wrong.When we talked, I was still so confident that this response was gonna look like the 2009 [H1N1] pandemic response, which was a good response. Initially, it had some problems… but once they realized what was going on, they kicked into gear and everything went pretty well.One thing that's super different is that the CDC in 2009 provided central leadership. They were proactively reaching out to state, regional, and local Health officials saying, ‘Here's what you need to be doing. Here's what this should look like.’ And people did it.I am scared and enraged because there's no central authority here. I don't understand what's going on. The CDC isn't giving press briefings. They're just absent. And that could be because the administration is muzzling them. Or it could mean that there's disarray inside the CDC. And I guess all of that will come out.But I feel guilty because I knew them. So it's a bit like not wanting to think your Uncle Bob did something wrong or was capable of doing something wrong. That's why I feel bad, because I just assumed that this response would look like the old response. And it doesn't at all, and I just feel so awful.I wasn't one of those people sounding the warning alarm. I really felt like we had a shot at containing [it]. But that meant that we had to have tests. I didn’t realize what 10 years of underfunding public health had done.
Advertisement
I was never tested, but if I had to lay bets I would say I have it. I’m still sick now. I’m on day 25. I got sick on March 1. It was the classic sore throat, feeling a little bit disgusting, and then at day five or six my fever started to spike. It got as high as 102.5 and never went below 100, despite taking massive amounts of fever reducer.I started having tightness in my chest. I had a dry cough. I went to the ER on March 9. They put me in a separate room. Before all this went down, I had been contacted to go to Washington to the House of Representatives and give a public statement before Congress about what we’ve learned in pandemics past. Of course, that all got shot out of the water.I asked the ER doctor, “Can you tell me in your professional opinion, are you prepared for this?” He said, "Absolutely not." He had been doing this for 12 years. He was there for the 2009 pandemic. He said in 2009 they were overprepared. They had extra flu kits, they had extra supplies, they were ready. They had been prepared by the Department of Health. The communication had been clear. He said, "I hate to tell you this but we’re underprepared now. We don’t have extra supplies. We don’t have any tests." That’s when I started to think, "This is serious."The only way we get out of this, the only way we return to a semblance of normal, is massive testing. And I’m starting to get worried because when are we doing that? It’s mind boggling.
Advertisement
After SARS [in 2003], everyone got real serious for a minute. And there was a lot of funding going into public health surveillance and response because the world got a little preview of what could happen, what was possible. And I feel like maybe that's also why 2009 went better. It was only six years after SARS, people had been drilling, and they had been planning, and they had been prepping. And they had a little bit more money because of SARS.Why do you think this happened and how do we make sure it doesn’t happen again?
We’ve been too successful. It’s the same story with vaccinations. As a culture, we have no institutional or cultural memory anymore of what it’s like to live with microbes. This is a crash course. It’s a wake up call. My hope is, the only thing that keeps me going, is maybe we’ll learn a lesson from this.Fund public health. Maybe we’ll change our culture so that it’s not expected or brave of you to go to work sick. Maybe we’ll start to protect each other the way Asian cultures do. It’s pretty normal in Asian societies to wear a mask when you’re sick when you go out in public and to stay home if you can. We are the exact opposite. We wear masks to protect ourselves and we feel free to show up at a meeting when we have a fever.The CDC has to be cut free of political influence. I can’t believe the agency is a federally-appointed administration. Everytime the administration changes, the leadership of CDC changes and that’s insane. We need to find a way to give places like the CDC and [National Institute of Health] autonomy with oversight.How are you processing your guilt?
I have made a resolution that going forward, I will not make the same mistake twice. I will not be so certain about what I know in the future. And I will do more due diligence on trying to figure out what the current situation is. And as a second thing that I'm doing with my guilt is I'm being extremely honest with my students and with my colleagues.