This article was written in 2006. One of the authors was Donald Henderson, the physician who headed up the WHO project that eradicated smallpox. He died four years ago. In addition:
From 1977 to 1990, [Henderson] was Dean of the Johns Hopkins School of Public Health. Later, he played a leading role in instigating national programs for public health preparedness and response following biological attacks and national disasters.
So Henderson’s credentials were impeccable.
Here are some prescient and cautionary quotes from the 2006 article, which discusses possible public health reactions to a future flu pandemic (up to and including something of the magnitude of the 1918 pandemic). But I see no reason it wouldn’t also apply to COVID:
…[T]here has been interest in a range of disease mitigation measures. Possible measures that have been proposed include: isolation of sick people in hospital or at home, use of antiviral medications, hand-washing and respiratory etiquette, large-scale or home quarantine of people believed to have been exposed, travel restrictions, prohibition of social gatherings, school closures, maintaining personal distance, and the use of masks. Thus, we must ask whether any or all of the proposed measures are epidemiologically sound, logistically feasible, and politically viable. It is also critically important to consider possible secondary social and economic impacts of various mitigation measures.
Note the balanced point of view, and the recognition that there are definitely costs to such mitigation measures that must be factored in. More:
A number of mitigation measures that are now being considered could have a serious impact on the ability of the health system to deliver adequate care and could have potentially adverse consequences for the provision of essential services. Many could result in significant disruption of the social functioning of communities and result in possibly serious economic problems. Such negative consequences might be worth chancing if there were compelling evidence or reason to believe they would seriously diminish the con-sequences or spread of a pandemic. However, few analyses have been produced that weigh the hoped-for efficacy of such measures against the potential impacts of large-scale or long-term implementation of these measures…
It has been recognized that most actions taken to counter pandemic influenza will have to be undertaken by local governments, given that the epidemic response capacity of the federal government is limited.
And yet, of course, with COVID Trump is being blamed for not having somehow figured out exactly what measures would stop the pandemic in its tracks and then implemented them by executive order.
The authors then discuss computer modeling to help with decision making, and they are somewhat skeptical about its efficacy:
No model, no matter how accurate its epidemiologic assumptions, can illuminate or predict the secondary and tertiary effects of particular disease mitigation measures. Nor,for example, can it assess the potential effects of high absentee rates resulting from home or regional quarantine on the functioning integrity of essential services, such as hospital care or provision of food and electrical service to the community. If particular measures are applied for many weeks or months, the long-term or cumulative second- and third-order effects could be devastating socially and economically. In brief, models can play a contributory role in thinking through possible mitigation measures, but the cannot be more than an ancillary aid in deciding policy.
We relied on models heavily, however, especially in the earlier reaction to the pandemic. Now we seem to be relying mostly on politics and hunches.
Here, the authors correctly foresee the possibility of closing schools and some of the attendant problems [emphasis mine]:
Some have suggested closure might be recommended for as long as a pandemic persists in a single community (perhaps 8 weeks) or for as long as a pandemic persists in the country (as long as 8 months).18Therationale for the strategy is to diminish contacts between students and so retard epidemic spread. However, if this strategy were to be successful, other sites where school-children gather would also have to be closed: daycare centers, cinemas, churches, fast-food stores, malls, and athletic arenas. Many parents would need to stay home from work to care for children, which could result in high rates of absenteeism that could stress critical services, including health care…
Political leaders need to understand the likely benefits and the potential consequences of disease mitigation measures, including the possible loss of critical civic services and the possible loss of confidence in government to manage the crisis.
The part that I highlighted is a very real consequence that we’ve been experiencing with COVID. But what the authors didn’t foresee was that this loss of confidence in government might be used as a political football by the party opposed to a president who is defined as not having responded to control the pandemic at the outset. Right now for the Democrats, loss of confidence in the federal government may be seen as a feature rather than a bug, if it hurts Trump’s chances of re-election.
The article then goes into a discussion of various strategies such as handwashing and quarantines, and adds that travel restrictions have not been found to be effective in the past. Here’s the discussion of prohibiting large gatherings:
Were consideration to be given to [banning large gatherings] on a more extensive scale and for an extended period, questions immediately arise as to how many such events would be affected. There are many social gatherings that involve close contacts among people,and this prohibition might include church services, athletic events, perhaps all meetings of more than 100 people. It might mean closing theaters, restaurants, malls,large stores, and bars. Implementing such measures would have seriously disruptive consequences for a community if extended through the 8-week period of an epidemic in a municipal area, let alone if it were to be extended through the nation’s experience with a pandemic (perhaps 8 months). In the event of a pandemic, attendance at public events or social gatherings could well decrease because people were fearful of becoming infected, and some events might be cancelled because of local concerns. But a policy calling for community wide cancellation of public events seems inadvisable.
Inadvisable. And yet it’s been going on now for close to half a year.
About distancing:
It has been recommended that individuals maintain a distance of 3 feet or more during a pandemic so as to diminish the number of contacts with people who may be infected. The efficacy of this measure is unknown. It is typically assumed that transmission of droplet-spread diseases, such as influenza, is limited to “close contacts”—that is, being within 3–6 feet of an infected person. Keeping a space of 3 feet between individuals might be possible in some work environments, but it is difficult to imagine how bus, rail, or air travelers could stay 3 feet apart from each other throughout an epidemic. And such a recommendation would greatly complicate normal daily tasks like grocery shopping, banking, and the like.
Well, we seem to have figured out a way around that, by making people wait in lines while standing on those little circles that designate the distance deemed proper. But what science is that distance based on? As the article states, “the efficacy of this measure is unknown.” And as far as I can tell, it’s still unknown.
Masks?:
In Asia during the SARS period, many people in the affected communities wore surgical masks when in public. But studies have shown that the ordinary surgical mask does little to prevent inhalation of small dropletsbearing influenza virus. The pores in the mask become blocked by moisture from breathing, and the air stream simply diverts around the mask. There are few data avail-able to support the efficacy of N95 or surgical masks out-side a healthcare setting. N95 masks need to be fit-tested to be efficacious and are uncomfortable to wear for more than an hour or two. More important, the supplies ofsuch masks are too limited to even ensure that hospitals will have necessary reserves.
And that is more or less how it has played out – first we were told not to bother with masks, and also that there were shortages of the N95 masks for healthcare workers. Now we are told we must wear masks even if they are makeshift and made of cloth.
The article ends this way:
Experience has shown that communities faced with epidemics or other adverse events respond best and with the least anxiety when the normal social functioning of the community is least disrupted. Strong political and public health leadership to provide reassurance and to ensure that needed medical care services are provided are critical elements. If either is seen to be less than optimal, a manageable epidemic could move towards catastrophe.
Cooler heads did not prevail, fear has been heightened, most of the suggestions in this article have not been followed, and we have moved towards catastrophe.






