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Thursday Review: “Better Prepare Than React: Reordering Public Health Priorities 100 Years After the Spanish Flu Epidemic”

This article is (you’ll pardon the reference) The Sixth Sense of pandemic scholarship.

Michael Greenberger writes a series of painfully accurate observations in the 2018 American Journal of Public Health. The statistics, facts, and warnings in the first half of the piece read like a checklist of things that have gone wrong to lead up to the COVID-19 crisis. The twist no one sees coming is that when Greenberger gets to an individual’s narrative during the 2014 Ebola outbreak, the problem is exactly the opposite of what the world faces in 2020.

Greenberger warns that the US in particular, but the world in general, is ill-prepared for another “Spanish flu”. Medical resources are spread thin, and public health budgets have been cut. The focus of Greenberger’s argument is that we are only capable of reacting to a pandemic, belatedly racing to identify and catalog the disease, instead of being prepared for it.

So far, so good, but here’s where the article pivots:

More often than not, these [non-pharmaceutical interventions], such as quarantine, are implemented in a highly reactive, fear-based environment, in which they are likely not based on a clear, evidence-based, scientific assessment of the pandemic.

The author then goes on to discuss the case of Kaci Hickox, a nurse who served with Doctors without Borders during the 2014 Ebola pandemic. Greenberger, an attorney, is concerned with both the public health and the civil liberties aspects of a response to pandemics. In a well-publicized case at the time, Hickox was unnecessarily subjected to both New Jersey and Maine’s quarantine procedures.

What is so interesting is that in the six years between Hickox’ involuntary quarantine and 2020’s mass stay-at-home orders, the thing that’s scaring us is slippery.

In the face of a danger like Ebola, it’s clear that the authorities were willing to put an individual’s rights in jeopardy in the name of protecting the public. In the face of a global virus like COVID-19, there was the same fear, as evidenced by the public’s hoarding of toilet paper and hand sanitizer. As the initial terror of the 2020 epidemic has lessened, the anxiety has shifted. After two months of social distancing and cabin fever, our fears are now about our continued livelihoods: the rent or mortgage is still coming due, isolation or no.

Every story starts with a problem. The odd thing that conspiracy theories, global pandemics, and personal finances have in common is that the easiest problem to find (the one that we are most anxious about at the moment) is the one we feel deserves to start the story.

If we fear Ebola breaking out in our state, the easiest story to act on becomes a reactionary quarantine. If we’re nervous about a novel coronavirus infecting our families, we act on the story that it’s best to become an honorary doomsday prepper and ride this out, together with our five-year supply of Lysol wipes. When we become terrified of losing everything we’ve worked for, the narrative we push forward is that the risk of spreading a tiny virus is an okay trade off for restarting the economy.

The difficult thing about internal narrative is that acting on a better story means finding a better problem to solve.

Greenberger was right, writing that we follow a cycle of panic–neglect–panic–neglect,1 and, through inadequate and slow development of countermeasures, we remain dangerously vulnerable to the threats these pandemics pose.

Getting off the “panic–neglect cycle” before, during, and after a pandemic means not seeing the problem bubbling up from our own anxieties, but seeing the real, medical challenges we face.


The article reviewed: Greenberger, Michael. 2018. “Better Prepare Than React: Reordering Public Health Priorities 100 Years After the Spanish Flu Epidemic.” American Journal of Public Health, 108 (11): 1465–1468.

1 Quick, Jonathan D. 2018. “Our Complacency About The Flu Is Killing Us.” Time.

Featured Image: corrupted photograph of soldiers from Fort Riley, Kansas, ill with Spanish flu; this image is in the public domain