Howard Markel: Saving Lives by Historic Proportions
As a doctor, Howard Markel knows how to save a life. As a medical historian and researcher, he knows how to save millions of them. Meet this renowned expert in global pandemics who helped the U.S. Centers for Disease Control and Prevention shape the response to COVID-19.
[AUDIO OF MARKEL PLAYS]
Wood: Well, it’s probably a good thing the playwright career didn’t work out, because Dr. Markel is now one of the foremost experts in the history of pandemics, and his work helped shape the U.S. Government’s pandemic response plan that was put into place this year to help battle the Covid-19 crisis.
[AUDIO OF MARKEL PLAYS]
Wood: And via Zoom he’s here with us now. Dr. Howard Markel, welcome.
Howard Markel: Well, thank you for having me.
Wood: The last time we saw each other was in the Michigan News studio. It was on March 12th when you were appearing on NPR’s Here and Now show.
Wood: The pandemic was officially declared the day before, March 11th. Now it’s December of 2020, in what feels like a lifetime ago.
Markel: Seems like ten years ago at middle.
Wood: Isn’t that crazy. Well, what have you been up to and how are you doing?
Markel: Well, I’m doing fine. And my loved ones are healthy and we’re social distancing and staying safe at home. I have been busy just as accountants say that January to April is their busy season. If you’re a historian of pandemics, this has been my busy season. So, one of the joys and honors of my work is that I’ve been commenting and helping elucidate this pandemic as it unfolds to, you know, hundreds of media outlets and I have done—I can’t count many, many hundreds of interviews for National Public Radio and Public Broadcasting and The New York Times, Wall Street Journal, you name it.
Markel: I’ve spoken to them and I can do about five or more interviews a day. I kind of look at that as part of my responsibility as a professor at a public university. I’ve always felt that playing a role in society, of explaining things is a big part of my job. And this has been a real test to try to make sense of this pandemic, which is, if not the worst one in 100 years. It’s a close second to the 1918 pandemic and certainly the most politicized pandemic in the history of medicine.
Wood: And to that point, you probably have studied pandemics more than—probably more than most people in the world, and particularly the 1918 flu Pandemic. But this one being politicized so much, how does that make you feel and what does that do as far as, you know, trying to help citizens do the right thing?
Markel: Well, it’s very upsetting and disorienting because many doctors and scientists, and I frequently fall into this category believe that, you know, if you just explain the science, that you just explain the medicine behind a particular intervention or treatment that people will understand and follow through or comply with that treatment. And with this pandemic, particularly under our current president, who has done more to fuel the fires of dissent on many levels, but especially with the pandemic than I’ve ever seen in a leader.
Wood: In 1918, although it was such a different time, you know, compared to our modern times, there were a lot of similarities. They were—people wore masks, people socially distanced? Was there also a political element at all?
Markel: A bit. You know, the social distancing measures that they used back then were because that’s all they had. There were no antivirals. There were no antibiotics. A lot of people with flu get a secondary bacterial pneumonia and you can die of that. There are no IVs. A hospital is barely a bed and perhaps a nurse feeding you broth or clear liquids. But people did seem to follow it. There was some political element. There were a few people in each city that disagreed with mask laws or social distancing that were scofflaws, particularly in the Western states where they made mandatory mask laws. But this was a minority that was easily squelched. More to the point, the 1918 flu pandemic coincided with the beginning and end of World War One for Americans, that is.
Markel: The Great War began far earlier, if you were in Europe. And so there was a lot of patriotic fervor in the United States. And doing the right thing by flu, got mixed into doing the right thing by the war to end all wars. So that became a sort of a combination one two punch. You know, the term slacker was really invented in 1918. It referred to men who tried to dodge the draft and to Americans who didn’t follow the social distancing policies of their local health department.
Wood: You conducted one of the—you and your team, one of the—well, the largest study on that pandemic. How did that come about? And how were you first contacted by the government regarding your pandemic studies?
Markel: Well, by that time, I had studied epidemics and pandemics for a long time, maybe 15 years of my career. And first, the Defense Department and then the Centers for Disease Control were interested in my work around 2005, 2006, which, as you may remember, was when we feared that bird flu (H5N1) would somehow mutate and become extremely contagious and easily transmitted human to human. Fortunately, that never happened. It remained a bird problem, but not a human problem. But the government became very interested in pandemic preparedness planning, and the idea was, “Could non-pharmaceutical interventions that’s what we called them back then or what we call now social distancing measures such as quarantine and isolation, school closures and public gathering bans reduce the mortality and morbidity in a particular city?”. Could it flatten the curve? And that’s where that expression came from actually, it was over a takeout dinner of some very bad noodles that had completely flattened and congealed. And so I said to my colleague Martin Cetron at the CDC, we were working late one night in Atlanta and I said, look, it’s just like the curve, it’s flat. And that’s where that expression came from. But what we found in those American cities, forty three of them, was that those that use these social distancing measures and use more than one in sort of a layered approach, a Swiss cheese layered approach so that you try to block the holes, did them early and did them for a long time, did far better than those that did not.
Markel: A subsequent study conducted by the Federal Reserve Bank of New York found that those cities that acted early, layered and for a long time also bounced back economically, far better and far faster than those that did not. So that was the basis of what became the federal government’s pandemic preparedness policy for a worst case scenario in a 1918-like pandemic. We wouldn’t roll these out willy nilly for a mild epidemic or pandemic that wasn’t all that lethal. And because they were so, as we know, so disruptive or so socially disruptive, economically disruptive, even politically disruptive, we would only roll them out if the death—the case fatality rate was high. And Covid surely falls into that. And so even though there were subsequent studies after our study that was published in 2007 in the Journal of the AMA, there were many subsequent studies, modeling studies, real time studies. But it was really this Covid-19 pandemic where it was shown to work again and again and again. But it only works to delay time before you get infected to hide from the virus. It also works to lower the number of people at any given time who are rushing to the hospital. And so you don’t have an overflow of people at your emergency rooms, at hospitals, and intensive care units. And it hopefully buys time until we could create a vaccine, which is the real silver bullet in all this. But it’s been very gratifying. It’s quite exhilarating as well as horrifying to know that you contributed to a measure that has saved millions of lives. I mean, that’s what doctoring is all about. So it’s been both very fulfilling and exhilarating and at the same time very horrifying to watch what’s going on around the world over these past nine or ten months.
Wood: How did you as a pediatrician, start studying pandemics, epidemics in general, that I’ll get started?
Markel: Well, after my pediatrics residency at Johns Hopkins, the department of pediatrics gave me a wonderful gift and said they would pay for my Ph.D. in the history of medicine at the Johns Hopkins Institute for the History of Medicine, which was right across the street. I had articulated that’s what I wanted to do. And they they helped me do that. And I was also seeing patients during that time, particularly adolescent patients in Baltimore. And I saw a lot of kids with sexually transmitted diseases—a lot of teenagers with STDs like gonorrhea and syphilis, and with the beginning of the HIV crisis, even HIV AIDS. And around that time, a friend of mine was starting an AIDS clinic for adults in Baltimore and asked if I would help because I had a lot of experience with sexually transmitted diseases. And I said yes, and I was fascinated by AIDS ever since I was a medical student. In fact, that was the pandemic that framed my medical career. And while I was seeing HIV patients, adults who could talk to me quite clearly as opposed to children or babies. And a lot of people asked me, hey, doc, do you think I’ll be quarantined because I have HIV? And for several times I said, no, of course not. It’s a sexually transmitted disease. That’s not the way quarantine works. But, you know, as a doctor, you don’t get the same social question over and over again without it meaning something, you know, people ask, will this hurt or how much does this cost? But they won’t ask you a broad question like, will I be quarantined? And then it hit me. Oh, you know, most of my patients were intravenous heroin users or gay men in an era where both groups were highly stigmatized, were not welcome into mainstream society. And it was not that big of a leap to think, well, I’m HIV positive they’re going to put me on an island somewhere.
Markel: So I began to be thinking as a historian. I began to be interested in the origins of quarantines and how it was used not only as a public health tool, but also misused as a political or social tool. And I started studying immigrant groups in New York City, where there are a lot of epidemics in the 19th century. And in 1892, there were two epidemics, one typhus fever, the second cholera that were thought to be imported by East European Jewish immigrants.
Markel: And, well, that’s my ethnic origins. My grandparents came from Eastern Europe, from Poland and Russia. They spoke Yiddish and so did my parents. So I learned Yiddish and I started reading the Yiddish press of that era. And of course, these immigrants knew exactly what was going on—of how the public health department was coming down a little bit harder on them than on other New Yorkers. And I just kept studying it, studying and studying it. And I was actually—when I got called by the Pentagon to start this work, it was July 3rd, 2005. I was getting ready to leave the office for the Fourth of July weekend. And I was actually starting a new book, it became a book. I wrote a book called “An Anatomy of Addiction”, which was about Sigmund Freud and the surgeon, William Halsted, who both discovered cocaine and liked it a little bit too much. So I was actually thinking of segwaying my research at the time. And just like Al Pacino in Godfather Part III, they pulled me back in and we started studying the 1918 flu pandemic, which was actually one of my least favorite epidemics as a graduate student. But the study of that became very important and has framed much of my subsequent scholarly life. And it was just a matter of being at the right place at the right time and choosing the right topic to study.
Wood: Isn’t that the way it goes. And I think that’s—I think it’s more than coincidence. I mean, you look at your career right now. You have a Ph.D. in the history of medicine. You’re a medical doctor, you’re a gifted writer. You’ve written books. You’ve, you know, just the gift of age. You know, if we’re smart enough, we get a little wisdom as well. But all the things—all the things you’ve done seem to have brought you to this point. Do you do you ever look back and say, “Wow, this was all meant to be!”?
Markel: It didn’t always seem that way because there are a lot of bumps in the road, but yes, I was thinking about this. I’ve been writing non-fiction stories for The New Yorker lately. And I’ve—I always dreamed of writing for The New Yorker. As a 14 year old, I used to send them bad essays and bad poems and have a file of rejection slips from that part of my life. But as I was writing a piece, I thought to myself, gosh, I have been studying for more than 30 or 40 years just for this moment. I’ve been preparing all these years, just for this moment. But chance always favors the prepared mind, as Louis Pasteur said. So there was a lot of luck. There was a lot of help. I had many mentors along the way who saw things in me before I did. I’ve had a lot of great opportunities to hone my craft as a writer. And I write every day, just like a surgeon would operate every day to keep—to keep my mind nimble. And it all worked out. And it began here at the University of Michigan when I was an 18 year old freshman, thinking of great things, not knowing how to get there.
Wood: I know you grew up in metro Detroit. What was your life like as a kid? I mean, what did your folks do, did you have siblings, kind of paint the picture for us?
Markel: In retrospect, I was a very weird kid. And in fact, I used to go to the Southfield Public Library and look things up on microfilm. I go to old copies of The New York Times to find, like Harpo Marx’s obituary or things like that. So, you know, I grew up in the suburbs of Detroit in a predominantly second generation East European, Jewish immigrant, native born American neighborhood. I always loved reading. I always—I wanted to be a playwright. I liked comedy, and I liked show business. And I—I thought I was a funny, clever guy. I just didn’t write very good plays. I have several of them in a file cabinet and they should stay there. I could write good jokes, but I wasn’t very good at plots. My father was a stockbroker. He was a businessman. He had a remarkably good mind. He only went to two years of college, though. But he could—he had a photographic memory with—many other people in my family have this memory. I used to have it. As I get older its going away. But he could remember stock quotes or whatever, and he studied the stock market just like I study epidemics in a way. So I saw that in my father. My mother was a high school graduate, never went to college. She worked for the city of Southfield as a bookkeeper, and she was an avid reader. So both of them, knew I loved to read and they always made sure I got—they always understood in some way that I was a different kind of a kid.
Markel: And when I came to college in Ann Arbor, I thought, well, I’d like to be a doctor, but I’d also like to be a writer. But I didn’t know how to combine those. And I met some wonderful professors who convinced me to major in English, which was actually one of the better decisions I made in my life. I wrote a lot. I read a lot of good books. I was exposed to a lot of good writers who I wouldn’t ordinarily read on my own. And then when I went to medical school, I was introduced to a really wonderful scientist named Horace Davenport. He was a member of the National Academy of Sciences and a very big deal in the world of physiology. But he was in retirement writing a history of the University of Michigan Medical School, and he asked me what I’d like to be. And I said, probably a pediatrician. And he said, good, you could write the history of the Department of Pediatrics chapter. I had no idea, I didn’t even know what medical history was at that point. And he took me to the Bentley Library and I fooled around and I found things. I was always— I’ve always been very lucky in finding things in the archives. And that started the whole ball rolling. And then he told me, you’re going to have to get a Ph.D., which is the last thing a first year medical student wants to hear when he’s looking down the barrel of, you know, four years of medical school and five years of training.
Markel: But I planned it very carefully each step, and I managed to leap to the next—to the next level each time.
Wood: That’s amazing. So knowing what you know now and after this career, you know, it’s been going on for this long. What advice would you give a young student just starting college or maybe a high school kid who was, you know, just not sure what they want to do and there’s just all these choices in front of them. Any advice?
Markel: Student asked me this just the other day. And gosh, I remember in real time agonizing over every decision I ever made, as if the world would collapse with with the great egocentrism of a twenty year old. The world didn’t collapse. And Horace Davenport said to me, no matter what decision you make in life, you’ll live to regret it. He was kind of a morose guy. That’s not exactly true. But what I have found that even after being able to make a career that is about as unlikely as you can get, what I found is, is that by pursuing. The things that I love, that I have great interest in, and doing my best each day, the rest took care of itself. And and I’ve used that philosophy for a long time, “Take care of the day’s work in front of you do the best you can and the next day will take care of itself”. That’s not always true. I mean, life has a way of punching you in the gut at various points. But and the other thing that helped me and still helps me because I went to my desk this morning just as excitedly as I did 30 or 40 years ago, and I do every morning. I start writing at five a.m., by the way, is that. You have to have curiosity in life, you have to ask why. Why is this the way it is? And hopefully you might want to fix it or understand it or find a way to articulate it to others. There’s never been an easier time in human history to be curious because we carry essentially the Library of Congress as well as every other library in our pocket in our phones.
Markel: You don’t want to go to the graduate library anymore to look a lot of things up. You can just type it into your phone. But you have to be curious and you have to ask why. And so that has guided me through all this. I’ve been very fortunate. I’ve been very grateful to, you know, the many people who helped me and to the University of Michigan, which has allowed me to pursue what some might think is a rather wacky career. And I would correct them. Turned out to be a very rewarding and useful one.
Wood: Well, yeah, on behalf of all of us who gain knowledge from, from the things you say on the radio or in The New York Times or whatever, you know, and what to do in guiding the government through all this. I mean, there’s a debt of gratitude. I mean, you’ve done this wacky career has somehow turned out to be to be really a blessing. And I know you’re busy, guy. I really appreciate your time today. And thanks for sharing your story.
Markel: My pleasure. It’s been my honor to do all this. Thank you.
Wood: And thank you all for taking the time to listen. I’d also like to thank the whole team here at Michigan News for their support of this podcast as we all stay isolated at home. Remember, if you liked what you heard, search for Michigan News Beyond the Headlines, wherever you get your podcasts. And don’t forget to hit that subscribe button so you won’t miss an episode. Season two is just started and there’ll be many more inspiring stories to come. I’m Mike Wood. Be well, be safe and I’ll see you, beyond the headlines.