If you’ve ever heard the phrase “flatten the curve,” you have Dr. Howard Markel to thank. Following the 2002-2004 SARS pandemic, the George W. Bush administration contacted Markel to help establish national response guidelines for future global outbreaks.
The Jewish-American medical expert helped influence policies that remain in place for today’s coronavirus response, but arguably Markel’s most popular legacy is the term “flattening the curve.” It means stretching the time frame of contagion to limit the number of cases and buy time for a response. Markel said he coined the phrase through an unlikely scenario.
“I was having some very bad, gooey noodle dish,” Markel said. “One flat noodle was bigger [than the others]. It flattened the curve.”
Markel is the George E. Wantz, M.D. Distinguished Professor of the History of Medicine, and Director of the Center for the History of Medicine at the University of Michigan. The medical doctor has written extensively about infectious diseases in history — including in his first book, “Quarantine! East European Jewish Immigrants and the New York City Epidemics of 1892,” as well as a subsequent book, “When Germs Travel: Six Major Epidemics That Have Invaded America Since 1900 and the Fears They Have Unleashed.”
In a year-long effort for the Bush administration, Markel studied the 1918-1919 Spanish flu pandemic, which is generally agreed to have come in two waves, with the second deadlier than the first. He focused on response measures called non-pharmaceutical interventions, or NPIs — ways to isolate people such as social distancing and lockdowns.
Studying 43 cities across the United States, he found that the most effective cities used NPIs earlier, implemented a layered system and acted over a longer period of time. However, 23 cities lifted their measures too early, and overall saw their cases rise.
Markel’s findings have been implemented not only in the US, but elsewhere in the world, including Mexico during its response to the 2009 avian flu pandemic.
Today, Markel is addressing the COVID-19 crisis through webinars, public interviews and op-eds. His ideas on NPIs have received praise from the Democratic governor of his home state of Michigan, Gretchen Whitmer. He said he speaks with Whitmer often and supports her policies. (He said the Trump administration has not contacted him.)
Whitmer recently extended Michigan’s state of emergency order until July 16, which allows the governor to moderate the state’s reopening. “The aggressive measures we took at the start of the COVID-19 pandemic have worked to flatten the curve, but there is still more to be done to prevent a second wave,” Whitmer said in a press conference last week.
A matter of faith
Markel recognizes that social distancing and lockdowns can have a disruptive effect on society and recent months have witnessed members of the public breaking quarantines by participating in mass protests.
Earlier this year, anti-lockdown protestors held demonstrations, including inside the Michigan state capitol in Lansing, where armed demonstrators denounced Whitmer. More recently, people have taken to the streets for a different reason — to protest police brutality and racism after the death of George Floyd.
The national mood seems reflected in a policy shift. While each state decides its own procedures and roll out, all 50 states are currently in some form of reopening, even as 27 states are recording new daily rises in cases, and some are reversing or pausing their plans, according to The New York Times. Houses of worship, including synagogues, have been the subject of heated debate ever since closures began.
“It’s a tough call but given how most states have gathering bans on 10 or more people, it seems that in person [prayer] at synagogues [is] not going to happen anytime soon,” Markel said. “Fortunately, we have such wonderful internet technologies like Zoom that allow us to connect and attend shul [synagogue] virtually if not actually.”
When The Times of Israel asked Markel what would be a good reference point for the country to reopen, he replied, “That’s the million-dollar question. We don’t know.” Yet he said that less than 50 new coronavirus cases per 100,000 people “seems like a good number, a good threshold.”
“COVID-19 is still circulating around the country, around the world,” he said. “Not everybody is getting tested … There are still 320 million Americans who have not caught it yet, who are still susceptible. If you open up a state, and people go out when the virus is still circulating, there’s a risk more people will get it.”
What’s happening in congregations today?
A recent US opinion poll shows that most Americans are not ready to return to places of worship. “Only 36 percent of Americans, including 40 percent of Americans who belong to a religious tradition, say they would feel comfortable attending an in-person worship service,” according to an American Enterprise Institute survey released this week. According to Religion News, 56% of those who reported their congregations offered in-person worship in the past week still chose not to go.
But it is harder for congregations that strictly follow halacha, or Jewish law, and cannot use technology to offer an online Shabbat services, for example. National organizations such as the Orthodox Union and Agudath Israel have released guidelines on reopening that stress the need for case-by-case decisions, but allow for reopening when the coronavirus outbreak is in abeyance.
In Georgia, which was among the earliest states to relax restrictions, a group of Atlanta-based Orthodox rabbis drafted an additional set of guidelines. As a result, some congregations in Atlanta have moved toward in-person worship.
“Most of the Orthodox synagogues in Atlanta intend on having indoor services this coming Shabbat,” Rabbi Yossi New, regional Chabad director of Georgia and head of Congregation Beth Tefillah, wrote in an email. “Masks and social distancing will be required. The larger synagogues require pre-registration.”
Rabbi Ilan Feldman of the Orthodox Congregation Beth Jacob told The Times of Israel in an email that “we are back in the building, with social distancing, masks, other restrictions (bring your own siddur [prayer book], no bathroom access, doors propped open).”
In contrast, The Temple, a historic Atlanta Reform synagogue, remains virtual, although it has “a plan to gradually open up, with safety being a top priority,” noted its senior rabbi, Peter Berg.
Whether looking to reopen or staying closed for now, rabbis often cited the halachic principle of pikuach nefesh, or the importance of saving a life above all else.
“I think for synagogues all over the world, safety and health is the single No. 1 priority,” Berg said, noting that at his synagogue, “we have learned how to create a series of sacred constructs without having people gather in the synagogue in-person.”
Another state that reopened on the earlier side is Oklahoma, which is now seeing rising numbers of new coronavirus cases. Oklahoma made headlines on June 20 for a Trump campaign rally in Tulsa that contrasted with numerous public health guidelines. Oklahoma City rabbis have indicated that they are not rushing to reopen.
Oklahoma City’s Reform Temple B’nai Israel is keeping its services virtual. Its board has approved a reopening plan, and it is reintroducing programs for youth. Yet, Rabbi Vered Harris wrote in a recent email, “We will continue to livestream our services with congregants participating from their homes, and we expect most of our congregation to stay on-line even when the sanctuary is open.”
In a conversation last month, Oklahoma City Chabad Rabbi Ovadia Goldman said that he has allowed individuals to come in for a hot meal or a delivery while his center is closed, and he offers Shabbat kits for pick-up outside. Beyond that, he adopts a wait-and-see policy depending on data.
In Kansas, Rabbi Doug Alpert, president of the Rabbinical Association of Greater Kansas City, has seen his Reform congregation of Kol Ami hold a recent outdoor service in solidarity with a peaceful protest supporting the African-American community. Otherwise, the congregation is staying virtual.
Kansas is the home state of two Baptist churches that successfully sued in federal court to hold in-person worship for gatherings beyond 10 people. Alpert described the position of these churches as “ill-advised.”
Atlanta-based The Temple’s Berg cited instances in other states when worshipers contracted the coronavirus after a church reopened. In Arkansas, 35 of 92 attendees at a rural church from March 6 to 11 became infected, and three died, according to the CDC.
“It certainly seems we’re opening up far too quickly and I think there are going to be repercussions for it,” Berg said. “There’s no question we want to figure out how to do this, but it has to be done at the right pace, using the numbers and statistics provided by experts.”