Dr. Howard Markel, director of the University of Michigan’s Center for the History of Medicine, has written extensively on American pandemics, as well as on the political uses of quarantine and isolation. The Michigan Daily spoke with Markel over the phone last month to hear more about his work as a doctor and scholar during the COVID-19 pandemic.

Markel began by explaining how he co-authored a paper with his colleague Dr. Marty Citron on “flattening the curve” in 2007, which suggested that cases are reduced when social distancing measures are implemented. Citron visualized data into a curve, now considered by many to be a defining public health image of COVID-19.

Markel said his work on flattening the curve began in 2005 in the era of the H5N1 avian flu. Citron, who worked as the head of the Division of Global Migration and Quarantine at the Centers for Disease Control and Prevention, would frequently travel with Markel to give presentations. Usually, their trips took them to Atlanta or to Washington, D.C. 

“I knew the room service menu at the hotel I stayed in by heart,” Markel recalled. “I always ordered the same thing. I can even tell you: chicken with a mustard sauce and rice.” 

Markel said he coined the term “flattening the curve” while opening a takeout container of pad thai, which looked like a flat curve.

“When I took out the pad thai, it was all flat like one giant noodle,” he explained. “I said: ‘it’s just like the curve. It’s flat!’ So, that’s where ‘flattening the curve’ came from.”  

Markel said the implementation of social distancing measures in Mexico during the 2009 influenza epidemic became the pair’s first living “laboratory” for their concept. At the time, Markel said he and Citron noticed that though the influenza epidemic was not as deadly as some feared, the application of social distancing measures had the desired effect they’d predicted: They extended the preparation time allotted to the Mexican government, ensuring its hospitals were able to see a smaller and therefore more manageable influx of patients. 

Despite the reduction in cases, Markel said he and Citron encountered strong doubt — and outright dismissal — when they presented their work to the public in the early 2010’s. Markel said he experienced contradictory emotions when seeing his life’s work suddenly become so relevant during the COVID-19 pandemic. 

“We didn’t have a crisis to apply this to until now,” Markel said. “It’s been incredibly exciting for me as a scholar and a professor, and as an observer, I’ve been horrified.”

While social distancing is “the nuclear option” because it is so disruptive to how society functions, Markel said it remains necessary for putting an end to the COVID-19 pandemic and, despite disagreements over public health programs and policies, the country needs a centralized program. 

In his book “When Germs Travel,” Markel makes the case for a globally funded public health program. 

Markel said the World Health Organization has a very small staff and must be invited into a country because it has no “police powers.”

“The main thesis of (the book) is that germs don’t respect borders,” Markel said. “There’s no sovereignty to an epidemic — they travel. An outbreak anywhere can easily go everywhere, as we found out.” 

Markel is especially interested in the weaponization of epidemics against immigrant and migrant groups. Markel, who worked at an AIDS clinic as a graduate student at Johns Hopkins University and at an immigrant hostel in Detroit, said this interest stemmed from his Eastern European Jewish heritage. 

Markel learned from his grandparents — who raised him in a bilingual household speaking Yiddish — that the typhus fever and cholera epidemics had been blamed on Eastern European Jewish immigrants in New York City at the turn of the century.

“I wanted to delve into the Yiddish press and sources to see how they experienced it, in comparison to how the Anglo-American or white American press encountered it,” Markel said. “Of course, they knew what was going on. They knew enough science and they knew they were being corralled.”

Markel said the “uses and misuses of public health measures as social means” contributed to staggering misconceptions about patients affected by the AIDS epidemic. While working at the AIDS clinic, Markel said many patients who were gay or used intravenous drugs asked him if they’d be quarantined.

“First, I said, ‘Well, no, it’s not the right disease, it’s sexually transmitted and that wouldn’t be the way to do it,’” Markel said. “But, I kept hearing this question and as a doctor, you don’t hear the same social question over and over again. You hear, like, ‘Will it hurt? How much does it cost?’ Or, ‘What are the side effects?’ But you don’t hear that.” 

Markel said the realization that the political manipulation of quarantine was used as an excuse to isolate already stigmatized or scapegoated populations struck him “like a lightning bolt.”

He also said his patients were painfully aware of this trend. To these patients, the word quarantine was not simply code for a public health policy, but rather a metaphor for the increasing stigmatization and isolation that resulted from their illness.

In his book “Quarantine,” Markel said his historical research and clinical practices are similar because they both require him to use primary sources to arrive at a diagnosis.

Markel said he feels an obligation to bring attention to marginalized communities, referencing his work with individuals who have AIDS. 

“(I have a) responsibility to bear witness and tell the stories (of scapegoated groups),” Markel said. “What I was inspired to do, based on what I saw in my clinic with AIDS patients, was to dig as deeply as I could.”

Markel said even while taking on various roles — such as medical historian, physician or writer — he never forgets the Hippocratic oath he took to protect and serve his patients. Though he said he has been accused of holding partisan opinions after writing about strategies for containing the virus, Markel said he cannot endorse viewpoints that do not protect his patients’ lives.

“I’m a pediatrician, and I take care of kids,” Markel said. “I’m pretty sure that if I told people I wouldn’t do everything in my power to preserve lives, no one would want me as their doctor.” 

When asked about what kind of work he will do for the remainder of the pandemic, Markel emphasized his range of expertise. 

“I’m a medical historian, and so I don’t pretend to know anything about how to predict the future,” Markel said. “But what we do know from history is what works, so I can say with confidence that we know social distancing and flattening the curve works.”

Daily News Contributor Sierra Élise Hansen can be reached at hsierra@umich.edu.

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