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Tuesday, May 21, 2024

A School Ran a Simulation of the Pandemic—Before the Pandemic

It began, as outbreaks do, with a spark. Three infections, of which two patients soon began showing symptoms. But by the time the coughing and fevers arrived, it was already too late. The virus had spread before its unfortunate hosts even appeared sick. And from there it moved quickly and quietly, multiplying faster through the population than teams of doctors and scientists could quell it.

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By Eve Sneider

This was in December 2019, around the time a virus later called SARS-CoV-2 was beginning to make its presence known within the city of Wuhan, China. But this pathogen was not that particular virus. Unlike SARS-CoV-2, this virus was indeed man-made, its attributes selected precisely for how difficult it would be to contain. A quick, invisible spread. An attenuated lethality that made interventions to stop it nearly impossible to calibrate. In mild cases, its symptoms overlapped with those of other respiratory illnesses, like colds and the flu. It had, in other words, all of the confounding qualities of the virus that would soon turn much of the world on its head. But this virus was a simulation—for middle schoolers in suburban Florida.

The “pandemic” was the culmination of a two-week course at a charter school called Sarasota Military Academy Prep. The organizers had seeded the digital virus via smartphone app, where it spread from student to student through Bluetooth signals. Todd Brown, the school’s outreach director and a longtime teacher there, had created the school’s pandemic simulation in 2016 as a way to teach a lesson in governance. Kids would act as epidemiologists, clinicians, the citizenry, the press, the military, and the government, racing to understand a novel virus and stop the plague while keeping as many people as possible safe and healthy. Plenty of civic lessons would be sure to ensue.

Since then, Sarasota Military Academy Prep has seen many such pandemics. Last year, the organizers chose to model a coronavirus like SARS. But students had previously taken ill with viruses akin to Ebola and pandemic flu. Former student Grace Wagler, now a high schooler, can recall at least three such outbreaks, each with its own zigs and zags. She had seen governments facing civil unrest and vaccines that had gone bust, or had chaotic rollouts. Her classmates had struggled to research the virus’s spread amidst funding constraints and misinformation, and found ways to do their pandemic response at a distance from one another. Most of all, they had come away with a sense of how messy it is when scientists, government officials, and citizens, ill-practiced in working together against a common foe, try to do just that. They were, in other words, prepared for our current moment.

“I can’t really imagine coming into this having no real knowledge and understanding of what’s happening behind the scenes,” Wagler says. “That would be scary.”

Wagler’s experience is unusual. Many Americans, it’s safe to assume, had little sense of what a pandemic would be like before living through one. (No, watching Contagion doesn’t count.) It can be hard to recall just how foreign the term “epidemiology” was to most people prior to February or March, or to contemplate a time when barely anyone knew the first thing about how a virus hijacks a cell. Fewer still are aware of the complex civic systems involved in combating a virus: Which arms of government see to which tasks, which figures are the ones to look to for guidance? (Provided, of course, they offer a functional response.)

In schools, the study of pandemics may be slotted, briefly, into the medieval history unit or as a footnote to World War I. But the subject of pandemic preparedness touches on so many subjects that it falls through the cracks. “So little of this is taught in school,” says Brown.

The simulation was initially low-tech. Infections took the form of stickers; teachers were throwing out twists and turns on the fly. That began to change later in 2016, when Brown was reading his daughter a bedtime story—which took the form of Time magazine’s list of the 100 most influential people. (“She’s very academic,” he says.) The list that year included a computational biologist at Harvard University named Pardis Sabeti, who was being honored for her work sequencing Ebola virus genomes to demonstrate how it was spreading from person to person. Brown’s daughter wanted Sabeti’s autograph, so he sent her an email. Sabeti was charmed by the teacher and his daughter, and impressed by the work he had done on the simulation, and offered to help.

Plus, Sabeti says, she had another motive. At the time, she had been looking into an outbreak of mumps on Harvard’s campus and was hoping to model how viruses spread within small, closed-off populations. But she and her collaborators had a problem: It was hard to gather data in those settings to link together patterns of exposure. Her lab had been at work on a Bluetooth contact tracing app—not unlike the system Google and Apple have built to track potential exposures to Covid-19—to help gather more.

A simulation, not unlike the ones that had been going on in Sarasota, would be useful for testing and gathering data from such an app. In the school simulation, the app would track the proximity of the students to each other. The organizers could set certain parameters for the virus—how infectious it was, how lethal—and allow the pathogen to spread to nearby phones via Bluetooth signals. The app would gather data from these model outbreaks and—a big plus—be a lot more realistic for the kids than passing around stickers.

Since then, Brown and the Harvard team have continued adding to the app, called Operation Outbreak, which is now available to other schools. (A more detailed open platform, with recommendations for how schools can conduct their own simulations, is coming soon, Brown says.) Each year, the organizers try to up the difficulty, epidemiologically speaking, from prior simulations. It’s a big event at the school, so often the younger students gossip and try to mine the older kids for tips on how to “win”—as Bradford Walker, now starting his junior year, can attest. He recalls “trying to be sneaky” as a seventh grader by chatting with the recent pandemic veterans. It didn’t work. Each year brings a new virus, and an entirely new set of challenges.

In the world of real emergency response planners, coronaviruses have long been discussed as a potential pandemic source. Viruses like SARS are an unfortunate combination: lethal enough to kill many people, but not so lethal that they kill their hosts before they can transmit the virus to others. So the organizers designed the virus to be a SARS mimic. It would have an R value—that’s the reproduction number, or the rate at which the virus spreads—of between 2 and 3, meaning each infection could be expected to spread to two or three more people. And to make it a real challenge, it would have a high rate of asymptomatic transmission—that is, it would move to a new host even if an infected person did not show any symptoms. In other words, the virus would be an uncannily predictive model, epidemiologically speaking, of SARS-CoV-2. “It almost sounds like a conspiracy theory,” Sabeti says.

The decision to include asymptomatic transmission was particularly auspicious. “People were very dogged that viruses don’t do that,” she says. But with Covid-19 it is clearly occurring, though scientists are still debating what percentage of people infected with the virus do not show symptoms, and how easily those people spread the virus. And Sabeti had seen a similar debate unfold with Ebola, and had also seen Ebola patients without symptoms. “People assume that if you get Ebola you’ll know, because you’ll bleed out of your eyes,” she says. “But that’s because you only test the people who are bleeding out of their eyes.”

So last December, the Sarasota teachers seeded their students with this imaginary virus, and it silently ravaged its way through an unsuspecting population. It had the desired effect. “They were more reactive and more panicked,” Brown says, of the way the students responded to not being able to tell which of their classmates had the virus. “It’s always easier to handle something you can see.”

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Now, the students’ real lives have been changed by a real virus. In March, they were sent home on perpetual spring break, switching over to distance learning for the rest of the semester. In this pandemic, instead of coordinating a vaccine rollout, as he had in the simulation, Walker was at home building a computer. Instead of researching a vaccine, Wagler was at home too, mostly, taking community college classes on Zoom between trips to high school for volleyball practice and shifts at Shake Shack, where she finds herself requesting that (mostly older) people please put on their masks.

But ever since the first reports emerged about a then-unnamed virus in China, Wagler had been watching the news closely and finding herself increasingly frustrated. The simulations had prepared students like her for many of the things that would happen. During her stint as an epidemiologist, she recalls how her budget was constrained, so she couldn’t research the virus and help develop a vaccine. (Ahem, Centers for Disease Control!) She recalled her frustration, while serving as vice president during a different year’s simulation, at seeing how the media (hello!) contributed to misinformation and acted as an echo chamber.

She also knew that pandemic responses are usually messy at the start. They are complex, chaotic collaborations. There are so many unknowns about a new pathogen, and so many factors to consider as people strategize with limited personnel and budget. But usually, in the school simulations, the chaos dissipated in time. The class would coalesce as best they could around a singular, virus-quashing purpose.

So she was surprised to see that in the US response to Covid-19, that had not occurred. What had the simulation left out? Politics. There were no such things as Republicans and Democrats in the pandemic response at Sarasota Military Academy Prep. That meant there were no pet political issues cutting into the relief efforts, or mixed signals from the highest reaches of government about whether to take the virus seriously. “In school it was: ‘OK, this is a problem. People are dying. How can we stop it?’” Wagler says. “The thing that annoys me the most is that this has become a political issue when it should be a ‘Let’s not let people die’ issue.”

“It was a surprise that two sides developed around the pandemic,” Walker says, though he prefers not to put it into political party terms. He prefers to put it in terms of those who take the virus seriously and those who don’t. With two elderly grandparents nearby—including one with cancer—he knows where he falls. He hopes that next time around the US will be more prepared. And perhaps it might be, if more people have some prior knowledge—like the eighth graders at Sarasota Military Academy Prep.

So how did the students do back in December 2019, when their teachers launched them on their alarmingly prescient challenge? The students were far better at social distancing than during past simulations—asymptomatic spread made it a grim necessity—and the triage between government officials, scientists, and doctors looked promising, Brown says. Still, they didn’t find a vaccine, and the death rate was about 35 percent. That wasn’t particularly bad, at least in simulation terms, Brown says; there was that one year when essentially everybody died. But to their teachers, it wasn’t really the students’ performance that mattered. It was their experience. Next time, they’d be readier, even if next time came sooner than anyone expected.

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