FIRST RESPONDERS

We are often encouraged to celebrate first responders: firemen who walk into burning buildings to help people escape the fire, EMS workers who rush people to the hospital, the doctors and nurses who care for Covid-19 patients and risk their own lives doing so. Some of the people doing these jobs do remarkably courageous things, saving people who would otherwise die or be severely harmed, and taking great personal risks themselves.

133 years ago a railroad inspector said the tracks across a bridge near White River Junction Vermont had deteriorated and should not be used through the fierce Vermont winter. His advice was dismissed. Thirty seven people perished when train cars derailed going over the bridge and the passenger cars peeled off the track falling about fifty feet onto the frozen river where they caught fire because of the oil lamps used at the time to light in the cars. While firemen and local people rushed to try to rescue the passengers, the real “first responder” was in fact the man who had foreseen the risk those tracks presented before the horrible accident occurred. He had not risked his own life and his relatively quiet action had simply been to prepare a report outlining the danger.

Very early when the Corona virus had barely made its presence known in the US, a number of epidemiologists began to warn that very stringent measures needed to be taken to forestall the threat of a pandemic spreading across the population of our country. As is well known, President Trump reassured the citizenry that there was little cause for concern, and that soon the virus would magically disappear. Of course, this did not happen. Quite the contrary: as of today, over 800,000 people have died. The physicians and epidemiologists who warned us when there were almost no cases in the US were, in fact, our “first responders.” They foresaw the terrible risks the Corona virus could pose. These warnings went unheeded. As the virus raced through the population with horrifying speed, EMT’s, nurses, physicians and others performed their duties under intensely difficult conditions. They richly earned the applause offered in many cities in public at 5 PM in appreciation of their exhausting efforts. They were almost always identified as “first responders,” but, in spite of their heroic efforts in caring for very ill patients, this is misleading. The very first people to see and appreciate great danger that was on (or over) the horizon, were the superbly trained public health professionals who knew, even before the virus had left China that it could represent a public health calamity. [Michael Lewis’s excellent book, Premonition, has an excellent examination of this.] Of course, like the bridge inspector in Vermont, their warnings were dismissed as excessive. Real first responders are the Cassandra’s of society, prophesizing disaster when no one else can see any cause for alarm. For them, it is much easier to say, as Trump did, “Oh, take it easy. Stop being such a worry-wart. Let’s play.” But like the grasshopper in the story of the ant and grasshopper, the winter does come, and all of the winter’s challenges come along with it.

Real first responders do not perform dramatic feats of heroism. They do not race into burning building to save people in terrible danger. They do not drive rescue vehicles to pick up people whose illnesses may threaten their own health and safety. They do not stay up days at a time trying to save terribly ill patients from dying from a new and poorly understood disease without adequate resources. All of these actions deserve our upmost respect and gratitude, but they are always rearguard efforts. Many heroic efforts were made to rescue the victims of the terrible train accident in 1887, but had the inspector’s quiet warning been heeded, there would have been no accident, no loss of life, no need for heroism. First responders whose warnings are heeded disappear without recognition, for we never know the horrors that never occurred.

In fact, while the story of this accident is true (and vivid to me because I drive beneath this old bridge often), I actually know of no warning and no inspection that preceded this terrible accident. Of course, there should have been. But that awful night the only “responders” were the local people who rushed to aid the passengers still alive and trapped inside the burning train cars, some of whom were heroically saved.

The World Health Organization energetically warned the world that this virus, at the time almost completely contained in China, was potentially very dangerous before almost anyone in the US had even heard of a Corona virus. These warnings, along with many others than soon came from public health physicians in the US, and others inside the administration, were almost entirely dismissed until the real peril began to be recognized in mid-March, 2020. The inability or unwillingness of US leaders (read: particularly Donald J Trump) to heed these early warnings allowed the pandemic to descend on us like a thousand hurricanes. This response is, tragically, common. While hundreds of thousands of people have contributed in various ways to helping others and deserve our deep appreciation, the actual first responders were being dismissed and insulted, particularly by our president.

There is a deep irony here. If we consider that the real first responders are those foresighted people who know how to anticipate grave danger long before most of us are able to, we can see how they are frequently invisible, “behind the scenes” people. They may or may not be attended to when they warn us of risks. When their warnings are heeded, we can never know what harm has been averted. When their warnings are heeded, thousands of lives may be saved, but we do not see those rescues. We will likely know nothing about them at all. When reminded, for example, of the extremely attentive Air Traffic Controller who foresaw the risk of a mid-air collision and helped avoid it, saving 500 lives, we might well say, “She was just doing her job.” And she was. Very well. But we will likely never be as impressed by the successful saviors who see trouble before it happens, and take action so as to avert that trouble, as we will be by heroics of a young man jumping from a helicopter into the ocean to save a sailor. The harbormaster who refused to allow that sailor to leave the harbor might have done much more to avoid trouble, but his reward will likely be only an irritated sailor.

How will we ever incorporate this sort of valuable foresight into our consciousness? Much of what we would like governance to do for us lies in this arena. The bank regulators who see a weakening bank and insist on corrective action may be perceived as a public nuisance, especially by the bank under observation, but in some circumstances may help to avert a serious crisis like the one the world faced in 2008 & 9. The dam inspectors, or bridge inspectors, or OSHA workers all fall into this category: first responders who must respond before the event. Unfortunately, dismissal of early warnings from competent evaluators is very common. We see instances nearly every day, both in the public arena and in our own circles. Very recently, we have learned that many engineers inside Boeing warned that the new 737 version, the 737 Max, was unsafe. Two horrifying crashes resulted because their concerns were not heeded. Quite recently, a building in Florida disintegrated and crashed to the ground, killing nearly 100 people. We learned shortly after this disaster, that a building engineer had warned of the risk three years before the collapse, but his warnings were not adequately acknowledged. We jump up and down to warn our teenage children of the risks present in the ordinary world: of drugs, speeding, unprotected sex, and various other ordinary worries we have. Far too often, these young people suspect us of exaggeration and overestimation of risk.

Why should any of this really matter? Is this simply a quibble about some semantic nicety? It is not, for as our vivid experience with this awful virus has shown us, the first person to spot the iceberg may do more than a thousand brave coast-guardsmen who arrive after the ship has begun to sink. Whether we call our public health savants “first-responders” or not, we must learn to know who they are and to listen with careful attention to their reports. And perhaps we should learn to give them an occasional 5 PM round of applause from time to time as well.