American Scandal: The Plague of San Francisco

Episode 5 – From Plague to COVID: What We Still Haven’t Learned

Release Date: October 14, 2025
Host: Lindsey Graham
Guest: Dr. Howard Markell, Physician, Historian, and Author

Episode Overview

In this episode, host Lindsey Graham speaks with Dr. Howard Markell—one of the nation’s foremost historians on epidemics and public health—about the recurring failures and lessons (often unlearned) connecting the 1900 San Francisco plague outbreak and the COVID-19 pandemic. The conversation explores society’s cyclical denial, misinformation, racism, and the ongoing politicization that impedes effective public health responses even a century apart.

Key Discussion Points & Insights

The Ever-Present Threat of Pandemics

• Pandemic Possibility: Dr. Markell warns that diseases like COVID-19 are not only possible but likely, given the vast unknown viral reservoirs in animal populations (e.g., bats).
  • Quote: “There are hundreds of viruses brewing out there in different animal communities…we don’t know what the next strain of whatever will look like.” (04:47)
• Progress in Response Speed: Scientific advancements mean we identify viruses much faster (it took centuries to identify the plague microbe, days for SARS-CoV-2).
  • Quote: “It took centuries to figure out the microbe of plague...It took eight days for SARS to get the actual virus. It took a day or two to get Covid. That is progress.” (08:35)

Institutional Protocols & the Importance of Transparency

• Surveillance and Communication: Effective pandemic response depends on swift, transparent international cooperation. Secretiveness (particularly from governments) impedes early action and vaccine development.
  • Quote: “...without that transparency, without that constant communication, without that constant surveillance, you can’t have the right actions that need to follow...” (07:40)
• Standard Operating Procedures: Decades of “tabletop exercises” and epidemic modeling inform protocols used to address new outbreaks, emphasizing isolation, social distancing, and vaccination. (07:04–09:18)

Public Health Victories & Vaccine Successes

• Vaccines as Transformative: Widespread vaccination campaigns have nearly eliminated diseases like measles, polio, and chickenpox.
  • Quote: “...that is a good thing. That’s like nine out of the ten greatest hits in medicine.” (10:41)
• Vaccine Amnesia: The absence of visible illness feeds skepticism and hesitancy.
  • Quote: “No one remembers how sick you get with real measles...so instead they focus on that risk that they heard it might cause autism, which has been, of course, disproven...” (12:06)

The Role of Denial, Misinformation, and Economic Anxiety

• Recurring Denial & Cover-Up: Denial by businesses, politicians, and the media—a common pattern—stems from fears of economic loss and reputational damage, and has consistently made outbreaks worse.
  • Quote: “It’s counterproductive. It never, ever works. And yet it’s something that the institutions have done quite a bit over centuries.” (17:07)
• Policy Trade-Offs: There’s often a zero-sum fight between commerce and public health, with delays and infighting costing lives.
  • Quote: “You can’t stall, you can’t wait, you can’t delay when you’re trying to save lives.” (19:02)

Public Health Communication & Political Savvy

• Evolving Communication: Unlike in the early 20th century, today’s public health officials are trained to adapt messaging to diverse audiences, though legacies of arrogance and cultural incompetence still linger.
  • Quote: “Public health officials...are trained how to deal with different constituencies and to change the tenor, how you describe something...” (22:34)
• Effective Leadership: Figures like Dr. Rupert Blue succeeded by understanding the political nature of public health:
  • Quote: “...the first word in public health is public. And you have to deal with a huge constituency of different types of people with different types of goals, aspirations, needs, etc.” (25:23)

Scapegoating and Racism During Outbreaks

• Historical & Modern Scapegoating: Epidemics routinely unleash nativism and racism—plague was racialized in 1900 San Francisco; COVID saw anti-Asian backlash.
  • Quote: “Why do we scapegoat? We love to blame people. Human beings love to blame one group...even if it’s completely false.” (26:53)
• Dangerous Consequences: Discrimination, scapegoating, and barring individuals from needed care are recurring features of American public health history.

Flattening the Curve: Historical Roots and Modern Impact

• 1918 Flu Data to COVID-19: Markell’s research on non-pharmaceutical interventions in 1918 helped inform “flatten the curve” strategies during COVID-19.
  • Quote: “Cities...that started their social distancing measures early, that did them for a long time and layered them...had far fewer deaths.” (33:30)
  • Origin Story: The metaphor “flattening the curve” arose from an accidentally compressed pad Thai meal. (34:30)
• Impact: Markell credits this concept for saving up to hundreds of millions of lives globally during COVID.

Politicization of Public Health

• COVID and Politics: Partisan conflict, deliberate misinformation, and denigration of science exacerbated the crisis and eroded trust.
  • Quote: “...to see how then and now current President Trump politicized it and denigrated and diminished science to create all this doubt—I knew there would be some, but the level is just incredible.” (35:37)
• Science vs. Opinion: Markell urges that public health facts should not be treated as matters of opinion.
  • Quote: “This is not a debate. This is not a matter of opinion. It’s a matter of fact, of provable, reproducible facts.” (36:18)

Lessons Learned—Or Not

• Societal Amnesia: After a pandemic, public memory fades, public health is underfunded, and preparations lapse.
  • Quote: “The forgetting is the biggest problem because then you lose touch with the preparing and you have to constantly prepare for these crises and it costs a lot of money even though you don’t see a benefit.” (39:41)
• Recommendations:
  • Support rebuilding global viral surveillance.
  • Restore CDC/agency independence and scientific integrity.
  • Invest in public service professionals and preserve global cooperation.
• Looking Forward: Markell expresses hope in the new generation of public health leaders but warns “tick tock, tick tock. Times are wasting.” (44:22)

Notable Quotes & Memorable Moments

• On the Infectiousness of COVID (03:27):
  “If you were designing the perfect virus to spread quickly...COVID-19 is a pretty good choice.”
  — Dr. Howard Markell

• On Denial & Cover-Up (17:07):
  “Why people would lie about that, as a doctor, I have no clue. It’s counterproductive. It never ever works. And yet it’s something that the institutions have done quite a bit over centuries.”
  — Dr. Howard Markell

• On Public Health Leadership (25:23):
  “The first word in public health is public...you have to constantly adjust your message to those different constituencies because most people don’t want to do what you’re asking them to do.”
  — Dr. Howard Markell

• On Scapegoating: HIV Example (27:06):
  “The FDA would not allow Haitians to donate blood till last about 10 years ago...because of HIV. We blamed Russian Jews for importing cholera and typhus into New York in 1892. It’s just a common ugly theme.”
  — Dr. Howard Markell

• On the Legacy of “Flattening the Curve” (34:30):
  “I said, hey Marty, look, the food did what we’re trying to do. They flattened the curve. And that’s where the phrase came from.”
  — Dr. Howard Markell

• On Pandemic Fatigue and Forgetting (39:41):
  “Once you’re done with an epidemic crisis or a pandemic crisis, you don’t want to think about it, you want to move on. Unless you’re somebody like me...”
  — Dr. Howard Markell

• On the Next Generation (44:14):
  “It’s a special kind of a person who goes into those fields. And I am very optimistic about that coming generation...but tick tock, tick tock. Times are wasting.”
  — Dr. Howard Markell

Timestamps for Key Segments

| Timestamp | Topic | |-----------|---------------------------------------------| | 03:11 | Is a catastrophic pandemic possible today? | | 04:47 | Virus surveillance, animal reservoirs | | 07:04 | Standard pandemic protocols, CDC roles | | 09:36 | Public health victories since 1918 | | 12:06 | Vaccine amnesia and misinformation | | 15:47 | Institutional denial in outbreaks | | 17:43 | Balancing economics and public health | | 19:39 | Racism in the 1900 SF plague response | | 22:34 | Training public health officials now vs. then | | 26:53 | Scapegoating in epidemics (racism, xenophobia) | | 31:14 | The science and origin of “flattening the curve” | | 35:27 | The political fight over pandemic measures | | 37:30 | Preserving and regaining public health trust | | 39:16 | “Epidemic amnesia,” the danger of forgetting | | 40:55 | Concrete steps for better pandemic preparedness | | 42:44 | Recognizing current public health heroes |

Conclusion

Dr. Howard Markell’s interview paints a stark picture of how history repeats in American public health. He celebrates the miracles of modern science but voices deep concern about our tendency to forget hard-earned lessons, scapegoat minorities, and let politics or profit interfere with life-saving action. His call is both sobering and hopeful: we must honor public health heroes, invest in science, and keep watchful memories if we want to survive the next inevitable outbreak.

“We live in a world of microbes, and we never conquer them. At best, we wrestle them to a dream.” — Dr. Howard Markell (41:48)