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You Cannot Manage What You Cannot Measure:
How to Implement Evidence-Based COVID-19 Strategy
By Shlomo Maital
As a management educator, I stress a simple principle: Management begins with measurement. What you do not, cannot, measure, you cannot, will not, manage. But you have to measure wisely, correctly, accurately, and promptly.
Man, does this ever apply to the chaos we find ourselves now, in my country Israel and in other hotspot countries like the US!
So, what should we be measuring? Here is a thorough, reasoned proposal by Tom Frieden and Cyrus Shahpar. Frieden is a former director of the Centers for Disease Control and Prevention, runs the nonprofit group Resolve to Save Lives, and Dr. Shahpar is the director of a team devoted to preventing epidemics. * https://www.nytimes.com/2020/07/21/opinion/coronavirus-state-data.html Here is the URL for the list of 15 (if it is hard to read the jpeg’s below: https://preventepidemics.org/covid19/resources/indicators/
Resolve to Save Lives, a coalition of national, state and academic partners including the American Public Health Association and the Johns Hopkins Center for Health Security, has developed a list of 15 indicators. Their report argues: Every state and county should be able to collect and publish nine of these immediately and the other six within a few weeks.
If we had these measures, our leaders, policymakers and the general public would know far better where we stand, what the goals are, how we are doing, and what lies ahead.
The mass media continue to report on new cases, total cases, and deaths. The result is misleading, because, for instance, “very ill” cases lag behind new cases by two weeks or more.
Here are the 15 measures that we really need, to manage the pandemic. CLI is COVID-like illness; ILI is influenza-like illness. PCR is polymerase chain reaction, widely used to rapidly make millions to billions of copies of a specific DNA sample, to detect, e.g., coronavirus. No country, I believe, has the full set of 15 – and very few countries have even a partial set of the 15.
So ideally: A team of epidemiologists, virologists and statisticians join together, and put in place a system for collecting data for the 15 indicators. In the US, this should be the Center for Disease Control and Prevention (notice: the acronym CDC omits the all-important P, Prevention!). The results are shown on a dashboard, simple, clear and understandable. And all of us can see for ourselves where we are, what is happening, what’s good, what’s bad, and how close we are to our goals. And, derived from the dashboard, what each of us needs to do to help reach the measured goals.
How Chinese Kids Return to School
By Shlomo Maital
US President Donald J. Trump wants American schools to open – now! He rejects the CDC guidelines to schools as expensive and burdensome. (For once, CDC refused to rewrite them, as he ordered). He offers no aid to schools, already facing huge deficits, for the costs of safely opening.
It is unthinkable for the US to learn from other countries – how can the greatest nation in the world learn anything from, say, Canada, Finland, Taiwan, Singapore, and, heaven forbid, China?! But in the unlikely event anyone in the US is listening – here is how the Chinese re-open their schools: * And keep in mind: China’s GDP per capita is $10,000, one-sixth that of the US ($62,000).
https://m.facebook.com/story.php?story_fbid=3654737014543735&id=1381450335205759
- Children enter the school one by one. Their hands are disinfected; their bodies; and the soles of their shoes.
- They have partitions between each desk. They practice social distancing.
- And they wear masks. Including small children.
- They disinfect again when they leave school – completely. Let’s face it. China is a rule-making society. Long before the Communist Party, China’s culture focused on ‘the greater good’ — collective responsibility. My friends in Asia simply cannot understand why Americans rebel against wearing masks, as an invasion of freedom. Schools should be re-opened. Kids need the social contact, more even than the knowledge. But it has to be done right. Israel did it – wrong. And we are now third in the world for new cases (as % of population).
- There is a simple point to be understood. You cannot save jobs, save the economy, restart the economy, while the novel coronavirus is raging. This will kill people. You have to support those who have lost all their income, restart very very cautiously, phase by phase, and first largely conquer the virus before you declare the economy open. IF you don’t, you get a second, third, fourth wave… and if we have a new wave on top of the Fall flu, which in Israel floods hospitals and puts people on beds in corridors – the bad news we have today will seem like a picnic in September. If you open schools stupidly, you will pay a very heavy price. We in Israel already are.
- America is a rule-breaking society. Proof? The gun laws, which allow automatic weapons. This has proved to be literally fatal, during the pandemic, when one rule-breaker can be a super-spreader. And basically, the POTUS, President of the United States, is metaphorically a super-spreader, denigrating masks, and spreading false optimism. Burdensome? Impractical? What in the world is so difficult, about making many thousands of plexiglass partitions, between school desks? Burger chain Shake Shack got $10 million in US emergency aid – the furor that resulted made them give it back, because, they did not need it in the least. Why can’t schools get the same deal that Shake Shack gets?
Kerala and KK Shailaja Show the Way!
By Shlomo Maital
KK Shailaja, Kerala Health Minister
On Jan. 21: The first case of the coronavirus is confirmed in the United States, in Seattle.
On Jan. 22: Trump makes his first comments about the coronavirus, saying he is not concerned about a pandemic: “No. Not at all. And we have it totally under control. … It’s going to be just fine.”
Contrast this with the Health Minister of Kerala, K.K. Shailaja, a former teacher. (She is known affectionately as Shailaja Teacher). Kerala is a state in southwest India, with some 35 million people, and its population is quite highly educated; its politics are socialist and, let’s say it, Communist.
According to a fine article in The Guardian by Laura Spinney:
“On 20 January, KK Shailaja phoned one of her medically trained deputies. She had read online about a dangerous new virus spreading in China. “Will it come to us?” she asked. “Definitely, Madam,” he replied. And so the health minister of the Indian state of Kerala began her preparations. Four months later, Kerala has reported only 524 cases of Covid-19, four deaths and – according to Shailaja – no community transmission. The state has a population of about 35 million and a GDP per capita of only £2,200. By contrast, the UK (double the population, GDP per capita of £33,100) has reported more than 40,000 deaths, while the US (10 times the population, GDP per capita of £51,000) has reported more than 82,000 deaths; both countries have rampant community transmission.
What does Shailaja Teacher and Kerala understand, that President Trump does not?
The Guardian continues: “Three days after reading about the new virus in China, and before Kerala had its first case of Covid-19, Shailaja held the first meeting of her rapid response team. The next day, 24 January, the team set up a control room and instructed the medical officers in Kerala’s 14 districts to do the same at their level. By the time the first case arrived, on 27 January, via a plane from Wuhan, the state had already adopted the World Health Organization’s protocol of test, trace, isolate and support. As the passengers filed off the Chinese flight, they had their temperatures checked. Three who were found to be running a fever were isolated in a nearby hospital. The remaining passengers were placed in home quarantine – sent there with information pamphlets about Covid-19 that had already been printed in the local language, Malayalam. The hospitalised patients tested positive for Covid-19, but the disease had been contained. “The first part was a victory,” says Shailaja. “But the virus continued to spread beyond China and soon it was everywhere.” In late February, encountering one of Shailaja’s surveillance teams at the airport, a Malayali family returning from Venice was evasive about its travel history and went home without submitting to the now-standard controls. By the time medical personnel detected a case of Covid-19 and traced it back to them, their contacts were in the hundreds. Contact tracers tracked them all down, with the help of advertisements and social media, and they were placed in quarantine. Six developed Covid-19.”
Spinney observes: “ The Communist Party of India (Marxist), of which she is a member, has been prominent in Kerala’s governments since 1957, the year after her birth. (It was part of the Communist Party of India until 1964, when it broke away.) Born into a family of activists and freedom fighters – her grandmother campaigned against untouchability – she watched the so-called “Kerala model” be assembled from the ground up; when we speak, this is what she wants to talk about.”
Trump vilifies socialism without understanding what it is, calls the Democrats ‘socialists’, and his sycophants caution against becoming “like Denmark” (a society and economy far more equitable, healthy and unified than the US). Imagine what Trump would say about Kerala, if he knew where India was on the map or what Shailaja Teacher had done.
How many people died, because Trump leads the US and not Communist Shailaja? How many lives could have been saved, had Trump acted weeks or even days sooner?
And will voters rightly fix the blame on his shoulders, on November 3, in the US?
Postscript: One of the world’s leading medical journals is The Lancet. Read The Lancet’s unprecedented Editorial, showing how Trump gutted the Center for Disease Control (CDC), politicized it, and made it unable to deal properly with the COVID-19 crisis. No-one can remember the last time when a scientific journal like the Lancet has editorialized so fiercely.
[Special thanks to Pramod Arikal, my former student, for drawing my attention to this important story].
How the US Screwed Up:
A Litany of Fumbles
By Shlomo Maital
Ooops…fumbled the ball!
The United States, led by the Trump administration, has fumbled the ball in dealing efficaciously with the COVID-19 pandemic. Here is the terrible litany of fumbles, mistakes and bad decisions, which in the end cause the deaths of many people. Needlessly.
April 2018. Some nine or ten months before the crisis arose, Trump and his National Security Council advisor John Bolton (later fired himself…justice?) fire the NSC team charged with pandemic preparation; on April 8 Tim Bossert is fired, as Home Secretary Advisor, in charge of “comoprehensive defensive strategy against pandemics”. Bye bye strategy and plans. In May Rear Amiral Tim Ziemer, who headed a ‘health security team’ was fired and not replaced.
Fast forward: China experiences early COVID-19, and, rather late, in late December, informs the world of it, and warns. On Jan. 20 the Center for Disease Control, in the US, announces the first case, a traveler from Wuhan, China. “We shut it down”, Trump says on Feb. 2. In February the CDC sends out its COVID-19 test, to public health testing labs in the US states; it doesn’t work. The US, (pride? Ego?) fails to purchase tests that are proven to work, from South Korea and other countries. The test is fixed, finally – but valuable weeks are lost. The public health labs work at developing their own test, something that has never before happened.
“When the CDC rolled out its tests, a component in them turned out to be faulty. That was unfortunate, but it put a big spotlight on the CDC’s decision to use its own test kit instead of test kits other countries have used, reportedly in an effort to create a more accurate test.”
As of March 9, well into the US pandemic, only 4,300 COVID-19 tests had been carried out. Trump says, “the tests are perfect” (like his phone call to the Ukrainian President).
Press reports: “Testing is crucial to slowing epidemics. First, it lets public health officials identify sick people and subsequently isolate them. Second, they can trace that sick person’s recent contacts to make sure those people aren’t sick and to get them into quarantine as well. It’s one of the best tools we have for an outbreak like this. It’s also something that the federal government has done well before — recently, with H1N1 and Zika. “It’s been surprising to me that the administration’s had a hard time executing on some of these things,” Ashish Jha, director of the Harvard Global Health Institute, said. “
America dropped the ball on testing. Press reports: “In the months before the coronavirus outbreak, the administration cut a public health position that was meant to help detect disease outbreaks in China, where the pandemic began, Even without such cuts, experts and advocates argue the US generally underfunds disease outbreak preparedness and public health programs more broadly. Further cuts just deepen the risks of pandemics. The common refrain among experts is that other countries’ actions, such as China’s draconian measures, gave the US a bit of time to do something, but the federal government has failed to get even the basics right in that time.”
What was President Trump’s role in this? “Trump “did not push to do aggressive additional testing in recent weeks, and that’s partly because more testing might have led to more cases being discovered of coronavirus outbreak, and the president had made clear — the lower the numbers on coronavirus, the better for the president, the better for his potential re-election this fall.”
Hospitals, especially in New York City, complain they lack equipment. Why? There is a large US strategic stockpile of lots of useful things. However, “While the administration has said it’s using federal authorities and tapping into its stockpiles to get more of this gear to the places that need it, health care workers on the ground complain that they still don’t have enough — forcing them to reuse possibly contaminated equipment and choose between working in unsafe conditions or not show up to work at all. All of this at a time when the country needs to, according to experts, boost health care capacity.” There are rumors, Trump dislikes Washington state and New York State and that this is impacting federal shipments.
In a pandemic, preparedness is crucial. The US Defense Department has contingency plans for a huge variety of threats. What about the health area? “….. this reflects on the lack of preparedness: A shortage of medical equipment is one of the many problems government simulations and exercises warned about before the current outbreak. But Trump simply didn’t prioritize pandemic preparedness beforehand. The US … was not prepared … A good preparedness plan would have helped address this and had things in place to allow for that increased need to be met.”
US health care system is inadequate, even with Obamacare (imagine if Trump had succeeded in annulling it!?). “With the outbreak growing, the US’s lack of universal health care has become an even more obvious problem: If people can’t get testing, they’re less likely to find out they have Covid-19 and take precautions to avoid spreading the virus. If they can’t get treatment in case of complications, they’re more likely to suffer, potentially spread the disease, and die.”
Fighting the poor, rather than the virus: “The administration has pushed forward on measures that will kick people off food stamps. This will not only lead people to suffer if they lose their jobs as a result of a coronavirus-caused recession, but it could lead to sick people going to work and spreading the disease, because they won’t have a safety net if they don’t bring in a paycheck.”
Chasing immigrants, instead of virus: “Experts also pointed to the “public charge” rule, which effectively discourages immigrants from seeking public services, including health care, by threatening their immigration status if they are “likely to be a public charge” by relying on those services.”
Yes, the United States has dropped the ball – fumbled it. And this litany is very very partial – it’s only 1,000 words, it could fill a book.
And the sad part, again, is that when a halfback fumbles in football, worst case, his team loses the game. In the US, when the administration fumbles, people die. Many people. And then ? Excuses. Boy, are we going to hear excuses, all the way to November and beyond.
Dr. Anthony Fauci predicts, as many as 200,000 Americans could die in this pandemic. Many of these deaths could have been prevented, if the Administration had simply held onto the ball.
There has to be accountability. At the very least, at the ballot box in November.
TIMnovate 