The Post-COVID-19 New Normal — The Arsenal of Virology Excellence

This post is a follow up to Process Triaging COVID-19 this past March 11. This post is a living document.

Our national response to the COVID-19 pandemic is sufficiently along to start making Lessons Learned notes. Here are mine, subject to better data:

  • A coronavirus epidemic is like a weather event, similar to a lingering cold front. It lasts about three to six weeks depending upon the factors favoring contagious respiratory infection transmission: population density, social distance, humidity, sunlight, virus type, and human immune system vulnerability.
  • The COVID-19 coronavirus is a nasty bastard. Contagious days before showing symptoms make it a silent spreader. Persistent on non-porous surfaces for days in favorable room characteristics (low humidity, no sunlight, sufficient virus quantity). It has an exponential infection growth rate of about 1.5 and doubles in about four days with an RO factor above 2. The most vulnerable are the elderly over 60 years old with the 80+ age group the most susceptible and those with compromised immune systems. The fatality rate has not been concluded as the ratio’s denominator is not known; we don’t know how many people have been infected because a large proportion of the infected (enough to make antibodies) do not develop symptoms. We know about one in four hospital admissions die, recognizing they are pretty sick by the time they are admitted based on current stay-at-home guidelines.
  • Immune system compromised patients escalate to ARDS — acute respiratory distress syndrome and pneumonia very quickly (in a couple of days) and requires ventilator breathing assistance (an ICU bed). It’s debilitatingly painful, as well.
  • Anecdotal trials indicate certain anti-malarial and rheumatoid arthritis drugs are therapeutic. Trials with COVID-19 antibody plasma show promise but the benefits are short term.
  • The exponential rise of the contagion wave is flattened by reducing the RO factor by social distancing, personal hygiene, and non-porous surface antiseptic cleaning. Regional or national scale enforcement of social distancing collapses an economy if sustained too long. At some point, the cure becomes more harmful than the disease, recognizing what that point is is more art than science.
  • The essential public health strategy is to (1) reduce the infection transmission rate, (2) minimize healthcare worker infections specifically, (3) size the ICU/ventilator equipped hospital room and support staff inventory to meet peak patient volume, (4) medicate prophylactically and therapeutically, and (5) test enough of the population to understand the virus’s pathology enough to design management strategies. The leading indicator of the wave is the daily number of virus-positive tested persons in the population and their infection profile.
  • It takes about three virus storm cycles or waves in a population to establish sufficient immunity in a population.

COVID-19-grade viruses are the new normal. The world has never had a coronovirus pandemic of this scale pile on top of a typical seasonal influenza (a very different rhinovirus). While virologists have forecasted such pandemics (including a wet market source like that of COVID-19), no pandemic planning has anticipated this magnitude. We were not ready and no one is to blame. This pandemic has exhausted our inadequate emergency stocks.

Process improvement design begins with The Ball, Not The Player. We do not care about the who or the how. We start with an overall strategic objective, often called The Big Number. Then we look at each supporting process and define its physical capability in one or more of four dimensions: Quality (of output), Speed (from process trigger to final product or state), Volume (how many final products or states), and Cost (the unit revenue or expense).

A Big Number might be something like, “Contain X number of coronavirus outbreaks within a population of X size within 6 weeks with no more than X% deaths with less than % economic depression.”

This might require the following Process Capability Goals:

  • Virus Outbreak Prevention A community must practice virus awareness behaviors. These best practices must become habits and integrated into cultural expressions and educational curricula. For example, people wearing anti-viral masks are visually common.
  • Virus Outbreak Detection A community must be capable of detecting a virus contagion outbreak and assessing its public health risk within X days of suspicion with 95% accuracy, anticipating two per year, on a budget of $X.XX per member of the population.
  • Virus Outbreak Response (Local) The community must be capable of sustaining standard virus abatement practices within 24 hours of a public health declaration and maintain this posture for up to 15 days. Community health care infrastructure must be capable of treating X% of ICU/ventilator necessary infected patience with on-hand facilities, technologies, supplies, and staff.
  • Virus Outbreak Response (State and Federal) Supporting health care infrastructure (State and Federal) must be able to deploy supporting treatment infrastructure, staff, and supplies within X days of request, state or federally funded, up to X times per year per state and X times per year federally.
  • Virus Life-Cycle Management The nation must be capable of developing and deploying prophylactic and therapeutic medications and vaccines for high-probability viruses in a timely manner within the budgets allocated to the nation and internationally as afforded.
  • Brand and Cultural Considerations The design and implementation of these virus management processes shall support and deliver the nation’s national brand promise of being the world’s Arsenal of Virology Excellence. The United States is the World’s brain trust and preferred anti-virus technology and best practice source.

That’s The Ball. Obviously it needs a lot of refining. Now we need to find the Players to make it happen.

Judge Crisis Leaders By Their Course Corrections

This is a post as much to myself as to my readers (Thank you!).

I have spent most of my professional life facilitating teams from good to great business process improvement to dumpster fire-interventions. Regarding these crises events, there are two kinds of work: first, solve the immediate problem and stabilize the situation, then secondly, after an after-action analysis, design and implement better practices that prevent a recurrence.

It is pointless to criticize leaders for not doing something good sooner. We simply don’t live with a real-time awareness of the events that trigger a crisis. Hindsight points out what was missed or not appreciated at the time. What matters is what one does with what one is focused.

We judge leaders in crisis management moments by the quality of their course corrections. Meaning, how fast can they cycle their OODA Loop. How fast do they Observe-Orient-Decide-Act. When two combat aircraft meet in arial combat (the perspective John Boyd applied to develop OODA Loop theory), the combatant that cycled the best OODA loop won. If the opponents are otherwise equal, the faster OODA loop won the day. Save the “What and why things went wrong?” questions for later — after the crisis is managed and when it is time to do so. Bugging crisis managers with whining and complaining about how and why things are FUBAR is a distraction to be rebuffed.

I have watched President Trump’s cycling through this COVID-19 crisis OODA Loop with no small interest. (My own company’s primary service is on pause because it requires teams to meet in person.) The simplest tasks are ridiculously complicated at very high frequency. Diagnose, isolate and treat a few COVID-19 virus-infected patients with a ventilator in a sealed room is not that difficult (respecting it is technical work). To treat hundreds of such patients in hundreds of locations, ramping up a capability from a near standing start within a few weeks is a massively complex undertaking with potentially catastrophic unintended consequences, like collapsing our economy. Our expectations from our government at all levels is at a wartime high.

I’m pretty impressed with the President so far. To be clear, I find his communication style a bit obnoxious, especially his use of conversation-leading and framing on Twitter. It is a very effective persuasion and negotiation entry technique. It includes exaggeration and hyperbole and setting expectations well above the actual satisfactory agreement positions. Mr. Trump’s fake news counter-punching has destroyed the media’s monopoly on setting the terms of public debate.

Setting that aside, is the president’s OODA Loop spun up? I think so. For example, his appointment of Ambassador Deborah Bisx, MD for the White House Coronavirous Response Coordinator is spot on. She is a fabulously informed and articulate expert on infectious diseases having managed the nation’s work on HIV/AIDS reductions. He has made a number of startling decisions that appear to be based on the advice of our very best scientists. He’s has not delegated the one thing he must absolutely accomplish — project the right attitude and demonstrate the right core values. We will beat this virus, no matter what, for the right reasons, using every resource available, including winning the national narrative.

After the dust clears and this crisis is in our rear view mirror, it will be time to assess Mr. Trump’s performance. Will he have set us on a course for new policies and practices based on the lessons learned?

In the mean time, how am I executing my OODA Loop? For my business. And my life.

P.S. The leader I am most impressed with is New York Governor Andrew Cuomo. His articulate, straight-talking briefings are simply superb.

What will the post-COVID-19 New Normal Be?

This is a follow-up “WHAT IF?” post to my COVID-19 epidemic Process Triage analysis.

The COVID-19 Virus pandemic may be a generational calamity if the morbidity forecasts prove true. It will pivot our national narrative to a new normal. Again — IF the morbidity forecasts prove true over the next few months.

If so — and we see 480,000 deaths in three to seven months, it will impact this generation, with comparisons to WWII in the 1940’s, the 9/11 attack and responses, and the investment derivatives-driven financial collapse in 2008. It will leave a very long shadow if it takes three to six months to work its way through the population, as Mr. Trump admitted (agreeing with Dr. Michael Osterholm’s “COVID-19 Winter” analogy.

Alfred Eisenstaedt and Gretta Zimmer Friedman’s V-J Day Kiss, August 14, 1945

We will pivot. Do not doubt it. Again, IF these dire forecasts materialize. The entire nation has paused a suspended animation of social distancing, made necessary by the virus’s nasty pathology, where the non-symptomatic are contagious. We have neither immunity nor vaccine. The only way to slow the contagion is stay away from each other enough to traumatize our economy if it lasts too long. The longer it drags on, the more catastrophic it will be. Hourly workers in our heavily service economy will be slaughtered absent direct replacement cash payments by some yet to be designed method. If we do not suppress this virus by eventual public immunity or vaccination, it will reset how we work and live as groups — if we can live as groups. (So we must establish an immunity from it).

The pandemic presents us with a rare, generational, finest-hour opportunity if we will seize it. The history of this, when written, will mimic the pattern of previously heroic or tragic (both conclusions are possible) narratives:

A few farsighted but powerless experts try to warn the powerful, as Dr. Osterholm forecast in 2017 in Deadliest Enemy. He described a coronavirus spreading from a Chinese wet market precisely as COVID-19 launched.

The required national-level response will be a stumbling, bumbling, fog-of-war ramp up with many and often appalling oversights, missteps and mistakes. There will be weeping and gnashing of teeth. The public square, both physical and virtual will be rife with rumor (this is a Chinese bioweapon), mob hysterias and overreactions (toilet paper hording). A heroically entrepreneurial optimism (Mr. Trump’s default settig) will drag well-reasoned skepticism (the mainstream media’s hyena howling) across the finish line kicking and screaming if our American Character has its way.

As the learning curve settles in, the incompetent will be replaced as meritocracy enforces its will, such as the unflappable Colonel (Ret.) Dr. Deborah Birx (please run for President!), the administrations COVID-19 Response Coordinator. In WWII, the US Army’s hapless North Africa Campaign exposed incompetence at every level until Major General George Patton, a maniacal tank warfare enthusiast demonstrated the style of fighting the war would require. His tactics and attitude set the new normal for what would characterize the fight. We have never been prepared for a new war and figuring out how to fight it always stumbles through a life-squandering learning curve. Fortunately, our geographical distance from nations infected before us accelerates our learning curve. But we’re only at the beginning of this contagion at this post’s date.

The charismatic solution implementers will become the public face of leadership as the less articulate step aside (yes, expect to see less Mr. Trump and more of the point team members) . Partisan politics will give lip service to cooperation while the long-game politicians will lay the foundations for the post-epidemic opportunities (such as Speaker Nancy Pelosi inserting language into an emergency spending bill to eviscerate the Hyde Amendment).

New products and services will launch along with businesses to monetize them. Homeland Security and TSA was the new normal after 9/11. COVID-19 drive-up testing may be the new normal now. They may become a permanent fixture on the landscape like TSA airport screening (because this virus may not go away and a vaccine is years away).

Will these disruptive changes and adjustments to daily life be normalized? A think a complete reset to the pre-epidemic status quo will not happen unless our most optimistic scenarios prevail. The frightening question will be the long-term impact of large gathering events and the business models of industries that depend upon such venues. Will we become more physically isolated and segregated as work-from-home becomes more necessary? Will the impact to commercial property be catastrophic until such spaces are repurposed? Will this scenario be a seismic shift in the economy for white collar work? Will the travel and tourism industry ever completely recover?

While we hope for the best, that being a non-disruptive level of deaths, the more likely outcome will be a generational reset on the way we live and work.

Will our better angels prevail? Will we bind together and find the best new normal?

At the date of this writing, the President is leading a private-public charge at flank speed. Let’s hope for the best.

I wish us all God’s speed.

Process Triaging COVID-19

Note: This 3/10/2020 post was last updated on 3/13/2020 to reflect my latest thinking.

How we think about caronoviruses is important. They are a deadly threat to the immunologically compromised. This post applies the ProcessTriage® Protocol to the COVID-19 virus epidemic. Here’s my triaging narrative so far:

The COVID-19 epidemic is a Process Pain Point. In no particular order, it inhibits business and community performance. It is a repeating event that disrupts our business by delaying supply chains, suppressing retail customer traffic, increasing employee absences, overwhelms medical ICU capabilities and is fatal to a specific demographic at rates quite higher than seasonal influenza (.1%), to perhaps +10x that, perhaps 2%, about half of what the 1918 Spanish Flu recorded.

Panic? Absolutely not. Pay attention? Absolutely. At this writing, it has an exponential growth rate about 1.15 (meaning each subsequent day’s infections will be 1.15 times the previous day’s) with an unknown inflection point date in sight (where the growth rate is 1.0, after which it will decline exponentially). Here is the latest data from Johns Hopkins University. A most sobering analysis of COVID-19 is Joe Rogan’s interview with infectious disease expert Michael Osterholm (March 10), Dr. Osterholm asserts “This will not be a flu blizzard, but a flu winter with potentially 480,000 deaths.” This is NOT the flu, although both are respiratory infections. There will not be a vaccine anytime soon. Unfortunately, forty percent of the US population have mitigating risk factors of obesity and high blood pressure, that increase their risk of complication, with an amplified risk to the elderly and those with weaker immune systems. The CDC’s Dr. Anne Schuchat gives a good summary as well (3/12/2020), from Senator Bill Frisk’s podcast (See episode #42).

Do we know the most likely cause? Yes, enough. COVID-19 is highly contagious and lasts from a few hours to perhaps ten days on surfaces. It originated in Wuhan, China, likely from a wet market.

Do we have a best practice that, if followed, addresses the pain point? Yes. During the epidemic’s expansion phase: SLOW IT DOWN until enough people recover from exposure until is stops spreading. It’s all about reducing the R0 ratio — the number of adjacent individuals a contagious carrier infects, thereby flattening the curve. Establish and maintain social distance. Avoid crowds. Practice good hygiene, diet, and exercise. Strengthen one’s immune system. Focus locally. Since the virus is spread by breathing, an R-95 grade breathing masks is required to prevent breathing it. One can be infected and contagious for typically four days before showing symptoms. If one is appears symptomatic, self-isolate and get tested if possible. Be especially aware of the immunologically compromised such as the elderly.

At some point, the strictness of this social separation can collapse the economy. Most hourly workers in all industries that serve gatherings of people will be unemployed. Schools, in-person entertainment, in-person sports, restaurants — the entire social services sector will collapse.

(Do not panic. Neurobiologically, keep your consciousness parked in your prefrontal cortex, where it’s emotionally safe. Focus on watching the empirical data — your local city and neighborhood numbers (not the numbers of places you’re not not going to visit, other than the trend lines). By focusing on the facts, we avoid the amygdala’s fight-flight-freeze lizard-brain panic; we suppress that nasty cortisol.)

Does this best practice need training or learning? YES. We need to TRAIN and ENFORCE this best practice with an effort and focus proportionate to the virus exposure rates within our neighborhoods and public places we frequent.

Is this triaged solution a Small (task size) or Big (project size) effort? Small for us individually, from a pre-infection viewpoint. Dealing with a serious COVID-19 infection individually or within one’s family will be a Big (project).

Let’s follow our best practice and lead by example, but be patient. This will take months to resolve. It will take a national strategy to stockpile the supplies needed for infectious disease outbreaks.

The above triage result focused on our individual-level solution. A similar triage from a national perspective yields a different solution: It’s a BIG DESIGN (and IMPLEMENT) a capability to detect and manage COVID-19 virus infected individuals. We must be patient and recognize our response will be clumsy and mistake-prone until a learning curve is completed enough. Since COVID-19 has a 10x+ morbidity rate than seasonal flu and it there is no vaccine, we will have to design and establish COVID-19 intake facilities based on the volume of serious infections. The best case is we size and deploy these facilities and staff in a flexible, scalable manner. Establishing dedicated facilities will answer itself depending upon severe infection frequency. Some things will never be the same, such as nursing home access; every visitor and staff member will have to cleared to enter. Obviously, we must decouple the medical supply chain from China and return all manufacturing of essential medicine and medical supplies to domestic manufacturers as a matter of national security.