Best Practices In Pathway Management, Stakeholder Engagement
As the United States and the rest of the world battle the deadly coronavirus, best practices regarding pathway management and crisis communications are in short supply. Americans deserve more than a $3-trillion con job with no vision, input, strategy or oversight. Ironically, our national response to the “China Virus” looks like a Chinese fire drill. A very costly and deadly fire drill. Citizens must hold public officials accountable.
The world is suffering through a public health crisis, while witnessing an unbelievable leadership crisis. Experts inside and outside the government identified the threat early on and sought to raise alarms as President Trump and other leaders minimized the threat.
In addition to a public health pandemic and an economic disaster, we may be staring at a constitutional crisis, which threatens the existence of the United States and other nations around the world. Bankruptcy has always threatened our democracy and that threat is clearly on the table today. Could it be a deliberate act? Our national debt swelled by more than 12 percent to fund the relief fund, which weakened the dollar accordingly.
Bankruptcy will kill our constitution, our rights, our property rights and savings accounts and our government. A replacement leadership structure will be waiting in the wings. The middle class will be eliminated and the world will devolve into a handful of fascist states driven by the rich and worked by the poor. It could happen at the state and national levels. It could happen around the world. Your Social Security, Medicare, Medicaid, pension, postal service and much more will be gone. Our national parks will be sold to corporations for exploitation.
The bankruptcy strategy has been cooking for years. In fact, the U.S. mastered the technique by overthrowing several healthy democracies around the world with this form of fascism and corruption. (We also overthrew the queen of Hawaii, but that was with brute force and deception.) Even Senator Mitch McConnell suggested that states might need to consider bankruptcy because of the pandemic.
Senate Majority Leader Mitch McConnell, R-Ky., said Wednesday that state governments should be able to “use the bankruptcy route” to deal with economic losses from the coronavirus pandemic. In an interview, McConnell said additional federal assistance to local and state governments needed to be “thoroughly evaluated,” while expressing concern about adding more money to the national debt in a way “that could indeed also threaten the future of the country.”
“I would certainly be in favor of allowing states to use the bankruptcy route. It saves some cities. And there’s no good reason for it not to be available,” McConnell said. “My guess is their first choice would be for the federal government to borrow money from future generations to send it down to them now. That’s not something I’m going to support.”
Meanwhile, the coronavirus will continue to target vulnerable populations—randomly and deliberately. If there has ever been a need for government accountability and citizen engagement, it is now. Remember, the only difference between fascism and capitalism is a bribe. Do we have any bribery (and blackmail) in our political system today? The risk is real, which is why we need to continue doing our part as citizens. Unfortunately, the Fourth Estate—a free and competitive media world—continues its rapid decline in our modern democracy.
Indeed, even former presidents and military brass have warned about the slippery slopes of democracy in the U.S. When President, and former General, Eisenhower left office, he warned the nation to beware of the military industrial complex. He was warning us about the threat of corruption and fascism, where the government no longer serves the citizens. Even President Franklin D. Roosevelt said that presidents are not elected— they are selected. So, why was the “Teflon Don” selected to the presidency? He certainly knows his way around the topic and he has a self-described “bankruptcy expert” running the Department of the Treasury.
It’s our duty as citizens to hold our leaders accountable. It’s our duty to make sure that we are respected as citizens and not relegated to consumers and statistics. It’s time to kick dark money out of politics and reclaim our democracy. Fraud, favoritism and fascism are unacceptable in the United States of America. We are paying the price now and its costing thousands of lives that could have been saved.
To help cities and citizens around the world dissect the issue, former President Barack Obama and Michael Bloomberg addressed hundreds of mayors and other civic leaders via an interactive video conference call last week. This forum and others will be vital to our survival as people and a nation. Our fearless leader clearly is taking no responsibility for the problem or the solution. After deliberately dragging his feet and ignoring sound science, the White House is now pushing the entire response onto each state, while playing politics in key battlegrounds, including Washington, New York and Massachusetts.
“Speak the truth. Speak it clearly. Speak it with compassion. Speak it with empathy for what folks are going through. The biggest mistake any of us can make in these situations is to misinform, particularly when we’re requiring people to make sacrifices and take actions that might not be their natural inclination,” said President Obama. “The more smart people that you have around you, and the less embarrassed that you are to ask questions, the better your response will be.”
Finally, President Obama encouraged city leaders to support their most vulnerable residents. He urged local leaders and national leaders around the world to be proactive.
“We’re seeing disparities in how people are affected in cities and towns and communities across the country. Look out for the vulnerable. When you start looking at issues of domestic abuse and you start looking at racial disparities that are popping up in your cities, paying attention to that is the kind of leadership I know all of you aspire to. You have to be intentional about it, and dedicate folks to thinking about those issues.”
Throughout the convening, mayors and other local leaders learned the latest facts from public health experts, and discussed best practices of crisis communications and ways different city leaders are helping their communities through this challenging time.
“Here in New York, we’ve now lost more New Yorkers to this virus than in the terrorist attacks of 9/11 – and the numbers continue to grow. While we’re starting to see ICU admissions stabilize, the city is still losing hundreds of people per day,” said Michael Bloomberg, three-term mayor of New York City and Founder of Bloomberg L.P. and Bloomberg Philanthropies. “People need to know that you are understanding what they’re going through – and that it’s hard. They also need to know that better days are ahead. It won’t be tomorrow, or next week, but things will get better – and they’ll get better specifically because of the sacrifices everyone is making today.”
Over the past month, Bloomberg Philanthropies has brought together world leaders to share insights, advice, and inspiration with the local officials on the frontlines of the pandemic. Previous sessions featured President Bill Clinton and President George W. Bush. President Clinton highlighted the important role that mayors play in sharing accurate, actionable information with residents.
“In historic times like this, it is important to keep three things top of mind: Truth, empathy, and especially hope,” said former President Bush.
This advice would serve President Trump better than the guidance that he is receiving now. Every time he steps in front of the microphone, Americans trust him less. That’s a dangerous dynamic during this unprecedented public health crisis that has killed more than 40,000 Americans in just a few weeks and more than 150,000 people around the world. The Trump administration still has no clear plan for ending the coronavirus crisis, but it has many task forces to help talk the issue to death. Unfortunately, these task forces ignore the national experts in favor of seasoned visionaries, including Jared Kushner and Hope Hicks. If we are putting the future of a world superpower in those hands, we might as well go bankrupt today and save the drama and the lies. If a corrupt world leader was trying to cripple his country, that blueprint would probably look much like what we are witnessing today.
Supposedly, the task forces are all working to defeat the novel coronavirus and get the nation back to normal quickly. But the reality is that we have a bureaucratic shit show with competing internal and political agendas. The White House has been slow to act at nearly every step of the pandemic and it still has no consensus plan for when or how to reopen parts of the economy. There is still no concerted plan for getting vital medical supplies to states, which are left to fight among themselves or seek favors from Trump. There is no plan for what happens if cases or deaths spike as people begin to return to work and school, or how to respond if the coronavirus surges again.
Jack Chow, a U.S. ambassador for global HIV/AIDS during the George W. Bush administration and former World Health Organization assistant director-general, said the problem is that the administration has yet to decide what the national recovery should look like or who is in charge–state or federal regulators.
“The whole response has been lagging the curve of the epidemic, and what ought to be happening is the designation of key strategic goals, key accomplishments that can happen within a specified timeline,” Chow said. “It sounds like they’re groping for that. There isn’t any clear direction as to what the strategic goals are in each different line of effort, and what the prospective timeline could be given the assets they have to deploy.”
Strong evidence was emerging as of mid-February — with the first cases of Covid-19 already in the United States — that the nation was about to be hit hard. The concern raised by medical experts in late January turned to alarm by the third week of February. That was when they effectively concluded that the United States had already lost the fight to contain the virus, and that it needed to switch to mitigation. One critical element in that shift was the realization that many people in the country were likely already infected and capable of spreading the virus, but not showing any symptoms.
Unfortunately, it appears that blood transfusions can also transmit the disease. The Red Cross is actively encouraging citizens to donate blood during the pandemic, but there are no safeguards to assure that we aren’t banking blood from healthy-looking people who are actually carriers of the disease. These carriers will test negative for the virus, while transmitting it to people who are already in a compromised state.
The COVID-19 pandemic represents the nation’s first 50 state disaster that will spare no community. Bloomberg Philanthropies is tapping into a wide range of partners to generate a robust set of support and resources to help local leaders combat the coronavirus and protect the social and economic wellbeing of cities. Since launching, hundreds of city leaders have joined the virtual convening each week. The aim of the program is to provide cities with the tools to understand, respond and manage a dynamic public health crisis, they will be better prepared to slow the spread of coronavirus in the United States and protect their residents.
As the circus continues to evolve, the White House just fired Dr. Rick Bright, Director of Health and Human Services Director of Biomedical Advanced Research Development Authority (BARDA)–the office involved in making coronavirus vaccine funding decisions. Bright is filing a whistleblower complaint against the Trump Administration, saying his firing was retaliation after he questioned drugs Trump praised. He says that science, not politics or cronyism, has to lead the way.
Former Centers for Disease Control and Prevention director Tom Frieden is disgusted with the incompetence of President Donald Trump’s administration in managing this explosive public health crisis.
“‘It’s mind-boggling, actually, the degree of disorganization,’ said Tom Frieden,” reported the Washington Post. “The federal government has already squandered February and March, he noted, committing “epic failures” on testing kits, ventilator supply, protective equipment for health workers and contradictory public health communication. The next failure is already on its way, Frieden said, because ‘we’re not doing the things we need to be doing in April.’”
Dr. Anthony Fauci told CNN on April 12th that some lives would have been saved if mitigation efforts to control the coronavirus had been put in place earlier. The slow pace of federal action was confusing to medical experts, who were increasingly alarmed that cities and states that were getting hit hard by the virus needed to move faster to take aggressive steps.
In the absence of federal direction, states and America’s top experts forge the path ahead. The report outlined how the main national efforts to combat the coronavirus pandemic are coming from state-level partnerships — rather than from the White House. Administration officials anonymously explain how the White House has made a deliberate political calculation that it will better serve Trump’s interest to put the onus on governors — rather than the federal government — to figure out how to move ahead.
“A collection of governors, former government officials, disease specialists and nonprofits are pursuing a strategy that relies on the three pillars of disease control: Ramp up testing to identify people who are infected. Find everyone they interact with by deploying contact tracing on a scale America has never attempted before. And focus restrictions more narrowly on the infected and their contacts so the rest of society doesn’t have to stay in permanent lockdown,” said the report. “But there is no evidence yet the White House will pursue such a strategy. Instead, the president and his top advisers have fixated almost exclusively on plans to reopen the U.S. economy by the end of the month, though they haven’t detailed how they will do so without triggering another outbreak,” said the report. “President Trump has been especially focused on creating a second coronavirus task force aimed at combating the economic ramifications of the virus.”
What remains unclear is whether this emerging plan can succeed without the backing of the federal government. Some states such as Massachusetts and Utah are already trying to implement parts of it. In the absence of federal leadership — as happened last month with stay-at-home orders — other states may watch and follow suit. But without substantial federal funding, states’ efforts will only go so far.
UN Secretary-General António Guterres said heightened solidarity is needed if the world is to defeat the crisis, which he called the “gravest test since the founding of this Organization”, with Governments already struggling to address rising unemployment and economic downturn.
“But the pandemic also poses a significant threat to the maintenance of international peace and security — potentially leading to an increase in social unrest and violence that would greatly undermine our ability to fight the disease”, he warned, later stating that the Council’s engagement will be critical to mitigate these implications. “In some conflict settings, the uncertainty created by the pandemic may create incentives for some actors to promote further division and turmoil. This could lead to an escalation of violence and possibly devastating miscalculations, which could further entrench ongoing wars and complicate efforts to fight the pandemic. A signal of unity and resolve from the Council would count for a lot at this anxious time.”
“The weaknesses and lack of preparedness exposed by this pandemic provide a window onto how a bioterrorist attack might unfold – and may increase its risks. Non-state groups could gain access to virulent strains that could pose similar devastation to societies around the globe.”
COVID-19 has also hindered conflict resolution efforts, and many peace processes have stalled as countries respond. The pandemic also has triggered or worsened numerous human rights challenges.
“We are seeing stigma, hate speech, and white supremacists and other extremists seeking to exploit the situation,” the UN chief said. “We are witnessing discrimination in accessing health services. Refugees and internally displaced persons are particularly vulnerable. And there are growing manifestations of authoritarianism, including limits on the media, civic space and freedom of expression.”
South Korea, Taiwan, China and Singapore, implemented variations on social controls, which allowed them to keep the virus in check even as they reopened parts of their economy and society. In America, testing is on the rise. Citizens across the country have learned how to quarantine. But when it comes to the second pillar of the plan — the labor-intensive work of contact tracing — local health departments lack the necessary staff, money and training.
Meanwhile, Trump insists that all citizens will not be tested. Experts and leaders in some states say remedying that weakness should be a priority and health departments should be rapidly shored up so that they are ready to act in coming weeks as infections nationwide begin to decrease. In a report released Friday, the Johns Hopkins Center for Health Security and the Association of State and Territorial Health Officials — which represents state health departments — estimate 100,000 additional contact tracers are needed and call for $3.6 billion in emergency funding from Congress.
The CDC is researching how to increase contact tracing capacity, its director, Robert Redfield, said. “We can’t afford to have multiple community outbreaks that can spiral up into sustained community transmission.”
“All people are talking about right now is hospital beds, ventilators, testing, testing, testing. Yes, those are important, but they are all reactive. You are dealing with the symptoms and not the virus itself,” said Tolbert Nyenswah, who led one of the most successful tracking efforts in Africa during the Ebola outbreaks. “You will never beat a virus like this one unless you get ahead of it. America must not just flatten the curve but get ahead of the curve.”
Six years ago, Nyenswah watched an even deadlier disease, Ebola, tear through his homeland. Liberia’s president tapped him to lead its response, and Nyenswah began immediately hiring an army of surveillance officers to do “shoe-leather” tracing. It involved going door to door to find anyone who interacted with someone with a confirmed case of the hemorrhagic disease and persuading them to stay indoors, even providing food and services to make that more likely.
Testing on its own is useless, Nyenswah explained, because it only tells you who already has the virus. Similarly, tracing alone is useless if you don’t place those you find into quarantine. But when all three are implemented, the chain of transmission can be shattered. Until a vaccine or treatment is developed, non-pharmaceutical interventions are the only tools that we can rely on, including locking down cities. But to expand that in a country as large as the United States will require a massive dose of money, leadership and political will. Nyenswah, who now lives in the United States and teaches at Johns Hopkins, has watched the disjointed U.S. response on TV with growing alarm.
“You cannot have leaders contradicting each other every day,” he said. You cannot have states waiting on the federal government to act, and government telling the states to figure it out on their own. You need a plan.”
In the absence of federal direction, Massachusetts last week unveiled a plan to begin building a contact tracing army.
“We could use a stronger voice out of the White House to mobilize this nation,” Washington Gov. Jay Inslee (D) said. “In the second wave, we have to have testing, a resource base, and a contact-tracing base that is so much more scaled up than right now,” he said. “It’s an enormous challenge.”
Gov. Charlie Baker (R) partnered with an international nonprofit group based in Boston that has been waging this kind of public health campaign against contagious diseases including tuberculosis in Africa and HIV and cholera in Haiti. The nonprofit Partners in Health quickly put together a plan to hire and train 1,000 contact tracers. Working from their homes making 20 to 30 calls a day, they could cover up to 20,000 contacts a day. The group is paying new hires roughly the same salary as census takers, more than $20 an hour. As of Tuesday — just four days after the initial announcement — the group had received 7,000 applicants and hired 150.
“People want to help. They’re tired of just sitting at home and waiting to be infected,” said KJ Seung, strategy and policy chief for the nonprofit’s covid response. “There’s a huge untapped resource of people in America if we would just ask.”
Utah has also taken action, reassigning government employees to increase contact tracing capacity, said state health department spokesman Tom Hudachko. State leaders are trying to pull together 1,200 more workers. San Francisco is trying to build a 150-person contact tracing team using city librarians, university staff and medical students.
“There needs to be a crash course in contact tracing because a lot of the health departments where this is going to need to happen are already kind of flat-out just trying to respond to the crisis at hand,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security. Experts have proposed transforming the Peace Corps — which suspended global operations last month and recalled 7,000 volunteers to America — into a national response corps that could perform many tasks, including contact tracing.
The editor in chief of JAMA, a leading medical journal, recently proposed suspending the first year of training for America’s 20,000 incoming medical students and deploying them as a medical corps to support the “test, trace, track, and quarantine strategy.”
Health workers who have been doing this kind of contact tracing for sexually transmitted diseases have proposed expanding an existing group of national disease investigation specialists — about 1,600 workers funded by the CDC and focused on ailments such as rectal gonorrhea — into a ready-made coronavirus tracing battalion. The national organization for local STD programs says $200 million could add roughly 1,850 specialists, more than doubling that current workforce.
As of now, nearly three months since the first coronavirus case was reported in the United States, no plan is set.
“I would want to see a clear indication that you are very, very clearly and strongly going in the right direction, because the one thing you don’t want to do is, you don’t want to get out there prematurely and then wind up back in the same situation,” Dr. Fauci said in an interview on CNN.
Right now the priority is to heal and repair the harm done by the swift and brutal emergence of COVID-19. But in time, we’ll need to shift our attention from treatment to prevention, and that means having to redefine of our public health policies to make the resurgence of such pathologies less likely.
Preventive policies will have to draw lessons from the rise and management of recent pandemics, starting with the novel coronavirus but including the bird and swine flus that strike at regular intervals. These actions will have to be based on scientific facts, detached from short-term economic interests, and take stock of the roles meat consumption and intensive animal farming play in generating epidemics.
Zoonoses — or pathogens passing between fauna and humans — constitute 60% of all infectious diseases worldwide, and cause 2.5 billion cases of illness among people, annually. Three quarters of new pathogens detected in recent years were of animal origin. This is not a new phenomenon: The Spanish flu of 1918, one of humanity’s deadliest pandemics, originated in birds. Other well-known infectious diseases like smallpox, measles, whooping cough or mumps probably originated in domesticated animals. The intensity of meat production in commercial circuits makes them facilitators of pathogenic transmission.
The big epidemics that have struck since the late 20th century include many that emerged from livestock farming: Creutzfeldt-Jakob (‘mad cow’) disease, linked to beef (1986); the Nipah virus originally transmitted by bats but proliferating through pig farming (1998); multiple flu episodes of avian origin (H5N1, 1997 and 2004, and H7N9 in 2016); or the swine flu (H1N1, 2009).
Other epidemics may have originated in the consumption of wild animals, including COVID-19 (pangolins or bats), Ebola (bush meat or bats) and the AIDS virus (monkey meat). Faced today with heavy human losses and the colossal economic costs of such illnesses, we must question the evolution of our food production systems. Intensive animal farming effectively favors viral infections. While it may be difficult, if not unrealistic, to prevent animal-to-human infections, control their appearance and manage their sanitary and economic consequences, one of the most efficient methods of reducing the risk of epidemics is to act ‘upstream,’ or reduce the number of animals that may be infected and to which we are exposed.
Strategic Planning Checklist
Preparedness and response to any crisis, especially the COVID-19 virus, can save lives. Failure to put public health first can cost your business in many ways, including lawsuits, so it pays to do your due diligence on all levels.
We need leaders, much like Governor Cuomo, who hope for the best, but who plan for the worst. We need leaders who can identify critical success factors collaboratively, not based on gut instinct and hindsight. We need leaders who have a hunger for the facts. Answers begin with the truth.
Just because some businesses want to open up again, each state and each business will have to assess the risk to lives and the life of the business in the face of a negligence lawsuit. Plus, customers will need facts so that they can self- regulate as they negotiate the new landscape.
Unlike some of our fearless leaders, take responsibility for actions and inactions. And don’t assume authority that doesn’t exist. Leaders can’t lead when they lose credibility and display incompetence.
Until we have a vaccine, the only way to beat any infectious disease is with pathway management. That means that we must identify all of the ways that the virus can be transmitted from one person to another. Social distancing is a start, but it’s only one strategy that must be considered. Any place where people collect is a hazard and that means grocery stores and many others. We are still thinking it through every day and tightening up the safety net accordingly. The pathway that will be almost impossible to stop is the population of silent carriers–people who have the virus, but don’t appear sick.
Meanwhile, the debate rages on about testing. It is a national disgrace that we can’t lead the world in testing technology and protocol, but we are bringing up the rear. However, I caution against putting blind faith ito testing. First of all, they offer plenty of false negatives and false positives. Secondly, tests are just a snapshot in time. The moment you complete a test, you could be exposed to the virus, so the test is a rearview assessment that can offer false hope.
Of course, contact tracing also is a critical tool, but it also is a rearview management system. There will be times when it is impossible to contract trace fast enough to get ahead of the spread. There are plenty of hopeful treatments in the pipeline. until then, social distancing, personal protective equipment and common sense are our best hope.
Who needs to hear what to maximize the safety of all stakeholders? Explain how to help themselves and others. Your web page page and social media accounts should be easy for your customers to find when they’re looking for updates or support. Customers will often go to your social accounts first when looking for updates. Be sure to segment your stakeholders as follows and address them all separately, if possible:
- Public Health Agencies
- First Responders
- Law Enforcement
- Industry leaders
Be a leader and the voice of reason. Be a defender and a problem-solver in ways that impact your stakeholders (including activities outside of your normal business. Redirect resources and capacity to help. Whether it’s a global issue like COVID-19 or a local emergency, businesses must have a crisis communication plan in place for their customers. This goes beyond minor adjustments to marketing messages. The plan must extend to customer service teams, your website, social channels, customer-facing staff, and more. Make sure that everyone included in that plan understands their role. The main teams to consider are marketing, customer service and support, social media, and PR. Make sure that you have clear communication channels set up to keep all of those groups in sync. Critical actions are more important than words. An effective preparedness and response plan can save lives, relationships and reputations.
It’s important to communicate to the company that employees should be reporting possible crises to the core response team. That will be the best way to ensure that you’re learning about incidents before they escalate. This is critical when you’re in the planning stages. In addition to working postmortems into your process, you should also assign a DRI and set a schedule for updating the contact information in the plan. Even a seasoned communications team can benefit from professional advice. Consider bringing in experts in crisis communication, public relations, media, security, legal, and other areas to help put together your crisis communication plan.
Messaging: Be open and honest about impact. The widespread closures and heavy demand for services are having a deep impact on businesses both large and small. Be transparent with your customers about how this is impacting your business, and in turn impacting your customers.
- Acknowledge uncertainty. Beyond email messages pertaining to the onset of COVID-19, you also need to explain the unpredictability of this situation and the need for flexibility. Email can help you establish consistent communication with your customers and announce changes in real-time.
- Express gratitude. Times are tough for everyone. When you’re planning your email communications, don’t forget to express gratitude towards your customers. Additionally, calling out wins is a welcome morale boost in tough situations.
- Offer an update on where you are with business.
- Let them know about the steps taken to ensure their safety during this time.
- Encourage them to continue business as appropriate and thank them for their support.
- Share helpful blog posts and videos.
- Ask and answer important/helpful questions.
Channels: This is a perfect time to expand your networks and channels to maximize your reach and influence.
- Mainstream media.
- Email is the preferred medium by most people for serious communications.
- Avoid postal service for now, unless vital.
- Use social media for general, public updates.
- Post updates on your website.
- Share/produce blogs/videos.
COVID-19 is an unprecedented crisis affecting the entire globe. And though every country is handling it differently. We are all in this together. And anything you can do to bolster that sense of solidarity with your stakeholders is appreciated.