Managing a Pandemic
RECOMMENDATION: Nationwide Coordination of the Pandemic Recovery Effort by U.S. Governors
ABSTRACT: Several states in the U.S. have formed loose coalitions to address pandemic response issues that the federal government has failed to address. It is time for most if not all states to form a nationwide coalition for that purpose.
Most pandemic recovery efforts by the U.S. federal government are failing to stabilize and unify the nation. Misinformation abounds; supply chains are uncoordinated; conversations about re-opening are ill-conceived; travel restrictions and screening are helter-skelter; schooling from home leaves poor children under-resourced and teachers over-worked; households in impoverished neighborhoods have experienced utility turnoffs, including water; testing kits are almost non-existent as compared to the need; citizens are scrambling for masks and hand sanitizers; hospitals lack ventilators, personal protective equipment (PPE), medicines, transfusion equipment, monitors, and ventilators; absentee voting (e.g., by mail) is constrained; medical personnel are dying; and federal funding to individual states is unbalanced at best and withheld at worst. Did I miss anything? Probably. Are you angry yet? You should be.
Results of Federal Control
If President Trump had listened to experts, admitted his administration’s failings early on, and fixed what needed to be fixed, tens of thousands of lives might have been saved. Even now, his nationally televised campaign rallies, masquerading as pandemic status updates, brag about fantasized successes as cover for dismal failures and botched opportunities. The latest: Mitch McConnell trumpets his desire for state bankruptcies; states are concealing shipments of supplies to avoid federal government confiscation and distribution by Trump for favors; and “opening” plans to “save the economy” threaten more lives. Can it be clearer that reliance on the federal government for most solutions is futile?
Still, hospitals and states are limping along to “make ends meet,” resulting in hand-made PPE, jury-rigged ventilators, valid information dissemination that Trump dubs fake news, municipal personnel working from home, laws to prevent utility shutoffs, and attempts by some states to provide mutual assistance. States are beginning to pick up the ball where the federal government drops it. That’s good, but not enough. What more can states do? In terms of administration, there is some analogy to corporate actions in dealing with pandemics.
Over the past decade, while assisting a number of large multinational businesses in pandemic response planning, it was generally apparent to me that corporate leaders recognized the need to delegate areas of coordination and decision-making to those whose competence lay in those areas. That recognition was observable not just in the development of plans but also in the exercise and implementation of those plans. During table-top exercises to try out strategies developed, CEO’s tended to allow their direct reports to react to the scenarios presented before declaring their own views. I’ve also observed corporate heads managing actual crises in like manner. Such leadership behavior fosters learning and communication across all corporate levels and results in successful outcomes.
Though corporate and government operations differ, principles of good leadership apply to both. It would be difficult to question the wisdom of delegating decision-making to those with the appropriate skills, expertise and positioning. U.S. governors are often positioned to manage their own states better than the federal government can mandate state operations in a crisis, just as states allow a good deal of independence and accountability to counties and municipalities. While decrees of the U.S. Congress or the executive branch are often welcomed or needed, coordination for certain aspects of a recovery effort is best managed at the state level, and a coalition of states may be needed to “lobby” the federal government for funding in addition to agreeing to cooperate among themselves.
In some ways, federal breakdowns make room for state breakthroughs. On the positive side, the U.S. federal government is taking a back seat to most of the COVID-19 recovery effort. Donald Trump has declared that the states are in charge of their own recovery efforts, and that the federal government is merely “backup.” However, that stand leaves a serious gap in recoverability when coordination is required among the states. It also leaves the Federal government in a difficult position when federal decision-making, such as funding, is required while data coming from the states is insufficient due to lack of coordination of state needs.
If states are to take charge in a meaningful way, there needs to be cooperation among them instead of competition for supplies and personnel, and there needs to be coherent, consistent, accurate and timely messaging to the public and to the federal government. Several states with common borders have formed coalitions in order to share and manage mutual handicaps, such as supply chain issues. I believe such coordination is needed nationally among the states as opposed to cobbling together coalitions among some states here and there. I am recommending a National Governors Coalition (NGC). Such an entity can be managed within the existing infrastructure of the National Governors Association (NGA) or be an independent entity.
Coordinating recovery efforts is required for the remainder of the COVID-19 pandemic and is workable for as many states as choose to cooperate. It may seem superfluous at this time to create additional infrastructure, as it may seem that the pandemic is nearing its peak in some states. Unfortunately, that thinking is mostly wishful. For one thing, pandemics don’t have a single peak, though the first is typically predominant. Pandemics tend to come in waves. Secondly, depending upon the virulence of the contagion, social distancing in various forms needs to be managed over weeks and months. The virus that causes COVID-19, known as SARS-CoV-2, is particularly virulent in terms of transmission, morbidity and mortality. Moreover, the COVID-19 pandemic is not the last to be experienced in this country or worldwide, so what is established now should remain in place after this epidemic and not be subject to disestablishment by the whims and gamesmanship of federal operatives or partisan politics.
What coordination is required? Here are the major categories of functionality required at the state level by phases of pandemic response, assuming minimal contributions from federal sources:
A. Prevention of Spread
- At the start of an epidemic, the number of patients is typically minimal, provided officials are alert and not blinded by potential political gains and losses. Therefore, as doctors and hospitals are dealing with the first few patients, the immediate requirement is to prevent the spread. Testing for microbes causing the disease and contact tracing is paramount. While that’s in progress, some amount of social distancing may be in order, for which unified, strategic messaging to the public becomes essential. As the spread increases, increased social distancing may be recommended and even enforced, such as limitations to the size of gatherings and encouragement of businesses to have employees work from home.
- The continued education of state leaders is important, including reminders about what works and what does not in managing an epidemic. The highest levels of state management, including governors, cannot be expected to have expertise in all things, especially in the complexities of epidemiology and medicine. They need expert advice, guidance and pertinent information that a coalition of states can be positioned to provide.
- Armed with such information, governors are better positioned to promote availability of hand sanitizers and masks for the public and acquisition of medical supplies to hospitals. With interstate cooperation via the NGC, such supplies can be distributed nationally according to need and without hoarding. Further, state requirements to fund acquisition and distribution can be better communicated to the federal government via a block of states rather than a gaggle of individual requests.
- Finally, because interstate travel is normally unhindered, some restrictions may be imposed and screening implemented at airports and bus and train stations. I am not suggesting anything as restrictive as road blocks at state borders, especially as governors are similarly versed in pandemic management and thereby agree (more than now) as to how to limit spread within their states. Also, with blocks of states managing supply lines, the need to curry favor with party-line executives at the federal level will be diminished in favor of more rational decision-making regarding activities to limit the spread. It’s possible, of course, that there will be governors who do not participate in the NGC, in which case more stringent interstate restrictions may be advisable to their neighboring states during the pandemic.
B. Patient Care and Household/Community Support
- By the very definition of pandemic, the disease will spread despite all efforts to suppress it. Efforts to limit the spread are nonetheless worthwhile because deaths will be substantially reduced due to fewer infections overall and “flattening the curve” such that hospitals will be better able to manage the flow. That said, hospitals will still need to manage patients. Likewise, basic care will be needed for households, including those with patients not hospitalized, as well as for other community elements, like nursing homes and shelters. Also, states need to develop the case for funding for nutrition assistance needed while millions of U.S. citizens subject to the economic fallout of social distancing continue to depend upon food banks. In addition to preparing and presenting this case and others to the federal government, they need to present the case simply and convincingly to the American public so that it cannot be easily ignored, misrepresented or disputed by partisan officials.
- Most important to patient care is the acquisition and distribution of medical supplies (masks, ventilators, PPE, medicines, beds, oxygen, transfusion equipment, blood, EKG and other monitors). Of course, all of those supplies are useless without medical personnel, technicians and support people. These folks could be in short supply in some states and less needed in others. Sharing such personnel, possibly with hazard pay, could allay some of the need to overwork them, yielding better outcomes through less fatigue and improved ability to focus.
- There is similarity here to management of other widespread crises, like hurricane damage, tornadoes, floods and forest fires. In those cases, however, help can come from states not experiencing the crisis, whereas in a pandemic, all states are vulnerable. However, they are vulnerable at different times, so national coordination along with cross-state physician licensing would allow focus on areas where the need is extreme. Certainly, even without coordination, doctors will voluntarily move to areas of need, as is happening now, and retired medical personnel will jump into the pool of volunteers, like Doctors Without Borders, but a coordinated effort would be enormously more productive.
- Sharing personnel, coordinating supply chains, managing the flow of patients among hospitals, ensuring basic care within communities and households requires both administrative and operational effort. A well-intentioned, well-advised and well-run federal government might be able to provide such effort, but those adjectives are surely a stretch in today’s world. Sadly, the current partisan, poorly-advised and “thusly” incompetent federal government is no match for the problems involved. NGC is the way to go.
C. Preparation for Returning to Normalcy
- While spread of the disease is being managed and those who are ill are being treated, the NGC must provide plans to return the nation to some form of normalcy, including the prevention of and response to subsequent biological catastrophes. Why the NGC? Once again, this planning is best accomplished through state cooperation while federal politicians are busy rustling up support for their next election campaign, putting in place laws and personnel to shore up their power base, and tearing down any progressive structure arranged by the opposing party. The NGC should strive to rise above this debacle and focus on the needs of the country and its citizens.
- Until a vaccine is developed, economic recovery needs to be balanced against population health. Management of test kits and contact tracing will help to determine which elements of national activities can be restored and how quickly. This restoration must be conducted with great care to avoid a resurgence of the disease, though some increase in occurrence is inevitable. Ultimately, it is likely that a vaccine will be developed, so the timing, distribution and publicity for the vaccine needs to be managed. Publicity should include the benefits of herd immunity and the responsibilities of citizens to participate as much as possible in meeting that objective as well as protecting themselves and the people they love.
- Part of prevention and management of the next epidemic is the encouragement of work-from-home technologies and protocols, helping corporations, mid-size and small businesses with the knowledge of existing technologies and how to use them, technologies like teleconferencing and educational means to cross-train for work-from-home jobs. The NGC can also assist in the sharing of technical knowledge and efforts for development of new technologies pertaining to pandemic response and similar disasters as well as the proliferation of information about the benefits of general disaster preparedness.
- States cannot leave messaging to the federal government. Much of Trump’s misinformation rhetoric is less than useless; it is obstructive, and the nation cannot count on expert guidance when a self-serving president calls the shots despite ignoring advice and honest communication from his expert advisors. Republicans have created and sustained a monster to whom experts must genuflect in order to retain their positions. On April 12, pandemic expert Dr. Anthony Fauci, head of the National Institutes of Allergy and Infectious Diseases, appeared on CNN and rightfully confirmed that the U.S. federal government “could have saved more lives” if it had acted earlier and more urgently to address the coronavirus. Within hours, Trump posted a re-tweet on Twitter calling for Fauci to be fired. Later, after Fauci essentially rescinded his truthful statement, Trump said he had no intention of firing him.
- On April 13, Trump tweeted, “For the purpose of creating conflict and confusion, some in the Fake News Media are saying that it is the Governors decision to open up the states, not that of the President of the United States & the Federal Government. Let it be fully understood that this is incorrect. It is the decision of the President, and for many good reasons. With that being said, the Administration and I are working closely with the Governors, and this will continue. A decision by me, in conjunction with the Governors and input from others, will be made shortly!”
- So, after saying that the federal government is only backup, he then says that “opening the country” is his decision alone, after taking input from others. If that isn’t confusing, consider this… “opening the country” is not like pushing a magic button at some predetermined time and saying, “Open Sesame! Everybody get back to work!” Getting back to some form of normalcy will take planning, testing, contact tracing, analysis and a phased in effort that will vary from region to region. If Trump wants to play God in this scenario, he will fail and the country will fail. On the other hand, if this tweet and other propaganda by this administration is merely to have his following THINK he’s allowed to play God, that’s not quite as dangerous — mostly just sad.
Here’s what’s needed for effective messaging…
- For consistent and credible communication, states need to provide a unified face to U.S. citizens as to rational and practical responses to pandemics so that misinformation is discouraged and minimized. People need information they feel they can count on. It’s unfortunate to need to spend legitimate media time and print to tell people NOT to drink Lysol or inject it into their veins and NOT to hoard hydroxychloroquine which is needed to treat lupus, malaria and rheumatoid arthritis. Misinformation is and will always be rampant, but we don’t need it to be shouted and repeated incessantly from our very own president’s bully pulpit while cabinet members and Republican legislators are too fearful of His Vindictive Majesty to make corrections or lower the pulpit.
- Despite this current hurdle at the federal level, I believe that most governors would have the courage to dissent from their party’s line enough to benefit their own constituency. A courageous posture is possible as part of a block of governors who are able to place sufficient pressure on federal authorities by pooling all resources that come from the federal government. If pooled resources were distributed by the NGC according to need, no governor would have a need to request special favors or kowtow to federal power players.
- In every phase of pandemic response and recovery, getting the real word out to the public effectively is important. For example, citizens need to know about testing, social distancing behaviors in and out of the workplace, screening policies and vaccine distribution. Municipalities, hospitals and eldercare services can be taught to use automated notification systems for emergencies and how to participate in the sharing of medical and technical personnel. Governors need to be educated and reminded about protocols and policies to manage a pandemic or public disaster.
- Because the federal government is a source of funds for pandemic response, the NGC should coordinate representation (lobbying) to the White House and Capitol Hill. Some of that representation must be on behalf of individuals facing unemployment and healthcare issues, and the NGC can assist in disseminating information about how having healthy citizens contributes to the economic health of the nation.
- The work of the NGC is ongoing, not to be terminated when a particular pandemic is gone and forgotten. A coalition of states is important for preparedness and maintaining vigilance for diseases on the horizon. Moreover, as the NGC gains experience in managing a pandemic crisis, governors will learn how to use that infrastructure to take more control of other crises that cross state borders. Pollution of air and waterways has a national (and worldwide) impact, but many regulations to control pollution occur within states.
- One of the difficulties in managing a pandemic is in convincing constituencies that social distancing will have an impact. That’s because the impact is not immediate, and a certain amount of faith in the expertise of epidemiologists and science is required. Similarly, other national and world crises have long term impacts where state and federal regulations today can protect against disasters in months or years to come. Global warming, for example, is very slow moving and difficult to detect on a day-to-day basis. A widespread belief in the science that explains and measures climate change is required in order to convince law makers to pass regulatory legislation despite the promise of campaign contributions from the oil industry. One way to disseminate politically unbiased scientific information could be via the NGC.
- Another example: Recently, the Trump administration sought to raise automobile pollution allowances, which could force all vehicle manufacturers to lower their standards in order to compete. Several manufacturers decided to cooperate in fighting the lower standard so that they could assist in the reduction of carbon pollution without significantly hurting themselves. Where certain individuals in the federal government have a stake in keeping carbon pollution high, individual states through the NGC can develop policy that is more in keeping with the welfare of the nation — and the world.
The operations described above require significant staffing. Contact tracing alone could require the efforts of hundreds or even thousands of people, somewhat analogous to census taking. Each participating state will need to contribute to the effort in some way. It is not the objective of this paper to detail how the NGC would function. Obviously, the organization would need areas of accountability and a reporting hierarchy. I leave that structuring for further study.
I am suggesting the National Governors Association (NGA) as the governing body because it is an existing organization. However, it may not be the best suited for operational requirements and coordination. The National Governors Coalition (NGC) can be a cooperative to which governors may join at their individual discretion. It can operate under the auspices of the NGA or independently.
Since 1908, the National Governors Association, a nonpartisan body, has been instrumental in communicating policy concerns of member entities to the federal government. The member entities are the fifty States and the five U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands). Chairmanship and Vice Chairmanship alternate annually between Republican and Democratic governors. A conference is held annually, the last of which was in February 2020.
In addition to providing membership perspectives on issues of national concern, the NGA provides services and seminars to state executive branch officials as well as management and technical assistance to governors. Services include representation in Washington DC, developing policy reports on state programs, and conducting the annual conference. It does not engage chiefly if at all in operational services, which is not to say that it cannot.
The functions of the NGC would be primarily operational. In order to function efficiently and cooperatively for pandemic response, coordination is required outside of federal control but with the ability to communicate requirements to receive aid from the federal government. While operating independently, the purpose of this entity is not to compete with the federal government, but to provide a unified and practical alternative to controlling a pandemic and avoid federal government interference due to misinformation and partisan politics.
Marv Wainschel has been developing pandemic response plans for large multinational corporations for over a decade, has studied pandemic response and developed and executed surveys on the subject, has lectured to corporate business continuity planners on pandemic response, has designed and conducted seminars and pandemic response table-top exercises, and has published numerous widely-read books and magazine articles on business continuity, including pandemic response.