Navigating a Crisis: Why Company Culture Is Key the present times call for leadership with “love and humility” and “a growth mindset” ......... “I’ve personally been on a journey to lead with love and humility instead of pride and fear” .......... In Thailand, everything is about the heart. The Thais have a word for it called jai, and it’s all jai. And since then I’ve personally been on a journey to lead with love and humility instead of pride and fear. .......... As I came into Amway, I was very clear that my first 100 days were all about “listen and learn.” ........ The biggest challenge we have faced in addition to keeping all our colleagues safe has been essentially around supply chain. ............ online is the new offline ......... management has become democratized through this process. Every person on a Microsoft Teams [meeting] or a Zoom call has an equal voice. .......... We have three cultural principles: Live to serve, love to learn, and lead from the heart. ......... long-term strategy is the best short-term strategy
COVID-19 on Campus: How Should Schools Be Redesigned? Redesigning academic institutions so that they can re-open and function safely in the aftermath of the COVID-19 pandemic is a challenging problem. Part of the value from a traditional education in an elite institution is socialization as a member of the future elites in finance, business more broadly, law, government, and industry. You meet and become friendly with people who will work with you for decades to come, whose trust you likewise will need for decades. ............ We can already see that improper design, even suboptimal design, can be catastrophic. ........... We need to determine to what extent we can deliver services adequately through virtual online alternatives. We need to determine to what extent we can deliver traditional services effectively through safe redesign, which manages public risks and to convince the public that risks have indeed been managed. And we need to find the optimal balance. .......... In some industries there is no redesign that saves it from total economic collapse. Movie theaters represent the most extreme example. ........... The vast majority of movie theaters will never reopen. ........ Retailing will be transformed but that industry already is adapting. ........ Redesigning elite academic institutions provides a concrete example of the most difficult design problem. ........ Military academies understand that their missions are complex, and they must include discipline and trust in your future cohort of peer officers as much as they include tactics, strategy, and military history. ............... a significant portion of the value of attending an elite institution is the informal time spent with faculty and with other students, and much of this value can be destroyed by improper redesign of the campus before reopening ............. We can also assume that state, local, and federal governments will still be dealing with the massive debt created by the virus over the past several months. Further, we can assume that many families are still dealing with the financial hardship created by the lockdown. .............. three age groups, corresponding to Students, most Faculty and Staff, and the Oldest faculty and staff. .......... We assume that essentially all non-academic activities, from sports to drama and music, will have been canceled. ......... We model the transition of individuals from the Healthy population, into Exposed, Infectious Asymptomatic, Infectious Sick, Recovered Immune, or Deceased. ............ First is full PPE or other protection for faculty and staff. Second is mandatory social distancing for students in the classroom. Third is mandatory social distancing for students in dining and student housing. Fourth is social contact tracing without testing. Fifth is social contact tracing with frequent and regular testing. These interventions can be combined to yield various strategies for reopening a campus. ............ Reopen and change nothing is not a viable strategy. ......... Protecting only the senior staff and hoping for herd immunity among the rest of the organization is not a viable strategy. ........... Unfortunately, there are very few industries where mixing virtualization and traditional labor is effective. .......... It is difficult to double the spacing between employees in a meat processing facility without doubling the size of the building or reducing output by half. .............. The combination of protecting senior staff and blending virtualization with traditional service delivery is possible in some industries but not others. Moreover, it is not sufficient in settings where employees or students also live together in close quarters after work, like a university or an aircraft carrier. ............ Strategy 4: Protect the Vulnerable and Slow the Spread of the Virus through Virtual Instruction and Redesigned Dormitory Experience ............ Strategy 5: Protect the Vulnerable, Slow the Spread of the Virus through Social Distancing in the Classroom and Dorms, and Remove the Contagious through Test and Trace ........... Even in the presence of all forms of intervention described above, testing will need to be constant and universal, with effective contact tracing after the identification of infected individuals. Daily testing across campus will not be possible. And when a significant portion of infected individuals are asymptomatic, hot spots are likely to have grown quite large before they are detected. ............. take samples from entire living groups of maybe 100 or 200 students. .............. aggressive programs of testing and contact tracing will also be required. .......... If a university does choose to open in the Fall, it will need to adopt the following practices, all of which are contained in Strategy 5. ........... Frequent testing and rapid social tracing will be essential to slow outbreaks of the virus, which inevitably will occur. ........ Students are not going to see the risk of COVID-19 as severe for them. They will not be certain that violating a social distancing norm will expose them, or that exposure will lead to illness, or that illness would be severe for them. They are not going to give up seeing friends or lovers. Redesign of living on-campus units will be the most ineffective part of the transformation, and campus living will be the most vulnerable part of the redesigned campus. And students will — quite reasonably — resist tracking through their phones. Where they sleep, and who they sleep with, and how late they are up drinking, and who they drink with, are all data they will not wish to share with their universities or with anyone else. .............. Every student would have a unique RFD token. Without the token they would not be admitted to any classroom building. ............ Super-spreader events should be banned; there probably will not be giant on-campus parties in the foreseeable future. ........... Contact tracing will be essential and contact tracing must be automatic, secure, and private. ........ Testing must be frequent. Students who have contracted the virus, whether they are symptomatic or not, must be quarantined, and quarantine must be without stigma. Ideally, quarantine of students who reside in dormitories would be in facilities nicer than existing dormitory facilities. Students who live off campus will be expected to quarantine at home. Students who are quarantined will have their RFD tags noted and will automatically be denied access to classroom buildings and dormitories. ........... Contact tracing must be immediate, compassionate, and anonymous. Students who have been exposed must be notified. They must be told as gently as possible. And they must not be told the name of the individual who may have exposed them. .......... The entire process must be transparent. Students must know the reason for each measure that has been imposed. And they must be able to know the state of the disease on campus at any time
Why We’re Losing the Battle With Covid-19 The escalating crisis in Texas shows how the chronic underfunding of public health has put America on track for the worst coronavirus response in the developed world. .......... the key to stopping a pandemic was preventing as many people as possible from landing in hospitals in the first place. ............ Decades of research shows that a robust national public-health system could save billions of dollars annually by reducing the burden of preventable illnesses and keeping the population healthier over all. But like most public-health departments across the country, Harris County’s was grossly underfunded. Shah likes to think of his fellow public-health practitioners as the offensive line of a football team whose fans know only the quarterback: clinical medicine. .............. the pandemic of the century ........ Politics had won out far too often over sound science. As a result, the state’s reopening had been hasty and poorly coordinated. And now, a month and a half in, case counts were rising and intensive-care units were bracing for an onslaught. ......... In other countries, officials locked down entire cities and employed large-scale, high-tech surveillance programs to stop the virus from spreading. In the United States, decades of near-total neglect had left the entire public-health apparatus too weak and uncoordinated to mount even a fraction of that response. ............ Without any clear guidance or coherent national strategy, states were on their own. In March and April, governors found themselves bidding against one another for ventilators and personal protective equipment. In May, several states — not just Texas — rushed to reopen. And by late June, case counts were surging in at least 20 of them. .............. The country was on track to achieve the least successful coronavirus response in the developed world, with the most total cases, the highest death toll and the worst projections for late summer and early fall: tens of thousands more deaths by year’s end ............. And that wasn’t even accounting for a possible “second wave.” Or for flu season or hurricane season, either of which would almost certainly worsen the current crisis. ............... Public-health interventions work best when the forces of politics and culture are aligned behind them — when elected officials provide the necessary resources, and citizens abide by the necessary strictures. Even now, with hospitals filling up, such convergence seemed unlikely. ........... The economy was in tatters now, and the virus was still spreading. ............... In the past century, the largest gains in human health and life expectancy have come from public-health interventions, not medical ones. Clinical medicine — treating individual patients with medication and procedures — has registered enormous gains. Hepatitis C is now curable; so are many childhood cancers. Cutting-edge gene therapies are curing rare genetic disorders, and new technology is making surgeries of every kind safer. But even stacked against those triumphs, public health — the policies and programs that prevent entire communities from getting sick in the first place — is still the clear winner. “It’s saved the most lives by far, for the least amount of money,” Tom Frieden, a former director of the C.D.C., told me recently. “But you’d never guess that based on how little we invest in it.” ................. Social policies that mitigate economic inequality would be at the base of the pyramid, followed immediately by public-health interventions like improved sanitation, automobile-and-workplace-safety laws, clean-water initiatives and tobacco-control programs. Clinical medicine would be closer to the top. ........ Less than 3 percent of the country’s $3.6 trillion total annual health care bill is spent on public health; a vast majority of the rest goes to clinical medicine. ............... Americans don’t like being told what to do. ................ We want to be protected from infectious diseases and dirty water and bad food and crazed gunmen. But not in a way that undermines our freedom. That ambivalence was baked into our public-health institutions from the start. ............ At the turn of the previous century, commissioned doctors had the same reputation for service and self-sacrifice as soldiers. ............. C.D.C. powers are limited. ..... “They treat the states like clients,” says Shelley Hearne, a professor of public health at Johns Hopkins University. “They provide funds and issue recommendations. But they don’t hold any feet to the fire.” ........... the nation’s public-health apparatus. The system, the authors wrote, was arbitrary, reactive and wildly uneven from one part of the country to another. Crises tended to be addressed, or not, based on political will, not scientific knowledge. Investment in public-health programs was thin in many places, and the capacity to gather and analyze essential data was poor. Leadership was also weak and unstable, with health departments increasingly staffed by political appointees instead of career civil servants. And schools of public health had become too academic and divorced from the actual needs of public-health agencies. What’s more, the relationship between medicine and public health was plagued by “confrontation and suspicion.”........................ There also seemed to be no clear coordination among federal, state and local health departments nor much agreement on who was in charge of what. “Responsibilities have become so fragmented,” the authors wrote, “that deliberate action is often difficult if not impossible.” .............. And if they could not contain the virus once they reopened, the entire shutdown would have been for nothing. .......... Infectious-disease outbreaks were trickier. Viruses were invisible — and slow. It took weeks to know if any given decision was the right one, and in the meantime constituents clamored for officials to do less, not more. When Hidalgo erected a temporary field hospital in April so that intensive-care units would not be overwhelmed by a surge of coronavirus infections, Republican lawmakers accused her of wasteful overreaction. When she ordered the release of low-risk inmates from the county jail, in an effort to prevent an outbreak there, a district judge ordered the sheriff to ignore her edict. And when she made masks mandatory in all public spaces, Lt. Gov. Daniel Patrick singled her out for rebuke. .......... It also inspired more citizens to take matters into their own hands. In mid-May, a handful of shops began reopening with the help of heavily armed militias who stood guard in an effort to discourage officials from interfering. ........ By Memorial Day weekend, Texas was almost fully reopened. The state had not met its own criteria for keeping the coronavirus in check. No one seemed certain about whether or how to enforce the social-distancing edicts that remained. And, while Harris County’s case counts had plateaued, case counts in other parts of the state were rising. ............ In the mid-1800s, even as American cities grappled with repeated cholera outbreaks, some officials balked at the expense of sanitation departments and municipal water systems, preferring instead to blame the poor for choosing to live in filth. And during the flu pandemic of 1918, public-health edicts were often subsumed by politics. The mayor of Pittsburgh, for example, ended a ban on public gatherings, not because the city was out of danger but because he had an election coming up and his constituents wanted to celebrate the Armistice with a parade. The city went on to suffer a spike in flu cases, even as the virus waned elsewhere. .................... These powers were often employed cruelly; quarantines in particular were aimed at minorities who were considered dirty and disease-carrying by nature. During an 1892 typhus outbreak in New York City, for example, Russian Jews were rounded up — some of them literally pried from the arms of distraught family members ...... and forcibly quarantined on an East River island downwind of the city garbage dump. .................. It was commonly held at the time that Eastern European Jews carried typhus fever. Very few of those who were quarantined turned out to have typhus, but six ultimately died from illnesses related to unsanitary quarantine conditions. .................... In 1900, when plague emerged in San Francisco, Asian residents were prevented by armed police battalions from leaving the city’s Chinatown section, while European-Americans continued to come and go freely. And Black and brown Americans were often excluded from emerging public-health programs altogether, even as their bodies were used in experiments that advanced the science underpinning those very programs. In an effort to learn more about syphilis, for example, the U.S. Public Health Service withheld treatment from scores of syphilitic Black men in and around Tuskegee, Ala., lying to them about the nature of the study they were participating in and causing many to suffer and die from the disease long after a cure was available. .............. in the 1940s, in an effort to determine whether penicillin could prevent sexually transmitted infections, the U.S. Public Health Service experimented on prisoners, prostitutes, soldiers and mental patients in Guatemala, infecting them with sexually transmitted diseases without informing them or seeking their consent. ................. “From there, we see growing libertarian rejection of public-health law and less and less exercise of public-health police powers,” Parmet says. “Now we’re in a once-in-a-century global pandemic, and everyone’s scrambling to figure out what the state can and can’t do to protect the public.” ............... By then, just about all businesses were open at some level, and case counts were rising with alarming speed. Shah felt as though he were trapped in the driver’s seat of a car with a stuck accelerator. “It’s like we’re shouting out the window, trying to tell everyone, ‘Hey, this thing is out of control,’” he told me. “But we can’t do anything to slow it down.” ............. America was a paradox — a beacon of science embedded in a culture increasingly suspicious of scientists ........... something much more fundamental would also have to change. The coronavirus pandemic has laid bare gnawing questions at the core of America’s many divisions: Are we willing to trust science and scientists in a crisis? What, exactly, do we want from our government? And what are we willing to sacrifice for one another? ............ the anti-mask set is hard to ignore, in part because it speaks to a broader current of American life. “People have grown comfortable putting their individual rights ahead of the needs of their community” ............... A common complaint among public-health workers is that this “neglect, panic, repeat” cycle makes it impossible to prevent crises instead of merely responding to them. ........... a new and bitter reality: Because of the economic crisis, which was triggered by the current pandemic, which was worsened by a lack of public-health investment, public-health agencies will probably suffer more budget cuts in the coming years. ........... “It’s a lot of isolated departments across the country, saying, ‘Oh, we’ll just keep doing God’s work over here, and if our budget gets cut again, we’ll just make do somehow.’” ............. “No one is going to vote for you or name a hospital wing after you because you kept them from getting something that they didn’t think they were susceptible to in the first place,” Frieden says. “The people who cure diseases are glorified, not the people who prevent them.” .............. And the same stories that played out in Wuhan and Lombardy and Seattle and New York were beginning anew. And not only in Texas. In more than 35 states, including some that had previously brought their outbreaks under control, daily case counts are rising, positivity rates are rising and new grim records are being set — and then quickly surpassed. People in Texas, Florida, California and New Jersey are bracing for a second wave of outbreaks in the fall, even as the first wave has yet to fully recede.
