“Before the Coronavirus Outbreak, A Cascade of Warnings Went Unheeded, Government Exercises, including a pandemic simulation last year, made it clear that the U.S. was not ready for a crisis like the coronavirus”
Re: “Halting Virus will Require Harsh Steps, Expert Says: Near Total Cooperation from Public is Key to Isolating Clusters of Infection.” (NYT, March 23, 2020).
There is Good News. China has turned the curve on the coronavirus (no new cases as of 3/19/20); South Korea, Singapore, and Hong Kong internationally are containing the virus….but America is not ready. There are things that these countries are doing that appear to work (called evidence-based practices). Why can’t we do the same thing? Are we ready to adapt these methods to this country? Of course, it will take hard work and “near total cooperation from public to stay 6 feet apart from everyone else, work from home (or not at all) for weeks or months, have no meetings, parties, not to go to gyms, sporting events, concerts, bars, or restaurants, maybe even not leave our neighborhoods or houses for a while. But it’s better than months of sickness all around us, our doctors and hospitals overwhelmed with more patients than they can care for, and our parents and grandparents denied intensive care because there isn’t enough, and dying before they have to.
The figure below shows we are on the increase in cases; can we flatten the curve?
Johns Hopkins Center for Systems Science and Engineering. screenshot taken on 3.30.20
But a big concern right now is that we see young people on the beaches of some states or celebrating Saint Patrick’s Day at neighborhood bars- ignoring this advice, congregating at parties and beaches and not getting it, that even if they get a mild illness, they will pass it on to people who will not do so well with it. Moreover, newer studies are identifying mortality occurring among younger persons who do not have comorbid diseases. South Korea and Singapore appear to be bending the Corona virus curve because their citizens recognized the need to step up and follow guidances disseminated by the federal governments to protect those around them.
As you know, it takes being willing (motivated) and able (capacity) to do something new-- whether it is stopping smoking, doing exercise regularly, learning to play an instrument. The same is true for our organizations e.g., government agencies or health care systems. These truths must be carried out not only in the corona virus epicenters (New York, Los Angeles, and San Francisco), but also in organizations in smaller states, rural areas, and in non-epicenter regions.
How can each organization understand what it means to be ready? At the Wandersman Center, an international leader in implementation science with evidence-based results that support positive long-term change for disparate public health initiatives, we are engaged in research and application to understand and build organizational readiness for public health concerns. One of our key areas of interest is improving organizational readiness and insuring organizational sustainability.
Below can help you think about whether the organizations we count on are ready. The ultimate success in halting the virus will relay on “near total cooperation from the public” combined with organizational efforts.
For example in regards to willingness/motivation to put into place the practices used in Asia, we can ask ourselves how each of these aspects of motivation will affect our organizations’ willingness to do the things that work--
Organizations will have to be willing to change how they implement prevention and screening methods as they learn what is working and what is not. This is called “re-planning” and was first named by General Dwight Eisenhower, who was aware of the first rule of disaster planning: “No Plan survives the first contact with the enemy unchanged.” An example today is the fact that many primary care doctors’ offices are not offering patients the Coronavirus test, because the health care system that they work for cannot obtain masks, gloves and gowns to protect nurses who obtain nasal swabs from patients. We are the middle of re-planning with soon to be FDA approved corona virus self-sampling efforts where the patient mails a swab of sputum to a central processing company. This is an example of how people and health care providers can work together (what Nobel Prize winners call co-production).
Now that you have a clearer idea about what it means to be ready—we ask the question: Are organizations ready to take the lead in flattening the coronavirus curve?
Abraham Wandersman PhD, Distinguished Emeritus Professor of Psychology, the University of South Carolina. Dr. Wandersman directs the Wandersman Center, an internationally recognized organization based on implementation science that performs research and program evaluation on citizen participation in community organizations.
James J Gibson MD, MPH is a medical epidemiologist retired from the US Centers for Disease Control and Prevention. He is now working part time lecturing at schools of Public Health in South Carolina and Georgia, and recently did part-time work on HIV Pre-Exposure Prophylaxis for South Carolina Department of Health and Environmental Control (SCDHEC). He retired as State Epidemiologist and Director of Disease Control from the South Carolina Department of Health and Environmental Controls CDHEC in 2012. He has also worked previously for the CDC and as an Associate Professor of Preventive Medicine at the University of South Carolina. He was a Peace Corps Volunteer in Malawi in 1964-66.
Charles L Bennett MD PhD MPP is the SmartState Chair and Director of the SmartState Center for Medication Safety and Efficacy at the University of South Carolina. He collaborated with the late Baruch Blumberg MD PhD, ’75 Nobel Prize in Medicine recipient in documenting the effectiveness of the World Health Organization’s hepatitis B eradication program was in decreasing the impact of hepatitis B in many Asian countries from 18% to 0.5% through nationwide vaccination programs.