The People, Process, & Progress Podcast - How Public Health, Healthcare and the U.S. as a Whole Can Improve our Outbreak Response | KEV Talks #6

Episode Date: November 2, 2022

Re-visiting my article from April 2020 and sharing how I believe Public Health, Healthcare and the United States as a whole should move forward in a post-COVID Emergency Preparedness world. Prompted by the controversy from Emily Oster's 'LET’S DECLARE A PANDEMIC AMNESTY' article in the Atlantic from October 2022.

In April 2020, with nothing else to do, my family took an enormous number of hikes. We all wore cloth masks that I had made myself. We had a family hand signal, which the person in the front would use if someone was approaching on the trail and we needed to put on our masks. Once, when another child got too close to my then four-year-old son on a bridge, he yelled at her, Social distancing! These precautions were highly misguided in april 2020 no one got the coronavirus from passing someone else hiking outdoor transmission was vanishing rare our cloth max made out of old bandanas wouldn't have done anything anyway but the thing

is we didn't know this is the first couple paragraphs from an article called let's declare a pandemic amnesty written by Emily Oster in The Atlantic. And I'll link to that in the show notes. This is Kevin Pinnell, your host. And today I'm going to talk about not that whole article. It's quite the buzz on the Twitters and Instagram and everywhere. And of course, as you can imagine, left and right, going back and forth over. No, there's not going to be any intimacy. People need to pay, go to jail, et cetera, et cetera, which quite frankly to me is not helpful at all. So in this episode six, no one has claim. All have claim. I'm going to share

some stuff. I actually wrote an article that came out in April 2020 about how we are all responsible and no one is responsible for both our decisions, what we knew, what we thought we knew, and frankly, a lot of what we did not know. But first, today's episode of KevTalks is sponsored by, well, you, the listener. Thank you for clicking play and for tuning into the show. KevTalks is the show that provides compelling interviews and value-added perspectives on topics primarily in the healthcare, wellness, technology, and public safety spaces. So enjoy your commute. Do we still do that? Coffee or morning walk, and let's fly into the KevTalks podcast in three, two, one. Thank you everybody for coming back to this podcast and for going to KevTalksPod.com to hear this, read more about this, read the write-up that I'm going to refresh.

And other past episodes, listen to them, see the write-up. There's a lot of good information there, some references. If you have interest in being on the show or have a guest that you think should be on the show, get them to fill out the form, guest request, and send some feedback too. I appreciate it. So episode six of the KevTalks podcast, no one has claim, all have claim. And I'm going to claim something. This is my opinion based on professional personal experience in my life. It does not represent those of who I work for now or have worked for. So no one has claim, all have claim. That's a statement. It was in the

movie Kingdom of Heaven. Orlando Bloom played the character Balian, and he was saying this talking about the city of Jerusalem, right? Disputed for centuries, still disputed. In particular, in this movie, it was the Christians against the Muslims trying to take back the city. And it really spoke to me because it's in relation to like our COVID-19 predicament, especially early on, where governments, experts, the media, no one's thought of preparing or responding to COVID-like outbreak, but they're wrong. They were wrong then, they're wrong now when people say, oh, we should find a better way to be operationally prepared. Well, guess what? There were ways to do that, but a lot of folks chose to be administratively prepared. And I'll link to previous episodes where I talked about this as

well. Public health has been an administrative overhead nightmare in preparedness, not an operationally actionable, ready plan and workforce. And that's not everyone. But a lot of folks that I work with at various levels focus more on making sure that your plan had everything spelled out with every word as opposed to does it have what we need and our people are trained to take action. I'll get into a little bit more. But early on, folks were wrong when they ran around saying, oh, we don't know what to do. We've never done this before. There's plans for it. And certainly, can you scale that is a challenge, but there were. So no one being responsible, not quite true. So it's

our fault, right? What does that mean? It means that pandemic planning exists in many, many planning documents at the local, state, and federal levels. This is where the all have claim comes in, right? The world is hearing statements like, and has heard, and did hear, no one could have planned for this. Who could have thought of this? Yes, we could have. We did think of it. In fact, there's a document that people sign that high level officials have signed that say they are national incident management system compliant that says they're going to use principles that say we practice doing this for real. We train our people to do this for real. And it's in a lot of plans that then people sign off on and then get some federal money for. So that's unfortunate.

It's a guide, right? NIMS, this National Incident Management System. But it exists and it exists everywhere. It's the standard. If there is a public health department that gets money that's funded, they are to be NIMS compliant, including the CDC and HHS, who actually oversee all that money and have overseen all this money and who advise and, as we all know, have been affected by politics unbelievably in the past two, three years.

The other thing that NIMS incorporates is how public health in particular and health care and other partners can incorporate this incident command system, which I've talked about quite a bit, especially in early episodes where this used to be called between the slides. But is this a one-off? Is this like, you know, just one thing and maybe people would know about it? No, there's a national response framework and it's there to help people know how to respond to all types of incidents. So I think you all get the point. But public health and health care are mentioned nine times in this national document.

And over the past two years, it's made me kind of sick to my stomach to hear public health officials, health care officials, emergency officials, government officials mostly say that we didn't know. We couldn't have known this. Well, maybe they didn't ask the right people maybe they you know in hindsight uh should have focused more on tying up their shoes and getting out there and practicing than running out of ink on their pens or typing for hours and hours and hours on end like i have just to meet an administrative, quote, readiness criteria, because it was nonsense. So I think we need to disrupt the norm, right? So, you know, I was a bit of an outlier when I was in public health and emergency management, because I latched onto the principles of this all hazardous management. That means I latched onto practicing and having and sharing that

knowledge with the public health folks that I work with, emergency management folks, public safety, everybody, right? All of our partners. And I wasn't perfect, but I realized, man, this stuff works. And honestly, it works more than just for public health response, public safety response, special events. It helps you plan everything. I latched onto it because I exposed it, really prepared myself and my colleagues in the health department to really be ready. This included partnering with public safety and general government partners. You know, we would drill regularly. We would fully exercise, which means every year we gave shots, gave flu shots. We practiced it for real. We did a briefing. We got all the equipment out. We trained the nurses. We had everybody in leadership positions. They led their units,

their groups, all the stuff you would do just like they've done the past few years. But then it actually happened in 2019, 2020. And it's like everybody forgot. And I'm not talking about where I work in particular, just in general. I know I wasn't the only one doing that, but it's like, poof, what do we do now? This is different. And I'll say this, tracking something that's invisible, that we're not 100% sure about, being overly cautious is probably smart. But as we also know, we did have data to dispute some of the overly cautious actions like keeping kids out of school. And that's a personal choice, I think, for families. I know it is for me, but it was horrible for the kids. They hated it.

Not being with their friends, not being able to develop relationships, social skills. It was very bad for them. So kind of back to the readiness thing, the myth that we couldn't have been ready. So if you practice that every year, then when another year rolls around and a different bug comes in, you at least have the bones for it, right? So I talked about the checklist. I've talked about that on previous episodes, but it's a horrible way to manage operational ready force, right? A force at the federal level, at the state level, at the local levels that should be ready to actually go out the door any given day. And FYI, we had practice for that, right? With the swine flu, with the various mosquito-borne illnesses before that, with Ebola screening, should have used the same procedures, the same incident command system, the same response,

the same incident action planning, and just tailor it to whatever the bug is, du jour, and then you're ready to scale up. So part of that scale up and part of that mismanagement, though, at the federal level from what I see was people that were appointed in positions that had no business being there. And the biggest one that strikes me is the Strategic National stockpile. That should have been coordinated by a logistics expert, right? Someone from UPS, kind of think about that, that can take requests, manage them, send them, manage the supply, not run out. The whole point of the SNS or strategic national stockpile is to provide for states and then provide for local governments when they ask for

help and say, we're running out of this and we need this. And of course, we all know the craziness that went on with supplies, particularly masks, shields, whatever policies were going on where. So how do I think in my professional opinion and experience that we can be truly ready to address that part of the argument? Because I can't address all the other stuff maybe not in this episode maybe a future episode maybe with future guests where we talk about kind of the whole gamut of things right the data we use the data that was manipulated messaging politicizing government all that stuff that's gosh that's I mean whole news stations right make money off that negative nonsense and so I'm not going to dive

into that now, but I'm going to talk about how can public health, you know, something that's near and dear to my heart that I spent five and a half years in, built some of the best relationships I've had in friendships with folks in public health, public safety, and other areas. How can they be more ready next time? And this part, after looking at it, and I wrote this in April 2020, it holds true, and it i think it applies uh just as much if not more today from even more lessons learned so let's get into this so how can we be truly ready for the next bug the next thing that the news is going to say is going to take us all out that hopefully we get good data on that we can be a little better next time so the

first thing is to me that public health and health get a better seat at the table. That means that public safety and emergency management partners must understand the value of public health and healthcare as partners in emergency preparedness. I saw this where I worked with where they were super valued. We had great partnerships, but it also didn't happen everywhere. Not in every locality that I saw or had colleagues that worked. Some folks had to fight as public health to be invited. Some folks as public health never invited their public safety partners. It was a shit show and sometimes, right? But it's a two-way street. Public health and healthcare need to step up. They need to truly prepare their own staffs for real-world response and with a louder voice among local, state, and federal partners, right?

So we need to get a better seat at the table, but we also need to have a louder voice and be more confident and insist on things. The second thing I think is that all employees in public health need to be trained up to the incident command system 300 level. What does that mean? So it's required for some government employees now now but it also should happen for the private sector right because supply chain private sector owns most of that jazz what is the 300 level 300 level is we build on basic concepts of what's a group what's its command system and then really you get to practice it for two days in the lower level classes it's all theory it's online online based. You see some slides, you take a test online and like any other training like that, it's not that great when you go to

actually do it unless you're with somebody that's done it before with 300, you'll get that chance or students will get that chance, a challenge time, right? Cause it's what a three day class if memory serves. And so it's hard to let everybody do three days, but you know what? You break it up, you cycle people through. Often what I saw is higher level people would go there, higher ranking or in higher positions, but they're not the folks that really needed the training because they wouldn't be the ones in the groups on the ground doing the screening or giving the shots or doing security. That's also not a great way to train, right? But the hands-on aspect of it is what's critical. So first, public health care gets a better seat at the table.

Second, when they get that seat, they need to be ready by training their folks up to at least the ICS 300 level. Probably not as popular, but I think we need to ditch or get rid of the hospital incident command system or HICS. It's its own customized incident command system made for healthcare. And I get it, it was probably adapted for folks that don't work in public safety or other areas, but it doesn't provide the broader skill set and a solid foundation that if if we taught everyone, the all hazards principles that you learn an incident command system 100, 200, 300, then those folks

in healthcare could use that anywhere, right? And where I saw maybe a great connect, so I was part of the incident manager team that organized this real huge bike race, a world level bike race, worked with healthcare a lot, right? So if they use their own system and we have kind of the standard system where there's intersect, where we had a mass casualty, or if we had one or something like that, that's where it gets sticky. HICS is very customized for hospitals, which is neat, but you can use the broader incident

command system and just name the groups or teams and operations what you need them to. You don't have to have so many specialized boxes. They do the same things that the standard units in the incident command system do. So any customization, any workaround causes communication gaps and confusion. Leaders need to make time. This is my fourth thing. Leaders see many documents across their desks. When those documents state a government or business is ready for hurricanes, outbreaks, et cetera, they need to take a few extra minutes or meetings to dig deeper and get examples of the practical preparations, right? So this is different than we would have meetings or readiness meetings that said, okay, go

through this plan, do this, tell me about that. But not always show me how your team has done this. How many times did you practice this? Why do you think you're ready? What's the proof that you're ready? Let's go through some discussions. And I get it, leaders are busy, meaning directors of health departments or chiefs of department or CEOs of

whatever business you're working with. But if you're going to say you're ready for something and then the Super Bowl comes in and you're not ready and you forget how to catch a pass, that's a problem. The next thing is to talk through the in plan for uncomfortable topics, right? People don't like to talk about death. I don't, um, been around it plenty. Um, still don't like it, but mass fatality management, medical surge management, crisis standards of care. That's when we're running out of stuff and people, we have to decide who gets treated and doesn't. And these were hot topics that no one wanted to own, that were hard to get solutions for, and there were solutions provided. So not all the time, but these are the times when

people really have to push and just realize it's the business you're in, right? But we have to own them, right? Work with funeral directors, partner with hospitals, practice and document how in the worst of times we can do the greatest good for the greatest number with limited resources. That's exactly what COVID response was, right? How can we try and do the greatest we can for everybody? And, you know, again, decisions to send people home, to wear masks everywhere, including outside on the trail, like I started or whatever, wipe down your mail. I know I wiped my mail a couple of times and I was in public health, but we didn't know. But that's really what we're trying to do. And

each of these real big disasters, big outbreaks is the greatest good for the greatest number. And sometimes that comes down to if someone has a comorbidity and, you know, or plural and the likelihood that they may make it is low and someone is young and healthy, they just happen to have this disease and they probably have a brighter outcome, then that younger, healthier person gets the treatment. It's a horrible place to be, but that's the kind of discussions you have to have ahead of time. Not when, you know, Governor X is all over the news talking about how many ventilators they have and there's an argument, you know, all the different government levels of who's doing better, blah, blah, blah.

We who get the stuff done at the street level, at the hospital level, at the county level, we need to have those conversations more often. Again, I was very lucky to work with awesome people that helped me have those conversations and we're at the table, but we have to do it. You have to, for real, this is my last point, practice points of dispensing. Not on paper, not on a tabletop. You need to get vehicles out there. You need to move a bunch of cars through it, right? I mean, that was part of the frustration and confusion that I saw of people trying to figure out how to do that in 2020 as if there were no plans for it. There's plans all over the place. I shared,

not that I'm the solution, but I and other planners and coordinators and stuff I know had plans and templates. So I know they exist. I know I've seen them from other states, from other places, but there's a difference between a tabletop where you just talk about something. And that's not just emergency response. That's everything. But there's a big difference between saying I would do this. and theoretically I would do that, than getting out there in your shoes with your staff and saying, oh, we forgot bathroom access. Uh-oh, we ran out of food. Right?

Practical things, let alone do you have enough swabs to give the shots and test kits and all that. That's how you work the kinks out. Giving your flu shots. If you're not doing that now and you work for a health department, every year, if you do a flu shot drive, whether it's drive-through, walk-up, walk through the building, practice what you plan for and do it for real. And are you right? Is your plan accurate or do you need to go dust it off? Set external security, internal security. Use nursing strike teams.

Manage the logistics of the vaccine coolers, but do it full scale. Don't just check the box. I think a lot of folks checked the box before 2019, 2020, and it came back and it bit all of us in the ass. We checked the box on if our IT systems work and the data reporting was disparate and disconnected. And some of the best guidance I've gotten is to quote, to say, quote, these data are subject to variability in reporting, end quote, on any report you put out. Well, my goodness, some of our trusted sources, the data was awful, right? There's no reason in 2020, let alone now in 2022 and beyond that we shouldn't have connected

much better, more efficient, more accurate data systems for public health and healthcare that we share with emergency management that we give access to. So all our partners are at the table at the same time. So what is the path forward? So how can we say that no one has claim? Well, here was my two cents in 2020 and kind of real time. I'll react to it. For pandemics like COVID-19 or others, we can never have enough ventilators, mask, gloves, et cetera. I agree with that.

We can think, I think one of this many will estimate that. And now I guess we can have a better number based on what happened. But the numbers are just too hard to keep up with, right? What we can do is prepare our minds and muscle memory through practice, discussions, and exercise. That's the key. That's the key for any of this, any successful venture, whether it's jiu-jitsu or exercise or project management or emergency response. You got to practice. You got to talk about it.

You got to do it for real. You got to get muscle memory. You got to figure out what's working and what's not. So in looking at the path forward that I said here in April 2020, I think I agree, right, for this last kind of full paragraph here. I submit we should also not rush to buy a bunch of stuff that will go bad. This happened after 9-11 and Hurricane Katrina, and it was wasteful. And I'm going to add real time right Katrina, and it was wasteful. And I'm going to add real time right now.

It happens after active shooters. Right now, there's radiation response, active shooter gear, gathering dust in the closets of localities across America. Instead, let's focus on continuing to shore up actionable plans, make them shorter and easier to follow, practice them, and know them before something bad happens. And of course, the show was called People Process Progress back then, but we must coordinate with our people. That means I don't fully agree with this article in The Atlantic, and that's fine to give full amnesty. But here's, I'm going to read, you know, this last paragraph from that article. Quote, the standard saying is that those who forget history are doomed to repeat it. But dwelling on the mistakes of history can lead to a repetitive doom loop as well. Let's acknowledge that we made complicated choices in the face of deep uncertainty and then try to work together to build back and move forward.

Quote, I agree with that, right? I agree with that. Emily Oyster's or Oster, sorry. Statement there closing out the article. Some folks i think read that and just freak out and say never never and i get it um but you know we do need to share processes and talk to people on all sides of the aisle at all levels of government public and private sector but we need to have an effective preparedness response process and programs. They need overhauled completely, complete overhaul, right? Look at them and make them shorter, easier, expect that everybody's going to practice, right? Or you get no money. And you know, that was always a stick, right? If you're, I can't click on this link in your plan and it goes to

there and I'll go on and on so I won't get sidetracked. But that's the only way we can make progress, right? We do have to talk to each other. So folks don't necessarily have to forgive each other, don't have to provide that mental amnesty or legal if folks are going to go for that. I don't know how many lawsuits are coming out of this pandemic and all that jazz. But we do have to work together to make it better and not just to say, oh, look, I made it better. Vote for me again. But to truly say for the folks on the ground, I am going to work with you well ahead of any disaster. We're going to practice together.

We're going to keep open communication because that didn't happen fully for the past couple years and it's bull crap and it's time to end all that nonsense. So thank you for staying to the end of this episode with me. Thank you for sticking with the KevTalks podcast as I transitioned from the People Process Progress podcast. Yes, had kind of some schedule pushes and got interviews lined up. Going to have to, you know, life happens. So we've got to reschedule. But thanks so much again, KevTalksPod.com. Please go check that out. Leave a rating and review on Apple Podcasts. That will help the show move up a little bit. Still in the top 10% of podcasts, which is pretty cool. Got this new replacement, Audio Technica. Hopefully, that sounds pretty good for everybody involved. I am at P-A-N-N-E-L-L-K-G on Instagram and Twitter. Thank you so much. Check out the Facebook group on Cap Talks Pod.

And remember, have that plan so you know what to do and your team knows what to do. Stay informed with facts, not fear, and get involved so you can help make the difference. For now, I've got to fly.