Back-to-school strategies: Good, Better, Best

One of benefits I have enjoyed from writing these weekly updates on our pandemic experience is the feedback I receive from readers.

Like all of us, I see the real-time events before us through the lens of my own experience. On many occasions, feedback from readers – praise and criticism, agreement and discordance – has helped me reshape my lens and hopefully broaden my perspective. I have learned elements of this crisis has been a universally shared experience. However, often the impact has been intensely personal and unique to individual circumstances.

Two bits of feedback this week helped to shift my thinking. The first was from a friend who sent me a splash page screenshot of a major national news outlet with side-by-side links to two stories. The first, an interview with Dr. Rochelle Walensky:

CDC chief warns U.S. headed for 'impending doom' as Covid cases rise again: 'Right now I'm scared.' The second, adjacent interview, was from former FDA director Dr. Scott Gottlieb: U.S. COVID vaccinations at 'tipping point' of helping turn the tide in pandemic. A few weeks ago, I wrote a piece on how to pick your pundit. Walensky and Gottlieb clearly check all the boxes as credible sources of information – truly accomplished leaders in their fields, interviewed by a hard news outlet. Although the full interviews were more nuanced than the headlines, the overall tone and messaging could not have been more different. Is it any wonder the lay general public has difficulty knowing what to think?

The second message I received this week was not from a lay person, but a highly educated and scientifically sophisticated Baylor faculty member, in response to last week's message: Back to Normal? As I wrote this, the vision of normal I carried in my head was the elimination of masking and distancing requirements in the workplace, relaxation of travel restrictions and return to non-distanced dining and entertainment. My conclusion was that now is not the time to make major return-to-normal steps, but we will likely get there soon – I think by this summer. In response to that e-mail, our faculty member wrote to me the following:

"… I am writing you as the mother of two young children who will not have access to vaccine anytime in the near future. I am curious what message you would share with those of us with young kids … yes, the vaccine is becoming more widely available to adults, and hopefully we will see widespread community vaccination. However, our children still remain at risk. While the morbidity and mortality in pediatrics has not been close to what we see in the adult population, disease in children is certainly not without consequence."

This is an important question, and to be honest, when I was writing about "return to normal" – through my grown-children-and-preschool-grandchildren frame of reference – one I did not consider. This week I would like to remedy this by reflecting on the timing of return to normal for children. When should you return to a normal classroom environment, if it is available? What about extracurricular activities? Social events? Sleepovers? Going out for family Sunday brunch?

Unfortunately, if you are looking for a credible authority figure to blow the "all clear" whistle to resume our normal lives, you will be waiting a very long time. The decision to ease back into normalcy for children will be made by parents and based on balancing the benefits of resuming normal activities against the risk of becoming seriously ill.

First, I think it is important to think deeply about the benefits of resuming activities for your child, as every situation is different. Is your child thriving in the virtual learning environment or – as many are – struggling? What teacher-mentorship relationships have been lost in virtual learning? What is the impact of sustained restrictions on their mental health and well-being? How concerned are you about lack of socialization and development? How important are extracurriculars to your child? What major social milestones are they missing (e.g., dances, proms, senior year events). In caring for a child at home, how disruptive has this been to your family's ability to go to work and earn a living? It is very important to acknowledge these are critical, non-trivial questions that will have different answers for every child and family and must be included in any risk-benefit analysis.

Second, the risk to children is far, far lower than in adults, but it is not zero. Children, particularly young children, are less likely to become infected, less likely to be symptomatic if infected, and far less likely to develop severe symptoms. Spend some time studying the following chart that stratifies new cases and deaths by age: COVID-19 Weekly Cases and Deaths per 100,000 Population by Age, Race/Ethnicity, and Sex.

Week to week, the rate of new cases and deaths in children on a per 100,000 population basis, carried out to two decimal places, often rounds to zero. To be sure, it is not zero. Children do develop severe COVID-19 infections, they can become critically ill and they can have severe outcomes. There are currently children in Houston area ICUs due to COVID-19 infections. As children reach their teen years, their risk steadily increases until it reaches young adult levels. On a statistical basis it is highly unlikely that your child will become critically ill. As a parent, I know every time your child walks out the door you think about all the terrible things that might happen – accidents, acts of violence. Thankfully, they rarely happen, but you do accept that risk as a necessary part of living in the world.

Third, we are still in a relatively high-prevalence viral environment. After a few weeks of decline, we have actually seen the national new case rate move up, largely driven by states in the northeast. In Houston, our daily case rate is in a month-long plateau, while hospitalizations continue to drift downward, likely due to our success in vaccinating people at-risk. The test positivity rate for Harris County is 8.6%. In a truly low prevalence environment, when we are at or approaching herd immunity, we should see new case rates drop sharply. Case positivity rates should drop well below 5%. You will start to see news stories about hospitals discharging their last COVID-19 patient. We are not yet in a low prevalence environment.

Fourth, when will your child be able to get vaccinated? Currently you can receive the Pfizer vaccine if you are 16 or older, Moderna at 18 or above. Clinical trials are underway in children and adolescents for all the available vaccines, and Pfizer just announced (via press release, not peer-reviewed publication) that their initial results in adolescents show the vaccine is highly effective. It may be possible we have an adolescent vaccine by the fall, but we will not see broad availability of child and adolescent vaccines until sometime in 2022.

In light of the above (continuing to hunker down has real cost, COVID-19 risk to children is very low but not zero, we remain in a relatively high prevalence state, and we do not currently have a vaccine for children), how do you make a decision as a parent?

Let us first acknowledge that this is hard, and a decision no parent wants to be forced to make. Parents should not feel guilt about making the wrong decision, as I honestly do not think there is a right or wrong answer at this point. The reality is the overwhelming majority of children and adolescents will come through the pandemic and be fine.

This analogy will be lost on many younger than me, but I remember going with my dad to buy tools at Sears. If we needed a hammer, we could choose between "good, better and best." The good version was perfectly serviceable, the best was $10 more expensive with a titanium re-enforced handle. No wrong choice. In terms of making a decision about your children, I think it we should consider "safe, safer and safest."

Safe
Start to relax restrictions on your child's activities. Based on the fact they are statistically less likely to develop severe illness, do not overly obsess on micromanaging the safety and design of every place they will be. Continue to encourage masking and distancing, as we all should at this point. Emphasize with them the importance of personal responsibility. In the current environment this is not a wrong decision. In my own personal risk-benefit analysis – as I look at my grandchildren – for me it is a little aggressive.

Safer
Actively promote a cautious return to activities (school, extracurriculars, community activities, social activities). Spend some time with your child listing the activities they need to resume and develop a means of prioritization. Return to face-to-face school and childcare seems to be high on the list. How important are after school activities? Sports? Face-to-face contact with friends?

Once you have your list, spend some time thinking about the safe design of the environment. Is there evidence that they (school, daycare, coach, family down the street) are taking the pandemic seriously, and putting reasonable safety measures in place? Has all the adult staff been vaccinated? Gradually reintroduce activities. This is where I land today in my personal decision-making process.

Safest
Continue to restrict activities and face-to-face interactions until we reach a low prevalence environment, and vaccines are available for children. This is clearly the safest option to prevent infection with COVID-19, but comes with significant, real cost. The titanium-handled hammer may be the "best," but there is a limit to what I am willing to pay. For most parents, I suspect the prospect of an additional six months or more of tightly restricted activity will be unstainable and come at an unacceptable price.

I truly wish this was a simpler process, but few things in the past year have been simple. Parents have been unsung heroes through the pandemic, working to preserve and protect the next generation. We owe you all a profound debt of gratitude.

 

 

(Note:  Between June 2020 through November 2021, I wrote weekly COVID-19 pandemic updates seen through the lens of a health sciences university.  My intent was to provide reliable information, acknowledge legitimate concerns, console, and encourage.  Each posting reflects issues our community was experiencing at that moment in time.  I have reproduced selected examples on this site).

 

Pick your pundit

The good news this week is the approval of the single-dose vaccine developed by Johnson & Johnson. We now have three highly effective vaccines that we need to administer as rapidly as possible, to as many people as possible, to bring this pandemic to an end.

Now that we have choices, increasingly the question will be is “which vaccine should I get?” The very simple and very clear answer is “the first one you can.”

There are some differences among the three available vaccines. The J&J vaccine displays 66% effectiveness overall, but critically, is close to 100% effective in prevention of severe disease, hospitalization and death. This is an unequivocal homerun of vaccine development.

There are potential nuances related to variable response between age groups or effectiveness against emerging variant strains. However, bottom line, if you have an opportunity to be vaccinated today with any of the approved vaccines, take it. Your risk of becoming infected and critically ill while waiting for a different vaccine is far, far greater than any incremental benefit you might receive from waiting for an arguably more perfect vaccine.

What I just engaged in above is punditry – per Merriam-Webster the provision of an opinion in an authoritative manner, usually through mass media. The word “pundit” derives from the Hindi “pandit,” a term of respect for someone considered learned and wise. In these modern and increasingly divisive times, the term has taken on a somewhat negative connotation, used to describe someone who forcefully conveys an opinion on one side or the other of an issue, often with political overtones. Perhaps a better term would be “expert opinion.”

Regardless of what we chose to call it, as we race to vaccinate and look forward to emerging from the pandemic, all of us will be dependent upon reliable and responsible punditry. When can we safely reopen schools and businesses? How should my behavior change once I am vaccinated? When will live performing arts return? When should attendance limits on sporting events be lifted? Can I plan a “normal” wedding in the Fall?

These questions, and others, will be partially addressed by science and partially addressed by CDC guidance. The black and white edges of science and guidelines are critical, but most of where we actually live is gray and blurred. We will need to make personal and policy decisions based on incomplete information, and experts will be necessary to assist in this process.

There is an inherent challenge in relying on this expert opinion. There are suddenly a lot of physician experts out there, and sometimes the advice is contradictory. Many – I would say most – approach their punditry with the same commitment to professionalism they would in the care of a patient. Most experts want to provide information that is accurate, evidence-based where possible, and delivered in a manner accessible to the lay-person.

However, there are some who seem to be at best ill-informed, at worst conflicted and self-promoting. The confidence and passion of the speaker is not a reliable guide. As I have listened to the various experts, some of the most misleading information is promulgated by doctors who appear supremely confident. Some of the most thoughtful commentary comes from those who appear awkward and uncomfortable in front of the camera.

How does the general public know to whom to listen for reliable information? This is a surprisingly difficult question to answer. I have collected a few tips below. Many are factors that could be useful in choosing not only your trusted pundit, but your personal physician as well.

Qualifications and Credibility

• Is the physician or scientist on the faculty of a well-regarded school of medicine? Only half-way jokingly, I would say if you are listening to a Baylor faculty member, you can skip the rest of these steps. During the pandemic, we have viewed part of our community responsibility as getting good information to the public. Eighty-eight of Baylor faculty have engaged in over a 1,000 COVID-19-related media appearances. As a health sciences university, we are committed to freedom of academic expression and diversity of opinion. However, we also pay attention to what is said by our faculty. We work to assure the information we are providing to the public is factually accurate and relatively free of bias. Most faculty members from major schools of medicine would have similar expectations.
• Is the physician currently board certified and licensed to practice medicine? This information is readily available and helps to identify physicians who are actively engaged in the practice of medicine, and who have remained current in their fields.
• How would you characterize the expert’s internet profile? A quick Google search will give you some valuable information. Does the expert tend to be aligned with consistently controversial opinions? Do they appear to lean heavily to one end or the other of the political spectrum? The fact that an expert opines on controversial issues with a clear political leaning does not necessarily mean their information is biased, but it is a factor to consider. Have they been quoted by a variety reputable news organizations or published in the peer-reviewed literature? Again, this is not a guarantee, but gives me a level of comfort they may be a credible source.

Evaluate the Media Environment

• Pay attention to what you are watching, reading or listening. If an opinion is being offered by a hard news outlet or publication, I would tend to give it more credence than opinions offered on entertainment, opinion, or “infotainment” programming.

Characteristics of the Expert

• Why you choose to trust an expert is similar to why you choose to trust your doctor. Are they speaking in a language you understand, or are their explanations laden with jargon and buzz words? Personally, I prefer a physician (or expert) who appears to be trying to teach me something, rather than prove to me how much they know.
• Be wary if the expert appears overly dogmatic. Inherent in our response to a novel worldwide infectious disease, there is much we do not know, and our knowledge evolves over time. Be suspicious of any expert who answers every single question with certainty. I think anyone who has tried to make predictions about this disease would agree that it has humbled all of us at one time or another. Especially be alert for a special breed of dogmatism: Someone who claims to have unique command of knowledge, that no one else possesses. If you hear something like “let me tell you what no one else wants you to hear,” quickly cross this person off your trusted list.

Get a Second (or Third) Opinion

• As you form your own opinion, listen to a wide range of experts. Assess their credibility using some or all of the criteria above. When you hear two or three qualified experts consistently hit common themes and reach similar conclusions, you can have a greater degree of confidence the advice is sound.

We still have miles to go before we rest. As we engage in the happy task of reclaiming our normal lives and activities, there are many controversies to come – how much, how soon, how quickly? Our path will be clearer if we all become more discerning consumers of responsible punditry.

Stay well.

 

 

(Note:  Between June 2020 through November 2021, I wrote weekly COVID-19 pandemic updates seen through the lens of a health sciences university.  My intent was to provide reliable information, acknowledge legitimate concerns, console, and encourage.  Each posting reflects issues our community was experiencing at that moment in time.  I have reproduced selected examples on this site).

 

Resiliency

What a week. I considered starting this message with a “plagues of Egypt” quip. A little humor often helps in difficult situations. However, in reflecting on the events of the past week, humor seems out of place.

We just passed a grim milestone of 500,000 dead from COVID-19 in the United States. More people have died from this virus than in any U.S. war (save the Civil War). In addition, we all lived through an unusual weather event where major catastrophic failures of public utilities turned what should have been a pleasant “snow day” into nearly a week-long ordeal of discomfort, anxiety, property damage and still more death. It seems appropriate at this point to at least pause for a moment and reflect – we have just lived through an unusually bad week, capping off an unusually bad year.

Thankfully, there is much good news. All our disease metrics are dropping rapidly. Over 75 million vaccine doses have been administered in the U.S., and about 13% of the population has received at least one dose. We are vaccinating about 1.6 million people every day. Many of those vaccinated are people with risk factors known to promote more severe disease, so even partial vaccination of the population will probably help decrease future demands on our hospitals.

Locally, FEMA is starting a six-week effort to vaccinate an additional 142,000 people. Vaccine supply is increasing and diversifying. True, we are engaged in a “Vaccine versus the Variants” race, but I am relatively optimistic we will win that race and return to some semblance of normal life by the Fall. Normality could even come by the summer if our vaccination rate continues to accelerate, which I believe it will.

In my opinion, we have a long way to go, and we need to maintain our focus on vaccinations and good viral control practices, but the worst is probably behind us. Increasingly, it will be important to start contemplating what is to come. What will life be like after the pandemic has faded? How has this experience changed us?

Think of the stressors many in our community have endured – economic insecurity of people at or near the poverty line; families ravaged and upended unexpected health challenges; small business owners watching personal savings dwindle and incurring debt as they fight to keep their life’s work afloat; front-line health care workers slammed by a tidal wave of disease, struggling to get to their feet only to be inundated by an even bigger wave, and then a bigger wave still.

We are learning a lot about ourselves through this ongoing crisis. We often grow in adversity. You know the platitudes: “The finest steel has to go through the hottest fire.” “What doesn’t kill us makes us stronger.” Unfortunately, what doesn’t kill us sometime leaves us broken and discouraged. Will we emerge stronger or impaired? The pandemic has been a test of our resiliency.

The role of resiliency has been a long-standing interest of the U.S. military. A colleague of mine recently brought to my attention a Rand Corporation report from 2011, “Promoting Psychological Resilience in the U.S. Military.” Per the report, “resilience is the capacity to adapt successfully in the presence of risk and adversity.” Risk and adversity seem to be apt adjectives to describe our past year. I do not mean to draw equivalency between our shared COVID-19 experience and that of our men and women in uniform – repeated military deployments for extended periods of time separated from family while living under the constant and unpredictable threat of violence – but I do think some of the findings from the report are applicable.

One useful construct in the Rand report is that of a “resilience continuum” to assess mission readiness. As I concluded this message, pause for a moment. Where you are on this continuum? Where are the people you care about?

Optimal. Clearly, this is where we all want and hope to be, truly mission ready: Functioning at peak performance; positive outlook; sense of purpose; embracing challenges.

Reacting. This may be where many of us are – still highly functional in a chronically stressful environment but beginning to fray at our psychological edges: Irritable; feeling overwhelmed; difficulty sleeping; inability to relax; problems concentrating.

Injured. Hopefully, very few of us reach the point where stress begins to take its toll, degrading our ability to function and impacting our quality of life: Feelings of guilt; decreased energy; anxiety; loss of interest; social isolation.

Ill. This is the point we want to prevent anyone from reaching, where you are unable to function effectively, and are truly in need of help: Depression; anxiety; anger; aggression; danger to self or others.

As in many things in life, prevention is preferable to cure. In a future message, I will attempt to summarize some specific strategies, but in the meantime, prevention starts with recognizing where you fall on this continuum. We are now almost a year into an event that fundamentally changed many lives. On the resilience continuum, where were you a year ago? Where are you today? Importantly, when you look at the people around you about whom you care the most, where do they fall on the continuum?

This pandemic has already extracted a steep price – 500,000 dead. It has stolen livelihoods and loved ones. It has derailed dreams. The price we have paid is high enough. As we look back at this time, when COVID-19 is an unpleasant memory, I want us all to be able to say that we bent but did not break.

If you need help, please seek help. Your primary care physician is a good place to start.

Stay well (and resilient).

 

(Note:  Between June 2020 through November 2021, I wrote weekly COVID-19 pandemic updates seen through the lens of a health sciences university.  My intent was to provide reliable information, acknowledge legitimate concerns, console, and encourage.  Each posting reflects issues our community was experiencing at that moment in time.  I have reproduced selected examples on this site).

 

A Lesson in Leadership

It has been a good week. Set aside for a moment significant concerns about emerging viral variants, and everything is trending in the right direction. New cases, hospitalizations and deaths are decreasing, locally and nationally. We are appropriately impatient regarding our pace of vaccine administration, which needs to increase, but at this point the U.S. has administered more than 42 million doses, more than any other nation in the world, and fourth on a per capita basis. It is far from over, but we are making progress.

I have spent this past week reflecting on leadership lessons learned during this experience. I had an opportunity to meet last week with participants in Baylor's Master Teachers Fellowship Program (BMTF), a faculty development program designed to enhance teaching knowledge and skills.

I was asked to speak on the topic of leadership during the pandemic. You might think this is a relatively easy topic to cover, but I found it challenging. On the one hand, for many of us just living through this year has been like attending a master's class on leadership. We have had an opportunity to sit in the front row and observe a variety of leadership styles both in our organization and our community. All I needed to do for BMTF was to distill those observations into my lessons learned. However, it is hard to describe something when you are too close to it. As you climb a mountain, you see only the path ahead of you. It is not until you reach the summit that you can take in the entire view, appreciate where you came from, and reflect upon the enormity of it all.

Along with all of you, I am still trudging along day-by-day on the pandemic path. My vision is limited, incomplete, developing.

Still, I made an attempt to distill what I have observed from watching leaders during this crisis from Baylor, across the TMC, and our community. I came up with a not-ready-for-prime-time list of seven lessons learned. I am not ready to share the entire list just yet, as I expect it will be different six months from now, once we are on the summit looking back at our pandemic experience. However, there is one lesson I am confident will endure:

To lead, you must stand in awe of your organization.

I stand in awe of Baylor College of Medicine, and one of the gifts of the pandemic has been the opportunity to see the best of who we are. Baylor has stepped up steadily and consistently – one foot in front of the other – in ways large and small:

• Testing. Early in the pandemic, when no diagnostic testing was available, leaders from the research mission stepped in. We adapted Baylor research laboratory equipment and raised $1 million from donors for the rapid construction of new laboratory space to provide PCR diagnostic tests to Harris County, the City of Houston, frontline workers at our affiliated hospitals and our patients. We continue to provide large-scale, rapid turnaround, high reliability community testing. To complement our testing capability, our specimen collection center is efficient and consumer friendly.
• Clinical trials. Baylor has been an important generator of new knowledge during the pandemic. We were a major site nationally for 25 interventional trials to date, including the testing of convalescent sera and Remdisivir. We are now recruiting volunteers for the Novavax vaccine clinical trial. A Baylor vaccine is undergoing phase 1 and 2 trials in India. During the pandemic, we have submitted more than 150 research proposals to the National Institutes of Health and other organizations, with topics ranging from basic science to overcoming vaccine hesitancy issues in ethnic and minority populations. Already, Baylor scientists and physicians have published their work on COVID in more than 300 publications, including the high-profile work in the New England Journal of Medicine showing efficacy of the Moderna vaccine.
• Vaccine hesitancy. While others fret about reluctance of some to receive the vaccine, particularly in populations known to be at risk, Baylor is doing something about it. The College is collaborating with local institutions such as Texas Southern University to educate minority populations to build trust and improve understanding of the benefits of vaccination. Baylor also has eight active Covid19 related treatment trials ongoing.

• Wastewater surveillance. Baylor technology designed to develop precision treatments for resistant bacteria was adopted to measure SARS-CoV-2 viral products in city wastewater. The quantification of viral product in wastewater proved to be an effective predictor of viral hot spot development. In collaboration with the City of Houston and Rice University, we now monitor 38 wastewater stations in the city, which has provided public health officials with valuable time to intervene in at-risk neighborhoods before the actual rise in disease.
• Healthcare workforce. Baylor clinical faculty physicians – with our nurses, MAs, residents, fellows, and medical and health profession students – are the front-line workforce for many of Houston's most important hospitals: Baylor St. Luke's Medical Center, Texas Children's Hospital, Michael E. DeBakey VA Medical Center, Ben Taub Hospital and others. From the perspective of the general public, the pandemic has waxed and waned over the past year. Not so for our physicians and healthcare workers. Baylor has played a critical role in keeping our major institutions staffed. This effort would not have been possible without the active engagement of a broad swath of leaders across the organization.
• Vaccine clinic. When the Pfizer vaccine was approved in December, Baylor immediately planned and built a vaccine administration clinic in anticipation of helping Houston to get people vaccinated as rapidly, safely, and conveniently as possible. The clinical operation is efficient and consumer-friendly – no lines, no waiting. From the very beginning, we have also scrupulously adhered to the state's mandated eligibility criteria. The vaccines are in short supply, shipments are difficult to accurately predict and require a high degree of technical expertise to store and administer. In spite of this complexity, our operational, clinical and quality leaders have managed to create an excellent patient experience.

I stand in awe of our organization. Why is this an important leadership lesson? To stand in awe puts you in a valuable place. It is a place where you actively seek to know your team and appreciate their unique skills, talents, and accomplishments. It is a place of humility, where it is blindingly obvious we accomplish far more together than separately. It is a place that evokes a feeling of thankfulness. Knowledge, humility, gratitude. As I reflect on my personal experience, finding this place is not optional, it is a necessity. I do not think it is possible to effectively lead if you do not stand in awe of your organization.

You have all had opportunities to lead during the pandemic – in your department, division, school, community, social network, family. You have seen examples of effective leadership, large and small. We are all on the same journey. The path immediately in front of us is clear, but we cannot yet rest on the summit and enjoy the view.

The lessons we have learned during this difficult time will stay with us for years to come. Stop and reflect. What is the most important leadership lesson you will carry into the future?

Stay well.

 

 

(Note:  Between June 2020 through November 2021, I wrote weekly COVID-19 pandemic updates seen through the lens of a health sciences university.  My intent was to provide reliable information, acknowledge legitimate concerns, console, and encourage.  Each posting reflects issues our community was experiencing at that moment in time.  I have reproduced selected examples on this site).

 

Déjà vu all over again…

Welcome back to what is now a familiar place: The backside of a COVID-19 surge. The past several months have been a long slog. Community cases have been climbing since late September and are finally starting to level off (but not fall dramatically). New cases peaked at an average almost twice that of the July surge. Hospitalizations now appear to have peaked about 10 days into January and are clearly declining, although hospitals are still stressed.

Nationally we are vaccinating an average of 1.4 million people per day. As I said last week, I think this needs to reach a rate of at least 2 million people per day, and quickly. There is good news that both Moderna and Pfizer have promised additional vaccine delivery by July (bringing the total to 600 million doses available in the U.S.), and it appears the much-more-stable and easier to administer Johnson & Johnson vaccine is on track for approval in the next few weeks. Texas has vaccinated about 10% of its population, and almost every U.S. state is making progress to solve the “last mile” administration challenge. We are currently the fifth ranked country in the world in terms of per capita vaccine administration.

As we ride the back of the current surge down, I am reminded how we felt at a similar point during first (April) and second (July) Houston surges. Some hopes and fears have been constant – others have changed.

In April we were grateful the surge had passed, and we did not relive the experiences of Lombardy, Italy, or New York City. We hoped the summer weather would prevent a summer surge (it did not). We hoped we could encourage masking, distancing and good viral control practices to drive our new cases below 200 a day, a level we thought we could still do effective contact tracing. We came through the first surge with fewer than 200 deaths in greater Houston from COVID-19.

We feared we would see a second wave.

In July it came, and it would tower over the first. At least three times the rate of new cases. Cumulatively, close to 1,500 Houstonians dead. Our health systems bent but did not break. Up to that point, no region had surged a third time. We hoped maybe we were through the worst of it. Maybe the virus would settle down to a low enough level we could start to resume elements of normal, pre-pandemic life. We hoped we would have a vaccine.

We feared the impact of cooler autumn weather driving people indoors. We feared vaccine would not arrive for a year or more. We feared we were losing our collective resolve to follow safe practices.

We feared we would see a third wave.

Like the strengthening bands of a tropical storm in September it came, more terrible than the last. New cases that eclipsed July levels. Cumulatively almost 4,500 Houstonians dead. More and more disturbing stories of COVID-19 survivors with prolonged respiratory, neurological, and cardiac symptoms. The health system is still bending and is weeks away from some semblance of normal operations. We are grateful we have vaccines and with them a realistic path out of this crisis. Local supply is slowly increasing, but still far inadequate to meet the demand. We are hopeful we will have adequate vaccine supply and the community-by-community logistical wherewithal to reach herd immunity quickly.

We fear we are now in a race against variants. That continually mutating viruses will ultimately produce a SARS-CoV-2 that is more virulent, more infectious and less susceptible to existing vaccines. That we are not bringing this to an end, but transitioning to an endemic state with fourth, fifth, sixth waves.

This fear is not groundless and should strengthen our resolve to maintain effective viral control practices (mask, distance, avoid crowded indoor spaces, do not work if you are sick). It should also drive a real sense of urgency around vaccine administration. Our best defense against emerging variants is to reach herd immunity as rapidly as possible to prevent viral spread. Less spread, less opportunity for mutation.

It is hard to believe, but we are now almost a year into our pandemic experience. It has been a year in which everyone has been impacted by the virus. Health, economic security, mental health, relationships have been affected; for many in profound and lasting ways.

I look to the future with optimism. I picture a time in the fall. A time when in a quiet moment you pause to reflect on your greatest hopes and greatest fears – and none are related to a global pandemic. That is my wish for all of us.

 

 

(Note:  Between June 2020 through November 2021, I wrote weekly COVID-19 pandemic updates seen through the lens of a health sciences university.  My intent was to provide reliable information, acknowledge legitimate concerns, console, and encourage.  Each posting reflects issues our community was experiencing at that moment in time.  I have reproduced selected examples on this site).

 

Moonshot

 

"We choose to go to the moon in this decade and to do the other things not because they are easy, but because they are hard; because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win...."

As I write this message, I sit less than a mile away from the football stadium at Rice University, where John F. Kennedy delivered his stirring "moon speech," a national call to action that set the United States on the path to landing a man on the moon. We will land a man on the moon and return him safely to earth. Three decades later, Jim Collins would use this as an example of a Big Hairy Audacious Goal (BHAG). A goal that is simple and compelling. A goal that instantly resonates and is readily understood. A goal that creates a frame of reference for all future planning, decisions, and action. It is a call to arms.

As our viral numbers in Houston now thankfully seem to be in decline, it seems to me the United States needs a national BHAG. Throughout history we have taken pride in ourselves as a nation that could do great things. As a nation that could simultaneously give voice to dissenting opinions yet pull together in times of crisis. Now we seem to be a nation that is half a step behind much of the world, one committed to polarization rather than unity. We should demand more of ourselves. We need a call to arms.

Here is my goal: Declare July 4, 2021 COVID-19 Independence Day – the day we drive the virus to a low enough level we can safely resume our lives. Businesses can reopen. People can work. Travel can resume. Grandchildren can visit grandparents. People can congregate in places of worship, graduations, theaters, sports venues, and even bars.

To declare this goal last January would have been unrealistic. One year later, we are driven by both opportunity and urgency. Opportunity in that we have the tools necessary to succeed. Urgency in that we are in a race against emergence of new viral strains.

It is easy to declare a goal, but much harder to create a national unity of purpose. In my view, here is what needs to be done:

• Declare a six-month COVID-19 bipartisan truce: national, state, and local. At the highest possible level, leaders of both parties should link arms and publicly commit to a spirit of cooperation in fighting the virus. Draft a written pledge. Encourage leaders across the political spectrum to sign. Work collaboratively. Focus legislative efforts on doing everything necessary to exceed the July 4 goal. On the federal level, work relentlessly to guarantee a steady vaccine supply. On a local level, drive collaborative efforts to get vaccine into arms.
  
  Whatever label describes you – liberal, conservative, progressive, populist – whether you gravitate towards the political center or tilt towards the extremes, whatever policy goals you want to achieve, let us publicly and deliberately remind ourselves that our clear and present danger is a microscopic virus. What is the single most important thing we can do to promote social equity? Eliminate the virus. How do we best provide relief to those impacted by the pandemic? Eliminate the virus. How can we aggressively promote economic growth and full employment? Eliminate the virus.

• Turbo-boost the CDC. If this were a moonshot, the CDC would be our NASA, and would impact every objective on this list. Short-term, the CDC should have no financial constraints. The agency should have access to the best minds in the country. The CDC should be contained within a political firewall and serve as our trusted arbitrator of scientific truth. Remember science is more than sequencing the viral genome. It is providing evidence-based guidelines across the entire spectrum of infection control activities, from the basic science of vaccine development, to the social science of overcoming vaccine hesitancy in minority populations.
• Define national, state, and local metrics for success. To achieve our goal, every community should understand their existing disease burden. Everyone should understand what we are measuring, and what result constitutes success.
  
  One metric we should track, but not the only one, should be vaccine administration progress. One hundred million doses over 100 days (one million per day) is not a stretch goal, it is the minimum necessary. We are already administering shots at that pace. To achieve herd immunity by our July 4 date we need a more aspirational target – something in the range of 2 million doses administered per day, seven days a week.

• Take the new variants seriously. One big threat to our goal is the potential emergence and spread of more infectious variants, or variants that are less suspensible to current vaccinations. Testing, sequencing, surveillance, containment. We failed this national test a year ago when SARS-CoV-2 first burst onto the scene. Now we have a chance to get it right. We should do everything possible to contain its emerging and potentially more lethal cousin.
• Pursue equity without sacrificing speed. We cannot leave vulnerable populations behind, but our experience to date has shown that states with overly nuanced, complex, and precise rules regarding vaccine eligibility have a much lower rate of vaccination. Keep it simple.
• Promote individual responsibility. Everyone must do all they can to keep from being infected and from infecting others. This is a challenging message. We all have COVID fatigue. However, I believe the message is more palatable if there is a defined endpoint.

It is within our power to bring this to an end. Calm the bipartisan rancor – improbable. Maintain public support around disruptive infection control practices – unlikely. Much is stacked against us. The 24-hour news cycle with its insatiable thirst for a whiff of controversy or conflict. Our addiction to social media platforms that amplify our differences rather than promote real dialog.

We should embrace this challenge not because it is easy, but because it is hard. Because the goal will serve to organize and measure the best of our energies and skills. Because it is a challenge, we are willing to accept, one we are unwilling to postpone, and one which we intend to win.

(Note:  Between June 2020 through November 2021, I wrote weekly COVID-19 pandemic updates seen through the lens of a health sciences university.  My intent was to provide reliable information, acknowledge legitimate concerns, console, and encourage.  Each posting reflects issues our community was experiencing at that moment in time.  I have reproduced selected examples on this site).

 

Happy (COVID) New Year

Last week a few of us were reflecting – via Zoom of course – on the year that was 2020. One of my colleagues made a relatively simple statement: "We should remember, the pandemic has taken from many, but it has given to a few."

Much has been written about our transition to a new and more hopeful year, but few of these ruminations will match the simple profundity of this statement. We immediately grasp that COVID-19 has "taken from many." It has taken our health. Nationwide, we are now at over 325,000 dead. Perhaps the only hint of a hopeful sign is the national death rate may have flattened out last week, after steadily increasing for the past seven weeks. Let us hope this trend continues.

Last Spring, I remember thinking that I do not really know anyone well with COVID-19, but we all knew of someone who had it – a friend of a friend. Now, most of us know multiple people close to us who have been impacted. I fervently hope this is not how we will come to feel about COVID deaths in the Spring. Today, most of us know of someone who has died. As we slog through this long, dark winter, death will sadly become more commonplace.

It has taken our vigor. A number of people have survived the disease only to discover they are in the small but significant group of people with lingering fatigue, shortness of breath or other symptoms. Although the percentage of people with longer-term sequelae may be relatively small – not yet firmly established, but likely 5-10% - a small percentage of 20 million U.S. cases is still a very big number.

It has not taken – but has severely tested – the emotional and physical resilience of our front-line hospital workers. If you look at the Texas Medical Center numbers this week, there are no signs this current surge has peaked. New community cases are up. Test positivity rates continue to climb. The rate of hospitalization is increasing, and the total hospital census is climbing steadily, day in and day out. Our regional COVID-19 census peaked in mid-July at 2,455 patients. Two weeks ago, we were at half that level – today, 70%. In the next month or so we will exceed our July peak census levels. To say our providers have performed admirably seems trite. To hail them as heroes seems too easy. They are people who are neglecting their own well-being and families to care for us.

It has taken our livelihoods. Many small businesses lie in ruin. To many of us, the shuttering of a business elicits a casual response: "I wonder what will go in that space next?" To business owners, it represents the death of a dream, loss of financial investment, and sweat of their owners. Particularly hard-hit are people on the lower end of the economic scale working in service industries. Many are either out of work, or if fortunate enough to have kept their jobs in environments where their risk of SARS-CoV-2 infection is high.

It has taken – or at least damaged – our future. It is difficult to assess at this point the impact of the disruption to our educational system, but there will be an impact on our youth. This impact will echo well beyond the end of the pandemic.

Much has been taken.

But my colleague is correct. The pandemic has taken from many, but given to a few. Not all businesses are failing. Look at the share price of Amazon, Netflix or UPS. Since March, they have increased between 70-100%. While it may be true that some white-collar workers have worked harder than ever and sacrificed personal travel and vacations, some who are able to work remotely have actually been given a gift of time. You may love to complain about Zoom, but, for some, work-life balance has actually improved during the pandemic - no commuting, the ability to interact with family during downtimes, and enhanced schedule flexibility.

As I look around our own organization, I see opportunity given to many. We are doing work that, while hard, is meaningful and fulfilling. For many, work performed this year will define careers. I have seen fruitful collaborations develop between people in the organization who literally would never have met each other in normal times. Research grant funding is up. Publications are up.

Never in my life have I approached a New Year recognition – "celebration" seems the wrong word – that is so meaningful. As we enter the last year of our Great Pandemic, I ask that each of you ask yourself a question: Are you better or worse off today than you were this time last year? On balance, have you been "taken from" or "given to?" Do not overthink the question. For most of us, the answer will be intuitively obvious.

If you find yourself in the "given to" group – you and your family have not suffered significant health problems, you have not suffered financially – perhaps you have a degree of survivor's guilt. As we enter 2021 – a year that will see an end to this collective nightmare – I ask we do more than feel a vague sense of guilt. Let us do some small thing to give back:

• Give the gift of your patience. Be kind to others. You do not know what might have been taken from your colleague, co-worker or grocery store clerk. Assume everyone you meet has experienced some degree of negative COVID-19 impact.
• Give your time. For those of you who may have gained time through remote work, give some of that time back. Contact your not-for-profit of choice, or your child's school. Ask if they can use your time and tell them you can give them a day (in a safe and appropriately distanced way). Recall that Baylor provides a benefit to all benefit-eligible employees to take one paid day to volunteer.
• Give your financial support. Americans are a generous people. Look at your typical charitable contributions and give a little bit more. Make a modest, unexpected financial gift to people who have helped you over the past year – hairdressers, paper carriers, repairmen. When you eat out (out-of-doors and well-spaced) or order in, increase your new "normal" tip by 5-10%. Many of us would not miss a $10 increase on the cost of the meal, but it will make a real difference to the person providing you service.

This has been a year like no other. I look with hope to the future. This current surge has not peaked but eventually will recede. Over the next several months, vaccinations will start to make a difference. The pandemic will end. The past year will no doubt be remembered as the year much was taken. Let us all come together to make sure 2021 becomes the year much is given.

Happy New Year.

 

(Note:  Between June 2020 through November 2021, I wrote weekly COVID-19 pandemic updates seen through the lens of a health sciences university.  My intent was to provide reliable information, acknowledge legitimate concerns, console, and encourage.  Each posting reflects issues our community was experiencing at that moment in time.  I have reproduced selected examples on this site).