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).