Dear Bill,
Fifty-one government leaders—the president and all 50 governors—have done their best but have left us short for additional strategies and actions to accomplish our goals related to COVID-19 reopening. It is time we now seriously listen also to thought-leaders like you. What I like about what you seem to have said in the past and what you seem now to be saying, again—and you have been making a huge point on this—is that we must immediately go after the pandemic largely proactively, and no longer just largely reactively! You are right! Let’s join forces and allow me to help you to immediately execute on that thought, as only you can.
The Rest of the Problem
Our current mitigation efforts to date, although well-meaning, have fallen short. If the US economic engine can quickly be made to work full-bore again, everyone in America will be better off.
The direct and indirect: (1) “economic” impacts on people, (2) “mental and emotional” impacts on them and their families, and (3) “physical harms and deaths” (the casualties of war, all) they are suffering—are the point. When do we really draw a firm-line and stop these? Only if we do more that is right than what is wrong. America’s strategy for winning this war has been well-intended but has fallen short. Were they available, Eisenhower’s strategic and logistical mind and leadership would be helpful, right now, in winning this war, Bill, as will yours.
To Spend or Not to Spend? That is the Question
Not spending sufficiently, and in a properly targeted way, the money to do things right—things that will have a real, present, and major impact on winning this war, now—is the biggest source of the shortfall. Clearly, we have been penny wise and pound foolish. And we have not played to win. The most direct and profound answer is: spend at least the right amount of money to put immediately in place a reasonable, appropriate and relatively (compared to the extreme, avoidable costs, both financial and human, that our people have suffered over the past six months) low-cost per worker, set of bundles of top-of-brand mitigation devices, products, and strategies.
And, then use an advanced strategy of a “double-sanctuary approach™” (one continuously protected, virus-free sanctuary at-work and the other at-home), to starve the virus and all-but-kill it, just like we did with Smallpox. This approach will save lives AND companies AND jobs—while we smartly spend the time, money and effort to eradicate the virus, at least down to levels that are largely controllable, again like Smallpox.
What Might a Good (It Does Not Have to be Perfect) Set of Mitigation Bundles Look Like?
What might be included in a strong set of good mitigation bundles? One thoughtful idea and strategy for an appropriate set of mitigation bundles (I reference the Safely2Prosperity™ bundle set containing items purchased from companies I have invested in and from other best-of-breed companies here, but undoubtedly there are more good bundle sets to come.)
A good mitigation bundle set is one containing:
A. Outside the Office or Plant Gate Bundle of Mitigation Devices, Products, Strategies and Practices
These outside the gate top-of-brand COVID-19 mitigation tools and practices might include use of:
1. Monthly “COVID-19 Test Device testing” using Big-Box, table-top, test devices or very-high-speed and very-low-cost, but just as good, handheld, self-administered COVID-19 Antibody Test Devices, or at employer option, any other type of COVID-19 Test Device they might prefer.
The employer’s special circumstances will and should dictate what COVID-19 Test Device is used. I the lab, a good test should have the capacity to on average produce 99% true negatives, i.e., only one false-negative (actually actively infected) worker mistakenly allowed to enter the otherwise safe office or plant. In the field, though, on average, the error rate is likely to be higher for most types of tests. (See the discussion below.)
2. Simultaneous “COVID-19 Test Device Integrated Test-Process-Oversight™,” using an assurance software app, such as the TestProcessOversight™ app (mine, but surely more similar products to come). It is believed that COVID-19 is more contagious and more harmful (including deadly) than normally more mild infectious diseases, such as the flu, that the tolerance for false-negatives in calculating what is reasonably safe for workers, coworkers, and workforces is small.
This software, now under development, is to be used to close a healthy part of the possible “testing data-error gap,” possibly as high as an additional 1% in the case of Big-Box tests, and possibly as great as an additional 3% or even 4% (we won’t know a better figure until a few studies are done; the current estimate is based on logic as much as it is based on specialized expertise and accumulated knowledge) in the case of the soon to be more popular fully self-administered Handheld Tests, created by testing-process errors (inadvertent user-errors and/or intentional user-errors made to defeat the test), and thereby make workers, their coworkers, and their workforces safer, and in the latter case, less prone to catastrophic-workforce-collapse. Fully self-administered tests and partly self-administered tests involve more user-error risk, precisely because they are fully self-administered tests and partly self-administered tests.
In other words, the use of this app is important to increasing the accuracy of test processes—leading to a lower risk of testing errors—so as to reduce the number of false-negative test results when testing in the field, where more testing errors are prone, and thereby creating a safer work environment. This is a good thing, always, but an essential thing in the “low-safety-margin” context of COVID-19 testing.
3. Weekly (or at employer option, bi-weekly) “Wellness (general immunity protection) testing” using a Wellness-Test, to help close an additional part of the possible testing data-error-gap (described above) by roughly .5%.
4. Daily “forehead heat testing” for fever. Fever is a key symptom of infection for those workers who symptomatic. Asymptomatic or very mildly symptomatic infected workers have no detectable fever, using current reasonably priced technology. It is estimated that some 40% of infected people tested are largely asymptomatic—accordingly, they have no detectable fever. This test will be administered by the chief/captain of each team (of likely size of 50 to 100 workers, at an employer’s discretion)—so as to vastly reduce the time and cost involved in heat testing, and to help to close an additional part of the possible testing data-error-gap described above by some .5%.*
*(In spite of its widespread solo use, studies have shown that forehead heat testing likely is only about 30% effective in keeping false-negative workers from entering the work facility.) **The Daily forehead heat testing device is included in the essential Administrative Bundle.
5. Daily modified (updated and upgraded) “CDC Questionnaire testing.” This government issued document, updated and upgraded as essential, is self-administered under the overall guidance of the chief/captain of each test group/team, usually consisting of some 50 workers, so as to vastly reduce the time and inconvenience (length of lines, especially) and cost involved in CDC Questionnaire testing. This simple form of daily screening is used to help close the possible testing data-error-gap described above by some .5%, both initially (along with other forms of testing) and continuously, daily, throughout the month until the next monthly cycle begins.*(If a worker fails this questionnaire test or the heat test, the worker immediately starts over by again using the assurance-supported COVID-19 test, and the wellness test.)
In spite of its widespread solo use, studies have suggested that CDC Questionnaire testing is only about 10% or less effective in keeping false-negative workers from entering the work facility. This is because the test is self-administered and therefore is subjective rather than objective—which means that it is very much subject to unintentional user-errors, such as forgetfulness, and intentional user-errors used by an actively infected, or recently exposed, worker to defeat the test, such as deception--so as enable a worker who is frantic about returning to work or staying at work to be allowed reentry to the work facility, or retention in it.
B. Inside the Gate Bundle of Mitigation Devices, Products, and Practices
These inside the gate mitigation tools and practices might include use of:
1. An “ultra-safe 12 x 12 = 144 square-feet per worker of clearly demarcated space “inside the work facility,” at very low-cost, reserved only for use of, and entry by, a single, designated worker. While tools and rules for social distancing are often broken by workers, if they are supplemented by re-enforcements, such as reminders, warnings, and alternative methods for working and communicating, they seem to be helpful for mitigating the impact of any actively-infected worker who makes it beyond the gate and into the office or plant. Some developers are making this decision on how much and when to reserve facility space for each worker far more complex than necessary. (If 12 x 12-foot demarcation is simply impossible, then lightweight hanging plexiglass shielding will be substituted.)
2. Rules for “other social distancing methods,” would be very low-cost. These might include, for example, taking a few minutes to grid the entire floor-space and then placing signs on the walls: (1) limiting the amount of traffic on many paths; and (2) importantly, at almost zero cost, simply selecting and posting a few of the paths as “one-way-streets.” Other rules might include requiring ALL meetings (of from two to more) workers be conducted via telehealth or other remote communications methodologies, such as basic telephones. Again, some developers are making this decision on how much and when to reserve facility space for each worker and other social distancing tools and rules electronically.
These are very simple rules to create and adopt. Every worker wants to protect from physical and emotional harm: (1) himself or herself; (2) members of his or her family; (3) his or her coworkers and members of their families; and (4) their workforce as a whole—so they and others don’t also suffer near-term or long-term financial hardships, including loss of jobs, such as by the employer laying-off workers, reclosing, going bankrupt, and/or going out of business permanently, or by other means such as by worker-driven sick-outs, walk-outs, or strikes.
3. Continuous monitoring of workers using a “Worker-Tracking Software App.” This novel, far less complex, and far less-costly version of tracking app, now under development, is used immediately after a worker is found to be a likely true positive for COVID-19, through use of tools found in the bundle (daily heat and questionnaire testing, for example).
These workers are generally workers who have recently been inside his or her main work facility or another facility owned by the employer. The key purpose of this app. is to determine who else the infected worker has had contact with, inside this own work facility or in other facilities, if the employer has more than one, and thereby exposed to the virus. Workers who are found to have been exposed to an infected worker are immediately re-tested using the key contents of the bundle, just as if it were a monthly regimen of testing. If one of these POSSIBLY exposed workers tests positive twice in a row, this worker’s contacts are tested also, and so on and so forth.
4. And, “optionally, for still better control of the space INSIDE the work facility,” continuous mask-wearing, or even if desired, continuous glove wearing, or any other mitigation device, product, or rule that an employer might desire to add to the Monthly Mitigation Bundle or to the Administrative Bundle. (Each bundle, monthly or administrative, can be tailor-made in accordance to the specifications of the employer or the employer’s advisors and consultants, from legal to financial.) *Most of the tools and rules needed to make the mitigation bundles, jointly, truly broad and fully comprehensive (or separately employer-requested, as extra precautions) will be placed in the critical Administrative Bundle.
How Might Such a Strong But Relatively Inexpensive Set of Mitigation Bundles Best Be Used?
The chief goal in using the mitigation bundles, both regular and administrative, is to employ a truly broad and fully comprehensive double-sanctuary™ mitigation approach—to stop the virus at the gate of the office or the plant and at the doorway of each worker’s residence, as much as is humanly possible. The secondary goal is to mitigate the damage that the virus can do if it gets inside the facility-gate or inside the residence-doorway.
It is expected that regardless of an employer’s determined and appropriate use of these ever increasing “today’s best practices” and “today’s standard of care” mitigation bundles, there is likely be one to two false-negative workers admitted past the gate of the office, the plant or even sometimes the residence. Use of inside-the-gate/residence mitigation tools and strategies will help to reduce this “leakage.” Neither “perfection” nor “just good enough” is the goal.
The key deployment goal under the evolving standard of care is to take all reasonable actions, meaning employing those mitigation techniques that are both reasonably available and reasonably (in terms of relative cost) priced. In other words, each employer’s key overall goal might be to do more than enough needed to fully satisfy at the very least ALL of the employers social, ethical, moral, and legal duties to: (1) workers and their families; (2) coworkers and their families; (3) investors/shareholders; and (4) the communities in which the employer’s work-facilities are located.
No mitigation bundle will ever be perfect. But, if used properly, it can be good at what it is intended to do. Each bundle in the two-member set of bundles comes with a detailed “set of instructions” for use and for deployment of specific mitigation strategies and methods.
Biggest Current Barriers to Mitigation Bundles’ Acceptance, Adoption, and Use
Before we get to use the mitigation bundles, we must first get support and acceptance of, at every level in the purchase decision-making process, for using them, from business to political. Bill, this is where your unique leadership, and the blue-ribbon team that I help you to recruit, lead and oversee, comes in. Since political insights, ideas, plans, and initiatives for better managing the crisis have largely run their course, it is just and necessary to assume that this kind of business initiative is required, immediately, and that it will be a very helpful add-on in reopening the US economy (which will also have a positive impact on reopening other economies worldwide. We need you to lead the way, here, Bill.
As the executive committee and the full group do their work under your leadership, please keep a close eye on frequency of use of each mitigation device in the bundles. Frequency has a big impact both on aggregate effectiveness and on aggregate cost. In spite of ready availability at very low-cost good mitigation bundles, some employers will likely choose to bet to some degree or another on nature looking after worker health and safety—and skimp on bundle contents and on frequency of use of the truly broad and fully comprehensive mitigation bundles (say, every other month) or one or more of its parts (say weekly instead of daily, or bi-weekly instead of weekly).
Such short-sighted decisions will almost certainly lead to failures, including worker harm, including deaths, and workforce collapse. Again, those employers almost certainly would be penny wise and pound foolish to take this course of action.
Some CEOs are inherently risk-takers and might want to do the things that they believe are possibly good enough and on aggregate cost little, and therefore are mostly for “show.” You, the executive committee, and the group might make as your highest priority dissuading those—especially penny wise and pound foolish—employers from taking this reckless (and likely to be seen that way by all key constituencies, especially judges, and characterized as such) course.
*(Luckily, many thoughtful companies should want to do “whatever it takes” to protect their workers, especially those most at risk, because of their specific job and/or because of their specific race. For example, it is believed that Black workers who have the lowest-paying and most risky jobs are both genetically and professionally at highest risk.)
In sum, the biggest current barriers to use of a proper set of mitigation bundles are:
(1) Aggregate non-relative (as opposed to relative) cost. Some employers are choking on the significant monthly payout, even if they realize the long-term benefits are likely to be many times greater;
(2) Slow pace at which employers of larger sizes are learning of, better comprehending and then fully understanding their COVID-19 enhanced duties to workers and the size of their liabilities, not just to workers and their family members, but also to board members and shareholders) if they fail to properly perform their social, ethical, moral, legal, business-best-practices, etc., duties;
(3) Slow pace at which courts, both state and federal (under their diversity jurisdiction), are defining the new “standard of care” for employers (a new standard of care that some really smart lawyers believe is coming soon) in protecting their workers and their workers family members. (Employers, beware: Major increases in duties to protect workers from the scourges of infectious diseases, such as COVID-19, are coming soon. Judges and policy-makers understand that employers, not workers, are in the best position to control mitigation decisions and to purchase insurance to protect both employer and worker financial interests.
Very importantly, efforts to grant federal or state COVID-19 immunity of ALL kinds to ALL employers have either been soundly defeated or nipped in the bud. Many thought-leaders believe broad immunity statutes are unconstitutional under the federal constitution and under many state constitutions, and that if not, they otherwise are socially, ethically and morally inappropriate—and therefore, that many judges likely would find them to be against sound public policy, no matter what federal or state law-makers say;
(4) Slow pace at which courts, both state and federal (under their diversity jurisdiction), also are advancing through the judicial process’s major personal injury and wrongful death liability cases brought against major (very visible) employers. But, watch out employers, a huge wave of large liability settlements (few cases are ever taken to trial; it takes too far long, and costs are far too much to do so) are likely on their way and will start arriving, soon;
(5) Slow pace at which insurers of all kinds, but especially personal injury and wrongful death liability insurers, are heavily pressuring their insured employers to reform their efforts to “catch up with the times;” and
(6) Slow pace at which insurers of all kinds, but especially personal injury and wrongful death liability insurers, and federal and state governments at the highest levels (and their involved government agencies, such as Medicare at the federal level and Medicaid at the federal and state levels) are expressing willingness to reasonably subsidize the cost of best-of-class mitigation programs.
All of these current barriers can be knocked down or removed by trusted education and training of CEOs, of Boards, and of Unions, provided by leadership that shows, and gains widespread support for, the best way forward and that pushes those political initiatives that are good over the top of the mountain. Your role, Bill. You are one of only a few American business leaders who can make all of this happen, if you have the will to do so.
My Call to Action by You, Bill
My call to action by you, Bill, is relatively very simple, except that it requires exceptional, for our time, leadership, conviction, and dedication to the service of mankind. If you want to change the world for the better, as I know you do, then start at the very base of difference-making—cleaning up the incapacitating shortfalls of some of the COVID-19 government initiatives at home by taking the following actions:
1. The first action. Might you be willing and brave enough to raise the volume of your voice today, Bill? Isn’t it well past time when someone stepped up to lead us to green pastures and we heard his or her loud voice and listened carefully to him or her?
2. The second action. Might you be willing to take a first step in this very direction of answering the calling of your country by forwarding this Open Letter to your 28 million followers on LinkedIn, in order to enroll significant early support for the insights, ideas and passions that it contains?
3. The third action. Might you take a second step early next week by announcing that you are convening “an emergency COVID-19 mitigation program meeting” late the following week of national non-political thought-leaders (the 51 have had their turn, and have done many things well but have left us far from our goals of healthy Americans and healthy federal and state economies; it is now the people’s job to complete their efforts and add new efforts, next).
The dictionary meaning of a “thought-leader” is someone who looks at the future and sets a course for it that others will follow. Thought leaders look at existing best practices then come up with better practices. They foment change, often causing great disruption. Better yet, they are authoritative groundbreakers (dish breakers and egg breakers, too), innovators, pioneers, and trailblazers to whom millions of people listen and hear, especially in times of crises, such as we have now.
This would include our thought-leaders in business, foundations and academia, and our religious thought-leaders, who have been eager to step in but who, like you, have hesitated because you did not want to undermine any of the sometimes weaker, but well-intended, efforts of the 51? You are a though-leader’s thought-leader. I will help you to organize such a meeting, if you will take charge.
If We Build It, Who Else Will Come?
Mostly because of who you are, and of what you have accomplished in your life, in loving support of others in the US and worldwide, but also because of their own calling, too, to serve mankind, I would bet that several national and international business, foundations, and academia, as well as our religious, thought-leaders, would, in turn, answer your call.
For example, I believe:
Our business thought-leaders, like Microsoft CEO Satya Nadella; Apple CEO Tim Cook; Medtronic CEO Geoffrey Martha; Harpo Productions CEO Oprah Winfrey; CVS Health CEO Larry Merlo; SAS CEO James Goodnight; and IBM CEO Arvind Krishna, all of whom I am sure you might know well, will likely answer your call and help me to organize the meeting and help us both to do the work of the group.
As likely will our foundation thought-leaders, such as Former McArthur Foundation CEO Julia Stasch; Ford Foundation CEO Darren Walker; and Packard Foundation CEO Nancy Lindborg, again all of whom I am sure you likely know well, will likely answer your call and help me to organize the meeting and help us both to do the work of the group.
And, as likely will our healthcare academic thought-leaders, like Harvard’s and the National Academy of Medicine’s Former President (and CEO of the Moore Foundation) Dr. Harvey Fineberg; Harvard’s and Mass General Brigham’s (Formerly Partners) Former CEO, Dr. Sam Thier; and Harvard and CVS Health EVP and CMO Troy Brennan; all three of whom I know well, will likely answer your call and help me to organize the meeting and help us both to do the work of the group.
And, as likely will our religious thought-leaders, such as Reverend Franklin Graham; Sephardi Chief Rabbi Yitzhak Yosef; and Professor Amir Hussain; whom you might know well, will likely answer your call and help me to organize the meeting and help us both to do the work of the group.
What Else Is Needed of You, Bill?
4. The fourth action. Might you at that meeting call for immediate national action to advance in some cases, and completely upend in other cases, the governments’ combined strategic-initiatives course the country and our businesses have been on for the past six months. Notwithstanding our governments’ combined best efforts, our people are still unsafe, our workers are still unsafe, and our federal and state economies are still weakened and only slowly recovering (in some people’s minds) or recovering slower than we might like (in other people’s minds). We, right now, need a thoughtful and crystal-clear strategy for action to make them all, our people at-large, our workers, and our economies, safe and strong again.
5. The fifth action. Might you then establish a world-class committee on a very short leash as to time, say two weeks (not two months), but not short as to insights, ideas, findings, as well as policies, and strategies, to craft a very thoughtful and very detailed emergency strategic action plan (SAP) for the nation to get the revised strategies and new, upended strategic-effort, envisioned, crafted, supported, and executed in a few weeks more time. Since governments have done all that they can do for now, businesses will need to lead the strategic-refinement and its execution, but ALL businesses must be encouraged, pushed, and supported in doing their fair share, by the rest of the thought-leader members of the group, who by then will have taken a stand.
6. The sixth action. Might you then stay on top of things (as will I) to (1) make sure actions are flowing continuously, and in the right direction of real and substantial progress, (2) trouble-shoot execution problems and obstacles, (3) cheer progress on, and (4) inform doers when they stray from course? There are books that say that nine out of ten businesses do not execute strategies well, so (5) some handholding might also be required. But with your overall leadership, I have confidence that the executive committee—and the larger group that you assemble (with a little bit of help from me)—can get the job done.
The US and Worldwide Difference that the Right Attack and/or Counter-Attack Might Make if Launched Right Now
The term “Manhattan Project” is widely overused, and for some, it is held negatively, but I do think that your answering this call to action to win this COVID-19 war will be viewed very widely as an exceptionally good thing. Plus, it has the promise to save a similar number of casualties (injuries and fatalities) over this next decade, both in the US and worldwide. COVID-19, and especially in combination with the flu and any other deadly bug that is just around the corner, will likely be with us at least for the balance of the decade, even if we begin immediately to manage it better, and then far better each year.
Let’s immediately, under your overall leadership, and in concert with many supporters (including many government leaders who will appreciate your kind assistance) launch our COVID-19 counter-attack (to the disease’s current attack wave) and prepare now for our November or December counter-attack when the flu joins forces with COVID-19. Once the virus is beaten down, we can attack it many times more and in many different ways, some of which we will learn in coming months and years.
Thanks, Bill, for seriously considering my call to action, which I know, because of the kind of man that you are, you will. Taking over leadership of the nation’s crisis (or any crisis, for that matter) is an extremely scary, time and energy consuming, and exhausting effort—no major change comes without serious discomfort, and sometimes agony, but also without dedication and sometimes glory and sometimes the opposite of glory. But someone has to do it. Let this be your true legacy, as it, to a far lesser extent, might be mine.
Best,
John
FDA Former Principal Deputy Commissioner John A. Norris, JD, MBA Harvard Former Health Policy and Management Faculty Member Chairman, FDTH Regulatory Affairs Strategies, LLC, and Norris Capital, LLC 531 West Washington Street, Hanson, MA 02341 617-680-3127 Email LinkedIn
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