Leading through COVID: Lessons from Past Pandemics

Adapted from a phone interview, May 13, 2020.

Q: How has the pandemic impacted you?

It’s been ironic, fascinating, and frustrating. Despite spending 15 years of my career involved in planning for, responding to, and determining how to recover from natural disasters, pandemics, and terrorist events, I’ve never had to live and work out of my apartment for 61 consecutive days. So, like everybody else, I am on new ground.

Q: Tell me about your work on internet emergency management systems.

Back in the 1990’s, a company I founded, E Team, developed the first internet software to manage large scale emergencies and events using the incident command system. We were directly involved in New York City’s recovery from 9/11 as well as every major health event including SARS, the anthrax attacks, and West Nile virus. Prior to COVID-19, SARS was the scariest, and most instructive for where we are now, and what you should, and shouldn’t do when faced with a global pandemic.

In 2003 SARS infected 8,096 people worldwide and 774 died. It could have been much worse. Regrettably, we didn’t learn the lessons we earned from that successful response.

We only had eight SARS cases in the United States and no deaths because other countries, particularly Canada, which had hundreds of cases right on our border, responded with alacrity, and were able to effectively contain and snuff out that particular strain of SARS.

The 2003 SARS activation proceeded rapidly through the critical stages of pandemic response. Fast detection of a new threat. Testing—deployed quickly throughout the health systems. Then from positive tests, containment and contact tracing. That was all done with speed. Speed is the absolute requirement for any pandemic response.

Communication is also critical. In every crisis, despite great upheaval, leaders must convey that; A, we are going to get through it. B, it is going to be hard. C, there will be ongoing, open, truthful communication, which limits people from perpetuating, in the form of misinformation, their worst fears. And D, the systems we have in place are acting in conjunction to achieve a clearly articulated set of goals and outcomes.

Sadly, with COVID, we’re seeing what happens when you don’t do any of that.

Q: How did you get into this work?

By accident. On January 17, 1994, I got launched into emergency management—literally. I was shaken out of bed at 4:31 in the morning by the Northridge earthquake. The epicenter was under my apartment building.

Prior to the earthquake, I had been working to launch a company to develop scalable internet-based command and control systems for the Defense Advanced Research Projects Agency (DARPA). Our startup had just deployed a brand-new way of doing battle management using the internet that didn’t require direct point-to-point communication. It was proving to be enormously effective in its initial deployment within a couple of experimental brigades.

After the earthquake, I had the only real epiphany I have ever experienced. I realized that battles are a kind of disaster, just manmade. The chaos in Los Angeles made that obvious. Coordination was a nightmare. Nobody could talk to anyone else. The police department couldn’t talk to the fire department or public works or public health.

I realized if we could coordinate the lethal interplay of tanks, helicopters, and fixed-wing aircraft that takes place on a modern battlefield, we could do the same thing for police, fire, ambulances, and all the other first responders. California was a good place to launch such a venture because of the state’s long history and experience in dealing with disasters of all kinds. The resultant spinout company and its flagship product were called E Team.

Because of wildfires in particular, California had gotten really good at managing large unplanned events. Wildfires are unpredictable. Responses always involve multiple agencies and teams from different parts of the state who are required to come together and organize quickly. Out of that experience, California had developed the Incident Command System (ICS). ICS had become the basic framework for local, state, and national response systems around the country.

It’s like the rules for a pickup basketball game. There’s a shared model with defined critical functions and protocols, so that even if the players and the specifics can’t be known in advance, everyone knows how to play with each other. E Team empowered that behavioral model with distributed technology, creating a robust incident command infrastructure.

Over the next few years, E Team developed public-private partnerships with Los Angeles, San Francisco, Philadelphia, and the Federal Department of Transportation. Part of our work was making sure their systems didn’t crash going into Y2K.

That brought us to the attention of New York City. We were selected to provide the system for a new state-of-the-art command center, which they were putting on the 23rd floor of 7 World Trade Center.

On September 7, 2001, I was in New York to meet with the leadership of emergency management operations for the city to discuss our planned deployment on September 17.

When the twin towers came down on 9/11, they took 7 World Trade Center with them. Because we’d worked with San Francisco, where an earthquake on the San Andres fault could destroy the command center, we had built E Team so that it could be deployed remotely. Four days later, when New York City opened a temporary command center on Pier 92 with 300 workstations, they turned on E Team. Our software was used to manage that entire recovery. It was the first disaster of that magnitude run using an internet command and control system.

Then three weeks after 9/11, the anthrax letters went out. Almost immediately, E Team had a federal procurement to serve as the core of the Pandemic Preparedness and Bioterrorism Command Center at the Department of Health and Human Services in Washington. Eventually the CDC and the National Pharmaceutical Stockpile (which is now call the National Strategic Stockpile) were using E Team, too.

Q: What’s the role of an international response in a pandemic?

When Ebola appeared in 2014, we all knew it was a dangerous disease. Because we activated our systems, there were only 11 patients treated for Ebola in the United States. We detected, identified, contact traced, and contained. It was very, very scary, but we did all the right things. Those actions dramatically limited the spread within the U.S.

Besides U.S. containment, we also recognized that it would be extraordinarily difficult for us to continue to keep the disease from spreading without addressing critical hotspots in conjunction with other countries. We deployed both civilian and military medical capabilities to West Africa with the full commitment that we were going to work with our international partners.

We have enormous resources in this country, but they’re only as effective as the leadership allows them to be. With COVID, when we discovered that we were going to be confronted by this unprecedented test, we waited. We ignored the lesson of previous threats that time is everything.

In the face of any large new threat, first and foremost, you need leaders. And they need access to relevant expertise and an infrastructure of systems that can be activated quickly.

The CDC has done a yeoman’s job focusing on the public health dimension. The disruption associated with COVID also has political, economic, security, and societal aspects. The National Security Council’s Directorate for Global Health Security and Biodefense was a key office. It had access to the highest executive level in the event that something happened. That office was effectively disbanded in 2018, so there was nobody available who could immediately understand and appreciate the potential consequences as this new threat emerged. Precious time was lost because no one at the senior White House executive level was in charge.

Q: What are you hoping for going forward?

In addition to all its tangible effects, this pandemic has caused universal trauma with consequences felt at the personal, institutional, and societal levels. Left unaddressed, trauma produces a lasting set of ingrained behavioral changes.

If we don’t explicitly recognize that subtle but profound trauma effects are going to now change many aspects of how we do what we do, we are deluding ourselves. We must recognize the trauma, and find ways to again feel safe at the individual, institutional, and societal levels.

As leaders, we’ve seen a lot. We’ve been through a lot. If we think we can respond to this by just being tough, we’re going to charge forward trying to force a return to the old normal as quickly as possible. If we don’t listen and notice, if we don’t recognize that the models that we’ve used no longer fit, we are going to fundamentally miss the fact that everything is altered.

If you want to find a somewhat dark reason for hope, look at the Black Death in the 14th century. While an unprecedented catastrophe, the plague shattered old, rigid systems and beliefs. It made new ways of thinking necessary. It made the Renaissance possible. It spawned the modern age.

With the right kind of leadership, we might see the emergence post-COVID of a new set of systems that recognize our interdependencies and respect our shared humanity to create a new structure for managing the incredible complexity of our rapidly evolving world.