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06 Aug

Posted at 22:02h in Uncategorized

How we do business in the aftermath of the COVID-19 pandemic, its effect on work, office space, and focus have been profound. Executives were working out of what had been guest rooms, attics, or walk-in closets. The need to work in corporate offices, once considered indispensable, is now being rethought in its entirety.

We’ve learned that maintaining our focus at home is different than at the office, and there are advantages and disadvantages to both places. But as office attendance has now been declared optional in many organizations,  it’s clear that office buildings and their functionality need to change to remain viable.

Having these thoughts about the ramifications of COVID-19 on workspace and focus, I felt immediately drawn to an article called The Office is Dead, Long Live the Office! that Eddy Badrina penned for Medium.

In 2020, I had the chance to sit down with Eddy, who is the CEO of Eden Green and President of BuzzShift, and Ryan Bricker, an urban designer for HNTB Corporation, to talk about the changing nature of office space, the needs of professionals, and the fight for focus. What follows is an abbreviated version of our conversation, which I hope will serve as inspiration to leaders and workers everywhere as they consider what office work and the space that contains it should become in the future.

Curt: We’re talking about reorganizing office space to make it valuable again. Even before COVID-19, only 23% said they worked better in an office than at home. So, when we talk about office space, it’s an odd combination of “expensive, but useless.” Those in commercial real estate should be interested in redesigning for a new era of human and work needs.

Eddy: So, if you’re talking to a real estate developer, what are you telling them in terms of an office worker’s perspective, or efficiency and effectiveness or from a corporate perspective?

Curt: It feels to me like the premise of commercial office real estate has become old. The real estate industry wants to establish a high value to make money, but companies and workers are no longer valuing it that way. We find value in space when it facilitates our work, and we’ve discovered on a massive scale that we can get that value at home. So, the core question for office building developers is, how do you create a better space, where people gain as much by going to the office as they save or reclaim by working at home?

Eddy: Ryan, from your perspective as an urban designer, how do you respond to that?

Ryan: What is happening all over the country in new development is about adjacencies between workspaces and what the city has to offer. In the downtown area where I work, you see an incredible emphasis on livability. I could show you 15 buildings where the ground floors are being reshaped into amenity centers, where anyone with a laptop can stop to work. As technology has gotten smaller, the portability of work has increased, so you don’t need the office to work. That means the office has to change — not just its layout, but its culture. If I’m going to commute two days a week into a downtown office, then that office has to have ten times the amenities and attractions of staying home.

Curt: Because otherwise, it’s just a crazy amount of wasted space.

Ryan: Right. And the burden falls not only on a company but also on those who develop the office buildings to figure out the cultural elements. But let me ask, how will that affect individuals and teams, and how they focus at work?

Ryan: Right. And the burden falls not only on a company but also on those who develop the office buildings to figure out the cultural elements. But let me ask, how will that affect individuals and teams, and how they focus at work?

Curt: Only a small percentage of office roles need to be performed at a particular spot. Most people don’t need to be in a specific location. The notion that we need an office for people to “collaborate” is an intriguing one because, so far, we’ve got it absolutely wrong. Most companies have gone to open offices or large communal workspaces, which actually suppress collaboration as people focus inward to produce work and shut out distractions. It’s the opposite of collaboration, which flourishes when you provide private spaces for people to think, and just a few larger spaces that teams can visit when they put those thoughts together and work collectively.

Eddy: From my perspective, as a business owner, I believe that if we take excellent care of our employees and look out for their efficiency, their effectiveness, and their well-being, they’re going to make our company better. I’m not talking about lip service or promoting a standard 401(k) plan, but thinking deeply about their day-to-day comfort and work, and the reasons and needs and motivations behind that. Our team is actually more effective at home for 80% of their work. But we really do feel the collaboration piece — being together — is missing.

So, we redesigned our space. We made the first floor available to everyone with a variety of seating areas – booths, tables, nooks, a kitchen, and a ten-person conference room. We designed the second floor as an open office concept with desks, etc. Guess what? No one uses the second floor. You might see one or two people there, but everyone else is downstairs.

Curt: Exactly, because the concept of fully open office space is actually paralyzing. When you need a place for sustained focus, well, you get that at home. Also, in your home, everything about it reflects that “you matter here.” In an open office space, which can feel dehumanizing, the suggestion is “you’re replaceable.” In a typical workday, you end up with large rooms of people who don’t talk to each other but look for ways to escape.

Eddy: And that’s why space needs to be designed for the comfort and convenience of the people in the organization, not for the organization’s comfort and convenience, which is how it has been until now. But speaking of spaces, let’s talk about the outdoors. In my article, I talked about people posting Instagram photos of themselves working outside at home. Obviously, they’ve got internet access outdoors. Ryan, where do you see architectural design and urban planning when it comes to outdoor spaces at work?

Ryan: Designing outdoor spaces in the public realm has most often involved things like recreation, play or relaxation, and sometimes reverence, memory, and contemplation, all traditionally built around human behavior. Landscape architecture hasn’t widely addressed work behavior within outdoor settings. So it’s a new question: How do you bridge that gap to design outdoor spaces for productive work?

Curt: There’s a study from the University of Michigan that proves a simple walk in nature can restore our focus. When you return, you can sustain a longer period of focus than you could without the nature walk. Nature creates a sensation of peace and rests the mind.

Ryan: Yes, but designing the outdoors for work could be a double-edged sword. If you’re outdoors, plugged in, focused on a screen, then you’re not really being in nature, right? And the same is true of the home environment. If you can’t totally unplug in the evening or on weekends to be at home with your family, then you’re not really “home from work.”

Eddy: One thing I’m struggling with is understanding my new cadence. What are my new patterns for work? Do I go to the office just for client meetings? What other work do I do there? Am I going to stay home today? Is there a trigger for choosing one or the other?

vvvvvEddy: One thing I’m struggling with is understanding my new cadence. What are my new patterns for work? Do I go to the office just for client meetings? What other work do I do there? Am I going to stay home today? Is there a trigger for choosing one or the other?

Curt: The bottom line is, we need to challenge this baseline assumption that we need to go into the office. If you can work from home, then isn’t all that commuting actually appropriating time from your home life, your private life, or being with your kids? So, whatever happens at the office better be something super valuable.

On the other hand, we also need rituals. So maybe on Tuesdays, I go into the office, do certain “Tuesday” things, and leave. But even as a ritual, it’s got to be easy to go there.

Ryan: What’s coming up quickly is the transportation side – flying cars, the hyperloop, or supersonic travel that could get you from New York to Shanghai in 60 minutes. As those transportation technologies come to life, you can live and work almost anywhere. It will radically change real estate, development, and communities.

Curt: In the end, I think this pandemic is forcing society to catch up to where technology was already heading. And that means new models of where we work, driven by why we work there.

Conclusion

The baseline of where people want to work has shifted. And that means we’re going to have spaces where people meet only once a week, not every day. It’s a huge opportunity for developers to create new, productive, focus-friendly flex spaces for work in locations that also give meaning and add cultural value to those who come to work there.

Curt Steinhorst speaks worldwide about our distracted lives, and authored the Amazon bestseller Can I Have Your Attention? Inspiring Better Work Habits, Focusing Your Team, and Getting Stuff Done in the Constantly Connected Workplace. Invite Curt to keynote your next virtual or live event.

Reprinted from Forbes, July 31, 2020, Revised January 2024.

30 Jul

Posted at 17:39h in COVID-19 Meetings Update, Face-to-Face Meetings, Uncategorized

A new eHandbook, that offers critical information for meeting and event planners who are resuming Face-to-Face Meetings, was released today by MeetingsToday.com and we are happy to share it with our readers.

The COVID-19 pandemic has put the brakes on the meetings and events industry, with only virtual events serving as a temporary solution to serve the primal human need for face-to-face interaction.

But while coronavirus has proven to be a stubborn adversary, one thing is for sure: We will meet face-to-face again, and hopefully soon. In fact, many destinations and facilities have already opened their doors, albeit in a “New Normal” mode of operation that is a very unfamiliar landscape to navigate.

To help meeting and event planners find their bearings as they prepare to hold live meetings again, Meetings Today has launched the “Navigating the New Meeting Landscape” eHandbook, filled with resources and critical tips and strategies to keep their attendees safe and protect the financial health of the organizations they plan for.

Included is information about:

  • The crucial contract clauses and other legal issues to be aware of
  • The very detailed safety and sanitation protocols that major hotel chains have instituted to ensure safety in the post-shutdown environment
  • Essential risk management and mitigation strategies to implement before welcoming attendees

The last section of the eHandbook provides a wealth of additional resources culled from Meetings Today’s coverage of the pandemic, from its very beginnings to where we are currently, including articles, podcasts with industry experts and free educational webinars that present a deeper dive into what you need to know to steer you in the right direction.  Click here to receive a copy

And check out our speakers who are available for Face-to-Face meetings and also our virtual speakers who deliver their message with the same enthusiasm as their stage events!

28 Jul

Posted at 00:18h in Uncategorized

Unleash your Potential Tony Robbins Virtual eventVirtual events can be as electric as LIVE events and Tony Robbins just proved it! Attracting a record-breaking attendance Tony Robbins’ virtual Unleash the Power Within event, held over the July 16th weekend, was the first in the speaker’s 43-year career to have been held virtually in people’s homes.  A real-time game engine technology with video capture and playback, secure and scalable cloud-based tools, and custom AI neural networks. The weekend was about taking the things that have happened to us and realize they are happening for us! He invites all to “trade your expectations for appreciation and your whole life will change in that moment.” Tony Robbins is a #1 New York Times best-selling author, entrepreneur, and philanthropist. For more than 37 years, millions of people have enjoyed the warmth, humor and dynamic presentation of Mr. Robbins’ corporate and personal development events. As the nation’s #1 life and business strategist, he’s called upon to consult and coach some of the world’s finest athletes, entertainers, Fortune 500 CEOs, and even presidents of nations. Watch it now and be inspired!

Check out our Featured Inspirational Speakers for your next virtual event!

25 Jun

Posted at 17:36h in Uncategorized

The protests occurring across the US beginning the day after Memorial Day were sparked by a shocking video that captured how black persons are often grossly abused and even killed by a broken criminal justice system. In front of our eyes, George Floyd died on May 25, 2020, as a police officer pressed his knee on Floyd’s neck as Floyd gasped, “I can’t breathe.”

In addition to attributing the cause of death to “cardiopulmonary arrest while being restrained by law enforcement officer(s),” Hennepin County prosecutors and an early account from the medical examiner in the case list other “significant conditions,” including “arteriosclerotic and hypertensive heart disease.”

At a time when many people in the US are awakening to the systemic racism in the criminal justice system, it is equally important to acknowledge its existence in the US health care system.

Research shows that because of systemic racism, black persons have higher levels of chronic illnesses compared with white persons. It is hard to fathom the gall it took to imply blame for Floyd’s death on the very disparities in which racism plays so large a role.

Evidence has shown for decades that black persons are treated differently (worse) than white persons by the US health care system. In the notorious Tuskegee experiments, members of the US Public Health Service followed up black men infected with syphilis without treating them to observe how the disease took its course; the experiments ended in 1972, but their effects are still being felt. The US Agency for Healthcare Research and Quality has been tracking racial disparities since 2000. They still remain.

Every single time I hear a presentation or read a manuscript pointing out differences in how black persons are treated with respect to health care, I despair. It seems to me that anyone who does not know this yet is actively remaining ignorant and will not be convinced by 1 more study.

Black women’s maternal mortality is 3 times that of white women. Black patients in the US are less likely to receive proper care for diabetes, kidney disease, and various cancers even though they have higher rates of almost every disease.

Sickle cell disease affects 3 times as many people in the US as cystic fibrosis. Yet cystic fibrosis receives 11 times as much funding per patient from the federal government, and 440 times more funding from foundations.

Black persons in the US face roadblocks in every aspect of health care and even in academic medicine. They are less likely to be able to access health care. If they are able to do so, they are less likely to get the care they need to remain healthy. They are less likely to succeed in the profession. They are less likely to be awarded grants. They are less likely to be promoted, and less likely to be in positions of leadership. There is evidence demonstrating all of this.

The coronavirus disease 2019 (COVID-19) pandemic has underscored the many levels of systemic racism. Black persons are more likely to have chronic conditions that lead to severe cases of COVID-19. They are more likely to hold lower-paying yet “essential” jobs that place them in harm’s way, more likely to be reliant on public transportation where social distancing is hard, and more likely to live in housing that compounds all that risk.

Even before any protests began, black persons were dying of COVID-19 at rates twice the rate that one would expect based on their share of the US population. In Wisconsin, COVID-19 deaths among black persons comprise more than one-quarter of such deaths, even though they are only 6% of the population. In a study in Louisiana, more than 70% of deaths occurred in black persons despite their comprising only 30% of the studied population. Disproportionately black counties account for more than half of COVID-19 deaths nationwide, and wealth and access to health care do not seem to equalize things.

Should the protests following George Floyd’s death cause transmission of infection, many will blame those who showed up. Those at higher risk—again, black persons—will be more likely to develop severe illness and die. This and all the other disparities are easily predicted, yet it seems, like so many US politicians, the health care community too often offers only “thoughts and prayers” rather than effecting change.

Part of public health is making sure the public is healthy. The US health care system has failed to do that with too many in this country. The US society in general and the health care community in particular need to acknowledge that so much of what is wrong with the health of black persons is the fault of the health care system and not of patients. “Personal responsibility” plays well, but it is often a way to blame the patient when the system fails to support their ability to care for themselves.

It is time to stop wasting time and money proving that disparities exist. It is clear that they do, and pointing out the problem is easy. It is time to do something about it, which is infinitely harder.

It is time to invest in public health to improve the ability of everyone to eat right and exercise regularly, and to quit smoking and drinking unsafely. Just telling them to do so is not enough. Massive investment into making it easier to do so is necessary.

It is time to make sure that everyone has access to the health care system and preventive care. The Affordable Care Act was necessary, but not sufficient. Too many still do not have access to Medicaid, and too many cannot afford care even when insured.

It is time to train physicians to avoid implicit and explicit racial bias when seeing patients. It is time to rebuild trust with black persons and for the health care community to own past mistakes and prevent them from happening again. And it is time to recognize that the reasons black persons fare so poorly with respect to health is because of disparities, not because they chose not to care for themselves, and to fix those disparities.

As efforts to contain the COVID-19 pandemic continue after protests subside, it is essential to recognize that systemic racism kills black persons through poor health as much as or even more than police brutality. It does so because society tolerates a system that sees them as expendable, even as it labels them essential.

(Reprinted from JAMA Network – JAMA Health Forum https://jamanetwork.com/channels/health-forum/fullarticle/2767595)

Aaron E. Carroll, MD, MSa healthcare speaker, professor of pediatrics at Indiana University School of Medicine who speaks/blogs on topics such as COVID-19, health research and policy at The Incidental Economist and speaks LIVE on Healthcare Triage. 

21 May

Posted at 23:10h in Uncategorized

 

“Singapore is knocking it out of the park in their approach to COVID-19 and they still had to succumb to lockdown.  The United States is no where near their game and we are already trying to reopen. We’ve got to scale up our response to this virus.  That’s the topic of this week’s Healthcare Triage.” Says Aaron Carroll, MD.  Singapore had one of the world’s most robust and effective responses to coronavirus and COVID19. Despite that, the country still had to enter lockdown and struggled to control the spread of the disease. What can this tell us about how the US has responded, and how and when American society can reopen?

Aaron E. Carroll, MD, MS  a healthcare speaker, professor of pediatrics at Indiana University School of Medicine who speaks/blogs on topics such as COVID-19, health research and policy at The Incidental Economist and speaks LIVE on Healthcare Triage. 

27 Apr

Posted at 17:26h in Uncategorized

Dave Knox sat down to talk about the rise of cybersecurity and why today – particularly in our new work from home environment – it is becoming a topic of board room discussion. In 2002, Scott Price was 26 years old when his employer, Arthur Andersen, went out of business following Enron. With his focus on auditing security around technology controls, Scott started his first company, growing it to $11 million in revenue seven years later. Sensing a broader opportunity, Scott left to start A-LIGN in 2009. As CEO and Founder of A-LIGN, they help companies comply with different regulatory and information security standards globally.

Dave Knox: When you started your career, audits and compliance were mostly financial. Early in your career, you saw that a change was coming and that need would broaden. How has cybersecurity changed compliance over the last decade?

Scott Price:  I think compliance really allows businesses to trust each other. I talk about the fact of what we do allows businesses to trust and respect each other. They want to be able to trust businesses back and forth of sharing data and us as consumers, we want to make sure our companies respect the data that we give to them. A-LIGN’s focus on having a very broad framework of how we attack those from a security controls perspective, I think really adds value to our clients because they see the fact that they can either raise funds, do business with a new company, move upstream or really just improve their business because of that trust. Having great cybersecurity controls in place is going to mitigate risk and make your company more successful.

Knox: Is the conversation around cybersecurity changing at the executive level?

Price: I think people are starting to talk about it moving from behind the scenes to the board room and I really do believe it’s become a board room discussion. But security is still not the place where we say okay, if we have a dollar to spend on sales and marketing or we have a dollar to spend on security, we’re going to choose security. Companies are going to consistently choose growth metrics and growth dollars over the fact that these are things that could happen. Let’s face it, with cybersecurity we know it’s going to happen, it’s not the if but the when it will happen. You do see it continuously getting more exposure at the board level though. And the focus will continue to increase as greater fines are incurred, companies lose major customers, and relationships are strained when you’ve influenced their cybersecurity environment.

We’re clearly biased as a company that helps organizations of all sizes reduce cybersecurity risks, but we feel that the ability to spend dollars to demonstrate compliance with cybersecurity regulations really will allow sales and marketing to drive further. We found that 66% of our client base takes on Series A funding or greater within 160 days of hiring us. We’ve seen the fact that they will get the funding and then want to move up market, so they’ll need to build these security controls in place. Or they’ll be looking for the funding and they’ll want to make sure that they have the best security controls as they go through due diligence. Investors and Strategic Buyers are starting to look at the compliance framework during the diligence process so it’s becoming a bigger, bigger issue.

Knox: Is there a way to measure an ROI when you think about security?

Price: I think the ROI is more if you don’t do something. You have to do it. People continuously underestimate the risk of bad things happening. I go back to the movie the Big Short. They found great investments because people don’t think that bad things are going to happen. They always undervalue it. I think it’s hard to put a dollar exactly on what the ROI is. I think it’s more along the lines of how it drives the sales and marketing aspect which you can put a dollar on that. It’s easier to measure the growth than to measure the penalty.

Knox: We mostly think of compliance and security as an IT responsibility but what you’re saying is it’s moving closer to being something the entire c-suite needs to care about. How do you think about that role of cybersecurity becoming more horizontal?

Price: There’s an often used phrase that they say cybersecurity is a team sport. It really is. We see the fact that sales and marketing are looking at their competition and seeing the types of certifications and assessments that those competitors can promote. They realize they need the same thing to be able to compete in the marketplace. We see it more and more driven by sales and marketing and then it becomes a responsibility of implementation by IT or operations. That in itself allows compliance and cybersecurity to have more visibility and not just sit in the back closet.

Knox: As a founder yourself, how do you coach and think about entrepreneurs engaging with security early on and planning ahead versus reacting?

Price: When you’re in a startup mode you don’t have time to go back and redo code, redo processes and procedures. You want to build those controls that are required for these cybersecurity regulations into the code, into your processes because you’re moving so fast. We really get excited when a CEO calls us of a startup and he or she is engaged with us before they’ve even been asked for the audit or the assessment, before they’ve even building their application and they just have this idea. That’s where we can have the most impact because it’s not going back and retooling a process. That allows us to understand what works for you at this stage and you can grow into that process. For us, the value that we get derived of interacting with what we call “Startup Steve” and that buyer persona is really fascinating for us.

What we find is that this founder is typically someone that came from a large company and they had first hand experience of going through that process, retooling things, and seeing their teams bogged down. They recall that pain and don’t want to have it happen with their startup. They want to align their strategy and their compliance objectives. We love to partner with them early on and be able to not have to experience that pain.

Not some people haven’t had to experience that pain before. For them, the biggest thing is to try to relate to them of where their objectives are and how we can fit into that and get them there sooner. They want to be able to get to market and they want to be able to acquire new customers. We tell them that if we partner now, we’ll be able to do that with you in a much easier format, take you to market quicker and be able to achieve whatever they want to do faster. We are able to talk about our experience with 2,400 clients, many of which we started working with when they were in the startup and small business phase. We can make those connections and help them understand why it’s so important to do this work at the startup phase rather than building processes and having to retreat later on.

Knox: In your own journey as an entrepreneur and as you have worked with over 2,400 companies, what lessons do you wish you had when you were starting that first company at 26 years old?

Price: I think the biggest thing that I’ve learned is I wish I would have focused more on how to be a good leader and CEO and to invest in our people early on. I constantly hear “you’ve built this great company in A-LIGN” but the thing is, we don’t sell a widget, we don’t sell a car. We sell our people being experts in their industry and being able to go out and interact with our clients. As we received our investment from FTV Capital, we’ve invested tremendously in our people with training and also in our technology. Those are the things that I wish I had done earlier and raised capital in order to be able to do that because we’ve seen the dividends of that pay off. If we had done that work in 2014, we might be 10 times where we’re at now.

We have four values and one of our four values is innovate constantly. We firmly believe that our clients want us to innovate and be on top of what we’re doing because they’ve chosen us as their trusted provider to be able to do just that. For someone that wants to grow and be pushed to the limit, this is the best feeling. This is what I love to do because we are constantly learning about new attack techniques that hackers are trying to do. The great thing is the hackers get worse every day and we have to get better to be able to support our clients. Standards change every day because cybersecurity threats change every day. This is one of the most interesting industries that allows us to have these constant changes, to keep it interesting. The standard is constantly evolving. Our client’s risk is constantly evolving. The technology behind what they’re doing is evolving. This makes this very interesting. We don’t sell black and white TV’s at A-LIGN. We’re in cybersecurity and it’s constantly evolving.

Knox: COVID-19 has created a new cybersecurity threat landscape for C-suite executives – especially CEOs, CIOs and CISOs. What kind of threats are organizations facing and what should you consider when choosing a compliance partner?

Price: The new threat landscape created by COVID-19 is our new reality – and even the most prepared business continuity plans likely did not plan for a worldwide pandemic that would disrupt business and IT operations. Organizations are facing new risks regarding a remote workforce and compliance initiatives as cyber criminals attempt to exploit the fear of the unknown. Continuing to maintain compliance, even during uncertain times, remains vital – and finding an experienced partner you trust that has the right people, process and platform will transform any security and compliance experience.

Dave Knox is a leading consultant, speaker, and coach in the areas of innovation, marketing, and digital transformation. Invite him to keynote your virtual or LIVE meeting/event.

(This article first appeared in Forbes on April 20, 2020)

 

08 Apr

Posted at 17:05h in Uncategorized

Everyone wants to know when we are going to be able to leave our homes and reopen the United States. That’s the wrong way to frame it.

The better question is: “How will we know when to reopen the country?”

Any date that is currently being thrown around is just a guess. It’s pulled out of the air.

To this point, Americans have been reacting, often too late, and rarely with data. Most of us are engaging in social distancing because leaders have seen what’s happening in Europe or in New York; they want to avoid getting there; and we don’t have the testing available to know where coronavirus hot spots really are.

Since the virus appears to be everywhere, we have to shut everything down. That’s unlikely to be the way we’ll exit, though.

Some cities or states will recover sooner than others. It’s helpful to have criteria by which cities or states could determine they’re ready. A recent report by Scott Gottlieb, Caitlin Rivers, Mark B. McClellan, Lauren Silvis and Crystal Watson staked out some goal posts.

  • Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care.

Other cities and states fear that they will approach New York City’s state of crisis. They’re trying to increase the number of available beds and ventilators — as well as doctors, nurses and other health care providers — to make sure they aren’t overwhelmed in their capacity to provide care to all those who need it.

This is the most immediate bar, and the focus of most public health officials’ attention. At the moment, there’s no reason to believe any area is over a surge of cases, and analysts’ models predict many places won’t peak for weeks to come.

  • A state needs to be able to test at least everyone who has symptoms.

Dr. Gottlieb and colleagues estimate that the nation would need to have the capacity to run 750,000 tests a week — this is after things have calmed down greatly. There are times we might need even more.

“The 750,000 number should be viewed as a reasonable expectation for when we haven’t been having any major pockets or regional outbreaks to manage,” said Mark McClellan, an author of the report and a professor of business, medicine and policy at Duke. “If more testing to help contain outbreaks and potential outbreaks is needed, which seems very plausible, especially early on, the number would need to be significantly larger. We’ll also have to do some surveillance of people without symptoms, especially in higher-risk settings.”

A national estimate means less in deciding whether a state can reopen than its local capabilities. A state would need to be sure it could test every single person who might be infected, and have the results in a timely manner. That would be the only way to achieve the next requirement.

  • The state is able to conduct monitoring of confirmed cases and contacts.

A robust system of contact tracing and isolation is the only thing that can prevent an outbreak and a resulting lockdown from recurring. Every time an individual tests positive, the public health infrastructure needs to be able to determine whom that person has been in close contact with, find those people, and have them go into isolation or quarantine until it’s established they aren’t infected, too.

This will be a big challenge for most areas. Other countries have relied on cellphone tracking technology to determine whom people have been near. We don’t have anything like that ready, nor is it even clear we’d allow it. The United States also doesn’t have enough people working in public health in many areas to carry out this task.

Building that capacity will take significant time and money, and the country hasn’t even started.

  • There must be a sustained reduction in cases for at least 14 days.

Because it can take up to two weeks for symptoms to emerge, any infections that have already happened can take that long to appear. If the number of cases in an area is dropping steadily for that much time, however, public health officials can be reasonably comfortable that suppression has been achieved, defined by every infected person infecting fewer than one other.

In suppression, cases will dwindle at an exponential fashion, just as they rose. It’s not possible to set a benchmark number for every state because the number of infections that will be manageable in any area depends on the local population and the public health system’s ability to handle sporadic cases.

“We wanted to suggest criteria that would allow locations to safely and thoughtfully begin to reopen, but what that looks like exactly will vary from state to state,” said Caitlin Rivers, another author of the report and an epidemiologist at the Johns Hopkins Center for Health Security. “We therefore included some flexibility for jurisdictions to tailor these criteria to their local context.”

These four criteria are a baseline. Other experts think we will need to add serological testing, which is different from the viral detection going on now. This type of testing looks for antibodies in the blood that our bodies created to fight the infection, not the infection itself. These tests can be much cheaper and faster than the ones we’re currently using to detect the virus in sick people.

Testing for antibodies will tell us how many people in a community have already been infected, as opposed to currently infected, and may also provide information about future immunity.

Gregg Gonsalves, a professor of epidemiology and law at Yale, said: “I’d feel better if we had serological testing, and could preferentially allow those who are antibody positive and no longer infectious to return to work first. The point is, though, that we are nowhere even near accomplishing any of these criteria. Opening up before then will be met with a resurgence of the virus.”

He added, “That’s the thing that keeps me up every night.”

Until we get a vaccine or effective drug treatments, focusing on these major criteria, and directing efforts toward them, should help us determine how we are progressing locally, and how we might achieve each goal.

It would also prevent us from offering false hope about when America can start reopening. Instead of guesses, people could have clear answers about when they might be able to go back to a closer-to-normal way of life.

 

Aaron Carroll, MD, MS is a professor, speaker and author who keynotes events on the future of healthcare.  Invite him to your next meeting.

Originally appeared on The Upshot (copyright 2020, The New York Times Company)

07 Apr

Posted at 23:56h in Uncategorized

In January, virologists in China isolated a new virus. In March the Coronaviridae Study Group of the International Committee on Taxonomy of Viruses named the virus SARS-CoV-2. Most people call it the coronavirus. The virus causes a disease called Covid-19. The vocabulary can be very confusing. The goal of this article is to shed some light on the various terms.

Let’s start with taxonomy, a scheme of classification of things, especially living things. A Swedish naturalist named Carolus Linnaeus is considered the “Father of Taxonomy”. In the 1700s, Linnaeus developed a method we still use today to name and organize species. The table below shows one version of the Linnaean Classification of Humans.

Kingdom Animalia
Phylum Chordata
Subphylum Vertebrata
Class Mammalia
Subclass Theria
Infraclass Eutheria
Order Primates
Suborder Anthropoidea
Superfamily Hominoidea
Family Hominidae
Genus Homo
Species Sapiens

The level of detail can make your head hurt. We humans are often referred to simply as Homo Sapiens. There is much more detail beyond the table if you want to drill down. When it comes to viruses, the taxonomy makes the human taxonomy look really simple. See the following table from Nature.com to get a glimpse of it. The complete 8,000-word article is here.

To put the complexity in perspective, consider SARS-CoV-2, the cause of the pandemic, is one of 6,828 virus species which have been named. Researchers say they know of hundreds of thousands more species. Some believe there may be trillions waiting to be found. This is the virosphere.

The good news is there are a number of profound research projects underway to deal with the world of viruses. This is incredibly important because viruses are not going away. Some experts are saying a new and different virus will appear next year or even later this year. Hopefully, we will be ready. The wake up call this time was so loud and clear, I believe we will be prepared.

One new approach under development is the use of synbio, as described in last week’s e-brief. A vaccine made from synthetic ingredients can potentially offer some significant advantages. The big one is scalability. Synbio vaccines could be produced efficiently for millions or even billions of doses. Synbio vaccines are developed using computer models, not flasks and test tubes. With billions of calculations, a nanoparticle can be designed which has the exact properties desired. The really big breakthrough with synbio is the attachment of multiple different viral molecules to the nanoparticle and thereby create a universal coronavirus vaccine. One vaccine for all corona viruses. That will be the breakthrough.

Another positive development in the silver lining of the coronavirus cloud is tech companies large and small are jumping in the boat to help. For example, IBM is collaborating with the White House Office of Science and Technology Policy and the Department of Energy to launch the COVID-19 High Performance Computing Consortium. The Consortium will provide supercomputing power to researchers developing predictive models to analyze the coronavirus progression and identify potential treatments. Researchers from around the world can submit proposals, and the Consortium will select the projects which could have the most immediate impact. Other partners in the consortium include NASA, MIT, and the Argonne National Laboratory.

Another significant Covid-19 effort is taking place at Oak Ridge National Laboratory in Oak Ridge, Tennessee. As of November 2019, Oak Ridge had the fastest supercomputer in the world. It is capable of performing one thousand million million (1015) operations per second.

Scientists at Oak Ridge have deployed the massive supercomputer to look for compounds which can bind to the “spike protein” of the virus. It is the spike protein which the virus uses to infect host cells. The right compound could render the spike protein ineffective, and the virus would be stopped from spreading. Using digital models, the supercomputer can simulate how particles in the viral protein would react to different drug compounds. The researchers started with a list of 77 compounds and narrowed it down to the top seven most promising candidates which could become effective treatments for covid-19. The research is at the early stage but I believe we can be hopeful.  

John Patrick is available for virtual and in-person keynotes. The post The World of Viruses appeared first on johnpatrick.com.

08 Jul

Posted at 23:43h in Uncategorized

By Aaron Carroll, MD

“Americans argue over insurance while Singaporeans keep perfecting the delivery of care.” says Dr. Aaron Carroll.

The following originally appeared on TheUpshot (copyright 2019, The New York Times Company).

Singapore’s health care system is sometimes held up as an example of excellence, and as a possible model for what could come next in the United States.

When we published the results of an Upshot tournament on which country had the world’s best health system, Singapore was eliminated in the first round, largely because most of the experts had a hard time believing much of what the nation seems to achieve.

It does achieve a lot. Americans have spent the last decade arguing loudly about whether and how to provide insurance to a relatively small percentage of people who don’t have it. Singapore is way past that. It’s perfecting how to deliver care to people, focusing on quality, efficiency and cost.

Americans may be able to learn a thing or two from Singaporeans, as I discovered in a recent visit to study the health system, although there are also reasons that comparisons between the nations aren’t apt.

Singapore is an island city-state of around 5.8 million. At 279 square miles, it’s smaller than Indianapolis, the city where I live, and is without rural or remote areas. Everyone lives close to doctors and hospitals.

Another big difference between Singapore and the United States lies in social determinants of health. Citizens there have much less poverty than one might see in other developed countries.

The tax system is progressive. The bottom 20 percent of Singaporeans in income pay less than 10 percent of all taxes and receive more than a quarter of all benefits. The richest 20 percent pay more than half of all taxes and receive only 12 percent of the benefits.

Everyone lives in comparable school systems, and the government heavily subsidizes housing. Rates of smoking, alcoholism and drug abuse are relatively low. So are rates of obesity.

All of this predisposes the country to better health and accompanying lower health spending. Achieving comparable goals in the United States would probably require large investments in social programs, and there doesn’t appear to be much of an appetite for that.

There’s also a big caveat to Singapore’s success. It has a significant and officially recognized guest worker program of noncitizens. About 1.4 million foreigners work in Singapore, most in low-skilled, low-paying jobs. Such jobs come with some protections, and are often better than what might be available in workers’ home countries, but these workers are also vulnerable to abuse.

Guest workers are not eligible for the same benefits (including access to the public health system beyond emergency services) that citizens or permanent residents are, and they aren’t counted in any metrics of success or health. Clearly this saves money and also clouds the ability to use data to evaluate outcomes.

The government’s health care philosophy is laid out clearly in five objectives.

In the United States, conservatives may be pleased that one objective stresses personal responsibility and cautions against reliance on either welfare or medical insurance. Another notes the importance of the private market and competition to improve services and increase efficiency.

Liberal-leaning Americans might be impressed that one objective is universal basic care and that another goal is cost containment by the government, especially when the market fails to keep costs low enough.

Singapore appreciates the relative strengths and limits of the public and private sectors in health. Often in the United States, we think that one or the other can do it all. That’s not necessarily the case.

Dr. Jeremy Lim, a partner in Oliver Wyman’s Asia health care consulting practice based in Singapore and the author of one of the seminal books on its health care system, said, “Singaporeans recognize that resources are finite and that not every medicine or device can be funded out of the public purse.”

He added that a high trust in the government “enables acceptance that the government has worked the sums and determined that some medicines and devices are not cost-effective and hence not available to citizens at subsidized prices.”

In the end, the government holds the cards. It decides where and when the private sector can operate. In the United States, the opposite often seems true. The private sector is the default system, and the public sector comes into play only when the private sector doesn’t want to.

In Singapore, the government strictly regulates what technology is available in the country and where. It makes decisions as to what drugs and devices are covered in public facilities. It sets the prices and determines what subsidies are available.

“There is careful scrutiny of the ‘latest and greatest’ technologies and a healthy skepticism of manufacturer claims,” Dr. Lim said. “It may be at the forefront of medical science in many areas, but the diffusion of the advancements to the entire population may take a while.”

Government control also applies to public health initiatives. Officials began to worry about diabetes, so they acted. School lunches have been improved. Regulations have been passed to make meals on government properties and at government events healthier.

In the United States, the American Academy of Pediatrics and the American Heart Association recently called on policymakers to impose taxes and advertising limits on the soda industry. But that’s merely guidance; there’s no power behind it.

In Singapore, campaigns have encouraged drinking water, and healthier food choice labels have been mandated. The country, with control over its food importation, even got beverage manufacturers to agree to reduce sugar content in drinks to a maximum of 12 percent by 2020.

Singapore gets a lot of attention because of the way it pays for its health care system. What’s less noticed is its delivery system.

Primary care, which is mostly at low cost, is provided mostly by the private sector. About 80 percent of Singaporeans get such care from about 1,700 general practitioners. The rest use a system of 18 polyclinics run by the government.

As care becomes more complicated — and therefore more expensive — more people turn to the polyclinics. About 45 percent of those who have chronic conditions use polyclinics, for example.

The polyclinics are a marvel of efficiency. They have been designed to process as many patients as quickly as possible. The government encourages citizens to use their online app to schedule appointments, see wait times and pay their bills.

Even so, a major complaint is the wait time. Doctors carry a heavy workload, seeing upward of 60 patients a day. There’s also a lack of continuity. Patients at polyclinics don’t get to choose their physicians. They see whoever is working that day.

Care is cheap, however. A visit for a citizen costs 8 Singapore dollars for the clinic fees, a little under $6 U.S. Seeing a private physician can cost three times as much (still cheap in American terms).

For hospitalizations, the public vs. private share is flipped. Only about 20 percent of people choose a private hospital for care. The other 80 percent choose to use public hospitals, which are — again — heavily subsidized. People can choose levels of service there (from A to C, as described in an earlier Upshot article), and most choose a “B” level.

About half of all care provided in private hospitals is to noncitizens of Singapore. Even for citizens who choose private hospitals, as care gets more expensive, they move to the public system when they can.

So Singapore isn’t really a more “private” system. It’s just privately funded. In effect, it’s the opposite of what we have in the United States. We have a largely publicly financed private delivery system. Singapore has a largely privately financed public delivery system.

There’s also more granular control of the delivery system. In 1997, there were about 60,000 ambulance calls, but about half of those were not for actual emergencies. What did Singapore do? It declared that while ambulance services for emergencies would remain free, those who called for nonemergencies would be charged the equivalent of $185.

Of course, this might cause the public to be afraid to call for real emergencies. But the policy was introduced with intensive public education and messaging. And Singaporeans have identifier numbers that are consistent across health centers and types of care.

“The electronic health records are all connected, and data are shared between them,” said Dr. Marcus Ong, the emergency medical services director. “When patients are attended to for an emergency, records can be quickly accessed, and many nonemergencies can be then cleared with accurate information.

“By 2010, there were more than 120,000 calls for emergency services, and very few were for nonemergencies.

Singapore made big early health leaps, relatively inexpensively, in infant mortality and increased life expectancy. It did so in part through “better vaccinations, better sanitation, good public schools, public campaigns against tobacco” and good prenatal care, said Dr. Wong Tien Hua, the immediate past president of the Singapore Medical Association.

But in recent years, as in the United States, costs have started to rise much more quickly with greater use of modern technological medicine. The population is also aging rapidly. It’s unlikely that the country’s spending on health care will approach that of the United States (18 percent of G.D.P.), but the days of spending significantly less than the global average of 10 percent are probably numbered.

Medical officials are also worried that the problems of the rest of the world are catching up to them. They’re worried that diabetes is on the rise. They’re worried that fee-for-service payments are unsustainable. They’re worried hospitals are learning how to game the system to make more money.

But they’re also aware of the possible endgame. One told me, “Nobody wants to go down the United States route.”

Perhaps most important, the health care system in Singapore seems more geared toward raising up all its citizens than on achieving excellence in a few high-profile areas.

Without major commitments to spending, we in the United States aren’t likely to see major changes to social determinants of health or housing. We also aren’t going to shrink the size of our system or get everyone to move to big cities.

It turns out that Singapore’s system really is quite remarkable. It also turns out that it’s most likely not reproducible. That may be our loss.

Aaron E. Carroll, MD, MS a healthcare speaker, professor of pediatrics at Indiana University School of Medicine who blogs on health research and policy at The Incidental Economist and makes videos at Healthcare Triage. 

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