The best laid schemes
Where did the Pandemic Flu plans go? ZacTax Roundup for February 2021
If only they'd asked for a writing sample, I probably never would have been hired by the Denton County Public Health Department. As anyone who has worked with me can attest, my spelling is shoddy, I have a tendency to make up words (see "nearburbs"), and my comma usage is both gratuitous and inexplicable. Nevertheless, as a graduate intern my main contribution to the department (in addition to attending meetings with other governmental agencies and working through the regional pandemic planning process) was to review and edit the County's pandemic plan.
My job was funded under Senate Bill 3678, the Pandemic and All-Hazards Preparedness Act, which was signed into law by President Bush on December 19, 2006. With a CBO-estimated program cost of $6 billion (from 2007-2011), the Act provided funding for planning and preparedness activities at the local level, more specifically within local county health departments. Across the State of Texas, local health departments and emergency management officials applied for and received funds to prepare for the inevitable pandemic.
The small role I played in developing the County's Pandemic Flu and Response Plan gave me an interesting perspective, however, as I was one of the few people that actually read every word of the document. And as anyone who has worked with me can attest, what I lack in grammar skills is more than balanced out with a photographic memory (which can be both a blessing and a curse).
Thus it was that my reaction to early reports of Covid-19 were on the more optimistic side. While sitting in a nondescript Florida bleacher watching the Houston Astro’s spring training last year (editor’s note: no trash cans were allowed at spring training per new MLB rules), we got word that our trip would end prematurely. Major League Baseball had canceled the remainder of spring practices. When my wife asked what I thought, I told her we had planned for this. We have procedures, we’ve coordinated regionally… I think we’ve got it.
On the bookshelf behind almost every city manager’s desk you will probably find a strategic plan, CIP plan, water and wastewater master plan, a five year financial forecast, and under a half-inch of dust, an emergency management and pandemic plan.
On the flight back, I asked our county emergency manager to email me (still a city manager at the time) the pandemic plan so I could review it prior to stepping off the plane. The response to this day still baffles me:
The county does have a Pandemic Flu and Business Continuity Plan. As the Emergency Management Coordinator for ********** and ***********, I can assure you and your residents that we are currently working through the applicable plans. However, we do not send copies of these secure documents out, they are for internal utilization only.
Please let me know if you have any additional questions.
To be fair, most officials were surprised by the pandemic, but this response made my heart sink into the pit of my stomach. After I landed, I went to the office and cleaned off the dust to read and refresh myself on the pandemic plan. These plans are not shared publicly so I will be very careful in what I say moving forward, but the forgone conclusion is simple: we pulled a Bill Buckner.
For those not familiar, Buckner was no Hall of Fame baseball player, but he had a solid 20+ year career that anyone would be proud of. He was a particularly good hitter, having won a batting title and never striking out more than twice in a game. For a player with such longevity, that’s a remarkable feat.
But that’s not what he’s remembered for. In 10th inning of Game 6 of the 1986 World Series, he let a routine ground ball slip between his legs at first base. The error gave the Mets the win and forced a Game 7, which the Mets also won.
Had Buckner fielded the ball, there’s no guarantee the Red Sox would have ended the Curse of the Bambino that night. Their bullpen had just blown a two-run lead, and the Mets had the home crowd on their side. But those are the types of routine plays that first basemen practice every day. They plan for them; they’re ready for them; they expect to make that play. In that situation, you can’t let the ball slip between your legs.
By my lights, that’s exactly what we’ve done.
As the next year unfolded, I found myself asking again and again: “Why are we not following the $6 billion dollar plan?”
The 2005 National Pandemic Plan laid out three pillars:
Pillar One: Preparedness and Communication
The plan was intended to define responsibilities at all levels of government and link up local plans with the federal response. In a federal system, it’s important to understand ahead of time which level of government bears responsibility for what. Without a clear delineation, any challenges or setbacks may devolve into an exercise in bureaucratic finger-pointing.
While we largely succeeded in outlining responsibilities, the process of linking our state, local, and federal plans were flawed in two ways: our plans relied on too many assumptions, and they struggled to provide a real-world outlook.
Tabletop exercises are great for defining responsibilities and stress-testing responses to different stimuli. Officials at all levels sit in a room and discuss available assets and planned responses as problems get thrown up on a board. We move these assets around like chess pieces, and we’re reassured that everyone in the room is on the same page. For this to work, however, we have to assume that the other players will fulfill their responsibilities. One of the tragedies in our Covid response was the lack of available resources that many in emergency management just believed would be available. We need to perform shot clinic? The feds will send help. We need personal protective equipment? We can request that from a stockpile (except many of those items were expired).
Tabletop exercises also lack the ability to “practice at game speed,” especially when preparing for a pandemic. When our assumptions are proven wrong, we have to be able to adapt in real-time. Our inability to do that exacerbated an already difficult public health crisis.
Pillar One also called for expanding domestic supplies, stockpiles at local and regional levels, production capacity, and scientific advancements in vaccine technology. At each step, we failed to fully implement what we had planned to do. Domestic supplies and stockpiles were inadequate (and as mentioned above, stocked with outdated equipment). Production capacity increased in the private sector as supply and demand attempted to reach equilibrium, but some companies have since been hit with unexpected regulatory burdens for helping out. And although the Moderna vaccine was developed in just two days, the regulatory process slowed widespread distribution for nearly a year (which still represented record time for vaccine approval). During that time, millions were infected, hundreds of thousands died, and many more lost their livelihoods. All this despite the federal plan calling for research and funding which would streamline vaccine development and approval much like our annual flu shots, especially for new technologies like the mRNA vaccines currently being distributed.
Our efforts in Pillar One failed largely due to complacency. We thought we were ready, had a beautiful plan, conducted a few tabletops, and had some warehouses with supplies. But we didn’t account for the idea that some (or all) of these elements would not actually be implemented by the time a pandemic struck.
Pillar Two: Surveillance and Detection
A large part of what makes the pandemic plan work is surveillance of pathogens around the world. In 2005, the concern was mainly avian flu. Today, it is obviously Covid-19 and its variants. The federal plan specifically states, “An effective surveillance and detection system will save lives by allowing us to activate our response plans before the arrival of a pandemic virus to the U.S., activate additional surveillance systems, and initiate vaccine production and administration.”
Our investments in Pillar Two actually worked well in the beginning. The virus was detected early and the scientific community immediately began work (vaccines were developed in just two days). The front end portions of Pillar Two performed well; it was the back end that struggled.
Surveillance also includes contact tracing and other steps necessary to limit the spread of infectious disease, and in this matter we obviously flunked. There appears to have been no coherent strategy for contact tracing. Many states relied on temporary labor, staffing agencies, and part-time university students to perform contact tracing.
The State of Texas even rummaged through its unemployment rolls, hiring a whopping 18 unemployed individuals through the Texas Workforce Commission as of August. Governor Abbott set a target of 4,000 contact tracers, although a model from George Washington University researchers suggested the state may need as many as 15,000.
Lacking dedicated software to perform this work, many states utilized a platform created by Salesforce (whose primary product is a sales CRM and a platform-as-a-service that allows organizations to build custom “apps” to access their data). Development on this new platform began in April (three months after the first confirmed case in the United States) at the behest of the governor of Rhode Island.
In the spring, Apple and Google both announced the development of privacy-focused contact tracing apps. Their apps went live in October, after 7 million cases had been confirmed and 200,000 had died.
In short, there was no coordinated effort to plan for contact tracing on a scale necessary to identify outbreaks and slow the spread of the virus.
At this point, most of the major models predict that about 15%+ of the Texas population has contracted Covid-19. That means that if you’re reading this, you most likely know at least one person who has tested positive (full disclosure, that includes myself).
If you tested positive for Covid-19, did you get a tracking phone call? In large counties, tracking is handled locally, but in smaller counties without local health departments the State is handling tracking. I took a small (and admittedly unscientific) poll of around 10 people in my circle who tested positive for Covid; I was the only person to get a tracing call.
While contact tracing is commonplace in parts of the world more familiar with viral outbreaks, it’s a relatively novel idea in America, and one that runs a bit counter to the traditionally understood American spirit of independence and individual freedom. On the surface it seems a bit Big Brother-esque. But the efforts of Apple and Google were actually quite inventive in the way they protected individual privacy (which is saying a lot for something Google developed). Perhaps if we had been working to build a platform like it before a pandemic hit, it might have been ready (and acceptable to the general public) in time to help.
Pillar Three: Response and Containment
When Pillar Two fails to protect the American public, we must aggressively move to Pillar Three and mobilize the local, state, and federal response according to those dusty plans on the shelf. Response and containment is activated when known human-to-human spread is occurring.
The goal is simple: contain the outbreak, limit the spread, and communicate effectively with the public to avoid panic. The federal plan outlines specific responses for containment, leveraging national medical and public health capacity, sustaining infrastructure and the economy, as well as ensuring effective risk communication. To keep from writing a book, let keep the light on risk communication.
Communication during any crisis is difficult, but it makes the situation even more challenging when you get in the way of your own messaging. Consider the debate over mask wearing. Early last year, officials suggested that masks were not effective for the general public, a position that has since been retracted by the same officials who have stated that they were trying to preserve mask availability for medical personnel.
The Texas Association of Municipal Information Officers (TAMIO) used to give out a crisis communication card for city officials to use when being interviewed, and I distinctly remember one of the key bullet points: “Tell the truth”. Much like the TAMIO, my mother also taught me that a lie is a lie, regardless of whether you said something overtly false or you left out pertinent information.
Telling the public it is not necessary to wear a mask without providing the context behind that message breeds distrust. Like many Americans, I’ll give experts the benefit of the doubt until they give me a reason not to. But once that line is cross, it’s hard to trust you ever again.
Those officials may have been well intentioned, but the failure to “puke honesty” has left us in a pickle. At a time when we needed honesty, our institutions - which have already struggled with a crisis of trust - didn’t give us the whole truth. And this is just one of many examples of messaging gone wrong during the pandemic.
As public officials, we love to plan. We’re always looking for ways to be ahead of the curve, whether it’s related to water use, development patterns, or public health crises. But a plan is only as good as its implementation. And in the past 12 months, we’ve seen how a failure to implement our plans can negate the value of making them in the first place.
We know far more about Covid-19 today than we did a year ago. Scientists and researchers are testing new treatments and vaccines, and high-risk populations are getting jabbed in the arm (to borrow a phrase from our friends across the pond). In fact, nearly 7% of the population has received at least one dose and we are averaging 1.3 million doses delivered per day. But we’re not out of the woods yet. We need to continue focusing on implementing the plan: increasing domestic production of vaccines/supplies, utilizing all governmental resources at the local level, and continuing to support economic stability efforts will help us crawl out of the pandemic.
We may never know why we navigated away from the pandemic response plans - mainly because the public was unaware of the process and accountability is lacking - but as management officials we should all be asking the tough questions locally and encouraging resiliency.
Since we’re talking about epic fails…
There is so much to unpack, and still so much to learn, about what caused the widespread power outages across Texas last week that it can’t be fully explored in this secondary section of the Roundup, which we traditionally have reserved for shorter discussions. But one thing that deserves a quick comment on is how utterly poor communication was both before and during the crisis.
During an emergency, proper public communication is often as important as, if not more important than, one’s ability to plan, coordinate, problem solve, and manage the crisis itself. In this regard, our leaders failed terribly. So terribly, in fact, that the best indication for the average news consumer that something awful might be about to happen was the fact that retail power companies began to publicly squirm in the days before the storm hit.
Griddy, which offers retail access to wholesale energy prices for a small monthly membership fee, sent a letter to its customers encouraging them to switch providers ahead of the storm if they could. Since their customers pay wholesale market rates for power, and those were expected to surge during the storm, they recognized the potential for extreme cost increases ahead for their customers.
Reports also came out of several retail providers offering incentives for their customers to switch providers before February 15th, most likely because they didn’t have the capital to foot the delta between the fixed rates their customers were paying and the about-to-explode wholesale costs they would have to pay themselves.
When both sides of the retail power market are trying to shed customers ahead of a major storm, it’s probably a good sign that something really bad is about to happen. But we didn’t hear that from anyone whom we should expect to tell us. ERCOT spent less than a minute discussing the storm in public session the week before it hit. Weather reports suggested prolonged periods of inclement weather, but virtually no one with the responsibility for overseeing our power grid sounded the warning bell to an extent that the average person could hear it.
Similarly, leaders local and national, current and former, started to place primary blame on minor elements of the outages. Failures in wind and solar were keyed in on as though they were the proximate cause for what we lived through, when that was far from the truth.
There are no grand solutions in life, only trade-offs. For all of the criticism that Texas’ “solo grid” and deregulated market has taken over the past two weeks, there have also been tremendous benefits of those decisions accrued to electric customers across the state. Pros and cons; good and bad. A trade off. Natural gas failures caused the bulk of our power outages last week, but our leaders couldn’t admit it in real time. That failure doesn’t condemn natural gas as a power source; it condemns our preparation. But we couldn’t get off message, because the political calculations are often more important than the truth. Unfortunately, that kind of bunker mentality can cause ripple effects that can last much longer than the crisis itself.
Emergency situations require trust, and trust requires honesty and transparency. When we fail to warn people ahead of time about the seriousness of the situation (ERCOT claimed yesterday that we were less than 5 minutes away from total catastrophe), and then deflect blame while the crisis is ongoing, all we do is make the next emergency that much more challenging for ourselves.
Finally, a special thank you from us to all of the front-line personnel who worked so hard last week to keep their communities safe. Street crews, line operators, water and sewer workers, public safety, and even you administration folks, you didn’t have the option of hunkering down with blankets by a fire. You had to go out and take care of your communities. That, ultimately, is what makes local government so special. So many circumstances are beyond your control. But when they arise, it’s your job to make the best of it for the people you serve. And for that, we thank you.