Thread by @provisionalidea

I'll start this off by saying I hope and pray for a swift end to the pandemic, and am deeply concerned for all those currently in the line of fire.

As an executive and scientist, I look at COVID19 and see learning opportunities. My birth country, Canada, is very prepared. Why?

Back in 2003, Canada (specifically, Toronto, where I'm writing this from today) was hit hard from SARS. 44 people died, all of them in Toronto -- including 3 healthcare workers. 438 people got infected across the country, most of them in the Greater Toronto Area.

It was a systemic failure; an inquiry was launched to prevent it from happening again. So:

WHAT WENT WRONG IN 🇨🇦 DURING SARS?
(a thread on what we learned and why we're prepared)

The issues should sound familiar to anyone following COVID19 today:
- Lack of surge capacity in clinical and health systems
- Difficulty with timely access to lab testing and results
- No protocols in information-sharing across government
- Unclear ownership of health data

- Inability to investigate outbreaks
- Lack of coordination across institutions to manage + respond to outbreaks
- Poor outbreak management protocols, infection control, and disease surveillance
- Weak links between public health and health services (hospitals, physicians, etc.)

This was a wake-up call. A new independent gov't agency was set up, the Public Health Agency of Canada, with a politically-independent Chief Public Health Officer with strong scientific and public health credentials.

Best practices were built off the CDC and Australian system.

The idea of the "system being overwhelmed" again was terrifying, so a National Emergency Strategic Stockpile was set up of medical, pharmaceutical, and other emergency supplies. This includes:
- 1.5 MILLION N95 masks
- 165 emergency mobile 200-bed hospitals
- drugs and antivirals

Building on the US National Disaster Medical System, which keeps over 7k volunteers at the ready in case of a health emergency, Canada set up Health Emergency Response Teams to deal with natural disasters, CBRN (chemical/biological/radiological/nuclear) threats, and epidemics.

A typology of pandemics was developed based on prospective virus characteristics, with each analyzed for their health, societal, and economic impact. Plans were developed to identify and suitably respond to each pandemic type.

Data sharing was a huge issue, so all laboratories across the country were joined into a Public Health Laboratory Network with integrated databases and monitoring systems. The federal government also created its own labs specifically to lead epidemic response.

Surprisingly (this lesson came from the CDC), when it comes to crises, downplaying the risk is one of the worst things you can do: "a fearless leader is a useless role model". While avoiding a panic is good, if you treat people like children, they'll be as helpless as children.

"Be at least as worried in public as you are in private" -- trust the public with an understanding of the risk, and use that trust as an opportunity to teach them what they can do to help the fight + why it matters. If you lie to the public, it will bite you in the ass.

Infection control was a huge issue -- hospitals were a major vector for infection, particularly with respect to a dreaded "second wave". Medical staff, overwhelmed with cases and new protocols, made mistakes. Simpler equipment + processes would prevent this from happening again.

Predicting the next pandemic would allow Canada to prepare and mobilize early, so a Global Public Health Intelligence Network was set up to monitor internet communications in nine languages to detect and report disease outbreaks and health threats from across the globe.

As the 2004 report says, public health "tends to operate in the background unless there is an unexpected outbreak of disease". It's one of those things that relies on thousands of doctors, nurses, engineers, and scientists, with expertise far removed from the general public.

But it's also one of those things we can never let break: there's a certain regularity to pandemics (every ~10 years, big ones every 30-35), but they're infrequent enough for us to forget + slip up. Priorities change, budgets get cut; maybe a president cuts the pandemic team.

But what if you're not in public health?
I'm a startup founder now -- how is this relevant?

1. Learn from your mistakes. When something breaks, engage with what went wrong. Instead of assigning blame, look for systemic causes. How was what happened a symptom of a broken system?

2. Protect your experts from politics. Their job is to have exceptional mastery of their field and they deserve the utmost respect for it. They should be able to voice concerns and fears clearly and without reprisal, and be adequately equipped to mitigate the risks.

3. Have updated plans, and access to emergency resources. Shit happens -- but the impact can be minimized if you know what to do, who to call, and can deploy cash, equipment, and personnel when needed.

4. Understand the risks to your organization. Categorize them based on their impact and the type of response needed, and build frameworks. If you treat each risk as a one-off, it will either overwhelm or underwhelm you. Be appropriately whelmed.

5. Make sure your people and systems talk to each other. The last thing you want is to be caught in a crisis with nobody knowing what's happening. An added benefit of this is, when things are good, you're in an even better place to take advantage of opportunities.

6. Treat your team like adults. If you trust them to do their jobs, and promptly communicate risks + problems to them, they will rise to the challenge and respond with intelligence and discipline. Be fearless in your conviction in your team, but appropriately fear problems.

7. Simplify your processes wherever possible. Complicated, convoluted systems lead to mistakes, particularly when people are under lots of stress and pressure.

8. Keep your ear to the ground! Dedicate time and energy to understanding the landscape you operate in, what challenges and competitors are coming up, and thinking about how to quickly respond. If you can integrate technology to help you do that, all the better.

Stay healthy!