Strengthening Resilience of Healthcare Infrastructure during Infectious Disease Outbreaks

Tony Cowan  00:00

Good evening, or perhaps morning or afternoon for some of you. Welcome to IBEC’s November “Lessons Learned” event. Today, we’re delving into a panel discussion focused on bolstering resilience in the healthcare sector. Our panelists tonight hail from diverse healthcare industries across the United States, Canada, and Asia. As we navigate this infectious disease outbreak, each has encountered unique challenges in both service delivery and information assimilation. Our intention, by engaging these multifaceted professionals, is to highlight strategies and solutions that amplify future preparedness, responsiveness, and resilience. We will explore the public and professional distinctions between disasters and public health emergencies. Concluding our discussion, we’ll garner recommendations on how varied support systems and protocols might more effectively shield our healthcare systems. I urge you to actively participate tonight; please utilize our live chat bar for questions as we collectively strive to bolster our understanding and find avenues to back our healthcare industry both now and ahead.

Today’s discussion will feature insights from Rika, an organization akin to IBEC, dedicated to disseminating vital knowledge for improved response strategies. Ted Cowan, an IBEC founder with vast experience as an All Disasters Emergency Response professional closely aligned with the medical sector, will share his insights. Randy Rowell, an IBEC scientific advisor and a specialist in healthcare infrastructure, will discuss the ramifications of our pandemic response choices on pivotal supply chains. Laurence Svirchev, another of our scientific advisors, will overlay our discussions with occupational industrial hygiene insights. Laurence’s affiliation with the Canadian Aerosol Transmission Coalition underscores the significance of diversified voices in thwarting airborne disease transmission.

I’m Tony Cowan, one of IBEC’s founders and its current treasurer. For those new to our platform, IBEC stands for Integrated Bioscience and Built Environment Consortium. Our consortium, just two years young, is a global collective of scientific advisors who specialize in pathogens and their interactions within built environments. Our inception in early 2020 by Ted Cowan, Dr. Janie Morrow, and Kenneth Martinez was spurred by the pressing challenges of COVID-19, especially when the airborne route of transmission seemed overlooked. IBEC’s mission revolves around enhancing public cognizance of the science behind pathogen transmission and its prevention. By congregating global thought leaders from business, policy-making, standards development, and scientific disciplines, we facilitate informed decisions across varied entities and organizations.

IBEC collaborates with multiple complementary global organizations, promoting safer indoor environments. RIKA, one such organization, will share insights today. I’d also like to highlight IBEC’s collaboration with the American Industrial Hygiene Association in crafting the CDC-funded “Commit to C.A.R.E.” learning package, aimed at curbing the spread of infectious diseases like COVID-19 through self-assessment.

In 2020, amidst the pandemic, IBEC introduced its C.L.E.A.N. summits, which garnered attention from 16 countries and marked IBEC as a trusted source for insightful information on infection mitigation. Our ongoing “Lessons Learned” sessions address varied facets of the pandemic, including economic impacts, the challenges of returning to work or school, and congregation in places of worship. Today, our focus pivots to those most impacted by the pandemic – our healthcare workers and their patients.

Without further ado, allow me to introduce today’s moderator, Dr. Sonya Stokes. A valued scientific advisor for IBEC, Dr. Stokes serves as an Assistant Clinician Professor of Emergency Medicine at Mount Sinai Icahn School of Medicine and is the Medical Director of the COVID-19 advisory team at Mount Sinai Health Partners. With her vast expertise and involvement in several esteemed health organizations, Dr. Stokes is indeed the ideal moderator for today’s session. Sonya, it’s always an honor to have you with us.

Sonya Stokes  06:29

Thank you, Tony. I appreciate the warm introduction, and I’m grateful to everyone present for taking the time to join us today. Let me start by offering some context about what healthcare professionals like me are witnessing on the frontlines, especially here in the US. Recently, the American College of Emergency Physicians reached out to President Biden through a letter, sounding the alarm on an escalating crisis of patient overcrowding within our emergency departments. With a sudden spike in acute respiratory illnesses, it has become commonplace to witness patients receiving treatment in unconventional spaces—hallways, waiting rooms, and even temporary settings like tents and garages. The strains on our resources are evident—we are running critically low on space and on available staff. This crisis isn’t confined to adults; our children are equally affected. Just last week, a joint request from the American Academy of Pediatrics and the Children’s Hospital Association was made to President Biden, urging him to declare a public health emergency. This appeal was a direct response to the alarming increase in pediatric respiratory illnesses.

This backdrop compels us to raise some pressing questions: Compared to the early days of the pandemic, are our health systems—in the US and globally—better equipped now to tackle a fresh outbreak? Have we absorbed and implemented the lessons from COVID-19, or are there gaps in our learnings? Furthermore, what measures should be in place to ensure our health systems can withstand not only future pandemics but other public health catastrophes?

Today, we’re joined by three esteemed members from the IBEC Scientific Advisory Board. They bring expertise in occupational health, industrial hygiene, and biosecurity. Their mission? To avert human exposure to detrimental biological and chemical hazards. As someone on the clinical side of healthcare, I can vouch for the age-old adage: prevention truly is the best medicine. Therefore, I’m genuinely eager and grateful to hear insights from our experts today.

Let me provide brief introductions for our panelists, each of whom has prepared a succinct presentation for us. I encourage you all to put forth your questions in the chat box, and we will strive to address as many as possible during this session.

Firstly, I’d like to present Dr. Ranit Chatterjee, co-founder of RIKA. Dr. Chatterjee’s work delves into disaster management across diverse domains, encompassing architecture, governance, and ecosystem services. He has an impressive history of collaborations, having worked with several UN agencies, NGOs, and government bodies across Asia. While his initial training was in architecture, he pursued his master’s in disaster management from Mumbai and later earned a PhD in environmental management from Kyoto University. Dr. Chatterjee has been recognized for his efforts and was honored with the Integrated Research on Disaster Risk Youth Scientist Fellowship. Beyond his academic and professional pursuits, he is also a talented amateur photographer, boasting publications in esteemed platforms like National Geographic. Notably, the idea for today’s discourse was conceptualized by Dr. Chatterjee. Ranit, a heartfelt thank you for orchestrating this invaluable collaboration between IBEC and RIKA. The floor is yours.

Ranit Chatterjee  09:23

Thank you, Sonia, for the introduction. Indeed, this session provides a moment to reflect on the pandemic’s effects and its continuing challenges. The goal is not just to review our setbacks but to use them as stepping stones for future successes. I’ll briefly share insights about RIKA, the contributions we’ve made to the healthcare sector, and my experiences in the Asia Pacific region.

RIKa is a social entrepreneurship startup we founded in India in 2018. Our mission is to bridge the research-policy gap, translating evidence into meaningful policy changes. We promote disaster management as a career, believing that the brightest minds should address such critical challenges. While our focus lies in resilience — the ability to reduce disruptions — we also champion sustainability, ensuring long-term growth after facing interruptions.

Moreover, we prioritize innovative, demand-driven solutions that can adapt to changing market needs, especially for marginalized communities. Apart from research, we emphasize disseminating findings and training young minds for resiliency, preparing the next generation to handle future challenges. Our primary expertise is in disaster risk management, and in the past five years, our impact has spanned the globe. While the majority of our work is in the Asia Pacific region, we’ve also collaborated with various governments, international NGOs, regional organizations, and private sector partners.

Drawing from our work during the past two and a half years, especially during the COVID-19 pandemic, I’d like to highlight a few key projects. These include integrating biological hazards into planning, assessing health disaster resilience in eastern India, and developing a COVID-19 risk assessment tool, which was one of the few tools at the time that focused on risk assessment rather than contact tracing.

One glaring observation from the ongoing pandemic is that our hazard management planning often struggles with the nonlinear transition of biological hazards. For instance, while the pandemic was initially labeled a health emergency, its multi-dimensional impacts weren’t addressed until much later. Several countries, while responding to the pandemic, faced additional challenges like cyclones or earthquakes, revealing the lack of preparation for cumulative impacts. These observations stress the importance of viewing the pandemic not merely as a health emergency but as a disaster.

When examining the responses in the Asia Pacific region, four major gaps emerged. Firstly, action plans often overlooked the complete disaster cycle. Secondly, the multi-sectoral impacts of the pandemic weren’t sufficiently addressed. Thirdly, many plans didn’t account for the long-term psychological and physiological effects of the pandemic. Lastly, national bodies worked in silos, lacking cohesive, translatable plans for local implementation. Alongside these, challenges in data literacy, risk communication, and inter-agency data management further complicated responses.

Reflecting on our journey from 1918 to 2020, it’s evident that while we’ve learned much from past pandemics, we still have a considerable distance to cover. Essential steps forward include refining our entire care pathway, from screening to rehabilitation, enhancing surveillance and data systems, and fostering innovative public-private partnerships. By doing so, we can not only manage the current pandemic better but also prepare for future challenges.

Thank you for your attention, and I’ll now pass the discussion back to you, Sonya.

Sonya Stokes  21:39

Thank you again, Ranit. Before you leave us, I understand it might be early to answer this, but I’ll still ask: In your experience, are there any countries whose health systems demonstrated resilient responses to COVID-19? If there are such countries, what can we learn from them?

Ranit Chatterjee  22:04

That’s an insightful question. In the Asia Pacific region, we’ve studied numerous countries to observe their responses to the pandemic, and each had its unique approach. Let me highlight two examples: Japan, where I am currently, and our neighboring country, South Korea.

Japan centered their decision-making around a scientific committee. Essentially, research was at the heart of their strategy, with an expert committee assisting policymakers based on their findings. On the other hand, South Korea’s response was largely driven by technology and innovation. Right from the early stages of COVID-19, their primary focus was on creating tools and mechanisms for detection, data dissemination, and communication. These are two contrasting yet commendable approaches.

Sonya Stokes  23:46

While I won’t ask you to pick a favorite, do you feel one approach was more effective initially? Did they each have their strengths and weaknesses?

Ranit Chatterjee  23:58

When evaluating based on the number of cases and outcomes, Japan appeared to fare well, especially considering the infection and death rates in the earlier parts of 2021. Two factors play into this success: the incorporation of evidence-based research into policy decisions and the public’s adherence to the guidelines provided. Building and maintaining trust is paramount. This trust often hinges on effective communication and data dissemination to the masses. This is a prime example I’ve observed.

Sonya Stokes  24:56

If you have an easy way of learning that, please come to us and teach us those lessons, because I think we’re still learning over here. Five years from now, granted, I’m going to ask you this exact same question. So be ready, because I want to see how this plays out over time. Thank you again for the presentation. I’d like to move us back over to the US and introduce our second panelist today, Mr. Ted Cowan, the CEO and founding board member of IBEC. Mr. Cowan has over 35 years of experience in disaster preparedness and emergency management, including strategic and operational planning, training, and exercise coordination. He offers a unique combination of proficiency in analytics and vulnerability assessment. Ted, thank you for sharing your experience with us today.

Ted Cowan  25:48

Thanks, Sonya, for the warm introduction. I want to start by noting that COVID is still ongoing. Everyone knows that, and it hits close to home for me. Tonight, I intended to telecast from Japan, where I planned to visit my daughter stationed in Okinawa. However, both my wife and I tested positive for COVID last week, so we couldn’t make the trip. This serves as a poignant introduction to our conversation tonight. Following Chatterjee is no easy task, but I’ll share my experiences dealing with COVID over the last nearly three years.

For background, I have over 30 years of experience in disaster preparedness and response. My journey began as a Navy helicopter pilot. Some may question the link between being a Navy helicopter pilot and discussing infectious disease control. A transformative moment in my career was when I was stationed at the Pentagon during 9/11. I served as the executive officer for the Crisis Action Team and the National Military Command Center. That event shaped my future. After retiring from the Navy, my work expanded to state pandemic planning, supporting responses to H1N1, collaborating with the US Department of Defense, and more. My responsibilities included planning for biological events, contributing to the US bBio Watch program, and authoring key planning documents for the Federal Emergency Management Agency (FEMA). More recently, I’ve assisted healthcare systems in navigating their federal funding in the US, particularly in the context of COVID.

I recognize my comments may come across as US-centric. However, I believe they have global relevance. A concerning trend I observed in the US is the gap between planning and actual implementation. Several states had pandemic response plans in place, but these plans weren’t executed when needed. Another point of contention was the choice to designate FEMA, rather than the CDC, as the lead agency for the pandemic. This posed unique challenges, as FEMA had never tackled an infectious disease event of this scale before.

One glaring issue we’re facing is a segment of our society overlooking the science behind infectious disease control. This is why platforms like IBEC and the domain of occupational health and safety are vital. They emphasize the importance of enhancing our built environments for overall safety. An area of concern has been the reluctance to reimburse healthcare facilities for essential upgrades like air handling, even though it’s pivotal in disease spread mitigation. I remain hopeful for policy changes, especially given the Biden administration’s focus on indoor air quality.

To our audience, if you have avenues to influence policy, I strongly advocate for the emphasis on enhancing air quality in our built environments. It’s essential to understand that identifying issues without taking action does not equate to genuine lessons learned. While we might face challenges in persuading everyone to adopt preventive measures like wearing masks or getting vaccinated, we have control over improving the spaces we occupy to make them safer. That’s where our collective efforts and investments should concentrate, and I hope our discussion today sparks that initiative.

Sonya, I’ll pass the conversation back to you. Thank you.

Sonya Stokes  38:18

Thanks so much, Ted. First of all, I want to offer my support to you and your wife. I’m truly sorry to hear about your recent illness. If there’s anything I can do to help, just let me know.

Ted Cowan  38:33

Thank you, I appreciate it.

Sonya Stokes  38:35

Please stay safe and well. And thank you for sharing about the complexities we face in the US, especially with interagency support, or sometimes its absence. You’ve also highlighted the importance of investing in the built environment to create safer spaces. Before we move on to our next panelist, I want to revisit a point I made earlier. Right now, we are witnessing a surge in acute respiratory illnesses, not just COVID-19 but also RSV, influenza, and more. These are straining our health systems. Given this, are there any short-term solutions that public health or the government can provide to improve our immediate resilience in the health system? And how do these align with the long-term solutions you mentioned?

Ted Cowan  39:31

Well, one thing we observed during COVID-19 was the reliance on the Strategic National Stockpile, which, as many of us recognized, fell short. It wasn’t adequately invested in and was understocked. Considering the future, and accepting that COVID isn’t going away and other threats might emerge, both federal and state levels need to effectively support local communities when their resources are exhausted. Presently, we’re not doing well in that regard. Despite the vast amount of money the federal government has spent on COVID-19, we should be better positioned. To address your question, we need strategic thinking paired with an effective tactical response. This largely involves improving information exchange, recognizing when hospitals are reaching their limits, and optimizing the distribution of patients and resources. A challenge in the US is that each hospital, even non-profits, operates with a profit mindset. They’re often competitors, yet during disasters, they must cooperate. For instance, in major cities like New York or here in Florida, there are numerous healthcare entities competing daily. But when a disaster strikes, they must collaborate. Changing this attitude, especially about resource and information sharing, is essential. The state and federal levels must anticipate the resources needed for specific events, and stockpiles must be tailored to expected challenges — something we haven’t done well. When local disasters occur, distributing these assets swiftly is crucial.

Sonya Stokes  43:07

So, Ted, when I hear this, it sounds like there aren’t immediate solutions, and we should be focused on the long game. For this winter, it seems we might just have to brace ourselves while navigating through potential surges.

Ted Cowan  43:19

It certainly requires a higher level of cooperation than what’s currently in practice, frankly.

Sonya Stokes  43:27

Speaking of cooperation, it’s an appropriate time for us to turn to our colleagues up north in Canada. We’re joined by the highly experienced Industrial Hygienist Laurence Svirchev from the Canadian Aerosol Transmission Coalition. With a career spanning 40 years in occupational health and safety and an MA in Disaster and Emergency Management from Royal Roads University, Mr. Svirchev brings immense expertise. He dedicated a decade to occupational epidemiology at the BC Canada Cancer Agency and spent 15 years as an occupational hygienist, also conducting fatality investigations for WorkSafe BC. He served as a member of the Vancouver SAR Scientific Community Committee and remains active in the American Industrial Hygiene Association, where he chairs its International Affairs Committee. Furthermore, he is a co-founder of the Canadian Aerosol Transmission Coalition, which we’re eager to learn about today. Laurence, could you please share more about yourself and your work?

Laurence Svirchev  44:31

Thank you, Sonya and Ted, for the warm introductions. I’d like to begin by noting that throughout every field I’ve ventured into, I’ve collaborated with individuals possessing remarkable scientific knowledge and a deep empathy to alleviate human suffering. These experts have always been eager to disseminate their insights, not just using the specialized vocabularies of their fields, but also in plain language to ensure clarity for all. My foundational training is rooted in occupational health and safety. On the disease prevention front, our aim has consistently been to minimize exposures to biological, chemical, and radiation hazards to the lowest possible levels, including threats like the SARS-CoV-2 virus. The safety aspect of my work also entails ensuring workplace machinery, including ventilation systems, operates as intended. As you highlighted, I also have training in disaster management, approached not from a pure science perspective but as a social science. This involved traversing the aftermath of the Wenchuan earthquake in Sichuan, China, over five years, collaborating with geologists from the Chengdu University of Technology. It’s quite a juxtaposition — a student of disaster management working alongside geologists and engaging with survivors of a catastrophic event that claimed over 70,000 lives in 2008. Such experiences have indelibly marked me. Whether in Canada, Fiji, Niger, Africa, Indonesia, or working as a safety manager for a Chinese construction firm building hydroelectric dams, I’ve strived to offer tangible solutions to stave off diseases, injuries, and fatalities. While these solutions didn’t always hit the mark, many times they did. Today, I’d like to underscore the value of interdisciplinary collaboration, epitomized by today’s gathering and our diverse audience. Sonya, I believe you had some questions for me?

Sonya Stokes  47:32

I did, Laurence, and I appreciate you underscoring the interdisciplinary approach. In my ideal world, along with our vast experience at AIPAC, I’d incorporate library scientists and historians. It truly demands an all-encompassing approach to tackle the myriad challenges we confront today. I want to revisit a point Rannit made earlier about failures serving as crucial learning opportunities.

Given your extensive experience with multiple disasters, I’m curious about COVID-19. Were there early moments in the pandemic that, due to initial failures, hampered a robust global response? And in its aftermath, do you perceive our health systems as being better equipped or more vulnerable in tackling future disasters?

Laurence Svirchev  48:31

Thank you, Sonya. Danny, could you display the initial slides? I want to begin by outlining four pivotal early missteps: First, underestimating risk and failing to adequately inform the public. Second, infrastructure shortcomings. Third, overlooking China’s approach to safeguarding healthcare workers. And fourth, the varied political systems and structures of governance in different countries. 

Delving into the fourth point, in Canada, healthcare is primarily a provincial responsibility. The country consists of multiple provinces, each governed by its provincial authority, with the federal government allocating healthcare funding. Viruses, however, disregard provincial and international boundaries. SARS-CoV-2 spread globally at an unprecedented pace. Each province in Canada responded uniquely, even though a unified strategy could’ve been devised under the federal government’s emergency powers. Countries like China, given their governance model, were able to make centralized decisions. New Zealand adopted a similar approach. 

Shifting to my first point, on January 30th, 2020, the then director of the US CDC, Dr. Redford, expressed that the immediate risk to Americans was minimal. The same sentiment was echoed by Dr. Theresa Tam in Canada. Yet, on that very day, Dr. Tedros of the WHO declared a global public health emergency. The disparity in assessments is perplexing. Underestimating risks can severely hamper preparedness and response, leading to increased mortality, illness, and distress. The consequences of infrastructure failures were evident in Canada’s post-SARS response. 

Tasked by the WHO, Canada established the Global Public Health Intelligence Network to detect global threats. However, a report highlighted that the system became inactive months before the Wuhan outbreak. Furthermore, Canada’s National Emergency stockpile, intended to aid in crises, was largely discarded in 2019. This blunder only surfaced due to a whistleblower from a disposal company. 

Another infrastructure lapse was the discarding of essential medical equipment, which the government later justified citing expiration concerns. Reflecting on the Wuhan episode, China’s rapid mobilization of healthcare workers, equipped with high-level protective measures, was commendable. The workers faced minimal infections, albeit at a significant psychological cost due to witnessing mass fatalities. Regrettably, the WHO and other entities haven’t extensively shared China’s experiences. These encapsulate the initial oversights I wanted to highlight.

Sonya Stokes  57:04

Oh, Laurence, I’d like to delve deeper into what you mentioned regarding infrastructure. To discuss this further, let’s turn to our final panelist. As you highlighted, without the necessary infrastructure to aid our healthcare workers, healthcare delivery becomes challenging. Understanding our health service delivery network and the repercussions of COVID-19 is crucial. If we don’t comprehend the strain COVID-19 has put on the system, improving the present shortages remains a daunting task. Therefore, I’d like to introduce Randy Rowell, CEO of One Pass Access. Mr. Rowell has dedicated over 25 years to our healthcare delivery systems in the US. His extensive knowledge encompasses healthcare supply chain, federal CMS requirements, compliance and quality control, as well as business operational performance. Throughout his career, Randy has occupied various leadership roles both in patient care service delivery and vendor supply businesses. Randy, thank you for joining us today and enlightening us on the resilience of the healthcare system, especially in terms of infrastructure support.

Randy Rowell  58:21

Thank you, Sonya. I genuinely appreciate being part of this dialogue and having the chance to share my insights. Most of my expertise lies in the US healthcare systems, but I hope to address various components and shed light on topics like the COVID pandemic, health system readiness, and emergency preparedness. My firsthand experience with COVID-19 began in 2020. I recall attending a DMV healthcare Conference in February. Surprisingly, after only two days, the event was abruptly halted, and participants, who were mainly compliance and risk management officers from hospitals, were instructed to return to their institutions to focus on patient care due to the emerging pandemic threat. This experience underscored the severity of the situation.

Throughout my career, I’ve transitioned from being a clinical director to specializing in areas like quality, compliance, and supply chain. Over the past couple of years, I’ve been invited to various platforms to discuss supply chain operations amidst current challenges. One key topic I recently presented on was fostering collaborative strategies between health systems and their suppliers. It’s essential to understand that in the US, our health systems don’t produce products, nor do they typically maintain expansive storage facilities. Instead, they heavily depend on distributors, vendors, and suppliers to ensure product availability and quality.

On a personal note, I own a business, One Pass Access. We’ve developed a software platform that seamlessly connects health systems with vetted vendors and suppliers. Our primary goal is to prioritize compliance, risk management, patient safety, and location security whenever a clinical care provider requires a product or service. Our platform aims to consolidate and streamline the healthcare supply chain, which relies on various elements like distributors, manufacturers, logistics, and transportation.

We also face challenges beyond COVID-19, with new infectious diseases like monkeypoxmonkey pox emerging. This compels our CDC to provide guidelines on managing these new threats alongside COVID-19. The focus remains on ensuring the safety of our healthcare workers and patients by providing the necessary protective gear and implementing effective infection control measures.

I’d like to share an observation from the Healthcare Industry Distributors Association in the US, highlighting the global nature of the medical product supply chain. The interconnectedness means that supply chain disruptions in one country can ripple across the globe. To provide some perspective on distribution in the US: our vast territory has numerous distribution centers usually situated within a 50-mile radius of most urban hubs. Our distributor networks support a vast array of healthcare facilities. The intricate web of manufacturers, distributors, clinics, and more ensures that essential products reach patients and communities.

I’ll wrap up my presentation here and revert to the discussion. As a participant in this conference and through my collaboration with IBEC, I’m thrilled to see a comprehensive examination of topics like COVID, infectious disease control, and emergency preparedness. The global impact of the pandemic underscored the interdependence of countries when it comes to supply chain resilience and emergency readiness. This crisis affected the entire global community, making collective action and understanding more critical than ever. I’m here to answer any questions and contribute to the dialogue, hoping my insights enrich the discussion further.

Sonya Stokes  1:08:43

Thank you, Randy. I’d like to bring back all of our panelists to discuss the various points we’ve covered. One of the key areas Ron highlighted was the initial successes in comparing different countries. I’d like for us to reflect on where we currently stand. We’ve seen the onset of COVID-19. Where are we now? And what mistakes do we still observe in our response, not just to COVID-19 but to the various acute respiratory illnesses circulating globally? Ranit, since this was your brainchild, I’m granting you moderator’s privilege to lead this discussion.

Ranit Chatterjee  1:09:30

Thank you, Sonya. In my opinion, we’re still making a significant mistake by fixating on a single event or hazard. We need to consider potential complex situations that might arise in the future. We often only recognize the severity of a situation when we’re deeply entrenched in it. This is precisely what occurred with the COVID-19 pandemic. Precursors were there, yet we continued to focus primarily on managing COVID-19, overlooking other simultaneous events like Mmpox and various respiratory issues. Moreover, due to the overwhelming nature of the pandemic, we’ve inadvertently sidelined other pre-existing concerns, not just in the health sector. Areas like elderly healthcare systems, psychosocial support, and trauma care have taken a backseat. This neglect will have prolonged societal repercussions even after we move past COVID-19.

Sonya Stokes  1:11:31

We observe similar patterns here in the US. However, RIKA, from your perspective, are there countries that have made substantial improvements? Is there a nation that stands out as having successfully navigated these challenges?

Ranit Chatterjee  1:11:53

Indeed, I’ve noticed Japan making strides. Their ‘Three C’ policy for managing COVID-19, which emphasizes avoiding closed spaces, crowded places, and close-contact settings, is commendable. The simplicity of this concept allows for easy community comprehension and adherence. Meanwhile, India presents a contrasting example. Given its vast population, handling a pandemic in India is inherently different from Japan. Nevertheless, India has showcased an impressive approach by actively engaging with NGOs, local actors, and other community-based organizations to reach its citizens.

Sonya Stokes  1:13:12

That’s a compelling example. I’d like to direct the same question to Ted and Randy, focusing on the US and Canada. From your experiences over the past nearly three years, can you highlight a significant improvement you’ve witnessed?

Ted Cowan  1:13:34

Randy, would you like to begin, or should I?

Randy Rowell  1:13:37

I’ll start. Reflecting on the US healthcare supply chain, we’ve made considerable progress in understanding what to avoid and learning what actions are effective. Enhanced communication and collaboration between organizations have bolstered our supply chain operations. While we recognize that the journey through COVID-19 isn’t over, and it may be another two to five years before we find some semblance of normalcy, there’s a clear realization that there’s no reverting to our old ways. This is our new reality. We’re aiming to prepare for future challenges and adapt to this new environment. It’s a long-term endeavor, and while there isn’t a quick fix, I perceive steady improvement. In my view, we’re becoming more resilient with each passing week.

Ted Cowan  1:15:04

Based on my observations, both at the state and federal levels, I believe many didn’t anticipate that we’d be addressing this three years in. The Biden administration recently extended the disaster declaration until at least April 11, 2023. The states I’ve engaged with have demonstrated adaptability over time. They’ve honed policies, bolstered local communities with testing resources, vaccinations, and more. This proactive attitude is heartening. Reflecting on Ranit’s comments about Japan, it’s fascinating to see how deeply rooted cultural perspectives influence a nation’s pandemic response. Having lived in Japan, I appreciate the societal emphasis on community welfare. Even in the 90s, if someone had a cold, they’d wear a mask out of respect for others. It’s intriguing to contrast this with the US, where some perceive mask-wearing as an infringement on personal freedoms, occasionally ignoring the scientific rationale behind such measures. Furthermore, the importance of enhancing air filtration systems to curtail disease spread wasn’t universally recognized at the federal level. I’ll pause here, but there’s so much more to discuss.

Sonya Stokes  1:17:41

One thing I believe we should emphasize is the substantial support from the White House for IQ. I’m hopeful we can continue to promote this. However, I’d also like to revisit a point Laurence made. While we discuss factors that pave the way for success, do you also consider the opposite idea – that of “disaster by design”?

Laurence Svirchev  1:18:28

Thank you. Honestly, I hadn’t considered this pandemic as a disaster until Dr. Chatterjee labeled it so, which is intriguing. It’s a fresh perspective. Typically, disasters are seen as immediate events like earthquakes with a set recovery period. This pandemic differs – it’s a sustained disaster. It occurred because we didn’t properly design responses for something we knew was inevitable. We all expected another pandemic, another SARS outbreak. An American sociologist, Dennis Miletti, who sadly passed during the pandemic, authored a book on natural disasters titled “Disaster by Design.” He posited that if we’re aware of impending events, we should design effective responses and refine our strategies over time. For example, if you reside in a floodplain, you can expect floods. “Disaster by design” doesn’t suggest someone intentionally designed a disaster; rather, it underscores inadequate planning. To address this, institutional memory is pivotal, and unfortunately, we lacked it. Moreover, while “aerosol transmission” is widely discussed and even recognized by the World Health Organization, their Chief Science Officer, who recently resigned, conceded in a “Science Today” interview that they needed more specialists for this issue. I’ve examined their scientific references and significant contributors like Dr. Donald Milton and Dr. Jimenez aren’t even mentioned. So, how do we rectify this? In Canada, we have the Canadian Aerosol Transmission Coalition. We’ve convened for two years, bringing together engineers, occupational health experts, lawyers, and others. We consistently disseminate scientific findings, promoting what I’d term “citizen science.” Our efforts with CATC exemplify this.

Sonya Stokes  1:22:24

Laurence, your insights have been illuminating. To conclude, I’d like all our panelists to think of two design solutions. Given a magic wand, what immediate changes would you implement to enhance our health system’s resilience, now and in the future? Ted, you can start.

Ted Cowan  1:22:51

Firstly, understanding that these ventures come with significant costs, it’s imperative that federal and state governments invest in infrastructure to upgrade the built environment. This isn’t feasible solely at the local level since hospitals often lack the necessary funding. This includes everything from HVAC systems to air handling cycles. Secondly, while the healthcare industry endeavors to provide hygienic, safe spaces for clinical care, COVID-19 highlighted the importance of ancillary areas like waiting rooms. The break areas for our hardworking clinicians also require attention. It’s unacceptable for professionals to work long hours without access to safe break spaces. Those would be my primary recommendations.

Sonya Stokes  1:24:32

I highly support this last aspect. Having just come off a night shift, I can attest that it is definitely needed right now. Randy, I’m turning to you for solutions. If you were a designer, what would you change right now?

Randy Rowell  1:24:48

There are two points I’d like to make, but I do agree with the forward-thinking approach. We must improve communication, especially in a health setting, between various associations and our government. My next step would involve bringing in frontline clinicians, like you, to focus on dynamics like infectious disease control, patient-centered care, and the integration with supply chain business operations. We need much better communication in these areas. Secondly, I think we need to reexamine health systems in the US. I emphasize the importance of the built space. What are we doing with HVAC systems? How can we change our thought process to provide a safer environment for workers, patients, and staff? It’s about looking beyond just HVAC and considering the entire environment by design. I hope that provides some clarity.

Sonya Stokes  1:26:17

It’s extremely insightful. Thank you, Randy. Ranit, as our architect, what are the two design solutions you would suggest?

Ranit Chatterjee  1:26:28

Interestingly, I’d approach this not primarily as an architect but more as a contributing researcher to society. Firstly, many references have been made to the Spanish flu from 100 years ago. Our current understanding is based on scant data from that period. I believe we should diligently record our current experiences, providing future generations with a well-documented account for their preparation. Secondly, risk assessment is crucial. It’s not just about the present but understanding the implications of our past actions. For example, while the Spanish flu might have spread slower due to limited mobility back then, our interconnected world today allowed the recent pandemic to spread rapidly. As we enhance infrastructure resilience, we must identify potential pitfalls and address the risks emerging from our advancements. Those are my two main points.

Sonya Stokes  1:28:42

Ranit, I want to emphasize your point on shared experiences. What I’ve realized over nearly three years is the significance of sharing knowledge. I thank all the panelists here today for doing just that. Your insights have been crucial for us in the healthcare sector. I’d like to specifically thank Ginny Morrow and Ken Martinez. During my time on the frontlines in New York City’s emergency departments, your guidance, along with the entire IBEC community, has been essential. From information on indoor air quality and ventilation to understanding the role of respirators, you’ve played a pivotal role in keeping us safe. I extend my gratitude to everyone in the IBEC network for your unwavering commitment to protecting healthcare workers. This session will be available for the next 48 hours, free of charge on our website. IBEC members will have continuous free access to all learning resources and publications. We’ll soon post details on membership registration. I urge healthcare workers to consider joining. IBEC’s resources have been invaluable for me and my peers. I appreciate everyone’s presence today, and a special thank you to the panelists.