TBU: True But Useless- Avoid at All Cost When in Decision Making Mode

The COVID-19 response requires collaborative meetings and fast decision making.  

Over the last several months I have participated (both internal and external to my institution) in multiple meetings and have witnessed a broad spectrum of managerial styles and results.

As is well known, an effective meeting requires an agenda, clear actions items, a mediator to effectively guide the discussion and an underlying respect for staying on time.

A major threat to effective decision making is TBU (True But Useless) information, as coined by the brothers Chip and Dan Heath in the book Switch. TBU is a saboteur of efficiency and clarity as it clutters both focus and facts that lead to a decision.

 

Minimizing TBU in meetings requires a disciplined and aware mediator who both politely and consistently redirects the discussion back towards immediate relevance. The rest is noise.

Avoid TBU.

Equipoise: Word of the Day

Equipoise, a balances of forces or interests, is the word of the day.

The need for equipoise in our response to COVID-19 (with a Reminder to Reason) is cogently explored in this New England Journal of Medicine perspective.

In our rush to 'do something'-  we act on anecdotal evidence, not considering the clinical biases of anchoring and availability.  Treatments may be hastily prescribed absent quality supporting evidence.

What is needed is balance: to act swiftly yet with caution and reason.

NPR All Things Considered: Masks 101

Masks 101, by way of NPR All Things Considered. My brief radio interview is available here.

Open the Universities Up this Fall? This Could Get Tricky

Source: Al Jazeera

My employer, Virginia Commonwealth University, is exploring all options for returning students to campus in Fall 2020. This issue is not unique.

An essay on re-opening universities, with a recipe for how to do it,  was published today in the New York Times (available here). 

I have no issues with the points raised which include COVID-19  testing,  contact tracing, social distancing strategies etc.

One element was conspicuously absent in the essay: student health services. These campus, ambulatory clinics are neither prepared, staffed nor integrated with local health systems to provide a coordinated public health response to COVID-19 across a student body, particularly in large state universities. The role of student health, public health departments and local health systems must be clear when thousands of students return to campus.

This could get tricky.

COVID-19 y El Personal De La Salud: Sociedad Argentina de Infectología (SADI) Webinar

Para quien puede interesar, el webinar sobre COVID-19 y el personal de la salud. 

Fue un honor compartir el programa con mis colegas argentinos.

Para el video en You Tube, haga clic aqui.

Collateral Damage: Effect of the Pandemic on Patients Without COVID-19

Without doubt, the current pandemic is impacting patients without COVID-19 by way of cancelled appointments, delayed elective procedures and less aggressive care for hospitalized cases. Some patients may simply avoid urgent hospital care out of fear of contagion.

Uncertainty is getting the worst of some of us. Typically, healthcare providers make decisions based on risk to the patient. Now medical decisions are commonly made on perceived risk to the provider. This is the equivalence of a world turned upside down in medicine. We have seen this before at the onset of the HIV/AIDS epidemic.

For a thoughtful perspective on the collateral damage of the pandemic on patients without COVID-19, I refer you to this article recently published in the NEJM.

We will soon enter a time of living with COVID-19, one where we will need to become comfortable in providing the standard of care for all patients, with or without COVID-19.

VCU Convalescent Plasma Protocol for COVID 19 Treatment

Click here for the WRIC Channel 8, Richmond, VA, news story on the use of convalescent plasma for COVID-19 treatment.

Thank you to all of my colleagues, especially to Dr. Jeff Donowitz, for operationalizing this compassionate use protocol for us and our patients.

 And, of course, we are looking for convalescent donors.

DIY Facemask for COVID-19: Good Housekeeping Magazine

It is not often that I am interviewed for Good Housekeeping magazine. Not my typical audience. The article is available here. 

Regardless, the Good Housekeeping video above, on the why and how of DYI face masks is well done.

VCU News: Central Virginia, We Are Seeking Convalescent COVID-19 Plasma Donors

Source: VCU News

VCU Medical Center is seeking COVID-19 convalescent plasma donations.

Read more about it here in VCU News.

Why is there so much variation in the severity of COVID-19 infections? No One Really Knows (Yet)

The physiologic response to COVID-19 infection varies. 

This may be secondary to viral virulence factors. More likely, variation reflects our differing (genetic) immune responses to viral antigens (cytokine storms) and heightened susceptibility from underlying chronic conditions (diabetes mellitus, respiratory conditions and advanced age).

Here is my soundbite for Radio IQ NPR, Richmond, VA. Another soundbite on the topic is available via this link.

Published! Impact of COVID-19 on Traditional Healthcare Associated Infection Prevention Efforts

Our perspective on the potential impact of COVID-19 on healthcare associated infection prevention efforts is now published free and open access in Infection Control and Hospital Epidemiology.

The manuscript is available here.

New Dark Age: Technology and the End of the Future

In this dark time of COVID 19 I plowed through a gripping book, New Dark Age by James Bridle.

The author elegantly explores a modern day paradox: despite greater accessibility of information, we are becoming less informed, lost in a sea of data and divided by fundamentalism, simplistic narratives, manipulative social media algorithms, conspiracy theories, and post-factual politics. For those in power, this popular lack of understanding serves to further their own interests. A new dark age is upon us.

For my next read, I plan on something more uplifting...

What Happens After The Peak? Normalcy is not Just Around The Corner

What happens after the peak? 

Normalcy is not just around the corner, or so I try to state in this CBS 6 Interview, available here.

We are in this for the long haul.

Armchair Epidemiology! An Epidemic, Please Stop the Madness

Source: Slate.com

All my infectious diseases and epidemiology colleagues in the trenches know what I am referring to here!

Please, let's stop the epidemic of armchair epidemiology, as clearly explored here in Slate magazine.

Trust the experts, especially in the face of pandemics. When in doubt, seek proper advice from a qualified professional.

Interminable Meetings Found Ineffective for Treatment of COVID-19

Spoof NEJM Article: Interminable Meetings Found Ineffective for Treatment of COVID-19

There is some truth in satire. Interminable meetings can get in the way of action and results, as suggested in this clever spoof. The authors? Not sure.

However, I generally favor the Get Out of My Way and Letting Me Do My Job approach to things. The goal is to find the sweet spot between planning and productivity.

Enjoy.

VCU COVID 19 Video Chat: Keeping You and Your Family Safe at this Time

For those at VCU who may be interested in this topic, please see the above COVID 19 video update.

VCU Virus Doc? Not Really, But I Try to Provide Some Common Sense Recommendations...

Well, I am not typically referred to as a 'virus doc,' particularly as I am not a virologist, regardless, in the interview referenced above,  I try to answer some common questions and provide some reasonable recommendations to viewers of CBS 6, Richmond, Virginia.