Neil Milner: Another example of the state health department’s mishandling of the pandemic

Opinion post badge“All you have to do is flash.”

This is part of the headline from an upbeat New York Times article that New York City’s Covid-19 wastewater monitoring system is now fully operational.

Hawaii has not implemented this wastewater program despite failing to meet Department of Health promises and deadlines. After many delays, what was supposed to happen this summer has been postponed indefinitely, according to the DOH.

The tagline here is “just wait”.

And wait and wait. Plus, the plumber won’t tell you when to show up. I don’t even have a phone.

Hmm, that’s exactly right.

Howing and humming is enough. The Covid wastewater situation is the latest example of the State Department of Health’s flawed response to the pandemic, where DOH appears to operate frequently.

In a normal bureaucratic day, missing a deadline would be disappointing. Dangerous in a pandemic.

DOH needs to be in crisis mode, not normal mode, when it comes to Covid.

Instead, the DOH’s response to surveillance looks like business as usual.This needs to change, not just because of the pandemic, but to deal with future crises.

DOH should do what the federal Centers for Disease Control and Prevention are planning. That means developing much better ways to acknowledge and respond to failure.

DOH should be pivoted.

“Pivot” is a term CDC Director Rochelle Walensky recently used to describe the need for a complete reorganization of her agency.

The CDC has come under a lot of criticism for how it handles Covid. Public health experts say the authorities’ Covid efforts have been a failed response that has led to a fundamental loss of trust.

Too late, too confused, and, as science communication experts put it, “a culture that is simply arrogant and overestimated its ability to get it right”.

All the same applies to DOH.

Warrenski, director of the CDC, is calling for a fundamental overhaul. It was a “watershed moment,” she said.

A view of Waikiki Beach, home to the Royal Hawaiian Hotel, during the recent spike in Covid-19 cases. August 22, 2021
The pandemic has exposed the Ministry of Health’s normal way of doing business. Corey Lam/Civil Beat/2021

CDC needs to refocus public health needs, respond quickly to emergencies and disease outbreaks, and provide information in a way that the public, state, and local health officials can understand and use. she said.

That’s also exactly what the DOH needs to do.

Easier said than done? I am not joking. But you can’t do it unless you say it first. And if you think that the normal way of doing things is always the best way, and if things don’t turn out the way they’re supposed to, we’re doing our best, then you don’t say it… you can under the circumstances.

So here are the fixes and adjustments DOH needs to make. This is not a blueprint for change. A preliminary blueprint for enabling change.

DOH has to stop thinking about things in the usual business and best way. Yes, this agency deserves some sympathy for how wastewater monitoring was done. Lack of equipment, difficult to adjust, etc. This institution was a small part of the public health system of a completely broken country.

understood. But there’s an irritating, kind of lazy, bearish tone within the DOH. Alright, let’s get another one of those. Things are more complicated. The public needs patience.

This sounds too much like the “can’t” stance DOH often takes in other areas. “No staff.” “It’s more complicated than we thought.”

True or not, that stance comes at a price.

Failure goes from being a problem to being the natural order of things.

DOH’s Day Greetings: What’s Not Happening?

This is infuriating because crisis response is not about being patient or accepting the status quo. A crisis requires impatience, workarounds, and a refusal to accept things as they are. It requires being nimble and clear to the masses.

That’s the difference between the fire department dealing with unexplained, rapidly spreading fires and the motor vehicle department checking license applications on an average Thursday afternoon in August.

We citizens should not be misled by generic terms that allow bureaucracies like the DOH to get out of jail free.

Two of these appear in media accounts of the department’s wastewater projects. “calm” and “work in progress”.

‘Calm down’ gives the impression that we are almost there. A better way to think about it is that being ready is an indicator that we are not there yet, even though we should be and may never be. It means that there is

Are you working? This is a term used to hide the fact that work is not actually progressing.

It’s not about saving Ocole, it’s about moving Ocole.

These terms are better viewed as biases rather than reassurances. In fact, it would be better if the media stopped using them.

Language is important. No one knows if the CDC reforms will succeed, but when we talk about watersheds and reorientation, we know that change is starting at least on the right foot.

DOH needs to think more in terms of pivots, thinking less about balance and more about watersheds and less about narratives that divert responsibility.

It’s not about saving Ocole, it’s about moving Ocole.

Take a look at the New York Times article on wastewater. Very cool pictures and interactive of scientists working both in the lab and in the sewers.

Although it puts science at the forefront, the text and photos make it clear that this effort is about organizational adaptation.

The science is hard, but in practice, the tissue changes required to go from fecal samples to reliable, average-person-friendly numbers are even harder.

At this time, there is no reason to believe that the DOH is capable of this type of organizational coordination. Because it’s not how we think about government agencies themselves, it’s not how the public thinks about government agencies.

It’s time for DOH to prove themselves wrong, not just themselves.

The first time I heard Gov. David Ige say, “Change is hard,” I laughed. Another rhetorical dud from a clever man who isn’t exactly a wordsmith.

But he’s right. Recognizing his simple reminders is part of the equation along with his two other parts. Change is necessary, and if we do not achieve it, we have failed our mission.

Good luck to the CDC. And be both encouraging and tough when it comes to DOH.

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