I have been staying at home for the past week or so since I returned from India . All my global team is working from home too and we are all getting used to the idea of 100% work from home as the new normal . Earlier today, I heard from my mom about the 21 day shut down in India to combat the pandemic . And my cousin in Britain is dealing with their shut down . It’s all a bit overwhelming to say the least .
It has also made me think hard on what’s next for us . As always – these are strictly my personal thoughts and opinions .
Grief offers a fresh perspective
I recently lost my dad . He was in critical care for nearly two weeks before he passed away and I saw a different part of life that I hadn’t experienced before .
The first is that money cannot always buy good outcomes in health . Just to see patients on ventilators was a shock and it still gives me nightmares . No amount of money and top notch care could save my dad . Helplessness need to be felt first hand to realize how bad it can be.
The second is that lack of money almost always leads to bad health outcomes . Every day at the hospital I saw families struggle to pay bills . I helped a few folks where I could – paying a little money , buying coffees and lunches and paying for cab rides etc . And the reactions ranged from gratitude to indifference to rejection . I didn’t take any offense , nor did I feel any happiness – it’s a strange sense of camaraderie that prevails amongst families of patients admitted in a hospital , especially in critical care . Words can’t describe it . Every day – often multiple times – I saw families dealing with death of their loved ones .
In some strange way – I feel blessed about the timing of dad passing away . At least I was able to go to INDIA as soon as he was admitted to the hospital and stay with him throughout and then stay with my mom a little bit to get her settled down a bit before coming back to US . If it had happened today – I am not sure I could have lived with myself . And yet – that is exactly what must be happening all around the world with folks with elderly and/or high health risk parents .
Hunger trumps health and social responsibility
The shut down in India seems like a much needed step to contain the pandemic – and kudos to the leaders who decided and acted quickly . But how practical is such a shut down ? I was born and raised there and I just spent some time there till last week . Significant part of the population earns their wages daily and without that they can’t afford their food . When the country is shut down – how will they eat ? I hope the government – and the society at large – steps up big time to help the most vulnerable citizens and do it quickly . Even for middle class people who can afford to stock up – I don’t know anyone in India with large enough fridges and freezers to stock up for several weeks at a time . And coupled with the population density in cities like Mumbai – I am seriously questioning how this shut down will sustain three weeks – or god forbid, longer .
It’s no different in US and UK . Not everyone can afford to stock up . And even if people and government can figure out food and shelter – mental health could be another large scale challenge . It will be almost like most of humanity being put in an open jail .
It’s a tight rope walk – but the North Star is clear
Governments all over the world have an unenviable job at hand – balancing between loss of life here and now and the long term negative effects on the economy . A binary view is clearly a terrible choice and I hope no government takes a benevolent equivalent of the “final solution” as their strategy . If we need a binary choice – I fully believe the only right answer is to save lives .
We need a fine grained approach
But that’s what made me start thinking about whether there are targeted approaches possible . A lot of analysis of the pandemic is based on age as the primary risk dimension . I am starting to think that age is too coarse grained for a targeted approach . We now have data about people who lost lives all around the world – and at least those who died in hospitals should have more than age as available data . Can we further narrow down by specific things like gender, blood pressure, COPD, A1C etc ? The better we narrow down – the more our ability to isolate fewer people and have a more realistic estimate of what’s the net impact .
Social distancing, washing hands etc are excellent steps and I am glad that most people are doing the right thing finally . But just like age being a coarse grained dimension – isn’t geography a coarse grained dimension too now ? I am not a pandemic expert and will gladly stand corrected if someone can show me the fallacy in my thinking . Can we zone into high, medium and low risk amongst geographies too ? Manhattan, NY is high risk and lockdown seems to be the right solution and everyone should stay home . But should Chandler, AZ be treated the same , or can some low risk segments of people go to work there ?
Test, test , test
Lack of testing – quantity especially but also quality – is a HUGE problem throughout US and INDIA and probably other countries too except maybe China and Korea . I am still livid that when I returned from India last Monday, there was not even a temperature test for passengers in TRV, DOH, DFW or PHX . Till it’s reasonably fixed I guess segmenting people is not a realistic safe strategy to pursue . Segmenting is a two phased problem – especially for assigning risk to a geographic segment. You need to know when to put people into a segment , but also a set of specific conditions that will get them out of that segment . Otherwise the purpose is kind of defeated .
We need to think holistically
It’s great to see the ventilator shortage situation being addressed with urgency . Better late than never . This is the time for us to be on our innovative best . I also hope that whatever else needs to go with ventilators – all the other ICU apparatus needed (as well as meds for people who cannot be intubated ) are being addressed in parallel . Two weeks of watching people in critical care on a full time basis and talking to doctors three times every day has now given me more information than I ever needed on this topic – and to put it mildly I think we are vastly under estimating the holistic nature of the problem .
We need a better strategy for effectively using medical professionals
Talking about doctors – it is great that retired medical pros are being requested to come back to work all over the place . I also read that many of the older folks who came back to work died in Italy . Doctors and nurses are probably the hardest part of this fight back equation and we need to think about a long term plan to use them . Maybe one way is to tier their use – let the retired folks at higher health risk take over telemedicine channels , and form a reserve capacity when front line active personnel eventually need to take breaks . Perhaps medical students and nurses can take over some of the upfront triages (perhaps some tech can help ? ) . And active duty pros can just focus on high risk patients needing immediate attention .
Fatigue is a real big issue for these amazing frontline healthcare workers . My heart breaks when I see the pictures everyday of thoroughly exhausted people who are going above and beyond . Given all of any country is not suffering at the same levels – can we send more help to the hot spots to take care of the issues there and contain it ? I don’t know if there are legal issues with licensing etc – but hopefully those are all addressable by governors and other government bodies quickly . We have to tackle this issue without letting geographic boundaries being a problem . Sharing pharma research globally , sharing data on patients , increasing production of test kits and medical equipment all need extreme co-operation. Nationalism needs to take a back seat .
We won’t fix the economy with just more money
When governments talk about the economy – we need to interpret it in two ways . What are they doing for companies (not just big ones – but the small ones too) and what are they doing for people .
Like everyone else, I find no joy in watching my 401(k) lose a good chunk of its value these last few weeks . I even joked on twitter that now it should be called 101(k) . I am blessed to be employed and with the flexibility to work from home and not having to worry about putting food on the table for my family . I also know that even paid sick leave which people like me take for granted is not common for a lot of people . It is also high time we divorced health insurance from employment in this country . If there is a positive side to this terrible crisis – it might be that now is a great time for our elected reps to do the right thing for the citizens for once .
Similarly when we talk about helping companies stay alive – we need to make sure it comes with guard rails on exec comp , stock buy backs etc . Hopefully we remember the lessons from 2008 meltdown and bailouts . Companies also need to be held to a higher standard when it comes to taking care of their employees .
Perhaps it’s time to fundamentally redesign and recalibrate the world’s capital markets
Capital markets have been wild, to say the least . At near zero interest rates, market strangely still craves even lower interest rates . Companies that have extremely healthy balance sheets and free cash flow and rock solid business models get punished irrationally in public markets without any specific fundamental reason to attribute, and so on .
I think it’s a good time now for the important people in the global financial markets to come together and rebaseline how companies are valued all over again . If that needs the markets to stay closed for a bit or for circuit breakers to be RE-calibrated or whatever, then so be it . Capital markets are divorced from the reality on Main Street now . The dog and it’s tail have reversed who wags who – and it needs to be fixed . Let’s try to fix that imbalance as well while we are at it rather than resort singularly to throwing more money into a system that no longer seems to be capable of reflecting reality.
This is perhaps the longest blog post I have ever written . A lot of thoughts are swirling around my mind – but it’s probably best that I leave those for a future post . Stay safe everyone !
(Cross-posted @ Vijay's thoughts on all things big and small)