Kyle King: [00:00:00] When a complex crisis strikes, leadership is tested. Decisions must be made in seconds. And the right call can mean the difference between disaster and resilience. So are you really ready for the moment when everything is on the line? Welcome to Season 4 of the Crisis Lab Podcast, the show where we break down the toughest challenges in crisis management, emergency response, and risk leadership.
Kyle King: And with every episode, we go beyond the headlines, dissecting real world complex crisis with those who were on the front lines. That includes leaders, decision makers, and experts who've navigated unprecedented challenges and lived to tell the story. This season, we're pushing the boundaries. From cybersecurity threats that can cripple entire nations, to high stakes disaster response, and the unseen risks lurking in global supply chains.
Kyle King: Season 4 is all about new frontiers of complex crisis leadership. We're bringing you The exclusive interviews with top emergency planners, intelligence insiders, and world class strategists who will reveal what it really takes to prepare for, respond to, [00:01:00] and recover from a complex crisis. But that's not all.
Kyle King: This season we're introducing something new. Short form episodes packed with insights, perspectives, and commentary on the most pressing issues facing our communities today. These episodes will complement our deep dive interviews, giving you timely analysis and actionable takeaways in a fast paced format.
Kyle King: So if you lead, manage risk, or simply want to understand how the world stays standing when everything falls apart, then this season is for you. So hit subscribe, follow us on your favorite podcast platform, and join us as we pull back the curtain on the world of complex crisis leadership. Because in a crisis, knowledge isn't just power, it's survival
Jim Wilson: hey there, I'm Jim Wilson. I am a health security professional and I specialize very narrowly in the domain of providing warning for high threat or high risk health security crises involving infectious disease and understanding how we can put that information of productive [00:02:00] use for Emergency response to protect our critical infrastructure.
Jim Wilson: I'm also a pediatrician, so I also have a lot of perspective managing patients in the clinical setting as well.
Sharon Parrillo: Hi, uh, Sharon Parrillo. I have spent the past 20 years working in infection prevention and uh, the past 15 years in infection prevention leadership. Board certified in infection prevention and control and also a certified professional in patient safety.
Kyle King: Okay, great.
Kyle King: Well, Thanks for joining us today. So we're going to unpack this topic of, infection control and prediction and analytics and everything that goes along with that. Because both of you have just completed a course with crisis lab. And so we wanted to take the opportunity to bring you on board to the podcast and just, give everybody more generally about awareness about this topic.
Kyle King: And some of the trends and things that you're seeing from your perspective. And so I'll just start off with a really quick question. Maybe Frank, maybe not, I guess we'll see, but you and your team [00:03:00] have been at the forefront of anticipating infectious disease threats and have warned about the threat of COVID.
Kyle King: As early as December 2019. So can you walk us through sort of the specific signals that alerted you to this pandemic? And what lessons on, can professionals in health security take away in terms of early warning?
Jim Wilson: So we talked about this in Module 3. We have a subset of critical indicators that we use to tip off analysts to take a closer look at a signal.
Jim Wilson: These critical indicators are considered pathognomonic for a virgin soil transmission event involving a novel pathogen. Okay, and these are indicators, right? So there's nothing certain about this process. It's more of a These are indicators that we have seen in the past, right? So we maintain a rather large library of health security crises going back to the 1600s, where we understand how humans communicate non routine or unusual outbreaks and epidemics.
Jim Wilson: And this [00:04:00] library includes You know everything from influenza pandemics, to Ebola, to Nipah, to SARS to plague. There are some examples where there was a verified lab accident involved. There are some examples where there were strong allegations of a biologic weapon deployment or bioterrorism.
Jim Wilson: And to us, again, it doesn't really matter. What the attribution was we're trying to understand how to humans communicate that they're seeing something that they're not used to seeing that is unfamiliar to them. So it's very sociological informed process. As far as China's concerned, we've been monitoring China for years and years and years.
Jim Wilson: There is a false alarm rate with this process. That's important to keep in mind, and that recently burned a few folks over the Democratic Republic of the Congo, where we had a report of mystery disease, also a noisy place to monitor. And we need to keep in mind that when you're watching the world there are, there's false alarms all the time, [00:05:00] and we need to be careful about that, and that goes back to some of our questions about how do you get it right?
Jim Wilson: How do you be, instead of the first to report, how do you be the first to be right? And that, that really speaks to. The misinformation cycles, the sensationalism, the hype in health security that I think is very counterproductive to building trust, right? This all feeds into that, right?
Jim Wilson: Is you've got to be grounded in an understanding of the history of warning signals. To understand and be prepared for recognizing critical indicators that, enable us to prioritize out of the thousands of outbreaks being reported throughout the world, this is the one thing that we've really got to focus in on and get outbreak verification for the quickest.
Jim Wilson: China, for us, remains the leading place in the world that we worry about, and that has nothing to do so much with their regime or their politics, it has to do with how humans interact with their environment. It is a high risk [00:06:00] area. Due to the exploitation of wildlife from the wet markets and it has long, for many, many decades, been a place where we see high threat disease emerge.
Jim Wilson: This is why we pay attention very closely to China. And even if we see a similar reporting pattern coming out of China show up in another country, there are differences in how we pay attention to those signals, just simply because of the location.
Kyle King: Yeah, very much so. and so when we're talking about this topic then so, what lessons professionals in the health security space can take away from this in terms of early warning. And you mentioned sort of like don't necessarily rush. There's a noisy environment.
Kyle King: We do need to be. First to be right. And so, but how do you decide, how do you decide when a public health warning is actually necessary in this rapidly changing information environment? And so how do you balance transparency with the risk of causing public alarm? Because that's also the other factor, right?
Kyle King: Within what you mentioned, which is okay. Sensationalism, [00:07:00] right? The first to publish, the first to get the click, so to speak.
Jim Wilson: Yeah, it's super tricky, right? Because we need trust. And I think the sensationalism and hype erodes trust. I feel very strongly about that. And it actually hurts the communities who are directly involved in whatever it is that's being reported, right?
Jim Wilson: It can be very counterproductive to a response. So really this is a difficult question. If we get it right, we're praised, and if we get it wrong, we're criticized, and we don't have consensus regarding when people want to be warned, and it totally varies depending on who you talk to and what part of the infrastructure they, live in.
Jim Wilson: Today's world, we favor early warning because of the issues we discussed before about how interconnected our world is. The tremendous complexity of our air traffic grid ensures that a human being can travel anywhere within 24 hours. But we still need to come back to basics.
Jim Wilson: We need to emphasize what we know, what we don't know, and what we're worried [00:08:00] about in terms of uncertainty, and hopefully that communication is occurring with people that you have a trust relationship with, that was the central lesson we learned during COVID was we had the. Absolute privilege of working with responders that we had a trust relationship with before that crisis began.
Jim Wilson: We have a strong moral and ethical duty to contribute to the international framework of warning, which includes notification international organizations, such as the World Health Organization. And we did participate in that process during COVID. I think the audience needs to. Remind themselves the process of outbreak verification is actually the hardest step.
Jim Wilson: It's very complex and it requires a lot of cooperation in the international community and there's a lot of time delays often associated with that process to do it right, to get it right. And it highlights, again, this importance of trust and trust in the process, trust in the tools we use to verify the [00:09:00] diagnostics that are employed in these investigations.
Jim Wilson: Our decision to provide warning communication at the end of the day is based on years of experience examining these signal patterns. Associated with these types of crises and understanding the geographic and cultural context within which they're reported.
Kyle King: that's interesting when we talk about from an international perspective. I mean, You've often emphasized the need for this type of credible and accountable sort of health security and intelligence. So how do misinformation or biased data impact critical health responses and what steps, do we need to take to maintain objectivity under pressure to, to have this trust that you're talking about, to be able to build upon that without causing false alarms?
Jim Wilson: Yeah, it comes down to experience. It comes down to spending years and years and years studying the history of these signal patterns, understanding how humans communicate these patterns of disease activity, and [00:10:00] understanding how humans behave in parallel.
Jim Wilson: So we, for instance, back in 1918, we saw elements of misinformation back then. We saw the rise of the armchair expert. We saw the rise of sham curers, right? We saw a lot of the same patterns in human behavior and human response to. Stress caused by these very frightening and brought within certain element type crises, right?
Jim Wilson: There's a psychological impact pattern that we see over and over again with these crises that is anticipatable. There are various analytic processes that can be employed to combat bias such as the analysis of competing hypotheses. And those are interesting tools. But I have found over the years that, nothing beats experience, and really understanding how this these patterns play out in the case of COVID, we found ourselves dealing with tremendous noise from social media produced by [00:11:00] individuals in academia and news media proposing hypotheses of outcomes.
Jim Wilson: Well, a lot of folks were worried about state actors manipulating the information, creating disinformation. We found it a lot more difficult to deal with misinformation produced by our own citizens, news media, and academia. And that's an old pattern, right? This is nothing new, and it's not unique to health security.
Jim Wilson: If you go and look at the Research in the disaster sociology community, they've long reported this issue. There is a powerful driver to communicate worst case scenarios and ignore scenarios. associated with lesser impact. That's a prevalent issue in health security. And that's problematic when we're trying to build trust.
Jim Wilson: We found this recently with the Democratic Republic of the Congo reporting an outbreak of malaria, which is a common, routine disease, that sadly does cause a lot of mortality in that country. However our [00:12:00] colleagues branded it a disease X. And this was prevalent all over the media, all over the international media, quoting health security experts claiming disease X before we had arrived at a conclusion to the outbreak investigative process.
Jim Wilson: Before even the first teams had arrived to even process the samples. We even saw one claim of a biological weapon or an engineered pathogen. And to us that is completely irresponsible to, to talk like that. Before we have arrived at a conclusion for the outbreak investigation. And again, if we want people to trust us and to invest in the health security enterprise, this is not a good way to do it, in our opinion.
Jim Wilson: In terms of accountability in our specific domain, we think it's critically important to hold regular warning failure assessments. These assessments need to be transparent and apolitical. We had hoped for a non partisan COVID commission to review the process of warning and emergency [00:13:00] response, but that just didn't happen.
Jim Wilson: It doesn't appear to be a priority right now for our society, and that's most unfortunate for the future.
Kyle King: When you're explaining all that, Jim, it sort of reminds me, I mean, we have a similar conversation in like the emergency and crisis management community, and it's the more that we introduce technology, you can't escape the fact that you have to communicate with people, and you have to talk to people, and you have to leave the office, and you have to go out and actually Try and build relationships and things like that.
Kyle King: And so communication is often really cited as the backbone of successful in infection prevention. So what strategies or systems do you think, or either of you, think that work best for ensuring hospitals, public health agencies, or, and even the staff remain in sync as infection risks escalate?
Kyle King: Because it is, as things escalate, then the risk escalates. That the misinformation, the noise, as you mentioned, grows and grows. So how do we maintain that sort of clarity and communication?
Sharon Parrillo: Communication during a rapidly escalating event is very [00:14:00] challenging, right?
Sharon Parrillo: Information is coming in very quickly and you are trying to funnel what you're hearing and tease out what you need others to know. And it requires a tremendously high level of commitment. Information was coming in so fast, during the COVID pandemic that there were many times processes were changing dramatically from one day to the next.
Sharon Parrillo: And even sometimes from early that morning into the late hours into the evening, right? You may be doing something completely different. And I can remember saying multiple times to individuals, forget what I told you yesterday. And, this is very confusing for staff, right? Because they're used to processes and they're used to doing things a certain way and you drill information in a certain way.
Sharon Parrillo: And then when you look at them and say, okay we're not going to do that. We're going to do this. It requires a tremendous amount of trust, and it also requires that face to face communication when situations are [00:15:00] escalating quickly, that face to face for your frontline staff, your providers, is really the most effective method, and, this allows people to ask questions in real time and it allows leaders to validate the understanding, with who you're speaking with, especially when things are changing so quickly.
Sharon Parrillo: Bye bye. Someone may hear something, as a hearsay and say I don't think we were doing that yesterday, so I'm not going to do that today. And that's when you can meet them in real time and say, no, I understand we were doing this yesterday, but yes, now we are doing this today. And you can be a validation for that.
Sharon Parrillo: And that really only happens when you have that face to face and you allow people to ask questions. I think also having one point person or one department. Funnel communication from public health agencies also reduces confusion, right? If you have lots of people trying to discern what's coming in it's difficult to funnel a consistent and clear message.
Sharon Parrillo: So if you designate either one individual [00:16:00] or one department or one specific group to funnel what has been received and then what needs to go out to the team members. I think that really helps reduce the confusion and facilities may need to adjust their response activities based on current staffing levels, supplies and consensus statuses.
Sharon Parrillo: So it's also remember that any guidance that does come in from public health agencies is really just that it's just guidance. You may not be able to do the exact prescriptive thing that has come in, and that's where that team of experts and individuals to funnel it, process it, discern what needs to be taken out of it, and then move forward in a way that makes sense for your particular facility, but in a consistent and clear message, right?
Sharon Parrillo: Because if someone is reading the guidance verbatim, They may say this isn't what it says, and you can explain to them this is what we're able to do at this time, and this is why, so I think really that, that face to face really is it's the most valuable.
Kyle King: Hey, just a quick break to remind you that the toughest decisions don't come with a warning. The people who handle them best are the ones who [00:17:00] prepare in advance. At Crisis Lab, we explore how professionals across the various different sectors think ahead, manage risk, and make sound decisions under pressure.
Kyle King: Get ahead of the next challenge. Check out crisislab. io today.
Kyle King: Yeah, I would, tend to agree, and I also, you know, to add a different dimension is that, healthcare staff are not immune from, In the stress and of daily life and trying to live while still being in the healthcare industry, providing support and services.
Kyle King: And so they're also looking for that certainty, right? That security that comfort of knowing they're on the right path and direction. It's very difficult to do that. When, as you said, Sharon, like things change every day. You know, Here's the new guidance today, and it might reverse what we did yesterday.
Kyle King: But, here's it. It's one of those things that is really challenging to manage, and they're not immune. To sort of the insecurity of a growing crisis. And so that's important to keep those communication channels open, but it also does bring into a different dimension on communication in terms of technology.
Kyle King: Because one of the things that COVID had showed in dealing with that in [00:18:00] a pandemic is really putting a spotlight on telemedicine as part of the infection control procedures. And so how do you see telemedicine fitting into the different tiers of infection prevention and what sort of potential does it have?
Kyle King: Or reshaping hospital resources or the resource landscape, maybe.
Sharon Parrillo: Yeah, so telemedicine really played a very important role during the COVID pandemic by allowing facilities to maximize resources while also reducing the risk of transmission to caregivers. This process can really be implemented at any time as the infection prevention tiers are not prescriptive, but it's really most likely to be considered in tier 4 and 5 as you're moving through this.
Sharon Parrillo: In a hospital setting, telemedicine has the ability to expedite triage, you can have a. If you're short on providers or there's a lot of activity coming in, you can dedicate one provider who can do this telemedicine triage right from their office, or they can even do it from outside of the facility if they're not able to come in, but they want to help out their colleagues, right?
Sharon Parrillo: So they can do that very quick [00:19:00] triage right away, get some tests ordered, get the patient kind of on a path to where when the provider does finally see them in the hospital in the emergency department, let's say, Some of the stuff's already been done, right? They have some laboratory data to look at.
Sharon Parrillo: They have a some radiologic, data to look at as well. I think that really can help expedite that. It jumpstarts the patient's medical evaluation. It streamlines the throughput and it provides consults for staff. Staff are not immune to the challenges that we face during these type of events.
Sharon Parrillo: They may not be able to get an appointment, elsewhere in order to expedite their own evaluations, right? For potential illness. So if you have some things in place specifically the telemedicine you can streamline that process, a lot better and really rule in or rule out infectious processes for staff as well.
Kyle King: Now, we can't talk about technology without mentioning AI. Which is just, what everybody's focused on these days. So with the increased reliance on AI and digital tools and health intelligence, where do you see the benefits and the risk? Because we're seeing two [00:20:00] converging spheres, right? Which is data privacy.
Kyle King: And the speed and efficacy of a response or analysis in terms of the health sector and the use of AI. So where do you see these benefits and risks overall?
Jim Wilson: So I, I get it. The most frustrating element of all of this is the human behavioral aspects, right? So maybe we could all chuckle and say let's welcome our robotic overlords to come in and solve all these problems, right?
Jim Wilson: But I think it's, the uncomfortable truth maybe for some folks is, we want to point out that we did not use AI to detect what was happening in Wuhan. And we were there at the same detection NIDUS as everyone else who were looking at this in those early days, right? We also did not use AI to detect what was happening in Mexico in April 2009 with H1N1, right?
Jim Wilson: We are far more concerned about AI presenting us with inaccurate information, per this so called hallucination phenomenon. [00:21:00] And the reason for that perspective is we find the risk to be intolerable if we get that wrong because of AI, if we're communicating wrong information we're dealing with big outcomes here and, trust can be eroded very quickly, right?
Jim Wilson: It can take you years to build trust and it takes a second to destroy it. We don't need a I to create more work for us as a result, particularly if you're in a time sensitive environment. So you really, you gotta be careful, right? You gotta be careful about how you deploy AI. And I think under industries have found this out as well.
Jim Wilson: We're not the only ones that You know, are being a bit circumspect about how we incorporate these powerful tools. AI can be helpful. There's no question about that to assist analysts. They struggle with burnout, right? So we deal with similar issues as many other analytic operation centers in that people get burned out looking at.
Jim Wilson: The firehose of information on a daily basis, right? But you [00:22:00] still need seasoned professionals who understand the analytic discipline and you need that supervision, right? You got to have trusted brokers that communication with our constituents, so there's a tendency after health security crises to push a narrative about technology being the panacea for our complex problems without doing the difficult work of sitting down among the humans and examining the human side of the problems and taking the time to examine the lessons we need to learn.
Jim Wilson: And we're see, we saw that with COVID, but we've seen that before with many other health security crises. There's always. this push to dis, almost to distract us away from taking the time to do a hot wash. And it happens over and over again. And it's a pattern. And that pattern prevents us from incorporating lessons that we need to learn to make our infrastructure more resilient for the future.
Kyle King: Yeah, we tend to think in terms of AI is you can never really take the human out of the loop, right? [00:23:00] Especially in higher risk areas like emergency management or in, in health sector and health security because it just really ends up. We're not there yet, and we may not ever be there it's an interesting tool for speed of execution, I guess I would say but It's not there yet in terms of the use of that type of technology in terms of final determination and we used it a lot in sort of emergency management to think through scenarios for ideation, for prompting, and things like that, but not necessarily, it doesn't necessarily aid in scenario or in a response, for example it's starting to grow, but it's just not there yet.
Kyle King: But speaking of that, I mean, during a crisis, we have been focused on different things. So like protocols and logistics. So how do you see the human factor, which we were just talking about but like staff and morale, and patient trust affecting the ability to implement higher tier infection prevention measures effectively.
Sharon Parrillo: Trust is a really important focus during a crisis event, and it's imperative to [00:24:00] make decisions with your staff safety in mind. I think step one is be present be present in these patient facing areas, meet staff where they're at, all of my critical conversations during COVID happened in hallways, break rooms.
Sharon Parrillo: If you're not confident in the process you're implementing, you will lose trust. And. It's important to outline what it is that you're trying to do and to, show the staff and the people that are implementing this work that, okay, I'm right here beside you, and this is what we're going to be doing, and here we go, arm and arm, and away we go, right?
Sharon Parrillo: You just, you, it's really impossible to do this work from a remote location. You know, you really need to be present. And spend time individually addressing people's concerns. Some people, are very easily adaptable and they're like, Okay, we're doing this today. Great. Some will have a really hard time with it.
Sharon Parrillo: And that's where you really need to spend some time not only surrounding the task at hand with what you're trying to [00:25:00] implement, But with personal matters also, you mentioned previously that these are regular people living regular lives. They have their own concerns during a pandemic situation.
Sharon Parrillo: crisis response is successful when everyone shows up, right? The work doesn't happen unless there are staff available to do the work. And if people don't come to work, you're not going to be able to effectively manage a crisis response. So it's important to show up for them. What we're asking them to do may be very unfamiliar and at times very uncomfortable.
Sharon Parrillo: And I think it's okay to acknowledge that out loud, right? It's okay to say that out loud. And to just the acknowledge the challenge of it, and that is difficult and that it may be difficult for them at home, right? You think about what happened in people's personal lives during the pandemic, and they're managing that as well while trying to show up for work.
Sharon Parrillo: But I think if you can stick with the teams. Be present to answer [00:26:00] questions just to field, any challenges or any uncertainties. I think that really goes a long way and it'll help you move through the higher tier infection prevention measures because really those measures are really very unfamiliar.
Sharon Parrillo: When you're implementing them,
Kyle King: Let's talk about some of those measures for a second, because, you know, as we talk about escalating crisis there's a tendency that as things escalate, the environment becomes more restrictive, restricting free movement or more protocols in place, especially in terms of infection prevention.
Kyle King: So in your experience, like with hospitals, because they were. Really, that's the focal point, the center of the pandemic response. And so how do hospitals balance this need for infection prevention with the demand to keep essential services running? So is there really a tension between these two goals, especially in terms of a crisis?
Kyle King: we've talked about throughout the podcast so far, there's this balance to be achieved. Between, the information, but then also with people and other aspects, but they're the services that provided by a hospital in a community are [00:27:00] vast, right? I mean, There's multiple levels of services.
Kyle King: So how do we strike that balance, especially with escalating protocols being put in place?
Sharon Parrillo: Yeah, I think establishing a core group or a task force is really very beneficial in decision making surrounding necessary protocols and managing your essential services. When everyone is rowing in the same direction, I think the tension tends to be minimal.
Sharon Parrillo: You get that that pushback or these higher level concerns when people are trying to do things in silo. And I don't think that's affected. Know that what you're doing is a marathon and not a sprint. And I think, you know, if you live in that mindset you can look ahead and anticipate potential disruptions, right?
Sharon Parrillo: As non essential services become deferred, right? When you may get to that point where you make really important decisions on what services may need to be deferred. Reallocating those staff to assist in the infection prevention effort, I really think is very beneficial as well. You can [00:28:00] complete just in time training for help, during the rounding process.
Sharon Parrillo: Especially if you are an infection preventionist of one, right? I think that's really important to acknowledge that there are many areas and many facilities and, smaller community settings where You may have one person doing this type of work, or you may have one person who does this type of work a little bit and also has to do other things, and pulling in that workforce to assist you, prioritizing the complex needs that you need to do for yourself, and delegating those simpler tasks you can do that, and I think that's really important And that will help people move through these responses and also try to keep as many essential services running as possible.
Sharon Parrillo: But, there may come a time when you need to really make. Hard and fast decisions about what you need to do in order to move forward and closing essential services may be a part of that conversation.
Kyle King: Yeah, definitely. So, and finally, I want to start wrapping up the podcast with a question for all guests.[00:29:00]
Kyle King: start with both of you, which is, if you could really rewrite the playbook or, especially in your field with. You know, For infection prevention tiers and really based on your expertise and everything you lived through and seen so far. What is sort of one major change that or addition that you would actually make?
Kyle King: What do you think that we're missing or what do you think that should be done in the current models that we have now?
Jim Wilson: What we presented in this course is indeed a proposed rewriting in the playbook. The actions we took during COVID with the state of Nevada as a test site was the first time to our knowledge where health security warning was directly bridged to hospital emergency response.
Jim Wilson: The lessons we learned from that engagement are presented here in the course, and we'll continue to analyze and work on this issue. In today's world, for some health security crises, this framework will be needed. Previously, we could afford to wait for organizations like the World Health Organization or [00:30:00] National Public Health Authorities to give guidance.
Jim Wilson: on how best to respond. However, COVID showed us how difficult it is for these organizations to arrive at a credible peer reviewed consensus, especially as information evolves over time. It's not a criticism, but rather a reflection of how interconnected our world is and how difficult it is to provide warning and credible guidance for response for some health security crises.
Sharon Parrillo: I think the one thing that we've learned is that the viruses when they go they're coming, whether you're prepared or not, right? So it's really important to be thinking about this. And you may not be able to wait for specific guidance before you have to make really critical decisions.
Kyle King: Okay. That's great. Yeah. Thank you very much for joining us today on the podcast. If somebody wanted to get in touch with you, Jim or Sharon, what's the best way to do that? Should they just connect on your LinkedIn or via your website? What's the best way to get in touch with you?
Jim Wilson: I, we do maintain a presence on LinkedIn.
Jim Wilson: They can certainly reach [00:31:00] us through email as well. But probably LinkedIn would be the best place to reach us.
Kyle King: Okay, that sounds good. We'll go ahead and include that in the show notes for anybody who wants to connect with you and ask any follow up questions. So thanks again, and thanks for your time and we'll see you next time.
