Monday, September 1, 2014

Labor Day – had usual call with Secretary Burwell (SMB) this AM at 8:30 AM. Clear and muggy day. We are going around in circles. I am concerned that the Secretary is a really smart and very competent person, but she is surrounded by people who may be good at management, but who have never been in a situation like this and who really do not have a clue how to address it → Leslie Dach (formerly of Walmart); Andrea Palm (have no idea where she came from). Bill Corr (Deputy Secretary) is the only one with corporate memory of former crises and he has been completely marginalized by the new kids in town. There really is no command and control at a higher level. At my suggestion, Francis sent a note to SMB suggesting that we bump this up to the White House level (perhaps the VP) in order to get DoD, USAID, HHS, and NSC working together. She has not yet responded to him. I mentioned on the call today that Tom Frieden is dealing with Assistant Secretary Lumpkin of DoD. He is a good person, but nothing is happening with the promise for mobile hospital beds. They are still quibbling about a 25 bed hospital when they really need 1000 beds. Plans for 5 X 100 beds have gone nowhere. My experience with the DoD is that they are well-meaning, but the culture and chain-ofcommand is such that you never know when you are speaking with someone who really has the authority to actually do what they are talking about. Something strange about the military culture in that they will never say “you are speaking to the wrong person; I cannot help you”. They will try to help (although they cannot) and all that happens is that time is wasted. I tried to make that point on the conference call. Importantly, WHO is saying that the epidemic could reach 20,000 cases. In fact, mathematical models that came out in ScienceInsider today from a physicist named Alessandro Vespignani showed that the curve is exponential, not linear, which means that there could be 10,000 cases by September 24. This is turning into a total catastrophe. Just spoke with Dawn O’Connell (Counsellor to SMB) and explained to her that the situation is out of control and that we need a higher command and control. I also explained to her the importance of the “exponential” curve of the epidemic. Dawn is really trying to be helpful.