Opinion article badge“All you have to do is blush.”

That’s part of the headline in an upbeat New York Times article about New York City’s fully operational Covid-19 sewage surveillance system. Sewage monitoring is the latest way to keep track of Covid.

Hawaii does not have this wastewater program despite Department of Health promises and missed deadlines. After many delays, what was supposed to happen this summer, according to the DOH, is now indefinitely delayed.

Here the tagline is “all you have to do is wait”.

And wait and wait. Plus, plumbers don’t tell you when they’ll show up. Not even a phone call.

Ho hum, that’s the way it goes.

Enough with the ho-ing and humming. The Covid sewage situation is the latest example of the State Department of Health’s flawed response to the pandemic. It is very much like the DOH has been operating often.

On a typical bureaucratic day, this failure to meet a deadline would be disappointing. In a pandemic it is dangerous.

When it comes to Covid, the DOH should still be in crisis mode, not ordinary mode, because that is what still requires an acceptable, necessary public health response.

Instead, the DOH’s response to the oversight looks very much like business as usual. This must change, not only for the pandemic, but also to deal with future crises.

The DOH should do what the federal government’s Centers for Disease Control and Prevention plans to do: admit failure and develop a much better way to respond.

DOH needs to be rotated.

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

The CDC has received a great deal of criticism for the way it has handled Covid. Public health experts have called the agency’s handling of Covid a misguided response that leads to a fundamental loss of confidence.

Too slow, too confusing and, as one science communication expert put it, “a culture that was just arrogant and overestimated their ability to get it right.”

All this also applies to DOH.

CDC Director Walensky has called for a major overhaul. It’s a “watershed moment,” she said.

A view of Waikiki Beach with the Royal Hawaiian Hotel during a recent spike in Covid-19 cases.  August 22, 2021
The pandemic has exposed the business-as-usual ways of the Department of Health. Cory Lum/Civil Beat/2021

The CDC needs to refocus on public health needs, she said, to respond much more quickly to emergencies and disease outbreaks and provide information in a way that ordinary people and state and local health authorities can understand and use.

This is also exactly what the DOH should do.

Easier said than done? No joke. But you can’t do it if you don’t say it first. And you won’t say it if you think that the usual ways of doing things are always the best way of doing things, and that if things don’t work out the way they’re supposed to, well, we’re doing our best. may under the circumstances.

So here are some corrections and adjustments that DOH needs to make. This is not a plan for change. It is a preliminary plan to make change possible.

DOH needs to stop thinking so much in terms of business as usual and the best we can. Yes, the agency deserves some sympathy for how wastewater monitoring has played out. Part of the delay was beyond her control. Equipment was scarce, coordination was more difficult, things like that. The agency was a small part of a thoroughly broken national public health system.

It is understood. But within the DOH there is a kind of disgruntled, let’s be patient, tone that is infuriating. Did the head of the lab leave? OK, we’ll get another one every now and then. Things are more complicated. The audience must be patient.

This is very similar to the stance that DOH cannot often make in other areas. “We don’t have staff.” “It’s more complicated than we thought.”

True or not, this attitude has costs because it reinforces crippling negative attitudes.

Failure moves from being a problem to being a condition that is the natural order of things.

DOH start of the day greeting: “Hey, buddy. What’s wrong?”

This is infuriating because a response to the crisis is not about being patient or accepting things as they are. Crisis requires impatience, resolution and refusal to accept things as they are. It requires being agile and clear with the public.

It’s the difference between a fire department fighting a fast-spreading fire of unknown origin and a motor vehicle department checking license applications on an average Thursday afternoon in August.

As for us citizens, don’t be fooled by the usual terms that allow bureaucracies like the DOH to get out of jail.

Two of them appear in media descriptions of the sewage department’s project – “ready” and “work in progress”.

“Poised” gives you the impression that we are almost there. A better way to think about it is that “ready” is an indication that we are not there yet, although we should be and may never be.

Work in progress? This is a term to hide the fact that the work is really in progress.

It’s about moving their eyes instead of saving them.

Better to see these terms as deviations, not assurances. In fact, it would be better if the media stopped using them altogether.

Language matters. Who knows if the CDC will successfully reform itself, but the talk of watersheds and rotations shows that change is at least starting on the right foot.

The DOH needs to think more in terms of pivots and less about preparation, more about watersheds and less about narratives that avoid responsibility.

It’s about moving their eyes instead of saving them.

Take a look at the New York Times sewage article. It’s interactive with very cool photos of scientists at work both in labs and, get ready for it, in the sewers.

It foregrounds the science, but you can see from the text and photos how much of this effort is about organizational fit.

The science is complicated, but actually the organizational changes needed to move from stool samples to reliable, average-people-friendly numbers are even more difficult.

At the moment, there is no reason to believe that the DOH can make these kinds of organizational adjustments because that is not how the agency thinks of itself and it is not how the public thinks of the agency.

It’s time for the DOH to prove us wrong.

The first time I heard Governor David Ige say, “Change is hard,” I laughed. Another rhetorical blunder from a smart guy who isn’t exactly a wordsmith.

But you know, he’s right. Recognizing his simple memory is one part of the equation along with two other parts: change is necessary and we are failing our mission if we don’t achieve it.

So, good luck to the CDC. And be encouraging and tough about DOH.

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