What our COVID response says about public management

Testing is all well and good, Steve Kelman notes, but true follow-through is the hard part.

contact tracing app (ProStockStudio/Shutterstock.com)

The New York Times had an interesting report last week questioning the idea that more coronavirus testing was a cure-all for dealing with our pandemic crisis. The "more testing" mantra has been a common theme of the administration’s version of events, with suggestions that the U.S. leads the world in testing.

While “leads the world” is an exaggeration, it is indeed true that compared to other areas of our response we are doing less badly on testing.

However, the Times article makes some simple but nonetheless important points. The purpose of testing is mostly to provide information that we can use to initiate other activities that will allow us actually to slow the disease. The most obvious of these is to isolate those who test positive. Also we could do contact tracing of those testing positive to locate others who may be spreading the disease.

Our problem has been that the U.S. done precious little of either of these things. So we should not be surprised that the slew of testing hasn’t done much to slow the spread.

This highlights a chronic problem with public management in our country. We often get new initiatives off the ground, but have trouble following through. That takes time and slogging, but too often we opt for quick hits. It is easier to proclaim a new initiative to improve cybersecurity or reduce payment errors in programs than to stick with it after the headlines. Too often we behave like with New Year’s resolutions, or diets, announced with fanfare but abandoned before anything happens.

Politicians are often negative role models for this. President Donald Trump’s most famous announcement with no follow-up was the threat to bring “fire and fury” to North Korea if that nation didn’t get rid of its nuclear weapons. But this is Trump all the time -- just in the past week, President Trump has threatened to withhold federal school aid to districts that do not re-open in the fall and to eliminate universities’ tax exempt status. These kinds of announcements occur so often that people hardly even expect any follow-up.

Forgetting is often easier than following up. Developing a system for contract tracing requires establishing new organizational capacity that didn’t exist before. If you want to be sure that people isolate themselves after a positive corona test, you again need a capacity to connect with them. This is especially hard to do in the middle of a crisis – thinking about these things before a crisis hits gives you much higher chances of success.

But if simple attention can help, this is of course a lower-cost route than creating new capacity. For example, with self-isolation after a positive test result, for many people it may be enough to receive repeated messages from trustworthy sources. I think if Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, repeatedly preached a message to those getting testing that they need to isolate themselves if they test positive, this would be follow-though that I think would help a lot.

Can we as managers repeat the mantra to remember the importance of follow-up? I fear we will forget.

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