Flipping the Script on Epidemics

By Larry McEvoy, MD
February 7, 2022

We now know more about how epidemics rise, propagate, and abate, but the patterns are as timeless as biology, and they are not going away.

 

Epidemics of skeptical mindsets and harmful behaviors have commingled amid COVID—those who thought the disease was a hoax were much more likely to flout practices that would limit its impact and spread, thereby unwittingly multiplying the phenomenon they didn’t think was real. Because we do not pay so much attention to them when they’re small and fragile, epidemics seem to just pop up, ooze under our doors, and grow. Once they get bigger and more widespread, they are much harder to reel back. Worse, epidemics spawn secondary epidemics. They literally multiply their own numbers and the numbers of problems they create.

 

We all want these epidemics to stop, to go away and never come back. But they don’t. We have managed to eliminate a few, smallpox being the poster child for disease eradication, but most are stubborn and relentlessly reappearing. Influenza is a classic example, returning every year when the time is right. Equipped with maddeningly adaptive changes in its DNA sequencing that allow it to slip past both our engineered barrier—the annual version of the flu vaccine and our advocacy programs for getting a flu shot—and our bodily surveillance—our individual immune systems—it is relentless among us. There are other epidemics we have made great progress on only to be foiled by an additive perceptual epidemic that has mitigated our efforts to stop the disease itself, as is the case with measles and anti-vaccine sentiment.

 

We’ve seen all of these intertwined realities with COVID, and the take-home message for leaders is less about COVID itself, bad as it is, and more about the pattern of epidemic action in our social identity, large and small. We now know more about how epidemics rise, propagate, and abate, but the patterns are as timeless as biology, and they are not going away. The epidemics I was battling were not new to me or to science on my overwhelming night in the emergency department. We had been seeing gonorrhea, chlamydia, and influenza for years; we had also been seeing obesity, diabetes, domestic violence, and opioid use advancing across our populations.

 

Epidemics are not just negative and devastating; they can be positive and empowering. They surf on the same principles of social networks and multiply via the same organizing elements which leaders can use to positive advantage. What differentiates the value of an epidemic is its pathogen, its “disease maker,” the thing that is multiplied and spread across a population. While the duration of a pathogen’s effects and how fast or slow it spreads are adjuncts of whether we see an epidemic as “bad” or “good,” the kernel of its value lies in its founding idea, which can unfold in unforeseeable combinations across populations. Bad ideas cause bad epidemics as they spread through our combined social networks, themselves powered by neural and technological networks; good ideas can seed good epidemics via the same approaches.

 

Excerpted from: Epidemic Leadership: How to Lead Infectiously in the Era of Big Problems, by Larry McEvoy, MD.

 

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Topics:

Physician Leadership and Ambulatory Care: Small and Rural Hospitals
Variation Reduction and Physician Concerns