As the United States passed the grim milestone of 100,000 lives lost COVID-19 at the end of May, it has become clear that the summer of 2020 will be unlike any other. As many of us continue to shelter in place and focus on activities closer to home than we may have in summers past, CASE will share key lessons from books written by our Senior Fellows and Advisory Council members to encourage discussion about how, together, we can work to help solve the world’s most pressing challenges.
To kick off our “summer book club,” we asked New York Times bestselling author and CASE Senior Fellow Dan Heath to answer some questions about his latest book Upstream, which explores strategies for preventing problems before they happen, and how upstream lessons apply to the global COVID-19 pandemic.
Q: Do you think that we, as a society, could have prevented COVID-19 if we engaged in upstream thinking? How do you think it would be different if we had engaged in upstream thinking?
A: “Downstream” actions react to problems once they’ve occurred. That’s where we are now with COVID. “Upstream” efforts aim to prevent those problems from happening. Could we have prevented the epidemic? It’s not likely, but it’s certainly possible. Some researchers think that COVID spilled over from bats to humans. And there are many ways we could potentially interrupt that kind of transmission. One example would be a massive investment in “viral discovery”—trying to discover viruses in their animal hosts before they cross over. It will be easy (one hopes) to get that kind of work funded now that we’ve suffered a pandemic. But the nature of upstream interventions is that you need to invest in them before the problem manifests. Before there’s any natural urgency. And that’s very, very difficult. On a personal level, how many of us have prepared a will? How many of us (of the right age) have sought out a colonoscopy? We have a strong urge to put off work on tomorrow’s problems in favor of today’s, even when tomorrow’s problems may be far more serious.
Q: Is there one specific theme or takeaway from your book that you think would have been, or could be, absolutely crucial for mitigating the COVID-19 pandemic?
A: To succeed upstream, it helps to have early warning that the problem is coming. That advance notice can make all the difference: Japan has spent millions on a cutting-edge system that can detect earthquakes 30-60 seconds before they begin. That may not sound like much, but it’s enough time to stop a medical procedure safely, for instance, or to bring a train to a halt. With COVID, we had a few months of advance warning in the United States, which is an incredible accomplishment. We may have squandered much of that time, unfortunately, but the mere fact that we had that warning at all is evidence of the success of the “surveillance systems” built over decades by public health leaders. And I just read that cities are starting to test the level of COVID in their sewage, which has been found to predict accurately the level of new COVID cases that will be discovered in the next week.
If you’re trying to find an upstream solution for a problem in your organization, ask yourself: What are the early warning signs that it’s coming? What signs might warn you that an employee is getting ready to leave? Or that a grantmaker might stop funding you?
Q: What do you think the biggest obstacle or pitfall to upstream thinking was for COVID-19?
A: The biggest obstacle was the lack of a forcing function. Downstream/reactive work demands action. A tornado devastates a town; a patient suffers a heart attack; a toddler soils a diaper. These problems MUST be addressed. It doesn’t feel like there’s a choice. Meanwhile, despite the enormous stakes, upstream work is often voluntary. All the public health experts who were focused on pandemics in years past—they constantly had to fight for attention. Fight for resources. The paradox is that it’s only after a problem strikes that you unlock the resources that would have been needed to prevent it. And that’s what we’re seeing now.
Q: Do you think that there are any Upstream heroes emerging from COVID-19 response? If so, who?
There’s an army of obvious heroes who have pulled us through the epidemic: from doctors and nurses to the front-line workers who kept coming to work at grocery stores. But it’s also interesting to consider what COVID has taught us about leadership. Warren Buffett said, “You only find out who is swimming naked when the tide goes out.” And the epidemic has shown us clearly which leaders had prepared their teams for an emergency and which hadn’t. The writer Charles Fishman wondered, How is it that the internet has mostly functioned just fine despite the huge and unanticipated surge in demand? And the answer is that it was anticipated. He found that AT&T’s leaders, for instance, had run pandemic simulations last year, to make sure they’d be ready. Another example: Long before the epidemic hit, the software firm Trello had wanted to make sure its employees were prepared to work remotely. So they had a policy that if you were holding a meeting, and someone needed to join remotely, then everyone would join remotely. Even if it meant people were logging into their laptops in the conference room. That’s a great example of how you can instill habits that build organization resilience. When COVID hit, Trello’s employees were ready to work from home. Because they’d been training for it.
To be clear, “upstream thinking” is not synonymous with “preparing for emergencies.” It’s much broader than that. It’s about devoting proper attention to next month’s and next year’s challenges, rather than always staying in firefighting mode.
Q: What is one thing, if any, that has made you hopeful for the future of upstream thinking due to COVID-19?
A: We’re learning. As a species, we’re learning. As horrific as this time has been—and 428,000 deaths globally is horrific—the truth is that it could have been far worse. People, in general, quickly embraced social distancing—an incredibly unnatural behavior. We mostly embraced prosocial efforts, such as wearing masks. Beyond that, we’ve had to train ourselves on the exponential math of epidemics and abstract concepts like “flattening the curve.” We’ve had to interpret complex data: If cases are going up, is that bad news (for obvious reasons) or might it also be good news (because we’re finally testing enough people to identify the cases that were previously undetected)? These patterns of thought and behavior are the building blocks of upstream interventions. And I have some hope, perhaps naïve, that after we’ve seen the power of COVID to disrupt our communities and organizations, we’ll emerge ready to take on even bigger challenges such as climate change.