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Baylor College of Medicine

'Never Surrender'

Master
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Oct. 14, 2020

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Dear Members of the Baylor College of Medicine Community,

Imagine a crisis in our community.  There is much about the crisis that makes it difficult.  The threat hangs over us continually; we can put it out of our minds temporarily, but it is always there in the background.  It strikes indiscriminately, causing death and disability to young and old alike.  Our best protection is defensive – everyone must modify their behavior to help keep all people safe.  As rigorously as we play defense, it does not eliminate the threat, and we yearn to go on offense.  We want an effective intervention that repels the invader, so we can return to our normal life.

SARS-CoV-2 and COVID-19?  As horrible as the global pandemic has been, and all the medical, social and economic turmoil it has wrought, I am describing the bombing of England during the Second World War.  From roughly June of 1940 to May of 1941, the English people endured a near continuous threat of death from the air.  In total, the nighttime bombings left 43,000 civilians dead, and more than three times that number wounded.  I just finished reading Erik Larson’s "The Splendid and the Vile," an excellent book that covers this period in history in a focused and engaging manner.  As I was reading, the parallels to our current crisis were unavoidable.

There are two major themes to the book.  First, in spite of the intermittent terror the population faced, life went on.  Weddings and baptisms; theater and music; the daily rhythms of work and school.  The English people endured incredible hardship, with no end in sight and the constant fear of invasion.  And life went on.

The second theme is the importance of leadership – specifically the role of Winston Churchill, who ascended to the office of prime minister during this most challenging time.

Churchill clearly had feet of clay: massive personal debt, probable over-indulgence in alcohol, odd personal boundaries (he was known to dictate correspondence to his secretary from the bathtub), quirky behaviors (he liked to wear a pink silk robe around 10 Downing Street) to name a few.  He was not perfect.

But he was a leader for that time.  He was masterful in his communication to the public: honest about the hardships faced and uncertainty of the situation, while maintaining a sense of unbridled optimism.  He dealt and managed in an environment of uncertainty (Will the U.S. enter the war? Will the Germans launch a land invasion?).  He assembled and maintained an effective leadership team.  He regularly visited sites of devastation.  He connected to, and wept with, the people.  He seemed to almost literally pick the nation up, and carry it through a horrific ordeal.

As I continue to monitor our COVID-19 metrics, and prepare to go to the polls to early vote, it is appropriate to pause and consider the importance of effective leadership.

The news out of Houston this week is a mixed bag. No one has a crystal ball, but on balance, I am discouraged by our numbers and believe we are on the cusp of another surge.  Although there is good news (the City’s test positivity rate is down to 5%), a number of our metrics are worsening.  From the TMC data, our R(t) value, after 32 days of staying below 1.0 (virus receding), snuck above 1.0 (virus is expanding).  New daily cases in the greater Houston area remain stubbornly in the 400-500 range, and the daily rate for the past three weeks is edging up (373, 394, 412).  New hospitalizations are increasing, albeit at a slow rate (0.9% daily increase) and the total census of COVID-19 patients in TMC facilities is again rising (1.3% daily).  Data from the Baylor diagnostic labs show the positivity rate increasing, along with the average viral load of specimens, a sign that the tested individuals may be more infectious.  There is increasing evidence that young adults (20s and 30s) are responsible for much of the spread.

I am afraid we will see the viral resurgence in the coming weeks, as are many regions across the world.  I hope I am wrong.  I hope the surge does not come, and if it does, that it is not as severe as we saw in July.  Let us all do what is within our power. Continue to beat the drum: mask/distance/avoid crowds.

As we prepare for a potential resurgence, and reflect on the role of leadership in crisis, I want to try to channel some of Churchill’s clear-eyed, realistic optimism.  I want us to come together, not be torn apart.  To that end, I have three specific requests of you today.

  • Vote.  Do not wait until the last minute, do it this week.  Democrats and Republicans; liberals, conservatives and libertarians; supporters of “big oil” and the Green New Deal.  “MAGA-fanatics” and “Never-Trumpers.”  Vote.  We are living in divisive and turbulent times, but the nation has seen and endured worse.  Over time – if you participate – our system will work.
     
  • Reach out to your Churchill.  We have all suffered through the pandemic, some far more than others.  I imagine everyone at some point has experienced a degree of anxiety and uncertainty; some have felt real despair.  Stop and reflect for a moment on who has helped you through this difficult time.  It may be a co-worker, supervisor, faith-leader, family matriarch/patriarch, teacher or civic leader.  Focus especially on those who are quietly leading out of the public eye – those who lead but do not get recognition.

    Now recognize your Churchill.  Right now, sit down and write them an e-mail.  Tell them how important they have been in helping you through this difficult time.  Tell them how they helped you.  Better yet, write them an actual letter.
     
  • Start a global pandemic of support.  We are battling the “R(t)” and the pernicious nature of exponential viral spread: one infects two, two infect four, four infect eight, etc.  

    Let us try to create exponential growth in support of each other.  Share this message with two other people and ask that they send a note of thanks to their Churchill: the person that has helped them most through this time.  Then ask that they encourage two others to do the same.  Not as a social media campaign, not as a meme, not as a hashtag. Privately, individually, sincerely.

At the risk of beating this theme to death, I will finish with Churchill:

“We shall not fail or falter; we shall not weaken or tire.  Neither the sudden shock of battle, nor the long-drawn trials of vigilance and exertion will wear us down.”
 
Stay well (and vote!)
 
James T McDeavitt, M.D.
Senior Vice President and Dean of Clinical Affairs
 
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