Lessons learned from managing COVID-19 (Week 1)

Practical lessons learned during the first week of managing the COVID-19 epidemic in South Korea.

Background

I’ve been embedded in a large organisation in South Korea, helping them to structure their response to the COVID-19 epidemic. It’s been one of the more dramatic project transitions I’ve had, being in Syria just prior to this.

Pandemics require a strong and unified approach. We’re all in this together. As such, I think it’s important to share what I’ve learned so far. I’ll aim to update add additional posts as I learn more (most likely one post each weekend).

In this article I’ll work through lessons learned relating to mitigation (including thermal screening), contact tracing, quarantine, and internal communications, prototyping and iterating playbooks, and practical benchmarking.

Some points up front:

• I’m busy, so I don’t have time for editing. Good news is I’m bad at editing, so you probably won’t notice. But please forgive any spelling and grammar issues.
• I’m a crisis management specialist and not a doctor. My focus here will be on the crisis management aspects of the epidemic and not the medical aspects.
• If you have different experiences, or better ways to do things, please share. Again, we’re in this together.

Tracking Public Cases

During your daily Working Group or Crisis Team meetings, I’m sure you will be reviewing updates on the number of cases in the country.

Over time, numbers will go up and maybe down. They may go up slowly or quickly. At the organisational level, these numbers will be difficult to make sense of. What do they mean for you? How do you change your response based on changes in these numbers?

To make sense of the numbers, I recommend focusing on the high level. Evidence of person-to-person transfer in an area where your employees live or work is cause for concern, and should trigger an increase in preparedness. A further expansion of cases in the same area may not necessarily mean anything for you other than things are getting progressively worse and you’re more likely to see more cases. Once your mitigation is in place, you’ll need to ride it out and respond to suspected or confirmed cases as they occur.

One point to note regarding the official numbers is that as the disease progresses, the number of new confirmed cases identified will be constrained by the rate at which people can be tested, and the rate at which those tests can be processed and people informed. As we’ve found already, many people with symptoms will be quarantined at home without testing. Treat the overall figures as an approximation and a guide as to whether things are generally getting worse or better. Focus on the locations of the outbreaks and activate your mitigation measures accordingly.

Mitigation

As you orientate to COVID-19, your first focus will be to establish mitigation measures across your organisation.

As you’ll learn along the way, this will require changing behaviours (wearing masks, using hand sanitiser etc) as well as deploying new practices (thermal screening, social distancing, regularly sanitisation of work areas etc).

Please note that the points below are lessons learned, and are not a checklist.

Two levels of mitigation

I’ve found it useful to implement two levels of facility level mitigation. We’re calling these “basic” and “enhanced”. I’ve found if you try to split it down further than this it’s not meaningful.

In the context of where I am in South Korea, all facilities would implement basic mitigation, and facilities in locations where we have one or more confirmed cases would implement enhanced mitigation.

When you increase your mitigation, you will naturally take a productivity hit. This is one reason why it’s useful to have two levels rather than only one. It’s also important to demonstrate a change in mitigation based on a change in the threat — “we now have a confirmed case in this area, so we’re increasing our level of protection”.

Implementing mitigation measures

When you send mitigation instructions to your facilities, include self-audit checklists that the facility leads can complete and return. You won’t be able to visit these facilities yourself (you should be limiting cross-site movement), and you’ll want to have a high level of assurance that everything is in place as it should be.

Assurance is particularly important when you transition from basic to enhanced levels. This change will be triggered by a local event, so you’ll want the new measures implemented as quickly as possible and verified through the self-audit checklist.

Be wary of any assumptions you make regarding the implementation of some mitigation measures. Over time, people may naturally relax some policies, like thermal checks or the wearing of masks. If your systems allow, checking in remotely via video surveillance is a good way to monitor some practices, like mask wearing. Effective management supervision is also key.

Identify and patch vulnerabilities

Your mitigation measures will only go so far. For example, even if people are wearing masks, they will need to take them off to eat lunch or have a coffee, and they may be doing this with a small group of colleagues.

Another example is bathrooms. Even if you have started additional cleaning and sanitisation, you simply won’t be able to clean the bathrooms enough to avoid potential surface contact. One option here is to put disinfectant in each stall and ask employees to disinfect before and after use. That’s better than relying on cleaners.

For each facility, identify higher-risk areas that are difficult to address, and think about work arounds to limit close unprotected contact.

Thermal screening

Thermal screening enables you to identify individuals with a fever, keeping them out of your facilities and away from other employees. In Seoul, thermal scanners are set up in corporate lobbies, hotels, and malls.

Consider 2–3 levels of thermal screening:

• At home, before employees leave for the office (this requires each employee to have a thermometer at home).
• On arrival at the building, inside the lobby.
• If you’re in a mixed tenant building, at the entry to your company area.

If you’re a tenant in a building, remember that not all employees will have thermometers at home, and you can’t fully rely on what building management has set up. You must establish your own checks at your own front lines.

If you are using thermal cameras, watch for the following:

• Be particularly careful about the backdrop. If the backdrop gets some sun, or is heated, it will prevent accurate readings.
• If people are coming in from a colder area outside, the surface temperature of their skin will be colder. You’ll need to reduce the detection temperature for your cameras. This may need to be adjusted during the day as outside conditions change.
• The cameras detect heat from skin surfaces. Where staff are wearing face masks, there isn’t a large surface area for detection. We’ve found that using two cameras (one from the side and one from the front) works effectively.

Once you set up thermal cameras, make sure you monitor them closely. Engage the vendor to assist with set up and calibration, and make sure you provide training to the staff at the monitors.

It’s particularly important to have good procedures for detection. If the thermal cameras are activated, you will need to have a secondary screening point with a contactless thermometer (the cameras may not always work). I also recommend having a table for people to place hot drinks before passing through the detection area.

The thermal screening process must be handled well to prevent people from being unnecessarily frightened. Some systems have a siren that activates when they detect temperatures in the target range. This can be unnerving. You’ll also need a private waiting area, and a procedure to get the person with the high temperature safely home. Provide training and rehearse the procedure.

If you have a limited number of cameras, you’ll need to reduce the number of access points and re-route traffic. This may have the effect of bringing more people into close contact with each other, which can be managed by adjusting reporting times by department (this also reduces the concentration of people in lift lobbies and elevators).

If you’re using thermometers, you must use non-contact thermometers. This is for two reasons. First and most obvious, to prevent the spread of the disease. Second, to prevent employees being afraid of, and possibly avoiding, testing.

One important thing to note is that COVID-19 is transmissible before infected individuals are showing symptoms. Thermal screening is not, therefore, a complete solution. That said, you should absolutely be doing it. It will help to screen out people with symptoms and it will also demonstrate to your employees that you’re taking all necessary precautions as an organisation.

Make contact tracing easier

As we’re learning here in South Korea, contact tracing for large facilities can be extremely difficult. It takes time and resources (both currently in short supply). You’re also relying on the memory of the suspected or confirmed case, which can’t be guaranteed (assuming you’re even able to speak to that person, which is not a given).

How can you make it easier?

Challenges with contact tracing

For facilities with large employee populations, it’s impossible to ask everyone if they’ve had close contact with a specific person. Do you remember who was in the elevator when you came to work yesterday?

You’ll also need to be careful and pragmatic with personal information. Once you have a confirmed case, the first thing that everyone will want to know is “did I have contact with that person?” The only way you can answer this question is to tell everyone the employee’s name. In large facilities where not everyone knows everyone else’s name, you’ll probably also need to share a photo. Both options are clearly highly problematic.

Break down contact tracing into stages

Contact tracing does not need to be one single process. This will require you to wait until it’s complete before you act. The approach we’ve adopted is to do it in stages, identifying obvious close contacts first and isolating them, then progressively refining other close contacts using more time consuming techniques.

The ideal approach is to be able to interview the suspected or confirmed case about their close contacts, then implement the first cut of quarantines based on this information. From here you can progress to other measures like calendar meeting records, access control queries, and video surveillance to identify other potential contacts. This will take longer.

Right now our target is to complete contact tracing within 24 hours. This gives us time to sanitise the facility then re-occupy it with some confidence that any close contacts are now quarantined and won’t be re-introduced to the facility.

Adjust practices to enable easier contact tracing

A more efficient approach is to adjust your work practices to enable rapid contact tracing. Here’s a few examples of how you could do this:

• Enforce fixed work positions, with the same people working in the same places. This is particularly important for locations using hot desking (not an ideal work practice in the context of a disease epidemic).
• Do not mix people between shifts. If you identify a confirmed case, and you determine she’s worked three shifts over the past four days, it’s better to have had the same people on each of these shifts (let’s say four, not including her) rather than different people (which would result in twelve unique potential close contacts over the three shifts).
• Minimise movement between buildings, floors, or even departments.
• If you have a staff cafeteria for lunch, implement table numbers and have staff record which table they used and what time they used it.

Effectively, you’re flipping the normal workplace model from “always communal” to “rarely communal”. If people are rarely communal, they’ll be better able to recall close contacts.

Elevators will always be a major issue. While bathrooms can normally at least be limited to a floor, elevators can be used be people from all floors. One way to address this is to change the programming of elevators so they only service specific floors. This is particularly important if you are in a multi-tenanted building. May not be possible, but worth investigating.

Remember that relaying on video surveillance as a means of identifying close contacts won’t necessarily help because people will be wearing face masks.

Address fears and concerns

You have a potentially short window to build trust before you experience your first suspected or confirmed case. All employees must have full trust that your organisation, and the team running the crisis, is reliable and trustworthy. This trust will take time, and repeated high quality communications, to build.

Here’s a few ideas on how to do that.

Provide regular updates to all employees

Provide a routine email update to all employees. You can start with three times a week (Monday morning, Wednesday afternoon, and Friday afternoon), and increase to daily as the situation intensifies.

Include the following in these email updates:

• An update on the company situation. The first thing people will want to know is whether there are any confirmed cases in the company. No news on this front will be good news. Mention that people are on home quarantine (but no exact number and no names).
• Fact-based updates on the general situation. Include the number of cases in areas where the company has operations, along with some basic analysis (generally getting better or worse, new outbreaks or clusters etc). Remember that this may be your employees’ only source of updates, so it needs to be accurate and relevant to them. Provide links back to source documents to lend credibility to the figures.
• An overview of any new actions the company has implemented, for example thermal screening or changes to shift practices.
• A reminder of basic personal hygiene practices. This will be repetitive, but it’s always good to reinforce this as often as possible.
• A link to company FAQs. Provide this link in all emails so that employees can access easily.

Segment your audience

Aside from your general communication, I also recommend that you segment your employees and develop specific additional messaging for different segments. Obvious segments may be customer facing employees (potentially higher-risk roles), as well as expatriates and their families. These segments will have different concerns and different needs that won’t be addressed by mass communication.

Use FAQs

It’s a very effective technique to have a central repository of facts and policies that employees can refer to. Develop an FAQ early on and build on over time, based on identified concerns. Make sure this is available to everyone. It may be that not everyone will have access to company email accounts.

Home quarantine

Home quarantine is an important measure to mitigate the spread of the virus within your organisation. In practice, you may find that very quickly you’ll have quite a number of people on home quarantine, for a range of different reasons (this is separate from people working from home for business continuity reasons).

Here’s a few ideas on how you can manage this more effectively.

Use a spreadsheet

Start with a simple spreadsheet, and tailor it over time to add additional information and charts. Over time you’ll be awash with data, so you’ll need a way to be able to visualise the information and highlight potential issues.

Break down by categories

It’s important to break down people on home quarantine into different categories. This will enable you to track them better, and will may help tp provide an early warning to potential cases.

Categories may include employees who have:

• Travelled to affected countries and were quarantined on return.
• Been in a location where there has been a reported case (e.g. a restaurant, religious congregation, or cinema).
• A family member (or close contact) showing flu-like symptoms.
• A family member (or close contact) who have been tested and are awaiting test results.
• A family member (or close contact) who have been tested and are confirmed to be carrying the virus.
• Flu-like symptoms (fever etc).
• Been tested and are confirmed to be carrying the virus.

Obviously you could add additional categories, and new ones may emerge.
Each of these are meaningful in their own way, and when you look at them listed out it’s easy to determine which are low risk (unlikely to be a significant threat of infection) or high risk (likely to have been infected due to sustained close contact).

In South Korea, many organisations with operations across the country will currently be dealing with cases where employees have had close contact with a family member who is showing symptoms or who has been tested positive.

It’s worth pointing out that the advice of many governments is not to immediately proceed for testing. In practice, this means that you may have employees that have flu-like symptoms, and who have the virus, but may never be tested and confirmed positive. That doesn’t reduce your risk, and it effectively means that anyone displaying symptoms has to be treated as positive even without testing. This demands a very conservative approach that will almost certainly result in large numbers of people being quarantined, and an unknown number of these being positive cases.

Parsing the data

As you monitor your quarantine figures over time, you’re looking for an uptick in people being quarantined because they have temperatures or flu-like symptoms. This could indicate an outbreak at a facility.

For large facilities, you’ll need to temper this with normal rates of sick leave. A few cases of high temperatures in a facility of 2,000 people isn’t necessarily a cause for alarm (but still needs to be monitored carefully in the context of the current epidemic).

One the subject of metrics, you should also looking for evidence of absenteeism, particularly amongst contractors or temporary staff. If they’re staying away, this may indicate that fear is building, or that people lack of trust in company procedures. This should trigger some investigation, and the refinement of your communications.

Check in calls

Employees sent home for quarantine will need support. At a minimum, someone from the company should check in with them every one or two days. People on home quarantine will feel detached from the company. They may be afraid for their own situation, or afraid for their friends still working at company facilities. Continual communication will help ameliorate this.

Automated surveys are another useful tool to gather key information (are they symptomatic, do they have enough masks etc).

Incident Briefings

When you start having suspected of confirmed cases, you will need to start briefing different groups of employees. This is different from the communications described above, which focus on general information updates. The stakes here are significantly higher, and poorly handled briefings can reduce trust and increase fear.

Use communications templates

As you face a new situation, centrally develop a communications template or script. Templates ensure consistency, particularly where you have multiple facilities and these briefings will be delivered to different groups in different locations.

You can iterate and refine these templates over time as you learn and new employee concerns arise.

Use briefing notes

In addition to the communications templates, I recommend including briefing notes with each communication. The delivery of direct updates and information to employees during a situation like this, when the level of fear is already elevated, must be at a high level.

Briefing notes should include a short FAQ tailored to the theme of the communication that answers the obvious questions that some employees may ask. Often you don’t want some statements in the main communication. For example, if you are briefing on a suspected case, you don’t want someone asking a general question like “what will happen to me if I get the disease?”.

Prototype and Iterate Playbooks

As you ease into the crisis, rapidly prototype and iterate playbooks for different aspects of the crisis. I’m using a tool called Notion, which is perfect for this.

You’ll come to a point when you’re busy (we hit that point very quickly), and you won’t have time to focus on any issues that aren’t demanding your immediate attention. If all the key people have access to the playbooks, they can use the communication scripts and response checklists to get on with things themselves.

As much as you can, decentralise the execution of basic tasks (e.g. contact tracing at facility level, interviews with suspected cases, etc).

Practical Benchmarking

Be aware of what others are doing, but don’t fixate on it.

Organisations like the Asia Crisis and Security Group (ACSG) do great work conducting polls to benchmark things like travel restrictions, business continuity policies et cetera.

By all means participate in polls like this, and reflect on the results, but at the same time remember that every organisation has different requirements. Where work from home may work for one organisation, it may be impossible for another.

Ok, that’s it for now.

We’ll continue to learn and iterate, and I’ll share additional insights when I can (most likely this time next weekend).

Stay safe, take care of each other, and don’t hoard masks.

If your organisation needs support during the COVID-19 pandemic, please feel free to reach out to us for advice and assistance. We can help you to implement mitigation measures, establish best practice for case management, or implement back to work plans that won’t place your employees at risk. You can learn more about what we do here.