Public Health Followership During Covid19: Are followers more dangerous than their leaders? Volume 5 - Issue 2

De Silva Prasanna*

• Department of Old Age Psychiatry, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Monkwearmouth Hospital, Newcastle Road, Sunderland SR1, UK

Received:May 11, 2021;   Published:May 19, 2021

Corresponding author:Department of Old Age Psychiatry, Monkwearmouth Hospital, Newcastle Road, Sunderland SR1, UK: [prasanna.desilva@cntw.nhs.uk]

DOI: 10.32474/SJPBS.2021.05.000209

Abstract PDF

Introduction

The Covid19 pandemic has been a hybrid of 3 components, a highly contagious virus SARSCov2 [1], a culture of fear leading to risk aversion [2], and an escalating sovereign debt overhang [3] risking austerity and loss of ‘non-viable’ jobs. Currently a ‘second wave’ involving all three components is underway. Followership is a recent notion within the leadership genre [4], with recent literature emphasising the effect followers have on moderating behaviour of leaders, through a combination of stable and dynamic factors, in keeping with the social impact theory [5]. Followers are expected to cultivate aptitudes to function in a subordinate role, whilst assisting ‘the Leader’ in enacting his or her wishes. Historically followers were volunteers to a cause, for example ‘people of the way’ who followed the teachings of Jesus, accepting the task of persuading others towards ‘God’s kingdom on earth’ There was no expectation of monetary or social gain, but a real risk of martyrdom [6]. However, over the last century followership has become professionalised, for example in medicine [7], with followers seeking employment in public services, charities or academia; motivated by monetary and career ambitions including the prospect of civic honours. Despite senior followers often having specialist expertise, which leaders have to depend on, they can suffer reputational damage on being demoted or transferred from their post if found wanting. In return, it is [or at least was], expected for leaders to ‘carry the can’ when actions by followers caused unfortunate outcomes. Consequently, relationships between leaders and their followers can be tense or ambivalent [8].

Known Knowns

Prior to Covid19, western governments had developed elaborate plans to manage pandemics. Early intervention was seen as crucial for avoiding exponential contagion and associated economic losses. Furthermore, ‘event 201’ - a scenario-based exercise was conducted in October 2019 organised by the World Economic Forum, the Gates Foundation and the Johns Hopkins University. This meeting concluded that robust organisational links should be created between public health agencies, universities and private logistics firms [9]. However, despite attendance of senior bureaucrats from all relevant stakeholders, no follow-through occurred; perhaps due to recent pandemics [SARS and EBOLA] petering out with negligible western deaths, probably compounded by public health bodies undergoing ‘restructuring’ with associated job insecurity.

Unknown Knowns [Pre-Covid19]

Leadership training in public services have tended to involve ‘in house’ expertise, rarely utilising insights from the financial sector. One key market risk analyst is Nasim Taleb; who coined the term ‘black swan’; events which are completely unpredictable but highly consequential, bursting bubbles of irrational investment; leading to major restructuring of businesses and public sector organisations. Taleb went on to write a follow up book; ‘Antifragilie; the things that gain from disorder’ [10]; the idea being that unexpected disruption revels fragile teams and organisations; which typically fold at an early stage during a black swan event, whereas other teams and organisations survive and thrive. Public services, charities and academia have largely ignored Taleb’s work, perhaps considering themselves protected from market forces, with posts guaranteed through public funding. Although these organisations have repeatedly discussed the need for ‘transformation’, this has not involved building antifragility. Furthermore, there is limited recognition that talented staff move jobs, to work with antifragilie minded teams and leaders.

On selection of senior followers, Warren Buffet [Berkshire Hathaway Investments] described his strategy in recruiting senior staff being based on 3 values; energy, intelligence and, most of all, integrity [11], suggesting that recruits without integrity could ‘kill’ organisations. Integrity, defined by C.S. Lewis as ‘doing the right thing when no one is watching’, is arguably not necessarily a quality foremost in public sector recruitment, where a talent to cut costs and capacity to remain ‘on message’ perhaps being more sought after. The other book relevant to followership is by Paul Babiac and Robert Hare; ‘Snakes in suits; when psychopaths go to work’ [12]. They describe 2 types of damaging followers, firstly those who use the organisational hierarchy to maximise power, and secondly, ‘enablers’ who enforce instructions of their leaders using bullying [13]. The consequences of these individuals include loss of trust between employees, loss of productivity and litigation when evidence of malfeasance comes to light.

Known Unknowns [Post Covid First Wave]

The main observation within the first 2 months of the pandemic was the failure by western public health bodies to communicate risks and safeguards to the public [14]. Perhaps they were awaiting guidance from the World Health Organisation [WHO], which delayed calling the pandemic, having ignored warnings on human-to-human transmission for a crucial 3 week period in January. These bodies were perhaps also awaiting orders from their political leaders, despite these individuals being conflicted on economic preservation and maintaining public popularity. However, public health bodies in the east, with experience of the original SARS pandemic, reacted promptly warning the public on the emerging problem alongside organising testing, contact tracing and quarantining of the vulnerable [15]. The other finding has been the gap between promises made by western politicians on testing and contact tracing compared to actual delivery of these targets. Despite the pre-pandemic protocols, public health has been unable to rapidly organise testing for the virus, alongside failures of contact tracing [16]. Early involvement of firms with track records on logistics was absent, alongside not involving private labs to increase testing capacity. It appears politicians were not aware of practical problems with delivery either due to subordinates not advising them of facts on the ground or due to followers wanting to please their masters with good news [including cost minimisation]. The decision by NHS England to discharge around 25,000 elderly hospital patients in April to care home beds before routine testing for SARSCOv2 was available [17] probably resulted in 50% of care homes contracting Covid19, with around 15,000 elderly deaths. This decision is awaiting legal review as there was no attempt to separate potentially infective people from the other residents, for example by setting up separate care home floors with dedicated staffing. The rationale for bed clearance was to ‘protect the NHS’ although in reality NHS hospitals did not come close to becoming overwhelmed [18]. Nevertheless, over 90% of care home residents were promptly placed on a combination of ‘Do not resuscitate’ orders and ‘Emergency health care’ plans, both reducing the possibility for active treatment of acute illness episodes. NHS England have denied influencing GP practices to carry this action and the government has ordered the Care Quality Commission to investigate blanket imposition of these orders in England [19].

Unknown Unknowns [Post ‘Second Wave’]

The main unknown pertains to how the virus will exert its effects on the population through continuing mutation, partly caused by attempts to degrade it by the immune system. There is concern that infectivity will increase [20], with long term disability affecting the heart, brain and lungs among Covid19 survivors, including those with ‘sub clinical’ initial symptoms [21]. Furthermore, uncertainty remains on effectiveness of the current crop of 11 vaccines undergoing human trials, especially on preventing community spread of infection, as viral carriage in the upper respiratory tract post vaccination is not guaranteed [22]. It is anticipated that spikes of infection will continue for the next 12 months resulting in local ‘circuit braking’ restrictions, although uncertainty remains as to the efficacy of these measures, partly due to less than full public adherence. Partially tested vaccines can be authorized for emergency use, but continuing concerns about delivery, storage and public uptake remain [23]. An evidence-based case for population wide prophylaxis using Vitamin D and Zinc supplementation has been made to public health bodies [24,25] in the face of commercial interests of vaccine and drug manufacturers.

Conclusion

Covid19 has cast a harsh light on weaknesses of public health bodies in the west and the resulting risk to populations they were meant to protect. It seems unfair to solely blame their political masters, as they are highly dependent on competent civil servant followers, who monitor situations on a week-to-week basis and take operational decisions. Differential roles of elected leaders and their subordinate followers needs redrawing, to avoid loss of public trust due to failures in delivering on promises. Followers must speak ‘truth to power’ on realities on the ground, whilst focusing on building ‘anti-fragility’ within organisational teams, utilising scenario planning and stress testing, thereafter by updating and simplifying practice algorithms. This would free up leaders to communicate with the public with confidence, whilst formulating the future direction of travel [‘the vision’]. This demarcation of roles would produce less conflict and better service delivery going forward, despite recurring ‘black swan’ events. Furthermore, ethical responsibilities of followers need redefining; with an emphasis on duty of care and candour towards the public who ultimately fund them through taxation. This includes admission of mistakes and the courage to ‘whistle blow’ if concerns on public safety are not being acted on by their political masters. Furthermore, capacity for integrity - described as essential by Warren Buffett - will need to be prioritised in recruitment post Covid19.

References

1. Kumar M, Kaling T, Gahlot R (2020) A chronicle of SARSCov2: Epidemiology, diagnosis, prognosis, transmission and treatment. Sci Total Environ 734:
2. Barone M (2020) Covid19 shows we are more risk averse than post World War II Americans.
3. (1963) UK public debt exceeds 100% of GDP for the first time since 1963.
4. Uhi Bien M, Riggio RE, Lowe KB, Carsten MK (2014) Followership theory; a review and research agenda. The Leadership Quarterly 25(1): 83-104.
5. Latane B (1981) the psychology of social impact. American Psychologist 36: 343-356.
6. Apostle Paul, Philippians Ch. 1; 21-30 of the Holy Bible.
7. Gibbons A, Bryant D (2013) Followership; the forgotten part of leadership.
8. Jay A (1980) ‘Informed sources’ the literature that lay behind the BBC television series, ‘Yes, Minister’. London Review of Books 2(10).
9. (2019) Event 201: Public-private cooperation for pandemic preparedness and response. A call for action. Johns Hopkins centre for health security.
10. Taleb NN (2012) Antifragilie; things that gain from disorder. Random House. ISBN 13: 978140067824
11. Buffet W (2015) My recruitment style.
12. Babiac P, Hare RD (2006) Snakes in suits, when psychopaths go to work. Harper Business ISBN 13: 97800608387.
13. De Silva PN (2014) Tackling Psychopathy; a necessary competency in leadership development? Progress in Neurology and Psychiatry 18(5): 4-6.
14. McGill University. Institutions and governments during the Covid-19 pandemic.
15. You J (2020) Lessons from South Korea’s Covid19 policy response. The American Review of Public Administration 50 (6-7): 801-808
16. Blackburn P (2020) A hidden threat; test and trace failure edges closer. News and Opinion.
17. National Audit Office. Readying the NHS and adult social care in England for Covid-19.
18. The British Medical Association. The hidden impact of Covid10 on patient care in the NHS.
19. Ford M (2020) Government orders review of DNACPR orders during the pandemic. Nursing Times.
20. Chen J, Wang R, Wang M (2020) Mutations strengthened SARSCov2 infectivity. Jour Mol Biol 432(19):5212- 5226.
21. Greenhalgh T, Knight M, A’Court C (2020) Management of post-acute covid-19 in primary care. BMJ 370: m3026.
22. Jeyanathan M, Afkhami S, Smaill F (2010) Immunological considerations for Covid19 vaccine strategies. Nat Rev Immunol 20(10): 615-632.
23. The DELVE Initiative. SARSCov2 vaccine development and Implementation: Scenarios, Options, Key Decisions.
24. Kaufman HW, Niles JK, Kroll M (2020) SARSCov2 positivity rates associated with circulating 25-hydroxyvitamin D levels. PLOS One 15(9): e0239252.
25. Wessels I, Rolles B, Rink L (2020) The potential impact of Zinc supplementation on Covid10 pathogenesis. Front Immunol.