Navigating Uncertainty: Lessons from the Frontlines of COVID-19 Testing

Adam  

Welcome back to This Anthro Life, the podcast that explores the intersection of anthropology and everyday life. I'm your host Adam Gamwell. And today we have an episode to intrigue you, challenge your perspective, and leave you with a renewed appreciation for the power of science and decision making during uncertain times. Have you ever wondered how our society can better prepare for future crises? And what does anthropology have to do with that? So today we're going to deep dive into the realm of crisis response, decision-making under uncertainty, and the importance of diagnostic infrastructure. Probably not the first thing you thought we were going to talk about. Now, in a world that's still grappling with the aftermath of the COVID-19 pandemic, it's become abundantly clear that preparedness and coordination are key factors when facing any crisis of any magnitude. And if one object were to symbolize COVID testing and response, it might be the nasal swab. Now, I certainly remember the first time I had one of those swabs that went into my nose so deep that I thought it was going to hit my brain. And if you recall during the early months of the outbreak, it seemed that nobody really knew what was going on. We found ourselves in the middle of a global pandemic and our healthcare systems were pushed to the limit. In the absence of any coordinated federal response, public safety and information, including diagnostic tests, had to be created from scratch through private sector partnerships. What many of us don't realize is just how Herculean of a task this was. So today we speak with one of the leaders who pulled it off. And I'm excited to introduce you to Dr. Jon Cohen. He's a surgeon of over three decades and expert in healthcare policy and business strategy. You see, Jon was CEO and Executive Chairman of BioReference Laboratories when the COVID-19 pandemic struck. Dr. Cohen led Bioreference to national prominence to become one of the country's largest providers of COVID-19 testing and the nation's leader in surveillance testing. He's somebody who's seen firsthand the triumphs and setbacks of testing during crises, and lived to write about it in a new book aptly titled Swab. And Swab is the story of how bio-reference laboratories, working with no roadmap, with no federal guidance or support, and no prior pandemic experience, established the processes to test every imaginable segment of the American public. We'll discuss how Dr. Cohen led teams at the forefront of COVID-19 testing efforts, developing innovative solutions to provide mass testing to communities in need. And this includes the first ever drive-through testing centers that we saw in New Jersey, partnering with the NFL and cruise lines, and even working with the NBA in a tightly controlled bubble so that the season could continue. But this is also not just about science or celebrities. The decisions made during a crisis have direct impact on people's lives. And so in our conversation, Dr. Cohen's going to break down the challenges that they faced, the difficult decisions that had to be made without complete information, and the importance of learning to trust your instincts. We'll explore how the lack of preparedness and coordination in testing during early stages of the pandemic shed light on the flaws in our system and how we can learn from these experiences to shape a more resilient future. And finally, we're going to discuss the importance of leadership, collaboration, and compassion in times of uncertainty. This is something that we've all been through, and it's been tough to think with and deal with. So whether you're a healthcare professional, a sports enthusiast, or simply curious about the inner workings of crisis management, this episode is for you. So make sure to subscribe to This Anthro Life on your favorite podcast player or YouTube player. Feel free to leave us a review or comment to help support the show. And don't forget to explore our extensive library of previous episodes. Each one is offering a fresh perspective on the world that we live in. So let's dive into the fascinating world of building up COVID testing from scratch with our guest, Dr. Jon Cohen. Let's get started. Well, Jon, I'm really excited to talk with you today and I appreciate you hopping on the podcast this Anthro Life. And so I think kind of a way to help us kick off is just say, you know, welcome to the program. And I'd love to get a bit about your background and kind of how that shaped your role and the work, you know, with BioReference Laboratories that we'll be talking about today, as well as what you're doing with Talkspace from the outbreak of COVID until today. But so first off, thanks for joining me on the program today.

Jon

Thank you. It's great to be here.

Adam 

Awesome. So I'd love to get this sense, too, in terms of telling folks a bit about your background and kind of giving us an introduction to the work that you've written with Swab as well as the kind of the stories that we'll talk through. But so how did you kind of find yourself into the in the world that we'll be exploring today in terms of diagnostic laboratories?

Jon 

So I'm a physician by training. I went the academic career and then ended up running a large part of a medical center and then chief medical officer for a large health system and Really got into health policy in a pretty deep way. I did a lot of public speaking and ran for public office actually for Lieutenant Governor of New York and ended up at the state running a lot of policy and strategy. And from there I ended up in the diagnostic world. So I was at Quest Diagnostics for over nine years in a senior leadership role. That's where I really learned about the diagnostic industry. From there I moved over to be executive chair and CEO of BioReference, which is one of the largest commercial laboratories in the country. there for barely one year when COVID hit, which of course changed my life and many others for the subsequent three years. I took some time off and I had been on the board of Talkspace because I have a real interest in digital health. I was invited to be on the board and after being on the board, they were looking for a CEO and they asked me if I would consider coming off the board to be CEO, which I did and accepted that role nine months ago. It's a long, complicated, sort of silly story, but that's how I ended up here today.

Adam  

Right on. No, I think that's exciting. And I mean, in the book that is just kind of coming out into the public here around called Swap, that's giving us the kind of story into the world of diagnostic laboratories and how you led teams through really unprecedented and uncharted territories. It's really this fascinating look, because I think for a lot of folks, diagnostic laboratories are not the first place their mind goes. And they're thinking about their COVID-19 experience, right? And you even talk about this in the book, too, that it's not where people tend to jump in terms of their reference points. And so I'm curious to think about this as we open up this, this part, like why was it important to tell this story around bio-reference laboratories and diagnostic labs today? Sure.

Jon

So, you know, most, it's so interesting. Most people, you know, they go to the physicians, they go to the hospital, they get a lab, they get a, they get a blood draw, right? In this case, it was a swab, but you know, you get, you get a test done and then you wait, you know, a couple of days, whatever it is, depending on what the test is, and you get your result back. But that, that by the time you go and get your blood drawn or swabbed on that, you get the result. No one, literally 99.9% of people have no idea what's in between that. Like how does that all happen? And it's just, no, I get my result and they would. What happened with COVID, of course, it elevated and put it in the minds of people, diagnostic industry that no one really ever thinks about. I mean, no, no one really knows about that much about Quest or LabCorp except, you know, they get a lot of bills and they pay them or, or by reference in that case. So, so I really want, I want to tell the story about what happens in between because it turned out there was a huge lack of knowledge and there was this massive misconception about what was going on with COVID and COVID testing and getting your swab done and why am I waiting so long and where can I get my result? It was a story that I really wanted to tell for a variety of different reasons, but one of them was that reason. I just wanted people to know what actually happens. What happens after you're in a drive-thru and you get this thing, this cotton tip swab thing stuck up your nose and You know, what happens after that? And, uh, and that was, that was part of why I wanted to tell the story. Hmm.

Adam  

Yeah, I think, I think that's a, that's a really cool idea. And then, cause that's something that, that really opened up my perspective too. Cause again, I hadn't, I hadn't thought much about that side of things. My, uh, my wife is a, is a microbiologist. So I had some semblance of an idea of, of lab work and pipetting and the importance of that side of it. you know, I think again, like an average, an average person is not going to be thinking about these pieces. And so even as you, as you noted there too, that was kind of one of the, one of the impetuses behind the book was to help tell that story of what happens in that, that kind of black box space for a lot of people. Then definitely another, another piece that, uh, you know, I took from the work and that I saw was, was, and you, you mentioned this too, that there is such a level of unprecedented coordination required. for putting together these, these, uh, these different Herculean tasks. I mean, and, and just even the, the kind of list of stories that you go through in bio-reference lab that you, you worked with in terms of like New York's first drive-through, you know, the NBA bubble test, the NFL teams that also then for the Buffalo Bills and the, the NFL actually going into the stadium too. So there's, there's a ton of, I think, really fascinating stories about this. And so I'm just curious, you know, that like a lot of these obstacles that you had to go through, you were kind of building the plane while flying it, while putting a compass together, while coordinating with ground control. You know, I'm just curious, like, you know, from your perspective, reflecting back on these experiences, like what were some of the key obstacles that you and your team faced when you're kind of putting these procedures together?

Jon 

So first, again, think about it, you get a swab and then what people don't know is it gets, you have to fill out information, which nobody has before, you got to put it in the form, you got to put the form and you got to label the tube, you send it to, then you got to transport it. We need a whole logistics network to get it from where you had it done to the lab. Now think about it, at the peak, we were testing 80,000 specimens a day, right? 80,000, it's hard for you to imagine, right? In a lab, all that data needs to be entered in a computer system. Then the tube goes over to the lab, it has to be pipetted out, you know, it's an infectious disease. It gets isolated, it gets put onto these analyzers, the results come off, and then we have to get the result to you. Like, how are we gonna get it back? You have to get it back through your employer, through your email, through your text, whatever. And you're doing this, you know, within a certain period of time. None of that, on March 7th, Right. None of that existed in terms of the ability to do it. The logistics network wasn't there. The IT systems to develop the result wasn't there. We didn't have the supplies to do it. And basically, so you're saying, people used to say outside, well, it's like you're building a plane while you're flying it. I used to tell people, not only were we building the plane, we had no compass, we had no ground control, and we were totally blind, and we had no idea where we were going. So it was this ridiculously complicated set of events on top of which it was unprecedented because no one had ever done it before. So then you say, well, what are the obstacles we were up against? Well, we were up against, We were up against one, we'd never done it before. Two, we had no idea what this disease meant. Three, every time we tried to do it, which I mentioned in the book, every crisis, a lot of crises, you have an event and you deal with it. Here, the crisis kept changing every single day. You probably know, at the beginning of the book, I have a quote, it says, COVID is where intuition goes to die. And I kept that on my whiteboard. Because every single day that I thought something was going to happen the next day, something else happened literally every day. So that way we were up against that. And then of course we were up against supply chain issues. We couldn't get what we needed. And then of course we, quite honestly, we were getting almost zero help from anybody. So, and then on top of we had to recruit, we went from 4,000 to 8,000 employees. Right. So it was truly uncharted territory for us and for everybody around us.

Adam  

Yeah, that was, I mean, that's, I think one of the most incredible pieces about this too, is that this had to be created on the fly in real time and it changed every single time. And I love, I love that kind of opening post that you had there too, that, uh, you know, COVID is where intuition has to go to die because every time we think we know something, the situation changes the next day, you know, whether it is how infectious a variant is or that, are we even testing for the right variant? How do we know when that's happening?

Jon 

And then the variants changed. Yeah.

Adam  

Right on top of that.

Jon 

Exactly. You know what that meant, right? And then people say, well, then point of care came about, meaning rapid testing, and then home testing came about. And then you had a resurgence in Delta and then Omicron. So there are literally almost hundreds of different events that happened during the two and a half years of COVID, none of which had really been predicted or happened before.

Adam  

Yeah. And I think, you know, as you kind of walked through the, that process of that happening, you know, and if you reflect back on the different areas, like, so that one of the first ones kind of in the, in the narrative timeline was, was developing the, the, the first drive through kind of a New York work with Andrew Cuomo. And so tell me a little bit about how that, that process came about. That was a really kind of fascinating opening point of, of when it kind of dawned on me as the reader and thinking about this as listeners too, when we realized how big the scope of trying to coordinate this was going to be.

Jon 

So, so I tell the story of the book literally, you know, I'm sitting at home watching, uh, watching the news and, you know, my wife sees the reference to what was going on in South Korea and South Korea really developed the drive-thru technology. And, and she literally, she goes, that's a pretty cool way to test people. And we, this is beginning of March and, you know, we were just beginning to figure out like, how are you going to test people? Remember. People couldn't go to doctors, couldn't go to the emergency room, couldn't go to hospitals, and there was nowhere to get tested or an urgent care. So nobody was doing testing because everybody was afraid that you were going to bring the disease to them. So then the question was, well, how are you going to test people? And that's how, at the beginning, how drive-thrus evolved. They said, okay, let's set up these drive-thrus. And the first one that was in Washington State was when the first case came to the country. And then, of course, we had the signature case here in Pelham in New York, in Westchester, with, you know, which is where it appeared on the East Coast. So we had just beginning to look at the drive-thru as a as a way of delivering care. I knew Andrew Como for when I had run for lieutenant governor. He was running for attorney general. So we went way back. He, of course, eventually became governor. And we'd stayed friends for years. And literally, he called me, said, you know, I know you're doing COVID testing. what's your capacity and can you help out the state because we desperately need more testing. And I committed to him that I would give him the majority of our testing at that time, as soon as we were up and running. And at the time, it seemed like a lot. I said, I probably could give you about 5,000 tests a day, which of course, was a joke subsequently, because we then ended up doing 80,000 with the capacity to 180,000 tests a day. So we designed the drive-through. And the big thing, the big difference for BioReference is one of the biggest decisions we made was to do, to be full service. And what I meant by that, so when we did these drive-throughs, or all the other entities I'm sure we'll talk about, we went out, we provided the staff, we swabbed the people, we provided the on-site technology, we provided the logistics to bring it back to the lab, and we did the testing. So when people called us, we had a full suite, you know, a deliverable solution so that you didn't have to go out and hire all these different people. A lot of people call, they say, oh, you do the testing, but what do I do about nurses? And who do I handle? And how do I make it? How do I design a drive-thru? And what do I do about the police? And where should it be located? So we, we had a full service soup to nuts operation, turnkey operation. which evolved out of the drive-thru that we set up in New York and then subsequently all around the state and then across the country. So that was the evolution. And yes, we kicked it off with Northwell Health, myself, and the state of New York where we opened the first drive-thru at the State Park up in Pelham. And I'll never forget getting there and seeing these hundreds of cars lined up to get tested. People come through, roll down their windows and get swabbed. It was all new. It was new to the American public. None of this had ever been done before.

Adam  

Hmm. How did you feel when you're, when you're standing there kind of watching the cars roll in for the first time?

Jon I was pretty afraid that I was going to get COVID. I mean, I, you know, like I remember at the beginning of COVID, you know, people had no idea. People were beginning to die. Was it infectious? Could it be treated? How did you protect yourself? You know, it was, it was a scary time. You know, I felt obviously very proud for the company because I knew we could pull it off, but it was, it was just absolutely, you know, groundbreaking, you know, precedent setting. It's probably the better word.

Adam 

So, yeah. No, I think, I think that's the, that's the exact right way to think about that too. Cause it was, it was setting this precedent that we hadn't seen before. And I think there was, I mean, it was really powerful too about this. And we can dive into some other examples to bring this to light as well is. how, you know, basically, you know, to kind of reiterate this idea that it was both building the plane with no compass and no ground control too. And that like there was zero coordination at the federal level in terms of how this can get put together. And so it was really kind of up to you. And that was something interesting to think about where it's like, we have public laboratories, we've got university laboratories, and we've got commercial laboratories. And really it's like thinking about that question of scale. It's like the public laboratory spaces were just not set up to work at this, the scale that we needed, right? And so it's an interesting kind of question of like, how do we know when, uh, you know, when, when we need commercial spaces to step in like this, and this is a great example of, you know, where we can have public private partnerships that work really well together. Um, and so I'm kind of curious about your, your thoughts in, in this arena too, obviously, and you said like Governor Cuomo called you at the time to help get the first run going, but how do we think about this idea of like, when we, we obviously need commercial and public and private partnerships together, especially in things that are, that are this kind of grand and scale. Um, so how can we think about that for, for addressing this kind of issue?

Jon

You know, the, the, the easiest analogy is what happened during world war II, you know, and that actually basically the U S turns, you know, turn to begin to make planes, right. They took all the battery base. That was part of the issue about, you know, using the defense act. They never really effectively use it during COVID. Um, but the, the problem was. in terms of the private sector doing it is the public health labs serve a very valuable function. They go out and if there's an outbreak, they're able to test people. But they can only test a couple of people at a time. They don't have the bandwidth. Universities and the research labs are the same. They're not designed. It just turns out that the commercial laboratories are designed to do high-throughput testing. That's what we do. We're in that business. So eventually the universities and some of the health systems had enough testing to provide for their patients, not at the beginning, because we also were doing testing for, I can't remember how many hospitals and health system because they couldn't scale either. We just, we just had the ability to scale because that's our business. We had the logistics, we had the ability to take, you know, thousands of specimens, put them through the IT systems, develop the IT systems. So we work at a different kind of level than people at universities and public health labs. And that's not a criticism, that's just what we do, right? We're a commercial industry that knows how to test. Remember, we do thousands and thousands of blood tests a day, right? So we know how to scale. And then we knew we had a partial logistics network in place, so we also knew how to build a pretty big, massive logistics network across the country to scale that also. All of those factors into it, it's that it's not atypical if the government has an issue to go to the private sector because they know how to do it. Look at planes now. I mean, if the Air Force needs, you know, contracts, they partner with the private industry to build what they need to build because government isn't made to do that, nor should they. So I'm a big believer in the public-private partnerships. It just has to be crafted in the right way. And that's what happened. You know, you referred earlier to New York City. Now, New York City eventually developed some ability to do testing, but we tested over 80% of all the public school students in New York City. We had the relationship in New York City, we had at one point over 100, 110 teams of people testing five to 600 schools, up to 5,000 students a day. Wow. We built that from scratch, same thing. How do we, how many people on the team, how are we going to get them out there? How are we going to get these kids tested? Who's going to get tested? How are we going to bring it back to the lab and how are we going to get the results back within a period of time that you can act on the results? So, you know, again, big public private partnership for us was our relationship with New York City.

Adam 

That's a really interesting point of the book too, because when you get to schools and with kids thinking about this, obviously parents have ideas of what other kids should be taken care of and what should be keep them keep them well or not, you know, so it's like you're adding an extra opinion elements there in terms of like, what's the best way to administer care and check and having both parental permission right in that regard. And then obviously, how we get them back to the kids in time and like, you know, especially if they're at school for different days of the week, for example. can totally change all those logistics up, you know, so it's like never the same thing twice. One thing I was thinking about with this too that really stood out to me that's also part of the book that I liked is that we both have these kind of different narrative areas or timelines that we can walk through in terms of, you know, the New York Public Schools, the drive-thrus, and also MBA I want to talk about here in a second. But part of this is that you're looking at is there's like the theme kind of of crisis leadership that lays throughout the book, right? And so you have some lessons for folks to think about as they're going through these different stories and then saying, what do we take away from this as we're trying to put these pieces together? And so I'd love to kind of get your sense. I've got a few of them that stood out to me that I want to ask you about, but I want to see if there's any off the top of your head in terms of leadership qualities that you kind of thought about across this this story that stand out to you that you still think about today of like, OK, this is definitely one that I'm applying in talk space right now.

Jon

Yeah, unless each each chapter has a has a small section about what I'll call, you know, which is really leadership. you they're not lessons, but they're, they're things for people to read about relative to how you lead during a crisis or the, what became important to us and to me during, during the crisis. And, and they're applicable to, to many other parts of leadership. So, you know, a lot of them, you know, are very important to stand out to me. I mean, picking great people, staying out of their way, keeping your hands on, you know, you got to walk the walk, as I say, and talk and, and be down there and understand that, you know, you have to, There are some other things we can talk about, about gut reaction and listening to your inner voice. But things, you know, other things that have always helped me, I think, you know, I definitely talked about is keeping in touch with people. I think that relationships are absolutely unbelievably important when you're in a leadership position, because you never know who you're going to call or who's going to call you. You know, owning up to your mistakes and, you know, just keep moving on, making sure that who you're serving is always right. I mean, as I always say, the customer is king. which is not easy for some people is, is not be afraid to make decisions. I mean, you're going to make good ones and you're going to make some bad ones and you just got to keep, you know, like I say, pushing through it and you got to treat people well. I mean, talk about this all the time. I teach leadership at Columbia. One of the most important things I tell people is you really should be nice to people because you never know what goes around comes around. And that's not telling a cheat, that's actually really true. I can't tell you how many times things have come back from people that I was able, had the good fortune of being involved with and treating them well has helped me in the future about all sorts of things, that they were helpful to me further on. A lot of lessons, you know, which I say were, you know, observations of leadership that are in the book that hopefully people will read about in addition, of course, to the sports things, which I think we'll get into soon.

Adam

Yeah, yeah, totally. Yeah. Yeah. So with that, I mean, one of the ones you mentioned there, too, is this this idea you call it listening to to the little man, right? Listening to that inner voice. That was a really interesting kind of first piece to stop. So tell me a little bit about this idea. Like, how do we trusting our inner voice. I think it's an intriguing and important prospect as part of leadership. So how did this happen for you in this timeline?

Jon

As I relate, I'm a surgeon by training. And there are different personalities in medicine, as you can imagine. Surgeons tend to be able to be decision makers, or they could decide with uncertainty in certain situations. But having said that, I've had a lot of experience, I've practiced for close to 20 years taking care of some really sick people as a vascular surgeon. And the brain has an unbelievable ability to assimilate all sorts of information really quickly. A little bit goes, we can talk about the book that's Blake about how you assimilate where people are. And what I mean by that is you can look at a patient and certainly a surgeon, and there's a whole bunch of factors that go into it, whether the patient has a fever or just doesn't look right. There are clues, and you can either assimilate that information and listen to your inner voice and say something's wrong, or you could not listen to your inner voice and try and make an excuse that something's really not wrong and the patient's gonna be fine. And that's a really, really fine line. as a physician to walk because you don't want to be wrong. In surgery, a lot of times that means you're making a decision to take a patient back to the operating room because something's going on and that's a tough call. So I always, I used to tell people all the time is listen to your inner voice. Listen, I call it little man syndrome, which means there's a little person sitting on your shoulder and he's whispering in your ear all day long. And you either listen to that person or you don't listen to that person. And you frequently know that that little voice is telling you the right and the wrong. And some people listen and some people don't. So for COVID, there were a lot of things we had to make decisions on without enough information. We just had to make a call. And as I said, some were right, some were wrong. We were fortunate, I think, we made a lot more right calls than we made wrong calls. And that's what that inner voice does. You just say, okay, this is where we need to head, and you just have to trust your instincts. And it's more than instinct. I wish I could put my finger on it, but there's no question it's the ability, it's the amazing ability of the brain to assimilate all sorts of information and come out with the right answer.

Adam

I love that idea too. Do you feel it's also, I agree with you, it's like instinct is not quite the right word, but it points us in that direction. But I think it's also right, the idea of assimilating experiences over time so that it's more honed in, that you can more quickly assess what would be better course of action that's going to give you the outcome you're looking for.

Jon

I mean, you know, listen, everybody, I think most people know and blink is, you know, that whole thing about, you know, knowing quickly when you meet somebody, but I think, you know, within a short period of time, when you meet somebody, you want to like continue to talk to. Oh, befriend this person or you don't. Now, whatever that is, some, there is something comes out. There are some clues that gives you that information about, about whether or not, I'm not saying it's certainly not always, a lot of people were wrong the first time, you know, that whole first impression thing. But a lot of time you're right. I have to tell you, a lot of times you're right.

Adam 

Right on, right on. I think that's a really interesting piece to think about because as the story develops, I'm excited to kind of dive into some of the sports stories too, and you know, working with the NBA, with the NFL, because I feel like even this idea of how do we both listen to ourselves and kind of develop that inner voice, I think comes up in conversations around how do we also respond to the broader public, you know, as part of that, too, because we're making decisions on one level for our staff and then one level, of course, in terms of how public response to things. I thought this is a really interesting challenge for I'm just going to dump us into a challenge point that was that was that took place when you're working with the NBA is that that really stood out to me was this interesting question of people are kind of saying, well, why are you prioritizing athletes? You know, why are they getting kind of testing treatment? And you had a really good response to that. So I want to give you the space to kind of talk about that area. Cause that was something that stood out to me that often gets really interesting leadership qualities to think about, but this is an interesting space. So tell me a bit about this, this moment, you're working with the NBA, you're the kind of the exclusive provider of testing. You've set up an entire village in Florida for them.

Jon

So if you remember, the NBA tried to finish their season, then they were going to do the playoffs. And they made the decision to do it at the ESPN Center in Orlando. And they basically formed this bubble, which is total lockdown. Couldn't get in, couldn't get out unless you got tested. We were chosen as the provider. We had a lab about an hour away. in Melbourne, Florida, and they, uh, and we were running shuttles, you know, 5, 10 times a day. We were, we had 120 people on staff in the bubble and we were the exclusive provider. Again, never been done before. Testing outside, bringing it back. I mean, testing, doing it, swabbing, bringing it to the lab and getting the results turned around so that they can finish the season. And by the way, they had a zero COVID rate in the bubble. Zero, unbelievable, it was miraculous when you think about it, right? In terms of the protocols they put in place, lockdown, players had an unbelievable amount of rules, what they could do, what they couldn't do, and they pulled it off. But what you're referring to is, we began to get criticized. Remember, this is early on, this is June, of 2020, the COVID, we'd get some press and they would say, well, why are you testing NBA players? Why are those so special? You're wasting COVID testing on people that shouldn't have it as opposed to other people get it. So there are several things that occurred. First off, when we started COVID, we initiated at least our priorities. And my priorities as a physician was very clear. People in the ICU, health care workers, frontline workers, all get first shot at our testing. So we actually had a special markers in place where you could, in the field, identify those people. So when they came to the lab, they went to the front of the line. So anybody who was in those categories, as I said, worked in the hospitals, patients in the ICUs, frontline responders, police, fire center, they all got priority, right? So they were number one urgent priority for us. After that, then the question is, well, who then should get tested? So people who are on frontline, like delivering certain services like grocery workers, do you test people who are bus drivers or train drivers? Do you test people who are delivering other really important services? Do you, do you test the general public? And it began to get on and on and on and on, like who gets tested? Who gets priority? How do I know if the general public, if somebody's getting tested because they want to get an airplane to go visit their friend? How do I know that they want to get tested because they want to go to a birthday party? How do I know if they're getting tested just because they don't feel that well, they feel like getting a test? So what we did is we prioritized the people I talked about. And then after that, I said, when someone tells me, like the US government, how to prioritize who comes next, I'll be glad to follow those rules. But you know what happened? They never issued any guidance. There was no guidance about who should get a test, because everybody's in the same situation. Nobody knew who to test. How do you decide? It was such a free-for-all. that there was just no way. And by the way, people love the idea that the NBA was actually playing. They had something to watch on TV. And one of the most important things is by keeping the NBA functioning, there were thousands and thousands of what I'll call middle class workers who were earning a job, going to work, earning an income, and keeping their families safe because we kept the NBA running. So it wasn't just about like I'm testing a player, it was that we were providing a mechanism so that they could continue to function, and a lot of people kept their jobs as a result of that. And the result of them keeping their jobs is they kept their families safe, and they were able to bring a home. They were able to basically bring a check home. So we're pretty proud of it, actually, to be honest. But yeah, we did catch a heat at the beginning. For sure. Yeah.

Adam 

No, I think that that was, that's a great response to because that's what really stood out to me as well is that, you know, part of it is, you know, it's the press are not bad guys, you know, but it's just like this interesting kind of question of like, sometimes stories can get a little bit spun out or like asking, like, they're focusing on one area, but it's like, When you look at that bigger picture, and this is actually I think speaks as a nice like encapsulation of actually as we as we turn our attention to what the diagnostic laboratory work environment has to be like in the space as you're building it, it's like this is showing us, oh, actually, we were saying, oh, why are you just testing players? But like, we're not actually we're actually prioritizing, you know, ICU physicians, health care workers, and also again, providing a lot of work for a number of other folks as well around the entire NBA.

Jon
 

I remember asking some of the press people to be like, Okay, what do you want me to test? Let me, send me your list. You know, it was like, you know, you know, it was like radio silence. Right. What's that? Right.

Adam 

Yeah. Yeah, totally. Yeah. But I think that that's the, I think the important part there too, or it's like, yeah, if we don't have that list, then, then we, you know, then we have to kind of make those calls. And I think that like healthcare workers and frontline workers is like the, the most sensible thing to do. So like I was, I think that was the right, the right move, but interesting just to kind of notice how that, that can take place. And then with that, too, you know, you somehow every single story scales across this timeline. Right. And so we've we've gone from getting the first drive through testing in New York and then to dealing with the supply chain shortages around swabs and then, you know, moving through NBA into into the NFL now. And they're not just NBA players in Florida. We're talking about 32 teams across the United States. How did you even say yes to that?

Jon

So the first of, you know, hopefully whoever's listening, if you're a sports fan, please read the book because you will be, there's at least two, three chapters of, you know, two big chapters book that's related. If you have any interest in sports about how we pulled it off. So, so we got, so we were in discussions with, with the NFL. We, we won the contract for a variety of reasons. One, we were really good at customizing the solution. We were good at partnerships. We had done the NBA. We knew how to deal with professional athletes. So for a variety of reasons, I think, you know, we ended up being the NFL contract. Now the NFL, as you said, 32 teams in 30 cities, right? Most of which we had no presence in. We have five labs across the country. So we built a solution to put our, so we had 10 to 15 full-time staff at every single NFL team in the country. we couldn't go into the training centers, because remember, nobody wanted to contaminate the training centers or anything else. So we came up with a solution where we rented these trailers, and the trailers had three or four examining rooms and an office in them, one entry in the front, one in the back with bathrooms, and every single NFL team had a trailer in the parking lot outside of the training facility. So we installed the trailers, they all got water, they all got set up ready to go, we had full-time staff, and those staff were the only people that tested that particular team and actually ended up traveling with the teams. So we set up a logistics network to be able to test. So we were testing 5,000 to 6,000 players, coaches, staff, every single day for the 32 teams in the 30 cities from around the country with a very short turnaround time. And our commitment was not to get any game canceled and not to have any player excluded unless he was really tested positive. And it was a huge learning curve for everybody, because again, never had been done before. And the NFL was great. They were unbelievably terrific partners in terms of helping us figure it out. We had some huge bumps along the way, but like you'll see in the book, we did 256 games, we finished all the playoffs, and we did the Super Bowl. You know, we, we, we help the NFL finish season. And I will tell you, I don't know what the odds are, but if you went to Vegas back in September of that year, the odds that the NFL will finish the season were really, really low. I mean, there were, you know, there was a lot of people said there's no way they're going to get through the season. And they did to their credit. because of all the things they put in place, and plus we had the opportunity to do testing. But we had a lot of bumps. We had some really interesting stories, which are in the book, about things that occurred along the way. I mean, we had what was called travels. We had chain of custody, which means that every single specimen was tracked the entire way from the time they got swabbed to the time that result got reported. So we had about two thirds were on the ground, which means every single specimen was driven by our drivers. And in the air, every single specimen was collected, brought to the airport. We ended up checking it, like you do at the gate, picking it up, bringing it to the lab. So we had basically chain and facility control of every single specimen, for every single team, for every single staff and player, for the entire season.

Adam 

Incredible, incredible, right?

Jon

It's just like… On top of it, if you remember, we then did the playoffs for the Buffalo Bills. You know, the same thing. We got a call from the governor's office. Can you test eight to 12,000 fans within 48 hours of the game so that everybody who goes to the Buffalo stadium for the playoff game is COVID negative. And we did, we pulled it up. We, we tested, you know, whatever it was, 8,000 plus fans within 12 hours. swabbed them, 35 lanes of traffic in the drive-thru at the Buffalo Stadium, collected the results, drove them back to our major lab, tested them, had the results back within 12 hours.

Adam 

Yeah, that's incredible. Like the operations there alone is just like, even thinking of 35 lanes of traffic by that self in a parking lot at a Bills game is insane.

Jon

And by the way, December and January.

Adam 

Oh yeah, of course, right. Yes, yes. So just in case it might snow. Yeah, exactly. Minimally frozen, right? Yeah. Um, something I'm curious about too that is interesting is that as we, as we think about the, the different, uh, reflections around, around, you know, what does it mean to lead in moments like this? Uh, there's, there's two, two points that I'm curious if there was how you see the relationship between these two. One of them is this idea about protecting your reputation, you know, kind of at all costs when, when, obviously we're looking at supply chain issue and challenges of like, how do we build this thing that has never existed before? I was thinking about that in conversation with one of the challenges that you ran into when working with the, with the NFL was the, uh, there was one kind of tainted supply, you know, of, of, uh, which ultimately, yeah, ultimately it was not your, not even the, you know, the, your, your fault in this case, but there's interesting thing. You just said, well, we had to eat crow or whatever, and we'll just say it was us to the press. Cause it's easier than trying to deal with trying to read, change the story in that perspective. So I'm curious about these two. perspectives of like, how do we protect our reputation, but then also the other, the lesson that you kind of pulled out here too is, is, is this idea of like, how do we be honest and deal with a crisis honestly?

Jon

So I've had two prior life experiences on the medical side relative to dealing with, you know, really big crises. And, and, you know, there's a lot of, you know, a lot of things to point to when there's a crisis and what you do, and this is my view, and I'm sure, is one, own up to it, tell the truth, tell exactly what happened, and if need be, just take responsibility, apologize, and move on. You cannot, the problem you get into these crises, I hate to say it, you can't be influenced by a lot of the legal issues that will serve it. The first thing, the lawyers will frequently say, like, you can't say this, you can't say that, we're gonna be sued for this, you're gonna be sued for that. And it's always that pull. You've gotta, like, shut it down and don't say anything till we can figure it out. And my view is, go public, tell people what's going on, tell them the truth. If it's a mistake, own up to it. And that's exactly what happened. It happened once before, twice before, and it happened during the NFL before preseason. We had, uh, I got a call, it was a Sunday from my chief medical officer. He said 84 players just tested positive from like six different teams. And I said, that's not possible. He said, no, it's not possible, but that's what happened. So here we were looking down, like pulling 84 players off the field from practice. And by the way, you know, the coaches are like Apple play. The league's apoplectic, the coaches are apoplectic, the players are, you know, these are not normal human beings, right? We're staring down, like, what are we gonna do? We thought it was a contaminant. We thought we had a contamination in the lab from a COVID-positive specimen, that we had somehow contaminated 84 specimens. We knew we didn't have 84 players that were positive, but we thought it was contamination, which, by the way, had never happened before. But we couldn't figure out, like, how is this possible? So as I said, and by the way, as I began to mention, the press is always going to find out. I don't care who you think you are. They are always going to find out what happened. So you might as well just suck it up, as I always say, and take the hit. So we did not know what the answer was. It looked like it was a contamination. We tested the hoods, we tested the people, we tested We could not find, but we very quickly, I went out publicly with a statement and said, we think there's a contamination. These are all the things we're gonna do to make sure it never happens before. Retesting, cleaning the lab twice a day. We went out with all these things that we were gonna do and we owned up and said it was our fault. So to be honest, the story died within 24 hours. It literally died a natural death because there was nothing for them to look at. We said we were wrong, we didn't be a couple and we moved on. It turns out it was probably a contaminant in the end of one of the reagents that we had bought, that we had shipped to us. We didn't know that. And we had this whole investigation, the FDA came in, the CAHPS, the College of American Health, I mean all these people come in to try and find out what we did wrong, and of course it ended up being a scam. But the lesson here is to take the hit and move on. That's what I think.

Adam 

Yeah. No, I think, I think that's, that's right. I mean, I think that society would be better if people could own up to mistakes and then just say, well, okay, we, we, we messed up here. Like let's, let's keep moving. And then I think well said that like it can die its own natural death. That's what a story should do in this case. Right. Cause it's not some controversy. Right. Um, you know, that's how we think about labs.

Jon

By the way, we tested all the players. Of course there were negatives.

Adam 

Yes. And the other key piece, right? And it's like, turns out it was actually fine the whole time too. I think, you know, some, some other things that kind of come to mind that I'd love to get your, your insight on is that, you know, as, as we're looking to the future, obviously, like the, you know, of course, I think a lot of people's minds like, okay, well, we were wildly underprepared and it's, it's great to get on one level, kind of this masterclass roadmap of how you and your team put together so many of these unprecedented ways of thinking forward and kind of building the way of doing diagnostic testing. And so, you know, I think, again, a lot of people's minds in this case is like, so how do we not have this kind of problem again? And so you do, you do offer some solutions and ways of thinking towards the end. So I'm kind of curious to hear some reflections on these ideas in terms of, you know, how can, how can we, like, I guess, what are some of the recommendations that we could think about in terms of, you know, at a social level, at a commercial level, at a private partnership level to kind of be more prepared for future crises?

Jon 

Yeah, so this is my view. My view is that at a very low, relatively inexpensive, I believe the country should build a diagnostic infrastructure that is what I'll call kept warm in case there's another crisis. It would not be expensive. Basically, my recommendation is you build five very large tent facilities that could do this type of high, it's very sophisticated, cold molecular, PCR testing for the next crisis, you staff it so that it's up and running. And if a crisis occurs, you're ready to do probably five million tests a day within a week, not sooner. The idea that we're going to go through this again and have to use possibly universities or public health labs or the commercial laboratories that have all taken down all of their infrastructure completely, to rebuild it again, rebuild everything, is just, I think, is an untenable solution. On top of which, there's no plan for testing centers. Remember, it's not just running the test. It's how do you get the test done? to me is identify test, identify locations where you can do a testing center, which is possibly, you know, drive-thru center, drive-thru places, big parking lots, highway access. Commit to a plan to staff it, which is either the National Public Service or Public Health Service and or National Guard. Every state, city, county should have a plan in place in case there's another outbreak. And you have these facilities that actually could to actually provide the testing. So the whole, well, and then the other, of course, the third and probably most important thing is develop a real infrastructure at the federal level with oversight to actually make this happen. Right now, there is no person in charge of testing for the US, for America, right? So there is no one. I mean, it comes under HHS, a little bit CDC, but the fact is, is nobody is a testing czar. They only point a testing czar when there's a crisis. So I think there should be someone with an office, I call it an office of pandemic preparedness for diagnostics, that actually sits at probably HHS that is tasked with, with oversight and putting this together. I don't think it's unreasonable. Um, you know, I, I, I do mention if you guys remember, if you remember when monkeypox hit post COVID a year later, we were back in the same situation. God forbid monkeypox became a real issue. We were totally unprepared again.

Adam

Yeah. I know. Yeah. It's kind of like we dodged a bullet there a little bit, you know, that it just didn't jump.

Jon

And a lot of people say it's not a matter of if, it's just a matter of when the next outbreak occurs.

Adam

Yeah. Yeah. And, and that's, and that's like not, um, yeah, it's, it's not a, a, um, you know, panic inducing thought. It's just like, we have to deal with, we have to deal with this possibility.

Jon

Like everything else. Or you're not prepared. Like, you know, make a choice. Yeah.

Adam

Exactly right. Kind of one one wrap question, and also thinking a little bit about talk space, I think it's interesting now that you're working at the kind of the forefront of telehealth and mental health and digital health space. And so one thing that you didn't actually talk about this too much in the book, so just wanted to get your thoughts on this as well is, is obviously the a huge part of leadership is setting organizational culture, right? And how do we, you obviously had a like insanely, an incredibly dedicated team, like, you know, people were called upon to say, Hey, can you put together the Royal Caribbean Cruise Line task force? Can you put together the NFL testing task force, you know, and so I'm curious to get your thoughts about this idea in terms of as a leader, how do we create cultures of basically people that want to step up and that want to like take on these like in like these huge tasks, right? I mean, obviously one is demonstrating because you're willing to do it. But I'm curious, like both, you know, in bio reference labs and also talk space, how do you how do you think about organizational culture as a leader? And how do we set set up a space for success for our employees?

Jon

Yeah, it's a good question. So, you know, Talkspace is now the largest telehealth, mental health and network provider. Meaning if you have over 110 million covered lives, meaning there's a pretty good chance you're covered to get Talkspace as your way of getting mental health therapy. And you don't have to pay for it. You have a small out of pocket. It's very different than it was. It's no longer for us a consumer product. It's a it's a it's a real health care provider. And that's that's what we do. And we do schools and universities. teens and large employers and just all sorts of people who need, you know, mental health support. And to me, it's a moral imperative, quite honestly, because for kids, it's you've seen a certain genre where the social media addiction and health issues is the greatest threat to children right now than cigarette smoking ever was. So the commitment there, you're saying the culture is, you know, I have a new executive team, nine senior executives, it's way too many people to report to me, but that's what I sort of inherited. And I think that, you know, the first time I met with them, I said to them, here's the way that I approach this. You guys are all senior, you're all executives, you're all responsible human beings. You've got, this is not gonna be what I call a permission culture. I'll have to call me to ask for permission for anything that you want to do. I will back you up. I'm sure you'll make the right decisions. If you make a wrong decision, don't worry about it. We'll figure it out. The non-permission culture is one of the most important things you can do to make people effective. You can't just say it, they've gotta feel like you've got their back. And if you have talented people and you let them go, you let them make their decisions, it's the most important leadership thing you can do to drive a team. If they feel like they are afraid, they can't make decisions, they've gotta go to you, you will never be able to scale, you will never be able to grow things because everybody's paralyzed. And the problem is, is a lot of people have, believe it or not, have never lived in that culture. What would the boss say? Should I do this? I gotta ask him to do it. I don't have… It's the non-permission culture that is unbelievably important to be an effective organization. And it was literally the first thing I told my team when I first got there. I said, still, I'll do your job. I promise you I will not criticize you for making a mistake. It's hard for people. You know, it is really hard, I'm just telling you, it's really hard for people to do that, you know, because they're just not used to it. They're, they just, whatever. That's to me is the critical issue on effective organizations.

Adam

Yeah, no, I think that's such an important and great piece of advice, too, because I'm sure, you know, you've seen it, too. Like we see it all the time, right, that that so many employees are disgruntled in their spaces because their management or leadership just kind of sits on them or kiboshes, you know, their their potential creative aspects of what they could do because it's either outside of the norms or whatever it is, right. Or leadership ego could even be a part of it as well. Right. And so there is I think that's an important piece to hear that where it's like we don't need to be stuck in permission culture. It's like, I'm here to back you up because you're already successful, you know, and that's how we can do it together. No, I'd love to hear it. Jon, I just want to say thank you so much for chatting with me. This has been a great conversation and I'm super excited to get the, you know, the book into the hands of listeners and watchers to be able to check it out. And, you know, as we kind of head off into the next space, I'm just curious to think about, you know, with Talkspace, what are you most excited about that's coming up? What's on your radar in terms of either, I don't know, new tech, new ideas, new things that you guys are kind of forefronting in that space?

Jon

I think it's the, well, we have an unbelievably scalable solution. I think, okay, we're in all 50 states. As I said, we're an in-network provider. I think that we are we are on the precipice of really finally being able to deliver a scalable solution to a lot of people. The need is just so enormous, because there's no way that people are gonna continue to make an appointment, go to a therapist, go to a psychiatrist, and be seen. Which is why, if you look at all of telemedicine, all of telemedicine, the dominant telemedicine visit is now a mental health visit, because it is such a scalable, an obvious solution that people could go online, either text, we do texting, and video, we do video, and make an appointment, don't have to drive there, or you could have a conversation on your phone with your therapist, basically anytime you want, 24-7. So what I'm most excited about is we have a scalable solution to get to a lot of people within a short period of time. So, you know, especially, as I said, kids and teens. You know, we're excited. We're growing, and as I say, stay tuned. And to remind that what you said is hopefully people will go out and buy the book, because I think they'll be entertained. There's a movie reference in every chapter also, by the way.

Adam 

That's right. That's right. I would agree with you. I'm not going to say what it is, but I agree with you that the best time travel film is what you said it is. Cool. Awesome. Thank you, Jon. This has been great and I'm excited to get this out. Thank you. And that wraps up our conversation with Dr. Jon Cohen on today's episode of This Anthro Life. And what a fascinating conversation it's been. Before we sign off, let's recap a couple takeaways from the conversation. So Jon Cohen is a surgeon with over three decades of experience and shared his insights on building diagnostic infrastructure and the importance of being prepared for future crises. We highlighted the need for testing centers, including drive-through locations and federal-level infrastructure dedicated to testing. Jons stressed the significance of leadership during crises and offered invaluable advice on decision-making and owning up to one's own mistakes, too. Now, I'm incredibly grateful for Jon joining me today on the podcast, sharing his expertise. His wealth of knowledge has shed light on the challenges faced in medical crises and the importance of collaboration and adaptability. So now I want to turn the spotlight over to you. Take a moment to reflect on today's conversation and consider how it relates to your own life or to the broader society. What steps could be taken to ensure that we're better prepared for future crises, both as individuals and society? I'd love to hear your thoughts and experiences. And I encourage you to subscribe to the podcast, whether on video or audio, leave us a review on your favorite podcast platform, and sharing this episode with someone who will love it is also a great way to support it. As always, if you're hungry for more thought-provoking content, don't forget to visit our Anthrocurious sub stack blog, where we explore even more fascinating topics. And speaking of resources, of course, I recommend you check out Jon Cohen's book, Swab, where he dives deeper into the stories and insights that we discussed today. Make sure to check it out. Remember, we value your feedback and suggestions for future episodes, so you can always reach out to me on the website, through our social media channels, and let's continue building the This Anthro Life community together. Thanks again for tuning in. As always, for sharing your energy, your time, your ears, your brain, your heart, all the good stuff. So until next time, keep exploring, keep questioning, and keep on living This Anthro Life. I'm your host, Adam Gamwell.