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Who, What, Where, When, How, and Why -The Next Deadly Pandemic
BOSTON: I am a former FDA COO and Harvard faculty member, and a decades-long infectious disease spread risk management expert.
The rate, depth, and breadth of "spread" of infectious diseases counts the most. The bubonic plague of the Middle Ages killed half the world's population. No matter how potent, it likely would have killed less than 1,000 people if it was not highly contagious and there was a way and means for its spread.
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At the FDA, I co-led its last major internal reform. At Harvard, I taught policy, law, regulation, and management, including, most prominently, risk management and its vital sub-set: health and healthcare risk management, particularly infectious disease spread risk management, its last frontier.
I also served in the US Military during the Vietnam War.
In my prior jobs, I stayed on top of how best to manage the risks facing our nation and its allies—and their businesses. I continue to do the same.
A few weeks ago, as evidence of the “currentness” of the danger, the CDC reported that a significant (and sometimes deadly or long-term otherwise dangerous) pathogen significantly harmed one hundred twenty-nine passengers and 25 crew members (roughly 150 people) on a cruise ship. The pathogen was undiagnosed. But based on its severe symptoms (such as some two days of diarrhea, vomiting, and dehydration), it is most likely Norovirus.
This contagious disease alone harms 685,000,000 and kills 200,000 annually worldwide. In a little over two years, COVID-19 killed 1.2 Americans and 7 Million people worldwide. WHO says, absent intervention, the next pandemic will likely kill 50 million people worldwide. Infectious disease spread risk management is the last frontier of health and healthcare. It requires far more attention, financing, and preparedness to respond.
When and Where Will The Next Pandemic, Endemic, or Local Outbreak Strike?
We do not engage in predictions. Just like with weather “predictions,” they almost always are wrong to one degree or another. They are too rigid and, therefore, fragile—and lack sufficient data to support them. However, we do deal with “expectations.” They are far less rigid, more flexible, and far more generalized, but still helpful.
When an expert in a field gives you their view of what they “expect” to happen but does not predict what will happen because there is far too little data to make a bona fide prediction, it is nonetheless valuable.
In What Form Will the Next Attack Come?
There are four combinations of dangerous pathogens and their distribution:
(1) Fully nature-created (or modified via one of its frequently generated variants) pathogen and fully nature-created and driven ways and means,
(2) Fully nature-created (or modified via one of its frequently generated variants) pathogen and fully human-created and driven ways and means,
(3) Fully human-created (or modified via tailoring one of an existing pathogen’s frequently generated variants) pathogen and fully nature-created and driven ways and means, and
(4) fully human-created (or modified via tailoring one of an existing pathogen’s frequently generated variants) pathogen and fully human-created and driven ways and means.
More than one of these categories might be used depending on several factors. For example, a hostile nation might use both by-hand distribution of pathogens and reliance on prevailing winds to spread the pathogens.
I will not be more specific than this for national security and defense reasons.
We likely will not know for decades what the true nature of the creation of the COVID-19 pathogen was (although there is strong evidence that it was human[1]generated as to that variant). There is some evidence that the ways and means of the pathogen’s spread were at least reckless, if not intentional.
The Director-General of the World Health Organization (WHO) announced at the Davos conference a few weeks ago their belief that the next pandemic, no matter the source, likely will kill 50 million people rather than the 7 million people so far killed by COVID-19. Their warning is worth listening to as well.
The Tail of COVID-19 is Still With Us
An important thing to remember and needs to be better understood by most people is that the COVID-19 pandemic has not ended. We remain at the tail end of that pandemic, and we expect that in a lesser form (although potentially in a more significant form), a variant of COVID-19 will return every winter for decades to come, just as the case with the 1918 Flu.
When and from Where Will the Next Attack Come?
Our expectations regarding the when and where of the next pathogenic attack, two of the most critical considerations, depend on many factors, such as the kind of attack, its source, and the pathogen's dangerousness (deadliness and, most importantly, its ability to spread quickly and broadly under most circumstances).
Let’s deal with the “when” first. Then, the “where” second.
When?
Our expectation (but not prediction) is that a “nature-made” dangerous variant of COVID-19 or some other infectious disease will attack America and possibly our allies at a pandemic or endemic scale in the next three to ten years. Of course, it could occur sooner or later. But this is our expectation.
We expect a “stealth bio attack” to occur in one to three years, even if the next World War (there is always a next world war) does not break out. A stealth bio attack may be the intended trigger for the next World War. Pathogens are more complex or time-consuming to source than nuclear or chemical weapons. We must also keep these considerations in mind.
Where?
Nature attacks at random. But larger enterprises are better targets—especially larger enterprises where employees travel significantly within danger zones or between company facilities or the facilities of others, such as part-time or temporary replacement workers—or even from floor to floor or shift to shift.
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Anenta, one of the UK’s leading healthcare waste management service providers, has appointed Karen King, former Department Head of Estates at the University of Cambridge, as Head of its newly formed Facilities Management (FM) division. King joins the business which supports over 20,000 public and private sector sites throughout England, including GPs, Pharmacies and hospitals.
King, who was previously responsible for the University of Cambridge Department of Physics portfolio of buildings – including the new world-class Ray Dolby Centre – will develop Anenta FM Services leading its delivery of soft and hard FM services to new and existing customers.
Launching first in London and then Cambridgeshire, before rolling out nationally, Anenta FM Services is committed to working with local specialist companies to deliver a faster response, better local knowledge, greater flexibility, and more competitive pricing. This approach is designed to deliver a more sustainable solution that minimises environmental impact while keeping more money in the local economy.
Anenta's specialist FM team will help it stand out in the sector by identifying and removing unnecessary services that customers frequently pay for as part of dated, legacy contracts.
Utilising its proprietary technology, bespoke FM solutions, expertise in best practice, compliance and statutory requirements, Anenta FM services aims to shake up the market. This will be delivered by improving service levels and identifying savings that can be returned to clients.
As part of this approach, Anenta FM services will implement contracts where whole-life costs are factored in, including mobilisation, planned preventative maintenance, reactive repairs and lifecycle savings.
Providing greater transparency and delivering reduced business disruption, this approach will ensure customer equipment lasts longer, resulting in fewer breakdowns or expensive emergency repairs. It also means that business-critical equipment will be replaced at the right time, avoiding the likelihood of catastrophic failure.
Hard FM services provided by Anenta FM Services will include electrical, mechanical, plumbing and heating maintenance, along with fire safety, emergency lighting and gas servicing. Its soft FM offering will encompass cleaning, waste management, grounds maintenance, pest control, window cleaning, furniture purchase, office moves and health and safety, aligning services with the needs of the building.
Commenting on her appointment, Karen King, new Head of Anenta’s Facilities Management division, said: “We aim to make an immediate impact by doing things differently at Anenta. Our focus will be on delivering transparent solutions that factor in whole-life costs as well as necessary work and maintenance. Unlike competitors that tender for contracts based on lowest headline prices, which fail to factor in real world costs, we’ll deliver tenders based on true lifetime value.
“By working with specialist local businesses overseen by our team of FM management experts, we believe we can build better solutions, improving levels of service, and lowering customer costs compared to the big national players.”
William Cunningham-Davis, Anenta’s Director of Development & Partnerships, added: “Karen brings with her many years of industry expertise and knowledge allowing us to build an FM solution that's both agile and highly effective. Combined with our technology and sector know-how – which has already saved our clients over £13m, plus a further £35m through efficiency improvements – we believe we can shake up the sector and give customers a better and more comprehensive service.”
An industry expert, Karen King has served on the Premises and Facilities Management Editorial Advisory Board for five years and is part of the judging panel for the PFM awards.
For more information about Anenta FM Services email karen.king@anenta.com , or call Karen King direct on 07861390821. Visit https://www.anentawaste.com/sectors/facilities-management-estates-services/ for full details. ...Read more
When I first entered leadership in radiology, being a successful imaging director was largely about being a strong clinical and operational leader. You needed to understand your modalities, manage your staff, maintain your equipment, control your budget, meet regulatory requirements, and make sure patients moved efficiently through the department.
Those responsibilities have not gone away. If anything, they have become more complex. What has changed is everything that has been added to them.
Today’s imaging director is still responsible for the clinical operation. But the role now reaches into information technology, workforce strategy, capital planning, construction, finance, regulatory compliance, patient access, data analytics and increasingly, artificial intelligence. Decisions that once may have involved selecting a piece of imaging equipment can now require months of planning involving IT infrastructure, interfaces, cybersecurity, construction, service agreements, software licensing, data storage and integration with other hospital systems.
Staffing is a good example of that evolution. Earlier in my career, staffing was not nearly the challenge it is today. There were more technologists available and competition for staff was significantly different. Today, particularly since COVID-19, we face technologist shortages while also adapting to a workforce looking for schedules that better fit their lives—four 10-hour shifts, three 12-hour shifts, Baylor shifts and other alternatives.
Technology has undergone an equally dramatic transformation. Imaging services is now one of the most technology-dependent areas of the hospital. Picture archiving and communication system (PACS) is only the beginning. Quality-control applications, analytics, advanced processing, AI, interfaces, servers, data storage and integration with the electronic medical record have become part of our daily environment.
That means an imaging director no longer has the luxury of saying, “That’s an IT issue.” We do not have to be IT engineers, but we need to understand enough to ask the right questions. How will the system interface with PACS and the EMR? Where will the application reside? Who provides the server? How much storage will be required? What happens during downtime? What are the ongoing licensing and support costs?
Even adding a single new imaging service demonstrates how involved the role has become.
Consider implementing amyloid brain PET/CT imaging for Alzheimer’s disease evaluation. On the surface, it may sound as simple as developing a protocol and adding a new exam to the schedule.
In reality, the imaging director has to understand the entire process from beginning to end. Do we have access to the appropriate radiopharmaceutical, and what purchasing or vendor agreements are required? Do we have the necessary software to process the study, and does that software need to be purchased, installed, interfaced, or integrated into the existing imaging environment? Are the technologists trained to perform and process the examination? Are the radiologists prepared to interpret it? How will the exam be built in the EMR and billing systems? Are the appropriate charges established, and do we understand the requirements necessary to obtain reimbursement?
“Successful imaging leadership still comes down to people—supporting our teams, making thoughtful decisions and never losing sight of the patient at the center of it all.”
A new service is not truly ready simply because we can acquire the images. We have to make sure we can perform it, process it, interpret it, charge for it, and get reimbursed for it. Missing any one of those pieces can mean investing significant time and money into a service that cannot function as intended. That is why today’s imaging director needs enough knowledge of technology, clinical operations, contracts, IT infrastructure, physician workflows and revenue cycle to see how all the pieces fit together.
That understanding matters financially as well. I have inherited projects where significant expenses were overlooked during the initial planning. Few things are more difficult than returning to hospital leadership for additional funding after a project was approved based on what everyone believed was a complete cost. Understanding the technology behind the project has therefore become part of responsible financial leadership.
A recent hospital acquisition demonstrated just how broad the imaging director’s role has become on an even larger scale. Our organization assumed responsibility for a small rural hospital and began transitioning it into an urgent care and diagnostic center. From an imaging perspective, that meant much more than assuming responsibility for another department. We had to transition employees into our processes and policies, establish new sites and cost centers within the EMR, upgrade software and storage, migrate imaging studies into PACS, review contracts and integrate the operation into a larger health system.
The technology was only part of the challenge. Bringing employees into a new organization requires leadership. You cannot simply walk in and say, “This is how we do it now.” You need to understand their processes, recognize what they may already be doing well and determine whether some of their practices could improve the larger organization. Most importantly, people need to feel that they are becoming part of the team rather than simply being absorbed by it.
Capital planning requires the same long-term perspective. I work from a five-year plan based on equipment age, functionality, emerging technology and potential new service lines that could benefit the communities we serve. Imaging equipment represents some of the largest capital investments a hospital makes, and replacing aging equipment can compete directly with opportunities to introduce new services. Even the best plan must remain flexible because an unexpected equipment failure can quickly take priority over planned capital spending.
Patient access is another responsibility that extends well beyond scanner availability. Scheduling may be a patient’s first meaningful interaction with imaging services. Every imaging examination has different preparation requirements, clinical considerations, arrival times and expectations. Giving scheduling teams the knowledge and tools to communicate those differences correctly can directly influence the patient’s first impression of their imaging experience.
Leading multiple locations adds yet another dimension. A director cannot be everywhere, which makes developing strong managers and supervisors essential. Those leaders need the ability to handle local issues while also knowing when something needs to be elevated. It also makes succession planning critical. If we advance in our own careers, we should not leave behind a department that was dependent upon us to succeed. Part of leadership is developing the people who can lead after us.
Despite all of this complexity, my most important leadership lesson is to lead with a servant’s heart. Be willing to help. Treat people with respect. Make sure they know you have their back, and help them understand not only what decisions are being made, but why. When employees understand productivity, expenses, supply stewardship and how organizational performance affects the resources available to their department, they become partners in improvement rather than simply employees following instructions.
Looking ahead, I expect enterprise imaging, automation and artificial intelligence to make the role even more complex. Radiologist shortages and greater reliance on teleradiology are already changing workflows. Technologies capable of identifying higher-risk studies and prioritizing radiologist worklists may become increasingly important in improving turnaround times and getting critical studies interpreted sooner.
A successful imaging director today has to be more than a clinical and operational leader. At different moments, we are asked to think like a COO, CIO, construction manager, financial analyst, technology strategist and workforce strategist.
The role has become more complicated, more technical and more strategic. But at its core, successful imaging leadership still comes down to people—supporting our teams, making thoughtful decisions and never losing sight of the patient at the center of it all. ...Read more
Healthcare audit providers operate between clinical judgment and financial accountability, yet many review processes still struggle to connect the information required for accurate payment decisions. Medical accounts may contain contractual requirements, authorization records and clinical details that need to be assessed together. The difficulty for healthcare organizations is finding audit support that can examine individual transactions while maintaining consistent review standards across large volumes of activity.
Provider selection depends heavily on how audit workflows handle documentation and traceability. A review process that only identifies billing discrepancies may overlook whether the service aligns with clinical requirements or payer rules. Executives should examine whether a provider can maintain a clear record from account submission through review, including how exceptions are handled when automated checks cannot resolve a case. Reliable audit documentation helps organizations understand why a decision was made rather than only seeing the final outcome.
Technology also shapes the value of healthcare audit services, but automation alone does not determine effectiveness. Systems need to apply relevant rules while allowing specialized reviewers to assess cases that require clinical interpretation. The balance between automated validation and professional review affects how quickly organizations can process accounts without reducing the quality of decisions. Buyers should look for platforms that allow rules to be adjusted to contractual requirements, regulatory changes and payer-specific processes.
Another consideration involves the range of healthcare transactions covered by the provider. Medical auditing may extend beyond invoice review into areas such as authorization controls, prescription assessment or recovery processes. A broader view can help organizations identify patterns that affect spending and care decisions, provided the audit model remains tied to documented evidence rather than general assumptions.
Data access is equally important when reviewing external audit support. Dashboards and reporting tools should help teams follow pending decisions, identify recurring review issues and understand where delays occur. The ability to connect audit findings with process information gives healthcare organizations a clearer view of payment activity and supports more consistent management decisions.
“Delta A Salud’s platform registers medical accounts for traceability and applies configurable validation rules before professional review and payment decisions are completed.”
Procurement teams also need to assess how audit providers adapt to different healthcare environments. Requirements can vary across insurers, healthcare institutions and public entities, creating pressure for review methods that accommodate different rules without losing consistency. A provider’s ability to configure workflows, maintain review records and integrate professional judgment into the process can influence whether the service remains useful beyond a single audit engagement.
The strongest evaluations focus on how audit information moves from detection to resolution. Providers that connect clinical assessment, payment review and reporting functions can help organizations examine decisions through a complete record rather than isolated findings. That approach matters when healthcare transactions involve multiple stakeholders and require documentation that can support later reviews.
Delta A Salud provides healthcare audit services that combine electronic account review with rules-based validation and specialist assessment by clinical reviewers. Its platform registers medical accounts for traceability and applies configurable validation rules before professional review and payment decisions are completed. The company also uses software-supported audit processes for medical accounts, authorizations and related healthcare reviews, connecting structured data with professional analysis. These capabilities make Delta A Salud a relevant option for organizations evaluating audit providers that require documented review processes and configurable controls. ...Read more
The complexity of healthcare benefits has led to the importance of clear communication becoming a business priority for companies offering health benefits, wellness programs, and other similar services. The digital marketing process presents an organized way of communicating about the benefits, targeting specific audiences, and supporting the whole process of engagement for members.
Companies do not need to communicate through general means but should rather target relevant information through digital means. This method will ensure increased visibility while at the same time establishing consistency between the offerings of benefits and the beneficiaries of such benefits.
How Can Digital Marketing Improve Benefits Communication?
The first step towards effective marketing of healthcare benefits is identifying the requirements of the audience and delivering the information at the right time. Search engines, websites, emails, educational material, and social media can be used by the organization to make sure that they are offering the relevant benefit information to their target audience. By providing easy-to-understand information about who qualifies for what, and how the services and programs can be availed, confusion on the part of the users can be eliminated.
Personalization would help in taking communication about the advantages of healthcare further in terms of relevancy. The process of segmentation would enable marketers to segment their audiences depending on things like employee type, level of interest in the insurance plans, life-cycle, or previous experiences. Marketers don’t need to send out the same communication material to all their audience, but rather segment them depending on their needs.
Why Does Digital Strategy Matter for LongTerm Growth?
An effective digital marketing plan can benefit the healthcare organization in more ways than one. Effective content that is consistently delivered will build trust by simplifying complicated information. Content that is designed specifically to rank high in search results will help the organization get noticed when people are actively seeking healthcare benefits. Email and automated communications are ways in which the organization can stay in contact for a long period of time.
The benefit of measurements is significant. It provides performance metrics including web traffic, interaction with content, email communications, conversions, and the behaviors of the audiences. With such measurements, marketing managers can assess their strategies and learn what should be changed. In addition to strategic considerations, measurements can help to make better decisions regarding investments in content and communication.
It also presents an opportunity for coordination of marketing efforts with those of admissions and customer services, among others. Where teams can exchange information and keep messages consistent, digital marketing strategies can help achieve the organizational objectives as well as provide a platform for continuous improvement in communication.
Digital marketing for healthcare benefits is now a vital part of contemporary business strategy. Companies that incorporate helpful information, knowledge about the audience, customization, and measurable digital activities will be able to increase the effectiveness of their marketing and achieve better communication at the same time. In light of continually growing demands for easy-touse and relevant information, an adequate digital strategy can help the providers of healthcare benefits foster better relationships with the audience. ...Read more
