A friend called me for medical advice two weeks ago. He’s single, in his thirties and generally healthy, but he’d developed a dry cough with mild congestion. After a self-administered Covid-19 test turned up negative results, he remained suspicious he could be infected.
He was set to fly west in a couple of days for a conference and dreaded the thought of infecting other passengers. I recommended a PCR test if he wanted to be more certain. When the lab results came back positive, he spent the next five days at home alone (per CDC guidance).
If you were in his shoes, chances are you, too, would make a reasonable effort to avoid infecting others. In the near future, that won’t be the case.
Americans are playing it safe—for now
Yet, there’s still one aspect of the pandemic Americans are taking very seriously.
As a society, we still expect people who test positive for Covid-19 to stay home and minimize contact with others. As a result of these expectations, 4 in 10 workers (including 6 in 10 low-income employees) have missed work in 2022. Overall, the nation’s No. 1 concern related to Omicron is “spreading the virus to people who are at higher risk of serious illness.”
Most Americans are eager to move on from the pandemic, but those who are sick continue to avoid actions that may potentially spread the virus.
Call it what you will—group think, peer pressure or the fear of violating cultural taboos—people don’t want to put others in harm’s way. That’s true, according to polls, regardless of one’s party affiliation or vaccination status.
What’s immoral today will be appropriate tomorrow
Don’t get used to these polite and socially conscious behaviors. All of it is about to change in the not-distant future. Let me paint a picture of tomorrow’s new normal:
- A factory worker tests positive over the weekend for Covid-19 and comes to work on Monday without a mask, informing no one of his infection.
- A vacationer with mild Covid-19 symptoms refuses to postpone her spa weekend, availing herself of massages, facials and group yoga classes.
- A couple plans an indoor wedding for 200-plus, knowing the odds are likely that dozens of people will get infected and that some of those guests will be elderly and immunosuppressed.
These actions, which seem inappropriate and immoral now, will become typical. It’s not that people will suddenly become less empathetic or more callous. They’ll simply be adjusting to new social mores, brought about by a unique viral strain and an inevitable evolution in American culture.
A crash course in a unique virus
To understand why people will behave in ways that seem so unacceptable today, you must understand how the Omicron variant spreads compared to other viruses.
Scientists now know that Omicron (and its many decimal-laden strains: BA.2, BA.2.12.1, BA.4, BA.5, etc.) is the most infectious, fastest-spreading respiratory virus in world history. The Mayo Clinic calls this Covid-19 variant “hyper-contagious.”
“A single case could give rise to six cases after four days, 36 cases after eight days, and 216 cases after 12 days,” according to a report in Scientific American. As a result, researchers predict that 100 million Americans will become infected with Omicron this year alone—via new infections, reinfections and vaccination breakthroughs.
In addition to Omicron’s high transmissibility, the virus is also season-less. Whereas influenza arrives each winter and exits in the spring, Americans will continue to experience high levels of Covid-19 infection year-round—at least for the foreseeable future.
With its 60-plus mutations, immense transmissibility and lack of seasonality, Omicron is an exceptional virus: one that will infect not only our respiratory systems but also our culture.
Over time, Omicron’s unique characteristics will drive Americans to deny and ignore the risks of infection. In the near future, they’ll make decisions and take actions that they’d presently deem wrong.
A culture shock is coming
Culture—which comprises the shared values, norms and beliefs of a group of people—doesn’t change because someone decides it should. It evolves because circumstances change.
The pandemic has no doubt been a culture-changing event and, as the circumstances of Covid-19 have changed, so too have our underlying values, beliefs and behaviors.
If 100 million Americans (one-third of the population) were to become infected with Omicron this year, we can expect that everyone will know someone with the disease. And when dozens of our friends or colleagues say they’ve had it, we will begin to see transmission as inevitable. And since, statistically, most Americans won’t die from Omicron, people will see infection as relatively harmless and they’ll be willing to drop their guard.
We’ll see more and more people going to work even when they’re infected. We’ll see more people on trains and planes, coughing and congested, having never taken a Covid-19 test. And we’ll see large, indoor celebrations taking place without any added safety measures, despite the risks to the most vulnerable attendees.
Amid these changes, health officials will continue to urge caution, just as they have for more than two years. But it won’t make a difference. Culture eats science for breakfast. Americans will increasingly follow the herd and stop heeding public-safety warnings.
The process of change has begun
Cultural shifts happen in steps. First, a few people break the rules and then others follow.
Recall my friend, the one who took two tests out of an abundance of caution. Next time, perhaps he’ll decide he’d rather not miss the conference. Perhaps when he returns home, he will tell his friends that he felt sick the whole trip. Perhaps they’ll ask, “Do you think you might have had Covid?” And perhaps he will reply: “What difference would it have made? I’m fully vaccinated and boosted.”
And so, it will go. The next time someone in his social circle feels under the weather, he or she won’t even bother to do the first test.
This change process has already begun. Take the White House Correspondents’ Dinner, for example. Last year, the event was cancelled. This year, guests had to show proof of vaccination or a negative same-day test. However, that rule didn’t apply to staff at the hotel who worked the event. Unsurprisingly, several high-profile attendees got Covid-19 but, so far, no reports of anyone being hospitalized. A year from now, assuming no major mutations cause the virus to become more lethal, we can expect all restrictions will be dropped.
Culture dictates how people behave. It influences their thoughts and actions. It alters their values and beliefs. The unique characteristics of Omicron will lead people to ignore the harm it inflicts. They won’t act with malicious intent. They’ll just be oblivious to the consequences of their actions. That’s how culture works.
The combined health system will become the sixth largest nationwide, with $27B in revenue and 67 hospitals across six Midwest and Southeast states. The system will be based in Charlotte, and known as Advocate Health, though Atrium will continue to use its name in its markets.
Atrium CEO Gene Woods is slated to ultimately lead the combined entity, after an 18-month co-CEO arrangement with Advocate Aurora CEO Jim Skogsbergh. While the cross-market merger is unlikely to create antitrust concerns about increased pricing leverage, the Biden administration has been making noises about applying stricter scrutiny to the impact of health system consolidation on labor market competition.
The Gist: Earlier this year, Utah-based Intermountain Healthcare and Colorado-based SCL Health combined to create a 33-hospital, $14B health system, which became the 11th largest nationwide. While these mega-mergers of regional systems can realize cost savings from back-office synergies, there is a significant opportunity to create larger “platforms” of care to win consumer loyalty, deploy digital capabilities, attract talent, and become more desirable partners for nontraditional players like Amazon, Walmart, and One Medical.
It will be critical to watch whether the governance and cultural challenges that often hinder health system mergers come into play here. Advocate Aurora has had two prospective mergers fall apart in recent years, the first with Chicago-based NorthShore University HealthSystem, and the second with Michigan-based Beaumont Health (who subsequently finalized a merger with Spectrum Health earlier this year).
But the combination with Atrium is structured as a joint operating agreement, essentially creating a new superstructure atop the two legacy systems. This may allow the combined entity more flexibility in local decision-making, but the ultimate question will be how the combined entity will create value for consumers. Time will tell.
Although CFOs often hold the key to resources, acting as gatekeepers, they can also be critical allies in innovation, enabling programs and initiatives, according to an April 12 McKinsey report.
While innovation is often thought of in a traditional sense, with new offerings and services coming to mind, innovation can also mean disruption and change in business models, productivity improvements and new ways to service consumers. The CFO has the perspective to see where fresh ideas are needed in the business from a financial perspective, and the power to make them happen.
Innovation also requires resources and capital, of which the CFO has control and say as to how it gets used. The CFO is an important part of determining which innovations will go ahead and is akin to a venture capitalist, deciding whether to invest in a start-up.
As members of the C-suite, CFOs also have an important role in encouraging a culture of openness and innovation where staff members feel comfortable coming to company leaders with new ideas. By creating an atmosphere of innovation, the company can build a pipeline of innovative talent and concepts, which the CFO can help bring to fruition.
Salt Lake City-based Intermountain and Broomfield, CO-based SCL Health have now formed a 33-hospital, $14B nonprofit health system, which immediately becomes the 11th largest nationwide. The system will operate across seven states under the Intermountain brand, although the SCL hospitals will keep their legacy names and Catholic affiliation. Regulators signed off on the interstate merger after the systems agreed not to close any locations or services.
The Gist: Intermountain has been trying to build scale across the Mountain West in the last few years, having recently come up short in an attempt to merge with South Dakota-based Sanford Health.
The SCL deal will allow Intermountain to expand its SelectHealth insurance plan and integrated care model into the fast-growing Denver metro area, as well as into Kansas and Montana. As with any merger, the difficult work of combining cultures and demonstrating meaningful value for patients and consumers lies ahead.
- A San Jose jury convicted Theranos founder Elizabeth Holmes on four counts of fraud, deciding that she lied to investors while raising more than $700M in funds for the company. Holmes was found not guilty on four other counts relating to defrauding patients, though Theranos ended up voiding tens of thousands of erroneous test results. Each conviction carries a maximum twenty-year sentence, although Holmes is widely expected to appeal.
The Gist: It’s rare that tech executives are convicted of fraud. Investors, including many health systems, have been flooding healthcare startups with large sums of cash in hopes of big returns. But the Theranos debacle is a reminder that Silicon Valley’s “fake it till you make it culture” is not always the best fit for healthcare. Providers must continue to hold new medical technologies to high standards, regardless of how much promise they hold to “revolutionize” aspects of patient care.
When COVID volumes waned in the spring and early summer, most health systems “de-escalated” dedicated COVID testing and triage facilities. But with the Delta variant surging across the country, consumers are now once again looking for services like drive-through testing, which is perceived as more convenient and safer.
One physician leader told us patients in the ED are asking why the hospital got rid of the “COVID tent”, which provided a separate pathway for patients with respiratory and other COVID symptoms—and a highly visible signal that the rest of the department was as COVID-free as possible.
Another system is now fielding questions from the media about whether they’ll bring back their dedicated COVID hospital: “We spent a lot of time last year convincing the community that the dedicated hospital was key to safely managing care during the pandemic. Now we’ve got almost as many COVID admissions spread across our hospitals.”
Over the past year, providers have learned how to safely manage COVID care and prevent spread in healthcare settings—but consumers may perceive the lack of dedicated facilities as a decline in safety.
Unlike last year, hospitals are full of non-COVID patients, as those who delayed care reemerge. And with the current surge likely to continue into flu season, emergency rooms will only get more crowded, necessitating a new round of communication describing how hospitals are keeping patients safe, and reassuring patients that healthcare settings remain one of the safest places to visit in the community.