Disaster preparedness expert Dr. Nicolette Louissaint draws from her experience managing healthcare supply chain readiness before, during and after natural disasters and disease pandemics. Bryan, Alex, and producer Megan explore the lessons Dr. Louissaint learned from the Ebola outbreak and what we’re still getting wrong about masks and toilet paper supply, plus how self-driving vehicles and automation may be able to help in the future.

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Episode Transcript

Alex Roy

Hi everyone. This is No Parking, the podcast that cuts through the hype around self-driving vehicles and artificial intelligence with seriously direct, honest, no-BS conversations around how technology will or won’t change our daily lives. I’m Alex Roy.

Bryan Salesky

And I’m Bryan Salesky.

Alex Roy

Alright, Bryan, today, we’re going to talk about the challenges of supply chain logistics during a global pandemic and how autonomous vehicles might offer a solution. But for everybody who doesn’t understand why supply chains matter, because a lot of people—their eyes just glaze over when they hear supply chain—I just got a dog. And of course I’m now watching lots of dog movies and one of them, which is just completely awesome, was with Willem Defoe and it’s called Togo. A lot of people don’t know the story of Togo, but in 1925 in Nome, Alaska, there was a diphtheria outbreak, and a lot of kids, and eventually adults, were getting sick. It was a bad scene. And the only way to get the vaccines across Alaska almost 600 miles was to fly them. But planes couldn’t fly because it was winter. And so they had to recruit mushers and sled dogs to get this vaccine across the state in the worst conditions.

Now today, in Central Park, there’s a statue of Balto, the the dog who got all the credit for this. But in reality, it took a bunch of different sled dog crews and mushers to get there. And the hero of the journey was a dog named Togo and his musher, a guy named Leonhard Seppala, who’s a Finnish immigrant, who eventually became famous—not just for delivering the vaccines almost 300 miles with Toga leading the crew—but for becoming kind of the father of the modern Siberian Husky mix. And that’s what Togo was. And Togo couldn’t make it all the way to Nome. And Balto was the dog who did the final 50 miles, got the credit, got the statue.

And all I could think about is, is that is what a supply chain problem is all about. We need to move vaccines. We need to save lives. And back in the day, when the weather got bad and a plane couldn’t fly, we had to rely on dogs. And today we have modern technology that hopefully can solve problems that maybe are unsolvable any other way. Anyway, a big ramble. I love dogs. I got a puppy and we’re going to talk about this today. But first I want to introduce our producer, my friend, Megan Harris. She used to be with NPR and she’s going to join us to make sure I don’t go off the rails like I just did with my dog story, but it was pretty relevant.

Dr. Nicolette Louissaint

Yeah. It’s not bad.

Alex Roy

Megan, tell us about our awesome guest.

Megan Harris

Yeah, so today we’ll be joined by Dr. Nicolette Louissaint. She’s the executive director of Healthcare Ready. It’s an organization that works to secure, maintain and improve critical supply chains during pandemics and natural disasters. So pretty big tasks these days…

Alex Roy

She’s filling enormous shoes and she probably needs bigger shoes because she fills them so well. She’s famous in what she does. And also we grew up in New York city together. We have a lot of friends in common, but that’s a different podcast. None of us, I think, have saved as many lives as the doctor has. Nicolette, welcome to the No Parking podcast.

Dr. Nicolette Louissaint

Thank you so much for having me. And did you name your dog Togo?!

Alex Roy

No. Um…

Bryan Salesky

I asked the same thing this morning and I was so disappointed!

Alex Roy

But the thing is, if you love dogs, you have to love modern supply chains, because modern supply chains make it possible NOT to use our dogs to (fulfill them)…

Bryan Salesky

He named his dog Mochi, which is so cute.

Alex Roy

Like the ice cream ball. Because she’s so little.

Bryan Salesky

It’s pretty good.

Alex Roy

But we’re here to talk. I want to hear what Nicolette has to say and get some education on this. Let’s bring this full circle. Megan, would you like to tell us a bit more about Nicolette?

Megan Harris

Well, doctor, I want to start with a little bit about how you got to Healthcare Ready, right? So you served as the Senior Advisor to the U.S. State Department under President Obama. That was during the Ebola outbreak in 2014, that ended up not becoming a global pandemic. It meant coordinating a lot of resources across a lot of borders. If you would, please tell us about that experience and maybe what it taught you about collaboration on a global scale.

Dr. Nicolette Louissaint

Sure. So, I’m actually a pharmacologist by training. So a lot of my focus has been understanding not just how to develop drugs, but how to get those drugs to the people that need them. So before I was actually thinking about supply chains directly, I was addressing what we now call like that “last mile” issue. You can have a great product, but if that product can’t get to the people that need it, then there’s no point, right?

There’s no value in the product until it can actually get to those patients. So yeah, when it, when it came to Ebola, it’s really interesting to look back at it now from the vantage point of working on the international side, because you know, when you’re working on the international side and there are, what, I think 12 cases in the U.S.? Where like there isn’t an Ebola outbreak in the U.S., you know? It was in West Africa, but a lot of the focus of what we had to do really centered around how do you engage the international community in a pandemic response, understanding that even though it’s not on their shores, there’s a role that they have to play. So first and foremost, global engagement to be able to stop the outbreak in the region that was being most impacted.

The second part though, and I think the more complicated piece, was now that you have all of these resources and you have all of this global engagement, how do we create a response that can use force multipliers like military, like, you know, the UN system, the world food program, and others, to be able to help us to go the next step, to getting the supplies, the resources, the people, to the parts of West Africa that were most disparately impacted. So that involved using motorcycles to be able to, you know, have essentially runners that could move product up down, you know, various hills and various regions of Liberia and Sierra Leone to be able to get to those Ebola treatment units that were more distal and involve thinking about, you know, do you do airdrops of supplies in certain regions to be able to get those products there, because there was a refresh rate.

It’s not about just getting supplies there once or you’ve got to pick up testing samples once—you’ve got to do it on a recurring basis. So that was, you know, the very not-so-glamorous job of thinking through what it looks like to coordinate, you know, that part of the international response. Um, and I think that really laid out the questions that I’m dealing with now. And I think that’s part of the reason that a lot of the various folks that have been talking about like, you know, the linkages across all pandemics and pandemic response can really think about the interconnections, because while it may not be the same type of last mile issue, there’s always going to be a last mile issue. You know, it may not be Togo and Balto, you know, going across Alaska, but it could be, you know, thinking about how do you get testing samples that need to be run to a laboratory and then vaccine when it’s finally available, moved throughout other parts of the globe. So, it can differ.

Alex Roy

I understand that there’s real issues getting stuff to remote locations in Africa, but you’re working on the COVID-19 pandemic in the U.S. Like, what are the problems in that supply chain versus a remote location like Africa?

Dr. Nicolette Louissaint

Sure. So I think there are a couple of things. One- it’s important to remember that when we were talking about Ebola, you know, it’s a totally different type of, and totally different level of social distancing. Um, we’re talking about a highly contagious, highly fatal infectious disease in the case of Ebola. So being able to keep as many people who were infected away from others was critical. So your supply chain issues began with being able to rapidly identify and then isolate people into treatment units. Again, not having a therapy in place, but knowing what the treatment protocol was, needing to have those supplies that—you know, like saline and basically like hydration—and some basic anti-infectives that were needed. So having those things available, but then also the other side of that being testing. You needed to get samples to laboratories that were able to test and confirm Ebola cases as early as possible.

Because when you are initially infected with Ebola, you may have a slight fever, but it progresses very rapidly. So the faster you can get the test—really it’s like a two to three day window. The faster you can get that test and get that diagnosis and isolate that person, the better their survival rates and the lower the likelihood that they spread it. With COVID, you’re dealing with a situation where we’re already at community spread. So what we’re trying to get to is a situation where ideally with community spread, we can get testing as quickly as possible. So that means getting the supplies in to do tests, but it also means getting the test samples to the labs that need to be able to test and confirm those samples. And then it also means all of the other supplies and supports that are needed, not just for health care systems, but ancillary care, to be able to maintain treatment and care of patients. And I think the hidden part of COVID, especially in the United States, you know, it’s commonly known—the U.S. chronic disease rate is pretty high. So it’s not just about making sure that COVID medicines are moving to where they need to be. It’s all of the other chronic care meds that we need to make sure are still getting to the people who need them

Megan Harris

Well, and as if that’s not enough to deal with on our shores, you’re also working with FEMA, right? So that’s emergency preparedness like wildfires, hurricanes. There’s been a few of those lately. What is it like to try to balance what’s happening on a national scale while also trying to mitigate the effects of a pandemic?

Dr. Nicolette Louissaint

So those are one in the same. I would caution against thinking about those as two separate pieces, because we have one emergency management system for the nation, just like we have really one global supply chain, but, you know, we like to talk about them as separate chains. But we’ve had different hazards, different actual events, as you mentioned, the wildfires being a big one. Just this weekend, a major hurricane in an already very active hurricane season moving through, and some other ones that we’re monitoring. So it’s really important to really think about collectively what all of these emergencies are doing to the system (and) how they’re straining the collective system. And again, remembering that it’s not just about a local event, all of these things are impacting all of us. And similarly, putting strains on supply chains, because when you do have a hurricane or a wildfire, those types of natural hazards also strain supply chains and complicate last mile delivery.

You’re in a situation where very quickly people are moving. So the medicines need to get to where the people are now. So those evacuations now, you know, you’re thinking about local pharmacies, or if they’re in hotels, instead of shelters, what are the nearby pharmacies or clinics that are going to be providing care? But also understanding that with each of those hazards, there are other things that happen to people. Smoke inhalation becomes an issue. There is a respiratory issue as it pertains to COVID and understanding that if you do have a respiratory issue and you’ve inhaled smoke, you’re the way in which COVID impacts your system seems to be more severe. Everything is coming together, you know, in the most 2020 type of way you could imagine, but it’s very much about the convergence and the strains that we’re seeing and the way in which they are straining overall global and national systems.

Bryan Salesky

Maybe to paint the supply chain picture a little bit better for people to sort of understand where we were and kind of what’s now coming together, maybe we could talk about just a real specific example and something that I think is on everyone’s minds. We could, we could pick either toilet paper or masks. I’ll let you choose A or B—masks is probably a better one.

Alex Roy

Toilet paper.

Dr. Nicolette Louissaint

I vote for toilet paper.

Bryan Salesky

OK, let’s do it! Help us understand sort of what changed overnight and then how the system ended up having to get rallied to respond sort of life of a roll of toilet paper then.

Dr. Nicolette Louissaint

Well, it’s funny because I actually went to the market over the weekend and saw like all of this toilet paper, but some very angry signs next to it saying, like “But you can only walk out of here with one.” It’s a reminder that we were in what I would call a spot shortage for a few months there. And the reason being that there’s a national, you know… When you, when you look at the total global availability of a product, manufacturers are producing products on a recurring basis based on what the typical demand would be. So I am not a toilet paper manufacturer, but toilet paper manufacturers in order to stay in business are going to produce at levels that are around their median production for toilet paper for a year, for a quarter, for a month. So whatever that unit is, they know about how much they would normally sell, how much turnover there would be, and they produce for that.

Well, they’re not planning for a global shortage. They’re not planning for parts of the world to be told to stay at home for weeks at a time. But then when that happens, they’re put in a position where everybody’s saying, “Oh my God. If me and my kids and my spouse and my dog are all going to be in the house for the next six to eight weeks, we need a bunch of supplies. We’re going to try to get everything that we would normally buy in two to three months today.” And that’s not what toilet paper manufacturers are planning for.

Bryan Salesky

Yeah. In this case, it’s really the consumer’s failure to like, not panic and like, just carry on. Now on the mask side of things though, it’s very different, isn’t it?

Dr. Nicolette Louissaint

It’s kinda not,. It’s all demand surge, right? And so one of the things that we see is that there’s a surge in demand, but how you handle that surge in demand is going to determine how strained the system is. So very much in the same way, you know, I don’t think that we have national stockpiles of toilet paper, but we do have some national stockpiles of masks. So the idea is that you have that demand and that within that demand, you’re able to be in a situation where you can say, “OK, there is going to be a surge. And that surge is going to be buffered in some way by that initial stockpile.” So that’s what the strategic national stockpile that’s maintained by the federal government is intended to do — is to get us through a little bit of that buffer. The problem is that hoarding is still hoarding.

And so you can’t control for human behavior. So even though it’s not going to the supermarket and buying all of the toilet paper on the shelf, there are systems that will go and purchase or try to procure as many masks as they possibly can. It’s not based on what they need, it’s based on what they can purchase. And so you have those two insults happening to the supply chain at the same time: legitimate demand, plus ability to hoard because you can afford to purchase more. And that’s what took us into a shortage as stark as we got it.

Bryan Salesky

Alright so let’s do some myth-busting here, because there’s a lot of people who read a lot of different sources and we all have heard different things on this subject. So true or false: China purchased all the masks globally. And so no one could get access to any masks for a period of time.

Dr. Nicolette Louissaint

I love easy questions, false.

Bryan Salesky

Okay. True or false: The CDC did not initially recommend we wear masks, because there was a huge shortage of masks and they didn’t want to run on them in order to make sure that first responders and medical care people can get sufficient access.

Dr. Nicolette Louissaint

False, and then I’ll put an asterisk there. So the science showed that face coverings were needed. And when we talk about masks, there are many different types of masks, but you know, for simplicity sake, we have N95 masks that are the masks that health care providers need that are able to filter out basically all but about 5% of particles in the air. And then you have surgical masks, which are a little less precise on the pore size, but able to be used by health care providers if they’re not actively treating a COVID patient. And then you’ve got like a cloth mask, right. Which is like, what I think the surgeon general was teaching people to create with their sock or what have you, right? Those are not all the same.

And the CDC’s guidance while it changed in terms of telling people like, “Yes, you absolutely need a face covering.” You’ll remember at the beginning of this, it was, you know, you, it is wise to think about using a face covering, but it wasn’t like the standard guidance, but it was, you don’t need an N95 and I’d still say you don’t need an N95, unless you are in one of the high risk immunocompromised categories. You don’t need an N95. And it’s important that we make that distinction, because the surgical mask is a surgical mask, right? A cloth mask is a cloth mask, and no health care provider is going to want to use a cloth mask when they’re delivering care. But I can use a cloth mask when I’m going to the supermarket. So that’s part of it — public health messaging. And, you know, one of the worst, and I think hardest things for us to do is manage public health messaging and nuance in science communication. But it’s something that I think has spun into this crazy myth of the CDC only said that, because they wanted to make sure that all of the masks were available health care. Now they needed to make sure that N95 masks were available for health care providers, but they also needed to make sure that you weren’t hoarding masks the way you were hoarding toilet paper and bacon, because that doesn’t help the system either.

Megan Harris

So I’m curious about that. Is there like a psychological element to some of this? You know, we’re talking about masks and toilet paper, which are things that we don’t really have already substitute for, right? Like, that’s a thing that we must have in that form.

Alex Roy

Three sea shells can substitute.

Megan Harris

You do you, man. But as opposed to something like you’d get at the supermarket, right? There’s a lot of food stuffs that we’re also getting like this incredible run on them in the early days, but we all kind of adapted. Or have we?

Dr. Nicolette Louissaint

Yeast, I think, was constantly in shortage, is that right? Like people started making bread, and so all of a sudden, like flour and yeast, weren’t available?

Megan Harris

Right, the sourdough phase across the nation. Yeah.

Alex Roy

Bryan, were you cooking, baking bread?

Bryan Salesky

Yes, absolutely. In fact, I got reacquainted with the kitchen and it was actually one of the unexpected pleasures in an otherwise just terrible thing that was happening — to be able to cook.

Megan Harris

What was your favorite thing to make?

Bryan Salesky

Well at the time when it first started, we were kind of still cold weather. So I was, I was making all sorts of different chilis. Yeah. It was really good.

Alex Roy

Connoisseur’s choice. Doctor, what were you preparing?

Dr. Nicolette Louissaint

Um, I was running an emergency response, so I was spending all of my money getting food delivered.

Alex Roy

Of course, of course. Because she is a professional.

Bryan Salesky

Thank you for your service, by the way. While I was cooking chili and trying to stay home to be a so-called hero, you are the real hero.

Alex Roy

Doctor, you’re very good-natured given the work that you do.

Question. So, I forget what year it was. There was this movie called “Outbreak,” which was about Ebola. People have this notion that that was handled really badly, but it seems like it was handled actually quite well. The real-world Ebola outbreak was handled quite well. Also, there’s this notion of exceptionalism. Like we know what we’re doing here in America, but over there, no one knows they’re doing. But, you know, there’s modern cities. There’s real infrastructure. But tell us what’s the real world, worst case scenario? What would have happened if Ebola had not been handled?

Dr. Nicolette Louissaint

Oh yeah. So I think it’s pretty funny, because I’ve heard people say like, “Ebola could have been COVID,” and I’m like, no, actually Ebola could not have been COVID, because Ebola being COVID decimates much larger populations. And it’s not at all to say that the loss of life during the COVID-19 pandemic has been small, but Ebola is a highly infectious disease that would have strained and buckled even the best of health care systems within days. So there was no option to have a globalized Ebola pandemic, because the world simply couldn’t survive that.

So you brought up “Outbreak.” … You know, one of my favorite quotes, and it’s always interesting to see the responses that I get when I use it, but Mike Tyson said “Everyone has a plan until they get punched in the face.”

And I think that is how emergency management works, right? Like you’ve got this beautiful plan and you know exactly what you’re going to do and how you’re going to carry it all out. And then you get punched in the face. And that is, you know, when you really figure out. Like, is this the plan? Am I reassessing? And I think that’s a big part of what we see right now. You know, it’s easy to Monday morning quarterback or compare them those two outbreaks and H1N1, but they’re not comparable. Every disease outbreak is its own.

But what we do see is that plan that you have is really tested at that moment of insult. Like when you get punched in the face, when that disease hits your shores, that’s what’s going to cause the real testing of the plan. And the reality is that most plans are not built on the assumption that there will be multiple insults at once.

So when we look at disease plans, when we look at disaster plans — and that’s part of the reason I made that point earlier — it’s not like, “Oh, these people are just working on pandemics and these people are working on natural disasters.” It’s all one thing. So what does it look like in a world where you have COVID plus civil unrest plus wildfires plus hurricanes plus a derecho in the Midwest? Like it’s all one thing, and there is no established plan for what happens when all of the events converge.

Megan Harris

Doctor, you talked a little bit about the challenge of the last mile. Here in the self-driving space, we’ve seen a lot of people try to attack that in different ways. It’s a lot of technical work. There’s a lot of logistics to sort out. Bryan, you actually authorized something kind of cool at Argo AI’s headquarters in Pittsburgh, helping pick up and deliver COVID test kits in neighborhoods where the local health department couldn’t necessarily get to specific clinics. I’m curious how Argo decided to approach that challenge.

Bryan Salesky

Sure, yeah. So this was thanks actually to the RK Mellon Foundation, who purchased a number of test kits that were on the market that were being heralded by some of the local health officials as among the better ones that you could get in terms of accuracy. But they do need to be administered by health care professionals. So this huge, huge amount of kit landed in Pittsburgh. And the question was, how do we get these distributed to all the Federally Qualified Health Centers in Pittsburgh — we really wanted to get these into the lower income, kind of more troubled areas of the city where folks really can’t help themselves very easily. So the question was, how do we get this all distributed? And, “Oh, by the way, as soon as the test is administered, it needs to be put on a plane hours later, taken back to California for processing.”

That was the nature of the particular samples they had. And they said,”Well, this is quite a logistics feat. We don’t even know where to get started.” The local Allegheny County health director, Dr. Debra Bogen, she had heard that Argo runs cars around the city for test purposes and wondered if we could also just happen to pick up some test kits while we’re out there. She called me and I said, “Absolutely, 100%. We will help you with the route planning and figure out the most efficient way to get these samples delivered to the health care centers. And then at the end of each day, back to the hanger where the plane then takes it off to California.”

Alex Roy

I’m going to give you props, Bryan, because, you know, I like PR like anyone else. You weren’t the only guy who had vehicles delivering stuff, but you were very understated about it because good deeds should not be exploited for positive press. So I give you props for that.

Bryan Salesky

Yeah. Well, I mean, it was just the right thing to do. I certainly wasn’t going to say no. They needed help and we were there to help them. We had the right resources to be able to help them.

I think the important part was that what they got out of it was not just us transporting these test kits, but was, we also helped them understand a little bit better how to do route planning, how to do logistics, how to take a limited number of resources and optimize their travels from one place to another. So the health centers were distributed throughout the city. There were real time constraints, and there’s limited number of vehicles and drivers, right? Now, that’s not any different than really any other transportation challenge, it just so happens we’re moving kits instead of people or packages. So the algorithms and the thinking behind how to do that sort of route planning, I think was particularly helpful here.

Megan Harris

So to a degree, it’s kind of about efficiency and just knowing how to move something from A to B very well.

Bryan Salesky

Yeah, and how to schedule limited resources and still meet all the constraints around, you know, “test kit, serial number XYZ needs to be to a certain place in time” within a very specific constraint.

Alex Roy

I have a question for the doctor. When Argo was doing those deliveries, you know, Bryan and his team have mapped the cities. They know the traffic patterns, they know where they have the A to B locations. They have a general sense of the terrain.

Doctor, when you are in a remote location having to deliver supplies to, you know, way, way, way outside a major city in Africa, are you starting from scratch in planning the routes for the mopeds that go through the mountains? Or is there a preexisting plan that you could open a book and say, here’s the script?

Megan Harris

Or a service like an autonomous company that kind of already knows the terrain? How do you do that?

Alex Roy

Like, what do you do?

Dr. Nicolette Louissaint

So you’ve got to rely on people who actually know the terrain. So for some parts of West Africa that are going to be more defined, you can absolutely use a map or some existing information that may actually come from a tech company that’s partnering there. In other instances, you’ve got to rely on the people who actually travel there for various reasons. You know, it may be because their family’s on the other side or it may be because, you know, they actually are a vendor that has a reason to go back and forth from one village to the next. But that’s the only way you’re going to know. There is an effort that I want to say the Red Cross spearheads that allows people to actually crowdsource mapping information during disasters. And that’s been probably the best data that we’ve gotten at the like sub-community level, but normally that’s how you’ve got to do it.

So I was actually interested in asking Bryan what he was able to teach the public health department about logistics, because, you know, talk about a challenge. What were you able to communicate and teach them?

Bryan Salesky

First of all, they just weren’t sure where to begin. And because the challenges were so great — and again, the thing that makes this hard is there was real time constraints around the delivery of these test kits. Because I think these test kits, I don’t have all the knowledge on this, how it works, but I believe these test kits sort of expire if you don’t get them to the laboratory. Right, doctor? Is that it?

Dr. Nicolette Louissaint

They do, they’re time sensitive.

Bryan Salesky

I was told they’re very time sensitive. So for that reason, I think the part that made this complicated was like, they wouldn’t have needed our help if they just needed to get it sometime next week, right? Like you can pay a guy in a van — or a girl — to just go take stuff around. This was much more difficult than that. We helped do the route planning and the logistics piece of it. We sort of described a little bit about sort of how to think through those types of scheduling problems. And then we actually helped them draw up an RFP to get a medical courier on board that can now do this going forward, so that they aren’t limited by whether it be Argo or what we’re able to do now or in the future. And they’re able to really expand out the capability. And so they knew what questions to ask for what and what capabilities they needed.

Alex Roy

In traditional business, you project out, you know, months, years of demand. You build infrastructure to service it yet. Steadiness is hoped for and assumed, and that’s how the structure is built. When a crisis happens, doctor, you’re assuming it’s not going to happen ever, but you want to be prepared and stockpile stuff. What are the organizations just on a high level that are in place that one can open the Rolodex and say, “Oh, pandemic arrived. Here’s who I’m going to call. Here’s what we have to do.” Like, what are the organizations, what’s the relationship between them?

Dr. Nicolette Louissaint

You start with the folks that maintain the national stockpile within HHS.

You know, the thing about disasters is there’s a framework that basically says that all disasters are local, which means that it is county level, then city, then state, then federal. However, when you are starting with a local event, that framework works. When you’re starting with the hurricane or a flooding event that impacts these counties, that works.

But when you’re starting with imported virus into the shores, yes, the local always maintains control. So stay-at-home orders and all of that happen, but it quickly escalates to state and federal levels, right? So those stockpiles, that’s the role of the states in coordination with the federal government.

But a lot of that planning about how long people should stay at home, whether or not company labs were going to be engaged, etc. So in Bryan’s example, some states and counties said, we only want our samples to be run by public health labs that are government owned labs. Others said let’s get as many laboratories that have the ability to certify and standardize the test working on this, whether it’s a government lab, a private sector lab — it doesn’t matter. And so that’s going to determine where those tests need to go.

Also. I mean, right now we’re talking about school reopenings and things of that nature, stay-at-home orders being extended or safer-at-home orders. Those are all local decisions. So part of it is that our emergency management framework has created this kind of scattershot approach where some elements are always local and some elements are always federal. And because we have a federal government and not a national government, we will continue to see that a lot of those decisions do remain at that local level. And that’s a part of the complexity — all the way to how many masks are being stockpiled for a county, or who’s able to do what lab tests — those decisions can remain at that county executive or mayor level.

Alex Roy

Where in this chain of issues, because there are obviously human things that have to be improved in terms of leadership and consistency of decision-making, sure. What are the pain points from top to bottom that automation could potentially solve?

Dr. Nicolette Louissaint

So I think public health logistics has long been a complexity that public health professionals are not really taught in grad school. Right? So understanding the complexity of logistics during the pandemic, for sure. But, you know, when you think about the breadth of things that public health professionals do, they’re running tests and samples every day. You know, it could be for sexually transmitted infections and tests that are being run out of one site. It could be for other screenings that they have. So helping them to understand just logistics and as much as possible in that blue sky time, so that they have that capability when the catastrophic happens. Also helping them to understand, just at the basics, how to engage the tech sector? I don’t think… Like there are a lot of like really kind of high-level discussions about, “Oh my God, it’d be so cool to engage, you know, AI or whatever,” and without any like actual granularity.

So rather than like waiting for the partnership to form, giving the concrete examples of what could be taught or what could be done. I think there’s also an opportunity to really think about serving as a linkage in the supply chain, which I think would be to the benefit of public health, but not necessarily kind of starting with public health, but really thinking about the partnerships that exist within the middle mile of the supply chain, the last mile of the supply chain, when we’re trying to get things to a household. And we’re trying to understand how to get things like a specific pharmacy. Or predict what that pharmacy would need during a hurricane. Like trying to build in algorithms and solutions that help us to not just understand how to deal with what happens or the need after it’s presented, but also understand how to predict what that need could be in a way that is a lot more specific and allows for us to react.

Alex Roy

So today, FEMA or whomever else. Something bad happens. Somebody calls FEMA, FEMA activates, and then FEMA has a Rolodex of trucking companies. Do they need to have an autonomous vehicle company in the Rolodex with a plan preexisting to deploy?

Dr. Nicolette Louissaint

You know, what’s interesting is as you asked that, like, I know FEMA does work with logistics companies, but most of the things that FEMA does move themselves, they would try to move.

Alex Roy

Themselves?

Dr. Nicolette Louissaint

Yeah.

Megan Harris

What does that mean on the ground? Are they renting a bunch of Penske trucks and just doing what they can?

Alex Roy

With drivers who’ve never driven a truck before?

Dr. Nicolette Louissaint

Yeah. So the idea is that they’re FEMA logistics. And FEMA logistics is pretty strong, but their recognition that like once it gets down to the state level, whatever happens at like, beyond that state really should not be FEMA. They’re pretty clear that.

And so my point in saying that is when they’re pulling out the Rolodex, I think instead of them pulling up the Rolodex for the contract, they should be pulling up the Rolodex of experts to say, “Who should we call to talk about how this should be done?” And I think that’s where you should be pulled into the conversation so that before those contracts are issued or before FEMA decides they’re doing it themselves, or the state is doing it themselves, that they’re working with you to see if there’s an easier or cheaper way to pull you in to get it done.

Alex Roy

So what should autonomous vehicle companies or anyone working automation be thinking about or working on right now? Like, is it the relationships first? Should we be developing specific vehicles or platforms to talk to emergency services? What should we be thinking about?

Dr. Nicolette Louissaint

From my view? I think one of the things that’s been hardest to predict is what the world would look like after COVID, or even in the next phases of COVID. One of my biggest concerns is what mass transit looks like after COVID. And it’s not just because that’s how people move, but that’s how commerce moves. Right? Is through these various forms of mass transit. And so thinking about what solutions autonomous vehicles could bring into those sorts of questions of, “How do you maintain a workforce when everyone is afraid to move to travel?” “How do you maintain commerce when everyone is afraid to leave their house?” Like, are there solutions for helping with the issues of people movement? And then I think there’s a question of commodities movement.

Part of what I think is going to be different is not just getting people back to where they normally went, but also understanding kind of like how people and goods need to move in this new era. And I’m not sure that we have any data or any frameworks that help us to predict or better understand what the world would look like post COVID.

To me there, there’s also this assumption that this new normal will be, you know, one day we’ll feel comfortable going the train again without a mask, but I feel like we could all be dead when that happens. Right? Because the reality is, it doesn’t matter. You know, I mean, truly like thinking about it, like, there’ll be a vaccine, there’ll be vaccine distribution, but there’s always going to be the lingering memory of needing to wear a mask, to feel comfortable, needing to maintain eight or six feet of distance to feel safe. And that’s going to be present for a very long time for those of us who have this as a part of our lived experience. So what does it look like to move people around in a world where they still want to remain six feet apart, right, for the next few decades? What does it look like to be able to move goods around when you need to have like no contact deliveries as a standard, whether that is to a hospital or a pharmacy or a supermarket or your house? Like, if, if the standard is we want to have as few hands on this box as possible, we want to have as limited contact, how can, you know, AI and autonomous vehicles be a part of that solution to really help give that assurance of public health safety?

Megan Harris

Are we thinking about it the right way, then? You know, you’re talking about the ways that technology could step in, perhaps. Should we be thinking about the ways we can move people to things? So whether it’s essential health care workers or maybe medical care, moving it to people where they are in their homes, as opposed to getting people across the city at once.

Dr. Nicolette Louissaint

No, I think you’re absolutely right. I got us a stat the other day, just to help with our planning, that stated that about 70% of the American workforce classifies as essential workers, 70%.

Alex Roy

Are they self-classified as essential workers?

Dr. Nicolette Louissaint

No, and I mean, that’s the crazy part. I don’t know. But it also goes to show you that, you know, those frontline workers — and we’re not just talking about like health care workers, we’re talking about, you know, grocery and retail, pharmacy techs, the people who before COVID, frankly, most people ignored. But when you’re thinking about their overall risk, because they, whether it is that they have chronic illnesses or the number of people they’re in contact with, I think you’re exactly right to frame it around, “How do you move those people to where they need to go?” Because that, I think, is also a part of the solution. If you can limit their exposure on public transit, if you can limit, you know, the ways in which they move that keep them safe, but also keep the people around them safe. That is a part of the solution as well.

Alex Roy

All right. So what’s the next, I mean, we’re in it now, but if you are anticipating the next bottleneck or problem, I imagine that’s around what happens the day a vaccine is ready to be delivered.

Dr. Nicolette Louissaint

I actually think it’s what we do on schools and reopenings. I think the vaccine is going to be a challenge. Vaccine distribution will be a challenge, but not necessarily in the first phase, because there simply won’t be enough vaccine for there to be a discussion about who gets what. Like, it’s going to be available in very limited quantities when first approved and made available. So it’s going to go to, you know, those, those few high-risk, you know, health care professionals that, that need to be protected. But I think there’s an illusion right now that things are stabilizing and that a lot of the practices and the behaviors that got us to this point can be largely forgotten. And I think we’re seeing that in how some schools are reopening, how some stay at home orders are being lifted. And my concern is that the next problem we see could very easily actually be a resurgence of COVID in the next six to eight weeks that we’re not prepared to deal with, and that could come up against the election as well.

Alex Roy

But is that a supply chain problem?

Dr. Nicolette Louissaint

It becomes a supply chain problem because the other thing that’s still happening is our very active hurricane and wildfire season. So while the supply chain, especially in the manufacturing side, is boosting production to try to replenish supplies — try to make sure that there are replenishments of masks and stockpiles and preparing for vaccine distribution with needles and syringes and all of that stuff — having another resurgence impacts those plants, impacts those stockpiles and all of those activities that would normally be used in the months to come as it relates to preparing for the vaccine distribution or preparing for the natural disaster readiness and needing to instead use it for a resurgence. That’s what happened to us in the spring. That May-June timeline when everything reopened. That became a supply chain problem, because we ended up seeing that while we were starting to kind of bend that curve, that next uptick created another resurgence that created a massive demand on the supply chain.

Megan Harris

Well, what is the cost of all that preparedness then? You know, if you’re always looking ahead and you’re trying to be proactive rather than reactive, how do you make the decisions about what is worthy of protection and in what order that might fall?

Dr. Nicolette Louissaint

I have personal opinions about that. I think that becomes a policy decision. Deciding what to protect, who to protect and how to protect them — that is the framework of how, you know, most jurisdictions build their preparedness policy. I think the thing that often happens is that especially once we get further and further out from a catastrophic event, we forget that it is significantly cheaper to have a robust preparedness plan and preparedness infrastructure that includes of the different types of innovation and technology that should be integrated into that preparedness infrastructure than it is to build a response. I think the last study showed that for every $1 spent on preparedness, you save $6 in response. So, you know, when you’re really thinking about the cost savings of being able to have that robust plan, it’s there, it’s just that there isn’t a harmonized view on what you do and how you prioritize.

Alex Roy

It seems to me as if everyone says, “Oh, everything’s becoming completely politicized.” But just competence, executing a plan, supersedes everything. What are we seeing right now … or what are we not seeing right now that was executed correctly when H1N1 or Ebola broke out?

Dr. Nicolette Louissaint

You know, so H1N1, I think, is an interesting one because it’s a similar type of virus where you’re dealing with a respiratory infection. One thing that happened very well very quickly was a partnership being established with the parts of the private sector that could support on the response. It was the pharmacies. It was, you know, the logistics folks. It was the tech and marketing companies that could think about how to create messages and then how to amplify those messages. Or how do you, how do you take, you know… This is the first real catastrophe in the social media era as a currently exists. But at that point, there was some initial sense of how do you take data? Like what data is available on where people are going, or where things are needed, and start to sketch out where we need to respond, where we need to provide supplies, where we need to push information. That concept of using social media surveillance to do what’s called syndromic surveillance.

People start tweeting about having a fever and a cough. And then all of a sudden you start to see cluster outbreaks. That’s a real thing. That was part of one of the newer technologies that people were so proud of themselves for during H1N1. Now we’d look at that and say, “Obviously!” You know, that you can think about what people are Googling and see, like, if they’re Googling for Tylenol or is my fever COVID, to see like that they could be a possible outbreak, but at that point that was novel and cutting edge and sophisticated. So, you know, just to show you how time moves.

Alex Roy

You’re the President. Let’s imagine I have an autonomous vehicle company. You get the report that there’s an outbreak of something. OK. You’ve got 50 human operated trucks over here, and I’m like, I’ve got 50 autonomous vehicles ready to roll. What should I do to them? Where should I send them? How will you use them?

Dr. Nicolette Louissaint

I think, what you do, if you’re the President and you’re making the decisions, you don’t decide where to send them. You decide where the needs are. And then you work with the 50 and the 50 to build a collective plan and where they need to go. Because what my job as President is not to make the logistics decisions. It’s to engage the folks that know how to make the logistics decisions. My job would be understanding, OK, here are the communities we’re most concerned about, and here are the supplies that we’re able to present to those communities. So if we work with these 100 vehicles and we have enough product to split across these 100 vehicles, let’s talk about where they need to go. And I think part of that is going to be a function of making sure we’re very clear in which communities need what, when, the most. But also making sure that we have a very clear picture as to the differences in the capabilities and when you would need to have a human operating the vehicle versus when you would need to be use an autonomous vehicle.

Megan Harris

But at a fundamental level, it feels like, you know, everything feels more desperate when you’re at the epicenter, right? How do you get people to care about something that doesn’t feel like it’s their problem yet?

Dr. Nicolette Louissaint

I don’t know that I have a successful answer for that, because I think that’s been one of the things that we struggled with the most over the last couple of months, or really just the entire arc of emergency management. If we’re being honest, people only care about things where they’re directly impacting them. You know, there’s a large case study in what’s happened in cancer research that actually demonstrates that the cancers that have impacted more people have had more investment in funding. So, we’ve invested more money in the cancers that have impacted congressmen or their wives or their daughters like breast cancer versus cancers that have been more rare and have not. All that to say, it’s very difficult because of human nature to get human to care about things that are not directly impacting them.

But the case that has been successful, because humans are selfish, is that if it impacts somebody else today, it could impact you tomorrow. And that recognition that you are not exempt has been helpful in helping people to think about it being important to them, even though it’s not directly impacting them in the moment.

Alex Roy

No one’s worried about being in a car crash — we talk about this road safety all the time — until someone they know has been in a crash or been killed. Are you hopeful about the next phase of the COVID pandemic?

Dr. Nicolette Louissaint

Not really. Probably not the answer you were expecting, sorry. I am hopeful that we as communities are clear on the ways in which the pandemic can impact the most vulnerable in our communities. I am hopeful that that recognition, that as more people are connected to people who are impacted from COVID, whether it’s that they died, or they’re still living with side effects from being infected and recognizing that this is real, it’s tangible, it can affect people you care about, that that is shifting behaviors.

Bryan Salesky

What do you think is not being worked on? What is sort of a glaring hole in your mind that if there was a call to action, what would it be, from your perspective?

Dr. Nicolette Louissaint

So I don’t know if you remember maybe a couple of weeks ago, some governors started creating regional testing compacts and regional supply compacts. And it was like the right solution to the wrong problem, from my view. And I think what we’re not working on yet is thinking about how, what happens in New York impacts Florida impacts Iowa impacts Washington State.

Bryan Salesky

Yeah. We’re setting all this regional policy and not recognizing that we’re humans and we move.

Dr. Nicolette Louissaint

Right. Like it’s as if one cannot get on a plane and be from one side of the coast to the next in five hours. It’s crazy.

Bryan Salesky

You’re so right. This so resonates with me. Because it’s like, if you haven’t noticed, we actually travel. That hasn’t stopped. It really hasn’t stopped. Yeah.

Dr. Nicolette Louissaint

It really hasn’t. And I think, you know, part of what I think about is when we started to see, for example… Like I started to see people posting pictures on Facebook of like their final family vacation before they took their kids to college. And I was like, great. So you’re leaving one state to go to another state for a vacation to come back to that state to then take your kid to another state for college. Fantastic. And we’re not moving at all. Right?

Bryan Salesky

And the roadways are packed, like, because people aren’t flying, the roads are actually packed again. It’s scary.

Dr. Nicolette Louissaint

Exactly.

Alex Roy

Dr. Nicolette Louissaint is the Executive Director of Healthcare Ready. Nicolette, thank you so much for joining us today.

Dr. Nicolette Louissaint

Thank you for having me. This is the most fun I’ve had in awhile.

Bryan Salesky

That’s great. Thank you for coming. It’s really great perspective and information and just thank you so much. Really appreciate it.

Megan Harris

So guys, that was the doctor. Do you have any parting thoughts?

Bryan Salesky

Wow. There’s a lot that goes into delivering toilet paper.

Alex Roy

A lot.

Bryan Salesky

And vaccines, when we get one.

Alex Roy

Dog food.

Bryan Salesky

And dog food, all sorts of things. There’s quite a bit that goes… On a serious note, there’s quite a bit that goes into the logistics of getting from A to B. Hopefully that gave you a little more appreciation for where we are. 

Alex Roy

I’m always fascinated by people who look back at, you know, World War II, for example, and they’d discuss, “Oh why did one side win the other side lost, and it’s logistics. It’s supply chain. The United States in World War II motivated one of the greatest supply chains in history. And it was at one point probably unstoppable, regardless of the outcome of the actual battles.

Bryan Salesky

I’d say we’re still pretty darn good at it. If you look at what the military is able to do in terms of troop movement, supply movement, creating bases from nowhere overnight, look at the hospitals that they constructed overnight in New York City and other cities. We’re good at it. 

Alex Roy

There’s a book for this.

Bryan Salesky

Yeah, prioritize and execute. That’s what it all comes down to.

Megan Harris

I don’t know, though. There’s a big difference between the American populace versus the U.S. military, which are by nature rule followers. They have to be, you’re in combat.

Bryan Salesky

But that’s the issue, right? And let’s face it. Autonomous vehicles isn’t fixing any of this. That’s a tool. It’s a tool in the toolbox.

Alex Roy

I can’t believe you’re using that again.

Bryan Salesky

That must be deployed as part of a master plan.

Alex Roy

You know, I’m going to deploy a few more cliches here today, because sometimes cliches are true. Technology is only as good as our understanding and use of it.

Bryan Salesky

Indeed.

Megan Harris

Everyone pull out your No Parking bingo card.

Alex Roy

At the end of the day, if you don’t deploy the best tool in toolbox, the right tool for the right problem… You know, I’m going too far down this road. It’s great. We agree.

Bryan Salesky

What a great discussion. It was really, really fantastic for the doctor to spend time from her arguably much higher priorities to talk with us.

Alex Roy

You know, but people in that position do need to blow off a little bit of steam and explain themselves. And it’s good for us to understand it. It is good.

Megan Harris

Always a pleasure, fellows.

Alex Roy

Well, that’s it from us. If you like what you’re hearing, please follow us on Twitter @noparkingpod. I’m everywhere @AlexRoy144. Bryan Salesky is the CEO of Argo AI. And Megan Harris is our producer. Please share No Parking with a friend. Like us. Subscribe. Give us a good review wherever you find your favorite podcasts. This show is managed by the Civic Entertainment Group.

Until next time, I’m Alex Roy, and this is the No Parking Podcast.