A View from Inside of West Virginia’s COVID-19 Response

It is great that so many national and international organizations and media are interested in understanding how West Virginia has responded so effectively to the COVID-19 pandemic. 

There has been a lot written about our decisions regarding local control of vaccines, West Virginia’s creation of a pharmacy vaccine network, and in our clarity and communication about our priorities. 

I think our culture in West Virginia contributes to our success, and the elements that are more visible simply reflect who we are.

I think it is our culture. Our willingness to sacrifice for the greater good. Our willingness to just be West Virginians together, and as Gov. Jim Justice says, “run to the fire.”

I recently read a CNN piece about a rural county in Washington State that had not wasted a single dose of vaccine. Reading their story reminded me of ours - a bottoms-up implementation of a top-down set of principles and desired outcomes. 

Let me try to articulate this for how we’ve done this in West Virginia and frame our approach to the entire pandemic. 

We look at COVID-19 as a “black swan event.” This is a reference to Nassim Taleb’s book “The Black Swan: The Impact of the Highly Improbable.” He referenced these types of events as rare, usually with a powerful negative impact (think 9/11, the Great Depression, flu pandemic of 1918.) Tremendous unease occurs that rocks the foundation and of our social, cultural and financial stability.  

In these events, cause and effect are very difficult to define. In other words, if you think you can predict outcomes for these events, you are wrong. Thus, rapidly adaptable approaches, rapid cycle learning and transparent communications are key. 

Why? Because these are dynamic, fluid environments. This is what Gen. Stanley McChrystal wrote about in “Team Of Teams.” Moreover, as was done in Washington state, there needs to be a spirit of innovation and bottoms-up solutions that are welcomed, as long as everyone is moving in the same direction. Gov. Justice calls this “pulling the rope in the same direction.”

Think of this as scramble golf. The top-down part is the hole everyone is hitting at, and the bottoms-up is playing the best ball, no matter who hits it. 

The only way you get this kind of system to work is by creating open communication, shared credit, lots of psychological safety and commitment to shared purpose. 

Like President Harry Truman said, "It is amazing what gets done if no one cares who gets the credit.”

It is also critical to be able to move away from solutions that don’t work and move to those that do. This requires maintaining the principle of optionality (keeping all options open), and a lot of trial and error. We like the 70% solution - if we think there is a 70% chance of success, we will implement it, and measure its success or failure over time.

Not being afraid to kill your own ideas is crucial.

It is also important to communicate clearly. Our governor has done a great job of keeping the state together with very frequent press briefings. We have formed a team that is ready to take questions from the media and stress our message for the state.

In this effort, we were incredibly grateful for the partnership with the WVU Reed College Public Interest Communication Lab Team. They have donated their time and effort to work on our communications efforts. Dr. Julia Fraustino, Dr. Geah Pressgrove, Dr. Daniel Totzkay, and others have definitely enhanced our ability to reach our citizens about the importance of this effort with consistent, scientific and relevant information to help our state and its people. Dr. Lisa Costello, pediatric specialist at WVU Medicine, has also been a real champion of the #CommunityImmunityWV effort.

Secretary of the West Virginia Department of Health and Human Resources Bill Crouch has been able to tell West Virginians, directly, how the state’s coordinated response is working to serve them. His leadership has weathered us through this storm.

Moreover, our team has been active on social media to address questions concerned West Virginians may have. Dr. Ayne Amjad serves as our state’s health officer with West Virginia DHHR, is also a fixture in our press briefings, and frequently helps our state’s people with their questions and concerns.

We have adopted the principle of elevating the most qualified people at leading varying parts of our response. By being a leader, we are also sometimes followers. Often, it is the following component of leadership that opens your eyes to problems and opportunities you could never see from a leadership vantage.

Lastly, we truly empower our team members. 

We were the first in the country to vaccinate our nursing home residents. We knew that 50% of our deaths from COVID-19 were from this population. In addition, our average age of death from COVID-19 in West Virginia is 77 and that 77.5% of our deaths were in residents greater than aged 70.

Thus, our initial plan included the commitment to vaccinate our nursing home residents and staff. We asked Marty Wright, the CEO of the Long-Term Care Association and the leadership of this sector to work with Krista Capehart, our representative from the West Virginia Pharmacy Board and WVU’s School of Pharmacy. 

This is how our network of pharmacies and nursing homes was shaped and with work from the West Virginia Joint Interagency Task Force, led by Maj. Gen. (retired) James Hoyer, who recently joined the WVU leadership team, and Lt. Col. (retired) Joseph Peal, our pharmacy network plan was hatched and did not include the federal pharmacy program. 

We submitted information and logistics to Operation Warp Speed, and they agreed with our plan to engage the state’s more than 200 independent pharmacies (many privately owned with pre-existing relationships with rural nursing homes). 

This series of contributions allowed us to plan on finishing our second doses in this highly vulnerable population before January has ended.

This is how all of our decisions are made, and of course, the governor is the final decision maker. But he operates the same way with us - no good idea is passed over, and he really listens and makes decisions with the same principles we all do. 

Save lives, promote wellbeing, maintain healthcare, and community capacity and function. 

May our approach continue to see success and that our neighbors see their own successes also.