By Thomas M. Loarie

Upstream Thinking and Getting Ahead of the Coronavirus

March 22, 2020
Column: CEO Learnings

Review of Upstream: The quest to solve problems before they happen, by Dan Heath — As the coronavirus crisis (COVID 19) subsides, there will be many dissecting our failure to anticipate and prepare for it, despite warnings that a pandemic was not a question of “if” but “when.” There will also be many who, with hindsight, will be dissecting how countries, states, counties, cities, civic and business leaders responded.

We will learn of unsung heroes, and goats, and will be flooded with case studies about leadership success and failure. Who saw this coming? Who didn’t? Who was prepared? Who were the leaders? Who were not? Why not?

COVID 19 will be viewed as a crisis that rivaled 9/11 and the great recession of 2017-2019. A lot of black ink was used after those crises to describe “problem blindness,” “the lack of problem ownership,” and “tunneling” – the three obstacles author Dan Heath in his just released book “Upstream” describes as major barriers to solving problems before they happen. You can expect a repeat of this for COVID 19.

Is COVID 19 a problem we could have prevented?

The world has been confronted with an ever-increasing number of (re-)emerging infectious diseases, like AIDS, Avian flu, SARS, MERS, Ebola, and Zika spilling over from animal reservoirs. We knew that a complex mix of predisposing factors in our globalized world paved the way for the unprecedented spread of infections in humans and animals with dramatic consequences.

As such, USAID (United States Agency for International Development), using upstream thinking, created an Emerging Pandemic Threats (EPT) “PREDICT” project in 2009 to aggressively preempt or combat other diseases that could spark future pandemics.

With technical assistance from the U.S. Centers for Disease Control and Prevention (CDC), the EPT global program has drawn on expertise from across the animal and human health sectors to build regional, national and local “One Health” capacities for early disease detection, laboratory-based disease diagnosis, rapid response and containment and risk reduction.

China:  What no one considered and why it matters

What no one counted on was the cover-up of the virus after patient #1 emerged in Wuhan, China. The Chinese government suppressed the information. In addition, China had the whistle-blower physician (who subsequently died from COVID19) recant his discovery of the virus.

This delay cost the world community valuable time to contain the spread of the virus and subsequently, limited its efforts to mitigate COVID19’s impact on global morbidity and mortality.

Where does Dan Heath’s “Upstream” come into play?

The U.S.’s response to the problem. This, I believe, will become a significant case study on how “upstream thinking” was used to curtail the pandemic here in the U.S.

Heath poses seven questions “upstream” leaders need to address in thinking upstream. These are useful in assessing our quest to get ahead of COVID 19:

  1. How will you unite the right people?
    1. The entire government and healthcare system have been mobilized on the Federal, State, and local level.
    2. A public/private partnership, the elimination of silos and regulations, as well as public involvement have been embraced.
  2. How will you change the system?
    1. We have recognized that the system we had in place was obsolete. The system of delivering health care, the production and testing of medical products, and the economic system are undergoing great change.
    2. These changes will not just help us to get ahead of the curve but will result in lasting changes which will improve our national readiness for future unforeseen crises.
  3. Where can you find a point of leverage?
    1. It appears that clear and constant communications, the public/private partnership (which has been mobilized to produce needed supplies and medications), and the involvement of the public are points of leverage.
  4. How will you get early warning of the problem?
    1. COVID 19 is no longer “the” problem we are dealing with but rather a series of potential downstream problems including the economy.
    2. In light of this, our U.S. leaders have painted a worst case scenario and are using data/solutions from earlier outbreaks and from other countries approaches to deal with unknowns.
  5. How will you know that you are succeeding?
    1. I suspect there will be multiple metrics but two are clear
    2. The two primary metrics will be in order 1) the bending of the “infected/death” curve and 2) job recovery.
  6. How will you avoid doing harm?
    1. This is the toughest question of all because we are dealing with something we have never dealt with nor on this scale in the past.
  7. Who will pay for what does not happen?
    1. I am not sure this will be a question we will have to deal with in the U.S. because we have plenty of comparisons available from other countries to know what can happen.

A pragmatic guide

Heath’s “Upstream” provides a pragmatic guide on how to avoid firefighting problems by preventing them to happen. If we stay downstream as most of us do, we find we are handling one problem after another. He takes us upstream in our thinking to get unstuck by fixing systems and finding solutions that prevent problems downstream. Heath uses stories and introduces us to thinkers who have overcome “problem blindness,” “the lack of problem ownership,” and “tunneling” to score massive victories in solving intractable problems related to homelessness, crime, chronic illness, and even customer complaints.

Author Dan Heath is the co-author, along with his brother Chip, of four New York Times bestsellers: Decisive, Switch, Made to Stick, and The Power of Moments. The Heath brothers’ books have sold more than three million copies worldwide and been translated into 33 languages. Dan is a Senior Fellow at Duke University’s CASE center, which supports social entrepreneurs.



Thomas M. Loarie is the CEO of BryoLogyx, a rotating host of THE MENTORS RADIO SHOW, and a senior editorial advisor and columnist for Catholic Business Journal. He may be reached at

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