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In The Midst Of The Pandemic
And The Protests: 
The New Perishable Pundit Podcast 
First Episode Is Right Here!


Things are changing in America... In the midst of a pandemic, the Black Lives Matter protests sprung up around the country. Masses are marching, though it is not exactly clear what changes they seek. The leaders of institutions who want to do the right thing have been making announcements and setting new policies.

Yet it is also true that the leaders of institutions are not all in line. Some are severely skeptical but are also feeling the need to say or do things they are not necessarily persuaded of — lest they be attacked for being insufficiently aligned with popular causes.

Many are afraid to speak their understanding of the truth. They see people being admonished, losing jobs; they fear for themselves, their families and their country.

Here at the Pundit, we are preparing for a celebration this October, as we will mark 35 years of contributing to the growth and enhancement of this industry and the people, companies and institutions that make up the industry.

One of the things we have learned during these 35 years is that the produce industry is not an island. Its success depends heavily on the way broader societal issues are resolved. Rarely is that as obvious as it is today.

So, starting this week, we will be producing a weekly podcast that will focus on the broader issues, the greater environment, in which the success of this industry is bound to be determined.

Here is Podcast Number One Link

You can see a video version here (Hint, the Pundit’s barber got COVID-19 and closed down so we lost the beard — at least for now!).

And here is the script.

Recorded 6 – 13 –2020
Episode 1:
Destructive Protests Hurt The Ones Most In Need 

By Jim Prevor

A terrible sadness is the appropriate emotion as the nation wrestles with the public protests following the death of George Floyd at the hands of the police. What we got, as a nation, was riots.

The attacks on companies, such as Walmart retail stores in Chicago, show the likely consequences of the riots will be to hurt those the protestors intended to help. 

There is little question that George Floyd was abused by his police captors, and a simple listening to the recording of Mr. Floyd’s arrest scene heavily implies that Mr. Floyd was killed by the police officer. We don’t know to what degree Mr. Floyd’s treatment was motivated by race. The police officer who is primarily charged, Derek Chauvin, had a reputation as a hot-head. He seems to have moonlighted working at a nightclub and knew George Floyd, who also worked at the club.

George Floyd was no saint. He had been arrested many times, spent five years in jail and held a gun to the belly of a pregnant woman, to name just a few things. All this, of course, doesn’t give a police officer the right to murder someone, nor does it excuse the police officers on site from failing to object and failing to prevent such impermissible behavior.

Although some have urged massive efforts to “Defund the Police” and, like all human beings, some percentage of police officers are going to be bad people, the reality is that the poor and most vulnerable parts of our population depend most on the police and would benefit from more and better trained police officers, not defunding.

In other words, if you want to help black people, especially poor black people, we really need to fund more police officers and better training. There are other issues — getting rid of bad cops is difficult, partly because of union rules — but which party will stand up to weaken the police unions?

In Chicago, there was a battle for years as Walmart fought to win the right to open stores in the city. It eventually won approval, primarily because it paid off its opposition by agreeing to a “Community Benefits Agreement” that included donating $20 million to various causes supported by local politicians and unions.

Think of it as an unofficial tax that the Mayor and City Council could impose, but could also dedicate the funds to their allies and friends.

Walmart thought Chicago an important market and paid up in order to enter the city, but things have not gone that well. The Wall Street Journal just ran a piece titled, Chicago’s Walmart Plea, pointing out that Chicago has the third highest real estate taxes in the country, and that with underfunded government employee pension plans, these taxes are expected to rise.

Chicago needs stores such as Walmart. Not only do they pay taxes and provide jobs, but they provide fresh foods that transform food deserts to providers of healthy meals.  So Chicago is pleading with Walmart and others to invest and reopen stores. But the Mayor has made no promises to provide more effective police protection in the future.

Walmart is a big company. Perhaps it will invest to be seen, globally, as the good guy, trying to rebuild the city. But, in the end, all businesses have to make money. If they don’t, one day, they will close. That day may be closer than we think.

The Wall Street Journal article goes on to cite a University of Illinois study that found 42,505 African-Americans have left Chicago between 2010 and 2016 and explains the cause: “Under-resourced or closing schools, rising rents, violence, and few economic opportunities characterize conditions in many majority black neighborhoods in the city’s South and West sides, and are contributing to the exodus of residents and families from these communities.”

Of course, it is not only Chicago that will see businesses leave. The CEO and owner of 7-Sigma, a designer and builder of high-performance polymer and metal components and assemblies for many industries, is irate that the police in Minneapolis did nothing to protect his employees or factory. He has announced that he will relocate the company.

Again, fewer jobs, fewer taxes, a diminished future. Nothing that will help the local Black population or the local community.

In an age of social media, it is highly likely that many acts of malfeasance by officials, such as police officers, will become widely known. If this leads to new policies that ensure better hiring, better training and quicker discipline for public officials who abuse their role, that will be a very good thing.

If, however, the frailties of human nature lead to riots and destruction, this is unlikely to help those who have little to begin with.

This is Jim Prevor. Thanks for listening.


If you would like to receive notification and a link when each new issue is out, please let us know here.

If you have a response to the Podcast, you can let us know here.

We’ve been trying to build a better industry for 35 years. Maybe we can also help build a better world. Thanks for sharing the journey.

Shouldn’t Our Industry Associations Try To Support One Another?
After Coronavirus, The Time May Be Right To Look At PMA/United Merger Once Again

Over the years, we’ve written hundreds of pages regarding the unusual situation of the produce industry having two national associations. Here are several columns we ran in PRODUCE BUSINESS magazine on the subject:

Let The Race Begin

Merger Mania

Merger Begs Question of Compatibility

Industry Concerns Should Trump Association Concerns In Merger Talk

Is United/PMA Merger Dead

Could Texas Association’s Realignment Suggest A New Direction For PMA/United Talks?

Here in the Pundit, we have written even more. You can see many of the pieces that referenced this issue here (in chronological order starting in 2006, with a few lapses in years as the topic seemed to die down and rejuvenate over time within the industry):

After a lull of many years, it was after the PMA convention in San Diego in the fall of 2006 that we first heard demands for a merger of PMA and United, motivated by a sense that the industry needed to present one voice on food safety issues. We discussed this issue in PMA/United Merger Fresh On Our Minds.

Next we heard commentary from Harris Cutler of Race-West Corporation and from Richard Kaiser of The Richard Kaiser Company as well as from Bob Davis of Maine Farmers Exchange. We put all these thoughts together in Pundit’s Mailbag — Should PMA and United Merge?

In PMA/United Merger-Mention Stirs Emotions, we heard the thoughtful voice of John McClung of the Texas Produce Association as he weighed on the subject based on his many years of experience with government relations efforts.

Lorri Koster of Mann Packing Company, Chuck Zambito of Zambito Produce Sales and and Jerry Van Solkema of Van Solkema Produce, Inc all added to our understanding of the issues by contributing to Pundit’s Mailbag — More On PMA/United Merger.

Tom Stenzel, President and CEO of United Fresh Produce Association, voiced his confidence in the ability of the boards of the respective associations to make a wise decision for the industry in Pundit’s Mailbag — United’s President/CEO Responds.

The Pundit tried to analyze a possible format for a merger in PMA/United Merger Dilemma: A Two-Track Proposal.

Then in our Pundit’s Mailbag — More on PMA/United Merger, we heard from Jim Allen, President/CEO of the New York Apple Association, who compared and contrasted the two associations.

Then we heard from John R. Baillie of Jack T. Baillie Co., Baillie Family Farms and Tri-County Packing, whose letter, focusing on effective policy advocacy, was featured in Pundit’s Mailbag — One-Voice Plea On PMA/United Merger Issue.

Dan’l Mackey Almy of DMA Solutions wrote us next and pointed out that one gets out of these associations whatever one puts into the associations. A thesis we reviewed in Pundit’s Mailbag — Profitable Participation.

We let the issue simmer for a while when the decision of the Western Growers Association to open a D.C. office raised issues regarding the representation of growers that struck at the core of the issues raised by a merger of United and PMA. We reviewed that in our piece entitled Pundit’s Mailbag — Bigger Picture For WGA’s DC Office.

We devoted the entire issue of July 20, 2007 to An Industry Discussion: Pros and Cons of A PMA/United Merger. In our discussion we mentioned three strong points in favor of merger and 10 strong points opposed. In doing so, we might have stumbled upon an explanation for why we have not had a merger.

Our analysis on July 20 brought a torrent of comments that we will be dealing with for some time. We printed two letters on July 24 pointing out the differences of opinion on these matters in Pundit’s Mailbag — Finding the Right Answers for Possible PMA and United Merger. Dick McKellogg of Lowe’s Food Stores told us that his primary interest is his customer, and a second letter came from a well-known industry leader who has worked the inside of this issue for some time.

The Mailbag on July 25 discussed reasons for PMA and United to remain separate with a letter from Frank McCarthy from Albert’s Organics, Pundit’s Mailbag — PMA And United Need To Remain Separate.

A United Fresh board member wrote to us on July 26. Our correspondent thought our readers might draw the conclusion that PMA performed international activities while United did not, and so sent us a letter in order to correct the record. See Pundit’s Mailbag — Getting The Facts Straight On United’s Global Outreach.

We’ve also dealt with topics that overlapped on the United/PMA merger discussion. Cool Compromise Shows Association Leadership But Battle Scars Remain was one such piece, as was another letter, which we dealt with in Pundit’s Mailbag — What Is The Best Model For industry Lobbying Efforts?

The Pundit’s Mailbag has continued to be busy. On July 31, we wrote A First-Step Suggestion for Merging PMA/United, in which Harris Cutler of Race-West Company suggested the creation of an interim group of representatives of each association to act as one cohesive voice.

Observations From Las Vegas: United Fresh Builds Momentum observed how after several years in alliance with other trade shows, United Fresh held its first solo show in six years. We were asked for meetings by several large exhibitors who told us they were spending well into the six figures to exhibit and couldn’t justify the expense. They were hoping we might bring up the possibility of merging the associations or of finding a way to have only one national show. We’ve dealt with the issue of potential merger before. Over the years the real obstacle to merger has been that many board members have great loyalty to their own association and, whichever association was doing well financially at the time, didn’t see any particular need to merge. For now, though, we have come to think of United as Daniel Webster thought of Dartmouth. He said “It is, Sir, as I have said, a small college. Yet there are those who love it.” 4/28/2009

Watch History Being Made At United In Las Vegas: Steffanie Smith Becomes First Ex-Staffer Ever To Chair The Organization; Kroger’s Reggie Griffin Is Set Up To Become First Retailer To Chair United describes how this year’s United Fresh convention and expo is filled with terrific presentations and wonderful networking opportunities. Inevitably it will bring to the fore the conversation of a possible merger between PMA and United. The forces driving a merger have not dissipated. Much as it took Nixon to go to China, it may well take a retailer to deliver a merger among the associations. 4/19/2010

Clarification: Reggie Griffin Of Kroger To Be First Retail Chairman of United — In The Modern Era explains that in the course of our earlier piece mentioning Reggie Griffin, VP of Produce Merchandising at The Kroger Company, was becoming chairman-elect of United and thus was set up to become the first retail chairman of United, We should have said of the United Fresh Produce Association or of United in the modern era. Allen Brock of Publix was chairman of the old United Fresh Fruit and Vegetable Association back in 1981, and Richard Jahnke, of Wetterau, was Chairman back in 1990. The questions raised by Reggie’s rise are two-fold: To what degree is United’s role to represent growers of produce and to what degree, if any, will having a retailer heading the association conflict with this goal? If a retailer can head United, then what, precisely, is it that prevents merger of United and PMA? 4/27/2010

In Another Move To Court Retailers, United Fresh Joins FMI And American Meat Institute To Co-Locate Event in 2012 announces that these organizations have joined forces to collocate their respective events. That means that United plans to stay in the business of doing a trade show designed to attract exhibitors who want to sell to retailers. In a time of activist government and when government lobbying has become a crucial activity, how will the produce trade finance its government relations efforts? One wonders if a deal couldn’t be struck… what if United gave up its retail-oriented event and PMA gave it some money for lobbying? 5/11/2010

PMA/United Interests Differ: Solution Offered our recent piece, In Another Move To Court Retailers, United Fresh Joins FMI And American Meat Institute To Co-Locate Event in 2012, brought this thoughtful comment from Christian Schlect, President of the Northwest Horticultural Council. Christian writes that our idea of United getting out of the retail show business in exchange for PMA funding its government relations efforts, could boil down to a matter of control. He is undeniably correct. We were suggesting something slightly different, something more akin to a sale allowing the associations separate spheres in which to operate. 5/13/2010

Pundit’s Mailbag — Clear Thinking Required On PMA/United ‘Solution’ our broad coverage of the relationship between United and PMA and, specifically, our piece, PMA/United Interests Differ: Solution Offered, brought this letter from Al Vangelos, CEO of Sun World International, and former Chairman of United, asking us to continue stimulating debate on this subject. There is no easy answer — but there are substantial reasons to look for better ways. What is clear is that we want to move while both associations are healthy so we can act, as Al Vangelos points out, methodically and thoughtfully, not out of desperation. 5/25/2010

Elephant In United’s Convention Halls: PMA-United Merger Possibilities as the industry gathers for the United Fresh convention in New Orleans, many will be discussing whether it would be a positive or a negative for the Produce Marketing Association and United Fresh to merge. It is a long-running industry controversy that strikes to the heart of what the industry would like to have its associations actually do and how the industry would like to pay for those functions. Last month in Pundit sister publication, PRODUCE BUSINESS, we dealt with the issue once more in a piece we titled, Industry Concerns Should Trump Association Concerns In Merger Talk, which we excerpt here. 5/2/2011

A PMA/UNITED MERGER IS UNDER DISCUSSION AGAIN Would It Make Government Relations More Effective? Will PMA’s Rebranding Be An Obstacle? observes how there is always a lot of hub-bub when word leaks out that PMA and United are discussing merger, and this time there is much industry support for it. There are many pros and cons to a merger proposal, but to anyone paying attention, it has been clear for some time that PMA executives have decided that whatever the future may bring, PMA will not feel constrained in its activities by any need to provide room in the marketplace for United. 10/27/2011

PMA And United: To Merge Or Not To Merge? That Is The Question quotes Bruce Peterson, who once said when assessing industry structures, “If we didn’t have the current organizational structure already set up, would we choose, today, to create this structure?” If that is the criteria by which we look at United and PMA, the answer is foreordained as it is almost surely certain that nobody would build the structures of either United or PMA the way they are today. It has simply become impossible to make a list of things that PMA does that United doesn’t and vice versa. So what, exactly, are the prime arguments for and against a merger? 6/1/2012

The United/PMA Fiasco: THE SPIN IS JUST HALF THE STORY Lessons Learned: Open Up To Industry Input And Focus On Big Things First explains that the narrative that has been promoted both on and off the record by United goes like this: The negotiations were arduous, but productive. A full agreement had been negotiated and agreed to; the only remaining issue was who should be the CEO of the newly merged association. The PMA board would not accept naming Tom as CEO; United’s board would not accept naming Bryan as CEO. There was an impasse, and the United board suggested punting the decision to the new association board to elect its own CEO. The PMA board would not acquiesce to this and thus the talks collapsed. The facts are correct, but there is a back story. 7/19/2012

Three Possible Reasons For The Collapse Of The United/PMA Merger Talks 

Our recent piece on The United/PMA Fiasco brought many thoughtful letters, including this one came from a former Chairman of PMA. This epistle raises some important issues. Most notably, the narrative that has been promoted is that the two associations agreed to all components of a merger except the question of leadership. Then over the question of who ought to be CEO of the newly merged organization, the whole thing collapsed. How could United, supposedly seeing a merger as so crucial, just walk away rather than have Bryan be CEO? It makes no sense, and there are only three possibilities. 7/21/2012

An Unusual Perspective — Leader Who Has Served On Both United And PMA Boards Offers Insights On Merger Failure: HARD TO BELIEVE IT REALLY CAME DOWN TO CEO shares a letter sent in response to our recent piece on The United/PMA Fiasco from a member of a rarified fraternity — those people who have served on the Board of Directors of both United and PMA. This is a most thoughtful letter from a most engaged industry participant. He raises four important questions that explain a great deal. 7/21/2012

Pundit’s Mailbag — Putting Leadership First: Consider The Example Of The Ohio Florist’s Association mentions how David Sasuga, Founder of Fresh Origins, has been a frequent contributor to the Pundit. It turns out that in a prior life, David was in the floriculture business, and he sent us a note with an example of how an effort similar to what we were doing in produce has been done more successfully in the floral industry. 7/21/2012

Pundit’s Mailbag — Power Lies In The Pocket Book our piece on The United/PMA Fiasco brought this letter from Eric Schwartz, President & Chief Executive Officer of Patterson Vegetable Company. There is a notion in all this discussion over merger that what some of the big boys want is not so much to see the industry gain great synergy by having only one national trade association as to be saved the pain of having to make difficult decisions on their own. It would seem that what these companies are attempting through the merger process to achieve a market situation that would be more optimal for them. It is not clear, however, that this is even possible. 7/21/2012

A Modest Proposal For Reviving The Merger Of PMA And United reports how one thing that came through loud and clear at PMA’s Foodservice Conference is that many industry leaders want to see consolidation of PMA and United into one national trade association. Let us deconstruct the breakdown of the talks and lay out a specific proposal for how to resolve the issue at hand. Then, it is up to the corporate leadership of the industry to decide if they care enough about the issue of merger to insist that this proposal be adopted. 7/24/2012

United/PMA Impasse More Than Just A Decision About A CEO — It Is A Battle For The Soul Of The New Association asks why did the choice of CEO matter so much? Understanding this issue may provide a key as to whether the industry ought to proceed with a merger. Tom and Bryan are both perceived to have successfully run trade associations and there are lots of other people who have a good track record at running associations. So, why was it so important to people to have “their guy” run the new association? The answer points to a problematic issue regarding the merger agreement. It is an issue so problematic that it ought to make the industry pause for a moment and reconsider whether it makes sense to merge at all. 7/27/2012

THIRTEEN VOICES: Industry Leaders Weigh In On United/PMA Merger describes how the issue of one national trade association for the produce industry and thus possible merger between PMA and United has long haunted the produce trade. We’ve been attempting to analyze the situation and see what can and should be salvaged from this effort. Today, in our July 30, 2012 Edition, we have selected out a Baker’s Dozen of industry letters to give the trade an opportunity to speak out on this important issue. 7/30/2012

Without Change, The Question Will Not Be Who Will Survive, But Rather Can Either Survive? “A Modest Proposal” Take-2 From The Pundit shares a letter from Rick Antle, CEO and President of Tanimura & Antle. Rick is 100% correct that the mission and objectives of these associations have become blurred. The problem is that there are real reasons for the blurring. In recent days, as word of the failure of merger talks has sunk in, many in the industry have responded by saying that if we are going to have two associations, we better make sure we rationalize their structure and goals to avoid duplication and waste. With that in mind, we would like to suggest a structure that actually would work. 7/30/2012

As Association Staff Feels The Strain, Would Wall Street M&A Group Provide Quick Solution To Merger? prints a letter from a former chairman of United and experienced helmsman of several produce companies, Al Vangelos, Co-founder & Principal of Novelle Consulting, LLC. Al is very right about the danger of a drawn-out process on staff morale and retention and his idea about bringing in an investment banker is surely the way to go if you want the transaction to happen. The M&A guys could get us to the optimal business outcome, but whether it is the association the industry wants is an open question. 7/30/2012

Where’s The Face Of The Industry? Is It The Face Of A PMA Or United Executive Or A Volunteer Leader? highlights a letter from Gina Nucci, Director of Healthy Culinary Innovation at Mann Packing Co., who furthers the conversation on the United/PMA merger breakdown. Gina is a person who knows of what she speaks, and she points out that the CEO question — Bryan or Tom — really should not be the question at all. 7/30/2012

How Much Duplication Is There? prints this letter from John Pandol, Director of Special Projects at Pandol Bros., who disagrees with the claim that the two national produce organizations are duplicating efforts. We appreciate this letter, and it brings into focus four important issues in the debate over the future of United/PMA. 7/30/2012

United/PMA Merger Comes Down To Philosophy & Function our piece, United/PMA Impasse More Than Just A Decision About A CEO – It Is A Battle For The Soul Of The New Association, brought many comments including this letter from Jim Carr, President / CEO of Produce Reporter Company. Jim believes the industry does want one association, but that the philosophy and function are the unresolved issues. Indeed, saying one wants one association is fine, but the devil is in the details. This is especially so in the produce industry, where even though a representative of a foodservice operator and a grower-shipper may both agree they want one association — the one they each want is likely to be very different from the one the other wants. 7/30/2012

Neither United Nor PMA Represent Production Agriculture shows how a line in our piece, United/PMA Impasse More Than Just A Decision About A CEO — It Is A Battle For The Soul Of The New Association, caught the eye of frequent Pundit contributor Richard W. VanVranken, Agricultural Agent & County Extension Department Head at the Rutgers Cooperative Extension of Atlantic County. Richard says that his: “perception of both organizations has always been that neither had much membership from, nor understood/represented very well, the needs of production agriculture, in Washington or elsewhere.” When it comes to advocacy, it is a bit of sticky wicket. The national associations are representing the interests of many growers who are not actually members of the associations. 7/30/2012

Do We Have To Wait Another Seven To Ten Years To Make A Merger Happen? writes that to some extent, the point of all these discussions is that those who Rick Antle, in his letter, called the “ownership” don’t, in fact, have to wait another 7-10 years for this discussion to come up again. FMI killed its trade show a few years back because the CEOs of the big supermarket chains got together and said that they wanted this ended. What we are about to learn is the degree to which those who advocate for merger are willing to actually push for it. Individual companies can serve their own interests while also serving the greater industry interest, and we can do it now. Why should we falter? 7/30/2012

A CLOSER LOOK AT THE DYNAMICS THAT LED TO THE COLLAPSE OF THE UNITED/PMA MERGER: Buyer/Seller Disconnect And Consensus-builders Versus Nonconformists finds that with all the sturm and drang over the issue of merger between United and PMA, it is worth a moment to consider the role of buying organizations and the style of association board members in the industry discussions. 8/2/2012

Pundit’s Mailbag — Get It Done received this letter over the issue of merger between United and PMA encouraging bold action, and naming the person to do it, from Steve Scaroni, Founder & CEO of Valley Harvesting & Packing, Inc./Vegpacker de Mexico. If the associations had gone through the paces, and each came to the conclusion that the industry would be better off if they were separate, that would be one thing. But if the association boards are not willing to say that, industry leadership has to find an alternative solution. Use ours — no charge — or come up with another plan, but as Steve Scaroni admonishes us: “Get it Done.” 8/2/2012

Pundit’s Mailbag — Good Ol’ Fashioned Produce Candor Needed our work on the United/PMA merger issue has brought this letter from Fred Williamson, President of Andrew & Williamson who wishes that: “good ol’ fashioned produce candor had been the driving force of the negotiations.” To us, the tragedy is that both sides thought they were the court of last appeal. If stuck in an impasse, surely the right approach would be to turn to others for insight and input. It was not dishonesty but, rather, a penchant for secrecy that kept things under wraps. Of course, such closed vessels sometimes explode and make a big mess, and that is what happened in this case. 8/2/2012

Pundit’s Mailbag — ONE Global Produce Industry Needs ONE Voice shares these comments from Richard Kochersperger, Practise Leader — Education and Research at KOM International, an informed observer without any skin in the game. Richard says that: “To effectively deal with these overwhelming issues, requires ONE voice which represents the entire supply chain.” In Richard’s eyes, many of the motivations for and against merger are small, rooted in individual self-interest and concerns over particular events or programs. How small our bickering seems when one reads this letter. Maybe that is the real issue. Can we get beyond our own limitations? Perhaps coming to one association may be a win beyond our calculations. 8/2/2012

Pundit’s Mailbag — Time To Join Hands And Unite In Prayer For Success prints this spiritual response from Jim Ellis, Citrus Grower and Past Member and Director of Seald Sweet Growers Inc. We appreciate Jim’s kind words. Many, like Jim, are not involved in the day-to-day details of PMA and United, but they sense, out in the Zeitgeist, a need for consolidation. To many, it is not the budgets or numbers of trade shows. It is that the weltanschauung instructs that unity is better, essential even in these stressful times where every day seems to bring another food safety recall and so the industry is always, in some way, under attack. The desire for merger is thus a kind of prayer for unity and a beseeching of industry leadership to go beyond the temporal to the eternal. 8/2/2012

Pundit’s Mailbag — When Confronted With A United/PMA Merger Question, What Would Jesus Do? found among the many letters in response to our articles on the United/PMA Merger, was this one from Fred Williamson, President and CEO of Andrew and Williamson Fresh Produce, that brought in a reference to a well known Christian bible verse. The verse is Jesus talking to his disciples and advising them that because of his actions, his willingness to go to the cross, the temporal concerns of the world will be transcended. In sending this verse, Fred holds out the hopeful thought that the tribulations of the trade are difficult but also temporary and the result inevitable. Of course, that raises a question of leadership. 9/6/2012

Waiting For Desperation? Is It Only Necessity That Can Prompt A PMA/United Merger? opinions keep coming in on the proposed merger of PMA and United. One note came from an important east coast shipper who writes that “Some kind of pain to either organization or to both will ultimately force the merger. Until then they each have enough time, money and member support to continue independently and work toward making themselves right.” One possibility is that the industry really doesn’t want a merger. An alternative possibility is that the associations have “gone rogue.” Still another possibility is that the associations aren’t all that important to the most important players. Finally, the whole idea of merger — the idea that there is just one industry ownership — may just not be quite true. 9/20/2012

PMA Restructures Dues: New Plan Brings In More Revenue, Boosts Costs For Larger Firms, Breaks Longstanding Link Between Retail And Grower/Shipper Dues... Does PMA Need More Money? reports the Produce Marketing Association (PMA), the industry’s largest trade association, has announced a new dues structure effective for 2015. The change is being positioned as a move to make the PMA dues structure more “fair and equitable.” It probably won’t get much push-back because most of the larger companies in the industry already do some kind of extra sponsorships with PMA. But the change in structure does raise other questions. 7/23/2014

Following the collapse of the official talks over merger in 2012, the industry seemed to accept the idea of the two associations going their separate ways.

In recent days, however, we have had discussions with several industry leaders who wondered if post-pandemic — with the possibility that many in the industry will have suffered severe financial losses — it wouldn’t behoove the industry to look at the possibility of the consolidation of PMA and United.

We are not sure how far that will go. One thing that came out in the last go-round is that the associations, at least at that time, had different priorities, with United being really more focused on representing the domestic grower/shipper and wholesale sectors, especially before the US Government, whereas PMA was a more buyer-centric organization, with a more global membership.

An outgrowth of this was that it would be difficult for PMA to advocate for things that supermarket chains and/or restaurant chains might oppose because its most important members, though key buyers, were typically vice presidents and couldn’t very well advocate publicly for policies that their bosses, the CEOs of the chains, would oppose. Thus PMA has not been outspoken about things such as the PACA Trust, which is opposed by most supermarkets.

For United, its most important members were grower/shippers, and the association had the support of owners and CEOs of most of these organizations. It was, in fact, so focused on defending the position of grower/shippers that some of the most important wholesalers in the country, though multi-generational supporters of United, felt the need to set up another association, NAPAR, the National Association of Perishable Agriculture Receivers, to protect them as they felt that United would, inevitably, side with its grower/shipper membership in a conflict over PACA or other issues.

In any case, for the past several years, PMA and United had a kind of entente, and the industry seemed happy.

This year, of course, United got a tough break when its annual convention, originally scheduled for June 16-18 in San Diego, CA, had to be cancelled.

The Association rebounded, and years of work by John Toner, vice president of convention & industry relations at United, paid off as the association was ready to jump into a virtual event.

Virtual events are very different than live events. They have, of course, both advantages and disadvantages.  On the pro side, many people who would never have attended because of expense and time commitment can easily go online from where they are and commit whatever amount of time they want. This is especially true in a situation such as this where United is not charging to virtually attend.

For exhibitors this might turn out to offer some new opportunities with potential buyers who had not thought the cost and time commitment of a trip worthwhile. We would guess that United will have an increase in attendance but a dramatic decrease in hours attended.

In addition, of course, in an industry as tight as ours, much of the value people get is a chance to strengthen existing relationships by sharing dinner, coffee, etc. — and this is all rather problematic in a virtual format.

In any case, it is a bit of an experiment and anyone who loves and values this industry can only hope that United finds success in this format, that industry members find value, and that on the whole United is sustained and strengthened so it can continue to serve the industry and, especially, those portions of the industry that see United as the advocate for their interests in Washington.

So, how disappointing it is to see that the PMA has decided it is desirable to conduct one of its own virtual events right in the middle of United’s annual convention.

PMA has been doing a nice job of presenting what it calls Virtual Town Halls during the pandemic. The association gets a few presenters and, in doing so, provides value to those signing on.

Just recently, on June 11th, many months after United announced its dates and times, PMA sent out a marketing piece announcing that right in the middle of the United Fresh event, PMA would hold one of these Virtual Town Halls.

It is not illegal. But it also is not what the industry wants of its associations. PMA could just as well have scheduled this for the week before or the week after or the week after that.

Over the years, there have been so many times we have avoided holding events that might weaken other produce industry institutions. This is because, in the end, we view ourselves as part of the industry, and if the industry prospers well, we always figured we would come out OK.

We’ve been proud of our association with PMA. We launched PRODUCE BUSINESS magazine at the PMA convention in 1985. On our office wall is a special commendation given to us at The PMA Board of Directors Dinner on the occasion of our 25th anniversary. We worked to write the first industry career guidance document when the Pack Family funded the development of the Pack Family/PMA Career Pathways Fund program. And of course, there have been thousands of connections over the years.

PMA is a large, successful and important produce industry organization. It doesn’t need to try to upstage other produce industry organizations that are valued by many in the industry. It is not what its membership wants.

In fact, maybe, as an industry it is time to take another look at what the industry wants. Certainly it is not funding multiple associations so they can spend the resources trying to undercut the other. Maybe in the post COVID-19 world, it would make sense to re-examine the idea of combining the national produce associations.

Produce Supply Chain Management Lessons Learned From The Medical Industry; Being Pro-Active On Possible Next Wave Of COVID-19 Or Future Pandemics Is A Start

The great challenge of something such as COVID-19 is that we don’t have the time to do decades of research to understand the effectiveness — or lack of effectiveness — of any given approach. We have to act. That means, though, that we could be “successful” at handling COVID-19 yet still fail society due to unmeasured impacts.

In other words, if we ban elective surgery — and define elective surgery as anything that gets scheduled as opposed to an emergency — we don’t know the full negative ramifications of making people wait an unknown amount of time to have their elective surgery. We also don’t know how people will react when limits are lifted. Will they really believe it is safe to engage with the medical system again?

We know of one close associate whose father was suffering and possibly needed surgery. He lived in New York metro area, and his wife was afraid of him catching COVID-19 and held off on visiting the hospital or calling an ambulance. It is entirely possible that he would have lived had he been treated.

When this passes, there will be many studies trying to understand the full medical impact of the COVID-19 pandemic, and this will include the impact of policy choices. In other words, if there is a Second Wave or a different pandemic down the road, would it be desirable to set up “virus-free’ hospitals so that people would not be afraid to get treatment?

We don’t know, but there is a most interesting study about to be published that starts to take us down this road. We asked Mira Slott, Pundit Investigator and Special Projects Editor, to find out more:

Tinglong Dai, Ph.D
Associate Professor of Operations Management
& Business Analytics
Johns Hopkins University 
Carey Business School 

Baltimore, Maryland

Q: The COVID-19 pandemic has thrown many industries, including the produce industry, into a tailspin and has spawned many transformations. As in most cases, addressing one big problem leads to other problems. To flatten the curve and reduce the strain of the impact of the COVID-19 pandemic, many hospitals and health systems halted a wide range of elective surgeries and procedures. A significant number of those procedures were cancer-related treatments, which are now expected to surge after the pandemic. This will challenge the capacity and quality of the healthcare delivery system, spurring your new research at Johns Hopkins.

As produce industry executives navigate the impacts of COVID-19 and strategies going forward, sometimes the most valuable lessons and insights can be gleaned through other industry perspectives.

A: The food industry is also tied to health. With the COVID-19 crisis, what your industry has been doing is very important in keeping Americans fed, but also from a health perspective -- and I would argue from a cost perspective -- the produce industry has been very resilient.

This research addresses the implications and management of post-pandemic demand surge of dermatologic surgery, with a possible second wave of disease outbreak in mind.

Q: Since this study is focused specifically on skin cancer, how applicable will its modeling/methodology and analysis be to other cancers, other diseases, surgeries and procedures?

Could this research provide wider applications across the healthcare system and can this analysis be transferred to hospital operations and supply chain management systems more broadly?

Does this open the door to other research? For example, what was the effect of parents holding off on getting their children vaccinated during the pandemic? Will this lead to an increase in measles outbreaks. Could this study methodology be applied to increased complexities of dental work due to patients holding off on seeing their dentist...

A: These are good questions. The project is motivated by the current situation in the Cutaneous Surgery and Oncology Unit in the Department of Dermatology at Johns Hopkins School of Medicine. Due to the COVID-19 pandemic, all elective surgeries have been deferred for at least three months. These skin cancers will continue to grow during this time and require expedited treatment when restrictions on care are relaxed.

An immediate concern is how pandemic-related deferrals of elective surgeries and how post-pandemic demand surges will impact revenue-generation, patient out-of-pocket costs, and most importantly, patient outcomes.

These concerns are not distinct to Johns Hopkins Dermatology and present a compelling research question widely applicable to a myriad of healthcare delivery settings disrupted by the current and future pandemics.

Q: What is your research plan?

A: We are conducting this research with three aims: First, to assess the operational and financial impacts of COVID-19-related surgery postponements on dermatological surgery nationwide; Second, to connect the impact of delayed surgery to clinically meaningful metrics of disease and patient-reported outcomes; and Third, to model and quantify the benefit of flattening the curve.

The project takes a multidisciplinary approach to understand the personal and financial cost of deferring skin cancer surgery while modeling efforts to flatten the “second wave,” such that each patient may receive comprehensive and expedited care. The database created will serve as a springboard for further projects exploring the intersection of physician-reported outcomes, cost of care, and individual financial burden in cancer therapy...

Q: Are there other studies with similar metrics that have looked at effects of patient care delays during pandemics or crises?

A: Research on non-Ebola care during the 2014-2016 West African Ebola virus epidemic suggests that flattening the post-pandemic demand curve for elective surgeries requires a broad view of the supply chain. Our research will incorporate both supply-and-demand side considerations. Based on our modeling and analysis, we will demonstrate the operational, financial and clinical implications of post-pandemic demand surge and suggest proactive steps to manage the surge.

We believe our research will have broad impact beyond the motivating setting by incorporating behavioral, incentive, and policy issues into the modeling and analysis of disaster preparedness and response, and to inspire new research from the healthcare operations management and health service research communities.

Q: What is the connection of measuring complexity in delay in treatment and patient costs and how it relates to actions to flatten the curve? What confounding factors are you regressing out, and what factors are you gathering that are important to understand impacts.

A: This study is about flattening the curve for the post-pandemic surge in skin cancer procedures specifically. Now if you go to the hospital, a lot of these procedures are being postponed. We’re looking at skin cancer patients that have tumors. There’s no way we’re not doing the surgery because the tumor needs to be removed. So, it’s just deferred, which means the tumor will just be getting bigger.

We must be more pro-active in the planning process to coordinate with patients, the primary care physicians and specialists and hospitals for treatments and surgeries, because if we don’t do this, we will have a surge that will far exceed the capacity of the healthcare system.

I’m also working on related research on colon cancer patients, a collaborate study between Johns Hopkins and Imperial College in the UK. There is real concern about all the postponements in surgeries and the cancellations and pent up demand because when these patients all come back, the hospitals won’t be ready.

Q: Are these patients still unable or afraid to come in for treatment?

A: They are coming back now in Maryland. Maryland has allowed elective procedures to begin again at hospitals. So, patients are coming back really slowly because they are still afraid, and there are challenges. Everyone must wear a mask, and there are strict restrictions in the waiting room, and other hospital limitations. The other thing is… patients are still kind of concerned about getting infections, so even though patients are being invited back, they are continuing to postpone procedures.

So, there is a supply issue and there is a demand issue. These reservations have occurred in other pandemics. This happened with the Ebola crisis in West Africa, and there are indications that is what we’re going to see here, that after the emergency is over, the huge increase in patients will overwhelm the system.

Q: To flatten the curve of COVID-19, people were ordered to shelter in place, and social-distance one another to reduce the number of coronavirus hospital cases, thus securing enough equipment, beds, ventilators, PPE, N95 masks and gear. In other words, decrease the number of sick coronavirus patients and increase the supply and capacity to treat them.

A: You don’t want your case load to overwhelm the medical facilities. Either increase your medical capability or reduce your patient load... We should either try to reduce the surge on post-pandemic patients or be pro-active to help prepare the healthcare industry to handle it.

There are three different components — the hospital perspective, the patient perspective, and the supply/demand side — that factor into how the patient demand will build up and the effect on the supply chain.

Looking at the operational side with any industry and how the supply chain interconnects is critical. The produce industry as an example…

So, people don’t walk into surgery. They have to see a general care physician first, then an oncologist before they are referred to a surgeon. Understanding the supply chain of the care is important.

During the coronavirus, patients weren’t seeing their primary physician for three months, but right now, you see cases where they’re going to their primary physicians, who are sending them to do tests, biopsies, etc., and some of them will be more serious than others. So, we have to understand the hierarchy of the supply chain.

By looking at the risk of delaying the cases, there are two aspects. If by delaying cases, are we putting lives in danger or making cases more complicated, involving more surgeries? On one hand, people have underlying conditions and are prone to coronavirus dangers. Are we putting more people at risk of contracting the coronavirus by treating their medical conditions.

You must balance and manage the risks. From a hospital perspective, you need to understand demand.

The other piece is from the patient perspective; people are hesitant from a mental health perspective. Part of the reason is this COVID-19 pandemic has been a traumatic experience for all Americans, and for some incredibly traumatic.

Most people know someone from their families -- a friend, or a friend of a friend, directly or indirectly affected. Understanding that quality aspect of mental health. We want to look at a patient’s anxiety as the economy is re-opening in deciding procedures.

Q: Do you think some of this anxiety could be based in real concerns of possibly getting infected with COVID-19? If the hospital didn’t have the proper gear and masks, procedures in place... This was an issue widely reported. Or perhaps the patients don’t have health insurance, or are afraid they won’t be able to afford the costs of the surgery...

A: Yes. There is a subjective concern, the psychological, behavioral side, and also the aspect of how well equipped the hospitals are. Do they have enough PPE; is there a chance of patient contamination...?

The fees and charges are another deterrent. Insurance fees for paying out of pocket can be huge.

Hospitals need to be really well prepared with social distancing, getting enough PPE for staff and patients, and accommodating testing... for instance, with organ transplants, if a patient needs a kidney, the recipient and donor have to undergo a lot of testing. It takes time and also capacity.

It requires coordination, and can create multiple bottlenecks in the system.

Something as basic as a waiting room can be a bottleneck. When people come back to the hospital, are you asking them to sit in a waiting room? That’s something we’re trying to understand in terms of patient anxiety and then provide accommodation to minimize the chance of infection, and also intervene on the mental health effects.

Q: Could you talk more about the parameters of the study? And what factors are being considered in the metrics?

A: First of all, we are measuring healthcare in the U.S., mostly focusing on Johns Hopkins Hospital. We’re looking specifically at skin cancer patients, comparing cases from 2019 without delay or cancellation before the COVID-19 pandemic to cases in 2020, where all elective surgeries have been deferred for at least three months.

In 2020 we see hundreds of backlogs in skin cancer cases. With skin cancer cases, you’re always going to have delays with treatments, because they involve a complicated process, and you’re not going to do them tomorrow. So, the patient condition is getting worse over time. What effect will the additional time waiting for the treatment have on the outcome and on complications?

After the case is performed, you can look at what treatment was used, and the effect on the patient’s medical condition, the financial impact, i.e., was the patient paying more for the treatment.

People with high mortality rates are prioritized. Most of the delays are with people whose condition could progress, but it might not be that much, so we want to look at patients of comparable conditions, and to understand, because of this COVID shock, how does this influence patient outcomes.

Q: So, the severity of the case would be one factor, in that those with high mortality rates would be prioritized for treatment. What other factors are involved in the metrics? For example, will you attempt to identify age of patient, gender, economic situation, other underlying health problems, etc., in analyzing the data?

A: This is a really interesting development. We’re doing an empirical study on patient characteristics and demographics to identify comparable kinds of patients. So, these two groups from 2019 to 2020 are almost one in being as comparable as possible, which is critical when analyzing the data.

Q: To clarify, this is research you’re just starting now?

A: We just got approved and got the funding from Johns Hopkins Department of Health, and the other part approved is from grants. The study is perfectly timed.

Our hypothesis is that delays in procedures are going to result in an overcompensation for demand. First of all, people who are coming back have worse conditions, and worse conditions are going to require more complex treatments.

Another problem will be the shock to hospitals. It’s also going to require more expenses. The costs will impact the health providers and also the patients with more out-of-pocket expenses. There are other pieces on how we are going to mend the situation and the negative implications, but this is the hypothesis.

Q: How does this relate to your study with Imperial College in the UK?

A: As I mentioned earlier, I’m part of another study, looking at UK and U.S. hospitals, with a focus on colon cancers, how the procedures and testing have been affected, and how patient outcomes have been affected. We started this study back in March and have already published information on this.

That study I’m participating in as part of the U.S. team at Johns Hopkins with the UK team at Imperial College. There are many, many things to look at.

Q: Are there notable differences in focusing on colon cancer as opposed to skin cancer? Comparing U.S. and UK outcomes could take your research to a whole new level... are you incorporating the differences in healthcare systems, cultures, etc., in handling of the coronavirus pandemic?

A: Yes. There are four phases of the study. In terms of patient outcomes, it’s too early to see whether the providers and the different natures of the healthcare systems are making the situation better or worse. Phase 4 objectives are to compare the impact of COVID-19 on the UK’s NHS and USA model of health care in terms of service provision and cost, and to propose a standardized model of delivering colorectal cancer services for future outbreaks using our collected data and prediction model.

Q: The premise for your research is that actions to flatten the COVID curve at hospitals creates a new curve in cancer-related elective procedures and treatments. How does your research actually lead to flattening that curve?

A: That is the significance of these studies. We are really, really paying attention to what’s going to happen, and the goal is to devise an action plan to minimize those impacts. We need a plan; if things don’t go as planned, we need options. What if we have a second wave?

The action is to understand the different parts of the supply chain and actively reach out to determine whether patients should be prioritized in terms of when they get biopsies and when they get surgery. There is a need to coordinate with people down the supply chain, so you can control the hundreds of referrals, and you have a more orderly process.

The other thing — really the basic minimum — is to try to understand the patients before they come to the surgical suite. The patient has to go through many stages. Surgeons need visibility to prepare, to ensure hospitals can get enough PPE, to have enough testing, because if you just react two weeks before, it will cause a lot of inefficiencies and problems.

Q: Are you saying the patient/hospital supply chain system is disconnected, and lacks visibility now?

A: Yes. It’s problematic. There is not that much visibility… physicians basically work in silos with their patients, and they rarely speak to each other. We hope through this research to promote a culture of coordination, at least in terms of information flow, to move from no information to some information, to make it better than it is now. This is how many patients I’m seeing right now, because eventually people are seeing their primary physicians, and more will see dermatologists. If members downstream have some information of what’s going on upstream, they can be better prepared to manage the demand surges.

Q: Your expertise and research in operations and supply chain management are extensive. I saw that you received scientific acclaim for your studies back in 2015 on remedies to flu vaccine delivery problems and research on contracting for on-time delivery in the U.S. influenza vaccine supply chain. This seems interesting with the current issues related to a COVID-19 vaccine... do you see some connections with the studies you did in the past and what you are doing now?

A: The connection comes from the fact that people have to plan ahead, operationally in terms of production and delivery. In our influenza study, most people need a flu vaccine in October, early November. We must understand the flu shot supply chain is very complicated, with so many different segments.

After the FDA has decided what should be produced — and it takes time to figure out what viruses should be protected against — it’s too late in the process. The production process involves many stages and issues. So, you really have to be proactive in starting the production even before FDA tells you what to produce to ensure you have what’s needed on time. That comes with risk, and you may have to discard a whole lot of product. It requires coordination with hospitals and pharmacists to have incentives to do that.

We don’t know when the COVID-19 pandemic will be over, and when it will come back, and what hospital demand will look like. We need to be proactive, knowing that, and work with different members of the whole supply chain to provide the best quality medical care.

Q: What you describe sounds like a broader systemic issue in orchestrating cost efficient and effective supply chain management... How do you coordinate that? Do you think it should be managed at a national level?

A: Ideally, you want there to be national coordination, but most of the healthcare system in the U.S. is highly decentralized. Even if the White House does coordinate some response, the healthcare system in the states has to provide the care to the patient. I do think the federal government is in a very good position to unify the coalition to help improve the healthcare supply chain and ensure PPE gets to hospitals and healthcare facilities, but eventually we have to work through individual healthcare systems.

This is why Johns Hopkins is working proactively to identify many of the issues, to help develop guidelines other hospitals could be using.

Q: Won’t those guidelines change based on different hospital structures and specialties, regions of the country, maybe a small rural hospital versus a large urban one in a densely populated area, supply and demand, etc. And where and who is getting COVID-19 now?

A: Changes at Johns Hopkins will be different than changes at Baltimore Medical Center, which is more like a community hospital. Because community hospitals don’t have as many COVID patients, we want to be aware of the differences across specialties and across different regions of the United States. Look at New York and COVID-19 infections and mortality rates. We have many different population densities and travel patterns...

This research is a collaboration with Johns Hopkins School of Medicine and Johns Hopkins School of Health, and Johns Hopkins Carey Business School, to build these common set of guidelines.

Q: That’s an advantage to have this integrated expertise...

A: Nobody can do this alone. The public health side is important, but also the business side. How can we do things on the operation marketing side to solve the problems. We have to work across the silos.

Q: Is there a reason why this research is just focusing on skin cancer? Going back to an earlier question, can the modeling and methodology you’re using to measure personal and financial costs in delays with skin cancer tumor growth be transferable to other cancers, or other elective surgeries, or does each specialty need its own research and modeling? For example, the study you’re working on with Imperial College focuses on colon cancer... are there too many differences?

A: You have different parts of the medical care -- the generalists, the primary care physicians, the specialists, and the surgeons... For this study, the key difference between skin cancer and colon cancer is the surgery involved. If you are a skin cancer surgeon, you have your own kingdom; you have your own physical space and you don’t have to share with the rest of the hospital. You’re also doing most of your work on an outpatient basis.

Other types of surgeries are in shared spaces, so you’re sharing operating rooms, and other things. The key difference with skin cancer care is you’re relatively insulated.

Q: That insulation is interesting because it separates some of the issues related to COVID-19.

A: Yes. And bigger departments are a concern. This provides a better understanding of how COVID-19 impacts delays in terms of practice because you don’t have to consider the interdependencies of other specialties when modeling.

Q: Are you studying whether there was a higher percentage chance of skin cancer patients dying if they stayed home and delayed treatment to avoid the risk of getting COVID-19? There are people who argue, for instance, that the cure is worse than the disease in relation to lockdowns and social distancing?

A: That’s a very good question. The chance of patients dying because of waiting for treatment with skin cancer is extremely low. Skin cancer is a very common type of cancer in the U.S. The mortality is low just because of medical pathology and the treatments and therapies, and people know what to do. The risk is much more that the tumor will grow and there could be other complications. Also in terms of the psychological anxiety, if I’ve known I’m a cancer patient, it affects my identity.

Q: So, mortality is low with skin cancer, but delaying treatment could lead to more complex surgery and higher medical costs that could have been avoided if they had gone in earlier. It’s about the personal health and financial tolls.

A: Yes. Exactly. The key drivers and risk factors for mortality when infected with COVID-19 could be your age and underlying medical conditions, so that group of patients is better off waiting.

Q: What is the timeline for your research plan?

A: To understand more broadly the impacts of COVID-19 related surgery postponements on dermatologic surgery, we’re surveying dermatologic surgeons across the U.S. to collect and assess data on operational and financial impacts. We’re also collecting data on patient care and outcomes to quantify, using clinically meaningful metrics, the effect of delay in surgery on surgical complexity and the difference in cost of treatment.

We will also survey patients about their psychological distress resulting from delayed cancer surgery and ongoing infection risk in the ambulatory setting.

Q: Could you clarify whether the data analysis and clinical metrics modeling are focused on Johns Hopkins Hospital, or more broadly?

A: More broadly, understanding impacts of practices overall, but the modeling on patients is focused on John Hopkins Hospital. Johns Hopkins is a very large oncology hospital, so I personally feel this is sufficiently representative, with people coming from other states for skin cancer treatment. So, I wouldn’t be overly concerned on the statistical veracity, like I would if it was a small-scale community hospital. The impact will be different in areas like New York for sure.

Our collaborative research between Johns Hopkins and Imperial College in the UK, which is focused on colon cancer, gives us another perspective.

Q: That sounds fascinating. The influences of the different healthcare systems in the U.S. and U.K. add an entirely new element to the analysis...

A: The financial models are vastly different from here. For the study, we’re looking at how the payment system effects how people are getting their care and the different outcomes, a comparison between the U.S. and UK, and how the different healthcare systems are playing a role in response to COVID-19.

Q: And the U.S. and UK’s timing and responses to COVID-19 were different as well. When you’re setting up your modeling for the Johns Hopkins research on impacts of COVID-19 delays on skin cancer surgeries, you’re using a baseline of patients in 2019 before the pandemic.

A: Yes. And we are comparing characteristics and procedure times in 2020 as a result of delays in surgery due to the pandemic.

Q: So, there are certain patients who may have delayed surgery whether there was COVID-19 or not. Perhaps they couldn’t afford the treatment, or didn’t have health insurance, but when you’re doing your modeling, you’re taking that into account...

A: Yes, and after COVID-19, the economic hardships could also have an impact, if some patients now can’t afford to pay their mortgage... It’s no different from the produce business, when modeling and anticipating people’s attitudes and behaviors, how the consumer is going to react. If people are staying at home and restaurants are closed, how is that effecting grocery shopping...

Q: From your vantage point and expertise, are there steps that could have been taken early on in the U.S. to avert the exponential spread of COVID-19 and lockdown measures to alleviate the surge of cases at hospitals...?

A: There’s been a lot of discussions that we could have handled the crisis better as a country. A lot of people think we are not doing very well at containing the COVID-19, which has resulted in a staggering number of deaths. We didn’t do our best as a country, but as good or better than many European countries in terms of per capita.

We obviously could have avoided a lot of deaths if we had acted differently. By building up our PPE stockpiles and having our own expedited, efficient manufacturing lines, we could have definitely helped avoid infections.

And we have a lot of nurses, doctors, and technicians infected. Around 40 percent of the deaths are attributed to the elderly and long-term care facilities with unchecked infections. Those things could have been avoided if we had better PPE and testing.

Our PPE supply chain failed. Nurses, physicians, and first line workers are our heroes, fighting this enemy. They do need this protection, and many couldn’t get N95 masks. Looking back, I attribute this to supply chain barriers and lack of coordinated actions. I believe this is transferable to the pandemic curve. We’re still facing PPE shortages. There are a lot of lessons to learn.

Q: Those lessons connect to your research to flatten the curve of elective procedures with the anticipated post-pandemic demand surge...

A: Yes. And if you know there’s a high percentage chance of a second wave of COVID-19, are you going to take proactive measures and ensure necessary procedures are in place? We need to anticipate and plan ahead to expand health care facilities and secure the necessary PPE ... a lot of mayors and governors are taking actions across the country, but we must have a contingency plan.

The beauty of America is the ingenuity and spirit of individuals and communities to get this done, with collective reflections of the failures, and resilience to adapt with a view of what’s next.


Our ability to project what is needed has not shown to be very good in this pandemic. In the epicenter of the US outbreak, we spent a fortune converting the Javits Center into a hospital, which was barely used. We sent a Navy hospital ship, the USNS Comfort, which was also barely used. Many temporary hospitals — in the Tennis Center, the Brooklyn Cruise Terminal and elsewhere — took in few or no patients.

This was a big issue, costing hundreds of millions of dollars, but could be put in the “better safe than sorry” category. A more serious question is whether we did harm by depriving non-COVID patients of medical treatment. The answer is probably yes, but we don’t know, yet, how serious the harm was.

With global travel as it is, there is no reason to think that we will never have another outbreak of this type. We need to understand the impact of our actions so as to be better prepared for a possible bounce-back of cases on COVID-19 and for the possibility of future pandemics.

We thank Tinglong Dai for helping to do the research that will provide direction for the future.


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