Superb interview questions from Andre Tomlin - Did my best to provide cogent answers, which I hope were balanced while reflecting some of the concerns expressed in my Forum presentation, ‘QI on the Brink: 5 Urgent Challenges to Address by 2030’

The world, especially the US, has been behind the curve of SARS-CoV-2 from day 1: controlling transmission, personal behavior, testing, contact tracing, now vaccine distribution. Advantage virus, which still may mutate & surprise. The corner may have turned, but respect the virus

Imagine if: Not only did SARS-CoV-2 evolve into an easily transmitted virus, but also became 10-fold more virulent. A true apocalypse. We may have escaped destruction by random good luck. We are way too confident in tech and way too lax in preparing systems to respond. Arrogant?

Inauguration reflection #1. I felt the power of faith. I am not a religious man, but the values expressed throughout were the core principles of faith. Moved to tears, feeling the power of faith.

Inauguration reflection #2. COVID and insurrection forced a more parsimonious inauguration. Parsimony allowed us to appreciate the power of the moment, the history and meaning of each aspect of the ceremony. These traditions are deeper than I've appreciated in the past.

Reflection on inauguration #3. I never saw the gift giving ceremony before. It was moving. Giving is joy and a source of understanding and dialog. I had a sense (hopefully correct) that the givers and receivers will remember this ceremony, exercised at this perilous time.

Reflection on inauguration #4. Lady Gaga nailed it! Wow. Basically have ignored her. No more. Best Star Spangled Banner I've seen. Ever. I am not a country devotee, but so did Garth Brooks. Love that belt buckle! Lots of pain and suffering in country music, lots to heal.

Inauguration reflection #5. I would love to work for someone who expresses the values and expectations Joe Biden articulated in swearing in his staff. Work harder than ever before. Be kind and listen. If you don't, you are in the wrong job. Sign me up.

Final inauguration reflection. For 4 years I have tried to say "the 45th President." Saying his name would endow it with unearned substance and respect. Now I can smile, jump up and say, proudly, Joe Biden is the 46th President of the United States! And god protect our troops.

The team that produced the inaugural celebration tonight deserves an Emmy. Turned the limitation of pandemic production on its head. Truly inspiring, not just entertaining. Spread the word. Do the right thing, ATAS, and honor this transformative production.

Treat S African & Brazilian strains as a “new” pandemic & do the screening and contact tracing we should have done in the 1st place plus real time sequencing. The differences in level of vaccine protection aren’t trivial & preventing serious disease isn’t enough to stop US spread

Worried that justifiable focus on COVID in long term care is affecting control of another pandemic, antibiotic resistance. Transmission is different & antibio stewardship is key. See my blog for the national COVID AHRQ/CDC/AHA/ECHO LTCF campaign. ihi.org/communities/bl…. Institute for Healthcare Improvement (IHI)

The Harvardx MOOC "Practical Improvement Science in Health Care: A Roadmap for Getting Results" has opened enrollment today. Sign up and learn with me, Don Berwick, Don Goldmann, MD, and others. #improvement science

Great to see the HarvardX MOOC on Practical Improvement Science in Healthcare now offered as a self-paced course! Check it out: edx.org/course/practic… Obtain HarvardX certificate or just audit if you choose

Congrats to Rombauer for winning the Preakness and his owner, who first thanked the trainer and second thanked the horse's mom. Got that one right!

Theater Pharmacy my small town anchor for 90 yrs. I'm loyal so fill my antenol (tier 1 generic) there. This time $56! Told that's PBM price, but discounted to $15. $0 at CVS, Anthem's "preferred" pharmacy along with other chains. Local pharmacy doomed. Ugly face of "integration."

Roger Bacon, 13th cent. empricist: 4 causes of ignorance/error: The example of unreliable and unsuited authorities, the long duration of habit, the opinion of the ignorant masses, and the propensity of humans for disguising ignorance by the display of psuedo-wisdom. So relevant!

Good sense before germ theory: Marcilio Facino, 1481, on Bubonic Plague: Avoid conversations...and when you converse stay at least two braccia (6 feet) away from your companion, and be in an open space...And make sure the wind is not blowing towards you.

More good sense before germ theory: Fracastoro's "seminaria" - infectious "seeds" spread by direct contact, indirect contact by "fomes" (fomites), and airborne by "strong" seeds that could prosper in the victim and spread to others - 1546. De contagione et contagiosis morbis

Got bivalent mRNA vaccine at branch of major pharmacy chain. Impression, confirmed by friends & colleagues: Even with limited COVID vaccine uptake, pharmacists are overwhelmed by increasing reliance on them for immunizations. Distracted, multi-tasking, feeling unheard. Unsafe.