Leadership principles to decrease psychological casualties in COVID-19 and other disasters of uncertainty

COVID-19 is a "disaster of uncertainty"with ambiguity about its nature and trajectory. These features amplify its psychological toxicity, and increase the number of psychological casualties it inflicts. Uncertainty was fueled by lack of knowledge about the lethality of a disaster, its duration, and ambiguity in messaging from leaders and healthcare authorities. Human resilience can have a buffering effect on the psychological impact. Experts have advocated "flattening the curve"to slow the spread of the infection. Our strategy for crisis leadership is focused on flattening the rise in psychological casualties by increasing resilience among healthcare workers. This paper describes an approach employed at Johns Hopkins to promote and enhance crisis leadership. The approach is based on four factors: vision for the future, decisiveness, effective communication, and following a moral compass. We recommend specific actionable recommendations for implementing these factors that are being disseminated to frontline leaders and managers. The COVID-19 pandemic is destined to have a strong psychological impact that extends far beyond the end of quarantine. Following these guidelines has the potential to build resilience and thus reduce the number of psychological casualties and speed the return to normal-or at least the new normal in the post-COVID world.