There is no such thing as a coronavirus disease 2019 (COVID-19) crisis. The virus, or more precisely its perceived threat, is more aptly thought of as the trigger. The actual crisis is a combination of two other factors: First and obvious, the direct health effects of this viral pandemic, and second and far more important, the effects of the measures necessary to mitigate the former. As with any crisis, infectious pandemic included, it is instructive to separate responders into two groups: those charged with ad hoc policy development (hereby called administrators) and those charged with executing those policies (hereby called frontline personnel). That administrative leadership being responsible for policy development can beget three outcomes: (1) aggravate the crisis; (2) merely manage it; or (3) lead the institution to emerge stronger. History is replete with leadership examples during pandemics to avoid or emulate, and administrators are well advised to study it.
The first well-documented pandemic crisis was the Athenian plague, described by Thucydides [1] . In 430 BC, Athens was stricken by a pandemic in the midst of the Peloponnesian war against Sparta. As the death toll mounted, eventually claiming nearly 100,000 lives or one-third of the population, social order broke down entirely. The crème de la crème of Athenian statesmanship failed their subjects. Athenians, who prided themselves in their commitment to the common good and service to the state, lost confidence in their leadership. Lawlessness took over [1, 2] , class distinctions became more acute, and eventually Athens fell to Sparta, ending the Greek experimentation with democracy.
Justinian's plague decimated the Byzantine empire in the 6th century AD [3] . Despite killing nearly half the population and upending production, distribution, and trade, the Emperor Justinian failed to implement effective policy changes. His business-as-usual approach and the absolute-centralized control by the state that was operative under normal circumstances proved inflexible. It led to loss of faith by the people in the state, tax revenues plummeted, army recruitment failed, and eventually the Empire's borders shrunk as enemies took advantage of Justinian's failed leadership [4] .
The most infamous plague was the black plague of the 14th century.
Leadership (state and church) implemented policy changes, although they did so not to address the pandemic but to protect their own interests and maintain their grip on power. Social upheaval was magnified by the blame game as these policy changes by the authorities (states and church) targeted the poor, "heretics," and the Jews [5] . Notwithstanding the horrific toll (some 20 million people perished in Europe), poor leadership resulted in disenfranchisement of the people and led to multiple revolts [6] that changed economic and social structure in Europe permanently.
A positive example of leadership, albeit during a metaphorical pandemic, is that of Winston Churchill carrying the British people through WWII. His style has been characterized by "selfconfidence, enthusiasm, assertiveness, emotional stability, extroversion, warmth, trustworthiness, frustration tolerance and even sense of humor" [7] . Just as importantly, Churchill never claimed undue credit for himself, praised those fighting on the front lines, and was quite tolerant of other's lapses under stressful circumstances. Churchill's leadership transcended the British Isles, and he 3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53 gave equal credit to non-British peoples. The falsehood of "the British stood alone" against the Germans was a jingoistic sentiment propagated by post-World War II nationalists [8] and an example of credit-seeking behavior to avoid.
Human history is rich in leadership lessons during crises that can help today's administrators. As we emerge into the post-COVID-19 world, it is important that these lessons are not short-lived. With globalization, the world's susceptibility to repeated pandemics is increased. The response at national level will tend toward self-sufficiency-the opposite of globalization. Similarly, health care institutional administration must help develop policies that are proactive and flexible and that render their institution as self-sufficient as possible. Importantly, administrators must, at times of health crises, relegate themselves to a role supportive of frontline personnel. Both administration and frontline personnel are necessary to succeed in managing the COVID-19 pandemic.
Thoughtfully targeted policies aimed to enhance the safety and efficacy of frontline personnel are necessary, and they ring true to General Patton's statement that a "pint of sweat today saves a gallon of blood tomorrow." Q3 At the same time, administration should heed the general's more famous statement: "Lead me, follow me, or get out of the way" by making sure those policies are indeed thoughtful and aimed solely to support the work of frontline personnel. 211  212  213  214  215  216  217  218  219  220  221  222  223  224  225  226  227  228  229  230  231  232  233  234  235  236  237  238  239  240  241  242  243  244  245  246  247  248  249  250  251  252  253  254  255  256  257  258  259  260  261  262   263  264  265  266  267  268  269  270  271  272  273  274  275  276  277  278  279  280  281  282  283  284  285  286  287  288  289  290  291  292  293  294  295  296  297  298  299  300  301  302  303  304  305  306  307  308  309  310  311  312  313  314 