Guest Post by Joseph Paris (first posted on CERM ® RISK INSIGHTS – reposted here with permission)
Unless you are a person that firmly believes there will be a second wave – or even that there might be a second wave – the reactions and measures taken to the COVID-19 pandemic are starting to calm down and the world is beginning to unwind the measures that have been put in place; albeit to varying degrees and velocities and with little consistency.
On thing is for certain; this event will be studied for years to come as data is gathered, scrubbed, and harmonized so that proper analysis can take place. Unfortunately, another thing which is as certain is that the analysis will be politicized – with, unfortunately, a priority of placing blame being a primary driver of the analysis and the outcomes.
Throughout this article, I will share the names of several people and organizations who were involved in the decision-making process – not just the people who made the decisions (whatever decisions they might have been), but also those who influenced the decisions being made. This is not to say that I am blaming anyone for any negative outcome from the decisions that were made and why, just that they were the characters involved. So please refrain from believing any of this is a personal attack on anyone – and also refrain from looking at this through a biased lens or introducing any logical fallacies in rebuttal.
I am going to start by sharing a few major concepts that were/are in-play in the engagement of the COVID-19 pandemic and which might illuminate influencing factors in the decision-making process.
Wicked Problems; A “wicked problem” is not a problem that is inherently evil – but rather a problem whose complexity is such that any approach to resolve it is incredibly difficult (or quite probably impossible) to formulate and deploy. The nature of wicked problems is that they consist of a large number of requirements and variables which are contradictory, fluid, and even unknown. Because of the complex web of interdependencies, a solution to one part of a wicked problem can result in the creation of other problems, misinterpretations, and other unintended consequences, which were previously unknown, to be revealed.
Mt. Stupid; The basis for Mt. Stupid is the Dunning-Kruger effect. In 1999, David Dunning and Justin Kruger were two psychologists at Cornell University who released a study – of what came to be known as the “Dunning-Kruger Effect” – that proposed, for a given challenge, incompetent people (who’s incompetence is not known, even to them) will pursue a path born out of ignorance and with great confidence until it is glaringly apparent that the path is wrong – with the resultant realization setting their confidence into a deep devaluation before the process of rebuilding can occur.
OODA-Loop; Colonel John Richard Boyd, a fighter pilot in the United States Air Force, is credited with having conceived and developed the concept of the OODA-Loop in the 1950’s during the Korean War for gaining the advantage during aerial combat based on an iterative four-stage process: Observe, Orient, Decide, and Act (OODA).
The premise is that time is the enemy and the dominant factor in engagement. The strength behind the OODA loop is the assumption that decisions need to be made quickly from imperfect data. The pilot who can engage the OODA loop – making decisive decisions rapidly and moving incrementally towards a goal – will have the advantage and will likely be victorious because the opposition will be caught responding to circumstances that have already changed. A critical key to the OODA loop’s success as a decision-making method is the loop itself, which acts to guide to refine the decisions in a series of continuously improving outcomes.
I would propose for your consideration that the engagement of the COVID-19 pandemic involved all three of the above concepts;
For Wicked Problems; The COVID-19 pandemic can certainly be classified as a “Wicked Problem”. There are so many variables to consider, many of them unknown or unsettled, that a solution to the problem will be difficult to achieve. And every decision made will put us on a path – a decision that cannot be undone, but rather creates a new starting point. Even defining what a “solution” is will be challenging. Is it the complete eradication of the virus (like with Smallpox)? Or will the solution be to learn how to manage it like any other virus (like the flu)?
For Mt. Stupid; With the COVID-19 pandemic; there is what is known, there are known unknowns, and there are unknown unknowns. Decision-makers and decision-influencers from around the world are boldly making grand decisions – often on scant evidence, even hunches. And although they are not in control or in charge of the situation, they act as if they are. This is ego and arrogance over practical, cerebral, and deliberate engagement. The carpenter’s adage of “measure twice and cut once” would be employed to better effect.
And for OODA-Loop; The key to the success of the OODA-Loop is a clear understanding of the capacity and capabilities of what you, and the resources at your disposal, can and cannot do (or even if your resources are available), and as clear and understanding of your adversary (in this case, COVID-19) as is possible. It has become quite obvious that there is a lack of understanding about everything – our capacities and capabilities and those of the virus – yet bold decisions are being made anyway.
Introduction to Research and Observations
The first and most important thing you need to keep in mind is that this article was drafted the week of May 25th, 2020. Therefore, it does not include any “adds, changes, or deletions” after this date. So, if your information differs from mine – and before you decide to light me up on social media – make sure to look at your calendar because the circumstances of the situation will have evolved and that you are comparing my information from today (all from credible sources) to your information. The last thing to keep in mind is that I am an American and, as such, the preponderance of the material here will relate to the American experience.
In the following, you will find my observations and the bit of research that I have done on the COVID-19 pandemic with an emphasis on the decisions being made. This article is not an exhaustive, peer-reviewed research document. But it is pretty darn good and should be able to withstand prima facie scrutiny and debate.
COVID-19 is a coronavirus in the family of cold viruses; the other being rhinovirus. Where a rhinovirus typically results in a headcold (rhino or nose), a coronavirus will often settle in the chest (lungs). A person infected with the viruses will usually not die directly from the virus itself, but rather the complications that will result by being infected, such as pneumonia.
COVID-19 is very pervasive. It is everywhere and no place on Earth should be considered completely safe from it. These “heat maps” from John Hopkins University (COVID-19 by US County and COVID-19 World) support this position and are the most detailed and maintained as I have been able to find. It shows the spread, penetration, and results of the COVID-19 pandemic and John Hopkins appears to update the information as it is available. Of course, the data is only as good as the reporting of the data for completeness and accuracy – so caveat emptor.
Politicians and Leadership
I start with leadership because this is the source of all decisions made and enacted. But the politicians, the ultimate leaders in society, know nothing about viruses and pandemics other than what their advisors tell them. And the advisors they listen to, well, we can only hope that they are wise and knowing. However, with little recent experience to draw upon, they could only base their recommendations – and the resultant decisions – on what they could draw and infer from past experiences that might be similar. What they did not know, and do not know yet, is what they know, what they think they know, and what they don’t know at all.
Other than politicians, people sought guidance and information from the Centers for Disease Control (CDC) and the World Health Organization (WHO). The challenge was that these organizations would only offer answers when they had actual answers. Most of what the CDC and WHO would offer (and they were right to do so) were their opinions and recommendations based on the information that is/was available to them.
But people wanted answers. So either the leaders or media would take the opinions and recommendations shared by the CDC and WHO and extrapolate the information being shared as answers, as facts. When these answers and facts would then be changed, it reflected poorly on the CDC and WHO – and pretty much everyone involved in the decision-making process.
245+ Labs (50 in the States alone)
Although the WHO – along with the CDC in the States and other health ministries around the world – are aggregating and creating guidance, in reality each country (and the 50 States within the United States) are acting as their own, independent, laboratory; nearly free to engage the pandemic as they see fit. Although this lack of cohesiveness would have serious drawbacks if engaging the known, that much is unknown will yield bountiful data from multiple sources yielding a much broader picture than one source would be able to achieve. And the subsequent analysis of the data will help to determine what actions were more effective, least effective, and even which were detrimental – and why these actions yielded what they did as results.
Do they work or don’t they? The communications on whether to wear masks or not were also muddled. First there were instructions to wear masks. But then the messaging was that masks were not effective in protecting against COVID-19. Then the messaging changed again that masks are not intended to protect the person wearing the mask from the virus, but to protect others in case the person wearing the mask had become infected. As an example, a surgeon does not wear a mask to protect him from the patient, but the patient from him. This Möbius strip in communication was enough to cause confusion and indecisiveness in the citizenry; the effects of which we are still seeing.
The CDC, WHO, and others have established six feet (or two meters for those on the metric system) as the recommended distance that people should remain away from one another. Other sources claim that the distance should be greater – that the virus can spread well beyond these recommendations. But what determines this?
It has been demonstrated by Lydia Bourouiba (a fluid dynamics scientist at MIT) that the droplets in a sneeze can travel 27 feet (approximately 9 meters) and can be suspended in the air for several minutes before settling. Another study, Talib Bdouk and Dimitris Drikakis of the University of Nicosia, the “cloud” from a cough can remain viable for up to 18 feet (approximately 6 meters).
In both studies, the movement of the air can also have a dramatic effect on particle disbursement, increasing or decreasing the range.
Then there is the question of how long the virus can exist and remain viable on a surface. Originally thought to remain a viable threat for hours or even days, the CDC now considers catching the virus from surfaces as being less likely and not the main way the virus spreads – but it also adds a disclaimer saying that the CDC is learning more about how the virus spreads.
So why six feet? Why not…
Shutting Down the Economy
The decision was made, without thinking it all the way through, that the best way to “defeat” the pandemic was to keep people from meeting. And the only way to do this was to close everything and every opportunity for people to meet – in effect, to shut down the economy. Certainly, there is a shared goal to slow the spread of the pandemic until a more permanent approach might be found, but was economic suicide the only way? The impulsive and bold reactions from leaders around the world brought a once-thriving global economy to its knees quickly and ruthlessly with the people in power and with means largely casting asunder those who had no power and little means. To those people, YO-YO; You’re On Your Own.
- Border Closings;On President Trump’s orders, the States placed travel ban for people coming from China on January 31st. This followed a ban (on short notice) from the countries who were members of the Schengen border-free travel area (except the United Kingdom and Republic of Ireland) effective March 13th and with Ireland and the United Kingdom being added to the ban a few days later. Poland, on March 15th, was among the first within the EU to close its borders to all other European countries. Other countries around the world soon followed suit.
The mad-dash to return to the States from Europe was chaotic. Watching the news reports and video of the masses of people crammed like canned sardines into passport control at airports that were international hubs (such as JFK and Newark, Philadelphia, Chicago, and Atlanta), I couldn’t help but wonder how many of those people were infected and how many became infected as a result of the exodus.
- Essential Businesses;As mentioned, the theory is that COVID-19 is highly contagious and the countermeasure was to keep people distant from one another. On the surface, therefore, closing businesses and shutting down events might seem like an appropriate course of action for achieving this – and allowing only “essential” businesses to remain open.
But what and who determines whether a business is essential or not and under what authority? Certainly, grocery stores and gas stations are essential. But the randomness and arbitrary criterion for determining whether a business is essential or not caused confusion and angst. For instance, why could someone go to Walmart, but not their place of worship? Or to shop at a liquor store or gun shop and not a clothing store? And what safeguards were there that limited the exposure to the virus within these businesses that were deemed essential, especially for the staff that worked at them?
And we were told that the virus can survive on surfaces for a considerable amount of time. Yet no safeguards were put in place or procedures recommended for the receiving of mail or packages from online shopping.
And lastly and most important; was it really necessary to put 30+ million people, or nearly 10% of the total population in the United States, out of work? For how long? And most important, how fast can these people be brought back to work?
- Defeating the Virus; In response to COVID-19, some leaders have been quick to shut-down their economies and some have not. The same is true as they begin to re-open, with some being quick and some being less so. During this, I have two concerns.
The first are the howls of doom awaiting being cast upon those who are deemed to be opening “too quickly” (whatever that means). How can they know that doom will be the result? Both the CDC and WHO share their desire for caution because a second wave might happen – but they do not claim that it will happen. And what if an uptick is thought to be a second wave and not a “dead-cat-bounce” that is just as likely? What to do with that information and words of caution are up to the citizenry to decide.
And the second is that there are others who promise that they will not re-open their States until the virus is “defeated”. What does “defeated” even mean? Does it mean absolute zero with no infections, no deaths? Some leaders claim that even a single death is too much, that no cost to great, and they will not re-open until the virus is defeated; in effect signing themselves (and others) to an economic suicide pact. While a noble goal, is it practical; or even achievable? How will this affect those being shut-down? Who is going to ensure their needs for survival are met?
The lack of clear, concise, and consistent recommendations and instructions from the leadership as the situation unfolded – born of ignorance and a self-inflicted sense of urgency to “do something, anything” – resulted in a series of panic-induced decisions from everyone (government, business, and the citizenry) with many of those decisions being flawed or outright wrong and caused unhelpful, but predictable responses. For instance;
Panic-Buying; People fled to the shops to buy-up, until the inventory was exhausted, items like; masks, gloves, hand-sanitizer, spray sanitizer, toilet paper, paper towels, as well as guns, ammunition.
Personal Protection Equipment (PPE); Governments and healthcare organizations spent unknown amounts of money to get as much PPE as they could find. The sudden demand and limited supply led to prices skyrocketing, not to mention created an environment where unethical behavior (canceling existing orders to fulfill more rewarding ones, for instance) and frauds could run unchecked.
Ventilators; Similar to PPE, the demand for ventilators also skyrocketed as it was felt there were not enough of them to meet the need that was anticipated. Almost overnight, companies changed their production from whatever it was that they normally produced to manufacturing ventilators – the vast majority of which will now sit in inventory, unused.
Temporary Hospitals; There were many temporary hospitals that were set-up on short notice. There were sixteen (16) temporary hospitals in Wuhan China that treated a total of 13,000 patients. The concern was such in New York City that the Javits Center (a convention center) was converted to a temporary hospital with bed capacity of 2,500 and the USNH Comfort, a floating hospital with a capacity of 1,000 beds was dispatched to New York City to assist with an expected overwhelming number of patients. But at any given time during the crisis, there was rarely (if ever) more than ten-percent (10%), or 200 beds, being utilized between these two temporary hospitals – and often fewer than 100 beds.
A similar story could be told in Los Angeles where the USNH Mercy with a capacity for 1,000 beds has only treated a few dozen patients since it arrived; with the biggest challenge being faced by the Mercy was that several members of the crew became infected with COVID-19.
Ironically and even shockingly, because most elective procedures had been delayed by various government orders, many hospitals found themselves under-utilized and in a dire financial crisis (with specialty hospitals nearly empty) and many healthcare workers were laid off for having nothing to do.
Government Largesse; In March and April of 2020, the United States government spent money like a sailor on shore-leave; a total of $2.0 Trillion Dollars in three phases. The details are dizzying to read. And I can’t imagine anyone knowing all that was included in, or excluded from, these bills. I have provided the details below for anyone who might be interested in finding out. But I am left wondering how much waste (defined as paid-for, but not needed) is included in these bills. I don’t suspect we will ever know.
However, included in some of the bills is direct relief payments to the citizens for those who are on the Federal tax rolls. But I am wondering why everyone got a payment. Not to bash the rich, instead this observation is on behalf of all taxpayers (and government indebtedness), why would someone who is well off (I will define that as earning $250k+ if single, $500k+ if married) need a $1,200/$2,400 relief check? Sure they can use it (everyone can use money), but do they need it.
- Phase-1: ($8.3B) Coronavirus Preparedness and Response Supplemental Appropriations Act 2020 (H.R.6074)
- Phase-2: ($192B) Families First Coronavirus Response Act (H.R.6201)
- Phase-3: ($1.8T) CARES Act (S.3548)
In addition to the three (3) phases that have already passed, there are discussions around a Phase-4 and even a Phase-5
Mark Twain famously said; “There are three kinds of lies; lies, damn lies, and statistics”. And in no recent time is this more true than in the COVID-19 pandemic. In March of 2020, the fatality rate of COVID-19 was placed at 7.2% by the Italian National Institute of Health (Istituto Superiore di Sanità [ISS]) as that country was hit early and hard by the pandemic. And from that early moment, this was the benchmark number used by all other countries in their engagement planning process.
Presently, the best estimates of symptomatic cases from the CDC places the overall fatality rate at 0.4% with those people aged under 50 years old at 0.05%, those people aged between 50 and 64 years old at 0.2%, and those people aged 65 or greater at 1.3%. And the overall hospitalization rate is placed at 3.4% with those people aged under 50 years old at 1.7%, those people aged between 50 and 64 years old at 4.5%, and those people aged 65 or greater at 7.4%.
A casual review of these number clearly demonstrates that those people who are 50 years old or older are at a magnitude greater risk than those under 50 years old. We also know that those who have underlying conditions are also at greater risk – with the majority of these people being 50 years old or older.
Perhaps a wiser course of action would have been to protect the people most at risk rather than having a general lockdown of society as a whole. Certainly, programs could have been quickly deployed to support these at-risk people in-place; whether at home or in a care facility, with more rigorous testing to ensure that, if they were infected, they were quickly transferred to a healthcare facility until recovery.
And it’s irrefutable and unconscionable that moving those people at highest risk (mostly the elderly) from hospitals back to nursing homes lacked imagination, if not judgement.
I am certain that such an approach – isolating and looking after the most at-risk along with remaining calm and deliberate as we engaged – would have cost considerably less than $2-Trillion.
Furthermore, the CDC estimates that 35% of those infected are asymptomatic; meaning, if counted, the overall fatality and hospitalization rates would be driven down another 35%. Afterall, only those confirmed as being sick enough to seek medical care are counted in the hospitalization and fatality rates.
How can this be explained? In a word, testing.
It’s really simple math.
Those who sought medical care, required hospitalization, and those who died determine the value of the respective “numerators”, and the total number of people infected determine the value of the denominator. These numbers are rather easy to determine because they are accurately (not precisely) counted.
The more people who are tested, the greater the value of the denominator will be as those who are discovered to have had COVID-19, including the asymptomatic, grows. The [Numerator] divided by [Denominator] yields the [Percentage] afflicted. And the percentage requiring hospitalization or those who died being the yielding the numbers to key-off for planning.
And I also wonder in how many deaths the COVID-19 virus was the primary cause of death and not a contributing cause of death, as this would reduce the numerator and drive the percentage further down. For example; take a person with terminal cancer who catches COVID-19 and dies. Is that person counted as dying from cancer or COVID-19? I don’t know, but it matters.
But testing has some caveats. Just because a person’s test comes back negative does not mean they are in the clear. A person might catch COVID-19 after being tested – especially since it can take up to two weeks for symptoms to appear (if they appear at all).
It would appear that the media acted as cheerleader for COVID-19, almost taking pleasure from the misery of others [schadenfreude] and completely ignoring any positive information; even seeking stories that would prove exceptions to the rule, rather than the rule itself. How many stories were there about the younger person or the athlete succumbing when we were told it was mostly the elderly and infirmed who were being affected.
Take this headline from National Public Radio (NPR), as one of countless examples; “Number Of Patients At Overflow Hospitals In New York Has Doubled”. We know New York City was greatly impacted by COVID-19. Every day, we were given an update on the “butchers bill” from Governor Andrew Cuomo and Mayor Bill De Blasio, and the numbers were indeed terrible. So taking a casual glance at the NPR headline and we would be aghast – thinking how terrible the numbers might be. But you had to dig into the article to read that the numbers were 189 being treated at the Javits Center and 15 were being treated and the USNS Comfort – not admitted, but being treated. The headline was obviously intended to convey fear rather than facts; a modus operandi that was pervasive throughout reporting.
And then there were countless stories and edited video clips that served to discredit anyone who was trying to share any cold facts. The media would seek (even fabricate) any opportunity to craft a message that served their agendas and narratives rather than just reporting on the facts as they were laid-out.
This did not serve the public good. And the media should do better – much better.
Just give the people the facts. By and large, they are intelligent and would show that intelligence given the opportunity. The Media should report what the leaders and experts are sharing and recommendations from credible sources – and keep their thoughts and opinions to themselves. If there is a redirect (such as with the masks), tell the people why the redirect.
And the Media needs to know who is an expert that can contribute to the conversation and who is not an expert but positioned as one. For instance, in addition to her being an expert on “climate change”, is Greta Thunberg also an expert epidemiologist or virologist as CNN would have you believe? It would be laughable if it wasn’t so cynical and pathetic.
Blame is for God and small children – this was not one of mankind’s finer moments.
The COVID-19 pandemic was certainly a Wicked Problem. Many (if not all) of our leaders climbed Mt. Stupid and fell off (and pushed others off). And the pandemic was engaged using the OODA-Loop; making decisions very quickly with leaders relying on the capacity and capabilities of their nations to engage and regain the lead – only to discover after the fact that they didn’t have an understanding of their adversary nor their own capacities and capabilities.
Those in leadership acted impulsively, were ill-informed, and reactive; almost devolving to the rule of the mob. We let fear, and not fact, dictate our actions. And we took as fact that which were mere notions. All the while, the citizenry played-out a 21st Century version of “The war of the worlds”, the fictional radio drama that caused many in the States to panic when it was aired. Even now, there are those who are driven by a fear so strong that they are paralyzed – and want everyone else to be similarly paralyzed. And another faction that believe they are libertarian gladiators; able to do what they want regardless of the concerns of others and invincible. The truth, the solution, will be found not in the extremes, but in the betweens.
And the seekers of the truth, the media, those who’s responsibility is ensure the populous is properly and accurately informed, instead played (and is still playing) a game of sensationalism one-upmanship; seeing whose stories and craftily edited videos will get the most engagement on social media and seeding division and derision on a captive audience – not free to go out and see how it actually is.
It’s too soon to play Monday Morning Quarterback. Being still in the midst of the pandemic (but hopefully on the tail-end) and not yet having the luxury of twenty-twenty hindsight, there will be ample opportunity to reflect at some point in the future. And the amount of data collected, actions taken, and experiences had will be fodder for many MBA and Doctoral thesis for years, perhaps decades, to come.
Let’s just be sure to do better next time.
Paris is an international expert in the field of Operational Excellence, organizational design, strategy design and deployment, and helping companies become high-performance organizations. His vehicles for change include being the Founder of; the XONITEK Group of Companies; the Operational Excellence Society; and the Readiness Institute.