Well it seems that the Great Tangerine, like a stopped clock, is right twice daily, was correct about one thing; many Western nations can’t actually survive a short period of shutdown. Only now have the majority of countries stopped playing wack a mole over the virus. Only now are they getting back to having a country that functions.
It seems that the ‘flattening of the curve’ had inadvertently been preceded by 40 years of ‘flattening of capacity.’ That hell for leather chase to reduce costs, take out waste, all usually accompanied with a three-year-old, uppity management consultant with a clipboard (later a shiny iPad Pro), had done exactly that, but at the same time crippled the Western world.
Being unable to even cope with day to day health care issues, or follow up on criminal cases were routinely ignored in the crass chase to reduce costs. Follow that up with supply chains that made cat cradles look sensible, with huge country concentration risk compounded the errors and problems. National stockpiles of nothingness, you need masks, ventilators, medicines, we can buy them in when we need them…oops!!!
Add on top a fetish for battering the poor as its all their own fault, along with dismissing the value of so many parts of the community as beneath; how’s the feelings about teachers now? Need that ability for a well-rounded kid, and to be able to offload them so you can actually go to work? Or do you fancy smelling that garbage piling up if you don’t have the workers to shovel the shit you don’t want to? Perhaps those grubby foreigners, you know, the ones you xenophobic fucks blame at the slightest drop of a hat, coming over here, taking our jobs; how you doing without them picking your fruit, packing your veggies, or god forbid, being in the hell hole of a massive distribution warehouse boxing up that 2 dollar t-shirt that no one really needs?
The West had spent all its precious time and capital shoveling the money into an ever small number of pockets all at the expense of having a planet with elasticity and capability to survive a disaster. Investment was at 25% globally; how’s that going to work when the next pandemic comes along? Or how about the next global crisis, climate change. But of course, crisis will be followed by amnesia, experts fawned over for the virus expertise will be ridiculed immediately when climate change is called out. ‘I don’t believe it, I don’t see it happening…’ all the same comments at the beginning of the last crisis.
The kicker though…
It was all dumb. Only later did it become clearer, much clearer, that the virus, while it infected billions, had a mortality rate that was tiny. The way that China had been counting cases overlooked one important thing…people who had mild symptoms or no symptoms were ignored. They didn’t put those cases into their numbers. That anchored perception of mortality being in the middle single digits, bordering on high singles if you have underlying health problems, or were over 60.
The lack of testing for many countries compounded the error, so the data was skewed in many ways. Plus with so many people being asymptomatic and spreading unknowingly meant the lockdown, the isolation periods weren’t aligned properly. Sitting at home for two weeks just in case, destroyed jobs, mental health, relationships and a ton of other things, and was effectively using a sledgehammer to crack a nut. Allied with the time it took to recover from the virus being anywhere between three and five weeks, which meant you may be out of action for close to 6 weeks, was a hit to the world economy that was over-egged in so many ways.
Only once antibody testing became widely available did it become clear how many people had been infected, had had no obvious symptoms and had been the major cause of the outbreak. If testing had been higher early it would have shown those who needed the isolation immediately and allowed much more of the planet to operate. If it had been combined with basic hygiene and mandatory mask usage much of this needn’t have happened.
And not forgetting Force Generation…
Let's change tack now. This is about lessons to take forward and make sure we don’t get into this situation again. But first some history lessons:
During the cold war, NATO ran regular exercises to reinforce Allied forces in West Germany called Exercise Reforger. This was solely to prove out the ability to take 100k+ troops from the CONUS and ferry them to Europe and marry them up with pre-positioned equipment. Essentially it was to show the USSR how quick forces could be generated into a potential conflict zone.
And now back to the Second World War; the British designed a sub-machine gun, the STEN:
And yes this looks like it was made in a back yard workshop; it was specifically designed to be this way. To be able to be rapidly made with handy tools and material just at hand. It allowed rapid equipping of troops with weapons however rudimentary.
So what does this have to do with the Pandemic? Well, this chart shows it all:
And it is that line that says Healthcare System Capacity. The fact that is a flatline, that doesn’t change over time. Why is that the case? Why doesn’t the Healthcare system scale? Why is it seen as a fixed capability asset? So here are some recommendations:
- Pre-identify spaces that can be converted rapidly for the living and the dead. Don’t get four months into a pandemic event, such as Victoria in Australia is doing and just start thinking about how to convert an exhibition center to an emergency field hospital. Also arrange upfront for rapid requisition of spaces, hotels or cruise ships as examples, for self-isolation areas. Such spaces have the ability to help enforce self isolation in a way that is much better than if the individuals are at home. Do as the military does and pay companies to supply cargo ships when needed, allow for a rapid take up of ships into service. Don’t leave this to when a pandemic has broken out.
- Look at the kit needed. Plan what you need. For example; you’d need beds. how do you rapidly get beds or make beds? What about ventilators? An example, develop an open-source design for ventilators that can be rapidly made in local workshops and factories. Put the blueprints on GitHub. Get the community to look at it. Simplify it. Develop it more. Enhance it so it can be made with new manufacturing techniques such as 3-D printing. Test the manufacturing regularly. Give the outputs to needy countries. Same with other physical items; predevelop the blueprints and get them out there. Buy more gloves or masks than needed. Rotate the stock. Give to the needy.
- Electronics. Identify what you need. Go talk to the likes of Apple and Samsung. Ask them to incorporate some of the simple things into their wearables, such as blood pressure, temperature and anything else necessary. Make sure there is a simple way to collate information from say ten wearables to a central ‘console’, likely a tablet, so a single nurse can keep an eye on vitals. You won’t easily be able to get electronics in a crisis as the supply chain will likely have collapsed. When in need go ask for donations of kit.
- Have a reserve force of health care workers. Don’t just rely on what you have. Keep a track of health workers who have recently left the workforce; pay them to be in a reserve so that in need they can be called up to augment the first-line workers. Have them on the roll for say five years. Pay them to be on the reserve list. Have them demonstrate continued training over those years. Who does this already? The military.
- Have a volunteer force of health care auxiliaries. Have these volunteers trained with a higher level of skills than your basic first aid course. So they can do somethings such as stick a needle in you, figure out how to put a ventilator on you, but can’t necessarily take part in surgery. Still have them as retained in the volunteer force. Pay them to be an ongoing volunteer.
My big boss, Satya, bangs on about not having a fixed mindset, we should have a growth mindset. We’ve managed to get ourselves to a point of seeing so many things as a fixed asset. Essentially health care should be seen as an asset that is scalable so when in time of need it can scale, at a known rate, that’s been tested regularly. That way when someone talks about flattening the curve, it can also be married with an increasing capability in the health care system.