We're living with the COVID-19 pandemic for more than 12 months already. And yet, according to my observations, surprisingly many people still do not get it:
- why is it considered so dangerous?
- does the threat level justify our lives being turned upside down (the issue of personal inconvenience)? or even whole industries getting paralyzed (the matter of global economics)?
- what are the potential, practical consequences of not adhering to the restrictions?
Some of them (usually the young ones, in good shape, middle-class+, well-educated) contest the situation and ostentatiously ignore the constraints and regulations introduced to stifle the pandemic. Their reasoning varies a lot (I've pre-filtered out all the most ridiculous justifications):
- some don't feel personally threatened (they are vital, strong, may not have any vulnerable loved ones)
- some haven't experienced COVID in their social circle: they didn't know any victim or anyone who suffered personally
- but what's most important - many simply have a skewed perception of what's 'pandemic' and how it 'is supposed to look like': they were expecting scenes similar to the ones from catastrophic movies - victims dying in the open, bodies piled in the street corners, riots and plundering in search of food, etc.
Obviously, that's not how it (the pandemic) looks like. But it doesn't mean it isn't dangerous (to the whole society, not just the weakest and elders). Why so?
Some raw data
To understand the nature of this particular threat, we need to apply some engineering thinking. But first, we have to start with two very well-known medical facts:
- COVID-19 has significantly higher mortality rates (0.9% with no health conditions, up to 10.5% with cardiovascular disease) than the most common respiratory system diseases typical to the modern world (like seasonal flu - 0.1-0.2%), but still lower than, e.g., SARS (10%) or MERS (34%) (source)
- COVID-19 has a basic reproduction number (aka R0 - an average number of individuals infected by every sick person) around 2.5 (some research studies claim it's even higher). That means it's comparably infectious to the influenza pandemic in 1918 (2.0-3.0), Ebola outbreak in 2014 (1.5-2.5), and less contagious than SARS (2.0-5.0) (source)
- mortality rate data presented above pre-dates the recent mutations (which represent a more morbid danger)
- R0 will inevitably be impacted by the vaccination rate, but apart from few countries (UK, Israel, etc.), this impact is not meaningful yet (in March 2021)
But what does that mean in practice?
- COVID-19 has a clear potential for being exponentially infectious (already proven in practice, that's why it's called a pandemic)
- from the individual point of view, someone without accompanying diseases is relatively safe - the mortality may be 10x bigger than in the case of flu, but it's still below 1%
It doesn't look so scary then, right? Even if you compare the actual global death toll (less than 2 million worldwide in 2020), it's still significantly lower than ischaemic heart disease (about 9 million) or stroke (over 6 million) (source). So, what's all the fuss about?
Enters the Systems Theory (and the engineering thinking I mentioned above).
The world we live in can be considered a system. Or rather an insanely complicated meta-system: a mesh of interconnected, constitutive sub-systems that interfere with each other (economic, social, infrastructural, etc.). Healthcare (in both micro- and macro-scale) is an excellent example of such a sub-system:
- it has some inputs: e.g., an inflow of sick patients, financial budgets, an inflow of available, qualified specialists (doctors, nurses, etc.)
- it has its resources/capacities: e.g., hospital wards' capacity, hired personnel, quantities of specialized equipment
- there are clear outputs: recovery ratios (for particular diseases), various mortality coefficients, and so on
- one can identify both the reinforcing and stabilizing loops, as well as the variables that control both inputs and outputs of the system
Let's consider this healthcare sub-system bounded to a specific context - an independent country, like Poland. Typically (in conditions we all are used to), this system is in stable yet fluent equilibrium: resources are provided (if possible) at levels needed - based upon:
- our knowledge of inputs (and their trends)
- our prior experience (whether past resource/capacity levels were sufficient, excessive, or inadequate)
Practically, it means that we (should) have an adequate number of pulmonologists to deal with an average need for their services (driven by how much the society suffers from respiratory diseases). The same applies to respirators, oxygen chambers, medicine supplies, etc.
The system is optimized to fit the statistically generalized needs. It has some contingency, but it doesn't have a massive excess capacity to handle the unprecedented "spikes" (anomalies) because, well ... healthcare is always underfunded.
Wrecking the balance
This equilibrium works (or 'sort-of works', if the general deficit is too high) as long as the needs are stable and there are no 'black swans' (extremely low probability events no-one takes under consideration that totally change the parameters of 'the game' for longer than the system can accommodate).
In case you wonder - yes, the pandemic is definitely such a 'black swan'. Not because it creates completely new inputs or eliminates some stocks. It subtly but non-temporarily (for more than a year already) changes the vital input parameters of the healthcare sub-system, wrecking its 'calibrated state' (internal balance), e.g.:
- more respiratory system disease patients require more hospital beds and dedicated specialist personnel
- higher R0 means that precautions and isolation conditions need to be tighter and more rigorous (which requires effort, resources, and additional headcount)
What is the potential consequence of negligence (ignoring the change of inputs)? Accelerated healthcare sub-system exhaustion and subsequent overload:
- all respirators utilized, no available hospital beds, no capacity to examine and qualify patients
- infected people (that were not taken care of) mixing with other vulnerable ones, hereby boosting the infection rates (it'd act like a flywheel that accelerates the velocity of disease spreading)
Negligence is a clear recipe for disaster. It would mean a total collapse and paralysis of healthcare in a given geography. That's what we are fighting for really: not to save another 10k people, but to save the whole socio-economic system, with the healthcare as its foundation.
Do you still have problems with imagining what would happen? Try to consider some completely abstract, hypothetical scenarios (taking places in parallel, alternative reality) - suddenly, literally overnight:
- all food gets 10% less nutritious
- water needs 10% more energy to heat up
- metal wears down 10% faster
Try to imagine what would happen if no one was doing anything about it. Literally, no action, just a meta-system calibrated to an old value of an important (ain't it?) parameter with plethora of dependencies.
Re-gaining the balance
OK, so if negligence is clearly a no-no, let's consider actual actions that can be taken:
First of all, we could try to re-calibrate the system - increase the capacities and/or resilience of the local healthcare. YES, it can work, but only short-term (the exhaustion can be just postponed in time) unless the basic reproduction number is reduced to 1.0 or less. Why so? R0 above 1 means that the number of infected people increases, so virtually every capacity level will eventually get exhausted.
We do it anyway (adjust the calibration) by creating field hospitals (dedicated to COVID-19 only), modifying healthcare budgets (to buy more equipment) or re-allocating medical personnel. But none of such actions are devoid of cascading (and increasingly harder to predict!) consequences, e.g.:
- other areas of healthcare (e.g., oncology and cancer treatment) get paralyzed, understaffed, and underfunded - specialists are hardly accessible, examinations get postponed, people who could have lived (with less morbid sicknesses) are left to die
- shortages in more developed countries may cause additional migrations of healthcare specialists (due to economic reasons), worsening the situation in the less developed countries even more
More and more effects could stack up (as they did in cases of past epidemics):
- the grip of control over the other sicknesses (not consider lethal at this point) could loosen (due to lowering medical standards) to the levels that would allow the development of other, secondary epidemics (e.g. viral pneumonia)
- well-developed countries could close the borders completely (including the import of goods, hereby damaging neighbors' economics) to cut off the infection sources that are out of their control
- the disproportion between the demand and supply in medical services may mean an ultimate collapse of public healthcare in many countries
So, to summarize: the corrective actions aimed to re-calibrate the system are needed (regardless of consequences), but they are both limited and not sufficient. To regain control, we need to introspect deeper into the mechanics of the pandemic itself.
By treating it as another system.
System thinking #2
I've actually created a simplified system diagram for the pandemic. The notation is taken from "Thinking in Systems" by Donella Meadows:
- boxes represent the stocks (in this cases: populations and their quantities)
- double-lined arrows represent the flows between stocks (e.g. infection 'moves' someone from a pool of 'Healthy people' to 'Infected people')
- valves (that look like hourglasses ...) are just connection point for factors that impact the flow throughput
- circles are control variables
- single-lined arrows indicate the impact (e.g. the size of 'Infected people' stock has an impact on the infection flow)
- clouds is how the ingredients of stocks (in this case: people) enter and leave the system, their details are out-of-scope for this consideration
The diagram is obviously a tad simplified (e.g. it doesn't consider a potential cure discovery, it doesn't differentiate between people w/ and w/o symptoms), but it's accurate enough to build some reasoning on what can be done to 'fix' the system (for real).
Here's my conduct of thought (the short version):
- Our goal is to minimize the stock named 'Infected people', not 'Fatalities' - because this one clogs the healthcare.
- Its main inflow ('Infection') is impacted by several factors:
A - reinforcing feedback effect from 'Infected people' stock
B - basic reproduction number
C - vaccinations
D - vaccine efficiencies
E - exposure to infected individuals (depend on several factors itself)
- B & D are constant; C is growing slowly, but it will have a permanent effect; E requires continuous effort (and has no permanent effect)
- A, B, C & D are all beyond control of an average person
- But E is mostly driven by our behavior: keeping the social distance, utilizing the tests, isolating while quarantained, reducing infection chance by using masks, etc.
The conclusion is freaking simple:
To stop the pandemic we need to put continuous, shared effort in E until C reaches a level when the society enters the state of herd immunity. There's just no other way. COVID-19 will not go just by itself, we need awareness and concentrated, sustained effort. Neither whining nor bitching will change it.
Q1: "No one will be telling me what to do and what not to do! It's a free country and I have my rights! Do you want to rob me of my FREEEDOM?!"
Q2: "There's no pandemic, it's just a conspiracy of Bill Gates, big pharma companies and Illuminati! Can you prove me wrong?!"
Q3: "I just don't care anymore, it takes too much time already. Just let me get back to whatever I was doing, so I can do mind business like nothing happened. OK?"
Q4: "It's just a flu. Why should we be afraid of the flu?"
Answer (collective, to all of the above): I am sorry, I can't help. I wish I could, but there's no point in any discussion - it'd be pointless. Have a nice day.