COVID-19: Making Risk Management Work

I am not a medical doctor, but an Electrical Engineer. I travel globally on advisory assignments or delivering lectures in distributed Smart Energy Systems architecture. The question often arises as to where (and how) the various risks needs to be allocated and the likelihood of such investments that offer the best pay offs, The “critical path” (must do) often weighs that against the “success odds”. There is never a single answer, but the task still needs to be done to move forward.

 I have been listening to the various medical experts (Hongkong, South Korea, Taiwan, Singapore, India, USA, Canada) talk on the various facets of this pandemic and their expert thoughts behind the potential mitigation measures. I have also been listening to the political leaders (USA, Canada and India) along with their respective State and City leadership on the proposed action plans and their frustrations behind people not following them obediently.

 The frustration fault-line (in my view) lie between opposing forces of “additional spend” in saving lives and “potential economic” collapse, if social isolation extended beyond a few months. Business-like questions are being raised, such as the tweet of POTUS (“We cannot let the cure be worse than the problem itself”) or the US Congressional debate on the size of stimulus package or similar Parliamentary debates around the world. There is a political fear that one needs to land on a 100% success formula (morbid as they may be) given past pandemic records. But the world has changed a lot since then.

 Rapid economic expansion and globalization in the last three decades has seen the move to much less economic tolerance for extended rainy days (low personal savings, high cost of urban living, part-time flexible work, hourly wages, subcontract, and many small business formations). Thus, while the government may think “medical care”, the average worker is thinking “survival/livelihood”. The two opposing forces however, can be brought together with swift political and transparent decisions (“Our focus is to restore economic activity soon ……our best efforts today……we may be a bit off …but will correct it as we go along.”). So, the policy pathway turns from being “despair” to” hope”.

 The true policy questions to be answered would be (a) what is the short-term-investment in medical care/people relief that is needed in the next few months (what, where, how); (b) what does this mean in tackling medical preparedness for the 2% severely affected and the relative risks; (c) can we time-limit the social isolations, and provide confidence to normalcy; and (d) how will economic revival activity be staged and resumed. Politicians of all countries have done a poor job at articulating this clearly to the public. The public understands there are no guarantees, but would like to hear best calculated rationale/assumptions.

 The “critical path” in all this, is planning medical capacity for the 2% severe cases (20,000 for every 1 million diagnosed and the early diagnostic detection). Higher this capacity, the shorter the “social lockdown” and faster the return to economic activity. Simpler and faster examinations allowing self-sample collections, (akin to South Korea - 300,000 tests, 600 centers and drive-throughs), the higher the detection towards the 2% severe cases. A further streaming process could explore if 60% of this severe segment can make do with less expensive $7,000 commercially available residential type ventilator machines and be located in make-shift clinics in schools and hotels, with only the critical (less than 1%) being treated in hospitals with $35,000 ventilator machines. In other words, a systemic triage process based on patient’s age, health, pre-conditions, etc.

 For a population count of say 100 million, it could mean testing 40 million (about 10 million a month, on a high priority), having readiness for 1.2 million severe cases requiring simple ventilators housed in make-shift clinics and the balance 800,000 critical cases requiring hospital treatment. If all goes well, a staged economic return can be accomplished beginning 2 months (after initial lockdown) at the rate of 10 million jobs per month over a 3-month period thereafter. The total national cost would be less than the $500 billion currently being touted in the USA.

 A strategy articulated along such lines will be much appreciated by the public (and willing to bear their share of the financial pain) in the hope of a speedy return back to work. The death risk from any disease needs to be duly acknowledged and compared with similar ones. Traditional methods employing long isolation periods and statistical watch to “flatten” the curve may be too long in today’s world leading to a national economic collapse.

 Developing countries, with much larger and more dense population (e.g. India) will find the above strategy difficult to implement due to sheer volume of testing. Such countries would need to concentrate on enforced (and perhaps longer) periods of social isolation (along the lines of China) to flatten the curve. To overcome the population density, other innovative ways of “social distancing” would need to be applied (e.g. masks, gloves, glasses, community awareness). Otherwise, the economic loss to their GDP will be much higher. Luckily, India’s current data shows much lower incidence (relative to its population) and it needs to be maintained that way for a few months at least.