Tackling The Chaos of Corona – It’s the Logistics, Stupid!

Many believe that the world is in economic and social chaos because of Novel Corona or COVID-19. The media is obsessed with doctors, scientists, politicians, and increasingly, bioethicists. The role of the last group seems reduced to telling us who should die first when we have to ration care.

This is not a unique medical emergency.

We need to shift focus. I understand the pain and suffering of patients, and their families, especially those who have lost loved ones, but this is not a unique medical emergency. The truth is that the chaos we find ourselves in is not due to the virus but rather an astounding lack of logistics leadership.

Consider the following.

·       The advice from doctors everywhere is essentially the same as it was during the Influenza pandemic of 1918.

·       If every country had built temporary capacity at the same time China built two large hospitals, we wouldn't be having the same rigorous 'flatten the curve' discussion, extreme lockdowns, or an economic recession.

·       If every country had the same ratio of ICU facilities per capita as Germany, the tragedy in countries like Spain and Italy would be significantly less dramatic. There would be no need for triage or the introduction of bioethicists. Passive euthanasia during an epidemic is only a choice when your logistics have failed. It is not an inevitability.

·       The configuration of the Coronavirus was known very early thanks to the Chinese scientists, and the time to medicine and vaccine will be relatively quick. The global cooperation between laboratories has been a bright spot in this crisis.

·       Corona itself is relatively benign in as much as that most people survive, most people have manageable symptoms, and herd immunity as a concept works. I say this as one who is actually in the higher risk category.

The truth is that as pandemics go, Corona is one of the easiest that modern society will ever face.

So why are significant parts of the world population locked down, and why are we enthralled every evening by the thoughts of the learned and esteemed Dr. Fauci? Simply stated, we are looking in the wrong place for solutions. If the answer to the chaos of Corona lies not in epidemiology but logistics, then our salvation will also come from logistical leadership. This realization is coming to politicians like Governor Cuomo of New York. Yet looking at the configuration of the many daily press conferences across the world, we are still treating this as a medical emergency. It isn't.

The lockdown, the triage, the unbearable strain that frontline care workers are under, it is all due to our failed logistics management. So, it is logical that when we combine what logistics knows well with what the scientists know differently, we will create new insights. As the Nobel laureate, Max Planck remarked, “When you change the way you look at things, the things you look at change.”

“Amateurs talk about strategy and tactics. Professionals talk about logistics and sustainability in warfare” - General Robert Hilliard Barrow

The good news is that the availability of secure public-cloud, data analytics, analytical modeling, and artificial intelligence means that we can and should combat epidemics through a modern global epidemic response system.

So, where did we go wrong, and what do we need to fix?

Hindsight is always easy, the four most critical mistakes made (and still being made) are:

1.      A failure to appreciate the essential exponential nature of epidemiology so that leaders, everywhere, mobilized too late. "Our intuition about the future is linear. But if the reality is exponential, that makes a profound difference. If I take 30 steps linearly, I get to 30. If I take 30 steps exponentially, I get to a billion." - Ray Kurzweil, Inventor, and Futurist

2.      A misplaced distinction between citizens/permanent residents and aliens. If governments had banned travel based on the probability of people being infected instead of their passport, the spread of the virus would have been better contained.

3.      A failure to understand and manage the critical elements of the epidemic care supply-chain (testing, PPE, ICU.) As demand surges, we move from one shortage to another like the 1970s arcade game, Whac-A-Mole. When it comes to epidemics, the supply-chain shouldn't be like Forrest Gump's box of chocolates. "You never know what you're gonna get."

4.      Applying a national approach to a global pandemic. There is criticism about the way China initially handled and then communicated about the virus; however, China knew from day ten that this was a global phenomenon that required a global response. Their approach changed to sharing information, and resources. That realization still hasn't landed in many places, e.g., The USA.

To address this pandemic, and those yet to come, I suggest that we focus on creating an epidemic response platform consisting of three systems of logistics governance.

We need to orchestrate

1.      Governance in the epidemic response system,

2.      Governance between the epidemic response system and other systems, and

3.      Governance on the epidemic response system. (keeping it viable)

We can start today, and we can begin with Corona.

Assumptions

As we approach this task, let us start with the universal assumption that a dense human population connected through trade and travel will inevitably create epidemics and pandemics? Perhaps we should assume that these epidemics may not conform to expectations as well as Corona does? Maybe, we should accept that there will always be a time lag between detection, decomposition of the disease and the treatment, and vaccines becoming available, such that temporary extreme scaling of the healthcare system will be necessary?

Using these assumptions, we can design a global epidemic response system to address outbreaks like Corona. This ambition appears daunting, but with the rapid emergence of big data capabilities, public-cloud, and AI, this is eminently doable.

In the System:

·       Define and secure the epidemic care supply-chain. Account for the rapid scaling of scarce resources. Do this to the most considerable extent possible for efficiency (nationally, EU, UN)

·       Define and plan for a testing regime at scale

·       Define and anticipate intelligent lockdown scenarios based on probability, halt the spread at the origin, and focus global resources to support the unlucky country or region that takes on the fight first.

Between the Systems:

·       Define and orchestrate the complex ecosystems necessary for providing an adequate epidemic response. Think of protocols for the travel and tourism sector, the manufacturing industry, the public and private laboratories, the technology companies, the healthcare providers. Think multi-disciplinary teams, think diversity!

Joined-up-thinking is key. Our inability to connect the dots has been painful to watch. For example, isn't it tragic that the basis for the USA 2020 'between the system' response is the Defense Production Act from 1950?

·       Firefighting using dynamic teams is admirable, sometimes it is the only initial option. However, 'throw-away teams' are also inefficient, do not institutionalize learning, and can cause unintended consequences in execution. It is better to orchestrate dynamic ecosystems that are configured to exchange data and share process between public and private actors. The secure public-cloud makes this so much easier than ever before.

·       It is also appalling that autocrats and dictators all use the lack of 'between the systems' capability to usurp powers under the, 'I alone can fix this' mantra. Let us not allow the vacuum for these miscreants to thrive?

On the System

·       We need to define how the global epidemic response system is mobilized? How will it adapt to new insights quickly? How does it learn organically?

·       Probably more importantly, how do we shut down the epidemic response system? While most countries are now in lockdown, how we get out of lockdown seems to be the subject of robust debate. All we seem to know is that testing will be a critical part of our recovery.

·       Maybe we expect too much from the World Health Organization. After all, epidemic response systems go well beyond healthcare. Perhaps we need a more modern institution where AI and big data across the complex ecosystem are collected, analyzed, and acted upon?

A significant advantage of this 'working on systems' approach is that we also avoid the economic meltdown driven by the necessity to rigorously flatten the curve. After all, "It is always better to dissolve a problem than to solve it." - Prof. Russell L. Ackoff, Wharton School, Penn University.

I have nothing but respect and gratitude for the talents and expertise of healthcare and frontline professionals. Their dedication, skill, and toil are immense. But they too deserve better. They shouldn't bear the brunt of a broken logistics system. It is logistics that got us into this, and logistics that will get us out.

When we combine what logistics knows well with what the scientists know differently, we will beat this and every other epidemic to come.