Wishing us all a happier new year… with 2021 vision

2020 was not a good year for vision, mine included. In April, I drafted a view of this pandemic intended to open up perspectives, and thereafter sent re-vision after re-vision to op editors and possibly-interested experts, few of whom were interested. I persisted because the pandemic persisted, as did our fixation with masking and distancing. Moreover, my one hero in this world is the little boy in the Hans Christian Andersen tale about the emperor’s new clothes, because his na?veté compelled him to see what had to be said. I end up with the following list of questions, supported by a video and a full text entitled “Beyond Hoping for the Best”, hoping for clearer vision in 2021. 

WHAT ELSE MIGHT BE GOING ON?

While we wait to be vaccinated, the pandemic persists. Wearing masks and keeping distant have proved to be both necessary and insufficient. Something else has to be going on. Yet I see little discussion of this among health care authorities. I am not one of them, but a professor of management who likes to infer patterns from anomalies, which I have been doing with this pandemic since April. My conclusion boils down to the following questions, some with evidence, others by inference. If even a few of these questions hold up, they could make all the difference.

Is COVID-19 more contagious than we think? Or less? Or both?

• Why are the cases so widespread while the outbreaks are confined to some places and facilities (for example, particular cities and certain senior residences but not airplanes)?
• How come some crowded places (certain congested slums or packed events) have escaped major outbreaks while some unexpected places have experienced them (near hog farms in Holland, a remote area of southwestern Iran, a latex plant in Indonesia)?
• Why do major outbreaks tend to step from place to place, as if on a random walk? (“Random” can be a pattern waiting to be recognized.) And why do outbreaks tend to plateau all of a sudden?
• Why are some new waves stronger than some earlier ones?

Why has smoke been present in a number of prominent outbreaks (hog plants in the U.S. that smoke pork, Chinese markets that roast ducks, the American embassy in Riyadh after a BBQ, perhaps pot smoking on some college campuses)? 

• Can smoke that circulates locally be responsible for pocket outbreaks of COVID-19? (In some outbreaks near hog plants, might the smoke, and not just the workers, have taken the virus to town?) 
• In India, might smoke from cremating the dead be carrying infection to the living? And how about methane, from both hog farms and fracking?
• Should we be suspending smoking-related activity on a few college campuses and other problematic places to assess the consequences on infection rates?

Might COVID-19 be a disease of pollution (like others associated with polluted air, water, or food), in its origins as well as its spread, indoors and outdoors? Pollution could be acting in three different ways:

• First, in the form of aerosols, the virus can travel farther than it can as droplets: Might bonding with particles of polluted air carry them even farther? (Imagine if the outbreaks in the Dakotas originated in the oilfields of Alberta.) 
• Second, the UV rays of the sun can inactivate the virus: What if polluted air, by blocking these rays, enables the infectious aerosols to last longer as they travel (with or without the bonding)?
• Third, living in polluted air can damage the respiratory systems of individuals: What if the health of some is so compromised that even a low density of the virus arriving from afar can infect them? And then, what if these people become superspreaders who infect many healthier people nearby (including in that first outbreak in Wuhan)?
• These three effects of pollution could be acting independently, but might they also act together, by carrying the active virus to places where a few individuals can initiate new outbreaks?
• What if some of the first waves ended because the lockdowns cleared the air, people thus being prevented, not only from spreading the virus personally, but also from polluting as usual? Might, therefore, reopening an economy to that polluting explain some of the second waves? If so, why not lock down the pollution instead of the economy: use selective closings of the heavy sources of pollution instead of extensive closings that kill the economy or widespread openings that kill more people?
• Are the authorities in schools, offices, factories, and arenas checking which of the many contaminants being used might carry the virus? And are they learning sufficiently from the successful experience of airlines in recycling confined air?
• Must we wait to recognize the golden opportunity provided by this pandemic to deal with two pollution problems of greater consequence: the millions of lives that pollution takes every year through other diseases, and the greater devastation that could be caused by climate change?

Above all, what if we see past our distancing, to get beyond those orthodoxies of the authorities and paradigms of the experts that have been obstructing our vision?

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? Henry Mintzberg 2021. Watch the video or read the full text. This work is licensed under a Creative Commons Attribution-Non Commercial 4.0 International License. For more questioning of the orthodoxies of health care, please see Managing the Myths of Health Care. 

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