31 July 2020

Ignoring COVID’s truly ‘wicked’ persona is not a strategy

Clinical Communicable Disease COVID-19 Public Health

The last few weeks of our COVID-19 journey have been particularly gruelling and deflating. It can’t be easy being in charge.

But increasingly the evidence is that government COVID protocols designed to slowly open up our economy while keeping the virus in check can’t work. Victoria seems to be our local statement of that inevitability and NSW may soon follow, but there is plenty of overseas second-wave evidence to point to the idea that controlled suppression is largely folly.

Without getting into the gritty detail let’s look at what you can and can’t do in NSW currently in hotels, clubs, restaurants and event venues:

  • Maximum of 10 people per booking or per table.
  • Maximum of 10 people on a group entering or being on the premises.
  • Alcohol can only be consumed by seated customers.
  • Maximum of 300 people in the venue at any one time or one customer per 4sqm, whichever is the lesser.
  • For venues that consist of separate areas, the maximum capacity is 300 people in the separate area at any one time or one customer per 4sqm, whichever is the lesser.

Newly understood aerosol evidence says you probably can’t effectively socially distance in any of these situations [1]. The importance of aerosol transmission is still being argued among some scientists, but there are hardly any who don’t feel it doesn’t have some role, and in enclosed spaces the issue is much less debated.

Unfortunately when scientists argue even a little bit, politicians can latch on to that and have important material downgraded in a public debate.

The main thing is that if an infected person is at a venue, you can’t stop transmission with any degree of confidence.

We won’t worry about public transport because we know that as much as the NSW government has tried, it is not succeeding in social distancing in this important area.

Now consider a few other pieces of now well established facts about COVID-19 that have emerged in the past few weeks.

Even if your testing is at very high capacity, as we now have in Australia, we now know that we could be missing up to six times the amount of actually infected individuals in the community [2]. So on a day in Victoria where you identify 700 cases, you might have 2100 to 4200 actually out there. In NSW where we still think we are in control, 20 cases, of which six we can’t trace yet, might mean another 40 to 120 cases.

How in the end do we catch that? How do we stop any of these unidentified individuals going to a club, restaurant, bar, sporting event or catching a bus, especially if they are asymptomatic, which they can be in high proportion?

We can’t, is the ugly but realistic answer.

We are now in a zero-sum game if you accept this evidence about the behaviour of the virus. If you add the behaviour of humans  – one in four door knocked positive carriers in Melbourne were found not to be self isolating – you are at a level of complexity which is bewildering.

In terms of problem solving it has just outed itself as truly a “wicked” problem.

Wicked problems are ones that cannot be resolved merely by gathering additional data, defining issues more clearly, or breaking them down into smaller problems, which has thus far been our approach to solving the twin priorities of saving lives and keep our economy afloat.

Wicked problems tend to have the following characteristics:

  • They involved many different stakeholders with different priorities
  • They can occur in a social context which multiplies the complexity
  • The source of the issue is tangled and complex
  • Attempts to come to grips with it often lead to new issues
  • The problem is evolving (literally in the case of COVID-19) so can’t be pinned down with one set of solutions
  • There’s little or no precedent to the issue

COVID-19 ticks every box here.

Part of the definition of wicked problems is that it’s impossible to solve them, so you need to develop an adaptive strategy that optimises “coping”.

Some of our governments could try to argue that this is what they are doing with “suppression and opening up”. Until a few weeks ago you might have agreed that we seemed to be coping. We aren’t any more.

So why is government continuing to sell the idea of “suppression” and “opening up slowly” to the public?

Worse, why are they constantly deferring to “the medical experts” to sell their story?

There are virtually no truly independent medical experts who now think that suppression and slow open is viable. If you read between the lines on some of the key independent professionals – Professor Bill Bowtell and Professor Raina MacIntyre, for example – they are pointing out the flaws in the current thinking now constantly.

They aren’t being overtly robust in their criticism yet because politically, even for an independent expert, it’s a very difficult place to put yourself. You can easily quickly end a great career. But you suspect that they will get their mojo as the numbers keep going the wrong way. It’s just that this might be too late to avert some really bad second-wave numbers.

Government medical experts are conflicted. They can’t just point out the emerging issues of new evidence. They are working to a different set of goals as defined by politicians who are trying to navigate their way to the next electoral cycle.

But get some of these government doctors in a back room and they cringe when one of their political masters fronts a camera and defers to them when they wish to justify what they are doing. Governments are deceiving the public when they say “we defer to the medical experts on everything” or “this is the best medical expert advice we have”.

There is no medical evidence any more to support the idea that suppression and a slow opening up is a good ongoing strategy.

So what is going on?

Ostensibly it looks like politically we are in a mode of hoping for the best. Governments have put in an enormous effort and expended so much emotional energy to arrive at what they finally felt was the right way forward. There is a lot of social and emotional momentum built up. It’s a difficult place to retreat from.

But suppression and opening slowly, followed by cluster whack-a-mole, isn’t now a sensible way to wait out the time to a vaccine. Victoria, Vietnam, Singapore, half of the US and so on are telling us.

Are there alternative ways to break down the problem now we know that what we currently have in play isn’t working?

Something that addresses the issues of aerosols, infectivity, the long presymptomatic incubation period, asymptomatic carriers, the inability of testing to identify most or all carriers and the economic issues of locking down again in certain geographic areas?

In wicked-problem-solving it’s important to remain open to rapidly iterating and adapting. Testing and retreating where necessary.

But as the wicked status of COVID-19 would suggest, nothing feels or seems like it is going to be that much better – another reason why governments are reluctant to change tack.

We probably need to step out and test something else and quickly.

One thing seems certain. Eventually the current strategy will be outed as attempting to be half-pregnant.

Some of the independent experts have been pushing for what they call an elimination strategy.

For some reason, most governments are scoffing at the idea. It involves putting in procedures again in those Australian areas of outbreak that reduce community transmission back to zero, getting your quarantine right, probably closing all your borders and accepting that you will only have local economic activity until you have a better solution – hopefully a vaccine.

Ironically, most governments describe their “suppression” strategy as ultimately eliminating community transmission. That’s a great, albeit accidental, alignment of objectives for a new path.

The next important step would be for governments to stop confusing (and even being deceptive to) the public by admitting that the science is against their current strategy and that new ideas and measures are needed.

The public can be very unforgiving when they realise they’ve been duped. The government has done much to build up public trust in how it is handling this crisis. The damage that might be done by government not being transparent now and admitting it may have this wrong, might be the worst sort of damage that can be done for future management of the crisis. It needs to input this variable somehow into its wicked-problem-solving algorithm.

From a national perspective – and presuming three Victorian girls on their version of an excellent adventure through metropolitan Brisbane doesn’t start something in that state – we only have NSW and Victoria to sort out.

Unfortunately, that accounts for nearly 60% of our GDP. But what do you do?

NSW is an interesting example of the politics at play because it is at a point in time and number of untraceable carriers that Victoria was six weeks ago, but we still have the transport minister and the Premiere persisting with a “we can control this still” argument.

Will persisting eventually outweigh the short- to mid-term cost of putting in a lot more restrictions in again and going for a harder path to total suppression of community transmission?

It’s a wicked problem.

  1. https://academic.oup.com/cid/article/doi/10.1093/cid/ciaa939/5867798
  2. https://theconversation.com/random-testing-in-indiana-shows-covid-19-is-6-times-deadlier-than-flu-and-2-8-of-the-state-has-been-infected-138709

 

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4 Comments on "Ignoring COVID’s truly ‘wicked’ persona is not a strategy"

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Glenn Rosendahl
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Glenn Rosendahl
1 day 11 hours ago
The COVID 19 virus does not have a ‘wicked’ persona. This assembly of RNA has no intelligence nor intellect. As individual entities, the virus cannot analyse its circumstance, nor lay plans for the future. As a comparison, I can say that Donald Trump can do these things. As can Premiers, and public health medical experts. Even Jeremy Knibbs. However viruses came into existence several billions of years before humans did. As part of the primordial ‘soup of life’, with its single celled life forms. Viruses were parasites then, and are parasites now. Their continued existence depended on their capacity to… Read more »
Kylie Fardell
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Kylie Fardell
3 days 7 hours ago

Can the seroprevalence study in Indiana really be extrapolated to Australia, where testing rates are presumably much higher? It’s certainly clear that the actual number of infections are greater than the numbers being detected, but six times higher seems a stretch. Hopefully there might be a seroprevalence study in Australia which could provide an answer.

nicholas mclernon
Member
nicholas mclernon
3 days 11 hours ago
It is indeed a wicked problem. Unless humans learn to stop breathing how do we have long term control? I am as scared as any doctor in this situation but for the sake of our world we need to be more calm. Ignoring every other aspect of health care apart from COVID will have long term effects on our patients. People die from diseases other than COVID. At any other time in history an 80 year old dying of viral pneumonia might be classified as “dying of old age”. What sacrifices are we making to control COVID? Perhaps too many.… Read more »
GEORGE QUITTNER
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GEORGE QUITTNER
3 days 13 hours ago

SARS2 VIRUS.
1. There are asymptomatic carriers.
2. The incubation period is variable.
3. The mode of contagion is not 100% controllable.
4. (young) People are not 100% reliable.
5. People need to keep moving and mingling to provide essential goods and services.

THEREFORE ELIMINATION OF THIS VIRUS IS IMPOSSIBLE … once it is prevalent in a community.

We are like the Wildebeest crossing the river in their thousands….Some will get taken by the crocs.
There is no option to stay out of the river … until we are vaccinated.

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