How Do You Measure Risk and Come Up With Policy That Works in the Age of Pandemic?

May 22, 2020 – Until early this year most economists and governments looking into the long term were assessing the risk of dealing with climate change. But in the past five months, climate change has moved to the background as the focus has changed to pandemic risk from the COVID-19 global outbreak.

For the most part governments have always recognized the potential threat of a global pandemic. There is enough history to fall back on to ensure that the subject doesn’t move too far from the agenda when dealing with public health. And governments have known for sometime that the risk of pandemic in the 21st century is far greater than at anytime in the past.

Why? Because we are living in a more crowded and physically interconnected world than at any time in human history. With over 7.5 billion of us on the planet we are exploiting more of the natural world than ever before and in encroaching upon it making ourselves more vulnerable to cross-species transmission of infectious diseases. And then there is the interconnectedness through travel and trade today whether it be global supply chains, or the vast increase in global tourism. So it behooves our policymakers to pay attention to emerging pandemic threats, and to making investments in health capacity preparedness and rapid response should a novel disease outbreak occur.

So What Went Wrong?

The World Health Organization (WHO) has been the United Nations’ coordinating body for the health of the global community to aggregate knowledge about the detection, reporting, and responding to outbreaks. Beginning with influenza, HIV, Ebola, SARS, MERS, Zika, and others, the WHO has established preparedness standards and probabilistic modeling and analytical tools for identifying, plotting the spread, and combating pandemics. And for the most part it has done the job effectively by becoming a knowledge aggregator and clearinghouse, an organizer of worldwide conferences, and through disseminating best practices and the publishing of policy and position papers.

COVID-19, however, has proven to be a different story. Called a novel coronavirus because no known previous contact with humans had been recorded, there have been so many unknowns attached to this virus that its spread was inevitable. If it had been contained at the onset it would have remained a regional outbreak within China and may never have gone beyond the country’s borders. But the controlling nature of China’s authoritarian government when practiced by local authorities made knowledge suppression and misinformation more important than physical containment.

In many respects, the COVID-19 story resembles the Soviet Union’s Chernobyl disaster where precedence was given to knowledge suppression before addressing the immediate and larger physical threat. In Chernobyl, committees of the local soviet debated while radiation contamination spread. Suppressing the truth, keeping locals close to the source of the nuclear contamination, and locking down the area made everything much worse.

The WHO, which has been well prepared to deal with influenza pandemics because it has a history of flu upon which to model and build a response, in the case of COVID-19 was wholly reliant on data from local Chinese authorities. This was a mistake. The WHO probabilistic modeling and analytical tools for influenza could have been adapted for COVID-19 and should have provided a means to understand and manage the outbreak. But modeling requires good data, and China fell short in the first few weeks on delivering just that. The local and national delay in locking down Wuhan and Hubei proved to be the country’s biggest mistake. China let the coronavirus out of the proverbial bag and a local outbreak became first an epidemic and then a global pandemic.

There are two measures for pandemic risk. One is called “spark.” The other is called “spread.”

• Spark refers to the beginning of the conflagration in situ and the onset of the first cases. Its was likely the Wuhan “wet market” where animals captured in the wild were and are still sold for food. This type of transmission is called “wildlife zoonosis.”
• The spread refers to the risk of the disease diffusing itself through first, a local number of hosts, and then to an ever-increasing population.

In March I wrote about BlueDot, a company that developed a dashboard that tracks infectious disease outbreaks. BlueDot’s risk model based on a combination of artificial intelligence algorithms and programs that could sift through unstructured data such as emails, memos, local news reports, and even airline tickets, was able to predict COVID-19’s spread beyond the borders of China nine days before the WHO. So what started as a local disease outbreak in Wuhan before Christmas 2019 has now infected more than 5.2 million, killed over 335 thousand, and done it all in less than a six-month window.

The collateral damage to the world economy has been unprecedented. The social and behavioural impacts will leave millions with emotional scars. And it is more than likely that a number of governments will face political stresses and tensions that will lead to disruptive consequences. We are already seeing this all over the world as governments that imposed quarantines and lockdowns struggle to try and reopen society and national economies. This is happening because of the knowledge gaps these governments currently have. What kind of knowledge?

• Governments don’t know the extent of silent spreaders because they have not done enough testing for the presence of the virus in the general population.
• Epidemiologists have not yet determined if once infected a person has lifetime or even temporary immunity.
• There is no mass testing on those who have recovered for the presence of immune antibodies.
• Situational awareness on when is the best time to reopen the country.

Barbara Matthews is the founder and CEO of BCMstrategy, Inc., an Alexandria, Virginia, creator of automated predictive analytics that measures policy risk objectively. I have had the pleasure of speaking and corresponding with her for the past year, and among the topics we have discussed is just how little understood is the means by which to calculate risk and costs associated with addressing the current pandemic.

Mitigation Policies That Have and Have Not Been There

The one most missed by governments in this current pandemic is preparedness. It appears no governments in the Developed or Developing World had the wherewithal to commit themselves to the resources and public health infrastructure needed.

The second missing in action policy was a lack of coordination between levels of government and public health in information dissemination, and testing.

The third missing in action policy was the lack of surge capacity to deal with peak levels of infection within the existing public health infrastructure.

The fourth missing in action policy was the lack of research investments to develop rapid response to the pandemic including drug and non-drug treatment, and the development of vaccines.

The fifth missing in action policy was the lack of contingency funding specifically to be used in the event of a pandemic.

The sixth missing in action policy was the lack of a central repository for collecting data from any and all sources not just to better understand the virus, but to also uncover potential ratholes and blind spots in treatment, and make corrections to optimize patient outcomes.

The seventh missing in action policy was the lack of understanding of the vulnerability of particular population groups to the virus, particularly seniors in long-term care facilities.

And of course there are the economic policies that governments and their minions have attempted as emergency measures to deal with the collapse of global business. No one in most governments knows what inevitably will work to right the economies of countries. No one knows whether lockdown measures already implemented can be weathered without causing permanent damage. And no one knows what governments and the planet will look like when we come out of this phase of the pandemic or what it will be like if we go through several subsequent spikes.

Living in a state of continuous emergency is like living with a heart arrhythmia (which the virus has given me). You don’t know if the whole thing is going to come crashing down or revert to previous norms.