The Tsunami is at Our Doors
I recorded a podcast with Dr. Kiyoshi Murakami of Iwate University who was instrumental in helping to guide the disaster response in the town of Rikuzentakata in the aftermath of Japan’s 311 triple disaster, the Great Sendai Earthquake of 2011. While each disaster is different, much can be learned in terms of the response and recovery to the 311 disaster in Japan. My thoughts below are largely based on this. The podcast may be found by clicking here.
Note: I usually add some media mashups and links to referenced sources to support my assessments and recommendations. That will follow, but in the spirit of expediency, I am just publishing this as is for now and will add that later.
Domino theory
In the 1950s and 1960s the Domino Theory was a prevailing justification for United States policies during the Cold War era. But it was a spurious theory that if one nation fell to communism, then neighboring countries would fall as well. Domino theory was used in the argument to send troops overseas to places like Vietnam (1960s and 1970s), and to send military aid to authoritarian regimes in Asia and groups in parts of Africa to prevent their governments from falling to communism propagated by the Soviet Union, then the U.S.’ global rival. The idea was that if we failed in places like Southeast Asia, then we would find ourselves surrounded by communist regimes on our own doorstep.
Indeed, in answer to this, the Soviet Union sent military aid to its allies in the U.S.’ backyard, to countries like Cuba, and promoted rebel movements in corrupt countries such as El Salvador and Nicaragua. We still see remnants of the so-called “Bolivarian Revolution,” now led by Nicolas Maduro, that have impoverished Venezuela. We know that the Cold War ended after the Soviet Union, declining into a decrepit system by the 1980s, overextended itself by propping up client states throughout the world and pumping too much investment into their nuclear and conventional arms programs. Eventually the Soviet Union was unable to sustain this support and their own system and their influence collapsed in the late 1989 with the fall of the Berlin Wall and dissolution of the Soviet Union in 1991.
While domino theory did not hold up well in the Cold War, the theory does come in handy when we look at a contagious disease like COVID-19. Unfortunately, we failed to fight this enemy on the front lines of Wuhan, and then failed in Japan, South Korea and the Asian rim. We are now fighting with an enemy on all of our shores, which has marched into every city and every hamlet, into the mountains and the remotest islands. But fight we must.
Everyone is a Domino
“Social connections lessened anxiety, depression, and fears over radiation more significantly than obvious factors such as health and wealth. Similarly, where residents trusted and interacted with one another before the tsunami has lower rates of more mortality from the tsunami.”
Daniel P. Aldrich, PhD Black Wave: How Networks and Governance Shaped Japans 3/11 Disasters. Chicago: The University of Chicago Press, 2019.
As Dr. Alrdrich has written, we should think of the measures we are being asked to take as physical distancing instead of social distancing. We want to maintain and strengthen our social ties at a time like this; we are social beings and the connections that bind us together are the ones that help us to survive. It’s a basic animal instinct. While I applaud and agree with the notion of calling it “physical distancing,” “social distancing” has become common usage. So I will use the term “social distancing” while emphasizing the need to maintain social ties.
We need to think about each other as connected dominoes. Each individual, each household is a small set of links that combine into a chain of a larger community. Each of those community chains connects further with other communities and businesses, and each of those with many others nationally and internationally. We are interconnected into complex networks. The resilience of those networks of connected chains is now being tested. When one domino or set of dominoes falls, others can fall around them, creating a domino effect.
This is why social distancing, and more importantly quarantine, or shelter-at-home as it is being called, needs to be enforced before coronavirus becomes contagion within a community. In the United Kingdom., the government is not asking for self-quarantines, while in the U.S. many communities have not enforced a quarantine even while cases are popping up around them. When the virus upon you, asking for a quarantine — let alone trying to enforce one —is a response that is a “day late and many dollars short.”
COVID-19 has rapidly knocked down supply chains in China, many of which the U.S. and Europe rely on. A full economic recovery in China is now very slow. Many workers are still not able to travel back to industrial centers in China and factories are working at reduced capacity due to continued disruptions. This chain is now being strained to its capacity in Northern Italy, France, and Spain, and rapidly spreading throughout Europe.
To Break the Chain of Transmission- Think Like a Saboteur
In the Soviet Union during the height of 1930s Stalinism, the idea of the saboteur or вредитель (wrecker), was used to identify anyone who would seek to due to harm to industry and the economy of the “Great Socialist State.” In reality, the campaign against the saboteur was a manifestation of Stalin’s paranoia about potential enemies. However, as Andy Grove, the founder of Intel, titled his 1999 book: “Only the Paranoid Survive.” A little paranoia can help us at a time like this.
So, as a thought experiment, we can think of coronavirus and COVID-19 as the enemy saboteur, personified as a super villain. Where would COVID-19, our arch enemy attack first?
COVID-19 would overwhelm our healthcare system, which it is now threatening to do. It would attack the acute care system (ER units) and specialized cardio vascular departments in large health care systems. It would intimidate older doctors and health care workers, and decimate their ranks, beginning with those who have no access to or who did not follow appropriate precautions with personal protective equipment (PPE). Not resting, it would sweep through medical supply chains to disrupt the supply of vital equipment, pharmaceuticals, and medical consumables, including PPE.
It would unleash itself on the power grid and power production sites. It would join forces with other villainous actors, such as cardiovascular disease, diabetes, and other ailments, and attack workers who maintain power plants and transmission lines.
After wreaking havoc in these first two critical infrastructures, COVID-19 would turn its attention to the transportation sector and international shipping. The global, integrated supply chain is ripe with multiple targets: major commercial ports, large container and cargo vessels, commercial rail and trucking, and then local shipping.
Once the global system is on its knees, with a weakened healthcare system, power grid decimated, and vital goods, parts, and other supplies in short stock or missing, the time would be right for the most critical element: the food supply chain and water. The U.S. food supply chain is dependent on migrant workers, many of whom would find it difficult to travel from one part of the country to another. A lack of workers would hobble producers both in the U.S., Mexico and throughout the Americas. Water supply might be available, but ensuring water safety might be challenging with many laborers and specialists sick themselves, tending to sick family members or still under quarantine.
Lying in wait, COVID-19 would find the right time when fire season was underway in the Western U.S., riverine flooding was inundating already weakened communities, and tornados begin to lay waste to those in Tornado Alley. The disease would hit already exhausted first responders and depleted emergency managers. Mutual aid would no longer be an option with all regions reeling from the effects and transportation virtually shut down. Coordinated and sustained emergency responses to massive natural hazards would be weak at best. With systems and populations weakened, massive displaced populations would seek refuge in emergency shelters that provide basic food provisions and necessities, most in very short supply and rationed for prioritized needs.
Does this picture look bleak? It might appear extreme, but it is consistent with what I have seen and written about in the last month; Italy, an economically well-developed country with a good health care system, is now on its back. Spain, France, and Germany might soon follow. So what do we do to avoid this bleak picture from becoming a reality in the U.S.?
Before we get into the recommendations, let’s be clear: COVID-19 is not a problem that will go away in a month or two. This will linger for months and possibly come back in another wave in the Fall. We are now facing the very real possibility of a national and global systemic risk that threatens our way of life. If we as a global society don’t get this right and are not able to stop the spread of COVID-19, then it may put a stop to life as we know it.
Every Day is Game Day
Every first responder, every emergency manager knows that every day is game day; you need to be ready on a moment’s notice with your “A Game” when emergencies happen. As they grow big and gnarly, you adapt and call in reinforcements and expand your capabilities. In emergency management ranks, we prepare, plan, drill, and exercise on large-scale plans of all types: mass care, mass feeding, points of distribution for mass prophylaxis (read vaccinations). These all need major logistical support and orchestration to run well.
Many of the large public health and emergency management agencies and departments at the Federal, state, tribal, territorial, and city level, as well as large health care providers and organizations, have planned and exercised for pandemic events for years, spurred on by H1N1, Ebola, and Zika. One thing that we know in emergency management is that you cannot easily ramp up your response; you need to go big or go home!
With each week that passes, there is a growing sense of urgency and a need to ramp up the response. So here are some essential recommendations. Some, I have written about before and will link to more information. Others have been made by leaders in the U.S. and elsewhere.
Non-pharmaceutical countermeasures should be fully implemented and in force, including a mandatory shelter-at-home (whether you are sick or not; in other words, a quarantine) for non-essential, credentialled workers.
Stand up mobile army surgical hospitals, engage Disaster Medical Assistance Teams (DMATS) and mobilize all of the Medical Reserve Corps to assist.
Repurpose any large facilities near hospitals, including large convention halls and university buildings, and turn them into emergency medical wards for quarantine and treatment of minor to low-level COVID-19 infections.
Call on and approve all retired health professionals (in good standing) to help. Provide protection (PPE and training) and support for them as needed.
Identify essential workers in all critical infrastructures and protect them, both in the physical realm (places, systems, and staff) and in the cyber realm. Confirm continuity plans are adequate in the face of COVID-19 and fill in staffing gaps and staffing patterns for sufficient coverage. This includes continuity of vital government services. Retirees might be needed, which may require increased measures of PPE and workplace hygiene.
Start getting ready for deploying emergency support plans for food, water, medical, sanitation, mass fatality, and emergency sheltering as needed.
If we can get this pandemic under control, and minimize the disruption to about a month or two, then we can move to recovery. But if we enter the same situation as in China and Italy, and we find ourselves in disaster response mode over a few months, recovery will not start until mid-Summer, or perhaps much later.
One thing that the Great Pandemic of 1918-1919 and the recent example of Taiwan have shown us is that an effective, layered approach to pandemics, can help reduce the number of cases, reduce the mortality rate, and help to return life to a new normal. We need to recognize that life will never truly be in a normal state as it was before this pandemic. If we can adhere to these strict guidelines, then we can emerge from this dark time as a healthier society and a stronger global community.
As we continue to learn, an ounce of prevention is worth a pound of cure.
Andrew Boyarsky is President of Pinnacle Performance Management, a business continuity and disaster recovery consultancy focusing on SME, non-profits, universities. He is also a Clinical Associate Professor in the Management and Systems MS at NYU and in the Emergency Management Graduate Program at the John Jay College of Criminal Justice, a part of the City University of New York. He is also host of the podcast Riding the Wave: Project Management for Emergency Managers.