We Can't Take This Risk
The recent letter from the President of the United States to the state governors asking them to consider relaxing current measures to fight COVID-19 is riddled with incorrect assertions and a gross misunderstanding of the fundamentals around risk.
Let's start with the foundations of risk (and this is for all my students in risk management and crisis management; this is a Risk 101 lesson for those who may be unfamiliar. For my colleagues who are professional risk managers, please feel free to weigh in under the comments):
Risk is defined primarily by three key elements: 1) probability of an event occurring; and as a factor of the 2) impacts of that event; 3) conditioned based on the exposure to the impacts, also known as the vulnerability to the risk. Basically: Risk Event= Probability x Impact x Vulnerability (to the risk).
There are several other factors associated with risks:
Velocity- speed of onset;
Volatility- how the probability and impact can change;
Duration- how long does it last;
Correlation- risks may have a correlation beyond its initial tier of influence, the simultaneous occurrence of losses from a single event.
Now let's unpack this letter from the US President one item at a time against this basic understanding of risk:
"There is still a long battle ahead, but our efforts are already paying dividends."
Not sure here whether the Whitehouse (WH) is paying much attention, but out on the healthcare front lines they are woefully under-resourced with PPE, ventilators, and also healthcare professionals to staff facilities being set up for the COVID-19 patient surge, in addition to testing capabilities (see below).
Non-pharmaceutical countermeasures, e.g. social distancing (I should say physical distancing; please keep up your social ties), stay-at-home (also known as self-quarantine), and personal hygiene measures have only been actively instituted over the past couple of weeks (not months). Moreover, they have been unevenly applied and communicated. Just witness the WH press conferences (note- this is from WH website dated March 26; Dr. Fauci and Dr. Birx, can you tell them what 6 feet distance looks like?!).
Despite the fact that COVID-19 is now epidemic (i.e. widespread), many states have still not implemented these aggressive countermeasures, asking people to stay at home/work from home if they are in non-essential industries (not part of the critical infrastructure).
Not sure what dividends are paying off, as the infection rate and mortality continue to climb. We will see the situation worsen in the weeks and months to come as exponential growth of COVID-19 cases continues.
"Our expanded testing capabilities will quickly enable us to publish criteria, developed in close coordination with the Nation's public health officials and scientists, to help classify counties with respect to continued risks posed by the virus"
Let's take the first assertion here, "expanded testing capabilities"; expanded distribution for testing for COVID-19 throughout the USA is still in progress, many parts of the country do not have test kits, and people are still being told that they cannot get tested, that the priority is for those who are extremely ill (or if you are a member of, or connected with, the Presidential Administration, NBA player, or VIP).
Now on to the second item, your own CDC does not provide data down to the county level, is lagging behind what the Johns Hopkins University Center for Systems Science and Engineering (CSSE) publishes on their dashboard (which is used by FEMA and most EOCs in the country), and does not show the mortality level by state. Just see below an illustration of the two:
Here is the CDC dashboard as of 3-26-2020 at 11:30PM
Note- where is the county data listed?
Here is the JHU CSSE COVID-19 Dashboard at the same date and time
"my Administration is working to publish new guidelines for State and local policymakers to use in making decisions about maintaining, increasing, or relaxing social distancing and other mitigation measures they have put in place"
How can we talk about relaxing measures as this disease continues to spread into regions of the country that have not instituted, unevenly or weakly instituted, these counter measures and may face mounting COVID-19 case loads, and similar or even more drastic resource shortages to fight this disease?! Just look at the State of Maryland above. They are only recently putting these measures into place. Their map will soon resemble New Jersey just to its North in a few weeks. Many states in other parts of our country will follow the same path.
"Under these data-driven criteria, we will suggest guidelines categorizing counties as high-risk, medium-risk, or low risk."
So now let's revisit the definitions and factors of risk cited above to analyze this proposal:
We have insufficient disease surveillance, an issue from the start of this pandemic, and data that is incomplete and still a lagging indicator based on what we understand of the morbidity factors (R factor, incubation period, etc.); therefore, we cannot accurately get a picture of the probability that any individual might be infected in any specific county in the country.
We know that there were numerous people out and about in the past few weeks, on Spring break, having a great time along the beaches in Florida, Texas, and Mexico; all great vectors for disease. While the number of people travelling has dropped off precipitously, airline travel has been permitted this whole time further allowing the disease to spread. Add to that the contributing factors mentioned above, and we really don't understand the true velocity of its spread into other parts of the country.
As we have discovered, our efforts to understand this disease and to get a better handle on it have eluded us, so we are dealing with a risk with a high degree of volatility.
The duration of COVID-19 is predicated based on the arrival of vaccinations and/or anti-virals, which are absent for now and unlikely to be developed for at last 12-18 months at best; on this point we need to be realistic. We can expect to be living and dealing with COVID-19 for at least a year, perhaps much longer.
Now to the last factor, correlation. We are now starting to come to terms with a depleted front-line of health care workers. We can witness this in Italy and are starting to see this here in major cities, already in the throws of the contagion. They are under-staffed, under-resourced, and overworked. Many are worried what will happen if they get ill. Support staff are wondering the same. We can expect tertiary impacts to vital services: police, fire, EMS. The list of industry work-forces goes on and on, and we just do not fully understand these ripple effects and their ramifications.
At this present time to even consider making a classification of risk by county in this country is the height of absurdity. Until we achieve the capacity to accurately test every individual within the USA, capture, and report that data from the county to state to Federal level (a very heavy lift), then any consideration of relaxing our current countermeasures puts the whole effort to combat COVID-19 on a national scale at risk. Just the opposite, we need to immediately implement aggressive and consistent non-pharmaceutical countermeasures nationwide, something that has been sorely needed now for weeks.
I will leave you with a final quote on the need to reveal and deal with the truth given this current crisis:
"Every lie we tell incurs a debt to the truth. Sooner or later that debt is paid."
-from the series Chernobyl, HBO; quote from Valery Legasov, Chief Investigator
As I have written for weeks and repeat again, an ounce of prevention is worth a pound of cure. The COVID-19 crisis is about to explode, similar to the reactor in Chernobyl in 1986, and we must provide that pound of cure in droves.