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Innovating Non-Pharma Interventions in the fight against COVID19

This medium story is the first of four that will describe the innovations practices needed to get to 0 covid19. It explores Aggressive Non-Pharmaceutical interventions, while the next ones will discuss regular testing, public health breakthroughs, and finally, vaccination.

Staying at home, avoiding friends and family, and not going to crowded places are all Non-Pharmaceutical Interventions (NPIs). Making Non-Pharma Interventions work is very important because they are the low hanging fruit in the fight against COVID19, and they serve the purpose of buying us time to develop better testing, better treatments, and a vaccine.

In a previous article, I outlined the importance of sequencing our innovations to get out of COVID19 hell. That post can be found here, and provides essential context to this series:

In the context of our emergency management response to this pandemic, I have been consulted by different state and municipal jurisdictions that are exploring paths to “re-open” the economy. One of the first things I have communicated is that, unlike other recovery plans, the recovery for COVID19 means reimagining a society entirely so it can co-exist with an ongoing “disaster.” This pandemic will be with us for a while, so we need to make Non-Pharma interventions work for long periods of time.

There are a few core innovations that will make Non-Pharma interventions more sustainable. It is the role of governments to send the right signals and even back the right startups so we can rapidly create an innovation pipeline that avoids market failures. It is the role of entrepreneurs to move fast and deploy as many of these as possible so we can build our new normal.

There are at least three categories or “verticals” that need rapid innovation to make Non-Pharma interventions sustainable.

Those innovation verticals are:

  • Personal innovations
  • Business innovations
  • Recurrent “Shelter at home” innovations

Personal Innovations

Funny Picture Stories #1 (Nov 1936). Comic source: Wikipedia

Let’s start with the example that is in front of our noses, quite literally: Face masks.

Introduced in 1936, Clock is, according to most comic historians, the first masked hero. Since then, we have equated masks with power and strength in our popular culture. When Hollywood wants to create a villain or a superhero, a mask of some kind may probably be an important prop in that quest.

Compare the mythological role of that garment in fiction to the options available for people today.

Instead of the cool form factor available to fictional characters, we are stuck with models that basically make it look like you are wearing underwear in your face.

These two are actually wearing underwear as masks.

This is what market failure looks like: customer needs are (still) unmatched by the goods and services provided by the free market.

If you think this is trivial, think again. Face masks are a garment, and as such, the role of aesthetics will be paramount in determining the rate of success or failure for this particular Non-Pharma intervention. If people feel stupid wearing them, they may and are deciding not to wear them.

LMP | Reusable Protective Silicone Face Mask, the only N99 Kickstarter campaign on April 15th, 2020

And while I started talking about looks as that is the most visual of all the problems with current “Personal Protective Equipment” (that is what any kind of mask would be) for nonmedical people, the market failure surrounding face mask design goes beyond aesthetics. At the moment of this writing, there is only one Kickstarter campaign for an effective, reusable mask that claims to provide N99-level protection to the wearer…and this, months into the pandemic.

We have witnessed how supply chains for Personal Protective Equipment failed to increase availability at the levels needed during a pandemic, leaving first responders underprotected.

Think about it: Even them, the original users of the products, have underserved needs, so it should not be a surprise that those same “pipelines” also failed to meet not only more demand but a different kind of demand.

The market desire for masks that actually can filter virus has gone from the highly specialized medical practitioners (a niche market) to the general population. Everybody familiar with the entrepreneurial literature will recognize what that means: Personal Protective Equipment has crossed the chasm.

source: https://gtm360.com/blog/2017/06/16/how-relevant-is-crossing-the-chasm-after-25-years/

The kinds of models and the supply for products that used to be aimed at a small specialized minority (medical professionals) is in this case insufficient to serve the needs of the majority of the people. Niche customers (early adopters) are more tolerant of masks that look like underwear, and medical practitioners and first responders are a really small percentage of the total population, so supply chains don’t have to be very big to match their needs.

Now we need to rapidly innovate both in function and style so that people can return to their activities with an acceptable level of protection and equipment. Cloth masks will not be enough, and national recovery plans need to do more to improve the capacity of people to be in proximity to each other even when the outbreak is in full swing.

Think of face masks just as an example. There are many more cases like this one. Improving the tools required for an individual to survive a higher degree of physical isolation is now an innovation priority.

Those blessed with big houses, great home theaters, and a great internet connection already have a structural advantage. The internet has been the lifeline for those who can work and receive education at home, “Netflix and chill,” and order groceries and supplies using Instacart and Amazon.

The flip of the coin is that the digital gap has never been more painful. Kids without access to good, stable internet connections may pay the price for the rest of their lives. The difference between the “good jobs” economy and the vulnerable underemployed (many in the internet created gig economy) is now more evident. Rapid public policy innovation to make “stay at home” orders more sustainable at the individual level is needed to close the digital gap faster (Starlink, we are looking at you!) and to make all jobs better, including those that cannot be conducted remotely.

Finally, we are social animals who need the outdoors, and we crave social interactions. Innovations to fulfill those needs will mean the difference between success or failure for Non-pharma interventions.

Virtual Reality technologies can compensate for some of that, and mechanisms to keep open parks and beaches while enforcing social distancing may make getting our outdoor “fix” more manageable. Still, things as simple as a media campaign to encourage families to rediscover board games and game designers to come up with new games will go a long way to make life in isolation more livable (Germany is doing it).

Innovation that makes personal Non-Pharma interventions more successful and sustainable should be a National Security priority.

Business Innovations

One thing that makes this pandemic different from that of 1918 is the existence of the internet. If you are one of the lucky few working for the knowledge economy, your job probably could be easily virtualized, and telework is a possibility. Many companies are discovering the advantages of remote work and may never come to a fully collocated structure once the worst is over.

Recovery plans should all have a substantial “digital transformation” component. Governments and small business associations need to make sure that any facet of a business that can be digitized is digitized. Stimulus packages should have been designed to accelerate the innovations required for companies to be “uploaded” to the internet, friction-free.

Restaurants that have migrated to Uber eats and Grubhub may actually survive the COVID19 crisis by running a transformed version of their service. Still, they should be using this time to prepare for when they are allowed to re-open to the public, with social separation rules in place. Business model innovation id, therefore, as urgent as innovation in tech.

Why shelter at home orders are not sustainable in one neat chart. Author: unknown

Sooner rather than later, people will put enough pressure in the system to force policy actors to relax some of the Non-Pharma interventions (in no small part because with success, the risk becomes less clear). This is why some more graduated elements of social distancing should be incorporated into almost every business model.

Bad photos taken by me during a trip to Tajikistan

During one visit to central Asia, I got to appreciate the configuration of many restaurants that provide intimacy to customers by placing curtains in between the tables.

It is not inconceivable that, with appropriate communicable disease research, some restaurants could implement similar models of social distancing. Using the right materials and with effective disinfecting practices in between groups of customers, innovations like this one could allow restaurants to remain open, even during a mid-level flare of the pandemic.

Model of micro-droplet (saliva) movement in a closed environment. Source: https://www.youtube.com/watch?v=vBvFkQizTT4

But for this to happen, many questions will need to be answered: How safe would it be? And what kind of disinfecting protocols are appropriate? are just two of the most important ones. These are R&D questions, and the time to perform the research is now. Depending on the results of these and some other answers, a new configuration for restaurants could be implemented. Interior designers and restaurant entrepreneurs could bring new styles and, who knows, maybe tall, self-contained booths make a comeback!

Designing furniture for public spaces could be one way to respond to the COVID19 challenge, but more R&D is needed.

Recurrent “Shelter at home” innovations

There is no way around it. Society needs a shelter-at-home “switch” that allows for the rapid deployment of Non-Pharma interventions without devastating the economy. COVID19 may come in multiple waves, and even if that is not the case, it has showcased the challenges of responding to a pandemic. Sooner or later, a new pandemic will happen again and, even scarier, human-made pathogens may be much more lethal and harder to combat. As bad as it is, COVID19 may be the dress rehearsal for the terrorist pandemic to come.

Did you come to France from far, far away? Sorry: we’re closed because of the summer vacations.

The good news is that we know how to build those society “switches.” Every year, around different times, parts of the economy shut down or transform seasonally. For example, summer visitors to Europe discover that many businesses close for long periods of time every year and both in the old continent and in the US, the movie industry is designed for people to work “intermittently” given the seasonality of the work.

More of our society should look like this.

It would be a lot less painful to take geographic sections of a country back into stay-at-home mode if that would, at the same time, trigger the support switch to make sure nobody is hurt disproportionally by the measure.

In this regard, we have seen an interesting delta between nations with strong welfare states in Europe and the US. While in Europe, many of the mechanisms for that switch are already in place, in America, they were not. Therefore, the US Congress literally had to invent in a week a series of institutional mechanisms to support people and companies in this time of need. European nations, on the other hand, only had to increase the funding to some of their social programs to be commensurate to the challenge.

While I will leave most of the content related to testing for a future post, I will say one thing here: To make this shelter-at-home switch effective, we need better data. A lot better. And faster data, almost real-time and at a geographic scale of the zip code or, maybe, even the neighborhood.

If we can contact trace immediately after a positive detection, and we can shelter at home the regions and businesses near the result of that contact tracing effort, it would be a lot simpler to design Non-pharma interventions with smaller footprints. The technology to do that does not exist right now (no, that Chinese app is not the solution, as I will explain in a future post), and innovation efforts need to be made for that it to be available now.

Non-Pharma interventions cannot be employed indefinitely, but they are certainly an important first line of defense in our path to 0 Covid19. Yet to be invented technologies are necessary for these interventions to be sustainable and successful. Good innovation management by governments, philanthropies, and the startup ecosystem will determine the velocity in which these entrepreneurial efforts take place and, evidently, sooner is better than later as the cost of delaying these innovations is paid in human lives.

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