Innovating to Zero COVID19

How to innovate our way out of Coronavirus hell by doing the right things in the right order

@RodrigoNieto
Mar 26, 2020 · 8 min read

In good system thinking practices, sequencing matters as much as the acts that are being sequenced. With COVID19, getting the sequencing right is more important than ever as millions of lives are at stake.

Entrepreneurs have perfected the sequencing of business deployments down to a science. Recent examples are Elon Musk’s “master plan” to chain-link technological steps towards a solar economy by removing, one by one, the hurdles that had stalled electric car adoption and Bill Gates’ famous Innovating to Zero plan to fight global warming, structured around research and development to respond to all the barriers that make CO2 reduction so difficult.

Bill Gate’s formula for zero CO2 emissions
Tesla: from a low volume sports car to a mass-produced one

Both interventions share something in common. They spend an uncanny amount of time thinking about how things fail to only then decide where you can actually intervene and in which order you should do it.

In a recent story, I described how the healthcare system's capacity to fight COVID19 is not a fixed value and why it matters to innovate to make sure that this value increases faster than the spread of the virus.

Here, I explain in which order those innovations need to be deployed to get out of COVID19 hell in a successful way. In subsequent posts, I will explore, one by one, the potential innovations needed, and how the government can play a central role in accelerating the development and adoption of those innovations.

Think of each of these first three steps as a stepping stone to the next one, until we reach the fourth one: global deployment of a vaccine.

Basically, in order to innovate to Zero COVID19, we need to rigorously follow this sequence of interventions. For those in Emergency Management, think of this as your “innovation lifeline”. If we do not stabilize this lifeline, we will have a harder time stabilizing the others:

First Stepping stone: Aggressive Non-Pharmaceutical Interventions (NPIs)

When you stay at home and distance yourself from your family and friends you are practicing what in disease control is called a “Non-Pharmaceutical Intervention” (NPI). Non-pharma interventions matter because they are the low hanging fruit of the disease control tree. You don’t need to develop or deploy any new technology and it can be done immediately. COVID19 needs a host to exist… remove the hosts and once those who are sick get better, the pandemic dies. If we could force every human to hibernate for 5 weeks, we would all wake up to a COVID19 free world. Germs are social creatures, so non-pharma interventions are social responses.

The goal of Non-Pharma interventions is to buy us time so we can work on the next stepping stones. In future articles, I will describe the innovation challenges for each stepping stone with more detail but suffice to say that it is paramount to do everything in our power to make Non-Pharma interventions successful: in particular, it is essential to accelerate the adaptation and discovery of new business models compatible with physical distancing so people can work and continuity of operations is assured.

Also, it is urgent to build technologically mediated avenues so we can all be socially connected while physically separated. People will abandon Non-Pharma interventions if they feel alone. Like the damn bug, we too are social beings. Internet technologies are now more essential than ever.

Second Stepping stone: Regular testing

A quick scenario:

“Honey, we are late for dinner with your parents” yelled Martin to his wife.

“Well, it would go a lot faster if you helped me finish testing the children before we leave“ she replied. “Liam has not yet taken the test and if he doesn't do it now, the results will not be ready before we arrive to their home. I am not getting inside of the house without it.” Annoyingly, Martin removed his coat and started chasing the toddler around the house. It was already damn hard enough to have to chase the kid around the house to dress him up, and now he always fought too the nasal swab they had to take before leaving the house.

Dystopian you say? Well, the only real alternative to distancing rules is aggressive, continuous testing. If I know I am not sick and I know you are not sick, we can have a nice meal together or have a playdate. If offered, I would only go to restaurants that administer a rapid test to its customers before allowing them inside of the venue.

Right now, this technology does not exist and we need it fast. Many companies and laboratories are already working on it and some pre-screening tests are now available. Non-pharma interventions are buying us time for better testing to be developed. The key variables: Self-administered, rapid and affordable. The more it looks like the way diabetics can control their glucose level the better.

The “quantified self” movement has gone from gimmicky to critical.

Third stepping stone: Public Health breakthroughs

If we can “flatten the curve” with stepping stone one, and we can improve testing with stepping stone two, we will buy time for medical research to work its magic (Note: it is not magic; it is science, but paraphrasing Arthur C. Clarke, it will feel like magic!).

More creativity in ventilator’s design is happening in a week than in the previous decade. and an improved supply chain of Personal Protective Equipment (PPE) is being created as we speak.

I will say more in future posts, but the most urgent breakthroughs right now are those who protect the life of our first responders. The worst of worst-case scenarios is the collapse of our Emergency Services Sector.

Many clinical trials are happening right now, experimenting with different drugs, so we can identify effective treatments. More studies will come about existing drugs, and more drugs will be developed.

Thankfully, good treatment, unlike vaccination, does not need to be produced on a large scale. Once available, as long as we can produce rapidly hundreds of thousands of units (unlike billions for vaccination), we can make a big difference.

Scientific breakthroughs are serendipitous in nature. But innovation theory shows that serendipity is a game of chances. The more you try, the more the odds are at your favor. The incentives are there, so sooner or later we will see improvements. Innovation friendly public health policy can accelerate that process.

The more we preserve the capacity of the system by following stepping stone 1 and stepping stone 2, the more lives we will save when stepping stone 3 gives us better medical interventions. You don’t want to get sick, but if you do get sick, you want to delay that as much as you can!

Fourth Stepping stone: Vaccine deployment

Potential SARS vaccines have been “in the freezer” for years. Many reasons prevented their distribution. In the last 10 years, government preparedness, for example, failed to address approval hurdles and funding for pandemics prevention has not been sufficient. The good news about this is that COVID19 vaccination is not an intractable scientific problem that will require years of research before a product can be manufactured. The knowledge on how to produce coronavirus vaccination exists and the failures to produce better vaccines are mostly market and regulatory failures.

This does not mean that producing a vaccine against COVID19 will be easy, though as it is true that vaccines often take more than 10 years to be developed in normal times… but these are not normal times. On planet Earth, today, there is not a single scientific project that is more important and, in a sort of Moonshot environment, resources are being marshaled towards the development of the vaccine (even your gaming computer can be commandeered).

Because part of the reason why we don’t have better tools against coronavirus pandemics is poor global public health policies, policy can have a big impact on accelerating innovation in this field. From streamlined approval processes to funneling public taxpayer money into medical research and encouraging companies to make a vaccine that probably will not be very profitable using the carrots and sticks of the power of the state, much can be made to make sure we have the vaccine earlier than what would be normally expected.

Manufacturing a vaccine that billions of people want to receive in a short period of time presents a problem that the public health system has never confronted in modern times. While we know how to give vaccines to everybody, we will have to learn how to do it fast. Companies are already experimenting with novel manufacturing processes.

Each stepping stone is critical to increasing the capacity of the healthcare system to innovate to zero COVID19. Without discipline, the system can actually regress and lose capacity. Taking away distancing away too soon, failing to increase continuous testing, not developing modern protective gear or tardiness on removing obstacles on vaccine development can force saturation in the system… and when the system saturates, people die.

Innovating to zero COVID19 is the most important sequential innovation challenge of our generation. Humanity’s future depends on the first responders who are risking their lives and on the entrepreneurs and scientists who are needed to provide a final solution to this problem. The job of the government is to give them everything they need to do their jobs. Our responsibility as citizens is to buy them time.