The KPI for Restarting and Managing BC’s Economy with COVID-19

Many of us are beginning to wonder about when people will be able to go back to work again. (Scroll to Step 2. below if you want to see SCR, our suggested KPI.)

(Image: https://www.flickr.com/photos/91261194@N06/49776073138/)

(Editors Note: Erik Kiss who as been studying COVID-19 data has suggested some amendments to my original post. Among other things, he made an important adjustment to the SCR KPI, explaining that we are really talking about our System’s Capacity Readiness. I have edited this article to incorporate his changes. Both Erik and I would welcome your input.)

Why is a KPI Important for Restarting Our Economy

People need to take an active role in managing their lives, being told what to do and when to do it without a clear and transparent framework for how those decisions are being made will lead to distrust between the public and policy makers.

The Canadian public has shown we can adjust our lives accordingly when we are given accurate information and clear explanations of consequences and behavioural impact. This needs to happen for opening the economy, but it’s going to be much more complex than what we’ve experienced with the shut down.

Restarting the economy is not just going to be flipping an “on switch”. The economy is going to gradually ramp up. New behaviours from businesses and individuals will be required. And most importantly there is a high likelihood that we will see subsequent outbreaks, and when we do it needs to be managed, no one wants to see another 2–3 months of a complete shutdown.

A simple KPI that is readily visible and communicated to the public and policy makers provides common ground for understanding our healthcare risk from a virus outbreak.

With a common understanding of risk, policy makers and the public can understand which economic behaviours and activities we can permit and those which we need to curtail for any given situation.

What is needed to return to economic normalcy?

Below I describe the process I think policy makers are following, but they have not communicated any KPI (Step 2), which I STRONGLY believe is essential to managing this process.

Step 1. Stabilize the Situation.

Policy makers needed to get control over the situation on the ground. That’s what all the “Flattening of the Curve” was about. It’s a new virus so there was a lot of unknown. With so much unknown, it is not surprising that there were many differing views on how to deal with this. But it appears there is growing understanding and alignment.

The situation is beginning to stabilize. Local economies across Canada are without question opening up to some extent in the coming weeks. However, many are still arguing it is way too soon, while some say it has not come soon enough. This is partly because there is no communicated KPI!

Step 2: Establish a System Capacity Risk KPI

Before I introduce the KPI it’s important to understand what Healthcare Surge Capacity is. It’s the most critical factor to understand if our economy or portions of it can be reopened. Surge Capacity is our health care system’s ability to rapidly mobilize to meet an increased demand, beyond normal services levels, in the event of a subsequent outbreak.

SCR (System Capacity Risk — This means the likelihood that we will be reaching the following capacity levels in a predictable future (to some level of confidence). It is not the situation we are currently experiencing but one we are likely to experience in say 2 weeks, thus giving us time to respond. The values to the KPI could be as follows:

5 — We are at typical capacity (whatever that is, like 90% or whatever we used to be pre-COVID)

4 — We are at maximum normal capacity (100% of normal capacity, like a typical health emergency/flu season)

3 — At maximum normal capacity and ramping up surge capacity

2 — We are at surge capacity

1 — We are exceeding surge capacity

With this understanding the public and policy makers can use tools to throttle up and down economic activity that increases or decreases our SCR.

So when will the economy reopen?

Assuming we are presently at an SCR of 2 in BC, we will start to open up when we are a 3. There are already some indications that is the case as well as Ontario and Saskatchewan. The economy would be completely open when we have an SCR of 5.

The SCR should be managed on a local and community level as well as provincial and national level. An outbreak in Kelowna should not necessarily impact Nanaimo. To accomplish this, digital contact tracing will become a critical tool. More on this later in the article.

How can the government manage SCR?

Without SCR the government only has these tools to manage the economy in broad swaths across the province.

1. shutting down non-essential businesses,
2. encouraging social distancing and PPE usage
3. initiating quarantines and travel restrictions

With SCR, governments can be more surgical in their approach.

Step 3: Open up the economy and manage SCR

Opening up the economy brings risk of infection. We need more precise, accurate and timely data on infection and potential infection.

Requirement for more timely and accurate data to manage SCR

As more businesses get back in operation, our predictive modelling will need to have timely information on how large increases in human interactions are changing our SCR. The three tools used to manage SCR need to be applied more finely now. The shutdown was a hammer. Going forward we will need a more surgical approach. We want to quickly identify and isolate areas of potential outbreak without resorting to shutting down areas unaffected. To do this we will need a couple new technologies and tools:

Digital Contact Tracing. This is an app on our smart phones that will let health authorities notify us if we have been in contact with someone who has or is likely to have been infected with COVID-19. Depending on the type and duration of contact you had with the infected, you will be asked to take certain precautions and behaviors until you’re deemed OK, usually lasting 2 weeks.

Faster infection data. Drive through or home testing for COVID-19 is going to be important for us to quickly confirm infection and track the spread.

With better data policy makers can be more precise in the tools they use to determine the level of economic activity based on SCR:

1. Broad Policies. Disinfection standards, travel restrictions, social distancing, maximum capacities, limits to venues or activities, public space closures, business closures, testing and measuring policies, etc.
2. Healthcare Management. Hiring, supply chain (PPE, medication, treatments, etc.), research, volunteer, surge space, non-urgent care, testing, monitoring, etc
3. Business Activity. Health monitoring for employees/customers, limit interpersonal contact, remote work, different business models that affect a businesses risk profile. (delivery, curbside pickup, online ordering, etc.)

Step 4. Making our economy more resilient to another outbreak.

We are likely going to need a more flexible business and consumer environment. One that can better react to the conditions brought about when managing SCR.

Business resilience

Opening and closing businesses is incredibly disruptive to all of our lives. But it is an important tool for managing SCR. It is likely going to happen again at some point in the future if we experience another outbreak, even at a local level. As such, businesses will be encouraged and in some cases required to adopt systems and processes that enable them to operate at a specific capacity with a distributed team working from home.

Services for an at risk public

We will need to improve the level and of private and public services for our at risk public. Edlerly, disabled, and those with compromised immune systems should not be “locked up”. We need to work on solutions so they can better participate in a post-COVID world.

Also, people who may be at risk of exposure cannot just quarantine themselves for 2 weeks every time they come in contact with someone who themselves “may be at risk”. There is likely going to be some level of status declaration which will permit at risk people access to certain outside businesses and services.

Summary

Defining and communicating the SCR KPI should be a priority for our policy makers. If the KPI has already been established, it must be communicated.

The SCR makes it clear to the public what conditions we are in and how to plan our lives accordingly. Without a KPI, trust will deteriorate between policy makers and the public.

We will need new tools and technologies so that the government’s management of SCR has minimal impact on our lives.

As a final point that was highlighted to me by Chuck Hamilton in the comments, a KPI like this can be ripe for abuse. As such the data collection for and reporting of the KPI should be independent of our government.