Leadership and behaviors matter
We have, rightly, heard much from public health professionals about keeping safe from the COVID-19 pandemic. However, apart from criticism of politicians’ perceived faulty responses, we’ve heard less about how other sciences, leadership, and our own behaviors — beyond social distancing, self-isolation and enhanced hygiene — can help make a difference.
My doctorate is political science, specializing in policy effectiveness and outcomes. This involves not just asking what’s been done, or if it meets someone’s definition of ‘standards’, but whether it works. Does it achieve intended outcomes? Outcomes science, like crisis management, operates alongside other disciplines, in this case, for optimal health and economic outcomes.
Clearly, ‘outcomes’ matter, but it’s such a common word that we seldom think about the science that can help reach our goals. Often, that’s when we don’t achieve intended objectives — as seems to be playing out with a worsening crisis in many countries.
Compounding matters, rather than supplementing expert medical advice with applied outcomes science, some leaders are ramping up scapegoating, war-like jingoism and political theater. This form of leadership may serve political purposes, but does little for better outcomes.
Insights offering deep understanding of what worked, and why, will take time. This article offers a preliminary view from an outcomes perspective.
Not which science matters, but when
A critic, insisting we use only “scientifically verified facts and solutions,” challenged me on social media. “What has so far been scientifically proven about this particular virus?” he demanded.
The superficial allure of “scientifically proven” risks casting us into the wrong science at the wrong time, and asking the wrong questions — with potentially disastrous consequences.
A definitive understanding of COVID-19’s underlying virus is, indeed, critically important, as my online interrogator says. Medical science remains front and center, but anti-viral medicines take time to develop, test, manufacture, distribute, and administer on a global scale. In the meantime, the ‘real’ issue — in the sense of what will have the most impact — is not so much the disease itself, as how we respond to it, beyond now-familiar precautionary measures.
In other words, the “proven science” that will make a difference is not just the science about the virus; it also involves the science about people, leadership, and outcomes.
What we do, and what our leaders do, matters. A lot.
Right now, it’s not so much about the virus, as about us
Our response to the pandemic, individually and collectively, will determine its course, and ultimate outcomes — including whether deaths stay in the low tens of thousands, or become millions — long before validated data about “this particular virus” produces a vaccine.
Cure-relevant knowledge about COVID-19 (the disease) and its underlying virus, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), will only come during vaccine development, so a key issue, now, is different.
The impact of COVID-19, beyond a hypothetical perfectly managed response, depends on our response to it. A toxic mix of uninformed or politically-driven decision-making, inflammatory journalism (as opposed to accurately reporting sometimes provocative reality), misinformation, and panic — all natural, and inevitable — will determine just how close to, or how far above, the ‘best scenario’ baseline this disease eventually plays out.
For example, if there’s a big spike or a gradual build-up of cases before vaccine availability, the former would overwhelm medical facilities, causing untold deaths. Until a few days ago, the latter was widely ‘preferred.’ If the rate of growth of new cases could be brought under control (“flattening the curve”), it was thought, a mitigated pandemic would ‘only’ be tragically bad, with far fewer projected fatalities.
But a new study suggests that, in the UK alone…
…the resulting mitigated epidemic would still likely result in hundreds of thousands of deaths and health systems (most notably intensive care units) being overwhelmed many times over.
Another approach now calls for intermittent social distancing, relaxed from time to time until each new wave of transmissions calls for stricter controls — allowing the health care system to better cope.
The underlying research involves medical science, but — even aside from ethical issues (authorities deliberately enabling fresh waves of disease) — the trajectory of this pandemic ultimately depends at least as much, perhaps more, on the science involving people, leadership, and outcomes.
So, the response to my social media critic is that much remains unknown about “this particular virus”, but, right now, it doesn’t much matter. Medical researchers are working on pharmaceutical solutions. Until then, other important factors associated with non-pharmaceutical interventions will determine the trajectory of COVID-19, and its ultimate impact — long before “scientifically verified facts and solutions” about the virus produces a vaccine.
Mixed responses, global consequences
We have already seen significant differences in response to COVID-19, from inspired leadership and responsible reporting, through denying the problem in its early stages — courting the risk of potentially catastrophic consequences.
With that risk now materializing in the United States, extreme measures are needed to mitigate damage. But the harsh reality is that only some of the social and economic harm was inevitable, due solely to the virus. The remainder can be attributed to being “caught woefully unprepared.” As other countries’ illustrate (like Singapore, below), the immense social upheaval and economic carnage now experienced, didn’t need to happen, or at least not on the same scale.
Moreover, fundamental differences between nations’ strategies matter, because spillover effects mean that failures in one country can ruin successful efforts elsewhere.
Nor is this effect new. One of the reasons the 1918 influenza pandemic was so devastating was not so much its timing, at the end of a major war, as its inept management. Rather than containing the disease, entire armies were demobilized, returning home with it.
That example a century ago also suggests a chilling comparison now. If the Tokyo Olympic and Paralympic games go ahead as planned, leaders need to grapple not just with the risk of one person infecting thousands (a prospect already causing qualifying and other sporting events to be cancelled, postponed, or played in empty stadiums). Around 15,000 athletes and a million spectators returning home afterwards would exponentially multiply any risks not adequately managed at the games.
However, globalization also has positive effects. Political leaders and health officials can learn, in real-time, what’s happening elsewhere, including what seems to work, and what doesn’t. Practical help is also more readily available. After dramatically changing the virus’ trajectory in China, doctors and supplies were sent to Italy, Europe’s COVID-19 epicenter. Jack Ma, an Asian billionaire, also sent planeloads of supplies to Korea, Japan, Italy, Iran and Spain, all struggling to contain the outbreak, and offered 500,000 test kits and a million masks to the United States, to help with shortages.
In any event, leadership decisions in affected countries will continue to influence local, regional, and global outcomes.
Leadership failure, not virus, mostly caused lockdowns, financial chaos, and massive bailouts
Huge variance in testing for the virus (as shown in this chart) offers one of many examples suggesting that some leaders appear not yet to have learned lessons from others, like Singapore’s apparent success.
Many countries test for the virus according to clinical indicators developed by health authorities. So-called ‘risk-based’ testing based on ‘standards’ sounds plausible, with protocols developed by experts. But, relying on medical expertise alone is dangerously limiting.
For example, testing only symptomatic people recently overseas from countries considered to pose transmission risks, or in contact with such people, misses non-symptomatic returned travellers and community outbreaks. This can be significant, due to the incubation period between contracting the disease and showing symptoms. (According to a recent study, 97.5 percent of people develop symptoms within 11.5 days, with a median incubation period of 5.1 days).
Testing a population based on medical protocols like those above, unconnected with effectiveness and outcomes principles, represents a strategy of hope.
That is because no evidence of community transmission, while not testing for it, does not mean no community transmission. If, fortuitously, there is found to be little community transmission, authorities might ‘get away with it.’ But, as many leaders have now found, a false sense of security can be unmasked in a few weeks, characterized by the true number of cases growing exponentially, unseen, and uncontrolled. Absent formal outcomes frameworks to contextualize expert medical advice, some governments learned these lessons the hard way, with more extensive testing only triggered reactively, by an explosive increase in cases, horribly late, overwhelming medical facilities.
Likewise, for countries with too few kits for comprehensive testing. Despite political rhetoric blaming the disease (and, in some places, its country of origin) for mounting cases and deaths, in truth, the main cause for a significant proportion likely relates to leadership decisions. For example, inconsistent with outcomes-oriented decision-making enabling optimal results, in January and early February, many countries’ leaders in effect waited for confirmed cases to emerge before reacting. When they did, with numbers climbing exponentially, it was too late.
In stark contrast, according to Professor Dale Fisher from Singapore’s National University:
…on December 31, when the world first became aware of coronavirus in China, Singapore started to get prepared. By the time the World Health Organization declared a public health emergency at the end of January, it was ready.
Early indications suggest that comprehensive evaluations of the response to COVID-19 may find, in many countries, that, rather than the virus, leadership decisions (notably delays, reactive decision-making and over reliance on standards) may be the most significant cause for widespread lockdowns, plummeting stock prices, economic chaos, and the need for massive financial assistance packages. That is because emerging evidence appears to indicate that the virus can be (and could have been) managed differently, significantly minimizing the extent of social and economic harm.
However, the official narrative in some countries has instead begun projecting images of a “war” against a killer disease, stoically endured, and fought with vast sums of public money. The war analogy is not necessarily bad, unless used to obscure mistakes under the cloak of nationalistic fervor, rather than learn from them in order to mobilize resources more effectively.
There are many such lessons.
Full analyses of the response to COVID-19 won’t be available for some time. Even at this early stage, however, it seems a plausible hypothesis that Singapore’s rapid “flattening of the (infection rate) curve” — the lowest of 39 countries in this chart — approximates a hypothetical ‘best case scenario’. Each country’s circumstances, and ‘best case,’ differs, and other countries may emerge as exemplars (including, perhaps, some with fewer than 100 confirmed cases, not appearing on the chart). In the meantime, if Singapore’s example presents an empirical ‘best case scenario,’ other countries’ divergence from its trajectory is starkly visible.
These findings suggest that, if (in early January) more countries had followed a similar course, it is a reasonable hypothesis that infection rates would not have climbed so high, they would have flattened earlier, fewer cities and countries would be locked down, millions more businesses and schools would still be open, and the economic impact — and chance of a global recession — would be lower.
For people in countries suffering those events, Singapore’s description may be unnerving (as a ‘what if’), or uplifting (viewed as a ‘what can be’):
In Singapore, we want life to go on as normal. We want businesses, churches, restaurants and schools to stay open. This is what success looks like. Everything goes forward with modifications as needed, and you keep doing this until there’s a vaccine or a treatment.
“It’s nothing really fancy”, added Fisher. “We don’t have the magic answer here, we just do it well and efficiently.”
Within that humble statement lies a profound observation. It is simple. It’s about leadership for outcomes.
The good news is that it’s not too late.
According to an old proverb generally attributed to China, the best time to plant a tree is 20 years ago. The second best time is today.
In the present context, the best time to start preparing for a coronavirus outbreak was 2003 (incorporating the lessons from the SARS outbreak into preparedness plans) and, for SARS-CoV-2 (the COVID-19 virus), in the first week of January — to begin aggressively implementing those plans.
Some countries did just that, with good interim results, like Singapore. Others did neither, with results accordingly.
(Curiously, unlike many other countries which appear also to have failed adequately to prepare for or respond to this pandemic, the United States even reduced its capabilities. In 2018, America’s lead global pandemic response health security team was disbanded. Also that year, reduced funding to the Centers for Disease Control and Prevention forced changes to a key program specifically designed “to stop future outbreaks at their source.” According to The Washington Post, the CDC “dramatically downsize[d] its epidemic prevention activities in 39 out of 49 countries,” including China).
Nonetheless, for countries seriously starting to pay attention to COVID-19 only in the past few weeks, they now at least have the benefit of what seems to be working; notably, at this stage, lessons from Asia.
For example, China and South Korea (which introduced an aggressive testing, contact tracing, and case-isolation quarantining regime —reportedly “the most expansive and well-organized testing program in the world” — without having to lock down cities) both appear to have “flattened the curve”, dramatically cutting transmission rates.
These initial examples offer salutary lessons favoring outcomes-oriented leadership, rather than adherence to self-limiting standards adversely affecting outcomes. Some of them may yet falter, and others may emerge as exemplars. But all share one thing. They offer the benefits of empirical evidence (what works) to help inform strategy, rather than theoretically attractive ideas like herd immunity, arguably so bad as to be unethical, and dangerous.
But it’s not all about leaders. Individuals have responsibility for outcomes.
Individual responses, global impact
As individuals, we can also do things that help save lives. This may involve engaging with reputable information, actively applying critical thinking to news and social media — and, if necessary, respectfully calling out harmful claims, like here and here.
In practical terms, we may become more familiar with what’s known about viruses, coronaviruses, symptoms and risk rate factors, the importance of hand washing and drying, the efficacy of facemasks, risks for children and babies, how to tell your kids about coronavirus, and differences between outbreak, epidemic, and pandemic, and why it matters.
We might also brush up on related issues like the effects of “insidious confusion” and fear-inducing journalism, how to filter misinformation, cope with anxiety, and spot bogus cures, and when safety measures counter-intuitively increase risk.
Official sources of evidence-informed advice for such purposes include the World Health Organization and national health agencies, with independent sources like The Conversation, Johns Hopkins (and map), and Tomas Pueyo’s guide for political and business leaders.
But, knowing the truth is not enough. Nor does every country enjoy all of the factors contributing to Singapore’s interim success. Fisher observed that its citizens have considerable faith in government, officials acted transparently, with clear and consistent messaging, and citizens played their part:
People know what to do and they know if there’s a lockdown, they’re going to be closed. There’s a lot of business and revenue to be lost.
As a result, he said, “everyone understands and adapts.” Singapore, like South Korea, didn’t need widescale lockdowns. Business continues, and people are adjusting to the ‘new normal’ until a vaccine is available.
In other countries, however, as well as following evidence-informed advice, sometimes we may need to encourage leaders to do likewise. Often, this can be as simple as writing to political representatives. Many have online contact forms. If enough people demand an evidence-informed response to crisis, rather than the destructive folly of politicized decision-making, each of us, collectively, can help save the world.
Finally, we might consider wider perspectives, such as other areas where the prodigious problem-resolution focus now on COVID-19 might be usefully deployed in future. For example, my 13-year-old daughter offered this viewpoint, framed in a bigger picture:
COVID-19 is important. We have to deal with it properly, to protect everyone. But it still seems a bit weird that old people immediately throw everything at solving a problem mostly affecting people like them, but only young people seem to really want to solve climate change, a problem that affects everyone on Earth.
The biggest variable as to how the pandemic will play out isn’t the current coronavirus itself. It will operate to capacity in whatever environment it finds. Instead, we are the critical variable in a tragic experiment in leadership, and humanity. If political leaders and citizens enable outcomes-oriented evidence-informed decision-making, the virus may yet run its course at what is now roughly the lowest possible level. Our lives and businesses may then settle in to the ‘new normal’ until a cure is available. Otherwise, with decisions affected by narrow science, dogma, and toxic politics, COVID-19 will take a different course, with more human-induced deaths and economic harm. The additional burden above the unavoidable base level will be blamed on the virus, but the real cause — just like 1918 — will be the decisions of political leaders.
In the meantime, amongst millions of people now isolated, countless examples of empathy and compassion augur well for humanity.
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Thank you for your precious time.
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