How to Crush the Curve
Q&A with Yaneer Bar-Yam, physicist, pandemic advisor
This isn’t the article I intended to write.
The article I wanted to write was going to be reeeally cooool.
**SPOILER ALERT: It was going to start with an allegory about WWI and turn into a cautionary tale about how the COVID-19 pandemic could lead to unexpected consequences. It had engaging characters, epic plot twists and an ambiguous cliffhanger ending.
It was going to read like a movie script.
As I was researching my article last week, I reached out to Yaneer Bar-Yam, president of the New England Complex Systems Institute, to procure some interesting quotes that would fit the story I wanted to tell.
Except they didn’t really fit.
His responses, eschewing all bluster in favor of focusing on the task at hand, gave me pause to reconsider.
Instead of imagining I observed. Instead of thinking I listened.
Maybe we all should.
After all, as far as the current pandemic goes, he’s been ahead of the curve.
The Precautionary Principle
On January 26th, when most in the US — including its Commander-in-Chief — were still writing off the Coronavirus as a slightly-more-bad version of the flu, Yaneer Bar-Yam, along with his friend and colleague Nassim Nicolas Taleb, author of The Black Swan, published A Note entitled, “SYSTEMIC RISK OF PANDEMIC VIA NOVEL PATHOGENS — CORONAVIRUS.” In it, they implored governments to heed the potential threat of the virus becoming a pandemic and cautioned against relying on traditional academic models of risk assessment:
“The general (non-naive) precautionary principle [3] delineates conditions where actions must be taken to reduce risk of ruin, and traditional cost-benefit analyses must not be used.”
In other words, when the potential risk is an extinction event, you get all hands on deck, even if the models prove to be false.
Unfortunately, Yaneer and crew were right.
As the virus began to spread from country-to-country, and as the lines on graphs arched frighteningly upwards, the prevailing strategy became to “flatten the curve”; to visibly reduce the exponential growth rate of the virus to avoid overwhelming fragile health care infrastructures.
Yaneer thinks we should aim lower.
His new project, Endcoronavirus.org, seeks to crush the curve, by adopting community-based solutions to contact-trace, isolate and prevent outbreaks before they happen. His plan is a loud call against the fatalist notion that we can do nothing, or that we must settle for a perpetual state of damage control.
The Problem with Predictions
I asked Yaneer whether the public can be expected to continue to comply with CDC/federally-issued guidance (social distancing, shelter-in-place orders, etc.) if the models on which the guidelines were based prove to be wildly inaccurate. The concern has been raised by some in the media. “What happens depends sensitively on what we do. It is not just whether or not we have a lockdown but the specific details of how that is being done,” he writes.
When it comes to modeling a pandemic…it’s complicated.
Models work great for smaller-scale systems. Plug in three variables — me, a box of ice cream sandwiches and a Sunday night alone in quarantine, for instance — and I can calculate, with fair accuracy, that I will eat four — yes, all four — of those ice cream sandwiches by midnight.
When it comes to complex systems — like the weather, or pandemics — models tend to lose accuracy. Anyone who’s regretted leaving their umbrella at home after trusting their local weather forecast understands this implicitly.
So it’s no surprise to Yaneer that several of the models have been off the mark. As far as he’s concerned, that also doesn’t matter.
“Predictions are not helpful,” he says when I ask about the models. “‘What will happen?’ is not the right question to ask. Promoting effective action ‘What should we do?’ is.”
So what are “effective actions”? And what “specific details” will prove most effective for “crushing the curve”?
Community-Based Responsibility
For someone who professionally studies complexity, Yaneer talks very little about “[un]helpful” models and charts, focusing instead on the actions we can take now to affect the reality in front of us.
Perhaps that’s because he’s seen it work before.
From an interview on 4/1/2020:
“In 2014[…]Ebola started in West Africa and was ten times the size of what people had experienced. So you had cases of a few hundred deaths and then all of a sudden you had ten thousand deaths. But that wasn’t all. People were expecting, at some point, that there would be ten million deaths…What we recommended is that the communities should be responsible for themselves. Instead of waiting until people went to the hospital, and said ‘hey, I have Ebola,’ […]they went around in the neighborhood and they measured everyone’s temperature. And if they had a temperature, then they isolated them. And that stopped the outbreak.”
Yaneer advocates a similar approach to contain the current pandemic, invoking “focused, adaptive and creative solutions,” such as forming neighborhood coalitions on social media to help track infection and offer support. It’s a grassroots approach to pandemic control, placing responsibility on an individual level and galvanizing the community around common-sense solutions to a complex problem.
If his ideas seem unorthodox, that’s because they are. But let’s remember that Americans similarly had a less than enthusiastic response to wearing masks in public; in retrospect, the hesitancy to adopt new norms that make us uncomfortable may be one of the reasons why cases are still increasing in the United States, as they drop off in other parts of the world.
In his newly released Guideline, “How We Win,” Yaneer shares the plan in detail:
“Get everyone on board: All levels/aspects of government, communities, companies, individuals have to go all out to stop this disease, even small “leaks” can sink the ship. Galvanize everyone to be focused, adaptive and creative to maximize their role. This virus attacks us exponentially, but when we fight back, we do the same to the virus.”
It seems that others are taking note as well. On Friday, Google and Apple announced a partnership to alert people if they have recently come into contact with others found to be infected with the coronavirus. And in Boston, the governor’s office announced the nation’s first community-wide effort to contact trace.
Preventing the Spread
The threat of increased travel creating a tipping point in a pandemic is nothing new to Yaneer; he has been warning the world about it for fifteen years. His concern stems from a decades-old model he created that showed that with the advent of widely-available air travel, local outbreaks would, over time, pose an existential threat to humankind. According to Yaneer, however, there is hope, as his model “doesn’t take into account how we respond to outbreaks. We must recognize the risks and make decisions both about the nature of the transportation system and the response to outbreaks.”
Yaneer’s guidelines recommend the following travel restrictions to curb the spread:
“Nations and states should impose 14 day quarantines on travelers, as should separate regions within a state. Essential transportation of goods and people should follow no contact protocols into a zone or across one zone to another[…]These will stop new outbreaks from starting, make contact tracing feasible, and preserve local achievement for a ratchet effect — maintaining forward progress by preventing backward retreat. Otherwise, it is never ending, like draining a bathtub with a running tap.”
But what do we do if we imagine the outbreak resurges in multiple waves? As for how we deal with repeated outbreaks, Yaneer challenges the assumption, questioning whether we should be asking if instead of when:
“Again, whether or not there are waves depends on what we do. We can prevent them if we take the right actions. One of the keys is to use travel restrictions so that we eliminate the disease progressively across parts of a country[…]Eventually, we eliminate the restrictions when we have control of the disease in the last region that is affected. In order to do this we also need effective testing to prevent one or a few cases from turning into a new outbreak.”
Fear as a Variable
The uncertainty surrounding the disease and the unknowns have created a vacuum for faux-epidemiologists to espouse their views, leading to a proliferation of disinformation that exponentially increases the fear surrounding the disease (Nassim Taleb, with whom Yaneer co-authors much of his academic papers, cheekily refers to hypotheses that give the illusion of science minus the rigor as “Scientism”). Yaneer shares a similar derision for misinformation and its role in creating imaginary fears:
“People are worried about unknown aspects of the disease and creating fears based upon them. We have a hard enemy but we don’t have to create movie scripts, we have to focus on the reality that we are facing now.”
Part of the fear is the uncertainty surrounding the economy. In the past month, nearly 17 million Americans have filed for unemployment since mid-March, and it is projected that over 10% of the American workforce is currently out of a job. Yaneer agrees that the second greatest threat from the virus was to the economy, though he disagreed on the acute cause of the economic damage:
“The main problem is the confusion about the impact of an exponentially growing outbreak on an economy. Fast action is needed. The collateral damage is small if we act quickly to stop it. Instead the fear of action has made the damage worse, and every moment we wait increases the damage. We have a hard enemy but we don’t have to create movie scripts, we have to focus on the reality that we are facing now.”
As pandemics go, time is money. Physical losses are proportionally tied to financial losses.
According to Yaneer, though it appears to hurt the economy in the near-term, taking strict mitigating measures is the only way to preserve our long-term economic lifeblood. Delaying containment now or opening up the economy too soon will only leave a lingering wound, a pervasive fear that fluctuates the market alongside spikes in new cases.
If we want a healthy economy, the smartest investment we can make is in the health of our people.
Focus on the Reality to Avoid Dropping the Ball…Again
When I ask Yaneer what has surprised him the most about the current pandemic, his response again points back to a breakdown in common sense. “The thing that was surprising is that seeing what happened in China, the rest of the world didn’t take early action to stop it from coming here.”
Above all, his message is plain and simple.
There is no need to wait for a miracle drug or a new technology to save us; the solutions we seek are mostly common sense and are freely available to us now if we take action.
Willingness, then, may be the first (and only) thing we need to crush the curve and defy predictions.
The last thing we need is another movie script.
For more info, go to endcoronavirus.org or follow Yaneer at https://twitter.com/yaneerbaryam
If you enjoyed this interview, consider subscribing to our mailing list:
