Process Triaging COVID-19
Note: This 3/10/2020 post was last updated on 3/13/2020 to reflect my latest thinking.
How we think about caronoviruses is important. They are a deadly threat to the immunologically compromised. This post applies the ProcessTriage® Protocol to the COVID-19 virus epidemic. Here’s my triaging narrative so far:
The COVID-19 epidemic is a Process Pain Point. In no particular order, it inhibits business and community performance. It is a repeating event that disrupts our business by delaying supply chains, suppressing retail customer traffic, increasing employee absences, overwhelms medical ICU capabilities and is fatal to a specific demographic at rates quite higher than seasonal influenza (.1%), to perhaps +10x that, perhaps 2%, about half of what the 1918 Spanish Flu recorded.
Panic? Absolutely not. Pay attention? Absolutely. At this writing, it has an exponential growth rate about 1.15 (meaning each subsequent day’s infections will be 1.15 times the previous day’s) with an unknown inflection point date in sight (where the growth rate is 1.0, after which it will decline exponentially). Here is the latest data from Johns Hopkins University. A most sobering analysis of COVID-19 is Joe Rogan’s interview with infectious disease expert Michael Osterholm (March 10), Dr. Osterholm asserts “This will not be a flu blizzard, but a flu winter with potentially 480,000 deaths.” This is NOT the flu, although both are respiratory infections. There will not be a vaccine anytime soon. Unfortunately, forty percent of the US population have mitigating risk factors of obesity and high blood pressure, that increase their risk of complication, with an amplified risk to the elderly and those with weaker immune systems. The CDC’s Dr. Anne Schuchat gives a good summary as well (3/12/2020), from Senator Bill Frisk’s podcast (See episode #42).
Do we know the most likely cause? Yes, enough. COVID-19 is highly contagious and lasts from a few hours to perhaps ten days on surfaces. It originated in Wuhan, China, likely from a wet market.
Do we have a best practice that, if followed, addresses the pain point? Yes. During the epidemic’s expansion phase: SLOW IT DOWN until enough people recover from exposure until is stops spreading. It’s all about reducing the R0 ratio — the number of adjacent individuals a contagious carrier infects, thereby flattening the curve. Establish and maintain social distance. Avoid crowds. Practice good hygiene, diet, and exercise. Strengthen one’s immune system. Focus locally. Since the virus is spread by breathing, an R-95 grade breathing masks is required to prevent breathing it. One can be infected and contagious for typically four days before showing symptoms. If one is appears symptomatic, self-isolate and get tested if possible. Be especially aware of the immunologically compromised such as the elderly.
At some point, the strictness of this social separation can collapse the economy. Most hourly workers in all industries that serve gatherings of people will be unemployed. Schools, in-person entertainment, in-person sports, restaurants — the entire social services sector will collapse.
(Do not panic. Neurobiologically, keep your consciousness parked in your prefrontal cortex, where it’s emotionally safe. Focus on watching the empirical data — your local city and neighborhood numbers (not the numbers of places you’re not not going to visit, other than the trend lines). By focusing on the facts, we avoid the amygdala’s fight-flight-freeze lizard-brain panic; we suppress that nasty cortisol.)
Does this best practice need training or learning? YES. We need to TRAIN and ENFORCE this best practice with an effort and focus proportionate to the virus exposure rates within our neighborhoods and public places we frequent.
Is this triaged solution a Small (task size) or Big (project size) effort? Small for us individually, from a pre-infection viewpoint. Dealing with a serious COVID-19 infection individually or within one’s family will be a Big (project).
Let’s follow our best practice and lead by example, but be patient. This will take months to resolve. It will take a national strategy to stockpile the supplies needed for infectious disease outbreaks.
The above triage result focused on our individual-level solution. A similar triage from a national perspective yields a different solution: It’s a BIG DESIGN (and IMPLEMENT) a capability to detect and manage COVID-19 virus infected individuals. We must be patient and recognize our response will be clumsy and mistake-prone until a learning curve is completed enough. Since COVID-19 has a 10x+ morbidity rate than seasonal flu and it there is no vaccine, we will have to design and establish COVID-19 intake facilities based on the volume of serious infections. The best case is we size and deploy these facilities and staff in a flexible, scalable manner. Establishing dedicated facilities will answer itself depending upon severe infection frequency. Some things will never be the same, such as nursing home access; every visitor and staff member will have to cleared to enter. Obviously, we must decouple the medical supply chain from China and return all manufacturing of essential medicine and medical supplies to domestic manufacturers as a matter of national security.