JUNE 20 UPDATES:
This post is a follow up to Process Triaging COVID-19 this past March 11. This post is a living document.
Our national response to the COVID-19 pandemic is sufficiently along to start making Lessons Learned notes. Here are mine, subject to better data:
- MOSTLY CORRECT: A coronavirus epidemic is like a weather event, similar to a lingering cold front. It lasts about three to six weeks depending upon the factors favoring contagious respiratory infection transmission: population density, social distance, humidity, sunlight, virus type, and human immune system vulnerability.
- MOSTLY CORRECT: The COVID-19 coronavirus is a nasty bastard. Contagious days before showing symptoms make it a silent spreader. Persistent on non-porous surfaces for days in favorable room characteristics (low humidity, no sunlight, sufficient virus quantity). It has an exponential infection growth rate of about 1.5 and doubles in about four days with an RO factor above 2. The most vulnerable are the elderly over 60 years old with the 80+ age group the most susceptible and those with compromised immune systems. The fatality rate has not been concluded as the ratio’s denominator is not known; we don’t know how many people have been infected because a large proportion of the infected (enough to make antibodies) do not develop symptoms. We know about one in four hospital admissions die, recognizing they are pretty sick by the time they are admitted based on current stay-at-home guidelines. MOST CASUALTIES WERE OVER 60 AND/OR COMPROMISED IMMUNE SYSTEMS
- INCORRECT: Immune system compromised patients escalate to ARDS — acute respiratory distress syndrome and pneumonia very quickly (in a couple of days) and requires ventilator breathing assistance (an ICU bed). It’s debilitatingly painful, as well. VENTILATORS LIKELY KILLED MORE THAN SAVED. IT IS AN OXYGEN ABSORPTION PREVENTING DISEASE SIMILAR TO HIGH ALTITUDE COMPROMISES.
- CORRECT BUT DISPUTED: Anecdotal trials indicate certain anti-malarial and rheumatoid arthritis drugs are therapeutic. Trials with COVID-19 antibody plasma show promise but the benefits are short term.
- CORRECT: The exponential rise of the contagion wave is flattened by reducing the RO factor by social distancing, personal hygiene, and non-porous surface antiseptic cleaning. Regional or national scale enforcement of social distancing collapses an economy if sustained too long. At some point, the cure becomes more harmful than the disease, recognizing what that point is is more art than science.
- CORRECT BUT TESTING HAS BEEN INCONSISTENT: The essential public health strategy is to (1) reduce the infection transmission rate, (2) minimize healthcare worker infections specifically, (3) size the ICU/ventilator equipped hospital room and support staff inventory to meet peak patient volume, (4) medicate prophylactically and therapeutically, and (5) test enough of the population to understand the virus’s pathology enough to design management strategies. The leading indicator of the wave is the daily number of virus-positive tested persons in the population and their infection profile.
- NOT CONFIRMED: It takes about three virus storm cycles or waves in a population to establish sufficient immunity in a population.
COVID-19-grade viruses are the new normal. The world has never had a coronovirus pandemic of this scale pile on top of a typical seasonal influenza (a very different rhinovirus). While virologists have forecasted such pandemics (including a wet market source like that of COVID-19), no pandemic planning has anticipated this magnitude. We were not ready and no one is to blame. This pandemic has exhausted our inadequate emergency stocks.
Process improvement design begins with The Ball, Not The Player. We do not care about the who or the how. We start with an overall strategic objective, often called The Big Number. Then we look at each supporting process and define its physical capability in one or more of four dimensions: Quality (of output), Speed (from process trigger to final product or state), Volume (how many final products or states), and Cost (the unit revenue or expense).
A Big Number might be something like, “Contain X number of coronavirus outbreaks within a population of X size within 6 weeks with no more than X% deaths with less than % economic depression.”
This might require the following Process Capability Goals:
- Virus Outbreak Prevention A community must practice virus awareness behaviors. These best practices must become habits and integrated into cultural expressions and educational curricula. For example, people wearing anti-viral masks are visually common.
- Virus Outbreak Detection A community must be capable of detecting a virus contagion outbreak and assessing its public health risk within X days of suspicion with 95% accuracy, anticipating two per year, on a budget of $X.XX per member of the population.
- Virus Outbreak Response (Local) The community must be capable of sustaining standard virus abatement practices within 24 hours of a public health declaration and maintain this posture for up to 15 days. Community health care infrastructure must be capable of treating X% of ICU/ventilator necessary infected patience with on-hand facilities, technologies, supplies, and staff.
- Virus Outbreak Response (State and Federal) Supporting health care infrastructure (State and Federal) must be able to deploy supporting treatment infrastructure, staff, and supplies within X days of request, state or federally funded, up to X times per year per state and X times per year federally.
- Virus Life-Cycle Management The nation must be capable of developing and deploying prophylactic and therapeutic medications and vaccines for high-probability viruses in a timely manner within the budgets allocated to the nation and internationally as afforded.
- Brand and Cultural Considerations The design and implementation of these virus management processes shall support and deliver the nation’s national brand promise of being the world’s Arsenal of Virology Excellence. The United States is the World’s brain trust and preferred anti-virus technology and best practice source.
That’s The Ball. Obviously it needs a lot of refining. Now we need to find the Players to make it happen.