Covid19

Corona approach – which factor can become decisive?

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Author: Manu Steens

In this blog I write my personal opinion and not that of any organization.

Recently, the VRT (Flemish Radio and Television) stated that the fifth wave has started, with an expected 125,000 infections per day by mid-January.

That is very appealing of course, such numbers. But people want to know what the risk is and what the risk factors are. Classically speaking, one can say that:

Risk = probability x impact

In the case of this pandemic, if we dig deeper into these two factors, we can say in simplified terms that:

–         Probability = exposure x susceptibility x behavior

–         Impact = sensitivity x behavior

In the case of probability, the exposure is a function of the environment (directly proportional to the number of infected people in the environment of the person) in which an individual is located and the susceptibility is an internal factor of the human body: how receptive the body is to the exposure. The behavior here is a factor that implies caution on the part of the individual. This without any degree of pejorative intent: it is regardless of whether the behavior is reckless, such as people hanging too close to each other at the pub, or whether the job is a contact profession that entails this behavior, such as people taking care for patients with Covid19 in the ICU.

At the impact level, the sensitivity is an internal factor of the person’s body, such as someone who naturally has a strong immune system or, unfortunately, just doesn’t have a strong one. The behavior here is best illustrated by people who do or do not have themselves vaccinated. By having themselves vaccinated, if necessary several times, it has been shown that people who get corona suffer a significantly lower impact: they may still get sick, but it is less bad, and therefore there is a good chance that they will not end up in the ICU.

What does that mean, if we put this analysis back into the original formula of risk?

That behavior has an influence of at least squared. Why at least? Because situations are possible where the behavior can have a serious influence on exposure, for example by reducing the number of contacts where possible. But more than that: you can also protect others by adopting good behavior, such as doing a self-test before organizing a party, for example.

So the risk is in higher powers (than the square) dependent on behavior. So far for mathematics from the secondary high school.

That means that not only people should be “good citizens”, the government should direct that behavior as a major factor that can influence this fifth wave (actually any wave).

This applies to citizens as individuals, but also to organizations that depend on their employees. Having an adapted BCP and pandemic plan that is coherent in a flexible way with what the politicians and the legislator prescribe is therefore of enormous importance in the pandemic.

So there is more to it than just infectiologists, virologists and biostatisticians: just as much importance must be attached to what psychologists, sociologists and anthropologists can say about how to deal with this pandemic.

So an identified lesson from this mathematics is

  • More so to work on behavior in any pandemic, endemic or epidemic. The low numbers of flu in 2021 show that it works. So good behavior must be maintained.
  • Without neglecting the medical reality, of course. But as support to healthcare.

And if possible, without fear mongering. One has to work through the trust of the citizens. That which they have with their General Practitioner, their specialist, their caregivers in their own family, their teachers, the caregivers of their relatives, the social workers, community workers…

Covid19 – How “not to waste this crisis”?

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Author: Manu Steens

In this article I am writing my own opinion, not that of any organization.

The former Belgian minister Philippe De Backer wrote a book “En nu is het oorlog” (And now it is war).

Let me take this statement literally, and view the future post-covid19 period as a post-war period.

The economic recovery after the wars and crises of 1870, 1918, 1945 happened very quickly: a matter of a few years. Usually five years or less. After that, production growth stagnated. (reference: Alfred Suavy, “Het probleem van overbevolking” (Malthus et les deux Marx)) The limitation of the growth of production after recovery did not exist because there was a shortage of injection of money, nor of machines, but because the population was limited in knowledge and skills. And the factor that one cannot include in accounting is that of people. As one can with money, property, equipment, buildings and debts.

Let’s create two lines of thought. The first: there is a huge war that is destroying all machines and buildings. But the people survive. What happens is that external parties provide them with food, people start making machines, and after a few years there is no longer a backlog. After a rapid return on the actions they take, they evolve towards a plateau of growth which then slows down. Because for more growth, even more knowledge and skills would be needed.

The second line of thought is one in which all medical staff and other highly skilled, such as managers, specialized employees,… would disappear.

Then it will not help in the same way to just bring more money or food to the area: the knowledge and skills needed lack to catch up with the region’s enormous skills shortage, it will take decades to even make any recovery. Let alone keep up with the normal extrapolation of the past.

Fortunately, we are not quite in this situation, although as far as healthcare is concerned, there is serious pressure.

From this short argument, which should actually be supported by figures, one can estimate that knowledge and skills are possibly the most important factors for a recovery after a huge crisis.

Governments have made huge financial sacrifices to allow some sectors to survive. “Golden rules” were also issued in Belgium. Some were very difficult, such as that of wearing a mask in several places, linked to social distancing. But there were also other rules that made us work differently where possible: working from home was sometimes recommended, sometimes (partially) mandatory.

Now I don’t know what other people experienced, some of us certainly miss the social chat with colleagues, which is certainly a loss to be mentioned, but there was also an advantage to mention. I speak for myself when I mention this, however, the days when I was working from home I was much more productive. I want to assume that this may have been the same for many people on such days. I sometimes went to my place of work, to relieve the social need, and those days my productivity was like an ordinary day before. However, I myself am only one ‘case’ and one cannot make a statistic on that, but it still inspired me to the following.

If, thanks to working from home, a number of people can do the “former” work of a week in 3.5 to 4 days, it would be interesting for both the employer and the employee to provide systematic training for these people. In a direct sense, this could include specialist training or employability-broadening training. But it is also possible to think indirectly: even matters that are not directly related to the ‘job’, such as training for many people in languages ​​or ICT applications, can indirectly inspire employees within or outside the job. And that will pay off for society, because during the aftercare phase of a crisis, every skill is super necessary.

Whatever it takes will be to perpetuate such work-and-learn behavior. Future generations will have to grow up with an implementation of lifelong learning, not just as a battle cry.

This is important to “not to let a good crisis go to waste”. Why ? I already wrote it: I read the book by Philippe De Backer, a former Belgian minister, “en nu is het oorlog” (And now it’s war). I took that statement literally. This means that if we can massively invest the time savings that we generate during this crisis in training, the knowledge and skills of the population will increase. The growth of production in the aftercare phase due to the grown creative capacity of more skilled personnel will find an engine in it to support it. As a result, economic growth will continue stronger for longer, and will help absorb some of the government’s financial injections. The flattening of economic growth will therefore slow down when we reach a higher level. And that could help curb potential future inflation.

A Cynefin look at covid19: Can Corona be stopped or must it be controlled?

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Author: Manu Steens

In this blog I write my personal idea, not that of any organization.

A first reading for inspiration from the Cynefin framework in the booklet “The Cynefin-Book – An introduction to complexity and the Cynefin framework” gives inspiration to think about the crisis of covid19.

Let me first explain the Cynefin framework itself, the theoretical framework that tries to create an order in types of systems, such as the world.

A first division is made between ordered systems and un-ordered systems .

An ordered system is strongly bounded, the behavior is very predictable. The causality is clear from experience, or is based on a virtuous analysis. The first case is a simple system , the second a complicated (but understandable) system .

We cannot establish causality in an un-ordered system. Some of these systems are stable, where the boundaries evolve over time, and so does the behavior. This evolution occurs through the interaction of its components. Evolution cannot therefore be called situational (i.e. caused purely by external factors) but dispositional: caused by internal, often unknown and changeable, dependencies and interactions. Thus, they are predestined to evolve in a predestined direction. But causality can only be proven retrospectively (in hindsight). These stable systems are the complex systems .

But some systems are not stable, they have little or no limitations or limitations, the behavior is or seems random. These are chaotic systems.

Finally, there are the systems that we have yet to classify, and those are the disturbed systems: we don’t know what they are yet.

The simple systems, we know them: “been there, done that”. They are known knowns. An unambiguous solution is possible for an unambiguous problem. The solution is given by SCR: sense, categorise, respond. We have best practices.

We no longer know what complicated systems are. They are known unknowns. But we can analyze it in great detail and then we can predict things about it. The approach is then SAR: sense, analysis and respond. We have good practices.

The complex systems are those of unkown unknowns. We need to conduct some experiments and hope they will guide us in the right direction. There are many hypotheses, without being able to call them wrong or right. So the approach is PSR: probe, sense and respond. Here we have newly emerging practices.

And the chaotic systems are the unknowable unknowns. The system requires immediate action, but we have no idea what the appropriate actions are. So we tackle it with ASR: act (do something), sense and respond. Here we have new but perhaps transient practices because they may only be usable once.

Finally, the desturbed systems, which we have yet to explore to classify them.

If a situation comes to us, the advice is: first differentiate which type of system it is. If we don’t know anything about it, or it is ‘forgotten’ matter and it seems something completely new, it is better to explore it first, bearing in mind that it can be a worst case system, so according to ordered or un-ordered systems a complicated or chaotic situation. If we do this, we avoid the risk of oversimplification in advance.

How does this fit with Covid19?

It was known from the first investigations that it was a corona-like virus. There was some experience with that. As a result, it appeared to be an ordered system. It soon became clear, however, that this particular corona was not as well known as originally thought. It was not a “simple cold”. The world with covid19 thus quickly became an un-ordered system from an ordered system. So we had to act quickly. In Philippe De Backer’s book “En nu is het oorlog” (“And now it’s war”) it appears that the ASR approach was taken very quickly. And that was a good thing. The first wave was systematically dealt with severely in a radical way. There was a lockdown, and the wave was contained. An almost second wave was tackled by the province of Antwerp with strict measures, and was also suppressed. So fast, in fact, that many dared to ask why it was necessary. For a while it seemed that the world under covid19 would become a complex system or even a complicated and ordered system. Been there done that? Existing techniques yielded new weapons: several types of vaccines saw the light of day. There was talk of “the light at the end of the tunnel”. Freedom was in sight. A chaotic system would be pushed back by science to a complicated system, where vaccinations are at the heart of it.

And a new danger threatens the battlefield: “groupthink”. By estimating it, it can be prevented.

Groupthink is an issue typical of complicated systems. Notwithstanding a great truth that lies behind the wisdom of the masses, as an average of a group of experts in the field. But then with standpoints that first make them independent of each other. This is to prevent them from influencing each other (too much). It is difficult to do this day-to-day, so an effective approach is needed against it, as well as to improve the scanning of information. To tackle this issue, it is best to involve different groups of experts, each from different areas of expertise, so that they can keep a ‘look of wonder’ about the other areas of expertise.

There are no stupid questions in such a group. But one must ask them. A question could concern the composition of the GEMS itself. After all, in addition to infectiologists, virologists and biostatisticians, are anthropologists, sociologists, behavioral experts, psychologists and weather experts also needed in an advisory body? The question occurred to me for two reasons.

  1. The disease always finds a way out in a new variant with which, when we return from a complicated system that seemed ordered thanks to the vaccines, to a chaotic system, which seems un-ordered by the arrival of a new deadly variant, but above all:
  2. The disease attacks through the people who are not ill at the time of the attack, but through their behaviors and habits threaten to expose themselves to the disease. The difference in people’s behavior during the different seasons determines the contacts they make. These behaviors thus form the channels through which the disease can spread.

Knowing this behavior of the different target groups with a sufficiently small resolution with regard to the evolution in previous disease waves could provide better parameters for statistical models concerning those target groups and between them. Even though they can never be seen as a model with a purely predictive value, it could provide an insight into the behavior of the past, so that more refined expectations can be created for the nearest future.

If these experts would already cooperate in the proposals and advice of an advisory body, this is not clear: I never see them in the news reports. I never hear any mention of their contributions.

Since the system on which a chaotic system must be dealt with is one by the acronym ASR, we can never assume that we know what is going to happen, even with the most sophisticated statistical models available at the moment. Therefore, as long as someone can make a coherent argument, their idea is valuable.

But with that comes the question: where does such a model lead? What will the approach to the current crisis lead to? Are they trying to beat the disease? Stop the spread? Or does it make more sense to work with a model in which one tries to control the disease?

Essential in a controlling mechanism is that one does not only look at the direct statistical measurements such as the Rt value, the number of sick people in the hospitals, the number of sick people in the ICU, the number of cases in the schools and the like. And that per province and over time. These are ‘direct’ indicators , the figures that we want low, except for the vaccination rates, which they want to see rise. By directly influencing behaviour.

If one accepts that corona will not just be defeated, but that we will have to serve a time in this prison called Earth, until the disease has adapted itself to its host, one could start in the fringe with ‘indirect’ indicators. By this I mean indicators with which one can indirectly influence people’s behavior, for which we have to rely on the expertise of anthropologists, sociologists, psychologists, together with weather experts and the experiences of the authorities with, among other things, tourism. One such indicator that one could track could be a “net good behavior promoter score”. One might take such a philosophy from a firm like Apple, which measures a “net promoter score” (NPS) to determine satisfaction from the customer’s perspective.

For Covid19, this means that with such an indirect measurement one could know the involvement within the different target groups, which can indirectly measure the effectiveness of the press conferences. After some time, one can plot these numbers in an evolution, and see how it evolves, but also how it compares to the infections in the different target groups. By also targeting these indirect indicators, in addition to an attempt to stop the disease, an attempt could also be made to rather control the disease than directly to stop it. And that until the virus has previously been weakened for its host, or until a vaccination technique emerges that allows for a single vaccination that offers lifelong protection if that might be possible. The additional advantage of such a controlling effect could be that people are prepared for the idea of ​​a one-time vaccination, which can then be more readily accepted.

Even if it has not been proven that such an approach would work in a short period of time, I think that in addition to trying to stop the crisis, we should also create every opportunity to try to control the crisis. But it is a lot of trying with ‘can’ and ‘could’ and ‘maybe’ one after the other. This approach would mean a radically different and additional approach to the traditional approach, in which one tries to reduce an un-ordered system to an ordered system on the basis of purely rational arguments. With which one tries to work on the behavior of the ‘homo rationalis’. With an indirect approach one can also work on those target groups where one has more to do with the ‘homo irrationalis’.

What are the possible futures of covid19 ?

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Author: Manu Steens

In this article I am writing my own opinion, not that of any organization.

Some time ago I read the book “Handboek Scenarioplanning-Toekomstscenario’s als strategisch instrument voor het managen van onzekerheid” (Handbook Scenario Planning-Future Scenarios as a strategic instrument for managing uncertainty). That book has worked on me like a red rag on a bull. It inspired me to apply the first steps of the procedure discussed in the book. I think that a productive result can be presented very quickly when going through those first steps: a crisis anticipation team can be used in any crisis center. How do I see that? As the procedure prescribes, I start from 2 axes with, in my opinion, a lot of impact and a lot of uncertainty:

  1. Disease flare-up vs further disease decline
  2. The hospital system breakdown vs the hospital system stays upright

This gives rise to four scenario’ s as follows :

  1. Further decline of the disease and the hospital system stays upright : “Road to freedom”
  2. Flare-up of the disease and the hospital system stays upright: “We survive”
  3. Further reduction of the disease and the hospital system collapses: “Delayed stress and PTSD”
  4. Flare of the disease and the hospital system collapses: “Doomsday” scenario.

Figure:

Only one scenario has been extensively proclaimed and explained in the media : the “Road to freedom”.

This can be brave, but one lesson identified that can be predicted from this is that a CAT (Crisis Anticipation Team) should work on developing the other 3 scenarios.

At the moment it is known that hospitals are groaning under the load of covid19 . Other illnesses are delayed for treatment. This entails separate future aspects that are already known and recognized in previous waves, and of which we already know that we will be confronted with them:

-> Postponement of non-urgent treatment results in an overrun of the hospital system with severe non-covid19 cases after the covid19 crisis, regardless of which scenario of the 4 we face.     

-> After the “Road to freedom” scenario, the scenario “Delayed stress & PTSD” can still occur with a high probability. This with a lower uncertainty of occurrence over time. So it would be logical that society, on a global level, should take measures to this end.     

-> This situation can also occur after the “We survive” scenario.     

-> I don’t even want to talk about the “Doomsday scenario”, because then there is no workable hospital system left. Although a “Doomsday scenario” may also occur in varying degrees, as a series of slow-falling dominoes in terms of falling short for hands on the beds .     

Conclusion: a crisis anticipation team can, in my opinion, devote itself with the greatest efficiency and effectiveness to preparing for a failure of the hospital system, when the hands on the beds start to fall short, for example due to burnout and other work-related illnesses.

In order to find solutions, we have to look thoroughly on the labor market for who can do what. A relaxation in job provision to migrants could possibly help? Those of them with medical experience may be able to contribute to the solutions. Or people who are still studying can, as under part of an internship, deal with the more simple tasks of some professionals who then receive the task of “hands on the bed in ICU.”

I hope I’m wrong. Either way, it will never be easy.

Ultimately, if citizens really want to opt for the “Road to freedom” scenario, they will have to exercise a lot of discipline themselves. Because the virus does not adhere to any rules.

Covid19 and Cognitive Dissonance.

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Author: Manu Steens

In this article I am writing my personal opinion, not that of any organization

Currently I am to delve into how people can spot opportunities. This has in common with having mission that one must have fantasy, creativity and imagination. This is needed in order to arrive at an alternative for merely dealing with threats within risk management. The advantage of opportunity management is that one already has a more developed leg within risk management on which one can rely, namely that same threat management. But one needs fantasy. And that is where things sometimes falter to be creative. In what way?

An important, well-known psychological obstacle is cognitive dissonance.

So with that I start with a difficult term from psychology, which can destroy both opportunities and mission by preventing them.

“What is cognitive dissonance and give a good example” you will ask.

Cognitive dissonance was introduced by the psychologist Leon Festinger in 1957. The term is used to describe the discomfort we feel when our beliefs are questioned by conflicting information. Because most people are driven by the desire to stay psychologically consistent. In order to achieve this, one will ignore, forget, not want to hear or know or even reason away any contradiction to one’s own truths . So one does not want to question one’s own “values”. These “values” are sometimes also called “frames” and are personal.

You can also find a word of explanation here: https://en.wikipedia.org/wiki/Cognitive_dissonance .

A strong example that made headlines is Alan Greenspan’s unshakable belief in market self-regulation, which saw the biggest housing crisis to trigger the worst global crisis since the Great Depression. The situation clamored for government oversight of credit institutions so that the banks would not lend money to unsuitable borrowers. Greenspan declined this, trusting that the market would filter out bad credit risks. It became a real estate bubble. Because of the cognitive dissonance of a man in a powerful position. He ignored all warnings. It wasn’t until October 23 that he acknowledged that he had made a mistake in relying on self-regulation of the markets. Those interested will find more here: https://en.wikipedia.org/wiki/Subprime_mortgage_crisis

What about Covid19 then ? An article about a report by the Secretary-General of the United Nations was published on September 20, 2019. The title block lettered : “The World Knows an Apocalyptic Pandemic Is Coming But nobody is interested in doing anything about it.” ( https://foreignpolicy.com/2019/09/20/the-world-knows-an-apocalyptic-pandemic-is-coming/ )

So there was this institution, the United Nations, that has to provide the world some protection, and it tried warn the world that a pandemic was at the door. Yet, after the facts, politicians around the world shouted they couldn’t know. There may have been some form of massive cognitive dissonance here, with all its consequences. Apparently a man can turn the world into crisis, but an organization of people who can see beyond their own truths are incapable of saving the world.

In addition, the question can always be asked what we could have done if massive credence had been attached to the report of the United Nations. Because actually, they did not know where it (the pandemic) would come from. They did not know that.

In the meantime, we hope that we can learn from Covid19, and we certainly have: there have been a number of strong examples. Vaccines have never been on the market so quickly, never before has a vaccination program on such a scale been rolled out so quickly, with growing pains though. But they do it anyway.

In the meantime, the researchers are of course not sitting still with the development of other vaccines for other diseases. One of these that is now very promising is one for malaria. To this end, there is an enormous lesson learned from Covid19: if we, the people, want it, we can vaccinate the entire world. This means that it is an opportunity from the lessons learned from covid19 to apply the vaccination experience on a large scale to this terrible disease. A plea on this issue can be found here: https://theconversation-com.cdn.ampproject.org/c/s/theconversation.com/amp/new-malaria-vaccine-proves-highly-effective-and-covid-shows -how-quickly-it-could-be-deployed-159585 

The question is whether an identified lesson here will also become a lesson learned for our world leaders, or whether they would react cognitively dissonant.

In the latter case, however, I have a question. People are allowed to be very committed to their jobs in high positions. However, this implies that these people have great responsibilities that their job entails. Do they then have the psychological right not to consider perspectives if they are inconsistent with their deeply held beliefs, whatever they are? Do they have the right to refuse? Not to consider? To reason away? In other words, are they entitled to cognitive dissonance? Or should they arm themselves against it? And do they have a duty to do so?

Can citizens around the world hope that the dramatic errors of judgment of Covid 19 will give rise to something beautiful, namely more research on vaccines and on logistics to bring the right vaccine to the right target groups? If not, we will again pay an expensive price for an inflexible attitude. World leaders must therefore (dare) to break through their frames.

So my advice here is: “break through the barriers of your frames, have imagination, create a mission ! Learn to recognize the opportunities that present themselves and take advantage of them. Help each other in this! Step out of the reign of the ‘yesterday till now’-activities and look out for possible futures, including those within seven generations.”

To be able to do that, a good risk culture is needed at the top of the world. This means that every employee within every organization (hence from bottom-up) must be open at his / her level to recognizing and tackling not only threats, but also using opportunities. You do not do that by declaring a story of risk management ex cathedra to the world. Maybe one can do that by realizing a cultural change in the world, perhaps first at the level of the high positions, whereby people not only have an eye for the negative, but rather for the positive. A mission is necessary for this. And maybe our generation will see the result, maybe only the next generation will see the result. But let’s try. After all, we don’t really have another option.