George Rebane
[After working on my epidemic spread and testing models, I cobbled together this structured draft on 7 May 2020, and have put off posting it due to other more compelling analytical problems having to do with the pandemic. Now that I’m seeing other systems professionals coming to the same conclusion – e.g. ‘How Control Theory Can Help Us Control Covid-19’ in the June issue of the IEEE Spectrum – it’s time to throw out my two cents worth, warts and all.]
Thesis: Managing the response to and recovery from a pandemic is a systems management problem, and NOT a crisis to be managed by healthcare clinicians whose proper role is to provide their specific expertise and counsel on the care of the infected as one element of a much more comprehensive response to an emergency that affects all elements of a society.
- Pandemics are very complex dynamic processes which are difficult to observe and even more difficult for lay people to grasp. Humans have come to understand natural processes through their synthesis of various systems that contain and also delimit (‘this is not that’) such natural processes – to function, nature does not need to define or compartmentalize itself into systems; however, to understand nature, humans do.
- Managing pandemics is fundamentally not a medical problem, but instead a problem in the field of systems management and engineering. Devising public policies to control an epidemic within a target population, let alone a pandemic raging among disparate target populations is a problem requiring the use of tools from the systems sciences.
- A farmer, expert in growing the food grocery stores sell, is not necessarily qualified to run a grocery store, let alone a grocery chain.
- A CO2-cycle atmospheric scientist or a meteorologist versed in the analysis of weather patterns usually do not have the skills to develop and run climate models.
- Healthcare professionals, including most epidemiologists, are not trained in the use of the highly math-based tools required to scientifically observe, estimate, identify, control, and optimize feasible public policies to respond to pandemics as cogent systems. Since politicians eschew science and technology for obvious reasons, we find policy decisions at all levels are made like sausages. A simple yet fundamental example of such deficiencies, few if any healthcare professionals have concepts of error propagation and of system state and its role in grasping the dynamics of a system.
- Once the health-related parameters of a contagious pathogen and its virulence are established, the healthcare professional joins with experts in other needed fields
- – logistics, supply, facilities, personnel, manufacturing, transport, data acquisition and handling, decision theory, … – to join the team that provides the systems expert to develop realworld solutions that integrate expertise from multiple knowledge domains.
- Workable solutions must satisfy multiple constraints and are usually formulated within a set of inter-related subsystem models that then integrate into a total pandemic response system which inputs time-late unreliable data, and outputs information for officials charged with making public policies to fight the pandemic.
- A jurisdiction’s total response effort to a pandemic should be headed by a systems manager who understands, can structure, and is experienced in leading a multi-function task force.
- Political jurisdictions, especially small ones, don’t understand this and count on people like county health officers (usually a hubristic physician) to be the prime resource to local electeds and their non-technical staffs, when instead, such healthcare personnel should be one of several sources of input to a systems management team to understand and integrate the incoming streams of disparate input data, and then provide the decision makers an understandable landscape of alternative actions along with their effectiveness and cost estimates.
- Testing is a key element of C19 response,
- yet no one, starting with the federal government, has been able to discuss, let alone describe, the decision support functions and processes of infection and immunity testing of target populations during the countless briefings given at all levels of government. Why?
- Because useful and effective testing is an element of a higher level estimation process that calls for skill sets that include probabilistics, estimation, and decision theory, skills prominently absent in the hubristic and mistake-prone medical industry.
- Meanwhile, Nevada County has implemented a plan to loosen the local lockdown. How they will control the different phases of loosening is not known, especially what kind of feedback will they use to update policy decisions.
- To my knowledge the county government has no internal resources who could counsel them on the critical systems aspects of selecting, let alone managing, a prudent policy to loosen our lockdown. In my years of interacting with and within various county government units (established and ad hoc), I can say unequivocally that I have yet to meet anyone there who is competent in any of the technical skill sets I have outlined above.
- This unrecognized deficit is not due to the dearth of appropriate expertise available to our county’s leadership – there is an abundance of it living within minutes of the Rood Center.
- I am always curious to know the make-up of these local decision-making cadres, and today what factors are being included in the deliberations that represent our understanding the county’s C19 situation, factors upon which to base a plan. Dealing with government officials I have often found myself to be one of the very few burdened by such a curiosity.
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