COVID-19, Systems Thinking and Preparing for the Next Pandemic

In all likelihood, supply chain managers, business leaders and everyday Americans will debate how the country handled the first nine months of COVID, prior to the vaccine rollout. There will continue to be those who praise the prior administration, those who praise the current administration and those who laud Germany, Korea and New Zealand for their responses and criticize America, Sweden, Brazil and now India for theirs.

In our view, both sides miss two simple facts: Countries are different and, more than 14 months after the first declaration of a national emergency in March 2020, the story is not yet fully written. There is much still to play out and more lessons to be learned.

Country comparisons are difficult at best; misleading and potentially damaging at worst. Superficial and premature comparisons limit learning, a critical outcome in a world where global supply chains have ushered in an era of pandemics (think SARS, bird flu, H1N1, MERS and COVID-19 in just 20 years).

What’s more important is this: Now is the time to plan for the more lethal pandemic that will certainly come. To handle the next pandemic effectively, decision makers need to grasp what worked, what didn’t—and why.

The good news: The supply chain manager’s toolkit can help. Supply chain management, the value-creation engine of every business, was largely invisible pre-COVID. But empty shelves caused by disrupted supply chains quickly caught everyone’s attention. People now appreciate their reliance on effective global supply chains. And in our view, supply chains work best when managers employ systems thinking, a tool that can mitigate the pain of the next pandemic.

Systems thinking posits that managers make better decisions if they know how a system works; that is, if they pull lever “Y” what happens to the rest of the system? Systems thinking presupposes three prerequisites: An understanding how elements in a system interact to affect performance, access to information to assess tradeoffs, and insight into constraints. When managers fail to use systems thinking, they tend to make myopic decisions with costly, even painful, outcomes.

The COVID Ecosystem
Let’s apply systems thinking to the coronavirus pandemic. We need to consider four critical systems elements: America’s open economic system, culture, federalist structure and the health of its citizens.

The U.S. isn’t just the world’s largest economy—it’s the world’s most open and mobile economy. New York is an international financial hub. San Francisco is a technology center. Miami is a winter tourist destination. Hundreds of thousands of international students, many from China, study in the U.S., returning from holiday each January.

What does this mean? In the two months before Trump instituted travel bans, 1,674,377 passengers arrived in the U.S. from China, Italy, Spain and the U.K. Mobility is an American tradition—if not a right. By the time the first case was confirmed in New York on March 1, 2020, COVID was spreading aggressively coast to coast. We just didn’t realize how quickly it was spreading.

Culturally, America is built for entrepreneurship and risk taking; not fighting pandemics. Geert Hofstede, the world’s foremost expert on culture, notes that Americans prioritize individualism over collective action and indulgence over self-restraint. They resent heavy-handed government restrictions. Mixed messaging—you can’t go to church but you can protest—further undermines adherence to public health recommendations.
In a federal system like America’s, the central government’s power is limited.

On March 28th of last year, President Trump noted that “Some people would like to see New York quarantined because it’s a hotspot.” New York’s governor Andrew Cuomo declared such a decision would be “A federal declaration of war on states.” America’s founders reserved authority over public health to the states. The goal: Enable rapid, customized local responses. After all, New York and Wyoming are different. Madhukar Pai, an epidemiologist at McGill University, thus notes, “every epidemic is local.”

COVID punishes poor health. Cancer, kidney disease, diabetes, heart disease, hypertension and obesity are comorbidities that make COVID lethal. Twenty-two percent of the world’s population suffer from a high-risk condition. Over 40% of American adults are high risk.

The bottom line: America was uniquely vulnerable to COVID. That said, one more element needs to be considered—the nature of COVID itself. As a novel infectious disease, it was easy for people to misspeak about the virus.

The key, however, is that COVID doesn’t behave like previous viruses. Unlike SARS and MERS, COVID is highly infectious. Worse, COVID is transmissible before symptoms manifest. And according to the CDC, most cases are either asymptomatic or mildly symptomatic. For every confirmed case, 8-10 people have it without knowing they have it. What does this mean? By the time the WHO declared COVID a pandemic on March 11, 2020, COVID’s stealth and transmissibility had made the traditional “identify, isolate, track-and-trace” playbook obsolete.

The role of information and constraints
Accurate and timely information enables decision makers to evaluate tradeoffs. Yet, during the outbreak’s first months, critical information was missing or misleading. Policy makers couldn’t assess the costs of early decisions. China and the WHO let the world down.

Moreover, as it became evident that COVID was not SARS, policy makers needed to aggressively streamline the process of bringing therapeutics and vaccines to market. Equally important, they needed to speak with one voice to encourage widespread behavioral change. Missing information led to mixed messaging about the effectiveness of masks and social distancing and stirred debates about what constitutes an essential activity. The result: The average person couldn’t easily evaluate tradeoffs in their own lives. Many didn’t change behavior to slow the spread.

Just as good data informs decision making, constraints limit options. Constraints can be almost anything and found anywhere—for example, inadequate testing and contact tracing. Political polarization, however, has been the most debilitating. In January, when leaders should have been paying attention to reports of a novel coronavirus, policy makers were distracted by Trump’s impeachment.

Through February and March, when Trump took a position on COVID, detractors’ reaction was rapid and dismissive. For instance, President Trump announced a China travel ban on January 31. The next day Joe Biden accused Trump of xenophobia and fearmongering. Schadenfreude characterized competition among red and blue states. Benchmarking successes and failures was sidetracked by a quest to score political points. Polarization continues to limit learning, constraining America’s COVID response.

Takeaways from a systems analysis
The U.S. was always going to struggle with a highly infectious, stealthy disease. The U.S. is not New Zealand, a small, isolated country. China’s severe Wuhan lockdown and South Korea’s information-invasive tracking and tracing approach would not be tolerated in the U.S. Once unleashed, COVID’s stealthy spread meant no administration would have handled COVID well. Add in political polarization and the U.S. response was doomed. Europe’s current spike in infections reveals that dynamic economies can’t hide indefinitely from a COVID-like disease.

Looking forward, four lessons learned stand out as critical to prepare for the next pandemic.

First, the world needs a trustworthy information arbiter. If the WHO isn’t up to the task, we need to stand up an entity that can, and will, quickly gather and share accurate information about the nature and danger of a future novel infectious disease—and strategies and tactics to combat it. Countries that limit information flow must be censured.

A related thought: As the world invests in scanning and sensing, decision makers might want to engage supply chain insight. By December 2019, many supply chain leaders already saw hints that something bad was happening in Wuhan. But they didn’t have a way to connect the dots—or inquire more deeply about the emerging health crisis.

Second, response speed matters. Trump was pummeled for his China and Europe travel bans—a response other countries quickly adopted—but we now know Trump acted too slowly. By early February COVID was spreading from coast to coast, with up to 60-65% of early seedings originating in New York. Locking down hot spots is critical to containment—and needed to give science time to perform triage. Policy makers must be nimble to respond as new data comes in.
 
Third, we need to radically rethink testing. In a world of stealthy viruses, we need a testing platform that is as fast, easy and accurate as a home pregnancy test, but much less expensive. And it must be scalable as close to Day 1 as possible. To keep society open, companies running and students learning, we need the capacity to tests millions every day. Waiting for people to manifest symptoms ensures a killer virus will spread undetected.

Fourth, adoption of the 3Ws—wear a mask, wash your hands and watch your distance—can slow the spread, hopefully long enough to get new-age testing up and fast-track vaccine development. To achieve reliable behavioral change requires realistic expectations. Angela Merkel got it right, warning in March that 60-70% of the German population should expect to be infected.

Ultimately, because U.S. policy makers didn’t grasp the U.S. COVID ecosystem, they stumbled in their response. The good news: We can learn from our missteps and use insights from systems thinking to build out an effective infrastructure to handle the next pandemic. If that pandemic is stealthy like COVID with the mortality rate of MERS (35%), we will be grateful we borrowed from the supply chain manager’s toolkit.

Stanley E. Fawcett, Ph.D., is a professor at Logistikum at the University of Applied Sciences Upper Austria and Chief Engagement Officer at ENGAGE2E. He can be reached at [email protected].

Michael Knemeyer, Ph.D., is a professor of logistics at Fisher College of Business at The Ohio State University. He can be reached at [email protected].

They are frequent contributors to SCMR. You can read Getting Over The Bar, their most recent piece here.

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