Pandemics are a Systems Management Problem

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.

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.

Comments

[Paul Emery]

George

Trump said in a recent press conference that his closing down the country saved well over two million lives and that Sweden was a prime example of how not to handle this problem. Do you agree with him in his assessment?

direct quote from Trump:

"In every way the best economy in the history of the world. We were blowing away China. We were blowing away everybody. We were the envy of the world and then they came in and they explained it, and they said, sir, you have to turn it off. We have to close the country. And I said, say it again. They said, sir, you have to close the country. Nobody ever heard of a thing like this but they were right because if I didn't we would have lost two million, two and a half million, maybe more than that people, and we'll be at 100,000, 110,000, higher -- the lower level of what was projected if we did the shutdown, but still you're talking about -- I say two Yankee stadiums of people."

https://www.cnn.com/2020/05/11/politics/donald-trump-coronavirus-quarantine/index.html

Direct quote from a tweet about Sweden:

Donald J. Trump
@realDonaldTrump
·
Apr 30
Despite reports to the contrary, Sweden is paying heavily for its decision not to lockdown. As of today, 2462 people have died there, a much higher number than the neighboring countries of Norway (207), Finland (206) or Denmark (443). The United States made the correct decision!

[George Rebane]

PaulE 226pm - We have yet to tally the total human cost of our lockdown. Let me know when you have the number, and we'll take from there.

[Bill Tozer]

Dr. Rebane. Good rundown of the systems management problem. Forgive me for straying off topic from the points you laid out, but...

Just got a text from WY yesterday. The State is going to open it wide open this month, including all schools. Don’t know who made the call, but I suspect it is because there is currently not one active case of C-19 in the State of Wyoming.

Don’t know who made the call or what their systems management team led to the decision. I am just a layman. :)

[Scott O]

George - govts of all sorts that have even the slightest desire to actually serve the citizens have, over the eons, developed some carefully thought out 'systems' in response to any sort of crises or calamity.
1 - Be sure to control the flow of information.
This is the most important one. It works great up to the point of collapse. Trump has almost no control of what the American public sucks up. It doesn't matter how well or worse he is doing compared to other countries. The public ends up being informed by a mish mash of good info/pabulum/self-serving BS and/or outright lies. The intelligent folk winnow out the good and take matters into their own hands.
2. - Have a good finger on the pulse of the general public. An accurate info feedback stream to the top works wonders.
3. - Make sure at some level there are some truly intelligent humans in a relevant field that will give educated, honest answers to the ruler/rulers.
4. - The hardest one. The ruler has to balance what's good for his/her continued rule vs what's good for the general public. Remember these rules are for rulers who actually might care at some level about the general public. Being too concerned about the public now might mean an upheaval ushering in a ruler that doesn't care about the general public at all.
5. - The moistened finger. It needs to be held high in the air on a regular basis.
And for the general public - the most educated will do the best over all and the devil will take the hindmost. No - it's not fair. Because life never has been and the more you try to mess with that fact, the more all the people will suffer.
Now you can, of course, layer onto all of this a veneer of some sort of sense of 'calm control' and employ all manner of the latest in scientific and medical knowledge to your heart's content.
When all is said and done, good luck with any sort of after-the-game analysis given that nearly all of the countries involved have either incompetent or outright bogus data to offer.

[Paul Emery]

Here's some words of wisdom from our Idiot in Cheif. Unbelievable that someone with this level of intelligence is President but he's your guy George. Perhaps he's just joking.:

"President Donald Trump came up with his latest idea for how to reduce cases of the coronavirus in the United States: stop testing.

Speaking at a roundtable on “Fighting for America’s Seniors” on Monday, Trump remarked, “If we stop testing right now, we’d have very few cases, if any.”

https://www.rawstory.com/2020/06/trump-if-covid-19-testing-stops-the-us-wont-have-coronavirus-cases-anymore/

[George Rebane]

PaulE 107pm - It sounds like he meant that testing discovers cases that otherwise would remain unknown - e.g. primarily being of the asymptomatic kind. I think people suffering from extreme TDS would intepret this statement to mean that 'testing causes C19 cases'. What's your interpretation?

[Paul Emery]

George

Never implied trump said testing causes only that he said without testing we wouldn't know of any-you know, see no evil.

Trump says there would possibly no cases. Once again his quote: "we’d have very few cases, if any.”

It's amazing that a man of your education and intelligence would give this idiot such slack.

[Paul Emery]

So essentially Trump is saying If he "smashed the gas meter on his car’s dashboard he'd never run out of gas again."

From a response to Trumps idiotic statement

[Gregory]

punchy 107pm

Again... rawstory is not an appropriate source. They lie.

[fish]

Posted by: Paul Emery | 15 June 2020 at 02:31 PM

It's amazing that a man of your education and intelligence would give this idiot such slack.

Why? He gives you plenty of "slack"!

[George Rebane]

PaulE - how does your 231pm jive with your 307pm? My 136pm interpretation of Trump's words are what you would then consider giving him "slack". I guess your interpretation depends on your prior assessment of his acumen. I'll stick with mine since it better explains away his accomplishments, which is where the rubber meets the road. A person with your attributions would never have been able to come close, and would have been institutionalized early in life. But whatever makes sense and gives you comfort.

[Paul Emery]

Direct quote from Trump Gregory.

If you go this link you will see the same quote from over a dozzen sources including many Conservative publications, Check it out.

https://www.google.com/search?client=firefox-b-1-d&q=%E2%80%9CIf+we+stop+testing+right+now%2C+we%E2%80%99d+have+very+few+cases%2C+if+any.

[Robert Cross]

George 1:36: I think people suffering from extreme Dunning Kruger Syndrome would interpret this statement to mean that testing discovers cases that otherwise would remain unknown rather than what trump really meant which was that testing makes him look bad and will hurt his chances for re-election because he bungled the whole thing so why not just stop testing altogether so he can claim the pandemic is over and how he single-handedly made it go away...just like he said would happen a few months ago...

your defenses of trump keep getting flimsier and flimsier. It must be very frustrating having to keep coming up with excuses every time trump puts is leg in his mouth.

[George Rebane]

RobertC 604pm - my "defenses of trump" ?? You must not frequent these pages very often. However, your lack of any critical insights about Biden and Team Pelosi even more telling, though not surprising.

[Robert Cross]

George: You and yours seem to do a good enough job castigating Biden and Pelosi without my help. Besides Biden and Pelosi aren't President. Biden has no political authority at all and Pelosi is the Speaker of the House just like Moscow Mitch is the Senate Majority Leader..so what? I haven't seen many, if any, critiques of sketchy little Mitchy. And if one were to do a content analysis of your comments, the vast majority of them would be in defense of trump rather than an honest critique. which seems to have only surfaced recently in the face of trump's total meltdown and shades of insanity. You seem to have a penchant for interpreting trump's stupid tweets in the most positive and least plausible light possible. So yes, your defenses of trump.

[scenes]

Gregory: "Again... rawstory is not an appropriate source. They lie."

It's just part of that 'news craft' thingie. You take a headline from a story which was written by reading some guy's tweet about another tweet that takes a statement out of context and, well, you have KVMR news in a nutshell. It isn't like Paul would look for the original source, to busy crafting I guess.

Here's the original quote.

https://twitter.com/SarahBurris/status/1272646877826162688

If a person listens to the whole thing, you can see how insanely dishonest Blue Mob news really is. I really should just ignore these people, the irritation it causes is valueless.