What Literature can teach us about the Response to Coronavirus

While the history books have yet to be written on the worldwide response to COVID-19, a recent article by Anne Applebaum, Senior Fellow at Johns Hopkins University has provided an interesting take on the response to the coronavirus. 

In 1947, Albert Camus, a French philosopher and journalist published a novel called The Plague. Like other novels of its decade, including Orwell’s 1984 and Animal Farm, the novel is allegorical. That is, while it is purportedly about the occupation of France, it really seeks to illuminate the unseen. As the primary character, Dr. Bernard Rieux bears primary responsibility for treating the afflicted in his town of 200,000, while vainly exhorting authorities to take measures to address the spread before it was too late. 

In modern Italy, the virus first appeared in the northern provinces of Lombardy and Veneto, a region heavily represented by the Northern League, a far-right political party led by Matteo Salvini. As Daniel Trilling reports in The Guardian, the defining feature of populism, namely the mistrust of elites and widely circulated conspiracy theories find the most fertile ground in times of uncertainty. 

[The quarantined town] continued with business, with making arrangements for travel and holding opinions. Why should they have thought about the plague, which negates the future, negates journeys and debates?

from The Plague, by Albert Camus (1947)

In an article published in the Harvard Business Review, four lessons have been considered that may have helped to mitigate the failure to contain COVID-19 in Lombardy and Veneto:

Skepticism and cognitive bias. Despite warnings that had been weeks in the making, Italian authorities engaged in confirmation bias and viewed with skepticism any position that did not align with their preferred position. This systematic refusal to listen to subject matter experts in the early days of the outbreak (defined from February 21 to March 22) resulted in the region being impacted by an “incessant stream of deaths.” (Pisano, et. al., 2020)

Avoiding partial measures. In response to the initial wave of COVID-19 cases, the Italian government issued decrees concerning lockdown areas (‘red zones’). These red zones were then expanded until they were applied to the whole country. This partial-measure approach backfired for two major reasons. Firstly, the known facts were non-predictive of the situation, so the partial lockdown followed the virus rather than prevented its spread. Secondly, partial lockdowns may have helped to accelerate the spread of the virus as Italians relocated to ‘non-lockdown’ regions, inadvertently spreading the virus to regions it had not been before.

Rapid learning is essential. A feature of ICS is the ability for it to rapidly scale up or down in response to changes in the facts. The Italian health care system is highly decentralized, and newly acquired knowledge was not given the priority it deserved. The article looks at the policy decisions of Lombardy and Veneto officials in depth as the two regions share similar socioeconomic traits, however experienced far different outcomes. Lombardy opted for a more conservative approach, with a strong focus on symptomatic cases whereas Veneto’s strategy was proactive and varied. As of March 26, 2020, the Lombardy region suffered 5,000 deaths in a population of 10 million, whereas Veneto experienced 287 deaths (in a population of 5 million) during the same period.    

Collection and distribution of data. As a corollary to the third lesson, the lack of data dissemination and standardization of virus statistics should be a priority. Documenting both macro (state) and micro (hospital) levels would help authorities to allocate available (often limited) resources accordingly. 

In the uncertain environment in which we find ourselves, both emergency management professionals and policymakers can benefit from the ‘fast tracked’ lessons being developed in real time.

Perhaps fittingly, the heroes of Camus’ novel remain the doctors and the volunteers who use science to contain and control the disease, without indulging fear-based hysteria. According to Dr. Rieux, “[it] may seem a ridiculous idea, but the only way to fight the plague is with decency.” (Camus, 1947).

As always, I look forward to reading your thoughts and insights.

How B.C. is Acing the Pandemic Test

The decisive action taken by the B.C. PHO on COVID-19, has focused on the twin pillars of containment and contact tracing.

A version of this post was featured on the Exploring Emergency Management & Homeland Security Blog by Timothy Riecker, CEDP.

The pandemic has upended how those in the emergency management field have seen traditional response frameworks. Lessons learned from the pandemic response will be useful to governments and the private sector alike in the coming years.

The ICS framework for emergency response is well equipped to address the unique needs of any disaster, including a global pandemic. The rapid scalability of the structure allows the response to move faster than the speed of government. It provides the framework for standardized emergency response in British Columbia (B.C.).

The B.C. provincial government response to the coronavirus pandemic, led by Dr. Bonnie Henry, the Provincial Health Officer (PHO) has received international acclaim. It is useful therefore to learn from the best practises instituted early on in the pandemic to inform future events. 

In February 2020, the Province of B.C. published a comprehensive update to the British Columbia Pandemic Provincial Coordination Plan outlining the provincial strategy for cross-ministry coordination, communications and business continuity measures in place to address the pandemic. Based on ICS, the B.C. emergency response framework facilitates effective coordination by ensuring the information shared is consistent and effective. The Province of B.C. has provided a daily briefing by Dr. Henry and Adrian Dix, the B.C. Minister of Health as a way to ensure B.C. residents receive up to date information from an authoritative source.

While we may consider the COVID-19 pandemic to be a unique event, a number of studies have provided guidance to emergency response practitioners of today. The decisive action taken by the B.C. PHO on COVID-19, has focused on the twin pillars of containment and contact tracing. Early studies regarding the effect of contract tracing on transmission rates have seen promising results, however the tracing remains a logistical burden. As studies indicate, these logistical challenges have the potential to overwhelm the healthcare system should travel restrictions be relaxed, leading to the possible ‘importation’ of new infections. 

B.C. has instituted robust contract tracing mechanisms to reduce the spread of COVID-19 in alignment with best practises in other jurisdictions. When instituted methodically, contact tracing, consistent communication, and Dr. Henry’s mantra to “Be calm. Be kind. Be safe.” remain critical tools to ensure limited spread, a well-informed and socially cohesive population.

How has your organization helped to slow the spread of COVID-19?  As always, I welcome your feedback and suggestions for how to improve the blog.