COVID-19 MANAGEMENT – A BUSINESS APPROACH

For many years I have helped businesses large and small solve problems, design better business processes and improve management information.  Here's a summary of my scientific and business experience.

Imagine your business was getting 2500 complaints a day.  Some of them would become serious.  Some customers would be lost. Some of them will complain recurrently for years.   You’d set up a process to track and manage the response across the various departments involved.  You’d capture data on how many reached each stage and calculate %’s at each stage, and seek to improve them.  You’d also seek to reduce the 2500 to a more manageable number, potentially zero.

Now imagine you’re getting 2500 new COVID-19 cases a day.  Applying the same principles you’d see that some of them became serious.  Some would die.  Some would have symptoms for months if not years – now called “LongCOVID”.

You’d set up a process across the various departments, 111, GPs, hospitals, follow-up, etc.  You’d capture the number of cases reaching each stage, and calculate the %s, and seek to improve them.  You’d also seek to reduce the 2500 to a more manageable level, potentially zero.

Any difference?  Only in the detail.  In fact managing COVID-19 is simpler than many cross-departmental business processes.


COVID-19 CHARACTERISTICS

The basic characteristics of COVID-19 are set out in the separate posting, including:

• COVID-19 is highly infectious and caused by a coronavirus known as SARS2
• The initial symptoms can resemble flu. but are usually broader
  
• But subsequent symptoms are dangerous, and can result in death
• For those people that survive, there can be severe ongoing symptoms, whether they’ve shown initial symptoms or not
• This is because if the virus gets into the blood stream it can cause microclotting and damage other organs such heart, kidneys, liver, digestive system and brain

A SIMPLE PROCESS FOR COVID-19

COVID-19 is a complex disease where we are still learning. 

But we already understand there’s a simple sequence of events.  Without deciding who needs to do what, if we model a typical infection progression such as suffered by PM Johnson, we get:

By tracking individuals through this process we can:

1. Monitor the numbers reaching each stage
2. Calculate stage percentages such as J/F, K/F and L/F (which in this case should add to 100%)
3. Also calculate numbers reaching each stage as a percentage of A, the number of new cases
4. Monitor numbers and %s over time by graphing
5. Identify reasons, e.g. die of lung problems, stroke etc
6. See where improvements are being made, or where situation is deteriorating
7. Focus on improving bad percentages
8. Track this all by age, gender, ethnicity, etc

Hospitalisations and death have been tracked and used to be displayed at the daily press conferences.  But there has been no evidence that the other numbers and percentages have been monitored.  In particular there has been no public evidence that Long COVID has even been recognised by government.

Key percentages relate to “Protecting the NHS”, in what proportion of people develop severe symptoms and then hospitalisation.  What is being done to try to reduce people reaching those two stages?  Do that and death and Long COVID incidence automatically reduce.  But what is the UK government doing to try and reduce those percentages?  Little if anything it appears.

Unless these things are happening behind the scenes:

• No evidence the basic process is being tracked
• No evidence that treatments are being sought for home use to avoid serious symptoms and hospitalisation.  Just treatments in hospital, which has uncovered the worth of dexamethasone
  
• Little specific advice as to how to avoid serious infections and hospitalisations.  The only guidance on NHS England is standard flu-type advice, to which “Things to try if you're feeling breathless” has only recently been added.   Nothing about deep breathing techniques, for example, which can reduce chance of lung symptoms worsening
  

In other words there is little evidence that COVID-19 is being managed in a business-like manner in England.


TYPICAL PERCENTAGES

Around 1% of people who have caught COVID-19 die.  Estimates were initially 1-2%, but with improvements already in treatments it is now perhaps as good as 0.1-0.5%.  Mainly in older people over 50, or those with pre-existing conditions.

Some 40% or more of people who contract COVID-19 are believed to never show the initial symptoms (asymptomatic), but can still develop LongCOVID symptoms

That means that some 99% of people getting infected are split between a full recovery and LongCOVID.  As LongCOVID affects people of all ages it is amazing this hasn’t been monitored more closely. It could dwarf the problem with death, especially for younger adults aged 20-50 who widely believe COVID-19 is an old person’s disease and they themselves can ignore safety advice.


BUT THE BIG ISSUE

We said at the outset that if were handling complaints in a business we would want to reduce them to zero, or more likely near zero.  It might be too costly to be ‘perfect’. 

The same applies to COVID-19.  Bearing in mind that some actions to reduce new infections can produce unwanted ‘side effects’.  For example closing schools adversely impacts children’s education, and can stop parents of younger children from working.

But it remains true that if new infections are higher than they need to be, deaths and LongCOVID symptoms will be higher than need be.

We also know that there are currently major issues of confidence:

• Parents not willing to send their children to school
• Consumers not willing to risk a trip to the shops, a restaurant, or have someone breathing over them for a haircut.

Confidence can be improved with lower infection rates.  Getting kids back to school and letting the economy recover strongly are both helped by having very low infection rates.

Currently England is at Alert Level 3, with infections “low”.  We need to do much better if we want to get back to normality in schools, shops, theatres and music venues amongst much else.  We need to be “very low”, well below 1000 new cases a day (of which “confirmed new cases” we see reported are just the tip of the iceberg).  That’s below level 2. 

That’s much more in line with what is happening in Scotland, Ireland and most of continental Europe.  Though they are still having local surges. For Spain, the overall number of new daily cases in local surges means there is a nationwide problme of a second wave that has now reached a dangerous level.  

But the lower the base number of new daily infections, the less impact local surges will have.  That’s where England needs to be.  Not necessarily zero but certainly Near Zero.

#NearZero