Friday, March 27, 2020

Pandemic Lost - Pandemonium Found.

So I went to the grocery store today, standing in very long short line, maybe 25 people each six feet apart waiting both patiently and impatiently.  I was passing the time reading emails, most with the title Global Pandemic Information.   Having one of those moments, gets one thinking.  The first thought was that this was crazy.  The second that was that what we were doing had little to do with an infectious disease and more with rules based on some very questionable science.
The word pandemic has Greek origins:   Pan meaning all and Demos meaning people.  It literally means  an infection affecting all people or a large proportion of people.
But that is  NOT what we are experiencing.  In Canada we have about 4000 cases- most with no symptoms (about 1:10,000 people).  In the US with about 90,000 cases (again most with no symptoms) it is about 1:4000; certainly not what anyone would call all or even most.
So Pandemic may be a nice science word but is not particularly descriptive of what we are experiencing.

Let me argue that a far better term for what is going on is Global Pandemonium.
When John Milton invented the word from Greek for Paradise Lost he wanted a term that had an sense of “all” or “global” but was more focused on the sense of a gathering together of evil spirits – the capital city of hell.   (It has long been said there are all sorts of good bacteria and bad bacteria, but there are no such things as good viruses.  Viruses are the essence of evil). 
It dawned on me that what we are experiencing is a lot less about disease, and a lot more of evil: sweeping confusion and bizarre acting out, and doing tremendous harm.  What we are experiencing is not a disease of all people,  Pandemic, but is certainly about confusion and harm, Pandemonium. 
Let’s change the terminology starting today.

Tuesday, March 3, 2020

CVP - The Coronavirus Vanity Project.

In his 1984 book Quality Without Tears: The Art of Hassle-free Management, Philip Crosby wrote:  “Take everything that would not have to be done if everything were done right the first time and count that as the price of non-conformance.”   He referred to that as the Measurement Absolute of Quality.   
He went on to say that all too often these non-conformance costs could add to more than 10 fold the costs of “doing it right the first time”

In our annual Certificate course in Laboratory Quality Management participants work their way through the analysis of poor quality costs for common examples of a laboratory error.  The wastes involved often range between $6,000 to $12,000 for a simple error that could have  been prevented but ultimately resulted in 50 patients receiving some incorrect results over few hour period.  In a medical laboratory that is a lot of wasted resources.
It is a useful and enlightening exercise.

But perhaps we should apply the same exercise to the disaster that we can now call covid-19.  

Stepping back, a few days before the New Years celebrations and its associated massive country-wide travel, doctors in China identified a small cluster of people with pneumonia.  They decided that if this was going to be another SARS like episode they better do something early and so they decided to curtail any and all travel in or out of Hubei province where these pneumonias were found.  (This was a definitely high risk but probably appropriate decision based on what they knew at the time in a country that has the authoritarian power to make those kinds of decisions)  Using modern technology they recovered a piece of viral nucleic acid from the secretions of one of the patients, and then passed the information to high level laboratories around the world so that other countries could use that as the basis of a diagnostic test.  

That too was a good and responsible decision, but assumed that everyone would be able to use the material to recreate the same strand that could be used for uniform responsible world wide diagnostic testing. Unfortunately that didn't happen.

Instead it created the opportunity for some really unhelpful next steps… like mass screenings on tourist ships… like quarantining totally asymptomatic people for extended periods… like allowing media analysts to go out to the public airways with beyond irresponsible panic… like politicians jumping onboard using the Churchillian axiom  "Never let a good crisis go to waste".  Ego and opportunism… the most deadly combination of the modern era. 

With hindsight (what should have been foresight) it became universally clear very early on that based on a untried untested unverified experimental diagnostic assay that the vast majority of people who were being tested and found positive were asymptomatic or at most had the signs of a mild common cold.  (What a surprise, since coronavirus has been long recognized as a common virus of the common cold for decades).   

So did we use that information for the next level of decision making?  Nooooooo!  We just kept on going.  An exercise in futility and vanity.

Forget influenza; forget common colds that kill as many elderly and infirm as influenza, Let’s all focus on our new favorite virus.

Which brings me back to Philip Crosby and the costs of nonconformance and poor quality.  In our course we look at costs in terms of TEEM (Time, Effort, Energy and Money).   
Let me argue that if we had accepted after the first two weeks that this was NOT the once-in-a century crisis that it might have been and had decided to step down, how much TEEM would we have saved: Quarantining, lost time and income for asymptomatic people… N-95 masks and hazmat suits, curtailment of travel; disruption of enterprise; reallocation of resources from serious medical and laboratory science to a glorified diversion.  

I suspect that somewhere there is a graduate student who will be asked to take on the task of working out the total costs of the last few weeks, compared to the benefits (maybe a manuscript or a book or a t-shirt).  My guess is that the total poor quality costs will be way beyond millions, and perhaps beyond billions.  

Take everything that would not have to be done if everything were done right the first time and count that as the price of bad judgement.

At least that is my personal opinion and I am sticking to it!!!