We are witnessing the collapse of the units of intensive care in hospitals. The coronavirus crisis, that apparently "nobody saw coming" has generated an unprecedented event affecting our daily lives and threatening our social model. However, we should guess if all the responsibility is in this evil virus that suddenly came to us from remote China. Was it absolutely unpredictable? Can we use this crisis to better understand the future and protect ourselves from the next one? Interesting questions that we should consider carefully. Our own survival can be in the game.
Essayist Nicolas Taleb warned about a “the great epidemic that is to come and that will nullify by far the progress made momentarily with remedies such as antibiotics” in his book "The Black Swan", published in 2008. With impeccable reasoning, Taleb had already proven his abilities to anticipate these "rare events". In fact, operating in the derivatives market, he managed to earn money during the economic crisis caused by the bankruptcy of Lehman Brothers, which also was able to foresee, by doing opposite than the recognized gurus, many of them bankrupted, did.
There are multiple causes that according to Taleb explain why we do not know or cannot anticipate rare events. One of them is the very nature of the phenomenon, the fact that “it has never happened before” and another, the most dangerous, our inability to accept that in disciplines that involve the interaction of multiple complex variables such as economics and social sciences overall, we are very bad making forecasts, but, and that's much worse, we do think that we do well. This combination is lethal when it comes to unpredictable high-impact events, what he calls "black swans."
The coronavirus would not fall into this category since it could be foreseen, at least by him. This "gray swan" is bringing the death for many people and creating extreme pain and fear, although it is not probable, in today's scenario, to be the great pandemic that could endanger the human race. In any case, it is quite possible that it will generate a great economic crisis, even deeper than that of 2008.
"Among Taleb's arguments to explain why we are so vulnerable to rare high-impact events, the core message to be taken is that we are creating a fragile society"
Among Taleb's arguments to explain why we are so vulnerable to rare high-impact events, the core message to be taken is that we are creating a fragile society. Competing in an open and barrier-free world, where for more and more products the only factor that matters is the price, the processes have to be optimized and for the margins not to be negative, important economies of scale must be achieved. Companies need to grow to remain alive, therefore markets suffer concentration processes and the surviving organizations are encouraged to eliminate duplications in order to reduce costs as much as possible.
At first, everything seems to be going well, the products reach the market at lower prices, the market grows because there are more and more consumers who can access them and everyone wins ... except that these organizations are like big ocean liner boats, and sometimes icebergs arise unexpectedly on their way. Then the collapse occurs because due to their size, contagion by interconnection can lead an entire system to crash, something we suffered in the last great crisis of 2008.
"Nature, as Taleb points out, has proven to be aware that optimized systems are dangerous, that is why her creatures maintain high levels of redundancy. Humans for example, are not "optimized": we have two eyes, two lungs, two kidneys, etc. "
Nature, as Taleb points out, has proven to be aware that optimized systems are dangerous, that is why her creatures maintain high levels of redundancy. Humans for example, are not "optimized": we have two eyes, two lungs, two kidneys, etc. Most of these organs are as "auxiliary engines" ready for operation if it occurs some failure in the main system. There are also different ways in which the human organism can generate its essential nutrients, so that, if a bad time comes, you can always use the reserve mode. This also occurs in the early stages of the growth of newborns and, in general, in all living organisms. We should learn a little from our old grandma.
Returning to the case of the collapse of hospitals, the coronavirus is attacking one of our most vulnerable points, the intensive care units. Each country tries to size them according to their needs and possibilities, as being an expensive resource, optimization is actually the main criterion, which means to meet the demand in normal times. However, a pandemic generates an unexpected and massive increase in cases. Under these conditions, the system collapses, what we are seen nowadays with the Covid-19, to the point of forcing in some cases (Italy, Spain) to choose which patients should be treated, with the consequent increase on evitable deaths and ethical conflict over the selection criteria that should apply in these cases.
It is quite difficult to think that, once the acute phase of the crisis is over, health systems can afford to increase the number of ICUs enough to respond to another similar pandemic, especially in communities with fewer resources. In addition, it would still be possible that the next virus to be faster and more lethal than this, which would mean that such efforts would not be sufficient. We should address this issue under a whole new perspective as many others to come.
A possible solution that we are proposing here and that is based on the concept of redundancy could be the creation at a big scale of first aid units equipped with low-cost mechanical ventilators, such as those made available, in open source, by Rice University (https://www.youtube.com/watch?v=NiMcbdYNMMI). These could be settled in strategic points following a predesigned emergency plan in case of need. Going a little further, it would be possible to organize a system so that the patient could be piped directly at home, supported by ambulatory care of medical professionals or alternatively basic training for their own families to do it in case of an emergency. The system could be centralized through a web portal providing training, monitoring, and management of online resources. The purpose of this project would never be to replace the standard process but to support in an emergency that would be activated through an established and well-defined protocol. Such a project would contribute to significantly reducing the fragility of the system. (more detailed explanation in the following link):
In other fields, it would be great progress for small communities (families, villages, small towns) to develop autonomous basic resource management systems that would make them less vulnerable to eventual catastrophes, not just healthcare diseases. As Taleb says, the following black swan will not resemble the previous one. From sustainable independent power generation systems to individual or community production of certain essential goods, the new philosophy should be to avoid pushing optimization to the limit. It is not a question of replacing, but of "securing". Under normal conditions, it is better and more effective to go to the hospital, buy in the supermarket and let the electricity company take care of everything, but today's globalized world is especially exposed to rare events, so learning to be a little redundant can mean the difference between surviving or disappearing.