The adaptive edge and beyond COVID-19

Once we’ve zapped the psychological melanoma of COVID-19 mania and diluted some of the fact-free panic fetishism, we can get back to renewing our corporate vitality – Pic by Shehan Gunasekara

Monday, 29 June 2020

I had indicated I would move on from COVID-19 and sought to do so in last week’s piece about moving on.

Since then, every conversation I encounter, again seems to be kowtowing to misinformed COVID-19

orthodoxy, to the extent I’m getting increasingly concerned we’re going to spend our lives continuing to read about mystical “second waves” rather than realising there will be periodic outbreaks, that will need to be targeted, briefly, in a focused way in that neighbourhood or town or locality, rather than shutting down the planet.

So, I need to come back briefly to this.

The one thing we have to get over is to stop looking at caseloads, as it’s irrelevant. Just new testing could produce a sense of a “spike” when we’re just getting more people finally assessed, and if they have no symptoms, or mild symptoms, forget about it.

If the asymptomatic were truly an infection risk, then with roughly 20% at least being anticipated to be asymptomatic, they must already have wreaked whatever havoc they were going to, particularly as we now know the contagion has been around since December, and may have done several “world tours” since.

Once more, as quickly as I can.


Studies of COVID-19 lethality

Stanford Professor John Ioannidis recently published an overview of COVID-19 antibody studies. According to his analysis, the lethality of COVID-19 (IFR) is below 0.16% in most countries and regions. Ioannidis found an upper limit of 0.40% for three leading hotspots.

In its latest report, the often-floundering US health authority CDC reduced the COVID-19 lethality (IFR) to 0.26% (best estimate). Even this value may still be seen as an upper limit, since the CDC conservatively assumes 35% asymptomatic cases, while most studies elsewhere indicate 50 to 80% asymptomatic cases.

At the end of May, however, Swiss immunologists led by Professor Onur Boyman published what is probably the most telling study on COVID-19 lethality to date. This preprint study comes to the conclusion that the usual antibody tests that measure antibodies in the blood (IgG and IgM) can recognise at most one fifth of all COVID-19 infections.

The reason for this discrepancy is that in most people the new coronavirus is already neutralised by antibodies on the mucous membrane (IgA) or by cellular immunity (T-cells). In most of these cases, no symptoms or only mild symptoms develop! Therefore, what is even the “testing” going to reveal? Most healthy immune systems will just “shrug” off the contagion without even triggering an antibody response.

This also means that the new coronavirus is probably much more common than previously thought and the lethality per infection is up to five times lower than previously assumed. The real lethality could thus be well below 0.1% and hence in the range of strong seasonal influenza.

Despite the comparatively low lethality of COVID-19 (deaths per infection), the mortality (deaths per population) can increase regionally and flare in the short term if the virus spreads rapidly and reaches high risk groups, especially patients in nursing homes, as indeed happened in several hotspots, which was more a catastrophic policy failure than COVID’s predatory prevalence.

Due to its rather low lethality, COVID-19 falls at most into level 2 of the five-level pandemic plan developed by US health authorities. For this level, only the “voluntary isolation of sick people” is to be applied, while further measures such as face masks, school closings, distance rules, contact tracing, vaccinations and lockdowns of entire societies are not recommended.

It is sometimes argued that the rather low lethality was not known at the beginning of the pandemic. This is not entirely true either, as data from South Korea, the cruise ships and even from Italy already showed in March that the risk to the general population is rather low.

Many health authorities also knew this, as recently surfaced emails from Danish authorities dating from mid-March show: “The Danish Health Authority continues to consider that COVID-19 cannot be described as a generally dangerous disease, as it does not have either a usually serious course or a high mortality rate.”

Some media nevertheless continue to calculate an allegedly much higher COVID-19 lethality rate of over 1% by simply dividing deaths by “infections”, without taking into account the age and risk distribution, which is absolutely crucial especially for any overall read-out or assessment of COVID-19.

The latest data from the European mortality monitoring Euromomo shows that several countries such as France, Italy and Spain are already entering a below-average mortality phase. The reason for this is that the average age of COVID-19 deaths was very high and fewer people than usual are now dying in this age group.


The role of nursing homes

Nursing homes played a tragically crucial role in the COVID-19 pandemic. In most countries, one to two thirds of all related deaths occurred in nursing homes and staggeringly up to 80% in Canada and some US states based on official data and published reports easily accessible to anyone interested. Even in Sweden, which did not impose a lockdown, the latest tally is 75% of deaths occurred in nursing facilities.

It is all the more horrifying as to the blinkered understanding of this pandemic that some authorities have obliged their nursing homes to admit COVID patients from the clinics, which of course triggered numerous new infections and deaths (northern Italy, England, New York, New Jersey, Pennsylvania – all hotspots and hotbeds, in substantial part due to this).

It is well known that even common corona viruses (cold viruses) can be very dangerous for people in nursing homes. Stanford professor John Ioannidis pointed out already in mid-March that coronaviruses may have a case mortality rate of up to 8% in nursing homes.

In addition, it is often not clear whether these people really died from COVID-19 or from weeks of stress and total isolation. For example, there were approximately 30,000 additional deaths in English nursing homes, but in only 10,000 cases is COVID-19 noted on the death certificate.


The role of hospitals

The second central factor regarding infections and deaths, in addition to the nursing homes, are the hospitals themselves. A well-publicised case study from Wuhan has already showcased that around 41% of hospitalised COVID patients had in fact contracted it in the hospital itself.

Contagion in hospitals also played a painfully decisive role in northern Italy, Spain, England and other regions that were severely affected, meaning that the clinics themselves became the main place of transmission among already weakened people (so-called nosocomial infection) – an issue that had already been reported and flagged during the SARS outbreak from 2003.

Based on current knowledge, those countries that managed to avoid outbreaks of infection in nursing homes and hospitals had comparatively few deaths. The general lockdown of society, however, it is asserted played no role or even a counterproductive role.


The clinical picture of COVID-19

Professor Püschel, a renowned Hamburg medical examiner, from a study of numerous autopsies, again emphasised that COVID-19 “is not nearly as threatening as was initially suspected”.

The danger was “too much influenced by media images”. The media had focused on severe individual cases and fuelled panic with “completely wrong messages”. COVID-19 is, he concludes, not overall a “killer virus” and the call for new medicine or vaccines is “driven by fear, not facts.”


Children and schools

Numerous studies that children are not at risk from COVID-19 and do not or hardly transmit the virus, confirms that damaging their education, and impinging upon their social and personal development, was pointless, paranoid panic.

Accordingly, all those countries that reopened their schools in May saw no increase in cases of infection. Countries like Sweden, which never closed their primary schools anyway, had no problems with this either.

The British Kawasaki Disease Foundation again criticised the dubious and lurid coverage of Kawasaki disease. In fact, there has been no significant increase in Kawasaki cases and no proven association with COVID-19. General inflammatory reactions in individual children are also known from other viral infections, but the number of cases reported so far is extremely low.

German medical associations have also given the all-clear: COVID-19 is imperceptible or very mild in almost all children. Schools and day-care centres should therefore be opened immediately and without restrictions, i.e. there is no need for imposing small groups, distance rules or masks.


Vaccines against COVID-19

Various politicians in Europe and the US have declared that the “corona crisis” can only be ended by a vaccine that is currently being developed.

However, many experts have pointed out this is a ludicrous talking point, arguing that an express vaccine against the new coronavirus is neither needed and may not be that helpful anyway due to the overall low lethality and clearly declining spread. Protecting high risk groups and learning from our nursing home bungles would be far more productive.

With low lethality, high asymptomatic prevalence and no demonstration that transmission from the asymptomatic is anything but rare, as given that the likelihood of that has still to be demonstrated conclusively, why pin our hopes on some potential “vaccine” rather than the salvific combination of applying what we’ve learned, trusting to natural immunity and protecting the most vulnerable?

A helpful summary comes from leading German virologist Prof. Hendrik Streeck, “All experts are returning to the assessment of the early days” that COVID-19 “should not be trivialised, but also should not be dramatised”. The reason for the declining risk assessment was the “enormous number of infections that remained without symptoms”.

Streeck does not expect any excess mortality in Germany by the end of the year, as the average age of death is “rather above life expectancy”, and he doesn’t consider “corona apps” and widespread corona tests to be useful. He also criticised the general use of masks, saying that these are a “wonderful breeding ground for bacteria and fungi”.


Shift corporate focus to the softer, adaptive edge

Okay, once we’ve zapped the psychological melanoma of COVID-19 mania and diluted some of the fact-free panic fetishism, we can get back to renewing our corporate vitality.

One perspective I would suggest to companies is to look at their businesses as a “trinity”. The “bedrock” is strategy, which is where and how you think you can best survive and thrive given all that has occurred. So jettisoning past assumptions, do a review of current and likely evolving realities for your business and industry in terms of: market (where you will compete and seek to create value), customers (current, and future, and what they need and earning their loyalty), competitors (how you will outperform them, or render them irrelevant with a more original or dynamic value proposition), substitutes (in a changing landscape, where with COVID-19 upheaval and confusion there may be products or services that may seem compelling “substitutes” for what you offer) and disrupters (how other countries act, second waves, economic ripple effects, and how you might anticipate some of these, both in terms of your own responses, but also in terms of resources and liquidity).

Next comes executing, this is the primary capability every successful business needs, particularly right now. You need delivery maniacs right now, not complacent windbags trudging through the pandemic debris. And this requires an organisational passion for speed (where does our metabolism have to speed up, where do we have be more flexible, where can we ruthlessly prune useless layers or red tape?), costs (working capital really, opportunity costs not just “cost,” what we invest in, and where we defer or delay, keeping cash flow vitality and regularity paramount), supply chain (mutual leverage between you and your suppliers, technologically tracking, monitoring in real-time, and insisting on clear performance parameters), organisational focus (a strong Pareto 20/80 focus on what really matters, and ensuring “the big rocks” go in first and foremost).

And then “the adaptive edge,” the “soft is hard” competitive edge. And here, in a period when everyone is reeling, and trying to define and redefine a working “normal,” we begin with Trust. And that trust relates to external markets, customers, suppliers, as well as your internal market. This gives you a retention advantage, a productivity advantage, it makes you authentic in the eyes of the market, you get needed grace periods.

Next is organisational learning and smarts and proprietary ways of doing things and liberating learning from challenges and inspiring perseverance. All of this coalesces and is expressed through social networks and high performing teams, the easiest of slogans and the most demanding of realities…the best of the best coming together in ways that are fast, flexible, mutually challenging and supportive, and ultimately creative.

Next comes the “flavour” of your corporate appeal, your “taste,” your design, your emotional connection with the emerging marketplace. It’s where via a growing niche you tap wonder and marshal desire. And then we come at last to the story, your narrative, and why anyone else should care. Did you contribute? Did you make your communities stronger? Are the people who work for you more successful as human beings? Do you add to national prosperity and light up the competitive firmament?


Here in Lanka

And then here’s how not to do it. I took my wife to a well-known hospital, not far from Union Place. She had to see a dermatologist, nothing too terrifying. But having been unusually busy, we tried to set this up via calling their help line to “channel” the appointment.

An appointment was given for 4 p.m., we were told she had to pay by 3:30. We arrived, were interrogated, sent up to the 9th floor, floundered around looking for guidance, found a place to register and pay, and then sat and waited…and waited.

We are accustomed to doctors running late, who isn’t? But the door behind which this doctor allegedly sat, never moved, or budged, there were no signs of life. About 25 minutes after the appointment time, my wife went in search of someone, who announced the doctor wasn’t even there! We were offered another doctor, and I kept receiving messages for fulfilling grocery orders while at the hospital. This was peculiar, and an interesting distraction, but not really what was sought.

Eventually a lovely, sari-draped fashionista swept in…apparently this was the doctor. I wondered if perhaps she moon-lighted as an event planner, or perhaps dermatology was her secondary gig? We were buoyed up, and thought perhaps we might finally move ahead with our lives.

The door opened to the doctor’s sanctum, then shut again. Several more minutes elapsed. We tried knocking. We then tried knocking louder. Suddenly, another woman appeared, saying we hadn’t paid enough! Though we had paid what we had been quoted, apparently that was the “local” rate and not the “foreigner tax”. We pointed out we paid what we were asked to. Deadpan she said, “That was a mistake.”

We were taken out, and went through a further several minute fiasco, as a new receipt was duly printed, the difference paid, and then at my insistence, the door was actually opened and my wife went through, once all the stamped receipts were meticulously handed over.

So, in terms of restarting and re-energising, please don’t inflict such outdated, outmoded, daft, customer disrespecting, imprecise processes and procedures, reeking of contempt and inefficiency on people. One of the things Sri Lanka can do to augment its tourism appeal, is like Cuba, and other locales, be a place for medical tourism, or a wonderful place to recuperate at least. But not if we don’t know what to charge, where to actually send someone, or having a doctor off at a fashion show, and then discovering at last that their pharmacy doesn’t even have the medication eventually prescribed. In isolation, any of these fumbles are understandable. Compounded, they create a service crisis.

This wasn’t serious, just a minor debacle. But multiply every staid, silly, stultifying service offering or process, every detached and dehumanising approach to standing out, and we will struggle, truly struggle to distinguish ourselves.

Going back through the adaptive “soft edge” dimensions, I don’t trust them as a result; they seemed to have an immunity to learning; the team let each other down; the flavour was of incompetence; and the story was of indifference. We’ll go again ‘perhaps’ if they’re convenient and try to work around this; and we’ll be even happier to jump ship the moment someone makes us feel human, or relevant, or cared for.

There is a lot of value space to express our concern and care and commitment and insight. As we seek to make our livings and revive our businesses, let us shine in our commitment and attention and uplift each other’s spirit. The contagion killed a lot of hope. We needn’t help it erode our positive expectations further.

A leader is an architect in possibility. That’s what we need to be and to share, to truly turn the corner and reclaim the present and future.