I’ve written about understanding the Asymptomatic cases here, but since we can’t have any real data on actual infection rates considering the generalized population for a while, I think it is important to understand how to make decisions with the data that we have in the short term. Insofar as what can be done, I’m all about “flattening the curve” and such. Whether one understands it completely or not, trust me — it’s the right thing to do. Let’s understand why, with the information we know.
- COVID-19 is a new disease. There are no treatments for it. The body must live or die in producing its own immunity.
- There currently is no vaccine for COVID-19. Any prior immunity is poorly understood, and information is starting to just emerge on long-term immunity. Evidence coming in shows typical virus immunity does indeed occur. This matters in the long run, and can affect the decisions we make now, but not by much.
- The way people die from COVID-19 is respiratory failure. It is a SARS virus (Severe Acute Respiratory Syndrome).
- The main reason for respiratory failure (not completely preventable) is poor treatment, and hospital’s overrun in ventilator capacity.
- The pandemic will continue until treatments and a vaccine come into play, or until herd immunity takes hold. The time to do that depends on the degree of localization we can successfully practice. Localization ranges in scale from things like lockdowns, to individual detection. This lengthens the timescale of the pandemic, lessening the short-term impact, and giving the society time to find a vaccine or effective treatments.
So what we can now understand is that in the short-term, the main reason for deaths is, and will continue to be, a lack of pandemic preparedness signified mostly by a lack of ventilators. It may be that the actual death rate from the disease is < 1% in the long run, which is still 10X the flu. But the real problem IN THE PRESENT is that our hospital system, instead of preparing for the potentials of outbreak viruses, has optimized medical care around two factors. These are:
- Winning the Medical Arms Race with other facilities — more treatments, often offered competitively, that are high-status and make the hospital look better relative to its peers (buying another PET scanner instead of coordinating use with another hospital close by.)
- Minimizing extraneous costs (like managing Just-In-Time supply dynamics) for a better bottom line, in part because of pressure from insurers. This McKinsey-esque crunch across our entire economy is driven by the need to return ever-higher returns to shareholders in the short term, and among other things, has killed innovation.
I’m not really into the blame game, as much as I am into understanding the structural memetic dynamics of the current situation. What we are seeing, however, is an expression of the lack of empathetic development of many of our core systems. And the deeper problem with that is the ancillary collapse of consequential thinking because of that lack of development. Authority/Status-driven systems suck at thinking in terms of long-term consequences — we’re seeing the effects of that right now — because status is whatever the equivalent Louis Vuitton handbag equivalent is in the medical profession. And it is intrinsically coupled to following the crowd, or whoever the highest-status institution/person is in the crowd. It is IRRATIONAL — based on limited data, and insulated from grounding consequences in the surrounding environment.
What happens when you take an Authoritarian/Legalistic social structure, and you starve it is exactly what we’re seeing in our hospital system right now. You have shortages of key items necessary for care above any legally mandated baseline. You have no reserve capacity for anything resembling an epidemic. You have no training for people to anticipate these kinds of things. It’s unsexy to have a container full of masks that you may never use. But, as we can see, that’s exactly the kind of thinking that would prevent a higher death rate from the current crisis.
And smaller countries, like Taiwan, are showing that having that “crisis insurance” mentality, saves lives and money. Taiwan knew something was up the minute a cluster of pneumonia cases showed up in Wuhan. They kicked into high gear immediately and sent a team there. 99% of Taiwanese covered by health insurance shows an empathetic foundation for a society — I covered the success of Taiwan in this piece. It shows how empathetic, geeky, non-narcissistic leadership actually had the correct consequential thinking that managed the initial outbreak, and will now contain the small resurgence that is coming as the Taiwanese elite (also high-status, low empathy) fled the island, and then started returning home.
And because their relational network was large — many Taiwanese work in China, and have no illusions about their narcissistic Authoritarian neighbor — they knew they’d be connected. That’s the deep power of empathetic development. The Wuhan outbreak was NOT a Black Swan for them. It was an event that happened. Read this piece to understand the dynamics.
What does all this mean? It is time to understand and modify the DeepOS of our hospital system. And the only way to do this is to understand that the current Authoritarian/Legalistic hierarchy that drives administrations, as well as physicians’ personal development has to change. If we don’t change, we shouldn’t expect any different long-term outcomes. We have to create a new medical system focused on wellness, and getting people OFF of drugs — that part is easily said. Understanding that it will require a re-thinking of social structure to create the thinkers we need will be the challenging part. Why? Because to understand the demands of complexity requires complexity in thinking to start. It’s a killer chicken-and-egg problem.
We can start at the bottom. When was the last time you knew that doctors and nurses engaged in an empathy circle? Or doctors and patients? What about understanding how nutrition affects health, and the development of support groups for people of all stripes? What about more forgiveness of student loans for nurses, and doctors, so they don’t have the pressure to move so many people through the system? There are other avenues and decisions to be made. They must be made, though, in maximizing the empathy development of the people involved — because those rewired brains, along with a radically different social network, will be the things that actually figure out the right thing to do.
I’ll wrap it up here. Here is a key point. We SHOULD have national health insurance. It is a necessary first step. But national health insurance/single payer did not stop this epidemic in countries that had it, and some of those countries (like Great Britain) are literally hurtling into the abyss through a series of Pollyanna thinking, and the same lack of consequential thinking present in our own system. The social structure may be somewhat different, but obviously is NOT different enough.
By doing this — realizing our problems, working on top-level solutions, like stockpiling medical supplies and developing individual identification, along with focusing on activities that develop empathy in the health care system, we will create the people to anticipate uncertainty. By evolving the people, we will create the pretext for the emergent future that will stop these pandemics. You have to trust in the social physics. We can’t know what we don’t know. But we can create the people, out there on the front lines, to be our early warning system.
And yeah — it’s all about empathy.
Postscript — there is a whole post to be written about very specific target areas in people’s bodies around the idea of loosely coupled/tightly coupled physical systems inside our bodies, and how management of pandemics needs to be centered around the tightly coupled systems. Respiratory systems are prone to causing mortality through failure because they are, intrinsically, tightly coupled inside our bodies. Gastrointestinal failure is less tightly coupled. If this intrinsically makes sense to you, then enjoy the brain candy!
3 thoughts on “Empathy in the Time of Coronavirus (IV) — Understanding the Grim Statistics, and Root Cause of Hospital Failure”
One thing to remember is that American capitalism is built on and dependent upon addiction, both psychologically and physically. It is, as I argue, how we maintain rigid hyper-individualism and social Darwinian hyper-competitiveness but also a certain kind of low-empathy neoliberal beauracracy.
Who are some of most highly addicted in our society? Doctors and other healthcare workers. Stress and addiction go hand in hand. It’s an entire self-reinforcing system, worldview, and mindset. By the way, have you heard about Michael Pollan’s new audiobook on caffeine?
Totally agree re: medical system. Re: Michael Pollan’s new audiobook — nope.