Posted by: Tony Shannon | February 29, 2020

Coronavirus 2020: Complex healthcare systems on the “edge of chaos”

With a background in emergency medicine and an eye on the news, the start, evolution and current state of the Coronavirus is of some interest.

To my eyes its a good way to understand the complexity of our world, our healthcare systems within and more than anything a reminder that we are not in charge of life on this planet, just one form of that life.

As I write at the end of February 2020, the main news of the year/decade that was climate change and its challenges has been knocked off by the story of the Coronavirus and its progress around the planet.
The WHO has just announced that earth is on highest level of alert about the potential spread of this viral disease.

Let me use the Cynefin framework as I have used it many times before to try to make sense as to what is happening around us. The Cynefin framework explains the world in 4 key aspects.. using the words simple, complicated, complex and chaos.

In simple terms the first case of CoronaVirus was officially reported to the WHO on 31 December 2019. It is alleged to have spread from bats to human in the Chinese city of Wuhan some time before than. It is easy to say, in retrospect, that in those first days the best possible chance to contain the virus was available, the reality of course was different, so it spread, as viruses tend to.

In complicated terms we then saw a hugely complicated effort by the Chinese government to contain the outbreak in and around the Wuhan City region, including a form of marshal law/quarantine that was massive its in size and scale, cordoning off a city of c 10 million people. That very complicated work (including the amazing construction of a new hospital facility within a few weeks) was largely possible to the culture of the Chinese people who were willing to make that effort for the greater good. It is worth considering if such a complicated containment effort to contain the virus would have worked in/around the city of Dallas, Texas for instance. Culturally I think not..

None the less despite all that complicate effort, the virus has continued to spread, beyond China and has now made its way to Italy and moving across Europe. We are now seeing a complex adaptive system in action, the key word here is complexity. Complex challenges are best understood by understanding the patterns within. The general pattern of disease transmission for viral illnesses is that those with the highest mortality rate (eg Ebola – up to 90%) are harder to transmit and spread than those with lower mortality rates (eg Influenza < 1%). We already know that the mortality rate of the coronavirus is low, < 2% and so is linked with a fairly high transmission rate as it can be passed on while the affected patient is very well. So this virus is clearly on the move and continuing to spread, despite massive effort to stop it.

So now we are at the stage where this outbreak is highlighting that the global healthcare system is a complex adaptive system.. that no one can control. Let me repeat that point, its is impossible to fully control a complex adaptive system as it is by definition made up of many parts and many interactions between those parts. We don’t hear enough of this complex adaptive systems science from the authorities, experts as to do so means that no one, not the Chinese government, the WHO , the US, EU or anyone else can control this outbreak now. In technical terms at this point we are seeing complex healthcare systems at the “edge of chaos”.

So we are looking into weeks/months of global chaos caused by this virus ahead of us. We are hearing talk of cancellation of events, of blocking the free movement of people, of shutting schools and colleges, etc etc.
What we know from Cynefin that chaotic systems require leadership. Clear leadership is required now to manage this situation but the leadership needs to be smart and understand the nature of the challenge we are up against.

My hope/instinct is that we will see this from the WHO very soon as/when we/they need to acknowledge that this virus is now reached the point of being outwith our capacity to contain it.. i.e. we are going to need to live with it.
Already I sense a slight shift in message telling people to focus on what they can do… wash hands, self care if symptoms develop, self isolate so as not to pass it on.. all good common sense advise, as we offer about all viral diseases of this type.

We’re seeing a fair bit of concern about the impact this will have in terms of illness and mortality from this virus for some while longer.. balanced against costs in economic terms. We will need to ask ourselves.. do we humans think we can control any/all other life forms on this planet.. do we need to change our lives at all?
We will not see a perfect response, more likely many imperfect choices, balancing risk and reward, decided in the face of complexity. We will need to learn as we go.
We are only human after all.

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