Rashid A Mughal
MUCH has been written and will continue to be written about Covid-19 as long as the disease is not completely eliminated in the world. What appeared to be a “flu” like virus, engulfed the whole universe in no time and within 4/5 months it spread from China, (where the first case was reported on 17 November 2019), to Europe, America, south America, Canada, Africa and Australia and New Zealand. The leaders were stunned and the health care workers were worried. By January 2020 the doctors knew how deadly it was and havoc it can create. They were damn right. Today we have 800,000 people dead globally because of virus and 12 million people affected and the number is rising with each passing day.
In its early stages, the Covid-19 crisis looked nothing like a big crisis. The initial state-of-emergency declarations were met by skepticism by both the public and many in policy-making circles — even though several scientists had been warning of the potential for a catastrophe for weeks. Similar opinions were repeated across many other countries and exemplify what behavioural scientists call “confirmation bias” — a tendency to seize upon information that confirms our preferred position or initial hypothesis.
Threats such as pandemics that evolve in a nonlinear fashion (i.e., they start small but exponentially intensify) are especially tricky to confront because of the challenges of rapidly interpreting what is happening in real time. The most effective time to take strong action is extremely early, when the threat appears to be small — or even before there are any cases. But if the intervention actually works, it will appear in retrospect as if the strong actions were an overreaction. This is a game many politicians don’t want to play. The systematic inability to listen to experts highlights the trouble that leaders — and people in general — have figured out how to act in dire, highly complex situations where there’s no easy solution. The desire to act causes leaders to rely on their gut feeling or the opinions of their inner circle. But in a time of uncertainty, it is essential to resist that temptation and instead take time to discover, organize and absorb the partial knowledge that is dispersed across different pockets of expertise.
Finding the right implementation approach requires the ability to quickly learn from both successes and failures and the willingness to change actions accordingly. Certainly, there are valuable lessons to be learned from the approaches of China, South Korea, New Zealand, Taiwan, and Singapore, which were able to contain the contagion fairly early. But sometimes the best practices can be found just next door. To study and learn from Italy, where Covid-19 played havoc, we need to know about how the system works there. The Italian health-care system is highly decentralized, different regions tried different policy responses. The most notable example is the contrast between the approaches taken by Lombardy and Veneto, two neighbouring regions with similar socio-economic profiles.
Lombardy, one of Europe’s wealthiest and most productive areas, has been disproportionately hit by Covid-19. As of March 26, it held the grim record of nearly 35,000 novel corona virus cases and 5,000 deaths in a population of 10 million. Veneto, by contrast, fared significantly better, with 7,000 cases and 287 deaths in a population of 5 million, despite experiencing sustained community spread early on. The trajectories of these two regions have been shaped by a multitude of factors outside the control of policymakers, including Lombardy’s greater population density and higher number of cases when the crisis erupted. But it’s becoming increasingly apparent that different public health choices made early in the cycle of the pandemic also had an impact.
Specifically, while Lombardy and Veneto applied similar approaches to social distancing and retail closures, Veneto took a much more proactive approach towards the containment of the virus. Veneto’s strategy was multi-pronged. It started extensive testing of symptomatic and asymptomatic cases early on, did proactive tracing of potential positives. If someone tested positive, everyone in that patient’s home as well as their neighbours were tested. If testing kits were unavailable, they were self-quarantined, strong emphasis on home diagnosis and care was introduced and whenever possible, samples were collected directly from a patient’s home and then processed in regional and local university labs. Specific efforts were made to monitor and protect health care and other essential workers which included medical professionals, those in contact with at-risk populations (e.g., caregivers in nursing homes), and workers exposed to the public (e.g., supermarket cashiers, pharmacists, and protective services staff). All these combined efforts and protocols yielded positive results, subsequently.
Following the guidance from public health authorities in the central government, Lombardy opted instead for a more conservative approach to testing. On a per capita basis, it has so far conducted half of the tests in Veneto and had a much stronger focus only on symptomatic cases — and has so far made limited investment in proactive tracing, home care and monitoring, and protection of health care workers. The set of policies enacted in Veneto are thought to have considerably reduced the burden on hospitals and minimized the risk of Covid-19 spreading in medical facilities, a problem that has greatly impacted hospitals in Lombardy. The fact that different policies resulted in different outcomes across otherwise similar regions should have been recognized as a powerful learning opportunity from the start. The findings emerging from Veneto could have been used to revisit regional and central policies early on. Yet, it is only in recent days, a full month after the outbreak in Italy, that Lombardy and other regions are taking steps to emulate some of the aspects of the “Veneto approach,” which include pressuring the central government to help them boost their efforts.
The difficulty in diffusing newly acquired knowledge is a well-known phenomenon in both private- and the public-sector organizations. But, in our view, accelerating the diffusion of knowledge that is emerging from different policy choices (in Italy and elsewhere) should be considered a top priority at a time when “every country is reinventing the wheel,” as several scientists told us. For that to happen, especially at this time of heightened uncertainty, it is essential to consider different policies as if they were “experiments,” rather than personal or political battles, and to adopt a mindset (as well as systems and processes) that facilitates learning from past and current experiences in dealing with Covid-19 as effectively and rapidly as possible. However it is noteworthy that when first case of virus surfaced in Wuhan on 17 November and by 30th November over 2500 persons were affected, why it took WHO a month to issue guidelines and prevention protocols. World expected immediate response and advisory policies from them much earlier.
— The writer is former DG (Emigration) and consultant ILO, IOM.
