We live in a complex system. Complex systems are those that are intrinsically difficult to model due to interactions between their parts or between a given system and its environment. Their reaction to a given input is unpredictable. The capacity of a complex system to absorb hits and disturbances and still retain basic function and structure is called resilience. Non-resilient systems destabilize and mutate to new, most frequently, less desirable states1. The coronavirus disease (Covid-19), the pandemic disease caused by the SARS-CoV-2 virus, demonstrates how susceptible our complex systems are, when the disturbance cannot be controlled rapidly and effectively.
Almost every thinkable component of our complex system was hit: our cells, organs and body, our souls, our welfare infrastructure, our nurses and therapists, our physicians, hospital managers, our political leadership, the small and medium businesses, the whole economy, whole countries. The list is almost endless. The exponential infection rate of the highly contagious SARS-CoV-2 virus together with our limited treatment options (no causal therapy, no vaccine) put our health system under a tremendous strain. As could be expected from a complex system composed of complex subsystems, the reactions were mixed. Some subsystems were resilient, others not. Thousands of people were infected, almost 40% did not show any or had light symptoms, others developed light to moderate symptoms that did not progress, others (approx. 5-10%) progressed to a full-blown Covid-19. Among the latter, approximately 10% further deteriorated and eventually died. We do not know the specific factors, which determine the kind of course the infection will take. We do know, however, that old age and underlying diseases are risk factors and that the release of variable amount of cytokines (up to the so called “cytokine storm”) plays a key role in the pathophysiology of this scary disease.
Locally speaking, the canton of Ticino and its health system, despite being so close to Northern Italy, the European epicentre of the pandemic, proved its resilience. It reorganized, adapted and absorbed the hit of the massive wave.
One common denominator for resilient systems is political leadership. The regions, cantons or countries, which performed better (i.e. that demonstrated good systemic resilience) were those with a central, top-down leadership composed of top level responsible politicians in concert with top notch specialists of infectious diseases, epidemiology, public health and civil protection, all organized in pre-existing or ad hoc established crisis-management teams with executive authority, organized communication and functional feedback logistics on the ground. Crisis needs strong leadership, technical competence and effective communication.
An eye-opening aspect of the SARS-CoV-2 tsunami-like pandemic is the factual demonstration of an impressive contrast: system resilience versus system efficiency and optimization. Resilience in an economic system means redundancy, which is exactly what an efficient and optimized industrial-type economic system tries to reduce to a minimum. There is no doubt (at least for me…), that if we had been able to provide the whole population with surgical face masks every day and for at least two months and the hospitals with sufficient amount of adequate protective equipment (together with social distancing and other effective measures) the impact of the pandemic would have been much lower. In numbers, this means billions of surgical masks. Nobody can expect that a state, even a rich one like Switzerland, would stock such an amount of surgical masks. A resilient system, however, should not completely rely on “on call” delivery from the Far East. It should foresee to maintain a small but adaptable local production of such relatively low cost items. This is obviously not cost efficient. However, at the end of the day or in our case, at the end of the crisis, this efficiency will reveal its cost: the loss of too many lives. Resilience of the system is “systems thinking”, a scientific approach to evaluate possible misalignments between our mental models and reality.
Our mental model of systemic economic efficiency did not pass the reality check. How much is the readiness of healthcare allowed to cost? How many Intensive Care Units are we willing to afford? To what extent should they be equipped and staffed? What is the degree of (strategic) autonomy we as citizens want to have and afford, when it comes to the ability of a state to protect its people? This is the new era of civil protection. The private bunkers, which were compulsory in Switzerland in the second half of the last century, were also not cost efficient. They were, however, perceived as necessary. Epidemics and other threats to public health are the new enemies, the new invisible armadas2.
We should rethink and evaluate our systemic resilience in this context. If an opportunity is hidden in the current crisis, this could be it.
- Walker, B., Salt D. (2012). Resilience Thinking. Island Press.
- Harari, Y. N. (2017). Homo Deus. C.H.Beck.