We need a rational approach to reopening

A polarised debate must give way to fine-grained, targeted responses.

If there were ever a time for rational decision-making, it is now. Picture: iStock

After unprecedented lockdowns and restrictions to flatten the curve of COVID-19 infection, business and government leaders are wrestling with the question of when and how to ease them. Various approaches are being tried, and there are wide differences of opinion. Much of the broader debate is polarised, as if only two conditions exist — closed or open. The stakes couldn’t be higher. If there were ever a time for rational decision-making, it is now.

BE CLEAR ABOUT THE OBJECTIVE

Objectives for reopening must balance competing considerations. Decision scientists call these “saddle point” problems, which typically involve minimising one quantity and maximising another. For example, an objective could be “to minimise COVID-19 impact while maximising non-COVID-19 health outcomes”. Or it could be “to minimise deaths from COVID-19 while maximising preservation of employment”. Framing the question precisely is the first step towards a clear solution.

APPLY GRANULARITY

In comparing US military efforts in Iraq and Afghanistan, General David Petraeus said in 2010: “We have never had the granular understanding of local circumstances in Afghanistan that we achieved over time in Iraq. One of the key elements in our ability to be agile in Iraq during the surge was a pretty good understanding of who the powerbrokers were in local areas, how the systems were supposed to work, how they really worked.” The initial COVID-19 responses have involved the broadest, bluntest instrument possible: mass shelter-in-place restrictions. Yet the impact of COVID-19 has been anything but uniform.

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There are striking granular differences across regions and highly compartmentalised effects within population/demographic groups and professional/occupational cohorts. Granular problems usually call for granular solutions — solutions that focus resources and interventions specifically and in a highly targeted way. There are many solution choices (between very open and very closed) that can be applied in different ways in different settings (for example, different areas, different cohorts, different circumstances).

So far, the most significant COVID-19 outbreaks have occurred in places with high density and high contact rates between people. These are places where “community spread” has occurred — think New York City and Milan. Although geography is most often thought of at a country or state/province level, granularity applies to cities, communities, neighbourhoods, campuses and even individual buildings or parts of buildings (think elevators versus individual offices): all can exhibit different densities and contact rates. A full commercial flight has a high density and contact rate, as does a crowded Apple store.

Epidemiologists believe that COVID-19 spreads primarily through close contact with an infected person (who may be a­symptomatic). Spread occurs in an interaction involving two or more people — a ride in an Uber, a stop at the grocery store, a visit to the hair salon. A granular approach to reopening must consider the most common interactions and the risk associated with each — which is related to the intensity of the interaction and the number of people involved. High-intensity interactions increase the risk that an infected person transmits the virus; a larger number of people increases the likelihood that someone in the group is infected and increases the risk of transmission to more than one person in the group. Increase the number of people and the possible routes of transmission multiply. This means that a tattoo studio or pet groomer, following appropriate guidelines, creates far less risk than a crowded flight does.

BUILD THE CAPACITY TO LEARN AND ADAPT QUICKLY

There is still much we don’t know about COVID-19, but we are learning more every day. The coming weeks will be marked by much experimentation and learning around which reopening strategies work well and which don’t. There are 200 country-wide experiments going on now, and in the US alone more than 100 experiments are taking place across 50 states.

Learning from these experiments and from the granular outliers is essential. Leaders must be able to cut through the noise of daily statistics and headlines to understand these experiments and decide how to apply what they learn to their own settings. Well-designed experiments — with specific hypotheses to test, data gathered and results monitored — will maximise what we can learn. A fundamental challenge is the lack of a shared set of assumptions and a common language. Establishing these early will accelerate progress.

Patrick Viguerie is the managing partner of Innosight. Alex Viguerie is a postdoctoral fellow at the University of Pavia.