COVID-19: Risk Based Response?


My background is in Occupational Health & Safety which means I tend to view things in terms of risk. What is risk? Well, I view risk as the level of uncertainty around an event or actions taken to influence that event.  When an event occurs or actions are taken, there are negative and positive consequences. When we manage risk, we try to increase the certainty of positive consequences and lessen the certainty and severity of negative consequences. This applies across all fields, not just OHS.

It pains me to see the level of devastation the world is going through right now. I think we can safely say that very few countries, if any, are going to receive an A grade for how they've handled the COVID-19 pandemic. The reasons for this are many and varied, but I believe a key factor is lack of preparedness. Decision-makers procrastinated; their risk tolerance was too high. They chose the comfort of short-term,  relatively certain, positive economic consequences,  over the uncertain, longer-term negative consequences of COVID19 (Our brains are hard-wired to favour soon; certain; positive consequences over later; uncertain; negative consequences). Where decisive, early action was taken, the tsunami of COVID-19 was held back. Unfortunately, as Singapore’s recent experience illustrates, controls need to be water-tight to hold the virus at bay. Singapore’s densely populated migrant-worker population now accounts for 80% of new cases. 

“The virus is out there, it’s not going away any time soon.”

Current Responses

Governments worldwide are implementing universal quarantine as a control for slowing the spread of the virus. The Lock-downs buy more time for preparation, but they do not eliminate the risk of COVID19.

Quarantine, lock-down, Stay Home or shelter in place orders do not eliminate the virus, they amortise the negative consequences over a longer period so that health-systems can cope with demand. But, we can’t live in quarantine forever. We need a risk based approach to re-open our communities.

Targeted lock-downs are effective at containing clusters, but blanket lock-downs are not sustainable. When thinking about lock-downs, let’s consider our own personal privilege. Are you reading this in the comfort of your own home? Do you feel safe and secure? Do you have food in your pantry? Do you have cash in your wallet/purse and money in the bank? Do you have a salary, other income or government payment coming in soon? If so, that’s great. Let’s be grateful and at the same time, considerate of those less fortunate than us: people living in shanty towns; living on the street; struggling to make rent; with no food to feed their kids. Lock-downs positively discriminate toward the privileged and have devastating impacts on lower socio-economic communities.

While delaying the spread of the virus (positive consequence), lockdowns also have negative consequences, not least of which is economic down-turn.

Let’s dive a little deeper:

Universal lock-down Positive consequences:

  • Delay the spread & reduce burden on healthcare system (particularly if it is under-funded)

  • Save COVID19 lives as ICU facilities are better able to cope with demand.

  • Provide time for increasing healthcare capacity

Level of certainty: HIGH

Universal lock-down Negative consequences:

  • Increase in mental health issues & suicides

  • Increase in deaths from non-covid19 factors due to fewer people accessing health-care e.g. delay in diagnosing cancer, difficulty securing supplies of maintenance medication.

  • Increase in domestic violence

  • Disproportionate burden on lower socio-economic members of society

  • Recession - businesses go bankrupt; people lose jobs; etc.

  • Increase in human rights violations

  • Dilution of trust in police - examples being Indian police beating citizens with sticks, 2 fatal shootings by the Police in the Philippines; countries deploying soldiers with armoured cars and machine guns and police in the UK publicly shaming people for taking a walk through the Derbyshire countryside.

  • Famine & starvation

  • Strain on democracy & rise of autocracy

Level of certainty: HIGH (Certainty is high, because we can predict outcomes based on studies from previous recessions & epidemics. )

The UN’s World Food Program has said lock-downs are “a hammer blow for millions who can only eat if they earn a wage". There is fear that 30 million people, and possibly more, could die in a matter of months.

Although there are certainly positive consequences from lock-down, there are also very serious negative consequences. How do we decide what action to take? The only solution is to take a risk-based approach, based on objective evidence, scientific evidence, and reliable data. 

What can we learn?

It is vital we learn from this crisis and implement sustainable long-term measures to prevent a similar event in the future:

  • Education: We must ensure our children understand and appreciate the importance of good hand & respiratory hygiene. This is a long game, but critical in breaking the transmission of infectious disease.

  • Primary Healthcare: We must ensure surge capacity is ready when we need it. Private industry already does this with disaster-recovery offices; hospitals can do it too.

  • Engineering controls for infectious diseases; we must rethink the design of our hospitals, ensuring as few people as possible are exposed to infectious diseases.

  • Fitness for work: It is unacceptable that anyone is exposed to a potentially fatal infectious disease if they are a member of a high-risk group. This is true for health-care and other "front-line" workers as it is for the general population. Too many health-care workers have died. It is simply unacceptable for anyone to say that deaths of healthcare workers is normal and to be expected. We are not at war. We need systems in place to ensure people on the front-line are not vulnerable to the disease.

  • Personal Protective Equipment: Our last line of defence, yet we have insufficient supplies globally. We must ensure a sufficient number of PPE is available for a surge in demand. Importantly, when we introduce engineering controls, we reduce our demand for PPE. We must ensure we have the right PPE available; e.g. powered air purifying respirators with an N95 filter beat a disposable N95 mask and homemade visor any day. I’m amazed we don’t have these at all hospitals. Yes, PAPR’s are comparatively expensive to a disposable mask, but in circumstances like this they save lives.

  • Training: We must ensure we regularly train our people and test our response. Drill, exercise, practice, improve.

  • Accurate data: There is currently a paucity of reliable data available; where data is available, it's difficult to compare to "normal" conditions and/or the data is inconsistently recorded with other countries. E.g. China excluded asymptomatic confirmed cases; US/Italy include deaths that were with COVID19, not by COVID19. It’s almost impossible to compare current to norm.

  • Border controls: It is clear that early intervention at our borders is highly effective. Taiwan and Vietnam are great examples of this. The International community must take note.

  • Monitor, audit, inspect. Run international exercises to test the system. Continually improve.

What’s next?

Now that most of the world is in lock-down/universal quarantine, it’s very difficult to come out of it. If we come out all at once, we risk a resurgence. So, we need to be very careful how we plan the lock-down exit.

There’s a lot more we need to learn about COVID19 and that increases uncertainty. But, we do know that COVID19 has a higher level of lethality for vulnerable groups in our society; people older than 65 and anyone with co-morbidities. Yes, there are reports of young healthy people dying and this is a tragedy, but these cases are outliers.

We also know that the vast majority of people (80%+) suffer minor symptoms and that practicing good hand & respiratory hygiene & social distancing reduce the risk of transmission.

We need to:

  • Pull together experts and diverse thinkers and formulate a step by step plan to exit lock-down.

  • Record accurate data and make it available to the public. Provide “normal” data for comparison.

  • Maintain social distancing rules, and hand & respiratory hygiene standards

  • Communicate widely on multiple channels and platforms; billboards, TV, Radio, Social media; Leaflets

  • Consult with local leaders; educate them on the risks and controls.

  • Support our Healthcare systems

  • Increase hospital capacity

  • Conduct an assessment on the control of substances hazardous to human health 

  • Ensure everyone is fit for work and NOT in one of the vulnerable groups

  • Adjust work methods and introduce engineering controls to reduce exposure

  • Ensure adequate PPE is available AND everyone is fit-tested AND trained 

  • Manage fatigue and ensure everyone has sufficient rest.

  • Safe disposal of hazardous waste

  • Protect vulnerable members of our society

  • Re-open Public Transport; Make it free, or contactless payment, so that there’s no interaction with the driver/conductor. Wear a mask.

  • Implement targeted isolation & quarantine when & where necessary.

  • Remove the army from the streets; if not feasible, at least remove military weaponry.

  • Re-open the economy… gradually, with controls in place.

  • People who can work from home should continue to work from home. Employers must support this.

We will get through this.

I’m amazed how we can all come together as one in the face of adversity. If we can harness this energy, maybe we can even reduce:

  • 800,000 childhood deaths from Lower Respiratory infections every year

  • 530,000 childhood deaths from diarrheal diseases every year

  • 350,000 childhood deaths from malaria every year

  • 80,000 childhood deaths from measles every year.

That’s just looking at deaths from infectious diseases in children under 5, every year.

The World Health Organisation estimates total Global Deaths in 2016 as follows:

Cardiovascular disease, while not infectious, is the biggest killer by far.

Almost 3 million people died from infectious respiratory disease in 2016.

At the time of publishing, confirmed COVID-19 deaths are 178,686.

Crises like the COVID19 pandemic can be an agent of change. 

Let’s work together for a more sustainable world.

Mark A. Doyle is an experienced international leader in Occupational Health and Safety. He has lived in the Asia-Pacific region for 20 years (in 4 different countries) and has successfully developed and implemented health & safety systems in developed & developing nations. Mark was previously Asia-Pacific Region Head for H&S for a Global 500 MNC, before founding his own H&S business in Singapore & Philippines. 

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