Thanks, Noemi! Mind if I think out loud then summarise?
Ok, so - worst case scenarios. I come from the flubie world: folks who were alerted by the World Health Organisation and more directly by a bunch of bloggers who wrote from a deep knowledge of epidemics and also from a condition of anonymity, which allowed them to truly speak their minds when those in official positions couldn’t. I’m thinking about the revere(s), one or more bloggers under one pen name, expert(s) in some aspects related to flu science, who wrote extensively about flu preparedness. A small but ilustrative sample - oddly appropriate to our subject, given that I just googled for “revere pandemic flu” - is here: Pandemic flu preparation: small steps in the right direction | ScienceBlogs
Gathering some good concepts from that era, I think of a few, and I can then expand: “staff and stuff”, “three family tribes”, “citizen manual”, “supply chain fragility”, “the role of the county”, “discovering real needs” … and maybe a few other concepts.
Sorry if this gets messy - unpacking long-time-packed concepts here - but then I can summarise and we can think more clearly about where we go next. Thanks!
“Staff and stuff” is what it says. In a crisis, for health care, you need to have people who can treat patients, and those people (health-care workers or family members or patients themselves, collectively called “staff”) need devices and supplies (a machine to analyse sugar in the blood, and also the reactants). In a bad pandemic flu scenario, both might be missing: healthcare workers may be “hit” (ill or taking care of their own families or frightened to go out), and supplies might be stuck somewhere along the supply chain because the truck drivers are “hit” too. (These problems go from 0% to 100% depending on the severity of the pandemic. At a certain point there are systemic effects added on: I could go to work but the bus driver is “hit”, therefore I’m “secondarily hit”.)
Now, what happens in a financial collapse (aka collapsonomics) scenario?
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Buildings and devices stay. Lack of maintenance is an issue later, not at the beginning. (Repairing needs supplies so it’s a supply issue, see later.)
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People (and their knowledge of science and each other) stay, at least at the beginning and in most instances. Some doctors (health-care workers in general, let’s talk about docs-etc) may flee to find jobs outside the country, but it’s not as if there are many jobs in those other countries, and language is an issue for many. If there’s no way to pay the docs-etc, we have a problem. Maybe we can just go back to mutuality: we feed the doc-etc, they treat our injuries-etc, we’re all better off.
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Supplies are the hardest issue here, because lack of money may mean stocks are not replenished. It’s happening in Greece, and again it’s may be 0% to 100% important, depending on the severity of the situation.
Some supplies are more vital than others. Diseases and injuries that kill the “young and otherwise healthy” - substracting many years from potential life - are a big priority. Insulin is a good example of that.
Some diseases or areas are more fragile than others, and the range is wide. Insulin-dependent diabetes is rapidly deadly in the total absence of injected insulin (3 days). (It’s like water to you or me. Can’t do without it, period.) Lack of medication for high blood pressure may mean a certain percentage of those with high pressure will have heart or brain complications and some of them might die in the next few months. At the lower priority end, some levels of anxiety can be treated with relaxation, exercise, food and meditation, maybe even showing how medication was not even the best solution to start with.
So, the model should include numbers, right? We’d need a list of prioritary diseases, with some numbers in a spreadsheet, so that supplies are sorted in terms of their priority. I think a good start would be the list of essential medicines published by the World Health Organisation (somewhere else on this page), with data from a specific country, and some knowledge about doses-per-day etc. I did that for insulin in the Canaries, as an exercise, and if my numbers were right we’d need maybe a couple of cubic meters of storage per million people and per month. In any case, those numbers are doable.
Ok, I’ll be back later, to add to the list of long-packed concepts. Please add your thoughts!
Ok, “three-family tribes”. This was a concept ideated by a fellow flubie (for the UK, where many people live in houses, but I don’t know if that’s needed).
In a bad pandemic, you don’t want flu to multiply like a wild fire - you want to slow it down. (That way, hospitals see how the severe cases are evened out over more weeks, so the same number of resources can cope better. You also buy time for other things, and maybe even reduce the total number of infected.) And one of the tools - talking bad pandemic here - is asking parents to keep kids at home for several weeks. This was explored by flubies - which, not taking into account that they are more worried about pandemic flu than most people, are also members of their own families - and the conclusion was that it was, erm, hard.
So one idea that came out was, let’s form tribes. Imagine 3 families, each with mom, dad, boy and girl - in 3 houses. Maybe they could split up: 2 adults and the 6 children go to the larger house, and don’t go out much. 4 adults stay in another house, go to work with facemasks, somehow buy food for the stay-at-home group.
But we’re not in a pandemic! Yes, sure. The concept is, form small tribes where people take care of each other. And this scenario is weird enough that we find other ideas more normal. (It’s what’s called a “provocation” in lateral thinking.) What would we do in an economic meltdown scenario?
I’ll cut it short here.
“Citizen manual”: http://fluwiki.info/ has a link to Influenza Pandemic Preparation and Response - A Citizen’s Guide version 2.0
The idea is a manual gives people ideas on how to be a good, safe citizen in a bad pandemic. I wonder what that would look like in a bad economic scenario. What would be in that booklet? What would we want to see? How would we get someone to write it? Would we trust the content?
“Supply chain fragility”. We’ve looked at that. A tough one. Supplies - of any kind - are produced, moved, stored, used. So we can act on any of those levels: produce more locally if you can, make sure it moves, store some just in case production or movement fail, and use less (or different) if you can. Easier said than done, but that’s the basic model.
“The role of the county”: some “flubies” approached pandemic flu as a “yoyo” (“you’re on our own”) situation: the state will be unable to help you deal with this, take care of your family, stock up and shelter in place. Others explored the “wowo” (“we’re on our own”) approach: we’ll work as communities and take care of each other. No community can produce their own insulin, but if the community is large enough there are doc-etc and maybe many other roles.
“Discovering real needs” … this was a big one for me personally. After looking at how systems would crumble down under the weight of a “bad enough” pandemic, you realise you’re left with needs. (I learned this through Vinay’s SCIM framework.) A “need” is something that doesn’t go away when the system fails. Thing is, before the system fails, needs are mostly invisible.
When talking about bad scenarios, I’m still surprised at how stbonrly we cling to our systems. “We _need _supermarkets, hospitals and schools to keep working.” Wait, we’re in the middle of a bad pandemic, right? What we need is food flowing to mouths, health needs taken care of as best we can, and kids growing as kids and into adults.
What I do is draw a very simple mind map. Mind map - Wikipedia A very simple one, with the system that’s about to break in the center. First order branches will have “needs”: what we want that system for, in terms of what breaks when the system breaks. Second order branches will have “substitutions”. An example would go like this:
If electricity fails at the hospital then these things fail:
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machine for killing germs in surgical knives. Need is “sterilisation”. So maybe we could boil them? Or use some chemicals? Or both? Then we set out to find someone who knows about these solutions and who can help us write a one-page document which we can distribute to hospitals.
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diagnostic devices like x-ray etc. Need is “diagnosis”. So maybe we could have solar panels for these devices alone? Or maybe we can use other ways to diagnose? What did retired doc-etc do when these devices hadn’t even been invented? Is there a multiquestion tool to help us diagnose when a specific device fails?
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Phones, email, etc. Need is “communications”. Can we use walkie-talkies? Walk? Send someone with a piece of written paper?
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etc.
So, what are “real health needs”? Could we brainstorm a list of 50-100? If we solve many of them without money, we’ll be healthy without being rich.
Ok, done for today. Thanks!
