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Investigating the Cause of the Coronavirus - Part II

5 April 2020

Part I. Identifying the Anomalies

Part II. EXPLAINING THE ANOMALIES

Shortly after posting Part I, Identifying the Anomalies, I came across a recent study with an insight that could reframe this whole discussion. For me at least, it seems to explain the anomalies. After considerable digging by colleagues (see below), here are the conclusions.

Part I. Identifying the Anomalies

Part II. EXPLAINING THE ANOMALIES

Shortly after posting Part I, Identifying the Anomalies, I came across a recent study with an insight that could reframe this whole discussion. For me at least, it seems to explain the anomalies. After considerable digging by colleagues (see below), here are the conclusions.

Authored by a number of academics and medical authorities in the north of Italy, the report links atmospheric pollution to the rapid propagation of the Coronavirus: it  attaches itself to minute particles  which can remain in the air—the report claims “even for hours, days and weeks, and that can be carried for long distances.”. But, importantly, other evidence suggests that most of it can remain active that way for only a few hundred meters.1

If true, then this might explain why people can get infected with no direct exposure, just from the air they breathe where they live. This could also explain why the outbreaks do not hop much from central cities to surrounding towns, sometimes even local suburbs. It also suggests why some places, especially big cities, get major outbreaks, while some others do not: they can be especially polluted by traffic and industrial activity (Wuhan, New York). Compare this with most rural areas, maybe even with favelas that have few cars or big factories (also higher temperatures, which appear to be negatively correlated with the spread of the virus.) Consider terrain as well: cities that are surrounded by mountains that trap polluted air (such as Tehran), and that experience inversions and heavy smog (such as New York), could be more susceptible to large outbreaks than  those in flat areas with stronger winds (such as in the Arab states of the Middle East). 

China and South Korea have been lauded for the isolation of their people to slow the spread of the virus. True enough, but perhaps another significant benefit has been serendipitous: with less driving and many factories closed, pollution has been greatly reduced. Can this explain the two rather abrupt endings to their outbreaks?

Let’s put this together in three levels of transmission: Level 1 is direct and personal—immediate exposure in a room or a park to droplets in the air, from a cough (with evidence now that this can extend beyond two meters), or that fall on a surface that is then touched. Level 2 is local and atmospheric, from particles in polluted air presumably inhaled (or touched when grounded?), most likely in an industrialized city, but not beyond.

In between these first two levels might be institutional and confined, as in senior homes, cruise ships and wedding halls, where problematic particles (aerosols? microplastic particles?) could be traveling through central ventilating systems. This raises a key question: what kinds of particles are most susceptible to carrying this virus around?

Level 3 is global and geographic, namely travel from infected centers to other places in the world. Coronavirus is certainly moving worldwide, but when it lands, how extensively is it spreading? This third level seems to be a combination of the first two levels: The virus could be traveling personally, and spreading directly, for example as someone infected flies in without being quarantined. But it could, or could not, be spreading locally, depending on the local conditions, such as pollution, temperature, wind, and terrain, maybe humidity as well.

What to do with all this? We can reframe our thinking from “It’s coming! It’s coming!” to the virus is coming everywhere but the outbreaks are not spreading everywhere. Hence we can consider where it might it be likely to spread, and, accordingly, how to allocate efforts and equipment. We can study weather patterns, especially wind,  and predict movements of the virus in the immediate area. Areas with outbreaks may have to take aggressive actions to reduce their pollution, for example by closing down polluting plants immediately (also for the sake of global warming—remember that?). Is this the handle off the polluted well? And traffic can be restricted when the outbreak is severe enough (even relying on electric vehicles where possible in the interim).

Guess what Dr Snow, We're back to the air!

_____________________________
Thank you Nathalie Duchesne for drawing my attention to the Italian study, and to Hanieh Mohammadi and Paola Adinolfi in Italy, as well as Nathalie, for digging out so much useful material.

 

Most of the viruses are super fragile and if they are flown away by the wind, most of them get deactivated because the outer shell of the virus will be broken. Tests that show the presence of the virus in long distances from the origin of the virus are only tracing the RNA of the virus (ribonucleic acid, a nucleic acid present in all living cells), but most of those RNAs are not active (PCR tests). Previous studies about other viruses, such as Zika and Ebola, appear to reinforce this finding.

© Henry Mintzberg, 2020. 

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Investigating the Cause of the Coronavirus - Part I

31 March 2020

Part I. Identifying the Anomalies

Part II. EXPLAINING THE ANOMALIES

The Pump

Part I. Identifying the Anomalies

Part II. EXPLAINING THE ANOMALIES

The Pump

Now is the time to revisit the story of Dr John Snow, who was selected by a poll of British physicians as their greatest one ever. This came more than a century after he was dismissed by the British medical establishment as a maverick for having questioned the accepted wisdom that Cholera had to be transmitted through the air. During an 1854 outbreak in London, he plotted pins on a map of London where each person had died. These clustered around a well, except for two outliers. He visited the home of one of them and was told that she liked the water in that well, and sent her maid to fetch it. Her niece also drank that water; she turned out to be the other outlier. And so, while the medical establishment was frantically dealing with the outbreak, the well was disabled, and the outbreak ended. Later, sewage was found to be seeping into the well from a pipe nearby.

My field is management, not medicine, although I have investigated the myths of managing health care in a book by that title. It describes the great strength of modern medicine—its capacity to categorize—as well as its debilitating weakness, namely getting stuck in those categories.

We have a number of explanations for the nature and transmission of the Coronavirus, all presumably correct (in one way if not the other). But are they adequate? There seem to be anomalies in the widely reported data: are these just curiosities, or do they reveal blindspots? Is there something else going on in the way this disease is manifesting itself? I may be badly misinformed about some of what follows, and things are changing so quickly that some of it might be outdated in hours. But if one seemingly ridiculous idea below reaches just one person who has the capacity to make something of it, then it will all be worth it. So please suspend disbelief and see if you can find one—the idea, or that person.

  • Everywhere I turn, locally and abroad, I am being told that “It’s coming! It’s coming!” But it’s not coming everywhere, only in some places. Why these places? Infections and deaths vary markedly across countries, regions, and spaces, often surprisingly so. It did come in China, or at least in Wuhan, yet not in neighboring countries, except South Korea. It has come to Italy and Spain but not Scandinavia that way. Iran has it badly, and Israel has many cases (both countries Caucasian), but not in the Arab countries in that region (even, apparently, less in southern Iran, that is more Arab). Is there something in the air, the practices, the diets? Why has this virus spread catastrophically in some confined spaces but not in some others: cruise ships, seniors’ residences, and a few Jewish weddings, but not so much in the favelas of Brazil (these surely being more densely populated that any cruise ship). Nor in rural areas and First Nation reserves in Canada. Are some countries and spaces intrinsically more—or less—at risk, and if so, why? We have some ready but inadequate explanations for this; how about some maverick ones?
  • Why do some people get the virus with no obvious exposure? Is this just a question of tracking down that exposure, or can there be some unknown form of transmission? Or might some people be intrinsically immune, and others intrinsically susceptible?
  • Italy and Germany are almost neighbors, yet the death rates have been vastly different. There are many explanations for this. Do they account for the difference? Surely the Italian population is not that much older than the German. And large teams from China were working, not only in northern Italy, but in a number of other places that have had no comparable outbreaks. Will the world continue to split into the Italys and the Germanys? If so, might there be something in the environment, the food, the lifestyle, the culture? One family in New Jersey has been devastated by deaths in two generations. They are of Italian origin. Is this an outlier that can explain something important?
  • How is it that China and South Korea seem to have arrested the spread (so far)? Can testing and confinement explain this in a country of over a billion people, whereas one person at a cocktail party or wedding in the West can infect dozens of others? Has nobody in China had a party recently?

Dr. Snow thought outside the paradigm of the time, so to speak. Our paradigms today are no different: they focus our thinking while blinding us to other possibilities. Dr. Snow used an unusual method of research by today’s medical standards, akin to detective work—better suited to investigating cause, if not to testing cure. His probe of a sample of two outliers made his case. He began with an idea and then looked at the data. His population was a targeted community.

I have been spending two hours a day on Zoom with a number of people in Quebec, mostly emergency room physicians, some working with the government health department. It has not been easy to make this argument, for good reason: they have to cope. Finally, on one of the calls, Joanne Liu, an ER doctor who just completed two terms as president of Doctors Without Borders, recalled a refugee camp in Bangladesh where an expected Cholera outbreak never materialized. She had wondered about the clay ground. Then a nurse from British Columbia, who is heading up the staffing for the response in the First Nations reserves there, commented that there had been no outbreak so far. Indeed, one member of a reserve, who recently flew in an airplane next to someone who tested positive, didn’t get it.

We set up a smaller group on Zoom—three lateral thinkers, and three seasoned physicians—to try to explain some of these anomalies. Detective work for cause has to go up every possible avenue. So here are a few, some probably absurd. Can certain medicines, themselves, beside treating a disease, make people more, or less, susceptible to the virus? We could take some common ones—for hypertension, cholesterol, anxiety—and get data on their usage in the places of high and low incidence of the virus.  (We’re trying. Hanieh Mohammadi, a doctoral student I supervise at McGill, emailed me as I write this about a report in Italy that the virus may be hitting people with Vitamin D deficiency harder.) Or how about Israel compared with the Arab states, and those Jewish weddings. Is there something in the food, the genes, the heart conditions?  Does salt or sugar consumption have something to do with susceptibility and severity? (I had had Vitamin D in this list originally, but took it out as too far-fetched!) Or those tiny plastic particles, that may be more in the air of urban and developed places? On one hand, air pollution damages the lungs. On the other, might it affect the travel of a virus that might somehow go farther than a meter or two? (I was going to take this out too, but reconsidered.) Frank Fan Xia, a business school professor in Rennes, France, wrote to me with the following comment: “Faecal-oral transmission may explain the 2003 outbreak of SARS-CoV in Hong Kong (Cotruvo et al, 2004, and Yeo et al. (2020) suggest SARS-CoV-2, which is found in patients’ faecal (Holshue et al, 2020) and toilet bowl (Ong et al, 2020), can also transmit in a faecal-oral route. If you live in an apartment/hotel building, or a cruise ship, and if any of the neighbors are infected, please use bleach to clean your toilets and drains.” Do I smell the Dr Snow story here? (Frank also mentioned aerosols and ventilation pipes.)  Who knows?

What I do know is that we should be thinking of everything possible, because some key explanation of cause might be staring us right in the face, as it did Dr Snow. Is there another Dr Snow out there?

Click here to Part II.

© Henry Mintzberg, 2020. Our Zoom group, "Blind spot", has been organized by galvanized participants and alumni of our International Masters for Health Leadership (imhl.org), a spinoff of our International Masters Program for Managers (impm.org). Thank you Rick Fleet and Jean-Simon Létourneau, IMHL class of 2020, who pulled the group together despite their ER responsibilities in Quebec City.

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Consolidation for Reformation

7 March 2020

“We will either find a way or make one.” (Hannibal)

The blog on January 1st introduced The Declaration of our Interdependence, for the restoration of balance across the three sectors of society—public governments, private enterprises, and plural communities. But how to get from words on a screen to rebalancing of societies? The blog that followed, on February 1st, outlined the first step—the taking of individual and collective actions (shown in a table of of 32 possibilities). This blog discusses how to consolidate such actions into a movement for grounded reformation.

“We will either find a way or make one.” (Hannibal)

The blog on January 1st introduced The Declaration of our Interdependence, for the restoration of balance across the three sectors of society—public governments, private enterprises, and plural communities. But how to get from words on a screen to rebalancing of societies? The blog that followed, on February 1st, outlined the first step—the taking of individual and collective actions (shown in a table of of 32 possibilities). This blog discusses how to consolidate such actions into a movement for grounded reformation.

The Message of the 16th Century Reformation


What is known as the Reformation began with words on a door in Germany and ended with a realignment of power in Europe. In 1517, with widespread outrage over corruption in the dominating religion, an obscure monk named Martin Luther challenged its prevailing authority by nailing a list of 95 theses (really grievances) to the door of one of its churches. His words spread within weeks, carried by the new social medium of the time, the printing press. A groundswell followed, as angry people in communities confronted the corruption. Eventually, new institutions formed and some existing ones reformed. Much of the world changed.

Can our world so change? That was Europe five centuries ago, concerning the corruption of one institution. Today we face corruption in many institutions, worldwide. Is reformation on a global scale impossible? Well, the devastating effects of climate change are not only possible but existent. Income disparities are on the rise. And another great war is possible—and would be the last—with several loose cannons elected by people fed up with these income disparities. When disaster looms, the impossible can become possible, indeed necessary.

Starting on the ground, not at the “top”


Where, then, to begin? At the top? The Reformation did not begin at any top, yet today that is where the  preferred solutions focus: the established authorities are supposed to fix the establishment. Elect heroic leaders. Hold lofty conferences. Make 30-year plans. Pretend to fix capitalism. All to no avail.

The record of heroic leadership is hardly stellar. Much of it has proved to be impotent when not autocratic. Have we not had enough of the leadership fix?

The lofty conferences on global warming seem to generate more of it, thanks to all the travel, let alone the talk (not to mention the swarms of private jets that descend on Davos every year to bemoan the warming). At home, politicians with four-year mandates proclaim 30-year plans. Why do we tolerate such nonsense?

Then there are the adjectival capitalism fixes—Progressive Capitalism, Caring Capitalism, Inclusive Capitalism, Sustainable Capitalism, even Democratic Capitalism (democracy being the adjective). Capitalism certainly needs fixing, but that will not fix societies broken by its own power. It is these societies that need fixing, by restoring balance across their sectors.

The change we require will have to begin on the ground, as it did in the Reformation. Franklin Delano Roosevelt caught the spirit of this when he was asked by an activist to champion a particular change. He replied: “I agree with you. I want to do it. Now go out and make me do it.” The message is clear: reforming established institutions may be the last step in reformation. The first ones have to be taken on the ground.

Pathway to Reformation


Consider these steps to reformation:


Declaration of common cause => Reframing beliefs => Reversing wrongs and Renewing rights => Consolidating this activity => Reforming institutions

The path to reformation is opened by a compelling statement of common cause that reframes what we believe, or have been made to believe, so that we can understand what is wrong and take action to make it right. If we believe that change must come from the top, then most of us will sit around waiting for it to happen. If we believe that the wealth of globalization trickles down to everyone, then we will take what we get. If we believe that democracy is about swinging between left and right, then we will not see the plural sector for the role it must play in buttressing the power of the public and private sectors. It is the reframing of beliefs that galvanizes action.

Consolidating Activities

The last blog presented a table outlining a variety of actions that can be taken to address our problems. We are, in fact, getting a great deal of it, more than ever before. One book estimated the number of social initiatives for such activities to exceed one million, on a wide variety of fronts: for social justice, sustainable environment, world peace, reformed education, and much more.

That book was published in 2007, yet consider what has been happening to the imbalance ever since. The more constructive activity we get, the worse the imbalance becomes. That is because, while the efforts for reformative change are scattered, the forces that exacerbate the imbalance work in concert, for self-interest—as when they promote conspicuous consumption. These efforts will have to consolidate, around a common cause, which I believe will have to be the restoration of balance. A clear focus of attention (such The Declaration of our Interdependence) is required to fuse a myriad of activities into a movement for regeneration. But this consolidation cannot center on any institution or plan; it has to happen as a groundswell of community activity, as in the Reformation, but this time networked worldwide.

We shall have to recognize that imbalance in society is a root cause of the major problems we face—the social injustices, income disparities, decline of democracy, even much of climate change. How, for example, are we to reverse climate change as long as private power drives so much conspicuous consumption? In other words, if you are concerned about the climate, you had better put the rebalancing of society front and center.

The corruption of established institutions is far more widespread than at the time of Luther, and the dangers we face are far more alarming. We have glorified greed and excess long enough; it is time to value balance and benevolence. Our choice comes down to this: grounded reformation or global devastation. We can continue to plunder this planet, and each other, or we can make our way to reformation.

© Henry Mintzberg 2020, adapted from a note on “Next Steps” on The Declaration of our Interdependence.   

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