Getting Past the Pandemic
Beyond Hoping for the Best
Overview Hoping for the best is not an acceptable strategy. We need a way out of this pandemic, beyond saving our economies by killing more of ourselves. The prevailing prescription, of keeping our distance or else wearing masks, is necessary but insufficient: it leaves too many anomalies unexplained. We shall have to investigate plausible options with an attitude of "why not?". One such option is to face the effects of pollution. Beyond the immediate transmission of the virus through droplets, as well as its intermediate transmission through aerosols, could be infection at a distance due to several consequences of polluted air, which could be carrying the virus farther, longer, and deeper. Stopping the pollution—perhaps not so extreme—might not only help us deal with the pandemic; it will enable us to confront two crises of greater magnitude: premature deaths and climate change. Beyond the orthodoxies of science and administration lies an open window of opportunity.
(A video summary of this is also available.)
I am not a physician or a health care administrator. I am a professor of management who established my reputation by reframing some thinking about managerial work, strategy formation, and certain myths of health care. If anything needs reframing, this pandemic is it. Since March, I have been trying to do that, particularly with regard to several roles that air pollution may be playing in this pandemic. Here is the full story.
The story can begin in 1854, during an outbreak of cholera in London. A Dr John Snow, dismissed by the medical establishment for believing that cholera could be transmitted through water, placed a pin on a map where each death had occurred. All but two were in the vicinity of a single well. Dr Snow visited the home of one of these and found out that both she and her niece had been drinking water from that well: her niece turned out to be the second outlier. Hence, while the medical establishment was struggling to contain the outbreak, the handle was taken off the well and the outbreak ended. But not the disease: 12 years passed, and more people died, before the medical establishment acknowledged that cholera could be transmitted through polluted water. Might this story be repeating itself now, but with polluted air? We don’t have 12 years, let alone 12 months, to find out.
Seeing beyond Distancing
We are stuck, between killing our economies or killing more of ourselves. Yet those in authority, struggling to contain the spread of the coronavirus, have for months remained largely fixated on one prescription: keep a two-meter distance from others or else wear a mask. This is necessary advice, in the second wave more than ever, but it is not sufficient. Doubling down is no strategy when we don't understand what is going on. Something else is going on.
A way out might be seen by suspending what we believe, not only about the administration and transmission of this disease, but also about the orthodox practice of science. We shall have to stop being fixated on the tried but not always true and start facing the outliers, and the anomalies.
The distancing-or-masking prescription is based on a belief in the immediate transmission of the virus, through direct exposure to droplets emitted by infected individuals. Some scientists, however, have asserted the case for aerosols, much finer particles that can carry the virus beyond two meters—across a restaurant, for example, or even through the ventilating system of a residence. After months of resistance, the World Health Organization acknowledged this, at least in principle. Practice remains largely focussed on the immediate transmission, for example, that masks should be worn only when close to others, even though the aerosols can lurk beyond that.
Some evidence appeared in March suggesting that there may be a third form of transmission, which we can call distant, beyond intermediate. A team of scientists in Italy reported that the virus could adhere to particles of polluted air, which could carry it farther, maybe across a city or throughout a cruise ship. This might help to explain two anomalies associated with the comings and goings of the coronavirus.
First, why did the early outbreaks in places such as Wuhan end rather abruptly? True, people locked down could not transmit the virus directly, although it could be a stretch to believe that any lockdown can be that effective. (How few superspreaders might it take to keep it going?) But neither can people who are locked down pollute the air as they did before with their cars and at work. Could the clearing of the air have thus been a serendipitous consequence of the lockdowns? And, if so, might the reopening of an economy, to polluting as usual, help to explain the second wave of the pandemic.
Second, why is it that the cases of COVID-19 can be found so widely but not the outbreaks? They seem to have concentrated in some locations, gatherings, and facilities but not others—some cities, some weddings, some residences. Indoors, studies of some cruise ships and senior residences had found high levels of contamination in their air. Might this help to explain where many of the outbreaks have occurred, even when people were locked down in their rooms? Outdoors, the team of scientists found that the outbreaks in Italy tended to occur where there was extensive air pollution. In April, we looked at the ten largest outbreaks worldwide—in China, the United States, Italy, Spain, and Germany—and found that all occurred in such areas.
Other anomalies seem evident. How to explain that while some polluted places have escaped outbreaks, some unexpected places have experienced them—for example, around hog farms in Holland and in a remote area of southwest Iran (amonia being present in the former, a sandstorm with an oil refinery nearby in the latter). And why the high frequency of outbreaks in some kinds of localities but not others—such as in senior residences but not on airplanes? Can the spread of this disease really be what mathematicians call a random walk, as it steps from one new place to another? And will this disease turn out to be more contagious than we believe, or less? Or both?
Farther, longer, deeper
Polluted air could be exacerbating the pandemic in three ways: by bonding with the virus to carry it farther, by blocking the sun's UV rays to allow it to remain active longer, and by weakening our defenses to enable it to infect our bodies deeper.
The first effect has been discussed above. As for the second, a study in Brazil, finding an elevated incidence of hospitalizations for influenza when farmers were burning their fallen trees, the author postulated that the UV rays of the sun, which would normally render the virus inactive, were blocked by the heavy smoke. This blocking could, of course, happen in a city where smog might enable the virus travelling in the polluted air to remain active for longer periods of time.
After reading about the smoke in Brazil, I noticed the presence of smoke in a surprising number of prominent outbreaks: in and around hog plants in America that smoke pork, in a Beijing open-air market that roasts ducks, in the American embassy in Riyad after a birthday BBQ, and in the closure of several fire stations in Toronto. In India, with funeral pyres so prevalent, might more people get sick as a consequence of more people being cremated? And how about smoking on college campuses? Where there’s smoke, might there be greater likelihood of COVID-19?
If bonding allows for greater distance of travel and blocking allows for greater duration of activation, then the third effect of pollution concerns the density of the virus that arrives on the ground. Some scientists believe that, even if the virus could survive all that travel, it would likely lack sufficient density (viral load) to infect people. There is evidence, however, that living in polluted air can increase our likelihood of getting COVID-19 in the first place (aside from getting it worse), because that air has compromised our respiratory and/or immune systems, enabling the virus to do its infecting deeper in our bodies. Might a lower density of the virus thus suffice to infect susceptible people, who in turn pass it on to others, and cause an outbreak1?
“Not enough evidence”?
Acting together, these three effects of pollution could have a major effect on the spread and intensity of the pandemic. Given that the stakes are so high and our options are so limited, you might think that a sufficient case exists, at least to investigate the role of pollution in this pandemic. Good luck. Since April, I have been trying to make the case for pollution, especially with epidemiologists and op editors of prominent newspapers. (See my several posts instead on mintzberg.org/blog.) Back came the reply, when it came at all, time and again: “Not enough evidence.” Compared with what: the evidence in support of opening up our economies? Hoping for the best is not an acceptable strategy.
One epidemiologist suggested that establishing the necessary evidence could take two to three years. We need proper evidence, to be sure, but do we have even two or three months to deal with this pandemic? Instead of just flattening the curve yet again, while waiting for a vaccine, we will have to reframe how we see the role of science in this pandemic. We need to use every sensible means to investigate every plausible option—about the cause and spread of the disease and not just its treatment.
“Why not?” research
In research, inference has to not only follow, but also precede, the collection of evidence. In other words, ideas have to drive investigation, in the manner of Dr Snow. There are times when we need to ask “Why not?” instead of “Why?” It has been said before, and needs to be said again, that the absence of evidence is not evidence of its absence.
Dr Snow could not wait for the endorsement of his naysaying colleagues, so he went ahead and investigated his inference personally, through inductive learning, on the ground. We can call this detective research, since it is in the spirit of a Sherlock Holmes more than a Karl Popper.2
Unfortunately, a dismissive attitude of “Why?” has prevailed among many of the authorities in medicine and management during this pandemic, at least with regard to ideas outside their own paradigm (used to explain everything while ignoring the outliers and the anomalies). The WHO long resisted, first asymptomatic transmission of the virus, and then aerosol transmission. Two blindspots. Even some aerosol experts have resisted the idea of atmospheric transmission: theirs is an indoor paradigm. Might the effects of polluted air turn out to be a third blindspot? (If the coronavirus can circulate in a restaurant, why not to an adjoining terrace, then to a street of such terraces, finally across a polluted city with several such streets?).
All research is flawed, just as all theory is false. Research is an imperfect search for better explanations of reality. Theory is an abstraction of that reality—connected symbols on paper or on screen, not reality itself. This means that we must choose our theories according to how useful they are, not how true, or false. (The flat earth theory works just fine to build soccer fields in Holland.) The day I began to do empirical research, I discovered how charmingly serendipious reality can be. (I was observing chief executives at work, who were not doing what half a century of literature claimed they did.). That is why we need more of a “Why not?” attitude in research—to open up our conversations rather than closing them down.
The Montreal columnist Josh Freed once wrote about our country that “Canada works in practice. It just doesn’t work in theory.” Must practice wait for theory to catch up, especially when the lives of people are at stake? For Dr Snow’s inference, theory took 12 years to catch up.
How, then, to do research for the advancement of practice? Just as did Dr Snow: pursue the outrageous for whatever becomes obvious; investigate the outliers; smoke out the causes, and, especially, experiment—take the handles off the wells.
Try it. Just try it.
There is a great deal that we can try without taking undue risks. We can suspend the smoking activity in even one problematic hog plant or food market to see what happens to infection rates.3 How about this on a college campus with its several kinds of smoking?4 We can check schools, offices, factories, and arenas to ensure that they are free of contaminants that might carry the virus And in cities with outbreaks, we can try selective closings instead of general openings: close down the heavy emitters of pollution to see if that works?5
Will stopping the pollution stop the pandemic? Not by itself. This is no more the answer than is keeping our distances and wearing masks. But together these may provide a better answer. More certain, however, is that the real answer will have to lie in reframing the questions we ask, to allow some fresh air into our investigations. (See the box on ”What if…?”)
What if we take questions like these below seriously, however naïve or misguided some may be?
Beyond the Pandemic
We face two crises associated with air pollution that are of greater magnitude than this pandemic itself: premature deaths and climate change.
I have seen estimates of from four to eight million deaths every year as a consequence of polluted air. We hardly need more evidence to act on this indignity. And climate change may well kill a lot more of us than that, and change life on earth as we know it. These crises need to be addressed urgently—on the ground, in communities where the global response to pollution can be localized.
This pandemic opens a window of opportunity to deal with the deadly effects of pollution. Miss it, and we may not get another. Seize it, and our progeny will be forever grateful.
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1 "In addition, inhalation transports the particles deep into the lungs, especially those smaller than 2.5 microns (PM2.5 and UFPs), and this allows the virus to develop within the respiratory tract and to cause infections…. After having demonstrated the positive correlation between viral infections in the respiratory tract and exposure to PM, it is necessary to analyze the mechanism by which exposure to these agents can impact the subject’s susceptibility and immune response to infection. As respiratory tract cells are the first target of PM, as well as the first target of respiratory viruses, pathogens will invade already compromised cells if subjects are exposed to PM for a long time." (MDPI)
2 Karl Popper, whose surname an assistant of mine once typed as Propper, wrote a book, widely accepted by proper scientists, about The Logic of Scientific Discovery (1934, 1959). In its first four pages, in a section entitled “The Problem of Induction,” Popper dismissed this aspect so that he could devote the rest of his book to “the deductive method of testing.” Where is the “Discovery” in that?
3 Might two hog plants in the United States prove to be the outliers that help solidify the case? “A small number of employees at the Wisconsin and Missouri facilities have tested positive for COVID-19... Both plants are located near areas where ‘community spread of COVID-19 has been prevalent’” (Business News). In both, there were more cases in the nearby communities, apparently downwind, than in the plants themselves. Might, therefore, not the workers but the smoke have carried in the virus?
4 Several people have assured me that there will be great resistance to this. From students who want their degrees? Or jobs after that?
5 This, I am told, is too radical. Not at all. Because of the lockdowns, some cities now find themselves pollution-free. They just need to stay that way, by opening up everything that does not pollute heavily. Many other cities are well on their way to this, thanks to the use of recycling and clean forms of energy as well as promoting different kinds of commuting. The shift from manufacturing to service industries has also helped to reduce pollution, as has the regulation of heavy polluters