THREAD: A recent article about “why COVID herd immunity is probably impossible” prompted this thread…It got me thinking about our "exit" from this pandemic.

Some thoughts on how we can make better decisions going forward.

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https://www.nature.com/articles/d41586-021-00728-2

And while I realize it's hard to imagine currently in Ontario (and other places like India and Brazil), times will eventually improve…though what does that look like?

Its seems increasingly unlikely that we’ll make a “clean” escape ie. that COVID will just be behind us.

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Rather many smart ppl think its more likely to become endemic, despite every day I hear people talking about how vaccines will "end" COVID.

If only humans complied with 2nd vaccine dose...
https://www.nytimes.com/2021/04/25/business/covid-vaccines-second-doses.html

3/ https://www.nationalgeographic.com/science/article/covid-19-will-likely-be-with-us-forever-heres-how-well-live-with-it

I definitely don’t know the answer but if I were advising an organization, govts or business community, I’d probably take a prospective hindsight approach in future planning.

What does that look like?

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https://fs.blog/2014/01/kahneman-better-decisions/

An incredibly powerful strategy is to conceptualize decisions/outcomes not as certainties but rather as probabilities. This inherently forces you to imagine alternatives.

Though its rarely done on the regular b/c we simply default towards optimism https://www.behavioraleconomics.com/resources/mini-encyclopedia-of-be/optimism-bias/

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Making probablistic decisions is beneficial when faced with uncertainty (which is most of the time). This means, imaging a few potential outcomes so they can plan accordingly..."with 80% certainty I think this will occur"...implying 20% something else will happen...

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Klein & Kahnemann describes the extreme process as “pre-mortem” planning.

Does it work? Well, yes…it increases the chance of correctly finding reasons for future outcomes by 30%

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In trauma care, we do this regularly. Before the patient arrives we “pre-brief”…calling out & labelling worst case scenarios, we normalize behaviors required to execute during rare instances.

cc: @HumanFact0rz
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E.g. patient w/ gunshot to neck.

Plan: Attempt orotracheal intubation but if unsuccessful we’ll move to cricothyroidotomy.

A cric no longer becomes taboo, but a potential outcome. It allows team members to call out if other options fail & we are prepared

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Back to #COVID19, as we plan for the future we shouldn’t only imagine that “vaccines will cure all”…rather, organizations & businesses will have higher success if they imagine several scenarios …

Here's a few broad possibilities

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1. Vaccines are widely administered & herd immunity achieved – great! but increasingly improbable (see above)

2. Vaccines are widely administered but herd immunity isn’t “achieved” – virus continues to circulate & we manage outbreaks periodically over coming months

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3. A variant becomes predominant that eludes our current vaccine… I really F@*!'in hope this doesn't happen

4. We have a 4th wave – I don’t know what this would look like, but its definitely on radar for @ASPphysician & @BogochIsaac

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5. Finally…any good leader asks “what else am I missing” – this is a phrase I’ve learned from @HumanFact0rz

Because its highly probable I haven't thought of all scenarios yet other team members have...create that psychologically safe env't

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I love science. Vaccines are amazing. But its increasingly likely that unless there’s a worldwide equitable roll out and near 100% uptake, #COVID19 will persist and impact our day to day lives for months/years. We should plan accordingly. What does this look like?

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1. Protocols for rapid pivots to work from home
2. Strategies to repatriate travellers (business/leisure)
3. Rapid testing/tracing/isolating both within companies and within populations. A strategy advocated since beginning by @IrfanDhalla

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4. Temporary/recurrent shutdown strategies
5. Concentrated/temporary online education

If orgs/business/institutions aren't running thru these possibilities now, frankly theres no excuse

We ( @HumanFact0rz & I) use simulation to help guide enhance decision making

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While there's certainly lots to do now...there's also ample opportunity to make better decisions going forward

I think we're past "hoping" for the best. We've seen how that plays out.

Time to plan for multiple possible outcomes. It will only improve our decisions.

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