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The Complexity of 21st Century Health Care

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With this preliminary framing and charting completed, we turn to what happens when we try to maximize the benefits of either side at the expense of the other side. In the case of sustaining the NPI/social distancing policy, the maximization of social distancing and related preventive measures would (as the epidemiological models indicate) tend to delay but ultimately accelerate the rate of infections and ultimately virus-related deaths. Furthermore, we now know that the masks don’t necessarily prevent the virus from spreading. The virus comes in through the sides of the masks which most people wore during the COVID-19 crisis (much as water comes in through the edges of our googles, not through the glass). We would soon be in despair regarding the failure of this NPI/social distancing policy. At some point, we might adopt the herd policy, but would probably find that it is too late.

Conversely, if we completely override the NPI/social distancing policy and fully adopt the herd infection policy, then we would witness massive death rates and would be deeply concerned within a short period of time (throughout the world) regarding the “heartlessness” of this policy. We would inevitably find that projections about the potential number of people who would die before herd immunization was established are staggering. We would feel deeply wounded about the decisions being made. If we are religious and view ourselves as culpable, then we might ask our deity for forgiveness. Other members of our society would be inclined to launch a vitriolic attack against those who enacted this grotesque policy. As a result, we are likely to return to a NPI/social distancing policy—though only after many deaths. And the NPI/social distancing policy would still be flawed.

As already noted, we must try to optimize the degree to which we are inclined toward one side or the other as well as the duration of our stay with consideration (or compassion) and enactment of this side. We are to take this approach rather than attempt to maximize any one side. How serious are we about focusing on this one side and how long are we going to sustain this focus? Optimizing also means that we must find a reasonable and perhaps flexible set-point as we act in favor of one side or another. Finding these acceptable optimum responses and repeatedly redefining them is the key to polarity management. This strategy is aligned with the suggestion made by many health policy experts that with future pandemic virus we should periodically adopt a NPI policy, rather than abandoning it all together.

The fundamental recommendation to be made in managing this particular polarity is to remain in the positive domain of each policy option long enough to identify all (or at least most) of the key benefits and potential actions to be taken that maximize these benefits. Time should also be devoted to and attention directed (in a slow and systemic manner) toward identification of potential ways in which the two policies can be brought together on behalf of an integrated response to the pandemic challenge. Consideration and compassion potentially join hands.

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