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The Complexity of 21st Century Health Care

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This polarity management recommendation is not easily enacted—especially when the stakes are high (as they certainly were in 2020 regarding COVID-19 and will be with any future pandemic crises). As Johnson and others engaged in polarity management have noted, effective management of polarities requires a constant process of vigilance, negotiation, and adjustments. The second option regarding future pandemic invasions that is offered by public health policy experts seems to be aligned with this recommendation of dynamic vigilance.

In agreement with the polarity management experts, those advocating the second option suggest that we must continuously seek and refine a dynamic, flexible balance between consideration and compassion. Each side’s beneficial contributions can be enjoyed without engendering serious negative consequences. We must accompany this balance with some immediate, tangible correctives, such as wide-spread distribution of better-designed masks, increased testing and improved tracing.

Johnson has one more important point to make regarding the management of polarities. He identifies the value inherent in setting up an alarm system as a safeguard against overshooting either side of the polarity. It would be prudent to build in an alarm system that warns us when we may be trying to maximize one side and are on the verge of triggering the negative reactions.

The alarm signal for the NPI policy might a growing debate regarding failure of this policy and the continual refinement of this policy by leaders in politics and business. We would observe a struggling system: abundant vacillation, frequent reversal of existing policy, and very short-term implementation, criticism, and abandonment of revised social distancing policies and stay-at-home orders. The signal might also be apparent at a deeper, psychological level. There would be a growing sense of helplessness and hopelessness.

The alarm system for safeguards against the herd immunization policy might be increasing occurrence of debates about who should receive the most care and who should “tragically” be allowed to die (for the sake of the “herd”). Major social unrest might arise among those populations receiving the least care and witnessing what seems to be cavalier societal disregard for their welfare. Control of health care policies might become more centralized and embedded in vested social and economic interests. At this point, the herd policies might be saving lives in the long term—but destroying (forever) the social fabric of the communities in which these policies are being implemented.

Hopefully, with the safeguards in place and the alarm signals clearly articulated, we can address the negative consequences of each option in a constructive manner. As a result, we might even be in a place to formulate an integrative, global policy regarding the handling of recurrent global pandemics (which will occur inevitably in our boundaryless world). We may also find ourselves with more time to appreciate the positive learnings inherent in traumatic events such as COVID-19—global post-traumatic growth if-you-will. Mother Nature is waiting there to teach us. She has provided us with COVID as a powerful disruptor. She hopes that COVID will get our attention and serve as a sufficiently strong motivator to bring about some changes in how we view ourselves, our health care system and our world.

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