What I would like to consider today is what COVID has taught us about human flourishing. What should we learn from the experience of COVID, and how ought we do things differently next time? I want to expand on Malcolm Gladwell’s idea in his talk for Google Zeitgeist in June of 2020. And recently moving explicitly into Interdisciplinary Studies, I realize that I consider myself a collector of theories.
We should understand that we live in a “weak-link” world. Now, what does this mean? Originally about soccer, this theory of a weak-link game comes from a book by Chris Anderson and David Sally called “The Numbers Game”. One of the questions they ask is: if you are going to improve a soccer team, what is your best strategy? To improve your best player? Or to improve your worst player? And they said the answer is obvious; the best strategy is to improve your worst player.
If you think about it, improving your worst player makes sense. Soccer is a game of mistakes. Games are often 1-0 or 2-0 and the goal is because of an error by a defender in his own zone. Worse players make more mistakes than the best players, so you are better off replacing your worst player. Moreover, soccer is an interactive sport; even the best player cannot move the ball from one end of the pitch to another without the help of her teammates. Goals are mainly scored after a series of several brilliant passes. If one of your players makes a bad pass, then the efforts of your other players come to nothing.
Anderson and Sally did a full computer simulation of the English Premier League. If you have played any sports video games you will know that players are assigned a percentile value which represents the overall talent of the player. If the best player was valued at 87% and you improved your best player to 92% how much better is your team? Well, quite a bit. They found that your team will score 10 more goals throughout a season, and 5 more points – which is a lot. What if you upgraded your worst player by 5%? The answer is that you would score 30 more goals and twice as many points.
It is not even close. Soccer is what we call a weak-link sport; your team is only as good as your weakest link.
Now compare that to basketball. Basketball is completely different. First of all, it is not mistake-driven. Players make mistakes all the time – even the best ones. Secondly, it tends not to be interactive. If Kevin Durant or Giannis Antetokumpo wants to move the ball from one end of the court to the other, he can. It doesn’t matter who the worst player on the team is. The Lakers won the championship 2 years ago, and they only had two star players – Lebron James and Anthony Davis. The rest were replacement-level players. Even the most dynastic teams followed this framework, including the 1990s Chicago Bulls and the 2010s Golden State Warriors. They had 3 great players, and the rest were, comparatively, mediocre.
Basketball, in contrast to soccer, is a strong-link sport. A team is as good as its strongest link. When you want to make a basketball team better, you upgrade its best player.
I think this strong-link, weak-link frame is very useful. You can understand the framework of many institutions and systems using this strong-link and weak-link framework.
If you are building a hedge-fund group that has Warren Buffet on it, it doesn’t matter who your 15th analyst is – it is a strong link organization. Computer programming at Google or Apple is also a strong link system. One great programmer is worth more than 10 average ones.
But there are clearly systems that are weak-link. If you are going to improve publicly accessible transportation – say, VIA Rail – you can’t do it by only pouring your money and investment into the Windsor to Quebec City corridor. Via did this because of a strong link mentality. However, for a viable public train network, it needs to strengthen its weak links. You would have to extend it from Halifax to Vancouver and discover how you would meet the needs of more northern communities of Edmonton and Saskatoon. VIA Rail treated their business difficulties as a strong link problem when in fact it was a weak link one.
The Greyhound bus network committed to the same decision. It seems as though the Alberta provincial government has done this with both the healthcare and education sectors. Instead of shoring up essential weak links in the systems, they have indeed poured money into the strong links. In the case of healthcare, Alberta has deliberately underfunded rural area hospitals and doctors and nurses. In the case of provincial education, they made cuts to the staffing of teaching assistants and support systems for students with special needs.
Gladwell analyzed philanthropy in the United States – specifically giving to University medical research facilities. The top 19 out of 20 philanthropic gifts occurred except in one instance, at the top 9 medical research universities – including Harvard, Johns Hopkins, the University of Chicago, Columbia, Princeton, Yale, and Stanford. In terms of philanthropy for medical research, the strong link mentality holds. People upgraded the strong links. They gave money to the best universities with the best facilities.
Much of the language about social inequality talks about the rich have gotten richer. More accurately, we might say, “the best has gotten better”. We have chosen a strategy for improvement by upgrading our strongest links.
Why am I going on about this? Well once you see that investment and development must always happen by improving your strong link, you have adopted a paradigm that will hamper you from dealing with problems that don’t fit the paradigm.
COVID was dropped into a world with a strong link framework. Why does this matter? Because COVID is a classic weak-link problem. In March of 2020, what was the crisis that we faced? It wasn’t a shortage of research labs or ICU beds. No! The problem we were facing was a shortage of the most basic medical supplies – gowns, gloves, masks, and nasal swabs. Masks, by the way, were wholesaled for $0.69 each before the pandemic. We ran out of cotton swabs (8 cents apiece), which led to us not doing as much testing as we wanted. The most mundane and low-tech thing prevented both the United States and Canada from dealing with the pandemic effectively. Remember, chief medical officers were not against the public wearing masks at first because they thought it wouldn’t protect us. No! They were worried that first responders wouldn’t have enough to protect themselves. That’s how much this shows that the virus was a weak-link problem.
Let’s look at this another way. Look at the people who were most affected by the virus. We are all aware of how this virus has a hugely disproportionate effect on the elderly. Unvaccinated, if you are over 75, you are 12 times more likely to die of this virus than if you are under 44. But the numbers are even more striking if you have what is called “co-morbidity”, i.e. if you have a lifestyle sickness when you catch it. In other words, you have hypertension, diabetes, smoking-related breathing disorders, or obesity – the population of which has made up 91% who have died from COVID in North America. If you are in the highest range of obesity, which is a body-mass-index above 45, you have a likelihood of dying which is 5 times greater than if you are not obese. That is an extraordinary discrepancy.
Let’s think about that for a minute. Over the past twenty years, we have made incredible investments in high-end medical care. We have built marvelous research hospitals, invested in top-end research, we have come up with very expensive medications for a wide range of diseases, and we have turned out Ph.D.’s by truckloads. But now we have encountered the worst medical crisis since the 1918 flu. Did any of that massively expensive infrastructure help us? No… none of it! Because this is a disease that is primarily affecting people with the most prosaic and mundane lifestyle issues.
For years, public health officials have been warning that obesity, hypertension, and diabetes are ticking time bombs. Well, they were right. This is our weak link. A whole country, in fact, a whole society, is at the mercy of a small proportion of the population with a serious set of lifestyle-related diseases.
Let’s do a thought experiment. Imagine if you went back to the year 2000 when the level of obesity was roughly half of what it is now – 4.7% rather than 10%. And when the level of diabetes was half of what it is now. Suppose I offered you a choice. Choice #1 is taking the path we took – investing at the high end, playing basketball, strengthening our strongest link, building better and fancier research institutions. Choice #2 is holding the spending at the high end at year 2000 levels and diverting all available and marginal investments and revenue to shoring up the weak links – on the primary prevention of obesity, overwork, diabetes, and smoking cessation. If we devoted every single available resource to those lifestyle problems such as hiring tens of thousands of home health care workers and nutritionists, if we funded education programs for nutrition in schools, if we built more bike lanes, if we had a soda tax, and if we subsidized gym memberships. You can imagine how it would go.
If you asked me two years ago, I think I would have chosen option #1. If you ask me now, I think we would have been way better off if we had focused our attention on these lifestyle-related issues for the last twenty years. If we had reduced obesity and diabetes back to their 2000 levels, this COVID crisis would likely have not been a crisis at all and would have more resembled a bad flu season.
Now, why did we choose option #1? Why did we focus all our energy on the strong links instead of focusing on the more common problems at the lower end of the continuum? Because, when you get trapped in a framework it is very hard to move to another. If you think of philanthropy as giving money to top-end institutions that already have money, it will be very difficult to focus on the 50th percentile not to mention the 20th percentile.
One more example… look at the way we conducted COVID testing. We insisted on using the most sophisticated method possible, and that is PCR testing. It is why tests are so expensive, and is why they can only be conducted in medical settings, and why they frequently take 48 or more hours to get results.
But from the beginning we could have done antigen testing for COVID, right? Less than a dollar per test, we could have done it at home – you could spit on a little stick – it’s as easy as a home pregnancy test – it takes 5 minutes. Why didn’t we take that approach? Why didn’t we go for mass, at-home, testing from the beginning? Governments, regulators, and the medical and pharmaceutical industry didn’t want to do that because they weren’t as perfect. Was the discrepancy in the quality of the tests a lot? No – only less than 2% difference in effectiveness in detecting COVID. Nope! “We want a perfect system.”
But remember – perfect only counts for playing basketball. But we are not playing basketball, we have been fighting an epidemic. If everyone had done a quick test before they left home and we had even caught 50% of the people before they went out into the world – this epidemic would have been over much sooner. We had the means, and the technology was remarkably easy, but we didn’t do it. Why? Because we are trapped in the wrong paradigm.
Let’s remember how we misplayed this one the next time there is an epidemic because it will most certainly happen again.