COVID-19 Crisis: a Perspective from an LCA Researcher
Company: What do you recommend for improving our environmental profile?
Me: I recommend assessing the environmental impacts of your product system throughout the supply chain and then designing mitigation measures focusing on the hot-spots.
Company: We'd rather spend our limited resources on actual improvement not so much on assessment.
Me: Without a baseline assessment, we can only guess what the key issues might be and we wouldn't know how effective the mitigation measures are.
Company: Well, we can build a composting facility here and reduce the wastes that we generate. It is obviously "greener," don’t you think?
Many variants to this conversation have been the story of my professional life. Over the last twenty-some years, I have been working on Life Cycle Assessment (LCA), an approach to quantify and analyze the environmental impacts of a product system throughout the supply chain. It draws a baseline, and identifies hot-spots to which targeted efforts can be exerted for cost-effective mitigation. As caricatured above, however, I encountered some organizations that are eager to implement their favorite "solutions" without a proper assessment in the first place.
It may sound strange, but I see a parallel between my past experience and what is happening in the face of COVID-19 crisis. Health officials in the U.S. are discouraging or even recommending to give up on testing. In a letter on last Thursday, LA county health official advised doctors to veer away from testing. The White House Coronavirus Task Force also signaled a similar message to restrict testing only to hospitalized patients, symptomatic patients, and healthcare workers.
These new directives are very concerning to me. Treating patients without large-scale testing and tracing efforts is like trying to put out fires around us leaving the flame that vigorously spews amber all over completely untouched. It is a shooting in the dark, a battle that is destined to lose.
Why are we where we are now? I gather that the U.S. missed the golden times for early testing due to the disastrous missteps of CDC and the glacial pace of FDA's approval process. Over the last 10 days, however, a number of testing methods acquired FDA's approval, and the nation is building the capacity to mass-produce and deploy testing kits. But now we are facing another problem: limited capacity for the healthcare sector to cope with the growing numbers of (1) COVID-19 patients and (2) testing requests. When prompted to choose between the two, treatment is being chosen as a priority over testing.
On top of all these, I believe that the failure of SARS-CoV-2 testing in the U.S. also reveals the widespread tendency to undervalue the effort to diagnose, understand the causes, and stem the root of a complex problem--such as testing, targeted isolation, and tracing of SARS-CoV-2 carriers (or performing an LCA, for that matter). Instead, our institutions tend to prioritize the myopic actions that directly address visible symptoms--such as applying a ventilator to a patient (or building a composting facility).
We've been here before. Take Cuyahoga River in Cleveland, Ohio as an example. The river was so polluted that it caught fires more than a dozen times since 1868. The responses to the problem focused primarily on increasing the capacity to extinguish fires. It took 100 years and another disastrous fire in 1969 before the authorities realize that pollution, not the fire, should be the focus, leading to the promulgation of the National Environmental Policy Act (NEPA) of 1970. No fire has occurred in Cuyahoga River ever since.
Likewise, understanding the root of the problem, identifying hot-spots, and efficiently deploying limited resources to major targets seem to be the logical strategy to contain the COVID-19 pandemic, and broadly accessible testing would be the key to that end. Limited resources today present all the more, no less, reasons to ramp up the effort on testing.
What's the cost of nation-wide testing? According to news media, SARS-CoV-2 testing costs around $130 per test in South Korea, where around 0.6% of the nation's entire population have been tested (as compared to 0.013% in the U.S. as of March 21st, 2020). If the same applies to the U.S., it would cost around $43 billion, if the entire U.S. population gets tested. It is a big number. But don't forget that the U.S. federal government is preparing $2 trillion stimulus package. Why are we pouring $2 trillion of taxpayers' money into something that won't address the root cause of the problem? For whom? Besides, in the absence of targeted effort based on testing and tracing, a quarter of the nation's workforce is forced to stay at home for who knows how long. Furthermore, the healthcare cost for COVID-19 treatment is snowballing, which will inevitably drive numerous families to the edge. Considering all these, the cost of testing looks rather inexpensive in comparison.
Figure 1. Number of confirmed cases in South Korea (drawn using the raw data from Humanitarian Data Exchange)
The case of South Korea seems to present a good example of how this could work. At around February 20th, the virus was spreading at a formidable velocity in South Korea, where I still have my family; confirmed cases were doubling almost every day for a week (Figure 1). At that point, a nation-wide community transmission or Wuhan-style draconian measures seem inevitable. But after a month of broad-spectrum efforts to provide free tests, and to isolate, trace, and treat targeted population, the country managed to dramatically turn the tide in both the number of new cases and mortality rate. What is remarkable is that the country seems to have contained the spread of the virus without any lock-down orders. That's the power of data and evidence, and the ability to know the enemy.
I believe that the following timeless words speak not only to management science but also to today's COVID-19 crisis--and equally to LCA research.
What gets measured gets managed. - Peter Drucker
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What can we do? Write to your representatives and senators and urge them not to give up on testing. Instead, tell them to allocate adequate resources to ramp-up testing: scaling-up production of test kits, building drive-through testing infrastructure, training people necessary for broad-scale testing. Tell them to accelerate the effort to identify the carriers of the virus, isolate them, trace their contacts, and exert targeted efforts to contain the spread. For the colleagues and friends outside the U.S.: urge the same to your representatives.