Say what you will, and I’m not discussing the politics of this situation we find ourselves in with the pandemic, the prevailing facts suggest that we did not have a plan to fight COVID19. Or any pandemic. Those same facts also suggest that our systems – public health, governmental, technological, - are actually more fragile than we thought. The tech advancements we’ve made gave us a false perception of our underlying conditions.
And it wasn’t like we didn’t know this pandemic was coming. Dennis Carroll, a scientist who used to be with the CDC and USAID, along with a few collaborators shared in a paper they published in Science (2018) about the risks humans faced from a pandemic spillover. They warned we were at risk of a biological shock and blamed growth and governmental inertia for the lack of planning they saw at that point. We had avian flu in 2005 and Ebola in 2014 and scientists, again including Carroll, warned that we did not develop plans to address any future outbreaks of those viruses. We were forewarned but didn’t prepare.
So, while we are in the middle of COVID19 what can we learn to aid our plans to ensure we are better prepared, resilient, for the next shock or pandemic? While I am far from being an epidemiologist, I have a postgrad in systems and this is what this is; a big biological system that we can work through. It is critical that we understand the three interconnected factors that enable us to address situations like this one. Those things are:
The plans we’ve put in place in advance of a pandemic or system shock.
Our level of preparedness to implement those plans. And
Our prevailing perceptions or narratives of who we are when the pandemic or shock hits.
Especially since we already have the signs of where the next shock will come from; water.
Without a resilience plan, you’re bound to struggle during a pandemic like Coronavirus. It’s what we’ve seen with our public health systems. We’d sucked out the redundancies within our healthcare system, the resilience, we needed to address this pandemic. We’d focused on just-in-time capacity for health services delivery at a cost that worked for those who could afford it. Even as healthcare prices went up, the medical journey for patients and practitioners had been little impacted by technology and innovation. All that is playing out catastrophically right now.
Resilience planning describes the process to ensure a community has the capacity to survive and thrive in the face of shocks and stresses to its systems. An event doesn’t even have to be at a pandemic scale for your city/system to struggle without a plan. Coming up with a plan takes humility and a willingness to accept that something catastrophic might happen in the future and, in the present, we might not be prepared. In developing a resilience plan, we need data to model out the possible shocks and stresses, and to develop an approach for allocating the required resources to address the shocks. To develop a resilience plan for a situation like the COVID19 pandemic, we’d have needed both historic data and future projections of possibilities of an outbreak to help in framing the problem we’d be addressing, and consequently which resources we would need to stem the pandemic. We’d have developed plans, backup plans, and contingency plans to address many possible scenarios to ensure we’d be ready for any issues.
Knowing what we know now, COVID19, or any pandemic, resilience plans would have factored in resources/tools in the form of medical technology innovation that would have meant we had
Online skill-based training, augmenting current approaches, to increase the quantity and overall capacity of medical delivery staff across the country/world.
Telemedicine and rapid point-of-care diagnostics as a method of health delivery that increases the capacity of physicians to provide care to citizenry (especially in a shelter-in-place world).
Secure Internet of Things (IoT) connected diagnostic equipment to capture and transmit data to aid health delivery from telehealth approaches.
Interoperability between different health systems, possibly through Application Programming Interfaces (APIs), to enable data sharing which increases the pace of health delivery and collaboration between national/international providers.
The availability of all this data will require the ‘brain-power’ of Artificial Intelligence to churn through the data and extract insights that can then be shared knowledge to increase global capability.
Localized supply chains that ensured medical supplies could be obtained, stored, and delivered at a pace shorter than what we’ve become used to.
While this is not an exhaustive list and one compiled from ideas from folk who understand this better than I do, the idea here is to take advantage of new technologies to increase the knowledge, resources, and preparedness of the health system to manage during a shock or pandemic.
So what does this look like for the industry I most worry about for the next possible shock, water?
Resilience Planning for Water Systems.
The current state of the U.S. water industry is worrisome: critical infrastructure is decaying, we are seeing increasing instances of contaminant shock (~1000 cities in California, Newark, Chicago, etc.), ~ 30% workforce attrition over the next few years, climate change is changing the stressors, and gaps in public perception of water systems [PDF]. Knowing all this, and the risks inherent in not taking action, the EPA put together America’s Water Infrastructure Act (AWIA) 2018. AWIA 2018 became law on October 23, 2018, and it requires that all utilities carry out resilience assessments and then come up with an emergency plan which they should certify with the EPA. Connected to the compliance requirements of the law is the need to maintain data and records to ensure that every system with >3,300 customers complies, or becomes subject to fines up to $25,000 for each day of non-compliance. While well-intentioned, there are two issues to note with AWIA
There are 18,832 water systems that are below the 3300 customer threshold, and, consequently, not mandated to be ‘resilient’. These serve ~39M Americans.
There are a further 9234 water systems, serving between 3300-100,000 customers, who aren’t mandated to do anything until June 2021. These serve ~145M Americans.
Let that sink in; 184M Americans are currently being served by water systems that either don’t have to have a resilience plan or might not have one until June 2021.
I’m the co-founder and CEO of Varuna. We ‘digitize’ water systems, small and medium-sized ones in particular, to improve their operational and financial decision-making. This is done by deploying connected sensors in places where the water systems have data gaps or converting their current assets/hardware into Internet of Things (IoT) devices. As we’ve engaged with water systems we’ve found that they are not in compliance with AWIA 2018, for which penalties will be put in place mid-2020. The main issue leading to non-compliance is the lack of current data on the state of the system. Most water system operators do not have the data to determine their baselines for the compliance metrics in the new laws. Gathering this data – converting paper printouts into electronic files, adding affordable data collection devices to remote locations within their distribution system, and upskilling their current staff – is the critical first and next step for the water system managers. Similar to where we were before COVID19 hit the medical system, water systems now there is a certain level of preparedness but have not started doing the work necessary to prepare for impending shocks to the system. And we know what happens when we are unprepared.
AWIA requires that the water system operators conduct a Risk and Resilience Assessment (RRA) which involves gathering data on current pipes and conveyances, water sources, treatment, and assets in use by the water system. Once this information is gathered, and an Emergency Response Plan (ERP) is put together, the system should put in place continuous monitoring of assets and water quality to ensure the RRA developed stays updated.
Water utilities need data and visibility to come up with their resiliency plan. Society has the technology but collectively – citizens, private sector, government - we’re not paying attention or giving water the urgent consideration it deserves. With the data, we also now have the technology (deep analytics and machine learning) to model out as many scenarios as required and develop as many plans as we need to address any of the scenarios. Especially modeling out the resource requirements necessary to implement those plans. We just have to decide to do it before we get to needing it. We’re failing at managing the perception before the shock and, I will hazard an educated guess, we’re not prepared to manage the perception when the shock hits.
Again, similar to the medical resilience planning and preparedness suggestions above, some technological advances that are required to manage the water systems in the near future will revolve around
the ability to deliver their assessments of distribution systems, getting the data from connected devices placed in formerly dark spaces/pools also providing data to point of receipt (mobile phones that are mini-computers).
With this data being fed into the modern data architecture (not just SCADA) to enable operability and access through APIs (Application Programmable Interfaces) that enable the water system to partner with companies that provide advanced technologies.
And while it might not be time for the water systems to fully dive into some of the insights tools that are in the market like Artificial Intelligence, there is a need to address the constraints on resources that the water system is experiencing by partnering with companies that can provide these capabilities. Increasing capability by partnering will enable the water system to get the full utility of the data received from connected devices/data receivers/mobile phones.
In ‘Narrative Economics’, Nobel Prize winner Robert Shiller suggests that narratives - stories – have a foundational role in determining the actions we take. Prevailing narratives do not have to be true or filled with descriptions that shed more light on that core message, but, once they’ve caught on, people’s perceptions and actions are now controlled by that narrative. Shiller dives deep into a particular narrative type, confidence narratives, which explain why individuals make decisions based on their confidence level as a result of a prevailing narrative.
Even when a plan has been developed and we’ve reached the required level of preparedness, there is also the serious issue of managing the citizenry’s perception. Without handling perception properly, your best-laid plans will still be ineffective at staving off panic. When shocks to a system occur, we go from disbelief to panic pretty quickly. When we panic, we look for those in charge to reassure us. If there was little trust or belief in those in charge we have little confidence in whatever they share with us. When those in charge don’t have a plan, we aren’t reassured, and we stop trusting them. Any information they provide us about the situation is untrustworthy, which dents our confidence in the systems that support us. Once confidence is gone, chaos ensues.
When those in charge have a plan, but they fail to communicate it properly or fail to implement it properly, we end up down the same path as when those in charge did not have a plan; panic, loss of assurance, loss of trust in those in charge, loss of confidence in the systems that are supposed to support us, and finally, chaos. The work of managing perceptions starts well before a pandemic hits and continues during the implementation of your plan. If there is a negative perception of your capability as a leader or organization before the pandemic or shock, you’ve already started to fail no matter how solid your plan.
We’ve missed the chance to be better prepared for COVID19. But we have the time to prepare for the next shock of pandemic and the time to start doing the work is/was yesterday. Water systems should prepare and ensure that resilience plans are developed with the preparedness to ensure that they are properly implemented when the shock does happen. At Varuna, we prefer to think systems need antifragility - the ability of a system to grow stronger and improve after a shock/damage - but we’ll take resilience for now. More than at any other time in our history, we require this from our water system operators. Thankfully, and positively, the conversations we are having with practitioners in the field suggest that there is a recognition that there is a lot of work and learning to be done. Now to get to work.