The COVID-19 virus originated in the Chinese Hubei province, Wuhan city, in December 2019, and it spread due to movement of people all over the world, including Lithuania. The virus spreads quickly and easily. Today (07.04.2020) 880 persons are ill, 15 persons have died, and eight persons have recovered from this virus in Lithuania. Available capacities of health care services will be insufficient due to a rapid rise in the number of persons infected with the virus. To contain the spread of the virus, a decision was made to declare quarantine in the country from 15 March 2020.
After quarantine has been declared, i.e. direct social contacts have been restricted, business activities involving gatherings of people have been prohibited. Some businesses have found themselves on the verge of bankruptcy. About 25 per cent of residents are not working due to quarantine. The unemployment rate has increased. More than 70 per cent of residents feel financially insecure. Consumption has shrunk. Hence business income. The national budget received about 15 per cent less revenue in March. Salaries of the public sector employees, pensioners’ pensions and other benefits are at risk. The Government of the Republic of Lithuania has been forced to borrow. I guess that due to declared quarantine we incur costs of around 1 billion every week. These costs include revenue foregone and increased expenditure. There have been calls for discontinuation of quarantine, even if this leads to the deaths of a share of the population.
Thus, a dilemma emerges: to continue quarantine – to discontinue quarantine. If we continue quarantine, the entire country will incur considerable losses. If we discontinue quarantine, a part of Lithuanian residents will die. Life or Money? Which is better? Both are highly important. Who wants to sacrifice their father, mother or child?
On the other hand, what to buy food for if you don’t have work and income?
This complex Dilemma has been resolved through a Win-Win approach, having applied the Thinking Process tools of the Theory of Constraints. Win-Win means that both sides win. The solution allows businesses to resume their activities without increasing pressure on the health care system and without overloading their capacities. The summary of this Solution is presented below.
A brief summary of the Solution
Having identified the UDEs (Undesirable Effects) of the current situation and having used them to design a CRT (Current Reality Tree), it has been determined that:
- The Ultimate Undesirable Effect – wages have decreased, company sales and revenues to the National Budget have been rapidly decreasing.
- The Core Problem that causes the Ultimate Effect – Quarantine declared throughout the country (restrictions of direct social contacts and business activities involving the gatherings of people).
- The Root Cause – It is not clear who is healthy and who is ill.
The EC (Evaporating Cloud) has been built on the basis of the Core Problem; the wrong assumptions have been identified and replaced with the right ones.
Replacing wrong assumptions:
| Wrong assumptions | Right assumptions |
| By limiting the direct contact of all people, sulėtinsime viruso plitimą ir ligonių kiekio didėjimą, leisiantį ligoninėms palaipsniui išgydyti visus | By limiting the direct social contacts of only the ill and those with a high risk of death, we will slow the spread of the virus and the rise in patient numbers, which will allow hospitals to gradually treat everyone |
| Quarantine, as a restriction of direct social contact, is implemente in the entire country‘s territory | Quarantine, as a restriction of dircet social contact is implemented only in localities (the family, the apartment, the building, the street, the district, the workplace, the municipality) where the risk to become ill and infect the healthy is elevated |
| We must sacrifice a part of citizens, who will die from infection due to a lifted quarantine | We must ensure that new deaths do not occur due to the lifting of quarantine |
Thus, a Win-Win Solution has been developed.
The Win-Win Solution to the Dilemma “To Continue Quarantine – To Discontinue Quarantine”:
- To categorise all country’s residents into: Healthy, Ill and At High Risk of Contracting COVID-19. To isolate only Ill and At High Risk of Contracting COVID-19. Declare a quarantine only in localities, which contain the infected: apartments, buildings, houses, streets, districts, regions, municipalities.
- To monitor every resident in order to know whether they comply with quarantine requirements and expeditiously (within 6 hours) identify the contacts of the ill person and find potentially infected persons in time (within next 6 hours). To quarantine them, test whether they are ill and monitor each of them.
- To allow all economic entities that can ensure that ill employees and/or other persons do not enter their territories and do not infect healthy people to resume business activities.
The benefits of the Win-Win Solution to the Dilemma “To Continue Quarantine – To Discontinue Quarantine”:
- The economic engine will start: employees, companies, institutions and the budget will start receiving income. Consumption will rise.
- Losses due to the declaration of quarantine will be reduced.
- The health care system will be protected from overload and will manage to save patients’ lives.
- We will get prepared for subsequent Pandemics.
This Solution, like every other solution, has Negative Consequences.
The Negative Consequences of the Solution to the Dilemma “To Continue Quarantine – To Discontinue Quarantine”
- All residents will have to be tested.
- Economic entities wishing to resume activities will have to ensure that ill persons do not enter their territories and do not infect healthy people.
- Every resident will have to be monitored to know whether they comply with quarantine requirements and their possible contacts will have to be identified, and potentially infected persons will have to be found expeditiously in order to quarantine them.
- Instant devices for virus diagnosis will have to be developed.
Conclusions of the Win-Win Solution to the Dilemma “To Continue Quarantine – To Discontinue Quarantine”:
- This universal quarantine is very costly for each of us.
- The economic engine must be started as quickly as possible to minimise losses due to the COVID-19 Epidemic.
- We cannot consider the Dilemma: to continue quarantine or to start the Economic Engine. Both are vital. We have to solve the problem: to start the Economic Engine as quickly as possible without risk to infecting more working population and other residents.
- We must identify who is healthy and who is ill as soon as possible. We have to isolate ill people and ensure safe working conditions to healthy people, thus letting them work.
- In order to contain the spread of the virus among the healthy, we must ensure strict monitoring of social contacts and very expeditious identification of social contacts that could contribute to the spread.
- A single person cannot manage this crisis. We all have to assume responsibility and become involved in the control of the COVID-19 Epidemic.
The description of the process to this solution is attached. I also indicate immediate actions that I consider to be necessary.
The solution of this Dilemma is also presented in a 33-minute long video: A Win-Win Solution to the COVID-19 Dilemma in Lithuania: To Continue Quarantine – To Discontinue Quarantine and the Proposal of Immediate Actions (In Lithuanian)
I invite everyone to join the implementation of this Dilemma Solution. The contribution of each of us is of the utmost importance. And we have a lot to do: test all residents, categorise them into Healthy, Ill and At Risk, start monitoring and controlling them. We will also have to take care that companies which resume business activities ensure that only healthy people can enter their territories.
One of the most complex tasks is to increase health care system capacities. This and other emerging tasks will require consultants in the fields of project management, TOC, Lean, Six Sigma, management and strategy, as well as other specialists. We have to start solving all arising problems in the coming hours.
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