Situational Analysis
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MAYBE Prior NCOV-19 infection confers some level of immunity.
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MAYBE Prior NCOV-19 infection confers little or no immunity.
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A lot of people still believe that the risk of quarantine is larger than the risk of mass infection.
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People are still comparing death rates to the flu and seeing that a lot less people have died so far.
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Some people believe that the State has an agenda to concentrate control.
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People believe that some things cause mass hysteria.
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The number of people who die from the flu every year is a baseline we know.
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The current COVID-19 death toll is lower than the seasonal death toll due to flu.
junctor
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Young people believe that their personal risk is low.
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The death rate from COVID-19 is low in young people without pre-existing conditions.
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Businesses drive towards efficiency.
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We do not have ICU capability for spikes in need above the baseline flu rate.
junctor
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Excess bed capacity is considered inefficient.
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Increasing collapse of the medical system.
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During a flu season a high percentage of people get it.
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We don't take serious measures to stop the spread of regular flu.
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We know and accept the number of people that die from the regular flu every year.
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The death toll from COVID-19 is catastrophically higher than a regular flu season.
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MAYBE The percentage of people who need hospitalization from COVID-19 is far higher than with regular flu. (Hospitalization rate)
junctor
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Humans have limited herd immunity to the regular flu.
junctor
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Some people engage in behavior that increases the risk of spreading the virus.
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The total number of people exposed to NCOV-19 is currently tiny compared to the flu.
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Within weeks the population is infected to saturation levels (60-70%), i.e., a similar number of people catch COVID-19 as get the flu.
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Decreased transmission and/or infection rates.
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Decreased hospitalizations.
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Decreased deaths.
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NCOV-19 Incubation periods are long (2-14 days, possibly higher).
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People are moving around infected without knowing it. Time passes before they start to show symptoms.
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People spread the virus unbeknownst to themselves or others.
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Some infected people begin to show symptoms. Time passes as symptoms worsen untreated.
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Some people's symptoms become bad enough to go to hospital.
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Time passes as patients symptoms worsen in hospital.
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Medical workers are highly exposed to infected patients.
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Medical workers are infected at 2x-5x over regular population rates
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Medical workers must themselves be hospitalized.
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The force of medical workers becomes critically low.
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Some people who do not now show symptoms will become sick or die.
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It is difficult to know the actual number of people infected.
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Widespread testing is currently unavailable.
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Widespread patient tracking is currently unavailable.
junctor
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NCOV-19 Infection can be passed by people who are not showing symptoms.
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Humans lack herd immunity to NCOV-19.
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MAYBE The infection rate is higher than with regular flu. (R0)
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MAYBE The effects of COVID-19 (pneumonia) are more severe than regular flu.
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MAYBE COVID-19 leaves some recovered patients with permanent damage and chronic health implications.
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The entire population eventually becomes herd immune. COVID-19 becomes just another annual flu strain.
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MAYBE People who survive COVID-19 are at risk of becoming infected again.
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The non-COVID-19 sick and the injured find it difficult or impossible to obtain emergency care or hospitalization.
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Increased deaths.
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MAYBE The percentage of people who die from COVID-19 is far higher than with regular flu. (CFR: Case Fatality Rate)
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Some people gather in groups where one-to-many community transmission takes place (superspreading).
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Some people become "portal pathways", introducing infection into isolated or high-risk communities. (Elder care, homeless shelters, prisons, etc.)
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The risks of death from COVID-19 are higher for high-risk populations such as older people and people with co-morbidities such as compromised respiratory systems.
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Isolated or high risk communities become infected.
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Isolated or high-risk communities are low priority for medical care.
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Isolated communities may be physically hard to reach with medical care.
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Isolated communities are often marginalized or considered low-value in society.
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High-risk communities are often triaged as having a poor prognosis.
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Increased death toll in isolated or high-risk communities.
junctor
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Work is under way to develop early diagnostic techniques.
Lack of Containment/Mitigation
The State of Diagnosis and Treatment
The Nature of NCOV-19
The Nature of Regular Flu
Public Attitudes
Isolated and High-Risk Communities
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There is a significant period where community transmission of NCOV-19 of the infection can take place.
junctor
junctor
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Decresed infection severity including lasting damage.
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Diagnosed patients are quarantined earlier than otherwise possible.
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Diagnosed patients are treated.
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Severity and duration of illness decreased.
junctor
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Humans lack prior exposure to NCOV-19.
junctor
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People without symptoms are unlikely to be tested.
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MAYBE chloroquin or hydroxychloroquin combined with azithromycin limit the duration and/or severity of COVID-19.
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MAYBE Successful development of early treatment techniques.
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MAYBE Successful development of early diagnostic techniques.
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More accurate information about the number of people infected and rate of spread becomes available.
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Only crisis treatment techniques are currently available (intubation, ventilators, etc.)
junctor
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Hospitals are run as businesses.
junctor
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Clinical trials of this combination begin in New York on Tuesday 3/24.
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MAYBE Side-effects of this combo (retinopathy, heart) do not limit its use.
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MAYBE Chloroquin has sufficient availability, including its use by other sorts of patients (e.g. Lupus).
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MAYBE Competition due to demand of the drug by COVID-19 patients starts causing hospitalization or death among non-COVID-19 patients who need it.
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MAYBE antivirals can limit the duration and/or severity of COVID-19.
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MAYBE cytokine inhibitors can inhibit out-of-control inflammatory response (cytokine storms) due to re-infection or therapeutic drug use.
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MAYBE ACE2 modulators can slow the rate of infection spread within the host.
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MAYBE antibodies can be transfered via plasma to confer immunity on others.
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No effective preventative techniques are currently available (except isolation.)
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Maybe successful development of preventative techniques.
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Chloroquine and Hydroxychloroquin
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Maybe this combination is effective at limiting the duration and/or severity of COVID-19.
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The more time that passes, the higher the likelyhood of success.
The Effect of Time on Research Success
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MAYBE A vaccine can be developed that confers immunity to NCOV-19.
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Half the people who are in ICU (intubated) in Italy are under 60 years old.
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MAYBE The percentage of younger people who have no underlying conditions and that require hospitalization (ICU) from COVID-19 is far higher than with regular flu.
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Remaining health workers forced to triage increasing number of patients.
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Increasing numbers of COVID-19 patients are triaged as untreatable due to lack of equipment and/or personnel and are let die.
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There are some cases in China and Japan of people diagnosed with COVID-19 who got better and then got worse again.
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Our bodies produce an antibody responses to infection by NCOV-19.
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MAYBE re-infection causes a worse case due to the immune response (cytokine storm).
junctor
junctor
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The flu mutates every year, leaving some people more susceptible.
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Some people die of the flu every year.
junctor
junctor
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The NCOV-19 virus mutates similar to the way the regular flu mutates.
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MAYBE Like the flu, our existing antibodies are less effective to mutated strains of NCOV-19.
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MAYBE immunity decreases over time due to virus mutation.
junctor
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The population eventually becomes infected to saturation levels (60-70%), i.e., each year a similar number of people catch COVID-19 as the flu.
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MAYBE The population decreases over time.
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The death toll from the regular flu continues.
junctor
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Maybe NCOV-19 stays in the body dormant after patient recovers from COVID-19.
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MAYBE chronic infection by NCOV-19 has other negative health outcomes for the patient.
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MAYBE certain events can trigger a recurrence of COVID-19 or related illness, possibly including contagion.
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Hospitals run out of places to put patients.
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Hospitals run out of personal protective equipment (PPE).
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Hospitals run of out of testing materials.
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Hospitals run out of treatment materials.
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Medical workers work extra shifts
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Medical workers become stressed and exhausted.
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Medical workers burn out and become unable to work.
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Medical workers' immune systems become compromised.
Government and Law Enforcement
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Law Enforcement Organizations (LEO), e.g., police and National Guard, are tasked with front-line enforcement.
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Gov issues public quarantine.
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Public does not fully voluntarily comply with quarantine.
junctor
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LEO does not have enough PPE or training for effective use.
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Front line enforcement requires effective use of PPE.
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Community spread of infection is high among LEO.
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Gov finds where surplus PPE exists.
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Business sells or donates surplus PPE.
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Gov determines where greatest need for PPE exists.
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Gov manages distribution of PPE and training for its use.
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LEO at acceptably low risk of becoming infected.
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Gov identifies firms that can manufacture high-need PPE.
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Businesses retool to manufacture high-need PPE.
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Government commissions high-need PPE via normal contracting process.
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Government commissions high-need PPE via Stafford Act.
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President declares national emergency, invoking Stafford Act.
junctor
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LEO workers are in close quarters with one another on the job.
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LEO untrained on sterile procedures to limit community spread.
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Front-line enforcemet requires work in environments with high risk of NCOV-19 infection.
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Government trains essential, high risk workers on sterile procedures.
junctor
Critical Infrastructure
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Utilities (e.g., electricity, water, Internet) must stay in operation.
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Supermarkets must stay in operation.
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Delivery services (UPS, FedEx, Postal Service) must stay in operation.
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Major online retailers (e.g., Amazon) must stay in operation.
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Pharmacies must stay open.
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For quarantine to work, essential services must stay available for the duration.
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Workers in this industry need PPE and/or hazmat gear and training to use it conditional on their level of on-the-job exposure.
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MAYBE Workers in this industry need to have no ensurement of payment.
junctor
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Sanitation companies must stay in operation.
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Workers go on strike.
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Companies are unable to make payroll.
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Company experiences financial hardship.
junctor
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Infrastructure workers at acceptably low risk of becoming infected.
junctor
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Increased infrastructure collapse.
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MAYBE Gov guarantees payroll in critical industries.
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Government covers payroll during hardship.
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Infrastructure stays strong.
junctor
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Community spread of infection is high in critical industry workers.
Government and Business
junctor
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Workers have insufficient PPE and training.
junctor
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Increasing numbers of LEO become ill.
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Increasing numbers of LEO become unable or unwilling to work.
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Decreased effectiveness of quarantine.
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Increasing number of critical industry workers become ill.
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Increasing number of critical industry workers unable or unwilling to work.
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Increased supply chain collapse.
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Security workers in prisons work in close quarters with inmates.
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Security workers in prisons are at high risk of exposure.
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Inmates in prisons have no way to practice social distancing.
junctor
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Security workers in prisons are likely to become portal pathways for NCOV-19 infection.
Prisons
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Security workers become sick or refuse to come to work.
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Inmates are at high risk of exposure.
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Inmates become sick.
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Prison hospital quickly overwhelmed with patients.
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Decreased security in prisons.
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Increased likelyhood of prison riots, takeovers, and escapes.
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Patients must be treated by prison health workers, released to external hospitals, or go untreated.
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MAYBE Chooses to release highest-risk, least-violent prisoners.
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MAYBE Released prisoners less likely to become infected.
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MAYBE Released prisoners pose new menaces to society.
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Flood/hurricane season is coming in the U.S.
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MAYBE NCOV-19 speads more easily in wet environments.
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A dry summer is coming to parts of the U.S.
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MAYBE NCOV-19 spreads more easily in dry environments.
Influence of the Environment and Seasons
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Parts of the U.S. experience wildfires part of the year.
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Increased demand on emergency first responders.
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Emergency first responders must stay in operation. (e.g., firefighters, paramedics)
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Increased exposure to wet or flooded environments.
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Increased risk of infection.
junctor
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Some parts of the United States experience earthquakes that damage property.
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People displaced from living quarters.
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Some areas will be flooded, damaging property.
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Some property will be damaged by fire.
junctor
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Quarantines broken, social distancing increasingly difficult.
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People have to move to shelter from hurricanes or tornadoes.
Implications for Politics
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Gov calls for quarantine during U.S. election voting.
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The U.S has no secure digital voting that works from home.
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The U.S. has no precedent for a pandemic during voting.
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MAYBE Gov encourages people to vote at polling places.
junctor
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Increased community spread via polling places.
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The demographic of who goes to vote adjusts depending on the public's perceived risk in physically going to vote.
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The outcome of the election is changed.
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MAYBE The demographic that chooses to vote has decidedly different political views from the demographic that would have voted but for the pandemic.
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MAYBE Gov rules that all voting will take place by mail.
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Several states have postponed primaries.
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MAYBE security problems are introduced into the voting process.
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MAYBE Reliability problems are introduced into the voting process.
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MAYBE Resource management problems are introduced into the voting process.
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Many states do not yet support all voting by mail.
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Colorado, Hawaii, Washington, and Oregon already have all-mail voting.
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65 percent of voters in California cast ballots this way in 2018.
junctor
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MAYBE Medical crisis lasts long enough to impact the election season.
junctor
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Stock market loses value in anticipation of economic slowdown.
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People stay home due to quarantine.
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People stop using businesses in numerous industries.
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Demand for goods and services in affected industies drops.
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GDP capaity drops 30-40% in a few months.
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National debt increases significantly.
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Government borrows for bailouts to subsidize lost GDP.
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Employers in affected industries lay off employees and/or shut down.
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Unemployment rises.
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Unemployment claims rise.
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Unemployed workers suffer economic hardship.
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Government borrows for economic stimulus.
Business, Economics, and Government
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Stock market continues to lose value on realization of economic slowdown.
junctor
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70% of workers live paycheck to paycheck.
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Many workers will push to return to work.
junctor
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Government borrows to uplevel medical system capacity.
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Government suspends rent and mortgage payments.
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Government postpones tax filing deadline.
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MAYBE Government lifts quarantine earlier than medically advisable.
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MAYBE Government provides stimulus money or UBI to workers.
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MAYBE Gov provides food and medicine provisioning to workers.
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Workers survive until economy recovers sufficiently to re-hire them.
Geopolitcal Implications
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China was able to mostly contain the outbreak to a single province.
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China is at the front of the infection curve, and has experienced the most recovery so far.
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Many first-world countries are being seriously hit by COVID-19.
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Many third-world and developing countries have high total population, high population density, high interaction among population, low ICU per-capita capability, and relatively low hygiene capability for large amounts of population
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Third-world and developing countries (e.g. India) are likely to be very hard-hit by COVID-19.
junctor
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The EU is not stepping in to help Italy or Eastern European countries.
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China is offering help other countries with equipment and training.
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China is where a lot of medical equipment is originally manufactured.
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China kept back news of the outbreak.
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Other countries were not aware of the outbreak until they were infected.
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China is where the outbreak started.
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Many countries are angry at China for holding back news of the outbreak.
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MAYBE China will lose future export business.
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Many countries such (e.g., US) are now concerned about dependencies on China for products related to critical infrastructure.
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China kept back shipments of PPE and other goods to help it better deal with its own outbreak.
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China has a highly authoritarian government.
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Loss of reputation ("face") is problematic in China's culture.
junctor
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The outbreak was discovered and traced back to China.
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China's international reputation has been damaged.
junctor
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China is starting to loosen quarentine.
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China reports no new cases in Wuhan province.
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China is starting to re-open Apple Stores, Starbucks stores, and movie theaters across the country.
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China is in some ways in the strongest position internationally it has been in, in a long time.
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China mobilized into a crisis/wartime mode to address the outbreak.
junctor
junctor
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Before the crisis, China has been savvy about getting international support and coordination, e.g., the Belt and Road initiative.
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The US appears to be moving into a weaker, more vulnerable position than it has been in for a long time.
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The US did not have an early, strong response to the outbreak.
Implications for China
Implications for the United States
Implications for Third World and Developing Countries
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The US can't do a single unified response due to States Rights.
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The US did not have diagnostics ready.
junctor
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MAYBE China starts dumping US Treasury Bonds.
junctor
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MAYBE China or other state or non-state actors step up cyber attacks on the US.
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There has been discussion of the crisis lasting up to 18 months. (Imperial College paper, UK)
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China or other state or non-state actors may have predatory intentions against the US.
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MAYBE China does a good job of offering aid in exchange for joining the Belt and Road initiative.
junctor
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MAYBE China campaigns against the US Dollar, proposing instead a digital currency.
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China limits international aid to delivery in the digital currency.
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China's digital currency becomes a world reserve currency.
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China experiences second outbreak.
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MAYBE NCOV-19 is still circulating in significant numbers of China's population.
junctor
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COVID-19 appears to be spreading globally in a variety of climates.
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MAYBE COVID-19 is not affected by seasonality.
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Seasonally increased risk of infection.
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Multiple arrows entering a box directly are independent, possibly reinforcing causes. (OR conditions)