Over the past few months, Dr. Yaneer Bar-Yam, a world-renowned expert in complex systems, has been trying to convey to Israel’s leaders one clear message: they are mistaken in all things to do with the battle against Covid-19. Bar-Yam’s strategy for eradicating the disease, detailed in an interview with "Globes" weekend magazine "G", is simple: a strict total lockdown followed by relaxations, opening up according to geographic, disease-free, regions - called "Green Zones" - until, in the end, the entire country is "green". The point of this lockdown would be to get rid of the disease entirely.
To accomplish this, Israel must enter into a full lockdown as soon as possible. "The faster, the better, and the stricter, the better." Plus, the lockdown’s purpose must be made clear: this is not "flattening the curve" to reduce the number of cases of infected and critically ill patients to controllable levels. The goal is more ambitious: Eradicate corona. Reach zero new cases. And it can be done.
Bar-Yam has been trying to deliver this message to decision-makers via a range of different channels' including joining the "Civil Coronavirus Cabinet" established by MK Naftali Bennett. Bar-Yam is convinced that his is the only logical solution. "There is only one correct action that could possibly be taken. This disease is terrible, and we know that. Anyone who says otherwise is dreaming. This disease proliferates quickly and is highly contagious. To stop its spread, very tough measures must be taken. But it can be stopped - and Israel had already done that, acting strongly enough to achieve a rapid decrease in spread of the disease. And then, they opened up."
The conversation with Bar-Yam takes place remotely, via Zoom, from his home in Boston. It’s impossible, however, not to note his extreme frustration with Israel’s management of the situation. "They opened up and said, ‘See, things here aren’t so bad, let’s open everything.’ And suddenly, you have coronavirus infection spikes at schools across the country, and now a huge second outbreak that’s worse than the first." All this can be fixed relatively easily, Bar-Yam is convinced, if we just do the right thing.
A choice between life and death, like the Bible says
Yaneer Bar-Yam (62) is the son of Israeli parents, an academic couple - a physicist and a psychologist - who immigrated to the United States. He received his doctorate in physics from the Massachusetts Institute of Technology (MIT), one of the world’s leading scientific institutions, and later worked as a lab researcher at IBM, then at the Weizmann Institute. In 1997, he left his position at Boston University, where he served as a professor in the Department of Engineering, to found the New England Complex Systems Institute (NECSI).
"The math we learned at university is very good at describing boring things, but not at describing things that are 'important'," says Bar-Yam when asked to explain his field. The mathematics of complex systems, which focuses on the way different elements affect one another, tries to identify the important variables within a system; those of crucial importance. "When you have interdependent relationships within a system, it can undergo dramatic changes like, for example, water coming to a boil."
But these changes, from one state to another, can be identified not only in the physical world, and not just in the lab, but also in events taking place in reality. And that's exactly what Bar-Yam is doing at his institute. In 2006, he published an article warning that once the number of international flights reached a certain point, diseases would begin behaving differently. "Instead of creating isolated pockets of infection, the disease spreads without restraint, and can turn into a devastating epidemic."
Over the years, Bar-Yam has cooperated with a long list of researchers that even includes financier-philosopher Nassim Nicholas Taleb, who coined the term "Black Swan", and has warned consistently about our short-sightedness regarding extreme events. On January 26 of this year, when Covid-19 was still regarded as a problem primarily for China, Bar-Yam and Taleb (together with NECSI colleague Joseph Norman), warned that standard measures would not be enough, this time, to halt the epidemic and called for more decisive action, including the use of lockdowns and travel restrictions.
"We wrote that action must be taken," says Bar-Yam. "There were a lot of warning signs. And the fact that we didn’t take tough measures at the time is the reason we’ve suffered badly since then. And the fact that we’re not taking action now, despite absolutely predictable dynamics, is a psychological problem. Somehow, society hasn’t managed to galvanize itself into action, and that’s due to society’s inability to act, not because of the disease."
Bar-Yam has, himself, taken a great deal of action over the past few months, publishing a stream of position papers, analyses, and proposals for technical innovation. Together with Taleb, for example, he published a critique of the British government’s Covid-19 policy and called for an urgent change in direction. At the same time, he set up an international volunteer coalition, Endcoronavirus.org, which gathers data from the field, and issues guidelines and recommendations. Nearly ten thousand volunteers, he says, have already joined the effort.
The insights and recommendations presented in our interview are based, he says, not only on models but also on experience. "It’s pure mathematics: this is a process of multiplication, and the conclusions are clear if you think in those terms. It’s also consistent with my work on epidemics over the past 15 years. And entirely consistent with all that we’ve seen around the world since the current outbreak began. It’s all consistent.
"Look, what’s happening is awful," he says when asked about his daily routine over the past half-year. "One of the main points that we must understand is that we have control. We can control the disease. The measures we take can have an immediate effect on what happens - within weeks. As in the Bible, humans have a constant choice, which is the choice between life and death. That’s how it’s been since January. I can describe this choice mathematically, we can characterize it scientifically, we can describe the path of what is happening. Right now, our duty is to explain this choice to people. "
The Swedish model? "They're crazy"
A pandemic like Covid-19 inevitably drags us into action, Bar-Yam explains. It's a matter of mathematics. "You look at the multiplier: how many cases will we have based on the number of cases we have today. Roughly, the multiplier is 10x per week. If you have you five instances in a day, the following week it will be 50 per day, a week after that it will be 500, the week after it's 5000, and so on. Obviously, things quickly become unsustainable. Except, perhaps, in Sweden, where they’re crazy. At some point, you need to take action - and if so, why not act soon as possible? It’s being done in country after country after country. In 50 different countries. You eradicate the disease within weeks. "
In other words, according Bar-Yam, Israel should have aspired to a single number: zero new cases. He lists several countries that have successfully adopted a similar strategy - from China to New Zealand and Ireland.
Bar-Yam’s statements are somewhat surprising and eye-opening as they contradict concepts we’ve become accustomed to - "containing the disease" and "flattening the curve" - which Bar-Yam rejects absolutely. He’s not alone in this, by the way. Dr. Harvey Fineberg, former dean of the School of Public Health at Harvard University and a prominent expert in the field, has also spoken about the need to "smash the curve" rather than flatten it.
The thinking behind "flattening the curve" and "containing the disease" is that the number of critical Covid-19 cases must be kept below a certain level' and that exceeding it could crash the health system. As far as Bar-Yam is concerned, "That’s a crazy idea."
Globes: Please explain.
"First of all, you have to talk about the ethics of it. People say, 'I'm going to be objective, mathematical, think about it logically. Then they say, what we have here is a problem of optimization, and we don’t care if people die or get sick, because that would be sentimental and we're not going to get all sentimental.' That’s crazy. Sick and dead people - why would we want something like that?"
Meaning that, for you, the goal is not to control the disease but to eradicate it.
"Once you eliminate the disease, it won’t come back. Just as the dinosaurs don'tcome back in the autumn, neither will the disease. People are losing focus - they think that you can’t get rid of it, it’s going to come back in waves, there’s no solution to the problem, and we have to wait for a drug, or vaccine, or a miracle to save us. But if you know that you can get rid of the disease within weeks, then this solution is the only one that makes sense. There’s no other. Any other solution will cost more lives, and will have more economic consequences".
Let’s really talk about the economic implications of your suggestion.
"Our society has developed a viewpoint, according to which human interest runs counter to economic benefit. But that’s unrelated to the pandemic. The pandemic is absolutely clear. It’s a wrecking ball. If you stand still, it will hit you in the face and you’ll get hurt, physically and financially."
"People won’t go to restaurants if the danger of walking inside is death. They’re not going to pretend everything is fine, spend money, and end up in hospital for weeks. It just doesn’t work that way. There are many studies that indicate this. But somehow, the idea that the disease competes with economics got stuck in people’s heads, and they say, 'Hey, we already did a lockdown and it cost us so much money.'
The answer is: 'There’s no choice. If you don’t do it now, you’ll do it later. Because the alternative is to wait while things keep getting worse, then do a lockdown, which will cost more and things will be much worse. It will be horrible. So, why not do it now, and improve the situation in the shortest amount of time?"
Bar-Yam explains why we shouldn’t settle for simply controlling the spread of the disease by referring to the now-familiar "R" number, i.e. the coefficient of disease reproduction, or the average number of people who will contract a contagious disease from one person with that disease.
"Remember, the R-value that we have naturally with this disease is between 3 and 5," he says, meaning that each person with the disease infects, on average, between 3 and 5 people. To bring the disease to a fixed level, that is, reducing the R value to 1, Bar-Yam says, much must be done.
"No events, no public transport, no schools, social distancing at two meters, and masks. In other words, flattening the curve and then maintaining the disease at a controlled, constant level, will have a huge and ongoing cost. But if we don’t do all of this, the disease will reoccur and spread."
Bar-Yam is not interested either of these two options. He offers a third possibility. What if we could take the whole matter one step further, and make a one-time effort to bring the R value down to 0.8, meaning, each person with the disease would infect less than one other person. Over time, the number of infected persons would decline. "In this scenario, the number of patients will fall to zero within a few weeks, after which we canease restrictions. We could have public events with lots of people, open schools, open everything. Within a few weeks, you make up the cost of the difference between 0.8 and 1, and you’ve gotten rid of the disease."
Given the current state of affairs, Bar-Yam says there is no logic in attempting to just trying to flatten the curve. "They're crazy. They didn’t do the math, they forgot what they were calculating, and so they missed the most important thing: the cost of an 'almost' complete lockdown is an ongoing cost."
The alternative solution he presented appeared to have been struck off the agenda, at least until last week, when statements from politicians and teams of experts began changing in tone: "Have a complete lockdown and finish this in a few weeks."
The "We can’t" syndrome
So, let's go back in time. Israel relaxed quarantine restrictions after Passover. What should we have done at that time?
"Israel had already managed to go from 500-600 cases a day to below 20 cases. You’d already had an exponential decrease, and all you would have had to do is continue that way for another two weeks. And by the way, a full lockdown wouldn’t have been necessary in that case. They should have implemented a Green Zones strategy. That was the part they missed."
"Under a Green Zone strategy, you impose travel restrictions, identify coronavirus-free areas, then ease travel restrictions between those areas. I looked at the maps from the period when the number of cases in Israel had dropped to 20 per day. The entire region north of Hadera, all of Haifa, the whole of the Galilee were coronavirus-free areas. All of the south, starting from somewhere south of Jerusalem, was disease-free. There were only a half -dozen instances in Jerusalem. One week more would have made 14 days without any new cases in Jerusalem. In Tel Aviv, it would have taken another week."
At this point in our conversation, Bar-Yam shares his computer screen and presents those countries that have adopted the Green Zone strategy - or failed in doing so. China, for example, imposed severe travel restrictions. "Within four or five weeks the virus was almost gone in all of China. And in Wuhan, it disappeared in six weeks." He moves over to Ireland: "Again, we see restrictions on movement between the provinces and very few outbreaks in areas other than Dublin."
Here in Israel they say we can’t do another closure.
"That's ridiculous. What you can't do is pay the price you’re paying now. The price you’re paying now is forever."
What about the schools?
"Schools are one of the last places that should open. They are super-spreader sites. If Israel was doing the right thing now, schools could open in September. Maybe not early September, but after the holidays. We can still can do this. It's being done in 50 countries. And Israel has already done it!"
Bar-Yam gets fired up. "There’s no time for 'We can’t do it'. This 'Can’t do' attitude… it's turned into a sickness of Westernization. The 'We can't'" disease."
How do you explain it?
"My take on it is that we've turned into a bureaucratic society. Bureaucracies say 'No, we can’t do it.' The only reason bureaucracies exist is to tell you what you can’t do. And that’s what our bureaucratic system is telling us, 'We can’t'".
And what’s the answer to that?
"The answer is: We clearly can".
What about a vaccine, is that part of your thinking?
"Our society has a fascination with molecular biology. We don’t need a vaccine, and it might not be achievable. Why should we hold our breath in expectation of something that may never happen? The last thing," Bar-Yam sums up, "is that everyone must be engaged. Make sure everyone understands this is a life and death decision - and the decision is in everyone’s hands. If we do this together, we can finish it.
"There’s no mystery about what needs to be done. And relief must be given in the light of the necessary sacrifices. The government can help. Industry must help - anyone with any resources has to help. All working together, whether the public or private sector. When a society faces a challenge, everyone needs to help out. And if we do it, this disease will disappear within weeks. And if Israel does it, it will be an example to others."
Published by Globes, Israel business news - en.globes.co.il - on July 19, 2020
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