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November 05, 2020, updated Dec 15, 2020 (Translated with GoogleTranslate)

Reflection on a social situation

Towards a New Paradigm Shift?

Test Asymptomatics Massively - Heal Quickly - Recover Quickly

Before the purpose

I understand the difficulty of the situation and the questions of politicians and scientists as well as the peoples of the different countries who live in fear and horror ... but I do not understand the strategies of treating patients late. This goes against my engineering principles and my knowledge in the organization of crisis situations.

So, here is a reflection that deserves to be evaluated by scientists in each country. I do not feel the legitimacy to propose it because it deviates from my usual practices but I know that paradigm shifts can take time to emerge in certain professions. And time is what is lacking in the face of certain emergencies.

We did not have time, for lack of technical means, to develop a mathematical simulation but I did not see the usefulness either because I am fundamentally in favor of experimenting with economic solutions which are related to my knowledge of complex systems and which can be paralleled with other models. This article is particularly interested in epidemics with a high number of healthy carriers such as SARS, Flu, Measles or EBOLA. In complex systems, when situations become difficult to control, a new mode of operation is investigated and sometimes it is necessary to think of the opposite of the culture of what a profession practices intuitively and historically.

Introduction

Image n*1: Model of Periods, representative of the state of an infected person
Image n°1: Model of Periods, representative of the state of an infected person [FTV]

As an expert in product and project organization and management, our company supports all types of projects and organizations, including organizations and teams in crisis. I present to you an empirical approach by Tests to manage a project in crisis which is based on precise and static assumptions. Crisis projects are usually our job, but I am neither an epistemologist nor a doctor. I have a Doctorate in Applied Mathematics and my specialty today leads me to work in the field of methodologies and governance of projects and organizations. I am therefore used to studying diagrams of complex situations which require an organization specific to the targeted profession. Recently, I was advising an accountant company manager, a nurse in charge of an operating room and an HR manager from a large company, for example. So I am used to advising groups and individuals facing a crisis situation.

[FTV] https://www.francetvinfo.fr/sante/maladie/coronavirus/coronavirus-le-schema-de-l-evolution-du-covid-19- went-viral-on-social-networks-is-exact_3896407.html

The Problem

The problem is this: What could we do if a new, more virulent virus, with a death rate of 10% instead of around 0.7%, were to break out? Imagine this same virus with a higher contamination detection time (delta> 0) via a physiological test.

What can we offer as an alternative to isolating people while waiting for a vaccine or waiting for symptoms to appear? Obviously, failing to treat and isolate a person who is contagious without symptoms increases the risk of spread.

Will the vaccine be able to limit the massive progression of contamination when healthy carriers (ie without symptoms) represent a high rate in a population? It was mentioned that this rate for covid-19 corresponded to a high rate according to the "Le Parisien"'s newspaper [PAR] [FEM]. The vaccine must be 100% generalized on the planet or it must be tested periodically and locally. It is the latter case, the test for all, which is presented in this article.

[PAR] https://www.leparisien.fr/societe/coronavirus-au-bout-de-combien-de-temps-un-gueri-n-est-il-plus-contagieux-06 -04-2020-8294679.php
[FEM] https://sante.journaldesfemmes.fr/fiches-maladies/2625903-porteur-sain-covid-19-coronavirus-asymptomatique-definition-test-anticorps-contagieux-transmission-pourcentage/

Goal

The objective of this paper is to propose a part of the crisis project organization that respects the time model of image n ° 1 in order to:

  • Slow an outbreak by detecting people with asymptomatic symptoms through testing;
  • Increase the probabilities of survival of the contaminated by anticipating care;
  • Repeat tests over a period of time to consolidate test quality and reduce the chance of test failure;
  • Change our societal culture to integrate a TEST TDAP logic to control critical epidemics.

Proposal

The solution presented is based on a paradigm shift: the importance of testing. The logic becomes the following cycle:

  • 1 - Rapidly the test asymptomatic cases
  • 2 - Treat Quickly
  • 3 - Quickly recover (see image n°2)
The positive person have to follow the health national protocol.

The difference from what has been done: Each asymptomatic individual isolated takes a Test BEFORE having symptoms and not only when symptoms are checked. An entire population is systematically tested. For example, this allows you to resume work after 6 days, while continuing the measurement of tests, for a pandemic such as COVID19 whose onset of symptoms is N days where N <6 days.

AgilBee - Test Driven Anti-Pandemy (TDAP)

Image n°2: Test Driven Anti-Pandemy (TDAP)

Example of a semi-automatic organizational process with TDAP:

  • Develop a large-scale and reliable individual test;
  • Massively distribute to an entire isolated population (country, region or city) a set of N manual tests (self-tests) such as, for example, N saliva test strip or N serological test per drop of blood; < / li>
  • Periodically (every m days), perform a Test ; If the test is positive on day D (0 <= J <= N), the person isolates himself from his entourage and follows the health instructions to be treated quickly; The entourage also isolates itself and goes back to 0 for the Tests if they are negative;
  • If after N x m days my tests stay negative, I can get out of lockdown;
  • Then - Repeat the protocol from point 2 at each new increase in the detected cases so that control the flow.

In the critical case, the image #3 shows the preliminary lockdown step:

Image n°3: Organizational process of semi-automatic test with self-lockdown.

In the controlled case, the image #4 shows the self-organization of the population:
Image n°4: Test Driven Anti-Pandemy (TDAP) without lockdown

Motivations

Why do this type of test before the first symptoms?

  • FACTOR 1: Infected without symptoms are not tested and can contaminate unconsciously;
  • FACTOR 2: Test Quicker = less of Complications : Because the faster the test, the faster the patients are taken care of, the more the complications are reduced.
  • FACTOR 3: More humanistic: It would be more humanistic to reduce the number of deaths.
  • FACTOR 4: More economical: It would be at least 10 to 1000 times more economical to test sooner than to let an epidemic spread.
  • FACTOR 5: TEST vs VACCINE: Because creating Tests is faster to manufacture than creating a vaccine. The Vaccine is a complement to the Tests. And THE TEST is harmless unlike the risk of a vaccine.
  • FACTOR 6: With Delta = 6 months, what will become of us? Because the next pandemic with an incubation time of 6 months, we will not be ready. It will be necessary to know how to spread the tests over N months; And the vaccine will come too late.
  • FACTOR 7: For the most fragile : Because the next epidemic (as for the flu), we will have an alternative to vaccines and it would be interesting to study it in the interest of our elders.

Why should this work?

  • FAIL FAST & LEARN FAST: There are too many systemic aspects to be sure. And from my experience, you have to try it to say that it doesn't work. An empirical opinion against this process cannot be valid on this proposition because there is a paradigm shift behind it. So let's test and learn at the same time that we are testing other solutions.
  • PRESENCE OF CONTRADICTIONS: The contradictions in the communication of government officials are a sign of pure empiricism and a fortiori a suspect sign of a need for a paradigm shift.

Why might this process fail?

It could fail if:

  • Tests are unreliable (at high rate).
  • This process is not sufficient for a virus whose delta variability is highly variable between people.
  • This process depends on the reliability of the tests. If the tests are unreliable, the control of contaminants becomes chaotic.
  • This process is not suitable for viruses with strong mutations
  • This process does not obey any effect shown in picture 1
  • The virus is more resilient in nature.

Explanations

Why is it a good idea to TEST first?


Image n*5: How to reduce the additional cost of anomalies to a reasonable situation or at best constant?

To finish the document, here are some explanations of why it would be wise to massively test asymptomatic cases. These explanations are based on our knowledge of the paradigms learned with the birth of the field of Agility and the importance of tests in the professional environment.

Before the Test reached its peak, in some areas the question engineers were asking themselves was, "How can we reduce the costs of fixing the anomalies that were increasing exponentially over time?" (cf. Image 3). All the professionals in this field had had the reflex to increase the quantity and the quality of the documentation only to realize that by increasing the writing time we were losing even more time and that this increased the number of anomalies. Obviously, they were heading towards risk rather than cleaning up the situation.

To remedy this, towards the end of the 90s, certain consultants said to themselves that this was a consequence of the youth of our profession and consequently that we had to improve our engineering practices. A series of practices emerged and the result did not change. And our products were rewritten because of too high technical debt; we therefore do not know the “bell” effect (pseudo-Gaussian curve called epidemic curve) corresponding to the cancellation of the debt. The solution was not therefore on the side of the engineers but concerned all the actors of the project in a systemic way.


Image n*6: Anti-paradigm and Test First paradigm and its automations.

A technique based on the observation of a paradigm emerged. She was answering the following question: If we want constant correction costs (picture # 6), what should we do? The technique of “TEST DONE FIRST” was born, called in our jargon “Test First”. By applying this Test-First logic, costs and times have been brought under control and new theories have emerged, including automation mechanisms.

However, this practice is counter-intuitive like many other agile practices. To do a "Test First" seemed a priori to most professionals a bad idea. How can we do a test before we manufacture anything? And yet, our tests have shown such powerful properties that it remains 25 years later, the technique of excellence for programming in the software world. If these professionals do not think like this, they have to redo their product every 4 years or suffer significant financial losses.

It was so counterintuitive that I decided to launch Agilbee on this idea: “To test is to master! »Without massively testing, there is therefore no mastery.


Image n°7: What is the new paradigm (if it exists)?

Historically, at the Industrial level, all products are tested before their release. For Business, we professionally stopped doing Darwinism. In the 90s, at the business level, we were developing 10 products and we knew that there was a 1 in 10 chance that a single product would emerge on the market. Since the 2000s with Agility, we have validated the functionalities of a product with our end customers before creating the product. We have stopped Darwinism in our business.

As for epidemics, let us then ask the questions: How to limit genetic mutations in viruses by limiting the spread of the virus? How to get a lower curve? What would then be the new paradigm which should replace “Wait for a vaccine” and “wait for your symptoms to appear”; are these paradigms costly in terms of number of lives, financially and that does not attenuate the curves? What would the principle of Test First give then on a Pandemic while waiting for a vaccine for the most vulnerable?

Conclusion

As I wrote above, imagine a Virus with a mortality rate greater than 10% instead of around 0.7% and a latency rate between asymptomatic and symptomatic cases very high. What will happen? How will we do? If another pandemic comes along with these kinds of characteristics and a test seems to be working, it is worth using this simple process and testing it ASAP.


Image n°8: Source from University of John Hopkins, December 2020

A paradigm emerges: TEST FIRST (SEMI)-AUTOMATICALLY rather than WAIT FOR A VACCINE.

The later we intervene, the more we increase the risks. Testing should reduce systemic risk as it does in most trades. The current governance organization remains on a model of propagation and not of verification. It would be interesting to test some thought model alternatives. Even if this is not the solution, there will be an impact on the number of recoveries.

And then, it joins our precepts of “Test & Learn” or “Fail Fast! Learn Fast! ". By trying this model, we only risk the ridiculous but the ridiculous does not kill a priori unlike the virus. I see an interest in applying it for other types of less critical pandemic in the interest of the most vulnerable.

Patrice Petit, Dr.

Specialist in work methodology and business organization, Patrice Petit is the founder of AgilBee; it helps companies to discover the new counter-intuitive paradigms essential to an harmonious and efficient company. He has worked in many organizations in the IT, Accountants, Industrial, Pharmaceutical and NGO activity domains, for example, to coach and train them. He has trained and certified more than 5,000 professionals in Agility with international certifications.

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