The Curves, the Matrix, and the CoronaVirus

“Flatten the curve” very early on became the byword for dealing with the coronavirus crisis.

“The curve” refers to a line graph representation of the number of COVID-19 cases at any given moment in time, and “flattening” refers to reducing or eliminating the numbers of cases which, at any moment in time, exceed the care capacities of the healthcare system.

As a hypothetical example, let us say that a particular hospital has ten operative ventilators which can help an ill patient to breathe.  Let us further say that each patient who needs a respirator will need it for exactly five days.  If no respirators are in use, and one coronavirus patient who needs a respirator is admitted to the hospital each day, then the curve will top out at five respirators, well within the hospital’s capacity to provide care.

If two such patients are admitted each day, then on Day One there will be 2 respirators in use; 4 respirators on Day Two; 6 respirators on Day 3; 8 respirators on Day 4; and 10 respirators on Day 5.  On Day 6, the two new patients could be accommodated because two of the respirator patients will be freed up because they (hopefully) have sufficiently recovered to breathe on their own.  The “curve” will top out at 10, the hospital’s maximum capacity.

But what happens if three patients in need of respirators present to the hospital each day?  On Days 1 through 3, all patients will be accommodated, but on Day 4 only one of the three new patients would be able to be accommodated.  The “curve” will top out at 15 patients, but that is above and beyond the hospital’s capacity of 10.

If the number of new coronavirus patients can be held down to 2 per day (and assuming that no other patient needs a respirator for whatever non-COVID purpose), then this hypothetical hospital will remain within its capacity to provide healthcare (albeit dangerously close to its breaking point).

The healthcare system can accommodate many patients if they arrive in manageable numbers over an extended period of time, but a sudden large influx of patients can cripple the healthcare system.

[A similar dynamic applies to financing one’s home purchase with a mortgage; smaller payments spread out over ten years are far more manageable than an immediate payment of a million sheqels; the mortgage is what flattens the financial curve of purchasing one’s home.].

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There are many graphic illustrations in connection with the coronavirus.  One “curve” that has been given sparse explicit mention is the Learning Curve, which in and of itself does not entail any data that directly derives from numbers of COVID-19 cases, but rather, the level of knowledge regarding the coronavirus and how to deal with it.

My first steady “real job” out of college was as an Assistant Production Manager in a printing plant.  While I was there the company relocated to better quarters.  During the move, my boss, the Production Manager, was at the old location overseeing the dismantlement and packing of the printing presses, silkscreen benches, guillotine shears, photographic lab, die-cutting machines, and other equipment and supplies, while I oversaw the erection of the equipment and the set-up of production lines at the new place (in addition to monitoring the work we were farming out to other printing houses during the move).  It took some time for everyone to become acclimated to the new shop, but after making some adjustments and innovations in our routines we brought our production efficiency to a level that far exceeded what we could achieve in the former location.

A graphic illustration of our output and revenues would show an improvement over time.  This was our “learning curve.”

That background in factory production postured me very well in subsequent jobs, including some cases I had in my law practice, and in my career as a Contracting Officer and Analyst for the US Department of Defense; I was able to intelligibly discuss with military contractors, large or small, the relevant industrial production issues as they related to quality and price (and security of sensitive information).

There are industrial processes of far greater complexity than a printing factory.  Aircraft manufacture comes immediately to mind.  Each individual aircraft is in many respects a manufacturing run unto itself because it is modified to embrace techniques learned in assembling previous airplanes for the same military contract, and to incorporate newly-available components from new subcontractors.  Some advances in the learning curve warrant retrofitting and/or reconfiguring individual aircraft which have already been completed, delivered, and placed into service.

Even during my childhood, my father would often tell the story about how he, as a recently-graduated electronics engineer in the employ of the United States Navy, had been instrumental in canceling a Navy contract for some electrical alternators which had been specified for an ongoing aircraft production run because the electromagnetic interference from those particular alternators caused the aircraft’s navigation and communications systems to malfunction.  [Following Dad’s passing, I found copies of his analysis document and the associated internal Navy memoranda among his papers.].

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The complexity of aircraft manufacture requires “Matrix Management,” such that an individual employee will report to two (or more) supervisors.  In addition to the administrative supervisor, who deals with general matters such as salary, personnel, and performance evaluation, the employee also reports to a functional supervisor who oversees one or more technical aspect of the employee’s work.  In order for Matrix Management to work, there needs to be effective cooperation between the administrative and the functional supervisor.  This alone entails a “learning curve” on how to cooperate, and developing a mechanism for resolving the conflicts among the supervisors and employee that will inevitably arise.

Once the formal and informal protocols for interpersonal relationships become stable, the matrix organization itself is then subject to a “learning curve” for each project.

There are aspects of “matrix management” in the Israeli healthcare system (and, for that matter, the healthcare systems of other nations).  For example, a hospital nurse will report to a Head Nurse as an administrative supervisor, but for any given patient also carry out the orders of one or more physicians.

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The concepts of learning curves and matrix management have played into Israel’s handling of the WuFlu epidemic.

Firstly, there were many unknowns when the coronavirus first hit Israel.  The ominous information emerging from China, together with the even more ominous (and more reliable) stories coming out from Italy gave rise to a justifiable fear that too many COVID-19 patients might require too much medical attention in too short a time frame for Israel’s healthcare system to adequately handle.  The healthcare system sought to “flatten the curve,” that is, to avert a crippling overload from a sudden influx of COVID-19 patients.

In view of what then was known – and what was unknown  – about the coronavirus, the Israeli government (such as a government existed at the time) elected to err on the side of stringency (which, in hindsight arguably was no error at all).  The pandemic needed to be managed from diverse governmental perspectives.  Though nominally a health issue, the Ministry of Health needed to coordinate with other functions, including but not limited to Economy, Construction, Labor, Tourism, and Foreign Affairs – every Cabinet portfolio has somehow been involved, as has the judiciary.

The government players all needed to learn how to work with one another, and with the public.  Though the learning curve has yet to top out, significant progress on the learning curve has occurred not only within the government, but amongst various portions of the public.

One notable learning curve progression has occurred amongst certain insular communities.

As noted in a previous TOI blog posting, “I have significant reservations about using terms such as “Haredi” or “ultra-Orthodox” because men who wear a black hats but who submit false claims for government funds, bribe government officials  (including bribes to cover for insurance fires in which responding firefighters are injured), commit tax fraud, and/or cheat on their wives are not more religious than I, and using such terms only perpetuates The Big Lie that they are.”

In such regard, the term “insular community” is accordingly most appropriate in discussing the COVID-19 because the notorious initial rejection of the social distancing regulations by the insular community top leadership was rooted not in religiosity, but in their disconnect from the world at large.

But after initially balking, the insular community has quickly internalized the realities of the coronavirus, and there now is great compliance among their ranks.  In other words, they have risen high and far along the learning curve.

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We now have justifiable fears of a COVID-19 resurgence.  There seems to be a correlation between a relaxation in adherence to the social distancing regulations and an increase in COVID-19 cases, and the government is now looking to tighten up in its enforcement efforts.  A simple walk down the street will show a significant number of people flouting the mask requirement, for example.

Those who a few weeks and months ago were critical of the insular communities for their nonadherence to the regulations, myself included, should now be no less exercised at the secular people whose compliance is now deficient.