Office in a Small City, by Edward Hopper, 1953. Courtesy Metropolitan Museum of Art and George A. Hearn Fund.

Read the Reflection, written 5 October 2021, below the following original Transmission.

Imagine a world where one had the opportunity to prevent cancer. And that this involved no medication and could be developed by every one of us without any special training, entirely from home. And that by preventing the disease for several months we would provide researchers the window of time required to develop a treatment, and doctors, nurses, and hospitals, the relief to effectively deploy it across the global population.

I suspect that we would all stay at home, strive as best as we could to remain productive, and thereby become an active part in one of the greatest prophylactic achievements in the history of public health. The Nobel Prize for medicine would be justly awarded to all the citizens of the world.

This is an impossible scenario for cancer. It is an impossible scenario for effectively all of the top 20 causes of deadly disease in the world.  For heart disease, cancer, stroke, and Alzheimer's we have at best a rather patchy understanding of their origins, how they cause illness, and how we might treat them.

Each of these diseases is correlated to different degrees with our genetics, behavioral habits, social systems, economies, and ecosystems. For example, heart disease has a strong genetic component; it is highly dependent on our diets and addictions and our behavior — particularly how active we are. The same factors have an impact on cancer but with a stronger influence from genetics and environmental factors and conditions. And these factors feed back on one another to make isolating a single optimum point of intervention nearly impossible. This is what we describe as Complex Causality. And it makes prevention and treatment of disease very hard.

But the world that we can only dream of for cancer, and for most of the top causes of mortality, is a reality for COVID-19 — we will have a treatment within a couple of years or less and it will work. So why the huge system shock with COVID-19? It has to do with a rather amplified property of causality that reaches out beyond the disease to touch the complex systems of the world.

Unlike with these other diseases, in the case of COVID-19 there is a rather unique convergence of causes that reestablishes a kind of simple causality, and these causes are transmission networks. The virus is transmitted initially from animal hosts to humans, typically through diet. Humans then transmit the virus to other humans by contact. These contacts are then transmitted through our transport systems and professional and social lives. This is perhaps the principal reason why the markets and society have been so volatile; the shared factor of transmission is so integral to modern life, it is to such a great extent the foundation of the modern world, that it touches nearly every factor of production. Just as monocultures can generate lethal simplicity in agriculture, transmission has generated lethal simplicity across the globe.

But there is a flip side to this entanglement of complex systems:  transmission, unlike the complexity of genetics, and social systems, economies, and ecosystems, can be relatively easily understood, and, by extension, controlled.  By following the few simple behavioral rules that we all have come to know well — quarantine, maintaining social distance in public, practicing appropriate hygiene, and developing new habits for home-work when possible — every citizen plays a meaningful and significant part in eliminating this scourge.

We use our understanding of the common factor of transmission to our advantage: continue to mobilize the largest information-transmission network the world has ever seen – our technologies of communication — to enable the collective action needed to eliminate the transmission of the virus. Strategic isolation is our anti-viral flash-anti-mob.  

And we recognize the extraordinary economic sacrifices that are being made to make citizen-based medicine a reality — position economic relief as fair sharing in the reward for the unprecedented scale of teamwork required to rid the world of a terrible disease. If we can transmit insight at the speed of light then we should do the same for compassion and support. If the economy is going to rebound anywhere near as fast as it declined, we need to understand the complex nature of transmission, in aligning emotion, reason, science, policy, and economies toward recovery as effectively as these alignments produced collapse.

By using transmission to our advantage, we can control coronavirus through citizen-based medicine.

David Krakauer
President and William H. Miller Professor of Complex Systems
Santa Fe Institute

T-000 (Krakauer) PDF

Read more posts in the Transmission series, dedicated to sharing SFI insights on the coronavirus pandemic.

Listen to SFI President David Krakauer discuss his Transmission in Episode 26 of our Complexity Podcast


October 5, 2021

Preventative Citizen-Based Medicine

In my Transmission, I proposed what in retrospect proved to be an overly optimistic approach to the pandemic. The premise was that the alignment of transmission mechanisms promoting viral outbreak, spread, and growth should be turned against the virus. That human collective action could work as a countertransmission mechanism. A large suite of relatively cheap and rational actions, including isolation, masking, and remote work, would reduce the threat of the pandemic. Such inexpensive and readily available behavioral remedies would do nothing in our efforts to reduce the incidence of diseases like cancer or Alzheimer’s but could accomplish a great deal in moderating a pandemic. And, unlike these diseases against which individual citizens often feel powerless and passive, in the case of COVID-19, everyone on the planet would become an active mechanism of defense against further infection.

We have witnessed that many citizens of the world understood they were a part of such a solution. However, trends quickly emerged that made truly effective collective-action measures a challenge. Men proved to be more resistant to using masks in indoor spaces than women (but no comparable difference was found for outdoor mask use). And while time spent watching COVID-19 news was associated with increased social distancing, several studies found contrary correlations between political affiliation, mask use, and a willingness to isolate.1

It is very difficult to come to terms with the unanticipated ways in which such a simple form of viral life morphed into chimerical ideology when encountering the complex economic and political doctrines of our time. It is true that history has shown us how even unequivocally positive steps have been met with resistance and criticism. Take, for instance, hand hygiene in health care. After Ignaz Semmelweis demonstrated that antiseptic agents could significantly reduce the transmission of germs in obstetric clinics, there was almost no adoption of his recommendation. This has been attributed to his failure to consult with colleagues and gave rise to the modern “recognize–explain–act” approach to successful infection control intervention.2 But this kind of failure is certainly not the whole story for COVID-19.

In a recent review of the pandemic in connection to political polarization in the UK, Vlandas and Klymak conclude,

The first death had a negative effect on the perceptions of government handling of health among both Labour and Conservative voters, while Boris Johnson’s hospitalisation improved perception among most voters for both dimensions. Lockdown improved perception of health handling but at the cost of lower perceptions of handling of economy among Conservative voters. It further led to a convergence in views about government handling of the economy towards a lower level among both Conservatives and Labour voters, whereas it led to partisan divergence in perceptions of its handling of health, despite leading to more positive views for all voter groups.3

This complex causality makes a Rube Goldberg machine look as straightforward as a spoon. It would seem to be impossible to predict such oscillations and affinities of belief. Certainly, increased public morbidity might elicit distrust in government, but a rise in trust across the board based on the hospitalization of a prime minister who declared that he had “shaken hands with everybody” is less comprehensible.

In conclusion, I still believe in my original premise. I just no longer believe that society can act rationally under pressure. This places a great burden on science to be readily available and communicated well in times of stability. In other words, citizen-based medicine needs to become preventive medicine rather than treatment.

Read more thoughts on the COVID-19 pandemic from complex-systems researchers in The Complex Alternative, published by SFI Press.

Reflection Footnotes

 1J.A. Gette, A. K. Stevens, et al., 2021, “Individual and COVID-19-Specific Indicators of Compliance with Mask Use and Social Distancing: The Importance of Norms, Perceived Effectiveness, and State Response,” International Journal of Environmental Research and Public Health 18 (16) doi: 10.3390/ijerph18168715

2 World Health Organization (WHO), 2009, WHO Guidelines on Hand Hygiene in Health Care, Genève, Switzerland: World Health Organization.

3 T. Vlandas and M. Klymak, 2021, “Pandemic and Partisan Polarisation: Voter Evaluation of UK Government Handling during Covid‐19,” Swiss Political Science Review 27 (2): 325–38, doi: 10.1111/spsr.12457