Published by Marin Independent Journal.
The missing link in the COVID-19 care chain is rapidly expanding and the size of a black hole.
The “care chain” is the entire strand of public health services, which includes the World Health Organization and Center for Disease Control and Prevention, as well as national, state and county health services.
While we stock up on toilet paper, cans of tuna and Nutella because we don’t trust the supply chain, the care chain can’t be trusted either. It is missing that critical link at the neighborhood level, aka the N Level.
Taiwan has had recent success in stopping the spread of coronavirus. Its seamless national public health system includes N Level links that are, reportedly, one of the many reasons why the country has the lowest number of coronavirus cases and deaths of any country in the world.
According to the Economist magazine, “Taiwan’s system of neighborhood (managers) … has helped enforce quarantines and deliver food to those who cannot go out to get it.”
Taiwan Vice President Chen Chien-jen, an epidemiologist and former health minister, is the “czar” of the Central Epidemic Command Center.
The small-is-beautiful reasoning behind these N Level centers for disease control and prevention is that neighborhood-based surveillance and management works better and faster in a tight community setting.
As Taiwan shows us, individuals can be identified and quarantined before the nasty virus reaches anyone in the neighborhood cluster.
It’s easier to put out a small fire in a neighborhood than wait until it becomes an uncontrollable, national conflagration.
If the virus breaches the local societal wall, victims can be carefully isolated and monitored without leaving the confines of the neighborhood.
Here in the United States, neither the federal government nor the state or county governments have the means to provide the type of individualized care that this epidemic requires, but they can help draw attention to the great need for N Level epidemic surveillance and management.
How do we definie a neighborhood? If I stand on the flat roof of my house; the 50-odd homes that I can see are my N Level cluster.
Folks living in apartments or condos would consider their neighbors to be everyone in the building or complex.
The problem I have in my neighborhood is that I really don’t know my neighbors at all, much less how I would help them in case of an emergency, so where would I begin as an individual cloistered in my home office for the duration?
This is where Marin County supervisors need to be working in tandem with public and private health and security services.
Our county officials need to rapidly organize, establish an epidemic management command center and commission a czar.
Job No. 1: Identify and develop pilot N Level community projects.
Once tested in the field, the czar would need to establish policies and procedures that would soon be extended to other N Level neighborhoods.
In order to catch up with the type of technological system that Taiwan has already implemented, we should identify similar, national N Level mobile phone applications that will fit the need for all participants within any given N Level cluster.
Oversight should be from a national coronavirus hub, and be managed by N Level czars whose sole duty is to communicate general and specific information, to monitor preventive, curative and household support activities and to help each neighbor as needed.
Since Taiwan already has the system and the experience for N-level management, perhaps we should invite Vice President Chen Chien-jen to advise us at all levels of organization, management and implementation.
But we need to get started now.
Every day tens of thousands of people are getting the virus, thousands are dying and millions are grieving, many are jobless and many more just worried.
The missing link is still missing — glaringly so.
The sooner we get started, the sooner we will create the most vital link in the care chain that includes our families, friends, you and me at the neighborhood level.