COVID-19 - how a pandemic reveals that everything is connected to everything else

The emergence of a coronavirus (SARS-CoV-2) with novel characteristics that made it highly infectious and particularly dangerous for an older age group and people with multiple morbidities brought our complex adaptive system (CAS) “society”—the economy, health systems, and individuals—to a virtual standstill. The COVID-19 pandemic—caused by SARS-Co-2—is a typical wicked problem¹—we did not see it coming, we experience its effects, and it challenges our entrained ways of thinking and acting. In our view, it is a classic example that demonstrates how suddenly changing dynamics can destabilize a system and tip it into an unstable state. COVID-19—rather than something else—turned out to be what we colloquially call the last straw that broke the camel's back or, put in system dynamics terms, what pushed our societal systems over a tipping point. When a system suddenly tips over, the linkages between most of its agents break, and a chaotic situation ensues. Chaotic states entail a high degree of uncertainty, a state in which previously proven interventions no longer maintain the status quo. The uncertainties triggered by COVID-19 have not only shown the fragility of health and national systems but also highlighted the intrinsic and tacit dynamics underpinning them. Most notable are the markedly different responses at the policy and community level. China drastically clamped down on all societal activities and rapidly built large new hospitals to deal with those fallen ill. Iceland rapidly tested every potential case. Sweden implemented limited social distancing measures. Italy hospitalized many mild cases in an environment of limited hospital resources, and the United States, for several weeks, denied that there is a significant problem. Each of these approaches has its own dynamics affecting individuals, communities, health systems, the economy, and the nation as a whole—new patterns emerge that become understandable with increasing knowledge (Figure 1). However, the long-term outcomes and effects on the system as a whole will only become evident over the next months and years.