Abstract
Despite a range of federal and state interventions to slow the spread of COVID-19, the US has seen millions of infections and hundreds of thousands of deaths. Top-down mandates have been ineffective because the community spread of the pandemic has been influenced by complex local dynamics that have evolved over time. Systems thinking approaches, specifically causal loop diagrams, and leverage points, are important techniques for representing complexity at the local level and identifying responsive systems change opportunities. This commentary presents a causal loop diagram highlighting the progressive effects of prolonged state-level COVID-19 mandates at the community level. We also identify potential system leverage points that address these effects and present an imagined future state causal loop diagram in which these solutions are implemented. Our future system demonstrates the importance of collaborations to enable community-driven, bottom-up approaches to public health crises, such as the COVID-19 pandemic, that are adaptive and responsive to local needs.
Highlights
As COVID-19 continues to evolve in the United States (US), it rages on in other parts of the world, re-emerging in countries that had brought it under control
We show the interactions of key economic, social, health, and environmental variables in a county as COVID-19 progresses and identify leverage points for change that can guide county-level actions and policies
We reviewed the peer-reviewed literature for Causal loop diagrams (CLDs) describing COVID-19 at the global or national level so that our county-level CLD could be linked to these higher-level dynamics where appropriate [12]
Summary
As COVID-19 continues to evolve in the United States (US), it rages on in other parts of the world, re-emerging in countries that had brought it under control. The US and most other countries failed to adopt community mitigation strategies in the early stages of COVID-19 As this initial opportunity was missed, the disease began to spread in complex and unpredictable ways. In the early days of the pandemic, Sahin et al used a CLD to depict the dynamics of the global pandemic and suggested leverage points to influence national and global policy [12] In this commentary, we extend this analysis to show how CLDs can be used to represent how local dynamics at the level of a county in the US progress over time and affect physical, mental, and social well-being at the community level. We show the interactions of key economic, social, health, and environmental variables in a county as COVID-19 progresses and identify leverage points for change that can guide county-level actions and policies. White Black or African American American Indian or Alaska Native Asian Native Hawaiian or Other Pacific Islander Two or more races Education [14] High school graduate or higher Bachelor’s degree or higher COVID-19 cases per 100,000 [1] COVID-19 case fatality rate [1]
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