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Is the COVID-19 pandemic the result of knowledge management failures? (part 1): Cognitive biases and disaster responses

This article is part 1 of the article series “Is the COVID-19 coronavirus pandemic the result of knowledge management failures?”, and also part of an article series exploring the COVID-19 coronavirus pandemic from a knowledge management perspective.

In January this year, the world first learnt about the emergence of a new coronavirus disease1 of apparent animal origin, later called COVID-19, in the Chinese city of Wuhan. COVID-19 (which means “coronavirus disease 2019”) is the respiratory illness caused by the SARS-CoV-2 coronavirus (which means “severe acute respiratory syndrome coronavirus 2”).

In the time since, the COVID-19 outbreak has become a global pandemic, spreading to over 200 countries worldwide. At the time of publishing this article, there have been more than 21 million cases and 770,000 deaths, with exponential growth in these figures2.

As the “Total cases” and “Total deaths” selections in Figure 1 show, the hardest hit country is the United States. As of today, (17th of August), it has around one-quarter of all global cases and one-fifth of all deaths, more than any other country, despite having only just over 4% of the world’s population.

With the death toll mounting, United States President Donald Trump has become progressively more and more critical of both China and the World Health Organisation (WHO). He asserts that the Chinese Government has failed to openly share important knowledge and information, particularly in the early stages of the pandemic, and that the WHO is a co-conspirator in this knowledge hiding.

In a 15th of April White House fact sheet, President Trump stated that he is “placing a hold on all funding to the WHO while its mismanagement of the coronavirus pandemic is investigated,” claiming that:

  • Despite the fact that China provides just a small fraction of the funding that the United States does, the WHO has shown a dangerous bias towards the Chinese government.
  • The WHO repeatedly parroted the Chinese government’s claims that the coronavirus was not spreading between humans, despite warnings by doctors and health officials that it was.
  • The WHO put political correctness over life-saving measures by opposing travel restrictions.

Subsequently, in remarks in a White House press briefing on the 18th of April, he further states that:

It could have been stopped in China, before it started, and it wasn’t. And the whole world is suffering because of it.

… if it was a mistake: a mistake is a mistake. But if it were knowingly responsible, yeah, then there should be consequences. You’re talking about, you know, potentially lives like nobody has seen since 1917.

Then, in an article on the 1st of May, The Washington Post reports that:

Senior U.S. officials are beginning to explore proposals for punishing or demanding financial compensation from China for its handling of the coronavirus pandemic, according to four senior administration officials with knowledge of internal planning …

President Trump has fumed to aides and others in recent days about China, blaming the country for withholding information about the virus, and has discussed enacting dramatic measures that would probably lead to retaliation by Beijing

Most recently, President Trump announced on the 7th of July that the United States would be withdrawing from the WHO, effective from July 2021. The planned withdrawal has sparked considerable concern. For example, the American Medical Association (AMA) has stated that “The Trump administration’s official withdrawal from the World Health Organization (WHO) puts the health of our country at grave risk.” Further, while acknowledging shortcomings in the WHO that require substantial reforms, expert commentary in leading medical journal The Lancet states that3:

Health and security in the USA and globally require robust collaboration with WHO—a cornerstone of US funding and policy since 1948. The USA cannot cut ties with WHO without incurring major disruption and damage, making Americans far less safe. That is the last thing the global community needs as the world faces a historic health emergency.

In addition to the allegations made by President Trump and others from his administration, multiple class actions totalling trillions of US dollars are also being mounted against the Communist Party of China (CPC). The allegations in these planned lawsuits include that the CPC sought to cover up the COVID-19 outbreak.

Australia, which the United States sees as a “vital ally, partner, and friend,” has also questioned the openness of information sharing by China and the WHO. In April, the Australian Government called for a global inquiry into the spread of the coronavirus, and expressed the view that the inquiry should be conducted independently of the WHO. This call was backed by Australia’s Opposition party.

Senator Marise Payne, Australia’s Minister for Foreign Affairs, was asked about the proposed inquiry in an interview with David Speers on the ABC News “Insiders” program on the 19th of April:

David Speers: What questions would you like China to answer?

Marise Payne: I think the key to going forward in the context of these issues is transparency. Transparency from China most certainly, transparency from all of the key countries across the world who will be part of any review that takes place. I think it’s fundamental that we identify, we determine an independent review mechanism to examine the development of this epidemic, its development into a pandemic, the crisis that is occurring internationally …

David Speers: When you say there’s a need for transparency, again, what would you like to know from China?

Marise Payne: Well, we need to know the sorts of details that an independent review would identify for us about the genesis of the virus, about the approaches to dealing with it, and addressing it, about the openness with which information was shared, about interaction with the World Health Organization, interaction with other international leaders. All of those sorts of things will need to be on the table.

David Speers: Who should conduct this independent review that you’re talking about?

Marise Payne: Well, as I say, there will need to be an agreed determined mechanism by which to do that. We’ve been able to do those sorts of things in the past for key independent reviews, often on egregious human rights issues, for example. And I think that there will be a path through, but it will need parties, countries to come to the table with a willingness to be transparent and to engage in that process, and also ensure that we have a review mechanism in which the international community can have faith.

David Speers: Could it be the World Health Organisation, or do you agree they’re too beholden to China?

Marise Payne: Well, I don’t think that it is so much about whether they are or are not beholden to China. And we share some of the concerns that the United States have identified in relation to the World Health Organization. That is certainly correct. I think it is about an independent mechanism, and I’m not sure that you can have the health organisation, which has been responsible for disseminating much of the international communications material, and doing much of the early engagement and investigative work, also as the review mechanism. That strikes me as somewhat poacher and gamekeeper.

David Speers: So it can’t be the World Health Organization, in other words, to do this review?

Marise Payne: Well, no, as I’ve said, that strikes me as a bit poacher and gamekeeper.

The call for an inquiry was formalised into a motion that was put to the the Seventy-third World Health Assembly meeting on the 18th and 19th of May. However, rather than being initiated by Australia, the motion was formulated by the European Union with some amendments then being made by Australia. The motion is also substantially different to what had been sought by Australia. Rather than specifically focusing on China’s response to the pandemic, it includes actions to examine the origins of SARS-CoV-2 and the international response to COVID-19 as part of a comprehensive overall global response to COVID-19.

The motion was supported by over 130 countries, including China, and adopted as a resolution by consensus. The resolution includes the following statements:

The Seventy-third World Health Assembly … REQUESTS the Director-General [of the WHO]:

… to continue to work … to identify the zoonotic source of the virus and the route of introduction to the human population, including the possible role of intermediate hosts … which will enable targeted interventions and a research agenda to reduce the risk of similar events occurring, as well as to provide guidance on how to prevent infection with severe acute respiratory syndrome coronavirus 2 (SARS-COV2) in animals and humans and prevent the establishment of new zoonotic reservoirs, as well as to reduce further risks of emergence and transmission of zoonotic diseases

… to initiate, at the earliest appropriate moment, and in consultation with Member States, a stepwise process of impartial, independent and comprehensive evaluation … to review experience gained and lessons learned from the WHO-coordinated international health response to COVID-19 – including … the actions of WHO and their timelines pertaining to the COVID-19 pandemic – and to make recommendations to improve capacity for global pandemic prevention, preparedness, and response

Australia’s call for the inquiry has triggered a strong backlash from China.

Concerns in regard to COVID-19 information and knowledge sharing have also been raised within the knowledge management (KM) community. For example, the very first comment in a discussion thread titled “What is the role of KM in a time of crisis – with specific reference to the current coronavirus/Covid-19 pandemic?” in the KM4Dev discussion forum was “can we also start with a notion that the current situation is a result of failure of KM?”

So are the assertions in regard to a lack of open information and knowledge sharing by China and the WHO true? Is the COVID-19 pandemic really the result of failures of knowledge management?

I’ll begin answering these questions by exploring my own personal experiences in regard to COVID-19.

Ignorance then shock

On Wednesday 22nd of January this year, I landed into Sydney International Airport after overnight flights from Nanjing, the capital city of China’s Jiangsu Province, which is about an hour by high-speed rail from my home in the city of Wuxi. I was returning to Australia for the winter break, a gap of three weeks between terms in the Australian university foundation studies program for which I’m a teacher in China.

As I was waiting for the Greyhound bus to Canberra, my Australian home and the national capital, I went into one of the convenience stores in the arrivals hall to buy some snack food. As I was paying for my purchases, I happened to glance down at the newspapers that were on display on the counter in front of me, and a front page headline left me reeling.

The article said that a Brisbane man who had recently returned from Wuhan was in quarantine pending the results of testing for what was potentially Australia’s “first case of China’s new deadly coronavirus.” I’d only learnt about the potential for the human-to-human transmission of this new “SARS-like virus” from a friend’s WeChat post just the day before, and was already troubled by that news, having been in Wuhan myself just two days earlier.

I had travelled to Wuchang by high-speed rail on the 18th of January to see a friend, returning on the 19th. Wuchang is one of the three directly adjoining historic towns that now make up the megacity of Wuhan. This bustling and friendly city instantly impressed me, and in my short time there we enjoyed visiting a number of interesting places. These included the very popular Hubei Provincial Museum and the even more crowded Hanjie Pedestrian Mall, the longest commercial pedestrian street in China, where I took the photograph at the head of this article above.

So much went through my mind as I walked out of the Sydney airport convenience store. My arrival point in Wuhan had been Hankou Railway Station, which is located just 800 metres from the Huanan Seafood Wholesale Market, the suspected origin of the coronavirus outbreak. Fortunately I had arrived late at night, when the market was presumably closed4. But how many market customers, particularly regular customers, had passed through the station and surrounds prior to my arrival? The Brisbane man was reported as having “flu-like symptoms,” whereas I was feeling fine. But could I still be carrying the coronavirus without displaying symptoms? What should I do? And why had I not known much more about this coronavirus outbreak before I went to Wuhan?

Daily Mirror front page - "Ebola: World goes on red alert"
Figure 2. Daily Mirror front page 30 July 2014 (source: Nick Sutton on Twitter).

The only potentially related news I’d previously seen was an article on the 4th of January that had talked about a pneumonia outbreak affecting 44 people, and then another on the 10th of January that said that the now 50 cases of pneumonia may have been caused by a new virus related to severe acute respiratory syndrome (SARS). I knew how serious SARS was from friends who had directly witnessed that earlier outbreak in Beijing and Hong Kong. However, headlines sounding the alarm over disease outbreaks that haven’t ended up happening are a regular occurrence (for example Figure 2), 50 people didn’t seem like many in a megacity of over 11 million, the articles had said that there were a number of possible causes with “no obvious human-to-human transmission,” and the outbreak wasn’t growing rapidly (just six more people in a week). So I hadn’t thought any more about it.

I sat down in one of the arrivals hall meeting points and commenced a frantic internet search for more information, which I continued during the bus journey. I would find out that the now confirmed coronavirus outbreak that I hadn’t worried about was now so serious that 440 people in 13 Chinese provinces had already become infected, with nine people dying. Human-to-human transmission had been confirmed by the WHO the day before, on the 21st of January, and a total lockdown of Wuhan would begin to be implemented from 10am on the following day, the 23rd of January.

From what I read online, it also appeared that it would be a good idea for me to try to isolate myself as much as possible for the incubation period of the virus, although I wondered how I was going to do that because details were vague. Some news articles had suggested the incubation period was around 14 days, but others seemed to be suggesting a longer isolation period.

Upon arrival in Canberra, I proceeded to isolate as much as possible for 14 days, with the growing information base increasingly confirming that this was an appropriate time period. Fortunately my living arrangements in Canberra made this isolation straightforward.

However, as I was isolating, I started to have another realisation that was just as disturbing as the awareness that I had gone to Wuhan while a new coronavirus that could be transmitted person-to-person was taking hold.

WeChat message in regard to severe flu-like illness
Figure 3. WeChat message sent on 22 December 2019 in regard to experiencing a severe flu-like illness.

I had taken a week’s leave over Christmas, with the plan of making a brief trip to Australia to spend the festive period with my parents and other family members, which I haven’t been able to do for a long time. However, on 19 December 2019, I came down with a severe dose of what I described at the time as a flu. It meant that I had to abandon my plans to travel to Australia, as shown in the message at right (Figure 3).

This flu-like illness matched exactly the symptoms5 that have since been identified for COVID-19. Indeed, if I enter my then symptoms into the Australian Government’s COVID-19 symptom checker, it tells me to “go to the nearest ED [emergency department] right now.”

My symptoms included the shortness of breath, which was quite frightening, waking me up numerous times through the night over two non-consecutive nights. Experiencing this shortness of breath prompted my comments in regard to pneumonia in the message in Figure 3. Another frightening aspect was the intensity of the fever, which caused severe delirium. I should really have sought medical aid, but the delirium prevented rational thought in this regard, and the strong feeling of fatigue meant that I also didn’t feel like dragging myself out to see a doctor (this reinforces the benefits of COVID-19 community health workers, as I recently discussed in another article6 in our COVID-19 series). My illness also had diarrhea as an early symptom, which research7 has found can be an initial presentation of COVID-19, and I also continued to sometimes experience bouts of shortness of breath at night for around two months afterwards.

Did I have COVID-19? The symptoms match, and I came down with the illness just a few days after travelling by high-speed rail and air travel to Taiyuan via Shanghai on the 13th to the 15th of December 2019. Taiyuan is the capital of northern China’s Shanxi Province, and was my home for four years before moving to Wuxi. On my journey I passed through crowded railway stations and airports, including the very busy Shanghai Hongqiao hub, mixing directly with numerous domestic and international travellers.

However, from the findings of initial research into the origins of the SARS-CoV-2 coronavirus, it would have been next to impossible for me to have contracted COVID-19 in December 2019. A paper8 published in The Lancet in mid-February identifies the 1st of December 2019 as the date of the first known infection, and given the known rate of spread through human transmission, this would mean that the chance that I could have become infected just two weeks later is pretty much zero.

But an emerging body of research is raising significant questions in regard to the origin and spread of SARS-CoV-2.  It appears that SARS-CoV-2 was already active outside China before the end of 2019, with a study9 finding that SARS-CoV-2 was already spreading in France in late December 2019, and indications that people were already falling ill with COVID-19 in the United States in December 2019.

Given the rate of spread and that the 1st of December 2019 was the date of the first known infection in Wuhan, it is illogical that the virus could have then spread internationally before the end of that month. This suggests to me that Wuhan, and indeed China, may not have been the source of SARS-CoV-2 at all.

Anger then acceptance

As I was isolating here in Canberra, my feelings of shock in regard to COVID-19 soon gave way to anger.

As I hadn’t been able to visit my parents over Christmas as originally planned, I had then intended to do it at the beginning of my three-week winter break, on my way to Canberra. It was only at the last minute that I changed my plans and decided to come to Canberra first, and then visit my parents on the way back to China.

With the COVID-19 epidemic rapidly escalating and international borders starting to close, my flights back to China were cancelled by the airline, meaning that I had to transition to teaching online when the new term began in mid-February. This has been the case ever since, but with China starting to open its borders to returning workers, I’m hopeful that I’ll be able to return soon.

State and Territory borders within Australia have also been closed, including the border of the state of Queensland where my parents live. This border was finally reopened on the 10th of July, meaning that after more than half a year of waiting, I was finally able to visit my parents and other family members in Queensland two weeks ago. However, just a few days after my visit, the Queensland Government has once again closed the border to travelers from Canberra, so I’m glad that I made the journey when I did.

My elderly parents have both suffered very serious respiratory problems over the past couple of years, so the thought that I could have brought a new and deadly respiratory coronavirus directly to them from Wuhan was extremely disturbing.

We should have taken stronger measures earlier: Wuhan CPC Secretary
Figure 4. CGTN article, “We should have taken stronger measures earlier” (source: CGTN).

My first response was to direct my distress in this regard towards my employers in China, particularly as they had known I was going to Wuhan before I went. In an email to them on the 28th of January, I wrote:

I wasn’t aware at all of the coronavirus outbreak until I returned to Australia last Wednesday (22 January) and saw it on the front page of a newspaper in a store at Sydney International Airport. So I had travelled to Wuhan on the weekend of 18-22 January, completely unaware of the coronavirus issues there. This is despite having advised … that I would be going to Wuhan

My employer replied to say that they had only learnt of the coronavirus outbreak themselves on the 21st of January, which as discussed above, is the date that human-to-human transmission had been confirmed.

I accepted this, particularly as a China Global Television Network (CGTN) article on the 1st of February reported an apology from the Wuhan Communist Party Secretary for disclosing the outbreak too late (Figure 4). In a further email to my employer on the 2nd of February I wrote:

I accept what you say that [you weren’t] … aware of the coronavirus problem until 21 January, and I saw a CCTV News interview yesterday in which the Wuhan government admitted that it should have taken stronger measures earlier … This is an extremely serious knowledge management failure

My own view that the COVID-19 pandemic was the result of failures of knowledge management would be further reinforced when just a few days later the global media carried stories of the 6th of February death of Dr Li Wenliang, a Wuhan ophthalmologist. Dr Li had been reprimanded by police in early January for alerting an online discussion circle of medical school classmates on the 30th of December 2019 in regard to the outbreak of a new virus that appeared to be similar to SARS.

Cognitive biases and disaster responses

However, by now you may well have identified the very serious flaws in my thinking. Despite having suffered a flu-like illness over Christmas that involved breathing difficulties and extreme fever, despite then seeing articles reporting the pneumonia outbreak in Wuhan including an article saying that it may have been caused by a new virus related to SARS, and despite knowing from friends who had witnessed the SARS outbreak in Beijing and Hong Kong just how serious that disease had been, I still went to Wuhan, and then sought to blame others for the COVID-19 risk I faced as a result of my decision!

Three cognitive biases are at play in my response – normalcy bias, optimism bias, and self-serving bias. Normalcy bias10 causes people to underestimate the likelihood of a disaster, when it might affect them, and its potential adverse effects, resulting in inadequate preparation for disasters such as pandemics. In the case of COVID-19 risk, normalcy bias is compounded by optimism bias11 which causes someone to believe that they themselves are less likely to experience a negative event12. The self-serving bias causes people to attribute positive events and successes to their own character or actions, but blame negative outcomes on external factors including other people.

At first, normalcy bias and optimism bias caused me to play down the COVID-19 risk in my mind, despite the fact that there was enough evidence available at the time to indicate a serious risk. So I went to Wuhan regardless. Then, when the reality of the seriousness of the situation hit me, self-serving bias caused me to blame others instead of accepting responsibility for my own decisions.

Given the significant impact that cognitive biases have on human decision-making, it isn’t at all surprising that almost identical biases to those at play in my own personal response to COVID-19 can also be identified in the overall reactions of different countries to the COVID-19 pandemic.

In a paper13 published in the journal Nature Human Behaviour in March, Professor of Behavioural Science Nick Chater identifies three different country-level responses to COVID-19:

In situations of extreme uncertainty, our brains struggle to organize this confusing mass of partial and jumbled information into a coherent interpretation. And we make decisions as if that interpretation is true, without entertaining alternatives. This strategy can often serve us pretty well, but sometimes it leads to bad, and even disastrous, decision-making. The misinterpretation of the COVID-19 outbreak has the potential to have devastating consequences.

At its most fundamental level, there are three interpretations of the challenge that face the governments of the world, which we might term ‘storm in a tea-cup’, ‘house on fire’ and ‘holding back the tide.’

The first interpretation is the mind’s natural default: most alarms are false alarms; most panics are overblown—so probably this one is too. China’s now-notorious early attempts to suppress news of the outbreak makes sense only in the ‘teacup’ interpretation; so too does the US’s initial downplaying of the crisis with the US President’s comment on 24 February that the virus is “very much under control in the USA” … According to this interpretation of the situation, the main aim is that people do not panic unnecessarily; the problem will resolve itself on its own (for example, with the arrival of warmer weather).

The ‘house on fire’ interpretation has driven unprecedented lock-downs first in China, South Korea and Japan, followed by Europe and the US. According to this viewpoint, tackling the virus is an overwhelming priority. The economic and social impacts of shutting down or drastically reducing sports, restaurants, pubs, flights and much more will be vast but have to be endured, rather like collateral water damage, however severe, caused by the firefighter’s hose. This interpretation of the situation also implies taking the strongest action as early as possible. The right time to start fighting a fire is: immediately!

The UK government … appeared to be working with the third narrative. The ‘holding back the tide’ viewpoint sees beating down the virus as workable only as a temporary stop-gap: we can build temporary defences against a rising tide, but inundation is unavoidable. If this is right, containment of the virus is not ultimately possible. So our aims should be to minimize the impact of its spread, by, for example, actively ‘flattening the peak’ to manage the burden on health-services, and to reduce the possibility of flare-up during winter, when those services are under most strain.

For the three countries discussed in this article – China, Australia, and the United States – it can be observed that:

  • China’s initial response was briefly ‘storm in a tea-cup’, followed by a much more extensive and effective ‘house on fire’ response in which the initial COVID-19 outbreak and some smaller outbreaks since have been successfully contained.
  • Australia’s initial response was primarily ‘house on fire’, although with a ‘storm in a tea-cup’ response in some sectors, followed by a ‘holding back the tide’ response. Overall, this response was working relatively well until a devastating second wave of COVID-19 erupted in the state of Victoria.
  • The United States’ initial response was a lengthy ‘storm in a tea-cup’ period, which still persists in the minds of many in the country, followed by a brief ‘house on fire’ response in some areas and then a weak ‘holding back the tide’ response.  Overall, this response has been a failure.

As discussed above and shown in Figure 4, normalcy bias and optimism bias are evident in China’s initial ‘storm in a tea-cup’ response. Normalcy bias and optimism bias are also evident in the more pronounced ‘storm in a tea-cup’ response and failed ‘house on fire’ and ‘holding back the tide’ responses of the United States, but to a very much greater degree than in China’s initial response. As an article in The Conversation states:

More U.S. citizens have confirmed COVID-19 infections than the next five most affected countries combined. Yet as recently as mid-March, President Trump downplayed the gravity of the crisis by falsely claiming the coronavirus was nothing more than seasonal flu, or a Chinese hoax, or a deep state plot designed to damage his reelection bid.

The current U.S. administration’s mishandling of the coronavirus threat is part of a larger problem in pandemic management. Many government officials, medical experts, scholars and journalists continued to underestimate the dangers of COVID-19, even as the disease upended life in China as early as mid-January.

The results of this collective inertia are catastrophic indeed. The U.S., along with Italy, Spain, Iran and the French Alsace, is now the site of humanitarian tragedies, the kind we see erupting in the aftermath of natural disasters or military conflicts.

With the United States experiencing such a massive and growing tragedy, it’s unsurprising that the country’s leaders have sought to blame others – China and the WHO – for their own failings. However, rather than demonstrating self-serving bias, two other related attribution biases are at play – group-serving bias and ultimate attribution error.

Group-serving bias “refers to the disparaging explanations that members of the dominant group make for the successes and failures of members of the out-group relative to members of their in-group.” The closely related ultimate attribution error is described in a 1979 paper14 by Thomas F. Pettigrew, a leading expert in the social science of race and ethnic relations:

An “ultimate attribution error” is proposed: (1) when prejudiced people perceive what they regard as a negative act by an outgroup member, they will more than others attribute it dispositionally, often as genetically determined, in comparison to the same act by an ingroup member: (2) when prejudiced people perceive what they regard as a positive act by an outgroup member, they will more than others attribute it in comparison to the same act by an ingroup member to one or more of the following: (a) “the exceptional case,” (b) luck or special advantage, (c) high motivation and effort, and (d) manipulable situational context.

Because of its comparative early success in dealing with COVID-19, Australia may have felt that it was in a good position to support its ally the United States in blaming China and the WHO for the catastrophe in the United States. In particular, Australia may have felt that it was in a better position than the United States to call for an international inquiry.

However, as I’ve previously discussed, COVID-19 is a wickedly complex problem15 where the influences of ignored or neglected parts of the system can lead to disaster. This is exactly what has since happened in Australia, with a devastating and increasingly deadly second wave outbreak in the state of Victoria having erupted due to serious failures in hotel quarantine and aged care. In the past few days, Australia’s Prime Minister has had to apologise for the failures in managing the risk of COVID-19 in aged care. Also in the past few days, an inquiry has revealed “reprehensible shortcomings” in regard to how the government of the state of New South Wales (NSW) allowed people with COVID-19 to freely disembark from the Ruby Princess cruise ship. These shortcomings include significant information and knowledge management failures.

The hotel quarantine, aged care, and Ruby Princess failures highlight that Australia was never really in a position to claim any moral authority or superiority over China or the WHO in managing the wicked complexity of COVID-19. This means that as with the United States, group-serving bias and ultimate attribution error are also evident in Australia’s response.

In part 2 of this series, I will put forward a considerable body of evidence in support of group-serving bias and ultimate attribution error in the campaigns of blame by the United States and Australia. This evidence of dark side knowledge management tactics16 includes clear examples of false statements and claims by the governments of the United States and Australia.

Header image: Hanjie Pedestrian Mall, Wuchang, Wuhan China. Photograph taken by Bruce Boyes on Saturday 18 January 2020. Licensed for reuse under the terms of a CC BY-NC-ND 4.0 Creative Commons license.

References and notes:

  1. Cascella, M., Rajnik, M., Cuomo, A., Dulebohn, S. C., & Di Napoli, R. (2020). Features, evaluation and treatment coronavirus (COVID-19). In Statpearls. StatPearls Publishing.
  2. Source: Our World in Data, as at 17th of August 2020.
  3. Gostin, L. O., Koh, H. H., Williams, M., Hamburg, M. A., Benjamin, G., Foege, W. H., … & Periago, M. F. R. (2020). US withdrawal from WHO is unlawful and threatens global and US health and security. The Lancet, 396(10247), 293-295.
  4. I would find out later that the market had actually been closed from the 1st of January in response to the outbreak.
  5. World Health Organization. (2020). Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19), p. 11-12.
  6. Haines, A., de Barros, E. F., Berlin, A., Heymann, D. L., & Harris, M. J. (2020). National UK programme of community health workers for COVID-19 response. The Lancet.
  7. Han, C., Duan, C., Zhang, S., Spiegel, B., Shi, H., Wang, W., … & Hou, X. (2020). Digestive symptoms in COVID-19 patients with mild disease severity: clinical presentation, stool viral RNA testing, and outcomes. The American Journal of Gastroenterology.
  8. Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., … & Cheng, Z. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 395(10223), 497-506.
  9. Deslandes, A., Berti, V., Tandjaoui-Lambotte, Y., Alloui, C., Carbonnelle, E., Zahar, J. R., … & Cohen, Y. (2020). SARS-COV-2 was already spreading in France in late December 2019. International Journal of Antimicrobial Agents, 106006.
  10. Wikipedia, CC BY-SA 3.0.
  11. Wikipedia, CC BY-SA 3.0.
  12. O’Sullivan, O. P. (2015). The Neural Basis of Always Looking on the Bright Side. Dialogues in Philosophy, Mental & Neuro Sciences, 8(1).
  13. Chater, N. (2020). Facing up to the uncertainties of COVID-19. Nature Human Behaviour, 4(5), 439-439.
  14. Pettigrew, T. F. (1979). The ultimate attribution error: Extending Allport’s cognitive analysis of prejudice. Personality and social psychology bulletin, 5(4), 461-476.
  15. Sahin, O., Salim, H., Suprun, E., Richards, R., MacAskill, S., Heilgeist, S., … & Beal, C. D. (2020). Developing a Preliminary Causal Loop Diagram for Understanding the Wicked Complexity of the COVID-19 Pandemic. Systems, 8(2), 20.
  16. Alter, S. (2006, January). Goals and tactics on the dark side of knowledge management. In Proceedings of the 39th Annual Hawaii International Conference on System Sciences (HICSS’06) (Vol. 7, pp. 144a-144a). IEEE.

Bruce Boyes

Bruce Boyes (www.bruceboyes.info) is editor, lead writer, and a director of the award-winning RealKM Magazine (www.realkm.com) and currently also teaches in the University of NSW (UNSW) Foundation Studies program in China. He has expertise and experience in a wide range of areas including knowledge management (KM), environmental management, program and project management, writing and editing, stakeholder engagement, communications, and research. Bruce holds a Master of Environmental Management with Distinction and a Certificate of Technology (Electronics). With a demonstrated ability to identify and implement innovative solutions to social and ecological complexity, Bruce's many career highlights include establishing RealKM Magazine as an award-winning resource for knowledge managers, using agile and knowledge management approaches to oversee the implementation of an award-winning $77.4 million river recovery program in western Sydney on time and under budget, leading a knowledge strategy process for Australia's 56 natural resource management (NRM) regional organisations, pioneering collaborative learning and governance approaches to support communities to sustainably manage landscapes and catchments, and initiating and teaching two new knowledge management subjects at Shanxi University in China.

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