key: cord-0766595-gp2tie7k authors: XiangNg, Qin; De Deyn, Michelle Lee Zhi Qing; Loke, Wayren; Chan, Hwei Wuen title: A Framework to Deal with Uncertainty in the Age of COVID-19 date: 2020-06-20 journal: Asian J Psychiatr DOI: 10.1016/j.ajp.2020.102263 sha: 251d4c87561097e40291a990b996d21bad5d6928 doc_id: 766595 cord_uid: gp2tie7k nan Uncertainty seems to be a constant in this evolving pandemic. Our current understanding of the SARS-CoV-2 is still limited, especially with regard to the epidemiologic features of the virus (Wang et al., 2020) . We are 'assaulted' with new (and even contradictory) findings and interpretations on an almost daily basis. Research studies are being published at a feverish pace (Laine et al., 2020) ; researchers have now highlighted and then disputed a previously underappreciated reservoir of asymptomatic 'spreaders' (Gandhi, Yokoe & Havlir, 2020; Wei et al., 2020) . There is also no definitive treatment or vaccine at present. Many have touted the efficacy of hydroxychloroquine despite the lack of rigorous clinical data (Molina et al., 2020) . This can be seriously confusing and dangerous for the layperson. In an extreme example, an Arizonian man died from consuming a form of chloroquine used to clean aquariums, days after the anti-malarial drug was touted by some as a potential cure for COVID-19 (Waldrop, Alsup & McLaughlin, 2020) . Governments worldwide have also adopted an assortment of approaches, from the partial or complete closures of public facilities and spaces, rigorous contact tracing to a less intensive approach, albeit with variable success (Forman et al., 2020) . There is a need to recognise which approaches and proposals work. The VUCA framework, which is commonly applied in business and military settings (Bennett & Lemoine, 2014) , well encapsulates the challenges individuals and governments face in these uncertain times. The framework also outlines the approach one should take, with due consideration of the amount of information available and the certainty of the situation. We adapted some of the key elements of the VUCA framework and correspondingly, we see in Figure 1 , that the complexity and uncertainty inherent in the COVID-19 pandemic mandates that governments must face "unknown unknowns". This also means enlisting the expertise J o u r n a l P r e -p r o o f of relevant specialists and building up resources to address the complexity; and being transparent with information to alleviate the ongoing uncertainty of the situation. An important lesson we have learned from this evolving pandemic is that the lack of transparency creates further confusion and undermines public trust (Alwan et al., 2020; Tandon, 2020) , and the bureaucratic process should aid and not hinder crisis management. Early reports of a 'SARS-like' illness were ignored by the Chinese government (Enos, 2020) , which led to widespread outrage at the injustice and inaction. (Stafford, 2020; Cousins, 2020) . On the other hand, much J o u r n a l P r e -p r o o f Evidence informing the UK's COVID-19 public health response must be transparent. The Lancet What a difference a word makes: Understanding threats to performance in a VUCA world New Zealand eliminates COVID-19. The Lancet How the Chinese Government Undermined the Chinese People's Attempts to Prevent and Respond to COVID-19. Heritage Foundation Backgrounder 12 Lessons Learned from the Management of the Coronavirus Pandemic. Health Policy Asymptomatic Transmission, the Achilles' Heel of Current Strategies to Control Covid-19 Thinking globally, acting locally-The US response to COVID-19 Public health interventions for COVID-19: emerging evidence and implications for an evolving public health crisis COVID19-The need for Public Health in a time of emergency No evidence of rapid antiviral clearance or clinical benefit with the combination of hydroxychloroquine and azithromycin in patients with severe COVID-19 infection Covid-19: Why Germany's case fatality rate seems so low The COVID-19 pandemic personal reflections on editorial responsibility. Asian journal of psychiatry Fearing coronavirus, Arizona man dies after taking a form of chloroquine used to treat aquariums. CNN Health The global impact of COVID-19 and strategies for mitigation and suppression WHO Collaborating Centre for Infectious Disease Modelling, MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures Presymptomatic Transmission of SARS-CoV-2 -Singapore COVID-19 coronavirus pandemic The authors report no conflicts of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors alone are responsible for the content and writing of the article. None.