Without any shadow of a doubt the biggest problem governments face at present is how to balance the benefits from measures to curb the pandemic against the economic costs of efforts to limit its spread. As the second wave of Covid-19 emerges it is clear that countries have coped in different ways. But what are the factors underpinning the differing performances and have countries learned from past mistakes which will prevent a repeat of the surge in mortality rates that we saw during the first wave?
An excellent paper in The Lancet looked at the varying approaches to assessing the criteria adopted by a number of industrialised economies for introducing lockdowns in the first place and the criteria for easing them. As is apparent from the differing infection and mortality rates across countries, there has been a wide diversity of responses. The authors of the study identify a number of factors which are necessary to ensure effective control of the spread. In the first instance we need some idea of the current status of infection rates which requires a surveillance system to be in place allowing us to track the reproduction number (R number) in real-time. A second prerequisite is community engagement which gives greater flexibility to local communities to take decisions to protect themselves. This has become a particularly fraught issue in the UK where government is highly centralised but where the four nations have increasingly adopted different approaches to easing the lockdown. Even in England there is now increasing tension between the London government and urban areas in the north, which threatens to have significant long-term political repercussions.
The authors note that “with few exceptions, such as Germany, New Zealand, Norway, Scotland, and South Korea, political leaders have struggled to secure public trust and thus support for continued lifestyle changes. More generally, countries with female leaders have done better at securing public confidence and adherence to new measures than have countries with male leaders.” Readers interested in the latter point can refer to the original paper (here).
One of the features of the past seven months across many countries has been the series of mixed messages which have sown confusion. This is evident, for example, in advice on how many people can congregate in confined spaces. More particularly it is evident in advice on wearing face coverings. At the start of the pandemic the World Health Organisation argued that masks would encourage a false sense of security and would deprive medical professionals of badly needed protective equipment. It also argued that there was insufficient evidence to suggest that healthy people should wear them. The WHO finally changed this advice in June. Whilst numerous Asian countries long ago adopted the practice of wearing masks in public places, it has been slower to catch on in Europe and North America and we have witnessed demonstrations in a number of countries against the requirement to wear a face covering. To add insult to injury, the UK government has recently confirmed that it will end the VAT waiver on personal protective equipment from 1 November. British households will thus have to pay 20% more for the masks which they are legally obliged to wear in shops and on public transport.
But by far the biggest factor determining the differences in performance across countries is the capacity of the heath system, most notably the track and trace system. Singapore and South Korea have mortality rates of 0.5 and 0.9 per 100,000 of population respectively compared with 66.9 in the UK, 68.1 in the US and 93.0 in Belgium. Singapore has a rigorously enforced system which has led some to complain about its personal data implications but its success cannot be denied. South Korea has introduced a mass testing regime and uses electronic health records, credit card transactions data and mobile phone-based GPS data to determine peoples’ movement. It also relies on tracers with detailed local knowledge to observe localised outbreaks. The UK’s experience has been much less impressive: after it abandoned its initial attempts at track and trace it attempted to develop its own smartphone app but later abandoned this approach and switched to an Apple–Google system – an approach which cost valuable time.
As the second wave intensifies, many industrialised countries have taken on board the lessons learned during the spring. Full lockdowns did prove to be effective in curbing the spread of the disease but they come at an enormous economic cost and they would only be repeated as a very last resort. There is thus a general recognition that over the coming winter, we are going to have live with Covid and keep the economy afloat as best we can, for even if we are close to a breakthrough in finding a vaccine it is not going to be widely available until the second half of 2021 at the earliest.
The epidemiologists who authored The Lancet article thus make a series of recommendations for the conduct of Covid policies:
i) In the first instance governments should be transparent about which factors are being taken into account when assessing the threat level and “ideally, these … should explicitly state the levels or phases of easing restrictions, the criteria for moving to the next level or phase, and the containment measures that each level or phase entails.”
ii) Lockdowns should not be eased until the infection situation can be adequately monitored which requires an emphasis on local conditions rather than simply the national average picture.
iii) Since it is obvious that distancing restrictions will have to remain in place for quite some time to come, “governments should educate, engage, and empower all members of society, especially the most vulnerable, to participate in the pandemic response. Rather than crafting these measures on the basis of assumptions about what communities can or cannot accept, citizens should be directly involved in the process of coproducing tailored solutions appropriate for the local context.”
iv) Most importantly, it is crucial to introduce an effective track, trace and isolate system. As the authors point out, “preliminary data for testing suggests that identifying and isolating mild and asymptomatic cases can significantly reduce R, health-care burden, and overall fatality.” Once the system is in place, it is important to ensure effective takeup, with some research suggesting that an overall participation rate of 56% is sufficient to stop transmission.
European governments have largely learned the importance of adhering to these conditions although they are complicated by differing forms of government with countries with decentralised government (e.g. Germany and Switzerland) posting better outcomes than more centralised systems such as France and the UK.
They may also work better if people find it in their interests to comply with more rigorously enforced rules when they have a stake in their success. An under-appreciated economic consequence is the distributional impact of lockdown measures with some sectors expected to take a much bigger hit than others. As MPC member Gertjan Vlieghe noted in a speech last week “we are really not all in this together. It is far, far worse for some than for others.” Accordingly, the measures may be more likely to work if governments can give reasonable assurances that there will be work for people to go back to when the pandemic subsides. That alone may be a good reason for governments to continue providing labour market support over the winter months.
Very interesting: one point to note is that Asian countries have coped much better than Europe and the west . In a recent article from parad khanna 3 reasons are offered : they already coped with a pandemic and wasted less time in arguing about already obvious facts like wearing face masks. People in general trust more in their governments to act in the interest of their people ( very controversial ) in general governments are more competent ( see Korea) . Fact is that Asia seems to be able to live with it .
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