Responding to coronavirus

The novel coronavirus has infected millions of people globally and is taking a severe toll on individuals, families, and economies as productivity drops and stock markets reflect increased global uncertainty.

2020: A YEAR FOR THE HISTORY BOOKS

2020 global GDP forecasts

-4.9% (IMF)

-6%/-7.6% (OECD)

“No country has been spared” Gita Gopinath – head of the IMF

Lost government revenue: $10TN

Global public debt will hit 100% of GDP

Surpass levels in WW2

While it will take time to truly understand impact of individual suppression measures on bottom line, initial modeling and empirical evidence is beginning to identify more and less effective measures.

Modeling(1,2,3)

Targeted isolation is the biggest bang for the buck:

  • Case isolation of infected patients, home quarantines of all patient contacts and social distancing, est. of vulnerable populations were estimated to have the greatest impact
  • School closure had a meaningful impact in most models, but was often less impactful (e.g. lowest effect in an imperial College London Study)
  • These assumed ability to identify and intervene the majority of cases, without this capability is broader suppression necessary

Not to over-interpret, keep in mind that:

Error bars are large: Researchers are using limited sets of noisy data, conclusions are suggestive but not final, and lack of significance does not mean no effect exists.
Data is based on a different stage of the pandemic: Data is based on growing stages of the pandemic and may not reflect the dynamics of releasing suppression as cases lessen.
Results may vary widely by geography: Suppression measures that are necessary in a geography with limited targeted mitigation capabilities or specific cultural characteristics may not be effective in other geographies.

Empirical

Restaurant closures proved effective, school closures, less so:

  • German analysis demonstrated effects for large event cancellation, school closure, business closure, and strict stay at home orders all had effects, though all effects were relatively minor until the full stay at home order (4)
  • US study suggest restaurant closures and stay at home orders were most effective, while school closures and large event cancellation did not have a significant effect (5)
  • Recent French outbreak connected to schools was misleading: most cases likely pre-dated reopening (6)

But this is just one half of the equation, governments are unlikely to make decisions based purely on suppression measure effectiveness. The economic and social impacts of suppression measures will be considered as well.
For example: limited evidence that school closures are effective will likely lead to significant pressure to reopen schools, mixed evidence around restaurants may result in more conservative behavior.

Schools reopening should be a top priority, but must be done safely – reopening only when community spread is low

Pediatric welfare depends on in-person schooling – researchers suggests students are falling behind standard progress due to remote learning (8). Children may also be at higher risk of abuse and neglect when not in school, as well as food insecurity for those who rely on school meals (9)

Effective contact tracing

Pairing manual and tech-based approaches with population awareness campaigns is expected to bring most value.

While full on contact tracing apps are lacking it’s uptake, The Swiss Federal Institute of Technology Lausanne (EPFL) is working on an app which uses a QR code to track people at places like restaurants, bars and private parties. It would send individual notifications to anyone exposed to an infected person (10)

On the top of that, expand the public health workforce and leverage existing or newly captured health and movement data to trace contacts of infected individuals. Mix of manual (individuals identification and reaching out to contacts) and technological (proximity tracking, cellphone tracking, credit-card tracking, etc.)

To bring the society up to speed with the covid-19 response, the approach requires leadership at the local level (e.g. municipality) with the cooperation of leaders in government, business, education and faith, organizations (which extends manpower and improves pubic cooperation)

Mobility “on the way up” is not as strongly correlated with case growth as it is on the way down (11)

One reason could be learned behaviors, which vary by country.

Germany

  • Like other countries, Germany saw substantial decreases in infection rate with corresponding decreases in mobility
  • However, their infection rate has mostly remained consistent throughout the majority of the pandemic, even as mobility has increased by nearly 100% from its lowest point
  • This suggests a degree of learned behavior among the German population – adequate hygiene and social distancing practices while in public likely mitigate negative effects from social mobility
  • Despite some spikes, overall transmission has remained relatively stable since the lockdown was lifted
  • Strong compliance with social distancing guidance will likely reduce the need for economic disruption throughout the pandemic
Oliver Wyman coronavirus infection rate vs. Google mobility indices
Oliver Wyman coronavirus infection rate vs. Google mobility indices

Source: 1 Imperial College London (link), 2 Science (link), 3 Lancent (link), 4 Science (link), 5 Health Affairs (link), 6 NBC News (link), 7 U Chicago (link), 8 NYT (link), 9 IPS News (link), 10 Swissinfo (link), 11 Oliver Wyman (link)

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