There is increasing evidence that in a pandemic, public health measures (including lockdowns) help the economy compared with the alternative of not locking down – countries which reduced deaths from Covid19 also had better economic (GDP) outcomes in the quarter ending June 2020.
Increasingly, studies are looking at the links between economic outcomes and Covid19 outcomes around the world. My favourite data source, Our World in Data, has just published some analysis about the second quarter, showing deaths per million from Covid19 graphed against the reduction in GDP for a wide variety of countries.
Given the wide variety of countries, this graph appears to show that good economic outcomes are closely associated with good health outcomes from Covid19. The place you want to be on this graph is the bottom right – low deaths per capital from Covid19, and the lower end of reductions in GDP. The insight from the graph is that increased deaths from Covid19 are largely accompanied by bigger reductions in GDP – worse economic outcomes.
This graph doesn’t show Australia, but Australia’s GDP for Q2 was -7.0%, with 26 Covid19 deaths per million of population, which puts Australia on the bottom right hand side of this graph, between Poland and Nigeria. China is also not on this graph – given its GDP was one of the very few in the world to grow in Q2 of 2020.
So what comes first? Given most, if not all, of the countries that have successfully reduced death rates have done it with a series of public health measures (such as closure of schools, restaurants, and various other forms of economic activity), you might expect that better health outcomes are associated with worse economic outcomes. While the correlation isn’t perfect, better health outcomes do appear to be associated with better (not worse) economic outcomes.
This association was seen in the 1918 Spanish flu pandemic also. This article showed that the ultimate economic outcome in 1918 was better for cities that had stronger public health responses.
And on a day when Victoria announces its roadmap out of lockdown, the key takeout from this analysis is that it is very much worth doing the hard work of determining which public health measures give the greatest public health benefit, for the least economic cost. Since the whole point of public health measures are to reduce virus spread, but they often have massive collateral damage on the economy, those which reduce that collateral damage are worth doing. I’ve got some links below about masks and ventilation – for us in the Southern Hemisphere, increasing the proportion of our economic activity that takes place out of doors, and in well ventilated areas and/or with protection from masks is likely to improve the position of our countries on the next iteration of this graph.
Links
This link is to a study of a particular mutation of Sars-Cov-2 (the D614G mutation) which appears to be more infectious than the initial version, and is increasingly the dominant variation globally. The study analyses the behaviour of this particular virus to understand the mechanism why this might be the case.
Early in the current pandemic, the D614G mutation arose in the Spike protein of SARS-CoV-2 and quickly became the dominant variant globally. Mounting evidence suggests D614G enhances viral entry.
And this study looks at a question which I’ve tried to answer before – with cases increasing in the US (and now in Europe) why aren’t deaths going up as fast as they did in March/April? I’ve always thought that it is mostly about increased testing, but this study points out that finding a disease earlier in its life cycle doesn’t (of itself) improve survivorship rates, but it does appear to.
How? When providers get better at looking for — and finding — a disease, it appears to lengthen the time someone survives after diagnosis. In reality, the patient is not necessarily living longer than they would have if the disease were discovered later. It just seems like they’re living longer because the disease is identified sooner, and the “clock” on survival time starts earlier.
And I’m increasingly thinking about ventilation wherever I go. This Time article sets out the evidence for increased transmission of the virus in badly ventilated rooms (via aerosols) – and this story of early virus spread on a bus in China in January gives some strong additional evidence.
In a fast-moving viral pandemic, scientific understanding will inevitably change as research catches up to the speed at which the virus spreads. However, it seems clear that aerosols are more important when it comes to transmitting COVID-19 than we thought six months ago—and certainly more important than public health officials are currently making them out to be.
It is important to think about ventilation and air cleaning. We take operable windows and HVAC systems for granted, rarely paying attention to how they work. Times are different now, and we need to learn how to best use these systems to decrease risk. We need to increase the amount of indoor air that is replaced by outdoor air, by opening windows or adjusting mechanical systems. We need better filters installed in many ventilation systems that recirculate some of the air.
Life Glimpses
This week was the week we really saw spring in Sydney – my favourite season here – lovely days with perfect weather (and without the heat of summer). For me it included a visit to Cockatoo Island and a bushwalk. Cockatoo Island really should be better known – it is worth visiting for each of its convict heritage (which sees it part of a World Heritage Listing) or its industrial heritage alone, and as an added bonus, it is part of the Sydney Biennale at the moment. Social distancing was quite straightforward on a weekday, given how big the island is.
Also this week saw me venturing into public transport (to get to Cockatoo Island, there is no alternative!) and the mask wearing proportion of the public transport population seems to be inching up at the moment. Here in NSW, it is not compulsory, but strongly recommended on public transport. I still don’t quite understand why masks are not compulsory, it is a low cost intervention that would reduce risk of transmission substantially (see this link from The Economist).
Bit of Beauty
Today’s bit of beauty comes from Cockatoo Island, where I’ve tried to capture some convict heritage and modern architecture in one photo.
Great article a Jennifer. Thankyou for your considered insights
As I mentioned before, I cannot comment on the serious part. Here in Israel the virus is rampant, the way to cope is governed by political needs. Not really good. I go out and wear a mask and try to keep a safe distance. Masks are supposedly compulsory, but not everybody wears. them. Cockatoo is lovely, I did not realise the Biennale was on. Please go there again and take another photo. The present one is great as you managed to capture the Convict Heritage and Modern architecture
Lots of good stuff in this one! With the economics vs health trade-off, I think it would be very interesting to do a graph where GDP is measured against a measure of how early an effective public health response was implemented. For example, Taiwan has had a great run as they got on top of the virus before they needed to go into lockdown, the UK has done terribly as they left things way too late and not only had to go into lockdown, but had to do it for a long time.
And I cant believe the debate is still ongoing about airborne transmission – it seemed obvious when you linked to the superspreader events article way back in April (?)
Thanks Karen, I agree, our world in data has some great data on public health measures by time, but I wasn’t quite up to the analysis involved by country.
Why not make mask-wearing compulsory?
The excuse (which doesn’t stack up for me) is that it would make people complacent.
I suspect that the reason has more to do with the stress it would place on the de facto enforcers of the policy (such as bus drivers). And there’s an ideological leaning towards free will.
Richard, nice to hear you say this, the rest of my family is sick of me talk about the need for compulsory masks!
I’m thinking of writing my next post about compulsion vs guidance vs suggestion. Australia does tend to be a very rule based society, and in this context, I think rules are quite a lot more effective than guidance, despite the media evidence, we are mostly pretty compliant when there is a rule. I agree though, tough for the bus drivers and retail workers to be enforcers, even for a small minority.