Epidemiological models assume that social distancing saves lives by reducing the frequency and closeness of contacts between infected and susceptible people.
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When French Prime Minister Édouard Philippe announced plans last week to reopen the French economy, he warned: “It is a fine line that must be followed. A little too much carelessness, and the epidemic restarts. A little too much caution, and the entire country sinks.”
The balancing act facing leaders like Mr. Philippe is difficult enough but it’s aggravated by a dearth of essential information: Which social distancing measures offer acceptable trade-offs in terms of lives saved and economic costs incurred?
Thus far, the estimated value of lives saved by social distancing exceeds the likely economic cost. But that may not always be true. For one thing, those estimates might change, altering the trade off arithmetic. More important, that doesn’t reveal which of the many measures implemented are delivering benefits in terms of deaths avoided, or what their costs are. This highlights the need for “risk based” social distancing that could potentially save lives at less cost to the economy.
Epidemiological models assume that social distancing saves lives by reducing contacts between infected and susceptible people. But the frequency and risk of contact varies considerably between countries and even cities depending on the age, gender and health of the population, household structure, and commuting and work patterns. Not all models are granular enough to capture those distinctions. Early projections by the University of Washington’s influential Institute for Health Metrics and Evaluation assumed a common behavioral response to a single set of social distancing measures, according to a study of pandemic models by economist Christopher Avery at the Harvard Kennedy School and four co-writers. An official at IHME said the models now incorporate mobility data to project the impacts of different social-distancing measures.
Even detailed models don’t have strong empirical foundations for their projected impacts. Henri Leleu, scientific director at Public Health Expertise, a French disease-modeling company, said it is easy to project the impact of a total lockdown. “Nobody sees anybody.” But with individual measures such as wearing masks, it’s “a lot harder to know and nobody has real good data on this, [although] we know it’s effective because it’s scientifically sound.”
Finally, epidemiological models don’t incorporate the costs of their measures, because that isn’t their job. Yet no epidemiologist disputes the importance of considering costs. “I’m also a health economist and I can tell you that the economy will have health-related consequences in the long term,” said Mr. Leleu.
Some mitigation measures to date may have incurred steep costs for questionable benefit. For example, most governments closed schools because that has long been part of the tool kit for pandemic flu. But whereas children are much more vulnerable to flu than adults, the reverse is true with Covid-19. And while there’s no consensus on how contagious children are, studies from Australia and France suggest suggest schools may not be a significant source of transmission. An April article in Lancet Child Adolescent Health, said schools played “no substantial role” in the 2003 outbreak of SARS, which like Covid-19 is caused by a coronavirus.
While the benefits of closing schools aren’t clear, the costs are: educators and support staff have been furloughed, many parents can’t work because they are looking after children, and the mental health of students has suffered. Over the long run, school closures tend to hurt educational achievement. A 2008 study co-written by Beate Sander, a health economist at the Institute of Health Policy, Management and Evaluation at the University of Toronto, estimated a 26-week school closure would cost $2,700 per resident due to lost work by parents, teachers and other professionals. For the U.S., that would translate into roughly $1 trillion in today’s dollars.
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Ms. Sander said health experts usually only looked at health in evaluating the costs of pandemics, not consumption or productivity. “We always thought of school closure as something extreme and never thought about physical distancing at the level we’ve done now. The situation we’re in now is unprecedented in a lot of ways. We need to think about what all the different impacts are.”
Disease modelers are striving to craft more nuanced solutions using more granular data. Using a model of New York City with 148 inputs, from hypertension to public transit contacts, Mr. Leleu and six co-authors concluded releasing people under 60 from quarantine eight weeks before older people would save far more lives than keeping everyone under quarantine for an even longer, period.
The American Enterprise Institute and Johns Hopkins University have compiled a comprehensive list of venues, from birthday parties to tradeshows, and the number and closeness of social contacts involved, to guide governors.
A definitive cost-benefit accounting of every such measure is probably impossible. But as the volume of evidence grows, qualitative rankings should be possible. For example, there’s a stronger case for keeping churches closed than schools because attendees are older and churches’ economic contribution is smaller (their spiritual contribution, of course, is another matter). Masks, which cost almost nothing yet significantly reduce the transmission of respiratory viruses, easily pass the test. Canceling elective surgery may not (so long as intensive care beds aren’t in short supply), since it puts severe financial stress on health-care providers and may discourage seriously ill people from seeking care.
Given the uncertainty surrounding Covid-19, the disease caused by the novel coronavirus, no restrictions should be lifted lightly. Ms. Sander said schools should only be reopened carefully, starting with the youngest pupils, rotating classes by day of the week. “Watch and see, if infection rates don’t go up, expand.” And of course, test as much as possible.
Write to Greg Ip at greg.ip@wsj.com
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