COVID-19: The path back (with updates)

Note: Article expanded on 24 April and again on 27 April. The middle now has more meat. So you can read it again!

As Paul Frijters has recently said on this site, many countries will soon ease their restrictions on social isolation.

As Paul has been pointing out, we pay a high economic and hence social cost for restricting various parts of the society. Paul thinks the current price is far too high. I hold him in high regard, but I simply don’t know enough to say, or whether he knows enough to say, or whether anyone else does either. The numbers do seem insanely hard to work out: you must determine not only what it costs to keep someone alive, but the price you would pay in extra infections by keeping restrictions lighter and letting them circulate, infected, in the population.

But there is a limit to how much any country will pay to save a life. (Australia’s published limit is somewhere above $4.9 million, according to a note from the PM’s department.)

So deep in the government, policymakers are building exit strategies (and, hopefully, briefing communications experts about how to express those strategies to people).

Too many people jump to the assumption that governments, especially those on the right,  will happily kill lots of people for the sake of lining shareholders’ pockets. My assumption is different: governments, including those on the right, want to win elections. And so far, Scott Morrison and indeed the whole national cabinet have prospered by making good – indeed, anti-Trumpian – decisions.

So here’s my guess about where the national cabinet will go from here, and why it won’t be easy.

When does the return begin?

Australia will probably move fairly carefully, finding the areas where activity can be opened up with near-zero damage. We may well follow the sort of course mapped out by Harvard’s Edmond J. Safra Center for Ethics in its newly-released Roadmap to Pandemic Resilience. It suggests the key steps in returning the economy to something more like normality are:

• expanded test-and-trace;
• a peer-to-peer warning app, ideally open-source;
• a national testing authority of some sort;
• certifications of immunity that demonstrate that a holder has had the disease and that it has run its course; and finally
• returning people carefully to work.

There’s more in the paper, although not that much more.

A remarkable number of people think that we’re waiting for the magic moment when we can turn the economy back to the “full speed” setting all at once. A UK Spectator article claims that only three options exist for this moment: “A cure, a vaccine or herd immunity. All remain out of reach.”

But this seems misguided.

First, a key point in the Harvard paper is that we will not be switching the economy from “closed” to “open”; it has never been closed. GDP is contracting substantially, but it’s not disappearing, or anything like that. At worst, Australian GDP may temporarily fall to 90 or 85 per cent of what it was.

Second, we are not going to solve this problem by waiting until a single solution appears. What we’re likely to see – what we should see – is a wide range of piecemeal easings. We won’t just open to the world. we’ll open selectively to other low-coronavirus nations. Governments will check each other’s results. We’ll iterate.

When will this happen? The Harvard paper suggests relaxation of measures should begin “when a testing program for the essential workforce is successfully and stably in place, case rates are declining, and public health capacity is sufficient to meet need.” That sounds close to where Australia and New Zealand are now.

The core strategy: inch forward

The important questions still to answer include how fast and in what areas we open up the economy as the numbers improve, and how we can offer better protection to that growing group of people working outside the home.

In workplaces, one key to this transition may be more testing of workers, with the aim of certifying many workers as having contracted the virus and developed immunity. This is one area where Australia and New Zealand may still have more to do (and effective testing is not necessarily simple).

A second key will likely be the maintenance in many situations of mask-wearing, social distancing and the like. Such norms will create problems for important infrastructure like airports, where users have often recently been crammed together. (This might be a good time to reconsider whether we still need the typical airport’s number-one choke point, the security scan. But Conrad in the comments below suggests we’ll need to add compulsory testing, which seems credible. Airports will be a tough challenge.) Less economically important crowd sites may have to stay closed. (Sorry, casino operators!)

And a third key to the transition may be tougher default restrictions for the over-60s (especially men) and other at-risk groups, compared to everyone else. We may have to establish special rules for them at re-opened airports, for instance.

The Harvard paper speaks of “sectoral phasing”. “The transitions will not be abrupt,” the authors say. “The Pandemic Resilience strategy gradually incorporates more and more workers into a steady-state testing and certification regime, and thus allows ever more workers to return to work safely.”

Achieving this will require new restrictions that are somewhere between lockdown and open-slather. For instance, we may need new (hopefully temporary) regulations for accommodation services, a field hard-hit by the current measures. For hotels and motels, regulation may be an attractive alternative to continued closure.

Gyms and restaurants? Leave them until later.

Along with selected work activities, the first phase will likely include steps like reopening beaches and allowing more than just exercise in parks. Most of what we know about COVID-19 suggests these outdoor activities pose very low risk. In South Korea, a test-and-trace leader, park activity is actually up compared to previous years.

As well as restoring some incomes and helping some people avoid going stir-crazy, these steps will help to allay concerns – clearly present in some slice of the population – that we are all being held prisoners indefinitely in our own homes.

Rocket-sciencey

None of this is rocket science. If you do want to see people try to build a rocket-sciencey model of the return-to-normality process, go here and read Restarting the economy while saving lives under Covid-19. This paper argues that you can get “a containment of the GDP loss within values that are one-fifth of the loss incurred with the continuation of the lockdown,” but that after that the curve turns sharply upwards, so that while “further containment is possible … it is extremely costly in terms of human lives”.

And of course, that conclusion comes with all the uncertainties of most models of a newly-emerged real-world biological process. Remember my comment about the numbers being insanely hard to work out? This is what that looks like.

What neither of these papers can say is how fast this transition should happen, in Australia or elsewhere. The truth is that again, no-one knows. We can and will make guesses. But we’ve never had a global pandemic rampage through the interconnected global economy.  We still really have no empirical evidence showing which interventions work against COVID-19. We will probably see a lot of speeding up and slowing down as countries experiment in search of the right balance. Armchair epidemiologists, take note. Me included.

The Armchair Epidemiologist pic.twitter.com/t4CvJo3KCL

— Mark Humphries (@markhumphries) April 9, 2020

Footnote: What other papers attempt to map out the return-to-normality process? List them in the comments.