The economy vs covid suppression: a false dichotomy

A number of commentators are suggesting that policy makers face a major trade off between prosperity and disease prevention in response to the coronavirus. Those who are doing so are largely, though not exclusively, arguing in favour of more relaxed social distancing measures to prevent job losses and loss of income to businesses. Readers will come to their own judgements about the morality of such arguments if this tradeoff exists. I'd like however to make some arguments for why in my mind, this tradeoff is likely to a false one.

1. If very large numbers of people become ill, they drop out of the labour market while they (hopefully) recover. We can't say for sure precisely what proportion of Covid cases are truly asymptotic, but a reasonable guess based on countries like Iceland and Korea with very large testing programs is not more than half. This means that if Covid spreads uncontrolled, large numbers of people drop out of the workforce regardless. It also means that those involved in key professions (NHS, food distribution, water, gas and electricity supply etc etc) who will have to try and continue to work in any situation are more likely to become ill, as higher rates of infection in the general population mean any given individual, key worker or otherwise, is more likely to become ill.

2. Very high levels of spread of the Covid could well lead to panic. Lockdown or otherwise, people with savings or supplies might simply refuse to go to work, whether their employer allows them to or not. Those who are don't have the economic security to do this might just tell their employer they have Covid symptoms and need to self isolate. 

3. Failure to enact suppression strategies will not be a politically sustainable option. If, as is likely, countries which stick to suppression strategies see a significant short term reduction in new cases and fatalities, any government which took a different route or reversed suppression measures prematurely due to 'economic' concerns would face extreme political pressure to introduce or reintroduce suppression strategies. 

4. The faster and more thoroughly you enact suppression strategies, the more quickly case numbers fall and you can legitimately start to think about easing things off. Getting ahead of the curve sooner means not just lower fatalities in the short term, but a shorter period of economic disruption. 

5. The long term economic damage from coronavirus isn't just about disruption this year. It's about what the labour market looks like after this is all over. Very large numbers of infections means, for reasons too grim and too obvious to spell out, a period of difficult adjustment in the labour market.

The broad thrust of these arguments is pretty simple. One way or other, we are going to see a period of major economic disruption. The choice is whether governments get ahead of the curve, and keep that period as short as possible, or let things get out of control and face the same, if not greater levels of disruption for a longer period of time. 

Social distancing fatigue

Part of the government’s current thinking on coronavirus seems to revolve around the idea that after a certain point, the public could become ‘fatigued’ at control measures, meaning they would become less and less effective. This, so it is argued, might justify postponing the implementation of social distancing measures to a later date. At the risk of becoming yet another non expert who should shut up about this, the underlying logic of this seems dubious, but I’ll try and reconstruct it as best as I can.

It’s true that some social distancing measures have to be delayed, as they can only effectively be implemented once you know where the mass of cases are (e.g restriction of travel to and from particularly affected areas). But some things can be done across the board (e.g school closures, banning large gatherings). So far as I can tell, these slow down infection rates irrespective of absolute numbers, provided there is some spreading to be reduced. Now, if you assumed that you could only implement social distancing measures for a short period of time, once, it might make sense to try and reserve this for the time you thought would be the peak (if nothing else to flatten the curve enough to help hospitals).  But this would be true if and only if measures carried out earlier did not prevent this high peak happening in the first place. The overall trajectory of the infection would have to be largely unaffected by earlier social distancing measures, just delayed.

This overall trajectory, presumably, would be the virus infecting a large enough proportion of the population for herd immunity to start kicking in and slowing down the rate of new infections. In other words, you basically have to assume that sooner or later, a very large part of the population is going to get infected and you can only implement social distancing measures for short time periods.

This seems like a rather bizarre position at a time that China and Korea seem to have managed to dramatically limit new cases to absolute numbers converging on something like 1/20,000 and 1/5000 of their respective populations. This seems to suggest that preventing large portions of the general population getting infected is very possible. Even if you don’t eradicate the infection entirely, extensive contact tracing and testing might well be enough to prevent the outbreak from ballooning again once numbers have been brought down through social distancing. But such measures would presumably only be possible if numbers were small. Even if you ended up with a bit of a cycle of lower and higher levels of social distancing measures, this would not need to be carried out in perpetuity, just until more effective treatment or vaccines were developed and mass produced.  

In effect, the logic behind delaying social distancing, if government statements are taken at face value, seem very shaky indeed. They are applying highly speculative behavioural science (can anyone find a citation that supports social distancing fatigue kicking in at specific time points?) in a way that even if true, require quite specific understandings of the spread of the disease which don’t seem to fit the pattern of what is occurring in countries with more rigorous social distancing measures. And that’s before we think about what ‘fatigue’ would actually result in (people can’t go to sports matches that aren’t happening, even if they want to). No other developed country has explicitly endorsed such a strategy, presumably because the risks are so asymmetric. If the government is right, they perhaps make things slightly easier in a very bad situation. But if they’re wrong, they will be the people who allowed the UK to see extremely widespread infections, when other countries avoided such an outcome.