Introduction
Through analysis of available data, we now know that the extensive social distancing precautions taken in the US, UK and elsewhere, have had a dramatic impact to slow the spread of Covid-19, despite their painful social and economic costs. Now, the world is watching closely as governments in multiple jurisdictions have begun the tentative process of easing social distancing requirements on select populations and industry groups. These decisions will have complex ramifications in the weeks and months to come, as policy makers will be forced to walk a tightrope between protecting public health and jump-starting their economies.
Plans for how to achieve this balance vary by location and, in many cases, remain unclear. The unifying feature of the plans to reopen is that they must be staged, and consider a variety of social, economic and medical factors. Consideration of these factors will inevitably involve mathematical modeling including the methodologies employed to forecast infection and fatality rates early on in the crisis. In an earlier article, we discussed the use of these models, and how they are impacted by the quality of underlying data.
Here, we look at the factors modelers and policy makers will need to consider as they devise and execute their plans for exiting the lockdown. Additionally, we perform analysis of US employment data and labor statistics that shed light on employee exposure risk to Covid-19 by industry. This, combined with analysis of economic output and supply chain risk data provides a rudimentary demonstration of how policy makers might decide to prioritize a staged opening of the US economy while simultaneously protecting the elderly and most vulnerable. Finally, by considering these variables and other known factors, we discuss how data can be used to enable decisions which have positive outcomes for both public health and the economy.
Overview of the Variables
Age
80% of Covid-19 deaths in the US have been 65 and older. This population tends to have weaker immune systems, lower lung capacities, more underlying conditions, and greater sensitivity to inflammation, all factors that make them more vulnerable to COVID-19's symptoms.
Health
94% of COVID-19 deaths in the US have been patients with at least one underlying condition. The most commonly reported conditions are heart disease, lung disease, diabetes, kidney disease and people who are immunocompromised.
Urgent Care Capacity
As medical technology has improved, it has tended to increase the number of outpatient procedures, shorten the average hospital stay and drive down the need for hospital capacity. Currently, the US has approximately 1 physician and 2.8 hospital beds per 1,000 people.
Population Density
The COVID-19 infection rate appears to be significantly accelerated by population density, as has been demonstrated by the outsized toll on large cities, such as New York and Wuhan, as well as particularly crowded situations such as the Diamond Princess cruise ship.
Immunity
Many countries that responded slower to COVID-19 - or opted not to impose strict social distancing - are currently incurring high infection rates, which may paradoxically facilitate herd immunity in its population and reduce the number and severity of future infections. This theory is still being tested.
Supply Chains
Many businesses will have supply chain issues that could prevent them from opening, even if social distancing restrictions are lifted. From a macro-economic perspective, preventing major disruptions in supply chains should avoid inflation during the exit.
Government Assistance to Businesses
Thousands of businesses in the US and UK are relying on government assistance to make payroll and remain solvent. Although government stimulus and furlough schemes will become more effective as people are allowed to return to work, the situation is fragile and the continuation of government assistance may need consideration.
Government Assistance to Individuals and Families
Many lower income citizens will only be able to maintain a lockdown for as long as government assistance is available to pay rent and supply necessities. If that ends or is insufficient, the quarantine will not sustain.
Global Exit Strategies
United Kingdom
The UK renewed its lockdown policy to continue until at least the middle of May, and has not yet outlined a centralized exit plan. Reports from government sources indicate a staged opening, targeting certain critical industries, schools and public sector services.
United States
The Trump Administration has published a roadmap for lifting of restrictions on businesses and public/private gatherings, based on phased periods of 14 or more days with continuous declines in COVID-19 diagnoses within a given region or state. The onus is on each respective state to determine whether it will follow the guidance, or enact an independent policy.
Spain
Spain remains in lockdown but the government has announced that key manufacturing and construction work can restart, but non-essential stores, bars and restaurants remain closed.
Germany
Germany has cautiously begun to scale back its lockdown with small shops having opened on April 20, and schools set to re-open in early May. The country is planning to increase its testing capacity in case the relaxed restrictions lead to a second wave of infection.
South Korea
Through a combination of rigorous selective early isolation and contact tracing via strong public-private�sector cooperation, South Korea has, to date, successfully flattened its COVID-19 infection curve without widespread quarantines. As of April 20, manufacturing, shopping, restaurants and schools remain open.
Using Data to Reopen the US
By utilizing US employment statistics, industry output and supply chain risk data, combined with estimates of the vulnerability of job roles to infection by COVID-19 (including for example, proximity to the general public), we demonstrate how policy makers might decide to prioritize a staged opening of the US economy.
The COVID-19 Employee Risk Score on the horizontal axis is based on aggregated data from the U.S. Department of Labor which details the working conditions of employees and their proximity to the public and other coworkers. A high COVID-19 Employee Risk Score indicates a greater relative risk of industry disruption due to COVID-19, through employee illness. The US Department of Labor data for each occupation has been averaged by industry, accepting there will be a degree of uncertainty in such estimates.
The Employment Metric on the vertical axis is an indication of the industry's relative significance to the US economy. We use labor figures as a simple proxy, cognizant that there are a number of approaches to indicating an industry's economic importance. To provide examples of the variety of additional information that can help decision makers, the diameter of the bubbles is proportional to the industry's contribution to U.S. GDP (giving a further guide to economic importance), and color indicates the industry's exposure to supply chain disruption.
Keys to Effective Global Exit Strategies
The primary lesson learned from the first stages of our entry into quarantine was that effective mass testing is essential from both a clinical and policy perspective. The reliability of our collective testing efforts will govern the reliability of the mathematical modeling, which in turn will guide effective policy and response. Without mass testing, it will be extremely difficult to systematically identify individuals with immunity, and free them up to restart normal economic activities.
Combined with testing, technology will be required to assist those willing to partake in mass contact tracing. Data indicates that this type of testing has helped other governments to quickly identify those who need to be isolated, in addition to the elderly and those with underlying conditions, in order to free up the remainder of the population to resume economic activity.
Underpinning all of this, an effective exit strategy will take time for governments to scale up ICU and diagnostic testing capacity. Even with effective testing and contact tracing, the data from jurisdictions such as South Korea indicate that thousands of healthcare workers will still be required to treat and test impacted populations. Finally, organization and funding will continue to be critical. Even considering the enormous debt burden already incurred by many developed nations, continued borrowing and stimulus is likely to be necessary. This challenge is even greater for developing economies that face capital flight, and will likely have to rely on the aid of the international community.
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