Professor Julian Jamison and Dr Sam Wilkinson look at the need for a more holistic approach to managing the COVID pandemic.
Much of the public discourse about responding to COVID-19 has been framed along one dimension – how we deal with the immediate healthcare emergency versus protecting the economy.
This is driven by the view that we need to focus on health now, so that we can have an economy later.
But this doesn’t actually reflect reality.
With limited resources (time, money, attention), governments will always have trade-offs. But the debate doesn’t need to be a narrow one of health vs economy. They are intrinsically interlinked.
Lockdowns and the consequent loss of jobs and income result in significant personal stress, mental health problems, domestic violence and loneliness – all of which impact health systems.
Lack of education causes other health problems. For instance, in developing countries, lack of maternity education and care is likely to contribute to extra deaths. Longer term is the health impacts among adults, whose primary and secondary education was affected as children.
People say that we won’t have an economy if a lot of people die – and that is true. But it’s also true that a lot of people will die if we don’t have an economy – and this is especially the case for vulnerable populations, whether locally or in the global south.
So, what should governments be doing now?
While much of the science was unknown at first, some facts are now well-established. We know that deaths occur more in older people (and others with specific conditions). Children rarely fall seriously ill, and do not spread it often. And the vast majority of transmission is due to ‘super-spreader’ events indoors.
Instead of arguing about masks or bubbles, we should take advantage of what we already know. There remain many months or even years until vaccine penetration is sufficiently widespread to relax our guard, so we need to optimize carefully now.
For example, in many parts of the US, schools are closed but restaurants remain open. This doesn’t make sense. Schools should remain open, even if rates rise. And there should be almost no restrictions outdoors.
However, indoor public eating and drinking should have been curtailed, except where the prevalence is low. Other indoor activities such as concerts or religious services shouldn’t have been allowed, and short-term indoor interactions (such as shopping) should be minimized, but allowed if careful.
Facilities for the elderly should be protected but also supported, making sure they get human interaction with people testing negative or with antibodies. Effective testing is also crucial, followed by smart forms of isolation if necessary.
Life goes on – even in a pandemic – we can’t ignore it, or underplay it, but we can’t afford to forget about everything else.
To achieve a more nuanced response, governments should involve a wider set of experts in policymaking. Leaders, yes, but also scientists, especially social scientists, and ordinary people. It is now very possible to get feedback in real time on what people care about – which restrictions matter to them, for instance.
President-elect Joe Biden, for example, may have the chance to change the narrative in the US, appealing across the spectrum. However, the make-up of his COVID advisory board is heavily weighted towards medical, public health and epidemiology experts, without reference to behavioural science or economics.
Ideology itself is not sufficient, but nor is data on its own. Governments need to estimate, but also be transparent about the full consequences of their actions – and they need to be clear what values people are bringing to the table. They should make hard choices when they are necessary, encourage practical science and information, and engage with the results.
Crucially, they also need to think about ethics, in the sense of assessing the values of different groups and individuals.
If we don’t get the interaction between health and economy right, then we risk a decreased lack of trust or legitimacy in policymaking. At the same time, if vocal health experts don’t acknowledge that other factors are equally important, people will reasonably lose trust in expertise. This is admittedly tempting, including for the media, especially if those other factors are more difficult to quantify as compared to charts of daily deaths and test positivity rates, but tangibility is not the same as importance.
What is the cost of a week of missed school? What is the cost of a missed trip to the theatre? What is the cost of not seeing a smile in a daily interaction where you otherwise normally would? What is the cost of lost freedom, and for whom?
We can’t neglect the importance of thinking ahead. This means beyond the next month, and even beyond the next electoral cycle – co-ordinating across regions (domestically and internationally).
Just as defaulting on a debt can be tempting in the short-run but ruinous in the long-run, so too can responses that temporarily improve one narrow (however important) and salient outcome, at the expense of many others that are less visible or less immediate.
Dr Sam Wilkinson is a Lecturer in Philosophy in the College of Social Sciences and International Studies at the University of Exeter.