Abstract
The chapter examines various public policy measures in response to COVID-19 from advisories, testing and tracking through to lockdowns of economy and society. The role of epidemiological modelling in making public policy, proportionality in decision-making, the weighing of competing goods, and the unintended consequences of public policy decisions are discussed.
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Notes
- 1.
The reason for this fell into two categories. One was a prejudice of public health officials against the idea of community immunity, even if the community carriers were low-risk young persons. The second was the fear that education employees—not so much teachers who skew young but ancillary staff who skew older—might be at risk.
- 2.
In a study of Wuhan published in the New England Journal of Medicine on January 29, 2020, Li et al. observed that: “It is notable that few of the early cases occurred in children, and almost half the 425 cases were in adults 60 years of age or older, although our case definition specified severe enough illness to require medical attention, which may vary according to the presence of coexisting conditions. Furthermore, children might be less likely to become infected or, if infected, may show milder symptoms, and either of these situations would account for underrepresentation in the confirmed case count. Serosurveys after the first wave of the epidemic would clarify this question.”
- 3.
On January 28, the journal Nature (Callaway and Cyranoski 2020, January 22) reported: “The WHO last week [January 21] published an estimated R0 of 1.4–2.5. Other teams suggest slightly higher values. These estimates are similar to the R0 of SARS during the early stages of the 2002–03 outbreak, and of the novel strain of H1N1 influenza that caused a pandemic in 2009… But researchers caution that R0 estimates come with large uncertainties because of gaps in the data, and the assumptions used to calculate the figure. They also point out that the R0 is a moving target and that estimates of the figure change over the course of an outbreak.” That might have suggested prudential measures to find out more, including testing for the virus and tracking infected persons, but it was hardly reason to panic. Adam Kamradt-Scott, a health-security specialist at the University of Sydney noted that the 1918 influenza outbreak killed 2.5% of those it infected, possibly as many as 50 million people worldwide. The China coronavirus, he told Nature, probably would not trigger such an apocalyptic scenario, because it wasn’t typically infecting or killing young, healthy people (Lewis 2020, January 31).
- 4.
- 5.
As of May 1, 2020, there were 27,510 confirmed COVID-related deaths in the UK. Of these 12,526 (45%) were care home residents. Holt and Butcher 2020.
- 6.
- 7.
Anon (2020a, March 9).
- 8.
Salje et al. (2020, May 13).
- 9.
* = Greater London boroughs. Dr. Foster, UK Coronavirus Tracker, https://drfoster.com/2020/04/06/uk-coronavirus-tracker/
- 10.
UK Office of National Statistics.
- 11.
Deaths per capita, 21 May 2020: Iceland (29), Taiwan (0.3), Hong Kong (0.5), South Korea (5), Japan (6), Latvia (11), Estonia (48), Sweden (380), Australia (4), United Kingdom (526), Italy (535), Spain (596).
- 12.
The study cited was Kucharski et al. (2020, February 18).
- 13.
Hubei death rate data: China’s National Health Commission, Health Commission of Hubei. Zhang et al. 2020 dates the peak of the daily death rate as January 23, 2020.
- 14.
Neil Ferguson was a member of the 17-member expert committee.
- 15.
This is consistent with the experience of the cruise ship, Diamond Princess, where the COVID-19 virus spread in a closed and close-contact environment for a month among 3700 passengers and crew. Eventually 19.2% of these were infected.
- 16.
Centers for Disease Control, Pandemic Influenza, Past Pandemics, 1918 Pandemic (H1N1 virus).
- 17.
“[Given] an estimated R0 of 2.4, we predict 81% of the [Great Britain] and US populations would be infected over the course of the epidemic.” Ferguson et al. 2020, March 16, p. 6.
- 18.
Avery et al. (2020, April) argue that various social heterogeneities are important in the spread of disease but heterogeneities are not incorporated in standard epidemiological models. They postulate the systematic differences in the patterns of daily life make a single transmission rate for a disease improbable. The strength of network ties to early cases is an example of how social heterogeneity may affect the pace of viral dissemination.
- 19.
A study of 7290 participants and the recorded characteristics of 97,904 contacts.
- 20.
“In China, human-to-human transmission of the COVID-19 virus is largely occurring in families. The Joint Mission received detailed information from the investigation of clusters and some household transmission studies, which are ongoing in a number of Provinces. Among 344 clusters involving 1308 cases (out of a total 1836 cases reported) in Guangdong Province and Sichuan Province, most clusters (78%–85%) have occurred in families. Household transmission studies are currently underway, but preliminary studies ongoing in Guangdong estimate the secondary attack rate in households ranges from 3–10%.” WHO, February 16–24, 2020.
- 21.
The scale of spending that this represents was only possible because of low interest rates on bonds.
- 22.
UK Office of National Statistics, Number of deaths registered by week, England and Wales, 28 December 2019 to 8 May 2020.
- 23.
Employment in the US health sector fell by 42,000 jobs in March 2020 (2.3%).
- 24.
Docherty et al. (2020, April 28). The researchers examined data through to April 22 2020.
- 25.
A letter-submission to the South Africa President by the actuaries Nick Hudson and Peter Castleden estimated that South Africa’s lockdown would cause a loss of life at least 29 times greater than the loss of life it stood to prevent. The actuaries looked at the aggregate years of life lost (YLL) from two impacts: the impact of COVID-19 overburdening of the South African health system and the impact of economic contraction stemming from COVID-19. The authors assumed a 10–15% decline in GDP in 2020 and a 10–15% unemployment rate. They note that, after 2008, South African employment took five years to fully recover and United States and Euro Area employment took six years. The bottom half of skill and pay grade occupations were the most affected and the slowest to recover. Actuaries use five socio-economic classes to determine relative mortality (life span years) for pricing life insurance. The letter-submission expected that, with mass employment, 10% of the population would experience the equivalent a drop of one level in socio-economic class for a period of ten years—resulting in a substantial number of years of life lost. Hudson and Castleden (2020, May 5).
- 26.
Of concern were the number of deaths resulting from undiagnosed serious illnesses due to the health industry focus on COVID-19 and the pattern of patients avoiding medical and hospital waiting rooms for fear of being exposed to the virus.
- 27.
Based on a rolling five-day average of new cases reported, the virus’ effective reproduction rate reached a peak of 1.39 in Australia on March 12 well before the country’s shutdown. Between March 29 and April 24—through Australia’s shutdown—the effective reproduction rate varied between 0.99 and 1.11. Cases (unlike deaths) are an imprecise measure of reality—for many cases are not detected. Nonetheless the data indicated a clear trend and approximated what happened.
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Murphy, P. (2020). Public Policy. In: COVID-19. Palgrave Pivot, Singapore. https://doi.org/10.1007/978-981-15-7514-3_2
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DOI: https://doi.org/10.1007/978-981-15-7514-3_2
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