A high-return strategy for a safer reopening

A high-return strategy for a safer reopening

The data on how to combat the pandemic is becoming increasingly clear.

Article by Amanda BrimmerVincent ChinMarin GjajaRich Hutchinson, Dan Kahn, and Phil Siegel

As COVID-19 cases surge throughout much of the US and in many developing countries, the data on how to combat the coronavirus is becoming increasingly clear. In addition to wearing masks, limiting large indoor activities, and avoiding superspreader events, governments need to protect those whose health is most vulnerable by adopting a relatively affordable, high-ROI package of policy interventions. Protecting the vulnerable will give societies a path to contain the virus, reopen most businesses, and allow students to return to schools, without reverting to lockdowns. Pursuing this sensible path will produce better health, economic, and social outcomes at a lower cost than other options.

About 20% to 30% of the world’s population qualifies as health vulnerable, although the exact percentage varies by region and country. In the US, for example, about 20% of the population has chronic health conditions, and about 10% is generally healthy but over the age of 65. By protecting these people, governments can avoid severely straining their health care systems. For example, if the US adopted specific measures to protect residents of long-term care and other congregate living settings—people who account for less than 2% of the population and yet are among the most health vulnerable—it could prevent up to 9% of all COVID-19 hospitalizations.

On the other hand, if countries reopen without protecting the vulnerable, the health outcomes could be catastrophic. If schools and most businesses reopened in the US without taking steps to limit harm to vulnerable people, many places in the nation would run out of intensive care unit (ICU) beds in just weeks, and demand would peak at twice its maximum ICU capacity. This represents the national average; many localities would fare much worse during the peak period of hospitalizations.

It does not need to be that way. The most health vulnerable—people over age 65 with underlying conditions—are 30 times more likely to require hospitalization if infected than are previously healthy adults under the age of 65. They deserve government’s protection, and protecting them offers path to recovery that rejects the false tradeoff between lives and livelihoods.

Health-vulnerable people are not the only group that needs government protection. So do exposure-vulnerable people—those who are especially likely to come into contact with the virus. They disproportionately include minorities and immigrants who work in high-contact jobs and live in high-transmission neighborhoods.

Home, Work, Money and Behavior

Home and work are the two primary avenues of infection for the health vulnerable, so policies must protect them in both places. Our models estimate that taking effective steps to protect the health vulnerable could reduce overall hospitalizations by 40% to 65% and cost governments far less than they have spent to date. For instance, the US—which authorized $3 trillion in government support during the first three months of the pandemic—could protect its health-vulnerable population for $35 billion to $80 billion a month. Moreover, it would probably not reach that $80 billion upper limit, as governments can spend less in areas that have lower infection levels. By cutting hospitalizations in half for this population, societies would have flexibility to manage the health consequences of the coronavirus and mitigate the risk of having to shut down a second time.

Money alone is not enough, however. Governments also need to encourage changes in rhetoric and behavior. By designing smart programs and incentives, governments can enable and encourage the health vulnerable to physically isolate, to wear masks and other protective equipment, and to undergo frequent testing. Unfortunately, the opportunity to embrace these changes in behavior is quickly vanishing in the US and many developing countries. In some regions with high infection levels, it is already too late. Governments there must first enact swift, stringent lockdowns to crush the virus.

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