LIVING WITH COVID-19: BALANCING COSTS AGAINST BENEFITS IN THE FACE OF THE VIRUS

Resting parasympathetic activity is associated with malodor-induced change in perceived foreignness of speakers

INTRODUCTION

To protect against infection, individuals have evolved context-dependent pathogen-avoidant strategies, including selective social behaviors aimed at avoiding foreign individuals who may possess greater risk of infection. Parasympathetic nervous system (PNS) activity is associated with social engagement and regulation of the classical immune system but has not been widely investigated in relation to changes in intergroup perception and the behavioral immune system.

METHOD

The current research investigated the relationship between parasympathetic activity and perceived foreignness of in and outgroup speakers during exposure to a pathogen-relevant odor (butyric acid). High-frequency heart rate variability was measured at rest and while participants rated foreignness of speakers with and without the odor present.

RESULTS

Findings show that exposure to the odor was associated with higher foreignness perceptions of outgroup speakers and lower foreignness perceptions of ingroup speakers. This effect was especially evident among individuals with higher resting parasympathetic activity.

CONCLUSION

These results suggest that the PNS may play a role in changes in social perceptions during a behavioral immune response.

Resilience, endogenous policy responses to COVID-19, and their impacts on farm performance

Policy measures aimed at containing the spread of the COVID-19 pandemic had unintended consequences on economic activities globally. In this study, we isolate and investigate the short-term partial impacts of six such measures on the farm and nonfarm incomes of agricultural households and examine the related resilience factors. Using Nigeria as a case study, we find that the COVID containment measures had mixed effects on farm and non-farm incomes in the short run. These varying effects are due to households' resilience and vulnerability factors, including land size, wealth, income diversification, involvement in processing activities, and reliance on hired labor. Our findings highlight the need for more targeted health crisis containment measures which consider the uniqueness, diversity, and regional heterogeneity of agriculture, especially the potential implications for farm viability.

Preparing for future pandemics: A multi-national comparison of health and economic trade-offs

Government investment in preparing for pandemics has never been more relevant. The COVID-19 pandemic has stimulated debate regarding the trade-offs societies are prepared to make between health and economic activity. What is not known is: (1) how much the public in different countries are prepared to pay in forgone GDP to avoid mortality from future pandemics; and (2) which health and economic policies the public in different countries want their government to invest in to prepare for and respond to the next pandemic. Using a future-focused, multi-national discrete choice experiment, we quantify these trade-offs and find that the tax-paying public is prepared to pay $3.92 million USD (Canada), $4.39 million USD (UK), $5.57 million USD (US) and $7.19 million USD (Australia) in forgone GDP per death avoided in the next pandemic. We find the health policies that taxpayers want to invest in before the next pandemic and the economic policies they want activated once the next pandemic hits are relatively consistent across the countries, with some exceptions. Such results can inform economic policy responses and government investment in health policies to reduce the adverse impacts of the next pandemic.

From lockdown to precise prevention: Adjusting epidemic-related spatial regulations from the perspectives of the 15-minute city and spatiotemporal planning

The COVID-19 pandemic challenged emergency management in cities worldwide. Many municipalities adopted restrictive, one-size-fits-all spatial regulations such as lockdowns without fully considering the inhabitants' daily activities and local economies. The existing epidemic regulations' unintended detrimental effects on socioeconomic sustainability necessitate a transition from the "lockdown" approach to more precise disease prevention. A spatially and temporally precise approach that balances epidemic prevention with the demands of daily activities and local economies is needed. Thus, the aim of this study was to propose a framework and key procedures for determining precise prevention regulations from the perspectives of the 15-minute city concept and spatiotemporal planning. Alternative regulations of lockdowns were determined by delineating 15-minute neighborhoods, identifying and reconfiguring facility supplies and activity demands in both normal and epidemic conditions, and performing cost-benefit analyses. Highly adaptable, spatially- and temporally-precise regulations can match the needs of different types of facilities. We demonstrated the process for determining precise prevention regulations in the case of the Jiulong 15-minute neighborhood in Beijing. Precise prevention regulations-which meet essential activity demands and are adaptable for different facility types, times, and neighborhoods-have implications for long-term urban planning and emergency management.

The effect of medical innovation on the cost-effectiveness of Covid 19-related policies in the United States using a SIR model

BACKGROUND

During 2020-21, the United States used a multifaceted approach to control SARS-CoV-2 (Covid-19) and reduce mortality and morbidity. This included non-medical interventions (NMIs), aggressive vaccine development and deployment, and research into more effective approaches to medically treat Covid-19. Each approach had both costs and benefits. The objective of this study was to calculate the Incremental Cost Effectiveness Ratio (ICER) for three major Covid-19 policies: NMIs, vaccine development and deployment (Vaccines), and therapeutics and care improvements within the hospital setting (HTCI).

METHODS

To simulate the number of QALYs lost per scenario, we developed a multi-risk Susceptible-Infected-Recovered (SIR) model where infection and fatality rates vary between regions. We use a two equation SIR model. The first equation represents changes in the number of infections and is a function of the susceptible population, the infection rate and the recovery rate. The second equation shows the changes in the susceptible population as people recover. Key costs included loss of economic productivity, reduced future earnings due to educational closures, inpatient spending and the cost of vaccine development. Benefits included reductions in Covid-19 related deaths, which were offset in some models by additional cancer deaths due to care delays.

RESULTS

The largest cost is the reduction in economic output associated with NMI ($1.7 trillion); the second most significant cost is the educational shutdowns, with estimated reduced lifetime earnings of $523B. The total estimated cost of vaccine development is $55B. HTCI had the lowest cost per QALY gained vs "do nothing" with a cost of $2,089 per QALY gained. Vaccines cost $34,777 per QALY gained in isolation, while NMIs alone were dominated by other options. HTCI alone dominated most alternatives, except the combination of HTCI and Vaccines ($58,528 per QALY gained) and HTCI, Vaccines and NMIs ($3.4 m per QALY gained).

CONCLUSIONS

HTCI was the most cost effective and was well justified under any standard cost effectiveness threshold. The cost per QALY gained for vaccine development, either alone or in concert with other approaches, is well within the standard for cost effectiveness. NMIs reduced deaths and saved QALYs, but the cost per QALY gained is well outside the usual accepted limits.

Differences in Resumption of Orthopedic Surgery According to Characteristics of Surgery during COVID-19 Pandemic: National Registry Data

Background

Healthcare services have been restricted after the coronavirus disease 2019 (COVID-19) outbreak. With the pandemic still ongoing, the patterns of orthopedic surgery might have changed. The purpose of this study was to determine whether the reduced volumes of orthopedic surgery were recovered over time. Among the trauma and elective surgery, which accounted for most orthopedic surgical procedures, we also sought to elucidate whether the changes in the volumes of orthopedic surgery differed according to the type of surgery.

Methods

The volumes of orthopedic surgery were analyzed using the Health Insurance Review and Assessment Service of Korea databases. The surgical procedure codes were categorized depending on the characteristics of the procedures. The actual volumes of surgery were compared with the expected volumes to elucidate the effect of COVID-19 on surgical volumes. The expected volumes of surgery were estimated using Poisson regression models.

Results

The reducing effect of COVID-19 on the volumes of orthopedic surgery weakened as COVID-19 continued. Although the total volumes of orthopedic surgery decreased by 8.5%-10.1% in the first wave, those recovered to a 2.2%-2.8% decrease from the expected volumes during the second and third waves. Among the trauma and elective surgery, open reduction and internal fixation and cruciate ligament reconstruction decreased as COVID-19 continued, while total knee arthroplasty recovered. However, the volumes of hemiarthroplasty of the hip did not decrease through the year.

Conclusions

The number of orthopedic surgeries, which had decreased due to COVID-19, tended to recover over time, although the pandemic was still ongoing. However, the degree of resumption differed according to the characteristics of surgery. The findings of our study will be helpful to estimate the burden of orthopedic surgery in the era of persistent COVID-19.

Economic evaluation of strategies against coronavirus: a systematic review

BACKGROUND

The COVID-19 outbreak was defined as a pandemic on 11 March 2020 by the World Health Organization. After that, COVID-19 has enormously influenced health systems around the world, and it has claimed more than 4.2 million deaths until July 2021. The pandemic has led to global health, social and economic costs. This situation has prompted a crucial search for beneficial interventions and treatments, but little is known about their monetary value. This study is aimed at systematically reviewing the articles conducted on the economic evaluation of preventive, control and treatment strategies against COVID-19.

MATERIAL AND METHOD

We searched PubMed, Web of Science, Scopus, and Google Scholar from December 2019 to October 2021 to find applicable literature to the economic evaluation of strategies against COVID-19. Two researchers screened potentially eligible titles and abstracts. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to quality assessment of studies.

RESULTS

Thirty-six studies were included in this review, and the average CHEERS score was 72. Cost-effectiveness analysis was the most common type of economic evaluation, used in 21 studies. And the quality-adjusted life year (QALY) was the main outcome applied to measure the effectiveness of interventions, which was used in 19 studies. In addition, articles were reported a wide range of incremental cost-effectiveness ratio (ICER), and the lowest cost per QALY ($321.14) was related to the use of vaccines.

CONCLUSION

Based on the results of this systematic review, it seems that all strategies are likely to be more cost-effective against COVID-19 than no intervention and vaccination was the most cost-effective strategy. This research provides insight for decision makers in choosing optimal interventions against the next waves of the current pandemic and possible future pandemics.

Time to Lift up COVID-19 Restrictions? Public Support towards Living with the Virus Policy and Associated Factors among Hong Kong General Public

The fifth wave of the COVID-19 pandemic has caused an unprecedented toll on Hong Kong. As more countries are starting to lift COVID-19 restrictions, it would be important to understand the public attitudes towards lifting COVID-19 restrictions and to identify its associated factors. The present study examined the level of support towards the living with the virus (LWV) policy for COVID-19 among the public in Hong Kong and to identify the associations between resilient coping, self-efficacy and emotional distress with support towards the LWV policy. A random population-based telephone survey was conducted among 500 Hong Kong Chinese adults from 7 March to 19 April 2022, i.e., during the fifth wave of COVID-19 outbreak. Of the respondents, 39.6% showed a supportive attitude towards the LWV policy. Results from the structural equational modeling showed a positive correlation between resilient coping and self-efficacy. Resilient coping was associated with support towards the LWV policy directly and indirectly through a lower level of emotional distress. Self-efficacy had a direct association with support towards the LWV policy but its indirect association through emotional distress was not significant. Interventions that foster resilient coping and self-efficacy would be effective in reducing public emotional distress and promoting their positive view towards the LWV policy.

Modeling Key Strategies for Reducing Socio-Economic and Health Crisis: Perspective from COVID-19 Pandemic

The pandemic outbreak has dramatically changed every sector and walk of life. Specifically, the developing countries with scarce resources are facing unprecedented crises that further jeopardize efforts to achieve sustainable life. Considering the case of a developing country, Pakistan, this study empirically identifies the most important strategies to reduce the socio-economic and health challenges during COVID-19. Initially, the study identified 14 key strategies from the prior literature. Later, these strategies were determined with the help of the interpretive structural modeling (ISM) approach through expert suggestions. The ISM model represents seven levels of pandemic containment strategies based on their significance level. The strategies existing at the top level of ISM model are the least important, while the strategies at the bottom of hierarchy levels are highly significant. Therefore, the study results demonstrated that "strong leadership and control" and "awareness on social media" play significant roles in reducing pandemic challenges, while "promoting online purchase behavior" and "online education" are the least important strategies in tackling pandemic crisis. This study will benefit government authorities and policymakers, enabling them to focus more on significant measures in battling this ongoing crisis.

Identifying factors associated with COVID-19 related deaths during the first wave of the pandemic in Europe

Aim

To clarify the high variability in COVID-19-related deaths during the first wave of the pandemic, we conducted a modeling study using publicly available data.

Materials and methods

We used 13 population- and country-specific variables to predict the number of population-standardized COVID-19-related deaths in 43 European countries using generalized linear models: the test-standardized number of SARS-CoV-2-cases, population density, life expectancy, severity of governmental responses, influenza-vaccination coverage in the elderly, vitamin D status, smoking and diabetes prevalence, cardiovascular disease death rate, number of hospital beds, gross domestic product, human development index and percentage of people older than 65 years.

Results

We found that test-standardized number of SARS-CoV-2-cases and flu vaccination coverage in the elderly were the most important predictors, together with vitamin D status, gross domestic product, population density and government response severity explaining roughly two-thirds of the variation in COVID-19 related deaths. The latter variable was positively, but only weakly associated with the outcome, i.e., deaths were higher in countries with more severe government response. Higher flu vaccination coverage and low vitamin D status were associated with more COVID-19 related deaths. Most other predictors appeared to be negligible.

Conclusion

Adequate vitamin D levels are important, while flu-vaccination in the elderly and stronger government response were putative aggravating factors of COVID-19 related deaths. These results may inform protection strategies against future infectious disease outbreaks.

The Tragedy of Liberal Democratic Governance in the Face of Global Threats

In hindsight, the early response of liberal governments to the SARS-CoV-2 pandemic was chaotic and generally inefficient. Though one might be tempted to attribute these failures to the incompetence of certain political decision-makers, we propose another explanation. Global threats require a coordinated international response, which is only possible if the threat is perceived in the same way by all, and if government priorities are similar. The effectiveness of the response also relies on massive adhesion of citizens to the measures imposed, which in turn requires trust in government. Our hypothesis is that certain fundamental features of liberalism complicate such global and collective responses: neutrality of the state and primacy of the individual over collective society. Liberalism considers that institutions and public policy must not be designed to favor any specific conception of the common good. That which is best for all is usually determined by a "competition of opinions," which frequently leads to scientific expertise being considered as only one opinion among many. Liberalism also imposes strict respect for individual freedoms and private interests and tends to reject any form of collectivism or dictate imposed by the common good. In order to solve these structural problems and improve society's management of global threats, we make several proposals, such as the introduction of a minimal and consensual definition of the common good and the promotion of a health policy guided by One Health-like concepts. Overall, our analysis suggests that because political ideologies provide their own definitions of the common good and the place of scientific knowledge in the governance process and can thus affect the response to global threats, they should be urgently taken into consideration by public health experts.

The fading impact of lockdowns: A data analysis of the effectiveness of Covid-19 travel restrictions during different pandemic phases

As countries struggled with SARS-COV2 outbreaks at the beginning of 2021, many citizens found themselves in yet another period of increasing travel restrictions, if not a strict lockdown. At the same time there was concern that further restrictions would prove to be less effective due to a range of reasons including increasing pandemic fatigue or the lack of appropriate supports. In this study we investigate whether restrictions remained effective as a way to limit non-essential travel in order to curb virus transmission. We do this by analysing adherence during periods of increasing and decreasing restrictions in 125 countries during three different 4-month phases, early (March-June 2020), middle (July-October 2020), and late (November 2020-February 2021) over the course of the first year of the pandemic, and prior to significant population-wide vaccination. We use the strength of the relationship between restriction levels and the level of personal mobility associated with non-essential travel in order to determine the degree of adherence to the restrictions imposed. We show that there is evidence of a significant decrease in adherence to restrictions during the middle and late phases of the pandemic, compared with the early phase. Our analysis further suggests that this decrease in adherence is due to changes in mobility rather than changes in restrictions. We conclude, therefore, that restrictions have become less effective at curbing non-essential travel, which may alter the cost-benefit analysis of restrictions and lockdowns, thus highlighting the need for governments to reconsider large-scale restrictions as a containment strategy in the future, in favour of more focused or flexible mitigation approaches.

Challenges of integrating economics into epidemiological analysis of and policy responses to emerging infectious diseases

COVID-19 has shown that the consequences of a pandemic are wider-reaching than cases and deaths. Morbidity and mortality are important direct costs, but infectious diseases generate other direct and indirect benefits and costs as the economy responds to these shocks: some people lose, others gain and people modify their behaviours in ways that redistribute these benefits and costs. These additional effects feedback on health outcomes to create a complicated interdependent system of health and non-health outcomes. As a result, interventions primarily intended to reduce the burden of disease can have wider societal and economic effects and more complicated and unintended, but possibly not anticipable, system-level influences on the epidemiological dynamics themselves. Capturing these effects requires a systems approach that encompasses more direct health outcomes. Towards this end, in this article we discuss the importance of integrating epidemiology and economic models, setting out the key challenges which such a merging of epidemiology and economics presents. We conclude that understanding people's behaviour in the context of interventions is key to developing a more complete and integrated economic-epidemiological approach; and a wider perspective on the benefits and costs of interventions (and who these fall upon) will help society better understand how to respond to future pandemics.

Measuring Pandemic and Lockdown Impacts on Wellbeing

With the onset of the COVID-19 pandemic, New Zealand's official statistical agency (Stats NZ) moved quickly to supplement the quarterly Household Labour Force Survey with wellbeing measures from the General Social Survey. The first supplement (June 2020) began toward the end of a restrictive national lockdown. Subsequent quarterly surveys continued through a second lockdown for the Auckland region, enabling tests of regional lockdown impacts. Survey measures include questions on life satisfaction, health, income adequacy, social capital (trust), and loneliness. Published aggregated data indicate that life satisfaction, social capital, health, and financial wellbeing were each higher through the pandemic (in 2020) than prior to it, including for disadvantaged groups, but loneliness rose. Analysis of the individual-level data, confined to the within-pandemic period, however indicates that more restrictive lockdowns were associated both with reduced life satisfaction and greater loneliness, with differing impacts according to labor market and household status.

Balancing Public & Economic Health in Japan during the COVID-19 Pandemic: A Descriptive Analysis

Despite loose restrictions and a low mortality rate due to COVID-19, Japan faced the challenge of stabilizing its economy during the pandemic. Here, we analyzed how the Japanese government attempted to maintain a balance between the health of the population and the health of the economy. We used a mix of quantitative data, information from policy documents, and news agency publications. Features of the Japanese government's handling of the pandemic include the lack of constitutional authority to enforce a lockdown, the laxer restrictions compared with other countries in which citizens were advised only to exercise self-restraint and avoid close social contact, and the existence of expert panels that had only an advisory role. Our findings address the slow initial response of the government, which feared that the 2020 Tokyo Olympics would be canceled, and the increased testing when the Olympics were postponed, as well as the expansion of vaccination efforts after the Olympics. In addition, there was a targeted campaign to promote national travel to increase economic revenue in the tourism sector, but this led to an increase in COVID-19 cases.

The cost of lost productivity due to premature mortality associated with COVID-19: a Pan-European study

BACKGROUND

Economic cost estimates have the potential to provide a valuable alternative perspective on the COVID-19 burden. We estimate the premature mortality productivity costs associated with COVID-19 across Europe.

METHODS

We calculated excess deaths between the date the cumulative total of COVID-19 deaths reached 10 in a country to 15th May 2020 for nine countries (Belgium, France, Germany, Italy, The Netherlands, Portugal, Spain, Sweden and Switzerland). Gender- and age-specific excess deaths and Years of Potential Productive Life Lost (YPPLL) between 30 and 74 years were calculated and converted into premature mortality productivity costs €2020 for paid and unpaid work using the Human Capital and the Proxy Good Approaches. Costs were discounted at 3.5%.

RESULTS

Total estimated excess deaths across the nine countries were 18,614 (77% in men) and YPPLL were 134,190 (77% male). Total paid premature mortality costs were €1.07 billion (87% male) with Spain (€0.35 billion, 33.0% of total), Italy (€0.22 billion; 20.6%) and The Netherlands (€0.19 billion; 17.5%) ranking highest. Total paid and unpaid premature mortality costs were €2.89 billion (77% male). Premature mortality costs per death ranged between €40,382 (France) and €350,325 (Switzerland). Spain experienced the highest premature mortality cost as a proportion of Gross Domestic Product (0.11%).

CONCLUSION

Even in the initial period of the pandemic in Europe, COVID-19-related premature mortality costs were significant across Europe. We provide policy makers and researchers with a valuable alternative perspective on the burden of the virus and highlight potential economic savings that may be accrued by applying timely public health measures.

Economic expectations and anxiety during the COVID-19 pandemic: a one-year longitudinal evaluation on Italian university students

The COVID-19 pandemic has produced an extensive aggravation of people's anxiety level. Different policies aimed at fighting the spread of the virus could affect anxiety in various ways. We built an ad hoc web-based survey, administered to the student population of three Italian universities at the beginning of the pandemic and at one year's distance, to collect information on retrospective and current anxiety levels and the underlining reasons. The survey also included questions concerning sociodemographic, economic, labor, lifestyle, academic career, and on-line teaching features, which prevents students from identifying the main survey topic to be anxiety. This research aims at assessing the change in anxiety levels between the analyzed periods and the main determinants of such change, focusing on students' economic expectancies. Results from a Poisson regression model show that anxiety has increased compared to both the pre-pandemic level and the one quantified during the first lockdown. This increase is revealed to be mostly driven by economic and career-related uncertainties, rather than by job loss and proximity to COVID-19. Thus, policymakers should take action to provide certainties both in terms of economic prospects and reopening strategies, especially to avoid that the resulting increase in anxiety translates into an amplified suicide risk.

A cost-benefit analysis of COVID-19 lockdowns in Australia

This paper conducts a cost–benefit analysis of Australia’s Covid-19 lockdown strategy relative to pursuit of a mitigation strategy in March 2020. The estimated additional deaths from a mitigation strategy are 11,500 to 40,000, implying a Cost per Quality Adjusted Life Year saved by locking down of at least 11 times the generally employed figure of $100,000 for health interventions in Australia. The lockdowns do not then seem to have been justified by reference to the standard benchmark. Consideration of the information available to the Australian government in March 2020 yields a similar ratio and therefore the same conclusion that lockdown was not warranted. If Australia experiences a new outbreak, and cannot contain it without resort to a nationwide lockdown, the death toll from adopting a mitigation strategy at this point would be even less than had it done so in March 2020, due to the vaccination campaign, lessons learned since March 2020, and because the period over which the virus would then inflict casualties would now be much less than the period from March 2020. This would favour a mitigation policy even more strongly than in March 2020. This approach of assessing the savings in quality adjusted life years and comparing them to a standard benchmark figure ensures that all quality adjusted life years saved by various health interventions are treated equally, which accords with the ethical principle of equity across people.

Estimating US Earnings Loss Associated with COVID-19 Based on Human Capital Calculation

Infection with COVID-19 could result in lockdown, quarantine of contacts, absenteeism from work, and temporary productivity loss. This research aims to calculate (1) how the pandemic affects on-the-job probability and earnings for the working population, and (2) how much productivity loss is associated with self or a family member sick with COVID-19. Based on data collected from the U.S Research and Development Survey (RANDS), this research projects the relationship between on-the-job possibility and age of the index group and calculates the employment possibilities of the index group relative to the healthy group, namely the employment ratio. The weekly loss of productivity, presented by earnings, associated with COVID-19 for groups aged 18-44 years and 45-64 years was calculated, since the 18- to 64-year-old population is an economy's active workforce. Analytical results indicate that the older the age group, the lower the on-the-job possibility, and the higher the weekly productivity loss due to self or a family member being sick from COVID-19. For the group aged 45-64 years, the employment ratio of the index group relative to the healthy group dropped from 0.863 to 0.39, corresponding to a weekly productivity loss of 136-590 US dollars. The overall impact would be about a 9% loss in GDP. Infected or quarantined people would be confined to working in relatively isolated offices or places to allow for social distancing. Proactive health promotion in the workplace plus reactive work through telecommunication systems would reduce such losses. Such preparedness needs to be implemented early for more vulnerable workers who are of middle or old age and/or those comorbid with diabetes.

Covid heterodoxy in three layers

Lockdowns and related policies of behavioral and economic restriction introduced in response to the COVID-19 pandemic are criticized, drawing on three sets of ideas and arguments that are organized in accordance with the likely degree of controversy associated with their guiding assumptions. The first set of arguments makes use of cost–benefit reasoning within a broadly utilitarian framework, emphasizing uncertainty, the role of worst-case scenarios, and the need to consider at least the medium term as well as immediate effects. The second draws on assumptions about the political value of basic liberties. The third draws on ideas about the roles of different stages within human life.

The SARS-CoV-2 Pandemic in High Income Countries Such as Canada: A Better Way Forward Without Lockdowns

The SARS-CoV-2 pandemic has caused tragic morbidity and mortality. In attempt to reduce this morbidity and mortality, most countries implemented population-wide lockdowns. Here we show that the lockdowns were based on several flawed assumptions, including "no one is protected until everyone is protected," "lockdowns are highly effective to reduce transmission," "lockdowns have a favorable cost-benefit balance," and "lockdowns are the only effective option." Focusing on the latter, we discuss that Emergency Management principles provide a better way forward to manage the public emergency of the pandemic. Specifically, there are three priorities including the following: first, protect those most at risk by separating them from the threat (mitigation); second, ensure critical infrastructure is ready for people who get sick (preparation and response); and third, shift the response from fear to confidence (recovery). We argue that, based on Emergency Management principles, the age-dependent risk from SARS-CoV-2, the minimal (at best) efficacy of lockdowns, and the terrible cost-benefit trade-offs of lockdowns, we need to reset the pandemic response. We can manage risk and save more lives from both COVID-19 and lockdowns, thus achieving far better outcomes in both the short- and long-term.

Cost-Effectiveness of COVID-19 Policy Measures: A Systematic Review

OBJECTIVES

The COVID-19 pandemic has had a major impact on our society, with drastic policy restrictions being implemented to contain the spread of the severe acute respiratory syndrome coronavirus 2. This study aimed to provide an overview of the available evidence on the cost-effectiveness of various coronavirus disease 2019 policy measures.

METHODS

A systematic literature search was conducted in PubMed, Embase, and Web of Science. Health economic evaluations considering both costs and outcomes were included. Their quality was comprehensively assessed using the Consensus Health Economic Criteria checklist. Next, the quality of the epidemiological models was evaluated.

RESULTS

A total of 3688 articles were identified (March 2021), of which 23 were included. The studies were heterogeneous with regard to methodological quality, contextual factors, strategies' content, adopted perspective, applied models, and outcomes used. Overall, testing/screening, social distancing, personal protective equipment, quarantine/isolation, and hygienic measures were found to be cost-effective. Furthermore, the most optimal choice and combination of strategies depended on the reproduction number and context. With a rising reproduction number, extending the testing strategy and early implementation of combined multiple restriction measures are most efficient.

CONCLUSIONS

The quality assessment highlighted numerous flaws and limitations in the study approaches; hence, their results should be interpreted with caution because the specific context (country, target group, etc) is a key driver for cost-effectiveness. Finally, including a societal perspective in future evaluations is key because this pandemic has an indirect impact on the onset and treatment of other conditions and on our global economy.

Analysis of social media data for public emotion on the Wuhan lockdown event during the COVID-19 pandemic

BACKGROUND

With outbreaks of COVID-19 around the world, lockdown restrictions are routinely imposed to limit the spread of the virus. During periods of lockdown, social media has become the main channel for citizens to exchange information with others. Public emotions are being generated and shared rapidly online with citizens using internet platforms to reduce anxiety and stress, and stay connected while isolated.

OBJECTIVES

This study aims to explore the regularity of emotional evolution by examining public emotions expressed in online discussions about the Wuhan lockdown event in January 2020.

METHODS

Data related to the Wuhan lockdown was collected from Sina Weibo by web crawler. In this study, the Ortony, Clore, and Collins (OCC) model, Word2Vec, and Bi-directional Long Short-Term Memory model were employed to determine emotional types, train vectorization of words, and identify each text emotion for the training set. Latent Dirichlet Allocation models were also employed to mine the various topic categories, while topic emotional evolution was visualized.

RESULTS

Seven types of emotions and four phases were categorized to describe emotional evolution on the Wuhan lockdown event. The study found that negative emotions such as blame and fear dominated in the early days, and public attitudes towards the lockdown gradually alleviated and reached a balance as the situation improved. Emotional expression about Wuhan lockdown event were significantly related to users' gender, location, and whether or not their account was verified. There were statistically significant correlations between different emotions within the subtle emotional categories. In addition, the evolution of emotions presented a different path due to different topics.

CONCLUSIONS

Multiple emotional categories were determined in our study, providing a detailed and explainable emotion analysis to explored emotional appeal of citizen. The public emotions were gradually easing related to the Wuhan lockdown event, there yet exists regional discrimination and post-traumatic stress disorder in this process, which would lead us to pay continuous attention to citizens lives and psychological status post-pandemic. In addition, this study provided an appropriate method and reference case for the government's public opinion control and emotional appeasement.

Welfare economics of managing an epidemic: an exposition

This paper reviews recent findings on the normative analysis of private and governmental countermeasures against infectious diseases, focusing on COVID-19. Based on a model that relates the economic activity to infectious disease epidemics, policies that maximize social welfare are considered. Lockdowns in many countries are measures that restrict economic activity over a wide area, and the economic damage they cause is extremely large. Existing studies on the net benefit of lockdown implemented in 2020 have reached mixed conclusions as to whether it is warranted or not. Although the estimates of costs and effects are relatively stable, the setting of the value of a statistical life for converting effects into benefits has a wide range and is also likely to overestimate benefits. Therefore, a careful procedure for setting is particularly crucial to obtain a reliable evaluation of countermeasures. Compared to uniform restriction of activities, taking measures to restrict activities by selecting targets may improve efficiency. Attributes that can be used to select targets include those that can be identified at little or no cost, such as age and industry, and those that can only be identified at a cost, such as close contact with infectious individuals and the presence of pathogens. In comparison to lockdown, these measures may reduce human suffering and economic suffering. No trade-off exists between uniform activity restrictions and selective activity restrictions.

Tracking GDP in real-time using electricity market data: Insights from the first wave of COVID-19 across Europe

This paper develops a methodology for tracking in real-time the impact of shocks (such as natural disasters, financial crises or pandemics) on gross domestic product (GDP) by analyzing high-frequency electricity market data. As an illustration, we estimate the GDP loss caused by COVID-19 in twelve European countries during the first wave of the pandemic. Our results are almost indistinguishable from the official statistics during the first two quarters of 2020 (the correlation coefficient is 0.98) and are validated by several robustness tests. We provide estimates that are more chronologically disaggregated and up-to-date than standard macroeconomic indicators and, therefore, can provide timely information for policy evaluation in time of crisis. Our results show that pursuing "herd immunity" did not shelter from the harmful economic impacts of the first wave of the pandemic. They also suggest that coordinating policies internationally is fundamental for minimizing spillover effects from non-pharmaceutical interventions across countries.

Deciphering the COVID-19 Health Economic Dilemma (HED): A Scoping Review

Lessons learnt from the initial stages of the COVID-19 outbreak indicate the need for a more coordinated economic and public health response. While social distancing has been shown to be effective as a non-pharmaceutical intervention (NPI) measure to mitigate the spread of COVID-19, the economic costs have been substantial. Insights combining epidemiological and economic data provide new theoretical predictions that can be used to better understand the health economy tradeoffs. This literature review aims to elucidate perspectives to assist policy implementation related to the management of the ongoing and impending outbreaks regarding the Health Economic Dilemma (HED). This review unveiled the need for information-based decision-support systems which will combine pandemic spread modelling and control, with economic models. It is expected that the current review will not only support policy makers but will also provide researchers on the development of related decision-support-systems with comprehensive information on the various aspects of the HED.

Optimal shutdown strategies for COVID-19 with economic and mortality costs: British Columbia as a case study

Decision makers with the responsibility of managing policy for the COVID-19 epidemic have faced difficult choices in balancing the competing claims of saving lives and the high economic cost of shutdowns. In this paper, we formulate a model with both epidemiological and economic content to assist this decision-making process. We consider two ways to handle the balance between economic costs and deaths. First, we use the statistical value of life, which in Canada is about C$7 million, to optimize over a single variable, which is the sum of the economic cost and the value of lives lost. Our second method is to calculate the Pareto optimal front when we look at the two variables-deaths and economic costs. In both cases we find that, for most parameter values, the optimal policy is to adopt an initial shutdown level which reduces the reproduction number of the epidemic to close to 1. This level is then reduced once a vaccination programme is underway. Our model also indicates that an oscillating policy of strict and mild shutdowns is less effective than a policy which maintains a moderate shutdown level.

Antibiotic resistance during and beyond COVID-19

Antibiotics underpin the 'modern medicine' that has increased life expectancy, leading to societies with sizeable vulnerable elderly populations who have suffered disproportionately during the current COVID-19 pandemic. Governments have responded by shuttering economies, limiting social interactions and refocusing healthcare. There are implications for antibiotic resistance both during and after these events. During spring 2020, COVID-19-stressed ICUs relaxed stewardship, perhaps promoting resistance. Counterpoised to this, more citizens died at home and total hospital antibiotic use declined, reducing selection pressure. Restricted travel and social distancing potentially reduced community import and transmission of resistant bacteria, though hard data are lacking. The future depends on the vaccines now being deployed. Unequivocal vaccine success should allow a swift return to normality. Vaccine failure followed by extended and successful non-pharmaceutical suppression may lead to the same point, but only after some delay, and with indefinite travel restrictions; sustainability is doubtful. Alternatively, failure of vaccines and control measures may prompt acceptance that we must live with the virus, as in the prolonged 1889-94 'influenza' (or coronavirus OC43) pandemic. Vaccine failure scenarios, particularly those accepting 'learning to live with the virus', favour increased outpatient management of non-COVID-19 infections using oral and long t ½ antibiotics. Ultimately, all models-except those envisaging societal collapse-suggest that COVID-19 will be controlled and that hospitals will revert to pre-2020 patterns with a large backlog of non-COVID-19 patients awaiting treatment. Clearing this will increase workloads, stresses, nosocomial infections, antibiotic use and resistance. New antibiotics, including cefiderocol, are part of the answer.

COVID-19: Rethinking the Lockdown Groupthink

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused the Coronavirus Disease 2019 (COVID-19) worldwide pandemic in 2020. In response, most countries in the world implemented lockdowns, restricting their population's movements, work, education, gatherings, and general activities in attempt to "flatten the curve" of COVID-19 cases. The public health goal of lockdowns was to save the population from COVID-19 cases and deaths, and to prevent overwhelming health care systems with COVID-19 patients. In this narrative review I explain why I changed my mind about supporting lockdowns. The initial modeling predictions induced fear and crowd-effects (i.e., groupthink). Over time, important information emerged relevant to the modeling, including the lower infection fatality rate (median 0.23%), clarification of high-risk groups (specifically, those 70 years of age and older), lower herd immunity thresholds (likely 20-40% population immunity), and the difficult exit strategies. In addition, information emerged on significant collateral damage due to the response to the pandemic, adversely affecting many millions of people with poverty, food insecurity, loneliness, unemployment, school closures, and interrupted healthcare. Raw numbers of COVID-19 cases and deaths were difficult to interpret, and may be tempered by information placing the number of COVID-19 deaths in proper context and perspective relative to background rates. Considering this information, a cost-benefit analysis of the response to COVID-19 finds that lockdowns are far more harmful to public health (at least 5-10 times so in terms of wellbeing years) than COVID-19 can be. Controversies and objections about the main points made are considered and addressed. Progress in the response to COVID-19 depends on considering the trade-offs discussed here that determine the wellbeing of populations. I close with some suggestions for moving forward, including focused protection of those truly at high risk, opening of schools, and building back better with a economy.

The psychological impact of COVID-19 pandemic lockdowns: a review and meta-analysis of longitudinal studies and natural experiments

Lockdowns to control the spread of the coronavirus disease 2019 (COVID-19) have had profound effects on everyday life worldwide, but their effect on mental health remains unclear because available meta-analyses and reviews rely mostly on cross-sectional studies. We conducted a rapid review and meta-analysis of longitudinal studies and natural experiments investigating the relationship between COVID-19 lockdowns and mental health. A total of 25 studies involving 72 004 participants and 58 effect sizes were analyzed. Using a random effects model, we found that lockdowns had small effects on mental health symptoms, g = 0.17, s.e. = 0.05, 95% CI (0.06-0.24), p = 0.001, but the effects on positive psychological functioning, g = -0.12, s.e. = 0.11, 95% CI (-0.33 to 0.09), p = 0.27, were not significant. Multivariate analysis of effect sizes revealed significant and relatively small effect sizes for anxiety and depression, while those for social support, loneliness, general distress, negative affect, and suicide risk were not significant. The results indicated substantial heterogeneity among studies, but meta-regression analyses found no significant moderation effects for mean age, gender, continent, COVID-19 death rate, days of lockdown, publication status or study design. The psychological impact of COVID-19 lockdowns is small in magnitude and highly heterogeneous, suggesting that lockdowns do not have uniformly detrimental effects on mental health and that most people are psychologically resilient to their effects.

COVID-19 pandemic in the United Kingdom

OBJECTIVES

To describe epidemiological data on cases of COVID-19 and the spread of Severe Acute Respiratory Syndrome Coronavirus 2 in the United Kingdom (UK), and the subsequent policy and technological response to the pandemic, including impact on healthcare, business and the economy.

METHODS

Epidemiological, business and economic data were extracted from official government sources covering the period 31st January to 13th August 2020; healthcare system data up to end of June 2019.

RESULTS

UK-wide COVID-19 cases and deaths were 313,798 and 46,706 respectively (472 cases and 70 deaths per 100,000 population) by 12th August. There were regional variations in England, with London and North West (756 and 666 cases per 100,000 population respectively) disproportionately affected compared with other regions. As of 11th August, 13,618,470 tests had been conducted in the UK. Increased risk of mortality was associated with age (≥60 years), gender (male) and BAME groups. Since onset of the pandemic, emergency department attendance, primary care utilisation and cancer referrals and inpatient/outpatient referrals have declined; emergency ambulance and NHS111 calls increased. Business sectors most impacted are the arts, entertainment and recreation, followed by accommodation and food services. Government interventions aimed at curtailing the business and economic impact have been implemented, but applications for state benefits have increased.

CONCLUSIONS

The impact of COVID-19 on the UK population, health system and economy has been profound. More data are needed to implement the optimal policy and technological responses to preventing further spikes in COVID-19 cases, and to inform strategic planning to manage future pandemics.

Neoliberal economics, planetary health, and the COVID-19 pandemic: a Marxist ecofeminist analysis

Planetary health sees neoliberal capitalism as a key mediator of socioecological crises, a position that is echoed in much COVID-19 commentary. In this Personal View, I set out an economic theory that emphasises some of the ways in which neoliberal capitalism's conceptualisation of value has mediated responses to COVID-19. Using the intersection of ecological, feminist, and Marxist economics, I develop an analysis of neoliberal capitalism as a specific historical form of the economy. I identify the accumulation of exchange value as a central tendency of neoliberal capitalism and argue that this tendency creates barriers to the production of other forms of value. I then analyse the implications of this tendency in the context of responses to COVID-19. I argue that resources and labour flow to the production of exchange value, at the expense of production of other value forms. Consequently, the global capitalist economy has unprecedented productive capacity but uses little of this capacity to create the conditions that improve and maintain people's health. To be more resilient to coming crises, academics, policy makers, and activists should do theoretical work that enables global economies to recognise multiple forms of value and political work that embeds these theories in societal institutions.

The Discounted Money Value of Human Life Losses Associated With COVID-19 in Mauritius

Background: Mauritius along with other 12 countries in the African Region was identified at the early start of the COVID-19 pandemic as being at high risk due to high volume of international travel, high prevalence of non-communicable diseases and co-morbidities, high population density and significant share of population over 60 years (16%). The objective of this study was to estimate the total discounted money value of human life losses (TDMVCLMAURITIUS ) associated with COVID-19 in Mauritius. Methods: The human capital approach (HCA) was used to estimate the TDMVCLMAURITIUS of the 10 human life losses linked with COVID-19 in Mauritius as of 16 October 2020. The HCA model was estimated with the national life expectancy of 75.51 years and a discount rate of 3%. A sensitivity analysis was performed assuming (a) 5 and 10% discount rates, and (b) the average world life expectancy of 73.2 years, and the world highest life expectancy of 88.17 years. Results: The money value of human lives lost to COVID-19, at a discounted rate of 3%, had an estimated TDMVCLMAURITIUS of Int$ 3,120,689, and an average of Int$ 312,069 per human life lost. Approximately 74% of the TDMVCLMAURITIUS accrued to persons aged between 20 and 59 years. Reanalysis of the model with 5 and 10% discount rates, holding national life expectancy constant, reduced the TDMVCLMAURITIUS by 19.0 and 45.5%, respectively. Application of the average world life expectancy at 3% discount rate reduced TDMVCLMAURITIUS by 13%; and use of the world highest life expectancy at 3% discount rate increased TDMVCLMAURITIUS by 50%. Conclusions: The average discounted money value per human life loss associated with COVID-19 is 12-fold the per capita GDP for Mauritius. All measures implemented to prevent widespread community transmission of COVID-19 may have saved the country 837 human lives worth Int$258,080,991. This evidence, conjointly with human rights arguments, calls for increased investments to bridge the existing gaps for achieving universal health coverage by 2030.

The Economics of Lockdown

In this paper, we suggest an approach to analysing policies relating to the COVID-19 pandemic. We discuss the formulation of policy and sketch how the approach can be applied to different specific challenges as policymakers try to make difficult choices for managing the pandemic and protecting the economy and society.

A cost–benefit analysis of the COVID-19 disease

The British government has been debating how to escape from the lockdown without provoking a resurgence of the COVID-19 disease. There is a growing recognition of the damage the lockdown has caused to economic and social life. This paper presents a simple cost–benefit analysis inspired by optimal control theory and incorporating the SIR model of disease propagation. It also reports simulations informed by the theoretical discussion. The optimal path for government intervention is computed under a variety of conditions. These include a cap on the permitted level of infection to avoid overload of the health system, and the introduction of a test and trace system. We quantify the benefits of early intervention to control the disease. We also examine how the government’s valuation of life influences the optimal path. A 10-week lockdown is only optimal if the value of life for COVID-19 victims exceeds £10m. The study is based on a standard but simple epidemiological model, and should therefore be regarded as presenting a methodological framework rather than giving policy prescriptions.