The world still struggles about a convincing strategy to handle the #coronavirus crisis. The developed world was affected first, but the forthcoming consequences for the developing countries may be much worse. Some insights from an interview with development economist Asad Islam of Monash University, Australia.
Some core messages of the interview:
The impact of COVID-19 is likely to be more severe in developing countries than in developed countries.
A temporary lockdown makes it possible to alert people that this is a serious health issue and everybody needs to protect themselves as much as possible.
Most developing countries have the capacity to provide three meals a day for its poorest population.
Developing countries need to allow their people to leave the lockdown earlier.
Our proposal for India suggested a broad-based transfer system, targeting more on poor people and increase the global fiscal stimulus substantially.
The pandemic is of more serious concern than initially thought.
Issues previously considered to be local ones are now recognized to be of global relevance and have to be addressed by global collaborations.
GLO Fellow Asad Islam is a Professor at the Department of Economics, and Director of the Centre for Development Economics and Sustainability (CDES) at the Faculty of Business and Economics at Monash University, Australia.
GLO: What is different with COVID-19 in a developing country than in a developed country?
Asad Islam: In developing countries, we see poorer health infrastructure such as a severe lack of hospital beds, intensive care units are not equipped with proper facilities for COVID-19 patients, missing trained nurses and doctors, lack of awareness among masses of people. Thus, the impact of COVID-19 is likely to be more severe in developing countries than in developed countries.
GLO:Is there no alternative to a complete lockdown of society and economy?
Asad Islam: The temporary lockdown in a developing country is a necessary evil to raise awareness about COVID-19. Social distancing won’t work without it. People have now almost stopped going to temple, mosque, church or social gatherings. This won’t happen without a lockdown! Lockdown needs to be temporary with gradual withdrawal (because of concerns for the poor) while making sure that the people try to maintain social distance (1.5 meter), and wear masks. A temporary lockdown makes it possible to alert people that this is a serious health issue and everybody needs to protect themselves as much as possible.
GLO:But unlike in developed countries, it seems very difficult for the government to financially support people. How can they survive?
Asad Islam: Most developing countries have the capacity to provide safety nets (e.g., providing three meals a day) for its poorest segments of the population. The problem is not lack of resources, but absence of mechanisms to reach the food to these poor people. The food distribution system could be made fairer even within this short period of time and most poor people can be brought under a direct transfer system. Of course, the pressure on the government is huge for maintaining this over a longer period. However, supporting its needy 30-40 percent of the population for 3-6 months using a public food distribution system is not an impossible job. International organizations such as the World Bank and the Asian Development Bank can also play a supportive role in ensuring this, particularly in countries where we see a serious lack of resources.
GLO:Lockdowns need to end at some time and one needs good statistics. What to do?
Asad Islam: We need to flatten the curve in developing countries, which means one needs to wait when the number of cases is rising rapidly. While the developed country can wait till there is no new case, in developing countries that would be very hard to achieve considering the economic hardship of poor people. One option is to allow the people to start working (for temporary period) who test negative, and younger people (age 20-50) if they do not have any major pre-existing condition.
GLO:With some colleagues you have recently proposed a strategy for India (see for a media report and the full memorandum). What is the message?
Asad Islam: Our main point was to have a broad-based transfer system, targeting more on poor people to enable them to cope with hardship during the lockdown, and increase the fiscal stimulus in manifold to address the economic woes of people.
GLO:Have economists underestimated the dangers of this pandemic?
Asad Islam: I think there were not enough data to begin with, and as it now stands both the number of infection cases and deaths were not reported accurately. As economists rely mostly on numbers there was more support for herd immunity in the beginning as the death rate was very low. However, as more accurate data are coming and we observe higher rate of deaths/infections we have now started to realize that the pandemic is of more serious concern on both health and economic grounds than initially thought.
GLO:How will the coronavirus change development economics?
Asad Islam: The world should now realize more that there are many issues we should not ignore, issues which sometimes we perceive to be the problem of a country or region only. Many problems including poverty and climate change need to be tackled globally and developed countries have more obligations to address them. The global public health issue will remain a serious concern in the coming years, and the problems of developing countries need to be better understood to address these challenges.
The world still struggles about a convincing strategy to handle the #coronavirus crisis. The taken measures may have helped to contain the development, but generate also very serious challenges for the longer future of the planet and global solidarity. The award-winning Jordanian author Hisham Bustani has been interviewed to provide his insights, requests and visions.
Some core messages of the interview:
The panic of the emergency situation eliminates any possibility to conduct the necessary discussions about the major failures, witnessed so far, of a “system” that has been taken for granted, unquestioned, for too long.
The measures taken in Jordan have succeeded so far to keep the spread of COVID-19 slow and manageable.
As a remedy to the future, a rapid detachment from the global economy should get underway initiating modes of production aimed at local needs, food security and sufficiency, in place of export-oriented “growth” strategies that serve banks and financial elites, not people.
The main challenge is to reconsider the “system” that governs human existence on this planet, and put forward, and struggle for, a more just alternative.
The current experience will be part of my future writing: The destructive presence of humans on Earth is one of the main areas of my literary exploration.
A sense of doom is very present now, along with eye-opening experiences of solidarity, collectiveness, and modesty in front of nature’s might and immensity.
Hisham Bustani is an award-winning Jordanian author of five collections of short fiction and poetry. His fiction and poetry have been translated into several languages, with English-language translations appearing in prestigious journals including The Kenyon Review, Black Warrior Review, The Poetry Review, Modern Poetry in Translation, World Literature Today, and The Los Angeles Review of Books Quarterly. His fiction has been collected in The Best Asian Short Stories, The Ordinary Chaos of Being Human: Tales from Many Muslim Worlds, The Radiance of the Short Story: Fiction From Around the Globe among other anthologies. His book The Perception of Meaning (Syracuse University Press, 2015) won the University of Arkansas Arabic Translation Award. Hisham is the Arabic fiction editor of the Amherst College-based literary review The Common and was the recipient of the Rockefeller Foundation’s Bellagio Fellowship for Artists and Writers in 2017.
GLO: The corona crisis has reached Jordan late on March 15 and the intensity of the disease is still low. How much is public life in your country nevertheless affected by the coronavirus debate and how do you judge the situation?
Hisham Bustani: Like everywhere else around the world, nothing is in the discussion and in the news except COVID-19, mainly in the crude form of statistics, more statistics, and even more statistics – the number of infected people, the number of those who died, and to a lesser extent, the number of those cured.
Although this might be a good way to raise awareness about the seriousness of the disease, and the calamity of the situation (thus stressing the importance of personal preventive measures and social distancing), the fever of numbers and the panic of the emergency situation eliminates any possibility to conduct the necessary discussions about the major failures, witnessed so far, of a “system” that has been taken for granted, unquestioned, for too long.
One can observe that the “free market”, “capitalist globalization”, and the reign of corporations and financial institutions was not just ineffective in dealing with the pandemic (among many other things), but costs tremendous human lives and suffering. This “system” is incapable of functioning in emergencies and is continuously in need of being bailed out with taxpayer’s money instead of bailing out the people themselves. As matters get worse, they get contained with intensive “socialist” remedies, imposed through government-led measures, and intensive government intervention, the exact opposite of the neoliberal doctrines vigorously promoted around the world since the 1980s.
One can observe that the most important people around the world today are not the CEOs of transnational corporations and their incompetent politicians, but the massive army of underpaid public health professionals and other low-paid laborers who are maintaining the necessities of life and survival.
One can observe that what really matters are not useless, valueless, glamor commodities but food essentials, ventilators, and a universal health system for all.
One can observe that the reversal of catastrophic pollution levels is attainable, and desirable results can be achieved in extremely short periods.
One can observe that “collaborative” institutions (like the European Union) have failed their “internal” test as each member state scrambled to contain its own situation, leaving other deeply-affected countries (like Spain and Italy) without help; the only efficiency they can claim is mediating and concentrating power, while during a pandemic: allies are no longer allies but cutthroat competitors for the acquisition of medical supplies and test kits.
While a curfew situation is being imposed in Jordan, as well as in many countries around the world, and while health carers are on the frontlines of confronting the pandemic, doing whatever they can to save lives in haphazard field hospitals erected in boulevards and piazzas; these are the observations that should provide food for thought, the material for a deep public discussion, possibly contributing to initiating another future for us humans, our ways and governing systems, after the disease.
GLO:How did your country initially reacted to the new threat, beyond the many others you already have: development, conflict and peace, and refugees?
Hisham Bustani: In Jordan, the governmental response was rapid and radical. A strict lockdown was imposed for a number of days starting March 21, eased later to a 6pm-10am curfew period while allowing people to go out during the day to purchase necessary items. Cars and not allowed to move except with special permits. The twelve governorates that comprise Jordan are isolated from each other and movement between them is banned. Flights in and out of the country were stopped, all borders closed down, and the last group of people who entered the country (more than 5000) were quarantined in hotels for two weeks.
These measures have succeeded so far at keeping the spread of COVID-19 slow and manageable. The country’s resources, and its political and societal composition cannot bear the consequences of the sort of health sector collapses witnessed in countries like Italy. The majority of Jordanians have been cooperative and collaborative. Except for a massive wave of shopping craze on March 20, just before the lockdown, things quickly returned to a quasi-normal state: grocery shops, bakeries and pharmacies reopened, shortly followed by banks, but all under strict conditions of social distancing and infection control. There are investigation teams that promptly identify and test people who were in contact with any infected person. The only missing element is wide scale testing, simply because test kits are not available, and the limited global supply is snatched by bigger, more powerful countries, sometimes through crooked ways.
There has been an upside to this lockdown situation: in addition to the extended calm and quite, the slowed-down pace of life, the cleaner air, and the reintroduction of walking as a daily routine, a rapid reorientation towards producing for local needs and necessities got under way, signalling that models of need-based self-sufficiency are more important than export-oriented models of massive consumption.
I am not sure what the future holds since many of the more-vulnerable segments of the population received a direct blow: daily workers ended up with no income at all, many employees were, or will be, laid off, and as the lockdown continues, people will become short of money needed to buy food and necessities as they spend their meagre savings.
However, the economic collapse and its effects will be global rather than local, it will happen either way, and I am happy that Jordanian decision makers (so far, and in a rare occurrence) have chosen people over the economy. As a remedy to the future situation, a rapid detachment from the global economy should get underway (there is an excellent window of opportunity to do this), initiating modes of production aimed at local needs, food security and sufficiency, in place of export-oriented “growth” strategies that serve banks and financial elites, not people.
GLO:It seems that the virus has crowded out currently most other major challenges in the world. Rightly or wrongly, there is debate about how large the virus threat really is; but the substantial lockdowns of the economies in most countries will reduce the possibilities to deal with the old challenges when they come back to the table soon. How will your society perceive this challenge?
Hisham Bustani: The main challenge in my society, and probably all other societies around the world, is to reconsider the “system” that governs human existence on this planet, and put forward, and struggle for, a more just alternative.
The COVID-19 experience illuminated for us what is necessary for life, and how destructive those unnecessary elements can be.
The COVID-19 experience showed us how economic concepts based on profit are unable to deal with global human emergencies.
The COVID-19 experience taught us that economic considerations should never come before people-nature nexus, and that the former can be easily compelled to serve the well-being of the latter.
The challenge is to maintain and develop those insights after everything goes back to “normal”.
GLO:War refugees in particular will receive in the future even lower support of the world to fight sources and misery. Countries like Jordan will have to expect further challenges. What do you think is our role as scientists, writers and poets in the corona crisis?
Hisham Bustani: The main role is to expose the hypocrisy and double standards of what goes on in the world today. Example: colonialist Europe has plundered the wealth of the global south, leaving their societies crippled and poor, and then unleashed upon them interventionist wars, interventionist politics and interventionist economics, burying them further into debt, corruption and tyranny, and once people started fleeing this doomed fate to that same Europe, now self-designated as “the bastion of human rights”, they were faced (in most, but not all instances) with barbwires, teargas, truncheons, and racism, left to drown in the Mediterranean.
It is quite revealing that a country like Jordan, with an area of 89,000 square kilometres, of which 75% is a desert, and a population of 9 million, has taken in what is estimated to be 1.3 million Syrian refugees as from 2011 alone, and that is not taking into consideration previous waves of Iraqi, Syrian and Palestinian refugees from 1948 onwards, mostly caused by Euro-US-supported settler-colonialism (in Palestine) and Euro-US invasion and/or interventionism (in Iraq and Syria).
On top of that, Europe offers pennies as “assistance packages” for countries like Jordan to “keep the refugees put”, not allow them to move. What kind of “free world” is that? I will tell you: one that sells aggressive regimes fighter planes for billions of dollars, then sends in their “international aid agency” to finance prosthetic limbs for the victims of its raids for a fraction of a fraction of the profit.
The corona crisis has moved this “divide”, that blockade, that hypocrisy, further up north towards US-Europe itself, in the same sense that (as Sven Lindqvist explains in his book A History of Bombing) massive bombings of native communities in the colonies finally found its way into Europe in WWI and WWII.
Is it not eye opening how the US blocked the export of facemasks to Europe, or how the US, UK and many EU countries failed to take sever measures in the favour of people’s health for the sake of “maintaining the economy” and “business as usual” which basically pours profit in the pockets of the few who flew their private jets to special disaster bunkers? All this happened after neoliberalism has robbed the public sector (in the previous rampage of privatization) of its capacity act efficiently in favour of the public, leaving doctors and nurses struggling with an ever-increasing number of sick people who can’t find a hospital bed, making tough decisions on who lives and who dies because of the lack of social resources created by neoliberalism.
In response to the corona crisis, scientists, writers and poets should think about all this, think about its opposite: an egalitarian future, and the means to achieve it.
GLO:Your work as a poet and a fiction writer has been inspired by the many realities you observe. Will you soon write about the bad and good sides of humans revealed by the crisis?
Hisham Bustani: Two weeks ago, I was invited to contribute to “The Quarantine Chronicles” series, curated by Carol Sansour for The Sultan’s Seal literary e-zine, I obliged by writing “Eyes Without a Face”, a literary text that explores the manifestations created by, and the consequences left behind, the compulsory quarantine: its tragedies, catastrophes, farces, and hopes. The title is inspired by a Billy Idol song with the same name that was playing in the background, the singer making a special appearance in the piece, telling me (from yet another of his songs): “There is nothin’ fair in this world, nothin’ safe, nothin’ sure, nothin’ pure. Look for something left in this world.” “I think about those long held in an indefinite quarantine in refugee camps, prisons and shantytowns,” I wrote in response.
I am sure this experience will be part of my future writing, especially that the destructive presence of humans on Earth is one of the main areas of my literary exploration; examples of this can be found, for example, in my book: The Perception of Meaning.
I’ve written about war and its deeper effect on sanity (as in the short stories: “One Moment Before the End” and “Skybar”), about human’s violence against nature, his selfishness and lack of consideration (as in the poem: “Mirror, Mirror”), the effect of urban enclosures and their continuity within an internal isolation of individuals (as in the prose/poem hybrid piece: “Voices Within”), the reproduction of enslavement in societies that uphold selfish individualism, competitiveness, and consumption as key principal values (as in: “Starddust”), all of this leading to a general sense of doom (as represented in the poem: “Apocalypse Now”, after Francis Ford Coppola’s film of the same name, which is based on Joseph Conrad’s Heart of Darkness).
This sense of doom is very present now, along with eye-opening experiences of solidarity, collectiveness, and modesty in front of nature’s might and immensity. This makes my literary work more relevant than any other time before. It makes art (as juxtaposed to “entertainment”) more relevant than before, since art is all about diving deep, contemplating, and opening up questions: the unleashing of creative possibilities within the recipient, things that entertainment has killed and replaced with passivity and idleness, undermining the “human condition” even more.
************* With Hisham Bustani spoke Klaus F. Zimmermann, GLO President on April 9, 2020. Both have been Rockefeller Foundation Bellagio Fellows in 2017. Further activities and reports of the GLO Research Cluster on the coronavirus.
Will happiness levels return to normal before the end of 2020? Talita Greyling and Stephanié Rossouw of GLO analyze the situation, as it happens – real-time happiness levels and emotions (www.gnh.today) during the evolution of the Coronavirus Crisis. The Gross National Happiness data set used (a real-time Happiness Index) is an ongoing project, the two researchers launched in April 2019 in South-Africa, New-Zealand and Australia.
The project is presented below and documents the development of real-time happiness in Australia, New Zealand and South Africa in the periods of the outbreak of the Coronacrisis in those countries.
Talita Greyling:School of Economics, University of Johannesburg, South Africa, and GLO; email: firstname.lastname@example.org Stephanié Rossouw:Faculty of Business, Economics and Law, Auckland University of Technology, Auckland, New Zealand,and GLO; email: email@example.com
Traditionally, economists measured the well-being of people or a nation by using objective economic indicators such as gross domestic product (GDP). We know that these indicators do not measure well-being per se, but merely specific conditions, which is believed to lead to a good life. What we should be measuring is whether people’s lives are getting better? In general, when people are happy and satisfied with their life, it signals that they have a higher level of well-being.
Gross National Happiness (GNH) refers to the level of happiness for a group of citizens or nations and the best-known surveys that captures cross country data are the Gallup World Poll Survey data and World Value Survey data. In these surveys we find measures of subjective-wellbeing, thus evaluative happiness, which if averaged across a country gives the mean subjective well-being of a specific country. Although these measures of subjective well-being are very useful and informative there are significant time-lags between real-time events and the reporting of this evaluative happiness levels. What is needed is a real-time measure of happiness.
Using social media and the voluntary information sharing structure of Twitter, Greyling and Rossouw (in collaboration with AFSTEREO) have been determining the happiness in real-time (mood) of citizens in Australia, New Zealand and South Africa since April 2019 (http://gnh.today/), and lately also been analyzing the specific emotions of Tweets, distinguishing between eight emotions, anger, anticipation, disgust, fear, joy, sadness, trust and surprise.
They analyze extracted Tweets using sophisticated software to determine the sentiment and the emotions of the Tweets. Sentiment analysis is used to label a ‘live’ stream of tweets of these countries as having either a positive, neutral or negative sentiment after which a sentiment balance algorithm is applied to derive a happiness score. The scale of the happiness scores is between 0 (not happy) and 10 (very happy), with 5 being neutral, thus neither happy nor unhappy. In this manner, they have been tracking the ‘mood’ of these nations and analyzed the impact of various economic (industrial actions), political (national elections), social (death of Kobe Bryant and COVID-19, xenophobia, music concerts) and sport events on happiness levels, as early as one hour after it happened. See Figures 1-3 for a peek into what the happiness index can ascertain.
As can be seen from Figure 1, on 25 January when Australia confirmed its first COVID-19 case, there was very little reaction. Happiness even increased somewhat after the announcement, though the higher levels of happiness were related to sport events. The dip in the happiness on 27 January was due to the death of the American basketball player, Kobe Bryant. On 17 March when Prime Minister Scott Morrison banned gatherings larger than 100 people, we for the first time saw a significant decrease in the happiness levels. The Australians are not on complete lockdown, but it seems that their happiness levels continue to stay below pre-Corona times. We will be tracking these changes in the coming weeks, to see if the happiness levels return to pre-Corona levels as time goes by.
Coincidentally, until the outbreak of COVID-19, the lowest happiness level in New Zealand was on 27 January (6.43), also signalling New Zealanders’ empathy with Kobe Bryant’s death. As can be seen from the Figure 2, on 28 February when New Zealand confirmed its first COVID-19 case, there was very little reaction. On 4 March, New Zealand experienced the ‘Toilet paper apocalypse’, but it wasn’t until 13 March that the lowest level of happiness (6.37) was recorded. People were devastated by all the concert and festival cancellations, because of COVID-19. The first day of complete lockdown was on 26 March. We will be monitoring whether New Zealanders adjust to their new normal over the coming weeks.
As can be seen from Figure 3, on 6 March when South Africa confirmed its first COVID-19 case, the happiness level was above the average for the period preceding the outbreak, as well as the total average. It wasn’t until 16 March when reality set in for most South Africans after President Cyril Ramaphosa declared a national state of disaster, that we saw a decrease in happiness levels. When the announcement came on 23 March, that a complete lockdown of South Africa will commence on 27 March, the index fell to its lowest level yet (5.35). We will be monitoring whether South Africans adjust to their new normal over the coming weeks.
Technical Support by AFSTEREO
Reference Greyling T. & Rossouw S. 2020. Gross National Happiness Project. Afstereo (IT partner). University of Johannesburg (funding agency). Pretoria, South Africa. www.gnh.today.
The world still struggles about a convincing strategy to handle the #coronavirus crisis. Radical alternatives focus around (i) herd immunity and selective social distancing and (ii) a total lockdown of the economy and the entire society. In previous posts the GLO website was reporting about the strategy of lockdown, the societal consequences and the arguments against it, and the alternative Swedish strategy. Today we listen to a feedback from Italy, the country hit hardest first after China.
Some core messages of the interview:
The course of the contagion is the same everywhere.
Italy is on its way out of the crisis.
It started in the most populated North with global connections, affecting the most vulnerable.
Italy has an efficient public health system which managed the crisis.
The radical lockdown had no alternative and saved very many lives.
The missing European solidarity may result in the end of European unification.
GLO Fellow Alessandro Cigno is a Professor of Economics at the University of Florence, and Editor of the Journal of Population Economics.
GLO: The coronacrisis in Italy has become a terrible catastrophe, and there is no end in sight…..
Alessandro Cigno: ….not quite true that there is no end in sight in Italy. The number of contagions has stabilized, and the number of intensive care cases is decreasing , the number cured or dead is larger than the number of new cases…..
GLO: But what can the other countries learn from the Italian experiences? Why was the coronavirus affecting Italy suddenly like a tsunami?
Alessandro Cigno: The course of the contagion is the same everywhere. It just started earlier in Italy.
GLO: Why has the disease largely affected first the North and so much the Old?
Alessandro Cigno: The North is more densely populated and has more intense relations with the rest of the world. The old are more likely to have other pathologies.
GLO: What role played the openness of the country, the strength of the healthcare system and the strong family relationships in the Italian culture? What role played missing data and slow government response?
Alessandro Cigno: Openness facilitated the contagion. Fortunately we have an efficient public health system. But the number of intensive care beds per 1000 inhabitants, while double that of the UK, was initially half of that of France and one third that of Germany. That number has been raised very quickly. Strong family relationships helped the contagion, especially from the young to the old. As Italy was the first to start, the government response was unavoidably tentative (that of other countries who started later had no excuse).
GLO: Italy is strongly related to China through the Belt & Road initiative. Has this played any role?
Alessandro Cigno: The Belt & Road initiative may have played a role.
GLO: Were the radical lockdown measures effective?
Alessandro Cigno: Radical lockdown is estimated to have saved 30 000 lives.
GLO: Did Italy discuss alternatives?
Alessandro Cigno: Alternatives to lockdown were and are discussed, but the scientific and medical consensus is that they are inferior.
GLO: How do Italians react to the missing European solidarity in this crisis?
Alessandro Cigno: Italians are offended by the missing European solidarity and fear that it will be the end of European unification.
************* With Alessandro Cigno spoke Klaus F. Zimmermann, GLO President.
Yun Qiu & Wei Shi are Professors at the Institute for Economic and Social Research (IESR), Jinan University, China
Xi Chen is a Professor at Yale University & President of the China Health Policy and Management Society
Author Abstract: This paper examines the role of various socioeconomic factors in mediating the local and cross-city transmissions of the novel coronavirus 2019 (COVID-19) in China. We implement a machine learning approach to select instrumental variables that strongly predict virus transmission among the rich exogenous weather characteristics. Our 2SLS estimates show that the stringent quarantine, massive lockdown and other public health measures imposed in late January significantly reduced the transmission rate of COVID-19. By early February, the virus spread had been contained. While many socioeconomic factors mediate the virus spread, a robust government response since late January played a determinant role in the containment of the virus. We also demonstrate that the actual population flow from the outbreak source poses a higher risk to the destination than other factors such as geographic proximity and similarity in economic conditions. The results have rich implications for ongoing global efforts in containment of COVID-19.
The world is shaken by the #coronavirus crisis. Top health economist Xi Chen, who has done new and original research on the virus, explains his conclusions on the management of the crisis based on the Chinese experiences and the challenges for research.
In the past decade, many nations in the world de-invested in their disease control and prevention.
Now it is better to overreact than to underreact.
The Chinese experience shows that only after ten days the harsh measures already altered the infection growth trajectory.
The UK’s strategy of obtaining “herd immunity” is very risky given the little knowledge about this new virus.
Social distancing can saliently reduce the risk of contracting virus via avoiding inhaling droplets or touching through handshake.
This very likely to be a long pandemic.
GLO Fellow Xi Chenis a Professor of Global Health Policy and Economics at Yale University, the GLO Cluster Lead of “Environment and Human Capital in Developing Countries”, and the President of the China Health Policy and Management Society(CHPAMS).
GLO:Your research is on health issues and their societal and economic consequences, how did you come to this research focus?
Xi Chen: The pursuit of health and longevity for mankind has no limits. As health spending has accounted for the largest share of GDP across many countries, it becomes very important to assess if our spending is cost-effective and affordable. A health and labor economist by training, I’m very passionate about using research findings to inform health resources allocation and improve actions at the individual, community, and societal levels.
GLO:You are currently the President of the China Health Policy and Management Society. What is the purpose of this society and what is your role as its head?
Xi Chen: China Health Policy and Management Society (CHPAMS) is a global professional organization with over 2,200 members around the world. Our mission is to improve health and health equity and contribute to the advancement of health research, practice, and education of areas including but not limited to, health policy and management, health economics, epidemiology, and global health. As president of CHPAMS, my Board of Directors and I have been striving to accomplish our mission by fostering and promoting scholarly exchanges among its members and with Chinese public health community, and by building health research capacities of China institutions.
GLO: As a frequent observer and researcher of the health conditions in China: How could the coronavirus outbreak happen and what is to learn?
Xi Chen: The heavily invested infectious disease surveillance system did not sound alarm for this novel virus. Part of the reasons include that the system did not allow medical workers to report new diseases, and that most medical professionals were not well trained to appropriately report cases. This important issue is not unique to China. In the past decade, many nations in the world de-invested in their disease control and prevention. In the meantime, they did not invest appropriately in building a primary care system to initial diagnosis of patients before they all flooded to overstretched hospitals. All these investments should be made ahead before the next pandemic.
GLO:Patient but careful responses or early harsh measures: Is the strict reaction of the Chinese government the right one as a model for the world?
Xi Chen: For infectious diseases, especially COVID-19 that is new to the world, it is better to overreacting than underreacting. The exponential growth trajectory of virus determines that the time it takes to double the number of cases keeps shrinking. Governments, social entities and individuals should intervene early and strong enough to flatten the curve for sustained medical resources to treat severely ill patients, rather than squandering the window of opportunity until reaching healthcare capacity. Overburdened health infrastructure leads to more infections and high fatality rate, like we are observing in Italy. China set a good example after it decided to lock down Hubei province with a number of stringent public health measures. Our latest study forthcoming as a GLO Discussion Paper shows that only after ten days the harsh measures already altered the infection growth trajectory.
GLO:Is re-infection with the virus possible? If the immune system is strengthened during an infection, harsh lock downs of the countries do not remove the need to adjust to the new threat at some time.
Xi Chen: Normally, people once contracted a virus will obtain at least temporary immunity for at least weeks or months. However, this time this is a novel coronavirus, we still know little about this. Some news and published clinical evidence already show cases people (in China’s Guangdong province and other areas) re-infected after being discharged from hospitals. Therefore, I thought the UK’s strategy of obtaining “herd immunity” is very risky given our little knowledge about this new virus. The “herd immunity” needs a threshold of at least 60% of population being infected, many of them are older adults, especially with multiple chronic conditions. A massive number of them will die. From a public policy perspective, we should try the best to protect these vulnerable groups, not leaving them behind as they were during pandemic in history. It is good to see that today the British government seems to change the strategy by offering protection to those above 70 and those living in nursing homes. In America, I was among the 15 Yale and Harvard colleagues to write an open letter to Vice President Mike Pence and the US government for an equitable response to this pandemic, and not unfairly operate at the cost of those most vulnerable.
GLO:What are the most effective single measures so far we understand this today to tame the speed of transitions?
Xi Chen: In my view it is social distancing, such as cancelling large social gathering, allowing flexible work schedule and working from home, leave more person-to-person space in public facilities. Social distancing can saliently reduce the risk of contracting virus via avoiding inhaling droplets or touching through handshake.
GLO:For the world-wide level: Can the disease be contained soon or do we have to accept a longer pandemic?
Xi Chen: I’m afraid it is very likely to be a long pandemic. Part of the reason is the lack of global coordination that delayed the joined efforts to contain the virus or avoid long scale community transmissions. While different countries are at different stages of this pandemic, we already see that most countries already abandoned the strategy of containment. Instead, the mitigating strategy has been widely adopted. Given the stronger infectiousness but weaker virulence of this novel coronavirus compared to other types of coronavirus like SARS and MERS, it is more likely we will see the recurring of this virus outbreak. In other words, we will have to adapt to the world where this virus will coexist with us. My hope is that this outbreak may not last too long to further disrupt the global supply chain.
GLO:Given the large economic and social impacts we observe, where are the larger challenges for research, on the medical or the psychological side?
Xi Chen: On the medical side, it is challenging so far to find the origin of the virus, and intermediate host. We are questing the answer to these questions in order to stop its transmissions to human society and to know the roots of the pandemic. Other challenges are more relevant to our economists. For example, what are the real social costs of this pandemic. We know that patients with other diseases were not able to be treated due to the crowding-out of medical resources. Many residents under lockdown suffer from mental illnesses which can be very costly to treat after the crisis. Finally, we know little about the potential benefits of stringent public health measures, which depends on our understanding of the counterfactual for this new virus outbreak.