Covid-19: Six Months On

15 Oct 2020

As governments take a wide range of measures in response to the COVID-19 outbreak, a new tool aims to track and compare policy responses around the world, rigorously and consistently. One of the lead researchers discusses what has been learned.

STI Experts

The University of Oxford’s Blavatnik School of Government has developed the Coronavirus Government Response Tracker, a tool for comparing the relative efficacy of different government policies in response to the pandemic. Thomas Hale, Associate Professor of Global Public Policy at Oxford, is among its developers and lead researchers. He was interviewed by the BBC’s David Aaronovitch about policies and behaviors intended to mitigate the impact of COVID-19. Which have helped and which have hindered? The following is an excerpted transcript of his interventions.

DA: At Oxford you have been tracking the policies introduced by various governments around the world. Which ones do you think have had the most positive impact in terms of controlling the virus?

TH:  The first months of the pandemic show very clearly two things: first that strong action matters. And second, that early action matters. Stopping people from being in contact with other people does really reduce the spread of the disease.

To cite just one example, one study showed that even just a week’s delay adopting stringent measures would lead to 70% more deaths over time. Now that makes sense because the disease is spread by contact between people, so to break the chain of transmission, you need to stop people gathering, especially in closed, confined spaces.

But what we have yet to pin down, to my mind the most important question, is what is that magic formula by which we get the biggest health benefit for the least disruption? And how that magic formula, that package of policies varies across different contexts.

DA: As far as you can see looking at it, which countries have had the most successful magic formula? 

TH: An analytic difficulty for us is that in the first months, most countries did mostly the same thing at mostly the same time and in mostly the same order. We hear a lot in the news about different kinds of exceptions. Sweden is often held up as a country that took a slightly different approach. But most countries actually followed a pretty similar pattern. So that makes it hard for us to pin down exactly the effect of any individual policy on the spread of the disease. And this sequencing was really quite common across countries. First, they introduced travel restrictions, then information campaigns, then school or workplace closings, and only then harder measures like stay at home orders or business shut downs. And as they have unwound those policies, they have also unwound them in a similar pattern. So as we go forward we really need to think about how to design research to really unlock exactly the effect of the individual policy as opposed to this package, which is what we have seen so far. It is improving, but we are still not confident to be able to say globally which is the policy that really matters.

DA: Are there any policies adopted in particular countries that we can now say with a reasonable degree of certainty didn’t really work and haven’t had any useful impact?

TH: One I would hold up from the early months is the approach countries took to international travel controls. Countries really struggled to put in place an effective system to manage the risk of importing and exporting cases. Most countries put in place travel controls after the virus was already spreading locally, and so were obviously not very good at keeping the virus from getting out from under the door. Some countries have done that ok. They have put in place systems for example to require all people entering a jurisdiction to be isolated until they can be tested and deemed safe. What we really need for that going forward is a coordinated system by which countries can trust that other countries are sending them people who have already been screened for risk.

DA: Policies are only good if the public actually obeys them. What can we say about how compliant we in the UK have ben, and how do we compare in compliance to other countries?

TH: The overall pattern in the UK and globally is really pretty good. Most people’s behavior has really changed in the last few months and most people follow most of the rules most of the time. The UK is a kind of the upper quartile of countries in terms of change in behavior, so that’s a pretty good result. Most of the differences are not between different countries but rather between different parts of society. For example, we see riskier behavior in men as opposed to women, and young people versus older people and, also in some countries, some riskier behavior correlated with different kinds of political ideologies.

DA: One of the assumptions was that it would be difficult to get the UK population to be compliant with strict measures. And the orthodoxy now is that that was proved to be wrong and British people are compliant and that we have become less compliant over time. Is that borne out?

TH: I think it is. Across all countries we see a general erosion of compliance over time, driven by a range of factors. Like fatigue with complying with all these measures over time also perhaps by a lower perception of risk and some other factors as well.

DA: Where have we seen those struggles at their sharpest? 

TH: In a paucity of evidence where the situation is changing quite quickly, sort of common sense rules of thumb are probably the best ones to follow. For example, many governments have tried to introduce economic stimulus policies to restart the economy in a targeted way. Here in the UK for example we have seen a lot of effort into “eat out to help out” to get people to use restaurants to support jobs in the hospitality sector. That has some positive benefits for restaurants of course, but it was designed in a way that maybe wasn’t ideal for maintaining social distancing. Because if you remember, if you get the discount only on certain days of the week, that meant that we saw people going to restaurants more on those days and less maybe on the other days. So it was a well-intentioned scheme, but one that probably had an unintended side effect of putting more people together than would have been ideal.       

DA: People get very confused about what seems to be conflicting information… What is the sense of these overall packages of measures where there seem to be these contradictions?

TH: These are hard lines to draw. Even though it maybe doesn’t make sense to ban one thing and not the other thing, the overall goal is to reduce the total number of contacts, particularly the most risky ones. So I can sympathize with a government that says well we can shut down pubs, which are providing economic revenue, providing jobs, or we can shut down house parties, which provide some of the same functions but without those economic benefits. Even though the risks might be similar across them – say it was – it’s a pretty clear case for making one choice and not the other there.

DA: What are we learning from experiences of return to university?

TH: Our team has been following the US experience very closely and it’s a major cause for concern actually because there have been some spectacular failures. For example, the University of North Carolina at Chapel Hill, a big university of 30,000 students took a pretty aggressive approach towards social distancing requiring all sorts of restrictions on what students could do and how full buildings could be, etc. But in the first week that students were there, the number of people who test positive went from 2.8% to 13.6% in a single week. So nearly a factor of five increase in just seven days. That’s pretty terrifying. And what’s really worrying is that even universities that took a really ambitious approach were not immune to these kinds of negative outcomes. The university of Illinois, a massive public university of 40,000 students was actually testing all of those students twice a week. To get into a building they had to scan an app on their phone that was connected to their test results. So it was a pretty good, robust policy. What that didn’t account for though, was that some students, after testing positive and being told that they had to isolate, went to parties anyway. So you had a small number of noncompliant actors who really scuppered the best laid plans.

DA: Is there any way the rest of us can isolate ourselves from university students?

TH: We can’t really separate any sector of society. We are really all in this together. Students going to university are interacting with people working there, people working there are interacting with people in their homes and in their social circles. So no, we can’t carve off a sector of the society and say “you’re on your own now”. We are really all in this together. Which is why I think promoting policies that draw on and play to that sense of solidarity is really a key ingredient for success.

 

Consult the Coronavirus Government Response Tracker here.

Listen to the BBC podcast here.