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Journal of Health Policy and Management

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Luis Menezes1*, Antonio Maia Goncalves2,3, Ricardo Mexia4 and Mariana Gonçalves5
 
1 UNILABS 4150-17, Portugal, Email: [email protected]
2 Multipurpose Intensive Care Unit, Casa Saúde da Boavista 4250-201 Porto, Portugal
3 Portugal Institute of Bioethics, Universidade Católica Portuguesa, 4169-005, Porto, Portugal
4 Portuguese Association of Public Health Doctors, Porto, Portugal
5 Faculty of Law, Universidade Católica, Porto, Portugal
 
*Correspondence: Luis Menezes, UNILABS 4150-17, Portugal, Email: [email protected]

Received Date: Jan 03, 2021 / Accepted Date: Jan 17, 2021 / Published Date: Jan 24, 2021

Citation: This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http://creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact [email protected]

This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http://creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact [email protected]

Abstract

The dimension of SARS-Cov-2 impact in the world economy will depend on the behavior of the virus and we don’t know enough about SARS-Cov2 to understand today, the full extent of its global impact. South Korea is analyzed as a model to replicate in the reopening that several countries are starting to undertake. The authors support electronic tracing as a solution to contain more strongly Covid-19, given all the necessary debates about privacy and individual rights, as well as generalized of masks and multiplex tests to contain virus surges. The article undertakes an analysis of reopening scenarios, linked to healthcare systems capacities, and virus intensity in each wave. The authors support open information exchange about the SARSCoV2, in order to help develop quicker solutions to end the pandemic.

Keywords

Economy; SARS-Cov-2; covid-19

Introduction

The Covid-19 pandemic will clearly be one of the defining moments of this century and of many generations. The world was not ready for this. No one saw it coming. But, and Quoting Henry Kissinger’s Wall Street Journal essay title, “ The Corona Virus Pandemic will Forever Alter the World Order”. It surely wills [1].

In the same article, the author states that “Nations cohere and flourish on the belief that their institutions can foresee calamity, arrest its impact and restore stability. When the Covid-19 pandemic is over, many countries institutions will be perceived as having failed. Whether this judgment is objectively fair is irrelevant. The reality is the world will never be the same. To argue now about the past only makes it harder to do what has to be done”

Most governments have acted, and have acted well with severe nonpharmacological interventions (NPI) in the beginning of the pandemic, from school closing, to travel limitations and in many cases with full lockdowns. These NPI are essential to flatten the curve from a healthcare perspective, but are equally critical to create a path to a quicker economic rebound after the crisis is over [2].

In that sense, there is no ethical dilemma regarding quick NPI for policy makers and politicians because NPI’s – softer or harder, depending on the pandemic spread in each country or region - are the win-win solution to both save lives and pave the ground for a faster recovery path [3].

But what comes next? This article pretends to put the emphasis on what needs to be done.

First by understanding the economic consequences of the pandemic and the general government and global institutions response to it was.

Secondly, by trying to understand how South Korea stayed open, controlling the pandemic, as an example to reopening models across the world: how to control the pandemic without closing down. On this angle we also look at the public health response measures we should take, as well as the relevance of the multiplex testing capabilities to have in place as quickly as possible, but mainly to face the potential October / November Flu Season + Covid-19 combined peak.

And finally, by proposing a modular approach to the release of NPI by governments and policy makers, that must be tracked with strong testing, tracing and pandemic monitoring, in a dynamic “dance” where we remove “ Lego Bricks ” – NPI ’ s – while measuring the virus behavior to these measures, and acting accordingly.

The objective is to find an approach that avoids full lockdowns in a second wave of the pandemic, by having the and the economy to have some certainty about not closing down massively once more – or knowing when that can happen - with the tremendous economic effects it brings [4].

How Deep is the Economic Valley

Like discussed in the first article where we analyzed the pandemic economic situation, this crisis comes completely unannounced and traditional economic modeling needs to be adapted to the virus behavior, as well as government and global institutions responses to it.

The initial economic predictions came out, came with a very large landing zone. An example of this, for the Portuguese situation, is the 23rd of March, study by the NECEP of the Portuguese Catholic University pointing to a recession in 2020 in Portugal between 4% and 20%, depending on 3 different scenario levels.

Since then, continuous studies come out almost on a daily basis. From governments, to banks, to several global institutions, there are dozens of different views and reports out there. The table below shows a wide range of those analysis and variability of the outcomes from several banks for GDP growth (Figure 1).

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Figure1) Bloomberg; BCG analysis.

The IMF World Economic Outlook of April brings, in our view, the most in-depth analysis so far [5].

On page vii and 2 of that report, the IMF states clearly that “up-front containment measures are essential to slow the spread of the virus and allow health care systems to cope and to help pave the way for an earlier and more robust resumption of economic activity”. This goes in line the analysis made by the FRB to the 1918-19 pandemic and to the conclusions of the author’s previous paper.

The IMF also dwells into the supply and demand shock that this pandemic creates in its many layers. Infections reduce labour supply; workplace closures disrupt the supply chains; layoffs, decreased incomes, fear of being infected, alongside with generalized uncertainty, makes individuals spend less, creating less demand, increasing layoffs, decreasing more income, in a never-ending spiral of business disruption, closures and rise in unemployment. A clear example of this is what happened in the United States with a rise in Jobless claims of 22 million people in 4 weeks, an unparalleled increase (Table 1).

Year Description Peak Jobless claims (4-wk total) % of U.S. Population
1975 Stagflation 2.24 million 1.00%
1980 Fed tightening (Volcker) 2.52 million 1.10%
1982 Double-dip recession 2.70 million 1.20%
1991 Early 1990s recession 2.00 million 0.80%
2001 Dotcom Bust 1.96 million 0.70%
2009 Great Recession 2.64 million 0.90%
2020 The Great Lockdown 22.03 million 6.70%

Table 1: Worst u.s. Job Losses on Record (Four Week Period).

The IMF reports also in page 4 the plethora of factors that interact together to create any economic forecast such as “the pathway of the pandemic, the progress in finding a vaccine and therapies, the intensity and efficacy of the containment efforts, confidence effects and volatile commodity prices”. On this point regarding commodity prices, the report came out before the extraordinary events that happened with Oil, namely WTI Oil prices, going negative for the first time due to lack of demand, excess production and lack of storage [7]. The IMF report was made with an average spot price per barrel of 35.20$ (average of Brent, Dubai Fateh and WTI).

This factor in the commodity prices, namely on oil, may be an early sign of higher demand decrease than projected or simply an issue related with physical closing of several futures contracts (Figure 2). Whatever this may be, it ’ s another moving target with a strong influence in the final outcome of any model. The IMF projections show the following picture [8]

health-policy-management-World-Economic

Figure 2) IMF Projections for Largest World Economic Outlook.

The IMF standpoint comes with a series of assumptions that are will be must be taken into consideration: “targeted fiscal, monetary and financial market measures for support and businesses”; actions of central banks to give liquidity to the markets supporting confidence and limiting the amplification of the shock; “ stimulus and liquidity facilities to reduce systemic stress can lift confidence and prevent an even deeper contraction in demand”.

In summary, the IMF is predicting a sharp decline in 2020 output, with a strong rebound in 2021. But many uncertainties, mainly in the virus behavior, will be the main ones to determine the final outcome.

In the same day this report came out, a study from the Harvard T.H. Chan School of Public Health came out, stating that “prolonged or intermittent social distancing may be necessary until 2022 ” and that “ longitudinal serological studies are urgently needed to determine the extent and duration of immunity for SARS-Cov-2”. And oil collapsed. Uncertainty is all around, and it has come to stay [9].

It Takes Two to Tango: How South Korea Refused to Dance with Covid-19

By the 28th of April, South Korea was in 81st place in number of deaths per million population with 209 deaths/million, 35th in number of cases with 10.738, and 52nd in number of tests per million habitants (Figure 3). South Korea highest number of cases in a single day was of only 909 positive cases on the 29th of March [10,11].

health-policy-management-contact-tracing

Figure 3) Testing, contact tracing and quarantining of Covid-19 in South Korea.

How can it be that a country so close to the epicenter of the pandemic – Wuhan in China with a high-density population, made it through the crisis, so far, without closing the economy, keeping things afloat, with a GDP decrease of only -1,2% in the IMF report for 2020, rebounding in 2021 with +3,4%?

Like many reports say, there is no magic bullet to attack this pandemic. The trick is not the “secret ingredient”, but the cocktail of measures South Korea toke to keep the pandemic at bay, as well as the speed of their implementation [12].

South Korea decided on a strategy: “ mapping the illness, maintaining transparency, convincing citizens to adhere to a set of rules and a policy of surveillance and – perhaps most significantly quickly testing people as it possibly could.”

In the paper by the UNDP Seoul Policy Centre for Knowledge Exchange through SDG Partnerships Social Distancing and the adherence of the population to the guidelines, the information given, and all other measures were of high relevance to succeed in this first wave of the pandemic.

The government allowed people to buy three discounted face masks per week under a public distribution system organized during March and stabilized during the month of April. Mask usage has been defended in many countries and articles in the last couple of months, and we will also reinforce this weapon’s power against the pandemic in this article [13].

But clearly the differentiating factor was the test, trace and contains strategy applied from the early stages of the epidemics.

The quickness with which South Korea attacked on the testing front was central from the beginning of the Covid-19 pandemic. Very quickly, five Korean companies were producing tests for detection of SARS-Cov2. Also, AI tolls played a critical role in helping on diagnosis, screening and controlling geographically the spread of the virus. But if testing was critical, tracing was also paramount to this this effort [14].

Tracing the contacts that positive Covid-19 tested patients (Figure 4) had, they tested, and with this containing the virus, was what made the strategy so successful: Test, trace and Contain [15].The following pictures are a simple example of why and how it works [16].

health-policy-management-health-systems

Figure 4) Alternative to prevent long term lockdown or overwhelmed health systems.

The tracing can be done by two ways: by asking each individual with whom they were, and put and army of “epidemics detectives” finding the contacts, or by using simple and available cell phone technology that warns anyone that has been in close range of an infected individual, ask that person to self-isolate and get tested, in a virtuous circle of containment of the virus.

This is, in the authors view, and in many papers and articles, tracing is the center piece of the strategy that South Korea implemented to fight Covid- 19: “The experience in Korea demonstrates the usefulness of an IT system in aggregating a wide range of both medical and nonmedical data in the process of containing the spread of a highly infectious disease. In doing so, the legal and technical infrastructure served as a crucial enabling factor.”

The same paper refers that not everything is perfect and bulletproof:

“At the same time, certain adverse effects were observed from the measures used. Further refinements are needed to better protect the privacy of infected individuals while not sacrificing the effectiveness of the measures taken.” We know that privacy issues are an issue to witch the Asian culture is more open to give in than in European or American cultural settings. And this is a debate that one can and must have: To which degree are we willing to be controlled, to give information about where we were, and to have the government control if we are keeping ourselves in quarantine? [17,18].

We can keep the “ detective ” approach, relying on people memories of where and with whom they have been, or we can try implementing opt-in Apps that allow you to choose to give this information in a centralized way. Both approaches are doing what is done automatically, but in a slower or information deficient way. Whatever the approach, quick testing, tracing and containment is critical, and the debate around privacy with any of the approaches related to tracing will always sparkle intense discussions.

One thing we can say: It takes two to tango. And South Korea is an example of how to refuse to dance with Covid-19.

The Role of the Public Health Response

There is clearly an ongoing discussion on the different approaches that can be implemented as the need to restart some activities becomes pressing. There is no definite procedure for this restart, as we lack previous experience. But both the WHO and ECDC have set some goals and measures to assess what needs to be put in place in order to go ahead [19,20].

We need to ensure transmission is controlled, while at the same time, we have robust Information Systems that enable us to monitor and control in real time the pandemic. We need to put in place health system capacities in order to detect, test, isolate and treat every case and trace every contact, as quickly as possible. Particularly as contact tracing concerns, we need to implement technological solutions that involve citizens as much as possible, while at the same time we have enough human resources and rapid response teams to follow up on existing and new epidemiological clusters that may appear.

Special measures need to be considered to address the most vulnerable in special settings, namely in healthcare facilities and nursing homes. All organizations need to adjust and adapt to this new normal making sure that preventive measures are in place all across the board: in workplaces, schools, community gathering centers and other places where it ’ s essential for people to go on a regular basis

And finally, the role of the community is essential. Individuals need to be “fully educated, engaged and empowered to adjust “, taking safe and healthy choices. One of these choices is clearly the use of community masks, like discussed in the example of South Korea in this article. Though evidence is not robust, several articles point into that direction, and the examples of several countries in adopting widespread use of masks have paved the way for other to implement it. But in order to enforce the use of this, we need masks to be available, ensuring quality, quantity and affordability at all times during this period [21,22].

Multiplex Testing: a Must Have for Fall and Controlling a Second Wave

We are living in the context of global pandemic, that until today, generated more than 3.5 million infected, 245 thousand deaths, representing a fatality rate of close to 7%. There were some countries, such as Sweden and the United Kingdom that initially adopted a strategy of trying creating group immunity – known has “herd” immunity - strategy that in different ways shapes and forms both countries had to abandon. Herd immunity without a vaccine is by definition not a preventative measure [23,24]

Therefore, and in the absence of a vaccine or effective therapy, nonpharmacological therapeutic measures for epidemiological control of the pandemic are of paramount importance, as well as individual protection measures to prevent contagion, rapid diagnosis, monitoring of high-risk contacts, isolation measures, effective hospital and “ at home” clinical surveillance. Therefore, there is no specific therapy for the virus, nor drugs that can contain the spread, there are only therapeutic strategies that are believed to potentially optimize the outcome [25-27].

In medicine everything starts with the patient's complaints, listening and understanding their list of symptoms. The doctor can, by physical examination, find some signs that suggest a diagnosis, but always requests auxiliary tests to make, or confirm, the diagnosis. In SAR- CoV-2 infection, the diagnosis is essentially made by detecting the virus using an RT-PCR technique, which uses molecular biology protocols to amplify viral RNA and detect it. However, being the gold standard test to use in this pandemic, the sensitivity of the test is not the best, with the possibility of up to 20% false negatives [28,29].

Some authors suggest that the association of serological tests when the clinical suspicion is high, when the RT-PCR of the virus RNA was negative, may increase the sensitivity up to 98%. There are also some authors who suggest that the Chest CT has almost pathognomonic images of this viral infection [30,31].

What we would like to emphasize is that clinical complaints are not specific, with up to 80% of patients being asymptomatic. The diagnosis has its specificities, and the use of serological tests still lacks scientific support. There is still no effective therapy against the virus, or to prevent its spread. That is why preventive measures are the only ones proven to be effective in helping to contain the pandemic. Strategies between different countries have had greater or lesser success, with the intended communality of flattening the epidemiological curve of disease progression, as a way of allowing, on the one hand, to control contagion, and, on the other, allowing time for the health services to reshape their size and capabilities to create the proper response, namely by increasing the number of beds and ventilation support [32-36].

According to the legislation of each country, containment rules have been imposed, public events have been banned, most companies and services have been closed, but as of May, the majority will proceed to a global, yet gradual, reopening of the society and the economy, being sure that a rigorous epidemiological monitoring will direct the speed moving forward, or retrogression of this reopening if needed.

However, it is thought that if it not before, in the beginning of autumn there will be a new upsurge of the pandemic. It is not expected that there will be a vaccine before next year, it is not expected that effective anti-viral therapy will emerge, and usually at that time of the year, outbreaks of influenza arise. It is in this context that the possibility of this new pandemic peak arises, alongside with other respiratory syndromes [37].

There is no sufficiently substantiated scientific explanation to justify the usual seasonality of flu outbreaks. The flu season in the U.S. can begin as early as October, but usually does not get into full swing until December. The season generally reaches its peak in February and ends in March. In the southern hemisphere, however, where winter comes during our summer months, the flu season falls between June and September. In other words, wherever there is winter, there is flu [38].

In fact, even its name, “influenza” may be a reference to its original Italian name, “influenza di freddo”, meaning “influence of the cold” But the truth is that there is no scientific explanation for this seasonality. The principle of vertical transmission model as a reasonable description of events is accepted. The usual pattern is for a rise in the incidence of flu in children, which precedes an increase in the adult population. Presumably children are infected at school or kindergarten, bring the virus home and infect their siblings and parents. The parents then pass on the flu to their friends and fellow workers, with a second generational leap upwards to the elderly. Nursing home epidemics are common, and that is where most of the serious complications and deaths due to flu occur [39-41].

Now, knowing that the SARS CoV-2 is highly contagious, it is foreseeable that the vertical transmission model that justifies / explains the seasonality of influenza outbreaks will also replicate with COVID-19 next autumn.

Due to this seasonality, there are diagnostic tests, which are usually called multiplex tests, which allow the differential diagnosis between rhinovirus, adenovirus, RSV, the various influenza and parainfluenza viruses, and some bacteria (Chlamydia, Mycoplasma and B. Pertussis). In influenza viruses, H1N1 is obviously distinguished, having been the one responsible for the last worldwide pandemic. It is imperative that the multiplex tests that will be available next autumn allow for the diagnosis of SARS-CoV-2.

Note that the symptoms of COVID-19 are in the early stages of the disease almost indistinguishable from a seasonal flu. If we have no tools that are easy and quick to use for differential diagnosis, between SARS-CoV-2 infection and other seasonal viruses, delay in diagnosis will necessarily have serious epidemiological consequences, overburdening the healthcare systems and their response capabilities to a potential confluence peak of the Flu season with SARS-CoV-2. There are some companies that already have it available, and it will be an essential tool to help contain this pandemic, while we wait for any vaccine or effective treatment solutions [42].

Economic Recovery and Reopening: A Lego Modular Approach to the Unknown

Arriving to this point, what can we say about the economic recovery? Will it be quick? Will it be slow? Will it come in waves? Will it take 2,3 or 4 years? No one knows. We know very little about the virus. We don’t when a Vaccine or efficient treatments will come. We are dependent on social distancing, containment policies and reopening monitoring and control approaches. Global and local policy and fiscal efforts will be key also be a key factor to the final scenario that will land in the real world.

We will focus our analysis to the virus behavior and the reopening approach, based on the assumption that we are looking at a scenario were full lockdown was implemented.

Many have said that the economic recovery comes in three possible “alphabet” letters:

A “V” shaped recovery: a quick come back to normal economic activity, that we related to an optimistic scenario on the virus behavior, An “U” shaped recovery: A large loss of GDP value, followed by a slow recovery with potential output loss, related to a moderate scenario in the Virus behavior, An “ L” shaped recovery: a growing loss in future GDP value and “infinite loss of future value”, a worst-case scenario for the virus behavior with no vaccine or treatment in sight [17].

For the virus behavior scenarios, we used 8 mitigation policies that have been commonly used across the globe fighting Covid-19. There are many more, but we used these for simplification purpose. Each of these policies is a “Lego” brick, and each one has a color, and different sizes to it, just like any Lego brick (Figure 5). Depending on the phase we are in, each type of measures (brick) can be used in different modulations (Brick size). The graphics used for economic output scenario came from the 14th of April BCG report – Page 20. The Virus behavior scenarios were designed by the authors. The bricks we used were:

Social Distancing measures, Social events closure, International travel Control, School closing, Workplace Closing, Closing or sharp reduction in public transports, Internal travel controls, Lockdown (that can be different across countries).

health-policy-management-analysis

Figure 5 “V” Recovery Scenario – Waking up quickly from a bad dream.

We start on this scenario with all 8 bricks implemented to their maximum extent, and after the first peak of the pandemic, the easing of measures starts. Seeing that the virus continues in a plateau (similar to what is happening in South Korea), measures an again reduced. We assume all measures stay in place, but with smaller bricks, meaning they are applied with more flexibility.

With the previewed peak in October and November of respiratory virus and Covid-19, we assume a rise in pandemic intensity in number of cases and intensive care needed support, with measures being revamped to higher levels, but without moving to any lockdown (Figure 6). We assume this, based on the change in behavior by individuals and quicker response by authorities to the measures [43].

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Figure 6 “U” Recovery Scenario – A bad dream repeated.

We start on this scenario with all 8 bricks implemented to their maximum extent, and after the first peak of the pandemic, the easing of measures starts, cutting lockdown. Seeing that the virus continues in a plateau, measures are again reduced. We assume all measures stay in place, but with smaller bricks, meaning they are applied with more flexibility.

A new peak erupts in end of May, with the reopening, needing to reinforce measures, to keep control of a small surge of the pandemic. The increase in containment measures can be smaller or bigger depending on the virus behavior. Seeing that the virus continues in a plateau, measures are again reduced. We assume all measures stay in place, but with smaller bricks, meaning they are applied with more flexibility.

With the previewed peak in October and November of respiratory virus and Covid-19, we assume a rise in pandemic intensity in number of cases and intensive care needed support, with measures being revamped to higher levels, but without moving to any lockdown. We assume this, based on the change in behavior by individuals and quicker response by authorities to the measures. With the end of the peak, we assume a return to a containment lower containment level, depending in each case on the severity of the peak and on the severity each measure taken.

This scenario may change with the development of treatments or vaccines for Covid19. We assume for this scenario the existence of a Vaccine in the 1st quarter of 2021 (Figure 7). Developed immunity response to the virus will also play a critical factor, and it’s not factored in.

health-policy-management-analysis

Figure 7 “L” Recovery Scenario – A nightmare we need to fight.

We start on this scenario with all 8 bricks implemented to their maximum extent, and after the first peak of the pandemic, the easing of measures starts, cutting lockdown. Seeing that the virus continues in a plateau, measures are again reduced. We assume all measures stay in place, but with smaller bricks, meaning they are applied with more flexibility.

A new peak erupts in end of May, with the reopening, needing to reinforce measures, to keep control of a small surge of the pandemic. The increase in containment measures can be smaller or bigger depending on the virus behavior. Seeing that the virus continues in a plateau, measures are again reduced. We assume all measures stay in place, but with smaller bricks, meaning they are applied with more flexibility [44].

With the previewed peak in October and November of respiratory virus and Covid-19, we assume a rise in pandemic intensity in number of cases and intensive care needed support, with measures being revamped to higher levels, including lockdown. The virus intensity overtakes the healthcare system capabilities and Intensive care capacity is not enough to sustain the conjunction of respiratory virus season and Covid-19, creating a new demand and supply shock in the middle of the recovery.

With the end of the peak, we assume a return to a lower containment level, depending in each case on the severity of the peak and on the severity each measure taken.

This scenario may change with the development of treatments or vaccines for Covid19. We assume for this scenario the existence of a Vaccine in the 1st quarter of 2021. Developed immunity response to the virus will also play a critical factor, and it’s not factored in.

In any given situation presented in this paper or in any other, there are 3 decisive factors determining the final outcome that we will be faced with:

The virus behavior, the individual behaviors, towards their own protection and the protection of those around them, the government response: trough the implementation on non-pharmacological interventions and trough the capacitation of the healthcare sector to test, to trace, to contain, but also to fight with hospital capacity reinforcement, namely in beds and ventilation capacity.

Societal Perspective

A brave new world

To start writing the conclusions of this article, I believe I could not find a more appropriate sentence than this one by Daniel Bornstein: “The greatest enemy of knowledge, is not ignorance, it is the illusion of knowledge” [45].

SARS-Cov-2 is the new kid on the block. He just arrived. And every day we know more about it. But every day, we must understand, that the more we get to know it, the more we need to discover the dimension of our ignorance about SARS-Cov-2. Covid-19 will shape our future in the years to come in a way we will learn to grasp only by living one day at a time, trying relentlessly to know a little bit more today, than we knew the day before. Assuming we are ignorant about it, and fighting to get the facts, that may give us the knowledge to fight it, and eventually, eradicate SARS-Cov-2.

Firstly, from an economic perspective, the economic recovery path will be mainly determined by the virus. The existence of intermediate waves, alongside with the intensity of the flu season peak, will determine which letter of the Alphabet will the recovery look like. The impacts of this crisis will be, from our perspective, devastating for the world economy. Countries will shut down into protectionist measures, global unemployment will rise, and several sectors will face serious service and liquidity issues.

In our view, with recent developments, the IMF perspectives for the World Economy, and other documents, show strong signs of decrease in GDP for 2020 with a strong rebound in 2021. Several factors can make this scenario even worse: stronger virus waves, commodities prices volatility, and political instability.

Secondly, to reduce the economic impact of SARS-Cov_2, Governments and institutions must do their jobs. First, by reinforcing the healthcare sector, taking advantage of public, private and social operators capabilities, to prepare the system for new waves. Secondly by giving liquidity to the markets and providing the appropriate targeted measures, with a “no regret” approach (3). Thirdly, by looking at this challenge, as a cooperation challenge, were no one gets left behind, were no country gets left behind. The economic challenge of this crisis is only one: to reestablish confidence, and for this we need to know more about SARS-Cov-2, every day.

Thirdly, from a public health angle, it’s all about test, trace and contain. On the tracing side, we believe that electronic tracing methodologies will be central in new waves to contain the virus, but major debates surrounding privacy issues will arise.

To which extent should we let go our privacy to help save more lives, more quickly? The authors clearly defend an intense and open debate to have in the months to come, were there is no right or wrong side, but were decisions will need to be made.

Also, to this point, the example of South Korea and other South Asian countries have taken the usage of face mask as a centerpiece of containment alongside with social distancing. Evidence grows everyday towards the usage of face masks, and the authors support a government supported scheme to deliver masks to each citizen.

Additionally, in the public health angle, to maximize the healthcare response and minimize a potential major peak in the Flu season this Fall, the introduction of multiplex testing will be a determining factor to allow clinicians to separate, as quickly as possible, SARS-Cov-2 patients, from influenza or other seasonal virus, enabling quicker isolation and treatment for those with Covid-19, and safer and more targeted approach to those suffering from another virus during that period.

As a final conclusion point, when analyzing reopening scenarios, we understand that our lack of knowledge should take us into prudent paths. Using the analogy with “Lego” bricks, we see each containment measure a Lego piece, which can have different sizes, meaning different intensities of implementation.

But again, the virus will dictate the rules. We believe that gradual and step by step approaches, like the ones being done in the US and Portugal, are the best ones to empirically test each measure we let go. These approaches allow to give small steps forwards, and when needed a small step back. These modular approaches, like Lego pieces, allow for economic agents to prepare for trigger points that show more opening measures, or more containment measures, enabling a more flexible and agile response from companies and individuals to the pandemic [46,47].

Conclusion

A model of reopening could resemble be the non-closure of South Korea during the pandemic. They never closed, ramped up testing, tracing and containment – using invasive electronic protocols – that give them, in almost all studies, a slower reduction of GDP in 2020 and a stronger recovery in 2021. Not everything about the South Korean model is perfect, but it worked, and we should take the best lessons possible from their experience.

In the end of the day, it ’ s up to us to make to turn this crisis into opportunity and make the best use of available technology to fight COVID- 19, but also to prepare to new pandemics or healthcare emergencies.

The authors strongly defend that all available information on COVID-19 should be shared as an open source to everyone around the world. Any information that can help us fight COVID-19 must be seen as a public good, and it should be readily available to everyone capable of making the best use of it to fight COVID-19 or to develop new weapons to fight it.

We have never been as connected as we are today. Any wisdom, knowledge and experience on Covid-19 must be shared quickly. Because someone, somewhere, with the right piece of information, can take the next step that can make the difference, to help us all.

This article shows, in our view, that we are all clearly walking into a brave new world.

In this brave new world, governments will see their power reinforced; the question is to which extent. In this brave new world, we will have to understand that cooperating is more important than being first. In this brave new world, strong multilateral coordination and cooperation will be paramount will be critical to create a stronger global recovery. In this brave new world, governments, institutions and corporations will have to think differently, to face potential new pandemics that given our level of interdependency and connection, must be a guiding policy factor going forward.

But one thing is certain: the world will be new, and we will have to be brave.

References

 

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