Social distancing in poor countries produces smaller benefits due to limited capacity to enforce guidelines: study

Yale University research suggests that most widely-cited model of COVID-19 transmission and mortality shows that world should expect fewer deaths in poor countries, and that social distancing policies in these countries produce smaller benefits.

Yale University professor of Economics Ahmed Mushfiq Mobarak (Bangladeshi economist) and lecturer Zachary Barnett-Howell Yale University came up with a research done at Yale Research Initiative on Innovation and Scale (Y-RISE).

As per the research, much of this result is based on differences in the age distribution across countries, because our present understanding is that COVID-19 mortality risk increases dramatically with age.

“If widespread social distancing must be pursued, then efforts must be made to get food, fuel, and cash into the hands of the people most at risk of hunger and deprivation. This is especially challenging in countries without well-developed social protection infrastructure.”

The study suggested it was important for governments, private and humanitarian sectors, mobile phone operators and technology companies to experiment with innovative solutions such as sending cash transfers via mobile phones.

Social distancing has become the primary policy prescription to combat COVID-19 pandemic, and has been widely adopted in Europe and North America.

To carry out the research, researchers combined country-specific economic estimates of the benefits of disease avoidance with an epidemiological model that projects the spread of COVID-19 to analyze whether the benefits of social distancing and suppression varies across rich and poor countries.

The study results are: populations in rich countries tend to skew older and COVID-19 mortality effects are therefore predicted to be much larger there than in poor countries, even after accounting for differences in health system capacity.

Social distancing measures are predicted to save a large number of lives in high-income countries, to the extent that practically any economic cost of distancing is worth bearing.

The economic value generated by equally effective social distancing policies is estimated to be 240 times larger for the United States, or 70 times larger for Germany, compared to the value created in Pakistan or Nigeria.

The value of benefits estimated for each country translates to a savings of 59% of US GDP, 85% of German GDP, but only 14% of Bangladesh’s GDP or 19% of India’s.

The much lower estimated benefits of social distancing and social suppression in low-income countries are driven by three critical factors  including developing countries have smaller proportions of elderly people to save via social distancing compared to low-fertility rich nations and social distancing saves lives in rich countries by flattening the curve of infections, to reduce pressure on health systems.

Delaying infections is not as useful in countries where the limited number of hospital beds and ventilators are already overwhelmed and not accessible to most while social distancing lowers disease risk by limiting people’s economic opportunities.

“Poorer people are naturally less willing to make those economic sacrifices and they place relatively greater value on their livelihood concerns compared to concerns about contracting coronavirus.”

Poorer countries also have limited capacity to enforce distancing guidelines, and lock-downs may have counterproductive effects if it forces informal sector workers and migrants to reverse-migrate from densely-populated urban areas and spread the disease to remote rural areas of poor countries.

The study said it is very important that the source code for influential epidemiological models (on which the widely-adopted social distancing guidelines are based) are made publicly accessible, so that social scientists can explore the sensitivity of benefit estimates to changes in assumptions about compliance with distancing guidelines or the baseline prevalence of co-morbidities, chronic illnesses or malnutrition that make COVID-19 infections more deadly with following guidelines:

•        Masks and home-made face coverings are comparatively cheap.

•        A universal mask wearing requirement when workers leave their homes is likely feasible for almost all countries to implement.

•        Targeted social isolation of the elderly and other at-risk groups, while permitting productive individuals with lower risk profiles to continue working.

•        Given the prevalence of multi-generational households, this would likely require us to rely on families to make decisions to protect vulnerable members within each household.

•        Improving access to clean water, hand-washing and sanitation, and other policies to decrease the viral load.

•        Widespread social influence and information campaigns to encourage behaviors that slow the spread of disease, but do not undermine economic livelihoods.

•        This could include restrictions on the size of religious and social congregations, or programs to encourage community and religious leaders to endorse safer behaviors and communicate them clearly.