Social distancing has become the primary policy prescription for combating the COVID-19 pandemic, and has been widely adopted in Europe and North America. We combine 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. This modeling exercise yields the following key insights:
- 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:
(a) Developing countries have smaller proportions of elderly people to save via social distancing compared to low-fertility rich nations.
(b) 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.
(c) Social distancing lowers disease risk by limiting people’s economic opportunities. Poorer people are naturally less willing to make those economic sacrifices. They place relatively greater value on their livelihood concerns compared to concerns about contracting coronavirus.
Not only are the epidemiological and economic benefits of social distancing much smaller in poorer countries, such policies may also exact a heavy toll on the poorest and most vulnerable. Workers in the informal sector lack the resources and social protections to isolate themselves from others and sacrifice economic opportunities until the virus passes. By limiting their ability to earn a living, social distancing can lead to an increase in hunger, deprivation, and related mortality and morbidity in poor countries. Flattening the epidemiological curve of COVID-19 to buy time until a vaccine can be developed may not be very useful for poor countries if the timeline for vaccine development is too long for social distancing to be maintained.
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. It is imperative 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. Not accounting for co-morbidities, or the greater pollution in poorer countries is an important limitation of these projections. Publicizing code would also allow the research community to quantitatively explore the costs and benefits of alternative harm-reduction measures that better allow poor people to sustain themselves economically while reducing COVID-19 related mortality to the greatest possible extent:
- 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.