Residents wearing face masks practice social distancing as they wait in a queue for free rice, amid Vietnam’s nationwide social isolation effort as a preventive measure against the spread of the Covid-19 coronavirus, in Hanoi on April 11, 2020. (Photo: Manan Vatsyayana, AFP)

Poor Countries and Covid-19: Flattening the Misery Curve

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Countries have gone all out to flatten the infection curve of Covid-19. But given the economic costs inflicted on the vulnerable poor, it might be time to think about flattening the misery curve.

Countries, states and regions with the highest reported Covid-19 infection and mortality rates have severely restricted movement through lockdowns to try and flatten the infection curve. The overall goal is to slow the spread of the virus so that healthcare systems can cope with the increase. While this is being done, another curve measuring the costs and misery associated with curtailment measures has been rising and is approaching worrying levels in poor countries. After a prolonged period of lockdown, the time to rethink the balance between the two curves may have arrived.

The fact that lockdowns can work is evidenced by the Wuhan experience, where curbs were recently lifted after infection rates reportedly diminished. They are not necessary for controlling the spread however, as the experience of Hong Kong or Taiwan demonstrates. But countries with low reported infection and mortality rates are also implementing lockdowns or increasingly draconian measures. For instance, Thailand, India and the Philippines recently extended their lockdowns into a second month. As of April 17, Thailand reported 47 deaths from Covid-19, with India and the Philippines around 400. These numbers do not suggest rampant community transmission. Why then are these and other countries with similar rates extending such draconian and costly measures?

It may be that governments do not trust the data, with limited testing revealing only the tip of the iceberg. Prevention is also better than cure, especially when one does not exist, and healthcare systems are weak. Therefore, incomplete information leads governments to err on the side of caution. Some governments that underestimated initial risks may also be over-reacting to try and catch-up or compensate, especially when lives are at stake.

Whatever the reason, these measures are exacting a huge toll in economic and social terms. Are these extreme measures justified?

Answering this question requires accurately evaluating benefits and costs of the lockdown. The main benefit would be the slowing or halting of the spread, and it may be too early to tell. Because the incubation period is between 2-14 days, what is reported today may reflect conditions in the past. Furthermore, even if reported infection rates are rising, as they have been in most lockdown countries, this could simply reflect increased testing. Or the lockdown may have limited the increase, but it is impossible to tell by how much given that the counterfactual is unknown. These factors complicate the measurement of the positive impacts of the curtailment measures.

The costs are less difficult to estimate. There are countless estimates of impacts on economic growth, household incomes and poverty, and every scenario points to massive negative impacts.

Although we may not be able to determine the outcome of the cost-benefit exercise definitively, decisions need to be made about the future course of action.

While we try to flatten the infection curve through lockdowns, another curve is rising sharply as a direct consequence. This is the misery curve, which measures the economic and social costs as a result of curtailment measures that result in all kinds of loss, from incomes to livelihoods to lives. This curve rises with the severity and length of curtailment measures, and declines with compensation through safety net measures.

While the debate in developed nations on when to open up may be regarded as putting the economy over saving lives, in poor countries undergoing prolonged lockdowns, the question is how to save the economy to preserve livelihoods – and lives.

Poverty raises not only the susceptibility to infection, it magnifies the misery from lockdowns. For instance, curfews will affect the urban poor who need to beg or scavenge for a living more than others, including the rural poor. With lockdowns already in their second month in some countries, the risk of the urban poor dying from hunger or hunger-related illness could already exceed that of dying from the virus.

Without comprehensive testing in these countries, it is impossible to tell if the infection is under control to safely lift the lockdown. But there could be specific measures that could be relaxed which would reduce misery without compromising the objectives of the lockdown. Consider Manila, where all transport except private vehicles is restricted. This disadvantages the poor not just by restricting their mobility and access to essential services, but also by removing livelihoods. During a lockdown, social distancing is possible on public transport because congestion is unlikely. This restriction on public transport punishes the poor without adequate compensating benefit.

There could be others like it but we need to look harder, and be prepared to take calculated risks, like Vietnam just did. Vietnam reported 268 infections as of 17 April and no deaths, so extended its lockdown to only 12 high-risk locations for up to the maximum incubation period of two weeks. This time-bound focus on hot-spots aims to balance health and economic concerns. A similar approach has been proposed by some epidemiologists, with rolling lockdowns or cycles of “suppress and lift” policy around the incubation period to keep both the pandemic and social costs manageable.

If poor countries had initially erred on the side of caution, the time has come for them to err on the side of reducing misery. Many have endured lockdowns for several cycles of the maximum incubation period, possibly reaching the maximum deprivation period too.

In countries unable to provide safety nets, the time to reconsider options that can keep both the infection and misery curves in check may have arrived. Focussing on either one at the expense of the other is bad policy in all countries, but rapidly becoming untenable in poor countries. While the debate in developed nations on when to open up may be regarded as putting the economy over saving lives, in poor countries undergoing prolonged lockdowns, the question is how to save the economy to preserve livelihoods – and lives.

2020/51