It is, indeed, possible to reconcile two conflicting desires: curbing the spread of COVID-19 while still keeping the economy open, according to an international team of researchers led by UCLA’s Akihiro Nishi.
Two strategies that haven’t received much attention in the U.S. — “dividing” and “balancing,” used together and followed closely — could reduce coronavirus transmission about as much as a strict lockdown while maintaining economic activity, said Nishi, an assistant professor of epidemiology at UCLA’s Fielding School of Public Health, along with researchers from London, Hong Kong, Ireland, UC Berkeley and UC Irvine, in research published in the Proceedings of the National Academy of Sciences.
“People are right now living in a dichotomy, thinking we either open or close the economy,” Nishi said. “We are shedding light on an alternative approach, and there may be other creative ways to sustain the economy and at the same time reduce the number of new infections.”
The balancing act requires some sacrifice, however, and the researchers note that “people in the real world may not be very consistent or rational.”
Time and space
The researchers ran sophisticated computer simulations using data based on tiny Sierra Madre, population 10,793, a suburb of Pasadena just 13 miles from downtown Los Angeles. They assumed that people engaged in group activities such as going to work and to the local grocery store.
Then they divided residents into discrete groups to limit the number of people interacting. That division can be done with time: One group could only go to the grocery store in the morning, for example, while the other group could only go in the afternoon. That division can also be done with space: One group could shop at the grocery store’s temporary outdoor setup in the parking lot, while the other shops inside the grocery store as usual.
Then they made sure that there was balance — i.e., that each grocery store had about the same number of customers, rather than one having a crush while another not far away had empty aisles.
The simulation showed that the two approaches, done together, could effectively bring the spread under control, with each sick person infecting just one other person. Throw in some of the current tools in the tool bag — wearing masks, physical distancing, self-isolating — and transmission would fall below 1 to 1.
“If the economy is reopened while people remain divided into subgroups, a lower number of new cases will arise compared to an undivided population, and new peaks may be avoided,” the researchers said.
Versions of this approach have been embraced in South Korea and Japan, where COVID-19 mortality is dramatically lower than in the United States: 0.96 deaths per 100,000 residents in South Korea, 1.49 in Japan, and 76.01 in the U.S., according to data gathered by Johns Hopkins University.
In some schools in those countries, for example, classes have been broken into smaller groups that attend at different times or on different days. That limits interactions, which limits spread.
“(I)n addition to sustaining the economy, there are several advantages to the proposed strategies,” the researchers write. “First, we anticipate several spillover effects that will result in benefits for populations where these strategies are implemented.”
The “dividing groups” strategy requires more manpower — one staff for the outdoor grocery store and another for the indoor one, for example — meaning they “may also function as an economic stimulus and lower the unemployment rate (e.g., part-time jobs become full-time jobs and new jobs are created to account for the need for multiple sets of staff),” they wrote.
Dividing by time — such as breaking work days into separate morning and afternoon shifts — also could ease rush-hour traffic and increase sustainability in major cities.
They’d clearly be more expensive, but could be paid for through government stimulus programs.
In the real world
Real people, though, tend to be more unpredictable than computer simulations.
“One of the critical considerations for implementing either of these network intervention strategies is the acceptability by the public,” they write. “The demonstrated strategies will be emotionally taxing because they require individuals to drastically alter their daily routines. Individuals may no longer be allowed to go to certain places at certain times; the balancing groups strategy may determine whether businesses are open or closed for particular individuals, while the dividing groups strategy may place time constraints on when businesses are available for particular individuals.
“However, compliance … may be higher than compliance with lockdown strategies, as they do not completely prohibit visiting specific types of businesses or utilizing certain services (as lockdowns do). Neither the dividing strategy nor the balancing strategy requires people to stay home all day, potentially preventing the development of ‘quarantine fatigue’.”
Historically, people in the U.S. and elsewhere have accepted restrictions on individual freedoms in the face of an economic or social crisis, they write. In the 1973 oil crisis, when gasoline was scarce, people accepted rationing strategies, and with a good public education campaign, could do so again.
There may be two vaccines on the near horizon, but life will remain in pandemic mode for many, many months to come, Nishi said.
“This type of behavior approach could be helpful now, and can also be used to prepare for the next pandemic,” he said. “We can use empty space and empty time more effectively.”
The work was supported by the UCLA Fielding School of Public Health High-Impact Data Initiative, the Nakajima Foundation, the Alan Turing Institute, the National Institute on Drug Abuse, the National Institute of Mental Health, the National Institute of Allergy and Infectious Diseases, the National Center for Complementary and Alternative Medicine and the Science Foundation Ireland.
Source: Orange County Register