We can’t go on reopening and closing economies forever (10 steps for permanently keeping economies open)
The virus will be with us for some time until a commercially mass-produced vaccine is available. This will take months if not years. In the meantime, we have to live with and adapt to the coronavirus. We have to put in place mitigations that will allow us to go about our lives with a near-normal functioning of our societies and economies.
Life and freedom, as we know it, will be different. But there will be opportunities presented that we can, in faith, take for us to succeed and thrive.
The lockdown strategies — elimination or suppression
New Zealand (and Taiwan) has adopted an elimination strategy with a nine-week ‘full-on’ lockdown. In terms of public health outcomes, we know that the elimination of community transmission is achievable in island jurisdictions. These countries have no reported community transmission for over two months as of 10 July 2020.
The advantage of elimination is that despite international border closures or strict quarantine, citizens can go about their lives with a near-normal functioning of their society and economy.
Transmission is difficult to control. People are most infectious before they show any symptoms. They may transmit the coronavirus even if they are asymptomatic. The spread of the coronavirus is hard to detect and control.
By the time a person is tested positive and overworked contact tracers have identified and isolated their contacts, they may have already infected several people, who in turn may have infected others.
The elimination strategy is, therefore, a far better option than the suppression strategy in the short- to medium-term.
Unfortunately, the majority of jurisdictions and countries have adopted the suppression strategy with varying degree of success. There is a high likelihood of recurrent outbreaks precipitating and lock-downs related to the suppression strategy.
This can cause prolong but significant social and economic disruption. Their citizens have experienced isolation fatigue due to recurrent outbreaks precipitating and lock-downs. That has lead to complacency post-isolation.
We have witnessed economies and boarders reopening but closing again due to higher rates of infections. With greater freedom of movement and gatherings, there will always be a higher potential to spread the coronavirus to more people.
With no end in sight, this prolonged recurrent outbreaks precipitating and lock-downs are detrimental for everyone. It impacts peoples’ livelihood and their mental health. Businesses will open and close leading to increased closures. People will regain and lose their jobs leading to increased unemployment.
Economic growth goes south. Public debt goes north.
Challenges for governments
Governments have to deal with three key challenges, as shown below.
There is a delicate balancing act between the public health crisis and economic crisis.
When the suppression strategy has been unsuccessfully used to mitigate the public health crisis, it is time to focus on an economic strategy to reopen the economy and restart businesses to bring life back to near normality.
By continuously suppressing the rates of transmission through reduced economic and social activities through the suppression strategy, governments are also significantly increasing and prolonging their economic and public debt risks. The trade-offs are enormous.
The unintended economic consequences of any failed public health response are huge and severe, as shown in the figure below.
Note that seven of the top ten global risks are economic. The economic impact of coronavirus can be severe, if not managed appropriately.
As a doctor in Melbourne wrote, “Suppression has failed because it underestimates this virus, it overestimates our ability to control it, and it fundamentally misunderstands human nature.” (my emphasis)
Don’t just focus on public health outcomes
Let us not forget the Maslow’s hierarchy of needs, as shown below.
Without economic and business activities that sustain or create jobs, people will not have the income to meet their physiological and other needs. Governments cannot afford to indefinitely provide financial safety nets for their citizens by incurring huge amounts of public debt!
The direct and indirect impact of prolonged suppression and isolation on people and economies are enormous.
Therefore, don’t just focus on public health outcomes. Bite the bullet with an elimination strategy. This will enable citizens can go about their lives with a near-normal functioning of their society and economy. There will be fewer deaths too.
At the core of our humanity is the desire for touch and intimacy. Many people just can’t go on for months without hugging someone. They may have slipped more than once in their social distancing.
What’s the strategy post-isolation?
I get it that we need government-imposed mandatory isolation to reduce community transmission of the coronavirus and to protect lives. The public health response takes precedence.
But for how long?
When the public health response has failed to suppress the transmission of coronavirus, what is next? What is the strategy post-isolation?
With a suppression strategy, the number of transmissions will increase post-mandatory lockdown. As the name says — the suppression strategy just suppresses the coronavirus for that time without eliminating it.
The coronavirus will always be in the community, lurking somewhere. It will become a common feature of our lives without it being eliminated with a solid elimination strategy.
Here are TEN actions steps to permanently reopen economies and mitigate public health risks until a commercially mass-produced vaccine is available.
(1) Provide strong and decisive leadership for strategy execution and change management
The elimination strategy is the preferred strategy even if the suppression strategy has not previously worked. It is never too late to bite the bullet!
As Albert Einstein once said, “Insanity is doing the same thing over and over again and expecting different results.”
Unfortunately, if a suppression strategy is more politically viable, then provide a clear roadmap for keeping economies continuously open regardless of the number of cases and deaths detected. These are the unintended consequences of the suppression strategy.
Future lock-downs, in whatever form, are no longer an option.
Tell us, the citizens, what we must do to be part of the solution, rather than the problem. Set clear targets and goals. Communicate them clearly, in different languages. Implement them ruthlessly regardless of the unintended consequences. Engage community leaders. Use crowdsourcing methods to spread community messages.
We know that the adoption of either the elimination or suppression strategy is a large scale change management program that has to be executed well.
Stakeholder engagement must also be world-class, without a doubt.
Unfortunately, we already know that many change efforts have failed in organisations. The failure rates will be much higher if done at a larger scale, i.e., country-wide.
Failure begins with the leadership’s inability to make a believable case of why change is necessary and beneficial. The lack of clear focus and direction is one of the fundamental reasons why organisational change initiatives fail.
We also know that 70 per cent of organisational change programs failed to achieve their goals. This is largely due to employee resistance and lack of management support. (McKinsey, 2015)
For any strategy to work, governments must work hard to overcome resistance to change. They must provide the necessary support for new behaviours to stick. Collaboration with other key stakeholders will be vital and necessary.
(2) Forming lasting habits and behaviours that will keep us safe
Hand-washing and good hygiene can help to protect our families from coronavirus and prevent its spread.
Charles Duhigg, a New York Times journalist and the author of The Power of Habit, found that a habit is not simply a behaviour. Rather, it is a three-part system called the habit loop. It consists of a trigger (the situation that sets it off); the behaviour; and the reward (why your brain says: next time, do this again.)
For a job seeker who has lost his job due to coronavirus, the trigger could be unemployment and no income. The behaviour is to find a part-time job, to physically distance himself when he is out in public spaces, and to maintain good hand and personal hygiene. The reward is income to survive and not get sick with the virus. This will enable him to continue working and earning an income.
Community messaging can adopt this habit loop. We need to use all tools in our arsenal to fight this war against coronavirus.
Other good habits and behaviours to cultivate that will minimise the risk of contracting the coronavirus include:
- Knowing how the virus spreads. There is currently no vaccine to prevent this coronavirus. The best way to prevent illness is to avoid being exposed to coronavirus. The coronavirus is thought to spread mainly from person-to-person: (1) between people who are in close contact with one another; or (2) through respiratory droplets produced when an infected person coughs, sneezes or talks. These droplets may linger in the air for long periods, especially in close internal or small spaces.
- Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, toilets, or after blowing your nose, coughing, or sneezing. If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Hand-washing is one of the simplest and best ways of preventing the spread of illness including the spread of coronavirus.
- Avoid touching your eyes, nose and mouth with unwashed or unsanitised hands. Our eyes, nose and mouth are also key gateways for bacteria and viruses to enter our bodies. Many people, unfortunately, do unconsciously touch their face with their hands regularly during the day, which is a major source of infection without proper hand hygiene. While masks don’t necessarily stop the virus completely, they make it harder to unconsciously touch our nose and mouth.
- Socially distance and avoid close physical contact with anyone, whether inside or outside your home — physical distancing. Yes, even inside your home. Maintain at least 1.5 meters or six feet between persons especially if you know they are sick or have symptoms. Note that people without symptoms can also spread the virus. Assume that everyone is a carrier, at least for now.
- Use a face mask to cover your mouth and nose when around others especially in public settings or when other social distancing measures are difficult to maintain. You could spread the coronavirus to others even if you do not feel sick or are healthy. The mask is also meant to protect other people in case you are infected or unknowingly carrying the coronavirus. However, face masks are not a substitute for physical distancing, which is the best mitigation strategy.
- Always cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow. Throw used tissues immediately in the trash. Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not readily available, clean your hands with a hand sanitizer that contains at least 60% alcohol.
- Clean and disinfect frequently touched surfaces daily or regularly. This includes tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks.
- Monitor your health daily. Be alert for symptoms. Watch for fever, cough, shortness of breath, or other symptoms of the virus. Regularly take your temperature if symptoms develop.
- Get tested if you feel unwell with any symptoms. Stay home until you get your coronavirus test result. Without regular testing, outbreaks can easily fester and spread out of control before a symptomatic person is ever identified. But there’s no guarantee that even the most rigorous testing strategies will prevent outbreaks.
- Stay home if unwell especially when you have any fever, chills, cough, sore throat, shortness of breath, runny nose, and loss of sense of smell or taste. Don’t go to work or visit friends and family.
The presence of coronavirus is an opportunity for everyone to increase their level of personal hygiene.
(3) Don’t go to work (or to public spaces) if you are unwell or have any symptoms
There is no place worse than an office environment (or public spaces) for containing virus (including coronavirus) and germs. There’s little air circulation. In most cases, outside windows can’t be opened.
Here are some alarming stats:
- 90% of employees in the US admit that they have gone to work when sick.
- 96.5% of non-healthcare workers Australia and 99.2% of healthcare workers said they went to work with minor flu symptoms.
- 70% of workers in the UK still go to work even when they are ill.
- More than 20% of workers in Singapore continued to work or carried on with their daily routine despite being sick.
The bottom line is that unwell workers do come to work rather than staying at home!
A culture of trust must, therefore, exist between employers and employees to encourage workers to take medical leave instead of reporting to work sick. Infected workers can easily transmit the coronavirus to other people like customers and colleagues.
Governments can provide some form financial assistance to people who have to quarantine themselves because they are infected (or tested positive), or have to self-isolate because they have been in close contact with an infected person.
Everyone is responsible for keeping the community safe. People have to cooperate to minimise or eliminate the transmission of coronavirus. This messaging should be clear.
(4) Enforce social responsibility to reduce public complacency
Everyone must do their part to act responsibly to slow the spread of coronavirus and to minimise its damaging effects.
Unfortunately, socially irresponsible behaviours have been experienced and witnessed. They pose a significant risk to everyone.
- In Singapore, one in five confirmed coronavirus patients went out despite being unwell.
- Reckless and selfish behaviours have been witnessed around the world — Florida, UK, Hong Kong and Sydney.
There’s a delicate balance between collective and individual responsibility.
Decisive collective rules and interventions may be faster and more reliable solution than the soft nudging of individuals to make the right choice.
As New York Times commentator Charlie Warzel observed, one reason the coronavirus advice has been framed as a matter of personal choice and responsibility was to avoid the costs and duties of political and collective intervention. This is where governments, corporations and other institutions must accept their share of responsibility too, even when this requires taking unpopular and costly measures.
Lockdowns and measures will not work if individuals do not cooperate with governments and continue to engage in socially irresponsible behaviours.
While many people do follow the advice, those who did not were enough to cause alarm across communities.
(5) Strengthen contact tracing and identifying and isolating potentially infectious people
Contact tracing is a process used to understand how coronavirus is spreading in a community. It has two purposes: (1) to figure out who a sick person caught an illness from, and (2) to find out who they’ve been in contact with while infectious.
The Contact Tracing Workforce Estimator (CT Estimator) uses a baseline of 15 contact tracers per 100,000 population. But the ratio varies, as shown in the table below. Interestingly, New Zealand, the country that adopted the elimination strategy, has the lowest ratio.
Ideally, interview positive cases (and their close contacts) within 24 hours of notification of their testing results. Placed them in isolation.
Maximise the usage of smartphones and digital adjuncts for initial
contact tracing. Monitor the adequacy of isolation via text message follow-up and GPS monitoring.
By its very nature contact tracing becomes less effective the bigger the outbreak. The job can be impossible and perhaps irrelevant as Britain and other nations found when they abandoned the process altogether.
Rather than abandoning one of the most powerful tools to stop the coronavirus, perhaps prioritise investigators’ efforts to areas where it can make a bigger difference using risk-based approaches.
(6) Use crowd density mobile applications
There are existing mobile technologies available to provide information about crowd density. Such mobile applications can tell us whether there are too many people in a particular location.
When this occurs, people should be avoiding these crowded locations. This will enhance our ability to physically distance from other people thus reducing the risk of contracting coronavirus.
Hot spot mapping via mobile signals can be used to piece together, in real-time, the movement individuals in order to send out public health warnings about particular locations where physical distancing could be breached.
It can also track individuals who have been tested positive where they should be quarantined for at least 14 days.
(7) Installing more sophisticated air filters in buildings
People won’t feel safe returning to schools, offices, bars and restaurants unless they can be assured they won’t be infected by coronavirus particles lingering in the air or being pumped through the buildings’ air ducts.
Installing more sophisticated air filters, drawing more fresh air into buildings and cranking up the humidity that kills coronavirus are some possible mitigations.
Research from the University of Oregon, in partnership with the University of California-Davis, suggests that heating, ventilation and air-conditioning systems could be contributing to the spread of coronavirus. The virus thrives indoors in both heated and cooled environments if the humidity is below 40%.
Prodded by more than 200 scientists, the World Health Organization acknowledged the emerging evidence of airborne transmission in crowded or poorly ventilated settings.
This is where environmental testing could provide early warnings of a potential outbreak of coronavirus.
(8) Overseas travellers must still undergo their 14-day quarantine
Travellers arriving from any country are to undergo enhanced health screening on arrival. All arrivals will be strictly quarantined for at least 14 days at their own cost, even if they don’t normally live there or plan to travel elsewhere.
Further travel restrictions may also apply to limit any potential outbreak.
(9) Mandate remote working, learning and meeting (stay-at-home and mobility restriction measures)
Governments should encourage, or perhaps even mandate, the use of remote working, learning and meetings as much as possible to reduce the likelihood of coronavirus transmission through physical or face-to-face contact.
For people who are worried about contracting coronavirus, no one will be compelled to be face to face.
This is where organisations can assist governments by implementing these mandates in their workplaces. They can do their part in fighting the coronavirus war with governments by extending their work-from-home guidance through the end of the year or beyond.
(10) Eliminate coronavirus misinformation and conspiracy theories
Conspiracy theories, misinformation, fake news, misleading claims, myths, and coronavirus speculation have flooded social media.
Coronavirus uncertainties have created a perfect breeding ground for conspiracy theories. This has resulted in more than 68,000 website domains that have been registered this year with keywords associated with the coronavirus.
In particular, the anti-vaccine movement could undermine efforts to end coronavirus pandemic. While the opposition to vaccines can be small, it can be far-reaching and growing. This is where proper and adequate messaging and public relations around coronavirus vaccines and their benefits must be carefully thought out and implemented.
When trust in governments are already at an all-time low, policymakers and government leaders must do much more to regain public trust and to proactively eliminate coronavirus misinformation, fake news and conspiracy theories.
Public-health authorities don’t inspire confidence when they keep changing their advice from week to week!
Opportunities for reforms
The coronavirus crisis can be turned into an important opportunity for both government and corporate reforms to be implemented swiftly. Hit the iron while it is hot!
Policymakers and corporate executives can demonstrate their leadership, courage and guts to promote and implement the required reforms. These transformations can enable fundamental progress for economies, communities and public health.
The reimagined economies can provide far-reaching opportunities for everyone to succeed and thrive in a new world, post-coronavirus.
As economies begin to re-open, unemployment is projected to fall gradually but remain above or close to its peak level during the global financial crisis until well into 2021. This reflects the scale of immediate job losses in some countries, and the likely declines in employment in others as temporary wage and employment support schemes end in the second half of 2020. In the double-hit scenario, unemployment remains high for even longer in OECD economies, raising the risk of hysteresis as long-term unemployment becomes entrenched and labour force participation falls as workers get discouraged. (OECD, 2020)
As jobs recovery is not expected until after 2021, many people will require government support to survive ad participate in the labour force.
The focus must, therefore, be on pushing economies back to its full potential and cushioning those most directly harmed by the downturn.
We have to be prepared for the fact that — much as individuals are changed by extended periods of isolation or fear — the economy will not go back to exactly what it was before.
Articles of interest
How organisations can survive COVID-19