Down or Out? Mobility and the management of epidemics

Jennifer Holdaway

Since Xiang Biao invited us to an online roundtable on Mobility and COVID-19, the virus has taken hold in Europe and the different approaches taken by various governments here and countries worldwide have provoked heated debate. These include the wisdom and effectiveness of restrictions on international travel and other limitations on mobility, the most radical of which involve the locking down of whole populations.

Since the conditions that encourage the leap of viruses from animals to humans are unlikely to change soon, even if we get a grip on this virus in the next few months, we can expect other, possibly more lethal, zoonoses in the future. As researchers, we need to be thinking long term about how our work can support effective and ethical responses.

The demography of the epidemic and its implications

COVID-19 is challenging to manage because it is 1) very infectious and 2) has a high mortality rate, though 3) deaths are mostly among the elderly and those with compromised immune systems. Until recently, most governments have chosen to limit the mobility of the majority, who are unlikely to be very ill, in order to protect the health of a minority of people who might die in larger numbers. But the massive economic and social cost of the lock down approach means that many countries have delayed introducing it. At the same time, no government is willing to say (or not publicly) that it doesn’t think the lives of the vulnerable and elderly are not worth the cost of a lock down, and so they have explained the delay in other ways, including the need to ‘flatten the curve’ of infections in order to meet the needs for care. Yet it now seems, in the UK at least, that in the absence of widespread testing, tracking of cases, and the enforcing of social distancing at an earlier stage, the delay will actually result in a longer period of lock down and higher economic and social costs.

As part of this forum, I’d like to raise this question: what if we had approached the problem from the other direction and, given the particular demography of COVID-19, acted quickly to block or narrow the pathways for transmission to the vulnerable minority?

Evacuation and Rationing

If introduced early, it seems that evacuation programmes – which were operated in the two world wars to which this epidemic is often compared – are worth considering for the future. Could we get people out instead of locking them down?

Evacuating school age children, along with their teachers, to hotels in rural areas could have a number of benefits. Children could continue to study, get school meals and be with their friends, and their parents would not have to stay home from work to look after them. This would be especially important if the parents work in health or social care. Parents who work at home would be more productive and grandparents or other relatives with weak immunity would not be exposed to risk from children bringing the virus home from school. If government funded this, it would also be an in-kind subsidy for the hospitality industry and would maintain employment. A similar programme could be made available to elderly people and those with weak immune systems unable or unwilling to self-isolate at home, with most of the same benefits.

Being separated from family members is painful, but if people were mentally prepared for the possibility, it would be very different from introducing such a programme in emergency mode. I asked my 92-year old mother what she thought about evacuation, and she said she would be happy to go, as long the food was OK. Preferably somewhere by the sea… It would be better than being stuck at home alone. Video technology makes it easy for families to keep in touch and evacuating whole schools/elderly from the same neighbourhood would mean they remained part of a community and reduce loneliness. Meanwhile, working-age people could continue their lives with somewhat less anxiety and the economy would take less of a hit.

The other wartime strategy, to which it seems there are no downsides, is better preparation for rationing and distributing food and other essential supplies. While supermarkets appear to have been through simulation trainings to deal with this kind of event, they still did not have a unified response in place to deal with the panic buying and distribution problems that are occurring now, leaving some people unable to buy what they need, or able to get home deliveries.

Transparency and open debate

Of course, there should be public debate to see whether such programmes would be acceptable and how institutions and communities might engage in designing and implementing them. And evacuation is only one idea. More generally, this crisis points to the need for a wide-ranging debate about how to respond to such crises in future.

In deciding when and where to introduce restrictions on mobility, governments are weighing the health and economic costs of action and inaction and making judgments that have momentous and long-term consequences.

Yet many of these costs (for example, people who fail to get treatment for other illnesses due to pressure on the health service) are currently insufficiently specified and documented to provide good evidence for decision-making.

There is also a worrying lack of transparency. So far, the UK government has released only its modelling of the spread of the coronavirus, and not its models of the economic costs or the knock-on and indirect impacts on public health of its control measures. These models should also be published so that the public can understand and participate in the painful choices that have to be made, especially since these are new issues for which the recent election gave no mandate and on which few politicians have any expertise. As governments are self-protective, there should be a platform where competing analyses of these data (and their limitations), and different responsive measures can be presented and debated. If done well, this could help to generate innovative ideas for policy and community initiatives to manage such crises. At a minimum it would ensure greater accountability and learning.

Finer grained assessments of needs and impacts

Assessing the impact on different economic sectors and their workers is key to providing support quickly to those who need it most and preventing the collapse of businesses and hardship for workers. At the moment, occupations and types of worker are referred to in general terms (people on zero hours, hospitality workers etc). We need much finer grained economic geography (including mobility patterns) to understand the pathways epidemics are likely to follow, and the distribution of the costs of responsive policies across locations and populations. This analysis might also point to cases where the government could facilitate the movement of workers across occupations, meeting sudden demand and reducing the need for state support, for example restaurant workers going to work for supermarkets or delivery firms.

It may not be possible to introduce what many might see as radical interventions now, but we must have these discussions before we find ourselves in this situation again. As researchers we can help by building evidence that can support these future debates.

About the author: Jennifer Holdaway is a research fellow of IIAS and co-director of the Forum on Health, Environment and Development (FORHEAD), an interdisciplinary network that promotes integrated, collaborative approaches to understanding the implications of environmental and social change for public health.