nep-hea New Economics Papers
on Health Economics
Issue of 2020‒04‒27
forty-two papers chosen by
Nicolas R. Ziebarth
Cornell University

  1. Inequality in Socio-Emotional Skills: A Cross-Cohort Comparison By Attanasio, Orazio; Blundell, Richard; Conti, Gabriella; Mason, Giacomo
  2. The Costs of Payment Uncertainty in Healthcare Markets By Abe Dunn; Joshua D. Gottlieb; Adam Hale Shapiro; Pietro Tebaldi
  3. Mandated Sick Pay: Coverage, Utilization, and Welfare Effects By Maclean, J. Catherine; Pichler, Stefan; Ziebarth, Nicolas R.
  4. Effects of the Affordable Care Act Dependent Coverage Mandate on Health Insurance Coverage for Individuals in Same-Sex Couples By Carpenter, Christopher S.; Gonzales, Gilbert; McKay, Tara; Sansone, Dario
  5. Understanding the Mechanisms Linking College Education with Longevity By Hong, Kai; Savelyev, Peter A.; Tan, Kegon T.K.
  6. Access to The Emergency Contraceptive Pill Improves Women's Health: Evidence from Chile By Clarke, Damian; Salinas, Viviana
  7. Where are you? The problem of location during emergencies By Elena Lucchese
  8. Office Visits Preventing Emergency Room Visits: Evidence from the Flint Water Switch By Danagoulian, Shooshan; Grossman, Daniel; Slusky, David
  9. The Response to Dynamic Incentives in Insurance Contracts with a Deductible: Evidence from a Differences-in-Regression-Discontinuities Design By Klein, Tobias J.; Salm, Martin; Upadhyay, Suraj
  10. Long-term care partnerships: are they fit for purpose? By Bergquist, Savannah; Costa-Font, Joan; Swartz, Katherine
  11. Entry decisions and asymmetric competition between non-profit and for-profit homes in the long-term care market By Iris Grant; Iris Kesternich; Johannes Van Biesebroeck
  12. Is Precarious Employment Bad for Worker Health? The Case of Zero Hours Contracts in the UK By Farina, Egidio; Green, Colin P.; McVicar, Duncan
  13. Childhood Circumstances and Young Adulthood Outcomes: The Role of Mothers’ Financial Problems By Clark, Andrew E.; D'Ambrosio, Conchita; Barazzetta, Marta
  14. Quantiles of the Gain Distribution of an Early Childhood Intervention By Battistin, Erich; Lamarche, Carlos; Rettore, Enrico
  15. Mass media coverage and vaccination uptake: evidence from the demand for meningococcal vaccinations in Hungary By Anikó Bíró; Ágnes Szabó-Morvai
  16. The Long-Term Cognitive and Schooling Effects of Childhood Vaccinations in China By Oskorouchi, Hamid R.; Sousa-Poza, Alfonso; Bloom, David E.
  17. Cream Skimming by Health Care Providers and Inequality in Health Care Access: Evidence from a Randomized Field Experiment By Werbeck, Anna; Wübker, Ansgar; Ziebarth, Nicolas R.
  18. Intergenerational Ties and Case Fatality Rates: A Cross-Country Analysis By Bayer, Christian; Kuhn, Moritz
  19. Triage Protocol Design for Ventilator Rationing in a Pandemic: Integrating Multiple Ethical Values through Reserves By Parag A. Pathak; Tayfun Sönmez; M. Utku Unver; M. Bumin Yenmez
  20. Impacts of Social and Economic Factors on the Transmission of Coronavirus Disease 2019 (COVID-19) in China By Qiu, Yun; Chen, Xi; Shi, Wei
  21. Burnout Among Healthcare Providers During COVID-19 Pandemic: Challenges and Evidence-based Interventions By Sultana, Abida; Sharma, Rachit; Hossain, Md Mahbub; Bhattacharya, Sudip; Purohit, Neetu
  22. Optimal Mitigation Policies in a Pandemic: Social Distancing and Working from Home By Callum J. Jones; Thomas Philippon; Venky Venkateswaran
  23. Social Distancing and Supply Disruptions in a Pandemic By Martin Bodenstein; Giancarlo Corsetti; Luca Guerrieri
  24. The Use of Artificial Intelligence in Health Care: Liability Issues By Mélanie Bourassa Forcier; Lara Khoury; Nathalie Vézina
  25. Artificial Intelligence against COVID-19: An Early Review By Naudé, Wim
  26. Italian Workers at Risk During the Covid-19 Epidemic By Barbieri, Teresa; Basso, Gaetano; Scicchitano, Sergio
  27. Health versus Wealth: On the Distributional Effects of Controlling a Pandemic By Andrew Glover; Jonathan Heathcote; Dirk Krueger; Jose-Victor Rios-Rull
  28. COVID-19 and the health policy recession: whatever it takes, grandma or the economy or what makes sense? By François Vaillancourt
  29. Polarization and Public Health: Partisan Differences in Social Distancing during the Coronavirus Pandemic By Hunt Allcott; Levi Boxell; Jacob C. Conway; Matthew Gentzkow; Michael Thaler; David Y. Yang
  30. Demographic Determinants of Testing Incidence and COVID-19 Infections in New York City Neighborhoods By Borjas, George J.
  31. CoronaNet: A Dyadic Dataset of Government Responses to the COVID-19 Pandemic By Cheng, Cindy; Barcelo, Joan; Hartnett, Allison; Kubinec, Robert; Messerschmidt, Luca
  32. Group Testing against COVID-19 By Christian Gollier; Olivier Gossner
  33. Do Quarantine Experiences and Attitudes Towards COVID-19 Affect the Distribution of Psychological Outcomes in China? A Quantile Regression Analysis By Lu, Haiyang; Nie, Peng; Qian, Long
  34. COVID-19: R0 is lower where outbreak is larger By Pietro Battiston; Simona Gamba
  35. A Simple Planning Problem forCOVID-19 Lockdown By Fernando Alvarez; David Argente; Francesco Lippi
  36. What Happened to the US Economy During the 1918 Influenza Pandemic? A View Through High-Frequency Data By Francois R. Velde
  37. Sub-National Allocation of COVID-19 Tests: An Efficiency Criterion with an Application to Italian Regions By C. Baunez; Mickael Degoulet; Stéphane Luchini; Patrick Pintus; Miriam Teschl
  38. India’s COVID-19 Episode: Resilience, Response, Impact and Lessons By Ganguly, Dibyasree; Misra, Sheuli; Goli, Srinivas
  39. How Deadly Is COVID-19? Understanding The Difficulties With Estimation Of Its Fatality Rate By Andrew Atkeson
  40. COVID-19 in Africa: socioeconomic impact, policy response and opportunities By Ozili, Peterson K
  41. Urban nature as a source of resilience during social distancing amidst the coronavirus pandemic By Samuelsson, Karl; Barthel, Stephan; Colding, Johan; Macassa, Gloria; Giusti, Matteo
  42. A review of infectious disease surveillance to inform public health action against the novel coronavirus SARS-CoV-2 By Larsen, David; Dinero, Rachel E.; Asiago-Reddy, Elizabeth; Green, Hyatt; Lane, Sandra; Shaw, Andrea; Zeng, Teng; Kmush, Brittany

  1. By: Attanasio, Orazio (University College London); Blundell, Richard (University College London); Conti, Gabriella (University College London); Mason, Giacomo (University College London)
    Abstract: We examine changes in inequality in socio-emotional skills very early in life in two British cohorts born 30 years apart. We construct comparable scales using two validated instruments for the measurement of child behaviour and identify two dimensions of socio-emotional skills: 'internalising' and 'eternalising'. Using recent methodological advances in factor analysis, we establish comparability in the inequality of these early skills across cohorts, but not in their average level. We document for the first time that inequality in socio-emotional skills has increased across cohorts, especially for boys and at the bottom of the distribution. We also formally decompose the sources of the increase in inequality and find that compositional changes explain half of the rise in inequality in externalising skills. On the other hand, the increase in inequality in internalising skills seems entirely driven by changes in returns to background characteristics. Lastly, we document that socio-emotional skills measured at an earlier age than in most of the existing literature are significant predictors of health and health behaviours. Our results show the importance of formally testing comparability of measurements to study skills dierences across groups, and in general point to the role of inequalities in the early years for the accumulation of health and human capital across the life course.
    Keywords: inequality, socio-emotional skills, cohort studies, measurement invariance
    JEL: J13 J24 I14 I24 C38
    Date: 2020–04
  2. By: Abe Dunn; Joshua D. Gottlieb; Adam Hale Shapiro; Pietro Tebaldi
    Abstract: What does it cost healthcare providers to collect payment in the complex U.S. health insurance system? We study this question using rich data on repeated interactions between a large sample of physicians and many different payers, and investigate the consequences when these costs are high. Payment uncertainty is high and variable, with 19% of Medicaid visits not reimbursed after the first claim submission. In such cases, physicians either forgo substantial revenue or incur costs to collect payment. Using physician movers and practices that span state boundaries, we find that providers respond to these costs by refusing to accept Medicaid patients in states with more severe billing hurdles. This supply margin is even more responsive to these costs than to reimbursement rates. Using these supply estimates, we calculate that the costs of billing Medicaid consume one-quarter of the average revenue from a Medicaid visit. We estimate a model of the billing process, and find that the variable costs of billing each visit account for 21 percentage points of this total cost. Analyzing healthcare prices without accounting for billing costs and payment uncertainty may substantially misrepresent differences between private payers and Medicaid.
    Keywords: healthcare markets; Medicaid; healthcare insurance; healthcare providers; healthcare pricing
    Date: 2020–04–13
  3. By: Maclean, J. Catherine (Temple University); Pichler, Stefan (ETH Zurich); Ziebarth, Nicolas R. (Cornell University)
    Abstract: This paper evaluates the labor market effects of sick pay mandates in the United States. Using the National Compensation Survey and difference-in-differences models, we estimate their impact on coverage rates, sick leave use, labor costs, and non-mandated fringe benefits. Sick pay mandates increase coverage significantly by 13 percentage points from a baseline level of 66%. Newly covered employees take two additional sick days per year. We find little evidence that mandating sick pay crowds-out other non-mandated fringe benefits. We then develop a model of optimal sick pay provision along with a welfare analysis. For a range of plausible parameter values, mandating sick pay increases welfare.
    Keywords: sick pay mandates, sick leave, medical leave, employer mandates, fringe benefits, moral hazard, unintended consequences, labor costs, National Compensation Survey (NCS), welfare effects, optimal social insurance, Baily-Chetty
    JEL: I12 I13 I18 J22 J28 J32
    Date: 2020–04
  4. By: Carpenter, Christopher S. (Vanderbilt University); Gonzales, Gilbert (Vanderbilt University); McKay, Tara (Vanderbilt University); Sansone, Dario (Georgetown University)
    Abstract: A large body of research documents that the 2010 dependent coverage mandate of the Affordable Care Act was responsible for significantly increasing health insurance coverage among young adults. No prior research has examined whether sexual minority young adults also benefitted from the dependent coverage mandate, despite previous studies showing lower health insurance coverage among sexual minorities and the fact that their higher likelihood of strained relationships with their parents might predict a lower ability to use parental coverage. Our estimates from the American Community Surveys using difference-in-differences and event study models show that men in same-sex couples age 21-25 were significantly more likely to have any health insurance after 2010 compared to the associated change for slightly older 27 to 31-year-old men in same-sex couples. This increase is concentrated among employer-sponsored insurance, and it is robust to permutations of time periods and age groups. Effects for women in same-sex couples and men in different-sex couples are smaller than the associated effects for men in same-sex couples. These findings confirm the broad effects of expanded dependent coverage and suggest that eliminating the federal dependent mandate could reduce health insurance coverage among young adult sexual minorities in same-sex couples.
    Keywords: Affordable Care Act, health insurance, dependent coverage, sexual minority, LGBTQ
    JEL: H75 I13 I18 J10
    Date: 2020–04
  5. By: Hong, Kai (New York University); Savelyev, Peter A. (College of William and Mary); Tan, Kegon T.K. (University of Rochester)
    Abstract: We go beyond estimating the effect of college attainment on longevity by uncovering the mechanisms behind this effect while controlling for latent skills and unobserved heterogeneity. We decompose the effect with respect to a large set of potential mechanisms, including health behaviors, lifestyles, earnings, work conditions, and health at the start of the risk period (1993–2017). Our estimates are based on theWisconsin Longitudinal Study and show that the effect of education on longevity is well explained by observed mechanisms. Furthermore, we find that for women, the positive effect of education on longevity has been historically masked by the negative effect of education on marriage. An adjustment for the relationship between education and marriage based on data for more recent cohorts increases the explained effect of education on longevity for women. We discuss the implications for policies aimed at improving health and longevity and reducing health inequality.
    Keywords: health behaviors, mechanisms, longevity, college education, lifestyles
    JEL: C41 I12 J24
    Date: 2020–04
  6. By: Clarke, Damian (Universidad de Santiago de Chile); Salinas, Viviana (Pontificia Universidad Catolica de Chile)
    Abstract: We examine the sharp expansion in availability of the emergency contraceptive pill in Chile following legalized access through municipal public health-care centres. Combining a number of administrative datasets on health outcomes and pharmaceutical use, and using difference-in-difference and event study methods, we document that this expansion improved women's reproductive health outcomes, particularly reducing rates of haemorrhage early in pregnancy. These improvements are most notable in areas of the country in which the rollout of the pill was largest. We also document some evidence that refusal to grant the pill upon a women's request is linked with a worsening in reproductive health outcomes.
    Keywords: emergency contraceptives, maternal morbidity, haemorrhage, abortion, event studies, difference-in-differences
    JEL: I18 J13 H75
    Date: 2020–04
  7. By: Elena Lucchese
    Abstract: Rapid response to an emergency call is crucial to its outcome, but little is known about the determinants of response time. Using a difference-in-differences strategy, it is shown that the time it takes to find the patient's location accounts for 30% of response time. The analysis compares the time required to cover each segment of the ambulance trip - from the hospital to the patient's location and then back to the hospital - according to whether the patient is at home or at some other location that responders can more easily locate. The magnitude of the effect does not appear to be affected by the distance travelled. It is suggested that introducing a technology that gives care providers precise information about a patient's location would substantially improve performance at a minimal cost.
    Keywords: Ambulance, Emergency, Organizational Performance, Response Time.
    JEL: D29 D90 I12 I18 R41
    Date: 2020–04
  8. By: Danagoulian, Shooshan (Wayne State University, Detroit); Grossman, Daniel (West Virginia University); Slusky, David (University of Kansas)
    Abstract: Emergency department visits are costly to providers and to patients. We use the Flint water crisis to test if an increase in office visits reduced avoidable emergency room visits. In September 2015, the city of Flint issued a lead advisory to its residents, alerting them of increased lead levels in their drinking water, resulting from the switch in water source from Lake Huron to the Flint River. Using Medicaid claims for 2013-2016, we find that this information shock increased the share of enrollees who had lead tests performed by 1.7 percentage points. Additionally, it increased office visits immediately following the information shock and led to a reduction of 4.9 preventable, non-emergent, and primary-care-treatable emergency room visits per 1000 eligible children (8.2%). This decrease is present in shifts from emergency room visits to office visits across several common conditions. Our analysis suggest that children were more likely to receive care from the same clinic following lead tests and that establishing care reduced the likelihood parents would take their children to emergency rooms for conditions treatable in an office setting. Our results are potentially applicable to any situation in which individuals are induced to seek more care in an office visit setting.
    Keywords: environmental regulation, lead, medicaid, emergency care
    JEL: H75 I12 I18 J13 Q53 Q58
    Date: 2020–03
  9. By: Klein, Tobias J. (Tilburg University); Salm, Martin (Tilburg University); Upadhyay, Suraj (Tilburg University)
    Abstract: We develop a new approach to quantify how patients respond to dynamic incentives in health insurance contracts with a deductible. Our approach exploits two sources of variation in a differences-in-regression-discontinuities design: deductible contracts reset at the beginning of the year, and cost-sharing limits change over the years. Using rich claims-level data from a large Dutch health insurer we find that individuals are forward-looking. Changing dynamic incentives by increasing the deductible by €100 leads to a reduction in healthcare spending of around 3% on the first days of the year and 6% at the annual level. The response to dynamic incentives is an important part of the overall effect of cost-sharing schemes on healthcare expenditures—much more so than what the previous literature has suggested.
    Keywords: health insurance, patient cost-sharing, dynamic incentives
    JEL: I13 H51
    Date: 2020–03
  10. By: Bergquist, Savannah; Costa-Font, Joan; Swartz, Katherine
    Abstract: Long-term care partnership (LTCP) programs were designed to both encourage middle-income individuals to purchase private long-term care insurance, and defer the time when an individual would become eligible for Medicaid to pay her long term care services and supports (LTSS). This paper exploits the timing of state Partnership implementation (including four pilot states) to evaluate the program’s effects on new yearly insurance applications and contract uptake. We draw upon data from the National Association of Insurance Commissioners (NAIC) on new long term care insurance (LTCI) purchases (traditional and Partnership) by US state (weighted by the population over age 65 to make the data comparable). We use a difference-in-differences strategy to obtain estimates of the program effect of the LTCP on the overall uptake of private LTCI, and specifically of LTCP contracts and applications for a subsample of states. Findings suggest no significant effect of LTCP on insurance uptake and an increase in insurance applications. This result points towards a substitution between traditional and partnership contracts.
    Keywords: long-term care (LTC) insurance; LTC partnerserhips (LTCP); subsidization; Medicaid; difference-in-difference (DD); insurance underwriting
    JEL: H31 I18 I38 J14
    Date: 2018–11–01
  11. By: Iris Grant; Iris Kesternich; Johannes Van Biesebroeck
    Abstract: Mostly due to population aging, the demand for long-term care (LTC) services is growing strongly. Historically, non-profit nursing homes dominated the German LTC market, but the recent entry wave was tilted towards for-profit competitors. Using a rich administrative dataset on all LTC facilities in Germany, we examine strategic interaction between these two ownership types in a static entry model. The estimates of competitive effects imply that non-profit and for-profit homes are substitutes, but competition is much stronger within-type, suggesting that they provide differentiated products. For-profit homes in particular act as if they operate in a different market segment, but over time their entry behavior has converged to that of the more established non-profits. Counterfactual simulations of proposed changes in government policy suggest a large impact on the fraction of markets that remain unserved or only served by a single type.
    Date: 2020–04–01
  12. By: Farina, Egidio (Queen's University Belfast); Green, Colin P. (Norwegian University of Science and Technology (NTNU)); McVicar, Duncan (Queen's University Belfast)
    Abstract: The increasing numbers of workers in employment with little to no job security, so-called precarious employment, has led to a range of concerns over worker outcomes. A particular focus is the effect of instability on health in general, and particularly, mental health. We provide new evidence on this, focusing on an extreme form of precarious employment that has grown rapidly in the UK, zero-hours contracts (ZHCs). We demonstrate that workers employed on ZHCs are more likely to report a long-lasting health problem than workers employed on other types of contract. In particular, reported levels of mental ill health are higher (almost double) among ZHC workers than for other workers. These associations remain, and a positive association between ZHC employment and physical ill health emerges, after controlling for a rich set of observable characteristics. Estimated associations vary little between different demographic groups, although they are concentrated in parts of the economy where underlying job instability is likely to be higher. Finally, we exploit sectoral variation in the historical prevalence of ZHC-like employment, in an instrumental variables framework, to demonstrate large and potentially causal effects of ZHC employment on reporting a long-lasting health problem and on mental ill health, but no effect on physical health. It is unlikely that these effects are currently factored into short-term employment conditions or that they attract compensating wage differentials.
    Keywords: zero hours contracts, atypical employment, precarious employment, casual employment, health, mental health, instrumental variables
    JEL: J21 J48 M55
    Date: 2020–04
  13. By: Clark, Andrew E.; D'Ambrosio, Conchita; Barazzetta, Marta
    Abstract: We here consider the cognitive and non-cognitive consequences on young adults of growing up with a mother who reported experiencing major financial problems. We use UK data from the Avon Longitudinal Study of Parents and Children to show that early childhood financial problems are associated with worse adolescent cognitive and non-cognitive outcomes, controlling for both income and a set of standard variables, and in value-added models controlling for children’s earlier age-5 outcomes. The estimated effect of financial problems is almost always larger in size than that of income. Around one-quarter to one-half of the effect of financial problems on the non-cognitive outcomes seems to transit through mother’s mental health.
    Keywords: Income, Financial Problems, Child Outcomes, Subjective well-being, Behaviour, Education, ALSPAC
    Date: 2019–01
  14. By: Battistin, Erich (University of Maryland); Lamarche, Carlos (University of Kentucky); Rettore, Enrico (University of Padova)
    Abstract: We offer a new strategy to identify the distribution of treatment effects using data from the Infant Health and Development Program (IHDP), a relatively understudied early-childhood intervention for low birth-weight infants. We introduce a new policy parameter, QCD, which denotes quantiles of the effect distribution conditional on latent neonatal health. The dependence between potential outcomes originates from a new class of factor models where latent health can affect the location and shape of distributions. We first show that QCD depends on quantiles of marginal outcome distributions given latent health. We then achieve identification of these marginal distributions and QCD by proxying latent health with neonatal anthropometrics and accounting for measurement error in these proxies. The effects of enrolling in IHDP are widely distributed across children and depend on neonatal health. Moreover, the large average effects documented in past work for close to normal birth weight children from low-income families are driven by a minority of children in this group.
    Keywords: early childhood, factor models, policy evaluation, quantile regression, treatment effect distributions
    JEL: C13 C21 I14 J18
    Date: 2020–03
  15. By: Anikó Bíró (Health and Population Lendület Research Group, Centre for Economic and Regional); Ágnes Szabó-Morvai (Health and Population Lendület Research Group, Centre for Economic and University of Debrecen)
    Abstract: We estimate the effect of mass media coverage of the meningococcal disease on the uptake of meningococcal vaccinations in Hungary. Our analysis is based on administrative county-level data on vaccination purchases linked to indicators of media coverage of the meningococcal disease and to administrative records of disease incidence. Using geographical and time variations in these indicators, our fixed effects estimates indicate a strong positive effect of mass media coverage of the disease on the rate of vaccination with all types of the meningococcal vaccine. At the same time, we do not find evidence that disease incidence itself has a positive impact on vaccination. These findings are broadly in line with imperfect information and the principles of bounded rationality and highlight the responsibility of mass media in influencing health-related behaviours.
    Keywords: vaccination, meningitis, mass media, imperfect information, bounded rationality
    JEL: I12 I18
    Date: 2020–04
  16. By: Oskorouchi, Hamid R. (University of Göttingen); Sousa-Poza, Alfonso (University of Hohenheim); Bloom, David E. (Harvard University)
    Abstract: By exploiting rich retrospective data on childhood immunization, socioeconomics, and health status in China (the China Health and Retirement Longitudinal Study), we assess the long-term effects of childhood vaccination on cognitive and educational outcomes in that country. To do so, we apply various techniques (e.g., propensity score and coarsened exact matching and correlated random effects) to different sets of conditioning variables and subsamples to estimate the average treatment on the treated effect of childhood vaccination. Our results confirm that vaccinations before the age of 15 have long-term positive and economically meaningful effects on nonhealth outcomes such as education and cognitive skills. These effects are relatively strong, with vaccinated individuals enjoying about one more year of schooling and performing substantially better later in life on several cognitive tests.
    Keywords: cognitive skills, vaccines, China, education
    JEL: I12 I18 I21
    Date: 2020–03
  17. By: Werbeck, Anna (RWI); Wübker, Ansgar (RWI); Ziebarth, Nicolas R. (Cornell University)
    Abstract: Using a randomized field experiment, we show that health care specialists cream-skim patients by their expected profitability. In the German two-tier system, outpatient reimbursement rates for both public and private insurance are centrally determined but are more than twice as high for the privately insured. In our field experiment, following a standardized protocol, the same hypothetical patient called 991 private practices in 36 German counties to schedule appointments for allergy tests, hearing tests and gastroscopies. Practices were 7% more likely to offer an appointment to the privately insured. Conditional on being offered an appointment, wait times for the publicly insured were twice as long than for the privately insured. Our findings show that structural differences in reimbursement rates lead to structural differences in health care access.
    Keywords: health care inequality, reimbursement rates, health care access, discrimination, cherry picking, gastroscopy, audiometry, allergy test, allergists, otorhinolaryngologist, gastroenterologist
    JEL: I14 I11 I18
    Date: 2020–03
  18. By: Bayer, Christian (University of Bonn); Kuhn, Moritz (University of Bonn)
    Abstract: COVID-19 is spreading and has reached the state of a worldwide pandemic and health systems are or will be tested in how they can deal with it. So far, during this early phase of the pandemic, outcomes in terms of case-fatality rates (CFR) differ widely across countries. We explore how differences in living arrangements of generations within families contribute to the cross country differences. We document a strong positive correlation between countries' CFRs and the share of working-age families living with their parents. This suggest that policy needs to focus on inter-generational social distance when combating this pandemic.
    Keywords: COVID crisis, COVID-19
    JEL: E00 I14
    Date: 2020–04
  19. By: Parag A. Pathak; Tayfun Sönmez; M. Utku Unver; M. Bumin Yenmez
    Abstract: In the wake of the Covid-19 pandemic, the rationing of medical resources has become a critical issue. Nearly all existing triage protocols are based on a priority point system, in which an explicit formula specifies the order in which the total supply of a particular resource, such as a ventilator, is to be rationed for eligible patients. A priority point system generates the same priority ranking to ration all the units. Triage protocols in some states (e.g. Michigan) prioritize frontline health workers giving heavier weight to the ethical principle of instrumental value. Others (e.g. New York) do not, reasoning that if medical workers obtain high enough priority, there is a risk that they obtain all units and none remain for the general community. This debate is particularly pressing given substantial Covid-19 related health risks for frontline medical workers. In this paper, we analyze the consequences of rationing medical resources through a reserve system. In a reserve system, ventilators are placed into multiple categories. Priorities guiding allocation of units can reflect different ethical values between these categories. For example, a reserve category for essential personnel can emphasize the reciprocity and instrumental value, and another reserve category for general community can give higher weight to the values of utility and distributive justice. A reserve system provides additional flexibility over a priority point system because it does not dictate a single priority order for the allocation of all units. It offers a middle-ground approach that balances competing objectives. However, this flexibility requires careful attention to implementation, most notably the processing order of reserve categories, given that transparency is essential for triage protocol design. In this paper, we describe our mathematical model of a reserve system, characterize its potential outcomes, and examine distributional implications of particular reserve systems. We also discuss several practical considerations with triage protocol design.
    JEL: D45 D47 I3
    Date: 2020–04
  20. By: Qiu, Yun; Chen, Xi; Shi, Wei
    Abstract: This paper models the local and cross-city transmissions of the novel coronavirus in China between January 19 and February 29 in 2020. We examine the role of various socioeconomic mediating factors, including public health measures that encourage social distancing in local communities. Weather characteristics two weeks ago are used as instrumental variables for causal inference. Stringent quarantine, city lockdown, and local public health measures imposed since late January significantly decreased the virus transmission rate. The virus spread was contained by the middle of February. Population out ow from the outbreak source region posed a higher risk to the destination regions than other factors including geographic proximity and similarity in economic conditions. We quantify the effects of different public health measures in reducing the number of infections through counterfactual analyses. Over 1.4 million infections and 56,000 deaths could have been avoided as a result of the national and provincial public health measures imposed in late January in China.
    Keywords: 2019 novel coronavirus,transmission,quarantine
    JEL: I18 I12 C23
    Date: 2020
  21. By: Sultana, Abida; Sharma, Rachit; Hossain, Md Mahbub; Bhattacharya, Sudip; Purohit, Neetu
    Abstract: Burnout is a major occupational problem among healthcare providers. During coronavirus disease (COVID-19) pandemic, the frontline health workforce is experiencing a high workload and multiple psychosocial stressors, which may affect their mental and emotional health, leading to burnout symptoms. Moreover, sleep deprivation and a critical lack of psychosocial support may aggravate such symptoms amidst COVID-19. Global evidence informs the need for adopting multipronged evidence-based approaches addressing burnout during this pandemic. Such interventions may include increasing the awareness of work-related stress and burnout, promoting mindfulness and self-care practices for promoting mental wellbeing, ensuring optimal mental health services, using digital technologies to address workplace stress and deliver mental health interventions, and improving organizational policies and practices emphasizing on addressing burnout among healthcare providers. As COVID-19 may impose unique workplace stress in addition to preexisting psychosocial burden among individuals, it is essential to prevent burnout through effective measures ensuring the mental and emotional wellbeing of healthcare providers globally.
    Date: 2020–04–14
  22. By: Callum J. Jones; Thomas Philippon; Venky Venkateswaran
    Abstract: We study the response of an economy to an unexpected epidemic. Households mitigate the spread of the disease by reducing consumption, reducing hours worked, and working from home. Working from home is subject to learning-by-doing and the capacity of the health care system is limited. A social planner worries about two externalities, an infection externality and a healthcare congestion externality. Private agents’ mitigation incentives are weak and biased. We show that private safety incentives can even decline at the onset of the epidemic. The planner, on the other hand, implements front-loaded mitigation policies and encourages working from home immediately. In our calibration, assuming a CFR of 1% and an initial infection rate of 0.1%, private mitigation reduces the cumulative death rate from 2.5% of the initially susceptible population to about 1.75%. The planner optimally imposes a drastic suppression policy and reduces the death rate to 0.15% at the cost of an initial drop in consumption of around 25%.
    JEL: E2 E6 I1
    Date: 2020–04
  23. By: Martin Bodenstein; Giancarlo Corsetti; Luca Guerrieri
    Abstract: Drastic public health measures such as social distancing or lockdowns can reduce the loss of human life by keeping the number of infected individuals from exceeding the capacity of the health care system but are often criticized because of the social and the economic cost they entail. We question this view by combining an epidemiological model, calibrated to capture the spread of the COVID-19 virus, with a multisector model, designed to capture key characteristics of the U.S. Input Output Tables. Our two-sector model features a core sector that produces intermediate inputs not easily replaced by inputs from the other sector, subject to minimum-scale requirements. We show that, by affecting workers in this core sector, the high peak of an infection not mitigated by social distancing may cause very large upfront economic costs in terms of output, consumption and investment. Social distancing measures can reduce these costs, especially if skewed towards non-core industries and occupations with tasks that can be performed from home, helping to smooth the surge in infections among workers in the core sector.
    Keywords: COVID-19; Epidemic; Recession; Infectious disease
    JEL: E10 E30 I10
    Date: 2020–04–17
  24. By: Mélanie Bourassa Forcier; Lara Khoury; Nathalie Vézina
    Abstract: This paper explores Canadian liability concerns flowing from the integration of artificial intelligence (AI) in health care (HC) delivery. It argues that the current Canadian legal framework is sufficient, in most cases, to allow developers and users of AI technology to assess each stakeholder’s responsibility should the technology cause harm. Further, it inquires as to whether an alternative approach to existing liability regimes should be adopted in order to promote AI innovation based on recognized best practices which, in turn, could lead to increased use of AI technology.
    Keywords: AI,Digital Health,Law,Liability,Doctor,Hospitals,Companies,
    Date: 2020–04–16
  25. By: Naudé, Wim (RWTH Aachen University)
    Abstract: Artificial Intelligence (AI) is a potentially powerful tool in the fight against the COVID- 19 pandemic. Since the outbreak of the pandemic, there has been a scramble to use AI. This article provides an early, and necessarily selective review, discussing the contribution of AI to the fight against COVID-19, as well as the current constraints on these contributions. Six areas where AI can contribute to the fight against COVID-19 are discussed, namely i) early warnings and alerts, ii) tracking and prediction, iii) data dashboards, iv) diagnosis and prognosis, v) treatments and cures, and vi) social control. It is concluded that AI has not yet been impactful against COVID-19. Its use is hampered by a lack of data, and by too much data. Overcoming these constraints will require a careful balance between data privacy and public health, and rigorous human-AI interaction. It is unlikely that these will be addressed in time to be of much help during the present pandemic. In the meantime, extensive gathering of diagnostic data on who is infectious will be essential to save lives, train AI, and limit economic damages.
    Keywords: data science, health, Coronavirus, COVID-19, artificial intelligence, development, technology, innovation
    JEL: O32 O39 I19 O20
    Date: 2020–04
  26. By: Barbieri, Teresa; Basso, Gaetano; Scicchitano, Sergio
    Abstract: We analyse the content of Italian occupations operating in about 600 sectors with a focus on the dimensions that expose workers to contagion risks during the COVID-19 epidemics. To do so we leverage extremely detailed and granular information from ICP, the Italian equivalent of O*Net. We find that several sectors need physical proximity to operate: the workers employed in Italy in sectors whose physical proximity index is above the national average are more than 6.5 million (most of them in retail trade). Groups at risk of contagion and complications from COVID-19 (mainly male above the age of 50) work in sectors that are little exposed to physical proximity, currently under lockdown or can work remotely. The sectoral lockdowns put in place by the Italian Government in March 2020 seem to have targeted sectors who operate in physical proximity, but not those directly exposed to infections (the health industry is not subject to lockdown). Most workers who can operate from home have not been put under lockdown and are currently working. Therefore, the number of workers who are not in workplaces could be up to 3 million higher than those whose sector has been shutdown.
    Keywords: Working conditions,Safety,Crisis policies,COVID-19 epidemics
    JEL: J28 J81 H12 I18
    Date: 2020
  27. By: Andrew Glover (Federal Reserve Bank of Kansas City); Jonathan Heathcote (Federal Reserve Bank of Minneapolis and CEPR); Dirk Krueger (University of Pennsylvania and CEPR); Jose-Victor Rios-Rull (University of Pennsylvania, UCL, CAERP, CEPR and NBER)
    Abstract: To slow the spread of COVID-19, many countries are shutting down non-essential sectors of the economy. Older individuals have the most to gain from slowing virus diffusion. Younger workers in sectors that are shuttered have the most to lose. In this paper, we build a model in which economic activity and disease progression are jointly determined. Individuals differ by age (young and retired), by sector (basic and luxury), and by health status. Disease transmission occurs in the workplace, in consumption activities, at home, and in hospitals. We study the optimal economic mitigation policy of a utilitarian government that can redistribute across individuals, but where such redistribution is costly. We show that optimal redistribution and mitigation policies interact, and reflect a compromise between the strongly diverging preferred policy paths of different subgroups of the population. We find that the shutdown in place on April 12 is too extensive, but that a partial shutdown should remain in place through July.Length: 81 pages
    Keywords: COVID-19; Economic Policy; Redistribution
    Date: 2020–04–18
  28. By: François Vaillancourt
    Abstract: Various Canadian politicians and some analysts argue that we should do ‘’whatever it takes’’ to save lives threatened by the COVID-19 epidemic. A few politicians, here and in the USA, have put forward that one should sacrifice older people for the ‘economy’. The first proposal is understandable as a spontaneous reaction to the pain and suffering caused by COVID-19. However, this proposal is an inefficient and inequitable policy choice if governments mean that we should value the lives of those threatened by COVID-19 more than the lives of those endangered by usual diseases such as cancer or diabetes. The second proposal is not the choice one is faced with. To justify these two statements, we: 1) summarize the intervention plan; 2) present the number of individuals at risk; 3) discuss the use of quality adjusted live years (QALY to assess health innovations; 4) present the number, age distribution and expected QALYs of lives saved from COVID-19; 5) value these QALYs; 6) and derive from this an amount of resources to allocate to this epidemic that makes sense given that we value years lived equally and equitably across all diseases and over time.
    Keywords: QALY,Health Policy Recession,COVID-19,Intergenerational Equity,Equal Treatment of Illnesses,
    Date: 2020–04–17
  29. By: Hunt Allcott; Levi Boxell; Jacob C. Conway; Matthew Gentzkow; Michael Thaler; David Y. Yang
    Abstract: We study partisan differences in Americans’ response to the COVID-19 pandemic. Political leaders and media outlets on the right and left have sent divergent messages about the severity of the crisis, which could impact the extent to which Republicans and Democrats engage in social distancing and other efforts to reduce disease transmission. We develop a simple model of a pandemic response with heterogeneous agents that clarifies the causes and consequences of heterogeneous responses. We use location data from a large sample of smartphones to show that areas with more Republicans engage in less social distancing, controlling for other factors including state policies, population density, and local COVID cases and deaths. We then present new survey evidence of significant gaps between Republicans and Democrats in beliefs about personal risk and the future path of the pandemic.
    JEL: D72 I12 I18
    Date: 2020–04
  30. By: Borjas, George J. (Harvard University)
    Abstract: New York City is the hot spot of the COVID-19 pandemic in the United States. This paper merges information on the number of tests and the number of infections at the New York City zip code level with demographic and socioeconomic information from the decennial census and the American Community Surveys. People residing in poor or immigrant neighborhoods were less likely to be tested; but the likelihood that a test was positive was larger in those neighborhoods, as well as in neighborhoods with larger households or predominantly black populations. The rate of infection in the population depends on both the frequency of tests and on the fraction of positive tests among those tested. The non-randomness in testing across New York City neighborhoods indicates that the observed correlation between the rate of infection and the socioeconomic characteristics of a community tells an incomplete story of how the pandemic evolved in a congested urban setting.
    Keywords: COVID-19, New York City, pandemic
    JEL: I10 J10
    Date: 2020–04
  31. By: Cheng, Cindy; Barcelo, Joan; Hartnett, Allison; Kubinec, Robert (Princeton University); Messerschmidt, Luca
    Abstract: As the COVID-19 pandemic spreads around the world, governments have implemented a broad set of policies to limit the spread of the pandemic. In this paper we present an initial release of a large hand-coded dataset of more than 4,500 separate policy announcements from governments around the world. This data is being made publicly available, in combination with other data that we have collected (including COVID-19 tests, cases, and deaths) as well as a number of country-level covariates. Due to the speed of the COVID-19 outbreak, we will be releasing this data on a daily basis with a 5-day lag for record validity checking. In a truly global effort, our team is comprised of more than 190 research assistants across 18 time zones and makes use of cloud-based managerial and data collection technology in addition to machine learning coding of news sources. We analyze the dataset with a Bayesian time-varying ideal point model showing the quick acceleration of more harsh policies across countries beginning in mid-March and continuing to the present. While some relatively low-cost policies like task forces and health monitoring began early, countries generally adopted more harsh measures within a narrow time window, suggesting strong policy diffusion effects.
    Date: 2020–04–12
  32. By: Christian Gollier (Toulouse School of Economics, University of Toulouse-Capitole); Olivier Gossner (CNRS – CREST, Ecole polytechnique, and London School of Economics)
    Abstract: It is well-known that group testing is an e cient strategy to screen for the presence of a virus. It consists in pooling n individual samples with a single test using RT-PCR. If no individual in the group is infected, the group test is negative. Thus, a single test may reveal this crucial information. We show how group testing can be optimized in three applications to multiply the power of tests against Covid-19: Estimating virus prevalence to measure the evolution of the pandemic; bringing negative groups back to work to exit the current lockdown; and testing for individual infectious status to treat sick people. For an infection level around 2%, group testing could multiply the power of testing by a factor 20. The implementation of this strategy in the short run requires limited investments and could bypass the current immense shortage of testing capacity.
    Date: 2020–03–28
  33. By: Lu, Haiyang; Nie, Peng; Qian, Long
    Abstract: While quarantine has become a widely used control measure during the outbreak of the 2019 novel coronavirus disease (COVID-19), empirical research on whether and to what extent quarantine and attitudes towards COVID-19 influence psychological outcomes is scant. Using a cross-sectional online survey, this paper is the first to investigate the heterogeneous impact of quarantine experiences and attitudes towards COVID-19 on the whole distribution of psychological well-being in China. We find that credibility of real-time updates and confidence in the epidemic control are associated with a decline in depression but an increase in happiness. Such effects are stronger in the upper distribution of depression and the median of happiness. We also discern that individuals with severe depressive symptoms (or lower levels of happiness) are more susceptible to the severity of the pandemic. Moreover, home self-quarantine is associated a decrease in depression but an increase in happiness, by contrast, community-level quarantine discourages happiness, especially in the lower distribution of happiness.
    Keywords: Quarantine,Attitudes,Quantile regression,Psychological well-being
    JEL: I10 I31
    Date: 2020
  34. By: Pietro Battiston; Simona Gamba
    Abstract: We use daily data from Lombardy, the Italian region most affected by the COVID-19 outbreak, to calibrate a SIR model individually on each municipality. These are all covered by the same health system and, in the post-lockdown phase we focus on, all subject to the same social distancing regulations. We find that municipalities with a higher number of cases at the beginning of the period analyzed have a lower rate of diffusion, which cannot be imputed to herd immunity. In particular, there is a robust and strongly significant negative correlation between the estimated basic reproduction number (R0) and the initial outbreak size, in contrast with the role of R0 as a predictor of outbreak size. We explore different possible explanations for this phenomenon and conclude that a higher number of cases causes changes of behavior, such as a more strict adoption of social distancing measures among the population, that reduce the spread. This result calls for a transparent, real-time distribution of detailed epidemiological data, as such data affects the behavior of populations in areas affected by the outbreak.
    Keywords: COVID-19, tests, basic reproduction number, social distancing, containment.
    JEL: I12 I18 C53 C22
    Date: 2020–04
  35. By: Fernando Alvarez (University of Chicago and NBER); David Argente (Pennsylvania State University); Francesco Lippi (LUISS and EIEF)
    Abstract: We study the optimal lockdown policy for a planner who wants to control the fatalities of a pandemic while minimizing the output costs of the lockdown. We use the SIR epidemiology model and a simple linear economy to formalize the planner’s dynamic control problem. The optimal policy depends on the fraction of infected and of susceptible in the population. We parametrize the model using micro data on theCOVID19 pandemic and the economic breadth of the lockdown. The quantitative analysis identifies the features that shape the intensity and duration of the optimal lockdown policy. Our baseline parametrization is conditional on a 1% of infected agents at the outbreak, no cure for the disease, and the possibility of testing (identifying those who acquired immunity to the disease). The optimal policy prescribes a severe lockdown beginning two weeks after the outbreak, covers 60% of the population after a month, and is gradually withdrawn covering 20% of the population after 3 months. The intensity of the lockdown depends critically on the gradient of the fatality rate as a function of the infected, and also on the assumed value of a statistical life. The absence of testing increases the economic costs of the lockdown, leads to worse welfare outcomes and shortens the duration of the optimal lockdown.
    Date: 2020
  36. By: Francois R. Velde
    Abstract: Burns and Mitchell (1946, 109) found a recession of “exceptional brevity and moderate amplitude.” I confirm their judgment by examining a variety of high-frequency data. Industrial output fell sharply but rebounded within months. Retail seemed little affected and there is no evidence of increased business failures or stressed financial system. Cross-sectional data from the coal industry documents the short-lived impact of the epidemic on labor supply. The Armistice possibly prolonged the 1918 recession, short as it was, by injecting momentary uncertainty. Interventions to hinder the contagion were brief (typically a month) and there is some evidence that interventions made a difference for economic outcomes.
    Keywords: 1918 Flu Pandemic; Covid-19; Labor Supply
    JEL: E32 I10 I18 H1 J22
    Date: 2020–04–10
  37. By: C. Baunez (INT - Institut de Neurosciences de la Timone - CNRS - Centre National de la Recherche Scientifique - AMU - Aix Marseille Université); Mickael Degoulet (INT - Institut de Neurosciences de la Timone - CNRS - Centre National de la Recherche Scientifique - AMU - Aix Marseille Université); Stéphane Luchini (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique); Patrick Pintus (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique); Miriam Teschl (AMSE - Aix-Marseille Sciences Economiques - EHESS - École des hautes études en sciences sociales - AMU - Aix Marseille Université - ECM - École Centrale de Marseille - CNRS - Centre National de la Recherche Scientifique)
    Abstract: Tests are crucial to know about the number of people who have fallen ill with COVID-19 and to understand in real-time whether the dynamics of the pandemic is accelerating or decelerating. But tests are a scarce resource in many countries. The key but still open question is thus how to allocate tests across sub-national levels. We provide a data-driven and operational criterion to allocate tests efficiently across regions or provinces, with the view to maximize detection of people who have been infected. We apply our criterion to Italian regions and compute the shares of tests that should go to each region, which are shown to differ significantly from the actual distribution.
    Keywords: acceleration of harm,deceleration of harm,epidemic dynamics,efficiency criterion,sub-national allocation of tests,real-time Analysis,COVID-19,Italy
    Date: 2020–04
  38. By: Ganguly, Dibyasree; Misra, Sheuli; Goli, Srinivas
    Abstract: Despite the commonality of loss of lives, every pandemic has played a role in shaping the socio-economic and public health outcomes depending on the nature and the magnitude of the outbreak. In this study, we have attempted to make a preliminary assessment of COVID-19 impact on India and commented on the country’s resilience, response, impact and draw the lessons for the future. Although lockdown was necessary to stop the transmission, is showing and will show a greater impact on all spheres of human life considering the country’s poor resilient socio-economic institutions. Our concurrent assessment in the middle of the outbreak predicts that the socio-economic, demographic and health costs in India would be much higher than developed countries. Initiation of timely action from the very beginning (when the first case reported in Kerala) could have plummeted the potential transmission in every corner of the country to a large extent and could have avoided socio-economic crises that presently surfaced in the country. The study provides a strong message for initiating sector-specific measures alongside relief packages to reduce the damage not only for now but also to build a resilient system for socioeconomically vulnerable groups, health care services, and education infrastructure to face future pandemics. Otherwise, the pandemic like this can cost more.
    Keywords: COVID-19, Pandemic, SARS-CoV-2, Socio-economic crisis, Public health, Migrants, Food security, Wage, Education, Social behaviour, Gender
    JEL: I11 I14 I18 I24 I31 I38 J33 J61 J78
    Date: 2020–04–17
  39. By: Andrew Atkeson
    Abstract: To understand how best to combat COVID-19, we must understand how deadly is the disease. There is a substantial debate in the epidemiological lit- erature as to whether the fatality rate is 1% or 0.1% or somewhere in between. In this note, I use an SIR model to examine why it is difficult to estimate the fatality rate from the disease and how long we might have to wait to resolve this question absent a large-scale randomized testing program. I focus on un- certainty over the joint distribution of the fatality rate and the initial number of active cases at the start of the epidemic around January 15, 2020. I show how the model with a high initial number of active cases and a low fatality rate gives the same predictions for the evolution of the number of deaths in the early stages of the pandemic as the same model with a low initial number of active cases and a high fatality rate. The problem of distinguishing these two parameterizations of the model becomes more severe in the presence of effective mitigation measures. As discussed by many, this uncertainty could be resolved now with large-scale randomized testing.
    JEL: A1 C13
    Date: 2020–04
  40. By: Ozili, Peterson K
    Abstract: The COVID-19 or coronavirus pandemic which has affected the global economy has also affected the African economy through spillovers to African countries. Many African countries have taken bold quarantine and lockdown measures to control the spread of COVID-19 although this has come at a cost such as the collapse of health systems and a painful economic crisis or recession. A coordinated and bold response by African authorities is needed. First, public funds should be provided to improve the capacity of health systems in African countries. Second, financial support should be provided to individuals, entrepreneurs and corporations to help them cope with the adverse effect of the coronavirus crisis. Third, employers should be granted incentives to preserve employment during the crisis to avoid mass layoff of workers. Finally, the Central bank in African countries should provide liquidity and credit support as well as asset purchase programs to prevent credit and liquidity crunch in domestic financial markets.
    Keywords: Africa, COVID-19, Coronavirus, SARS-CoV-2, outbreak, pandemic, economic crisis, financial crisis, global recession, public health, spillovers, monetary policy, fiscal policy, liquidity provision, Central banks.
    JEL: G18 G20 G23 I1 I15 I18
    Date: 2020
  41. By: Samuelsson, Karl; Barthel, Stephan; Colding, Johan; Macassa, Gloria; Giusti, Matteo
    Abstract: The 2020 coronavirus pandemic caused countries across the world to implement measures of social distancing to curb spreading of COVID-19. The large and sudden disruptions to everyday life that result from this are likely to impact well-being, particularly among urban populations that live in dense settings with limited public space. In this paper, we argue that during these extraordinary circumstances, urban nature offers resilience for maintaining well-being in urban populations, while enabling social distancing. We discuss more generally the critical role of urban nature in times of crisis. Cities around the world need to take the step into the 21st century by accepting crises as a new reality and finding ways to function during these disturbances. Thus, maintaining or increasing space for nature in cities and keeping it accessible to the public should be part of the sustainability agenda, aiming simultaneously to strive towards SDG 3 (good health and well-being), and SDG 11 (sustainable and resilient cities).
    Date: 2020–04–11
  42. By: Larsen, David; Dinero, Rachel E.; Asiago-Reddy, Elizabeth; Green, Hyatt; Lane, Sandra; Shaw, Andrea; Zeng, Teng; Kmush, Brittany
    Abstract: The SARS-CoV-2 pandemic exposed the inadequacy of infectious disease surveillance throughout the US and other countries. Isolation and contact tracing to identify all infected people are key public health interventions necessary to control infectious disease outbreaks. However, these activities are dependent upon the surveillance platform to identify infections quickly. A robust surveillance platform can also reinforce community adherence to behavioral interventions such as social distancing. In situations where contact tracing is feasible, all suspected cases and contacts of confirmed cases must be tested for a SARS-CoV-2 infection and effectively isolated. At the community level wastewater surveillance can identify areas where transmission is or is not occurring, and genetic sequencing of SARS-CoV-2 can help to elucidate the intensity of transmission independent of the number of known cases and hospitalizations. State and county public health departments should improve the infectious disease surveillance platform whilst the public is practicing social distancing. These enhanced surveillance activities are necessary to contain the epidemic once the curve has been sufficiently flattened in highly burdened areas, and to prevent escalation in areas where transmission is minimal.
    Date: 2020–04–12

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