Instead of focusing solely on deaths, policymakers should consider the totality of the pandemic’s impact
Picture by Jacek Dylag for Unsplash
COVID-19 is the greatest public health crisis in a century, but, paradoxically, public health considerations are not the primary drivers of policy response to the global spread of SARS-CoV-2, the virus that causes the disease. Instead, political leaders have largely ceded priority to mathematical models. These models use descriptive epidemiology, viral dynamics, and human behavioural factors as inputs, along with judgment about a multitude of unknown or uncertain parameters to navigate the huge uncertainties and data gaps that accompany any fast-moving health crisis like this one. Taken as part of a broader scientific and public health evidence base, models like these can provide useful input for decision-making. However, focusing models on a single indicator, such as COVID-19 deaths, could result in a lack of understanding of relevant trade-offs and the overall health effect of the pandemic on society.
‘These strategies, now being applied across a range of contexts, have never been systematically evaluated nor is their policy end-point clearly defined’
The initial COVID-19 models, which drove much of the current approach, are of questionable accuracy. First, they do not consider the real-life conditions under which the virus is transmitted in a complex urban environment. For example, real-time hospitalisation data from New York City reveals that the virus hit earliest and hardest in low-income communities with medically vulnerable households. The fact that some areas can differ from others in terms of these risk factors is not accounted for in the models. Second, the models assume most people infected with the novel coronavirus would either exhibit symptoms or be hospitalised. This assumption inflates projected death rates. Third, the models make assumptions about the effectiveness of proposed mitigation strategies (e.g., school closures, social distancing) to influence transmission dynamics. However, these strategies, now being applied across a range of socioeconomic and cultural contexts, have never been systematically evaluated nor is their policy end-point clearly defined.