key: cord-0799104-lgbod553
authors: Danielli, Shaun; Patria, Raman; Donnelly, Patrice; Ashrafian, Hutan; Darzi, Ara
title: Economic interventions to ameliorate the impact of COVID-19 on the economy and health: an international comparison
date: 2020-07-13
journal: J Public Health (Oxf)
DOI: 10.1093/pubmed/fdaa104
sha: 3dc1b9e18810e13d9f8621bc918213f72b4a170d
doc_id: 799104
cord_uid: lgbod553

BACKGROUND: The COVID-19 pandemic continues to challenge governments and policymakers worldwide. They have rightfully prioritised reducing the spread of the virus through social distancing interventions. However, shuttered business and widespread restrictions on travel and mobility have led to an economic collapse with increasing uncertainty of how quickly recovery will be achieved. METHODS: The authors carried out a review of publicly available information on the economic intervention’s countries have put in place to ameliorate the impact of COVID-19. RESULTS: The strategies and scale of economic interventions have been broad, ranging from 2.5% to a reported 50% of Gross Domestic Product. CONCLUSIONS: Numerous countries are beginning to ease lockdown restrictions and restart economies in different ways. There is therefore evolving, real-world data that should be used dynamically by governments and policymakers. The strategies on restarting the economy must be balanced against the uncertainty of a possible second wave of COVID-19. A nuanced approach to easing restrictions needs to take into account not only immediate risk to life but longer-term risks of widening inequalities and falling life expectancy.

Countries have introduced measures including social distancing and infection testing to decrease the immediate risk to life. 1 Economic interventions are also crucial in this response as the World Health Organization defines one of the biggest determinants of health is income 2 with lives significantly shortened by socioeconomic inequality. 3 Therefore, alleviating financial pressures will allow people to follow government advice leading to reduced infectious spread and ultimately also save lives in both the immediate and medium time frame.

The authors carried out a review of publicly available information on the economic interventions countries have put in place to ameliorate the impact of COVID-19.

Government strategies have differed. The UK extended restrictions on the movement of people; as did other countries when numbers of deaths continued to increase. Sweden in contrast has favoured 'herd immunity', having notably less restrictions on the population, but specific guidance to protect the most vulnerable. The scale of economic interventions too has differed. Initially measures such as statutory sick pay from the first day of absence were put in place to ensure people self-isolated immediately when displaying symptoms. Latterly economic measures served to mitigate the financial pressure on businesses and employees as countries went into lockdown. The size of fiscal input has been relatively large but varied within each country 4 (see Table 1 ). The number of deaths and Gross Domestic Product (GDP) expenditure however do not seem to be directly proportionate; e.g. New Zealand have spent 4% of their GDP with 21 deaths as of 20 May 2020, the USA spent 11% with 91 664 deaths, 5 and Sweden (14.9% GDP) has recorded 3 831 deaths. 6

Internationally, there is clear intention from governments to protect its people and businesses amidst what is likely to be the biggest recession of our time. The strategies and scale of economic interventions have been broad, ranging from 2.5% to a reported 50% of Gross Domestic Product. Governments have subsidised from 80%, 70% to 50% of an employee's salary in the UK, France and the USA, respectively. 7 This aims to temporarily protect businesses and jobs whilst affording people to pay for necessities. Governments are providing support on mortgage repayments; in Spain and Italy, mortgage payments are suspended for 6 and 12 months, respectively. 8 Protection for businesses is provided through loans and grants.

The COVID-19 pandemic, caused by severe acute respiratory syndrome-associated coronavirus type-2 (SARS-CoV-2), is putting healthcare systems across the world under severe strain. Although COVID-19 is a mild to moderate febrile respiratory infection in most people, viral infection can trigger potentially fatal lung inflammation. We know that both COVID-19 and measures to reduce the spread of COVID-19 have disproportionately affected some populations groups including the elderly, ethnic minority groups, those with underlying health conditions and those on lower incomes. 9

As major economies pass the peak of infections fear of spiralling unemployment loom, KPMG, the global accountancy firm, estimates approximately 20 million job losses in the USA by the second quarter of 2020. 10 Europe has responded to EU hardships by releasing billions of euros to ameliorate the situation. 8 Japan injected a further 8.9 trillion yen ($82.6 billion) to cover the crisis. 11 The UK estimates 12 million people could be unemployed in the next quarter. 12 Political nervousness therefore seems justified.

Establishing strategies on restarting the economy must be balanced against the uncertainty of a possible second wave and overwhelming the healthcare system. Researchers highlight that saving lives through social distancing far outweighed economic damage. The analysis showed benefits outweighed the economic costs by $5.2 trillion. 13 There is no trade-off between saving lives and livelihood. 14 However, this next phase requires a more nuanced strategy taking into account not only immediate risk to life but longer-term risks of widening inequalities and falling life expectancy.

Numerous countries are beginning to ease lockdown restrictions and restart economies in different ways. There is therefore evolving, real-world data. This intelligence should be used dynamically by governments. Leaders are recommended to strategise for the long game whilst building in agility to respond to international learnings. A disproportionate economic intervention package should be put in place to match the disproportionate impact of COVID-19 on lower socioeconomic groups and ensure the opportunity of 'levelling up' is not lost. Dialogue and collaboration with business leaders and public and population representative bodies should inform the strategy, and this should be underpinned by investment in public health as restarting the economy in full depends on easily accessible testing and tracing, vaccination, treatment and care.

This study is limited to publicly available information. The COVID-19 pandemic and countries' responses are an evolving situation, and the information presented here was correct as of 24 May 2020.

Oxford COVID-19 Government Response Tracker, Blavatnik School of Government. Data use policy: Creative Commons Attribution CC BY standard

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Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study

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