Jun 18, 2020
It is not about time, but how one uses the time to fight COVID-19
Written with Thomas Taussi
We thank Wilder-Smith et al. [1] for providing a valuable perspective on COVID-19-induced lockdowns. There has been a myriad of ever-changing public health responses against the ongoing during the COVID-19 pandemic as well as new innovative community-led responses. Some of these, most notably countries in Asia, have been able to eliminate the spread.
Wilder-Smith et al. highlight the importance of time and timing in responding to this complex humanitarian crisis. We are especially thrilled by a paragraph that encapsulates a critical insight on lockdowns,
The lockdown is a window of opportunity to bolster basic public health systems. […] Lockdowns provide some additional time to build up basic public health interventions needed to suppress new outbreaks without having to reinstate the economically damaging lockdown measures necessarily.
We want to point out that this view, stressing the importance of time, is best captured by real options theory. [2] Countries that implement lockdown measures, or otherwise strictly restrict everyday societal activities, to fight against the disease are paying an immediate price for the additional time they perceive necessary to acquire, rather than exposing the whole society to tail risk, under extreme uncertainty. [3]
In the case of communities responding to the immediate threat of COVID-19, there are significant uncertainties that relate to several aspects of the pathogen and the virus itself. When the big picture of COVID-19 is uncertain, many experts tend to rely on numerous assumptions based on past experiences and knowledge. As the complex situation unfolds and things change, assumptions can turn out to be misleading as one might not consider distinct but intricate issues such as long-range connections and connectivity. [4]
In theory, it is possible to estimate the cost of lockdown measures. Still, on the other hand, it is improbable that we can predict with any certainty, something that is highly unpredictable and uncertain. Therefore, as Wilder-Smith et al. cleverly argue, it would have been much better if countries had prepared for the pandemic via specific necessary capabilities, thus minimizing the overall costs and damages caused by unpreparedness. In the case of an effective and orderly lockdown, costs induced by this intervention would become limited sunk costs as a tiny number of people in the contained transmission is much easier to test, track, isolate and treat than active transmission. [5]
We recommend complementing discussion around lockdowns with additional considerations on real options theory as real options, in general, are used to seek benefits from asymmetries, limiting downside without losing flexibility and the possibility to change the course of action as new data emerges drastically.
Instead of committing to an inflexible decision that could have significant downsides, a minor upfront investment (e.g., investing in early testing and border control measures) might grant access to the apparent upside as the future unfolds.
Thus, as Wilder-Smith et al. at least implicitly seem to think, a lockdown is a real option that can be expected to improve subsequent decision making in the future. Here is where public health scholars may often underestimate real options: while extra time is necessary, time is not the real driver of successful action. What makes the difference, in the end, is how the government uses the time one acquires via the “opportunity,” or option in more formal terms, to which one has committed oneself by enforcing lockdown procedures. Furthermore, there are matters that we might never know, or the time needed to know something is too long to inform any immediate further action.
Two crucial issues remain to be considered by public health scholars: How one uses the extra time that lockdowns have supposedly generated in the most effective way to minimize unnecessary suffering and maximize human flourishing? Is time a resource to generate future action, or is it used only to observe and follow whatever seems to be rational at any given moment?
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[1] Wilder-Smith A, Bar-Yam Y, Dale Fisher. Lockdown to contain COVID-19 is a window of opportunity to prevent the second wave. J Travel Med 2020.
Published: 30 May 2020
[2] Trigeorgis L. Real Options: Managerial Flexibility and Strategy in Resource Allocation. Cambridge, MA: MIT Press, 1996.
[3] Caggiano G, Castelnuovo E, Kima, R. The global effects of Covid-19-induced uncertainty. Bank of Finland Research Discussion Papers 2020.
Published: 8 June 2020
[4] Rauch EM, Bar-Yam Y. Long-range interaction and evolutionary stability in a predator-prey system. Phys Rev E 73 020903(R), 2006.
Published: 27 February 2006
[5] Ferretti L, Wymant C, Kendall, M et al. Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing. Science 368(6491), 2000.
Published: 8 May 2020
Written by Thomas Brand & Thomas Taussi.
The opinions expressed in this blog are strictly those of the authors. They should not be construed as the opinion(s) and position(s) of their current or former employers or the institutions with which the authors are affiliated.
