58 Suggestions for Reopening the Economy and Public Life while Continuing to Limit the Damage COVID-19 Is Doing
An earlier version of this article was published as a Google Doc on April 5, 2020.
COVID-19 poses a very serious threat: Many more people could die, either from COVID-19 — the disease caused by the novel coronavirus — or from other conditions that could not be properly treated because hospitals are running over capacity due to the influx of COVID-19 patients.
The current strategy that many Western countries follow is to try to ‘flatten the curve’. The goal of this strategy is to distribute the number of COVID-19 infections over a longer period of time so that hospitals don’t get overloaded in any particular period. In practice flattening the curve requires that we practice extreme forms of social distancing to reduce transmission rates, and hence that we shut down large sectors of the economy.
This too, however, has severe negative consequences: Tens of millions of people have already lost their jobs or seen their hours cut, businesses will go under, retirement accounts lose value etc. The economic, financial, political and social consequences of this are devastating and scary to think about. In addition, the sudden restrictions on civil liberties are unprecedented: People are no longer allowed to take to the streets to protest; Many are not even allowed to visit friends or family or go to their job unless government deems that job “essential”.
Moreover, even when it comes to health care, the lockdown may have serious unintended consequences: in preparation for the expected surge of COVID-19 patients many hospitals have suspended “elective” care and cut hours, which means important activities such as screening cancer patients for progress of the disease are put on hold. Fear of going to the hospital and getting infected with the virus also causes people who would benefit from medical care to stay home instead. Many carers are also staying home for fear of getting infected. In part as a result, nursing homes are hit particularly hard by the virus. Lastly, all the medical care that was put on hold during the COVID-9 crisis will cause a surge in demand once the lockdown is lifted, which will likely result in serious capacity problems.
At this point it is not even obvious that ‘flattening the curve’ is effective at achieving its narrow goal. Judging from results in South Korea, Japan, Taiwan, Sweden and other countries, shutting down the economy may not be necessary to deal with the virus in a harm-minimizing way. None of these countries are experiencing significant hospital capacity problems and their COVID-19 deaths per capita are similar to and often significantly lower than in countries that did impose a lockdown. Moreover, looking at countries such as Italy, Spain and France — hit hard by the virus despite many weeks of intense lockdowns — lockdowns may not even be sufficient.
In general, there appears to be no correlation between the intensity of a country’s lockdown and the number of deaths per capita in that country. If anything, the opposite seems to be the case, although many caveats apply (for example, different countries count COVID-19 deaths in different ways; countries already hardest hit may be more likely to impose strict lockdowns than those that aren’t; etc).
In addition, when it comes to reducing mortality rates the strategy has severe limits: Unless a vaccine and/or effective treatment is found in record time — and there is no guarantee we will be able to develop a vaccine or treatment within the next few years, or at all — a lockdown is not going to stop the virus. After all, the goal of the lockdown is not to prevent COVID-19 cases per se, only to distribute them over a longer period of time.
So lockdowns are problematic for a number of reasons. But what is the alternative? Are there effective ways to contain the pandemic or at least reduce the number of deaths as much as possible without imposing a lockdown?
First note that shutting down large parts of the economy is incredibly costly, almost unfathomably so. A lockdown means that large parts of the economy simply stop producing: Hundreds of billions of dollars worth of goods and services that could have been created are now not being created. Moreover, the stimulus packages intended to e̵n̵r̵i̵c̵h̵ ̵p̵o̵l̵i̵t̵i̵c̵a̵l̵l̵y̵ ̵c̵o̵n̵n̵e̵c̵t̵e̵d̵ ̵c̵o̵r̵p̵o̵r̵a̵t̵i̵o̵n̵s̵ ̵a̵t̵ ̵t̵h̵e̵ ̵e̵x̵p̵e̵n̵s̵e̵ ̵o̵f̵ ̵e̵v̵e̵r̵y̵b̵o̵d̵y̵ ̵e̵l̵s̵e̵ cushion the blow of shutting down the economy are incredibly expensive too. If the lockdown continues for much longer it will simply become impossible to compensate people for lost wages and revenue. So it makes sense to spend considerable sums of money on measures that could help to end the lockdown as soon as possible.
With that in mind, below are 58 measures we can take right now to reopen the economy in a responsible manner while continuing to limit the damage that COVID-19 is doing.
To be sure, there is no need to commit to all 58 measures. Different (private and/or government) decision makers have different powers capabilities and responsibilities; different situations require different solutions; and some solutions may work better than others. Moreover, as we develop more knowledge about Covid (the virus, the disease, prevention, treatment, transmission) and about the crisis and the effects of the measures we are taking, some of the proposed measures may simply stop making sense. There may also be other concerns — concerning civil rights, for example — that make some of the measures unappealing. Lastly, while some may disagree with the usefulness of some measures — e.g. universal mask wearing — it may still make sense to implement them if said measures have few negative consequences and can help persuade others to endorse reopening the economy.
So rather than committing to all of them, decision makers can simply use the list to choose those measures that are best suited for their situations and their powers, capabilities and responsibilities.
Please note that while this document refers to academic and other sources to argue for and/or against specific claims, the author has no specific expertise in any of the relevant areas. The document is intended primarily as a starting point for much needed discussion and research. It will be updated with new information when needed. Corrections, suggestions etc are very welcome at @koenswinkels or email@example.com. Please share and feel free to use any content, with or without attribution.
For an alternative take on the COVID-19 crisis, see this interview with prof Knut Wittkowski (summary) who argues not just that the lockdown cure is worse than the disease but that the disease is not as big of a problem as commonly thought, and that a lockdown actually makes the disease itself worse. For criticism of Wittkowski’s position see for example here. For his responses see here. Wittkowski is by no means the only expert who argues that the Covid problem is not nearly as great as often portrayed and/or that the lockdown is making things worse, see e.g. here, here, here, and also here (120 experts; in German but you can use an auto-translate extension). For 20+ interesting and varied perspectives on the crisis you can subscribe to this Twitter list.]
For a much shorter list of simple steps that may be effective against future respiratory virus pandemics see this article.
Reopen Public life
Allow both essential and non-essential businesses as well as other public spaces to reopen, under the following conditions:
1.Masks: Everyone should wear masks when in close contact with other people, both indoors and outdoors. While it is true that a mask does not offer 100% protection against getting infected or infecting others it is also likely that if a large enough percentage of the population starts wearing masks a lot fewer people will become infected (for counterarguments about the efficacy of mask wearing see here and here).
At least strongly encourage or require that people wear masks in public transport and in other closed spaces with multiple people and poor ventilation. Wearing masks outdoors, in parks etc is likely a lot less useful.
To the extent that shortages of masks remain, give the best masks (eg N95) to medical professionals and allow all other masks to be sold or handed out to the public. Also encourage people to make their own DIY masks. DIY masks are still a lot better than nothing.
Also keep reminding the public that masks don’t make them or the people around them invulnerable. Advise that people keep practising the other healthy habits.
Update December 5: With widespread mask usage seemingly having had little influence on the spread of the virus in many Western countries, and with few persuasive academic studies supporting the effectiveness of mask in reducing the risk for either the wearer or the people around them, the case for recommending universal mask usage seems considerably weaker than when this article was first written.
2.Healthy habits: Continue to encourage frequent & thorough hand washing, no hand shaking; ̶w̶a̶s̶h̶i̶n̶g̶ ̶g̶r̶o̶c̶e̶r̶y̶ ̶p̶a̶c̶k̶a̶g̶i̶n̶g̶; no face touching etc.
3.No Crowds: Events with big crowds should be cancelled and the organizers should be partially compensated. Professional sports leagues can resume but in empty arenas & with continuous testing (and maybe group-quarantining) of players, staff etc.
4.Clean Spaces: Require public spaces (stores, government buildings, public transport etc) to disinfect their facility frequently and thoroughly. Inspect often: Fine at a first violation, close at a second. Financially reward businesses that pass inspections. To minimize the potential for abuse and to ensure quality control all inspections should be video recorded.
Recent research suggests that the virus does not easily transmit via surfaces but for the time being it makes sense to better be safe than sorry.
5.Humidity Control: Humidity is likely a key factor in how easily the virus is transmitted. Specifically, a humidity level between 4,6 and 5,4 g/kg seems to be the most conducive to transmission. Research this in more detail and in the meantime, wherever humidity control is possible, aim for levels between 6 and 7 g/kg. In locations where climate control is difficult but where the temperature and humidity do cause a significant transmission risk — meatpacking plants, for example — look for additional solutions.
6.Avoid Closed, Unventilated Spaces with Multiple People Singing, Laughing etc: In general, being in close quarters and unventilated interiors, for a prolonged period of time, with people talking, singing, laughing etc, is a recipe for transmission disaster. For example, the forceful breathing action of singing disperses a relatively high number of viral particles into a room, which makes it more likely that others get infected and that they receive a large viral dose, which likely increases the severity of the disease. So for the time being, cancel events where people sing, especially in closed spaces with poor ventilation. In nursing homes any activities involving song should be cancelled. Wherever possible, windows should be open.
7. Avoid Superspreading Events: In general, avoid events with crowds in confined spaces, especially if there is singing, laughing and shouting involved (concerts, parties, but also sports arenas and stadiums) but also some forms of public transportation where there is a lot of touching of objects (straps, for example) or where people stand very close to one another. Events like that appear to have been major accelerators in this pandemic.
8.Bars & Restaurants: In restaurants and bars wearing masks is obviously a problem, so while servers and other staff should wear face masks, customers should not have to. To decrease the risk of transmission the maximum capacity of restaurants and bars should be reduced so that customers are not too close to one another. Establishments should be partially financially compensated for the reduction in revenue. ̶ ̶I̶n̶ ̶a̶d̶d̶i̶t̶i̶o̶n̶,̶ ̶e̶n̶c̶o̶u̶r̶a̶g̶e̶ ̶t̶h̶e̶ ̶u̶s̶e̶ ̶o̶f̶ ̶g̶l̶a̶s̶s̶ ̶o̶r̶ ̶p̶l̶a̶s̶t̶i̶c̶ ̶d̶i̶v̶i̶d̶e̶r̶s̶.̶ Whenever possible use humidity control to further minimize the risk of transmission.
9.Outdoors: People should be encouraged to go outdoors (sunlight, fresh air and exercise are good while the infection risk is minimal). Parks and other spaces should be open. Green spaces that are currently unused or underused should be made available and their use promoted. Moreover, whenever possible indoor activities should be moved outdoors or at the very least take place with the windows open. Natural air flow reduces the risk of transmission significantly.
10.Travel Bans: Travel bans may be significantly less effective at containing a pandemic than is often thought. Specifically, once significant community transmission already exists within a region or country, a travel ban may delay the spread of the virus by a few days or weeks but it will not prevent it. Screening prospective travellers for COVID-19 symptoms and banning those that do exhibit symptoms will still be useful to some extent. In some circumstances it could also make sense to require travellers to take a COVID-19 test before being allowed in. If a community has not yet been hit by the virus, extreme travel bans that isolate the community from affected regions will work better. The problem, however, is that the more the rest of the world has already been hit by the virus the more severe the negative economic and social consequences of such bans will be.
The goal is to take extra good care protecting vulnerable people in the period that the virus is active and until herd immunity is built up and/or a vaccine and/or treatment is available. If the rest of the population can more or less continue their daily lives and the economy can keep going, more resources will be available to spend on protecting the vulnerable. And to the extent that a larger percentage of the rest of the population builds up immunity this too will help to protect vulnerable groups later on.
11.Self-Quarantine: Vulnerable people should continue to self-quarantine and be provided with all the care and services they need. Unless very strict protocols to prevent infection can be established, do not let vulnerable people quarantine in the same home as other family members unless those family members 1) tested negative and 2) are also self-quarantining: The infection risk is simply too high when people live in close quarters with each other — like they do in homes, nursing homes & hospitals. This is a major reason why in the absence of pervasive testing putting everybody — instead of just vulnerable people — on lockdown may make the problem worse. Use and pay for hotels, AirBnBs and other currently underused facilities whenever extra capacity is needed. Consider paying people who meet certain criteria to self-quarantine.
12.Carers: Carers who tested positive for antibodies for the virus should be the first choice to assist vulnerable people as they have little to no risk of infecting others or getting infected themselves. Strict measures to prevent infection (for example, use of personal protective equipment) should nonetheless continue.
13.Outdoors: Opportunities for vulnerable people to be outdoors should be created as much as possible. At the very least encourage open windows for fresh air.
14.Quarantine but not Isolate: Strongly encourage ways in which people in self-quarantine can interact with loved ones and others without exposing them to risk. Pay special attention to people with few or no relatives (people with antibodies can play an important role here too).
15.Nursing homes: The risk of infection is high in nursing homes. And given the type of population the people who are infected will tend to have a considerably worse outcome than the general population. In a lot of areas nursing homes account for over half of all COVID-19 deaths. So a lot of additional resources need to be invested in preventing infection in these settings. Also consider awarding prizes for ideas for better protocols to prevent transmission. Because the risk of transmission is much smaller in open air settings, nursing homes should consider open air visiting hours.
16.Pay Carers a Lot of Money to Quarantine with the Vulnerable: Right now, the main infection risk for vulnerable people comes from the people who care for them. For example, if carers commute from home to work (often using public transport which seems to be one of the main sources of transmission) they may get infected and pass it on. How to prevent or minimize this risk? Pay carers a *lot* of money to be quarantined together with (in the same building as) the people they care for. If carers are paid $100,000 for 2 months of quarantine, many would happily do it. Same for nursing home staff in general, including non-carers who come into contact with the vulnerable or with the environments they are in, such as cleaning staff.
17.Use Special Transportation for Carers: If quarantining carers is not feasible, at least provide special transportation for their commute so that they don’t have to use public transportation. Google does this for its employees, schools do it for their students and airport hotels do it for their guests. Clean and disinfect the vehicles after every use.
18.Prisons: The risk of infection is very high in prisons too, although the average outcome of the illness will tend to be less bad than in nursing homes because the prison population is on average significantly younger and healthier. Still, invest a lot of money in providing prisons and prisoners with the soap and other disinfection materials they need, and develop rigorous protocols for disinfecting shared spaces. Also strongly consider releasing non-violent offenders deemed to be low risk if they have tested negative for the virus. If prisoners test positive, they should go to designated sections of the prison that are isolated from the rest of the prison.
19.Vitamin D: Vulnerable people should be encouraged to take vitamin D supplements to compensate for reduction in exposure to sunlight. Vitamin D seems to reduce risk of lung infections (it also seems to lower COVID-19 risk) and there is little to no downside to taking it as a supplement.
Testing & Tracing
To get a much better understanding of the spread of the virus, how deadly it is, how contagious it is and how many people already have immunity (based on the unproven but plausible assumption that people can’t get reinfected), and to be able to contain new outbreaks as quickly as possible we need a lot of testing and tracing.
20.Small Random Samples: Quickly and frequently test a small random (as random as possible) sample of the population (maybe 2,000 people) for:
- the virus (who has it?)
- antibodies for the virus (who had it?)
21. ̶M̶a̶s̶s̶ ̶T̶e̶s̶t̶i̶n̶g̶:̶ ̶E̶n̶c̶o̶u̶r̶a̶g̶e̶ ̶e̶v̶e̶r̶y̶o̶n̶e̶ ̶t̶o̶ ̶g̶e̶t̶ ̶t̶e̶s̶t̶e̶d̶ ̶f̶o̶r̶ ̶t̶h̶e̶ ̶v̶i̶r̶u̶s̶ ̶a̶n̶d̶ ̶f̶o̶r̶ ̶a̶n̶t̶i̶b̶o̶d̶i̶e̶s̶.̶ ̶M̶a̶k̶e̶ ̶t̶e̶s̶t̶s̶ ̶a̶v̶a̶i̶l̶a̶b̶l̶e̶ ̶a̶t̶ ̶h̶o̶m̶e̶,̶ ̶i̶n̶ ̶d̶r̶i̶v̶e̶-̶t̶h̶r̶o̶u̶g̶h̶s̶,̶ ̶i̶n̶ ̶s̶t̶o̶r̶e̶s̶,̶ ̶i̶n̶ ̶g̶o̶v̶e̶r̶n̶m̶e̶n̶t̶ ̶b̶u̶i̶l̶d̶i̶n̶g̶s̶ ̶e̶t̶c̶.̶ ̶M̶a̶k̶e̶ ̶t̶e̶s̶t̶s̶ ̶f̶r̶e̶e̶.̶ ̶C̶o̶n̶s̶i̶d̶e̶r̶ ̶p̶a̶y̶i̶n̶g̶ ̶p̶e̶o̶p̶l̶e̶ ̶t̶o̶ ̶g̶e̶t̶ ̶t̶e̶s̶t̶e̶d̶.̶
Update January 16, 2021: The benefits of mass asymptomatic testing are unclear at this point. Asymptomatic transmission appears to be very rare so there is not much point in testing people who don’t have symptoms. Pre-symptomatic transmission is more common but by the time people get their test results they will likely already have become symptomatic. Rapid antigen testing may be more useful, at least in some contexts. While the benefits of mass asymptomatic PCR testing are unclear the downsides are obvious: Besides the substantial costs there is the problem of false positives. The lower the incidence of the virus in a population the higher the percentage of positive tests that are false. Typically when somebody tests positive they will have to isolate and can’t go to their jobs or to school or see their friends or family. And often it is not just they themselves who have to isolate but their close contacts will have to quarantine as well. This puts unnecessary pressure on people and institutions. Take healthcare workers, for example: False positives means doctors and nurses and their close contacts have to stay home, thereby reducing healthcare capacity. False positives and true positives of asymptomatic people also create an inflated sense of the pandemic threat, which in turn can lead to unnecessary policies and excessive fear in the population.
22.Research Origins & Early Stages of the Virus: Pandemic models are based in part on assumptions about when the first cases appeared. There are reports of unusual forms of pneumonia in Italy, the US and elsewhere in late 2019. When possible, test those patients for COVID-19 antibodies to determine if the virus has been in Europe and the US for much longer than originally thought.
23.Genetic Sequencing Tests: Wherever available, use tests that let you test someone for all known and unknown pathogens in one go.
24.On-Site Waiting for Test Results: Keep people who are getting tested on-site until the results are in (use tests that give results within hours not days) to prevent infected people from going back home and infecting others on the way or at home.
25.Antibodies Certificates: Issue certificates to people who test positive for antibodies so that these people can be used for jobs that carry a significant risk of getting infected or infecting others. Suspend this practice the moment there is persuasive evidence that a person can be infected a second time.
Update April 2021: And *do not* introduce vaccine passports.
26.Share Results: Encourage sharing of test results in anonymized form in freely accessible databases.
27.Guarantee Free Treatment: To encourage testing and treatment guarantee that nobody who tests positive and who does not have insurance will have to pay for their treatment.
28.Pay for Missed Work: To encourage testing and treatment also guarantee that people who test positive and need treatment or quarantining will be paid at least 75% of their lost wages (the lower the income the higher the compensation percentage).
29.Tracking: Conduct detailed interviews with anyone who tests positive about who they have been in contact with in the past few weeks. Then contact as many of those people as possible and strongly encourage or incentivize them to get tested too. Also see to what extent it is possible to use cell phone location data of those who test positive to determine where they may have been infected and who they may have infected. Share all this data in anonymized form in freely accessible databases. Do note that the higher the infection rate is in a population, the more difficult and less useful it becomes to do contact tracing at scale. Also, for a general counterargument to the idea that tracking (via apps) is effective see here.
30.Volunteer Contact Tracers: Find a lot of volunteers to help with contact tracing. Make the forms they use as idiot-proof as possible so that more people are able to help.
31.Create Red and Green Zones: Based on the data gathered from testing and contact tracing locations (neighborhoods, towns, cities, regions) can be labeled as being at low (green zone) or high (red zone) risk of the virus spreading. Such maps could inform the public in their travelling choices and the lifting of restrictions on locations could be informed by/based on this data.
32.Track Hospital Capacity: To get a better sense of how the crisis is impacting hospital capacity, strongly incentivize hospitals to publish up to date numbers on use of hospital beds, in particular ICUs, and publish the results in freely accessible databases.
It should be noted that there is a risk in developing this infrastructure of testing, tracking and vaccines as described in the section above, especially if it comes in the form of ‘public-private partnerships’: It is quite possible that the virus turns out to be not nearly as dangerous as we were initially led to believe, that it actually is more akin to the risk of a bad flu season. This would mean that we may be turning a manageable passing problem into a chronic condition requiring a lot of resources and privacy-invading measures that a lot of special interests will be benefiting from. Those special interests will then have a strong incentive to lobby for the continuation of this infrastructure even if it doesn’t prove to be necessary or useful. We should be very alert to this danger.
The goal is to treat patients as quickly and effectively as possible with the means that are currently available while also reducing the risk of transmission and without overloading hospitals.
33.Pay Doctors & Hospitals to Continually Share Their Treatment Data: It is of the utmost importance that we find out which treatments work, and that we find this out as soon as possible. The entire world is working on this problem so there is a lot of experience to learn from. But this can only happen if the data is shared. In real-time. Continually. So that researchers can get an immediate, comprehensive overview of the different treatments that are tried and their success or lack thereof.
34.Telemedicine as First Point of Contact: To avoid spreading the virus people who suspect they have COVID-19 should NOT go to their GP but instead first contact a special COVID-19 hotline where an initial screening is done and people are separated into mild, moderate and severe. Once this pandemic is over this same model could also be used every flu season: It is a bad practice to make flu patients go to their GPs and make them wait with other (typically vulnerable) patients in the same confined space. So set up specific flu hotlines and flu clinics.
35.Avoid Hospitalization: The vast majority of COVID-19 cases are mild. To reduce pressure on hospitals only those patients who need specialized medical equipment and care (ventilators) should be hospitalized. If symptoms are deemed mild to moderate, care for patients should be provided at home or in special facilities. They should not live in the same house or facility as non-infected people unless the risk of infection is very low (for example, due to adherence to strict protocols). Patients at home should be constantly monitored to see if their symptoms (especially fever, pulmonary function tests, oxygen levels, inflammation) worsen. One simple, cheap device that can help with that is a pulse oximeter.
36.Visits: Every effort should be made to create protocols and other safety measures that allow close relatives to safely visit patients who are hospitalized, not just for comfort and companionship but also because loved ones can alert nurses when something is wrong.
37.BLS, ALS, RNs and NRs: Te reduce the workload of nurses and to improve patient comfort consider using volunteers (preferably those with antibodies) with relevant qualifications (BLS, ALS, RNs and NRs) to help in hospitals (doing simple tasks but also alerting nurses when something is wrong).
38.Strict Separation: To prevent COVID-19 patients from infecting other people in hospitals, they should be treated only in designated COVID-19 areas of a hospital that are fully isolated, or in specially created new facilities.
39.Telemedicine in General: To reduce the burden on hospitals and to prevent the spread of the virus by people making unnecessary trips provide as much COVID-19 and non-COVID-19 medical care online as is reasonably possible. But don’t overdo it. Don’t risk reducing in-person medical care by so much that it has deleterious consequences for patients’ health.
40.Expand Right-to-Try: Allow not just terminally ill patients to opt for experimental treatment. Encourage experimental treatment as long as data is continuously shared. Reserve the right to intervene if a jury of experts randomly selected from a larger pool of experts determines the treatment is too risky.
41.Hydroxychloroquine and Chloroquine: COVID-19 is a new disease and as a result there have not been any large RCTs to determine the efficacy of various treatment options. However, medical professionals in many different locations around the world appear to be having considerable success using hydroxychloroquine and chloroquine in early stages of the illness. Although the evidence of these drugs’ efficacy is by no means conclusive yet (and some say the evidence suggests it is not effective), there are no obviously superior alternatives available at this point. Moreover, the drug is relatively cheap and it has been widely used and studied for decades. It therefore makes sense to encourage medical professionals to seriously consider these as their first choice for treatment. Strongly encourage sharing of data and reconsider use if results are disappointing.
Update April 21: A new retrospective study finds increased mortality with hydroxychloroquine and no increased mortality with hydroxychloroquine and azithromycin. Do note that hydroxychloroquine, with or without azithromycin, was more likely to be prescribed to patients with more severe disease (though increased mortality remained after adjusting for that) while proponents typically argue hydroxychloroquine should be used as early as possible in treatment, which is not what happened in the cases this study is about.
Update April 2021: Although conclusive evidence is still lacking, the case for hydroxychloroquine does not seem to have become more compelling over time.
42.Proning instead of Ventilators: Ventilators can be a lifesaver, but they also can do considerable damage to patients and the survival rate of people on ventilators is shockingly low. An increasing number of doctors have success with using an alternative: Proning. Proning involves the patient taking oxygen through a mask (not ventilator) and then rolling onto their sides or on their bellies, to quickly have oxygen levels in their blood to normal levels. If more patients can use this proning technique instead of having to go on a ventilator it will also reduce the burden on hospital staff.
We need innovation in testing, treatment, vaccines, preventon, disinfection methods for consumer, commercial, transportation and industrial use, and many other solutions for the various problems the pandemic and our efforts to contain it have created. And we need them fast. Rather than a top-down government directed approach we should encourage bottom-up innovation. The goal is to harness the expertise, creativity and resources present throughout society.
44.Permissionless innovation: Switch from a precautionary principle framework to a permissionless innovation framework. Instead of having to first prove that a specific innovation is safe (a long, expensive and bureaucratic process) the burden of proof should be on those who wish to prevent or stop the introduction of that innovation.
45.Tort Law & Common Law: To curb excesses and prevent recklessness within a framework of permissionless innovation, use tort law, common law, class action activity, property laws, contract law and other tools. (p. 122)
46.Voluntary variolation: One possible way to create herd immunity fast is through voluntary variolation: There is strong evidence for the thesis that viral dose affects illness severity: Deliberately infecting volunteers with very small doses may make them immune without causing them to be ill. Once immune such people can be used to care for vulnerable groups and in general, to the extent that a virus is likely to infect a large part of the population anyway, deliberate low dose infection may significantly reduce severity of illness and deaths. And there are other potential benefits.
47.Controlled Human Challenge Trials: To speed up the development and rollout of vaccines, replace Phase 3 testing of vaccine candidates with a setup wherein volunteers who are previously uninfected, and at high risk of infection but low risk of complications or mortality receive the vaccine candidate (or a placebo) and after an interval to permit an immune response to the vaccine are administered a controlled exposure to the virus.
48.Research Airborne Transmission & Air Conditioning Systems: Recent anecdotal evidence suggests the risk of airborne transmission is higher than usually thought, at least in some contexts. It is very important to know if this is so. Prioritize research into this issue. Here’s an example of such useful research.
Another potentially important area of research and innovation is ventilation systems (i.e. air conditioning). It is likely that one cause of superspread events in e.g. hospitals, nursing homes, cruise ships etc is their air conditioning systems circulating air with droplets that contain infectious virus particles from room to room. It may be possible to have the system remove these particles from the air. Some interesting speculative ideas here and here. This is an important topic as transmission through AC systems could be a major source of transmission when reopening the economy.
49.Research Potency of Different Strains: It appears that some strains are considerably more dangerous than others. Prioritize research into this issue.
50.Research Immunity: It is crucial to know whether people who’ve had the virus become immune or could get infected a second time. Prioritize research into this issue.
51.International Cooperation: Encourage the sharing of ideas, research and personnel between countries. Cut as much red tape as possible. Provide 1-year visas to foreign scientists, researchers, entrepreneurs etc who have a sponsor or some party (university, business, investor, research institute etc) that will vouch for them, no (or few) questions asked. Also encourage scientists to go abroad to learn from the experiences in other countries, and share their expertise with those countries.
52.Subsidize Data Sharing: Find ways to incentivize the sharing of useful data (without incentivizing sharing of useless data).
53.Prizes: Create prizes for scientific and technological breakthroughs that might otherwise not be sufficiently financially rewarded. Jury members should be randomly selected from a larger pool of relevant experts. One non-technological/scientific example: It would be very good to have protocols in nursing homes that are relatively easy to adhere to but that are effective at drastically reducing the risk of transmission. At the same time, it is difficult to see easy monetization for ideas that can help with this. So a prize could be very useful to incentivize people from different areas of expertise to contribute to this project.
54.Continue Production: PPE and medical equipment such as ventilators will continue to be important and the risk of shortages remains. Continue producing such equipment and train staff to use them. To the extent that is possible, innovate so that e.g. ventilators and other devices become easier to use so that people can be trained relatively quickly to operate them in an effective and responsible manner. This additional capacity of equipment and staff will be useful for the future even if they turn out to be unnecessary in this pandemic.
55.Shame and Punishment: Fire the authorities who failed to properly prepare us for this pandemic, who hindered private efforts to develop and distribute tests and other equipment, who spread misinformation such as telling the public it was OK to go to big events o̶r̶ ̶t̶h̶a̶t̶ ̶(̶s̶u̶r̶g̶i̶c̶a̶l̶)̶ ̶m̶a̶s̶k̶s̶ ̶d̶on’̶t̶ ̶w̶o̶r̶k. At the very least publicly shame them, relentlessly.
56.Suspend Salaries: Give politicians and officials skin in the game. They should not receive salaries as long as the lockdown continues. If e.g. 10% of the lockdown is lifted they should get back 10% of their salary, if 50% is lifted they get 50% of their salary and so on. Cut their pay immediately if the number of infections (or deaths) starts to go back up by some percentage.
57.Get Rid Of Bad Models and Bad Modelers: Models play a huge role in preparing for and responding to a pandemic. But models are often way off. Start with several companies or even individuals who create models (provide as much data as possible so that even skilled outsiders could enter the ’market’) and closely monitor how accurate they are over time. Ditch the ones that perform worst after evaluation. Be very transparent about your deliberations concerning which models to base policy on and why.
58.NOT the New Normal: There should be a strong sentiment among the public and also in government that all intrusive measures (restrictions, privacy-invasive measures) should be ended as soon as possible, that this is not a new normal, and that we only had to resort to these emergency measures because of the spectacular failure of government to prepare us properly for this pandemic. The data gathered during this pandemic should be as anonymized as possible and once the emergency is over, any data that could not be properly anonymized should be destroyed. Tracking apps should be removed. We should be much better set up to limit the damage that future pandemics can do, putting effective measures & systems in place that threaten neither our civil rights nor our economic life. Start insisting on a path to normalcy right now.
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