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COVID-19 Policies from Around the World
Ideas meet action in public policy. At its best, policy policy can encapsulate the best evidence based analysis. To do that, elected leaders and appointed officials need information that summarizes research in a balanced and effective manner. They do not have the time, nor the patience, to wade through length technical papers. They also lack the expertise to grasp what most academic research is about, nor are they able to internalize the nuances of debate. An effective leader is more of a master of the possible than a master of the seminar room.
Thus, it is incumbent on the academic community to condense its labor into short discussions that are rigorous, accessible, and actionable. The COVID-19 crisis heightens the need for such communication. Immediately, medical researchers and epidemiologists will be called upon to offer help for the sick and dying, as well as help people avoid infection. Social science must also take a seat at the table. Why were some governments better at responding than others? What impact will virus prevention policies have on the poor and wealthy alike? What impact did these efforts have on the economy and was it worth it? Such questions will not be answered in the laboratory. They will be answered with the tools of sociology, political science, and related fields.
Modern communication technology makes it easier for scholars to start collecting information on policy responses to COVID-19. These op-eds do truly represent a global reflection on the global health crises unfolding before use. Using Ireland as a case, Joseph Whelan asks how the crisis might change the way we think about the social safety net. Ditte Anderson and Sine Kirkegaard explore how in Denmark public health is “co-produced” among various institutions. Eva Bogdan describes what might be termed a typical response by the Alberta government. Janet R. Hankin, Allen C. Goodman, and Sara H. Goodman outline the range of tools available to governments as they consider various infection reduction efforts.
These policy discussions are only the beginning. If there is any collective learning to be done about COVID-19 policy, it will start in this way.
– Rashawn Ray and Fabio Rojas
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- ”A Pro-Welfare Imaginary?” by Joe Whelan
- ”Alberta’s Response to COVID-19” by Evalyna Bogdan
- “The Co-production of Public Health: The Case of Denmark” by Ditte Andersen and Sine Kirkegaard
- ”Economic Models of COVID-19” by Janet R. Hankin, Allen C. Goodman, and Sara H. Goodman
A Pro-Welfare Imaginary? by Joe Whelan
In the face of continuing global developments arising out of the COV, SARS 2, COVID-19, CORONA Virus pandemic, the social contract is quickly being rewritten and the social safety net expanded as emergency welfare payments are being rolled out across jurisdictions. In this respect, Ireland has seen the introduction of a ‘COVID-19 Pandemic Unemployment Payment’ for those whose employment has been disrupted by the crisis. This particular measure appears to contain the vestiges of a social, alongside a health and economic response to the crisis. Other measures introduced under emergency legislation include, amendments to the Residential Tenancies Act to prevent evictions and rent increases for private renters during the period of the crisis. On the owner-occupier side of things, The Banking and Payments Federation of Ireland is offering a payment break to affected customers for up to three months and has adjourned all court proceedings for the same period. Many more measures, from both government and civil society, will undoubtedly be needed as unemployment is expected to rise to levels exceeding 10% in the coming weeks and months. This raises questions about how welfare provision will be further widened and, moreover, about how increasing levels of reliance on state welfare will be received in the public consciousness.
There is a historical precedent in Ireland for widening the social safety net in a time of burgeoning health crisis, although it is necessary to go back 123 years to the Poor Laws to find it. In Britain a new poor law, which replaced the Elizabethan Poor Laws, was introduced in 1834. Under this law, Poor Law Unions were established to administer relief. Each union was tasked to establish a workhouse and all forms of ‘outdoor relief’ and subsidies, which were viewed as undermining the work ethic, ceased to be available. Coupled with this, the application of the ‘workhouse test’ was to be applied uniformly. In practice, the abolition of outdoor relief meant that relief would only be available inside the workhouse. Alongside this, the workhouse test meant that conditions inside the workhouse should never be so good as to deter the poor from seeking work. Ireland, a colony of Britain at that time, saw the introduction of a Poor Law in 1838. The Irish Poor Law was based on the British model and involved the establishment of Poor Law Unions and the initial building of 130 workhouses which were to be run by boards of Poor Law Guardians and overseen by a London based Poor Law Commission. It is clear from how the Poor Laws were both conceived and actualized that they were underpinned by questions of deservingness. However, the Great Famine of 1845-52 in Ireland, during which over a million people died and a further million emigrated, effectively ‘broke’ the Poor Law system through exponentially increasing levels of demand. Conditions outside the workhouses were undoubtedly appalling as people literally starved to death in country lanes and city streets. As a result, the effectiveness of the workhouse test was completely eroded and this saw the (re)widening of the social safety net via the eventual re-introduction of outdoor relief in 1847, albeit in strictly limited form. This meant that relief was once again available outside of the workhouse, a facet of welfare provision that remains in Ireland to the present day. Nevertheless, despite loosening restrictions, the considerable social stigma that attached to the Poor Law and to the workhouse remained alive in the Irish welfare imaginary and this is where the parallel with the current health crisis ceases on the basis that stigma, in the context of emergency welfare or ‘poor relief’, appears to be largely absent at the current juncture.
If sustained, this represents a serious about turn. Work in the global north, in the sense of paid formal employment, is something that is strongly linked to feelings, experiences and inherent ideas of self-value and self-worth. This type of thinking also includes and incorporates a tendency towards the ‘valorization’ of work, and overwork, which together dominate popular and political discourses surrounding what it means to be of value and to be valued in modern western societies at least. Conversely, being in receipt of social welfare, of various types, is considered almost as the antithesis of being in work and is therefore seen as a deeply shameful social position. Despite this, and perhaps understandably given the present unprecedented global circumstances, welfare; that most stigmatized form of social altruism, is being welcomed and even demanded in the Irish context. The value of a strong social safety net in the form of universal welfare provision is being recognized. The social stigma that usually attaches to unemployment related benefits is nowhere to be seen, at least for now. Does this then represent an opportunity to establish the value of a functioning welfare system in public consciousness and in doing so foster a pro-welfare imaginary? Furthermore, will changes introduced now be easy to row back on once and if the crisis subsides? In a time of uncertainty, the opportunity to foster a positive sense of welfare that returns it to its altruistic roots and the ethos of a ‘welfare commons’ seems a vivid possibility. The Irish example of the COVID 19 Pandemic Unemployment Payment may be part of the catalyst for this. However, cracks may also quickly appear, and, in some respects, this has begun already. Initially established at a rate of 203 Euros per week for those who lost their employment due to the pandemic, the payment has since been increased to a rate of 350 Euros. The first figure of 203 Euros mirrored the basic adult rate of payment for welfare recipients across payments. The second figure is entirely novel. This is telling. In the first instance it tacitly acknowledges that the basic rate of social welfare was never enough to live on comfortably. In the second, it raises, once again, the specter of deservingness by drawing a distinction between those who ‘work’ and those who don’t or at least weren’t before the introduction of the emergency payment. The establishment mask is also slipping, with questions of ‘fraud’ in respect to the emergency payment being evoked in parliamentary debate. This suggests that fostering a positive sense of welfare, one based on solidarity and an ethos shared risk, is far from certain, despite the initial positive response.
Joe Whelan is a lecturer in the School of Applied Social Studies at University College Cork, Ireland. His research interests include the political economy of welfare and the lived experiences of welfare recipients.
Alberta’s response to COVID-19 by Evalyna Bogdan
In the province of Alberta, Canada, Premier Jason Kenney asserted: “This province is resilient and we are ready for the test.” (Black, 2020). In response to a growing number of COVID-19 cases, Alberta is taking aggressive new measures to respond to the pandemic. Alberta’s experience with disasters—2016 Fort McMurray fire, 2013 floods, and 2003 “mad cow” disease crisis—resulted in lessons learned. This article describes Alberta’s response to COVID-19 with a focus on policies that impact education, employees and employers, finance, and health.
State of Crisis
The first case of COVID-19 in Canada was confirmed on January 25, 2020. Less than two months later (March 19), there are 736 cases reported and 9 deaths in Canada and 146 cases and 1 death in Alberta. On March 17, Premier Kenney proclaimed that the COVID-19 “situation is very serious” (Black, 2020) and declared a state of public health emergency under the Public Health Act. The Emergency Management Act allows the government to enact several other emergency powers such as implementing emergency plans or programs, controlling or prohibiting travel to or within Alberta, procuring or fixing prices for flood, fuel, or other essential supplies. Alberta’s Emergency Management Agency (AEMA) leads the coordination and co-operation of all organizations involved in emergencies. On March 17, AEMA upgraded the Provincial Operation’s Centre from level 3 to 4, the highest level possible.
Limiting Community Transmission
The Premier announced new measures on “social distancing” to keep at least two metres distance between individuals to reduce infection. Social distancing efforts are made to “flatten the curve” on graphs depicting COVID-19 infection cases and to mitigate the pressure on health resources. Albertans are encouraged to stay home and limit outings. Travellers are asked to self-isolate for 14 days after their return as are those exposed to confirmed cases or feeling ill. Confirmed cases are asked to self-isolate until recovered and to avoid clinics unless they are having difficulties breathing. Employees are encouraged to work from home. Mass gatherings including religious gatherings, funerals, weddings, and conferences are limited to a maximum of 50 people. Public officials have banned other gatherings in entertainment, art, community, sports, and recreation centres and libraries. Prohibitions also include cafes, restaurants, and bars which are limited to the lesser of 50% capacity or 50 people and encouraged to provide take-out and delivery services. Grocery stores, shopping centres, health facilities, and airports are exempt from the 50-person maximum rule. Some stores are offering exclusive shopping hours for seniors and those with health conditions. Albertans and Canadians have responded to such restrictions by developing social media groups (with names such as “caremongering,” a play on “scaremongering”) to provide information, resources, and support.
Education
Childcare facilities, out-of-school programs, preschool programs, kindergarten to Grade 12 classes have been cancelled. Alberta is the only province without a timeline for return. Grades 1 to 11 students’ final mark will be their average mark attained prior to class cancellation. Grade 12 students will write diploma exams required for graduation and entering post-secondary institutions but the provincial assessment and achievement tests have been cancelled. Post-secondary institutions moved classes online. Academic research is to be reduced or paused by March 20.
Employees & Employers
The Employment Standards Code was amended on March 17, implementing job-protected leave. Employees working full and part-time (does not include self-employed or contractors) are allowed to take 14 days of job-protected leave if they are required to self-isolate or to care for a child or dependent adult that is required to self-isolate and will also be given a one-time payment of $1,146 to fill the gap until federal emergency payments begin in April. The one-week waiting period for Employment Insurance benefits has been waived by the federal government. Support for employers include deferring corporate income tax and instalment payments until August to increase employers’ access to cash to pay employees and continue operations. Small commercial customers, farmers, and residents qualify for a “utility payment holiday” for 90 days.
Finances
The Alberta provincial budget was passed on March 17 in one day with an unprecedented restricted debate. The Opposition leaders called the United Conservative Party’s (UCP) push to get the budget through undemocratic and as using the pandemic as a strategy to promote certain agendas. Among the budget $800M cuts was defunding of the Alberta Distance Learning program, a considerable loss given the value of distance learning during a pandemic. The budgets cuts are intended to reduce Alberta’s current $6.8B deficit which has been growing as a result of oil prices fluctuating since 2015 and plummeting in 2018: Alberta’s main revenue is from oil and gas. There have been new funding announcements in March for health care funding for COVID-19 response ($500M), funding for social agencies, adult homeless shelters, and women’s emergency shelters ($60M), as well as funding from the federal government to provinces. Canada’s six largest banks announced they will defer mortgage payments for up to six months for struggling clients.
Health
As of March 2020, all elective and non-urgent surgeries have been cancelled. The provincial government had announced drastic cuts to health care earlier in 2019, including eliminating 500 full-time nursing positions and changes to doctor’s fees and service delivery. Will these decisions be reversed to help fight the pandemic? One consequence of a weakened economy, job losses, and increased stress was that Alberta’s women faced the highest risk of domestic violence in a decade. The rate of domestic violence increases under quarantines as seen in China and following disasters such as Hurricane Katrina. Women’s shelters and sexual assault centers in Alberta were unable to meet demand prior to the pandemic and they are now bracing for a surge of violence linked to the latest social disruption from COVID-19.
Recommended Resources
Black, M. (2020, March 17). ‘The situation is very serious’: Alberta to declare a state of public health emergency over COVID-19. CTV News Edmonton. Retrieved from https://edmonton.ctvnews.ca/the-situation-is-very-serious-alberta-to-declare-a-state-of-public-health-emergency-over-covid-19-1.4856794
Evalyna Bogdan is a SSHRC Postdoctoral Researcher and a MEOPAR Postdoctoral Fellow at the University of Waterloo. Her research focuses on how diverse and competing priorities are navigated in policies and practices addressing socio-environmental problems, especially related to flood risk governance.
The Co-production of Public Health: The Case of Denmark by Ditte Andersen and Sine Kirkegaard
On March 11th, 2020, the Danish Prime Minister, Mette Frederiksen, announced extensive measures, such as a lock-down of all schools, to curb the coronavirus outbreak in Denmark. Before presenting a catalogue of measures to the public, Frederiksen made the following plea:
We are going to need good citizenship. We are going to need helpfulness. I would like to thank citizens, companies, organizers, NGOs – everyone who to this day have showed that this is what we have in Denmark – good citizenship. (Prime Minister’s Office 2020; translated from Danish)
This policy brief explores how Danish authorities aim to secure public health in cooperation with citizens, companies and civil society organizations in the midst of an unfolding pandemic. We build upon our ongoing research on co-production of health care in the Scandinavian welfare state of Denmark. The concept of co-production refers to modes of governance that encourage cross-sectorial partnerships and expect citizens, companies, NGOs etc. to cooperate in the production of desired outcomes such as welfare and public health. In this paper, we provide examples of co-production of public health, explicate the importance of generalized trust and responsive societal structures, and discuss how the current co-production strategy risk feeding into a nationalistic ‘us-them’ rhetoric.
Co-production of public health: Examples
At the current early stage of the pandemic, an abundance of co-production initiatives has emerged in Denmark. Some measures orient towards managing the health care crisis while others aim to cope with secondary effects of the virus such as practical challenges due to the widespread practice of self-isolation and home quarantine. The majority of these initiatives are small-scale and emerge in e.g. local sport clubs or neighborhoods. However – within days – some of the co-production initiatives have been established as formal and large-scale social enterprises and support networks.
One example of such a co-produced enterprise, that directly responds to the health care crisis, is the ‘Corona job-bank’. This is a register where volunteers with health care skills sign up to help alleviate the shortage of health care personnel which is expected to be an urgent reality very soon. Denmark is organized in five regions, and a few days after the Prime Minister’s first national press conference on the coronavirus, all five had ‘corona job-banks’ and several thousands of volunteers had registered. The volunteers include doctors, nurses and other health care workers that have retired or left the health care sector to pursue other careers. Volunteers are recruited by local health care units in need of assistance and they are to be paid in accordance with Danish union regulations.
Another example of a co-production initiative, that primarily aims to alleviate secondary effects, is the ‘Corona Support Network’, established by the Danish Red Cross, where more than 10.000 citizens quickly signed up to offer voluntary support to people who are in quarantine, sick or particularly vulnerable to the coronavirus. The network operates by matching a volunteer with a local citizen who lives in the same community. The volunteers provide practical assistance such as grocery drop offs, dog walking, medicine- and package pickup. The rapid establishment of co-production initiatives are facilitated by a general familiarity with voluntary work. Recent surveys show that about one third of the Danish population are already routinely involved in organized voluntary work, and the strategy to co-produce public health builds upon this.
Trust, collaboration and closed borders
Time will tell how effective co-production of public health will be in Denmark in the face of Covid-19. What we already know is that certain societal conditions amplify the chances of success. First, the collaboration between citizens, companies and civil society organizations requires mutual trust and Denmark has a long history of a high level of generalized trust. Second, a rapid mobilization of society requires structures that are geared to facilitate cooperation. In Denmark, one example of a key structure is ‘the Danish model’ where unions and employers routinely negotiate labor market regulations. As soon as March 16, the Danish state entered the first of a series of agreements with employers and unions to avoid mass lay-offs and business bankruptcies. This kind of cooperation reduce citizens’ fear of being fired and enable (in combination with a relatively generous level of cash benefits to unemployed citizens) people to stay home if they experience symptoms of coronavirus so they avoid infecting others. Hence, the cooperation between labor market parties stand to impact directly on public health.
Previous sociological research on pandemics found that “emerging diseases provoke common reactions, which are only slightly modified by national environments” (Dingwall, Hoffman & Staniland 2013: 172). Denmark is neither the first nor the only welfare state to encourage co-production in response to the threat of pandemics. It is worth noting, however, that the Danish authorities, exemplified by the Prime Minister, encourage co-production of public health in a nationalistic frame that link the practice to the enactment of ‘good citizenship’. Denmark was the first European country to close the borders, and the pandemic currently appears to reinforce an us-them rhetoric. In a fortress-like approach, Danes seek to help Danes and keep the suffering and chaos of the outer world at a distance. The ethics and viability of this approach stand to be tested.
Recommended Sources:
Dingwall, R., Hoffman, L. M., & Staniland, K. (2013). Introduction: why a sociology of pandemics? Sociology of Health & Illness, 35(2), 167-173.
Frederiksen, M. (2014). And mistrust take the hindmost: generalized trust in Denmark from 1990-2008. Nordic Journal of Social Research, 5.
Kirkegaard, S. 2020. The Everyday Drama of Coproduction in Community Mental Health Services: Analyzing Welfare Workers’ Performance as the “Undercover Agent” Symbolic Interaction (X), 1-24.
Kirkegaard, S. & D. Andersen (2018). Co-Production in Community Mental Health Services: Blurred Boundaries or a Game of Pretend? Sociology of Health & Illness 40(5):828–42.
Prime Minister’s Office (2020). Statsminister Mette Frederiksens indledning på pressemøde i Statsministeriet om corona-virus den 11. marts 2020. Available at: http://stm.dk/_p_14916.html (Accessed: March 20 2020).
Ditte Andersen is a senior researcher at VIVE – The Danish Center for Social Science Research and Sine Kirkegaard is a postdoctoral researcher the same place. Andersen studies social inequality and welfare state measures with a special attention towards vulnerable citizens, while Kirkegaard studies collaborative approaches to the organization of public and voluntary social services for citizens in need of mental health care.
Economic Models of COVID-19 by Janet R. Hankin, Allen C. Goodman, and Sara H. Goodman
Health economists have worked for many years in interdisciplinary teams with epidemiologists and sociologists to look at the implications of epidemics and pandemics. Working together we have constructed simple, yet powerful, analytic models that can provide insights into the transmission, immediate impact, and long-term consequences of epidemics. This essay provides such models to look at the economic impacts of COVID-19, as well as some policy prescriptions that follow directly. We present two models that refer to:
- Epidemics as “taxes”
- External transmission of epidemics, or “cigars”
Taxes
Economists have argued that epidemics constitute taxes on communities. The COVID-19 virus regrettably fits this model too well. For us, it has features of a sales tax AND an income tax.
Suppose that a taxing authority suddenly levied a sales tax of 100%, effectively doubling the prices of all goods and services. People would:
- pay more for what they buy;
- purchase less of what they buy, and switch to substitutes (which would also be taxed);
- “do without” entirely;
- buy goods or services on the “black market” or engage in other sorts of activities to avoid the tax.
Such a tax would severely damage commerce and lead to short-term economic hardship. We have already seen this type of impact with the COVID- 19 virus. Consumers have stopped traveling, going out for dinner, buying large- ticket items, and going to sporting events. Consumers have changed food- shopping habits. More affluent people can dip into savings and “ride out the storm”, at least in the short term. The poor have few such options.
COVID-19 also acts as an income tax. People’s incomes and wealth fall, activities slow, and there is decreased demand for goods and services. We have already seen this as well. Canceled activities and canceled purchases of both big and small ticket items all have major macroeconomic impacts. In the short term this has already meant pay cuts, and unprecedented lay-offs, further reducing incomes. Some, especially women, must stop working in order to take care of children and other family members. Many workers currently earn below the minimum wage and do not have paid sick leave, vacation benefits, adequate health insurance, or the option to work from home. The reduction in income for minority group members and poor people is exacerbated by the recent rules to “shelter in place,” which make it difficult for them to meet their basic needs. The reduced expenditures are not always offset by increased subsequent expenditures. China has seen this already, and we will see it soon.
Transmission
Transmission of COVID-19 introduces the concept of economic externalities. Most economic analysis starts with individuals who make decisions on buying and selling. People’s market decisions involve someone on the other side, but they don’t usually affect parties other than those doing the transacting. In contrast, a smoker lighting up a cigar alone in a desert bothers no one else; in a crowded room the smoker becomes a pariah because of the pollution. The pollution is an economic externality, impacting others who are not involved in the transaction. Epidemics such as COVID-19 provide just this kind of externality. “Social distancing” (now in place in most of the United States) is designed to mitigate this externality.
Epidemics can be addressed only by public health methods. Although a vaccination for COVID-19 is nowhere near, it is useful to look at models that apply vaccinations to influenza. Epidemiologists start with the Susceptible- Infective-Removed (SIR) model originally developed by Kermack and McKendrick and reinterpreted mathematically by Hethcote.(Hethcote 2000, Kermack and McKendrick 1927) This model relates the disease incidence to its (1) infectiousness, (2) the size of the population, and (3) the percentage of the population that is susceptible. R0, or reproductive rate is the number of susceptible people that one infected person can infect. The higher the reproductive rate, the more quickly an infection can spread (Van den Driessche and Watmough 2002).
Public health alleviation activities must target the three incidence factors above. Epidemic-related public health (i.e. government) interventions such as information, quarantine policies, or vaccines produce profound economic good. Sufficient vaccine coverage is needed to protect the population to attain “herd immunity”, which once achieved, will cause the rate of new cases to fall. The equation for vaccine coverage indicated by reproductive rate is 1 – 1/R0.(Scherer and McLean 2002) The 1918 influenza had an R0 value of about 2, implying that about 50 percent of the population would have required inoculation. Interestingly, those who would be vaccinated last “do not need” to be vaccinated because there is no one to infect them.(Coburn, Wagner and Blower 2009).
Policy
Given what we know about the “tax” and the “transmission” issues, what short-term policy implications follow?
- Sales Tax Response – Reduce state sales taxes to 0. Make commerce easier with drive-through and on-line shopping methods. These interventions (some already implemented) will effectively lower the COVID-19 tax, although they will not reduce it to zero.
- Income Tax Response – Restore demand by putting purchasing power in the hands of consumers. The Coronavirus Aid, Relief, and Economic Security Act (H.R. 748), passed on March 25, 2020 provides for one such payment to households. One check will not do it! Our proposal is for the government to send a $1,000 check EACH MONTH for six months to each of the approximately 130,000,000 households in the United States. The “back of the envelope” cost of this is $780 billion.
Transmission
Institute broad public health measures to reduce the infectiousness, the size of the at-risk population, and the percentage of the population that is susceptible. Such measures include:
- Testing extensively for COVID-19 and isolating the affected population.
- Implementing broad public health measures to reduce the infectiousness including “shelter in place” and “social distancing”.
- Assume responsibility at the federal level. Only the federal government has the financial resources to support these activities. The federal government can print money, borrow on international markets, and organize resources at the national level – options that are simply not available to even the most capable state and local officials.
We have variously characterized COVID-19 as either a “tax” or a “cigar.” We are circumspect in our claims. Economic models cannot cure COVID-19, nor can they alleviate pain and suffering, but they can provide valuable insights into characterizing diseases, proposing policies, and measuring the accompanying costs of disease-related policies and interventions.
References
Coburn, Brian J, Bradley G Wagner and Sally Blower. 2009. “Modeling Influenza Epidemics and Pandemics: Insights into the Future of Swine Flu (H1n1).” BMC medicine 7(1):30. Hethcote, Herbert W. 2000. “The Mathematics of Infectious Diseases.” SIAM review 42(4):599-653.
Kermack, William Ogilvy and Anderson G McKendrick. 1927. “A Contribution to the Mathematical Theory of Epidemics.” Proceedings of the royal society of london. Series A, Containing papers of a mathematical and physical character 115(772):700-21.
Scherer, Almut and Angela McLean. 2002. “Mathematical Models of Vaccination.” British Medical Bulletin 62(1):187-99.
Van den Driessche, Pauline and James Watmough. 2002. “Reproduction Numbers and Sub-Threshold Endemic Equilibria for Compartmental Models of Disease Transmission.” Mathematical biosciences 180(1-2):29- 48.
Janet R. Hankin is a Professor of Sociology at Wayne State University. Allen C. Goodman is a Professor of Economics at Wayne State University. Sara H. Goodman is a Doctoral Student in the Department of Population Health and Disease Prevention at University of California, Irvine.
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