Welcome to Plugging the Gap (my email newsletter about Covid-19 and its economics). In case you don’t know me, I’m an economist and professor at the University of Toronto. I have written lots of books including, most recently, on Covid-19. You can follow me on Twitter (@joshgans) or subscribe to this email newsletter here.
One of my pet theories is that we actually did exceptionally well in handling this pandemic. I have been reading a book by Lawrence Wright called The End of October. It is a fictional account of a global pandemic in 2020. It came out in April so was written prior to this. Wright recently wrote an account of Covid-19 in The New Yorker which I recommend, called “The Plague Year” so he has the advantage of knowing his stuff. Interestingly, what grabs you about Wright’s fiction is how much worse he expected it all to be. In particular, both from the government response but also from individuals basically doing little initially to protect themselves. By contrast, for Covid-19, individuals globally reacted very quickly. As I outline in this article in Stat, I credit the Internet for this. I consider this as evidence that people exceeded expectations.
That is just my (controversial) thesis. But a new paper provides some insight into this. It has many co-authors including my colleague Laura Derksen and it looks at information and its role in pandemic management in four countries in Africa. Here is what they do:
We analyze the level of health knowledge and whether health knowledge increased the adoption of NPIs such as mask-wearing and social distancing using detailed survey data from four African countries collected early in the pandemic, early April through mid-June, less than 2 months after the virus was first reported in each country. Our countries represent varied geography–West, East, and Southeastern–and income–lower-middle and low income. We asked people in Ghana, Malawi, Sierra Leone, and Tanzania about their knowledge of coronavirus symptoms and transmission mechanisms, their and their household’s experience with social distancing, and how their households were affected by the pandemic. With unified measures across four countries, we compare the knowledge, risk mitigation practices, and consequences of the pandemic (including associated lockdowns).
The surveys are not a very large sample — a few hundred people in each case — but with a high response rate. The interesting thing is that the four countries had some different strategies giving rise, superficially, to some difference in trends on knowledge.
This translated into different protective and social distancing patterns.
There are four main findings:
1) We find high levels of knowledge that are associated with increased take-up of risk mitigation measures–the the average respondent correctly reported 3 symptoms, 2 transmission mechanisms, and almost no incorrect symptoms or transmission mechanisms and undertook 2.3 “effective” protective measures.
2) Early government action, including messaging, mask mandates, and lockdowns led to meaningful behavior change–we found about a 50 percentage point gap in mask use between the mask mandate (Ghana and Sierra Leone) and non-mask mandate countries (Malawi and Tanzania) with a similar gap in the likelihood of coming into close contact with another person at a house of worship between countries that mandated their closure (Ghana and Sierra Leone) and those that did not (Malawi and Tanzania).
3) Knowledge was not sucient for adoption of social distancing, behavior that is likely the most effective at reducing disease transmission. The average respondent patronized 3.1 different places in the last week where they were in close physical contact with people outside of their household, often in places satisfying basic needs, i.e. transportation, markets, and shared toilet facilities. However, non-essential contacts were also common—46 percent of respondents on average reported visiting another person’s home in the previous week.
4) Across all countries this pandemic and the policies enacted in response, had severe impacts relatively early–54 percent of respondents reported income loss as a result of the pandemic and 49 percent reported increased stress.
These results are indicative and interesting but not conclusive. Nonetheless, they do suggest the importance of enabling people to manage their own risk and how policies, information and mandates translate into population-level behaviour.
What did I miss?
Science and the policy response