富国和穷国社会距离的利益和成本
The Benefits and Costs of Social Distancing in Rich and Poor Countries
摘要：
社交距离是对抗COVID-19疫情的主要政策处方，并已在欧洲及北美广泛采用。我们使用一个流行病学模型来估计避免疾病的价值，该模型预测了COVID-19在富国和穷国的传播。预计在高收入国家，“拉平”疾病曲线以使需求在医疗保健系统的能力范围内的社会距离措施将挽救许多生命，因此实际上任何经济成本都值得承担。据估计，这些社交距离政策在贫穷国家的效果较差，因为这些国家的年轻人口不太容易感染COVID-19，而且医疗保健系统也较为有限，在大流行之前已经不堪重负。此外，社会距离通过限制人们的经济机会来降低疾病风险。穷人不太愿意做出这些经济牺牲。与感染COVID-19相比，他们对生计问题的重视程度相对更高。在较贫穷的国家，社会距离的流行病学和经济效益要小得多，不仅如此，这种政策还可能对最贫穷和最脆弱的人造成沉重的代价。非正规部门的工人缺乏资源和社会保护，无法自我隔离，牺牲经济机会，直到病毒消失。通过限制他们谋生的能力，社交距离可能导致饥饿、贫困和相关死亡率和发病率的增加。我们主张探索替代性的减少危害策略，包括普遍采用口罩和增加卫生措施，而不是全面采取社交距离措施。
英文摘要：
Social distancing is the primary policy prescription for combating the COVID-19 pandemic, and has been widely adopted in Europe and North America. We estimate the value of disease avoidance using an epidemiological model that projects the spread of COVID-19 across rich and poor countries. Social distancing measures that "flatten the curve" of the disease to bring demand within the capacity of healthcare systems are predicted to save many lives in high-income countries, such that practically any economic cost is worth bearing. These social distancing policies are estimated to be less effective in poor countries with younger populations less susceptible to COVID-19, and more limited healthcare systems, which were overwhelmed before the pandemic. Moreover, social distancing lowers disease risk by limiting people's economic opportunities. Poorer people are less willing to make those economic sacrifices. They place relatively greater value on their livelihood concerns compared to contracting COVID-19. Not only are the epidemiological and economic benefits of social distancing much smaller in poorer countries, such policies may exact a heavy toll on the poorest and most vulnerable. Workers in the informal sector lack the resources and social protections to isolate themselves and sacrifice economic opportunities until the virus passes. By limiting their ability to earn a living, social distancing can lead to an increase in hunger, deprivation, and related mortality and morbidity. Rather than a blanket adoption of social distancing measures, we advocate for the exploration of alternative harm-reduction strategies, including universal mask adoption and increased hygiene measures.
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