Research Monitor

February 22nd 2021

Health

COVID-19 in Lusaka

A new study published in the British Medical Journal (BMJ) investigates whether African nations have escaped the COVID-19 pandemic as unscathed as conventional data suggest.

Official government statistics suggest that African nations have suffered remarkably low levels of COVID-19 infection and mortality overall. However, there is continued debate over whether this simply reflects lower testing capacity or whether Africa’s exceptionally young population has shielded it from the worst of the virus. To get a better sense of the true impact of COVID-19 on the continent, a team of researchers from the Boston University School of Public Health (BUSPH) performed post-mortem tests on hundreds of deceased individuals passing through the University Teaching Hospital morgue in Lusaka, Zambia. An estimated 80% of people who die in Lusaka pass through the institution.

The study found that 15-19% of recently deceased people arriving at the morgue between June and September 2020 tested positive for COVID-19. This figure peaked at 31% in July. In the United States and Europe, the majority of people to die from COVID-10 deaths have been older adults. However, in Lusaka the majority of the deceased tested were less than 60 years old, including 7 children. The latter deaths were surprising given how rare paediatric COVID-19 deaths continue to be elsewhere, but this finding does not establish that COVID-19 was the prime cause of these deaths. It does however suggest that the seroprevalence of COVID-19 is higher than conventional data implies and that in association with other conditions (such as tuberculosis, HIV-AIDS, alcohol misuse and diabetes) the mortality rate may be somewhat higher than previously thought.

These findings emphasise the urgent need for African nations to gain faster and greater access to the COVID-19 vaccines. Otherwise, the world risks allowing hundreds of thousands of unnecessary deaths on the continent, and continued development of novel strains of SARS-CoV-2.

Our Commissioner Siddhartha Mukherjee has similarly studied the surprisingly low COVID-19 mortality rates in India, Nigeria and other countries in this New Yorker article.

Life expectancy in the United States

A new report published by the American National Centre for Health Statistics (NCHS) calculates the impact of the COVID-19 pandemic on life expectancy in the United States.

Over the past year, the United States has suffered more deaths from COVID-19 in absolute numbers than any other country in the world. That death toll—which this week passed 500,000—will have had an impact on the average life-expectancy of the country. To establish a preliminary estimate of what that impact might be, Elizabeth Arias, Betzaida Tejada-Vera and Farida Ahmad from the NCHS used provisional mortality data in the United States between January and July 2020 to construct a series of life-expectancy estimates.

Their results were stark. The report estimates that life-expectancy at birth in the United States dropped by a full year in the initial months of the COVID-19 pandemic, from 78.8 years of age (2019) to 77.8 (2020). The difference was felt more acutely by men than by women. For men, life-expectancy dropped by 1.2 years (76.3 to 75.1). For women, the drop was 0.9 years (81.4 to 80.5). This reflects the fact that COVID-19 has killed more men than women globally.

The estimates also confirm that COVID-19 has hit minority communities much harder than white Americans. For non-Hispanic black Americans, COVID-19 has reduced average life-expectancy by a full 2.7 years (74.7 to 72.0). For Hispanics, life expectancy has fallen by 1.9 years (81.8 to 79.9). Finally, for non-Hispanic white Americans, life expectancy has dropped by 0.8 years (78.8 to 78.0).

As concerning as these numbers are, the worst of the COVID-19 pandemic only hit the United States in the latter half of 2020. As a consequence, the true cost to average life-expectancy is likely to have been higher.

Economics

A new paper published in the International Monetary Fund (IMF) Working Paper Series looks at the global COVID-19 R&D vaccine push to better understand the fundamental drivers of innovation.

The question of what determines innovation and technological change has long drawn the attention of economists. To disentangle the specific drivers behind the unprecedentedly rapid development of COVID-19 treatments and vaccines in the last year, Ruchir Agarwal and Patrick Gaule, two researchers at the IMF, compared data on COVID-19 R&D over the past year with historical data on R&D for treatments of other infectious diseases.

Traditionally, it is thought that the primary driver of R&D investment in a particular technology is the potential market size for a resulting innovation. The historical data on pharmaceutical R&D confirms that the market size of a potential treatment—which means a combination of prevalence of the disease and ability to afford medicines—is strongly correlated with R&D investment. Nevertheless, there is a notable “law of diminishing effort”, as the researchers describe it. As a disease’s prevalence grows, so too does investment in treatments but at an ever-slower rate.

However, COVID-19 R&D has bucked this trend, with investment 7 to 20 times greater than one might expect given the disease’s prevalence. The difference appears to have been the overwhelming investment by public research institutions, accounting for 70% of all COVID-19 clinical trials. It appears that early-stage incentives from governments (such as Operation Warp Speed in the United States) and other non-monetary incentives have also played a significant role.

Politics

A new paper published in the Centre for Economic Policy and Research (CEPR) publication COVID Economics investigates the repercussions of pandemics on social unrest.

In a pandemic, there are two countervailing forces when it comes to social unrest. On the one hand, the increased deprivation and frustration precipitated by a pandemic might increase the odds of broad social unrest. On the other hand, policies established to mitigate and combat a pandemic can also suppress social unrest by limiting the avenues for social activity. To investigate which of these forces wins out, Philip Barrett and Sophia Chen from the IMF made use of a new monthly dataset on historical social unrest in 130 countries to track levels of unrest during local epidemics and global pandemics.

In their analysis, Barrett and Chen discovered a notable positive relationship between epidemics and pandemics, and social unrest in the medium and long terms. However, in the short run the opposite is true. This suggests that the deprivation and frustration left in the wake of epidemics does indeed contribute to greater social unrest eventually, but that initial mitigation efforts successfully suppress both social unrest and the relevant disease.

The authors stress-tested these conclusions by looking at levels of social unrest immediately before and during the COVID-19 pandemic. They found that the same relationship has held.