Sliding Doors

Pandemic-hit countries were faced with a choice. But that choice had big consequences.

According to the WHO, the COVID-19 outbreak is the worst pandemic of our modern times. Country after country seems to be falling under its grip.

As the virus spreads, we see their various responses: going into total lockdown, staying open with fingers crossed, relying on citizens to keep the virus at bay, using government powers to the full, or, in the case of Turkmenistan, denying that the outbreak even exists.

But let’s look back to the early days, when the “novel coronavirus” was just breaking out. The first round of cases was apparently isolated in China, and turned into a national emergency just as Chinese families were about to celebrate Lunar New Year.

The second cluster country was Korea — and the city of Daegu in particular.

Both countries took very different approaches to handling the pandemic. Both approaches worked equally well. But if we peer below the surface, we find this decision is crucial. In fact, it’s a classic “sliding door” moment — a phrase that comes from a 1998 sci-fi movie.

Helen Quiley, PR representative, has just been fired from her job. While travelling down in the lift, she clumsily drops her earring, which a man picks up for her. Still flustered, she tries to make her way home, and eventually finds herself racing across a London Underground platform with the train just pulling out.

She runs towards the train, but swerves to avoid a wayward child in her path, and misses the closing doors by a hair’s breadth. To add to her woes, she then hears the next train service will be delayed, so ends up having to hail a taxi home. And so the troubles go on…

But wait. Rewind.

She runs towards the train. The wayward child gets pulled out of the way by motherly hands, and Helen manages to wedge her elbow into the closing doors. In she gets, and ends up sitting next to the man from the lift — who is very helpful, and eventually encourages her to start her own PR firm.

The coronavirus outbreak has just begun, and people are starting to get infected. To make things worse, it’s happening during the Lunar New Year — a festive time when everyone is travelling to and fro to meet their friends and families. And so, the government quickly swings into action.

China declares a national emergency, and the government uses a strategy which I will refer to as ‘Containment’. This involves acting with a heavy hand to keep people apart and contain virus spread.We have forced closures in businesses, total lockdown of ‘cluster’ areas, and inhibition to leave homes for the population. Police and surveillance cameras make sure people don’t step out of line — a bit restrictive, but then it’s for your own good.

But wait. Rewind.

Korea sends a strong message to its people about the lockdown, but it follows a different strategy — one which I will refer to as ‘Behavioural’. Authorities specify a list of prudent conducts. It advises people on what to do and what to avoid, but, instead of enforcing this with cameras and police, it relies on the population — both businesses and individuals — to comply with the rules themselves. Stronger enforcement is possible in geographically defined clusters.

Helen, the lead character in the movie Sliding Doors, lives two parallel existences. One shows what happens after she misses the train, and the other what happens when she manages to catch it.

Directed by writer-director Peter Howitt, the movie shows how small, seemingly inconsequential decisions can have a big impact: the mother’s hesitancy in pulling her child back sends Helen’s life into a downward spiral, while holding the child makes Helen’s life comparatively less unhappy. The movie alternates between these two narratives, showing what happens in each case.

One interesting point is that both life trajectories have elements in common. The ‘sliding door’ moment modified her life, but some things still stayed the same.

Our coronavirus sliding door moment has common elements too. Both China and Korea conducted extensive testing to see if people were infected, and, if they were, kept them mandatorily isolated in hospitals or clinics. Keep this in mind, because it’s important for what is to follow.

Both strategies worked handsomely too. For the first infection waves in China and Korea, the time-to-peak (after which the number of cases would stop rising and start going down) was 16 and 11 days respectively.

In this article, I argue that when the virus hit, Italy experienced one such sliding doors moments.

When, around the end of February, the disease was detected in significant numbers in Europe, with two huge Italian clusters in Lombardia and Veneto, authorities had the choice between two winning strategies: the one I call ‘Containment’, or its alternative, ‘Behavioural’.

Italy quickly followed the steps of China. Other countries, after initial hesitations, followed suit: among major countries, only Sweden has opted for the ‘Behavioural’ strategy.

While choosing a strategy for itself, Italy had inadvertently chosen for everyone else as well. Does this matter?

There are two categories of pandemics’ costs. There is the human cost, in brief, the death toll. But there also is an economic cost, or the loss in economic activity caused by the epidemics.

These two costs can be either small or very large, depending on whether it’s a minor (and short-lived) infection event or a large (and long-lasting) epidemics. However, they create a trade-off for public health authorities, who have to choose between how severe the outbreak will be, and how long it will last.

If they opt for the behavioural way, and rely on people to keep themselves safe, their hospitals would quickly fill up and the whole public health response would choke. But should they choose to contain — as has now been done in almost all the affected countries— then they’d end up triggering large-scale economic damage.

Does this choice affect the outcome? Looking at China and Korea, it does not seem to matter much. Yet for Western countries, this sliding door moment would have been one of long-lasting consequences.

It becomes crucial insomuch as most of the Western countries, especially at the start of the epidemics, have been deviating from China and Korea on two determinant elements. Their testing has initially been much more limited (except in Germany), and symptomatic people have been told to self-isolate at home rather than in hospital.

These two differences may be minor, but they add up. And their cumulative effect is to increase the time it will take before infection rates go down. Without pervasive testing and hospital admittance for infected patients, it is reasonable to argue that it takes longer to reach infection peaks. Less strict arrangements means more chance for the virus to spread, and more time taken till it’s brought under control.

This has been the case in all European countries, the U.S. and other Western democracies.

Why time is important? Because the cost trade-off between the two alternative public health strategies evoked above only holds in short-term.

The ‘Containment’ strategy will save more lives than the ‘Behavioural’ — but only if the time it takes for the epidemic to abate is relatively short. If not, the economic damage would be so profound that misery, hunger, and poor hygiene will lead to an acceleration of fatalities indirectly caused by the original infection. The same number of people would die, albeit for a different reason.

Like with the dual story of Helen Quiley, things diverge for a bit, but they also come back to the same point if you stick around long enough.

Here lies an interpretation key of the choices made by China and Korea. Pre-virus, the Chinese economy was ‘officially’ growing at 6%. Even if this overstates actual economic growth, one or two ‘blank’ months followed by a gradual restart of the economy could be partially absorbed by brisker economic activity before and after. For Korea, with a potential GDP growth rate of merely 1.5%, a public health policy very heavy on economic consequences was less optimal than a choice.

What about the West? ‘Containment’ is a calculated economic risk for countries with brisk economic growth, or where public budget surpluses make it possible to act with decisive fiscal policies to protect the economic structure. This is especially true, if weakness in public health infrastructure — lack of sufficient hospital care, insufficient testing, infections among healthcare personnel — makes you at risk of a longer time-to-peak.

But if economic shock absorbers are not there, as in the majority of the countries in the West, then ‘Containment’ becomes a choice that is more dictated by public pressure, rather than the result of a serious assessment of costs in a holistic manner.

A better choice for the West, I feel, would therefore have been a true ‘Behavioural’ strategy. Governments today are disbursing funds to enforce containment, and to pay wages for workers from private companies. This makes sense, because it’ll help avoid mass unemployment and corporate bankruptcies. But instead of spending money there, what if the governments had focused on acquiring or making test kits, and setting up make-shift ‘fever’ clinics to treat diagnosed patients away from their homes?

This is not ‘not caring’ for the humanitarian aspect. On the contrary — considering that this is virus that kills ‘only’ approximately 2% of the infected — by protecting the economic structure of the country, it is creating the conditions for a better recovery of personal situations and household stability as well.

It is not too late, and in the unfortunate situation that peak infections come much later in the year, many countries might switch to a ‘behavioural’ strategy, especially as more efficient testing becomes available.

The situation, eventually, will be in check. But with our puzzling unpreparedness and sub-optimal choices, we would have created long-lasting disruptions in supply chains and the industrial texture of the West. And a significant shift in the geo-political balance of the world, tilting more and more on the East’s side.

Scrolling through my feed, I learn that Peter Howitt, director of Sliding Doors, is all set to make a new film set in COVID-19 time. Called Lock Down, it will tell the story of seven different characters with different backgrounds, whose stories are thrown together as the pandemic unfolds across the planet.

Ironically, while the story is set during the pandemic, the company behind it is already looking ahead to a post-lockdown world: a world where film shooting and production can continue unhindered.

As Korea announces a second spike in cases and China spots minor hotspots flare up once in a while, we are reminded that the crisis is far from over — but also that people are learning to cope with it and move on. Lockdown or no lockdown, humanity will eventually find a new normal to settle into.

We just need to decide what’s the best route to get there.