Študija: Ne popolno zaprtje javnega življenja, pač pa bolje ciljane spodbude za omejevanje fizičnih kontaktov

Kljub 10-tedenskemu lockdownu slovenski drugi val epidemije že 8 tednov vztraja na platoju okrog 20,000 okuženih in povprečnega dnevnega prirastka nekaj pod 1,500. V drugih državah, ki so uvedle lockdowne pred nami (Irska, Češka, Francija) ali istočasno z nami (Avstrija, Belgija, Nemčija), je prirast okužb hitro upadel (po ponovnem odprtju v začetku decembra je v Češki in Irski sicer število okužb spet eksplodiralo). Ta manjša učinkovitost v zamejevanju epidemje v Sloveniji govori o tem, da je v dizajnu slovenskega vladnega lockdown pristopa prisotna neka velika sistemska napaka. Vladni ukrepi kljub omejitvam gibanja med občinami, kljub nošenju mask tudi na prostem, kljub prepovedi zbiranja, kljub zaprtju vseh nenujnih trgovin, kljub zaprtju vrtcev in šol in kljub policijski uri ne uspejo obrniti krivulje epidemije navzdol.

Covid stanje_2021-01-09

Glede na to, da so ostale odprte le industrijske in storitvene panoge, kjer ni fizičnega stika s strankami, je očitno, da se lahko okužba širi le med zaposlenimi in se nato prek družin prenaša še na druge delovne organizacije. In že pred mesecem smo pisali o tem, da razlog najverjetneje tiči v neenotno urejenem bolniškem nadmestilu za okužene. Na kratko: če se zaposleni okuži izven službe, je upravičen do 80% nadomestila plače, ki ga plača zdravstvena zavarovalnica (ZZZS), če pa se okuži v službi, je upravičen do 100% nadomestila plače, ki pa ga plača delodajalec. Glede na te “sistemske spodbude” zaposleni torej raje prikrivajo, da so se okužili izven službe, sicer utrpijo upad prihodkov (20% + nadomestilo potnih stroškov in za malico) in hodijo v službo vse do zelo izrazitih simptomov. Delodajalcem pa ni v interesu, da bi ugotavljali okužbe med zaposlenimi, saj breme nadomestila plače za okužene, pade nanje. In to je ključna razlika v ureditvi nadomestila med Slovenijo na eni in Avstrijo in Nemčijo na drugi strani.

Kljub večkratnim pozivom vladi v zadnjem mesecu, naj poenoti sistem bolniških nadomestil za okužene s Covid, vlada tega ni naredila. Zato zaradi teh napačnih spodbud okužba s Covid pri nas ne pojenja in že 8 tednov vztraja na isti ravni.

Potrditev o pomenu zgodnjega in visokega bolniškega nadomestila za zmanjševanje števila okužb daje tudi nedavno objavljena empirična študija avtorjev Liming Chen, David Raitzer, Rana Hasan, Rouselle Lavado & Orlee Velarde (2021) z naslovom “What Works to Control COVID-19? Econometric Analysis of a Cross-country Panel“. Študija ugotavlja, da sistem sledenja pravzaprav postane učinkovit šele z učinkovitim bolniškim nadomestilom in da kombinacija obojega v povprečju zniža faktor okužbe za 0.2: “the effect of tracing on 𝑅𝑡 arises from the combined effect of contact tracing and providing PSL benefits. On average, economies with PSL and tracing experience a 0.21 unit of reduction in 𝑅𝑡 compared to economies only implementing tracing, meaning that one infected individual on average infects 0.21 fewer other people“.

Tudi iz tega sledi, da so za omejevanje okužb v prihodnje ključni ne popolni lockdowni, ampak predvsem bolje ciljani ukrepi omejevanja fizičnih kontakov in bolje ciljane spodbude za ljudi, da se izolirajo, kar povzroča tudi manjše ekonomske stroške od popolnega lockdowna.

Spodaj je nekaj izsekov iz študije.

We use cross-country panel data to examine the effects of a variety of nonpharmaceutical interventions used by governments to suppress the spread of coronavirus disease (COVID-19). We find that while lockdown measures lead to reductions in disease transmission rates as captured by the reproduction number, R_t, gathering bans appear to be more effective than workplace and school closures, both of which are associated with large declines in gross domestic product. Further, our estimates suggest that stay-at-home orders are less effective in countries with larger family size and in developing countries. We also find that incentives are very important, as efforts at ramping up testing and tracing COVID-19 cases are more effective in controlling the spread of disease in countries with greater coverage of paid sick leave benefits. As future waves of the disease emerge, the use of more targeted and better incentivized measures can help keep the epidemic controlled at lower economic cost.

Finally, we consider a potentially important measure of COVID-19 control that has so far been missed by the cross-country literature: the use of PSL benefits as a tool for incentivizing and enabling potentially infected workers to self-isolate. Although widely viewed as a key element of social protection policies, PSL can also play an important role in controlling the spread of infectious diseases. Indeed, the effects of PSL on the spread of diseases such as influenza has been well demonstrated in the scientific literature (Kim 2017). Workers without PSL are more likely to report for work when contagious—a phenomenon often referred to as contagious presenteeism—leading to a spread of disease among coworkers and others. Conversely, providing workers access to PSL has been shown to reduce the spread of contagious diseases (e.g., Pichler, Wen, and Ziebarth 2020; Pichler and Ziebarth 2017).

[…] we find most coefficients on the remaining NPIs to be negative and significant, and that the interaction term on contact tracing and PSL is the largest among all control measures considered. Specifically, when not controlling for PSL, tracing leads to a 0.16 unit of reduction in 𝑅𝑡 , and the coefficient is significant. But when tracing is interacted with PSL, the coefficient on tracing is no longer significant and its level becomes much smaller. On the other hand, the coefficient of the interaction term between tracing and PSL is negative and statistically significant, suggesting that tracing is effective in reducing 𝑅𝑡 in countries that provide PSL benefits. In other words, the effect of tracing on 𝑅𝑡 arises from the combined effect of contact tracing and providing PSL benefits. On average, economies with PSL and tracing experience a 0.21 unit of reduction in 𝑅𝑡 compared to economies only implementing tracing, meaning that one infected individual on average infects 0.21 fewer other people. We also find the coefficient on early tracing to be negative and significant.

Intuitively, offering PSL incentivizes workers who may be infected to report their symptoms and self-isolate. In the absence of PSL benefits, workers may choose to hide their symptoms or illness and continue to report for work and get paid. This is particularly relevant for COVID-19 where a large share of cases have mild symptoms or are asymptomatic, but are still capable of spreading the disease. When a worker with a mild case has to choose between staying at home and losing income or reporting for work and getting paid, the absence of PSL can nudge the worker to choose the latter even it means that they might infect coworkers. Providing PSL can not only reduce such “contagious presenteeism,” it is also very likely to make tracing of COVID-19 cases easier and more accurate.

Vir: Chen et al (2021)

One response

  1. “je očitno, da se lahko okužba širi le med zaposlenimi”
    malo nižje: “zaposleni torej raje prikrivajo, da so se okužili izven službe”
    Kje točno torej?
    Naj pomagam: okužbe se širijo na zabavah/druženjih/obiskih, znotraj družin, v službah. Kakšne točno so kavzalne povezave/dinamika, pa ne bom ugibal.

%d bloggers like this: