Negative Externalities and Communicable Diseases

Will we internalize these externalities going forward?

Lisa: (sneezes, moans and blows her nose)
Marge: Mmmm, how you feeling, sweetie?
Lisa: (nasally) Much better. (sneezes loudly)
Marge: Oh, my, you're burning up. I'm going to tell the school you're staying home. (picks up the phone)
Lisa: (pressing down on the receiver) I'm afraid I can't allow that.

My wife and I visited Japan in late 2019. Like most Westerners visiting Japan, I was struck by the number of people wearing masks in public. Of course, this makes sense when considering Japan’s recent history of public health scares and its collectivist culture. It’s no surprise then that Japan has been fairy successful at limiting the spread of COVID:

In the United States, while communicable diseases like the flu predated COVID, those diseases were not as salient or visible. I believe the COVID pandemic is a one-time shock that will cause a notable number of Americans to make enduring changes to their behavior concerning all communicable diseases. While the United States is an individualistic culture as a whole, many Americans have voluntarily modified their behavior to avoid spreading COVID to others (above and beyond just getting vaccines). Going forward, it seems likely that many people will feel more empowered to actually take sick days when they are sick.

I keep thinking about the degree of culpability we should assign to high-risk behaviors in a pandemic. Some people seem willing to risk spreading disease in public but would never consider taking those same risks if it put their family and friends at risk. I don’t mean to single out Zvi Mowshowitz here because I’m sure his views are widely held:

Which seems exactly right. Some amount of transmission is inevitable, and we make trade-offs. That doesn’t mean that you can’t make different trade-offs with the people you care about, or adapt your actions to different situations. Would I go out to the grocery store five days after my positive test if I have a negative one? Maybe. Would I go to grandma’s house? Absolutely not.

So someone might decide they don’t want to visit their grandma because they might have COVID but would feel comfortable going grocery shopping (perhaps where someone else’s grandmother works or shops). While the individual risk of interacting in a grocery store may be small, there is the potential that a single infection of another person ends up spreading many times over, endangering many others.

I’m not sure if there’s an easy way to internalize these externalities. Realistically, I think we’ll have to look to coworkers and members of the public to use moral suasion to convince people who are visibly symptomatic to stay home.