Discover COVID cases with behavioural economics, not force of law
16 November 2020
The Hong Kong SAR Government, in its efforts to eliminate the SARS-CoV-2 virus from HK, is pursuing entirely the wrong approach to incentivise people with symptoms to come forward and be tested, breaking the transmission chains in the community. Put simply, there's no incentive to be tested, in the form of compensation for you and your close contacts if you are found positive. It's all stick and no carrot.
In an announcement and Gazette Notice on Saturday (14-Nov-2020), the Chief Executive in Council made a new law which provides for "Compulsory Testing for Certain Persons". The Secretary for Food and Health can announce categories of people to be tested. Also under the new law, a medical doctor may, if she suspects that a person has COVID-19, require that person to take a test. The word used is "may", not "shall", but it clearly puts pressure on doctors to test, for fear of being accused of medical malpractice.
That might on its face seem reasonable, but the financial and social consequences of being found positive and put into compulsory isolation, both to the patient and his close contacts, can be substantial. The new law deters such people with COVID-like symptoms from seeing a doctor when (on current statistics) they are far more likely to be suffering from influenza, tuberculosis or other respiratory illness than COVID-19. This could lead to larger outbreaks and deaths from those diseases by discouraging people from seeing doctors as we head into winter.
Ask yourself this: what do wet-market stall-holders, taxi drivers and construction workers have in common, apart from disproportionately high rates of COVID-19 relative to the general population? The answer is that they are mostly self-employed or work for a daily wage. If they don't open their stall, drive a cab (rented from the licence cartel) or come to the construction site, they don't get paid. By contrast, how many supermarket workers, franchised bus drivers and architects have you heard of catching the virus in HK? The big supermarket chains and bus companies employ far more people than wet markets. These are people on monthly salaries who qualify for statutory sick pay if they are off work through sickness. If they are feeling unwell, they are more likely to call in sick and see a doctor than go to work and expose others - indeed, their employers have a rational self-interest in encouraging the employee to stay away to prevent infecting other staff.
Other such categories include proprietors of small family-run restaurants. At least 3 of these categories (taxis, wet-markets and small restaurants) are customer-facing in which an infectious person can see far more people in a typical day than the average HK worker, increasing the propagation rate of the virus.
The COVID Isolation Compensation Scheme (CICS)
To rebalance the incentives, we call on the Government to establish the "COVID Isolation Compensation Scheme" (CICS), to pay a daily allowance to anyone who tests positive for the virus and to all of their close contacts, for the duration of their confinement in hospital or compulsory quarantine. We estimate, based on a substantial premium to the local median wage, that around HK$1,000 (US$129) per person per day would be sufficient incentive to encourage most (but not all) people who have symptoms to come forward for testing. This is pretty basic behavioural economics and will cost a tiny fraction of what other Coronavirus schemes have cost, including the madcap HK$81bn+ employer subsidy and the $70bn+ handout of $10k to each Permanent Resident. Even if 1,000 people are in compulsory isolation at a time, compensating them will cost only $1m per day or $365m per year.
No sane person would deliberately get infected, endangering their life for so little money, and given the low case rates in HK, it would be difficult to deliberately get infected anyway.
CICS will not only increase voluntary testing of symptomatic people, but it is also just and equitable that when a government, by force of law, deprives you of your liberty for the benefit of others, then that government should compensate you for any loss arising.
The Chief Executive, who by now is quite comfortable with making laws outside of the Legislative Council, can use Section 8(3)(e) of the Prevention and Control of Disease Ordinance (Cap. 599) to pass CICS. This Ordinance has been used for all the other Coronavirus regulations. Section 8(3)(c) already provides for compensation for the requisition of property (for example, taking over someone's ship or building as a field hospital). Section 8(3)(e) provides for "such incidental and supplementary matters as appear to the Chief Executive in Council to be necessary or expedient for the purposes of the regulation." Compensating isolated persons would fall squarely into that.
For the avoidance of doubt, people returning to HK and serving 14 days' inbound hotel quarantine would not be eligible for CICS, as that return is a choice they make.
© Webb-site.com, 2020