Economic Growth Initiative

Research

As the COVID-19 pandemic continues to have serious economic implications, many researchers have accelerated their investigations to better understand the potential short-and long-term effects on workers, businesses and the economy at large. On this page, we present a select list of recommended academic studies and empirically rigorous reports that focus on the economic impacts of the COVID-19 pandemic. These studies are primarily early working papers, and have not been vetted by the peer review process, so check back regularly for updates. In addition, we will update this page with other studies as they are released.

All NBER papers related to COVID-19 are open-access: https://www.nber.org/wp_covid19_rco_07062020.html

Recommended Research

Brown A., E. Ghysels, and L. Yi, 2020, Estimating Undetected COVID-19 Infections—The Case of North Carolina, UNC Kenan Institute working paper.

Acemoglu, D., Chernozhukov, V., Werning, I., & Whinston, M.D., (2020). Optimal Targeted Lockdowns in a Multi-Group Sir Model (NBER Working Paper No. 27102) Retrieved from: National Bureau of Economic Research website: https://www.nber.org/papers/w27102

Chetty, R., Friedman, J.N, Hendren, N., & Stepner, M. (2020). How Did COVID-19 and Stabilization Policies Affect Spending and Employment? A New Real-Time Economic Tracker Based on Private Sector Data. Retrieved from: https://opportunityinsights.org/paper/tracker/

Djogbenou, A., Gourieroux, C., Jasiak, J., Rilstone, P., and Bandehali, M. (2020). Transition Model for Corona Virus Management. Retrieved from:

Gourieroux, C., & Jasiak, J. (2020). Time varying Markov process with partially observed aggregate data; an application to coronavirus. Retrieved from: https://arxiv.org/abs/2005.04500

Gourieroux, C., & Jasiak, J. (2020). Analysis of Virus Propagation: An Overview of Stochastic Epidemiological Models. Retrieved from: https://arxiv.org/pdf/2006.10265.pdf

Housni, O.E., Sumida, M., Rusmevichientong, P., Topaloglu, H., & Ziya, S. (2020). Future Evolution of COVID-19 Pandemic in North Carolina: Can We Flatten the Curve? Retrieved from: http://ziya.web.unc.edu/files/2020/07/CovidModelandAnalysis-NC-Version-July-2.pdf


Resources

Annual 2020 NC Economic Report

2020 brought an end to North Carolina’s decade-long economic expansion that began in 2010 after the Great Recession. It has now been a year since COVID-19 arrived on U.S. shores, and we can see some changes clearly, while others are just starting to emerge from the haze. It will likely be years before we fully grasp the myriad ways COVID-19 has affected the nation’s and the state’s economies. Now seems like a good time to take stock of the fallout from 2020, the trends we’re seeing a year into the crisis and where things are starting to turn around for North Carolina.

Read the Full Report

Current Thinking on Vaccine Production, Distribution, and Acceptance

Summary

Overall it seems that in general the public has been focusing on the wrong question. The question should not have been if we get a vaccine, but should have been will be able to get the vaccine out the door (do we have vials, syringes, needles, bottle stoppers). As things stand now, it seems that we will have a vaccine approved by the FDA by the end of the year (give or take a couple of months), but we may not be able to package all of the vaccines due to supply shortages (e.g. glass vials, etc.) and potential storage issues. Finally, state and local health departments, which have been tasked with distributing the vaccine to their communities, are underequipped to meet the demand. In essence, while we were so enamored by the heroic efforts of the medical community and the drama surrounding the vaccine development, we have become like the fated son of Zeus, Tantulus, banished to the underworld and unable to reach the lush fruit trees growing above him to quench his unyielding hunger and thirst.

Additionally, public perception of the safety of a vaccine will be important to a successful distribution of the vaccine. Currently, a recent Pew Research poll found that 49% of Americans would “probably not” or “would not” get the vaccine, up from 27% in May (). Right now, doctors estimate the 60-70% of the population need antibodies in order to reach herd immunity.

As for who should get the vaccine first – there are two primary models: (1) providing vaccines to healthcare workers and the most vulnerable; and, (2) distributing based on population. Many public health academics and economists are thinking about global distribution, rather than a U.S.-specific strategy, arguing a global pandemic need a global response. However, the United States has declined to join the WHO’s global efforts for vaccine development and distribution.

Read the Full Report

Covid-19 Testing: A Primer for Employers and Business Leaders

Updated as of: August 5, 2020

Overview: Determining the appropriate levels of COVID-19 testing necessary for the complete and safe reopening of the economy is incredibly complicated and nuanced. There are two main items to consider: the science behind testing and the logistics of testing.

Science: The science surrounding COVID-19 is complicated by the “newness” of COVID-19 – with such a new virus there are many things that the scientific community does not yet know. For example, the overall prevalence of the virus in communities remains unknown. Yet, knowing the overall prevalence is important for determining the accuracy of tests (both viral and antibody) and for determining the overall level of antibodies needed to protect an individual. An example of how this further complicates testing is the vast differences in the false positive antibody test results. In areas with a prevalence of 5%, the CDC notes that only about 50% of those who test positive will have antibodies, compared to areas with a prevalence of 30%, where roughly 88% of positives will be accurate.1 Another complication is how quickly tests were developed and FDA approved. The FDA use of Emergency Use Authorization, while speeding up development of certain products, has led to some COVID-19 tests with poor accuracy.2 In addition to these issues, estimates vary widely in terms of how many tests need to be conducted on an ongoing basis. Experts agree that the level of infection in a community will affect the number of recommended tests for identifying all cases. Since community infection rates remain largely unknown, this appears to be contributing to the variation in recommended levels of testing. However, there are other benefits to testing (discussed below) which may also contribute to variation in recommendations.

Testing logistics provide another challenge. These include: time gaps from testing (such as the wait to get tested and receive results, and how often do people need to be tested), supply chain issues (such as labs not having the proper equipment to complete the tests, and lack of PPE), testing infrastructure (and importance of contact tracing), and types of tests (testing versus screening). In addition, legal challenges are beginning to emerge – such as liability of employees and employers, requiring tests, and health data protections.

Testing Basics

Testing is the most critical part of any plan to ensure a safe and complete reopening of the economy. Testing, however, is further complicated by the underlying uncertainty as to the overall rate of infection in the population. Yet, while ensuring proper test availability is crucial, a testing protocol cannot be fully effective without proper contact tracing and monitoring. Thus, the effectiveness of testing is further complicated by the effectiveness of contact tracing.

Types of Testing

Viral Antibody
Description Indicates if person has an infection currently. Detects presence of antibodies to an infection. Can take up to 3 weeks after an infection to develop testable antibodies.
Results Dependent on test, generally 1-2 days when there is not a significant backlog Generally 3-5 days
Accuracy Unclear due to multiple factors including manufacture of the test and overall unknown prevalence of infection. In addition, accuracy appears to depend on where the infected person is in the infection cycle and the type of test. Thus, there is a wide range of estimated false negatives (from 2% to 29%).3 Unclear due to the unknown overall prevalence of infection and on the unknown amount of antibodies needed to provide protection against future infection. Some research suggests false positives can be quite high for a single test.4
Availability See DHHS Website. Available via most healthcare providers and laboratories.

Health Screenings for Employees

Health screenings in conjunction with testing, can help businesses identify employees who may have the virus. OSHA recommends employers develop policies and procedures for employees to report when they are sick or experiencing symptoms of COVID-19. Additionally, the CDC recommends conducting daily health checks. These health checks can include:

  • Temperature screening
  • Asking questions about potential COVID-19 symptoms.

However, the CDC notes, it is important to conduct health screenings in a way that keeps employees safe (e.g. social distancing) and respects their privacy (e.g. conduct screenings in private). Also, signs and symptoms can vary, and some carriers may never exhibit symptoms (asymptomatic) or have not yet exhibited symptoms (pre-symptomatic). While businesses should seek their own specific legal advice regarding testing of employees, current legal opinions appear to indicate that businesses may provide testing as a healthcare option (akin to offering flu shots) but may not require employees to be tested.

Employer guidance resources (see appendix for full text of links):

State Monitoring Indicators per White House Recommendations5

In response to the spread of COVID-19, many states issued stay-at-home orders in an attempt to contain the spread. To assist states with their reopening plans, the White House released guidelines containing suggested indicators to monitor the spread of COVID-19 and allow for a phased reopenings. However, it is important to note that state planning is left to the discretion of state governors. Additionally, local government can impose even stricter restrictions. The suggested indicators include some criteria related to testing and others related to symptoms and hospital capacity:

COVID-19 Symptoms and COVID-19 Cases:

  • Downward trajectory of influenza-like illnesses (ILI) reported within a 14-day period
  • Downward trajectory of COVID-like syndromic cases reported within a 14-day period
  • Downward trajectory of documented cases within a 14-day period

Hospital Capacity:

  • Treat all patients without crisis care

Testing Capability:

  • Robust testing program in place for at-risk healthcare workers, including emerging antibody testing
  • Downward trajectory of positive tests as a percent of total tests within a 14-day period (flat or increasing volume of tests)

While these guidelines are not mandatory, many states combine these along with other indicators to monitor and help inform reopening plans. North Carolina is following a three-phased approach for reopening.

State Testing Methods

Many states are conducting mitigation testing. According to the Harvard Global Health Institute, mitigation testing is when “the focus is on reducing the spread of the virus through broad testing of symptomatic people, tracing and testing a recommended 10 contacts per new case and isolating positive contacts, and social distancing, mask wearing or stay-at-home orders as necessary.”6 However, the Institute notes that as states reopen, this strategy is ineffective when preventing new outbreaks. According to the Institute, as of August 4, 26 states are not meeting mitigation testing levels.

The Harvard Global Health Institute recommends states move toward suppression testing, which “requires large, proactive testing -- including regular testing of asymptomatic people in high-risk environments such as nursing homes, colleges, and parts of the service industry -- paired with rapid contact tracing and supported isolation (TTSI), as well as other measures.”7 As of August 4, only a handful of states have built the infrastructure to conduct this type of response.

Experts Testing Recommendations: There is a wide range of expert recommendations for testing to ensure a safe reopening. Specific estimates include:

  • University of Minnesota Center for Infectious Disease Research and Policy: Smart Testing-Testing should be guided by local epidemiology of COVID-19 and by resource availability.8
  • American Enterprise Institute: 750,000 per week in conjunction with contact tracing in phase 1, to move to phase 2 the ability of each state to test all people with COVID-19 symptoms and able to conduct active monitoring of confirmed cases and their contacts.9
  • Harvard Global Health Institute: about 1,000,000 a day.10
  • Harvard Center for Ethics and Rockefeller center: Roadmap to pandemic Resilience: 20 million per day.11
  • Paul Romer: test every person every two weeks, which is roughly 25 million tests per day.12

Though increasing substantially over the last two months, new daily testing levels in the U.S. have fallen short of almost all recommended levels:13

  • May 1: 297,568
  • May 15: 360,803
  • June 1: 413,933
  • June 15: 449,488
  • July 1: 621,114
  • August 1: 713,277

Testing gap

Why do we have a testing gap?

Because testing has grown in recent weeks, laboratories are now faced with a backlog leading to slower test results. Currently, the demand for viral tests is surpassing the supply. A recent statement from the American Clinical Laboratory Association (ACLA) said “ACLA member laboratories have seen a steady increase in the volume of COVID-19 test orders. While our members are collectively performing hundreds of thousands of tests each day, the anticipated demand for COVID-19 testing over the coming weeks will likely exceed members’ testing capacities. This significant increase in demand could extend turnaround times for test results… the reality of this ongoing global pandemic is that testing supplies are limited. …. We are in active conversations with the Administration and supply partners about ways to address these challenges.”14 Current shortages include test kits, PPE, chemicals needed for tests, materials needed to perform tests (e.g., cartridges, filter tips, deep well plates, etc.).15

Other Testing Solutions, Challenges and Benefits

Pooled Testing

In pooled testing, batch samples from several people are tested together to identify the overall presence of the virus.16 A positive test indicates that at least one person is positive for the virus, then repeat tests are conducted on all individuals in the batch sample.

  • Pros: Can reduce time and cost of mass testing up to 50%.
  • Cons: The need to retest cases when a batch member tests positive can increase the average time for individual positive identification. Less useful when rates of infection are high and substantial re-testing is required. In addition, pooled testing faces the same accuracy challenges due to the uncertainly in the overall underlying prevalence of infection and potential for testing errors as test are developed.

Environmental mass methods

  • Water testing:17 current research is evaluating the use of waste-water samples to identify infected communities. These data may then be utilized for targeted smart-testing to mitigate community spread.

Ongoing testing challenges

  • Invisible spread: asymptomatic individuals are unlikely to seek testing and so must be identified by contact tracing. Contact tracing capacity is currently insufficient in most areas.
  • Logistics and supply shortages of COVID-19 screening and testing are growing.
  • Accuracy of testing, especially antibody testing, remains uncertain.
  • Reliable and effective contact tracing is necessary for eliminating community spread.

Benefits of widespread testing

There are at least two potential benefits from widespread suppression testing. Most of the potential benefit described above focusses on the direct healthcare and containment consequences of testing. However, there are broader societal and economic benefits as well. A comprehensive testing and contact tracing program that effectively eliminates community spread will provide confidence to the general public that the pandemic is under control. This confidence will lower anxiety about the health risks. Lower anxiety will reduce stress-related ailments and behaviors as well as increase individual’s willingness to undertake non-essential activities outside the home. These non-essential activities include more economic activities (e.g., shopping, entertainment, and travel) as well as social activities (e.g., visiting with friends and relatives). As long as the efficacy of widespread testing is accurately communicated and interpreted, the non-healthcare effects are likely to be positive.

References:

American Clinical Laboratory Association. (2020). ACLA Update on COVID-10 Testing Capacity. https://www.acla.com/acla-update-on-covid-19-testing-capacity/
As Coronavirus Surges, How Much Testing Does Your State Need To Subdue The Virus? (2020, June 30). National Public Radio (NPR). https://www.npr.org/sections/health-shots/2020/06/30/883703403/as-coronavirus-surges-how-much-testing-does-your-state-need-to-subdue-the-virus
Basu, A., Zinger, T., Inglima, K., Woo, K.-M., Atie, O., Yurasits, L., See, B., & Aguero-Rosenfeld, M. E. (2020). Performance of Abbott ID NOW COVID-19 rapid nucleic acid amplification test in nasopharyngeal swabs transported in viral media and dry nasal swabs, in a New York City academic institution. Journal of Clinical Microbiology. https://doi.org/10.1128/JCM.01136-20
Center for Disease Control. (2020). Interim Guidelines for COVID-19 Antibody Testing. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/lab/resources/antibody-tests-guidelines.html
Edmond J. Safra Center for Ethics at Harvard University. (2020). Roadmap to Pandemic Resilience. https://ethics.harvard.edu/files/center-for-ethics/files/roadmaptopandemicresilience_updated_4.20.20_1.pdf
Gottlieb, S., Rivers, C., McClellan, M. B., Silvis, L., & Watson, C. (2020). National Coronavirus Response (p. 20). American Enterprise Institute. https://www.aei.org/wp-content/uploads/2020/03/National-Coronavirus-Response-a-Road-Map-to-Recovering-2.pdf
Harvard Global Health Institute. (2020). July 6, 2020 State Testing Targets. https://globalepidemics.org/july-6-2020-state-testing-targets/
Kucirka, L., Lauer, S., Laeyendecker, O., Boon, D., & Lessler, J. (2020). Variation in False-Negative Rate of Reverse Transcriptase Polymerase Chain Reaction–Based SARS-CoV-2 Tests by Time Since Exposure. Annals of Internal Medicine. https://doi.org/10.7326/M20-1495
Lakdawalla, D., Keeler, E., Goldman, D., & Trish, E. (2020). Getting Americans Back to Work (and School) With Pooled Testing. USC Schaeffer. https://healthpolicy.usc.edu/research/getting-americans-back-to-work-and-school-with-pooled-testing/
Romer, Paul. (2020). Roadmap to Responsibly Reopen America. https://roadmap.paulromer.net/paulromer-roadmap-report.pdf
The COVID Tracking Project. (2020). Our Historical Data. Retrieved from https://covidtracking.com/data/us-daily
The White House. (2020). Guidelines Opening Up America Again. Retrieved from https://www.whitehouse.gov/openingamerica/
Ulrich, A., Bartkus, J., Moore, K., Hansen, G., Mathieson, M., & Osterholm, M. (2020). Part 3: Smart Testing for COVID-19 Virus and Antibodies. Center for Infectious Disease Research and Policy: University of Minnesota. https://www.cidrap.umn.edu/sites/default/files/public/downloads/cidrap-covid19-viewpoint-part3.pdf
Wastewater test could provide early warning of COVID-19. (2020, March 31). ScienceDaily. https://www.sciencedaily.com/releases/2020/03/200331092713.htm
Woloshin, S., Patel, N., & Kesslheim, A. (2020). False Negative Tests for SARS-CoV-2 Infection—Challenges and Implications. The New England Journal of Medicine. https://doi.org/10.1056/NEJMp2015897

Appendix

Full text of other links:


1 See Center for Disease Control (2020)
2 See Basu et al. (2020)
3 See Kucirka et al. (2020) and Woloshin et al. (2020)
4 See Center for Disease Control (2020)
5 See The White House (2020)
6 See Harvard Global Health Institute (2020)
7 See Harvard Global Health Institute (2020)
8See Ulrich et al. (2020)
9 See Gottlieb et al. (2020)
10 See “As Coronavirus Surges, How Much Testing Does Your State Need To Subdue The Virus?” (2020)
11 See Edmond J. Safra Center for Ethics at Harvard University (2020)
12 See Romer, Paul (2020)
13 See The COVID Tracking Project (2020)
14 See June 27, 2020, statement by American Clinical Laboratory Association (2020)
15 See Ulrich et al. (2020)
16See Lakdawalla et al. (2020)
17 See “Wastewater Test Could Provide Early Warning of COVID-19” (2020)

North Carolina Business Survey

The Kenan Institute of Private Enterprise in conjunction with the CEO Leadership Forum are conducting an ongoing survey of North Carolina executives regarding the challenges their businesses face as a result of the ongoing COVID-19 pandemic. We ask business leaders to provide information on their greatest needs, including from the government. Survey responses are updated on an ongoing basis and no identifying information is made public. Respondents represent a wide variety of industries and geographies and many do substantial business outside of North Carolina.

We ask North Carolina business leaders to contribute their insights by completing the survey. Please contact Ashley Brown, Director of Research Services at the Kenan Institute, for a link.

Business Challenges

Demand shocks due to lockdowns

Most of the respondents note a decrease of demand in services or products due to the economic lockdown. While certain industries have been hit harder than others, there have been substantial dislocations beyond restaurants, entertainment, travel/tourism, and retail.

  • “Customers (I'm B2B) getting skittish about the future and cutting back projects.”
  • “We're seeing lots of frozen budgets and shut down operations. This creates a sub-optimal selling environment.”
  • “0 new clients because the economy is shut down.”

Prolonged Uncertainty for both Virus Spread and Economic Downturn

Respondents note the challenges of planning for the coming year with the uncertainty surrounding the virus response, and state shutdowns.

“The uncertainty around the depth and duration of the economic downturn makes planning and communication a challenge.”

  • “Trying to assess the pace of change and how that pace will impact business metrics (e.g. revenue, sales, employee engagement).”
  • “The pipeline of business in 2021 is not very clear.”

Keeping Workers and Consumers Safe; Understanding Liabilities

Most of the respondents stress the importance of providing a safe environment for both their employees and customers, but some feel unease around whether they had enough clear information about the best practices to take precautions. Additionally, some respondents indicate that they would like some liability protection if someone gets sick at their business.

  • “Ensuring the safety of our customers and our associates is our top priority and we have put tremendous focus on doing just that. This has been a challenge due to the lack of consistency and clarity around what these measures should be.”
  • “The uncertainty as relates to work policy and the relative compliance legalities associated with returning to work is most troubling. Even our legal counsel and the legal community have limited guidance as to how businesses should proceed. Testing or no testing? Providing flexibility to everyone or only those at-risk or with family members at-risk? What’s our liability if someone gets sick while at work or working from a client site? What level of preventive measures and advisories to our associates is sufficient to keep them safe and out of harm’s way?
  • “[Company] has taken extensive steps to protect its associates and customers during the pandemic and businesses now need reasonable liability protection to ensure companies are not subject to abusive litigation.”

Variety of Funding Issues

Companies are facing a variety of funding impacts. For some, the government relief packages, which have largely been aimed at small businesses, has not provided the necessary support often times due to being ineligible.

  • “Our primary business is supported by governmental funding--both federal as well as state & local. It is anticipated that the [corona virus] and all of its repercussions will affect future levels of funding.”
  • “Limited access to funding because we do not have W2 employees. We have applied to several grants but haven’t gotten any yet.”
  • “Fund raising, which still requires old fashioned physical interaction with clients and prospects, who are already skittish about their own funding and generally about markets, economies and their own businesses.”
  • “Target support for businesses and industries hurting most. “

Recommendations to Government Response

Re-Open the Economy while concurrently fighting the virus.

Many of the respondents indicate the need of reopening the economy while balancing the public health response. For some, this means more testing and increased transparency in the government’s response to the virus in order to build consumer confidence.

  • “Balance the healthcare emergency and the economic emergency in decision making and in making trade-offs….Communicate clearly what we are doing [to address the healthcare emergency] so that citizens maintain and business supports the virus non-spread protocols. Give reasonable timelines that we may be living with the virus for a relatively long period of time to gain compliance and to not give false hope around a vaccine. Secure protections for our most vulnerable citizens while allowing the rest of us to get back to work.”
  • “Huge surge in testing and tracking so that we can INTELLIGENTLY get back to business.”
  • “Fund more testing; being clear on the strategy both short- and long-term. “Increased and focused spending - More testing and easy availability of COVID-19 related resources across the board, clearer process and transparency in contact tracing and accelerated support for vaccine creation.”
  • “Support the creation of consumer optimism. Optimism begets the creation of demand and the creation of jobs via consumer spending. This creation of the demand is what will bring the economy back. Government payments and stimulus is not a replacement for steady income.”

Uniform Statewide Guidance

Some respondents would like to see more cohesion in the response across various state and local governments, making it easier for companies that operate in several locations and/or simplify needs across the supply chain.

  • “Varying state and local mandates that include disparate restrictions for our brand are challenging to address and unnecessarily distract our business from its overarching goal to support our customers and associates…”

Stop Politicizing the Public Health and Economic Responses

Some respondents showed frustration that the pandemic response has had political undertones, which is counterproductive to enacting policy that addresses both the public health and economic ramifications of COVID-19.

  • “Stop making it political.”
  • “Create a non-partisan crisis management board with healthcare professionals, business leaders and owners and education professionals that seek solely to inform based upon data."

Additional Resources Needed

Increased Access to Testing and PPE Supplies

To ensure the safety of workers and consumers, businesses need reliable and fast access to both testing, and PPE supplies.

  • “Testing Site Access & Rapid Results - As part of the critical infrastructure, our business would benefit from increased access to facilities that provide rapid testing for our associates so we are not unnecessarily quarantining staff who may have been in contact with infected individuals.”

COVID-19 Resources

For more than 30 years, the Kenan Institute of Private Enterprise has worked to leverage the private sector for the public good. At no time in our history has this mission been more relevant or vital than today. Through press briefings, webinars, op-eds and more, our experts are strengthening our commitment to share academically rigorous and sound research with the public on the business and economic ramifications of COVID-19.

Access Resources