Remdesivir

Introduction

Remdesivir, an antiviral drug designed to treat both hepatitis and a common respiratory virus, seemed fated to join thousands of other failed medications after proving useless against those diseases. The drug was consigned to the pharmaceutical scrap heap, all but forgotten by the scientists who once championed it. But on Friday, the Food and Drug Administration issued an emergency approval for remdesivir as a treatment for patients severely ill with Covid-19, the disease caused by the coronavirus.

The story of remdesivir’s rescue and transformation testifies to the powerful role played by federal funding, which allowed scientists laboring in obscurity to pursue basic research without obvious financial benefits. This research depends almost entirely on government grants. Dr. Mark Denison of Vanderbilt University is one of a handful of researchers who discovered remdesivir’s potential. He began studying coronaviruses a quarter-century ago, a time when few scientists cared about them the ones infecting humans caused colds, he recalled, and scientists just wanted to know how they worked.

“We were interested from the biologic perspective,” Dr. Denison recalled. “No one was interested from a therapeutic perspective.”

Neither he nor the scores of other scientists interested in coronaviruses foresaw that a new one would unleash a plague that has killed nearly a quarter-million people worldwide. The F.D.A. rushed to approve remdesivir under emergency use provisions, after a federal trial demonstrated modest improvements in severely ill patients. The trial, sponsored by the National Institute of Allergy and Infectious Diseases, included more than 1,000 hospitalized patients and found that those receiving remdesivir recovered faster than those who got a placebo: in 11 days, versus 15 days.

Vials of remdesivir at a Gilead Sciences facility in La Verne, Calif.Credit...Gilead Sciences, via Reuters

Implication on Government

As Africa’s largest economy with a population of close to 200 million, Nigeria is critical to the COVID-19 response in the region. One in five sub-Saharan Africans are Nigerians and the economic and social impacts of the COVID-19 in the country will have major ripple effects across the continent. With government revenues collapsing following the fall in oil prices, mitigating the health emergency and subsequent economic ramifications from COVID-19 will be an unprecedented challenge for Nigeria’s policymakers.

Fatalities from COVID-19 in Nigeria are currently relatively low in the global context, standing at 12, with 267 active cases. However, the Federal Government has warned that up to four million people could be infected after six months if social distancing measures are not well implemented and observed. This high burden of infectious disease is likely to put extra strain on an already underfunded health sector.

The subsequent economic fallout for Nigerians will be severe. GDP forecasts are suggesting that if oil prices stay low, GDP growth will be -3.4% in 2020. Worryingly, this is the prediction if the outbreak is effectively contained in the country. By contrast, if it is not contained effectively, then Nigeria could see GDP growth in 2020 fall to -8.8%, driven by declining consumer spending.

This will have a profound impact on employment. For instance, Nigeria’s film industry, known locally as Nollywood, will face major challenges. The industry is the second largest source of jobs in the country, employing one million people and producing an estimated 1500 movies a year. Nollywood movies are popular across Africa, but with its production hub, Lagos, in lockdown, movie production is likely to plummet. Evidently, this will have a major knock-on effect on employment. Beyond Nollywood, there is a major concern for the country’s huge army of informal workers, over 80% of the workforce, who have seen wages evaporate overnight as restrictions are introduced.

Implication on Public

Wealthy Nigerians have often preferred travelling abroad for medical treatment with the Minister of Health estimating that the country spends over $1 billion annually on medical tourism. But with borders shutting around the world, Nigeria’s elite must now confront using their country’s own healthcare facilities in battling COVID-19. They will be concerned by what they see.

Latest data from Africa’s 10 largest economies show that only Ethiopia has fewer hospital beds per capita than Nigeria, as depicted in figure 1 below. The most recent WHO data puts the number of hospital beds at only five per 10,000 people in Nigeria.

Implication on Educational Sector

The COVID-19 pandemic has affected educational systems worldwide, leading to the near-total closures of schools, universities and colleges.

As of 10 May 2020, approximately 1.268 billion learners are currently affected due to school closures in response to the pandemic. According to UNICEF monitoring, 177 countries are currently implementing nationwide closures and 13 are implementing local closures, impacting about 73.5 percent of the world's student population.^[1] On 23 March 2020, Cambridge International Examinations (CIE) released a statement announcing the cancellation of Cambridge IGCSE, Cambridge O Level, Cambridge International AS & A Level, Cambridge AICE Diploma, and Cambridge Pre-U examinations for the May/June 2020 series across all countries.^[2] International Baccalaureate exams have also been cancelled.^[3] In addition, Advanced Placement Exams, SAT administrations, and ACT administrations have been moved online and canceled.

School closures impact not only students, teachers, and families, but have far-reaching economic and societal consequences.^[4][5] School closures in response to COVID-19 have shed light on various social and economic issues, including student debt,^[6] digital learning,^[7][8] food insecurity,^[9] and homelessness,^[10][11] as well as access to childcare,^[12] health care,^[13] housing,^[14] internet,^[15] and disability services.^[16] The impact was more severe for disadvantaged children and their families, causing interrupted learning, compromised nutrition, childcare problems, and consequent economic cost to families who could not work.^[17][18]

In response to school closures, UNESCO recommended the use of distance learning programmes and open educational applications and platforms that schools and teachers can use to reach learners remotely and limit the disruption of education.^[19]

Going to school is the best public policy tool available to raise skills. While school time can be fun and can raise social skills and social awareness, from an economic point of view the primary point of being in school is that it increases a child’s ability. Even a relatively short time in school does this; even a relatively short period of missed school will have consequences for skill growth. But can we estimate how much the COVID-19 interruption will affect learning? Not very precisely, as we are in a new world; but we can use other studies to get an order of magnitude.

Two pieces of evidence are useful. Carlsson et al. (2015) consider a situation in which young men in Sweden have differing number of days to prepare for important tests. These differences are conditionally random allowing the authors to estimate a causal effect of schooling on skills. The authors show that even just ten days of extra schooling significantly raises scores on tests of the use of knowledge (‘crystallized intelligence’) by 1% of a standard deviation. As an extremely rough measure of the impact of the current school closures, if we were to simply extrapolate those numbers, twelve weeks less schooling (i.e. 60 school days) implies a loss of 6% of a standard deviation, which is non-trivial. They do not find a significant impact on problem-solving skills (an example of ‘fluid intelligence’). 

A different way into this question comes from Lavy (2015), who estimates the impact on learning of differences in instructional time across countries. Perhaps surprisingly, there are very substantial differences between countries in hours of teaching. For example, Lavy shows that total weekly hours of instruction in mathematics, language and science is 55% higher in Denmark than in Austria. These differences matter, causing significant differences in test score outcomes: one more hour per week over the school year in the main subjects increases test scores by around 6% of a standard deviation. In our case, the loss of perhaps 3-4 hours per week teaching in maths for 12 weeks may be similar in magnitude to the loss of an hour per week for 30 weeks. So, rather bizarrely and surely coincidentally, we end up with an estimated loss of around 6% of a standard deviation again. Leaving the close similarity aside, these studies possibly suggest a likely effect no greater than 10% of a standard deviation but definitely above zero. 

Perhaps to the disappointment of some, children have not generally been sent home to play. The idea is that they continue their education at home, in the hope of not missing out too much. 

Families are central to education and are widely agreed to provide major inputs into a child’s learning, as described by Bjorklund and Salvanes (2011). The current global-scale expansion in home schooling might at first thought be seen quite positively, as likely to be effective. But typically, this role is seen as a complement to the input from school. Parents supplement a child’s maths learning by practising counting or highlighting simple maths problems in everyday life; or they illuminate history lessons with trips to important monuments or museums. Being the prime driver of learning, even in conjunction with online materials, is a different question; and while many parents round the world do successfully school their children at home, this seems unlikely to generalise over the whole population. 

So while global home schooling will surely produce some inspirational moments, some angry moments, some fun moments and some frustrated moments, it seems very unlikely that it will on average replace the learning lost from school. But the bigger point is this: there will likely be substantial disparities between families in the extent to which they can help their children learn. Key differences include (Oreopoulos et al. 2006) the amount of time available to devote to teaching, the non-cognitive skills of the parents, resources (for example, not everyone will have the kit to access the best online material), and also the amount of knowledge – it’s hard to help your child learn something that you may not understand yourself. Consequently, this episode will lead to an increase in the inequality of human capital growth for the affected cohorts.

Implication on Health Institute

In the short-term, it is paramount that spending/resources to fight COVID-19 in Nigeria are supplementary and not diverted from existing healthcare services fighting other diseases. Studies of the Ebola crisis in West Africa from 2014-2016 have found that as many people died because of overwhelmed health systems’ inabilities to treat malaria, HIV, and tuberculosis than from Ebola itself. A similar trend can only be avoided in the fight against COVID-19 if funds are additional, and not diverted from other crucial healthcare services.

Conclusion

The COVID-19 crisis is like no other. It has exposed flaws in the response of governments to healthcare and social security in both the developed and developing world alike. Nigeria is therefore not unique in facing difficulties. Yet, its reliance on oil exports to fund government expenditure has made the country particularly vulnerable following the collapse in oil prices. It remains to be seen whether the aggressive steps the Federal Government has taken will be enough to successfully mitigate the effects of the crisis. A small silver lining is the belief that the oil price crash will act as a catalyst for the economic diversification that Nigeria requires. The country’s growing population, standing at close to 200 million already, is counting on it.

Reference

  CDC. 2019 Novel Coronavirus, Wuhan, China. CDC. Available at https://www.cdc.gov/coronavirus/2019-ncov/about/index.html. January 26, 2020; Accessed: January 27, 2020.

  Gallegos A. WHO Declares Public Health Emergency for Novel Coronavirus. Medscape Medical News. Available at https://www.medscape.com/viewarticle/924596. January 30, 2020; Accessed: January 31, 2020.

  Ramzy A, McNeil DG. W.H.O. Declares Global Emergency as Wuhan Coronavirus Spreads. The New York Times. Available at https://nyti.ms/2RER70M. January 30, 2020; Accessed: January 30, 2020.

  The New York Times. Coronavirus Live Updates: W.H.O. Declares Pandemic as Number of Infected Countries Grows. The New York Times. Available at https://www.nytimes.com/2020/03/11/world/coronavirus-news.html#link-682e5b06. March 11, 2020; Accessed: March 11, 2020.

  Coronavirus Updates: The Illness Now Has a Name: COVID-19. The New York Times. Available at https://www.nytimes.com/2020/02/11/world/asia/coronavirus-china.html. February 11, 2020; Accessed: February 11, 2020.

  WHO Director-General's remarks at the media briefing on 2019-nCoV on 11 February 2020. Available at https://www.who.int/dg/speeches/detail/who-director-general-s-remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020. February 11, 2020; Accessed: February 13, 2020.

  Gorbalenya AE. Severe acute respiratory syndrome-related coronavirus – The species and its viruses, a statement of the Coronavirus Study Group. Available at https://doi.org/10.1101/2020.02.07.937862. February 11, 2020; Accessed: February 13, 2020.

  CDC. Coronavirus Disease 2019 (COVID-19): Recommendations for Cloth Face Covers. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html. April 3, 2020; Accessed: April 6, 2020.

  CDC. Coronavirus Disease 2019 (COVID-19): COVID-19 Situation Summary. CDC. Available at https://www.cdc.gov/coronavirus/2019-ncov/summary.html. February 29, 2020; Accessed: March 2, 2020.

https://www.nytimes.com/2020/05/01/health/coronavirus-remdesivir.html

https://www.theigc.org/blog/when-a-failure-to-diversify-meets-covid-19-implications-for-nigeria/

The impact of COVID-19 on education

Simon Burgess, Hans Henrik Sievertsen 01 April 2020

The global lockdown of education institutions is going to cause major (and likely unequal) interruption in students’ learning; disruptions in internal assessments; and the cancellation of public assessments for qualifications or their replacement by an inferior alternative. This column discusses what can be done to mitigate these negative impacts.

The COVID-19 pandemic is first and foremost a health crisis. Many countries have (rightly) decided to close schools, colleges and universities. The crisis crystallises the dilemma policymakers are facing between closing schools (reducing contact and saving lives) and keeping them open (allowing workers to work and maintaining the economy). The severe short-term disruption is felt by many families around the world: home schooling is not only a massive shock to parents’ productivity, but also to children’s social life and learning. Teaching is moving online, on an untested and unprecedented scale. Student assessments are also moving online, with a lot of trial and error and uncertainty for everyone. Many assessments have simply been cancelled. Importantly, these interruptions will not just be a short-term issue, but can also have long-term consequences for the affected cohorts and are likely to increase inequality.  

Impacts on education: Schools 

Going to school is the best public policy tool available to raise skills. While school time can be fun and can raise social skills and social awareness, from an economic point of view the primary point of being in school is that it increases a child’s ability. Even a relatively short time in school does this; even a relatively short period of missed school will have consequences for skill growth. But can we estimate how much the COVID-19 interruption will affect learning? Not very precisely, as we are in a new world; but we can use other studies to get an order of magnitude.

Two pieces of evidence are useful. Carlsson et al. (2015) consider a situation in which young men in Sweden have differing number of days to prepare for important tests. These differences are conditionally random allowing the authors to estimate a causal effect of schooling on skills. The authors show that even just ten days of extra schooling significantly raises scores on tests of the use of knowledge (‘crystallized intelligence’) by 1% of a standard deviation. As an extremely rough measure of the impact of the current school closures, if we were to simply extrapolate those numbers, twelve weeks less schooling (i.e. 60 school days) implies a loss of 6% of a standard deviation, which is non-trivial. They do not find a significant impact on problem-solving skills (an example of ‘fluid intelligence’). 

A different way into this question comes from Lavy (2015), who estimates the impact on learning of differences in instructional time across countries. Perhaps surprisingly, there are very substantial differences between countries in hours of teaching. For example, Lavy shows that total weekly hours of instruction in mathematics, language and science is 55% higher in Denmark than in Austria. These differences matter, causing significant differences in test score outcomes: one more hour per week over the school year in the main subjects increases test scores by around 6% of a standard deviation. In our case, the loss of perhaps 3-4 hours per week teaching in maths for 12 weeks may be similar in magnitude to the loss of an hour per week for 30 weeks. So, rather bizarrely and surely coincidentally, we end up with an estimated loss of around 6% of a standard deviation again. Leaving the close similarity aside, these studies possibly suggest a likely effect no greater than 10% of a standard deviation but definitely above zero. 

Impacts on education: Families 

Perhaps to the disappointment of some, children have not generally been sent home to play. The idea is that they continue their education at home, in the hope of not missing out too much. 

Families are central to education and are widely agreed to provide major inputs into a child’s learning, as described by Bjorklund and Salvanes (2011). The current global-scale expansion in home schooling might at first thought be seen quite positively, as likely to be effective. But typically, this role is seen as a complement to the input from school. Parents supplement a child’s maths learning by practising counting or highlighting simple maths problems in everyday life; or they illuminate history lessons with trips to important monuments or museums. Being the prime driver of learning, even in conjunction with online materials, is a different question; and while many parents round the world do successfully school their children at home, this seems unlikely to generalise over the whole population. 

So while global home schooling will surely produce some inspirational moments, some angry moments, some fun moments and some frustrated moments, it seems very unlikely that it will on average replace the learning lost from school. But the bigger point is this: there will likely be substantial disparities between families in the extent to which they can help their children learn. Key differences include (Oreopoulos et al. 2006) the amount of time available to devote to teaching, the non-cognitive skills of the parents, resources (for example, not everyone will have the kit to access the best online material), and also the amount of knowledge – it’s hard to help your child learn something that you may not understand yourself. Consequently, this episode will lead to an increase in the inequality of human capital growth for the affected cohorts.

Assessments 

The closure of schools, colleges and universities not only interrupts the teaching for students around the world; the closure also coincides with a key assessment period and many exams have been postponed or cancelled.  

Internal assessments are perhaps thought to be less important and many have been simply cancelled. But their point is to give information about the child’s progress for families and teachers. The loss of this information delays the recognition of both high potential and learning difficulties and can have harmful long-term consequences for the child. Andersen and Nielsen (2019) look at the consequence of a major IT crash in the testing system in Denmark. As a result of this, some children could not take the test.  The authors find that participating in the test increased the score in a reading test two years later by 9% of a standard deviation , with similar effects in mathematics. These effects are largest for children from disadvantaged backgrounds. 

Importantly, the lockdown of institutions not only affects internal assessments. In the UK, for example, all exams for the main public qualifications – GCSEs and A levels – have been cancelled for the entire cohort. Depending on the duration of the lockdown, we will likely observe similar actions around the world. One potential alternative for the cancelled assessments is to use ‘predicted grades’, but Murphy and Wyness (2020) show that these are often inaccurate, and that among high achieving students, the predicted grades for those from disadvantaged backgrounds are lower than those from more advantaged backgrounds. Another solution is to replace blind exams with teacher assessments. Evidence from various settings show systematic deviations between unblind and blind examinations, where the direction of the bias typically depends on whether the child belongs to a group that usually performs well (Burgess and Greaves 2013, Rangvid 2015). For example, if girls usually perform better in a subject, an unblind evaluation of a boy’s performance is likely to be downward biased. Because such assessments are used as a key qualification to enter higher education, the move to unblind subjective assessments can have potential long-term consequences for the equality of opportunity. 

It is also possible that some students’ careers might benefit from the interruptions. For example, in Norway it has been decided that all 10th grade students will be awarded a high-school degree. And Maurin and McNally (2008) show that the 1968 abandoning of the normal examination procedures in France (following the student riots) led to positive long-term labour market consequences for the affected cohort. 

In higher education many universities and colleges are replacing traditional exams with online assessment tools. This is a new area for both teachers and students, and assessments will likely have larger measurement error than usual. Research shows that employers use educational credentials such as degree classifications and grade point averages to sort applicants (Piopiunik et al. 2020). The increase in the noise of the applicants’ signals will therefore potentially reduce the matching efficiency for new graduates on the labour market, who might experience slower earnings growth and higher job separation rates. This is costly both to the individual and also to society as a whole (Fredriksson et al. 2018).

Graduates

The careers of this year’s university graduates may be severely affected by the COVID-19 pandemic. They have experienced major teaching interruptions in the final part of their studies, they are experiencing major interruptions in their assessments, and finally they are likely to graduate at the beginning of a major global recession. Evidence suggests that poor market conditions at labour market entry cause workers to accept lower paid jobs, and that this has permanent effects for the careers of some. Oreopoulos et al. (2012) show that graduates from programmes with high predicted earnings can compensate for their poor starting point through both within- and across-firm earnings gains, but graduates from other programmes have been found to experience permanent earnings losses from graduating in a recession. 

Solutions?

The global lockdown of education institutions is going to cause major (and likely unequal) interruption in students’ learning; disruptions in internal assessments; and the cancellation of public assessments for qualifications or their replacement by an inferior alternative. 

What can be done to mitigate these negative impacts? Schools need resources to rebuild the loss in learning, once they open again. How these resources are used, and how to target the children who were especially hard hit, is an open question. Given the evidence of the importance of assessments for learning, schools should also consider postponing rather than skipping internal assessments. For new graduates, policies should support their entry to the labour market to avoid longer unemployment periods.

References

Andersen, S C, and H S Nielsen (2019), "Learning from Performance Information", Journal of Public Administration Research and Theory.

Bjorklund, A and K Salvanes (2011), “Education and Family Background: Mechanisms and Policies”, in E Hanushek, S Machin and L Woessmann (eds), Handbook of the Economics of Education, Vol. 3.  

Burgess, S and E Greaves (2013), “Test Scores, Subjective Assessment, and Stereotyping of Ethnic Minorities”, Journal of Labor Economics 31(3): 535–576.

Carlsson, M, G B Dahl, B Öckert and D Rooth (2015), “The Effect of Schooling on Cognitive Skills”, Review of Economics and Statistics 97(3): 533–547

Fredriksson, P, L Hensvik, and O Nordström Skans (2018), "Mismatch of Talent: Evidence on Match Quality, Entry Wages, and Job Mobility", American Economic Review 108(11): 3303-38.

Lavy, V (2015), “Do Differences in Schools' Instruction Time Explain International Achievement Gaps? Evidence from Developed and Developing Countries”, Economic Journal 125. 

Maurin, E and S McNally (2008), "Vive la revolution! Long-term educational returns of 1968 to the angry students", Journal of Labor Economics 26(1): 1-33.

Murphy, R and G Wyness (2020), “Minority Report: the impact of predicted grades on university admissions of disadvantaged groups”, CEPEO Working Paper Series No 20-07 Centre for Education Policy and Equalising Opportunitites, UCL Institute of Education.

Oreopoulos, P, M Page and A Stevens (2006), “Does human capital transfer from parent to child? The intergenerational effects of compulsory schooling”, Journal of Labor Economics 24(4): 729–760.

Oreopoulos, P, T von Wachter, and A Heisz (2012), "The Short- and Long-Term Career Effects of Graduating in a Recession", American Economic Journal: Applied Economics 4(1): 1-29.

Piopiunik, M, G Schwerdt, L Simon and L Woessman (2020), "Skills, signals, and employability: An experimental investigation", European Economic Review 123: 103374.

Rangvid, B S (2015), "Systematic differences across evaluation schemes and educational choice", Economics of Education Review 48: 41-55.