Willingness to Accept Trade-Offs Among COVID-19 Cases, Social-Distancing Restrictions, and Economic Impact: A Nationwide US Study

Abstract

Objective: To conduct a discrete-choice experiment to quantify Americans' acceptance of severe acute respiratory syndrome coronavirus 2 infection risks for earlier lifting of social-distancing restrictions and diminishing the pandemic's economic impact.

Methods: We designed a discrete-choice experiment to administer 10 choice questions to each respondent representing experimentally controlled pairs of scenarios defined by when nonessential businesses could reopen (May, July, or October 2020), cumulative percentage of Americans contracting coronavirus disease 2019 (COVID-19) through 2020 (2% to 20%), time for economic recovery (2 to 5 years), and the percentage of US households falling below the poverty threshold (16% to 25%). Respondents were recruited by SurveyHealthcareGlobus.

Results: A total of 5953 adults across all 50 states completed the survey between May 8 and 20, 2020. Latent-class analysis supported a 4-class model. The largest class (36%) represented COVID-19 risk-minimizers, reluctant to accept any increases in COVID-19 risks. About 26% were waiters, strongly preferring to delay reopening nonessential businesses, independent of COVID-19 risk levels. Another 25% represented recovery-supporters, primarily concerned about time required for economic recovery. This group would accept COVID-19 risks as high as 16% (95% CI: 13%-19%) to shorten economic recovery from 3 to 2 years. The final openers class prioritized lifting social distancing restrictions, accepting of COVID-19 risks greater than 20% to open in May rather than July or October. Political affiliation, race, household income, and employment status were all associated with class membership (P<.01).

Conclusion: Americans have diverse preferences pertaining to social-distancing restrictions, infection risks, and economic outcomes. These findings can assist elected and public-health officials in making difficult policy decisions related to the pandemic.

Keywords: COVID-19; discrete-choice experiment; social-distancing restrictions; stated preference.

Figure 1

Relative importance of discrete-choice experiment factors. Relative importance weights for each class sum to 100. Larger weights represent greater importance to members of each class, conditional on the range of levels shown for each factor. Note: Relative importance weights for reopening nonessential businesses for classes 1, 3, and 4 represent preferences for earlier reopening. For class 2, the relative importance weight represents preference to reopen later. COVID-19, coronavirus disease 2019.

Figure 2

Maximum acceptable cumulative risk of COVID-19 by preference group. Each of the 4 figures represents COVID-19 risk levels considered important to members of each latent class as avoiding undesirable changes in other factors. For example, in the waiters class, respondents would accept an increase in the risk of COVID-19 by 5.9 percentage-points to avoid an increase in the percentage of households below the poverty line from 13% to 16% rather than from 13% to 20%. The dashed lines indicate that acceptable COVID-19–related risks for the subsequent level were greater than 25%. Note: Acceptable COVID-19 risks are negative for the waiters class, because they considered it desirable to delay reopening of nonessential businesses whereas the other 3 classes considered such delays to be undesirable. COVID-19, coronavirus disease 2019.