Individually optimal choices can be collectively disastrous in COVID-19 disease control

Abstract Background The word ‘pandemic’ conjures dystopian images of bodies stacked in the streets and societies on brink collapse. Despite this frightening picture, denialism noncompliance with public health measures are common historical record, for example during 1918 Influenza pandemic or 2015 Ebola epidemic. unique characteristics SARS-CoV-2—its high basic reproduction number (R 0 ), time-limited natural immunity considerable potential asymptomatic spread—exacerbate repercussions interventions (such as vaccines masks) to limit disease transmission. Our work explores rationality impact aimed at limiting spread SARS-CoV-2. Methods In work, we used game theory explore when confers a perceived benefit individuals. We then epidemiological modeling predict control SARS-CoV-2, demonstrating that presence noncompliant subpopulation prevents suppression spread. Results demonstrates is Nash equilibrium under broad set conditions existence population can result extensive endemic long-term after return pre-pandemic social economic activity. Endemic poses threat both compliant individuals; all community members protected if complete achieved, which only possible degree compliance. For highly effective preventing spread, however, consequences borne disproportionately by Conclusions sum, our limits free-market approaches compliance pandemic. act intervention creates negative externality, rendering SARS-CoV-2 ineffective. underscores importance developing strategies prophylaxis through need focus level.