This paper will describe and analyze restrictions on connection and interaction (i.e., social distancing) during the first pandemic in a century. During a pandemic, decision makers are required to make difficult decisions with incomplete information, under high levels of uncertainty, public scrutiny and urgency. Many critical and far-reaching priority setting decisions have occurred outside the health sector, for instance the closing of schools or restrictions on businesses or transportation. These decisions, like decisions about allocating vaccine or hospital care, involve the allocation of some budgetary and human resources. However, more so than in healthcare, they also explicitly involve the allocation of burdens or costs, from both limits on movement and, for instance for service workers, greater exposure to infection. These decisions, like those about allocating healthcare resources, have critical consequences for health. Households suffer job losses and reduced income; children miss school; many, especially those residing in institutions, suffer social isolation—outcomes which have been associated with declines in physical and mental health. These burdens of restrictions on movement and connection and consequent health outcomes may be unevenly distributed and exacerbate existing health inequities. Fair decision making about priorities for connection and interaction is as crucial as fair decision making about allocating intensive care and vaccine. The application of priority setting methods and principles, however, has focused on healthcare and not on other policy actions that can profoundly influence health. This paper presents an analysis of restrictive measures introduced during the COVID-19 pandemic, what we have learned, so far, about the consequences of those restrictions, and makes recommendations for the development and application of priority setting frameworks in this arena to inform future research and practice.
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