Biological Threats

CREATE has examined naturally occurring contagious disease, such as COVID-19, as well as biological weapons designed and intended to harm people. Example research is described below.

Biological Weapons

CREATE has studied economic consequences of attacks through biological weapons, including Anthrax, as well as the value of biosurveillance technology. CREATE has also developed tools for estimating likelihoods of biological attacks through expert elicitation.

Human-Induced Errors

CREATE has developed methods for countering human induced errors within established medical protocols to detect and contain outbreaks of Ebola and other infectious diseases spread through inadvertent or deliberate contact in both clinical and non-clinical settings.

Human-Transmissible Disease

CREATE researchers are investigating economic impacts and risk management for COVID-19.

• USC CREATE’s research project sponsored by the DHS Center for Accelerating Operational Efficiency (CAOE) is studying impacts on the U.S. economy.

• Visit covid19datasource for our work on integrated modeling of patient flow and disease transmission.

• Watch webinar on Learning from Pandemic.

Our COVID-19 projects continue CREATE’s research on health threats, costs to healthcare, availability of vaccines, avoidance behavior, resilience and economic consequences.

Tracking COVID-19 Cases and Deaths in the United States

Authors: Andrew Moore, Mingdong Lyu, Randolph Hall

This research is funded by the Zumberge Innovation Fund and the Viterbi School Curve program.

Abstract: We analyze the progression of COVID-19 in the United States with a novel metric representing the partial-average day-of-event, where events are new cases and new deaths. The metric is calculated as a function of date and location to illustrate patterns of disease, showing growing or waning cases and deaths. The metrics enable the direct comparison of the time distribution of cases and deaths, revealing data coherence and how patterns varied over a one-year period. We also compare different methods of estimating actual infections and deaths to better understand on the timing and dynamics of the pandemic by state. Download Paper, Code and Data

This research was funded by the DHS Center for Advancing Operational Efficiency (CAOE) and by the Centers for Disease Control and Prevention (CDC).

Abstract: While most of the attention to COVID-19 is being focused on the physical transmission of the virus across country borders, there is also an analogous spatial transmission of economic impacts through international trade and global supply chains. This paper presents an analysis of the extent to which the economic shocks of mandatory closures to mitigate the pandemic ripple through the world economy. We utilize a state-of-the-art computable general equilibrium (CGE) model to analyze these interconnections through international trade. We compare estimates of the impacts on US GDP in isolation and then examine the impacts taking into account US trade with China and the rest of the world (ROW). Our analysis indicates that these international trade linkage impacts are generally negative and range from near zero to very large overall, depending on the region, and that own- and cross-country impacts differ by region as well. At the same time, we find that China is able to capitalize on the situation by actually being able to increase its exports through international trade following mandatory closures in other regions. We also confirm that the US economy was relatively insulated from trade linkages with the rest of the world. Sectoral impacts provide further insight into the results.

This research was supported by funding from the DHS Center for Advancing Operational Efficiency (CAOE) and by Samsung Electronics Co., Ltd.

Abstract: This paper places the COVID-19 pandemic into perspective by comparing it to other recent disasters in terms of impacts on the macroeconomy of the U.S. We present a short summary of advances in the state-of-the-art of economic consequence analysis, as well as estimates this approach yields on economic impacts of 9/11, a variety of natural disasters, the Great Recession, and COVID-19. The prevention of these negative impacts represents the benefits of various types of risk management tactics and strategies. In light of the enormously greater economic impact of COVID-19 as compared to natural and man-made disasters, it is reasonable to question whether adequate investments are being made to prevent future pandemics.

The Impacts of the Coronavirus on the Economy of the United States

Authors: Terrie Walmsley, Adam Rose, Dan Wei

This study was sponsored by the DHS Center for Advancing Operational Efficiency (CAOE). It provides a comprehensive assessment of the macroeconomic impacts of COVID-19 and includes the broadest range of causal factors in such analyses to date:

     • mandatory closures and gradual re-openings of businesses;
     • decline in workforce due to morbidity, mortality and avoidance behavior;
     • increased demand for health care; decreased demand for public transportation and other leisure activities;
     • potential resilience through telework;
     • increased demand for communication services;
     • pent-up demand.

Abstract: We present a formal analysis of the macroeconomic impacts of the COVID-19 pandemic in the U.S., China and the rest of the world. Given the uncertainty regarding the severity and time-path of the infections and related conditions, we examine three scenarios, ranging from a relatively moderate event to a disaster. The study considers a comprehensive list of causal factors affecting the impacts, including: mandatory closures and the gradual re-opening process; decline in workforce due to morbidity, mortality and avoidance behavior; increased demand for health care; decreased demand for public transportation and other leisure activities; potential resilience through telework; increased demand for communication services; and increased pent-up demand. We apply a computable general equilibrium (CGE) model, a state-of-the-art economy-wide modeling technique. It traces the broader economic ramifications of individual responses of producers and consumers through supply chains both within and across countries. We project that the net U.S. GDP losses from COVID-19 would range from $3.2 trillion (14.8%) to $4.8 trillion (23.0%) in a 2-year period for the three scenarios. U.S. impacts are estimated to be higher than those for China and the ROW in percentage terms. The major factor affecting the results in all three scenarios is Mandatory Closures and the Partial Reopenings of businesses. These alone would have resulted in a 22.3% to 60.6% decrease in U.S. GDP across the scenarios. Pent-up Demand, generated from the inability to spend during the Closures/Reopenings, is the second most influential factor, significantly offsetting the negative impacts stemming from other causal factors.

Abstract: We estimate the macroeconomic impacts of mandatory business closures in the U.S. and many other countries in order to control the spread of the COVID-19.  The analysis is based on the application of a modified version of the GTAP computable general equilibrium (CGE) model.  We simulate mandatory closures in all countries or parts of countries that had imposed them as of April 7 for three-month and six-month cases.  For the three-month scenario, we estimate a 20.3% decline of U.S. GDP on an annual basis, or $4.3 trillion.  The employment decline of 22.4% in the U.S. for the three-month closure represents 35.2 million workers for that time period.  Should the mandatory closures be extended to six months, these negative impacts slightly more than double.  The employment impacts are slightly greater in percentage terms than the GDP impacts because most service sectors, which are generally more labor-intensive, are much more negatively impacted by the closures than are manufacturing sectors and other critical sectors.  Our results should be considered upper-bound estimates given such assumptions as businesses laying off workers no longer paying them wages or salaries.  Note also that the paper examines the mandatory closures alone and does not factor in any countervailing fiscal or monetary policies.

Abstract: Perceptions of health risks inform decisions about protective behaviors, but COVID-19 was an unfamiliar risk as it began to spread across the U.S. In the initial stage of the epidemic, authors examined perceived risks for COVID-19 infection and infection fatality and whether these risk perceptions were associated with protective behaviors. They also examined whether findings differed between later versus earlier responders. Between March 10 and March 31, 2020, a cross-sectional online survey was conducted with a nationally representative U.S. sample (n=6,684). Half responded before March 13, 2020 (versus later). Participants assessed their risks of COVID-19 infection and infection fatality (0%–100%) which were transformed into quartiles (1–4). They reported their implementation of protective behaviors like handwashing and social distancing (yes/no). Analyses were conducted in April‒May 2020. Median perceived risk was 10.00% for COVID-19 infection and 5.00% for infection fatality, but respondents showed large disagreement. An increase of 1 quartile in perceived infection risk was associated with being 1.45 times (95% CI=1.33, 1.58) more likely to report handwashing, with perceived infection fatality risk showing no significant association. When predicting social distancing behaviors such as avoiding crowds, both quartile-based risk perceptions were significant (OR=1.24, 95% CI=1.17, 1.30 for infection and OR=1.19, 95% CI=1.13, 1.26 for infection fatality). Perceived COVID-19 infection risk, protective behaviors, and their relationship increased among later (versus earlier) responders. Despite disagreements about the risks, people perceiving greater risks were more likely to implement protective behaviors—especially later (versus earlier) in March 2020. These findings have implications for risk communication.

A Critical Analysis of Multi-Criteria Models for the Prioritisation of Health Threats

Authors: Gilberto Montibeller, Pratik Patel, Victor J. del Rio Vilas

Abstract: Multi-criteria assessments are increasingly being employed in the prioritisation of health threats, supporting decision processes related to health risk management. The use of multi-criteria analysis in this context is welcome, as it facilitates the consideration of multiple impacts of health threats, it can encompass the use of expert judgment to complement and amalgamate the evidence available, and it permits the modelling of policy makers’ priorities. However, these assessments often lack a clear multi-criteria conceptual framework, in terms of both axiomatic rigour and adequate procedures for preference modelling. Such assessments are ad hoc from a multi-criteria decision analysis perspective, despite the strong health expertise used in constructing these models. In this paper we critically examine some key assumptions and modelling choices made in these assessments, comparing them with the best practices of multi-attribute value analysis. Furthermore, we suggest a set of guidelines on how simulation studies might be employed to assess the impact of these modelling choices. We apply these guidelines to two relevant studies available in the health threat prioritisation domain. We identify severe variability in our simulations due to poor modelling choices, which could cause changes in the ranking of threats being assessed and thus lead to alternative policy recommendations than those suggested in their reports. Our results confirm the importance of carefully designing multi-criteria evaluation models for the prioritisation of health threats.

Media Mentions and Webinars of Research and Advising by CREATE on COVID-19

July 12, 2021

Adam Rose Discusses the Cost Savings of Preventative Efforts to Combat COVID-19 Infections vs. the Potential for Trillions of Dollars in Losses without Intervention (interview segment begins at 1:45) – NBC4 Los Angeles

July 12, 2021

Adam Rose Quoted in Article on the Cost of Fighting COVID in California – LAist

December 9, 2020

CREATE Researchers Project $5 Trillion in Economic Losses from Pandemic – BioSpace

December 3, 2020

CREATE Warns that Pandemic Could Result in a Net Loss of $4.8 Trillion in US Real GDP – World Economic Forum

December 2, 2020

Research from CREATE Projects COVID-19 Pandemic Could Cost U.S. Anywhere from $3 Trillion to $5 Trillion in GDP – CBS News

December 1, 2020

CREATE Researchers: Pandemic Could Cost $3-5 Trillion in GDP Over Two Years – Spectrum News 1

November 30, 2020

Adam Rose and Dan Wei Featured in Article on the COVID-19 Pandemic’s Economic Impact on U.S. GDP – KPBS

November 30, 2020

Adam Rose Interviewed for Story on CREATE Research: “USC Economists Project COVID-19 Pandemic Could Take a Toll of $5 Trillion on GDP Over 2 Years” – KNX Radio

November 30, 2020

Terrie Walmsley, Adam Rose and Dan Wei  Featured in a USC News Story on “COVID’s Financial Impact”

November 18, 2020

Terrie Walmsley, Adam Rose, and Dan Wei presented the paper “Impacts of COVID-19 on the U.S. Economy,” at the Center for Accelerating Operational Efficiency (CAOE) and Center for Risk and Economic Analysis of Terrorism Events (CREATE) Webinar Series

September 23, 2020

Adam Rose Gave Plenary Lecture on “Impacts of COVID-19 on the U.S. Economy" at the Annual Meeting of the International Society for Integrated Disaster Risk Management (IDRiM).

August 27, 2020

Business Resilience Calculator Now Available for Small and Mid-size Businesses Struggling with Disasters

August 13, 2020

Adam Rose and Richard John Participate in DHS Centers of Excellence Workshop on Supply of Labor During the Pandemic

July 6, 2020

Wändi Bruine de Bruin Quoted on Face Mask Mandates and Compliance – ABC 7 WJLA

July 1, 2020

Wändi Bruine de Bruin Quoted on COVID-19 Trends and Human Behavior – The Guardian

May 26, 2020

CREATE Research Team Webinar: Impacts on the U.S. Macroeconomy of Mandatory Business Closures – USC Price

May 19, 2020

CREATE Researchers Discuss the Importance of Prior Probabilities in Coronavirus Testing –

April 29, 2020

Vicki Bier Discusses Lessons Learned from the 1918 Spanish Flu Pandemic – SRA Podcast

April 24, 2020

Robin Dillon-Merrill Discusses Perceptions of Acceptable Risk During the Coronavirus Pandemic – Washington Post

April 17, 2020

Vicki Bier Discusses How Lawmakers Can Balance Public Health and the Economy – Wisconsin Public Radio Podcast

April 9, 2020

Gilberto Montibeller Discussed Efficient Health Capability Building for Pandemics – SRA Webinar

April 1, 2020

Vicki Bier Discussed What Was Learned from the Spanish Flu Pandemic of 1918 – Miami Herald

March 27, 2020

Gilberto Montibeller Discussed Perceived Risk to COVID-19 – Financial Times

CREATE studies into health threats include:

Rosoff, H., John, R. S., Prager, F. 2012. Flu, risks, and videotape: Escalation of fear and avoidance behavior, Risk Analysis, 32(4), 729-743. doi: 10.1111/j.1539-6924.2012.01769.x

CREATE researchers conducted an experiment to learn about public reaction to an escalating flu epidemic. The study used a scenario simulation, in which 600 respondents in Southern California and the DC Metro Area were shown a series of 7 videos describing a hypothetical escalating crisis over a 15-day period. Two aspects of the scenarios were manipulated: cause and proximity of the epidemic. Respondents were told the epidemic was caused by terrorists, by a laboratory accident, or an unknown origin. Respondents were also told the epidemic was either in their same location or in a location on the opposite coast. Perceptions of risk, fear, and avoidance behavior all increased dramatically over the 7 episodes, regardless of indicated cause or proximity. Although the overall levels of these factors  were similar for the 3 cause conditions, the trajectory of increase was steeper in all 3 for the unknown cause compared to either terrorism or laboratory accident. The behavioral factors increased more rapidly when the epidemic was in the respondents’ geographic region . Public response to the epidemic was remarkably similar across different demographic groups. These results suggest that perceived risk, fear, and avoidance behavior are attenuated when the origin of the epidemic is known and the epidemic is perceived as far away. 

Prager, F., Wei, D., and Rose, A. 2017. Total Economic Consequences of an Influenza Outbreak in the United States, Risk Analysis 37(1): 4-19. doi:10.1111/risa.12625

Pandemic influenza represents a serious threat not only to the population of the United States, but also to its economy. This study analyzed the total economic consequences of potential influenza outbreaks in the U.S. for four cases based on the distinctions between disease severity and the presence/absence of vaccinations. The analysis was based on data and parameters on influenza obtained from the Centers for Disease Control and the general literature. A state-of-the-art economic impact modeling approach, computable general equilibrium (CGE), was applied to analyze a wide range of potential impacts stemming from the outbreaks. The study examined the economic impacts from changes in medical expenditures and workforce participation, and also took into consideration different types of avoidance behavior and resilience actions not previously fully studied. The  results indicated that, in the absence of avoidance and resilience effects, a pandemic influenza outbreak could result in a loss in U.S. GDP of $25.4 billion, but that vaccination could reduce the losses to $19.9 billion. When behavioral factors are taken into account, the GDP impacts more than doubled to $58.8 billion without vaccination and $45.1 billion with vaccination. However, resilience tactics, especially the abilities of U.S. firms to recapture lost production after workers return, help reduce the GDP losses by nearly 25%.  The results indicated the importance of including a broader set of causal factors to achieve more accurate estimates of the total economic impacts of not just pandemic influenza but biothreats in general. The results also highlighted a number of actionable items that government policymakers and public health officials can use to help reduce potential economic losses from the outbreaks.  For example, efforts to influence avoidance behavior through public messaging and information campaigns and various incentives may hold the potential tor greatly reduce the economic costs of an influenza outbreak at a relatively low cost.

Rose, A., Asay, G., Wei, D., and Leung, B. 2009. Macroeconomic Impacts of Shutting Down the U.S. Borders in Response to a Security or Health Threat, Chapter 13 in H. Richardson, P. Gordon, and J. Moore, II (eds.), Global Business and The Terrorist Threat.  Cheltenham, UK: Edward Elgar.

A coordinated terrorist attack or major health threat may raise the consideration of a partial or complete shutdown of the U.S. borders to people and commodities.   Given that the U.S. economy is highly dependent on international mobility and trade, the economic impacts of a partial or total border closure are likely to be significant. This study used a macroeconometric forecasting model from Regional Economic Models, Inc. (REMI) to analyze disruptions to both imports and exports, international travel bans to both inbound and outbound traffic, and a halt of both documented and undocumented migrants. The simulations of a complete shutdown of the borders to both trade and people for one year predicted a reduction in GDP of as much as $1.4 trillion measured in 2006 dollars, or about 10.5% of GDP. Employment losses were predicted to be more than 22 million, or more than 12%below base levels.. The two major factors affecting the results were export and import shutdowns. Curtailment of international travel is a far smaller influence but still significant, while a halt in in-migration had negligible effects on the results. The estimates in this study should be considered upper bounds because of the omission of adaptive resilience tactics by businesses and countervailing government policies.. Also, the study focused entirely on the cost side of the ledger. A complete assessment of the decision to close the U.S. borders needs to also consider the benefits of that action (e.g., avoided losses from a health emergency), with due consideration of the risk involved (the probability of occurrence of the threat).

Dixon, P., J. Giesecke, M. Rimmer, and A. Rose. 2011. The Economic Costs to the U.S. of Closing Its Borders:  A Computable General Equilibrium Analysis, Defence and Peace Economics 22(1): 85-97.

This study provided an update and an extension of the 2008 study using a computable general equilibrium (CGE) model, in particular the U.S. Applied General Equilibrium Model (USAGE), developed by CREATE Senior Research Fellow, Peter Dixon.  It too simulated the effects of a one-year U.S. border closure. The analysis suggested that the costs of a prolonged closure could be much greater than indicated by previous studies. The study found that cutting all imports by 95% in a context of sticky real wages would reduce U.S. GDP by 48%. However, if bottleneck imports (mainly oil) were exempt and workers accepted real wage cuts, then the GDP reduction would be only 11%. Again, the analysis represented an upper bound, because it did not consider various types of offsetting effects resilience.

Dixon, P., M. Rimmer, B. Lee, A. Rose et al. 2010. Effects on the U.S. of an H1N1 Epidemic:  Analysis with a Quarterly CGE Model, Journal of Homeland Security and Emergency Management 7(1): Article 7. 

This study simulated the effects of a hypothetical H1N1 epidemic in the U.S. using a quarterly version of the USAGE model. Quarterly periodicity was able to capture the short-run nature of an epidemic. The study found potentially severe economic effects in the peak quarter, but, averaged over the epidemic year, the effects were considerably damped. The results indicated that the macroeconomic consequences of an epidemic are more sensitive to demand-side effects, such as reductions in international tourism and leisure activities, than to supply-side effects, such as reductions in productivity. This suggests that demand stimulus policies might be an appropriate economic response to a serious epidemic. However, as in the previous studies omit considerations of resilience, as well as considerations of “avoidance behavior" included in subsequent CREATE studies.

Manheim, D., H. H. Willis, S. R. Shelton, R. Vardavas, and H. Rosoff. 2015.  Understanding Biosurveillance Value of Information using an Exploratory Tool.  CREATE Working Paper. 

Rose, A., D. Wei, F. Prager and S. Rao. 2015. Modeling the Temporal and Spatial Consequences of Radiological and Nuclear Terrorism Events. CREATE Report to the National Biosurveillance Integration Center.

Oladosu, G., A. Rose, and B. Lee.  2013. Economic Impacts of Potential Foot and Mouth Disease Agro-terrorism in the United States:  A Computable General Equilibrium Analysis, Journal of Biothreats and Biodefense S12: 001. doi:10.4172/2157-2526.S12-001

Additional studies by CREATE researchers included a report to the National Biosurveillance Integration Center (NBIC) on the value of information and on economic consequence analysis of health threats. The latter served as the basis for the Pandemic Module of CREATE’s Economic Consequence Analysis Tool (E-CAT), see:  Another study examined the economic impacts of a US Foot and Mouth Disease epidemic, whose major impacts would be transmitted by a steep reduction in exports of U.S. beef products. 

CREATE researchers are well positioned to perform analyses of the economic consequences of the coronavirus based on their prior research specific to health threats, as well as research on the use of major economic models to simulate behavioral responses to numerous types of threats, and resilience in business continuity. CREATE is also strengthening its ties with USC’s Schaeffer Center for Health Economics and Policy based on a recent collaborative study on the economic impacts of the California Institute for Regenerative Medicine (CIRM) on the economy of the state and the U.S. as a whole.