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From an epidemiological perspective, the COVID-19 pandemic is a public health crisis. From an economic perspective, it is an externality and a social cost. Strikingly, almost all economic policy to address the infection externality has been formulated within a Pigovian analysis of implicit taxes and subsidies directed by a social planner drawing on social cost-benefit analysis. In this paper, we draw on Coase (1960) to examine an alternative economic view of the externality, seeking to understand how an exchange-focused analysis might give us a better understanding of how to minimise social cost. Our Coasean framework allows us then to further develop a comparative institutional analysis as well as a public choice theory analysis of the pandemic response.