http://archive.ph/dA63S
The ‘zero-Covid’ approach got bad press, but it worked – and it could
work again
Laura Spinney
The places that chose to pursue elimination suffered less overall.
Unfortunately, few had the determination to do so
A sign in front of UC Davis Medical Center.
‘Eighteen months into its No-Covid experiment, Davis, California, is
puzzled that other US towns haven’t followed suit.’ Photograph: Peter
Dasliva/EPA
Mon 28 Mar 2022 08.22 EDT
It was the alt-history, the policy that didn’t get enacted. No-Covid,
zero-Covid or elimination aimed to stamp out community transmission of
Covid-19 in a given area, rather than just reduce it to “manageable”
levels. Most of the world eschewed it, and it got bad press from the
start. Only autocratic regimes could pull it off, one mantra went.
Countries like China and ah, New Zealand and, oops, that notorious
police state Davis in California.
There was something of the self-fulfilling prophecy about this. Many
people thought No-Covid was impossible, but the handful of places that
embraced it proved them wrong. Now that some of those places are
themselves shifting to a reduction or mitigation strategy, countries
that opted for mitigation from the beginning are enjoying a “we told you
so” moment. But No-Covid’s early champions had to shift in part because
other countries let the virus rip. Even if their strategy didn’t remain
the optimal one, it bought them time to prepare others. It’s important
that we remember that when the next pandemic sidles along.
The power of language is terrifying sometimes. We talk about pandemics
“erupting” – I’ve done it myself – but sidling seems a more appropriate
verb for something that grows quietly in the dark before exploding into
the light. The concept of exponential growth is one we have trouble
grasping, yet grasping it empowers us. It means that for a time the
disease spread is limited and potentially controllable. It means that
explosive growth falls off rapidly once it is deprived of fuel. And it
means that not everybody has to pursue elimination for it to succeed –
as long as a critical mass do.
We’ve found one factor that predicts which countries best survive Covid
Thomas Hale
Read more
No-Covid was dogged by problems of definition. People confused
elimination with eradication, for example. Only one human disease,
smallpox, has been eradicated, but plenty have been eliminated. The UK
was measles-free until 2017, when partly, due to low vaccine uptake, it
lost that status. Elimination is not an unattainable dream, but it does
require a concerted effort. In the current pandemic, the word often
applied to such efforts was “restrictions”, as if the efforts themselves
deprived us of liberty. No. The virus deprives us of liberty; the
efforts preserve it. That’s why nobody in Davis is complaining, 18
months into their No-Covid experiment, and why they’re puzzled other US
towns haven’t followed suit.
Though lockdowns might have been necessary in the beginning, because we
had no other shields against the virus, they soon stopped being
synonymous with elimination. Cheap mass testing plus isolation of the
infected, ventilation, masking, distancing and – importantly – social
and financial support for those inconvenienced by these measures, became
the preferred tools, used most effectively in combination.
The claim that elimination exacerbates inequality is a red herring; it
doesn’t, with the right support. A circulating virus certainly does, on
the other hand, by preferentially encountering gig workers, keeping kids
out of school, and closing mental health clinics.
It’s true that some diseases are easier to eliminate than others. Many
western countries assumed that Covid would behave like flu, and decided
that elimination would be too difficult. China assumed that it would
behave like Sars, which it successfully beat 20 years ago. It actually
behaves a bit like both, but not exactly like either. Countries tended
to get the outcome they aimed for.
Last June, a study in The Lancet showed that those that chose
elimination over mitigation did a better job of protecting life, the
economy and civil liberties – the hat-trick. But no country is an island
to a highly transmissible virus – even those that are islands – and the
emergence of Delta and Omicron variants of the Sars-CoV-2 virus,
combined with the rollout of vaccines that protect against severe
disease and death, was bound to change the calculus. Some who favoured
elimination previously now think it has outlived its usefulness.
New Zealand, for example, has switched to a mitigation strategy.
Epidemiologist Michael Baker expects his country’s high levels of
vaccination will protect it from a wave of hospitalisations and deaths
as Omicron sweeps the country. Hong Kong, which also pursued No-Covid
until recently, has tragically not avoided that fate, due to its
relatively low vaccination rates.
The lesson from Hong Kong is not that elimination doesn’t work, it’s
that you need a plan B in case the context changes. Baker and economist
Donald Low, who has chronicled Hong Kong’s experience, agree that
elimination was the right strategy for the first 18 months of the
pandemic. Baker stands by his analysis of December 2020 that,
“Elimination might be the preferred strategy for responding to new
emerging infectious diseases with pandemic potential and moderate to
high severity, particularly while key parameters are being estimated.”
What we’re learning about long Covid – or post-Covid-19 condition as the
World Health Organization (WHO) now calls it – only strengthens that
case, since it’s looking increasingly likely that countries that
tolerated high infection rates, including the UK, are facing a sizeable
burden of long-term disability. The vaccines do not stop transmission
completely, and by abandoning the non-pharmaceutical interventions that
do, those countries also increase the likelihood – far from trivial, as
scientists highlighted again this month – that a variant more severe
than Omicron or its “stealth” subvariant could arise.
These emerging facts demonstrate how pointless it is to cost
elimination, or any other containment strategy. How do you measure what
it has saved you? In speculative fiction terms, what’s the counterfactual?
The right way to respond to an unknown disease is to fix a goal and work
towards it, adjusting your strategy as you learn. Because there’s
another unknown in the equation, human determination, no response should
be ruled out initially. As Nelson Mandela said, and the WHO itself likes
to quote: “It’s only impossible until it’s done.”
Laura Spinney is a science journalist and the author of Pale Rider: The
Spanish Flu of 1918 and How it Changed the World
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