As we emerge from the devasting second wave of the virus, there is a growing feeling among some virologists that it is time for a strategic change in the current policy of mitigation. If the UK tackles a third COVID-19 wave in the same way as the first two, will we be inviting a destructive cycle of a fourth, fifth and ‘n’ waves? Here, Dermot Martin ponders over the consequences of not changing our approach and a potential new strategy referred to as 'Zero COVID'.
Vaccines are the great hope, but with the virus’s agility and ability to mutate, they can only be a part of the solution unless the infection rates are reduced to close to zero.
Students of Greek mythology would recognise this situation as Tantalean punishment. As a punishment for his crimes the Gods made Tantalus stand in a pool of water under a fruit tree with low branches. The branches were forever moving just out of Tantalus’s reach and the water would recede if he stooped to drink it. He was deprived of nourishment for eternity (a fair punishment, some might say, for the murder of his own son).
The déjà vu Groundhog Day analogy is a more contemporary analogy but there is nothing funny or whimsical about the state of grief we are in.
A fresh strategic approach: Zero Covid
A consensus is emerging among some in the scientific community that to breakout from this trap we need a fresh approach. It’s called Zero Covid and it is being discussed in Germany, Ireland and Canada. There seems to be little talk about it in the UK beyond an excellent comment piece in The Lancet.
Top German Virologist, Melanie Brinkmann, and physicist, Matthias Schneider, argue that it is time for a consistent containment strategy to avoid a permanent economic shutdown. It’s called Zero Covid. Instead of more passivity, they say, we need to design an active collective response and it needs to be a “bottom-up process” which embraces tangible and measurable goals leading to the termination of COVID-19.
“We have to move away from reactive harm reduction and towards proactive control of the pandemic, comprising all social, health and economic areas of our society, with a clear goal that enables a return to freedom and stability.”
This is what Zero Covid supporters want to see.
Zero Covid focuses on regional green zones
With Zero Covid there would be a firm regional focus. For example, in the UK, when the incidence of infection in a region falls to zero, that region should be declared a Green Zone. Intense, protective contact and travel restrictions should be imposed around this zone. Such a policy calls for robust test, trace, and isolate protocols which in the UK we have failed to effectively deliver locally - but we can improve.
Individuals and communities would be motivated to conform and support the plan as part of a social consensus - a collective objective for the regional populations. It would be assisted by local daily communication with the public.
The Zero Covid strategy takes a layered approach
The Zero Covid strategy would have several layers: an effective lockdown until defined regions reach below 10 cases per 100,000 people. Germany dropped as low as 2.5 cases per 100k last year. It is a doable target. In Melbourne, hitting this target only took four weeks to achieve.
The UK currently has 33 cases per 100,000* and with a Zero Covid policy the current lockdown would remain in place until the figure was below 10 cases per 100k. We might divide the UK along county lines with larger cities London, Birmingham, Manchester counted as counties in their own right. Once a region, county or city reaches near zero cases, it would be classified as a Green Zone. With this GZ status comes normal activity but only within carefully monitored county borders.
As other ‘adjacent’ GZs spring up, normal travel and interactions could take place, while protecting the hard-won successes and providing the rewards of COVID-free living.
The lynchpin of this system would be a rigorous test, trace and support system to ensure the spread does not resume and keeps COVID cases at zero. This would entail robust, sometimes painful, protocols and firm policing.
To cool any virus hotspots, locally based authorities could commit - as Australia and New Zealand did - to go hard and early in introducing new lockdowns and measures to tackle any new outbreaks. In a pandemic, we have seen that over reaction is the most effective response when it comes to stopping exponential growth.
Proponents of Zero Covid believe this new focus would be mentally good for the population. It might help reduce the passive daily consumption of COVID statistics on deaths, infections and hospitalisations.
Lack of global response
With COVID-19 there has been no true global response. There has been a tragic lack of collaborative or systematic effort among nations to learn from each.
The Lancet comment on Zero Covid states: “(This is) Puzzling, certainly, but more than that - dispiriting that the human family seems to care so little for itself that we were unable to pool our experience, our understanding, and our knowledge to forge a common and coordinated response."
With the Zero Covid approach people could keep track of the expansion of Green Zones, the restoration of civil liberties and the reopening of economies.
Why bother now we have vaccines?
Some will say, “But now we have vaccines. Why bother?”
The news regarding vaccines is promising, and when they are widely distributed, will be a key element in the response to COVID-19. However, a return to normality requires population immunity, and not just the vaccination of high risk individuals. To reach this level of vaccination in the population will take 6 – 12 months and possibly even longer.
In Ireland, infectious disease experts estimate the vaccination will start to have a wide impact in fourth quarter of 2021. Until then we will remain in jeopardy of two to four lockdown cycles, with significant restrictions, in between waves of infection.
The yo-yo effect on the economy
Supporters of Zero Covid believe elimination of the virus is better for the economy than repeated yo-yo cycles of lockdowns - and that is acknowledged by a number of leaders in the services sector. Economists point to Asia-Pacific countries, whose economies are now rebounding significantly because they applied strict rules on track, trace, and isolate.
The dilemma for businesses in the west revolves around why they should bother closing if there is no exit strategy to help return to normality? It is an entirely rational concern - and it is why the best strategy for a true revival is to stamp on the virus.
People like Brinkmann and Schneider recognise that Zero Covid will be challenging to implement with track, trace and isolate at its core but, without such a plan or something similar, countries like ours will be stranded like Tantalus stuck in his pool of water deprived of nutrition.
For the sceptics and politically motived, who want to open the doors on the economy as quickly as possible, the words of Prof Devi Sridhar, chair of global public health at the University of Edinburgh are worth thinking about.
“It’s the virus that’s killing the economy NOT the restrictions.”
Author: Dermot Martin
*Our World in Data: https://ourworldindata.org/grapher/uk-daily-covid-cases-7day-average?tab=chart&stackMode=absolute&time=2020-08-04..latest®ion=World