A characteristic of those countries dealing effectively with the coronavirus pandemic is that many of them are islands. It is hardly a surprise that the centuries-old practice of quarantine, one of the critical methods for controlling the spread of infectious diseases, is greatly helped by being an island. Places such as Taiwan, New Zealand, Japan, and even Guernsey and the Isle of Man, have all taken advantage of this to eliminate the virus. But it is notable that countries such as Vietnam and Thailand have done so too.
These and other countries’ success stand in stark contrast to the appalling death toll and economic destruction that has affected many countries in Europe, particularly the UK. But there are also success stories, including Norway and Finland, which have managed to contain the spread of the virus. The knowledge that deaths from Covid-19 are preventable has spurred a so-called zero-Covid movement across the Continent. While it is known by various names, for example, “No Covid” in Germany, there is a common goal of eliminating the virus and giving everyone an open, fully functioning social, educational and economic life.
Elimination of the virus does not mean that there are never any cases. Rather, that when cases occur, they are in managed isolation facilities such as hotels, where international travellers will spend their quarantine period. If cases occur in the community, the outbreak’s source will be rapidly located and onward transmission prevented. It is in effect a “zero tolerance” approach to the virus, as has been applied towards road traffic deaths or domestic abuse in some states in the US.
The three major components of a strategy for achieving zero-Covid are, first, a strict, time-limited lockdown to rapidly and decisively reduce case numbers. Second, the imposition of strict public health controls on all international passenger movement. Air and ferry freight can move, but it is people who carry the virus and need to be isolated until they can be guaranteed not to have an active infection. Third, it requires an efficient find, test, trace, isolate and support system to suppress community clusters. The UK’s existing test and trace system does not get close to what is recommended internationally by the World Health Organisation and should be replaced by something that works.
Enacting these three approaches across the country will end national lockdowns. Local areas that have low levels of infection should be designated as “green zones”. People’s entry to the green zones should be restricted, and any new spread that occurs dealt with by aggressive local testing and tracing and assisted isolation.
Within the green zones, life could return to some form of normality, and communities in cities, towns or counties could be mobilised to ensure that this is maintained. Resources such as public health specialists and nurses can then be organised and concentrated on enabling the communities with the highest infection levels to mobilise themselves and drive down the virus.
Vaccination is clearly a transformative moment: it holds out the prospect of substantially cutting the toll of death and illness. The implementation of vaccination across the UK is a great credit to the NHS. But vaccines alone cannot rid us of the virus. There will always be some people who cannot be vaccinated on health grounds and some people for whom the vaccine will not work.
There is also the fact that population vaccination programmes always struggle to reach high population coverage levels. The continuing emergence of ever more dangerous variants of the virus may well also blunt the beneficial effect of vaccination. So far, none of the vaccines have been made available to children and it is unacceptable for us to allow them to be exposed to a virus that produces long-lasting symptoms in at least one in eight of the schoolchildren who are infected.
The possibility that the virus could affect the brain, which may not result in immediate illness but could be connected with neurological problems in the future, cannot be easily cast aside. There is a possible precedent: epidemiologists found an increased number of Parkinson’s disease cases in the US among those who lived through the 1918 Spanish flu.
The only way to ensure the safety of the whole population is to take maximum advantage of vaccination and supplement it with a zero-Covid solution, including green zones. The alternative approach, one that tolerates an acceptable level of death from Covid, is ethically dubious and medically and scientifically avoidable.
The “living with Covid” mantra is well illustrated by the oft-repeated claim that Covid is no worse than influenza. No clinician working on a Covid ward could agree with that claim. In any case, it is wrong that the UK tolerates such a high level of excess winter deaths and wrongly attributes them to “influenza”, rather than considering them the result of low-quality housing, fuel poverty, and poor access to medical care.
Countries such as Taiwan and New Zealand that have successfully contained Covid-19 and reduced it to a tiny number of cases have been able to protect their economies from substantial damage and provide their citizens with a near-normal life experience. There are signs from other countries, such as Germany and Ireland, that people and politicians are shifting towards adopting zero-Covid as their preferred approach.
The UK government needs to look at countries that have handled Covid well, find out what made them so successful and copy it. At the heart of an elimination strategy will be the realisation that Britain is an island and that this confers tremendous advantages in attempting to suppress infectious diseases. Even at this late stage, there is still a chance to do the right things and save lives and livelihoods.
This article appears in the 24 Feb 2021 issue of the New Statesman, Britain unlocks