Offline: The case for No-COVID

Abstract

As many countries continue to struggle with a third wave of COVID-19—Hong Kong is suffering its fourth wave and is contemplating a fifth and sixth—all governments and public health authorities will need to remain open to new ideas for controlling the pandemic. This past week, Ilona Kickbusch, founding director of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva, shared a proposal being widely discussed in Germany. The approach devised by a group of clinicians and academics, which in addition to Kickbusch includes Melanie Brinkmann, Michael Hallek, Matthias Schneider, and others, is a “No-COVID strategy”. There are three elements to their plan, based on the twin objectives of No-COVID and the creation of virus-free green zones. First, a rapid reduction in numbers of infections to zero. Second, avoidance of further virus transmission or reintroduction through rigorous test, trace, and isolate systems, together with local travel restrictions. Third, rapid outbreak management if new cases of COVID-19 occur sporadically. Experience from several east Asian countries shows that complete elimination causes the least harm to society. Every infection is one too many. The German proposal recommends a regional focus—when the incidence of infection in an area falls to zero, the region should be declared a green zone. Strict protective contact and travel restrictions should be imposed around this zone, with robust test, trace, and isolate protocols. Individual motivation and social consensus to support this plan—a collective objective for the entire population—would be assisted through daily communication with the public. Messaging would now focus less on positive test results, hospitalisations, and deaths. Instead, public support would be built around the broader goals of societal wellbeing, returning to work, and the restoration of civil liberties. To maintain public commitment, cohesion, and morale, authorities need to offer a clear reopening plan based on progress to No-COVID. The eventual aim would be to expand and fuse green zones across Germany. This strategy could also be implemented across Europe if governments could agree to a common No-COVID goal. The German team argue that the first realistic assessment of their plan came with the way Melbourne successfully handled its recent outbreak. The “path to normality” would consist of four phases. Phase 1: lockdown to achieve an incidence of infection below ten cases per 100 000 population per week. Phase 2: continued measures to reach below five cases per 100 000. Phase 3: reaching zero incidence. Phase 4: declaration of green zone status. © 2021 Michele Tantussi/Getty Images 2021 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. The strategy produced by Kickbusch and her colleagues ends with an appendix listing myths that have come to distort public and political debate about how to manage this pandemic. There is a trade-off between health and the economy. No: the fate of our wellbeing and our wider lives go hand-in-hand. We can protect vulnerable groups. Practically, given the vast numbers who are vulnerable, impossible. COVID-19 only concerns the elderly. Even among a younger population, COVID-19 is harmful, sometimes deadly. Once infected, people are forever immune. We simply don't know, but unlikely. Only vaccination will save us. Over time, maybe, but not in the short term. Herd immunity can be achieved by infection. Neither a feasible nor a desirable strategy. Closing schools is more stressful for children and families than keeping them open. What may matter more is scaled up educational and economic support. Vaccinations will end the COVID-19 pandemic quickly. Sadly, not for some time. Germany is not Australia, not an island, not a totalitarian regime. Yet we should still strive to learn from the best. Learning from the best: here is one of the most puzzling aspects of the global response to this pandemic. Because there has been no global response. No collaborative or systematic effort among nations to learn from one another. 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. By coincidence last week, on the 1-year anniversary of the first paper from China describing the clinical features of COVID-19, a Zero-COVID Coalition was launched in the UK. After more than 2 million deaths worldwide, perhaps there is an emerging agreement that the elimination of this coronavirus is not only necessary but also achievable. © 2021 Tyler/LightRocket/Getty Images 2021 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.