By Andrew Lee
Around the world, countries are having to strike a balance between COVID-19 cases and restrictions. In the UK and the US, daily new cases number in the thousands, but restrictions and limitations are being lifted. In contrast, New Zealand has started a short national lockdown to contain just a handful of cases.
For the past 20 months, New Zealand, Australia and several other east Asian countries have pursued tough policies aiming to completely eradicate COVID-19. The hallmarks of these “zero COVID” approaches are strict border controls and quarantine arrangements as well as the early introduction of lockdowns when discovering cases.
So far they’ve helped minimise infections and deaths. The economic impacts experienced by countries adopting these approaches have also been less severe than those who have not. New Zealand has said it intends to continue its COVID-19 eradication strategy indefinitely.
Is this sustainable? In an ideal world, completely eliminating COVID-19 is what all countries would aim to do, and earlier on in the pandemic I supported this strategy. But now the pandemic has evolved, the approach makes less sense.
An impossible dream?
Many countries now have high levels of the virus circulating and aren’t aiming to eradicate it. And it’s unlikely countries with few infections, such as New Zealand or Australia, can continue to keep COVID-19 at bay indefinitely in a world where the virus circulates.
There will always be the risk of importation by infected travellers from other regions. And in a globalised world, isolating a country from most others long term would likely be too costly and unpopular to maintain. Plus, it requires a degree of luck. Vietnam, Thailand and South Korea, once cited as zero COVID success stories, have struggled to contain the virus when it’s been imported despite various border controls being in place.
The fact that the virus is mutating may explain why they’ve found it harder to keep it at bay. The virus is becoming better at spreading in humans. The alpha variant is around 50% to 100% more transmissible than the original virus that emerged in late 2019, and delta around 50% more transmissible than alpha. The more infectious the virus becomes, the more that has to be done to enforce suppression.
There are other factors to consider too. The virus can infect both domestic and wild animals. If humans give the virus to animals, such that new viral reservoirs are created, then the virus could then potentially spill back into humans after being suppressed.
On top of this, a large proportion of human infections are asymptomatic. These infections are difficult to detect early and so are likely to spread. Both factors raise the likelihood of COVID-19 being reintroduced at some point – unless high levels of restrictions in zero COVID countries persist.
But how long will people continue to support a zero COVID approach if it means periodically entering lockdown to handle a small numbers of cases? In Australia, people appear to be growing tired of repeated restrictions, especially as the virus seems to be taking hold anyway. Trust in the government’s COVID-19 response is waning and stress is building. That said, support is still there for New Zealand’s strict approach.
The role of vaccines
An important counterpoint is that countries such as Australia and New Zealand still have low vaccine coverage. Relaxing current policies may see the virus spread quickly and cause large amounts of disruption, illness and death that could be avoided.
And although zero COVID policies are costly, one thing this pandemic has taught us is that in the short term, adopting a stringent approach leads to the least damage to the health and wealth of societies. In countries with low levels of infection and low vaccine coverage, there’s a very good case for continuing with maximum suppression.
But it’s less clear what the optimal long-term solution is. The virus has yet to settle into its ecological niche, so it’s unclear what behaviours it will eventually fall into. There are several possible outcomes, and they depend on to what degree vaccines block people from catching and spreading the virus, as opposed to simply stopping them from getting ill.
If vaccines protect well enough against infection, and enough of the population is vaccinated, then cases should subside to low levels. It may then be possible to achieve eradication of COVID-19 across much of the world through immunisation, much like measles. There will remain the risk of the virus being reintroduced from areas where cases are higher or of the virus persisting in unvaccinated groups – which is how measles behaves today.
However, it’s not known how long vaccine protection lasts, and substantial inequity in global vaccine distribution is a significant barrier to widespread suppression of COVID-19. Increasingly, the view of public health experts is that reaching population-level immunity is unachievable at the present time.
The other possibility is that vaccines do not sufficiently block the spread of infection. In this scenario, the virus would continue to circulate, but with severe disease, hospitalisations and deaths reduced. We would see periodic outbreaks and probably seasonal epidemics, similar to flu. This is the more likely scenario. The focus then would be less on trying to stop the spread of infection and more on protecting vulnerable individuals through immunisation.
Accepting that COVID-19 will become endemic – as many already are – and preparing for that eventuality may be the only realistic endgame strategy for all countries. As such, countries with low levels of infection and immunity, like Australia and New Zealand, should urgently immunise their populations. This is key if they want to avoid the considerable COVID-19 mortality and morbidity seen in Europe and the Americas.
But once this is done, continuing with recurrent lockdowns could be both socioeconomically disruptive and challenging to maintain public support for. Together with the virus being more transmissible, the near impossibility of having completely closed off borders long term, and the fact that other countries aren’t pursuing zero COVID, these factors likely will make completely eliminating the virus unachievable.
Andrew Lee is a Reader in Global Public Health at the University of Sheffield, U.K.
Its all Over says
We’re Doomed………We’re all going to die …….. Its over, throw in the towel…… No my Dog can catch the virus and he passes to the neighbors Cat who gives it to her owner Mrs. Pussface. She turns around and gives it to Mr. Pussface who now goes out to the Elks Club forgetting his Mask and gives it to 34 other Elkheads……… Does this mean my little Squirrel friends are now going to catch it and leave little Squirrel virus droppings on my picnic table so the Grandkids come over and play Grand Theft Auto on their electronic big screen iPads ? I can’t take anymore, I’m going fishing…oh Christ tell my that 7lb Speckled Trout I just caught doesn’t have Covid-19 3.0 fish virus. Its time ALL animals, Pets, Wild Life and Fish start wearing mask……Wait, that’s not going to happen.
Oh well, I will just stay hunkered down in my 3 bedroom Palm Coast home hoping the virus doesn’t sneak in thru the air condition cooling my sorry ass………… Perhaps we should rename this city Palm Toast !
Ray W. says
A cautious yet apparently realistic appraisal of a current pandemic that may yet prove to have been an endemic in the making all along, unless those who still claim that Covid-19 is a hoax are right (they aren’t, but their belief remains strong, and belief is all some need these days; facts being unimportant to them). If the virus continues to prove capable of mutating as commonly as it already has (an Indian variant, a Brazilian variant, a South African variant, an UK variant, and on and on), we may experience wave after wave of mutations that are more transmissible, more deadly, or both. The grandmother’s adage that there is no cure for the common cold may prove more truthful than ever. Those who built or are currently building political careers out of repeatedly proclaiming we should do nothing at all, because Covid, in all its forms, will somehow magically disappear, or that masks, social distancing, and shutdowns do not work, may actually prove to have been accidentally prescient without ever knowing why or wanting to know why. The intentionally distorting blind leading the ignorant blind to the world’s detriment. If the intentionally distorting blind actually knew what they were doing, would malice be a sufficiently descriptive term to describe their behavior?
FLF says
I’m more interested in where you caught a 7# trout? Now I have something to live for!!!
This life ain’t yours! says
It’s all fun and games until your kids come home and infect your entire house and now you’re on TV talking about “I wish I would have gotten the vaccine!” Or one of your kids gets it and dies because your freedom to choose…life is short enough and now we have to deal with stupidity. We ARE all gonna die one day but you lessen your time by living in conspiracies and ignorance!
herewegoagain . says
LOVE your comment . Its all Over
I agree, we’re screwed, and I’ll jest subcome to MY reclusivity here in Flagler Beach ..
NO more afternoon drinks with attempts to hustle the cute – but 30 years younger – bartenderess ..
NO more feeding the neighborhood feral cats ..
Publix, pizza, Dahlia, Chipolte, Uber, DoorDash – just leave it on the table near the door – your tip is under the Kindness Rock
Onward to Armageddon, and a better life .. and Liquor delivery – might as well get snookered on the way out :-)
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Seems to me, this virus being Worldwide, needs a Worldwide approach to eliminate it ..
The World is a Giant Interconnected System and the idea that Individual Countries
have their own ideas of resolve is terrifying ..
A GREAT EXAMPLE is the USA where the government has passed the solution onto the state
governors, and some of those state governors have passed it to the individual cities ..
WHO IS TAKING RESPONSIBILITY TO ERADICATE THIS VIRUS ?? seems to me NOBODY
Grey Man says
FYI….the student from Indian Trails Middle School will be back in class on Monday with no negative covid test in hand. God Bless America
Carl V Jones says
The World Health Organization is supposed to be the mouthpiece for the world regarding global health but someone started alternative facts against them and now they are trying to regain their credibility. It’s not over! But we definitely are not the most powerful country in the world anymore, we are the Divided States of Corruption…We can’t even agree that a highly contagious virus is deadly. We can’t agree that wearing a mask is safer than not wearing one. A large percentage agree with a racist conspiracy theorist ex-president that the disease is a “Hoax” that killed almost a million people, are these hoax deaths?
USA is supposed to the land of the free (not), home of the brave (not)…this country is the laughing stock of the world. I’m ashamed to call myself an American. It damn sure does not help four years of a failed reality show called the “Trump Presidency”, which was a major fail and even though the new administration is dealing with the fallout, this country has failed it’s citizens and expects us to sit by quietly and die! Not I, I will speak out against stupidity every day of the week and three times on Sunday, no rest for the sane!!!
bethechange says
Over by Easter