Ever since I learnt all about infectious/communicable diseases and the control of outbreaks during my route to qualifying as an EHP, I realised the importance of the work involved and the profound impacts that they have on society as a whole.
During the Covid-19 pandemic, I have watched closely the approach taken by many countries to control the outbreaks, in particular those countries trying to keep economies running whilst letting the virus rip through their populations; essentially going through lockdown-release cycles, and perpetuating many health and economic harms caused by the virus and lockdowns.
In the absence of pharmaceutical interventions, such as vaccines, it is difficult to see how countries around the world can really get on top of this virus unless they adopt a Zero Covid strategy; this does not have to mean ‘zero’ cases of Covid-19 within borders. However, it does mean suppressing the virus to very low (manageable) case numbers through the rigorous use of other non-pharmaceutical interventions, i.e. traditional outbreak control measures, and keeping them consistently low.
A country that allows the virus to continue to spread will mean that there are very large numbers of people who have to self-isolate. Self-isolation brings with it other problems in terms of sickness absence from work and the financial problems this causes. And it is already known that many with symptoms do not self-isolate, thus increasing the risk of further spread.
Aside from reducing the risk of health services being once again overwhelmed with Covid-19 patients, countries who adopt Zero Covid or maximum suppression strategies will find that their health systems won’t be overwhelmed by a second epidemic in the future, or over the longer term, by high numbers of people presenting with Long Covid symptoms. Indeed, recently, the ONS estimated 1.1 million people currently have Long Covid in the UK, so all of these people have ongoing health issues caused by the virus, which will place a significant strain on our health service now and into the future.
Zero Covid will also reduce the risk of further lockdowns. Lockdowns cause significant health and economic problems, from increased mental health issues to the shutdown of the economy and public unrest, and all of the social problems these cause. Significantly, regularly having to shut down education is storing up a generation of problems in the future. The health and wellbeing of children is paramount and we must remember that it is this generation we shall be relying upon to look after us when we get older.
Maximum suppression of the virus and targeting Zero Covid will also help preserve vaccination programmes and reduce the ongoing risks of emerging variants, which could reduce the efficacy of the vaccines and potentially lead to further, more sustained spikes, in infections. Indeed, a vaccine-centred containment strategy is risky without maintaining all of the other containment measures. And it is important to note that we are not safe until the whole world is safe. Unless the world unites and adopts aggressive, maximum suppression/Zero Covid strategies, we will be in for regular waves of this virus, even with a vaccine; it is crucial that science and vaccines are one step ahead of the variants so that the world can finally get on top of this pandemic.
Finally, it is important to also say that a Zero Covid/maximum suppression strategy must be accompanied by strict border controls to help preserve the benefits of any lockdown. Two reasons why this virus spread so quickly are due to extensive global travel and ‘porous’ borders, allowing the virus to seed in countries all across the world and to transmit rapidly within populations through social contact. Even if a six-week lockdown eliminates coronavirus transmission, the absence of strict, enforced quarantine requirements for all incoming travellers means cases will be imported from neighbouring regions/countries, and if the ‘R’ rate exceeds 1, cases will again grow exponentially in the absence of ongoing restrictive non-pharmaceutical interventions.
In summary, the benefits of a Zero Covid strategy far outweigh those of a non-Zero Covid strategy. The trade-off is where countries have lives and economies very much back to normal within their own borders, but limited travel abroad (with very strict quarantine requirements where only essential travel is permitted). In contrast, the alternative is to continue to yo-yo between lockdowns (or some form of ongoing restrictions on our lives) and the partial reopening of the economy. A Zero Covid strategy is orders of magnitude less costly, and the evidence for this is clear. Let’s just take a moment and look to East Asia for proof of this, and reflect on where the world could be with positivity and ambition to follow suit.
