Zero-Covid Strategy

JUNE 2021 Download this Article

It has been more than 20 months since the world started fighting this pandemic. Statistics of this pandemic is overwhelming, heard only in wars.

 While human misery continues, governments across the globe are struggling to get infection rates in control. As a result, 3rd wave is next, and the world must prevent it.

 Here are some of the measure taken and challenges faced to achieve Zero-Covid.

Lockdown

There have been various levels of lockdown to control the contagion. Different countries have used varying degrees of strictness and duration. 

It is unheard of in history. Some countries have used curfew, while others like the USA have hesitated. Alongside, there had been a restriction in the movement of people across cities and countries. 

The point here is to suggest that these restrictions have not stopped variants sneaking into countries far from their origin. Wuhan, where the infections originated, is geographically far-flung from areas the variant was later found. 

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Like the Kent variant, later renamed as Alpha variant, first found in the United Kingdom, it made its way to India, the middle east, the Americas and the far east. 

Like Alpha (Kent), Brazil Variant, South African Variant, Delta Variant, and Delta plus are prevalent. Out of which, the Delta variant is now a worldwide threat. 

These variants travelling across continents is a good enough example to conclude that partial lockdown, which countries are practising, is not working.

 The Sooner we learn about it, the more effective the Zero-Covid strategy we will formulate.

The fact that we have waves means that some measures are working, and others are not. For example, lockdown is effective in curbing the contagion and unlock reversing the effects of lockdown.

At what stage the population should be allowed to mix is the most pertinent question of current times.

Previously we have seen an entire city or country lockdown. Their government have put restrictions even in areas that had no cases. 

For places where the population was sparse, due to the nature of their work, like fishing in the high seas or farming in the middle of acres, still, governments required them to be in lockdown. 

One size fits all was the unjustified strategy. Consequently, the economy suffered, and the population became impatiently rebellious.

Instead, customized and micro geography level lockdown is the potent answer. Surgically, the area needs to be identified by zip code, pin code, postcode etc., into the smallest unit of the neighbourhood. 

For the sake of discussion, call it a “bubble”. The target should be to get zero covid in each of these bubbles. The movement of people can happen between any geo-code bubble that is in green. 

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A single case and the entire zip code (unit) goes to red and lockdown. Every time we get R=0 and P=0, the bubble becomes green, and they join the other green to follow an everyday life. 

This strategy is one of the strictest, and people can complain about their civil liberties, but worth pursuing. It is also comprehensible that micro-management would require a mammoth effort, but it is a robust solution. 

Micro-management of geo-codes is needed locally, but it is also a method the entire world must follow simultaneously. For a Zero-Covid strategy (if pursued) to succeed, geographical uniformity in implementation will be necessary.

A complete lockdown is challenging as there is pressure on governments to restart the economy. The livelihood of a large population will severely hurt as it did last year. In turn, global interconnectedness will continue to hamper international trade. 

The shortage of chips for cars and mobile phones is a prime example of lockdown in one country and its consequence on world trade.

 Businesses, especially the small ones, are already restless and in a hurry to reopen the economy. Restarting their everyday life is a top priority now. 

Statistically, when the infection curve dips, governments cannot continue to impose a lockdown as the public becomes impatient. 

The governments then are at risk of losing popularity due to subdued economic activity and curbing civil liberties. Lockdown and restrictions have been detrimental to mental health too.

Vaccines

Vaccines are administered with four assumptions. Firstly, all brands of vaccines will be successful – partially or fully. Secondly, they will work for all variants, now or in future. 

Thirdly, the entire global population will be inoculated, at least 75%, which will create “Herd Immunity”. 

Fourth, the link between infection and hospitalization or death is broken with vaccination. Any one of these assumptions fail, and the contagion will rebound.

The role of vaccines is adding to the complexity of the Zero-COVID strategy. There are many vaccines available from different companies in different countries. 

These vaccines are developed using varied biotechnology like mRNA and dead virus. Their claimed efficacy is also different. 

It will get verified only with time, and so will their performance with variants. With these inequalities of efficacies, developing a zero-covid strategy is complex.

Vaccine hesitancy is another factor we need to consider when designing a zero-covid strategy.

 A large section of the population in many countries, especially the developed ones, are avoiding vaccines. How do the government deal with their mindset?

From a “Systems Thinking” point of view, a vaccine is considered the best and only weapon the governments rely on. It makes the vaccine a single-point-of-failure. 

With multiple variants we had till now, vaccines seem to be hitting a moving target. There is no plan-B known to the public if the vaccines fail or are partially successful.

The roll-out of vaccines within the nations is not consistent. All parts of a country must be inoculated progressively and equally. Especially it concerns countries like India and Brazil. 

For an effective Zero-Covid strategy, all countries must simultaneously complete their vaccination of the entire population. 

Like intra-country vaccination, inter-country matching of vaccination progress is essential because international travel is unavoidable. 

If the countries allow only fully vaccinated travellers, they are going to hamper their economics. 

Usually, the immigrant workforce like in the Middle East comes from developing countries like India, Pakistan, Philippines, Bangladesh, Sri Lanka, African countries etc. 

The same is the case within Europe. All 23 countries in the union will have to get their vaccination program completed simultaneously. 

If any of those countries are falling behind vaccination programs, then the labour market will get affected. Also, in desperation, the emigrants will take shortcuts. 

Hoarding, price escalation and fake vaccine certificate related issues in home countries will sky-rocket as the frantic demand will rise.

Inequality of vaccination and international travel is a perfect recipe to restart a contagion anywhere in the world. It would be the Korean Patient P=31 phenomenon all over again. 

As this article goes into publishing, we see an outbreak in Australia. It has been a country dealing pandemic with strictest measures. So how could the Delta variant breach?

 There are few suspected breakpoints. One was the hotel quarantine where the government lodged the travellers. 

But P=0 was the limo driver who contracted the infection from a passenger driven to the quarantine centre. So all the objectivity of tight border control has gone for a spin. 

The learning from Australia and earlier from Korea is all about rigour and sustained precautions. To be followed for both the domestic and international travellers. One minor slip-up and the aftermath is grave. 

Journey to achieve Zero-Covid?

Achieving “Herd Immunity” to naturally subdue the transmission of infection is another strategy that scientific and medical advisors envisage.

 It could be an option if the vaccine works, even though with average efficacy.

 Less and fewer people will be sick and transmit infection at R much lower than 1. Considering vaccines works just enough to prevent hospitalization and death, then the biggest problem is resolved. 

People may contract the infection and survive with minor flu-like symptoms. It is a target the vaccine companies and governments need to aim.

 Losing precious lives to reach herd immunity is unacceptable, as attempted earlier by the British government.

There are not many options available to reach zero Covid. Primarily people must take precautions, and there is only a limit to it. 

It is not a perfect solution and dependent on personal practices, mental fatigue, personal liberty, compulsions at work and home. Government can only keep reminding up to a limit about the precautions as a newly adopted national habit. 

The reality is harsher than we anticipate. Many have trouble following traffic laws, even though they know the consequences when breaking the law.

 Following a practice that is not legally enforceable is challenging. World over, we have seen Prime Ministers, Presidents, and senior lawmakers, including the British Health Secretary flouting Covid rules.

If the vaccine is ineffective due to multiple variants and resistant mutations, then lockdown is the only option. However, it has to be done smartly with the concept of a bubble.

Is Zero-Covid strategy realistic, and is it a strategy worth pursuing?

Although these strategies followed in some form, only an international combined effort will make an interconnected world free of Covid.

The world aims to get the cases to zero, but realistically, it is not reachable soon. One can only guess that after two years, Zero-Covid is attainable. 

Before that, the world will be lucky if mutation itself weakens and human immunity is enough to beat the infection.

Like smallpox, everyone would like to see an end to covid. However, it must be pursued and not be left untreatable like HIV AIDS.

With these complexities, it seems governments are not keen on pursuing Zero Covid Strategy. Instead, there are calls from many quarters, especially from various governments, that world must learn to live with it. 

The softness in the approach is evident from the reopening of major economies like the US, UK, India, and others worldwide, even though the infections dangerously looming. 

The benefit of livelihood seems to surpass the cost of lives in their calculation.

The rhetoric needs to change here. Instead, the world must learn to live safely with Zero-Covid Strategy.

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