Covid zero strategy: four phases for a return to normalcy

LondonOn 9 February, Ilona Kickbusch, director of the Geneva Institute for Global Health, a leading public health research institute, and Maximilian Mayer, from the University of Bonn, proposed in a jointly published article a new strategy to combat the pandemic. The text reflected a debate that has been going on in Germany for three weeks now, and which in turn was based on another article signed by thirteen leading German researchers, including Ilona Kickbusch herself, virologist Melanie Brinkmann, researcher Michael Hallek of the University Hospital of Cologne and Matthias Schneider of the University of Cambridge.

The summary of their approach is that the SARS-CoV-2 virus cannot be lived with: it needs to be eliminated from the outset. One case is too many. The debate has also been taken up by a publication such as The Lancet. The plan they proposed is both simple and complex. It has three legs. It is based, however, on the objective of no covid - or zero covid - and on the creation of green areas free of the virus.

Melbourne as an example

The Australian city of Melbourne would be the example to follow, according to the German proposal.

The road to normality had four phases, they recall: 1) hard lockdown to achieve an incidence of infection of less than ten cases per 100,000 inhabitants per week, 2) extreme measures to achieve a level of five cases per 100,000 inhabitants, 3) zero target and 4) declaration of a green zone totally free of covid. At this point, not only Melbourne, but all of Australia is in very good conditions.

There was only one case in the whole country on 17 February, and an average of five in the previous seven days. The images of the Australian Open, first with spectators, and then without spectators for three days, when three cases were detected, can be a mirror in which to look at.

Tough measures to encourage the decline of cases, an effective isolation system and rapid management of resurgences if new infections occur are key to achieving level zero covid-19.

Although most of the examples of success that first come to mind are islands - in addition to Australia, New Zealand, Taiwan and Iceland are also islands -, the proposal of the thirteen German scientists believe it can be extended to Europe, provided that there is coordination and political will to carry it out.

To speak of Europe, however, and of a shared strategy may seem, or until now has been, a utopia. The Spanish case, with the diversity of measures followed by the different communities, with very different results, is proof of this. It is also difficult to think about coordination if we take into account what the United Kingdom, France or Sweden has gone through, especially with the first and second waves.

Still, waiting for widespread vaccination to create herd immunity and control the spread of the virus could lead to "even greater damage to economies and, perhaps, to democratic societies", the authors of the proposal stress.

Impossible goal?

A long year after the outbreak of the pandemic, with an evident psychological and physical exhaustion of the population, with an economic destruction much more serious than that of 2008, is it possible to make this policy a reality - not only in Germany but in Europe?

For Kingston Mills, professor of experimental immunology at Trinity College Dublin, the case of New Zealand, where from May 13 to August 12 they had practically no cases, highlights the difficulty of the goal, since new cases emerged in mid-August. The fact shows, in his opinion, that "while it is possible to flatten the curve, reaching zero covid is more difficult". "Eliminating the virus in much of the world, while not unthinkable, may take many years", he said in an article published in October. Another case that would prove him right is Uruguay. The 5,000 cases up to the end of November have now become almost 51,000, with a cumulative incidence of 202 per 100,000.

What is certain, however, is that there are countries, and not exactly in the developed world, that have fought the pandemic very efficiently.