Is a covid zero strategy realistic in Catalonia?

BarcelonaSpain called it the "new normal" and Catalonia the "the resumption" but, nomenclatures aside, the message that the authorities sent at the end of lockdown, in June, was the same: the virus will not disappear and the population will have to learn to live with it. And to contain the curve, the authorities are using yo-yo restrictions: when the spread is controlled, the measures are relaxed, and when the indicators rebound, they are tightened again.

This has been the strategy followed by Europe and the United States throughout the seven months of the pandemic. But it is not the only one and, in fact, it is not the most effective in terms of contagion, mortality and economic impact. Some Asian countries such as South Korea, Taiwan or China, but also Australia and New Zealand, have implemented a much more drastic but effective plan: to apply very harsh restrictions in a short period of time and lower the cases to residual levels to achieve the elimination of the virus for 28 days, two incubation periods. It sounds chimerical, but it is not impossible. All these countries are following a covid zero strategy.

Covid zero is based on basic epidemiological surveillance preventive action: the search for suspected cases, mass testing, chain tracing and contact identification, and isolation accompanied by a large expenditure on social support. Lockdowns are only used when there are few cases in order to recover the management of outbreaks and always in a targeted manner.

"Covid zero is classic epidemiology: you focus on transmission to reduce the damage of a disease that is preventable", summarizes the epidemiologist of the Hospital Clínic and researcher at the Institut de Salut Global de Barcelona (ISGlobal) Anna Llupià. This is the opposite of the European approach, which only proposes lockdowns once the epidemic is out of control.

In any case, how does the covid zero strategy work? And, above all, is it realistic to apply this plan in Catalonia?

Containment vs elimination

Covid zero is a radically different strategy from the one followed in Catalonia and Spain, but also in the rest of Europe. "Containment measures are taken, not elimination measures. The aim is not to make the virus disappear but to smooth the curve to avoid overloading hospitals", Llupià explains.

European countries thus chronic transmission and are trapped in a circle of lockdown and easing of restrictions that should be exceptional, such as the curfew and the ban on leaving the municipality or county in the Catalan case. "With this action the phases of low transmission are underestimated and it is necessary to act forcefully again, generating more socio-economic damage, because the contagion is out of control", argues the ISGlobal study: Què és una estratègia de Covid-0 i com pot ajudar-nos a minimitzar l’impacte de la pandèmia? ("What is a Covid-0 strategy and how can it help us minimize the impact of the pandemic?")

The effects of the prevailing strategy in Europe are serious: a high mortality rate is maintained, the occupation of ICUs is skyrocketing and there is no material time to reduce it before a new wave. And the more the virus circulates, the more it mutates and the greater the risk of new variants being born. In addition, in the case of Catalonia and Spain, there is not enough economic aid, nor is everyone guaranteed sick leave in the event of a positive result or contact, which amplifies social inequalities and perpetuates the crisis.

"What we should all understand is that hospitals fill up when the real brakes on the pandemic fail: a powerful public health and primary care very endowed," explains the researcher at the Instituto de Salud Carlos III and co-spokesman for the Madrid public health association Fernando Garcia.

The countries that deploy covid zero, eminently Asian, already had previous experience with other epidemics and have always had in mind the importance of reducing infections to zero to avoid all this aggravation. How? Through an exhaustive monitoring of cases and contacts. "The result is surprising: the average mortality rate in Europe and the United States is 618 cases per million inhabitants, and in countries with zero covid, of 11," says Garcia, who also notes that the fall in GDP is almost four times higher in the West.

Political commitment

"There are countries that have done better and we have to look at them to learn", says Llupià, referring to Australia or China, where citizens can enjoy a practically pre-pandemic life. Both Llupià and Garcia believe that if some countries have been able to deploy a covid zero, Spain and Catalonia could also do it. "It is undoubtedly the optimal strategy", García says. "There are countries like Vietnam or Uruguay that do maximum suppression without so many economic resources. Aren't we rich enough?  Stronger economies are also stronger because they are more protective of themselves", defends Llupià, who adds that there is a lot of resistance to change: within governments and in the sectors affected by the restrictions.

Experts argue that there is an alternative to the management model followed in Europe, and Germany is the example: Chancellor Angela Merkel embraces a covid zero plan, although somewhat less ambitious (she wants to reduce to 35 cases per 100,000 inhabitants). However, epidemiologists warn that such a strategy requires a strong political commitment to ensure financial support for those affected by the measures and quarantines, and a robust surveillance system, with an army of trackers. Neither in Catalonia nor in Spain there is sufficient support, nor is there yet a Public Health structure trained in surveillance and knowledgeable about the community. But change is imperative. Covid is the first pandemic of the century, however, they warn, it will not be the last - and we must be prepared.