Continuous lockdowns not the solution to bringing Covid under control | Coronavirus epidemic


isIn April, cafes and restaurants opened in Vietnam full of life and bustle. In July, 10,000 baseball fans attended a game at a stadium in Taiwan. In August, thousands of people gathered for a music concert at Wuhan Maya Beach Water Park in China. And this month, the rugby internationals take place in New Zealand with stadiums at full capacity.

Daily life in these places has largely returned to normal. Compared to other countries, they suffered minimal economic damage. In fact, Taiwan has never even had a lockdown, while lockdown measures in Vietnam, New Zealand and China have been early, brief, and to the point. Out of a population of 1.4 billion, China has suffered only 4,634 deaths linked to Covid-19; Vietnam, Taiwan and New Zealand had 67 together. How are these countries keeping Covid-19 under control, their health services functioning and their economies and societies afloat?

This is the question we should all be asking ourselves. Instead, seven months after the start of this crisis, the UK remains stuck in endless cycles of lockdown measures, its media still fixated on crippling debates about the true severity of the virus and the optimal strategy for it. to face.

The UK initially made the mistake of treating the coronavirus like the flu. It was late to lock in, initially allowing the virus to spread through the population like a cold. Once the severity of the virus became clear and the government imposed a lockdown, it wasted time and instead waited to see what would happen.

In recent months, the number of cases has increased and decreased. Over the summer, the UK appears to have crushed the curve and brought its R-number under control. But rather than replace strict lockdown measures with a functional testing and tracing strategy, moving from quarantine to the population to quarantine only those who had been exposed to the virus, the UK has lifted restrictions without an effective back-up. Meanwhile, the government actively encouraged people to go on vacation abroad, which meant the virus was continually re-imported into the country, triggering new chains of infection when those people returned.

To the government, the purpose of the lockdown seemed to be just that: to lock down the country and hope the problem would go away. But the lockdown itself does not fundamentally change the virus or its trajectory. It saves us time. And over time, fatigue and anger set in. People have started to equate removing the virus with staying at home and shutting down businesses. The alarm bells have started ringing: could the cost of these measures be greater than the toll of the virus itself? Should the lives of millions of people be limited just to prevent the deaths of thousands?

It is not surprising that those who offer simple and convincing solutions – “You can get your life back before Christmas”; “It’s either the economy or health”; “This virus is practically harmless to those under 55” – found a willing audience in a frustrated and tired society. Many of these arguments can be grouped together under terms such as “collective immunity”, “targeted protection” or “protection of vulnerable persons”. If the virus appears only a risk for the elderly or those with pre-existing conditions, they say, why not protect the vulnerable and let everyone live normal lives?

Unfortunately, there are no such simple solutions. This plan may seem good on the surface, but it runs into deep problems in practice. It is not only the vulnerable who need to protect themselves, but the members of their household and those with whom they are in regular contact. And how do we distinguish the vulnerable from the healthy? It’s not just a matter of age – Covid has been shown to have worse outcomes in people who are overweight, of particular ethnicities, or with pre-existing conditions they may not even be aware of.

We are only just beginning to understand the effects of the virus on people even with mild cases. Covid-19 doesn’t just attack the lungs; it also affects the kidneys, liver and blood vessels and can attack the brain. This can cause long-term problems for young and previously healthy people, so ‘long Covid’ is now recognized as a condition by the NHS.

Another problem is that immunity to coronaviruses quickly wanes and reinfection is possible. “Collective immunity” is illusory – we don’t know whether immunity against Covid is lasting, so we’re unlikely to reach a position where people who were protecting could safely emerge. After decades, we no longer have collective immunity against cholera, yellow fever, polio, measles, tuberculosis, malaria or plague. Public health measures were used to control their spread until vaccines or elimination strategies were developed. In fact, malaria was rampant in parts of the United States until the new Centers for Disease Control launched a massive federal public health campaign to eliminate the disease in the early 1950s. Collective immunity against measles has only been achieved with a vaccine. Similar stories can be told for many pathogens that have plagued mankind.

So what are the strategies to fight the coronavirus before the arrival of an effective vaccine? The answer cannot simply be continued foreclosure, given the significant economic and social costs that this entails. A recent peer-reviewed article from The Lancet, which I co-authored, looked at international lessons from easing the lockdown and identified three key elements that are essential in bringing the virus under control.

Most important is a robust testing, tracing and isolation system, where test results are returned within 24 hours, at least 80% of people’s contacts are reached, and there is strong adherence to a rule of thumb. 14-day isolation for people exposed to the virus. . Strong public health guidelines for avoiding the virus at any age are needed, encouraging people to get out as much as possible, to avoid indoor, crowded and poorly ventilated spaces, and to use face coverings and distances where possible. And we need tough border measures to prevent re-importation of the virus, instead of our current system which is lax and poorly monitored.

This pandemic is still in its first or second chapter. Waiting for the virus to magically disappear, allowing it to run its course in society, or impose continual lockdown measures without a clear strategy beyond waiting for a vaccine are all suboptimal choices that will hurt your health. our health, our economy and our society. At what point will Britain look to East Asia and the Pacific and say ‘We want what they have’? When will we learn the lessons from their manual: suppress the virus, open the economy and regain some semblance of normalcy in our daily lives?

• Professor Devi Sridhar is President of Global Public Health at the University of Edinburgh


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