BECOMING a covid-19-free zone sounds like the ultimate goal for any nation. Several countries around the world have come pretty close and, according to a group of independent scientists, the UK could join them. The group says that, as an island nation, the UK could introduce specific measures over the next year and follow in the footsteps of other island success stories, such as Iceland, Taiwan and New Zealand.
But closer scrutiny reveals that no country has truly eliminated the coronavirus from its shores and that doing so would mean making such large sacrifices in other areas of public well-being that it might not be worth it.
Earlier this month, Independent SAGE – a self-appointed group of scientists that provides advice with the intention of guiding UK government policy on the coronavirus – published a report recommending that the UK aims for zero reported cases, known as elimination, within the next 12 months.
“Achieving elimination would allow all social distancing measures to be lifted, schools to be fully open, the hospitality and entertainment industries to reopen fully, revitalisation of the economy and a sense of much needed normality for the population,” the report said.
All the researchers New Scientist contacted agreed that elimination is a worthy goal. Most say it is theoretically possible for many countries, including the UK, to rid themselves of the virus even without a vaccine.
Success would require tough measures, however. The steps suggested in the Independent SAGE report are familiar ones. They include boosting test, trace and isolate programmes, maintaining lockdown policies and strictly restricting travel.
Such measures would be a departure from the current phased return to normal life proposed by the UK government. It recently advised people to return to office working and will soon offer discounts on restaurant meals to encourage dining out. Recent figures suggest England’s test and trace programme is only reaching about 80 per cent of infected people’s contacts, and it is unclear how many of those told to isolate are doing so.
Tight restrictions on travel and border control would have costs for business, tourism and the broader economy.
The steps needed to move to elimination would have other costs. “It’s really difficult to know [what the goal should be],” says Kathleen O’Reilly at the London School of Hygiene & Tropical Medicine. “It’s all about balancing what’s feasible, what resources you have available and what the disadvantages are with putting your resources into one disease.”
Even those countries that have come the closest to reaching elimination are now in a constant battle to keep things that way. New Zealand was tentatively described as “virus free” early in June, when all restrictions except tight border controls were lifted. But the country has been reporting small numbers of new cases of covid-19 on a near-daily basis for the past month. As of 21 July, the Ministry of Health reports 27 active cases in managed isolation and quarantine. More individuals there could have symptomless infections, says Rajiv Chowdhury at the University of Cambridge. Scotland looked like it was close to elimination at the end of June, but it is still seeing a number of new daily cases.
Elimination is worth aiming for if all we want to do is put an end to covid-19, says O’Reilly. But lockdown has already significantly affected other areas of healthcare provision. In the UK, elective medical procedures have been delayed, cancer screening has been put on hold and thousands of people have avoided seeking care for serious health issues, including for heart attack symptoms.
The balance is an even greater challenge in countries with more limited resources. Those that were well on the way to eliminating polio and measles via widespread vaccination efforts, for instance, have had significant setbacks due to the diversion of healthcare resources during the coronavirus pandemic. “Polio virus is now spreading more, certainly in some African populations and in Pakistan,” says O’Reilly.
Given these difficulties, some scientists are proposing an alternative approach: eliminating the coronavirus as a public health concern. In practice, this would mean there are so few cases that people would be unlikely to come into contact with an infected person while on an outing or visiting a restaurant, says O’Reilly. But how this relates to actual case numbers is unclear.
The Independent SAGE group suggests that having one case per million people in a population could be used to define having the coronavirus “under control”, but group member Gabriel Scally admits that this figure isn’t based on hard evidence about how the virus spreads.
Even this goal would mean significant, prolonged changes to behaviour in terms of social distancing, personal hygiene and mask wearing. “From what I’ve seen so far, I’m not hopeful,” says Chowdhury.
Eradication – having zero global cases of the virus – is an even bigger challenge. We have only ever eradicated one human disease, smallpox. That came about through a massive global effort, helped by a very effective vaccine. It was also much easier to see who was infected with the smallpox virus. For now, eradication of the coronavirus seems impossible. Even if a vaccine were developed, we don’t yet know how effective it would be or how long its effects might last.
Attempts to eliminate – or at least significantly lower – cases in one nation must also consider the global picture. “We have to tackle this as a world issue,” says Stephen Griffin at the University of Leeds, UK. This is why the US government’s decision to pull out of the World Health Organization is so “unproductive”, he says.
“We have to act together,” says Griffin. “If we don’t, we’re going to have real trouble for the foreseeable future.”
newscientist.com, 22 July 2020
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