The COVID-19 emergency has challenged (and is challenging) healthcare and economic systems around the world, especially in terms of their ability to prevent and respond to an event of such magnitude that has impacts beyond the geographic boundaries of a single country.
The choices adopted by the countries, while presenting some heterogeneity, have been directed towards two lines of action: specific interventions to strengthen healthcare systems and public health measures. These interventions are strongly interconnected: the former directly support the capacity of national healthcare systems to cope with the emergency, the latter seek to alleviate the stress that healthcare systems are facing by introducing measures aimed at containing/eliminating the circulation of the virus.
THE “ZERO COVID” STRATEGY: ANALYSIS AND REFLECTIONS
The amount of available data by two years since the start of the pandemic could be the basis for the development of effective COVID-19 response plans. Data available to date suggest, in fact, that countries pursuing a COVID-19 elimination strategy (also known as the “Zero-COVID” strategy) are achieving better results than those implementing a suppression strategy: in other words, aiming for zero COVID-19 cases is producing more positive results than trying to “live with the virus”. Michael Baker (Professor of Public Health, University of Otago) and Martin McKee (Professor of European Public Health, London School of Hygiene and Tropical Medicine) identified 16 reasons why all countries should implement a “COVID-19 elimination strategy”:
- REDUCES MORTALITY – Countries pursuing the elimination strategy have an incidence of daily COVID-19 deaths typically less than 1 death per million population, which is almost 20 times lower than in many other countries “living with” the virus.
- AVOIDS THE EFFECTS OF LONG COVID-19 – Countries that implement the COVID-19 elimination strategy avoid the effects of “Long COVID” on populations, which causes health problems in most hospitalized patients, but can also affect those with mild symptoms.
- REDUCES INEQUALITIES – Pandemics inevitably cause greater harm to the weakest parts of the population, and adopting an elimination strategy, along with the introduction of social protection measures, helps minimizing these inequalities.
- RESULTS IN LESS ECONOMIC CONTRACTION – Countries that have introduced the elimination strategy are experiencing less economic contraction than countries trying to live with the virus.
- WORKS IN VARIOUS CONTEXTS – This type of strategy can be implemented in countries that are very different in terms of geography, size, available economic resources, and governance.
- IT IS EFFECTIVE EVEN AFTER INTENSIVE LOCAL TRANSMISSION – The virus can be eliminated even after an intensive transmission has occurred within a given country.
- EASIER TO ACHIEVE IF MORE COUNTRIES ADOPT THE SAME STRATEGY – In case more countries (especially neighboring ones) adopt this approach, success in eliminating the virus is easier and faster.
- SUPPORTED BY VACCINATION – Launching effective vaccines will make it easier to eliminate COVID-19, especially if vaccination is implemented in combination with other public health measures.
- SETS A MOTIVATING GOAL AND PUSH TO COORDINATION – Countries adopting the elimination strategy have set a challenging goal and implement integrated and coordinated policies to achieve it.
- IT IS SUSTAINABLE – Countries pursuing elimination may have experienced setbacks (resumption of infections and cross-border outbreaks) but have mostly been able to contain them and to regain their elimination status.
- EFFECTIVE IN CASE OF VIRUS MUTATION – The main methods used for COVID-19 elimination (cross-border management, physical distancing, use of masks, testing, and contact tracing) are also effective in the case of virus mutations (although testing may be less effective if the virus changes significantly).
- INTEGRATES BENEFITS OF VACCINES CHARACTERIZED BY LIMITED PROTECTION – In case vaccines provided only limited protection in the long-term and were poorly effective at preventing transmission, elimination methods could integrate this limitation.
- REDUCES THE EMERGENCE OF DANGEROUS VIRUS VARIANTS – Elimination strategy reduces the circulation of the virus, therefore reducing the possibility of more dangerous virus variants circulating (variants that are more infectious and more lethal and could escape the protective effects of vaccines).
- REDUCES THE INTRODUCTION OF LOCKDOWNS – A relatively brief and intense lockdown to eliminate COVID-19 transmission in an area should allow for a relaxation of control measures in the absence of circulating virus.
- CREATES COLLATERAL BENEFITS – Elimination approaches have reduced transmission of other respiratory viruses, particularly influenza, resulting in fewer hospitalizations and deaths from these respiratory pathogens.
- IT IS A GOOD INTERIM STRATEGY – This approach represents a good interim strategy and is optimal in the long term, as it could lead to regional elimination or even global eradication and to the transformation of the pandemic into an endemic infection that can be managed through vaccine administration (as it is the case of influenza).