A nurse tends to a Covid-19 patient affected in an intensive care ward at the Ambroise Pare clinic in Neuilly-sur-Seine, near Paris, March 19, 2021. © Thibault Camus, AP
Swathes of France go into lockdown for the third time on Friday, the latest instance of a government taking emergency measures after attempts to manage the pandemic failed. In this context, many experts advocate a more hawkish "Zero Covid" strategy to bring the virus's spread as low as possible, even if eliminating the virus is an elusive prospect.
Franceimposed month-long confinement measures on 16 regions including the Paris area on Friday to deal with a resurgent epidemic after two nationwide lockdowns in 2020.
The rapid jab programmes in Israel and the UK seems to show one exit route from this gruelling cycle, but the EU's slow vaccine roll-out makes this solution look distant to many on the continent.
Meanwhile several Asia-Pacific countries famously avoided the Groundhog Day-like repetition of lockdowns by stamping on the virus at the outset – with New Zealandrecording just 26 Covid-19 deaths after adopting this strategy.
To many experts, this provides a shining example of what non-pharmaceutical interventions can do – suggesting that European countries have been defeatist in trying to merely manage the pandemic through on-and-off confinement measures. Instead, say many advocates of the Zero Covid strategy, governments should adopt a hawkish approach to bring transmission as low as possible as vaccines are rolled out.
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FRANCE 24 spoke to Claire Standley, an assistant professor at Georgetown University's Center for Global Health Science and Security about how to interpret the Zero Covid goal, and how the virus's spread can be minimised over the coming months.
How would you define the Zero Covid goal?
When people say Zero Covid, they're not always talking about the same thing and that has led to quite a lot of confusion in the public debate about it, and has led to some of the controversy surrounding it. Then there's the very strict definition of Zero Covid – saying we should eliminate the virus completely.
I think the latter is probably an impossible, if laudable, goal. It would require an unprecedented level of international co-operation, which has not exactly been the hallmark of the pandemic to date. It's also the nature of the disease itself that makes that unlikely: the fact that it has asymptomatic transmission. And it's also a zoonotic disease: we don't talk about having eradicated SARS-1, for example, in part because of the unknowns; the virus may still be there in animal reservoirs.
On the other hand, widespread uncontrolled transmission – even with policies in place to shield the vulnerable – has not worked terribly well. There has been a very high human cost, especially seeing as it's hard for authorities to tell accurately who's going to be at risk of severe disease. We can try to shield the very elderly, for example, but there's a large number of people in younger age groups who have had severe bouts of Covid, sometimes without obvious underlying conditions.
The evidence shows that attempts to shield the elderly while letting the disease spread for younger people doesn't work. In Germany the public health institute the Robert Koch Institute publishes a kind of heat map of cases by age groups over time. With that you can really see that last summer there was low transmission, then towards the end of the summer incidents increase for young people – but even with recommendations for the elderly to limit their exposure, you very quickly see in the autumn a massive increase in all age groups. Meanwhile some of the new variants may have severity, including in younger age groups, as there are many unknowns related to them.
What might the situation look like if Covid-19 were to become endemic?
It's hard to know exactly what this virus looks like would like in this stage. But we do have a basic datapoint for this in that we already have endemic coronaviruses. There are four very common human coronaviruses that circulate as the common cold.
So there's a precedent for seeing how Covid-19 could become less virulent through mutation and/or increasing population immunity. Also, in the case of widespread vaccination, its impact could be reduced, as with influenza.
How low will vaccines bring Covid-19 transmission?
It's a miracle that they've been developed so quickly and seem to be so safe and effective – and they're a critically important piece of our strategy. We're going to get problems until we get some degree of immunity. In countries that, implicitly or explicitly, tried to build it up naturally with herd-immunity strategy, it led to health systems collapsing and lots of avoidable deaths.
Some evidence from the very fast jab roll-outs in Israel and the UK suggests that vaccines play a role in reducing transmission but won't do so completely. We shouldn't expect to see cases disappear through vaccination alone; it's not a complete panacea. And when you have less than half of your population vaccinated – as many countries do – there's still a big risk of cases increasing. So it's still going to be necessary to ensure low transmission through other public health measures like physical distancing and wearing masks.
In terms of making Covid much less of a threat, it depends on how quickly vaccines can be rolled out and what the uptake rate is. There is a big question about whether adolescents should get a jab; some US states are allowing 16- and 17-year-olds to take them, but in most countries it's only 18 and above.
What do you say to the libertarian argument that any further lockdowns would be too much?
There's a logical disconnect in what some people are saying, arguing that one more series of restrictions – or one more lockdown – would not be any different from the previous ones and would result in some sort of authoritarian state. That said, we certainly do need to be cautious about ensuring civil liberties are not negatively impacted by any new policies that might increase invasion of privacy or allow for greater interference in personal lives.
Most people advocating the continuation of strict restrictions to bring cases down to very low levels are not arguing for more control by the government; they're just arguing for the same policies that have previously been used.
That said, I understand that many people are very tired of restrictions, so I wonder how high compliance with lockdowns might be at this stage.
In EU countries, the months to come are going to be extremely challenging, with the slow vaccine roll-out, the fatigue with the pandemic that everyone is experiencing and the sense that few politicians feel comfortable with the economic impact of further lockdowns.