New Zealand closed its borders to all non-residents and non-citizens in mid-March, becoming one of the earliest countries to do so. At the time, that decision may have felt drastic, especially for a country that at that stage had experienced no deaths from Covid-19. Fast-forward four months, and New Zealand is hailed as an example of what has been dubbed the Zero Covid approach – essentially, the near-banishment of the virus from a country. And the approach seems to work: at the end of July, New Zealand’s death count stood at 22 confirmed Covid-19 deaths.
Last week, Independent Sage, a group of scientists who are publishing advice around Covid-19, called for England to formally adopt a Zero Covid approach, which both Scotland and Northern Ireland have been pursuing. A Zero Covid approach doesn’t mean no cases at all – it just means eliminating transmission as much as possible.
“There is a difference between eradication and elimination,” explains Martin McKee, a professor of European Public Health and a member of the Independent SAGE committee. “Eradication would be like what we had with smallpox, but elimination is where we can reduce all other kinds of transmission except for imported cases.” This would essentially require far stronger measures at the border – such as what South Korea, Australia and other countries have done, where visitors are made to stay in hotels or government facilities, or to use a tracking bracelet.
In the final Downing Street press conference at the end of June – as many lockdown restrictions were eased – chief medical officer Chris Whitty said that he expected a significant amount of “coronavirus circulating” at least until next spring. The Independent SAGE group pointed out in a report that this level of circulation – which Whitty was referring to – could potentially amount to thousands of deaths over the coming months. At no point has prime minister Boris Johnson said that the government is aiming for a Zero Covid approach. Earlier this week, Nicola Sturgeon said that she is trying to get all four nations of the UK to commit to the elimination of Covid-19.
In April, the Scottish government diverged from the UK government’s approach and put out a statement saying that there would be “no acceptable number of Covid-19 cases.” While Scotland went into lockdown at the same time as the rest of the UK, pubs were closed for a week longer than in England, and face masks were made mandatory in shops from July 10 (as opposed to July 24, in England). Until July 3, households were not encouraged to travel far away from their homes. Additionally, contact-tracing efforts in Scotland drew on local authorities more than their counterparts in England, rather than turning immediately towards an app (as England did). Currently, there are an estimated 10 to 30 daily infections in Scotland, compared to 2,800 in England.
“What we’ve seen in the UK is a mixture of collective ignorance, as well an ideological response. If we had followed WHO guidance and implemented the recommendations and acted on the findings of the WHO China report from February 24, we would have been in a much better position,” says Allyson Pollock, the director of the Newcastle University Centre for Excellence in Regulatory Science, and a member of the Independent SAGE group.
That’s what governments scientists and policy makers did in New Zealand. They observed that mitigation – the strategy of “flattening the curve” – was failing and that more decisive action needed to be taken. Lockdown provided New Zealand with the time to put in place the intensive measures necessary for the pursuit of Zero Covid – such as contact tracing and isolating, an intensive quarantine for people entering the country (which is now the subject of some controversy). None of these measures have been thoroughly implemented for England.
The Independent SAGE group has laid out a plan about how Zero Covid can be achieved now. “It’s important to have good local data on the cases in the community and have effective contact-tracing in place – but you need a complex range of public health interventions,” adds Pollock. It may sound ambitious, but experts say it is doable. It just requires a reorientation of the government’s priorities, alongside better systems for tracking and tracing and data-sharing. And it needs to happen fast.
A Department of Health and Social Care spokesperson says that the decisions it has taken have been guided by scientific advice.
“We are taking a phased, cautious approach to reopening our economy so we do not risk a second peak that could overwhelm the NHS," they say, adding its decisions are under regular review and can change based on scientific evidence.
The fundamentals of a Zero Covid approach include stricter checks on international travel, a support system for people who are in isolation, and the attribution of more power to local governments and councils to monitor local outbreaks and enforce new regulations – although that would admittedly be a long-term effort.
“You have to actively work at getting there,” says Gabriel Scally, a Visiting Professor of Public Health at the University of Bristol and a member of the Independent SAGE group. “One of the significant problems in England, for example, was the inability to put in place local control measures, right from the beginning. It wasn’t the full suite of measures that was needed to bring the outbreak under control.”
Some elements of the Independent SAGE group’s recommendations for Zero Covid are already in place in some form – such as encouraging people to socialise outdoors where possible. Others would require that the government back on previous policy announcements such as government guidance encouraging employers to welcome their staff back in the workplace, slated to become effective from August 1. Other measures are on their way – such as the announced investment in bike lanes and pedestrian infrastructure to help commuters avoid crowded public transport. But some key elements of a Zero Covid strategy are not part of the government’s plans, and they will be difficult to ramp up adequately – like for instance the creation of better data-sharing arrangements and contact-tracing between local governments and regions.
Pollock, Scally and McKee also point out that the UK’s infrastructure for dealing with a crisis like this has been thoroughly hollowed out, after years of cuts and closures have affected local councils. “There’s a huge gap between local governments and Whitehall, and local areas haven’t been empowered to do the job, and that’s going to be a big problem in getting cases down,” says Scally.
“Information about positive cases now flows to Public Health England, so labs don’t have to notify local departments and they have no entitlement to receive this information, “says Pollock. “There are highly ineffective and inefficient privatised test and trace systems, commercial labs which haven’t sent test results to the right authorities on time – it’s a total mess.”
The pursuit of a Zero Covid approach would also require some significant changes at the border. Scally points out that the UK government has been hesitant to establish broad travel restrictions, which has led to confusion when Downing Street suddenly imposed quarantine measures on people returning from Spain. “It’s been slow, it’s been partial, it’s been inept,” he says.
In principle, a Zero Covid approach could be pursued by any country. Countries including Thailand, Lesotho, and Mongolia are now pursuing this elimination approach. There is no reason why that strategy could not be adopted in England, too.
“A number of countries have managed to keep exceptionally low levels, and it’s not impossible to do,” says McKee.”But there has to be political will – we have to say that we want to do this, and we have to develop a strategy to do so.”
This article was originally published by WIRED UK