by
Les May
SPARROW
Hawks
and birds which hunt like them seem to have
the ability to lock onto a specific target and however much it weaves
and dives remain doggedly on its tail. Did
something similar happen in January and February when the response to
the potential for a Covid-19 pandemic was being thrashed out in the
UK?
Was there a fixation on the type of
response
which has
worked in the past with respect to Influenza
epidemics. Essentially
that amounts to ‘you
can’t stop Influenza, so rely on mitigating the harm it causes’.
Did
the UK government’s advisers ‘lock
on’
to
an Influenza response strategy and fail to consider possible
alternatives?
There
are two important differences between Covid-19 and Influenza.
Covid-19 has a higher death rate and a longer incubation period than
Influenza.
The
first means it is even more dangerous, the second that there is a
longer window in which to test, trace and track potential sufferers.
I
am
prompted to ask these questions because New
Zealand,
which followed a different strategy after abandoning mitigation, now
believes that it has largely
eliminated community transmission of the virus and is in the process
of easing its ‘lockdown’
measures. Of course New Zealand has a much smaller population than
the UK, but if we standardise the infection rate in terms of cases
per million of the population we find that for New Zealand the
numbers are about 300
per million
and for the UK they are about 2,300
per million.
The
strategy followed by New Zealand was ‘containment
as a stepping stone to elimination’.
The
steps needed to make such a strategy work were discussed in a paper
published in the New
Zealand Medical Journal
on 3 April 2020. Some of the requirements for making elimination
work which were presented in that paper are:
‘Elimination is a
well-recognised strategy for infectious disease control, and New
Zealand can draw on public health experience of eliminating a range
of human and animal infectious diseases. In particular there are
lessons to be learned from the measles and rubella elimination
strategy, albeit with the difference that we do not yet have
an effective vaccine for COVID-19. Past experience has taught us
that there are three factors that are critical to elimination
success: 1) high-performing epidemiological and laboratory
surveillance systems; 2) an effective and equitable public health
system that can ensure uniformly high delivery of interventions
to all populations, including marginalised groups (in this instance
intervention is focused on diagnosis, isolation of cases and
quarantine of contacts rather than vaccine); and 3) the ability
to sustain the national programme and update strategies to
address emerging issues.
The
essential elements of an elimination strategy for COVID-19 are likely
to include:
1.
Border controls with high-quality quarantine of incoming
travellers;
2.
Rapid case detection identified by widespread testing, followed by
rapid case isolation, with swift contact tracing and quarantine for
contacts;
3.
Intensive hygiene promotion (cough etiquette and hand washing) and
provision of hand hygiene facilities in public settings;
4.
Intensive physical distancing, currently implemented as a lockdown
(level 4 alert) that includes school and workplace closure, movement
and travel restrictions, and stringent measures to reduce contact in
public spaces, with potential to relax these measures if elimination
is working;
5.
A well-coordinated communication strategy to inform the public about
control measures and about what to do if they become unwell, and to
reinforce important health promotion messages.’
(my
emphasis)
I
have repeatedly suggested that we should watch carefully what is
happening in China and not get too ‘hung
up’
on the accuracy of the figures it publishes. This is what the
authors of the paper have to say:
‘The
strongest evidence that containment, on the path to elimination,
works comes from the remarkable success of China in reversing a large
pandemic. Of particular relevance to New Zealand are the
examples of smaller Asian jurisdictions, notably Hong Kong,
Singapore, South Korea and Taiwan.’
In
the UK the stable door was left wide open and the horse has well and
truly bolted. We have had 20,000+ deaths so far and to get out of
‘lockdown’ we are going to have to have in place the
measures which might have eliminated some of this pain if they had
been applied earlier, detection
identified by widespread testing, case isolation, contact tracing and
quarantine for contacts.
Questions need to be asked of someone.
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