As many countries continue to struggle with a third wave of COVID-19—Hong Kong is suffering its fourth wave and is contemplating a fifth and sixth—all governments and public health authorities will need to remain open to new ideas for controlling the pandemic. This past week, Ilona Kickbusch, founding director of the Global Health Centre at the Graduate Institute of International and Development Studies in Geneva, shared a proposal being widely discussed in Germany. The approach devised by a group of clinicians and academics, which in addition to Kickbusch includes Melanie Brinkmann, Michael Hallek, Matthias Schneider, and others, is a “No-COVID strategy”.
There are three elements to their plan, based on the twin objectives of No-COVID and the creation of virus-free green zones. First, a rapid reduction in numbers of infections to zero. Second, avoidance of further virus transmission or reintroduction through rigorous test, trace, and isolate systems, together with local travel restrictions. Third, rapid outbreak management if new cases of COVID-19 occur sporadically. Experience from several east Asian countries shows that complete elimination causes the least harm to society. Every infection is one too many.
The German proposal recommends a regional focus—when the incidence of infection in an area falls to zero, the region should be declared a green zone. Strict protective contact and travel restrictions should be imposed around this zone, with robust test, trace, and isolate protocols. Individual motivation and social consensus to support this plan—a collective objective for the entire population—would be assisted through daily communication with the public.
Messaging would now focus less on positive test results, hospitalisations, and deaths. Instead, public support would be built around the broader goals of societal wellbeing, returning to work, and the restoration of civil liberties. To maintain public commitment, cohesion, and morale, authorities need to offer a clear reopening plan based on progress to No-COVID. The eventual aim would be to expand and fuse green zones across Germany. This strategy could also be implemented across Europe if governments could agree to a common No-COVID goal.
The German team argue that the first realistic assessment of their plan came with the way Melbourne successfully handled its recent outbreak.
The “path to normality” would consist of four phases. Phase 1: lockdown to achieve an incidence of infection below ten cases per 100 000 population per week. Phase 2: continued measures to reach below five cases per 100 000. Phase 3: reaching zero incidence. Phase 4: declaration of green zone status.
Source : Lancet