Health experts around the world are now re-evaluating their nations’ responses to COVID-19 as “mitigation policies” have failed to contain two waves of the pandemic — with a probable third wave of highly infectious variants on the way.
By now every Canadian knows what COVID mitigation looks like: imprecise lockdowns with no real targets followed by ill-timed openings that result in more exponential grief.
And then politicians, who look as dazed as Bill Murray in Groundhog Day, call for another round of lockdowns with no strategy and no goals.
It’s a policy of constant déjà vu — all pain, no gain and more COVID-19.
Both groups are recommending a dramatic departure from the status quo, with clear targets aimed at engaging the entire community to end COVID-19’s rule.
These two proposals now probably represent the best roadmaps for finding a way out of the COVID morass at a time when there has been little critical reflection on what works. (Ireland, by the way, has also put forward another excellent proposal.)
The German proposal, lauded in an excellent Lancet editorial, is simply called the No-COVID strategy. Germans are now fiercely debating its contents.
Instead of more passivity, the policy calls for an active collective response from the people (a bottom-up process) that embraces tangible and measurable goals leading to the end of COVID-19.
“We have to move away from reactive harm reduction and towards proactive control of the pandemic, comprising all social, health and economic areas of our society, with a clear goal that enables a return to freedom and stability: No-COVID,” says the proposal.
The strategy comes with several layers: an effective lockdown until German states reach 10 cases per 100,000 people. Germany got to 2.5 cases last year, so this goal is doable: it took Melbourne four weeks to achieve this goal. (B.C. is currently at 84.5.)
In simple terms, aggressive action brings aggressive declines in exponential growth.
But none of that matters if you don’t protect the gains and move forward.
Once a state, region or city reaches no cases, it becomes a Green Zone, and normal activity is allowed within carefully watched borders. Adjacent Green Zones are open to normal travel and interactions, thereby protecting hard-won successes and providing the rewards of COVID-free living.
A rigorous test, trace and support system ensures the spread does not resume and keeps COVID cases at zero. To put out spot fires, jurisdictions must commit, just like Australia and New Zealand, to go hard and early in introducing new lockdowns and measures if there are any outbreaks. Over-reacting works when it comes to stopping exponential grief.
With this new focus, the population no longer passively consumes daily COVID statistics on deaths and hospitalizations. Instead, people keep track of the expansion of Green Zones, the restoration of civil liberties and the reopening of economies.
“The No-COVID strategy motivates the population through a common goal and shows citizens a perspective to end this ‘walking on eggshells’ situation permanently,” the report says. “It conveys that we are members of a community who can do something to return to a normal life, but also that you can rely on government measures and aid.”
Just imagine how different Europe would look today if citizens had demanded their leaders roll out this strategy across the continent and every nation agreed to a common No-COVID goal.
The advantages, say the German experts, are self-evident.
“This No-COVID approach is legitimized by a new narrative. There are clearly defined goals and criteria. The population becomes part of the common objective and one important actor in achieving goals (bottom up, not top down). This way the fight against the pandemic is in the hands of the entire population as a collective task.”
What Germany is proposing is what Australia is now doing. To date, only 909 Australians have died. Both the U.K. and the U.S. have daily death tolls greater than that, and Canada has had more than 20 times as many deaths, despite a population only 1.5 times greater.
Here’s what Ian Mackay, a virologist, recently told the New York Times.
“We have a way to save lives, open up our economies and avoid all this fear and hassle,” said Mackay, who devised the celebrated and multilayered “Swiss cheese” model for fighting respiratory pandemics. “Everyone can learn from us, but not all are willing to learn.”
In Canada, an interdisciplinary force with expertise in both public health and economies has taken that advice to heart and prepared the Building the Canadian Shield report, offering a radical and bold plan.
Its authors argue that mitigation has failed the country and it’s time for Canada to learn from winners: Taiwan, Thailand, Vietnam, Australia, New Zealand, the Canadian North and Atlantic Canada, jurisdictions that have all done a better job of controlling COVID-19 than Canada’s so-called wealthy provinces.
The plan proposes mobilizing Canadians to achieve a 75-per-cent reduction in COVID cases during a four-to-six-week lockdown, followed by restrictions that ensure a continuing weekly reduction in active cases of between 17 and 25 per cent while minimizing economic and societal costs.
Is this doable? Yes, it is. Atlantic Canada went from a seven-day rolling average of 29 cases a day on Nov. 26 to less than eight on Dec. 29. Where there is a political will, there is a way.
Will it be easy? Absolutely not. “It will require thoughtful targeting and outstanding execution by governments,” the report says.
The strategy depends on clear goals, not vague assessments of when restrictions should be put in place or lifted. And it requires a shift from Groundhog Day mitigation which brings surges, lockdowns and more surges in an endless cycle.
At the same time, authorities must ask communities what support they need to get the job done by recognizing “the asymmetric effects of the lockdown policies across individuals, businesses and communities, and provide direct assistance to those most affected.”
The basic bottom line is simple, and something I’ve advocated from the beginning of the pandemic: “Move faster than the virus with testing and tracing, isolation and support.”
Canada’s Atlantic provinces and three territories are the only places in Canada with strategies similar to the No-COVID approach. And what have they achieved?
A hell of a lot more than Alberta or Ontario. Fewer cases and deaths compared to the rest of Canada; healthier economies than the rest of Canada; and a 78-per-cent public approval rating for their governments’ measures compared to 58 per cent elsewhere in the country.
While other provinces drowned in the second wave, these jurisdictions resisted. That’s the power of going to zero.
Not surprisingly, much of the Canadian Shield proposal calls for many of the same principles of public engagement and collective action raised by the German No-COVID strategy.
Both require “every community to be more completely involved.”
And they outline a reality that Canada’s politicians don’t yet understand. “With a renewed clear, credible strategy with weekly reconfirmations of progress, renewed engagement is possible.”
And setting clear goals to reduce COVID cases is a much saner strategy than the current merry-go-around approach.
Andrew Morris, who describes himself as “your friendly infectious disease expert” and one of the authors of the report, says, “The most important thing is target setting and having a strategic plan. There isn’t a province in the country with clear messaging.”
Morris, like all the paper’s authors, believes that Building a Canadian Shield “is a credible, attractive alternative to the likely setbacks and disappointments, the human and economic cost, of the present mitigation strategy.”
German and Canadian public health experts are not alone. After watching COVID variants crush the U.K.’s health-care system, a brilliant scientist, Devi Sridhar, chair of global public health at the University of Edinburgh, came to a clear conclusion.
“It’s no longer enough to just flatten the curve, or treat COVID-19 like a yearly flu. This will devastate our economy and society and run down our health services. The model of living with the virus and allowing it to run through the population has failed.”
Canada now needs a debate about the path forward: more dithering or concrete collective action with clear goals.
But only Canadian citizens can make that happen.