Elimination Is The Only Strategy For COVID-19

It works. We have real-world examples. It just takes will

Medical workers in Wuhan in February. They’re eating hot-pot and having parades now.

We know how to beat COVID-19. We don’t need hypothetical arguments when we have the real world. China and almost all of its neighbors (Taiwan, Vietnam, Mongolia, etc) have beat this disease. New Zealand has beat it. It can be done.

Elimination is the only destination. Not living with the disease. Beating it down to zero, and getting back to living with each other. My country, Sri Lanka, has done this before. I am trying to tell us, we can do it again.

The Elimination Strategy

As epidemiologist Devi Sridhar keeps saying, over and over:

Three paths for governments: 
1. ‘simmer’ virus & be stuck in lockdown/release cycles
2. do nothing & let it rip or 
3. aim for *elimination* with strong test/trace/isolation, good guidance to public & border measures. 
Two of the above paths lead to large economic costs; one less so.

Elimination, elimination, elimination. What does elimination mean? Getting local cases down to zero. Do they stay at zero? No, the bugger gets back in. What do you do then? Eliminate it again. Vietnam has showed us this in Da Nang. Australia with its 111 day lockdown of Victoria.

The whole debate about health vs. economy is, at this point, settled. The countries that debated this nine months ago are still debating it (and have neither). The countries that eliminated the damn virus have both. It’s a stupid dichotomy, but I won’t even get into why. Just look.

Countries like Sweden and even much of Europe tried to ‘live with the virus’ in some way, never going hard and never even having the goal of getting clear. This is like the tale of the ant and the grasshopper. They did the bare minimum and then went back to the bars. Now winter is here, and they’re shutting down again. They cry economics, but have the economic sense of a toddler that cannot delay gratification. These countries are on a roller-coaster of death now, throwing up their morale with each peak.

Countries like Vietnam, China, Mongolia did whatever it takes to eliminate the virus. Shutting borders, locking down, testing, tracing, whatever it took. The methods differed but they had the same goal. Elimination. Look at them now. They’re hanging out. They’re in school. They’re working.

They’re free.

Of white nations, only the ones in Asia figured this out. New Zealand and Australia. And they too are living. Australia had another outbreak in Victoria and — despite Murdoch papers trying to sabotage it — they bit the bullet again and locked down for 111 days. A great sacrifice, but now they’re at zero. They’re off the roller coaster. It’s not easy, but look around.

Elimination is the least bad option. Yes it sucks, but where would you rather be, healthy and free in Taiwan or sick and going into lockdown anyways in the UK, and paying in blood? The lesson is simple and eternal. Never put off till tomorrow what you must do today.

How To Do It

The basic tactics of fighting disease would be familiar to Ibn Sina 1,000 years ago. To eliminate COVID-19 you have to find infected people and isolate them. That’s it, the only novel element is PCR testing. The devilish thing is time. This is easy with one person, difficult with one-hundred, and impossible with a thousand. And it grows exponentially. By the time you find 100 cases, congratulations, you actually have a 1,000.

Stop it immediately (<100 cases)

If you have robust border controls and you quarantine every infected person, congratulations, you’re Mongolia. Mongolia has never had local transmission at all.

Stop it later (<1,000 cases)

If you have border controls, the virus still gets through and you test, trace and quarantine all first degree contacts (away from their homes) you can beat it. You’re Vietnam.

Stop it too late (>1,000 cases)

If the virus gets out of control you have to lockdown entire regions until the tools above can even begin to work. If it’s your first time, probably the whole country. This is painful but it works. China, Australia and — once upon a time — Sri Lanka did it.

There is a lot of debate about lockdowns and, yes, they’re awful. So’s chemotherapy. The results, however, are better than cancer.

How To Do It Again

Elimination is NOT eradication. Because the whole damn world is infected the thing will still somehow get back in. It has got back into China, New Zealand, Australia, Vietnam, everyone (including Sri Lanka, where I live, right now). What do you then?

You do it again. How?

Test, test, test

At this point you probably have better tools. You can use testing more. What China did, using a technique also pioneered in Africa, is test everyone, often with pooled testing. They tested entire cities. Ghana, for example, would get swabs from a hundred people, run one test and see if someone has the thing. China woke up everyone in the middle of the night to do this. Again, the goal was not mitigation. It was elimination.

Local lockdowns

If a second outbreak gets out of control (which can happen in a matter of days), you can depend on your test/trace/isolate regime to do this without lockdown, but this seems to inevitably fail. What places like New Zealand and Victoria, Australia have done are local lockdowns. Same for Vietnam in Da Nang. You have to isolate the entire (local) population until more surgical isolation techniques can get to work.

Is this painful? Absolutely. But again, this is strategy, not Christmas shopping. This is by far the least bad option.

As we have seen in all the countries above, it works.

What Doesn’t Work

What doesn’t work is any other strategy. Living with the virus, herd immunity, shielding the elderly. Again, I won’t debate why. Just look. America, the UK, Sweden. These places are not doing well. Either humanly or economically. BECAUSE HUMANS ARE THE ECONOMY YOU FOOLS. Healthy people healthy economy. That’s it.

You cannot live with this thing. It’s us or them. That’s it. The countries that understand this suck it up, put in the work, and are now back to life. The countries that hedged their bets are stuck in endless waves of virus. They will be stuck there for years. They are ruined.

Anyone saying the cure is worse than the disease, look at China which is completely back to life. They took the cure. Then look at America. The disease is obviously worse.

“Flattening the curve” is also bad advice. The goal is for this thing to never hit your hospitals at all. Keeping the virus at levels your hospitals can handle only guarantees levels that your hospitals can’t handle in a few weeks. You cannot keep this thing on a leash and control it. You need to get it out of the house.

Herd immunity is also insane. It will take months if not years to reach that level of infection, and having that many people get sick and die when eliminating it is cheaper and faster is just insane. This is not a more ‘economic’ strategy. It both costs and kills more.

Again, we do not need to debate this on points. This is no longer theoretical. We have done a horrific worldwide experiment and there is a winning strategy. Elimination. Roll with the winners.

Motivation for your destination

I write this for my country, where we are facing a second, worse, wave. We eliminated it before but people are tired. They’re tired of lockdowns, they’re looking for an easier way out. But I’m telling you, there is only one way. Elimination. And you don’t have to take my word for it. Look around.

Countries have beat this. It is possible. Yes, rich countries like Taiwan, but also poorer countries like Vietnam and Mongolia. Even Rwanda, Trinidad & Tobago, etc. Yes they keep getting waves but they keep fighting. We should follow them, we should take heart in them, and we should do it again.

We should not be asking how to lose gracefully to this thing. We should be motivated to win. And if we get knocked down, we must keep getting up. It is eminently possible. We can do this.

The uniting thread of all of these nations is will. Competent government, absolutely, but ultimately the will to sacrifice whatever it takes in the short term to have a long term. The will to lockdown without endlessly bitching about it, to mask without complaint, to protect each other and thus ourselves.

We know what it takes to beat COVID-19. We beat the virus by beating it. We eliminate it by eliminating it. My country was there once and by God it was so sanctimonious and sweet. I desperately want to get there again. We must follow the one strategy that is proven to work. Eliminate COVID-19.