Of course an epidemic can be stopped. It will require sacrifices from society and will be costly in terms of financial resources. But it is a choice. The COVID-19 has a fatality rate of somewhere between one and seven percent, mostly among people above 60 and people already suffering from other illnesses (diabetes, hearth problems etc.). With a well-functioning health system that is not overburdened, the fatality rate is probably around one per cent. But let us for a moment hypothesize that it was say 30 per cent, or like the ebola even higher, and that it affected all age groups. I guess nobody would then claim that it was impossible to stop it. There would be an almost unanimous claim that it should be stopped, no matter what. And then of course it can be stopped. The measures would be draconian and the economic costs would be high. But it could be done.
What it is important is to insist that this is a political choice. No expert or epidemiologist can tell us what is right and wrong. They can describe the options, the cost in fatalities and the cost to the economy – job losses, business failures, budget deficits etc. Then somebody has to make the choice, and in all societies, democratic or authoritarian, the decision has to be taken by the government on a very short notice.
As described in an excellent recent paper by Imperial College COVID-19 Response Team, there are basically three choices: let the epidemic run its course (‘do nothing’), try to delay it so it takes longer (now called ‘flattening the curve’) or stop it (called ‘supression’). We are witnessing all strategies now in different parts of the world. China went for stopping it. It took six weeks of very harsh measures and with a high impact on the economy, but now basically all new cases are imported from the outside world so the local epidemic has stopped and the Chinese are gradually going back to work. South Korea went for a similar, but softer version putting the main emphasis on massive testing, tracing of contacts with infected people and isolation. The epidemic has not stopped yet in South Korea, but it has weakened significantly and will probably (and hopefully) be contained as well. Then there is the US and European version. The mantra there has been to do very little but stay vigilant. The result is that the epidemic has run out of control in Italy, Spain, Switzerland, the Nordic countries, Germany and France, with the UK and the US catching up fast. Now harsher measures are being introduced in mainland Europe, practically locking down several countries. However, it is not clear whether the goal is to contain the epidemic (‘supression’) or only to delay it so not to overwhelm the health services (‘flatten the curve’). It is worth mentioning that the above study by Imperial College recommends UK and US to stop the epidemic as the only responsible strategy. I sincerely hope the US and the UK (and the rest of Europe) are listening.
The management of the epidemic in Europe and the US has been astonishingly incompetent, even when it became clear that the epidemic was spreading rapidly in Northern Italy and from there to other European countries. A lot of commentators were taking an ideological angle: China is an authoritarian country and that is why it has been so heavily affected by the virus. Europe and the US are open and democratic societies so here the epidemic would obviously be much easier to control. There are so many examples of these nonsense stories that it is overwhelming, but one of the more representative (and ridiculous) is by the Peruvian novelist (and Nobel Price Winner) Vargas Llosa in the Spanish newspaper, El País (I love his books, but he is an extremely miserable politician).
It is difficult to say whether this ideological blindness has been important in the response to the virus in Europe and the US. It might also be simple incompetence and covardice: lack of will to take difficult decisions that could cause malaise in the public. Anyway, the response has been leaned-back, surprisingly enough in many places with support from the scientific advisers to the governments. ‘No cause for alarm, the risk is very small’. ‘This is like a flue, somewhat more deadly, but it would be too costly to try to stop it’. China is far away, and we have much better systems in place to control it. Then the more cynical: this is part of normal life. We do not care for all the people dying from the normal flue, traffic accidents etc. Why make a fuss out of couple more dying from this epidemic? You get the suspicion (unproven) that some are thinking by themselves that as the virus is mainly weeding out the sick and elderly, there is no economic loss to society. And then there are of course also human rights warriors who think that restricting the rights of individuals to freely move around for a couple of months is more cause for concern than the lives of a couple of thousands of old and sick people (they will die soon anyway, right?).
Whatever the reasons, the lack of response has been astonishing – until now when governments are scrambling to put into place measures that in some aspects are even harsher than in China and in some cases appear improvised. The development of the epidemic in China gave the rest of the world around six to eight weeks to prepare for what was coming. If the strategy was to avoid harsh measures and build on test-and-trace: then where is the massive build-up of testing capacity? If the strategy was to delay the epidemic so it would not overwhelm the health care system: where is the build-up of capacity of the intensive care units in the hospitals, particularly the respirators? Or the care for the health staff with protective gear?
This is astonishing, taking into account that we are talking about the richest countries in the world. Learning from the Chinese? No way, we are not dictatorships. Learning from the South Koreans, Taiwanese and Singaporeans? Nope, they may be democracies but the Asians are authoritarian and the measures are too harsh.
The lack of testing capacity is difficult to understand. Most grotesque in the US, but also in Europe. Despite getting a six-week head start on the Chinese. The lack of capacity for testing in the US is a long and sad story. As the World Health Organisation is saying: ‘Our key message is: test, test, test’.
The lack of action on behalf of the European Union is notorious. It has protested when EU countries have taken their own measures, but has not come up with any own proposal on what to do. When the epidemic span out of control in Italy, there were no acts of solidarity. Did I miss that voluntary health personnel from other EU countries has been sent to Italy to offer their help? Or that other EU countries sent ventilators and protective gear to Italy? Recently health staff has come from China to Italy with medical supplies. Why not Germany or Denmark? Even tiny and poor Cuba has sent medical staff to Italy after request from the Lombardy Government.
The other thing I find amazing is the lack of empathy. No empathy with the embattled Italians. No expressions of solidarity with China from leading Western Countries during the height of the epidemic. Only scorn for Iran suffering from the virus. The US President Trump leading the pack with tasteless comments.
What is the right strategy to tackle COVID-19? China has opted for rapid containment and succeeded at a high economic cost. Most of Europe has opted for ‘flattening the curve’. UK and Sweden had originally opted for ‘doing-very-little’, but have apparently now changed tack, but still with softer measures than other European countries.
It is worth noting that applying different strategies within the EU will create problems in the medium run. If some countries decide to stop the virus while others decide to delay it, permanent travelling restrictions will have to be in place in the countries going for containment, as otherwise this strategy will not work. If most countries go for containment and some opt for delaying it only, the latter will be pariahs kept out by travel restrictions. At least until a reliable vaccine is available, and that will probably take 12-18 months.
My take on it? The best strategy is to my opinion as proposed by the Imperial College Study: radical locking-down measures for a short period to break the curve and bring the number of new cases dramatically down, and once that is achieved, lift the measures gradually and follow-up with extensive testing and tracking of infected people and their contacts. So the production of test kits should be increased dramatically now. And then wait for the vaccine…..