Abstract
Countries opting to eliminate covid-19 rather than reduce its spread have fared best – and there's still time to adopt the strategy, reports Graham Lawton
COUNTRIES that pursued strict pandemic suppression strategies fared better on measures of health, wealth and civil liberties than those that didn't, according to an analysis published this week (The Lancet, doi.org/f89p). The analysis covers the pandemic's first year from February 2020, but has relevance to ongoing efforts to end it. Moving to an elimination strategy even at this stage could lead to better health, prosperity and freedom, say the authors.
The researchers compared 37 wealthy nations' deaths from covid-19, GDP growth and strictness of lockdown measures. They classified the countries into two groups: five “elimination” countries, which took maximum action at all times to suppress the outbreak; and 32 “mitigation” countries, which reacted to events to stop their health systems from being overwhelmed.
“What we found was that there were far fewer deaths in the five elimination countries compared to others,” says team member Jeffrey Lazarus at the Barcelona Institute for Global Health in Spain. “Likewise, swift lockdown measures in line with elimination were less strict and of shorter duration, and we found that elimination is superior to mitigation for GDP growth.”
An elimination strategy is best for the economy, best for health and impinges the least on civil liberties
An elimination strategy essentially means mass testing, supporting people infected with the coronavirus to isolate, tracing those they have come into contact with and helping them to self-isolate too, border surveillance, and swift and stringent lockdowns when needed. This is “infectious disease class 101”, says Lazarus.
According to Lazarus, these measures are often criticised on the grounds that, while they may protect heath, they damage economies and infringe on civil liberties. In fact, the study shows they are superior on all of these measures.
The five elimination countries are Australia, Iceland, Japan, New Zealand and South Korea. They didn't succeed in eliminating the virus but set out to do so and stuck to their guns, says Lazarus.
The 32 mitigation countries are the other members of the Organisation for Economic Co-operation and Development, minus Costa Rica. The researchers wanted to include China but couldn't get enough data.
Elimination countries had just 4 per cent of the per capita death toll of mitigation countries. Their GDP growth returned to pre-pandemic levels early in 2021, while the 32 are still below pre-pandemic levels. Crucially, elimination had less of an impact than mitigation on civil liberties, according to a “lockdown stringency” index developed by the University of Oxford.
Alice Roberts at the University of Birmingham, UK, a member of the UK's Independent SAGE group, describes the analysis as a “very firm evidence base that an elimination strategy is best for the economy, best for health and impinges the least on civil liberties, which seems to be the main argument against it”.
Island benefits
It is notable that the five elimination countries are island nations or South Korea, which has one tightly controlled land border. Lazarus accepts that isolation could have something to do with their success. “It is easier to protect the borders of an island state, if you want to,” he says. But it isn't impossible for other countries to police their borders. Denmark nearly qualified as an elimination country, says Lazarus, but struggled to control Danes living in Sweden from going back and forth over the Øresund Bridge.
The analysis can inform policies for the rest of the pandemic, says Lazarus. “Obviously it's a retrospective study, but we can learn from the past.” He says that the crisis isn't over and with more transmissible variants on the loose, countries that act as if it is over before they have high-enough levels of vaccination will find themselves repeating mistakes of the past.
It is never too late to pivot to an elimination strategy and doing so now could mean a much healthier, wealthier and freer summer in the northern hemisphere, he says.
Overcoming economic and libertarian prejudices against elimination won't be easy, says team member Ilona Kickbusch at the Global Health Centre in Geneva, Switzerland. She was part of a group of scientists in Germany that unsuccessfully lobbied for an elimination strategy. They were branded as “Stalinists trying to close down society”, she says. “Actually our argument was just the opposite.”
The analysis has been criticised for using 20/20 hindsight in its selection of countries, says Martin McKee at the London School of Hygiene & Tropical Medicine, who wasn't involved in the study. But its conclusion that the elimination strategy produces the best outcome stands up, he says.