The policy that didn't get enacted was the alt-history. No- Covid, zero- Covid or elimination was meant to stamp out community transmission of Covid-19 in a given area, rather than just reduce it to manageable levels. It got bad press from the beginning. One slogan went, "Only autocratic regimes could pull it off." China, New Zealand, and the notorious police state of Davis in California are some of the countries.
There was a prophecy about this. Many people thought No- Covid was impossible, but a few places embraced it. Now that some of those places are shifting to a reduction or mitigation strategy, countries that opted for it from the beginning are enjoying it. No-covid's early champion had to shift because other countries let the virus rip. They had time to prepare others even if their strategy wasn't the optimal one. It is important that we remember that when the next outbreak occurs.
Sometimes the power of language is frightening. I've done it myself and it seems like a more appropriate way to say "erupting", since it grows quietly in the dark before exploding into the light. We have trouble grasping the concept of exponential growth, yet it gives us power. It means that for a while the disease is limited and controllable. It means that rapid growth is stopped when you don't have fuel. It means that if a critical mass are present, elimination won't have to be pursued.
No- Covid was plagued by problems of definition. People were confused about elimination and eradication. The only human disease that has been eradicated is smallpox. The United Kingdom lost its status as a Measles-free country due to low vaccine usage. It does require a concerted effort to eliminate. The word "restrictions" was used to describe the efforts that deprived us of liberty. No. The efforts preserve liberty because of the virus. Nobody in Davis is complaining, 18 months into their No- Covid experiment, and they're puzzled other US towns haven't followed suit.
When we had no other shields against the virus, they stopped being synonymous with elimination. The preferred tools were cheap mass testing, isolation, and social and financial support for those affected by the measures.
The claim that elimination makes inequality worse is a red herring. A circulating virus can cause problems, such as keeping kids out of school, and closing mental health clinics.
Some diseases are easier to eliminate than others. Many western countries assumed that Covid would behave like flu and decided that elimination would be difficult. It was assumed by China that it would behave the same as it did 20 years ago. It behaves like both, but not exactly. The countries got the outcome they wanted.
In June of last year, a study in The Lancet showed that those who chose elimination did a better job of protecting life, the economy and civil liberties. No country is an island to a highly transmissible virus, even those that are islands, and the emergence of Delta and Omicron variant of the sars-coV-2 virus, combined with the rollout of vaccines that protect against severe disease and death. Some people think elimination has outlived its usefulness.
New Zealand has switched to a different strategy. Michael Baker believes that his country's high levels of vaccination will protect it from a wave of hospitalisations and deaths. Hong Kong has not avoided that fate due to its low vaccination rates.
The lesson from Hong Kong is that if the context changes, you need a plan B. Baker and Donald Low agree that elimination was the right strategy for the first 18 months of the epidemic. Elimination is the preferred strategy for responding to new emerging infectious diseases with potential and severity that are moderate to high severity.
The case for long Covid is strengthened by what we know about it and the fact that countries that tolerate it are increasingly likely to do so. The vaccines do not stop transmission completely, and by abandoning the non-pharmaceutical interventions that do, those countries also increase the likelihood of a variant more severe than Omicron.
These facts show how pointless cost elimination is. What has saved you? What is the counterfactual in speculative fiction?
Fix a goal and work towards it, adjusting your strategy as you learn is the right way to respond to an unknown disease. There is another unknown in the equation, human determination, so no response should be ruled out initially. It's only possible until it's done, as Nelson Mandela said.
Pale Rider: The Spanish Flu of 1918 and How it Changed the World was written by Laura Spinney.
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