General responses to coronavirus epidemic

RESPONSE STRATEGIES

In countries with well established governments that seek to manage in the interests of the people, an orderly response to any situation requires an acceptance of outcomes - where one is heading - and of operational strategies - the means on e might 

Outcomes

There are a number of strategies that one might employ to handle an epidemic of a disease for which there is no treatment or inoculation. These will be conducted  in pursuit of the following outcomes, targets or 'exit strategies'

1. "Bring out your dead"  Do nothing. Let the disease become part of the regular background of bronchial diseases including the common cold and influenza. While it is becoming  established, treat some of the more severe cases. Allow most to recover or die on their own or with their families and accept the social cost.
2. "Flatten the curve". Take social responsibility for everyone who has the disease, but accept that it is going to pass through the population sooner or later. Try to ensure that the medical system is not overwhelmed, to minimise deaths and reduce infection among medical personnel, by slowing the rate of infection within manageable limits..
3. "Kill it before it kills us," Eradicate it, and then close or quarantine borders for as long as is necessary to continue with zero internally transmitted cases.

Operational strategies

The two operational strategies that can be used in support of the above are 

A, Locate, quarantine and track. People presenting with the illness are isolated or hospitalised, monitored or treated as necessary, and their contacts are also located and advised, tested or quarantined. In support of this we have

• Testing. Testing on as wide a scale as possible is necessary. In order of who needs to be tested, depending on how many test are available,we have: seriously ill, contacts of the ill, incoming from high risk areas, people with some symptoms, general population. 
• Quarantining. Borders with areas known to have high incidence of the disease need to be closed, and immigrants need to be quarantined closely monitored and immigrants tested.
• Tracking Known contacts are examined for infection. More sophisticated strategies use credit cards, mobile phones, cctv cameras, social media and apps  to track and monitor.

B. Lockdown. In previous use of the term, 'lockdown' usually meant closing and locking doors - and this was actually done in China. However the term now applies to a procedural emergency response.  There seems to be no international standard for lockdown emergency responses graded by severity, but they run something like

• Lockdown Stage 1. International travellers are put in quarantine. Workers are encouraged to practice social distancing, wash hands frequently, or to work from home.
• Lockdown Stage 2. Public gatherings of more than 500 people are discontinued and fines are introduced. Beaches, parks and most public facilities are closed. 
• Lockdown Stage 3. Heavy fines are implemented. International travel is banned. Meetings in public or at home are restricted to two people. Outside trips are only for specific  purposes (eg food, exercise or medical). All enterprises are closed except for medical, grocery and takeaway food. Numbers of persons allowed inside are 1 person every 4 square metres. Schools if open are only for babysitting children of 'essential workers'.  

Stage 3 is currently in force for half of the world's population, which poses severe risks for those in the informal sector or 'gig economy. Stages 4 and 5 are yet to be be implemented except perhaps in China.

Who is doing what?

Oddly, almost no-one has chosen eradication. One might have thought that this would be the first reaction, as SARS -1 and MERS were fairly rapidly eradicated, Ebola outbreaks are always eradicated as quickly as possible, and even the deeply endemic killer smallpox has been eliminated. Seeking other exits is a tacit admission that a virus has been allowed to get out of control

Only New Zealand has adopted the target.of outright eradication. China has also had this implicit aim in Wuhan through its very aggressive lockdown policy.

Minimal response has also only been tried in one country Sweden. Almost everyone has gone for some sort of lockdown, even middle-income countries.The poorest countries may have little option but to follow this path, if COVID-19 becomes well established in any of them.

Flatten the curve. Strangely, this novel approach has been adopted almost everywhere, spreading as a meme from one country to another as leaders have sought some way to proceed and sound competent in their situation of helplessness. The eagerness to embrace this rather technical, limited and somewhat hard-nosed target may be due firstly to the relatively low mortality rate of CV and the speed with which it has spread. The meme appears to have first come from Britain [1], who adopted the strategy of a series of rolling lockdowns to buy time to ramp up testing and the medical response, preventing facilities from being overwhelmed as they were in Italy and Spain.

Tied in with curve-flattening, in Britain at least, has been the idea of 'herd immunity' - however this was never a viable proposition as it involves deaths of perhaps 1% of the population. Even in the most heavily afflicted countries like Italy, infection has slowed in this round to less than a hundredth  of the necessary proportion. 

So far (6 April), only China and South Korea have definitively achieved 'flattening' and brought the epidemic under control. Australia and Austria have also achieved it. Other European countries have reached  the inflection point (maximum daily cases). 

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