Opting for a ‘no-COVID-19’ or an elimination strategy and not a mitigation strategy is the way we can get out of this pandemic.
Public Health, economic growth, and civil liberties are crucial factors when considering an exit strategy from the pandemic. There are four types of strategies – exclusion, elimination, suppression and mitigation – elimination being the best approach for curbing the COVID-19 pandemic. Countries like New Zealand, Australia, China, Japan, and Korea that have adopted the elimination strategy have low to nil COVID-19 cases and associated deaths unlike many of the European Union countries and the USA that have opted for the mitigation strategy where the mortality rate is still high.
Exclusion is the complete eradication of the virus. Elimination strives to completely control the spread of the virus as well as stop community transmission through short term stringent measures. Suppression is the stepwise increase in action to lower the number of cases and outbreaks. Mitigation is less stringent than suppression and aims to ‘flatten the curve’ so as to alleviate pressure off the healthcare system. Implementing exclusion and elimination strategies can ensure return to the ‘new normal’ within a shorter period of time (2-3 months) as compared to suppression and mitigation strategies (12-18 months to return to normal). Suppression and mitigation strategies heavily rely on antimicrobial interventions, vaccine availability and herd immunity. Some countries don’t even have a substantial strategy and rely mainly on herd immunity.
Oliu-Barton et al did a study comparing COVID-19 deaths, gross domestic product (GDP) growth, and strictness of lockdown measures during the first 12 months of the pandemic for countries that preferred elimination or mitigation. The results were published in The Lancet. Elimination aims to utilise stringent measures of lockdown and non-pharmaceutical interventions for a short period of time. These countries observed deaths per million population to be 25 times lower than the countries that preferred mitigation.
While assessing the GDP growth, a dip towards the negative quadrant was observed during the lockdown period. However, the GDP numbers returned to pre-pandemic numbers in countries that opted for elimination, whereas growth is still negative in countries that opted for mitigation measures.
Despite helping the health and economic sectors, elimination measures are often criticised for severely limiting civil liberties. The researchers measured the strictness of lockdown based on indicators of containment and closure policies, health system policies and public information campaigns. In the countries that favoured mitigation, civil liberties are still impacted due to ongoing lockdowns. Minimal restrictions on civil liberties were observed in countries that chose elimination despite having strict and swift lockdown measures.
Mitigation relies a lot on vaccinations and herd immunity, a.k.a, living with the virus to help with reducing the number of COVID-19 cases and its associated morbidities. Being under the assumption that the virus is not going anywhere is going to prolong the time to exit the pandemic. Solely depending on vaccines is quite detrimental as the vaccine rollout is inconsistent. Eradication of the virus by the vaccine alone is a perpetual process that will take decades to happen. Many of the vaccines need not offer protection against the other variants of the virus. Living with the virus strategy has not worked either as the virus has the tendency to mutate and form deadlier variants which has led to the more robust second wave claiming more lives than the first.
While implementing strategies to tackle the pandemic, decision makers should consider mortality rate (represents the extent of the effect of the disease) and the possible long term morbidities that can occur post SARS-CoV-2 infection. The disease is biological, but the strategies employed rely on political and social fronts. Elimination requires vigorous control measures with advanced technology, scientific consideration and strong political support.
The use of the mitigation strategy will continue to pose a threat to the countries that opted for elimination and to the world. A clear global plan, not country-wise approaches, is required to exit the pandemic. The constant pressures of continuous lockdowns will impact the mental health of the population as well as stifle economic growth. Global trade and travel will continue to be affected. A lack of proper political stance will also reduce the trust in the government. The consequences of these varying responses will have an effect in the long haul post the pandemic.