The ZeroCovid debate: can the disease be eliminated?

Dr Devi Sridhar, the American public health professor currently Chair of Global Public health at Edinburgh has been a regular pundit and commentator throughout the pandemic. I first heard her talk in March on the BBC, and was very impressed with her explaining the coronavirus issues of the day, clearly and articulately.

Professor Sridhar is now a leading light in the ZeroCovid movement, and is a senior advisor to Nicola Sturgeon and the scottish government. Her suggested strategy is the opposite of Sweden’s more laissez-faire approach of allowing life to continue as normal, with no lockdown, no facemasks, voluntary social distancing etc.. Instead of being more permissive, she is calling for governments to follow the Scottish lead and commit to a “ZeroCovid” strategy — ie that any level of Covid-19, no matter how low, is considered unacceptable, and that within national borders, governments should aim to eliminate the virus completely. Liberty, achieved through greater suppression, is the paradoxical idea.

So if you want a preview of the next phase of the political debate around Covid-19, this is it. Nicola Sturgeon (who Professor Sridhar advises) is calling for England to join the other home nations in committing to a ZeroCovid strategy, the so-called “Independent Sage” group of scientists is in agreement, and the Liberal Democrat Layla Moran has begun to demand that Boris Johnson takes the pledge.

Full interview with Prodessor Sridhar on Unherd TV

The key argument is as follows. “Health versus the economy” was never the right framing — the countries that have fared best so far in this pandemic, whose economies and societies are returning to normal fastest, are the ones that acted to lock down decisively and early, drove the virus down to very low levels, and are employing massive testing and track and trace programmes to keep it there.

If you try to open up society while the disease is still in circulation it will firstly not work because people are still feeling afraid (Prof Sridhar points to the mostly empty cinemas and theatres since they reopened) and, what’s more, the virus will come back. She gives Spain as an example of a country that had driven the virus to low levels but, since opening to tourists and restarting the “night-time economy” of bars and clubs, has seen a large surge in case numbers. In her view, they should have controlled the border more aggressively, been more activist in testing, tracing and isolating, and kept things like nightclubs closed.

When pressed on what exactly would be different from today in a ZeroCovid-committed England, the impression is of “do more of the same, but do it better and try harder”. More testing (up to 1 million a day), replace 14-day quarantine with testing twice at the border, and improve the NHS Test and Trace programme. One striking detail was the idea of making ZeroCovid zones within the country, ring-fenced with limited movement in or out, that could link up until the whole country was rid of the disease.

Opponents will say that the ZeroCovid goal ends up being fanatical, potentially consigning the population to years of life-altering restrictions in pursuit of a goal that can never be achieved, in response to a threat that doesn’t warrant it in the first place, which I totally agree with. Covid-19 can only be eliminated by the whole population achieving herd immunity, and that a zero-covid strategy will be doomed to failure.

This is the most worrying example of the divergence of covid-19 policies between the four Nations of the UK, although the local lockdowns in England seem to be a sign that the UK government is moving towards this zerocovid policy, which could be another big mistake. Only time will tell.

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