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What is a zero-COVID strategy and could it be implemented in Europe?

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A bartender brings drinks to customers in a cafe of Saint Jean de Luz, southwestern France, Tuesday June 2, 2020.
A bartender brings drinks to customers in a cafe of Saint Jean de Luz, southwestern France, Tuesday June 2, 2020.   -   Copyright  Bob Edme/AP Photo
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When European countries reopened their economies in summer 2020, officials said it was time to learn to live with the virus.

But a year into the pandemic and with physical distancing measures still in effect throughout much of the continent, some experts are wondering if "living" with the virus is still possible and to what extent.

"It’s just not a favourable thing to be living with. This is very virulent; it’s very transmissible and also the economic recovery is not going to be fully realised if we have high levels of virus circulating," said Jay Patel, a researcher at the University of Edinburgh.

Many public health experts and economists agree that the end of the first wave of the COVID-19 pandemic was a "missed opportunity" in Europe.

Instead of moving towards eliminating COVID-19, as several countries in the Asia-Pacific region did, there was a swift reopening of economies and in the fall, the virus came back with a vengeance as a more deadly second wave.

Now there’s an increasingly vocal group of academics and experts across Europe that are calling for governments to implement stricter measures to try and drive down COVID-19 transmission rates instead of implementing what they see as half-measures in the hope that vaccination will reduce the spread of the disease.

Many say that the slow start to vaccination globally means that without driving down infections quickly, it will be difficult to reopen economies.

And with the emergence of new, more transmissible variants, vaccination, though an essential tool, is not necessarily a panacea.

A recent editorial published in multiple European news outlets called for a “zero COVID strategy” and the use of zoning, implementing travel restrictions on COVID-19 hotspots, to defeat the pandemic.

What is a zero-COVID strategy and what countries have implemented it?

It’s a strategy to drive down COVID-19 cases to manageable levels in the community.

“It sort of sounds as though it’s an aim to get to absolute zero when actually it’s more to do with suppressing cases to as low as feasibly possible, and to low levels which can be managed quite easily through test-trace-isolate support systems,” says Patel.

“So it’s not a call to eradicate absolutely to zero.”

Some experts point to the example of New Zealand and wonder whether European countries could have used a similar model to defeat COVID-19.

New Zealand's government “initially went with an influenza pandemic plan” like most Western countries but halfway through made a “pivot” towards a COVID elimination plan, said Patel.

The flu strategy is “mainly a mitigation approach” where countries accept that the virus will flare up and just try “to keep healthcare capacity in a state that is manageable,” he adds.

Given that coronavirus is so much more deadly than flu, it’s hard to implement. A recent French study found that COVID-19 was up to three times deadlier than flu.

“It became apparent that if we followed the steps in our pandemic plan (designed for flu), we would go down the track of other countries in not being able to manage the outbreak in our communities,” said Dr Ashley Bloomfield, New Zealand’s health director-general, in June.

“So we had to change tack.”

When New Zealand eliminated community transmission, they continued strict border measures and when four new cases were found in August, they issued strict physical distancing measures.

The Australian state of Victoria locked down in July for four months to control the spread of COVID-19, and recently went back into a "circuit breaker lockdown" for five days after 13 cases of the virus were found linked to a quarantine hotel outbreak.

Strict measures have allowed New Zealand and Australia to implement travel bubbles between COVID-free areas where passengers do not have to quarantine.

But some experts say most of the COVID success stories are in countries with few borders that were able to control travel to their country better. Iceland, for instance, brought down cases to mere single digits as European countries suffered large second waves.

Although land borders and cross-border workers create a challenge in Europe, it's a strategy some experts say could be implemented in Europe if countries use an "aggressive" effort to reduce virus numbers.

This, in combination with identifying "green zones" (areas with low virus levels) and only allowing travel to other green zones, would mean people travelling from virus hot spots do not further spread coronavirus.

What happened in Europe after the first wave of COVID?

European countries issued strict lockdowns to drive down transmission amid the first wave of the pandemic but countries' actions taken over the summer likely influenced the second waves, experts say.

“We saw in the summer obviously with tourism and no restrictions, those few places in Europe which still had high incidences reintroduced it to many other places,” says Bary Pradelski, an associate professor of economics at the National Centre for Scientific Research (CNRS) in France.

While there was some effort to introduce green zoning in France and Spain, the restrictions in France allowed people to travel within a 100-kilometre radius of their house, something that was probably too large, he says.

“In retrospect, we should have opted for eliminating the virus,” said Pradelski, who worked on proposals of green zoning.

Many see it as a mistake that cost European countries greatly as the summer’s tourism drove high infection numbers in September and October.

“I think the end of the second wave in the summer of last year was a period of complacency in Europe in general," said Guntram Wolff, an economist and director of the Brussels-based think tank Bruegel.

"Many health experts, many academics, even economists had warned that there could be a second and a third wave but the political focus at the time was very much of dealing with the recovery."

The Conclusions of the July 2020 European Council meeting said member states were now focussing on recovery, for instance.

“We are slowly exiting the acute health crisis. While utmost vigilance is still required on the sanitary situation, the emphasis is now shifting to mitigating the socio-economic damage,” the European Council said in a statement.

“Policymakers underestimated the risk of a second wave and were sort of assuming that the severe and acute health crisis was behind us,” said Wolff.

In June, there was also a push from the European Commission to open borders and continue free movement.

Throughout Europe, the COVID-19 strategy has since been largely "reactive" to the situation.

"We react when the situation is deteriorated enough to react," says Antoine Flahault, director of the Institute of Global Health at the University of Geneva, explaining that countries have only been locking down at the last possible moment.

"If you lift the measures with a high level of circulation, [the virus] starts circulating again and...you need lockdown measures," he added.

Pradelski explains that the problem with "only locking down when you have a hotspot is that you are actually too late."

The French government held off on issuing restrictions in September and October until the end of the month when President Emmanuel Macron stated that without a lockdown, hospitals would quickly become saturated.

Pradelski says that, instead, countries should focus on protecting zones with low transmission from a reintroduction of more cases.

Could a zero COVID strategy really be implemented in European countries?

Several European countries are already changing their strategy and moving to reduce cases to low levels quickly while controlling borders.

Germany has been in a strict lockdown since January and officials have said that even as schools reopen, lockdown cannot be lifted until there are 35 new infections per 100,000 people.

Locally, there has been some interest in establishing a "green zone" at the city level as well, with the zero-COVID strategy supported by the mayor of Cologne, in particular.

Italy has implemented a system of regional zoning, preventing people from travelling between regions without a necessary reason.

"Italy has been doing quite a job of zoning for two or three months. They had the same second wave as most other European countries and they do zoning by region and the travel restrictions are strict and are enforced...so [the population] mainly adheres to them," said Pradelski.

Some expect that as some countries in Europe reduce COVID numbers significantly, they could be in a place to create travel bubbles to protect areas with low transmission. Denmark, for one, has reduced cases with the closure of non-essential shops and largely remote learning.

But other countries are finding that the pressure from the new more transmissible variants of COVID-19 has prevented certain measures from working.

"I would say that because of the new variant, the French strategy is failing to reduce cases substantially," said Flahault despite "strong measures" including a 6 pm to 6 am curfew and the closure of bars and restaurants.

Non-lockdown measures are sometimes viewed as more politically favourable among populations that are tired of constant distancing restrictions.

Lockdowns have large consequences too, with multiple studies showing the deleterious impact of restrictions on mental health and on young people in particular. Calls to domestic violence hotlines also increased significantly during lockdowns in Europe.

As England unveiled its plan to come out of lockdown over the next four months, Prime Minister Boris Johnson insisted that the "cautious reopening" is to prevent having to lock down the county again.

Proponents of a zero-COVID strategy argue that it would be a tradeoff for many countries, who by instituting tough restrictions now could reap the benefits later with a faster return to normal afterwards.

But some say, to be effective, it would need to happen at a European level.

"I think definitely when you think about the short term, you can think of the severity of the lockdown to be in a tradeoff with economic activity. If I shut down all the restaurants and the shops I take a bigger hit on my economy," said Wolff, the director of Bruegel.

"The question is what is the better medium-term or long term strategy?"