What zero-COVID countries can teach the rest of the world
Most of the handful of countries pursuing zero COVID-19 cases are now starting to move towards cautiously living with the virus, but their efforts hold lessons for the rest of the world in a future where the virus is here to stay.
- 24 February 2022
- 4 min read
- by Priya Joi
There is almost no corner of the globe that COVID-19 hasn’t reached. Indeed, the World Health Organization’s list of countries with zero COVID-19 cases is vanishingly small – made up mostly of tiny island states. While a zero-COVID policy is not only unattainable but now impossible for most countries to achieve, there are lessons to be learned from countries that took a hardline approach to clamping down on cases.
COVID-19 testing, contact tracing and strict lockdowns were critical in the pursuit of zero-COVID; these have been important in many countries in controlling the spread of the virus too, but countries aiming for zero-COVID implemented them far more intensively with the goal of maximum suppression.
Lessons learned
When China, with its 1.4 billion population, decided to pursue a zero-COVID policy, many were sceptical. But official figures claim the country has had very few deaths from the virus, although the reality on the ground seems to be far worse than recorded numbers. Regardless of whether its policies, especially on surveillance and track and trace approaches, could be applied to democratic countries, it is clear that China has invested heavily in testing capacity.
New Zealand was one of the best-known examples of how a stringent lockdown imposed after just a handful of cases led cases to fall to zero, and stay that way for an extended period of time. However, a similar approach in Melbourne took much longer to bring cases down, and scientists in The Lancet point to other aspects of New Zealand’s approach that led to successful control of SARS-CoV-2 spread. This includes “early decisive reactions from health authorities, performant surveillance systems, and targeted testing strategies as much as stringency”.
Zero-COVID policies have come at a high cost, however. Millions of people in China, for example, have had food or medicine shortages and border closures that have stopped anyone from leaving the country and anyone else from getting in. As one of the largest global manufacturers, China’s policy has affected the rest of the world too by disrupting supply chains.
Co-existing with the virus
Some countries have pursued zero-COVID at the risk of damaging their economies. But the extreme transmissibility of the Omicron variant combined with the understanding that SARS-CoV-2 will become endemic – it’s just a question of when – means that countries with zero-COVID policies may not be able to hold tight for much longer. Hong Kong, for example, has become so overwhelmed by its zero-COVID policy, which meant every infected person was being sent to hospital regardless of symptoms, that hospitals are having to lay patients out on gurneys on the concrete outside.
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As Rafael Araos, a physician and epidemiologist at the University for Development in Santiago told Nature: “You can’t stop the wind with your hand.”
Beijing has made restrictions more localised and less widespread, and for a shorter period of time, a direction that the rest of the world seems likely to adopt for future restrictions.
For many countries, vaccinations have paved the way to a gradual loosening of restrictions. With 93% of eligible people vaccinated, even New Zealand began to open up this month in a bid to move towards living with the virus rather than the alternative of staying sealed off for years to come.
Singapore too, with 82% vaccinated, has abandoned its zero-COVID approach in favour of carefully maintaining restrictions as necessary.
COVID-19 testing, contact tracing and strict lockdowns were critical in the pursuit of zero-COVID; these have been important in many countries in controlling the spread of the virus too, but countries aiming for zero-COVID implemented them far more intensively with the goal of maximum suppression. And for a while, zero-COVID policies helped several countries keep the disease largely at bay. Even though cases are rising as these countries open up, being equipped with more tools than were available at the start of the pandemic has kept deaths relatively low.
Although such an intense and prolonged effort to suppress the virus often came with high economic and social costs, the principles of widespread testing, surveillance, and caution are lessons all countries can learn for the next pandemic – as a future pandemic is an inevitability.
