Tuesday, November 10, 2020

Eradicating COVID-19

Eradicating COVID-19 Should Be Goal

Nicholas Johnson
The Gazette, November 10, 2020, p. A6

A post-election return to a pre-COVID “normal” requires our understanding the difference between mitigation and eradication. The most important step in reaching one’s goal is to clearly define what it is.

Hospital beds and health workers, masks and social distancing are examples of essential, ongoing mitigation efforts when numbers of sick and dying coronavirus victims are surging. [Photo credit: President Trump rally; wikimedia; Hayden Schiff, Cincinnati, Oct. 13, 2020]

But the goal is – or should be – global eradication of the virus. Mitigation efforts may slow the surge of COVID, but they won’t eradicate it. It continues to spread.

What about a vaccine, or herd immunity?

Yes, a vaccine ultimately eliminated global smallpox. But consider the history.

Edward Jenner’s first experiments and papers were in the 1790s. The disease was not eliminated in the U.S. and Europe until the 1950s.

In 1959 the World Health Organization began its global eradication effort. The last death occurred in 1978, and WHO declared mission accomplished in 1980.

Although herd immunity (“survival of the fittest”) or “vaccination” might mitigate, neither is the answer. Each is rejected by many, takes too long, and produces many thousands of avoidable additional deaths.

Yes, the “test, trace, quarantine, and isolate” procedure would have been multiples cheaper and easier when experts first urged it. (See my April 4 column, “How to Eliminate COVID-19,” https://tinyurl.com/yxymwpol). But it is still the fastest and most effective path to the goal of eradication.

Impossible? Too expensive? Too slow? A Chinese city of nine million tested everyone in five days. We’ve spent trillions trying to boost a COVID-crippled economy. Even massive testing could be done for low billions.

It works. The World Health Organization reported countries’ COVID cases and deaths per 1 million population during an October week (not our worst). The U.S. was 23,000 cases and 576 deaths per one million. Australia 1068 and 35. New Zealand 314 and 5.

It also works politically.

The New Zealand prime minister’s electoral victory is credited to her management of COVID-19. And President Trump’s lack of response was a major issue in our recent election.

There are many alternative ways to do it today. Here are samples.

Start with a dozen or fewer cities or states. Choose the most successful, with metrics such as infected persons per 100,000 population, or lowest percentage infected of those tested.

Test-trace everyone in the selected areas every two weeks including newcomers to the area. Isolate or quarantine those infected and contacts.

In about two months, when no one tests positive, all businesses can open while testing continues. Gradually expand the number of participating areas. Disinterested cities and states need not participate.

Or the focus could start with the most vulnerable (the 5 percent age 80 and over; those in long term living facilities). Or groups working in proximity (meat packing and factory workers; college students). There are many alternatives.

Mitigation, yes. But until we make eradication our goal, as Dr. Anthony Fauci has put it, “We’re in for a whole lot of hurt.”
Nicholas Johnson of Iowa City is a former co-director of the Iowa Institute for Health, Behavior and Environmental Policy. Contact: mailbox@nicholasjohnson.org

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Smallpox – History of Smallpox, CDC, https://www.cdc.gov/smallpox/history/history.html (“Almost two centuries after Jenner published his hope that vaccination could annihilate smallpox, on May 8, 1980, the 33rd World Health Assembly officially declared the world free of this disease. Eradication of smallpox is considered the biggest achievement in international public health.”)

China – “Covid-19: China’s Qingdao to test nine million in five days,” BBC News, October 12, 2020, https://www.bbc.com/news/world-asia-54504785 (“The Chinese city of Qingdao is testing its entire population of nine million people for Covid-19 over a period of five days. The mass testing comes after the discovery of a dozen cases linked to a hospital treating coronavirus patients arriving from abroad. . . . The country has largely brought the virus under control.”)

WHO – "Coronavirus disease (COVID-19)," World Health Organization, Oct. 12, 2020, https://www.who.int/docs/default-source/coronaviruse/situation-reports/20201012-weekly-epi-update-9.pdf

New Zealand – Damien Cave, “Jacinda Ardern, Hero to Liberals Abroad, Is Validated at Home; New Zealand’s prime minister and her party are coasting to victory in national elections, though it is unclear how far she will push her progressive promises,” New York Times, Oct. 17, 2020, https://www.nytimes.com/2020/10/17/world/asia/jacinda-ardern-election-new-zealand.html (“Riding a wave of support for her ‘go hard, go early’ response to the coronavirus, which has effectively been stamped out in the country, [Prime Minister Jacinda] Ardern has now cemented her position as New Zealand’s most popular prime minister in generations, if not ever.”)

5% over 80 – “Population 65 Years and Over by Age, 1990, 2000, and 2010,” Infoplease (Source: U.S. Census Bureau, 2010 Census Brief), https://www.infoplease.com/us/population/population-65-years-and-over-age-1990-2000-and-2010

Fauci - Josh Dawsey and Yasmeen Abutaleb, “‘A whole lot of hurt’: Fauci warns of covid-19 surge, offers blunt assessment of Trump’s response,” Washington Post, Oct. 31, 2020, https://www.washingtonpost.com/politics/fauci-covid-winter-forecast/2020/10/31/e3970eb0-1b8b-11eb-bb35-2dcfdab0a345_story.html

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Anonymous said...

As always you have pointed out the problem and have made some excellent possible solutions!

Yankinoz said...

I agree, but will nitpick.

Smallpox vaccination is not a good analogy. It is very effective irrespective of herd immunity and eliminated the disease in the early to mid-nineteenth century throughout much of northern Europe, though in some places infected migrants carried it. What took time was worldwide eradication by vaccinating everyone or close to it.

No one is claiming COVID-19 vaccination will be as effective, but it will help.

Sooner or later the pandemic will pass. Unknowns are whether it will simmer here and there or mutate into variants to spread again. As it dies down, a choir will sing, I told you so, we never needed to do those lockdowns. Never mind that the infections and death rates in the US will be orders of magnitude higher than in NZ or Australia. Never mind it will have been ten tiomes higher in Sweden than in Norway, at no advantage in how the economny fared.