The perils of COVID-zero—how policymakers should manage endemic COVID-19

August 22, 2021 By Nicholas Kerr 2 Comments

As the COVID-19 pandemic has evolved and we’ve learned more about the virus, the way we manage it should have evolved as well. From a policymaking perspective, step one is acknowledging that it’s one of many risks we face in life; we need to weigh up all of life’s risks as we decide how to tackle this problem. 

Second, it’s important to note that, as we learned early on, COVID’s risks differ dramatically across age deciles and health conditions. At the onset of the pandemic, when we knew little about the coronavirus, it seemed reasonable to adopt a stricter set of blanket policies until we could properly assess risk. However, because risks differ dramatically for those two metrics (age and underlying health conditions), we should design policy approaches that are weighed against the risks that each subset of our population faces.

Third, COVID-19 and its variants are going to be with us forever, i.e. we’ve moved from a pandemic to a virus that is endemic. It’s not something we’ll ever be able to eliminate like smallpox, because while smallpox was something isolated to humans, the coronavirus is also found in animals. This means it’s futile to approach this problem with an elimination or “COVID-zero” policy.

Where states or countries fell short initially is protecting the elderly population and the sick. New York state and Sweden both failed on this count. Because these population groups face the highest risks, the policy settings for them need to involve isolating them from transmission until they can be vaccinated and continuing to adopt strategies to minimize the risks of transmission now that we are seeing even the vaccinated get infected.

For other age groups, unless you have underlying health conditions, your risk of a serious problem from COVID is low. The policy for them should involve arming people with information about how to minimize their chances of getting it (social distancing, not touching your face or eyes, consider getting a vaccine if you’re eligible), and then letting families assess their risks and develop their own strategies. Only in extreme circumstances (e.g. hospitals at capacity) does it seem reasonable to implement mandates like lockdowns and then for only very limited periods (weeks, not months).

New Zealand’s and Australia’s elimination strategies in the early months of the pandemic were defendable, especially as they were in a relatively unique position of being able to easily close their borders. But as more was learned about the virus, it’s become increasingly hard to justify the continued policy of COVID-zero.

Once the virus’s risks were properly known, the strategy should have pivoted, but it’s continued as if COVID is the only risk in life. It’s come at an enormous cost to many people that can minimize their risk of getting it and for whom if they contracted it would most likely be asymptomatic or have very mild symptoms and recover rapidly.

Take, for example, the four people in Sydney who recently died after contracting COVID-19 as the country’s most populous city and business capital enters it third month of strict lockdown, which many anticipate will continue through November or beyond. All four of them were at high risk from COVID-19:

The deaths include a woman in her 40s in palliative care who was unvaccinated, a man in his 70s who had pre-existing conditions and was vaccinated, a man in his 80s who was not vaccinated, and a woman in her 70s whose vaccination status has not yet been confirmed.

In addition to the enormous number of deaths of elderly and infirm, another major tragedy from COVID-19 has been the astronomical learning loss among children as a result of schools closing. In Texas alone (where most schools were open last year, but offered a virtual option), 800,000 more students fell below grade level in math than we’d usually see in a non-COVID year.

In other words, across all states, we’re probably talking tens of millions of American children with a huge learning loss, which in many cases will never be made up. For large numbers of them, this will translate into lower life expectancy, lower lifetime earnings, mental and physical health issues, and more. Of course, these are also the people who were least likely to get COVID, least likely to transmit it if they did, and least likely to suffer any consequences from the virus. They’re paying a terrible price, which was entirely avoidable.

Fortunately, in the United States, the school year has begun as normal and here in Texas at least, most schools are not offering a virtual learning option. Sadly, in New Zealand and major states in Australia, schools are closed again.

We should also spare a thought for all of the businesses, especially small family ones, that have permanently closed or are barely hanging on. For example, the New Zealand Herald reports that 70% of travel agents in the country have left the industry as tourism and travel have dried up. In 2020, the country’s economy shrank a record 2.9%. Again, the harm to children and young families—those least likely to be impacted by COVID-19—will be profound. This loss of income and employment will translate to poorer nutrition, mental health issues, broken families and more.

Unfortunately for New Zealand, there is no end in sight to these snap lockdowns. It just entered another, which if the country is lucky will ease to level 3 by October and all will be well by November. However, the country is far from being able to open its borders again. The country’s vaccination rollout is the slowest in the developed world. It was paused as the country entered lockdown again.

Even more problematic is that the country’s universal healthcare system is simply unable to deal with the inevitable cases that arise when the borders do reopen some time in 2022. As Matthew Hooton noted last week, the country ranks 21 out of 22 OECD nations in terms of ICU capability, with less than a third of ICU beds per capita than the OECD average. This was known when the country adopted its elimination strategy in March 2020, but the government has failed to address it a year and a half later. Prime Minister Jacinda Ardern has said she’s not giving up on this elimination strategy so more harsh lockdowns are inevitable.

As is the case with so much in life, the wealthy in New Zealand and Australia have the resources to ensure their families come out of the current lockdown (and future lockdowns) relatively unscathed. The countries’ least privileged citizens aren’t so fortunate. They’re the ones that suffer the most from this strategy and the costs they’re being asked to bear will be with many of them for life. These lands down under are failing their most vulnerable with a policy of COVID-zero.

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