Halloween visitors to Shanghai Disneyland may have felt tricked rather than treated. On October 31, 2021 some 30,000 of them were corralled into crowded lines and prevented from leaving the park until each had been tested for COVID-19. The trigger? A single positive test amongst the crowd and the concern by Chinese officials for greater viral spread. Although Taiwan, New Zealand, and Australia weren’t as aggressive, these island nations had adopted a similar goal: zero COVID. That means eliminating community spread by preventing not just deaths or hospitalizations but infections as well. The policy has meant closed public parks and strict lockdowns. 

Perhaps the polar opposite of zero COVID policies, early in the pandemic Sweden eschewed mask mandates, school closures, and lockdowns. The government relied on citizen’s judgments and adherence to social distancing. Despite an initially high number of deaths (especially among nursing home residents) and a recent commission criticizing its slow implementation of mass testing, over the course of 2020 it boasted a far smaller increase in its overall mortality rate than most European countries. While Spain and Belgium enforced extended lockdown periods, their excess mortality rates rose more than 16% over 2019. Sweden had 7.7% more deaths in 2020. Out of 30 European countries, only nine did better by that measure. With different approaches leading to similar outcomes, what are some of the lessons learned from the COVID-19 pandemic?

Pandemic Policies

Over two years ago, the first reports of an infectious virus in China traveled across the world. One U.S. intelligence report noted that three researchers from China’s Wuhan Institute of Virology became sick enough in November 2019 to enter a hospital. Whether from a lab or an animal, there was no denying that over the next few weeks more people in the region became ill from the virus later labeled: SARS-CoV-2. Despite containment efforts labeled “draconian,” COVID-19 spread far beyond the Chinese border. By March of 2020, entire countries were locked down.

While there is ongoing debate about how effective the lockdowns were at eliminating viral spread, they were universally effective at eliminating jobs and economic growth. In July of 2021 China’s rate of growth was cut in half partly due to anti-coronavirus controls. In the U.S., California was the first state to implement a full lockdown and one of the last to emerge from restrictions over a year later. Despite the optimistic projections of economists by the fall of 2021, its unemployment rate remained stuck at 7.5% while less restrictive Florida’s was below 5%.

Although at 277 COVID-related deaths per 100,000 people, Florida’s rate is far higher than California’s 182, the state fared far better by the fall of 2021 than states with more restrictions like New York or New Jersey. Such disparate outcomes are part of the reason that many have shifted away from the notion of elimination of the virus. Instead, breakthrough infections among the vaccinated demonstrated a shift toward accepting it as endemic. As a McKinsey report recently explained, “Soon, the daily risks we run with COVID-19 may seem as much a part of normal daily life as the risks we run when we put the car in drive or navigate flu season each winter.”  In other words, we may have to learn to live with it. The question is how.

Politics are Happening

A recent study suggested a more targeted approach than 2020’s widespread lockdowns. Using human mobility data rather than harder to obtain cell phone locations along with a complex algorithm, the study proposed “sustainable targeted interventions.” This method applies strict lockdowns to small portions of an urban environment. Using Hong Kong, one of the world’s most densely populated cities, researchers were able to project viral containment. Whether their efforts work in real world scenarios remains to be seen. Still, many would prefer targeted lockdowns to the wider approach of 2020.

However, in democracies like the U.S., one size fits all approaches are bound to fail. Complaining about pandemic politicization while seeing the opposing viewpoint as false is actually political (and a bit illogical). Instead, with COVID-19, vaccinations of the most vulnerable have led to a sustained decrease in hospitalizations and deaths. While mandating vaccines may drive up compliance, it has also led to thousands of job losses in already understaffed critical areas like law enforcement and health care.  There is then the possibility that lack of staff could have a greater impact on patient care (and survival) than an unvaccinated worker would.

The unanswered question is whether or not strict lockdowns and mandates will even be accepted if and when the next pandemic hits. Throughout the COVID-19 crisis, the patient profile has remained remarkably consistent: over 65, often with pre-existing conditions including obesity and heart disease. The average age of death during the 1918 Spanish Flu pandemic was 28–which means the next pandemic could kill a broader swath of the population even as governments encounter stiffer resistance to lockdowns and mandatory measures.

References

• China Locks 30,000 Visitors Inside Shanghai Disneyland After One Guest Got Covid-19
• ‘Zero Covid’ strategies abandoned in the face of the delta variant
• Sweden acted too slowly as pandemic hit, commission finds
• Sweden saw lower 2020 death spike than much of Europe – data
• Intelligence on Sick Staff at Wuhan Lab Fuels Debate on Covid-19 Origin – WSJ
• Our Pandemic Year – A COVID Timeline
• Italy expands COVID-19 lockdown to whole country
• Official: China’s growth likely to slow due to virus, floods
• After a COVID downturn, California economy ready to rebound
• California : Western Information Office : US Bureau of Labor Statistics
• Florida Economy at a Glance
• • US COVID-19 death rate by state
• Pandemic to endemic: How the world can learn to live with COVID-19
• Sustainable targeted interventions to mitigate the COVID-19 pandemic: A big data-driven modeling study in Hong Kong
• Many Older Americans Still Aren’t Vaccinated, Making the Delta Wave Deadlier
• How many employees have hospitals lost to vaccine mandates? Here are the numbers so far
• 95 Percent of Americans Killed by COVID Were 50+
• Age-Specific Mortality During the 1918 Influenza Pandemic: Unravelling the Mystery of High Young Adult Mortality