August 25, 2020

“When I look at people of the Swedish perspective that life can go on, we’re actually aligned on a lot of things,” says Devi Sridhar, the American public health professor currently Chair of Global Public health at Edinburgh and a leading figurehead of the “ZeroCovid” movement. “We’re both against lockdown, we both want social lives to continue, we both want schools back, but we want it done safely.”

In order to achieve these goals, however, Prof Sridhar’s suggested strategy is the opposite of Sweden’s more laissez-faire approach. Instead of being more permissive, she is calling for governments to follow the Scottish lead and commit to a “ZeroCovid” strategy — ie that any level of Covid-19, no matter how low, is considered unacceptable, and that within national borders, governments should aim to eliminate the virus completely. Liberty, achieved through greater suppression, is the paradoxical idea.

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If you want a preview of the next phase of the political debate around Covid-19, this is it. Nicola Sturgeon (who Professor Sridhar advises) is calling for England to join the other home nations in committing to a ZeroCovid strategy, the so-called “Independent Sage” group of scientists is in agreement, and the Liberal Democrat Layla Moran has begun to demand that Boris Johnson takes the pledge. The group has a distinctly Left-progressive-idealist flavour, perhaps unsurprising given that the policy is driven by a conviction that, with enough willpower, governments and collective action can remake the world.

The key argument is as follows. “Health versus the economy” was never the right framing — the countries that have fared best so far in this pandemic, whose economies and societies are returning to normal fastest, are the ones that acted to lock down decisively and early, drove the virus down to very low levels, and are employing massive testing and track and trace programmes to keep it there.

If you try to open up society while the disease is still in circulation it will firstly not work because people are still feeling afraid (Prof Sridhar points to the mostly empty cinemas and theatres since they reopened) and, what’s more, the virus will come back. She gives Spain as an example of a country that had driven the virus to low levels but, since opening to tourists and restarting the “night-time economy” of bars and clubs, has seen a large surge in case numbers. In her view, they should have controlled the border more aggressively, been more activist in testing, tracing and isolating, and kept things like nightclubs closed.

When I pressed her on what exactly would be different from today in a ZeroCovid-committed England, the impression is of “do more of the same, but do it better and try harder”. More testing (up to 1 million a day), replace 14-day quarantine with testing twice at the border, and improve the NHS Test and Trace programme. Partly, she feels that change would already come from making the commitment, as it would give citizens clarity as to the national strategy. One striking detail was the idea of making ZeroCovid zones within the country, ringfenced with limited movement in or out, that could link up until the whole country was rid of the disease. (I wouldn’t want to be the one to inform the inhabitants of a town that they couldn’t leave because it had become Covid-free!)

I asked her about the dramatic improvements to mortality rates that we are seeing in these apparent “second waves” across Europe. She acknowledged the trend and thinks it is down to spread among the younger population and improvements to treatment, but says that she has not yet seen convincing proof of either widespread T Cell immunity or mutations towards a milder strain. I asked whether, if the virus becomes provably less severe, it would reach a point where she would abandon the ZeroCovid idea altogether:

“Of course. We have to change our strategies based on the evolving nature of this virus and that’s why my mind has changed over the course of watching this virus. What worries me is the health impact — not only on the deaths but the disability for younger people. I’m concerned about the long-haulers. If a new strain emerged that was more infectious but less severe like the common cold — well then that would be fantastic and I would not be saying we have to push for zero Covid.”

She’s keen to emphasise that, despite the name, the policy is not a plan to live in perpetual lockdown until the last human being is cured of Covid-19. She describes herself as “anti-lockdown” and that “CovidZero is not about keeping restrictions forever — you don’t want to destroy a society chasing down the last person who has the virus. It’s actually saying that we are going to continue seeing spikes and mitigating the economic effects… It’s about mass testing, good tracing and getting life back…”

So what about a disease-like flu, which according to some estimates is already killing more people per week in England than Covid-19? Should we have a zero-flu policy, with mass testing, local lockdowns and a test and trace system?

“Covid is nothing like the flu,” Prof Sridhar says. “Flu is a respiratory disease, whereas Covid is a multi-system disease. You have young people a few weeks after catching Covid having heart attacks, which does not happen with the flu, along with kidney failure, blood clots and pulmonary embolisms. There is something different about this virus — it is nothing like the flu.”

Opponents will say that the ZeroCovid goal ends up being fanatical, potentially consigning us to years of life-altering restrictions in pursuit of a goal we will never achieve, in response to a threat that doesn’t warrant it in the first place. Yesterday’s announcement by New Zealand that Covid-19 sufferers will be removed to a quarantine facility and Scotland’s drive to require masks in schools will only add to their concerns. But Professor Sridhar clearly believes that concerted activism and short-term pain is a more responsible route back to life as normal — she makes an eloquent case and our thanks to her for such a stimulating discussion.