Skribenten som gjorde ”Hammer and the dance” känd i våras tror jag är inne på rätt spår gällande vad länder med helt olika strategier gör för fel. Han beskriver själv ”TOTAL lockdowns" som ”destructive”, för en vettig strategi handlar varken om att totalt stänga ned samhällen i månader eller låta det sprida sig fritt. Då är man fel ute, man upprepar bara samma misstag med eller utan en lockdown.
Citat:
”You’d imagine eight months into the pandemic most countries would know exactly what to do to stop the coronavirus. And yet here we are.
Japan, Taiwan, China, Hong Kong, Singapore, South Korea, New Zealand, Australia, Mongolia, Thailand or Vietnam all followed different variants of the Hammer (heavy lockdowns when there’s an uncontrolled outbreak and they don’t know what to do) and the Dance (a series of intelligent measures to keep infections low), yet all have been successful.
This list includes all types of countries: democratic, authoritarian, continental, islandic, freedom-loving, Anglo-Saxon, developing, developed… They prove any country can succeed. And they’re not the only ones: From the Caribbean to Uruguay, Canada’s Atlantic Provinces or several African countries, many countries controlled the epidemic.
Meanwhile, most Western countries didn’t pay attention, suffered massive outbreaks, applied heavy Hammers to stop them, but never learned how to dance. When the summer recess ended, they were not prepared for the back to school season and its new wave of cases. As the winter progresses, it will only get worse.
In Europe, multiple countries have woken up from their midsummer night’s dream and started and restricting movement again, including Ireland, UK, France, Belgium, Spain, Italy, Germany, and even Sweden.
How to Dance
To keep the coronavirus at bay in your community, you have four layers of defence:
1. Stop as many infections from coming in as possible
2. For those that make it in, minimize the people they meet
3. When they do meet people, minimize the likelihood that they will infect somebody else
4. When they do infect somebody else, identify that infection quickly and neutralize it
None of these defences is perfect. But, together, they can stop enough cases to reduce the transmission rate R to below 1 and keep the virus out.
Let’s look at each one of them.
1. The Fence: Keep Infections out
I call Fences the measures to stop the virus at the border. There are three types:
Walls: Ban travelers from infected areas.
Quarantines: Allow people to come in but isolate them for 4 to 14 days.
Checkpoints: Test people at the border.
Walls are very expensive, so they should be used sparingly. Checkpoints can be quite cheap, but won’t catch all cases. Quarantines are probably the sweet spot: a test, a filled form telling the authorities where the traveler will be, enforcement to make sure the quarantine is respected, and a big fine for those who don’t. With rapid tests on the day of arrival and after four days of quarantine, you will likely stop most of the infections.
Some people look at studies about border closures and say: “They don’t work! They only delay the inevitable!” That’s because these studies always look at these measures in absence of other measures. Of course they’re not sufficient! Fences alone can not stop the epidemic. They are only one layer of defence. Somebody will eventually pass through and seed an outbreak. No Fence, no defence.
What these people miss is that they might not be sufficient, but they’re necessary: They don’t work standalone, but without using them, it’s impossible to stop the virus. Tell me a single country that has been able to keep the number of cases low without a strong Fence. They don’t exist.
Eventually, they get overrun. That’s why Japan, Taiwan, China, Hong Kong, South Korea, New Zealand and Australia all have strong Fences.
Conversely, that’s one of the big failures of the European Union during the summer. After a very hard spring, with heavy lockdowns across the continent, European countries let their guards down and opened their borders to each other, trading seeds. Now we know that a majority of EU’s current cases came from Spain. Something similar happened between US states. No Fence, no defence.
2. Social Distancing: Abstinence from Meeting Others
Measures that promote social distancing go from the least aggressive, such as limits to the size of crowds, all the way to total lockdowns: closures of the economy that require every family to remain in their bubble.
Other measures include curfews, limits to the number of people that businesses allow at the same time, staggered operation hours, bans of certain types of gatherings, business closures…
Total lockdowns are destructive. They ask people to stay home and close all the economy but for essential businesses. That’s what I called the Hammer back in March, when I exhorted governments to apply it to stop the virus.
That made sense back then, when the true extent of the epidemic was orders of magnitude higher than we knew because we didn’t test enough, when our healthcare systems were collapsing, when we had no idea how to dance to tackle the virus. The Hammer would stop the growth of the epidemic and give governments a few weeks to get their act together.
That’s not the case today. If a country is hit by a first wave, applies a Hammer, then has seven months to prepare to Dance, yet has a second wave, and then wants to apply a second Hammer…
What makes citizens believe the government will learn better this time around? Why would they believe there won’t be a third wave, a third Hammer, and then a fourth? Why wouldn’t they believe the government is irresponsibly playing yoyo between lockdowns and outbreaks?
Lockdowns CAN be justified, but only for a few weeks, to get the new wave under control, and only when a country has a good plan to learn how to dance: the faster the decline, the shorter and less harmful the lockdown, and the quicker people can resume a coronavirus-free life.
In fact, this is exactly how the WHO says we should use them. Otherwise, they should be avoided as much as possible.
So what should countries do?
*Target places that are likely to cause super-spreader outbreaks, such as prisons, elderly care homes, rehab centers, universities, or food packing plants. Help them prevent outbreaks with much tighter measures.
* Avoid lockdowns. And if you have to close establishments, schools should be the last ones to go, especially childcare.
3. “Contrafection”: Reduce Contagiousness When People Meet
The next layer of defence is to reduce contagiousness when people do meet.
4. Test — Trace — Isolate: Catch and Neutralize Infections
We’ve talked about preventing infections from coming into a community, avoiding meetings when they do, and avoiding contagions when there’s meetings. The last layer of defence is to identify infections when they do happen and neutralize them. That’s what testing, contact tracing, isolations and quarantines do (in short, test — trace — isolate).
What seems like a pretty easy thing to do has been completely botched by most Western governments — and journalists have not asked the right questions to keep politicians accountable.
Everybody obsesses over testing. And that’s good. It’s important. It’s necessary. Positivity (share of tests that turn out positive) needs to be below 3–5%, and tests need to come back quickly, ideally in 24 hours.
But it’s not sufficient. Testing tells you who is infected, so you can isolate them. But you also need to quarantine their contacts. And you need to make sure isolations and quarantines are actually respected
(...)Thankfully, it is not necessary to trace all contacts. Japan has been very successful in part because of a tactic called “cluster-busting”. Most people don’t infect many others.
Instead, just focus on clusters. When you catch a case, figure out where it got infected (that process called “backwards tracing”), and when you find a cluster, chase everybody there. If the infection was not in a cluster, move on.
No enforcement or support means no quarantines or isolations.
Imagine the stupidity of lockdowns in countries that don’t have a good test-trace-isolate program. It’s literally like saying:
“It’s too hard to isolate just a few people, so we’ll isolate them all.”
Governments such as those of Spain and France had no problem enforcing lockdowns with millions of fines. How come we never hear about fines for isolations and quarantines? It’s because they don’t exist.
Finally, there are the rapid tests: Tests that cost less than $5, can tell how contagious people are within a few minutes, and can be manufactured in the tens of millions.
Slovakia has realized how much of a game-changer this is and is testing all its population this way. With these tools, tens of millions of people can be tested every day. That means the intelligence part of test-trace-isolate can be done extremely quickly and even with little reliance on contact tracing. But most governments don’t realize it.
Unfortunately, Western countries never learned to use these cheaper layers effectively, so they keep going back to the one they know, layer 2. (TOTAL lockdowns) And they keep destroying their economies instead of learning how to Dance with the other layers."
