An "Elimination Strategy" for COVID-19

[MUSIC PLAYING] Welcome, everyone. You're watching "Coronavirus in Context." I'm Dr. John Whyte, Chief Medical Officer at WebMD. Everyone is talking about the variant and how we need to vaccinate as many people as we can. But some experts are suggesting that's not enough. We actually need a no-COVID strategy, an elimination strategy.

So to help explain what that means, I've asked Dr. Yaneer Bar-Yam to come back. He is Professor and President of the New England Complex Systems Institute. Dr. Bar-Yam, welcome back.

Thank you.

So what is this elimination strategy? Aren't we actually trying to do that?

So what we've been doing is the live-with-a-virus strategy, which is not working very well, because what we end up doing is giving up our ability to do what we want to do, and we have the virus around, which is causing all the disease, and disability, and the long-term consequences. And the problem is, of course, that there is not an end to this that we see, even with the vaccination. So first of all, with the vaccines, it's clear that we can't get out of this with 6 to 12 months of vaccinations.

Why is that? Why do you say that? Take, for argument's sake, that we can reach 70% to 80% immunity. A lot of people say we're not going reach that. But let's be optimistic and say we will.

So first of all, that will take time. You can estimate about 9 months, 6 to 12 months before we have enough vaccines to get the level that would protect the population. But what we've seen already is that there are variants that are reducing the effectiveness of the vaccine. And so we have to expect that there will be variants that will undermine the vaccine.

And then we're talking about having another round of vaccinations, or boosters, or multivalent vaccines, and all of that just means that we don't know that there is an end to it. And we see that with the flu, where we have to have vaccines every year, and they still don't protect us. So the current situation is not an end game. It's just a way of perpetuating the harm that the virus is doing, both to health and to the economy.

And so what is the way out of this? What we need is an exit strategy, one of these exit signs on top of a door that says this is the way out. And the answer is that we already know what that looks like.

What we have to do is we have to drastically suppress the virus. And we have to realize that where we don't have virus we can open up normally. And we can open up normally by protecting areas using restrictions of non-essential travel for a short amount of time, not a long amount of time, until other areas are able to open up also because they're also without the virus.

So you talked about that we have to use non-pharmacologic interventions as well. You talked about lockdowns. We've talked about that before. But here is it these targeted lockdowns, these creation of green zones? I want to ask you about that, because some people will say, can we actually get that done here in the United States? There's so much resistance to that.

And didn't we try that? Or we just didn't try it well enough? I mean, it's easy to say let's suppress the virus. We all agree to that. But again, I'm pushing on you, how do we realistically do that, recognizing what the sentiment is right now?

The main thing is to realize that it's not the same to get to a few hundred cases and say, hey, we're safe enough, let's open up. What you have to do is realize that you need to get to zero. In the summer, there were many, many parts of the country that could have opened up safely if we had protected them and we had kept going in the other areas for a few more weeks.

So really, the question is not doing something completely different, but doing it intentionally. The point is that if we think that we're able to open up when we have-- it's, like, it goes back to this issue of a fire. If you have a fire-- we have a no-fire policy. Our no-fire policy means we don't let fires burn in houses, we don't let fires burn in the city and then put them down when they're big enough. What we do is we put them out.

But let's get very practical.

And by putting them out--

And we talked about the fire metaphor before, and it's a very good one. We don't just do certain sections. We try to get it out completely. So let's be very practical. Tomorrow, you're in charge. What do you do?

So the question is, what am I in charge of? So we could do this in a town. We could do this in a city. We could do this in the country or in a state. It's super straightforward.

We say, look, we've been living with a virus. We do not want to live with the virus. All of the ideas of finding some way to live with it are not working. So we're going to make this decision we are going to get rid of it. In order to get rid of it, we have to do the strong action over just five weeks.

And by doing it over five weeks-- so what we're going to do is we're going to do all of the things we know. We're going to do a stay-at-home order. We're going to do drive-by, pickup, or we're going to do delivery. We're going to protect family members by making sure that if someone is sick, we quickly isolate ourselves so we don't affect them. We're going to do all of that. And then in five weeks, there are going to be many, many parts of the country that are going to be virus-free.

How'd you decide five weeks, scientifically?

So five weeks has to do with the incubation period. It's two weeks for the first incubation period. Then we identify people who are sick, but they've already infected some of their housemates. So then we need another two weeks to eliminate those cases from being infectious.

And then we need a little bit more. And this has been shown in multiple countries, if we really go all out, we can go down very rapidly. We didn't do all of that the first time, so it took longer. We lost patients. And then we opened up because we thought it was OK to open up with a few cases. Why does a few cases matter? But it does, because then it blows up again, as we saw.

Did we have too many exceptions when people tried to say we were in a lockdown mode?

Absolutely. The point is the following. If you're trying to make it a little less bad, then you say, well, I'll do a little bit of this, or I'll do a little bit of that. But if you say, look, we want to eliminate the virus. In my town, in my neighborhood, I want to have the ability to meet with my family, to meet with my friends, to go to restaurants, to have everything open.

If we want to get there, the way we get there is by making sure that we don't transmit at all. Now, of course, some is going to happen. We can't avoid everything. But the more we limit ourselves during the first period of time, the less time it takes, and that's the most important thing.

You support travel restrictions, correct? So you create these green zones, and then you'd have a lot of restrictions on travel. Is that realistic when we really have these very porous borders?

So yeah, it is realistic. The important thing to know is that, again, it's not for a long amount of time. So we're going to be really hunkered down for five weeks. It's a great time to do it in the winter when there's a really great cold spell, because we're not going to go out maybe very much anyway. It's a good time to take all of the precautions. And then--

You would close all the schools.

--we don't have to travel.

You'd close all the schools, correct, as part of this?

Absolutely. Schools are very dangerous for transmission. But it's only--

Well, people have pushed back on that, to be fair. Everyone doesn't agree with that sense of transmission in the schools, to be fair. Is that correct?

There are two ways to say this. Not everyone agrees with it. People are concerned about kids. People are concerned about the taking care of kids.

People are concerned about not being able to work when their kids are home. All of these are issues. But the main thing-- and by the way, there is new information about kids with long COVID, which is very, very disturbing.

But CDC says we can reopen the schools. So isn't that in conflict?

It is. But the whole point is that, again, if we do it for a short period of time-- you don't want the kids to be home for years and years. But if you do it for a short amount of time, then not only can the kids go back to school, they can go back safely, and everything can be done in the way we want to do it, which is without the fear, without the disease, without the restrictions that we need to follow if we are with the virus, if we--

In many areas, kids have been home for a year. You're suggesting we haven't done it correctly in terms of the lockdown. It's been too liberal in terms of people being able to leave. So we'd have this lockdown, which would be much more comprehensive than we've done before, but for five weeks.

But then there's also a significant role of testing. And in some ways, we've seen testing decrease lately, where one can argue we should be doing more testing, especially epidemiologic surveillance testing. Tell us about the role of testing.

The role of testing is to find out where the disease is, not just one person. So one person is super important, but everybody should be isolating as soon as they have any symptoms so they don't transmit. But then they're tested. They know to isolate for the right amount of time, and we have to support them.

This is one of the really important things to realize that in order for people to be able to isolate, we have to help them, because many of the people who are infected are workers that have to support themselves from week to week. So we have to make sure that people are supported in being able to isolate themselves, as well as the quarantine of people who are their, quote, "close contacts."

So by doing that we enable people to take these actions. Once they can take these actions, it's really not that long. We've been doing this for a year. Do we want to do this for another year or maybe two years? Because if we don't control the virus, the living with this virus is what we've been seeing for the last year. We do not want to be living with this virus.

Well, there is one exit. And this exit has been now declared by the editor-in-chief of The Lancet. It's been very clearly articulated by key epidemiologists. They say it's not only the thing that we want, it's possible. And the main thing that we need to do is to recognize that we have to do things that we wouldn't normally do, and that's OK, because it's the exit. We just need to know to walk through the door.

Is part of this a political solution, as well as a scientific solution, meaning we need to have that political leadership, that political will to make this no-COVID strategy happen?

The disease is biological. But the action that we need to take is a political, social action. It is about our desire to do something for ourselves and not to be at the mercy of this disease. And just to be clear, it's been super bad over the last year.

But with the variants, it's going to get a lot worse, because a more rapidly spreading variant, it's going to go way back up very quickly, and we're going to anyway have to do much stronger action, much stronger restrictions in order to just maintain it at a level that's not swamping our hospital systems and killing huge numbers of people that cannot even get treatment. So if we're not doing the right thing, we will anyway have to do much more restrictions. And why shouldn't we get the benefit of getting to zero and opening up normally, which has been demonstrated to be effective?

Where have we seen that happen?

We've seen it in countries that are Western countries, Australia and New Zealand. They have large cities. They have lots of traffic between them. And they've done travel restrictions even within the city of Melbourne. They've put in travel restrictions in order to protect the areas that didn't have the disease so that they didn't have to lock down from the area that did have to lock down.

We've seen it in New Zealand, which had an early, fast lockdown. We've seen it in Taiwan. We've seen in Vietnam, which has a very high-density population with 100 million people. Even India is being successful, where they have high-density slums that they've been able to overcome the disease.

And the way they've been able to do this is by really careful action, making sure that they do identify cases, isolate people, do testing where it's essential to figure out what's going on and to stop the disease. And of course, it was also done in China. So we have lots of different countries, big countries and small countries, island countries, and Vietnam is surely not an island country.

There are lots of different countries with different governments. And by the way, it's also, of course, been done in Atlantic Canada. Atlantic Canada has a zero-COVID strategy. They have been taking care of the disease and making it have very, very few cases and have been very successful.

And those were done pre-vaccination, so there really wasn't a vaccination strategy. This really was a non-pharmacological intervention.

The vaccination strategy has not been important anywhere in the world except for perhaps in Israel. And even in Israel, the outbreak now is at maximum. They're trying to have a solid lockdown in order to prevent the transmission. The vaccine is not going to solve the problem in the short term.

Tell me how confident you are that we'll be able to institute this elimination strategy in the United States.

I've seen it being done in many, many places. I know that the US, despite all of the people who say we're fragmented and so on, has a tremendous ability to rise to challenge. If we're willing to give our all to winning, then there is 100% certainty that we'll be able to overcome this. It is not a challenge that we cannot meet.

Dr. Bar-Yam, I want to thank you for providing your insights for helping us to understand how an elimination strategy can work.

Thank you.

And thank you for watching. If you have questions about COVID, drop us a line. You can email me at [email protected], as well as post it on Facebook, Twitter, and Instagram. Stay safe.

[MUSIC PLAYING]