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(July 10, 2020)

Only Sustainable Measures Are Helping COVID-19 Control



The whole world has surely noticed that China, Australia and the United States are having COVID-19 community spread again. While several places are locked down again, it is time that every government honestly informs people that we are inevitably going to live with the coronavirus for a while. Only sustainable measures, which is absolutely not another lockdown, can really help everybody get through it together.



After some restrictions were lifted in May or June, many people might think the coronavirus has gone and it’s not necessary any more to strictly practice social distancing, to wear a face covering in public and to wash hands that often. It is highly likely to be the reason why a number of places are having the second wave. Every government should learn the lesson and offer people proper information about the current status of the pandemic to at least have the majority of people keep practicing the precaution measures to maintain a flat, or downward, infection curve.



Taiwan, with more than 23 million citizens, has not reported any domestic COVID-19 cases since April 13. Even though, its nationwide health education system kept reminding people in the whole month of May to maintain social distancing, to wear a mask in public and to practice good personal hygiene. Taiwanese government is therefore confident to announce on June 17 that they will ease quarantine regulations exclusively for visitors from 11 low-risk countries and areas, including New Zealand, Australia, Macau, Palau, Fiji, Brunei, Vietnam, Hong Kong, Thailand, Mongolia and Bhutan.



Although there have been more than 350 import cases challenging Taiwan’s public health system since the country encountered the first one from China on January 21, Taiwanese government has never enforced any lockdown or stay-home orders. With no lockdown, as of July 9, only 55 domestic cases have been reported and 7 patients sadly died in Taiwan. Apparently, Taiwan has been showing the world a relevant example of the sustainable way that people can fearlessly live with the coronavirus in the long run.



A number of solid research findings have also offered evidence to prove there are effective protection measures helping people live with the coronavirus before vaccines are available. For example, a meta-analysis report published on June 1 in The Lancet showed 1-meter social distance significantly reduced the chance of human-to-human transmission to 2.6% from 12.8% with no social distancing intervention. Face masks also helped lower the chance from 17.4% to 3.1%. Eye protection decreased the chance to 5.5% from 16%. (Ref. 1)



An analysis published on June 11 in the Proceedings of the National Academy of Science analyzed data from three epicenters - Wuhan (China), Italy and New York City - and proved that mandated face covering “alone” significantly reduced the number of COVID -19 infections. The researchers concluded that wearing of face masks in public corresponds to the most effective means to prevent human-to-human transmission, and this inexpensive practice, in conjunction with simultaneous social distancing, quarantine, and contact tracing, represents the most likely fighting opportunity to stop the COVID-19 pandemic. (Ref.2)



There are, of course, studies showing lockdowns help as well. The journal Nature published two scientific articles on June 8, which support the effect of large-scale lockdowns. One of the researches examined data from 11 European countries and showed that lockdowns effectively slowed the pandemic and saved 3.1 million lives. (Ref. 3) (Ref. 4)



However, many people were probably willing to sacrifice their freedom and convenience for saving lives in March and April and hoping everything would be fine after the pandemic ended. In May, especially late May, "lockdown fatigue" has emerged. It seems less people are comfortable in June with the all-or-nothing nature of strict lockdowns because many people have started noticing the huge uncertainty for the future after three-month lockdowns.



In fact, at least two "excess deaths" analyses based on statistics of EuroMOMO, the European morality monitoring activity, have shown that the strictness of a country’s lockdown measures had little associations with its fatality of COVID-19. These analyses concluded that it’s better to respond quickly, with proper testing and tracing protocols, rather than replying on strict lockdowns. (Ref.5) (Ref.6)



The biggest myth about lockdown is to believe it is the only solution when the epidemic gets worse. In fact, lockdown is a measure to lock the seriously-affected area in order to protect people in other areas. When SARS hit Taiwan 17 years ago, the health authority there locked a hospital where a serious nosocomial infection occurred to protect the community outsides. When Wuhan became a miserable epicenter of China in January, Chinese government issued a lockdown order in Wuhan to avoid the coronavirus from further spreading to other cities and provinces.  



To live with the coronavirus, in addition to people’s good personal hygiene and social distancing practice, since COVID-19 is highly contagious and an increased testing capacity will definitely find more infections, government officials have to learn that the number of positive cases is not an optimal indicator to monitor pandemic control and hospitalization is. Singapore is the best example regarding this. As of July 9, this city state, with 6 million residents, has reported 45,423 positive cases through its aggressive testing protocol. But Singaporeans did not panic. They watched hospitalization rate carefully. Their well-prepared medical system has controlled the death toll as low as 26.



In addition, the public health system needs to offer extra care to the elderly, especially those who live in nursing homes, to avoid the mistakes many countries have made in the past several months, which caused a lot of deaths among the seniors. The system also needs to remind the other high-risk group - people with underlying medical conditions, such as hypertension, diabetes and lung disease - to try their best to get their chronic illness under control before the coronavirus hits our community again.




Ref. 1 The Lancet:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext

Ref. 2 Proceedings of the National Academy of Science:

https://www.pnas.org/content/early/2020/06/10/2009637117

Ref. 3 Nature:

https://www.nature.com/articles/s41586-020-2404-8

Ref. 4 Nature:

https://www.nature.com/articles/s41586-020-2405-7

Ref. 5 The Economist:

https://www.economist.com/graphic-detail/2020/04/16/tracking-covid-19-excess-deaths-across-countries

Ref. 6 Bloomberg:

https://www.bloomberg.com/graphics/2020-opinion-coronavirus-europe-lockdown-excess-deaths-recession/