Continuing from the previous post, what about countries that haven’t wiped out the novel coronavirus in their populations, but kept it to a low level? Examples of such places include but are not limited to:
- Czech Republic
- Germany
- Hong Kong
- Singapore (later an example of missteps)
- South Korea
- Taiwan
Notice that most of these countries are in Asia, where the SARS epidemic of several years ago is clearly remembered. In some Asian countries, many people wear face masks in public or are quick to begin doing so whenever there is a threat of another respiratory epidemic. Contact tracing early in this pandemic in China suggests that face masks may be somewhat protective, contrary to what Western experts tend to tell the public.
Let’s begin by looking more closely at some of these Asian success stories, beginning where lockdowns haven’t been needed and closures of sections of the economy have been limited. Then we’ll get to Germany, which is just beginning to try to ease lockdown as I write this.
East Asia tended to get more of the second variant of SARS-CoV-2 virus. (To see a brief description of research conducted jointly at Cambridge in the UK and Germany, click here.) Mutations of the virus can be grouped into three general variants dubbed A, B and C which appeared in that order. We don’t yet understand the implications of which variants a country gets, but the variants may differ in how easily they spread and exactly how they affect people. Even so, Germany is distinctly European and its record with the pandemic is similar to that of the Asian places I listed.
All of these places executed their pandemic plans vigorously. They were not as quick to clamp down as New Zealand and Australia, but they were quick enough and thorough enough to prevent the virus from spreading like a wildfire. Some never went into lockdown or stringent economic constraints.
Notably, Singapore’s plan was essentially copied from the United Kingdom, which failed to apply its plan properly. Success has not come from simply having a good plan. The keys have been having a good plan, doing the preparation required by the plan beforehand, firing up pandemic response early and implementing it diligently… which is not always entirely driven by the government.
They didn’t clamp down early enough to starve the virus into extinction. But the general pattern is that as soon as they saw the virus surfacing, they began striving to find every infected person, tracing contacts of those people, and isolating them. Highly active testing programs have typically been crucial for finding out who had the virus.
Contact tracing requires a lot of effort. To keep prevalence of the virus at a manageable level, pandemic response had to be started early enough and thoroughly enough to keep the case load within the limits of not only what the health care system can handle, but also what the testing and contact tracing workforce can handle. It’s the next best thing to starving out the virus entirely. These places did that. They never got a lot of cases or deaths from this coronavirus.
Singapore (Consequences of Small Mistakes)
Except… Singapore overlooked a segment of its workforce near the bottom of the economic food chain. It has a single border, so controlling entries is not difficult. Its government and police force are strong. It has a good health care system. With those advantages, Singapore was able to find and quarantine cases so effectively that it did not impose lockdown or severe economic restrictions that were needed elsewhere. For a while, it looked like the virus had been beaten there.
Unfortunately, Singapore had 200,000 low-paid migrant workers living in dormitories, 12 to 20 to a room with shared bathrooms and kitchens. When the coronavirus found them, it was like a lighted match in dry tinder. In the middle of March, Singapore began suffering a second wave of COVID-19 from that tinderbox.
As a result, Singapore had to implement what it calls a “circuit breaker.” Schools and entertainment facilities were closed, and public gatherings were banned. Face masks became mandatory. Penalties for violating the new rules are harsh. Perhaps most importantly, the overlooked migrant workers were moved into other living quarters. Data indicates these measures are squelching the second wave.
Hong Kong (No Lockdown, Smart Populace)
With many visitors from China, Hong Kong could easily have been one of the first places hammered by the pandemic. Instead, it followed World Health Organization recommendations to test everyone who showed symptoms, quarantine them in hospital, trace their contacts, and make the contacts self-isolate. At the border, anyone arriving from any country with COVID-19 cases had to go through 14 days of quarantine. Schools were closed and people were encouraged to work from home if they could.
Lockdown was not imposed, but people changed their behavior of their own accord. Surveys found 85% of people avoiding crowded places and 99% wearing face masks whenever they left home. This may be partly because Hong Kong was severely hit by SARS in 2003, and that is recent enough for people to remember it.
Germany (Dipping a Toe into Lockdown Exit)
To me, Germany is a bridge between the no-lockdown examples in Asia and the many countries that are struggling to find their way after the pandemic got ahead of their efforts to control it. COVID-19 began to break out in Germany before it reached Italy, yet Italy was inundated and suffered many deaths while Germany kept its death rate low. However, Germany did impose lockdown, albeit partial in most of its states. They may pave the way for at least some other countries that need to figure out how to emerge from lockdown.
Prime Minister Angela Merkel, who holds a PhD in quantum chemistry, epitomizes Germany’s famously methodical, analytical, precise and no-nonsense national archetype. Her decisions and her televised addresses to the public have become among the world’s best models of how to lead during this pandemic.
To say that Germany dove into testing, tracing and isolating does not capture how meticulous they have been. They documented the first known chain of COVID-19 human-to-human transmissions outside Asia, pinpointing it to a salt shaker in a company canteen at car parts company Webasto Group in Stockdorf. An employee had unknowingly brought the novel coronavirus from China when she facilitated workshops. She touched the salt shaker, from which it spread to other workers who used it on 22 January. She tested positive for the virus a few days later. (To see reference, click here.) Germany’s testing and contact tracing program has been awe-inspiring.
The German states of Bavaria, where the virus first arrived, and Saarland went into lockdown. The rest of Germany went into less extreme restrictions. Restaurants could only offer food delivery or curbside pick-up. Schools and non-essential businesses on an official list (e.g. hairdressers and tattoo parlors) shut. Public gatherings of more than two people were banned except for people who live together. Exercising alone with adequate separation from other people was allowed. In general, social distancing was imposed.
This means Germany has to find a way to ease restrictions without suffering resurgence of COVID-19. Merkel directly warns that easing up too early may lead to more cases, which in turn may require tightening restrictions again.
Unusually, the groups of experts advising the German government are not filled with virologists and epidemiologists. They are broadly based, including academics from the humanities such as philosophers, historians, social scientists, educators, ethicists, and theologians. This has drawn some criticism, but it appears to be helping Germany consider reopening society as a complex system rather than heavily relying on mathematical models of contagious spread.
This may be why Germany is starting by reopening schools, small shops, car dealerships and bicycle shops, with masks recommended in public and new hygiene measures required. Bars, restaurants, cinemas and music venues must stay closed. Large public gatherings remain banned through the end of the summer, including religious gatherings.
It is a significant contrast from some other countries that are focusing first on how to reopen factories, construction sites, and other elements they regard as crucial to their economies. The Germans have considered not only financial impacts but also non-financial impacts of lockdown, and in some aspects of society they opted to try to ease those impacts before larger portions of the economy.
Time will tell how this German experiment in exiting from pandemic restrictions will turn out. Their insistence on applying systems thinking, plus willingness to admit up front that it may not go well enough and they may have to take a step back, could be the most important lessons they offer about how to exit from lockdown.
They appear to be not even considering immunity passports. In the next post, I will take a look at what harder-hit countries face, including reasons I can see beyond what the WHO has mentioned for not pinning too much of the exit on immunity passports.
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