The Economist - USA (2020-03-21)

18 BriefingThe pandemic The EconomistMarch 21st 2020

2 fear may increasingly add its weight to gov-

ernment say-so and social stigma. Still,

good behaviour does tend to wear off.

South Korea started to take social dis-

tancing seriously long before Europe did,

telling the citizens of Daegu and Gyeong-

buk, two early hotspots, to stay at home in

the middle of February and those of metro-

politan Seoul to do so in early March. Pub-

lic spaces emptied out. This was not the

only factor in the country’s apparent suc-

cess in containing the disease. A huge

amount of testing and contact tracing, as is

now being implemented in Italy, has been

crucial. But it helped. However there is

some evidence that people may be becom-

ing more restive. Use of the Seoul metro

has ticked up a bit.

No government other than the most re-

pressive will believe it can keep its country

on lockdown for months on end—and even

if it could, the economic effects would be

intolerable. China, having instituted a dra-

conian lockdown, has, now that new cases

are rare, begun to ease some restrictions

where it can. A couple of provinces that

were not badly affected are starting to re-

open schools. In Beijing, by contrast, the

rules have tightened since orders went out

to protect the capital from imported infec-

tions. Office buildings are open, but ten-

ants must show that their workplaces are

not too crowded; some are allowing only a

half or a third of their staff in at any one

time. Guards with loud hailers count shop-

pers in and out of markets and chide those

who stand less than a metre apart.

And next time?

Citizens must wear masks to go outside;

after weeks of shortages these can now be

found, but at a price. In Hong Kong, where

there were admittedly very few cases, the

ubiquitous masks are the only indication

that the city is not quite back to normal—

whether you are on the as-crowded-as-

usual metro or at a rave, there is not an un-

shielded nostril to be seen.

Epidemiologically, these places have, in

a way, returned to the tail end of 2019. Just

as the world did then, they face a new

pathogen to which the population has no

immunity. But now they are forewarned.

They know about sars-cov-2, and no lon-

ger see a need to try to deny its existence;

they know how to react should it rear its

head, and are ready to do so. The emphasis

is thus not on suppression, but on hygiene

and surveillance.

China is using a variety of smartphone

apps to facilitate this. In Shanghai qrcodes

are used to determine whether a person

can be admitted to a building, or even the

city—and to provide a detailed contact his-

tory should that person later be found to

have become infected. Each subway car has

its own qrcode to be scanned when you get

on. If one of the passengers gets sick, only

that car, rather than the whole train, needs

to be contacted.

Citizens of other countries might be

willing to tolerate such surveillance if they

really believed it was temporary. One thing

that might make it so would be better treat-

ment. Drugs do not make people immune

to disease; but if severe cases could be

treated more effectively, there would be

much less to fear about letting people cir-

culate quite freely. On March 17th Chinese

doctors reported that Avigan (favipiravir), a

drug used against influenza in Japan, led to

clinical improvements in patients. The day

before a drug called hydroxychloroquine

jumped to prominence after a small, un-

randomised trial. Results from large trials

of remdesivir, an antiviral developed to

tackle Ebola, are weeks away but eagerly

anticipated.

Then there is the possibility of giving

people immunity without requiring them

to get the disease: that is, vaccination. The

first genome sequence for sars-cov-2 was

published on January 10th. The next morn-

ing Sarah Gilbert, a virologist at Oxford

University, headed straight for her labora-

tory to see what she could do to turn that

sequence into a vaccine—as did hundreds

of others at dozens of institutions and

companies.

Adrian Hill, a professor at Oxford, says

that in general terms “six months from se-

quence to vaccination is very doable if the

right vaccine technology is used”. That

means vaccines could be in efficacy tests by

summer. There is a risk that they will not

work; some microbes, such as hivand ma-

laria, have proved resistant to being imper-

sonated by vaccines for decades. But other

cases—such as that of Ebola—have been

comparatively easily cracked.

Suppression strategies may work for a

while. But there needs to be an exit strat-

egy—be it surveillance, improved treat-

ment, vaccination or whatever. If govern-

ments impose huge social and economic

costs and the virus cuts a swathe through

the population a little later, they will dis-

cover that when politicians disappoint the

people over something this serious there is

hell to pay. 7

Anticipatinganencore

Britain,covid-19,critical-carebedsoccupiedper100,000population

Source:ImperialCollegeCovid-

ResponseTeam,March16th 2020

0

100

200

300

400

2020 2021

Mar Apr May JulJun Aug Sep Oct Nov Dec Jan Feb Mar

Donothing

Periodinwhichinterventionsare

assumedtoremaininplace

Estimated

surge ICU bed

capacity: 8

Suppression strategy scenarios

for ICU bed requirements:

School and university closure,

case isolation and general

social distancing

Case isolation, household

quarantine and general

social distancing

8

AM J J A

16 beds

2