22 BriefingCovid-19 in Europe The EconomistNovember 7th 2020
2 disease poses much less risk to them than
it does to older generations, acted as
though its spread through their cohort
would be without too much consequence.
Over time, though, the virus crosses gener-
ational boundaries just as it does geo-
graphic ones (see chart 3).
When the new lockdowns come to an
end—most are envisioned as lasting for a
month or so—many public-health officials
plan to make use of a tool not available back
in the summer: cheap testing kits which
provide results in 15-30 minutes. In princi-
ple these offer a wealth of advantages. Us-
ing them to ramp up the rate of testing
could, by finding new infections whole-
sale, reduce the burden on contact tracers.
They could also be used to confirm
whether someone found through contact
tracing is indeed infected. If individuals
asked to self isolate could test themselves
before deciding to mix again—a develop-
ment that would require antigen testing to
be licensed for home use, as pregnancy
tests are—many of them would, and those
who tested positive would be likely to act
accordingly. This would reduce transmis-
sion by people without symptoms. If new
drugs become available which, taken early
on, reliably improve the prognosis, such
self testing would benefit the individual as
well as society.The rock of reason
Until now, testing in rich countries has re-
lied almost entirely on pcrtests which de-
tect tiny amounts of the rnaon which the
covid-19 virus stores its genome. Such tests
are the gold standard for diagnosis, but
they have to be done in laboratories and
typically take hours. Tests which look in-
stead for viral proteins—“antigens”—are
quicker and cheaper. They are also less ac-
curate, missing about a quarter of the in-
fections pcrpicks up. But the cases they
miss are mostly in the early or late stages of
infection, when people are thought to be
less contagious.
In mid-October Germany’s testing strat-egywasexpandedtoincludeantigen tests
which, at €10 ($12) a pop, are around a quar-
ter the price of a pcrtest. About 10m such
antigen tests are now available every
month. They are being used to enable safe
visits to hospitals and care homes. America
has placed orders for 150m such tests,
which are also being sent to care homes
and other high-risk places. And for devel-
oping countries, a global procurement
fund led by the World Health Organisation
has cut a deal for 120m tests at a ceiling
price of $5 apiece. Many experts expect
prices to drop further, perhaps as low as
$1—the current price point for rapid malar-
ia tests that use similar technology.
On November 6th, the day after its na-
tional lockdown begins, Britain will begin
trying out “whole city” testing in Liverpool,
where the infection rate is currently partic-
ularly high. A combination of pcrand anti-
gen tests sufficient to test the whole popu-
lation is being laid on, and everyone living
or working in the city will be encouraged to
avail themselves of the opportunity. The
idea is to gain experience of the approach
so that after the lockdown is over it can be
used to avoid the need for a repeat.
Slovakia, where infections took off in
October, is trying something similar to
avoid the need for any lockdown at all. Onthe last weekend of October it undertook a
testing drive meant to cover everyone over
the age of ten. Soldiers and volunteers were
recruited to swab the noses of the 3.6m
people (66% of the population) who turned
up. The exercise will be repeated over the
weekend of November 7th-8th. If the in-
fected self isolate effectively, the procedure
could offer much of the benefit of a lock-
down with a lot less economic cost.
How well the Liverpool and Slovakia ex-
periments work will go some way to show-
ing whether rapid testing can indeed be a
game-changer. To bear out its promise,
though, it will need a context in which iso-
lating after a positive test (some of which
will be false alarms) is tolerable. Adam
Briggs of the Health Foundation, a British
think-tank, notes that growing numbers of
local-authority contact-tracing teams are
now also offering help—be it with shop-
ping, prescriptions or just company—to
encourage those who have tested positive
to isolate. More countries are now offering
some reimbursement for lost wages to
such people.
Another route to easier compliance is
shortening the quarantine period to fewer
than the 14 days recommended by the
World Health Organisation. In the vast ma-
jority of cases the first week or so is the
most infectious period, which is why
France and Sweden have already cut the
period to one week and other countries are
mulling over a reduction to ten days. Rapid
testing to show that the infectious period
has passed would make such approaches
safer.
David Heymann of the London School
of Hygiene and Tropical Medicine believes
that the best approach is to inform people
of the risks and let them decide how to pro-
tect others and themselves, rather than im-
posing blunt lockdowns against which
people are likely to rebel. There is some evi-
dence from Britain that he is right. In Sep-
tember, only 19% of 18- to 24-year-olds sur-
veyed in England claimed that they
adhered to the rules completely; in Octo-
ber, as transmission picked up again, a
third said they were following all the rules.
Many people in Europe are dealing with
the pandemic like one 29-year-old London-
er, who characterises the official restric-
tions on socialising as “suck it up or you’re
killing granny”. He has devised his own set
of rules, avoiding contact with over-40s—
including all of his family—but socialising
relatively freely with friends his age. “I’m
taking these decisions based on caring
about people, not the letter of the rules,” he
says. “I have a flat that is well sound-insu-
lated and you can get people in and out dis-
creetly.” Such an attitude might be fine if all
those entering and leaving discreetly hold
themselves to the same standards. As yet,
though, such consistency had not been a
hallmark of Europe’s response. 7Breakingthegenerationbarrier
Europe*,covid-19casesbyagegroup,’000Sources:WHO;Brazeauetal.(2020);TheEconomist *Estimatebasedoncasebyagewhereavailable †Estimate,includesundiagnosedinfections35Age
groupWeek ending
July August September October
12 19 26 2 9 16 23 30 6 13 20 27 4 11 18 2525 25 26 28 30 31 35 42 47 56 65 78 85 111 161 239 33945 56 7810121416 22 29 31 32 43 65 975444 55 77811 13 16 17 20 30 46 84105 108 115 126 140 150 177 207 230 270 314 383 424 553 770 1,0891,56 712 12 11 12 13 14 16 19 21 26 29 35 38 48 69 102 15346 49 52 57 62 67 80 92 100 116 132 159 171 214 306 454 67111 12 15 16 19 21 25 29 33 39 44 57 72 117 150 170 20422 33 44 556 7 9 11 10 10 11 14 191.040
0.01
0.0 2
0.127
0.660
2.548
10.93Fatality
rate†, %
0-4
5-1 4
15-24
25-49
50-64
65-79
80+To t a lLearning a lesson
% of people saying they wear a face
mask when in public places, 2020Source:YouGov2100806040200
NOSAJJMAMUS BritainSpainGermanyFranceSwedenTaiwan