A smattering of places, mainly across the Asia-Pacific region, have seen breathtaking victories in the battle against COVID-19 by effectively wiping it out within their borders. Now they face a fresh test: rejoining the rest of the world, which is still awash in the pathogen.
In some ways, the success of “COVID zero” locations is becoming a straitjacket. As cities like New York and London return to in-person dealmaking and business as usual — tolerating hundreds of daily cases as vaccination gathers pace — financial hubs such as Singapore and Hong Kong risk being left behind as they maintain stringent border curbs and try to stamp out single-digit flare-ups.
After a brutal 18 months that claimed 3.3 million lives worldwide, nations such as Taiwan, China, Singapore, Australia and New Zealand have suffered fewer deaths during the entire pandemic than many countries, even highly vaccinated ones, continue to log in a matter of days.
That achievement has allowed people to experience largely normal lives for much of the past year. Some have not even had to wear masks. However, sustaining this vaunted status has also required stop-start lockdown cycles, near-blanket bans on international travel and strict quarantine policies. The few travelers permitted to enter have had to spend weeks in total confinement, unable to leave a hotel room.
Now that mass inoculation drives are allowing other parts of the world to normalize and open up to international travel, experts and residents are starting to question whether walling off from the virus is worth the trade-off, if implemented for the long term.
“The whole world is not going to be COVID zero,” said Rupali Limaye, director of behavioral and implementation science at the International Vaccine Access Center at Johns Hopkins School of Public Health. “That’s not an option here.”
Aggressive reactions to tiny caseloads might seem overblown to observers in countries facing thousands of infections a day, but the aim is to snuff out the coronavirus before more disruptive restrictions like months-long lockdowns are needed — and largely the strategy has worked. Still, the slower pace of vaccination in these places, and the threat of new variants, has meant that measures have become increasingly onerous.
The most recent figures show that New York logs 95 new daily cases per 1 million people, and the US has just lifted its mask mandate for those who are vaccinated. Singapore found just 4.2 new cases per million on Thursday last week, boosting locally acquired cases to the highest level since July last year, and is returning to restrictions it last imposed a year ago, banning indoor dining and limiting gatherings to two people. The resurgence is also putting its highly anticipated travel bubble with Hong Kong in doubt.
When Taiwan recorded just 16 local cases on Wednesday last week, that daily record high prompted restricted access to gyms and other public venues. In Hong Kong, anyone living in the same building as a person infected with a new COVID-19 variant was required to spend as much as three weeks in government isolation until the policy changed last week. Australia has said that it would not likely open its international borders until the second half of next year.
“Because we have been so successful, we are even more risk-averse than we were before,” said Peter Collignon, a professor of infectious diseases at the Australian National University Medical School in Canberra.
“We are very intolerant of letting any COVID come into the country,” he said. “The fear has almost gotten out of proportion to what the risk is.”
PAYING THE PRICE
Continued isolation is the price these places are to pay for maintaining this approach in the long term, as other parts of the world learn to tolerate some infections as long as medical systems are not overwhelmed.
Most experts agree that the virus is unlikely to disappear completely. Instead, it is expected to become endemic, meaning that it circulates at some level without sparking deadly outbreaks that are unusually high.
To maintain near-zero infection rates, these economies should implement measures that are harsher and stricter, said Donald Low (劉浩典), professor at the Institute of Public Policy of the Hong Kong University of Science and Technology.
“This is neither wise nor tenable for much longer,” he said. “All this puts the places that have done well to suppress COVID-19 so far at a serious disadvantage as their societies, not having been exposed to the possibility of COVID-19 becoming endemic, are not willing to accept any relaxation of measures that may put their health at risk.”
Meanwhile, many countries, particularly those in the West that are awash in vaccines, are starting to reopen.
Travelers from England and Scotland are to be permitted to visit a dozen countries without quarantining, starting today. In the US, where about 35,000 people were diagnosed with the virus on Wednesday last week, the strict quarantine rules that prevented the import of the pathogen never existed. Most states are starting to lift their pandemic restrictions and 25 have removed them completely.
For Hong Kong and Singapore, the drawbacks of maintaining an elimination strategy as financial centers such as London and New York City reopen could be significant. As aviation hubs and financial centers, the cities’ economies are particularly reliant on travel, compared with export-led economies such as China and Australia, which can stomach being shut for longer.
In 2019, Hong Kong was the world’s most popular urban travel destination for international visitors, even after months of political unrest, while Singapore came in fourth place. London was No. 5 and New York No. 11.
A major obstacle to reopening is the slow vaccine rollout in these “COVID zero” havens, due to a combination of supply limitations and citizens’ lack of urgency about scheduling shots.
China has administered enough vaccinations for about 12 percent of its population. In Australia, the figure is 5 percent and just 3 percent in New Zealand. Meanwhile, more than one-third of the US and one-quarter of the UK are fully protected, as those countries’ failures to mitigate the spread of the virus meant vaccination was prioritized.
In places with very few infections, the public has not developed the searing fear of the virus that emerged in the US, Europe, India and Brazil, where many families were cut off from dying loved ones or left unable to visit elderly relatives in care facilities.
That many people fear the vaccine more than the virus is another obstacle. Reports of routine side effects, including fever and injection-site pain, as well as rare and potentially deadly complications such as blood clots, have made many feel hesitant. The lack of an immediate threat from COVID-19 means some would rather wait until vaccine development has progressed.
Not everyone agrees that elimination cannot be pursued in the long term. For Michael Baker, professor of public health at the University of Otago in Wellington, New Zealand, the approach’s benefits are evident in how deaths in the country, from any cause, dropped last year.
“The evidence is overwhelming for zero COVID, if you can achieve it,” he said. “If there had been the commitment to having elimination as the first option, we may have been able to eliminate it entirely and avoided this global disaster.”
Baker is still hopeful that the strategy can be more broadly adopted with the help of vaccination, so that coronavirus follows the measles model rather than an endemic one.
“With the measles approach, you largely stop outbreaks in every country that has high coverage,” he said.
Nonetheless, the “COVID havens” face a growing dilemma. If vaccinations do not pick up pace, they risk being stuck in a perpetual cycle, unable to move past the pandemic.
“If their vaccination rates are low, that further jeopardizes their ability to open up,” Low said. “If so, the earlier ‘victory’ of these places over COVID-19 would have been a Pyrrhic one.”
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