Delta destroyed the defenses of Australia and China. Does it signal the end of the zero Covid strategy?

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For some, it is difficult to understand why Asia Pacific is being hit so hard. Many Asia-Pacific countries have turned into hermit nations, closing borders to almost all foreigners, imposing strict quarantines on arrivals, and introducing aggressive testing and tracing policies to detect any cases that escape their control. defenses. They were living with these strict border rules so that cases could be reduced to zero – and keep people safe.

And it worked – until the highly contagious Delta variant took hold.

Now, the new outbreaks are calling into question the zero Covid strategy favored by China and Australia, and sparking a wider debate on the sustainability of the approach.

In Australia’s Covid hotspot, New South Wales – the state that is home to Sydney – authorities said they were reaching a 50% vaccination rate might be enough to start easing the state’s strict lockdown, a change from the country’s previous attempts to reduce cases to zero.

In China, where a handful of cases can trigger mass testing, a growing number of public health experts are now favoring a mitigation approach over zero tolerance, according to Huang Yanzhong, senior global health researcher at the Council on Foreign Relationships. .

Dropping the zero Covid approach is what other fortified territories like New Zealand and Hong Kong will likely have to do, experts say, they cannot stay cut off from the world forever. Hong Kong has confirmed around 12,000 cases since the start of the pandemic, while New Zealand has confirmed just over 2,880 cases – and none currently have local confirmed cases, according to their respective authorities.

“The zero Covid strategy has clearly been successful in some parts of the world over the past 18 months. I don’t think anyone wants this to be the future,” said Karen A. Grépin, associate professor at the University of Hong Kong . School of Public Health. “The choice is now: when do you want to start letting people die? It will not be a perfect transition, there will be parts of the population that will understand this and die. “

Are China and Australia Taking the Right Approach?

As Covid-19 was rampant in Europe and the United States, countries like China and Australia took an elimination approach – they wanted zero local cases of Covid-19.
There were costs involved. Tourism dependent countries like New Zealand and the Pacific Islands, for example, have seen their travel industry hit hard. Thousands of Australians were unable to return due to the limited number of flights and quarantine spaces – and Australians could not go abroad without an exit visa.
But there was also a huge advantage. China and Australia have never seen the same catastrophic epidemics that have hit the United States and the United Kingdom. And until a few weeks ago, life was largely back to normal, with people coming together for music festivals and sporting events.

“Asia-Pacific countries, as a whole, have had an incredibly successful year and a half responding to Covid,” said Grépin. “It would be very difficult to say that the strategies adopted in this region were not the right ones.

Singer Tina Arena after the first concert of her enchanted national tour on May 2, 2021, in Brisbane, Australia.
Dale Fisher, professor of infectious diseases at Singapore’s National University Hospital, said Australia and China’s strategies focus on tight border closures – and swift follow-up of any leaked cases. with mass testing. But these approaches have been harshly contested by Delta, which is estimated to be as transmissible as chickenpox, and is between 60% and 200% more contagious than the original strain first identified in Wuhan.

“I think (China and Australia) overestimated the integrity of their borders,” Fisher said. “It might not have been that big of a deal with the Wuhan version. But then you get something much more communicable, and then any violation is exposed.”

Once Delta arrived in Australia, it exposed a major flaw in the country’s strategy – a slow rollout of the vaccine. When other countries frantically rolled out vaccines earlier this year, the Australian leader appeared in no rush.

“We (…) are at the forefront of the deployment of the vaccine in many other countries where they have had to (deploy them) due to their urgent crisis situation,” Australian Prime Minister Scott Morrison said in March. “And the lessons that have been learned have been taken into account.”
As of Sunday, only 17% of Australia’s population of 25 million had been fully vaccinated – well below the UK’s 58% or 50% in the US – meaning there is little immunity in community to stop the spread of Delta.

“(This) was a huge mistake,” said Alexandra Martiniuk, professor at the University of Sydney’s School of Public Health. “So we’re stuck in this position (in Australia) where there are very few people vaccinated and a very dangerous variant.”

Can a zero Covid approach work?

Chinese authorities have cracked down on domestic transportation and rolled out mass testing after more than 300 cases were detected in more than two dozen cities across the country. These are familiar strategies in China – and they will likely work again, said Ben Cowling, professor of infectious disease epidemiology at the University of Hong Kong.

“For this outbreak, I think they will be at zero pretty soon, but this illustrates the risks of Covid still in a zero Covid strategy,” Cowling said. “This will not be the last outbreak – there will be more outbreaks in the months to come.”

For months, the zero Covid strategy has worked well. While other countries have struggled with overburdened health systems and high death tolls, China and Australia have reported just 4,848 and 939 deaths respectively. This allowed them to resume normal life within their borders, and their economies were less affected.

Longer term, however, many experts believe that a zero Covid strategy is not sustainable. Eventually, all countries will want to open up to the world again – and when they do, they may have to accept that some people would likely get sick, a difficult change in Asia-Pacific countries used to preventing the virus completely. to enter.

“Unless you’re prepared to cut yourself off from society forever, you’re going to have Covid in your country. So it’s a matter of when you let it in and when you live with it,” Fisher said.

This change could be politically difficult.

In China, for example, officials and state media have hailed the country’s strategy and its success as a sign of Chinese superiority, said Huang of the Council on Foreign Relations. The government will have to justify its decision if it moves from a zero Covid approach to a mitigation approach, he said.

“This containment-based approach is still popular among the Chinese people, in a way that reflects (of) how it has been so internalized among the Chinese people. They accepted it as the only effective approach to cope. pandemic, ”he said. noted. “So we’re not just talking about changing the incentive structure of government officials, but also about changing the mindset of people, preparing them for a new strategy.”

Police, security guards and volunteers help enforce a cordon around a neighborhood placed under lockdown after a resident tested positive for Covid-19, in Shanghai, China on August 3, 2021.

But abandoning the zero Covid strategy is not something Australia and China should necessarily be thinking about at this time, Grépin said.

When more than 80% of people are vaccinated, countries can relax borders, Fisher said.

China is relying on local vaccines, including Sinovac, which was around 50% effective against symptomatic Covid-19, and 100% effective against serious illness, according to test data submitted to the WHO, and Sinopharm, which has an estimated efficacy for both symptoms and hospitalized illness of 79%, according to the WHO. This is lower than the Pfizer / BioNTech and Moderna vaccines, which are over 90% effective against symptomatic Covid-19.

In China, they may need to add additional injections to boost immunity, Grépin said.

Opening the borders too soon could mean “the death they fought so hard to avoid,” she added.

It is not finished

The collective experience of China and Australia also highlights the risk that other countries with tight border restrictions may not be able to prevent Delta – or some other variant – forever.

Fisher said delta epidemics would likely occur in other countries that had not yet experienced it, such as New Zealand.

An abandoned baggage cart in front of the Jetstar terminal at the Auckland Airport Domestic Terminal on October 7, 2020, two days before the restrictions for the Auckland region that were put in place following the re-emergence of Covid- 19 in the community.
Like Australia, New Zealand and Hong Kong have relatively low vaccination rates with 16% and 39% respectively fully vaccinated as of Sunday. If Delta enters, they are also vulnerable to epidemics.

“There should be the same urgency to vaccinate when you don’t have Covid because it’s only a matter of time, and we know the social and economic impact when you have to lock in and test en masse in response.” , said Fisher.

He recommended maintaining certain restrictions – such as wearing masks indoors – even when a country has sealed off borders and no local cases have been reported.

“Every country should pretend that there are cases at its borders, and at least have a mask inside, limit gatherings,” he said. “Of course it bothers people, but I can tell you when you have a business suddenly life is much easier.”

Countries should continue to learn from other countries on how to deal with the pandemic, Fisher added.

“If anyone thinks it’s over, they’re wrong,” Fisher said. “Everyone has to face it and live with it someday – and it is not over yet for any country.”

CNN’s Jadyn Shum, Kristie Lu Stout and Nectar Gan contributed to this reporting.

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