Zero-COVID
Zero-COVID, also known as COVID-Zero and "Find, Test, Trace, Isolate, and Support" (FTTIS), was a public health policy implemented by some countries, especially China, during the COVID-19 pandemic.[1][a] In contrast to the "living with COVID-19" strategy, the zero-COVID strategy was purportedly one "of control and maximum suppression".[1] Public health measures used to implement the strategy included as contact tracing, mass testing, border quarantine, lockdowns, and mitigation software in order to stop community transmission of COVID-19 as soon as it was detected. The goal of the strategy was to get the area back to zero new infections and resume normal economic and social activities.[1][4]
"Zero-COVID policy" redirects here. For the policy in China, see Chinese government response to COVID-19 § Zero-COVID policy.
A zero-COVID strategy consisted of two phases: an initial suppression phase in which the virus is eliminated locally using aggressive public health measures, and a sustained containment phase, in which normal economic and social activities resume and public health measures are used to contain new outbreaks before they spread widely.[4] This strategy was utilized to varying degrees by Australia, Bhutan,[5][6] Atlantic and Northern Canada,[7] mainland China, Hong Kong,[8] Macau,[9] Malaysia,[10] Montserrat, New Zealand, North Korea, Northern Ireland, Singapore, Scotland,[11] South Korea,[12] Taiwan,[13] East Timor, Thailand, Tonga,[14] and Vietnam.[15][16] By late 2021, due to challenges with the increased transmissibility of the Delta and Omicron variants, and also the arrival of COVID-19 vaccines, many countries had phased out zero-COVID, with mainland China being the last major country to do so in December 2022.[17]
Experts have differentiated between zero-COVID, which was an elimination strategy, and mitigation strategies that attempted to lessen the effects of the virus on society, but which still tolerated some level of transmission within the community.[18][4] These initial strategies could be pursued sequentially or simultaneously during the acquired immunity phase through natural and vaccine-induced immunity.[19]
Advocates of zero-COVID pointed to the far lower death rates and higher economic growth in countries that pursued elimination during the first year of the pandemic (i.e., prior to widespread vaccination) compared with countries that pursued mitigation,[18] and argued that swift, strict measures to eliminate the virus allowed a faster return to normal life.[18] Opponents of zero-COVID argued that, similar to the challenges faced with the flu or the common cold, achieving the complete elimination of a respiratory virus like SARS-CoV-2 may not have been a realistic goal.[20] To achieve zero-COVID in an area with high infection rates, one review estimated that it would take three months of strict lockdown.[21]
Reception[edit]
Support[edit]
Proponents of the zero-COVID strategy argued that successful execution reduced the number of nationwide lockdowns needed,[222] since the main goal was focused on the elimination of the virus. When the virus was eliminated, people would be at ease given that COVID-19 caused a lot of health impacts. As such, healthcare and economic costs were lower under a zero-COVID strategy because the elimination of the virus allowed new outbreaks to be easily monitored and curtailed, and that there was less economic disruption since only certain areas were affected, which could be easily monitored.[223][224] This resulted in a situation that was less costly to society,[225] that it reduced dependence on pharmaceutical interventions such as vaccines,[226] and that it increased quality of life and life expectancy as there would have been fewer citizens contracting COVID-19.[227]
Opposition[edit]
The zero-COVID strategy, unlike other strategies such as mitigation or living with COVID-19, aimed to eliminate the virus altogether. While mitigation and living with COVID-19 aimed to tolerate outbreaks of COVID-19, to the extent of ignoring outbreaks altogether, the zero-COVID strategy required quick, efficient, and immediate containment of the virus in order for the policy to work. This meant that governments that decided to use this strategy would need to utilize all means possible, from closing schools and shops, to implementing strict lockdowns or even culling animals deemed to carry the virus, in order to get the cases down to zero. Such measures had resulted in negative connotations which can affect lives, livelihoods, and mental health as seen in the following examples.
Chinese virologist Guan Yi had criticized the Chinese government's zero-COVID measures, telling Phoenix Hong Kong Channel that, if the government persisted with the policy for a handful of cases, the economy would have suffered. The implementation of the zero-COVID policy in China resulted in multiple business closures, citywide lockdowns, and stay-at-home notices in order to prevent the spread of COVID-19. This resulted in loss of revenue and production, leading to an economic contraction in the country. Guan had advocated for increased vaccination and research into the efficacy of homegrown vaccines against new variants, as the vaccines would prevent death and reduce the impact of COVID-19, which could enable people to swiftly recover without interruption from COVID-19.[228]
Other opponents of the zero-COVID strategy argued that the strategy caused the economy to suffer,[229] that before vaccinations were common, elimination strategies lowered herd immunity,[230] that zero-COVID is not sustainable,[231] and that newer variants such as the Omicron variant were so transmissible that the zero-COVID strategy was no longer feasible.[232]
In May 2022, World Health Organization director-general Tedros Adhanom Ghebreyesus commented that the zero-COVID strategy was no longer considered sustainable based on "the behavior of the virus now" and future trends. The comment was suppressed on the Chinese Internet.[233] The Lancet, mostly supportive of a zero-COVID strategy before the appearance of less severe but more transmissible variants, also published a news article detailing the problems in China's implementation.[234]
All countries which pursued zero-COVID, such as Vietnam, Singapore, and Australia, later decided to discontinue it, citing increased vaccination rates and more transmissible variants.[230] Singapore abandoned zero-COVID in August 2021 after the Delta variant started spreading there, Australia and Vietnam reopened their borders in early 2022, and China—the last major country to hold out on zero-COVID—abandoned its policy on December 7, 2022.