Last weekend’s rapid government U-turn over travel to Spain has left both tourists and holiday companies reeling. Who can be sure of flying to any country if a quarantine can be imposed at such short notice? Arguments are now raging over whether the government acted too impulsively and failed to consider the consequences. Yet, for the most part, these all miss an essential point: that encouraging travel abroad in the middle of a pandemic makes no epidemiological sense.
With every arriving overseas visitor or returning holidaymaker, the risk of bringing Covid-19 into the country increases. The government has so far justified allowing this travel because it believes community transmission of the virus in the UK is inevitable until a vaccine arrives. It is not.
Great Britain and the island of Ireland are just that – islands. Other islands, such as New Zealand and Taiwan, have shown that the Covid-19 virus can be eliminated like the first Sars virus. In these countries, life is going on largely as usual with families gathering, full stands at sporting events, and internal economies almost back to normal. Shakespeare called England: “This fortress built by nature for herself against infection.” And now the Independent Sage committee (which shadows Britain’s official science advisory group) and other experts have called for a goal of zero coronavirus – elimination of the virus – rather than settling for suppression.
Of course, both New Zealand and Taiwan avoided substantial “first waves” – making their tasks much easier. Both also scaled up their public health workforces to aggressively test, trace and isolate cases and their contacts. But both, even now, have mandatory 14-day hotel quarantine for incoming travellers.
Yes, international tourism has dried up, but it has been replaced by domestic tourism. And despite this, these countries are hardly isolated – the proportion of Taiwan’s GDP accounted for by external trade is double that of the UK and continues largely uninterrupted. Can we replicate these successes in the UK and Ireland?
Ireland and Scotland had large epidemics, with the death rate per million in Ireland being fractionally higher at its peak in late April than that of the UK. But both Ireland and Scotland have brought their infection and death rates down dramatically. Last week the Republic of Ireland reported 11 Covid-19 deaths, and Northern Ireland and Scotland reported none. England and Wales’ combined populations are five times higher than the other three countries’ total, yet the number of deaths in that week was many times greater. Ireland and Scotland demonstrate that the virus can be almost fully suppressed even after a strong first wave. Can we reach beyond that to elimination?
There is a technocratic objection to the word “elimination”. In infectious disease circles it usually refers to absence of community transmission in a country or region, for some substantial period (for measles, it is 12 months). Because outbreaks may still occur, many specialists prefer the concepts of infection “control” or “suppression”.
In the context of the Covid-19 pandemic, however, it seems reasonable to define elimination as a preliminary, though not necessarily durable, absence of community transmission. New Zealand has had no community-transmitted cases for nearly three months (all new cases have been in quarantined arrivals from overseas). In the context of a worldwide pandemic, as Australia has found, reintroduction of the virus from abroad is an ever-present threat.
First minister Nicola Sturgeon has claimed that Scotland is “not far away” from eliminating coronavirus, and a committee of Irish scientists has called on their government to adopt a policy of virus elimination. Such a goal has three major advantages over suppression: absence of transmission means no Covid-19 illnesses and deaths; life and the economy can go back to a (guarded) level of normality; and it makes a second wave in the winter much less likely.
But is elimination achievable? We think it is – though it would require major changes to the British government’s current thinking.
A bold elimination goal would require further strengthening of the test, track and isolate system with clear, transparent and spin-free reporting of its successes and failures. The release of data to local public health authorities is a welcome first step. It would entail income support for people who are asked to self-isolate, and consideration of supervised hotel accommodation for those who represent a risk to their families.
It would also require abandoning the troubled air-bridge system – the deficiencies of which are becoming increasingly clear. So, for British people planning their summer holidays, it would mean replacing trips abroad with UK travel. Of course, international airlines will need subsidies to avoid bankruptcy; it would also mean that lorries arriving in the UK would be driven to their destinations by British drivers.
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All this is a big ask.
But the prize is huge. It would mean a relatively normal internal economy, with domestic tourists replacing international ones. The prize is getting children back to school; releasing our aged population from home isolation or confinement in care homes; protecting our black and minority-ethnic communities; revitalising the arts and sport. And a reduction in the probability of a second wave in the winter, crippling the NHS and requiring a second national lockdown.
We all hope one or more vaccines will work and be relatively free of side-effects, but experience shows we cannot assume such a vaccine will be widely available any time soon.
Compared to the costs, the benefits are huge. This prize is within our grasp. It’s up to our politicians to change course and seize it.
• David Hunter is the Richard Doll professor of epidemiology and medicine at the University of Oxford; Neil Pearce is professor of epidemiology and biostatistics at the London School of Hygiene and Tropical Medicine