Because the northern hemisphere strikes into winter, coronavirus charges are rising in elements of Europe and the USA. Consultants are warning of a protracted winter forward as COVID-19 and influenza put the squeeze on hospitals and different healthcare amenities. In response to the menace offered by the second wave, European international locations and lots of US states have instituted inhabitants lockdowns that contain various restrictions on motion, assembly folks, work, education, purchasing, hospitality and leisure.

We’ve got seen from the primary wave that, when instigated at scale, these measures can shrink the epidemic however at an amazing value to society and financial life. When utilized for a very long time resembling in Melbourne, Australia, which locked down for almost 4 months, the variety of instances might be diminished to shut to zero with rigorous sporting of masks, night-time curfews, closed colleges, strict journey restrictions and heavy policing.

However is there one other means? Ten months into the pandemic, what have we realized and what different measures do now we have in our collective toolkit?

Mass testing

China, having managed the primary wave of the epidemic and with fewer than 100 reported instances per day, now use a mass testing technique at any time when a brand new cluster seems. This was efficiently carried out in Wuhan (a metropolis of 11 million) in Might, and the cities of Qingdao and Kashgar in October.

This has been carried out effectively utilizing PCR (polymerase chain response) testing of batches of 5 to 10 samples at a time, then going again to check particular person samples if a batch checks optimistic. The rationale for this method is to search out individuals who didn’t know they had been contaminated to allow them to be suggested to isolate and due to this fact cut back transmission.

Chinese language authorities have additionally acted with pace to guard a inhabitants that remembers the SARS outbreak and therefore takes management of an epidemic significantly, exhibiting excessive ranges of compliance with public well being measures. Persons are prepared to put on masks and settle for different interventions are a part of a dedication to the higher good on the expense of particular person freedoms. That is accompanied by strict enforcement from the federal government which has at instances deployed drones utilizing loudspeakers to rebuke residents who usually are not following the foundations.

In Europe, Slovakia instituted mass testing of their total inhabitants of four million over two weekends throughout October and November. About 95% of the focused inhabitants has now been reached and examined, with 38,000 optimistic instances being requested to go house and self-isolate. This represents a 1% positivity fee. That is an anticipated fee for a European nation’s inhabitants at current. Slovakia additionally used fast antigen testing, which regardless of having a variable false optimistic fee, may give outcomes inside 30 minutes, is cheaper than PCR, and might be carried out with out the necessity for a specialised laboratory.

The World Well being Group has supported the event and facilitated entry to reasonably priced fast checks, at lower than US$5 per check, notably for low and middle-income international locations.

Speedy checks have been trialled in different a part of Europe, for instance in Liverpool within the UK. In instances the place there’s a devoted check web site and skilled personnel, these checks returned optimistic outcomes for 99.6% of true infections, and returned detrimental outcomes for 76.8% of people that didn’t have COVID-19.

The implications of this are that if there’s a basic positivity fee of two.2% within the native inhabitants, as instructed by the newest surveys, for each 1,000 folks examined, 17 can be recognized appropriately as contaminated and suggested to self-isolate, 5 uninfected folks can be incorrectly recognized as contaminated and unnecessarily suggested to self-isolate and three who’re contaminated can be incorrectly recognized as uninfected. Since these three folks will in all probability have low viral hundreds, they will not be very infectious.

The upshot is that if folks take up testing and comply with the recommendation (which isn’t assured) this method has the potential to scale back transmission and therefore new infections by no less than 50% within the brief time period.

Efficient contract tracing

Vietnam has used aggressive contact tracing because the begin of its epidemic, and there are presently lower than 100 reported instances per day within the nation, and no latest deaths. Anybody who’s contaminated is hospitalised, which helps to implement isolation, whereas contacts are remoted at house with the instant neighbourhood positioned beneath a neighborhood lockdown. There was clear communication and the difficulty is seen as non-political and a matter of public well being.

South Korea, in the meantime, has used retrospective contact tracing to research outbreaks and perceive the place transmission is happening. In consequence many bars, night time golf equipment, karaoke bars and locations of worship have been closed.

Taiwan, the place there have been no reported deaths since Might, has in all probability the simplest testing and tracing programme. Circumstances are adopted up twice day by day by phone, textual content messages or house visits to bolster the self-isolation message, and to supply assist, which might embrace meal and grocery supply. Contact tracing is extremely efficient, figuring out on common 20-30 contacts per case.

Crucially, contact tracing solely works if it’s carried out correctly. The World Well being Group stresses the significance of not simply figuring out instances, however following them up and giving assist. They estimate that on common every case wants three days of labor from the testing and tracing group. Clearly, this could solely be possible if the variety of day by day instances is introduced right down to manageable numbers, which isn’t the case in lots of European international locations, nor in elements of the US.

Sadly, with case numbers as excessive as they’re in these locations, the most effective method for western international locations getting by way of the winter appears to be to proceed to make use of nationwide or native lockdowns. However these needs to be mixed with new instruments, together with mass testing, to convey down the variety of new infections in order that efficient case detection and call tracing with native follow-up and assist can management persevering with chains of transmission.

In fact, the success of all these measures will rely upon understanding, belief and participation from all inhabitants teams.

Jimmy Whitworth receives funding from Wellcome Belief, Medical Analysis Council and Nationwide Institute for Medical Analysis.