Update, February 16, 2021
The February 13 Economist’s headline article brings it to the point: even in countries like China and New Zealand a no-/zero-covid strategy will not be sustainable in the long-run. As the author of the article puts it, “the best outcome would be for a combination of acquired immunity, regular booster jabs of tweaked vaccines and a menu of therapies”. I personally have stronger doubts on the effectiveness of the novel vaccines largely because we do not have enough data from randomized controlled trials, which would oversample the old and frail (see my blog “Vaccination Tales”), and I therefore also interpret the incoming data from Israel with greater care than most commentators do, but I may be wrong. Even if I am, then in light of the desire of citizens to return to a “normal” or more normal life and in light of mutations of the virus it seems indispensable for policy makers to shift attention more strongly to supporting research on treatments.
Blog, revised on February 12, 2021
In my view, pursuing the strategies of zero-covid and no-covid would not appropriately strike the balance between the costs and benefits of fighting the corona pandemic involved. I rather think that a strategy of taming the pandemic should be pursued. We have better measures to contain the virus and extended lockdowns to achieve zero or minimal infections are too costly. Lockdowns should only be used to buy time.
Neither from an epidemiological perspective nor from an economic and social perspective do I find the ideas of zero-covid or no-covid particularly convincing. In light of the interconnectedness of the European continent, I find it extremely difficult to envision a situation in which such a strategy would work. As the no-covid group argues in a critical reflection, they admit that they might be wrong with respect to their goal of 10 incidences per a population of 100000 may not be reached. I think they are right in admitting so. This is an illusion, or, reaching it through the suggested concept of green zones would be both socially and economically too costly.
The economics of the concept zero-covid are very weak. The authors write that the costs can be financed by taxes on wealth and high marginal taxes on the rich. Even if that could be implemented ex-post ‑ which I find very hard to imagine for a variety of reasons ‑, it will imply big economic and social losses until implementation. As I have argued with my co-authors in previous work and in a blog of myself, the economic and social costs of lockdowns are huge. What proponents often forget is the persistence of these costs. With my co-authors, I have addressed one type of persistent costs, the costs of school closures, but there are many more caused by human capital depreciation, long-term unemployment and the disruption of supply chains, just to name a few. In addition, come the social costs, which are hard to quantify but immense. With my co-authors, I have also documented in another study that lockdowns save lives, at least in a given wave. That does, unfortunately, not imply that they should be used. It does also not imply that alternative measures do not also save lives. The movement no-covid cites numerous economic articles that apparently show that cities that reacted to the Spanish flu with sharp measures had to bear higher costs in the lockdown but were more successful in the longer run. At the same time, the authors write that they have to admit that one cannot compare one epidemic to another. I think this is exactly the bottleneck, and I want to add that it is also extremely difficult to draw causal inference of measures during a pandemic, as I have shown in the afore cited paper with my co-authors.
At the other extreme to the zero Covid movement, is the Great Barrington Declaration. While I do not agree with every word of it, the declaration rightly emphasizes the enormous social and economic costs of lockdowns, and it lays out an intermediate path to achieve herd immunity. In fact, in my view, herd immunity should not be the objective at all. We have to tame the pandemic, which means that looking at incidence is the entirely wrong measuring rod, because it depends on testing intensity and does not distinguish between symptomatic and asymptomatic cases. We instead need to exclusively look at UCI capacities and measures related to mortality and health, and we have to invest into improving treatment. Furthermore, the declaration builds on two key economic principles: the efficient use of scarce resources and the decreasing marginal benefit of each additional measure to contain the spread of the virus.
In my view, governments around the world, and the German government in particular, have failed because they have not efficiently used scarce resources to protect the elderly and vulnerable. Rapid tests are insufficiently used and governments focused too much on vaccination – and it is unclear if this is the resort, see my blog “Vaccine Tales” ‑ rather than spending resources on improving treatment. Rapid tests may not be as reliable as PCR tests, but are cheaper and can be more easily and repeatedly applied. On the other hand, it is important to note that PCR testing results must also be interpreted with care. A publicly available referee report on the PCR test concludes as follows: “the RTPCR test to detect SARS-CoV-2 reveals 10 major scientific flaws at the molecular and methodological level: consequences for false positive results.” Thus, the respective refereed publication on the effectiveness of the PCR test is faulty. The very read worthy resignation letter of Thomas Aigner from the Academy of Science and Literature in Mainz expresses these concerns and leads him to cast strong doubts on the lockdown and vaccination programs. That PCR testing may lead to false positive findings is also the content of this WHO notice also stating that: “Most PCR assays are indicated as an aid for diagnosis, therefore, health care providers must consider any result in combination with timing of sampling, specimen type, assay specifics, clinical observations, patient history, confirmed status of any contacts, and epidemiological information.” Returning to rapid tests: now, since January 24 – which, in my view, is very late ‑ Jens Spahn, the German health minister, finally wants them to be used at home! I never understood why they have not been used more earlier on, in nursing homes, in hospitals, in schools, in firms, etc. During the first wave in Spring, a lockdown might have been a sensible strategy in light of all the uncertainty, but only to buy time. Since then, governments could have prepared, but they failed, because of an inefficient hyperactivity taking measures in all sorts of directions not understanding these two key principles: efficient use of scarce resources and decreasing marginal benefits.
Null-Covid – KeinCovid: Ein kritischer Kommentar
Deutsche Übersetzung folgt