Understanding #ZeroCovid

So we need a useful framework to be able to talk about #ZeroCovid versus #flattenthecurve, because apart from straight BS, there is also a lot of confusion and plain chaos in this debate.

In comparing #ZeroCovid to #flattenthecurve, this text does not aim to be “neutral”, as if we were talking about two equally viable and valuable strategies. I merely cut out a lot of comments about #flattenthecurve to make this more readable for adherents of that strategy.

To be clear, we should be doing #ZeroCovid right now, and every shortcut to an actual implementation by governments must have priority. People are dying as we speak. Writing this for a better understanding of #ZeroCovid-strategy is not plan A or plan B or plan C. It’s more like plan X or plan Y or plan Z, and it is very bad indeed that we are on plan X.

Strategy and Tactics.

There are many definitions of strategy and tactics, and I am going to add one. We need a common ground and this is my suggestion:

Tactics come from factual knowledge.
Examples: We know that traces of SARS-CoV2 show up in stool, so we develop sewage testing from that. That’s a tactic. We know that SARS-CoV2 is often transmitted via aerosoles, so we have tactics to stop this kind of transmission: Masks, fresh air, ventilation systems. And so on. These are tactics. They are worked up from factual knowledge. Which tactics are used, at what time, how long and how thoroughly, depends (ideally) on your strategy. So if we keep calling tactics strategies, actual strategies are crowded out of our discourse and even out of our thinking.

#ZeroCovid and #flattenthecurve are not tactics but strategies.

Strategies come from a bird’s viewpoint. Strategic thinking is a skillset, and it has nothing to do with facts: If you can do it, you can apply it in any situation and circumstance. From a strategic viewpoint, you want to see the whole thing: The place where you are, the place where you want to be (your goal), and the steps inbetween (that’s where tactics come in). You want to see different paths from where you are to where you want to be, you want to see which paths lead elsewhere and which ones have a dead end. You also want to see the whole landscape and all the other actors and what they are doing, whether they play on your team or not. And you want to see beyond the place where you are going: What will come out of it all after you achieved your goal?

Then you can pimp your strategic thinking with a lot of other skills: backward planning and bottleneck mangement for example are not really very complex, but useful. Then there’s frameworks like game theory and other stuff. For an individual strategy (not to be confused with an individual tactic) obviously you have to get the facts right. Otherwise you cannot see where you are or where you go, bird’s eye or no. But facts are not the fabric of a strategy. A strategy is a complex dance of facts and counterfactuals, and yet it is completely different from fiction.

So if you think that this is all a load of esoteric rubbish, you are part of an overwhelming majority. Most people just don’t want to bend their minds in this way, and that’s okay. We still have to make a difference between strategy and tactics or we won’t understand ->

the key differences between #ZeroCovid and #flattentecurve.

Both strategies can be summarized as “somehow dealing with this pandemic”. Both strategies can use all the known tactics against the pandemic (excepting hygiene theater). The key differences between the different strategies are not in the tactics that are implemented whithin each strategy.

The setting in which these strategies occur is defined by the qualities of the coronavirus, which are consistent around the world (including mutations: the qualities of the mutant strains are also consistent with themselves). There are claims that geography and government system play a role for the choice of strategy, but these claims don’t pass even the most superficial smell test, so we are going to ignore them.

So first of all we would normally look at the goals. We could deal with the subject of goals either in a normative or an idealized way. But if we try to describe which goals governments actually try to achieve with their pandemic-related strategies, we hit a wall. Because (arguably) these strategies (except #ZeroCovid) are not likely to achieve any goal that a government can rationally and legitimately strive for. “Rationally” is used here in the very limited sense that the means are actually apt to achieve the goal. “Legitimately” refers to the fact that governments cannot legitimately make it their goal to have their populations or certain parts of their populations be infected with SARS-CoV-2. (In this paragraph I’m merely stating my own reasons for ignoring the subject of goals. If you don’t agree, it will not stop you at all from understanding the rest.)

It is vital to speculate about what drives governments to adhere to strategies like #flattenthecurve or worse, as a tool to understand their motives, so we can do something about it. Only we’re not doing it here.

So instead of comparing the goals of #ZeroCovid and #flattenthecurve, we will first compare the measures of their success.

The #ZeroCovid-strategy aims at eliminating the virus on a national level, to eradicate it on the global level, or to keep infections down, ideally to zero, on any level below national. So the measure of success is zero cases, not at a single point in time but continually.

The #flattenthecurve-strategy aims to keep infections below a certain threshold. This threshold may be defined by hospital capacity or ICU capacity or contact tracing capacity or it may be defined by political considerations or totally arbitrarily.

The “acceptable” level of infections may also be influenced by a couple of myths. One of them is the myth that economic concerns and / or concerns for freedom and democracy have to be balanced AGAINST health concerns. Another one is the myth that the severity of measures is reverse proportional to the amount of infections.

So the measure of success is a threshhold that can be expressed in different ways, for example x % test positivity rate or x cases per week per 100.000 people. So the respective threshold is also the measure of success of the individual #flattenthecurve strategy.

Another point of comparison is the ultimate outcome: How will it all end?

The #ZeroCovid-strategy aims at global eradication, that means in this case that the virus will most probably live on in some animal species but not in humans. If a pathogen lives on in animals, that requires constant surveillance, but not constant pandemic. Examples for that are MERS and Ebola and the actual plague (as in black death).

That cannot be done by a vaccine alone. There have to be NPIs to accompany them. On the other hand, with SARS-CoV-2, #ZeroCovid can be done with NPI alone, as several countries have demonstrated. While a vaccine is super-welcome in a #ZeroCovid-strategy, it is not strictly necessary. On the other hand, a vaccine will have a much larger impact worldwide if combined with #ZeroCovid.

With #flattenthecurve, the outcome is radically different. Covid-19 becomes endemic, and is kept down through herd immunity. This herd immunity can probably not be achieved in foreseeable time with a vaccine alone, so part of this herd immunity has to be by infection.

I am not discussing here the practical absurdity and moral hideousness of herd-immunity-by-infection-strategy, it has been done sufficiently.

Related to the ultimate outcome is the subject of normality. After all, we want normal life back.

The stark difference between the two strategies is that with #flattenthecurve, normality means living with the virus, while #ZeroCovid normality means living whithout the virus.

So what does this mean strategically? Living-without-the-virus has to be set up very differently from living-with-the virus. With #ZeroCovid you have to catch eventual transmission at the earliest possible time. You don’t want to do that by running after infections that have already occured. Tactics like sewage testing, population testing, self-testing and so on are vital. Of course you also have to stop incoming transmission from other countries. It has been done before. The difference is not lockdown versus no lockdown. The difference is much bigger outside of lockdown.

Another difference related to this one is the time-dynamic. (Sorry, I invented that word. If you know a better expression, let me know in the comments.)

With #flattenthecurve, you try to keep infections down to a certain level. In order to do that, you have to have some infections first. Right? So it’s primarily the existence of infections, and secondarily the number of those infections that trigger actions. Also, if there are already infections above your “acceptable” threshold, you push them down below that threshold and then stop.

With #ZeroCovid, you don’t wait till there are infections, you have to prevent them before they happen. Or if you already have infections in your country or jurisdiction or business or school or elderly residence, you have to get them down all the way, and keep them there, and not just below a certain threshold. So you cannot wait for infections to happen before you take action.

If you imagine a game of chess, the difference between the two strategies is this: With #flattenthecurve, the pandemic gets to make the first move, again and again. With #ZeroCovid, humans make the first move, and that’s what we want: Always make the first move. We don’t have to rely on luck though, as we would in a game of chess: We can move first because we have the knowledge we need for that. And if we are in the middle of a big wave, well we have to get infection numbers down anyway. So that’s not what stops us from doing #ZeroCovid. We have to move first.

This different time-dynamic has consequences for the implementation of tactics. For example, contact tracing has to happen in a much tighter time frame if you want to get (back) into the first-move-position, or stay there. Testing has to be set up so that it doesn’t take three days until you have the outcome. And so on.

An important difference is the analytic focus behind the two strategies.

To arrive at #flattenthecurve, most people start at the SEIR model and the immunologic naivete of humans. The problem to solve, the thing to fight with human pandemic response is not as much the illness or infection itself but the fact that human immune systems are not familiar with it. In the end, not only analysis but also strategy hinges on that. The key difference between the flu and SARS-CoV-2, why we have to fight SARS-CoV-2 harder than the flu, is “missing” herd immunity, if you think like that.

For #ZeroCovid, the problem is the illness itself. It has to be fought because it maims and kills humans, and because it destroys the economy by way of destroying people, and because it also kills health systems. It has to be fought harder than the flu because it is more deadly and because it is harder to stop transmission.

So the two different solutions are actually for two different problems.

Following from the analytical focus and other features of both strategies, there is a huge psychological difference.

With #flattenthecurve, there is always a temptation to negotiate, to use a mindset of tradeoffs. Instead of asking “How can we stop transmission AND keep producing and distributing food?” we ask which tradeoffs we “have to” make between the two. Also, we ask how we can better track infections that have already taken place instead of asking how to stop them in the first place. We are always debating how many infections are too many, instead of taking a clear stand that every infection is too much. This is not only technically unfeasible, it leads us into a moral abyss, too.

Psychologically and morally, #flattenthecurve is toxic. This psychological issue is not the only reason for the continued failure of #flattenthecurve-strategies all over the globe. But it contributes.

With a #ZeroCovid-strategy we are making our own life easier in that respect, as long as we don’t forget that every society (yes, #ZeroCovid-countries too) has people in it who like the suffering of other people and to whom it is a positive value that they strive for. Every society who wants to do #ZeroCovid (or any other policy that is not positively anti-human) has to deal with that and it is not a reason to forego a #ZeroCovid-strategy (or any other policy).

So what about the economy?

#Flattenthecurve strategies are based in a fictional tradeoff between economy and public health. Since reality offers no basis for this framing, what does? It’s probably ideology. For example, there is a narrative in political science that says politics is the distribution of scarce goods. So, to do politics, there must be scarcity. So scarcity becomes ascribed to public health and economy: You can’t have everything, dear. Another narrative says that politics is about conflict and compromise between different interests. So economy and public health get different interests assigned and are being set up to compete. If such framings make no reference to reality, but to narrative, we usually call the resulting policies “ideological”.

#ZeroCovid calls for actions that protect the economy and public health at the same time, because both are attacked by SARS-CoV-2 ipso facto. That means it is not like the pandemic weirdly has some features that attack humans and then others that attack the economy, but that the pandemic attacks the economy by attacking humans and vice versa.

If we look at the justification of countermeasures to the individuals who are expected to follow them, we see the whole scope of the intellectual slapstick that #flattenthecurve is.

With #flattenthecurve, individuals are asked to follow severe measures, again and again, not in order to not get infected by SARS-CoV-2, but in order to get infected at a later time.

With #ZeroCovid, people are following measures that are much lighter over time, so that they don’t get infected, period.

So one last difference between the two strategies is their legal justification.

The #flattenthecurve strategy relies explicitly on infections that have already occurred for the justification of infection control measures. It appears logical that this justification tactic is not apt to justify prevention of any kind, against anything.
Implicitly, this justification relies on ignorance of facts and reasons that call for a #ZeroCovid-strategy.

Justifying #ZeroCovid is more complex. The imposition of countermeasures has to be justified separately from their severity, and seperately again from their timing. To justify the imposition of measures, the projected outcomes of countermeasures have to be weighed against the pandemic doing its thing unmitigated. The severity of measures for #ZeroCovid has to be weighted against the equally severe but repeated measures of #flattenthecureve and their relatively much worse outcomes. And the proactive #ZeroCovid timing and its projected outcome has to be weighted against reactive strategies and their projected outcomes.

#ZeroCovid is a prevention strategy: preventing infections before they occur. Since it is not possible to prevent things that have already occured, it follows that the justification of preventive strategies cannot hinge on final conclusive evidence. Because by the nature of prevention you can have either prevention or final evidence, but not both. So by making this level of evidence a prerequisite for the justification of prevention, you prevent any prevention.

Unfortunately, we have accumulated loads of evidence about what SARS-CoV-2 does with #flattenthecurve-strategies and what it does under a #ZeroCovid-regime. We shouldn’t have gotten all this evidence in the first place and we didn’t need to. Now that we have it, we ignore it, and bely our claims that we have not enough evidence to justify #ZeroCovid.

So what’s wrong with #suppression as a strategy?

There is another option called #suppression, which consists in keeping the number of infections as low as possible until a vaccine “arrives”. Also, there is advocacy for suppression which is based on the assumption that a) we’re not getting #ZeroCovid anyway and b) the difference is not so big, anyway.

The time-dynamic for #suppression is the same as for #ZeroCovid, and #suppression does not rely on a fictional tradeoff between economy and public health. Therefore, the strategy seems more sane than #flattenthecurve at first glance.

However, #suppression has things in common with #flattenthecurve. One of them is the anticipated end of the pandemic crisis. With #ZeroCovid, it’s elimination, fighting back and confining the virus to its most remote animal resources. With #suppression, as with #flattenthecurve, the pandemic ends with herd immunity. People are still asked to live with the virus and find it normal to not get infected all at once but one after the other, as the hospitals find time to treat us. #Suppression hinges on the same analytic focus: The problem is “missing” herd immunity, not the illness itself. That’s a huge glaring difference far beyond the seemingly small difference in infection numbers. With #suppression, you have a threshold of “acceptable” infection numbers, and if you are there, you have a hard time justifying further measures in spite of the proactive character of this strategy. Also, the psychological and moral pitfalls are the same as in #flattenthecurve. The imagined “controlled infections” are a contradiction in terms: You can either have infections or control, but it is at least very doubtful whether you can have both.

Then there is an argument for #suppression over #ZeroCovid that goes like this: “But it is much harder to get to zero cases since we were stupid enough to let the virus take hold on our countries, so we can’t do #ZeroCovid because we will maybe not achieve zero. Therefore we’d better go for #suppression, because we can reach that.”

This argument is based in a circular confusion between facts and counterfactuals. I said before that strategies are a dance of facts and counterfactuals. If you get confused, you trip and fall on your face. I’ll demonstrate with an analogy: Let’s say you have a heating system for your apartment and it has a defect. If you put the thermostat to maximum, your place will just be lukewarm. It is bitter cold outside. Would you say: “Oh but if I put the thermostat to maximum, I won’t get maximum, so this will not be successfull” and then freeze as a consequence? Or would you put the thermostat to maximum and have it lukewarm?

The fact that even with a #ZeroCovid-strategy, a country might only achieve very low numbers of infections instead of zero infections is not a valid reason not to try in the first place. Because if you circle back and set your expectations lower, you have a completely different strategy, and the outcome will be worse than what you might have achieved with #ZeroCovid.

Why are not more countries doing #ZeroCovid then?

The countries that do #ZeroCovid don’t seem to be generally more enlightened than the countries that don’t.

If you ask a #ZeroCovid-democracy how they do it, they say: We have to do it because we are a democracy. If you ask a #flattenthecurve-democracy, they say: We can’t do it because we are a democracy. If you ask a #ZeroCovid-autocracy, they say: Yeah we can do it because we are an autocracy. If you ask other autocracies, they say: It’s just the flu. If you ask a collective-minded official, they say: Oh in our country, people think more about the common good and are not so selfish, therefore we can do it. If you ask an individual-minded official, they say: Oh in our country we care about every individual’s health and wellbeing, therefore we had to do it. There are systems where the health department is apparently quite autonomous on the national level. These include Taiwan and Sweden. Some #ZeroCovid-countries are islands, some are not. Some #flattenthecurve-countries are islands, some are not. And so on.

Countries use what they have to fight SARS-CoV-2, or they don’t, and if you ask them how they do it, they will talk about the respective features of their countries that they used to their advantage. The point is: These features are not what differentiates #ZeroCovid-countries from #flattenthecurve-countries. The only consistent difference between #ZeroCovid-countries and others is that these countries’ decisionmakers made the decision for #ZeroCovid on the national level and acted accordingly. Everything else is fog.