Zero Covid policy: When the cure is worse than the disease

Bengaluru: A dynamic flexible Live with Covid strategy with mix and match booster vaccines is at present the best option. Early development and deployment of multivalent and nasal vaccines is desirable.
ZERO COVID OR LIVE WITH COVID: ZERO COVID strategy is expected to reduce incidence of new covid infections to zero and eventually enable normal economic and social activities. It involves contact tracing, mass testing, quarantine and lockdowns to completely suppress spread of the infection locally and prevent spread from elsewhere. It is in sharp contrast with LIVE WITH COVID strategy, where covid appropriate behaviour and mass vaccination is used to drastically reduce the number of Covid cases and deaths. This strategy accepts that the virus will eventually become endemic like a seasonal flu so that economic and social activities are not interrupted. The alternating quarantine strategy proposed by Meidan et al in a January 2021 publication in Nature, was initially tried this month in Shanghai by alternately locking down half of the city but failed. Now the 25 million residents are in lockdown in Shanghai, the financial capital of China, suffering shortage of food and essentials, financial and mental distress, repeated testing of the entire population with mass quarantine and hospitalisation. Official reports on April 14 mention 27,000 active Covid cases in this city, of which more than 2500 are symptomatic. The Zero Covid Chinese cure is worse than the disease.
U-TURN OR NO RETURN: China, Taiwan, Australia, New Zealand, South Korea, Singapore, Vietnam initially adopted the Covid Zero strategy. However, later they are unable to control the highly transmissible but milder virus variants, all these nations except China modified their strategy. A U-turn on public policy is often perceived negatively as a volte-face or flip-flop by a leader, institution or government on a bad policy with associated loss of face. A U-turn can actually be a positive move like the politically astute withdrawal of farm laws in India, or a financially sensible sale of a loss-making enterprise like return of Air India to the Tata group or a tactical withdrawal by an army for better asset deployment. President Xi Jinping has invested so much of his reputation and Chinese efforts and assets in ensuring Zero Covid that any about-turn or backtracking now seems unacceptable to him.
COVID HERO DEMOCRAT OR AUTOCRATIC COVID ZERO: When vaccines were not ready, PM Modi’s policy of early nationwide lockdown while enabling agriculture, logistics and essential services; followed by massive scaling up of protective, medical and vaccine supplies and later global distribution of vaccines, medicines and now food and essential supplies has made him, the much maligned underdog earlier, a global Covid hero now. In April 2020, Wuhan had a light show to celebrate the elimination of Wuhan virus while the rest of the world was suffering the horrors of the pandemic. China boasted about the success of its strategy and vaccines in eliminating Covid with youth celebrating at a huge water side concert in Wuhan in August of 2020. They mocked Indian crematorium fires contrasting them with their successful space launch fires. Eventually the Chinese vaccines were found to be ineffective and rejected by many nations. This entire propaganda about communist Chinese success in sharp contrast to suffering and deaths in democracies has now come back to haunt president Xi as the XE variant that is ravaging the Chinese while Xi is inflicting untold misery on the Chinese public and economy with draconian measures enforceable only in the dragon nation. Meanwhile India, the Trans-Himalayan neighbour who was denigrated and lampooned earlier by China, the western media and their local agents has recovered so well that the entire world including the Chinese public can perceive the difference between reality and propaganda.
ZERO COVID OR HERD IMMUNITY: It is now obvious to every observer that a dynamic flexible strategy of Covid appropriate behaviour by all, testing of those exposed to Covid, self-quarantine of those infected, hospitalisation of those who cannot be managed at home, and mass vaccination of all age groups to control the pandemic is both feasible and effective without serious disruption of the economy and basic human needs. Persistence with Zero Covid strategy is as much a policy paralysis as the other extreme policy of inaction by leaders who early in the pandemic called Covid 19 as just another flu that will get controlled by development of herd immunity and refused to lockdown or mandate Covid appropriate behaviour. Politically expedient hasty abandoning of Covid appropriate behaviour and vaccination is likely to prove dangerous.
VACCINES –MIX AND MATCH; BOOSTER OR MULTIVALENT; NASAL SPRAY OR INJECTIBLE: A variety of vaccines against Covid 19 are available now and on presently available data we should continue with a booster dose of a different vaccine (Mix and match), 6 months after the second dose, vaccinate all age groups globally at the earliest, develop multivalent vaccines to protect against multiple current variants as has been achieved with Flu vaccine, and facilitate early test and approval of the nasal spray vaccine as it will provide local immunity in the upper respiratory tract in addition to systemic immunity and will increase safety while reducing costs by eliminating the need for syringe and needle or a Jet injector. To conclude a dynamic flexible Live with Covid strategy with mix and match booster vaccines is at present the best option. Early development and deployment of multivalent and nasal vaccines is desirable.
Dr P.S.Venkatesh Rao, MBBS(Vellore), MS(Vellore), DNB, FRCS(Glasg), FACS, FICS, FMAS, FAES is Consultant Endocrine, Breast & Laparoscopic Surgeon and Former Faculty CMC (Vellore), AIIMS (New Delhi), UCMS (Delhi), MSRMC (Bengaluru).