There's another issue with the idea of whether or not a New Zealand "prevention till vaccination" strategy will work. It requires some other, western, modern nation to actually have infections in order to develop the vaccine. It's fallacious to think that even if everyone could have actually prevented infection with NPIs, that it would have been preferred, because it would have to happen in perpetuity due to absence of a vaccine. New Zealand's "success" came at the cost they imposed upon themselves for the NPIs, and the cost that other nations, including the UK, bore to take the infections along with the vaccine development.
In short, you cannot have one without the other, that would be a fantasy.
I'll correct my last statement, you could have one without the other. You can have focused protection without covid zero, but not the other way around.
Yes this is true, and of course this would ultimately lead to immense global inequity. For example, in a situation where HIC in the northern hemisphere somehow managed to achieve elimination, this is totally unthinkable in much of the global south. Then all vaccine trials must be performed in, and for, LMICs. As much as I would like to think otherwise, it seems very likely the immense pressure to get them approved and deployed would suddenly disappear once it's no longer a "first world problem".
My thoughts are that nothing we did made any difference other than slowing down the inevitable virus to infect most people. I disagree that we couldn't have had better focused protection prior to vaccination. If we could find money for furlough then instead of businesses laying off so many, we could have found funding to manage care homes with staff that didn't work in more than one facility. These staff could have been paid more for their sacrifice keeping away from family for 2 weeks at time. We could have provided accommodation for healthcare workers. There could have been a system of quarantine and/or testing after being with their families in order to return to work. FFP3/N95 masks should have been worn more frequently in high risk areas. (I know these weren't necessarily available, but this is part of the lessons we should be learning, isn't it?) Prior to testing being available, sensible policies such as staying away from work if you displayed symptoms. (Most people who got covid had at least one symptom.)
It's true that we couldn't completely separate healthy young people getting infected to eventually passing it to the vulnerable, I agree. However, we didn't avoid that from our lockdowns regardless, so focused protection, in my opinion should have been at least trialled. We should never have closed schools, playgrounds, swimming pools or limited outdoor activities. I think restaurants should have remained open for those who wished to utilised them. Many wouldn't choose to go based on their own person risk. We should have been able to decide for ourselves who we met and where we met. Given the risks were clearly a sliding scale as age increases.
I agree with large gatherings/crowds needing to cease, and shops requiring a certain number in at a time, (pre-vaccine), but not much else.
The biggest lesson that I wonder will ever be rectified, is that our healthcare facilities run on poor staffing levels. We don't have the people or structural healthcare resources, and each winter our systems hit boiling point. Upping our capacity to deal with covid and all other health matters in general is paramount to lessons learned.
I agree, for those at risk. The vast majority of people were not at risk. There was data of the co-morbidities that held risk factors. Or course this was never absolute, but guidelines and the choice to make personal decisions were taken from us. This is what I disagree with.
I personally feel that you are optimistic on a number of points:
- that people understand the risks and how their actions effect
- that people will make the right decision (both for themselves and for others)
- and that you can effect spread, so that some groups (consisting of 15-30% of the population) are infected at significantly lower rates (or not at all) without the full cooperation of the rest of society.
Thanks David. Most people can understand person risk when it is explained well, and I believe are able and willing to take sensible precautions to protect others too. To the extent this occurs depends a lot on societal cohesion and trust, as well as the effectiveness of public health communication. If guidance is offered in the strongest possible terms, it is almost certainly not necessary to enact it into law. For example, in Scotland it was never a legal requirement to self isolate after a positive test, but there was no difference in adherence.
There's another issue with the idea of whether or not a New Zealand "prevention till vaccination" strategy will work. It requires some other, western, modern nation to actually have infections in order to develop the vaccine. It's fallacious to think that even if everyone could have actually prevented infection with NPIs, that it would have been preferred, because it would have to happen in perpetuity due to absence of a vaccine. New Zealand's "success" came at the cost they imposed upon themselves for the NPIs, and the cost that other nations, including the UK, bore to take the infections along with the vaccine development.
In short, you cannot have one without the other, that would be a fantasy.
I'll correct my last statement, you could have one without the other. You can have focused protection without covid zero, but not the other way around.
Yes this is true, and of course this would ultimately lead to immense global inequity. For example, in a situation where HIC in the northern hemisphere somehow managed to achieve elimination, this is totally unthinkable in much of the global south. Then all vaccine trials must be performed in, and for, LMICs. As much as I would like to think otherwise, it seems very likely the immense pressure to get them approved and deployed would suddenly disappear once it's no longer a "first world problem".
My thoughts are that nothing we did made any difference other than slowing down the inevitable virus to infect most people. I disagree that we couldn't have had better focused protection prior to vaccination. If we could find money for furlough then instead of businesses laying off so many, we could have found funding to manage care homes with staff that didn't work in more than one facility. These staff could have been paid more for their sacrifice keeping away from family for 2 weeks at time. We could have provided accommodation for healthcare workers. There could have been a system of quarantine and/or testing after being with their families in order to return to work. FFP3/N95 masks should have been worn more frequently in high risk areas. (I know these weren't necessarily available, but this is part of the lessons we should be learning, isn't it?) Prior to testing being available, sensible policies such as staying away from work if you displayed symptoms. (Most people who got covid had at least one symptom.)
It's true that we couldn't completely separate healthy young people getting infected to eventually passing it to the vulnerable, I agree. However, we didn't avoid that from our lockdowns regardless, so focused protection, in my opinion should have been at least trialled. We should never have closed schools, playgrounds, swimming pools or limited outdoor activities. I think restaurants should have remained open for those who wished to utilised them. Many wouldn't choose to go based on their own person risk. We should have been able to decide for ourselves who we met and where we met. Given the risks were clearly a sliding scale as age increases.
I agree with large gatherings/crowds needing to cease, and shops requiring a certain number in at a time, (pre-vaccine), but not much else.
The biggest lesson that I wonder will ever be rectified, is that our healthcare facilities run on poor staffing levels. We don't have the people or structural healthcare resources, and each winter our systems hit boiling point. Upping our capacity to deal with covid and all other health matters in general is paramount to lessons learned.
But delaying infection to the point where you have mass vaccination and/or effective treatments is a good goal by itself.
I agree, for those at risk. The vast majority of people were not at risk. There was data of the co-morbidities that held risk factors. Or course this was never absolute, but guidelines and the choice to make personal decisions were taken from us. This is what I disagree with.
I personally feel that you are optimistic on a number of points:
- that people understand the risks and how their actions effect
- that people will make the right decision (both for themselves and for others)
- and that you can effect spread, so that some groups (consisting of 15-30% of the population) are infected at significantly lower rates (or not at all) without the full cooperation of the rest of society.
Thanks David. Most people can understand person risk when it is explained well, and I believe are able and willing to take sensible precautions to protect others too. To the extent this occurs depends a lot on societal cohesion and trust, as well as the effectiveness of public health communication. If guidance is offered in the strongest possible terms, it is almost certainly not necessary to enact it into law. For example, in Scotland it was never a legal requirement to self isolate after a positive test, but there was no difference in adherence.