Containment strategies for the 2019 Novel Coronavirus: flatten the curve or crush it?
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CORRESPONDENCE
Containment strategies for the 2019 Novel Coronavirus: flatten the curve or crush it? Gerry Killeen1 Received: 29 May 2020 / Accepted: 12 June 2020 © The Author(s) 2020
Coverage in a national newspaper here in Ireland prompted me to read through the recent epidemiological modelling paper in the European Journal of Epidemiology by Dr. Chowdhury and his colleagues in the Global Dynamic Interventions Strategies for COVID-19 Collaborative Group [1]. The modelling approaches taken look solid and reasonable to me, and indeed several of the numerical predictions match our own projections [2]. Worryingly, these similarities including a mean fatality rate of about 1% of the overall population, even in high income countries, in the event of a full-blown, uncontained epidemic. In the Republic of Ireland, that would mean over 40,000 direct COVID-related deaths and obviously many more through indirect effects on health, well-being, social cohesion and economic resilience. Unfortunately, and consistent with the way their work was represented in one of our national newspapers, the authors only emphasize one side of their own results in the abstract of their paper. There are two issues the authors fail to mention in their own summary: (1) at the end of the 18 month period they presented (Figure 1), epidemics suppressed sufficiently for ICUs to consistently cope with are still going strong, requiring just as much effort to keep contained and continuing to cause illness, death and socioeconomic disruption, (2) when they simulated crush the curve [3] approaches to eliminating the virus with sustained and uninterrupted restrictions, their timelines to that exit point are about 3 months (Figure 2), very similar to our own predictions [2, 4]. As explained by Dr. Chowdhury and his colleagues dynamic interventions entail repeatedly imposing, lifting and re-imposing restrictions until the epidemic hopefully burns itself out through herd immunity, perhaps after 4 years * Gerry Killeen [email protected] 1
AXA Research Chair in Applied Pathogen Ecology, School of Biological, Earth and Environmental Sciences, and Environmental Research Institute, University College Cork, Cork, Ireland
[5], so the graphs presented in figure 1 of their paper [1] probably represents less than half the longer-term picture. Furthermore, assuming the epidemic will indeed burn itself out may prove a dangerous gamble. Instead, it’s likely that COVID-19 establishes itself as a permanently endemic pathogen with volatile and unpredictable dynamics that lead to sporadic epidemics every few years [5]. In the meantime, national strategies intended to flatten the curve may well result in a wild roller coaster ride of sequential epidemic surges and re-imposed restrictions that need to be considered before embarking on such a long-term trajectory. On the economic front, such deliberately incomplete suppression of the epidemic means extending the damage over years rather than months [5], asking business to spend more time operating under restrictions t
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