Thread by @kakape

Across Europe #covid19 cases are surging and the continent is shutting down again. Germany‘s second shutdown began yesterday, Austria‘s starts today, England is following on Thursday. How did we get here? What‘s the plan? Quick thread and my story here: sciencemag.org/news/2020/11/e…

First: What went wrong? Many ways to think about this. But to be clear: It was always going to be hard. I wrote about Europe‘s „dangerous“ path out of the lockdowns in April (science.sciencemag.org/content/368/64…). Consensus was it would be trial and error. We erred, but did we really try?

In April, @gmleunghku explained 3 dials governments had to keep transmission in check:
test, trace, isolate -TTI
border restrictions
physical distancing

TTI worked reasonably well in some European countries. Border restrictions: meh. Backbone of strategy was #physicaldistancing

But over time, as measures were lifted and people became more complacent, #physicaldistancing worked less and less. Spread from hotspots in Europe added to the pressure. TTI was never expected to hold the line against the virus on its own and eventually buckled under the pressure

(It‘s worth noting too that TTI and physicaldistancing are not independent of each other. TTI relies on people adhering to quarantine and isolation. It’s reasonable to assume that in populations adhering less to #physicaldistancing there will also be problems with TTI.)

Part of the problem is that reduction in first lockdowns was not big enough. "The infectious seeds in the community have always remained above a certain threshold, where if you relax the physical distancing, it’s all going to come back", @gmleunghku told me.

All of this happened with Europe heading into the winter season, actually making stricter measures necessary. „I think winter does make things much harder,” @AdamJKucharski told me. „Countries have probably been doing control on ‘easy’ setting over the summer.”

Now #covid19 case count per capita is higher in Europe than US. Thousands are dying every week, hospitals in some places are close to collapse and so countries are heading into a second round of lockdowns.

I keep coming back to this sentence from @mlipsitch who told me in April: „We’ve managed to get to the life raft. But I’m really unclear how we will get to the shore.” It seems in Europe we decided to just swim, realized we won‘t make it and are now heading back to the life raft.

What if anything have we learnt from that first round of shutdowns? (side note: „Shutdowns“ come in all kinds of flavors, for ease of discussion I use the word to mean any combination of broad measures that involve closing large parts of society to reduce case numbers).

1. It‘s not health vs. the economy, stupid.
Shutdowns take a massive toll on the economy, often hitting the most vulnerable hardest. But as @devisridhar told me and has been pointing out for months: „In the longer term, having uncontrolled spread is much worse for the economy.“

2. Locking down later means locking down longer. Countries that locked down earlier in their epidemic generally reduced numbers faster. “If you wait until your infection level is quite high, probably your 2-week lockdown is going to become a 3-month lockdown,” says @devisridhar

3. A strategy helps. China, Australia, NZ did hard lockdowns to get to zero and then fight to keep virus out. Korea, Japan, reduced numbers to very low levels, so that TTI and #physicaldistancing can keep spread in check even if there are occasional superspreading events.

Europe meanwhile is using lockdowns to avoid health care system from collapsing. The strategy if there is one seems to be: Reduce numbers to manageable levels, then relax measures. I call it the 3Re ‚strategy’: Reduce. Relax. Repeat.

Is a different strategy possible? Ab Osterhaus and Devi Sridhar are arguing for „maximum suppression“, emulating South Korea or even New Zealand. Others think that is simply not possible in Europe. Either way, we need to use the second shutdown to chart a path forward.

But for now, more than anything else, we all have to do our part to get back to that life raft as soon as possible.