From lockdown to liberalization, what has the global anti-epidemic experience been like?
Bloomberg has launched the Covid Resilience Ranking (Covid Resilience Ranking) since November 2021, based on 11 indicators including vaccination rate, infection rate, death rate, degree of blockade, degree of universal health care coverage, and GDP forecast, through the “maximum- “Minimum Rules” analyzes 53 countries with pre-COVID-19 economies of more than $200 billion, capturing how the world’s largest economies are handling the COVID-19 crisis while keeping social and economic damage at bay.
The ranking of most countries on this list fluctuates wildly. The epidemic prevention curve of the United States is a big M shape, Vietnam is a fat U shape, and France is a wavy line with folds and folds. In the past two years, Asia-Pacific countries such as South Korea, Singapore, New Zealand, and Australia have had the best anti-epidemic strategies and effects.
Zhang Hui, a professor at the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, summarized the anti-epidemic strategies of countries other than China into three categories: one is a large population and impoverished areas, which have adopted a real “lay-down strategy” with 1.5 The second is the flattening of the curve (Flatten the curve) adopted by most western countries, with the main means of enhancing medical (vaccine and drug) capacity and reducing population contact (public policy of epidemic prevention), using Different efforts should be made to suppress the curve of the total number of infected people who need medical assistance in society at that time, and try to control it within the medical capacity, avoid medical runs, and reduce humanitarian disasters.
The third category is described by Zhang Hui as “Dynasty, Qin and Twilight”, mainly Singapore, Vietnam, Japan, South Korea, Australia, New Zealand and other Asia-Pacific countries. In the first half of the fight against the epidemic, they adopted a strict anti-epidemic clearing policy, and then quickly changed the policy to the above. Intermediate policies of the two categories: Towards universal immunization with flexible policies.
The new crown resilience list ends on June 28, 2022. According to Bloomberg, after two years of fluctuations, most countries have stabilized in the fight against the epidemic. “All of the top-performing countries have implemented strategies that most of the world has embraced: accept that the virus will persist, aggressively vaccinate the most vulnerable, and try to restore economic and social activity to 2019 levels.”
Bloomberg’s data tracking revealed some of the determinants of the world’s fight against the epidemic. The best performers are rich countries that have the ability to supply vaccines, arrange injections and other later work. On this list, three countries have never dropped to the bottom half of the ranking: the United Arab Emirates, Canada and Finland, all rich countries with low population densities. The second is the degree of social trust and social cohesion, which are the decisive factors for the effective mobilization of citizens by different governments at different stages: in countries such as Singapore, more people have been complying with mask orders and social restrictions, and a large number of citizens have taken the initiative to vaccinate. “A clear lesson from the COVID-19 era is that countries with strong social trust and social cohesion are most likely to survive a crisis of this magnitude,” Bloomberg concluded. Viewed in this light, the United States and the United Kingdom have some of the highest death rates from COVID-19 in the developed world, despite their wealth and top science — they have played a major role in developing vaccines and selling them around the world . In the final ranking of the new crown resilience list, Britain and the United States ranked 22nd and 36th respectively.
Australian Prime Minister Anthony Albanese prepares to receive his fourth dose of the COVID-19 vaccine at the Adore polypharmacy in Sydney, July 12, 2022. Figure/Visual China
The United States most often compares Australia’s epidemic prevention experience with itself: they are all English-speaking countries with similar population structures, but Australia’s new crown death rate is only one-tenth of that of the United States. Intuitively, Australia restricted personal communication and travel before the vaccine was popularized, implemented regional blockades in the country many times, and once closed national and state borders. Then when the vaccine was vigorously promoted, the most vulnerable groups were given priority, and then gradually opened up. Although Australia has also experienced an increase in the number of deaths due to irregular epidemic prevention in nursing homes or the failure to strengthen control when the mutated strain of Omicron spread.
But in the eyes of some intellectuals in the United States, what is more important is the trust Australians have in science and institutions, and in each other. According to the Australian Bureau of Statistics survey, 76% of Australians say they trust the health system (compared with about 34% of Americans); Support outside the home. In this regard, WVS, an authoritative survey on global values, shows that Australians rank very high in the option “most people can be trusted”.
”The Lancet” published a survey of 177 countries around the world on February 1, 2022, and found that among the factors affecting the infection rate and death rate of the new crown, trust is more important than smoking rate, medical expenditure or government form. It is a key factor in getting people to reduce their activities, wear masks and get vaccinated, thereby more effectively controlling the spread of the virus.
Repeated callbacks to the policy
Singapore is one of the first countries in the world to propose a coexistence route, and its government is also one of the most trusted by the people in the world. At the end of May 2021, when Singapore Prime Minister Lee Hsien Loong first stated that Singapore would shift to co-exist with the new crown virus, the public reaction was mixed.
At the same time, Bloomberg added a category of opening progress to the new crown resilience list, using air traffic, travel restrictions, vaccination rates and the degree of blockade as indicators. “As of early 2021, lockdowns to eliminate local transmission of the virus have been one of the best outcomes. But as more and more places are able to limit severe illness and death through vaccines, social and business activities (including Progress in global travel) restrictions is an important manifestation of recovery from the epidemic.”
Singapore’s opening road map shows that they have decided to take small steps towards opening up. The United Kingdom and the United States took the lead in opening up in mid-2021, but due to failure to achieve the ideal vaccination rate, the number of deaths in the two countries has not decreased significantly. The death toll in the United States remained almost the same before and after the vaccine was rolled out, which was seen as the price of serious political differences hindering vaccination.
Following Lee Hsien Loong’s statement at the end of May 2021 that Singapore will shift to coexistence with the new crown virus, in mid-June, Singapore relaxed its epidemic prevention policy when the vaccination rate was 35%, and entered the third stage of “high vigilance and liberalization”. Less than a month later, Singapore returned to the second stage of “opening on high alert” under the pressure of a rapidly rising infection rate, and it took another half a month to increase the vaccination rate from 48% to 65%. On August 6, Singapore announced that it will officially embark on the road of “covid resilience”. On October 9, Lee Hsien Loong stated in his national speech that Singapore must adhere to the coexistence strategy, and the next few months will be the key.
Another important shift in Singapore’s epidemic prevention policy is to allow eligible patients diagnosed with the new crown to recuperate and recover at home. From September 15, 2021, confirmed COVID-19 patients under the age of 50 who have completed two doses of vaccination, as well as children over the age of 5 who are diagnosed but asymptomatic or mildly symptomatic, if there are no complications or other underlying diseases, will be eligible to receive the vaccine at After being evaluated by the hospital, you can rest and recover at home. Singapore has added ventilators to the community medical system, and requires patients to wear monitoring bracelets as required to ensure that they do not leave the designated room during home recovery. Violation of the quarantine order will result in a fine of SGD 10,000 or imprisonment for six months, or both.
From June to the end of 2021, Singapore’s epidemic prevention policy has been adjusted several times, either because of concerns about the impact of the Delta mutant strain on the medical system’s capacity, or because of the surge in infections caused by the Omicron mutant strain. Such cautious and repeated adjustments to policy have also drawn criticism. Jeremy Lim, an associate professor at the National University of Singapore and an expert on health policy, believes that politicians should not wait for perfect conditions for opening up, because the world will never be perfect. However, the Singaporean government insists on taking the vaccination rate as the key condition for whether to relax: only when the two-shot vaccination rate reaches 80%, Singapore will cautiously lift the blockade.
labor pains
Although South Korea’s long-term performance in Bloomberg’s new crown resilience list is very high, compared with Singapore, South Korea’s process of opening up is slightly passive.
Before 2022, South Korea’s 3T strategy – “Test, Trace and Treat” – is considered a successful example of dealing with the new crown epidemic. At the beginning of the spread of the Omicron mutant strain in South Korea, South Korea tightened social restrictions, only allowing gatherings of less than 4 people, and imposing a curfew after 9 p.m. on businesses and other public places. But this restriction has had little effect. Before Omicron, South Korea, with a population of nearly 52 million, had never had more than 7,849 new confirmed cases of new crowns every day. And since February 17, the daily increase has exceeded 100,000.
South Korea’s policy shift will begin in early February 2022. South Korea’s Minister of Health and Welfare, Kwon Deok-chul, said South Korea must use limited resources more effectively and focus on protecting critically ill patients and reducing deaths. Since Omicron could overwhelm the public health system, 3T’s strategy is unsustainable or even pointless. From February 9, South Korea relaxed the isolation regulations for confirmed cases and their close contacts, allowing infected persons to treat at home. Mild and asymptomatic general home treatment patients manage themselves, but they must be isolated for 7 days according to regulations. Government management is carried out for home treatment providers such as high-risk groups over the age of 60 and those over the age of 50 with underlying diseases. South Korea has invested 650 medical institutions in the management of home-treated patients: For doctors and full-time nurses allocated in proportion, they will call 1-2 times a day to confirm the status of patients, and distribute oxygen saturation meters and other home treatment equipment. As South Korea shut down the app used to track cases and enforce quarantines, most of the government’s 60,000 workers who arranged for the app have turned to helping vulnerable people treated at home, including providing medicines and answering calls.
The shift sparked brief unrest in South Korea, even as the government continued to communicate to citizens that the shift in policy was inevitable and that resources must be directed toward caring for the most vulnerable. According to reports from South Korean media, the New York Times, and the Wall Street Journal, many South Korean respondents felt uneasy about the sudden loss of the government’s strict virus prevention and control measures. They kept complaining about the lack of some medical necessities such as thermometers, hand sanitizer, oximeters, etc., and felt as if they were abandoned. In South Korea, it took two months to complete the transition from sending every person infected with the new crown to the hospital to sending only vulnerable people to the hospital. ICUs around the country have always kept empty beds to deal with emergencies.
”In the process of transitioning from a pandemic to an endemic disease, it is necessary to experience huge storms.” Sun Ying, a senior health official at the Disaster Management Division of the Ministry of Health and Welfare of South Korea, said.
After the policy shifted, South Korea’s confirmed cases of COVID-19 quickly reached a daily increase of more than 300,000 in March. But with South Korea’s adult vaccination rate of more than 96 percent, the damage from the Omicron variant was reduced to a low point. Omicron has an overall mortality rate of 0.18%, but for those under the age of 60, Omicron brings a mortality rate close to 0%. Overall, South Korea has consistently had one of the lowest COVID-19 death rates in the world, about one-tenth that of the United Kingdom and the United States.
After completing a public policy shift, South Korea in late March accelerated the development of indigenous vaccines and drugs to better provide continuous vaccination and help the elderly recover.
Monica Gandhi, a professor of infectious diseases at the University of California, San Francisco, predicted that South Korea would become the first country to downgrade the new crown pandemic to an endemic disease. This is based on South Korea’s highest adult vaccination rate and high public trust in the public health system. And the correct route out of the epidemic.
On April 25, 2022, after nearly five months of experiencing Omicron, South Korea downgraded the infectious disease level of the new coronavirus from Class A to Class B, and comprehensively promoted the work of epidemic prevention and the restoration of the medical system. So far, people infected with the new crown in South Korea are no longer required to be isolated at home, hospitals are no longer required to report positive cases immediately, and the national health care system will no longer pay for treatment in full. Patients infected with the new coronavirus must pay part of their own medical expenses like patients with other diseases, but the vaccine continues to be free.
Although the daily number of confirmed cases announced by South Korea is still experiencing fluctuations: in mid-August, the number of confirmed cases increased by more than 100,000, and after falling back, it still increased by more than 10,000. Since mid-October, the number of hospitalizations and deaths in South Korea has remained at low.
long road
The process of opening up is bound to be accompanied by labor pains. For Singapore, it is dealing with the Delta mutant strain, and for South Korea, it is dealing with the Omicron mutant strain. As for India, they rushed to open the country when the vaccine was insufficient and the Delta mutant strain entered the country, but what it brought was a fatal tragedy. Between mid-April and end-May 2021, the death toll in India surpassed 140,000: the virus overwhelmed the healthcare system, and millions were helpless. It should be noted that because there is no large-scale universal testing and a complete reporting system, the new crown data released by India is considered to be far lower than the reality.
In February 2022, India experienced the third round of infection peaks brought by Omicron. Just over a month later, after three days of daily new infections dropping below 10,000 cases — the level seen before the rapid spread of Omicron — India began gradually easing restrictions, including lifting curfews and opening restaurants , theaters, game halls and other places, allowing inter-city mobility, etc. The Indian government has cited the decline in cases and the lesser harm of Omicron to the human body as the reasons behind the gradual return to normalcy in India.
In this regard, a study led by Padmanabha Shenoy, a well-known local immunology expert in India, pointed out that Omicron has little impact on India because more than 70% of Indians have been infected with the delta variant strain, and because more than Eighty percent of Indian adults are vaccinated, and this combination of immunizations brings antibody levels 30 times higher than those who received two doses of the vaccine. The idea of a “hybrid immune wall” is widely accepted in India. Another Indian virologist Gagandeep Kang believes that this is India’s advantage, which means that the possibility of large-scale nationwide infections in India in the future is very low, sporadic at best outbreaks and local case surges.
Huang Yanzhong, a senior researcher for global health at the Council on Foreign Relations of the United States, pointed out that it is an extremely rare case for India to rely entirely on natural immunity. However, he communicated with Indian scholars and learned that India has gone through the labor pains and returned to normal.
On November 21, 2022, the Indian government issued an announcement stating that due to “the continued decline in the development trajectory of the new crown and the significant increase in the coverage of the new crown vaccine globally and in India”, India will cancel all mandatory entry requirements related to the new crown. The Croon epidemic is in its final stage.
As for Singapore, on November 7, 2022, a year and a half after first announcing the blueprint for coexistence, the new crown was truly regarded as a common epidemic and no longer specifically dealt with: the number of new crown cases was no longer announced, and the number of new crown cases was changed to Seven-day average; no beds reserved for COVID-19 patients. Regardless of whether it is other Asia-Pacific countries or European and American countries, no government has promised to completely end the response to the new crown virus: these countries have said that they will still adjust their prevention and control policies at any time according to the fluctuations of the epidemic.
what we are going through
At the beginning of November 2022, my country reported a sharp increase in the number of positive infections of the new crown. An unnamed expert who has been involved in the prevention and control of the new crown epidemic for a long time and has supported the epidemic prevention work in many cities told Southern People Weekly that the winter of 2022 is very important to China. He judged at the time that by flattening the curve as much as possible through various measures and passing through the winter of 2022 with slow mass infection, China will truly enter the end of the new crown epidemic.
On November 11, the Joint Prevention and Control Mechanism of the State Council announced the “Twenty Measures” to further optimize the prevention and control of the epidemic.
On November 29, the Joint Prevention and Control Mechanism of the State Council issued the “Work Plan for Strengthening the New Coronary Virus Vaccination of the Elderly”, which is considered a key step towards opening up. The plan adheres to the principle of “receiving as much as possible”, insists on the government’s leadership, departmental linkage, implementation of territorial responsibilities, accurate investigation, optimization of services, accelerating the increase in the vaccination rate of people over 80 years old, and continuing to increase the vaccination rate of people aged 60-79.
On December 7, the “Notice on Further Optimizing and Implementing the Prevention and Control Measures of the New Coronary Pneumonia Epidemic” “New Ten Articles” was promulgated. Asymptomatic infections and mild cases are encouraged to be treated at home, and close contacts are no longer tracked. The notice calls for accelerating the vaccination of the elderly against the new crown virus, conducting a thorough investigation of the health status of the elderly suffering from cardiovascular and cerebrovascular diseases, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, tumors, immunodeficiency and other diseases, and providing health services in different categories. On the same day, the “Medical Consortium as a Carrier to Do a Good Job in Hierarchical Diagnosis and Treatment of New Coronary Pneumonia” was issued, aiming to fully ensure the timely treatment of infected persons with high risk of severe illness such as elderly patients with underlying diseases, and to reduce the severity rate and mortality rate to the greatest extent possible. Normal medical services will be carried out, and a more scientific and orderly order for medical treatment will be established.
In an interview with “Southern People Weekly”, several medical experts believed that this winter will pose a great challenge to the medical system, and that the next one to two months will be a painful period in different cities across the country.
”An important consideration in deciding whether to adjust the prevention and control policy is whether you are willing to endure this period of pain and bear the consequences of the pain. Judging from the ‘New Ten Articles’, for long-term considerations, China is preparing to deal with this period of pain. The consequences of coming.” Huang Yanzhong said in an interview with the media.
An expert from the Department of Infectious Diseases of Shanghai’s top tertiary hospitals, who did not want to be named, emphasized that young and middle-aged people are the first to be infected, and it may affect vulnerable groups such as the elderly and patients with underlying diseases after one to two weeks. It is necessary to avoid a large number of infections of vulnerable groups and a large number of severe patients, which will lead to a run on medical resources and rescue resources, and then affect all patients who need to see a doctor.
Professor Hu Bijie, Director of the Department of Infectious Diseases and Director of the Department of Hospital Infection Management, Zhongshan Hospital Affiliated to Fudan University, gave a speech entitled “How to Scientifically Respond to the Omicron Epidemic in Medical Institutions” to Shanghai medical staff in early December. He analyzed the situation with theoretical models. , with the characteristics of the Omicron mutant strain, in the absence of prevention and control measures at all, the virus can spread for one generation in 3 days, and the R0 (basic number of infections) is 10. In theory, it only takes 18 days to infect more than 20 million people . However, if proper prevention and control measures are taken, the R0 will be reduced to 5, and the virus will spread to one generation in 3 days, and it will take one month to infect more than 20 million people; if the prevention and control measures are better, the R0 will be reduced to 3, and this cycle will be extended again. to two months. As R0 decreases, the infection cycle will be prolonged.
Taking Shanghai as an example, Zhang Wenhong believes that Shanghai will reach the peak of social infection within 3 or 4 weeks, and will gradually get out of this wave of epidemics in 3 months. Prolonging the infection cycle of the entire vulnerable population can reduce or avoid the serious consequences of running out of medical resources. Based on this, Zhang Wenhong’s team recently wrote an article calling for doing everything possible to delay the infection time of the elderly group and minimize the number of elderly infected people in the peak of the first wave of the epidemic. “Even if it is only delayed by 1-2 months, the vaccine immunity barrier of the whole society will be stronger, and medical resources will be more sufficient and calm after the peak of the first wave of the epidemic, and the treatment resources for the elderly in nursing homes after the outbreak It will also be richer.” The article reads.
For any country, trust and cooperation are the key to getting out of the haze of the new crown epidemic. “After three years of walking in the long anti-epidemic tunnel, we are about to walk out of the tunnel. Air, sunshine, and free travel are all waiting for us. But in the final journey, we need the mobilization of the whole society. The new crown virus is not For the disease of a single person, it is a test for each family and our society. We need every member of every family to take action, to be the person in charge of their own health, and also to be the umbrella of the elderly in the family and support them. them, protect them.”
