Coronavirus: Elimination or containment? The OECD countries proving what works

Now, there are many differences between the UK and these five other island nations - from population density and public health preparedness to pre-existing levels of sickness and frailty and the ways they are governed (centralised, federal, devolved etc).

UK Covid waves have been larger and/or more prolonged than countries which pursued elimination

But one of the key differences is how they responded to the pandemic: namely with rapid deployment of mass testing and quarantine, border closures and a goal of elimination, or a slower and sceptical "take it on the chin" and treat it like flu approach characterised by Britain where international travel was late to stop and resumed in summer, and measures to get infected people to fully self-isolate have been half-hearted at best.

READ MORE: 'The vaccine isn't perfect' - dramatic fall in severe Covid, but 113 patients known to have died more than three weeks after first dose 

The UK's strategy has been one of containment and mitigation.

In hindsight (but worth noting for future viral pandemics, which are tragically inevitable) it seems clear that elimination is the superior option.

That was certainly the conclusion of researchers (including Scottish Government advisor Professor Devi Sridhar) writing in the Lancet this week, who compared outcomes during the first 12 months of the pandemic among OECD countries depending on whether they pursued a policy of elimination or containment.

Overall, they found that "countries that consistently aim for elimination - ie. maximum action to control SARS-CoV-2 and stop community transmission as quickly as possible - have generally fared better than countries that opt for mitigation".

On Covid-19 deaths per million population, these "have been about 25 times lower" in the OECD countries which opted for elimination (Australia, Iceland, Japan, New Zealand and South Korea) compared to those which favoured mitigation.

This is not proof of a "causal connection" between elimination and mortality, they admit, noting that mortality is at least in part "a proxy for a country's broader disease burden".

Long before the pandemic struck, the UK (and even more so Scotland) had one of the highest rates of obesity, heart disease, diabetes, and chronic lung conditions such as emphysema and bronchitis in Europe.

Income inequality by nation, 2016-2019 (Source: OECD)

Deprivation has also emerged as a major risk factor for Covid deaths and, according to the OECD, income inequality in the UK is the highest of any of its current European members.

Only in Costa Rica, Chile, Mexico, Bulgaria (a prospective member) and the United States is the gulf between rich and poor wider.

Which segues nicely into gross domestic product (GDP) - another of the outcomes analysed by the Lancet authors.

OECD countries opting for elimination (orange); OECD countries opting for mitigation (blue)

Again, elimination "is superior to mitigation for GDP growth on average and at almost all time periods".

GDP growth, they found "returned to pre-pandemic levels in early 2021 in the five countries that opted for elimination, whereas growth is still negative for the other 32 OECD countries."

READ MORE: Chile, Israel, and the lockdown exit lessons for Scotland 

The fundamental difference here is that those countries which were quick off the mark in imposing highly stringent measures such as travel bans and pro-active lockdowns prevented the virus from ever spiralling out of control. New Zealand, for example, has had just 26 deaths to date; Iceland 29.

With borders closed, supervised hotel quarantine for nationals returning home, and domestic cases driven to levels that test and trace systems could easily keep on top of, the domestic economies were able to fully reopen.

Contrast this with the UK's stop-start cycle of months-long national lockdowns, simmering virus rates, and hospitality and leisure businesses which have been driven to the brink of collapse (and many have gone under) and it is easy to see why "over-reaction" early pays off in the long-run.

OECD countries opting for elimination (orange); OECD countries opting for mitigation (blue)

And what of liberties? Again, it was countries who adopted containment - not elimination - where freedoms were most severely impacted overall. By contrast, "swift lockdown measures...were less strict and of shorter duration".

Why does any of this matter now though? Cases are disappearing, 60 per cent of the adult population is vaccinated, and our exit from lockdown is underway.

Well, one potential fly in the ointment is variants. In London in particular, the percentage of cases not caused by the Kent variant has soared from less than 5% at March 23 to more than 20% by mid-April.

Source: UK Government

To date 400 cases of the Indian B1.617 variants have been detected in the UK, up from 73 two weeks ago. This is cause for caution - not alarm - at this stage, but we still do not know whether this 'double mutant' strain can escape the vaccine.

Meanwhile, there are reports that the UK Government is being advised that it is safe to abandon social distancing at large events from June 21 - including indoors "with good ventilation". This is based on pilot events such as the World Snooker Championships.

READ MORE: Netherlands and Denmark turn to testing and Covid passports to open up economy 

Perhaps it is, but it is worth remembering we are resuming these sorts of activities at a much earlier stage in our vaccination curve than Israel did.

Meanwhile, Japan, whose early strategy of aggressive contact tracing and mandatory hospitalisation of anyone testing positive kept cases well below 11 per million per day until mid-November last year, declared a state of emergency last weekend.

Japan is battling its second surge in cases since November

The emergence of several variants, including the UK's high transmissible 'Kent' strain, has been blamed although - to be clear - Japan is declaring crisis at a point when cases are averaging 40 per million per day, while the UK is opening up with cases averaging 34 per million per day. 

Of course the trajectories vary (steadily downwards in the UK and spiralling upwards in Japan) and vaccine coverage is also vastly different: less than 2% of the total population in Japan has had a first vaccine dose, compared to 50% in the UK. 

But vaccines on their own are not enough.

As the Lancet authors note, "relying solely on Covid-19 vaccines to control the pandemic is risky due to their uneven roll-out and uptake, time-limited immunity, and the emergence of new SARS-CoV-2 variants".

And they have a final warning to countries which might be tempted to move too quickly: a reminder that a pandemic, by its nature, is global.

"National action alone is insufficient and a clear global plan to exit the pandemic is necessary.

"Countries that opt to live with the virus will likely pose a threat to other countries, notably those that have less access to Covid-19 vaccines...Meanwhile, countries opting for elimination are likely to return to near normal: they can restart their economies, allow travel between green zones, and support other countries in their vaccination campaigns and beyond."