Above photo: A nurse in Washington state prepares to enter an acute COVID-19 care ward. Elaine Thompson via the Associated Press.
Now We Must ‘Get to Zero’ or Face Catastrophe.
Half measures haven’t worked. It’s time to beat the virus the way other places have done.
Are you tired of COVID?
I fucking am.
But as a longtime science writer and the author of two books on pandemics, I have to report what you probably don’t want to hear. We have entered the grimmest phase of this pandemic.
And contrary to what our politicians say, there is only one way to deal with a rapidly mutating virus that demonstrates the real power of exponential growth: Go hard. Act early. And go to zero.
Last January, one strain of this novel virus began its assured global conquest, and since then our leaders have hardly learned a goddamn thing.
So yes, I am angry, and I will not disguise my frustration with comfortable or polite language.
In the last three months, several super-variants have emerged that are 30 to 70 per cent more infectious than the original Wuhan strain.
The old COVID-19 doubled its numbers every 40 days under a particular set of restrictions; under the same conditions, the variants double every 10 days. That means they can outrun any vaccination campaign.*
That means if you haven’t eliminated — or almost eliminated — cases in your region, you are going to learn the meaning of grief.
These highly-contagious variants have emerged in jurisdictions with high infection rates: the U.K., Brazil, South Africa and California. They became global tourists months ago, before you read about them.
Meanwhile, governments still do not understand the threat at hand.
To illustrate it, British mathematician Adam Kucharski recently compared a virus mutation that was 50 per cent more deadly with one that increased transmission by 50 per cent.
With a reproduction rate of about 1.1 and a death rate of 0.8 per cent, current strains of COVID-19 now deliver 129 deaths per 10,000 infections.
A virus that is 50 per cent more lethal will kill 193 people in a month. A variant that is more transmissible wins the game with 978 deaths in just one month.
The virus is finding its optimal configuration, its ideal form for contagiousness. And you thought this was over?
A new pandemic
Now don’t think of these variants as the same old COVID-19. That’s a big mistake.
They actually represent an entirely new pandemic.
In this new maelstrom, this complex coronavirus is just getting warmed up. It has the potential to become even more infectious than the current variants.
We allowed this to happen by not taking the measures needed to go to zero, doing whatever was needed to eliminate COVID-19 in our province or country. We pretended we could live with this virus and that vaccines would save the day.
We were wrong. Dead wrong.
Jurisdictions that chose not to stamp out this virus and blithely tolerated high infection rates, like Denmark, the U.K., Ireland and Portugal, already know how painful this error can be.
Meanwhile Canada’s vaccine campaign is flailing. It can’t end this pandemic by itself, because immunity won’t last as long as the vaccination campaign. And the South African variant can already impair their efficacy.
Moreover, our politicians have placed their bets on two high-tech, two-shot and costly vaccines, Pfizer and Moderna. They require refrigeration that half the world can’t afford.
American science has given us a Lamborghini when what the world needs is a Toyota, a cheap one-shot deal that can be easily stored, says public health expert William Haseltine.
Oxford’s AstraZeneca vaccine may be that Toyota. And if we had a competent federal government, we would be making that vaccine here in Canada for Canadians. And so the emergency grows. (Health Canada hasn’t yet approved this vaccine, and Prime Minister Justin Trudeau failed to engage the National Research Council lab in Montreal in making it.)
Others went to zero
COVID-19 should have taught us one glaring lesson by now: If you do not stamp out this virus, the shapeshifter will come back to defeat you.
New Zealand, Australia, Vietnam, Iceland and Taiwan got it right. They went to zero and eliminated the virus. Atlantic Canada and the North got it right, too.
But the rest of this country has failed and continues to fail.
(Would I have fired chief public health officer Dr. Theresa Tam and Heath Minister Patty Hajdu last year? You bet. Parroting declarations from the World Health Organization isn’t a competent pandemic response.)
As the U.S. physicist Yaneer Bar-Yam notes, “The enemy won’t stop fighting because we surrender. The only exit is to learn from our mistakes and choose to win.”
Instead of comparing our mediocre performance to the horror show in the United States, Canada needs to adopt a much higher set of standards. And by New Zealand’s or Taiwan’s measure, we look very bad.
Until citizens demand a go to zero protocol in their communities, they will live in the Groundhog Day alternative — a public game with no real end goal other than endurance that depletes both our communities and economies.
The current approach begins with incomplete lockdowns with no defined goals, travel restrictions that let the rich get away with murder and endless public health chatter about bending curves followed by careless and incoherent openings.
Exponential viral growth then roars back, jams the hospitals with the sick and surprises our daft politicians, igniting the whole abusive cycle all over again.
Contrast that reality with New Zealand, which went for zero. That country has had no COVID-19 infections for eight of the last 10 months. People attend concerts and sport events. They visit their families without fear. They only wear masks on public transit. There are real international travel restrictions and quarantines.
Bending the curve doesn’t get us into New Zealand’s safe place, because the power of exponential growth will always win. You have to crush the curve and go to zero.
While we slowly react, it mutates fast
Now here is the problem: The virus is evolving while our reactive response is devolving out of neglect, incompetence and fatalism.
In many parts of Canada, our vaccine programs are being administered improperly.
In Quebec, the authorities are not following proper schedules. If you don’t follow the schedules, the vaccine won’t work very well. That means Quebec has created an experimental population of half-vaccinated individuals who can support viral evolution.
The ever-acerbic public health expert Amir Attaran calls this negligence what it is. “If an evil scientist were devising a strategy to help the virus evolve and evade existing vaccines, he would do exactly what Quebec is doing.”
As the variants rapidly move through the country, politicians are doing what they did last spring — reacting instead of getting ahead of the virus.
And that’s where we started one year ago.
By ignoring or half-heartedly adopting the best advice about travel, testing, contract tracing, masks and aerosol transmission (and the best information did not come from the World Health Organization), our politicians allowed controllable viral spot fires to become towering infernos.
Our current reactive public health goals are outrageous and pretend that it’s OK to contain these infernos to long-term care facilities, prisons, working-class immigrant neighbourhoods and hospitals. Instead of going for zero transmission and getting the job done in six weeks, they just aim to keep the virus simmering or keep our hospitals on life support.
Letting the pandemic multiply injustice and inequality exponentially isn’t OK. And the longer we pretend we can live with a virus that kills one to two per cent of those infected and disables another 10 per cent with “long COVID,” the greater these inequalities will grow.
And that’s why we must get to zero, because the longer we draw out this siege, the greater the damage to the body politic. What you have heard is true: pandemics have never been democratic.
A deadly variant at work
Now consider the trauma of Roberta Place, a long-term care facility in Barrie, Ont.
But let’s call these institutions what they are: industrial feedlots for the aged often run by corporations with minimal community oversight. (These institutions should remind us of our successive moral and cultural failures as a civilization to treat our elders with respect.)
In Roberta Place, the U.K. variant, B117, appeared on Jan. 8. It flew in on a jet, because travel connects everything on this planet with a dangerous totality. (Is there anything wrong with travel? No. But with billions travelling a year, the scale has become an unremitting health hazard that, with a different virus, could drive our sorry-assed civilization to extinction in a matter of weeks.)
But back to B117, which slammed the U.K. with its highest infection rates and death tolls to date.
In just 10 days, a single case at Roberta Place became a massive outbreak affecting half the residents, and nearly half the workers. Today, every resident of Roberta House and almost all workers are infected. All the physicians and essential visitors got infected too.
The variant moved so fast that the facility couldn’t even separate the infected from the non-infected. There are more than 40 dead.
There is a message here: “If we wanted to get serious vs B.1.1.7,” tweeted one physician recently, “vaccinate 24/7 like it’s an emergency. Because it is.”
Given that B117 overwhelmed a long-term care facility in Ontario just two weeks ago, it is already burning through the community. (This variant only needs about six weeks to become the dominant strain in a community.)
To date, B117 has been reported in Ontario, Quebec, British Columbia and Alberta, which means it is likely everywhere. The bomb has been planted; it will explode before you know it.
Canada does little genomic sequencing — a tool that tells us the lineage of viral strains (a sort of Ancestry.com for viruses). That means Canada has picked up a fraction of existing cases.
So we are once again thinking about how to react to evidence that we have not collected. Taiwan and New Zealand didn’t do that. They went to zero.
An astonished virologist
Now listen to German virologist Christian Drosten.
He finds it astonishing that COVID-19 has boosted its infectiousness by 30 to 50 per cent over previous strains by doing what viruses do: evolve, mutate and adapt for more effective reproduction.
He notes that a more infectious virus is more dangerous than a more lethal one, “because every new case will infect more people, and each of them will infect more people, such that the number of cases will grow exponentially.”
Drosten was the virologist who developed the first diagnostic test for COVID-19 and discovered that children carry high viral loads and are just as infectious as adults.
No politician wanted to hear that evidence, and many continue to ignore it.
He compares the variant phase of the pandemic to a truck with bad brakes driving down a steep mountainside.
“We don’t know what curves are coming up and whether the road is suddenly about to get steeper. We also don’t know how far we still have to go, but we do know that we absolutely have to avoid missing a corner. In a situation like this, closing our eyes doesn’t help. We have to keep going and do one thing in particular: Hit the brakes, even if they might be rusty.”
He thinks getting to zero — no active cases in Germany — is possible but would be tough.
“But it would absolutely be worthwhile to at least identify zero new infections as a target. Primarily because I am quite apprehensive about what might otherwise happen in the spring and summer.”
Ripping through the Amazon and Ireland
Let’s go now to Manaus, a city located in the Amazon jungle where rubber barons once listened to Italian opera while their Aboriginal slaves died in the bush. Nearly 70 per cent of the population was infected in the first wave. The city dug mass graves in the red earth of the Amazon.
Now a variant is ripping through the community with such intensity that hospitals have run out of oxygen. And more graves are being dug, largely for people below the age of 60.
Marcus Lacerda, an infectious disease specialist in the city, had hoped the first wave would grant the population some immunity against the second wave. “But the truth is there’s just no way. The falloff in people’s immunity and the changes in the virus mean this second wave is uncontrollable,” he told the Guardian.
Now let’s go to Ireland, where the U.K. variant has filled hospitals to overflowing. The country got off easy in the first wave and then threw things open before Christmas just as the variant arrived.
Patrick Mallon, a professor of infectious diseases in Dublin, knows that letting the virus simmer in the population was a huge mistake.
“I think that what we’re experiencing is the inevitable outcome of that strategy,” he told Der Spiegel.
“I think that this is a lesson that governments around Europe should learn. What is happening in Ireland shows just how vulnerable countries are that are trying to live with the virus, and that it’s becoming increasingly more difficult to do that dealing with the new variant of the virus. What’s happened in Ireland really just shows you how unpredictable this virus is.”
And what did the U.K.’s chief scientific adviser Sir Patrick Vallance say after COVID-19 killed 50,000 citizens in the last three months? “The lesson is go earlier than you think you want to, go harder than you think you want to, and go a bit broader than you think you want to in terms of applying the restrictions.”
It’s only going to get worse. Go to zero
For my last point, consider this paper by Israel’s Weizmann Institute of Science.
In the lab, researchers fooled around with the virus (they modified the genome) to mimic what occurs naturally as it mutates and evolves. Not surprisingly, the lab variants sported many of the same mutations that Mother Nature has thrown out recently, plus this shocker. One lab variant bound 600 times more successfully to human cells than the original strain.
“The laboratory experiments described here suggest that naturally-occurring variants have not yet reached the peak of infectivity,” researchers concluded. (The good news: natural virus selection is not as efficient as in vitro selection.)
Haseltine suggests imaging COVID-19 as a rapidly growing tree. The original strain serves as the trunk. New branches represent the variants. Each branch is “more fit to survive in its environment, the human population, than is its immediate ancestor.”
There is only one way to prune this tree, and that’s by reducing the number of infected humans by going to zero.
Getting to zero is a political choice. The best public health experts support it, and most Canadians would rally behind direct action that brings freedom from COVID-19.
It’s a nuanced strategy with a clear goal of eliminating the virus so we can all breathe again. It combines travel restrictions between sensibly defined geographic “regions” (towns, rural areas and counties), along with brief and decisive localized lockdowns followed by an aggressive program of find/test/trace/isolate/support while hunting down the virus.
Counties and towns free of the virus connect to other COVID-19 free zones, just like the successful Atlantic Bubble.
Eliminating the virus is a much better way to live, as one Irish doctor put it, “than the confused and meandering uncertainty of mitigation.”
If you want to fail and live through a third wave, just wait for a vaccine.
If not, then flood your politicians with one message: Go to zero.
And remember this: normal is gone. In this most inattentive world, whatever light we find at the end of this pandemic will not be the same light we once bathed in.
*Story updated on Jan. 28 at 3:59 p.m. to clarify the rate at which the new COVID variants double compared to previous strains of the virus.
Tyee contributing editor Andrew Nikiforuk is an award-winning journalist whose books and articles focus on epidemics, the energy industry, nature and more.