The China Model of Containment - Simply Slowing the Day When We Finally Have Heard Immunity

Bradley Tanner, MD, ME, MBA
April 9, 2020

Containment is possible in the short term if you isolate your country impose a severe lockdown, but expecting it to last is based on hope, not science.

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First, a vocabulary discussion. One hears the words “containment” and “mitigation," although it seems that few really understand what they mean or they're used inconsistently. I prefer the simpler version: “stop the spread” and “slow the spread”. “Stop the spread” is a more accurate term than containment since it says that the goal is to stop it does not necessarily imply that it will be stopped forever since one is not saying “eliminate the virus” as with smallpox. The goal with HIV is to stop the spread.

In contrast, “slow the spread” can replace the confusing term mitigation. It more accurately describes the goal is to tamp down the potential impact of the virus, but the further spread is inevitable. The goal is simply to spread out the risk of spread over a more extended time. The total number of cases will be the same, they just won't happen with the same frequency in the beginning. The term mitigation is currently (and confusingly used in the hope that mitigation can proceed to the point that there are no positive infections, but the population has not yet reached herd immunity. It more honestly recognizes it'll come back later regularly, say in a few months. That solution is typically accompanied by the hope that a solution will come online that makes the next bump more manageable.

Let’s first discuss strategies that attempt to “Stop the Spread”.

Did China succeed? We need to reject any comment that says China gives us hope. Folks who use those words should be required to supplement them with a more detailed version of that statement which says that implementing the Chinese model of containment with its severe limitation on movement, severe restrictions use of technology, long-term lock-downs, and removal of most if not all personal freedom and privacy can result in containment of the virus. That is a much longer statement, but it is more accurate. In fact, it is still too short because it is ignoring the reality that containment is a temporary measure. The introduction of new viruses into China will require Draconian measures to identify all potential new cases and strict border controls since containment demands early and quick identification of positive cases.

Any mistake in terms of identifying such cases could easily lead to another epidemic in China with rapid growth and return to lockdown and closed borders. We know from experience that once the virus sets in a contained area such as a cruise ship or a nursing home that a conference, as in Boston, that it spreads at an enormously fast rate. China is densely populated; if it opens up all of its global transportation channels the virus could quickly spread to the rest of the country once all the restrictions are eliminated. In fact, the country is still closed to foreign travelers and aggressively screens Chinese nationals returning to China.

Again it's tempting to say that there's a lot we can learn from China, and there is indeed a lot we can learn from the epidemic in China. But it’s strategy of containment/stopping the spread is incompatible with western values, nor is it a guaranteed model for success. The recent rise of new cases in early April in China and a new epicenter and Italy make it clear that the virus is transmitted easily and as such that it will continue to spread no matter what is done including the Draconian measures of China and the last lock down measures of Italy. This virus is so transmissible that we're seeing it transmitted to animals. Do we really believe that a virus that spreads so easily and so quickly to the animal population (and from the animal population to humans) will be quickly contained through various measures? And the recent rapid dissemination in a nursing home in Pennsylvania repeats the well known finding this virus is very quickly spread. A single mistake in containment can lead to a restart of a process leading toward lockdown.

A China-light strategy is best seen in New Zealand, pretty much the only country attempting to repeat the China model. Someday, New Zealand may need to acknowledge that it is buying into a false narrative that it can forever stop the virus because it is an island. The virus will come roaring back as soon as the limitations are lifted.

That basically leaves us with the unfortunate conclusion, despite efforts to contain it eventually, the virus will spread throughout the population in some time, probably in the short term. And it will spread most likely before any kind of rescue solution is identified. We need to plan for that eventuality and make changes to deal with that reality.

The most reasonable future solution is to let the virus run its course and to identify those who've been impacted so that they can return to regular activity. Delaying the inevitable causes harm that will soon or already has proven higher than what we see from the virus.

Slowing the Spread. Everyone is well versed in flattening the curve, that is keeping new infections below the rate at which the care system can cope with new infections. It assumes that spread is inevitable but can be tamed. Although the term is not used, it is essentially a herd immunity model assuming that the virus will eventually make to the entire population, it's just a matter of time.

In Italy, the medical-focused leadership is mainly pursuing a herd immunity mentality, though not entirely admitting that reality. As we see in Italy, there still is an assumption of possible containment since when containment fails, there is a desire to quarantine the entire location to further contain it. We can assume that other areas will arise, and the spread will continue, and the "mitigation as containment" solution will continue to fail. It appears that "stopping the spread" is not solely on protecting the care system from catastrophe but to keep the number of infections, hospitalizations, ICU admissions, patients requiring ventilator support, and deaths at a low number. Is the effort thus an attempt to make the above more palatable for the population? Does this allow the narrative to say there are “fewer” deaths? This is disingenuous. Worse yet, the public is getting no actual savings since the care system is theoretically not overwhelmed. In contrast, the narrative is harming the public by the lock down intervention and the curtailment of liberty and choice. In other words, the overall benefit is nil, and the costs are higher.

So as long as illness does not overwhelm the care system, society can be release intelligently to return to its standard. That's not to say that the solution is to expose all individuals in the society. It's clear that those with a pre-existing medical condition, especially severe ones are at higher risk, and they need to be protected from the virus and receive extreme social isolation until a treatment or vaccination is available. For the rest of us, we have to assume that we will eventually acquire the virus. Some of us will undoubtedly have symptoms, and some small portion of us, despite not having a pre-existing medical condition, will suffer some of the more severe consequences. But to deny that reality is as foolish as it was when our leadership buried it's head in the beginning and said the entire virus thing was a hoax. This virus is not going to go away; its transmissibility is well-known. The subsequent rapid spread is inevitable. And its lethality for specific populations is also well-known. These are facts that we cannot run away from or ignore.

The alternative narrative is to accept the reality that we should only stop the spread sufficiently to protect the care system from being overwhelmed. Efforts that limit personal freedom and economic activity beyond those necessary to achieve that goal are providing no health benefit and furthering the damage done by our response to the COVID-19 epidemic.

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