Crush the curve: why we better crush the virus completely – Health

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Now that the smoothing of the curve has not curbed the coronavirus, experts argue to extend the measures and crush the virus. “It is the only way we can return to some form of normality.”

Since the corona measures were tightened again last week, it is clear that a new strategy is emerging. In the first wave, Belgium, like just about all other European countries, opted for the containment strategy. The virus could have spread unseen for several weeks. In other words, it was too late to keep it out. By announcing a lockdown, the spread was curtailed. In this way, the virological curve flattened, so that the healthcare system would not be flooded by a sudden influx of patients. Once the curve flattened, governments were able to release the lockdown measures again, so that ‘normal life’ could be somewhat resumed.

Since the corona measures were tightened again last week, it is clear that a new strategy is emerging. In the first wave, Belgium, like just about all other European countries, opted for the containment strategy. The virus could have spread unseen for several weeks. In other words, it was too late to keep it out. By announcing a lockdown, the spread was curtailed. In this way, the virological curve flattened, so that the healthcare system would not be flooded by a sudden influx of patients. Once the curve flattened, governments were able to release the lockdown measures again, so that ‘normal life’ could be somewhat resumed. But besides flattening (‘flatten the curve’) there is a second strategy: crush the curve, crush the curve. It is the method that the Chinese province of Hubei applied at the beginning of this year, when it turned out that the virus had spread to the metropolis of Wuhan for more than a month. The province was hermetically locked for eleven weeks. Residents were ordered to stay in their homes and public life was paralyzed. When the province reopened on April 8, the virus had completely eradicated. No new outbreaks have been recorded since then. In most Western countries, this Chinese approach was met with incomprehension. The almost unanimous opinion was primitive and far too radical. According to policymakers, it was sufficient to flatten the curve. In Belgium, the number of detected infections per day never fell below 85. This satisfied the consignments of the European Center for Disease Control, which recommends European countries not to relax as long as there are more than twenty new cases per 100,000 inhabitants. Virologists already warned then that the easings would come too early. Marc Van Ranst noted that he would have preferred the number of day infections to drop below fifty before easing. Nevertheless, some countries opted for a more dire strategy. New Zealand, Finland, Scotland and Cuba decided to crush the curve. On June 8, after an extremely severe lockdown, New Zealand became the first country in the world to officially call itself covid-free, and despite some new incidents of returning travelers, the country has been spared new measures for the time being. The success of those countries consisted in keeping the measures in place until the infection had almost completely disappeared. Devi Sridhar, the health system expert who advises the Scottish government on its covid policy, plans to continue lockdown measures in Scotland until fewer than 10 cases are recorded per day. There is a growing consensus among experts that in the current second wave we need to go further than in the original outbreak. “We relaxed too early,” confirms Pierre Van Damme, epidemiologist at the University of Antwerp. “We never went below 85 daily infections, and that’s just too much. Especially when you consider that the actual number was probably three times as high, because many infected people have little or no symptoms. The infection has never disappeared from society, and that is now breaking our minds. ” Biostatistician Geert Molenberghs (Hasselt University) also argues for extending the measures this time and also ‘crushing the tail of the curve’. “We should not be satisfied with the curve of the ceiling,” says Molenberghs. “This approach means that we will have outbreaks again in no time as soon as we relax the measures. It’s like you’ve put out a 95 percent fire, then put a bellows on the smoldering fire to rekindle it. ” The downside of the crush the curve approach? It takes longer before we can resolve the restrictions. The economy and the business world will also suffer longer and will therefore suffer more damage. On the other hand, that approach probably offers the only way to deal with the virus while waiting for a vaccine, says Van Damme. “We must avoid ending up in a yo-yo system, where we constantly relax and tighten. That undermines the support for the measures. ‘ But there are practical objections between flattening and crushing. For example, the crushing strategy only makes sense if the virus cannot enter the back door again. “As long as the borders are open, there is no point in crushing the curve if our neighbors don’t follow that strategy. Because then you risk bringing the virus back in and causing a flare-up, ‘says Molenberghs. “The borders opened too soon after the first wave.” During the first wave, it proved unfeasible to coordinate the control plans of the EU member states. The European agreement that was concluded two weeks ago also hardly provides for policy coordination. Nevertheless, Molenberghs sees positive signs. “About all European countries are now experiencing new outbreaks. The realization is growing that we cannot continue in this way. So I can perfectly imagine that we can now make agreements with our neighboring countries. ‘ A second challenge is the tracking capacity. The pulverization strategy only works if the sources of infection are identified quickly enough. “Even if we crush the curve, there will still be flare-ups,” Molenberghs warns. ‘It is therefore important that you can locate sources of infection quickly so that you can contain them. It is the only way we can return to some form of normality. ” It is precisely this contact tracing that is still very difficult in our country. Due to the lack of cooperation between the local and regional level, it often takes too long before sources of infection are detected. This makes it almost impossible, as already proved in Antwerp, to nip new distributions in the bud. The question remains how far we should go exactly. Pierre Van Damme advocates continuing until fewer than 30 infections are diagnosed per day. “That is a manageable number, with which you can quickly identify any flare-ups with a small investigation team.” Ideally, that guide number becomes part of a click system. ‘You could work with color codes, where you adjust the situation based on the number of day infections. If the infection rate rises rapidly, the measures automatically become stricter. That way people know better what to expect. That is an important way to convince the population to continue to follow the rules. ‘ Boudewijn Catry, head of service and spokesperson at Sciensano, wants to go even further, and calls for the epidemic to stop completely. “The epidemic never stopped in a city like Antwerp,” says Catry. ‘Antwerp has had at least one infection every day for more than 150 days in a row. In fact, there should be no contamination for several days or weeks before we relax the measures. ‘

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