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Could a 'zero-COVID' approach end Europe's worst coronavirus outbreak?

Some scientists are warming to the idea that the U.K. might be able to follow in the footsteps of another island nation, New Zealand.
Image: England
Beachgoers enjoy the sunshine and sea in Brighton, England, in July.Alastair Grant / AP

LONDON — The United Kingdom has been battered by the coronavirus.

The government’s response has been heavily criticized, the human and economic costs have been huge and a "second wave" may be looming.

Of the 20 countries most affected by COVID-19, the U.K. has the highest deaths per capita — more than 70 per 100,000 — according to Johns Hopkins University.

But an increasing number of experts believe it doesn't have to be this way.

Scientists are warming to the idea that the U.K. might be able to follow in the footsteps of another island nation, New Zealand, and eliminate community transmission in a matter of months.

New Zealand had gone 102 days without any new infections, before four new infections prompted the city of Auckland to lock down on Wednesday. Prime Minister Jacinda Adern has urged people to stay home and stop the spread.

This "zero-COVID-19 approach" has already been adopted by the governments in Scotland and Northern Ireland, both of which are part of the U.K. but have national governments that set their own health policy.

Image: Ireland
Gardai police officers man a checkpoint on the border between the Republic of Ireland and Northern Ireland as they check for non-essential travel between the two countries, i April.Charles McQuillan / Getty Images file

And supporters of a zero-COVID-19 approach are now imploring British Prime Minister Boris Johnson, who has faced criticism for what political opponents and some health experts call a sluggish and lackluster response to the pandemic, to do the same in England.

"It's like peeing in a swimming pool," said Devi Sridhar, professor of global public health at the University of Edinburgh and an adviser to the Scottish government.

"Just because someone is peeing in one side doesn't mean everyone isn't going to get dirty," she said, referring to the idea that a COVID-19-free country or region could still be vulnerable to importing infections from outside if it doesn't impose quarantines and other restrictions.

The current policy in England is to prioritize the reopening of society where possible, while imposing local lockdown measures in areas where the virus flares up. The government likens this to hitting a car's gas or brake pedal depending on the desired speed.

Critics worry that this reactive strategy, accepting that the virus will circulate at a certain level, will lock the nation in purgatory, putting businesses in an impossible bind if they are forced to open and close repeatedly.

A zero-COVID-19 approach, on the other hand, would favor immediate caution in the hope of a larger pay-off later. In theory, this would stamp out transmission within the community and then use an aggressive testing regime to find and isolate any imported new cases.

It doesn't aim to just "flatten the curve" — but to crush it.

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Lockdown measures would be eased more slowly than they have been in England. And there would be quarantines and restrictions on nonessential travel, not only at external borders but inside the country, too, if domestic hot spots emerge.

These might sound extreme, but such policies have already been imposed in New Zealand. Only citizens and residents are allowed entry — everyone else is barred without a good reason — and even then they must pay $2,000 for the cost of their own 14-day government-enforced isolation. In Australia, the border of the virus-hit state of Victoria has been closed to nonessential travel.

Image: Barcelona
People sit on terraces of restaurants after restrictions to contain the spread of COVID-19 were lifted in Barcelona, Spain, in JulyNacho Doce / Reuters file

However, New Zealand is far smaller than the U.K. in terms of its economy and population, so if England were to go down this route there would be huge implications for international trade and vacations.

Andrew Hayward, professor of infectious disease epidemiology at University College London, told NBC News that New Zealand should to be congratulated on its success.

Still, with fewer than 6 million people and very low population density, that level of success would be much harder to achieve in the U.K., with nearly 70 million with a vastly higher population density, he said.

Supporters of the zero-COVID-19 approach say this is a price worth paying given the potential rewards: making the British isles an enclave of isolated but reclaimed normality.

"It's about trade-offs and choices," said Sridhar, who was born and raised in Miami. "I think the New Zealand leadership outlined those really well. They said: You can have your normal life back and go to these big rugby matches. But if you want to leave the country, it's not going to be easy to come back."

Vicky Pryce, board member at the London-based CEBR consultancy and a former U.K. government economic advisor, said the economic impact of isolating England or the United Kingdom would be "disastrous" and may not even work.

"A lot of these restrictions [in New Zealand] are short-term and if you did them here... there has to be faith that the track and trace system works. People probably trust the New Zealand model more than they would trust the system here.

"I don't think they [the British government] can afford to do another lockdown."

Image: Kulturgarten Open Air Festival 2020
Fans at the Bonn Live Kulturgarten Open Air Festival 2020 in July, in Bonn, Germany.Andreas Rentz / Getty Images file

Some of these zero-COVID-19 measures have already been put in place in Scotland, where there are an estimated 10-30 daily infections compared with some 4,200 in England.

"Our decisions continue to be informed by our clear strategic objective, which is to seek to eliminate COVID," Scottish First Minister Nicola Sturgeon said in a speech last week..

Even its advocates say true zero-COVID-19 probably won't happen so long as Scotland's 96-mile border with England remains open and unchecked. That's why Sturgeon and others find it frustrating that the U.K. isn't using its natural island defenses to better effect.

Zero-COVID-19 would be extremely difficult to adopt in a country such as Germany, with its porous borders with nine other nations, Sridhar said. And it's almost unthinkable as a realistic strategy for the United States, with its sprawling patchwork of state and federal bureaucracies.

Despite the challenges, many experts maintain it is realistic for a country to eradicate COVID-19.

"It is indeed possible to be COVID free," said Ian Jones, a professor of virology at the University of Reading in England.

"If infected people are isolated so that they cannot transmit to another, then the virus dies out when the primary case resolves. It doesn't lurk somewhere waiting to jump out, it has gone."

However, he said, this is difficult because asymptomatic cases are not routinely spotted, maintaining a low level of infection in the community.

"The key is widespread testing so you do pick up the mild cases, followed by rapid isolation until the infection has run its course," he said.