The end of the coronavirus pandemic will be a case of ‘buying time’, either to secure your hospital capacity or to execute a meaningful exit strategy, according to global health expert Professor Devi Sridhar.

Professor Sridhar made the comments as part of her presentation at Citywire Berlin Virtual, which took place in the week prior to Pfizer announcing the high success rate of its vaccination trials.

In her talk, Sridhar, who holds a personal chair in global health at the University of Edinburgh, outlined how the Covid-19 pandemic had spawned from a seemingly innocuous note from the World Health Organisation on 5 January 2020 to be a global event that will change our lives for a few years.

Sridhar said as the pandemic has evolved many questions remain unanswered, such as why children are less affected and what the potential lifespan of any successful vaccination could be, particularly as it pertains to reinfection.

Looking at future scenarios, Sridhar listed three key ways of approaching the ‘end game’ for coronavirus, which are drawn from ways in which countries have responded to the challenges posed by the pandemic.

#1 The island approach

‘You can have effective elimination, which is the New Zealand model,’ she said, highlighting how islands are best-placed to stop the spread as they don’t have physical borders with neighbours which could result in easy transport of infection.

‘You lock down hard, you clear the virus with huge testing and tracing and then you basically seal yourself off from the world with strict border measures and you try to stop imported cases. China, New Zealand, Australia, East Asian countries.’

#2 The ‘control’ approach

In the approach favoured more by the German or South Korean models, Srdihar said this is less harsh than we have seen in some states but it does depend on a huge amount of popular compliance.

‘It is a voluntary/light lockdown with strong test/trace/isolate and strict rules over superspreading events, because that is when you get the acceleration of the epidemic with many people becoming infected at once. So you have to have rules over large gatherings.

‘Then you have light border checks with possible testing at airports, but you are not really sealing yourself off; just trying to catch some flow. This model also works, especially if you are like in Germany where you have borders with nine countries and you want interaction with the wider world. But it does mean living with some restrictions for quite a long time.’

#3 ‘Herd immunity’ approach

Sridhar said she ‘cheekily’ referenced Sweden in this regard, as the country has introduced only minor impositions on the population as it sought to keep society moving largely as normal. However, she said, it has now moved to more of a ‘control’ approach.

‘[In herd immunity] you have the flow running through, you essentially say “life goes on and we continue”. People need to become infected and we hope either for a mutation and this coronavirus becomes more like our common cold and it passes and doesn’t kill people and cause lockdowns.

‘Or we use treatment to keep people out of hospital. But during this time we try to keep deaths and disability to a minimum and try to ensure your health services don’t collapse. This involves hard triage decisions and you try to keep confidence in the economy.

‘In Sweden, even though the government didn’t mandate people to stay at home, people stayed at home and now Sweden is pivoting towards more of a control model and are trying to do this through guidance. Compliance seems to be really good because people respond to that.’

The East Asian effort

While all countries will have their own means of approaching this, Sridhar said the East Asian response is markedly different to the European experience.

She highlighted how countries such as Vietnam and China had only undergone minor economic damage and limited loss of life, while countries such as the UK had suffered on both fronts.

‘So countries that were unable to control their outbreaks have tended to suffer the most economic pain. There has been this false debate as to whether to choose the economy or do we chose health services and public health. You can see the East Asian countries are winning and how do we learn from them and how do we pivot our responses to there?

‘The key point is flattening the curve means, with measures, we try to stay within healthcare capacity but this means we will see multiple bumps over the next year or year and a half – with or without a vaccine.

‘Your choice as a country hope to stay within that loop and hope you can somehow get out of it in the next year or two, or do you crush the curve fully and push down coronavirus fully and hope that a vaccine can help you leave this?

‘It could really end in four ways,’ she said. ‘Basically, the ways out of this are very few. Either it is buying time for a vaccine through lockdowns or through contact tracing and testing.

‘Or through global cooperation towards elimination, with every country eliminating it one by one, or finally at a certain point, does this just become an endemic virus and we try to develop services to make sure the health services don’t collapse and people don’t die.’

To watch this debate in full, please view below. For more from the Citywire Berlin Virtual event, please follow this link.