A third choice in COVID prevention
In my last post, I argued that living with COVID-19 is not a sensible choice for China. In this post, I will first show that the zero-COVID strategy is suboptimal against the Omicron variant. Then, I will point out a way out of the antinomy between living with COVID and zero-COVID. In addition, I will propose both short-run measures and long-run measures against COVID-19 and other transmissive diseases. These proposals are based on the model that the government should adopt a supportive rather than directive role.
Questionable effects of the zero-COVID strategy
The recent invasion of Omicron puts China’s zero-COVID strategy to test. The screening process, the quarantine measure, and the lockdown policy all significantly disrupted people’s life and the economy.
The screening process is the most debatable among the three. We can observe in every city long, winding queues composed of citizens waiting for a PCR test. First, using the time-consuming, cost-inefficient PCR test for universal screening is already absurd. Such screening should have been conducted with the Rapid Antigen Test (RAT). Second, these long, winding queues are ideal for the transmission of Omicron. What is the point if the screening identifies 100 infected but creates 100 more, whom the same screening cannot identify yet? Third, Omicron’s shorter incubation period and infectious period reduce screening’s usefulness. The quick onset of the symptom itself serves as screening, and shortly after the screening the infected may no longer be infectious, even without treatment. I do not see any point in screening other than warning the citizens of the severity of the pandemic.
The quarantine and city lockdown are also questionable. Many neighborhoods are blocked either for screening or because of their risk exposure, and the quarantine becomes a nightmare for those with acute or chronic diseases. Quarantine, as a measure against the epidemic, is used to prevent a further outbreak and hence reduce the death rate in a future time. It is not a measure to increase the death rate in the spot time! A draconian quarantine is as stupid as trading present lives for future lives. In addition to the threat to human lives, the city lockdown also has a heavy toll on the economy. With the income reduced, families will have less to spend and potentially cut their expenses on COVID prevention. With the export reduced, the government will have less to support medical workers. A ruthless lockdown will only hurt the economy and thus the sustainability of COVID prevention.
The zero-COVID strategy may produce the opposite consequence that it intended. Instead of eliminating the virus, it can spread viruses, kill lives, and complicate COVID prevention.
A way out of the antinomy
If neither living with COVID nor zero-COVID is viable in China, what should the Chinese government do?
To answer this question, we need to realize that both living-with-COVID and zero-COVID are marketing terms. Just like a product claiming anti-bald does not necessarily help grow new hairs, a zero-COVID strategy does not necessarily promise zero COVID infection. A zero-COVID strategy can lead to a living-with-COVID outcome regardless of people’s wishes. Conversely, a living-with-COVID strategy can also adopt radical measures, in which case the government aims for the best and prepares for the worst (outcome).
Instead of hesitating between the two eye-catching slogans, a more sensible decision process is to find the optimal solution to reduce the transmission of the virus and its impact on the economy and people’s life to the minimum. This minimum might not be zero-COVID; it can be 10-COVID, 100-COVID, or more generally, flattening the curve. Different viruses imply different optimal solutions and thus different minima. Hong Kong fails to recognize this, and its death rate skyrockets. At the beginning of the Omicron epidemic, the Hong Kong government overcommitted and strived for a zero-COVID outcome. They spent all resources for patients with mild symptoms and later became helpless when a huge wave of patients with severe symptoms arrived. Learning from Hong Kong’s lesson, Doctor Zhang Wenhong in Shanghai advised the hospitals to keep some redundancy.
The outcome does not depend on the marketing term; it depends on the concrete measures taken. It is the appropriateness of the measures that matters, not the slogan.
Directive vs. supportive
Concerning the measures optimal for COVID prevention, people have split opinions. The Chinese government believes that they should play a directive role, whereas I would like to argue that a supportive role is more appropriate.
The Chinese government has been adopting draconian measures in Jan 2020 since the Wuhan outbreak. Technologies such as big data, machine learning, and artificial intelligence allow the Chinese government to micro-control the Chinese like the units in the game StarCraft. Health code and trajectory code become Chinese people’s e-shackle. The Chinese government happens also to be the richest in the world. Expensive PCR tests are used extravagantly without any worry about the social security fund. Fortune and technology empower the Chinese government to do whatever they want.
I, albeit being an expert on machine learning, disagree with this approach. Being able to do one thing does not mean that one should do that. The Chinese government can micro-control people, but they cannot micro-control the virus. I believe that the Chinese government should, instead, play a supportive role. Traffic accidents, for instance, are similar to and as frequent as COVID transmission, but the government never micro-controls every vehicle to avoid crashes or lock cities down to reduce the accident rate. Rather, the government raises public awareness and encourages companies to design safer vehicles.
The Chinese government regards people as feelingless, displaceable objects, whereas I regard people as rational agents who can make the best choice for them. I strongly maintain that rationality is the key to winning the battle against Omicron and that a supportive role by the government makes the best use of people’s rationality.
In this section, I will propose several short-run measures, which are all supportive and take both epidemic and economy into consideration.
First, the government should raise public awareness. The Chinese government’s directive measures have made the Chinese too dependent on the government. The Chinese still do not understand COVID’s transmission mechanism. Rather than using facial masks as a tool of distancing, they see them as bulletproof vests. During an outbreak, many walk alone on the street with a mask on their face as if some sniper would shoot the virus into their mouth. When an epidemic is not announced, many do not wear a mask even in a crowded lift.
Second, the government should advise people to increase social distance. Social distance includes but is not limited to physical distance. The social distance between two persons wearing N95 masks is greater than wearing ordinary masks with the same physical distance. On the other hand, one meter in the cinema is closer than one meter on the street. The government can advise people to wear N95 masks in closed spaces, such as buses, trains, and airplanes. These N95 masks can be reused depending on the actual length of wearing time to prevent waste.
Third, PCR tests should be saved for the service sector, especially small, family-run businesses. These people have higher exposure and are riskier once infected. In these businesses, restaurants have the most hazard. Apart from the cooked food’s nature as an ideal transmission medium, employees in this industry are poorly educated and thus less likely to follow regulations (e.g., wearing masks). On the other hand, cooked food is essential to people from all social layers, and it ignores physical distance through delivery. The government should test them regularly as the Holland government regularly tests sex workers in the red district.
Fourth, the government should adopt a more flexible quarantine strategy. The current compulsory quarantine measure not only ignores the function of the quarantined in his company and family but also unnecessarily increases the burden on medical resources. Here are some scenarios where better measures can be taken.
- Infectious single persons. Infectious single persons can be isolated at home. There is no need to transfer him to the collective quarantine location.
- Infectious delivery husband and healthy wife. The husband can be quarantined with other infectious, and the wife can stay at home.
- Infectious streamer wife and healthy husband. The husband can be displaced and live in a location reserved for people in a similar condition. The wife can be quarantined at home and continue her streaming and receive income.
- Infectious parents with healthy children. The children can be displaced and supervised in a special-purposed facility. The parents can be quarantined at home.
- Infectious worker with important social or family function. The infectious worker is separated from his family but still allowed to work. He should take strict measures to protect others and report his trajectory.
These quarantine measures can be carried out even without a universal screening. For instance, an infected husband naturally will want to leverage the government’s quarantine facilities to protect his family member. As long as the government makes sensible policy and good quarantine facilities, people will make the right choice for their families and society.
Instead of making ad hoc micro-control, the government should take measures with a long-term effect on contagious diseases in general. For instance, the government can establish standards for the ventilation system. They can also improve outdoor air quality by shutting down polluting factories so that residents are more willing to open their windows.
There is also a big market for companies. Instead of installing stupid face recognition systems at the neighborhood entrance, companies can, for instance, develop voice-controlled lifts. Users control the lift by voice, rather than pushing contaminated buttons, and thus reduce exposure.
Both zero-COVID and living-with-COVID are slogans; they are not concrete measures nor actual outcomes. The pandemic can only be defeated by concrete, realistic measures that balance epidemic and economy and short-term and long-term goals.
The Chinese government has been adopting exclusively a directive role. I believe, however, that they should also explore the supportive role by trusting people’s rationality.
The advice in this post is made assuming the unavailability of Rapid Antigen Tests (RAT). With RAT, more creative strategies are available, which will be the subject of a future post.