Zero-COVID

A barrier on the state border of Queensland and New South Wales preventing interstate travel in April 2020 during the COVID-19 pandemic in Australia.

Zero-COVID, also known as COVID-Zero and "Find, Test, Trace, Isolate and Support" (FTTIS), is a public health policy that has been implemented by some countries during the COVID-19 pandemic.[1] In contrast to the living with COVID-19 strategy, the zero-COVID strategy is a "control and maximum suppression" strategy.[1] It involves using public health measures such as contact tracing, mass testing, border quarantine, lockdowns and mitigation software in order to stop community transmission of COVID-19 as soon as it is detected. The goal of the strategy is to get the area back to zero new infections and resume normal economic and social activities.[1][2]

A zero-COVID strategy consists of two phases: an initial suppression phase in which the virus is eliminated locally using aggressive public health measures, and a sustained containment phase, in which normal economic and social activities resume and public health measures are used to contain new outbreaks before they spread widely.[2] This strategy has been utilized to varying degrees by Australia, Canada,[3] mainland China, Hong Kong,[4] Macau,[5] New Zealand, Singapore, Scotland,[6] South Korea,[7] Taiwan,[8] Tonga,[9] and Vietnam.[10][11] As of late 2021, due to challenges with the increased transmissibility of the Delta variant and Omicron variant, and also the arrival of COVID-19 vaccines, some countries are no longer pursuing zero-COVID. Currently, Mainland China,[12] Hong Kong,[13] Taiwan and [14] Tonga[9] are still pursuing a zero-COVID strategy.

Experts differentiate between zero-COVID, which is an elimination strategy, and mitigation strategies that attempt to lessen the effects of the virus on society, but which still tolerate some level of transmission within the community.[15][2] These initial strategies can be pursued sequentially or simultaneously during the acquired immunity phase through natural and vaccine-induced immunity.[16]

Advocates of zero-COVID have pointed to the far lower death rates and higher economic growth in countries that have pursued elimination, compared with countries that have pursued mitigation,[15] and argue that swift, strict measures to eliminate the virus allow a faster return to normal life.[15] Opponents of zero-COVID argue that "it's not realistic to eliminate a respiratory virus such as SARS-CoV-2, any more than it is to eliminate the flu or the common cold".[17] To achieve zero-COVID in an area with high infection rates, one review estimated that it would take three months of strict lockdown.[18]

Elimination vs. mitigation

Goals of mitigation include delaying and reducing peak burden on healthcare (flattening the curve) and lessening overall cases and health impact. In contrast, zero-COVID strategies aim to completely eliminate the virus and return to normal social and economic activities.

Epidemiologists differentiate between two broad strategies for responding to the COVID-19 pandemic: mitigation and elimination.[2][19][20] Mitigation strategies (also commonly known as "flattening the curve") aim to reduce the growth of an epidemic and to prevent the healthcare system from becoming overburdened, yet still accept a level of ongoing viral transmission within the community.[2] By contrast, elimination strategies (commonly known as "zero-COVID") aim to completely stop the spread of the virus within the community in order to allow the resumption of normal social and economic activity.[2] In comparison with mitigation strategies, elimination involves stricter short-term measures to completely eliminate the virus, followed by milder long-term measures to prevent a return of the virus.[2][19]

After elimination of COVID-19 from a region, zero-COVID strategies require stricter border controls in order to prevent reintroduction of the virus, more rapid identification of new outbreaks and better contact tracing to end new outbreaks.[19] Advocates of zero-COVID argue that the costs of these measures are lower than the economic and social costs of long-term social distancing measures and increased mortality incurred by mitigation strategies.[19][2]

The long-term "exit path" for both elimination and mitigation strategies depends on the development of effective vaccines and treatments for COVID-19.[19][2]

Containment measures

The zero-COVID approach aims to prevent viral transmission, using a number of different measures, including vaccination and non-pharmaceutical interventions such as contact-tracing and quarantine. Successful containment or suppression reduces the basic reproduction number of the virus below the critical threshold.[20] Different combinations of measures are used during the initial containment phase, when the virus is first eliminated from a region, and the sustained containment phase, when the goal is to prevent reestablishment of viral transmission within the community.[21]

Lockdowns

Lockdowns encompass measures such as closure of non-essential businesses, stay-at-home orders and movement restrictions.[21] During lockdowns, governments must often supply basic necessities to households.[21][2] Lockdown measures are commonly used to achieve initial containment of the virus.[21] In China, lockdowns of specific high-risk communities are also sometimes used to suppress new outbreaks.[2]

Quarantine for travelers

In order to prevent reintroduction of the virus into zero-COVID regions after initial containment has been achieved, quarantine for incoming travelers is commonly used. As each infected traveler could seed a new outbreak, the goal of travel quarantine is to intercept as large a percentage of infected travelers as possible.[21][22]

International flights to China are heavily restricted, and incoming travelers are required to undergo PCR testing and quarantine in designated hotels and facilities.[23] In order to facilitate quarantine for travelers, China has constructed specialized facilities at its busiest ports of entry, including Guangzhou and Xiamen.[21] New Zealand and Australia have also established managed isolation and quarantine facilities for incoming travelers.[22]

Through November 2020, border quarantine measures prevented nearly 4,000 infected international travelers from entering the wider community within China.[24] Each month, hundreds of travelers who test negative before flying to China subsequently test positive while undergoing quarantine after arrival.[21]

Contact tracing, quarantine and isolation

Transmission chains

Contact-tracing involves identifying people who have been exposed to an infected person. When an infected person is identified, public health workers attempt to locate the people with whom they have come into close contact, and to quarantine and test them. Various studies have argued that early detection and isolation of infected people is the single most effective measure for preventing transmission of SARS-CoV-2.[21][2]

In China, when an infected person is identified, all close contacts are required to undergo a 14-day quarantine, with multiple rounds of PCR testing.[24] In order to minimize the risk that infected people will transmit the virus to family members, China has implemented quarantine in centralized facilities for those close contacts deemed to be at the highest-risk of infection.[21] Secondary close contacts (contacts of close contacts) are sometimes required to quarantine at home.[21]

The widespread use of smartphones has enabled more rapid "digital" contact tracing. In China, "health code" applications are used to facilitate the identification of close contacts.[2] Taiwan has made use of digital contact tracing, notably to locate close contacts of passengers who disembarked from the Diamond Princess cruise ship, the site of an early outbreak in February 2020.[25]

Routine testing of key populations

In China, routine PCR testing is carried out on all patients who present with fever or respiratory symptoms.[24] In addition, various categories of workers, such as medical staff and workers who handle imported goods, are regularly tested.[24]

In China, routine testing of key populations has identified index patients in a number of outbreaks, including outbreaks in Beijing, Shanghai, Dalian, Qingdao, and Manchuria.[21] In some cases, index patients have been discovered while asymptomatic, limiting the amount of onward transmission into the community.[21]

Community-wide screening

An additional tool for identifying cases outside of known transmission chains is community-wide screening, in which populations of specific neighborhoods or cities are PCR tested. In China, community-wide PCR testing is carried out during outbreaks in order to identify infected people, including those without symptoms or known contact with infected people.[24] Community-wide screening is intended to rapidly isolate infected people from the general population, and to allow a quicker return to normal economic activity.[24] China first carried out community-wide screening from 14 May to 1 June 2020 in Wuhan, and has used this technique in subsequent outbreaks.[24] In outbreaks in June 2020 in Beijing and July 2020 in Dalian, community screening identified 26% and 22% of infections, respectively.[21] In order to test large populations quickly, China commonly uses pooled testing, combining 5 to 10 samples before testing, and retesting all individuals in each batch that tests positive.[21]

Zero-COVID implementation by region

Australia

COVID-19 travel restrictions for Australians and permanent residents

The first confirmed case in Australia was identified on 25 January 2020, in Victoria, when a man who had returned from Wuhan, Hubei Province, China, tested positive for the virus.[26] A human biosecurity emergency was declared on 18 March 2020. Australian borders were closed to all non-residents on 20 March,[27] and returning residents were required to spend two weeks in supervised quarantine hotels from 27 March.[28] Many individual states and territories also closed their borders to varying degrees, with some remaining closed until late 2020,[29] and continuing to periodically close during localised outbreaks.[30]

Social distancing rules were introduced on 21 March, and state governments started to close "non-essential" services.[31][32] "Non-essential services" included social gathering venues such as pubs and clubs but unlike many other countries did not include most business operations such as construction, manufacturing and many retail categories.[33]

During the second wave of May and June 2020, Victoria underwent a second strict lockdown with the use of helicopters and the Army to help the police enforce the "zero Covid" lockdown in Sydney.[34][35] The wave ended with zero new cases being recorded on 26 October 2020.[36][37][38] Distinctive aspects of that response included early interventions to reduce reflected transmission from countries other than China during late January and February 2020; early recruitment of a large contact tracing workforce;[39] comparatively high public trust in government responses to the pandemic, at least compared to the US;[40] and later on, the use of short, intense lockdowns to facilitate exhaustive contact tracing of new outbreaks.[41][42] Australia's international borders also remained largely closed, with limited numbers of strictly controlled arrivals, for the duration of the pandemic.[43] Australia sought to develop a Bluetooth-based contact tracing app that does not use the privacy-preserving Exposure Notification framework supported natively by Android and Apple smartphones, and while these efforts were not particularly effective,[44][45][46] QR code-based contact tracing apps became ubiquitous in Australia's businesses.[47][48][49]

Due to the transmissibility of the Delta variant, which led to a major outbreak in New South Wales, the federal government and certain states of Australia outlined plans to phase out the zero-COVID strategy in August 2021, once the country reached a threshold of vaccination in the population.[50]

Canada

Canadian federal vaccination certificate "Vaccine Passport" issued in Yukon territory

The virus was confirmed to have reached Canada on January 27, 2020, after an individual who had returned to Toronto from Wuhan, Hubei, China, tested positive. The first case of community transmission in Canada was confirmed in British Columbia on March 5.[51] In March 2020, as cases of community transmission were confirmed, all of Canada's provinces and territories declared states of emergency. Provinces and territories have, to varying degrees, implemented school and daycare closures, prohibitions on gatherings, closures of non-essential businesses and restrictions on entry. Canada severely restricted its border access, barring travellers from all countries with some exceptions. The federal Minister of Health invoked the Quarantine Act, introduced following the 2002–2004 SARS outbreak.[52] The act was used to legally require all travellers (excluding essential workers) returning to the country to self-isolate for 14 days, until rules were changed to accommodate the fully vaccinated.[52] York University health law professor Steven Hoffman described the use of the act as the broadest in Canadian history.[52]

On September 23, 2020, Prime Minister Trudeau declared that Canada was experiencing a "second wave" of the virus.[53] New restrictions from provincial governments were put in place once again as cases increased, including variations of regional lockdowns. In late November, there was the disbandment of the Atlantic Bubble, a travel-restricted area of the country (formed of the four Atlantic provinces: New Brunswick, Prince Edward Island, Nova Scotia, and Newfoundland and Labrador) which had been established in July 2020.[54]

Nation-wide cases, hospitalizations and deaths spiked again preceding the Christmas and holiday season in December 2020 and January 2021. Alarmed by hospital capacity issues, fatalities and new cases, heavy restrictions (such as lockdowns and curfews) were put in place again in affected areas (primarily Ontario, Quebec, and Alberta) and across the country. These lockdowns resulted in active cases to steadily decline, reaching a plateau in active cases in mid-February 2021.[55] After the Christmas and holiday season in December 2021 and January 2022, cases began to surge again across Canada, notably in the provinces of British Columbia, Alberta, Quebec and Ontario. During this fourth wave of the virus, return to pandemic restrictions such as business closures and capacity limits were reinstated in provinces like Ontario, British Columbia and Alberta.[56] Vaccine passports were adopted in all provinces and two of the territories.[57][58]

China

Since 25 January 2020, all passengers entering or exiting mainland China in Beijing, Shanghai and Guangdong must write a health declaration where the individual must answer whether they have been to Hubei Province. This declaration form can also be filled by using WeChat.[59]

China was the first country to experience the COVID-19 pandemic. The first cluster of pneumonia patients was discovered in late December 2019 in Wuhan, Hubei Province, and a public notice on the outbreak was distributed on 31 December 2019.[60]

On 23 January 2020, the Chinese government banned travel to and from Wuhan, and began implementing strict lockdowns in Wuhan and other cities throughout China.[60] These measures suppressed onward suppressed transmission of the virus below the critical threshold, bringing the basic reproduction number of the virus to near zero.[60] On 4 February 2020, around two weeks after the beginning of the lockdowns in Hubei province, case counts peaked in the province and began to decline thereafter.[60] The outbreak remained largely concentrated within Hubei province, with over 80% of cases nationwide through 22 March 2020 occurring there.[23]

The death toll in China during the initial outbreak was approximately 4,600 according to official figures (equivalent to 3.2 deaths per million population),[61] and has been estimated at under 5,000 by a scientific study of excess pneumonia mortality published in The BMJ.[62]

As the epidemic receded, the focus shifted towards restarting economic activity and preventing a resurgence of the virus.[63] Low- and medium-risk areas of the country began to ease social distancing measures on 17 February 2020.[63] Reopening was accompanied by an increase in testing and the development of electronic "health codes" (using smartphone applications) to facilitate contact tracing.[63] Health code applications contain personalized risk information, based on recent contacts and test results.[63] Wuhan, the last major city to reopen, ended its lockdown on 8 April 2020.[64]

China reported its first imported COVID-19 case from an incoming traveler on 30 January 2020.[63] As the number of imported cases rose and the number of domestic cases fell, China began imposing restrictions on entry into the country.[63] Inbound flights were restricted, and all incoming passengers were required to undergo quarantine.[63]

After the containment of the initial outbreak in Wuhan, the Chinese Center for Disease Control and Prevention (China CDC) argued, "The successful containment effort builds confidence in China, based on experience and knowledge gained, that future waves of COVID-19 can be stopped, if not prevented. Case identification and management, coupled with identification and quarantine of close contacts, is a strategy that works."[2] The China CDC rejected a mitigation strategy, and instead explained that "[t]he current strategic goal is to maintain no or minimal indigenous transmission of SARS-CoV-2 until the population is protected through immunisation with safe and effective COVID-19 vaccines, at which time the risk of COVID-19 from any source should be at a minimum. This strategy buys time for urgent development of vaccines and treatments in an environment with little ongoing morbidity and mortality."[2]

Since the end of the initial outbreak in Wuhan, there have been additional, smaller outbreaks caused by imported cases, which have been controlled through short-term, localized intense public health measures.[64] From July through August 2021, China experienced and contained 11 outbreaks of the Delta variant, with a total of 1,390 detected cases (out of a population of 1.4 billion in mainland China).[65] The largest of these outbreaks, in both geographic extent and in the number of people infected, began in Nanjing.[65] The index case of the outbreak, an airport worker, tested positive on 20 July 2021, and the outbreak was traced back to an infected passenger on a flight from Moscow that had arrived on 10 July.[65] The outbreak spread to multiple provinces before it was contained, with a total of 1,162 detected infections.[65] China has made use of mass testing to control several outbreaks. For example, nearly the entire population of the city of Guangzhou - approximately 18 million residents - were tested over the course of three days in June 2021, during a Delta variant outbreak.[66]

Hong Kong

Tong Ming Street Park Covid-19 testing center

The virus was first confirmed to have spread to Hong Kong on 23 January 2020.[67] On 5 February, after a five-day strike by front-line medical workers, the Hong Kong government closed all but three border control points – Hong Kong International Airport, Shenzhen Bay Control Point, and Hong Kong–Zhuhai–Macau Bridge Control Point remaining open. Hong Kong was relatively unscathed by the first wave of the COVID-19 outbreak. Some experts believe the habit of wearing masks in public since the SARS epidemic of 2003 may have helped keep its confirmed infections rates low.[68] In a study published in April 2020 in the Lancet, the authors expressed their belief that border restrictions, quarantine and isolation, social distancing, and behavioural changes likely all played a part in the containment of the disease up to the end of March.[69]

After a much smaller second wave in late March and April 2020,[70] Hong Kong saw a substantial uptick in COVID cases in July.[71] Experts attributed this third wave to imported cases – sea crew, aircrew members, and domestic helpers made up the majority of 3rd wave infections.;[71] Measures taken in response included a suspension of school classroom teaching until the end of the year, and an order for restaurants to seat only two persons per table and close at 10:00 p.m. taking effect on 2 December;[72] a further tightening of restrictions saw, among other measures, a 6pm closing time of restaurants starting from 10 December, and a mandate for authorities to order partial lockdowns in locations with multiple cases of COVID-19 until all residents were tested.[73] From late January 2021, the government repeatedly locked down residential buildings to conduct mass testings. A free mass vaccination program with the Sinovac vaccine and Pfizer–BioNTech vaccine was launched on 26 February. The government sought to counter the vaccine hesitancy by material incentives, which led to an acceleration of vaccinations in June.[74] From early 2022, to prevent the spread of the Omicron variant, Hong Kong had been placed under tightened alert until the day it became 70% fully inoculated.[75]

New Zealand

An Emergency Mobile Alert sent at 18:30 on 25 March 2020, informing of the imminent move to Alert Level 4.

New Zealand reported its first case of COVID-19 on 28 February 2020.[76] From 19 March, entry into New Zealand was limited to citizens and residents,[77] and the country began quarantining new arrivals in converted hotels on 10 April.[78]

On 21 March, a four-tier alert level system was introduced, and most of the country was placed under lockdown from 25 March.[79] Due to the success of the elimination strategy, restrictions were progressively lifted between 28 April and 8 June, when the country moved to the lowest alert level, and the last restrictions (other than quarantine for travelers) were removed.[80][81][82][83][84]

After the lifting of restrictions, New Zealand went for 102 days without any community transmission.[85] On 11 August 2020, four members of a single family in Auckland tested positive for SARS-CoV-2, prompting a city-wide lockdown, and lesser restrictions throughout New Zealand.[85] Additional cases related to this cluster of infections were identified over the following weeks. On 21 September, after a week without any new cases of community transmission, restrictions were dropped to the lowest level outside of Auckland. Restrictions in Auckland were eased somewhat two days later,[86] and moved to the lowest level on 7 October.[87]

Additional small outbreaks led to temporary restrictions in parts of New Zealand in February, March, and June 2021.[88]

The country moved to a nationwide lockdown on 17 August 2021, after the detection of one new local case outside of quarantine in Auckland.[89] Over the following weeks, Auckland remained under lockdown as cases rose, while the most of the rest of the country progressively eased restrictions.[88] On 4 October 2021, the government of New Zealand announced that it was transitioning away from its zero-COVID strategy, arguing that the Delta variant made elimination infeasible.[90]

North Korea

North Korea also reportedly follows an 'elimination strategy'.[91]

Masikryong Ski Resort, a popular ski resort in North Korea. Due to the outbreak of the virus, ski resorts and spas in North Korea have been closed.

North Korea was one of the first countries to close borders due to COVID-19.[92][93] Starting from 23 January, North Korea banned foreign tourists, and all flights in and out of the country were halted. The authorities also started placing multiple suspected cases, those with slight symptoms such as flu in quarantine for two weeks in Sinuiju.[94][95][96] On 30 January, the state news agency of North Korea, Korean Central News Agency, declared a "state emergency" and reported the establishment of anti-epidemic headquarters around the country.[97] Though many parts of the border were closed, the bridge between Dandong and Sinuiju remained open and allowed supplies to be delivered.[98] In late February, the North Korean government said that it would keep the border closed until a cure was found.[99]

On 2 February, KCNA reported that all the people who had entered the country after 13 January were placed under "medical supervision".[97] South Korean media outlet Daily NK reported that five suspected COVID-19 patients in Sinuiju on the Chinese border had died on 7 February.[100] Within the same day, The Korea Times reported that a North Korean female living in the capital Pyongyang was infected.[101] Despite no confirmation by North Korean authorities on the claims, the country implemented further strict measures to combat the spread of the virus.[102][103] Schools were closed starting on 20 February.[104] On 29 February, Supreme Leader Kim Jong-un called for stronger measures to be taken to prevent COVID-19 from spreading to North Korea.[105]

In early February, the North Korean government took severe measures to block the spread of COVID-19. Rodong Sinmun, the Workers' Party of Korea newspaper, reported that the customs officials at Nampo port were performing disinfection activities, including placing imported goods in quarantine.[106] All international flights and railway services were suspended in early February, and connections by sea and road were largely closed over the following weeks.[99] In February, wearing face masks was obligatory and visiting public places such as restaurants was forbidden. Ski resorts and spas were closed and military parades, marathons, and other public events were cancelled.[99] Schools were closed throughout the country; university students in Pyongyang from elsewhere in the country were confined to their dormitories.[107][104]

Although South Korean media reported the epidemic had spread to North Korea, the WHO said there were no indications of cases there.[108] On February 18, Rodong Sinmun, the official newspaper of North Korea's ruling party, quoted a public health official reiterating that there had been "no confirmed case of the new coronavirus so far". The WHO prioritised aid for North Korea, including the shipment of protective equipment and supplies.[109]
Kaesong, where a suspected case was reported in July 2020
On July 25, Kim Jong-un attended an emergency meeting after a suspected COVID-19 case was reported in the city of Kaesong. Kim declared a state of emergency and imposed a lockdown on the city.[110][111] The suspected case was reported to be an individual who had defected to South Korea three years earlier, before returning to North Korea. According to a South Korean senior health official, the individual was neither registered as a COVID-19 patient nor classified as someone who came in contact with other patients. Two close contacts of the defector in South Korea tested negative for the virus.[112] On August 5, Salvador said the returning defector was tested but the "results were inconclusive".[113] On August 14, the three week lockdown in Kaesong and nearby areas was lifted by Kim Jong-un,[114] after 'the scientific verification and guarantee by a professional anti-epidemic organisation'.[115]

Scotland and Northern Ireland

Scotland, led by its devolved government, pursued an "elimination" COVID-19 strategy starting from April 2020.[116] The Scottish government's approach diverged with that of the central British government in April 2020, after a UK-wide lockdown began being lifted. Scotland pursued a slower approach to lifting the lockdown than other nations of the UK, and expanded a "test and trace" system.[116] Although Northern Ireland also pursued the strategy[6][117] and Scottish First Minister Nicola Sturgeon advocated for the approach to be adopted by the whole of the UK,[117] the central British government pursued a different mitigation strategy that applied to England, with commentators noting that this combined with an open Anglo-Scottish border could undermine Scotland's attempts at elimination.[118][6][119]

Singapore

An automatic self-check-in station at Paya Lebar Square mall implemented to facilitate contact tracing.

Singapore recorded its first COVID-19 case on 23 January 2020.[120] With that, many Singaporeans had purchased and worn masks when not at home; practiced social distancing and on 7 February 2020, Singapore raised the Disease Outbreak Response System Condition (DORSCON) level from Yellow to Orange in response to additional local cases of uncertain origin.[121] On 3 April 2020 a stringent set of preventive measures collectively called the "circuit breaker lockdown" was announced.[122] Stay-at-home order and cordon sanitaire were implemented as a preventive measure by the Government of Singapore in response on 7 April 2020. The measures were brought into legal effect by the Minister for Health with the COVID-19 (Temporary Measures) (Control Order) Regulations 2020, published on 7 April 2020.[123]

The country introduced what was considered one of the world's largest and best-organised epidemic control programmes.[124][125] The "Control Order" implemented various measures such as; mass testing the population for the virus, isolating any infected people as well as introducing contact tracing apps and strictly quarantining those they had close contact with those infected All non-essential workplaces closed, with essential workplaces remaining open. All schools transitioned to home-based learning. All food establishments were only allowed to offer take-away, drive-thru and delivery of food. Non-essential advertising at shopping centres are not allowed to be shown or advertised and only advertising from essential service offers and safe management measures such as mask wearing and social distancing are allowed.[126]

Such measures have helped avoid further lockdowns after the end of the circuit breaker lockdown measures in June 2020. With its relative success in curbing the early spread of the virus in Singapore, the term "circuit breaker" and its measures was subsequently adopted by other countries, particularly in Canada and the United Kingdom.[127][128] In October 2021, Singapore began phasing out its zero-COVID strategy after vaccinating the majority of its population.[129]

South Korea

A drive-through testing site in South Korea

The first case in South Korea was announced on 20 January 2020.[130] On 4 February 2020, in order to help prevent spread of the disease, South Korea began denying entry to foreigners traveling from China.[131][132] Various other measures have been taken: mass testing the population, isolating infected people, and trace and quarantine of those they had contact with.[133][134] The rapid and extensive testing undertaken by South Korea has been judged successful in limiting the spread of the outbreak, without using drastic measures.[133][135][136] There was no general lockdown of businesses in South Korea, with supermarkets and other retailers remaining open. However, schools, universities, cinemas, and gyms were closed soon after the outbreaks, with schools and universities having online classes.[137]

The government is providing citizens with information in Korean, English, Chinese, and Japanese on how to not become infected and how to prevent spreading the disease as part of its "K-Quarantine" measures. This includes information on cough etiquette, when and how to wear a face mask, and the importance of physical distancing and staying at home.[137] The South Korean government has also been sending daily emergency notifications, detailing information on locations with reported infections and other status updates related to the pandemic.[138] Infected South Koreans are required to go into isolation in government shelters. Their phones and credit card data are used to trace their prior movements and find their contacts. People who are determined to have been near the infected individual receive phone alerts with information about their prior movements.[139]

Taiwan

Body temperature checkpoint at National Taiwan Normal University

Due to its extensive cultural and economic exchanges with mainland China, Taiwan was initially expected to be at high risk of developing a large-scale outbreak of COVID-19.[140][141]

Immediately after China notified the WHO of a pneumonia cluster in Wuhan on 31 December 2019, Taiwanese officials began screening passengers arriving from Wuhan for fever and pneumonia.[141] This screening was subsequently broadened to all passengers with respiratory symptoms who had recently visited Wuhan.[141] Beginning in early February 2020, all passengers arriving from mainland China, Hong Kong or Macau were required to quarantine at home for 14 days after arrival in Taiwan.[25] Mobile phone data was used to monitor compliance with quarantine requirements.[141]

Public places such as schools, restaurants and offices in Taiwan were required to monitor body temperature of visitors and provide hand sanitizer.[142] Mask-wearing was encouraged, and on 24 January, an export ban and price controls were placed on surgical masks and other types of personal protective equipment.[142]

On 20 March 2020, Taiwan initiated 14-day quarantine for all international arrivals, and began converting commercial hotels into quarantine facilities.[143] In early April, Taiwanese public health officials announced social distancing measures, and mandated mask use in public transport.[25]

The first known case of COVID-19 in Taiwan was identified on 21 January 2020.[142] On 31 January, approximately 3,000 passengers from the Diamond Princess cruise ship went ashore in Taiwan. Five days later, it was recognized that there was an outbreak on the ship.[144] Taiwanese public health authorities used mobile phone data and other contact tracing measures to identify these passengers and their close contacts for testing and quarantine.[144] No cases related to these passengers were identified in Taiwan.[144]

Taiwan maintained near-zero viral prevalence throughout 2020, totaling just 56 known locally transmitted cases (out of a population of 23.6 million) through 31 December 2020.[140]

Taiwan experienced its largest outbreak from April to August 2021, initially caused by violations of COVID-19 quarantine rules by international flight crews.[145][146] On 15 May 2021, Taiwan identified more than 100 daily cases for the first time since the start of the pandemic.[147] The outbreak was brought to an end on 25 August 2021, when Taiwan recorded no new locally transmitted cases for the first time since May 2021.[148]

Tonga

Tonga has followed a "COVID-free" policy, and there has been only one confirmed case in the country (a traveller in quarantine in October 2021). The country's zero-COVID policy has caused complications with international aid following the Hunga Tonga volcano eruption in 2022.[149] To keep the country virus-free, an Australian aid flight had to return to base after detecting a case midflight, while HMAS Adelaide (L01) made plans to stay at sea after 23 members of her crew tested positive for COVID-19.[150]

Vietnam

A Vietnamese COVID shopping coupon, it is used to manage the number of people entering market or supermarket.

The virus was first confirmed to have spread to Vietnam on 23 January 2020, when two Chinese people in Ho Chi Minh City tested positive for the virus.[151][152] In response the government issued a diagnostic and management guidelines for COVID-19, providing instructions on contact tracing and 14-day isolation.[11] Health authorities began monitoring body temperatures at border gates and started detection and contact tracing, with orders for the mandatory isolation of infected people and anyone they had come into contact with.[153]

In 2020, Vietnam was cited by global media as having one of the best-organized epidemic control programs in the world,[154][155][156] along the lines of other highlights such as Taiwan and South Korea.[157] This success has been attributed to several factors, including a well-developed public health system, a decisive central government, and a proactive containment strategy based on comprehensive testing, tracing, and quarantining.[10] Howerver, instead of relying on medicine and technology, the Vietnamese state security apparatus has adopted an widespread of public surveillance system along with a public well-respected military force.[158][159]

Starting in April 2021, Vietnam experienced its largest outbreak to date, with over 1.2 million infections recorded by November.[160] This led to two of its largest cities (Ho Chi Minh City and Hanoi) and around a third of the country's population coming under some form of lockdown by late July.[161] A degree of complacency after successes in previous outbreaks, and infections originating from foreign workers were all considered to have contributed to the outbreak. In response, government-mandated quarantine for foreign arrivals and close contacts to confirmed cases was extended to 21 days, and accompanying safety measures also tightened up.[162]

In September 2021, Vietnam abandoned its zero-COVID strategy, after a three-month lockdown of Ho Chi Minh city caused major economic disruption in the city and failed to contain the outbreak. The country shifted to a phased reopening and more flexible approach while expanding its vaccination programme.[163][164]

Views on the zero-COVID strategy

Proponents of the zero-COVID strategy argue that successful execution reduces the number of nationwide lockdowns needed,[165] that healthcare and economic costs are lower,[166][167] that it is less costly to society,[168] that it reduces dependence on pharmaceutical interventions such as vaccines,[169] and that it increases quality of life and life expectancy due to fewer citizens contracting COVID-19.[170]

Opponents of the zero-COVID strategy argue that a vaccine would be required to end the pandemic,[117] that zero-COVID causes the economy to suffer,[171][172] that before vaccinations were common, elimination strategies lowered herd immunity,[173] that zero-COVID is not sustainable,[174] and that newer variants such as the omicron variant are so transmissible that the zero-COVID strategy is no longer feasible.[175]

Some countries such as Vietnam, Singapore, and Australia pursued zero-COVID but later decided to discontinue it.[173]

See also

References

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Further reading

External links

Media files used on this page

Coronavirus. SARS-CoV-2.png
Author/Creator: Alexey Solodovnikov (Idea, Producer, CG, Editor), Valeria Arkhipova (Scientific Сonsultant), Licence: CC BY-SA 4.0
Scientifically accurate atomic model of the external structure of the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2), a strain (genetic variant) of the coronavirus that caused Coronavirus disease (COVID-19), first identified in Wuhan, China, during December 2019

Each separate locus (amorphous blob) is an atom of:

  cobalt: membrana
  crimson: E protein
  green: M protein
  orange: glucose (glycan)
  turquoise : S (spike) glycoprotein
SARS-CoV-2 (Wikimedia colors).svg
Author/Creator: Geraki, Licence: CC BY-SA 4.0
SARS-CoV-2 logo in Wikimedia colors
Canadian COVID-19 proof of vaccination.jpg
Author/Creator:

Government of Canada

, Licence: PD

Canadian COVID-19 proof of vaccination

PRC Exit-Entry Health Declaration Form - February 2020.jpg
Author/Creator: Amakuha, Licence: CC BY-SA 4.0
Exit/Entry Health Declaration Form of the People's Republic of China. (Second edition. Published on 29 January 2020). Travellers leaving China had to fill in this form in early February. Third question: "Have you been to Hubei Province, China in the past 14 days?". Location of the photo: Futian Checkpoint, Shenzhen.
COVID-19 travel restrictions for Australians.png
(c) Australian Government Department of Home Affairs, CC BY 3.0 au
Screenshot of the Australian Government Department of Home Affairs page stating travel restrictions for Australian citizens and permanent residents.
Vietnam's shopping coupon used during COVID-19.jpg
Vietnam's shopping coupon used during COVID-19
Coronavirus Check by Drive-Through.jpg
Author/Creator:

Government of S.Korea: http://www.gyeongju.go.kr

Applets-screenshooter.svg This photo was taken with Nikon D4S, Licence: KOGL Type 1
Corona Virus Drive Thru Test in South Korea
Qld Border Closure - Coolangatta Boundary St.jpg
Author/Creator: Advanstra, Licence: CC BY-SA 4.0
Queensland Border Closures during the COVID-19 Pandemic
HK TKO 將軍澳 Tseung Kwan O 唐明街公園 Tong Ming Street Park Covid-19 testing sample collection community centre by 相達生物科技 PHASE Scientific February 2022 Px3 04.jpg
Author/Creator: Gorgeo Wrmalauoi Htainup, Licence: CC BY-SA 4.0
HK TKO zh:將軍澳 Tseung Kwan O zh:唐明街公園 Tong Ming Street Park Covid-19 testing sample collection community centre by 相達生物科技 PHASE Scientific in February 2022
Covid-19-Contact-tracing-Infectious-timeline-02.gif
Author/Creator: Siouxsie Wiles & Toby Morris, Licence: CC BY-SA 4.0
An example of transmission chains
Masikryong-Hotel-and-Lift.jpg
Author/Creator: Bjørn Christian Tørrissen, Licence: CC BY-SA 3.0
The hotel and base station at the Masikryong Ski Resort. A large video screen is located next to the ski lift's starting point.
Emergency Mobile Alert NZ, COVID-19, 25 March 2020.jpg
Author/Creator: Lcmortensen, Licence: CC BY-SA 4.0
An Emergency Mobile Alert message in New Zealand on 25 March 2020, regarding the imminent move to COVID-19 Alert Level 4 (nationwide lockdown) at 11:59pm that night.

Message text:

NATIONAL EMERGENCY MANAGEMENT AGENCY ALERT: From 11:59pm tonight, the whole of New Zealand moves to COVID-19 Alert Level 4.

This message is for all of New Zealand. We are depending on you.

Follow the rules and STAY HOME. Act as if you have COVID-19. This will save lives.

Remember:

  • Where you stay tonight is where YOU MUST stay from now on.
  • You must only be in physical contact with those you are living with.

It is likely Level 4 measures will stay in place for a number of weeks.

Lets all do our bit to unite against COVID-19.

Kia kaha.

Issued 25 March 2020 6:30pm.
20200410 Flatten the curve, raise the line - pandemic (English).gif
Author/Creator: RCraig09, Licence: CC BY-SA 4.0
Animated graphic showing "flattening the curve" (by slowing the spread of pandemics) and "raising the line" (increasing healthcare capacity), so that health care demands stay within capacity.

Designer's note:

  • An "international" version, without text, is shown and linked below.
  • Based on general ideas published in this source:
Barclay, Eliza; Scott, Dylan; Animashaun, Animashaun (April 7, 2020). "The US doesn’t just need to flatten the curve. It needs to “raise the line.”". Vox. Archived from the original on April 7, 2020.
  • Example of visualizing increasing healthcare capacity is found at:
Radtke, Alexander Flatten the coronavirus curve. FlowingData.com. Nathan Yau (editor) (March 9, 2020). Archived from the original on March 12, 2020.
  • I made 49 individual graphic frames manually with Inkskape (esp. its Bezier tool) and exported as 49 unique PNGs. I imported the 49 PNGs as layers into Gimp. To pad the beginning and end with a "stationary" intro and finish, I added about 30 extra first and last frames within Gimp before exporting as a 30 ms/frame GIF.
National Taiwan Normal University Coronavirus Prevention Efforts 20200410 105311.jpg
Author/Creator: Geographyinitiative, Licence: CC BY-SA 4.0
National Taiwan Normal University Coronavirus Prevention Efforts
Streets in Kaesong 09.JPG
Author/Creator: Nicor, Licence: CC BY-SA 3.0
Straße in Kaesong