Covid-19 Elimination Strategy [P.61/2020]

STATES OF JERSEY

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COVID-19 ELIMINATION STRATEGY

Lodged au Greffe on 14th May 2020 by Deputy J.H. Perchard of St. Saviour

STATES GREFFE

2020  P.61

PROPOSITION

THE STATES are asked to decide whether they are of opinion

1. to request  the  Chief  Minister  to  develop  and  implement  a  new Covid-19 elimination strategy', arising from which the Government of Jersey should revise its delay, contain, shield' policy and the safe exit framework' to reflect this new strategy;
2. that the elimination strategy' must detail a plan of action that will be implemented with the explicit aim of eliminating the virus in Jersey through  well-recognised  measures  used  to  eliminate  infectious diseases –

• rapid case detection identified by widespread testing, and rapid case isolation and contact tracing;

• continued intensive hygiene promotion;

• border controls with high-quality quarantine of those arriving in Jersey;

• intensive physical distancing that may include various severities of lockdown; and

• a co-ordinated communication strategy for elimination;

3. to request the Chief Minister to publish this elimination strategy' in a report to the States within 2 weeks of the date this proposition is adopted, and to publish updated versions of the strategy whenever guidance is altered, in order to ensure that everyone remains fully informed about the current strategy.

DEPUTY J.H. PERCHARD OF ST. SAVIOUR

REPORT

The problem with herd immunity' and flattening the curve'

To date, it has been clear that the Government believes that most people in the Island would need to contract Covid-19 in order for herd immunity to occur. This was an understandable assumption when first made, given that this pandemic was sudden and given what we know about other similar diseases; however, since then, we have learnt that there are many unanswered questions regarding Covid-19 immunity that render this approach less credible.

The World Health Organization ("WHO") recently stated that –

There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.'[1] (WHO, 24 April 2020).

It is clear that we do not yet know enough about the virus to know whether those who are infected obtain immunity, and, until there is a vaccine, Covid-19 will remain highly infectious and a threat to our community.

Furthermore, Dr. Ryan, Executive Director of the WHO's emergencies programme, stated at a recent press conference that –

the concept of herd immunity is generally reserved for calculating how many people will need to be vaccinated and the population in order to generate that effect'.

He went on to state the following –

I do think this idea that maybe countries who had lax measures and haven't done anything will all of a sudden magically reach some herd immunity, and so what if we lose a few old people along the way?' – is a really dangerous, dangerous calculation.'

In addition, flattening the curve without elimination will mean that we will need to continue to suppress social and economic activity for the next 12–18 months, maybe longer, writes CEO of the Grattan Institute, John Daley. As Daley (2020) points out, for many businesses, the absence of normal activity for even just a few months could be detrimental. He goes on to predict that the result of flattening the curve without pursuing elimination would be high levels of unemployment and a greater number of deaths[2].

The case for elimination

If we were to eliminate the virus locally, we could eventually see Jersey and its people experience a life that is somewhat similar to normality while we wait for a vaccine. Elimination could mean that social and economic activity would be allowed to increase,

which would bring with it a range of benefits both in terms of our well-being and our economy.

In an article published in The New Zealand Medical Journal, Baker et al. (April 2020) state that elimination is a well-recognised strategy for infectious disease control'3. In the context of Covid-19, they set out 5 essential elements' for a strategy for the elimination of Covid-19.

These are –

1. Border controls with high-quality quarantine of incoming travellers.
2. Rapid case detection identified by widespread testing, followed by rapid case isolation, with swift contact tracing and quarantine for contacts.
3. Intensive  hygiene  promotion  (cough  etiquette  and  hand-washing)  and provision of hand hygiene facilities in public settings.
4. Intensive  physical  distancing,  currently  implemented  as  a  lockdown (level 4 alert) that includes school and workplace closure, movement and travel  restrictions,  and  stringent  measures  to  reduce  contact  in  public spaces, with potential to relax these measures if elimination is working.
5. A well-co-ordinated communication strategy to inform the Public about control measures and about what to do if they become unwell, and to reinforce important health promotion messages.

As part of its aim to eliminate the virus, New Zealand closed its schools, non-essential workplaces, stopped social gatherings and implemented strict travel restrictions; these actions will no doubt sound familiar to Jersey residents. Indeed, as a result of some of the actions taken by the Government, we have successfully flattened the curve of the pandemic. In a short amount of time, we have managed to reduce the number of new cases to almost zero.

However, despite mirroring the start of New Zealand's elimination' approach, our Government's declared ambition has been to delay, contain, shield' – not eliminate' – and we are now hearing disturbing rumours of Jersey entering into a potential bubble' with the UK, whose infection rate is alarming.

The Economics

This proposition requires the States Assembly to make an in-principle choice about the approach to dealing with Covid-19; part of the result of this will be a need to understand the economic consequences and offer targeted support to ensure that those who are financially vulnerable are secure. We already have a process of support for businesses in place. We will need to continue to adopt the principles of that support and apply it to businesses that will suffer most from an elimination approach.

3 Baker, M. et al. (2020). New Zealand's elimination strategy for the COVID-19 pandemic

and what is required to make it work' in The New Zealand Medical Journal. Vol. 133. No. 1512. Pp. 10-14.

As part of the process of implementing an elimination strategy, I would expect the Chief Minister to instruct the quantitative analysis of which sectors would be hardest hit by this approach. For example, work could be done to assess that impact of movement between Jersey and the UK on a business GVA in order to establish the impact of further restriction of the movement of people. Following this, it is imperative that those sectors, such as those who have a high reliance on incoming visitors, such as hospitality and tourism, who would be at the greatest disadvantage, are supported financially by the Government.

There will be an economic impact of adopting this strategy which needs to be quantified by experts, but with robust analysis and targeted support, I believe elimination can be achieved alongside providing support for those who need it. Furthermore, the economic benefit of short, intense lockdown, followed by a greater freedom of movement, will serve to help the economy in the longer term.

Conclusion

Given the success of the steps taken so far in Jersey, and given that we have effectively started working towards elimination, it is hard to justify decisions that would cause the virus to spread and, therefore, cause more lives to be lost.

We now have a rare and short opportunity to change our approach to this crisis.

Islanders would be better served by a short period of intense lockdown whilst we achieve elimination, followed by a longer period of relatively free internal movement. A policy of elimination that includes clear border controls and strategies could mean that we have the ability to socialise, to slowly open schools, perhaps go to cafés and restaurants and, importantly, make care homes a safer place to be and allow people to visit vulnerable relatives. Constant tracking, testing, tracing, isolating and defeating the virus will reap more health and economic benefits for society than simply allowing Covid-19 to spread and hoping that we can cope with the number of people infected.

Most importantly, this is an ethical issue. The Public do not want to keep hearing that more people will die'. The Government have to justify the decision not to strive for elimination, given the lives it would certainly save.

I thank Members in advance for their support and consideration. Financial and manpower implications

Officers have been working tirelessly to develop and implement the Government's strategy and guidance in response to Covid-19. Whilst this proposition would result in the use of officer time, it requires a change in strategy and, therefore, will be carried out using current resources.