ABSTRACT
This paper critically evaluates the Suppression Threshold Strategy (STS) for controlling Covid-19 (C-19). STS asserts a "fundamental distinction" between suppression and mitigation strategies, reflected in very different outcomes in eventual mortality depending on whether reproductive number R is caused to fall below 1. We show that there is no real distinction based on any value of R which falls in any case from early on in an epidemic wave. We show that actual mortality outcomes lay on a continuum, correlating with suppression levels, but not exhibiting any step changes or threshold effects. We argue that an excessive focus on achieving suppression at all costs, driven by the erroneous notion that suppression is a threshold, led to a lack of information on how to trade off the effects of different specific interventions. This led many countries to continue with inappropriate intervention-packages even after it became clear that their initial goal was not going to be attained. Future pandemic planning must support the design of "Plan B", which may be quite different from "Plan A".
ABSTRACT
The initial response to the Covid-19 pandemic was characterised by swift "lockdowns," a cluster of measures defined by a shared goal of suppressing Covid-19 and a shared character of restricting departure from the home except for specific purposes. By mid-April 2020, most countries were implementing stringent measures of this kind. This essay contends that (1) some epidemiologists played a central role in formulating and promulgating lockdown as a policy and (2) lockdowns were foreseeably harmful to the Global Poor, and foreseeably offered them little benefit, relative to less stringent measures. In view of the widespread commitment to reducing global health inequalities within the profession, this should prompt reflection within the epidemiological community and further work on pandemic response measures more appropriate for the Global Poor.