The Island Strategy: a common sense path to reach virus-zero

So, what to open first? Schools? Parks? Garden centres? Hair salons?

This question is the current pre-occupation of most Western governments. In the UK, the current “exit strategy” from lockdown supposedly comprises three phases:

Phase 1 — Reopening primary schools, some high school years, and resuming some elective surgeries.

Phase 2 — Progressively more shops and businesses would open, followed later in the summer by pubs and restaurants.

Phase 3 — Finally, after a vaccine has been developed, would come the release of the vulnerable and over 70s.

This seems fairly typical of a lot of thinking around the world at present, and has some merits in that what we open will influence the infection rate of the disease. However it doesn’t take any sort of “expert” to see that this analysis alone is insufficient.

This is for two reasons:

  1. There is little certainty that, on relaxing the lockdown, the case numbers won’t shoot up again, prompting a reversion (something which is readily acknowledged).
  2. And moreover, there is no certainty that a vaccine will ever be developed (something that is not readily acknowledged).

You cannot, under any circumstances, base any strategy in any field on the assumption of the existence of something that doesn’t exist yet.

Any coronavirus strategy must be designed based on the assumption that a vaccine will never be devleoped.

If one is, then great, that’s a bonus. But if not, we still need to have a path out of this crisis.

Fortunately there is such a path. A path which is still non-mainstream, but is gradually gaining traction in some localities around the world. A path which doesn’t rely on any medical breakthroughs whatsoever (although naturally we must continue to seek these). A path which has the potential to allow for far less social distancing, far more quickly.

The essence of the path is this:

It’s not what you open but where you open.

Rather than concerning ourselves simply with schools vs. restaurants, we should be focusing on X country vs. Y county; A town vs. B town.

Even as we speak, there are places in the world — island communities and the like — that have zero cases of coronavirus. How would you behave if you were in command of one of these communities? It’s simple no?

  • Life as normal (i.e. free movement) within the community
  • But extreme restrictions on movement in and out of the community; between communities

So long as there is uncontrolled movement between areas you will never be able to achieve freedom within areas, because you will never truly be able to know if you are “virus free”. However any reasonably small locality, if it has no movement in or out, will eventually be able to declare itself clean — and thus will be able to continue life more or less as normal.

This is the logic which we should be employing to reopen our societies.

To illustrate how it might work on an organised scale, I will use the UK as an example. It’s a useful country for such an exercise because 1) it’s currently under full lockdown, 2) it’s divided by counties, 3) it’s an island (leaving aside Northern Ireland for the purposes of this exercise), and 4) it currently has no reasonable public strategy whatsoever.

Here’s roughly how the strategy would work:

Step 1 — Cease all international travel, with the exception of the completely essential, which must be heavily controlled with testing, quarantining, whatever is appropriate in the context to prevent the import of any new cases.

Step 2— Divide the nation into reasonably sized self-contined “islands”. In reality there would have to be some sophisticated way of doing this, based on population density, hospital locations, etc.; but for the sake of this example I shall just assume it would be counties (of which there are 48 in the UK).

Step 3— Restrict movement between these islands, between the counties, whilst also maintaining lockdown. This would essentially mean road blocks. Naturally this would be logistically extremely challenging, due to 1) logistics and 2) some key workers inevitably living “across border” from where they work. Such problems would however be manageable with reasonable precautionary systems, in particular because resources would be concentrated on border lines, rather than being spread thinly everywhere. Furthermore you do not need an infection rate of zero in order to crush the virus in a given area, only less than 1; so even an imperfect border would still be effective.

Step 4— Wait for each county to be declared “clear”, or be designated as a “green zone”. Under full lockdown this would eventually happen; as defined by a sensible measure (not my place to say what this would be, but for sake of argument let’s say 2 weeks since the last new case — it may not need to be that draconian). At this moment movement within the county would be released.

Step 5— Gradually, starting with the most rural areas, more and more of the country would be cleared. Any travel between green zones would be unrestricted, but any travel from red to green would be severely restricted — potentially with border testing, or mandatory quarantine. Such measures are already being utilised in some island communities around the world.

Step 6— The goal, naturally, would be to turn the whole map within the UK (or any given country) green. Providing borders were well managed, such an outcome is plausible. Even if the virus were not completely eradicated within a given area or country, you would have set up the necessary infrastructure to clamp down hard on any localised flare-ups in the future without unduly harming the rest of the country.

Step 7 — More long term, movement between countries would start to be determined by their green/red status. A flight between two green countries, both of which are known to be managing their borders competently? Relaxed and normal. A flight from an “iffy” country into a green country? Airport testing, mandatory quarantine, whatever is considered medically robust. A flight from a heavily infected country to a green country? Just doesn’t happen (with probably exception of cargo under heavily controlled protocols).

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The important thing to note about the above strategy is this:

It doesn’t have to work perfectly in order to work.

Could it eradicate the virus? Theoretically maybe, but probably not. But what it would do is embed a “fire door” behaviour system globally which would be invaluable in stomping on outbreaks of coronavirus, or any other disease as and when they occur in the future.

Borders, ultimately, in spite of their bad rep, are essential tools for the health of any system. In nature, semi-permeable borders, which selectively let some things through and other things not, are everywhere. Your skin is such a border. Climactic zones are such a border. Mountain ranges are such a border. So too do we need to maintain such borders for our own systemic health, and should have no shame in doing so.

Our strategy must adapt to a geographic one; one of borders. There is no other way (short of a currently imaginary vaccine) to release populations from restrictions which hamper not only “the economy”, but life itself.

I would rather live free within (semi) closed borders, than locked down within open ones.