Dhaka Courier

The Fergussion Report on Tackling Covid-19: ‘Mitigation’ Vs ‘Suppression’

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Britain’s Prime Minister Boris Johnson speaks during a news conference on the ongoing situation with the coronavirus disease (COVID-19) in London, Britain March 16, 2020.

The British have emotionally and intellectually been forever drawn to Classical Greek philosophies. For instance, a variant of ‘Stoicism’, the set of beliefs that enjoined self- discipline, fortitude and remaining calm in adversity upon the society has always appealed to the British masses, the elite and the commoner. Hence the predilection and reputation for the ‘stiff upper lip’. In preparation for the Second World War the government had urged that people ‘keep calm and carry on’. Received wisdom has it that it did help to a large extent to raise public morale during the incessant German aerial attack during the blitzkrieg.

In a somewhat similar fashion Prime Minister Boris Johnson recently, confronting the scourge of Covid-19, sought to motivate the citizens through the application of the so-called ‘British model’ of response. He went by the views of his official scientific advisers who had concluded that the virus could not be avoided, and measures undertaken by many countries to that end, were unsustainable and ineffective in preventing its spread. So, the government’s best bet was to try ূদ slow down infection rates to a level which would allow medical services to cope with the most severe cases to ‘flatten the statistical curve’ of infections. The Johnson government therefore initially accepted the fact that two-thirds of the population might become infected, but subsequently acquire the necessary immunity to be able to ‘carry on’.

But suddenly the course changed. In the past week public gatherings have been banned, foreign travel largely stopped, academic institutions closed, work from home encouraged, and anyone over the age of seventy isolated.  This was because Boris Johnson showed another streak of English propensity, which was the ability to change theoretical convictions when presented with what is believed to be superior, at any rate more persuasive, counter arguments. These came from a scientific paper published on 16th March, compiled by 31 members of the Covid-19 Response team of Imperial College, who were led by a foremost epidemiologist, Professor Neil Ferguson. It was entitled The Impact of Non-Pharmaceutical Interventions to Reduce Covid -19 Mortality and Healthcare Demand. The study reached the sobering extrapolation that there could be 260,000 additional deaths this year from the coronavirus, if drastic containment measures were not introduced. This was a sufficiently dire conclusion to shake any kind of Stoic fortitude. The government appeared persuaded as to these new findings.

The Report argued that two fundamental strategies were possible. One was mitigation, which focussed on slowing but not necessarily stopping the spread of the epidemic, concentrating on reducing healthcare demand while protecting those most at risk of disease from infection. The other was suppression, which aimed at reversing epidemic growth, reducing case numbers to low levels, and maintaining that situation indefinitely. Each policy had major challenges. The research found that optimal mitigation policies (combining home isolation of suspect cases , home quarantine of those living in the same house as suspect cases, and social distancing of the elderly and others at most risk of severe disease) might reduce peak healthcare demand by two-thirds and deaths by half. However, the resulting mitigated epidemic would still likely result in hundreds and thousands of deaths, and health systems being overwhelmed many times over.

The preferred option of the Ferguson Report, for countries able to achieve it, was ‘suppression’ as opposed to ‘mitigation’. ‘Suppression’ would minimally require a combination of social distancing of the entire population home isolation of cases and household quarantine of their family members. This may need to be supplemented by school and university closures down the line. The major challenge of suppression is that this type of intensive intervention package- or something equivalently effective at reducing transmission-would call for it to be maintained until a vaccine became available ( potentially 18 months or more)- given that transmission could quickly rebound if interventions were relaxed. Intermittent social distancing, triggered by trends in disease surveillance, might allow interventions to be relaxed temporarily in relative short-term windows, but measures would need to be reintroduced if or when case numbers rebounded. China, as also South Korea, were cited as examples showing that suppression was possible, at least, as of now, in the short term.

The researchers analysed data from China and Italy to mathematically model how the spread of the coronavirus would affect the United Kingdom and the United States in an uncontrolled social environment. The predicted number of fatalities was large enough for the Trump Administration in the US to now take heed. While the report will be thoroughly examined everywhere, one country that has earned plaudits for combining these very ideas even before their articulation in this fashion is one which was affected early but now displays the signs of least impact because of impressive governance. It is the small but densely populated island-republic of Singapore.

Physical, ethnic and economic linkages with China were part causes of the early vulnerability of Singapore to the virus. Prime minister Lee Hsien Loong moved rapidly to take necessary steps to prevent, mitigate and suppress its spread, almost immediately with the first detections. The DORSCON (‘Disease Outbreak Response System Condition’) level was raised to ‘orange’. A Multi-Ministry Task Force co-chaired by National Development Minister not only initiated the necessary steps  but also kept the public regularly apprised of those taken, lowering public anxiety. In consonance with World Health Organization recommendations ‘to isolate, test, treat, and contact-trace’(every contact made by a patient was traced by the administrative machinery) were sought to be implemented. Singaporeans, by and large, displayed commendable conduct by complying. As a result, panic, as evidenced in other countries, has been largely avoided. Experts say that numbers which could have risen to 5000 at this writing, has been thereby contained to 313.

A footnote to this article: Professor Neil Ferguson, the author of the Report which is the main subject of this article, earned well-deserved praise by a laudable conduct on his part immediately following his coordination of this impactful study. He went into self-isolation after developing a dry cough and fever, in line with another English adage that example was better than precept!

Dr Iftekhar Ahmed Chowdhury is Principal Research Fellow at ISAS, National University of Singapore, former Foreign Advisor and President of Cosmos Foundation Bangladesh.

  • ‘Mitigation’ Vs ‘Suppression’
  • The Fergussion Report on Tackling Covid
  • Dr Iftekhar Ahmed Chowdhury
  • Vol 36
  • Issue 38
  • DhakaCourier

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