• The Star Staff

How the world is learning to live with a deadly pandemic

By Sui-lee Wee, Benjamin Mueller and Emma Bubola

China is testing restaurant workers and delivery drivers block by block. South Korea tells people to carry two types of masks for differing risky social situations. Germany requires communities to crack down when the number of infections hits certain thresholds. Britain will target local outbreaks in a strategy that Prime Minister Boris Johnson calls “Whac-A-Mole.”

Around the world, governments that had appeared to tame the coronavirus are adjusting to the reality that the disease is here to stay. But in a shift away from damaging nationwide lockdowns, they are looking for targeted ways to find and stop outbreaks before they become third or fourth waves.

While the details differ, the strategies call for giving governments flexibility to tighten or ease as needed. They require some mix of intensive testing and monitoring, lightning-fast response times by authorities, tight border agement and constant reminders to their citi- zens of the dangers of frequent human contact. The strategies often force central gov- ernments and local officials to share data and work closely together, overcoming incompat- ible computer systems, turf battles and other longstanding bureaucratic rivalries. Already, in Britain, some local officials say their efforts are not coordinated enough.

The shifting strategies are an acknowl- edgment that even the most successful coun- tries cannot declare victory until a vaccine is found. They also show the challenge presented by countries like the United States, Brazil and India, where the authorities never fully con- tained initial outbreaks and from where the coronavirus will continue to threaten to spread. “It’s always going to be with us,” said Simon James Thornley, an epidemiologist from the University of Auckland in New Zealand. “I don’t think we can eliminate the virus long term. We are going to need to learn to live with the virus.”

Even in places where the coronavirus appeared to be under control, big outbreaks remain a major risk. In Tokyo, there have been 253 new infections in the past week, 83 from a nightlife district. In Gütersloh in western Ger- many, more than 1,500 workers from a meat processing plant tested positive, prompting au- thorities to shut down two districts. South Ko- rea, another poster child for fast responses, has man-announced dozens of new infections in recent days.

In Rome, which recently emerged from one of the strictest lockdowns in Europe, 122 people have been linked to a cluster case at a hospital, the San Raffaele Pisana Institute. Sev- eral days later, 18 people who lived in a build- ing with shared bathrooms came down with the virus.

“As soon as we lowered our guard,” said Paolo La Pietra, who owns a tobacco shop in the neighborhood, “it hit us back.”

Some countries, like South Korea and Japan, aimed to make their responses nimble.

South Korea calls its strategy “everyday life quarantine.” The country never implement- ed the strict lockdowns that were seen in other places, and social-distancing measures, while strongly encouraged, remain guidelines. Still, it has set a strict target of a maximum of about 50 new infections a day — a target that it says its public health system, including its testing and tracing capacity, can withstand.

Officials shift the rules as needed. After a second wave of infections broke out in Seoul, city officials made people wear masks in pub- lic transportation and closed public facilities for two weeks.

The South Korean government has add- ed new guidelines as it has learned more about outbreaks. It advises companies to have em- ployees sit in a zigzag fashion. Air-conditioners should be turned off every two hours to in- crease ventilation, it said. It has discouraged singing in markets and other public places.

It has also advised people to carry two types of masks in summer — a surgical mask and a heavy-duty mask, similar to the N95 res- pirator masks worn by health care workers, to be used in crowded settings.

Japan, which endured only limited lock- downs, also wants to keep its limits light to help restart its economy. It is considering al- lowing travelers from Australia, New Zealand, Thailand and Vietnam. As an island nation, Ja- pan cannot afford to keep its borders closed any longer, said Shinzo Abe, its prime minister. Last Friday, Japan launched a contact tracing app that would alert users if they had been in touch with a person who tested posi- tive in the last 14 days. Railway operators have launched an app and websites telling commut- ers how crowded the trains are at any given time.

Some countries, like China, are learning to ease back from their more draconian meth- ods. The Chinese government virtually isolated tens of millions of people in the city of Wuhan and surrounding Hubei province when the outbreak began.

Mindful of the economic damage, Chi- nese leaders have adopted looser restrictions. In Beijing, officials told residents that they could take off their masks outdoors. Temperature screening in the city became less wide- spread.

Then, on June 12, Beijing officials an- nounced that 53 people had tested positive for the coronavirus. Instead of locking up the capi- tal city, officials promptly shut down a market and residential communities surrounding it and mobilized close to 100,000 community workers to test roughly 2.3 million residents in about a week.

“A city as big as Beijing can’t be in a state of wartime resistance forever,” said Mao Shou- long, a professor of public policy at Beijing’s Renmin University. “How many more times can we endure this?”

Unlike Wuhan, the effort was targeted. Other Beijing neighborhoods stayed open as usual. The Chinese government tends to favor a mass testing approach focused on specific groups — in addition to the people connected to the market, it said it would also test resi- dents living in high- and medium-risk neighborhoods, restaurant and retail staff, students and teaching staff, and health caThough many of these efforts are intensely local, they re- quire close coordination with central officials and neighboring jurisdictions. England, for ex- ample, is exploring limited, tailor-made shut- downs around clusters of infections, but local officials warn that the system is full of potential holes.

Health officials in England, Wales, Scot- land and Northern Ireland are largely respon- sible for their own strategies. In England, where local officials have complained about a lack of testing data from the central government, em- ployers or building managers have picked up the slack by keeping track of infections and re- spond to outbreaks. Some, like the headquar- ters of a major retailer in East Lancashire, have been praised by public health officials for tak- ing quick action.

But controlling the virus would require an understanding of where it is lurking, espe- cially difficult for a disease in which 80% of the cases have mild symptoms. Several local public health directors said in interviews that they learned about outbreaks from the news. The level of detail that officials need to decide on localized shutdowns — the postal codes of people testing positive, for example — remains elusive.

“Every pandemic begins as a local out- break,” said Lincoln Sargeant, the director of public health in North Yorkshire. “It’s granular intelligence that we need in a timely fashion.”

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