Intended for healthcare professionals

Letters Covid-19: elimination debate

Achieving zero covid is not easy, but the alternative is far worse

BMJ 2020; 371 doi: (Published 07 October 2020) Cite this as: BMJ 2020;371:m3859
  1. Martin McKee, professor of European public health
  1. London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK
  1. martin.mckee{at}

Thornley and colleagues confuse eradication, permanent reduction to zero of the worldwide incidence of infection, with the reduction to zero of infection in a defined geographical area.12 New Zealand, and other countries, has shown that elimination of SARS-CoV-2 transmission can be achieved for periods of time, even though the virus might occasionally be imported either in infected individuals or on fomites, as seems likely to have been the case in Auckland. An elimination strategy accepts this and adopts measures to prevent further spread throughout the country. New Zealand has been successful in doing this with the recent outbreak.

As Thornley and colleagues note, ascertaining the case fatality rate is difficult, but the range they quote is below the now generally accepted figure of 0.5% to 1%.3 This is considerably higher than for seasonal flu. Moreover, a narrow focus on deaths ignores what is emerging as a major problem, so called long covid.4 A failure to bear down on this disease risks leaving very large numbers of people with long term disability. The claim that covid-19 “is not dramatically life shortening” seems strange given evidence that each covid death causes 12-14 years of life lost, on average.5

Their pessimism about vaccines is remarkable. There is no previous case in which the genome of a new virus was decoded within days or a vaccine progressed to phase III trials within months. In light of the encouraging evidence so far, their suggestion that this could take 10 years is difficult to understand.

As is now clear from many countries, as long as this virus continues to circulate in substantial quantities, any lifting of restrictions will allow infections to spread, unless there is a robust system to find, test, trace, isolate, and support. The historical evidence from 1918 is clear6—places that imposed the strictest limitations and retained them longest saw a faster economic recovery. Moreover, as is all too clear, there is little point in removing restrictions if a large proportion of the population is too worried to place themselves at a real or perceived risk.

No one pretends that achieving zero covid is easy, but in the long term the alternative is far worse.


  • Competing interests: I am a member of Independent SAGE, which argues for a zero covid strategy.

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