Policies on SARS-CoV-2 should not be judged solely with current knowledge. The body of Knowledge that was available in January 2020 should be included in the assessment framework, as well as the policy strategies presented since then. The question is, why measures for the effective containment of the virus have been rejected since March 2020 without further justification.
As of 16 June 2020, the National Institute for Public Health and the Environment still pretends to have chosen the approach of "Maximum control" of the virus. "Maximum control" is based on the assumption that there are risk groups that can be isolated, while so-called "non-risk groups" should gradually become infected with SARS-CoV-2 in order to protect the risk groups.
In order to assess the policy strategies pursued to date, I will provide the knowledge that has been available from January 2020 onwards.
1. Available knowledge since January 2020: scientific articles, media reports and warnings
- September 31, 2003: The Board on Global Health organized the international conference: Learning from SARS: Preparing for the next outbreak. Preventing and combating future SARS outbreaks is central to the sub-topics Containment strategies, Impact on Health Care Systems for Combating Future Outbreaks, Political Influences on the Response to SARS. SARS: Down but still a threat. The script can be downloaded from the page of The National Academies of Sciences Engineering Medicine;
- June 26, 2006: "SARS / Lung virus is much more dangerous than it looks", Trouw, June 26, 2006 (last access June 16, 2020);
- 2009: National Research Committee on Achieving Global Capacity for Surveillance and Response to Emerging Diseases of Zoonotic Origin publishes "Sustaining Global Surveillance and Response to Emerging Zoonotic Diseases";
- October 2007: Severe Acute Respiratory Syndrome Coronavirus as an Agent of Emerging and Reemerging Infection, Clinical Microbiology Reviews, 2007 Oct; 20 (4): 660-694;
- June 2016: SARS and MERS: recent insights into emerging coronaviruses, Nature Public Health Emergency Collection, Nature Reviews Microbiology, 2016; 14 (8): 523-534;
- January 2017: Understanding bat SARS-like coronaviruses for the preparation of future coronavirus outbreak- Implications for coronavirus vaccine development, Human Vaccines and Immunotherapeutics, 2017 Jan; 13 (1): 186-189.
- November 2017: After 15 years of research, the gene pool of SARS-CoVs from the Yunnan region has been fully mapped. The ORF8a and ORF8b proteins of bat SARSr-CoV are similar to those of human-transmitted SARS-CoVs. The researchers warn of the threat of a 'spillover' that will cause a disease such as SARS (2003). Therefore, it is emphasized that surveillance is necessary. Human behavior must also be adjusted to avoid the risk of infection with a subsequent SARS-CoV. See "Discovery of a rich gene pool of bat SARS-related coronaviruses provides new insights into the origin of SARS coronavirus", PLoS Pathogens, 2017 Nov; 13 (11): e1006698);
- March 2019: researchers warn that livestock markets, where various wild animals are slaughtered at the spot, increase the risk of an outbreak in hotspot China: "Bat Coronaviruses in China", MDPI Viruses, 2019 Mar; 11 (3): 210;
- 08 January 2020: 'New virus identified as likely cause of mystery illness in China: The legacy of SARS has haunted the race to understand a respiratory infection that has affected 60 people, Nature news;
- January 10, 2020: genome SARS-CoV-2 published in the database of GenBank (code: MN908947), on January 12, 2020 MN908947.1 was available via GenBank, accessible via NCBI;
- January 20, 2020: State Key Laboratory of Respiratory Diseases in Guangzhou reports successful human-to-human transmission of 2019-nCoV. The virus is closely related to SARS-CoV-1 (2003). The report was posted on January 21, 2020, “Stop the Wuhan Virus, Nature Edt., Online January 21, 2020;
- January 27, 2020: transmission rate estimated high and reproduction number R estimated between 1.4-2.5;
- January 28, 2020: Warning from D. Heymann (London School of Hygiene and Tropical Medicine) to heed aerogenic transmission of 2019-nCoV;
- January 30, 2020: WHO declares 2019 nCoV a 'global emergency';
- February 11, 2020: the ICTV officially declares 2019-nCoV to be SARS-CoV-2. The similarities with SARS-CoV-1 (2003) are officially confirmed, making clear that it is not a completely new virus;
- 2 March 2020: WHO stresses the need to pursue containment: testing, isolation and tracing are the measures to be taken.
As of 16 June 2020, the National Institute for Public Health and the Environment still pretends to have chosen the approach of "Maximum control" of the virus. "Maximum control" is based on the assumption that there are risk groups that can be isolated, while so-called "non-risk groups" should gradually become infected with SARS-CoV-2 in order to protect the risk groups.
In order to assess the policy strategies pursued to date, I will provide the knowledge that has been available from January 2020 onwards.
1. Available knowledge since January 2020: scientific articles, media reports and warnings
- September 31, 2003: The Board on Global Health organized the international conference: Learning from SARS: Preparing for the next outbreak. Preventing and combating future SARS outbreaks is central to the sub-topics Containment strategies, Impact on Health Care Systems for Combating Future Outbreaks, Political Influences on the Response to SARS. SARS: Down but still a threat. The script can be downloaded from the page of The National Academies of Sciences Engineering Medicine;
- June 26, 2006: "SARS / Lung virus is much more dangerous than it looks", Trouw, June 26, 2006 (last access June 16, 2020);
- 2009: National Research Committee on Achieving Global Capacity for Surveillance and Response to Emerging Diseases of Zoonotic Origin publishes "Sustaining Global Surveillance and Response to Emerging Zoonotic Diseases";
- October 2007: Severe Acute Respiratory Syndrome Coronavirus as an Agent of Emerging and Reemerging Infection, Clinical Microbiology Reviews, 2007 Oct; 20 (4): 660-694;
- June 2016: SARS and MERS: recent insights into emerging coronaviruses, Nature Public Health Emergency Collection, Nature Reviews Microbiology, 2016; 14 (8): 523-534;
- January 2017: Understanding bat SARS-like coronaviruses for the preparation of future coronavirus outbreak- Implications for coronavirus vaccine development, Human Vaccines and Immunotherapeutics, 2017 Jan; 13 (1): 186-189.
- November 2017: After 15 years of research, the gene pool of SARS-CoVs from the Yunnan region has been fully mapped. The ORF8a and ORF8b proteins of bat SARSr-CoV are similar to those of human-transmitted SARS-CoVs. The researchers warn of the threat of a 'spillover' that will cause a disease such as SARS (2003). Therefore, it is emphasized that surveillance is necessary. Human behavior must also be adjusted to avoid the risk of infection with a subsequent SARS-CoV. See "Discovery of a rich gene pool of bat SARS-related coronaviruses provides new insights into the origin of SARS coronavirus", PLoS Pathogens, 2017 Nov; 13 (11): e1006698);
- March 2019: researchers warn that livestock markets, where various wild animals are slaughtered at the spot, increase the risk of an outbreak in hotspot China: "Bat Coronaviruses in China", MDPI Viruses, 2019 Mar; 11 (3): 210;
- 08 January 2020: 'New virus identified as likely cause of mystery illness in China: The legacy of SARS has haunted the race to understand a respiratory infection that has affected 60 people, Nature news;
- January 10, 2020: genome SARS-CoV-2 published in the database of GenBank (code: MN908947), on January 12, 2020 MN908947.1 was available via GenBank, accessible via NCBI;
- January 20, 2020: State Key Laboratory of Respiratory Diseases in Guangzhou reports successful human-to-human transmission of 2019-nCoV. The virus is closely related to SARS-CoV-1 (2003). The report was posted on January 21, 2020, “Stop the Wuhan Virus, Nature Edt., Online January 21, 2020;
- January 27, 2020: transmission rate estimated high and reproduction number R estimated between 1.4-2.5;
- January 28, 2020: Warning from D. Heymann (London School of Hygiene and Tropical Medicine) to heed aerogenic transmission of 2019-nCoV;
- January 30, 2020: WHO declares 2019 nCoV a 'global emergency';
- February 11, 2020: the ICTV officially declares 2019-nCoV to be SARS-CoV-2. The similarities with SARS-CoV-1 (2003) are officially confirmed, making clear that it is not a completely new virus;
- 2 March 2020: WHO stresses the need to pursue containment: testing, isolation and tracing are the measures to be taken.
2. Policy strategies
- February & March 2020: no negative travel advice or restrictions imposed on travel to and from 'high-risk areas'. No quarantine or mandatory isolation of travelers from fires. No isolation of travelers from 'repatriation flights'. Carnival allowed without restrictions;
- Wearing face masks to minimize airborne transmission of SARS-CoV-2 discarded as 'a false sense of security'.
3. Scenario 'Group immunity'
- On March 16, 2020, less than 0.01% of the population (17,000,000) has been tested positive twice for SARS-CoV-2. In order to obtain at least 60% coverage, 10,200,000 people should be infected to counterbalance the approximately 0.01% cases of infection identified at the time;
- Containment is rejected without justification. The 'Maximum containment of the virus' scenario is presented as 'a lockdown where everything is shut down and everyone has to stay indoors. All activities should then actually have to be shut down for a year or even longer. In the period after the lockdown, when everyone goes out again, the virus will be transferred again and the closure will have been pointless.” (Still present on the RIVM page as of 16 June 2020);
- Scenario 'Maximum control', the chosen policy strategy, is based on the conscious spread of the disease over a longer period. The aim is to spread the virus to groups that would be least at risk. This scenario lists two scientifically unsubstantiated assumptions as 'benefits':
Benefit 1: Most people only get mild complaints from SARS-CoV-2 and recover from the virus themselves;
Benefit 3: People can become immune to protect high-risk groups.
- February & March 2020: no negative travel advice or restrictions imposed on travel to and from 'high-risk areas'. No quarantine or mandatory isolation of travelers from fires. No isolation of travelers from 'repatriation flights'. Carnival allowed without restrictions;
- Wearing face masks to minimize airborne transmission of SARS-CoV-2 discarded as 'a false sense of security'.
3. Scenario 'Group immunity'
- On March 16, 2020, less than 0.01% of the population (17,000,000) has been tested positive twice for SARS-CoV-2. In order to obtain at least 60% coverage, 10,200,000 people should be infected to counterbalance the approximately 0.01% cases of infection identified at the time;
- Containment is rejected without justification. The 'Maximum containment of the virus' scenario is presented as 'a lockdown where everything is shut down and everyone has to stay indoors. All activities should then actually have to be shut down for a year or even longer. In the period after the lockdown, when everyone goes out again, the virus will be transferred again and the closure will have been pointless.” (Still present on the RIVM page as of 16 June 2020);
- Scenario 'Maximum control', the chosen policy strategy, is based on the conscious spread of the disease over a longer period. The aim is to spread the virus to groups that would be least at risk. This scenario lists two scientifically unsubstantiated assumptions as 'benefits':
Benefit 1: Most people only get mild complaints from SARS-CoV-2 and recover from the virus themselves;
Benefit 3: People can become immune to protect high-risk groups.
