This portal[edit | edit source]
Initially written in Spanish / Castilian by User: LucasG. Click on "Page data" to find translation links! Or contribute to grow the twin portal, mostly by porting Spanish content at this stage.
Goals[edit | edit source]
- The overall goal is to contribute to greatly improved mitigation and even elimination. We try to take advantage of the world's collective experience in a way that is useful for each country, for several countries that decide to work in coordination, or even for the entire planet. The portal focuses on covid but in large part it should serve for other future respiratory pandemics.
- The specific goals are:
- Document the different open source non-pharmacological measures.
- Facilitate the improvement of each one so that they are more effective, more practical, and more applicable in different environments.
- Facilitate the integration of measures in territorial and sectoral plans, and for different epidemic situations.
How to contribute[edit | edit source]
- The main contribution would be to implement what is learned here. Or to take even better actions.
- It is very useful to share experiences in order for all to improve.
- It is possible to contribute to the wiki with links, modifications, comments and questions. To do this you can:
- Contact on Twitter and Telegram:
- Directly with Lucas: User: LucasG, fluscim, lucasgonzalez.
- Directly with Libres de Covid: Libresdecovid.
- In the Telegram groups of Libresdecovid.
- Facilitating communication on twitter, perhaps with a family of tags (hashtags): "#zcaetc", where "zca" is "zero covid appropedia" and "etc" is the specific topic, for example "#zcafiltrar".
- Become an appropedia editor, to contribute content, translate or monitor changes. Help:Create_account
- Contact on Twitter and Telegram:
Current activity[edit | edit source]
Metaphorical description of the intention of this portal[edit | edit source]
Strategies[edit | edit source]
The approximately 200 countries of the world have faced what in principle is the same pandemic: the same disease (COVID-19), caused by the same microorganism (SARS-CoV-2).
However, different countries have used very different approaches.
Collaboration between countries and even within the same country can be described as having "room for improvement".
Components of strategies[edit | edit source]
The response components are, in general, the following:
- Prevention of contagions ("non-pharmacological measures"), which constitute the bulk of this portal.
- Treatments and vaccines ("pharmacological measures"), not explored here except for illustration.
- Management of problems secondary to the epidemic situation itself ("disruption", "alterations to the normal functioning of society, especially in terms of vital or important supplies and services"), in general without reaching the extremes that would be necessary in a more severe pandemic (in general, or worse).
Strategic patterns[edit | edit source]
The components mentioned above have been articulated in strategies that broadly correspond to these 3 strategic patterns:
- Herd immunity: allowing infection in the least vulnerable in the hope that they would act as a firewall for the most vulnerable.
- Mitigation: regulate the intensity of the restrictions to, in addition to the above, keep hospital capacity and economic activity operational.
- Elimination: go after the virus with elimination strategies within the territory and control at the borders.
To this, the vaccination strategy is added. It has had surprising promptness, safety and initial effectiveness. However, vaccine production is limited and slow and not reaching all territories on the planet. Furthermore, even in countries where they are available, vaccines do not completely eliminate transmission, the degree of protection seems to decrease over time, and there are variants with some degree of vaccine escape. For all these reasons, vaccines cannot be used as the only intervention, and they need to be complemented by measures to reduce infections.
There is enough scientific knowledge, experience, and diagnostic, preventive and control tools that it would be possible to optimize to arrive, in all territories, to Maximum Sustainable Mitigation (MMS) strategies, which informally can also be called Much Improved Mitigation (MIM).
These strategies would be simultaneously more effective and less costly and disruptive.
They include the following:
- Maybe elastomeric respirators with lip visibility could be considered to be in the same category as footwear. More protective "hoods" equipment could be used in certain situations that require even more intense protection. (See ZeroCovidEng/Manufacture.)
- Measuring the degree of reuse of air in rooms using visible result sensors, and flexible ventilation and filtering adapted to the situation, would provide an extra layer of protection, whose limits in terms of technical effectiveness and cost-effectiveness are yet to be explored. (Help Libresdecovid and Aireamos.)
- Low-cost, widely distributed, immediate-result antibody diagnostic tests, coupled with tracing activities based on hand-collected data and non-privacy-invasive phone apps aimed at serving citizens, would allow a proportion of important of people in an infectious state to withdraw their lungs from circulation, in exchange for economic and logistical support from the community, businesses or the state.
- Border control is used only occasionally and refers to the points of origin considered most dangerous. It could be done better by learning from different countries.
If border control components (allow a certain flow of people but prevent the passage of the virus) are added to the MMS or MIM strategies, with borders not only between countries but also internal with a "divide and conquer" approach, they become Elimination strategies (ES) . The ES could be considered, in theory, at the level of Spain (ESS), or in Spain and Europe (ESSE). Elimination strategies make it possible to eliminate restrictions within the territory that carry them out effectively, and gradually expand said opening to similar territories. (See endcoronavirus.)
Motivations to change strategy[edit | edit source]
There are a number of reasons why people and governments in a territory may decide to abandon mitigation strategies and instead employ elimination strategies. This can be done directly, or through an intermediate stage of "enhanced mitigation".
Among the reasons are the following:
- Uncertainties regarding the future behavior of the variants and vaccines, which cause uncertainty regarding the deadlines for the termination of the pandemic, causing the doubt that the time of suffering that still remains may not be acceptable.
- Fatigue of populations, health workers and financial compensation systems.
- Perception of damage caused by the pandemic. For example, longcovid.
- The need to prepare systems for future pandemic threats, which will inevitably appear in the years and decades to come.
- Decreased cost of improved mitigation and elimination, which makes strategies that were considered excessive now seem more feasible. The set of pages of this portal has been created with the intention of reducing these costs, in case the rest of the factors unbalance the balance in the direction of the mentioned changes.
Objectives of the elimination strategy[edit | edit source]
- Lower the incidence even when starting from high levels, with effective, fast and as least disruptive mitigation as possible:
- Keep those levels low or even, optionally, reach "zero".
- Open society to all activities, maintaining surveillance within the territory, and barriers to entry into the territory, opting to re-unify the territories that become free of the virus.
Measures and how to improve them[edit | edit source]
The measures used are as diverse as masks and confinement. The next section attempts to structure them in a way that facilitates their joint understanding, and the development of alternatives.
Panoramic and video[edit | edit source]
Pharmacological and non-pharmacological measures[edit | edit source]
There is pharmacological measures, which don't belong in this portal:
- Vaccines for specific immunity.
- Possibly supplements if found to non-specifically boost immunity, although it is not clear that they have conclusive support.
- Treatments: widely debated.
There are non-pharmacological measures, which are the objective of this portal, and which can be grouped as follows:
1) Fewer respiratory contacts[edit | edit source]
Measures that restrict respiratory contact, reducing in a more or less intense way the number of contacts between "contagious persons" and "contagious persons":
- border control
- lockdown, more or less massive and prolonged
- Targeted lockdown: isolation and quarantine that are ideally guided by broad symptoms and with epidemiological intelligence - perhaps even with apps if they meet requirements and create an ecosystem that make them more useful, and repeated fast and cheap tests, and economically and logistically supported
- Measures of reduction of contacts: online work and education, shifts and different days of work so that there are fewer people simultaneously in the office and in public transport, online or simplified shopping with delivery at home or collection at the store or at an intermediate point, and school de-compression with ruralization by classrooms and mini-tribes for parents of young children.
2) Protected respiratory contacts[edit | edit source]
Measures that protect respiratory contact, for situations in which "the contagious" and "the susceptible" share physical space. These measures make use of the confirmed fact that most infections occur from aerosols in poorly ventilated interiors where people do not wear masks and either there is no distance or it is insufficient:
The distance is useful outdoors and in well-ventilated indoors. Its usefulness is less in poorly ventilated interiors.
Hand and surface hygiene is of very obvious importance for other pathogens. Its importance to respiratory pathogens is the subject of sometimes heated conversation among scientists. There are scientific articles that argue that the transmission of COVID-19 is mainly by aerosols: droplets small enough that, instead of falling to surfaces right away, they float for a while.
How to describe each measure[edit | edit source]
- Describe the participation of the different "jurisdiction levels": individual, local and regional, national and international. As an example, masks are used by individuals, produced at the national or international level, and their use is based on science and recommendations that are generated at the global level. The jurisdiction levels could be represented visually like the frets of a guitar.
- Mention in which strategies, phases and situations the measure is useful.
- Collect links to experts and pages with more information and activity.
- Note the life-cycle of the measure: raw materials, prefabricated elements, manufacturing, distribution, use, reuse and disposal / garbage / recycling.
How to improve each measure[edit | edit source]
We have compared the different measurements to the strings of a guitar, a harp or a ukulele.
We could improve each of the "strings", and then integrate them into "strategies" (stringed instruments that use several measures simultaneously). To do this, we could:
- Focus, individually or as a team, on "one" measure.
- Assess what works well. Make a list, trying to make it a full one, with the points that we find.
- Assess what are the shortcomings, damages and limitations. Make another list.
- Explore what are the immediate, obvious improvements, easy to implement. Both to improve what works well, and to correct what works badly. Again, make a list.
- Explore the possibilities that are ambitious, not obvious, more creative, and sometimes more difficult. (But more profitable.)
- Experiment, and tell others the results of our experiments.
- Educate and educate ourselves.
Later, or another day, we could repeat for the rest of the measures. Or we could have teams working in parallel, and then present the results from one team to another.
How to integrate measures into strategies[edit | edit source]
For each epidemic situation[edit | edit source]
In each situation of the epidemic control process it is possible to use different measures.
If we start from high incidence levels (which with the vocabulary of traffic lights could be "going from red to orange zone"):
- it may be necessary to apply population confinement. Except if a combination of measures is found that has the same effect without causing the disruption. Although in that case it might be interesting to use "all" to shorten the process.
- As many measures as practical will be applied simultaneously, seeking speed compatible with the maintenance of vital and important functions.
- It is not practical to follow up contacts unless it is managed by the cases themselves or in a very local way, or with computer support (apps).
When we start from lower levels and try to get to zero:
- It is already possible to include measures of search for contacts, intense, fast and of exhaustive intention.
- Border control measures are included if practical, if dangerous variants are feared, or if an elimination strategy is adopted.
To regain control after reintroduction, it is often interesting to seek effectiveness with quick measures that may seem excessive, such as massive population confinement for a short period of time.
In each sector[edit | edit source]
The different measures will be used specifically in each sector of activity. At the time, we may have a page for each sector, but for now it is enough to put some general ideas on what to emphasize in each sector:
- Education: online and shifts to reduce population density, adjusters, measure CO2 to guide ventilation and air filtering, strategies for reducing respiratory contacts.
- Healthcare: personal protective equipment, especially "elastomeric" and hoods.
- Public concurrence spaces: measure CO2 to guide ventilation and air filtering.
- Purchases of essential items (food and pharmacy): compile strategies for online or simplified ordering and for delivery or collection outdoors.
- Work and Transportation: online and shifts for reduce population density, and measure CO2 to guide ventilation and air filtering.
Each territory[edit | edit source]
Each country and each territory will be able to make their own adaptations, while contributing to the global experience. In due course we will be able to have all the countries ordered by continents, and create a page for each country. For now, we put what little there is, as a model.