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 the authorities, tight border management and constant reminders to their citizens of the dangers of frequent human contact.
The strategies often force central governments and local officials to share data and work closely together, overcoming incompatible 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 acknowledgment that even the most successful countries 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 contained 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 Germany, more than 1,500 workers from a meat processing plant tested positive, prompting the authorities to shut down the district. South Korea, another poster child for fast responses, has 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. Several days later, 18 residents who lived in a residential building 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 implemented 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 public transportation and closed public facilities for two weeks.
The South Korean government has added new guidelines as it has learned more about outbreaks. It advises companies to have employees sit in a zigzag fashion. Air-conditioners should be turned off every two hours to increase 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 respirator masks worn by health care workers, to be used in crowded settings.
Japan, which endured only limited lockdowns, also wants to keep its limits light to help restart its economy. It is considering allowing travelers from Australia, New Zealand, Thailand and Vietnam. As an island nation, Japan 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 positive in the last 14 days. Railway operators have launched an app and websites telling commuters how crowded the trains are at any given time.
Officials are also warning people constantly to change the ways they live. Through bars and clubs are reopening, hostesses are told to refrain from being next to a client when singing karaoke and dancing. Nightclubs must minimize music and crowd volumes to reduce the spread of respiratory droplets. Citizens are advised to continue avoiding the “Three Cs” — closed, crowded and close-contact activities.
“We need to run the economy strongly by controlling the infection risks with less-restrictive measures and take measures which put more emphasis on protecting jobs and life,” said Mr. Abe.
Some countries, like China, are learning to ease back from their more draconian methods. 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, Chinese leaders eased back. In Beijing, officials had told residents that they could take off their masks outdoors and workers eased up on the city’s ubiquitous temperature screening points.
Then, on June 12, Beijing officials announced that 53 people had tested positive for the coronavirus. Instead of locking up the capital 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 Shoulong, 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 residents living in high- and medium-risk neighborhoods, restaurant and retail staff, students and teaching staff, and health care workers.
Frequently Asked Questions and Advice
Updated June 22, 2020
Is it harder to exercise while wearing a mask?
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
I’ve heard about a treatment called dexamethasone. Does it work?
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
What is pandemic paid leave?
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
Does asymptomatic transmission of Covid-19 happen?
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
What’s the risk of catching coronavirus from a surface?
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
How does blood type influence coronavirus?
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
How many people have lost their jobs due to coronavirus in the U.S.?
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
My state is reopening. Is it safe to go out?
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
What are the symptoms of coronavirus?
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
How can I protect myself while flying?
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
What should I do if I feel sick?
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
How do I get tested?
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
China’s strategy is not to bring infections to zero, said Zhang Wenhong, an adviser to the Shanghai government on the pandemic. Instead, in an interview with China’s Caixin magazine, he described China’s game plan as “getting close to zero cases.”
“Prevention and control with precision, coupled with rapid medical treatment,” Dr. Zhang said. “This strategy will be applicable to China for a long time.”
European governments are also learning to be more flexible following their strong responses, though the process can be slow. In Germany, officials have stipulated that regions or municipalities that register more than 50 new infections per 100,000 people in seven days must quickly respond to quell the outbreak, using tools like school closings, full quarantines and mass testing.
Though many of these efforts are intensely local, they require close coordination with central officials and neighboring jurisdictions. England, for example, is exploring limited, tailor-made shutdowns around clusters of infections, but local officials warn that the system is full of potential holes.
Health officials in England, Wales, Scotland and Northern Ireland are largely responsible for their own strategies. In England, where local officials have complained about a lack of testing data from the central government, employers or building managers have picked up the slack by keeping track of infections and respond to outbreaks. Some, like the headquarters of a major retailer in East Lancashire, have been praised by public health officials for taking quick action.
But controlling the virus would require an understanding of where it is lurking, especially difficult for a disease in which 80 percent 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 outbreak,” said Lincoln Sargeant, the director of public health in North Yorkshire. “It’s granular intelligence that we need in a timely fashion.”
Mr. Johnson, the prime minister, has maintained that local shutdowns are sufficient to control new waves of the virus. In the beginning, the government “had very few instruments at our disposal,” he said on Friday. Now, he said, officials can “identify outbreaks where they happen.”
He has likened the effort to Whac-A-Mole, the decades-old arcade game. Officials can “take the preventive measures necessary on the spot, rather than going back to the national lockdown approach,” he said. “That’s what we hope.”
In Rome, the outbreak at the San Raffaele Pisana Institute tested the ability of the local authorities to find and stop outbreaks.
Local health officials tested patients and staff at the hospital, emptied three wards and sealed off the building. Former patients and their contacts queued in their cars outside drive-in testing stations. Rome’s prosecutors opened an investigation into clusters’ origin.
One of the people who became ill was a pulmonologist, Vittorio Bisogni. He came down with a slight fever after he visited a patient who had been released from the hospital. Dr. Bisogni was diagnosed with the virus on June 9. His patient died a few days later.
“I got angry,” Dr. Bisogni said, “After getting hit so hard, we can’t afford to be so naïve.”
Reporting was contributed by Hisako Ueno in Tokyo, Su-Hyun Lee in Seoul and Christopher F. Schuetze in Berlin. Liu Yi contributed research.