Reflections about the middle path

By Dr David Nabarro, a Special Envoy of the World Health Organization Director-General on COVID-19

There are new COVID challenges everywhere.  Tricky times for all leaders.  The virus has not changed and still has the potential to do lots of damage.  There is plenty of advice available, much of it is conflicting. 

Some commentators say ‘more restrictions needed now’. 

Others say ‘let the virus run wild and build up herd immunity’.   

A middle path is needed….  Too many restrictions damage people’s livelihoods and provoke resentment.  ‘Virus run wild’ will lead to lots of deaths as well as debilitating long-Covid among younger people. 

…with three interlinked emphases:

a) People are encouraged to adopt all precautions all the time.  As Tedros of WHO says: ‘Do it All’: physical distancing, proper face-masking, hand/cough/surface hygiene, self-isolating when ill and shielding those most at risk.  There should be no exceptions anywhere.  This is best achieved through engaging people and trusting them rather than coercion if at all possible. 

b) Public health services are organized to offer locally-integrated support for interrupting transmission and suppressing clusters.  This means test-trace-isolate-protect services everywhere, with clearly justified performance metrics.  It is important there is enough testing capacity to pick up where the virus is, to detect spikes and manage surges.  From time to time it will be necessary briefly to restrict movement locally to enable suppression of outbreaks.  [NB Building public health capacity is not the same as implementing lockdowns.  It is about building up the capability of public health services to interrupt transmission in localities.  Experience around the world shows that this capability is key to a successful COVID responses.  Lockdowns just freeze the virus in pace they do not lead to elimination]. 

c) Messaging is consistent and clear within and between nations.  If leaders are not consistent in their requests and advocacy, their people will be confused, perhaps frustrated.  In that context the virus is unforgiving and may well spread massively.

The reality is that the virus is a common foe: it is here to stay, and we all have roles to play in keeping it at bay.  People are the solution to stopping spikes and surges from welling up and overwhelming us all.  Integrated local action that involves local and national authorities, businesses, professional bodies, community organizations, schools, academe, the media, international organizations, is essential, with all making themselves available to support people as they act for the common good.   Recognition of those who do this, and coordination among actors, are both essential. 

Looking aheadHumanity will eventually work out how to live with this virus.  I say: the sooner the better. 

What will it mean for all of us?  We will all learn to do the right things at the right time in the right way … because that is what we choose to do.

We will also respond to misleading information sensitively (because we think we understand why some people believe in conspiracies) and firmly (because some of what is being shared is without evidence to support it). 

Surely a vaccine that will save us all will be available soon?  It would be great if that happens.  However even if safe and effective vaccines appear in a few months it will take many more months – even years – to make sure that they are available to all.   

That is why decisions made now are really important for people, societies and economies everywhere. 

Yes, it is not an easy time for leaders.  More and more of them know that they cannot “wish the virus away” with bluster and ridicule.  We are close to the start of the long haul, and finding ways to do the right thing is deadly serious.


Snapshot from WHO COVID-19 Weekly Epidemiological Update, as of 10:00 CET 20 September 2020.

Over 30.6 million COVID-19 cases and 950,000 deaths have been reported to WHO. From 14 through 20 September, there were almost 2 million new cases of COVID-19, which represents a 6% increase compared to the previous week, and the highest number of reported cases in a single week since the beginning of the epidemic.


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