Zero-COVID - Wikipedia

14. 04. 2023.
11:25 Zero-COVID - Wikipedia
Zero-COVID
Zero-COVID, also known as COVID-Zero and "Find, Test, Trace, Isolate, and Support"
(FTTIS), is a public health policy that has been implemented by some countries, especially China,
during the COVID-19 pandemic.[1][a] In contrast to the living with COVID-19 strategy, the zero-
COVID strategy is one "of control and maximum suppression".[1] It involves using public health
measures such as contact tracing, mass testing, border quarantine, lockdowns, and mitigation
software in order to stop community transmission of COVID-19 as soon as it is detected. The goal
of the strategy is to get the area back to zero new infections and resume normal economic and
social activities.[1][4]
A zero-COVID strategy consists of two phases: an initial suppression phase in which the virus is
eliminated locally using aggressive public health measures, and a sustained containment phase, in
which normal economic and social activities resume and public health measures are used to
contain new outbreaks before they spread widely.[4] This strategy has been utilized to varying
degrees by Australia, Bhutan,[5][6] Atlantic and Northern Canada,[7] mainland China, Hong
Kong,[8] Macau,[9] Malaysia,[10] Montserrat, Montenegro, New Zealand, North Korea, Northern
Ireland, Singapore, Scotland,[11] South Korea,[12] Taiwan,[13] East Timor, Tonga,[14] and
Vietnam.[15][16] Since late 2021, due to challenges with the increased transmissibility of the Delta
and Omicron variants, and also the arrival of COVID-19 vaccines, many countries have phased out
zero-COVID, with mainland China being the last to do so in December 2022.
Experts differentiate between zero-COVID, which is an elimination strategy, and mitigation

strategies that attempt to lessen the effects of the virus on society, but which still tolerate some
level of transmission within the community.[17][4] These initial strategies can be pursued
sequentially or simultaneously during the acquired immunity phase through natural and vaccine-
induced immunity.[18]
Advocates of zero-COVID have pointed to the far lower death rates and higher economic growth in
countries that have pursued elimination during the first 12 months of the pandemic (i.e., prior to
widespread vaccination) compared with countries that have pursued mitigation,[17] and argue that
swift, strict measures to eliminate the virus allow a faster return to normal life.[17] Opponents of
zero-COVID argue that "it's not realistic to eliminate a respiratory virus such as SARS-CoV-2, any
more than it is to eliminate the flu or the common cold."[19] To achieve zero-COVID in an area
with high infection rates, one review estimated that it would take three months of strict
lockdown.[20]
Elimination vs. mitigation

Epidemiologists differentiate between two broad strategies for responding to the COVID-19
pandemic: mitigation and elimination.[4][21][22] Mitigation strategies (also commonly known as
"flattening the curve") aim to reduce the growth of an epidemic and to prevent the healthcare
system from becoming overburdened, yet still accept a level of ongoing viral transmission within
the community.[4] By contrast, elimination strategies (commonly known as "zero-COVID") aim to
completely stop the spread of the virus within the community, which was seen as the optimal way
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14. 04. 2023. 11:25 Zero-COVID - Wikipedia
to allow the resumption of normal social and economic

activity.[4] In comparison with mitigation strategies,
elimination involves stricter short-term measures to
completely eliminate the virus, followed by milder long-
term measures to prevent a return of the virus.[4][21]
After elimination of COVID-19 from a region, zero-

COVID strategies require stricter border controls in order
to prevent reintroduction of the virus, more rapid Goals of mitigation include delaying and
identification of new outbreaks and better contact tracing reducing peak burden on healthcare
to end new outbreaks.[21] Advocates of zero-COVID argue (flattening the curve) and lessening overall
that the costs of these measures are lower than the cases and health impact. In contrast, zero-
economic and social costs of long-term social distancing COVID strategies aim to completely
measures and increased mortality incurred by mitigation eliminate the virus and return to normal
strategies.[21][4] social and economic activities.
The long-term "exit path" for both elimination and

mitigation strategies depends on the development of effective vaccines and treatments for COVID-
19.[21][4][23]
Containment measures
The zero-COVID approach aims to prevent viral transmission, using a number of different
measures, including vaccination and non-pharmaceutical interventions such as contact-tracing
and quarantine. Successful containment or suppression reduces the basic reproduction number of
the virus below the critical threshold.[22] Different combinations of measures are used during the
initial containment phase, when the virus is first eliminated from a region, and the sustained
containment phase, when the goal is to prevent reestablishment of viral transmission within the
community.[24]
Lockdowns
Lockdowns encompass measures such as closures of non-essential businesses, stay-at-home

orders, and movement restrictions.[24] During lockdowns, governments must often supply basic
necessities to households.[24][4] Lockdown measures are commonly used to achieve initial
containment of the virus.[24] In China, lockdowns of specific high-risk communities are also
sometimes used to suppress new outbreaks.[4]
Quarantine for travelers
In order to prevent reintroduction of the virus into zero-COVID regions after initial containment
has been achieved, quarantine for incoming travelers is commonly used. As each infected traveler
could seed a new outbreak, the goal of travel quarantine is to intercept as large a percentage of
infected travelers as possible.[24][25]
International flights to China are heavily restricted, and incoming travelers are required to
undergo PCR testing and quarantine in designated hotels and facilities.[26] In order to facilitate
quarantine for travelers, China has constructed specialized facilities at its busiest ports of entry,
including Guangzhou and Xiamen.[24] New Zealand and Australia have also established managed
isolation and quarantine facilities for incoming travelers.[25]
Through November 2020, border quarantine measures prevented nearly 4,000 infected
international travelers from entering the wider community within China.[27] Each month,
hundreds of travelers who test negative before flying to China subsequently test positive while
undergoing quarantine after arrival.[24]
Contact tracing, quarantine, and isolation
Contact-tracing involves identifying people who have been

exposed to (or "came into close contact with") an infected
person. Public health workers then attempt to locate all of
those exposed persons, and quarantine them until they
either are unlikely to be infectious or receive several
negative tests. This is in addition to isolating the known
infected person. Various studies have argued that early
detection and isolation of infected people is the single most Transmission chains
effective measure for preventing transmission of SARS-CoV-
2.[24][4] "Quarantine" refers to the separation of exposed
persons who could possibly be infected from the rest of society, while "isolation" refers to the
separation of persons who are known to be infected.[28]
In China, when an infected person is identified, all close contacts are required to undergo a 14-day
quarantine with multiple rounds of PCR testing.[27] In order to minimize the risk that these close
contacts pose for outbreak containment, China has implemented quarantine in centralized
facilities for those deemed to be at the highest-risk of infection.[24] Secondary close contacts
(contacts of close contacts) are sometimes required to quarantine at home.[24]
The widespread use of smartphones has enabled more rapid "digital" contact tracing. In China,
"health code" applications are used to facilitate the identification of close contacts, via analysis of
Bluetooth logs which show proximity between devices.[4] Taiwan has also made use of digital
contact tracing, notably to locate close contacts of passengers who disembarked from the Diamond
Princess cruise ship, the site of an early outbreak in February 2020.[29]
Routine testing of key populations
In China, routine PCR testing is carried out on all patients who present with fever or respiratory
symptoms.[27] In addition, various categories of workers, such as medical staff and workers who
handle imported goods, are regularly tested.[27]
In China, routine testing of key populations has identified index patients in a number of outbreaks,
including outbreaks in Beijing, Shanghai, Dalian, Qingdao, and Manchuria.[24] In some cases,
index patients have been discovered while asymptomatic, limiting the amount of onward
transmission into the community.[24]
Community-wide screening
An additional tool for identifying cases outside of known transmission chains is community-wide
screening, in which populations of specific neighborhoods or cities are PCR tested. In China,
community-wide PCR testing is carried out during outbreaks in order to identify infected people,
including those without symptoms or known contact with infected people.[27] Community-wide
screening is intended to rapidly isolate infected people from the general population, and to allow a
quicker return to normal economic activity.[27] China first carried out community-wide screening
from 14 May to 1 June 2020 in Wuhan, and has used this technique in subsequent outbreaks.[27]
In outbreaks in June 2020 in Beijing and July 2020 in Dalian, community screening identified
26% and 22% of infections, respectively.[24] In order to test large populations quickly, China
commonly uses pooled testing, combining 5 to 10 samples before testing, and retesting all
individuals in each batch that tests positive.[24]
Zero-COVID implementation by region
Australia
The first confirmed case in Australia was identified on 25

January 2020, in Victoria, when a man who had returned from
Wuhan, Hubei Province, China, tested positive for the
virus.[30] A human biosecurity emergency was declared on 18
March 2020. Australian borders were closed to all non-
residents on 20 March,[31] and returning residents were
required to spend two weeks in supervised quarantine hotels
from 27 March.[32] Many individual states and territories also
closed their borders to varying degrees, with some remaining
closed until late 2020,[33] and continuing to periodically close
during localised outbreaks.[34]
COVID-19 travel restrictions for
Social distancing rules were introduced on 21 March, and state
Australians and permanent
governments started to close "non-essential" services.[35][36]
residents
"Non-essential services" included social gathering venues such
as pubs and clubs but unlike many other countries did not
include most business operations such as construction, manufacturing and many retail
categories.[37]
During the second wave of May and June 2020, Victoria underwent a second strict lockdown with
the use of helicopters and the Army to help the police enforce the Zero-COVID lockdown, which
would become a norm of deployment, such as during the COVID-19 Delta variant outbreak in
Sydney a year later.[38][39] The wave ended with zero new cases being recorded on 26 October
2020.[40][41][42] Distinctive aspects of that response included early interventions to reduce
reflected transmission from countries other than China during late January and February 2020;
early recruitment of a large contact tracing workforce;[43] comparatively high public trust in
government responses to the pandemic, at least compared to the US;[44] and later on, the use of
short, intense lockdowns to facilitate exhaustive contact tracing of new outbreaks.[45][46]
Australia's international borders also remained largely closed, with limited numbers of strictly
controlled arrivals, for the duration of the pandemic.[47] Australia sought to develop a Bluetooth-
based contact tracing app that does not use the privacy-preserving Exposure Notification
framework supported natively by Android and Apple smartphones, and while these efforts were
not particularly effective,[48][49][50] QR code-based contact tracing apps became ubiquitous in
Australia's businesses.[51][52][53]
In July 2021, the Australian National Cabinet unveiled plans to live with COVID and end
lockdowns and restrictions contingent on high vaccine uptake.[54] By August 2021 amid outbreaks
in New South Wales, Victoria and the ACT, Prime Minister Scott Morrison conceded a return to
Zero-COVID was highly unlikely.[55] Over the following months, each Australian juristiction began
a living with COVID strategy either through ending lockdowns or voluntarily allowing the virus to
enter by opening borders.[56][57]
Bhutan
As of January 2022, Bhutan was following a Zero-COVID strategy. The country enforced
lockdowns on districts (dzongkhags) whenever local cases of COVID-19 were detected, and health
personnel isolated elderly people and others with comorbidities who were in close contact with
those COVID-19 cases.[5] However, the Omicron variant challenged Bhutan's elimination strategy,
and the country abandoned it in mid-April, instead focusing on hospitalization rates.[6]
Canada (Atlantic and Northern)
The virus was confirmed to have reached Canada on 27

January 2020, after an individual who had returned to Toronto
from Wuhan, Hubei, China, tested positive. The first case of
community transmission in Canada was confirmed in British
Columbia on 5 March.[58] In March 2020, as cases of
community transmission were confirmed, all of Canada's
provinces and territories declared states of emergency. Traveling inside the Atlantic Bubble:
Provinces and territories have, to varying degrees, a New Brunswick checkpoint on the
implemented prohibitions on gatherings, closures of non- Trans-Canada Highway, when
essential businesses and restrictions on entry with Atlantic entering from Nova Scotia in August
Canada and the three Canadian Territories adopting a COVID- 2020.
Zero approach. [59] On 24 June 2020, it was announced that
the four Atlantic provinces: New Brunswick, Prince Edward
Island, Nova Scotia, and Newfoundland and Labrador had come to an agreement of creating a
free-travel bubble while maintaining low case numbers inside, effective 3 July 2020.[60][61] In late
November 2020, mounting cases led to the disbandment of the Atlantic Bubble,[62] with each of
the Atlantic provinces maintaining their own travel restrictions and Zero-COVID policies after the
bubble burst.[63] Throughout 2020 and 2021 infection rates and deaths in the Atlantic provinces
remained low, especially compared to the more populated areas of Canada which did not
implement COVID-Zero.[59] The appearance of the Delta and Omicron variants led to the
successive abandonment of COVID-Zero in Atlantic Canada at the end of 2021.[63]
China
Mainland
China was the first country to experience the COVID-19 pandemic. The first cluster of pneumonia
patients was discovered in late December 2019 in Wuhan, Hubei Province, and a public notice on
the outbreak was distributed on 31 December 2019.[65]
On 23 January 2020, the Chinese government banned travel to and from Wuhan, and began
implementing strict lockdowns in Wuhan and other cities throughout China.[65] These measures
suppressed transmission of the virus below the critical threshold, bringing the basic reproduction
number of the virus to near zero.[65] On 4 February 2020, around two weeks after the beginning of
the lockdowns in Hubei province, case counts peaked in the province

and began to decline thereafter.[65] The outbreak remained largely
concentrated within Hubei province, with over 80% of cases
nationwide through 22 March 2020 occurring there.[26]
The death toll in China during the initial outbreak was approximately
4,600 according to official figures (equivalent to 3.2 deaths per
million population),[66] and has been estimated at under 5,000 by a
scientific study of excess pneumonia mortality published in The
BMJ.[67]
As the epidemic receded, the focus shifted towards restarting

economic activity and preventing a resurgence of the virus.[68] Low- Since 25 January 2020, all
and medium-risk areas of the country began to ease social distancing passengers entering or
measures on 17 February 2020.[68] Reopening was accompanied by exiting mainland China in
an increase in testing and the development of electronic "health Beijing, Shanghai and
codes" (using smartphone applications) to facilitate contact Guangdong must write a
tracing.[68] Health code applications contain personalized risk health declaration where
information, based on recent contacts and test results.[68] Wuhan, the the individual must answer
whether they have been to
last major city to reopen, ended its lockdown on 8 April 2020.[69]
Hubei Province. This
China reported its first imported COVID-19 case from an incoming declaration form can also
be filled by using
traveler on 30 January 2020.[68] As the number of imported cases
rose and the number of domestic cases fell, China began imposing WeChat.[64]
restrictions on entry into the country.[68] Inbound flights were
restricted, and all incoming passengers were required to undergo
quarantine.[68]
After the containment of the initial outbreak in Wuhan, the Chinese Center for Disease Control
and Prevention (China CDC) argued, "The successful containment effort builds confidence in
China, based on experience and knowledge gained, that future waves of COVID-19 can be stopped,
if not prevented. Case identification and management, coupled with identification and quarantine
of close contacts, is a strategy that works."[4] The China CDC rejected a mitigation strategy, and
instead explained that "[t]he current strategic goal is to maintain no or minimal indigenous
transmission of SARS-CoV-2 until the population is protected through immunisation with safe and
effective COVID-19 vaccines, at which time the risk of COVID-19 from any source should be at a
minimum. This strategy buys time for urgent development of vaccines and treatments in an
environment with little ongoing morbidity and mortality."[4]
Since the end of the initial outbreak in Wuhan, there have been additional, smaller outbreaks
caused by imported cases, which have been controlled through short-term, localized intense public
health measures.[69] From July through August 2021, China experienced and contained 11
outbreaks of the Delta variant, with a total of 1,390 detected cases (out of a population of 1.4
billion in mainland China).[70] The largest of these outbreaks, in both geographic extent and in the
number of people infected, began in Nanjing.[70] The index case of the outbreak, an airport
worker, tested positive on 20 July 2021, and the outbreak was traced back to an infected passenger
on a flight from Moscow that had arrived on 10 July.[70] The outbreak spread to multiple provinces
before it was contained, with a total of 1,162 detected infections.[70] China has made use of mass
testing to control several outbreaks. For example, nearly the entire population of the city of
Guangzhou—approximately 18 million residents—were tested over the course of three days in June
2021, during a Delta variant outbreak.[71]
Since mid-February 2022, China has faced unprecedented waves of infections caused by the
Omicron variant and subvariants, with daily cases reaching record highs in the thousands—levels
not seen at any prior point in the pandemic.[72] Similar zero-COVID measures were deployed in
some areas with lockdowns in Shenzhen,[73] Shenyang[74] and Jilin.[74] Other areas such as
Shanghai had previously adopted a less strict approach avoiding wholesale lockdowns,[75][76] only
to issue a snap lockdown in late March due to rapidly rising case counts.[77] Since 1 April, most
areas of Shanghai had instituted "area-separated control".[78] This is widely considered to be the
largest lockdown event in China since Hubei in early 2020.[79] These measures have seen some
rare pushback from residents over the overzealousness of the implementation and the perceived
lack of benefit.[80][81][82][83][84]
Nationwide protests broke out in November 2022 amid growing discontent among residents over
the zero-COVID policy and the resulting economic costs.[85] The Guardian wrote that "The
consensus among global health experts is that zero-COVID is unsustainable in the long term".[86]
Paul Hunter, professor of the University of East Anglia said that the vaccines approved in China
were not as protective as the main Western vaccines, that vaccination and booster rates for the
elderly were too low, and that any lifting of restrictions should be incremental to avoid
overwhelming hospitals.[87] In response to the protests, the government loosened and overhauled
many of its rules, including detention for people who test positive and compulsory PCR tests, on
December 7, 2022.[88][89][90] On 12 December, the Chinese government announced it was taking
offline one of the main health code apps, which was key in tracking people's travel history to
identify whether they've been to high-risk areas.[91][92] Due to this, many sources have reported
that China's zero-COVID policy has effectively ended.[93][94][95]
Hong Kong
The virus was first confirmed to have spread to Hong Kong on

23 January 2020.[96] On 5 February, after a five-day strike by
front-line medical workers, the Hong Kong government closed
all but three border control points – Hong Kong International
Airport, Shenzhen Bay Control Point, and Hong Kong–
Zhuhai–Macau Bridge Control Point remaining open. Hong
Kong was relatively unscathed by the first wave of the COVID-
19 outbreak. Some experts believe the habit of wearing masks
in public since the SARS epidemic of 2003 may have helped Tong Ming Street Park COVID-19
keep its confirmed infections rates low.[97] In a study testing center
published in April 2020 in the Lancet, the authors expressed
their belief that border restrictions, quarantine and isolation,
social distancing, and behavioural changes likely all played a part in the containment of the disease
up to the end of March.[98]
After a much smaller second wave in late March and April 2020,[99] Hong Kong saw a substantial
uptick in COVID cases in July.[100] Experts attributed this third wave to imported cases – sea
crew, aircrew members, and domestic helpers made up the majority of 3rd wave infections.;[100]
Measures taken in response included a suspension of school classroom teaching until the end of
the year, and an order for restaurants to seat only two persons per table and close at 10:00 p.m.
taking effect on 2 December;[101] a further tightening of restrictions saw, among other measures, a
6pm closing time of restaurants starting from 10 December, and a mandate for authorities to order
partial lockdowns in locations with multiple cases of COVID-19 until all residents were tested.[102]
From late January 2021, the government repeatedly locked down residential buildings to conduct
mass testings. A free mass vaccination program with the Sinovac vaccine and Pfizer–BioNTech
vaccine was launched on 26 February. The government sought to counter the vaccine hesitancy by
material incentives, which led to an acceleration of vaccinations in June.[103] From early 2022, to
prevent the spread of the Omicron variant, Hong Kong had been placed under tightened alert until
the day it became 70% fully inoculated.[104] Nonetheless, earlier focus and messaging about
eliminating all cases had weakened the case for getting vaccinated in the first place, with less than
one-quarter of people aged 80 or older having received two doses of a vaccine before Omicron
surged.[105]
By mid-February 2022, the Omicron variant had caused the largest outbreak to date in the
territory; authorities modified their eradication protocols, but continued to pursue
containment.[106] By mid-March, the virus spread rapidly in the densely populated city, and
researchers at University of Hong Kong estimated that almost half the population was infected at
one point since the start of the outbreak, compared to only 1 percent of the population before the
surge.[105][107] Daily new cases peaked to over 70,000 by March, a far cry from the single-digit
daily case loads from Hong Kong's successful implementation of Zero-COVID. Total deaths
increased from around 200 over the two years of the pandemic[108] to exceeding 7,000 in a span of
a few weeks, leading Hong Kong's COVID-19 deaths per capita, once far lower than those of
Western nations, to become the highest in the world during March.[107] The massive death toll and
high infection rates while maintaining strict eradication protocols led to the calls for authorities to
review Hong Kong's Zero COVID strategy, as well as questioning the sustainability of such an
approach with the Omicron variant.[109][110]
Macau
Macau, like mainland China and Hong Kong, has followed a zero-COVID strategy (Portuguese:
Meta Dinâmica de Infecção Zero). The city, whose economy is heavily dependent on revenues
from its casinos, has closed its borders to all travelers who are not residents of Greater China.
Despite its proximity to mainland China, from the beginning of the pandemic through 11 March
2022, Macau confirmed only 82 total infections and not a single death.[111]
From mid-June to mid-July 2022, Macau saw an unprecedented wave of infections driven by the
BA.5 Omicron subvariant. Health authorities imposed restrictions on activities, including ordering
residents to stay at home and the closure of non-essential businesses, including for the first time
since February 2020, all its casinos.[112] After nine consecutive days of no local cases and over 14
rounds of mandatory mass testing, Macau reopened in what the city's government called a
"consolidation period".[113]
In December 2022, in line with mainland China's easing of its zero-COVID policy, Macau eased its
testing and quarantine policies.[114]
Montserrat
The British territory and Caribbean island of Montserrat has used a Zero-COVID strategy, using
testing and quarantine on inbound travelers to prevent localized outbreaks. It had suffered just 175
cases and two deaths as of April 2022.[115] From 31 December 2021, Montserrat suffered its first
major outbreak, with 67 locally transmitted infections and one death.[116] On 1 March 2022, the
ministry of health declared the outbreak to be over, having gone 31 days without a locally
transmitted case.[117] In October 2022 Montserrat ended measures.[118]
New Zealand
New Zealand reported its first case of COVID-19 on 28 February

2020.[119] From 19 March, entry into New Zealand was limited to citizens
and residents,[120] and the country began quarantining new arrivals in
converted hotels on 10 April.[121]
On 21 March, a four-tier alert level system was introduced, and most of

the country was placed under lockdown from 25 March.[122] Due to the
success of the elimination strategy, restrictions were progressively lifted
between 28 April and 8 June, when the country moved to the lowest alert
level, and the last restrictions (other than quarantine for travelers) were
removed.[123][124][125][126][127]
After the lifting of restrictions, New Zealand went for 102 days without
any community transmission.[128] On 11 August 2020, four members of a
single family in Auckland tested positive for SARS-CoV-2, prompting a
city-wide lockdown, and lesser restrictions throughout New Zealand.[128]
Additional cases related to this cluster of infections were identified over
An Emergency Mobile
the following weeks. On 21 September, after a week without any new
Alert sent at 18:30 on 25
cases of community transmission, restrictions were dropped to the
March 2020, informing
lowest level outside of Auckland. Restrictions in Auckland were eased
of the imminent move to
somewhat two days later,[129] and moved to the lowest level on 7 Alert Level 4.
October.[130]
Additional small outbreaks led to temporary restrictions in parts of New Zealand in February,
March, and June 2021.[131]
The country moved to a nationwide lockdown on 17 August 2021, after the detection of one new
local case outside of quarantine in Auckland.[132] Over the following weeks, Auckland remained
under lockdown as cases rose, while the most of the rest of the country progressively eased
restrictions.[131] On 4 October 2021, the government of New Zealand announced that it was
transitioning away from its zero-COVID strategy, arguing that the Delta variant made elimination
infeasible.[133]
North Korea
North Korea also reportedly follows an "elimination strategy."[134]
North Korea was one of the first countries to close borders due
to COVID-19.[135][136] Starting from 23 January 2020, North
Korea banned foreign tourists, and all flights in and out of the
country were halted. The authorities also started placing
patients with suspected COVID, including those with slight,
flu-like symptoms, in quarantine for two weeks in
Sinuiju.[137][138][139] On 30 January, the state news agency of
North Korea, the Korean Central News Agency (KCNA),
declared a "state emergency", and reported the establishment
of anti-epidemic headquarters around the country.[140] Though Masikryong Ski Resort, a popular
many parts of the border were closed, the bridge between ski resort in North Korea. Due to the
Dandong and Sinuiju remained open and allowed supplies to outbreak of the virus, ski resorts and
be delivered.[141] In late February, the North Korean spas in North Korea have been
government said that it would keep the border closed until a closed.
cure was found.[142]
On 2 February, KCNA reported that all the people who had entered the country after 13 January
were placed under "medical supervision".[140] South Korean media outlet Daily NK reported that
five suspected COVID-19 patients in Sinuiju, on the Chinese border, had died on 7 February.[143]
The same day, The Korea Times reported that a North Korean female living in the capital
Pyongyang was infected.[144] Although there was no confirmation by North Korean authorities of
the claims, the country implemented further strict measures to combat the spread of the
virus.[145][146] Schools were closed starting on 20 February.[147] On 29 February, Supreme Leader
Kim Jong-un called for stronger measures to be taken to prevent COVID-19 from spreading within
North Korea.[148]
In early February, the North Korean government took severe measures to block the spread of
COVID-19. Rodong Sinmun, the Workers' Party of Korea newspaper, reported that the customs
officials at the port of Nampo were performing disinfection activities, including placing imported
goods in quarantine.[149] All international flights and railway services were suspended in early
February, and connections by sea and road were largely closed over the following weeks.[142] In
February, wearing face masks was obligatory, and visiting public places such as restaurants was
forbidden. Ski resorts and spas were closed, and military parades, marathons, and other public
events were cancelled.[142] Schools were closed throughout the country; university students in
Pyongyang from elsewhere in the country were confined to their dormitories.[150][147]
Although South Korean media reported the epidemic had spread to North Korea, the WHO said
there were no indications of cases there.[151] On 18 February, Rodong Sinmun, the official
newspaper of North Korea's ruling party, quoted a public health official reiterating that there had
been "no confirmed case of the new coronavirus so far". The WHO prioritised aid for North Korea,
including the shipment of protective equipment and supplies.[152]
On 25 July, Kim Jong-un attended an emergency meeting after
a suspected COVID-19 case was reported in the city of
Kaesong. Kim declared a state of emergency and imposed a
lockdown on the city.[153][154] The suspected case was reported
to be an individual who had defected to South Korea three
years earlier, before swimming back to North Korea in July (a
rare case of "re-defection"). According to a South Korean
senior health official, the individual was neither registered as a
COVID-19 patient, nor classified as someone who came in
contact with other patients. Two close contacts of the defector Kaesong, where a suspected case
in South Korea tested negative for the virus.[155] On 5 August, was reported in July 2020
Salvador said the returning defector was tested but the "results
were inconclusive".[156] On 14 August, the three week
lockdown in Kaesong and nearby areas was lifted by Kim Jong-un,[157] after "the scientific
verification and guarantee by a professional anti-epidemic organisation".[158]
On 12 May 2022, the North Korean government declared a "severe national emergency", after
samples from an unspecified number of people tested positive for COVID-19. This marked the first
time that North Korea had publicly acknowledged the existence of COVID-19 cases in the country.
The Korean Central News Agency stated that Supreme Leader Kim Jong-un had called an
emergency meeting of the Politburo of the Workers' Party of Korea after learning of the samples,
which were sourced from residents of Pyongyang and had symptoms "consistent with" the
Omicron variant. The Politburo recommended the implementation of a "maximum" emergency
quarantine, to include nationwide lockdowns, border restrictions, and restrictions on group sizes
in workplaces.[159][160][161][162][163] During the politburo meeting, the previous anti-pandemic
strategy was criticised.[164][163] NK News reported that the entire country had been placed under a
lockdown two days prior, though farmers in border regions close to South Korea were seen still
tending the fields.[160] It was later reported by state media that at least one North Korean died
after testing positive, and that 187,800 people are now under quarantine due to "fever".[165]
Scotland and Northern Ireland
Scotland, led by its devolved government, pursued an "elimination" COVID-19 strategy starting
from April 2020.[166] The Scottish government's approach diverged with that of the central British
government in April 2020, after a UK-wide lockdown began being lifted. Scotland pursued a
slower approach to lifting the lockdown than other nations of the UK, and expanded a "test and
trace" system.[166] Although Northern Ireland also pursued the strategy[11][167] and Scottish First
Minister Nicola Sturgeon advocated for the approach to be adopted by the whole of the UK,[167]
the central British government pursued a different mitigation strategy that applied to England,
with commentators noting that this combined with an open Anglo-Scottish border could
undermine Scotland's attempts at elimination.[168][11][169]
Singapore
Singapore recorded its first COVID-19 case on 23 January

2020.[170] With that, many Singaporeans had purchased and
worn masks when not at home; practiced social distancing and
on 7 February 2020, Singapore raised the Disease Outbreak
Response System Condition (DORSCON) level from Yellow to
Orange in response to additional local cases of uncertain
origin.[171] On 3 April 2020, a stringent set of preventive
measures collectively called the "circuit breaker lockdown" was
announced.[172] Stay-at-home order and cordon sanitaire were An automatic self-check-in station at
implemented as a preventive measure by the Government of Paya Lebar Square mall
Singapore in response on 7 April 2020. The measures were implemented to facilitate contact
brought into legal effect by the Minister for Health with the tracing.
COVID-19 (Temporary Measures) (Control Order) Regulations
2020, published on 7 April 2020.[173]
The country introduced what was considered one of the world's largest and best-organised
epidemic control programmes.[174][175] The "Control Order" implemented various measures such
as; mass testing the population for the virus, isolating any infected people as well as introducing
contact tracing apps and strictly quarantining those they had close contact with those infected. All
non-essential workplaces closed, with essential workplaces remaining open. All schools
transitioned to home-based learning. All food establishments were only allowed to offer take-away,
drive-thru and delivery of food. Non-essential advertising at shopping centres are not allowed to
be shown or advertised and only advertising from essential service offers and safe management
measures such as mask wearing and social distancing are allowed.[176]
These measures helped to prevent these lockdowns after the end of the circuit breaker lockdown
measures in June 2020 with reopening being staggered in different steps all the way until April
2021.[177][178] The high transmissibility of the Delta and Omicron variants challenged Singapore's
Zero-COVID approach, and the country phased it out after vaccinating the majority of its
population in October 2021.[179]
South Korea
The first case in South Korea was announced on 20 January

2020.[180] On 4 February 2020, in order to help prevent
spread of the disease, South Korea began denying entry to
foreigners traveling from China.[181][182] Various other
measures have been taken: mass testing the population,
isolating infected people, and trace and quarantine of those
they had contact with.[183][184] The rapid and extensive testing
undertaken by South Korea has been judged successful in
limiting the spread of the outbreak, without using drastic A drive-through testing site in South
measures. [183][185][186] There was no general lockdown of Korea
businesses in South Korea, with supermarkets and other
retailers remaining open. However, schools, universities,
cinemas, and gyms were closed soon after the outbreaks, with schools and universities having
online classes.[187]
The government is providing citizens with information in Korean, English, Chinese, and Japanese
on how to not become infected and how to prevent spreading the disease as part of its "K-
Quarantine" measures. This includes information on cough etiquette, when and how to wear a face
mask, and the importance of physical distancing and staying at home.[187] The South Korean
government has also been sending daily emergency notifications, detailing information on
locations with reported infections and other status updates related to the pandemic.[188] Infected
South Koreans are required to go into isolation in government shelters. Their phones and credit
card data are used to trace their prior movements and find their contacts. People who are
determined to have been near the infected individual receive phone alerts with information about
their prior movements.[189]
Taiwan
Due to its extensive cultural and economic exchanges with mainland

China, Taiwan was initially expected to be at high risk of developing a
large-scale outbreak of COVID-19.[190][191]
Immediately after mainland China notified the WHO of a pneumonia

cluster in Wuhan on 31 December 2019, Taiwanese officials began
screening passengers arriving from Wuhan for fever and
pneumonia.[191] This screening was subsequently broadened to all
passengers with respiratory symptoms who had recently visited
Wuhan.[191] Beginning in early February 2020, all passengers arriving
from mainland China, Hong Kong or Macau were required to
quarantine at home for 14 days after arrival in Taiwan.[29] Mobile
Body temperature
phone data was used to monitor compliance with quarantine
checkpoint at National
requirements.[191] Taiwan Normal University
Public places such as schools, restaurants and offices in Taiwan were

required to monitor body temperature of visitors and provide hand
sanitizer.[192] Mask-wearing was encouraged, and on 24 January, an export ban and price controls
were placed on surgical masks and other types of personal protective equipment.[192]
On 20 March 2020, Taiwan initiated 14-day quarantine for all international arrivals, and began
converting commercial hotels into quarantine facilities.[193] In early April, Taiwanese public health
officials announced social distancing measures, and mandated mask use in public transport.[29]
The first known case of COVID-19 in Taiwan was identified on 21 January 2020.[192] On 31
January, approximately 3,000 passengers from the Diamond Princess cruise ship went ashore in
Taiwan. Five days later, it was recognized that there was an outbreak on the ship.[194] Taiwanese
public health authorities used mobile phone data and other contact tracing measures to identify
these passengers and their close contacts for testing and quarantine.[194] No cases related to these
passengers were identified in Taiwan.[194]
Taiwan maintained near-zero viral prevalence throughout 2020, totaling just 56 known locally
transmitted cases (out of a population of 23.6 million) through 31 December 2020.[190]
Taiwan experienced its largest outbreak from April to August 2021, initially caused by violations of
COVID-19 quarantine rules by international flight crews.[195][196] On 15 May 2021, Taiwan
identified more than 100 daily cases for the first time since the start of the pandemic.[197] The
outbreak was brought to an end on 25 August 2021, when Taiwan recorded no new locally
transmitted cases for the first time since May 2021.[198]
In April 2022, the government departed from Zero-COVID, launching a revised strategy — billed
as the "new Taiwanese model" — that no longer focuses on total suppression, but rather shifts to
mitigating the effects of the pandemic. Premier Su Tseng-chang was cited as saying the new model
is not the same as "living with COVID-19", as the virus would not be allowed to spread unchecked,
but active prevention of the virus' spread would be balanced with allowing people to live normal
lives and a stable reopening of the economy.[199] As of early May 2022, the government has
maintained the policy amidst a wave of infections that crossed 30,000 new COVID-19 cases for the
first time since the pandemic began, and that Health minister Chen Shih-chung said was on track
to reach up to 100,000 new infections daily.[200] On 7 May 2022, Taiwan reported 46,377 new
cases, overtaking the United States as the highest daily new case region.[201]
East Timor
Due to its fragile healthcare system, East Timor would have been deeply affected by a widespread
COVID-19 outbreak. The East Timor government implemented a strategy to keep the virus out by
closing the border with Indonesia, and only allowing entry of citizens by repatriation flights.[202]
This strategy was effective initially. During 2020, the country reported 44 infections and zero
fatalities, and the country was able to function normally, with no lockdowns and largely maskless
crowds celebrating Christmas in 2020.[202] However, new variants caused a spike beginning in
March 2021, prompting mask mandates and some restrictions on business operations.[203]
Timorese authorities were able to contain this outbreak by November 2021, and on 30 November,
the state of emergency ended. Business restrictions, as well as the outdoor mask mandate, were
lifted.[204] The indoor mask mandate was lifted on 7 January 2022, and as of March 2022, the
country maintained an elimination strategy to keep out all infections.
Tonga
Tonga has followed a Zero-COVID policy, but more than a year and a half into the pandemic, on 29
October 2021, the first COVID-19 case—a seasonal worker who returned from New Zealand and
entered quarantine—was confirmed. The country's COVID-19 policy caused complications with
international aid following the Hunga Tonga volcano eruption in 2022.[205] To keep the country
virus-free, an Australian aid flight had to return to base after detecting a case midflight, while
HMAS Adelaide (L01) made plans to stay at sea after 23 members of her crew tested positive for
COVID-19.[206]
Vietnam
The virus was first confirmed to have spread to Vietnam on 23

January 2020, when two Chinese people in Ho Chi Minh City
tested positive for the virus.[207][208] In response the
government issued a diagnostic and management guidelines
for COVID-19, providing instructions on contact tracing and
14-day isolation.[16] Health authorities began monitoring body
temperatures at border gates and started detection and contact
tracing, with orders for the mandatory isolation of infected A Vietnamese COVID shopping
people and anyone they had come into contact with.[209] coupon, it is used to manage the
number of people entering market or
In 2020, Vietnam was cited by global media as having one of
supermarket.
the best-organized epidemic control programs in the
world,[210][211][212] along the lines of other highlights such as
Taiwan and South Korea.[213] This success has been attributed to several factors, including a well-
developed public health system, a decisive central government, and a proactive containment
strategy based on comprehensive testing, tracing, and quarantining.[15] However, instead of
relying on medicine and technology, the Vietnamese state security apparatus has adopted an
widespread of public surveillance system along with a public well-respected military force.[214][215]
Starting in April 2021, Vietnam experienced its largest outbreak to date, with over 1.2 million
infections recorded by November.[216] This led to two of its largest cities (Ho Chi Minh City and
Hanoi) and around a third of the country's population coming under some form of lockdown by
late July.[217] A degree of complacency after successes in previous outbreaks, and infections
originating from foreign workers were all considered to have contributed to the outbreak. In
response, government-mandated quarantine for foreign arrivals and close contacts to confirmed
cases was extended to 21 days, and accompanying safety measures also tightened up.[218]
In September 2021, Vietnam abandoned its zero-COVID strategy, after a three-month lockdown of
Ho Chi Minh City caused major economic disruption in the city and failed to contain the outbreak.
The country shifted to a phased reopening and more flexible approach while expanding its
vaccination programme.[219][220]
Reception
Support
Proponents of the zero-COVID strategy argue that successful execution reduces the number of
nationwide lockdowns needed,[221] since the main goal is focused on the elimination of the virus.
When the virus is eliminated, people would be at ease given that COVID-19 causes a lot of health
impacts. As such, healthcare and economic costs are lower under a zero-COVID strategy because
the elimination of the virus allows new outbreaks to be easily monitored and curtailed, and that
there is less economic disruption since only certain areas are affected, which can be easily
monitored.[222][223] This will result in a situation that is less costly to society,[224] that it reduces
dependence on pharmaceutical interventions such as vaccines,[225] and that it increases quality of
life and life expectancy due to fewer citizens contracting COVID-19.[226]
Opposition
The zero-COVID strategy, unlike other strategies such as mitigation or living with COVID-19, aims
to eliminate the virus altogether. While mitigation and living with COVID-19 aim to tolerate
outbreaks of COVID-19, to the extent of ignoring outbreaks altogether, the zero-COVID strategy
requires quick, efficient and immediate containment of the virus in order for the policy to work.
This means that a government that decides to use this strategy would need to utilize all means
possible, from closing schools and shops, to implementing strict lockdowns or even culling
animals deemed to carry the virus, in order to get the cases down to zero. Such measures have
resulted in negative connotations which can affect lives, livelihoods and mental health as seen in
the following examples.
Chinese virologist Guan Yi has criticised the Chinese government's zero COVID measures, telling
Phoenix Hong Kong Channel that, if the government persists with the policy for a handful of cases,
the economy will suffer. The implementation of the zero-COVID policy in China has resulted in
multiple business closures, citywide lockdowns and stay-at-home notices in order to prevent the
spread of COVID-19. This has resulted in loss of revenue and production, which has contracted the
economy. Guan has advocated for increased vaccination and research into the efficacy of
homegrown vaccines against new variants, as the vaccines would prevent death and reduce the
impact of COVID-19, which can enable people to swiftly recover without interruption from
COVID-19.[227]
Other opponents of the zero-COVID strategy argue that the strategy causes the economy to
suffer,[228] that before vaccinations were common, elimination strategies lowered herd
immunity,[229] that zero-COVID is not sustainable,[230] and that newer variants such as the
Omicron variant are so transmissible that the zero-COVID strategy is no longer feasible.[231]
In May 2022, World Health Organization director-general Tedros Adhanom Ghebreyesus

commented that the zero-COVID strategy is no longer considered sustainable based on "the
behavior of the virus now" and future trends. The comment was suppressed on the Chinese
Internet.[232] The Lancet, mostly supportive of a zero-COVID strategy before the appearance of
less severe but more transmissible variants, also published a news article detailing the problems in
China's implementation.[233]
Some countries which pursued zero-COVID, such as Vietnam, Singapore, and Australia, later
decided to discontinue it, citing increased vaccination rates and more transmissible variants.[229]
Singapore abandoned zero-COVID in August 2021 after the Delta variant started spreading there,
while Australia and Vietnam reopened their borders in early 2022.
See also
COVID-19 portal
Baltic Bubble
Endemic COVID-19
Eradication of infectious diseases
List of COVID-19 pandemic legislation
Protective sequestration
Use and development of software for COVID-19 pandemic mitigation
Explanatory notes
a. simplified Chinese: 动态清零; traditional Chinese: 動態清零; pinyin: Dòngtài qīng líng; lit.
'Dynamic Clearing',[2] Portuguese: Meta Dinâmica de Infecção Zero[3]
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Further reading
Skegg, David; Hill, Philip C (15 July 2021). "Defining covid-19 elimination" (https://www.bmj.co
m/content/374/bmj.n1794). BMJ. 374: n1794. doi:10.1136/bmj.n1794 (https://doi.org/10.1136%
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elimination in the covid-19 pandemic? (https://www.bmj.com/content/370/bmj.m3410.full) BMJ
2020; 370 :m3410 doi:10.1136/bmj.m3410
Moon, Joshua and Chekar, Choon Key and Barberá, David and Davey, Gail and Gaisser,
Sibylle and Gaisser, Tobias and Iwuji, Collins and Meseguer, Enrique and Ryan, James G and
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22 Pages, Social Science Research Network
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External links
EndCoronavirus.org (https://www.endcoronavirus.org/zero-covid) – List of "zero-COVID"
advocacy groups
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14. 04. 2023.

11:25 Zero-COVID - Wikipedia

Experts differentiate between zero-COVID, which is an elimination strategy, and mitigation

Elimination vs. mitigation

to allow the resumption of normal social and economic

After elimination of COVID-19 from a region, zero-

The long-term "exit path" for both elimination and

Lockdowns encompass measures such as closures of non-essential businesses, stay-at-home

Quarantine for travelers

Contact tracing, quarantine, and isolation

Contact-tracing involves identifying people who have been

Routine testing of key populations

Zero-COVID implementation by region

The first confirmed case in Australia was identified on 25

Canada (Atlantic and Northern)

The virus was confirmed to have reached Canada on 27

the lockdowns in Hubei province, case counts peaked in the province

As the epidemic receded, the focus shifted towards restarting

The virus was first confirmed to have spread to Hong Kong on

New Zealand reported its first case of COVID-19 on 28 February

On 21 March, a four-tier alert level system was introduced, and most of

North Korea also reportedly follows an "elimination strategy."[134]

Scotland and Northern Ireland

Singapore recorded its first COVID-19 case on 23 January

The first case in South Korea was announced on 20 January

Due to its extensive cultural and economic exchanges with mainland

Immediately after mainland China notified the WHO of a pneumonia

Public places such as schools, restaurants and offices in Taiwan were

The virus was first confirmed to have spread to Vietnam on 23

In May 2022, World Health Organization director-general Tedros Adhanom Ghebreyesus

Use and development of software for COVID-19 pandemic mitigation

30. "First confirmed case of novel coronavirus in Australia" (https://www.health.gov.au/ministers/th

43. "Coronavirus Australia: How contact tracing is closing in on COVID-19" (https://www.smh.com.

83. "Frustration, fears of citywide lockdown as Omicron tests Shanghai" (https://www.scmp.com/ne

144. "Coronavirus spreads to North Korea, woman infected" (https://www.thestandard.com.hk/break

202. "How tiny Timor-Leste kept the coronavirus at bay" (https://www.aljazeera.com/news/2020/12/2

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