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Comment by cfn | Hacker News Reader

I live in the Azores on an island with less than 15k people which was mostly closed last year. There are only two ways to enter the island: the port and the airport there isn't a lot of movement and everyone coming in is tested twice. On top of that people here are terrified of the virus and take it very seriously (masks, distancing, etc) and can even be hostile to newcomers.

Still, cases keep popping up even without systematic testing. There are no deaths or even ICU cases but the virus keeps finding its way in. I believe that, like New Zealand, we are just postponing the inevitable.

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I believe that, like New Zealand, we are just postponing the inevitable

New Zealand (and Australia) don't have cases, because every single traveler who enters those island nations is kept in hotel quarantine, and tested multiple times before being released only after the quarantine period ends. It isn't the same as testing people when they come in and letting them straight into the community if they test negative.

That said, with vaccines now being rolled out, it may well be that these countries managed to dodge the bullet. It's hard to see what was "inevitable" about Covid, except the dogma (still promoted by the WHO, when I last checked) that travel bans are bad.

This is enforceable in remote island countries, but in ie Europe its not. You can't 100% lock the borders, there would be shortages of basically everything, from food to materials used in all industries. Europe is not so unified as US for example, there is a lot of independence, for better or worse. Food is transported on trucks, till it reaches from Spain say Poland it crosses minimum of 4-5 countries, each with their own covid situation, laws, rules, bans etc.

If we knew back a year ago how bad things would get and are still getting, I believe such a lockdown for say a month could pass, otherwise not and there isn't a central authority that could enforce it. And saying it was to be expected doesn't make much sense, spread of predicted outcomes was basically between yet another flu to another spanish flu.

New Zealand and Australia have had cases outside of quarantine despite every single traveller who enters those island nations being kept in hotel quarantine, tested multiple times, and being released only after the quarantine period ends. Some of those cases are directly traceable to quarantined travellers, some aren't. In any case, even those measures which aren't practical except in an island nation aren't effective enough to prevent outbreaks when implemented on a larger scale; the bigger the country the more opportunities for one of those cases to turn into something that's not easily controlled.

China successfully followed the same strategy, so the strategy certainly can work for large, non-island countries.

China had a few outbreaks (after Wuhan, obviously), but it responded to each one with quick restrictions on the affected location and mass testing of everyone in the region. That worked to contain these subsequent outbreaks.

As a result, China has been essentially CoVID-19-free for about a year now.

It's hard to tell what on earth is going on in China because a lot of the information coming out of there seems... dubious. As you say, they've had a few outbreaks which they responded to with large-scale lockdowns and mass testing, but if you believe their reporting the mass testing generally didn't find any cases at all which (if accurate) would mean the whole thing was for nothing. This seems unlikely. There were also weird WTF moments like in-hospital spread in a major city in a border region with a known outbreak going undetected for way too long at a time where even western countries that were "failing" at testing had enough in place to detect that. Also, a lot of the information about the source of the outbreaks and their successful methods for eradicating Covid is really obvious propaganda. On the other hand, their hospital system doesn't seem to be collapsing under a mass of Covid cases either.

It's not that difficult to know what's going on in China. There are many millions of Chinese people who call friends and family outside the country regularly. You can go read Chinese social media. There are Westerners in China who post to Western social media. There are even many people on HN who live in China.

> if you believe their reporting the mass testing generally didn't find any cases at all

That's not true. Their mass testing typically picked up further cases, which were isolated:

* In the June 2020 Beijing outbreak, mass testing uncovered over 300 cases.[1]

* In the October 2020 Qingdao outbreak, 9 additional cases (beyond the original three) were caught by mass testing.[2] That suggests that this outbreak was detected early.

* In the October 2020 outbreak in Kashgar, over a hundred additional cases were detected through mass testing.[3]

And of course, there was a more widespread outbreak in December (still concentrated in the Northeast), which peaked at over 100 new cases a day nationwide, and which was stopped with widespread lockdowns and mass testing.

> Also, a lot of the information about the source of the outbreaks and their successful methods for eradicating Covid is really obvious propaganda.

I assume you're talking about the cold chain. I don't see how that's "obvious propaganda." There's good evidence from contact-tracing that some of the subsequent outbreaks originated in people who work in the cold chain. It may seem strange from an American or European point of view, because the cold chain is way less of a problem than the literally millions of infected people walking around in Europe and the US. But in a country with essentially zero community spread and strict quarantine at the border, much less common pathways become a concern. It only takes one person touching a contaminated package and then touching their eyes to set off a new epidemic.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445627/

2. https://www.nejm.org/doi/full/10.1056/NEJMc2032361

3. https://www.bbc.com/news/world-asia-china-54687533

> There's good evidence from contact-tracing that some of the subsequent outbreaks originated in people who work in the cold chain.

Well, that's technically true. It just probably didn't come from the goods being handled like China claimed. In particular, formites and surface contamination of any kind don't seem to be a major source of transmission, and the Beijing outbreak they originally used this to explain seems to actually trace back to infected truckers travelling from somewhere in China with a previously-undetected outbreak that wasn't noticed before because locations outside Beijing didn't have the same level of testing. That is, they found it within their cold chain because that was where they were looking. This is also a lot more consistent with what we know about how Covid is transmitted.

> formites and surface contamination of any kind don't seem to be a major source of transmission

When there are millions of infected people walking around breathing and coughing, then fomite transmission is not a major source of transmission. But it is a source of transmission, and it could become the dominant source of new introductions of the virus into the country if quarantine of travelers is good enough (to go to China, you generally have to get a negative PCR test before your flight, then quarantine for two weeks in a special hotel on arrival, and finally get another negative PCR test). That's not to say that cold chain was actually the source of the Beijing or the Qingdao outbreaks, but there's evidence that points in that direction. In other words, this isn't simply propaganda.

But the larger issue that we were originally discussing is the overall situation in China. There clearly has not been significant community transmission over the past year, showing that the strategy (sharp lockdowns followed by strict border quarantines and mass testing during localized outbreaks) has been effective.

Some of those cases are directly traceable to quarantined travellers, some aren't

One of those countries has been able to trace all cases in the last few months and makes extensive use of genomic sequencing. The leaks have all come out of hotel quarantine breaches. I believe that some Australian states that do not receive overseas travelers have not had a single case in months.

It may (or may not) not be feasible for bigger and non-island countries, although I suspect that the border closures will happen far more swiftly if there's another pandemic in our lifetimes.

The state which has the most international arrivals (NSW) just had its first locally transmitted (ie not in hotel quarantine) case in 55 days.

The positive case is a security guard that works at quarantine hotels. Immediate and immense efforts have been put into place to contact trace as many contacts as possible, and to sequence the genome to understand the direct link between existing cases.

We expect these occaisonal breaches in quarantine, and as long as they remain occaisonal they are relatively cheap and easy to contain. Meanwhile restrictions continue to ease and life is almost as normal as you could want - and will certainly be even better once the vaccination program is in full swing.

It worked in China as well, so geographical size and population are not barriers to implementing this strategy.

We also had quarantine during last year and on top we grounded all the planes except for emergency and supplies.

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