The 7-Stage Elimination Framework

ICAN’s 7-Stage Elimination Framework is a structured process that can be implemented in any jurisdiction – whether it is a city, a county, or a country – to end a contagious outbreak within that region. The goal of the following posts is to explain the Framework, and to do so in simple terms so that readers of all levels can understand how an elimination approach would work in practice. The success of this, or any national plan, will depend in large part on the public’s support for it. It is important that the analysis is made accessible to them.

In the process of explaining the Framework and its policies, these posts also hope to convince the reader that elimination is not a notion or a pipedream, but a sensible approach to the management of contagious outbreaks, and an achievable goal that depends only on the hard-work and good sense of all involved.

This Framework comprises a set of policies – a protocol – that must be followed in order to achieve elimination within the specified region. While the protocol is strict, there is room for policymakers to adjust the plan to the local conditions at the time, both in the plan’s design and its ongoing management. The key variable that will enable them to do so, is the level of medical resources available and in particular, the supply of rapid testing capacity.

A stockpile of rapid testing offers many strategic opportunities that are not possible with the NPHET’s ‘PCR-only’ approach to testing. Stockpiles of key equipment and surplus resources represent spare capacity that can be accessed in an emergency. In the context of this elimination protocol, a stockpile of rapid tests would allow policymakers to douse a region with testing capacity in order to suppress and then eliminate transmission. Beyond elimination, spare testing capacity also allows policymakers to react quickly and decisively to unanticipated events, giving them more control over the outbreak.

The following posts will explain each part of the Elimination Framework, from the preparations that must happen in advance of implementation, to the gradual easing of social distancing measures once elimination has been established. They describe the policies that would be implemented at each Stage, explaining their purposes and the actions that must be taken to ensure that they will be effective. The Stages are listed in order and with timeframes for each so that the reader can visualise the process and consider their responsibilities at each Stage.

We describe how the 7-Stage Elimination Framework would be applied to eliminate the virus from a single Irish county. This is a hypothetical scenario that demonstrates the conditions necessary to achieve elimination in the target region. We purposely start with a simplified example so that the key characteristics of the process can be seen and understood. With that understanding, we can pursue a more detailed analysis that will lead to the development of a national elimination plan.

There will be points in this discussion where such a national plan would require additional measures to this county-level analysis. We feel it is important to address the ‘elephants in the room’, and these situations will be noted and discussed in the sections headed “International”.

No single document describing an elimination protocol – whether applied to an individual county or the whole island – could adequately address every possible criticism or answer every question that it would naturally elicit. This summary is necessarily incomplete and imperfect, and it will leave many questions unanswered. That is not to say that there are no answers, but rather that the answers require further research and analysis, and may depend on discussions that could only take place at a later stage.

Stage 1: Prepare

Stage 2: Seal

Stage 3: Stay

Stage 4: Test

Stage 5: Isolate

Stage 6: Wait

Stage 7: Reopen