This is Stage 6 of ICAN's 7 Stage Elimination Framework. You can read the Introduction here.
Goal: To build confidence that the virus has been eliminated.
Timeframe: The 14-day confirmation period is a threshold at which policymakers can consider reopening society.
There is no single, established definition of the elimination of COVID-19. Some regard the existence of clusters that can be managed within the public health infrastructure as being consistent with elimination. This Framework presents a stricter definition that is consistent with the approach taken in New Zealand and Taiwan.
The goal of establishing a series of 0-case days is to build confidence across society that the virus has been eliminated. Prematurely reopening society risks sparking an outbreak that could set the plan back many weeks, and this would deal a great blow to the public’s morale. Given that many carriers are asymptomatic, policymakers must be especially cautious at this stage. There is always a small possibility that the virus is circulating out of sight, and it simply isn’t worth reopening a few days earlier if it means risking further community transmission.
While it is possible to eliminate the virus, it is not possible to know when the point of elimination has been reached. This creates an ambiguity that some find difficult to accept. They can resolve the ambiguity by recognising that every day without a confirmed case provides more evidence that elimination has been achieved. For most people, this period will be characterised by feelings of nervousness and excitement as they will be so close to getting their lives back, and the uncertainty about the presence of the virus will diminish over time.
Implementation | Prepare for Stage 7 – Reopen
Policymakers can use this period to prepare for the reopening of society. Their primary responsibility is to ensure that the public health functions are ready to identify infections and to suppress transmission without resorting to restrictions on civil society. These measures include a robust contact-tracing program that backward traces 14 days, and a surplus of testing capacity to perform the population-level screening and surveillance testing required to detect rogue cases in the population at the earliest possible time.
The reopening process is managed in phases, with the degree of social distancing reducing with each subsequent phase. The measures that are in effect in each phase are communicated by the government well in advance of implementation. Most venues are open from the start of Stage 7, so businesses, clubs, community centres, and other public spaces can use this time to make their own preparations for reopening, and the government will support them with clear guidance.
Implementation | The Uncertainty of Establishing Elimination
While it is possible to eliminate the virus from the island, it is not possible to prove that it has been eliminated, or to know the exact moment at which elimination has been achieved. That means that we are implementing a plan with a clear goal, but one that we can’t know that we have reached. For some, this will create a feeling of ambiguity or uncertainty, but it will only be temporary. While it is true that there will always be a small possibility that the virus is circulating out of sight, each additional day without recording a case allows the people to be more confident that elimination has truly been achieved. In addition, with the appropriate public health measures in place – a strong contact tracing system and a stockpile of testing capacity – the people can be confident that any further infections can be managed without heavy restrictions on their lives.