High-Efficiency Mask Based Covid Elimination Strategy

Despite the carnage, this pandemic has wreaked on humanity; it has also highlighted pockets of true resilience and achievement, from individuals to communities. The breakthroughs in vaccine science, the fine-tuning of public health instruments such as testing and contact tracing, and coordination of collective behavior-change are a few of these accomplishments. While the future appears bleak for the global eradication of SARS-CoV-2, we must use these triumphs and build from them. The solution is necessarily multipronged: the combination of our achievements better position us to end this pandemic for good.

Of all the exit strategies, the high-efficiency mask-based elimination strategy is the most robust component in eliminating community transmission of SARS-COV-2. The number of individuals infected globally has surpassed 110,000,000 individuals; Given the widespread availability of high-efficiency masks, we could eliminate the virus from the population in several weeks. Implementing a High-Efficiency PPE strategy should be implemented at the municipal scale. Smaller geographic areas might work even better; however, it is considerably more challenging to implement such a mandate at the national level. By acknowledging people’s needs concerning lockdowns, vaccines, and masks, our decentralized exit strategy proposes a hybrid plan tailored to communities to end COVID-19 once and for all.

When it is obvious that the goals cannot be reached, don’t adjust the goals. Adjust the action steps.

-Confucius
The goal is clear. Communities need to achieve Covid Zero and ensure that community transmission stays at zero. The problem arises when discussing how to achieve Covid Zero, as there are legitimate financial and political concerns. Undoubtedly, there is no “one size fits all” solution, as societies’ cultures and economies differ. Therefore, communities under the leadership of their mayors need to select from an array of Covid Zero exit-strategies that are best suited for them.

Three Viable Strategies

Lockdown Strategy

We have witnessed how some regions have eliminated COVID-19 from lockdowns, while others couldn’t (most notably, the US and Israel, the latter enforcing over 150 days of lockdown, far more than ideal). Communities in South Korea and Japan began to relax their lockdowns towards the end of 2020. They were once experiencing remarkably low community transmission numbers; nonetheless, community transmission picked up again in the fall/winter. Places with high population density are more prone to outbreaks given that it only takes one person to introduce the virus into the population; the interconnectedness of the modern world makes this all too likely. While the lockdown option addresses these well, this strategy also results in some adverse effects: People have temporarily lost their freedoms and livelihood, smaller businesses have gone bankrupt, there has been an increase of theft/violence against women and children, and a severe increase in the prevalence of suicides, drug abuse, and mental disorders, to name a few.

Immunization Strategy

The currently available mRNA vaccines, given swift distribution, could be a modern miracle to achieve Covid Zero. Given their innovative design, mRNA vaccines can be developed at a much higher pace than traditional vaccines, tailored to different strains. Moreover, mRNA vaccines don’t use a ‘weak’ version of the active virus, but instead, a marker (spike protein) found on the surface of the virus; this further reduces the risk of adverse reactions to inoculation.

However, the vaccines do not eliminate the virus, SARS-Cov-2, from our bodies; they simply give our immune systems a better chance of mitigating its symptoms. The risk of ill effects can still arise, given the lack of vaccine efficacy.

Allowing the virus to remain in the population (for the foreseeable future) will require us to use masks even if we are vaccinated. By the time vaccines are thoroughly distributed, novel strains will most likely introduce dangerous uncertainty regarding vaccine efficacy. One clear example is the B.1.1.7 variant, which is proven to be far more transmissible than the original strain, and there are other noted variants already. Moreover, there has been emerging evidence that vaccinated individuals still have the capacity to be infectious; Yale epidemiologist Joseph Fauver, when studying the E484K variant, stated that “this doesn’t appear to be great news for vaccine efficacy.” The need to regularly ‘update’ our vaccines, similar to updating our computer’s virus protection, is not sustainable in the long-run; this scenario would result in far more morbidity and deaths than needed. Furthermore, as of February 2021, children cannot be safely vaccinated; the chances of achieving the herd-immunity threshold become even slimmer.
The vaccine is an incredibly potent tool in our fight to achieve Covid Zero. However, it is the only exit-strategy described that cannot be conducted alone. In conjunction with other exit-strategies, the vaccine intervention will provide great benefit in protecting individuals from the strains the vaccine addresses.

High-Efficiency PPE Strategy

Considering that SARS-Cov-2 principally spreads through airborne transmission, it is best to block transmission at the source – namely our mouth and nose. Viruses eventually degrade and cannot replicate so long as they are outside of the body. In that SARS-CoV-2 is not replicating, it also means that no mutations can come into existence. Hence, the more effectively we block transmission pathways, the sooner we can eliminate this disease. High-efficiency masks and respirators with low aerosol penetration can block those pathways. This strategy can work in all environments, from highly dense cities to rural communities. To learn more, you may visit PPEHOTLINE.com

The purpose of an Exit Strategy

These strategies can be used alone, but are best in tandem so communities (and eventually regions at a greater scale) can achieve Green Zone status quickly. A Green Zone is a region that has had no internal transmission for two consecutive weeks; moreover, a Green Zone has no neighboring regions that are Red Zones. A Yellow Zone is one that has met the first requirement of a Green Zone but does border with a Red Zone. Lastly, a Red Zone is a region that has experienced community transmission within the last two weeks.

A Way Out

Individuals should reach out to their neighbors and community leaders to discuss how they can best implement an exit strategy. We outline a general template that can guide communities on how to begin drafting a plan tailored to their localities.

A template for a Covid Zero exit strategy consists of three  general development phases:

  1. Preparation phase
    1. Each community should discuss internally how best to incorporate the described exit-strategies. We recommend using the Hub & Spoke Strategy for organizing content, whereby experts need to vet the Hub first. Creating a universal communication platform where the overwhelming majority (preferably all) of the community members can be both informed about initiatives and provide input is essential; this does not have to be one single medium of communication (common messaging apps such as WhatsApp, Telegram, Signal, Facebook) but all of them, if and only if the same message is being transmitted and the availability for community input is being received to one point. For example, some community members may opt to receive information and offer input through their landlines or telephone calls; the receiver would take note of any added information and add it to the central data pool of information being gathered for the entire community. Simple flyers with infographics need to be accessible in public places and sent to the residences. An incredible resource would be to incorporate local TV programs into the communication strategy. While difficult, the people need to feel that the programs are custom-designed for them by people they trust and see in their local communities. 
    2. A target date should be discussed and agreed upon by the majority of the community members. The target date is a strict date where all community members will begin acting on the combination of exit-strategies previously agreed upon. The flexibility of this intervention comes from the fact that it is not necessary for all households to agree on adopting one exit-strategy. They hold the freedom to pick the ones which suit their living conditions as long as it ensures that the household contributes zero community transmission. People need to understand that getting to zero is the only viable option to eliminate Covid-19, and it has been already achieved by other communities around the world. 
    3. The preparation phase prioritizes its efforts on education and not enforcement. The community leaders taking on this challenge should be seen as the support group, a locus of encouragement and guidance. They should listen to the needs and priorities of the community members and guide them on how best to act in accordance with the facts. The more people are educated, the less need to enforce norms/interventions on communities. Full transparency and honesty throughout the preparation phase (and the entirety of the intervention) further emphasizes the unity this endeavor necessitates. Consultations with public health practitioners and other communities who have successfully implemented an exit-strategy are a valuable asset for communities undertaking this challenge. 
  2. Execution phase consisting of lockdown, mainly for those not using High-Efficiency Masks and monitoring until Zero Covid is achieved.
  3. Based on a clear reopening plan, expand to solidify green zones for neighboring regions and maintain Zero Covid by surveillance of possible outbreaks
    1. A community can only achieve green zone status when all its neighboring regions are deemed “Broaden the green-zones.”
    2. Contact Tracing
    3. Testing surveillance
    4. Wastewater surveillance
Below are links to recommendations on how to guide your community’s exit-strategy, that have roots in military strategy, business management, epidemiological studies, and biblical concepts; the primary aim is to drive COVID-19 cases to zero in several weeks and keep them there.
While enhancing communal harmony, they help our neighborhoods collaborate efficiently, adapt quickly, and act decisively and effectively.