Dealing with COVID-19: the hammer and the dance
After the press conference last Tuesday, we now know that the restrictions on our lives will only be slightly lifted in an attempt to slowly and carefully return to something we once called ‘normal life’. The Netherlands is also choosing an approach that epidemiologists are calling ‘the hammer and the dance’. The term was coined in a much-cited article by Thomas Pueyo, a prolific health writer, which was published on the online platform Medium in March.
In this article, he discusses how COVID-19 will remain a challenge to the world for the months to come. He compares the approaches that different countries have taken in combating COVID-19 and uses the term ‘the hammer and the dance’ to describe the most successful approaches. So, what does it mean exactly?
The hammer is a relatively short period (weeks) with rather extreme measures such as a lockdown of most aspects of public life, along with:
- travel restrictions
- contact tracing
- widespread testing
- identification, isolation and care for those infected
The goal of this first phase is to get the spread of the virus under control as quickly as possible. The aim is to get the R0 value (a measure for virus transmission rates between people) as far as possible under 1.
The second phase, called the dance‚ is a period of stabilisation where as many restrictions as possible are lifted while still maintaining the low R0 value through:
- proper testing
- isolating and quarantining those infected and those in high-risk categories
- focussing on hygiene and social distancing
- maintaining bans on large gatherings
During the dance phase, there is always the possibility of tightening the restrictions again when needed (i.e. when infection rate is on the rise again).
The main focus of this approach is to buy time to develop a vaccine or causal treatments for COVID-19 while spreading out the strain on the healthcare sector as much as possible and supporting the economy wherever possible. In another article, Pueyo compares the approaches of different countries in effectively applying this hammer-and-dance strategy. At the top of the list is South Korea, which, although it was initially hit with a large number of infections, has effectively kept the further spread of the epidemic in check. At the other end of the spectrum are countries such as Russia, which implemented stringent measures rather late, as well as the US, which has approached the problem haphazardly.
The Netherlands? It lands somewhere in the middle but is clearly on its way towards the ‘dance’ phase. Should the country have acted differently? More aggressively? I believe that we also have to take into account the culture of a society and whether or not its citizens would easily accept restrictive measures. Maybe the approach in the Netherlands and Germany, with a measured response and a strong democratic tradition, will be more sustainable in the long run.
Extensive testing is key
Whatever the approach, extensive testing to determine the infection status, virus transmission rate and mortality rate seems to be a key factor for making sensible policy decisions. But what information can this approach provide? Antibody testing in Gangelt, Germany, just across the border from Limburg, showed that 15% of the population has developed antibodies against COVID-19. The large majority of those with antibodies had experienced no or very few symptoms and their infections had not been detected earlier. This would mean that the actual mortality rate of COVID-19 is significantly lower than 1%.
The Gangelt study has since been criticised by virologists, who question its results because the infection rate was found to be much higher than that of other studies, such as those of the Dutch blood bank or recent findings in California. But even the figures in these latter studies (with an average infection rate of 3%) suggest a greater spread of COVID-19 and a lower mortality rate than initially suspected.
Thus, the saga continues and we have to wait—wait for more data—and see. And in the personal sphere, hopefully, it will be just a little bit longer before we get to the ‘dance’ phase. Of course, you can go ahead and start practicing your dance moves in the comfort of your own living room.