Zero-COVID

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Zero-COVID, also known as COVID-Zero and "Find, Test, Trace, Isolate, and Support" (FTTIS), was a public health policy implemented by some countries, especially China, during the COVID-19 pandemic.^[1][a] In contrast to the "living with COVID-19" strategy, the zero-COVID strategy was purportedly one "of control and maximum suppression".^[1] Public health measures used to implement the strategy included as contact tracing, mass testing, border quarantine, lockdowns, and mitigation software in order to stop community transmission of COVID-19 as soon as it was detected. The goal of the strategy was to get the area back to zero new infections and resume normal economic and social activities.^[1][4]

A zero-COVID strategy consisted of two phases: an initial suppression phase in which the virus is eliminated locally using aggressive public health measures, and a sustained containment phase, in which normal economic and social activities resume and public health measures are used to contain new outbreaks before they spread widely.^[4] This strategy was utilized to varying degrees by Australia, Bhutan,^[5][6] Atlantic and Northern Canada,^[7] mainland China, Hong Kong,^[8] Macau,^[9] Malaysia,^[10] Montserrat, New Zealand, North Korea, Northern Ireland, Singapore, Scotland,^[11] South Korea,^[12] Taiwan,^[13] East Timor, Thailand, Tonga,^[14] and Vietnam.^[15][16] By late 2021, due to challenges with the increased transmissibility of the Delta and Omicron variants, and also the arrival of COVID-19 vaccines, many countries had phased out zero-COVID, with mainland China being the last major country to do so in December 2022.^[17]

Experts have differentiated between zero-COVID, which was an elimination strategy, and mitigation strategies that attempted to lessen the effects of the virus on society, but which still tolerated some level of transmission within the community.^[18][4] These initial strategies could be pursued sequentially or simultaneously during the acquired immunity phase through natural and vaccine-induced immunity.^[19]

Advocates of zero-COVID pointed to the far lower death rates and higher economic growth in countries that pursued elimination during the first year of the pandemic (i.e., prior to widespread vaccination) compared with countries that pursued mitigation,^[18] and argued that swift, strict measures to eliminate the virus allowed a faster return to normal life.^[18] Opponents of zero-COVID argued that, similar to the challenges faced with the flu or the common cold, achieving the complete elimination of a respiratory virus like SARS-CoV-2 may not have been a realistic goal.^[20] To achieve zero-COVID in an area with high infection rates, one review estimated that it would take three months of strict lockdown.^[21]

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