The benefits, costs and feasibility of a low incidence COVID-19 strategy

In the summer of 2021, European governments removed most NPIs after experiencing prolonged second and third waves of the COVID-19 pandemic. Most countries failed to achieve immunization rates high enough to avoid resurgence of the virus. Public health strategies for autumn and winter 2021 have ranged from countries aiming at low incidence by re-introducing NPIs to accepting high incidence levels. However, such high incidence strategies almost certainly lead to the very consequences that they seek to avoid: restrictions that harm people and economies. At high incidence, the important pandemic containment measure test-trace-isolate-support becomes inefficient. At that point, the spread of SARS-CoV-2 and its numerous harmful consequences can likely only be controlled through restrictions. We argue that all European countries need to pursue a low incidence strategy in a coordinated manner. Such an endeavour can only be successful if it is built on open communication and trust. Copyright (C) 2021 The Authors. Published by Elsevier Ltd.Funding Agencies|European UnionEuropean Commission [101016233]; Max Planck SocietyMax Planck SocietyFoundation CELLEX; "Netzwerk Universitatsmedizin" (NUM) project egePan [01KX2021]; Digital Society research program - Ministry of Culture and Science of the German State of North Rhine-Westphalia; University of Malta; Luxembourg National Research Fund (FNR) as part of the COVID-19 Fast-Track research project Cov-Screen [COVID-19/2020- 1/14715687]; European Research Council (ERC) under the European UnionEuropean Research Council (ERC) [863664]; Slovenian Research AgencySlovenian Research Agency - Slovenia [P1-0403, J1-2457]; University of Crete; Maastricht University; European CommissionEuropean CommissionEuropean Commission Joint Research Centre; UK Economic and Social Research Council (ESRC)UK Research & Innovation (UKRI)Economic & Social Research Council (ESRC) [ES/T014164/1]; UK Medical Research Council (MRC)UK Research & Innovation (UKRI)Medical Research Council UK (MRC) [MR/S035818/1]; Leverhulme TrustLeverhulme Trust [RPG-2020-295]; Wellcome TrustWellcome Trust [209519/Z/17/Z, 106612/Z/14/Z]; Polish National Science Centre OPUS grant [2019/33/B/NZ2/00956]; Luxembourg National Research Fund (FNR) as part of the COVID-19 Fast-Track research project CO-INFECTOMICS [COVID-19/2020-1/14729513]; European Research Council (ERC) under the European Unions Horizon 2020 research and innovation programmeEuropean Research Council (ERC) [863664]