Each option involves terrible costs, but if we can effectively employ the right strategy, we can reduce these costs as much as possible, and potentially save millions of lives.

(A third approach is doing nothing and let most people get infected. This 'uncontroled spread' option is discussed below, but doesn’t have major supporters in rich countries.)

The most popular explanation of why many, including me, believe suppression is the preferred approach is The Hammer and the Dance by Tomas Pueyo.

The key benefits people see in suppression are:

If successful, only a small fraction of the population is ultimately infected, so the disease causes few direct fatalities.

After the suppress phase, there'll be far fewer new cases left. This makes it much more practical to identify a large fraction of the remaining active cases through testing, and trace anyone they might have infected and offer them testing as well.

At this point, the economy might be able to mostly return to normal in just a few months' time. By contrast, a mitigation approach that aims to spread out cases in a way that doesn't overload the healthcare system could take months.

If we start with suppression, we can always back out to mitigation by loosening the restrictions. But the more cases arise the more costly suppression becomes — lockdowns would need to last longer to get case numbers down to a manageable level again.

I've listed some other arguments here .

Who's taking the suppression approach you suggest above?

While there's no consensus, many epidemiologists, economists and public health experts have pointed to it as the general plan we should have in mind for now.

A growing list of countries are now asking people to remain in their homes, with the aim of 'suppressing' the disease, including Italy, the UK, France, and some US states, among others.

China is currently in phase 2, seeing how much it can return to normal life without the disease again running out of control.

Countries like Singapore, South Korea and Taiwan are still mostly succeeding at suppressing the disease with very active testing and tracing, without so far having to go into lockdown. But that may not hold forever.

Where do the time estimates in your plan come from?

The plan above is just one version of how a suppression strategy might look. The numbers are my best guess at how long each phase will take. In practice, we’ll need to adjust the plan as we go, and different countries will take different approaches.

Here is a little more detail about the thinking behind the numbers:

Suppress: A 6-8 week lockdown is enough for most people who have already been infected to develop the disease and clear the virus. It's also enough for family member to get infected at home, develop the disease, and clear it.

Release: We don't know how long it will take us to figure out the level of public activity that is compatible with the disease remaining under control. But over six months, with different countries trying this, I expect we'll have learned a great deal. It appears to be the UK government's best guess as well.

Cope: 12-18 month is a hopeful guess as to when we'll have a more permanent solution. There are several ways this could happen.

Scientists have said that a vaccine would take 12 months to be available at the earliest, and scaling its delivery will take substantially longer.

But there are many mortality-lowering treatments being tested in trials right now, including existing medicines that might help to reduce the symptoms of COVID-19.

Alternatively, in a year's time our testing capacity may have expanded enormously, allowing people to test themselves cheaply and often, helping to contain the spread.

Finally we can make the virus less dangerous by building ventilators, thereby increasing our capacity to treat it.

Nobody knows when we'll achieve one or a sufficient combination of these things. But 18 months is a realistic aspiration.

Can I see a more detailed version of the plan?

Sure, that’s here.

Are you sure this will work?

No, it's not possible for anyone to be that confident this plan will work. The 'suppress' phase may not stop the spread sufficiently, or transmission may go back up too much during the 'release' phase.

And we can't know when effective antivirals or vaccines will be available, though huge resources are going into developing them.

Alternatively, the financial, psychological and health costs of the suppression effort may exceed the benefits.

Nonetheless, it has a decent enough shot, and could save a very large number of lives. It seems to be working for China, Taiwan and South Korea so far, and there are promising signs in the US and Italy. So it's a natural place to start until we learn it's not possible.

Where can I read a more detailed case for suppression? What experts support this?

Above we mentioned The Hammer and the Dance as a popular explanation of the case. A follow-up article by the same author is Coronavirus: Out of Many, One.

Some more credentialed folks who have been supportive of some form of suppression approach include:

If you would like to submit some even better articles that are in favour, against, or neutral about this plan, please let me know about them here: robertwiblin@gmail.com.

What are some arguments against taking a suppression approach?

There are five main things people can believe which lead them to oppose this approach:

Suppression is unlikely to work because we won't be able to reduce social contact sufficiently, or for the length of time needed, and so the disease will end up infecting most people anyway. This approach will cause a lot more economic hardship and disruption than letting the disease take its course, and thereby leave society as a whole worse off. While suppression will work in the short run, the disease will come back in a severe 'second wave' after we leave the suppression phase but before we have treatments that lower the fatality rate. It's unrealistic to believe we'll have a vaccine within a year or two — or other better treatments that reduce the fatality rate. Some suspect that the actual fatality rate is low once you take account of all mild cases — perhaps 0.1% rather than a more common estimate of 0.5%. This would make it less valuable to suppress the disease.

Here are some posts arguing against following something like suppression, on various grounds:

Below I link to some articles below that specifically criticise the merits of suppression for developing countries.

Why don't you think those critics are right?

Well, they may turn out to be right, but here's why I think this approach is worth giving a go first.

Perhaps my biggest disagreement with the critics is that they speak as though the only cause of our economic problems is the lockdown.

But the virus itself is likely doing a large fraction of the damage. So long as this disease is spreading through society killing a large number of people — and hospitalising so many that others don't expect to be able to get healthcare — people are going to be behaving very differently.

That means people limiting how much they go out, avoiding shops, not going on holiday, not starting new businesses, and potentially not going to the office, especially if it involves interacting with others.

I'm young and healthy, but with hundreds of thousands of people in my country suffocating to death on their own bodily fluids, I don't think I'd be in much mood to go out if I could avoid it.

So the economy would be in deep trouble, lockdown or no lockdown. I have not yet seen a strong argument that the lockdown will cause greater economic damage than the virus would in a mitigation scenario.

Indeed, there is some evidence to the contrary. During the 2018 Spanish flu, cities that implemented lockdowns earlier and for longer found their economies did better during the recovery. This and other suggestive lines of evidence are covered halfway through this essay. Surveys also find the overwhelming majority of economists support the lockdown.

If we successfully pull off the suppression strategy, we can potentially enormously reduce case numbers and make it safe to go out again (while we use widespread testing to quarantine the small number of remaining cases).

As a result, suppression could end up reducing the severity of any recession. But ultimately nobody knows, and because we only get to go down one path, we may never know.

Personally I feel the best case against suppression has yet to be written, so email me at robertwiblin@gmail.com if you find it.

Can I see some articles that discuss this issue without taking a strong stance either way?

Sure, here's a few of those:

Under what conditions would we need to give up on suppression?

There are several things that could cause us to reconsider a suppression approach.

First, there is ongoing research to figure out what fraction of people who get COVID-19 die or face severe health consequences. We currently think around 0.2-0.8% die when medical treatment is available, and more if it's not (see a growing review here). We're also trying to figure out how common it is for survivors to face ongoing health issues.

That work may show that more people are infected with COVID-19 than we yet realise, with most of them having only mild symptoms. If so, we may decide the disease isn't dangerous enough to warrant pulling out all the stops to contain it.

Second, if the economic consequences are much worse than forecast, above all, if it starts a chain reaction in the financial system, we may need to reconsider if the approach isn't doing more harm than good. Long-lasting economic damage from a financial crisis would be bad for people's health and happiness.

But of course this has to be compared with the economic damage that would occur regardless due to the fatalities and a large fraction of the population hiding at home to avoid the disease.

Third, if the suppression phase slows the spread of the disease but doesn't shrink the number of new cases we see each day, we would have to reconsider our strategy. In some countries the government may not have the capacity or authority to enforce a lockdown to the sufficient level — if less than ~80% of the population goes along, the disease will probably keep spreading out of control.

Fourth, how much we'll actually be able to lower our guard during the 'release' phase is still unknown. Hopefully we will have better evidence from China's experience soon, as well as indirect evidence from Singapore and South Korea.

What about doing nothing?

In the scenario where we did literally nothing, the US for example could have 150-200 million people contract the virus in a matter of a few months (around half of its population).

Of these, 5-10 million might require hospitalisation. Unfortunately there are under 100,000 ICU beds in the United States, so only a small fraction of these could receive appropriate care and support breathing, should they need it.

In such an extreme scenario, at least 1 million people would likely die, and potentially several million, due to the incapacity of the medical system to provide any support.

One modelling exercise estimated 2.2 million would die — 0.7% of the US population.

As discussed above, this seems like it would have dire economic consequences in itself.

The figures above are all rough estimates based on preliminary data about the hospitalisation and fatality rates of COVID-19. But this picture has been very unappealing to most governments, and while it was floated by a few people early on, I'm not aware of any rich countries that are currently pursuing it as a policy option.

What should poorer countries do?

I have mostly paid attention to the UK, where I live, and other high-income countries. The situation in some low income countries is pretty different, and I don't know what they should do.

To be more concrete, if we compare Nigeria to the UK:

The population is much younger, so we would expect fewer people to die of the disease if infected, potentially 1/7th as many if we ignore any other differences. This makes suppression less attractive.

Controlling for age, background health and nutrition are likely worse in Nigeria. For instance, around 3% of adult Nigerians have HIV, while fewer than 0.5% of people living in the UK do. These comorbidities could increase the rate at which people die of COVID-19, making suppression more attractive.

Nigeria has fewer hospital beds and ventilators per capita. This would push up the rate at which people die of the condition. It also means a mitigation strategy aiming to build 'herd immunity' without overloading the medical system would take many many years to play out, and is probably unviable. This could make suppression more attractive.

Nigeria has a warmer and more humid climate than the UK, which we suspect reduces spread of the disease. This makes suppression more practical to achieve in Nigeria.

More people in Nigeria are likely living hand to mouth, or would struggle to get rapid government support, which might find it less practical to stop working for 1-2 months required for a suppression strategy.

Nigeria may lack the state capacity required to enforce home isolation, or the resources to deploy a 'track and trace' approach at the next stage. This may make it impractical to attempt suppression even if it were desirable. (As noted above, we don't know if the UK has what it takes to do this either.)

The UK and Nigeria probably differ in their level of urban density and general standards of sanitation. Whichever naturally sees more disease transmission will find it harder to successfully drive the reproductive rate of the virus below 1 and successfully suppress COVID-19.

With so many major differences like this we can't easily generalise, and this is a question that warrants focused research from experts.

Some articles on this topic by people more knowledgeable than me include:

Are you motivated by some nefarious purpose? Do you own shares in Big Suppression Corp or something?

Mostly I just don't want to die, and I'm also not that hot on an economic calamity either.

This website sucks and/or I'd like to suggest an improvement

Sure you can help me improve this site by commenting on this Google Doc here.

Who made this?

I'm Rob Wiblin a researcher at 80,000 Hours. At first I made this site to help explain what some governments were trying to do. I then decided to add a discussion of whether it's actually a good idea.

How can I help beat COVID-19?

There's a lot we can all do to help defeat COVID-19, via science research, improving government policy, manufacturing, logistics, advocacy, and more.

Me and some of my colleagues at 80,000 Hours have written a guide to this. A few pieces include: