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?:abstract
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The traditional long-term solutions for epidemic control involve eradication or herd immunity. Neither of them will be attained within a few months for the COVID-19 pandemic. Here, we analytically derive the existence of a third, viable solution: a stable equilibrium at low case numbers, where test-trace-and-isolate policies partially compensate for local spreading events, and only moderate contact restrictions remain necessary. Across wide parameter ranges of our complementary compartmental model, the equilibrium is reached at or below 10 daily new cases per million people. Such low levels had been maintained over months in most European countries. However, this equilibrium is endangered (i) if contact restrictions are relaxed, or (ii) if case numbers grow too high. The latter destabilisation marks a novel tipping point beyond which the spread self-accelerates because test-trace-and-isolate capacities are overwhelmed. To reestablish control quickly, a lockdown is required. We show that a lockdown is either effective within a few weeks, or tends to fail its aim. If effective, recurring lockdowns are not necessary -- contrary to the oscillating dynamics previously presented in the context of circuit breakers, and contrary to a regime with high case numbers -- if moderate contact reductions are maintained. Hence, at low case numbers, the control is easier, and more freedom can be granted. We demonstrate that this strategy reduces case numbers and fatalities by a factor of 5 compared to a strategy focused only on avoiding major congestion of hospitals. Furthermore, our solution minimises lockdown duration, and hence economic impact. In the long term, control will successively become easier due to immunity through vaccination or large scale testing programmes. International coordination would facilitate even more the implementation of this solution.
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