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Green Zone Can Return

author
Paul Gonzalez
• Saturday, 27 November, 2021
• 8 min read

Download the report in English | French | German | Italian | Spanish (PDF) This article is a summary of a larger research paper under production. A wide range of social distancing and confinement measures have been implemented to reduce the progression of infections.

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Contents

We propose a practical exit strategy that is based on two key elements: identifying green zones, and progressively joining them together once it is safe to do so. The idea of “six degrees of separation,” first formulated in the late 1920s, is that everyone in the world can be reached within at most six links.

Firstly, by reducing the intensity of direct contact with social distancing (two meters between people outside the household) and sanitary measures such as frequent handwashing, coughing into the elbow and wearing face masks. It is now almost impossible to travel between European countries, thus rendering them separate sub-networks of the physical proximity network (see figure below).

Partitioning the world population into disconnected components, in terms of physical proximity, is the key purpose of lock-down. However, these measures are ineffectively mirrored within countries, for example many flights are running within the United States.

Although such a measure is useful to slow down and reduce interactions, the virus can still travel through the entire network. An empty metro station in France during the Covid-19 outbreak (Photo: L. Genet /Wikimedia)Instead of enforcing a radius of movement for each individual, we propose to let people move within disconnected areas, such as towns or districts (or Parisian “arrondissements”), in order to cut the physical proximity network into disconnected pieces, and thus prevent the virus from travelling throughout the territory.

Instead of enforcing a radius of movement for each individual, we propose to let people move within disconnected areas Specifically, two Parisians living in different suburbs cannot infect each other, even via intermediate steps.

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This would have the important advantage that tracking the contagion and evaluating which zones are at higher or lower risk becomes much more feasible. Building on these ideas, we propose a safe, efficient and easily controlled exit strategy from the Covid-19 pandemic.

After the initial spread is contained, we focus on how to transition back to a normal life, that is, how to rebuild the physical proximity links. To control the process and the inevitable partial resurgence of the virus we advocate an approach that was labelled green -zoning” in a recent article by Months.

To illustrate, consider a town with some 10,000 inhabitants where most people work in a local factory, or in other occupations within the community. Once no new infections have been detected for seven consecutive days (despite thorough randomized testing) we propose labelling the town as green, meaning that its inhabitants can progressively return to their usual social and economic interactions.

After this initial step, several green zones with an average size of 10,000 people will be identified. In this way, ever-larger green zones are created with people sharing the same shops, workplaces, parks and schools.

Within a green zone, inhabitants should feel as secure as during their initial individual confinement because there is evidence (negative tests and no more infections) that supports the absence of the Covid-19 virus in the zone. When this happens, the green labelling of the entire area is lost, and we go back to the previous lock-down situation, to identify and confine the new cases.

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We formalize a model which will be used to evaluate the impact of these new infections on the process of identifying green zones. We propose to partition a nation into cells that are given by a town or area with an average of 10,000 inhabitants.

To limit economic damage, this partition should consider “commuting zones” as introduced by Charles Colbert and Molly Sizer. Here, we illustrate the partitioning of the French region Île-de-France into small geographical cells (“communes”) which also belong to progressively larger areas (“departments” and “regions,” respectively).

Each day, new infections are potentially detected, and the rate at which this occurs depends on the number of red cells. After seven additional days, neighboring green zones are merged to form a larger green zone.

These triggers testing for Covid-19 cases within the area, and so other infections are detected in the surrounding cells (step 2). However, as soon as the probability of new infections is controlled, the proposed process will enable an exponentially fast return to normality.

Based on our simulation study (see the appendix), the entire re-unification of a country such as France (67 million inhabitants) would take between 2 and 4 months, assuming sufficient sanitary measures are maintained and testing becomes more widely available. Slowly restarting normal relationships with neighbors and colleagues in an organized manner can help overcome these newly learned unsocial behaviors.

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This enables the process of rebuilding and restoring a physical proximity network within a few months. As the notion of a green zone is flexible, it can be adapted to fit the current possibilities of each region, e.g. availability of testing or immunity certificates, practice of sanitary precautions, voluntary social distancing, etc.

To reap the full advantages that green -zoning offers, important policy choices must be made and complementary measures must be implemented, such as wide-spread testings (see the Nobel laureate Paul Rome's blog, for an enlightening discussion) and adherence to high sanitary standards. Specify (for example, on a weekly basis) what living in a red or green zone means for its inhabitants in terms of sanitary rules (for example, no hand shaking and obligatory face masks), any restrictions based on age or medical preconditions, and the intensity of testing inside each zone and at its borders as key workers will still have to cross them.

This can be implemented via an online platform, a mobile application, or announcements on radio and TV. As during the lock-down, different countries have used a number of measures that range from recommendations, rules with hefty fines, to the tracking of each citizen's movements via their mobile phones (see Singapore's Trace Together application).

By re-building our social and economic interactions through the progressive enlargement of green zones we will reach re-unified countries within two to four months. Our approach does not require tracking inhabitants at a personal level, and thus respects individual privacy.

In summary, we firmly believe that green -zoning can play an important role in minimizing societal and economic damage. Here, we show below a simulation run for an area consisting of 4×4 cells, five of which are initially infected.

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Some thoughts on Covid-19 from a labor mobility perspective: From red-zoning to green -zoning, VOX CPR Policy Portal Chianti, Andrea and Antonio Carson (2020). In one Italian town, we showed mass testing could eradicate the coronavirus, The Guardian Colbert, Charles M & Molly Sizer (1996).

Us commuting zones and labor market areas: A 1990 update, Technical report Nobel laureate Paul Rome's blog Avoid sharing utensils, face coverings, musical instruments, drinks, or other high touch personal items.

People exposed in an outdoor setting have less risk of acquiring COVID-19. Yelling, singing, and playing wind instruments can increase risk of spread.

Fever or chills Cough Shortness of breath or difficulty breathing Fatigue Muscle or body aches Headache New loss of taste or smell Sore throat Congestion or runny nose Nausea or vomiting Diarrhea Fever is defined as 100.4 or higher (a cutoff of 100.0 is recommended for screening at workplaces).

People with these symptoms should be excluded immediately from the school environment, evaluated by a medical professional and tested to rule out COVID-19. The amount of virus on a surface decreases over time, so risk of infection goes down.

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All playground equipment should be cleaned regularly, according to school protocols. The current guidelines do not recommend testing students and staff who do not have symptoms of COVID-19 before they return to school.

If people are hospitalized, they are infectious/contagious for 20 days after they start to feel ill. The Texas Education Agency (TEA) offers specific guidance for this in their guidebook and in their responses to various scenarios within schools.

The school should notify the local health authority by calling 210.207.8876. The school is required to notify student families, teachers, and staff in writing.

The school should follow appropriate cleaning protocols and collaborate with the local health authority for following up potential contacts of the person with COVID-19 (case investigation and contact tracing). People with COVID-19 can return to work or school after it has been 10 days since their symptoms started, symptoms are better, and they haven’t had a fever for 24 hours even without taking fever reducing medicines.

Older adults people of any age with obesity type 2 diabetes chronic kidney disease chronic obstructive pulmonary disease cancer history of a solid organ transplant serious heart conditions sickle cell disease NOTE: Someone who was a close contact to a person with COVID-19 should quarantine/isolate for 14 days, even with a negative test.

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What kind of Personal Protective Equipment (PPE) does a school nurse need? Recommendations for school nurses caring for people with suspected COVID-19 include: a fresh, fit-tested N95 mask each day and eye protection (face shield or goggles).

Fit testing is an OSHA requirement, and a user seal check should be performed each time a mask is used. For hands-on care of a symptomatic person, gloves should be worn, and an impermeable gown if there is splash or spray risk.

Nurses should have thermometers, biohazard disposal, at least a 2-week supply of PPE and a handwashing station. All children should be encouraged to use face masks while indoors, particularly when they are within 6 feet of others.

Each school should have one or more isolation care rooms, which is a designated place to safely evaluate and hold a person awaiting transportation. The area should be away from other students and staff, allow privacy of the evaluation, and have a clear sight line for a supervising adult.

It is best for this space to include a cot that can be wiped down and cleaned easily, a dedicated bathroom, and exterior exits to prevent sick individuals from mixing with healthy staff and students. Ideally, isolation care areas are located on an exterior wall to maximize ventilation options.

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Anyone who enters a designated isolation care room must use appropriate PPE and should be logged to facilitate contact tracing. Bear in mind that isolation is not a diagnosis; it is a recognition that someone is sick, and needs extra care.

Take steps to reduce fear, anxiety, and stigma related to isolation. After the individual leaves isolation care, the room must be closed and cleaned before it can be used again.

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Sources
1 en.wikipedia.org - https://en.wikipedia.org/wiki/Gulf_of_tonkin_resolution