Achieving herd immunity against COVID-19 at the country level by the exit strategy of a phased lift of control

The COVID-19 pandemic has affected the entire world causing substantial numbers of cases and deaths in most countries. Many have implemented nationwide stringent control to avoid overburdening the health care system. This has paralyzed economic and social activities and may continue to do so until the large-scale availability of a vaccine. We propose an alternative exit strategy to develop herd immunity in a predictable and controllable way: a phased lift of control. This means that successive parts of the country (e.g. provinces) stop stringent control, and COVID-19-related IC admissions are distributed over the country as a whole. Importantly, vulnerable individuals need to be shielded until herd immunity has developed in their area. We explore the characteristics and duration of this strategy using a novel individual-based model for geographically stratified transmission of COVID-19 in a country. The model predicts that individuals will have to experience stringent control for about 14 months on average, but this duration may be almost halved by further developments (more IC beds, better treatments). Clearly, implementation of this strategy would have a profound impact on individuals and society, and should therefore be considered carefully by various other disciplines (e.g. health systems, ethics, economics) before actual implementation.