Crush and Contain
for Safer Reopening

The fight against COVID-19 will be long—
we are still in its early days
Source: BCG analysis.
1
Estimated timeframe for a safe and effective vaccine to be developed, manufactured, and delivered on a wide scale to minimize disease risk.
Economic
activity
Health care
system
capacity
Critical care
patients
Time
We are here
Flatten Fight Future
Re-start:
Mid-May/
late-June 2020
Disease risk
minimized:
Q1 2022 +/-
6 months1
Vaccine:
Late 2020/
Early 2021

Three patterns have emerged in governments’
COVID-19 response—crush and contain is the
most effective
Virus was crushed and contained Flattened but cases resurging Cases still rising or at high levels
Seven-dayrollingaverage
Jan 01 Oct 01Jul 01Apr 01 Jan 01 Oct 01Jul 01Apr 01 Jan 01 Oct 01Jul 01Apr 01
South Korea New Zealand Taiwan Spain France Germany United States Brazil India
Sources: Johns Hopkins CSSE, Our World in Data, BCG analysis.
Note: China excluded from crushed and contained graphic due to a much earlier outbreak than South Korea, New Zealand, and Taiwan.
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240
0
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240
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20
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240

Many governments missed the
opportunity to crush and contain. They
should prepare now to make sure they
don’t miss that opportunity again.

When governments need to bring the virus under control,
they can crush it with short-term lockdown measures
Source: BCG analysis.
Limit interactions
• Trigger localized general lockdown
Ensure safer interactions
• Develop guidelines by industry
• Enforce mask wearing
Protect borders
• Prohibit traveling in and out
of region
Monitor the virus
• Build virus monitoring system
• Build testing and tracing capacity
and process
Amplify medical response
• Increase hospital capacity, supplies,
and PPE
• Develop system to track demand
and supply needs
Protect the vulnerable
• Make shelter-in-place more
sustainable
• Ensure vulnerable have income
and food security

Limit interactions
• Start opening low-risk activities
with high economic or social value
(e.g., restaurants with outdoor
seating, public transport), then
progressively open riskier activities
Ensure safer interactions
• Roll out activity-based guidelines
(e.g., no tables of >5 in restaurants,
continuous health screening when
entering hotels)
• Enforce mask wearing
• Ensure physical distancing (e.g., six
feet apart)
Protect borders
• Enforce mandatory quarantine
for new entrants (except from
green zones)
• Test and trace travelers
• Track itinerary and movement
of travelers
Monitor the virus
• Conduct and optimize effective
testing strategy (e.g., pooled testing,
individual testing)
• Implement full contact tracing using
test and location data to trace, treat,
and quarantine
Amplify medical response
• Effectively distribute medical
supplies, treatments, and PPE, and
ensure access for the most
vulnerable
Protect the vulnerable
• Distribute masks to vulnerable
• Prioritize testing for vulnerable
• Make shelter-in-place more sustainable
• Ensure vulnerable have income and
food security
• Enforce guidelines in congregate
living facilities
When cases are stable and manageable, governments
can contain the virus with these policies
Source: BCG analysis.

COVID-19 hits two groups of people especially hard
HEALTH VULNERABLE
UP TO
People older than 65 with underlying
health conditions (roughly 30% of
the US population)
Higher hospitalization rate
for those older than 65 with
preconditions versus healthy
adults under 65
EXPOSURE VULNERABLE
People living in dense settings or
unable to work from home, especially
in communities of color
30x Higher infection rate for persons
of color versus white Americans,
which explains nearly all of the
difference in fatality rates
~2-3x
Sources: CDC; BRFSS; COVID Tracking Project; BCG.

1
Governments can protect the vulnerable by
adopting six cost-efficient policies
Reduction in hospitalizations (%)
5
6
4
3
2
1
Ideal1
Effective1
Mandate wearing face coverings in public spaces
Provide high-quality masks to vulnerable people and ensure they are worn
Skew sentinel testing to the most health vulnerable people, those in close
contact with them, and communities of color
Support sheltering in place by providing food, counseling, and social connections
Accommodate vulnerable people who cannot work from home by enabling
employer innovation and supporting shelter-in-place for the most vulnerable
Enforce congregate living best practices and standards
Combined impact of all six policies
Sources: Ycharts Indicators; Gallup; PEW; NPR; BCG analysis.
1
Ideal represents 80% compliance of a given intervention for vulnerable people (50% for broader public), while effective represents 50%
compliance for vulnerable people (33% for broader public); studies suggest current compliance range of 33%-50% for mask wearing.
–47
–15
–27
–12
–10
–3
–3
–89
–40
–48
–25
–19
–10
–9
Policiestoprotect
thevulnerable
Broader
public

Protecting the vulnerable could reduce overall hospitalization
levels and enable widespread reopening
Source: BCG analysis.
1
Assumes that schools and businesses reopen but basic social distancing measures (for example, limiting interactions to less than pre-pandemic levels and banning mass gatherings) remain in place throughout the duration of pandemic; this is a US average.
2
At 50% compliance. Studies suggest that current compliance with mask wearing ranges from 33% to 50%.
Hospitalizations
Reopening
Full reopening
Including mass gatherings
Reopening1
schools and some
businesses; no mass gatherings
Five policies to protect
health-vulnerable2
While reopening schools and some
businesses; no mass gatherings
Five policies to protect vulnerable,
plus general face-covering mandates2
While reopening schools and some
businesses; no mass gatherings
ICU capacity
Reopening requires some
restrictions on general public
and high compliance levels

If governments commit to
this high-return strategy for a
safer reopening, they can contain
the virus without reverting
to lockdowns.