Lockdown exit strategies around the world
There are three common key elements that are the foundations for all lockdown exit strategies:
- The disease must be under control. This will pose a challenge for some, as it presupposes that national authorities have accurate and timely information on cases and deaths. Measures taken must be judged against their ability to keep the rate of transmission or ‘reproduction number’ (R0), below 1. In other words, each infected person should not infect more than one other.
- Countries must ensure that they have sufficient health system capacity, especially to provide intensive care, given the risk of a second wave of infections. Fortunately, there have been many examples of countries with spare capacity, such as Germany and China, offering care to patients from other countries that have been hit especially hard.
- There must be sufficient capacity for large scale testing and monitoring, linked to the ability to track and trace contacts of those infected. This too will be challenging for some and will necessitate bringing additional laboratories on board.
One of the important considerations of such a roadmap is that there must be similar measures across borders. There is no point having stringent protocols in place in one country or state and no restrictions at all just across the border. There needs to be communication and close collaboration in lockdown exit strategies between neighbouring countries / regions.
The World Health Organisation roadmap
Countries under coronavirus lockdowns should only ease those restrictions if they can control new infections and trace contacts, the World Health Organisation clearly states. The world should be ready to "change our behaviours for the foreseeable future," they say, as the agency updates its advice on when to lift COVID-19 lockdown orders.
Any government that wants to start lifting restrictions said the WHO Director General, Dr Tedros Adhanom Ghebreyesus, must first meet the following conditions:
- Disease transmission is under control
- Health systems are able to "detect, test, isolate and treat every case and trace every contact"
- Hot spot risks are minimised in vulnerable places, such as nursing homes
- Schools, workplaces and other essential places have established preventive measures
- The risk of importing new cases "can be managed"
- Communities are fully educated, engaged and empowered to live under a new normal.
The European Commission roadmap
The European Commissioner is careful to provide a framework but not to prescribe what measures should be taken as part of all lockdown exit strategies. This is the responsibility of national governments.
There is a requirement for a universal system for reporting and contact tracing, expansion of testing, strengthened healthcare systems, improved provision of personal protection equipment (PPE) and progress in development.
It is universally recognised that the threat will only be lifted by an effective treatment or a suitable vaccine.
The EC roadmap is underpinned by the following principles:
- Change needs to be gradual. This will allow time to determine the impact of lifted restrictions.
- General measures should be replaced progressively with more specific ones thereby protecting vulnerable people for longer.
- Lifting border controls must be carefully coordinated with neighbouring countries.
- Economic activity phased in gradually and those who can work from home should continue to do so for longer.
- Risk of transmission in gatherings should be carefully considered, focusing on sports activities, cafes, schools and cultural events.
- Measures such as social distancing and enhanced hygiene must continue long-term.
- Monitoring must not be allowed to drop.
The EU see this as an opportunity to enhance the vision to revitalise the economy, returning to a path of sustainable growth and a greener society, supported by a major recovery programme, accompanied by a package of measures including research on vaccines and treatments and international cooperation. Preparation for a future pandemic must also be strengthened across the Union.
The United States Federal exit strategy
There are three criteria for moving to the three-phased exit strategy approach:
Symptoms - downward trajectory of influenza / COVID-19 like cases for 14 days
Cases - downward trajectory of confirmed cases for 14 days
Hospitals - capacity to treat all patients and have a robust testing programme and have adequate provision of PPE
Phase One
Individuals
- Vulnerable individuals shelter in place
- Physical distancing in public
- No gatherings of more than 10 people
- Minimise non-essential travel
Employers
- Telework wherever possible
- Phased return to work
- Close communal areas
- Minimise non-essential travel
- Shelter vulnerable personnel
Special considerations
- Schools remain closed
- Prohibit visitors to nursing homes/aged living facilities/hospitals
- Movie theatres, sporting venues, places of worship, gyms to open under strict physical distancing
- Resume elective surgery and outpatient appointments
- Bars remain closed
Phase Two
Individuals
- Vulnerable individuals shelter in place to continue
- Physical distancing in public to continue
- Resume non-essential travel
Employers
- Telework wherever possible to continue
- Close communal areas
- Shelter vulnerable personnel
Special considerations
- Schools can reopen
- Prohibit visitors to nursing homes/aged living facilities/hospitals
- Movie theatres, sporting venues, places of worship, gyms to open under moderate physical distancing
- Resume elective surgery
- Bars remain closed
Phase Three
Individuals
- Vulnerable individuals resume public interactions with physical distancing
- Low risk individuals to minimise time in crowded places
Employers
- Unrestricted staffing
Special considerations
- Resume visits to nursing homes/aged living facilities/hospitals
- Movie theatres, sporting venues, places of worship, gyms to open under limited physical distancing
- Bars can operate with increased standing occupancy
