21 September, 2020

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Way Forward For A Responsible Lockdown Exit Strategy

By Dilip H. Liyanage –

Dr. Dilip H. Liyanage

Following the countless days of social and economic quarantine, political leaders and citizens across the globe, eager to re-emerge from CoVid-19 fuelled lockdowns. The question is, how? Propose a framework for what is arguably the ever-difficult challenge that any governments has ever faced since the existence of the governance: a responsible lockdown exit strategy.

Literally, physical distancing measures such as lockdowns only slow down the spread of the virus. Lockdown measures only can’t eradicate it. Closed schools, businesses and stay-at-home orders will help, buy time to develop targeted measures to strike the virus and improve the understanding of how to confront the spread of the virus.

Ending The Lockdown 

Though, no precise exit strategy has yet been formed, can we rely on a substantial slowdown in the epidemic of Covid-19 – the so-called “flattening the curve” – and a downward trend, which has not yet happened in the UK? The number of deaths is also still rising as the UK moves towards the peak of its epidemic, which is expected within the next week to 10 days. But will that necessitate an end to physical distancing, or could we be facing a strategic lockdown measures with continuous physical distancing until the end of the year or until the reproduction, or “R,” below one (R<1)?

The goal: R<1

The intent of a further continuing lockdown is to keep reproduction, or “R,” below one (R<1) – with each case infecting fewer than one other person, by applying two strategies. 

Mitigation, “slowing but not necessarily stopping epidemic spread” – by isolating suspected cases and their households, and physical distancing the elderly and vulnerable people.

Suppression, or lockdown, “aims to reverse epidemic growth, reducing case load to low levels” by physical distancing the entire populations which will reduce peak critical care demand by two-thirds and halve the number of deaths.

How Long We Must Continue? 

Lifting lockdown restrictions and letting people resume their normal lives all at once will certainly lead to a second wave and the re-introduction of severe restrictions, which will further damage the economy rather than stimulating it as intended. We must take measures, gradually lift the lid on controls while closely monitoring the behaviour of the virus in the community.

When cases can be kept to a lower level (R<1) – and the NHS can cope with them – then restrictions may gradually be lifted. This could include a series of “short releases” or targeted measures, such as lifting controls by geography or by age and those most at risk to continue staying at home or some businesses being allowed to open their doors.

Likelihood Of The Lockdown Being Removed With “Immunity Passport”/ “Risk-Free Certificate”? 

At this point, the UK has no real grip on number of infected people, and what proportion of infected individuals are immune to the disease. Besides, there is too little evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an “immunity passport” or “risk-free certificate.” Individuals who assume that they are immune to a second infection because they have received a positive test result may disregard the public health advice, which gives false assurance and will fuel the chain of transmission. At present, WHO recommends the use “immunity passport” risk-free certificate only in research settings, but not clinical decision-making, until evidence is available.  Therefore, the concept of “Herd immunity” is not a passport for exit strategy but will be a scientific concept, in long term battle with the virus.

Are We Close To Getting A Vaccine?

Though we have started the first human trial in Oxford – UK with more than 800 recruits. In, reality, only very few will end up with positive results in new vaccine development process. CoVid-19 will be no different and presents new challenges. This will take time and it is unlikely that, it could happen before the end of this year.  Until such time, we may re-propose existing drugs to fight or reduce the severity of the illness or “to live with the virus” until a vaccine is discovered through major social reform.

Economy And Dynamics Of Transmission

Nonetheless, from social and an economic point of view, quarantine measures will not be practicable in the long run. Prolonging lockdown will create negative impact on public-health budgets, which might create more non–CoVid-19-related deaths than CoVid-19. Therefore, a well-designed exit strategy is imminent and crucial. 

So, When May The Lockdown In The UK Come To An End?

Unfortunately, due to the lack of evidence it is extremely premature for any responsible expert to be speculating when this may end or the best strategy to use.  On the other hand, providing people with false hope is real danger and might find the best way out as we go along.

Best Possible Exist Strategies???

1. Physical distancing measures to be continued – until disease transmission is under control and to a point where hospitals have capacity to cope with much lower number of patients.

2. In parallel, health system capacity needs to be greatly upscaled to detect, test, isolate and treat every case and trace every contact while minimizing the risks in vulnerable places such as nursing homes. 

3. Expect essential, virtual work should be continued for vulnerable people and these who can work from home. 

4. Schools, to be reopened gradually in a phased way when preventive measures are in place.  Where for example half the class taught in the morning and the other half in the afternoon and allow some non-essential businesses to open again in pre-planned order while maintaining transparency. 

5. Develop confidence and safeguard keyworkers (testing and providing adequate PPE) in all possible aspects. 

6. Global action towards intense communications, information sharing, research and innovative solutions will play crucial role towards eradication. For example, contact tracing using mobile phone app. 

7. Populations are fully engaged, understand and empowered to live under a new state of “normality”.

However, the successful management of this crisis will depend mainly on the support of the population by adhering to basic  principles we’ve been talking about – washing hands, not going out when sick, wearing a face mask in public regardless of the antibody test result you get for the foreseeable future.


References:

Considerations in adjusting public health and social measures in the context of COVID-19. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/critical-preparedness-readiness-and-response-actions-for-covid-19

Coronavirus: when might the UK lockdown come to an end? The Independent. https://www.independent.co.uk/life-style/health-and-families/coronavirus-lockdown-uk-remove-end-review-schools-when-government-a9453246.html [Accessed 21 April 2020]

Covid-19: What is the UK’s exit strategy from lockdown? Coronavirus | Published: Apr 6, 2020 https://www.expressandstar.com/news/uk-news/2020/04/06/covid-19-what-is-the-uks-exit-strategy-from-lockdown/  [Accessed 21April 2020] 

COVID-19: What’s the UK’s exit strategy out of lockdown? BBC Science Focus Magazine 15th April 2020 https://www.sciencefocus.com/news/covid-19-whats-the-uks-exit-strategy-out-of-lockdown/ [Accessed 21 April 2020]

Dekel, U. The System-Wide Campaign to Battle the Corona Crisis in Israel. Institute for National Security Studies (2020) https://www.jstor.org/stable/resrep23538

Gates, B. (2020). Responding to Covid-19—a once-in-a-century pandemic? New England Journal of Medicine.  https://www.nejm.org/doi/full/10.1056/NEJMp2003762

Gilbert, M., Dewatripont, M., Muraille, E., Platteau, J. P., & Goldman, M. (2020). Preparing for a responsible lockdown exit strategy.  Nature Medicine, 1-2. 

https://www.dailymail.co.uk/news/article-8246303/Dominic-Raab-delivers-rebuke-lockdown-looseners.html?ito=social-facebook&fbclid=IwAR00wV2DPWPotOiUrW85TNI2qGF7nlE6ZhtDLdJtq6DZL6hJ1XGCnzRYluE

When will the UK lockdown end? The four potential exit strategies. Sarah Knapton, science editor https://www.telegraph.co.uk/news/2020/04/21/end-coronavirus-lockdown-uk-exit-strategy/  [Accessed 21 April 2020] 

WHO recommendations for international traffic in relation to COVID-19 outbreak | Published: 29 February 2020 COVID-19 Travel Advice https://www.who.int/news-room/articles-detail/updated-who-recommendations-for-international-traffic-in-relation-to-covid-19-outbreak [Accessed 21 April 2020]

Why lockdowns can halt the spread of COVID-19. Samantha Sault. World Economic Forum. https://www.weforum.org/agenda/2020/03/why-lockdowns-work-epidemics-coronavirus-covid19/ [Accessed 21 April 2020]

*Dr. Dilip H Liyanage. MD, Honorary Fellow – Medical Directors Office (MDO)- Milton Keynes University Hospital NHS Foundation Trust, UK

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Latest comments

  • 1
    0

    Once Corona emergency goes down, UN & other medical reports suggests the hospitals should change wards’ amenities to receive Corona Boomers. They would arrive or bring some immediate problems. But it may ease the aging demographic problem, which being felt by all economies. On the other side too, the corona deaths too is mainly on the aged people. People don’t like to sell a plight to buy a plight; they feel happy with whatever they already have. So, societies may not welcome it, but still they stand to benefit out of it.

  • 3
    0

    Dilip,
    Your article is about the situation in UK, thus why publish it in a mainly local Sri Lankan website. Very few people will be able (or even want) to comment since they’d lack a deep understanding of the intricate issues, social dynamics, and the thinking of the current British politicians who would be the ultimate decision makers of what the exit strategy should be. As it is there are several conflicting schools of thought amongst the top politicians of the UK government on the exact way forward.

    In a more generic sense, your suggestions of a possible exit strategy appears well and good on paper, in a pure theoretical perspective, However you’ve failed to address the “real world” issues of rolling out such a plan.

    Most of your suggestions are heavily correlated to the “people factor”, whose variability is very much unpredictable. Also the variations of bahaviour of the Human factor will depend on many other pivoting factors like, geography, cultural values, level of awareness, social norms etc, etc.

    I’d have liked to comment on the pros and cons of a possible roll-out your plan in a Sri Lankan context, but time and other commitments does not allow to me to tread that path.

    My suggestion is for you to add a concluding chapter to your article, summarizing the real world implications of all your suggestions in the preceding chapters.
    Also, clearly define your TOR, in the intro chapter of your write-up so that the readers know upfront, so that they what the contents uphold.

  • 3
    0

    Dilip

    Following the countless days of social and economic quarantine, political leaders and citizens across the globe, eager to re-emerge from CoVid-19 fuelled lockdowns. The question is, how? Propose a framework for what is arguably the ever-difficult challenge that any governments has ever faced since the existence of the governance: a responsible lockdown exit strategy.

    *** The best Exit Strategy is prepare for National Elections. See how Gotha has manipulated it. Impose Curfew under the theme Socical Distancing then when it suits you sing ” Samathama Nan Unkal Coodavara Samatha” . Lift all restrictions and have elections. Corona Or No Corona

  • 1
    0

    Let us not be too harsh on Dr. Liyanage. Apparently, he has his UK experiences which he wants to share with the Sri Lankan public. We should be thankful for information on world-wide experiences. As a Sri Lankan, he has genuine concerns about our welfare. I appreciate that.

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