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