What lessons can we learn from easing COVID-19 restrictions?
As the COVID-19 pandemic death toll is now approaching the 1,000,000 fatalities, a new study published by the Lancet has focussed on the restrictions imposed by nine high-income countries (Hong Kong, Japan, New Zealand, Singapore, South Korea, Germany, Norway, Spain and the UK).
"Although such measures might have saved lives, they have come at a heavy socioeconomic cost," the authors noted.
"Lockdowns and other extreme restrictions cannot be sustained for the long term in the hope that there will be an effective vaccine or treatment for COVID-19," they wrote, highlighting the current need for finding the right balance between "various health, social, and economic concerns".
In order to learn from experience, the study identified five public-health principles that countries should consider while designing their strategy: infection status, community acceptance, public-health capacity, health-system capacity and border control.
A high-quality system of surveillance is fundamental according to the researchers.
To enable targeted measures, real-time data is necessary to calculate the reproduction number — which indicates how contagious an infectious disease is.
"Unfortunately (...) this principle has often been disregarded," they wrote, pointing to Spain and the UK who "have struggled".
The study stressed the importance of consistency when designing a post-lockdown strategy successfully.
"Messaging around what is considered a safe physical distance between people has been confusing and inconsistent", noting that the recommended distance is not the same across the UK.
The same applies to face masks where "an absence of international consensus is especially apparent" or with school closings.
A detection, testing, and isolation strategy is also considered to be very important — which entails having enough facilities.
"The rapid pace of the pandemic meant that many countries were poorly prepared", they noted.
Countries should be equipped with efficient contact tracing devices and adequate large scale testing of its population.
The health-system capacity is also "crucial", says the study.
It includes having enough treatment facilities (with intensive care units), medical equipment and sufficient health-care workers to cope with surges.
"Germany’s experience shows the benefits of investing in the health system for the future", it noted.
With this exception, "all countries also adopted triage systems (although some were unofficial) in which only patients with severe disease would be treated at designated hospitals".
Border control measures
The study advised managing the inflow of travellers to reduce the risk of infected people travelling into the country.
"European countries have been slow to require routine testing of travellers," it wrote, unlike Hong Kong.
The authors of the study finally argued that people are becoming aware that "removing COVID-19 restrictions is not about returning to the prepandemic normal, but about gradually and cautiously transitioning to a new normal, while being ready to reimpose measures if, and when, necessary."