5 Factors to Consider in Easing COVID-19 Shutdowns

A review of policies established in 9 high-income countries and regions who underwent eased coronavirus 2019 (COVID-19) lockdown measures uncovered a quintet of key factors for every country to consider.

The findings, published in The Lancet Thursday night, could contribute toward “Zero COVID” strategies implemented by countries including New Zealand in past months.

The international analyses, led by Dr. Helena Legido-Quigley, of the National University of Singapore and London School of Hygiene & Tropical Medicine, assessed the easement of COVID-19 lockdowns put in place among a series of Asia Pacific and European countries and cities: Hong Kong, Japan, New Zealand, Singapore, South Korea, Germany, Norway, Spain, and the UK.

Legido-Quigley and colleagues sought to interpret how these 9 regions each began to “reopen society,” with considerations to health, social, and economic factors among its residents. As the investigators noted, the World Health Organization (WHO) has been among a series of international agencies to advise caution in lifting lockdowns, as premature measures could result in a resurgence of COVID-19 spread—and even worse damage to the economic and societal state of regions.

In their assessment, the authors highlighted 5 consistent factors each region should consider when easing COVID-19 lockdowns:

• The application of robust infection monitoring systems prior to easement. Though the reproduction value (R value) is an important metric to follow, it requires highly accurate realtime data that is defined by epidemiological implication—as has been practiced by Hong Kong.
• The application of controlling measures including masks and social distancing, as observed in New Zealand’s “social bubbles,” which have allowed social interaction in reduced transmissionrisk areas. This requires government-led education and engagement with the public, trust among all parties, and an understanding as to what measures are appropriate by the public’s standards.
• The establishment of find, test, trace, isolate, and support systems prior to easement. Drivethrough and walk-through screening facilities in South Korea have allowed the country to emphasize proactive testing for at-risk case contacts, while staying ahead of tracing needs. Such practices have fallen short in countries including Spain and the UK—both of which continue to struggle with outbreaks.
• The adoption of an actual Zero COVID strategy, much like that in New Zealand. The strategy should put in place means to eliminate domestic transmission, with particular consideration to growing cases of “long COVID19”—symptoms which have persisted in patients well beyond the expected range of time.

Practices and successes behind contact tracing and isolation have varied greatly across the observed countries, investigators noted. Many Asian countries, which previously experienced epidemics with SARS and MERS, had healthcare and public health infrastructure in place that aided their response to COVID-19.

As such, they were the most prevalent among countries to begin prompt testing, tracing, and isolation of cases at the outbreak’s beginning. They were also prepared to establish face mask and social distancing protocols. Erstwhile, European countries faced a considerable delay in such responses.

In a statement accompanying the findings, Legido-Quigley cited an increasingly-evidenced fact: COVID-19 is a serious, long-term public health issue.

“There is increasing realization that easing of lockdown is not about returning to a pre-pandemic normal, and governments have to find strategies that will prevent rapid growth of infections in ways that are sustainable and acceptable to the public over many months,” she said.

The team’s review of international practices and outcomes should be used to identify lessons of both successes and failures across governments, Ledigo-Quigley noted.

“We are not advising that the exact same measures should be replicated in different countries, but it is not too late for governments to consider novel policy solutions developed by other countries and adapt them to fit their own context,” she said.