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five ways to lift lockdown and succeed

lancet study looks at the world's getting-back-to-life-after-covid success stories.

lancet study: 5 lessons on how to safely reopen after a lockdown
an ontario biostatistician says the province needs to continue being diligent. "phase three is simply that: another phase. it does not mean a full re-opening where we can resort to being complacent." getty images
how do you safely lift a lockdown?

according to a new report , there are five key strategies for success.

researchers from multiple countries looked at the past six months in nine high income countries in europe and the asia pacific region: hong kong, japan, new zealand, singapore, south korea, germany, norway, spain, and the uk. here are the strategies they found that set apart countries that have successfully lifted their lockdowns from those who are still struggling to control the virus.

1. innovative surveillance strategy

before a country reopens, it should have a gauge on exactly how many people are infected and have the virus suppressed from spreading. they should be able to report estimates of r (reproductive number that rates a disease’s ability to spread) that are less than 1.

one example the authors note is hong kong’s real-time r data which avoids any time lags. japan, germany, and south korea also have reopening strategies that depend on the number of daily new cases and infections. however, some other countries like the u.k. and spain have struggled with implementing test, trace, and isolate systems.

2. community engagement

having a population that’s engaged, empowered, and understands that they need to do their part is key to fending off the virus. this comes down to having a government that provides consistent and credible messaging instead of confusing and inconsistent.

one example of confusing messaging was the lack of consensus we saw here in canada on the use of face masks early on the pandemic. countries that already had widespread mask-wearing as a cultural norm before the pandemic, like hong kong, japan, and south korea, had no issue with face masks. and while other countries like germany , spain , and the u.k. took longer to adopt masks, they have since made them mandatory in indoor settings. singapore also eventually made face masks mandatory outdoors after a confusing start counselling their population against masks, the government has since provided reusable cloth masks to the entire population.

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even in hong kong, where political unrest has led citizens to have a deep mistrust in government, the people have still had a high level of adherence for physical distancing and mask-wearing. this could be due to lessons learnt from the sars outbreak in 2003 which include investing to improve its health system and infectious disease programs, cancelling schools, and taking firm measures early on.

it’s important for governments to get their citizens’ trust in order to enact behavioural and lifestyle changes, say the authors. this has been a challenge for many countries, with the exception of germany, new zealand, norway, scotland, and south korea.
the study authors also noted that in general, countries with female leaders have done better at securing public confidence and adherence to new measures, than countries with male leaders. in the reference quoted by authors, researchers write:
“with female leaders demonstrating more effective management of the pandemic by taking the problem seriously, listening to health experts, and acting quickly. this trend seems to confirm that progressive female leadership is more engaged on issues of health and wellbeing, social equality, sustainability, and innovation, making societies more resilient.”

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3. public health capacity

in order to know how many citizens have covid-19, it’s important to have a robust public health system that actually has the capacity to do large-scale testing. many countries did not have widespread testing at the beginning of the outbreak and saved tests for those with symptoms. this criteria has since evolved in the last months with new global evidence of mild and asymptomatic transmission.
each country should have an effective find, test, trace, isolate, and support system in place. authors applaud the novel drive- and walk-through models in south korea that encourage proactive testing of potential cases.

contact tracing apps are also lauded in the report as tools that can help stop transmission if at least 56 per cent of the population downloads and uses them, but traditional manual tracing is still needed and irreplaceable.

4. a robust healthcare system

one of the more challenging factors that can contribute to a successful lockdown lift is having an existing health system that can handle surges in infections. this means having enough hospitals with intensive care units, ventilators, ppe for healthcare workers and patients. the report notes that germany’s prior investments in its healthcare system prepared the country well — before the covid-19 outbreak, it already had 34 critical care beds for every 100,000 citizens, compared to 9.7 in spain and 5.2 in japan.

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hong kong, singapore, south korea, and the u.k. repurposed large spaces, like conference centres and stadiums into community care facilities.

5. strict border controls and quarantines for visitors

hong kong, new zealand, and singapore have not yet opened their borders to visits, but the rest of the countries analyzed have done so with strict control measures. visitors to south korea or japan are subjected to a mandatory covid-19 test or 14-day quarantine. in contrast, european countries have been slower to require testing.
the authors write, “we hope that countries will continue to share their experiences, information, and strategies as they respond to this virus that knows no borders.”

dduong@postmedia.com | @dianaduo
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