ROUTES OUT OF LOCKDOWN
By Dr David Nabarro and John Atkinson
Many Governments are taking tough decisions: they have decided that their countries should slow down their economies and go into lockdown in order to reduce opportunities for the COVID-19 virus to be transmitted between people. The decisions made on when and how to emerge from lockdown are even more difficult: they are also delicate.
Deciding to impose lockdown is a reaction to the mounting threat to people’s health caused by rapidly escalating outbreaks. Reducing opportunities for the virus to be transmitted through enforcing physical distancing is essential not least because of the inevitability that hospital services will be overwhelmed unless decisive action is taken.
Governments are finding that the numbers of people with whom newly infected individuals have been in contact after lockdowns were imposed are many fewer than the numbers of contacts of infected people before lockdowns were imposed. Over time – two to three weeks after the imposition of lockdown – the numbers of infected people, and the fatalities, are starting to fall.
The sequence for easing a lockdown will vary from place to place. Decision makers will be considering multiple factors when deciding how best to do this.
This is certainly happening in Western Europe and in some parts of the US as well. Italy’s Health Minister Roberto Speranza outlined that the next phase of the national response includes more testing and reinforced local health systems with a view to creating the conditions needed to live with the virus. This will make it possible for the lockdown to be eased, gradually.
The routes out of lockdown will be messy. Quality information is at a premium. Decisions will be based on data about the spread of the virus disaggregated by locality. Numbers of people becoming infected will need to be factored into decisions. The goal is to understand the extent of transmission and whether the rate of increase in people infected is starting to reduce.
The sequence for easing a lockdown will vary from place to place. Decision-makers will be considering multiple factors when deciding how best to do this. We try to imagine the kinds of questions they will be asking and here we explore the questions and indicate some of the factors they might consider.
Our seven potential questions
Managing the messiness
The situation of a gradual release from lockdown as we have described it is clearly rather messy. Judgements will need to be made rapidly and will have many unforeseen consequences. The strategy will need to be highly adaptive and rapidly responsive to what is actually happening. That may be fresh outbreaks, or it may be citizen responses to changes in lockdown conditions. This means a built-in process of learning that takes into account the inevitability of differences in perspectives and responses to each change that is brought forward. Without this capacity for fast and high-quality feedback, things can rapidly begin to unravel. We think there are three areas to focus on.
Focusing on these three areas gives leaders the chance to sense what is both legitimate and proportionate at every point in time. Things will change rapidly and differ by geography, sector or community.
This is the moment for leaders to feel into the pace, rhythm and readiness of the situation as they make their decisions.
Responses based on high-quality information, made transparently and with a view to maintaining solidarity, will succeed.
Download Narrative Seventeen as PDF English (136kb)
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On 21 February 2020, Dr David Nabarro, Co-Director of the Imperial College Institute of Global Health Innovation at the Imperial College London and Strategic Director of 4SD, was appointed as one of six Special Envoys to the World Health Organization (WHO) Director-General on COVID-19.
In this role, David provides strategic advice and high-level political advocacy and engagement in different parts of the world to help WHO coordinate the global response to the epidemic.
The COVID-19 Narratives are being written by David and peers to share with those who want more information about the situation and to help raise awareness and readiness of all actors.
Snapshot from WHO COVID-19 Situation Report – 80, as of 10:00 CET 9 April 2020.
→ WHO Risk Assessment Global Level VERY HIGH
→ 1,436,198 confirmed cases (+82,837 new in the last 24 hours)
→ 85,522 deaths (+6,287 in the last 24 hours)
→ Transmission scenarios for each country are now included in the daily situation report
→ WHO releases guidance for religious leaders and faith-based communities