In a surreal turn of events over the past few months, the world has found itself at a complete standstill, with doors locked, and social distancing becoming the buzz word of 2020. As the world begins to come to terms with the fallout from the Covid-19 lockdown, a pressing question now is: how can we effectively exit lock down without undoing the stalling effect of lockdown on infection and death rates?
In Europe, this is now a question of how to prevent further spikes that might overload the health system, while Australia and New Zealand are looking at an entirely different scenario where they may be able to eradicate transmission of the virus within the country. The purpose of the lockdowns is different as well. In countries where there are already high infection rates the purpose of lockdown is to reduce transmission of the virus and to allow the health care system to run at a manageable capacity. The purpose of lockdowns in Australia and New Zealand is to eradicate transmission of the virus within the countries altogether. All countries need to consider the best approaches to ending lockdowns eventually, but the options being considered in Australia and New Zealand will need to be very different given their different purpose and situation.
European nations have seen infection rates skyrocket, and with that, a huge death toll and an overwhelmed health system. The long-term ramifications of this will not be known for many months to come, but already we are seeing a potential fall-out in the health care sector, with one in five health care workers saying that they may quit as soon as the pandemic is over – causing huge shortages in a sector already stretched thin.
When a country gets to a point when contact tracing is no longer viable, policies must be aimed at mitigating the damage. These are the “lockdown” policies being seen across Europe and the UK. The less interaction people have, the less likely they are to pass on the virus to another person. Since lockdown came into effect, the transmission of the virus has come down from an average of 2.7 people being infected by every carrier, to 0.7, showing that they have been effective at their aim to flatten the curve. Keeping transmission down and re-opening services is a delicate balancing act and is increasingly on the mind of many European countries. Worries on how long lockdowns can last are becoming more acute following the IMF already predicting an economic downturn greater than the Great Depression. However, it is inhumane and economically irresponsible to launch back into normal routines immediately – not least because of the health sector fall out, but the many other ramifications associated with letting this virus escalate unchecked. This makes the question of how to exit incredibly important for nations who must strike the right balance between lifting restrictions and keeping transmission rates as low as possible.
Some of the options currently being explored include issuing an “immunity passport”, which was officially launched in Chile. The concept behind this scheme is that it can be provided to who have developed antibodies in response to COVID-19 and are therefore “immune” as proof that they are no longer infectious or at risk. However, the World Health Organisation strongly recommends against this approach, as there is no reliable antibody test yet, or evidence that people who have recovered from the virus are ‘immune’ to re-infection, and subsequently, re-infecting others.
A staged lifting of lockdowns would gradually re-open services, retailers and other workplaces in a controlled manner. There is some indication that doing so would not trigger masses of people to run out to the first pub that re-opens. Some hypothesise that there is in fact a huge amount of fear and anxiety reminiscent of some responses to WWII stay home directives that may instil long-term suspicion and fear of others. Some of the clear options for opening services would be firstly to re-open schools with certain provisions. The infection rate in children is still an unknown, but parents currently working from home are some of those struggling the most with lockdowns, and there is a strong economic and social welfare argument to be made for their re-opening. Other options include the construction industry – if not already continuing – given their ability to distance during work, and other retail stores if provisions for social distancing can be maintained.
Perhaps the most viable option is intermittent lockdowns in combination with staged lifting of restrictions. This would involve staging several lockdowns over an extended period – probably into 2021 to allow for a balance to be struck between economic operations to continue and to ensure that the health system is not overloaded. This is a dire prospect for many who have experienced lockdowns first-hand but a manageable option where eradication is no longer a viable option.
Australia and New Zealand are in the fortunate position that rates of infection across the country have always been low due to the early restrictions on travel and implementation of social distancing. The bulk of infections came from the Ruby Princess, a huge oversight on behalf of the government, but have had contact tracing to minimise transmission as a result. This low infection rate puts Australia and New Zealand in the unique position of leading the way in their own approach. If they can reduce all infections by maintaining lockdowns and contact tracing, there is a possibility that the virus can be eradicated within the country. If this happens, the economy can re-start without fears of an outbreak or the possibility of further lockdowns. Any re-opening would need to be staged, and constantly monitored. This would mean that all people travelling into the country would need to continue to be quarantined at least until a vaccine can be administered to the population. Being strict now about controlling hotspots and transmission is essential for Australia and New Zealand to come out of this situation well. If it is not controlled now, it will set the country back behind the rest of the world and see everyone facing many more months of lockdown but this time, to relieve the health care system from overloading, not to prevent local transmission.
Vivienne Moxham-Hall is a health policy researcher in London. Twitter