Unlocking Lockdown: The Science Behind It

Background
The emergence of the novel corona virus has spark a lot of drastic measures from governments across the globe. Following the World Health Organization’s declaration of the disease as a pandemic on March 11, 2020 [1], governments and states across the globe have adopted what is known as a ‘lockdown’ which has led to the closing down of schools, churches, businesses and forcing people to stay home. The Chinese city Wuhan, in the Hubei Province was the first geographic area to institute a lockdown [2]. Following the spread of the disease to Europe, the Middle East and Africa, other countries have followed suit. India, China, France, Italy, New Zealand, Poland and the UK are amongst the countries with the most restrictive mass quarantines and lockdown. In Africa, South Africa initiated a 21-day lockdown on March 26 but later extended to end by April 30. Some countries like Japan and Thailand have even initiated a state of emergency.

It must be noted that the aim of these lockdowns and other restrictions is to ultimately control the spread of the disease and provide the health systems an opportunity to better enhance their tracing and testing. In as much as these lockdowns are important to the control of the spread of the COVID-19, many are concerned about when the lockdown will be lifted; what will warrant the lifting of a lockdown and many more. For this reason, this article will explore the science behind lockdowns by specifically focusing on what will inform the lifting of a lockdown so that socioeconomic life can return back to normal.

In order to fully understand the science behind unlocking lockdowns, it is important to see what the WHO has on it. According to recommendations from the WHO, countries can begin to lift restrictions and lockdown only when they meet all of these six criteria: the COVID-19 transmission must be under control; health systems need to have the capacity to detect, test, trace and isolate cases; outbreak risk in high-vulnerable contexts must be minimized; schools and workplaces must have preventive measures in place; and, communities must be willing to make major changes, comply with the rules, and actively enforce measures such as contact tracing and social distancing. What this implies is that, before a country will decide to lift its restrictions on movement and social gathering, it must ensure that all of these measures are operational in full strength. The COVID-19 pattern across the globe is such that, the cases increase astronomically, spike and then begin to fall. It is at the point of reduction in the rates of infection that countries can start to think around the status quo to see if they meet the WHO criteria for lifting restrictions and lockdowns.

Transmission Control
The first requirement by the WHO is that the COVID-19 transmission must be under control. It is now anecdotal knowledge that the COVID-19 is transmitted mainly through large respiratory droplets and direct or indirect contact with infected secretions. There are other studies that have found the virus to be airborne. Therefore, controlling the transmission of the disease implies acknowledging all of these modes and putting preventive mechanisms that will limit the potential for easy transmission. The best way to control the transmission is to observe the social distancing protocol. Additionally, there must be strict directives and adherence to the use of Personal Protective Equipment (PPEs) which may include nose masks, surgical gloves, overalls, etc. Until a country can enforce strict adhere to the use of PPEs, particularly in public space, it is not fit to lift its lockdown restrictions.

Revamping health systems
The next course of criteria is that the health system of that country must have the capacity to detect, test, trace and isolate cases. This is a very critical condition because the purpose of lockdowns is to ensure that majority of the population can be reached, detected, tested, traced and isolated to prevent further spread of the disease. Therefore, lifting a lockdown implies that the country has gotten to a stage where its health system is robust enough to do early detection of cases and contact tracing as well as effectively and efficiently isolate cases in a way that will not put health workers and other frontline workers at risks of the disease. This means that there must be more than one testing centre in the region, district. Municipality or metropolis. It also implies that palliative and hospice care givers need to be incorporated in the isolation of cases so that they focus on those who may be dying while the mainstream health system manages those that will survive.

Reducing risk for high-vulnerable groups
As part of the criteria for considering a lifting of lockdown, the WHO postulates that countries thinking of this option must ensure that they have reduced the risk for high-vulnerable groups including pregnant women, the aged population, migrants and refugees. The pattern of mortality as a result of this pandemic suggests that older people, that is 60 years and above, as well as those with underlying conditions are at high risk of dying from COVID-19 infection. For that matter, any country that envisions to lift its lockdown ought to ensure that such groups are catered for and out of danger. This is where palliative, hospice and home care giving comes plays a critical role. These care givers can ensure that such vulnerable groups receive prompt attention and health care service. Also, it is important to note that social inequalities can exacerbate the risk of contracting the disease. Therefore, countries must ensure that there is enough socioeconomic support and relief packages including rent control, unemployment benefits, etc. that targets the needs of these vulnerable groups. This will enable them stay at home and prevent further spread of the disease.

Community participation and acceptance
This, by far may be the most important yet difficult criteria of all. It is important for the community to accept that we are not in ordinary times and for that matter, they must conform to a new norm call social distancing. Many people are engulfed in the culture of hugging, kissing and shaking of hands; hence, the adaptation to the new norm of social distancing may be quite challenging to them. Therefore, if a country deems it necessary to lift imposition on movements and lockdown, then it must access its citizenry to see if they are at the point where they accept the new norm; maintaining a social distance and staying at home even in the absence of impositions. This is the most critical criteria and for that matter, any country that cannot guarantee this criterion is not fit to unlock its lockdown.

Conclusion
The COVID-19 pandemic has forced a third of the world population to initiate some sort of lockdown or imposition on movements. These impositions have affected and disrupted daily living activities. Following a seemingly decline in the rate of infection of the COVID-19, particularly in Europe, countries have begun to loosen their restrictions and lift the lockdowns that were imposed on the populace. This article argues that there is no need to rush to lift the lockdowns. Rather, countries must understand the science behind it and follow accordingly. I therefore conclude that counties must follow the recommendations of the WHO and operationalize it to meet the needs of their local setting. A gradualist approach may be the best for lifting lockdowns. #Stay home, stay safe!

Reference

1. Chattu VK, Yaya S. Emerging infectious diseases and outbreaks: implications for women’s reproductive health and rights in resource-poor settings.2020
2. Zhang L, Lin Z, Chen F. Origin and Evolution of the 2019 Novel Coronavirus. Clinical Infectious Diseases. 2020. doi: 10.1093/cid/ciaa112