As Lockdowns Ease, Societies Need To Adjust To 'New Norm' To Impede COVID-19 Re-Surge

As Lockdowns Ease, Societies Need to Adjust to 'New Norm' to Impede COVID-19 Re-Surge

With countries considering easing lockdowns and similar restrictions imposed due to the spread of the novel coronavirus respiratory disease (COVID-19), societies should adjust to the new reality, where most physical distancing and hygiene measures would remain in place for a while, rather than expect a soon return to the way things were before the pandemic, epidemiologists told Sputnik

MOSCOW (Pakistan Point News / Sputnik - 17th April, 2020) With countries considering easing lockdowns and similar restrictions imposed due to the spread of the novel coronavirus respiratory disease (COVID-19), societies should adjust to the new reality, where most physical distancing and hygiene measures would remain in place for a while, rather than expect a soon return to the way things were before the pandemic, epidemiologists told Sputnik.

To date, more than 2,180,000 COVID-19 cases and over 147,000 deaths from the disease have been reported globally, according to data from the Johns Hopkins University Coronavirus Resource Center. Normally, it would take up to several years to develop a vaccine from scratch, but the World Health Organization (WHO) expects a vaccine in approximately a year and a half, given the major international push in research. There are now more than 70 candidates under development.

With efficient and safe vaccine still at least months away, European countries are now moving toward gradually easing restrictions to help their economies recover from huge losses sustained throughout lockdowns. Austria, Belgium, Czech, Denmark, Italy and Spain have already partially eased their restrictions. Italy allowed stationery and children's clothes shops to open, while Spain resumed manufacturing and construction. Austria and Belgium allowed garden supplies and DIY shops to reopen. Czech Republic allowed its citizens to travel aboard for essential reasons, while Denmark started reopening schools and day-care centers.

Even after hitting the coronavirus peak countries need to tread carefully when easing quarantine restrictions, and the full return to "normal" in the nearest future seems unlikely, experts say.

"Generally speaking, it should be done gradually, by stage perhaps. Give people, and the society as a whole, time to slowly adjust back to what it was before the lockdown. I think it will be unreasonable to think that everything and everyone will just go back to where they were as if nothing had happened," Emma Bartfay, professor at the Faculty of Health of the Ontario Tech University, told Sputnik.

HOW SHOULD POST-LOCKDOWN REALITY LOOK LIKE?

At a mission briefing on Thursday, WHO Director-General Tedros Adhanom Ghebreyesus outlined six key factors for easing of lockdowns and stay-at-home orders.

"First, that transmission is controlled. Second, that health system capacities are in place to detect, test, isolate and treat every case and trace every contact. Third, that outbreak risks are minimized in special settings like health facilities and nursing homes. Fourth, that preventive measures are in place in workplaces, schools and other places where it's essential for people to go; Fifth, that importation risks can be managed. And sixth, that communities are fully educated, engaged and empowered to adjust to the 'new norm,'" Tedros said, as quoted on the organization's web-site.

According to Professor Santiago Mas-Coma, the director of parasitology at the University of Valencia and an expert member of the World Health Organization, one of the key considerations of governments that plan easing of restrictions should be the fact that their health care systems had just experienced tremendous pressure or even collapse and health workers needed a break and could not be faced with similar pressure again soon.

"To avoid this and considering the age-dependent COVID-19 bad prognosis in elder people, the first priority when relaxing individual isolation/quarantine measures is to keep subjects aged 60 or more at home. Thus, companies re-starting work should try to do it by counting only on their younger employers, whenever possible," he told Sputnik.

George Rutherford, professor of epidemiology and biostatistics at the University of California-San Francisco, similarly noted the importance of ensuring capabilities of a country's health care system before lifting lockdowns.

"You need to have enough hospital beds available in case it backfires and does not work. You have a place to put patients if it does not work," Rutherford told Sputnik.

According to Mas-Coma, governments also need to make sure that there is sufficient stock of personal protective equipment not only for health workers, but also public transportation workers, for instance, before restrictions are eased. The epidemiologist also underlined the need to prioritize single-use face masks and gloves, while ensuring proper disposal of used items as they could be infection sources.

Daily disinfection both indoors and outdoors, active propaganda of hygienic measures, including frequent washing hands, leaving shoes when entering home and disinfecting or removing food packages, along with calls on keeping distance in public places would become a part of the new reality of the coronavirus era world, according to the expert.

"Additional emphasis should be given to the importance of avoiding all kinds of agglomerations, mainly those of public transport daily used by many people," Mas-Coma stressed.

Mass gatherings and events, on the other hand, would be gone for long as they pose significant risks of a surge in the spread of the virus and make contact tracing difficult. At the same time, governments should keep testing, case isolation and contact tracing as aggressively as during the ascendant arm of the epidemic, Mas-Coma stressed.

"Besides the tests, taking the temperature at the entry of food markets, stores, metro stations, etc., may be additionally useful to detect infected people with mild symptoms. Indeed, fever is one of the first symptoms to appear and there are subject, who feel sufficiently well despite having fever, behave normally and go to work," he said.

Another area of scrutiny, according to the expert, should be international travel in order to prevent re-entry of the virus from other countries and a second wave.

"International connections should be analyzed country by country, to differentiate between high risk travelers coming from countries where the pandemic may be very active from those already having it more or less behind," Mas-Coma said.

The expert noted that foreign travelers should be checked upon their arrival, while countries that consider opening of their borders need to prepare special locations for mandatory 14-day quarantine for all international arrival.

IS THERE RISK OF A SECOND WAVE?

Even in most affected areas, such as China's Hubei province or Northern Italy, the laboratory confirmed cases make up only several percent of the total population. "It is nowhere near the kind of big numbers you think for a widespread immunity," Professor Rutherford of the University of California-San Francisco said.

Besides, little is known about the immunity against the new strain of coronavirus itself.

"Nobody really knows what the antibodies mean. Are they just the marker of this disease just like with HIV or are they truly represent the immune memory and the ability to fight off that virus, the next exposure to it," the expert said.

Last week, researchers at Fudan University in Shanghai released a study of plasma in 175 recovered patients. According to the paper, while samples of most individuals showed a strong antibody response, nearly a third of recovered patients had low levels of antibodies or none at all. The study has not been peer-reviewed yet.

Rutherford told Sputnik that he believed that at least some portion of COVID-19 patients that are antibody-positive have neutralizing antibodies that fight off the infection. "But what that proportion is, how effective those antibodies are, how long the immunity lasts - those are all very much open questions, there are just now being addressed. But we obviously have to know the answers if we are going to have a vaccine," he stressed.

The fact that only a very small share of population could have developed the immunity against the virus poses a risk that the number of cases could jump once again after lockdown are eased, Mas-Coma said.

"Reappearance of local outbreaks are possible because, once the epidemic is controlled in a country, most of the population will still have had no previous contact with the virus," the expert said.

"Governments should understand that insufficient success in control may give rise to a longer or much longer descending branch of the epidemiological curve (when not secondary outbreaks) and the consequent economic and social repercussions may be pronouncedly worse," he added.

Bartfay, in turn, did not rule out the possibility of a new wave of the outbreak. "Second waves, and even third waves, are common with pandemics," she said.

All these factors make a decision to ease restrictions a very difficult and challenging one for governments, the expert underlined.

"On one hand, lifting the restrictions too soon, you risk the return of disease transmission. On the other hand, the longer you wait, the longer it will take the society to function properly again. As we slowly return to 'normal,' we need to be flexible in terms of deciding how to proceed to the next step," Bartfay said.