What are the health measures that must be in place before lifting the shutdown across States?

The story so far: From March 24, the country went into a 21-day lockdown period as an emergency measure to combat the COVID-19 pandemic. With the available evidence, it was believed that physical distancing was the best weapon to combat this little-known virus, transmitted through respiratory droplets. The government announced a shutdown believing that it would stagger the progress of the epidemic, allowing health systems to manage the crisis that would inevitably unfold. With the extension, that several States had been seeking, it is perhaps the best way to go. But some basic public health parameters must be put in place to guide the eventual lifting of the lockdown.

What is the logic behind the extension of the lockdown?

Being an unprecedented situation, there is a stark absence of too many examples from the past of a lockdown of this scale. But there are a number of recommendations as to the period of withdrawal, and pretty much everyone is in agreement over what should be done from a public health standpoint, within that period.

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As America’s face of epidemic-control, Anthony S. Fauci, who heads the National Institute of Allergy and Infectious Diseases, said in a podcast with The Wall Street Journal: “It’s not a light switch, on and off. It’s going to be gradual, not all or none.” He went on to say that getting back to normal must be preceded by a “really clear indication that those areas with big outbreaks, with peaks, have not only stabilised and are starting to turn the corner, and the number of cases are coming down. I don’t think you need to get down to zero, though before you contemplate pulling back”.

While he was speaking in an American context, the medical science indubitably strikes a chord with nations seeking to safely emerge out of the lockdown. “If you are going to consider a relaxation you have to have the capability for rapid identification, isolation and testing. People are also going to have to continue to be careful. We should never shake hands again.”

Consider Wuhan, which just reopened its borders after a long 76-day shut down: Reports from the Chinese city indicate that local health authorities remain vigilant to prevent fresh imports and resurgence of local transmission. Healthy residents and visitors are allowed to move out, but eternal vigil is clearly the price a connected world, where epidemics loom large, has to pay.

Not surprisingly, the hints from what happened over a 100 years ago are strikingly similar. The Spanish flu of 1918 spread across the globe causing similar havoc, though the world was a vastly different place then. Retrospective studies that are being recirculated today indicate that putting distance between people did help retard the spread of the 1918 flu and reduce the mortality rate overall. As German Lopez wrote in vox.com, one of the key lessons was that it was important not to give up early. In American cities that gave up on physical distancing measures early consistently caused a recurrence of flu cases and deaths, in 1918.

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Even States in India have recommended a minimum of two months’ extension, in order they may be sure that they can progress to the next phase.

What are the phases to follow?

The American Enterprise Initiative (AEI), in its document, “National Coronavirus Response: A road map to reopening” (https://bit.ly/3a2qZ6b), has outlined four phases in the epidemic. While recording slowing the spread of the epidemic is taken as phase 1, state-by-state (America) reopening is outlined as phase 2.

Individual states can move to phase 2 when they are able to safely diagnose, treat, and isolate COVID-19 cases and their contacts. Caitlin Rivers, one of the authors of the report, explained during a conference with the Johns Hopkins Bloomberg School of Public Health, that progress towards phase 2 should be capability based, rather than time line based. Schools and businesses can reopen, and much of normal life can begin to resume in a phased approach.

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However, some physical distancing measures and limitations on gatherings will still need to be in place. For vulnerable populations, continuing to limit time in the community will be important.

Public hygiene has to be improved, and deep cleaning of shared spaces should become more routine. People may initially be asked to wear face masks while in the community to reduce their risk of asymptomatic spread. Those who are sick will be asked to stay home and seek testing for COVID-19. Testing should become more widespread and routine, the report suggests.

COVID-19 | Interactive map of confirmed coronavirus cases in India

Multiple experts, in India and abroad, are urging a consultation with local communities on both the hotspot zones and areas that have not had too many cases, before deciding anything further on the lockdown.

As per the AEI report during phase 3, physical distancing restrictions may be lifted, after establishing immune protection. This means safe and effective tools for mitigating the risk of COVID-19 are available, including broad surveillance, therapeutics that can rescue patients with significant disease or prevent serious illness in those most at risk, or a safe and effective vaccine. This, along with sufficient data, improvement in health-care system capabilities (both in the private and public sectors), will help ensure that reliance by nations on physical distance as a primary tool to control the epidemic is reduced.

Phase 4 — rebuild readiness for the next pandemic — might seem too far in the future, but the AEI report cautions that it is an important part of the plan. Nations will need to be prepared to face any new infectious diseases threat, and governments will have to invest in research and development, expansion of public and private health-care infrastructure and workforce.

What is the future?

The world post-COVID-19 might well turn out to be a vastly different place to what it was before the SARS-CoV-2 virus swept across the globe, leaving mass casualties in its path. But the lessons from this epidemic — hand and surface hygiene, physical distancing — must never be forgotten. They are valuable in ensuring that if the next virulent pathogen were to strike, the world would be able to tackle it head on.