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Can unlocking be counterproductive given the surety of a third wave?

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Dr Sushil Jain, Pulmonologist, Masina Hospital believes that as the future of COVID-19 is unknown at present, we should plan and prepare for the worst case scenario. He presents some lessons to be learnt and applied now for an effective exit strategy from COVID-19 restrictions

We have implemented restrictions on population movement to slow the spread of severe acute respiratory syndrome Coronavirus 2 and prevent health systems from becoming overwhelmed.

Now the question arises whether unlocking could be counterproductive given the surety of a third wave. However, lockdowns and other extreme restrictions cannot be sustained for the long term.

State governments now face the common challenge of easing lockdowns and restrictions while balancing various health, social, and economic concerns. There is an increasing realisation that removing COVID-19 restrictions is not about returning to the pre-pandemic normal but about gradually and cautiously transitioning to a new normal, while being ready to re-impose measures if, and when, necessary. Although the future of COVID-19 is unknown at present, we should plan and prepare for the worst case scenario. It is not too late for the following lessons to be learnt and applied now.

First, as described here, we can move forward mainly on the basis of the epidemiology. However, a clear and transparent plan that prescribes which factors are being taken into account is essential. Ideally these plans should explicitly state the levels or phases of easing restrictions, the criteria for moving to the next level or phase, and the containment measures that each level or phase entails.

Second, we should not ease restrictions until there are robust systems in place to closely monitor the infection situation.

Third, continued measures to reduce transmission will be needed for some time. It is now accepted that wearing face masks can significantly reduce person to person transmission. Crucially government should educate, engage, and empower all members of society, especially the most vulnerable to participate in the pandemic response. Rather than crafting these measures on the basis of assumptions about what can communities can or cannot accept, citizens should be directly involved in the process of co-producing tailored solutions appropriate for the local context.

Fourth, each state should have an effective find, test, trace, isolate and support system in place.

Easing of restrictions requires:

Knowledge of infection status

It seems intuitive that a state should not open up until it has a surveillance system of high quality in place and has confirmed that infections are being suppressed.

Community engagement 

For societies to reopen safely, communities should be fully engaged and empowered to protect themselves from the virus and the effect of the crisis, especially the most vulnerable populations.

Public health capacity

The core of any effective exit strategy for COVID-19 restrictions should be a surveillance system that includes active case finding, testing all people with suspected infection, tracing their close contacts, isolating people with a confirmed infection, and supporting them in isolation.

Health system capacity

An adequate health system capacity is crucial to cope with possible surges in infection after lockdowns are lifted. This capacity includes having sufficient treatment facilities, medical equipment and healthcare workers.

Border control measures

As countries and regions gradually reopen their borders, the inflow of travellers should be managed to reduce the risk of people with COVID-19 travelling into the area.

With all these measures, we would be better prepared to face a possible third wave.

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