As a concerned business owner and wanting to pre-empt the ending of the lockdown I’ve been looking at how we come out of this….
There are four phases in dealing with a Pandemic.
- Slow the Spread
- Region by Region Reopening
- Establish Immune Protection and Lift Physical Distancing
- Plan/Prepare for the next outbreak….
We’ve been living through phase 1 for the past few months. The main aim in this phase was to ensure the number of people infected never exceeded the capacity of the Health Service.
There are a number of things we need to have achieved before we can relax the Phase 1 Restrictions. Generally they are regarded as follows –
- A sustained reduction in cases for at least 14 days,
- Hospitals are safely able to treat all patients requiring hospitalisation without resorting to crisis standards of care,
- The state is able to test all people with COVID-19 symptoms, and
- The state is able to conduct active monitoring of confirmed cases and their contacts.
When we move onto Phase II, the majority of schools, universities, and businesses can reopen. Teleworking will probably continue where convenient; social gatherings will still continue to be limited to fewer than 50 people wherever possible. Other local restrictions will have to be considered, such as those that limit people from congregating in close proximity.
Health officials will probably recommend increased social hygiene measures and cleaning of shared surfaces. See my post on Contact Cleaning
The goals of Phase II are to:
- Lift strict physical distancing measures in a concerted and careful fashion
- Allow the vast majority of businesses and schools to open
- Continue to control Covid-19 transmission so we do not revert back to Phase I.
The adoption of these Phase II measures will require a careful balance. We will need to constantly re-evaluate the implementation of these measures based on available surveillance data, and we will need to be ready to adjust our approach over time according to the epidemiology of local, national, and global spread. This is especially true as we transition from one phase to the next.
It will also require continued cocooning of vulnerable people/communities. While easing of physical distancing is taking place, highly vulnerable populations, such as individuals older than age 70 and those with compromised immune systems or compromised lung and heart function, should continue to engage in physical distancing as much as possible until a vaccine is available, an effective treatment is available, or there is no longer community transmission. Special attention should be paid to long-term-care facilities and nursing homes. These facilities will need to maintain high levels of infection prevention and control efforts and limit visitors to prevent outbreaks.
If a treatment or prophylactic, such as a monoclonal antibody, becomes available, high-risk and vulnerable populations should be prioritised to receive it, to both protect those individuals and reduce the likelihood of an increase in severe illnesses and additional patient surge in hospital intensive care units (ICUs).
We also need to identify Those Who Are Immune. Serology is a method used to identify evidence of immunity in someone who has recovered from infection. With accurate and widely available serological testing, we can identify people who are immune and therefore no longer vulnerable to infection. While we need to better understand the strength of the immune response in mild cases and how long people remain immune from reinfection, we know there is a period where most people will have sufficient antibodies to offer protection. People who are immune could:
- Return to work
- Serve in high-risk roles such as those at the front lines of the health care system
- Serve in roles that support community functioning for people who are still physically distancing (e.g., the elderly who continue to quarantine at home).
The trigger for moving to Phase 3 will require the production of a Vaccine and the ability to manufacture it in the kind of volume to roll out through out the community quickly.
Once a robust surveillance sentinel system is in place, coupled with widespread point-of-care testing and a robust ability to implement tracing, isolation, and quarantines—and this is supported by the availability of therapeutics that can help mitigate the risk of spread or reduce serious outcomes in those with infections—or alternatively a vaccine has been developed and tested for safety and efficacy, we can enter Phase III.
The availability of these technologies (and eventually a safe and effective vaccine) will have economic and social benefits, in addition to health benefits.
The goals of safe and effective technologies for controlling transmission are to:
- Prevent infection
- Treat those with early disease to prevent bad outcomes
- Provide a prophylaxis for those exposed to infection to prevent them from developing disease or reduce its severity
- In the case of a vaccine, build population-level immunity to the virus in order to reduce illness and death and stop or greatly slow spread
- Enable the lifting of all physical distancing measures.
The COVID-19 pandemic has exposed serious gaps in the worlds pandemic preparedness. COVID-19 will not be the last public-health emergency to threaten our society. We must invest in the scientific, public-health, and medical infrastructure needed to prevent, detect, and respond to the next infectious disease threat.