Across the world, governments are embarking on enormous experiments as they work out how to exit their coronavirus lockdowns and resume economic activity. As there's no international consensus over how best to do it, many countries are looking on nervously, asking themselves whether any of the exit strategies will avoid a second wave of infections.
With experts saying a vaccine is at least a year away, the accepted thinking is that countries can come out of lockdown when the transmission potential of Covid-19 has fallen enough. In a population where everyone is susceptible, R0 – the basic reproduction number - is the number to watch. This is the average number of secondary infections produced by a typical case of an infection. For example, an R0 of 2 means each infected person infects two more. But once an epidemic starts spreading, some people in the population develop immunity. The key number then is R - the effective reproduction number. This accounts for the number of people infected when some people in the population have developed immunity. This is the crucial number that matters for judging whether to relax lockdown, according to Shroders.
But Harder than the decision about when to lift restrictions is choosing which restrictions they should begin to ease and when as the evidence that when countries reach a specific number of cases they should take particular actions does not yet exist. “There are no absolutes here,” says Mike Ryan of the World Health Organisation (WHO). Dr Michael Tildesley, an expert in infectious diseases at Warwick University, says that it is difficult to untangle the relative effectiveness of all the lockdown measures to work out what effect each of them has. "It may be that the only way we can do that - and get a real understanding - is when we start to relax them. We may have to lift a certain measure and monitor what that does to the epidemic,” he told BBC Radio 4's The Briefing Room.
Several European countries that previously imposed restrictions have recently begun taking their first steps out of lockdown. Although the approach and results are mixed, none of the countries are going back to “normal.”
The UK government announced a series of adjustments to its lockdown on Sunday night, including allowing unlimited outdoor exercise and encouraging more people to return to work. This week Germany reopened its Hairdressers, playgrounds, churches, and museums, as well as some schools. All restaurants will be able to reopen in mid-May. On Monday, half of Spain’s population entered "Phase 1" reopening, where restaurants, bars, and store can have limited openings, and hotels, gyms, and museums can reopen. However, some of Spain’s largest cities, including Madrid and Barcelona are still are still stuck with the same restrictions as last week In Italy, Bars and restaurants opened for takeout on May 4. Building sites and factories have also reopened. There will be no new measures until 18 May, when more shops will reopen, along with museums and libraries, the Catholic Church will be allowed to hold masses and sports teams will be allowed to hold group training again. The French government has also begun a staggered lockdown which has seen the country divided into red and green zones depending on the level of infections in different regions.
The big question is whether any of the exit strategies will be enough to keep the virus from coming roaring back. As Europe and much of the rest of the world wrestle with how to ease curbs on business and public activity, China, which implemented some of the strictest lockdown measures globally, is already facing the specter of a second wave of infections. For most of the past month, China consistently reported small numbers of daily new cases, most of which were “imported.” But health authorities in recent days said there were new local clusters of infections. In Shulan, a small city in Jilin province, which neighbors North Korea and Russia, has been put under a partial lockdown since Saturday, with all non-essential transportation banned for its over 630,000 citizens. The city has reported 13 locally transmitted cases as of today, ending Jilin’s more than two-month streak of reporting no new cases, according to Shulan’s mayor, who said the city is in “wartime” mode. The measures implemented in Shulan are reminiscent of those that were taken in the early days of the pandemic’s spread in China in January following the announcement of the outbreak in Wuhan. The outbreak in Shulan comes after authorities have re-imposed lockdowns in other parts of the northeast region in recent weeks.
The news out of China would be worry on its own, but it is not the only apparent success story to report a regression recently. South Korea, which has been praised as a model and a beacon of hope for the world in its desperate fight to slow the spread of the coronavirus, is now grappling with some of its largest infection clusters yet after authorities began to loosen some social distancing restrictions this month. All it took to reverse the positive trend was a single undetected case: a young man who stopped in at several clubs and bars in Seoul the night of May 1. Suddenly, scores of new cases were reported. Authorities then closed down more than 2,100 bars and other nightspots in its Capital on Saturday. Plans to reopen schools have been delayed.
The stands at SK Wyverns club's Happy Dream Ballpark, are filled with placards featuring their fans during the Korean Baseball Organization (KBO) League opening game between SK Wyverns and Hanwha Eagles at the empty SK Happy Dream Ballpark on May 05, 2020 in Incheon, South Korea. (Getty)
The outbreak threatens to detail the success of a strategy that has gained praise around the world. South Korea has been widely lauded for its successfully proactive approach in averting a large outbreak of without resorting to oppressive restrictions over its people and chocking off as much of its economy as other countries have. Instead, the country of 52 million, managed to flatten the curve with a multi-pronged public health response based on extensive and rapid testing and tech-powered contact tracing, aided by social distancing, near-universal use of masks, and public cooperation. But its envied strategy may have now reached its limit. Before they were shuttered over the weekend, many bars and clubs in Seoul required patrons to have their temperatures taken and leave their name and phone numbers to enter—but some revelers left false or incomplete information. Officials in Seoul said they had only been able to get in touch with about 2,400 of the approximately 5,500 people who visited the affected area, according to local media. Authorities said they would try to track the remaining people with credit card records and police assistance.
President Moon Jae-in warned of a second wave of the epidemic later this year, saying the recent cluster underscored the risks that the virus which causes Covid-19 can spread widely again at any time. “It’s not over until it’s over. While keeping enhanced alertness until the end, we must never lower our guard regarding epidemic prevention,” he said in a televised speech marking the third anniversary of his inauguration. “We are in a prolonged war. I ask everyone to comply with safety precautions and rules until the situation is over even after resuming daily lives.”
The government estimates that the medical system can comfortably control Covid-19 if there are fewer than 50 new cases per day, and epidemiologists can trace the source of infection at least 95 percent of the time — milestones the country passed last month. A government task force of economists and sociologists, as well as infectious-disease experts, drafted a 68-page “guidebook for distancing in daily life.”It outlined measures like installing partitions at cafeteria and dining-hall tables, keeping masks on in church and having visitors to weddings, funerals, karaoke bars, nightclubs and internet-game parlors write down their names and telephone numbers so they can be traced later. It calls for workers with even minor potential symptoms of Covid-19 to call in sick for a few days. “There is no going back to the life we had before Covid-19,” Kim Gang-lip, a senior policy coordinator at Central Disaster Management Headquarters told The New York Times. “Instead, we are creating a new set of social norms and culture."
The resurgence of cases in both countries, where the easing of lockdown has been accompanied by extensive contact tracing and quarantining those infected and their close contacts, underscores the difficulties that governments are likely to face as they emerge from lockdowns. It also serves as a painful reminder that countries that plan to stop infections after they lift their lockdowns with masks, good hygiene and social distancing may not be enough.
Jeff Duchin, an epidemiologist for the King County, Washington, public health department told Voxthat in order to beat back the virus, countries have to be able to identify almost all the cases, “even a few cases, if unrecognized, will spark an outbreak that will spiral out of control,” he said. But this has been a difficult task even with the most diligent testing-and-tracing regimen. In South Korea, they have are using cellphone data to identify some 10,000 people who may have been in contact with the new cluster and telling them to get tested. China also introduced a health status smartphone app. In Wuhan, the city where it all started, residents must show their status to use public transport. If they're green, they're healthy and good to go. If they're red, they should be in isolation as a known sufferer of Covid-19.
In an interview with The Telegraphthis week, Dr Hans Kluge, director for the WHO European region, delivered a stark warning to countries beginning to ease their lockdown restrictions, saying that European countries should brace themselves for a deadly second wave of coronavirus infections because the pandemic is not over and that now is the “time for preparation, not celebration.” With an eye on the risk of a second wave, governments across Europe are still trying to ramp up the number of tests; introduce contact-tracing apps; and increase capacity in intensive care units to deal with severe COVID-19 case. There are early signs that a resurgence may already be here. After easing some restrictions, Germany has seen an increase of the reproduction rate of the virus above 1, meaning that one infected person can pass the virus to more than one other person, effectively contributing to the exponential rise in the number of cases.
European countries and others around the world will be watching closely to see what happens in South Korea and China. But we know for certain is that coming out of lockdown will require swift responses and abundance of resources like testing kits and tracing apps to keep sufficient numbers of infected people tightly quarantined to prevent a surge in infections that would overwhelm their health systems. But as most countries failed to do so during the first round of covid-19, it unclear whether they will do enough the second time around to prevent a resurgence of the pandemic.