How can coronavirus lockdowns end safely and effectively? - WHO briefing

More than a third of the world is currently under some form of lockdown as a result of the COVID-19 coronavirus pandemic, with schools, workplaces and places of worship closed. As these shutdowns slow the spread of the virus, many are eagerly looking ahead to how these restrictions will soon be lifted. At today's World Health Organization (WHO) briefing, Michael J. Ryan, Chief Executive Director of the WHO Health Emergencies Programme, explained that a strategic "calibrated, step-wise approach" will be the safest and most effective way to ease these limitations.

Key questions
Before easing restrictions, countries should first examine key statistics such as their rates of infection and the capacity of their healthcare systems. Areas with hospital bed capacity near 100% are not yet ready to reduce lockdown restrictions, he said.

"You need to be in a position where you have free beds in your system so you’re managing and coping with the case load," said Ryan. "That means you have some absorption capacity left."

Other numbers will be equally important, such as: their doubling rate (how many days it takes for the number of cases to double); the number of contacts generated per infected case; and the positivity rate (the proportion of all samples tested that are positive).

"You’ll see in somewhere like [South] Korea, they’re testing, and 2% to 6% of their samples are positive. Last week, in New York, 37% of tested samples were positive. So you need to carefully look at what proportion of people that I test are positive."

Countries should also consider which shutdown elements will be most effective to ease, while and ensuring that leaders understand the epidemiology of the disease in each shutdown area. "That's the safe way out of lockdown," Ryan added.

Preparing for a transition
Once those key questions are answered, countries must put elements in place for a transition. For instance, a strong public health capacity must be built to take over from the lockdown, said Ryan, as well as a strengthened health system that can cope, should the disease rebound.

"Once you raise the lockdown, you have to have an alternative method to suppress the infection," said Ryan. "The way to do that is active case finding, testing, isolation of cases, tracking of contacts, quarantining of contacts."

Strong community education is an additional essential aspect of this transition, said Ryan. The public must be engaged and informed about physical distancing methods after restrictions are raised. "If you have strong public health capacity, if you’ve got a community that’s mobilized and empowered, and if you’ve strengthened your health system, then you’re potentially in a position to start unlocking or unwinding the lockdown."

Test and evaluate
Ryan was careful to say that strategies will vary depending on a country's unique situation.

Instead, a customized, step-wise approach will be the safest and most effective, providing the chance to make adjustments as needed. "You need to say, 'We will stop doing this element of the shutdown and then we will wait and we will look at the data. And if that works we go to the next stage and the next stage.'"

"There no absolutes here. There are no answers. There are no numbers that say, 'If this number is this than you do this.' That doesn’t exist," he noted.