Lessons learnt from easing COVID-19 restrictions: an analysis of countries and regions in Asia Pacific and Europe

14th October 2020

Article published in The Lancet.

The COVID-19 pandemic is an unprecedented global crisis. Many countries have implemented restrictions on population movement to slow the spread of severe acute respiratory syndrome coronavirus 2 and prevent health systems from becoming overwhelmed; some have instituted full or partial lockdowns. However, lockdowns and other extreme restrictions cannot be sustained for the long term in the hope that there will be an effective vaccine or treatment for COVID-19. Governments worldwide now face the common challenge of easing lockdowns and restrictions while balancing various health, social, and economic concerns. To facilitate cross-country learning, this Health Policy paper uses an adapted framework to examine the approaches taken by nine high-income countries and regions that have started to ease COVID-19 restrictions: five in the Asia Pacific region (ie, Hong Kong [Special Administrative Region], Japan, New Zealand, Singapore, and South Korea) and four in Europe (ie, Germany, Norway, Spain, and the UK). This comparative analysis presents important lessons to be learnt from the experiences of these countries and regions. Although the future of the virus is unknown at present, countries should continue to share their experiences, shield populations who are at risk, and suppress transmission to save lives.

Introduction

The COVID-19 pandemic is an unprecedented global crisis. By mid-September, 2020, over 22 million confirmed cases of COVID-19 had been reported worldwide, with almost 930 000 deaths.1 At least 186 countries have implemented varying degrees of restrictions on population movement to slow the spread of the severe acute respiratory syndrome coronavirus 2 and prevent health systems from becoming overwhelmed; these restrictions have amounted to lockdowns in 82 countries.2 Although such measures might have saved lives, they have come at a heavy socioeconomic cost. The World Bank's projections point to the deepest global recession since World War 2, with millions of people falling into unemployment and poverty.3 Lockdowns and other extreme restrictions cannot be sustained for the long term in the hope that there will be an effective vaccine or treatment for COVID-19. Rather, these restrictions give time for countries to reduce the incidence of disease and put in place robust, yet sustainable, measures to prevent and control transmission.

When and how a country should ease restrictions are the common challenges that governments worldwide now face as they seek to balance various health, social, and economic concerns. WHO has warned that a premature lifting of lockdowns could spark a resurgence of infections and cause even more severe, longer-term damage to the economy than exists as a result of lockdowns.4 Rawaf and colleagues5 have outlined four public-health principles that should be considered in each country's exit strategy: infection status, community acceptance, public-health capacity, and health-system capacity. Adapting and building on these principles, we developed a framework with additional components and subcomponents (panel). Using this comparative framework, we examined the measures taken in nine high-income countries and regions that have started to ease restrictions that were imposed in response to COVID-19, which were selected to provide a range of epidemiological experiences and policy responses. Five countries or regions were in the Asia Pacific region (ie, Hong Kong [Special Administrative Region], Japan, New Zealand, Singapore, and South Korea) and four were in Europe (ie, Germany, Norway, Spain, and the UK). In Asia Pacific, they include countries and regions with and without experience of severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS). In Europe they include countries that, in the initial wave of COVID-19, were (ie, Spain and the UK) or were not (ie, Germany and Norway) severely affected. In reviewing international experiences, we have been concerned about an apparent absence of clear and consistent strategies for exiting restrictions. We have identified five prerequisites for easing COVID-19 lockdowns and restrictions: knowledge of infection status, community engagement, adequate public-health capacity, adequate health-system capacity, and border controls. We describe how each of these nine countries and territories have addressed these issues. Although it might not be possible or beneficial to replicate the exact same measures in different countries due to varying socioeconomic contexts, countries can consider policy alternatives and novel solutions developed by other countries and calibrate them according to their domestic circumstances and resources.

[url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32007-9/fulltext]Read the full article HERE[/url]