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[SYDNEY] As the second wave of COVID-19 infections sweep many countries, governments are facing the challenge of when and how to ease restrictions and lockdowns while balancing health with socio-economic consequences.
A health policy paper published in The Lancet medical journal on 24 September recommends that governments consider five key factors — knowledge of infection levels, community engagement, public health capacity, health system capacity, and border control measures — while lifting restrictions.
“The two most important common principles are the importance of bringing the level of circulating virus in the population as low as possible before reopening, and only reopening whenever there is a robust ‘find, test, trace, isolate, and support system’ in place”
Martin McKee, London School of Hygiene and Tropical Medicine (LSHTM)
The World Health Organization (WHO) has warned that a premature lifting of lockdowns could spark a resurgence of infections and cause worse damage to the economy than caused by lockdowns.
Researchers from Asia and the UK analysed strategies for easing COVID-19 restrictions from the first wave of infections in nine countries of Europe and the Asia-Pacific — Germany, Hong Kong, Japan, New Zealand, Norway, Singapore, South Korea, Spain and the UK.
They are urging governments to consider achieving a ‘Zero COVID’ strategy (eliminating domestic transmission) like in New Zealand and learn from other countries’ experiences. They have identified common principles for governments to follow for protecting the populations and economies.
“The two most important common principles are the importance of bringing the level of circulating virus in the population as low as possible before reopening, and only reopening whenever there is a robust ‘find, test, trace, isolate, and support system’ in place,” says Martin McKee, co-author and professor of European public health at the London School of Hygiene and Tropical Medicine (LSHTM).
For control measures to be effective, Mckee notes, “governments should develop a clear strategy setting out the responsibilities of everyone involved and establish a high level of public trust in their messaging”.
Asia Pacific countries were better prepared than European nations in stemming the spread of COVID-19 because of their experience with past pandemics. The paper highlighted that Asian countries had strengthened their public health and surveillance infrastructure following the severe acute respiratory syndrome (SARS) epidemic in 2003 and Middle East respiratory syndrome (MERS) outbreak in 2015.
In Europe, public health systems have struggled as a result of a decade of austerity measures. “It is certainly an important factor in Spain and in the UK. In both, there has been substantial budgetary cuts over the last decade, weakening the public health structure considerably,” says McKee.
In Asia, confirmed cases are mostly isolated in hospitals and other facilities whereas in Europe, mild cases are isolated at home.
“Culture has also played a role in the different ways that countries have responded to the pandemic in Asia and Europe,” Helena Legido-Quigley, lead author and associate professor in Health Systems at the National University of Singapore, and LSHTM tells SciDev.Net.
“Although this aspect is still poorly understood, many Asian counties share a culture of collectivism and group identity that could point to a trend of these countries being more responsive to policies and rules than Western societies,” says Legido-Quigley.
Wearing of facemasks was also adopted more widely in Asia than in Europe. For example, people in Hong Kong, Japan and South Korea were already in the habit of wearing face coverings for protection against seasonal viruses or air pollution, notes the paper.“We do know that there are some low-income countries elsewhere that have put in place well-functioning systems using community health workers, such as in Rwanda,” McKee says in response to whether successful strategies of high-income countries can be replicated or customised for developing countries.
“Overall, the pandemic highlights the importance of a good public health infrastructure, including village-level health workers, and the need for them to be integrated into the broader system,” Duckett adds.
The report acknowledges that lifting COVID-19 restrictions is not about returning to the pre-pandemic normal but about cautiously and gradually transitioning to a new normal with sustainable measures.
This piece was produced by SciDev.Net’s Asia & Pacific desk.