Exit strategy: Gradual lifting of lockdown measures without return to normality

Exit strategy: Gradual lifting of lockdown measures without return to normality
Source: JRC, WebCritech

Most EU member states started to put into place lockdown measures in mid-March without any coordination or guidance by the European Commission. Last week, the Commission published a joint roadmap towards a common lifting of the measures.

The roadmap, presented by Commission president Ursula von der Leyen and Council President Charles Michel on Wednesday (15 April), goes some way in supporting the member states in the transition back to “normality”, especially in providing common tools to assess and monitor the situation.

Coincidentally, the World Health Organisation (WHO) on the following day issued a guidance paper on adjusting public health and social measures in the context of COVID-19. The two documents share the same view that any lifting of lockdown measures should be gradual and based on a risk assessment of epidemiological data and health-care capacity.

Another important message in both papers is that we cannot expect to return to normality even after the lifting of lockdown measures. “If done too quickly, we risk a resurgence that could be even worse than our present situation,” WHO Director-General Dr Tedros Adhanom Ghebreyesus warned.

Corona normality

The WHO guidance was issued after consultation with all 53 members of the Europe region. At a briefing last week, WHO described the document as a framework paper to help countries to ask the right questions and to apply the same triggers when deciding on lifting the lockdown measures but they are expected to do it only on the basis of their own risk assessment.

WHO underlines that a careful risk assessment and staged approach is needed to balance the benefits and potential harms of adjusting the lockdown measures. “Until specific and effective pharmaceutical interventions (e.g. therapies and vaccines) are available, countries may need to continue to loosen or reinstate measures throughout the pandemic.”

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Based on current evidence, the most plausible scenario may involve recurring epidemic waves interspersed with periods of low-level transmission. WHO advises that measures should be lifted in a controlled, slow, and step-wise manner, for example, using two-week (one incubation period) intervals to identify any adverse effects.

To minimize the risk of a resurgence in COVID-19 cases, WHO writes that individual measures, including medical masks for symptomatic people, isolation and treatment of ill individuals, and hygiene measures should be sustained.

Physical distancing in enclosed spaces (e.g. cinemas, theatres, night clubs, bars, restaurants, gyms) and crowded public spaces (e.g. public transportation, supermarkets, markets, universities and schools, places of worship, mass gatherings such as sporting events, etc.) would also have to be respected during the transition to a new kind of “normality”.

The risk of exporting and importing cases from communities or countries with high risks of transmission will have to be managed. That include exit and entry screening and capacities for isolation of sick travellers, as well as capacity to quarantine individuals arriving from areas with community transmission.

Public health priority

Until now, there was hardly any overview of which measures the member states had put into place. According to the roadmap, all member states have prohibited public gatherings, closed (totally or partially) schools and introduced border/travel restrictions. The extent of the measures and the closure of non-essential economic functions vary by country and does not appear in the roadmap.

More than half of the EU’s member states have also proclaimed a state of emergency but this issue is not addressed in the roadmap. According to other statements by the Commission, emergency measures are allowed but should be strictly proportional and limited in time.

While recognising that the lockdown measures were necessary to fight the coronavirus, the Commission also notes that they come at a high social and economic cost. This is a dilemma that all member states face. That said, the protection of public health in the short and long term should remain the primary goal of member states’ decisions.

The Commission does not expect that the lifting of lockdown measures can be coordinated in time. What it expects, at a minimum, is that member states should notify each other and the Commission in due time through its Health Security Committee before they announce lifting measures and take into account their views.

“De-escalating from the COVID-19-imposed measures in a coordinated manner is a matter of common European interest. While the timing and specific modalities will differ between Member States, it is essential that there is a common framework.”

In fact, for the time being it is questionable if any member state meets the criteria for de-escalating. Member states could learn from each other on how to lift the lockdown measures but it is too early to identify any “best European practice”. Scientific data on the spread of the virus is still missing and measuring methods differ by country.

More solidarity

The roadmap lists a number of criteria for assessing whether lockdown measures can be lifted but it is up to the member states, depending on their own structures, to decide at what level compliance with the criteria should be assessed.

The Commission admits that coordination and solidarity between member states were put into question at the outset of the pandemic but stresses that the past few weeks have seen growing examples of solidarity throughout the EU.

Examples of solidarity are the treatment of intensive-care patients in other member states, the sending of doctors and nurses, the supply to other countries of protective suits and masks as well as ventilators, and the repatriation of European citizens stranded in third countries.

“This is the right approach and it should be continued. It will lead the way to further solidarity measures at EU level to support some member states and regions that will need it to overcome the pandemic or that will be even harder affected than others by the ensuing economic crisis.”

To facilitate the decisions on lifting the lockdown measures, the Commission will promote the gathering and sharing of data at national and subnational level by public health authorities in a harmonised way.

Subject to some precautions, it also gives the green light to the use of mobile applications that warn citizens of increased risk due to contact with a person tested positive for COVID-19. Such tracing is particularly relevant in the phase of lifting containment measures, when the infection risk grows as more and more people get in contact with each other.

Transition period

More testing is necessary but it should be of acceptable quality and should be carried out so that there is mutual acceptance of test data within and among member states. The roll-out of serological testing (blood tests of antibodies) to assess the acquired immunity of the population is part of such a strategy.

The Commission intends to establish a network of COVID-19 reference laboratories across the union, together with a supporting platform. To ensure sufficient supply of equipment, member states should set up a single contact point for all questions related to personal protective equipment and medical devices to link testing bodies and relevant market surveillance authorities.

Concretely, gatherings of people should be progressively permitted. When reflecting on the most appropriate sequencing, member states should focus on the specificities of different categories of activity, such as education, commercial activities and social activities.

The perhaps most difficult issue is the opening of internal and external borders. There the Commission says that a phased approach for the opening of the borders is needed, eventually restoring the normal functioning of the Schengen area.

At the beginning of the outbreak of the virus, the Commission was reluctant to closing borders and imposing travel restrictions. It now writes that the travel restrictions and internal border controls currently applied should be lifted once the border regions’ epidemiological situation converges sufficiently and social distancing rules are widely and responsibly applied.

External border reopening and access of non-EU residents to the EU should happen in a second stage, and should take account of the spread of the virus outside the EU, and of the dangers of reintroduction.

Last but not the least, when designing exit strategies, a distinction is usually also made between low-risk and high-risk groups of the population. Younger people might have become immune and could return to their jobs and keep the economy going. Elderly people might continue to have to stay in their homes.

On this, the Commission and the WHO agree. The most vulnerable groups should be protected for a longer time. The WHO Director-General stated that one factor for countries as they consider lifting restrictions is to minimize outbreak risks in special settings like health facilities and nursing homes.

M. Apelblat

The Brussels Times

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