As many countries start to ease lockdown measures, these authors advise that any relaxation of measures should be gradual, cautious, and constantly reviewed

The global lockdown in response to covid-19 was unprecedented. As countries have moved past the peak, many are starting to relax their lockdown restrictions to restart their economy, but in the absence of an effective vaccine against SARS-CoV-2, governments must continue to protect their citizens from further infection. Governments must balance saving lives and protecting livelihoods. There are some key issues affecting this balance and which should inform the UK Government’s lockdown exit strategy.

Saving lives: protecting the public’s health 

There are three central aspects to lifting the lockdown measures to protect the public and avoid a second epidemic wave. Firstly, we need to make sure that lockdown restrictions have suppressed the virus sufficiently. This means R—the basic reproduction rate—is and remains below 1. Effective approaches to keep R below 1 include continued testing, contact-tracing, and isolation of infected cases. 

Secondly, we need to accurately measure all covid-19 infections and deaths. Studies have suggested that the proportion of asymptomatic individuals can range from 18% as on the Diamond Princess cruise ship to 78% in China [1,2]. Only large-scale antibody testing of the population will allow us to understand the extent of the infection in the population.

Thirdly, if the past four pandemics are anything to go by, a second wave of covid-19 is very likely to occur once restrictions are lifted; ensuring the public are protected is key. [3-6] This includes having a contingency plan for public protection in place, for example, personal protective equipment (PPE) for key workers, and masks for the population. 

Minimising economic harm: protecting the economy 

UK’s Office of Budget Responsibility and Bank of England have forecast that economic growth will fall by 35% and 25%, respectively, in the second quarter of 2020 and 14% overall in 2020. [7,8] On those predictions it will be the worst recession since The Great Depression. There is considerable uncertainty surrounding how long the recession will be and how quickly the economy can bounce back.

A common lockdown measure across most countries was to limit the amount of non-essential employment outside of the home, which severely affected workers in manufacturing, hospitality, and other retail services. Employment contraction in the UK meant around 1.4 million new Universal Credit claims since mid-March and 30% of the employers having either reduced number of employees and/or the number of contracted hours. [9,10] Forecasts suggest that unemployment could rise by 2.5 million by end of the summer should the current UK lockdown strategy continue. [7] While the UK government is supporting furloughed workers via the Coronavirus Job Retention Scheme, economic consequences are likely to be worse for those with low income; for example, in the UK up to 70% of high income earners are still able to work from home, whereas only 30% of those earning less than £20k are able to do that [11,12].

Fine balance

While lockdown strategies help flatten the epidemic curve they have exacerbated the recession curve, a range of stimulus packages and other fiscal policies have sought to flatten the recession curve [13]. Maintaining the balance between saving lives and saving livelihoods is dependent on the effectiveness of these government policies to flatten the recession curve, and the resilience of the public and their continued support to flatten the epidemic curve, even when out of lockdown. 

Lifting lockdown measures too early risks a significant second wave of infections and associated economic damage due to additional lockdown periods, e.g. industries ability to shutdown again after starting back. If we delay lifting the lockdown then the likelihood of a second epidemic wave may be much smaller, but the economic consequences may be more severe as many businesses may no longer be financially viable even with government support. The latter, that is delaying the lifting, is seen by some as less risky as the increased government debt required to support families and businesses is not expected to have major effects on long-term inflation and expenditure [8]. Although there are other effects beyond the immediate growth/contraction predictions that also need to be balanced, for example the impact of continued lockdown on individuals’ wellbeing and children’s school attainment.

Way forward?

So how do we move forward in a way that balances saving lives and saving livelihoods?

We propose that any relaxation of measures needs to be gradual and constantly reviewed to determine compliance with social distancing requirements, which combined with a strategy for wide scale testing, contact tracing, and isolation of infected individuals can both save lives and prevent further economic harm [14]. This would comprise saliva testing for active infection (i.e. PCR tests for SARS-CoV-2) of the general population, followed by rapid contact-tracing of individuals within the network of the infected person and isolation of all contacts for 14 symptom free days to prevent onward transmission. For this to be effective it is imperative that there is an increase in testing capacity, a defined tracing strategy, and effective contact tracing. 

J.Panovska-Griffiths, Senior Research Fellow and and Lecturer in Mathematical modelling at UCL and Lecturer in Applied Mathematics at The Queen’s College, Oxford University. 

M.Gomes, Department of Applied Health Research, University College London, London, UK

E.Pizzo, Department of Applied Health Research, University College London, London, UK

T.Colbourn, Institute for Global Health, University College London, UK

P. Lorgelly, Department of Applied Health Research, University College London, London, UK

Competing interests: None declared

References:

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