COVID-19 Healthcare Challenge - is there a right way to ease the lockdown?

“Nobody has got any real idea what the best strategy is to use” says a prominent epidemiology professor.

When it comes to the issue of easing the lockdowns that were put in place around the world beginning in March 2020 as part of the ongoing responses to the COVID-19 pandemic, like much about the disease, the best course of action is untested, unknown and involves learning for many governments and scientific experts as time goes on.

UK vs the World

How are countries around the world easing the lockdown and how does the UK compare to other countries with high case-fatality rates? Based on the scientific advice available in different countries, the following measures taken so far:

UK (deaths 39,728, cases 279,856): non-essential shops opening, gatherings of 6+ from 1^st June

Correct as of 5^th June 2020. Source: European Center for Disease Control and Prevention.

All about the R rate

The difficulty of comparing which lockdown measures have been most successful and which easing of restrictions will be most successful in reducing the virus’s Reproduction rate (R rate) lies largely in the different times at which the case numbers began to rise within that country and when a lockdown was put into place.

Every nation experienced a COVID-19 epidemic "peak" (when number of cases and deaths were at their highest) at different times and to different extents, and so it is not surprising that the response to the lockdown lifting measures has been so varied globally.

Even considering countries with comparable case-fatality rates (e.g. the UK’s 14.6% compared to Italy’s 14.4%), there are political and socioeconomic factors unique to these countries that influence what becomes an “acceptable” R rate at which to lower the government's lockdown measures or end them entirely.

What are the UK’s lockdown rules now?

At the time of writing on the 5^th June 2020, the UK’s road map for easing lockdown restrictions have been outlined by central government on 28^th May and remain largely the same since then, albeit gaining different response to uptake per devolved government:

The UK public can now do the following that we couldn’t before:

• Spend time outdoors, including private gardens and other outdoor spaces, in groups of up to six people from different households, following social distancing guidelines
• Visit car showrooms and outdoor markets
• In line with the arrangements made by your school, send your child to school or nursery if they are in early years, reception, year 1 or year 6, if you could not before
• If you are an elite athlete as defined by this guidance, train and compete using the specified gyms, pools and sports facilities you need - which will enable others to watch live sport on TV

The UK public still cannot:

• Visit friends and family inside their homes
• Stay overnight away from your own home, except for in a limited set of circumstances, such as for work purposes
• Exercise in an indoor sports court, gym or leisure centre, or go swimming in a public pool
• Use an outdoor gym or playground
• Gather outdoors in a group of more than six (excluding members of your own household)

More recently, on the 4^th June, the UK public were told that from the 15^th, “face coverings” would be mandatory for everyone travelling on public transport, with fines imposed on those who do not adhere to this guideline (after months of previously advising face masks and coverings are ineffective against viral spread. Year 10 and 11 pupils will also be able to attend school face-to-face once more (excluding those in Wales).

It has been speculated this requirement will extend to some shops, such as hairdressers, but these non-essential services have yet to be reopened so the exact way in which precautions will be enforced in them as yet unclear.

If conditional targets are met, a review of “Stage 3” of lockdown release, which will include opening pubs and restaurants across the UK will be completed in June.

Are we still in lockdown?

As many people have returned to work, albeit in a very different way than before (including construction and manufacturing workers), the government is still advising those who can to work from home and everyone to avoid public transport where possible. This is because it will make it easier to maintain social distancing if we still adhere to these guidelines.

The new guidance is a way of easing the restrictions but is certainly not an end to the lockdown in totality. As COVID-19 is likely to be with us for some time, especially in the absence of a vaccine or approved treatment in widespread use, these restrictions are likely to remain in place well into next year.

Children are likely to all go back to school in September but we have already heard from vice chancellors around the country that their pledge to offer 100% online courses in some cases has meant hundreds if not thousands of university students deferring their place.

Wider picture considerations

Most governments have opted to set conditional targets that ensure some safety precautions remain in place whilst the effect of easing restrictions on the R rate is carefully monitored.

Aside from this approach, there is currently no available evidence that any specific lockdown-easing approach will be effective or “right” for any one country without measuring the R rate and target outcomes in situ.

It is difficult to predict the effect lockdown restrictions will have had on the economy, on people’s mental health and on our social systems. We will look back on what actions were taken by individual governments during this critical time and have more data to inform future outbreaks, however. That is, at least, something to look forward to.