COVID-19
By Dr David Nabarro, Strategic Director of 4SD, Special Envoy to the World Health Organization Director-General on COVID-19 and Co-Director of the Imperial College Institute of Global Health Innovation at the Imperial College London
By Dr David Nabarro and John Atkinson
Many Governments are taking tough decisions: they have decided that their countries should slow down their economies and go into lockdown in order to reduce opportunities for the COVID-19 virus to be transmitted between people. The decisions made on when and how to emerge from lockdown are even more difficult: they are also delicate.
Deciding to impose lockdown is a reaction to the mounting threat to people’s health caused by rapidly escalating outbreaks. Reducing opportunities for the virus to be transmitted through enforcing physical distancing is essential not least because of the inevitability that hospital services will be overwhelmed unless decisive action is taken.
Governments are finding that the numbers of people with whom newly infected individuals have been in contact after lockdowns were imposed are many fewer than the numbers of contacts of infected people before lockdowns were imposed. Over time – two to three weeks after the imposition of lockdown – the numbers of infected people, and the fatalities, are starting to fall.
The sequence for easing a lockdown will vary from place to place. Decision makers will be considering multiple factors when deciding how best to do this.
This is certainly happening in Western Europe and in some parts of the US as well. Italy’s Health Minister Roberto Speranza outlined that the next phase of the national response includes more testing and reinforced local health systems with a view to creating the conditions needed to live with the virus. This will make it possible for the lockdown to be eased, gradually.
The routes out of lockdown will be messy. Quality information is at a premium. Decisions will be based on data about the spread of the virus disaggregated by locality. Numbers of people becoming infected will need to be factored into decisions. The goal is to understand the extent of transmission and whether the rate of increase in people infected is starting to reduce.
The sequence for easing a lockdown will vary from place to place. Decision-makers will be considering multiple factors when deciding how best to do this. We try to imagine the kinds of questions they will be asking and here we explore the questions and indicate some of the factors they might consider.
1. What are the health criteria which can prompt release?
2. What will a gradual release mean in reality?
3. Who gets to decide?
4. So what about the politics?
5. How is the pandemic and its containment impacting the economy?
6. What are the consequences for business?
7. What about human rights?
The situation of a gradual release from lockdown as we have described it is clearly rather messy. Judgements will need to be made rapidly and will have many unforeseen consequences. The strategy will need to be highly adaptive and rapidly responsive to what is actually happening. That may be fresh outbreaks, or it may be citizen responses to changes in lockdown conditions. This means a built-in process of learning that takes into account the inevitability of differences in perspectives and responses to each change that is brought forward. Without this capacity for fast and high-quality feedback, things can rapidly begin to unravel. We think there are three areas to focus on.
To date, information about the disease and the virus itself has been patchy and people have been slow to pay attention to it. To safely manage a gradual release from lockdown we need much better information about the disease itself, levels of immunity or otherwise, and differences in the behaviour of the virus. We need to know much more about case rates through far higher volumes of testing. We need to greatly increase our capacity for contact tracing so that we know how and where it is spreading and what actions will stop it. We need high quality, real-time information on health supplies and hospital capacity so that we can rapidly switch responses. We need good business barometers that point to shifts in markets. We need accurate assessments of compliance in populations in order to judge what is driving behaviour.
Tolerance of exceptional use of executive power will last as long as it is still perceived to be in the public good. Gaining high-quality information is necessary to make good decisions but making it open and available allows public scrutiny of those decisions and reduces unhelpful opposition. Being clear on the criteria used at each stage in a gradual release from lockdown and where this phase fits within a longer-term view is also vital. Leaders need to tell the story of the journey ahead, describe the route they are taking.
It is easy for leaders under pressure to attempt to diffuse scrutiny through apportioning blame elsewhere. There will be a time when everyone will be held accountable for their actions. Pitching community against community, nation against nation or sector against sector undermines the solidarity needed to engage the legitimate voices of dissent during lockdown. Frustrations and grievances can easily turn to social disorder without this sense of the importance of solidarity. For solidarity to hold and to allow a gradual release of lockdowns to occur, a balance needs to be found. That balance is between building a strong sense of togetherness and hearing the hurt and anger. Maintaining this solidarity requires constant and sensitive attention. Simply repeating slogans (we’re all in it together) is not enough. Communication needs to be nuanced to each situation through carefully chosen language and attitude in each and every leader.
Focusing on these three areas gives leaders the chance to sense what is both legitimate and proportionate at every point in time. Things will change rapidly and differ by geography, sector or community.
Copyright © 2023 4SD Foundation. All Rights Reserved.
4SD Foundation, Maison Internationale de l’Environnement II, Chemin de Balexert 7-9
1219 Geneva, Switzerland.
With generous support from:
Copyright © 2023 4SD Foundation. All Rights Reserved.
4SD Foundation, Maison Internationale de l’Environnement II, Chemin de Balexert 7-9
1219 Geneva, Switzerland.
With generous support from:
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