The Lancet: Experts compare strategies for easing lockdown restrictions in Europe and Asia Pacific and identify key cross-country lessons

September 24, 2020

Authors of a review of policies, based on the experiences of nine high-income countries and regions' easing of lockdown measures, published in The Lancet journal, are urging governments to consider five key factors in lockdown exit strategies.

The report analyses nine countries and regions' strategies for easing COVID-19 restrictions from a first wave of infections: five in the Asia Pacific (Hong Kong, Japan, New Zealand, Singapore, South Korea) and four in Europe (Germany, Norway, Spain, the United Kingdom).

After instituting full or partial lockdowns, many governments face the challenge of reopening society while balancing health, social, and economic considerations. Meanwhile, 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. [1]

Lead author, Dr Helena Legido-Quigley, National University of Singapore and London School of Hygiene & Tropical Medicine, says, "COVID-19 is a serious disease that will be with us for a long time. There is increasing realisation that easing of lockdown is not about returning to a pre-pandemic normal, and governments have to find strategies that will prevent rapid growth of infections in ways that are sustainable and acceptable to the public over many months." [2]

Dr Legido-Quigley adds, "Our review of international experiences identifies lessons governments can learn from each other's successes and failures. We are not advising that the exact same measures should be replicated in different countries, but it is not too late for governments to consider novel policy solutions developed by other countries and adapt them to fit their own context." [2]

Co-author on the paper, Professor Martin McKee, London School Hygiene & Tropical Medicine, UK says, "As some countries around the world begin to see a resurgence in cases and retighten restrictions, it is imperative that countries learn the lessons that we've laid out for the future. There are no simple solutions but great benefits from learning from the experiences of others." [2]

The authors identify key learnings from these countries experiences which have implications for lockdown exit strategies worldwide: Another co-author on the paper, Professor Yik-Ying Teo, Saw Swee Hock School of Public Health, National University of Singapore, says, "In reviewing international experiences, we were concerned about the large divergence in government preparedness. There is an urgent need to understand the contextual differences that have led to such contrasting results, and to identify common principles that governments can follow to protect their people and economy." [2]

The authors identify five key areas to consider when easing lockdowns - knowledge of infection levels, community engagement, public health capacity, health system capacity, and border control measures.

They point out that responses so far have varied significantly across countries.

In particular, the methods and success of contact tracing and isolation have varied significantly across countries. Many Asian countries, except Japan, promptly did extensive testing, tracing, and isolating of all cases (ie, not just severe cases) from the start of the outbreak, strengthened by innovative surveillance technology, whereas these processes have been considerably delayed in most of Europe, except Germany (where existing resources were redeployed quickly). Furthermore, confirmed cases are mostly isolated at institutions in Asia rather than at home, such as in Europe.

Wearing of face coverings to protect others was, at least initially, adopted to a much greater extent in Asia than in Europe. This is partially to do with greater cultural acceptance. For example, in Hong Kong, Japan, and South Korea, the habit of wearing face coverings was already widespread before the pandemic.

Experience with previous epidemics like SARS and MERS meant that many Asian countries had robust healthcare and public health infrastructure already in place. There has historically been a high level of public acceptance of strict rules in times of crisis, with the majority accepting a trade-off between their personal rights and public health. In Europe, public health systems in Spain and the UK have struggled with the consequences of a decade of austerity.

This study was funded by National University Health System and Singapore Population Health Improvement Centre. It was conducted by researchers from National University of Singapore, University of Maribor, Slovenia, University of Edinburgh, UK, The University of Hong Kong, Hong Kong Special Administrative Region, China, King's College London, UK, World Health Organization Regional Office for South-East Asia, India, Seoul National University, South Korea, Universitat de Barcelona, Spain, Centro de Investigaca?o em Saude de Manhica, Mozambique, LSHTM, UK, Robert Koch Institute, Germany, The Helen Clark Foundation, New Zealand.

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[2] Quote direct from author and cannot be found in the text of the Article.

Peer-reviewed / Review and Opinion / People

The Lancet

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