Unlocking the lockdown

The Covid-19 pandemic has hit the world hard. In four months, we have seen millions infected, thousands dying and the healthcare systems, even in the most developed countries, stretched to breaking point.

It is now time to start considering how you will get people back into the workplace as many economies worldwide are struggling and may even collapse if this crisis continues.

While not necessarily knowing with any certainty the timescales or details of how restrictions will actually be lifted, or in what order, governments and organisations need to do their best to understand how they can prepare to bring their country out of lockdown.

Countries are making different changes to their restrictions as coronavirus outbreaks are at different stages around the world.

In some places, lockdowns are being eased; in others, the restrictions are being kept in place; and elsewhere they are being strengthened.

The World Health Organisation has advised countries that when easing restrictions, they should wait at least two weeks to evaluate the impact, before taking further action.

Lockdown cannot last forever
Until we safely get to immunity, we will need to hit and release the brakes on physical distancing, again and again.

Extreme forms of physical distancing like lockdowns and quarantines are curbing the spread of Covid-19.

But they cannot last indefinitely, at least not without causing enormous damage to economies and compromising people’s good will and emotional wellbeing.

The first objective of any response, anywhere, must be to protect and try to save as many lives as possible with whatever means are available, avoiding the collapse of the healthcare system.

Anyway, the ultimate objective must be to bring the epidemic down to a slow burn to buy time for the world’s population to acquire, one way or another, immunity to Covid-19.

Experts say that the Covid-19 pandemic can only be prevented from resurging when at least half of the world’s population has become immune to the new virus.

And that can happen in only one of two ways:
1. After enough people have been infected and have recovered.
2. After enough people have been inoculated with a vaccine.

Allowing the first option to happen, unmitigated, would be a humanitarian catastrophe and it would mean very many deaths, mostly among the elderly and poor people with limited access to healthcare.

The second option, developing a safe, effective vaccine and making enough of it for everybody, is still far away, at least for one, perhaps two years. Massive lockdowns and distancing measures cannot be sustained that long.

Immunity serological tests
The understanding of the pandemic could be improved by conducting blood serology, to study how many people in countries that have already experienced a first wave of infections are producing antibodies that are specific to SARS-CoV-2.

These tests, which detect antibodies that a person’s immune system produces, could reveal not only who is currently infected but also who has already contracted Covid-19 and recovered, as the antibodies remain present in the body after illness.

But this measure rests on the assumption that those who catch Covid-19 develop and retain immunity to the disease for some time.

A study suggests that monkeys develop immunity to SARS-CoV-2 after being exposed, at least in the short term. But longer and larger follow-up studies must be done in primates to learn how immunity to the virus persists through time and these findings must still be compared to clinical findings in humans. Even if people develop immunity to one strain of the virus, the pathogen could mutate into a new form and potentially infect those people again. In those cases, obviously, there will be a second wave of infection.

To see us through the next year or more, we must all prepare for the possibility of several cycles during which restrictions are applied and relaxed, in ways that can keep the pandemic under control but at an acceptable economic and social cost.

Going through the pandemic with this approach is like driving a car on a long and tortuous road as we need to keep moving forward without crashing and to safely reach the final destination.

When will the Coronavirus Pandemic end?
Some experts believe our routines will not return to “normal” this year.

At present, the only hope we have is by taking these drastic measures to control the viral spread.

Developing a “herd-immunity” will only be possible when enough people survive the illness. Consequently, the incidence of new infections, hospitalisation and mortality rates would start coming down after peaking.

The difficult reality is that experts’ guesses are just guesses as there is not a concrete answer at the moment.

We can say that the kind of normal where we go travelling, to restaurants, to concerts, to religious services, on cruises, the way it used to be, will not happen until we have a vaccine.

One thing is certain: when we get out of confinement, we will not go back to “normal” as it existed in February. However, in recent weeks, it has become increasingly clear that we must instead accept a “new normal”, at least for the time being.

“Like flying blind”
After what, for some, has been a very extended period in lockdown, you may find that adjusting back to normality proves equally challenging.

It is scary when we see that we still have individuals who are working on the old normal.

Will we rethink the world we want?
Will we stick to patterns that have helped drive temperatures ever higher, or will we develop some new ones?

It is possible that when all this is over, we will revert straight back to something like the “old normal”, or … to some worse version of it.

However, the great hope must be that when we are finally out of quarantine, we will take pleasure in the things we have denied ourselves the past decades, and especially the past months.

Several questions regarding the nature of the coronavirus are giving scientists and government leaders sleepless nights and a lot depends on their answers.

Government leaders are weighing several questions: Is the impact of the virus going to change with the seasons? Will the collective immunity increase with more and more infections?

What happens if we let up too soon?
To help make the transition period easier, we need to accept that any restrictions that remain in place are there to protect the health of the individual and the global community, helping to save lives.

Getting life back on track after unlocking the lockdown will not be easy.

The so-called “new normal” has to be viewed as a staging post on a journey forward to a future when we will again, hopefully, live life the way we want.

Best healthy wishes,
Dr. Maria Alice

By Dr Maria Alice
|| features@algarveresident.com

Dr Maria Alice is a consultant in General and Family Medicine. General Manager/Medical Director – Luzdoc International Medical Service. Medical Director – Grupo Hospital Particular do Algarve/ Hospital S. Gonçalo de Lagos