Five key factors for easing lockdown restrictions

The public health experts examined the strategies of nine countries and regions for easing COVID-19 restrictions to identify key learnings which have implications for lockdown exit strategies worldwide

NUS public health experts are urging governments to consider five key factors in lockdown exit strategies. In a new study published in The Lancet, the experts identified knowledge of infection levels, community engagement, public health capacity, health system capacity, and border control measures, as important considerations when developing strategies to ease restrictions.

Led by the NUS Saw Swee Hock School of Public Health and in collaboration with the London School of Hygiene & Tropical Medicine, the researchers analysed nine countries’ strategies for easing COVID-19 restrictions: five in the Asia Pacific (Hong Kong, Japan, New Zealand, Singapore and South Korea), and four in Europe (Germany, Norway, Spain and the United Kingdom).

Professor Teo Yik-Ying, Dean of the NUS Saw Swee Hock School of Public Health and co-author of the paper, explained the reasoning behind this study. “We were concerned about the large divergence in government preparedness. There is a 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 the economy,” he said.

Five measures to adopt before easing restrictions

The authors urged governments to adopt the following five measures:

  1. Have a coherent plan with clearly outlined levels of restriction easing, containment measures, and criteria for moving between levels.
  2. Implement robust systems to monitor infections. The experts point out that the R value is important, but caution that this requires high quality data in real time to be accurate, and needs to be interpreted using epidemiological knowledge.
  3. Control measures, including face masks and social distancing, will be needed for some time. Governments must educate and engage with the public, building trust, and selecting appropriate measures that the public are willing to comply with.
  4. Each country must have an effective test, trace, and isolate system which must also be supported by sustained investment in public health capacity and health system capacity, including facilities, supplies, and workforce.
  5. The authors concluded that there is a strong argument for adopting a “zero-COVID-19” strategy that aims to eliminate domestic transmission, particularly with emerging evidence of “long COVID” (symptoms of illness and fatigue months after having the disease).

Associate Professor Helena Legido-Quigley from the NUS Saw Swee Hock School of Public Health, who is the lead author on the paper, said, “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.”

“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,” she continued.

Research Associate and doctoral student, Ms Melisa Tan Mei Jin, who is one of the joint first authors of the paper, said, “The threat of COVID-19 is beyond health. To rebuild a fairer and resilient society, governments have to engage communities and design strategies that include the most vulnerable populations. The borderless nature of this pandemic highlights the importance of international cooperation and value of multilateralism, and governments can consider ways to strengthen collaboration in areas of common interest.”