On Monday, Reuters reported, “global coronavirus cases pass three million as lockdowns begin to ease.”
The pressure is building in many countries to remove restrictions from COVID-19. As unemployment rises, and the public protests to get back to work, governments are looking for a way out of the crisis – even in areas, like India and Brazil, where new-case counts are several thousand per day.
It is not just a question of ‘when’ to reopen but also ‘how.’ The difficulty lies in finding the right combination of public safety and economic interests. Many governments are using stepped plans that allow certain sectors to open before others. Basically ‘testing’ whether reopening will cause a resurgence in virus cases. Public health officials warn reopening too soon could be worse than staying closed longer. Others argue there was never any need to close down in the first place. Sweden, for example, has banned large public events but relies on voluntary social distancing everywhere else. However, the countries that flattened their curves fastest used a combination of testing, isolation, and contact tracing to control the virus. But not all countries considering reopening have these in place.
Stratfor described how the world might proceed from lockdowns. “The world is slow[ly] beginning to emerge from various COVID-19 lockdowns. The reemergence obviously will not happen all at once, so areas that exit lockdowns earlier will serve as test cases for best practices for restarting economies.”
Writing for The Guardian, Robert Booth reported on the precarious position of the U.K.:: “On Sunday, the foreign secretary and first secretary of state, Dominic Raab, warned the outbreak remained at a ‘delicate and dangerous’ stage and said it was irresponsible to speculate about steps to modify the rules underpinning government’s ‘stay home, protect the NHS, save lives’ strategy.” On Tuesday, April 21st, Reuters described the World Health Organization’s (WHO) position: “…the [WHO] is warning [that easing restrictions] should be done slowly and only when there is capacity to isolate cases and trace contacts.”
Everyone wants to go back to ‘normal,’ but where we go depends mostly on how we got here. Countries that acted decisively and early are way ahead of the virus. As a result, their graph of total cases looks like a flat-top mesa rather than a steep mountainside. Their next steps are clear; reopening makes sense for them. The way forward for other countries – not so much.
In the U.S., which accounts for one-third of all cases worldwide, new-case counts have been over 24,000 a day since March 31st and climbed to 34,000 on May 1st. Moreover, without a strong mandate from the federal government, not all states agree on when reopening should take place. For example, NY and MA are actively recruiting and training contact tracers while still in lockdown. Yet, Georgia started reopening last week without contact tracing in place. According to public health officials, a few basics are required before restrictions can be removed: a two-week decline in new COVID-19 cases, adequate testing and contact tracing capabilities, and procedures for isolating potential cases. Without these basics in place, countries lose the ability to control a second wave of infections. Everyone knows the old adage – “Do it right, or do it twice.”
Ever since SARS-CoV-2 emerged in Wuhan back in December 2019, countries have responded with varying degrees of competence in fighting the virus. The best responses came from the more experienced Asian countries. For example, Vietnam closed its borders early and began strict quarantine and contact-tracing procedures right away. They now have only 51 active cases and their total case count only ever reached 270. In contrast, Brazil also announced their first case on Feb 25, but since then, President Jair Bolsonaro claimed the virus was a hoax, recently fired his own health minister, and attended a protest against social distancing. Consequently, Brazil has over 40,000 active cases and is rapidly climbing a steep mountainside of more than 6,500 cases a day. In other countries where politics trumped public health, like the U.K. and the U.S., case burdens (the number of active cases over total cases) are still 84% and 82%, respectively. These countries’ case counts are teetering on the edge of what could become a mesa or another steep climb.
Dr. Anthony Fauci cautions that a “step-wise approach, with restrictions gradually lifted as areas reach certain milestones” is not a process one can short cut. “Any attempt to leapfrog over these almost certainly will result in a rebound, and then we can set ourselves back,” Dr. Fauci told an online meeting of the National Academy of Sciences.
The emergence of COVID-19 this past year has shown a spotlight on the strengths and weaknesses of public health systems. Contrary to expectations, it was not the wealthiest or the most powerful nations that had the best response to the virus. The U.K., despite its National Health Service, tried to emulate the Swedish response by waiting for herd immunity, essentially allowing the virus to run unchecked. But changed course after researchers at Imperial College London projected close to 250,000 people would die if the virus wasn’t slowed or stopped. The U.S. also with a long history of powerful public health institutions fumbled its response by not acting quickly or decisively. Yet, smaller, less wealthy countries like Vietnam and Singapore were models of response. But even countries without recent experience fighting virus outbreaks had success. Austria which reported their first case on March 12th, now has a virus burden of 13%, new-case counts in double digits, and are descending the other side of the flat-top mesa graph. They did it in just over a month.
In the end, it wasn’t about size or wealth. It came down to politics. Countries that placed politics first lost, and lost hugely.
- High Risk, No Reward - May 11, 2020
