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Covid-19: Lockdown exit will be “very long,” European officials warn

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1549 (Published 17 April 2020) Cite this as: BMJ 2020;369:m1549

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  1. Michael Day
  1. London

European Union officials have unveiled their “roadmap” to phase out the ongoing coronavirus containment measures. But they warned of a “very long” exit from a crisis that has been a devastating double whammy to the continent’s health and economic wellbeing.

The European Commission president, Ursula von der Leyen, warned that a failure by countries to work together on their exit strategies could lead to a dangerous second wave of covid-19. “If shops are open on one side of the border, we don’t want people moving from one member state to the next to use the shopping opportunity,” she said, urging authorities in EU member states not to erase the progress made from the painful lockdowns imposed over the past month.

Over 80 000 people have died in Europe from covid-19, about two thirds of the global death toll, but some EU countries have already started easing their lockdowns by allowing some school classes and businesses to reopen. Von der Leyen said that EU countries should use a “gradual, tailormade approach” to lifting lockdown restrictions.

“The way back to normality will be very long,” the commission’s roadmap says, warning that masks, gloves, tests, and applications to track people’s movements will become routine—and that a full economic recovery will probably have to wait until a vaccine is found.

Testing capability

Stella Kyriakides, commissioner for health and food safety, said, “Until effective treatments and a vaccine are found, we will have to learn to live with this virus. But Europe will be back on its feet, together and united. This is the only way.”

For relaxation of the lockdown, the European roadmap recommends:

  • Epidemiological criteria showing that the spread of the disease has significantly decreased and stabilised for a sustained period;

  • Sufficient health system capacity, such as taking into account the occupation rate for intensive care units, the availability of healthcare workers, and medical material; and

  • Appropriate monitoring capacity, including large scale testing capacity to quickly detect and isolate infected people, as well as tracking and tracing capacity.

Von der Leyen has also announced a “virtual pledging conference” on 4 May for governments, institutions, and private entities to raise money for vaccine research.

John McCauley, director of the Crick Worldwide Influenza Centre in London, told The BMJ that much of the UK’s ability to successfully come out of the lockdown and follow the EU’s easing of restrictions would depend on its testing capability. He noted the lack of a very reliable and widely available antibody test to facilitate easing restrictions.

“This question [of testing capability] applies to Europe, as well,” he said. “If we have to rely on RNA tests, how are we going to prioritise testing, given that it will have to be done repeatedly?”

Ahead of the UK government’s announcement on 16 April that the current lockdown would continue for at least three more weeks, Neil Ferguson, Imperial College epidemiologist and government adviser, said that social distancing would probably need to continue for another 18 months—namely, until a vaccine became available.

But many commentators have said that regulations will need to be nuanced. Robert Dingwall, a professor of sociology at Nottingham Trent University, said that the UK government would need to consider the disproportionate burden the lockdown had placed on poorer Britons. “There has been a lack of awareness among our policy and scientific elite on how policy has been made by people with gardens for those without gardens,” he said.

The UK’s strategy for exiting the lockdown

On 17 April the business secretary, Alok Sharma, outlined the five tests that would need to be satisfied before the government considered relaxing current social distancing measures:

  1. Ensure that the NHS can cope and can provide sufficient critical care and specialist treatment across the UK.

  2. See a sustained and consistent fall in the daily number of covid-19 deaths, to be confident that the UK has moved beyond the peak.

  3. Have reliable data from the Scientific Advisory Group for Emergencies showing that the rate of infection is decreasing to manageable levels.

  4. Be confident that the range of operational challenges, including testing capacity and personal protective equipment, are in hand, with the supply able to meet future demand.

  5. Be confident that any adjustments to the current measures will not risk a second peak of infections that overwhelms the NHS.

Sharma said, “The worst thing we could do now is ease up too soon and allow a second peak of the virus to hit the NHS and hit the British people.

“Now is not the time to let up. The risk still persists—not only for yourself, but for the people around you. So we must stay vigilant.”

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