Exit strategy to control covid-19 and relaunch the economy
BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1851 (Published 11 May 2020) Cite this as: BMJ 2020;369:m1851
- Cam Bowie, retired director of public health Somerset and professor of community health Malawi1,
- Tony Hill, independent public health consultant and health strategist and retired director of public health Lincolnshire2
- cam.bowie1{at}gmail.com
In a fast expanding epidemic, after the surge is contained by physical distancing, the public health option of choice is to control the contact of new cases.1 This has worked in the past and with covid-19 in parts of Asia and in New Zealand with physical distancing234 and in other Asian countries without physical distancing or recourse to lockdown.567 Elimination, not suppression, is the goal. Public health staff are rapidly deployed to trace contacts, virus test, and confirm new cases, with impressive results. Economies and education continue nearly as before.
The UK lockdown has started to achieve mitigation by reducing the number of cases requiring hospital care and elimination by breaking the chain of transmission. Both are needed, but elimination is the goal. After control is achieved, generalised physical distancing can be judiciously withdrawn. Testing and tracing will avoid reinstating lockdown.8
The epidemic is at different stages throughout the UK,9 so the need for physical distancing and curtailed economic activity will vary between areas. Contact tracing remains the key control measure and must be restarted immediately by each local authority.10 Numbers of people required to identify cases, test, and contact trace will vary from place to place1112 and will fall as new cases fall. In China, outside Hubei, this was 5.5% per day after the peak.2
Technologies using smartphones might help but do not obviate the need for ground level public health work. Until a vaccine provides herd immunity, local outbreaks will continue to occur with the potential for more large outbreaks. New Zealand, already in the control phase, is aware of the need to anticipate and respond expeditiously.13
An early return to full economic activity is possible in many parts of the country if local public health departments take back communicable disease control.14
Footnotes
Competing interests: None declared.
Full response at: https://www.bmj.com/content/368/bmj.m1284/rr-9.
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