Covid-19: It’s too soon to lift lockdown

The ‘COVID-19 Pandemic’ has necessitated the evolution of ‘New Normals’ in the ‘Lexical Armoury’ for the ‘Programmatic Interventional Conversations’ in the ‘Global Fight’ against the ‘Unprecedented Ravaging and Devastating 21st Century Coronavirus Disease 2019’! One such ‘Programmatic Intervention’ is ‘LOCKDOWN’. This is also ‘Shutdown’; ‘Shelter-in-Place’ is also introduced and intended to achieve, in complementarity, the objective of the ‘Lockdown’! The ‘Novel COVID-19 Pandemic’ caught the World completely off-guard and grossly unprepared! The World has had ‘Epidemics-Pandemics Experience’ from which so much ought to have been learnt to clearly avoid the embarrassing ‘Global Unpreparedness’! Some ‘Epidemics-Pandemics’ include, among others: Spanish Flu 1918, SARS 2003, H1N1-Swine Flu 2009, Ebola Virus Disease 2014, Zika Virus Disease 2017 etc [1,2]! The ‘Lessons Learnt’ have thus become ‘Missed Opportunities’!! The ‘COVID-19 Interventions’ have been ploughed into the ‘Pandemic Works’ with palpable ‘Apprehension for the Outcomes’.

Several ‘Communications’ dispose possible impact of the ‘Pandemic Interventions’ with the following: Anti-COVID-19 Drugs (Hydroxychloroquine, Azithromycin, Zinc, Selenium, Vitamin D etc), Convalescent Serum, Candidate Vaccines in Clinical Trials, Antibodies Formulations, Emergency Critical Care Facilities, Immunomodulators etc! Hydroxycholoroquine efficacy, a case-in-point, has not been confirmed [3]! These ‘Questionable Pharmaceutical Interventions’ have received unjustified ‘Disproportionate Research Funding’ in the search for ‘Effective Solutions’ against the ‘COVID-19 Pandemic’. This is ‘Interventional Inequity’ [4]! Worse still, a huge ‘Body of COVID-19 Pandemic Literature’ accrues from ‘Poor Quality Research’ tantamount to ‘Waste in COVID-19 Research’ [5-7]! The ‘Rational Anti-COVID-19 Programmatic Approach’ is to focus on ‘Interventions that Work’: The ‘Non-Pharmaceutical Interventions (NPIs)’! These include, among others: Social Distancing, Mass Gatherings Restrictions, Social Solidarity, Self-Isolation, Country Shutdown, Economic Shutdown, Schools Shutdown, Public Worship Prohibition, Travel Lockdown etc! Also included are Universal and Specific Precautionary Measures: Appropriate Hand-washing Techniques/ Hand Hygiene/ Proper Hand Sanitizer Use, Avoiding Touching Eyes, Nose and Mouth, Good Respiratory Hygiene and Avoiding and Frequently Cleaning Surfaces that are Frequently Touched!! While ‘Lockdowns’ are proven to be effective in slowing the spread of the ‘COVID-19 Pandemic’, the issue of ‘Easing the Lockdown’ or ‘Reopening from the Lockdown’ has become contentious!

As the ‘Lockdown’ has its toll and huge burden on Countries, Economies, Businesses, National and International Conferences and Meetings, Sports Championships/ Tournaments, Education, Industries, Religious Public Worships etc, the ‘Immense Pressure’ to ‘Ease the Lockdown’ has meant eking a judicious ‘Critical Balance’ between ‘Livelihood and Life’ and ‘Making a Living and Living’. Several ‘Communications’ suggest that ‘Easing the Lockdown’ has been too hastily/ hurriedly effected or, indeed, clearly precocious [8,9]! It is increasingly reported that Countries that hurriedly ‘Eased their Lockdown’ have had untoward ‘SURGES’ in their ‘New COVID-19 Cases and Deaths’ while still on the ‘Ascending Limb’ of their ‘COVID-19 Epidemic Curves’ or ‘RESURGENCES’ if they were already on the ‘Descending Limb’ of their ‘Epidemic Curves’! From ‘Pandemic Epidemiological Perspectives’ and for ‘Programmatic Expedience’, ‘Easing the Lockdown’ should start ONLY when ‘Epidemic Metrics’ are EVIDENT in the ‘COVID-19 Epidemic Curve’! These are: The ‘Peak Number (New Cases and New Deaths)’ has been reached, the ‘Possible Plateau’ is observed for a while, the ‘New Cases and New Deaths’ are well down on the ‘Descending Limb’ and the ‘Low Numbers’ have been persistently down AT LEAST for 14 DAYS!! It is after these ‘Epidemic Metrics’ are FULFILLED that ‘Easing from Lockdown’ or ‘Reopening from Lockdown’ can be EFFECTED!! Additionally, there MUST be effective Testing-Isolation-Treating and Tracing-Tracking-Quarantining before the ‘Easing from the Lockdown’! ‘New Normals’ with ‘Proper Face Masks Use’ and ‘Appropriate Social Distancing’ MUST be assured!! Anything else amounts to ‘Programmatic Interventional Precocity’!!!

It is more disturbing that the ‘Non-Pharmaceutical Interventions (NPIs)’ are not STRICTLY enforced with the ‘Precocious Easing from the Lockdown’! The ‘Face Masks Use Intervention’ and ‘Social Distancing Intervention’ are not ENFORCED: ‘Face Masks’ are either not worn or are inappropriately worn while the ‘Prescribed Social Distance’ is not observed! More contentious is what constitutes an ‘Optimal Social Distance’ to protect against ‘Contracting’ or ‘Transmitting’ the ‘COVID-19’ [10-12]; the ‘2 Meters Spacing’ appears inadequate and ‘Programmatically Inappropriate’ [13]! In the circumstance, it is better to maintain the ‘Lockdown’ UNTIL the ‘Epidemic Metrics’ are more reassuring to prevent ‘SURGES’ and ‘RESURGENCES’!! The ‘Mass Gatherings’ occasioned by the ‘Easing of the Lockdown’ are associated with several ‘Human Behavioural Activities’ with ‘Large Volume and Energetic Breaths’ resulting in wide distribution of ‘Droplets and Aerosols’ making ‘Social Distancing’ a SINE QUA NON for keeping safe and well in the ‘COVID-19 Pandemic Era’!! The current ‘Rallies’, ‘Protests’, ‘Celebrations’, ‘Social Activities’ in Bars, Restaurants, Parks, Gardens etc in the world constitute further ‘Confounding Difficulties’!! Some others have argued more in favour of limiting the duration of ‘COVID-19 Pandemic-related Lockdowns’ largely because of several identified ‘Negative Consequences’: Economic, Health, Educational, Sports, Social etc [14]! It is suggested that the ‘Prolonged Lockdown’ could be justified at the outset of the ‘COVID-19 Pandemic’ when not much was known but certainly not now when much more is now known about the ‘Pandemic’!! The fact of the matter is that increasingly much more is unknown by the day as increasingly much more is ‘Rapidly Dynamically Transmuting’ concerning the ‘COVID-19 Pandemic’ and, therefore, the case for cautious justified ‘Easing from Lockdown’ is further strengthened and upheld and ‘Interventional Precocity’ MUST be AVOIDED!!

In the ‘Lockdown Period’, ALL ‘Human Activities/ Engagements’ MUST not be completely halted! That is, ‘Lockdown’ MUST not be ‘Lockout’!! With ingenious Interventions, several ‘Activities/ Engagements’ are conducted in VIRTUALITY. With ‘ICT-compliant Cloud-based Technology’, several ‘Virtual Activities/ Engagements’ are being discharged globally as ‘New Normals’ in the ‘COVID-19 Pandemic Lockdown Era’ [15]!! The World is now facilitating the following: Tele-Medicine, Tele-Health, Tele-Consultation, Tele-Psychiatry, Virtual Wards, Virtual Meetings, Video Conferencing, Webinars, Virtual Religious Worships, Virtual Sports Championships etc! Of course, On-line Trading-Commerce, Internet Banking, Internet Employment Engagements etc have been ‘Matters in the Works’!! Really, ‘Lockdown is not Lockout’ and ‘Easing from Lockdown’ should not dispose WEALTH ahead of HEALTH!!!

This ‘Communication’ contributes to the extant ‘Lockdown Conversation’. Lockdown is not Lockout and ‘Interventional Precocity’ MUST be avoided in effecting ‘Easing from Lockdown’. Health should count ahead of Wealth. Countries should assure their citizens stay sane and safe always!

REFERENCES
1. WHO. Disease Outbreaks. https://www.who.int/emergencies/disease/en of 12th February 2020
2. COVID-1: Lessons and Recommendations. www.isglobal.org/coronavirus of 12th March 2020
3. Vinetz JM. Lack of efficacy of hydroxychloroquine in covid-19. BMJ 2020; 369:m2018
4. Eregie CO. Obesity as a Public Health Emergency: A look at the ‘Pre-FOAD Hypothesis’ as a Panacea for the ‘Interventional Inequity. https://www.bmj.com/content/366/bmj.l5463/rr-0 of 4th October 2019
5. Clinical Trials.gov. History of changes for study. NCT04280705, 1 May 2020. https://clinicaltrials.gov/ct2/history/NCT04280705?A=10&B=15&C=Side-by-S....
6. Glasziou PP, Sanders S, Hoffmann T. Waste in covid-19 research. BMJ 2020; 369:m1847
7. Eregie CO. COVID-19 Pandemic: The multifaceted picture of compromised COVID-19 research and the COVID Phenomenon’. https://www.bmj.com/content/369/bmj.m1847/rr-12 of 10th June 2020
8. Melnick ER. Should governments continue lockdown to slow the spread of covid-19? BMJ 2020; 369:m1924
9. Godlee F. Covid-19: It’s too soon to lift lockdown. BMJ 2020; 369:m2202
10. Denison D, Porter A, Mills M, Schroter RC. Forensic implications of respiratory derived blood spatter distributions. Forensic Sci Int 2011; 204:144-55
11. Schroter RC. Social distancing for covid-19: is 2 meters far enough? BMJ 2020; 369:m2010
12. Eregie CO. COVID-19 and social distancing: more work in the works to be there. https://www.bmj.com/content/369/bmj.m2010/rr-1 of 12th June 2020
13. Hwang J, Lee K. Determination of outdoor tobacco smoke exposure by distance from a smoking source. Nicotine Tob Res 2014; 16:478-84
14. Ioannidis JPA. Coronavirus disease 2019: The harms of exaggerated information and non-evidence-based measures. Eur J Clin Invest 2020; 50:e13222
15. Wilkinson E. How mental health services are adapting to provide care in the pandemic. BMJ 2020; 369:m2106

Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education),
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria.
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria.
UNICEF-Trained BFHI Master Trainer,
ICDC-Trained in Code Implementation,
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria.
*No Competing Interests.