Buzz
Much like my young daughter eagerly counts down the days to Christmas each year, those of us practicing physical distancing are equally excited about the idea of 'reopening.' However, reopening feels more like a hopeful dream than a concrete plan, as we’ll likely spend months navigating changing restrictions. We all yearn for a return to normalcy, don’t we? The World Health Organization has outlined six critical conditions for lifting restrictions. Let’s explore what these conditions entail.
These six conditions are thoroughly explained in the WHO’s April 15, 2020 COVID-19 strategy update (refer to page 10) and briefly highlighted in a series of tweets here.
Controlling the spread of the virus is essential
This is the first and most critical requirement: transmission must be effectively managed.
In simpler terms, lockdown measures will remain until we can confidently interact without constant risk of exposure. Public health authorities must have a clear understanding of all active cases, ensuring no undetected person-to-person transmission occurs and no individuals are left uncertain about their infection status.
This goal will only be achieved when new COVID-19 cases are limited to sporadic instances or small clusters, all traceable to known contacts or imported cases—a scenario the US hasn’t experienced since around January.
Effective transmission control also demands that new cases remain at a level hospitals can manage, with ample clinical care capacity in reserve. If the healthcare system is overburdened, we haven’t met this criterion, even if all cases are accounted for.
Comprehensive testing and care must be accessible to everyone
This is another significant challenge. Currently, many individuals with COVID-19 symptoms still lack access to testing. According to WHO guidelines, anyone suspected of having the virus should be tested and receive results within 24 hours. They should also have the option to retest to confirm they are no longer infected. Unfortunately, the US is far from meeting this standard.
This guideline also mandates that confirmed cases be isolated, and all their contacts quarantined for two weeks. Essentially, reopening hinges on a “dramatic shift from focusing solely on severe cases to identifying and isolating every case, regardless of severity or origin.”
Reducing risk in hospitals and nursing homes is essential
The third prerequisite focuses on “high-risk environments” where the virus can spread rapidly and with severe consequences. This includes healthcare facilities and residential care settings, such as assisted living homes. To mitigate risk, workers must have the tools to prevent disease transmission, particularly sufficient PPE (personal protective equipment like masks and gloves). Given the current nationwide shortage of PPE, achieving this milestone remains a distant goal.
Workplaces must also implement measures to lower risk
Even beyond healthcare and residential settings, workplace safety is crucial. This includes maintaining safe physical distancing, regular handwashing, and proper respiratory hygiene (such as covering your mouth and nose when coughing). Even after reopening, we’ll continue to keep our distance from others as much as possible.
We must remain vigilant about imported cases
When restrictions are lifted in one area, we must stay alert to the possibility of new COVID-19 cases arriving from regions where the virus is still widespread. This mirrors the longstanding challenge with measles: every local case can be traced back to someone who brought it from abroad.
Everyone must contribute
The final requirement is that communities actively participate in halting the virus’s spread and preventing resurgence. Life won’t return to the carefree days of 2019. As the WHO emphasizes, communities must “recognize that this transition requires a significant shift...that preventive behaviors must continue, and that everyone plays a vital role in adopting and sometimes enforcing new control measures.”
Even after meeting all these conditions, restrictions should be lifted gradually. Robust and widespread testing must be in place to support decision-making, and all actions should be guided by the best available scientific evidence and expert advice.
This implies that recommended measures may evolve as we gather more knowledge about the virus. We need to remain adaptable to these changes and prepare for an extended period of physical distancing. Patience will be essential throughout this process.
