Like everyone else, I’m getting fatigued with everything COVID-19, while still being fascinated by new information. But this week I started wondering… what comes next? We won't be couped up in our homes forever (even if it's starting to feel like it!). So, I thought I’d see what some of the experts are saying…
We’ve been told that life is unlikely to return to normal until we have a vaccine or until enough people have had the virus (and hopefully developed natural immunity) to prevent easy spread. Finding safe and effective treatments will also make a difference in how we need to behave when we leave our homes.
I read this week that the economies of many countries are the worst they’ve been since the crash of 1929. Loosening the widespread restrictions we currently have—closed businesses, restaurants and schools, physical distancing and staying at home—will help our failing economies but we risk a second wave of infection: more people catching the virus, more admitted to hospital and more dying.
It will be a careful balancing act. Experts are recommending a gradual reopening while closely monitoring for any spike in the spread of the virus. Those of us in North America have the advantage of being farther behind in the course of the pandemic and we can benefit from observing the results of actions taken in Asian and European countries where it began earlier.
So, what do experts think we need to do to reopen our countries safely? Here is a step-by-step scenario:
Phase 1—Slowing the spread
We are currently in this stage in North America. We know the extreme measures in place are designed to limit human-to-human contact, the main route of spread. We understand hand washing and sanitizing surfaces are also important to reduce the chance of viral spread through touching contaminated objects.
But we are still learning about the virus. We know it can survive 16 hours (or possibly as long as 3 days) on smooth non-porous surfaces like stainless steel and plastic (depending on the reference you read) but only several hours on porous surfaces like cloth. (Yet another reason to avoid use of plastic!). It is also affected by other factors like temperature and humidity. Experts now tell us that the virus can be passed on to others, not just by coughing and sneezing, but by simply talking and breathing.
Some countries or areas within countries are mandating use of masks in public while others are still recommending them but as a voluntary measure. We are reminded not to use medical masks, however, as supply is short and needed for those caring for sick patients. Although all agree staying at home is the most effective way to decrease virus spread especially since it can be passed on by people without symptoms, as restrictions are lifted, masks may become an important additional part of the virus control strategy.
Phase 2—Gradual reopening
Businesses and schools will gradually be allowed to reopen once 4 things happen:
The rate of virus spread is under control
There is no risk of overwhelm of health services
Authorities can detect local outbreaks quickly
Communities are able to adapt to changes necessary to prevent virus spread in workplaces, public areas (like parks) and schools as they reopen
This will not happen everywhere at once, so some communities will reopen before others. If a spike in virus activity occurs, a community may need to close again for a while.
People at highest risk, the elderly and those with chronic diseases, will still need to be protected. Those over 60 and especially over age 80 will need to continue to limit exposure to others, as these populations are at increased risk of harm from the virus. There will still be a need to control the rate of spread to avoid spikes in hospital admissions. Public hygiene will need to be improved, and cleaning of public places will need to become routine. We will be required to continue physical distancing. Public gatherings will be limited initially, and it is likely that people will be asked to wear cloth face coverings when in public to reduce asymptomatic spread, as was announced this week in New York and Los Angeles. Even the Village of Cap-Pelé, where I live, posted advice to wear a mask in public and shared a video of Dr. Jerome Adams, Surgeon General of the US, demonstrating how to make a simple mask without a sewing machine. Click here to view it.
Anyone with COVID-19 symptoms will be asked to stay home and seek testing. Tests will become widespread and routine with point-of-care (rapid, in-house) testing in health care facilities for anyone with symptoms. Contacts of positive cases will be efficiently tracked to reduce the amount of asymptomatic spread.
Phase 3—Lifting physical distancing
Once wide surveillance, safe and effective treatments and an effective vaccine are available, we will be able to lift the requirement for physical distancing.
Phase 4—Preparing for the next pandemic
It’s important that we learn all we can from this pandemic so we can reduce the impact of the next one. We need to maintain effective surveillance systems and supply chains, and enable coordination between health systems. Communicating what has been learned in each country will help us all deal better with the next pandemic and even with the yearly seasonal flu, from which too many die each year.
Watching and learning
This is where a few countries stand, as of April 16, 2020:
Greece closed their country early and have had a low number of cases—about 2000 in total, with 102 deaths. Restrictions remain in place there.
Sweden has remained mostly open, challenging the scientific mainstream.
The Czech Republic, where masks were mandated early, had an easier time than other countries (total 166 deaths to April 16, 2020) and is now easing their lockdown.
Spain and Italy both closed in a later stage of their pandemic resulting in a hard hit. This week Spain is reopening manufacturing and construction and Italy is now loosening restrictions somewhat, allowing small stores to open as part of a step by step reopening of the country.
Denmark plans to speed up the lifting of restrictions, after their latest numbers were lower than expected.
The actions of each country will contribute information that can be used by others. Hopefully researchers will analyze the many factors that enabled the Coronavirus to spread so quickly and widely in some areas and will determine what strategies combined to best limit it in others.
How will we all be changed?
How much this pandemic affects us over the long term remains to be seen. Will we hesitate to shake hands with a stranger? Will we continue to wash our hands more often and stop touching our faces in public? Will we want to wear a mask when using public transit or travelling by plane?
It’s hard to know right now but, after our harrowing trip back from Spain in mid-March, I expect my travel habits will change. Meanwhile, I’m keeping myself occupied by making cloth masks for family and friends. At least I feel that I’m doing something positive to help others while waiting at home for Phase 2 of this pandemic.
Are you doing anything special to keep busy these days without going near others? Comment below...
References:
National Coronavirus Response -- American Enterprise Institute
A look at when and how Canada should reopen after COVID-19 closures -- Global News
These countries are reopening after coronavirus – here’s how they’re doing it -- CNN.com
COVID-19: As Sweden’s death toll mounts, epidemiologists urge leaders to ignore their own public health agency -- The National Post
