Photo: AP Photo/Jeff Chiu

The Messy Road Out of Lockdowns

Effectively ending the quarantine will be harder than imposing it, and as many nations start to talk about reactivating the economy, we must be aware of the pitfalls of our new routines

Lockdowns are working, there’s no doubt. Curves are flattening and the epidemic is contracting. The basic reproductive number (R0) of COVID-19 in the UK, for instance, has recently been calculated by Imperial College to be 0.7; as long as the number remains below 1, the contagion rate is expected to reduce. Without strict social-distancing measures, it would be around 4, meaning that every case could infect 4 new people.

The problem now is that the cost of the stringent measures can be as devastating as the disease itself.

The United Kingdom Treasury expects the country’s GDP to contract by 35% in the second half of 2020 and unemployment to reach 10% if lockdowns remain in place by June. A similar scenario is expected in most countries, and the International Monetary Fund expects an 8% GDP drop in countries like Spain and Portugal, and up to 10% in Italy. Unemployment in Spain might reach 21%. On the other side of the Atlantic, lockdowns have pushed about 15% of the United States workforce to file for unemployment benefits.

In underdeveloped countries, the impact might be worse. Take Venezuela, where massive GDP contractions and stratospheric unemployment rates are nothing new. A nation-wide fuel crisis, ongoing as new price controls and nationalizations are announced, threatens to cause a severe food shortage in the middle of the pandemic.

Lockdowns can keep the pandemic at bay, buying us time to revamp health services and prepare, but they don’t cure anything. Therefore, thorough planning is required to restart the economy while preventing another disease outbreak. Researchers from the Tony Blair Institute for Global Change, a think-tank founded by the former British Prime Minister, devised a plan based on two major strategies: Containment and Shielding.

This strategy could be especially useful in underdeveloped countries where scaling up diagnostic capacity is particularly complicated.

Containment refers to the strategies that will limit the virus spread once people resume their activities. These activities can be restarted sequentially as long as certain baseline conditions exist, the single most important element being testing capacity; focused testing of particularly vulnerable groups is quite feasible and healthcare workers, which are disproportionately affected by the disease, are a good place to start. Testing them once a week, coupled with isolation of symptomatic personnel could reduce overall transmission by up to 23%, according to Imperial College models.

This strategy could be especially useful in underdeveloped countries where scaling up diagnostic capacity is particularly complicated.

Shielding, on the other hand, means protecting the most vulnerable people as long as there’s risk of infection. People over 65 years old account for 87% of all registered COVID-19 deaths. This disproportion indicates that as long as the virus circulates, elderly folks will be prone to catching it. For that reason, bringing back the younger population first into a normal economic routine could help reactivate the economy while protecting health systems and citizens. Strikingly (or not), Nicolás Maduro has just announced he intends to do the exact opposite.

Other shielding strategies include gradually reopening different sectors of the economy. Schools could be first, as the impact of keeping them closed is high and children are less likely to develop severe disease. Large businesses, where social distancing can be kept, would follow. 

Using antibody tests to identify immune individuals could also lead to their reincorporation to the active workforce. Nonetheless, these tests aren’t perfect and certain ethical considerations arise; think about a country with limited testing capacity, where large sectors of the population can’t afford self-isolating for long periods of time. How long would it take corrupt authorities to sell “immunological passports” to people desperate to start working again? It isn’t hard to imagine underpaid Venezuelan government workers profiting from this by selling licenses.

There’s also the risk that, as the situation gets better, people feel there’s no need for stringent measures anymore. This “prevention paradox” already keeps Germany’s chief virologist awake at night. A similar phenomenon is happening in Venezuela; since the government insists on showing that the situation is “under control” and only a few cases are diagnosed everyday, there’s no sense of urgency and quarantine measures are widely ignored in certain zones of the country.

Effectively ending lockdowns will likely prove to be considerably harder than imposing them in the first place. In the best conditions, the transition might last for months. For Venezuelans, this means Maduro will have quite a large window to strengthen his social control strategies, something the dire socioeconomic perspectives will probably force him to do, as social unrest peaks in the coming weeks.

Juan Carlos Gabaldón

Medical doctor from Merida, currently studying Medical Parasitology at the London School of Hygiene and Tropical Medicine