As the COVID-19 pandemic is approaching or has surpassed it's peak intensity in a number of countries, governments are rushing to chart roadmaps to exit lockdowns. Mandatory shelter-in-place requirements and shutdowns of businesses and public activities have imposed a significant toll, not only on the economy, but also mental and emotional well-being of the public. So there is considerable pressure on governments to lift restrictions. But public health experts and epidemiologists, including the World Health Organization, are concerned about the possibility of a second wave of the epidemic. In its COVID strategy document, WHO outlined 6 conditions that must be met before a government starts lifting restriction, as below:
1. Disease transmission is under control
2. Health systems are able to "detect, test, isolate and treat every case and trace every contact"
3. Hot spot risks are minimized in vulnerable places, such as nursing homes
4. Schools, workplaces and other essential places have established preventive measures
5. The risk of importing new cases "can be managed"
6. Communities are fully educated, engaged and empowered to live under a new normal
While few countries have met WHO's conditions, many are far from it. But the lockdown fatigue, economic shock and the looming mental health crisis are pushing governments towards a speedy easing of lockdowns. To balance the concerns about resurgence in spread of infection, most governments are adopting a phased approach to lifting restrictions. Phasing allows governments to spread the risk of a second wave over a longer duration, so that it can be monitored and managed better, while immediately providing certain concessions to the public and businesses.
We conducted a comparative analysis of the exit strategies of Ireland, Australia, Netherlands, Germany, Spain, Italy, Russia, Israel, Belgium, France, Austria and India. Typically, 3-5 phases are spread over durations ranging from a few weeks to a few months. The most interesting aspect of the comparative analysis is that it reveals the priorities of different governments, which in turn reflect the biggest pain points of the respective citizenries and economies. We summarise these findings in terms of the order in which restrictions are typically lifted by the governments and cross-country variations in these patterns.
Primary phases (1-2 weeks)
In this phase, concessions are limited to low risk activities which can provide some relief to public and businesses, while also providing early indications to the governments about people's behavioral responses to lifting restrictions and the chances of a second wave of infections.
Key concessions across countries:
· Less crowded public and private spaces such as libraries and small shops
· Businesses where remote work is not possible, with distancing and masks
· Visitors at home or small gatherings (not more than 5-10 people)
· Physical activities like running, cycling and small group sports, with adequate distancing
Variations:
· Netherlands, Ireland, Germany and France are opening up primary schools and childcare services early
· Netherlands, Germany and Spain are opening 'contact professions' such as hairdressers and salons, despite these being considered riskier
· India is allowing sale of liquor at government certified outlets, as liquor sale is a major source of revenue for state governments
Intermediate phases (3-6 weeks)
In the intermediate phases, governments are willing to take more risks, if the early signals are positive. More recreational and social activities are allowed, especially in controlled environments such as theatres, cinemas, gyms, community centres and religious establishments. More movement is also allowed to help the recovery of economic activity.
Key concessions across countries:
· Limited movement, including public transport and flights with distancing and masks. India is allowing interstate public transports for migrant workers.
· Some public spaces like gyms, playgrounds, cinemas, theatres, community centres and religious establishments, with a cap on numbers and distancing
· Schools and childcare services
· Non-essential retail outlets, except in malls and shopping centres
Final phases (more than 6 weeks)
While some high risk activities may not be permitted for months, some activities that play a key role in society and economy will be allowed in due time if early stages of the exit plan are successful.
Key concessions across countries:
· Contact and professional sports, without spectators
· Shopping centres, restaurants, cafes, bars and nightclubs
· Amusement parks and mass events like festivals
· Contact professions like salons and hairdressers
· Hotels and tourism/hospitality services
· Educational institutions
· Free movement, including international travel
Framing to influence behaviour
An interesting aspect of countries easing out of lockdowns is the different ways in which countries have framed the description of the period. The words used to convey the change of state is also a subtle way in which governments can provide risk and motivation based cues to the public. For instance, the Indian government has continued communicating phases of massive relaxation using the terminology, Lockdown 1.0-4.0. The usage of the word ‘lockdown’ to mark a phase of gradual relaxation was debated in some quarters. But, by retaining the word the government could effectively draw more attention to continued risk and continued protective strategies, rather than towards a complete change in state. It indicated a period of lockdown with some features of it retained and some relaxations added (differently in different zones). This framing kept the risk available and allowed vigilance to sustain.
Spain on the other hand, used the terminology of conflict and resolution while easing out of lockdowns. The four phase ‘de-escalation’ plan communicated reduction in the intensity of both the problem and the mitigation strategy for it. It was necessary for a country which had been under a prolonged period of lockdown and had seen a significant number of fatalities.
France has been using the terminology of de-confinement and re-containment interchangeably to mark the lockdown and the relaxation plan. De-confinement seems to directly acknowledge and address the coping anxiety of the population and stress on relief from that phase. The ‘re-containment’ plan on the other hand communicates the uncertainty of the pandemic and prepares the people for transitions in the future. Importantly, re-containment signals that the risk is not yet over.
The phasing along with the framing of lockdowns and relaxations across the world, reflect the priorities of governments and provide subtle nudges to influence behaviour.
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