September 24, 2020

expert reaction to review and opinion on strategies for easing lockdown restrictions in Europe and Asia

A review and opinion piece, published in The Lancet, looked at strategies for easing lockdown restrictions in Europe and Asia.

Dr Julian Tang, Honorary Associate Professor in Respiratory Sciences, University of Leicester, said:

“This is a nice opinion piece with a multi-national authorship.

“Having worked with some of the coauthors from Singapore and Hong Kong previously, I agree with them that one of the main drivers for a lack of a consensus approach has been the difference in shared histories between countries, particularly between the Asian countries that experienced SARS 2003 and the Western countries that did not.

“The debate over the wearing of face masks illustrates this very well, with Asian countries already used to this for over a decade since SARS 2003, compared to the more gradual acceptance by more of the Western countries.

“Also well demonstrated is the diverse resource availability across these countries when having to deal with a rapidly developing and moving pandemic – particularly with laboratory testing and ICU beds.

“An interesting angle that the authors were not afraid to highlight and discuss is the growing lack of trust in their respective governments, via confused messaging (often undergoing last minute reversals), as well as how individual events (like government officials violating their own guidelines) can add fuel to this distrust.

“They also discuss the BAME population vulnerability to COVID-19, though I was surprised to learn that Germany did not collect this type of data – and whilst Singapore has seen many immigrant workers acquiring COVID-19, the article did not mention the fact very few of them have actually needed hospitalisation or died.

“It is a long article, but just reading the Discussion will be enough to understand the complexities of the different approaches taken by different countries, and whilst these are outlined in detail, the authors stop short of trying to define a consensus approach for all countries – perhaps because this may just be impossible with the wide cultural and socio-economic diversities that exist between them.”

Prof Noel McCarthy, Professor in Population Evidence and Technologies, Warwick Medical School, said:

“This paper highlights the need for an experimental approach that actively involves communities in responding to COVID-19.  This markedly contrasts with approaches that have been incorrectly titled as “following the science” but are profoundly non-experimental and non-scientific, treating science as set of answers defining rules rather than an approach of open questioning and continuous learning.

“The paper also highlights the critical importance of active individual and community engagement and of each member of these communities becoming expert in their part to play rather than passive followers of rules based approaches.  It shows how varied this balance between full citizen engagement or more passive citizen involvement has been across countries.

“The structured comparison across countries offered here also highlights the advantages available from joint learning among the global community in how to address a crisis that is in largely shared but in part takes on strong local dimensions.  The implicit call for collaboration over competition is as important underlying theme of this work.”

Dr Simon Clarke, Associate Professor of Cellular Microbiology at the University of Reading, said:

“The Lancet review and discussion piece provides a useful and helpful overview of different approaches of nine rich nations around the world.  It should provide health authorities with valuable context, and overview of the policy options that are available in efforts to find a workable exit strategies to lockdowns.

“Of particular relevance now is the comparison of systems for test, trace and isolate.  After the problems with testing in recent weeks, this should be required reading for UK health ministers, highlighting how inadequate the UK system for testing has been – particularly as other lockdown measures have been eased.  Other countries are in a far better position than the UK and Spain to ease restrictions on movement and socialising, because they have more effective and capable test and trace systems in place.

“The study praises the approach of New Zealand for its ‘Zero Covid’ policy, citing concerns about long-term health impacts to some Covid-19 survivors, which we are only just learning about.  However, only time will tell if unilateral elimination of Covid in one country is the best policy.  If a working vaccine is available sooner rather than later, and New Zealanders can be immunised quickly and en masse, it will look like a great policy.  However, if vaccines aren’t available fast enough, New Zealand will increasingly be vulnerable to infection from abroad, and will have to maintain costly global isolation to protect its public.

“The article suggests that austerity in European health systems since the economic crash more than a decade ago has left Europe in a worse position than Asia, which has invested in public health after heeding their warning shots provided by the outbreaks of SARS and MERS.  While a well-resourced and run health system will undoubtedly be better equipped to deal with pandemics than a cash-starved one, this study provides little new evidence that austerity is to blame for a worse response by European countries.  They seem to be suggesting that the NHS of 2007 would have dealt better with a coronavirus outbreak than the NHS of 2020, but there is no evidence of that in this study.”

Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton, said:

“This excellent paper highlights how preparedness has been key in for many Asian countries in promoting a good and rapid outbreak response.  Lessons have been learned from previous outbreaks, such as SARS and ‘bird flu’, which led to investment in public health and surveillance infrastructure.  One key factor has been the use of technology to carry out extensive testing and tracing of all cases, as well as behavioural aspects such as the widespread use of facemasks.

“Before the next pandemic, for there will be a ‘next time’, preparedness is key to ensure a swift and efficient response.  Here we see some lessons that could and should be learned by European countries in order to mitigate current and future infectious disease threats.”

‘Lessons learnt from easing COVID-19 restrictions: an analysis of countries and regions in Asia Pacific and Europe’ by Emeline Han et al. was published in the Lancet at 23:30 UK time on Thursday 24 September 2020.

DOI: 10.1016/S0140-6736(20)32007-9

Declared interests

None received.