What It Takes to Reopen Everything, According to WHO

Just like my tiny daughter is looking forward to Christmas all year, all of us, physically distanced, look forward to “reopening”. Rediscovery is more of a wish than a plan, as we will likely have to adjust constraints for months. We just want to get things back to normal, right? So, the World Health Organization has put forward six preconditions for relaxing the constraints . Let’s see what they are.

These six points are discussed in detail in the April 15, 2020 WHO COVID-19 strategy update (see page 10) and are summarized in several tweets here .

The transmission must be controlled

This is the first requirement and it is very important. The transmission must be under control.

In other words, we will not emerge from isolation until we are confident that we are not at risk every time we approach other people. This means that public health officials need to know where all cases are. No transmission from person to person will go unnoticed, and people will not wonder if they have it.

We will not be here until new cases of COVID-19 exist only at “the level of sporadic cases and groups of cases, all from known contacts or imported.” This situation in the United States has not been around since January.

Transmission control also requires new cases to be at a level that hospitals can handle, “with significant clinical care capacity in reserve.” In other words, if the health care system is overwhelmed, we have not reached the goal yet – even if we know where all the cases are.

We need to be able to check and take care of everyone

This is another important question. Right now, many people with COVID-19 are still unable to get tested for it. The WHO guidelines state that everyone with suspected disease should be tested and get results within 24 hours. They should also be able to retest to see when they will be virus free again. In the US, we are very, very far from this.

This clause also requires cases to be quarantined and all their contacts quarantined for 14 days. In short, re-discovery will only take place after “a major transition from identifying and treating mostly serious cases to identifying and isolating all cases, regardless of severity and origin.”

The risk must be minimized in hospitals and nursing homes.

The third requirement is for “high vulnerability settings”, where the virus can spread quickly and destructively. This includes health care and residential institutions such as serviced homes. To minimize the risk there, workers must be able to prevent the spread of the disease, which is critical to have an adequate supply of personal protective equipment (personal protective equipment such as masks and gloves). Currently, our country is experiencing an acute shortage of personal protective equipment, so this is another milestone, which is still far away.

Jobs should also reduce risk

Even outside medical and residential areas, people need to be safe in their workplaces. This means you can practice safe physical distancing, hand washing, and respiratory etiquette (such as covering your mouth and nose when coughing). So even when everything “opens up,” we will still keep as much distance from each other as possible.

We need to beware of imported cases

When we lift restrictions in one place, we still need to be aware of new cases of COVID-19 coming from other places where it still thrives. This is the situation we’ve been in with measles for decades : every case here could be related to someone who brought it in from another country.

We should all chip away

The final requirement is for “communities to be involved” in stopping the spread of the virus and making sure it doesn’t bounce back. We’re not going back to our 2019 carefree lifestyle. WHO writes that communities must “understand that the transition is a major shift … that behavioral prevention interventions must be maintained, and that all people have a key role to play in ensuring and, in some cases, implementing new controls.”

Even if all these requirements are met, the restrictions should still be removed in stages. We need to have good enough and widespread testing to support our decisions. And all decisions must be based on a better understanding of the facts by scientists and our leaders.

This means that the recommended measures may change as we learn more about the virus. We must be patient with these changes, and we must also be patient with distancing in general. This will last for a while.