A group of experts from the thinktank American Enterprise Institute drew up a roadmap towards reopening, published on March 28, in which it marks four phases until total deconfinement in the United States. For its part, the Spanish Society of Preventive Medicine, Public Health and Hygiene (SEMPSPH) has published a proposal that, instead of marking stages, details more than 140 measures and issues to consider for the transition phases of the pandemic in Spain. released April 10.
Both documents coincide in several aspects and contain recommendations for governments. These are your proposals.
As I once heard from a master engineer, “when we can’t work in optimal conditions, we work in suboptimal conditions,” but we move forward. I consider it sterile, at this time, to get involved in whether the Government took the appropriate measures before confinement. What matters is what is being done since March 14 (phase I), and what will be done in the coming weeks.
Citizens have done our part. Now, how, when and at what speed we get out of this is the direct responsibility of the authorities.
Phase I: Reduce the extension, brake the curve
It is the phase in which we are, of confinement. The objective is to brake the curve, to reduce the speed of propagation. It is not that there are fewer infected, but that growth is not so fast: reaching the famous “peak of the curve”. The chain of transmission of the virus must be cut and, as there is no vaccine, the message is “you are the vaccine”, “stay home”.
During this phase, what we should achieve is to protect the health system, prevent infections and increase our response capacity. We must avoid collapse and protect the weakest and most likely to die, the elderly and those with previous pathologies, something that unfortunately we have not achieved in Spain.
What measures should be taken during this phase I?
- Confinement to avoid contagion: closing public places, promoting teleworking (in non-“essential” jobs), limiting trips, canceling mass meetings. In short, stay home.
- Secure and protect the health system: have sufficient capacity, including staffing, number of beds and ICUs, respirators, personal protective equipment and masks.
- Maintain the capacity of the Primary Care services to provide routine health care and be able to monitor cases in home isolation, promote remote care of routine and simple cases.
- Increase the capacity to carry out diagnostic tests : especially to hospitalized patients, health personnel and essential jobs, contacts of infected people, nursing homes and more susceptible people and caregivers. To be able to detect infected cases and their contacts and to be able to isolate them.
- Develop epidemiological surveillance systems: have safe, reliable, rapid and cheap diagnostic tests that allow us (in phase II) to be able to distinguish between infected, convalescent, immune cured and susceptible to infection.
- Provide masks for the entire population, for use in public places, leaving those for health use only for health personnel, the sick and caregivers, as long as there is not enough material. Have the ability to replenish hand hygiene dispensers in strategic locations in public buildings, public transportation, and workplaces.
- Offer places of voluntary confinement for those who require it.
How long should this phase I last and could we move on to phase II?
The reports mark three milestones that should be achieved at the same time in order to continue advancing in the deconfinement:
- That the number of new cases decreases continuously, for at least 14 consecutive days (the incubation period),
- That the health system recovers from the collapse and is able to continue care appropriately.
- The availability of diagnostic systems that make it possible to quickly detect cases and symptomatic contacts and isolate them.
Are these three conditions fulfilled at this time to continue moving towards the next phase? Saving life or livelihood, that is the dilemma.
Phase II: Sequential Deconfinement
The objective of this second phase is not to go back to confinement. Do not collapse the health system again and continue to protect the most susceptible.
It must be assumed that there will be more waves of the virus, the intensity of which will depend on the number of people immunized in the first phase. But in the following he has to catch us prepared. Reopening measures must be sequential and will have to be reassessed at every step.
- During this phase, businesses will be opened (it may be sequentially or in shifts, it will depend on the type of business), colleges and universities (if there is time before the end of the course).
- The telecommuting option will continue, if possible.
- Meetings or events of more than 50 people will be limited.
- The measures of social distancing, personal contact, hygiene, cleaning of surfaces, use of masks will continue, without forgetting that the mask itself is a fomite, and that maintaining distance and washing hands will continue to be essential.
- At first, people over 60 years of age and immunosuppressed patients, cancer patients or those with cardiovascular or respiratory risk factors should remain in phase I of confinement.
All these measures could have different speed depending on the epidemiological situation of each locality or region: depending on whether they are more or less populated areas, the incidence of the disease and the situation of the health system. Confinement will take longer to lift for populations at risk and for geographic areas where outbreaks appear.
During this phase II we have to be able to:
- Quickly and efficiently detect those infected in order to isolate them at home, hospital or other premises voluntarily. Detect your contacts to quarantine them (14 days), follow up and, if they have symptoms, give them diagnostic tests. Special attention to the most vulnerable cases (elderly, sick and caregivers) who will continue with very close surveillance measures.
- Assess population immunity: detect people already immune. Many may be asymptomatic or have mild symptoms and have already recovered from the infection. They can return to work immediately. It is very important to detect it as soon as possible in health personnel, essential jobs, caregivers …
- Accelerate the development of safe and effective therapies, promote research, development, production and distribution systems.
Some measures that are recommended in workplaces, as far as possible:
- Promote and facilitate teleworking, especially for the highly vulnerable population.
- Consider strategies for staggering personnel or dividing the workforce with alternate schedules.
- Recommend distancing in the workplace.
- Create a strict stay-at-home policy in case of illness.
- Employees with sick household contacts will stay home and can telework in case of symptoms.
- Implement mandatory hand hygiene upon entry to the workplace and set regular times to remember it. Provide the common areas with dispensers of alcoholic solutions located at the entrance to these areas.
- Promote respiratory etiquette and other measures, such as avoiding touching your eyes, nose, and mouth.
- Assess the use of personal protective equipment in the workplace appropriate to the characteristics of each job.
- Promotion of lunch at the desk or workplace, rather than in the common dining room, whenever possible. Otherwise, always maintaining the safety distance between workers.
- Reorganize the distribution of furniture in common areas to guarantee, as far as possible, the safety distance between workers.
- Facilitate regular disinfection of high contact surfaces and between users.
- Evaluate the opening of windows to favor the exchange of air and adjust the air conditioning.
- Promote the use of videoconferences to hold meetings and avoid holding face-to-face meetings. If required, care will be taken to maintain a distance of at least 1.5 meters between the attendees and they will be held preferably in places with good ventilation, semi-open or outdoors, if possible.
- Evaluate in a scaled way the authorization of meetings and encounters, taking into account as a limit the attendance of 10 people who can comply with the safety distance measures, hand hygiene and respiratory etiquette in the room.
- Propose the creation of evaluation and continuous improvement measures in the event of overcrowding situations in the workplace that allows their rescheduling, staggering and cancellation.
- Evaluate the risks of staff business trips in accordance with the Foreign Health recommendations.
- Promote a no handshake policy in the workplace.
When could we go to phase III?
According to this report, when we have a safe and effective vaccine (or when a large number of the population is found to be immune).
Phase III: Total lifting of restrictions
According to the report, the total lifting of restrictions should occur when we once again have a robust and safe healthcare system, when we have effective diagnostic systems widely implemented, an effective system for detection and isolation of outbreaks , and therapies for cases more severe and an effective vaccine.
In my opinion, all this together may take many years, if it ever comes.
Phase IV: Prepare for the Next Pandemic
This pandemic will pass, but another will hit us again. When it will happen we do not know, but it is not as remote a probability as that of a meteor hitting us and extinguishing us.
That is why a fourth phase in this process is necessary: preparing for the next one. We will have to rethink our commitment to research and development, investment in basic science, in health infrastructures, make epidemiological surveillance plans, promote public-private collaboration and think globally.
We have learned that viruses have no borders, they do not know nationalities, they make us all the same, they do not distinguish between people.
The response to the next pandemic must be global from the beginning: science, cooperation and solidarity.
A version of this article was originally published on the author’s blog, MicroBIO.
Ignacio López-Goñi, Professor of Microbiology, University of Navarra
This article was originally published on The Conversation. Read the original.
