Lockdown will end but golden rules will live on, say epidemiologists

13 April 2020 - 09:44
By Tanya Farber
No-one knows when soldiers will return to their bases, even if lockdown ends on April 30.
Image: Esa Alexander No-one knows when soldiers will return to their bases, even if lockdown ends on April 30.

Even if the lockdown ends on April 30, no-one knows when normal life will resume.

Dr Kerrin Begg, a public health expert at Stellenbosch University, told SowetanLIVE''s sister publication TimesLIVE: “There is a range of options available, with lockdown on the one end and returning to the normal way of doing things on the other.”

After the stringent regulations of lockdown, a period could ensue which “allows for some measure of increased economic activity” but even so, “people would have to continue with the golden rules of hand hygiene, and physical distancing”.

Begg said a possible strategy would be “a staggered return to work”, but that would be “very difficult to assure compliance and to police”.

Rules for public transport could be adjusted so that, for example, even after lockdown taxis would only be allowed a capacity of 50%, but even so, measures would be needed where people congregate, like taxi ranks and bus terminuses.

Ultimately, said Begg, every strategy “really comes down to each person understanding why it is so imperative for all our sakes to stick to the golden rules”.

Another option could be a “soft lockdown” in which people are asked to stay at home unless they need to shop or visit a doctor.

Authorities rely on peer pressure to encourage compliance, though reports from Japan’s soft lockdown suggest it’s business as usual.

Image: University of Cape Town "Data is key for an appropriate response," said University of Cape Town epidemiologist Prof Jabulani Ncayiyana.

Selecting the best option was all about the data, said University of Cape Town epidemiologist Prof Jabulani Ncayiyana.

SA was “at the beginning of the virus” and navigating through uncharted territory, but even though better data would be available by the end of April “it is very difficult to talk about time frames now”.

Scientists could create models to predict the spread, the results of efforts to curb it, the mortality rate and more, but there were “so many variables”.

Even so, we have to work with the data we have to plan the next move, and Ncayiyana said “data is key for an appropriate response” and we would start to get a much clearer picture of “the numbers since testing was scaled up”.

The one thing we can predict is the mental and physical fallout. A study of four weeks in lockdown in China revealed those who’d stopped working were at higher risk of worse mental and physical health, as were those with existing health conditions.

The study, led by the University of Adelaide in Australia, focused on 369 adults in 64 cities. Lead author Stephen Zhang said it offered “a crystal ball into the mental health of residents in other countries once they’ve been in the lockdown for a full month”.

Co-author Prof Andreas Rauch from the University of Sydney said: “We weren't surprised ... Work can provide people with a sense of purpose and routine, which is particularly important during this global pandemic.”

Prof Shabir Madhi
Image: nrf.ac.za Prof Shabir Madhi

Prof Shabir Madhi, an infectious diseases expert at Wits University, said what happens after lockdown would be determined by what happened over the next three weeks in terms of testing, tracing, isolation and quarantining.

“As soon as you lift the lockdown, you get a rebound,” he said, adding that SA had not done enough testing in the early part of lockdown.

“In terms of reducing transmission, you have to identify cases in households and then put them into isolation and quarantine their contacts. Otherwise, those in the house spread the virus to one another at a rapid rate, and then go out and spread the virus back into the community,” he said.

“With us not having done early identification during the course of the first lockdown, we risk this rebound.”

Begg said educational institutions could be a hotspot for rebounds, and another strategy would mean a delayed return to in-person education.

“This would have a knock-on effect but it is a high risk to return: kids aggregate in big groups, as do university and technikon students, and we definitely want to avoid that,” she said.