For the last few months, much of the world has lived under unprecedented public health restrictions, social-distancing mandates, and other emergency measures. At least 137 countries imposed partial or total lockdowns to slow the spread of the novel coronavirus. One hundred forty-one restricted internal travel, and 169 closed at least some of their schools. In many ways, these measures have had their intended effect, helping to reduce transmission and ease the strain on health-care systems. Although more than eight million people have tested positive for COVID-19, the disease caused by the virus, and over 400,000 have died, these numbers would likely be far higher had countries not acted as they did.

But much of the world has now begun the process of reopening, even though the spread of the disease continues to accelerate in many places. The United States recorded its largest one-day total of new infections this week, even as many states push ahead with plans to reopen their economies.

This new phase of pandemic response is risky, but it may have been inevitable. Tight restrictions on people’s lives cannot be maintained forever. Their purpose was to “flatten the curve”—that is, to avoid a crush of sick patients that would overwhelm hospitals and to give governments time to bolster their public health systems. But where those aims have been achieved, it becomes difficult to justify the painful economic and social costs of extended lockdowns. It is little wonder, then, that so many are experiencing “quarantine fatigue.”

For some people, particularly in low- and middle-income countries, getting back to work is a matter of life and death. For others, especially in the United States, the issue has taken on a partisan dimension, with Republicans more likely to oppose coronavirus-related restrictions than Democrats. Further complicating the picture are the protests that erupted in the United States and many other countries in the wake of George Floyd’s death. The first wave of the pandemic is not yet over (and a second wave could be on the horizon), but the era of the lockdown is coming to an end—at least for now.  

That doesn’t mean every country is now on the same trajectory, however, or that all reopening strategies are created equal. Countries that proceeded cautiously, maintaining lockdowns until their outbreaks were mostly under control and their health systems were ready to handle new outbreaks, have fared better than those that opened rapidly and prematurely. Similarly, those that followed careful—and reversible—stepwise processes while communicating effectively with their publics have had more success handling inevitable surprises than those that flipped the “on” switch all at once. In other words, the when and how of reopening has proved enormously consequential.  

TIMING IT RIGHT

The trend toward reopening is scarcely a month old, but already it is clear that countries that waited for the right time to ease restrictions are in better shape than those that moved to reopen despite ongoing community transmission and gaps in public health capacity. Just as places that acted swiftly to implement lockdowns fared better than those that dragged their feet, those that waited for a lull in transmission to begin reopening have outperformed those that did not. Australia, Germany, Hong Kong, New Zealand, and Norway all maintained lockdowns or strict social-distancing guidelines until new case numbers had come down to a level where the risk of resurgence was relatively low. With transmission rates leveled off, these countries have been able to begin reopening schools and businesses and to allow people to resume their social lives, without a high risk that the epidemic will spiral out of control.  

Places that have pushed ahead with reopening despite ongoing community transmission, increasing case numbers, or other metrics of epidemic growth are on a much more troubling trajectory. In Brazil, for instance, a number of big cities began reopening this month even as coronavirus cases, hospitalizations, and deaths appeared to be peaking. As a result, Brazil has surpassed 50,000 deaths and is on track to become the hardest-hit country in the world. It has some competition for that distinction from the United States, which has begun to lift business and other restrictions even though cases are increasing in more than half of states. While a few states have paused reopening after experiencing spikes in new infections and hospitalizations, others have pushed ahead despite worrying signs.

In Brazil and the United States, reopening has led to surges in public activity at a time of already widespread community transmission—a recipe for uncontrolled spread of the disease, it turns out.

In both Brazil and the United States, reopening has led to surges in public activity at a time of already widespread community transmission—a recipe for uncontrolled spread of the disease, it turns out. Certainly, part of the challenge for large, federalized governments such as those in Brazil and the United States is that some of the responsibility for public health lies at the state and local levels, meaning that reopening policies can be inconsistent and even contradictory in different locations. But a federal system doesn’t have to mean an ineffective approach to reopening—as Germany, Canada, and Australia can attest.  

Part of the reason countries that waited for a lull in new cases to begin reopening are in better shape now is that they had time to shore up their public health systems. Those that bolstered their testing, contact tracing, and isolation capacities during the lockdown period have an insurance policy: the ability to detect the new clusters of cases that will inevitably emerge as they reopen and to prevent these clusters from seeding full-blown resurgences of disease.

Several countries in the process of reopening have already demonstrated just how important these capabilities can be in the event of a new outbreak. In April and May, South Korea tested tens of thousands of people and did exhaustive contact tracing in order to isolate a cluster of cases in the capital, Seoul. Germany has also been able to respond quickly and effectively to recent outbreaks linked to a meat-processing plant and to several religious congregations. And China has shown that it can mount aggressive interventions to prevent new outbreaks of the disease: last month the government tested 11 million people in Wuhan after new cases were detected there, and earlier this month it locked down much of Beijing and began an enormous test-and-trace operation after new clusters of cases were detected in the capital.

By contrast, countries that didn’t shore up their ability to test, trace, and isolate before reopening have proved much less able to respond to new outbreaks. The United States and Brazil are in this boat, but so are the United Kingdom and, to a lesser degree, Sweden, both of which have relaxed restrictions and taken steps to reopen despite lingering questions about their ability to identify and contain outbreaks and to protect the vulnerable.

FLEXIBLE PLANS, CLEAR MESSAGES

Not everything is about timing and preparation, however. Flexibility and public messaging also matter. Scientists and public health officials have learned a lot about the risks associated with this virus over the last six months, but considerable uncertainties remain. As a result, countries that have taken more conservative and methodical approaches to reopening have been better able to pause or recalibrate their policies when faced with new outbreaks than those that have relaxed all of their precautionary measures at once. It was for this reason that public health experts recommend reopening in stages, starting with regions and activities that are lowest risk and moving progressively toward those that are higher risk.

Germany moved cautiously but deliberately in reopening and has now reached the point where all shops can serve customers, soccer matches can be played, and internal travel restrictions have been lifted.

With the requisite testing and tracing capabilities in place, governments that followed this approach have been able to monitor the effects of their reopening policies as they are implemented—enabling them to proceed to the next stage of reopening only after it is clear that they haven’t ignited a wave of reinfections. Germany moved cautiously but deliberately in reopening and has now reached the point where all shops can serve customers, soccer matches can be played (though without spectators), and internal travel restrictions have been lifted. Several U.S. states that mounted aggressive initial responses have followed this cautious approach, lowering community transmission before beginning phased reopening processes.

Just as important for managing the transition from lockdown to reopening is clear, science-based public messaging. Leaders in Germany, Ireland, New Zealand, and Singapore in particular have done an exemplary job of communicating their countries’ policies and the logic behind them. Unsurprisingly, these countries have enjoyed high rates of compliance with their lockdown and reopening policies, enhancing their effectiveness. The public messaging from leaders in Brazil and the United States, by contrast, has been inconsistent and even counterproductive, contributing to widespread confusion about the utility of masks, for instance, and undercutting compliance with official guidelines.

A REAL-TIME EXPERIMENT

It has been more than a month since many countries began to reopen, and there is little sign that the lifting of lockdowns has spurred a significant resurgence of COVID-19 in most places— though the number of new cases continues to grow in many parts of the world that never got their initial outbreaks under control. The countries that locked down long enough for transmission to die down, bolstered their public health systems, and approached reopening with flexibility and clear messaging have shown that a return to daily life need not spell disaster. Yet the success of these countries has been partially overshadowed by others, such as Brazil and the United States, that rushed into reopening without much preparation and are now paying a heavy price. Countries that have been reckless in their approach to reopening not only face preventable outbreaks within their own borders but pose spillover risks to countries that have managed their reopenings more responsibly, given the global nature of this pandemic.

Reopening during the coronavirus pandemic remains an experiment in real time. Effective public health systems can reduce the risk of new outbreaks, but even countries that reopen cautiously and with all the right capabilities are likely to see further outbreaks and may even face a dreaded “second wave” sooner or later. Vigilance, enhanced protections for the vulnerable, and agility in the face of uncertainty will be necessary for months—and potentially years—to come. Even the best plans for reopening can meet with unexpected realities on the ground, as was the case with the protests that upended stay-at-home orders and social-distancing guidelines in countries around the world. While it is reassuring to know that a road map for reopening is taking shape, it may need to be rewritten in the weeks and months ahead. 

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  • JOSH MICHAUD is Associate Director for Global Health Policy at the Kaiser Family Foundation and an Adjunct Lecturer at the Johns Hopkins University School of Advanced International Studies.
  • JEN KATES is Senior Vice President and Director of Global Health & HIV Policy at the Kaiser Family Foundation and an Adjunct Lecturer at the Johns Hopkins University School of Advanced International Studies
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