Coronavirus: World Health Organization releases criteria for countries to consider when lifting lockdown

As countries consider lifting strict restrictions introduced to limit COVID-19's spread, the World Health Organization (WHO) has warned this decision must be based on "protecting human health".

Both Spain and Italy - two of the world's COVID-19 hotspots - have begun gently easing strict lockdown measures implemented last month to combat the deadly respiratory illness. Spain is allowing factory workers to return to work, while Italy is allowing some shops to reopen. New Zealand, which introduced some of the world's toughest rules nearly three weeks ago, will consider whether to lift its lockdown on Monday.

The WHO warned on Tuesday that countries' decision to lift restrictions should be "based first and foremost on protecting human health", just as the choice to implement them was. The world is still only learning about SARS-CoV-2, the WHO stated, but evidence shows it is 10 times more deadly than the 2009 flu pandemic, "spreads fast" and "decelerates much more slowly". 

"In other words, the way down is much slower than the way up," WHO Director-General Dr Tedros Adhanom Ghebreyesus said in a press briefing on Tuesday morning (NZ time).

"That means control measures must be lifted slowly, and with control. It cannot happen all at once."

Dr Ghebreyesus said WHO will be releasing updated strategic advice on Wednesday summarising what it has learnt about the virus. That will include six criteria for countries to consider when lifting restrictions:

  • Transmission is controlled
  • Health systems have the ability to quickly detect, test, isolate and treat new cases as well as to trace close contacts
  • Outbreaks are "minimised" in some settings, like health facilities and retirement villages
  • Preventative measures are put into place in workplaces, schools and shops
  • Importation risks are managed
  • Communities are educated, engaged and empowered to adjust to a "new norm".

"Every country should be implementing a comprehensive set of measures to slow down transmission and save lives, with the aim of reaching a steady state of low-level or no transmission," Dr Ghebreyesus said.

"Countries must strike a balance between measures that address the mortality caused by COVID-19, and by other diseases due to overwhelmed health systems, as well as the social economic impacts."

He said that the development and delivery of a "safe and effective vaccine" will be needed to "fully interrupt transmission", and that the world can expect that "the risk of re-introduction and resurgence of the disease will continue" due to our global connectedness. 

Modelling released last week found that in an "optimistic" scenario New Zealand could contain the virus after its four-week lockdown if fast contact tracing was underway. Our current daily numbers track similarly to that "optimistic" view, however, in "realistic" or "pessimistic" scenarios, New Zealand could see another outbreak if the lockdown was lifted. Having the lockdown in place for 45 days would likely see the virus contained while a 90-day lockdown could see it eliminated.

An influential paper from the Imperial College of London last month noted that countries will need to maintain some form of restrictions until a vaccine is developed "given that we predict that transmission will quickly rebound if interventions are relaxed". That may mean lifting lockdown measures but quickly ramping restrictions back up if there is a spike in cases.

New Zealand has 1349 COVID-19 cases, and five deaths. Over the last week, the number of cases reported daily has trended downwards, suggesting Aotearoa is turning a corner and that lockdown measures are working. However, officials have warned people not to become complacent.

There are 1.9 million cases of the illness around the world, with nearly 120,000 deaths.

What we know about the coronavirus

The WHO was first notified of cases of the virus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) in Wuhan, China on December 31. It was identified as a coronavirus on January 7 and can spread via human-to-human transmission. It causes the coronavirus COVID-19 illness.

The virus is primarily spread through droplets in the air after someone sneezes or coughs, however, it can also be contracted by touching surfaces where the illness is present. The length of time the virus stays alive on surfaces isn't fully understood, but some studies have suggested that on some materials it could be for days.

"Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death," the WHO says.

"Standard recommendations to prevent infection spread include regular hand washing, covering mouth and nose when coughing and sneezing, thoroughly cooking meat and eggs. Avoid close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing."

There is currently no vaccine for the sickness.