… e um pouco menos de crença nos poderes imensos do “pensamento positivo”. Deixo uma onga citação, para quem tiver preguiça em ler o original.
Lessons learnt from easing COVID-19 restrictions: an analysis of countries and regions in Asia Pacific and Europe
There is increasing realisation that removing COVID-19 restrictions is not about returning to the prepandemic normal but about gradually and cautiously transitioning to a new normal, while being ready to reimpose measures if, and when, necessary. Nonetheless, countries have diverged in terms of the speed, scale, and intensity at which they have implemented similar interventions, and differences can be observed between Asia and Europe in this regard. For example, many Asian countries, except Japan, promptly did extensive testing, tracing, and isolating of all cases (ie, not just severe cases) from the start of the outbreak, strengthened by innovative surveillance technology, whereas these processes have been considerably delayed in most of Europe, except Germany. Furthermore, confirmed cases are mostly isolated at institutions in Asia rather than at home, such as in Europe.
Wearing of face coverings to protect others has also been adopted to a much greater extent in Asia than in Europe. These differences should be regarded against the background of experiences with past pandemics and economic policies adopted in the years leading up to this current crisis. In Europe, more than a decade of austerity measures have substantially weakened health systems and social protection in many countries. By contrast, major epidemics, such as SARS in 2003 and MERS in 2015, drove many Asian countries to invest in building robust health-care and public-health infrastructure that would be well equipped to handle the next outbreak. The public has also been better conditioned to cooperate with strict rules and invasive surveillance in times of crisis compared with the public in countries without experience of major epidemics, with most people accepting a trade-off between their personal rights and the public good.Although the future of COVID-19 is unknown at present, countries should plan and prepare for the worst-case scenario. It is not too late for the following lessons to be learnt and applied now. First, as described here, countries can move forward mainly on the basis of the epidemiology or on the epidemiology in combination with other considerations; however, a clear and transparent plan that describes which factors are being taken into account is essential. Ideally, these plans should explicitly state the levels or phases of easing restrictions, the criteria for moving to the next level or phase, and the containment measures that each level or phase entails.Second, countries should not ease restrictions until they have robust systems in place to closely monitor the infection situation. Although much has been said about the use of R as a decision-making indicator, it requires data of high quality in real time (eg, use of R in Hong Kong) and it needs to be interpreted in the context of a good understanding of the epidemiology.For example, a small localised outbreak can increase the R value for the whole country, but it does not necessitate a nationwide lockdown.
Third, continued measures to reduce transmission will be needed for some time. For example, decreasing interactions to a few repeated contacts to create social bubbles, as pioneered by New Zealand, can allow interaction while reducing transmission. It is now accepted that cloth face coverings can significantly reduce person-to-person transmission, with one German study reporting that the use of face coverings reduced the daily growth rate of reported COVID-19 infections by 40–60%..Crucially, governments should educate, engage, and empower all members of society, especially the most vulnerable, to participate in the pandemic response. Rather than crafting these measures on the basis of assumptions about what communities can or cannot accept, citizens should be directly involved in the process of coproducing tailored solutions appropriate for the local context.Fourth, each country should have an effective find, test, trace, isolate, and support system in place. Preliminary data for testing suggests that identifying and isolating mild and asymptomatic cases can significantly reduce R, health-care burden, and overall fatality.
The novel drive-through and walk-through screening models in South Korea that encourage proactive testing of potential case contacts offer a safe and efficient way to expand and enhance case finding.A modelling study has also suggested that institution-based isolation, as adopted by some Asian countries, is more effective than is home-based isolation at reducing household and community transmission.
On contact tracing, app-based tracing is estimated to stop transmission if there is a 56% uptake rate in the population, and can be effective at slowing transmission at lower uptake rates.However, digital tracing cannot replace traditional manual tracing. As more evidence becomes available, some of these strategies might be able to aid countries in maintaining viral suppression and avoiding return to a full lockdown.Fundamentally, this find, test, trace, isolate, and support system needs to be supported by sustained investment in public-health capacity and health-system capacity in terms of facilities, supplies, and workforce. WHO and the International Monetary Fund have jointly appealed for governments to prioritise health expenditures, which should go hand in hand with training and retaining skilled workers to fuel economic recovery.
Finally, the argument is strong for countries adopting a so-called zero-COVID strategy, which aims to eliminate domestic transmission. The New Zealand experience shows that this strategy is challenging but is an important aspiration, not least as the growing burden of so-called long COVID becomes apparent in people who have survived COVID-19 but continue to have symptoms for longer than expected.
As more countries start to reopen their borders, screening tools and quarantine measures become essential to identify potential cases and prevent further transmission in the community. To ensure that control measures are adequate, it is important for countries to review and optimise these processes regularly.