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After enduring weeks of coronavirus lockdowns, more than 100 million travellers in China flocked to key tourist sites this week, while businesses including barbershops, nail salons, and shopping malls reopened in parts of the United States.
Families separated by strict social-distancing rules in Italy reunited for the first time in two months, and Spaniards rushed out of their homes to exercise after being cooped up for seven weeks.
In Germany, churches, museums, and some schools opened their doors, while in Nigeria, the cities of Abuja and Lagos came to life after a month-long shutdown; the streets once again clogged with cars and minibusses.
With the new coronavirus exacting an economic toll unseen since the Great Depression of the 1930s – wiping out millions of jobs and raising the spectre of unrest and hunger – governments around the world are trying to chart a way out of prolonged lockdowns and beginning to phase out restrictions. But without a vaccine or widespread testing, health experts say some leaders are taking a “gamble” that could result in a new surge of infections and deaths.
“We are in unchartered territory,” said Dr Annelies Wilder-Smith, professor of emerging infectious diseases at the London School of Hygiene and Tropical Medicine. “Governments are having to strike a balance between this virus and the negative impacts of lockdowns on societies, including economic downturns, societal strife, and mental health concerns. It’s a large experiment.”
Indeed, researchers at the UK’s Oxford University, in a note published on May 1, say no countries fully meet the World Health Organization’s criteria to safely ease shutdowns.
The key among the agency’s six guidelines is controlling transmission to the level of sporadic or clusters of cases. Second is bolstering health sector capacity to contain future outbreaks, through widespread testing, rapid and effective contact tracing, as well as adequate infrastructure to support extended isolation and quarantine for positive cases and their contacts.
The Oxford study says only a handful of countries and territories come close to meeting the WHO measures. They include Taiwan and South Korea, which did not impose nationwide shutdowns but controlled the virus’ transmission with an early, swift and transparent test, trace, and quarantine campaigns.
Also ranked high on the two key measures is China, which imposed a strict lockdown, deployed an army of contract tracers, and utilised mass surveillance to contain its outbreak. And despite suffering a historic economic slump, authorities in Beijing only began lifting lockdown measures after daily infections fell and stayed for weeks at about 100 cases. In recent days, China’s cases have fallen to single digits, most of them involving travellers from overseas.
But many hard-hit nations in Europe – including Spain, Italy, and France – are moving to gradually reopen their economies despite recording more than 1,000 daily cases – based on a seven-day moving average.
“In Europe, the governments and the people have decided containment is not possible. We mitigate, we keep it under control, but we cannot totally contain it,” said Wilder-Smith, noting the number of daily cases marked a significant drop from peaks of between 4,000 and 7,000 daily cases in some countries.
“The intent is now to live in a compromised situation, where you live with this virus and try to find a balance between the economic standstill and the cases and deaths.”
Germany, notable in Europe for keeping deaths low despite recording a high number of cases, said its aim was to keep the rate of infections below a replacement rate of one-for-one so that cases decline over time and never overwhelm health systems.
The US, which has more confirmed cases than anywhere else in the world and more than 75,000 people have died, is taking a different path.
About half the country’s 50 states, concerned by record job losses and egged on by US President Donald Trump, have begun to lift restrictions despite rising infections. One model by Trump’s administration is projecting a rapid rise in daily infections and the doubling of deaths to 3,000 by June 1.
While small groups of Americans have protested against the lockdowns, a global survey published this week found about two-thirds of people globally felt governments should prioritise protecting lives over profit. The Edelman Trust Barometer surveyed people in 11 countries around the world including India, China, and the United States.
Wafaa El-Sadr, professor of epidemiology at Columbia University, said easing curbs in some states while the US remained in the grip of a pandemic was a “risk and a gamble” as “epidemics don’t know borders”.
“A major Achilles heel for many states in the US is the availability of sufficient testing capability,” she said. “Another challenge is the urgent need for a large cadre of health workers poised to do the hard work of going out into communities to expand testing, do case, and contract tracing.”
The US has so far conducted 7.5 million tests in total, but a Harvard University study estimates five million tests a day by June and 20 million a day by July would be necessary for a return to normal life. The Johns Hopkins University estimates the US needs to add an extra 100,000 contact tracers nationwide to keep the virus in check.
Dr Hadi Halazun, assistant professor of cardiology at Weill Cornell Medicine in New York City, blamed the US’s shortfall – in part – on the lack of guidance and coordination at the national level.
“I don’t see any leadership,” he said. “There has been very little federal guidance or a unified national strategy… There is a lack of awareness in many big cities. In places where the pandemic hasn’t struck as hard, it’s difficult to fathom what doctors are seeing inside the hospitals here in New York City.”
Iran, one of the hardest-hit countries in the Middle East, faces a wholly different calculus.
It began lifting lockdown measures in late April despite continuing to record more than 1,000 cases on a daily basis. President Hassan Rouhani on April 22 called reopening the economy, already struggling under US-imposed sanctions, a “necessity for the country”.
For Iranian leaders, keeping the lockdown in place risks protests such as those seen in November last year when tens of thousands took to the streets over economic hardship. The demonstrations posed the biggest challenge to the country’s rulers in decades and were swiftly quelled.
“There is fear that an economic meltdown in the wake of the coronavirus crisis could result in renewed protests. Bread revolts by the lower classes who are disproportionately affected” said Ali Fathollah-Nejad, a visiting fellow at the Brookings Doha Center.
In Lebanon, anti-government demonstrators who paused their protests during the country’s two-month-long lockdown returned to the streets in late April. They torched and vandalised banks in several cities as the economic disruption decreased the value of the Lebanese pound further.
Authorities allowed restaurants to open this week, but at 30-percent capacity.
In Africa, where infections and deaths remain comparatively low, officials and experts say the rising spectre of starvation is making prolonged lockdowns untenable.
In Nigeria, where millions live on daily wages, the lockdowns Abuja and Lagos have left many without money to buy food. The pandemic has also caused the price of oil, Nigeria’s main export, to plunge, adding to the country’s financial woes.
President Muhammadu Buhari, announcing the phased and gradual opening of the country’s most populous states, said: “No country can afford the full impact of a sustained lockdown while awaiting the development of vaccines.”
South Africa, which won praise from the WHO for its strict lockdown, is also beginning to ease restrictions as economic hardship worsens. There was looting in some areas during the shutdown, as well as violent protests over undelivered food aid.
African countries need to come up with strategies other than lockdowns, wrote Salma Abdalla and Sandro Galea at the Council on Foreign Relations.
African governments and donors need to further invest in rapid testing, contact tracing, and isolation. This can help isolate those with the disease quickly, limiting its spread, they said. A second proposal suggested targeted physical-distancing guidelines aimed at protecting those who are at high risks, such as those more than 70 years of age.
“The United States and Europe have failed at implementing testing widely, but time here is on Africa’s side,” they said.