Exit strategies from lockdowns due to COVID-19: a scoping review

Abstract

Introduction In response to the ongoing COVID-19 pandemic, countries have adopted various degrees of restrictive measures on people to reduce COVID-19 transmission. These measures have had significant social and economic costs. In the absence of therapeutics, and low vaccination coverage, strategies for a safe exit plan from a lockdown are required to mitigate the transmission and simultaneously re-open societies. Most countries have outlined or have implemented lockdown exit plans. The objective of this scoping review is to (a) identify and map the different strategies for exit from lockdowns, (b) document the effects of these exit strategies, and (c) discuss features of successful exit strategies based on the evidence. Methods A five-step approach was used in this scoping review: (a) identifying the research question and inclusion/exclusion criteria; (b) searching the literature using keywords within PubMed and WHO databases; (c) study selection; (d) data extraction; (e) collating results and qualitative synthesis of findings. Results Of the 406 unique studies found, 107 were kept for full-text review. Studies suggest the post-peak period as optimal timing for an exit, supplemented by other triggers such as sufficient health system capacity, and increased testing rate. A controlled and step-wise exit plan which is flexible and guided by information from surveillance systems is optimal. Studies recommend continued use of non-pharmaceutical interventions such as physical distancing, use of facemasks, and hygiene measures, in different combinations when exiting from a lockdown, even after optimal vaccination coverage has been attained. Conclusion Reviewed studies have suggested adopting a multi-pronged strategy consisting of different approaches depending on the context. Among the different exit strategies reviewed (phase-wise exit, hard exit, and constant cyclic patterns of lockdown), phase-wise exit appears to be the optimal exit strategy.

Multiple Concurrent Causal Relationships and Multiple Governance Pathways for Non-Pharmaceutical Intervention Policies in Pandemics: A Fuzzy Set Qualitative Comparative Analysis Based on 102 Countries and Regions

“…When social distance exceeds 1 m, it can reduce virus infection to a great extent, and the probability of contracting the virus will be halved for every 1 m increase in social distance within a certain range [18]. Reducing population density at fixed sites can reduce the rate of virus transmission [19,20]. Public transport plays an important role in disease transmission and control [21,22].…”

Is SARS-CoV-2 elimination or mitigation best? Regional and disease characteristics determine the recommended strategy

“…Early in the COVID-19 pandemic, countries implementing an elimination strategy were praised for obtaining better public health outcomes, economic growth, civil liberties, and general population well-being [82, 10, 9, 43]. However, by late 2021, and especially with more people becoming vaccinated and the spread of the more transmissible Omicron (B.1.1.529) variant of concern, most countries had abandoned the elimination strategy [8, 26, 46], and the societal costs of strict restrictions were increasingly highlighted [13, 75, 118]. These observations indicate that neither elimination, nor mitigation is the indisputable optimal strategy, and that the preferred strategy may vary regionally and change over time.…”

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“…1 Many public health interventions have been tried to control this pandemic, including lockdowns, mask wear, and vaccinations. 2 , 3 , 4 However, lockdown intervention leads to a reduction of recommended levels of physical activity and an unhealthy lifestyle. 5 , 6 Besides, a reduction in physical activity and an unhealthy lifestyle are associated with obesity, diabetes, hypertension, and cardiovascular disease (CVD), all of which are risk factors for COVID-19 severity and mortality.…”