Coronavirus explainer: Testing, lockdowns and exit strategies

For all you need to know about coronavirus testing, lockdowns and exit strategies in one place, New African provides a handy explainer

Despite many warnings, including from billionaire philanthropist Bill Gates five years ago in what has become a famous Ted talk, the coronavirus pandemic has caught the world off-guard.

Governments are reacting as the situation unfolds, adapting measures that would have been unthinkable a few months ago, including confining half the world’s population to their homes after enforced lockdowns from New York to New Delhi and Casablanca to Cape Town.

Advice from governments, WHO and scientific centres of research is continuously evolving as they get to grips with the virus, how it’s transmitted and the best way to mitigate the damage it has inflicted, from both a health and economic perspective.

Governments have used different tactics and strategies to limit the impact, with varying results. Here we identify the techniques that have been used and to what end.

Testing

This has stirred wide debate. Countries such as Germany, South Korea, the UAE, Iceland and Singapore have won plaudits for the amount of testing they have done. But how does it work and is more really better?

There are two types of tests that you will hear scientists and governments talk about. There is the antigen test, that tells you whether you have the virus and there is the antibody test that tells you whether you’ve had the virus. The latter is not yet on the market and has not been validated but is seen as critical as part of a post-confinement strategy.

You will have heard the WHO say Test, Test, Test. Countries have been using the antigen test, in a strategy that is called Test, Trace, Contain. If a person tests positive, you limit the spread of the virus by ensuring you trace all the people that person has been in contact with and effectively ask all of them to quarantine, thus breaking the chain of transmission.

This has worked well in South Korea, Singapore, Taiwan and other countries that have caught the virus early. Timing is key. You also need to have the resources to be able to test massively.

Having suffered and learnt from the SARS epidemic a decade earlier, countries in South East Asia managed to react quickly when China announced this new virus to the world and deployed rapid testing and containment programmes.

Testing in itself is not a cure but it helped suppress the virus in those countries. It is the most effective way of suppressing the virus whilst not having the put the whole country under lockdown, like we have seen elsewhere.

In Asia they have also been using smartphones to help data tracing, tracking people’s movements, where they’ve been and who they’ve been in contact with. Thus, if someone tests positive you can quickly inform the people that person has been in close contact with, to then get them to quarantine and again break the chain of transmission.

This does raise a number of moral questions in terms of personal data. It effectively means that the authorities are operating a mass surveillance scheme and collecting a lot of personal data. In Singapore, to avert this problem, the phone app is voluntary and the data is destroyed after 28 days.

Acting fast and decisively is therefore critical with this highly contagious virus. With the flu one person typically infects 1.3 people, but with Covid-19 the figure may be as high as 2.5 people – this is called the reproduction rate. The spread of the virus is exponential; 2.5 other people may be directly infected, but each of them will pass it on to another 2.5, and after 10 rounds of infection it will have reached over 2,000 people. 

If you don’t catch the contagion early and the virus has spread to a large proportion of the population, as it did in France and the UK, testing becomes less effective as a means of containing the virus. The virus was so widespread that the way to stop the situation from getting out of control was to limit contact and adopt country-wide lockdowns.

Testing in those countries is reserved for the very ill patients coming to hospitals (to ensure they are properly diagnosed and thus treated with other Covid-19 patients) and critical staff (doctors, nurses, care workers, ambulance drivers etc).

Where testing capabilities are limited or there is a fragile healthcare system, as is the case in most African countries, the same strategy of lockdowns and home confinement has been adopted. Morocco moved very quickly after seeing what was happening in Spain and other African countries followed quickly. Given that the virus was “imported” from travellers who had contracted it abroad, countries also closed their borders.

The main challenge in developing countries such as those on the continent or in other countries such as India, is the large informal sector and those that earn a living on a day-to-day basis. Confinement also means people are “compressed” in small living spaces, which can also mean the virus will easily spread. Hence the debate whether confinement as a strategy works in developing countries.

To ensure citizens follow the advice to stay in, governments such as that of Rwanda are delivering food baskets to those most in need and applying cash handouts on a massive scale.

It is too early to say whether we have contained the virus on the continent (the virus can have an incubation period of up to two weeks before showing any symptoms) but South Africa has recently won plaudits for its testing and containment policy. It has also managed to conduct large amounts of testing including in the townships.

What lockdowns really give us is time. Slowing the spread of the virus allows us to win time to put in place the necessary mitigation policies. That is, increase capacity in the health system and develop the mechanisms to contain the virus whilst keeping the economy functioning.

This is what we are seeing in China and other countries in Asia where business activity has more or less resumed to pre-virus levels. Once you lift lockdowns, testing becomes a critical and the only effective mechanism to keep a lid on the virus.

This is also when the antibody test becomes effective. It is said that, like the flu, you will develop an immunity to the virus – or at least the current ‘version’ of the virus. How long this immunity lasts is still being debated, but if you’ve had it the likelihood of you catching it again is slim, which means you cannot catch it nor spread it.

Testing (on a mass scale) will also be important to ensure the virus does not re-emerge, or if it does that it is quickly suppressed.

What next? Exit strategies

So when will life return to normal? That is the question on everyone’s lips – what’s the exit strategy from these lockdowns?

There is currently no treatment for the virus: no vaccine; no pharmaceutical treatment. A French institute in Marseille says that hydroxychloroquine (medication used against malaria) is effective but no proper clinical trials have yet been finalised to confirm this.

Countries in Asia, if not back to full activity, are open for business. The rest of the world is in effective lockdown. Until they find a vaccine or an effective treatment, the likelihood is that they will lift the curbs slowly and reduce the restrictions either region by region, or sector by sector, whilst continuing to shield the most vulnerable. Borders will open up slowly, but don’t expect it to happen overnight. Countries with fragile economies and fragile health systems will not want to import the virus a second time round.

Countries that will want to get back to business will have to undertake mass testing of those not previously tested (to determine who may have caught the virus and built some immunity) as well as to continuing testing anyone showing any symptoms to help trace, track and contain.

Vaccine and pharmaceutical labs are working around the clock to find some treatment. The good news is that if the virus has spread at an alarming rate – and it is its insidious and contagious nature that differentiates it from Ebola, SARS and other outbreaks we have experienced recently – scientists working on the vaccines are also advancing quickly. They anticipate a vaccine, which historically is a long and laborious process to get to market, in the next 12-18 months. Previously it would have taken 20 years!

Masks or no masks? 

The advice on masks has changed over the past six weeks in terms of the wider public and today countries such as Austria are imposing the wearing of masks for anyone visiting public places such as supermarkets. Advice has changed in the US and other countries in Europe. In Asia, the wearing of masks to protect against infection is deep-rooted, but not for the reasons that we may think. It’s done more to protect others than to protect oneself.

Masks are useful in two ways: they stop you from touching your face (which is how the virus is transmitted, by picking up the protein off a surface and then transmitting it to your mouth, nose or eyes); and if you do have the virus, the mask stops you from contaminating others by capturing the droplets that you would be spreading through breathing, coughing or sneezing.

Some masks can also limit the droplets that you would inhale (droplets in a non-ventilated room can stay in the air for up to 45 minutes according to the latest reports).

But there are caveats: you need to wear the mask properly and depending on the make and model you need to respect the wearing time.

A mask can therefore help limit the contagion but it should not lull you into a false sense of security. It is there more to protect others from your germs. You will still need to disinfect your hands from either washing or alcohol-based gels before and after putting on and taking off the mask.

Keep safe, and whatever you do make sure to challenge what you get sent on social media. Misinformation is rife!

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