In my opinion, exit strategies can be more testing of individuals.

To overcome the economic crisis there is need to maintain the employees with lower payment , but don't expelled them. Need to focus on largely manufacturing sector for more employment and income generation for companies. There is need for investment in steady phases.

I had a look at the papers and have saved them for future reading. My concern is that the exit may be carried out too early?

Interesting question Renaud Di Francesco .

I will watch the responses with keen interest.

I am not an expert in this area, but I would advocate for a "staged exit."

Mary C R Wilson you hit the pain point: how to release the pressure of a universal "stay at home" progressively, without triggering an aggravated propagation of the pandemic.

There has been material shared here:

US National Academy of Medicine,

COVID-19 conversations webinar 1 The Science of Social Distancing, Part 1

link:

https://nam.edu/event/webinar-the-science-of-social-distancing-nam-apha-covid-19-conversations-series/

and there have been earlier studies on the 1918 influenza pandemic and how the trigger/release achieved results or not on the multiple comparable cases of US cities then:

Public health interventions and epidemic intensity during the 1918 influenza pandemic

Richard J. Hatchett, Carter E. Mecher, and Marc Lipsitch

link:

https://www.pnas.org/content/104/18/7582

Now there may be strategies to "select" (dangerous word, to use with extreme care and democratic control) categories and regions fairly, to avoid any re-infection spread.

Some claim "free the young", other "choose regions clear of infection".

There may be the need for accompanying measures like continued social distancing, compulsory mask in public (there are accounts of a person shot by the police in San Francisco in the 1918 pandemic for refusing to wear a mask).

Hence, what scenarios would you envisage? Which steps?

Lock down strategy difficult to implement because our people so disobedient.

We are luck, they closed the airport and banned public transport.

Maybe Uganda has low cases less than 60 cases due to those strategies.

I am pleased to share with you the announcement of an online event of the US National Academy of Medicine:

Webinar: Emerging Evidence on COVID-19 Spread and Treatment (NAM-APHA COVID-19 Conversations Series)

this is on 9 April, free upon registration at:

https://nam.edu/event/webinar-emerging-evidence-on-covid-19-spread-and-treatment-nam-apha-covid-19-conversations-series/

Agenda

12:30 pm | Welcome 

• Victor J. Dzau, MD, President, National Academy of Medicine

12:32 pm | Introductory Remarks

• Margaret “Peggy” Hamburg, MD, (moderator) Foreign Secretary, National Academy of Medicine

12:35 pm | Expert Panel Discussion

• COVID-19 Surface and Aerosol Stability and Transmission
  • John-Martin Lowe, PhD, Assistant Vice Chancellor for Inter-professional Health Security Training and Education, College of Public Health, University of Nebraska Medical Center
• Emerging and Promising Treatment Modalities
  • Arturo Casadevall, MD, PhD, Chair, Molecular Microbiology & Immunology, Johns Hopkins Bloomberg School of Public Health
• Ethics of Utilization of Untested Therapeutics
  • R. Alta Charo, JD, Warren P. Knowles Professor of Law and Bioethics, University of Wisconsin at Madison

1:20 pm | Audience Q&A

1:55 pm | Concluding Remarks

2:00 pm | Adjourn

*Subject to change

RECOMMENDATIONS from French National Academy of Medicine for future exit of lockdown in France. Proceed step by step, by location not age category.

See their recommendation translated in English using google translate:

[French source here:

http://www.academie-medecine.fr/communique-de-lacademie-covid-19-sortie-du-confinement/

]

Covid-19: release from containment

Press release from the (FRENCH) National Academy of Medicine

April 5, 2020

The Covid-19 epidemic curve shows that a plateau is starting in the 53 Member States of the WHO Euro zone. [1]

In the absence, to date, of vaccine, of demonstrated effective antiviral treatment, and in a situation of shortage of masks and diagnostic tests, force has been, in France as in many countries, to resort to the method of containment of the home population.

The purpose of confinement was to slow the spread of the virus and to attenuate the brutality of the influx of patients in health establishments, in particular the most serious cases in the intensive care units whose capacities are limited. This confinement has a strong economic and social impact.

The French Government has provisionally fixed the end of the confinement period at April 15, 2020.

So that the release from containment is done in the best conditions of treatment of serious cases in health establishments, limitation of the spread of the virus, resumption of professional activities, and understanding by the public, the Academy National Medicine recommends the following principles:

- That the exit from containment be decided on the basis of the Region and not by age class;

- That this discharge is only authorized in Regions in which a net decrease in the number of Covid-19 patients requiring hospitalization and a return to resuscitation needs in the pre-epidemic state are observed;

- That people residing in a Region emerging from confinement are not authorized to go to a Region still in a confinement situation;

- That the decision concerning the border regions be taken in concert with neighboring states;

- That the release from confinement be accompanied by the maintenance of the ban on gatherings (except in exceptional cases, such as funerals, for which the maximum number could be 20 people), the maintenance of sanitary barrier measures (hand washing, hydro gel -alcoholic ..), but also of their reinforcement by the compulsory wearing of a general public anti-projection mask, even if it was handcrafted, in public space. [2] This last obligation would be the mark that the exit from containment is not yet a return to normal life and it should be maintained until the transmission of the virus is stopped (absence of new cases in the last 14 days);

- That the arguments for the decision to exit or maintain containment be developed Region by Region, in order to ensure the best possible understanding of the population concerned;

- That the decision to exit containment is not based on the results of individual biological tests, the availability and reliability of which do not appear to be guaranteed in the short term, and the operational implications of which will cause confusion;

- That serology studies (Elisa test) for epidemiological purposes in the general population be initiated as quickly as possible throughout the country on a Regional basis, with a view to assessing the risk of the occurrence of a second epidemic wave.

- That, by all means, scientific, technical, industrial and regulatory, and at all levels, French, European and worldwide, the development, then the production, of a vaccine be accelerated.

Considering that the measures that will be taken during the phase of confinement will have the objective of protecting health, the National Academy of Medicine invites the population to be informed about the health benefits of these measures and encourages them to respect them.

[1] World Health Organization, Coronavirus Situation Report 75, April 4, 2020

[2] National Academy of Medicine, Press release of April 2, 2020 on “Covid-19 pandemic: reinforced barrier measures in containment phase and for exit containment "

Great question - here are some possible answers

Article COVID-19 Community Stabilization and Sustainability Framewor...

Thanks for sharing this interesting article.

It might be useful to also consider the impact of lockdown, and the subsequent propagation of the disease inside a household, which can unfortunately be very quick when one member of the household is infectious at lockdown:

-the article here studies three use cases, including a household in lockdown, for which it produces a model to estimate the speed of transmission

Preprint Covid19-transmission-model-Elderly Care Home-etc-2020-04-28

Good question indeed! Should be more calculated during exit.

Developed country can mange but look at the real scenario of low and middle income countries after the lockdown. Crowds are everywhere not only for earning but also for their traditional behavior. Sometimes they have to trade off between risk and hunger.