In order to delay the next wave, a dynamic unlock strategy is key
As the second wave ebbs, bazaars are witnessing crowds, and holiday destinations, especially hill stations, are overwhelmed by visitors. While restrictions needed to be eased, many states appear to have acted in haste, opening too much too quickly. This approach is in contrast with that of other countries such as the United Kingdom (UK), which prepared a detailed, granular opening up strategy, implemented over many months.
The timing and intensity of the next wave are dependent upon a combination of four factors — immunity after natural infection, people’s adherence to Covid-appropriate behaviours (CAB), vaccination coverage, and the emergence of new variants and their transmissibility. If people adhere to CAB and vaccination rapidly scales up, the next wave can be delayed and managed.
As governments continue to ease restrictions and as citizens leap back into the world, they must remember that the virus is still around; new variants are more transmissible; vaccination coverage is low; and the opening up strategy has to be science-based and graded. This can have the following components.
One, since we now know that the virus transmits through air (in addition to droplets), any strategy must be based on opening outdoor spaces first and then drafting and implementing a detailed strategy to open indoor spaces. The owners of indoor establishments should be encouraged and facilitated to improve ventilation in their shops. The government may allow such indoor establishments to operate partially from the outdoor space. This principle needs to be reiterated since some governments haven’t recognised that the airborne nature of the disease requires an emphasis on the outdoors.
Two, increase monitoring to track adherence to CAB. Professional agencies can be involved in real-time data collection, and academic institutions should analyse this data. This analysis should be used for a calibrated and evidence-based opening up as well as to design targeted communication strategies for the adoption of CAB.
Three, learn from other relevant settings. Bangladesh effectively used the NORM approach to increase mask-use in public places, where NORM stands for No cost (or free) distribution of masks; Offering Information about CAB; Reinforcing messages at public places and markets; and Modelling of behaviour by community leaders. Shopkeepers and resident welfare associations in urban areas and panchayats in rural areas should be actively engaged in the process.
Four, a granular strategy essentially means that in a manner similar to the creation of micro-containment zones (for residential areas) in the initial months of the pandemic, a dynamic micro-social behaviour determined strategy is needed to implement localised restrictions. If data reveals that any market or public area is crowded and adherence to CAB is low, there must be monitoring and action by engaging with the market association. The number of people allowed to enter such market areas should be controlled, and possibly temporary restrictions should be implemented. This has to be a participatory and consultative process between market associations and the government, but with self-monitoring by shop-owners.
The vaccination status of individuals should be used to facilitate the opening up of activities. This should be accompanied with targeted communication campaigns to tackle vaccine hesitancy and facilitate free vaccination of people involved in public dealings.
The test positivity rate and the number of active cases cannot be the only parameters to open up. People’s behaviour and scientific learnings should be the basis of an unlock strategy, with flexibility for adoption in the local context. It should also be implemented in a decentralised manner, especially through ward-level administrative units.
Unlock is not merely the removal of Covid-19-related restrictions but a strategy, between two waves of the pandemic, to slow down and halt virus transmission. If designed and implemented well, it can prove useful in increasing adherence to CAB and, hence, buy time to vaccinate more people.
Chandrakant Lahariya, a physician-epidemiologist, is a public policy and health systems expert and co-author of Till We Win: India’s Fight Against The COVID-19 Pandemic
The views expressed are personal
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