Gabriel Leung: Lockdown Can’t Last Forever – Here’s How to Lift It.!


Dear Commons Community,

Dr. Gabriel Leung, an infectious disease epidemiologist and dean of medicine at the University of Hong Kong, has an op-ed in today’s New York Times, entitled, “Lockdown Can’t Last Forever. Here’s How to Lift It.”  His piece gets quite technical at times and he explains in some detail a statistic – the Rt reproductive number.  The “effective” version of the Rt — or the reproductive number at time “t” — is the virus’s actual transmission rate at a given moment. It varies according to the measures to control the epidemic — quarantine and isolation protocols, travel restrictions, school closures, physical distancing, the use of face masks — that have been put in place.   An Rt of 1 means that the epidemic is holding steady: For every person who is infected, another one becomes infected, and as the first one either recovers or dies, the second one replaces it; the size of the total pool of infected people remains the same. At a rate below 1, the epidemic will fade out. Above 1, it will grow, perhaps exponentially.   An example of a Rt graph is above.

He summarizes his op-ed by posing the following questions:  “How long can the population accept the restrictions required to maintain that level of infections? Will people stop complying? Are their mental and emotional well-being being jeopardized?” And responds.

There is no right or wrong answer about the best way to respond to a threat as great and as complex as this pandemic. One can imagine a variety of individual views: “I’d rather protect the economy and take a chance with the epidemic”; “I’d rather take no chance and allow the economy to tank, partly because I’m sure it will bounce back in a year”; “I’m already going crazy after one week of lockdown; I can’t see myself sticking to this for three months.” This range is the reason the general public, especially in Western democracies, should have a chance to shape this discussion.

And yet, even though different communities will strike a different balance between these interests, the “suppress and lift” strategy is generalizable to all.

After achieving a sustained decline in the Rt and bringing the number of daily new cases down to an acceptable baseline thanks to stringent physical distancing, a society can consider relaxing some measures (say, reopen schools). But it must be ready to reimpose drastic restrictions as soon as those critical figures start rising again — as they will, especially, paradoxically, in places that have fared not too badly so far. Then the restrictions must be lifted and reapplied, and lifted and reapplied, as long as it takes for the population at large to build up enough immunity to the virus.

Trying to see our way through the pandemic with this “suppress and lift” approach is much like driving a car on a long and tortuous road. One needs to hit the brakes and release them, again and again, to keep moving forward without crashing, all with an eye toward safely reaching one’s final destination.

I strongly urge everyone to read Dr. Leung’s article.  It is sobering but makes a lot of sense.  We may be in for periods of lockdown/no lockdown or “suppress and lift” for quite a while and until a vaccine is develop for the coronavirus.




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