Lockdowns affecting entire populations is a price countries pay for failing to ensure people with coronavirus and their contacts self-isolate, according to an expert from the World Health Organization.
The WHO does not recommend that countries enter lockdowns. It has consistently said that the key to controlling epidemics, whether Covid-19, Sars or flu, is to test people, trace their contacts and ensure all those who are positive or who have been close to those infected are quarantined.
While countries like the UK have been massively increasing the numbers of tests carried out, contact tracing has fallen short, and studies have shown that as few as 20% of people in England fully comply with self-isolation.
“For me, the big missing link in what’s going on in many European countries is management of isolation,” said Dr Margaret Harris of the WHO. “That’s not just isolation of people who are sick – it’s isolation of people who have contacts and are first-degree contacts.
“They don’t think they have Covid, because they feel fine, and even if they are told they should stay home, they don’t feel a strong social obligation or they do not necessarily have that reinforced as happens in some countries.
“So for instance, in a place like Hong Kong, you would be called every day, or the police come to your house,” she said.
Across Asia, there is a mixture of economies that have managed the virus well – not just those that may be non-liberal, non-democratic command economies, she added. “Taiwan, for instance, probably has the best management. They are definitely a highly liberal society.”
A lockdown which effectively isolates everyone does work, Harris said, “but it also causes massive dislocation, massive disruption. And unless you’ve worked out how you can possibly put that pause button on and maintain your economic and social lives, the price you pay is very, very high.”
The WHO doesn’t say don’t do it, she said. “We just say, if you’re doing it, you’re paying a very high price, so therefore get some return for what you pay.”
That means getting test and trace to work efficiently “and you could think very hard about how to make self-isolation doable” she said.
“You’ve got to do it at grassroots level, because it’s very different, say, in London from somewhere rural, it’s different in housing estates, you may have people living on the streets, you may have people living in institutions. So, you have to really know your society, and know how you’re going to make it possible for them to self-isolate.
“There will be people who cannot possibly self-isolate, because they live in crowded conditions or on the streets. You may have to think of offering them somewhere else to stay.
“It does require a lot of planning. It requires a lot of a great deal of partnership with community and with local authorities, and really listening to your mayors and your councils and all the people in your local groups or your NGOs who understand how communities really function and ensure that you’re reaching everyone.
“You might have communities who don’t have access to standard English-language channels and all the rest of it, and don’t really know what is being asked of them or whether it’s possible.”
Harris said that some countries, such as Hong Kong, isolate those who have Covid-19 by putting them in hospital with even mild symptoms, which means it is far easier and quicker to spot those who deteriorate and treat them, saving lives. Early medical monitoring helped with getting people the right treatment, she added, and although it’s not yet clear, getting earlier care to people could also save some from the after-effects known as long Covid.