The first steps after confinement: this way we will return to normal life
Half a dozen experts explain how the measures will be de-escalated. The start can happen by allowing outings to the street alone or with children
As the Covid-19 pandemic progressed, countries and international organizations were developing guides on the measures to adopt: detect and isolate cases, when they should start social distancing, how… What they have not yet published is a manual on how get out of them. It is not an exact science. It will depend on trial and error, experts acknowledge, in a process in which governments will learn from failures and successes, both their own and those of others.
Since confinement, both citizens and authorities and researchers have their sights set on how they will return to normal. EL PAÍS has consulted half a dozen specialists in public health. Everyone insists that it will depend on how the epidemic progresses and that it will be discovered how many people have actually passed the disease to know the degree of immunization of the population, at least theoretically, because even this there is no scientific certainty. And to discover this, tests will be necessary; many (millions) and with sufficient quality, something that, given the international market, is not so simple.
The respondents also agree that the defrosting measures will not be taken at once. Once the transmission levels are low enough, the hand will gradually be opened, allowing more activities and it will be checked with very strict vigilance if there is any regrowth. It would not be unusual, epidemiologists explain, that there are measures that have to be reversed. There is an example in China, which opened 600 theaters and cinemas and had to close them again soon.
It may also happen that they are not for everyone equally. As Antoni Trilla, an epidemiologist and member of the Government’s advisory team, points out, it is likely that older people or those with certain pathologies will have to prolong their confinement more than healthy young people. “We will have to adjust the age, if over 55, 60 … what everyone is clear is that it will affect those who are over 65 or 70”. Trilla even talks about issuing something like a “sanitary pass” so that people who have already passed the disease and, supposedly, have immunization, can join a normal life sooner after passing an antibody test. It is something that countries like Germany or the United Kingdom are studying.
This would be especially useful in healthcare, where knowing which professionals have passed the Covid-19 would be crucial to pose the answer. “We will not have services as until now, but there will be a separation. It will be necessary to avoid attending to respiratory symptoms in the same place as other illnesses so that possible cases of Covid-19 do not share waiting rooms with those who use them the most: the elderly and vulnerable people, ”says Ildefonso Hernández, professor at the Miguel Hernández University and spokesperson for the Spanish Society of Public Health (Sespas).
Some epidemiologists also speak of a possible differentiation by autonomous community. Not all of them are going through the same moment of the epidemic, so it may make sense that not all measures are identical and at the same time for them. Daniel López Acuña, former director of Sanitary Action in Crisis at the World Health Organization (WHO), believes that it will be “complicated” because for this, areas should be “compartmentalized and sealed”. “If you start going to or from hot areas, you run a high risk of reintroducing the virus to a place where it was no longer there,” he adds.
The last report on measures of social distancing of the European Center for Disease Control, on March 23, recommended deciding and announcing to the population an end date as soon as possible, although it added that the body is studying how those strategies should be. They depend on so many factors that any forecast runs the risk of being wrong. The group of experts advising the Government is in full debate; WHO will also publish recommendations “the next few days,” according to an adviser to the agency. No one knows exactly what decisions will be made or when they will arrive, but there is a rough idea of how they should be.
The first exits to the street
There is unanimity that practically the entire month of April the containment measures will continue. The Prime Minister, Pedro Sánchez, announced on Saturday that he will extend the state of alarm for another 15 days until April 26 and that, in one way or another, it will go much further. The first step, he assured, will be to return to the first measures starting on the 11th, recovering the non-essential activities that were canceled a week ago.. Most of the experts consulted are also optimistic that soon they will be able to open their hands and start allowing sporadic and solitary outings, as well as taking children out on the street. The Health Minister, Salvador Illa, said this week in Congress that this possibility is “being studied”. “I think that for example, it would be possible to start allowing sports very soon, to go out running individually and in a controlled and separate way, so that parents can walk with their children, even if it is close to their homes and over short distances, provided they make sure that social distancing is fulfilled ”, says Pere Godoy, president of the Spanish Society of Epidemiology (SEE). “Allowing walks could be a first step, but with a lot of discipline in the distance and alone,” adds López Acuña.
The coming week will be key to know the progress of the epidemic and check the resistance of the ICUs at the most critical moment. With this information in hand, it will probably be outlined to what extent and when restrictions such as this will be relaxed. “Some way out must be given: young children cannot stay home that long, or they and their parents will go crazy,” reflects Trilla.
Back to school
More and more universities have already ended face-to-face classes. It is not so clear what will happen to the schools, whose end of the year coincides approximately with the deadlines that the experts consulted consider that a return would be sensible. In general, they believe that during practically all of May, activities involving crowds of people will be very limited, or even suppressed. “I find it difficult to return to school this course, because although the illness in children is generally mild, if the virus enters a school or kindergarten, they will all become infected, take it to the family and expand again Godoy reflects. Ten autonomous communities have already postponed the EVAU to July, assuming that before it will be impossible to carry out the old selectivity, while another 10 are waiting to set a date due to uncertainties about the progress of the epidemic.
Returning to work and teleworking
Just as not everyone stopped working at the same time, not everyone will return to their jobs at the same time. “I think that it is necessary to facilitate as soon as possible the return to work of the youngest and those who are already immunized. Among other things to try to sustain the economy that sustains us all, “says José María Martin Moreno, professor of Medicine and Public Health at the University of Valencia. “The criterion would always be that we could do those things that bring us as close to normal as possible and that can be done while maintaining a certain social distance. It is necessary to study how this is done in those essential productive activities, so that they can return to work. Many are outdoor activities such as construction, or highly industrial sectors,
Respondents agree that teleworking will be extended beyond the end of confinement where possible. “As long as he can, he will stay,” says Trilla. “Everything that can be done from home must be done; and it is quite a lot ”, adds López Acuña. “It is not suitable for everyone, but it will become more and more consolidated, since it is capable of minimizing the consequences of processes with contagious infectious diseases, or with adverse meteorological phenomena,” adds Martin Moreno.
Bars, restaurants and events
The return to social life as we knew it is perhaps the most difficult point to make for public health specialists. They insist that it will depend on the evolution of the epidemic, the ability to carry out massive tests and to thoroughly control each suspected case in case they have to be isolated or, even, go back on some decisions. A widespread opinion is that perhaps, to begin with, it will be necessary to reduce the capacity of establishments. “We have to get used to being wider,” says Trilla.
“Many of these measures seem like common sense, but they must be discussed in order to have a perspective, including the entrepreneurs themselves: there are businesses in which if the capacity is very limited they are not profitable. We will have to balance this with security to find the balance. It is also necessary to understand population psychology: if they see that the establishments are limited, they will perceive that there is a risk and perhaps they will not even go, “reflects Rodríguez Artalejo.
Ildefonso Hernández also mentions this balance: “It is difficult to have such an important part of the economy closed. Perhaps, in principle, as the good weather arrives, you can take advantage of the terraces, always with maximum hygiene measures and constant handwashing by the waiters ”.
It is very difficult to anticipate dates on when all this can be happening, including concerts and sports shows. “With social congregations it would be ultra-cautious and would not allow or encourage them throughout the month of May, because there is a risk of amplification of the disease, and that is what we want to avoid,” adds López Acuña.
“We will surely enjoy concerts, festivals and massive sporting events again”, thinks Martin Moreno, although, he adds, at the beginning, measures that until now were not usual should be taken, such as less dense seating, allocation of seats and hygiene measures that also involve the public itself, “which should be part of the solution with proper behavior.”
How will the summer be
“It is going to be a very familiar summer,” says Trilla. “It will not be normal at all because tourism will not recover,” he continues. Can we go to the beach? The further away the forecasts are, the more difficult it is to hit them, but the majority opinion is yes. “It is reasonable to think that one will be able to enjoy many outdoor leisure environments, including the beach, as long as it is not overcrowded,” says Rodríguez Artalejo.
Martin Moreno believes that if the comparison of summers in recent years is used as “normal”, “it will be different”: “As I mentioned, density and crowding will decrease, especially in closed premises. But I do hope that we can go to the beach and I am convinced that we will have great opportunities to live life with affection and intensity and to enjoy one of the benefits of this period of confinement: the best quality of air and water at have decreased pollution ”.
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