WHEN TO LIFT COVID RESTRICTIONS

The World Health Organization (WHO) warned countries on Friday to be cautious about lifting restrictions introduced to curb the spread of the new coronavirus and voiced alarm it was taking hold in Africa.

The United Nations agency would like to see an easing, but at the same time "lifting restrictions could lead to a deadly resurgence," WHO Director General Tedros Adhanom Ghebreyesus told a press conference.

He said there had been a "welcome slowing" of epidemics in some European countries - Italy, Germany, Spain and France - but there had been an "alarming acceleration" elsewhere including community transmission in 16 countries of Africa.

Nearly 1.5 million confirmed cases of COVID-19 and more than 92,000 deaths have been reported to the Geneva-based agency, Tedros said.

Yemen reported its first case of the novel coronavirus on Friday as aid groups braced for an outbreak in a country where war has shattered health systems and spread hunger and disease.

Tedros said he was particularly concerned by the large number of infections reported among health workers.

"In some countries reports of up to 10 percent of health workers being infected, this is an alarming trend," he said.

A new U.N. supply task force will coordinate and scale up the procurement and distribution of protective gear, lab diagnostics and oxygen to the countries that need it most.

"Every month we will need to ship at least 100 million medical masks and gloves, up to 25 million N-95 respirators, gowns and face shields, up to 2.5 million diagnostic tests and large quantities of oxygen concentrators and other equipment for clinical care," he said.

The World Food Program - the U.N. agency that handles logistics - will deploy eight 747 aircraft, 8 medium-sized cargo aircraft and several smaller passenger planes to transport the goods and aid workers needed in the operation which will have 8 hubs, he added.

Tedros urged donors to contribute to WFP's operation which will cost an estimated $280 million, while the cost of procuring supplies will be "much greater".

Michael Ryan, executive director of the WHO Health Emergencies Program said the world owed a tremendous debt to front-line health workers, and it was vital they got the right protective gear.

Tedros said no country was immune from the pandemic, which was spreading panic around the world. Cases have recently been found in some parts of Japan with no known links to other outbreaks.

"From this pandemic we have to try to learn…what the gaps are, this is a message even for the developed countries. Across the board you see a lack of preparedness of the public health system," Tedros said.

"No country is immune. No country can claim it has a strong health system. We have to be really honest and assess and address this problem."

The key to opening up the American economy rests on the ability to conduct mass testing, according to the Infectious Diseases Society of America (IDSA).

As policymakers weigh how to safely reopen parts of the United States, the IDSA, along with its HIV Medicine Association, issued a set of recommendations outlining the steps that would be necessary in order to begin easing physical distancing measures.

"A stepwise approach to reopening should reflect early diagnosis and enhanced surveillance for COVID-19 cases, linkage of cases to appropriate levels of care, isolation and/or quarantine, contact tracing, and data processing capabilities for state and local public health departments," according to the recommendation document.

Some of the recommended steps include the following:

• Widespread testing and surveillance, including use of validated nucleic acid amplification assays and anti–SARS-CoV-2 antibody detection.
• The ability to diagnose, treat, and isolate individuals with COVID-19.
• Scaling up of health care capacity and supplies to manage recurrent episodic outbreaks.
• Maintaining a degree of physical distancing to prevent recurrent outbreaks, including use of masks, limiting gatherings, and continued distancing for susceptible adults.

"The recommendations stress that physical distancing policy changes must be based on relevant data and adequate public health resources and capacities and calls for a rolling and incremental approach to lifting these restrictions," Thomas File Jr., MD, IDSA president and a professor at Northeastern Ohio Universities, Rootstown, said during an April 17 press briefing.

The rolling approach "must reflect state and regional capacities for diagnosing, isolating, and treating people with the virus, tracing their contacts, protecting health care workers, and addressing the needs of populations disproportionately affected by COVID-19," he continued.

In order to fully lift physical distancing restrictions, there would need to be effective treatments for COVID-19 and a protective vaccine that can be deployed to key at-risk populations, according to the recommendations.

During the call, Tina Q. Tan, MD, professor of pediatrics at Northwestern University, Chicago, and a member of the IDSA board of directors, said that easing social distancing requirements requires comprehensive data and that "one of the major missing data points" is the number of people who are currently infected or have been infected. She warned that easing restrictions too soon could have "disastrous consequences," including an increase in spread of infection, hospitalization, and death rates, as well as overwhelming health care facilities.

"In order to reopen, we have to have the ability to safely, successfully, and rapidly diagnose and treat, as well as isolate, individuals with COVID-19, as well as track their contacts," she said.

The implementation of more widespread, comprehensive testing would better enable targeting of resources, such as personal protective equipment, ICU beds, and ventilators, Dr. Tan said. "This is needed in order to ensure that, if there is an outbreak and it does occur again, the health care system and the first responders are ready for this," she said.