It’s time to admit our COVID-19 ‘exit strategy’ might just look like a more flexible version of lockdown

Toby Phillips, University of Oxford

As the COVID-19 curve starts to flatten in Australia and New Zealand, people are rightly wondering how we will roll back current lockdown policies. Australia’s federal health minister Greg Hunt says Australia is looking to South Korea, Japan and Singapore to inform our exit strategy. New Zealand is relaxing some measures from next week.

A long-term solution – a vaccine – is many months, probably years, away.

In the meantime, we must rely on social distancing policies to contain the epidemic – and begin to accept the idea that an “exit strategy” may really look more like a more flexible version of lockdown.

What can we learn from other countries?

Total lockdown is not a prerequisite for success, but nonetheless seems to be where most countries are going.

In a study of more than 100 countries, currently under peer review, my colleagues and I find that on average, stricter policies (as measured by what we called a “stringency index”) lead to lower death rates after two to four weeks.

When looking at most of the other countries mentioned by Australian health minister Greg Hunt we see that they are not exiting lockdown but are, in fact, getting stricter.

Indeed, of Minister Hunt’s countries, Japan is the only one that has not escalated its policies recently. It has, however, seen an uptick in daily deaths over the last week, going from an average of five deaths per day to 20.

(COVID-19 deaths is a better measure of epidemic severity than case numbers, as case numbers are vastly underestimated in some countries. For instance, some researchers have estimated that the United Kingdom might have over 10 times more cases than reported.)

South Korea, Hong Kong and Singapore all initially managed to keep their curve flat through aggressive testing, a small amount of targeted closures, and voluntary social distancing by citizens.

But from mid-March onwards, these countries started banning small gatherings and closing businesses. First South Korea, then Hong Kong and finally Singapore (with their April 7 “circuit breaker” measures).

Even though they aren’t exiting lockdown, there are still useful lessons: despite being officially “open” at the time, these countries had slow infection growth rates over February and March.

We should add Taiwan to the list of countries to watch. They seem to have the epidemic under control – or close to it – without a national lockdown. The key seems to have been rapid tracing and quarantining, community measures (such as temperature testing checkpoints), and citizen compliance. They have been preparing for a major pandemic since SARS in 2004.

When should we start to loosen the rules?

Last week the Australian prime minister Scott Morrison outlined three things Australia needs to have before restrictions can be lifted:

• a more extensive testing regime (including asymptomatic people)
• industrial scale contact tracing
• stronger local response capabilities.

Broadly speaking, these mirror the criteria set by the WHO director general, Dr Tedros Adhanom Ghebreyesus, three days earlier. Tedros also included that epidemic transmission should be under control and communities must be adjusted to the “new normal”.

On these criteria, Australia is one of the leading countries in the world. For testing, South Korea used to be at the front of the pack, but now we’ve conducted more tests per person than most countries (although not as many as New Zealand or Italy).

In terms of controlling the epidemic, we are averaging around one or two deaths each day. Australia ramped up its policy approach three and half weeks ago; and now we are seeing the curve start to flatten.

So we’re approaching the point where it makes sense to start thinking about loosening rules. But there aren’t really any examples to learn from. China has made the most significant reductions in policy strictness, but it is still too early to assess the impact of this.

What does life look like after lockdown?

Ultimately, we can’t think of lockdown as a national on-off switch. Just as there is an epidemic curve of cases, so too there is a curve of policy responses. Over 200 Australian economists signed an open letter on Monday urging the government not to roll back too far too quickly.

All eyes will be on New Zealand as they reduce their lockdown level next week. It is the first step of a slow and measured roll back – many aspects of a “lockdown” will remain. Some businesses must stay closed. People must still stay at home unless working or making essential trips.

Until a vaccine arrives, containing the virus is about reducing how often people come into contact and how closely – as we saw from Taiwan, a formal lockdown may not be necessary. Data from firms such as Apple and Google can serve as a proxy for people’s movement and likelihood of coming into contact with others.

As Australia was heading into the pandemic, the data in the chart above suggest it took blunt lockdown measures (late-March) for people to reduce their contact with each other (for example, Bondi Beach was closed after crowds gathered there in defiance of social distancing recommendations).

Conversely, individual Singaporeans and South Koreans reduced their level of interaction back in February, without the strict lockdowns that are only just now being implemented in their countries.

Exiting the lockdown doesn’t mean going back to business-as-usual. Under the “new normal” we will need people to behave like Singaporeans and South Koreans did in February: voluntarily limiting contact. Hiking will be back on the cards; big barbecues might not be.

What’s more, we will need to figure out how to scale the response up and down as needed – possibly several times and in ways you might not expect.

We might need to return to full lockdown in a specific place when a flare-up is detected there. This requires new policy instruments to flexible and locally switch areas on and off – not the whole country – to deal with isolated outbreaks.

We can’t remain in a nationwide lockdown forever. If people can voluntarily practise the behaviours that slow the virus’ spread, then the formal lockdown can relax. But life can’t return to how it was before. At least not yet.

The Oxford data on policy measures is available on GitHub, and the data on movement is available from Apple’s website.

Toby Phillips, Public policy researcher, University of Oxford

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What might trigger a return to ‘normal’? Why our coronavirus exit strategy is … TBC

Katherine Gibney, The Peter Doherty Institute for Infection and Immunity and Jodie McVernon, University of Melbourne

The unprecedented restrictions Australians are living with are working, so far, to curb the rise in new COVID-19 cases.

Nationally, on average around 50 new COVID-19 cases were reported each day in the week leading up to April 15, compared with a peak of 460 on March 28.

Fewer people are testing positive, and these cases are infecting fewer additional people, as we close international borders, work and study from home, keep 1.5m apart and limit unnecessary travel.

New modelling indicates ten people with the virus now infect only five others.

So many people are asking when physical distancing measures can be relaxed.

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Read more:
Latest coronavirus modelling suggests Australia on track, detecting most cases – but we must keep going

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When can life go back to normal?

The simple answer is, life as normal cannot resume anytime soon. Prime Minister Scott Morrison has said current restrictions will be in place for at least the next four weeks.

COVID-19 remains highly infectious, and our population is still almost entirely susceptible to catching it.

Most people won’t have been exposed to the virus and won’t have built up immunity to it. And we’re unlikely to have a vaccine for at least the next 12–18 months.

This means we need to continue to modify the way we work, socialise and travel to minimise the chance of catching the virus.

What might trigger a return to ‘normal’?

When we know who’s immune

Serosurveys survey the population for antibodies in blood that protect against COVID-19. These can indicate the proportion of the population with natural immunity after COVID-19 infection.

These studies are underway internationally, including in the United States, and are planned for Australia.

Eventually they could inform who gets vaccinated and guide decisions around lifting restrictions. But these results are still likely to be some time away.

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Read more:
Here’s why the WHO says a coronavirus vaccine is 18 months away

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Few new unexplained local cases for at least two weeks

The widespread physical distancing measures in place in Australia aim to prevent community transmission of COVID-19. This is distinct from border measures, which are designed to prevent the introduction of new cases from overseas.

As the restrictions on daily life have important health, social and economic ramifications beyond COVID-19, we will need to begin to roll them back before the Australian population is COVID-19 immune (and before we have results from serosurveys to confirm this).

These changes could begin when the number of locally acquired cases, particularly those transmitted in the community without a known source, is very low for a sustained period. This would need to be longer than the incubation period (the time from infection to symptoms showing), which for COVID-19 can be up to two weeks.

Now is an appropriate time to develop this “exit plan”, but we need to be cautious and responsive in doing so.

More testing, tracing and quarantine

First, we need an even stronger capacity to identify and isolate cases, and to trace and quarantine contacts.

As we’ve increased testing capacity in Australia, we’ve also expanded testing criteria. While initially restricted to returned travellers and contacts of a known case, some jurisdictions are now testing all people with COVID-19 symptoms – regardless of their travel or contact history – to determine the extent of community transmission.

Testing should continue to identify geographical areas or sub-populations with ongoing (or new) transmission, to pave the way for rapid and targeted public health responses.

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Read more:
More testing will give us a better picture of the coronavirus spread and its slowdown

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Once a case is identified, a network of thousands of contact tracers work to to identify their contacts and provide advice around quarantine requirements.

Many countries have employed technological solutions such as contact tracing apps, and Australia is looking to follow suit. But such an app will be effective only if uptake is high.

Fewer than one-fifth of Singapore’s population had downloaded their TraceTogether contact tracing app by April 1, well short of their target.

When we know more about people with mild or no symptoms

Social distancing measures minimise the risk a person will transmit the virus to others when that person doesn’t know they’re infected. So before we consider relaxing them, we need to better understand the relative infectiousness of people with no or mild symptoms.

Studies currently underway are following families and close contacts of cases to see who develops typical COVID-19 symptoms, who is infected with mild or no symptoms, and who is not infected.

Likewise, understanding the role of children in transmitting infection is essential to support reopening schools, with appropriate social distancing in place. Research is similarly underway to attempt to answer this question.

We will likely see restrictions lifted in stages

While returning children to classrooms and opening businesses will be a priority, restrictions around international travel are likely to be in place for many months. Isolation of cases and quarantine of contacts are likely to be ongoing.

While Australia is developing its “exit plan”, other countries have revealed theirs. Iceland has announced physical distancing restrictions will be gradually lifted starting on May 4, including increasing the limit for gatherings from 20 to 50 people, and re-opening schools and universities.

Likewise, Norway is planning to re-open kindergartens, primary schools and certain businesses from April 20.

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Read more:
The coronavirus contact tracing app won’t log your location, but it will reveal who you hang out with

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Even the best-laid plans might not eventuate. Physical distancing measures had been relaxed in Singapore, Japan and South Korea after flattening the curve, but were recently re-introduced following a surge in cases.

No-one knows how the coming months will play out, but this is a marathon, not a sprint. We’ll need to carefully manage the risks that come with easing restrictions. But Australia is well-placed to do this, having successfully navigated the COVID-19 journey so far.

Katherine Gibney, NHMRC early career fellow, The Peter Doherty Institute for Infection and Immunity and Jodie McVernon, Professor and Director of Doherty Epidemiology, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Crystal Cathedral Being Sold Off Due to Financial Crisis

The famous mega-church building, the Crystal Cathedral in California, is being sold to meet financial debts that may see the church able to exit bankruptcy. The Crystal Cathedral is the mega-church which was/is pastored by Robert Schueller and his family.

For more visit:
http://www.christianpost.com/news/crystal-cathedral-to-open-bidding-on-church-property-50813/

 

Second Wave of Deportations Hits Foreign Christians in Morocco

Muslim hardliners pressure government; nationals fears they may be next victim of ‘purging.’

ISTANBUL, May 21 (CDN) — In a second wave of deportations from Morocco, officials of the majority-Muslim country have expelled 26 foreign Christians in the last 10 days without due process.

Following the expulsion of more than 40 foreign Christians in March, the deportations were apparently the result of Muslim hardliners pressuring the nation’s royalty to show Islamic solidarity.

The latest deportations bring the number of Christians who have had to leave Morocco to about 105 since early March. Christians and expert observers are calling this a calculated effort to purge the historically moderate country, known for its progressive policies, of all Christian elements – both foreign and national.

“I don’t see the end,” said Salim Sefiane, a Moroccan living abroad. “I see this as a ‘cleansing’ of Christians out of Morocco, and then I see this turning against the Moroccan church, which is already underground, and then persecution of Moroccan Christians, which is already taking place in recent days.”

At least two Moroccan Christians have been beaten in the last 10 days, sources told Compass, and police have brought other Moroccan Christians to police stations daily for psychologically “heavy” interrogations.

Authorities are enquiring about the activities of foreign and local Christians.

Forcibly Ejected

Legal sources said that according to Moroccan law, foreigners who have lived in the country for more than 10 years cannot be deported unless they are accused of a crime. They have the right to appeal the deportation order within 48 hours.

With only hours’ notice and forced escort to the country’s exit ports, almost none of the deportees were able to appeal their deportations.

“Most of these [deportations] are happening over the weekends, when the courts are closed,” Sefiane said. “Most of them are done in a way where they’re bringing them in [to the police station], intimidating them, and manhandling them out of the country. Many of them are not even going back to say goodbye to their wives, or even to pack a bag.”

With the exception of three foreigners, in none of the forced deportations did authorities produce an official deportation order, sources said. In many cases, Moroccan officials used embassies to notify foreigners that they were being deported. In most cases, foreigners were presented with a document in Arabic for them to sign that stated that they “understood” that they were being deported.

Compass learned of one case in which a foreigner was forced to the airport, and when he resisted he was forcibly drugged and sent to his native country.

“The expats in the country are very vulnerable, and the way it has happened has been against the laws of the country,” said a European Christian who was deported last week after nearly a decade of running his business in Morocco. “When I tried to walk away from the situation, I was physically stopped.”

The deported Christian said that authorities never informed any of the Christian foreigners of their rights, when in fact there are national laws protecting foreigners. 

“Basically they are trying to con everyone into leaving the country,” he said.

Deported foreigners have had to leave their families behind in Morocco, as well as their friends and communities. Many of the deportees were the male breadwinners of the family and have left their families behind as they try to decide their future.

“It’s devastating, because we have invested years of our lives into our community, business community and charity sectors,” said the European Christian. “People flooded to our house when they heard I was bundled into the back of a police car by the local authorities. It was like a death in the family – forcibly ejected from the country without being able to say goodbyes, just like that.”

The deportees have included Christians from North America, Latin America, Europe, Africa, New Zealand and Korea.

“It’s come out of left field,” said the European. “No one really knows why this is happening.”

Internal Pressure

A regional legal expert said on condition of anonymity that a small number of extremist Muslims have undertaken a media campaign to “get [Christians’] good works out of the public eye and demonize Christians,” in order to expel them and turn the nation against local Christians – some of whom are third-generation followers of Jesus.

“There are too many eyes and ears to what they want to do to the native Christians,” said the expert. “They’re trying to get to them …They want to shut down the native Moroccan Christians.”

Deportation orders are coming from the Ministry of Interior, and speculation on the reason for the sudden spike in expulsions has centered on the arrival of a new, hard-line Muslim interior director in January.

Moroccan officials have cited “proselytism” as the reason for the deportations. Reuters news agency reported Religious Endowments and Islamic Affairs Minister Ahmed Toufiq as saying “proselytism” and “activism of some foreigners” had “undermined public order.”

On April 12 local media reported that 7,000 religious Muslim leaders signed a document describing the work of Christians within Morocco as “moral rape” and “religious terrorism.” The statement from the religious leaders came amid a nationwide mudslinging campaign geared to vilify Christians in Morocco for “proselytism” – widely perceived as bribing people to change their faith.

Religious rights advocates point out that under Article 18 of the United Nations Universal Declaration of Human Rights, the more than 100 foreigners who had lived in Morocco, some for decades, not only had the right to stay in the country but had contributed to the nation. 

“They expelled people who helped build up the country, trained people, educated Moroccan children, cared for orphans and widows, increased the GDP and trade,” said the regional legal expert. “These people they expelled weren’t even proselytizing under their own law. There’s an international standard, yet they changed the definition of the terminology and turned it into this horrible ‘religious terrorism.’”

One of the country’s most prestigious educational institutions, George Washington Academy in Casablanca, has come under fierce criticism from media and investigation by authorities.

“The biggest problem is the image the Ministry of Justice is pushing about who the Christian foreigners are,” said another observer on condition of anonymity. “All the articles have been extreme exaggerations of the manipulative aspect of what foreigners were doing, and especially when it comes to minors.”

Local Christians have reported to sources outside of Morocco that attitudes towards them, which used to be more tolerant, have also shifted as a result of the extremist-led campaign, and some are experiencing family and societal pressure and discrimination as well.

International Forces

While the deportations have perplexed the local Christian community, the regional legal expert said that in some ways this was calculated and inevitable.

He said that the Organization of the Islamic Conference had been putting pressure on countries across the Middle East and North Africa to remove their Christian elements. Iraq, with its decline in Christian population from a few million to a few hundred thousand over the last decade, is a case in point.

“Countries which have been more forward looking and spoken about rights, freedoms and equalities have been pressured to demonstrate their Muslim credentials, and the best way to do this is to sanitize [religious] minorities from the borders,” he said.

Congressman Frank Wolf (R-Va.), co-chairman of the Tom Lantos Human Rights Commission, has called congressional hearings on June 17 to examine the human rights situation in Morocco in light of the expulsions. On Wednesday (May 19) Wolf called on the U.S. government to suspend $697.5 million in aid it has pledged to Morocco based on criteria that it is “ruling justly.”

“We’ve been told the Christians are a threat to the national security, so they are using terrorism laws against peace-loving Christians,” said the deported European Christian. “But it is massively backfiring.”

The Christian described how the Moroccan friends of Christian foreigners have been asking why they are being deported for their faith.

“They are being impacted by the reality of Christ through this, and it’s having more of an effect on the community than years and years of quietly demonstrating Christ peacefully and lawfully,” he said. “By breaking their own laws, they have opened the lid on the reality of the life of Christ.”

There are an estimated 1,000 Moroccan Christian converts. They are not recognized by the government. About 99 percent of Morocco’s population of more than 33 million is Muslim.

Report from Compass Direct News 

GAZA CONFLICT TAKING TOLL ON BOTH SIDES OF BORDER

Christians normally permitted to leave Gaza for Bethlehem during Christmas found themselves unable to return home and separated from their families when fighting erupted between Israel and Hamas-controlled Gaza in late December, reports Baptist Press.

Isa,* a layman at Gaza Baptist Church, was one of those separated from his family. He returned to Gaza on Dec. 26 to take care of some church business. His family remained in Bethlehem, unaware the borders were about to close. “This is the worst it has ever been [in Gaza],” Isa told a Christian worker.

The Gaza Baptist Church building has sustained damage over the past two weeks. According to a Christian worker, the majority of the damage occurred Dec. 27 when a police station across the street took a direct hit.

Another Christian family found themselves separated when they tried to exit Gaza to find safety in Israel, the Christian worker said. The father and his two sons were allowed to go to Bethlehem, but the wife and two daughters were not. The man quickly returned to Gaza, despite the violence.

Residents of Israel are struggling, too.

One Israeli soldier asked a Christian worker to pray for him while he was at war. To the worker’s surprise, the soldier didn’t ask him to pray for his safety but rather that he wouldn’t have to use his gun.

Life must go on — even in scary situations, the Christian worker added.

A nurse in southern Israel was on her way to a hospital one morning when bomb sirens started blaring. “You can’t stay in your car, because the shrapnel will kill you,” a Christian worker in the area said. “You have to get out of your car and lie in the ditch beside the road.”

Schools in southern Israel have been closed because of bomb threats. Many kindergarten buildings have been hit directly by missile fire from Gaza, a worker said; however, no children or teachers were inside at the time.

“Pray that those who want peace will have the victory,” the worker said. “There’s a lot of praying [among Israeli believers], not only for the soldiers but for the believers in Gaza.”

The hope of Christian workers in Israel is that calm will be restored quickly and that the economy will recover.

Employment in Gaza has plummeted, the worker noted. Twenty years ago nearly 100,000 men went into Israel daily to work; before the latest conflict that number had decreased dramatically. Now, with the border closing, it is down to zero.

Flour has been scarce for more than a week in Gaza — in a culture where bread is served with every meal, the worker said. When a bakery does receive a shipment, it is not uncommon for more than 600 people to line up for the chance to get one piece of flatbread.

Even if families have flour, rotating blackouts make baking nearly impossible, the worker explained. They never know when electricity will be available. Some areas of Gaza haven’t seen power for five days.

Because food, water and electricity are limited in Gaza, Israel is promising to allow aid to reach Palestinian civilians during a three-hour period each day, according to news reports. Food, water, cooking oil and medicine are among the supplies expected to flow into the area.

Report from the Christian Telegraph