A novel index-based decision support toolkit for safe reopening following a generalized lockdown in low and middle-income countries

Abu S Shonchoy,Sajedul Talukder,Rajiv Chowdhury,Nasar U Ahmed,Khandker S Ishtiaq

doi:10.1038/s41598-021-93415-1

Abu S Shonchoy, Sajedul Talukder + Show 3 more

Open Access

https://doi.org/10.1038/s41598-021-93415-1

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Abstract

While the effectiveness of lockdowns to reduce Coronavirus Disease-2019 (COVID-19) transmission is well established, uncertainties remain on the lifting principles of these restrictive interventions. World Health Organization recommends case positive rate of 5% or lower as a threshold for safe reopening. However, inadequate testing capacity limits the applicability of this recommendation, especially in the low-income and middle-income countries (LMICs). To develop a practical reopening strategy for LMICs, in this study, we first identify the optimal timing of safe reopening by exploring accessible epidemiological data of 24 countries during the initial COVID-19 surge. We find that a safe opening can occur two weeks after the crossover of daily infection and recovery rates while maintaining a negative trend in daily new cases. Epidemiologic SIRM model-based example simulation supports our findings. Finally, we develop an easily interpretable large-scale reopening (LSR) index, which is an evidence-based toolkit—to guide/inform reopening decision for LMICs.

Highlights

While the effectiveness of lockdowns to reduce Coronavirus Disease-2019 (COVID-19) transmission is well established, uncertainties remain on the lifting principles of these restrictive interventions
We considered a broad range of potential determinants of successful reopening: gross domestic product (GDP) per capita, “mobility reduction” as a proxy of lockdown execution[16], human development index (HDI, a statistic composite index of life expectancy, education and per capita income indicators, which are used to rank countries into four tiers of human development)[17], social progress index (SPI, measures the extent to which countries provide for the social and environmental needs of their citizens)[18], and worldwide governance indicators (WGI, which includes accountability, political stability, government effectiveness, regulatory quality, rule of law and control of corruption indicators)[19]
We found that "successful" countries reopened the economy after the daily recovery rate intersects the infection rate from below while observing the continuous negative trend in the daily new cases

Summary

Introduction

While the effectiveness of lockdowns to reduce Coronavirus Disease-2019 (COVID-19) transmission is well established, uncertainties remain on the lifting principles of these restrictive interventions. This is of particular relevance to the LMICs where complex, resource-intensive approaches to monitor the epidemic growth in real time by generating effective reproduction number or R estimates remain unfeasible In this regard, World Health Organization (WHO) recommends case positive rate of 5% or lower, continuing for two weeks, as a single global threshold to inform safe r eopening[14], this generalized approach lacks flexibility to account for context-specific social, structural and economic diversities, especially across the LMIC. World Health Organization (WHO) recommends case positive rate of 5% or lower, continuing for two weeks, as a single global threshold to inform safe r eopening[14], this generalized approach lacks flexibility to account for context-specific social, structural and economic diversities, especially across the LMIC Against this backdrop, there remains an urgent need for a standardized evidence-driven approach, which could be utilized as a guiding tool for prompt economic reopening (while reducing the likelihood of a rapid resurgence), in the current and future pandemics

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