Abstract
BackgroundThe severity of COVID-19, as well as the speed and scale of its spread, has posed a global challenge. Countries around the world have implemented stringent non-pharmaceutical interventions (NPI) to control transmission and prevent health systems from being overwhelmed. These NPI have had profound negative social and economic impacts. With the timeline to worldwide vaccine roll-out being uncertain, governments need to consider to what extent they need to implement and how to de-escalate these NPI. This rapid review collates de-escalation criteria reported in the literature to provide a guide to criteria that could be used as part of de-escalation strategies globally.MethodsWe reviewed literature published since 2000 relating to pandemics and infectious disease outbreaks. The searches included Embase.com (includes Embase and Medline), LitCovid, grey literature searching, reference harvesting and citation tracking. Over 1,700 documents were reviewed, with 39 documents reporting de-escalation criteria included in the final analysis. Concepts retrieved through a thematic analysis of the included documents were interlinked to build a conceptual dynamic de-escalation framework.ResultsWe identified 52 de-escalation criteria, the most common of which were clustered under surveillance (cited by 43 documents, 10 criteria e.g. ability to actively monitor confirmed cases and contact tracing), health system capacity (cited by 30 documents, 11 criteria, e.g. ability to treat all patients within normal capacity) and epidemiology (cited by 28 documents, 7 criteria, e.g. number or changes in case numbers).De-escalation is a gradual and bi-directional process, and resurgence of infections or emergence of variants of concerns can lead to partial or full re-escalation(s) of response and control measures in place. Hence, it is crucial to rely on a robust public health surveillance system.ConclusionsThis rapid review focusing on de-escalation within the context of COVID-19 provides a conceptual framework and a guide to criteria that countries can use to formulate de-escalation plans.
Highlights
El Bcheraoui et al Globalization and Health (2021) 17:106. This rapid review focusing on de-escalation within the context of COVID-19 provides a conceptual framework and a guide to criteria that countries can use to formulate de-escalation plans
[3] Mitigation centres on the concept of “flattening the curve”, where the overall number of cases is distributed over a greater period of time, allowing the health system to respond within its capacity. [3, 4] Suppression aims to reduce the number of cases through the use of intensive nonpharmaceutical interventions (NPI) such as physical distancing and school closures until effective countermeasures – either treatment or vaccine – are available
18] An indefinite timeline for a return to normal or a “new normal” puts public compliance at risk as strict non-pharmaceutical interventions (NPI) become socially, politically and economically unacceptable and unviable. [3, 8, 12, 19, 20] we have seen two additional major threats during the COVID-19 pandemic: first, there is a risk of resurgence when interventions are de-escalated, and second, the unanimity of control measures and public health interventions has led to the emergence of more transmissible variants of concerns, including some that are vaccineescaping, from the original SARS-CoV-2wildtype. [3, 4, 11, 21] This creates an imperative for governments to use transparent criteria that allow NPI to be deescalated and re-escalated in response to the changing epidemiological situation
Summary
As of early June 2021, there have been over 170 m cases globally and over 3.7 m deaths attributed to COVID-19, the disease caused by a novel strain of the coronavirus. [1] On February 3rd 2020 the World Health Organization (WHO) published a Strategic preparedness and response plan for COVID-19, based on mitigating the pandemic by limiting human-to-human transmission: this is done by reducing international spread, reducing social contacts and isolating infected patients. [2] The two key strategies in pandemic control are mitigation and suppression. [3] Mitigation centres on the concept of “flattening the curve”, where the overall number of cases is distributed over a greater period of time, allowing the health system to respond within its capacity. [3, 4] Suppression aims to reduce the number of cases through the use of intensive nonpharmaceutical interventions (NPI) such as physical distancing and school closures until effective countermeasures – either treatment or vaccine – are available. [5] At the start of the pandemic, some countries began by introducing mitigation measures, while most moved to an approach that blends mitigation and suppression. [3] A limited number of countries such as Australia, followed a CVID-Zero approach through complete shutdown for a period of time, followed by almost-complete borders closure. [6] Introducing such strict measures raises ethical, social, political, economic and legal issues that must be considered to ensure their feasibility and sustainability. [7, 8]Physical distancing is the “first line of defence” against outbreaks of novel strains for which there is not yet a vaccine or effective treatment, when it is activated without delay and maintained for a relatively long period. [9, 10] While a number of vaccines effective against COVID-19 have been developed, approved, and are being rolled out, there remains huge uncertainty around the timeline for a worldwide effective vaccination coverage, with physical distancing in place for anywhere between 25 and 70 % of that time. [3, 11, 12] The strict lockdown measures during this pandemic come with inherent social and economic consequences. Countries around the world have implemented stringent non-pharmaceutical interventions (NPI) to control transmission and prevent health systems from being overwhelmed. These NPI have had profound negative social and economic impacts. With the timeline to worldwide vaccine roll-out being uncertain, governments need to consider to what extent they need to implement and how to de-escalate these NPI. This rapid review collates deescalation criteria reported in the literature to provide a guide to criteria that could be used as part of de-escalation strategies globally
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