Following the sharp rise in the number of suspected cases of the COVID-19 virus, and given the seriousness of the virus, with large numbers of people being admitted to emergency and reanimation services, and many deaths, around 3 billion individuals in a large number of countries suddenly found themselves in lockdown conditions. On 29 April 2020, more than sixty countries had at least part of their territory in lockdown - more than half the planet, including eleven countries within the European continent. The main objective of this lockdown is to ‘flatten the curve’ in order to reduce the pressure that this relatively unknown epidemic is exerting on health systems. Apart from a few countries, such as Germany and the Nordic countries, emergency services in the northern hemisphere have been saturated with seriously affected patients, amongst whom the vast majority are over 65 years old. Given the lack of options, choosing to implement a lockdown was coherent with the need to reduce this saturation and mortality. It meant that hospital departments were able to regain some room for manoeuvre and meet people’s other needs. At the same time, this decision has had - and will continue to have - major impacts on societies and economies: schools closed, economies on stand-by with growing unemployment and increased inequality between different population groups and territories. People’s lives have been put on hold, generating a major level of stress.
Understanding of the virus’s behaviour and the mortality that it causes is improving. At the same time, there are a number of major unknowns which are making numerous decisions complex gambles: the reality and duration of immunity; the resistance of the pathogen in different environments and in different temperatures and levels of humidity; and how long the pathogen is present in waste water, etc. Even the list of symptoms is constantly changing; the Atlanta Center for Disease Control regularly adds new indicators to those promoted by the WHO1 . There have also been unexpected deaths (even of young people) which have not yet been fully explained scientifically. In addition to these uncertainties, there are different scenarios for a second, or even a third wave, and there is talk of miracle cures and the development of vaccinations within different time periods. We are finally beginning to understand the impact that simple preventive measures, such as wearing masks, testing, contact tracing, and ‘physical distancing’ can have on transmission of the virus. And we are also beginning to look into other possible ways of breaking the transmission chain.
Obviously, this is a public health issue with complex dynamics that vary depending on the population and the context. There is no consensus about the various theoretical models and solutions adopted in developed countries (which we will refer to as the North). It will not be possible to use these in numerous developing countries (which we will refer to as the South). The situation is full of uncertainty, competition, rumours and risks, and yet choices have to be made regarding public health, how physical space and mobility are to be organized, and how the economy and food security are to be managed. Political decisions also have to be made.
In theory, the virus contaminates each individual in the same way, but its impact can vary a great deal.
Studying the contamination curves within cities, suburban areas and rural areas shows how much population density affects different contamination dynamics. The aging population in certain countries has made the virus more deadly. The rapid spread of the virus from limited ‘hotspots’ to wider areas, sometimes a long way away, shows that, if no precautions are taken, mobility is a risk factor. This is even more the case in numerous countries of the South, between densely and sparsely populated regions, between urban and rural areas, between crop and livestock farmers, between slum areas and residential neighbourhoods.
Here too, the measures taken will have a variety of different impacts that we can, to a great extent, anticipate and try to reduce. Thus, beyond the health impacts of the current crisis and the financial repercussions of mobilising resources and energy for the response, it is important to have a broad view of its repercussions in economic, social and political terms. It is also important to act based on reason, rather than in panic mode! Different scenarios need to be taken into consideration, with sentinel indicators to steer the response in an agile manner. This briefing note aims to take a first step in this direction. It focuses on four major areas - health, the economy, food security2 and social wellbeing - which are managed by different administrative, institutional and political bodies. These four areas will be essential to manage the pandemic effectively both in the North and the South. Countries that have established a way to articulate these four pillars are the most likely to flatten the curve.