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Table of Contents
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 318-321

Lockdowns for community containment of COVID-19: Present challenges in the absence of interim guidelines

1 Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al Majmaah, 11952, Saudi Arabia
2 Somnogen Canada Inc., College Street, Toronto, ON, Canada; National Plan for Science and Technology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
3 National Plan for Science and Technology; The University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia

Date of Submission13-Jun-2019
Date of Decision24-Jun-2020
Date of Acceptance28-Jun-2020
Date of Web Publication02-Oct-2020

Correspondence Address:
Ahmed S Bahammam
University Sleep Disorders Centre, College of Medicine, King Saud University, 11324 Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JNSM.JNSM_68_20

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The implementation of lockdown as a method of community containment is complex and affects the several aspects of daily living. There is an urgent need for the development of guidelines for lockdowns as community containment methods to prevent pandemics. This opinion presents five broad areas of concern affecting community-containment strategies. This viewpoint may help in the development of an interim guide for the adequate implementation of community containment strategies. The presence of the COVID-19 pandemic, which now influences nearly every country, emphasizes the urgency of adopting meaningful and doable-threat reduction strategies that will fulfill the need of the local populations.

Keywords: Economy, health policy, mental health, pandemic, public health, severe acute respiratory syndrome-Co-V-2

How to cite this article:
Manzar MD, Pandi-Perumal SR, Bahammam AS. Lockdowns for community containment of COVID-19: Present challenges in the absence of interim guidelines. J Nat Sci Med 2020;3:318-21

How to cite this URL:
Manzar MD, Pandi-Perumal SR, Bahammam AS. Lockdowns for community containment of COVID-19: Present challenges in the absence of interim guidelines. J Nat Sci Med [serial online] 2020 [cited 2022 Sep 25];3:318-21. Available from: https://www.jnsmonline.org/text.asp?2020/3/4/318/297120

  Introduction Top

The current number of reported COVID-19-related deaths exceeds the combined casualty levels caused by Middle East respiratory syndrome and severe acute respiratory syndrome.[1] The control and eradication of COVID-19 are increasingly challenging; the infections are now reported from almost all countries and territories of the world. This massive number of confirmed COVID-19 cases, together with the lack of therapeutic tools and vaccines, is making it very difficult to control this pandemic.

The management of the COVID-19 pandemic relies heavily on the classical approaches of epidemic control. Many of these classical approaches necessitate exploration and implementation of desperate measures that may often be termed as drastic.[2],[3] These interventions of infection control can be grouped in those in which ill persons are isolated or those who are likely/assumed to be exposed to the infection are quarantined or separated from the population. The other approach is broadly called community containment strategies, which tries to minimize the interaction of unidentified cases with the community.[3],[4] This group of strategies may include measures such as complete or partial lockdown of regions or cities, curfews, bans on public gatherings, closure of academic institutes, offices, markets, restaurants, and social-distancing measures [Figure 1].[5] The WHO has published and is constantly updating various interim guidelines regarding the implementation of individual and group quarantine and isolation strategies for reducing the spread of COVID-19 infection.[6]
Figure 1: Normally busy streets in cities across the world were mostly empty due to lockdown and curfew

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In this viewpoint, we review some of the considerations and complexities that may potentially influence the implementation of lockdown as a method of community containment in a place affected by a pandemic-like COVID-19 [Figure 2]. In brief, this commentary may help in the identification of key areas for developing an interim guide for the implementation of community containment effectively.
Figure 2: An illustration of the considerations and complexities that may potentially influence the implementation of lockdown as a method of community containment

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  Lockdown: Reveal the Whole Strategies to Citizens Top

In the absence of a separate guideline for initiating and stopping lockdowns as an instrument of community containment, starting early is important as advised for quarantine and isolation strategies.[6] However, there was no uniformity across countries in the urgency of the implementation of lockdowns during the current pandemic. Several practical questions did not have any direct answers based on epidemic curve statistics such as what sectors/services to close, how long to close, and finally, when to start opening and how to open. When and how to enforce lockdown or lift it? Should the enforcement of lockdown be abrupt without giving citizens time to move as India did or give them some time to relocate as Italy did? This sudden/time-lagged enforcement may depend on some epidemic curve parameters. We need to explore epidemic curve characteristics to get some modelling-based solutions to these questions. This becomes more important because of pro/anti-voices of lockdowns across countries. Moreover, an evidence-based approach would be desirous than leaving such important questions) to be decided by the instincts of political leaders.

  Increased Incidence of Psychological and Mental Health Problems Top

As time elapses, more and more information is coming about the impact of COVID-19 on psychological health. In addition to increased psychological stress among health-care workers, current data suggest increased stress among the general public.[7] Empirical evidence indicates that the majority of participants in a Chinese study reported moderate-to-severe levels of mental health issues in the general population during the initial period of the COVID-19 epidemic.[8] Females, people with physical conditions, and those with inadequate self-rated health were more likely to have stress, anxiety, and depression.[8] A large nationwide survey of the Chinese population found a high level of psychological distress in the general population after the spread of COVID-19. The study also identified that young adults, elderly people, women, and migrant workers were vulnerable to mental health effects.[9] However, it has been highlighted that overwhelming evidence from previous disasters indicate that the psychological distress may be ubiquitous in the COVID-19 affected populations as well.[10] Therefore, a prospective interim guide on the subject of community containment of the COVID-19 may be better placed to incorporate essential strategies for managing the increased incidence of psychological health issues.

  Plan to Ensure Access and Supply of All Essential Services, Healthcare, and Food Top

There has been concern regarding people not accessing emergency health care because of COVID-19 fear. There was a decrease of 25% in the number of visits to hospital emergency departments in the United Kingdom in the 1st week after the COVID-19 lockdown.[11] This raises serious concerns inasmuch as policies intended to contain the virus may have indirectly acted as a deterrent for seeking medical attention.[11] An interim guide on lockdown may include steps such as running informative advertisements on mobile devices and television, encouraging people not to ignore signs of medical emergencies such as stroke, mini-stroke, heart attacks, and angina.[11] It is also suggested that wherever feasible, facilities such as telemedicine, virtual assessments, and therapy advice be provided.[11] Similarly, there is a growing concern in Afro-Asian countries, where large sections of people working in informal sectors may be in danger of hunger because of loss of livelihood resulting from lockdown.

  Apprehension and Incidence of Politicization of Covid-19 Lockdown Top

Using pandemic situations to score political points is a common scenario across the world, and it must be strongly discouraged. This includes targeting a specific race, ethnicity, or religious groups. Hence, caution must be exercised during the lockdown period. There have been instances that have increased apprehensions regarding the politicization of lockdown policies, and that these concerns may ultimately reduce the effectiveness and desired response to community containment programs. Blofield et al. raised concerns that some governmental authorities might try to use the COVID-19 pandemic for narrow political gains, which in certain areas, e.g., in Latin American countries, might increase the risk for political conflict.[12] Similar concerns were raised for Afro-Asian countries. The government and the major opposition political groups in some countries had differing opinions regarding the extension of lockdown. These examples underscore the importance of prioritizing public health objectives over sociopolitical differences, and to put up a united fight against an emergency which threatens all members of society. In this regard, an interim guide released by the WHO may help in acquiring a proactive response from religious leaders and faith practitioners in implementing community containment strategies against COVID-19.[13]

  Economic Concerns of Most Vulnerable Groups during a Lockdown Top

The COVID-19 pandemic has had clear social and economic ramifications. In a survey carried out in China, it was found that migrant workers experienced the highest level of anxiety after the COVID-19 epidemic became officially recognized.[9] Blofield et al. pointed to the urgent need for delivering any promised assistance to the economically most affected sections of the society. Furthermore, the delivery system should involve a collaborative approach with the participation of both local and national governments. Such an approach may help in encouraging the cooperation of people from all social sectors in the implementation of lockdowns and are likely to be essential for ensuring the desired response.[12] A case of differential response is that of Indian informal sector workers in the bigger cities.[14] There were media reports of desperate Indian migrant workers trying to return to their countryside homes by walking hundreds of kilometers. Some of them died in accidents or from suspected hunger during the long, tortuous journey.[15] There were also the reports of suicides by some of these workers because of COVID-19-related lockdown and its fallout on their life and associated distress.[16] These examples suggest that it is essential for government policies to be sensitive to potential reactions of the most vulnerable segments in society.

  Improvisation to Implement Lockdown in High-Density Pockets Such as Slums, Favelas, Camps, and Camp-Like Settings Top

Lockdown can be easily implemented in low-density human habitats, but it is nearly impossible in high-density areas such as slums, favelas, and camps where associated restrictions against personal freedoms or primary economic needs (e.g., gaining access to food or water) may prove a potentially severe humanitarian crisis following exposure to an epidemic.[17] In such circumstances, improvised strategies are needed to achieve community containment in high human density pockets. These methods rely on identifying and shielding the most vulnerable such as the elderly with the burden of noncommunicable and other immuno-suppressing diseases. Such vulnerable populations can be shielded in three types of containment areas called house-level, street-level, and neighborhood-level zones. Such shielding measures need to be supported by other infection control methods, as well as diligent measures to ensure social acceptability and supportive services. It is also imperative to develop guidelines for when to start/stop the shielding of vulnerable peoples.[17] These suggestions by Dahab et al. 2020 can be the starting point for further explorations of community-containment strategies in high-density areas of the world. Interdisciplinary approaches are suggested to resolve the issues nationally as well as internationally.[3]

  Conclusions Top

In summary, sections of the society may be affected differently by some of the strategies of community containment that are being used in the absence of an interim guide. In this perspective, out of many, five broad areas of concern affecting community-containment strategies have been outlined. This discussion may help in the improvement of an interim guide for the adequate implementation of community containment strategies for future pandemics. The presence of the COVID-19 pandemic, which now influences nearly every country, emphasizes the urgency of adopting meaningful and doable threat reduction strategies that will fulfill the need of the local populations.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Mahase E. Coronavirus covid-19 has killed more people than SARS and MERS combined, despite lower case fatality rate. BMJ 2020;368:m641.  Back to cited text no. 1
Wilder-Smith A, Freedman DO. Isolation, quarantine, social distancing and community containment: Pivotal role for old-style public health measures in the novel coronavirus (2019-nCoV) outbreak. J Travel Med 2020;27: taaa020. doi: 10.1093/jtm/taaa020.  Back to cited text no. 2
Paital B, Das K, Parida SK. Inter nation social lockdown versus medical care against COVID-19, a mild environmental insight with special reference to India. Sci Total Environ 2020;728:138914.  Back to cited text no. 3
Cetron M, Simone P. Battling 21st-century scourges with a 14th-century toolbox. Emerg Infect Dis 2004;10:2053-4.  Back to cited text no. 4
Das K, Paital B. The synergy between philosophy and science, need of the contemporary society. Int J Humanities Soc Sci Res 2020;6:45-51.  Back to cited text no. 5
World Health Organization. Considerations for Quarantine of Individuals in the Context of Containment for Coronavirus Disease (COVID-19): Interim Guidance. World Health Organization; 2020: https://apps.who.int/iris/handle/10665/331497. [Last Accessed on 5 June 2020].  Back to cited text no. 6
Jahrami H, BaHammam AS, AlGahtani H, Ebrahim A, Faris M, AlEid K, et al. The examination of sleep quality for frontline healthcare workers during the outbreak of COVID-19. Sleep Breath 2020;1-9. doi: 10.1007/s11325-020-02135-9. Online ahead of print.  Back to cited text no. 7
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. 2020 Mar 6;17:1729. doi: 10.3390/ijerph17051729.  Back to cited text no. 8
Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations. Gen Psychiatr 2020;33:e100213.  Back to cited text no. 9
Pfefferbaum B, North CS. Mental health and the Covid-19 pandemic. N Engl J Med. 2020. doi: 10.1056/NEJMp2008017. Online ahead of print.  Back to cited text no. 10
Thornton J. Covid-19: A&E visits in England fall by 25% in week after lockdown. BMJ 2020;369:m1401.  Back to cited text no. 11
Blofield M, Hoffmann B, Llanos M. Assessing the political and social impact of the COVID-19 crisis in Latin America. Giga Focus Latin Am 2020;https://www.giga-hamburg.de/en/system/files/publications/gf_lateinamerika_2003_en.pdf:1-12.[Last Accessed on 03 June 2020].  Back to cited text no. 12
World Health Organization. Practical Considerations and Recommendations for Religious Leaders and Faith-Based Communities in the Context of COVID-19: Interim Guidance. World Health Organization; 2020. Available from: https://apps.who.int/iris/handle/10665/331707. [Last Accessed on 01 June 2020].  Back to cited text no. 13
Pulla P. Covid-19: India imposes lockdown for 21 days and cases rise. BMJ 2020;368:m1251.  Back to cited text no. 14
Ray D, Subramanian S. Covid-19: Is there a Reasonable Alternative to a Comprehensive Lockdown? Ideas for India; 2020. Available from: https://www.ideasforindia.in/topics/macroeconomics/is-there-a- reasonable-alternative-to-a-comprehensive-lockdown.html. 20. [Last accessed on 2020 Apr 20].  Back to cited text no. 15
PTI. Suicide Leading Cause for Over 300 Lockdown Deaths in India: Study. The New Indian Express; 2020. Available from: https://www.newindianexpress.com/nation/2020/may/04/suicide-leading-cause-for-over-300-lockdown-deaths-in-india -study-2138877.html pp. [Last Accessed on 07 June 2020].  Back to cited text no. 16
Dahab M, van Zandvoort K, Flasche S, Warsame A, Spiegel PB, Waldman RJ, et al. COVID-19 Control in Low-Income Settings and Displaced Populations: What can Realistically be Done? Health in Humanitarian Crises Centre; 30 April 2020. Available from: https://reliefweb.int/report/world/covid-19- control-low-income-settings-and- displaced-populations-what-can-realistically pp. [Last Accessed on 07 June 2020].  Back to cited text no. 17


  [Figure 1], [Figure 2]


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