Licensed under CC BY 4.0 International License which permits use, distribution and reproduction in any medium, provided the original work is properly cited.J. Lumbini. Med. Coll. Vol 8, No 1, Jan-Jun 2020 ___________________________________________________________________________________ Submitted: 29 May, 2020 Accepted: 31 May, 2020 Published: 03 June, 2020 a- Professor and Head, Department of Internal Medicine, b- Public Health Consultant, c- Senior Radiologist, d- Professor, Department of Psychiatry, e- Former Regional Advisor, f- Universal College of Medical Sciences, Bhairahawa, Nepal. g- Karachi, Pakistan. h- Memon Hospital, Karachi, Pakistan. i- B.P. Koirala Institute of Health Sciences, Dharan, Nepal. j- World Health Organization, South East Regional Office, Bangladesh. Corresponding Author: Rano Mal Piryani e-mail: rano.piryani@gmail.com ORCID: https://orcid.org/0000-0003-2574-7226 How to cite this article: Piryani RM, Piryani S, Piryani S, Shakya DR, Huq M. COVID-19 And Lockdown: Be Logical in Relaxing It. Journal of Lumbini Medical College. 2020;8(1):4 pages. DOI: https://doi.org/10.22502/ jlmc.v8i1.361 Epub: 2020 June 03. _______________________________________________________ Perspectivehttps://doi.org/10.22502/jlmc.v8i1.361 Rano Mal Piryani,a,f Suneel Piryani,b,g Shomeeta Piryani,c,h Dhana Ratna Shakya,d,i Muzaherul Huq e,j COVID-19 And Lockdown: Be Logical in Relaxing It Lockdown Cambridge Dictionary defines ‘lockdown’ as a situation in which people are not allowed to enter or leave a building or area freely because of an emergency.[1] Merriam-Webster outlines three definitions of lockdown: a) the confinement of prisoners to their cell for all or most of the day as a temporary security measure, b) an emergency condition in which people are temporarily prevented from entering or leaving a restricted area during a threat of danger and c) a temporary condition imposed by governmental authorities as during the outbreak of an epidemic disease in which people are required to stay at their homes and refrain from or limit activities outside the home involving public contact.[2] Our focus, here, is on lockdown strategy adopted to contain corona virus disease 2019 (COVID-19) pandemic. Lockdown strategy adopted to contain COVID-19 pandemic As of May 28, 2020 (11.52 GMT), the COVID-19 has affected 213 countries and territories around the world and two international conveyances infecting more than 5.8 million with approximate deaths of 0.357 million.[3] The COVID-19 has almost swept around the world but the responses to contain it is greatly varied from country to country. More than 21 weeks into the COVID-19 pandemic, lockdown has become a global response to it.[4] Lockdown is among the non-pharmacological interventions adopted by most of the countries in various scales to contain the virus from spreading to other parts of the country. In South Africa, tens of thousands of troops have been brought to enforce one of the world’s strictest lockdowns, while countries like South Korea and Taiwan have managed to contain their outbreaks without merely closing anything.[5] Lockdown is done to flatten the curve and get prepared to face the continuing epidemic. Merely locking down the population without other interventions such as infection control and preventive measures, social distancing, robust testing, isolating and treating the infected, contact tracing and quarantining, will take nowhere because lots of problems are associated with the lockdown. It is an expensive intervention leading to closure of businesses and leading to steep rise in unemployment rates. It further aggravates inequality.[4] Anderson et al., have developed simulation of transmission model of COVID-19. They mentioned that social distancing compounded with Piryani RM, et al. COVID-19 And Lockdown: Be Logical in Relaxing It jlmc.edu.npJ. Lumbini. Med. Coll. Vol 8, No 1, Jan-Jun 2020 other non-pharmacological measures flattens the curve. These measures prevent transmission from symptomatic and asymptomatic but there is risk of resurgence following lifting of interventions.[6] This important aspect must also be kept in mind as there is no vaccine or effective antiviral drug likely to be available soon. Lockdown in South Asia Almost no nation has been spared as COVID-19 has swept around the globe but responses to contain it is not same in every country. Quarantines and lockdowns have become ubiquitous, but there is great variance in their strictness. Three densely populated countries of South Asia: India, Pakistan, Bangladesh are under lockdown (Limited-Partial- Complete) since the mid-March, 2020. They have adopted similar strategies but could not yet succeed in flattening the curve as expected. They however, delayed the rapid surge. There is still uncertainty of what will happen after relaxation.[7,8] The number of reported new cases and deaths has been increasing, not only in these three Country *First Case reported Jan 2020 Feb 2020 Mar 2020 Apr 2020 May 28, 2020 Total Afghanistan Feb 24 Arrived from Iran 0 1 173 1997 10,865 13,036 Bangladesh Mar 6 Arrived from Italy 0 0 51 7616 32654 40, 321 Bhutan Mar 6 Arrived from USA 0 0 4 3 24 31 India Jan 30 Arrived from China 1 2 1394 33466 124,391 159,054 Maldives Mar 6 Arrived from Italy 0 0 18 450 989 1,457 Nepal Jan-13 Arrived from China 1 0 4 52 985 1042 Pakistan Feb 26 Arrived from Iran 0 4 1934 14535 44,754 61, 227 Sri Lanka Jan 26 Arrived from China 1 0 142 520 808 1,4 71 Table 1. Number of new cases reported month wise Jan-May 28,2020 at 11.52 GMT. countries, but also in other five countries of South- east Asia as depicted in Table 1.[3] Lockdown has impacted life and livelihood in many ways. Gupta et al., mentioned that migrant workers in India, Pakistan and Nepal are crushed by poverty as earnings come to an abrupt halt in the lockdown forced by the COVID-19 pandemic. [9] There is enormous effect of lockdown in terms of livelihood on daily wager, contractual staff, taxi or private and public transport workers, small and medium business men, and other skilled or unskilled workers who depend on day to day work and earnings.[9] There has been significant reduction in emissions of greenhouse gases during the lockdown making the environment cleaner and pleasant. Levels of particulate matter (PM10) dropped by up to 44% in the parts, 24 hours of lockdown in the megalopolis. Distant Himalayan peaks are vividly visible through clear blue skies from in many south Asian cities in this lockdown period for the first time in many years.[10] With the start of monsoon, there is a fear of surge of other infectious diseases like dengue, malaria and scrub typhus.[11,12] Lockdown has made us realize the potential of online learning, distance learning, webinars and meetings through online available applications like Zoom, Google classroom, Teams etc. The serious impact on physical and mental health of fellow citizens especially children and elderly due to lockdown should not be overlooked.[13] In fact, it has affected everyone, every sector, every class of society, more vulnerable being poor, disabled and socially deprived class. Is adversity a solution? There is a dilemma as to when the pandemic would end. According to historians, pandemics predictably have two types of endings: the medical which occurs when the incidence and death rates significantly fall, and the social when the epidemic of fear about the disease fades.[14] The chief of World Health Organization (WHO) remarked “Lifting lockdowns does not signal the end of COVID-19. Countries must now ensure that they can detect, test, isolate and care for every case and trace every contact”.[15] There is an uncertainty on how long the lockdown can and should be permitted. At some point in time, people will be forced to defy all rules and come out due to the economic crisis despite the fear of this invisible virus. If the workplaces open up, there is a fear of rapid spread of infection from asymptomatic carriers to others. In such cases the symptomatic cases be tested, isolated and treated. A few critically ill with severe infection would require hospitalization. Although mortality cannot be denied, the risk-benefit ratio of natural herd immunity of the population by being exposed to the virus is to be considered. In the current scenario where the pharmacological therapy to treat is yet to be discovered, timely and mandatory contact tracing of all symptomatic cases and acting upon them quickly as per WHO guidelines is the only way out that should be adopted by all the countries.[16] Conclusion: Lockdown is not a permanent solution; however, it has produced positive impact in slowing the curve and offered sufficient time for the countries to prepare and face the ongoing pandemic with many uncertainties. The mitigation strategies in South Asia should focus to reduce risks of transmission versus the deprivation and hunger resulting from prolonged economic disruption. It is better to invest in low-cost preventive measures to improve physical distancing, such as continue stopping of international travel, reducing the number of people at religious and social gatherings, universal masking using non-medical cloth masks for the community, focus on measures protecting elderly, permit individuals restricted working hours for income generation, information campaigns for personal hygiene, physical distancing and hand washing. As lockdowns are relaxing and physical distancing measures are lessened; proactive surveillance, case detection and contact tracing with isolation and quarantine will be required to prevent a dramatic resurgence of COVID-19 cases. In long run we have to live with COVID-19. Conflict of interest: Authors declare that no competing interest exists. Funding: No funds were available for the study. Piryani RM, et al. COVID-19 And Lockdown: Be Logical in Relaxing It jlmc.edu.npJ. Lumbini. Med. Coll. Vol 8, No 1, Jan-Jun 2020 REFERENCES: 1. 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