Table 5 Process of exiting- Findings on types and effects of suggested exit strategies from the reviewed studies

Country

Study (type of study)

Details of strategy

Determinants

Effects

Belgium

Abrams et al. [30]

(Modelling study)

Phase 1b —Shops re-opened under strict requirements related to the organization of the work and restricting access to the store to avoid overcrowding;

Phase 2a — Schools partially re-opened (first phase —selected grades in primary and secondary schools);

Phase 2b — Schools partially re-opened further (second phase — pre-primary schools);

Phase 3 — Restaurants, bars, and cafes re-opened un-der strict measures including physical distancing and a limited number of customers;

Based on the daily number of new hospitalizations and admissions to the ICU.

None given

Coletti et al. [31]

(Modelling study)

Phase 1 – Work-places reopen

Phase 2 – Schools reopen

Phase 3 – Leisure activities reopen

Regular re-assessment is crucial to adjust to evolving behavioural changes that can affect epidemic diffusion. In addition to social distancing, sufficient capacity for extensive testing and contact tracing is essential for successful mitigation.

None given

Germany

Dorn et al. [32]

(Modelling study)

Gradual lifting of shut down

Long duration of remaining restrictions would increase relative economic costs compared to alternative gradual opening strategies

Reproduction number is around 0.8.

USA

Gulbudak et al. [33]

(Modelling study)

Rapid measured lockdown with intermediate fatigue (rapid reactive lockdown as soon as possible) in conjunction with the subsequent wave being detected lasting 30 days before 50% return to normalcy

Sustained public social distancing and mask wearing, targeting transmission reduction rather than removing susceptible altogether, to reduce R.

None given

India

Bhattacharya et al. [34]

(Modelling study)

Graded/staggard exit Progressive social awareness

This can minimize the peak and flatten the infection curve.

Goel et al. [35]

(Observational study)

Phase 1-Relaxation of all zones except containment zones. Opening of liquor shops. Govt offices opened with 33% capacity. Movement with a pass.

Phase 2 - Domestic travel resumes. Opening commercial activity decided at the state level.

Phase 3- Lockdown in containment zones and social gatherings and venues closed.

Phase 4 – Night-time curfew from 9 pm-5 am.

Phase 5 - Gyms and yoga institutes open. Revocation of night curfew.

Economic relief measures

Technological advances

Evolution of testing criteria and testing methods

Strengthening health system

Any initial success of handling the pandemic will not last without continuous and reliable testing followed by contact tracing.

France

Boulmezaoud et al. [36]

(Modelling study)

Zigzag strategy of alternating between periodic and moderate deconfinement. The period should remain small compared to the time needed to reach the peak of the epidemic if deconfinement is maintained (which is in the order of 4 to 5 months). A periodic deconfinement is equivalent to a weekly organized deconfinement with 3 and a half days of strict lockdown per week.

Scenarios alternating strict lockdown and moderate deconfinement can allow the epidemic to be brought under control without resorting to group immunity.

Moderate deconfinement with strong but non-drastic interventions, whether gradual or sudden, can lead to a rapid resumption of the epidemic, with a saturation of intensive care units in the fall and a peak of the epidemic in winter.

Germany

German et al. [37]

(Modelling study)

Repetitive short-term contact reductions. Such reductions can be triggered adaptively if death rates, need for ICU, etc. exceed a threshold.

With additional hygienic measures, the situation can be enhanced further. However, repetitive short-term lockdowns and hygiene measures need to be in place for the next two or three years until herd immunity can be obtained (if vaccination is not available before).

The effects of antibody tests would add significant benefit to exclude people with antibodies from the contact reductions.

 None given

India

Chowdhury et al. [25]

(Policy paper- overview)

Zonal or local lockdowns may be suitable for some countries where systematic identification of new outbreak clusters in real-time would be feasible

Requires generalised testing and surveillance structure, and a well-thought-out (and executed) zone management plan.

 None given