Atrocities against the injured people one on one east investigates on al jazeera. The number of coronavirus cases is still rising in europe but some countries are already easing their lock downs is it too soon and how can we deal with the risk of a 2nd wave of infection this is inside story. Hello welcome to the program im Bernard Smith measures to stop the spread of coronavirus are affecting the lives of billions around the world shops closed public gatherings and travel a severely restricted europe accounts for half of the 2000000 cases recorded worldwide but some countries are easing their lock downs saying the rate of new infections appears to be stabilizing Health Experts have warned that lifting the restrictions too soon may lead to a 2nd wave of infections the e. U. Is urging its Member States to carefully coordinate their plans germany has the 4th highest number of cases behind the us spain and italy but its death toll is much lower chancellor Angela Merkel says some small shops can reopen next week but schools wont resume until early may bars and restaurants will stay closed and large Public Events will be banned until august. But the fear of. What weve achieved is an intermediate success no more and no less and i emphasize that it is a fragile intermediate success on the one hand we said shops up to 800. 00 square metres can open but only with good hygiene precautions in place and we have to make sure that there are no long queues on the street outside thats part of the responsibility too and will require a lot of preparation as well as other European Countries have started to gradually lift restrictions children in denmark are returning to school in nurseries while smaller shops are reopening in austria Shopping Centers and had dressers jus to follow at the beginning of may italy has allowed some businesses to reopen but lockdown measures remain in effect in the hard hit northern regions in spain a few nonessential workers in manufacturing and construction are able to return to work in the Czech Republic shops that sell Building Materials and bikes have reopened and some social distancing rules have been relaxed. Lets introduce our panel in grendel world switzerland we have Anneliese Wilder Smith a professor of emerging Infectious Diseases at the London School of hygiene and tropical medicine in singapore drew thompson a Research Fellow at the league new school of Public Policy and a Research Scientist at c. N. A. Corporation and in new york l. Souter a professor of epidemiology and Medicine Columbia University welcome to you all i can i start with you professor in new york what do you think needs to be in place before you can begin to think about loosening lockdown restrictions. I believe that there needs to be a decision regarding the loosening of any of these lockdown measures should be anchored in evidence it should be anchored in data that are available for each of the countries and even better for each of the communities that were talking about for example we know that there need we need to have evidence that theres a decrease a sustained decrease in the numbers of new infections and by sustained i mean not just for one day or 2 days or sorry days preferably we need to see that the sustained decreases for 10 or 14 days at a minimum we need to see also a decrease in the numbers of deaths and that also should be sustained and we also need to make sure that we have the resources to be able to continue to test people to identify cases rapidly and to be able to contain isolate those cases and their contacts so the decision needs to be anchored its in these metrics and and then there has to be very careful thought given to what should be loosened or eased 1st and what should be done 2nd and at the same time as the easing of these restrictions is is taking place we should also be continuing to measure very carefully the metrics that i mentioned before so that we can rapidly determine if theres a resurgence in the numbers of cases and act accordingly and ollies of esau the calculations you are making. I totally agree with her. S. V. Deescalate some of the lesser sleep sank then need to escalate need to build other measures and the measures that must be in place before we even think of listing some of my long time measures include the testicular guillotine less able to liberally test and identify new cases and quickly isolate them we should not even be thinking about lifting i also agree with that that one of the criteria for lifting is a close system declining of new cases so that we can then start to gradually lift some of the measures but also pull in the main n. B. C. That the cases increase began over through singapores reported a record 447 new cases the 3rd straight day of sharp spikes did singapore take their eye off the ball everybody in the rest of it was sort of looking over those Asian Countries as examples to follow what singapore is a unique case because the majority of those of those new infections over the past week have occurred in the Migrant Worker population which are housed in massive dormitories comprising up to 20000. 00 workers in each you know lodged in rooms between 12 and 20 people per room so its a very densely packed environment where the infections are spreading very rapidly and the government is putting a lot of effort into trying to bend that curve by pulling out people when theyre sick massive testing as i think testing is key as well as isolating patients when when theyre identified but if i can go back to the last question i doubt a couple of a couple of other conditions that i think ought to get met ideally a vaccine is available when lifting a curse the other thing i think that would be very helpful is preferred Decision Makers would be large scale Antibody Testing so that you can have a. Better sense of what the true spread is throughout the country not just the testing of potential cases but to determine who is infected already and maybe didnt present any symptoms because then i think Decision Makers have a much better chance of being able to determine and strike that balance between the need to restart economies and the need to protect Public Health and without good data on how many people were actually infected and that can only i think be done retroactively because so many of the capacity of many countries to do testing at the outset was just limited including in the United States so i think Antibody Testing will provide valuable data for governments to make decisions about letting people then go back and make society the other question that i think really needs to be answered is whether or not having been previously infected gives you a degree of immunity i think thats an open question at this point as well. As we know from the United StatesPresident Donald Trump is a chink some way of getting the economy going again of easing restrictions we understand that one way might be to ease restrictions in let in areas with low coronavirus transmissions youve got 9 states with fewer than 100. 00 cases plus a few 100. 00 cases just a dozen new infections every day is that a way i had to allow some states to reassess to ease up on restrictions before new york and california for example. Well you are absolutely right theres a certain itching to ease restrictions and thats probably driven by concerns about economic the economy and whats happening to the economy in the United States and now as well as concern a legitimate concern about you know fatigue the population fatigue with the prolonged restrictions and being imposed in in many different areas that i think we need to be very cautious because you know i always say that epidemics dont know warders and certainly they dont know warders between countries but this isnt on the borders and the respect borders between states in one country and the fear is that if you ease restrictions in one state for example that has not had a huge burden of disease then that does not mean that there wont be at the same time the potential for resurgence of of infections because of incoming of travel from other parts of the country so similar to what is being observed in singapore that was just mentioned so i think that it is a risky strategy to to assume that by easing there is frictions in one part of the country that somehow this this part is completely isolated from neighboring states where there could be a raging epidemic. Its a race in new york a gamble you know its just going to gamble its a risk going to gamble and and again if their goals are and then it will be incredibly important to monitor whats happening in those settings not just through counting of numbers of new cases but also with expansion of testing as was mentioned on elise presses in europe as well to get the economies really going and yes we know the virus knows no borders but Different Countries are doing Different Things is it too soon in europe to to start reopening even Small Businesses before everythings in place for testing. So the capabilities to test i increasingly by the day and i do think we need to strike a balance between between the negative impacts on the society as a side to strive Mental Health and economy and and this and this virus of which we know it will be with us for the next months and years until we have a vaccine and we will not have a vaccine probably for the next 12. 00 to 18. 00 or even 24 months so we need to live but as that scene and we need to strike a balance that is reasonable and acceptable for coming it to us by we also need to governments need to be very wise and know well that we need to pull the rain again so what i what i expect what will happen is that you know s. Now seen a europe. That every country is going to a different timing of the wave of ways without scandinavia probably starting in the very near future italy and spain is now basically almost over it and some countries have not been so affected like that austria and also already had only a few 100 s. And we started to open lift the some of that them as it measures and i think we all look towards as well and we just need to be have we know he has and tried it and we do not know which of the many measures are is the most effective is a school goes yes maybe the school goes is not that important but clearly its also distancing and any variation there are needs to be implemented and needs are being continued over so drew for the moment then do we stop having to ask when this will all just carry on living with it is that hard going to be for the foreseeable. I think its finally starting to sink in that were not going to be able to go back to normal there isnt just going to be a sudden lifting i mean at best there will be incremental lifting and stages and as as one of the speakers just mentioned that yeah its quite likely that theres going to be cycles and will be let out of lockdown and then have to go back into it at some point so i think all of those different social distancing measures each country will have to determine based on its own risk tolerance and on a sound social conditions how does it want to change and one of the Big Questions will be at what point do you start opening up your borders because many countries particularly here in asia closed their borders to outside travel so thats going to be critical particularly in places like conquering in singapore china where Foreign Trade and commerce is critical its not just a domestic economy that needs to be revived those domestic economies rely on International Travel so how and tourism for example so how do you determine which countries do you open up your travel to which countries do you start allowing citizens to visit how much risk do you accept from that how much you know you cant realistically restart your Tourism Industry if you then insist on all Tourist Spending 14 days in quarantine once they arrive so all of these measures have to be carefully considered and some some risks are going to have to be taken and accepted ok i just lied to tell our viewers about the criteria that the w. H. O. As laid out theyve laid out 6 countries to consider when lifting restrictions on the 1st of those is how well the virus is on to control followed by the capability of the Health System to to detect test isolate treat and trace every contact while ensuring outbreak risks minimized in vulnerable places like Nursing Homes making sure workplaces schools and other essential places have preventive measures in place why the risk of importing new cases can be managed. And finally ensuring communities are fully engaged educated and empowered to adjust to the new norms. What do you think in the United States theyre ready to Pay Attention to those w. H. O. Get guidelines you get a sense that over there they the politically they just want to lift the restrictions and carry on. Well it really depends who youre talking about i mean i am here in new york city for example and which is the epicenter of this and then they actually the epicenter in the u. S. And probably the epicenter of the world with regards to cope with 1000 at present and i think for example the mayor of new york city the governor of new york state they have been very very measured in terms of the actions they have articulated and they certainly put a lot of weight to using data and various there are very similar to the ones you just and the metrics you just shared with the audience that are have been articulated by the your show in terms of how it went to make decisions and what kind of the citizens to make so it really depends at the local level theres a lot of very careful thinking about what to do and when to do it and and in in reality in the us a lot of the decisions about what to do next will happen at a local level rather than at a National Level so im heartened that i see again and again that leaders here many of them are at the local level at the state level and very much coming to the experts to ask them for guidance in terms of what they should do next and what are they that they should be looking at next and in many ways its going to depend on balancing the benefits and the risks of every decision and almost you need to almost make a list of this is what we could do and this would be the benefit and the risk of doing whatever is being proposed and make those tough decisions and then be ready to reverse those decisions if there are negative consequences that are as are trained quickly. Only is one option we often hear of talked about in your piece is flex tensions flexible extensions of a strengthening and reducing guidelines and social distancing and thats going to explain to us how that would work and whether thats a realistic option. Well its a combination of of a stepwise approach where you relaxed a few measures but then if you refuse when you as soon as you see a resurgence of cases and then you reverse that. And i think most countries will go for this because to be honest none of us really know which of the a ray of measures that we have that we can play with is similar successful i mean you know School Closures and university closes over a longer term has so much Collateral Damage and we know that they have to take us into account at the so so so clear clearly what we need to do is continue tell it working or you know if at all where we can and and opening those those those places wessels distance it can be insurance. But keeping any any situation where theres a lot of social intermixing like restaurants fire as entertainment cinemas not these concerts leave that to the very very end through when we talk about the need to increase testing dramatically increase testing what is it that we learn by knowing what to put what proportion of the population have been or are infected well i think the issue for Decision Makers is i mean it to dilemma that they face if you. Open up too soon then you get sick if you lock down for too long then you starve to death so its a siberian dilemmas they say so how do you how do you make that decision and one of the ways to determine how far has it already spread so you have a better sense of what true mortality rates are if you just look at the people who are sick and in hospitals then your mortality rates are very high but if you have a much better sense of the spread through the general population then you can make a better judgement you need that science so you can make a better decision and its terrible but its like its like. You know its like an insurance adjuster they have to look and make very very difficult decisions about about you know how much to charge somebody for their insurance these are tough decisions for you know these are life and death decisions that politicians are going to have to make so the more data they have the better sense of of how bad the virus is already hit a community or a society how bad the impact was then they can balance that Public Health impact against the Economic Impact and the Economic Impact is been huge and you know its easy to say that we should close bars and restaurants and and social gathering points but those are major employers and thats a