CORONAVIRUS LOCKDOWN PERIOD

Is 14 or even 21 days lockdown adequate to eliminate Coronavirus?

Paper presented by J. Muthu Kumar, an oil and gas project management consultant.

Disclaimer:

The data, analysis and any other information (‘Content’) contained in this document is for informational purposes only and is not intended as a substitute for advice to any decisions including healthcare, financial and investments. Whilst reasonable efforts have been made to ensure the accuracy of the contents of this document, the author makes no warranties or representations as to its accuracy or comprehensiveness and assumes no liability or responsibility for any error or omission and/or for any loss arising in connection with or attributable to any action or decision taken as a result of using or relying on the contents of this document.

The material contained in this document may be used and/or reproduced for educational and other non-commercial purposes without prior written permission from the author.

Globally countries are locking down regions for 14 days or 21 days as an attempt to eliminate the Coronavirus.

Is 14 or even 21 days lockdown adequate to eliminate Coronavirus? There are discussions ongoing for extended lockdown.

I believe that the minimum lockdown days required is 56 if Coronavirus has to be eliminated through lock down and isolation model. This shall be followed by phased relaxation of lockdown in stages for another 28 to 56 days depending on the severity.

Second critical point is that as the effectiveness of total lock down is difficult to achieve, expanding the testing to a very wide range of people by random sampling even for those with no symptoms and history and isolating them to prevent virus spread to others at community level must be done in parallel.

I have mapped the model below to demonstrate the reasons for the 56 days of minimum lock down period.

Considerations based on Available Information:

  1. For some persons affected by Coronavirus, the incubation period is anywhere between 2-14 days. 
  2. People tested initially who showed “negative” had become “positive” after few days during a repeat test.
  3. For several people the Coronavirus creates only mild symptoms or no symptoms at all but they can spread the virus to others. Although unconfirmed, it is also possible that the virus stays in the system without creating obvious symptoms or complications and may arise later.
  4. New symptoms seem to be developing continuously with more and more data obtained from the affected persons are analyzed.
  5. In rare cases, people have developed complications without showing any symptoms even after 21 days. Hence, the limit of 14 days quarantine or self-isolation is questionable as an effective limit if the person has history of contact with an affected person or travelled from a pandemic area or any suspected source of virus carrier.
  6. Most of the tests done today (apart from healthcare workers) are for:
  1. Healthcare workers;
  2. elderly and 65+ years old;
  3. for persons with symptoms;
  4. recent history of travel to pandemic areas;
  5. contact with a traveler from pandemic area;
  6. being closer to an affected person;
  7. persons selected through contact tracing;
  8. random selection;
  1. It is impractical to test every person in this world. Hence, chances of several people who are affected by Coronavirus going untested are high.
  2. Even if every person in this world is tested, it has to be cyclic and it is impractical and beyond comprehension. As several people who tested negative initially, tested positive later due to extended incubation period, just one test is inadequate. Hence, the tests must be cyclic which means each person needs to be tested at least twice in a span of 2 weeks or so.
  3. Accuracy of the test kits. The information is unclear but the quoted accuracy levels vary significantly. Hence, there is potential for False Positive or False Negative that may lead to further complications.
  4. Possibility of repeating infection. Cases have been reported where a person declared as “cured”, gets a positive if tested after some time. Seems like the virus does not get eradicated fully from the body.
  5. Test, Test and Test model is very good but it alone may be inadequate due to all of the above as there is always a chance that not all positive cases are captured. There must be a parallel action to mitigate and eliminate Coronavirus.
  6. So far, no vaccine or cure drug has been found for the Coronavirus.

What are the different ways of eliminating Coronavirus?

  1. Medical breakthrough to get a vaccine or drug to cure Coronavirus.
  2. Lockdown and complete isolation.
  3. Model of herd immunity or community immunity or herd protection based resistance development. Normally this works when majority of the people are vaccinated against a virus. However, as there is no vaccination for Coronavirus, the resistance needs to be developed naturally. This method requires exposing enough people to Coronavirus to develop antibodies and immunity to achieve a natural herd immunity and society based resistance but the success of this attempt is not guaranteed. However, by the time the herd immunity is achieved, the number of deaths occurred might be higher and so this approach is a tough decision to take.

In the absence of any medical breakthrough to get a vaccine or drug to cure Coronavirus so far and the model of herd immunity based resistance development will not be easily adapted by any country, the only way to eliminate Coronavirus today is by lockdown and complete isolation combined with large number of testing including random testing for people without symptoms covering wide areas of possible virus spread.

However, the lockdown and complete isolation model will be successful only if every person adheres to the model. Ineffective or namesake lockdown is meaningless as the flattening of the curve and subsequent declining trend after the lockdown is proving to be premature. Even if just 10 persons are still affected, they can start a whole new process of virus spread after the lockdown is lifted based on the early indications of flattening of the curve. So the lockdown and isolation model will be a failure if not adhered properly and may need to keep extending for months if not implemented properly.

How can the lockdown model become successful?

The current model followed by several countries seems to be unsuccessful as the expected flattening of the curve is not happening. There are few instances of reduced new cases in a 24 hours period but the decline rate is not sustaining as it seems to switch the direction after few days.

People still defy the principle of lockdown and move around even for unjustified reasons. The real issue is the management of poor people, labours of daily/weekly wages and migrant workers who have no financial means to sustain weeks of lockdown without continued work. They would try to come out of lockdown seeking jobs to survive and provide food to their family. While it as a genuine issue but it will fail the primary objective. This is another challenge to every government in the fight against Coronavirus.  If this mode of lockdown continues ineffectively, then it will have to be extended for months as days or weeks will be inadequate.

The right lockdown model shall be at least as follows:

  1. Only those who are on truly (emphasis on the word truly) essential services and healthcare workers must be allowed to move around. However, they must be provided all means to follow extreme diligence to protect themselves without compromise. If they get infected, then the purpose is defeated. They must be tested regularly as number one priority even if they show no symptoms to ensure that affected persons are identified and isolated without any delay to avoid them spreading the virus to others.
  2. All others, irrespective of their status and work category must be isolated under lockdown. There can be no exception to that including industries, plants, banks and educational institutions. All money transactions shall be through online and net banking. This may pose very practical problem in some countries where cash exchanges are much common than digital.
  3. Only very essential systems shall be allowed to work under restricted and controlled conditions and they shall be monitored and reported diligently.
  4. Having parties and gathering even within families and neighbours as if the lockdown is a paid vacation must be avoided. Religious gathering, weddings and celebrations need to be regularized to avoid large group of people in a single place or if possible cancelled/delayed.
  5. Lockdown does not mean that the family members in a house are free to be in contact with all. They still must follow all precautions of cleanliness, sanitation and social distancing. As no one really knows if any of the family member is affected by the virus until symptoms are seen or test is done, it is important that even within the house, the social distancing and cleanliness are adhered.

Factors Affecting the Total Lockdown
Economy

Economic suffering, due to lockdown and isolation, must be accepted if the Coronavirus is to be eliminated and to save the life of people. The primary goal must be to eliminate the Coronavirus and not to protect the economy. While we cannot allow uncontrolled fall of the economy but at the same time, it is much more important to ensure that no deaths occur due to inadequate precautionary measures against the Coronavirus, isolation, lockdown model, hunger and famine. Governments must first ensure proper care for the poor, migrant workers and daily wages labours, then direct those who can survive on their own, if required under legislation, to follow the lockdown accepting potential financial and economic loss. Another way to protect the economy, if possible, is by financial, business and industrial experts working online using the web without any physical movement or direct interface.
Diseases and Medical Care other than Coronavirus
The next biggest challenge is the care and attention required for people who are sick and in need of medical care including surgeries and emergencies for diseases unrelated to Coronavirus. During the total lockdown, Governments need to have a clear plan of how this issue will be handled and managed. Government and private hospitals must have a solid and robust plan to ensure no lapse or compromise while this issue is managed.
Personal Loss Including Death Unrelated to Coronavirus
The third biggest challenge is personal tragedies including death (unrelated to Coronavirus) in a family. As this is highly connected to emotional aspects of life, controlling people or even preventing them from gathering to carry out ceremonies for the dead is extremely difficult. Local police and authorities, despite the directives and even law may be forced or even emotionally moved to allow the gathering. There is no easy solution to this problem but this will remain a challenge for achieving total lockdown and isolation.
Distribution and Retail Sales of Basic Provisions and Vegetables
It is impractical for the entire population of a country to stock food, vegetables and meat for extended lockdown periods. People will come out of home to buy food and other essentials at least once in 2 weeks as a minimum if not every week. Distribution of food materials and retail sales is another major challenge for the total lockdown. It is critical that people go into “subtractive model” voluntarily to consume less food than normal so that the stock can last longer than few weeks. It is time to eat to live and not the other way.
Definition of Essential Services

How does one define essential services? Probably this is one of the most complex questions in the whole situation.

Just as an example, it may be easier to shut down the cities and towns but in rural areas where agriculture and farming are the primary source of work, it might be more difficult. As farming is season bounded, if the farmers are not allowed to farm in the season, it will not only affect their monetary system, it may also lead to food shortage in the region or country.

The risk in defining the criteria for essential services is that economic considerations may take priority instead of truly essential requirements.
Migrant Workers and Labour
In many countries, migrant workers form a major group of people, especially in cities. In total lockdown model, many of them may lose their jobs. Being daily or weekly wages group, they will be pushed to real hardship if they lose their jobs and revenue. In that case, they may tend to return to their native places ignoring the lockdown. This group will pose a major challenge as they can carry the virus from cities to rural villages. If the virus spreads to rural areas, due to lack of adequate infrastructure and medical facilities, it will become totally impractical to manage the affected persons.

Secondly the migrant workers and labour may be staying in groups in dormitories, sometimes several persons in a room, with common toilets shared by many. Even in a total lockdown situation, achieving proper social distancing, cleanliness, sanitation and isolation among them will be almost impossible.

There may be several others to add but for this article, the issues listed above are adequate to demonstrate the underlying difficulties in achieving total lockdown and isolation. Hence, it is critical that not only Governments, every individual must step up to own the responsibility and accountability to self-isolate and follow the lockdown model strictly. Unless people step up willingly to co-operate, Governments will have tough time to successfully implement the lockdown.

As we stand today with nearly 1.6 million people affected by the Coronavirus globally and nearly 75,000-85,000+ new cases identified in a day, there is no way economic concern and Coronavirus elimination can work in parallel. Only one, Coronavirus elimination, must be the priority. Unless this is understood by all people and all nations, elimination of Coronavirus will stay as a dream as majority of non-adherence of lockdown may be happening because of economic reasons including businesses, people going to find work or to buy food and other essentials.

What is the minimum lockdown period?

Assuming that the lockdown and isolation is strictly adhered and diligently followed as discussed above, then what is the minimum lock down period to be effective in eliminating the Coronavirus?

The minimum lockdown period is 56 days.

If people are allowed to move in between even in stages, the chance of virus spreading rapidly is high because several people may still be carrying the virus. If the lockdown is lifted in between even for a short time, people will try to aggressively to enjoy the short moment thereby increasing the risk of virus spreading further. The lockdown hence must be continuous without gaps in between.

I have shown two different models, Model 1 and Model 2. Both models demonstrate that the minimum and most likely case lockdown period is 42/56 days.

Model 1

For understanding the minimum effective lockdown period, we need to assume worst case scenario of say 6-10 days for incubation (although the incubation period is considered to be 2-14 days).

For the model, a family of five is considered.

This model assumes that the family members do not come into contact with anyone else including domestic workers like drivers, gardeners and maids. This is evaluated as a closed system of containment.

This model can be extended to include several variabilities like contact with strangers or even to a society with a larger group but it will be cumbersome to explain. If we consider a family as a sample to demonstrate the model, it will amplify the message clearly as a society management will be much more complex.

Let us consider they are 5 members in a family and their names as A, B, C, D and E.

Day 1 of the Lockdown

  1. One person “A” in the family is affected by Coronavirus on day 1 of the lockdown.

Let us assume it takes 6 days for the virus to incubate in “A” and he/she does not show any symptoms.

Day 7 of the Lockdown

  1. The virus is incubated in “A” during this period.
  2. However, “A” still does not show any symptoms.
  3. So the family thinks that they are safe from the virus and move around the house casually.
  4. “A” spreads the virus to two of his/her family members “B” and “C” without knowing that he/she has been infected.

Let us assume it takes 10 days for the virus to incubate in both “B” and “C”.

Day 18 of the Lockdown

  1. “A”  starts showing symptoms and tests positive and is isolated from others.
  2. All others are also tested but all show negative. So they are monitored closely.
  3. “B” and “C” although infected by “A” do not show any symptoms.
  4. “B”  comes in to contact with “D” and infects “D” unknowingly.

Let us assume it takes 9 days for the virus to incubate for “D”.

Day 28 of the Lockdown

  1. “B” and “D” test positive and are isolated.
  2. Although infected, “C” is not showing any symptoms and also tests negative (this is the 18th day after he/she getting infected).
  3. “E” tests negative.

At this stage of 28 days after the commencement of the lockdown,

  1. there is uncertainty if “E” is affected as virus may still be incubating;
  2. “C” is affected but he/she is testing negative and showing no symptoms;

However, as B and D were tested positive, both “C” and “E” are to be isolated at least for another 14 days of lockdown/isolation. That will be 42nd day from the start of the lock down.

Day 42 of the Lockdown

After 14 days, on the 42nd day from the commencement of the lockdown, the test result shows “C” is positive and “E” tests negative.

Now this becomes tricky. Can “E” be allowed to move out? Can the lockdown be lifted?

The answer is no. As “C” is tested positive, condition of “E” must be suspected. Hence, the lockdown must be extended for another 14 days as a minimum.

The above case shows that considering incubation period of 6, 10 and 9 days for three different persons, the minimum number of days for lock down for this family is 56 days.

Minimum Lockdown Period

Based on the above Model 1, the minimum number of lockdown required is 42 but most likely case is 56 days.

Fig.1 describes the Model 1.

Fig.1 – Minimum Lockdown Days Map Model 1

Model 2

For Model 2 unlike Model 1, let us assume a different case scenario of say 4-8 days for incubation.

For the Model 2, I have considered the same family in Model 1.

This model assumes that the family members do not come into contact with anyone else including domestic workers like drivers, gardeners and maids. This is evaluated as a closed system of containment.

This model can be extended to include several variabilities like contact with strangers or even to a society with a larger group but it will be cumbersome to explain. If we consider a family as a sample to demonstrate the model, it will amplify the message clearly as a society management will be much more complex.

Let us consider they are 5 members in a family. Their name is A, B, C, D and E.

Day 1 of the Lockdown

  1. One person “A” in the family is affected by Coronavirus on day 1 of the lockdown.
  2. Let us assume it takes 4 days for the virus to incubate in “A” and “A” does not show any symptoms.

Day 5 of the Lockdown

  1. Virus is incubated in “A” during this period.
  2. However “A” still does not show any symptoms. So the family thinks they are safe from the virus.
  3. “A” spreads the virus to “B” without knowing that he/she has been infected.

Let us assume it takes 8 days for the virus to incubate in “B”.

Day 13 of the Lockdown

  1. Both “A” and “B” are infected but are not showing symptoms.
  2. Virus is incubated in “B” during this period.
  3. “B” comes in to contact with “D” and infects “D” unknowingly.
  4. As both “A” and “B” are not showing symptoms, the family is comfortable that they are safe from the virus and no one is tested.

Let us assume it takes 6 days for the virus to incubate for “D”.

Day 20 of the Lockdown

  1. “A” is showing symptoms, tests positive and is isolated from others.
  2. “B” is not showing any symptoms but as “A” was tested positive, he/she is also tested. “B” shows positive and is isolated from others.
  3. All others are tested and test negative.
  4. “D” is infected but not showing any symptoms.
  5. “C”  and ”E” are not infected.

As “A” and “B” tested positive, all the remaining three “C”, “D” and “E” are in lockdown/isolation mode for another 14 days.

Day 28 of the Lockdown

  1. “D” starts showing symptoms, tests positive and is isolated from others.
  2. However, between Day 20 and 28, before showing symptoms, “D” infects “C”.
  3. ”E” is not infected.
  4. Testing of “C” and “E” shows negative for both.

As “D” tested positive, both “C” and “E” are in lockdown/isolation mode for another 14 days.

The virus takes 7 days to incubate in “C”.

Day 42 of the Lockdown

  1. “C” starts showing symptoms, tests positive and is isolated.
  2. ”E” tests negative.

At this stage of 42 days after the commencement of the lockdown,

  1. “C” is showing positive and is isolated;
  2. there is still uncertainty if “E” is affected as virus may still be incubating in “E”;

Now this becomes tricky. Can “E” be allowed to move out? Can the lockdown be lifted?

The answer is no. As “C” has tested positive, condition of “E” must be suspected. Hence, the lockdown must be extended for another 14 days as a minimum.

To confirm “E” is free of Coronavirus, he/she needs to be tested again at least after another 14 days of lockdown/isolation. That will be 56th day from the start of the lock down.

The above case shows that considering incubation period of 4, 6 and 8 days for three different persons, the minimum number of days for lock down for this family is 56 days.

Minimum Lockdown Period

Based on the above Model 2 also, the minimum number of lockdown required is 42 but most likely case is 56 days.

Fig.2 describes the Model 2.

Fig.2 – Minimum Lockdown Days Map Model 2

Note 1:

If we use 14 days of incubation for each case, then the number of days would be higher than 42/56 but it will not represent the factual observations. It will lead to a false model of pessimism.

Note 2:

If we use just 2 days of incubation for each case, then the number of days would be lower than 42/56 but it will not represent the factual observations. It will lead to a false model of optimism.

A Note on Models:

The models based on a family of 5 members may seem to be limited in a constraint of a home but that is more than adequate to demonstrate the compleity of the problem if the model is expanded to a society where strangers interface with each other. If the models are expanded to a society or town, it will lead to the same conclusion on the minimum number of days for the lockdown.

Conclusions

  1. It is important to understand that Coronavirus is easier to catch if self-hygiene, cleanliness and social distancing are not followed and the worst part is it can spread to others by infected persons who show no symptoms. Hence a few affected persons unknowingly can impact a huge population by spreading the virus rapidly.
  1. So, if lockdown and isolation model needs to work, it has to be properly implemented and adhered to prevent any lapse or gaps. Partial or ineffective lockdown model will be ineffective. It must be treated as a binary system – it is “Yes” or “No”.

Secondly lockdown alone is insufficient as full effectiveness is difficult to achieve. Hence, the testing pattern needs to expanded beyond contact tracing to a very wide range of people by random selection even for those who don’t show any symptoms or history of travel/being close to an affected person to identify the extent of spread through community and control before it spreads further.

Both combined, total lockdown for minimum length of period and random selection testing model for large number of people across a wide range, might prove to be much more effective.

  1. For lockdown and isolation model, 14 or 21 days are inadequate. The lockdown must be for at least for 56 days.
  1. Lockdown or isolation may not be successful even after the 56 days if the freedom of movement is opened wide  and people become careless. The removal of the lockdown must be done in stages in a phased manner that may take another 56 days depending on the severity.
  1. The relaxation of the total lockdown normally will also include opening of borders and international travel. The travel between states and countries must be allowed in a very controlled and systematic manner in a phased approach with quarantine and testing before at the origin and after travel at the destination.
  1. The reported number of infected and negative cases may be unreliable due to accuracy of the test kits and methods. Due to this uncertainty, even if the lockdown is eased slowly after 56 days plus the 56 days phase down period, the general population would need to adhere to their own self-discipline of personal hygiene and social distancing for another 8 weeks at least. It is important that everyone does not aggressively try to move in to normal life at the same time including partying, large gatherings and leisure/tourism trips.
  1. Hence, in order to eliminate the Coronavirus, the following model may be much effective:
Sequence Plan Days Cumulative Days
First Stage Total Lockdown 56 56
Second Stage Phased Relaxation of Lockdown 56 112
Third Stage Continued Social Distancing and Cleanliness after the removal of the Lockdown 56 168

During the entire 168 days through all the stages, continued testing for very wide range of people through random selection, with repeat tests to ensure consistent test results must be carried out relentlessly.

It is not either but the combination of both, (a) total lockdown with phased relaxation followed by continued social distancing process and (b) testing for very wide range of people to check and validate the extent of Coronavirus elimination throughout the three stages is the best chance we may have to eliminate the Coronavirus.

  1. Hence, in order to eliminate the Coronavirus, the following model may be much effective:
Sequence Plan Days Cumulative Days
First Stage Total Lockdown 56 56
Second Stage Phased Relaxation of Lockdown 56 112
Third Stage Continued Social Distancing and Cleanliness after the removal of the Lockdown 56 168

During the entire 168 days through all the stages, continued testing for very wide range of people through random selection, with repeat tests to ensure consistent test results must be carried out.

  1. We all may not like the idea of extended lockdown period. It is tough and difficult. There will be resistance against extended lockdown due to various reasons. However, in the absence of a vaccine/cure drug and herd immunity model is not acceptable for obvious reasons and the high risk involved in that, is there any other effective alternative?

Sometimes in life, tough decisions are to be taken against a formidable adversary. Coronavirus is a challenge that requires such tough decision. Extended lockdown and expanded testing, both combined, is one solution that exists as of now. However, Governments and Healthcare workers alone cannot implement this solution effectively. Every one, every single person living on this earth, must stand up with responsibility and accountability to do each one’s bid to support the Governments and Medical Healthcare workers to eliminate the Coronavirus.

Let us remember – If we fail to prepare and act in time, we need to prepare to fail and suffer consequences.

Note:

Medical Experts, Virology Scientists, Contagious Disease Specialists and others may have a different concept and model for lockdown and testing to eliminate the Coronavirus. I am not an expert like them but mine is a humble attempt from engineering approach to understand the lockdown model and minimum period of lockdown required to achieve its full effect to eliminate the virus based on data and literature available and my paper is only for information and awareness and not an advise or guidance for implementation. Hence, please ignore if any of the facts or interpretation in this paper is inappropriate.

Share Article :

Leave a Comment

Your email address will not be published. Required fields are marked *