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COVID-19

What needs to happen before European countries lift coronavirus restrictions?

With signs in some European countries that the coronavirus pandemic may have reached a plateau, governments are looking at how to lift lockdown restrictions on their crippled businesses and restless populations.

What needs to happen before European countries lift coronavirus restrictions?
AFP

But what are the conditions that countries should meet before they can start safely easing these strict measures and return to some kind of normalcy?

Don't act too quickly

Experts fear that governments will bow to economic and social pressure to lift their lockdowns prematurely, and warn that such a move could allow COVID-19 to return.

“Lifting the restrictions too quickly could lead to a deadly resurgence,” World Health Organization chief Tedros Adhanom Ghebreyesus has said.

Christian Brechot, Institut Pasteur president and former head of French national medical research institute INSERM, said we must be “very humble and very careful” with a virus that many nations have already underestimated.

“It's not clear with a pandemic of this scale how everything can miraculously return to normal,” Brechot told France Info radio.

European nations begin lifting

Despite such advice, in the hardest-hit continent Europe — where more than 78,000 people have died from the virus — several countries have already started partially lifting confinement measures.

Germany, which has seen new cases drop and was already less affected than some of its neighbours, appeared Monday to be moving towards lifting restrictions in stages.

Austria will allow small businesses to reopen after the Easter break, believing it has sufficiently flattened its infection curve.

Denmark will reopen daycare nurseries, kindergartens and primary schools from April 15, while the Czech Republic has already begun to gradually ease restrictions, including opening some shops.

The countries are following in the footsteps of China, which has loosened its unprecedented lockdown on the city of Wuhan, where the coronavirus emerged in December, after the strict measures appeared to have paid off.

'Very high plateau'

Elsewhere in Europe, however, there are fewer signs that restrictions will soon ease.

Britain passed the grim milestone of 10,000 deaths on the weekend while France is expected to extend its lockdown for at least several weeks.

France's national health service director Jerome Salomon said a slight decrease in intensive care admissions was a “pale ray of sunshine,” adding that “a very high plateau” seemed to be setting in.

The continent's hardest-hit countries Italy and Spain also seem to have reached such a high plateau, with their daily death rates gradually falling.

But after such a devastating period, neither country is letting down its guard — Italy has extended its confinement measures until May 3, while Spain has done the same until April 25. Ireland, Portugal and Belgium have also extended their measures.

Gradual relaxation from mid-May?

“It's not when we have arrived at a plateau that we should lift confinement measures which have helped avoid massive congestion in hospitals,” said Antoine Flahault, a specialist in public health and epidemiology at the University of Geneva.

It must only happen “when we see a decline,” he told broadcaster France 2.

Researcher Brechot said he “hopes that from mid-May we will be in a situation of deceleration” which will allow a “gradual relaxation” of restrictions.

Jean-Francois Delfraissy, who leads the coronavirus science council advising the French government, said “we are not going to go from black to white, but from black to grey, with continued confinement”.

“We can start to discuss post-confinement, but the essential and principal factor is to pursue strict confinement for several weeks.”

Three conditions

Delfraissy said there were several prerequisites for lifting confinement measures.

First, there would need to be an established decline in the number of COVID-19 cases in intensive care.

This would give exhausted health workers a badly needed respite and allow hospitals to restock equipment and supplies.

The transmission rate of COVID-19 — the number of people an infected individual infects in turn — would need to have dropped below one, compared to 3.3 people at the start of the outbreak.

And finally there would need to be a sufficient number of masks to protect the populace and tests to closely monitor the virus's spread. 

For example in France, screening capacity would need to increase from the current 30,000 tests a day to 100,000 or even 150,000 a day by the end of April, Delfraissy said.

Unknowns

Of course, these conditions are subject to much uncertainty, including the possible development an app that uses smartphones to trace the contacts of infected people.

Mobile operators have already been providing location data to health researchers in France and Germany.

Another major unknown is the effect that summer has on slowing COVID-19's spread in the northern hemisphere. 

Respiratory viruses are generally less prevalent in warmer months — flu season is in winter — but will the coronavirus be the same?

“If there is no summer brake, then it will be more complicated” to lift confinement measures, said epidemiologist Flahault.

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HEALTH

Ticks in Denmark: How to protect yourself and what to do if you get bitten

Thousands of people in Denmark are bitten by ticks each year, especially during the summer months. Although most people are left unaffected, an estimated three thousand cases a year in Denmark turn into Lyme disease.

Ticks in Denmark: How to protect yourself and what to do if you get bitten

The humid and warm weather Denmark has experienced so far this year could make ticks even more common than usual this summer, an official said.

Ticks (skovflåter) can be found all over Denmark in forests, meadows, and long grass. They are particularly active during the summer months and increase in number if the weather has been warm and humid. So if you’re hiking, camping or berry-picking this summer, there’s a risk of getting a tick bite (skovflåtbid).

What are ticks?

Ticks are small, spider-like creatures which vary in size, usually between 1mm to 1cm long. They do not fly or jump but climb on to animals or humans as they brush past. Once a tick bites into the skin, it feeds on blood for a few days before dropping off. In Denmark, ticks are often found on rodents or deer and they are particularly prevalent between May and October. 

Lyme Disease (Borreliose

In Denmark, the most common disease ticks transmit is Lyme disease and around 15 per cent of ticks in Denmark’s forests carry this.

It is not known exactly how many people in Denmark get Lyme disease every year, but it is estimated that there are a few thousand cases.

However this is a very small percentage of those who have been bitten by a tick. Broadcaster TV2 has reported that in 98 per cent of cases, people do not get ill from a tick bite.

“If you remove the tick within 24 hours, you most likely won’t get Lyme disease, as it takes longer than this for the bacteria, called borrelia, to transfer to the bloodstream,” Peter Andersen, senior medical officer at the State Serum Institute’s Infectious Disease Epidemiology and Prevention department, told The Local.

Andersen said that humid and warm weather in Denmark so far this year has caused a high number of ticks.

For those who do develop Lyme disease, the symptoms usually appear between two and six weeks after the bite, but sometimes longer.

Some people can get flu-like symptoms a few days or weeks after being bitten by an infected tick. Children may complain of stomach ache, lose their appetite or lack energy.

But the most obvious sign of Lyme disease is a red circular rash around the bite.

“If you’ve had a tick bite, observe the area to check you don’t get a circular rash, which can indicate you’ve been infected. If this happens, contact a doctor to get treatment. Most infections will be treated with penicillin,” Andersen said.

Treating Lyme disease is straight forward, the senior medical officer said. “But the danger is if you don’t acknowledge the rash, then the disease can spread to the nervous system,” he said.

This is called neuroborreliosis and occurs in around one in ten of of Lyme disease cases.

The symptoms of neuroborreliosis typically appear as headaches and neck or back stiffness and radiating nerve pain or muscle paralysis, typically in the face.

People with neuroborreliosis need to be treated in hospital.

There were 216 cases of neuroborreliosis in Denmark last year, according to the State Serum Institute, the country’s infectious disease control agency. That’s an increase from 197 cases in 2020 and 171 cases in 2019.

Most cases each year are detected between July and September and neuroborreliosis most frequently occurs in children aged 5-10 and adults aged 60-70.

TBE – Tick-borne encephalitis (flåtbåren hjernebetændelse)

This is more rare and is a viral brain infection caused by a particular tick bite. Flu-like symptoms can occur a week or more after the bite and can develop to include nausea, dizziness, and in around a third of cases, severe problems. 

In Denmark, TBE cases tend to only occur on Baltic Sea island Bornholm, where there are around 3 cases a year. There have been two reported cases in North Zealand in 2008 and 2009.

In Denmark, a TBE vaccination is recommended for people who travel regularly in areas with TBE. There isn’t a vaccination for Lyme disease.

What if I get bitten by a tick?

If you do find a tick, you should remove it quickly with a special tick remover (available at all pharmacies), tweezers or your nail. The sooner you can do this, the lower the risk the tick will be able to infect you.

The important thing is making sure you remove the whole tick, by grabbing it as close to the skin as possible and pulling slowly. Then wash and clean the bite, and contact a doctor if you’re worried.

Prevention

If you’ll be spending time in wooded areas with long grass, especially those known to have a high tick presence, you should wear boots along with long sleeved light clothing so you can see the ticks, and tuck trousers into socks. Mosquito repellent has also been proven to help deter ticks.

“Proper clothing is a good prevention but it’s not always realistic to wear long sleeves and trousers when it’s warm. So if you have been outside in nature, you should check yourself in the evening or get a family member to check you for ticks,” Andersen suggested to The Local.

Ticks tend to bite around thin areas of the skin such as kneecaps, groin, armpits and hairline. In children, they can often be found on their scalp and behind the ears.

“Ticks are very small and look like a tiny dot so they can be easily missed. They start to enlarge when they suck blood and then the red rash can appear,” Andersen said. 

Despite their high presence, ticks shouldn’t put you off enjoying Denmark’s nature this summer. Being vigilant to the tiny black insects should keep any tick-related illness at bay.

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