To maintain suppressed community transmission while monitoring and safely enabling gradual resumption of civil life, several critical indicators must be tracked and criteria met to inform when to relax physical distancing measures, and by how much. This includes confirmed cases falling for more than 2-4 weeks in presence of adequate testing capacity, transmission falling to the level of local/sporadic clusters, and that local hospitals and ICUs have sufficient capacity to handle a surge. This will vary depending on local conditions, but decision-makers are urged to err on the side of caution. This will require establishing and maintaining sufficient public health and healthcare capacity, including testing, and the ability to do contact tracing for all cases.
It is essential that if another surge starts to build, prompt action must follow. Lawmakers should be prepared to reimpose restrictions when evidence suggests that a region or city is poised to see a surge of infections, and this should be communicated to the public to build support. Special attention will need to be paid to mitigating transmission risk in vulnerable settings, such as healthcare facilities, nursing homes, assembly line conditions.
Most importantly, the criteria for decisions around restarting must be communicated to the public clearly, with an acknowledgement that this will be an on again/off again approach depending on local conditions. Triggers for taking action should be determined well in advance.