Historical review and reflections on the participation of acupuncture and moxibustion in the treatment of epidemics in the People’s Republic of China (from 1950 until now)

Since the establishment of the People’s Republic of China, both the Communist Party and the government have placed great emphasis on the advancement of traditional Chinese medicine. Acupuncture and moxibustion have been actively involved in combating major epidemics such as malaria, schistosomiasis, and COVID-19. This article conducts a historical review of these three significant cases to elucidate how the acupuncture community has effectively utilized its unique advantages and characteristics through theoretical discussions, clinical practices, experimental research, as well as receiving administrative leadership and political support from the Communist Party of China and government. We provide an objective evaluation of their effectiveness while summarizing historical experiences to serve as a reference for future utilization of acupuncture and moxibustion therapy in epidemic relief efforts. Additionally, propose four suggestions: strengthening Party leadership and enhancing political support;timely summarization of experiences to establish programs and systems;deepening scientific research by integrating experimental findings with clinical practice;focusing on public awareness campaigns and education to solidify grassroots foundations.

Study on Influence of the COVID-19 Epidemic on Tourism Consumption Structure in Shandong Province

At the end of 2019,the sudden outbreak of the COVID-19 epidemic brought great challenges to the world,and China's tourism industry suffered an unprecedented heavy blow.Exploring the impact of the epidemic on tourism consumption structure has become a research focus in the post-epidemic era.In this study,based on Shandong Tourism Statistics Handbook from 2018 to 2020,taking Shandong Province as an example,the changes of total tourism revenue and tourism consumption structure in Shandong Province before and after the COVID-19 epidemic were compared to predict the development of tourism in Shandong Province in the post-epidemic era and find out existing problems,and optimization paths were put forward for the development of tourism in Shandong Province in the post-epidemic era.

Risk Factors for Severity and Mortality of Patients Hospitalized for COVID-19 during the 3rd Wave of the Epidemic-Sao Tome and Principe

Rationale: In the literature, some risk factors for severity and mortality from COVID-19 have been indicated. However, these factors can change, depending on the characteristics of the population and health services. In this sense, longitudinal studies can be useful for understanding local realities and subsidizing health actions based on these realities. Objective: To analyze the risk factors for severity and death in hospitalized patients with COVID-19. Methods: A retrospective cohort of patients with COVID-19 hospitalized from August 1 to October 16, 2021 (3rd wave of the pandemic), notified by the Department of Epidemiological Surveillance of Sao Tome and Principe. We employed measures of strength of associations for the analysis of exposure risk factors. Results: We analyzed 110 hospitalized patients (31.8% severe-critical and 68.2% non-severe). The risk factors for severe forms of COVID-19 were: being aged ≥60 years (RR = 3.3), being male (RR = 2), having comorbidities (RR = 2) and the risk increases to 10-fold for multicomorbidities, with emphasis on obesity, neoplasia, skin-muscle-surgical infection, dementia and to some degree CVD. 62.9% of patients with severe forms of the disease were not vaccinated. Risk factors for death among hospitalized and severe/critical cases, respectively, were having comorbidities (RR = 8 and 2.4) multicomorbidities (RR = 10 and 2.8 for those with 2 comorbidities and RR = 33.3 and 4 for those with 3 or 4 comorbidities), especially diabetes, dementia, neoplasia, cutaneous-muscular infection, and obesity. Although CVD was not associated with risk factors for death, these were the most frequently found among the severely hospitalized and deaths. In addition, important risk factors associated with death were not using corticoids (RR = 3.3, 230-fold risk) and not using anticoagulants-heparin (RR = 1.3, 30% risk) more compared to the severe cases that did use them. Most of the patients who died (63.2%) were not vaccinated. Moreover, having only 1 dose of the vaccine was a risk factor 1.9 times more for death among all hospitalized patients, but in the severe cases, there was no association between the variable vaccination and death. Among those hospitalized with 2 doses, it was a 0.5-fold protective factor among those hospitalized. The Delta variant of Sarscov-2 was the one found among severe cases and deaths investigated by genetic sequencing, with more exuberant clinical features compared to the other 2 previous vaccinations. Conclusion: Being elderly, male and presenting comorbidities, mainly multicomorbidities were the main characteristics associated with severity of COVID-19. On the other hand, comorbidities, and even worse, multicomorbidities, hospitalization for respiratory failure, lowered level of consciousness, no use of corticoid and no use of anticoagulation in critically ill patients, and not having at least 2 doses of vaccine for covid-19, were characteristics associated with death by COVID-19. These results will help inform healthcare providers so that the best interventions can be implemented to improve outcomes for patients with COVID-19. Public health interventions must be carefully tailored and implemented in these susceptible groups to reduce the risk of mortality in patients with COVID-19 and then the risk of major complications. Intensive and regular follow-up is needed to detect early occurrences of clinical conditions.

Dynamics of the coronavirus disease 2019(COVID-19)epidemic in Wuhan City,Hubei Province and China:a second derivative analysis of the cumulative daily diagnosed cases during the first 85 days

Background:Controlling the coronavirus disease 2019(COVID-19)epidemic requires information beyond new and cumulative cases.This study aims to conduct an in-depth analysis by geographic strata:Wuhan City(hereafter referred to as Wuhan)only,Hubei Province(hereafter referred to as Hubei)excluding Wuhan,and China excluding Hubei.Methods:Daily cumulative confirmed COVID-19 cases between December 8,2019(the date of symptom onset based on patients'recall during the investigation),and March 1,2020,from official sources and published studies were analyzed.The second derivative model was used for information extraction.Data analysis was conducted separately for the three strata.Results:A total of 80026 diagnosed COVID-19 cases were reported during the first 85 days of the epidemic,with 49315 cases from Wuhan,17788 from Hubei excluding Wuhan,and 12923 from China excluding Hubei.Analytical results indicate that the COVID-19 epidemic consists of an Acceleration,a Deceleration,and a Stabilization Phase in all three geographic strata,plus a Silent Attack Phase for Wuhan only.Given the reported incubation period of 14 days,effects of the massive anti-epidemic actions were revealed by both the Acceleration and Deceleration Phases.The Acceleration Phase signaled the effect of the intervention to detect the infected;the Deceleration Phase signaled the declines in new infections after the infected were detected,treated and quarantined.Conclusion:Findings of the study provide new evidence to better monitor the epidemic,evaluate its response to intervention,and predict the trend long.In addition to re-evaluating the control of the COVID-19 epidemic in China,this study provided a model for monitoring outbreaks of COVID-19 in different countries across the world.

Risk factors and strategies for prevention of depression, anxiety and eating disorders among adolescents during the coronavirus disease 2019 (COVID-19) pandemic: a review

The purpose of this review is to identify prevalent trends and risk factors in depression,anxiety,and eating disorders in the adolescent population in the post coronavirus disease 2019(COvID-19)scenario.We examined the literature published on adolescent mental health since the COVID-19 pandemic.We chose to summarize studies published from 2019 to 2022,using bibliographic search tools.We developed criteria for selecting articles for our review using diagnostic indicators and keywords.Mental health conditions such as depression,anxiety and eating disorders are commonly prevalent in this population and have shown increasing rates in the past three years.Some risk factors associated with these diagnoses include reduction in social interaction,increased workloads,routine shifts,sleep quality,social media usage and parental involvement.Routines,sleep cycles,physical activity,and social media should all be considered as a part of prevention in this population.Approaches that seem to be successful include maintaining social ties and avoiding negative social media usage with harmful content.Increased global public awareness,as well as parental awareness,through media campaigns,is critical to slowing the spread of mental health challenges in adolescents and teenagers in the post-COvID-19 era.

Prediction System for Diagnosis and Detection of Coronavirus Disease-2019(COVID-19):A Fuzzy-Soft Expert System

In early December 2019,a new virus named“2019 novel coronavirus(2019-nCoV)”appeared in Wuhan,China.The disease quickly spread worldwide,resulting in the COVID-19 pandemic.In the currentwork,we will propose a novel fuzzy softmodal(i.e.,fuzzy-soft expert system)for early detection of COVID-19.Themain construction of the fuzzy-soft expert systemconsists of five portions.The exploratory study includes sixty patients(i.e.,fortymales and twenty females)with symptoms similar to COVID-19 in(Nanjing Chest Hospital,Department of Respiratory,China).The proposed fuzzy-soft expert systemdepended on five symptoms of COVID-19(i.e.,shortness of breath,sore throat,cough,fever,and age).We will use the algorithm proposed by Kong et al.to detect these patients who may suffer from COVID-19.In this way,the present system is beneficial to help the physician decide if there is any patient who has COVID-19 or not.Finally,we present the comparison between the present system and the fuzzy expert system.

The Sunspot Cycle Leads to Origin and Epidemic Mechanism of Novel Coronavirus COVID-19

Listed examples of virus transmission epidemics that can be strongly transmitted through the air caused by sunspot change cycle, analyzed the mechanism that promotes the generation of new viruses. From the schematic diagram of the changes in the combined force of the hydrodynamic effect of the sun sweeping the earth and the sweeping force, we obtain the places that are prone to light vortices are 30 degrees north latitude and 30 degrees south latitude on the east coast of the mainland creatively. The curved continental lines are perfect, the range of the light vortex generated is more obviously, and the effect is stronger. And the curved continental lines are perfect, the range of the light vortex generated is more obviously, and the effect is stronger. It is inferred that the light vortex produces the special amplified energy so that can make the virus mutate to produce a new highly infectious novel coronavirus. The earliest known place and time of the novel coronavirus origin are consistent with the reasoning of the new theory. Because the radius and frequency of the light vortex are different, the resulting virus strains are also different. Moreover, the fatality rate in the light vortex area is much higher than that in the non-light vortex area, indicating that the virus’s toxicity and lethality are higher in the light vortex area, so it can explain why Russia, India, and countries in the African equatorial region mortality are much lower than the United States, Italy, Spain and Brazil. Finally, preventive and recommended measures are proposed.

Global pattern and determinants of coronavirus disease 2019(COVID-19)vaccine coverage and progression:a global ecological study

Background:Understanding and minimizing existing global coronavirus disease 2019(COVID-19)vaccination disparities is critical to global population health and eliminating health inequities.The study aims to investigate the disparities of vaccination coverage and progression and the associated economic and educational determinants to inform global COVID-19 vaccination strategies.Methods:COVID-19 vaccination coverage data from 206 countries used in the study were derived from“Our World in Data”website.After obtaining the vaccination coverage indicators,we fitted the progression indicators for vaccination.Correlation and multiple linear regression analysis were used to examine the effects of gross domestic product(GDP)per capita,Gini index,education,and their interactions on the coverage and progression of the COVID-19 vaccination.Results:The coverage of COVID-19 vaccination ranged from less than 30 doses to more than 150 doses per hun­dred people,from less than 15%to more than 75%for proportion of people vaccinated,from less than 15%to more than 60%for proportion of people fully vaccinated.Similarly,the progression of vaccination ranged from less than 0.1 to more than 0.6 for progression of total number of doses,from less than 0.1 to more than 0.3 for progression of proportion of people vaccinated,and from less than 0.1 to more than 0.4 for progression of propor­tion of people fully vaccinated.GDP per capita and education were positively associated with the coverage and progression,while Gini index was negatively associated with the coverage and progression.Negative interaction between GDP per capita and education was also observed for coverage(0=-0.012 to-0.011,P<0.05)and progression(0=-0.012 to-0.011,P<0.05).Conclusions:Substantial geographic disparities existed for the coverage and progression of COVID-19 vaccination.

2019冠状病毒疾病大流行背景下可逆性后部脑病综合征的特点分析

在2019冠状病毒疾病(COVID-19)大流行背景下,可逆性后部脑病综合征(PRES)的发病率有所增加。我们通过计算机检索Pubmed、中国知网、万方据库,检索时间为建库到2022年6月;检索到COVID-19合并PRES共45例,均排除了PRES的其他危险因素。综合分析显示,COVID-19合并PRES比单纯PRES可能更容易出现脑出血并发症,COVID-19合并PRES病人的脑出血风险与COVID-19病情严重程度有关;低氧可能是PRES的诱因。

Impact of COVID-19 Epidemic on the International Food Supply Chain and Countermeasures of Shandong Province

The COVID-19 epidemic has exerted an impact on the global food supply chain,and also has contributed to the tendency of food hoarding and short supply;strong food demand has led to a rapid rise in international food prices,which has put enormous pressure on China's food import,and domestic food price showed a rise trend accordingly.In order to ensure sufficient and stable supply of China's food market,it is necessary to adhere to the food security strategy of"food self-sufficiency"for a long term.In the spring agricultural production,Shandong Province has taken effective measures to stabilize food production and achieved good results.It has not been greatly affected by the COVID-19 epidemic;however,under the continuous spread of foreign epidemics,we must adhere to the dual hard core operation of epidemic prevention and production,and explore the establishment of technical specifications for agricultural production under normal conditions for epidemic prevention and control to ensure the food security.

Mathematical Modelling of the COVID-19 Epidemic in Northern Ireland in 2020

In this study, we investigate the dynamics of the COVID-19 epidemic in Northern Ireland from 1st March 2020 up to 25th December 2020, using several copies of a Susceptible-Exposed-Infectious-Recovered (SEIR) compartmental model, and compare it to a detailed publicly available dataset. We split the data into 10 time intervals and fit the models on the consecutive intervals to the cumulative number of confirmed positive cases on each interval. Using the fitted parameter estimates, we also provide estimates of the reproduction number. We also discuss the limitations and possible extensions of the employed model.

Increased alcohol consumption during the COVID-19 pandemic:A cross-sectional study

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has significantly impacted health,mental well-being,and societal functioning,particularly for individuals with psychiatric conditions and substance use disorders.Recent evidence highlights a concerning increase in alcohol consumption during the pandemic,with a study spanning 2015-2020 indicating heightened usage,especially among young and middle-aged adults,for relaxation and tension relief.Additionally,addressing challenges exacerbated by the pandemic,another study underscored persistent barriers to healthcare access,resulting in increased alcohol and tobacco use rates and limited healthcare options.These findings shed light on the unique vulnerabilities exposed by the pandemic,emphasizing the need to investigate further its impact on alcohol consumption in diverse non-urban American communities.AIM To investigate the impact of the COVID-19 pandemic on alcohol abuse using socioeconomic and medical parameters in diverse non-urban community in America.METHODS Based on a cross-sectional analysis of 416 participants the United States in 2021,the study utilized The Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition criteria to categorize alcohol consumption levels.Participants aged 21 years and above were surveyed through an online platform due to COVID-19 challenges.The survey was conducted from January 14 to January 31,2022,recruiting participants via social media and ensuring anonymity.Informed consent was secured,emphasizing the voluntary nature of participation,and participants could only take the survey once.RESULTS Out of 416 survey respondents,396 met eligibility criteria,with 62.9%reporting increased alcohol consumption during COVID-19.Males(68.8%)and ages 21-29 years(34.6%)predominated.Low alcohol consumption decreased by 2.8%(P=0.237),moderate by 21.4%(P<0.001),and heavy increased by 14.9%(P<0.001).Alcohol abuse rose by 6.5%(P=0.0439),with a 7%increase in self-identified alcohol abusers/alcoholics.Seeking treatment during COVID-19 rose by 6.9%.Easier alcohol access(76.0%)was reported,while 80.7%found it harder to access medical care for alcohol-related issues.These findings highlight the pandemic's impact on alcohol consumption and healthcare access,emphasizing the need for targeted interventions during public health crises.CONCLUSION The COVID-19 pandemic exacerbated alcoholism and abuse,with increased heavy consumption(P<0.001)and abuse(P=0.0439).Access to medical programs for addressing alcohol abuse declined,highlighting the need for targeted intervention.

体外功能性肺组织模型构建、调控及在肺纤维化和COVID-19中的应用

肺纤维化是很多肺部疾病发生发展过程中出现的病理现象。近年出现的2019冠状病毒病(coronavirus disease 2019,COVID-19)引发的呼吸系统综合征也会出现弥漫性肺泡损伤,并诱发肺纤维化。因此,开展肺纤维化和COVID-19体外模型构建与调控研究在肺部疾病治疗和药物筛选方面意义重大。目前,现有研究已建立了多种体外肺组织二维、三维细胞培养模型,本文将全面概述这些模型的构建方法,并结合这些模型在肺纤维化及COVID-19中的应用研究,对体外肺组织模型在药物传递、高通量药物筛选及发病机制研究等生物医学领域中的应用前景进行综述,为其进一步研究提供参考。

Analysis of the Role of General Practitioners Services in Rural Areas during the COVID-19 Epidemic

Since the outbreak of the COVID-19,various regions of China have been rapidly deployed under the leadership of the Central Committee of the Party to actively prevent and control the COVID-19.The rural areas of my country have weak links to the prevention and management of public health emergencies.Problems include lack of medical and health resources and farmers’low awareness of epidemic prevention.Situations that correspond to the prevention and management of the COVID-19 are more serious.As the patient’s first contact and“gatekeeper”in the fight against the epidemic,the general practitioner is responsible for the“first visit-subsequent ongoing intervention”.This article is about the prevention and control of the COVID-19 epidemics and epidemic prevention in terms of dissemination of knowledge,informed crowd control,joint prevention and control,and standardized management of people.This is a summary of the efforts of general practitioners.Quarantine at home,interactive referrals to medical consortiums,special care for contracted families.The function during the management period aims to analyze the role played by general practitioners during the epidemic and to provide new ideas for the prevention and management of the epidemic.Provide more targeted general practitioner-style services in rural areas to promote the implementation and improvement of health and poverty alleviation.The health level of the rural population provides a theoretical standard.

Analysis on the Changes of Research Hotspots in the Prevention and Treatment of COVID-19 by Traditional Chinese Medicine Based on Knowledge Graph

Objective: To grasp the changing trend of research hotspots of traditional Chinese medicine in the prevention and treatment of COVID-19, and to better play the role of traditional Chinese medicine in the prevention and treatment of COVID-19 and other diseases. Methods: The research literature from 2020 to 2022 was searched in the CNKI database, and CiteSpace software was used for visual analysis. Results: The papers on the prevention and treatment of COVID-19 by traditional Chinese medicine changed from cases, overviews, reports, and efficacy studies to more in-depth mechanism research, theoretical exploration, and social impact analysis, and finally formed a theory-clinical-society Influence-institutional change and other multi-dimensional achievement systems. Conclusion: Analyzing the changing trends of TCM hotspots in the prevention and treatment of COVID-19 can fully understand the important value of TCM, take the coordination of TCM and Western medicine as an important means to deal with public health security incidents, and promote the exploration of the potential efficacy of TCM, so as to enhance the role of TCM in Applications in social stability, emergency security, clinical practice, etc.

Effects of policies and containment measures on control of COVID- 19 epidemic in Chongqing

BACKGROUND Coronavirus disease 2019(COVID-19)is an emerging,rapidly evolving disease that spreads through the respiratory system and is highly contagious.In March 2020,the World Health Organization declared the COVID-19 outbreak a pandemic.In China,the pandemic was controlled after 2 mo through effective policies and containment measures.Describing the detailed policies and containment measures used to control the epidemic in Chongqing will provide a reference for the prevention and control of COVID-19 in other areas of the world.AIM To explore the effects of different policies and containment measures on the control of the COVID-19 epidemic in Chongqing.METHODS Epidemiological data on COVID-19 in Chongqing were prospectively collected from January 21 to March 15,2020.The policies and prevention measures implemented by the government during the epidemic period were also collected.Trend analysis was performed to explore the impact of the main policy measures on the effectiveness of the control of COVID-19 in Chongqing.As of March 15,the cumulative incidence of COVID-19 in Chongqing was 1.84/100000(576 cases)and the infection fatality rate was 1.04%(6/576).The spread of COVID-19 was controlled by effective policies that involved establishing a group for directing the COVID-19 epidemic control effort;strengthening guidance and supervision;ensuring the supply of daily necessities and medical supplies and equipment to residents;setting up designated hospitals;implementing legal measures;and enhancing health education.Medical techniques were implemented to improve the recovery rate and control the epidemic.Policies such as“the lockdown of Wuhan”,“initiating a first-level response to major public health emergencies”,and“implementing the closed management of residential communities”significantly curbed the spread of COVID-19.Optimizing the diagnosis process,shortening the diagnosis time,and constructing teams of clinical experts facilitated the provision of“one team of medical experts for each patient”treatment for severe patients,which significantly improved the recovery rate and reduced the infection fatality rate.CONCLUSION The prevention policies and containment measures implemented by the government and medical institutions are highly effective in controlling the spread of the epidemic and increasing the recovery rate of COVID-19 patients.

Symptomatic COVID-19 in University Students: A School-Wide Web-Based Questionnaire Survey during the Omicron Variant Outbreak

Aim: To detect risk and preventive factors associated with the Omicron variant infection in university students, a combination of a web-based survey and multivariate logistic regression analysis was introduced as the front-line initiatives by the school health practitioners. Design: Questionnaire survey. Methods: The school-wide web-based questionnaire survey was conducted among our university students as a part of the annual health check-up in April, 2023. The positive outcome was confined to the first symptomatic COVID-19 onset during the Omicron variant outbreak. Results: In this self-administered survey, risk or protective associations were merely estimated statistically in university students (n = 5406). In measured factors, karaoke and club/group activities could maintain the statistical significance in adjusted odds ratios (ORs) as relative risk factors, and science course, measles/ rubella (MR) vaccination, and COVID-19 vaccination remained as relative protective factors in adjusted OR analyses. Club/group activities with member gathering and karaoke sing-along sessions in university students may frequently have WHO’s three Cs. These risk factors are still important topics for the infection control of COVID-19 in university students. Together with some recent reports from other researchers, the significant protective role of MR vaccine in our survey warrants further clinical investigation. If the breakthrough infection continuously constitutes the majority of infection, real data in test-negative case-control or web-based questionnaire design continue to be important for statistical analysis to determine the minimal requirement of our strategies which may be equivalent to or replace COVID-19 vaccines.

Understanding the Treatment of COVID-19 and other Epidemics in Traditional Chinese Medicine

Epidemics spread quickly and are highly contagious.And there has been a profound understanding of etiology,pathogenesis,prevention,and treatment of these diseases in traditional Chinese medicine(TCM).Coronavirus disease 2019(COVID‑19)falls into the category of“epidemic dampness”,and the core pathogenesis is that latency of externally‑contracted dampness turbidity and epidemic toxin in pleurodiaphragmatic interspace provokes Shaoyang ministerial fire and causes concomitant attack of external and internal pathogens,resulting in wood fire tormenting metal and the upward rushing of dampness fire(toxin),ultimately leading to a syndrome of epidemic toxin blocking the lung.Throughout the treatment of COVID‑19,Professor Shiyun Yan uses the“harmonizing”method and sticks to the basic principles of“protecting middle qi,pectoral qi and yin fluid”to consolidate the root,dispersing externally and clearing internally and using in combination drugs cold and warm in property.The specific treatment approaches include ventilating lung and expelling pathogens,clearing heat and removing the toxin,tonifying qi and nourishing yin,activating blood and resolving stasis,resolving dampness,and dredging collaterals,to prevent the patient’s condition from getting worse and save the dying.

Understanding the Treatment of COVID-19 and other Epidemics in Traditional Chinese Medicine

Epidemics spread quickly and are highly contagious.And there has been a profound understanding of etiology,pathogenesis,prevention,and treatment of these diseases in traditional Chinese medicine(TCM).Coronavirus disease 2019(COVID-19)falls into the category of“epidemic dampness”,and the core pathogenesis is that latency of externally-contracted dampness turbidity and epidemic toxin in pleurodiaphragmatic interspace provokes Shaoyang ministerial fire and causes concomitant attack of external and internal pathogens,resulting in wood fire tormenting metal and the upward rushing of dampness fire(toxin),ultimately leading to a syndrome of epidemic toxin blocking the lung.Throughout the treatment of COVID-19,Professor Shiyun Yan uses the“harmonizing”method and sticks to the basic principles of“protecting middle qi,pectoral qi and yin fluid”to consolidate the root,dispersing externally and clearing internally and using in combination drugs cold and warm in property.The specific treatment approaches include ventilating lung and expelling pathogens,clearing heat and removing the toxin,tonifying qi and nourishing yin,activating blood and resolving stasis,resolving dampness,and dredging collaterals,to prevent the patient’s condition from getting worse and save the dying.

Partial Unlock for COVID-19-Like Epidemics Can Save 1 - 3 Million Lives Worldwide

Background: A large percentage of deaths in an epidemic or pandemic can be due to overshoot of population (herd) immunity, either from the initial peak or from planned or unplanned exit from lockdown or social distancing conditions. Objectives: We study partial unlock or reopening interaction with seasonal effects in a managed epidemic to quantify overshoot effects on small and large unlock steps and discover robust strategies for reducing overshoot. Methods: We simulate partial unlock of social distancing for epidemics over a range of replication factor, immunity duration and seasonality factor for strategies targeting immunity thresholds using overshoot optimization. Results: Seasonality change must be taken into account as one of the steps in an easing sequence, and a two-step unlock, including seasonal effects, minimizes overshoot and deaths. It may cause undershoot, which causes rebounds and assists survival of the pathogen. Conclusions: Partial easing levels, even low levels for economic relief while waiting on a vaccine, have population immunity thresholds based on the reduced replication rates and may experience overshoot as well. We further find a two-step strategy remains highly sensitive to variations in case ratio, replication factor, seasonality and timing. We demonstrate a three or more step strategy is more robust, and conclude that the best possible approach minimizes deaths under a range of likely actual conditions which include public response.