Interventions

From
Jump to: navigation, search

This page collects observations, interpretations, and consequences for action about the Interventions for SARS-CoV2 in general. Please observe the structure of the page, when you add your content. Please use references where possible. Remember to find the relevant page. For example, if your observation is about transmission routes, please use that page, instead of posting your content here.

What does Global health say?

WHO

  • * "To suppress and control the epidemics, countries must isolate, test, treat and trace. If they don't, transmission chains can continue at a low level, then re-surge once physical distancing measures are lifted. WHO continues to recommend that isolating, testing and treating EVERY suspected case and tracing every contact, must be the backbone of the response in every country. This is the best hope of preventing widespread community transmission." [1]
    • “You can’t fight a virus if you don’t know where it is,” [2]
    • “Find, isolate, test and treat every case to break the chains of Covid transmission. Every case we find and treat limits the expansion of the disease.” [2]
    • "The real moral dilemma is [..] when a health worker faces a COVID19 patient and they do not have the PPE to protect them. Would you want to be that health worker?" [3]
    • "We cannot care about millions, when we do not care about an individual" [4]
    • "No white flag, no surrender. We must fight. Every life counts" [4]
    • "You need to make the first move, not react to each move the virus makes. Or you will not control this" [5]
    • "if you have to 'be right' before you make a move, you will lose [control over the outbreak]" [5]
    • "The problem with so many countries now is: so many people are afraid to make a mistake." [5]

This approach is known as “Five Early”, that is, “Early Detection, Early Reporting, Early Investigation, Early Isolation and Early Treatment”.

Five Early Approach

Under the SARS-like strategy, in order to stop transmission and reduce health impact, it is necessary to realize “Five Early”, that is, “Early Detection, Early Reporting, Early Investigation, Early Isolation and Early Treatment”, so as to realize the strict management of the source of infection, and to block transmission gradually.[6]

“Early Detection”

That is by improving the awareness and sensitivity of medical staff, early detection of suspected cases, rapid tests and diagnosis should be taken, so as to promote timely and effective management of all patients, which are the most important source of infection for COVID-19.

“Early Reporting”

That is, suspected patients and confirmed cases need to be reported to the health authority or disease control departments within a specified time, in order to start the investigation and response.

“Early Investigation”

That is after receiving reports of confirmed patients, suspected patients or positive tested persons, the department of disease control and prevention needs to send out the epidemiologists to investigate the patients’ exposure before the onset of illness and the persons getting contacted with him/her after getting ill, so as to find out the source of infection of the patient and all of the close contacts associated with him/her (Contact Tracing). Through in-depth “Early Investigation” to identify the transmission chain of each case, it will be totally possible to achieve an overall identification and management of all possible patient-related infected persons.

“Early Isolation”

That is all confirmed cases should be treated in isolation, all suspected cases should be treated in isolation, and all close contacts should be placed under medical observation and isolation, or be quarantined. “Early Isolation” of confirmed and suspected cases would be effective in preventing transmission of the virus from COVID-19 patients to healthy individuals. “Early Isolation” of close contacts will help to detect new cases of infection including atypical mild cases at an early stage, as well as to ensure strict management of those with latent or incubation period infections, so that they could not spread the virus to other people. Through the single-room isolation of the suspected patients and close contacts, it can effectively prevent the possible cross-infection between these isolated patients or quarantined people.

“Early Treatment”

That is through the effective symptomatic treatment, support treatment and available anti-viral or traditional Chinese medicine treatment, efforts are made to prevent the progression of mild cases to severe or critical, and the severe cases to be given full care, all these efforts are trying to reduce case fatality. At the same time, through “Early Treatment” , it can also achieve the elimination of patients’ status as a source of infection.

Through “Five Early” , and to achieve the full hospitalization of all the confirmed cases, suspected cases and positive tested persons, to achieve the full management or quarantine of close contacts, which are called in China “Due Hospitalization, Due Management”, it will lead to the effective control of the further spread of the virus, and ultimately interruption of the virus transmission.

ECDC

  • "Measures taken at this stage should ultimately aim at protecting the most vulnerable population groups from severe illness and fatal outcome by reducing transmission." [7]


Expert commentary on international interventions

  • An excellent overview (in English) by Dr. Ni Daxin (deputy director China CDC) can be found here. [6]
  • The short-term cost of containment will be far lower than the long-term cost of non-containment. However, closures of institutions and public places, and restrictions in travel and trade, cannot be maintained indefinitely. Countries have to face the reality that individual-case containment might not be possible in the long run, and there might be the need to move from containment to mitigation, balancing the costs and benefits of public health measures. [8]

What do we see in the European Member States?

For a detailed and up to date overview of COVID19 policies in ALL countries, check out these:

Instructions

Please use the bullet points below, to share your observations of policy, preferably with reference to formal publication and date. I will transpose those to the table (WikiTables are a headache, and difficult to edit, so I want to make it as easy as possible for everyone). Please use the information fields from the table, as much as possible, so that data can be transposed easily. Since this is a Wiki, each change is logged, and you can always browse through the page history to see the snapshot in time.

Bullet point notes

  • AU: Social distancing measures: people are advised only to entertain strict necessary personal contacts and replace all others by phone, digital or defer altogether. Allowed are: professional contacts; elementary daily shopping; care for those in need; avoid indoor activities outside the home. Since 16 March, for 1 week. The area of Tirol has quarantined certain municipalities. The Skying season has been ended by 15 March. Large events are forbidden. All shops that do not supply basic necessities are closed. Restaurants and bars are closed. Universities, schools and kindergartens are closed.
    • Since 16 March 2020, citizens should only leave their house for three reasons: work engagements and activities that can¶t be delayed or carried out from home, urgent food purchases, or to aid other people in urgent need. Since 17 March 2020, all restaurants and bars, as well as secondary schools and institutes of higher education are closed. The UK, the Netherlands, Russia and Ukraine have been added to the list of countries from which flights are denied permission to land in Austria. [9]
  • BE: Belgium in LockDown as of 17 March.
    • On 20 march: Belgium is enforcing heavy fines for cross border tresspassing.
  • BU: Bulgaria’s President and Prime Minister, Rumen Radev and Boyko Borissov met on Sunday (15 March) and announced that all doctors and nurses “on the first line” will receive an additional 1000 leva (EUR 500) per month, which is a substantial amount by Bulgarian standards. 12 March: proposed emergency measures. More drastic measures to enforce the decision to close restaurants and shops other than those selling food and medicaments are in preparation (on 13 March). kindergarten, schools and universities will be closed, and that nationals of countries with coronavirus outbreak will not be allowed to enter the country. Violation of quarantine is punishable by jail and a fine up to EUR 25000. The Ministry of Foreign Affairs advised Bulgarians not to travel abroad. Bulgarians returning from countries with major coronavirus outbreak such as Italy, but also France, are automatically assigned to quarantine.[10]
  • CY: On 15 March 2020, authorities in Cyprus declared a state of emergency for a period of 15 days, during which people will only be allowed to leave their homes for basic necessities. As of 21 March 2020 03:00, Cyprus will prohibit all flights to Larnaka and Pafos airports coming from the countries listed here. [9]
  • CZ:
  • DE: 17 March: RKI raised the threat level to high. Avoid travel, avoid public transport, try to work from home. Reduce all contacts to a bare minimum. Avoid gatherings or meetings. People over 70 years need pneumococcal vaccination. The 16 German federal autonomous states each can have their own Corona policy.
    • 16 March: Federal agreement on measures: bars, clubs, theatres, musea, cinema, zoos, sporting facilities, playgrounds are closed. Meetings in clubs, leisure, sport, church, mosques, other religious orders are forbidden.[11]
    • Since 16 March 2020, Germany¶s borders with Austria, Denmark, France, Luxembourg and Switzerland are closed. Due to the COVID-19 situation in Germany and worldwide, the RKI has also cancelled the nationwide recommendation to perform contact tracing on flights from 18 March 2020 onwards, so that available resources can be are focused primarily on case finding and contact tracing within Germany.[9]
    • 22 March: Intensified measures; a prohibition for social contact outside of the household for the next 2 weeks. Enforcement established, with fines up to 25000 Euro per offence.
  • DK: Public schools and universities, childcare, libraries, and cultural institutions in Denmark will be closed for two weeks, starting on Friday (13 March) while all public sector employees will be sent home with full payment. Only public employees in the health sector, police, and other sensitive functions will continue to work. Meetings with more than 100 participants will be banned from next week and public transport will be limited to those with seat reservations on trains. There will be no standing capacity on buses and trams.[12]
    • On 14 March, Denmark restricted the cross border movements for population [9]
  • EE: As of 16 March, public venues have closed down, and restrictions on the freedom of movement on the islands of Hiiumaa, Saaremaa, Muhumaa, Vormsi, Kihnu and Ruhnu have been established. As of 17 March 2020, Estonia has restricted cross-border movements and reintroduced border controls in order to contain the spread of SARS-CoV-2.[9]
  • ES: 11 March: schools and universities closed in Madrid.
    • On 14 March, Spanish authorities declared a state of emergency for a period of 15 days, during which people will only be allowed to leave their homes for basic necessities. [9]
    • 22 March: State of Emergency is expanded with 1 week.
  • FI:
  • FR: Containment. Full Lockdown for 2 weeks. Police enforcement of state of emergency
    • On 14 March, France implemented additional control measures (level 3). This implies the closure of non-essential gathering points. [9]
  • GR: Mitigation approach. Schools and universities, all department stores, restaurants, theaters, museums, cinemas, beauty salons, are closed, all events are cancelled, advise working at home, stay at home when symptomatic or hen having a close contact with a confirmed case. Also, there was a decision on 16/03/2020 churches to apply measures (and all celebrations/rituals as we are going towards the Easter period to be canceled or performed following basic rules such as every person to have at least 2 meters distance from the other). There was also a law issued recently that says that whoever is advised to stay at home (case or contact) and is caught not to be following the instructions will face legal consequences (up to 2 years of prison)! The same applies for professionals that disobey the rules. Already there are some arrests of people that opened their restaurants and other services to serve clients. Doctors have been advised not to examine patients with fever at their private offices as much as they can.
    • Take away services, supermarkets and pharmacies are open as well as other services that have to do with transportation of goods. An online number is available for employees to call and get information on their rights on sick leave and reimbursement. At supermarkets since they were overcrowded the first days of the measures there was the decision to have a queue and based on the size of the space to let a specific number of persons enter. Inside the supermarkets there are sanitizers available and people should keep A distance of more than 2 meters from each other. super-markets will remain open on the weekends to avoid overcrowding. These are in summary some of the measures on 17/03/2020 that Greece has 353 reported cases and 4 deaths.
    • 18/03/2020: 418 cases and 5 deaths. Further social distancing measures: groups of more than 10 people are forbidden (fine of 1000 euros). All non-essential commercial stores and leisure places (malls, bars, restaurants etc.) are closed in Greece. Schools/universities/daycare centres remain closed. Supermarkets, pharmacies and other essential stores are advised to only allow one person per 10 square meters at any given time.[9]
  • HU: Ban on visits in hospitals and elderly homes (8 March), declaration of state of emergency (11 March), creation of 10 action groups, e.g. Action Group for the Construction of an Epidemic Mobile Hospital, Action Group for Essential Businesses, Communication Action Group, Extraordinary Legal Order Acton Group, a Research Action Group (13 March), government offices should be visited only in an emergency (14 March), extraordinary break in Hungary’s judicial proceedings (15 March), closure of schools with the launch of a remote digital learning programme, sporting events should be held behind closed doors unless the organizers cancel those events altogether; pubs, cinemas and other cultural facilities will also be closed, restaurants, cafes and shops will be allowed to remain open until 3pm, the restriction will not apply to food stores, pharmacies and drug stores; people are called on to postpone all gatherings except for family events; local councils will be obliged to organize supplies for elderly people staying at home and look after them (16 March), hospitals are suspending elective surgeries and examinations, only emergency interventions will be carried out; only Hungarian citizens will be allowed to enter the country, the restriction relates to all road, railway, water and air borders (17 March), several hospitals designated as quarantine centers and "epidemic hospitals" (18 March), defense ministry sets up operative groups to ensure operation of essential services, people displaying mild symptoms must stay in home quarantine (20 March) (Source)
  • IC: Since 19 March 2020, all residents of Iceland entering the country are required to go into quarantine for 14 days, regardless of where they have come from, excluding airline crew and freight personnel. [9]
  • IT: As of 15 March 2020, all positive cases detected by confirmatory tests carried out by regional reference laboratories can be considered as confirmed cases of SARS-CoV-2 infection, if the region has evidence of sustained local or widespread transmission and there was an agreement in the last week between the regional and National Reference Laboratory test results. [9]
  • LT: As of 16 March 2020, Lithuania has restricted cross-border movements for persons and vehicles, with the exception of freight. On 16 March 2020, authorities declared a state of emergency and imposed a 14-day quarantine. [9]
  • LV: Social distancing in place (see table) Suspended the international carriage of passengers by air through airports, ports, buses and railways, except public passenger transport by national air forces and military transport. Since 12 of March until 14th of April. Work from home promoted
  • MT:
  • NL: (see below as per 15 March 2020). 17 March: Prime Minister advised Dutch not to travel abroad.
  • PO:
  • PT: On 17 March 2020, Portugal implemented border checks with Spain and temporary measures at ports with international traffic. [9]
  • RO: On 14 March 2020, the Romanian President announced that a state of emergency will be declared as of Monday 16 March and asked all citizens to comply with the instructions given by the authorities. According to EWRS, Romanian authorities have suspended all flights for passengers to and from Italy and Spain for 14 days (with exception of humanitarian or medical flights). In addition, the serving of food and beverages in restaurants, hotels, bars, coffee shops, and other hospitality units is prohibited (restriction does not apply to drive-in, room-service and home delivery services). All indoor cultural, scientific, religious and sports activities, as well as the spa and personal care services, are suspended. Outdoor events with over 100 people are also banned. [9]
  • SE: On 19 March 2020, Sweden will implement a ban (active for 30 days) on incoming travellers from countries outside of the EU, excluding EU/EEA citizens, diplomats and those in need of international protection or individuals with certain occupations such as healthcare workers. [9]
  • SK:
  • SV: As of 14 March 2020, authorities have imposed further restrictions, including the closure of Ljubljana airport. As of 16 March 2020, schools, public institutions and public transportation systems have been closed down. [9]

Table

Country AU BE BU CY CZ DE DK EE ES FI FR GR HU IC IT LT LV MT NL PO PO PT PT RO SE SK SV
Stay in when flu-like symptoms Yes Yes y No Yes yes yes yes yes yes yes yes Yes Yes Yes
Stay in when no good reason to go out Yes Yes y No Yes yes yes yes yes yes yes yes Yes Yes Yes
Requested medical students to do voluntary work No Option considered, not yet implemented under discussion Yes Yes Yes
Cancelled large scale events Yes Yes Yes Yes yes yes yes groups of more than 10 people are forbidden yes yes yes Yes Yes Yes yes
Cancelled all events Yes Yes yes (except meetings of less than 100 persons) yes yes yes yes yes ves (if over 50 persons) Yes Yes Yes
Closed cafes and restaurants Yes Yes Yes yes yes yes yes Can stay open until 3pm yes no, but 2 m distancing Yes Yes No yes
Closed schools Yes Yes Yes Yes yes yes yes yes yes yes yes Yes Yes Yes yes
Closed borders yes Yes yes yes yes yes partially No Yes Yes
Other national policies Skying season has ended since 15 March On 20 march: Belgium is enforcing heavy fines for cross border tresspassing. State of Emergency. All frontline doctors and nurses receive 500 Euro per month additional salary. Violation of quarantine is punishable by jail and fine up to 25000 Euro. On 15 March 2020, authorities in Cyprus declared a state of emergency for a period of 15 days, Church, Mosques, other religious gathersings: Forbidden public transport will be limited to those with seat reservations on trains. There will be no standing capacity on buses and trams State of emergency and full lockdown. State of emergency and full lockdown law issued recently: whoever is advised to stay at home (case or contact) and is caught not to be following the instructions will face legal consequences (up to 2 years of prison) State of emergency (since 11 March) Since 19 March 2020, all residents of Iceland entering the country are required to go into quarantine for 14 days, regardless of where they have come from, excluding airline crew and freight personnel. as of 16 March 2020, Lithuania has restricted cross-border movements for persons and vehicles, with the exception of freight. On 16 March 2020, authorities declared a state of emergency and imposed a 14-day quarantine state of emergency Advise not to travel abroad (17 march). School exams cancelled (24 March) None None state of emergency
Additional measures by local government The UK, the Netherlands, Russia and Ukraine have been added to the list of countries from which flights are denied permission to land in Austria Full Lockdown 16 autonomous federal states have specific policies. Federal: Intensified measures; a prohibition for social contact outside of the household for the next 2 weeks. Enforcement established, with fines up to 25000 Euro per offence. full lockdown full lockdown None None Reduction of the business hours of cafes and bars
Since when 16 March 2020 17 March 2020 16 March 13 March 2020 16 march 14 march 17 march 11 March 2020 19 March 16 March 12 march 1-2 weeks ago 11 March 13 March 16 March 19 March 16 march
Implementation pace Gradually. Step by step, as the number of cases increased Step by step, as the number of cases increased Step by step, as the number of cases increased Step by step, as the number of cases increased
For how long will these measures be effective? Until 23 March Until 5 April Closing schools until 20 April; other measures untill further notice 2 weeks Until 26 April 2 weeks At least until 6 April At least until 27 March Until 9 April
Additions to the governmental policies Tirol province has municipalities in quarantine. Work from home promoted, not obligatory. Ban on gathering, except families Advise not to travel abroad None Supermarkets, pharmacies and other essential stores are advised to only allow one person per 10 square meters at any given time Suspended the international carriage of passengers by air through airports, ports, buses and railways, except public passenger transport by national air forces and military transport. None None Suspension of flights from Italy and Spain. the serving of food and beverages in restaurants, hotels, bars, coffee shops, and other hospitality units is prohibited (restriction does not apply to drive-in, room-service and home delivery services). All indoor cultural, scientific, religious and sports activities, as well as spa and personal care services, are suspended. Outdoor events with over 100 people are also banned Sweden will implement a ban (active for 30 days) on incoming travellers from countries outside of the EU, excluding EU/EEA citizens, diplomats and those in need of international protection or individuals with certain occupations such as healthcare workers. As of 14 March 2020, authorities have imposed further restrictions, including the closure of Ljubljana airport. As of 16 March 2020, schools, public institutions and public transportation systems have been closed down
Date info updated 24-3-2020 24-3-2020 24-3-2020 24-3-2020 24-3-2020 09-04-2020 24-3-2020 24-3-2020 24-3-2020 24-3-2020 24-3-2020 24-3-2020 24-3-2020 24-3-2020

Variance in National Policies promotes anxiety

Observations

  • Discussions emerge on social media between citizens that are confused, anxious or downright upset because of the variance in policies.
    • For example, in the Netherlands, some parties ask for a total lockdown, since Belgium and France do the same. They claim the NL government is not doing enough
  • Polls on 17 March show unprecedented high confidence in the Dutch Prime Minister (Mark Rutte): 73%
  • News outlets and media report on crowded public places (e.g. north-sea beaches) where social distancing is not respected. (21 March)
  • Israel focusses on isolating the elderly while letting the epidemic rage through the rest of the population to generate herd immunity. After that 'the old people can come out again'. [13]

Analysis and interpretation

  • As for the situation in the Netherlands: though the confidence in government is high, it may be vulnerable. When a minority keeps shouting that we still do not do enough and backs such statement with 'evidence', referring to countries that go further, this may undermine public confidence, and in general compliance with current policy
  • As evidence grows that compliance to NL government advice for social distancing is not sufficient, it may be necessary for the NL government to take more drastic steps in enforcement.
  • There could be a risk that the English approach may jeopardize the measures in the rest of Europe because it generates much public debate and confusion on what is really necessary.
  • The SARS-CoV2 virus is known for less than a year. It is a risky choice to adopt a strategy of herd immunity as a key strategy, at a time when so much is still unknown about this virus.
    • Even when we let the virus circulate, it may take much longer than a few months, for the virus to circulate. When we let 'the old folks go out again'. the virus will still circulate. As older generations may cluster (e.g. in communities or institutions, her immunity will not be distributed homogenously. All of this make this strategy very risky, and not evidence-based (but more wishful thinking based).

Consequences for action

  • Short term:
    • Keep explaining why policy for one country is appropriate, and why it is not obligatory to do what your neighbour does, simply because countries differ in the health system and other relevant infrastructure. Measures also depend on the phase of the epidemic in each country (not all countries are at the same phase simultaneously)
  • Midterm:
    • Create discussion and debate on the need for EU coordination. This means practically: a political decision to give up national autonomy in matters of PHEIC and hand over competence to the EU
  • Long Term:
    • Expand ECDC mandate, when political support has reached a majority.

References

  1. Dr Tedros at Daily Press Conference WHO, 18 March 2020. https://www.linkedin.com/video/live/urn:li:ugcPost:6646076941306773504/
  2. 2.0 2.1 Dr Tedros Adhanom Ghebreyesus at a briefing on Friday 13 March.
  3. Dr Mike Ryan at the Daily COVID19 Press Conference, 9 march 2020, https://www.pscp.tv/w/1nAJEdnnzEaGL
  4. 4.0 4.1 Dr Tedros, at the Daily COVID19 Press Conference, 9 March 2020. https://www.pscp.tv/w/1nAJEdnnzEaGL
  5. 5.0 5.1 5.2 Dr Mike Ryan, at the Daily COVID19 Press Conference, 13 March 2020. https://www.linkedin.com/video/live/urn:li:ugcPost:6644258800868175872/
  6. 6.0 6.1 Gastbijdrage: Comparative Study of the Two Kinds of Strategies and Measures for the Prevention and Control of COVID-19. Jop De Vrieze. Maart 27, 2020
  7. Rapid risk assessment: Novel coronavirus disease 2019 (COVID-19) pandemic: increased transmission in the EU/EEA and the UK – sixth update https://www.ecdc.europa.eu/en/publications-data/rapid-risk-assessment-novel-coronavirus-disease-2019-covid-19-pandemic-increased
  8. Wilder-Smith, Annelies, Calvin J. Chiew, and Vernon J. Lee. "Can we contain the COVID-19 outbreak with the same measures as for SARS?." The Lancet Infectious Diseases (2020).
  9. 9.00 9.01 9.02 9.03 9.04 9.05 9.06 9.07 9.08 9.09 9.10 9.11 9.12 9.13 9.14 ECDC CDTR Report 21 March 2020
  10. Euraktive 13 March 2020: https://www.euractiv.com/section/health-consumers/short_news/bulgaria-update-covid-19/
  11. Bundesregierung Website Corona: https://www.bundesregierung.de/breg-de/themen/coronavirus/coronavirus-1725960
  12. CORONAVIRUS-Danish public employees sent home for two weeks. EU Observer 13 March 2020 https://euobserver.com/coronavirus/147714
  13. Bennett: Isolating the elderly as nation develops herd immunity is key to defeating virus. i24NEWS. March 20, 2020, 06:59 PM - latest revision March 21, 2020, 01:02 AM