Covid-19. The European Commission prepares a roadmap heralding ‘phase 2’. On 4/15/20 President Ursula Von Der Leyen announces the program, which will soon be presented and discussed in the European Parliament and the Council.
EU Roadmap, premise
The restrictive measures needed to slow the spread of the virus have had (and have) an economic and social cost that will affect the functioning of the domestic market and all international supply chains. As the FAO has already warned, for the food sector.
The return to ‘normalcy‘ will be ‘very slow,’ although it is clear that extraordinary confinement measures cannot last indefinitely. It is therefore necessary to plan – well in advance – for the stage at which member states can restart economic and social activities, identifying strategies to contain the impact on the health of citizens. Most importantly, prevent overloading of health care systems.
The Commission recommends a coordinated approach, to the oxen that have already fled the barn. Based on guidance from theEuropean Center for Disease Control and Prevention (ECDC ) and a panel of scientific advisors. Also taking into account the (tragic) experiences in the member states.
General recommendations for phase 2
The European Commission’s outlines aim at a ‘gradualreduction‘ of containment measures, with a view to a ‘gradual return‘ to community life. Guidelines, non-binding guidance on issues beyond the jurisdiction of the EU. Each member state will therefore be able to consider them and adapt them in relation to the characteristics of its health system (central and territorial), population distribution and economic dynamics.
The elements to be considered in the planning of ‘phase 2’ of coronavirus, according to the Commission:
1) gradualness of action, to be implemented in different stages with sufficient time intervals to verify their ‘beneficial effect’. Above all, to allow vigilance for possible contraindications, with respect to the primary goal of safeguarding the lives and health of populations
2) Progression of measures, from general to specific. Namely:
– Extended protection of the most susceptible population groups (elderly and chronically ill) and COVID-19-positive or pauci-symptomatic individuals(in isolation),
– Gradual replacement of prohibitive measures (general, e.g., suspension of public transportation) with specific protective measures (e.g., intensive and frequent sanitization of means of transportation, as well as safe distances and other precautions),
– gradual exit
from the general state of emergency, in order to ensure democratic accountability of the measures taken and foster broad consensus among the people, (1)
3) Hierarchy of reopenings. That is, to revoke containment measures starting from the local level. With the idea of ensuring the effective appropriateness of measures to individual contexts, taking into account the requirements of progressivity. Keeping in mind the need for ongoing health surveillance and possible reinstatement of restrictions (cordons sanitaire) if new outbreaks emerge,
4) Gradual reopening of internal and external borders by adopting main and complementary hygiene measures to mitigate the risks of virus transmission in communities:
– Mandating the use of face masks, for example. Especially where transit is expected in confined spaces (e.g. shopping centers, distribution establishments, transportation, etc.),
– assert good health education practices (maintaining appropriate physical distance between people), personal hygiene (frequent washing and sanitizing of face and hands, reducing hand contact with face, nose, eyes and mouth), respiratory hygiene (protecting nose and mouth when coughing or sneezing).
Specific recommendations
Specific recommendations are made for communities to protect workers, students and frequenters of public and private places open to pluralities of people.
Progressiveness in the authorization of gatherings. For colleges and universities it should refer to the 2020/2021 school and academic year, although representatives of some member states have announced their intention to bring forward the reopening.
Social distancing, to be ensured first of all, in communities, through suitable measures such as organizing:
– different times for access to canteens and break places (e.g., cafeterias, vending machine areas, courtyards, smoking areas),
– hygiene (often still lacking),
– smaller classrooms,
– Increased use ofe-learning, etc.
Social distancing
Additional recommendations are directed to the management of:
– business activities (food and non-food distribution, B2B and B2C),
– public establishments,
– sports centers and clubs,
– Mass gatherings (e.g. sports and music events, etc.
– public and private offices, professional offices, health care facilities, etc.
Risk analysis is the premise of any procedure to ensure effective compliance with social distancing measures. Therefore, one must consider:
▶️ the state of the places (premises and open spaces) and the different possible scenarios of their attendance at various opening hours),
▶️ the concrete risks of violating interpersonal safety distances. That they remember being the first hygienic precaution to avoid infection through direct contact.
Therefore, procedures must come from the owners and/or managers or legal representatives of each organization, based on a thorough and specific risk analysis, considering the following aspects:
– maximum number of people allowed, of which to display notice by signs at the entrance of the premises and ensure compliance under the responsibility of their managers,
– OPENING HOURS. These can be appropriately quotaed by population groups to prevent gatherings and unnecessary waiting,
– schedules and fast lanes for vulnerable population groups (e.g., the elderly, disabled, sick, pregnant women and new parents).
Means of transportation
In Brussels there is speculation about the provision of ‘new modes of transporting people‘. Electric micro-mobility is clearly the solution to be favored, although neither the European Commission nor the member states have so far stimulated its deployment with concrete support measures (regulatory simplification and tax or economic incentives).
Thus, private means of transportation are expected to be authorized in the first place, as they present less exposure of passengers to the risk of infection. However, mass transportation will have to be reorganized as soon as possible, reducing passenger density and therefore increasing the frequency (and fleets, carbon-free?) of services. In addition to the requirement to wear personal protective equipment (PPE) for driver and/or passenger personnel.
The use of protective barriers (or allocation of space inside carriages, ensuring adequate ventilation at all times?) and the marking of hand-disinfection routes, on board transport vehicles and at stops, is being studied.
However, action must be taken on the community, with hammering of awareness, until everyone has incorporated the serial habit of good hygiene practices (safe distance, frequent hand washing, face covering, sanitization of surfaces and objects).
Continuous monitoring
Health monitoring is a prerequisite for phasing out containment measures. Indeed, it is necessary to ensure:
A) continuous surveillance of any new outbreak of infection,
B) the timely interception of any outbreaks by:
– Isolation of any new positivity,
– Identification of all related contacts (domestic, work, social),
– analysis and precautionary measures on the aforementioned,
C) taking any necessary measures to prevent the spread of the virus.
‘Any level of gradual relaxation of the confinement will unavoidably lead to a corresponding increase in new cases. This will require constant and detailed monitoring as well as the readiness to adjust and reintroduce new measures if needed’ (European Commission, 4/15/19)
The responsibility of public administrators is in addition to that of each organization’s legal representatives and individuals, given the seriousness of the danger and the risk of having to apply new and potentially drastic containment measures.
Criticality
The biggest critical issue on closer inspection today is precisely the inability to carry out ‘blanket’ monitoring of the entire population, following the examples of China and South Korea. Where data show how isolating the virus before it reaches hospitals is the key to achieving ‘zero new infections’. And this achievement is in turn the prerequisite for activities, work and the economy to really resume. Albeit by applying different schemes, marked by strict adherence to basic hygienic precautions.
Member states are therefore urged to rapidly equip their health services, with the twin goals of:
– test. ensure the availability and execution of large-scale analysis as a ‘precondition for the relaxation of social distancing measures‘,
– tracing app
. The development of cell phone applications are recommended to track the virus and warn people of increased risk due to contact with a COVID-19 positive person. ‘These applications can help break chains of infection and reduce the risk of further virus transmission.’
Proximity tracking between mobile devices can be carried out in compliance with privacy legislation by collecting data on an anonymous and aggregate basis, without disclosing names to other users. However, the use of these apps-already operational in China, Singapore and Israel-remains voluntary.
Coordination
The coordination that has so far been lacking between state, regional and local levels must be activated without delay. Unambiguous criteria for epidemiological risk assessment and its consistent management must also come to be agreed upon at the European level. To this end, it will be useful to apply the modus operandi already developed-albeit with relative and improvable success-in food security crisis management:
– Timely risk analysis based on shared canons,
– Transparent and timely communication in network information,
– Gradual extension intervention on all affected territories.
The complexity of the scenario-involving a plurality of sectors, with significant impacts on society, the economy and competition-requires a systems approach. As suggested in a recent study by the Institute of Clinical Science at Queen’s University Belfast, published in The Lancet. (2) Reason, strategic vision and above all solidarity (!).
Dario Dongo, Claudio Biglia and Amaranta Traverso
Notes
(1) A conceptual error. The state of emergency provides the legal basis for allowing exceptions and flexibility in the application of otherwise untenable regulations (e.g., tax measures, tax and bureaucratic burdens, public office calendars and deadlines, etc.). It represents a risk management tool, as such based on its scientific analysis.
Rather, the European Commission and the Council should take action against Hungary, to sanction the so-called ‘anti-coronavirus defense law‘. The law by which Parliament abdicated its powers in favor of Prime Minister Viktor Horbán. V. Hungary’s premier Orban gets sweeping new powers in coronavirus fight. Business standard (Hungary), 30.3.20,
(2) Bradley, Declan Terence et al. (2020).
A systems approach to preventing and responding to COVID-19
. EClinicalMedicine (The Lancet). Volume 0, Issue 0, 100325. https://doi.org/10.1016/j.eclinm.2020.100325