We spoke to Dr Ihor Perehinets, who leads WHO/Europe’s Public Health and Social Measures pillar (part of the COVID-19 Incident Management Support Team), to better understand what public health and social health measures mean, what difference they have made during the pandemic, and why we still need to apply them alongside the rollout of COVID-19 vaccination programmes.
1. What are public health and social measures?
Put simply, public health and social measures are preventive measures at the individual and community level.
Preventive measures can be applied at different times and in different combinations to reduce exposure to, and the spread of, COVID-19. These include interventions introduced by government institutions as well as measures taken by individuals and communities at national and local levels.
Preventive measures range from: testing, contact tracing systems and vaccination programmes implemented by health authorities; personal protective measures, such as cleaning hands and physical distancing or wearing masks; to the rules applied to businesses and educational institutions.
Taken together, targeted and appropriate preventive measures enable lives to continue while controlling COVID-19 and avoiding widespread and damaging lockdowns.
2. How were they implemented when the COVID-19 pandemic began?
On 30 January 2020, WHO categorized the outbreak of COVID-19 as a Public Health Emergency of International Concern, and countries in the WHO European Region began to rapidly apply strong preventive measures, including restricting access to schools, shops and workplaces, as well as regulating travel and public gatherings, both to pre-empt the arrival of the virus and also to help combat its spread when outbreaks occurred.
Such stringent measures were needed to quickly reduce the case surge at a time when we had no effective medical treatments, such as vaccines, for controlling or combatting the virus.
3. Are preventive measures equivalent to lockdowns and restrictions on personal liberties?
No, on the contrary – if planned, implemented and managed properly, and based on clear evidence and transparent data, preventive measures can help avoid hard lockdowns or prolonged quarantines and enable societies to stay open. Lockdowns should only be used as a measure of last resort, when the threat from a disease is so strong that it cannot be controlled by other means.
4. What do preventive measures mean for individuals?
Part of preventive measures are the precautions we take for protecting ourselves and others from catching or spreading the COVID-19 virus. These personal protective measures include getting vaccinated as well as:
- regular hand-cleaning
- maintaining physical distance from others
- mask-wearing in closed spaces
- coughing or sneezing into a bent elbow or tissue
- avoiding closed, confined and crowded spaces
- ensuring good ventilation indoors.
By combining all these measures, we can significantly reduce infection, not just from COVID-19, but also from other respiratory viruses, such as influenza (flu).
5. What evidence is there that any of these personal protective measures work?
More and more studies show the impacts of a range of preventive measures, such as regularly cleaning hands, maintaining a physical distance from others, wearing masks, and ventilation. Each of these measures is important on their own, but when used together with other measures, including vaccination, their impact is multiplied.
Personal protective measures were proven to be effective infection prevention measures long before the current pandemic. For example, the last flu season saw a minimal circulation of the flu virus due to the application of personal protective measures. All these measures have been used previously in different settings while responding to different infection outbreaks. It is only because of the global scale of the pandemic and their widespread adoption that we’ve become so acutely aware of them.
6. Now that we have vaccines, why is there then a need for people to continue with these measures?
Although vaccination is proven to protect from severe disease and death, it reduces, but does not eliminate, the chance of catching and spreading COVID-19. With the highly transmissible Delta variant in circulation in the Region, and with many people still unvaccinated, we risk a surge in cases, particularly at a time when the colder weather is making us socialize indoors more.
With COVID-19 still widely circulating, we also risk the emergence of new variants that could prove to be even more highly transmissible and lead to further deaths. Our best chance to finally end this pandemic is therefore to get vaccinated when you can and make sure you follow all the personal protective measures, regardless of your vaccination status.
7. What preventive measures might governments and authorities consider when faced with a rise in COVID-19 infections?
Governments have a range of ways that they can deal with an increase in cases of COVID-19. These include rolling out vaccination programmes as well as (depending on the severity of the situation):
- environmental measures, such as promoting enhanced cleaning, disinfection and ventilation;
- surveillance and response measures, such as COVID-19 testing, genetic sequencing, contact tracing, isolation and quarantine, as well as risk communication and community engagement;
- physical distancing measures, such as regulating the number and flow of people attending gatherings, closing/adapting schools and businesses, maintaining distance in public or in workplaces, protecting the clinically vulnerable, and protecting those in close settings;
- domestic movement restrictions, such as suspending or restricting movement, stay-at-home orders, and restricting entry to certain areas; and
- international travel-related measures, such as quarantining and restrictions to countries with high rates of transmission, providing travel advice or warnings, restricting visas, restricting entry, restricting exit, entry screening and isolation or quarantine, exit screening, suspending or restricting international flights, and suspending or restricting international ferries or ships.
8. How should governments decide on the types and level of preventive measures to implement? When can they be relaxed?
Government decisions to tighten, loosen or introduce preventive measures need to weigh up the positive and negative impacts that any measures will have on societies and individuals, making a fine balance between protecting lives and livelihoods. This needs to be considered at both a national and local level, taking into account particularly the communities that could be most affected. In countries where strong preventive measures are already in place, measures can be relaxed after individuals have gained natural or vaccine immunity. Easing measures in this targeted way can help reduce the economic and social burden of tighter restrictions.
9. How is WHO helping countries make decisions on preventive measures?
WHO/Europe has developed a new online Public Health and Social Measures (PHSM) Calibration Tool for Member States to use when deciding on the type and level of preventive measures needed at both the national and local levels. This tool brings together all the crucial information on the factors determining preventive measures, such as levels of COVID-19 transmission, and capacities of the health system, including the number of hospital beds available, as well as other contextual considerations, including upcoming events, which may have an impact on transmission or capacity.
By regularly using this tool, governments and local authorities can quickly adjust their measures to suit the current or predicted situation, which in turn should help reduce transmission of the virus, relieve pressures on health systems, and lessen numbers of people becoming seriously ill or dying from COVID-19.
10. Will we ever see an end to COVID-19 and having to follow preventive measures?
It is possible that we will have to learn to live with COVID-19, as we do with other diseases, such as influenza (flu). And as with flu, we may need to continue to protect our most vulnerable populations through vaccination. In addition, we can help these vulnerable people, ourselves, and our families by making personal protective measures part of our normal routine. For example, in the same way that we routinely put on a seatbelt when driving to protect ourselves from injury, we should routinely think to clean our hands regularly or keep a safe distance when mixing with others, to protect against disease infection.