Africa CDC Guidance on Community Social Distancing During COVID-19 Outbreak

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Friday, March 06, 2020 / 05:25 PM / by Africa CDC / Header Image Credit: Twitter; @AfricaCDC


Background

In Africa, the number of COVID-19 cases and impacted countries has been increasingly steadily. As of 12 March 2020, 129 cases have been diagnosed in 12 countries, with one death recorded. The experience in other countries is that, after cases are diagnosed, community transmission occurs. Member States need to immediately implement individual social distancing and make plans for implementing community social distancing. Social distancing is an accepted strategy to delay and reduce the magnitude of outbreaks of pandemic influenza. At the individual level, social distancing involves the use of non-contact greetings, maintaining at least 1 meter distance between yourself and other people, and staying home when ill. At the community level, social distancing involves closure of any events or settings in which people gather together, including schools, work places, houses of worship, and cultural, social, and sports events. For COVID-19, social distancing may be necessary at the individual and community level, because transmission occurs frequently from person-to-person, infection causes severe illness in up to 20% of people, no population immunity exists, and no vaccine or cure exists yet. Reducing contact between people reduces the cumulative number of opportunities for transmission and may help protect people who are at high risk for severe COVID-19 disease.

 

Little is known about the effectiveness of community social distancing for COVID-19. As of March 2020, what we know is:

  1. For the most similar comparable infection, influenza virus, individual and community social distancing, combined with rigorous isolation of people with symptoms (confirmed or suspected cases), delays and reduces the magnitude of outbreaks.

 

  1. Transmission is facilitated by proximity, duration, and number of contacts. The aim of community social distancing is to reduce the number, closeness and length of contacts between people as much as possible. Full lockdown may not feasible, but all effort should be made to prevent as many unnecessary opportunities for contact as possible. 

 

  1. Community social distancing should be instituted as soon as there is any evidence of community transmission, if not sooner, and then maintained for weeks or months depending on the stage of the outbreak or presence of cases within the community.

 

  1. The primary outcome of community social distancing is to slow transmission and reducing daily case numbers, permitting:
    1. Health facilities to attend to a manageable volume of patients without compromising care;
    2. Public health officials to apply new knowledge to target interventions more precisely;
    3. Researchers to develop vaccines and medications.

 

  1. Specific transmission characteristics of COVID-19 suggest that community social distancing is necessary to delay and reduce the magnitude of outbreaks:
    1. Transmission occurs frequently among close contacts.
    2. Transmission may occur from people who are infected and do not yet have symptoms.
    3. Transmission may occur from people who are infected and never develop symptoms.

 

  1. Rigorous application of community social distancing in China slowed transmission.

 

  1. Community social distancing is disruptive, difficult, and potentially dangerous, severely and inequitably impacting economic, social, and cultural activity.

 

Many questions exist about community social distancing for COVID-19, including:

  1. How effective is individual social distancing without or when combined with community social distancing delaying and reducing the magnitude of outbreaks?

 

  1. For community social distancing, how effective is school closure, particularly for different levels of schools (e.g., primary, secondary, tertiary)?

 

  1. How effective is community social distancing if other contact activities such as work and public transport continue? What measures can workplaces take to reduce transmission?

 

  1. How severe are the harms from community social distancing on individuals and communities, including physical health, mental health, social cohesion, and economic life?

 

  1. How feasible and acceptable is community social distancing in different communities and cultures, particularly if people cannot earn income, cannot purchase goods at markets, and cannot attend religious services?

 

Recommendations

1.       Member States, at all levels of government, should implement prominent public messaging about individual social distancing, specifically:

    1. Use non-contact greetings,
    2. Maintaining distance between yourself and other people of 1 meter when in public and where feasible
    3. Stay home if you have fever, cough, shortness of breath, or other respiratory symptoms.
    4. Only seek medical care for severe symptoms, such as difficult breathing.

 

2.  Member States, at all levels of government, should monitor compliance in healthcare facilities and congregate settings, such as prisons and nursing facilities, with individual social distancing and infection prevention and controls standards.

 

3.  Member States, at all levels of government, must begin messaging now to key opinion leaders and the general public about the future possibility of community social distancing. Messaging must be clear, consistent, and culturally respectful. Information must be provided about why such measures will be important and must be provided far in advance of their application to give people time to prepare psychologically and practically.

 

4.      Governments should review their laws at national and sub-national levels to ensure they have the authority to implement community social distancing.

 

5.  Governments and public health agencies should identify trusted channels and actors to explain community social distancing measures and to listen to concerns and obstacles to community social distancing.

 

6. Community social distancing should be implemented immediately after populations have been sensitized and a specific epidemic threshold has been crossed. Because community social distancing will only be effective if implemented before there is widespread community transmission, Africa CDC recommends use of the following thresholds:

a.      Two (2) or more cases occurring in a defined geographic area, e.g., city, with no known link to international travel and no known link to each other or to a common source case within a two week period;

b.      Two (2) or more cases occurring in a defined geographic area and the only link between the cases is attendance at a gathering place such as wedding ceremony, church, mosque, or other house of worship;

c.      A single case diagnosed in a person that attends or teaches at a school.

 

7.  After it has been instituted, community social distancing should be maintained for a sustained period and reviewed carefully before it is withdrawn.

 

8.  Community social distancing should only be used in the most narrow geographic unit necessary to achieve the desired impact.

 

9.   Member States should ensure that any state enforcement of community social distancing, isolation, and quarantine is conducted with full respect for human rights and dignity.

 

10.  Community social distancing includes:

    1. No planned gatherings of 50 or more people
    2. No activities at primary, secondary, or tertiary schools
    3. No activities at churches, mosques, or other houses of worship
    4. In routine gathering places, such as bus stations and markets, people maintaining individual social distancing precautions, e.g., 1 meter distance from other people, non-contact greetings, and staying home if ill.
    5. Employers permitting staff to increase physical distance between employees, including changing shift patterns and staggering work schedules, allowing work-from-home, moving work activities outdoors, and limiting work-related gatherings.
    6. Employers considering providing paid sick leave, support for parents to provide child care, and incentivizing workers to stay at home if they have any respiratory symptoms.
    7. Prominent public messaging encouraging people age 60 or older and people with chronic lung or heart disease to strictly limit their time in public and restrict any travel.
    8. Prominent public messaging instructing people with fever, cough, shortness of breath, or other respiratory symptoms to:

i.   Immediately isolate themselves in their home and contact relevant public health agencies.

ii.       Only seek medical care if they have severe symptoms, such as difficult breathing.

iii. Follow effective infection prevention in the household and receive support from government and/or community to do so.[1]


    1. All levels of government and non-government entities ensuring widespread availability of hand hygiene materials at the entrance of every building and in every bathroom facility, such as soap and water and alcohol-based hand rub.
    2. Public transportation being kept open to maintain health and safety, including access to food, medical services, and other social supports.
    3. Physical force not being used to restrict movement of people outside their homes or outside the geographic unit that is implementing community social distancing.

 

11.   Once widespread community transmission is confirmed, public health agencies should:

    1. Prioritize COVID-19 testing for patients severe enough to require hospitalization or in special circumstances, e.g., an outbreak in a congregate setting.
    2. Only elicit, trace, and quarantine contacts of cases in special circumstances, e.g., an outbreak in a congregate setting.
    3. Provide opportunities, where feasible, for virtual health visits using phone or video.

 

12.  Government agencies should consider all possible mechanisms to provide food, financial support, medicines, religious support, and social support to all individuals adversely impacted by community social distancing.


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