What they are?
These are criteria that any country should use to keep transmission of COVID-19 low and at manageable levels.
These steps can help countries gradually lift restrictions in phases. This will allow some resumption of economic and social life, while minimizing the risk of disease.
Why are they important?
The 6 criteria outline what should be in place before transitioning away from these measures currently in place, such as physical distancing and “shutdowns”.
This “slow and strategic” response is necessary because the virus spreads rapidly and outbreaks can occur quickly.
There are no new vaccines or medicines to prevent or treat COVID-19. Physical distancing measures and movement restrictions are effective in slowing the spread of the virus by limiting contact between people. If these measures are lifted too early or too quickly it is likely to lead to a sharp increase in COVID-19 cases.
What they are NOT.
These 6 steps do not guarantee that COVID-19 will not re-emerge or increase. Without vaccines or medicines, our societies must balance the need and hardship of physical distancing measures to control COVID-19 and the need to resume important activities in our lives. As these 6 criteria are applied, decisions about when and where to move away from restrictions should be based on real time assessments of disease activity. Measures should be lifted in a phased, step-by-step manner.
Refer to COVID-19 strategy update, 14 April 2020 (page 10) - Transitioning to and maintaining a steady state of low-level or no transmission
For many countries and subnational authorities and communities, managing a controlled and deliberate transition from a scenario of community transmission to a sustainable, steady state of low-level or no transmission is, at present, the best-case outcome in the short and medium term in the absence of a safe and effective vaccine. For countries yet to report community transmission, preventing the escalation of transmission and maintaining a steady state of low-level or no transmission may be feasible.
Achieving either of these aims will hinge on the ability of national and/or subnational authorities to ensure that six key criteria are satisfied:
- COVID‑19 transmission is controlled to a level of sporadic cases and clusters of cases, all from known contacts or importations and the incidence of new cases should be maintained at a level that the health system can manage with substantial clinical care capacity in reserve.
- Sufficient health system and public health capacities are in place to enable the major shift from detecting and treating mainly serious cases to detecting and isolating all cases, irrespective of severity and origin:
- Detection: suspect cases should be detected quickly after symptom onset through active case finding, self‑reporting, entry screening, and other approaches;
- Testing: all suspected cases should have test results within 24 hours of identification and sampling, and there would be sufficient capacity to verify the virus-free status of patients who have recovered;
- Isolation: all confirmed cases could be effectively isolated (in hospitals and/or designated housing for mild and moderate cases, or at home with sufficient support if designated housing is not available) immediately and until they are no longer infectious;
- Quarantine: all close contacts could be traced, quarantined and monitored for 14 days, whether in specialized accommodation or self-quarantine. Monitoring and support can be done through a combination of visits by community volunteers, phone calls, or messaging.
- Outbreak risks in high-vulnerability settings are minimized, which requires all major drivers and/or amplifiers of COVID‑19 transmission to have been identified, with appropriate measures in place to minimize the risk of new outbreaks and of nosocomial transmission (e.g. appropriate infection prevention and control, including triage, and provision of personal protective equipment in health care facilities andresidential care settings).
- Workplace preventive measures are established to reduce risk, including the appropriate directives and capacities to promote and enable standard COVID‑19 prevention measures in terms of physical distancing, hand washing, respiratory etiquette and, potentially, temperature
monitoring. - Risk of imported cases managed through an analysis of the likely origin and routes of importations, and measures would be in place to rapidly detect and manage suspected cases among travelers (including the capacity to quarantine individuals arriving from areas with community transmission).
- Communities are fully engaged and understand that the transition entails a major shift, from detecting and treating only serious cases to detecting and isolating all cases, that behavioural prevention measures must be maintained, and that all individuals have key roles in enabling and in some cases implementing new control measures.
Decisions about when and where to transition must be evidence based, data driven and implemented incrementally. It is essential to have real-time, accurate data on the testing of suspected cases, the nature and isolation status of all confirmed cases, the number of contacts per case and completeness of tracing, and the dynamic capacity of health systems to deal with COVID-19 cases.
To reduce the risk of new outbreaks, measures should be lifted in a phased, step-wise manner based on an assessment of the epidemiological risks and socioeconomic benefits of lifting restrictions on different workplaces, educational institutions, and social activities (such as concerts, religious events, sporting events). Risk assessments may eventually benefit from serological testing, when reliable assays are available, to inform understanding of population susceptibility to COVID‑19.
Ideally there would be a minimum of 2 weeks (corresponding to the incubation period of COVID‑19) between each phase of the transition, to allow sufficient time to understand the risk of new outbreaks and to respond appropriately.