Community-Based Measures for COVID-19 Resurgence - September 1 to October 16, 2020
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ENVIRONMENTAL SCAN
Community-Based Measures for COVID-19
Resurgence – September 1 to October 16, 2020
Date: 11/13/2020
Key points
• Between September 1 and October 16, many jurisdictions implemented new measures primarily
targeting social gatherings and events, with a focus on the number of people permitted.
• Some jurisdictions included other measures such as recommended or mandatory mask-wearing,
defining gathering based on individual persons as well as numbers of different households
allowed to gather, applying alert/risk levels with predefined public health measures, and
providing modified gathering limitations under specific circumstances such as weddings and
funerals.
• Bars, restaurants and entertainment venues were also common settings for re-implementing
measures across jurisdictions, with many services closed. Restrictions for services that remained
open focused on take-away or delivery, number of people at a table, and restricting operating
hours and alcohol service.
• Fewer new measures were implemented for education and transit. School measures addressed
closures, masking, capacity, activities, and testing. Transit measures included advice to limit
travelling, as well as masks and capacity.
Purpose and scope
This document aims to summarize community-based public health measures and relevant context for
COVID-19 resurgence that has occurred since the last environmental scan (Community-based Public
Health Measures for COVID-19 Resurgence). The summary can be used by decision-makers to inform
understanding of use and types of measures implemented in the context of COVID-19 resurgence
globally. Settings and types of measures were scanned for member jurisdictions of the Organisation for
Economic Co-operation and Development (OECD). An overview of the epidemiological impact of
previously instated public health measures in response to COVID-19 resurgence and consequent public
health measure modifications for two sample jurisdictions has been included.
Methods
Jurisdictional scans of government and public health agency websites, along with media reports, were
conducted between September 1 and October 16. Hospitals and long-term care settings were out of
scope for our scan.
Community-Based Measures for COVID-19 Resurgence – September 1 to October 16, 2020 1General summary of measures reported as
re-implemented by setting
This section includes a high-level description of re-implementation of new measures across settings in
different jurisdictions for COVID-19 resurgence, during the time period scanned. Previous details on
specific jurisdictions may be found in the original environmental scan.
Gathering limits
Many jurisdictions in the scan imposed measures on gatherings and/or events.
• Some jurisdictions implemented a complete ban on private gatherings (e.g., red alert zones in
Quebec)1 or mass gatherings (e.g., red zones in New York City)2.
• Where gathering limits were imposed, some jurisdictions established different limits for indoor
versus outdoor gatherings (e.g., up to 10 people allowed to gather indoors, up to 20 people
outdoors in Czech Republic)3 whereas in other jurisdictions, the number of persons allowed to
gather indoors or outdoors did not differ (e.g., up to six people are permitted to gather indoors
or outdoors in England)4. Wherever gathering limits differed, the number permitted to gather
outdoors was always greater than the number permitted indoors.
• When specified, the limits for weddings or funerals may be the same (e.g. Switzerland)5 or
higher (e.g., England,6 Republic of Ireland)7 than for other gathering or event types.
• Other factors used in describing measures for gatherings were the number of households
permitted to socialize/mix (e.g., Netherlands);8 private home or other organized indoor setting
(e.g., Republic of Ireland);9 family versus non-family gatherings (e.g., Israel); mandatory mask
use (some exceptions for children and sports) (e.g., Spain);10 alert/risk level of the area (e.g.,
England);4 use of attendance lists or percent of indoor capacity used (e.g., Illinois).11
• Measures for places of worship included outdoor prayer services only (e.g., Israel),12 online-only
services or individual prayer permitted (e.g., Republic of Ireland),9 capacity restrictions based on
alert/risk level (e.g. New York City),13 or an absolute number (e.g., Quebec).1
Restaurant, bars, recreation and entertainment
Common measures targeting food and drink establishments included closures of bars (e.g., Iceland);14
prohibiting indoor dining (e.g., Republic of Ireland);7 service to customers at tables only, as opposed to
at the bar (e.g., Spain);10 limits on number of people per table (e.g., Czech Republic);3 alcohol service
hours (e.g., Netherlands);8 restricted operating hours (e.g., Belgium);15 nightly curfew (e.g., France);16
providing contact information (e.g., Illinois);11 and operating at half capacity (e.g., Spain)10. Jurisdictions
tended to impose multiple measures.
Measures in cultural (e.g., museums, galleries), entertainment (e.g., casinos, nightclubs) and
recreational facilities (e.g., gyms, fitness centres) varied from operating at limited capacity (e.g., Spain),10
to operating via reservations (e.g., Netherlands),8 to outright closures (e.g., France).17 Measures in these
settings also addressed masking in select public outdoor spaces (e.g., Denmark)18 or for most indoor
spaces (e.g., Denmark, Alberta).18,19
Community-Based Measures for COVID-19 Resurgence – September 1 to October 16, 2020 2Regarding sports, measures included restricting recreational team matches with some exceptions for children and professional athletes (e.g., Netherlands);8 closing sports facilities (e.g., France);20 and limiting the number of spectators at sporting events (e.g., Republic of Ireland).9 Schools and education For schools and education facilities, approaches included school closures (e.g., Israel);12 moving to distance learning (e.g., New York City);13 masking for students and teachers, with some exceptions by student age and for teachers, which area of the school they are in (e.g., Quebec);1 alternating days for student attendance (e.g., Quebec);1 limiting classroom/lecture hall capacity (e.g., France);20 and alert/risk level and implementing COVID-19 testing schedules (e.g., New York City).13 Public transit, travel and population movement Measures for transit and travel included advice to limit outings, avoiding busy places and travel (e.g., Netherlands),8 restricting travel distance from home (e.g., Israel),12 masking (e.g., Denmark),18 limiting public transit capacity and asking residents to limit travel between high and low risk regions (e.g., Republic of Ireland).9 Focused review of select jurisdictions: resurgence, measure re-implementation and epidemiological impacts Belgium and the state of Victoria, Australia are reviewed below with information spanning from initial recognition of resurgence, the changes to measures throughout the resurgence, and current measures implemented as of October 19, 2020. Belgium presents as a case wherein measures have not yet been successful to address a steady, but recently exponential, rise in cases over time; whereas strict lockdown measures in Victoria following a rapid resurgence effectively mitigated a prolonged duration of the resurgence. Belgium Context: New measures were announced following Belgian authorities reporting a 71% jump in the number of new weekly cases from July 17 to July 23 relative to preceding weeks, and an accompanying rise in hospital admissions (26%).21 The increase in cases was seen across demographic groups. Case counts fluctuated throughout the months of August (min=115 new cases, max=873 new cases), with an average 508 new cases reported daily; September (min=155, max=3,241), with an average 1,319 new cases reported daily; and, in the first 16 days of October (min=1,035, max=12,556), with a daily average of 5,943 new cases.22 Throughout this period, Flanders, Wallonia, and Brussels have consistently accounted for the majority of the cases in the country.23,25,26 For the week ending on October 5, Belgium reported an incidence of 185.6 new cases per 100,000 persons; the following week (Oct 6-12), the country reported a higher incidence rate of 364.0 cases per 100,000 persons, representing a 96.1% increase.26 Response: On July 29, 2020 the Prime Minister announced a set of public health measures across sectors. Social bubbles were decreased in size from allowing a household to have 15 external contacts down to 5 persons per household (children under the age of 12 are excluded from bubble counts). Informal gatherings were capped at 10 (again, excluding children under the age of 12). Formal events Community-Based Measures for COVID-19 Resurgence – September 1 to October 16, 2020 3
adhering to public health protocols were limited to 100 indoors and 200 outdoors. Shopping restrictions were re-imposed, namely restricting entry to individual shoppers, and limiting time spent in any store to a maximum of 30 minutes. Community centers and other athletic venues require sign-in with contact information.27 Earlier imposed national public health measures, including limits to social gatherings and public events, largely remained in place throughout August. In spite of increasing case counts, Belgian authorities began easing some restrictions in September. While social bubbles remained at five, social gathering limits stayed capped at 10 people, formal events adhering to public health protocols could now include up to 200 people indoors and up to 400 outdoors.28 Starting September 23, self-isolation periods for confirmed cases were reduced from 14 days to at least seven days from symptom onset (for symptomatic cases) or testing date (asymptomatic cases).28,29 As of October 1, wearing a face mask in crowded outdoor public spaces was no longer mandatory, although face masks are required in indoor public spaces (e.g., shops, cinemas, public transit).29 Belgian authorities’ efforts to curb increasing transmission included introducing a number of new restrictions, effective October 9, 2020. The size of social bubbles was reduced from up to five people from different households down to three people, and social gatherings were now capped at up to four people, down from 10.30 Bars, previously permitted to operate until 1:00 a.m., now had to close by 11:00 p.m., and restaurants and bars were allowed to seat up to four people per table. Regionally, additional measures were introduced in Brussels, Flanders, and Wallonia on October 19.31 Social bubble sizes were reduced to two people from different households, although groups of up to four people could still meet indoors as long as social distancing could be maintained; these four people must remain the same for two weeks, after which they may change. Bars, restaurants, and cafes in these regions had to close, though they are permitted to offer takeaway service until 10:00 p.m.; nightly curfews were introduced (12:00 a.m. to 5:00 a.m.); alcohol could not be sold after 8:00 p.m.; the number of spectators at professional sports games were halved from 400 to 200 people; indoor sports where physical distancing is not possible were prohibited (except for children under 12 years); and flea markets and Christmas markets were prohibited from opening. Australia (Victoria) Context: The state of Victoria in Australia experienced a rise in cases from the end of June (30 cases per day among a population of 6.4 million) to the end of July (nearly 700 cases reported daily). The measures were re-imposed in the context of increasingly widespread community transmission in the Melbourne Metropolitan area. Daily case counts in Victoria peaked with 687 new cases reported on August 4, 2020; by mid-August, fewer than 300 new cases were being reported daily.32 Daily COVID case counts continued to decrease: on September 1, 87 new cases were reported in the state, and on September 13, the date when some restrictions began to ease, the 14-day rolling average was 56.9 new cases diagnosed per day for metropolitan Melbourne and 4.1 for regional Victoria.33 Regional Victoria subsequently entered the Third Step of reopening on September 16, whereby additional restrictions were eased. By October 1, only 5 new cases were reported in the state. Response: The Melbourne Metropolitan area was placed under lockdown (stage 4 restrictions) on August 2, 2020, with a stay-at-home order (with curfew between 8:00 p.m. and 5:00 a.m.); closure of non-essential businesses, schools, community and athletic facilities (including outdoor spaces such as Community-Based Measures for COVID-19 Resurgence – September 1 to October 16, 2020 4
playgrounds); banning of gatherings (public gatherings capped at 2, including members of one’s own household); restrictions on travel in and out of the affected area, and masking in all public spaces (indoor and outdoor).34 Beyond metropolitan Melbourne, stage 3 restrictions applied across the state of Victoria, which also included a stay-at-home order, albeit less strict (no curfew or restricted perimeter of travel), more lenient restrictions on businesses (e.g. hair salons allowed to operate), and allowance for select ceremonies.35 Of note, on June 22, 2020, restrictions on social gatherings (5 indoors and 10 outdoors) and restaurant capacity (capped at 20 patrons) were put in place in the state of Victoria in response to a rise locally-acquired cases. Of the 163 reported cases between June 8th and June 21, 49% were acquired locally with no known epidemiological link (or pending investigation at the time of report).36 A roadmap for reopening37 has been developed wherein four documents outline the reopening process for general living, as well as conditions for work in metropolitan Melbourne and regional Victoria. In early September, the regional lockdown of Melbourne was extended until September 28, with the majority of stage four restrictions remaining in place.38 However, a set of modifications would take effect on September 14 (step 1 of the roadmap for reopening). Nightly curfews were expected to be changed from 8:00 p.m. to 9:00 p.m., and still ending at 5:00 a.m. Further, public gatherings of two people, or a household, would now be permitted for up to two hours daily. And, finally, travel limits of 5 km would be allowed for four reasons (not explicitly listed in roadmap document). Other regions of Victoria would enter the third step of reopening on September 16, thus allowing increased reopening for sport, recreation, ceremonies and special occasions. Contact tracing measures would also be increased. Some restrictions were modified at the end of September as metropolitan Melbourne moved to the second step of the reopening roadmap. As of Sunday, October 11, the wearing of fitted face masks became mandatory in public spaces and face shields, bandanas and scarfs were no longer deemed sufficient. As of October 16, 2020, metropolitan Melbourne was still in the second step and regional Victoria in the third step of the reopening roadmap. Modifications of the steps within the roadmap appear to be made and therefore the roadmap, as reviewed at the time of writing, may not reflect the roadmap at a later date or have accurately captured the roadmap at an earlier date.38 Ontario applicability Since late August and as of November 2020 a resurgence of COVID-19 cases in Ontario has led to the highest daily and 7 day rolling average case counts since the pandemic began. Ontario has re- implemented indoor and outdoor social gatherings limitations, and restrictions on the operation of restaurants and bars, among other measures. In some regions experiencing COVID-19 growth, local responses have been implemented so as to achieve a balance of control of cases without applying restrictions across all regions with fewer cases. Ontario decision makers may look to examples of control of resurgence, such as those measures implemented in Victoria, Australia, and reflect on options for measures currently implemented in Ontario in order to consider what additional measures may be necessary for control. Community-Based Measures for COVID-19 Resurgence – September 1 to October 16, 2020 5
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34. State Government of Victoria. Victoria's current restriction levels [Internet]. Victoria: Department of Health and Human Services, State Government of Victoria, Australia; 2020 [cited 2020 Nov 3]. Available from: https://www.dhhs.vic.gov.au/victorias-restriction-levels-covid-19 35. State Government of Victoria. Victoria's restriction levels [Internet]. Victoria: Department of Health and Human Services, State Government of Victoria, Australia; 2020 [cited 2020 Nov 3]. Available from: https://www.dhhs.vic.gov.au/shopping-retail-and-personal-services-regional-victoria-covid-19 36. COVID-19 National Incident Room Surveillance Team. COVID-19, Australia: epidemiology report 19: fortnightly reporting period ending 21 June 2020. Commun Dis Intell (2018). 2020;44. 37. State Government of Victoria. Coronavirus (COVID-19) roadmap for reopening [Internet]. Victoria: State Government of Victoria; 2020 [cited 2020 Nov 4]. Available from: https://www.coronavirus.vic.gov.au/coronavirus-covid-19-restrictions-roadmaps 38. World Health Organization. Tracking public health and social measure: a global data set [Internet]. Geneva: World Health Organization; 2020 [modified 2020 Oct 16; cited 2020 Nov 5]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/phsm Community-Based Measures for COVID-19 Resurgence – September 1 to October 16, 2020 9
Citation Ontario Agency for Health Protection and Promotion (Public Health Ontario). Environmental scan: community-based measures for COVID-19 resurgence – September 1 to October 16, 2020. Toronto, ON: Queen's Printer for Ontario; 2020. © Queen’s Printer for Ontario, 2020 Disclaimer This document was developed by Public Health Ontario (PHO). PHO provides scientific and technical advice to Ontario’s government, public health organizations and health care providers. PHO’s work is guided by the current best available evidence at the time of publication. The application and use of this document is the responsibility of the user. PHO assumes no liability resulting from any such application or use. This document may be reproduced without permission for non-commercial purposes only and provided that appropriate credit is given to PHO. No changes and/or modifications may be made to this document without express written permission from PHO. Public Health Ontario Public Health Ontario is an agency of the Government of Ontario dedicated to protecting and promoting the health of all Ontarians and reducing inequities in health. Public Health Ontario links public health practitioners, front-line health workers and researchers to the best scientific intelligence and knowledge from around the world. For more information about PHO, visit publichealthontario.ca. Community-Based Measures for COVID-19 Resurgence – September 1 to October 16, 2020 10
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