COVID-19 Operationalization of the Global Response Strategy in the WHO European Region
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© Times of Malta
COVID-19
Operationalization of the
Global Response Strategy in
the WHO European Region
September 2020
© WHO
Acknowledgements The Incident Management Support Team (IMST) in the WHO Regional Office for Europe developed this document under the supervision of Dr Dorit Nitzan, Regional Emergency Director. The document is the result of the contributions from across all the divisions in the Regional Office for Europe, working together in support of the Member States response to COVID-19. © World Health Organization 2020 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition: COVID-19 operationalization of the global response strategy in the WHO European Region. September 2020. Copenhagen: WHO Regional Office for Europe; 2020”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. (http://www.wipo.int/amc/en/mediation/rules/). Suggested citation. COVID-19 operationalization of the global response strategy in the WHO European Region. August 2020. Copenhagen: WHO Regional Office for Europe; 2020. Licence: “https://creativecommons.org/licenses/by-nc-sa/3.0/igo/” CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Designed by: www.freightdesign.co.uk Document number: WHO/EURO:2020-1073-408190-55167
COVID-19 Operationalization of the Global Response Strategy in the WHO European Region
COVID-19 Strategy for the WHO European Region 5 About this document 6 Current situation and key insights in the WHO European Region 7 European regional strategy to respond to COVID-19 9 Working together as one 10 National strategies to respond to COVID-19 11 National operational plans for responses 11 Engage and mobilize communities to limit exposure 12 Find, isolate and test cases; track and quarantine contacts to control transmission 13 Provide clinical care and maintain essential health services to reduce mortality 14 Adapt strategies to national and local contexts based on risk, capacity and vulnerability 15 Prevent and suppress community transmission 15 Transition and maintain a steady state of low-level or no transmission 16 Adapt to low-capacity settings 17 Humanitarian settings, vulnerable and high-risk groups 18 International community’s response to COVID-19 20 Coordinate support for countries and monitor country preparedness and response 20 Understand the regional epidemiology, develop regional analytics and conduct 20 ongoing risk assessments Coordinate supply chain management across the Region 21 Accelerate research, innovation and knowledge sharing 22 Strengthen preparedness for future emergencies 23 Annex 25 Annex 1: Adaptation of response measures based on scale of transmission 25 Annex 2: Adaptation of response measures based on health system capacity, 30 resourcing and context
6 COVID-19 Strategy for the WHO European Region
About this document
© WHO
The COVID-19 pandemic has been exacting an Every country needs to implement a
enormous toll on individuals, families, communities comprehensive set of measures according to their
and societies across the globe. Since mid-February, own capacity and contextual specificities in order
COVID-19 has quickly spread across Europe and has to slow down transmission and to reduce the
profoundly impacted the societal and economic morbidity and mortality associated with COVID-19,
situation, even in countries with the most robust while maintaining comprehensive health care
and sophisticated health systems in the WHO services along the continuum of care and life-
European. course, public health services and maintaining civil
liberties as much as possible, with the ultimate aim
This document outlines the WHO European of reaching and/or maintaining a no transmission
Regional strategy to respond to COVID-19 and its status. Practical guidance on adaptations of
consequences, based on WHO’s global strategy response measures, based on transmission
update for COVID-191, covering the period February scenarios and health system capacities, is provided
-December 2020. The estimated funding needs of in Annex 1 and 2 of this document.
the WHO European Region, for this period, amount
to US$ 175 million.2 This strategic document is
relevant to the diverse contexts that exist across
the WHO European Region, and to countries
implementing a wide range of national and
subnational responses. The strategy is flexible and
adaptable to national and subnational contexts
and guides countries in rapidly bringing COVID-19
cases under control, and in preparing for a phased
transition from a widespread transmission to a
steady state of low-level or no transmission.
This strategy considers the needs of the WHO
European Region (Member States and Secretariat)
to prepare for a new operating norm in which the
COVID-19 virus is taken into account in decision-
making across the whole of society and the whole
of government until such a time that transmission
of the virus can be suppressed nationally and
globally. It highlights the coordinated support that
is required from the international community and © WHO/Tunc Ozceber
complements other plans (including the Global
Humanitarian Response Plan (HPRP)). 3
1 WHO. COVID-19 strategy update, 14 April 2020. Geneva: World Health Organization; 2020. (https://www.who.int/publications/i/item/covid-19-strategy-update-13-april-2020,
accessed 11 May 2020).
2 COVID-19 WHO Appeal, updated 24 May 2020, Geneva World Health Organization, 2020 (https://www.who.int/publications/m/item/covid-19-who-appeal, accessed 14 July 2020)
3 The HPRP addresses COVID-19 response in humanitarian and fragile settings. For the Global Humanitarian Response Plan, see: UN. Global humanitarian response plan
COVID-19. New York: United Nations; 2020. (https://www.unocha.org/sites/unocha/files/Global-Humanitarian-Response-Plan-COVID-19.pdf, accessed 11 May 2020).
COVID-19 Strategy for the WHO European Region 7
Current situation and
key insights in the
WHO European Region
© WHO
COVID-19 is a new disease and, although many Since late February 2020, the pandemic has
gaps in knowledge remain, much has been evolved extremely rapidly, first in the WHO
learned about its characteristics and impact on European Region, then in the Regions of the
health during the response. The COVID-19 virus Americas, the Eastern Mediterranean and
spreads rapidly and can quickly overwhelm South-East Asia, with most countries in the
health systems while also placing societies under European Region reporting community
significant strain. Governments, WHO and partners transmission.
have been working urgently to save lives through
the development of public health and clinical Based on the available information,6 (11 March
countermeasures.4 At present, there are no specific 2020 to 26 June 2020) in the WHO European
treatments for COVID-19, though early evidence Region:
indicates that dexamethasone may reduce
mortality in severely ill patients. • 21% of all reported infections were in health
care workers.
According to data from countries affected early in
the pandemic, about 40% of cases experience mild • 89% of deaths were in people aged 65 years
disease, 40% have moderate disease, 15% of cases and older.
suffer from severe disease, and 5% of cases require • 95% of deaths were in people who had at least
intensive and critical care. one underlying condition, with cardiovascular
disease the leading comorbidity (66%).
Over 26 million cases of COVID-19 have been
seen worldwide, with deaths exceeding 863,020 • 46% of all cases and 57% of all deaths were
(as of 4 September 2020). The most recent situation among males. 27% of cases required hospital
update can be found on our website. 5 admission and 2% of laboratory-confirmed cases
were admitted to intensive care units (ICUs).
WHO’s risk assessment of the situation is being
regularly reviewed as the emergency evolves, and • 76% of intensive care unit admissions were in
the current level of risk to public health associated persons aged 50–79 years of age, with 70% of
with COVID-19 is considered globally as very high all ICU admissions in men.
risk.
Countries are at different stages in the evolution of
their national outbreaks with significant variations
observed at subnational levels.
4 WHO. A coordinated global research roadmap. Geneva: World Health Organization; 2020. (https://www.who.int/publications/m/item/a-coordinated-global-research-roadmap,
accessed 11 May 2020).
5 WHO. Coronavirus disease (COVID-2019) situation reports [website]. Geneva: World Health Organization. (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/
situation-reports, accessed 11 May 2020).
6 The analysis of this data has been conducted based on the information available on the case forms reported so far to the WHO Regional Office for Europe. It is relevant to note
that not all case reporting forms include complete data; for example, the existence of underlying conditions or on whether the patient is a health care worker. Countries are
encouraged to continue sending their case reporting forms to inform this regional analysis.
8 COVID-19 Strategy for the WHO European Region
Several lessons have already been identified needed to mobilize and coordinate response.
efforts.
• Political leadership and strong governance,
with effective structures and participatory • Communicating risks effectively, promoting
mechanisms to incorporate the whole of health-seeking behaviours, and encouraging
government and whole of society, are needed community engagement enable individuals and
for preventing, preparing for, responding to and communities to make informed choices to stay
recovering from the spread of the virus. safe and healthy, prevent the further spread of
the virus and contribute to the response.
• Early and comprehensive public health
measures, including case identification, isolation, • Identifying and activating surge capacities at
testing, contact tracing and quarantine can all levels of clinical care, public health and social
prevent explosive transmission, allowing health services is needed as the disease spreads.
systems to cope with the demand.
• Physical distancing measures are necessary
• Removal of barriers to access free testing when community transmission is widespread
and health services is critical to preventing and should be complemented with health
spread and protecting health care workers and promoting strategies around mental health,
communities, particularly those at higher risk nutrition, physical activity, and tobacco and
of exposure and in situations of vulnerability. alcohol consumption.
• The health workforce must be protected at • Ensuring excluded communities or
all levels of care, including in social and care communities at greater risk of vulnerability,
services. such as the homeless, refugees and migrants,
those at risk of domestic violence, single parents,
• Protecting older people and other vulnerable
people with pre-existing conditions or those
populations is key, in particular those
at risk of isolation, children living in poverty
with underlying health conditions, such
and relying on school meals are supported
as noncommunicable diseases (diabetes,
through community- based or local government
cardiovascular diseases, cancer and severe
initiatives is essential to the response.
obesity).
• Having access to real-time health information • Effectively leverage and integrate different
for decision-making at all levels of the health data and information systems, at national and
system is crucial in guiding an effective, timely subnational levels, can facilitate data-driven
and targeted response, including for the decisions to achieve desired outcomes.
allocation of vital equipment and resources
© Baku Media Center
COVID-19 Strategy for the WHO European Region 9
European regional strategy
to respond to COVID-19
© WHO
Response principles: data-focused; balanced; • Prevent and suppress community
agile; flexible; context-appropriate; time-sensitive; transmission through context-appropriate
participatory; preparedness-driven. infection prevention and control measures,
physical distancing measures and appropriate
The overarching goal of the regional strategy is and proportionate restrictions on non-essential
for all countries to slow and stop transmission, domestic and international travel, while
preventing outbreaks and delaying the spread of minimizing the impact of the pandemic on
COVID-19; to reduce mortality and morbidity by social services and economic activity.
providing optimized care for all patients, especially
• Ensure continuity of essential, people-centred
the seriously ill; and minimize the impact of the
health and social services.
pandemic on health systems, social services,
communities and economies. Simultaneously, this • Learn from the European experience
plans looks to identify ways in which the continuity and innovate for the development of safe
of essential health services can be maintained, and effective vaccines, therapeutics and
with the ultimate objective of ensuring overall technologies that can be delivered at scale,
sustainability of the health system. with equitable access and an approach based
on global solidarity.
The strategic objectives of the regional strategy
• Leverage effective partnerships to mitigate
are to:
the socioeconomic impact of COVID-19
• Mobilize and engage all sectors and response measures.
communities to ensure that every sector of • Build resilient health systems with emphasis
government and society takes ownership of on the essential public health operations, to
and participates in the response. advance universal health coverage, including
• Identify and control sporadic cases and preparedness capabilities to withstand epidemic
clusters and prevent community transmission shocks. While this objective will require medium-
by rapidly finding and isolating all suspected and long-term actions, efforts to suppress the
cases and/or those with suspected symptoms pandemic today may lead the way for building
though large-scale decentralized testing; the resilient, integrated and person-centred
providing them with appropriate care; and health and long-term care systems of tomorrow.
tracing, quarantining and supporting all
The WHO Regional Office for Europe COVID-19
contacts.
strategy is in line with and will contribute to the
European Programme of Work (EPW) towards
“United Action for Better Health” 7 being presented
for discussion and adoption by the WHO Regional
Committee for Europe in September 2020.
7 WHO. Vision and strategic directions: Why is united action for better health needed? [website]. Copenhagen: WHO Regional Office for Europe; 2020.
(https://www.euro.who.int/en/about-us/regional-director/vision-and-strategic-directions, accessed 11 May 2020).
10 COVID-19 Strategy for the WHO European Region
It will also support the implementation of the and the Emergency Medical Teams (EMTs).11 WHO
Thirteenth General Programme of Work (GPW13)8 is also making use of mechanisms such as the
and achievement of the Strategic Development Regional Issue-based Coalition for Health (IBC),12
Goals (SDGs).9 The activities are built around a bringing together 14 UN agencies and other
comprehensive strategy to prevent the spread of development partners and the Global Action Plan
the pandemic, save lives and minimize impact, by for Health.13 Professional networks of experts in
targeting four areas: prepare and be ready; detect, respiratory pathogens have also been leveraged
protect and treat; reduce transmission; innovate to support countries. In addition, GOARN, IFRC,
and learn. UNICEF and WHO coordinate technical and
operational support on risk communication, with
Working together as one a special focus on highly vulnerable populations.
The international community has been working WHO is collaborating with the European Centre for
together across borders and at the country level Disease Prevention and Control (ECDC), regional
through the “one UN approach” when applicable. networks and counterparts, to update and enhance
WHO representatives have been leading the surveillance strategies. Together with humanitarian
health response in collaboration with UN Resident partners, support is being provided for the
Coordinators (UNRCs) and all members of the implementation of public health measures in
UN Country Teams (UNCTs), while contributing over-crowded environments, such as refugee and
to the public health implications of the broader migrant camps, detention centres and prisons.
socioeconomic response to the pandemic led by
UNRCs. As many European countries have become
the pathfinders of the current global response,
WHO is providing, and will continue to provide, different regional platforms are being used
substantial technical and operational support to to further disseminate the know-how and to
countries in the areas of operational planning, share experiences and expertise (including the
laboratory support, health systems preparedness Commonwealth of Independent States (CIS), the
and hospital readiness, surveillance, infection South-Eastern European Health Network
prevention and control, clinical management, (SEEHN)14, the European Union, WHO’s Small
essential medicines and packages of care, public countries initiative, WHO’s Regions for Health
health services and risk communication and Network15, the WHO European Healthy Cities
community engagement. Network, the Schools for Health in Europe
network, and the Partnership for Health in the
Support to countries is delivered through WHO Criminal Justice System).
Country offices, in coordination with the Incident
Management Support Team (IMST) at the WHO
Regional Office for Europe and in collaboration
with operational partners, including the Global
Outbreak and Response Network (GOARN) 10
8 WHO. Thirteenth General Programme of Work 2019–2023. Geneva: World Health Organization; 2019. (https://www.who.int/about/what-we-do/thirteenth-general-programme-of-
work-2019---2023, accessed 11 May 2020).
9 UN. Transforming our World: the 2030 Agenda for Sustainable Development. New York: United Nations (https://sustainabledevelopment.un.org/post2015/transformingourworld,
accessed 11 May 2020).
10 For more information about GOARN, see: GOARN: Global Outbreak and Response Network [website]. Geneva: World Health Organization. (https://extranet.who.int/goarn,
accessed 11 May 2020).
11 For more information about EMTs, see: WHO. Emergency medical teams and World Health Organization [website]. Geneva: World Health Organization. (https://www.who.int/
emergencies/partners/emergency-medical-teams, accessed 11 May 2020).
12 WHO. Partnerships. In: Sustainable Development Goals [website]. Copenhagen: WHO Regional Office for Europe (https://www.euro.who.int/en/health-topics/health-policy/
sustainable-development-goals/partnerships-and-intersectoral-action, accessed 11 May 2020).
13 WHO. Global action plan for healthy lives and well-being for all. In: Global Action Plan [website]. Geneva: World Health Organization. (https://www.who.int/sdg/global-action-plan,
accessed 11 May 2020).
14 SEEHN. South-Eastern Europe Health Network [website]. (https://www.euro.who.int/en/about-us/networks/south-eastern-europe-health-network-seehn, accessed 11 May 2020).
15 WHO. WHO European Healthy Cities Network [website]. Copenhagen: WHO Regional Office for Europe. (https://www.euro.who.int/en/health-topics/environment-and-health/
urban-health/who-european-healthy-cities-network, accessed 11 May 2020).COVID-19 Strategy for the WHO European Region 11
National strategies
to respond to COVID-19
© WHO
Each country should continue implementing • Implementation of context-appropriate public
its Country Preparedness and Response Plan health measures to slow transmission and
(CPRP) and associated operational plans, based control sporadic cases.
on whole-of-government and whole-of-society
approaches, and a realistic appraisal of what is • Preparation of the health system to reduce
feasible to achieve in terms of slowing down COVID-19-associated mortality, adapt its
transmission and reducing mortality. Plans must capacity to the increased burden of cases,
be flexible and adaptable to respond rapidly to maintain essential services, protect health
changes in epidemiological situations and take workers and be ready for the next emergency.
into account the local contexts and capacities to
The following sections provide strategic direction
respond.16 The core pillars of an effective national
for national authorities to take immediate action.
response have been set out in detail in the
Strategic Preparedness and Response Plan (SPRP National operational plans for responses
February 2020) and their practical implementations Successful implementation of adaptive
are outlined in Annexes 1 and 2. COVID-19 preparedness and response strategies
will depend on the whole-of-society being
The International Health Regulations (IHR) 2005 17
engaged in the plan, and strong national
remain the legal and technical basis for all country-
and subnational coordination mechanisms
level and international preparedness and response
being in place, with well-managed command-
efforts. They are the normative basis for all actions
and-control structures implemented, when
undertaken to prepare for, respond to and recover
necessary. Many countries have activated national
from this pandemic. IHR core capacities are being
public health and disaster/crisis management
put to the test: gaps are being revealed even in the
policies, empowering authorities to prepare, plan
most robust public health and health care systems,
and respond to COVID-19, such as the Pandemic
and the lessons of COVID-19 are being documented
Influenza Preparedness plans (PIPs). These plans
so that they can be applied in future joint efforts to
should be adapted to the COVID-19 context and
strengthen health systems, including the essential
include capacity assessments and risk analyses
public health operations, and reinforce health
to identify high-risk and vulnerable populations.
security.
Where appropriate, plans should include local
Every national strategy plays a crucial part in government, not-for-profit providers such as those
meeting the regional and global objectives in working with the homeless, civil society, faith-based
the response to the pandemic, and must, at a organizations and nongovernmental organizations
minimum, set out the basis for: (NGOs) to extend the reach of public health and
socioeconomic interventions.
• Leadership and coordination of the national
and subnational responses.
• Engagement, empowerment and mobilization
of communities.
16 For current WHO guidance, see: WHO. Critical preparedness, readiness and response actions for COVID-19 [website]. Geneva: World Health Organization.
(https://www.who.int/publications/i/item/critical-preparedness-readiness-and-response-actions-for-covid-19, accessed 14 July 2020).
17 WHO. International Health Regulations. Geneva: World Health Organization; 2008. (https://www.who.int/ihr/publications/9789241596664/en/, accessed 11 May 2020).12 COVID-19 Strategy for the WHO European Region
The coordinated management of COVID-19 The role and importance of trust is central to this:
preparedness and response should include the essential factors contributing to trust are timely,
engagement of all levels of government and accurate and transparent communications,
relevant ministries, such as health, agriculture, coordination and consistency, relevant and tailored
education, environment, finance, public works, messages based on risk perception and delivered
social protection, transport, travel and tourism, through effective channels and key influencers.
and water and sanitation, to ensure a coordinated Engaging communities and empowering
whole-of-government approach and to mitigate stakeholders to find and implement the solution
the social and economic impacts. is at the core of an effective response. This also
includes establishing mechanisms to gather risk
WHO, together with the UN and its partners and perception and behavioural insights of segmented
all national and regional health sector partners, will population groups as the basis of RCCE strategies.
act in coordination, to ensure that the best support
possible is provided to national and local authorities Strong coordination between national and
and communities affected by COVID‐19. subnational stakeholders and across sectors is
essential to establishing authority and trust. One
Engage and mobilize communities of the objectives of the RCCE strategy is to establish
to limit exposure an RCCE working group, engaging all response
Stopping the transmission of COVID-19 and authorities centrally and locally to ensure the
protecting people will require the participation development and implementation of a nationally
of communities, including those at risk and most coordinated communication strategy and plan
affected. Informed and empowered populations across all transmission scenarios.
can protect themselves by taking measures at
Participatory community engagement
the individual and community level that will
interventions should include accurate information
reduce the risk of transmission. It is therefore
on risks, what is still unknown, what is being done
essential that international, national and local
to find answers, what actions are being taken by
authorities engage through participatory two-
health authorities, and what actions those at risk
way communication efforts proactively, regularly,
can take to protect themselves. Nonmedical
transparently and unambiguously with all those
sectors need to be engaged to ensure availability
affected, while acknowledging the uncertainty of
of hygiene measures, water, hygiene articles,
the outbreak evolution, with a view to harnessing
soap and disinfectants, to allow implementation
community resilience and social solidarity.
of guidance at all levels of society. Action at the
Ensuring that global and regional recommendations community level is also essential to addressing
and communications are tested and adapted to other health consequences of response measures
local contexts, and that messages and public health to the pandemic, such as the impact on mental
advice are based both on the risk assessment and health or on gender-based violence (GBV). The
the risk perception, is an essential part of helping emphasis for engagement should be on vulnerable
countries to empower communities to own the people and populations.
response and control the COVID-19 pandemic.
The WHO Regional Office for Europe will continue
Risk communication and community engagement supporting countries with RCCE guidance and
(RCCE) are integral parts of the WHO European strategies along the various scenarios. To manage
Region COVID-19 readiness and response strategy rumours and respond to the infodemic, WHO
and are public health interventions in themselves. monitors communication about COVID-19 at the
At the country level, the overall RCCE goal is to regional and country levels and support countries
ensure that people comply with health protection establishing agile risk perception mechanisms
measures recommended by the health authorities through the Behavioural Insight tool18.
and adopt protective behaviours that contribute to
the control of the COVID-19 pandemic nationally
and globally.
18 WHO. WHO tool for behavioural insights on COVID-19. In: Coronavirus disease (COVID-19) outbreak [website]. Copenhagen: WHO Regional Office for Europe; 2020.
(http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/technical-guidance/who-tool-for-behavioural-insights-on-covid-19)COVID-19 Strategy for the WHO European Region 13
Trusted channels of health systems to train non-public health
communication and information, professionals and volunteers, and using novel
through resources, such as global technologies where possible.
and regional COVID-19 dashboards,
global WHO social media chatbots During periods of sustained community
and EPI-WIN, and the regional transmission, diagnostic capacity may be limited
HealthBuddy,19 Global ShaperS 20 and it may be necessary to prioritize testing
and the RCCE topic webinars, of: vulnerable populations, including those at
play critical roles in meeting risk of developing severe disease; symptomatic
© WHO
information needs. health workers and essential staff; those needing
additional measures in order to receive testing,
such as the homeless or undocumented migrant
Find, isolate and test cases; track and
populations; and the first symptomatic individuals
quarantine contacts to control transmission
in closed settings (e.g. schools, long-term living
Mild cases continue to be the driver for the
facilities, prisons, hospitals, camps etc.) to identify
pandemic. Stopping the spread of COVID-19
and control outbreaks.
requires finding, isolating and testing all
suspected cases/symptomatic patients so © WHO
that they are promptly isolated, tested, receive
care and their contacts are identified and
quarantined for the duration of the incubation
period. Suspected cases should be isolated and
tested. Within 48 hours of symptom onset. It is
essential to identify and trace contacts of every
confirmed or probable case, and quarantine them
for 14 days. This ensures that even asymptomatic
cases that may arise do not mix with the general
population.
As per obligations under IHR (2005), every effort
must be made to support individuals undergoing
quarantine, including through the provision of
psychosocial support, ensuring continuity of any
routine medication and health care as needed.
Countries and communities must strengthen
their capacity to find suspected cases of COVID-19
in the general population. Repurposing proven
surveillance systems already active in the
WHO European Region and rolled-out in close
collaboration with the ECDC for respiratory
diseases is essential. This includes indicator‐based
surveillance, community event‐based surveillance
and sentinel surveillance (e.g. severe acute
respiratory infection and influenza‐like illness),
and active case-finding at points of entry, health
facilities and in communities. Countries may need
to rapidly scale-up their workforces to find cases,
including by looking outside traditional public
19 WHO. HealthBuddy. In: Coronavirus disease (COVID-19) outbreak [website]. Copenhagen: WHO Regional Office for Europe; 2020. (https://www.euro.who.int/en/health-topics/
health-emergencies/coronavirus-covid-19/healthbuddy, accessed 19 May 2020).
20 WHO. COVID-19: WHO joins forces with young Global Shapers to disseminate health advice. In: Coronavirus disease (COVID-19) outbreak [website]. Copenhagen: WHO Regional
Office for Europe; 2020. (https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/5/covid-19-who-joins-forces-with-young-global-
shapers-to-disseminate-health-advice, accessed 19 May 2020).14 COVID-19 Strategy for the WHO European Region
In these contexts, where widespread testing is the negative health impacts of COVID-19 on
not possible or is limited, a syndromic approach individuals who depend on essential, non-COVID-
to COVID-19 case detection based on reported 19-related services. It is crucial to ensure the
symptoms or signs can be applied to identify continuity of emergency and essential care services,
and isolate suspected cases. All COVID-19 such as vaccinations,21 for children, pregnant
suspected cases should be safely and rapidly women, older people and for people living with
isolated (whether confirmed through testing or and affected by noncommunicable diseases and
based on symptoms or signs) to prevent onward mental health conditions (e.g. cancer, diabetes,
transmission in the community. They can be hypertension, asthma, depression, dementia and
isolated in households or, if it is possible and alcohol or drug-use disorders) along the continuum
feasible, in dedicated facilities. In either case, all of care, from prevention, early detection, diagnosis,
isolated confirmed cases should be provided with treatment, management, rehabilitation and
appropriate care and support. palliation. The Policy Brief22 and interim technical
guidance on health system strengthening for the
The WHO Regional Office for Europe will continue COVID-19 response23 developed by the WHO
supporting countries with guidance for finding, Regional Office for Europe, and the three surge
isolating and testing as well as strengthening their planning tools24 should be used by Member States
capacity to find suspected cases and contacts to to plan and ensure surge capacities for all health
COVID-19 cases. system functions.
Provide clinical care and maintain essential Innovative solutions to increase health care
health services to reduce mortality capacity, including for non-COVID-19 cases, will be
One of the defining features of COVID-19 is the required, such as repurposing existing public and
burden placed on health systems and health private facilities to provide safe areas for emergency
workers by the large proportion of patients who case management, quarantine and isolation – this
require safe and effective clinical care. Many should be feasible even in remote and low resource
patients with severe disease need help to breathe, areas. Rapid expansion of clinical capacity for life-
with outbreaks placing strain on staffing levels, saving measures should be focused on care for
availability of equipment, and crucial supplies most patients through simple treatments such
such as medical oxygen and personal protective as providing oxygen. It is also likely there will be
equipment (PPE). Establishing effective pathways substantial number of individuals with long-term
for COVID-19 and non-COVID-19 cases along sequelae (e.g. lung fibrosis) which will need follow-
the continuum of care, through early detection, up. Continuity of care should be coupled with
screening, triage, transitions, targeted referral, early an international research agenda that provides
planned discharge, among other community care evidence for treatment as well as modifications
and general practice, is essential in all settings to health services to address new needs.
of care. The use of digital technologies, such as
telemedicine, mobile health, and other innovative Maintaining population trust in the capacity of
approaches that facilitate access to remote health services and the health system to safely
care and monitoring, should be explored and meet essential needs and to control infection risk
incorporated into mainstream care pathways. in health facilities is key to ensuring appropriate
care-seeking behaviour and adherence to public
This burden on the health systems, combined health advice.
with the disruptive impact on widespread control
measures, must be mitigated in order to minimize
21 WHO. Guidance on routine immunization services during COVID-19 pandemic in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2020.
(https://www.euro.who.int/__data/assets/pdf_file/0004/433813/Guidance-routine-immunization-services-COVID-19-pandemic.pdf, accessed 11 May 2020).
22 WHO. Strengthening the health system response to COVID-19. Recommendations for the WHO European Region. Policy brief (1 April 2020). Copenhagen: WHO Regional Office
for Europe; 2020. (http://www.euro.who.int/__data/assets/pdf_file/0003/436350/strengthening-health-system-response-COVID-19.pdf?ua=1, accessed 11 May 2020).
23 WHO. Strengthening the health systems response to COVID-19: Technical guidance #1, 18 April 2020. Copenhagen: WHO Regional Office for Europe; 2020. (https://www.euro.
who.int/en/health-topics/Health-systems/pages/strengthening-the-health-system-response-to-covid-19/technical-guidance-and-check-lists/strengthening-the-health-systems-
response-to-covid-19-technical-guidance-1,-18-april-2020, accessed 11 May 2020).
24 WHO. Surge planning tools [website]. Copenhagen: WHO Regional Office for Europe. (https://www.euro.who.int/en/health-topics/Health-systems/pages/strengthening-the-
health-system-response-to-covid-19/surge-planning-tools, accessed 11 May 2020).COVID-19 Strategy for the WHO European Region 15
The WHO Regional Office for Europe will continue Prevent and suppress community
supporting countries to provide safe and effective transmission
clinical care and maintenance of essential health While countries must find, isolate and test
services through technical assistance, support and suspected cases; track and quarantine contacts
supplies together with evidence-based guidance to control transmission, in countries and/or
that can be tailored to each country’s needs, level subnational regions where there is a risk of
of outbreak and settings. community transmission becoming established,
authorities must immediately adopt additional
Adapt strategies to national and local contexts physical distancing measures and movement
based on risk, capacity and vulnerability restrictions (see Annex 1, Part 3 Prevent, suppress
and slowdown transmission).
Adaptation of strategies should be governed
by evidence-based criteria using continuous Targeted and time-limited implementation
monitoring of the situation and based on the of these measures will potentially reduce
precautionary principle. The ability of countries to morbidity and mortality by slowing the
engage and mobilize communities; find, isolate transmission of COVID-19 and relieving some
and test cases; provide effective clinical care; pressure on clinical care services. However, these
and maintain essential health services will differ measures should be based on a thorough risk
according to their specific context, including their assessment, proportionate to the public health
capacities to respond to the diverse levels of risk risk, be time-limited and reconsidered regularly,
exposure, intensity and prevalence of COVID-19 as well as implemented with the understanding,
transmission, and the pre-existing and emerging consent and participation of communities, and
or developing situations of vulnerability in based on the principle of doing no harm.
communities.
Support systems must be in place to ensure
Every country must put in place comprehensive communities are able to comply with these
public health and primary health care measures to measures. Individuals, especially the most
maintain a sustainable steady state of low-level or vulnerable, must also be supported (and be
no transmission and have the capacity to rapidly provided with refuge or safe spaces and supplies
control sporadic cases and clusters of cases to where necessary) through coordinated economic
prevent community transmission from occurring. and social measures that provide incentives to
This approach needs to be applied at the lowest participate, and which mitigate negative social
administrative level possible in each country and economic consequences. Food security,
to ensure a tailored and appropriate response mental health, and gender safeguarding issues,
depending on the situation and local capacities. including the need to protect women and children
In addition, public health and primary health care from an increased risk of domestic abuse, are
services will need to be guided and supported areas of particular concern.
while preparing to respond to non-COVID-19
critical needs of the community. The precise nature and feasibility of implementing
these measures will be heavily dependent on
The WHO Regional Office for Europe will the context in which affected communities live.
support countries in adopting and adapting Measures for humanitarian settings, vulnerable
WHO normative guidance to local contexts and and high-risk groups and low-capacity settings
conditions, taking factors such as feasibility, equity are detailed below.
and acceptability into consideration, in view of
facilitating and scaling-up the implementation The WHO Regional Office for Europe stands ready
of evidence-based strategies and interventions. to provide the guidance and support needed for
countries to find the best ways to implement these
measures in each setting.16 COVID-19 Strategy for the WHO European Region
© WHO
Transition and maintain a steady state • isolation of cases and quarantine (and
of low-level or no transmission support) of traced contacts for 14 days;
For many countries and subnational authorities
• case investigation and contact tracing for
and communities, managing a controlled transition
confirmed cases, or cases with COVID-19
from a scenario of community transmission to
compatible symptoms; and
a sustainable, steady state of low-level or no
transmission is the best-case outcome in the short • large-scale decentralized testing of
and medium term in the absence of safe and suspected cases and/or symptom-based
effective pharmaceutical solutions and a vaccine. case-finding.
For countries yet to report community 3. Outbreak risks in special settings are
transmission, preventing the escalation of minimized. All major drivers and/or amplifiers
transmission and maintaining a steady state of of COVID-19 transmission would be identified,
low-level or no transmission may be feasible. with appropriate measures in place to minimize
Achieving either of these aims will hinge on the the risk of new outbreaks (e.g. appropriate
ability of national and/or subnational authorities infection prevention and control in health care
to ensure that six key criteria are satisfied: facilities, long-term care facilities and other
residential care settings, prisons and other places
1. COVID-19 transmission is controlled. Ideally, of detention, universities and trade schools, bars
there would be at most sporadic cases, all from and restaurants, places of worship, etc.).
known contacts or importations; at a minimum,
new cases would be reduced to a level that the 4. Workplace preventive measures are
health system can manage based on clinical established to reduce risk, including the
care capacity. appropriate directives and capacities to promote
and enable standard COVID-19 prevention
2. Sufficient health system capacities are in measures in terms of physical distancing,
place. Three key capacities would need to be in hand washing, respiratory etiquette and,
place to contain all new cases and transmission potentially, temperature monitoring.
chains, whether due to indigenous cases
(including asymptomatic cases) or importations:COVID-19 Strategy for the WHO European Region 17
5. Importation risks can be managed. populations need to have a say in how they value
The likely origin and routes of importations these factors over the duration of the pandemic.
would be understood, and measures would be
in place to rapidly detect and manage suspected The WHO Regional Office for Europe will continue
cases among travellers at points of entry, health supporting countries with tailored guidance
care facilities and communities (including the and technical support. It is also engaged in the
capacity to quarantine with possible contacts processes relating to the development and delivery
or those individuals arriving from countries with of a safe and effective vaccine, or vaccines, and
community transmission). therapeutics that may enable a transition away
from some of the measures necessary to maintain
6. Communities are engaged in the transition. this state of low-level or no transmission. The
Communities are an integral part of the principal role of the WHO Regional Office in vaccine
transition phase and contribute to it by development and roll-out will be on preparing for
continuing to adhere to guidance. This includes safe and equitable vaccination and deployment
embracing a “new normal” in which prevention when the vaccine is available.
measures would be maintained, and playing
their role in enabling and in some cases Adapt to low-capacity settings
implementing new control measures. Countries with comparatively weak health and
social care systems, and limited capacity to
Decisions about when and where to attempt offset economic and social costs, including some
the transition to a steady state of low-level or no countries with marked health system fragility and
transmission must be entirely evidence-based high levels of populations who live in vulnerability,
and data driven. No decision of this nature should are now reporting sporadic cases, clusters of cases
be contemplated without real-time, accurate data and community transmission.26 The window for
on the testing of suspected cases, the nature and containment at the subnational and national level
isolation status of all confirmed cases, the number is closing in many countries.
of contacts per case and completeness of tracing,
and the dynamic capacity of health systems to deal The impact of outbreaks in these facilities/settings
with COVID-19 cases. The WHO Regional Office will depend not only on how effectively health
for Europe is developing guidance to countries for system capacity can be increased and public
transitioning in and out of such measures and this health measures implemented, but also on the
guidance will accompany this strategy.25 complex interplay of demographics, the prevalence
of underlying conditions associated with poor
The risk of re-introduction and resurgence of COVID-19 outcomes, the frequency of infections
the disease will continue and will need to be which have similar presentations to COVID-19 (such
sustainably controlled through the rigorous as bacterial pneumonia and tuberculosis), the
application of public health and primary health relative importance of social, religious and cultural
care interventions as the virus circulates between gatherings that have been shown to be important
and within countries. drivers of COVID-19 transmission in other contexts,
and the local capacity to provide sustained support
A balance needs to be struck between the effect to national and subnational authorities in their
of the virus on the community and the effect of response efforts.
the control measures in terms of limiting human
rights, economic damage with secondary effects
of poverty, social isolation, lack of continuity of
education and adverse impacts on mental health
and well-being. Communities and affected
25 WHO. WHO/Europe publishes considerations for gradual easing of COVID-19 measures, 24 April 2020 [website]. Copenhagen: WHO Regional Office for Europe. (https://www.
euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/4/whoeurope-publishes-considerations-for-gradual-easing-of-covid-19-measures,
accessed 11 May 2020).
26 For all current WHO guidance on preparing for and responding to COVID-19 in humanitarian operations, camps and other fragile settings, see: WHO. Coronavirus disease
(COVID-19) technical guidance: Humanitarian operations, camps, and other fragile settings as well as refugees and migrants in non-humanitarian and non-camp settings
[website]. Geneva: World Health Organization. (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/humanitarian-operations-camps-and-
other-fragile-settings, accessed 11 May 2020).18 COVID-19 Strategy for the WHO European Region
Humanitarian settings,
vulnerable and high risk
groups
© WHO
There is a great diversity of vulnerabilities among It is essential to consider the need for measures
the countries and populations within the WHO tailored specifically to humanitarian settings and
European Region and the COVID-19 pandemic high-risk groups, such as people living in informal
adds to the ongoing responses to emergencies in settlements, prisons and youth detention centres
the Region (Whole-of-Syria, Ukraine, Region-wide and residents of refugee, migrant and internally-
measles outbreak and a series of earthquakes) displaced people (IDP) camps, and high-risk
while also having the potential to have both direct groups, including people who use drugs and
and indirect effects across the Region. Moreover, people with substance-use disorders.
support to implement effective responses and Significant mortality from COVID-19 has been
save lives in politically contested areas should reported in long-term care facilities in a number
be continued and reinforced in the context of of countries; residents of these facilities – mainly
COVID-19. older people, many living with a cognitive,
psychosocial or physical disability – therefore
constitute a highly vulnerable group. The outbreak
© UNODC/Maxim Shubovich
may exacerbate circumstances in these settings
and deepen social inequality among certain
categories of populations. Not dedicating enough
resources to these vulnerable groups may also
prolong the pandemic as these groups may have
a role in driving community transmission.
Residents of high-density settings will find it
especially hard, or impossible, to effectively
comply with physical distancing measures and
movement restrictions as envisaged in other
contexts, while health facilities in these contexts
are unlikely to cope. Widespread testing, contact
tracing, treatment, isolation and quarantine
measures may also not be feasible without
major and rapid coordinated capacity
strengthening. In addition, within these contexts,
groups such as elderly people, people with
disabilities, people in poverty and people with
comorbidities have an increased risk of severe
outcomes from COVID-19.COVID-19 Strategy for the WHO European Region 19
© Syria Relief and Development
Protecting high-risk groups effectively from
COVID-19 will require specific planning and
implementation from the national level down to
the neighbourhood level. As national governments
act rapidly to protect their most vulnerable
populations, WHO has partnered with the UN
Office for the Coordination of Humanitarian
Affairs (OCHA) to produce a COVID-19 Global
Humanitarian Response Plan (GHRP; issued on
25 March 2020).27 The GHRP sets out the most
urgent health and humanitarian actions required
to prepare and respond to COVID-19 in these
contexts.
In Ukraine and Turkey, the GHRP stresses that
countries should ensure core support is maintained
to the programmes for the most vulnerable,
including through UN-coordinated humanitarian
and refugee response plans, rather than diverted
to fill gaps in the COVID-19 response plans.
© Press Centre, Ministry of Health, Kyrgyzstan
27 For the Global Humanitarian Response Plan see: UN. Global humanitarian response plan COVID-19. New York: United Nations; 2020. (https://www.unocha.org/sites/unocha/files/
Global-Humanitarian-Response-Plan-COVID-19.pdf, accessed 11 May 2020).20 COVID-19 Strategy for the WHO European Region
International community’s
response to COVID-19
© WHO
The scale of the COVID‐19 pandemic has required Member States have been actively engaged in
an extraordinary shift in the international system to the response and the WHO Regional Director
support countries to plan, finance and implement for Europe will continue providing the highest
their responses. Countries need authoritative real‐ possible level of leadership, representation, advice
time information on the evolving epidemiology and and support to all requests from Member States,
risks; timely access to essential supplies, medicines donors, partners, as well as other multilateral
and equipment; the latest available technical organizations.
guidance and examples of good practices; rapidly
accessible and deployable technical expertise; The WHO Regional Office for Europe activated
access to an adequately-resourced emergency its Incident Management Support Team (IMST)
health workforce and medical teams; and equitable in early January 2020 to initially monitor and then
access to newly developed vaccines, therapeutics, to swiftly respond to the growing needs of our
diagnostics and other innovations. Region. The IMST coordinates WHO’s response
in the Region, and comprises technical experts
Particular attention and support from donors, the and functional teams covering critical incident
UN and NGOs will be needed in countries with management functions and response pillars. It is
low‐capacity and humanitarian settings, which are country-focused and also includes the WHO Health
ill-equipped to cope due to weak health systems. Emergencies Programme (WHE) Hub-Coordinators
and their teams in priority countries. The IMST will
Coordinate support for countries and monitor continue supporting all countries in the Region,
country preparedness and response including those countries without WHO Country
The WHO Regional Office for Europe will continue Offices. The IMST is based in the Regional Office in
focusing all its resources and repurposed staff to Copenhagen, under the leadership of the Regional
support the response within the Region. WHO Emergencies Director (RED) and reports to the
Country Offices are fully focused on leveraging WHO Regional Director.
resources, expertise and networks, including
technical expertise, in support of country Understand the regional epidemiology,
operations, readiness and response to COVID-19. develop regional analytics and conduct
ongoing risk assessments
WHO support is being implemented through Comprehensive and verified surveillance data
global, regional and country-level activities and is about COVID-19 is being collected from all
being allocated based on needs, assessments and countries, territories and areas. This data is
availability of funds. This categorization28 will be accessible through multiple channels, including
updated regularly based on the evolving COVID-19 a dynamic regional dashboard,29 as well as
situation in each country to identify changes in downloadable data extracts. Challenges in some
needs. cases remain, such as delays in receiving data, lack
of integration and interoperability between the
28 WHO country preparedness and response status for COVID-19 is regularly maintained and available in the public domain, see: WHO. Updated country preparedness and
response status for COVID-19 as of 1 June 2020 [website]. Geneva: World Health Organization (https://www.who.int/publications/i/item/updated-country-preparedness-and-
response-status-for-covid-19-as-of-1-june-2020, accessed 14 July 2020).
29 WHO. COVID-19 situation in the WHO European Region dashboard [database]. Copenhagen: WHO Regional Office for Europe. (https://who.maps.arcgis.com/apps/
opsdashboard/index.html#/ead3c6475654481ca51c248d52ab9c61, accessed 14 July 2020).You can also read
