Current Status of Public Health Measures and Epidemiology Context in European Jurisdictions
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ENVIRONMENTAL SCAN
Current Status of Public Health Measures and
Epidemiology Context in European Jurisdictions
03/11/21
Key Points
• In the context of managing the Coronavirus Disease 2019 (COVID-19) pandemic and emerging
Variants of Concern (VOC), findings from this scan show that public health measures vary across
jurisdictions in Europe. Some describe plans for future gradual re-opening after a lockdown (e.g.,
England, Denmark, Ireland, Scotland), while others maintained restrictions (e.g., Germany), or
increased restrictions (e.g., Finland, France).
• Many re-opening plans included a phased approach. Some jurisdictions have specified that they
will be using a data-driven approach rather than committing to specific dates for re-opening.
These jurisdictions have prioritized schools as one of the first settings to re-open.
• England has discarded their regional tier-system framework towards a data-driven approach to
re-opening after recent resurgence and lockdown. A few countries aim to return to their COVID-
19 frameworks once targets are met. Many jurisdictions are using their national-level
epidemiology to inform re-opening, rather than at a sub-national level.
• While the European jurisdictions reviewed have higher vaccine doses administered for the
population than Canada, no countries were identified to have exemptions for public health
measures at the individual-level.
• The scan results demonstrate that public health measures continue to be important in the
context of VOC, even as vaccination programs accelerate.
Background
Many jurisdictions around the world experienced resurgence of COVID-19 in late 2020. The United
Kingdom (UK), Ireland and continental Europe are relevant as they experienced significant COVID-19
resurgence in fall 2020 and winter 2021, similar to Ontario. Further, many countries experienced the
impacts of VOC emergence, in particular B.1.1.7, earlier than Ontario. Thus, an important consideration
related to public health measures and related plans is the relative proportion of VOC, which are more
transmissible and may lead to increased disease severity.1 The concern for controlling the spread of VOC
is important in decisions about easing or increasing public health measures, due to rapid resurgence
seen in some jurisdictions, leading to health systems being overwhelmed.2 European jurisdictions are
therefore relevant and useful to examine to inform understanding of public health measures required
for winter and spring 2021 in Ontario, as B.1.1.7 is on track for strain replacement.3
Current Status of Public Health Measures and Epidemiology Context in European JurisdictionsThe purpose of this document is to describe the current public health measures, restrictions and plans in
select European jurisdictions (i.e., England, Ireland, Scotland, Denmark, Germany, Finland and France)
during winter 2021. This report describes the plans and measures that have been proposed or are
underway in various jurisdictions to lift public health measures, or maintain their current measures in
the context of VOC. Developments related to re-opening and the impact of vaccinations on decision-
making and/or progress are also described where applicable.
Methods
A rapid environmental scan of the current epidemiological context, status of public health measures and
any plans for adjusting public health measures in select European jurisdictions was conducted.
Specifically, the countries examined were England, Ireland, Scotland, Denmark, Germany, Finland and
France. Records were obtained through online searches conducted between February 22 and 25, 2021
(and updated on March 9, 2021) of recent policies, media articles, government websites, official press
and reports. The epidemiological indicators summarized in this report represent the most recent week
of complete reporting from the jurisdictions included, which varies across the indicators and
jurisdictions.
Findings
The findings below describe recent context of the COVID-19 pandemic in England, Ireland, Scotland,
Denmark, Germany, Finland and France. The findings update the epidemiologic and contextual
information described in the previous PHO scan Lockdown Duration and Re-opening including
Considerations for COVID-19 Variants of Concern.2
England
EPIDEMIOLOGICAL CONTEXT
• On February 25, 2021, the incidence rate (averaged over seven days) in England was 97.1 cases
per 100,000 population (a decrease from the previous 7-day period’s rate of increase which was
a 7-day average of 132 cases per 100,000 on February 18, 2021). This is a marked decrease from
the weekly incidence of 654.5 cases per 100,000 population on January 5, 2021 when England’s
national lockdown measures were initially implemented.2,4
• The weekly number of deaths due to COVID-19 as of February 19, 2021 (the most recent full
week of complete data) was 3,891 deaths. This is down from 5,464 COVID-19 deaths the week
ending on February 12, 2021.5
• By March 1, 2021, a total of 17,373,384 individuals received their first dose of the COVID-19
vaccine (34% of the national population) and 612,567 individuals in England had received both
doses (1.15% of the national population).6
• As of reporting on March 5, 2021, there has been a cumulative total of 97,257 confirmed and
probable cases of VOC 202012/01 (B.1.1.7) in England, which accounts for 92% of all B.1.1.7
cases in the UK (cumulative total of 105,428 B.1.1.7 cases).7 Additionally, there have been 147
confirmed cases of the 501Y.V2 B.1.351 variant (first identified in South Africa) and 38
confirmed cases of the Variant of Interest P2 under investigation (descendent of B.1.1.28
variant, first identified in Brazil).7 The most recent UK COVID-19 infection survey (for the week
Current Status of Public Health Measures and Epidemiology Context in European Jurisdictions 2 of 24ending on February 19, 2021) reported that the percentage of people testing positive for all
variants was decreasing in England (an estimated 0.4% of cases were compatible with the
B.1.1.7 variant).8
PUBLIC HEALTH MEASURES
According to an analysis from the University of Oxford, in February 2021, England had the sixth strictest
lockdown in the world and the second strictest in Europe.9 The plan for easing restrictions will be split
into four separate steps and applied to the country as a whole, with no return to the regional tier
system/framework that was previously in use in the second part of 2020.9 The plan to end restrictions in
England by June 21, 2021 is outlined below (plan described as of February 22, 2021).10 The country will
progress through a four-stage plan to ease England's lockdown if strict conditions are met. The four
conditions that must be met for easing the lockdown include: 10
1. The vaccine program goes as planned;
2. Evidence shows that vaccines are reducing the number of deaths and hospitalizations;
3. Infection rates do not risk a surge in hospital admissions;
4. New variants do not change the risk of lifting restrictions.10
The four proposed re-opening stages are described in Table 1 below. The government has noted that
dates could change depending on the scale of the coronavirus outbreak.9
Currently, the plan for England’s re-opening does not include considerations at the individual-level
related to vaccination.
Table 1. Re-opening Plan in England
Step Description of Measures9,10
Starting March 8, 2021
• Schools open and outdoor after-school sports allowed
• All schools and college students back in class
• Mandatory face masks for secondary school students
• Some university students return
• Two people can sit together outdoors
Step 1 • Care home residents are allowed one regular visitor
Starting on March 29, 2021
• Six people or two households are allowed to meet outdoors
• Outdoor sports facilities open and organized sports are allowed
• Travel outside the local area is allowed
• The ‘stay at home’ order is replaced with a ‘stay local’ message
• Workers are still encouraged to work from home
Starting April 12, 2021 (at the earliest)
• Non-essential retail and personal care opens
Step 2
• Hospitality outdoors opens (e.g., pubs and restaurants with
outdoor seated service)
Current Status of Public Health Measures and Epidemiology Context in European Jurisdictions 3 of 24Step Description of Measures9,10
• Indoor leisure opens (e.g., gyms, swimming pools)
• Self-contained holiday locations open (e.g., campsites)
• Funerals continue with up to 30 people; weddings with up to 15
guests
• Wider social distancing rules remain in place for public settings
• International holidays are still not permitted
Starting May 17, 2021 (at the earliest)
• Outdoors, most social contact rules lifted (e.g., rule of six
outdoors lifted)
• Up to 10,000 or 25% capacity (whichever is less) spectators can
attend the very largest (i.e., 16,000 people or more) outdoor
seated venues like football stadiums
Step 3 • Smaller outdoor sport venues are allowed with 4,000 fans or 50%
capacity (whichever is less)
• Six people or two households can meet indoors
• Indoor hospitality and hotels open
• Up to 30 people will be able to attend weddings, receptions,
funerals and wakes
• Possible return of international travel
Before implementing Step 4, ministers will review social distancing and
other long-term measures designed to reduce transmission, including the
"one metre plus" rule and wearing of face coverings. They will also
consider whether to lift the "work from home" guidance, which the
government says people should continue to follow until the review has
Step 4 been completed.
Starting June 21, 2021 (at the earliest)
• All legal limits on social contact removed
• Hope to re-open final closed sectors of the economy (e.g.,
nightclubs, hospitality)
• Large events and performances can restart with full audience
Denmark
EPIDEMIOLOGICAL CONTEXT
• As of February 28, 2021, the 7-day average of newly identified COVID-19 cases was down to 8.9
per 100,000 population (down from a peak of 61.1 per 100,000 population on December 18,
2020).11 When Denmark’s national lockdown began on January 5, 2021 the weekly average was
35.4 new cases per 100,000 population, which decreased to 13.3 per 100,000 population by
January 25, 2021.2
• As of February 28, 2021, the number of deaths due to COVID-19 (averaged over a seven-day
period) was 0.05 deaths per 100,000 population (down from a peak of 0.61 deaths per 100,000
population on January 21, 2021).11
Current Status of Public Health Measures and Epidemiology Context in European Jurisdictions 4 of 24• As of March 11, 2021, 11.5% of Denmark’s national population received the first dose of the
COVID-19 vaccine, and the uptake of the second dose was 4.4% of the national population.12
• The B.1.1.7 variant is the most prevalent VOC in Denmark; it was first detected in Denmark on
November 13, 2020 and was identified in 28.5% of COVID-19 positive samples during the first
week of February 2021.13
PUBLIC HEALTH MEASURES
• National lockdown was implemented January 5, 2021 until February 28, 2021 with some
measures set to end February 7, 2021.2 Concerns about the variants are the key reason why
strict lockdown measures continue to be in place in Denmark, despite a decline in COVID-19
cases.13
• On February 8, 2021, in-class teaching resumed for younger students (i.e., pre-school to
the fourth grade) as Denmark has seen a steady reduction in COVID-19 infection numbers
in recent weeks.14
• Starting Sunday February 7, 2021, Denmark introduced increased restrictions upon arrival in
order to limit the spread of new virus variants and prevent accelerated spread. All individuals
entering Denmark will be required to be tested and subsequently isolate for 10 days.15
• On February 22, 2021, the Danish government released a plan for gradual re-opening.16 The plan
included restrictions implemented on March 1. The current national lockdown was scheduled to
expire on February 28, 2021; however, it has been extended until April 5, 2021.17
• The recommendations for lifting restrictions were based on mathematical modelling projections.
The recommendations published by the Ministry of Health on February 22, 2021 include:18
• Gatherings: A maximum of five people can gather in private homes and meet in social
bubbles; however, citizens are advised to meet with as few people as possible and still
maintain a minimum physical distance of two metres.17
• Retail: Shops with an area of up to 5,000 square metres that sell durable goods (e.g.,
clothes, appliances, furniture) can reopen. This would be with restrictions on the number
of customers per square metre. Malls and stores which are part of shopping malls must
remain closed.18
• Grocery stores/supermarkets, pharmacies and specialist shops selling medical
equipment can remain open.17
• Restaurants can still sell takeaway food.17
• Schools: Currently, schools are opened nationally for grades 0-4. The expert group report
recommends that older students at elementary schools and at upper secondary schools be
allowed to return in specified regions only. These regions are North Jutland, West Jutland
and the Baltic Sea island Bornholm. The reopening for older school age groups will be
limited. Further reopening would not take place until after the Easter holiday on April 6,
2021 and would depend on a review of epidemiologic trends following the easing of
restrictions in March.
Current Status of Public Health Measures and Epidemiology Context in European Jurisdictions 5 of 24• Outdoor clubs: Organized outdoor activities (e.g., sports clubs) can resume.18
• Outdoor cultural institutions: These venues (e.g., zoological gardens) can reopen with the
precondition that visitors can document a negative polymerase chain reaction (PCR)
COVID-19-test in the last 72 hours.17 The exact cultural institutions which would be
encompassed are not specified in the report.18
• Masking: Masking in certain areas, among others public transport and supermarkets is still
required.17
• Currently, Denmark’s public health measures do not include considerations at the individual-
level related to vaccination.
Ireland
EPIDEMIOLOGICAL CONTEXT
• As of February 27, 2021, the 7-day average of daily new COVID-19 cases was down to 11.3 per
100,000 population (down from a peak of 132.2 per 100,000 population on January 10, 2021).11
A month prior, on January 26, 2021, the weekly average was 37.6 per 100,000 population.2
• As of February 28, 2021, the number of deaths due to COVID-19 (averaged over a seven-day
period) was 0.51 deaths per 100,000 population (down from a peak of 1.2 deaths per 100,000
population on February 4, 2021).11
• As of March 11, 2021, 10.1% of the national population had received the first dose of COVID-19
vaccination, and 4% of the national population had received their second dose.12
• On February 15, 2021, an update from the European Centre for Disease Prevention and Control
(ECDC) noted that the B.1.1.7 strain was the dominant circulating SARS-CoV-2 strain in Ireland,
constituting 75% of all COVID-19 cases in the country.19 However, the ECDC also noted concern
for the B.1.351 strain that has been increasingly reported in European countries as well as the
P.1 variant which is linked to travel from Brazil.19
PUBLIC HEALTH MEASURES
• According to an analysis from the University of Oxford, the recently implemented public health
measures in Ireland were the third strictest lockdown in the world.9
• On February 22, 2021, it was announced that Level 5 restrictions (which are previously described
in the PHO report titled Lockdown Duration and Re-opening including Considerations for COVID-
19 Variants of Concern2) would be extended until April, but schools and childcare will reopen.20
• The government’s COVID-19 Resilience and Recovery 2021 - The Path Ahead document was
updated on March 3 and describes updated public health measures.21
• Pre-schools are set to reopen on March 8 under a revised ‘Living with COVID’ plan with no other
major lifting of restrictions next month. The restrictions will be reviewed again on April 5,
2021.20
Current Status of Public Health Measures and Epidemiology Context in European Jurisdictions 6 of 24• Schools: Schools will be partially reopened in March. Junior and senior infants, first and second
class (i.e., equivalent to Grades 1 and 2) and Leaving Certificate students (i.e., students who
completed the secondary school system) will return on March 1, 2021. This is expected to be
followed by a further reopening two weeks later on March 15, 2021 for other primary school
pupils and fifth years. Under this plan, though it is yet to be approved by ministers, the
remaining secondary school students will not return until after the Easter holidays, on April 12,
2021.20 Table 2 describes proposed school opening timing.
Table 2. School Re-opening in Ireland
Date Description21
• Special schools at 100% capacity
• Junior and senior infants, 1st and 2nd class (i.e., grades 1 and 3) to
March 1, 2021
return to school
• Final year Leaving Certificate classes to return to school
• Resumption of the Early Childhood Care and Education (ECCE)
March 8, 2021
programme and return to school of ECCE-age children
• 3rd, 4th, 5th and 6th class at primary level
March 15, 2021
• 5th year post-primary students to return to school
March 29, 2021 • Early learning and care, and school-age childcare services to reopen
April 12, 2021 • 1st to 4th years post-primary return to school
• Retail: No reopening of non-essential retail is planned.20
• Working from home: The population is urged to continue working from home and the
government will encourage people to continue to observe the restrictions in order to keep
the reproduction number less than one.20
• Vaccinations: The government is also expected to announce changes to the vaccination
schedule, with people with respiratory illnesses likely to be offered earlier vaccinations.20
• No public health measures or exemptions for vaccinated individuals were identified.
• Travel quarantine: There is expected to be an update on the plans to impose a mandatory
quarantine in designated hotels on travelers from high-risk countries.20
Scotland
EPIDEMIOLOGICAL CONTEXT
• As of March 8, 2021, the 7-day average of daily new COVID-19 cases was 64.5 per 100,000
population.22 This is down from the peak 7-day average of 301.8 per 100,000 on January 8,
2021.23
• As of February 25, 2021, the number of deaths due to COVID-19 (averaged over a seven-day
period) was 18.6 deaths (down from a peak of 62.3 deaths on January 22, 2020).22
Current Status of Public Health Measures and Epidemiology Context in European Jurisdictions 7 of 24• As of March 1, 2021, 29% of the national population (1,611,578 people) had received the first
dose of the COVID-19 vaccination, and 1.4% of the national population (78,865) had received
their second dose. This includes care home residents and staff, health care and social workers,
and those classified as extremely vulnerable.24
• As of March 1, 2021, 17 cases of the coronavirus variant first detected in South Africa (B.1.351)
have been identified and Scotland has identified its first cases of the P.1 variant first identified in
Brazil.25 Additionally, the B.1.1.7 variant (first identified in England) has been present in Scotland
since mid-December; as of early February 73% of Scotland’s COVID-19 cases were consistent
with this variant.26
PUBLIC HEALTH MEASURES
In Scotland, the goal is to move nationally from a strict lockdown back to a levels system by the end of
April.27 More details will be discussed in mid-March, including the order in which parts of the economy
will reopen. The first minister said all decisions will be "driven by data rather than dates".28 The aim is to
have a "progressive easing" of the level four restrictions at three-week intervals. Below are some
potential key dates for lifting restrictions:29
February 22, 2021
• Early learning and primary school students return to school
• Care home residents are allowed two visitors per week
March 15, 2021
• Students in grades 4 to 7 return to school
• Blended learning for some secondary school students
• Phased return for universities and colleges
• Non-contact outdoor sports for ages 12 to 17 allowed
• Four people from two households can meet outdoors
April 5, 2021
• Stay at home restrictions are lifted
• Schools are reopened for all ages
• Some communal worship allowed
• “Click and collect” resumes
• Six people from two households can meet outdoors
April 26, 2021
• Return to a levels system27
Current Status of Public Health Measures and Epidemiology Context in European Jurisdictions 8 of 24• Aim for all of Scotland to move to level three
• Non-essential retail, pubs and restaurants to re-open
• Gyms, swimming pools and other leisure activities resume
Germany
EPIDEMIOLOGICAL CONTEXT
• As of February 28, 2021, the 7-day average of daily new COVID-19 cases was down to 9.5 per
100,000 population (down from a peak of 30.7 per 100,000 population on December 23,
2020).11
• As of February 28, 2021, the number of deaths due to COVID-19 (averaged over a seven-day
period) was down to 0.4 deaths per 100,000 population (down from a peak of 1.1 deaths per
100,000 population on January 13, 2021).11
• As of March 11, 2021, 7.5% of the national population had received the first dose of the COVID-
19 vaccination, and 3.6% of the national population had received their second dose.12
• By mid-January, three VOC (those first identified in the UK, Brazil and South Africa) were
identified in Germany. The variants in Germany are estimated to have increased the risk of
COVID-19 infection by 15 to 40%.30 The ECDC has reported that by mid-February 2021, the
B.1.1.7 variant constituted 5.6% of all COVID-19 cases in Germany.19
PUBLIC HEALTH MEASURES
The lockdown measures began in November 2020, and were extended and further restricted before the
winter holidays, with the number of COVID-19 patients threatening to overwhelm hospitals.31
The following restrictions were in place until February 14, 2021:32
• Face masks are mandatory in all public places. Medical masks are mandatory on public
transportation and in shops.
• In private gatherings, one household was allowed to meet with one person from another
household.
• Employers were obligated to allow their employees to work from home if possible.
• Schools and daycares closed, offering emergency care only.
• Cafes, restaurants and bars closed, but can offer take away and delivery.
• All facilities associated with leisure activities, as well as beauty salons were closed. Amateur
sport activities were suspended.
• All non-essential shops were closed. Only supermarkets and shops for essential goods remain
open.
• In high-risk areas you cannot travel further than 15 km from your home.
Current Status of Public Health Measures and Epidemiology Context in European Jurisdictions 9 of 24On February 10, 2021, the federal and state governments in Germany agreed to extend the level of
restrictions listed above until March 7, 2021. If at that time, the seven-day incidence of new infections
per 100,000 population reached a stable level below 35, then relaxing restrictions could proceed in a
stepwise manner. An exception was to be made for hairdressers, which were to be allowed to reopen at
the beginning of March under strict hygiene conditions.32
On March 4, 2021, national lockdown measures were further extended until March 28, 2021, with some
additional information on the thresholds for easing measures based on regional COVID-19 incidence.32
The restrictions in place until March 28, 2021 include:
• Schools and daycares may slowly re-open depending on local infection numbers. Remaining
schools will still learn via virtual or distance learning.31,32
• Hair salons and necessary sanitary services may reopen from March 1, 2021.32
• Face masks remain mandatory in all public places. On public transportation and in shops,
medical masks are mandatory.32
• In private gatherings, five people from two households are permitted to meet. This has
increased from the previous restriction of one household being permitted to meet only one
person from another household.32
• Employers are obligated to allow their employees to work from home if possible.32
• Book shops, florists and garden centres may re-open from March 8, 2021 if hygiene
requirements are met.32
• In regions where the incidence rate is below 100 new infections per 100,000 inhabitants,
museums, galleries, zoos, botanical gardens and memorial sites could open for visitors with
appointment bookings, in addition to appointment shopping in the retail sector. Individual
sports alone or in pairs and sports in groups of up to ten children (up to 14 years of age) will be
permitted outdoors.32
• In regions with a stable seven-day incidence of less than 50 new infections per 100,000
inhabitants, non-contact sports in small groups outdoors will be permitted.32 If previous steps do
not lead to a worsening seven-day incidence for at least 14 days, then outdoor restaurants,
cinemas, theaters, concert halls and indoor contact sports will be permitted.
• Additional regional re-opening is conditional upon a ‘stable’ seven-day incidence of no more
than 35 new infections per 100,000 inhabitants.32
• More rapid tests (one rapid antigen test per week for every citizen) and vaccinations are
expected to bring a faster return to normalcy. In order to improve the vaccination
administration, general practitioners and specialists are to be involved more extensively by
April.32
• No public health measures or exemptions for vaccinated individuals were identified.
Current Status of Public Health Measures and Epidemiology Context in European Jurisdictions 10 of 24Finland
EPIDEMIOLOGICAL CONTEXT
• As of February 28, 2021, the 7-day average of daily new COVID-19 cases was 10.1 cases per
100,000 population which is an increase from January 8, 2021 (when the average dropped after
second wave resurgence) when the 7-day average was 4.3 cases per 100,000 population.11 This
increase in the average is higher than the peak of the second wave on December 11, 2020
where the 7-day average of daily new COVID-19 cases was 8.5 cases per 100,000 population.11
• As of February 28, 2021, the number of deaths due to COVID-19 (averaged over a seven-day
period) was down to 0.04 deaths per 100,000 population. This marks a decrease from the recent
peak of 0.1 deaths per 100,000 people on December 23, 2020.11
• As of March 11, 2021, the national uptake for the second dose of the COVID-19 vaccine in
Finland was 1.9%, and the uptake for the first dose was 11%.12 A week prior on March 2, 2021, a
cumulative total of 466,538 individuals had received both doses of the vaccine, and a large share
of these individuals were aged 80 years or older (186,676 individuals or 40%).33
• Finland is currently on high alert due to a rise in cases caused by VOC, and rising incidence rates.
By March 5, 2021, a total of 1,295 cases caused by coronavirus variants were identified in
Finland (1,223 cases of the B.1.1.7 variant, 71 cases of the B.135 variant, and one case of the P.1
variant).34 This is an increase from the VOC prevalence on February 18, 2021, when there were
only 450 cases caused by VOC, the majority of which are the B.1.1.7 variant first identified in the
UK35,36 (422 cases caused by B.1.1.7, 22 cases caused by B.135, and one caused by P.1).37
PUBLIC HEALTH MEASURES
On March 1, 2021 a national state of emergency was recently declared in Finland.38,39
• Restaurant restrictions: As part of the state of emergency, there is a three week closure of
restaurants and other food and beverage service businesses, with only takeaway and delivery
permitted.38,39 The closures are in effect from March 8, 2021 until March 28, 2021. The closure
applies to food and beverage service businesses in regions evaluated to be in the “acceleration”
or “community transmission phase” of Finland’s COVID-19 framework (described below in
Appendix A, Table 1).38,39
• School restrictions: From March 8, 2021, the upper grades of comprehensive schools (which
encompasses grade one to grade nine) and all grades of secondary schools are instructed to
transition to temporary distance learning in areas where the epidemic is in the acceleration or
community transmission phase.38
• Currently, there are no published considerations or plans to ease restrictions for individuals who
are fully vaccinated in Finland.
In addition to the state of emergency, the restrictions assessed at the regional level in accordance with
Finland’s National COVID-19 Action Plan remain in place (the epidemiological indicators and associated
public health measures can be found in Appendix A, Table 1). The epidemiological situation is assessed
at the regional level and assigned a phase from the action plan (baseline phase, acceleration phase,
community transmission phase), each of which is associated with a different level of restrictions. The
Current Status of Public Health Measures and Epidemiology Context in European Jurisdictions 11 of 24evaluation of the phase that each region is in is updated on the Finnish Institute for Health and
Welfare’s website.40
On January 26, 2021, the three tiers of prevention measures were added to Finland’s COVID-19 action
plan to curb the escalation of the epidemic and prevent the spread of VOC.41,42 Finland’s national COVID-
19 action plan evaluates regions across Finland using the three phases of the action plan to assess
regional epidemiological situation and the additional three tiers to determine the level of restrictions
and public health measures required.
• Each phase of Finland’s COVID-19 action plan has a defined set of indicators, which must be
evaluated before a region can move to a less stringent level of restriction. The three phases, the
indicators that define the epidemiological situation of each phase, and the associated public
health measures at each phase are described in Appendix A, Table 1.
• The three tiers of the action plan intend to guide, support and contribute to the review of the
use of public health measures in the new situation caused by COVID-19 variants.41,42 The three
new tiers correspond with increasing degrees of restrictions and are described in Appendix A,
Table 2.
France
EPIDEMIOLOGICAL CONTEXT
• On March 3, 2021, the 7-day average of daily new COVID-19 cases in France was 32.6 per
100,000 population (up from 28 per 100,000 population two weeks prior on February 17,
2021).43 The 7-day average in France has been increasing steadily since early January 2021. On
January 1, 2021, France began the year with a 7-day average of 20 per 100,000, which has been
steadily increasing throughout February and March.43
• On March 4, 2021, the number of deaths due to COVID-19 (averaged over a seven-day period)
was 0.5 deaths per 100,000 population.44 This is a decrease from the 7-day average on February
17, 2021, which was 0.6 deaths per 100,000 population.44
• As of March 11, 2021, the national uptake for the second dose of the COVID-19 vaccine in
France was 3.6%, and the uptake for the first dose was 7.4%.12
• On February 24, 2021, the B.1.1.7 variant (first identified in the UK) accounted for almost half of
all new cases, according to Health Minister Olivier Véran.45,46 As of March 4, 2021, this variant
increased in prevalence as it is now reported to constitute 60% of the total COVID-19 cases in
France.47
PUBLIC HEALTH MEASURES
Due to increasing incidence rates in France, a curfew, business closures and additional mobility
restrictions were introduced in metropolitan areas beginning in January 2021.48 All major restrictions in
France are implemented in metropolitan areas/regionally, as opposed to at the national level. The
current public health measures implemented in metropolitan areas of France are summarized below:
• Curfew: 6:00 pm to 6:00 am, implemented in many metropolitan areas on January 2 and January
10, and in all metropolitan areas by January 16, 2021.49
Current Status of Public Health Measures and Epidemiology Context in European Jurisdictions 12 of 24• Mobility: Individuals can only leave home for essential purposes, including: commuting to work
or school, medical appointments, essential family or support purposes, administrative or judicial
purposes, walking a pet within 1 km of one’s residence.50
• Retail: Remains open, but must close at 6:00pm due to curfew.50
• Schools: All schools remain open, except for universities which have moved to virtual learning.
Face masks are compulsory for all children above the age of six.50
• Bars and restaurants: Restaurants, bars, restaurants, cinemas, theatres, museums and gyms
remain closed.50
• Currently, there are no published considerations or plans to ease restrictions for individuals who
are fully vaccinated in France.
Several other regions, including the French Riviera and the northern French post of Dunkirk, have
implemented weekend lockdowns to help control the spread of COVID-19 in areas that are considered
tourist destinations.51
In late February 2021, French government officials considered implementing additional local restrictions
in an effort to avoid a national lockdown.52,53 However, on March 4, 2021, French Prime Minister Jean
Castex publicly stated that the government would work to avoid a new national lockdown.54 The French
government has since backtracked on earlier proposals to introduce three-week lockdowns in Paris and
other populous cities at-risk, instead choosing to shut down large non-food commercial retail spaces to
slow down the circulation of the COVID-19 virus.47
Comparison of Vaccines Administered: European Countries and Canada
Related to vaccination program and implementation across countries, Figure 1 below displays an
overview of Canada’s current status based on publicly reported vaccine doses administered as reported
on the Our World in Data website,55 compared with the European countries reviewed. The majority of
European countries included in this review (France, Germany, Finland, Denmark, and Ireland) have
followed the same trend in COVID-19 vaccine administration, reaching between 9.4 and 13.8 per 100
people by March 10, 2021. England and Scotland have consistently had the highest vaccine doses
administered per 100 people from February 1 onward, reaching 36.5 and 36.0 per 100 people
respectively. Canada has consistently reported lower daily vaccine doses administered, when compared
to the European countries included in this review.
Current Status of Public Health Measures and Epidemiology Context in European Jurisdictions 13 of 24Figure 1. Comparing Canada with Select European Countries for COVID-19 Vaccine Doses Administered per 100 People55 Source: Ritchie H, Ortiz-Ospina E, Beltekian D, Mathieu E, Hasell J, Macdonald B, et al. Coronavirus (COVID-19) vaccinations [Internet]. Oxford: Our World in Data; 2021 [cited 2021 Mar 12]. Chart, COVID-19 vaccine doses administered per 100 people. Available from: https://ourworldindata.org/grapher/covid-vaccination-doses-per- capita?country=CAN~DNK~England~FRA~IRL~Scotland~FIN~DEU Conclusions The emergence of VOC has heightened the importance of public health measures. Experiences from European jurisdictions demonstrate there are broadly two different approaches being pursued. One is to take steps to ease restrictions while keeping a close eye on case numbers and the spread of VOC (e.g., England, Scotland, Ireland and Denmark). The other approach is ongoing maintenance of current measures (e.g., Germany) or increasing stringency (e.g., France, Finland) in response to VOC and increasing transmission rates. The reviewed jurisdictions in Europe do not currently include any exemptions at the individual-level for public health measures, while all appear to be further ahead than Canada in vaccines administered for their population, based on publicly reported information. These findings show broad areas of agreement that can guide important decisions for Ontario. A common criterion is a data-driven approach, basing decisions about public health measures on incidence rates despite some progress with vaccination. Attention is also paid to a federal or regional approach. Maintaining current restrictions or increasing the stringency of restrictions is also a consistent approach in relation to controlling VOC transmission. Community-based public health measures are a critical public health intervention for Ontario in the weeks and months ahead. Measures used in Europe have been very stringent to control VOC and in the setting of worsening epidemiologic trends in Ontario, should be intensified and applied swiftly, in response to leading indicators. Current Status of Public Health Measures and Epidemiology Context in European Jurisdictions 14 of 24
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33. Finnish Institute for Health and Welfare. Coronary vaccinations in Finland: total coronary vaccinations by region and age group [Internet]. Helsinki: Finnish Institute for Health and Welfare; 2021 [cited 2021 Mar 2]. Available from: https://sampo.thl.fi/pivot/prod/fi/vaccreg/cov19cov/summary_cov19covagearea 34. Finnish Institute for Health and Welfare. Situation update on coronavirus [Internet]. Helsinki: Finnish Institute for Health and Welfare; 2021 [cited 2021 Mar 11]. Available from: https://thl.fi/en/web/infectious-diseases-and-vaccinations/what-s-new/coronavirus-covid-19-latest- updates/situation-update-on-coronavirus#Coronavirus_variants 35. Xinhua News. Roundup: Finland on high alert over COVID-19 variants of concern. Xinhua News [Internet], 2021 Feb 19 [cited 2021 Mar 03]; Europe. Available from: http://www.xinhuanet.com/english/europe/2021-02/19/c_139751036.htm 36. Finland. Ministry of Social Affairs and Health, Finnish Institute for Health and Welfare. Current COVID-19 situation in Finland: new virus variants cause concern [Internet]. Helsinki: Finnish Government; 2021 [cited 2021 Mar 1]. Available from: https://valtioneuvosto.fi/en/-/1271139/current- covid-19-situation-in-finland-new-virus-variants-cause-concern 37. Daily Sabah, AA. New COVID-19 mutation in Finland may escape PCR tests. Daily Sabah [Internet], 2021 Feb 19 [cited 2021 Mar 8]. Available from: https://www.dailysabah.com/life/health/new-covid-19-mutation-in-finland-may-escape-pcr-tests 38. Finnish Government. Restrictions during the coronavirus epidemic [Internet]. Helsinki: Finnish Government; 2021 [modified 2021 Mar 1; cited 2021 Mar 1]. Available from: https://valtioneuvosto.fi/en/information-on-coronavirus/current-restrictions 39. Finland. Ministry of Economic Affairs and Employment. Government proposal: restaurants to be temporarily closed to customers - takeaway and delivery still permitted [Internet]. Helsinki: Finnish Government; 2021 [modified 2021 Mar 1; cited 2021 Mar 1]. Available from: https://tem.fi/- /hallituksen-esitys-ravintolat-suljetaan-valiaikaisesti-asiakkailta-ruokaa-voi-tilata-ja- noutaa?languageId=en_US 40. Finnish Institute for Health and Welfare. The COVID-19 epidemic: regional situation, recommendations and restrictions [Internet]. Helsinki: Finnish Institute for Health and Welfare; 2021 [cited 2021 Mar 2]. Available from: https://thl.fi/en/web/infectious-diseases-and-vaccinations/what-s- new/coronavirus-covid-19-latest-updates/situation-update-on-coronavirus/the-covid-19-epidemic- regional-situation-recommendations-and-restrictions 41. Finnish Government. Phases of the COVID-19 epidemic and tiers of prevention measures [Internet]. Helsinki: Finnish Government; 2021 [cited 2021 Mar 1]. Available from: https://valtioneuvosto.fi/en/information-on-coronavirus/phases-of-the-covid-19-epidemic 42. Finland. Ministry of Social Affairs and Health. Coronavirus epidemic stages and levels of control 1-3 [Internet]. Helsinki: Finnish Government; 2021 [modified 2021 Feb 25; cited 2021 Mar 1]. Available from: https://stm.fi/koronavirusepidemian-tasot 43. Our world in data. Daily new confirmed COVID-19 cases - France [Internet]. University of Oxford; 2021; [cited 2021 Mar 5]. Available from: https://ourworldindata.org/coronavirus-data- explorer?zoomToSelection=true&time=2020-03- Current Status of Public Health Measures and Epidemiology Context in European Jurisdictions 18 of 24
01..latest&country=~FRA®ion=World&casesMetric=true&interval=smoothed&perCapita=true&smoo thing=7&pickerMetric=location&pickerSort=asc 44. Our World in Data. Daily new confirmed COVID-19 deaths per million people: France [Internet]. Oxford: Our World in Data; 2021 [cited 2021 Mar 5]. Available from: https://ourworldindata.org/coronavirus-data-explorer?zoomToSelection=true&time=2020-03- 01..latest&country=~FRA®ion=World&deathsMetric=true&interval=smoothed&perCapita=true&smo othing=7&pickerMetric=location&pickerSort=asc 45. France 24. Covid-19: Paris eyes strict lockdown that would then allow city to ‘reopen everything’. France 24 [Internet], 2021 Feb 26 [cited 2021 Mar 5]. Available from: https://www.france24.com/en/france/20210226-paris-eyes-three-week-covid-19-lockdown-in-bid-to- then-reopen-everything 46. France 24. UK variant accounts for 'about half' of France's Covid-19 cases, PM says. France 24 [Internet], 2021 Feb 25 [cited 2021 Mar 5]. Available from: https://www.france24.com/en/europe/20210225-uk-variant-accounts-for-about-half-of-france-s-covid- 19-cases-pm-says 47. Desai S. France rules out weekend lockdowns for Paris. Anadolu Agency [Internet], 2021 Mar 5 [cited 2021 Mar 5]. Available from: https://www.aa.com.tr/en/europe/france-rules-out-weekend-lockdowns- for-paris/2165407 48. Government of France. Coronavirus information [Internet]. Paris: Government of France; 2021 [modified 2021 Mar 4; cited 2021 Mar 5]. Available from: https://www.gouvernement.fr/info- coronavirus 49. Government of France. COVID-19 government action: chronology of actions [Internet]. Paris: Government of France; 2021 [modified 2021 Feb 4; cited 2021 Mar 5]. Available from: https://www.gouvernement.fr/info-coronavirus/les-actions-du-gouvernement 50. Government of France. Restrictions and requirements in metropolitan France [Internet]. Paris: Government of France; 2021 [modified 2021 Feb 25; cited 2021 Mar 5]. Available from: https://www.gouvernement.fr/en/coronavirus-covid-19 51. France 24. France's Dunkirk set for weekend lockdown amid ‘alarming’ Covid-19 situation. France 24 [Internet], 2021 Feb 24 [cited 2021 Mar 5]. Available from: https://www.france24.com/en/europe/20210224-france-puts-dunkirk-area-under-lockdown-amid- alarming-covid-19-situation 52. France 24. France considers new local lockdowns to stem ‘worsening’ Covid-19 situation. France 24 [Internet], 2021 Feb 24 [cited 2021 Mar 5]. Available from: https://www.france24.com/en/europe/20210224-france-considers-new-local-lockdowns-to-stem- worsening-covid-19-situation 53. France 24. Regional lockdowns? All options still in the table in France to fight Covid-19, says govt. France 24 [Internet], 2021 Mar 2 [cited 2021 Mar 5]. Available from: https://www.france24.com/en/video/20210302-regional-lockdowns-all-options-still-in-the-table-in- france-to-fight-covid-19-says-govt Current Status of Public Health Measures and Epidemiology Context in European Jurisdictions 19 of 24
54. Reuters Staff. French PM Castex: we must do all we can to avoid new national COVID-19 lockdown. Reuters [Internet], 2021 Mar 4 [cited 2021 Mar 5]; World News. Available from: https://www.reuters.com/article/uk-health-coronavirus-france-outlook/french-pm-castex-we-must-do- all-we-can-to-avoid-new-national-covid-19-lockdown-idUKKCN2AW2EN 55. Ritchie H, Ortiz-Ospina E, Beltekian D, Mathieu E, Hasell J, Macdonald B, et al. Coronavirus (COVID- 19) vaccinations [Internet]. Oxford: Our World in Data; 2021 [cited 2021 Mar 12]. Chart, COVID-19 vaccine doses administered per 100 people. Available from: https://ourworldindata.org/grapher/covid- vaccination-doses-per-capita?country=CAN~DNK~England~FRA~IRL~Scotland~FIN~DEU Current Status of Public Health Measures and Epidemiology Context in European Jurisdictions 20 of 24
Appendix A: Finland’s National COVID-19 Action Plan
The tables below outline the phases and tiers of Finland’s National COVID-19 Action Plan. The phases
and tiers of the action plan guide the level of stringency of public health measures implemented at the
regional level across Finland.
Table 1. Epidemiological Indicators and Public Health Measures/Restrictions at Each Phases of
Finland’s Covid-19 Action Plan
Indicators for Moving into Each
Phase Restrictions
Phase
Gatherings
• Hygiene measures in place
Work from home
• Work remotely to the extent possible in
• Low incidence;
both the public and private sectors
• Manageable regional
(nationally until further notice, will be
chains of infection
reviewed by 30 June 2021)
• Those exposed are Restaurants
traceable
Baseline • Businesses must stop serving alcohol by
• No significant spread
Phase midnight
outside known clusters;
• Businesses that primarily serve alcoholic
• New cases are either
beverages must close by 1:00am
occasional individual
• Other food and beverage service
cases or are found in
businesses may be open round the clock
those quarantined.
• No restrictions on the number of
customers
Education
• Normal, in-person attendance in school
Gatherings
• Closure of businesses and facilities for
• Regional 7-day
customers/participants for two weeks
incidence of infections
including: indoor sport facilities, pools,
is 10-15 per 100,000
dance halls, amusement parks, indoor
population;
playgrounds
• Regional 14-day case
Work from home
sum < 25 per 100,000
• Work remotely to the extent possible in
population;
Acceleration both the public and private sectors
• Test positivity > 1%;
Phase (nationally until further notice, will be
• Sources of infection can
reviewed by 30 June 2021)
be identified and the
Restaurants
chains of infection can
• As part of the state of emergency, there is
be severed; and
a three week closure of restaurants and
• Need for hospital care
other food and beverage service
can be met without
businesses, with only takeaway and
special measures.
delivery permitted.
• Closures in effect until March 28, 2021
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