A tier system to assess transmission and public health responses may be able to avoid the economic fallout from long term COVID-19 lockdowns, while combatting transmission of the disease, WHO has said.

The European region has recorded over 15.7 million total COVID-19 cases, over 4 million of which occurred in November alone. Europe now accounts for 28% of global cases and 26% of global deaths, joining the US as an epicentre of the pandemic. Several countries are resorting to lockdowns, with significant economic collateral damage.

A tier-based system that ranks regions based on the rate of community transmission is hoped to help stem the spread of the virus, and Hans Kluge, WHO Regional Director for Europe, has now encouraged governments to implement similar systems.

He said: “A set of proportionate measures that could be considered under each tier can better situate government actions along a gradient of severity that can go both ways without ever stalling.”

The tier system is included in the interim guidance updated by the WHO European Regional Office on 4 November. The document provides indicators and thresholds to gauge the intensity of transmission and the capacity of the health system to respond. This information is then used to guide decisions to introduce, adapt or lift public health and social measures.

On-going situational assessments at national and sub-national levels based on epidemiological indicators will provide policy coherence and predictability to decision-making on COVID-19.

It is hoped that this methodological approach would ensure “people do not think that policymakers are flip-flopping,” said Kluge. The evidence-based guidelines divide community transmission into seven categories, ranging from no active cases to very high case incidence, and assess the response capacity of health systems as limited, moderate or adequate.

“The transmission scenario, the coping capacity and the response is really the important thing to keep in mind,” said Catherine Smallwood, Senior Emergency Officer at WHO Europe.

“The ultimate aim is to prevent countries from going into a worse situation where stricter measures would be implemented. It’s really relying on an increased knowledge that we have around what works and an increased ability within the public health agencies … to calibrate those public health responses to the specific situations.”

80% of countries in Europe have reported an increase in cases over the past two weeks, overwhelming their health systems and leading to national lockdowns.

The proposed tier system would take time to impact new cases and deaths and will need to be adapted and improved based on the situation.

Kluge’s statement comes two weeks into the UK’s nationwide lockdown, which followed what is now largely considered to be a failed tier system.

Introduced in early October, the UK’s three-tier system was criticised for its ‘confusing’ restrictions, and disproportionate enforcement across the country.

New Vaccine Results Too Late for Wide Winter Distribution

Two vaccines for COVID-19 recorded an efficacy rate of more than 90% in phase 3 clinical trial, conducted by Pfizer and Moderna, but WHO has warned against public complacency.

“Technologies and pharmaceutical developments are offering us a new horizon. While vaccines won’t stop COVID-19 entirely and don’t answer all our questions, they do represent a great hope in the war against this virus,” said Kluge.

As the vaccine will be too late to be widely distributed and administered to the public this winter, low technology public health measures – including hand washing, cough hygiene, physical distancing, and mask wearing – need to be prioritized.

Masks are a particularly important measure. Although they are not a panacea for COVID-19, if mask use reached 95%, instead of the current 60% or lower, it is expected that national lockdowns would not be needed.

In addition, vaccinating against the seasonal influenza and mitigating COVID-19 transmission, through contact tracing, isolating cases, and monitoring high risk situations, are essential strategies.

“The vaccine is very important, but it’s not the silver bullet,” said Kluge.

Up to 75% COVID-19 Patients Could Be Taking Antibiotics Unnecessarily

Meanwhile, the coinciding of COVID-19 and drug-resistant bacteria is a growing concern. Antimicrobial resistance (AMR) poses a serious threat to health systems globally and could place patients with COVID-19 on antibiotics at a greater risk.

“We have a pandemic of COVID-19 that should not turn into an antimicrobial resistance pandemic, because we know from evidence that about 15% of the COVID-19 patients, in fact, need antibiotics because of bacterial infections,” Kluge said.

But studies WHO conducted in 9 European countries revealed that up to 90% of COVID-19 patients are taking antibiotics.

This week, the Wellcome Trust released a new update on “The Global Response to AMR” that said concrete progress on attacking the root causes of AMR had been too slow and key priorities like water, sanitation, and hygiene (WASH) and infection prevention and control (IPC) have not been addressed.

Image Credits: S. Lustig Vijay/HP-Watch, Pfizer.