Some Countries Ease Lockdowns, But Others Battle New COVID-19 Surges Surveillance 23/02/2021 • Raisa Santos & Kerry Cullinan Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window) Frankfurt, Germany The United Kingdom, Switzerland, Israel and Turkey are cautiously reopening businesses and relaxing limits on gatherings and travel as COVID-19 cases declined both globally and within these countries. However, parts of France, the Czech Republic, and Sweden are preparing for harder lockdown measures as their cases surge in contrast to worldwide trends. As of 23 February, there were 2,530,101 new cases in the past week. The COVID-19 Epidemiological Update reported a 16% global decline in cases, with over 500,000 fewer cases than the beginning of the month. Five out of six WHO regions were showing double-digit percentage declines in new cases, with only the Eastern Mediterranean Region showing a 7% rise. Europe and the Americas continue to see the greatest drops in absolute numbers of cases while the number of new deaths has also declined in all regions. UK & Switzerland Outline Roadmaps to Relax Restrictions Lockdown “Green” border roads between Switzerland and Germany Switzerland will relax some restrictions from 1 March, allowing museums, shops, and zoos to open at limited capacity. Private outdoor events with up to 15 people will also be permitted. A second phase of reopening should commence on 1 April. On Monday, UK Prime Minister Boris Johnson announced the government’s roadmap to ease restrictions in England, which will be guided at all stages by data as opposed to set dates. Step 1 of the roadmap will begin in March with a return to in-person education in schools and colleges. Most outdoor attractions and settings, as well as non-essential retail, which includes zoos, pubs, restaurants, gyms, and retail stores, will stay closed for at least another month. Step 4, which will see a wider opening of a number of businesses, is expected no later than 21 June. The United Kingdom had implemented a national lockdown in response to the rising cases that resulted from the B.1.1.7 variant, and has even extended the lockdown in Northern Ireland, to 1 April. London, UK: Camden High Street in lockdown Together with an ongoing vaccine campaign, these measures appear to be working, with case rates declining across all age groups and regions, in the most recent weekly surveillance report published. “Our efforts are working as case rates, hospitalisation rates and deaths are slowly falling,” said Dr Yvonne Doyle, Medical Director at Public Health England. Doyle still expressed concern about the new infection numbers, which were still higher than the cases at the end of September. “This could increase very quickly if we do not follow the current measures. Although it is difficult, we must continue to stay home and protect lives.” The UK roadmap for reopening outlines four steps: continued successful vaccine deployment, evidence that demonstrates vaccines are sufficient in reducing hospitalizations and deaths in those vaccinated, reduction in infection rates that prevent a surge in hospitalizations, and assessment of the risks not to be fundamentally changed by the new emerging variants of concern. There will be a minimum of five weeks between each step: four weeks for the data to reflect changes in restrictions; followed by seven days’ notice of the restrictions to be eased. Istanbul, Turkey Turkey also plans to start a gradual normalization process in March, with measures to be lifted “on a provincial basis”. The country’s 81 provinces will be categorized based on risk levels – from very high to low – and progress in vaccinations to determine whether they are ready for normalization. This new process for normalization comes after the Turkish Health Ministry started announcing an average of weekly cases for provinces last week. This data will be used to determine whether restrictions are lifted. Israel Re-opens For Business – Except During Holiday & At Airport Meanwhile, the Israeli government began to reopen hotels, shopping centers, and even cultural events on 21 February after its government approved the second and third phases of the exit plan from lockdown as new COVID cases continued to decline, particularly among people over 60, most of whom have been immunized. Infections rates and serious cases in Israel have declined sharply after more than 80% of people over the age of 60 either were vaccinated or recovered from COVID-19. The campaign has since opened to everyone over the age of 16. However, airports and land borders will be closed for 14 more days, and the country’s borders closed until 6 March. Only 200 people a day are allowed to board “rescue flights”, and this has left thousands of Israeli citizens stranded around the world. Restrictions on mass gatherings have also been relaxed to 20 people outdoors and 10 people indoors, instead of 10 and 5 respectively. At the same time, it was likely that the government would declare a curfew over the upcoming Purim weekend, a holiday traditionally observed by raucous celebrations commemorating the biblical story of the rescue of Persian Jews by the Queen Esther. Coinciding with the relaxation measures, a Green Pass system was put into place to grant Israelis who have had two vaccine doses automatic access to gyms, studios, cultural and sports events, fairs and hotels. Those without the pass have to show proof of a recent COVID test. Children under 16, who can’t be immunized, may still be admitted to some venues, like hotels, along with their immunized parents. Palestine Vaccination Campaign to Begin, Calls on Israel to Reserve More Vaccines for Palestinians Nabi Moussa, Occupied West Bank Palestinians in Gaza were also reportedly due to get their first jabs as another 20,000 vaccines donated by the United Arab Emirates arrived Sunday in the barricaded strip from Egypt via the Rafah crossing. Israel allowed the transfer of 2,000 vaccine doses into the Strip last week. In the Occupied West Bank, vaccine campaigns by the Palestinian Authority with Russia’s Sputnik V vaccine were only just beginning – although West Bank Palestinian infection rates have been comparatively lower than those in Israel, even after the latter had immunized over 50% of its 9.3 million citizens with at least a first dose. A World Bank report on Monday called on Israel to share more of its vaccines with the PA, saying: “While Israel has been leading the world in terms of per capita vaccinations, no one has been vaccinated in the Palestinian territories yet, and the Israeli MoH has not formulated an allocation strategy to support the territories, beyond providing 5,000 vaccines for Palestinian doctors. Humanitarian organizations in both Israel and West Bank and Gaza have called for Israel to reserve a higher amount of vaccines for the Palestinian territories. Given the challenges for the Palestinian Authority to procure vaccines, the statement calls for operational and financial support from Israel to PA.” The Economic Monitoring report further stated: “In order to ensure there is an effective vaccination campaign, Palestinian and Israeli authorities should coordinate in the financing, purchase and distribution of safe and effective COVID-19 vaccines,” noting that the Palestinian Authority faces a US$ 30 million shortfall in vaccine funding, even after support from the WHO co-sponsored COVAX facility. Germany Considers Reopening Even if Cases are Rising Angela Merkel, Chancellor of Germany. Germany’s Chancellor Angela Merkel has also proposed a plan to ease that country’s lockdown which has been in place since November. Merkel reportedly told her Christian Democrat (CDU) party that lockdown measures could be eased in several stages, combined with increased coronavirus testing. The stages would focus on personal contacts (how many people a person meets); schools, sports, restaurants, cafes, and cultural events. However, talk of easing restrictions in Germany belies the upward trend of infections in the country. The Robert Koch Institute reported 4,369 new COVID-19 cases as well as 62 associated deaths. There are major concerns of the COVID-19 variants pushing up numbers. Frankfurt, Germany: Masks required on cycle path France, Sweden, and the Czech Republic – Tougher Lockdowns Paris, France: A woman serves a hot dog in front of a restaurant in the Latin Quarter. French bars and restaurants can no longer accommodate consumers because of the measures taken to combat the COVID-19 pandemic. Some restaurants remain open and serve drinks and take-out meals. While other countries will soon enjoy relaxed restrictions, there have been increases in Nice in France, the Czech Republic, and Sweden. Nice reported 740 new cases per week per 100,000 residents, triple the national average. France has applied a localized lockdown over the next two weekends from Théoule-sur-Mer to Menton, and Nice. French Health Minister Olivier Veran said that measures could include a stricter form of the curfew imposed nationwide in France or a weekend lockdown in the city. “Consultations will be conducted over the weekend to take additional measures to stem the epidemic, ranging from a reinforced curfew to local lockdown at weekends,” Véran said. The Czech Republic is also experiencing a rise, with 11, 233 cases reported on Tuesday, an increase of 7,100 in a single day. Test positivity rate also increased to 40.6%, the highest since 9 January. The Czech Ministry of Health has mandated that masks must be worn in places with larger concentrations of people, especially shops, public transportation, and hospitals, effective Thursday. The Ministry has also submitted to the government a law on emergency measures in an effort to curb the resurgence of COVID-19 in the country, including restrictions on services, a ban on mass events, and the restriction of public transport. “The purpose of the proposed law is to legally enshrine the measures that we issue as a crisis in accordance with the crisis law as part of the COVID-19 epidemic. Thanks to this, it is possible to issue measures for which we have so far needed an emergency, ” explained the Minister of Health Jan Blatný. Uppsala, Sweden: People social distancing Meanwhile, Sweden is preparing the strictest restrictions yet, in an effort to curb a resurgence in COVID-19 cases as the variant first detected in the UK spreads rapidly. “The British variant is increasing very fast. This variant will with fairly high probability be the dominant one within a few weeks or a month… We have a package [of national measures] being readied that will be presented tomorrow,” said Chief Epidemiologist Anders Tegnell at a news conference. Concerns about a possible third wave of the pandemic have been growing since the number of new infections have risen and the new variants have spread. The Swedish government has laid the ground for potential lockdown measures to be tougher than previously measures enacted earlier in the pandemic. The list of businesses that will face mandatory closure in Sweden include shops, hair salons, gyms, and restaurants. The country has also closed its borders to Denmark and Norway. Negative COVID-19 tests are now required for entry into Sweden. Declines Also Seen in United States and India New York City, United States: Outdoor dining during pandemic While declines in serious cases in Israel and the UK may be attributed to vaccines, it remains unclear why numbers are declining globally as some countries battle their second, third, and fourth waves of COVID-19. For the United States, the scale-up of vaccination and the shift in seasons are driving down cases, according to the Institute for Health Metrics and Evaluation (IHME) during a briefing last week. However, variants including the more infectious B.1.1.7 which first emerged in the UK in November 2019, have been detected in the US which could drive transmission. Epidemiologists in India have also questioned the declining cases, pointing to low rates of testing and habitual underreporting of causes of death, particularly in rural India. However, Prime Minister Narendra Modi is hoping that the vaccination drive that began in January will spur wider recovery. Though vaccine uptake remains slower than officials hoped, as of 18 February, more than 98 million vaccine doses have been administered in India. “I don’t think anyone really thinks that without vaccines and a vaccination program being widely available that we can go back to whatever is full normalcy,” said Sireesha Yadlapalli, a Hyderabad-based senior director at the United States Pharmacopeia, a scientific nonprofit organization. “Hopefully this is the slowdown and there’s no second wave.” Bangalore, India: Empty streets during lockdown in early 2020. Despite a nationwide declide, there has been a rise in cases seen in the Indian state of Maharashtra, which has ordered new restrictions on people’s movement and imposed night time curfews. Mumbai, Maharashtra’s capital and India’s financial hub, also banned religious, social, and political gatherings. The state has reported nearly 7,000 new cases on Sunday, a steep rise from 2,000 daily cases earlier this month. The Indian Ministry of Health and Family Welfare has stated that the surge in COVID cases in the state cannot be attributed to strains N440K and E484Q, which have been detected in other countries. WHO Warns Against Complacency Dr Michael Ryan, Health Emergencies Executive Director While some of the declines, such as those in England, Scotland and Israel, may be attributed to massive vaccine campaigns – in other regions, where vaccination is only just getting under way, global health officials have had few explanations for the dip in cases. “We’re certainly not out of the woods yet,” said Health Emergencies Executive Director Dr Mike Ryan at a WHO press conference in Geneva last Thursday. “The virus still has a lot of energy. You’re also dealing with urban settings, many people still living in areas that are overcrowded, multi-generation, multi-family homes. It is very difficult to break chains of transmission in a complex society. Some countries are coming down that hill more quickly than others.” WHO technical lead on COVID-19 Dr Maria van Kerkhove stressed: “We cannot let ourselves get into a situation where the virus can resurge again. Remember what we need to continue to do to drive it down and get cases down into single digits. “We just need to stay the course, hold on to what is working consistently deliberately as we roll out vaccines and make sure that vaccinations start in all countries,” said Van Kerkhove. Ryan also cautioned that, although the global COVID-19 cases are now at their lowest since last October, this could be the result of the natural patterns of the virus. “I do think a good portion of that has been done to the huge efforts made by communities. There have been very stringent lockdowns and stay-at-home orders and other things, but also serum prevalence is rising,” said Ryan. “We need to understand what is driving those transmission dynamics. Is it natural seasonality and wave-like pattern of the disease? Are we building up a level of immunity in the population that’s preventing the disease from finding the next case? Are our control measures having an impact on that?’ asked Ryan. “I think as we move into [northern hemisphere] springtime, we need to drive towards higher levels of vaccinations, getting an equitable distribution of that vaccine, getting rid of the deaths and the hospitalizations and the suffering, but [also] continuing to drive the case numbers down.” Image Credits: Twitter, 7C0/Flickr, Falk Lademann/Flickr, Marc Barrot/Flickr, Sergey Yeliseev/Flickr, Health Policy Watch , David King/Flickr, Ben Hartschuh, 7C0/Flickr, Flickr: IMF Photo/Cyril Marcilhacy. 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