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COVID-19 Update World Health Organization Issues Guidelines on ReopeningVarious countries have begun the process of "reopening," lifting various lockdown and social distancing measures for purposes of restarting various activities such as schools, public events and businesses. The World Health Organization (WHO) on May 12 issued guidance on this process, entitled, "Public health criteria to adjust public health and social measures in the context of COVID-19." This document is a follow up to previous guidance issued April 16 entitled, "Considerations in adjusting public health and social measures in the context of COVID-19," at a time when most countries were experiencing a sharp increase in cases and deaths. The criteria issued May 12 are grouped into three domains that the WHO says should be evaluated to address three main questions: 1. Epidemiology -- Is the epidemic controlled? (Yes or No) 2. Health system -- Is the health system able to cope with a resurgence of COVID-19 cases that may arise after adapting some measures? (Yes or No) 3. Public Health Surveillance -- Is the public health surveillance system able to detect and manage the cases and their contacts, and identify a resurgence of cases? (Yes or No) The WHO goes on to state, "The criteria are not prescriptive, and it may not be feasible to answer some of them owing to lack of data, for instance. To the extent possible countries should focus on the criteria most relevant for them to inform decision-making. The thresholds are indicative and may need to be revisited as further information about the epidemiology of COVID-19 becomes available. It is recommended to systematically assess the criteria at least weekly at a subnational administrative level when feasible." Regarding the first criterion, the WHO states that if the effective number of secondary cases per infectious case in the population (Rt) is less than one for at least two weeks, this is the best indication that the epidemic is under control and declining. It adds that in countries with large populations, the number of secondary cases per infectious case should be estimated at a regional level. The WHO also provides other supplementary criteria to assess whether the epidemic is controlled if the above rate cannot be properly assessed. Regarding the second criterion, the WHO states that the key measure to assess the capacity of the health care system to handle a resurgence is whether the number of new cases requiring hospitalization is smaller than the estimated maximum hospital and ICU bed capacity of the health system (i.e., the health system can cope with new hospitalizations without becoming overwhelmed while maintaining delivery of essential health services). It provides a list of additional assessment criteria if the above figure cannot be determined. The third criterion concerns whether a country has sufficient laboratory testing capacity and a clear testing strategy in place to reliably identify cases, and to do so in a timely manner with daily reporting, as well as the ability to carry out effect contact tracing.[1] The WHO states its May 12 document presents only public health criteria, "while other critical factors, such as economic factors, security-related factors, human rights, food security, and public sentiment, should also be considered." It is crucial that the WHO is providing this guidance at a time when reopening societies is on the horizon in various countries. However, it also brings out the political situation facing working people in Canada, Quebec, the United States and other countries around the world where the liberal democratic system of representative democracy deprives them of political power. They are the ones most affected by the pandemic, yet they are deprived of the power to decide when and how society should reopen, regardless of whether the health criteria to do so have been satisfied. Already, tragedies continue to unfold because private interests and the governments that represent them are pushing self-serving agendas, while health care and other essential workers are not guaranteed the equipment and conditions to do their work safely. Working people must take up their own empowerment as part of ensuring that future pandemics cannot wreak havoc on humanity. Note1. To read the document in full, click here.
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