COVID-19: Readiness criteria and indicators for easing restrictive public health measures

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• About restrictive public health measures
• Deciding to instate, maintain, ease or re-instate restrictive measures
• Indicators for easing public health measures

About restrictive public health measures

Restrictive public health measures aim to control the spread of COVID-19 by reducing the number of exposures to the virus. These measures include:

• curfews
• travel restrictions
• closing non-essential businesses, places of worship, and leisure and sports venues

Deciding to instate, maintain, ease or re-instate restrictive measures

These indicators were developed with a data driven approach to support public health professionals and government decision makers in considering when to ease or re-instate public health measures, taken into consideration that thresholds and application of these indicators may vary based on local epidemiology and level of restrictive measures already in place.

Further, adjustments to restrictive public health measures must be considered in the context of risk associated with variants of concern, and the effect of increasing vaccine coverage.

In general, decisions regarding not easing, easing, and instating or re-instating of public health measures should take into account the following factors considered collectively within each category.

No easing

No easing if restrictive public health measures are already in place when:

• transmission is uncontrolled
• variants of concern are becoming increasingly prevalent
• there is insufficient health care capacity to respond to surges
• there is limited public health capacity to test, trace and monitor those in isolation

Consider easing

Consider easing if restrictive public health measures are already in place when:

• transmission is controlled
• there is sufficient testing and contact tracing capacity
• there is low incidence allowing for testing and tracing to cope with:
  • outbreaks
  • surges in cases
• there is high vaccine coverage in populations that are at higher risk and in higher-risk settings
• there is a phased plan in place that starts slowly with:
  • easing up on restrictions in the least risky venues
  • at least 3 weeks between phases to allow detection of resurgence

Instate or re-instate

Instate or re-instate if restrictive public health measures are not already in place when:

• modelling-based forecasts suggest:
  • resurgence
  • case incidence overall is increasing (and Rt rising)
  • adherence to public health measures is declining
• evidence exists of community spread of variants of concern with potential negative impacts on:
  • transmissibility
  • ability of diagnostics tests to detect cases
  • the effectiveness of therapeutics or vaccines

Indicators for easing public health measures

1. COVID-19 transmission is controlled to a manageable level

• Incidence of new cases per 100,000 is low enough for testing and tracing capacity to control the epidemic in addition to:
  • wearing a mask
  • physical distancing
• Laboratory positivity rates are low and steady or declining in the context of high population rates of laboratory testing.
• Modelling forecasts (short- and long-range) do not suggest resurgence.
  • This means sustained declines in incidence and Rt <1 or sustained low incidence and constant Rt.
• Any community spread of an emerging variant of concern is mitigated by augmented and more:
  • rapid testing
  • contact tracing
  • capacity to monitor those in isolation and quarantine
  • the development of new laboratory tests, treatments or vaccines, as appropriate
• Vaccine rollout has reached a level that could reduce transmission rates in the population.

2. There is sufficient public health capacity to test, trace, isolate and quarantine a high proportion of cases and contacts

• Community-based testing rates are high enough to detect a low prevalence of infection, allowing for control by:
  • case isolation
  • contact tracing
• Testing backlogs are minimal.
• Cases are detected early in their infection.
  • This means time between getting symptoms and test date is minimized.
• There is sufficient contact tracing.
• Programs are in place to systematically screen asymptomatic individuals at high risk of acquisition or transmission such as:
  • schools
  • outbreaks
  • workplaces
  • leisure venues
• Proportion of cases that can be linked to a known case is increasing or high and stable.
• Laboratory capacity is not impaired by disruptions in the supply of staff, reagents, or equipment.
• Sufficient sequencing capacity to sequence 100% of high priority samples for variants of concern.
• Sufficient additional capacity to support outbreak investigations and background testing is maintained.

3. Sufficient health care capacity exists (including substantial clinical care capacity) to respond to surges

• Hospital and intensive care unit (ICU) bed capacity is sufficient for both COVID-19 and other patient volumes.
• ICU bed capacity is sufficient to accommodate the current level of COVID-19 ICU hospitalizations and expected patient volumes from emergencies and surgeries.
• ICU forecast (modelling) does not indicate upcoming bed shortages
• Surgeries are not cancelled.
• No need to enable patient transfers between hospitals and/or add temporary bed/staff capacity.

4. Risk reduction measures are in place for high-risk populations and settings

• Resources exist to rapidly detect and respond to outbreaks of COVID-19.
• Vaccine coverage is high in populations that are at higher risk and in higher-risk settings.
• The following are low or decreasing:
  • importation risk assessments
  • rate of imported infections (COVID-19 cases per 100,000 travellers)
  • number of individuals who are infected arriving in Canada (model estimates)
• Quarantine compliance is monitored.