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Recommendations for local government officials on preventing the spread of the SARS-CoV-2 virus and other infectious diseases in their communities.

02 June 2020

Although the quarantine is being eased, SARS-CoV-2 is not going to disappear, so it is necessary to introduce the right measures to mitigate the risks of its further spread. The health and wellbeing of the community is the responsibility of local governments. For far too long, public officials at various levels have avoided the topic of healthcare as something toxic or hopeless. Now is the time to fundamentally change this attitude and make the issue of the health of one’s city, village or UTC [united territorial community] a top priority on the government’s agenda. 

The ArcUA team has prepared the following set of recommendations for local governmental officials who oversee their citizens’ health. These recommendations will help prevent the spread of the SARS-CoV-2 virus and other infectious diseases more effectively. 

1. Know your community and prioritize the protection of the most vulnerable population groups.

▪ 70% of people who have died from SARS-CoV-2 in Ukraine are people over the age of 60 , thus this contingent  is in the high-risk group. [1]  It is imperative to know how many people in high-risk groups (people over 60, those living with chronic lung or heart disease, kidney failure, immuno-compromised conditions, and/or diabetes) live in your region/city/UTC/village.

▪ Prioritize the protection of those people to whom the COVID-19 disease poses the greatest threat, while gradually restoring “normal life” for other citizens. Monitor the data on infections and deaths from COVID-19 in your region and take measures accordingly. It’s important to understand, in detail, the methodology of the collection and verification of data in order to base your decisions on accurate information.

▪ Introduce separate times for seniors and people in high-risk groups to visit retail and government locations. This will result in lower concentrations of people at these locations, and decrease the risk for transmitting the virus accordingly. 

For example, many retailers in Australia [2] and the USA [3] have designated specific hours and days for seniors to shop in supermarkets. In Ukraine, some stores and supermarkets have adopted this practice, including the ATB chain, which has set aside an hour every day from 9-10 AM for this purpose. [4]

▪ For government services, introduce an “electronic queue”   registration system. If physical lineups are unavoidable, then limit the number of people who can be present at one time, or issue “reservations” [numbers] for hour long windows of time depending on the location.

One example of this approach is the quarantine exit strategy adopted by the TsNAPs [Centers for the Provision of Administrative Services], wherein specific hours are set aside for the general public, while separate days are designated for people at higher risk (people over the age of 60, and other days for medical workers, police, retail, delivery and transport workers). [5]

2. Ensure communications between patients and primary care doctors.

Family doctors remain the first line of defence in diagnosing and treating COVID-19, thus it is necessary to ensure  unimpeded communication between them and their patients, if they do not already exist. 

▪ Provide the residents of your communities with full access to family doctors, particularly via telephone. For example, in Kirovohrad oblast, the local government purchased 50 mobile phones and SIM-cards for the working needs of primary care doctors, paid for with funds from the local budget. The mobile phone numbers of each family doctor were made public on the city council website and elsewhere. Many locals had complained about communication problems with doctors, and the issue was resolved in this way. [6]

3. Organize your systems for contact tracing, testing and ventilator maintenance.

In the United States, scientists are forecasting an inevitable second wave of the SARS-CoV-2 virus outbreak in the autumn of 2020. [7] The same will, most likely, occur in Ukraine. Thus, it is important to invest in systemic capacity (including at the local level) in order to be able to quickly deploy mass testing, localize outbreaks, and prepare the processes of hospitalization, isolation and contact tracing.

▪ Establish an effective model and provide people access to testing. Currently, the following algorithm is in place: doctors send samples of materials collected by the PCR method (polymerase chain reaction) for diagnosis; the tests arrive at laboratories that have the required reagents and laboratory workers trained to work on special equipment; if COVID-19 is confirmed, then the facts of the case are submitted for epidemiological investigation, i.e. to establish the infected individual’s contact history [8]. If one of the links in the chain of this algorithm is broken, then it needs to be fixed promptly.

▪ Ensure proper financing is in place for this process. The collection of samples for testing, their storage and transport require concrete materials and resources, that have often not been included in local budgets.

▪ Make sure there is a hospital with a ventilator, oxygen, electricity, medicines, operational materials and a contract with the company that services the ventilator. Also, assure there are medical workers present who know how to use the equipment and have the necessary personal protective equipment (suits, masks, gloves). 

4. Coordinate your actions with neighboring communities. 

▪  Viruses cross the borders of oblasts, raions, cities or UTCs. This necessitates helping one another according to the “everyone teaches everyone” principle, whereby best practices are instantly shared and introduced everywhere. This requires communications with neighbouring villages, UTCs, and raions (counties), in order to coordinate activities and understand what is occurring in your community’s vicinity. 

5. Invest in public health. 

▪  Effective measures for counteracting the spread of the SARS-CoV-2 virus are: thorough and frequent handwashing with soap and water; when water and soap are unavailable, the use of alcohol-based antiseptics is an alternative; introducing physical distancing practices and installing physical barriers; and teaching coughing and sneezing etiquette. [9] These measures (if performed correctly) are highly effective in preventing infection by the SARS-CoV-2 virus that causes the COVID-19 disease. But they require investment. 

▪  Install alcohol-based antiseptic dispensers (no less than 60% alcohol) in public spaces where there is no access to water and soap, for example in public transit (buses, trolleys, streetcars, subways, where applicable) and government buildings.  

ArcUA has registered a petition with Kyiv City Council in support of installing alcohol-based antiseptic dispensers at Kyiv Metro stations in order to provide easy access to proper hand hygiene. [10]

▪ Provide opportunities to maintain physical distancing by affixing markings that indicate distances of 1.5 to 2 metres. 

▪ Install physical barriers between passengers and drivers (glass partitions) or introduce the practice of “rear-door boarding”. [11] Installing physical barriers is also appropriate at points of reception in government offices, banks, stores, etc. 

▪ Invest in or develop, together with socially-responsible businesses, information campaigns whose aim is to raise public awareness about measures to prevent the spread of the SARS-CoV-2 virus. In Zhytomyr, for example, local businesses, government and donors conducted an information campaign about the importance of maintaining physical distancing and affixed stickers on the floors of the city’s shopping centers, banks and pharmacies. [12]

▪  Do not neglect important measures such as vaccination. Encourage the public to vaccinate in accordance with the national schedule of preventive vaccinations. [13] Keep tabs on unused vaccine doses in your region (report on the distribution of vaccines, if necessary). Stay in touch with the local healthcare department. Create a local program to ensure that, come the autumn, there is enough flu vaccine for seniors and people in high-risk groups, paid for by the oblast/city budget.

6. Introduce cashless payment options and improve access to online services.

▪  Going cashless is not only important for people in high-risk groups, but will benefit everyone: the fewer people there are inside a bank, for example, the lower the chances that people will congregate into a cluster, which in turn lowers the risk of the virus’ spread. One example: a Council of Europe project produced a video that explains how to pay for communal services online. [14]

7. Cooperate with socially-responsible businesses.

▪  Encourage businesses / propose ideas or cooperation in launching initiatives, information campaigns, etc., that will help your community better prevent infection by the SARS-CoV-2 virus or combat the consequences of the COVID-19 disease. 

▪  Propose businesses introduce “payforward”, e.g. paying for something a senior citizen may need. This would be practical in private medical clinics or pharmacies. For example, in the autumn, when the flu vaccine becomes available, a person can pay for their own vaccination and that of one other person. In return, they would receive a bonus or discount. 

8. Do not waste taxpayer money on unproven measures.

The Kyiv City State Administration’s website reports that, everyday, some 50 spray trucks and 140 city workers are engaged in washing and disinfecting the capital city’s streets. [15] The virus cannot survive for long in the environmental conditions of the outdoors, which is why washing the streets with disinfectant is not an economically expedient intervention. It would be more effective to invest in public health measures such as installing antiseptics in public spaces, for example.

Now is the time for local government officials to take responsibility and make changes to improve public health and security in their communities. Take strategic action to protect the health of your citizens in an effective and evidence-based manner, because healthy and protected citizens will be more inclined to fulfill their civic duty, like voting in the local elections scheduled for the autumn of 2020. 

Sources:

1. Online briefing regarding coronavirus countermeasures from April 24 2020.

[Ministry of Healthcare’s channel]

[https://cutt.ly/VyGd409]

2. David Williams. Some grocery stores are offering 'elderly hours' to help protect older shoppers.

[CNN, Business]

[https://cutt.ly/hyRBwy6]

3. List of stores with ‘senior shopping hours’ for customers who have higher risk of contracting coronavirus.

[WIS News 10 Staff]

[https://cutt.ly/CyRVYxg]

4. Kompaniya «ATB-Market» zaprovadzhuye spetsial’nu hodynu dlya lyudey pokhyloho viku 

[ATB corporation]

[https://cutt.ly/VyGaCyP]

5. Stratehiya vykhody TsNAP z karantynu 

[U-LEAD z Evropoyu. Pokrashchennya yakosti nadannya administratyvnykh posluh dlya naselennya]

[https://cutt.ly/RyFumST]

6. Hromady protydiyut’ pandemiyi COVID-19 (dobirka 43)

[Association of Ukrainian Cities]

[https://cutt.ly/JyFuClD]

7. Jake Lahut. Fauci says second wave of COVID-19 is ‘not inevitable’ in the fall.

[Business Insider]

[https://bit.ly/2An9UYd]

8. Alhorytm diy dlya systemy laboratornykh tsentriv. Approved by MHU Order № 827 from 09.04.2020 (Addendum to “Standardy medychnoyi dopomohy «COVID-19»)

[Order № 827 from 09.04.2020 of the Ministry of Healthcare of Ukraine]

[https://bit.ly/2XhQKMN]

9. How to Protect Yourself & Others

[Centers for Disease Control and Prevention]

[https://bit.ly/3cewOOP]

10. Ulana Suprun. Petition №9666 “Vstanovyty na stantsiyakh Kyivs’koho metropolitenu spyrtovmisni antiseptyky dlya vil’noho dostupu do hihiyeny ruk”

[Electronic petition. Kyiv City Council]

[https://cutt.ly/pyL8CNc]

11. Matthew Dickens. Summary: A Guide for Public Transportation Pandemic Planning and Response (NCHRP Report 769).

[The American Public Transportation Association (APTA)]

[https://cutt.ly/JyLG5BZ]

12. Informatsiyna kampaniya za 5 dniv: yak u Zhytomyri zaklykayut’ dotrymuvatysia dystantsiyi v umovakh pandemiyi 

[GURT Resource Center]

[https://cutt.ly/kyJ41R4]

13. Kalendar profilaktychnykh shcheplen’ MOZ

[Ministry of Healthcare of Ukraine]

[https://cutt.ly/iyL42Q9]

14. Komunikatsiyni initsiatyvy z protydiyi poshyrennyu COVID-19

[Council of Europe]

[https://cutt.ly/ZyFpW9A]

15. Vden’ i vnochi bez vykhidnykh: sanitarna obrobka, myttya ta dezinfektsiya obyektiv dorozhn’o-transportnoyi infrastruktury tryvayut’ u posylenomu rezhymi – Valentyn Osypov 

[Kyiv City Official Portal. Kyiv City Council. Kyiv City State Administration]

[https://cutt.ly/RyFsZpH]

Brief developed by: Ivanna Pavliuk, Stanislav Hreshchyshyn, Diana Rusnak, Ulana Suprun, Marko Suprun, Volodymyr Kurpita, Fedir Lapiy 

Translated by Stephen Bandera

 

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