Relaxation of Public Health ­­­Measures must take a phased approach – PAHO Director

The Director of the Pan American Health Organization, Dr Carissa F. Etienne, says countries planning to relax public health measures must take a phased approach based on local conditions and be prepared to impose preventive measures again if the epidemiological situation changes.

“The key is to think both nationally and locally and base decisions on the latest data. The more granular our understanding of where the virus strikes, the more targeted our response will be,” she told a media briefing on June 30.

“As we are seeing, countries, states and cities that do not embrace preventive measures or relax restrictions too soon can be flooded with new cases,” Etienne said. “Timing is critical. At national or at local level, we must open gradually, taking a phased approach that relies on robust surveillance, data, and expanded testing and contact tracing capacity.” If the situation changes and infections rise, localities and countries must adjust course quickly, she added.

Noting that 5.1 million cases and more than 247,000 deaths due to COVID-19 have been reported in the Americas through June 29, she said, “To truly understand the impact of the virus, and to plan more effectively for what comes next, it’s important to look beyond regional and national data and focus on the local level.”

“We often hear about the number of cases in large countries like Brazil, Mexico or the United States without the appreciation of their considerable societal and geographic diversity. In fact, multiple epidemiological curves coexist both within our region and within each country, and public health responses must be tailored to these specific situations,” Etienne said.

The PAHO director said reopening requires public health measures to track new cases and build sufficient capacity to detect and control new outbreaks. “Transmission in your area should be going down in a sustainable way, deaths should be decreasing, and hospital bed occupancy rates should be low before restrictions are relaxed,” Etienne added.
She listed public health measures local and national governments should take including timely tests, isolation of cases to reduce transmission, contact tracing to find infected persons and isolate them, access to Personal Protective Equipment and training for health workers, and if necessary, travel measures to limit new infections such as screening, case finding, quarantines and other measures.

“We need tests, but we also need test results to be reported quickly to paint an accurate picture,” Etienne said. “Anyone with symptoms should have the guidance and support needed to reduce the chance of transmitting to others,” she added.

Contact tracing, when anchored to a strong primary health care system, “can help reduce the risk of transmission among vulnerable communities,” Etienne said, and the health system needs enough hospital beds and intensive care units to provide care for severe cases.

PAHO is working closely with countries and, “in many cases, local governments to analyze these trends to help guide their decision making, she said. “PAHO has supported countries in every aspect of the response, providing guidance, training, and supplies. Over the past two months we have donated almost 5 million PCR tests to the region and procured more than 10 million tests on behalf of our countries. We made 54 shipments of PPEs to 26 countries.”