COVID-19 response guidelines
COVID19 response guidelines
Several countries are requesting WHO for guidance on enforcing limitations on mass gatherings, closure of institutions and commercial outlets, and travel restrictions. While such measures may assist in the overall management of the response to COVID-19, these should not divert attention, energy, or resources from the proven public health measures.
The most effective measures in controlling disease transmission remain early detection, early isolation and case-management/treatment, contact tracing, and risk communications/community engagement.
These containment measures should continue to constitute the central pillar of the response. Other additional measures play a supportive role. Clear and transparent communications to the community around all measures is vital.
Consider the following:
Priority measures to interrupt chains of transmission.
- Early detection, isolation and case-management/treatment. Experience from China has demonstrated that the essential public health measures of early detection, diagnosis, isolation and case-management/treatment for all cases of COVID-19 - including mild cases - can change the course of the outbreak. Therefore, rapid scaling up of capacities for disease surveillance, laboratory testing, isolation of all cases and early case-management/treatment are vital. Clear and regular communications to instruct the public on how to recognize symptoms of the disease and to seek care as soon as these are identified is core to the success of these measures. Wherever possible, mild cases should be isolated in a medical facility such as a hospital or temporary isolation unit. Where that is not possible, home isolation should be employed and WHO guidance followed: https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
- Contact tracing. Early identification and tracing of contacts – especially close and high-risk contacts – is also essential. Contacts include those with whom a confirmed case has had close interacting within 24-48 hours prior to the development of symptoms. Where resources permit, close contacts should be quarantined in a temporary quarantine unit and should be tested as soon as they begin to develop even mild symptoms. Where that is not possible, home quarantine can be used, together with daily follow up.
- Risk communication and community engagement. Regular and clear communications to the community about COVID-19 and the measures that individuals can take to protect themselves and their families is vital to controlling the disease. As above, they should also be aware of how to recognize and seek care for disease rapidly, and be regularly informed of any additional measures taken in support of the response (see below);
- Additional measures to enable the response/priority measures
- Limitation of mass gatherings. Limiting mass gatherings can contribute to the control of transmission. WHO does not have established thresholds for the number of people who can assemble in one place at a given time and different countries are applying their own limits based on cultural and contextual considerations. In general, these thresholds range between 50 and 500 people. In the current context, the authorities may consider recommendations on limiting gatherings to no more than 25 - 50 people. This would include continuing the suspension of Friday prayers, religious events, sporting events, and other mass gatherings for the next 4 weeks; subsequent limitations could then be reviewed at that time. For the upcoming Norwuz New Year celebrations, the government should advise the population that unnecessary travel should be strictly limited and that large family gatherings should be avoided;
- Temporary closure of institutions, such as schools, and commercial outlets. Temporary closure of schools, universities, restaurants, cafes and other places where people gather in large numbers should also be considered for a period of 4 weeks. Essential services such as supermarkets, food stores, petrol stations and others should be allowed to continue to operate, with limitations on the numbers within the store at a given time. Restaurants and cafes may be able to continue home delivery services. As far as possible, ensure that measures are evidence-based, proportionate to risk, and short-term. Compensatory and supportive measures to individuals, communities and businesses may be required, focusing on the most vulnerable;
- Travel restrictions. Travel restrictions are not very effective at controlling the transmission of diseases such as COVID-19, but may assist in the management of the response. Their application must be considered in light of their public health benefit and the degree of social and economic disruption caused. Travel restrictions may be considered between provinces, or between cities and towns within a province. The most useful application of travel restrictions would include check points where screening the temperature of travelers occurs – this alone may have a deterrent effect on people traveling. Such screening should ideally not be undertaken by security forces. Those who have a fever should be referred to an appropriate health facility immediately. Those who are allowed to continue to travel must have a valid justification for doing so, e.g. work-related, returning home after travel/displacement, seeking health care;
- Communications. Successful application the additional measures is highly dependent on community engagement and trust. How the additional measures are applied and how the community responds may impact community trust and how well they adopt other government guidance on the more important public health measures. The justification for the additional measures – as well as any penalties for lack of adherence - must be clearly and frequently conveyed to the community.
- Enforcement. In general, the community must be considered a partner in the application of the additional measures and not a population to be controlled. Coercive measures and strict enforcement should be avoided, wherever possible. Where penalties are applied, e.g. for a mass gathering to continue, the initial penalty should be light, but could be progressively increased for repeat offences.
- Role of military and security forces. The military’s role should primarily be for logistic and operational support, e.g. as per the establishment of hospices, check points. They can support the set-up of check points on main roads to check temperatures of travelers and to screen for the justification of onward travel. They should employ a tempered role in monitoring and enforcing adherence to limitations of mass gatherings and closures of institutions. The recent use of military institutions and assets to house COVID-19 patients and contacts is appropriate. When available, the repurposing of military industrial capacity to produce supplies and equipment for the management of the response such as PPE is welcome – but these supplies and products must adhere to specified standards. The role of security forces in restoring public order in settings of violence or obstruction to the response must be seriously considered and proportionate to the disruption.
Ask EMRO - COVID-19 vaccines in the Eastern Mediterranean Region
Invitation to the media
WHO virtual press conference
On World Health Day 2022: our planet, our health
Wednesday, 6 April 2022, 10:00 am Cairo time (GMT+2)
دعوة للإعلاميين
مؤتمر صحفي عن بعد لمنظمة الصحة العالمية
حول يوم الصحة العالمي 2022: كوكبنا، صحتنا
الأربعاء، 6نيسان/ أبريل 2022
10:00 صباحاً بتوقيت القاهرة (GMT+2)
One question per journalist
Limb Reconstruction Centre launched to assist patients with gunshot injuries in Gaza
5 March 2020, Gaza Strip - Today the World Health Organization in partnership with the Ministry of Health launched a Limb Reconstruction Centre for Gaza Strip, providing hundreds of Palestinians injured with gunshot wounds, with permanent specialized and centralised care.
Based at Nasser Medical Complex in Khan Yunis and generously funded with UK aid, EU humanitarian aid, by the Swiss Agency for Development and Cooperation, the United Nations oPt Humanitarian Fund and the Spanish Agency for International Development Cooperation, the new Centre features a 32-bed ward, two dedicated operating theatres, and 25 specialized multidisciplinary staff (including four orthopedic surgeons, psychologists and physiotherapists).
“The Limb Reconstruction Centre is a new centre of care and excellence, which will provide better quality, faster and more sophisticated treatment and rehabilitation to patients with gunshot injuries sustained during the Great March of Return. It will cater for a wide range of patient needs from wound care, surgery, infection control and physiotherapy to mental health support,” said Dr Gerald Rockenschaub, WHO’s Head of Office for the occupied Palestinian territory.
“This Centre will help transform the lives of those affected by preventing disabilities and amputations, and also restore dignity and hope to those patients who have been left powerless, unable to function and support their families and communities in what is already a difficult environment,” said Mr Jamie McGoldrick, Humanitarian Coordinator for the oPt.
Since the start of the Great March of Return in the Gaza Strip from March 2018 to 31 December 2019, 33,141 injuries and 322 deaths (including 65 children) have been reported. More than 7,951 suffered from gunshot wounds, and 88% of these presented limb wounds.
''The Great March of Return demonstrations in the Gaza Strip, has not only caused tremendous suffering for many families in Gaza but also has placed enormous strain on Gaza’s already under-resourced and over-burdened health care system. Gaza health facilities are facing a critical shortage of essential medicines and supplies, as well as a lack of specialised doctors and nurses. This new Centre will help to address some of these challenges through providing specialised treatment and support for patients requiring limb reconstruction surgery,'' said the EU Representative Sven Kühn von Burgsdorff.
''Today is yet another occasion to recall that the situation in Gaza remains fragile and unpredictable. It is the time to turn the page. Only a political solution can bring fundamental change and put an end to the violence, suffering and hardship,'' he added.
Six hundred patients have already been identified as being in need of limb reconstruction surgery (according to the Ministry of Health as of February 2020) and hundreds more wait to be assessed. Already more than 40 patients have been operated on since the Centre began operation in December 2019.
Gunshot injuries are complicated, expensive and difficult to treat: they can take up to two years to treat per patient; involve four to five surgeries for bone, muscles, soft tissue and nerves; and often involve serious bone infections. Rates of bone infection are extortionately high and an increasing number of patients are showing signs of antibiotic resistance, which increases the chance of amputation and the risk of infection to other patients. A dedicated osteomyelitis (bone infection) treatment centre, built by Médecins Sans Frontières-France in 2020, will be located adjacent to the Limb Reconstruction Centre and complement it.
While there have been medical missions for limb reconstruction in Gaza in the past, there hasn’t been a centralised service which provides permanent and dedicated operating theatres and resources from a multidisciplinary team. This Centre will help coordinate specialized limb reconstruction treatment to rationalize human resources, time, equipment and costs and also establish a patient database to unify information used by all partners deploying emergency medical teams for limb reconstruction services. The Limb Reconstruction Center will also facilitate much-needed training to upskill Gaza’s medical professionals, paving the way for a new generation of trained medical professionals in Gaza. Visiting specialist medical teams will focus their interventions in a centralized structure, maximizing training opportunities for younger resident staff.
Also at Nasser Medical Complex, WHO has installed a CT Scanner, funded by EU humanitarian aid, which will benefit an estimated 11,000 patients per year.
Background information:
The Limb Reconstruction Centre is a vital part of WHOs’ trauma and emergency care programme, which is working with the Ministry of Health (MoH) and partners on an extensive series of interventions that aim to improve the management of traumatic injuries, from the point of injury, at the prehospital level all the way to hospital care, including emergency departments and surgery, to rehabilitation and recovery. With the generous support of donors, since the start of GMR demonstrations in 2018, this programme has helped establish and upgrade 10 Trauma Stabilization Points (TSPs) in critical zones in Gaza with the Palestinian Red Crescent Society (PRCS) and MoH to reduce the burden on the overloaded hospitals substantially. At the TSPs, wounded patients receive life-saving care close to the point of injury and saved on average 1200 lives in a year (from 30 March 2018 to 30 March 2019).
As part of the trauma pathway, in 2020 WHO will:
- upgrade six trauma hospitals in Gaza and four in the West Bank to create a trauma response network, providing a range of interventions, from improved infrastructure, provision of supplies, training and clinical coaching for all doctors and nurses working at the emergency departments
- build on the success of the TSPs, by expanding them to the Eastern Mediterranean region to respond to conflict related trauma in the region
- support the PCRS to centralize all ambulance movements through a new ambulance dispatch centre
- provide training for surgeons on acute surgery in the six trauma hospitals to improve damage control surgery through basic principles of control of haemorrhage, prevention of contamination and protection from further injury
- provide training to PRCS and MoH staff to provide frontline care in an acute emergency
- support the running costs and supplies for the Limb Reconstruction Centre.
The World Health Organization (WHO) is appealing for US$ 20 million over three years to provide life- and limb-saving interventions to large numbers of injured patients and to build on the previous success of the WHO supported interventions and ensure better health outcomes for Palestinians through strengthened continuum of care along the trauma pathway.
For more information, please contact:
Alice Plate, WHO Communications Specialist, occupied Palestinian Territory
+972 54 6153900 |
WHO doctor awarded for helping the mothers and babies of Gaza, December 2019
WHO obstetrician and gynaecologist Dr Nashwa Skaik, leads the pioneering Early Essential Newborn Care project which assists with 75 per cent of all births in Gaza , has been awarded WHO Director General’s Award of Excellence for her work. Credit: WHO
29 December 2019, Gaza - “Families and in particular, mothers and infants, are the essence of any society and they should never be neglected. I am immensely honoured and grateful to this recognition, which is a true reflection of the global and regional efforts to improve mother and newborn health in all settings. This reward is a huge push forward to myself and the team in our office,” WHO’s obstetrician and gynaecologist in Gaza Dr Nashwa Skaik reflects after receiving the WHO Director General’s Award of Excellence for her work managing a pioneering maternal and newborn healthcare project in the Gaza Strip to prevent and treat the key causes of newborn death and diseases.
In Palestine, babies aged less than one-month old account for 50 per cent of deaths in children under five. Half of these baby deaths occur in the first day of life, mainly from complications related to prematurity, birth asphyxia, and infection.
Based on international evidence, Dr Nashwa and colleagues at the World Health Organisation, rolled out the Early Essential Newborn Care project in 2017 with the Ministry of Health in Gaza to ensure that quality essential care is provided during critical moments around birth, in addition to care for premature, low-birthweight and sick babies.
The project has strengthened the Ministry of Health’s system from the bottom up, by coaching local clinical staff with a package of simple and cost effective evidence-based interventions during childbirth and immediately after, and focusing on the elimination of harmful and outdated practices in the first 24 hours of life. This includes reshaping policy and guidelines; managing supplies and staff and providing health information.
The project now covers 75 per cent of all births in Gaza in maternity and neonatal units in four targeted hospitals and widespread adoption has resulted in significant improvements since 2017 in key areas including:
early and exclusive breastfeeding take up improved from 21% to 52.5% from 2017 to 2019. These practices, where the infant receives breastmilk within one hour of birth and infant only receives breastmilk without additional food or drink, are known to lower newborn deaths by 22%. Breastfeeding protects the baby from common childhood illnesses such as diarrhoea and pneumonia and may also have longer-term health benefits, such as reducing the risk of overweight and obesity in childhood and adolescence.
babies receiving sustained skin-to-skin (STS) contact, increased from 0 to 35% from 2017 to 2019. This practice, when a baby is laid directly on their mother’s bare chest shortly after birth, is essential to prevent temperature losses and diseases that lead to infection and death. Among infants who received this care, there is a reduction in newborn admission to intensive care due to respiratory problems by 5% in Gaza. In addition, it helps parents bond with their babies supports better physical and developmental outcomes for the baby.
Caption: WHO obstetrician and gynaecologist Dr Nashwa Skaik, leads the pioneering Early Essential Newborn Care project which assists with 75 per cent of all births in Gaza, has been awarded WHO Director General’s Award of Excellence for her work.
Dr Skaik said she treasures the opportunities she gets at the World Health Organization, “They are like no other place. I enjoy my everyday work with the team and the space I am given to be more creative and innovative. We try our best to deliver high quality and unique care to all mothers and babies in Gaza which ensure they thrive and survive despite the difficult circumstances.”
The WHO team congratulates Dr Skaik and colleagues in Gaza for their dedication and achievements to improving the lives of mothers and babies in Gaza.
