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Ukraine outlines plan to end quarantine

The Ukrainian government has outlined a five-stage plan for lifting quarantine measures that have been gradually imposed since March 12 to slow the spread of COVID-19. 

Prime Minister Denys Shmygal said on April 24 that the restrictions might be relaxed after May 11, the day when the official quarantine expires, provided that the number of new infections in the country declines and the healthcare system isn’t under excessive pressure. 

According to the plan, businesses and public places may gradually reopen long before public transport resumes running. There’s also no mention of when the country’s authorities plan to reopen borders and allow air travel. 

The plan doesn’t have set dates, only a tentative timescale where the launch of each phase is pegged to the number of confirmed coronavirus cases. 

Moreover, the prime minister said that if the infection rate falls, the second, third and fourth phases may start simultaneously, meaning a complete reopening of all businesses, public places and transport at once. 

“There will be no need to wait 10-20 days for the next stage,” Shmygal wrote on Facebook on April 27.

However, he warned that if the number of people sick with COVID-19 increases, quarantine measures may be tightened. 

Some European countries such as Italy, Spain and Switzerland have also announced gradual easing of lockdowns. The World Health Organization initially warned against lifting restrictions too early, but the burden on economies has been growing. And the global health agency set six conditions for gradual easing of restrictions. One of them is having disease transmission under control. 

Ukraine has not yet flattened the curve nor has it reached its disease peak, which is projected for May 2-8 by scientists. However, this is a significant margin or error due to limited data. 

By April 27, the number of confirmed coronavirus cases in Ukraine reached over 9,000 with 220 deaths and 864 recoveries. Almost 20% of the infections are among medical workers. 

Two Ukrainian experts that the Kyiv Post spoke to criticized the criteria for lifting restrictions chosen by the Ukrainian government. Instead of comparing the absolute number of new cases, which directly depends on the scale of testing, the authorities should look at the number of patients in intensive care units with severe cases of COVID-19 and fatality rates, as well as consider a gradual easing of restrictions within regions rather than nationwide, the experts said. 

Moreover, each step requires time to gauge the transition and prevent new outbreaks. 

“If restrictions are lifted at once, the situation may get out of control,” Yuriy Zhigarev, an infectious disease specialist from Kyiv, said. 

What are the stages

The first stage may start on May 12 if disease transmission is contained by then. This means that the ratio of confirmed cases to the total number of tested people in the country doesn’t change for 10 consecutive days or grows by no more than 5%.

The measures include:

People are allowed to walk in parks, forests and coastal areas, which has been banned since April 6. But playgrounds and sports grounds remain closed; 

Businesses such as car washes, bike rentals, non-grocery stores, notaries, law and audit firms, some beauty salons and hairdressers may reopen;

Coffee shops may start selling takeaway coffee;

Athletes in team sports may resume training. 

The second stage will start only after the percentage of new coronavirus cases among all tested people in the country declines on a daily basis, and the number of recovered patients goes up. 

The measures include: 

Cafes and restaurants may reopen for takeaway service;

Gyms may reopen with some restrictions and without swimming pools; 

Open-air cinemas, hotels, as well as businesses providing domestic services (indoor cleaning, dry cleaning, clothing and shoes repair shops, etc.) may reopen;

High schools reopen, and preparations for the national exam for admission to universities start;

Sports competitions of no more than 50 people are allowed, but without spectators.

The third stage will start after the number of recovered patients exceeds the number of new coronavirus cases by two times or more over 10 consecutive days, and COVID-19 patients make up less than 10% of patients in hospitals.  

The measures include: 

Playgrounds and sports grounds, some schools, theaters and cinemas, hostels, sanatoriums and recreation camps may reopen;

Cafes and restaurants may reopen for dine-in service;

Malls may reopen, but without children’s playgrounds and entertainment areas;

Public transit between cities within regions resumes; 

The metro reopens for certain groups of workers. 

The fourth stage will begin if the number of new coronavirus cases unconnected with one another per day is five or fewer in every oblast for 10 consecutive days.

The measures include:

Public transport such as the metro, buses and trains open to the public. It has been halted since March 18;

Malls and entertainment centers, gyms, cafes and restaurants, museums and theaters, kindergartens and universities reopen;

Dentistry and elective care resumes. 

The remaining restrictions — they are not specified by the government —  will be lifted at the fifth stage, which might begin when internal transmission of the disease stops, and the only confirmed cases of COVID-19 are imported.

Shmygal said that, even after the quarantine ends, Ukrainians will have to adapt their social behavior and continue social distancing, disinfecting regularly, and using masks and gloves in crowded places. Online shopping, contactless delivery, and cashless payments should also become a new normal. 

Vague criteria

Volodymyr Kurpita, who led the Center for Public Health in 2018-2019, says the criteria for easing quarantine measures are unclear to him. 

Since the number of new cases depends on the scale of testing, this could give way to manipulation, he said. “If the number of tests is reduced, the number of new cases will fall too,” he said. 

This appears to contradict the government’s intention to scale up testing, which will lead to a spike in new confirmed cases.

Testing in Ukraine is still low compared to many European and Asian countries. The country’s laboratories test around 5,000 samples per day. The health authorities promised to double this number, but testing capacity has been undermined by weak infrastructure, understaffing and outdated equipment. 

Kurpita said it would make more sense to look at the prevalence and fatality rate per 100,000 people, because regions vary in population size and density. 

Infectious disease specialist Zhigarev suggests looking at the number of severe COVID-19 patients in intensive care units and those on lung ventilators, as well as at the fatality rate. 

Moreover, since the disease spreads in population clusters and each region has varied in the size of its coronavirus outbreak, it would be reasonable to ease restrictions in each region separately, rather than to take a one-size-fits-all approach, Zhigarev said. 

According to the WHO, before easing lockdowns, countries should demonstrate that they have COVID-19 transmission under control and are able to “test, identify, isolate, trace contacts and quarantine them.” 

In high-risk zones such as retirement homes and crowded residential areas, responsible authorities should take efforts to minimize outbreak risks. Schools and workplaces should adopt preventive measures such as physical distancing, handwashing and respiratory etiquette. 

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